General phenomenon and communication experience of physician and nurse in night shift communication: A qualitative study

Night Physician-Nurse Collaboration: Developing the Scale of Physicians' Difficulties and Exploring Related Factors in Acute Care Hospitals

Background

Responding to inpatient deterioration is less favorable at night than during the day, and this may be related to barriers in collaboration between physicians and nurses. However, there had been no way to assess the problem. This study aimed to develop a scale for physicians to measure difficulties in nighttime collaboration with nurses in response to deteriorating inpatients and to identify factors associated with the developed scale scores.

Methods

We developed a draft scale of Nighttime Collaboration Difficulties between Nurses and Physicians for Physicians (NCDNP-P) based on key informant interviews with physicians. Psychometric validations, including structural validity, criterion-related validity, and reliability tests, were conducted among physicians who worked on night duty or on call in acute-care hospitals in Japan using a cross-sectional web-based questionnaire. Multiple linear regression analyses were performed using independent variables including individual backgrounds, style of working at night, and facility characteristics.

Results

By performing exploratory factor analysis, we confirmed the structural validity of the NCDNP-P, consisting of seven items and two domains (Domain 1: Dissatisfaction with reporting, Domain 2: Barriers to working with nurses). Cronbach's alpha and McDonald's omega coefficients were 0.81-0.84 and 0.81-0.89, respectively. The criterion-related validity for interprofessional collaboration was confirmed. Multiple regression analysis revealed that the variables employment status, number of night shifts, frequency of nighttime calls about patients under another physician's charge, and handover between physicians before changing shifts were statistically significantly associated with NCDNP-P scores.

Conclusion

We developed the NCDNP-P, confirming its reliability and validity. Identified factors reflect physicians' characteristics and the problems experienced working at night and may be associated with barriers in nighttime collaboration. The NCDNP-P can highlight issues in clinical settings and lead to the consideration of initiatives to address such issues.

Unsafe doctor-nurse interactions in the process of implementing medical orders: A qualitative study

AIM

This study aimed to explore challenges faced by clinical nurses in the process of implementing medical orders.

DESIGN

A qualitative study using inductive content analysis.

METHODS

Semi-structured individual interviews were carried out with 17 participants including nurses, nurse managers and medical doctors who were purposefully selected. The collected data underwent inductive qualitative content analysis.

RESULTS

The main research finding was the category of 'unsafe doctor-nurse interaction'. It included three subcategories: 'conflicts in documenting and executing orders', 'not accepting the nurse's suggestions for writing and correcting orders' and 'failure to accept the responsibility of orders by the doctor'. Challenges in the professional relationship between doctors and nurses cause mistrust and conflict. They also enhance nurses' concerns about professional and legal issues in the workplace and endanger patient safety.

Experiences and perceptions of nurses working night shift: a qualitative systematic review

OBJECTIVE

The objective of this review was to examine the available evidence on the experiences and perceptions of nurses working the night shift within any specialty in the acute care, subacute, or long-term care setting.

INTRODUCTION

Nurses are required for around-the-clock patient care. Night shift nurses can experience detrimental effects because of their work hours, which disrupt their normal circadian rhythm. Understanding nurses' experiences and perceptions when working night shift will facilitate the development of strategies to minimize the potential negative effects of working at night. In examining nurses' experiences and perceptions of working night shift, there is scope to explore how to improve night shift nurses' practice environment and job satisfaction, which will then translate to improved nurse and patient outcomes.

INCLUSION CRITERIA

This review included qualitative studies focused on the experiences and perceptions of registered nurses and licensed practical nurses who work the night shift or rotate between day and night shift.

METHODS

This review followed the JBI methodology for systematic reviews of qualitative evidence. The methodology used was consistent with the a priori protocol. Studies included in this review were those published in full text, English, and between 1983 (when the seminal work on hospitals that attract and retain nurses was published) and February 2021, when the search was completed. The main databases searched for published and unpublished studies included MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science.From the search, two reviewers independently screened the studies against the inclusion criteria, and then papers selected for inclusion were assessed for methodological quality. Qualitative data were extracted from the included papers independently by the four reviewers. Results from each reviewer were discussed and clarified to reach agreement. The extracted findings were pooled and examined for shared meaning, coded, and grouped into categories. Common categories were grouped into meta-synthesis to produce a comprehensive set of synthesized findings. The final synthesized findings were graded using the ConQual approach to determine the level of confidence (trust) users may have in the value of the synthesized findings.

RESULTS

Thirty-four papers, representing 33 studies, met the criteria for inclusion. The studies were conducted in 11 countries across six continents, with a total of 601 participants. From these, a total of 220 findings were extracted and combined to form 11 categories based on similarity in meaning, and three syntheses were derived: i) The "Other" Shift: the distinctiveness of night nursing; ii) Juggling sleep and all aspects of life when working nights; and iii) Existing in the Twilight Zone: battling the negative impact of sleep deprivation consumes nurses who strive to keep patients, self, and others safe.

CONCLUSIONS

The major conclusions from this review are the uniqueness of working the night shift and the sleep deprivation of night nurses. Organizational strategies and support are needed for those working this shift, which will enhance nurse and patient safety.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019135294.

Getting on the Same Page: A Quality Improvement Project to Enhance Nurse-to-Resident Communications and Reduce Overnight Sleep Interruptions

BACKGROUND

Many residency programs utilize "home call" residents who answer hospital communications and place orders from home. Often, residents are required to live nearby and arrive in-person if needed. Residents work normal daytime work hours while on home call, which can last several nights. This disrupts sleep and creates the potential for increased resident fatigue and patient safety issues.

OBJECTIVE

To implement and evaluate a novel program to reduce non-urgent overnight pages from nurses to home call physical medicine and rehabilitation (PM&R) residents between 11 pm and 6 am.

METHODS

At an inpatient acute rehabilitation unit in a tertiary care university teaching hospital, we implemented a 2-step prospective quality improvement study with interventions derived from nurse-physician meetings implemented 9 months apart in 2018 and 2019. The first intervention was a centralized nightly handoff sheet. The second intervention was to display suggested PRN medication lists in resident workrooms. The primary outcome measure was the percentage of nights with non-urgent pages between 11 pm and 6 am. Tracking urgent pages and 7-10 am emergent pages were used as balancing measures.

RESULTS

A total of 1835 text-based nursing pages (366 pre- and 1469 post-intervention) were received and categorized by content, urgency, and timing over a 17-month period. Post-intervention, there was a stable 25% decrease in nighttime non-urgent pages. The most common hour to be paged shifted from 11 pm to 8 pm. Pain, constipation, insomnia, and nausea were the most common complaints overnight.

CONCLUSIONS

By characterizing and studying nighttime pages, residents collaborated with nighttime nursing staff through structured meetings to reduce non-urgent nighttime pages for more than 1 year.

Examining the views of operating room nurses and physicians on the relationship between professional values and professional communication

Purpose

Professional communication and professional values are two basic concepts in operating rooms and should be studied more closely in view of the nature of work and the high circulation of patients in operating rooms.

Methods

The present work is a descriptive-analytic study with a cross-sectional design. The sample was 603 operating room physicians and personnel selected from the public hospitals of Shiraz. The data collection instruments were the 41-item professional communication questionnaire and the 26-item professional values scale.

Results

The results showed that the operating room nurses and physicians perceived the status of professional communication and professional values to be satisfactory. As for professional communication, the participants’ perception of the domains of mutual respect and trust (p ≤ 0.001), teamwork (p ≤ 0.001), ethical competence (p ≤ 0.017), and workplace conflicts (p ≤ 0.001) was significant. As for professional values, only the dimension of care (p ≤ 0.016) was perceived to be significant. Moreover, a significant positive relationship was found to exist between professional communication and professional values (p ≤ 0.001).

Conclusion

Considering the significance of the concept of professional communication and its connection with professional values, it is recommended that operating room personnel and physicians receive systematic education about professional communication and the harms of destructive attitudes as part of their academic education and afterwards.

The influence of shift work on the psychomotor capabilities of emergency medicine residents

OBJECTIVE

Shift work affects health status of healthcare providers and patients. We assessed the effect of shift work on psychomotor activities of emergency medicine residents of 3 university hospitals.

METHODS

The participants were enrolled to perform selected psychomotor tests via the Vienna test system (VTS) after written consent. They passed 4 episodes of test performance before and after 2 consecutive day and night clinical shifts of 12 hours. The status of general health, circadian rhythm, sleepiness, smoking habits, and the scores of the cognition test (COG), the determination test (DT), and the visual pursuit test of emergency medicine residents were compared before and after morning and night shifts.

RESULTS

Overall, 23 residents (34.8% were male) performed tests. The mean (SD) age was 35.7 + 8.5 years. The mean general health and circadian scores before and after day/night shifts were not different. The Stanford sleepiness scale showed higher scores after night shifts. In the cognition test, the sum of correct rejections was higher after day shifts. Moreover, in the DT results, correct responses were more prevalent, the omitted responses were fewer accompanied by better median reaction time after day shifts. The sum of correct rejections of the COG test showed difference in terms of improved results in night tests compared to day-shift tests. The mean reaction time of the DT showed significant difference with shorter reaction time in night-shift tests. The visual pursuit test results were not different between day and night shifts.

CONCLUSIONS

Sleepiness was higher after night shifts. The results of selected psychomotor tests showed that the psychomotor function of the residents was not delayed or worse after night shifts in comparison to the day shifts.