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Oftung B, Tyssen R. Occupational stress among Norwegian physicians: A literature review of long-term prospective studies 2007-2019. Scand J Public Health 2024:14034948241243164. [PMID: 38600437 DOI: 10.1177/14034948241243164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
AIMS There are signs of increased stress at work among Norwegian physicians over the last decades, not least among general practitioners (GPs). In this review, we identify trends in both occupational stress and adverse work-related predictors of such stress and burnout in Norwegian physicians. METHODS We performed an extensive literature search using MEDLINE, Embase and PsycINFO. We included prospective and repeated cross-sectional studies of work stress among Norwegian physicians published in 2007-2019. RESULTS Nine studies with observation periods of 1-20 years were included. Occupational stress (global measure) among all doctors decreased gradually from medical school to 20 years later. The prevalence of an effort-reward imbalance increased fourfold among GPs during the period 2010-2019. Five studies reported higher levels of occupational stress among female physicians than among their male colleagues. Work-home conflict levels increased after graduation until 10 years after leaving medical school and plateaued thereafter. Physicians who graduated in a later cohort reported lower levels of work-home conflict and less workplace violence. Work-home conflict, low colleague support, number of work hours and workload/low autonomy were all independent predictors of occupational stress. CONCLUSIONS The reduction in occupational stress during the years after leaving medical school may result from increased competency in clinical work and decreased on-call work. The Co-ordination Act implemented in 2012 may explain the increase in occupational stress among GPs. These findings suggest that both reducing work-home conflict and increasing colleague support are important for doctors' well-being.
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Affiliation(s)
- Bendik Oftung
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Reidar Tyssen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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Idsøe-Jakobsen I, Dombestein H, Wiig S. Exploring homecare leaders' risk perception and the link to resilience and adaptive capacity: a multiple case study. BMC Health Serv Res 2024; 24:340. [PMID: 38486286 PMCID: PMC10941597 DOI: 10.1186/s12913-024-10808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Home-based healthcare is considered crucial for the sustainability of healthcare systems worldwide. In the homecare context, however, adverse events may occur due to error-prone medication management processes and prevalent healthcare-associated infections, falls, and pressure ulcers. When dealing with risks in any form, it is fundamental for leaders to build a shared situational awareness of what is going on and what is at stake to achieve a good outcome. The overall aim of this study was to gain empirical knowledge of leaders' risk perception and adaptive capacity in homecare services. METHODS The study applied a multiple case study research design. We investigated risk perception, leadership, sensemaking, and decision-making in the homecare services context in three Norwegian municipalities. Twenty-three leaders were interviewed. The data material was analyzed using thematic analysis and interpreted in a resilience perspective of work-as-imagined versus work-as-done. RESULTS There is an increased demand on homecare services and workers' struggle to meet society's high expectations regarding homecare's responsibilities. The leaders find themselves trying to maneuver in these pressing conditions in alignment with the perceived risks. The themes emerging from analyzed data were: 'Risk and quality are conceptualized as integral to professional work', 'Perceiving and assessing risk imply discussing and consulting each other- no one can do it alone' and 'Leaders keep calm and look beyond the budget and quality measures by maneuvering within and around the system'. Different perspectives on patients' well-being revealed that the leaders have a large responsibility for organizing the healthcare soundly and adequately for each home-dwelling patient. Although the leaders did not use the term risk, discussing concerns and consulting each other was a profound part of the homecare leaders' sense of professionalism. CONCLUSIONS The leaders' construction of a risk picture is based on using multiple signals, such as measurable vital signs and patients' verbal and nonverbal expressions of their experience of health status. The findings imply a need for more research on how national guidelines and quality measures can be implemented better in a resilience perspective, where adaptive capacity to better align work-as-imagined and work-as-done is crucial for high quality homecare service provision.
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Affiliation(s)
- Ingvild Idsøe-Jakobsen
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway.
| | - Heidi Dombestein
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
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Antoniadou M, Mangoulia P, Myrianthefs P. Quality of Life and Wellbeing Parameters of Academic Dental and Nursing Personnel vs. Quality of Services. Healthcare (Basel) 2023; 11:2792. [PMID: 37893866 PMCID: PMC10606752 DOI: 10.3390/healthcare11202792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/03/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Quality of life (QOL) is based on one's perception of one's position in life with respect to one's goals, expectations, standards, and concerns. It is also influenced by one's culture and value system, workflow, and workplace situation; in turn, QOL influences the quality of service one is able to provide. In this study, we aim to report on dental and nursing academics' QOL and wellbeing at the end of the third year of the COVID-19 pandemic. There are several studies on the impact of the COVID-19 pandemic on health professionals (nurses and dentists), but it is important to investigate their quality of life three years later; furthermore, knowledge about academic staff is very limited. The World Health Organization Quality of Life-BREF Scale (WHOQOL-BREF) tool, recording the physical, psychological, social, and environmental dimensions of QOL, was used. The WHOQOL-BREF was modified using a spiritual coaching/mentoring approach in a two-step design and validation procedure. The modified SHQOL-BREF (Spiritual Healthcare version) designed for this study was uploaded and filled in online during April-June 2023. The staff (N = 120, 75% female) of the Departments of Dentistry (44.2%) and Nursing (55.8%) of the National and Kapodistrian University of Athens participated anonymously. QOL in terms of physical health was reported at a higher level (M = 72.2 points) compared to social relationships (M = 69 points), psychological health (M = 65 points), and environment (M = 59 points) (scores reported on a 0-100 scale). Overall, QOL was rated at 66 points, while satisfaction with one's health was at 72 points. Job satisfaction (M1 = 3.2) and spirituality (M2 = 3.0) were reported at a medium level on a five-point scale, while personal beliefs and values were reported at a high level (M3 = 4.0). The four areas of QOL are associated with job satisfaction, personal beliefs, and spirituality. Participant age presented a significant moderate-strong effect on physical health (F (3.97) = 2.89, p < 0.05, η2p = 0.08) and on the environment (F (3.97) = 2.80, p < 0.05, η2p = 0.08), and marital status had a significant effect on social relationships (F (1.97) = 9.66, p < 0.05, η2p = 0.09). Married participants reported consistently higher levels of QOL compared to single participants, for all age groups. The department had a significant moderate effect on social relationships (F (1.97) = 5.10, p < 0.05, η2p = 0.05), and education had a significant moderate-strong effect on psychological health (F (2.97) = 3.74, p < 0.05, η2p = 0.07). PhD-level participants in both departments presented higher levels of psychological health compared to those with lower educational levels. Also, participants from the Department of Dentistry reported higher levels of social relationship QOL in all educational groups compared to the Department of Nursing. Overall, according to our findings, PhD participants generally had better psychological health. Those under 40 years of age had higher levels of physical health and environmental quality of life, while married participants and those from the Department of Dentistry had higher levels of social interactions than those from the Department of Nursing. Strategic planning on sustainability and QOL initiatives should be introduced after the COVID-19 pandemic for dental and nursing academic personnel to promote resilience and QOL scores. Enhancing the QOL of academic staff is essential for developing health promotion activities at universities and can help boost performance among staff and students.
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Affiliation(s)
- Maria Antoniadou
- Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Thivon 2 Street, Goudi, GR-11527 Athens, Greece
- Certified Systemic Analyst Professional, CSAP Executive Mastering Program in Systemic Management, University of Piraeus, GR-18534 Piraeus, Greece
| | - Polyxeni Mangoulia
- Department of Nursing, School of Health Sciences, Papadiamantopoulou 123 Street, Goudi, GR-11527 Athens, Greece; (P.M.); (P.M.)
| | - Pavlos Myrianthefs
- Department of Nursing, School of Health Sciences, Papadiamantopoulou 123 Street, Goudi, GR-11527 Athens, Greece; (P.M.); (P.M.)
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Al Sabei SD, Ross AM. The Relationship between Nursing Leadership and Patient Readmission Rate: A Systematic Review. Can J Nurs Res 2023; 55:267-278. [PMID: 36734052 DOI: 10.1177/08445621231152959] [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] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nurse leaders play a fundamental role in improving patient quality care delivery, thus improving patient clinical outcomes. PURPOSE This systematic review examined the knowledge to date of nursing leadership on reducing patient readmission rates. METHODS A literature review was conducted using seven electronic databases: Medline Ovid, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Emerald, PsycINFO, ABI/INFORM collection, and EBSCO, with the addition of references for relevant papers reviewed. FINDINGS The search resulted in a total of 15 articles. Findings revealed that leadership practices of nurses have an impact on reducing patient readmission rates. CONCLUSIONS The results suggest a need for further rigorous studies investigating the mechanism of how nursing leadership relates to patient readmission rates and how to translate this into practice across diverse cultures.
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Affiliation(s)
- Sulaiman Dawood Al Sabei
- Fundamentals and Nursing Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Amy M Ross
- Systems & Organizational Leadership Program, Oregon Health and Science University, School of Nursing, Portland, OR, USA
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Van Graas R, Gobbens RJ. Learning and Developing Together for Improving the Quality of Care in a Nursing Home, Is Appreciative Inquiry the Key? Healthcare (Basel) 2023; 11:1840. [PMID: 37444674 PMCID: PMC10340465 DOI: 10.3390/healthcare11131840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
To investigate the impact of Appreciative Inquiry (AI) on learning and developing together for improving the quality of care in a nursing home, and to explore experiences following the four phases of the AI cycle, an AI was performed as part of participative action research. Interviews, group discussions, creative methods of storytelling, and reflections were used in the AI sessions. Staff members were interviewed to evaluate the AI process. All of the interviews were recorded and transcribed. Data were analyzed thematically using Maxqda and were discussed by the interviewers until consensus was reached. The sessions resulted in ten action proposals to improve healthcare. One proposal was worked out in agreements on cooperation. The evaluation revealed that the sessions have given a boost to the team spirit, and involvement at the location leading to more cooperation and communication during the shifts. The evaluation indicated that it is important to convert the action plans of the sessions into actions, which are then evaluated. AI was advised as a way of learning where everyone is involved, and mutual agreements are made. This study has shown that AI can be a valuable way to support learning and development to promote the quality of care in a nursing home.
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Affiliation(s)
- Regula Van Graas
- Faculty of Health, Sports, and Well-Being, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands;
| | - Robbert J. Gobbens
- Faculty of Health, Sports, and Well-Being, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Tranzo Academic Centre for Transformation in Care and Welfare, Faculty of Behavioural and Social Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands
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Feo R, Urry K, Conroy T, Kitson AL. Why reducing avoidable hospital readmissions is a 'wicked' problem for leaders: A qualitative exploration of nursing and allied health perceptions. J Adv Nurs 2023; 79:1031-1043. [PMID: 35332579 DOI: 10.1111/jan.15220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
AIMS To investigate nursing and allied health professional perceptions of the interrelationship between avoidable hospital readmissions and fundamental care delivery. DESIGN A qualitative, exploratory study using a critical realist approach. METHOD One-to-one semi-structured interviews with 14 nursing and allied health professionals conducted between May and September 2019. RESULTS Several tensions and contradictions were identified in the data, which demonstrated clinicians' perceptions about the priority of both fundamental care and two avoidable readmission conditions (aspiration pneumonia and constipation). These tensions are illustrated in two major themes: Avoidable versus inevitable; and everyone versus no one. The first theme demonstrates clinicians' perceptions that readmissions for aspiration pneumonia and constipation are not common, despite acknowledging that they generally lacked knowledge on readmission rates; and that these conditions may not be preventable in acute settings. The second theme demonstrates clinicians' perception that preventing readmissions is everyone's responsibility, however, this was coupled with a lack of articulation around how this multidisciplinary approach could be achieved, leading to a distinct lack of agency for care delivery. CONCLUSION Articulating the tensions described in the results provides vital knowledge for understanding how clinicians may respond to initiatives designed to reduce avoidable readmissions. Avoidable hospital readmissions may be usefully understood as a wicked problem: one that is complex and requires adaptive, not linear, solutions. Wicked problems pose a challenge for leaders and managers in healthcare because top-down, hierarchical strategies are unlikely to be successful. Effective prevention of avoidable readmissions requires leaders to enable facilitator-led change through relational leadership strategies. IMPACT Avoidable hospital readmissions are a global problem increasingly addressed via funding changes and the introduction of penalties to hospitals. This study provides insights on clinicians' perspectives of avoidable hospital readmissions and their prevention, demonstrating the complexity of this challenge and the need for healthcare leaders to enable individual and organizational readiness for change.
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Affiliation(s)
- Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kristi Urry
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
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Zhang Y, Zhao X, Zhao B, Xu L, Chen X, Ruan A. Nursing factors associated with length of stay and readmission rate of the elderly residents from nursing home based on LTCfocus database. Public Health 2022; 213:19-27. [PMID: 36332413 DOI: 10.1016/j.puhe.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Nursing factors have been found to be associated with a reduction in readmission rates. Nevertheless, few attentions have been given to the effect of nursing factors on nursing home (NH) residents. This study was to assess the impact of nursing factors on the hospital readmissions and length of stay (LOS) of the elderly residents from the NH. STUDY DESIGN This was a cross-sectional study. METHODS Data were extracted from the NH of the LTCFocus.org data set between 2011 and 2018. The study included residents aged ≥55 years who were admitted to NH in the United States, following a hospitalization event. The nursing factors included facility-level data elements and medical care personnel. An unsupervised machine learning algorithm (K-means) was used to cluster NH according to readmission rate and LOS. Multivariate logistic regression analysis was performed. RESULTS This study consisted of 107,000 NH-year observations. The median readmission rate was 17%, with a median LOS was 28.00 days. Three clusters were identified: cluster 1 was a high readmission rate with high LOS, cluster 2 was a low readmission rate with low LOS, and cluster 3 was a high readmission rate with low LOS. Multifacility and admission/bed were associated with a reduction in readmission rate and LOS in both cluster 1 vs cluster 2 and cluster 3 vs cluster 2. The special care unit and registered nurses' ratio were associated with decreased readmission rate and LOS in cluster 1 vs cluster 2. Total beds and Alzheimer unit decreased the readmission rate and LOS, whereas certified nursing assistant increased the readmission rate and LOS in cluster 3 vs cluster 2. NH for profit was associated with elevated readmission rate and LOS in cluster 1 vs cluster 2 and decreased readmission rate and LOS in cluster 3 vs cluster 2. Based on the subgroup analysis, the certified nursing assistant decreased readmission rate and LOS in cluster 1 vs cluster 2 and increased readmission rate and LOS in cluster 3 vs cluster 2 (all P < 0.005). CONCLUSION This study indicates the importance of the improvement of nurse number and level and the inputs of facility characteristics in NH.
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Affiliation(s)
- Yunping Zhang
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huaian 223005, PR China.
| | - Xueping Zhao
- School of Nursing, Soochow University, Suzhou 215031, PR China
| | - Beibei Zhao
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huaian 223005, PR China
| | - Lu Xu
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huaian 223005, PR China
| | - Xiaofang Chen
- Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, 215021, PR China
| | - Aichao Ruan
- Department of Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223001, PR China
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Paulus A, Baernholdt M, Kear T, Jones T, Thacker L. Factors Associated With Hospital Readmissions Among U.S. Dialysis Facilities. J Healthc Qual 2022; 44:59-68. [PMID: 34191751 DOI: 10.1097/jhq.0000000000000300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The Centers for Medicare and Medicaid uses the standardized readmission ratio (SRR) to evaluate 30-day readmissions among dialysis providers in the U.S. Readmissions among dialysis recipients remains 37%. This study investigates associations among dialysis facilities and patient characteristics with facility's performance on the SRR. METHODS Descriptive, longitudinal, approach using multivariate regression analysis on data retrieved from the Dialysis Facility Report to evaluate the associations between facility-level (staffing, profit status, chain membership, clinic size, care, length of care, vascular access type, glomerular filtration rate (GFR), creatinine, hemoglobin, use of erythropoietin-stimulating agent, albumin, and primary dialysis modality) with the SRR. RESULTS Factors associated with a high SRR included nurse ratios, facility average GFR, and Northeast geographic location. Factors associated with a low SRR included patient care technician ratio, length of predialysis nephrology care, initiation of dialysis with an arteriovenous fistula, average hemoglobin, and Western geographic location. CONCLUSIONS This study defines the influence predialysis nephrology care has on dialysis facilities SRRs. Access to care, adequate preparation for dialysis, and transitional support affect facilities' performance; however, without an appropriate staffing model, dialysis facilities may continue to struggle to reduce readmissions.
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Glette MK, Kringeland T, Røise O, Wiig S. Helsepersonells erfaringer med reinnleggelser fra primærhelsetjenesten – en oppsummering av en casestudie. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Koskinen S, Burke E, Fatkulina N, Fuster P, Löyttyniemi E, Salminen L, Stubner J, Thorsteinsson HS, Leino-Kilpi H. Graduating nurse students' interest in older people nursing-A cross-sectional survey in six European countries. Int J Older People Nurs 2022; 17:e12446. [PMID: 35080809 PMCID: PMC9285737 DOI: 10.1111/opn.12446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/27/2021] [Accepted: 12/30/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Countries vary in the number of qualified nurses employed in older adult services. Moreover, students' views of older people nursing as a career differ internationally. Studying future nurses and their career intentions for the field is warranted to meet the increased nurse workforce expectations in terms of quantity and competence. AIM To analyse graduating nurse students' interest in older people nursing and the factors associated with it. METHODS A cross-sectional multicountry survey design was applied. Data were collected between May 2018 and March 2019 from several educational institutions in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Non-probability convenience sampling was used to recruit graduating nurse students (n = 1796). The data were collected with a structured questionnaire comprising background factors and the Willingness sub-scale (six items) of the Students' Interest in Nursing Older People Scale. Data were analysed using a linear mixed model including relevant background variables. RESULTS Overall, students' interest in older people nursing was low (score 20.5, on a 0-100 scale). Among the studied countries, Spanish students scored the highest (38.8) and German students the lowest (3.6). Students' interest in older people nursing was associated with country (p < .001), the length of work experience (p = .006), plans for further study (p = .007), competence (p < .001) and the extent that nursing is valued by society (p < .001). The students who were most interested in older people nursing had higher self-reported competence level (p < .001). CONCLUSION In the studied sample of future nurse professionals, interest in older people nursing is low at a time when the field suffers from workforce shortage. As for quality workforce, it was promising that the students who considered working in the field also evaluated themselves as competent. IMPLICATIONS FOR PRACTICE Multidimensional actions are required to promote interest in the field, including continued development of competence in both undergraduate education and workplaces, and investing in various career pathways to envisage potential opportunities.
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Affiliation(s)
- Sanna Koskinen
- Department of the Nursing Science, University of Turku, Turku, Finland
| | - Eimear Burke
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Natalja Fatkulina
- Institute of Health Sciences, Vilnius University, Vilnius, Lithuania
| | - Pilar Fuster
- Nursing Department, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | | | - Leena Salminen
- Department of the Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Juliane Stubner
- Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | - Helena Leino-Kilpi
- Department of the Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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Karnehed S, Erlandsson LK, Norell Pejner M. Nurses' perspectives on an electronic medication administration record in home healthcare: Qualitative interview study (Preprint). JMIR Nurs 2021; 5:e35363. [PMID: 35452400 PMCID: PMC9077506 DOI: 10.2196/35363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/21/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background eHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals. Objective The objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality. Methods This qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz. Results Of the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects of the delegated nursing tasks rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses’ superior position. The experience of the eMAR was regarded as transitioning the nurses’ professional role—away from the point of care and toward more administration—and further strengthened the way of managing work through delegation to health care assistants. Conclusions Previous analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals’ work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels.
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Affiliation(s)
- Sara Karnehed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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12
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Su Z, Meyer K, Li Y, McDonnell D, Joseph NM, Li X, Du Y, Advani S, Cheshmehzangi A, Ahmad J, da Veiga CP, Chung RYN, Wang J, Hao X. Technology-based interventions for nursing home residents: a systematic review protocol. BMJ Open 2021; 11:e056142. [PMID: 34853115 PMCID: PMC8638465 DOI: 10.1136/bmjopen-2021-056142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19. METHODS AND ANALYSIS Databases including the PubMed, PsycINFO, CINAHL and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between 1 January 2010 to 30 September 2021. Titles, abstracts and full-text papers will be reviewed against the eligibility criteria. The Cochrane Collaboration evaluation framework will be adopted to examine the risk of bias of the included study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process and implications for existing interventions and research evaluated by a multidisciplinary research team. ETHICS AND DISSEMINATION As the study is a protocol for a systematic review, ethical approval is not required. The study findings will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER CRD 42020191880.
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Affiliation(s)
- Zhaohui Su
- School of Nursing, Center on Smart and Connected Health Technologies, Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kylie Meyer
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Yue Li
- Health Services Research & Policy (HSRP) PhD & MS Programs; Director of Research, Division of Health Policy and Outcomes Research (HPOR); Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Dean McDonnell
- Department of Humanities, Institute of Technology Carlow, Carlow, Ireland
| | - Nitha Mathew Joseph
- Department of Under Graduate Studies, Cizik School of Nursing, The University of Texas Health Science Center, Houston, Texas, USA
| | - Xiaoshan Li
- Program of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, Guangdong, China
| | - Yan Du
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Shailesh Advani
- Terasaki Institute of Biomedical Innovation, Los Angeles, California, USA
| | - Ali Cheshmehzangi
- Architecture and Urban Design, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, Zhejiang, China
| | - Junaid Ahmad
- Department of Public Health, Peshawar Medical College, Peshawar, Pakistan
| | | | - Roger Yat-Nork Chung
- School of Public Health & Primary Care, Faculty of Medicine (RY-NC) and Institute of Health Equity (RY-NC), The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Social Sciences, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Hong Kong, Hong Kong
| | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Xiaoning Hao
- Director of Division, Division of Health Security Research, China National Health Development Research Center, National Health Commission, Beijing, China
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13
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Moilanen T, Suhonen R, Kangasniemi M. Nursing support for older people's autonomy in residential care: An integrative review. Int J Older People Nurs 2021; 17:e12428. [PMID: 34601784 DOI: 10.1111/opn.12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/14/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nurses play a crucial role in enabling older people's autonomy in residential care. However, there is a lack of synthesised knowledge about how nurses can support older people. OBJECTIVE The aim of this study was to identify and synthesise nursing support for older people's autonomy in residential care. METHODS An integrative review was carried out by searching the CINAHL, Philosopher's index, PubMed, SocINDEX, Scopus and Web of Science databases, supplemented by manual searches. The searches focused on peer-reviewed scientific empirical research papers published in English, without date limitations. The constant comparison method was used for the analysis. RESULTS The review identified 24 papers, and these showed that older people's autonomy was based on dignity. Nurses protected older people's autonomy in eight different ways. They protected their right to make their own decisions, acted as advocates, respected their wishes, provided opportunities for autonomy, fostered independence, gave information to residents and relatives, provided individualised care practices and protected older people's safety. However, there were also barriers that needed to be overcome. CONCLUSIONS Nurses used multiple, individually tailored activities to support older people's autonomy, but they also had different reasons for supporting or hindering it. Work and leadership structures are needed to ensure that older people's autonomy is driven by ethical practices. IMPLICATIONS FOR PRACTICE The results of this review can help nurses who provide residential care for older people to recognise the different nursing activities that can be used to support older people's autonomy and to develop strategies to apply them in different daily care situations. However, further research is needed to determine how these activities can be realised in daily care and how they cover different aspects of older people's lives in residential care.
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Affiliation(s)
- Tanja Moilanen
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, Faculty of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
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Laugaland K, Billett S, Akerjordet K, Frøiland C, Grealish L, Aase I. Enhancing student nurses' clinical education in aged care homes: a qualitative study of challenges perceived by faculty staff. BMC Nurs 2021; 20:111. [PMID: 34174881 PMCID: PMC8235807 DOI: 10.1186/s12912-021-00632-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/07/2021] [Indexed: 11/11/2022] Open
Abstract
Background Ageing populations are increasing the demand for geriatric care services. As nursing schools respond to this demand, more high-quality clinical placements are required, and aged care homes offer suitable placement sites. Although an aged care experience for students is beneficial, the basis for effective implementation of these placements is yet to be fully established. The aim of this study was to explore faculty staff perspectives on the challenges associated with providing effective clinical education in aged care homes for first-year student nurses. Methods An exploratory qualitative study was performed. Fifteen in-depth interviews were conducted with program leaders of nursing degree programs (n = 4), course leaders (n = 6) and practice coordinators (n = 5) in three Norwegian universities. Data were analysed using thematic analysis. The findings were reported using the Standards for Reporting Qualitative Research (SRQR). Results Five themes were identified regarding the perceived challenges to implementing effective clinical education in aged care homes: (1) low staffing levels of registered nurses limit the capacity to effectively host students; (2) prevalence of part-time teachers can compromise the quality of students’ learning experiences; (3) tensions about the required qualifications and competencies of nurse teachers; (4) variation in learning assessments; and (5) lack of quality assurance. Conclusions These challenges signal key areas to be addressed in quality assurance for effective aged care placements. Further research into the minimum staffing levels required to support student learning in the aged care setting is required. Methods for developing shared practices to facilitate learning in aged care homes need to address the prevalence of part-time teaching appointments. Further research into the levels of qualification and competence required to support student learning in aged care facilities can assist with setting standards for this sector. Finally, academic-practice institutions must engage with government officials and national nursing bodies to develop national standards for clinical education in aged care homes. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00632-0.
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Affiliation(s)
- Kristin Laugaland
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, 4036, Stavanger, Norway.
| | - Stephen Billett
- Education and Professional Studies, Griffith University, Brisbane, Australia
| | - Kristin Akerjordet
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, 4036, Stavanger, Norway
| | - Christina Frøiland
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, 4036, Stavanger, Norway
| | - Laurie Grealish
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Gold Coast, Australia
| | - Ingunn Aase
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, 4036, Stavanger, Norway
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15
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The role of organizational factors in how efficiency-thoroughness trade-offs potentially affect clinical quality dimensions – a review of the literature. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-12-2020-0134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions.Design/methodology/approachThe paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality.FindingsIdentified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews.Originality/valueBalancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.
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Cheng TJ, Hsu YM, Tsai TH, Chen MY, Tsay SF, Shieh SH. Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249413. [PMID: 33334015 PMCID: PMC7765356 DOI: 10.3390/ijerph17249413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022]
Abstract
With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. Nursing assistants (NAs) are the primary providers of direct care services to older adults with disabilities, whose knowledge, skills, and beliefs affect the quality of care provided. This study aimed to investigate the influential factors affecting NAs’ current competences. A total of 255 NAs’ valid questionnaires were collected from 20 long-term care institutions in Taiwan through convenience sampling. The questionnaire comprised dimensions of demographics and care competence. The study results indicated that NAs had the greatest care competence in the domain of recognition of patient rights (4.64 ± 0.54 points). The multiple regression indicated that age, religion, job category, disability care experience, the receiving of performance bonuses, and the receiving of year-end bonuses significantly affected the level of care competence (p < 0.05). With the aforementioned findings, the results of this study serve as references for the government in employing long-term care NAs and developing management policies. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities.
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Affiliation(s)
- Tsai-Jung Cheng
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan; (T.-J.C.); (T.-H.T.); (S.-F.T.)
| | - Yi-Min Hsu
- Department of Public Health, China Medical University, Taichung 40402, Taiwan;
- Department of Nursing, China Medical University Hospital, Taichung 40402, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan; (T.-J.C.); (T.-H.T.); (S.-F.T.)
| | - Ming-Yu Chen
- Taichung Hospital attached Nursing Home, Head Nurse Ministry of Health and Welfare, Taichung 40343, Taiwan;
| | - Shwu-Feng Tsay
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan; (T.-J.C.); (T.-H.T.); (S.-F.T.)
- Department of Nursing and Health Care, Ministry of Health and Welfare, Taipei 11558, Taiwan
| | - Shwn-Huey Shieh
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan; (T.-J.C.); (T.-H.T.); (S.-F.T.)
- Department of Nursing, China Medical University Hospital, Taichung 40402, Taiwan
- Department of Nursing, Asia University, Taichung 41354, Taiwan
- Correspondence:
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17
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Su Z, Meyer K, Li Y, McDonnell D, Joseph NM, Li X, Du Y, Advani S, Cheshmehzangi A, Ahmad J, da Veiga CP, Chung RYN, Wang J. Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol. RESEARCH SQUARE 2020:rs.3.rs-56102. [PMID: 36597539 PMCID: PMC7444297 DOI: 10.21203/rs.3.rs-56102/v2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19. Methods Databases including PubMed, PsycINFO, CINAHL, and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between January 1st, 2010 to December 4th, 2020. Titles, abstracts, and full-texts papers will be reviewed against the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process, and implications for existing interventions and research evaluated by a multidisciplinary research team. Results NA-protocol study. Conclusions Our study will fill critical gaps in the literature by providing a review of technology-based interventions tested in the nursing home setting. As the older adult population grows, there is an urgent need to identify effective technology-based interventions that can address the distinctive characteristics and preferences of nursing home residents. Clear and comprehensive understanding of how available technology-based health solutions facilitate healthcare for nursing home residents will shed light on the approaches open to residents to fend off the negative health consequences amid and beyond the influence of COVID-19. Systematic Review Registrations PROSPERO CRD 42020191880.
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Affiliation(s)
- Zhaohui Su
- University of Texas Health Science Center at San Antonio
| | - Kylie Meyer
- University of Texas Health Science Center at San Antonio
| | - Yue Li
- University of Rochester Medical Center
| | | | | | - Xiaoshan Li
- Beijing Normal University-Hong Kong Baptist University United International College
| | - Yan Du
- University of Texas Health Science Center at San Antonio
| | | | | | | | | | | | - Jing Wang
- University of Texas Health Science Center at San Antonio
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18
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COVID-19 among nursing home residents: results of an urgent pre-hospital intervention by a multidisciplinary task force. Braz J Infect Dis 2020; 25:101039. [PMID: 33290728 PMCID: PMC7718835 DOI: 10.1016/j.bjid.2020.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 12/15/2022] Open
Abstract
The current coronavirus disease-2019 (COVID-19) pandemic caused 10,541 deaths among nursing home residents in France, by July 17th, 2020. This study reported the results of an urgent pre-hospital intervention in eight French nursing homes. A retrospective study was conducted from March 26th to May 7th, 2020, before and after the intervention of a task force which took action from April 9th to April 11th, 2020. The task force included nurses and specialists of the county general hospital. The intervention had four steps: i) daily notification of deaths; ii) audit by infectious diseases and hygiene specialists focused on nursing team reinforcing, tracking of suspected cases, patients’ cohorting, review of preventive and protective measures, hydration, thromboembolism prevention; iii) intervention of an emergency team which urgently performed procedures suggested; iv) relay with a geriatric team. There were a total of 770 residents distributed in eight facilities with capacity varying from 53 to 145 residents. The number of deaths peaked at 139 in week 2 and the trough at 0 occurred in weeks 6−7. Comparison between periods (before vs after intervention) showed a significant decrease in number of new deaths (83/770; 11% vs 35/687; 5%, p = 0.0001) and new COVID-19 cases (348/770; 45% vs 123/422; 29%, p < 0.001). The urgent pre-hospital intervention by a multidisciplinary task force achieved mortality reduction during COVID-19 outbreak in nursing homes. Pre-hospital intervention is a valid alternative to hospitalization in case of hospital saturation.
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19
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Veenstra M, Gautun H. Nurses' assessments of staffing adequacy in care services for older patients following hospital discharge. J Adv Nurs 2020; 77:805-818. [PMID: 33222214 PMCID: PMC7894527 DOI: 10.1111/jan.14636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/21/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022]
Abstract
Aims To explore community nurses' assessments of staffing adequacy in care provision for older patients following hospital discharge and analyse the extent to which their assessments are associated with characteristics of the system level of municipality and vertical coordination between hospital and community care services. Design Nation‐wide cross‐sectional survey. Methods Web‐based survey conducted in 2017 among 3,461 nurses working with older persons (65+) in homecare services, residential care and nursing homes in Norway. Responses from individual homecare nurses were linked with municipal‐level register data (age structure, economic flexibility, service profiles). Stratified multilevel analyses were used to analyse the association of staffing adequacy with municipal characteristics and perceived quality of vertical coordination. Results Almost half of the nurses experienced inadequate staffing in general, whereas a similar share indicated that staffing was adequate. Nursing home nurses showed the least positive ratings of staffing adequacy. Most nurses indicated that there were too many unqualified care workers at their workplace. More positive assessments of staffing adequacy were associated with better vertical coordination. Average ratings of staffing adequacy were lower in larger municipalities and municipalities with an older population. Conclusion Healthcare providers, nurse managers and policy makers may benefit from a stronger focus on rebalancing skill‐mix and on new models of vertical coordination in addressing current and future nurse staffing shortages in care services for older people following hospital discharge. Impact statement This study adds to the scarce national and international research literature on nurse staffing in community care services, addressing the pressing challenges of staffing and skill‐ mix in long‐term care provision. Findings support the development of nurse‐led models of care coordination for older patients following hospital discharge and stimulate future research on the effects of recruitment and retainment strategies in different municipalities and different models of vertical coordination.
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Affiliation(s)
- Marijke Veenstra
- Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway
| | - Heidi Gautun
- Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway
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20
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Nilsen MK, Olsen RM, Sletvold H. Kan organisering av omsorgsboliger for eldre påvirke praksis i forbindelse med legemidler som gis ved behov? TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Su Z, Meyer K, Li Y, McDonnell D, Joseph NM, Li X, Du Y, Advani S, Cheshmehzangi A, Ahmad J, da Veiga CP, Chung RYN, Wang J. Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol. RESEARCH SQUARE 2020:rs.3.rs-56102. [PMID: 32839768 PMCID: PMC7444297 DOI: 10.21203/rs.3.rs-56102/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19. Methods: Databases including PubMed, PsycINFO, CINAHL, and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between January 1 st , 2020 to July 7 th , 2020. Titles, abstracts, and full-texts papers will be reviewed against the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process, and implications for existing interventions and research evaluated by a multidisciplinary research team. Results: NAâ€"protocol study Conclusions: Our study will fill critical gaps in the literature by providing a review of technology-based interventions tested in the nursing home setting. As the older adult population grows, there is an urgent need to identify effective technology-based interventions that can address the distinctive characteristics and preferences of nursing home residents. Clear and comprehensive understanding of how available technology-based health solutions facilitate healthcare for nursing home residents will shed light on the approaches open to residents to fend off the negative health consequences amid and beyond the influence of COVID-19. Systematic Review Registrations: PROSPERO CRD 42020191880.
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22
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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The COMFORT Communication Model: A Nursing Resource to Advance Health Literacy in Organizations. J Hosp Palliat Nurs 2020; 22:229-237. [PMID: 32282558 DOI: 10.1097/njh.0000000000000647] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The COMFORT Model has recently been revised based on feedback from bedside nurses working in palliative care and oncology and includes the following components: Connect, Options, Making Meaning, Family Caregiver, Openings, Relating, and Team. Based on clinical and nonclinical research in hospital, hospice, palliative care, and interdisciplinary education settings, the authors present the updated COMFORT Model. Originally introduced in 2012 to support the work of the nurse, the model is not a linear guide, an algorithm, a protocol, or a rubric for sequential implementation by nurses, but rather a set of communication principles that are practiced concurrently and reflectively during patient/family care. In its restructuring, we focus on the role of health literacy throughout the COMFORT components in relationship to the health literacy attributes of a health care organization. A brief summary of COMFORT components is provided and includes strategies and competencies contributing to a health-literate care organization. Both health literacy and COMFORT are explored using specific communication challenges that underscore the role of the nurse in accomplishing person-centered and culturally responsive care, especially in chronic and terminal illness. The integration of the COMFORT Model into nursing education is proposed.
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Johannessen T, Ree E, Aase I, Bal R, Wiig S. Exploring challenges in quality and safety work in nursing homes and home care - a case study as basis for theory development. BMC Health Serv Res 2020; 20:277. [PMID: 32245450 PMCID: PMC7118914 DOI: 10.1186/s12913-020-05149-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/24/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the services are struggling with fragmentation of care, discontinuity and restricted resource availability. The aim of the study was to explore the current challenges in quality and safety work as perceived by managers and employees in nursing homes and home care services. METHOD The study is a multiple explorative case study of two nursing homes and two home care services in Norway. Managers and employees participated in focus groups and individual interviews. The data material was analyzed using directed content analysis guided by the theoretical framework 'Organizing for Quality', focusing on the work needed to meet quality and safety challenges. RESULTS Challenges in quality and safety work were interrelated and depended on many factors. In addition, they often implied trade-offs for both managers and employees. Managers struggled to maintain continuity of care due to sick leave and continuous external-facilitated change processes. Employees struggled with heavier workloads and fewer resources, resulting in less time with patients and poorer quality of patient care. The increased external pressure affected the possibility to work towards engagement and culture for improvement, and to maintain quality and safety as a collective effort at managerial and employee levels. CONCLUSION Despite contextual differences due to the structure, size, nature and location of the nursing homes and home care services, the challenges were similar across settings. Our study indicates a dualistic contextual dimension. Understanding contextual factors is central for targeting improvement interventions to specific settings. Context is, however, not independent from the work that managers do; it can be and is acted upon in negotiations and interactions to better support managers' and employees' work on quality and safety in nursing homes and home care.
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Affiliation(s)
- Terese Johannessen
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 39, 4021, Stavanger, Norway.
| | - Eline Ree
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 39, 4021, Stavanger, Norway
| | - Ingunn Aase
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 39, 4021, Stavanger, Norway
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Siri Wiig
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 39, 4021, Stavanger, Norway
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25
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Knutsen Glette M, Kringeland T, Røise O, Wiig S. Hospital physicians' views on discharge and readmission processes: a qualitative study from Norway. BMJ Open 2019; 9:e031297. [PMID: 31462486 PMCID: PMC6720230 DOI: 10.1136/bmjopen-2019-031297] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore hospital physicians' views on readmission and discharge processes in the interface between hospitals and municipalities. DESIGN Qualitative case study. SETTING The Norwegian healthcare system. PARTICIPANTS Fifteen hospital physicians (residents and consultants) from one hospital, involved in the treatment and discharge of patients. RESULTS The results of this study showed that patients were being discharged earlier, with more complex medical conditions, than they had been previously, and that discharges sometimes were perceived as premature. Insufficient capacity at the hospital resulted in pressure to discharge patients, but the primary healthcare service of the area was not always able to assume care of these patients. Communication between levels of the healthcare service was limited. The hospital stay summary was the most important, and sometimes only, form of communication between levels. The discharge process was described as complicated and was affected by healthcare personnel, by patients themselves and by aspects of the primary healthcare service. Early hospital discharges, poor communication between healthcare services and inadequacies in the discharge process were perceived to affect hospital readmissions. CONCLUSION The results of this study provide a better understanding of hospital physicians' views on the discharge and hospital readmission processes in the interface between the hospital and the primary healthcare service. The study also identifies discrepancies in governmental requirements, reform regulations and current practices in municipalities and hospitals.
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Affiliation(s)
- Malin Knutsen Glette
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences - Haugesund Campus, Haugesund, Norway
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Tone Kringeland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences - Haugesund Campus, Haugesund, Norway
| | - Olav Røise
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Siri Wiig
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
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