Nursing rounds: A quality improvement project to improve outpatient satisfaction

Nurse-led care versus neurologist-led care for long-term outcomes of patients who underwent craniotomy in traumatic brain injuries: an efficacy analysis

Background

After craniotomy, patients require rehabilitation efforts for the recovery process, and neurologists are mostly engaged for that (in the management of post-craniotomy complications). However, neurologists are not always available for care after neurosurgery during follow-up (situation of our institute). The objectives of the study were to compare the effects of two different types of care (nurse-led and neurologist-led) on various long-term outcomes in patients who have undergone craniotomy due to traumatic brain injuries.

Methods

Electronic medical records of patients (aged ≥18 years) who underwent craniotomy for traumatic brain injuries and their caregivers were extracted and retrospectively reviewed. Patients received nurse-led care (NL cohort, n = 109) or neurologist-led care (GL cohort, n = 121) for 6 months after craniotomy.

Results

Before the nurse-or neurologist-led care (BC), all patients had activities of daily living (ADL) ≤ 11, ≤ 50 quality of life (QoL), and 69% of patients had definitive anxiety, 87% of patients had definitive depression, and all caregivers had Zarit Burden interview scores ≥50. Nurse-led post-surgical care was associated with improved ADL and QoL, relieved anxiety and depression of patients, relieved the burden on caregivers, and the higher overall satisfaction of patients and their caregivers after 6-months of care (AC) as compared to their BC condition (p < 0.05) and also compared to those of patients in the GL cohort under AC condition (p < 0.01). Patients in the GL cohort reported pressure sores (p = 0.0211) and dizziness [15 (12%) vs. 5 (5%)] after craniotomy during follow-up than those in the NL cohort.

Conclusion

ADL, QoL, and psychological conditions of patients who undergo craniotomy for traumatic brain injuries must be improved and the burdens of their caregivers must be relived. Not only is the care provided by nursing staff equivalent to that offered by neurologists, but in some aspects, it is superior for patients who have undergone craniotomy for traumatic brain injuries and their caregivers during follow-up.

The effect of regular nursing rounds on patients' comfort and satisfaction, and violence against nurses in surgical ward

Background

Patients' satisfaction and comfort are known as the quality indicators of nursing care. Nowadays, violence against nurses has an increasing trend. Regular nursing rounds are one of the caring programs that help improve these indicators. This study aimed to examine the effect of regular nursing rounds on patients' comfort, satisfaction, and violence against nurses.

Materials and methods

This quasi-experimental study was conducted in two groups consisting of 100 patients and 35 nurses in a surgery ward in the northwest of Iran. The satisfaction with nursing care quality questionnaire, Kolcaba's general comfort questionnaire, and work environment violence were used for data collection. In the present study, the control and intervention groups were selected using a simple sampling method. The control group received routine care only; however, the intervention group received a regular nursing round program every 2 h from the second day of their admission for three days. The satisfaction questionnaire and comfort scale were completed on the second and fifth days of admission, and the evaluation of violence against nurses was performed from the second to the fourth day. The results were analyzed using chi-square, Fisher, independent t, and paired t tests.

Results

Before the intervention, no statistically significant difference was observed between the two groups in terms of demographic and dependent variables (p > 0/05). After the intervention, statistically significant differences were observed among the mean scores of satisfaction with nursing care (p < 0/001), comfort (p < 0.001), and violence against nurses (p = 0.041) between the two study groups, so that in the intervention group, the patients' satisfaction and comfort increased and violence against nurses reduced during the intervention period.

Conclusions

The use of regular nursing rounds had a positive effect on the study results. Therefore, it is recommended that nurse managers design, implement, encourage, and evaluate regular nursing rounds to improve nursing care.

Do Patient Experiences Have Mediating Roles on Patient Loyalty?

The study aimed to evaluate the mediating roles of patient experiences on patient loyalty. The data were collected through an electronic questionnaire regarding feedback from 5732 patients received outpatient clinics. Patient loyalty was evaluated using the Net Promoter Score (NPS₁₁) that patients were asked whether they would like to recommend the hospital to their relatives or friends. Patient experiences with physicians, nurses, and waiting times were also asked in the questionnaire. After preliminary analysis, mediation analyses were performed to evaluate direct and indirect causal effects among variables for NPS_11. While patient experiences are used as possible mediators, Branch Groups in the first and Admission Time in the second model are independent variables. In the analyses, Surgical Medical Science (p = 0.019) and Day Shift (p = 0.000) have a direct mediating effect on NPS₁₁. Nursing care experiences were found to be a mediator variable for NPS₁₁ in both models (p = 0.000 for both). Patient loyalty was associated with Surgical Medical Science and Day Shift primarily whereas Nursing care experience had a mediating role.