"The button": initiating the patient-nurse interaction

The needs and experiences of critically ill patients and family members in intensive care unit of a tertiary hospital in Malaysia: a qualitative study

BACKGROUND

Admission to an intensive care unit (ICU) is a stressful experience for patients and their family members. While the focus of management is primarily on medical care, there can be other areas which are overlooked. The purpose of this study was to investigate the needs and experiences of ICU patients and family members.

METHOD

This qualitative study involved four trained researchers conducting in-depth interviews (IDI) based on a semi-structured interview guide. The participants were ICU patients and family members. All IDIs were audio-recorded and transcribed verbatim. Four researchers independently analyzed the data via thematic analysis with the aid of QDA Miner Lite®. The themes and subthemes were generated and confirmed by literature and expert opinion.

RESULTS

Six IDIs were conducted with three patients and three family members, whose ages ranged from 31 to 64 years old. One pair of participants consisted of a patient and his respective family member, while the other four participants did not have a familial relationship with each other. Three main themes emerged from the analysis: (I) critical care services; (II) physical spaces; and (III) monitoring technology. Medical, psychological, physical, and social needs for critical care services were expressed by both patients and family members. Patients' needs in clinical spaces were highlighted as a conducive ICU environment with ambient temperature and controlled noise levels. In non-clinical spaces, family members expressed a need for more chairs in the waiting area. Participants expressed the need for call bells as well as patients' negative perceptions of medical equipment alarms in the ICU when it pertained to monitoring technology.

CONCLUSION

This study provides an in-depth view at the needs and experiences of ICU patients and family members who have a variety of unmet needs. This understanding is critical for guiding ICU personnel and stakeholders in their efforts to humanize ICU care.

Implementation and experience of an innovative smart patient care system: a cross-sectional study

Background

Although a patient care system may help nurses handle patients’ requests or provide timely assistance to those in need, there are a number of barriers faced by nurses in handling alarms.

Methods

The aim of the study was to describe the implementation and experience of an innovative smart patient care system (SPCS). This study applied a cross-sectional descriptive design. We recruited 82 nurses from a medical center in Taiwan, with 25 nurses from a ward that had introduced an SPCS and 57 nurses from wards that used the traditional patient care system (TPCS). The major advantages of the SPCS compared to the TPCS include the specification of alarm purposes, the routing of alarms directly to the mobile phone; the capability of immediate communication via phone; and three-stage bed-exit alerts with low false alarm rate.

Results

Approximately 56% of nurses in the TPCS wards perceived that the bed-exit alert was easily ignorable, while this rate was reduced to 32% in the SPCS ward. The immediate communication via phone was considered as the most helpful function of the SPCS, with a weighted average score of 3.92/5, and 52% of nurses strongly agreed (5/5) that this function was helpful. The second-highest ranked function was the three-stage bed-exit alert, with an average score of 3.68/5, with approximately 24% of nurses strongly agreeing (5/5) that this function was helpful. The average response time using TPCS was 145.66 s while it was 59.02 s using the SPCS (P < .001). Among the 110 observed alarms in the SPCS ward, none of them were false bed-exit alarms. In comparison, among 120 observed alarms in the TPCS wards, 42 (35%) of them were false bed-exit alarms (P < .001). In this study, we found that 30.91% of alarms using SPCS were processed because nurses received and responded to the alert via mobile phone.

Conclusions

A smart patient care system is needed to help nurses make more informed prioritization decisions between responding to alarms and ongoing tasks and finally assist them in adjusting their work in various situations to improve work efficiency and care quality.

Impact of Inpatient Unit Design Features on Overall Patient Experience and Perceived Room-Level Call Button Response

This study explores the relationship between inpatient unit design and patient experience and how spatial features and visibility impact patients' perception of staff responsiveness. The first part of this study is a retrospective pre-post and cross-sectional study evaluating the impacts of unit design on patient experience at the unit level. This study compares patient experiences based on Press Ganey and HCAHPS surveys in two orthopedic units (existing unit in Atrium building and new unit in Tower) with differing design features at Rush University Medical Center. The chi-square test results show that when moving from the old orthopedic unit to the new unit, almost all patient survey items related to patient experience showed statistically significant improvements. The second part of this study is a room level on the new unit. The ANOVA and Pearson correlation tests revealed that the visibility measure of metric step depth had significant impacts on patients' perception of staff's "promptness in responding to call button" and "help with toileting". This study confirms that inpatient unit design plays a direct role in improvement for patient experience and should be considered as an important area of focus for future development.

Capturing nurses' perception of communicative technologies in nursing facilities: Survey instrument development

BACKGROUND

Despite the common perception of the call light system as crucial for patient safety, there are usability gaps between what features staff in nursing facilities need to address an alarm quickly and how the call system is designed. A survey instrument was developed to investigate nursing home staff experiences in using call light technology.

METHODS

A survey instrument was developed and distributed to staff in two nursing facilities in Up-State, New York (N = 278). The strength and direction of relationships between pairs of variables were measured using Pearson correlation and analysis of variance to investigate the perceived effect of staff's perception of the call light system on the work system's elements, process and staff outcomes.

RESULTS

The study found correlations between the job-level workload and the noise in the unit (r = 0.272, p = .000), between job-level workload and the ease of locating call lights (r = 0.154, p = .023), and between job stress and burnout (r = 0.176, p = .009). Only 64% of nursing home staff believed that the call light system reflected urgent needs, with younger staff relating to this group. The staff gave the work environment a high score, which corresponds to excessive noises caused by the call light alarm, according to 74% of the staff. These associations stem from gaps caused by a lack of user feedback in the design and acquisition process, leading to usability issues that reduce performance and satisfaction over time.

CONCLUSION

The study found that the type of call light system used is associated with usability challenges that often impeded the performance of the nursing home staff's response to residents. These insights can improve the selection of a new call light system that avoids usability issues and challenges identified by end-users.

Nursing staff's evaluation of facilitators and barriers during implementation of wireless nurse call systems in residential care facilities. A cross-sectional study

Background

Traditional nurse call systems used in residential care facilities rely on patients to summon assistance for routine or emergency needs. Wireless nurse call systems (WNCS) offer new affordances for persons unable to actively or consciously engage with the system, allowing detection of hazardous situations, prevention and timely treatment, as well as enhanced nurse workflows. This study aimed to explore facilitators and barriers of implementation of WNCSs in residential care facilities.

Methods

The study had a cross-sectional descriptive design. We collected data from care providers (n = 98) based on the Measurement Instrument for Determinants of Innovation (MIDI) framework in five Norwegian residential care facilities during the first year of WNCS implementation. The self-reporting MIDI questionnaire was adapted to the contexts. Descriptive statistics were used to explore participant characteristics and MIDI item and determinant scores. MIDI items to which ≥20% of participants disagreed/totally disagreed were regarded as barriers and items to which ≥80% of participants agreed/totally agreed were regarded as facilitators for implementation.

Results

More facilitators (n = 22) than barriers (n = 6) were identified. The greatest facilitators, reported by 98% of the care providers, were the expected outcomes: the importance and probability of achieving prompt call responses and increased safety, and the normative belief of unit managers. During the implementation process, 87% became familiar with the systems, and 86 and 90%, respectively regarded themselves and their colleagues as competent users of the WNCS. The most salient barriers, reported by 37%, were their lack of prior knowledge and that they found the WNCS difficult to learn. No features of the technology were identified as barriers.

Conclusions

Overall, the care providers gave a positive evaluation of the WNCS implementation. The barriers to implementation were addressed by training and practicing technological skills, facilitated by the influence and support by the manager and the colleagues within the residential care unit. WNCSs offer a range of advanced applications and services, and further research is needed as more WNCS functionalities are implemented into residential care services.

Perspectives of Nursing Homes Staff on the Nature of Residents-Initiated Call Lights

Little research has been conducted to capture the perceptions of nursing home staff when using the call light system. There is also a lack of information regarding the effects that these perceptions of the call light system have on their workload, safety, quality of care, or overall satisfaction. In response to the high volume of complaints from residents and their families regarding long response times to call light alarms, we developed this exploratory cross-sectional survey study. This study aims to capture nursing home staff experiences while using a call light system; to investigate the challenges the staff face when using the system; and to determine how these challenges contribute to their workload, performance, and satisfaction. A survey instrument was developed and distributed to all 153 of the nursing staff, certified nursing assistants, and licensed practical nurses in a nursing home in upstate New York. A total of 105 completed surveys were retrieved for an overall response rate of 68.63%. Descriptive analysis, Pearson correlation, and the Kruskal-Wallis test were used to analyze the collected data. The results showed a significant correlation between the processes of being notified and locating call light alarms and workload. The staff reported many usability challenges that may contribute to longer response time such as lack of prioritization, low/no discriminability, noise, and overwrite previous alarm. In addition, 78% of the staff agreed that responding to a call light can prevent serious harm; however, 56% of the staff agreed that call light system is not meaningful; and around 78% think that call light system is disruptive in the environment and source for constant noise. The study finds that incorporating the insights provided by nursing home staff may improve the acceptance of new and existing technology, which ultimately improves the delivery of care through greater usability.

Predictors of therapeutic communication between nurses and hospitalized patients

Background

Therapeutic communication is a purposeful interaction between health professionals and patients that helps to achieve positive health outcomes. There is a pressing need for research examining factors influencing effective implementation of therapeutic communication in relation to patient-centered care and satisfaction.

Objective

This study was aimed at determining the effective implementation of therapeutic communication and its predictors.

Methods

Institution based cross-sectional study was conducted at the Jimma University Specialized Hospital from March 21 to April 9, 2016. One hundred ninety two patients were recruited using stratified sampling. A questionnaire was used to collect data. One-way ANOVA for mean difference by socio-demographic characteristics, simple and multivariable linear regressions were conducted.

Results

The study revealed that 67(34.9%) of the patients rated high level of therapeutic communication. Significant predictors of therapeutic communication implementation were educational status (β = 5.87, P = 0.011), language difference (β = -6, P = 0.014), education difference (β = 5.21, P = 0.010) and perceived patient view score (β = 3.57, P˂0.001).

Conclusion

Therapeutic communication was poorly implemented. Education, language difference, education difference and perceived patient view scores were significant predictors of therapeutic communication.

Perspectives of 30 English Patients on Call Light Technology, Eloquence Revisited

Call light technology is important because it serves as a direct link for patients to get their healthcare needs fulfilled by their healthcare providers. As primary users of call light technology, patient perspectives are important and warranted. Despite this fact, there is a lack of published literature regarding patient perspectives and call light technology. The present study examined a technologically advanced call light system (Eloquence) by incorporating 30 patient participants' perspectives regarding its usefulness, effectiveness, and appropriateness gathered from individual interviews. Using qualitative descriptive research methods, five major themes and multiple minor themes emerged from the data.

'I need complete trust in nurses' - home mechanical ventilated patients' perceptions of safety

BACKGROUND

Although home care has advanced over the last few decades, little research on patient safety has been carried out in this setting. Furthermore, it is unclear how patients perceive their situation and safety. The insiders' views might be especially relevant for technology-dependent individuals, such as users of home mechanical ventilation (HMV).

AIM

The aim of this study was to examine how HMV patients perceive their situation and what makes them feel safe or unsafe.

DESIGN

Explorative qualitative study.

METHODS

Data were collected in two regions in Germany between April and December 2014 by means of semi-structured interviews with 21 HMV patients. Thematic analysis was used to analyse data.

FINDINGS

Three themes emerged: the meaning of an interpersonal relationship between the nurse and HMV patient is expressed in the theme Being familiar - Having trust. The importance of the attentiveness of nurses for the patients' feeling of safety is described in the theme Being able to communicate - Being noticed. The theme Experiencing continuity - Feeling presence points to the organisational dimension of HMV care provision.

CONCLUSIONS

The interpersonal nurse-patient relationship plays a key role in promoting HMV patients' feeling of safety. Thus, HMV patients have a relational approach to safety. In order to enhance the patients' feeling of safety, nurses should strive to develop a trusting relationship with patients and demonstrate their presence and attentiveness. Regarding the provision of care, competent and continuous care should be made a priority.

Perspectives of Nurses on Patients With Limited English Proficiency and Their Call Light Use

Patients use call light systems to initiate communication with their health care team. Little is known how this process is affected when language barriers exist between an English-speaking nurse and a patient with limited English proficiency (LEP). The aims of this study are to describe (a) the perceptions of nurses regarding their communication with patients with LEP, (b) how call lights affect their communication with patients with LEP, and (c) the perceptions of nurses on the impact of advancement in call light technology on patients with LEP. Using focus groups, nurses were asked about their interactions with patients with LEP. The following themes emerged: barriers to communication, formal tools for communication, gestures and charades, reliance on family, creating a better call light system, and acceptability of Eloquence™. This results show that call lights affect the interaction of nurses with patients with LEP and complex issues arise in the subsequent communication that is initiated by the call light.

Does revealing contextual knowledge of the patient's intention help nurses' handling of nurse calls?

OBJECTIVES

An inherent part of nurses' work is to handle nurse calls that often cause challenging interruptions to ongoing activities. In situations when nurses are interrupted by a nurse call, they need to decide whether to continue focusing on the task at hand or to abort and respond to the nurse call. The difficult decision is often influenced by a number of factors and can have implications for patient safety and quality of care. The study investigates how technology could be designed to support nurses' handling of nurse calls by allowing patients to communicate a more contextualised message revealing their intention to the nurse when issuing a nurse call.

METHODS

Through a qualitative methodology employing a scenario-based design approach, three different nurse call system concepts are evaluated by nurses from different departments of a Norwegian university hospital.

RESULTS

Nurses find the uncertainty of not knowing the reason behind a nurse call stressful in situations where they are required to prioritise either the calling patient or a patient they are currently nursing. Providing information about a patient's intention behind a nurse call influences the nurse's decision to various degrees depending on the situation in which they find themselves and the information that is communicated. The nurses' reflections suggested that the message communicated should be designed to contain neither too little nor too much information about the patient's needs.

CONCLUSIONS

A nurse call system that allows nurses to discern the reason behind a nurse call allows them to make a more accurate decision and relieves stress. In particular, the information communicated would reduce uncertainty and lessen nurses' dependence on other factors in their decision. The design of such a system should, however, carefully consider the needs of the department in which it is deployed.

Perspectives of Nurses and Patients on Call Light Technology

Call lights are prevalent in inpatient healthcare facilities across the nation. While call light use directly influences the delivery of nursing care, there remain significant gaps both in research and technology that can affect the quality of care and patient satisfaction. This study examines nurse and patient perceptions of the use of a new call communication solution, Eloquence, in the acute care inpatient setting. Eighteen patients were recruited for the study and participated in individual semistructured interviews during their hospital stay. Eighteen nurses were recruited and participated in focus groups for this study. Qualitative descriptive methods were used to analyze the data. Results revealed themes of usability, improved communication, and suggestions for improvement to the alpha prototype design. After a demonstration of the use and capability of Eloquence, nurse and patient participants found Eloquence as a welcomed advancement in nurse call technology that has the potential to improve workflow and patient outcomes. In addition, the participants also proposed ideas on how to further develop the technology to improve its use.

Improving communication among nurses and patients

Patients use nurse call systems to signal nurses for medical help. Traditional push button-flashing lamp call systems are not integrated with other hospital automation systems. Therefore, nurse response time becomes a matter of personal discretion. The improvement obtained by integrating a pager system into the nurse call systems does not increase care efficiency, because unnecessary visits are still not eliminated. To obtain an immediate response and a purposeful visit by a nurse; regardless of the location of nurse in hospital, traditional systems have to be improved by intelligent telephone system integration. The results of the developed Nurse Call System Software (NCSS), the Wireless Phone System Software (WPSS), the Location System Software (LSS) and the communication protocol are provided, together with detailed XML message structures. The benefits of the proposed system are also discussed and the direction of future work is presented.

When practice precedes theory - A mixed methods evaluation of students' learning experiences in an undergraduate study program in nursing

A key area for consideration is determining how optimal conditions for learning can be created. Higher education in nursing aims to prepare students to develop their capabilities to become independent professionals. The aim of this study was to evaluate the effects of sequencing clinical practice prior to theoretical studies on student's experiences of self-directed learning readiness and students' approach to learning in the second year of a three-year undergraduate study program in nursing. 123 nursing students was included in the study and divided in two groups. In group A (n = 60) clinical practice preceded theoretical studies. In group (n = 63) theoretical studies preceded clinical practice. Learning readiness was measured using the Directed Learning Readiness Scale for Nursing Education (SDLRSNE), and learning process was measured using the revised two-factor version of the Study Process Questionnaire (R-SPQ-2F). Students were also asked to write down their personal reflections throughout the course. By using a mixed method design, the qualitative component focused on the students' personal experiences in relation to the sequencing of theoretical studies and clinical practice. The quantitative component provided information about learning readiness before and after the intervention. Our findings confirm that students are sensitive and adaptable to their learning contexts, and that the sequencing of courses is subordinate to a pedagogical style enhancing students' deep learning approaches, which needs to be incorporated in the development of undergraduate nursing programs.