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Pruijsten R, Gilst GPV, Schuiling C, van Dijk M, Schluep M. Does a Transition to Single-Occupancy Patient Rooms Affect the Incidence and Outcome of In-Hospital Cardiac Arrests? HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:68-76. [PMID: 38390921 DOI: 10.1177/19375867241226600] [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: 02/24/2024]
Abstract
BACKGROUND It is proposed that patients in single-occupancy patient rooms (SPRs) carry a risk of less surveillance by nursing and medical staff and that resuscitation teams need longer to arrive in case of in-hospital cardiac arrest (IHCA). Higher incidences of IHCA and worse outcomes after cardiopulmonary resuscitation (CPR) may be the result. OBJECTIVES Our study examines whether there is a difference in incidence and outcomes of IHCA before and after the transition from a hospital with multibedded rooms to solely SPRs. METHODS In this prospective observational study in a Dutch university hospital, as a part of the Resuscitation Outcomes in the Netherlands study, we reviewed all cases of IHCA on general adult wards in a period of 16.5 months before to 16.5 months after the transition to SPRs. RESULTS During the study period, 102 CPR attempts were performed: 51 in the former hospital and 51 in the new hospital. Median time between last-seen-well and start basic life support did not differ significantly, nor did median time to arrival of the CPR team. Survival rates to hospital discharge were 30.0% versus 29.4% of resuscitated patients (p = 1.00), with comparable neurological outcomes: 86.7% of discharged patients in the new hospital had Cerebral Performance Category 1 (good cerebral performance) versus 46.7% in the former hospital (p = .067). When corrected for telemetry monitoring, these differences were still nonsignificant. CONCLUSIONS The transition to a 100% SPR hospital had no negative impact on incidence, survival rates, and neurological outcomes of IHCAs on general adult wards.
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Affiliation(s)
- Ralph Pruijsten
- Section Nursing Science, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Intensive Care, Ikazia Hospital, Rotterdam, the Netherlands
| | - Gerrie Prins-van Gilst
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Chantal Schuiling
- Section Nursing Science, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique van Dijk
- Section Nursing Science, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc Schluep
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Anesthesiology and Intensive Care, Bravis Hospital, Bergen op Zoom, the Netherlands
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2
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Pruijsten R, Ista E, Maben J, van Heel L, van Dijk M. Nurses' perceptions of the transition to 100% single-occupancy patient rooms in a university hospital in the Netherlands: an uncontrolled before and after study. BMC Nurs 2024; 23:106. [PMID: 38326800 PMCID: PMC10851588 DOI: 10.1186/s12912-024-01758-7] [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: 10/24/2022] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND To improve patients' privacy, comfort and infection control, newly built hospitals increasingly offer 100% single-occupancy patient rooms. Our study examines how nurses perceived the transition from a hospital with multi-bedded patient rooms to one with solely single-occupancy patient rooms designed according to principles of a healing environment. METHODS In a single-centre, before-after survey study, nurses completed a questionnaire of 21 items in three domains: perceived patient safety and monitoring, nurses' working conditions and patient environment. Before-measurements (n = 217) were compared with two after-measurements in the new hospital, respectively after one (n = 483) and two years (n = 191). RESULTS Nurses considered the single rooms in the new hospital worse for visibility and monitoring but this had improved somewhat after two years. In either setting, the majority perceived working conditions (walking distances and designated rest area) as unfavourable. The patient environment in the new hospital was generally perceived as much better than in the former hospital. CONCLUSION The transition to solely single-occupancy patient rooms was largely considered positive by nurses in terms of patient environment. However, monitoring of patients and working conditions remain a concern. When designing new hospitals, attention should be paid to optimal working conditions for nurses. To improve monitoring of patients, we recommend the use of remote-sensoring.
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Affiliation(s)
- Ralph Pruijsten
- Section Nursing Science, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
- Department of Intensive Care, Ikazia hospital, Rotterdam, the Netherlands.
| | - Erwin Ista
- Section Nursing Science, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Liesbeth van Heel
- Department of Public Health, Real Estate Department, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique van Dijk
- Section Nursing Science, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Søndergaard SF, Rasmussen B, Kerr D, Frederiksen K, Redley B, Trueman M, Kolbaek R, Laursen HS, Bloomer MJ. Nurses' work experiences in hospital wards with single rooms: An integrative review. J Clin Nurs 2023; 32:7036-7049. [PMID: 37462296 DOI: 10.1111/jocn.16824] [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: 02/17/2023] [Revised: 06/03/2023] [Accepted: 07/04/2023] [Indexed: 09/21/2023]
Abstract
AIM AND OBJECTIVE To evaluate evidence that examined nurses' work experiences in hospital wards with single rooms. The research question was 'What does the research tell us about nurses' work experiences in hospital wards with single rooms?' BACKGROUND In the last decades, new hospital builds have moved towards including a high proportion of single rooms. Yet, single rooms create 'complex environments' that impact the nurses. DESIGN A structured integrative review was undertaken of empirical evidence. METHODS Original, peer-reviewed articles, written in English, were sourced from four databases: CINAHL, PubMed, Embase and Web of Science. The initial searches were performed in April 2021 and repeated in December 2022. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis approach was used to analyse the data. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS Twelve studies, published between 2006 and 2022, with an international origin, and representing n = 826 nurses, were included in this review. The synthesis revealed mixed perspectives about nurses' work experiences in wards with single rooms. Whilst single rooms are 'all good in theory (and) a good idea', the reality was quite different. Synthesised findings are presented in four categories: (i) aesthetics and the physical space, (ii) privacy vs. isolation, (iii) safety, which includes situational awareness and (iv) communication and collaboration. CONCLUSION This review describes how single rooms affects nurses' work experience. Whilst nurses shared multiple concerns about single rooms and the challenges they also acknowledged patient preference for the privacy and space afforded by single rooms. RELEVANCE TO CLINICAL PRACTICE Findings from this review highlight the need for careful planning to maintain and strengthen teamwork, prevent nurses' sense of working in isolation, as well as creating opportunities for mentorship, and collaboration among nurses when working in single-room settings.
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Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing, Regional Hospital Central Jutland, Viborg, Denmark
- VIA University College, Nurse Education Viborg, Aarhus University, Health, Aarhus, Denmark
| | - Bodil Rasmussen
- Department of Nursing, Western Health Partnership, Deakin University, Geelong, Victoria, Australia
- Institute for Healthcare Transformation, Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Debra Kerr
- Institute for Healthcare Transformation, Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | | | - Bernice Redley
- Institute for Healthcare Transformation, Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Melody Trueman
- Department of Nursing and Midwifery, Western Health, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Nursing Services, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Raymond Kolbaek
- Centre for Research in Clinical Nursing, Regional Hospital Central Jutland, Viborg, Denmark
- VIA University College, Nurse Education Viborg, Aarhus University, Health, Aarhus, Denmark
| | | | - Melissa J Bloomer
- Department of Critical Care and Nursing, School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Wong K, McLaughlan R, Collins A, Philip J. Designing the physical environment for inpatient palliative care: a narrative review. BMJ Support Palliat Care 2023; 13:45-51. [PMID: 34972689 DOI: 10.1136/bmjspcare-2021-003087] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND It is essential that the physical environments in which inpatient palliative care is provided support the needs of patients and the facilitate the multidimensional delivery of palliative care. This review aims to identify the features and characteristics of inpatient palliative care environments that enhance or detract from the patient experience; and identify opportunities for progress within this field. METHOD Three databases were searched: MEDLINE (1946-2020), PsycINFO (1806-2020) and CINAHL (1937-2020). Articles were screened by title and abstract with included studies read in full for data extraction. Data synthesis involved thematic analysis informed by the findings of the included literature. Inclusion criteria were studies with empirical methodology examining adult palliative care in the hospital, hospice or nursing home environment. Studies that examined palliative care delivered within the emergency department, ICU or within the home were excluded, as were those related to paediatric palliative care. RESULTS Four main themes were identified: the provision of privacy, facilitating interactions with family, facilitating comfort through homeliness and connections to nature. CONCLUSIONS The board acceptance of single rooms as the preeminent design solution for supporting privacy, dignity and family interaction, alongside current conceptions of homeliness that typically focus on matters of interior design, are limiting possibilities for further design innovation within palliative care settings. Research that investigates a broader set of design strategies through which the built environment can support care, alongside enhanced interdisciplinary collaboration, could positively contribute to patient and family experiences of inpatient palliative care.
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Affiliation(s)
- Kevin Wong
- Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca McLaughlan
- School of Architecture & the Built Environment, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Anna Collins
- Palliative Care Service, The University of Melbourne Medicine at St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Jennifer Philip
- Palliative Care Service, The University of Melbourne Medicine at St Vincent's Hospital, Fitzroy, Victoria, Australia
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5
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Edwards N, Dunn S, Barach P, Vaughan L. The Wolfson Prize: designing the hospital of the future. Future Healthc J 2023; 10:27-30. [PMID: 37786505 PMCID: PMC10538682 DOI: 10.7861/fhj.2022-0105] [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: 02/05/2023]
Abstract
Background The 2021 Wolfson Economics Prize asked how new hospitals should be designed to radically improve patient experiences, clinical outcomes, staff wellbeing and integration with wider health and social care. With a major programme to rebuild and renew hospitals in England underway, the Prize offered an opportunity to understand current thinking about hospitals and their future place. Methods The 41 submissions that were identified as 'most promising' were reviewed and subjected to framework analysis. Emerging themes were identified and discussed iteratively. Results Five dominant themes were identified: a calming environment; systems of care; distribution of services; use of technology; and going green. Several tensions and trade-offs were evident across the submissions and a number of gaps were identified in the knowledge base that need to be remedied to ensure that new hospitals are safe and efficient. Conclusion The previous approach to building new hospitals, with its over-riding drive to reduce costs, has not served the UK well. New ways of thinking about hospital building and design are urgently needed, especially the funding of research and the creation of a national repository devoted to design solutions and post-build evaluations of new hospitals.
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Affiliation(s)
| | | | - Paul Barach
- College of Population Health, Thomas Jefferson University, Philadelphia, USA and Sigmund Freud University, Vienna, Austria
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Cusack L, Munt R, Verdonk N, Schultz T, Maben J. Comparison of experiences of nursing staff and patients before and after move to 100% single-bed room hospital in Australia: mixed methods. BMC Health Serv Res 2023; 23:81. [PMID: 36698126 PMCID: PMC9875193 DOI: 10.1186/s12913-023-09073-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There is sufficient and consistent international evidence of issues reported by nurses working in single-bed room environments, requiring a design that is not only comfortable for patients but meets nurses working needs. This paper presents a comparison of nursing staff and patients experience prior to a move to 100% single-bed room hospital in 2016 (Stage 1) and actual experiences after the move in 2021 (Stage 2) in South Australia. METHOD Mixed method case study design. Survey sample of forty-two nursing staff; twelve patient interviews of their experiences of current environment and; thirteen nursing staff interviews of their experiences delivering nursing care in 100% single bed-room environment. RESULTS Nurses and patients highlighted single-bed rooms contributed to patients' privacy, confidentiality, dignity and comfort. As anticipated in Stage 1, nurses in Stage 2 reported lack of patient and staff visibility. This impacted workload, workflow and concern for patient safety. CONCLUSION Patient and nursing staff experiences are interdependent, and implications of single-bed room accommodation are complicated. Future impacts on the health system will continue to affect hospital design, which must consider nurses working needs and patient safety and comfort.
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Affiliation(s)
- Lynette Cusack
- grid.1010.00000 0004 1936 7304Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia Australia
| | - Rebecca Munt
- grid.1010.00000 0004 1936 7304Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia Australia
| | - Naomi Verdonk
- grid.1010.00000 0004 1936 7304Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia Australia
| | - Tim Schultz
- grid.1014.40000 0004 0367 2697Flinders University, Adelaide, South Australia Australia
| | - Jill Maben
- grid.5475.30000 0004 0407 4824University of Surrey, Guildford, UK
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Mclaughlan R, George B. Unburdening expectation and operating between: architecture in support of palliative care. MEDICAL HUMANITIES 2022; 48:497-504. [PMID: 35296542 DOI: 10.1136/medhum-2021-012340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
The role of design and materials in the enactment and experience of healthcare has gained increasing attention across the fields of evidence-based design, architecture, anthropology, sociology and cultural geography. Evidence-based design, specifically, seeks to understand the ways in which the built environment can support the healing process. In the context of palliative care, however, the very measure of healing differs vastly. Physicians Mount and Kearney suggest that 'it is possible to die healed', and that such healing can be facilitated through the provision of 'a secure environment grounded in a sense of connectedness' (2003: 657). Acknowledging this critical difference raises important questions around the various ways through which the built environment might support healing, but also about the potential of architecture to impart care. This paper reports on 15 interviews with architects, experienced in the design of palliative care settings, from the UK, USA and Australia, to provide a deeper understanding of the questions being asked within the briefing processes for these facilities, the intentions embedded in the ways that architects respond, and the kinds of compromises deemed allowable (by various stakeholders) within the procurement process. Our findings suggest that palliative care architects often respond to two briefs, one explicit and the other unspoken. Design responses in relation to the first include: formally expressing a differentiation in the philosophy of care (signalling difference), attention to quality, extending comfort and providing 'moments'. The second relates to the unburdening of palliative care facilities from their associative baggage and responding to the tension between the physical and imaginative inhabitation of space. In revealing the presence of this hidden brief, and the relationship between the two, this paper invites a broader discussion regarding the capacity of architecture to support palliative care patients, their families and staff.
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Affiliation(s)
- Rebecca Mclaughlan
- School of Architecture and the Built Environment, University of Newcastle, Newcastle, New South Wales, Australia
- Sydney School of Architecture, Design and Planning, University of Sydney, Sydney, New South Wales, Australia
| | - Beth George
- School of Architecture and the Built Environment, University of Newcastle, Newcastle, New South Wales, Australia
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Karvonen S, Holma T, Korpelainen J, Leivonen K, Michelsson K, Rantala MR, Porkkala T, Lukkarila P. Key Flow Processes on Wards. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 16:208-222. [PMID: 36325801 DOI: 10.1177/19375867221134550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: The aim of the study is to test a new nurse movement route analysis (NMRA) method for measuring nurses’ traffic volume between rooms on wards. Background: The World Health Organization calls for urgent investment in nurses. On the other hand, the challenges in the availability, direct care activity, and staffing of registered nurses make increasing the quality of care by process improvement a central objective for nursing. Method: The method is based on cellular operations with from/to matrix that describes nurse movements between rooms on a ward. The NMRA can be implemented by traditional manual observation or with a novel internet-of-things solution named SKAnalysis. Results: The greatest nurse flows led to patient rooms, nurses’ stations, and medicine rooms. The manual NMRA recorded a total of 3,040 room visits by nurses; visits to patient rooms accounted for 33% of all room visits, while visits to nurses’ stations accounted for 28%, and visits to the medicine room for 10%. The internet-of-things NMRA recorded a total of 25,841 room visits by nurses; patient room visits accounted for about 43% of all room visits, while nurses’ station visits accounted for 26% and medicine room visits for about 8%. Based on the results, researchers present the development examples and priorities for nursing. Conclusions: NMRA works and is a new universal method for analyzing nurses’ traffic which is a basic premise for improving working methods and productivity on the wards. Internet-of-things solution makes the implementation of NMRA six times more efficient than by the manual NMRA.
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Affiliation(s)
| | - Tuomas Holma
- Northern Ostrobothnia Hospital District, Oulu University Hospital, Finland
| | - Juha Korpelainen
- Northern Ostrobothnia Hospital District, Oulu University Hospital, Finland
| | - Kirsi Leivonen
- Siun sote – Joint municipal authority for North Karelia social and health services, Finland
| | | | | | - Timo Porkkala
- Heart Hospital, Tampere University Hospital, Finland
| | - Pirjo Lukkarila
- Northern Ostrobothnia Hospital District, Oulu University Hospital, Finland
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van der Schoor AS, Severin JA, van der Weg AS, Strepis N, Klaassen CHW, van den Akker JPC, Bruno MJ, Hendriks JM, Vos MC, Voor In 't Holt AF. The effect of 100% single-occupancy rooms on acquisition of extended-spectrum beta-lactamase-producing Enterobacterales and intra-hospital patient transfers: a prospective before-and-after study. Antimicrob Resist Infect Control 2022; 11:76. [PMID: 35655322 PMCID: PMC9164559 DOI: 10.1186/s13756-022-01118-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) are a well-known cause of healthcare-associated infections. The implementation of single-occupancy rooms is believed to decrease the spread of ESBL-E. Additionally, implementation of single-occupancy rooms is expected to reduce the need for intra-hospital patient transfers. We studied the impact of a new hospital with 100% single-occupancy rooms on the acquisition of ESBL-E and on intra-hospital patient transfers. METHODS In 2018, the Erasmus MC University Medical Center moved from an old, 1200-bed hospital with mainly multiple-occupancy rooms, to a newly constructed 522-bed hospital with 100% single-occupancy rooms. Adult patients admitted between January 2018 and September 2019 with an expected hospitalization of ≥ 48 h were asked to participate in this study. Perianal samples were taken at admission and discharge. Patient characteristics and clinical information, including number of intra-hospital patient transfers, were collected from the patients' electronic health records. RESULTS Five hundred and ninety-seven patients were included, 225 in the old and 372 in the new hospital building. Fifty-one (8.5%) ESBL-E carriers were identified. Thirty-four (66.7%) patients were already positive at admission, of which 23 without recent hospitalization. Twenty patients acquired an ESBL-E, seven (3.1%) in the old and 13 (3.5%) in the new hospital building (P = 0.801). Forty-one (80.4%) carriers were only detected by the active screening performed during this study. Only 10 (19.6%) patients, six before and four during hospitalization, showed ESBL-E in a clinical sample taken on medical indication. Fifty-six (24.9%) patients were transferred to other rooms in the old hospital, compared to 53 (14.2%) in the new hospital building (P = 0.001). Intra-hospital patient transfers were associated with ESBL-E acquisition (OR 3.18, 95%CI 1.27-7.98), with increasing odds when transferred twice or more. CONCLUSION Transitioning to 100% single-occupancy rooms did not decrease ESBL-E acquisition, but did significantly decrease the number of intra-hospital patient transfers. The latter was associated with lower odds on ESBL-E acquisition. ESBL-E carriers remained largely unidentified through clinical samples. TRIAL REGISTRATION This study was retrospectively registered in the Dutch National Trial Register on 24-02-2020, with registration number NL8406.
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Affiliation(s)
- Adriënne S van der Schoor
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anna S van der Weg
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nikolaos Strepis
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corné H W Klaassen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Johanna M Hendriks
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Karvonen S, Eskola M, Haukilahti A, Porkkala T. Patient-Flow Analysis for Planning a Focused Hospital Layout: Tampere Heart Hospital Case. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:264-276. [PMID: 35341358 DOI: 10.1177/19375867221086199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is present how a patient movement-based patient-flow analysis is performed for planning the new Heart Hospital of Tampere University Hospital and how patient transfer distances can be shortened by this method. BACKGROUND The Heart Hospital had served patients as a service line organization for years. However, the Heart Hospital layout rather looked like functional layout instead of service line layout because the units of the Heart Hospital have been spread out around the large university hospital campus. METHOD The flow routes of patients treated over the course of 1 year were analyzed by information technology systems in the hospital planning phase. Then, the proximity ranking of the main functions of the Heart Hospital was made. Layout planning was performed based on the proximity ranking. Nine months after the opening of the new Heart Hospital, the distances between the various hospital functions were calculated for the old Heart Hospital and the new one. RESULTS In the old Heart Hospital, patients' transfer distance was 5,654 km (3,513 miles), while the corresponding figure for the new Heart Hospital was 3,797 km (2,359 miles), which means the distance was reduced by 33%. CONCLUSION The patient-flow analysis works as it generated substantially shorter patient transfer distances in the new Heart Hospital. Shorter distances have supported more fluent patient flows that, in turn, has contributed higher productivity and quality of care.
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Affiliation(s)
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Finland.,Faculty of Medicine and Health Technology, Tampere University, Finland
| | | | - Timo Porkkala
- Heart Hospital, Tampere University Hospital, Finland
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11
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McLaughlan R, Richards K, Lipson-Smith R, Collins A, Philip J. Designing Palliative Care Facilities to Better Support Patient and Family Care: A Staff Perspective. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:149-162. [PMID: 35021917 DOI: 10.1177/19375867211059078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To contribute staff perspectives on the design of palliative care facilities to better align with the philosophy of palliative care, in support of patient, family, and staff well-being. BACKGROUND The receipt of palliative care differs from other inpatient experiences owing to its distinct philosophy of care, longer lengths of stay, a greater presence of family members, and more frequent end-of-life events. While research regarding the optimal design of palliative care environments recognizes these differences, this knowledge has been slow to exert change on the guidelines and procurement processes that determine the design solutions possible within these settings. Sustained research attention is required. METHODS An online survey, comprising a series of open-ended questions, elicited the perceptions of palliative care staff regarding the relationship between the physical environment and the distinct philosophy of palliative care. RESULTS Responses from 89 Australian-based palliative care professionals confirmed the high value that staff place on environments that offer privacy, homeliness, safety, and access to gardens to assist the delivery of optimum care. CONCLUSIONS Our findings illustrate that the implications of privacy and homeliness extend far beyond the patient room and that homeliness is about more than an aesthetic of comfort. This highlights a broader capacity for design to better support the philosophy of palliative care. Importantly, the data reveal a key relationship between staff well-being and the environments in which they work; environments that are unable to match the quality of care that staff aspire to deliver can engender frustration and distress.
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Affiliation(s)
- Rebecca McLaughlan
- School of Architecture and the Built Environment, University of Newcastle, Callaghan, Australia
| | - Kieran Richards
- School of Architecture and the Built Environment, University of Newcastle, Callaghan, Australia
| | - Ruby Lipson-Smith
- School of Architecture and the Built Environment, University of Newcastle, Callaghan, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Anna Collins
- Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Jennifer Philip
- Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Australia
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12
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Mclaughlan R, Lyon C, Jaskolska D. Architecture as change-agent? Looking for innovation in contemporary forensic psychiatric hospital design. MEDICAL HUMANITIES 2021; 47:e11. [PMID: 33106241 DOI: 10.1136/medhum-2020-011887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
History suggests that departures from accepted design practice can contribute to positive change in the delivery of mental healthcare, the daily experience of hospitalised patients and public perceptions of mental illness. Yet the question of how architecture can support the therapeutic journey of patients remains a critical one. The availability of evidence-based design literature to guide architects cannot keep pace with growing global demand for new forensic psychiatric hospital facilities. This article reports a global survey of current design practice to speculate on the potential of three new hospitals to positively improve patient experience. A desktop survey was conducted of 31 psychiatric hospitals (24 forensic, 7 non-forensic) constructed or scheduled for completion between 2006 and 2022. This was supplemented by advisory panel sessions with clinical/facilities staff, alongside architectural knowledge obtained through workshops with architects from the UK and the USA, and the inclusion of Australian architects on the research team. Data analysis draws on knowledge from architectural practice, architectural history and environmental psychology, arguing that there is a responsibility to integrate knowledge from across these disciplines in respect of such a pressing and important problem.
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Affiliation(s)
- Rebecca Mclaughlan
- School of Architecture and the Built Environment, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Codey Lyon
- NTC Architects, Melbourne, Victoria, Australia
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Kelly R, Noelle Brown D, Mccance T. 'Owning the space'-person-centred practice in a 100% single-room acute-care environment: an ethnographic study. J Clin Nurs 2021; 31:2921-2934. [PMID: 34761439 DOI: 10.1111/jocn.16119] [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: 06/28/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES Exploring the influence of the 100% single-room environment on staff and patient experience of person-centred practice in an acute-care setting. BACKGROUND Current building guidance for the NHS advocates increasing the single-room inpatient environment. There is little evidence of the impact of this design in adult acute-care settings on the experience and delivery of person-centred care. DESIGN Ethnography, underpinned by McCormack and McCance's Person-centred Practice Framework. METHODS Data collection took place between March and June 2018. Staff and patients in a National Health Service hospital in the United Kingdom took part in observations of practice (n = 108 hours); face to face inpatient interviews (n = 9); and participatory reflective staff groups (n = 3). A reflexive journal was kept by the researcher throughout the study. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS Themes relating to care delivery and interactions were identified. Staff and patients' views converged around visibility and isolation. Patients appreciated the privacy afforded by the single rooms, while staff experienced a psychological shift, being viewed (and viewing themselves) as 'visitors'. There was space for more sympathetic presencing, encouraging patients to speak more openly, to facilitate knowing and authentic engagement. However, time remained an issue resulting in more task-focused care. CONCLUSION Changes to the physical environment have an impact on the delivery and experience of person-centred practice. While the facilities enhance patient experience, the interweaving of engagement, emotional support and the development of therapeutic relationships remain challenging.
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Affiliation(s)
- Rosemary Kelly
- School of Nursing, Ulster University, Newtownabbey, United Kingdom of Great Britain and Northern Ireland
| | - Donna Noelle Brown
- School of Nursing, Ulster University, Newtownabbey, United Kingdom of Great Britain and Northern Ireland
| | - Tanya Mccance
- School of Nursing, Ulster University, Newtownabbey, United Kingdom of Great Britain and Northern Ireland
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15
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Søndergaard SF, Beedholm K, Kolbæk R, Frederiksen K. Patients' and Nurses' Experiences of All Single-Room Hospital Accommodation: A Scoping Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:292-314. [PMID: 34636692 DOI: 10.1177/19375867211047548] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM AND OBJECTIVE To identify, examine, and map literature on the experiences of single-room hospital accommodation, exploring what is known about how single-room accommodation in hospitals is viewed by patients and nurses. BACKGROUND Worldwide, hospital design is changing to mainly single-room accommodation. However, there is little literature exploring patients' and nurses' experiences of single-room designs. DESIGN Scoping review following the Joanna Briggs Institute guidance on scoping reviews. METHODS We conducted the search in medical databases for scientific and gray literature. The four authors independently used a data extraction tool to include sources from the searches. The sources were discussed during the process, and in case of a disagreement between two reviewers, the third and fourth reviewer would be invited to participate in the discussion until consensus was achieved. RESULTS We included 22 sources published during the period 2002-2020, with a majority (n = 16) during the period 2013-2020. The sources were distributed on 10 different countries; however, England dominated with 14 publications. We found three main maps for reporting on patients' experiences: (1) personal control, (2) dignity, and (3) by myself. For the nurses' experiences, we found four main maps: (1) the working environment, (2) changes of nursing practice, (3) privacy and dignity, and (4) patient safety. CONCLUSION We suggested that patients' and nurses' experiences are predominantly interdependent and that the implications of single-room accommodation is a large and complex issue which goes beyond hospital design.
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Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing, Regional Hospital Viborg, VIA University College, Aarhus University, Denmark
| | | | - Raymond Kolbæk
- Centre for Research in Clinical Nursing, Regional Hospital Viborg, VIA University College, Aarhus University, Denmark.,Deakin University, Burwood, Victoria, Australia
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Berry D, Wakefield E, Street M, Considine J. Clinical deterioration and hospital-acquired complications in adult patients with isolation precautions for infection control: A systematic review. J Adv Nurs 2020; 76:2235-2252. [PMID: 32449184 DOI: 10.1111/jan.14435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/31/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
AIM To review and synthesize literature examining clinical deterioration and hospital-acquired complications in adult patients with isolation precautions for infection control. BACKGROUND Isolation precautions are a common infection prevention and control strategy which may have impact on safety and quality of care. DESIGN The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided this systematic review, which was registered with PROSPERO [CRD42019131573]. DATA SOURCES A search of Medline, Embase, and Cumulative Index to Nursing and Allied Health Literature was conducted for studies published in English up to 5 April 2019. REVIEW METHODS Risk of bias was determined using Critical Appraisal Skills Program tools. Quality appraisal was performed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. The primary outcomes of interest were clinical deterioration events and hospital-acquired complications. In-hospital death and hospital length of stay were secondary outcomes. Data were synthesized using a narrative approach. RESULTS The search yielded 785 citations after removal of duplicates, of which, six studies were relevant. Certainty of evidence for outcomes of interest was low to very low. CONCLUSION There is no strong evidence that adult medical and surgical ward patients in isolation precautions for infection control are more or less likely to experience clinical deterioration or hospital-acquired complications. IMPACT What problem did the study address? Are patients in isolation precautions more likely to experience clinical deterioration or hospital-acquired complications than non-isolated patients? What were the main findings? There is no strong evidence that clinical deterioration and hospital-acquired complications are more likely to occur to patients in isolation precautions for infection control. This research is of relevance to acute care nurses.
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Affiliation(s)
- Debra Berry
- Centre for Quality and Patient Safety - Eastern Health Partnership, Box Hill, Vic., Australia.,School of Nursing and Midwifery & Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
| | | | - Maryann Street
- Centre for Quality and Patient Safety - Eastern Health Partnership, Box Hill, Vic., Australia.,School of Nursing and Midwifery, Centre for Quality and Patient Safety Research & Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
| | - Julie Considine
- Centre for Quality and Patient Safety - Eastern Health Partnership, Box Hill, Vic., Australia.,School of Nursing and Midwifery, Centre for Quality and Patient Safety Research & Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
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Leon-Villapalos C, Wells M, Brett S. Exploratory study of staff perceptions of shift safety in the critical care unit and routinely available data on workforce, patient and organisational factors. BMJ Open 2020; 10:e034101. [PMID: 32554719 PMCID: PMC7304836 DOI: 10.1136/bmjopen-2019-034101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/19/2020] [Accepted: 05/01/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To explore bedside professional reported (BPR) perceptions of safety in intensive care staff and the relationships between BPR safety, staffing, patient and work environment characteristics. DESIGN An exploratory study of self-recorded staff perceptions of shift safety and routinely collected data. SETTING A large teaching hospital comprising 70 critical care beds. PARTICIPANTS All clinical staff working in adult critical care. INTERVENTIONS Staff recorded whether their shift felt 'safe, unsafe or very unsafe' for 29 consecutive days. We explored these perceptions and relationships between them and routine data on staffing, patient and environmental characteristics. OUTCOME MEASURES Relationships between BPR safety and staffing, patient and work environment characteristics. RESULTS 2836 BPR scores were recorded over 29 consecutive days (response rate 57.7%). Perceptions of safety varied between staff, including within the same shift. There was no correlation between perceptions of safety and two measures of staffing: care hours per patient day (r=0.13 p=0.108) and Safecare Allocate (r=-0.19 p=0.013). We found a significant, positive relationship between perceptions of safety and the percentage of level 3 (most severely ill) patients (r=0.32, p=0.0001). There was a significant inverse relationship between perceptions of safety and the percentage of level 1 patients on a shift (r=-0.42, p<0.0001). Perceptions of safety correlated negatively with increased numbers of patients (r=-0.44, p=0.0006) and higher percentage of patients located side rooms (r=0.63, p<0.0001). We found a significant relationship between perceptions of safety and the percentage of staff with a specialist critical care course (r=0.42. p=0.0001). CONCLUSION Existing staffing models, which are primarily influenced by staff-to-patient ratios, may not be sensitive to patient need. Other factors may be important drivers of staff perceptions of safety and should be explored further.
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Affiliation(s)
| | - Mary Wells
- Imperial College London, London, UK
- Directorate of Nursing, Imperial College Healthcare NHS Trust, London, UK
| | - Stephen Brett
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Griffiths P, Saville C, Ball JE, Chable R, Dimech A, Jones J, Jeffrey Y, Pattison N, Saucedo AR, Sinden N, Monks T. The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08160] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe Safer Nursing Care Tool is a system designed to guide decisions about nurse staffing requirements on hospital wards, in particular the number of nurses to employ (establishment). The Safer Nursing Care Tool is widely used in English hospitals but there is a lack of evidence about how effective and cost-effective nurse staffing tools are at providing the staffing levels needed for safe and quality patient care.ObjectivesTo determine whether or not the Safer Nursing Care Tool corresponds to professional judgement, to assess a range of options for using the Safer Nursing Care Tool and to model the costs and consequences of various ward staffing policies based on Safer Nursing Care Tool acuity/dependency measure.DesignThis was an observational study on medical/surgical wards in four NHS hospital trusts using regression, computer simulations and economic modelling. We compared the effects and costs of a ‘high’ establishment (set to meet demand on 90% of days), the ‘standard’ (mean-based) establishment and a ‘flexible (low)’ establishment (80% of the mean) providing a core staff group that would be sufficient on days of low demand, with flexible staff re-deployed/hired to meet fluctuations in demand.SettingMedical/surgical wards in four NHS hospital trusts.Main outcome measuresThe main outcome measures were professional judgement of staffing adequacy and reports of omissions in care, shifts staffed more than 15% below the measured requirement, cost per patient-day and cost per life saved.Data sourcesThe data sources were hospital administrative systems, staff reports and national reference costs.ResultsIn total, 81 wards participated (85% response rate), with data linking Safer Nursing Care Tool ratings and staffing levels for 26,362 wards × days (96% response rate). According to Safer Nursing Care Tool measures, 26% of all ward-days were understaffed by ≥ 15%. Nurses reported that they had enough staff to provide quality care on 78% of shifts. When using the Safer Nursing Care Tool to set establishments, on average 60 days of observation would be needed for a 95% confidence interval spanning 1 whole-time equivalent either side of the mean. Staffing levels below the daily requirement estimated using the Safer Nursing Care Tool were associated with lower odds of nurses reporting ‘enough staff for quality’ and more reports of missed nursing care. However, the relationship was effectively linear, with staffing above the recommended level associated with further improvements. In simulation experiments, ‘flexible (low)’ establishments led to high rates of understaffing and adverse outcomes, even when temporary staff were readily available. Cost savings were small when high temporary staff availability was assumed. ‘High’ establishments were associated with substantial reductions in understaffing and improved outcomes but higher costs, although, under most assumptions, the cost per life saved was considerably less than £30,000.LimitationsThis was an observational study. Outcomes of staffing establishments are simulated.ConclusionsUnderstanding the effect on wards of variability of workload is important when planning staffing levels. The Safer Nursing Care Tool correlates with professional judgement but does not identify optimal staffing levels. Employing more permanent staff than recommended by the Safer Nursing Care Tool guidelines, meeting demand most days, could be cost-effective. Apparent cost savings from ‘flexible (low)’ establishments are achieved largely by below-adequate staffing. Cost savings are eroded under the conditions of high temporary staff availability that are required to make such policies function.Future workResearch is needed to identify cut-off points for required staffing. Prospective studies measuring patient outcomes and comparing the results of different systems are feasible.Trial registrationCurrent Controlled Trials ISRCTN12307968.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane E Ball
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Rosemary Chable
- Training, Development & Workforce, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Dimech
- Clinical Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Yvonne Jeffrey
- Nursing & Patient Services, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Natalie Pattison
- Clinical Services, The Royal Marsden NHS Foundation Trust, London, UK
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | | | - Nicola Sinden
- Nursing Directorate, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Thomas Monks
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
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Griffiths P, Saville C, Ball J, Jones J, Pattison N, Monks T. Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. Int J Nurs Stud 2019; 103:103487. [PMID: 31884330 PMCID: PMC7086229 DOI: 10.1016/j.ijnurstu.2019.103487] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/10/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
Background The importance of nurse staffing levels in acute hospital wards is widely recognised but evidence for tools to determine staffing requirements although extensive, has been reported to be weak. Building on a review of reviews undertaken in 2014, we set out to give an overview of the major approaches to assessing nurse staffing requirements and identify recent evidence in order to address unanswered questions including the accuracy and effectiveness of tools. Methods We undertook a systematic scoping review. Searches of Medline, the Cochrane Library and CINAHL were used to identify recent primary research, which was reviewed in the context of conclusions from existing reviews. Results The published literature is extensive and describes a variety of uses for tools including establishment setting, daily deployment and retrospective review. There are a variety of approaches including professional judgement, simple volume-based methods (such as patient-to-nurse ratios), patient prototype/classification and timed-task approaches. Tools generally attempt to match staffing to a mean average demand or time requirement despite evidence of skewed demand distributions. The largest group of recent studies reported the evaluation of (mainly new) tools and systems, but provides little evidence of impacts on patient care and none on costs. Benefits of staffing levels set using the tools appear to be linked to increased staffing with no evidence of tools providing a more efficient or effective use of a given staff resource. Although there is evidence that staffing assessments made using tools may correlate with other assessments, different systems lead to dramatically different estimates of staffing requirements. While it is evident that there are many sources of variation in demand, the extent to which systems can deliver staffing levels to meet such demand is unclear. The assumption that staffing to meet average need is the optimal response to varying demand is untested and may be incorrect. Conclusions Despite the importance of the question and the large volume of publication evidence about nurse staffing methods remains highly limited. There is no evidence to support the choice of any particular tool. Future research should focus on learning more about the use of existing tools rather than simply developing new ones. Priority research questions include how best to use tools to identify the required staffing level to meet varying patient need and the costs and consequences of using tools. Tweetable abstract Decades of research on tools to determine nurse staffing requirements is largely uninformative. Little is known about the costs or consequences of widely used tools.
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Affiliation(s)
- Peter Griffiths
- University of Southampton, Health Sciences, United Kingdom; National Institute for Health Research Applied Research Collaboration (Wessex), United Kingdom; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
| | - Christina Saville
- University of Southampton, Health Sciences, United Kingdom; National Institute for Health Research Applied Research Collaboration (Wessex), United Kingdom
| | - Jane Ball
- University of Southampton, Health Sciences, United Kingdom; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Jeremy Jones
- University of Southampton, Health Sciences, United Kingdom
| | - Natalie Pattison
- University of Hertfordshire, School of Health and Social Work, United Kingdom; East & North Hertfordshire NHS Trust, United Kingdom
| | - Thomas Monks
- University of Exeter, College of Medicine and Health, United Kingdom; National Institute for Health Research Applied Research Collaboration (Wessex), United Kingdom
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Harris R, Sims S, Leamy M, Levenson R, Davies N, Brearley S, Grant R, Gourlay S, Favato G, Ross F. Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
© Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0© Queen’s Printer and Controller of HMSO 2019. This work was produced by Harriset al.under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.20132019Crown copyrightQueen’s Printer and Controller of HMSOBackgroundThe government response to the care failures at the Mid Staffordshire NHS Foundation Trust led to the policy imperative of ‘regular interaction and engagement between nurses and patients’ (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013. © Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0) in the NHS. The pressure on nursing to act resulted in the introduction of the US model, known as ‘intentional rounding’, into nursing practice. This is a timed, planned intervention that sets out to address fundamental elements of nursing care by means of a regular bedside ward round.ObjectivesThe study aims were to examine what it is about intentional rounding in hospital wards that works, for whom and in what circumstances.DesignA multimethod study design was undertaken using realist evaluation methodology. The study was conducted in four phases: (1) theory development; (2) a national survey of all NHS acute trusts in England; (3) in-depth case studies of six wards, involving individual interviews, observations, retrieval of routinely collected ward outcome data and analysis of costs; and (4) synthesis of the study findings.SettingThe study was conducted in acute NHS trusts in England.ParticipantsA total of 108 acute NHS trusts participated in the survey. Seventeen senior managers, 33 front-line nurses, 28 non-nursing professionals, 34 patients and 28 carers participated in individual interviews. Thirty-nine members of nursing staff were shadowed during their delivery of intentional rounding and the direct care received by 28 patients was observed.Review methodsA realist synthesis was undertaken to identify eight context–mechanism–outcome configurations, which were tested and refined using evidence collected in subsequent research phases.ResultsThe national survey showed that 97% of NHS trusts had implemented intentional rounding in some way. Data synthesis from survey, observation and interview findings showed that only two of the original eight mechanisms were partially activated (consistency and comprehensiveness, and accountability). The evidence for two mechanisms was inconclusive (visibility of nurses and anticipation); there was minimal evidence for one mechanism (multidisciplinary teamwork and communication) and no evidence for the remaining three (allocated time to care, nurse–patient relationships and communication, and patient empowerment). A total of 240 intentional rounds were observed within 188 hours of care delivery observation. Although 86% of all intentional rounding interactions were observed to be documented, fidelity to the original intervention [i.e. the Studer Group protocol (Studer Group.Best Practices: Sacred Heart Hospital, Pensacola, Florida. Hourly Rounding Supplement. Gulf Breeze, FL: Studer Group; 2007)] was generally low.LimitationsIntentional rounding was often difficult for researchers to observe, as it was rarely delivered as a discrete activity but instead undertaken alongside other nursing activities. Furthermore, a lack of findings about the influence of intentional rounding on patient outcomes in the safety thermometer data limits inferences on how mechanisms link to clinical outcomes for patients.ConclusionsThe evidence from this study demonstrates that the effectiveness of intentional rounding, as currently implemented and adapted in England, is very weak and falls short of the theoretically informed mechanisms. There was ambivalence and concern expressed that intentional rounding oversimplifies nursing, privileges a transactional and prescriptive approach over relational nursing care, and prioritises accountability and risk management above individual responsive care.Future workIt is suggested that the insights and messages from this study inform a national conversation about whether or not intentional rounding is the optimum intervention to support the delivery of fundamental nursing care to patients, or if the time is right to shape alternative solutions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Ruth Harris
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Sarah Sims
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | | | - Nigel Davies
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Sally Brearley
- Centre for Health and Social Care Research, Kingston University and St George’s University of London, London, UK
| | - Robert Grant
- Centre for Health and Social Care Research, Kingston University and St George’s University of London, London, UK
| | | | | | - Fiona Ross
- Centre for Health and Social Care Research, Kingston University and St George’s University of London, London, UK
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Cusack L, Wiechula R, Schultz T, Dollard J, Maben J. Anticipated advantages and disadvantages of a move to 100% single‐room hospital in Australia: A case study. J Nurs Manag 2019; 27:963-970. [DOI: 10.1111/jonm.12753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/08/2019] [Accepted: 01/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lynette Cusack
- Adelaide Nursing School The University of Adelaide Adelaide South Australia Australia
| | - Rick Wiechula
- Adelaide Nursing School The University of Adelaide Adelaide South Australia Australia
| | - Tim Schultz
- Adelaide Nursing School The University of Adelaide Adelaide South Australia Australia
| | - Joanne Dollard
- Adelaide Medical School The University of Adelaide Adelaide South Australia Australia
| | - Jill Maben
- Faculty of Health and Medical Sciences, School of Health Sciences University of Surrey Guildford UK
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Grealish L, Chaboyer W, Darch J, Real B, Phelan M, Soltau D, Lunn M, Brandis S, Todd JA, Cooke M. Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events. J Clin Nurs 2019; 28:1346-1353. [PMID: 30520196 DOI: 10.1111/jocn.14724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 11/02/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. BACKGROUND While there are evidence-based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. DESIGN Critical incident technique. METHODS Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south-east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. RESULTS Three themes emerged from 23 reflective accounts of fall events: "direct observation is confounded by multiple observers" and "knowing the person has cognitive impairment is not enough," and "want to rely on the guideline but unsure how to enact it." While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. CONCLUSIONS Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. RELEVANCE TO CLINICAL PRACTICE To reduce falls, nurses can involve the family to support "knowing the patient" to enable prediction of impulsive actions; shift the focus of in-service from lectures to specific case presentations, with collaborative analysis on person-focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.
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Affiliation(s)
- Laurie Grealish
- Menzies Health Institute Queensland, Griffith University, QLD, Australia.,Gold Coast Hospital and Health Service, QLD, Australia.,School of Nursing & Midwifery, Griffith University, QLD, Australia
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, QLD, Australia.,Gold Coast Hospital and Health Service, QLD, Australia.,School of Nursing & Midwifery, Griffith University, QLD, Australia
| | - Jacob Darch
- Gold Coast Hospital and Health Service, QLD, Australia
| | - Belinda Real
- Gold Coast Hospital and Health Service, QLD, Australia
| | - Maggie Phelan
- Gold Coast Hospital and Health Service, QLD, Australia
| | - Dawn Soltau
- Gold Coast Hospital and Health Service, QLD, Australia
| | - Matthew Lunn
- Gold Coast Hospital and Health Service, QLD, Australia
| | | | - Jo-Anne Todd
- School of Nursing & Midwifery, Griffith University, QLD, Australia
| | - Marie Cooke
- Menzies Health Institute Queensland, Griffith University, QLD, Australia.,School of Nursing & Midwifery, Griffith University, QLD, Australia
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Lin FF, Chaboyer W, Foster M, Hervey L, Marshall AP. Facilitating the relocation of an intensive care unit from shared room to single room setting: Staff perceptions on the effectiveness of a multicomponent intervention. Aust Crit Care 2018; 32:279-284. [PMID: 30087061 DOI: 10.1016/j.aucc.2018.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/20/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Current strategies for new and redesigned intensive care units (ICUs) involve incorporation of single occupancy rooms. These changes have largely been made for infection control and patient privacy reasons. However, there is limited literature available on how to manage the transition of an ICU from shared room to a single room environment. AIMS The aim of this study was to evaluate staff members' perceived effectiveness of a multicomponent intervention to facilitate transition from a shared to a single room setting. METHODS This qualitative study was conducted in a 20-bed ICU of an Australian tertiary teaching hospital. In total, 24 staff members were interviewed in five groups and five individual interviews 6 months after the ICU relocation. FINDINGS Three themes emerged from data analysis: (1) facilitating staff members' transition and engagement during relocation planning; (2) simulating new work processes for the single room setting; and (3) supporting nurses working in the single rooms. The components of the intervention, including the change agent, the relocation working party, Assistance, Coordination, Contingency, Education, Supervision, and Support nurse rounding model, and the safe single room model, were perceived as important strategies to support the relocation transition. The regular newsletter and the information dissemination strategy informed by the social networking survey were viewed to improve communication. Staffing levels and education models that are suitable for the single room setting were identified as areas for improvement. DISCUSSION AND CONCLUSION A systematic change management approach, clear communication, staff engagement, and continuously monitoring new work processes are important strategies to ensure the success of the relocation. Delivery of education in the clinical area needs to be further explored to ascertain the impact of a single room environment on its delivery. Intervention co-creation involving research team members and the clinical staff was important in building change management capacity, which may contribute to intervention sustainability and continued clinical practice improvement.
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Affiliation(s)
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Australia; National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients (NCREN), Menzies Health Institute Queensland, Griffith University, Australia
| | - Michelle Foster
- Intensive Care Unit, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Lucy Hervey
- Intensive Care Unit, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Australia; National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients (NCREN), Menzies Health Institute Queensland, Griffith University, Australia; Intensive Care Unit, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
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Thorup CB, Hougaard M, Blindum PF, Sørensen EE. Hospitalised patients' experiences during Negative Pressure Wound Therapy due to surgical site infection after vascular and cardiac surgery. Int Wound J 2018; 15:707-716. [PMID: 29927043 DOI: 10.1111/iwj.12913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 01/04/2023] Open
Abstract
Surgical site infections that develop after vascular and cardiac surgery are often treated with Negative Pressure Wound Therapy (NPWT). Due to the severity of the infection and risk of bleeding, this NPWT often requires hospitalisation. Fourteen patients were selected for qualitative interviews to investigate their experiences and the meaning of patient participation during hospitalisation with NPWT. Results show that hospitalisation induces tension between an intrusion of privacy and being part of a community. Patients do not feel ill nor are considered ill. They feel minimised, lack participation and miss continuity, yet they still accept their circumstances by adjusting to hospital routines and treatment. The hospital's organisational framework compromises patient participation, yet patients still participate in supporting their own wound healing. They worry, are bored, lack a clear time horizon, and appear to be in an apathetic mood despite having significant time on their hands. In conclusion, the tension between a patient's privacy and sense of community, as well as involuntary participation in other patients' lives, compromises dignity and increases stress. Wound healing appears to be prolonged due to fasting, inactivity and stress. Self-reliant patients are at risk of being minimised and lack adequate emotional care, and the hospital's organisational framework hampers patient feelings of involvement and participation.
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Affiliation(s)
- Charlotte B Thorup
- Department of Cardiothoracic Surgery and Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Clincal Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Hougaard
- Department of Heart and Lung Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Pernille F Blindum
- Department of Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Erik E Sørensen
- Clincal Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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25
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Taylor E. Letter to the Editors. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 11:82-84. [DOI: 10.1177/1937586717747410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mitchell BG, Williams A, Wong Z. Assessing the functionality of temporary isolation rooms. Am J Infect Control 2017; 45:1231-1237. [PMID: 28689979 DOI: 10.1016/j.ajic.2017.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/25/2017] [Accepted: 05/25/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Challenges with limited single rooms and isolation facilities in hospitals have created an opportunity for temporary, portable isolation technology. This article describes the process used to evaluate the prototype of a new isolation room (RediRoom; CareStrategic Ltd, Brisbane, Queensland, Australia) that can be installed in existing hospital ward areas. Our aim is to assess the functionality of this new room, and in so doing, to evaluate the methods used. METHODS We employed a mixed-methods approach involving video recording, interviews, and objective temperature and humidity measurements within a crossover interventional study. Participants completed a range of clinical activities in the RediRoom and a control. The setting for the study was a clinical ward environment at an Australian higher education institution. RESULTS There were similarities between the RediRoom and the control using a range of measures. The time taken to complete a range of clinical activities in both rooms was broadly consistent. Network analysis also suggested broad similarities in the movement of nurses undertaking activities in both rooms. CONCLUSION Our study attempted to simulate a clinical environment and clinical activities and provide the best possible comparison by completing activities sequentially, with immediate feedback to researchers. Video recording added significant value to the process because it provided some objectivity. A form of reflexive ethnography with participants could be of value in similar studies in the future.
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27
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Myers RA, Parikh PJ. Nurses’ work with interruptions: an objective model for testing interventions. Health Care Manag Sci 2017; 22:1-15. [DOI: 10.1007/s10729-017-9417-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023]
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28
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Mitchell BG, Williams A, Wong Z, O'Connor J. Assessing a temporary isolation room from an infection control perspective: A discussion paper. Infect Dis Health 2017; 22:129-135. [DOI: 10.1016/j.idh.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 11/29/2022]
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29
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Voigt J, Mosier M, Darouiche R. Private Rooms in Low Acuity Settings: A Systematic Review of the Literature. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2017; 11:57-74. [PMID: 28831819 DOI: 10.1177/1937586717702597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Determine if the peer-reviewed evidence supports single-patient ward bedrooms in low-acuity care settings within a hospital. BACKGROUND New evidence exists since the 2006 Facility Guideline Institute guideline recommended single-bedded rooms (SBRs) in low-acuity care settings. Additionally, prior studies evaluated high-acuity care settings (e.g., critical care) in their recommendations on SBRs. There is a need to reevaluate the evidence. METHODS A systematic review of the literature was completed including electronic and hand searches of references. A data extraction form was utilized. Two reviewers evaluated the studies independently. Studies that were included examined the effect of single-patient rooms on medical surgical ward beds only. Each study was graded using accepted clinical evidence grading instruments. RESULTS Over 1,400 records were identified. After excluding studies, a total of 49 records were graded. The highest quality evidence identified (Center for Evidence-Based Medicine [CEBM]: 2a, 2b, and Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] C) did not support the use of single-patient rooms for reducing infections, for minimizing patient falls, for reducing medication errors, or for patient satisfaction. Operational efficiencies were improved with SBRs but only addressed the maternity ward. The lowest quality evidence (CEBM: 4/5 and GRADE D) supported the use of single-patient rooms. CONCLUSIONS Based on CEBM and GRADE assessments, there is a lack of high-quality data supporting the use of low-acuity SBRs throughout the entire hospital. Furthermore, it is recommended that more research be conducted on the effect of SBRs, so higher quality evidence is developed.
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Affiliation(s)
- Jeffrey Voigt
- 1 Medical Device Consultants of Ridgewood, LLC, Ridgewood, NJ, USA
| | - Michael Mosier
- 2 Department of Mathematics and Statistics, Washburn University, Topeka, KS, USA
| | - Rabih Darouiche
- 3 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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30
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Patterson ES, Sanders EBN, Sommerich CM, Lavender SA, Li J, Evans KD. Meeting Patient Expectations During Hospitalization: A Grounded Theoretical Analysis of Patient-Centered Room Elements. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2017; 10:95-110. [PMID: 29056092 DOI: 10.1177/1937586717696700] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify patient needs and expectations that can be utilized to inform the design or renovation of medical-surgical patient rooms in a hospital. BACKGROUND There is an increased interest in supportive room design to increase patient satisfaction and improve the healing process. METHODS Patients' and family caregivers' reactions were elicited to intentional room elements embedded in a set of five full-scale simulated room prototypes. Small groups of patients and caregivers toured two of the five rooms and provided verbal and written evaluations of room features. A grounded theory approach was employed to generate a codebook, identify the frequency of codes, and to group codes and memos into emerging themes. Insights from emergent themes were compared with findings from written surveys on the importance of various room design elements completed at the beginning of each session. RESULTS A theoretical design framework was generated, showing patients expect a hospital room that provides them with the core components of comfort to support healing, facilitates a strong sense of connection to people and the outside world, enables quick and independent access to the patient's things, and offers suitable levels of control to the patient throughout their hospital stay. CONCLUSIONS The implications for assisting architects, healthcare planners, and interior space designers are described using this framework, as well as its potential for design guidance. In addition, the connection between patient-centered room elements and relevant survey questions in publicly reported patient satisfaction scores for hospitals is discussed.
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Affiliation(s)
- Emily S Patterson
- 1 School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, OH, USA
| | | | - Carolyn M Sommerich
- 3 Department of Integrated Systems Engineering, Ohio State University, Columbus, OH, USA
| | - Steven A Lavender
- 3 Department of Integrated Systems Engineering, Ohio State University, Columbus, OH, USA
| | - Jing Li
- 3 Department of Integrated Systems Engineering, Ohio State University, Columbus, OH, USA
| | - Kevin D Evans
- 1 School of Health and Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, OH, USA
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31
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Randall D, Rosenberg JP, Reimer S. Solid and liquid modernity: A comparison of the social geography of places to die in the UK and Australia. DEATH STUDIES 2017; 41:103-111. [PMID: 27685542 DOI: 10.1080/07481187.2016.1225858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Preferred place of care and death is a widely used quality measure for palliative and end of life care services. In this article we explore the use of Zygmunt Bauman's ideas on solid and liquid modernity to understand the complexity of the social geographical contexts of delivering and receiving care. Although solid ways of dying offer certainty and standardized care, more liquid ways allow for individualized care connected to family and communities. Understanding the complex tensions between solid and liquid aspects of palliative care may allow practitioners to help dying people to die in the ways and places they prefer.
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Affiliation(s)
- Duncan Randall
- a Health Sciences , University of Southampton , Southampton , UK
| | - John P Rosenberg
- b Faculty of Health , Queensland University of Technology , Brisbane , Australia
| | - Suzanne Reimer
- c Geography and Environment , University of Southampton , Southampton , UK
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Simon M, Maben J, Murrells T, Griffiths P. Is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls. J Health Serv Res Policy 2016; 21:147-55. [PMID: 26811373 PMCID: PMC4904344 DOI: 10.1177/1355819615625700] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A wide range of patient benefits have been attributed to single room hospital accommodation including a reduction in adverse patient safety events. However, studies have been limited to the US with limited evidence from elsewhere. The aim of this study was to assess the impact on safety outcomes of the move to a newly built all single room acute hospital. METHODS A natural experiment investigating the move to 100% single room accommodation in acute assessment, surgical and older people's wards. Move to 100% single room accommodation compared to 'steady state' and 'new build' control hospitals. Falls, pressure ulcer, medication error, meticillin-resistant Staphylococcus aureus and Clostridium difficile rates from routine data sources were measured over 36 months. RESULTS Five of 15 time series in the wards that moved to single room accommodation revealed changes that coincided with the move to the new all single room hospital: specifically, increased fall, pressure ulcer and Clostridium difficile rates in the older people's ward, and temporary increases in falls and medication errors in the acute assessment unit. However, because the case mix of the older people's ward changed, and because the increase in falls and medication errors on the acute assessment ward did not last longer than six months, no clear effect of single rooms on the safety outcomes was demonstrated. There were no changes to safety events coinciding with the move at the new build control site. CONCLUSION For all changes in patient safety events that coincided with the move to single rooms, we found plausible alternative explanations such as case-mix change or disruption as a result of the re-organization of services after the move. The results provide no evidence of either benefit or harm from all single room accommodation in terms of safety-related outcomes, although there may be short-term risks associated with a move to single rooms.
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Affiliation(s)
- Michael Simon
- Tenure-Track Assistant Professor, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland Head of Nursing Research Unit, Directorate of Nursing/AHP, Inselspital Bern University Hospital, Bern, Switzerland
| | - Jill Maben
- Professor Florence Nightingale School of Nursing and Midwifery, King's College, London, UK
| | - Trevor Murrells
- Statistician, Florence Nightingale School of Nursing and Midwifery, King's College, London, UK
| | - Peter Griffiths
- Professor, Centre for Innovation and Leadership in Health Sciences & National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Highfield Campus, Southampton UK
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Maben J, Griffiths P, Penfold C, Simon M, Anderson JE, Robert G, Pizzo E, Hughes J, Murrells T, Barlow J. One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs. BMJ Qual Saf 2016; 25:241-56. [PMID: 26408568 PMCID: PMC4819646 DOI: 10.1136/bmjqs-2015-004265] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. METHODS Mixed methods pre/post 'move' comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms. RESULTS Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time. CONCLUSIONS Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms.
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Affiliation(s)
- Jill Maben
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Clarissa Penfold
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Directorate of Nursing/AHP, Inselspital Bern University Hospital, Bern, Switzerland
| | - Janet E Anderson
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Elena Pizzo
- Faculty of Population Health Sciences, Institute of Epidemiology & Health, UCL,London, UK
| | | | - Trevor Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Maben J, Griffiths P, Penfold C, Simon M, Pizzo E, Anderson J, Robert G, Hughes J, Murrells T, Brearley S, Barlow J. Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jill Maben
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Peter Griffiths
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Clarissa Penfold
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Michael Simon
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Elena Pizzo
- Imperial College Business School, London, UK
| | - Janet Anderson
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Glenn Robert
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Jane Hughes
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Trevor Murrells
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Sally Brearley
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
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