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McCullough K, Baker M, Bloxsome D, Crevacore C, Davies H, Doleman G, Gray M, McKay N, Palamara P, Richards G, Saunders R, Towell-Barnard A, Coventry LL. Clinical deterioration as a nurse sensitive indicator in the out-of-hospital context: A scoping review. J Clin Nurs 2024; 33:874-889. [PMID: 37953491 DOI: 10.1111/jocn.16925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
AIMS To explore and summarise the literature on the concept of 'clinical deterioration' as a nurse-sensitive indicator of quality of care in the out-of-hospital context. DESIGN The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review and the JBI best practice guidelines for scoping reviews. METHODS Studies focusing on clinical deterioration, errors of omission, nurse sensitive indicators and the quality of nursing and midwifery care for all categories of registered, enrolled, or licensed practice nurses and midwives in the out-of-hospital context were included regardless of methodology. Text and opinion papers were also considered. Study protocols were excluded. DATA SOURCES Data bases were searched from inception to June 2022 and included CINAHL, PsychINFO, MEDLINE, The Allied and Complementary Medicine Database, EmCare, Maternity and Infant Care Database, Australian Indigenous HealthInfoNet, Informit Health and Society Database, JSTOR, Nursing and Allied Health Database, RURAL, Cochrane Library and Joanna Briggs Institute. RESULTS Thirty-four studies were included. Workloads, education and training opportunities, access to technology, home visits, clinical assessments and use of screening tools or guidelines impacted the ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting. CONCLUSIONS Little is known about the work of nurses or midwives in out-of-hospital settings and their recognition, reaction to and relay of information about patient deterioration. The complex and subtle nature of non-acute deterioration creates challenges in defining and subsequently evaluating the role and impact of nurses in these settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Further research is needed to clarify outcome measures and nurse contribution to the care of the deteriorating patient in the out-of-hospital setting to reduce the rate of avoidable hospitalisation and articulate the contribution of nurses and midwives to patient care. IMPACT What Problem Did the Study Address? Factors that impact a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting are not examined to date. What Were the Main Findings? A range of factors were identified that impacted a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting including workloads, education and training opportunities, access to technology, home visits, clinical assessments, use of screening tools or guidelines, and avoidable hospitalisation. Where and on whom will the research have an impact? Nurses and nursing management will benefit from understanding the factors that act as barriers and facilitators for effective recognition of, and responding to, a deteriorating patient in the out-of-hospital setting. This in turn will impact patient survival and satisfaction. REPORTING METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines guided this review. The PRISMA-Scr Checklist (Tricco et al., 2018) is included as (supplementary file 1).Data sharing is not applicable to this article as no new data were created or analysed in this study." NO PATIENT OR PUBLIC CONTRIBUTION Not required as the Scoping Review used publicly available information.
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Affiliation(s)
- Kylie McCullough
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Melanie Baker
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Dianne Bloxsome
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Carol Crevacore
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Hugh Davies
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Gemma Doleman
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
| | - Michelle Gray
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Nilufeur McKay
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Peter Palamara
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Gina Richards
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
| | - Linda L Coventry
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
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Albsoul RA, FitzGerald G, Alshyyab MA. Missed nursing care: a snapshot case study in a medical ward in Australia. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:710-716. [PMID: 35797073 DOI: 10.12968/bjon.2022.31.13.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Missed nursing care is a global issue in acute healthcare settings. It is a complex phenomenon that refers to nursing care that is required by patients but left undone or significantly delayed. AIM To investigate the nature of missed nursing care and influencing factors in a general medical ward in an acute care hospital in Brisbane, Australia. METHOD This is a descriptive case study. The study was carried out in a 29-bed inpatient general medical/cardiology/telemetry ward in an acute care tertiary hospital. RESULTS The study ward has been identified as a high complexity unit. The survey data found that the most frequent nursing care elements missed, as reported by the patients, were oral care, response to machine beep, and response to call light. The most frequent nurse-reported missed care items were ambulation, monitoring fluid intake/output and attendance at interdisciplinary conferences. CONCLUSION Despite mandating nurse-to-patient ratios in the study ward, inadequate staffing was still perceived as being problematic and one of the most frequent reasons leading to missed nursing care. This possible disconnect between mandated staffing ratios and the persistence of perceived missed care suggests a more complex relationship than can be managed by macro (large-scale) resourcing formulas alone.
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Affiliation(s)
- Rania Ali Albsoul
- Assistant Professor in Healthcare Management, Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Gerard FitzGerald
- Professor in Public Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Muhammad Ahmed Alshyyab
- Assistant Professor in Health Services Management, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Hernantes N, Bermejo-Martins E, Øvergård KI, Pumar-Mendez MJ, Lopez-Dicastillo O, Iriarte-Roteta A, Antoñanzas-Baztan E, Mujika A. Theory-based capacity building intervention for intersectoral action for health at local governments: An exploratory pilot study. J Adv Nurs 2022; 78:1798-1814. [PMID: 35436006 PMCID: PMC9322672 DOI: 10.1111/jan.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/24/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Aim To design, implement and evaluate a nurse‐led capacity building intervention (PromoGOB) for intersectoral action for health at local governments. Design The programme was based on theories of the policy process and organizational change and facilitated by a nurse developing a health broker role. A complex intervention perspective was adopted in carrying out the study. The intervention was evaluated using a mixed method embedded design. Methods Quantitative component relied on a specific questionnaire. This tool, designed and piloted ad hoc, measured the capacity in terms of knowledge, awareness, resources, skills, and commitment, both at sectoral and government levels. For the qualitative component, semi‐structured interviews were conducted. These explored the perceived capacity and feasibility and acceptability issues. The programme was initiated at the end of October 2019, and it lasted a total of 5 weeks. Nineteen individuals representing various sectors at a local government in northern Spain participated in the study. The data analysis was concluded by the end of March 2020. Findings PromoGOB positively influenced participants' capacity for addressing health promotion. Awareness component, intersectoral work and the nurse as health broker were essential in the programme. The necessity of political participation was identified as an issue to be prioritized in future studies. Conclusion This study highlights the relevance of capacity building at local governments and the role that nurses can play in it. Further work should be undertaken to continue developing Health in All Policies approach at local level. Impact This study offers a starting point for nurses to get involved in the policy process of health promotion, performing a specific role as health brokers, building capacity at local governments for addressing social determinants of health, and delving into theories and concepts of the Health in All Policies field.
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Affiliation(s)
- Naia Hernantes
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, Donostia-San Sebastián, Spain.,School of Nursing, University of Navarra, Pamplona, Spain
| | - Elena Bermejo-Martins
- School of Nursing, University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research, Idisna. Pamplona, Spain
| | - Kjell Ivar Øvergård
- Research group for Health Promotion in Settings, Department of Health-, Social-, and Welfare Studies, University of South-Eastern Norway, Kongsberg, Norway
| | - María Jesús Pumar-Mendez
- Navarra Institute for Health Research, Idisna. Pamplona, Spain.,Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Olga Lopez-Dicastillo
- Navarra Institute for Health Research, Idisna. Pamplona, Spain.,Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Andrea Iriarte-Roteta
- School of Nursing, University of Navarra, Pamplona, Spain.,Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain.,Osasunbidea Health Care Service, Navarra, Spain
| | - Elena Antoñanzas-Baztan
- Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain.,Osasunbidea Health Care Service, Navarra, Spain.,Government of Navarra, Department of Health, Navarra, Spain
| | - Agurtzane Mujika
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, Donostia-San Sebastián, Spain
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Haile S, Lööf H, Johansson UB, Linné A, Joelsson-Alm E. Increasing patients’ awareness of their own health: Experiences of participating in follow-up programs after surgical treatment for intermittent claudication. JOURNAL OF VASCULAR NURSING 2022; 40:47-53. [DOI: 10.1016/j.jvn.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 06/23/2021] [Accepted: 11/29/2021] [Indexed: 01/10/2023]
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Giltenane M, Sheridan A, Kroll T, Frazer K. Work environment challenging Irish public health nurses' care quality: First postnatal visit. Public Health Nurs 2021; 39:202-213. [PMID: 34672017 DOI: 10.1111/phn.12993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Exploring views and experiences of public health nurses of their work environment and measurement of care practices at first postnatal visits. DESIGN An exploratory qualitative design. Data collected using four focus groups and analyzed using thematic analysis. SAMPLE Nineteen public health nurses from four health service regions in Ireland participated. RESULTS Two themes emerged. Theme one identified "challenges of providing a quality service." Public health nurses identified workload demands and that the working environment can detract from the ability to provide a quality service. Challenges within the home, language barriers, and lack of support from management were key issues. Theme two identified "challenges of measuring quality of public health nursing practice." While Measuring practice through quantitative outcomes such as key performance indicators were viewed as inadequate to measure the quality of care provided, positive views of using quality process indicators to measure the quality of their practice emerged. CONCLUSIONS Key issues concern the working environment of public health nurses and challenges of providing and measuring care practices. Absence of appropriate supports and resources means public health nurses work hard to provide quality care. Public health nurses were confident they would score high on quality process measurements of their practice.
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Affiliation(s)
- Martina Giltenane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Ann Sheridan
- Mental Health. Subject Head-Mental Health Nursing, Irish Institute of Mental Health Nursing, UCD School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
| | - Thilo Kroll
- Health Systems Management, Research, Innovation and Impact, UCD School of Nursing, Midwifery and Health Systems, UCD Geary Institute for Public Policy, UCD Health Sciences Centre, University College Dublin (UCD), Belfield, Dublin, Ireland
| | - Kate Frazer
- Public Health and Community Nursing, European Academy Nursing Science, UCD Geary Institute Public Policy, UCD School of Nursing, Midwifery and Health Systems, UCD College of Health and Agricultural Sciences, Belfield, Dublin, Ireland
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Nahasaram ST, Ramoo V, Lee WL. Missed nursing care in the Malaysian context: A cross-sectional study from nurses' perspective. J Nurs Manag 2021; 29:1848-1856. [PMID: 33544403 DOI: 10.1111/jonm.13281] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/08/2021] [Accepted: 01/31/2021] [Indexed: 12/15/2022]
Abstract
AIM To determine the occurrence, factors and outcome of missed nursing care from the perspective of Malaysian nurses. BACKGROUND Missed nursing care is an important issue in the global health care sector. However, little is known on the extent of missed nursing care in the Malaysian context and its contributing factors. METHODS A cross-sectional design was adopted for data collection using the MISSCARE Survey instrument. Participants comprised 364 nurses from medical and surgical wards of a large teaching hospital. Data were analysed using descriptive, binomial logistic and hierarchical regression analyses. RESULTS The overall occurrence of missed nursing care was 1.88 (on a scale of 1.00-5.00), which differed across 24 nursing care elements. Basic nursing care and communication-related care were the most frequently missed elements. Types of ward and labour resources were identified as contributing factors to missed nursing care (p < .001). No significant association was found between missed nursing care and nurses' intention to leave (p > .05). CONCLUSION The occurrence of missed nursing care was noted to be low. IMPLICATIONS FOR NURSING MANAGEMENT Practical strategies such as an acuity-based staffing system, close monitoring of rendered care and strengthening of teamwork are recommended to minimize missed nursing care.
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Affiliation(s)
- Sri Theyshaini Nahasaram
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vimala Ramoo
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Ling Lee
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kritsotakis G, Georgiou ED, Karakonstandakis G, Kaparounakis N, Pitsouni V, Sarafis P. A longitudinal study of multiple lifestyle health risk behaviours among nursing students and non-nursing peers. Int J Nurs Pract 2020; 26:e12852. [PMID: 32645751 DOI: 10.1111/ijn.12852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/18/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022]
Abstract
AIM The aim of this paper is to compare the evolution of health risk behaviours between undergraduate nursing and social work students. BACKGROUND Nursing includes the promotion of health and the shaping of healthy behaviours. An important determinant for providing lifestyle advice is the lifestyle of nurses themselves. DESIGN Longitudinal comparative study. MEASUREMENTS We compared lifestyle risk behaviours (binge drinking, cannabis/hashish/marijuana use, smoking, oral hygiene/toothbrushing, breakfast/fruit/vegetable consumption, physical activity and screen time/sedentary behaviours) using a self-administered standardized questionnaire in nursing (n = 121) and social work (n = 140) students at the beginning (2012) and the end of their studies (2015). Adjusted multivariable logistic/Poisson regression models were performed. RESULTS There were no statistically significant differences between the departments in most risk factors in both assessments. However, in relation to their first year, both nursing and social work students displayed higher relative risk of engaging in more behavioural risk factors at the end of their studies (in delivery/junk food consumption, sunburns, hashish/marijuana use and multiple sexual partners). Social work students displayed better behaviours in physical activity and breakfast intake. CONCLUSION Nursing students share the patterns of their nonnursing peers in behavioural risk factors compromising their future health and health-promoting role. We need strategies to safeguard the professional nursing practice.
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Affiliation(s)
- George Kritsotakis
- Laboratory of Epidemiology, Prevention & Management of Diseases, Nursing Department, Hellenic Mediterranean University, Crete, Greece
| | - Evangelos D Georgiou
- University Centre for Field Studies, Department of Psychology, University of Cyprus, Lefkosia, Cyprus
| | - Georgios Karakonstandakis
- Laboratory of Epidemiology, Prevention & Management of Diseases, Nursing Department, Hellenic Mediterranean University, Crete, Greece
| | - Nikos Kaparounakis
- Laboratory of Epidemiology, Prevention & Management of Diseases, Nursing Department, Hellenic Mediterranean University, Crete, Greece
| | | | - Pavlos Sarafis
- Nursing Department, Cyprus University of Technology, Limassol, Cyprus
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