Living with dementia in hospital wards: a comparative study of staff perceptions of practice and observed patient experience

AIMS AND OBJECTIVES

To ascertain the experiences, attitudes and knowledge of staff working in two Maltese hospital wards and the observed experiences of people with dementia living there. To examine the impact of recommendations made in October 2011 for improving the psychosocial and physical environments of the wards 1 year later.

BACKGROUND

There is an increasing policy recognition of the need for a better trained and educated dementia care workforce and of ensuring that the environmental design of care settings meets the needs of people with dementia.

DESIGN AND METHODS

At both time points, three established and validated data-collection methods evaluated (i) staff/patient interaction and patient experience, (ii) the extent to which the wards met dementia friendly principles and (iii) staff views about their work environment and their perceptions about their practice. Sixteen (five male and 11 female) patients with dementia and 69 staff in the two wards participated in the study.

RESULTS

We noted small but important changes; however, the physical and psychosocial environments of the wards did not always align to current recommendations for dementia care, with staff perceptions of care delivery not always reflecting the observed experiences of care of those living with dementia.

CONCLUSIONS

Comparing staff questionnaire data with observational methods offered a unique opportunity to understand multiple perspectives in a complex hospital setting. Incorporating these perspectives into staff and management feedback allowed for recommendations that recognised both patient-centred values and staff constraints.

2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines

PRACTICAL RELEVANCE

The '2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines' (hereafter the 'Cat Friendly Veterinary Environment Guidelines') describe how the veterinary clinic environment can be manipulated to minimise feline patient distress. Many components of a veterinary clinic visit or stay may result in negative experiences for cats. However, much can be done to improve a cat's experience by making the veterinary clinic more cat friendly. Exposure to other cats and other species can be reduced, and adjustments made with consideration of the feline senses and species-specific behaviour. Caregivers can prepare cats for a clinic visit with appropriate advice. Waiting rooms, examination rooms, hospital wards and other clinic areas can be designed and altered to reduce stress and hence encourage positive emotions. Changes need not be structural or expensive in order to be effective and make a difference to the cats and, in turn, to cat caregivers and the veterinary team. Moreover, by improving the all-round experience at the veterinary clinic, there are positive effects on preventive healthcare, identification of and recovery from illness, and compliance with treatment.

CLINICAL CHALLENGES

Good feline healthcare necessitates visiting the veterinary clinic, which, simply by being outside of a cat's territory and familiar surroundings, may lead to negative experiences. Such experiences can trigger negative (protective) emotions and associated physiological stress, which can result in misleading clinical findings, patient distress, prolonged recovery from illness, further difficulties with handling at subsequent visits and potential veterinary personnel injury. There may be a mistaken belief that veterinary clinics must undergo significant renovation or building work to become cat friendly, and that, if species cannot be separated, then clinics cannot improve their care of cats. These Guidelines aim to dispel any such misconceptions and provide detailed practical advice.

EVIDENCE BASE

These Guidelines have been created by a Task Force of experts convened by the International Society of Feline Medicine and American Association of Feline Practitioners, based on an extensive literature review and, where evidence is lacking, the authors' experience. Endorsements: These Guidelines have been endorsed by a number of groups and organisations, as detailed on page 1161 and at icatcare.org/cat-friendly-guidelines and catvets.com/environment.

Influence of the Acoustic Environment in Hospital Wards on Patient Physiological and Psychological Indices

Patients in general wards are often exposed to excessive levels of noise and activity, and high levels of noise have been associated with depression and anxiety. Previous studies have found that an appropriate acoustic environment is beneficial to the patient's therapeutic and treatment process; however, the soundscape is rarely intentionally designed or operated to improve patient recovery, especially for psychological rehabilitation. To gain the most accurate, and least variable, estimate of acoustic environmental stimuli/properties, virtual reality (VR) technology should be used to ensure that other environmental factors are stable and uniform in order to reduce the stimulation of other environmental factors. Therefore, this study aims to discuss the influence of the acoustic environment on patient physiological/psychological indicators and the mechanism of the effect on recovery using VR technology. A digital three-dimensional (3D) model of a hospital room was constructed, and experimental subjects wore VR glasses to visualize a real ward scene. Four typical sound categories were selected to analyze the effect of the acoustic environment on recovery; physiological indicators were monitored, and psychological factors were subjectively evaluated. The results show that music plays an important role in reducing stress as it can aid in a patient's physiological (skin conduction levels) and psychological stress recovery. Furthermore, mechanical and anthropogenic sounds exert negative effects on a patient's stress recovery. However, the effect is only limited to psychological stress indicators. The interaction effects of demographic characteristics and the acoustic environment are not significant, and future studies could consider the social-economic characteristics of patients. Based on these findings, we provide evidence that indicates that a hospital's acoustic environment is an important influencing factor on the stress recovery of patients and can serve as a reference for healthcare architects and policy makers.

Dynamics of an orthopaedic team: Insights to improve teamwork through a design thinking approach

BACKGROUND:

Supporting teamwork in healthcare is a way to foster both the quality and safety of care, and better working conditions for all the team members. Although increasing attention is paid to this topic on a general level, there is less knowledge about its unfolding in orthopaedic units and its translation to interventions.

OBJECTIVE:

To identify concrete opportunities for teamwork intervention through a design thinking approach by analysing the teamwork dynamics of an orthopaedic team.

METHODS:

An adaptation of the learning history method, comprising shadowing, observations and interviews involving 26 orthopaedic team members at a top clinical teaching hospital in the Netherlands, was applied. A thematic analysis was conducted to derive themes that describe team dynamics and to subsequently extrapolate opportunities for intervention.

RESULTS:

We identified five themes and translated them into four design opportunities for intervention, namely: a) Improve daily rounds by reducing cognitive overload and promoting confidence; b) Improve collaboration by building empathy; c) Connect the patient with the professional team; and d) Support changes by fostering learning. Suggestions for concrete actions are presented for each opportunity.

CONCLUSIONS:

Opportunities to improve teamwork among healthcare professionals, specifically those in orthopaedics, revolve around the creation of common knowledge, the fostering of mutual understanding, and the design of tools and activities that support these processes.

Using appreciative inquiry to implement person-centred dementia care in hospital wards

The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an appreciative inquiry approach to implement person-centred dementia care in two hospital wards. Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using appreciative inquiry approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in appreciative inquiry workshops, during which they are listened to and appreciated for what they can contribute.

The Role of the Nurse in Informed Consent to Treatments: An Observational-Descriptive Study in the Padua Hospital

BACKGROUND

The process to obtain valid informed consent in healthcare reflects many aspects. Healthcare professionals that take care of the patient must provide him all the necessary information and verify his understanding, considering individual characteristics. Nurses are one of the main participants in this process.

OBJECTIVE

This study assesses nurses' perceptions of their role in the informed consent process.

MATERIAL AND METHODS

An observational study involving 300 nurses operating in 13 wards of the Padua Hospital, through the submitting of a questionnaire in the period November-December 2018.

RESULTS

The final sample is made up of 206 nurses-27 males (13.11%) and 179 females (86.89%). Work experience, on average 15 years, is significant in determining the answers to questions about opinions and experiences. Age is significant in determining how often nurses provide information to the patient's family members about the actions to be taken after discharge. The ward was decisive in the responses related to information provided to patients on the nursing care level and the actions to be taken after discharge, and the definition of the nurse's duties.

CONCLUSIONS

The data collected show the need for interventions to reduce the causes of difficult that the nurse has in informing patients.

Assessment of Microbiological Quality of Indoor Air at Different Hospital Sites of Dilla University: A Cross-Sectional Study

BACKGROUND

In both residential and hospital indoor environments, humans can be exposed to airborne microorganisms. The hospital's indoor air may contain a large number of disease-causing agents brought in by patients, staff, students, visitors, ventilation, or the outside. Hospitalized patients are at a higher risk of infection due to confined spaces, crowdedness, and poor infection prevention practices, which can accumulate and create favorable conditions for the growth and multiplication of microorganisms. Therefore, the aim of this study was to evaluate the indoor air bacterial load in Dilla University Hospital, Southern Ethiopia.

METHODS

An institutional-based cross-sectional study design was used to assess the bacterial load in the indoor air at Dilla University Hospital. To determine the bacterial load, a passive air sampling technique was used. The settle plate method was used to collect data, which involved exposing Petri-dishes filled with blood agar media to the indoor air of the sampled rooms for 60 minutes.

RESULT

A total of 72 indoor air samples were collected once a week for 2 weeks at 14-day intervals from 18 rooms in 8 wards, and samples were collected twice a day in the morning and afternoon. The mean bacterial concentrations ranged from 450 to 1585.83 CFU/m³ after 60 minutes of culture media exposure. The mean bacterial concentrations in the obstetrics, surgical, pediatric, gynecology, and medical wards exceeded WHO guidelines. A high indoor air bacterial load was found in 58 (80.6%) of the samples in this study. Gram-positive bacteria in the air were the most common 51 (71%) of the bacterial population measured in all indoor environments. Fungal growth was found in 65 (90.3%) of the samples. Temperatures (26.5°C-28.3°C) and relative humidity (61.1%-67.8%) in the rooms were both above WHO guidelines, creating favorable conditions for bacterial growth and multiplication.

CONCLUSION

The majority of the wards at Dilla University Hospital had bacterial loads in the air that exceeded WHO guidelines. Overcrowding, high temperatures, inadequate ventilation, improper waste management, and a lack of traffic flow control mechanisms could all contribute to a high concentration of bacteria in the indoor air. To control the introduction of microorganisms by patients, students, caregivers, and visitors, it is critical to regularly monitor indoor air bacterial load and implement infection prevention and control measures.

Organizational identity and the state of organizational identification in nursing organizations

AIM

This study qualitatively identified the organizational identity of a nursing organization and determined the state of organizational identification of staff in hospital wards.

DESIGN

Cross-sectional descriptive survey study.

METHODS

Interviews were conducted using interview guides; a qualitative inductive analysis was performed for the three attributes of organizational identity (central, distinctive and enduring). The study included three head nurses working in different facilities and three teams comprising three nurses each, who worked under each of the head nurses (12 nurses total).

RESULTS

Centrality comprised two subcategories: "ward work attributes" and "ward care attributes". Clear centrality originating from a head nurse showed a strong influence on organizational culture in a hospital ward. As young staff is identified by distinctiveness in wards, it is important to clarify distinctiveness. When centrality and distinctiveness were not clear, enduring was weak.

Improving sepsis screening and care in a developing nation health setting: A description of implementation

Evidence on sepsis screening and care in developing nations is insufficient to inform implementation practices in hospital wards. The aim of this multi-method study was to describe and evaluate the implementation of a three-step intervention (sepsis screening, alert activation, care) in five wards in Argentina in 2017. The implementation involved three stages: (1) context assessment, (2) development/participation in implementation strategies, and (3) evaluation of intervention adherence. Results were variable. The context assessment (Stage 1) demonstrated the value of education, proactivity towards care and team structures. Strategies developed (Stage 2) included sepsis screening and response guide, education, team rounding, posters, champions, audit/feedback and knowledge brokering. In Stage 3, staff screened 92% patients (506/547) for sepsis at ≥60% of set times; only 33% (21/64) patients had a sepsis alert activated when needed. A similar proportion of patients who had alerts activated (n = 16, 76%) or not (n = 32, 74%) received at least one element of care. The use of implementation strategies resulted in adherence to some aspects of the intervention. Future research is needed to improve sepsis screening and alert activation and care in this setting.

Bacteria profiles and antimicrobial susceptibility pattern of isolates from beds and door handles of hospital wards in Tiko Health District, Cameroon

Introduction

in low- and middle-income countries, hospital surfaces contaminated with bacteria, namely beds and door handles in hospital wards, are a major source of nosocomial infections. We sought to evaluate bacterial isolates from beds and door handles of hospital wards and ascertain their antibiotic susceptibility patterns in Tiko Health District (THD), Cameroon.

Methods

using a multistage sampling technique, this hospital-based cross-sectional study included 40 beds and 20 door handles in THD. Gram staining methods, biochemical reactions, and features of bacterial colonies were used to identify bacterial isolates. A frequency table and bar charts were used to display the data.

Results

Bacillus spp., Clostridium perfringens, Klebsiella pneumoniae, Clostridium spp., and Staphylococcus aureus were identified. Patient beds were mainly contaminated with S. aureus (42.5%, 17/40). However, C. perfringens (35%, 7/20) was the most common isolate from door handles. S. aureus was resistant to bacitracin (100%, 21/21) but sensitive to gentamycin (95.2%, 20/21) and azithromycin (95.2%, 20/21). While C. perfringes was resistant to bacitracin (100%, 8/8), it was sensitive to gentamycin (75%, 6/8) and chloramphenicol (75%, 6/8).

Conclusion

beds and door handle harbour largely S. aureus and C. perfringes, respectively. High sensitivity to gentamycin and resistance to bacitracin were observed in S. aureus and C. perfringes, respectively. Good and regular hand hygiene and the cleaning and disinfecting of door knobs and hospital beds should be practiced. Hospitals should fully adopt food safety protocols to prevent or control food poisoning effectively.

Views of family members on using video calls during the hospital admission of a patient: A qualitative study

BACKGROUND

Utilization of video calls on hospital wards to facilitate involvement of and communication with family members is still limited. A deeper understanding of the needs and expectations of family members regarding video calls on hospital wards is necessary, to identify potential barriers and facilitate video calls in practice.

AIM

The aim of this study was to explore the views, expectations and needs of a patient's family members regarding the use of video calls between family members, patients and healthcare professionals, during the patient's hospital admission.

METHODS

A qualitative study was carried out. Semi-structured interviews with family members of patients admitted to two hospitals were conducted between February and May 2022. Family members of patients admitted to the surgical, internal medicine and gynaecological wards were recruited.

RESULTS

Twelve family members of patients participated. Family members stated that they perceive video calls as a supplemental option and prefer live visits during hospital admission. They expected video calls to initiate additional moments of contact with healthcare professionals, e.g. to join in medical rounds. When deploying video calls, family members mentioned that adequate instruction and technical support by nurses should be available.

CONCLUSION

Family members considered video calls valuable when visiting is not possible or to participate in medical rounds or other contacts with healthcare professionals outside of visiting hours.

IMPLICATIONS

Family members need to be supported in options and use of video calls on hospital wards. Additional knowledge about actual participation in care through video calls is needed as well as the effect on patient, family and healthcare professional outcomes.

IMPACT

Using video calls on hospital wards can provide family members with flexible alternatives for contact and promote family involvement.

REPORTING METHOD

COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Family members of patients admitted to hospital have contributed by sharing their perspectives in interviews. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Family members perceive additional value from the use of video calls on hospital wards. For family, use of video calls needs to be facilitated with clear instruction materials and support.

TRIAL AND PROTOCOL REGISTRATION

Amsterdam UMC Medical Ethics Review Committee (ref number W21_508 # 21.560).

Incorporation of the health care system in the west

A reflection is made, from an interpretative perspective, on the historical evolution of health care in the West. It starts from the moment that this became a way to intervene the sick and an instrument for healing diseases, focusing on original documents and written sources which account for results of historical research, which range from XV century until today. To do this, it tries to understand the health care as an ideographic body of knowledge consisting of five pieces of a puzzle composed by: the state policy of hospitals accumulation implemented in Spain, the accumulation of medical practices in what is currently Germany, the hospital wards in England, the nosological rationality in France, and the US sanitizing machine; all these movements as producers of closely linked health care developments, that are nothing more than collective actions regulated by social norms around health.

Effectiveness of Remote Patient Monitoring Equipped With an Early Warning System in Tertiary Care Hospital Wards: Retrospective Cohort Study

BACKGROUND

Monitoring vital signs in hospitalized patients is crucial for evaluating their clinical condition. While early warning scores like the modified early warning score (MEWS) are typically calculated 3 to 4 times daily through spot checks, they might not promptly identify early deterioration. Leveraging technologies that provide continuous monitoring of vital signs, combined with an early warning system, has the potential to identify clinical deterioration sooner. This approach empowers health care providers to intervene promptly and effectively.

OBJECTIVE

This study aimed to assess the impact of a Remote Patient Monitoring System (RPMS) with an automated early warning system (R-EWS) on patient safety in noncritical care at a tertiary hospital. R-EWS performance was compared with a simulated Modified Early Warning System (S-MEWS) and a simulated threshold-based alert system (S-Threshold).

METHODS

Patient outcomes, including intensive care unit (ICU) transfers due to deterioration and discharges for nondeteriorating cases, were analyzed in Ramaiah Memorial Hospital's general wards with RPMS. Sensitivity, specificity, chi-square test for alert frequency distribution equality, and the average time from the first alert to ICU transfer in the last 24 hours was determined. Alert and patient distribution by tiers and vitals in R-EWS groups were examined.

RESULTS

Analyzing 905 patients, including 38 with deteriorations, R-EWS, S-Threshold, and S-MEWS generated more alerts for deteriorating cases. R-EWS showed high sensitivity (97.37%) and low specificity (23.41%), S-Threshold had perfect sensitivity (100%) but low specificity (0.46%), and S-MEWS demonstrated moderate sensitivity (47.37%) and high specificity (81.31%). The average time from initial alert to clinical deterioration was at least 18 hours for RPMS and S-Threshold in deteriorating participants. R-EWS had increased alert frequency and a higher proportion of critical alerts for deteriorating cases.

CONCLUSIONS

This study underscores R-EWS role in early deterioration detection, emphasizing timely interventions for improved patient outcomes. Continuous monitoring enhances patient safety and optimizes care quality.

Determination of the indoor air bacterial profile in Jimma University Specialized Hospital, Southwest Ethiopia

Objective:

Microorganisms are one of the main indoor air contaminants. In a hospital setting, a range of hospital-acquired infectious diseases are caused due to indoor air pollution. Studies conducted on hospital patients and healthcare workers revealed that indoor air pollution is causing more severe health problems than outdoor air pollution. Thus, this study aimed to determine the bacterial indoor air quality in Jimma University Specialized Hospital in southwest Ethiopia.

Method:

An institution-based cross-sectional study was conducted from late May to October 2020. Indoor air samples were collected through a passive method by exposing prepared sample plates for prescheduled exposure time, and bacterial species were identified using morphology and biochemical tests.

Result:

Based on the findings, neither of the wards showed a similar microbial concentration. Among the studied wards, the minimum and the maximum bacterial distribution ranged from 280 to 6369 cfu/m³, respectively. Staphylococcus aureus, coagulase-negative spp., Klebsiella spp., Escherichia coli, Bacillus spp., Proteus spp., and Streptococcus spp. were bacterial isolates. Statistically, the concentration of the bacteria in all the studied wards was tested significantly different (p ⩽ 0.001).

Conclusion:

Among studied wards, the emergency outpatient ward showed a maximum bacterial concentration in contrast to the minor operating room. Based on the criteria of the World Health Organization on hospital-acquired infections, studied wards were highly contaminated.

Machine Learning in Optimising Nursing Care Delivery Models: An Empirical Analysis of Hospital Wards

OBJECTIVE

This study aims to assess the performance of machine learning (ML) techniques in optimising nurse staffing and evaluating the appropriateness of nursing care delivery models in hospital wards. The primary outcome measures include the adequacy of nurse staffing and the appropriateness of the nursing care delivery system.

BACKGROUND

Historical and current healthcare challenges, such as nurse shortages and increasing patient acuity, necessitate innovative approaches to nursing care delivery. For instance, the COVID-19 pandemic highlighted the need for flexible and scalable staffing models to manage surges in patient volume and acuity.

MATERIALS AND METHODS

A descriptive study was conducted in 39 inpatient wards across a university hospital and three state hospitals, involving 117 ward-level observations. Data were collected using the Rush Medicus Patient Classification Scale and analysed using k-Nearest Neighbour, Support Vector Machine, Random Forest, and Logistic Regression algorithms. Effectiveness was measured by the accuracy of machine learning predictions regarding nurse staffing adequacy, while suitability was determined by the congruence between observed nursing care models and patient needs.

REPORTING METHOD

STROBE checklist.

RESULTS

The Random Forest algorithm demonstrated the highest accuracy in predicting both nurse staffing adequacy and the appropriateness of nursing care delivery systems. The study found that 68.4% of wards had sufficient nurse staffing and 26.5% of wards used appropriate care delivery models, with functional nursing and total patient care models being the most commonly used.

DISCUSSION

The study highlights functional nursing and total patient care models, emphasising the need to consider nurse qualifications and patient needs in selecting care systems. Machine learning, particularly the Random Forest algorithm, proved effective in aligning staffing with patient requirements.

CONCLUSION

Machine learning, particularly the Random Forest algorithm, proves effective in optimising nursing care delivery models, suggesting significant potential for enhancing patient care and nurse satisfaction.

IMPLICATIONS

The research underscores machine learning's role in improving nursing care delivery, aligning nurse staffing with patient needs, and advancing healthcare outcomes.

IMPACT

The findings advocate for integrating machine learning in the planning of nursing care delivery models. This study sets a precedent for using data-driven approaches to improve nurse staffing and care delivery, potentially enhancing global clinical outcomes and operational efficiencies. The global clinical community can learn from this study the value of employing machine learning techniques to make informed, evidence-based decisions in healthcare management.

PATIENT OR PUBLIC CONTRIBUTION

While the study lacked direct patient involvement, its goal was to enhance patient care and healthcare efficiency. Future research will aim to incorporate patient and public insights more directly.

Feasibility of an electronic fluid balance chart to detect and understand the significance of oliguric acute kidney injury in a general ward setting: a prospective observational cohort study

Background

Outside critical care environments, few studies have assessed the significance of oliguric acute kidney injury (AKI). This study investigated the feasibility of an electronic fluid balance chart to diagnose oliguric AKI. Data were used to determine if oliguric AKI was met earlier than creatinine AKI and to establish outcomes of those who developed AKI.

Methods

A single-centre prospective cohort study investigated Kidney Disease Improving Global Outcomes oliguric and creatinine AKI criteria on general surgical wards.

Results

2,149 cases were included in the analysis. Incidence of oliguric AKI was significantly higher than creatinine criteria (73 versus 10.1%) and detection occurred earlier (2.1 versus 6.1 days, p<0.05). In cases with oliguric AKI, 8.1% also developed AKI by creatinine criteria. In cases not meeting oliguric AKI criteria, fewer cases developed creatinine AKI, as compared to those meeting oliguric AKI criteria (7.9% versus 11%, p=0.043). There was a high incidence of missing data.

Conclusions

Oliguric AKI was met in a high proportion of cases and occurred earlier than by changes in creatinine. Barriers to consistency of recording must be addressed before oliguric criteria could be implemented in clinical practice.