Validation of the Nurses' Skills to Care for Alcohol-Intoxicated Patients in Emergency Department (NSCAIP-ED) instrument

Aim To report the development and validation of the Nurses' Skills to Care for Alcohol-Intoxicated Patients in Emergency Department instrument, shortened NSCAIP-ED. Methods: A mixed-methods design was used to develop the instrument. It was used to conduct a survey where ED nurses self-evaluated their skills to care for acutely ill alcohol-intoxicated patients (N = 1220, n = 252). The data were utilised to perform instrument validation using confirmatory factor analysis (CFA) and Cronbach's alpha. Results: The construct validity was tested statistically. The CFA model fit indicators showed mostly acceptable fit (chi-square test p < 0.001; RMSEA 0.079; CFI 0.923; TLI 0.918; SRMR 0.084) and instruments' scales had well acceptable Cronbach's alpha values (all alphas were in the range of 0.866-0.912). Conclusions: The NSCAIP-ED is a feasible and reliable instrument that can be used when measuring nurses' skills to care for alcohol-intoxicated patients in the ED. This instrument could be useful for nursing managers in EDs for evaluating their nursing staff's skills in the care area in question, but also for designing continuing education based on the results.

Care Complexity Individual Factors Associated With Hospital Readmission: A Retrospective Cohort Study

PURPOSE

To determine the frequency of care complexity individual factors documented in the nursing assessment and to identify the risk factors associated with hospital readmission within 30 days of hospital discharge.

DESIGN

Observational analysis of a retrospective cohort at a 700-bed university hospital in Barcelona, Spain. A total of 16,925 adult patient admissions to a ward or intermediate care units were evaluated from January to December 2016. Most patients were admitted due to cardiocirculatory and respiratory disorders (29.3%), musculoskeletal and nervous system disorders (21.8%), digestive and hepatobiliary conditions (17.9%), and kidney or urinary disorders (11.2%).

METHODS

Readmission was defined as rehospitalization for any reason within 30 days of discharge. Patients who required hospital readmission were compared with those who did not. The individual factors of care complexity included five domains (developmental, mental-cognitive, psycho-emotional, sociocultural, and comorbidity or complications) and were reviewed using the electronic nursing assessment records. Multivariate logistic analysis was performed to determine factors associated with readmission.

FINDINGS

A total of 1,052 patients (6.4%) were readmitted within 30 days of hospital discharge. Care complexity individual factors from the comorbidity or complications domain were found to be the most frequently e-charted (88.3%). Care complexity individual factors from developmental (33.2%), psycho-emotional (13.2%), mental-cognitive (7.2%), and sociocultural (0.7%) domains were less frequently documented. Independent factors associated with hospital readmission were old age (≥75 years), duration of first hospitalization, admission to a nonsurgical ward, major chronic disease, hemodynamic instability, immunosuppression, and relative weight of diagnosis-related group.

CONCLUSIONS

A substantial number of patients required readmission within 30 days after discharge. The most frequent care complexity individual factors recorded in the nursing assessment at index admission were related to comorbidity or complications, developmental, and psycho-emotional domains. Strategies related to transition of care that include clinical characteristics and comorbidity or complications factors should be a priority at hospital discharge and after leaving hospital, but other factors related to developmental and psycho-emotional domains could have an important effect on the use of healthcare resources.

CLINICAL RELEVANCE

Nurses should identify patients with comorbidity or complications, developmental, and psycho-emotional complexity factors during the index admission in order to be able to implement an effective discharge process of care.

Accuracy and completeness of records of adverse events through interface terminology

OBJECTIVE

To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC.

METHOD

Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. The diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. The record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution.

RESULTS

The sample evaluated included 459 records. The accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. The accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. The completeness of results is remarkable, except for the risk of bronchoaspiration.

CONCLUSION

The adverse event recorded by nurses with greatest accuracy is pressure ulcers.

What patients' problems do nurses e-chart? Longitudinal study to evaluate the usability of an interface terminology

BACKGROUND

The nurses' ability to document patient's status, problems and progress is an important issue in patients' safety. Nursing terminologies are intended to support nursing practice but as any other clinical tool, they should be evaluated to assure quality and warrant effective written communication among clinicians.

OBJECTIVES

This study was aimed to evaluate the usability of the diagnosis axis of an interface terminology by assessing its completeness and the frequency of use of its concepts.

DESIGN

Observational, longitudinal, multicentre study.

SETTING

A total of 8 hospitals representing 162 acute medical-surgical, obstetric and mental health nursing wards, step-down units and home in-patient units were included.

PARTICIPANTS

Overall, 246,400 electronic care plans were studied; 53.5% from male patients; 14.6% paediatrics and 33.7% from patients elder than 70 years old. Most were admitted due to cardiocirculatory, respiratory, digestive or musculoskeletal conditions (50.5%), other acute medical or surgical disorders (29.8%) and obstetrics (19.3%).

METHODS

The main outcome measures were: the use of nursing diagnoses from the interface terminology evaluated and their accumulated frequency, analysed over a 3-year retrospective review of the electronic nursing care plans. The analysis of data included descriptive statistics with a confidence level of 95% for confidence intervals.

RESULTS

Most of the diagnostic concepts from the interface terminology were used (92.3%) by nurses to illustrate patients' problems in the electronic care plans. Their frequency of use widely varied, from some very frequent diagnoses like Risk for haemorrhage (51.4%; CI 95%: 51.25-51.65) or Acute pain (49.6%; CI: 49.49-49.88) to others used only in exceptional cases like Faecal impaction or Extravasation. The first nursing diagnosis related to family or caregiver emerges in the 32nd place of the ranking.

CONCLUSIONS

Results for outcome measures oriented that the diagnosis axis of this interface terminology meets the usability criterion of completeness when assessing for the use of its concepts in the acute care setting.