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Allum L, Apps C, Pattison N, Connolly B, Rose L. Informing the standardising of care for prolonged stay patients in the ICU: A scoping review of quality improvement tools. Intensive Crit Care Nurs 2022; 73:103302. [PMID: 35931596 DOI: 10.1016/j.iccn.2022.103302] [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] [Received: 07/16/2021] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To inform design of quality improvement (QI) tools specific to patients with prolonged intensive care unit (ICU) stay, we determined characteristics (format/content), development, implementation, and outcomes of published multi-component QI tools used in ICU irrespective of length of stay. RESEARCH METHODOLOGY Scoping review searching electronic databases, trial registries and grey literature (January 2000 to January 2022). RESULTS We screened 58,378 citations, identifying 96 studies. All tools were designed for use commencing at ICU admission except 3 tools implemented at 3, 5 or 14 days. We identified 32 studies of locally developed checklists, 28 goal setting/structured communication templates, 23 care bundles, and 9 studies of mixed format tools. Most (43 %) tools were designed for use during rounds, fewer tools were designed for use throughout the ICU day (27 %) or stay (9 %). Most studies (55 %) reported process objectives i.e., improving communication, care standardisation, or rounding efficiency. Most common clinical processes QI tools were used to standardise were sedation (62, 65 %), ventilation and weaning (55, 57 %), and analgesia management (58, 60 %). 44 studies reported the effect of the tool on patient outcomes. Of these, only two identified a negative effect - increased ICU length of stay and increased ICU days with pain and delirium. CONCLUSION Although we identified numerous QI tools for use in ICU settings, few were designed to specifically address actionable processes of care relevant to the unique needs of prolonged ICU stay patients. Tools that address these needs are urgently required. SYSTEMATIC REVIEW REGISTRATION The review protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE.
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Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
| | - Chloe Apps
- Critical Care Research Group and Physiotherapy Department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London SE1 7EH, UK.
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East & North Herts NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK.
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Centre for Human and Applied Physiological Sciences, King's College London, UK; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
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Allum L, Apps C, Hart N, Pattison N, Connolly B, Rose L. Standardising care in the ICU: a protocol for a scoping review of tools used to improve care delivery. Syst Rev 2020; 9:164. [PMID: 32682427 PMCID: PMC7368855 DOI: 10.1186/s13643-020-01414-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety; however, these tools have not been designed for the specific needs of patients with prolonged ICU stay. The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice. METHODS We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings. DISCUSSION The findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research. SYSTEMATIC REVIEW REGISTRATION This protocol is registered on the Open Science Framework, https://osf.io/ , DOI https://doi.org/10.17605/OSF.IO/Z8MRE.
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Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK. .,Lane Fox Clinical Respiratory Physiology Research Centre, London, UK.
| | - Chloe Apps
- Physiotherapy department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, UK.,Critical Care Research Group, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, London, UK.,National Institute for Health Research Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation and King's College London, London, UK
| | - Natalie Pattison
- University of Hertfordshire; East & North Herts NHS Trust; Florence Nightingale Foundation, London, UK
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, London, UK.,Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK.,Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, London, UK
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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Li Y, Wang X, Zhu XR, Zhu YX, Sun J. Effectiveness of problem-based learning on the professional communication competencies of nursing students and nurses: A systematic review. Nurse Educ Pract 2019; 37:45-55. [PMID: 31082712 DOI: 10.1016/j.nepr.2019.04.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 04/21/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
The objective of this systematic review was to estimate the effectiveness of problem-based learning (PBL) in developing the professional communication competences of nursing students and nurses. We have searched PubMed, EMBASE, MEDLINE, PsycINFO, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Database for Chinese Technical Periodicals to identify all the English and Chinese language studies that used PBL to determine the effectiveness of developing professional communication competences of nursing students and nurses. Then two reviewers independently assessed eligibility and extracted data. Quality assessment using the Cochrane Collaboration's risk of bias tool for randomized controlled trials and Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for quasi-experimental studies. A total of 12 studies were included, all of which were inclined to low bias. Eleven articles showed that PBL developed the communication skills of nursing students or nurses, while only one article revealed no significant difference between PBL and the traditional method. Owing to differences in experimental design and the method and duration of intervention, some of these studies combined PBL with other methods, and the evaluation tools were different. This systematic review cautiously supports the outcomes of PBL compared with traditional learning.
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Affiliation(s)
- Yuan Li
- First Hospital of Jilin University, Changchun, 130021, China.
| | - Xiu Wang
- First Hospital of Jilin University, Changchun, 130021, China.
| | - Xuan-Rui Zhu
- First Hospital of Jilin University, Changchun, 130021, China.
| | - Yan-Xin Zhu
- Weifang Medical University, Weifang, Shandong, China.
| | - Jiao Sun
- First Hospital of Jilin University, Changchun, 130021, China; School of Nursing, Jilin University, 965 Xinjiang St., Chaoyang, Changchun, Jilin, China.
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Gilbert J, Kim JA. To err is human: medication patient safety in aged care, a case study. QUALITY IN AGEING AND OLDER ADULTS 2018. [DOI: 10.1108/qaoa-11-2017-0048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore an identified medication error using a root cause analysis and a clinical case study.
Design/methodology/approach
In this paper the authors explore a medication error through the completion of a root cause analysis and case study in an aged care facility.
Findings
Research indicates that medication errors are highly prevalent in aged care and 40 per cent of nursing home patients are regularly receiving at least one potentially inappropriate medicine (Hamilton, 2009; Raban et al., 2014; Shehab et al., 2016). Insufficient patient information, delays in continuing medications, poor communication, the absence of an up-to-date medication chart and missed or significantly delayed doses are all linked to medication errors (Dwyer et al., 2014). Strategies to improve medication management across hospitalisation to medication administration include utilisation of a computerised medication prescription and management system, pharmacist review, direct communication of discharge medication documentation to community pharmacists and staff education and support (Dolanski et al., 2013).
Originality/value
Discussion of the factors impacting on medication errors within aged care facilities may explain why they are prevalent and serve as a basis for strategies to improve medication management and facilitate further research on this topic.
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Mitchell BG, Gardner A, Stone PW, Hall L, Pogorzelska-Maziarz M. Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature. Jt Comm J Qual Patient Saf 2018; 44:613-622. [PMID: 30064955 DOI: 10.1016/j.jcjq.2018.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous literature has linked the level and types of staffing of health facilities to the risk of acquiring a health care-associated infection (HAI). Investigating this relationship is challenging because of the lack of rigorous study designs and the use of varying definitions and measures of both staffing and HAIs. METHODS The objective of this study was to understand and synthesize the most recent research on the relationship of hospital staffing and HAI risk. A systematic review was undertaken. Electronic databases MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for studies published between January 1, 2000, and November 30, 2015. RESULTS Fifty-four articles were included in the review. The majority of studies examined the relationship between nurse staffing and HAIs (n = 50, 92.6%) and found nurse staffing variables to be associated with an increase in HAI rates (n = 40, 74.1%). Only 5 studies addressed non-nurse staffing, and those had mixed results. Physician staffing was associated with an increased HAI risk in 1 of 3 studies. Studies varied in design and methodology, as well as in their use of operational definitions and measures of staffing and HAIs. CONCLUSION Despite the lack of consistency of the included studies, overall, the results of this systematic review demonstrate that increased staffing is related to decreased risk of acquiring HAIs. More rigorous and consistent research designs, definitions, and risk-adjusted HAI data are needed in future studies exploring this area.
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Incorporation of Daily Goals in Daily Care Planning Does Not Shorten Length of Stay in the Intensive Care Unit. Crit Care Nurs Q 2018; 41:178-185. [DOI: 10.1097/cnq.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reeves S, Clark E, Lawton S, Ream M, Ross F. Examining the nature of interprofessional interventions designed to promote patient safety: a narrative review. Int J Qual Health Care 2017; 29:144-150. [DOI: 10.1093/intqhc/mzx008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
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Improving Communication During Cardiac ICU Multidisciplinary Rounds Through Visual Display of Patient Daily Goals. Pediatr Crit Care Med 2016; 17:677-83. [PMID: 27176731 DOI: 10.1097/pcc.0000000000000790] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To improve communication during daily cardiac ICU multidisciplinary rounds. DESIGN Quality improvement methodology. SETTING Twenty-five-bed cardiac ICUs in an academic free-standing pediatric hospital. PATIENTS All patients admitted to the cardiac ICU. INTERVENTIONS Implementation of visual display of patient daily goals through a write-down and read-back process. MEASUREMENTS AND MAIN RESULTS The Rounds Effectiveness Assessment and Communication Tool was developed based on the previously validated Patient Knowledge Assessment Tool to evaluate comprehension of patient daily goals. Rounds were assessed for each patient by the bedside nurse, nurse practitioner or fellow, and attending physician, and answers were compared to determine percent agreement per day. At baseline, percent agreement for patient goals was only 62%. After initial implementation of the daily goal write-down/read-back process, which was written on paper by the bedside nurse, the Rounds Effectiveness Assessment and Communication Tool survey revealed no improvement. With adaptation of the intervention so goals were written on whiteboards for visual display during rounds, the percent agreement improved to 85%. Families were also asked to complete a survey (1-6 Likert scale) of their satisfaction with rounds and understanding of daily goals before and after the intervention. Family survey results improved from a mean of 4.6-5.7. Parent selection of the best possible score for each question was 19% at baseline and 75% after the intervention. CONCLUSIONS Visual display of patient daily goals via a write-down/read-back process improves comprehension of goals by all team members and improves parent satisfaction. The daily goal whiteboard facilitates consistent development of a comprehensive plan of care for each patient, fosters goal-directed care, and provides a checklist for providers and parents to review throughout the day.
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Makic MBF, Bueno E. Improving Interprofessional Communication Through Structured Rounds. J Perianesth Nurs 2016; 31:340-2. [PMID: 27444766 DOI: 10.1016/j.jopan.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 11/15/2022]
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Analgosedation: Improving Patient Outcomes in ICU Sedation and Pain Management. Pain Manag Nurs 2016; 17:204-17. [DOI: 10.1016/j.pmn.2016.02.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE To understand the perspectives and attitudes of ICU clinicians about use of a daily goals checklist on rounds. DESIGN Our three data collection methods were as follows: (1) Field observations: two investigators conducted field observations to understand how and by whom the daily goals checklist was used for 80 ICU patient rounds over 6 days. (2) Document analysis: The 72 completed daily goals checklists from observed rounds were analyzed using mixed methods. (3) Interviews: With 56 clinicians, we conducted semistructured individual and focus-group interviews, analyzing transcripts using a qualitative descriptive approach and content analysis. Triangulation was achieved by a multidisciplinary investigative team using two research methods and three data sources. SETTING Fifteen bed closed ICU in a tertiary care, university-affiliated hospital. PATIENTS Medical-surgical ICU patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Field observations: The daily goals checklist was completed for 93% of observed rounds, largely by residents (86%). The champion of the verbal review was commonly a resident (83%) or medical student (9%). Document analysis: Domains with high completion rates included ventilation, sedation, central venous access, nutrition, and various prophylactic interventions. Interviews: The daily goals checklist enhanced communication, patient care, and education. Nurses, physicians, and pharmacists endorsed its enhancement of interdisciplinary communication. It facilitated a structured, thorough, and individualized approach to patient care. The daily goals checklist helped to identify new patient care issues and sparked management discussions, especially for sedation, weaning, and medications. Residents were prominent users, finding served as a multipurpose teaching tool. CONCLUSIONS The daily goals checklist was perceived to improve the management of critically ill patients by creating a systematic, comprehensive approach to patient care and by setting individualized daily goals. Reportedly improving interprofessional communication and practice, the daily goals checklist also enhanced patient safety and daily progress, encouraging momentum in recovery from critical illness. Daily goals checklist review prompted teaching opportunities for multidisciplinary learners on morning rounds.
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Lancaster G, Kolakowsky-Hayner S, Kovacich J, Greer-Williams N. Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel. J Nurs Scholarsh 2015; 47:275-84. [PMID: 25801466 DOI: 10.1111/jnu.12130] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Historically, health care has primarily focused on physician, nurse, and allied healthcare provider triads. Using a phenomenological approach, this study explores the potential for hospital-based interdisciplinary care provided by physicians, nurses, and unlicensed assistive personnel (UAPs). DESIGN This phenomenological study used a purposive nonprobability, criterion-based, convenience sample from a metropolitan hospital. THEORETICAL FOUNDATION Malhotra's (1981) Schutzian lifeworld phenomenological orchestra study provided the theoretical basis for the conductorless orchestra model, which guided this study. In an orchestra, each member sees and hears the musical score from a different vantage point or perspective and has a different stock of knowledge or talent; however, members work together to produce a cohesive performance. Like the orchestra, individual talents and perspectives of physicians, nurses, and UAPs can be collaboratively blended to create a symphony: enhanced patient-centered care. METHODS Qualitative semistructured face-to-face, individual interviews were carefully transcribed and coded with the aid of NVivo 9, a qualitative data analysis software program, to discover emergent patterns and themes. FINDINGS The study suggests that most of the time physicians, nurses, and UAPs operate as separate healthcare providers who barely speak to each other. Physicians see themselves as the primary patient care decision makers. Many physicians acknowledge the importance of nurses' knowledge and expertise. On the other hand, the study indicates a hierarchical, subservient relationship among nurses and UAPs. Physicians and nurses tend to work together or consult each other at times, but UAPs are rarely included in any type of meaningful patient discussion. CONCLUSIONS Since physicians, nurses, and UAPs each provide portions of patient care, coordination of the various treatments and interventions provided is critical to prevent errors and fragmentation of care. Tensions, misunderstandings, and conflicts caused by differences of opinions and interests can interfere with effective interdisciplinary communications and collaboration. Improving patient safety in the hospital requires addressing the current hierarchical professional structure inherent in healthcare delivery. A hospital patient care model based on the conductorless orchestra model would mitigate hierarchy; recognize physician, nurse, and UAP contributions to care; promote improved communication and collaboration; and enhance patient safety. CLINICAL RELEVANCE Study results provide additional information supporting interdisciplinary communication and collaboration education and training among physicians, nurses, and UAPs to support positive patient care outcomes.
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Affiliation(s)
- Gwendolyn Lancaster
- Assistant Nursing Care Coordinator, Omicron Delta, Mount Sinai St. Luke's Hospital, New York, NY
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Basuni EM, Bayoumi MM. Improvement critical care patient safety: using nursing staff development strategies, at Saudi Arabia. Glob J Health Sci 2015; 7:335-43. [PMID: 25716409 PMCID: PMC4796447 DOI: 10.5539/gjhs.v7n2p335] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/18/2014] [Indexed: 12/04/2022] Open
Abstract
Intensive care units (ICUs) provide lifesaving care for the critically ill patients and are associated with significant risks. Moreover complexity of care within ICUs requires that the health care professionals exhibit a trans-disciplinary level of competency to improve patient safety. This study aimed at using staff development strategies through implementing patient safety educational program that may minimize the medical errors and improve patient outcome in hospital. The study was carried out using a quasi experimental design. The settings included the intensive care units at General Mohail Hospital and National Mohail Hospital, King Khalid University, Saudi Arabia. The study was conducted from March to June 2012. A convenience sample of all prevalent nurses at three shifts in the aforementioned settings during the study period was recruited. The program was implemented on 50 staff nurses in different ICUs. Their age ranged between 25-40 years. Statistically significant relation was revealed between safety climate and job satisfaction among nurses in the study sample (p=0.001). The years of experiences in ICU ranged between one year 11 (16.4) to 10 years 20 (29.8), most of them (68%) were working in variable shift, while 32% were day shift only. Improvements were observed in safety climate, teamwork climate, and nurse turnover rates on ICUs after implementing a safety program. On the heels of this improvement; nurses’ total knowledge, skills and attitude were enhanced regarding patient safety dimensions. Continuous educational program for ICUs nursing staff through organized in-service training is needed to increase their knowledge and skills about the importance of improving patient safety measure. Emphasizing on effective collaborative system also will improve patient safety measures in ICUS.
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Ganz FD, Endacott R, Chaboyer W, Benbinishty J, Ben Nun M, Ryan H, Schoter A, Boulanger C, Chamberlain W, Spooner A. The quality of intensive care unit nurse handover related to end of life: a descriptive comparative international study. Int J Nurs Stud 2014; 52:49-56. [PMID: 25443309 DOI: 10.1016/j.ijnurstu.2014.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Quality ICU end-of-life-care has been found to be related to good communication. Handover is one form of communication that can be problematic due to lost or omitted information. A first step in improving care is to measure and describe it. OBJECTIVE The objective of this study was to describe the quality of ICU nurse handover related to end-of-life care and to compare the practices of different ICUs in three different countries. DESIGN This was a descriptive comparative study. SETTINGS The study was conducted in seven ICUs in three countries: Australia (1 unit), Israel (3 units) and the UK (3 units). PARTICIPANTS A convenience sample of 157 handovers was studied. METHODS Handover quality was rated based on the ICU End-of-Life Handover tool, developed by the authors. RESULTS The highest levels of handover quality were in the areas of goals of care and pain management while lowest levels were for legal issues (proxy and advanced directives) related to end of life. Significant differences were found between countries and units in the total handover score (country: F(2,154)=25.97, p=<.001; unit: F(6,150)=58.24, p=<.001), for the end of life subscale (country: F(2, 154)=28.23, p<.001; unit: F(6,150)=25.25, p=<.001), the family communication subscale (country: F(2,154)=15.04, p=<.001; unit: F(6,150)=27.38, p=<.001), the family needs subscale (F(2,154)=22.33, p=<.001; unit: F(6,150)=42.45, p=<.001) but only for units on the process subscale (F(6,150)=8.98, p=<.001. The total handover score was higher if the oncoming RN did not know the patient (F(1,155)=6.51, p=<.05), if the patient was expected to die during the shift (F(1,155)=89.67, p=<.01) and if the family were present (F(1,155)=25.81, p=<.01). CONCLUSIONS Practices of end-of-life-handover communication vary greatly between units. However, room for improvement exists in all areas in all of the units studied. The total score was higher when quality of care might be deemed at greater risk (if the nurses did not know the patient or the patient was expected to die), indicating that nurses were exercising some form of discretionary decision making around handover communication; thus validating the measurement tool.
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Affiliation(s)
- Freda DeKeyser Ganz
- Hadassah Hebrew University, School of Nursing at the Faculty of Medicine, Jerusalem, Israel.
| | - Ruth Endacott
- Critical Care Nursing, Plymouth University, Faculty of Health, Plymouth, UK; Monash University, Nursing & Midwifery, Melbourne, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Griffith University, PMB 50 Gold Coast Mail Centre, Bundall, QLD 9726, Australia
| | | | - Maureen Ben Nun
- Intensive Care Unit, Kaplan Medical Organization, Rehovot, Israel
| | - Helen Ryan
- Yeovil District Hospital NHS Foundation Trust, Yeovil, Somerset, UK
| | - Amanda Schoter
- Intensive Therapy Unit, Royal Devon & Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Carole Boulanger
- Critical Care, Royal Devon & Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Wendy Chamberlain
- Critical Care, Taunton & Somerset Hospital NHS Foundation Trust, Taunton, Somerset, UK
| | - Amy Spooner
- Adult Intensive Care Services, The Prince Charles Hospital and University of Queensland, Chermside, QLD, Australia
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