Sample records for care unit environment
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Nurse work environment and quality of care by unit types: A cross-sectional study.
Ma, Chenjuan; Olds, Danielle M; Dunton, Nancy E
2015-10-01
Nursing unit is the micro-organization in the hospital health care system in which integrated patient care is provided. Nursing units of different types serve patients with distinct care goals, clinical tasks, and social structures and norms. However, empirical evidence is sparse on unit type differences in quality of care and its relation with nurse work environment. Nurse work environment has been found as an important nursing factor predicting nurse and patient outcomes. To examine the unit type differences in nurse-reported quality of care, and to identify the association between unit work environment and quality of care by unit types. This is a cross-sectional study using nurse survey data (2012) from US hospitals nationwide. The nurse survey collected data on quality of care, nurse work environment, and other work related information from staff nurses working in units of various types. Unit types were systematically classified across hospitals. The unit of analysis was the nursing unit, and the final sample included 7677 units of 14 unit types from 577 hospitals in 49 states in the US. Multilevel regressions were used to assess the relationship between nurse work environment and quality of care across and by unit types. On average, units had 58% of the nurses reporting excellent quality of care and 40% of the nurses reporting improved quality of care over the past year. Unit quality of care varied by unit types, from 43% of the nurses in adult medical units to 73% of the nurses in interventional units rating overall quality of care on unit as excellent, and from 35% of the nurses in adult critical care units to 44% of the nurses in adult medical units and medical-surgical combined units reporting improved quality of care. Estimates from regressions indicated that better unit work environments were associated with higher quality of care when controlling various hospital and unit covariates; and this association persisted among units of different types. Unit type differences exist in the overall quality of care as well as achievement in improving quality of care. The low rates of nurses reporting improvement in the quality of nursing care to patients suggest that further interventions focusing at the unit-level are needed for achieving high care quality. Findings from our study also suggest that improving nurse work environments can be an effective strategy to improve quality of care. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Work environment for Chinese nurses in different types of ICUs: a multisite cross-sectional survey.
Bai, Jinbing; Zhang, Qing; Wang, Ying; Yu, Li-Ping; Pei, Xian-Bo; Cheng, Lei; Hsu, Lily
2015-05-01
To investigate the current nurse work environment, levels of job satisfaction and quality of patient care, and to identify intensive care units with a healthier work environment in mainland China. A healthy work environment is closely related to a higher nurse job satisfaction and a better patient care quality. The work environment has not been extensively explored among Chinese intensive care unit nurses. The Chinese version of the Essentials of Magnetism II was used to measure the nurse work environment and another two 0-10 single-item scales were used to assess nurses' overall job satisfaction and nurse-assessed quality of care. The study found that the eight essentials of Chinese version of the Essentials of Magnetism II were significantly correlated with each other and also correlated with overall job satisfaction and quality of care. Nurses from medical intensive care units had a healthier work environment with higher scores of overall job satisfaction and quality of care than other intensive care units, while surgical intensive care units showed the least healthy work environment with the lowest overall job satisfaction and quality of care scores identified. The essentials of Chinese version of the Essentials of Magnetism II, overall job satisfaction and quality of care were also correlated with nurses' work experience and their education level. Nurse administrators and health policy-makers should establish a healthy work environment for intensive care units nurses, especially for those from surgical intensive care units. © 2014 John Wiley & Sons Ltd.
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Bartley, Judene; Streifel, Andrew J
2010-08-01
We review the context of the environment of care in the intensive care unit setting in relation to patient safety and quality, specifically addressing healthcare-associated infection issues and solutions involving interdisciplinary teams. Issues addressed include current and future architectural design and layout trends, construction trends affecting intensive care units, and prevention of construction-associated healthcare-associated infections related to airborne and waterborne risks and design solutions. Specific elements include single-occupancy, acuity-scalable intensive care unit rooms; environmental aspects of hand hygiene, such as water risks, sink design/location, human waste management, surface selection (floor covering, countertops, furniture, and equipment) and cleaning, antimicrobial-treated or similar materials, ultraviolet germicidal irradiation, specialized rooms (airborne infection isolation and protective environments), and water system design and strategies for safe use of potable water and mitigation of water intrusion. Effective design and operational use of the intensive care unit environment of care must engage critical care personnel from initial planning and design through occupancy of the new/renovated intensive care unit as part of the infection control risk assessment team. The interdisciplinary infection control risk assessment team can address key environment of care design features to enhance the safety of intensive care unit patients, personnel, and visitors. This perspective will ensure the environment of care supports human factors and behavioral aspects of the interaction between the environment of care and its occupants.
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Differences in nursing practice environment among US acute care unit types: a descriptive study.
Choi, JiSun; Boyle, Diane K
2014-11-01
The hospital nursing practice environment has been found to be crucial for better nurse and patient outcomes. Yet little is known about the professional nursing practice environment at the unit level where nurses provide 24-hour bedside care to patients. To examine differences in nursing practice environments among 11 unit types (critical care, step-down, medical, surgical, combined medical-surgical, obstetric, neonatal, pediatric, psychiatric, perioperative, and emergency) and by Magnet status overall, as well as four specific aspects of the practice environment. Cross-sectional study. 5322 nursing units in 519 US acute care hospitals. The nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index. The Practice Environment Scale of the Nursing Work Index mean composite and four subscale scores were computed at the unit level. Two statistical approaches (one-way analysis of covariance and multivariate analysis of covariance analysis) were employed with a Tukey-Kramer post hoc test. In general, the nursing practice environment was favorable in all unit types. There were significant differences in the nursing practice environment among the 11 unit types and by Magnet status. Pediatric units had the most favorable practice environment and medical-surgical units had the least favorable. A consistent finding across all unit types except neonatal units was that the staffing and resource adequacy subscale scored the lowest compared with all other Practice Environment Scale of the Nursing Work Index subscales (nursing foundations for quality of care, nurse manager ability, leadership, and support, and nurse-physician relations). Unit nursing practice environments were more favorable in Magnet than non-Magnet hospitals. Findings indicate that there are significant variations in unit nursing practice environments among 11 unit types and by hospital Magnet status. Both hospital-level and unit-specific strategies should be considered to achieve an excellent nursing practice environment in all hospital units. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units.
Rochefort, Christian M; Clarke, Sean P
2010-10-01
This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses' perceptions of care rationing, job outcomes, and quality of care. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Over a 6-month period in 2007-2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). A total of 339 nurses (61.3%) completed questionnaires. Overall, 18.6% were dissatisfied with their job, 35.7% showed high emotional exhaustion, and 19.2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units. © 2010 Blackwell Publishing Ltd.
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Anåker, Anna; von Koch, Lena; Sjöstrand, Christina; Heylighen, Ann; Elf, Marie
2018-04-20
To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units. Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce. This work is a comparative descriptive case study. Patients (N = 55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015. The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care. Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.
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Rethinking the intensive care environment: considering nature in nursing practice.
Minton, Claire; Batten, Lesley
2016-01-01
With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of 'nature-based' nursing interventions as a way to improve care outcomes. The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients. This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units. Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice. There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients' families and nurses. Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes. © 2015 John Wiley & Sons Ltd.
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Family centered care within an infant-toddler unit.
Neal, Annmarie; Frost, Michelle; Kuhn, Janna; Green, Angela; Gance-Cleveland, Bonnie; Kersten, Rebecca
2007-01-01
Family centered care (FCC) is an essential component of pediatric nursing. A unit-based FCC Committee was charged with evaluating care on an inpatient infant-toddler unit. The committee adapted the Institute of Family Centered Care survey tools and used them to evaluate parent and staff perceptions of FCC care provided on the unit. The survey tools covered the following areas: environment, nursing care, education, communication, and respect and equality. A convenience sample of 38 parents and 75 staff completed surveys. Families provided significantly more positive responses than the staff did, indicating overall satisfaction with the care received. However, they did identify concerns about educational issues and pain assessment. In contrast, the staff reported more negative perceptions regarding the delivery of FCC, and their primary concern was the unit environment. The FCC Committee used the findings from the survey to first educate the staff and then implement changes to improve the environment and the care delivered.
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Smith, Thomas J
2012-01-01
This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.
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Nursing management and organizational ethics in the intensive care unit.
Wlody, Ginger Schafer
2007-02-01
This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.
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Vogel, Barbara; De Geest, Sabina; Fierz, Katharina; Beckmann, Sonja; Zúñiga, Franziska
2017-03-01
Although caring for residents with dementia in nursing homes is associated with various stressors for care workers, the role of the unit type, and particularly the proportion of residents with dementia, remains unclear. This study aimed to explore associations between unit type and care worker stress, taking into account additional potential stressors. This cross-sectional study was a secondary data analysis in the Swiss Nursing Homes Human Resources Project, which included data from 3,922 care workers from 156 Swiss nursing homes. Care workers' stress was measured with a shortened version of the Health Professions Stress Inventory. Generalized estimating equation models were used to assess care worker stress and its relationships with three unit types (special care units and others with high or low proportions of residents with dementia), work environment factors, and aggressive resident behavior. After including all potential stressors in the models, no significant differences between the three unit types regarding care worker stress were found. However, increased care worker stress levels were significantly related to lower ratings of staffing and resources adequacy, the experience of verbal aggression, and the observation of verbal or physical aggression among residents. Although the unit type plays only a minor role regarding care worker stress, this study confirms that work environment and aggressive behavior of residents are important factors associated with work-related stress. To prevent increases of care worker stress, interventions to improve the work environment and strengthen care workers' ability to cope with aggressive behavior are suggested.
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Rathert, Cheryl; May, Douglas R
2007-01-01
Experts continue to decry the lack of progress made in decreasing the alarming frequency of medical errors in health care organizations (Leape, L. L., & Berwick, D. M. (2005). Five years after to err is human: What have we learned?. Journal of the American Medical Association, 293(19), 2384-2390). At the same time, other experts are concerned about the lack of job satisfaction and turnover among nurses (. Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academy Press). Research and theory suggest that a work environment that facilitates patient-centered care should increase patient safety and nurse satisfaction. The present study began with a conceptual model that specifies how work environment variables should be related to both nurse and patient outcomes. Specifically, we proposed that health care work units with climates for patient-centered care should have nurses who are more satisfied with their jobs. Such units should also have higher levels of patient safety, with fewer medication errors. We examined perceptions of nurses from three acute care hospitals in the eastern United States. Nurses who perceived their work units as more patient centered were significantly more satisfied with their jobs than were those whose units were perceived as less patient centered. Those whose work units were more patient centered reported that medication errors occurred less frequently in their units and said that they felt more comfortable reporting errors and near-misses than those in less patient-centered units. Patients and quality leaders continue to call for delivery of patient-centered care. If climates that facilitate such care are also related to improved patient safety and nurse satisfaction, proactive, patient-centered management of the work environment could result in improved patient, employee, and organizational outcomes.
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Kudchadkar, Sapna R; Beers, M Claire; Ascenzi, Judith A; Jastaniah, Ebaa; Punjabi, Naresh M
2016-09-01
The architectural design of the pediatric intensive care unit may play a major role in optimizing the environment to promote patients' sleep while improving stress levels and the work experience of critical care nurses. To examine changes in nurses' perceptions of the environment of a pediatric critical care unit for promotion of patients' sleep and the nurses' work experience after a transition from multipatient rooms to single-patient rooms. A cross-sectional survey of nurses was conducted before and after the move to a new hospital building in which all rooms in the pediatric critical care unit were single-patient rooms. Nurses reported that compared with multipatient rooms, single-patient private rooms were more conducive to patients sleeping well at night and promoted a more normal sleep-wake cycle (P < .001). Monitors/alarms and staff conversations were the biggest factors that adversely influenced the environment for sleep promotion in both settings. Nurses were less annoyed by noise in single-patient rooms (33%) than in multipatient rooms (79%; P < .001) and reported improved exposure to sunlight. Use of single-patient rooms rather than multipatient rooms improved nurses' perceptions of the pediatric intensive care unit environment for promoting patients' sleep and the nurses' own work experience. ©2016 American Association of Critical-Care Nurses.
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Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David
2017-01-01
Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. A cross-sectional design was used. Residents ( n = 1460) and staff ( n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents . Descriptive and comparative statistics, independent samples t-test, Chi 2 test, Eta Squared and Phi coefficient were used to analyse data. Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.
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Butler, Ashleigh E; Copnell, Beverley; Hall, Helen
2017-12-30
This study explores the influences of the paediatric intensive care environment on relationships between parents and healthcare providers when children are dying. It forms part of a larger study, investigating parental experiences of the death of their child in intensive care. Constructivist grounded theory. Four Australian paediatric intensive care units. Audio-recorded, semi-structured interviews were conducted with twenty-six bereaved parents. Data were analysed using the constant comparison and memoing techniques common to grounded theory. The physical and social environment of the intensive care unit influenced the quality of the parent-healthcare provider relationship. When a welcoming, open environment existed, parents tended to feel respected as equal and included members of their child's care team. In contrast, environments that restricted parental presence or lacked resources for parental self-care could leave parents feeling like 'watchers', excluded from their child's care. The paediatric intensive care unit environment either welcomes and includes parents of dying children into the care team, or demotes them to the status of 'watcher'. Such environments significantly influence the relationships parents form with healthcare staff, their ability to engage in elements of their parental role, and their experiences as a whole. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Mazzei, Francesco; Gillan, Roslyn; Cloutier, Denise
2014-06-01
Limited research explores the experience of individuals with dementia in acute care geriatric psychiatry units. This observational case study examines the influence of the physical environment on behavior (wandering, pacing, door testing, congregation and seclusions) among residents in a traditional geriatric psychiatry unit who were then relocated to a purpose-built acute care unit. Purpose-built environments should be well suited to the needs of residents with dementia. Observed trends revealed differences in spatial behaviors in the pre- and post- environments attributable to the physical environment. Person-centred modifications to the current environment including concerted efforts to know residents are meaningful in fostering quality of life. Color coded environments (rooms vs dining areas etc.) to improve wayfinding and opportunities to personalize rooms that address the `hominess' of the setting also have potential. Future research could also seek the opinions of staff about the impact of the environment on them as well as residents. © The Author(s) 2013.
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Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik
2014-08-01
To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Kim, Kyoung-Ja; Yoo, Moon Sook; Seo, Eun Ji
2018-04-20
This study aimed to explore the influence of nurse work environment and patient safety culture in hospital on instances of missed nursing care in South Korea. A cross-sectional design was used, in which a structured questionnaire was administered to 186 nurses working at a tertiary university hospital. Data were analyzed using descriptive statistics, t-test or ANOVA, Pearson correlation and multiple regression analysis. Missed nursing care was found to be correlated with clinical career, nursing work environment and patient safety culture. The regression model explained approximately 30.3 % of missed nursing care. Meanwhile, staffing and resource adequacy (β = -.31, p = .001), nurse manager ability, leadership and support of nurses (β = -.26, p = .004), clinical career (β = -.21, p = .004), and perception on patient safety culture within unit (β = -.19, p = .041) were determined to be influencing factors on missed nursing care. This study has significance as it suggested that missed nursing care is affected by work environment factors within unit. This means that missed nursing care is a unit outcome affected by nurse work environment factors and patient safety culture. Therefore, missed nursing care can be managed through the implementation of interventions that promote a positive nursing work environment and patient safety culture. Copyright © 2018. Published by Elsevier B.V.
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[Continuing training plan in a clinical management unit].
Gamboa Antiñolo, Fernando Miguel; Bayol Serradilla, Elia; Gómez Camacho, Eduardo
2011-01-01
Continuing Care Unit (UCA) focused the attention of frail patients, polypathological patients and palliative care. UCA attend patients at home, consulting, day unit, telephone consulting and in two hospitals of the health area. From 2002 UCA began as a management unit, training has been a priority for development. Key elements include: providing education to the workplace, including key aspects of the most prevalent health care problems in daily work, directing training to all staff including organizational aspects of patient safety and the environment, improved working environment, development of new skills and knowledge supported by the evidence-based care for the development of different skills. The unit can be the ideal setting to undertake the reforms necessary conceptual training of professionals to improve the quality of care. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.
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Nakanishi, Miharu; Tei-Tominaga, Maki
2018-05-08
Background : Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods : A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results : Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions : Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.
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Carroll, Diane L
2014-01-01
In a growing number of requests, family members are asking for proximity to their family member during resuscitation and invasive procedures. The objective of this study was to measure the impact of intensive care unit environments on nurse perception of family presence during resuscitation and invasive procedures. The study used a descriptive survey design with nurses from 9 intensive care units using the Family Presence Self-confidence Scale for resuscitation/invasive procedures that measures nurses' perception of self-confidence and Family Presence Risk-Benefit Scale for resuscitation and invasive procedures that measures nurses' perception of risks/benefits related to managing resuscitation and invasive procedures with family present. There were 207 nurses who responded: 14 male and 184 female nurses (9 missing data), with mean age of 41 ± 11 years, with a mean of 15 years in critical care practice. The environments were defined as surgical (n = 68), medical (n = 43), pediatric/neonatal (n = 34), and mixed adult medical/surgical (n = 36) intensive care units. There were significant differences in self-confidence, with medical and pediatric intensive care unit nurses rating more self-confidence for family presence during resuscitation (F = 7.73, P < .000) and invasive procedures (F = 6.41, P < .000). There were significant differences in risks/benefits with medical and pediatric intensive care unit nurses rating lower risk and higher benefit for resuscitation (F = 7.73, P < .000). Perceptions of family presence were significantly higher for pediatric and medical intensive care unit nurses. Further education and support may be needed in the surgical and mixed intensive care units. Evidence-based practice guidelines that are family centered can define the procedures and resources for family presence, to ultimately promote professional practice.
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Stalpers, Dewi; Van Der Linden, Dimitri; Kaljouw, Marian J; Schuurmans, Marieke J
2017-06-01
To examine nurse-perceived quality of care, controlling for overall job satisfaction among critical care nurses and to explore associations with work environment characteristics. Nurse-perceived quality of care and job satisfaction have been positively linked to quality outcomes for nurses and patients. Much evidence exists on factors contributing to job satisfaction. Understanding specific factors that affect nurse-perceived quality potentially enables for improvements of nursing care quality. A multicentre survey study was conducted in three Dutch intensive care units. The Dutch version of the Essentials of Magnetism II questionnaire was used; including the single-item indicators: (i) nurse-perceived quality of care; (ii) overall job satisfaction; and (iii) 58 statements on work environments. Data were collected between October 2013 - June 2014. The majority of 123 responding nurses (response rate 45%) were more than satisfied with quality of care (55%) and with their job (66%). No associations were found with nurse characteristics, besides differences in job satisfaction between the units. After controlling for job satisfaction, nurse-perceived quality was positively associated with the work environment characteristics: adequacy of staffing, patient-centeredness, competent peers and support for education. Patient-centeredness and autonomy were the most important predictors for overall job satisfaction. Factors that contribute to nurse-perceived quality of care in intensive care units, independent from the effects of overall job satisfaction, were identified. Hereby, offering opportunities to maximize high quality of care to critically ill patients. Research in a larger sample is needed to confirm our findings. © 2016 John Wiley & Sons Ltd.
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Nurse Burnout and Patient Satisfaction
Vahey, Doris C.; Aiken, Linda H.; Sloane, Douglas M.; Clarke, Sean P.; Vargas, Delfino
2010-01-01
Background Amid a national nurse shortage, there is growing concern that high levels of nurse burnout could adversely affect patient outcomes. Objectives This study examines the effect of the nurse work environment on nurse burnout, and the effects of the nurse work environment and nurse burnout on patients' satisfaction with their nursing care. Research Design/Subjects We conducted cross-sectional surveys of nurses (N = 820) and patients (N = 621) from 40 units in 20 urban hospitals across the United States. Measures Nurse surveys included measures of nurses' practice environments derived from the revised Nursing Work Index (NWI-R) and nurse outcomes measured by the Maslach Burnout Inventory (MBI) and intentions to leave. Patients were interviewed about their satisfaction with nursing care using the La Monica-Oberst Patient Satisfaction Scale (LOPSS). Results Patients cared for on units that nurses characterized as having adequate staff, good administrative support for nursing care, and good relations between doctors and nurses were more than twice likely as other patients to report high satisfaction with their care, and their nurses reported significantly lower burnout. The overall level of nurse burnout on hospital units also affected patient satisfaction. Conclusions Improvements in nurses' work environments in hospitals have the potential to simultaneously reduce nurses' high levels of job burnout and risk of turnover and increase patients' satisfaction with their care. PMID:14734943
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UnitedHealth Group provides accessible and affordable services, improved quality of care, coordinated health care efforts, and a supportive environment for shared decision making between patients and their physicians.
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Informatics for the Modern Intensive Care Unit.
Anderson, Diana C; Jackson, Ashley A; Halpern, Neil A
Advanced informatics systems can help improve health care delivery and the environment of care for critically ill patients. However, identifying, testing, and deploying advanced informatics systems can be quite challenging. These processes often require involvement from a collaborative group of health care professionals of varied disciplines with knowledge of the complexities related to designing the modern and "smart" intensive care unit (ICU). In this article, we explore the connectivity environment within the ICU, middleware technologies to address a host of patient care initiatives, and the core informatics concepts necessary for both the design and implementation of advanced informatics systems.
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Bullich-Marín, Ingrid; Miralles Basseda, Ramón; Torres Egea, Pilar; Planas-Campmany, Carme; Juvé-Udina, María Eulalia
A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment. Copyright © 2015 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.
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Aitken, Leanne M; Burmeister, Elizabeth; Clayton, Samantha; Dalais, Christine; Gardner, Glenn
2011-08-01
Factors previously shown to influence patient care include effective decision making, team work, evidence based practice, staffing and job satisfaction. Clinical rounds have the potential to optimise these factors and impact on patient outcomes, but use of this strategy by intensive care nurses has not been reported. To determine the effect of implementing Nursing Rounds in the intensive care environment on patient care planning and nurses' perceptions of the practice environment and work satisfaction. Pre-test post-test 2 group comparative design. Two intensive care units in tertiary teaching hospitals in Australia. A convenience sample of registered nurses (n=244) working full time or part time in the participating intensive care units. Nurses in participating intensive care units were asked to complete the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Nursing Worklife Satisfaction Scale (NWSS) prior to and after a 12 month period during which regular Nursing Rounds were conducted in the intervention unit. Issues raised during Nursing Rounds were described and categorised. The characteristics of the sample and scale scores were summarised with differences between pre and post scores analysed using t-tests for continuous variables and chi-square tests for categorical variables. Independent predictors of the PES-NWI were determined using multivariate linear regression. Nursing Rounds resulted in 577 changes being initiated for 171 patients reviewed; these changes related to the physical, psychological--individual, psychological--family, or professional practice aspects of care. Total PES-NWI and NWSS scores were similar before and after the study period in both participating units. The NWSS sub-scale of interaction between nurses improved in the intervention unit during the study period (pre--4.85±0.93; post--5.36±0.89, p=0.002) with no significant increase in the control group. Factors independently related to higher PES-NWI included intervention site and less years in critical care (p<0.05). Implementation of Nursing Rounds within the intensive care environment is feasible and is an effective strategy for initiating change to patient care. Application and testing of this strategy, including identification of the most appropriate methods of measuring impact, in other settings is needed to determine generalisability. Copyright © 2010 Elsevier Ltd. All rights reserved.
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The effects of arts-in-medicine programming on the medical-surgical work environment
Sonke, Jill; Pesata, Virginia; Arce, Lauren; Carytsas, Ferol P.; Zemina, Kristen; Jokisch, Christine
2015-01-01
Background: Arts in medicine programs have significant impacts on patients and staff in long-term care environments, but the literature lacks evidence of effectiveness on hospital units with shorter average lengths of stay. Methods: The qualitative study used individual structured interviews to assess the impacts of arts programming on job satisfaction, stress, unit culture, support, quality of care, and patient outcomes on a short-term medical-surgical unit, and used a qualitative cross comparison grounded theory methodology to analyze data. Results: The study confirmed that arts programming can positively affect unit culture, nursing practice, and quality of care on short-stay medical-surgical units. Significant insights related to nursing practice and the art program were found, including that music can cause negative distraction for staff. Conclusions: While positive impacts of arts programming on the medical-surgical environment are clear, potential negative effects also need to be considered in the development of practice protocols for artists. PMID:25544861
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Sleep and sedation in the pediatric intensive care unit.
Carno, Margaret-Ann; Connolly, Heidi V
2005-09-01
Sleep is an important and necessary function of the human body. Somatic growth and cellular repair occur during sleep. Critically ill children have disturbed sleep while in the pediatric intensive care unit related both to the illness itself and to light, noise, and caregiver activities disrupting an environment conducive to sleep. Medications administered in the pediatric intensive care unit can also disrupt sleep. This article reviews what is known about sleep in the pediatric intensive care unit and the effects of common sedation medications on sleep.
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Using evidence-based leadership initiatives to create a healthy nursing work environment.
Nayback-Beebe, Ann M; Forsythe, Tanya; Funari, Tamara; Mayfield, Marie; Thoms, William; Smith, Kimberly K; Bradstreet, Harry; Scott, Pamela
2013-01-01
In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), a facility-level Evidence Based Practice working group composed of nursing.Stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses' clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.
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2012-02-01
Faced with rising acuity levels and surging demand, Virginia Mason Medical Center modified the Clinical Decision Unit concept used in many EDs, and developed a new Patient Accelerated Care Environment (PACE) to care for observation patients, process patients for discharge, and to prepare patients for admission.The approach is designed to utilize ED beds for initial processing of patients, allowing resuscitative care if needed, and treating and releasing the patients with quick care needs. Using the Virginia Mason Production System, a methodology that is modeled after Toyota production techniques, developers designed an optimal work flow pattern and then built infrastructure to facilitate that process. All patients who present to the ED for care are seen by the ED team through a "team greet" approach. Approximately 35% to 40% of patients who come to the ED for care are transferred to the PACE unit. Patients assigned to the PACE unit typically remain there for 4 to 48 hours, depending on their care needs.
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Tessier, R; Charpak, N; Giron, M; Cristo, M; de Calume, Z F; Ruiz-Peláez, J G
2009-09-01
This study tested the hypothesis that Kangaroo Mother Care creates a climate in the family, which enhances infants' performance on the developmental quotient scale. The largest social security hospital in Colombia with a neonatal intensive care unit. At 12 months of corrected age, 194 families in the Kangaroo Mother Care group and 144 families in the Traditional Care group were available for analysis. Infants were kept 24 h/day in an upright position, in skin-to-skin contact until it was no longer tolerated by the infants. Babies in the Traditional Care were kept in incubators on the Minimal Care Unit until they satisfied the usual discharge criteria. The Home Observation for Measurement of the Environment (HOME), Father Involvement and Developmental Quotient (Griffiths) scores. 1) Kangaroo mothers created a more stimulating context and a better caregiving environment than mothers in the Traditional Care group; 2) this environment was positively correlated to father involvement and 3) the family environment of male infants was most improved by Kangaroo Mother Care. Kangaroo Mother Care has a positive impact on home environment. The results also suggest, first, that both parents should be involved as direct caregivers in the Kangaroo Mother Care procedure and secondly, that this intervention should be directed more specifically at infants who are more at risk at birth. The Kangaroo Mother Care intervention could be an excellent means to ensure parents' mature involvement in the future of their children.
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Armellino, Donna; Quinn Griffin, Mary T; Fitzpatrick, Joyce J
2010-10-01
The aim of the present study was to examine the relationship between structural empowerment and patient safety culture among staff level Registered Nurses (RNs) within adult critical care units (ACCU). There is literature to support the value of RNs' structurally empowered work environments and emerging literature towards patient safety culture; the link between empowerment and patient safety culture is being discovered. A sample of 257 RNs, working within adult critical care of a tertiary hospital in the United States, was surveyed. Instruments included a background data sheet, the Conditions of Workplace Effectiveness and the Hospital Survey on Patient Safety Culture. Structural empowerment and patient safety culture were significantly correlated. As structural empowerment increased so did the RNs' perception of patient safety culture. To foster patient safety culture, nurse leaders should consider providing structurally empowering work environments for RNs. This study contributes to the body of knowledge linking structural empowerment and patient safety culture. Results link structurally empowered RNs and increased patient safety culture, essential elements in delivering efficient, competent, quality care. They inform nursing management of key factors in the nurses' environment that promote safe patient care environments. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.
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Preparing Students for Practice in a Managed Care Environment
ERIC Educational Resources Information Center
Claiborne, Nancy; Fortune, Anne
2005-01-01
Managed care has profound effects on health and mental health service delivery in the United States. This article describes the knowledge that students need for effective social work practice within a managed care environment and evaluates a course to deliver the content. (Contains 3 tables.)
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Applying Lean Six Sigma for innovative change to the post-anesthesia care unit.
Haenke, Roger; Stichler, Jaynelle F
2015-04-01
Many healthcare organizations are building or renovating patient care facilities. Using Lean Six Sigma methods, nurse leaders can eliminate unnecessary waste and improve work and patient care environments. Starting with a key department like the post-anesthesia care unit is a good way to expose staff and leaders to the potential of Lean.
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The Neonatal Intensive Care Unit: Environmental Stressors and Supports
Williams, Kristen G.; Patel, Kayla T.; Stausmire, Julie M.; Mathis, Mary W.; Barkin, Jennifer L.
2018-01-01
The relationship between maternal mental health and infant development has been established in the literature. The Neonatal Intensive Care Unit (NICU) is a particularly challenging environment for new mothers as several natural processes are disrupted. The objective of this study is to elucidate protective factors and environmental deficits associated with the NICU. The experiences of forty-six (n = 46) mothers of infants admitted to a Level III NICU in the Midwestern United States, who responded to a related open-ended question, were analyzed thematically. Five themes related to the NICU environment emerged as being either stressful or helpful: (1) amount and quality of communication with medical staff, (2) bedside manner of medical staff, (3) feeling alienated from infant’s care, (4) support from other NICU mothers and families, and (5) NICU Physical Environment and Regulations. There is a need for medical staff training on awareness, communication, empathy, and other behaviors that might improve maternal (and parental) experiences in the NICU. The physical environment, including rules and regulations of the NICU, should be reexamined with family comfort in mind in addition to the clinical care of the infant. PMID:29301343
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The Neonatal Intensive Care Unit: Environmental Stressors and Supports.
Williams, Kristen G; Patel, Kayla T; Stausmire, Julie M; Bridges, Christy; Mathis, Mary W; Barkin, Jennifer L
2018-01-03
The relationship between maternal mental health and infant development has been established in the literature. The Neonatal Intensive Care Unit (NICU) is a particularly challenging environment for new mothers as several natural processes are disrupted. The objective of this study is to elucidate protective factors and environmental deficits associated with the NICU. The experiences of forty-six ( n = 46) mothers of infants admitted to a Level III NICU in the Midwestern United States, who responded to a related open-ended question, were analyzed thematically. Five themes related to the NICU environment emerged as being either stressful or helpful: (1) amount and quality of communication with medical staff, (2) bedside manner of medical staff, (3) feeling alienated from infant's care, (4) support from other NICU mothers and families, and (5) NICU Physical Environment and Regulations. There is a need for medical staff training on awareness, communication, empathy, and other behaviors that might improve maternal (and parental) experiences in the NICU. The physical environment, including rules and regulations of the NICU, should be reexamined with family comfort in mind in addition to the clinical care of the infant.
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Patient outcomes for the chronically critically ill: special care unit versus intensive care unit.
Rudy, E B; Daly, B J; Douglas, S; Montenegro, H D; Song, R; Dyer, M A
1995-01-01
The purpose of this study was to compare the effects of a low-technology environment of care and a nurse case management case delivery system (special care unit, SCU) with the traditional high-technology environment (ICU) and primary nursing care delivery system on the patient outcomes of length of stay, mortality, readmission, complications, satisfaction, and cost. A sample of 220 chronically critically ill patients were randomly assigned to either the SCU (n = 145) or the ICU (n = 75). Few significant differences were found between the two groups in length of stay, mortality, or complications. However, the findings showed significant cost savings in the SCU group in the charges accrued during the study period and in the charges and costs to produce a survivor. The average total cost of delivering care was $5,000 less per patient in the SCU than in the traditional ICU. In addition, the cost to produce a survivor was $19,000 less in the SCU. Results from this 4-year clinical trial demonstrate that nurse case managers in a SCU setting can produce patient outcomes equal to or better than those in the traditional ICU care environment for long-term critically ill patients.
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Mitchell, Sarah; Dale, Jeremy
2015-04-01
The majority of children and young people who die in the United Kingdom have pre-existing life-limiting illness. Currently, most such deaths occur in hospital, most frequently within the intensive care environment. To explore the experiences of senior medical and nursing staff regarding the challenges associated with Advance Care Planning in relation to children and young people with life-limiting illnesses in the Paediatric Intensive Care Unit environment and opportunities for improvement. Qualitative one-to-one, semi-structured interviews were conducted with Paediatric Intensive Care Unit consultants and senior nurses, to gain rich, contextual data. Thematic content analysis was carried out. UK tertiary referral centre Paediatric Intensive Care Unit. Eight Paediatric Intensive Care Unit consultants and six senior nurses participated. Four main themes emerged: recognition of an illness as 'life-limiting'; Advance Care Planning as a multi-disciplinary, structured process; the value of Advance Care Planning and adverse consequences of inadequate Advance Care Planning. Potential benefits of Advance Care Planning include providing the opportunity to make decisions regarding end-of-life care in a timely fashion and in partnership with patients, where possible, and their families. Barriers to the process include the recognition of the life-limiting nature of an illness and gaining consensus of medical opinion. Organisational improvements towards earlier recognition of life-limiting illness and subsequent Advance Care Planning were recommended, including education and training, as well as the need for wider societal debate. Advance Care Planning for children and young people with life-limiting conditions has the potential to improve care for patients and their families, providing the opportunity to make decisions based on clear information at an appropriate time, and avoid potentially harmful intensive clinical interventions at the end of life. © The Author(s) 2015.
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Critical care unit design: a nursing perspective.
Williams, M
2001-11-01
The task of designing a new critical care unit is best accomplished with the input of people representing multiple disciplines including architects, engineers, physicians, nurses, and equipment manufacturers. It is imperative that the critical care nursing staff and management take an active role in planning the layout of the unit and patient rooms, as the nurses will be the bedside providers 24 hours a day. The new unit should be designed to offer efficient patient care as well as a healing, comfortable environment for both the patients and their families.
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Prevalence of health promotion programs in primary health care units in Brazil
Ramos, Luiz Roberto; Malta, Deborah Carvalho; Gomes, Grace Angélica de Oliveira; Bracco, Mário M; Florindo, Alex Antonio; Mielke, Gregore Iven; Parra, Diana C; Lobelo, Felipe; Simoes, Eduardo J; Hallal, Pedro Curi
2014-01-01
OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil. PMID:25372175
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Anåker, Anna; von Koch, Lena; Sjöstrand, Christina; Bernhardt, Julie; Elf, Marie
2017-01-01
Early mobilization and rehabilitation, multidisciplinary stroke expertise and comprehensive therapies are fundamental in a stroke unit. To achieve effective and safe stroke care, the physical environment in modern stroke units should facilitate the delivery of evidence-based care. Therefore, the purpose of this study was to explore patients' activities and interactions in a stroke unit before the reconstruction of the physical environment, while in a temporary location and after reconstruction. This case study examined a stroke unit as an integrated whole. The data were collected using a behavioral mapping technique at three different time points: in the original unit, in the temporary unit and in the new unit. A total of 59 patients were included. The analysis included field notes from observations of the physical environment and examples from planning and design documents. The findings indicated that in the new unit, the patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than the patients in the original unit. The reconstruction involved a change from a primarily multi-bed room design to single-room accommodations. In the new unit, the patients' lounge was located in a far corner of the unit with a smaller entrance than the patients' lounge in the old unit, which was located at the end of a corridor with a noticeable entrance. Changes in the design of the stroke unit may have influenced the patients' activities and interactions. This study raises the question of how the physical environment should be designed in the future to facilitate the delivery of health care and improve outcomes for stroke patients. This research is based on a case study, and although the results should be interpreted with caution, we strongly recommend that environmental considerations be included in future stroke guidelines.
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Nursing Unit Environment Associated with Provision of Language Services in Pediatric Hospices.
Lindley, Lisa C; Held, Mary L; Henley, Kristen M; Miller, Kathryn A; Pedziwol, Katherine E; Rumley, Laurie E
2017-04-01
Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization's structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.
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Nursing unit environment associated with provision of language services in pediatric hospices
Lindley, Lisa C.; Held, Mary L.; Henley, Kristen M.; Miller, Kathryn A.; Pedziwol, Katherine E.; Rumley, Laurie E.
2016-01-01
Background Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Methods Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1,251 pediatric hospice agencies. Variable selection was guided by Structural Contingency Theory, which posits that organizational effectiveness is dependent upon how well an organization’s structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. Results The majority of hospices provided translation services (74.9%) and interpreter services (87.1%). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Conclusions Findings indicate that nursing unit environment predict provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staff who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency, and ultimately reduce ethnic disparities in end-of-life care for children and their families. PMID:27059050
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Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes
ERIC Educational Resources Information Center
Molony, Sheila L.; Evans, Lois K.; Jeon, Sangchoon; Rabig, Judith; Straka, Leslie A.
2011-01-01
Background: Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. Purpose: To compare and contrast trajectories of at-homeness and health over…
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Use of active noise cancellation devices in caregivers in the intensive care unit.
Akhtar, S; Weigle, C G; Cheng, E Y; Toohill, R; Berens, R J
2000-04-01
Recent development of noise cancellation devices may offer relief from noise in the intensive care unit environment. This study was conducted to evaluate the effect of noise cancellation devices on subjective hearing assessment by caregivers in the intensive care units. Randomized, double-blind. Adult medical intensive care unit and pediatric intensive care unit of a teaching hospital. Caregivers of patients, including nurses, parents, respiratory therapists, and nursing assistants from a medical intensive care unit and pediatric intensive care, were enrolled in the study. Each participant was asked to wear the headphones, functional or nonfunctional noise cancellation devices, for a minimum of 30 mins. Subjective ambient noise level was assessed on a 10-point visual analog scale (VAS) before and during headphone use by each participant. Headphone comfort and the preference of the caregiver to wear the headphone were also evaluated on a 10-point VAS. Simultaneously, objective measurement of noise was done with a sound level meter using the decibel-A scale and at each of nine octave bands at each bedspace. The functional headphones significantly reduced the subjective assessment of noise by 2 (out of 10) VAS points (p < 0.05) in environments of equal objective noise profiles, based on decibel-A and octave band assessments. Noise cancellation devices improve subjective assessment of noise in caretakers. The benefit of these devices on hearing loss needs further evaluation in caregivers and critically ill patients.
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Dahl, Asa; Nyberg, Helene; Edéll-Gustafsson, Ulla
2003-10-01
Our knowledge of unstable critically ill patients placed in an inverse bed position on the neurointensive care unit (NICU) is fairly limited. The purpose of this study was to ascertain the variation in nurses' conceptions of the impact of clinical experiences on the care and working environments among patients with the head towards the centre of the room on an NICU. An important research question was: how is the nursing care of patients facing inwards on an NICU perceived? Interviews were conducted and analysed with 15 nurses, using the method of phenomenography. From a nursing perspective, four descriptive categories were found, which partly distinguished the nursing psychosocial environment from the physical environment. These were safety and security of mobile computer tomography (CT) on the NICU, availability and overview, integrated holistic view in an open nursing psychosocial environment and adaptation of practical equipment. In conclusion, inverse bed position is important for more individualised neurointensive nursing care among unstable patients subjected to frequent CT scans on the unit. More stable patients should be turned back to the traditional bed position in order to promote their recovery process. This new knowledge is important for the development of quality assurance, with regard to, amongst other things, the patient's dignity.
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Blake, Nancy; Leach, Linda Searle; Robbins, Wendy; Pike, Nancy; Needleman, Jack
2013-01-01
A healthy work environment can improve patient outcomes and registered nurse (RN) turnover. Creating cultures of retention and fostering healthy work environments are 2 major challenges facing nurse leaders today. Examine the effects of the healthy work environment (communication, collaboration, and leadership) on RN turnover from data collected from a research study. Descriptive, cross-sectional, correlational design. Pediatric critical care RNs from 10 pediatric intensive care units (PICU) completed the Practice Environment Scale of the Nursing Work Index Revised and a subscale of the Intensive Care Unit Nurse-Physician Communication Questionnaire. These staff nurses were asked whether they intend to leave their current job in the next 6 months. Statistical analysis included correlations, multiple linear regression, t tests (2-tailed), and 1-way analysis of variance. A total of 415 RNs completed the survey. There was a statistically significant relationship between leadership and the intent to leave (P < .05). There was also an inverse relationship between years of experience and intent to leave. None of the communication variables between RNs and among RNs and MDs or collaboration were significantly associated with PICU nurses' intention to leave. Effective leadership in the PICU is important to PICU RNs and significantly influences their decisions about staying in their current job.
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Sundberg, Fredrika; Olausson, Sepideh; Fridh, Isabell; Lindahl, Berit
2017-12-01
It has been known for centuries that environment in healthcare has an impact, but despite this, environment has been overshadowed by technological and medical progress, especially in intensive care. Evidence-based design is a concept concerning integrating knowledge from various research disciplines and its application to healing environments. The aim was to explore the experiences of nursing staff of working in an evidence-based designed ICU patient room. Interviews were carried out with eight critical care nurses and five assistant nurses and then subjected to qualitative content analysis. The experience of working in an evidence-based designed intensive care unit patient room was that the room stimulates alertness and promotes wellbeing in the nursing staff, fostering their caring activities but also that the interior design of the medical and technical equipment challenges nursing actions. The room explored in this study had been rebuilt in order to create and evaluate a healing environment. This study showed that the new environment had a great impact on the caring staffs' wellbeing and their caring behaviour. At a time when turnover in nurses is high and sick leave is increasing, these findings show the importance of interior design ofintensive care units. Copyright © 2017 Elsevier Ltd. All rights reserved.
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A taxonomy of nursing care organization models in hospitals
2012-01-01
Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an “ideal” nursing professional practice model described by some leaders in the contemporary nursing literature. While the two professional models appear closer to this ideal, the two functional models are farther removed. PMID:22929127
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Oximeter reliability in a subzero environment.
Macnab, A J; Smith, M; Phillips, N; Smart, P
1996-11-01
Pulse oximeters optimize care in the pre-hospital setting. As British Columbia ambulance teams often provide care in subzero temperatures, we conducted a study to determine the reliability of 3 commercially-available portable oximeters in a subzero environment. We hypothesized that there is no significant difference between SaO2 readings obtained using a pulse oximeter at room temperature and a pulse oximeter operating at sub-zero temperatures. Subjects were stable normothermic children in intensive care on Hewlett Packard monitors (control unit) at room temperature. The test units were packed in dry ice in an insulated bin (temperature - 15 degrees C to -30 degrees C) and their sensors placed on the subjects, contralateral to the control sensors. Data were collected simultaneously from test and control units immediately following validation of control unit values by co-oximetry (blood gas). No data were unacceptable. Two units (Propaq 106EC and Nonin 8500N) functioned well to < -15 degrees C, providing data comparable to those obtained from the control unit (p < 0.001). The Siemens Micro O2 did not function at the temperatures tested. Monitor users who require equipment to function in subzero environments (military, Coast Guard, Mountain Rescue) should ensure that function is reliable, and could test units using this method.
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Shaw, M; Singh, S
2015-04-01
Diagnostic error has implications for both clinical outcome and resource utilisation, and may often be traced to impaired data gathering, processing or synthesis because of the influence of cognitive bias. Factors inherent to the intensive/acute care environment afford multiple additional opportunities for such errors to occur. This article illustrates many of these with reference to a case encountered on our intensive care unit. Strategies to improve completeness of data gathering, processing and synthesis in the acute care environment are critically appraised in the context of early detection and amelioration of cognitive bias. These include reflection, targeted simulation training and the integration of social media and IT based aids in complex diagnostic processes. A framework which can be quickly and easily employed in a variety of clinical environments is then presented. © 2015 John Wiley & Sons Ltd.
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Daniels, Jacki M; Harrison, Tondi M
2016-01-01
Infants with complex congenital heart disease are at high risk for developmental delays. Although the etiology of these delays is multifactorial, the physical environment may be a contributory factor. Extensive studies have been conducted in neonatal intensive care units measuring environmental influences on development, resulting in policy and practice changes. Cardiothoracic intensive care units and cardiac step-down units are new environments in which newborns with heart disease receive care. No environmental studies have been conducted in units caring for newborn infants recovering from cardiac surgery. The aim of this study is to examine the environmental experience of a newborn infant with heart disease after surgical intervention within the first month of life. Measurements of illumination, sound levels, and sleep were recorded on 1 infant for 2 consecutive postoperative days in the cardiothoracic intensive care unit and 2 consecutive days in the step-down unit. Although average daily noise exposure remained below recommended guidelines on 3 of 4 days, the infant experienced intermittent periods of excessive noise (≥55 dBA) during 59 of 87 hours and 110 episodes of acute noise events greater than 70 dBA. Average daily light exposure was below the recommended guidelines. However, light levels were more than twice the recommended levels at multiple points daily. For each of the 4 observation days, the infant experienced 66 to 102 awakenings during sleep, and sleep durations were less than 30 minutes 90% of the time. This study provides the first report of potential environmental stressors in newborn infants cared for in cardiac specialty units. Excessive levels of light and noise as well as frequent interruptions for medical and nursing care may contribute to disorganized sleep and increased patient distress and may impact subsequent neurodevelopment. Studies are needed to identify potentially adverse aspects of the intensive caregiving environment for newborn infants who have undergone cardiac surgery.
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A step ahead: strategies for excellence in critical care nursing practice.
Albano, Amy; Elliott, Sheila; Lusardi, Paula; Scott, Susan; Thomas, Diane
2005-06-01
The adult intensive care unit (ICU) at Baystate Medical Center is a 24-bed medical-surgical-trauma ICU that provides high-quality care to critically ill patients. Collaboration and expertise among the nursing staff, intensivists, and interdisciplinary colleagues have contributed to its development into a Beacon Award-winning unit. Its primary goal is reflected in the unit's mission: "Care for our patients is guided by knowledge, motivated by compassion, and performed in collaboration with others." Common interests, values, and purposes have created an environment of communication that supports the delivery of exceptional critical care to patients and their families.
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Andersen, Gunn Robstad; Westgaard, Rolf H
2013-11-15
Ergonomic and work stress interventions rarely show long-term positive effect. The municipality participating in this study received orders from the Norwegian Labour Inspectorate due to an identified unhealthy level of time pressure, and responded by effectuating several work environment interventions. The study aim is to identify critical factors in the interaction between work environment interventions and independent rationalization measures in order to understand a potential negative interfering effect from concurrent rationalizations on a comprehensive work environment intervention. The study, using a historic prospective mixed-method design, comprised 6 home care units in a municipality in Norway (138 respondents, response rate 76.2%; 17 informants). The study included quantitative estimations, register data of sick leave, a time line of significant events and changes, and qualitative descriptions of employee appraisals of their work situation gathered through semi-structured interviews and open survey responses. The work environment interventions were in general regarded as positive by the home care workers. However, all units were simultaneously subjected to substantial contextual instability, involving new work programs, new technology, restructurings, unit mergers, and management replacements, perceived by the home care workers to be major sources of stress. Findings suggest that concurrent changes induced through rationalization resulted in negative exposure effects that negated positive work environment intervention effects, causing an overall deteriorated work situation for the home care workers. Establishment and active utilization of communication channels from workers to managers are recommended in order to increase awareness of putative harmful and interruptive effects of rationalization measures.
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2013-01-01
Background Ergonomic and work stress interventions rarely show long-term positive effect. The municipality participating in this study received orders from the Norwegian Labour Inspectorate due to an identified unhealthy level of time pressure, and responded by effectuating several work environment interventions. The study aim is to identify critical factors in the interaction between work environment interventions and independent rationalization measures in order to understand a potential negative interfering effect from concurrent rationalizations on a comprehensive work environment intervention. Methods The study, using a historic prospective mixed-method design, comprised 6 home care units in a municipality in Norway (138 respondents, response rate 76.2%; 17 informants). The study included quantitative estimations, register data of sick leave, a time line of significant events and changes, and qualitative descriptions of employee appraisals of their work situation gathered through semi-structured interviews and open survey responses. Results The work environment interventions were in general regarded as positive by the home care workers. However, all units were simultaneously subjected to substantial contextual instability, involving new work programs, new technology, restructurings, unit mergers, and management replacements, perceived by the home care workers to be major sources of stress. Findings suggest that concurrent changes induced through rationalization resulted in negative exposure effects that negated positive work environment intervention effects, causing an overall deteriorated work situation for the home care workers. Conclusions Establishment and active utilization of communication channels from workers to managers are recommended in order to increase awareness of putative harmful and interruptive effects of rationalization measures. PMID:24238560
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40 CFR 264.603 - Post-closure care.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Post-closure care. 264.603 Section 264.603 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED... treatment or storage unit has contaminated soils or ground water that cannot be completely removed or...
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The critical care air transport program.
Beninati, William; Meyer, Michael T; Carter, Todd E
2008-07-01
The critical care air transport team program is a component of the U.S. Air Force Aeromedical Evacuation system. A critical care air transport team consists of a critical care physician, critical care nurse, and respiratory therapist along with the supplies and equipment to operate a portable intensive care unit within a cargo aircraft. This capability was developed to support rapidly mobile surgical teams with high capability for damage control resuscitation and limited capacity for postresuscitation care. The critical care air transport team permits rapid evacuation of stabilizing casualties to a higher level of care. The aeromedical environment presents important challenges for the delivery of critical care. All equipment must be tested for safety and effectiveness in this environment before use in flight. The team members must integrate the current standards of care with the limitation imposed by stresses of flight on their patient. The critical care air transport team capability has been used successfully in a range of settings from transport within the United States, to disaster response, to support of casualties in combat.
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A comparison of salary-wage and hourly-wage acute care nursing units: a pilot study.
Hickey, Rosa G; Buchko, Barbara L; Coe, Paula F; Woods, Anne B
2015-05-01
This pilot study examined differences in RN perception of the professional practice environment and financial indicators between salary-wage and hourly-wage compensation models. There is a dearth of current information regarding use of salary-wage models for compensation for direct care nurses. A descriptive, comparative design was used to examine the Revised Professional Practice Environment Scale (RPPE) and financial indicators of nurses in a nonprofit healthcare system over a 6-month period. Mean scores on the RPPE were significantly lower for hourly-wage RNs, and the hourly-wage model resulted in a 1.2% additional cost for overtime hours compared with the fixed cost of the salary-wage model. Nurses in an hourly-wage unit reported a significantly lower perception of the clinical practice environment than did their peers in a salary-wage unit, indicating that professional practice perceptions in a salary-wage unit may provide a more effective professional practice environment. Financial analysis resulted in a budget-neutral impact.
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Characteristics of the Nursing Practice Environment Associated With Lower Unit-Level RN Turnover.
Nelson-Brantley, Heather V; Park, Shin Hye; Bergquist-Beringer, Sandra
2018-01-01
The aim of this study is to examine characteristics of the nursing practice environment associated with lower RN turnover. Identifying characteristics of the practice environment that contribute to lower RN turnover is important for meeting the national quality strategy priority of reducing healthcare costs. Data from 1002 adult care units in 162 National Database of Nursing Quality Indicators participating hospitals were analyzed using multivariate linear regression. The Practice Environment Scale of the Nursing Work Index was used to measure practice environment characteristics. RN turnover was measured at the unit level. Nursing units with higher overall ratings of the nursing practice environment had lower rates of RN turnover. Units with higher RN perceived staffing and resource adequacy experienced significantly lower RN turnover. Unit managers and hospital administrators should consider RN perception of staffing and resource adequacy and the overall practice environment when developing targeted strategies for decreasing RN turnover.
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Wang, Zhe; Downs, Betsy; Farell, Ashley; Cook, Kimberly; Hourihan, Peter; McCreery, Shimby
2013-01-01
To investigate the role of a dedicated service corridor in intensive care unit (ICU) noise control and staff stress and satisfaction. Shared corridors immediately adjacent to patient rooms are generally noisy due to a variety of activities, including service deliveries and pickups. The strategy of providing a dedicated service corridor is thought to reduce noise for patient care, but the extent to which it actually contributes to noise reduction in the patient care environment and in turn improves staff performance has not been previously documented. A before-and-after comparison was conducted in an adult cardiac ICU. The ICU was relocated from a traditional hospital environment to a new addition with a dedicated service corridor. A total of 118 nursing staff participated in the surveys regarding pre-move and post-move environmental comfort, stress, and satisfaction in the previous and new units. Acoustical measures of noise within the new ICU and a control environment of the previous unit were collected during four work days, along with on-site observations of corridor traffic. Independent and paired sample t-tests of survey data showed that the perceived noise level was lower and staff reported less stress and more satisfaction in the new ICU (p < 0.01). Analyses of acoustical data confirmed that the new ICU was significantly quieter (p < 0.02). Observations revealed how the service corridor impacted patient care services and traffic. The addition of a dedicated service corridor works in the new unit for improving noise control and staff stress and satisfaction. Critical care/intensive care, noise, satisfaction, staff, work environment.
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Factors Influencing Active Family Engagement in Care Among Critical Care Nurses.
Hetland, Breanna; Hickman, Ronald; McAndrew, Natalie; Daly, Barbara
2017-01-01
Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing work-flow partially mediated the relationships between the intensive care unit environment and nurses' attitudes and between patient acuity and nurses' attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit. ©2017 American Association of Critical-Care Nurses.
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Ventilator-associated pneumonia improvement program.
Murray, Theresa; Goodyear-Bruch, Caryl
2007-01-01
Ventilator-associated pneumonia (VAP) is a significant clinical problem associated with increased intensive care unit and hospital length of stay and substantial increases in delivery cost and associated morbidity and mortality. With system changes and management of the environment of care, the incidence of VAP was reduced in seven of our intensive care units across the system. Steps necessary to reduce VAP were identified and put into place in all the intensive care units. Patient positioning, oral care, nutrition, and management of comfort drugs are a few of the processes addressed to reduce VAP. Standardization of these essential care practices can reduce the incidence of this nosocomial infection and its associated increases in the cost of care delivery and mortality.
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Chaudhury, Habib; Hung, Lillian; Rust, Tiana; Wu, Sarah
2017-10-01
Purpose Drawing on therapeutic physical environmental design principles and Kitwood's theoretical view of person-centered care, this study examined the impact of environmental renovations in dining spaces of a long-term care facility on residents' mealtime experience and staff practice in two care units. Method The research design involved pre- and post-renovation ethnographic observations in the dining spaces of the care units and a post-renovation staff survey. The objective physical environmental features pre- and post-renovations were assessed with a newly developed tool titled Dining Environment Audit Protocol. We collected observational data from 10 residents and survey responses from 17 care aides and nurses. Findings Based on a systematic analysis of observational data and staff survey responses, five themes were identified: (a) autonomy and personal control, (b) comfort of homelike environment, (c) conducive to social interaction, (d) increased personal support, and (e) effective teamwork. Implications Although the physical environment can play an influential role in enhancing the dining experience of residents, the variability in staff practices reveals the complexity of mealtime environment and points to the necessity of a systemic approach to foster meaningful culture change.
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Hamilton, Jessica; Verrall, Tanya; Maben, Jill; Griffiths, Peter; Avis, Kyla; Baker, G Ross; Teare, Gary
2014-12-19
Releasing Time to Care: The Productive Ward™ (RTC) is a method for conducting continuous quality improvement (QI). The Saskatchewan Ministry of Health mandated its implementation in Saskatchewan, Canada between 2008 and 2012. Subsequently, a research team was developed to evaluate its impact on the nursing unit environment. We sought to explore the influence of the unit's existing QI capacity on their ability to engage with RTC as a program for continuous QI. We conducted interviews with staff from 8 nursing units and asked them to speak about their experience doing RTC. Using qualitative content analysis, and guided by the Organizing for Quality framework, we describe the existing QI capacity and impact of RTC on the unit environment. The results focus on 2 units chosen to highlight extreme variation in existing QI capacity. Unit B was characterized by a strong existing environment. RTC was implemented in an environment with a motivated manager and collaborative culture. Aided by the structural support provided by the organization, the QI capacity on this unit was strengthened through RTC. Staff recognized the potential of using the RTC processes to support QI work. Staff on unit E did not have the same experience with RTC. Like unit B, they had similar structural supports provided by their organization but they did not have the same existing cultural or political environment to facilitate the implementation of RTC. They did not have internal motivation and felt they were only doing RTC because they had to. Though they had some success with RTC activities, the staff did not have the same understanding of the methods that RTC could provide for continuous QI work. RTC has the potential to be a strong tool for engaging units to do QI. This occurs best when RTC is implemented in a supporting environment. One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects. Use of an established framework, like Organizing for Quality, could highlight the distinctive supports needed in particular care environments to increase the likelihood of successful engagement.
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Effects of work environment on patient and nurse outcomes.
Copanitsanou, Panagiota; Fotos, Nikolaos; Brokalaki, Hero
2017-02-09
Several parameters of the nurse's work environment lead to fewer patient complications and lower nurse burnout. The aim of this systematic review was the analysis of research data related to the effect of nurses' work environments on outcomes for both patients and nurses. Medline was searched by using keywords: 'working conditions', 'work environment', 'nurses', 'nursing staff', 'patients', 'outcomes'. In total, 10 studies were included, of which 4 were cross-sectional and the remaining were descriptive correlational studies. Patients who were hospitalised in units with good work environments for the nurses were more satisfied with the nursing care than the patients in units with poor work environments. Nurses who perceived their work environment to be good experienced higher job satisfaction and lower rates of burnout syndrome. A good work environment constitutes a determinant factor for high care quality and, at the same time, relates to improved outcomes for the nurses.
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Two Types of Learning Environment: Enabling and Constraining a Study of Care Work
ERIC Educational Resources Information Center
Ellstrom, Eva; Ekholm, Bodil; Ellstrom, Per-Erik
2008-01-01
Purpose: The purpose of this paper is to first elaborate on the notion of a learning environment based on an empirical study of care work. Second, to explore how aspects of a learning environment may differ between and within units in the same organization, and how to understand and explain such differences. Design/methodology/approach: The study…
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Transforming Care at the Bedside (TCAB): enhancing direct care and value-added care.
Dearmon, Valorie; Roussel, Linda; Buckner, Ellen B; Mulekar, Madhuri; Pomrenke, Becky; Salas, Sheri; Mosley, Aimee; Brown, Stephanie; Brown, Ann
2013-05-01
The purpose of this study was to examine the effectiveness of a Transforming Care at the Bedside initiative from a unit perspective. Improving patient outcomes and nurses' work environments are the goals of Transforming Care at the Bedside. Transforming Care at the Bedside creates programs of change originating at the point of care and directly promoting engagement of nurses to transform work processes and quality of care on medical-surgical units. This descriptive comparative study draws on multiple data sources from two nursing units: a Transforming Care at the Bedside unit where staff tested, adopted and implemented improvement ideas, and a control unit where staff continued traditional practices. Change theory provided the framework for the study. Direct care and value-added care increased on Transforming Care at the Bedside unit compared with the control unit. Transforming Care at the Bedside unit decreased in incidental overtime. Nurses reported that the process challenged old ways of thinking and increased nursing innovations. Hourly rounding, bedside reporting and the use of pain boards were seen as positive innovations. Evidence supported the value-added dimension of the Transforming Care at the Bedside process at the unit level. Nurses recognized the significance of their input into processes of change. Transformational leadership and frontline projects provide a vehicle for innovation through application of human capital. © 2012 Blackwell Publishing Ltd.
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Safety and Security Concerns of Nurses Working in the Intensive Care Unit: A Qualitative Study.
Keys, Yolanda; Stichler, Jaynelle F
Intensive care units (ICUs) exist to serve as a safe place for critically ill patients to receive care from skilled practitioners. In this qualitative study, ICU nurses shared their perspectives on elements that promote safety and security on their units. After obtaining institutional review board approval, participants participated in telephone interviews with a nurse researcher who has experience as a bedside ICU nurse. Five categories and 14 themes were identified and then confirmed using member checking. Results indicate that participants prefer to provide care in ICUs with no more than 12 to 14 beds and provide the following: visibility of patients and coworkers; more than 1 way to exit; and can be locked in case of emergency or threat. Nearly all respondents mentioned adequate staffing as the most important attribute of a safe, secure care environment for patients and families. More research is needed to identify design features that make the most impact on providing a safe, secure ICU environment.
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Recovery-based services in a psychiatric intensive care unit - the consumer perspective.
Ash, David; Suetani, Shuichi; Nair, Jayakrishnan; Halpin, Matthew
2015-10-01
To describe the implementation of recovery-based practice into a psychiatric intensive care unit, and report change in seclusion rates over the period when these changes were introduced (2011-2013). Recovery-based practices including collaborative care, safety care plans, a comfort room, and debriefing after coercive interventions were introduced. A carer consultant was employed. A restraint and seclusion review committee, chaired by a peer worker, was established. A consumer exit interview was introduced and these data were collected, reviewed by staff and the peer worker and used to improve the ward environment. Rates of seclusion were measured during the period when recovery-based practices were introduced. Consumer feedback indicated that positive aspects of the psychiatric intensive care unit included approachable, helpful staff and completion of a safety care plan. Negative aspects included lack of involvement in decisions about admission and about medications, the non-smoking policy, and being placed in seclusion or restraint. There was a significant reduction in the number of consumers secluded and the total number of seclusions. Recovery principles can be successfully introduced in a psychiatric intensive care unit environment. Introduction of recovery based practice was associated with a reduction in seclusion. © The Royal Australian and New Zealand College of Psychiatrists 2015.
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40 CFR 265.117 - Post-closure care and use of property.
Code of Federal Regulations, 2010 CFR
2010-07-01
.... 265.117 Section 265.117 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID.... (a)(1) Post-closure care for each hazardous waste management unit subject to the requirements of... this part. (2) Any time preceding closure of a hazardous waste management unit subject to post-closure...
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40 CFR 264.117 - Post-closure care and use of property.
Code of Federal Regulations, 2010 CFR
2010-07-01
.... 264.117 Section 264.117 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... for each hazardous waste management unit subject to the requirements of §§ 264.117 through 264.120... preceding partial closure of a hazardous waste management unit subject to post-closure care requirements or...
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Compassion Fatigue and the Healthy Work Environment.
Kelly, Lesly; Todd, Michael
2017-01-01
Burnout is a concern for critical care nurses in high-intensity environments. Studies have highlighted the importance of a healthy work environment in promoting optimal nurse and patient outcomes, but research examining the relationship between a healthy work environment and burnout is limited. To examine how healthy work environment components relate to compassion fatigue (eg, burnout, secondary trauma) and compassion satisfaction. Nurses (n = 105) in 3 intensive care units at an academic medical center completed a survey including the Professional Quality of Life and the American Association of Critical-Care Nurses' Healthy Work Environment standards. Regression models using each Healthy Work Environment component to predict each outcome, adjusting for background variables, showed that the 5 Healthy Work Environment components predicted burnout and that meaningful recognition and authentic leadership predicted compassion satisfaction. Findings on associations between healthy work environment standards and burnout suggest the potential importance of implementing the American Association of Critical-Care Nurses' Healthy Work Environment standards as a mechanism for decreasing burnout. ©2017 American Association of Critical-Care Nurses.
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HIPP lead to self-health: healthy infection prevention practices in intensive care units.
Grota, Patti G; Meinzen, Sarah; Burleson-Rine, Penny
2009-01-01
Healthy infection prevention practices (HIPP) include hand hygiene, respiratory etiquette, environmental cleanliness, and use of personal protective equipment. These healthy practices are most used to protect individuals against exposure to bacterial and viral infections in the workplace, as well as in the home. Most often these infection prevention behaviors in critical care units are promoted to protect the patient from healthcare-associated infections. Yet, these practices are just as important to the health of the critical care nurse. Self-health in the workplace is essential to creating a healthy workplace environment, which is the goal of many intensive care units today. The benefits of creating a healthy work environment are improvement of patient/nurse satisfaction and nurse retention. HIPP reduce the risk of the critical care nurse's exposure to microbial pathogens such as methicillin-resistant Staphylococcus aureus and influenza. Pathogens that cause infections may contaminate the hands, the clothing, equipment, and blood, putting the nurse at risk for unhealthy hands, unhealthy flora, and unhealthy blood. The intensive care nurse is encouraged to embrace HIPP to nurture self, as well as protect the patient.
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Corchia, Carlo; Fanelli, Simone; Gagliardi, Luigi; Bellù, Roberto; Zangrandi, Antonello; Persico, Anna; Zanini, Rinaldo
2016-04-02
Neonatal units' volume of activity, and other quantitative and qualitative variables, such as staffing, workload, work environment, care organization and geographical location, may influence the outcome of high risk newborns. Data about the distribution of these variables and their relationships among Italian neonatal units are lacking. Between March 2010-April 2011, 63 neonatal intensive care units adhering to the Italian Neonatal Network participated in the SONAR Nurse study. Their main features and work environment were investigated by questionnaires compiled by the chief and by physicians and nurses of each unit. Twelve cross-sectional monthly-repeated surveys on different shifts were performed, collecting data on number of nurses on duty and number and acuity of hospitalized infants. Six hundred forty five physicians and 1601 nurses compiled the questionnaires. In the cross-sectional surveys 702 reports were collected, with 11082 infant and 3226 nurse data points. A high variability was found for units' size (4-50 total beds), daily number of patients (median 14.5, range 3.4-48.7), number of nurses per shift (median 4.2, range 0.7-10.8) and number of team meetings per month. Northern regions performed better than Central and Southern regions for frequency of training meetings, qualitative assessment of performance, motivation within the unit and nursing work environment; mean physicians' and nurses' age increased moving from North to South. After stratification by terciles of the mean daily number of patients, the median number of nurses per shift increased at increasing volume of activity, while the opposite was found for the nurse-to-patient ratio adjusted by patients' acuity. On average, in units belonging to the lower tercile there was 1 nurse every 2.5 patients, while in those belonging to the higher tercile the ratio was 1 nurse every 5 patients. In Italy, there is a high variability in organizational characteristics and work environment among neonatal units and an uneven distribution of human resources in relation to volume of activity, suggesting that the larger the unit the greater the workload for each nurse. Urgent modifications in planning and organization of services are needed in order to pursue more efficient, homogeneous and integrated regionalized neonatal care systems.
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Everyday practices at the medical ward: a 16-month ethnographic field study
2012-01-01
Background Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships. Methods Ethnographic fieldwork was conducted over a 16-month period (between 2009 and 2011) by two researchers working in parallel in a Swedish coronary care unit. Observations, informal talks and formal interviews took place with registered nurses, assistant nurses, physicians and patients in the coronary care unit. The formal interviews were conducted with six registered nurses (five female, one male) including the chief nurse manager, three assistant nurses (all female), two cardiologists and three patients (one female, two male). Results We identified the structures that either promoted or counteracted the various actions and relationships of patients and healthcare professionals. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialogue, restricted the choices available to both patients and healthcare professionals. This resulted in feelings of guilt, predominantly on the part of the registered nurses. Conclusions The care environment restricted the choices available to both patients and healthcare professionals. This may result in increased moral stress among those in multi-professional teams who work in the grey area between biomedical and person-centred care. PMID:22748059
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Hanson, Daphne
Central line-associated bloodstream infections (CLABSIs) prove to be detrimental to both the patient and the hospital. The present study was a quality improvement training project to affect CLABSI rates in the cardiac intensive care unit in the context of a caring-healing environment, and contributed to a culture of patient safety to empower staff to speak up if they see a breach in protocol at any time. A caring-healing environment encouraged staff to take the extra time and precautions to prevent infections for their patients and created a better quality of care for the patients.
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Abnormal environmental light exposure in the intensive care environment.
Fan, Emily P; Abbott, Sabra M; Reid, Kathryn J; Zee, Phyllis C; Maas, Matthew B
2017-08-01
We sought to characterize ambient light exposure in the intensive care unit (ICU) environment to identify patterns of light exposure relevant to circadian regulation. A light monitor was affixed to subjects' bed at eye level in a modern intensive care unit and continuously recorded illuminescence for at least 24h per subject. Blood was sampled hourly and measured for plasma melatonin. Subjects underwent hourly vital sign and bedside neurologic assessments. Care protocols and the ICU environment were not modified for the study. A total of 67,324 30-second epochs of light data were collected from 17 subjects. Light intensity peaked in the late morning, median 64.1 (interquartile range 19.7-138.7) lux. The 75th percentile of light intensity exceeded 100lx only between 9AM and noon, and never exceeded 150lx. There was no correlation between melatonin amplitude and daytime, nighttime or total light exposure (Spearman's correlation coefficients all <0.2 and p>0.5). Patients' environmental light exposure in the intensive care unit is consistently low and follows a diurnal pattern. No effect of nighttime light exposure was observed on melatonin secretion. Inadequate daytime light exposure in the ICU may contribute to abnormal circadian rhythms. Copyright © 2017 Elsevier Inc. All rights reserved.
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Outbreaks in Health Care Settings.
Sood, Geeta; Perl, Trish M
2016-09-01
Outbreaks and pseudo-outbreaks in health care settings can be complex and should be evaluated systematically using epidemiologic tools. Laboratory testing is an important part of an outbreak evaluation. Health care personnel, equipment, supplies, water, ventilation systems, and the hospital environment have been associated with health care outbreaks. Settings including the neonatal intensive care unit, endoscopy, oncology, and transplant units are areas that have specific issues which impact the approach to outbreak investigation and control. Certain organisms have a predilection for health care settings because of the illnesses of patients, the procedures performed, and the care provided. Copyright © 2016 Elsevier Inc. All rights reserved.
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Rosbergen, Ingrid Cm; Grimley, Rohan S; Hayward, Kathryn S; Walker, Katrina C; Rowley, Donna; Campbell, Alana M; McGufficke, Suzanne; Robertson, Samantha T; Trinder, Janelle; Janssen, Heidi; Brauer, Sandra G
2017-11-01
To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. Controlled before-after pilot study. An acute stroke unit in a regional Australian hospital. Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. The enriched environment group ( n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in 'any' activity (71% vs. 58%, P = 0.005) compared to the usual care group ( n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). Embedding an enriched environment in an acute stroke unit increased activity in stroke patients.
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Transcultural comparison of hospital and hospice as caring environments for dying patients.
Gates, M F
1991-01-01
Leininger's nursing Theory of Cultural Care Diversity and Universality provided the framework for this comparative study of two environments for persons who are dying; namely a hospital oncology unit and a free-standing hospice unit. Analysis of data from ethnographic and ethnonursing research methods including unstructured interviews, observation-participation, and field journal materials yielded contrasts with two settings. The presence of a caring atmosphere/ambience was apparent in both the hospital and hospice. Universal patterns common to both were: caring beliefs and practices of staff; identification of each setting as "community" or "home"; and multiple symbolic uses of humor and food. Diversities included hierarchical organizational structure and cure orientation in the hospital; interdisciplinary collaboration and care orientation in hospice; more pronounced use of touch as a caring modality; and greater evidence of symbolism and ritual related to death and dying in hospice. Adoption of the cultural care modes of accommodation, repatterning, and maintenance are suggested in promoting a caring atmosphere wherever dying patients are served.
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Lundgren, Dan; Ernsth Bravell, Marie; Börjesson, Ulrika; Kåreholt, Ingemar
2018-06-01
This study examines the association between nursing assistants' perceptions of their psychosocial work environment and satisfaction among older people receiving care in nursing homes and home care. Cross-sectional surveys were conducted among people receiving care ( N = 1,535) and nursing assistants ( N = 1,132) in 45 nursing homes and 21 home care units within municipal old-age care. Better psychosocial work environment was related to higher satisfaction in old-age care among the recipients. Significant and stronger associations were more common in nursing homes than in home care. Perception of mastery and positive challenges at work were associated with higher recipient satisfaction both in home care and in nursing homes: social climate, perception of group work, perception of mastery, and positive challenges at work only in nursing homes. Findings suggest that recipient satisfaction may be increased by improving the psychosocial work environment for nursing assistants, both in nursing homes and in home care.
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Designing a low cost bedside workstation for intensive care units.
Michel, A.; Zörb, L.; Dudeck, J.
1996-01-01
The paper describes the design and implementation of a software architecture for a low cost bedside workstation for intensive care units. The development is fully integrated into the information infrastructure of the existing hospital information system (HIS) at the University Hospital of Giessen. It provides cost efficient and reliable access for data entry and review from the HIS database from within patient rooms, even in very space limited environments. The architecture further supports automatical data input from medical devices. First results from three different intensive care units are reported. PMID:8947771
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Servel, A-C; Rideau Batista Novais, A
2016-09-01
The quality of the environment is an essential point in the care of preterm newborns. The design of neonatal intensive care units (NICUs) (open-bay, single-patient room, single-family room) directly affects both the preterm newborns and their caregivers (parents, healthcare staff). The aim of this systematic review was to evaluate the impact of single-family rooms on the preterm newborn, its parents, and the staff. Single-family rooms improve outcome for the preterm newborn, with increasing parental involvement and better control of the environment (fewer inappropriate stimulations such as high levels of noise and illumination). This kind of NICU design also improves parental and staff satisfaction. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
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Quality Improvement Process in a Large Intensive Care Unit: Structure and Outcomes.
Reddy, Anita J; Guzman, Jorge A
2016-11-01
Quality improvement in the health care setting is a complex process, and even more so in the critical care environment. The development of intensive care unit process measures and quality improvement strategies are associated with improved outcomes, but should be individualized to each medical center as structure and culture can differ from institution to institution. The purpose of this report is to describe the structure of quality improvement processes within a large medical intensive care unit while using examples of the study institution's successes and challenges in the areas of stat antibiotic administration, reduction in blood product waste, central line-associated bloodstream infections, and medication errors. © The Author(s) 2015.
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Wong, Pauline; Liamputtong, Pranee; Koch, Susan; Rawson, Helen
2017-12-01
To discuss families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit. The overwhelming emotions associated with the unexpected admission of a relative to an intensive care unit are often due to the uncertainty surrounding the condition of their critically ill relative. There is limited in-depth understanding of the nature of uncertainty experienced by families in intensive care, and interventions perceived by families to minimise their uncertainty are not well documented. Furthermore, the interrelationships between factors, such as staff-family interactions and the intensive care unit environment, and its influence on families' uncertainty particularly in the context of the Australian healthcare system, are not well delineated. A grounded theory methodology was adopted for the study. Data were collected between 2009-2013, using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit in Australia. This paper describes the families experiences of heightened emotional vulnerability and uncertainty when a relative is admitted unexpectedly to the intensive care unit. Families uncertainty is directly influenced by their emotional state, the foreign environment and perceptions of being 'kept in the dark', as well as the interrelationships between these factors. Staff are offered an improved understanding of the barriers to families' ability to regain control, guided by a grounded theory of family resilience in the intensive care unit. The findings reveal in-depth understanding of families' uncertainty in intensive care. It suggests that intensive care unit staff need to focus clinical interventions on reducing factors that heighten their uncertainty, while optimising strategies that help alleviate it. Families are facilitated to move beyond feelings of helplessness and loss of control, and cope better with their situation. © 2017 John Wiley & Sons Ltd.
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Andrews, B C; Kaye, J; Bowcutt, M; Campbell, J
2001-01-01
This study examines the consequences of adding a geriatric subacute unit to the traditional health care mix offered by a nonprofit hospital. Historically, geriatric health care offerings have been limited to either acute care units or long-term care facilities. The study's findings demonstrate that the addition of a subacute unit that is operated by an interdisciplinary team is a competitively rational move for two reasons. First, it provides a continuum of care that integrates services and departments, thereby reducing costs. Second, it provides a supportive environment for patients and their families. As a consequence patients have a higher probability of returning home than patients who are assigned to more traditional modes of care.
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Rippin, Allyn S; Zimring, Craig; Samuels, Owen; Denham, Megan E
2015-01-01
This comparative study of two adult neuro critical care units examined the impact of patient- and family-centered design on nurse-family interactions in a unit designed to increase family involvement. A growing evidence base suggests that the built environment can facilitate the delivery of patient- and family-centered care (PFCC). However, few studies examine how the PFCC model impacts the delivery of care, specifically the role of design in nurse-family interactions in the adult intensive care unit (ICU) from the perspective of the bedside nurse. Two neuro ICUs with the same patient population and staff, but with different layouts, were compared. Structured observations were conducted to assess changes in the frequency, location, and content of interactions between the two units. Discussions with staff provided additional insights into nurse attitudes, perceptions, and experiences caring for families. Nurses reported challenges balancing the needs of many stakeholders in a complex clinical environment, regardless of unit layout. However, differences in communication patterns between the clinician- and family-centered units were observed. More interactions were observed in nurse workstations in the PFCC unit, with most initiated by family. While the new unit was seen as more conducive to the delivery of PFCC, some nurses reported a loss of workspace control. Patient- and family-centered design created new spatial and temporal opportunities for nurse-family interactions in the adult ICU, thus supporting PFCC goals. However, greater exposure to unplanned family encounters may increase nurse stress without adequate spatial and organizational support. © The Author(s) 2015.
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Changes to nurses' practice environment over time.
Roche, Michael A; Duffield, Christine; Friedman, Sarah; Twigg, Di; Dimitrelis, Sofia; Rowbotham, Samantha
2016-07-01
To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. Positive nurse practice environments have been linked to nurse retention and care quality outcomes. The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared. On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period. The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline. Managers need to apply existing evidence to improve nurse practice environments and manage instability. © 2016 John Wiley & Sons Ltd.
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Review of noise in neonatal intensive care units regional analysis
NASA Astrophysics Data System (ADS)
Alvarez Abril, A.; Terrón, A.; Boschi, C.; Gómez, M.
2007-11-01
This work is about the problem of noise in neonatal incubators and in the environment in the neonatal intensive care units. Its main objective is to analyse the impact of noise in hospitals of Mendoza and La Rioja. Methodology: The measures were taken in different moments in front of higher or lower severity level in the working environment. It is shown that noise produces severe damages and changes in the behaviour and the psychological status of the new born babies. Results: The noise recorded inside the incubators and the neonatal intensive care units together have many components but the noise of motors, opening and closing of access gates have been considered the most important ones. Values above 60 db and and up to 120 db in some cases were recorded, so the need to train the health staff in order to manage the new born babies, the equipment and the instruments associated with them very carefully is revealed.
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Bellagamba, Gauthier; Gionta, Guillaume; Senergue, Julie; Bèque, Christine; Lehucher-Michel, Marie-Pascale
2015-01-01
This study measures the association between hospital staff's job strain (JS), mental quality of life (MQL) and how they are influenced by the organization models within emergency and critical care units. This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL. Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employer's efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score. If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
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Current provision of care for older persons in A & E units in the UK.
Howe, C A
1998-10-01
This study investigates the state of care for older persons within Accident and Emergency (A & E) units in the UK. As the proportion of older persons in the population continues to inexorably increase, A & E units will be expected to cope with a greater number of older people than ever before. Are they prepared for this increase, and do they possess the skills, knowledge and environment to care adequately for older people and the many special problems they present? One hundred A & E units were surveyed by a postal questionnaire consisting of a benchmark of best practice deemed by literature search and expert opinion to be important in caring for older persons in A & E. The data produced gives an overall picture of the current provision of care for older persons in A & E units, and indicates to fellow A & E nursing professionals where current performance may be improved.
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Poveda Andrés, J L; García Gómez, C; Hernández Sansalvador, M; Valladolid Walsh, A
2003-01-01
To determine monetary impact when traditional drug floor stocks are replaced by Automated Drug Dispensing Systems (ADDS) in the Medical Intensive Care Unit, Surgical Intensive Care Unit and the Emergency Room. We analysed four different flows considered to be determinant when implementing ADDS in a hospital environment: capital investment, staff costs, inventory costs and costs related to drug use policies. Costs were estimated by calculation of the current net value. Its analysis shows that those expenses derived from initial investment are compensated by the three remaining flows, with costs related to drug use policies showing the most substantial savings. Five years after initial investment, global cash-flows have been estimated at 300.525 euros. Replacement of traditional floor stocks by ADDS in the Medical Intensive Care Unit, Surgery Intensive Care Unit and the Emergency Room produces a positive benefit/cost ratio (1.95).
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Grathwohl, Kurt W; Venticinque, Steven G
2008-07-01
Critical care in the U.S. military has significantly evolved in the last decade. More recently, the U.S. military has implemented organizational changes, including the use of multidisciplinary teams in austere environments to improve outcomes in severely injured polytrauma combat patients. Specifically, organizational changes in combat support hospitals located in combat zones during Operation Iraqi Freedom have led to decreased intensive care unit mortality and length of stay as well as resource use. These changes were implemented without increases in logistic support or the addition of highly technologic equipment. The mechanism for improvement in mortality is likely attributable to the adherence of basic critical care medicine fundamentals. This intensivist-directed team model provides sophisticated critical care even in the most austere environments. To optimize critically injured patients' outcomes, intensive care organizational models similar to the U.S. military, described in this article, can possibly be adapted to those of civilian care during disaster management to meet the challenges of emergency mass critical care.
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ERIC Educational Resources Information Center
Lakatos, Patricia P.; Matic, Tamara; Carson, Melissa C.; Williams, Marian E.
2017-01-01
Infants are born primed to develop attachment relationships. However, when infants are hospitalized in the neonatal intensive care unit at birth, the stress and trauma associated with the highly specialized medical environment can threaten the development of a nurturing and secure caregiving relationship. Infant mental health is an evidence-based…
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Levy, Mitchell M
2004-07-01
There are certainly many coping behaviors that may assist ICU caregivers in the process of caring for themselves. Staff support groups,regular interdisciplinary meetings to discuss difficult cases,and bringing trained personnel into the intensive care unit (ICU)environment to offer staff training in communication and conflict resolution skills have been suggested as methods for alleviating caregiver stress. Combining these as well as other tools with a deeper look at the caregiver-patient relationship are important building blocks for creating a sane, healthy environment in the ICU. Over the next years, as the population ages, and as technologic advances continue, the critical care units will play an even more prominent role in health care. Given the threat posed by the severe nursing shortage, it becomes apparent that, to prepare for this increased need for critical care services, efforts must be directed to identify the sources of distress for ICU caregivers and develop focused training programs that alleviate the inevitably strains and pressures that arise in the process of compassionate caring for the critically ill.
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ERIC Educational Resources Information Center
Robison, Julie; Curry, Leslie; Gruman, Cynthia; Porter, Martha; Henderson, Charles R., Jr.; Pillemer, Karl
2007-01-01
Purpose: This article reports the results of a randomized, controlled evaluation of Partners in Caregiving in a Special Care Environment, an intervention designed to improve communication and cooperation between staff and families of residents in nursing home dementia programs. Design and Methods: Participants included 388 family members and 384…
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Evaluation and comparison of health care Work Environment Scale in military settings.
Maloney, J P; Anderson, F D; Gladd, D L; Brown, D L; Hardy, M A
1996-05-01
The purpose of this study was to describe health care providers' perceptions of their work environment at a large U.S. Army medical center, and to compare the findings to other military medical centers. The sample (N = 112) consisted of the professional nursing staff working on the nine inpatient units. The Work Environmental Scale (WES) was used to measure perceptions of the workplace relative to gender, position (head nurses, staff nurses, and agency nurses), specialty nursing (intensive care unit [ICU] versus non-ICU), education (MSN, BSN, and ADN), and patterns of differences between the WES subscales of four military medical centers. Results of the study indicate that there were no significant gender differences. Head nurses, non-ICU nurses, and MSN nurses perceived their environment more positively. There were significant differences in the WES subscales between the military hospitals. Implications for nursing using the WES were recommended.
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De Jesus, Maria; Earl, Tara R
2014-01-01
Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.
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De Jesus, Maria; Earl, Tara R.
2014-01-01
Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care. PMID:24461570
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New concepts in palliative care in the intensive care unit
Coelho, Cristina Bueno Terzi; Yankaskas, James R.
2017-01-01
Some patients admitted to an intensive care unit may face a terminal illness situation, which usually leads to death. Knowledge of palliative care is strongly recommended for the health care providers who are taking care of these patients. In many situations, the patients should be evaluated daily as the introduction of further treatments may not be beneficial to them. The discussions among health team members that are related to prognosis and the goals of care should be carefully evaluated in collaboration with the patients and their families. The adoption of protocols related to end-of-life patients in the intensive care unit is fundamental. A multidisciplinary team is important for determining whether the withdrawal or withholding of advanced care is required. In addition, patients and families should be informed that palliative care involves the best possible care for that specific situation, as well as respect for their wishes and the consideration of social and spiritual backgrounds. Thus, the aim of this review is to present palliative care as a reasonable option to support the intensive care unit team in assisting terminally ill patients. Updates regarding diet, mechanical ventilation, and dialysis in these patients will be presented. Additionally, the hospice-model philosophy as an alternative to the intensive care unit/hospital environment will be discussed. PMID:28977262
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Mattsson, Janet Yvonne; Arman, Maria; Castren, Maaret; Forsner, Maria
2014-12-01
When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment. © The Author(s) 2013.
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Accounting for health-care outcomes: implications for intensive care unit practice and performance.
Sorensen, Roslyn; Iedema, Rick
2010-08-01
The aim of this study was to understand the environment of health care, and how clinicians and managers respond in terms of performance accountability. A qualitative method was used in a tertiary metropolitan teaching intensive care unit (ICU) in Sydney, Australia, including interviews with 15 clinical managers and focus groups with 29 nurses of differing experience. The study found that a managerial focus on abstract goals, such as budgets detracted from managing the core business of clinical work. Fractures were evident within clinical units, between clinical units and between clinical and managerial domains. These fractures reinforced the status quo where seemingly unconnected patient care activities were undertaken by loosely connected individual clinicians with personalized concepts of accountability. Managers must conceptualize health services as an interconnected entity within which self-directed teams negotiate and agree objectives, collect and review performance data and define collective practice. Organically developing regimens of care within and across specialist clinical units, such as in ICUs, directly impact upon health service performance and accountability.
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An evaluation of the critical care assistant role within an acute NHS Trust Critical Care Unit.
McGloin, Sarah; Knowles, Judie
2005-01-01
This study provides an evaluation of a training programme designed for developing six critical care assistants to work alongside registered nurses to care for patients within the critical care environment. The programme was run as a pilot funded from the Department of Health's 'critical care bid'. At 18 months long, the programme incorporated a foundation programme, and National Vocational Qualification (NVQ) level 3 in care and adapted Operating Department Practitioner (ODP) NVQ units. Six critical care assistants successfully completed the programme; however, they all then left the unit to undertake further study for pre-registration nursing qualifications. Upon evaluation, a number of key issues were identified. Clear definition of the critical care assistants's role is essential as are dedicated practice development staff, who focus purely on developing the critical care assistant role. More importantly, however, with such key changes in the staffing structure within critical care units, appropriate change management techniques should be employed, ensuring that all staff contributing to the training and development are fully involved from the start.
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[Nursing interventions on the physical environment of Neonatal Intensive Care Units].
Miquel Capó Rn, I
2016-01-01
The objectives of this study are to analyse nursing interventions regarding noise and lighting that influence neurodevelopment of the preterm infant in the Neonatal Intensive Care Unit. A review of the literature was performed using the databases: Cuiden Plus, PubMed, IBECS and Cochrane Library Plus. The inclusion and exclusion criteria were established in accordance with the objectives and limits used in each database. Of the 35 articles used, most were descriptive quantitative studies based on the measurement of sound pressure levels and lighting in the Neonatal Intensive Care Units. The countries included in this study are Brazil and the United States, and the variables analysed were the recording the times of light and noise. Based on the high levels of light and noise recorded in the Neonatal Intensive Care Units, nursing interventions that should be carried out to reduce them are described. The evidence indicates that after the implementation of these interventions, the high levels of both environmental stimuli are reduced significantly. Despite the extensive literature published on this problem, the levels of light and noise continue to exceed the recommended limits. Therefore, nurses need to increase and enhance their efforts in this environment, in order to positively influence neurodevelopment of premature newborn. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
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Who Should Care for Infants and Toddlers? A Family Day Care Perspective.
ERIC Educational Resources Information Center
Gellert, Sandra
This discussion concerns the advantages and disadvantages of using family day care, the most widely used form of day care in the United States. Advantages are that family day care providers generally: (1) accept younger infants than do centers; (2) are often conveniently located; (3) often have flexible hours; (4) provide home-like environments;…
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White, Robert D
2004-06-01
Meeting the varied lighting needs of infants, caregivers, and families has become more complex as our understanding of visual development and perception and the effect of light on circadian rhythms advances. Optimal lighting strategies are discussed for new unit construction, as well as modifications to consider for existing units. In either case, the key concept is that lighting should be provided for the individual needs of each person, rather than the full-room lighting schemes previously used. Ideas gleaned from nonhospital settings, re-introduction of natural light into the neonatal intensive care unit, and new devices such as light-emitting diodes will dramatically change the lighting and visual environment of future neonatal intensive care units.
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Nursing work environment, patient safety and quality of care in pediatric hospital.
Alves, Daniela Fernanda Dos Santos; Guirardello, Edinêis de Brito
2016-06-01
Objectives To describe the characteristics of the nursing work environment, safety attitudes, quality of care, measured by the nursing staff of the pediatric units, as well as to analyze the evolution of quality of care and hospital indicators. Methods Descriptive study with 136 nursing professionals at a paediatric hospital, conducted through personal and professional characterization form, Nursing Work Index - Revised, Safety Attitudes Questionnaire - Short Form 2006 and quality indicators. Results The professionals perceive the environment as favourable to professional practice, and consider good quality care that is also observed by reducing the incidence of adverse events and decreased length of stay. The domain job satisfaction was considered favourable to patient safety. Conclusions The work environment is favourable to nursing practice, the professionals nursing approve the quality of care and the indicators tended reducing adverse events and length of stay.
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Nurses' autonomy in end-of-life situations in intensive care units.
Paganini, Maria Cristina; Bousso, Regina Szylit
2015-11-01
The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude that inserts them into the decision-making process. © The Author(s) 2014.
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40 CFR 258.72 - Financial assurance for post-closure care.
Code of Federal Regulations, 2010 CFR
2010-07-01
... care. 258.72 Section 258.72 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... assurance for post-closure care. (a) The owner or operator must have a detailed written estimate, in current dollars, of the cost of hiring a third party to conduct post-closure care for the MSWLF unit in compliance...
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Academic Radiology in the New Healthcare Delivery Environment
Qayyum, Aliya; Yu, John-Paul J.; Kansagra, Akash P.; von Fischer, Nathaniel; Costa, Daniel; Heller, Matthew; Kantartzis, Stamatis; Plowman, R. Scooter; Itri, Jason
2014-01-01
Ongoing concerns over the rising cost of health care are driving large-scale changes in the way that health care is practiced and reimbursed in the United States. To effectively implement and thrive within this new health care delivery environment, academic medical institutions will need to modify financial and business models and adapt institutional cultures. In this paper, we review the expected features of the new health care environment from the perspective of academic radiology departments. Our review will include background on Accountable Care Organizations, identify challenges associated with the new managed care model, and outline key strategies—including expanding the use of existing information technology infrastructure, promoting continued medical innovation, balancing academic research with clinical care, and exploring new roles for radiologists in efficient patient management—that will ensure continued success for academic radiology. PMID:24200477
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Bench-to-bedside review: Leadership and conflict management in the intensive care unit
Strack van Schijndel, Rob JM; Burchardi, Hilmar
2007-01-01
In the management of critical care units, leadership and conflict management are vital areas for the successful performance of the unit. In this article a practical approach to define competencies for leadership and principles and practices of conflict management are offered. This article is, by lack of relevant intensive care unit (ICU) literature, not evidence based, but it is the result of personal experience and a study of literature on leadership as well on conflicts and negotiations in non-medical areas. From this, information was selected that was recognisable to the authors and, thus, also seems to be useful knowledge for medical doctors in the ICU environment. PMID:18086322
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Bench-to-bedside review: leadership and conflict management in the intensive care unit.
Strack van Schijndel, Rob J M; Burchardi, Hilmar
2007-01-01
In the management of critical care units, leadership and conflict management are vital areas for the successful performance of the unit. In this article a practical approach to define competencies for leadership and principles and practices of conflict management are offered. This article is, by lack of relevant intensive care unit (ICU) literature, not evidence based, but it is the result of personal experience and a study of literature on leadership as well on conflicts and negotiations in non-medical areas. From this, information was selected that was recognisable to the authors and, thus, also seems to be useful knowledge for medical doctors in the ICU environment.
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Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers.
Ma, Chenjuan; Park, Shin Hye
2015-11-01
To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals. A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States. Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals. Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93). Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs. Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention. © 2015 Sigma Theta Tau International.
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How medical schools can encourage students' interest in family medicine.
Rohan-Minjares, Felisha; Alfero, Charles; Kaufman, Arthur
2015-05-01
The discipline of family medicine is essential to improving quality and reducing the cost of care in an effective health care system. Yet the slow growth of this field has not kept pace with national demand. In their study, Rodríguez and colleagues report on the influence of the social environment and academic discourses on medical students' identification with family medicine in four countries-the United Kingdom, Canada, France, and Spain. They conclude that these factors-the social environment and discursive activity within the medical school-influence students' specialty choices. While the discourses in Canada, France, and Spain were mostly negative, in the United Kingdom, family medicine was considered a prestigious academic discipline, well paying, and with a wide range of practice opportunities. Medical students in the United Kingdom also were exposed early and often to positive family medicine role models.In the United States, academic discourses about family medicine are more akin to those in Canada, France, and Spain. The hidden curriculum includes negative messages about family medicine, and "badmouthing" primary care occurs at many medical schools. National education initiatives highlight the importance of social determinants in medical education and the integration of public health and medicine in practice. Other initiatives expose students to family medicine role models and practice during their undergraduate training and promote primary care practice through new graduate medical education funding models. Together, these initiatives can reduce the negative effects of the social environment and create a more positive discourse about family medicine.
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Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.
Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie
2016-01-01
There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.
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End-of-life care beliefs among Hindu physicians in the United States.
Ramalingam, Vijaya Sivalingam; Saeed, Fahad; Sinnakirouchenan, Ramapriya; Holley, Jean L; Srinivasan, Sinnakirouchenan
2015-02-01
Several studies from the United States and Europe showed that physicians' religiosity is associated with their approach to end-of-life care beliefs. No such studies have focused exclusively on Hindu physicians practicing in the United States. A 34-item questionnaire was sent to 293 Hindu physicians in the United States. Most participants believed that their religious beliefs do not influence their practice of medicine and do not interfere with withdrawal of life support. The US practice of discussing end-of-life issues with the patient, rather than primarily with the family, seems to have been adopted by Hindu physicians practicing in the United States. It is likely that the ethical, cultural, and patient-centered environment of US health care has influenced the practice of end-of-life care by Hindu physicians in this country. © The Author(s) 2013.
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2016-02-01
not reflect the official policy or position of the US government, the Department of Defense , or Air University. In accordance with Air Force...capability in the AE environment. Utilizing current civilian and Department of Defense (DoD) vICU research, an analysis of the principles demonstrates...deliver integrated medical care. This paper provides a historical narrative of telemedicine and vICU principles and highlights the utility of this
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Manaouil, C; Montpellier, D; Sannier, O; Defouilloy, C; Radji, M; Jardé, O; Dupont, H
2010-01-01
Ambulatory anaesthesia is an anesthesia allowing the return of the patient home the same day. Even if the ambulatory hospitalization can, in theory, be applied to a prisoner as to every patient, caution is essential in such approach. Every anaesthetist reanimator doctor practicing in public hospitals may give care to patient prisoners while he is far from dominating all features of the prison world and while he must put down his therapeutic indications. The ambulatory anaesthesia in prison environment does not guarantee full security for the patient. Procedures could be set up between hospital complexes, caretakers practicing within penal middle (Unit of Consultation and Ambulatory Care [UCAC]) the prison service and hospital, the prefecture, to identify possible ambulatory interventions for a patient prisoner and to set up all guarantees of patient follow-up care in his return in prison environment. The development of interregional secure hospital units (ISHU) within teaching hospitals, allows an easier realization of interventions to the prisoners, but exists only in seven teaching hospitals in France. Copyright 2009 Elsevier Masson SAS. All rights reserved.
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Assessing and developing critical-thinking skills in the intensive care unit.
Swinny, Betsy
2010-01-01
A lot of resources are spent on the development of new staff in the intensive care unit (ICU). These resources are necessary because the environment in the ICU is complex and the patients are critically ill. Nurses need an advanced knowledge base, the ability to accurately define and change priorities rapidly, good communication and teamwork skills, and the ability to work in a stressful environment in order to succeed and give their patients quality care. Critical thinking helps the nurse to navigate the complex and stressful environment of the ICU. Critical thinking includes more than just nursing knowledge. It includes the ability to think through complex, multifaceted problems to anticipate needs, recognize potential and actual complications, and to expertly communicate with the team. A nurse who is able to think critically will give better patient care. Various strategies can be used to develop critical thinking in ICU nurses. Nurse leaders are encouraged to support the development of critical-thinking skills in less experienced staff with the goal of improving the nurse's ability to work in the ICU and improving patient outcomes.
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Hung, Lillian; Chaudhury, Habib; Rust, Tiana
2016-12-01
This qualitative study evaluated the effect of dining room physical environmental changes on staff practices and residents' mealtime experiences in two units of a long-term care facility in Edmonton, Canada. Focus groups with staff (n = 12) and individual interviews with unit managers (n = 2) were conducted. We also developed and used the Dining Environment Assessment Protocol (DEAP) to conduct a systematic physical environmental evaluation of the dining rooms. Four themes emerged on the key influences of the renovations: (a) supporting independence and autonomy, (b) creating familiarity and enjoyment, (c) providing a place for social experience, and (d) challenges in supporting change. Feedback from the staff and managers provided evidence on the importance of physical environmental features, as well as the integral nature of the role of the physical environment and organizational support to provide person-centered care for residents. © The Author(s) 2015.
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Rashid, Mahbub
2014-01-01
In 2006, Critical Care Nursing Quarterly published a study of the physical design features of a set of best practice example adult intensive care units (ICUs). These adult ICUs were awarded between 1993 and 2003 by the Society of Critical Care Medicine (SCCM), the American Association of Critical-Care Nurses, and the American Institute of Architects/Academy of Architecture for Health for their efforts to promote the critical care unit environment through design. Since 2003, several more adult ICUs were awarded by the same organizations for similar efforts. This study includes these newer ICUs along with those of the previous study to cover a period of 2 decades from 1993 to 2012. Like the 2006 study, this study conducts a systematic content analysis of the materials submitted by the award-winning adult ICUs. On the basis of the analysis, the study compares the 1993-2002 and 2003-2012 adult ICUs in relation to construction type, unit specialty, unit layout, unit size, patient room size and design, support and service area layout, and family space design. The study also compares its findings with the 2010 Guidelines for Design and Construction of Health Care Facilities of the Facility Guidelines Institute and the 2012 Guidelines for Intensive Care Unit Design of the SCCM. The study indicates that the award-winning ICUs of both decades used several design features that were associated with positive outcomes in research studies. The study also indicates that the award-winning ICUs of the second decade used more evidence-based design features than those of the first decades. In most cases, these ICUs exceeded the requirements of the Facility Guidelines Institute Guidelines to meet those of the SCCM Guidelines. Yet, the award-winning ICUs of both decades also used several features that had very little or no supporting research evidence. Since they all were able to create an optimal critical care environment for which they were awarded, having knowledge of the physical design of these award-winning ICUs may help design better ICUs.
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Effective leadership within hospice and specialist palliative care units.
Barker, L
2000-01-01
In this study the Repertory Grid interview technique was used to investigate constructs of leadership held by a group of male and female senior managers from within hospice and Specialist Palliative Care Units (SPCUs) in the UK. The themes that emerged were compared with those from existing research models of leadership. Men and women in these roles describe different constructs of effective leadership. The women's constructs that emerged were predominantly transformational, whilst the men's were predominantly transactional. Themes were also identified in this study, which differed from previous studied, i.e. those of political and environment awareness and the valuing of others' views regardless of their status. These themes do not feature highly in other research, and may be in response to the environment within which hospice and specialist palliative care functions.
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Family-centred care in the paediatric intensive care unit: an integrative review of the literature.
Butler, Ashleigh; Copnell, Beverley; Willetts, Georgina
2014-08-01
To review extant research on family-centred care in a paediatric intensive care environment and identify gaps in the literature. Family-centred care is currently a core concept in paediatric nursing, focusing on the premise that families are central to a child's well-being, and as such, should be included as equal members of the child's healthcare team. Due to the nature of critical care, family-centred care may be challenging to implement and maintain. An integrative literature review. The review was conducted using the Cumulative Index to Nursing and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar databases, from 1990 to present. The search focused on the following terms: 'p(a)ediatric critical care', 'paediatric intensive care unit', 'family cent(e)red care', 'parental needs', 'family presence' and 'family/nurse roles'. Additionally, the search was limited to studies conducted in a developed country and published in English. Eighteen studies were included in the review. The results demonstrated that implementing family-centred care into a paediatric intensive care environment posed several challenges. The discrepancy between nurses' and parents' perception of their roles, the reluctance of medical staff to share potentially negative or rapidly changing information, restrictive family presence and poor understanding of family needs emerged as the key difficulties. No studies evaluated strategies to improve family-centred care practice. Family-centred care presents many challenges in a paediatric intensive care environment; however, nurses are uniquely positioned to foster relationships with families, encourage accurate and honest information sharing and advocate for families to be present when they choose. This review outlines the extant research to enhance awareness of the unique state of family-centred care in paediatric intensive care and makes recommendations for future research. © 2013 John Wiley & Sons Ltd.
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Threading needles in the dark: the effect of the physical work environment on nursing practice.
Simmons, Debora; Graves, Krisanne; Flynn, Elizabeth A
2009-01-01
Frequently, the most critical calculations, considerations, and preparations for patient care and medication administration are made in noisy, dimly lit, and chaotic areas of the nursing unit. Healthcare has begun to recognize the impact of the physical work environment plays in the ability of humans to perform reliably and safely. This article reviews the draft guidelines recently released by the United States Pharmacopeia for public comment for the physical environment to promote safe medication administration.
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Chiropractic practice in military and veterans health care: The state of the literature
Green, Bart N.; Johnson, Claire D.; Lisi, Anthony J.; Tucker, John
2009-01-01
Objective To summarize scholarly literature that describes practice, utilization, and/or policy of chiropractic services within international active duty and/or veteran health care environments. Data Sources PubMed, the Cumulative Index to Nursing and Allied Health Literature, and the Index to Chiropractic Literature were searched from their starting dates through June 2009. Review Methods All authors independently reviewed each of the articles to verify that each met the inclusion criteria. Citations of included papers and other pertinent findings were logged in a summary table. Results Thirteen articles were included in this study. Integration of chiropractic care into military or veteran health care systems has been described in 3 systems: the United States Department of Defense, the United States Department of Veterans Affairs, and the Canadian Forces. Conclusion Chiropractic services seem to be included successfully within military and veteran health care facilities. However, there is a great need for additional written evaluation of the processes, policies, practices, and effectiveness of chiropractic services in these environments. PMID:19714234
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Ford, Karen; Tesch, Leigh; Dawborn, Jacqueline; Courtney-Pratt, Helen
2018-06-01
To evaluate the impact of an arts in health programme delivered by a specialised artist within an acute older person's unit. Acute hospitals must meet the increasingly complex needs of older people who experience multiple comorbidities, often including cognitive impairment, either directly related to their admission or longer term conditions, including dementia. A focus on physical illness, efficiency and tasks within an acute care environment can all divert attention from the psychosocial well-being of patients. This focus also decreases capacity for person-centred approaches that acknowledge and value the older person, their life story, relationships and the care context. The importance of arts for health and wellness, including responsiveness to individual need, is well established: however, there is little evidence about its effectiveness for older people in acute hospital settings. We report on a collaborative arts in health programme on an acute medical ward for older people. The qualitative study used collaborative enquiry underpinned by a constructivist approach to evaluate an arts programme that involved participatory art-making activities, customised music, song and illustration work, and enlivening the unit environment. Data sources included observation of art activities, semi-structured interviews with patients and family members, and focus groups with staff. Data were transcribed and thematically analysed using a line by line approach. The programme had positive impacts for the environment, patients, families and staff. The environment exhibited changes as a result of programme outputs; patients and families were engaged and enjoyed activities that aided recovery from illness; and staff also enjoyed activities and importantly learnt new ways of working with patients. An acute care arts in health programme is a carefully nuanced programme where the skills of the arts health worker are critical to success. Utilising such skill, continued focus on person-centeredness and openness to creativity demonstrated positive impacts for patients, families, staff and the ward environment. This study affirms the contribution of an arts in health program for older persons in an acute care setting in challenging the dominance of a task based medical model and emphasising person-centred care and outcomes. © 2018 John Wiley & Sons Ltd.
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Bachnick, Stefanie; Ausserhofer, Dietmar; Baernholdt, Marianne; Simon, Michael
2018-05-01
Patient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care. The aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care. This is a sub-study of the cross-sectional multi-center "Matching Registered Nurse Services with Changing Care Demands" study. We included 123 units in 23 acute care hospitals from all three of Switzerland's language regions. The sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included. Patients' perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level. Patients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30-0.98]). Higher leadership ratings were associated with sufficient information (β 0.403 [95%-CI: 0.03-0.77) and adapted treatment and care (β 0.462 [95%-CI: 0.04-0.88]). Furthermore, higher levels of implicit rationing of nursing care were associated with lower levels of patient-centered care, e.g., adapted treatment and care (β -0.912 [95%-CI: -1.50-0.33]). Our study shows a negative association between implicit rationing of nursing care and patient-centered care: i.e.the lower the level of implicit rationing of nursing care, the better patients understood nurses, felt sufficiently informed and recognized that they were receiving highly individualized treatment. To improve patient-centered care, the nurse work environment and the level of implicit rationing of nursing care should be taken into consideration. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Neonatal Intensive Care Unit Layout and Nurses' Work.
Doede, Megan; Trinkoff, Alison M; Gurses, Ayse P
2018-01-01
Neonatal intensive care units (NICUs) remain one of the few areas in hospitals that still use an open bay (OPBY) design for patient stays greater than 24 hr, housing multiple infants, staff, and families in one large room. This creates high noise levels, contributes to the spread of infection, and affords families little privacy. These problems have given rise to the single-family room NICU. This represents a significant change in the care environment for nurses. This literature review answers the question: When compared to OPBY layout, how does a single family room layout impact neonatal nurses' work? Thirteen studies published between 2006 and 2015 were located. Many studies reported both positive and negative effects on nurses' work and were therefore sorted by their cited advantages and disadvantages. Advantages included improved quality of the physical environment; improved quality of patient care; improved parent interaction; and improvements in nurse job satisfaction, stress, and burnout. Disadvantages included decreased interaction among the NICU patient care team, increased nurse workload, decreased visibility on the unit, and difficult interactions with family. This review suggests that single-family room NICUs introduce a complex situation in which trade-offs occur for nurses, most prominently the trade-off between visibility and privacy. Additionally, the literature is clear on what elements of nurses' work are impacted, but how the built environment influences these elements, and how these elements interact during nurses' work, is not as well understood. The current level of research and directions for future research are also discussed.
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Benzies, Karen M; Shah, Vibhuti; Aziz, Khalid; Lodha, Abhay; Misfeldt, Renée
2018-05-11
To describe the perspectives of health care providers and hospital administrators on their experiences of providing care for infants in Level II neonatal intensive care units and their families. We conducted 36 qualitative interviews with neonatal health care providers and hospital administrators and analysed data using a descriptive interpretive approach. 10 Level II Neonatal Intensive Care Units in a single, integrated health care system in one Canadian province. Three major themes emerged: (1) providing family-centred care, (2) working amidst health care system challenges, and (3) recommending improvements to the health care system. The overarching theme was that the health care system was making 'too much noise' for health care providers and hospital administrators to provide family-centred care in ways that would benefit infants and their families. Recommended improvements included: refining staffing models, enhancing professional development, providing tools to deliver consistent care, recognising parental capacity to be involved in care, strengthening continuity of care, supporting families to be with their infant, and designing family-friendly environments. When implementing family-centred care initiatives, health care providers and hospital administrators need to consider the complexity of providing care in Level II Neonatal Intensive Care Units, and recognise that health care system changes may be necessary to optimise implementation. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.
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[Philosophical perspectives about the use of technology in critical care nursing].
Schwonke, Camila Rose G Barcelos; Lunardi Filho, Wilson Danilo; Lunardi, Valéria Lerch; Santos, Silvana Sidney Costa; Barlem, Edison Luiz Devos
2011-01-01
The context of health assistance has been influenced by changes which are produced in the dimension of technology. They have triggered a lot of inquietude and questioning regarding benefits, risks, and relations constructed among workers and sick, and the use of machines as indispensable tools for care. This paper aims at reflecting on the use of technology in nursing care given to the critical sick in the intensive care unit. It is expected that this reflection can minimize doubts which permeate technological environments, such as the intensive care unit, and the conceptions of nursing care since it involves the use of machines and equipment which provide advanced life support in this field of health assistance.
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Relationship Between State Malpractice Environment and Quality of Health Care in the United States.
Bilimoria, Karl Y; Chung, Jeanette W; Minami, Christina A; Sohn, Min-Woong; Pavey, Emily S; Holl, Jane L; Mello, Michelle M
2017-05-01
One major intent of the medical malpractice system in the United States is to deter negligent care and to create incentives for delivering high-quality health care. A study was conducted to assess whether state-level measures of malpractice risk were associated with hospital quality and patient safety. In an observational study of short-term, acute-care general hospitals in the United States that publicly reported in the Centers for Medicaid & Medicare Services Hospital Compare in 2011, hierarchical regression models were used to estimate associations between state-specific malpractice environment measures (rates of paid claims, average Medicare Malpractice Geographic Practice Cost Index [MGPCI], absence of tort reform laws, and a composite measure) and measures of hospital quality (processes of care, imaging utilization, 30-day mortality and readmission, Agency for Healthcare Research and Quality Patient Safety Indicators, and patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]). No consistent association between malpractice environment and hospital process-of-care measures was found. Hospitals in areas with a higher MGPCI were associated with lower adjusted odds of magnetic resonance imaging overutilization for lower back pain but greater adjusted odds of overutilization of cardiac stress testing and brain/sinus computed tomography (CT) scans. The MGPCI was negatively associated with 30-day mortality measures but positively associated with 30-day readmission measures. Measures of malpractice risk were also negatively associated with HCAHPS measures of patient experience. Overall, little evidence was found that greater malpractice risk improves adherence to recommended clinical standards of care, but some evidence was found that malpractice risk may encourage defensive medicine. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.
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Hallowell, Sunny G; Rogowski, Jeannette A; Spatz, Diane L; Hanlon, Alexandra L; Kenny, Michael; Lake, Eileen T
2016-01-01
Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Cross sectional analysis combining nurse survey data with infant discharge data. A national sample of neonatal intensive care units (N=97), nurses (N=5614) and very low birth weight infants (N=6997). Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on "any human milk") and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p<0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p<0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p=.056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p<0.001). Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Hallowell, Sunny G.; Rogowski, Jeannette A.; Spatz, Diane L.; Hanlon, Alexandra L.; Kenny, Michael; Lake, Eileen T.
2016-01-01
Context Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. Objectives To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Design and setting Cross sectional analysis combining nurse survey data with infant discharge data. Participants A national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997). Methods Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on “any human milk”) and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). Results The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor’s degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001). Conclusions Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge. PMID:26518107
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Management of patients with Alzheimer's disease in long-term care facilities.
Maas, M
1988-03-01
The care of residents with AD in long-term care facilities presents a number of challenges to nursing staff. The institutionalized person with AD displays a number of behaviors that are difficult to manage on traditional, integrated nursing units. In these units, behaviors such as wandering and falling are often managed by chemical and physical restraints. Multiple, complex stimuli, common on integrated units, contribute to the confusion and disorientation experienced by residents with AD. An alternative setting, the special-care unit designed specifically to meet the needs of residents with AD, has been described. Special-care units modify the environment of the traditional nursing unit to promote the safety of demented residents. The units are an attempt to reduce or control the amount of sensory stimulation in order to prevent catastrophic behaviors in the residents and maximize patient functioning. Staff on special-care units are selected specifically for their commitment to the unique care demands required by residents with AD. Ordinarily, staff in long-term care settings need specialized education to provide this care. A research project designed to evaluate the effectiveness of a special-care unit was also described. This research is valuable to residents with AD, their families, managers, and policy makers of long-term care institutions concerned with the effective use of resources. Considerable costs are involved in the construction and staffing of special-care units. However, the potential costs and threats to quality of care associated with care of residents with AD on traditional units make it imperative to evaluate the effectiveness of special-care units. With the increasing number of persons expected to develop AD, nurses, managers of long-term care facilities, and policy makers are faced with the difficult prospect of determining the most effective means of caring for these residents. Because there have been no definitive, comprehensive studies of special care units, there is an absence of empiric support for the many proposed advantages. Few studies have used systematic measurement techniques or measures with established reliability and validity. Given the growing number of elderly persons in the United States and the expected growth in the number of nursing home residents with AD, it is important to establish the value of special treatment units for residents with AD.
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Winner-Stoltz, Regina; Lengerich, Alexander; Hench, Anna Jeanine; OʼMalley, Janet; Kjelland, Kimberly; Teal, Melissa
2018-06-01
Neonatal intensive care units have historically been constructed as open units or multiple-bed bays, but since the 1990s, the trend has been toward single family room (SFR) units. The SFR design has been found to promote family-centered care and to improve patient outcomes and safety. The impact of the SFR design NICU on staff, however, has been mixed. The purposes of this study were to compare staff nurse perceptions of their work environments in an open-pod versus an SFR NICU and to compare staff nurse perceptions of the impact of 2 NICU designs on the care they provide for patients/families. A prospective cohort study was conducted. Questionnaires were completed at 6 months premove and again at 3, 9, and 15 months postmove. A series of 1-way analyses of variance were conducted to compare each group in each of the 8 domains. Open-ended questions were evaluated using thematic analysis. The SFR design is favorable in relation to environmental quality and control of primary workspace, privacy and interruption, unit features supporting individual work, and unit features supporting teamwork; the open-pod design is preferable in relation to walking. Incorporating design features that decrease staff isolation and walking and ensuring both patient and staff safety and security are important considerations. Further study is needed on unit design at a microlevel including headwall design and human milk mixing areas, as well as on workflow processes.
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Spence Laschinger, Heather K; Fida, Roberta
2015-05-01
A model linking authentic leadership, structural empowerment, and supportive professional practice environments to nurses' perceptions of patient care quality and job satisfaction was tested. Positive work environment characteristics are important for nurses' perceptions of patient care quality and job satisfaction (significant factors for retention). Few studies have examined the mechanism by which these characteristics operate to influence perceptions of patient care quality or job satisfaction. A cross-sectional provincial survey of 723 Canadian nurses was used to test the hypothesized models using structural equation modeling. The model was an acceptable fit and all paths were significant. Authentic leadership had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses' perceptions that inadequate unit staffing prevented them from providing high-quality patient care. These workplace conditions predicted job satisfaction. Authentic leaders play an important role in creating empowering professional practice environments that foster high-quality care and job satisfaction.
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Decreased Stress Levels in Nurses: A Benefit of Quiet Time.
Riemer, Heather C; Mates, Joanna; Ryan, Linda; Schleder, Bonnie J
2015-09-01
The benefits of quiet time, a therapeutic method of improving the health care environment, have been evaluated in patients, but only a few studies have examined the effects of quiet time on intensive care nurses. To evaluate the effects of implementing quiet time in a medical-surgical intensive care unit on levels of light, noise, and nurses' stress. Quiet time consisted of turning down the unit lights for a designated time. Levels of light, noise, and nurses' stress were measured. Nurses' stress levels were measured by using a 100-point visual analog scale; unit noise, by using a digital sound level meter (model 407736, Extech Instruments); and unit light, by using an illumination light meter (model 615, Huygen Corporation). Measurements were obtained 30 minutes before and 30 minutes, 1 hour, and 2 hours after implementation of quiet time. Analysis of variance and comparisons of means indicated that both light levels and nurses' stress levels were significantly decreased after quiet time (both P < .001). Noise levels were also decreased after quiet time, but the decrease was not significant (P = .08). Use of quiet time resulted in decreased light levels and decreased stress levels among nurses. Quiet time is an easily performed energy-saving intervention to promote a healthy work environment. ©2015 American Association of Critical-Care Nurses.
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The relationship between individualized care and the practice environment: an international study.
Papastavrou, Evridiki; Acaroglu, Rengin; Sendir, Merdiye; Berg, Agneta; Efstathiou, Georgios; Idvall, Ewa; Kalafati, Maria; Katajisto, Jouko; Leino-Kilpi, Helena; Lemonidou, Chryssoula; da Luz, Maria Deolinda Antunes; Suhonen, Riitta
2015-01-01
Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies. The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries. This study had an international, multisite, prospective, cross-sectional, exploratory survey design. The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey. Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study. Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model. Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care. The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Neonatal intensive care: satisfaction measured from a parent's perspective.
Conner, J M; Nelson, E C
1999-01-01
Health care systems today are complex, technically proficient, competitive, and market-driven. One outcome of this environment is the recent phenomenon in the health care field of "consumerism." Strong emphasis is placed on customer service, with organized efforts to understand, measure, and meet the needs of customers served. The purpose of this article is to describe the current understanding and measurement of parent needs and expectations with neonatal intensive care services from the time the expectant parents enter the health care system for the birth through the discharge process and follow-up care. Through literature review, 11 dimensions of care were identified as important to parents whose infants received neonatal intensive care: assurance, caring, communication, consistent information, education, environment, follow-up care, pain management, participation, proximity, and support. Five parent satisfaction questionnaires-the Parent Feedback Questionnaire, Neonatal Index of Parent Satisfaction, Inpatient Parent Satisfaction-Children's Hospital Minneapolis, Picker Institute-Inpatient Neonatal Intensive Care Unit Survey, and the Neonatal Intensive Care Unit-Parent Satisfaction Form-are critically reviewed for their ability to measure parent satisfaction within the framework of the neonatal care delivery process. An immense gap was found in our understanding about what matters most and when to parents going through the neonatal intensive care experience. Additional research is required to develop comprehensive parent satisfaction surveys that measure parent perceptions of neonatal care within the framework of the care delivery process.
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Medical surgical nurses describe missed nursing care tasks-Evaluating our work environment.
Winsett, Rebecca P; Rottet, Kendra; Schmitt, Abby; Wathen, Ellen; Wilson, Debra
2016-11-01
The purpose of the study was to explore the nurse work environment by evaluating the self-report of missed nursing care and the reasons for the missed care. A convenience sample of medical surgical nurses from four hospitals was invited to complete the survey for this descriptive study. The sample included 168 nurses. The MISSCARE survey assessed the frequency and reason of 24 routine nursing care elements. The most frequently reported missed care was ambulation as ordered, medications given within a 30 minute window, and mouth care. Moderate or significant reasons reported for the missed care were: unexpected rise in volume/acuity, heavy admissions/discharges, inadequate assistants, inadequate staff, meds not available when needed, and urgent situations. Identifying missed nursing care and reasons for missed care provides an opportunity for exploring strategies to reduce interruptions, develop unit cohesiveness, improve the nurse work environment, and ultimately leading to improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.
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What can health care professionals in the United Kingdom learn from Malawi?
Neville, Ron; Neville, Jemma
2009-01-01
Debate on how resource-rich countries and their health care professionals should help the plight of sub-Saharan Africa appears locked in a mind-set dominated by gloomy statistics and one-way monetary aid. Having established a project to link primary care clinics based on two-way sharing of education rather than one-way aid, our United Kingdom colleagues often ask us: "But what can we learn from Malawi?" A recent fact-finding visit to Malawi helped us clarify some aspects of health care that may be of relevance to health care professionals in the developed world, including the United Kingdom. This commentary article is focused on encouraging debate and discussion as to how we might wish to re-think our relationship with colleagues in other health care environments and consider how we can work together on a theme of two-way shared learning rather than one-way aid. PMID:19327137
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40 CFR 258.72 - Financial assurance for post-closure care.
Code of Federal Regulations, 2011 CFR
2011-07-01
... care. 258.72 Section 258.72 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... dollars, of the cost of hiring a third party to conduct post-closure care for the MSWLF unit in compliance with the post-closure plan developed under § 258.61 of this part. The post-closure cost estimate used...
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Health care aides use of time in a residential long-term care unit: a time and motion study.
Mallidou, Anastasia A; Cummings, Greta G; Schalm, Corinne; Estabrooks, Carole A
2013-09-01
Organizational resources such as caregiver time use with older adults in residential long-term care facilities (nursing homes) have not been extensively studied, while levels of nurse staffing and staffing-mix are the focus of many publications on all types of healthcare organizations. Evidence shows that front-line caregivers' sufficient working time with residents is associated with performance, excellence, comprehensive care, quality of outcomes (e.g., reductions in pressure ulcers, urinary tract infections, and falls), quality of life, cost savings, and may be affiliated with transformation of organizational culture. To explore organizational resources in a long-term care unit within a multilevel residential facility, to measure healthcare aides' use of time with residents, and to describe working environment and unit culture. An observational pilot study was conducted in a Canadian urban 52-bed long-term care unit within a faith-based residential multilevel care facility. A convenience sample of seven healthcare aides consented to participate. To collect the data, we used an observational sheet (to monitor caregiver time use on certain activities such as personal care, assisting with eating, socializing, helping residents to be involved in therapeutic activities, paperwork, networking, personal time, and others), semi-structured interview (to assess caregiver perceptions of their working environment), and field notes (to illustrate the unit culture). Three hundred and eighty seven hours of observation were completed. The findings indicate that healthcare aides spent most of their working time (on an eight-hour day-shift) in "personal care" (52%) and in "other" activities (23%). One-to-three minute activities consumed about 35% of the time spent in personal care and 20% of time spent in assisting with eating. Overall, caregivers' time spent socializing was less than 1%, about 6% in networking, and less than 4% in paperwork. Re-organizing healthcare aides' routine practices may minimize the short one-to-three minute intervals spent on direct care activities, which can be interpreted as interruptions to continuity of care or waste of time. Fewer interruptions may allow healthcare aides to use their time with residents more effectively. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A
2016-03-01
To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Developing emotional intelligence ability in oncology nurses: a clinical rounds approach.
Codier, Estelle; Freitas, Beth; Muneno, Lynn
2013-01-01
To explore the feasibility and impact of an emotional intelligence ability development program on staff and patient care. A mixed method, pre/post-test design. A tertiary care hospital in urban Honolulu, HI. Rounds took place on a 24-bed inpatient oncology unit. 33 RNs in an oncology unit. After collection of baseline data, the emotional intelligence rounds were conducted in an inpatient oncology nursing unit on all shifts during a 10-month period. Demographic information, emotional intelligence scores, data from rounds, chart reviews of emotional care documentation, and unit-wide satisfaction and safety data. The ability to identify emotions in self and others was demonstrated less frequently than expected in this population. The low test response rate prevented comparison of scores pre- and postintervention. The staff's 94% participation in rounds, the positive (100%) evaluation of rounds, and poststudy improvements in emotional care documentation and emotional care planning suggest a positive effect from the intervention. Additional research is recommended over a longer period of time to evaluate the impact emotional intelligence specifically has on the staff's identification of emotions. Because the intervention involved minimal time and resources, feasibility for continuation of the intervention poststudy was rated "high" by the research team. Research in other disciplines suggests that improvement in emotional intelligence ability in clinical staff nurses may improve retention, performance, and teamwork in nursing, which would be of particular significance in high-risk clinical practice environments. Few research studies have explored development of emotional intelligence abilities in clinical staff nurses. Evidence from this study suggests that interventions in the clinical environment may be used to develop emotional intelligence ability. Impact from such development may be used in the future to not only improve the quality of nursing care, but also potentially limit the negative effects of high-stress environments on nurses.
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Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René
2015-09-01
Implicit rationing of nursing care refers to the withdrawal of or failure to carry out necessary nursing care activities due to lack of resources, in the literature also described as missed care, omitted care, or nursing care left undone. Under time constraints, nurses give priority to activities related to vital medical needs and the safety of the patient, leaving out documentation, rehabilitation, or emotional support of patients. In nursing homes, little is known about the occurrence of implicit rationing of nursing care and possible contributing factors. The purpose of this study was (1) to describe levels and patterns of self-reported implicit rationing of nursing care in Swiss nursing homes and (2) to explore the relationship between staffing level, turnover, and work environment factors and implicit rationing of nursing care. Cross-sectional, multi-center sub-study of the Swiss Nursing Home Human Resources Project (SHURP). Nursing homes from all three language regions of Switzerland. A random selection of 156 facilities with 402 units and 4307 direct care workers from all educational levels (including 25% registered nurses). We utilized data from established scales to measure implicit rationing of nursing care (Basel Extent of Rationing of Nursing Care), perceptions of leadership ability and staffing resources (Practice Environment Scale of the Nursing Work Index), teamwork and safety climate (Safety Attitudes Questionnaire), and work stressors (Health Professions Stress Inventory). Staffing level and turnover at the unit level were measured with self-developed questions. Multilevel linear regression models were used to explore the proposed relationships. Implicit rationing of nursing care does not occur frequently in Swiss nursing homes. Care workers ration support in activities of daily living, such as eating, drinking, elimination and mobilization less often than documentation of care and the social care of nursing homes residents. Statistically significant factors related to implicit rationing of care were the perception of lower staffing resources, teamwork and safety climate, and higher work stressors. Unit staffing and turnover levels were not related to rationing activities. Improving teamwork and reducing work stressors could possibly lead to less implicit rationing of nursing care. Further research on the relationship of implicit rationing of nursing care and resident and care worker outcomes in nursing homes is requested. Copyright © 2015 Elsevier Ltd. All rights reserved.
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McCauley, Kathleen; Irwin, Richard S
2006-11-01
The American Association of Critical-Care Nurses Standards for Establishing and Sustaining Healthy Work Environments and the American College of Chest Physicians Patient-Focused Care project are complementary initiatives that provide a road map for creating practice environments where interdisciplinary, patient-focused care can thrive. Healthy work environments are so influential that failure to address the issue would result in deleterious effects for every aspect of acute and critical care practice. Skilled communication and true collaboration are crucial for transforming work environments. The American College of Chest Physicians project on patient-focused care was born out of a realization that medicine as currently practiced is too fragmented, too focused on turf battles that hinder communication, and too divorced from a real understanding of what patients expect and need from their healthcare providers. Communication as well as continuity and concordance with the patients' wishes are foundational premises of care that is patient-focused and safe. Some individuals may achieve some level of genuine patient-focused care even when they practice in a toxic work environment because they are gifted communicators who embrace true collaboration. At best, most likely those efforts will be hit-or-miss and such heroism will be impossible to sustain if the environment is not transformed into a model that reflects standards and initiatives set out by the American Association of Critical-Care Nurses and the American College of Chest Physicians. Other innovative models of care delivery remain unreported. The successes and failures of these models should be shared with the professional community.
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Use of aromatherapy to promote a therapeutic nurse environment.
Johnson, Kari; West, Toni; Diana, Shelly; Todd, Jodi; Haynes, Brianna; Bernhardt, Judy; Johnson, Roberta
2017-06-01
Workplace stress can affect nurse satisfaction. Aroma therapy as a therapeutic use of essential oil can be beneficial in reducing stress. Assess perceived stress pre-post introduction of Essential Oil Lavender among registered nurses, charge nurses, and patient care technicians in a trauma intensive care unit, surgical specialty care unit and an orthopedic trauma unit. Pre-post intervention with a quasi-experimental design. After a pre-survey, Essential Oil Lavender was diffused 24h per day over 30days in a designated nursing area that all nurses were not required to enter on each unit. Dependent sample t-test for "how often do nurses feel stressed a work in a typical week" revealed pre-survey mean 2.97 (SD=0.99) which was significantly higher than post-survey mean 2.70 (SD=0.92) with significance, t(69)=2.36, p=0.021, suggesting a difference in how often staff felt stressed at work in a typical week, trending down from "feeling stressed half of time" to "once in a while". There were no statistically significant differences in pre-post survey scores for TICU, TOU, or SSC as separate units. Use of essential oils to decrease work-related stress among nursing staff may improve retention, workplace environment, and increase nurse satisfaction. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Serio-Melvin, Maria; Yoder, Linda H; Gaylord, Kathryn M
2010-06-01
Nursing plays a critical role in the comprehensive burn care delivered at the US Army Institute of Surgical Research, otherwise known as the US Army's Burn Center serving the Department of Defense. This center serves as a model for burn units nationally and internationally. It also provides a challenging and innovative work environment for military and civilian nurses. Nurses in the Burn Center contribute to innovations in acute, rehabilitative, and psychological care for patients with burns. This article provides an overview of the complex nursing care provided to burn patients treated at the Burn Center. Copyright (c) 2010 Elsevier Inc. All rights reserved.
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Leadership and the psychosocial work environment in old age care.
Lundgren, Dan; Ernsth-Bravell, Marie; Kåreholt, Ingemar
2016-03-01
To study leadership factors and their associations with psychosocial work environmental among nursing assistants who are engaged in old age care and to analyse (i) differences in the assessment of leadership factors and the assessment of psychosocial work environmental in nursing homes and home help services and (ii) the association between the psychosocial work environment and factors that are related to leadership in nursing homes and home help services. Leadership factors are an important element of the psychosocial work environment in old age care. The physical distance between leaders and nursing assistants is larger in home help services than in nursing homes. Therefore, it is important to study leadership separately in nursing homes and home help services. Assessments from 844 nursing assistants in nursing homes and 288 in home help services (45 nursing homes and 21 home help service units) were analysed. The data were analysed using linear regression. Age, gender, number of staff at the unit, number of years at the current working unit and educational level were controlled in Model 1. Summarised indexes that were based on all independent variables except the main independent variable were additionally controlled in Model 2. Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. Empowering leadership, support from superiors, the primacy of human resources and control over decisions were associated with higher assessments on all the variables that were related to the psychosocial work environment in both the nursing homes and home help services. Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better prerequisites for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services. Due to the differences in organisational settings, it is important to consider the differences in prerequisites in conducting leadership. To influence nursing assistants' performance and to increase quality in old age care in the long term, appropriate leadership is necessary. © 2015 The Authors. International Journal of Older People Nursing Published by John Wiley & Sons Ltd.
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ERIC Educational Resources Information Center
Castro, Dina C.; Espinosa, Linda M.
2014-01-01
This article discusses the current knowledge on the developmental characteristics and contexts of care for infants and toddlers who are growing up in bilingual environments at home and in their early care settings in the united States. The authors highlight relevant findings from the work of the Center of Early Care and Education Research-Dual…
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Price, David; Howard, Michelle; Hilts, Linda; Dolovich, Lisa; McCarthy, Lisa; Walsh, Allyn E; Dykeman, Lynn
2009-09-01
The new family health teams (FHTs) in Ontario were designed to enable interprofessional collaborative practice in primary care; however, many health professionals have not been trained in an interprofessional environment. To provide health professional learners with an interprofessional practice experience in primary care that models teamwork and collaborative practice skills. The 2 academic teaching units of the FHT at McMaster University in Hamilton, Ont, employ 6 types of health professionals and provide learning environments for family medicine residents and students in a variety of health care professions. Learners engage in formal interprofessional education activities and mixed professional and learner clinical consultations. They are immersed in an established interprofessional practice environment, where all team members are valued and contribute collaboratively to patient care and clinic administration. Other contributors to the success of the program include the physical layout of the clinics, the electronic medical record communications system, and support from leadership for the additional clinical time commitment of delivering interprofessional education. This academic FHT has developed a program of interprofessional education based partly on planned activities and logistic enablers, and largely on immersing learners in a culture of long-standing interprofessional collaboration.
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Campos Andrade, Cláudia; Lima, Maria Luísa; Pereira, Cícero Roberto; Fornara, Ferdinando; Bonaiuto, Marino
2013-05-01
This study analyses the processes through which the physical environment of health care settings impacts on patients' well-being. Specifically, we investigate the mediating role of perceptions of the physical and social environments, and if this process is moderated by patients' status, that is, if the objective physical environment impacts inpatients' and outpatients' satisfaction by different social-psychological processes. Patients (N=206) evaluated the physical and social environments of the care unit where they were receiving treatment, and its objective physical conditions were independently evaluated by two architects. Results showed that the objective environmental quality affects satisfaction through perceptions of environmental quality, and that patients' status moderates this relationship. For inpatients, it is the perception of quality of the social environment that mediates the relationship between objective environmental quality and satisfaction, whereas for outpatients it is the perception of quality of the physical environment. This moderated mediation is discussed in terms of differences on patients' experiences of health care environments. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Notes on critical care-review of seminal management and leadership papers in the United Kingdom.
Coombs, Maureen
2009-06-01
Review of recent critical care provision reveals substantial changes in clinical unit operating, and policy drivers influencing international critical care delivery. Practitioners who have worked in healthcare environments over this time, will have witnessed substantial shifts in healthcare policy, changes in professional body guidance and greater service evaluation have impacted on critical care management and leadership. This paper offers a personal perspective on seminal management and leadership papers published in the critical care literature over the past decade. Presenting a range of national and international work that utilise diverse approaches, ten key papers are highlighted that have impacted in the United Kingdom setting. Through this, the influence of the modernisation agenda, the increasing significance of outcome studies, and the need for flexible, interdependent practice emerges. A key message to surface from this paper is the need for all in critical care to engage with, and understand the wider implications of management and leadership change for critical care delivery.
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Takemura, Y; Ishibashi, M
2000-02-01
Failure to slow the exponential growth of total health care expenditures in the United States through the government policies resulted in a rapid and progressive penetration of managed care organizations(MCOs) in the early 1990s. Diagnostic testing is viewed as a "commodity" rather than a medical service under the managed care environment. Traditional hospital-based laboratories are placed in a downward spiral with the advent of managed care era. A massive reduction of in-house testing resulted from shorter lengths of patients' hospital stay and a marked decrease in admission under the dominance of managed care urges them to develop strategies for restoring tests deprived by the managed care-associated new businesses: consolidation and networking, participation in the outreach-testing market, and point-of-care/satellite laboratory testing in non-traditional, ambulatory settings are major strategies for survival of hospital laboratories. A number of physicians' office laboratories(POLs) have been closed owing to regulatory restrictions imposed by the Clinical Laboratory Improvement Amendments of 1988(CLIA '88), and to the expanded penetration of MCOs which limit reimbursement to a very few in-house procedures. It seems likely that POLs and hospital laboratories continue to reduce test volumes, while commercial reference laboratories(CRLs) gain more tests through contracting with MCOs. In the current stream of managed care dominance in the United States, clinical laboratories are changing their basic operation focus and mission in response to the aggressively changing landscape. Traditional laboratories which are unwilling to adapt themselves to the new environment will not survive in this country.
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[Decreasing the Output of Biomedical Waste in the Intensive Care Unit].
Shen, Ming-Yi; Chang, Chun-Chu; Li, Mung-Yeng; Lin, Jui-Hsiang
2017-10-01
Advancing healthcare technologies have increased the use of disposable supplies that are made with PVC (polyvinyl chloride). Furthermore, biomedical effluents are steadily increasing due to severe patient treatment requirements in intensive care units. If these biomedical wastes are not properly managed and disposed, they will cause great harm to the environment and to public health. The statistics from an intensive care unit at one medical center in northern Taiwan show that the per-person biomedical effluents produced in 2014 increased 8.51% over 2013 levels. The main reasons for this increase included the low accuracy of classification of the contents of biomedical effluent collection buckets and of personnel effluents in the intensive care unit and the generally poor selection and designation of appropriate containers. Improvement measures were implemented in order to decrease the per-day weight of biomedical effluents by 10% per person (-0.22 kg/person/day). The project team developed various strategies, including creating classification-related slogans and posting promotional posters, holding education and training using actual case studies, establishing an "environmental protection pioneer" team, and promoting the use of appropriate containers. The implementation of the project decreased the per-day weight of biomedical effluents by 13.2% per person. Implementation of the project effectively reduced the per-person daily output of biological wastes and improved the waste separation behavior of healthcare personnel in the unit, giving patients and their families a better healthcare environment and helping advance the cause of environmental protection worldwide.
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History of pulmonary critical care nursing and where we are going.
Lareau, Suzanne C; Mealer, Meredith
2012-09-01
Pulmonary critical care nurses have played a prominent role in the ICUs from the inception of critical care units. This article describes how the history of pulmonary critical care nursing has evolved and discusses a few of the challenges in the years to come: stress imposed by working in a critical care environment, enhancing the care of patients by altering patterns of sedation and promoting early mobilization, and dealing with increasing infection rates.
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Optimal resources for children's surgical care in the United States.
2014-03-01
In summary, the Task Force does understand that change is difficult and, in the circumstance of the US health care environment, quite complex. Having acknowledged this, the Task Force firmly believes that if optimal resource standards are clear, providers will act in the best interests of their patients, infants, and children undergoing surgery in this circumstance. We intend to provide evidence to this point, to define optimal resources, and to facilitate this process. The hope and the underlying intent of these recommendations is to insure that every infant and child undergoing a surgical procedure in the United States will receive his or her care in an environment that offers all of the facilities, equipment, and, most especially, access to the professional providers who have the appropriate background and training to provide optimal care. This must be done while balancing the issues of access, staff, and the need to improve the value proposition. The Task Force is unanimous in its intent to advocate for this agenda.
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Potter, Rachel; Sheehan, Bart; Cain, Rebecca; Griffin, James; Jennings, Paul A
2018-05-08
Forty percent of residents living in care homes in the United Kingdom have significant depressive symptoms. Care homes can appear to be depressing places, but whether the physical environment of homes directly affects depression in care home residents is unknown. This study explores the relationship between the physical environment and depressive symptoms of older people living in care homes. In a prospective cohort study the physical environment of 50 care homes were measured using the Sheffield Care Environment Assessment Matrix (SCEAM) and depressive symptoms of 510 residents measured using the Geriatric Depression Scale (GDS-15). The study was supplemented with semi-structured interviews with residents living in the care homes. Quantitative data were analyzed using multi-level modeling, and qualitative data analyzed using a thematic framework approach. The overall physical environment of care homes (overall SCEAM score) did not predict depressive symptoms. Controlling for dependency, social engagement, and home type, having access to outdoor space was the only environmental variable to significantly predict depressive symptoms. Residents interviewed reported that access to outdoor space was restricted in many ways: locked doors, uneven foot paths, steep steps, and needing permission or assistance to go outside. We provide new evidence to suggest that access to outdoor space predicts depressive symptoms in older people living in care home. Interventions aimed at increasing access to outdoor spaces could positively affect depressive symptoms in older people.
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Borim, Bruna Cury; Croti, Ulisses A; Silveira, Patricia C; De Marchi, Carlos H; Moscardini, Airton C; Hickey, Patricia; Jenkins, Kathy
2017-11-01
The nursing profession faces continuous transformations demonstrating the importance of professional continuing education to extend knowledge following technological development without impairing quality of care. Nursing assistants and technicians account for nearly 80% of nursing professionals in Brazil and are responsible for uninterrupted patient care. Extensive knowledge improvement is needed to achieve excellence in nursing care. The objective was to develop and evaluate a continuing education program for nursing technicians at a pediatric cardiac intensive care unit (PCICU) using a virtual learning environment entitled EDUCATE. From July to September 2015, a total of 24 nursing technicians working at the PCICU at a children's hospital located in the northwestern region of São Paulo state (Brazil) fully participated in the continuing education program developed in a virtual learning environment using Wix platform, allowing access to video classes and pre- and post-training theoretical evaluation questionnaires outside the work environment. The evaluation tools recorded participants' knowledge evolution, technological difficulties, educational, and overall rating. Knowledge development was descriptively presented as positive in more than 66.7%. Content and training were considered "excellent" by most participants and 90% showed an interest in the use of technological resources. Technical difficulties were found and quickly resolved by 40% of participants including Internet access, login, and lack of technical expertise. The continuing education program using a virtual learning environment positively contributed to the improvement in theoretical knowledge of nursing technicians in PCICU.
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Decision making in the neonatal intensive care environment.
Rivers, R P
1996-04-01
Consideration as to whether withdrawal of intensive care support might be a more appropriate line of action than to continue with full intensive care has become a part of the life and death decision making process undertaken in neonatal intensive care units. After outlining the moral objectives of delivery of health care, the arguments for taking quality of life and its various components into account during these deliberations are presented. The circumstances in which the appropriateness of continuing care should be considered are highlighted and the care options presented. The crucial importance of allowing time for parents to come to terms with the situation is emphasised as is the need for giving clear guidelines to junior staff over resuscitation issues. Finally, an environment for providing optimal family support during the process of withdrawal is suggested.
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Experiences of Turkish undergraduate nursing students in the intensive care unit.
Tastan, Sevinc; Iyigun, Emine; Ayhan, Hatice; Hatipoglu, Sevgi
2015-01-01
Clinical practicum provides many opportunities for nursing students to learn more about their subject and develop essential nursing skills. In contrast, nursing students often have difficulties during their clinical practicum. This study aims to describe the clinical experiences of undergraduate nursing students in the intensive care unit. A descriptive qualitative approach was used in this study. The study was performed at a military medical academy between 1 March and 30 April 2008. The study was conducted with 15 fourth-year baccalaureate nursing students. Data were obtained through open-ended and in-depth audio-taped interviews, which lasted approximately 35-45 min. Themes emerged from the participants' descriptions of their experiences in the intensive care unit: anxiety, fear of doing harm, emotional connection and empathy, improving self-confidence, perceived responsibility for patients, prioritizing care of patients, preserving dignity, coping with confronting situations, and communication in the intensive care unit. The views and expectations of nursing students regarding intensive care practice are important for the organization of the nursing education environment. The nursing curriculum must be revised and developed according to the needs of students.
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Personalizing death in the intensive care unit: the 3 Wishes Project: a mixed-methods study.
Cook, Deborah; Swinton, Marilyn; Toledo, Feli; Clarke, France; Rose, Trudy; Hand-Breckenridge, Tracey; Boyle, Anne; Woods, Anne; Zytaruk, Nicole; Heels-Ansdell, Diane; Sheppard, Robert
2015-08-18
Dying in the complex, efficiency-driven environment of the intensive care unit can be dehumanizing for the patient and have profound, long-lasting consequences for all persons attendant to that death. To bring peace to the final days of a patient's life and to ease the grieving process. Mixed-methods study. 21-bed medical-surgical intensive care unit. Dying patients and their families and clinicians. To honor each patient, a set of wishes was generated by patients, family members, or clinicians. The wishes were implemented before or after death by patients, families, clinicians (6 of whom were project team members), or the project team. Quantitative data included demographic characteristics, processes of care, and scores on the Quality of End-of-Life Care-10 instrument. Semistructured interviews of family members and clinicians were transcribed verbatim, and qualitative description was used to analyze them. Participants included 40 decedents, at least 1 family member per patient, and 3 clinicians per patient. The 159 wishes were implemented and classified into 5 categories: humanizing the environment, tributes, family reconnections, observances, and "paying it forward." Scores on the Quality of End-of-Life Care-10 instrument were high. The central theme from 160 interviews of 170 persons was how the 3 Wishes Project personalized the dying process. For patients, eliciting and customizing the wishes honored them by celebrating their lives and dignifying their deaths. For families, it created positive memories and individualized end-of-life care for their loved ones. For clinicians, it promoted interprofessional care and humanism in practice. Impaired consciousness limited understanding of patients' viewpoints. The 3 Wishes Project facilitated personalization of the dying process through explicit integration of palliative and spiritual care into critical care practice. Hamilton Academy of Health Science Research Organization, Canadian Intensive Care Foundation.
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Mora, Maximilian; Mahnert, Alexander; Koskinen, Kaisa; Pausan, Manuela R.; Oberauner-Wappis, Lisa; Krause, Robert; Perras, Alexandra K.; Gorkiewicz, Gregor; Berg, Gabriele; Moissl-Eichinger, Christine
2016-01-01
Indoor environments, where people spend most of their time, are characterized by a specific microbial community, the indoor microbiome. Most indoor environments are connected to the natural environment by high ventilation, but some habitats are more confined: intensive care units, operating rooms, cleanrooms and the international space station (ISS) are extraordinary living and working areas for humans, with a limited exchange with the environment. The purposes for confinement are different: a patient has to be protected from infections (intensive care unit, operating room), product quality has to be assured (cleanrooms), or confinement is necessary due to extreme, health-threatening outer conditions, as on the ISS. The ISS represents the most secluded man-made habitat, constantly inhabited by humans since November 2000 – and, inevitably, also by microorganisms. All of these man-made confined habitats need to be microbiologically monitored and controlled, by e.g., microbial cleaning and disinfection. However, these measures apply constant selective pressures, which support microbes with resistance capacities against antibiotics or chemical and physical stresses and thus facilitate the rise of survival specialists and multi-resistant strains. In this article, we summarize the available data on the microbiome of aforementioned confined habitats. By comparing the different operating, maintenance and monitoring procedures as well as microbial communities therein, we emphasize the importance to properly understand the effects of confinement on the microbial diversity, the possible risks represented by some of these microorganisms and by the evolution of (antibiotic) resistances in such environments – and the need to reassess the current hygiene standards. PMID:27790191
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Mora, Maximilian; Mahnert, Alexander; Koskinen, Kaisa; Pausan, Manuela R; Oberauner-Wappis, Lisa; Krause, Robert; Perras, Alexandra K; Gorkiewicz, Gregor; Berg, Gabriele; Moissl-Eichinger, Christine
2016-01-01
Indoor environments, where people spend most of their time, are characterized by a specific microbial community, the indoor microbiome. Most indoor environments are connected to the natural environment by high ventilation, but some habitats are more confined: intensive care units, operating rooms, cleanrooms and the international space station (ISS) are extraordinary living and working areas for humans, with a limited exchange with the environment. The purposes for confinement are different: a patient has to be protected from infections (intensive care unit, operating room), product quality has to be assured (cleanrooms), or confinement is necessary due to extreme, health-threatening outer conditions, as on the ISS. The ISS represents the most secluded man-made habitat, constantly inhabited by humans since November 2000 - and, inevitably, also by microorganisms. All of these man-made confined habitats need to be microbiologically monitored and controlled, by e.g., microbial cleaning and disinfection. However, these measures apply constant selective pressures, which support microbes with resistance capacities against antibiotics or chemical and physical stresses and thus facilitate the rise of survival specialists and multi-resistant strains. In this article, we summarize the available data on the microbiome of aforementioned confined habitats. By comparing the different operating, maintenance and monitoring procedures as well as microbial communities therein, we emphasize the importance to properly understand the effects of confinement on the microbial diversity, the possible risks represented by some of these microorganisms and by the evolution of (antibiotic) resistances in such environments - and the need to reassess the current hygiene standards.
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Stressors in the relatives of patients admitted to an intensive care unit.
Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner
2016-09-01
To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors.
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Creating learning momentum through overt teaching interactions during real acute care episodes.
Piquette, Dominique; Moulton, Carol-Anne; LeBlanc, Vicki R
2015-10-01
Clinical supervisors fulfill a dual responsibility towards patient care and learning during clinical activities. Assuming such roles in today's clinical environments may be challenging. Acute care environments present unique learning opportunities for medical trainees, as well as specific challenges. The goal of this paper was to better understand the specific contexts in which overt teaching interactions occurred in acute care environments. We conducted a naturalistic observational study based on constructivist grounded theory methodology. Using participant observation, we collected data on the teaching interactions occurring between clinical supervisors and medical trainees during 74 acute care episodes in the critical care unit of two academic centers, in Toronto, Canada. Three themes contributed to a better understanding of the conditions in which overt teaching interactions among trainees and clinical supervisors occurred during acute care episodes: seizing emergent learning opportunities, coming up against challenging conditions, and creating learning momentum. Our findings illustrate how overt learning opportunities emerged from certain clinical situations and how clinical supervisors and trainees could purposefully modify unfavorable learning conditions. None of the acute care episodes encountered in the critical care environment represented ideal conditions for learning. Yet, clinical supervisors and trainees succeeded in engaging in overt teaching interactions during many episodes. The educational value of these overt teaching interactions should be further explored, as well as the impact of interventions aimed at increasing their use in acute care environments.
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Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses.
Sacco, Tara L; Ciurzynski, Susan M; Harvey, Megan Elizabeth; Ingersoll, Gail L
2015-08-01
Although critical care nurses gain satisfaction from providing compassionate care to patients and patients' families, the nurses are also at risk for fatigue. The balance between satisfaction and fatigue is considered professional quality of life. To establish the prevalence of compassion satisfaction and compassion fatigue in adult, pediatric, and neonatal critical care nurses and to describe potential contributing demographic, unit, and organizational characteristics. In a cross-sectional design, nurses were surveyed by using a demographic questionnaire and the Professional Quality of Life Scale to measure levels of compassion fatigue and compassion satisfaction. Nurses (n = 221) reported significant differences in compassion satisfaction and compassion fatigue on the basis of sex, age, educational level, unit, acuity, change in nursing management, and major systems change. Understanding the elements of professional quality of life can have a positive effect on work environment. The relationship between professional quality of life and the standards for a healthy work environment requires further investigation. Once this relationship is fully understood, interventions to improve this balance can be developed and tested. ©2015 American Association of Critical-Care Nurses.
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Broom, Margaret; Gardner, Anne; Kecskes, Zsuzsoka; Kildea, Sue
2017-07-01
To facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. In 2012, an Australian regional neonatal intensive care unit transitioned from an open-plan to a two-cot neonatal intensive care unit design. Research has reported single- and small-room neonatal intensive care unit design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such neonatal intensive care units. Staff highlighted their concerns regarding the impact of the new design on workflow and clinical practice. A participatory action research approach. A participatory action group titled the Change and Networking Group collaborated with staff over a four-year period (2009-2013) to facilitate the transition. The Change and Networking Group used a collaborative, cyclical process of planning, gathering data, taking action and reviewing the results to plan the next action. Data sources included meeting and workshop minutes, newsletters, feedback boards, subgroup reports and a staff satisfaction survey. The study findings include a description of (1) how the participatory action research cycles were used by the Change and Networking Group: providing examples of projects and strategies undertaken; and (2) evaluations of participatory action research methodology and Group by neonatal intensive care unit staff and Change and Networking members. This study has described the benefits of using participatory action research to facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. Participatory action research methodology enabled the inclusion of staff to find solutions to design and clinical practice questions. Future research is required to assess the long-term effect of neonatal intensive care unit design on staff workload, maintaining and supporting a skilled workforce as well as the impact of a new neonatal intensive care unit design on the neonatal intensive care unit culture. A supportive work environment for staff is critical in providing high-quality health care. © 2016 John Wiley & Sons Ltd.
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Work experience, work environment, and blood exposure among home care and hospice nurses.
Leiss, Jack K
2012-01-01
Blood exposure rates among home care and hospice nurses (RNs) in the United States are markedly lower for nurses with more home care/hospice experience, whether or not they have more total years of nursing experience (i.e., in other work environments). This study examined whether the protective effect of home care/hospice experience was greater for nurses who worked under three types of circumstances that are typical of the home care/hospice work environment and conducive to blood exposure. A mail survey was conducted in 2006 among home care/hospice nurses in North Carolina, a largely rural state in the southeastern U.S. The adjusted response rate was 69% (n=833). Blood exposure rates were higher among nurses with ≤5 years' experience in home care/hospice. Contrary to expectations, the protective effect of more experience was greater among nurses who did not have limited access to safety devices/personal protective equipment, did not have to rush during home visits, and did not often visit homes with unrestrained pets, unruly children, poor lighting, or extreme clutter. These results suggest that characteristics of the home care/hospice work environment limit nurses' ability to use their experience to prevent blood exposure.
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Price, James R; Cole, Kevin; Bexley, Andrew; Kostiou, Vasiliki; Eyre, David W; Golubchik, Tanya; Wilson, Daniel J; Crook, Derrick W; Walker, A Sarah; Peto, Timothy E A; Llewelyn, Martin J; Paul, John
2017-02-01
Health-care workers have been implicated in nosocomial outbreaks of Staphylococcus aureus, but the dearth of evidence from non-outbreak situations means that routine health-care worker screening and S aureus eradication are controversial. We aimed to determine how often S aureus is transmitted from health-care workers or the environment to patients in an intensive care unit (ICU) and a high-dependency unit (HDU) where standard infection control measures were in place. In this longitudinal cohort study, we systematically sampled health-care workers, the environment, and patients over 14 months at the ICU and HDU of the Royal Sussex County Hospital, Brighton, England. Nasal swabs were taken from health-care workers every 4 weeks, bed spaces were sampled monthly, and screening swabs were obtained from patients at admission to the ICU or HDU, weekly thereafter, and at discharge. Isolates were cultured and their whole genome sequenced, and we used the threshold of 40 single-nucleotide variants (SNVs) or fewer to define subtypes and infer recent transmission. Between Oct 31, 2011, and Dec 23, 2012, we sampled 198 health-care workers, 40 environmental locations, and 1854 patients; 1819 isolates were sequenced. Median nasal carriage rate of S aureus in health-care workers at 4-weekly timepoints was 36·9% (IQR 35·7-37·3), and 115 (58%) health-care workers had S aureus detected at least once during the study. S aureus was identified in 8-50% of environmental samples. 605 genetically distinct subtypes were identified (median SNV difference 273, IQR 162-399) at a rate of 38 (IQR 34-42) per 4-weekly cycle. Only 25 instances of transmission to patients (seven from health-care workers, two from the environment, and 16 from other patients) were detected. In the presence of standard infection control measures, health-care workers were infrequently sources of transmission to patients. S aureus epidemiology in the ICU and HDU is characterised by continuous ingress of distinct subtypes rather than transmission of genetically related strains. UK Medical Research Council, Wellcome Trust, Biotechnology and Biological Sciences Research Council, UK National Institute for Health Research, and Public Health England. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.
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Danielson, Samantha J; Rappaport, Charles A; Loher, Michael K; Gehlbach, Brian K
2018-06-01
Critically ill patients exhibit profound disturbances of circadian rhythmicity, most commonly in the form of a phase delay. We investigated the specific zeitgeber properties of a medical intensive care unit to develop a model that explained these abnormalities. Prospective, observational study conducted during 2013-2014. Twenty-four-hour ambient light (lux, 672 hours) and sound pressure levels (dBA, 504 hours) were measured in patient rooms. Patients and families were surveyed regarding their perceptions of the environment. University-based adult medical intensive care unit. The timing and intensity of the ambient light-dark cycle and sound environment and the relationship of these measurements to patient/family perceptions. Twenty-four-hour light-dark cycles were extremely weak and phase delayed relative to the solar cycle. Morning light averaged 12.1 (4.8, 37.2) lux, when only 24.9% ± 10.9% of available light was utilised; yet patients and families did not identify low daytime light levels as problematic. Median noise levels were invariably excessive (nighttime 47.9 [45.0, 51.3] dBA) with minimal variation, consistent with the absence of a defined rest period. The intensive care unit functions as a near-constant routine protocol disconnected from solar time. Behavioural interventions to promote entrainment should be supported by objective measurements of light and sound. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Fernandes, Ananda; Campbell-Yeo, Marsha; Johnston, C Celeste
2011-08-01
Neonates who are born preterm and are admitted to neonatal intensive care units endure frequent procedures that may be painful. Nonpharmacological interventions that have been studied to relieve their pain may be categorized in 2 main groups according to their nature: interventions that focus on creating a favorable environment and offering pleasant sensorial stimuli and interventions that are centered on maternal care. These interventions may be considered within the philosophy of developmental care, since they are aimed at adjusting the environment to the needs of the neonate and involve family-centered care. In this article, the first of a 2-part series, we will synthesize the evidence from experimental studies of interventions that focus on the environment and on tactile and gustatory stimulation. The mechanisms suggested by researchers as possible explanations for the efficacy of these interventions are pointed, and the implications for procedural pain management in neonatal care are drawn.
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One Stop Post Op cardiac surgery recovery--a proven success.
Joyce, L; Pandolph, P
2001-01-01
The One Stop Post Op model for open heart surgery recovery is an innovative approach to post op care utilized in only a few facilities in the country. This model calls for an integration of acute ICU and step-down phases of care, thus changing the paradigm for nursing care of the open heart surgery patient. Typically, hospitals incur inefficiencies transferring the patient through multiple levels of care, thus resulting in a "disconnect" as new caregivers relearn the patient's care requirements and special needs. The construction of a "one stop" unit allows the patient to remain stationary while the service level changes to accommodate changing care needs. The cardiac "one stop" model is similar to the LDRP concept for obstetrical care. The One Stop Post Op patient rooms are designed to accommodate every level of patient acuity. All rooms meet the regulations for critical care room design, however this is where the aesthetic similarity ends. The patient environment looks more like hotel rooms rather than the traditional ICU setting. Cabinets designed to cover medical gases, in the room's private bathrooms and comfortable furnishings help to create a patient focused environment conducive to recovery. This model has been utilized by several facilities and has demonstrated clear clinical and economic advantages for patients, families, and health care providers. Implementing an open heart surgery (OHS) program presents the opportunity for several community based hospitals to challenge the way they have been providing patient care and establish an innovative approach to post surgery patient care. The One Stop Post Op cardiovascular recovery unit is designed to receive the OHS patient directly from the operating room and to be the "care unit" for the patient's entire stay. Patient flow, quality monitoring and caregiver acceptance in this unit requires new paradigms from the traditional two or three step post OHS care delivery process. The One Stop Post Op model focuses the delivery of care on the patient. With proven success in clinical outcomes, patient, physician and caregiver satisfaction, it is anticipated that this innovative approach will drive hospitals to integrate clinical process with physical planning in the future.
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Strand, H; Blomqvist, Y T; Gradin, M; Nyqvist, K H
2014-04-01
To compare attitudes towards Kangaroo mother care (KMC) among staff in two high-tech neonatal intensive care units, which provided parents with different opportunities to get involved in their infants' care. Questionnaires were completed by healthcare staff in Unit A, which provided parents with unrestricted access so that they could provide continuous KMC, and Unit B, where parents could only practice KMC intermittently. Unit A staff were more positive about the benefits and use of KMC, including its use in unstable infants, and rated their knowledge and practical skills more highly than staff in the other unit. Unit B staff also appreciated the method, but expressed more hesitation in using it with unstable infants. In particular, they stressed the need to adapt the physical environment of the NICU to enable parents to stay with their infants and practice the method. Staff working in the NICU that gave parents unrestricted access were more positive about KMC than staff in the NICU that offered limited opportunities for parents to stay with their children. This finding suggests that it is important to eliminate unjustifiable obstacles to the presence of parents in the NICU, so that they can provide KMC. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
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Impact of Noise on Nurses in Pediatric Intensive Care Units.
Watson, J'ai; Kinstler, Angela; Vidonish, William P; Wagner, Michael; Lin, Li; Davis, Kermit G; Kotowski, Susan E; Daraiseh, Nancy M
2015-09-01
Excessive exposure to noise places nurses at risk for safety events, near-misses, decreased job performance, and fatigue. Noise is particularly a concern in pediatric intensive care units, where highly skilled providers and vulnerable patients require a quiet environment to promote healing. To measure noise levels and noise duration on specialty pediatric intensive care units to explore sources of noise and its effects on the health of registered nurses. In a cross-sectional pilot study, levels and sources of noise in 3 different specialty pediatric intensive care units were assessed. Fifteen nurses were observed for 4-hour sessions during a 24-hour period. Sound pressure levels (noise) and heart rate were measured continuously, and stress ratings were recorded. Descriptive statistics were calculated for noise (level, source, location, and activity), heart rate, and stress. The Pearson correlation coefficient was calculated to analyze the relationship between heart rate and noise. Mean noise level was 71.9 (SD, 9.2) dBA. Mean heart rate was 85.2/min (SD, 15.8/min) and was significantly associated with noise, unit, within-unit location, nurse sources, and noise activities. The most frequent sources of noise were patients' rooms, care activities, and staff communications. Noise levels in pediatric intensive care units exceed recommended thresholds and require immediate attention through effective interventions. Although noise was not associated with stress, a significant correlation with increased heart rate indicates that noise may be associated with adverse health outcomes. ©2015 American Association of Critical-Care Nurses.
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Individual and organizational predictors of health care aide job satisfaction in long term care.
Chamberlain, Stephanie A; Hoben, Matthias; Squires, Janet E; Estabrooks, Carole A
2016-10-13
Unregulated health care aides provide the majority of direct health care to residents in long term care homes. Lower job satisfaction as reported by care aides is associated with increased turnover of staff. Turnover leads to inferior job performance and negatively impacts quality of care for residents. This study aimed to determine the individual and organizational variables associated with job satisfaction in care aides. We surveyed a sample of 1224 care aides from 30 long term care homes in three Western Canadian provinces. The care aides reported their job satisfaction and their perception of the work environment. We used a hierarchical, mixed-effects ordered logistic regression to model the relative odds of care aide job satisfaction for individual, care unit, and facility factors. Care aide exhaustion, professional efficacy, and cynicism were associated with job satisfaction. Factors in the organizational context that are associated with increased care aide job satisfaction include: leadership, culture, social capital, organizational slack-staff, organizational slack-space, and organizational slack-time. Our findings suggest that organizational factors account for a greater increase in care aide job satisfaction than do individual factors. These features of the work environment are modifiable and predict care aide job satisfaction. Efforts to improve care aide work environment and quality of care should focus on organizational context.
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Resources and quality of care in services for the elderly.
Winsløw, Jacob Hilden; Borg, Vilhelm
2008-05-01
To investigate the association between resources of the workplace and the quality of care in municipal long-term care. At the municipal level, the resources comprised the proportion of care workers with a long period of professional training and the relative availability of care-giving manpower. At the level of the organizational unit, the resources comprised aspects of the psychosocial working environment. A survey of 7,500 care workers in 36 municipalities in Denmark was performed. Quality of care was measured by seven standardized questions in a questionnaire. Data on the psychosocial resources of the workplace were aggregated responses from the care workers to questions from the Copenhagen Psychosocial Questionnaire. Data on the training and relative availability of care workers were derived by combining information from payroll lists and data available from government databases. There was a positive association between psychosocial resources at the level of the organizational unit and the quality of care provided by the individual care worker. There was no association between the level of professional training of the municipal workforce of care-givers and the quality of care provided by the individual care worker. There was a complex relationship between the relative availability of care-giving manpower at the municipal level and the quality of care provided by the individual care worker. Improving the psychosocial working environment of care workers is one key to securing sufficient caring staff for the long-term care sector; increasing manpower or increasing the proportion of highly trained staff are not in themselves such keys.
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Noise and acoustics in renal units and hospitals [corrected].
James, Ray
2008-03-01
The quality of the patient's life while in the hospital setting is important and hence the quality of the hospital environment is equally important. The effect of noise on health varies depending upon the susceptibility of the individual, but can include higher blood pressure, stress and annoyance in staff, and can erode quality of care. This paper ascertains what the noise levels are in a typical renal unit and considers the potential effects on staff and patients. The quality of the hospital environment plays an important part in treating patients effectively and efficiently. The use of acoustic design principles can reduce the level and impact of noise and, in doing so, improve the quality of care and the patient experience.
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Ward, Nicholas S; Read, Richard; Afessa, Bekele; Kahn, Jeremy M
2012-02-01
Increases in the size and number of American intensive care units have not been accompanied by a comparable increase in the critical care physician workforce, raising concerns that intensivists are becoming overburdened by workload. This is especially concerning in academic intensive care units where attending physicians must couple teaching duties with patient care. We performed an in-person and electronic survey of the membership of the Association of Pulmonary and Critical Care Medicine Program Directors, soliciting information about patient workload, other hospital and medical education duties, and perceptions of the workplace and teaching environment of their intensive care units. Eighty-four out of a total 121 possible responses were received from program directors or their delegates, resulting in a response rate of 69%. The average daily (SD) census (as perceived by the respondents) was 18.8 ± 8.9 patients, and average (SD) maximum service size recalled was 24.1 ± 9.9 patients. Twenty-seven percent reported no policy setting an upper limit for the daily census. Twenty-eight percent of respondents felt the average census was "too many" and 71% felt the maximum size was "too many." The median (interquartile range) patient-to-attending physician ratio was 13 (10-16). When categorized according to this median, respondents from intensive care units with high patient/physician ratios (n = 31) perceived significantly more time constraints, more stress, and difficulties with teaching trainees than respondents with low patient/physician ratios (n = 40). The total number of non-nursing healthcare workers per patient was similar in both groups, suggesting that having more nonattending physician staff does not alleviate perceptions of overwork and stress in the attending physician. Academic intensive care unit physicians that direct fellowship programs frequently perceived being overburdened in the intensive care unit. Understaffing intensive care units with attending physicians may have a negative impact on teaching, patient care, and workforce stability.
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Measuring Family Satisfaction With Care Delivered in the Intensive Care Unit.
Clark, Kathleen; Milner, Kerry A; Beck, Marlene; Mason, Virginia
2016-12-01
In our competitive health care environment, measuring the experience of family members of patients in the intensive care unit to ensure that health care providers are meeting families' needs is critical. Surveys from Press Ganey and the Centers for Medicare and Medicaid Services are unable to capture families' satisfaction with care in this setting. To implement a sustainable measure for family satisfaction in a 12-bed medical and surgical intensive care unit. To assess the feasibility of the selected tool for measuring family satisfaction and to make recommendations that are based on the results. A descriptive survey design using the Family Satisfaction in the Intensive Care Unit 24-item questionnaire to measure satisfaction with care and decision-making. Forty family members completed the survey. Overall, the mean score for families' satisfaction with care was 72.24% (SD, 14.87%) and the mean score for families' satisfaction with decision-making was 72.03% (SD, 16.61%). Families reported that nurses put them at ease and provided understandable explanations. Collaboration, inclusion of families in clinical discussions, and timely information regarding changes in the patient's condition were the most common points brought up in free-text responses from family members. Written communication, including directions and expectations, would have improved the families' experience. Although patients' family members reported being satisfied with their experience in the intensive care unit, there is room for improvement. Effective communication among the health care team, patients' families, and patients will be targeted for quality improvement initiatives. ©2016 American Association of Critical-Care Nurses.
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[The margin of autonomy of nurses in psychiatry: for a clinical approach in the institution].
Langellotti, Grégory
2013-01-01
In care units, nurses operate in working environments which offer them a margin of autonomy. When they seize upon this opportunity, they invent therapeutics tools. Their creativity as well as the pleasure given in the care contributes to the clinical dynamics within the institution.
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ERIC Educational Resources Information Center
Monahan, Felicia
A special unit within a nursing home for serving residents with dementia was developed and implemented at the Cape Cod Nursing Home in Buzzards Bay, Massachusetts. The purpose of the special unit is to create a structured and protective environment which holistically supports the residents with dementia in achieving their maximum potential. A…
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Nursing care of the brain injury patient on a locked neurobehavioral unit.
Becker, Christine
2012-01-01
Behavioral problems after a brain injury can be extremely challenging for those working with brain injured people. Nursing staff must be familiar with commonly used post brain injury medications and their effects, behavioral management plans, appropriate use of restrictive devices, and verbal or physical crisis intervention techniques when necessary. Rehabilitation nurses caring for brain injured patients on a locked neurobehavioral unit must maintain continual training and specific competence in this environment to ensure patient and staff safety. © 2012 Association of Rehabilitation Nurses.
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Building a vertical provider system.
Barnett, A E
1993-01-01
There is probably no geographic area in the United States in which the health care environment is more turbulent than that of Southern California. Long before President Clinton's proposals began serious national debate on health care reform, a massive provider-driven realignment of the system was occurring in that region of the country. Multispecialty medical groups have generally led the way and have acquired ever larger managed care populations through merger and acquisition of other groups and practices. Hospitals, hampered by large fixed capital bases, have struggled to reinvent themselves as cost-effective and primary care-friendly environments in order to be attractive to managed care physicians. Almost ignored in this reconfiguration has been the university teaching hospital. This article discusses one attempt to reconcile contractually an integrated, capitated, and managed care-oriented health care system with an academic medical center in a strategic alliance.
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Increasing Military Physician Productivity in a Managed Care Environment
1992-07-13
allows us to obtain to a common denominator, or one single rating even though the services are dissimilar and the input units are not "weighted." Serway ...many ideas as possible to catalyze the process. In removing barriers to productivity in the work environment, a thorough analysis of the physical ...physician and the organization has increased. The whole text of the book "Doctor’s Decisions and the Cost of Medical Care" is dedicated to this concept
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Stressors in the relatives of patients admitted to an intensive care unit
Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner
2016-01-01
Objective To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Methods Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. Results The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Conclusion Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors. PMID:27737424
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Nursing work environment in Saudi Arabia.
Aboshaiqah, Ahmad E
2015-05-01
The purpose of this study was to assess the work environment as perceived by nurses in a large tertiary hospital in Saudi Arabia. The quality of patient care services has been associated with the quality of work environment of nurses. It is therefore important to assess the work environment in order to acquire baseline data and enable the institution to benchmark their status from established quality standards. This study used a descriptive survey with 1007 staff nurses across service units of a 1000-bed government-operated hospital. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Questionnaire was used for data collection. Scores were aggregated and interpreted. Effective decision making, authentic leadership, appropriate staffing, true collaboration, skilled communication and meaningful recognition were rated as good (mean range 3.53-3.76). Healthy work environments mutually benefit patients, nurses, nurse managers, health care providers, the health team, administration, the institution and the community at large. Valuable baseline data on the status of the work environment in this setting were generated. This should allow administrators and staff to work together in improving weaknesses and strengthening further whatever gains that are attained to ensure consistent provision of safe and quality patient care. © 2013 John Wiley & Sons Ltd.
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Behrens, Sue A
Despite utilization of the advanced practice registered nurse (APRN) in the United States health care system, there is little information about the introduction, utilization, and challenges of the APRN role globally, especially in the Middle East. This article will look at how one hospital in the United Arab Emirates introduced the APRN role to a health care environment of a country where it has not been recognized historically. Cultural challenges and barriers for the implementation of the role include regulatory, societal, and institutional. Innovation and collaboration are necessary to address these challenges and barriers and to pave the way for a successful advanced practice model pilot, as well as for the future use of the role. Innovation is also one of the key performance indicators for the country's health care. However, the idea of advanced practice is a new concept that has been outside the mainstream health care practice for the United Arab Emirates. To help with the implementation, a road map was developed to outline the steps necessary to provide a safe practice environment. The plan included aligning with the ministry of health nursing and midwifery council, as well as the Health Authority of Abu Dhabi, to help them learn more about the US model of advanced practice, along with benefits, and outcomes of the role. Developing the role of the APRN will benefit the future state of the health care infrastructure for not only the United Arab Emirates but throughout the Middle East.
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Cognitive Tools for Assessment and Learning in a High Information Flow Environment.
ERIC Educational Resources Information Center
Lajoie, Susanne P.; Azevedo, Roger; Fleiszer, David M.
1998-01-01
Describes the development of a simulation-based intelligent tutoring system for nurses working in a surgical intensive care unit. Highlights include situative learning theories and models of instruction, modeling expertise, complex decision making, linking theories of learning to the design of computer-based learning environments, cognitive task…
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Comfort experience in palliative care: a phenomenological study.
Coelho, Adriana; Parola, Vitor; Escobar-Bravo, Miguel; Apóstolo, João
2016-08-02
Palliative care aims to provide maximum comfort to the patient. However it is unknown what factors facilitate or hinder the experience of comfort, from the perspective of inpatients of palliative care units. This lack of knowledge hinders the development of comfort interventions adjusted to these patients. The aim of this research is to describe the comfort and discomfort experienced by inpatients at palliative care units. A phenomenological descriptive study was undertaken. Ten inpatients were recruited from a Spanish palliative care unit and seven from a Portuguese palliative care unit. Data were collected using individual interviews and analysed following the method of Giorgi. Four themes reflect the essence of the lived experience: The Palliative Care as a response to the patient's needs with advanced disease, attempt to naturalize advanced disease, confrontation with their own vulnerability, openness to the spiritual dimension. Informants revealed that they experience comfort through humanized care, differentiated environment, symptomatic control, hope and relationships. The discomfort emerges from the losses and powerlessness against their situation. Even if such findings may seem intuitive, documenting them is essential because it invites us to reflect on our convictions about what it means to be comfortable for these patients, and allows incorporating this information in the design of focused interventions to maximize the comfort experience.
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Carter, B S; Carter, A; Bennett, S
2008-12-01
Parents whose newborns were cared for in the old neonatal intensive care unit (NICU) environment and then moved to the new NICU environment describe their impressions of the impact upon their infant's care, information access and support, of the two care settings. To determine the perceptions of parents in the NICU regarding noise, light, space, access to caregivers and personal privacy as they experience both old and new NICU environments in the continuum of care for their infant. In the first 9 months after moving into the new private room NICU, a convenience sampling of parents was voluntarily administered a 20-question Likert scale survey addressing length of stay (LOS) in the respective NICU environment, environmental stimuli, access to caregivers, access to information and personal privacy. Scores reflect frequency of perceptions as never=1, sometimes=2, usually=3 and always=4. The responses of 53 parents are reported. This represents 10% of admissions to the private room NICU during the 9-month sampling time. Fifty-nine percent had LOS of
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The Therapeutic Use of Music in Critical Care.
1995-01-01
Music therapy is an area that is oftentimes not widely accepted in the highly technological environment of the critical care unit. This is...physiological and psychological benefits to music therapy . These benefits include reductions in blood pressure, heart rate, respiratory rate...intervention is dependent upon how well the individual can relate to the music selection. Music therapy promotes a holistic approach to patient care that
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Stone, Katie; Papadopoulos, Irena; Kelly, Daniel
2012-12-01
models of care based on the hospice model have delivered effective support to dying people since their inception. Over the last 20 years this form of care has also been introduced into the prison system (mainly in the United States) to afford terminally ill inmates the right to die with dignity. the aim of this review is to examine the evidence from the United States and the United Kingdom on the promotion of palliative care in the prison sector, summarizing examples of good practice and identifying barriers for the provision of end-of-life care within the prison environment both in the USA and UK. an integrative review design was adopted using the Green et al. model incorporating theoretical and scientific lines of enquiry. literature was sourced from six electronic databases between the years 2000 and 2011; the search rendered both qualitative and quantitative papers, discussion papers, 'grey literature' and other review articles. the results highlight a number of issues surrounding the implementation of palliative care services within the prison setting and emphasize the disparity between the USA model of care (which emphasizes the in-prison hospice) and the UK model of care (which emphasizes palliative care in-reach) for dying prisoners. the provision of palliative care for the increasing prison population remains under-researched globally, with a notable lack of evidence from the United Kingdom.
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Characterizing noise and perceived work environment in a neurological intensive care unit.
Ryherd, Erica E; Waye, Kerstin Persson; Ljungkvist, Linda
2008-02-01
The hospital sound environment is complex. Alarms, medical equipment, activities, and ventilation generate noise that may present occupational problems as well as hinder recovery among patients. In this study, sound measurements and occupant evaluations were conducted in a neurological intensive care unit. Staff completed questionnaires regarding psychological and physiological reactions to the sound environment. A-weighted equivalent, minimum, and maximum (L(Aeq),L(AFMin),L(AFMax)) and C-weighted peak (L(CPeak)) sound pressure levels were measured over five days at patient and staff locations. Acoustical descriptors that may be explored further were investigated, including level distributions, restorative periods, and spectral content. Measurements near the patients showed average L(Aeq) values of 53-58 dB. The mean length of restorative periods (L(Aeq) below 50 dB for more than 5 min) was 9 and 13 min for day and night, respectively. Ninety percent of the time, the L(AFMax) levels exceeded 50 dB and L(CPeak) exceeded 70 dB. Dosimeters worn by the staff revealed higher noise levels. Personnel perceived the noise as contributing to stress symptoms. Compared to the majority of previous studies, this study provides a more thorough description of intensive care noise and aids in understanding how the sound environment may be disruptive to occupants.
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Global theory and the nature of risk, Part 2. Towards a choice-based model of managed care.
Emery, D W
1999-01-01
Orthodox managed care depends on top-down, command and control techniques to squeeze efficiency out of the system. But for every unit of economic good this approach produces, two or three bad units come as result. The key to moving to an environment where value and efficiency become self-sustaining is to structurally recognize the medicoeconomic reality of medicine: the episode of care. The episode forms a natural unit of analysis that not only renders costs and outcomes information translucent and accessible, but it also forms the natural conduit through which premium dollars can find their optimal value. By bifurcating probability risk from technical risk and allocating them in the ex ante and ex post markets, respectively, health care insurers and providers return to their rightful economic roles, and to their appropriate fiduciary duties. And patients regain some semblance of reasonable sovereignty in managing their own medical affairs.
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Ferlie, E B; Shortell, S M
2001-01-01
Fueled by public incidents and growing evidence of deficiencies in care, concern over the quality and outcomes of care has increased in both the United Kingdom and the United States. Both countries have launched a number of initiatives to deal with these issues. These initiatives are unlikely to achieve their objectives without explicit consideration of the multilevel approach to change that includes the individual, group/team, organization, and larger environment/system level. Attention must be given to issues of leadership, culture, team development, and information technology at all levels. A number of contingent factors influence these efforts in both countries, which must each balance a number of tradeoffs between centralization and decentralization in efforts to sustain the impetus for quality improvement over time. The multilevel change framework and associated properties provide a framework for assessing progress along the journey.
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Mission (IM) possible? Nurse civility in the NICU.
Simons, Sherri Lee
2008-01-01
Nurses will work in a unit and choose to stay because they feel pride in their work and are respected. Eliminating horizontal hostility at the unit level begins with a commitment from the NICU's leadership. Establishing and maintaining an environment of civility is essential if the unit is to successfully recruit and maintain the best staff to care for the patients entrusted to it.
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The neonatal nurses' view of their role in emotional support of parents and its complexities.
Turner, Melanie; Chur-Hansen, Anna; Winefield, Helen
2014-11-01
To explore the nurses' views of their role both in the neonatal intensive care unit and in the provision of interacting with, and emotionally supporting, families. The neonatal intensive care nurse has a large and complex clinical role and also a role of emotional supporter for parents in the neonatal intensive care unit. Identifying components of their role and recognising the elements within the nursery that obstruct or encourage this role can allow for modification of nurse education and peer support. Qualitative study based on semistructured interviews. Nine neonatal nurses from a single neonatal intensive care unit were interviewed and the data analysed thematically using NVIVO version 10. Participants viewed their role as an enjoyable yet difficult one, requiring seniority, training and experience. They provided support to parents by communicating, listening, providing individualised support and by encouraging parental involvement with their baby. Constructive elements that contributed to the provision of support included a positive neonatal intensive care unit environment and providing a parent support group. More obstructive elements were a lack of physical neonatal intensive care unit space, little time available for nurse-to-parent conversation and language and cultural barriers between nurses and parents. The role of the neonatal nurse in providing emotional support is complex and requires a high level of ongoing support and education for staff, and minimisation of physical and staff-related obstructions. The modern neonatal intensive care unit offers complex medical and nursing services and with this care comes higher needs from both babies and their parents. Neonatal intensive care unit nurses should be supported in their roles by having peer support available in the neonatal intensive care unit and education and training in emotional support and counselling skills. The nursing staff also require a comfortable and practical physical working space in which to assist parents to be with their baby. © 2014 John Wiley & Sons Ltd.
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Understanding the Culture of Chinese Children and Families
ERIC Educational Resources Information Center
Cheung, Ruth; Nelson, Warren; Advincula, Luzelle; Cureton, Virginia Young; Canham, Daryl L.
2005-01-01
Providing appropriate health care to a client can be accomplished only in an environment that is sensitive to the cultural values and beliefs of the client. As the population of first-and second-generation Chinese immigrants increases in the United States, the need to develop culturally sensitive health care becomes significant. Chinese immigrants…
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Influence of workplace culture on nursing-sensitive nurse outcomes in municipal primary health care.
Hahtela, Nina; Paavilainen, Eija; McCormack, Brendan; Slater, Paul; Helminen, Mika; Suominen, Tarja
2015-10-01
To explore the influence of workplace culture on sickness absences, overtime work and occupational injuries in municipal primary health care. The need to improve nursing sensitive outcomes has been highlighted. Therefore, an adequate understanding of the influence of workplace culture on nursing-sensitive nurse outcomes is essential for nurse managers to meet the requirements of improving nursing outcomes. A cross-sectional survey design was used to incorporating the data from 21 inpatient acute care units of nine organisations at the Finnish municipal primary health care system from 2011 to 2012. Findings emphasise in particular the importance of the practice environment as being an interpretative factor for nurses' absences owing to sickness, overtime work and occupational injuries. To ensure favourable nursing sensitive outcomes it is essential that there is a shared interest in the unit to invest in the creation of a supportive practice environment. Outcome improvements require a special focus on issues related to nursing management, adequate staffing and resources and intention to leave. © 2014 John Wiley & Sons Ltd.
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[Aspergillus species in hospital environments with pediatric patients in critical condition].
Fernández, Mariana; Cattana, María; Rojas, Florencia; Sosa, María de Los Ángeles; Aguirre, Clarisa; Vergara, Marta; Giusiano, Gustavo
2014-01-01
Aspergillus is a group of opportunistic fungi that cause infections, with high morbimortality in immunosuppressed patients. Aspergillus fumigatus is the most frequent species in these infections, although the incidence of other species has increased in the last few years. To evaluate the air fungal load and the diversity of Aspergillus species in hospitals with pediatric patients in critical condition. The Intensive Care Unit and Burns Unit of a pediatric hospital were sampled every 15 days during the autumn and spring seasons. The air samples were collected with SAS Super 100(®) and the surface samples were collected by swab method. The UFC/m(3) counts found exceeded the acceptable levels. The UFC/m(3) and the diversity of Aspergillus species found in the Intensive Care Unit were higher than those found in the Burns Unit. The fungal load and the diversity of species within the units were higher than those in control environments. The use of both methods -SAS and swab- allowed the detection of a higher diversity of species, with 96 strains of Aspergillus being isolated and 12 species identified. The outstanding findings were Aspergillus sydowii, Aspergillus niger, Aspergillus flavus, Aspergillus terreus and Aspergillus parasiticus, due to their high frequency. Aspergillus fumigatus, considered unacceptable in indoor environments, was isolated in both units. Aspergillus was present with high frequency in these units. Several species are of interest in public health for being potential pathogenic agents. Air control and monitoring are essential in the prevention of these infections. Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.
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Hilliard, Neil; Brown, Stuart; Mitchinson, Steve
2015-03-01
This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine. A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil. A continuous subcutaneous infusion of dexmedetomidine was started and titrated to achieve pain relief. The patient's pain and delirium cleared. The treatment was successful in fulfilling the patient's goal of care: not to be deeply and continuously sedated, but to be rousable and of clear mind while still having good pain control. Dexmedetomidine is a potentially useful medication for the targeted treatment of intractable pain and delirium in the tertiary palliative care environment. Future research is required to compare dexmedetomidine infusion to standard treatment with midazolam infusion for treatment of intractable symptoms in the palliative care environment. © The Author(s) 2014.
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Kol, Emine; Aydın, Perihan; Dursun, Oguz
2015-07-01
Noise is a substantial problem for both patients and healthcare workers in hospitals. This study aimed to determine the effectiveness of environmental strategies (creating single-patient rooms and reducing noise sources) in noise reduction in a pediatric intensive care unit. Noise measurement in the unit was conducted in two phases. In the first phase, measurements aimed at determining the unit's present level of noise were performed over 4 weeks in December 2013. During the month following the first measurement phase, the intensive care unit (ICU) was moved to a new location and noise-reducing strategies were implemented. The second phase, in May 2014, measured noise levels in the newly constructed environment. The noise levels before and after environmental changes were statistically significant at 72.6 dB-A and 56 dB-A, respectively (p < .05). Single-patient rooms and noise-reducing strategies can be effective in controlling environmental noise in the ICU. © 2015, Wiley Periodicals, Inc.
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Clinical dashboards: impact on workflow, care quality, and patient safety.
Egan, Marie
2006-01-01
There is a vast array of technical data that is continuously generated within the intensive care unit environment. In addition to physiological monitors, there is information being captured by the ventilator, intravenous infusion pumps, medication dispensing units, and even the patient's bed. The ability to retrieve and synchronize data is essential for both clinical documentation and real-time problem solving for individual patients and the intensive care unit population as a whole. Technical advances that permit the integration of all relevant data into a singular display or "dashboard" may improve staff efficiency, accelerate decisions, streamline workflow processes, and reduce oversights and errors in clinical practice. Critical care nurses must coordinate all aspects of care for one or more patients. Clinical data are constantly being retrieved, documented, analyzed, and communicated to others, all within the daily routine of nursing care. In addition, many bedside monitors and devices have alarms systems that must be evaluated throughout the workday, and actions taken on the basis of the patient's condition and other data. It is obvious that the complexity within such care processes presents many potential opportunities for overlooking important details. The capability to systematically and logically link physiological monitors and other selected data sets into a cohesive dashboard system holds tremendous promise for improving care quality, patient safety, and clinical outcomes in the intensive care unit.
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Hutchinson, Amy L; Van Wissen, Kim A
2017-12-01
Many people would choose to die at home, and this can be an option for intensive care patients. However, there is limited exploration of the impact on the family. To gain insight into family members' experiences when an adult intensive care unit patient is taken home to die. Methodology is qualitative description, utilising purposeful sampling, unstructured interviews and thematic analysis. Four participants, from two different families were interviewed. The setting was a tertiary level Intensive Care Unit in New Zealand. The experience was described as a kaleidoscope of events with two main themes: 'value' family member's found in the patient going home, and their experience of the 'process'. 'Value' subthemes: going home being the patient's own decision, home as an end-of-life environment, and the patient's positive response to being at home. 'Process' subthemes: care and support received, stress of a family member being in intensive care, feeling that everything happened quickly, and concerns and uncertainties. Going home to die from the intensive care unit can be a positive but challenging experience for the family. Full collaboration between the patient, family and staff is essential, to ensure the family are appropriately supported. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Caring for dying infants: experiences of neonatal intensive care nurses in Hong Kong.
Yam, B M; Rossiter, J C; Cheung, K Y
2001-09-01
Ten registered nurses working in a neonatal intensive care unit in Hong Kong were interviewed to explore their experiences of caring for infants whose disease is not responsive to curative treatment, their perceptions of palliative care, and factors influencing their care. Eight categories emerged from the content analysis of the interviews: disbelieving; feeling ambivalent and helpless; protecting emotional self; providing optimal physical care to the infant; providing emotional support to the family; expressing empathy; lack of knowledge and counselling skills; and conflicting values in care. The subtle cultural upbringing and socialization in nurse training and workplace environment also contributed to their moral distress. Hospital and nurse administrators should consider different ways of facilitating palliative care in their acute care settings. For example, by culture-specific death education, peer support groups, bereavement teams, modification of departmental policies, and a supportive work environment. Future research could include the identification of family needs and coping as well as ethical decision-making among nurses.
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[Fear of child/family in pediatric intensive care units: what is the nurse's role?].
Machado, Cidália; Sousa, Pedro Jácome
2007-01-01
The fear is considered a negative emotion, lived with apprehension, uncertainty and a sense of threat or danger to the personal integrity (Torres & Guerra, 2003). It is often associated with hospitalization of the chid/family, and may be the cause to start an emotional crisis due to the separation from environment and the usual routines, the loss of independence and autonomy, and also due to be with strange people (Bicho, 2006; Festas 1994; Freitas &Freitas, 2005; Hockenberry, 2006). Hospitalization in a Pediatric Intensive Care Unit (PICU) may worsen an already existing crisis not only for the given reasons but also because the child may be in life danger. The environment "aggressive"and stressant characteristic of these units also contributes to this situation. To minimize the fear and his negative effects, the nurse has an important role to play. Because of his/her activities and function he/she is the closest health care professional to the child/family, and therefore in a better position to establish a relationship of trust and empathy that will minimize such effects, as well as to the interventions best suited to achieve this objective.
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The patient experience of intensive care: a meta-synthesis of Nordic studies.
Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit; Henricson, Maria; Granberg-Axell, Anetth; Storli, Sissel Lisa
2015-08-01
Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care. The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human suffering during life-threatening illness. We conducted a meta-synthesis in which we collected, assessed, and analyzed published qualitative studies with the goal of synthesizing these findings into a new whole. Analysis was based on the scientific approach of Gadamerian hermeneutics. Nordic intensive care units. Patients in Nordic intensive care units. We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and PsycINFO. Each original paper was assessed by all authors using the Critical Appraisal Skills Program instrument for qualitative research. We included 22 studies, all of which provided direct patient quotes. The overarching theme was identified as: The patient experience when existence itself is at stake. We constructed an organizing framework for analysis using the main perspectives represented in the included studies: body, mind, relationships, and ICU-environment. Final analysis and interpretation resulted in the unfolding of four themes: existing in liminality, existing in unboundedness, existing in mystery, and existing on the threshold. Our main finding was that human suffering during intensive care is still evident although sedation is lighter and the environment is more humane. Our interpretation suggested that patients with life-threatening illness descend into a liminal state, where they face the choice of life or death. Caring nurses and family members play an important role in assisting the patient to transition back to life. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Use of physical restraints in adult critical care: a bicultural study.
Martin, Beth; Mathisen, Lars
2005-03-01
Although controversial, physical restraints are commonly used in adult critical care units in the United States to prevent treatment interference and self-inflicted harm. Use of physical restraints in Norwegian hospitals is very limited. In the United States, an experimental design for research on use of restraints has not seemed feasible. However, international research provides an opportunity to compare and contrast practices. To describe the relationship between patients' characteristics, environment, and use of physical restraints in the United States and Norway. Observations of patients and chart data were collected from 2 intensive care units (n = 50 patients) in Norway and 3 (n = 50 patients) in the United States. Sedation was measured by using the Sedation-Agitation Scale. The Nine Equivalents of Nursing Manpower Use Score was used to indicate patients' acuity level. Restraints were in use in 39 of 100 observations in the United States and not at all in Norway (P = .001). Categories of patients were balanced. In the Norwegian sample, the median Nine Equivalents of Nursing Manpower Use Score was higher (37 vs 27 points, P < .001), patients were more sedated (P < .001), and nurse-to-patient ratios were higher (1.05:1 vs 0.65:1, P < .001). Seven incidents of unplanned device removal were reported in the US sample. Critical care units with similar technology and characteristics of patients vary between nations in restraint practices, levels of sedation, and nurse-to-patient ratios. Restraint-free care was, in this sample, safe in terms of treatment interference.
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Environment surveillance of filamentous fungi in two tertiary care hospitals in China.
Hao, Zhen-feng; Ao, Jun-hong; Hao, Fei; Yang, Rong-ya; Zhu, He; Zhang, Jie
2011-07-05
Invasive fungal infections have constituted an increasingly important cause of morbidity and mortality in immunocompromised patients. In this study, a surveillance project was conducted in three different intensive care units of two large tertiary hospitals in China. A one-year surveillance project was conducted in two tertiary hospitals which located in northern China and southwest China respectively. Air, surfaces and tap water were sampled twice a month in a central intensive care unit, a bone marrow transplant unit, a neurosurgery intensive care unit and a live transplant department. Environmental conditions such as humidity, temperature and events taking place, for example the present of the visitors, healthcare staff and cleaning crew were also recorded at the time of sampling. The air fungal load was 91.94 cfu/m(3) and 71.02 cfu/m(3) in the southwest China hospital and the northern China hospital respectively. The five most prevalent fungi collected from air and surfaces were Penicillium spp., Cladospcrium spp., Alternaria spp., Aspergillus spp. and Saccharomyces spp. in the southwest China hospital, meanwhile Penicillium spp., Fusarium spp., Aspergillus spp., Alternaria spp. and Cladospcrium spp. in the northern China hospital. The least contaminated department was intensive care units, and the heaviest contaminated department was neurosurgery intensive care unit. Seventy-three percent of all surfaces examined in the northern China hospital and eighty-six percent in the southwest China hospital yielded fungi. Fifty-four percent of water samples from the northern China hospital and forty-nine percent from the southwest China hospital yielded fungi. These findings suggested that the fungus exist in the environment of the hospital including air, surface and water. Air and surface fungal load fluctuated over the year. Air fungal load was lower in winter and higher in summer and autumn, but seldom exceeded acceptable level. The higher values were created during May to August in the northern China hospital and May to June and September to October in the southwest China hospital. A correlation between air fungal load and humidity, as well as personnel was observed.
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Acoustics and psychosocial environment in intensive coronary care
Blomkvist, V; Eriksen, C; Theorell, T; Ulrich, R; Rasmanis, G
2005-01-01
Aims: To examine the influence of different acoustic conditions on the work environment and the staff in a coronary critical care unit (CCU). Method: Psychosocial work environment data from start and end of each individual shift were obtained from three shifts (morning, afternoon, and night) for a one-week baseline period and for two four-week periods during which either sound reflecting or sound absorbing tiles were installed. Results: Reverberation times and speech intelligibility improved during the study period when the ceiling tiles were changed from sound reflecting tiles to sound absorbing ones of identical appearance. Improved acoustics positively affected the work environment; the afternoon shift staff experienced significantly lower work demands and reported less pressure and strain. Conclusions: Important gains in the psychosocial work environment of healthcare can be achieved by improving room acoustics. The study points to the importance of further research on possible effects of acoustics in healthcare on staff turnover, quality of patient care, and medical errors. PMID:15723873
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Nurses well-being in intensive care units: study of factors promoting team commitment.
Galletta, Maura; Portoghese, Igor; Coppola, Rosa C; Finco, Gabriele; Campagna, Marcello
2016-05-01
Intensive care units (ICUs) are challenging work environments because of the critical condition of patients, and ICU nurses frequently lament low job satisfaction and high staff turnover. Nevertheless, organizational and work characteristics, and the quality of relationships with staff can help to maintain nurses' enthusiasm and increase job satisfaction. The aim of this study was to analyse how nursing work environment factors affect identification and commitment among ICU nurses. A cross-sectional study was carried out in 12 ICUs from four Italian urban hospitals. A total of 222 nurses participated and completed a self-reported questionnaire. Results show that nursing work characteristics are directly related to team commitment, and that the nursing work characteristics and team commitment relationship was mediated by both perceived supervisor support and job satisfaction. Our findings may concretely contribute to literature and offer additional suggestions to improve nurses' work conditions and patient health in ICUs. © 2014 British Association of Critical Care Nurses.
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Wood, Dora; Geoghegan, Sophie; Ramnarayan, Padmanabhan; Davis, Peter J; Pappachan, John V; Goodwin, Sarah; Wray, Jo
2018-05-01
Critically ill adolescents are usually treated on intensive care units optimised for much older adults or younger children. The way they access and experience health services may be very different to most adolescent service users, and existing quality criteria may not apply to them. The objectives of this pilot study were, firstly, to determine whether adolescents and their families were able to articulate their experiences of their critical care admission and secondly, to identify the factors that are important to them during their intensive care unit (ICU) or high dependency unit (HDU) stay. Participants were 14-17 year olds who had previously had an emergency admission to an adult or paediatric ICU/HDU in one of four UK hospitals (two adult, two paediatric) and their parents. Semi-structured interviews were conducted with eight mother-adolescent dyads and one mother. Interviews were transcribed and analysed using framework analysis. The main reported determinant of high-quality care was the quality of interaction with staff. The significance of these interactions and their environment depended on adolescents' awareness of their surroundings, which was often limited in ICU and changed significantly over the course of their illness. Qualitative interview methodology would be difficult to scale up for this group. What is known • Critically ill adolescents are usually treated on intensive care units optimised for older adults or younger children. • The way they access and experience health services may be different to most adolescent patients; existing quality criteria may not apply. What is new • Reported determinants of high-quality care were age-appropriateness of the environment, respectfulness and friendliness of staff, communication and inclusion in healthcare decisions. • The significance of these depended on adolescents' awareness of their surroundings, which was often limited and changed over the course of their illness.
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Younger, D; Martin, G W
2000-11-01
The audit reported in this paper and submitted to the Psychiatry of Old Age Management group, assessed six units within each of two health districts in the UK. Using a nonparticipatory observation method in the units selected, the aim was to measure quality and the environment of care. Dependency levels of the clients/residents were also estimated to give a clearer picture of the setting and the care requirements. This was intended to establish a baseline for the units mapped and to enable care developments to be focussed upon intended outcomes. Results led to a number of observations related to the levels of interaction between staff and clients/residents, the need for a wider range of activities to promote person-centred care, and a suggested route to the improvement in quality of life for this vulnerable group of people. Assessment of dependency levels linked to the results of the mapping showed that high dependency does not lead automatically to a lower quality of person centred care.
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Armstrong, Susan J; Rispel, Laetitia C; Penn-Kekana, Loveday
2015-01-01
Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers' recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care.
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Armstrong, Susan J.; Rispel, Laetitia C.; Penn-Kekana, Loveday
2015-01-01
Background Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high-quality patient care. PMID:25971397
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[Fungus microbiota in air conditioners in intensive care units in Teresina, Piauí].
Mobin, Mitra; do Amparo Salmito, Maria
2006-01-01
With the aim of identifying the fungus microbiota in air conditioners in intensive care units (ICUs) within public and private hospitals in Teresina, Piauí, solid material was collected from ten different ICUs. Thirty-three species of Moniliaceae and Dematiaceae were isolated, which was the first report of these in Piauí. High frequencies of Aspergillus niger Van Tieghem (60%), Aspergillus fumigatus Fres (50%), Trichoderma koningii Oudem (50%) and Aspergillus flavus Link: Fr. (40%) were recorded. The air conditioner cleanliness validity had expired in all the ICUs, and the quantity of colony-forming units exceeded the levels permitted by Law 176/00 from the Ministry of Health. It is important to provide individual protection equipment for professionals, adopt hospital infection control measures, raise the awareness of the presence of fungus infection, improve air circulation around the environment, periodically clean the air conditioners, and make health professionals alert to the importance of these fungi in the hospital environment.
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Caring and technology in an intensive care unit: an ethnographic study.
Price, Ann M
2013-11-01
Critical care practice is a mixture of caring and technological activities. There is debate about whether the balance between these two elements is correct and a concern that critical care units can dehumanize the patient. This research sought to examine aspects that might affect this balance between the caring and technology within the critical care setting. What aspects affect registered health care professionals' ability to care for patients within the technological environment of a critical care unit? A qualitative approach using ethnography was utilized as this methodology focuses on the cultural elements within a situation. Data collection involved participant observation, document review and semi-structured interviews to triangulate methods as this aids rigour for this approach. A purposeful sample to examine registered health care professionals currently working within the study area was used. A total of 19 participants took part in the study; 8 nurses were observed and 16 health care professionals were interviewed, including nurses, a doctor and 2 physiotherapists. The study took place on a District General Hospital intensive care unit and ethical approval was gained. An overarching theme of the 'Crafting process' was developed with sub themes of 'vigilance', 'focus of attention, 'being present' and 'expectations' with the ultimate goal of achieving the best interests for the individual patient. The areas reflected in this study coincide with the care, compassion, competency, commitment, communication and courage ideas detailed by the Department of Health (2012). Thus, further research to detail more specifically how these areas are measured within critical care may be useful. Caring is a complex concept that is difficult to outline but this article can inform practitioners about the aspects that help and hinder caring in the technical setting to inform training. © 2013 British Association of Critical Care Nurses.
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Foureur, Maralyn; Davis, Deborah; Fenwick, Jennifer; Leap, Nicky; Iedema, Rick; Forbes, Ian; Homer, Caroline S E
2010-10-01
Recent advances in cross-disciplinary studies linking architecture and neuroscience have revealed that much of the built environment for health-care delivery may actually impair rather than improve health outcomes by disrupting effective communication and increasing patient and staff stress. This is also true for maternity care provision, where it is suggested that the design of the environment can also impact on the experiences and outcomes for birthing women. The aim of this paper is to describe the development of a conceptual model based on literature and understandings of design, communication, stress and model of care. The model explores potential relationships among a set of key variables that need to be considered by researchers wishing to determine the characteristics of optimal birth environments in relation to birth outcomes for women and infants. The conceptual model hypothesises that safe satisfying birth is reliant on the level of stress experienced by a woman and the staff around her, stress influences the quality of communication with women and between staff, and this process is mediated by the design of the birth unit and model of care. The conceptual model is offered as a starting point for researchers who have an appreciation of the complexity of birth and the ability to bring together colleagues from a range of disciplines to explore the pre-requisites for safe and effective maternity care in new ways. Copyright © 2010 Elsevier Ltd. All rights reserved.
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Providing a healthy work environment for nurses: the influence on retention.
Cohen, Jayne; Stuenkel, Diane; Nguyen, Quyen
2009-01-01
Differences in registered nurses' (RNs) perceptions of their work environment were measured with the Insel and Moos' Work Environment Scale to identify factors in the work environment that may influence retention. Statistically significant differences for perceptions of supervisor support and innovation were found between those RNs who left their unit or hospital during a 24-month period and those who stayed. Implementing strategies to promote retention of RNs to ensure safe, quality patient care is essential.
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Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René
2015-10-01
To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. Cross-sectional study. National, randomly selected sample of Swiss nursing homes, stratified according to language region and size. A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
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Stevens, Dennis C; Helseth, Carol C; Khan, M Akram; Munson, David P; Reid, E J
2011-01-01
The purpose of this research was to test the hypothesis that parental satisfaction with neonatal intensive care is greater in a single-family room facility as compared with a conventional open-bay neonatal intensive care unit (NICU). This investigation was a prospective cohort study comparing satisfaction survey results for parents who responded to a commercially available parent NICU satisfaction survey following the provision of NICU care in open-bay and single-family room facilities. A subset of 16 items indicative of family-centered care was also computed and compared for these two NICU facilities. Parents whose babies received care in the single-family room facility expressed significantly improved survey responses in regard to the NICU environment, overall assessment of care, and total survey score than did parents of neonates in the open-bay facility. With the exception of the section on nursing in which scores in both facilities were high, nonsignificant improvement in median scores for the sections on delivery, physicians, discharge planning, and personal issues were noted. The total median item score for family-centered care was significantly greater in the single-family room than the open-bay facility. Parental satisfaction with care in the single-family room NICU was improved in comparison with the traditional open-bay NICU. The single-family room environment appears more conducive to the provision of family-centered care. Improved parental satisfaction with care and the potential for enhanced family-centered care need to be considered in decisions made regarding the configuration of NICU facilities in the future.
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Disher, Timothy C; Benoit, Britney; Inglis, Darlene; Burgess, Stacy A; Ellsmere, Barbara; Hewitt, Brenda E; Bishop, Tanya M; Sheppard, Christopher L; Jangaard, Krista A; Morrison, Gavin C; Campbell-Yeo, Marsha L
To identify baseline sound levels, patterns of sound levels, and potential barriers and facilitators to sound level reduction. The study setting was neonatal and pediatric intensive care units in a tertiary care hospital. Participants were staff in both units and parents of currently hospitalized children or infants. One 24-hour sound measurements and one 4-hour sound measurement linked to observed sound events were conducted in each area of the center's neonatal intensive care unit. Two of each measurement type were conducted in the pediatric intensive care unit. Focus groups were conducted with parents and staff. Transcripts were analyzed with descriptive content analysis and themes were compared against results from quantitative measurements. Sound levels exceeded recommended standards at nearly every time point. The most common code was related to talking. Themes from focus groups included the critical care context and sound levels, effects of sound levels, and reducing sound levels-the way forward. Results are consistent with work conducted in other critical care environments. Staff and families realize that high sound levels can be a problem, but feel that the culture and context are not supportive of a quiet care space. High levels of ambient sound suggest that the largest changes in sound levels are likely to come from design and equipment purchase decisions. L10 and Lmax appear to be the best outcomes for measurement of behavioral interventions.
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Lin, Tzu-Ching; Lin, Huey-Shyan; Cheng, Su-Fen; Wu, Li-Min; Ou-Yang, Mei-Chen
2016-04-01
This study aimed to examine the relationship between work stress and depression; and investigate the mediating effect of occupational burnout among nurses in paediatric intensive care units. The relationships among work stress, occupational burnout and depression level have been explored, neither regarding occupational burnout as the mediating role that causes work stress to induce depression nor considering the paediatric intensive care unit context. A cross-sectional correlational design was conducted. One hundred and forty-four female paediatric intensive care unit nurses from seven teaching hospitals in southern Taiwan were recruited as the participants. Data were collected by structured questionnaires including individual demographics, the Nurse Stress Checklist, the Occupational Burnout Inventory and the Taiwan Depression Questionnaire. The results indicated that after controlling for individual demographic variables, the correlations of work stress with occupational burnout, as well as work stress and occupational burnout with depression level were all positive. Furthermore, occupational burnout may exert a partial mediating effect on the relationship between work stress and depression level. This study provides information about work stress, occupational burnout and depression level, and their correlations, as well as the mediating role of occupational burnout among paediatric intensive care unit nurses. It suggests government departments and hospital administrators when formulating interventions to prevent work stress and occupational burnout. These interventions can subsequently prevent episodes of depression in paediatric intensive care unit nurses, thereby providing patients with a safe and high-quality nursing environment. © 2016 John Wiley & Sons Ltd.
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Characterising the ambient sound environment for infants in intensive care wards.
Shoemark, Helen; Harcourt, Edward; Arnup, Sarah J; Hunt, Rod W
2016-04-01
The purpose of this study is to characterise ambient sound levels of paediatric and neonatal intensive care units in an old and new hospital according to current standards. The sound environment was surveyed for 24-h data collection periods (n = 80) in the Neonatal and Paediatric Intensive Care Units (NICUs and PICUs) and Special Care Nursery of the old and new Royal Children's Hospital Melbourne. The ambient sound environment was characterised as the proportion of time the ongoing ambient sound met standard benchmarks, the mean 5-s sound levels and the number and duration of noise events. In the old hospital, none of the data collection periods in the NICU and PICU met the standard benchmark for ongoing ambient sound, while only 5 of the 22 data collection periods in the new hospital met the recommended level. There was no change in proportion of time at recommended Leq between the old and the new Special Care Nursery. There was strong evidence for a difference in the mean number of events >65 dBA (Lmax ) in the old and new hospital (rate ratio = 0.82, 95% confidence interval: 0.73 to 0.92, P = 0.001). The NICU and PICU were above 50 dBA in 75% of all data collection periods, with ventilatory equipment associated with higher ongoing ambient sound levels. The ongoing ambient sound suggests that the background sound environment of the new hospital is not different to the old hospital. However, there may be a reduction in the number of noise events. © 2016 The Authors Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
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Work stress of primary care physicians in the US, UK and German health care systems.
Siegrist, Johannes; Shackelton, Rebecca; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John
2010-07-01
Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. Copyright 2010 Elsevier Ltd. All rights reserved.
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Work stress of primary care physicians in the US, UK and German health care systems
Siegrist, Johannes; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John
2010-01-01
Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005–2007. Results demonstrate country-specific differences in work stress- with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. PMID:20494505
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Bonner, Oliver; Beardsall, Kathryn; Crilly, Nathan; Lasenby, Joan
2017-02-01
The neonatal intensive care unit (NICU) can be one of the most stressful hospital environments. Alongside providing intensive clinical care, it is important that parents have the opportunity for regular physical contact with their babies because the neonatal period is critical for parent-child bonding. At present, monitoring technology in the NICU requires multiple wired sensors to track each baby's vital signs. This study describes the experiences that parents and nurses have with the current monitoring methods, and reports on their responses to the concept of a wireless monitoring system. Semistructured interviews were conducted with six parents, each of whom had babies on the unit, and seven nurses who cared for those babies. The interviews initially focused on the participants' experiences of the current wired system and then on their responses to the concept of a wireless system. The transcripts were analysed using a general inductive approach to identify relevant themes. Participants reported on physical and psychological barriers to parental care, the ways in which the current system obstructed the efficient delivery of clinical care and the perceived benefits and risks of a wireless system. The parents and nurses identified that the wires impeded baby-parent bonding; physically and psychologically. While a wireless system was viewed as potentially enabling greater interaction, staff and parents highlighted potential concerns, including the size, weight and battery life of any new device. The many wires required to safely monitor babies within the NICU creates a negative environment for parents at a critical developmental period, in terms of physical and psychological interactions. Nurses also experience challenges with the existing system, which could negatively impact the clinical care delivery. Developing a wireless system could overcome these barriers, but there remain challenges in designing a device suitable for this unique environment.
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Cunha-Cruz, Joana; Milgrom, Peter; Huebner, Colleen E; Scott, JoAnna; Ludwig, Sharity; Dysert, Jeanne; Mitchell, Melissa; Allen, Gary; Shirtcliff, R Mike
2017-12-20
Dental care delivery systems in the United States are consolidating and large practice organizations are becoming more common. At the same time, greater accountability for addressing disparities in access to care is being demanded when public funds are used to pay for care. As change occurs within these new practice structures, attempts to implement change in the delivery system may be hampered by failure to understand the organizational climate or fail to prepare employees to accommodate new goals or processes. Studies of organizational behavior within oral health care are sparse and have not addressed consolidation of current delivery systems. The objective of this case study was to assess organizational readiness for implementing change in a large dental care organization consisting of staff model clinics and affiliated dental practices and test associations of readiness with workforce characteristics and work environment. A dental care organization implemented a multifaceted quality improvement program, called PREDICT, in which community-based mobile and clinic-based dental services were integrated and the team compensated based in part on meeting performance targets. Dental care providers and supporting staff members (N = 181) were surveyed before program implementation and organizational readiness for implementing change (ORIC) was assessed by two 5-point scales: change commitment and efficacy. Providers and staff demonstrated high organizational readiness for change. Median change commitment was 3.8 (Interquartile range [IQR]: 3.3-4.3) and change efficacy was 3.8 (IQR: 3.0-4.2). In the adjusted regression model, change commitment was associated with organizational climate, support for methods to arrest tooth decay and was inversely related to office chaos. Change efficacy was associated with organizational climate, support for the company's mission and was inversely related to burnout. Each unit increase in the organizational climate scale predicted 0.45 and 0.8-unit increases in change commitment and change efficacy. The survey identified positive readiness for change and highlighted weaknesses that are important cautions for this organization and others initiating change. Future studies will examine how organizational readiness to change, workforce characteristics and work environment influenced successful implementation within this organization.
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Hua, Ying; Becker, Franklin; Wurmser, Teri; Bliss-Holtz, Jane; Hedges, Christine
2012-01-01
Studies investigating factors contributing to improved quality of care have found that effective team member communication is among the most critical and influential aspects in the delivery of quality care. Relatively little research has examined the role of the physical design of nursing units on communication patterns among care providers. Although the concept of decentralized unit design is intended to increase patient safety, reduce nurse fatigue, and control the noisy, chaotic, and crowded space associated with centralized nursing stations, until recently little attention has been paid to how such nursing unit designs affected communication patterns or other medical and organizational outcomes. Using a pre/post research design comparing more centralized or decentralized unit designs with a new multi-hub design, the aim of this study was to describe the relationship between the clinical spatial environment and its effect on communication patterns, nurse satisfaction, distance walked, organizational outcomes, patient safety, and patient satisfaction. Hospital institutional data indicated that patient satisfaction increased substantially. Few significant changes were found in communication patterns; no significant changes were found in nurse job satisfaction, patient falls, pressure ulcers, or organizational outcomes such as average length of stay or patient census.
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Artificial intelligence applications in the intensive care unit.
Hanson, C W; Marshall, B E
2001-02-01
To review the history and current applications of artificial intelligence in the intensive care unit. The MEDLINE database, bibliographies of selected articles, and current texts on the subject. The studies that were selected for review used artificial intelligence tools for a variety of intensive care applications, including direct patient care and retrospective database analysis. All literature relevant to the topic was reviewed. Although some of the earliest artificial intelligence (AI) applications were medically oriented, AI has not been widely accepted in medicine. Despite this, patient demographic, clinical, and billing data are increasingly available in an electronic format and therefore susceptible to analysis by intelligent software. Individual AI tools are specifically suited to different tasks, such as waveform analysis or device control. The intensive care environment is particularly suited to the implementation of AI tools because of the wealth of available data and the inherent opportunities for increased efficiency in inpatient care. A variety of new AI tools have become available in recent years that can function as intelligent assistants to clinicians, constantly monitoring electronic data streams for important trends, or adjusting the settings of bedside devices. The integration of these tools into the intensive care unit can be expected to reduce costs and improve patient outcomes.
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Primary care in the United States: practice-based innovations and factors that influence adoption.
Goldberg, Debora Goetz
2012-01-01
This study aims to explore the use of specific innovations in primary care practices. The research seeks to examine whether a relationship exists between environmental factors and organizational characteristics and the level of innovation in primary care practices in Virginia. The study utilized multiple secondary data sets and an organizational survey of primary care practices to define the external environment and the level of innovation. Institutional theory was used to explain the connection between innovations in primary care practices and institutional forces within the environment. Resource dependency theory was used to explain motivators for change based on a dependence on scarce financial, human, and information resources. Results show a positive association between organizational size, organizational relationships, and stakeholder expectations on the level of innovation. A negative association was found between competition and the level of innovation. No relationship was found between degree of Medicare and managed care penetration and innovation, nor between knowledge of, and difficulty complying with, payer organization requirements and innovation. Primary care physician practices exist in a market-driven environment characterized by high pressure from regulatory sources, decreasing reimbursement levels, increasing rate of change in technologies, and increasing patient and community expectations. This study contributes new information on the relationship between organizational characteristics, the external environment and specific innovations in primary care practices. Information on the contributing factors to innovation in primary care is important for improving delivery of health care services and the ability of these practices to survive.
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Impact of NICU design on environmental noise.
Szymczak, Stacy E; Shellhaas, Renée A
2014-04-01
For neonates requiring intensive care, the optimal sound environment is uncertain. Minimal disruptions from medical staff create quieter environments for sleep, but limit language exposure necessary for proper language development. There are two models of neonatal intensive care units (NICUs): open-bay, in which 6-to-10 infants are cared for in a single large room; and single-room, in which neonates are housed in private, individual hospital rooms. We compared the acoustic environments in the two NICU models. We extracted the audio tracks from video-electroencephalography (EEG) monitoring studies from neonates in an open-bay NICU and compared the acoustic environment to that recorded from neonates in a new single-room NICU. From each NICU, 18 term infants were studied (total N=36; mean gestational age 39.3±1.9 weeks). Neither z-scores of the sound level variance (0.088±0.03 vs. 0.083±0.03, p=0.7), nor percent time with peak sound variance (above 2 standard deviations; 3.6% vs. 3.8%, p=0.6) were different. However, time below 0.05 standard deviations was higher in the single-room NICU (76% vs. 70%, p=0.02). We provide objective evidence that single-room NICUs have equal sound peaks and overall noise level variability compared with open-bay units, but the former may offer significantly more time at lower noise levels.
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Radford, Sarah A.; Johnson, Elizabeth M.; Leeming, John P.; Millar, Michael R.; Cornish, Jacqueline M.; Foot, Annabel B. M.; Warnock, David W.
1998-01-01
We have developed a PCR-based method for the subspecific discrimination of Aspergillus fumigatus types by using two primers designed to amplify the intergenic spacer regions between ribosomal DNA transcription units. The method permitted the reproducible discrimination of 11 distinct DNA types among a total of 119 isolates of A. fumigatus collected from patients and from the environment of a bone marrow transplantation (BMT) unit over a three-year period. Ten DNA types of A. fumigatus were isolated from patients in the BMT unit; eight of these types were also found in the hospital environment, and six of these were present in the unit itself. Thirteen BMT patients developed infection with one of three DNA types some months after these had first been found in the environment of the unit. In other instances, the same DNA types of A. fumigatus were isolated from BMT patients that were later recovered from the environment of the unit. Several DNA types of A. fumigatus were found in the hospital environment over an 18-month period. Molecular typing of multiple isolates of A. fumigatus, obtained from postmortem tissue samples, showed that one patient was infected with a single DNA type, but two others had up to three different DNA types. Our findings suggest that A. fumigatus infection in BMT recipients may be nosocomial in origin and underline the need for careful environmental monitoring of units in which high-risk patients are housed. PMID:9574694
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Operational integration in primary health care: patient encounters and workflows.
Sifaki-Pistolla, Dimitra; Chatzea, Vasiliki-Eirini; Markaki, Adelais; Kritikos, Kyriakos; Petelos, Elena; Lionis, Christos
2017-11-29
Despite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration. The study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review. Overall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows. Existing patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web platform, based on a strong theoretical framework, can serve as a robust integration evaluation tool. This could be a first step towards restructuring and improving PHC services within a financially restrained environment.
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Patients and their families weigh in on evidence-based hospital design.
Trochelman, Kathleen; Albert, Nancy; Spence, Jacqueline; Murray, Terri; Slifcak, Ellen
2012-02-01
In 2 landmark publications, the Institute of Medicine reported on significant deficiencies in our current health care system. In response, an area of research examining the role of the physical environment in influencing outcomes for patients and staff gained momentum. The concept of evidence-based design has evolved, and the development of structural guidelines for new hospital construction was instituted by the American Institute of Architects in 2006. To determine perceptions of patients and their families of evidence-based design features in a new heart center. Hospitalized patients and their families, most of whom were in intensive care and step-down units, were surveyed and data from the Hospital Consumer Assessment of Healthcare Providers and Systems were reviewed to determine perceptions of evidence-based design features incorporated into a new heart center and to assess patients' satisfaction with the environment. Results Responses were reviewed and categorized descriptively. Five general environment topics of focus emerged: privacy, space, noise, light, and overall atmosphere. Characteristics perceived as being dissatisfying and satisfying are discussed. Critical care nurses must be aware of the current need to recognize how much the physical environment influences care delivery and take steps to maximize patients' safety, satisfaction, and quality of care.
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Coughlin, Mary; Gibbins, Sharyn; Hoath, Steven
2009-01-01
Title Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. Aim This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Background Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America’s Joint Commission’s concept of ‘core measures’ for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Data sources Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Discussion Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Conclusion Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes. PMID:19686402
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Care zoning in a psychiatric intensive care unit: strengthening ongoing clinical risk assessment.
Mullen, Antony; Drinkwater, Vincent; Lewin, Terry J
2014-03-01
To implement and evaluate the care zoning model in an eight-bed psychiatric intensive care unit and, specifically, to examine the model's ability to improve the documentation and communication of clinical risk assessment and management. Care zoning guides nurses in assessing clinical risk and planning care within a mental health context. Concerns about the varying quality of clinical risk assessment prompted a trial of the care zoning model in a psychiatric intensive care unit within a regional mental health facility. The care zoning model assigns patients to one of 3 'zones' according to their clinical risk, encouraging nurses to document and implement targeted interventions required to manage those risks. An implementation trial framework was used for this research to refine, implement and evaluate the impact of the model on nurses' clinical practice within the psychiatric intensive care unit, predominantly as a quality improvement initiative. The model was trialled for three months using a pre- and postimplementation staff survey, a pretrial file audit and a weekly file audit. Informal staff feedback was also sought via surveys and regular staff meetings. This trial demonstrated improvement in the quality of mental state documentation, and clinical risk information was identified more accurately. There was limited improvement in the quality of care planning and the documentation of clinical interventions. Nurses' initial concerns over the introduction of the model shifted into overall acceptance and recognition of the benefits. The results of this trial demonstrate that the care zoning model was able to improve the consistency and quality of risk assessment information documented. Care planning and evaluation of associated outcomes showed less improvement. Care zoning remains a highly applicable model for the psychiatric intensive care unit environment and is a useful tool in guiding nurses to carry out routine patient risk assessments. © 2013 John Wiley & Sons Ltd.
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Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S
2013-10-01
Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n = 357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care. © 2012 John Wiley & Sons Ltd.
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Brelsford, Gina M; Ramirez, Joshua; Veneman, Kristin; Doheny, Kim K
2016-08-01
Preterm birth is an unanticipated and stressful event for parents. In addition, the unfamiliar setting of the intensive care nursery necessitates strategies for coping. The primary study objective of this descriptive study was to determine whether secular and religious coping strategies were related to family functioning in the neonatal intensive care unit. Fifty-two parents of preterm (25-35 weeks' gestation) infants completed the Brief COPE (secular coping), the Brief RCOPE (religious coping), and the Family Environment Scale within 1 week of their infant's hospital admission. This descriptive study found that parents' religious and secular coping was significant in relation to family relationship functioning. Specifically, negative religious coping (ie, feeling abandoned or angry at God) was related to poorer family cohesion and use of denial. These findings have relevance for interventions focused toward enhancing effective coping for families. Further study of religious and secular coping strategies for neonatal intensive care unit families is warranted in a larger more diverse sample of family members.
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Helder, Onno K; Verweij, Jos C M; van Staa, AnneLoes
2012-05-01
To explore parents' and nurses' experiences with the transition of infants from the neonatal intensive care unit to a special care nursery. Qualitative explorative study in two phases. Level IIID neonatal intensive care unit in a university hospital and special care nurseries (level II) in five community hospitals in the Netherlands. Twenty-one pairs of parents and 18 critical care nurses. Semistructured interviews were used. Thematic analysis and comparison of themes across participants were performed. Trust was a central theme for parents. Three subthemes, related to the chronological stages of transition, were identified: gaining trust; betrayal of trust; and rebuilding confidence. Trust was associated with five other themes: professional attitude; information management; coordination of transfer; different environments; and parent participation. Although nurses at an early stage repeatedly mentioned a possible transition to community hospitals, the actual announcement took many parents by surprise. Parents felt excluded during the actual transfer and most questioned its necessity. In the special care nursery, parents found it difficult to adjust to new routines and to gain trust in new caregivers, but eventually their worries dissolved. In contrast to neonatal intensive care unit nurses, special care nursery nurses quite understood the impact of transition on parents. Both parents and nurses considered present transitional arrangements to be inadequate. Nurses should provide more effective discharge planning and transitional care. A positive labeling of the transition as a first step to home discharge for the newborn seems appropriate. Parents need to be better-informed and should be involved in the planning process.
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Innovative Information Systems in the Intensive Care Unit, King Saud Medical City in Saudi Arabia.
Al Saleem, Nouf; Al Harthy, Abdulrahman
2015-01-01
The purpose of this paper is to discuss the experience of implementing innovative information technology to improve the quality of services in one of the largest Intensive Care Units in Saudi Arabia. The Intensive Care Units in King Saud Medical City (ICU-KSMC) is the main ICU in the kingdom that represents the Ministry of Health. KSMC's ICU is also considered one of the largest ICU in the world as it consists of six units with 129 beds. Leaders in KSMC's ICU have introduced and integrated three information technologies to produce powerful, accurate, and timely information systems to overcome the challenges of the ICU nature and improve the quality of service to ensure patients' safety. By 2015, ICU in KSMC has noticed a remarkable improvement in: beds' occupation and utilization, staff communication, reduced medical errors, and improved departmental work flow, which created a healthy professional work environment. Yet, ICU in KSMC has ongoing improvement projects that include future plans for more innovative information technologies' implementation in the department.
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Siu, Heidi; Spence Laschinger, Heather K; Finegan, Joan
2008-05-01
The aim of this study was to examine the impact of nurses' perceived professional practice environment on their quality of nursing conflict management approaches and ultimately their perceptions of unit effectiveness from the perspective of Deutsch's theory of constructive conflict management. Rising reports of hostility and conflict among Canadian nurses are a concern to nurses' health and the viability of effective patient care delivery. However, research on the situational factors that influence nurses' ability to apply effective conflict resolution skills that lead to positive results in practice is limited. A nonexperimental, predictive design was used in a sample of 678 registered nurses working in community hospitals within a large metropolitan area in Ontario. The results supported a modified version of the hypothesized model [chi2(1) = 16.25, Goodness of Fit = 0.99, Comparative Fit Index = 0.98, Root-Mean-Square Error of Approximation = 0.15] linking professional practice environment and core self-evaluation to nurses' conflict management and, ultimately, unit effectiveness. Professional practice environment, conflict management, and core-self evaluation explained approximately 46.6% of the variance in unit effectiveness. Positive professional practice environments and high core self-evaluations predicted nurses' constructive conflict management and, in turn, greater unit effectiveness.
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Rationing of nursing care within professional environmental constraints: a correlational study.
Papastavrou, Evridiki; Andreou, Panayiota; Tsangari, Haritini; Schubert, Maria; De Geest, Sabina
2014-06-01
The purpose of this study was to examine rationing of nursing care and the possible relationship between nurses' perceptions of their professional practice environment and care rationing. A total of 393 nurses from medical and surgical units participated in the study. Data were collected using the Basel Extent of Rationing of Nursing Care (BERNCA) instrument and the Revised Professional Practice Environment (RPPE) Scale. The highest level of rationing was reported for "reviewing of patient documentation" (M = 1.15, SD = 0.94; 31.2% sometimes or often) followed by "oral and dental hygiene" (M = 1.06, SD = 0.94; 31.5% sometimes or often) and "coping with the delayed response of physicians" (M = 1.04, SD = 0.96; 30% sometimes or often). Regression analyses showed that teamwork, leadership and autonomy, and communication about patients accounted in total 18.4% of the variance in rationing. In regard to application, the association between the practice environment and rationing suggests improvements in certain aspects that could minimize rationing.
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Saving our backs: safe patient handling and mobility for home care.
Beauvais, Audrey; Frost, Lenore
2014-01-01
Predicted work-related injuries for nurses and home healthcare workers are on the rise given the many risk factors in the home environment and the escalating demands for home healthcare workers in the United States. Fortunately, safe patient handling and mobility programs can dramatically decrease injuries. Despite strides being made to promote safe patient handling and mobility programs in acute care, more can be done to establish such initiatives in the home care setting.
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The Cost-Effectiveness of Supported Employment for Adults with Autism in the United Kingdom
ERIC Educational Resources Information Center
Mavranezouli, Ifigeneia; Megnin-Viggars, Odette; Cheema, Nadir; Howlin, Patricia; Baron-Cohen, Simon; Pilling, Stephen
2014-01-01
Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom.…
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Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand.
Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H
2011-12-01
To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001). Improving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.
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Symbolic interactionism and nurse-mother communication in the neonatal intensive care unit.
Cleveland, Lisa Marie
2009-01-01
The admission of an infant to the neonatal intensive care unit (NICU) has the potential to cause significant stress for the mothers of these infants. Researchers have found that nurse-mother communication has the potential to either aid or hinder the mother's adaptation to the NICU environment. These communication patterns are relatively complex in nature and therefore warrant further investigation. Symbolic interactionism (SI) is a theoretical framework that offers the potential to direct such an investigation. The purpose of this article is to examine nurse-mother communication patterns in the NICU through the theoretical lens of SI.
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Calhoun, Darlene A; Christensen, Robert D
2004-03-01
The practice of complete bowel rest in prematurely delivered neonates and those who have undergone surgery for congenital anomalies of the gastrointestinal (GI) tract is common in neonatal intensive care units (NICU). However, increased recognition of the critical role of growth factors in GI development suggests that this practice might be modified to include the administration of synthetic amniotic fluid-like solutions designed to bridge the neonate between their intra-uterine environment and that of the NICU. This article reviews advances in administering synthetic amniotic fluid-like solutions in the NICU.
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As CMS makes another policy change, policy makers distinguish between different forms of care.
2013-10-01
As observation care continues to draw fire from critics who charge that the designation ends up costing hospitals money while also sticking patients with exorbitant fees, the medical directors of dedicated observation units counter that the kind of care delivered by their specialized units actually saves money and gets patients out of the hospital sooner. They note that the problem is that only about one-third of hospitals actually have dedicated observation units, so patients placed on observation typically wind up in inpatient beds, where they may only be evaluated once a day. CMS has just released a new policy rule on observation that should help patients avoid excessive charges, but many experts would like to see the agency take steps to incentivize the kind of quality care that is delivered in dedicated units. The new CMS rule for 2014 caps observation stays at 48 hours. Patients who remain in the hospital beyond this point become inpatients, as long as they meet inpatient criteria. Proponents of observation care contend that the average length-of-stay in a dedicated observation unit is just 15 hours--typically much shorter than the LOS of patients who are placed on observation in inpatient beds. Care in a dedicated observation unit is generally driven by protocol in an emergency medicine environment where there is continuous rounding. Discharges can occur at any time of the day or night. Experts note that observation patients account for the largest portion of both misdiagnoses and malpractice lawsuits stemming from emergency settings.
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Raboshchuk, Ganna; Nadeu, Climent; Jancovic, Peter; Lilja, Alex Peiro; Kokuer, Munevver; Munoz Mahamud, Blanca; Riverola De Veciana, Ana
2018-01-01
A large number of alarm sounds triggered by biomedical equipment occur frequently in the noisy environment of a neonatal intensive care unit (NICU) and play a key role in providing healthcare. In this paper, our work on the development of an automatic system for detection of acoustic alarms in that difficult environment is presented. Such automatic detection system is needed for the investigation of how a preterm infant reacts to auditory stimuli of the NICU environment and for an improved real-time patient monitoring. The approach presented in this paper consists of using the available knowledge about each alarm class in the design of the detection system. The information about the frequency structure is used in the feature extraction stage, and the time structure knowledge is incorporated at the post-processing stage. Several alternative methods are compared for feature extraction, modeling, and post-processing. The detection performance is evaluated with real data recorded in the NICU of the hospital, and by using both frame-level and period-level metrics. The experimental results show that the inclusion of both spectral and temporal information allows to improve the baseline detection performance by more than 60%.
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Nursing leadership in intensive care units and its relationship to the work environment 1
Balsanelli, Alexandre Pazetto; Cunha, Isabel Cristina Kowal Olm
2015-01-01
AIM: To establish whether there is any relationship between the work environment and nursing leadership at intensive care units (ICUs). METHOD: Correlational study conducted at four ICUs in southern São Paulo (SP), Brazil. The study population was comprised of 66 pairs (nurses and nursing technicians) established by lottery. The nurses responded to three instruments: 1) characterization; 2) a validated Portuguese version of the Nursing Work Index Revised (B-NWI-R); and 3) Grid & Leadership in Nursing: ideal behavior. The nursing technicians responded to 1) characterization and to 2) Grid and Leadership in Nursing: actual behavior, relative to the corresponding randomly-assigned nurse. The data were analyzed by means of analysis of variance (ANOVA) at p ≤ 0.05. RESULTS: The work environment was not associated with actual nursing leadership (p = 0.852). The public or private nature of the institutions where the investigated ICUs were located had no significant effect on leadership (p = 0.437). Only the nurse-physician relationship domain stood out (p = 0.001). CONCLUSION: The choice of leadership styles by nurses should match the ICU characteristics. Leadership skills could be developed, and the work environment did not exert any influence on the investigated population. PMID:25806638
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Nadeu, Climent; Jančovič, Peter; Lilja, Alex Peiró; Köküer, Münevver; Muñoz Mahamud, Blanca; Riverola De Veciana, Ana
2018-01-01
A large number of alarm sounds triggered by biomedical equipment occur frequently in the noisy environment of a neonatal intensive care unit (NICU) and play a key role in providing healthcare. In this paper, our work on the development of an automatic system for detection of acoustic alarms in that difficult environment is presented. Such automatic detection system is needed for the investigation of how a preterm infant reacts to auditory stimuli of the NICU environment and for an improved real-time patient monitoring. The approach presented in this paper consists of using the available knowledge about each alarm class in the design of the detection system. The information about the frequency structure is used in the feature extraction stage, and the time structure knowledge is incorporated at the post-processing stage. Several alternative methods are compared for feature extraction, modeling, and post-processing. The detection performance is evaluated with real data recorded in the NICU of the hospital, and by using both frame-level and period-level metrics. The experimental results show that the inclusion of both spectral and temporal information allows to improve the baseline detection performance by more than 60%. PMID:29404227
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Organizational climate and intensive care unit nurses' intention to leave.
Stone, Patricia W; Larson, Elaine L; Mooney-Kane, Cathy; Smolowitz, Janice; Lin, Susan X; Dick, Andrew W
2006-07-01
The purposes of this study were to a) estimate the incidence of intensive care units nurses' intention to leave due to working conditions; and b) identify factors predicting this phenomenon. Cross-sectional design. Hospitals and critical care units. Registered nurses (RNs) employed in adult intensive care units. Organizational climate, nurse demographics, intention to leave, and reason for intending to leave were collected using a self-report survey. Nurses were categorized into two groups: a) those intending to leave due to working conditions; and b) others (e.g., those not leaving or retirees). The measure of organizational climate had seven subscales: professional practice, staffing/resource adequacy, nurse management, nursing process, nurse/physician collaboration, nurse competence, and positive scheduling climate. Setting characteristics came from American Hospital Association data and a survey of chief nursing officers. A total of 2,323 RNs from 66 hospitals and 110 critical care units were surveyed across the nation. On average, the RN was 39.5 yrs old (SD = 9.40), had 15.6 yrs (SD = 9.20) experience in health care, and had worked in his or her current position for 8.0 yrs (SD = 7.50). Seventeen percent (n = 391) of the respondents indicated intending to leave their position in the coming year. Of those, 52% (n = 202) reported that the reason was due to working conditions. Organizational climate factors that had an independent effect on intensive care unit nurse intention to leave due to working conditions were professional practice, nurse competence, and tenure (p < .05). Improving professional practice in the work environment and clinical competence of the nurses as well as supporting new hires may reduce turnover and help ensure a stable and qualified workforce.
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Family Perspectives on Overall Care in the Intensive Care Unit.
Hansen, Lissi; Rosenkranz, Susan J; Mularski, Richard A; Leo, Michael C
Family members' perspectives about satisfaction with care provided in the intensive care unit (ICU) have become an important part of quality assessment and improvement, but national and international differences may exist in care provided and family perspectives about satisfaction with care. The purpose of the research was to understand family members' perspectives regarding overall care of medical patients receiving intensive care. Family members of medical patients who remained 48 hours or more in two adult ICUS at two healthcare institutions in the U.S. Pacific Northwest took part by responding to the Family Satisfaction with Care in the Intensive Care Unit survey. Qualitative content analysis was used to identify major categories and subcategories in their complimentary (positive) or critical (negative) responses to open-ended questions. The number of comments in each category and subcategory was counted. Of 138 responding family members, 106 answered the open-ended questions. The 281 comments were more frequently complimentary (n = 126) than critical (n = 91). Three main categories (competent care, communication, and environment) and nine subcategories were identified. Comments about the subcategory of emotional/interrelational aspects of care occurred most frequently and were more positive than comments about practical aspects of care. Findings were similar to those reported from other countries. Emotional/interrelational aspects of care were integral to family member satisfaction with care provided. Findings suggest that improving communication and decision-making, supporting family members, and caring for family loved ones as a person are important care targets. Initiatives to improve ICU care should include assessments from families and opportunity for qualitative analysis to refine care targets and assess changes.
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Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit.
Engwall, Marie; Fridh, Isabell; Johansson, Lotta; Bergbom, Ingegerd; Lindahl, Berit
2015-12-01
Patients in an intensive care unit (ICU) may risk disruption of their circadian rhythm. In an intervention research project a cycled lighting system was set up in an ICU room to support patients' circadian rhythm. Part I aimed to compare experiences of the lighting environment in two rooms with different lighting environments by lighting experiences questionnaire. The results indicated differences in advantage for the patients in the intervention room (n=48), in perception of daytime brightness (p=0.004). In nighttime, greater lighting variation (p=0.005) was found in the ordinary room (n=52). Part II aimed to describe experiences of lighting in the room equipped with the cycled lighting environment. Patients (n=19) were interviewed and the results were presented in categories: "A dynamic lighting environment", "Impact of lighting on patients' sleep", "The impact of lighting/lights on circadian rhythm" and "The lighting calms". Most had experiences from sleep disorders and half had nightmares/sights and circadian rhythm disruption. Nearly all were pleased with the cycled lighting environment, which together with daylight supported their circadian rhythm. In night's actual lighting levels helped patients and staff to connect which engendered feelings of calm. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Exploring the human emotion of feeling cared for in the workplace.
Baggett, Margarita; Giambattista, Laura; Lobbestael, Linda; Pfeiffer, Judith; Madani, Catherina; Modir, Royya; Zamora-Flyr, Maria Magdalena; Davidson, Judy E
2016-09-01
To explore the emotion of feeling cared for in the workplace. The emotion of feeling cared for drives health-promoting behaviours. Feeling cared for is the end-product of caring, affecting practice, environment and outcomes. Identifying behaviours that lead to feeling cared for is the first step in promoting caring practices in leadership. A survey with open-ended questions was designed, validated and electronically distributed. Data from 35 responses were thematically analysed. Unit culture and leadership style affect caring capacity in the workplace. First level coding revealed two caring behaviour categories: recognition and support. Themes emerged aligned to Chapman's model of workplace appreciation: words of affirmation, receiving gifts, quality time and acts of service. The importance of being treated as a whole person was reported: being appreciated personally and professionally. Feeling cared for drives outcomes such as feeling valued, important, teamwork and organisational loyalty. This study generalises the applicability of Chapman's model developed for workplace appreciation in the health-care setting. Concrete examples of how leaders stimulate feeling cared for are provided. Caring leadership behaviours have the potential to improve retention, engagement, the healing environment and the capacity for caring for others. © 2016 John Wiley & Sons Ltd.
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[Factors affecting the recovery in the intensive care unit].
Turkov, P N; Nikitin, V V; Antsupova, M A; Podkopaev, V N; Panfilova, R P; Ivanova, I N; Nesterova, L I
2013-01-01
Urgency of the problem is defined by economical, regulatory and legislative acts, regional social and moral factors. There is critical situation in Russian Pediatric Healthcare system. This situation is due to inadequate funding, high medical technologies inaccessibility for some Russian children, their adverse health state. The article presents a retrospective analysis of intensive therapy and resuscitation outcomes with technical equipment and work environment assessment in the intensive care unit of Tushinskaya city pediatric clinic for the period from 2007 to 2011. Anaesthetic and emergency care quality and safety depend on several factors: permanent equipment improvement, comprehensive analysis of every fatal case and full implementation of "Anti-epidemic (prophylactic) actions plan" and "Program of monitoring compliance with the sanitary norms".
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Videoconferencing and Web-based conferencing to enhance learning communities.
Daley, Linda K; Spalla, Tara L; Arndt, Mary Jo; Warnes, Anne-Marie
2008-02-01
Preparing nursing students to develop the leadership and management skills necessary to adapt to ever-changing practice environments is a challenge for educators. Videoconferencing and Web-based conferencing allow for expansion of traditional classroom walls to develop partnerships among peers, exchange perspectives, and gain a more global understanding of nursing care delivery systems. A collaborative leadership seminar using videoconferencing was used to connect two large colleges of nursing in the midwestern United States, and through Web-based conferencing, one of the midwestern colleges was connected to a university in the United Kingdom. Objectives for students were exposure to different schools of thought, management of care via technology, network and cultivation of global perspectives on health care delivery, and experience of novel educational approaches.
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Barriers and facilitators for breastfeeding among working women in the United States.
Johnston, Marina L; Esposito, Noreen
2007-01-01
To review the literature and describe the barriers and facilitators to the continuation of breastfeeding for at least 6 months by working women in the United States. A search of PubMed, CINAHL, Sociological Abstracts, ISI, PsychInfo, and ProQuest. Twenty studies based on the inclusion criteria and published between January 1, 1995, and January 2006. An ecologic framework, which includes the individual (microsystem), social support and relationships (mesosystem), and the workplace environment (exosystem). When working mothers possess certain personal characteristics and develop a strategic plan, breastfeeding is promoted. When social support is available and when support groups are utilized, lactation is also facilitated. Part-time work, lack of long mother-infant separations, supportive work environments and facilities, and child care options facilitate breastfeeding. Health care providers can use the findings of this review to promote breastfeeding among working women by using tactics geared toward the mother, her social network, and the entire community.
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Venkataraman, Rohini; Kamaluddeen, Majeeda; Amin, Harish; Lodha, Abhay
2018-01-15
In utero sensory stimuli and interaction with the environment strongly influence early phases of fetal and infant development. Extremely premature infants are subjected to noxious procedures and routine monitoring, in addition to exposure to excessive light and noise, which disturb the natural sleep cycle and induce stress. Non-invasive ventilation, measures to prevent sepsis, and human milk feeding improve short-term and long-term neurodevelopmental outcomes in premature infants. To preserve brain function, and to improve quality of life and long-term neurodevelopmental outcomes, the focus now is on the neonatal intensive care unit (NICU) environment and its impact on the infant during hospital stay. The objectives of this write-up are to understand the effects of environmental factors, including lighting and noise in the NICU, on sensory development of the infant, the need to decrease parental and caregiver stress, and to review existing literature, local policies and recommendations.
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Gausvik, Christian; Lautar, Ashley; Miller, Lisa; Pallerla, Harini; Schlaudecker, Jeffrey
2015-01-01
Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR) on an acute care for the elderly (ACE) unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication.
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A security architecture for interconnecting health information systems.
Gritzalis, Dimitris; Lambrinoudakis, Costas
2004-03-31
Several hereditary and other chronic diseases necessitate continuous and complicated health care procedures, typically offered in different, often distant, health care units. Inevitably, the medical records of patients suffering from such diseases become complex, grow in size very fast and are scattered all over the units involved in the care process, hindering communication of information between health care professionals. Web-based electronic medical records have been recently proposed as the solution to the above problem, facilitating the interconnection of the health care units in the sense that health care professionals can now access the complete medical record of the patient, even if it is distributed in several remote units. However, by allowing users to access information from virtually anywhere, the universe of ineligible people who may attempt to harm the system is dramatically expanded, thus severely complicating the design and implementation of a secure environment. This paper presents a security architecture that has been mainly designed for providing authentication and authorization services in web-based distributed systems. The architecture has been based on a role-based access scheme and on the implementation of an intelligent security agent per site (i.e. health care unit). This intelligent security agent: (a). authenticates the users, local or remote, that can access the local resources; (b). assigns, through temporary certificates, access privileges to the authenticated users in accordance to their role; and (c). communicates to other sites (through the respective security agents) information about the local users that may need to access information stored in other sites, as well as about local resources that can be accessed remotely.
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McHugh, Matthew D.; Rochman, Monica F.; Sloane, Douglas M.; Berg, Robert A.; Mancini, Mary E.; Nadkarni, Vinay M.; Merchant, Raina M.; Aiken, Linda H.
2015-01-01
Background Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. Objectives To determine the association between nurse staffing, nurse work environments, and IHCA survival. Research Design Cross-sectional study of data from: (1) the American Heart Association’s Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics. Subjects A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey). Results Each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge (odds ratio = 0.95; 95% confidence interval, 0.91–0.99). Further, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival (odds ratio = 0.84; 95% confidence interval, 0.71–0.99) than patients cared for in hospitals with better work environments. Conclusions Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an IHCA. These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA. PMID:26783858
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Influence of the helicopter environment on patient care capabilities: Flight crew perceptions
NASA Technical Reports Server (NTRS)
Meyers, K. Jeffrey; Rodenberg, Howard; Woodard, Daniel
1994-01-01
Flight crew perceptions of the effect of the rotary wing environment on patient care capabilities have not been subject to statistical analysis. We hypothesized that flight crew perceived significant difficulties in performing patient care tasks during air medical transport. A survey instrument was distributed to a convenience sample of flight crew members from twenty flight programs. Respondents were asked to compare the difficulty of performing patient care tasks in rotary wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position, and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type 111 sum of squares, and analysis of variance. Alpha was defined as p is less than or equal to .05. Fifty-five percent of programs (90 individuals) responded. All tasks were rated significantly more difficult in the rotary wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month, or aircraft used. We conclude that the performance of patient care tasks are perceived by air medical flight crew to be significantly more difficult during rotary wing air medical transport than in hospital settings.
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Influence of the helicopter environment on patient care capabilities: flight crew perceptions
NASA Technical Reports Server (NTRS)
Myers, K. J.; Rodenberg, H.; Woodard, D.
1995-01-01
INTRODUCTION: Flight crew perceptions of the effect of the rotary-wing environment on patient-care capabilities have not been subject to statistical analysis. We hypothesized that flight crew members perceived significant difficulties in performing patient-care tasks during air medical transport. METHODS: A survey was distributed to a convenience sample of flight crew members from 20 flight programs. Respondents were asked to compare the difficulty of performing patient-care tasks in rotary-wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type III sum of squares, and analysis of variance. Alpha was defined as p < 0.05. RESULTS: Fifty-five percent of programs (90 individuals) responded. All tasks were significantly rated more difficult in the rotary-wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month or aircraft used. CONCLUSIONS: We conclude that the performance of patient-care tasks are perceived by air medical flight crew to be significantly more difficult during rotary-wing air medical transport than in hospital settings.
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Experiences of teenagers and young adults treated for cancer in Sweden.
Olsson, Maria; Jarfelt, Marianne; Pergert, Pernilla; Enskär, Karin
2015-10-01
Approximately 600 teenagers and young adults, TYAs (ages 15-29), are newly diagnosed with cancer in Sweden every year and treated in many different units. The knowledge about TYAs is limited and there might be a need for a new approach in the care for this particular age group. The purpose of this study was to identify requirements TYAs in Sweden acknowledge as important to them. 44 participants aged 15-29 who were treated at either pediatric or adult cancer units in Sweden, participated in focus group interviews. They were interviewed in groups based on whether they were treated in pediatric (14-18 years old) or adult units (18-29). The focus group interviews were recorded, transcribed, and analyzed using qualitative content analysis. Results of the study can be summarized into four categories: personal professional interaction, knowledge and participation, age-appropriate environment, and support. Important TYA care needs vary over time due to individual situations. The time line of the cancer experience can be described as a continuum; at diagnosis, during treatment, and in life-after cancer treatment. TYAs treated in Sweden have special needs that are not being satisfied, whether at pediatric or adult units. Areas that need closer attention are: close relatives' participation in the care, information on sex and fertility, age-appropriate social physical environments during treatment, and psychosocial support after treatment. In Sweden, there is a demand for increased knowledge on the special needs for TYAs in clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Evaluation of the 12-hour shift trial in a regional intensive care unit.
Dwyer, Trudy; Jamieson, Lynn; Moxham, Lorna; Austen, Debbie; Smith, Karen
2007-10-01
Given the shortage of critical care nurses, emphasis has been placed upon improving their working lives through the implementation of flexible work hours. This descriptive exploratory study evaluated the effects of the implementation of the 12-hour roster in a regional intensive care unit (ICU). Staff (n = 19) completed a survey 12 weeks following the implementation of the 12-hour roster. The study demonstrated widespread acceptance (92%) positive impact on physical and psychological well-being and increased work satisfaction (58%) for the nursing participants. Similarly, nurses working both the 8- and 12-hour rosters (75%), the doctors and allied health care workers all identified increased continuity of patient care as an outcome of the 12-hour shift. Participants strongly agreed that 12-hour rostering was a good recruitment (67%) and retention (75%) strategy. In an environment with considerable shortages of experienced critical care nurses, the use of flexible shift patterns such as the 12-hour roster was a positive recruitment and recruitment strategy.
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Nurses' care practices at the end of life in intensive care units in Bahrain.
O'Neill, Catherine S; Yaqoob, Maryam; Faraj, Sumaya; O'Neill, Carla L
2017-12-01
The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. This study explored nurses' care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Despite the avoidance of death talk and nurses' lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.
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Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study.
Cheung, Ngai Fen; Mander, Rosemary; Wang, Xiaoli; Fu, Wei; Zhou, Hong; Zhang, Liping
2011-10-01
to report the clinical outcomes of the first six months of operation of an innovative midwife-led normal birth unit (MNBU) in China in 2008, aiming to facilitate normal birth and enhance midwifery practice. an urban hospital with 2000-3000 deliveries per year. this study was part of a major action research project that led to implementation of the MNBU. A retrospective cohort and a questionnaire survey were used. The data were analysed thematically. the outcomes of the first 226 women accessing the MNBU were compared with a matched retrospective cohort of 226 women accessing standard care. In total, 128 participants completed a satisfaction questionnaire before discharge. mode of birth and model of care. the vaginal birth rate was 87.6% in the MNBU compared with 58.8% in the standard care unit. All women who accessed the MNBU were supported by both a midwife and a birth companion, referred to as 'two-to-one' care. None of the women labouring in the standard care unit were identified as having a birth companion. the concept of 'two-to-one' care emerged as fundamental to women's experiences and utilisation of midwives' skills to promote normal birth and decrease the likelihood of a caesarean section. the MNBU provides an environment where midwives can practice to the full extent of their role. The high vaginal birth rate in the MNBU indicates the potential of this model of care to reduce obstetric intervention and increase women's satisfaction with care within a context of extraordinary high caesarean section rates. midwife-led care implies a separation of obstetric care from maternity care, which has been advocated in many European countries. Copyright © 2010 Elsevier Ltd. All rights reserved.
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40 CFR 264.603 - Post-closure care.
Code of Federal Regulations, 2011 CFR
2011-07-01
....603 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... treatment or storage unit has contaminated soils or ground water that cannot be completely removed or...
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The Effect of Defense R&D Expenditures on Military Capability and Technological Spillover
2013-03-01
ix List of Figures Page Figure 1. Decision Tree for Sectoring R&D Units...approach, often called sectoring , categorizes R&D activities by funding source, and the functional approach categorizes R&D activities by their objective...economic objectives (defense, and control and care of environment) (OECD, 2002). Figure 1 shows the decision tree for sectoring R&D units and
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Competencies for health management practice: a practitioner's perspective.
Wenzel, F J; Grady, R; Freedman, T J
1995-01-01
The current health care environment will require executive leadership with a new set of management competencies to effectively lead and manage the various components of a restructured health care delivery system. The traditional management skills of planning, organizing, directing, controlling, and staffing resources will remain relevant, but the true measure of professional success will be the development of conceptual skills. This means the ability to look at the health care enterprise as a whole, and recognize how changes in the environment shape your strategic mission, goals, and objectives. The successful health care leader will have a demonstrated ability to apply these conceptual skills to the development of information systems and integrated networks that position their organization to accept capitated risks. This paper examines the United States and Canadian health care systems from the perspective of both the more traditional hospital and the emerging medical care organizations. New importance of the team approach to leadership and management and all that entails is stressed.
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Amin, Pravin; Fox-Robichaud, Alison; Divatia, J V; Pelosi, Paolo; Altintas, Defne; Eryüksel, Emel; Mehta, Yatin; Suh, Gee Young; Blanch, Lluís; Weiler, Norbert; Zimmerman, Janice; Vincent, Jean-Louis
2016-10-01
The role of the critical care specialist has been unequivocally established in the management of severely ill patients throughout the world. Data show that the presence of a critical care specialist in the intensive care unit (ICU) environment has reduced morbidity and mortality, improved patient safety, and reduced length of stay and costs. However, many ICUs across the world function as "open ICUs," in which patients may be admitted under a primary physician who has not been trained in critical care medicine. Although the concept of the ICU has gained widespread acceptance amongst medical professionals, hospital administrators and the general public; recognition and the need for doctors specializing in intensive care medicine has lagged behind. The curriculum to ensure appropriate training around the world is diverse but should ideally meet some minimum standards. The World Federation of Societies of Intensive and Critical Care Medicine has set up a task force to address issues concerning the training, functions, roles, and responsibilities of an ICU specialist. Copyright © 2016 Elsevier Inc. All rights reserved.
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Lee, Yuna S H; Stone, Patricia W; Pogorzelska-Maziarz, Monika; Nembhard, Ingrid M
Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality.
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State of the art and recommendations. Kangaroo mother care: application in a high-tech environment.
Nyqvist, K H; Anderson, G C; Bergman, N; Cattaneo, A; Charpak, N; Davanzo, R; Ewald, U; Ludington-Hoe, S; Mendoza, S; Pallás-Allonso, C; Peláez, J G; Sizun, J; Wiström, A M
2010-11-01
Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low-income settings, the original KMC modelis implemented. This consists of continuous (24 h/day; 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding and, adequate follow up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC modelin all types of settings was discussed at the 7th International Workshop on KMC Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents'role, modification of the NICU environment, performance of care in KMC, and KMCin case of infant instability. Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.
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State of the art and recommendations. Kangaroo mother care: application in a high-tech environment.
Nyqvist, K H; Anderson, G C; Bergman, N; Cattaneo, A; Charpak, N; Davanzo, R; Ewald, U; Ludington-Hoe, S; Mendoza, S; Pallás-Allonso, C; Peláez, J G; Sizun, J; Widström, A-M
2010-06-01
Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow-up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents' role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability. Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.
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Johnson, Patricia
2004-08-01
Critical care nurses are increasingly seeking to base patient care on evidence derived from research studies. The purpose of this study was to explore the meanings former patients attributed to being on long-term mechanical ventilation in a critical care unit (CCU) in Australia. Using Heideggerian phenomenology, unstructured interviews were undertaken with nine participants. Data were analysed thematically using the method developed by van Manen. Thematic analysis revealed four major themes. This article presents the findings from the theme titled: Reclaiming the everyday world, which describes how the study participants gained comfort from the presence of nurses and their families, sought control over their treatments, and questioned and interpreted the environment, in order to reclaim self. The study highlighted the central role of nurses in patient care, and served as a basis for a number of recommendations, which include recognising the significant role of nurses and family in patient care, and being aware that patients may want more control over their environment and instigate ways to facilitate this. Further research is warranted to examine CCU patients' perceived level of control and power, and to investigate the extent and type of involvement CCU patients would like to have in their care.
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The culture contributing to interruptions in the nursing work environment: An ethnography.
Hopkinson, Susan G; Wiegand, Debra L
2017-12-01
To understand the occurrence of interruptions within the culture of the medical nursing unit work environment. Interruptions may lead to errors in nursing work. Little is known about how the culture of the nursing work environment contributes to interruptions. A micro-focused ethnographic study was conducted. Data collection involved extensive observation of a nursing unit, 1:1 observations of nurses and follow-up interviews with the nurses. Data were analysed from unstructured field notes and interview transcripts. The definitions of interruption and culture guided coding, categorising and identification of themes. A framework was developed that describes the medical nursing unit as a complex culture full of unpredictable, nonlinear changes that affect the entire interconnected system, often in the form of an interruption. The cultural elements contributing to interruptions included (i) the value placed on excellence in patient care and meeting personal needs, (ii) the beliefs that the nurses had to do everything by themselves and that every phone call was important, (iii) the patterns of changing patients, patient transport and coordination of resources and (iv) the normative practices of communicating and adapting. Interruptions are an integral part of the culture of a medical nursing unit. Uniformly decreasing interruptions may disrupt current practices, such as communication to coordinate care, that are central to nursing work. In future research, the nursing work environment must be looked at through the lens of a complex system. Interventions to minimise the negative impact of interruptions must take into account the culture of the nursing as a complex adaptive system. Nurses should be educated on their own contribution to interruptions and issues addressed at a system level, rather than isolating the interruption as the central issue. © 2017 John Wiley & Sons Ltd.
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Van Bogaert, Peter; van Heusden, Danny; Timmermans, Olaf; Franck, Erik
2014-01-01
Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Design: Cross-sectional survey. Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services. PMID:25431563
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Van Bogaert, Peter; van Heusden, Danny; Timmermans, Olaf; Franck, Erik
2014-01-01
To explore the mechanisms through which nurse practice environment dimensions, such as nurse-physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Cross-sectional survey. Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Nurse practice environment dimensions predicted nurses' ratings of job outcome variables as well as quality of care. Features of nurses' work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses' perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services.
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Sevdalis, Nick; Brett, Stephen J
2009-01-01
Effectiveness and efficiency of care of the critically ill patient are subject to a number of systemic influences, including skills of individual physicians/nurses (technical and non-technical), team-working in the intensive care unit (ICU), and the ICU environment. We first discuss the paper of Fackler and colleagues as a contribution to the systems approach to clinical performance in the context of intensive care. We then highlight features of care delivery that are unique to intensive care and discuss the need for better understanding of human and non-human elements of the system of care of the critically ill patient as a driver for improvement of care delivery. PMID:19439048
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Gunnarsdóttir, Sigrún; Clarke, Sean P; Rafferty, Anne Marie; Nutbeam, Don
2009-07-01
To investigate aspects of nurses' work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital. Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care. Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavík. Nurses' work environments were measured using the nursing work index-revised (NWI-R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches. An Icelandic adaptation of the NWI-R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses' personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse-doctor relations. The NWI-R measures elements of hospital nurses' work environments that predict job outcomes and nurses' ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses' relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care.
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Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital.
Walters, Tessa L; Howard, Steven K; Kou, Alex; Bertaccini, Edward J; Harrison, T Kyle; Kim, T Edward; Shafer, Audrey; Brun, Carlos; Funck, Natasha; Siegel, Lawrence C; Stary, Erica; Mariano, Edward R
2016-06-01
The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement. © The Author(s) 2015.
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Patients' and relatives' experiences of transfer from intensive care unit to wards.
Cullinane, James P; Plowright, Catherine I
2013-11-01
This literature review looks at the evidence around transferring patients from intensive care units (ICU) to wards. The literature informs us that patients and their families experience problems when being transferred from an ICU environment and that this increases overall anxiety. The effects of surviving critical illness often have a profound psychological impact on patients and families This study examines the experiences of adult patients, and their families, following their transfer from the ICU to the ward. Five themes emerged from this literature review: physical responses, psychological responses, information and communication, safety and security, and the needs of relatives. This review reminds us that these problems can be reduced if information and communication around time of transfers were improved. As critical care nurses it is essential that we prepare patients and families for transfer to wards. © 2013 British Association of Critical Care Nurses.
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Martínez Pérez, María; Dafonte, Carlos; Gómez, Ángel
2018-05-19
Patient safety is a principal concern for health professionals in the care process and it is, therefore, necessary to provide information management systems to each unit of the hospital, capable of tracking patients and medication to reduce the occurrence of adverse events and therefore increase the quality of care received by patients during their stay in hospital. This work presents a tool for the Intensive Care Unit (ICU), a key service with special characteristics, which computerises and tracks admissions, care plans, vital monitoring, the prescription and medication administration process for patients in this service. To achieve this, it is essential that innovative and cutting-edge technologies are implemented such as Near Field Communication (NFC) technology which is now being implemented in diverse environments bringing a range of benefits to the tasks for which it is employed.
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Swedish nurses' experiences of caring for dying people: a holistic approach.
Iranmanesh, Sedigheh; Häggström, Terttu; Axelsson, Karin; Sävenstedt, Stefan
2009-01-01
Most people need to be cared for at the end of their lives by professionals. This study aimed to elucidate the meaning of nurses' experiences of caring for dying persons at home and in a special unit in a hospital. Four registered nurses working in private homes and 4 registered nurses working in a specific unit in a hospital setting were interviewed. The study was planned and carried out with a phenomenological hermeneutic approach. A naive reading guided a structural analysis, which resulted in 3 main themes: meeting patients and family members as unique persons, learning in a challenging environment, and gaining personal strength. The interpreted comprehensive understanding conveyed a meaning that caring for families with a member awaiting the end of life created a situation where the presence of an inevitable death demanded nurses to create close relationships with each unique person involved.
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Religious and Secular Coping and Family Relationships in the Neonatal Intensive Care Unit
Brelsford, Gina M.; Ramirez, Joshua; Veneman, Kristin; Doheny, Kim K.
2017-01-01
Background Preterm birth is an unanticipated and stressful event for parents. In addition, the unfamiliar setting of the intensive care nursery necessitates strategies for coping. Purpose The primary study objective of this descriptive study was to determine whether secular and religious coping strategies were related to family functioning in the neonatal intensive care unit. Methods Fifty-two parents of preterm (25–35 weeks’ gestation) infants completed the Brief COPE (secular coping), the Brief RCOPE (religious coping), and the Family Environment Scale within 1 week of their infant’s hospital admission. Findings This descriptive study found that parents’ religious and secular coping was significant in relation to family relationship functioning. Specifically, negative religious coping (ie, feeling abandoned or angry at God) was related to poorer family cohesion and use of denial. Implications for Practice These findings have relevance for interventions focused toward enhancing effective coping for families. Implications for Research Further study of religious and secular coping strategies for neonatal intensive care unit families is warranted in a larger more diverse sample of family members. PMID:27391569
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Aydon, Laurene; Hauck, Yvonne; Zimmer, Margo; Murdoch, Jamee
2016-09-01
The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit. Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question. A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview. One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'. Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team. The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to appropriately question aspects around medication administration. © 2016 John Wiley & Sons Ltd.
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Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip
2014-03-01
Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, but would be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating an ICU environment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICU to one that is well integrated into the rest of the institution. Creating a "pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends.
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Engaging patients with digital tools: what we think we know.
Fox, Brent I; Felkey, Bill G
2014-11-01
Patients who are engaged in their own care have better outcomes and cost the health care system less money. Creating the environment that supports patient engagement has been a recent focus across the United States, and digital tools have been suggested as an important piece of patient engagement. We discuss what we think we know about digital engagement, and present data of what is actually occurring.
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Oshodi, Titilayo O; Crockett, Rachel; Bruneau, Benjamin; West, Elizabeth
2017-09-01
To explore the structure of the Essentials of Magnetism II (EOMII) scale using data from nurses working in England; and to describe the impact of different aspects of the nursing work environment on nurse-assessed care quality (NACQ). The EOMII Scale was developed in the United States to measure nursing work environments. It has been widely used in the United States and in a number of other countries, but has not yet been used in the UK. Cross-sectional study. Registered nurses (n = 247) providing direct patient care in two National Health Service hospitals in England completed the EOMII scale and a single-item measuring NACQ. Principal components analysis was used to assess the structure of the scale. Correlation and regression analyses were used to describe the relationships between factors and NACQ. A solution with explanatory variance of 45.25% was identified. Forty items loaded on five factors, with satisfactory consistency: (i) ward manager support; (ii) working as a team; (iii) concern for patients; (iv) organisational autonomy; and (v) constraints on nursing practice. While in univariate analyses, each of the factors was significantly associated with NACQ, in multivariate analyses, the relationship between organisational autonomy and NACQ no longer reached significance. However, a multiple mediation model indicated that the effect of organisational autonomy on NACQ was mediated by nurse manager support, working as a team and concern for patients but not constraints on nursing practice. Subscales of the EOMII identified in an English sample of nurses measured important aspects of the nursing work environment, each of which is related to NACQ. The EOMII could be a very useful tool for measuring aspects of the nursing work environment in the English Trusts particularly in relation to the quality of care. © 2017 John Wiley & Sons Ltd.
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Effectiveness of the surgical safety checklist in a high standard care environment.
Lübbeke, Anne; Hovaguimian, Frederique; Wickboldt, Nadine; Barea, Christophe; Clergue, François; Hoffmeyer, Pierre; Walder, Bernhard
2013-05-01
Use of surgical safety checklists has been associated with significant reduction in postoperative surgical site infection (SSI), morbidity, and mortality. To evaluate the effectiveness of an intraoperative checklist in high-risk surgical patients in a high standard care environment with long-standing regular perioperative safety control programs. Quasi-experiment pre-post checklist implementation. Surgical patients above 16 years with an American Society of Anesthesiologists (ASA) score 3-5 operated upon at a large tertiary hospital. Unplanned return to operating room for any reason, reoperation for SSI, unplanned admission to intensive care unit, and in-hospital death within 30 days. A total of 609 patients (53% elective, 85% ASA 3, mean age 70 y) were included before and 1818 after implementation (52% elective, 87% ASA 3, mean age 69 y), the latter with 552, 558, and 708 in period I, II, and III, respectively. Comparing preimplementation to postimplementation periods: unplanned return to operating room occurred in 45/609 (7.4%) versus 109/1818 (6.0%) interventions [adjusted risk ratios (RR) 0.82; 95% confidence interval (CI), 0.59-1.14]; reoperation for SSI in 18/609 (3.0%) versus 109/1818 (1.7%) interventions (adjusted RR 0.56; 95% CI, 0.32-1.00); unplanned admission to intensive care unit in 17 (2.8%) versus 48 (2.6%) interventions (adjusted RR 0.90; 95% CI, 0.52-1.55); and in-hospital death occurred in 26 (4.3%) versus 108 (5.9%) patients (adjusted RR 1.44; 95% CI, 0.97-2.14). Checklist use during 77 interventions prevented 1 reoperation for SSI. A trend toward reduced reoperation rates for SSI was observed after checklist implementation in this high standard care environment; no influence on other outcome measures was observed.
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Dedicated Education Unit: an innovative clinical partner education model.
Moscato, Susan Randles; Miller, Judith; Logsdon, Karen; Weinberg, Stephen; Chorpenning, Lori
2007-01-01
This article describes the implementation and evaluation of the Dedicated Education Unit (DEU) as an innovative model of clinical nursing education. A partnership of nurse executives, staff nurses and faculty transformed patient care units into environments of support for nursing students and staff nurses while continuing the critical work of providing quality care to acutely ill adults. Various methods were used to obtain formative data during the implementation of this model in which staff nurses assumed the role of nursing instructors. Results showed high student and nurse satisfaction and a marked increase in clinical capacity that allowed for increased enrollment. This article reports on a 3-year project to operationalize the DEU concept with 6 nursing units in 3 hospitals. The development of staff nurses as clinical instructors, best practices to teach and evaluate critical thinking in students, and the mix of student learners continue as focus areas.
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The effect of nurse manager turnover on patient fall and pressure ulcer rates.
Warshawsky, Nora; Rayens, Mary Kay; Stefaniak, Karen; Rahman, Rana
2013-07-01
The purpose of this study was to explore the effects of nurse manager turnover on the occurrence of adverse events. Nurse managers create professional nurse practice environments to support the provision of quality patient outcomes. Inconsistent findings were reported in the literature testing the relationship between nurse managers and patient outcomes. All prior studies assumed stable nursing management. A longitudinal quasi-experimental study of 23 nursing units in two hospitals was used to determine whether unit characteristics, including nurse manager turnover, have an effect on patient falls or pressure ulcers. Statistical analyses included repeated measures and hierarchical modelling. Patients in medical/surgical units experienced more falls than in intensive care units (F1,11 = 15.9, P = 0.002). Patients in units with a nurse manager turnover [odds ratio: 3.16; 95% confidence interval: 1.49-6.70] and intensive care units (odds ratio: 2.70; 95% confidence interval: 1.33-5.49) were more likely to develop pressure ulcers. Nurse manager turnover and intensive care unit status were associated with more pressure ulcers. Medical/surgical unit status was associated with more falls. The study was limited by a small sample size. Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events. © 2013 John Wiley & Sons Ltd.
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Backman, Chantal; Bruce, Natalie; Marck, Patricia; Vanderloo, Saskia
2016-01-01
The purpose of this quality improvement project was to determine the feasibility of using provider-led participatory visual methods to scrutinize 4 hospital units' infection prevention and control practices. Methods included provider-led photo walkabouts, photo elicitation sessions, and postimprovement photo walkabouts. Nurses readily engaged in using the methods to examine and improve their units' practices and reorganize their work environment.
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Machado, Juliana Pereira; Veiga, Eugenia Velludo; Ferreira, Paulo Alexandre Camargo; Martins, José Carlos Amado; Daniel, Ana Carolina Queiroz Godoy; Oliveira, Amanda dos Santos; da Silva, Patrícia Costa dos Santos
2014-01-01
Objective To determine and to analyze the theoretical and practical knowledge of Nursing professionals on indirect blood pressure measurement. Methods This cross-sectional study included 31 professionals of a coronary care unit (86% of the Nursing staff in the unit). Of these, 38.7% of professionals were nurses and 61.3% nurse technicians. A validated questionnaire was used to theoretical evaluation and for practice assessment the auscultatory technique was applied in a simulation environment, under a non-participant observation. Results To the theoretical knowledge of the stages of preparation of patient and environment, 12.9% mentioned 5-minute of rest, 48.4% checked calibration, and 29.0% chose adequate cuff width. A total of 64.5% of professionals avoided rounding values, and 22.6% mentioned the 6-month deadline period for the equipment calibration. On average, in practice assessment, 65% of the steps were followed. Lacks in knowledge were primary concerning lack of checking the device calibration and stethoscope, measurement of arm circumference to choose the cuff size, and the record of arm used in blood pressure measurement. Conclusion Knowledge was poor and had disparities between theory and practice with evidence of steps taken without proper awareness and lack of consideration of important knowledge during implementation of blood pressure measurement. Educational and operational interventions should be applied systematically with institutional involvement to ensure safe care with reliable values. PMID:25295455
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Kaunonen, Marja; Salin, Sirpa; Aalto, Pirjo
2015-07-01
To explore factors associated with nursing intensity, work environment intensity and nursing resources that may affect nurse job satisfaction and risk of dissatisfaction in outpatient care at one university hospital in Finland. Much research has been done to study how nursing intensity, work environment intensity and nursing resources are associated with nurse job satisfaction, but not in the context of outpatient care. This research used a cross-sectional design. The data were collected from the hospital information systems of outpatient units (n = 12) in autumn 2010. Management style showed a statistically significant association with job satisfaction. The risk of dissatisfaction increased when nursing staff had no influence over the design of their jobs, when conflicts and contradictions were not addressed in the workplace and when feedback was not processed. Nursing intensity and work environment intensity had no effect on nurse job satisfaction. Nursing resources and patient satisfaction, on the other hand, were important to nurses' job satisfaction. The results indicate that nursing management should involve nursing staff in the development of their jobs and the care delivery model. © 2013 John Wiley & Sons Ltd.
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A unifying framework of the demand for transnational medical travel.
Osterle, August; Johnson, Tricia; Delgado, Jose
2013-01-01
Transnational medical travel has gained attention recently as a strategy for patients to obtain care that is higher quality, costs less, or offers improved access relative to care provided within their home countries. This article examines institutional environments in the European Union and United States that influence transnational medical travel, describes the conceptual model of demand for medical travel, and illustrates individual dimensions in the conceptual model of medical travel using a series of case studies. The conceptual model of medical travel is predicated on Andersen's behavioral model of health services. Transnational medical travel is a heterogeneous phenomenon that is influenced by a number of patient-related factors and by the institutional environment in which the patient resides. While cost, access, and quality are commonly cited factors that influence a patient's decision regarding where to seek care, multiple factors may simultaneously influence the decision about the destination for care, including culture, social factors, and the institutional environment. The conceptual framework addresses the patient-related factors that influence where a patient seeks care. This framework can help researchers and regulatory bodies to evaluate the opportunities and the risks of transnational medical travel and help providers and governments to develop international patient programs.
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CAN-Care: an innovative model of practice-based learning.
Raines, Deborah A
2006-01-01
The "Collaborative Approach to Nursing Care" (CAN-Care) Model of practice-based education is designed to meet the unique learning needs of the accelerated nursing program student. The model is based on a synergistic partnership between the academic and service settings, the vision of which is to create an innovative practice-based learning model, resulting in a positive experience for both the student and unit-based nurse. Thus, the objectives of quality outcomes for both the college and Health Care Organization are fulfilled. Specifically, the goal is the education of nurses ready to meet the challenges of caring for persons in the complex health care environment of the 21st century.
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Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck
2015-04-01
This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
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McCaughey, Deirdre; DelliFraine, Jami; Erwin, Cathleen O
2015-01-01
Hospitals in North America consistently have employee injury rates ranking among the highest of all industries. Organizations that mandate workplace safety training and emphasize safety compliance tend to have lower injury rates and better employee safety perceptions. However, it is unclear if the work environment in different national health care systems (United States vs. Canada) is associated with different employee safety perceptions or injury rates. This study examines occupational safety and workplace satisfaction in two different countries with employees working for the same organization. Survey data were collected from environmental services employees (n = 148) at three matched hospitals (two in Canada and one in the United States). The relationships that were examined included: (1) safety leadership and safety training with individual/unit safety perceptions; (2) supervisor and coworker support with individual job satisfaction and turnover intention; and (3) unit turnover, labor usage, and injury rates. Hierarchical regression analysis and ANO VA found safety leadership and safety training to be positively related to individual safety perceptions, and unit safety grade and effects were similar across all hospitals. Supervisor and coworker support were found to be related to individual and organizational outcomes and significant differences were found across the hospitals. Significant differences were found in injury rates, days missed, and turnover across the hospitals. This study offers support for occupational safety training as a viable mechanism to reduce employee injury rates and that a codified training program translates across national borders. Significant differences were found.between the hospitals with respect to employee and organizational outcomes (e.g., turnover). These findings suggest that work environment differences are reflective of the immediate work group and environment, and may reflect national health care system differences.
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Work Environment Questionnaires and Army Unit Effectiveness and Satisfaction Measures
1977-09-01
satisfaction indices (retention rates and disciplinary actions) and place more emphasis on these outcomes. In balance , the work environment and...last me a year"), and that "effective" supervisors and organizations planned carefully to stay within these constraints and balance expenditures over...scale was out of balance with its higher end. Most instruments reviewed used Likert scales with numerical anchors; very few provided specific descriptive
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Organizing Safe Transitions from Intensive Care
Häggström, Marie; Bäckström, Britt
2014-01-01
Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients' transfers from high technological intensive care units (ICU) to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient's care before, during, and after transfer from intensive care. Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using qualitative content analysis. Results. The results showed that the categories secure, encourage, and collaborate are strategies used in the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated how all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction was described: between staff and patient/families, between team members and involved units, and between patient/family and environment. Discussion/Conclusions. The findings highlight that ICU transitional care implies critical care rehabilitation. Discharge procedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, early mobilization, and a multidiscipline approach. PMID:24782924
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Ulrich, Connie M.; Zhou, Qiuping (Pearl); Hanlon, Alexandra; Danis, Marion; Grady, Christine
2016-01-01
Purpose Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. Methods This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. Results Ethics preparedness and confidence were significantly associated with perceived quality of care (p < 0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p < 0.01). Forty-four percent of the variance in quality of care was explained by these factors. Conclusions Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care. PMID:24613597
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Ulrich, Connie M; Zhou, Qiuping Pearl; Hanlon, Alexandra; Danis, Marion; Grady, Christine
2014-08-01
Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. Ethics preparedness and confidence were significantly associated with perceived quality of care (p<0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p<0.01). Forty-four percent of the variance in quality of care was explained by these factors. Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care. Copyright © 2014 Elsevier Inc. All rights reserved.
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Sabbath, Erika L; Sparer, Emily H; Boden, Leslie I; Wagner, Gregory R; Hashimoto, Dean M; Hopcia, Karen; Sorensen, Glorian
2018-06-01
Preventive medical care may reduce downstream medical costs and reduce population burden of disease. However, although social, demographic, and geographic determinants of preventive care have been studied, there is little information about how the workplace affects preventive care utilization. This study examines how four types of organizational policies and practices (OPPs) are associated with individual workers' preventive care utilization. We used data collected in 2012 from 838 hospital patient care workers, grouped in 84 patient care units at two hospitals in Boston. Via survey, we assessed individuals' perceptions of four types of OPPs on their work units. We linked the survey data to a database containing detailed information on medical expenditures. Using multilevel models, we tested whether individual-level perceptions, workgroup-average perceptions, and their combination were associated with individual workers' preventive care utilization (measured by number of preventive care encounters over a two-year period). Adjusting for worker characteristics, higher individual-level perceptions of workplace flexibility were associated with greater preventive care utilization. Higher average unit-level perceptions of people-oriented culture, ergonomic practices, and flexibility were associated with greater preventive care utilization. Overall, we find that workplace policies and practices supporting flexibility, ergonomics, and people-oriented culture are associated with positive preventive care-seeking behavior among workers, with some policies and practices operating at the individual level and some at the group level. Improving the work environment could impact employers' health-related expenditures and improve workers' health-related quality of life. Copyright © 2018 Elsevier Inc. All rights reserved.
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Fox, Mary T; Persaud, Malini; Maimets, Ilo; O'Brien, Kelly; Brooks, Dina; Tregunno, Deborah; Schraa, Ellen
2012-01-01
Objectives To compare the effectiveness of acute geriatric unit care, based on all or part of the Acute Care for Elders (ACE) model and introduced in the acute phase of illness or injury, with that of usual care. Design Systematic review and meta-analysis of 13 randomized controlled and quasi-experimental trials with parallel comparison groups retrieved from multiple sources. Setting Acute care geriatric and nongeriatric hospital units. Participants Acutely ill or injured adults (N = 6,839) with an average age of 81. Interventions Acute geriatric unit care characterized by one or more ACE components: patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment. Measurements Falls, pressure ulcers, delirium, functional decline at discharge from baseline 2-week prehospital and hospital admission statuses, length of hospital stay, discharge destination (home or nursing home), mortality, costs, and hospital readmissions. Results Acute geriatric unit care was associated with fewer falls (risk ratio (RR) = 0.51, 95% confidence interval (CI) = 0.29–0.88), less delirium (RR = 0.73, 95% CI = 0.61–0.88), less functional decline at discharge from baseline 2-week prehospital admission status (RR = 0.87, 95% CI = 0.78–0.97), shorter length of hospital stay (weighted mean difference (WMD) = −0.61, 95% CI = −1.16 to −0.05), fewer discharges to a nursing home (RR = 0.82, 95% CI = 0.68–0.99), lower costs (WMD = −$245.80, 95% CI = −$446.23 to −$45.38), and more discharges to home (RR = 1.05, 95% CI = 1.01–1.10). A nonsignificant trend toward fewer pressure ulcers was observed. No differences were found in functional decline between baseline hospital admission status and discharge, mortality, or hospital readmissions. Conclusion Acute geriatric unit care, based on all or part of the ACE model and introduced during the acute phase of older adults' illness or injury, improves patient- and system-level outcomes. PMID:23176020
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Ohtake, Patricia J; Lazarus, Marcilene; Schillo, Rebecca; Rosen, Michael
2013-02-01
Rehabilitation of patients in critical care environments improves functional outcomes. This finding has led to increased implementation of intensive care unit (ICU) rehabilitation programs, including early mobility, and an associated increased demand for physical therapists practicing in ICUs. Unfortunately, many physical therapists report being inadequately prepared to work in this high-risk environment. Simulation provides focused, deliberate practice in safe, controlled learning environments and may be a method to initiate academic preparation of physical therapists for ICU practice. The purpose of this study was to examine the effect of participation in simulation-based management of a patient with critical illness in an ICU setting on levels of confidence and satisfaction in physical therapist students. A one-group, pretest-posttest, quasi-experimental design was used. Physical therapist students (N=43) participated in a critical care simulation experience requiring technical (assessing bed mobility and pulmonary status), behavioral (patient and interprofessional communication), and cognitive (recognizing a patient status change and initiating appropriate responses) skill performance. Student confidence and satisfaction were surveyed before and after the simulation experience. Students' confidence in their technical, behavioral, and cognitive skill performance increased from "somewhat confident" to "confident" following the critical care simulation experience. Student satisfaction was highly positive, with strong agreement the simulation experience was valuable, reinforced course content, and was a useful educational tool. Limitations of the study were the small sample from one university and a control group was not included. Incorporating a simulated, interprofessional critical care experience into a required clinical course improved physical therapist student confidence in technical, behavioral, and cognitive performance measures and was associated with high student satisfaction. Using simulation, students were introduced to the critical care environment, which may increase interest in working in this practice area.
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Bos, Elisabeth; Alinaghizadeh, Hassan; Saarikoski, Mikko; Kaila, Päivi
2015-01-01
Clinical placement plays a key role in education intended to develop nursing and caregiving skills. Studies of nursing students' clinical learning experiences show that these dimensions affect learning processes: (i) supervisory relationship, (ii) pedagogical atmosphere, (iii) management leadership style, (iv) premises of nursing care on the ward, and (v) nursing teachers' roles. Few empirical studies address the probability of an association between these dimensions and factors such as student (a) motivation, (b) satisfaction with clinical placement, and (c) experiences with professional role models. The study aimed to investigate factors associated with the five dimensions in clinical learning environments within primary health care units. The Swedish version of Clinical Learning Environment, Supervision and Teacher, a validated evaluation scale, was administered to 356 graduating nursing students after four or five weeks clinical placement in primary health care units. Response rate was 84%. Multivariate analysis of variance is determined if the five dimensions are associated with factors a, b, and c above. The analysis revealed a statistically significant association with the five dimensions and two factors: students' motivation and experiences with professional role models. The satisfaction factor had a statistically significant association (effect size was high) with all dimensions; this clearly indicates that students experienced satisfaction. These questionnaire results show that a good clinical learning experience constitutes a complex whole (totality) that involves several interacting factors. Supervisory relationship and pedagogical atmosphere particularly influenced students' satisfaction and motivation. These results provide valuable decision-support material for clinical education planning, implementation, and management. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Leadership and management skills of first-line managers of elderly care and their work environment.
Abdelrazek, Fathya; Skytt, Bernice; Aly, Magda; El-Sabour, Mona Abd; Ibrahim, Naglaa; Engström, Maria
2010-09-01
To study the leadership and management skills of first-line managers (FLMs) of elderly care and their work environment in Egypt and Sweden. FLMs in Egypt and Sweden are directly responsible for staff and quality of care. However, FLMs in Sweden, in elderly care, have smaller units/organizations to manage than do their colleagues in Egypt. Furthermore, family care of the elderly has been the norm in Egypt, but in recent years institutional care has increased, whereas in Sweden, residential living homes have existed for a longer period. A convenience sample of FLMs, 49 from Egypt and 49 from Sweden, answered a questionnaire measuring leadership and management skills, structural and psychological empowerment, job satisfaction and psychosomatic health. In both countries, FLMs' perceptions of their leadership and management skills and psychological empowerment were quite high, whereas scores for job satisfaction and psychosomatic health were lower. FLMs had higher values in several factors/study variables in Egypt compared with in Sweden. The work environment, both in Egypt and Sweden, needs to be improved to increase FLMs' job satisfaction and decrease stress. The cultural differences and levels of management have an effect on the differences between the two countries. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.
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Critical care nursing: Embedded complex systems.
Trinier, Ruth; Liske, Lori; Nenadovic, Vera
2016-01-01
Variability in parameters such as heart rate, respiratory rate and blood pressure defines healthy physiology and the ability of the person to adequately respond to stressors. Critically ill patients have lost this variability and require highly specialized nursing care to support life and monitor changes in condition. The critical care environment is a dynamic system through which information flows. The critical care unit is typically designed as a tree structure with generally one attending physician and multiple nurses and allied health care professionals. Information flow through the system allows for identification of deteriorating patient status and timely interventionfor rescue from further deleterious effects. Nurses provide the majority of direct patient care in the critical care setting in 2:1, 1:1 or 1:2 nurse-to-patient ratios. The bedside nurse-critically ill patient relationship represents the primary, real-time feedback loop of information exchange, monitoring and treatment. Variables that enhance information flow through this loop and support timely nursing intervention can improve patient outcomes, while barriers can lead to errors and adverse events. Examining patient information flow in the critical care environment from a dynamic systems perspective provides insights into how nurses deliver effective patient care and prevent adverse events.
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Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti
2017-01-01
Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) (p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs. PMID:28379207
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Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti
2017-04-05
Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients' homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs' work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) ( p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs' job is feasible and can effectively promote HCAs' health, especially among older HCAs.
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The silver lining of disposable sporicidal privacy curtains in an intensive care unit.
Kotsanas, Despina; Wijesooriya, W R P L I; Sloane, Tracy; Stuart, Rhonda L; Gillespie, Elizabeth E
2014-04-01
The environment is a well-known source of health care-acquired infection. Because of the known risk of contamination, patient privacy curtains require frequent changes to decrease the risk of spread from patients to curtain and visa versa. Fourteen disposable sporicidal privacy curtains were tested from December 2012 to June 2013 while hanging in a busy intensive care unit. Significant bacterial pathogens were identified and total bacteria enumerated as colony-forming units. Antimicrobial activity of curtain swatches was also tested against a range of bacteria in the laboratory. Measurements were recorded as zone of inhibition and contact inhibition. A cost analysis to replace standard curtains with disposable sporicidal curtains was also undertaken. Cultures grew low numbers of skin and environmental microorganisms with no methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, or Clostridium difficile detected. Vancomycin-resistant enterococci were recovered in very low numbers from 2 curtains where vancomycin-resistant enterococci-infected patients had been located. Privacy curtains demonstrated antimicrobial activity against C difficile and 13 additional bacterial pathogens. We conclude that disposable sporicidal privacy curtains are cost-effective and best replaced at 6 months in a high-risk area such as an intensive care unit. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
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The cost-effectiveness of supported employment for adults with autism in the United Kingdom
Megnin-Viggars, Odette; Cheema, Nadir; Howlin, Patricia; Baron-Cohen, Simon; Pilling, Stephen
2014-01-01
Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom. Thus, a decision-analytic economic model was developed, which used outcome data from the only trial that has evaluated supported employment for adults with autism in the United Kingdom. The main analysis considered intervention costs, while cost-savings associated with changes in accommodation status and National Health Service and personal social service resource use were examined in secondary analyses. Two outcome measures were used: the number of weeks in employment and the quality-adjusted life year. Supported employment resulted in better outcomes compared with standard care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year. In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (i.e. it produced better outcomes at a lower total cost). The analysis suggests that supported employment schemes for adults with autism in the United Kingdom are cost-effective compared with standard care. Further research needs to confirm these findings. PMID:24126866
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The "Flipped Classroom" Model for Teaching in the Intensive Care Unit.
Tainter, Christopher R; Wong, Nelson L; Cudemus-Deseda, Gaston A; Bittner, Edward A
2017-03-01
The intensive care unit (ICU) is a dynamic and complex learning environment. The wide range in trainee's experience, specialty training, fluctuations in patient acuity and volume, limitations in trainee duty hours, and additional responsibilities of the faculty contribute to the challenge in providing a consistent experience with traditional educational strategies. The "flipped classroom" is an educational model with the potential to improve the learning environment. In this paradigm, students gain exposure to new material outside class and then use class time to assimilate the knowledge through problem-solving exercises or discussion. The rationale and pedagogical foundations for the flipped classroom are reviewed, practical considerations are discussed, and an example of successful implementation is provided. An education curriculum was devised and evaluated prospectively for teaching point-of-care echocardiography to residents rotating in the surgical ICU. Preintervention and postintervention scores of knowledge, confidence, perceived usefulness, and likelihood of use the skills improved for each module. The quality of the experience was rated highly for each of the sessions. The flipped classroom education curriculum has many advantages. This pilot study was well received, and learners showed improvement in all areas evaluated, across several demographic subgroups and self-identified learning styles.
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Feather, Janice; McGillis Hall, Linda; Trbovich, Patricia; Baker, G Ross
2018-04-22
To rigorously review the literature on the prosocial workplace behaviours of nurses. Prosocial workplace behaviours, predominantly organisational citizenship behaviours have been theoretically and empirically found to promote individual and group level performance in various industries. However, little consensus exists in the literature regarding the impact of nurses' workplace behaviours on the work environment and organisational performance. An integrative literature review was conducted on studies between 1980 and 2016. Nineteen articles were included related to nurses' prosocial behaviours and performance. A positive relationship was noted between workplace behaviours and individual level performance and unit level performance. Albeit multifactorial, leadership and the social structure of the work environment are important factors contributing to the workplace behaviour-performance relationship. Prosocial behaviours influence the social functioning of the work environment and offer insights into the delivery of quality care. Nurse managers should recognize the influence of leadership style and characteristics in the work environment that encourage employee participation in prosocial behaviours. These additional voluntary efforts by nursing staff may improve organisational effectiveness and quality of care. Inclusion of these behaviours in performance reviews and as cultural norms may help to foster a more collaborative work environment. © 2018 John Wiley & Sons Ltd.
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Mander, Rosemary; Cheung, Ngai Fen; Wang, Xiaoli; Fu, Wei; Zhu, Junghong
2010-02-01
To explore issues arising during preliminary stages of a research project in order to consider the feasibility of a midwife-led normal birthing unit in mainland China. Midwife-led normal birthing units, as a route to ensuring normality, have become a feature of western maternity care, but are unknown in China. Action research, using a qualitative descriptive approach, was performed. Data were collected at meetings, by non-participant observation and by face-to-face semi-structured interviews. Observation was undertaken in the midwife-led normal birthing unit and a standard care setting. Data analysis was by thematic analysis using constant comparison techniques. In the labour ward of a large general hospital in a major city, stakeholders included midwifery staff, managers, university staff and researchers. Childbearing women proved keen to use this service, but were unable to participate in the planning. The midwife-led normal birthing unit sought to provide one-to-one care in labour and support by a birth companion. Routine interventions were to be avoided. The midwives in the midwife-led normal birthing unit created a more suitable environment for supportive care. The midwives demonstrated high-quality communication skills. The woman's choice of position/mobility was limited. Difficulties with staffing were identified. The preliminary findings suggest that continuation of the project is feasible. The woman's role demonstrates passivity. The perception of staff shortage has serious implications. This action research project suggests that a study of a midwife-led normal birthing unit in China is feasible, with some attention to staffing issues.
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Primary Care Practice Development: A Relationship-Centered Approach
Miller, William L.; Crabtree, Benjamin F.; Nutting, Paul A.; Stange, Kurt C.; Jaén, Carlos Roberto
2010-01-01
PURPOSE Numerous primary care practice development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relationship-centered practice development approach to understand practice and to aid in fostering practice development to advance key attributes of primary care that include access to first-contact care, comprehensive care, coordination of care, and a personal relationship over time. METHODS Informed by complexity theory and relational theories of organizational learning, we built on discoveries from the American Academy of Family Physicians’ National Demonstration Project (NDP) and 15 years of research to understand and improve primary care practice. RESULTS Primary care practices can fruitfully be understood as complex adaptive systems consisting of a core (a practice’s key resources, organizational structure, and functional processes), adaptive reserve (practice features that enhance resilience, such as relationships), and attentiveness to the local environment. The effectiveness of these attributes represents the practice’s internal capability. With adequate motivation, healthy, thriving practices advance along a pathway of slow, continuous developmental change with occasional rapid periods of transformation as they evolve better fits with their environment. Practice development is enhanced through systematically using strategies that involve setting direction and boundaries, implementing sensing systems, focusing on creative tensions, and fostering learning conversations. CONCLUSIONS Successful practice development begins with changes that strengthen practices’ core, build adaptive reserve, and expand attentiveness to the local environment. Development progresses toward transformation through enhancing primary care attributes. PMID:20530396
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Dyess, Susan; Sherman, Rose
2011-01-01
The authors of the recently published Institute of Medicine on the Future of Nursing report emphasized the importance of preparing nurses to lead change to advance health care in the United States. Other scholars linked practice environments to safe quality care. In order for nurses to fully actualize this role in practice environments, they need to possess leadership skills sets that identify and respond to challenges faced. New nurses are no exception. This article presents a program with a 5-year track record that is designed to support transition and enhance the skill sets of leadership for new nurses in their first year of practice. Qualitative and quantitative evaluation measurements at baseline and postprogram provided data for evaluation of the first 4 cohorts in the program. Evaluative outcomes presented indicate that new nurses gained leadership and translational research skills that contributed to their ability to influence practice environments. Nonetheless, practice environments continue to need improvement and ongoing leadership from all levels of nursing must be upheld.
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Patient focused care team design. Critical aspects of a cost-effective design strategy.
Leander, W J
1993-01-01
It is the critical, yet largely unknown aspects of Patient Focused care team design--the "how" of a design process--which make LRMC's "Care Pairs" a ground-breaking innovation rather than just a distinctive-sounding name. Unfortunately, many hospital leaders of Patient Focused Care programs know the "what" of LRMC's "Care Pairs" but very little, if anything, about this "how." To create Patient Focused care teams which are "right" for your own institution, you must quantify the Costs of Continuity, Competency and Compartmentalization and their associated benefits. Without these informed trade-offs, you and your hospital will be forced to live with someone else's Patient Focused care team design. In summary, it is what you don't know about LRMC's "Care Pairs," not what you do know, that is important to your Patient Focused Care program. Hospitals just beginning to implement Patient Focused Care must understand this "how" if they are to design effective care teams which optimize the performance of their initial unit(s) within their unique environments. Hospitals like LRMC with established Patient Focused Care units must also periodically draw upon this "how" or they face the very real danger of having their Patient Focused care team design(s) become outdated, less effective and eventually detrimental. Or, said another way: "The man who does not read good books has no advantage over those who cannot." Mark Twain. "An out-of-date Patient Focused hospital has no advantage over those which remain unrestructured." The PFCA. The three critical aspects of Patient Focused care team design explored in this article are just the tip of the iceberg.(ABSTRACT TRUNCATED AT 250 WORDS)
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Perianesthesia Nurses Are My Second Family: A Qualitative Descriptive Study.
Seefeldt, Julanne; Wood, Stacey; Bolton, Pamela; Fitzpatrick, Tara; Stegenga, Kristin; Roberts, Cristine
2017-12-01
Identify the perceptions of perianesthesia nurses regarding behaviors that promote or detract from sustaining a safe, efficient, and satisfying work environment. Two focus groups and seven individual interviews (n=14) were conducted exploring the perceptions regarding team behavior of registered nurses in one pediatric perianesthesia unit. Qualitative descriptive data collection, inductive content analysis. Nurses described a responsive, engaged health care team whose leadership is available and directive when needed, as creating an effective, satisfying work environment. Primary themes that emerged were Leadership Sets the Tone, Playing Fair, No One Gets Hurt, and Why We Stay. This nursing team acknowledged that inattentive, distracted team members cause frustration, work inequities, and care delays, potentially undermining patient safety. Results demonstrate the need to create and sustain consistently respectful perianesthesia work cultures. Research focusing on unit specific approaches to work distribution, communication, leadership, and technology use is needed. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
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Staff perception of patient discharge from ICU to ward-based care.
James, Stephen; Quirke, Sara; McBride-Henry, Karen
2013-11-01
The quality of information exchange between intensive care unit (ICU) and ward nurses, when patients are transferred out of intensive care, is important to the continuity of safe care. This research aimed to explore nurses' experiences of the discharge process from ICU to the ward environment. The study was conducted in a New Zealand Metropolitan hospital, using an exploratory descriptive design we adapted a questionnaire based on Whittaker and Ball's research on ICU patient handover. The questionnaires were then analysed using a descriptive thematic approach. The response rate of 48% included 45 ICU and 47 ward nurses. Key findings were that the written and verbal communication needs differ dependent upon setting and the timing of a discharge. Timing of handover also requires negotiation. Being able to negotiate the timing and nature of handover is important for nurses. In addition, standardized approaches to communication are believed to enhance patient safety. Standardized handover, with content and processes that are mutually negotiated, is crucial to providing the safest environment for patients. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.
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Nydén, Kristoffer; Petersson, Martin; Nyström, Maria
2003-03-01
Little attention is paid in Emergency Care Units (ECUs) in Sweden to the special needs of older people. The aim of this study was thus to analyse older people's basic needs in the emergency care environment. The study was carried out with a life-world interpretative approach, and the theoretical framework for interpretation was Abraham Maslow's theory of motivation and personality. Seven informants aged between 65 and 88 years, with various experiences of being patients with urgent as well as non-urgent health-related problems, were interviewed about their experiences of ECU care. Their basic needs at the lower levels of Maslow's hierarchy were well-represented in the data. Higher needs, such as desire to know and understand, appeared to be totally neglected. Safety needs dominated the whole situation. Our conclusion is that standards of care must be developed in Sweden to make older patients feel safer and more secure in ECUs. Furthermore, the principles of nursing care for older patients need to be defined in order to encourage them to take an active part in their own health process.
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Have procompetitive changes altered hospital provision of indigent care?
Campbell, E S; Ahern, M W
1993-10-01
In the past decade alone there have been numerous changes in the financial and competitive environment of hospitals in the United States. Some examples include the advent of Medicare's Prospective Payment System, growth in managed care options, relaxation of states' Certificate of Need (CON) regulations, and court cases questioning the tax-exempt status of nonprofit hospitals. In this paper we attempt to reveal how hospitals alter their provision of care to the poor in a more cost conscious and competitive environment. Using hospital data from the State of California for the fiscal years ending in 1983 and 1987, estimates explaining uncompensated care commitments are presented. In particular, this study illustrates how hospitals under different ownership control varied their provision of uncompensated care over the period studied on average and by profitability level. Other factors, such as hospital location, teaching status, medicare patient load, and contractual adjustments, are also included in the analysis. A number of interesting trends are detected. Moreover, the results are found to be compatible with a quid pro quo hypothesis which states that hospital regulators reward large uncompensated care providers with profitable CON licenses.
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Noise measurements during high-frequency oscillatory and conventional mechanical ventilation.
Berens, R J; Weigle, C G
1995-10-01
To evaluate the noise levels with high-frequency oscillatory ventilation and conventional mechanical ventilation. An observational, prospective study. Pediatric intensive care unit. The caretakers and environment of the pediatric intensive care unit. High-frequency oscillatory and conventional mechanical ventilation. Caretakers evaluated noise using a visual analog scale. Noise was measured with a decibel meter and an octave band frequency filter. There was twice as much noise perceived by the caretakers and as measured on the decibel A scale. All measures showed significantly greater noise, especially at low frequencies, with high-frequency oscillatory ventilation. High-frequency oscillatory ventilation exposes the patient to twice as much noise as does the use of conventional mechanical ventilation.
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Replacing revolving door: a collaborative approach to treating individuals in crisis.
Lauer, Michelle; Brownstein, Rose
2008-06-01
The Crisis Assessment and Psychiatric Emergency Services (CAPES) unit was designed to improve the quality of psychiatric treatment, contain costs, and provide relief to overburdened psychiatric inpatient and emergency services in Delaware. This innovative program is the result of collaboration between public and private agencies to treat individuals in crisis. The myriad factors that contributed to a broken system and instigated Delaware's search for a solution are discussed in this article. The CAPES unit has resulted in improved communication among providers, decreased committal rates, better linkage to appropriate levels of care, increased safety, and improved coordination of services. Clinical implications for nursing practice include providing more holistic care in a safer environment.
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Bartlett, Mark J; Shephard, Elizabeth A
2016-06-01
The study of pharmacogenomics has, by harnessing sequence information from human genomes, the potential to lead to novel approaches in drug discovery, an individualized application of drug therapy, and new insights into disease prevention. For this potential to be realized results need to be interpreted to the prescriber into a format which dictates an action. This mini review briefly describes the history, the regulatory environment, opinions towards, and implementation, integration and interpretation of pharmacogenomics in the United States of America and Europe. The article discusses also how interpretation of pharmacogenomics could move forward to better implementation in health care.
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Dignity in long-term care: An application of Nordenfelt's work.
Kane, Jennifer; de Vries, Kay
2017-09-01
The concept of dignity is recognised as a fundamental right in many countries. It is embedded into law, human rights legislation and is often visible in organisations' philosophy of care, particularly in aged care. Yet, many authors describe difficulties in defining dignity and how it can be preserved for people living in long term care. In this article, Nordenfelt's 'four notions of dignity' are considered, drawing on research literature addressing the different perspectives of those who receive, observe or deliver care in the context of the long-term care environment. A review of the literature was undertaken using the terms 'nursing homes', 'residential care' or 'long-term care'. The terms were combined and the term 'human dignity' was added. A total of 29 articles met the inclusion criteria from the United Kingdom (14), United States (2), Australia (1), Sweden (3), Hong Kong (2), Norway (3), Nordic (1), Taiwan (1), Netherlands (1). Ethical Considerations: Every effort has been made to ensure an unbiased search of the literature with the intention of an accurate interpretation of findings. The four notions of dignity outlined by Nordenfelt provide a comprehensive description of the concept of dignity which can be linked to the experiences of people living in long-term care today and provide a useful means of contextualising the experiences of older people, their families and significant others and also of staff in long-term care facilities. Of particular interest are the similarities of perspectives of dignity between these groups. The preservation of dignity implies that dignity is a quality inherent in us all. This links directly to the exploration and conclusions drawn from the literature review. Conversely, promoting dignity implies that dignity is something that can be influenced by others and external factors. Hence, there are a number of implications for practice. We suggest that two of Nordenfelt's notions, 'dignity of identity' and 'dignity of Menschenwüde', are a common thread for residents, family members and staff when conceptualising dignity within long-term care environments.
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Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha
2014-01-01
Context: Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. Aim: The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. Materials and Methods: A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. Results: The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. Conclusion: ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments. PMID:25400363
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Unlicensed care homes in the United States: a clandestine sector of long-term care.
Lepore, Michael; Greene, Angela M; Porter, Kristie; Lux, Linda; Vreeland, Emily; Hawes, Catherine
2018-06-11
Residential care facilities operating without a state license are known to house vulnerable adults. Such unlicensed care homes (UCHs) commonly operate illegally, making them difficult to investigate. We conducted an exploratory, multimethod qualitative study of UCHs, including 18 subject matter expert interviews and site visits to three states, including a total of 30 stakeholder interviews, to understand UCH operations, services provided, and residents served. Findings indicate that various vulnerable groups reside in UCHs; some UCHs offer unsafe living environments; and some residents are reportedly abused, neglected, and financially exploited. Regulations, policies and practices that might influence UCH prevalence are discussed.
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Myburgh, John; Abillama, Fayez; Chiumello, Davide; Dobb, Geoff; Jacobe, Stephen; Kleinpell, Ruth; Koh, Younsuk; Martin, Claudio; Michalsen, Andej; Pelosi, Paolo; Torra, Lluis Blanch; Vincent, Jean-Louis; Yeager, Susan; Zimmerman, Janice
2016-08-01
End-of-life care in the intensive care unit (ICU) was identified as an objective in a series of Task Forces developed by the World Federation of Societies of Intensive and Critical Care Medicine Council in 2014. The objective was to develop a generic statement about current knowledge and to identify challenges relevant to the global community that may inform regional and local initiatives. An updated summary of published statements on end-of-life care in the ICU from national Societies is presented, highlighting commonalities and differences within and between international regions. The complexity of end-of-life care in the ICU, particularly relating to withholding and withdrawing life-sustaining treatment while ensuring the alleviation of suffering, within different ethical and cultural environments is recognized. Although no single statement can therefore be regarded as a criterion standard applicable to all countries and societies, the World Federation of Societies of Intensive and Critical Care Medicine endorses and encourages the role of Member Societies to lead the debate regarding end-of-life care in the ICU within each country and to take a leading role in developing national guidelines and recommendations within each country. Copyright © 2016 Elsevier Inc. All rights reserved.
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Weigl, M; Schneider, A; Hoffmann, F; Angerer, P
2015-09-01
Poor hospital work environments affect physicians' work stress. With a focus on hospital pediatricians, we sought to investigate associations between work stress, burnout, and quality of care. A cross-sectional study was conducted in N = 96 pediatricians of a German academic children's hospital (response rate = 73.8 %). All variables were assessed with standardized questionnaires. Multivariate regression analyses were applied to investigate associations after adjusting for potential confounders. Critically high work stress (effort/reward ratio, ERR > 1.0) was reported by N = 25 (28.4 %) participants. Pediatricians in inpatient wards had significantly more work stress than their colleagues in intensive care units and outpatient wards; 10.2 % of surveyed pediatricians reported critically high burnout. Again, inpatient ward staff reported significantly increased emotional exhaustion. After controlling for several confounders, we found that pediatricians with high work stress and emotional exhaustion reported reduced quality of care. Mediation analyses revealed that especially pediatricians' emotional exhaustion partially mediated the effect of work stress on quality of care. Results demonstrate close relationships between increased work stress and burnout as well as diminished quality of care. High work stress environments in pediatric care influence mental health of pediatricians as well as quality of patient care. • The quality of pediatricians' work environment in the hospital is associated with their work stress and burnout. • The consequences of pediatricians' work life for the quality of care need to be addressed in order to inform interventions to improve work life and care quality. • Our study shows associations between increased work stress and burnout with mitigated quality of care. • Beyond indirect effects of work stress through emotional exhaustion on quality of care we also observed direct detrimental effects of pediatricians' work stress on mitigated care quality.
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En route care patient safety: thoughts from the field.
McNeill, Margaret M; Pierce, Penny; Dukes, Susan; Bridges, Elizabeth J
2014-08-01
The purpose of this study was to describe the patient safety culture of en route care in the United States Air Force aeromedical evacuation system. Almost 100,000 patients have been transported since 2001. Safety concerns in this unique environment are complex because of the extraordinary demands of multitasking, time urgency, long duty hours, complex handoffs, and multiple stressors of flight. An internet-based survey explored the perceptions and experiences of safety issues among nursing personnel involved throughout the continuum of aeromedical evacuation care. A convenience sample of 236 nurses and medical technicians from settings representing the continuum was studied. Descriptive and nonparametric statistics were used to analyze the quantitative data, and thematic analysis was applied to the qualitative data. Results indicate that over 90% of respondents agree or strongly agree safety is a priority in their unit and that their unit is responsive to patient safety initiatives. Many respondents described safety incidents or near misses, and these have been categorized as personnel physical capability limitations, environmental threats, medication and equipment issues, and care process problems. Results suggest the care of patients during transport is influenced by the safety culture, human factors, training, experience, and communication. Suggestions to address safety issues emerged from the survey data. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.
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Young, W B; Minnick, A F; Marcantonio, R
1996-05-01
The authors determine the importance that patients, nurses, and nurse managers place on aspects of care and measure nurses' care values based on their perceptions of their patients and nurse manager care values and their desire to meet these care expectations. The literature has documented gaps in how nurses and patients define quality and value specific care aspects, but little is known about the situation in the current continuous quality improvement and patient-centered care environment, which emphasizes a customer focus. Misunderstanding patients' values and expectations may impede service improvement. Information about any existing gaps could help managers begin to devise patient satisfaction improvement strategies. Two thousand fifty-one medical-surgical patients, 1264 staff members, and 97 nurse managers from 17 randomly selected hospitals participated in study activities related to selected aspects of patient care. Trained interviewers surveyed patients by telephone within 26 days of discharge using a pretested instrument. Staff members and managers completed a coordinated written tool. Descriptive and correlational statistics were used in individual and unit-level analyses. Staff members perceive correctly that patients value differently various aspects of care but do not agree with their managers on patients' value of aspects of care. Unit staff members' and managers' beliefs regarding patients' care values did not match those of their patients (-14 to 0.11 and -0.01 to 0.06 zero order correlations, respectively). A unit's errors in defining patients' values may be self-reinforcing. Strategies to reorient personnel, including adoption of those suggested by the diffusion of innovation literature, may help bridge the gap and change practice.
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Sonenberg, Andréa; Knepper, Hillary J
Health disparities persist among morbidity and mortality rates in the United States. Contributing significantly to these disparities are the ability to pay for health care (largely, access to health insurance) and access to, and capacity of, the primary care health workforce. This article examines key determinants of health (DOH) including demographics, public and regulatory policies, health workforce capacity, and primary health outcomes of four states of the United States. The context of this study is the potential association among health care disparities and myriad DOH, among them, the restrictive nurse practitioner (NP) scope of practice (SOP) regulatory environment, which are documented to influence access to care and health outcomes. This descriptive study explores current NP SOP regulations, access to primary care, and health outcomes of key chronic disease indicators-diabetes, hypertension, and obesity in Alabama, Colorado, Mississippi, and Utah. These states represent both the greatest disparity in chronic disease health outcomes (obesity, diabetes, and hypertension) and the greatest difference in modernization of their NP SOP laws. The Affordable Care Act has greatly expanded access to health care. However, it is estimated that 23 million Americans, 7% of its total population, will remain uninsured by 2019. Restrictive and inconsistent NP SOP policies may continue to contribute to health workforce capacity and population health disparities across the country, with particular concern for primary care indicators. The study findings bring into question whether states with more restrictive NP SOP regulations impact access to primary care, which may in turn influence population health outcomes. These findings suggest the need for further research. NPs are essential for meeting the increasing demands of primary care in the United States, and quality-of-care indicator research supports their use. Copyright © 2016 Elsevier Inc. All rights reserved.
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ERIC Educational Resources Information Center
General Accounting Office, Washington, DC. Resources, Community, and Economic Development Div.
This report by the United States General Accounting Office discusses federal, state, and local programs and activities to inspect for and address lead hazards in the nation's child care facilities and schools, and existing information on the extent and treatment of lead hazards in these facilities and schools. Federal agencies conduct numerous…
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Cappabianca, Agnes; Julliard, Kell; Raso, Rosanne; Ruggiero, Jillian
2009-01-01
We asked our patients, "What is the most important thing I can do for you today?" and analyzed the self-identified patient needs. Eleven themes emerged; we used these findings to drive a unit-based project and a hospital-based project, hard-wiring strategies into the infrastructure of Relationship-Centered Care to build relationships between patients/families and staff and to establish a healing and caring environment.
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Vatovec, Christine; Senier, Laura; Bell, Michael
2013-09-01
Healthcare organizations are increasingly examining the impacts of their facilities and operations on the natural environment, their workers, and the broader community, but the ecological impacts of specific healthcare services provided within these institutions have not been assessed. This paper provides a qualitative assessment of healthcare practices that takes into account the life-cycle impacts of a variety of materials used in typical medical care. We conducted an ethnographic study of three medical inpatient units: a conventional cancer ward, palliative care unit, and a hospice center. Participant observations (73 participants) of healthcare and support staff including physicians, nurses, housekeepers, and administrators were made to inventory materials and document practices used in patient care. Semi-structured interviews provided insight into common practices. We identified three major domains that highlight the cumulative environmental, occupational health, and public health impacts of medical supplies and pharmaceuticals used at our research sites: (1) medical supply procurement; (2) generation, handling, and disposal of medical waste; and (3) pharmaceutical handling and disposal. Impacts discovered through ethnographic inquiry included occupational exposures to chemotherapy and infectious waste, and public health exposures to pharmaceutical waste. This study provides new insight into the environmental, occupational, and public health impacts resulting from medical practices. In many cases, the lack of clear guidance and regulations regarding environmental impacts contributed to elevated harms to the natural environment, workers, and the broader community.
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Effects of a multifaceted minimal-lift environment for nursing staff: pilot results.
Zadvinskis, Inga M; Salsbury, Susan L
2010-02-01
Nursing staff are at risk for musculoskeletal injuries because of the physical nature of patient handling. The purpose of this study is to examine the effectiveness of a multifaceted minimal-lift environment on reported equipment use, musculoskeletal injury rates, and workers' compensation costs for patient-handling injuries. The pilot study consists of a mixed measures design, with both descriptive and quasi-experimental design elements. The intervention consists of engineering (minimal-lift equipment), administrative (nursing policy), and behavioral (peer coach program) controls. The comparison nursing unit has received engineering controls only. The convenience sample includes nursing staff employed on two medical-surgical nursing units, who provide direct patient care at least 50% of the time. Nursing staff employed in a multifaceted lift environment report greater lift equipment use and experience less injury, with reduced worker's compensation costs.
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Ncube, Rosinah K; Barlow, Hilary; Mayers, Pat M
2016-08-30
Preterm and low-birth weight infants are often separated from their mothers when admitted to neonatal units for stabilisation of body temperature and technological support. The aim of the study was to explore and describe the lived experiences of mothers regarding care of their hospitalised preterm infants in a neonatal unit in a public hospital in Gaborone, Botswana. This study utilised a qualitative exploratory and descriptive phenomenological study design. Mothers of hospitalised preterm infants were purposefully selected, with whom there was extensive engagement. Two in-depth interviews were conducted with each participant (P). Mothers were shocked by the sudden birth of a preterm infant and found the neonatal environment intimidating. This increased their fear and anxiety and delayed development of a relationship with their infants. Support from staff, other mothers in the neonatal unit and family members enabled the mothers to overcome their fear and to develop an emotional connection with their infants. On-going supportive communication with the mothers by healthcare professionals promotes their confidence and competence in caring for their preterm infants, which in turn promotes mother-infant attachment.
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Borhani, Fariba; Abbaszadeh, Abbas; Rabori, Roghayeh Mehdipour
2016-01-01
Background: Patient’s dignity is an important issue which is highlighted in nursing It is an issue that is highly dependent on context and culture. Heart disease is the most common disease in Iran and the world. Identification of facilitator and threatening patient dignity in heart patients is vital. This study aimed to explore facilitator and threatening patient dignity in hospitalized patients with heart disease. Methods: This qualitative content analysis study was performed in 2014 in Kerman, Iran. 20 patients admitted to coronary care units and 5 personnel were selected using purposeful sampling in semi-structured and in depth interviews. Researchers also used documentation and field notes until data saturation. Qualitative data analysis was done constantly and simultaneously with data collection Results: Three central themes emerged: a) Care context which includes human environment and physical environment, b) Holistic safe care including meeting the needs of patients both in the hospital and after discharge, c) Creating a sense of security and an effective relationship between patient and nurse, including a respectful relationship and account the family in health team. Conclusion: The results of this study showed that care context is important for patient dignity as well as physical environment and safe holistic care. PMID:26793729
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Broom, Margaret; Kecskes, Zsuzsoka; Kildea, Sue; Gardner, Anne
2018-01-01
In 2012, a tertiary neonatal intensive care unit (NICU) transitioned from an open plan (OP) to a dual occupancy (DO) NICU. The DO design aimed to provide a developmental appropriate, family-centered environment for neonates and their families. During planning, staff questioned the impact DO would have on staff workflow and activity. To explore the impact of changing from an OP to a DO NICU, a prospective longitudinal study was undertaken from 2011 to 2014, using observational, time and motion, and surveys methods. Main outcome measures included distance walked by staff, minutes of staff activity, and staff perceptions of the DO design. Results highlighted no significant difference in the distances clinical nurses walked nor time spent providing direct clinical care, whereas technical support staff walked further than other staff in both designs. Staff perceived the DO design created a developmentally appropriate, family-centered environment that facilitated communication and collaboration between staff and families. Staff described the main challenges of the DO design such as effective staff communication, gaining educational opportunities, and the isolation of staff and families compared to the OP design. Our study provides new evidence that DO provides an improved developmentally environment and has similar positive benefits to single-family room for neonates and families. Such design may reduce the larger floor plan's impact on staff walking distance and work practices. Challenges of staff transition can be minimized by planning and leadership throughout the development and move to a new design.
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Hayes, Margaret M; Chatterjee, Souvik; Schwartzstein, Richard M
2017-04-01
Critical thinking, the capacity to be deliberate about thinking, is increasingly the focus of undergraduate medical education, but is not commonly addressed in graduate medical education. Without critical thinking, physicians, and particularly residents, are prone to cognitive errors, which can lead to diagnostic errors, especially in a high-stakes environment such as the intensive care unit. Although challenging, critical thinking skills can be taught. At this time, there is a paucity of data to support an educational gold standard for teaching critical thinking, but we believe that five strategies, routed in cognitive theory and our personal teaching experiences, provide an effective framework to teach critical thinking in the intensive care unit. The five strategies are: make the thinking process explicit by helping learners understand that the brain uses two cognitive processes: type 1, an intuitive pattern-recognizing process, and type 2, an analytic process; discuss cognitive biases, such as premature closure, and teach residents to minimize biases by expressing uncertainty and keeping differentials broad; model and teach inductive reasoning by utilizing concept and mechanism maps and explicitly teach how this reasoning differs from the more commonly used hypothetico-deductive reasoning; use questions to stimulate critical thinking: "how" or "why" questions can be used to coach trainees and to uncover their thought processes; and assess and provide feedback on learner's critical thinking. We believe these five strategies provide practical approaches for teaching critical thinking in the intensive care unit.
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Efficacy beliefs predict collaborative practice among intensive care unit nurses.
Le Blanc, Pascale M; Schaufeli, Wilmar B; Salanova, Marisa; Llorens, Susana; Nap, Raoul E
2010-03-01
This paper is a report of an investigation of whether intensive care nurses' efficacy beliefs predict future collaborative practice, and to test the potential mediating role of team commitment in this relationship. Recent empirical studies in the field of work and organizational psychology have demonstrated that (professional) efficacy beliefs are reciprocally related to workers' resources and well-being over time, resulting in a positive gain spiral. Moreover, there is ample evidence that workers' affective commitment to their organization or work-team is related to desirable work behaviours such as citizenship behaviour. A longitudinal design was applied to questionnaire data from the EURICUS-project. Structural Equation Modelling was used to analyse the data. The sample consisted of 372 nurses working in 29 different European intensive care units. Data were collected in 1997 and 1998. However, our research model deals with fundamental psychosocial processes that are not time-dependent. Moreover, recent empirical literature shows that there is still room for improvement in ICU collaborative practice. The hypotheses that (i) the relationship between efficacy beliefs and collaborative practice is mediated by team commitment and (ii) efficacy beliefs, team commitment and collaborative practice are reciprocally related were supported, suggesting a potential positive gain spiral of efficacy beliefs. Healthcare organizations should create working environments that provide intensive care unit nurses with sufficient resources to perform their job well. Further research is needed to design and evaluate interventions for the enhancement of collaborative practice in intensive care units.
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Chatterjee, Souvik; Schwartzstein, Richard M.
2017-01-01
Critical thinking, the capacity to be deliberate about thinking, is increasingly the focus of undergraduate medical education, but is not commonly addressed in graduate medical education. Without critical thinking, physicians, and particularly residents, are prone to cognitive errors, which can lead to diagnostic errors, especially in a high-stakes environment such as the intensive care unit. Although challenging, critical thinking skills can be taught. At this time, there is a paucity of data to support an educational gold standard for teaching critical thinking, but we believe that five strategies, routed in cognitive theory and our personal teaching experiences, provide an effective framework to teach critical thinking in the intensive care unit. The five strategies are: make the thinking process explicit by helping learners understand that the brain uses two cognitive processes: type 1, an intuitive pattern-recognizing process, and type 2, an analytic process; discuss cognitive biases, such as premature closure, and teach residents to minimize biases by expressing uncertainty and keeping differentials broad; model and teach inductive reasoning by utilizing concept and mechanism maps and explicitly teach how this reasoning differs from the more commonly used hypothetico-deductive reasoning; use questions to stimulate critical thinking: “how” or “why” questions can be used to coach trainees and to uncover their thought processes; and assess and provide feedback on learner’s critical thinking. We believe these five strategies provide practical approaches for teaching critical thinking in the intensive care unit. PMID:28157389
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Matchett, Debbie; Haddad, Michel; Volland, Jennifer
Consumers are increasingly becoming the voice and impetus for hospital organizational change in the United States. This is in part due to their increased stake in cost sharing with hospitals, health systems, and the ambulatory setting and revisions to health plans with higher deductibles and copays. With customers wanting services better, faster, and more economical than in the past, organizations need to break the ceiling on improvement levels for exceeding expectations of patient experience. Of interest is the hospital critical care area, because of the heightened patient needs, support, and resources that are required in this acute setting. Bluewater Health, located in Sarnia, Ontario, Canada, is a top-industry performer on the patient experience access-to-care dimension. Much can be learned from the multiple practices it has used to create an environment that embraces patients and families to the fullest extent, ensuring the resources needed for optimizing care are received.
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[Management of technology in intensive care].
Madureira, C R; Veiga, K; Sant'ana, A F
2000-12-01
The lives of hospitalized patients depend on diagnostic-therapeutic procedures and on the care provided by the health team. It also depends on the quality and availability of factors such as: physical structure and material and human and financial resources. The need to optimize these resources and re-establish patients' health has brought about the Intensive Care Units (ICU), whose design must consider the physical environment and clinical equipment which are indispensable in health care. Aiming at identifying the level of knowledge of health professionals as to technical and operational information in equipment manuals and the perception of the interviewed professionals in relation to the adequacy of the physical and electrical installations of such units, we conducted a descriptive study in an ICU of a public hospital in Salvador, Brazil. The results show that such installations were considered to be unsuitable for the safe development of activities and that most of the health team members did not know the technical or operational specifications in the equipment manuals.
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U.S. academic medical centers under the managed health care environment.
Guo, K
1999-06-01
This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U.S. health care system through their missions of conducting cutting-edge biomedical research, pursuing clinical and technological innovations, providing state-of-the-art medical care and producing highly qualified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical science. To survive the threats of managed care in the health care environment, academic medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 108 CEOs in all the academic medical centers in the U.S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.
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The effect of transforming care at the bedside initiative on healthcare teams' work environments.
Lavoie-Tremblay, Mélanie; O'Conner, Patricia; Harripaul, Anastasia; Biron, Alain; Ritchie, Judith; Lavigne, Genevieve L; Baillargeon, Sophie; Ringer, Justin; Macgibbon, Brenda; Taylor-Ducharme, Sharon; Sourdif, Jacynthe
2014-02-01
Different initiatives have been implemented in healthcare organizations to improve efficiency, such as transforming care at the bedside (TCAB). However, there are important gaps in understanding the effect of TCAB on healthcare teams' work environments. The specific aim of the study is to describe findings regarding the TCAB initiative effects on healthcare teams' work environments. A pretest and posttest study design was used for this study. The TCAB initiative was implemented in fall 2010 in a university health center in Montreal, Canada. The sample consisted of healthcare workers from four different care units. Statistically significant improvement was observed with the communicating specific information subscale from the measure of processes of care variable, and a significant difference was found between the support from colleagues variable, which was higher at baseline than postprogram. The differences for psychological demand, decisional latitude, and effort-reward were not significant. TCAB is an intervention that allows healthcare teams to implement change to improve patients' and families' outcomes. Ongoing energy should focus on how to improve communication among all members of the team and ensure their support. © 2013 Sigma Theta Tau International.
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Public Employees: Facts at a Glance.
ERIC Educational Resources Information Center
American Federation of Labor and Congress of Industrial Organizations, Washington, DC. Public Employee Dept.
Seventeen million people are employed in the delivery of government services in the United States, more than half of these in education, health care, and public safety. Others provide services related to defense, postal service, the environment, housing, and administration. Though 82 percent of public employees work for state and local government,…
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Being a Nursing Aide; Student Manual.
ERIC Educational Resources Information Center
American Hospital Association, Chicago, IL.
Developed for students receiving on-the-job training as nursing aides, this illustrated manual contains these chapters: (1) Orientation, (2) Introduction to the Patient, (3) Your Working Environment, (4) The Patient's Unit: Making the Unoccupied Bed, (5) Lifting, Moving, and Transporting Patients: Making the Occupied Bed, (6) Personal Care of the…
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Aalto, Anna-Mari; Heponiemi, Tarja; Väänänen, Ari; Bergbom, Barbara; Sinervo, Timo; Elovainio, Marko
2014-08-01
International mobility of health care professionals is increasing, though little is known about how working in a culturally diverse team affects the native physicians' psychosocial work environment. We examined Finnish physicians' perceptions of work-related wellbeing according to whether they had foreign-born colleagues (FBCs) in their work unit. We also examined whether work-related resources moderate the potential association between work-related wellbeing and working alongside FBCs. A cross-sectional survey was conducted for a random sample of physicians in Finland in 2010 (3826 respondents, response rate 55%). Analyses were restricted to native Finnish physicians working in public health care. The results were analyzed by ANCOVA. In unadjusted analyses, having FBCs was related to poor team climate (p<0.001) and poor job satisfaction (p=0.001). Those physicians who reported high procedural justice and high job control perceived also higher job satisfaction even if they had many FBCs in the work unit (p=0.007 for interaction between FBCs and procedural justice and p<0.001 for interaction between FBCs and job control). These associations were robust to adjustments for age, sex, health care sector, specialization, on-call duty, employment contract, full-time employment and leadership position. The results indicate that culturally diverse work units face challenges related to team climate and job satisfaction. The results also show that leadership plays an important role in culturally diverse work units. The potential challenges of culturally diverse teams for native physicians may be reduced by fair decision-making and by increasing physicians' job control. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Pickworth, Thomas; Jerath, Angela; DeVine, Rita; Kherani, Nazmin; Wąsowicz, Marcin
2013-01-01
The use of volatile-based sedation within critical care environments has been limited by difficulties of drug administration and safety concerns over environment pollution and staff exposure in an intensive care unit (ICU) with no scavenging. The aim of this study was to develop a simple scavenging system to be used with the Anesthesia Conserving Device (AnaConDa(®)) and to determine whether or not ambient concentrations of residual anesthetic are within current acceptable limits. The scavenging system consists of two Deltasorb(®) canisters attached to the ICU ventilator in series. AnaConDa is a miniature vaporizer designed to provide volatile-based sedation within an ICU. The first ten patients recruited into a larger randomized trial assessing outcomes after elective coronary graft bypass surgery were sedated within the cardiac ICU using either isoflurane or sevoflurane. Sedation was guided by the Sedation Agitation Scale, resulting in an end-tidal minimum anesthetic concentration of volatile agent ranging from 0.1-0.3. At one hour post ICU admission, infrared photometric analysis was used to assess environmental contamination at four points along the ventilator circuit and scavenging system and around the patient's head. All measurements taken within the patient's room were below 1 part per million, which satisfies criteria for occupational exposure. This study shows that volatile agents can be administered safely within critical care settings using a simple scavenging system. Our scavenging system used in conjunction with the AnaConDa device reduced the concentration of environmental contamination to a level that is acceptable to Canadian standards and standards in most Western countries and thus conforms to international safety standards. The related clinical trial was registered at www.clinicaltrials.gov (NCT01151254).
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The evolution and development of an instrument to measure essential professional nursing practices.
Kramer, Marlene; Brewer, Barbara B; Halfer, Diana; Hnatiuk, Cynthia Nowicki; MacPhee, Maura; Schmalenberg, Claudia
2014-11-01
Nursing continues to evolve from a task-oriented occupation to a holistic professional practice. Increased professionalism requires accurate measurement of care processes and practice. Nursing studies often omit measurement of the relationship between structures in the work environment and processes of care or between processes of care and patient outcomes. Process measurement is integral to understanding and improving nursing practice. This article describes the development of an updated Essentials of Magnetism process measurement instrument for clinical nurses (CNs) practicing on inpatient units in hospitals. It has been renamed Essential Professional Nursing Practices: CN.
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Zhang, Yuan; Punnett, Laura; McEnany, Geoffry Phillips; Gore, Rebecca
2018-01-01
The effect of shift work on nurses’ sleep is well-studied, but there are other challenging aspects of health care work that might also affect the sleep of direct caregivers. This study examined the influence of the long-term care work environment on sleep quantity and quality of nursing assistants. A cross-sectional survey collected data from 650 nursing assistants in 15 long-term care facilities; 46% reported short sleep duration and 23% reported poor sleep quality. A simple additive index of the number of beneficial work features (up to 7) was constructed for analysis with Poisson regression. With each unit increase of beneficial work features, nursing assistants were 7% less likely to report short sleep duration and 17% less likely to report poor sleep quality. These results suggest that effective workplace interventions should address a variety of work stressors, not only work schedule arrangements, in order to improve nursing assistants’ sleep health. PMID:26384714
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Oltra-Rodríguez, Enrique; Martínez-Riera, José Ramón; Mármol-López, María Isabel; Pastor-Gallardo, Francisco Javier; Gras-Nieto, Elvira; Holgado-Fernández, Ana
To analyze the current situation of the training of specialists in family and community nursing from the perspective of nurses responsible for teaching units. Exploratory analysis using nominal group technique of the contributions made by representatives of 19 multidisciplinary teaching units in family and community care from 11 Spanish autonomous communities. They categorized and weighted those contributions. The emerging categories on the strengths and difficulties encountered related to the tutors, the environment where the training took place, the structure of the teaching unit, the organization of the teaching and the official programme of the speciality, the external supports and the theoretical training. Training in Family and Community Nursing is an opportunity to improve primary health care to train in news and necessary but complex skills. Support is required for training to be effective and the specialty and training should be made known. Tutors are a key part of this process. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
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Economic organization of medicine and the Committee on the Costs of Medical Care.
Perkins, B B
1998-01-01
Recent strategies in managed care and managed competition illustrate how health care reforms may reproduce the patterns of economic organization of their times. Such a reform approach is not a new development in the United States. The work of the 1927-1932 Committee on the Costs of Medical Care exemplifies an earlier effort that applied forms of economic organization to medical care. The committee tried to restructure medicine along lines consistent with its economic environment while attributing its models variously to science, profession, and business. Like current approaches, the committee's reports defined costs as the major problem and business models of organization as the major solution. The reports recommended expanded financial management and group medicine, which would include growth in self-supporting middle-class services such as fee clinics and middle-rate hospital units. Identifying these elements as corporate practice of medicine, the American Medical Association-based minority dissented from the final report in favor of conserving individual entrepreneurial practice. This continuum in forms of economic organization has limited structural reform strategies in medicine for the remainder of the century. PMID:9807547
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Through the Eyes of Nurse Managers in Long-Term Care: Identifying Perceived Competencies and Skills.
Dever, Kathleen H
2018-05-01
Nurse managers (NMs) in long-term care supervise health care services for individuals with high acuity levels and numerous comorbidities. There is minimal research identifying NMs' skills and competencies as unit leaders within the long-term care environment. The current mixed-methods study identified NMs' leadership skills and competencies. Nineteen NMs with ≥5 years' long-term care management experience completed the Nurse Manager Inventory Tool and were individually interviewed. They rated their clinical skills at the competent level and their financial/strategic management skills at the novice level. All other skill categories, including leadership reflective practice, diversity, human resource leadership/management, relationship management, performance improvement, and problem solving, were rated at a competent level. Emergent interview qualitative themes included their visibility on the unit, trial and error learning, a sense of "aloneness" due to the absence of other RNs, NM position being a tough job, need for peer support, role modeling, and importance of supporting the resident through their "final journey." [Journal of Gerontological Nursing, 44(5), 32-38.]. Copyright 2018, SLACK Incorporated.
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Respiratory High-Dependency Care Units for the burden of acute respiratory failure.
Scala, Raffaele
2012-06-01
The burden of acute respiratory failure (ARF) has become one of the greatest epidemiological challenges for the modern health systems. Consistently, the imbalance between the increasing prevalence of acutely de-compensated respiratory diseases and the shortage of high-daily cost ICU beds has stimulated new health cost-effective solutions. Respiratory High-Dependency Care Units (RHDCU) provide a specialised environment for patients who require an "intermediate" level of care between the ICU and the ward, where non-invasive monitoring and assisted ventilation techniques are preferentially applied. Since they are dedicated to the management of "mono-organ" decompensations, treatment of ARF patients in RHDCU avoids the dangerous "under-assistance" in the ward and unnecessary "over-assistance" in ICU. RHDCUs provide a specialised quality of care for ARF with health resources optimisation and their spread throughout health systems has been driven by their high-level of expertise in non-invasive ventilation (NIV), weaning from invasive ventilation, tracheostomy care, and discharging planning for ventilator-dependent patients. Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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Dendaas, Nancy
2011-01-01
To describe the degree to which Environmental Congruence (EC) is present in sampled units and considered important/desirable by staff RNs; staff RNs' reported level of work-related stress (WRS); the perceived contribution of the physical environment to WRS; and the relationship between existing levels of EC and WRS. Few studies have focused on how the physical environment might contribute to nurses' WRS and chronic nursing shortages. The construct of EC can be used, within a Person Environment (PE)-Fit framework, to assess the fit among nurses, nursing work, the physical work environment, and WRS. EC was measured using investigator-developed, literature/criterion-based survey instruments. Staff RNs reported WRS variables by using two single-item self-report measures. The final convenience sample consisted of 471 staff RNs from 39 medical/surgical units from 12 hospitals in the upper Midwest. Data were collected over a 7-month period. The mean level of existing EC in the sample was roughly 70% percent of highest capacity and that of important/desired EC in the sample was 93%. Staff RNs' mean level of WRS was 6.7; the mean contribution of the physical environment to WRS was 5.8. Moderate negative correlations were found between EC and WRS (r = -.41, p < .05), and between physical environment contribution to WRS and EC (r = -.55, p <.001). Staff RNs in the sampled units wanted a significantly higher level of EC. They rated their WRS moderately high and the contribution of the physical environment to it as moderate. A moderately negative relationship was found between EC and WRS. EC may be a useful construct in research that attempts to improve hospital nursing work environments.
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Perceived and actual noise levels in critical care units.
White, Brittany Lynn; Zomorodi, Meg
2017-02-01
To compare the noise levels perceived by critical care nurses in the Intensive Care Unit (ICU) to actual noise levels in the ICU. Following a pilot study (n=18) and revision of the survey tool, a random sample of nurses were surveyed twice in a 3-day period (n=108). Nurses perception of noise was compared to the actual sound pressure level using descriptive statistics. Nurses perceived the ICUs to be noisier than the actual values. The ICU was louder than the recommended noise level for resotrative sleep. This finding raises the question of how we can assist nurses to reduce what they perceive to be a loud environment. Future work is needed to develop interventions specifically for nurses to raise awareness of noise in the ICU and to provide them with skills to assist in noise reduction. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Brainard, Jason; Gobel, Merit; Bartels, Karsten; Scott, Benjamin; Koeppen, Michael; Eckle, Tobias
2015-03-01
The rotation of the earth and associated alternating cycles of light and dark--the basis of our circadian rhythms--are fundamental to human biology and culture. However, it was not until 1971 that researchers first began to describe the molecular mechanisms for the circadian system. During the past few years, groundbreaking research has revealed a multitude of circadian genes affecting a variety of clinical diseases, including diabetes, obesity, sepsis, cardiac ischemia, and sudden cardiac death. Anesthesiologists, in the operating room and intensive care units, manage these diseases on a daily basis as they significantly affect patient outcomes. Intriguingly, sedatives, anesthetics, and the intensive care unit environment have all been shown to disrupt the circadian system in patients. In the current review, we will discuss how newly acquired knowledge of circadian rhythms could lead to changes in clinical practice and new therapeutic concepts. © The Author(s) 2014.
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Blood Glucose Measurement in the Intensive Care Unit: What Is the Best Method?
Le, Huong T.; Harris, Neil S.; Estilong, Abby J.; Olson, Arvid; Rice, Mark J.
2013-01-01
Abnormal glucose measurements are common among intensive care unit (ICU) patients for numerous reasons and hypoglycemia is especially dangerous because these patients are often sedated and unable to relate the associated symptoms. Additionally, wide swings in blood glucose have been closely tied to increased mortality. Therefore, accurate and timely glucose measurement in this population is critical. Clinicians have several choices available to assess blood glucose values in the ICU, including central laboratory devices, blood gas analyzers, and point-of-care meters. In this review, the method of glucose measurement will be reviewed for each device, and the important characteristics, including accuracy, cost, speed of result, and sample volume, will be reviewed, specifically as these are used in the ICU environment. Following evaluation of the individual measurement devices and after considering the many features of each, recommendations are made for optimal ICU glucose determination. PMID:23567008
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Boakye-Dankwa, Ernest; Teeple, Erin; Gore, Rebecca; Punnett, Laura
2017-11-01
We performed an integrated cross-sectional analysis of relationships between long-term care work environments, employee and resident satisfaction, and quality of patient care. Facility-level data came from a network of 203 skilled nursing facilities in 13 states in the eastern United States owned or managed by one company. K-means cluster analysis was applied to investigate clustered associations between safe resident handling program (SRHP) performance, resident care outcomes, employee satisfaction, rates of workers' compensation claims, and resident satisfaction. Facilities in the better-performing cluster were found to have better patient care outcomes and resident satisfaction; lower rates of workers compensation claims; better SRHP performance; higher employee retention; and greater worker job satisfaction and engagement. The observed clustered relationships support the utility of integrated performance assessment in long-term care facilities.
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[Noise in neonatology, the impact of hospital staff].
Jonckheer, P; Robert, M; Aubry, J-C; De Brouwer, C
2004-11-20
To identify the various sources of noise in a neonatal intensive care unit in a university hospital centre and to assess the noise level. The nursing staff was interviewed to obtain a qualitative assessment of the noise in the department. Quantitative observations using a sound level meter and a dosimeter were then made. The measurements presented here were carried out in two different units caring for the newborn: on the heated table and in an incubator. Many sources of noise were identified in the unit. They were responsible for a noisy environment, the level of which was far greater than current recommendations and left few periods of quiet. The alarms of the various monitors and maintenance apparatuses, the crying of the newborn and the activity of the staff were the principal sources of noise. The impact of hospital staff on the extent and frequency of sources of noise is crucial. An enhanced awareness strategy should therefore be developed.
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Domanico, R; Davis, D K; Coleman, F; Davis, B O
2011-01-01
Objective: To test the efficacy of single family room (SFR) neonatal intensive care unit (NICU) designs, questions regarding patient medical progress and relative patient safety were explored. Addressing these questions would be of value to hospital staff, administrators and designers alike. Study Design: This prospective study documented, by means of Institution Review Board-approved protocols, the progress of patients in two contrasting NICU designs. Noise levels, illumination and air quality measurements were included to define the two NICU physical environments. Result: Infants in the SFR unit had fewer apneic events, reduced nosocomial sepsis and mortality, as well as earlier transitions to enteral nutrition. More mothers sustained stage III lactation, and more infants were discharged breastfeeding in the SFR. Conclusion: This study showed the SFR to be more conducive to family-centered care, and to enhance infant medical progress and breastfeeding success over that of an open ward. PMID:21072040
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The relationship between nurse staffing and failure to rescue: where does it matter most?
Talsma, AkkeNeel; Jones, Katherine; Guo, Ying; Wilson, Deleise; Campbell, Darrell A
2014-09-01
This study further expands on the relationship between nurse staffing levels and patient outcomes, in particular, failure to rescue. Many studies are based on single-site hospitals or single-year data, thus limiting the generalizations of the findings. The purpose was to evaluate in a multisite multiyear study the relationship between unit-level nurse staffing and FTR mortality, for ICU and non-ICU patients. Using administrative and actual unit level nurse staffing data, we used AHRQ 2003 Patient Safety Indicator (2003) software and matched those with the patient's discharge month. Fixed effects multilevel logistic analyses were used to take into account the hierarchical structure of the database and patient clustering within units. We controlled for patient demographics, clinical conditions, and CCS categories. The majority (94%) of cases were discharged from general care units, ICUs reported higher nurse staffing levels based on patient complexity. Expired cases were 3 years older, male, and nonwhite. For general care discharges, the relationship between RN level HPPD approached significance (P = 0.07), suggesting increased odds of higher FTR mortality with higher staffing levels. We did not observe any of the expected associations between the nurse staffing variables and FTR for either general care unit or ICU discharges. The comprehensive risk adjustments provided adequate "leveling of the playing field" to evaluate the impact of unit-based nurse staffing levels on FTR mortality. Future studies should evaluate the influence of unit environment and patient risk.
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Andersen, Gunn Robstad; Westgaard, Rolf H
2015-07-25
The present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore potential organizational discrepancies in the appraisals of factors relating to home care workers' working conditions. The study, using a mixed-methods design, comprised six home care units. It included survey responses of home care workers (80 respondents, response rate 54 %) and qualitative descriptions of stakeholders' appraisals of organizational issues gathered through semi-structured interviews (33 interviews with stakeholders at three organizational levels). Employees at different organizational levels in the home care services expressed divergent appraisals of factors related to the working conditions of home care workers, including impact of organizational measures (i.e. time pressure, work tasks, a new work program, organizational changes, budget model, budget allocation and coping strategies). Survey responses supported interview descriptions by home care workers. Results suggest that organizational discrepancy serve as an important barrier to a sustainable, well-functioning organization in general and to quality-enhancing changes to work procedures in particular. It is recommended to improve communication channels and facilitate the exchange of information across levels to ensure a common understanding of matters significant to the organization of the home care services and to the work environment of home care workers. The prevalence and impact of organizational discrepancy should be included in organization research, particularly when exploring explanatory factors of an unhealthy organization.
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The challenges of caring in a technological environment: critical care nurses' experiences.
McGrath, Mary
2008-04-01
This paper presents and discusses the findings from a phenomenological study which illuminated the lived experiences of experienced critical care nurses caring within a technological environment. While nursing practice is interwoven with technology, much of the literature in this area is speculative. Moreover, there is a debate as to whether and how 'high tech' and 'high touch' are reconcilable; this orientation is referred to as the optimism vs. pessimism debate. On a personal level, the motivation for this study came from the author's 13 years' experience in the critical care area. Following ethical approval, 10 experienced nurses from two cardiothoracic critical care units in Ireland participated in the study. A Heideggerian phenomenological methodology was used. Data collection consisted of unstructured interviews. A method of data analysis described by Walters was used. The findings provide research-based evidence to illuminate further the optimistic/pessimistic debate on technology in nursing. While the study demonstrates that the debate is far from resolved, it reveals a new finding: life-saving technology that supports the lives of critically ill patients can bring experienced nurses very close to their patients/families. The three main themes that emerged: 'alien environment', 'pulling together' and 'sharing the journey' were linked by a common thread of caring. Experienced critical care nurses are able to transcend the obtrusive nature of technology to deliver expert caring to their patients. However, the journey to proficiency in technology is very demanding and novice nurses have difficulty in caring with technology. Relevance to clinical practice. It is recommended that more emphasis be placed on supporting, assisting and educating inexperienced nurses in the critical care area and that the use of technology in nursing be given serious consideration.
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Neo, Jun Rong Jeffrey; Sagha-Zadeh, Rana; Vielemeyer, Ole; Franklin, Ella
2016-06-01
Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission and nosocomial infections. However, most HH interventions (HHI) have not been sustainable. This review aims to provide a comprehensive summary of recently published evidence-based HHI designed to improve HH compliance (HHC) that will enable health care providers to make informed choices when allocating limited resources to improve HHC and patient safety. The Medline electronic database (using PubMed) was used to identify relevant studies. English language articles that included hand hygiene interventions and related terms combined with health care environments or related terms were included. Seventy-three studies that met the inclusion criteria were summarized. Interventions were categorized as improving awareness with education, facility design, and planning, unit-level protocols and procedures, hospital-wide programs, and multimodal interventions. Past successful HHIs may not be as effective when applied to other health care environments. HH education should be interactive and engaging. Electronic monitoring and reminders should be implemented in phases to ensure cost-effectiveness. To create hospitalwide programs that engage end users, policy makers should draw expertise from interdisciplinary fields. Before implementing the various components of multimodal interventions, health care practitioners should identify and examine HH difficulties unique to their organizations. Future research should seek to achieve the following: replicate successful HHI in other health care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions, examine ways (eg, hospital leadership, financial support, and strategies from public health and infection prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
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Parvinian, Bahram; Scully, Christopher; Wiyor, Hanniebey; Kumar, Allison; Weininger, Sandy
2018-06-01
Part of the mission of the Center for Devices and Radiological Health (CDRH) at the US Food and Drug Administration is to facilitate medical device innovation. Therefore, CDRH plays an important role in helping its stakeholders such as manufacturers, health care professionals, patients, patient advocates, academia, and other government agencies navigate the regulatory landscape for medical devices. This is particularly important for innovative physiological closed-loop controlled (PCLC) devices used in critical care environments, such as intensive care units, emergency settings, and battlefield environments. CDRH's current working definition of a PCLC medical device is a medical device that incorporates physiological sensor(s) for automatic manipulation of a physiological variable through actuation of therapy that is conventionally made by a clinician. These emerging devices enable automatic therapy delivery and may have the potential to revolutionize the standard of care by ensuring adequate and timely therapy delivery with improved performance in high workload and high-stress environments. For emergency response and military applications, automatic PCLC devices may play an important role in reducing cognitive overload, minimizing human error, and enhancing medical care during surge scenarios (ie, events that exceed the capability of the normal medical infrastructure). CDRH held an open public workshop on October 13 and 14, 2015 with the aim of fostering an open discussion on design, implementation, and evaluation considerations associated with PCLC devices used in critical care environments. CDRH is currently developing regulatory recommendations and guidelines that will facilitate innovation for PCLC devices. This article highlights the contents of the white paper that was central to the workshop and focuses on the ensuing discussions regarding the engineering, clinical, and human factors considerations.
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How Nurse Work Environments Relate to the Presence of Parents in Neonatal Intensive Care.
Hallowell, Sunny G; Rogowski, Jeannette A; Lake, Eileen T
2017-09-25
Parental presence in the neonatal intensive care unit (NICU) is essential for families to participate in infant care and prepare them to transition from hospital to home. Nurses are the principal caregivers in the NICU. The nurse work environment may influence whether parents spend time with their hospitalized infants. To examine the relationship between the NICU work environment and parental presence in the NICU using a national data set. We conducted a cross-sectional, observational study of a national sample of 104 NICUs, where 6060 nurses reported on 15,233 infants cared for. Secondary analysis was used to examine associations between the Practice Environment Scale of the Nursing Work Index (PES-NWI) (subscale items and with a composite measure) and the proportion of parents who were present during the nurses' shift. Parents of 60% (SD = 9.7%) of infants were present during the nurses' shift. The PES-NWI composite score and 2 domains-Nurse Participation in Hospital Affairs and Manager Leadership and Support-were significant predictors of parental presence. A 1 SD higher score in the composite or either subscale was associated with 2.5% more parents being present. Parental presence in the NICU is significantly associated with better nurse work environments. NICU practices may be enhanced through enhanced leadership and professional opportunities for nurse managers and staff. Future work may benefit from qualitative work with parents to illuminate their experiences with nursing leaders and nurse-led interventions in the NICU and design and testing of interventions to improve the NICU work environment.
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Medical providers' dental information needs: a baseline survey.
Acharya, Amit; Mahnke, Andrea; Chyou, Po-Huang; Rottscheit, Carla; Starren, Justin B
2011-01-01
Articulation of medical and dental practices has been strongly called for based on the many oral-systemic connections. With the rapid development and adoption of electronic health records, the feasibility of integrating medical and dental patient data should be strongly considered. The objective of this study was to develop an initial understanding of the medical providers' core dental information needs and opinion of integrated medical-dental electronic health record (iEHR) environment in their workflow. This was achieved by administering a 13 question survey to a group of 1,197 medical care providers employed by Marshfield Clinic in Wisconsin, United States. The survey received a response rate of 35%. The responses were analyzed based on provider 'Role' and 'Specialty'. The majority of the respondents felt the need for patient's dental information to coordinate or provide effective medical care. An integrated electronic health record environment could facilitate this holistic patient care approach.
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Terp, Karina; Sjöström-Strand, Annica
2017-12-01
For parents, having a child admitted to a paediatric intensive care unit (PICU) is a very stressful experience filled with anxiety. Parents are often scared and traumatised. This stress can lead to PTSD. The aim was to describe parents' experiences and the effect on the family two years after their child was admitted to a paediatric intensive care unit. Ten parents were interviewed according to a semi-structured interview guide. An inductive approach was applied for the study and qualitative content analysis was used to analyse the data. The parents carried vivid memories and they were still strongly affected by the experience of having their child admitted to a paediatric intensive care unit. They could clearly recall the environment, feelings that affected them and how they felt powerless. The relationship between the parents had been strengthened. Parents, siblings and the ill child could all show symptoms of anxiety, stress and sleeping disorders. The parents valued life differently. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Assessing RN-to-RN peer review on clinical units.
Pfeiffer, Judith A; Wickline, Mary A; Deetz, Jill; Berry, Elise S
2012-04-01
The primary purpose of this study was to measure informal registered nurse (RN)-to-RN peer review (defined as collegial communication about the quality of nursing care) at the work-unit level. Survey design with cluster sampling of 28 hospital or ambulatory care units (n = 541 respondents). Results were compared with existing patient safety and satisfaction data. A chi-squared test was used to compare responses against nurse characteristics. Nurses agreed that RN-to-RN peer review takes place on their units, but no correlation with patient safety and satisfaction data was found. Misunderstandings about the meaning of peer review were evident. Open-ended comments revealed barriers to peer review: fear of retribution, language barriers and lack of professionalism. Nurses need clarification of peer review. Issues with common language in a professional environment need to be addressed and nurses can learn collaboration from each other's cultures. Managers should support RN-to-RN peer review on clinical units. Methods used here may be useful to assess current departmental nurse peer review. © 2011 Blackwell Publishing Ltd.
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Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.
Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A
2018-01-01
Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.
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A school of nursing's experience with providing health care for Hurricane Katrina evacuees.
Rami, Janet S; Singleton, Enrica K; Spurlock, Wanda; Eaglin, Angela R
2008-01-01
This article describes how Southern University School of Nursing (SUSON) participated in meeting the immediate health care needs of evacuees from New Orleans and environs that were victims of Hurricane Katrina. It describes how SUSON's advanced practice nurses use a mobile health unit (the Jag Mobile) to continue to serve evacuees that now live in Renaissance Village, a transitional housing trailer park. Ideas are presented that can help schools of nursing create a disaster response plan.
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Hung, Jui-Tai; Lin, Ching-Wen; Wen, Wei-Chun; Lin, Esther Ching-Lan
2015-08-01
The nursing practice environment has been shown to wield significant influence on nursing retention and nursing quality of care. Because a large percentage of Taiwan nurses currently work at regional teaching hospitals, exploring the perception toward the practice environment of nurses working at this type of hospital is important. This study explored the perception of nurses working at a regional teaching hospital in central Taiwan toward their practice environment. A cross-sectional research design with a sample of 474 nurses from a regional hospital in central Taiwan was conducted. Instruments including the demographic data and the Chinese-version Practice Environment Scale-Nursing Work Index (CPES-NWI) were anonymously self-administered. Overall, participants were moderately satisfied with their practice environment, with the greatest dissatisfaction focused on staffing and resource adequacy. Work unit and nursing level, respectively, had significant impacts on perceptions regarding the practice environment. Furthermore, discriminant analysis identified two new compound variables: 1) adequate staffing resources and partnership in the workplace and 2) supportive administrative management environment. Participants who worked in medical and surgical units were significantly more dissatisfied with the adequacy of staffing resources and partnership in the workplace than participants who worked in acute/intensive and special units. Participants at the N2 level were significantly more dissatisfied with the supportive nature of the administrative management environment. These findings support that the nursing practice environment of regional hospitals may be improved using several measures, including: modifying the staffing and resource adequacy of nurses, fostering collaborative nurse-physician relationships, and further involving nurses in administrative management and decision-making.
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Vanderzalm, Jeanne; Hall, Mark D; McFarlane, Lu-Anne; Rutherford, Laurie; Patterson, Steven K
2013-01-01
The development and implementation of interprofessional (IP) clinical learning units as a method to enhance IP clinical education and improve patient care in a rehabilitation setting are described. Using a community-based participatory research approach, academia and healthcare delivery agencies formed a partnership to create an IP clinical learning unit in a rehabilitation setting. Preimplementation data from surveys and focus group data identified areas for improvement to enhance IP understanding and collaboration. A working group developed and implemented initiatives to enhance IP practice. Preimplementation, eight themes emerged from which the working group identified goals and implemented strategies to strengthen IP learning. Goals included Creation of an IP Learning Environment, Increased Awareness of IP Practice, Role Clarification, Enhanced IP Communication, and Reflection and Evaluation. Postimplementation data revealed six themes: Communication, Informal IP Learning, Role Awareness, Positive Learning Environment, Logistics, and Challenges. The development of the IP clinical learning unit was successful and rewarding, but not without its challenges. Formal IP education was necessary to enhance collaborative practice, even in a multidisciplinary environment. Commitment and support from all participants, particularly managers and administrators from the healthcare agency, were critical to success. The focus of this unit was on a stroke rehabilitation unit; however, the development and implementation principles identified may be applicable to any team-based clinical setting. © 2013 Association of Rehabilitation Nurses.
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Burnout in the intensive care unit professionals: A systematic review.
Chuang, Chien-Huai; Tseng, Pei-Chi; Lin, Chun-Yu; Lin, Kuan-Han; Chen, Yen-Yuan
2016-12-01
Burnout has been described as a prolonged response to chronic emotional and interpersonal stress on the job that is often the result of a period of expending excessive effort at work while having too little recovery time. Healthcare workers who work in a stressful medical environment, especially in an intensive care unit (ICU), may be particularly susceptible to burnout. In healthcare workers, burnout may affect their well-being and the quality of professional care they provide and can, therefore, be detrimental to patient safety. The objectives of this study were: to determine the prevalence of burnout in the ICU setting; and to identify factors associated with burnout in ICU professionals. The original articles for observational studies were retrieved from PubMed, MEDLINE, and Web of Science in June 2016 using the following MeSH terms: "burnout" and "intensive care unit". Articles that were published in English between January 1996 and June 2016 were eligible for inclusion. Two reviewers evaluated the abstracts identified using our search criteria prior to full text review. To be included in the final analysis, studies were required to have employed an observational study design and examined the associations between any risk factors and burnout in the ICU setting. Overall, 203 full text articles were identified in the electronic databases after the exclusion of duplicate articles. After the initial review, 25 studies fulfilled the inclusion criteria. The prevalence of burnout in ICU professionals in the included studies ranged from 6% to 47%. The following factors were reported to be associated with burnout: age, sex, marital status, personality traits, work experience in an ICU, work environment, workload and shift work, ethical issues, and end-of-life decision-making. The impact of the identified factors on burnout remains poorly understood. Nevertheless, this review presents important information, suggesting that ICU professionals may suffer from a high level of burnout, potentially threatening patient care. Future work should address the effective management of the factors negatively affecting ICU professionals.
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Caplan, R L
1991-01-01
This paper is divided into three main parts. The first part describes chiropractic in the 1960s, 1970s and 1980s. While harassment by the medical profession largely characterized the 1960s, the health care environment of the 1970s was more favorable. However, during the 1980s, the spread of prospective payment schemes and the intensification of competition have largely hurt the development of chiropractic. All three possibilities: co-optation, subordination and nationalization are problematic as far as chiropractic is concerned. In light of these prospects, this paper makes four policy recommendations: research, education, alliance-building and politics (or REAP). The paper concludes with a brief discussion of each one.
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New, Karen; Bogossian, Fiona; East, Christine; Davies, Mark William
2010-06-01
The incubator environment is essential for optimal physiological functioning and development of the premature infant but the infant is ultimately required to make a successful transfer from incubator to open cot in order to be discharged from hospital. Criteria for transfer lack a systematic approach because no clear, specific guideline predominates in clinical practice. Practice variation exists between continents, regions and nurseries in the same countries, but there is no recent review of current practices utilised for transferring premature infants from incubators to open cots. To document current practice for transferring premature infants to open cots in neonatal nurseries. A descriptive, cross-sectional survey. Twenty-two neonatal intensive care units and fifty-six high dependency special care baby units located in public hospitals in Australia and New Zealand. A sample of 78 key clinical nursing leaders (nurse unit managers, clinical nurse consultants or clinical nurse specialists) within neonatal nurseries identified through email or telephone contact. Data were collected using a web-based survey on practice, decision-making and strategies utilised for transferring premature infants from incubators to open cots. Descriptive statistics (frequencies and crosstabs) were used to analyse data. Comparisons between groups were tested for statistical significance using Chi-squared or Fisher's exact test. Significant practice variation between countries was found for only one variable, nursing infants clothed (p=0.011). Processes and practices undertaken similarly in both countries include use of incubator air control mode, current weight criterion, thermal challenging, single-walled incubators and heated mattress systems. Practice variation was significant between neonatal intensive care units and special care baby units for weight range (p=0.005), evidence-based practice (p=0.004), historical nursery practice (p=0.029) and incubator air control mode (p=0.001). Differences in these variables were also found between nurseries in metropolitan and rural locations. Practice variation exists however; many practices are uniformly performed throughout neonatal nurseries in Australian and New Zealand. Commonality was seen between countries and in nurseries with a neonatal intensive care unit. Variation was significant between neonatal intensive care units and special care baby units and nurseries in metropolitan and rural locations. (c) 2009 Elsevier Ltd. All rights reserved.
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Lacher, Stefanie; De Geest, Sabina; Denhaerynck, Kris; Trede, Ines; Ausserhofer, Dietmar
2015-09-01
Anticipating nursing shortages, the Swiss healthcare system recently introduced the position of allied healthcare assistant (AHA). However, indicators of AHAs' integration and stability, particularly their perceptions of their work environment quality and related outcomes (i.e., burnout, job satisfaction, and intention to leave), remain unclear. (a) To describe AHAs' ratings of the quality of the nurse work environment, job satisfaction, burnout, and intention to leave their workplaces; (b) to compare AHAs' and registered nurses' (RNs') work environment quality ratings and related outcomes; and (c) to assess links between AHAs' work environment quality ratings and related workforce outcomes. A secondary analysis of RN4CAST data (October 2009 to June 2010) on 61 AHAs and 466 RNs in 13 Swiss acute care hospitals. We used descriptive statistics to summarize data of AHAs and RNs on their units and hospitals. Via binary logistic regression models, we compared AHAs and RNs and identified associations between work environment ratings and workforce outcomes. AHAs' work environment quality ratings were significantly higher than those of RNs, and were associated with lower odds of burnout and intention to leave their current job and higher odds of reported job satisfaction. This study provides primary evidence linking AHAs' work environment quality ratings to burnout, job satisfaction, and intention to leave in acute care hospitals. Given the increasing importance of AHAs for nursing care provision, hospitals should assess the quality of nurse work environment and nurse outcomes from the perspective of all nurses. © 2015 Sigma Theta Tau International.
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Aydon, Laurene; Hauck, Yvonne; Murdoch, Jamee; Siu, Daphne; Sharp, Mary
2018-01-01
To explore the experiences of parents with babies born between 28-32 weeks' gestation during transition through the neonatal intensive care unit and discharge to home. Following birth of a preterm baby, parents undergo a momentous journey through the neonatal intensive care unit prior to their arrival home. The complexity of the journey varies on the degree of prematurity and problems faced by each baby. The neonatal intensive care unit environment has many stressors and facilitating education to assist parents to feel ready for discharge can be challenging for all health professionals. Qualitative descriptive design. The project included two phases, pre- and postdischarge, to capture the experiences of 20 couples (40 parents), whilst their baby was a neonatal intensive care unit inpatient and then after discharge. Face-to-face interviews, an online survey and telephone interviews were employed to gather parent's experiences. Constant comparative analysis was used to identify commonalities between experiences. Recruitment and data collection occurred from October 2014-February 2015. Overlapping themes from both phases revealed three overarching concepts: effective parent staff communication; feeling informed and involved; and being prepared to go home. Our findings can be used to develop strategies to improve the neonatal intensive care unit stay and discharge experience for parents. Proposed strategies would be to improve information transfer, promote parental contact with the multidisciplinary team, encourage input from fathers to identify their needs and facilitate parental involvement according to individual needs within families. Providing information to parents during their time in hospital, in a consistent and timely manner is an essential component of their preparation when transitioning to home. © 2017 John Wiley & Sons Ltd.
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Intensive care window: real-time monitoring and analysis in the intensive care environment.
Stylianides, Nikolas; Dikaiakos, Marios D; Gjermundrød, Harald; Panayi, George; Kyprianou, Theodoros
2011-01-01
This paper introduces a novel, open-source middleware framework for communication with medical devices and an application using the middleware named intensive care window (ICW). The middleware enables communication with intensive care unit bedside-installed medical devices over standard and proprietary communication protocol stacks. The ICW application facilitates the acquisition of vital signs and physiological parameters exported from patient-attached medical devices and sensors. Moreover, ICW provides runtime and post-analysis procedures for data annotation, data visualization, data query, and analysis. The ICW application can be deployed as a stand-alone solution or in conjunction with existing clinical information systems providing a holistic solution to inpatient medical condition monitoring, early diagnosis, and prognosis.
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Marx, Katherine A; Stanley, Ian H; Van Haitsma, Kimberly; Moody, Jennifer; Alonzi, Dana; Hansen, Bryan R; Gitlin, Laura N
2014-12-01
Hospital clinical staff routinely confront challenging behaviors in patients with dementia with limited training in prevention and management. The authors of the current article conducted a survey of staff on a chronic care hospital unit concerning knowledge about dementia, perceived educational needs, and the care environment. The overall mean score for a 27-item knowledge scale was 24.08 (SD = 2.61), reflecting high level of disease knowledge. However, staff indicated a need for more information and skills, specifically for managing behaviors nonpharmacologically (92.3%), enhancing patient safety (89.7%), coping with care challenges (84.2%), and involving patients in activities (81.6%). Although most staff (i.e., nurses [80%] and therapists [86.4%]) believed their care contributed a great deal to patient well-being, approximately 75% reported frustration and being overwhelmed by dementia care. Most reported being hit, bitten, or physically hurt by patients (66.7%), as well as disrespected by families (53.8%). Findings suggest that staff have foundational knowledge but lack the "how-to" or hands-on skills necessary to implement nonpharmacological behavioral management approaches and communicate with families. Copyright 2014, SLACK Incorporated.
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Barriers to intensive care unit nurses' autonomy in Iran: A qualitative study.
AllahBakhshian, Maryam; Alimohammadi, Nasrollah; Taleghani, Fariba; Nik, Ahmadreza Yazdan; Abbasi, Saeed; Gholizadeh, Leila
The acute nature of the intensive care unit (ICU) environment necessitates that urgent clinical decisions are frequently made by the health care team. Therefore, it is important that critical care nurses have the authority to make decisions about their patient care. The purpose of this study was to explore perceived barriers to the practice of professional autonomy from the perspectives of ICU nurses in Iran. In this qualitative study, 28 critical care nurses were interviewed using a semistructured in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Data analysis led to identification of two main themes and five subthemes: (a) the profession-related barriers with two associated subthemes of "lack of capacity to exercise autonomy" and "lack of strong professional bodies"; (b) organizational barriers with the associated subthemes of "role ambiguity," "a directive rather than supportive workplace," and "lack of motivation." ICU nurses in Iran may face many challenges in gaining professional autonomy. The identified inter- and intraprofessional barriers to the exercise of autonomy need to be addressed to promote critical thinking, job satisfaction, and motivation of ICU nurses, which can in turn lead to improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.
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Recent advances in multidisciplinary critical care.
Blot, Stijn; Afonso, Elsa; Labeau, Sonia
2015-01-01
The intensive care unit is a work environment where superior dedication is crucial for optimizing patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the numerous research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovation in the field. This article broadly summarizes new developments in multidisciplinary intensive care. It provides elementary information about advanced insights in the field via brief descriptions of selected articles grouped by specific topics. Issues considered include care for heart patients, mechanical ventilation, delirium, nutrition, pressure ulcers, early mobility, infection prevention, transplantation and organ donation, care for caregivers, and family matters. ©2015 American Association of Critical-Care Nurses.
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[Radiology in managed care environment: opportunities for cost savings in an HMO].
Schmidt, C; Mohr, A; Möller, J; Levin-Scherz, J; Heller, M
2003-09-01
A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were docu-mented in Microsoft Excel(R) and analyzed by non-parametric tests using SPSS(R) 8.0 (Statistical Package for the Social Sciences) for Windows(R). The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. We identified initiatives with estimated potential savings of approximately $ 5.5 million. Some of these initiatives are similar to the reforms to reduce cost and improve quality that are already implemented or proposed within the German healthcare system.
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Yu, Yao; Yin, Sufeng; Kuan, Yi; Xu, Yingjun; Gao, Xuguang
2015-06-01
To describe the characteristics of airborne micro-organisms in the environment in a Chinese neurological intensive care unit (NICU). This prospective study monitored the air environment in two wards (large and small) of an NICU in a tertiary hospital in China for 12 months, using an LWC-1 centrifugal air sampler. Airborne micro-organisms were identified using standard microbiology techniques. The mean ± SD number of airborne bacteria was significantly higher in the large ward than in the small ward (200 ± 51 colony-forming units [CFU]/m(3) versus 110 ± 40 CFU/m(3), respectively). In the large ward only, the mean number of airborne bacteria in the autumn was significantly higher than in any of the other three seasons. A total of 279 airborne micro-organisms were identified (large ward: 195; small ward: 84). There was no significant difference in the type and distribution of airborne micro-organisms between the large and small wards. The majority of airborne micro-organisms were Gram-positive cocci in both wards. These findings suggest that the number of airborne micro-organisms was related to the number of patients on the NICU ward. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
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The effect of medical malpractice liability on rate of referrals received by specialist physicians.
Xu, Xiao; Spurr, Stephen J; Nan, Bin; Fendrick, A Mark
2013-10-01
Using nationally representative data from the United States, this paper analyzed the effect of a state’s medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state’s malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state’s medical malpractice environment on physicians’ referral behavior.
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Patient care in a biological safety level-4 (BSL-4) environment.
Marklund, LeRoy A
2003-06-01
The greatest threats to America's public health include accidental importation of deadly diseases by international travelers and the release of biologic weapons by our adversaries. The greatest failure is unpreparedness because international travel and dispersion of biologic agents by our enemies are inevitable. An effective medical defense program is the recommended deterrent against these threats. The United States has a federal response plan in place that includes patient care and patient transport by using the highest level of biologic containment: BSL-4. The DoD has the capability to provide intensive care for victims infected with highly infectious yet unknown biologic agents in an environment that protects the caregiver while allowing scientists to study the characteristics of these new agents and assess the effectiveness of treatment. Army critical care nurses are vital in the biologic medical defense against unidentified infectious diseases, accidental occupational exposures, or intentional dispersion of weaponized biologic agents. Research that carefully advances healthcare using BSL-4 technology addresses the challenges of the human element of BSL-4 containment patient care, and BSL-4 patient transport enhances our nation's ability to address the emerging biologic threats we confront in the future.
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Hinno, Saima; Partanen, Pirjo; Vehviläinen-Julkunen, Katri
2012-03-01
The working environment of nurses is receiving international interest, because there is a growing consensus that identifying opportunities for improving working conditions in hospitals is essential to maintain adequate staffing, high-quality care, nurses' job satisfaction and hence their retention. Thus, the aim of this study was to investigate the relationship between nurse work environment characteristics and nurse-reported job outcomes in hospital settings in Finland and the Netherlands and to compare these results. A comparative cross-sectional nurse survey was conducted. Data were collected from the two countries randomly sampling the countries' National Nurses Association' membership databases. In this paper, the results from Registered Nurses working in hospital settings are used. In total, 869 hospital nurses participated: 535 from Finland and 334 from the Netherlands with the response rate of 44.9 and 33.4%, respectively. Fifty-five items from the Nursing Work Index-Revised were used as a main tool for the practice environment. Exploratory factor analysis was used to identify a set of internally consistent subscales. Further, logistic regression analysis and T-tests were used. Three practice environment characteristics were identified: adequacy of resources, supportiveness of management and assurance of care quality via collaborative relationships. Favourable evaluations of the adequacy of resources and supportiveness of management were positively correlated with nurse-assessed quality of care and job-related positive feelings and negatively correlated with intentions to leave a unit, organization or the entire profession. In neither of the participating countries were adverse incidents affecting nurses related to nurses' evaluations of their current professional practice environment. Compared with Finland, in the Netherlands, RN appears to evaluate the majority of work environment characteristics more positively; nevertheless, to some extent, the results were uniform as adequacy of resources and supportiveness of management were main predictors for nurse-reported job outcomes considered. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.
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De Almeida Vicente, Alexandra; Shadvar, Sanaz; Lepage, Stephanie; Rennick, Janet E
2016-08-01
Experienced pediatric nurses caring for increasingly sick and vulnerable children on medical and surgical units may be at particular risk for work-related stress. In view of their positive impact on quality of care, and the fact that they are particularly difficult to retain, it is imperative to understand the work-related stressors these nurses encounter in order to develop effective organizational interventions to minimize stressors and promote retention. To explore experienced pediatric nurses' perceptions of work-related stressors in medical and surgical units. Qualitative descriptive design with semi-structured interviews. Medical and surgical units at a quaternary care pediatric hospital in Montreal, Canada. Nurses recognized as experienced by the nursing leadership team as reflected by having been 'in charge' of the unit, or having trained junior staff, and who had been practicing full-time for three years or more on a general medical or surgical pediatric unit were eligible to participate. Purposive sampling was used, and nurses recruited until data saturation was reached (n=12). There were no refusals to participate. Semi-structured interviews were conducted between August and December 2013. Nurses described a strong sense of responsibility for providing excellent patient care, and identified stressor that negatively impacted their ability to do so. Stressors are reflected in three themes: (1) "The kids are getting sicker and sicker": Difficulty ensuring excellent patient care to an increasingly vulnerable population, (2) Feeling powerless to provide quality care, and (3) Being a "Jack-of-all-trades": Struggling with competing demands. Experienced pediatric nurses felt powerless to provide quality care to an increasingly acute and vulnerable population. Dealing with multiple and diverse responsibilities, and limited resources and support, were important stressors. Nurse Managers and educators could mitigate stressors and improve retention of experienced pediatric nurses by offering targeted continuing education to those newly responsible for additional roles, and building supportive working environments that encourage collaboration and empower experienced nurses. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.
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Process Improvement to Enhance Quality in a Large Volume Labor and Birth Unit.
Bell, Ashley M; Bohannon, Jessica; Porthouse, Lisa; Thompson, Heather; Vago, Tony
The goal of the perinatal team at Mercy Hospital St. Louis is to provide a quality patient experience during labor and birth. After the move to a new labor and birth unit in 2013, the team recognized many of the routines and practices needed to be modified based on different demands. The Lean process was used to plan and implement required changes. This technique was chosen because it is based on feedback from clinicians, teamwork, strategizing, and immediate evaluation and implementation of common sense solutions. Through rapid improvement events, presence of leaders in the work environment, and daily huddles, team member engagement and communication were enhanced. The process allowed for team members to offer ideas, test these ideas, and evaluate results, all within a rapid time frame. For 9 months, frontline clinicians met monthly for a weeklong rapid improvement event to create better experiences for childbearing women and those who provide their care, using Lean concepts. At the end of each week, an implementation plan and metrics were developed to help ensure sustainment. The issues that were the focus of these process improvements included on-time initiation of scheduled cases such as induction of labor and cesarean birth, timely and efficient assessment and triage disposition, postanesthesia care and immediate newborn care completed within approximately 2 hours, transfer from the labor unit to the mother baby unit, and emergency transfers to the main operating room and intensive care unit. On-time case initiation for labor induction and cesarean birth improved, length of stay in obstetric triage decreased, postanesthesia recovery care was reorganized to be completed within the expected 2-hour standard time frame, and emergency transfers to the main hospital operating room and intensive care units were standardized and enhanced for efficiency and safety. Participants were pleased with the process improvements and quality outcomes. Working together as a team using the Lean process, frontline clinicians identified areas that needed improvement, developed and implemented successful strategies that addressed each gap, and enhanced the quality and safety of care for a large volume perinatal service.
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76 FR 62295 - Child Health Day, 2011
Federal Register 2010, 2011, 2012, 2013, 2014
2011-10-07
... Health Day, 2011 By the President of the United States of America A Proclamation One of the greatest responsibilities we have as a Nation is to ensure the health and well-being of our children. Today, we rededicate ourselves to providing our children with the quality health care, healthy food, clean environments, and safe...
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How to Show One-Fourth? Uncovering Hidden Context through Reciprocal Learning
ERIC Educational Resources Information Center
Abramovich, S.; Brouwer, P.
2007-01-01
This paper suggests that mathematics teacher educators should listen carefully to what their students are saying. More specifically, it demonstrates how from one pre-teacher's non-traditional geometric representation of a unit fraction, a variety of learning environments that lead to the enrichment of mathematics for teaching can be developed. The…
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Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units.
Kleinpell, Ruth; Barden, Connie; Rincon, Teresa; McCarthy, Mary; Zapatochny Rufo, Rebecca J
2016-01-01
Information on the impact of tele-intensive care on nursing and priority areas of nursing care is limited. To conduct a national benchmarking survey of nurses working in intensive care telemedicine facilities in the United States. In a 2-phased study, an online survey was used to assess nurses' perceptions of intensive care telemedicine, and a modified 2-round Delphi study was used to identify priority areas of nursing. In phase 1, most of the 1213 respondents agreed to strongly agreed that using tele-intensive care enables them to accomplish tasks more quickly (63%), improves collaboration (65.9%), improves job performance (63.6%) and communication (60.4%), is useful in nursing assessments (60%), and improves care by providing more time for patient care (45.6%). Benefits of tele-intensive care included ability to detect trends in vital signs, detect unstable physiological status, provide medical management, and enhance patient safety. Barriers included technical problems (audio and video), interruptions in care, perceptions of telemedicine as an interference, and attitudes of staff. In phase 2, 60 nurses ranked 15 priority areas of care, including critical thinking skills, intensive care experience, skillful communication, mutual respect, and management of emergency patient care. The findings can be used to further inform the development of competencies for tele-intensive care nursing, match the tele-intensive care nursing practice guidelines of the American Association of Critical-Care Nurses, and highlight concepts related to the association's standards for establishing and sustaining healthy work environments. ©2016 American Association of Critical-Care Nurses.
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Brauer, Sandra G; Fitzhenry, Sarah; Grimley, Rohan S; Hayward, Kathryn S
2017-01-01
Objective An enriched environment embedded in an acute stroke unit can increase activity levels of patients who had stroke, with changes sustained 6 months post-implementation. The objective of this study was to understand perceptions and experiences of nursing and allied health professionals involved in implementing an enriched environment in an acute stroke unit. Design A descriptive qualitative approach. Setting An acute stroke unit in a regional Australian hospital. Participants We purposively recruited three allied health and seven nursing professionals involved in the delivery of the enriched environment. Face-to-face, semistructured interviews were conducted 8 weeks post-completion of the enriched environment study. One independent researcher completed all interviews. Voice-recorded interviews were transcribed verbatim and analysed by three researchers using a thematic approach to identify main themes. Results Three themes were identified. First, staff perceived that ‘the road to recovery had started’ for patients. An enriched environment was described to shift the focus to recovery in the acute setting, which was experienced through increased patient activity, greater psychological well-being and empowering patients and families. Second, ‘it takes a team’ to successfully create an enriched environment. Integral to building the team were positive interdisciplinary team dynamics and education. The impact of the enriched environment on workload was diversely experienced by staff. Third, ‘keeping it going’ was perceived to be challenging. Staff reflected that changing work routines was difficult. Contextual factors such as a supportive physical environment and variety in individual enrichment opportunities were indicated to enhance implementation. Key to sustaining change was consistency in staff and use of change management strategies. Conclusion Investigating staff perceptions and experiences of an enrichment model in an acute stroke unit highlighted the need for effective teamwork. To facilitate staff in their new work practice, careful selection of change management strategies are critical to support clinical translation of an enriched environment. Trial registration number ANZCTN12614000679684; Results. PMID:29273658
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Barnas, Kim
2011-09-01
For 2003-2008, ThedaCare, a community health system in Wisconsin, achieved significant improvements in quality and the elimination of waste through the development of an improvement system, which included Value Stream analysis, rapid improvement events, and projects applied to specific processes. However, to meet its continuous daily improvement goals, particularly the goal of increasing productivity by 10% annually, ThedaCare needed to change the way its managers and leaders (in its hospital division) conduct and manage their daily work. Accordingly, it developed its Business Performance System (BPS) to achieve and sustain continuous daily improvement. BUILDING THE BPS: ThedaCare devised a multipart pilot project, consisting of "learning to see" and then, "problem solving." On completion of the 15-week alpha phase (6 units) in July 2009, the BPS was spread to the beta pilot (12 units; September 2009-January 2010) and then to cohort 3 (10 units; September 2010-January 2011). Each alpha unit improved performance on (1) the key driver metric of increasing productivity from 2008 to year-end 2009 (by 1%-11%) and (2) its respective safety/ quality drivers over the respective 2008 baselines. For 2010, improvements across the alpha, beta, and cohort 3 units were found for 11 of the 14 safety/quality drivers-85% of the 11 customer satisfaction drivers, 83% of 6 people engagement drivers; and 48% of 23 financial stewardship drivers. The tools developed for the BPS have enabled teams to see, prioritize, and pursue continuous daily improvement opportunities. Unit leaders now have a structured management reporting system to reduce variation in their management styles. Leaders all now follow leadership standard work, and their daily work is now consistently aligned with the hospital and system strategy.
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Vardaman, James M; Rogers, Bryan L; Marler, Laura E
2018-04-11
Because nurses are on the front lines of care delivery, they are subject to frequent changes to their work practices. This change-laden environment puts nurses at higher risk for turnover. Given the frequent disruption to the way nurses perform their jobs, change-related self-efficacy (CSE), or confidence that one can handle change, may be vital to their retention. The purpose of this article is to examine the roles of CSE and job embeddedness in reducing turnover intentions among nurses. Specifically, this article tests a model in which CSE is the intervening mechanism through which job embeddedness influences turnover intentions. Drawing on a sample of 207 nurses working in the medical/surgical unit of a major metropolitan hospital in the United States, this study employs OLS regression to test for direct effects of job embeddedness and CSE on turnover intentions and bias-corrected bootstrapping to test for the indirect effects of job embeddedness on turnover intentions through CSE. Results show that CSE is directly linked to turnover intentions, and the effects of job embeddedness on turnover intentions become fully manifest through CSE. Improved nurse retention may lead to stable patient care and less disruption in service delivery. Improved retention also benefits health care organizations financially, as costs of replacing a nurse can exceed 100% of the salary for the position. Given the shortage of nurses in some geographic areas, retention remains an important goal.
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Al-Samsam, Rim H; Cullen, Pauline
2005-09-01
To document the quantity and architecture of sleep using objective electrophysiologic assessment in sedated mechanically ventilated pediatric intensive care unit patients over a 24-hr period and to investigate the effect of noise and staff interventions on sleep pattern in these subjects. Prospective observational study. Pediatric intensive care unit at a university hospital. A total of 11 patients studied between September 2000 and June 2001, with ages ranging from 3 to 21 months. All patients were intubated, mechanically ventilated, and sedated with morphine and midazolam infusions. Limited sleep polysomnograph, staff interventions, and noise levels were continuously monitored during a 24-hr period. Noise levels were consistently >48 dB(A); the highest night peak reached 103 dB(A). Staff interventions lasted for a mean of 240 (SD 90) mins in a 24-hr period. There was no significant difference in the number of interventions between day and night. Severe alterations to sleep architecture were found throughout the 24 hrs, with no diurnal variations. Active sleep was severely reduced to a mean of 3% (SD 4%; range, 0-11%) of total sleep time. There was severe sleep fragmentation as reflected by the high number (mean, 40 [SD 20]) of wake episodes. The above findings suggest a significant electrophysiologic abnormality of sleep in the pediatric intensive care unit patients. Our pediatric intensive care unit environment is characterized by both, high noise levels and frequent staff interventions. This study has several limitations and future studies are needed, with larger sample size and an attempt to manipulate the environmental factors to minimize their negative effects on sleep.
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Professionalism, responsibility, and service in academic medicine.
Souba, W W
1996-01-01
Academic medical centers have responded to health care reform initiatives by launching a series of strategic plans designed to maintain patient flow and reduce hospital expenditures. Thought is also being given to processes by which the faculty can individually and collectively adjust to these changes and maintain morale at a time when reductions in the labor force and pay cuts are virtually certain. Physicians are concerned because managed care threatens their autonomy and jeopardizes the traditional ways in which they have carried out their multiple missions. Some doctors believe that it will become increasingly difficult to obtain genuine satisfaction from their job. The strategies that academic medical centers have begun to use to address the numerous challenges posed by a system of health care based on managed competition are reviewed. Potential mechanisms by which academic departments can continue to find fulfillment in an environment that threatens their traditional missions and values are discussed. A study of the social and historical origins of medicine in the United States reveals that the introduction of corporate medicine in the United States was destined to happen. Strategies implemented by academic medical centers in response to managed care include building an integrated delivery network, the acquisition of primary care practices, increasing cost-effectiveness, and creating physician-hospital organizations. Emphasis must be placed on integrating traditional core values (excellence, leadership, and innovation) with newer values such as patient focus, accountability, and diversity. A shift from rugged individualism to entrepreneurial teamwork is crucial. These reforms, although frightening at the onset, can serve to reaffirm our commitment to academic medicine and preserve our mission. The evolving managed care environment offers unique opportunities for academic medical centers to shape and positively impact health care delivery in the twenty-first century. In a reconfigured model that combines core values with newer values, university-based physicians can continue to reap the intangible rewards derived from patient care, research, and education.
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Noise level in a neonatal intensive care unit in Santa Marta - Colombia.
Garrido Galindo, Angélica Patricia; Camargo Caicedo, Yiniva; Velez-Pereira, Andres M
2017-09-30
The environment of neonatal intensive care units is influenced by numerous sources of noise emission, which contribute to raise the noise levels, and may cause hearing impairment and other physiological and psychological changes on the newborn, as well as problems with care staff. To evaluate the level and sources of noise in the neonatal intensive care unit. Sampled for 20 consecutive days every 60 seconds in A-weighting curves and fast mode with a Type I sound level meter. Recorded the average, maximum and minimum, and the 10th, 50th and 90th percentiles. The values are integrated into hours and work shift, and studied by analysis of variance. The sources were characterized in thirds of octaves. The average level was 64.00 ±3.62 dB(A), with maximum of 76.04 ±5.73 dB(A), minimum of 54.84 ±2.61dB(A), and background noise of 57.95 ±2.83 dB(A). We found four sources with levels between 16.8-63.3 dB(A). Statistical analysis showed significant differences between the hours and work shift, with higher values in the early hours of the day. The values presented exceed the standards suggested by several organizations. The sources identified and measured recorded high values in low frequencies.
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Staal, Jason A; Sacks, Amanda; Matheis, Robert; Collier, Lesley; Calia, Tina; Hanif, Henry; Kofman, Eugene S
2007-01-01
A randomized, controlled, single-blinded, between group study of 24 participants with moderate to severe dementia was conducted on a geriatric psychiatric unit. All participants received pharmacological therapy, occupational therapy, structured hospital environment, and were randomized to receive multi sensory behavior therapy (MSBT) or a structured activity session. Greater independence in activities of daily living (ADLs) was observed for the group treated with MSBT and standard psychiatric inpatient care on the Katz Index of Activities of Daily Living (KI-ADL; P = 0.05) than standard psychiatric inpatient care alone. The combination treatment of MSBT and standard psychiatric care also reduced agitation and apathy greater than standard psychiatric inpatient care alone as measured with the Pittsburgh Agitation Scale and the Scale for the Assessment of Negative Symptoms in Alzheimer's Disease (P = 0.05). Multiple regression analysis predicted that within the multi-sensory group, activities of daily living (KI-ADL) increased as apathy and agitation reduced (R2 = 0.42; p = 0.03). These data suggest that utilizing MSBT with standard psychiatric inpatient care may reduce apathy and agitation and additionally improve activities of daily living in hospitalized people with moderate to severe dementia more than standard care alone.
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Understanding safety culture in long-term care: a case study.
Halligan, Michelle H; Zecevic, Aleksandra; Kothari, Anita R; Salmoni, Alan W; Orchard, Treena
2014-12-01
This case study aimed to understand safety culture in a high-risk secured unit for cognitively impaired residents in a long-term care (LTC) facility. Specific objectives included the following: diagnosing the present level of safety culture maturity using the Patient Safety Culture Improvement Tool (PSCIT), examining the barriers to a positive safety culture, and identifying actions for improvement. A mixed methods design was used within a secured unit for cognitively impaired residents in a Canadian nonprofit LTC facility. Semistructured interviews, a focus group, and the Modified Stanford Patient Safety Culture Survey Instrument were used to explore this topic. Data were synthesized to situate safety maturity of the unit within the PSCIT adapted for LTC. Results indicated a reactive culture, where safety systems were piecemeal and developed only in response to adverse events and/or regulatory requirements. A punitive regulatory environment, inadequate resources, heavy workloads, poor interdisciplinary collaboration, and resident safety training capacity were major barriers to improving safety. This study highlights the importance of understanding a unit's safety culture and identifies the PSCIT as a useful framework for planning future improvements to safety culture maturity. Incorporating mixed methods in the study of health care safety culture provided a good model that can be recommended for future use in research and LTC practice.
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Dietz, I; Gerbershagen, K; Mielke, A; Pattberg, S; Pesch, E; Poels, M; Schmalz, O; Joppich, R
2012-09-01
Recently palliative care has become an integral and compulsory part of undergraduate medical training in Germany. From 2014 onwards every German medical faculty must have developed and implemented undergraduate teaching in this cross-disciplinary medical field and to conduct examinations. At Witten/Herdecke University (Germany) this new cross-sectional course in palliative care was taught for the first time in 2011. The film "Keep on the open road" was incorporated and the use of this film as part of compulsory palliative care education was evaluated from the student perspective. In two teaching units (1.5 h each) the film was watched with the students and discussed in the context of the palliative care setting with a special focus on psychosocial aspects. A semi-quantitative evaluation was performed after the debriefing. A total of 23 students participated in the course, 87 % (n = 20) evaluated the use of the film as unrestricted useful and 14 indicated a benefit from the film in terms of their medical attitude. Most of the students (n = 19, 83%) did not consider bed-side teaching to be more useful than the film unit. The free text answers underlined that primarily the multidisciplinary aspects of a palliative treatment situation and the meaning of a social environment were highlighted by the film. According to the evaluation of the students and the judgement of the participating teachers the use of the film is a suitable method to clarify complex medical, social and psychological aspects in palliative care. Especially at faculties with much larger numbers of students the film unit is thought to be a helpful method to teach psychosocial aspects and to promote development of attitude in palliative care. In future semesters further experience with the unit and the use of films in palliative care teaching will be collected.
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Van Bogaert, Peter; Kowalski, Christoph; Weeks, Susan Mace; Van Heusden, Danny; Clarke, Sean P
2013-12-01
To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community. Cross-sectional survey. Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N=1201) in two independent hospitals and one hospital group with six hospitals in Belgium. Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively. The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Community-Oriented Primary Care in Action: A Dallas Story
Pickens, Sue; Boumbulian, Paul; Anderson, Ron J.; Ross, Samuel; Phillips, Sharon
2002-01-01
Dallas County, Texas, is the site of the largest urban application of the community-oriented primary care (COPC) model in the United States. We summarize the development and implementation of Dallas’s Parkland Health & Hospital System COPC program. The complexities of implementing and managing this comprehensive community-based program are delineated in terms of Dallas County’s political environment and the components of COPC (assessment, prioritization, community collaboration, health care system, evaluation, and financing). Steps to be taken to ensure the future growth and development of the Dallas program are also considered. The COPC model, as implemented by Parkland, is replicable in other urban areas. PMID:12406794
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Nestor, M S
2000-09-01
Health care delivery in the United States has changed dramatically during the past 10 years. Dermatologists are faced with challenging changes in the way they learn new skills, practice, and provide dermatologic care. Dermatologists can survive and flourish in this environment if they learn proper management and enhancement skills. These skills include proper coding and documentation, regulatory compliance, and new levels of practice effectiveness and efficiency. Dermatologists can offer also the benefit of cosmetic procedures and ethical office-based dispensing to their patients. Greater future unification of this specialty will allow dermatology to flourish and show its need, efficiency, and cost-effectiveness.
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[Biosecurity and clinical care nursing: contributions for the promotion of worker's health].
Gallas, Samanta Rauber; Fontana, Rosane Teresinha
2010-01-01
Qualitative study that aimed at investigating concepts and practices of nursing technicians on biosecurity and its interface with biological hazards, with 20 workers developed a clinical care unit of a hospital in the interior of Rio Grande do Sul. Data were collected through interviews and systematic observation. Thematic analysis was the methodology used for data processing. The negligence of its employees on the use of individual protection equipment and work overload are risk factors for accidents with biological material. Suggested that partnerships between the actors involved in caring for the construction of healthy environments and accountability for negligence on biosecurity.
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Primary care training and the evolving healthcare system.
Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V
2012-01-01
With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. © 2012 Mount Sinai School of Medicine.
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Estabrooks, Carole A; Knopp-Sihota, Jennifer A; Cummings, Greta G; Norton, Peter G
2016-08-01
The success of evidence-based practice depends on clearly and effectively communicating often complex data to stakeholders. In our program of research, Translating Research in Elder Care (TREC), we focus on improving the quality and safety of care delivered to nursing home residents in western Canada. More specifically, we investigate associations among organizational context, the use of best practices and resident outcomes. Our data are complex and we have been challenged with presenting these data in a way that is not only intuitive, but also useful for our stakeholders. To illustrate a technique of organizing and presenting complex data to nonresearch stakeholders. Using observational data previously collected within the TREC study, we used k-means cluster analysis to categorize nursing home resident care units or facilities within our sample into two distinct groups-those with more favorable contexts (work environment) and those with less favorable contexts. We then produced scatter plots to illustrate group differences between context and various quality indicators among resident care units or facilities. Care aides working on units with more favorable context reported higher use of best practices. When aggregated at the nursing home facility level, facilities with low rates of both urinary tract infections and indwelling catheter use are higher in organizational context. When feeding back these results to stakeholders, we identify their units so that they are able to visually assess their units, both relative to each other and relative to all other units and facilities both within and among provinces. Although we have not formally evaluated this method, we have used it extensively as part of the feedback we provide to stakeholders. As we are examining modifiable aspects of context, the stakeholder can then identify areas for improvement and thus implement a focused plan. © 2016 Sigma Theta Tau International.
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Crow, Gregory L; Nguyen, Thanh; DeBourgh, Gregory A
2014-01-01
The Vietnam Nurse Project has been operating in Hanoi since 2007. Its primary purpose is to improve nursing education through curriculum development, faculty development, and the introduction of a more student-centric teaching and learning environment. The Virtual Nursing Grand Rounds component of the project is an academic-practice partnership between the Vietnam Nurse Project at the University of San Francisco School of Nursing and Health Professions and the Thanh Nhan Hospital intensive care unit. Its goal is to improve nursing practice in the Thanh Nhan Hospital intensive care unit. The Virtual Nursing Grand Rounds is a fully interactive real-time synchronous computer technology-assisted point-to-point program that provides ongoing evidence-based staff development and consultative services.
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Muck, Andrew E; Givens, Melissa; Bebarta, Vikhyat S; Mason, Phillip E; Goolsby, Craig
2018-05-01
Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully participated as an integrated part of the military's health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM) training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.
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Sadatsafavi, Hessam; Walewski, John; Shepley, Mardelle
2015-01-01
The expected increase in healthcare needs resulting from the Affordable Care Act and the growing population of older citizens in the United States is challenging owners and operators of hospitals to improve quality of care and reduce operational costs. Meanwhile, studies have indicated a serious shortage in the healthcare workforce and have highlighted the critical role of employees' job-related attitudes and feelings. The main objective of this study was to test whether employees' evaluations of important environments within hospitals were significantly associated with their job-related attitudes and feelings, and whether this relationship varied across different demographic groups. About 700 healthcare professionals from 10 acute-care hospitals run by three healthcare organizations participated in this cross-sectional study. Structural equation modeling found that employees' evaluations of their physical work environment were significantly associated with lower rates of job-related anxiety, higher levels of job satisfaction, and increased rates of organizational commitment. Perceived organizational support was responsible for mediating part of these relationships, indicating that employees can perceive a healthy work environment as a sign of their organization valuing them and caring about their well-being. When distinguishing between different spaces, analysis found that satisfaction with rest areas and work spaces had the largest effect size, while the influence of patient areas was small. Employees newer to the facility and to the organization were more influenced by the physical work environment. This study provides preliminary evidence that facility design can be used as a managerial tool for improving employees' job-related attitudes and feelings and earning their commitment.
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Ramos-Pascua, L R; Sánchez-Herráez, S; Casas-Ramos, P; Izquierdo-García, F J; Maderuelo-Fernández, J A
2014-01-01
To analyse the waiting periods elapsed since soft tissue sarcomas become symptomatic until their specific treatment in our unit, and to determine new strategies for the improvement of referral circuits. This is an ambispective observational study of a cohort of 61 patients, with previously untreated soft tissue sarcomas, obtained from our Musculoskeletal Tumors Database. Several variables related to the patient, tumour, and health care circuit were analysed, as well as the different periods between the initial symptoms of the disease and the first consultation in our unit. The significance level was α=0.05. The mean size of the sarcomas was 11.3 cm. Thirty-six patients (59%) followed the usual circuit of the National Health System in Spain. The time elapsed since the disease became symptomatic until the first medical consultation was greater than 9.5 months, and nearly another 8.5 months to the consultation in our specific unit. Statistically significant relationships were found between the independent and dependent variables. The study shows that the care of patients with soft tissue sarcomas in our environment is far away from the times of care in our neighbouring countries. It is essential to make the population and health professionals aware of this disease, as well as to remember that there is a referral circuit that must be used. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.
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Nursing intellectual capital theory: testing selected propositions.
Covell, Christine L; Sidani, Souraya
2013-11-01
To test the selected propositions of the middle-range theory of nursing intellectual capital. The nursing intellectual capital theory conceptualizes nursing knowledge's influence on patient and organizational outcomes. The theory proposes nursing human capital, nurses' knowledge, skills and experience, is related to the quality of patient care and nurse recruitment and retention of an inpatient care unit. Two factors in the work environment, nurse staffing and employer support for nurse continuing professional development, are proposed to influence nursing human capital's association with patient and organizational outcomes. A cross-sectional survey design. The study took place in 2008 in six Canadian acute care hospitals. Financial, human resource and risk data were collected from hospital departments and unit managers. Clearly specified empirical indicators quantified the study variables. The propositions of the theory were tested with data from 91 inpatient care units using structural equation modelling. The propositions associated with the nursing human capital concept were supported. The propositions associated with the employer support for nurse continuing professional development concept were not. The proposition that nurse staffing's influences on patient outcomes was mediated by the nursing human capital of an inpatient unit, was partially supported. Some of the theory's propositions were empirically validated. Additional theoretical work is needed to refine the operationalization and measurement of some of the theory's concepts. Further research with larger samples of data from different geographical settings and types of hospitals is required to determine if the theory can withstand empirical scrutiny. © 2013 Blackwell Publishing Ltd.
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Development and psychometric evaluation of supportive leadership scales.
McGilton, Katherine S
2003-12-01
The purpose of this study was to develop and evaluate the psychometric properties of 2 supportive leadership scales, the Charge Nurse Support Scale and the Unit Manager Support Scale, designed for long-term-care environments. These 6-item self-report scales were administered to 70 nursing staff and their internal consistency reliability, test-retest reliability, content validity, factor structure, and construct validity investigated. Content validity was established with the assistance of experts. Both scales were deemed reliable. As hypothesized, a significant relationship was found between the measure of how nursing staff related to residents and measures of charge nurses' supportive behaviours (r = .42, p = .05). Reliable and valid measures of supportive leadership could be developed for use in identifying the quality of support provided to staff in long-term-care environments.
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Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review.
Williamson, Heather J; Contreras, Graciela M; Rodriguez, Erica S; Smith, Jennifer M; Perkins, Elizabeth A
2017-10-01
Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.
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Linking patient satisfaction with nursing care: the case of care rationing - a correlational study.
Papastavrou, Evridiki; Andreou, Panayiota; Tsangari, Haritini; Merkouris, Anastasios
2014-01-01
Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses' perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were: a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses' perceptions of their practice environment while adjusting for patient and nurse characteristics. b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels. A descriptive, correlational design was employed. Participants in this study included 352 patients and 318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were used: the BERNCA scale for rationing of care, the RPPE scale to explore nurses' perceptions of their work environment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The statistical analysis included the use of Kendall's correlation coefficient to explore a possible relationship between the variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together with organizational characteristics on patient satisfaction. The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0-3), the overall mean of RPPE was 2.76 (SD = 0.32, range = 1.28 - 3.69) and the two scales were significantly correlated (τ = -0.234, p < 0.001). The regression analysis showed that care rationing and work environment were related to patient satisfaction, even after controlling for nurse and patient characteristics. The results from the adjusted regression models showed that even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction. The results support the relationships between organizational and environmental variables, care rationing and patient satisfaction. The identification of thresholds at which rationing starts to influence patient outcomes in a negative way may allow nurse managers to introduce interventions so as to keep rationing at a level at which patient safety is not jeopardized.
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ERIC Educational Resources Information Center
Priano, Staci J.
2017-01-01
With the largest incarcerated population in the world, the United States has an urgent but unmet need for a correctional nurse workforce that is prepared with effective, evidence-based (EBP) care-strategies especially focused towards violence and sexual abuse mitigation. Standardized, proactive orientation and education processes within the world…
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3Ts--Training, Testing, and Telling: A Guide for Community Partners
ERIC Educational Resources Information Center
US Environmental Protection Agency, 2006
2006-01-01
The United States Environmental Protection Agency (EPA) wants to ensure schools and child care facilities are safe environments for the nation's children. In response to rising public concern over the health risks posed to young children by lead in the drinking water, EPA is launching a "3Ts--Training, Testing, and Telling" program. This…
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Defining Eligibility Criteria for Preventive Early Intervention in an NICU Population.
ERIC Educational Resources Information Center
O'Brien, Marion; Rice, Mabel; Roy, Carolyn
1996-01-01
This study evaluated the usefulness of perinatal medical status, environmental risk, and infant developmental status as predictors of low IQ at age 4 among 70 4-year-olds who had been in a neonatal intensive care unit at birth. It found family environment the most predictive, 18-month developmental assessments somewhat useful, and perinatal health…
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Cultivating a Culture of Awareness: Nurturing Reflective Practices in the NICU
ERIC Educational Resources Information Center
Steinberg, Zina; Kraemer, Susan
2010-01-01
The authors describe the challenges to nurturing reflective practices in a neonatal intensive care unit (NICU)--an environment in which life and death hang in fragile balance and where the need to defend against unbearable realities is natural, even an adaptive response. Working as consultants to this acute setting, the authors describe how they…
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International exchange program: findings from Taiwanese graduate nursing students.
Shieh, Carol
2004-01-01
This study explored Taiwanese graduate nursing students' transcultural experiences in the United States during an international exchange program. A qualitative method with content analysis was used to analyze journal entries on perceptions of American culture, American nursing, and reflections on personal and professional growth written by nine graduate nursing students from Taiwan. The mean age of the participants was 32 (range, 29-45). Taiwanese nursing students perceived American culture as full of hospitality and patriotism, valuing human rights and social welfare, and favoring direct and expressive affection. American nursing was viewed as a combination of independence, confidence, autonomy, and knowledge, with caring being the core element, fostered by an environment conducive to patient care. In personal and professional growth, three themes surfaced: reinforcement of holistic care, nursing without borders, and lifelong learning and changing. American culture and nursing were perceived by Taiwanese students as a paradigm of Western culture valuing individual rights, autonomy, and independence. A caring and supportive patient care environment was a positive perception of American nursing; it was the desired practice standard that was lacking in these students' homeland. Overall, the exchange program was thought by these students to foster their personal and professional growth.
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Orchestrating care: nursing practice with hospitalised older adults.
Dahlke, Sherry Ann; Phinney, Alison; Hall, Wendy Ann; Rodney, Patricia; Baumbusch, Jennifer
2015-12-01
The increased incidence of health challenges with aging means that nurses are increasingly caring for older adults, often in hospital settings. Research about the complexity of nursing practice with this population remains limited. To seek an explanation of nursing practice with hospitalised older adults. Design. A grounded theory study guided by symbolic interactionism was used to explore nursing practice with hospitalised older adults from a nursing perspective. Glaserian grounded theory methods were used to develop a mid-range theory after analysis of 375 hours of participant observation, 35 interviews with 24 participants and review of selected documents. The theory of orchestrating care was developed to explain how nurses are continuously trying to manage their work environments by understanding the status of the patients, their unit, mobilising the assistance of others and stretching available resources to resolve their problem of providing their older patients with what they perceived as 'good care' while sustaining themselves as 'good' nurses. They described their practice environments as hard and under-resourced. Orchestrating care is comprised of two subprocesses: building synergy and minimising strain. These two processes both facilitated and constrained each other and nurses' abilities to orchestrate care. Although system issues presented serious constraints to nursing practice, the ways in which nurses were making meaning of their work environment both aided them in managing their challenges and constrained their agency. Nurses need to be encouraged to share their important perspective about older adult care. Administrators have a role to play in giving nurses voice in workplace committees and in forums. Further research is needed to better understand how multidisciplinary teams influence care of hospitalized older adults. © 2014 John Wiley & Sons Ltd.
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Kardaş Özdemir, Funda; Küçük Alemdar, Dilek
2017-05-01
It is known that fathers whose infants are hospitalized in NICUs (Neonatal Intensive Care Units) are severely stressed. This study was conducted for the purpose of determining the effect of supporting and visiting infants in NICUs on stress levels of Turkish fathers. This was a pretest-posttest quasi-experimental study. The population of the study consisted of 47 fathers who had their infants receiving treatment in NICU at a state hospital in the eastern Turkey and agreed to participate in the study. The data were collected by using "Father-Infant Introductory Information Form" and "Parental Stressor Scale: Neonatal Intensive Care Unit, PSS:NICU". When comparing the PSS:NICU total mean scores of the fathers before and after interventions; it was determined that their mean scores were higher before visits compared to those obtained after interventions and the difference between them was significant at advanced level. It was found that the fathers visiting and supporting their infants in NICUs had the decreased stress levels. It is a useful nursing intervention to support fathers to visit their babies in NICUs and establish environments where they could spend time with their babies.
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2016-01-01
Background Workplace environment is related to the physical and psychological well-being, and quality of work life (QWL) for nurses. Objective The aim of this paper was to perform a comprehensive literature review on nurses’ quality of work life to identify a comprehensive set of QWL predictors for nurses employed in the United States and Canada. Methods Using publications from 2004–2014, contributing factors to American and Canadian nurses’ QWL were analyzed. The review was structured using the Work Disability Prevention Framework. Sixty-six articles were selected for analysis. Results Literature indicated that changes are required within the workplace and across the health care system to improve nurses' QWL. Areas for improvement to nurses’ quality of work life included treatment of new nursing graduates, opportunities for continuing education, promotion of positive collegial relationships, stress-reduction programs, and increased financial compensation. Conclusions This review’s findings support the importance of QWL as an indicator of nurses’ broader work-related experiences. A shift in health care systems across Canada and the United States is warranted where health care delivery and services are improved in conjunction with the health of the nurses working in the system. PMID:27734769
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Nowrouzi, Behdin; Giddens, Emilia; Gohar, Basem; Schoenenberger, Sandrine; Bautista, Mary Christine; Casole, Jennifer
2016-10-01
Workplace environment is related to the physical and psychological well-being, and quality of work life (QWL) for nurses. The aim of this paper was to perform a comprehensive literature review on nurses' quality of work life to identify a comprehensive set of QWL predictors for nurses employed in the United States and Canada. Using publications from 2004-2014, contributing factors to American and Canadian nurses' QWL were analyzed. The review was structured using the Work Disability Prevention Framework. Sixty-six articles were selected for analysis. Literature indicated that changes are required within the workplace and across the health care system to improve nurses' QWL. Areas for improvement to nurses' quality of work life included treatment of new nursing graduates, opportunities for continuing education, promotion of positive collegial relationships, stress-reduction programs, and increased financial compensation. This review's findings support the importance of QWL as an indicator of nurses' broader work-related experiences. A shift in health care systems across Canada and the United States is warranted where health care delivery and services are improved in conjunction with the health of the nurses working in the system.
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Nickerson, Jason W
2015-01-01
There is an emerging demand for complex continuing care for patients who are too ill to safely return home, but for whom hospitalization in an acute care environment is unnecessary or inappropriate. Despite the need and medical complexity of these patients, few respiratory therapists are practising in this environment, and little evidence exists to guide the implementation of respiratory therapy services in this setting. In response to a perceived need for greater respiratory services at Saint Vincent Hospital (Ottawa, Ontario), a needs assessment was undertaken to assess the prevalence of respiratory diseases and for increased respiratory therapist coverage at this complex continuing care hospital. An initial literature review was conducted to guide the assessment, and identified only one tool of relevance, which was obtained and formed the basis of the further development of tools for collecting data at the hospital level and on patient care units at the facility. This needs assessment tool was expanded to include priority areas of relevance that fall within the scope of practice of respiratory therapists, and was supplemented by the analysis of administrative databases and qualitative data gathered through unit walkthroughs and unstructured key informant interviews. A health systems framework was used to structure recommendations for the development of interventions and programs for this patient population. The burden of respiratory disease was significant, and included a high prevalence of inhaled medication and oxygen use, and a significant workload that could be attributed to addressing the respiratory needs of patients. A range of tools and methods are needed to conduct needs assessments for respiratory therapy in complex continuing care. Using multiple data sources, a significant burden of respiratory diseases was present at the Saint Vincent Hospital; further studies in other complex continuing care hospitals are needed to understand the significance of these findings among this patient population more generally.
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Patients' experiences of technology and care in adult intensive care.
Stayt, Louise Caroline; Seers, Kate; Tutton, Elizabeth
2015-09-01
To investigate patients' experiences of technology in an adult intensive care unit. Technology is fundamental to support physical recovery from critical illness in Intensive Care Units. As well as physical corollaries, psychological disturbances are reported in critically ill patients at all stages of their illness and recovery. Nurses play a key role in the physical and psychological care of patients;, however, there is a suggestion in the literature that the presence of technology may dehumanise patient care and distract the nurse from attending to patients psychosocial needs. Little attention has been paid to patients' perceptions of receiving care in a technological environment. This study was informed by Heideggerian phenomenology. The research took place in 2009-2011 in a university hospital in England. Nineteen participants who had been patients in ICU were interviewed guided by an interview topic prompt list. Interviews were transcribed verbatim and analysed using Van Manen's framework. Participants described technology and care as inseparable and presented their experiences as a unified encounter. The theme 'Getting on with it' described how participants endured technology by 'Being Good' and 'Being Invisible'. 'Getting over it' described why participants endured technology by 'Bowing to Authority' and viewing invasive technologies as a 'Necessary Evil'. Patients experienced technology and care as a series of paradoxical relationships: alienating yet reassuring, uncomfortable yet comforting, impersonal yet personal. By maintaining a close and supportive presence and providing personal comfort and care nurses may minimize the invasive and isolating potential of technology. © 2015 John Wiley & Sons Ltd.
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Edkins, Renee E; Cairns, Bruce A; Hultman, C Scott
2014-03-01
Accreditation Council for Graduate Medical Education mandated work-hour restrictions have negatively impacted many areas of clinical care, including management of burn patients, who require intensive monitoring, resuscitation, and procedural interventions. As surgery residents become less available to meet service needs, new models integrating advanced practice providers (APPs) into the burn team must emerge. We performed a systematic review of APPs in critical care questioning, how best to use all providers to solve these workforce challenges? We performed a systematic review of PubMed, CINAHL, Ovid, and Google Scholar, from 2002 to 2012, using the key words: nurse practitioner, physician assistant, critical care, and burn care. After applying inclusion/exclusion criteria, 18 relevant articles were selected for review. In addition, throughput and financial models were developed to examine provider staffing patterns. Advanced practice providers in critical care settings function in various models, both with and without residents, reporting to either an intensivist or an attending physician. When APPs participated, patient outcomes were similar or improved compared across provider models. Several studies reported considerable cost-savings due to decrease length of stay, decreased ventilator days, and fewer urinary tract infections when nurse practitioners were included in the provider mix. Restrictions in resident work-hours and changing health care environments require that new provider models be created for acute burn care. This article reviews current utilization of APPs in critical care units and proposes a new provider model for burn centers.
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Diagnosis and management of tetanus outside the intensive care unit: a case report
NASA Astrophysics Data System (ADS)
Bravo, T. E.; Siregar, M. L.; Jamil, K. F.
2018-03-01
Tetanus is an acute, toxin-mediated disease caused by Clostridium tetani infection. Under favorable anaerobic conditions, such as in the unclean environment, necrotic wounds, this ubiquitous bacillus may produce tetanospasmin, an extremely potent neurotoxin. A 38-year-old man was admitted to an emergency room, at Zainoel Abidin General Hospital, with the main complaint of back-muscle stiffness. Based on physical examination, he was fully alert with a slightly rapid breathing, trismus with the maximum oral cavity opening was only about one finger width, but rhisus sardonicus was not evident. Ten days before admission, while gardening, his left foot accidentally stabbed by wooden tree stake. We immediately started a single dose of tetanus immunoglobulin followed by intravenous metronidazole, penicillin G, and intravenous diazepam. Tetanus diagnosed by physical clinical finding. The management of tetanus patients including the use of immunoglobulin and antibiotic therapy, analgesia, sedation and neuromuscular blockade management and mechanical ventilation, the care was delivered outside the Intensive care unit.
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The carbon footprint of acute care: how energy intensive is critical care?
Pollard, A S; Paddle, J J; Taylor, T J; Tillyard, A
2014-09-01
Climate change has the potential to threaten human health and the environment. Managers in healthcare systems face significant challenges to balance carbon mitigation targets with operational decisions about patient care. Critical care units are major users of energy and hence more evidence is needed on their carbon footprint. The authors explore a methodology which estimates electricity use and associated carbon emissions within a Critical Care Unit (CCU). A bottom-up model was developed and calibrated which predicted the electricity consumed and carbon emissions within a CCU based on the type of patients treated and working practices in a case study in Cornwall, UK. The model developed was able to predict the electricity consumed within CCU with an error of 1% when measured against actual meter readings. Just under half the electricity within CCU was used for delivering care to patients and monitoring their condition. A model was developed which accurately predicted the electricity consumed within a CCU based on patient types, medical devices used and working practice. The model could be adapted to enable it to be used within hospitals as part of their planning to meet carbon reduction targets. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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Authentic leadership and nurses' voice behaviour and perceptions of care quality.
Wong, Carol A; Spence Laschinger, Heather K; Cummings, Greta G
2010-11-01
The purpose of the present study was to test a theoretical model linking authentic leadership with staff nurses' trust in their manager, work engagement, voice behaviour and perceived unit care quality. Authentic leadership is a guide for effective leadership needed to build trust and healthier work environments because there is special attention given to honesty, integrity and high ethical standards in the development of leader-follower relationships. A non-experimental, predictive survey design was used to test the hypothesized model in a random sample of 280 (48% response rate) registered nurses working in acute care hospitals in Ontario. The final model fitted the data acceptably (χ(2)=17.24, d.f.=11, P=0.10, IFI=0.99, CFI=0.99, RMSEA=0.045). Authentic leadership significantly and positively influenced staff nurses' trust in their manager and work engagement which in turn predicted voice behaviour and perceived unit care quality. These findings suggest that authentic leadership and trust in the manager play a role in fostering trust, work engagement, voice behaviour and perceived quality of care. Nursing leaders can improve care quality and workplace conditions by paying attention to facilitating genuine and positive relationships with their staff. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.
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Kuhn, Pierre; Astruc, Dominique; Messer, Jean; Marlier, Luc
2011-03-01
To assess the main determinants of the newborn's nosocomial olfactory environment. An electronic questionnaire was sent to 99 neonatal units in France. Senior nurses and/or physicians described the nature and use of skin care products (e.g. umbilical cord and skin disinfectants, adhesive removers), lubrications used for tubes positioning, disinfectants used to clean materials, hand hygiene products (e.g. alcohol-based hand rubs, soaps) and newborns' bath. Nine groups of products and 76 distinct commercial preparations were identified. Depending on their level of respiratory support, preterm newborns were estimated to be exposed to nosocomial odours (NO) an average of 1320-1800 times during their first month of life. During their whole hospital stay, newborns of 28 and 32 weeks of gestational age could be exposed to NOs products an average of 3448 and 2024 times, respectively. The use of these products varied among medical centres. Newborns were most frequently exposed to the odour of aqueous alcoholic solutions. Vulnerable preterm infants are daily exposed to multiple NOs most of them be considered as irritant for the nose. Minimizing infants' exposure to them would be beneficial. Future studies should describe the exact olfactory properties of the products considered essential for infant care and should assess their effects on the infant's well-being and development. © 2010 The Author(s)/Acta Paediatrica © 2010 Foundation Acta Paediatrica.
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Parra, Johanna; de Suremain, Aurelie; Berne Audeoud, Frederique; Ego, Anne; Debillon, Thierry
2017-12-01
This study measured sound levels in a 2008 built French neonatal intensive care unit (NICU) and compared them to the 2007 American Academy of Pediatrics (AAP) recommendations. The ultimate aim was to identify factors that could influence noise levels. The study measured sound in 17 single or double rooms in the NICU. Two dosimeters were installed in each room, one inside and one outside the incubators, and these conducted measurements over a 24-hour period. The noise metrics measured were the equivalent continuous sound level (L eq ), the maximum noise level (L max ) and the noise level exceeded for 10% of the measurement period (L 10 ). The mean L eq , L 10 and L max were 60.4, 62.1 and 89.1 decibels (dBA), which exceeded the recommended levels of 45, 50 and 65 dBA (p < 0.001), respectively. The L eq inside the incubator was significantly higher than in the room (+8 dBA, p < 0.001). None of the newborns' characteristics, the environment or medical care was correlated to an increased noise level, except for a postconceptional age below 32 weeks. The sound levels significantly exceeded the AAP recommendations, particularly inside incubators. A multipronged strategy is required to improve the sound environment and protect the neonates' sensory development. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
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Patients' and Health Care Providers' Perception of Stressors in the Intensive Care Units.
Abuatiq, Alham
2015-01-01
The purposes of this study is first, to investigate intensive care patients' perceptions of stressors; second, to investigate the health care provider's perception of what constitutes a stressor from the patient's perspective; and third, to describe how health care providers manage their patients' stressors. This was a mixed-methods study; the quantitative section replicated Cornock's 1998 study of stress in the intensive care unit (ICU), with difference in sampling to include all health care providers in the ICU, in addition to nurses. The qualitative section added information to the current literature by describing how health care providers manage their patient's stressors. This article reports the quantitative findings of this study, as the qualitative section is presented in a separate article. It is important to describe ICU patients' stressful experiences to assess patient's stressors, provide holistic care to eliminate stressors, and provide feedback to health care providers. There is a need to describe the clinical practice related to stress perception and management of stressors in the critical care environment. A mixed-methods comparative descriptive design was used for the quantitative section, and a phenomenological approach guided the qualitative section. Lazarus and Folkman's theory formed the bases for integrating all variables investigated in this study. The sample included 70 ICU patients and 70 ICU health care providers. After consenting to participate in this study, subjects were given a demographic form and a paper-based tool, the Environmental Stressors graphic data form Questionnaire. Questionnaires were filled out by subjects anonymously in the ICU and returned to the researcher in the same setting. Descriptive statistics were analyzed using SPSS data analysis software. The top 3 most stressful items ranked by the patients included "being in pain," followed by "not being able to sleep" and "financial worries"; on the other hand, health care providers perceived "being in pain" followed by "not being able to communicate" and "not being in control of yourself" as the top 3 stressors perceived by their patients. The findings of this study are crucial and may inform nursing assessments and care of the ICU patient. In addition, this information may encourage the ICU staff to manipulate and redesign the ICU environment to be less stressful. Also, the findings of this study guided the development of an ICU stressor control policy.
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Zielstorff, R D; Estey, G; Vickery, A; Hamilton, G; Fitzmaurice, J B; Barnett, G O
1997-01-01
A decision support system for prevention and management of pressure ulcers was developed based on AHCPR guidelines and other sources. The system was implemented for 21 weeks on a 20-bed clinical care unit. Fifteen nurses on that unit volunteered as subjects of the intervention to see whether use of the system would have a positive effect on their knowledge about pressure ulcers and on their decision-making skills related to this topic. A similar care unit was used as a control. In addition, the system was evaluated by experts for its instructional adequacy, and by end users for their satisfaction with the system. Preliminary results show no effect on knowledge about pressure ulcers and no effect on clinical decision making skills. The system was rated positively for instructional adequacy, and positively for user satisfaction. User interviews related to satisfaction supplemented the quantitative findings. A discussion of the issues of conducting experiments like this in today's clinical environment is included.
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Chatot-Henry, Didier; Chatot-Henry, Carole; Courcier, Dominique
2014-01-01
The financial difficulties encountered by Martinique hospitals has led to restructuring of the territory's medical project with the merger of three healthcare facilities. These new constraints impacting the work environment with organizational consequences in services. A management experiment was attempted in a geriatric day care hospital based on the use of health promotion concepts. After an overview of the unit's activity based on the perceptions of staff, patients and private physicians, a one-day research-action structural seminar was organized. Group dynamics, unit functioning, shared values, success factors, and improvement strategies were discussed. This seminar resulted in the development of a business model based on five values (respect, professionalism, cohesion, empathy, communication). Three operational working groups were established to implement the conclusions of the seminar in the unit. This experiment focused on an alternative approach to the management of small health care services by the use of health promotion.
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Twenty years of a multidisciplinary paediatric diabetes home care unit
McEvilly, A; Kirk, J
2005-01-01
As only a minority of patients with type 1 diabetes are unwell at diagnosis, these patients could be managed at home if appropriate facilities were available. A multidisciplinary diabetes home care service was established over 20 years ago at Birmingham Children's Hospital, to support children with diabetes mellitus within the home environment from diagnosis, reducing emotional upset and separation. Despite increase in the size and distribution of the unit over this time (from 230 to 400 patients (now spread over two hospitals)), the proportion of newly diagnosed children managed wholly at home (median 43%; range 31–67%), and the reduction in number and duration of admissions has been sustained (readmission rate with diabetic ketoacidosis 4.1 bed-days per 100 patients/year; range 2.9–7.1), with no deterioration in overall blood glucose control. In this way the savings achieved by reductions in expensive hospital bed occupancy have more than offset the costs of maintaining the unit. PMID:15781919
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Domanico, R; Davis, D K; Coleman, F; Davis, B O
2010-01-01
Objective: With neonatal intensive care units (NICUs) evolving from multipatient wards toward family-friendly, single-family room units, the study objective was to compare satisfaction levels of families and health-care staff across these differing NICU facility designs. Study Design: This prospective study documented, by means of institutional review board-approved questionnaire survey protocols, the perceptions of parents and staff from two contrasting NICU environments. Result: Findings showed that demographic subgroups of parents and staff perceived the advantages and disadvantages of the two facility designs differently. Staff perceptions varied with previous experience, acclimation time and employment position, whereas parental perceptions revealed a naiveté bias through surveys of transitional parents with experience in both NICU facilities. Conclusion: Use of transitional parent surveys showed a subject naiveté bias inherent in perceptions of inexperienced parents. Grouping all survey participants demographically provided more informative interpretations of data, and revealed staff perceptions to vary with position, previous training and hospital experience. PMID:20072132
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Hesse, Bradford W; Hanna, Christopher; Massett, Holly A; Hesse, Nicola K
2010-01-01
The use of health information technology (IT) to resolve the crisis in communication inherent within the fragmented service environment of medical care in the United States is a strategic priority for the Department of Health and Human Services. Yet the deployment of health IT alone is not sufficient to improve quality in health service delivery; what is needed is a human factors approach designed to optimize the balance between health-care users, health-care providers, policies, procedures, and technologies. An evaluation of interface issues between primary and specialist care related to cancer reveals opportunities for human factors improvement along the cancer care continuum. Applications that emphasize cognitive support for prevention recommendations and that encourage patient engagement can help create a coordinated health-care environment conducive to cancer prevention and early detection. An emphasis on reliability, transparency, and accountability can help improve the coordination of activities among multiple service providers during diagnosis and treatment. A switch in emphasis from a transaction-based approach to one emphasizing long-term support for healing relationships should help improve patient outcomes during cancer survivorship and end-of-life care. Across the entire continuum of care, an emphasis on "meaningful use" of health IT-rather than on IT as an endpoint-should help put cancer on a path toward substantive continuous quality improvement. The accompanying research questions will focus on reducing the variance between the social and technical subsystems as IT is used to improve patient outcomes across the interfaces of care.
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A delicate subject: The impact of cultural factors on neonatal and perinatal decision making.
Van McCrary, S; Green, H C; Combs, A; Mintzer, J P; Quirk, J G
2014-01-01
The neonatal intensive care unit (NICU) is a high-stress environment for both families and health care providers that can sometimes make appropriate medical decisions challenging. We present a review article of non-medical barriers to effective decision making in the NICU, including: miscommunication, mixed messages, denial, comparative social and cultural influences, and the possible influence of perceived legal issues and family reliance on information from the Internet. As examples of these barriers, we describe and discuss two cases that occurred simultaneously in the same NICU where decisions were influenced by social and cultural differences that were misunderstood by both medical staff and patients' families. The resulting stress and emotional discomfort created an environment with sub-optimal relationships between patients' families and health care providers. We provide background on the sources of conflict in these particular cases. We also offer suggestions for possible amelioration of similar conflicts with the twin goals of facilitating compassionate decision making in NICU settings and promoting enhanced well-being of both families and providers.
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Vaaler, Arne E; Iversen, Valentina C; Morken, Gunnar; Fløvig, John C; Palmstierna, Tom; Linaker, Olav M
2011-03-18
The aims of the present study were to investigate clinically relevant patient and environment-related predictive factors for threats and violent incidents the first three days in a PICU population based on evaluations done at admittance. In 2000 and 2001 all 118 consecutive patients were assessed at admittance to a Psychiatric Intensive Care Unit (PICU). Patient-related conditions as actuarial data from present admission, global clinical evaluations by physician at admittance and clinical nurses first day, a single rating with an observer rated scale scoring behaviours that predict short-term violence in psychiatric inpatients (The Brøset Violence Checklist (BVC)) at admittance, and environment-related conditions as use of segregation or not were related to the outcome measure Staff Observation Aggression Scale-Revised (SOAS-R). A multiple logistic regression analysis with SOAS-R as outcome variable was performed. The global clinical evaluations and the BVC were effective and more suitable than actuarial data in predicting short-term aggression. The use of segregation reduced the number of SOAS-R incidents. In a naturalistic group of patients in a PICU segregation of patients lowers the number of aggressive and threatening incidents. Prediction should be based on clinical global judgment, and instruments designed to predict short-term aggression in psychiatric inpatients. NCT00184119/NCT00184132.
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2011-01-01
Background The aims of the present study were to investigate clinically relevant patient and environment-related predictive factors for threats and violent incidents the first three days in a PICU population based on evaluations done at admittance. Methods In 2000 and 2001 all 118 consecutive patients were assessed at admittance to a Psychiatric Intensive Care Unit (PICU). Patient-related conditions as actuarial data from present admission, global clinical evaluations by physician at admittance and clinical nurses first day, a single rating with an observer rated scale scoring behaviours that predict short-term violence in psychiatric inpatients (The Brøset Violence Checklist (BVC)) at admittance, and environment-related conditions as use of segregation or not were related to the outcome measure Staff Observation Aggression Scale-Revised (SOAS-R). A multiple logistic regression analysis with SOAS-R as outcome variable was performed. Results The global clinical evaluations and the BVC were effective and more suitable than actuarial data in predicting short-term aggression. The use of segregation reduced the number of SOAS-R incidents. Conclusions In a naturalistic group of patients in a PICU segregation of patients lowers the number of aggressive and threatening incidents. Prediction should be based on clinical global judgment, and instruments designed to predict short-term aggression in psychiatric inpatients. Trial registrations NCT00184119/NCT00184132 PMID:21418581
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O'Hara, Susan; Klar, Robin Toft; Patterson, Emily S; Morris, Nancy S; Ascenzi, Judy; Fackler, James C; Perry, Donna J
2018-04-01
The objectives of this research were to describe the interactions (formal and informal), in which macrocognitive functions occur and their location on a pediatric intensive care unit, to describe challenges and facilitators of macrocognition using space syntax constructs (openness, connectivity, and visibility), and to analyze the healthcare built environment (HCBE) using those constructs to explicate influences on macrocognition. In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple healthcare settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, "macrocognition in the healthcare built environment" (mHCBE) addresses this relationship. A focused ethnographic study was conducted including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data. Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs). Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help increase understanding of how use of the framework of Macrocognition in the HCBE can improve design and support adaptation of interprofessional team practices, maximizing macrocognitive interaction opportunities for patient, family, and team safety and quality.
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Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis
2013-04-01
To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.
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Implementation of Advanced Warehouses in a Hospital Environment - Case study
NASA Astrophysics Data System (ADS)
Costa, J.; Sameiro Carvalho, M.; Nobre, A.
2015-05-01
In Portugal, there is an increase of costs in the healthcare sector due to several factors such as the aging of the population, the increased demand for health care services and the increasing investment in new technologies. Thus, there is a need to reduce costs, by presenting the effective and efficient management of logistics supply systems with enormous potential to achieve savings in health care organizations without compromising the quality of the provided service, which is a critical factor, in this type of sector. In this research project the implementation of Advanced Warehouses has been studied, in the Hospital de Braga patient care units, based in a mix of replenishment systems approaches: the par level system, the two bin system and the consignment model. The logistics supply process is supported by information technology (IT), allowing a proactive replacement of products, based on the hospital services consumption records. The case study was developed in two patient care units, in order to study the impact of the operation of the three replenishment systems. Results showed that an important inventory holding costs reduction can be achieved in the patient care unit warehouses while increasing the service level and increasing control of incoming and stored materials with less human resources. The main conclusion of this work illustrates the possibility of operating multiple replenishment models, according to the types of materials that healthcare organizations deal with, so that they are able to provide quality health care services at a reduced cost and economically sustainable. The adoption of adequate IT has been shown critical for the success of the project.
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Developing preceptorship through action research: Part 1.
Hilli, Yvonne; Melender, Hanna-Leena
2015-09-01
Clinical preception in practice plays a significant role in both registered and practical nurse studies. As such, the cooperation between the faculty and working life is important to narrow the theory-practice gap, with emphasis being placed on a student-oriented approach promoting self-direction and lifelong learning. The aim of this project was to develop the preceptorship at five different units within the health-care sector in western Finland by implementing an action research (AR) approach. This article is the first of a two-part article on the project, focusing on a cultural analysis and the development of preception models conducted within the project. The five units participating in the study were the following: a long-term care ward in the community, a ward for people with dementia, a geriatric ward, a medical ward and a surgical ward representing specialised care. The starting point of the study was a cultural analysis, which was made in all the five units to obtain a 'bottom-up' perspective. In each of the five units 3-5 nurses were appointed to become members of the core groups. This meant that all the units would start from the perspective of their own working environment when creating a preception model that would fit into their particular workplace. During this process, the participants received continuous support from the researchers. Several workshops and seminars were also arranged to further support the core groups and staff. The models were implemented and tested during the academic year 2010-2011 followed by an evaluation of the project. The evaluation results will be presented in the second part of the two-part article. The project showed that reflective practice and critical thinking can be improved through an AR approach. © 2015 Nordic College of Caring Science.
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Owens, Sonal T; Owens, Gabe E; Rajput, Shaili H; Charpie, John R; Kidwell, Kelley M; Mullan, Patricia B
2015-01-01
The 24/7 in-house attending coverage is emerging as the standard of care in intensive care units. Implementation costs, workforce feasibility, and patient outcomes resulting from changes in physician staffing are widely debated topics. Understanding the impact of staffing models on the learning environment for medical trainees and faculty is equally warranted, particularly with respect to trainee education and autonomy. This study aims to elicit the perceptions of pediatric cardiology fellows and attendings toward 24/7 in-house attending coverage and its effect on fellow education and autonomy. We surveyed pediatric cardiology fellows and attendings practicing in the pediatric cardiothoracic intensive care unit (PCTU) of a large, university-affiliated medical center, using structured Likert response items and open-ended questions, prior to and following the transition to 24/7 in-house attending coverage. All (100%) trainees and faculty completed all surveys. Both prior to and following transition to 24/7 in-house attending coverage, all fellows, and the majority of attendings agreed that the overnight call experience benefited fellow education. At baseline, trainees identified limited circumstances in which on-site attending coverage would be critical. Preimplementation concerns that 24/7 in-house attending coverage would negatively affect the education of fellows were not reflected following actual implementation of the new staffing policy. However, based upon open-ended questions, fellow autonomy was affected by the new paradigm, with fellows and attendings reporting decreased "appropriateness" of autonomy after implementation. Our prospective study, showing initial concerns about limiting the learning environment in transitioning to 24/7 in-house attending coverage did not result in diminished perceptions of the educational experience for our fellows but revealed an expected decrease in fellow autonomy. The study indirectly facilitated open discussions about methods to preserve fellow education and warranted autonomy in our PCTU; however, continued efforts are needed to achieve the optimal balance between supervised training and the transition to autonomous practice. © 2015 Wiley Periodicals, Inc.
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From Toyota to the bedside: nurses can lead the lean way in health care reform.
Johnson, Joyce E; Smith, Amy L; Mastro, Kari A
2012-01-01
The advent of health care reform means new pressures on American hospitals, which will be forced to do more with less. In the next decade, increased use of "Lean" principles and practices in hospitals can create real value by reducing waste and improving productivity, costs, quality, and the timely delivery of patient care services. In 2010, the Institute of Medicine recommended that nurses lead collaborative quality improvement efforts and assume a major role in redesigning health care in the United States. In this article, we provide an overview of the use of Lean techniques in health care and 2 case studies of successful, nurse-directed Lean initiatives at the Robert Wood Johnson University Hospital. The article concludes with some lessons we have learned and implications for nursing education in the future that must include the concepts, tools, and skills required for adapting Lean to the patient care environment.
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LGBT Older Adults and Nurse Administrators: An Opportunity for Advocacy.
Thornton, Marleen
One of the greatest health care challenges of the 21st century is the rapidly growing number of older adults in the United States. This aging population is also becoming increasingly diverse, and with this diversity comes an increased number of older adults who identify as lesbian, gay, bisexual, and transgender (LGBT). The needs and health outcomes of this specific subgroup of the older adult population cannot be extrapolated from the more general population of older adults. Nurses have the opportunity to lead health care providers in improving care for this vulnerable and sometimes invisible population. Leading this charge will require nurse executives who advocate, create care environments that are inclusive, and staff with nurses who can care for the specific needs of LGBT older adults. The purpose of this article is to raise awareness of the health needs of LGBT older adults and identify how nurse executives can advocate to improve care for this overlooked population.
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Ashton, Susan Elizabeth; Roe, Brenda; Jack, Barbara; McClelland, Bob
2016-09-01
End of life decisions for people with advanced dementia are reported as often being difficult for families as they attempt to make appropriate and justified decisions. To explore the experiences of advance care planning amongst family caregivers of people with advanced dementia. Qualitative research including a series of single cases (close family relatives). A purposive sample of 12 family caregivers within a specialist dementia unit was interviewed about their experiences of advance care planning between August 2009 and February 2010. Family caregivers need encouragement to ask the right questions during advance care planning to discuss the appropriateness of nursing and medical interventions at the end of life. Advance care planning can be facilitated with the family caregiver in the context of everyday practice within the nursing home environment for older people with dementia. © The Author(s) 2014.
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Carlfjord, S; Andersson, A; Nilsen, P; Bendtsen, P; Lindberg, M
2010-12-01
The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC. © 2010 Blackwell Publishing Ltd.
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Wodinski, Lindsay M; Mattson McCrady, Heather M; Oswald, Christie M; Lyste, Nicole J M; Forbes, Karen L L
2017-10-01
This paper presents family bedside orientations, an innovative bedside peer support model for families of paediatric patients piloted in one unit at the Stollery Children's Hospital in Edmonton, Alberta. The model invites family members of former patients back to the hospital as volunteer peer mentors responsible for meeting one-on-one with current inpatient families to provide a listening presence, discuss patient safety practices and encourage families to participate in their child's care. Using qualitative and quantitative data collection methods, the model was evaluated over 1 year (December 2014 to December 2015). Data sources included peer mentor field notes (from 163 visits) detailing the number of family bedside orientations completed by peer mentors and how they interacted with families, as well as post-visit family (n=35) surveys, Hospital-Child Inpatient Experience Survey data, peer mentor (n=6) questionnaires, focus groups with unit staff (n=10) and interviews with members of the project leadership team (n=5). Our findings indicated that family bedside orientations became an established practice in the pilot unit and positively impacted family care experiences. We attribute these successes to championing and support from unit staff and our multidisciplinary project leadership team. We discuss how our team addressed family privacy and confidentiality while introducing peer mentors in the unit. We also highlight strategies used to integrate peer mentors as part of the staff team and enhance peer support culture in the pilot unit. Practical considerations for implementing this model in other paediatric environments are provided.
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Christensen, Martin; Dodds, Andrew; Sauer, Josh; Watts, Nigel
2014-08-01
The aim of this survey was to assess registered nurse's perceptions of alarm setting and management in an Australian Regional Critical Care Unit. The setting and management of alarms within the critical care environment is one of the key responsibilities of the nurse in this area. However, with up to 99% of alarms potentially being false-positives it is easy for the nurse to become desensitised or fatigued by incessant alarms; in some cases up to 400 per patient per day. Inadvertently ignoring, silencing or disabling alarms can have deleterious implications for the patient and nurse. A total population sample of 48 nursing staff from a 13 bedded ICU/HDU/CCU within regional Australia were asked to participate. A 10 item open-ended and multiple choice questionnaire was distributed to determine their perceptions and attitudes of alarm setting and management within this clinical area. Two key themes were identified from the open-ended questions: attitudes towards inappropriate alarm settings and annoyance at delayed responses to alarms. A significant number of respondents (93%) agreed that alarm fatigue can result in alarm desensitisation and the disabling of alarms, whilst 81% suggested the key factors are those associated with false-positive alarms and inappropriately set alarms. This study contributes to what is known about alarm fatigue, setting and management within a critical care environment. In addition it gives an insight as to what nurses' within a regional context consider the key factors which contribute to alarm fatigue. Clearly nursing burnout and potential patient harm are important considerations for practice especially when confronted with alarm fatigue and desensitisation. Therefore, promoting and maintaining an environment of ongoing intra-professional communication and alarm surveillance are crucial in alleviating these potential problems. Copyright © 2014. Published by Elsevier Ltd.
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Children visiting family and friends on adult intensive care units: the nurses' perspective.
Clarke, C M
2000-02-01
Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.
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Collegial relationship breakdown: a qualitative exploration of nurses in acute care settings.
Cowin, Leanne S
2013-01-01
Poor collegial relations can cause communication breakdown, staff attrition and difficulties attracting new nursing staff. Underestimating the potential power of nursing team relationships means that opportunities to create better working environments and increase the quality of nursing care can be missed. Previous research on improving collegiality indicates that professionalism and work satisfaction increases and that staff attrition decreases. This study explores challenges, strengths and strategies used in nursing team communication in order to build collegial relationships. A qualitative approach was employed to gather nurses experiences and discussion of communication within their nursing teams and a constant comparison method was utilised for data analysis. A convenience sampling technique was employed to access both Registered Nurses and Enrolled Nurses to partake in six focus groups. Thirty mostly female nurses (ratio of 5:1) participated in the study. Inclusion criteria consisted of being a nurse currently working in acute care settings and the exclusion criteria included nursing staff currently working in closed specialty units (i.e. intensive care units). Results revealed three main themes: (1) externalisation and internalisation of nursing team communication breakdown, (2) the importance of collegiality for retention of nurses and (3) loss of respect, and civility across the healthcare workplace. A clear division between hierarchies of nurses was apparent in how nursing team communication was delivered and managed. Open, respectful and collegial communication is essential in today's dynamic and complex health environments. The nurses in this study highlighted how important nursing communication can be to work motivation and how leadership fosters teamwork.
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Creating a Highly Reliable Neonatal Intensive Care Unit Through Safer Systems of Care.
Panagos, Patoula G; Pearlman, Stephen A
2017-09-01
Neonates requiring intensive care are at high risk for medical errors due to their unique characteristics and high acuity. Designing a safer work environment begins with safe processes. Creating a culture of safety demands the involvement of all organizational levels and an interdisciplinary approach. Adverse events can result from suboptimal communication and lack of a shared mental model. This chapter describes tools to promote better patient safety in the NICU through monitoring adverse events, improving communication and using information technology. Unplanned extubation is an example of a neonatal safety concern that can be reduced by employing quality improvement methodology. Copyright © 2017 Elsevier Inc. All rights reserved.
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The Supply and Demand of the Cardiovascular Workforce
Narang, Akhil; Sinha, Shashank S.; Rajagopalan, Bharath; Ijioma, Nkechinyere N.; Jayaram, Natalie; Kithcart, Aaron P.; Tanguturi, Varsha K.; Cullen, Michael W.
2017-01-01
As the burden of cardiovascular disease in the United States continues to increase, uncertainty remains on how well-equipped the cardiovascular workforce is to meet the challenges that lie ahead. In a time when health care is rapidly shifting, numerous factors affect the supply and demand of the cardiovascular workforce. This Council Commentary critically examines several factors that influence the cardiovascular workforce. These include current workforce demographics and projections, evolving health care and practice environments, and the increasing burden of cardiovascular disease. Finally, we propose 3 strategies to optimize the workforce. These focus on cardiovascular disease prevention, the effective utilization of the cardiovascular care team, and alterations to the training pathway for cardiologists. PMID:27712782
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Wille, I; Mayr, A; Kreidl, P; Brühwasser, C; Hinterberger, G; Fritz, A; Posch, W; Fuchs, S; Obwegeser, A; Orth-Höller, D; Lass-Flörl, C
2018-01-01
In intensive care units (ICUs), inanimate surfaces and equipment may be contaminated by nosocomial pathogens, including multi-drug-resistant micro-organisms. To assess the degree of environmental contamination close to and distant from patients, and contamination of healthcare workers' (HCWs) hands with nosocomial pathogens under real-life conditions and to investigate potential transmission events. Over the course of three weeks, agar contact samples were taken close to and distant from patient areas and from HCWs' hands in eight ICUs of a tertiary care hospital in Innsbruck, Austria. Each ICU was visited once without announcement. Species identification and antimicrobial susceptibility testing were performed according to standard methods, and corresponding strains from patient, environment and hand samples were genotyped using pulsed-field gel electrophoresis. Among 523 samples, HCWs' hands were most frequently contaminated with potentially pathogenic bacteria (15.2%), followed by areas close to patients (10.9%) and areas distant from patients (9.1%). Gram-positive bacteria were identified most often (67.8%), with Enterococcus spp. being the most prevalent species (70% vancomycin sensitive and 30% vancomycin resistant) followed by Staphylococcus aureus, of which 64% were classified as meticillin-resistant Staphylococcus aureus. Molecular typing documented identical strains among patient, environment and hand isolates. This study found widespread contamination of the ICU environment with clinically relevant pathogens, including multi-drug-resistant micro-organisms, despite cleaning and disinfection. The bioburden might not be restricted to areas close to patients. The role of extended environmental disinfection of areas distant from patients in order to improve infection prevention needs further discussion. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
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Hoang, S.; Georget, A.; Asselineau, J.; Venier, A-G.; Leroyer, C.; Rogues, A. M.; Thiébaut, R.
2018-01-01
Pseudomonas aeruginosa (P.aeruginosa) remains a prominent nosocomial pathogen responsible for high morbi-mortality in intensive care units (ICUs). P.aeruginosa transmission is known to be partly endogenous and exogenous. Main factors have been highlighted but the precise role of environment in regard to antibiotics use remained unclear. Objective To assess the role of environment, medical care and individual risks factors for P. aeruginosa colonization and infection. Study design and setting A French multicentric prospective study involved ten ICUs for a five months period. Every adult patient newly hospitalized in ICUs with no P. aeruginosa carriage up to 48 hours after admission was included and weekly screened before discharge or death. Screening swabs were either rectal, sputum or oropharyngeal samples. Hydric environment was also sampled each week. Data on patient clinical features, environmental and device exposures, and antibiotics supports were regularly collected. Multivariate analysis was performed with a multistate model. Results The overall prevalence of P. aeruginosa carriage was 15.3% (201/1314). Risk factors associated with patient colonization were: use of inactive antibiotics against P. aeruginosa (HR = 1.60 [1.15–2.21] p<0.01), tap water contamination at the entry in the room (HR = 1.66 [1.01–2.27] p<0.05) and mechanical invasive ventilation (HR = 4.70 [2.66–8.31] p<0.0001). Active antibiotics prevented from colonization (HR = 0.67 [0.48–0.93] p = 0.02) and from infection (HR = 0.64 [0.41–1.01] p = 0.05). Interaction between hydric environment antibiotics support was not statistically associated with patient colonization. Conclusion Hydric contamination and antibiotics pressure seem to remain key independent risk factors in P. aeruginosa colonization. These results advocate the need to carry on preventive and targeted interventions toward healthcare associated infections. PMID:29522559
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Personal Cooling for Extra-Vehicular Activities on Mars
NASA Technical Reports Server (NTRS)
Pu, Zhengxiang; Kapat, Jay; Chow, Louis; Recio, Jose; Rini, Dan; Trevino, Luis
2004-01-01
Extra-vehicular activities (EVA) on Mars will require suits with sophisticated thermal control systems so that astronauts can work comfortably for extended periods of time. Any use of consumables such as water that cannot be easily replaced should be of particular concern. In this aspect the EVA suits for Mars environment need to be different from the current Space Shuttle Extra Vehicular Mobility Units (EMU) that depend on water sublimation into space for removing heat from suits. Moreover, Mars environment is quite different from what a typical EMU may be exposed to. These variations call for careful analysis and innovative engineering for design and fabrication of an appropriate thermal control system. This paper presents a thermal analysis of astronaut suits for EVA with medium metabolic intensity under a typical hot and a nominal cold environment on Mars. The paper also describes possible options that would allow conservation of water with low usage of electrical power. The paper then presents the conceptual design of a portable cooling unit for one such solution.
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Noise level in a neonatal intensive care unit in Santa Marta - Colombia.
Garrido Galindo, Angélica Patricia; Velez-Pereira, Andres M
2017-01-01
Abstract Introduction: The environment of neonatal intensive care units is influenced by numerous sources of noise emission, which contribute to raise the noise levels, and may cause hearing impairment and other physiological and psychological changes on the newborn, as well as problems with care staff. Objective: To evaluate the level and sources of noise in the neonatal intensive care unit. Methods: Sampled for 20 consecutive days every 60 seconds in A-weighting curves and fast mode with a Type I sound level meter. Recorded the average, maximum and minimum, and the 10th, 50th and 90th percentiles. The values are integrated into hours and work shift, and studied by analysis of variance. The sources were characterized in thirds of octaves. Results: The average level was 64.00 ±3.62 dB(A), with maximum of 76.04 ±5.73 dB(A), minimum of 54.84 ±2.61dB(A), and background noise of 57.95 ±2.83 dB(A). We found four sources with levels between 16.8-63.3 dB(A). Statistical analysis showed significant differences between the hours and work shift, with higher values in the early hours of the day. Conclusion: The values presented exceed the standards suggested by several organizations. The sources identified and measured recorded high values in low frequencies. PMID:29213154
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Building Partner Capacity to Combat Weapons of Mass Destruction
2009-01-01
EDUCATION ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE INTERNATIONAL AFFAIRS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE AND...also met with officials from the government of the United Kingdom (the 12 The Science Applications International Corporation study team identified...Activity Description Ends Ways International Science and Technology Center Provides weapons experts in CIS the opportunity to redirect their
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ERIC Educational Resources Information Center
Smith, Becky J.
The United States has a higher child mortality rate than most other industrialized countries, but most childhood injuries, although called "accidents," are the result of predictable and preventable behavior. This book demonstrates how teachers, parents, and caregivers can provide and maintain safe environments while teaching children how to avoid…
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1983-06-01
constrained at each step. Use of dis- crete simulation can be a powerful tool in this process if its role is carefully planned. The gross behavior of the...by projecting: - the arrival of units of work at SPLICE processing facilities (workload analysis) . - the amount of processing resources comsumed in
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Understanding the Dynamics between Preterm Infants and Their Families
ERIC Educational Resources Information Center
Chesney, Anna R.; Champion, Patricia R.
2008-01-01
The high-tech environment of the Special Care Baby Unit (SCBU) may seem a million miles away from the classroom, but the baby who has been born prematurely, wired up in an incubator in the former, will in five years' time be a learner in the other. The journeys through our education system of children who have survived premature birth to become…
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Undergraduate Student Expectations of University in the United Kingdom: What Really Matters to Them?
ERIC Educational Resources Information Center
Money, Julie; Nixon, Sarah; Tracy, Fran; Hennessy, Claire; Ball, Emma; Dinning, Track
2017-01-01
Students spend 12 to 14 years in school settings learning in what could be considered a carefully controlled and structured environment. Higher education may not offer the same landscape to students and it appears that many enter with unrealistic conceptions of what is expected of them and are faced with different approaches to aspects of…
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Ostermann, Thomas; Bertram, Mathias; Büssing, Arndt
2010-03-09
Neurological rehabilitation is one of the most care-intensive challenges in the health care system requiring specialist therapeutic and nursing knowledge. In this descriptive pilot study, we investigated the effects of a team building process on perceived work environment, self-ascribed professional competence, life satisfaction, and client satisfaction in an anthroposophic specialized hospital for neurological rehabilitation. The team-building process consisted of didactic instruction and training in problem-solving, teambuilding and constructive conflict resolution. Seventy seven staff members and 44 patients' relatives were asked to complete a survey that included the Work Environment Scale (WES-10), a Life Satisfaction Scale (BMLSS), the Conviction of Therapeutic Competency (CTC) scale and the Client Satisfaction Questionnaire (CSQ-8). To evaluate the outcome of the team building process, we analyzed changes over time in the WES-10 subscales. Additionally the interrelationship between the WES-10 subscales with other subscales and with sociodemographic parameters like age, gender was calculated by means of a bivariate correlation analysis. The team building process had a significant positive effect on perceived work environment in only one area. There was a significant improvement in the ward staffs' perception of their ability to constructively resolve conflicts 3 years after inception of the team building process than there was before inception. However, even in a unit that utilized holistic treatment and nursing in the care of severely disable patients, such care necessitating a very heavy workload, the measurements on the Self Realization, Life Satisfaction and Conviction of Therapeutic Competency scales remained high and unchanged over the three year time period of the study. Strategic interventions might be an option to improve interpersonal relationships and finally quality of patient care.
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2010-01-01
Background Neurological rehabilitation is one of the most care-intensive challenges in the health care system requiring specialist therapeutic and nursing knowledge. In this descriptive pilot study, we investigated the effects of a team building process on perceived work environment, self-ascribed professional competence, life satisfaction, and client satisfaction in an anthroposophic specialized hospital for neurological rehabilitation. The team-building process consisted of didactic instruction and training in problem-solving, teambuilding and constructive conflict resolution. Methods Seventy seven staff members and 44 patients' relatives were asked to complete a survey that included the Work Environment Scale (WES-10), a Life Satisfaction Scale (BMLSS), the Conviction of Therapeutic Competency (CTC) scale and the Client Satisfaction Questionnaire (CSQ-8). To evaluate the outcome of the team building process, we analyzed changes over time in the WES-10 subscales. Additionally the interrelationship between the WES-10 subscales with other subscales and with sociodemographic parameters like age, gender was calculated by means of a bivariate correlation analysis. Results The team building process had a significant positive effect on perceived work environment in only one area. There was a significant improvement in the ward staffs' perception of their ability to constructively resolve conflicts 3 years after inception of the team building process than there was before inception. However, even in a unit that utilized holistic treatment and nursing in the care of severely disable patients, such care necessitating a very heavy workload, the measurements on the Self Realization, Life Satisfaction and Conviction of Therapeutic Competency scales remained high and unchanged over the three year time period of the study. Conclusions Strategic interventions might be an option to improve interpersonal relationships and finally quality of patient care. PMID:20214789
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Tong, Xunliang; Xu, Hongtao; Zou, Lihui; Cai, Meng; Xu, Xuefeng; Zhao, Zuotao; Xiao, Fei; Li, Yanming
2017-01-01
Invasive fungal infections acquired in the hospital have progressively emerged as an important cause of life-threatening infection. In particular, airborne fungi in hospitals are considered critical pathogens of hospital-associated infections. To identify the causative airborne microorganisms, high-volume air samplers were utilized for collection, and species identification was performed using a culture-based method and DNA sequencing analysis with the Illumina MiSeq and HiSeq 2000 sequencing systems. Few bacteria were grown after cultivation in blood agar. However, using microbiome sequencing, the relative abundance of fungi, Archaea species, bacteria and viruses was determined. The distribution characteristics of fungi were investigated using heat map analysis of four departments, including the Respiratory Intensive Care Unit, Intensive Care Unit, Emergency Room and Outpatient Department. The prevalence of Aspergillus among fungi was the highest at the species level, approximately 17% to 61%, and the prevalence of Aspergillus fumigatus among Aspergillus species was from 34% to 50% in the four departments. Draft genomes of microorganisms isolated from the hospital environment were obtained by sequence analysis, indicating that investigation into the diversity of airborne fungi may provide reliable results for hospital infection control and surveillance. PMID:28045065
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Impacting patient outcomes through design: acuity adaptable care/universal room design.
Brown, Katherine Kay; Gallant, Dennis
2006-01-01
To succeed in today's challenging healthcare environment, hospitals must examine their impact on customers--patients and families--staff and physicians. By using competitive facility design and incorporating evidence-based concepts such as the acuity adaptable care delivery model and the universal room, the hospital will realize an impact on patient satisfaction that will enhance market share, on physician satisfaction that will foster loyalty, and on staff satisfaction that will decrease turnover. At the same time, clinical outcomes such as a reduction in mortality and complications and efficiencies such as a reduction in length of stay and minimization of hospital costs through the elimination of transfers can be gained. The results achieved are dependent on the principles used in designing the patient room that should focus on maximizing patient safety and improving healing. This article will review key design elements that support the success of an acuity adaptable unit such as the use of a private room with zones dedicated to patients, families, and staff, healing environment, technology, and decentralized nursing stations that support the success of the acuity adaptable unit. Outcomes of institutions currently utilizing the acuity adaptable concept will be reviewed.
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2014-01-01
Background People with dementia living in care homes often have complex mental health problems, disabilities and social needs. Providing more comprehensive training for staff working in care home environments is a high national priority. It is important that this training is evidence based and delivers improvement for people with dementia residing in these environments. Well-being and Health for People with Dementia (WHELD) combines the most effective elements of existing approaches to develop a comprehensive but practical staff training intervention. This optimised intervention is based on a factorial study and qualitative evaluation, to combine: training on person-centred care, promoting person-centred activities and interactions, and providing care home staff and general practitioners with updated knowledge regarding the optimal use of psychotropic medications for persons with dementia in care homes. Design The trial will be a randomised controlled two-arm cluster single blind trial that will take place for nine months across 80 care homes in the United Kingdom. Discussion The overarching goal of this trial is to determine whether this optimised WHELD intervention is more effective in improving the quality of life and mental health than the usual care provided to people with dementia living in nursing homes. This study will be the largest and best powered randomised controlled trial (RCT) evaluating the benefits of an augmented person-centred care training intervention in care homes worldwide. Trial registration Current controlled trials ISRCTN62237498 Date registered: 5 September 2013 PMID:25016303
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Care and companionship in an isolating environment: Inmates attending to dying peers
Hollenbeak, Christopher S.; Penrod, Janice; Smith, Carol A.; Kitt-Lewis, Erin; Crouse, Sarah B.
2013-01-01
The purpose of this study was to examine the values, beliefs, and perceptions of end-of-life (EOL) care held by inmates caring for peers approaching end of life. The study is part of a broader participatory action research project to infuse enhanced EOL care into state prisons. Face-to-face interviews using a semi-structured discussion guide were conducted with 17 male prisoners who were providing care for peers with advanced chronic illness and approaching end of life. Qualitative data were analyzed using content and thematic analyses. Key themes were: getting involved; living the role; and transforming self through caring for others. As well, contextual features at the organizational, peer, and personal levels were identified that either facilitated or impeded inmate caregiving. Provision of enhanced EOL care by inmate peers shows promise for improving prison community relations and morale, reducing suffering, and demonstrating care and compassion within the harsh prison environment. This study provides clear evidence that providing compassionate care for dying peers may result in transformative experiences for inmate caregivers. Implications for correctional nursing practice include providing training for inmate caregivers, including them in team meetings, and implementing grief support programs. Also, upholding nursing’s code of ethics and watching for predatory behavior are critical. “Prisons in the United States contain an ever growing number of aging men and women who…are incontinent, forgetful, suffering chronic illnesses, extremely ill, and dying” (Human Rights Watch, 2012, p. 4) PMID:24158099
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Hsueh, P-R; Huang, H-C; Young, T-G; Su, C-Y; Liu, C-S; Yen, M-Y
2014-04-01
A contaminated hospital environment has been identified as an important reservoir of pathogens causing healthcare-associated infections. This study is to evaluate the efficacy of bacteria killing nanotechnology Bio-Kil on reducing bacterial counts in an intensive care unit (ICU). Two single-bed rooms (S-19 and S-20) in the ICU were selected from 7 April to 27 May 2011. Ten sets of new textiles (pillow cases, bed sheets, duvet cover, and patient clothing) used by patients in the two single-bed rooms were provided by the sponsors. In the room S-20, the 10 sets of new textiles were washed with Bio-Kil; the room walls, ceiling, and air-conditioning filters were treated with Bio-Kil; and the surfaces of instruments (respirator, telephone, and computer) were covered with Bio-Kil-embedded silicon pads. Room S-19 served as the control. We compared the bacterial count on textiles and environment surfaces as well as air samples between the two rooms. A total of 1,364 samples from 22 different sites in each room were collected. The mean bacterial count on textiles and environmental surfaces in room S-20 was significantly lower than that in room S-19 (10.4 vs 49.6 colony-forming units [CFU]/100 cm(2); P < 0.001). Room S-20 had lower bacterial counts in air samples than room S-19 (33.4-37.6 vs 21.6-25.7 CFU/hour/plate; P < 0.001). The density of microbial isolations was significantly greater among patients admitted to room S-19 than those to room S-20 (9.15 vs 5.88 isolates per 100 patient-days, P < 0.05). Bio-Kil can significantly reduce bacterial burden in the environment of the ICU.
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Practice environment as perceived by nurses in acute care hospitals in Sharjah and North Emirates.
Al-Maaitah, Rowaida; AbuAlRub, Raeda F; Al Blooshi, Sumaya
2018-04-01
To explore nurses' perceptions of their practice environment in acute care hospitals in Sharjah and North Emirates in the United Arab Emirates (UAE). The health of the environment in which registered nurses' work is critical to nursing outcomes. The interest to examine the practice environment extended to the Gulf area which has a complex healthcare system including the UAE. The study used an exploratory descriptive design with a qualitative part using two focus group interviews. The sample size was 450 nurses selected through a random sampling method. A self-administered questionnaire including the Practice Environment Scale of Nursing Work Index (PES-NWI) was used. In addition, semi-structured interviews for two focus groups were done. The results showed that UAE practicing nurses reported favorable perceptions of most aspects of their practice environment. Unfavorable perceptions were only reported for Staffing and Resource Adequacy. The analysis of focus group discussions resulted in different emerged themes such as Lack of Recognition and Career Promotion, and Nurses' Workload due to Paper and Administrative Work. The findings of this study suggest that strategic interventions are needed to secure adequate staff and resources and implement an effective system for evaluation of performance. © 2018 Wiley Periodicals, Inc.
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Bench-to-bedside review: Humanism in pediatric critical care medicine – a leadership challenge
Kissoon, Niranjan
2005-01-01
A humanistic approach to leadership is especially important in the case of children in the technology-rich intensive care unit (ICU) environment. Leaders should create a humanistic milieu in which the needs of critically ill children, their families and staff are never overlooked. Humanistic leaders are tactful, accessible, approachable and versatile, and have a sense of humour. Humanness in the ICU environment has many faces and poses a challenge to many in leadership positions. Humanistic leaders treat others as they hope they will become. They are constantly questioning themselves, seeking awareness of themselves and others, but most importantly they are constantly learning and evolving. Ultimately, humanistic leadership creates an ICU culture that supports all, is conducive to enriching lives, and is sensitive to the needs of patients and their families. PMID:16137386
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Essential elements of the nursing practice environment in nursing homes: Psychometric evaluation.
de Brouwer, Brigitte Johanna Maria; Kaljouw, Marian J; Schoonhoven, Lisette; van Achterberg, Theo
2017-06-01
To develop and psychometrically test the Essentials of Magnetism II in nursing homes. Increasing numbers and complex needs of older people in nursing homes strain the nursing workforce. Fewer adequately trained staff and increased care complexity raise concerns about declining quality. Nurses' practice environment has been reported to affect quality of care and productivity. The Essentials of Magnetism II © measures processes and relationships of practice environments that contribute to productivity and quality of care and can therefore be useful in identifying processes requiring change to pursue excellent practice environments. However, this instrument was not explicitly evaluated for its use in nursing home settings so far. In a preparatory phase, a cross-sectional survey study focused on face validity of the essentials of magnetism in nursing homes. A second cross-sectional survey design was then used to further test the instrument's validity and reliability. Psychometric testing included evaluation of content and construct validity, and reliability. Nurses (N = 456) working at 44 units of three nursing homes were included. Respondent acceptance, relevance and clarity were adequate. Five of the eight subscales and 54 of the 58 items did meet preset psychometric criteria. All essentials of magnetism are considered relevant for nursing homes. The subscales Adequacy of Staffing, Clinically Competent Peers, Patient Centered Culture, Autonomy and Nurse Manager Support can be used in nursing homes without problems. The other subscales cannot be directly applied to this setting. The valid subscales of the Essentials of Magnetism II instrument can be used to design excellent nursing practice environments that support nurses' delivery of care. Before using the entire instrument, however, the other subscales have to be improved. © 2016 John Wiley & Sons Ltd.
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Hamman, William R; Beaubien, Jeffrey M; Beaudin-Seiler, Beth M
2009-12-01
The aims of this research are to begin to understand health care teams in their operational environment, establish metrics of performance for these teams, and validate a series of scenarios in simulation that elicit team and technical skills. The focus is on defining the team model that will function in the operational environment in which health care professionals work. Simulations were performed across the United States in 70- to 1000-bed hospitals. Multidisciplinary health care teams analyzed more than 300 hours of videos of health care professionals performing simulations of team-based medical care in several different disciplines. Raters were trained to enhance inter-rater reliability. The study validated event sets that trigger team dynamics and established metrics for team-based care. Team skills were identified and modified using simulation scenarios that employed the event-set-design process. Specific skills (technical and team) were identified by criticality measurement and task analysis methodology. In situ simulation, which includes a purposeful and Socratic Method of debriefing, is a powerful intervention that can overcome inertia found in clinician behavior and latent environmental systems that present a challenge to quality and patient safety. In situ simulation can increase awareness of risks, personalize the risks, and encourage the reflection, effort, and attention needed to make changes to both behaviors and to systems.
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2013-01-01
Background Nursing home patients with dementia use psychotropic drugs longer and more frequently than recommended by guidelines implying psychotropic drugs are not always prescribed appropriately. These drugs can have many side effects and effectiveness is limited. Psychotropic drug use between nursing home units varies and is not solely related to the severity of neuropsychiatric symptoms. There is growing evidence indicating that psychotropic drug use is associated with environmental factors, suggesting that the prescription of psychotropic drugs is not only related to (objective) patient factors. However, other factors related to the patient, elderly care physician, nurse and the physical environment are only partially identified. Using a mixed method of qualitative and quantitative research, this study aims to understand the nature of psychotropic drug use and its underlying factors by identifying: 1) frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms in nursing home patients with dementia, 2) factors associated with (appropriateness of) psychotropic drug use. Methods A cross-sectional mixed methods study. For the quantitative study, patients with dementia (n = 540), nursing staff and elderly care physicians of 36 Dementia Special Care Units of 12 nursing homes throughout the Netherlands will be recruited. Six nursing homes with high average rates and six with low average rates of psychotropic drug use, based on a national survey about frequency of psychotropic drug use on units, will be included. Psychotropic drugs include antipsychotics, anxiolytics, hypnotics, antidepressants, anticonvulsants and anti-dementia drugs. Appropriateness will be measured by an instrument based on the Medication Appropriateness Index and current guidelines for treatment of neuropsychiatric symptoms. Factors associated to psychotropic drug use, related to the patient, elderly care physician, nurse and physical environment, will be explored using multilevel regression analyses. For the qualitative study, in depth interviews with staff will be held and analyzed to identify and explore other unknown factors. Discussion This study will provide insight into factors that are associated with the frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms. Understanding psychotropic drug use and its associations may contribute to better dementia care. PMID:24238392
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Survey on death and dying in Hong Kong: attitudes, beliefs, and preferred end-of-life care.
Mjelde-Mossey, Lee Ann; Chan, Cecilia L W
2007-01-01
Social Workers in end-of-life and palliative care have a particular opportunity to ease the dying process by providing culturally appropriate services to the dying and their families. In today's multicultural social environment, with an ever-increasing immigrant population, social workers are challenged to be knowledgeable about diverse cultures. Recently, a forum of health care professionals and social workers in Hong Kong conducted a survey of the general population to assess death and dying attitudes, beliefs, and preferences for end-of-life care. Four-hundred-thirty Hong Kong Chinese participated in a telephone interview. Responses were compared by gender. The survey results not only contribute to an understanding of Hong Kong Chinese, but can inform social workers who practice with Chinese immigrants to the United States.
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Accountable care around the world: a framework to guide reform strategies.
McClellan, Mark; Kent, James; Beales, Stephen J; Cohen, Samuel I A; Macdonnell, Michael; Thoumi, Andrea; Abdulmalik, Mariam; Darzi, Ara
2014-09-01
Accountable care--a way to align health care payments with patient-focused reform goals--is currently being pursued in the United States, but its principles are also being applied in many other countries. In this article we review experiences with such reforms to offer a globally applicable definition of an accountable care system and propose a conceptual framework for characterizing and assessing accountable care reforms. The framework consists of five components: population, outcomes, metrics and learning, payments and incentives, and coordinated delivery. We describe how the framework applies to accountable care reforms that are already being implemented in Spain and Singapore. We also describe how it can be used to map progress through increasingly sophisticated levels of reforms. We recommend that policy makers pursuing accountable care reforms emphasize the following steps: highlight population health and wellness instead of just treating illness; pay for outcomes instead of activities; create a more favorable environment for collaboration and coordinated care; and promote interoperable data systems. Project HOPE—The People-to-People Health Foundation, Inc.
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Gómez-García, Teresa; Ruzafa-Martínez, María; Fuentelsaz-Gallego, Carmen; Madrid, Juan Antonio; Rol, Maria Angeles; Martínez-Madrid, María José; Moreno-Casbas, Teresa
2016-01-01
Objective The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. Methods This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. Results 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). Conclusions Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers. PMID:27496241
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Dedicated education unit: student perspectives.
Nishioka, Vicki M; Coe, Michael T; Hanita, Makoto; Moscato, Susan R
2014-01-01
The study compared students' perceptions of their clinical learning experiences in a dedicated education unit (DEU) with their experiences in traditional clinical education. Unlike traditional academic-instructor models, expert nurses in the DEU provide clinical education to students with faculty support. This repeated measures design used student surveys, supplemented by focus group data. Students were more likely to agree that their clinical learning experience was high quality and they had a consistent mentoring relationship during DEU rotations. Students also reported the quality of the unit's learning environment, the leadership style of the nurse manager, and the nursing care on the unit was more favorable in DEUs than traditional units. Consistent with their changed role in DEUs, faculty members were less active in helping students integrate theory and practice. These findings provide additional evidence of the value that the DEU model contributes to high-quality clinical education.
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Vickery, K; Deva, A; Jacombs, A; Allan, J; Valente, P; Gosbell, I B
2012-01-01
Despite recent attention to surface cleaning and hand hygiene programmes, multiresistant organisms (MROs) continue to be isolated from the hospital environment. Biofilms, consisting of bacteria embedded in exopolymeric substances (EPS) are difficult to remove due to their increased resistance to detergents and disinfectants, and periodically release free-swimming planktonic bacteria back into the environment which may may act as an infection source. To establish whether reservoirs of MROs exist in the environment as biofilms. Following terminal cleaning, equipment and furnishings were removed aseptically from an intensive care unit (ICU) and subjected to culture and scanning electron microscopy (SEM). Samples were placed in 5 mL of tryptone soya broth, sonicated for 5 min before plate culture on horse blood agar, Brillance MRSA and Brilliance VRE agar plates. Samples for SEM were fixed in 3% glutaraldehyde and hexamethyldisilizane (HMDS) prior to sputter-coating with gold and examination in an electron microscope. Biofilm was demonstrated visually on the sterile supply bucket, the opaque plastic door, the venetian blind cord, and the sink rubber, whereas EPS alone was seen on the curtain. Viable bacteria were grown from three samples, including MRSA from the venetian blind cord and the curtain. Biofilm containing MROs persist on clinical surfaces from an ICU despite terminal cleaning, suggesting that current cleaning practices are inadequate to control biofilm development. The presence of MROs being protected within these biofilms may be the mechanism by which MROs persist within the hospital environment. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
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Copeland, Darcy; Chambers, Misty
2017-07-01
The purpose of this study was to determine what differences occurred in steps taken and energy expenditure among acute care nurses when their work environment moved from a hospital with centralized nurses' stations to a hospital with decentralized nurses' stations. Additional goals were to determine design features nurses perceived as contributing to or deterring from their work activities and what changes occurred in reported job satisfaction. Since design features can also affect patient outcomes, patient falls were monitored. The construction of a replacement facility for a 224-bed Level 1 trauma center provided the opportunity to compare the effects of centralized versus decentralized nurses' stations on nurses' experiences of their work environments. A pre-post quasi-experimental design was used. RN participants completed an open-ended questionnaire and recorded pedometer data at the end of each shift, working for 3-month pre-relocation and for 3-month post-relocation. Nine months passed between the move and post-relocation data collection. There were significant reductions in nurses' energy expenditure ( p < .001) and steps taken ( p = .041) post-relocation. Overall, nurses' job satisfaction was high and improved post-relocation, and patient falls decreased by 55%. Post-relocation, a number of the dissatisfiers associated with the physical environment were eliminated, and nurses identified more satisfiers (in general and related to the physical environment). Patients are safer post-relocation as indicated by a decrease in falls. This decrease is even more noteworthy when considering that the numbers of patient beds on each unit is higher post-relocation.
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Navigating Through Chaos: Charge Nurses and Patient Safety.
Cathro, Heather
2016-04-01
The aim of this study was to explore actions and the processes charge nurses (CNs) implement to keep patients safe and generate an emerging theory to inform CN job descriptions, orientation, and training to promote patient safety in practice. Healthcare workers must provide a safe environment for patients. CNs are the frontline leaders on most hospital units and can function as gatekeepers for safe patient care. This grounded theory study utilized purposive sampling of CNs on medical-surgical units in a 400-bed metropolitan hospital. Data collection consisted of 11 interviews and 6 observations. The emerging theory was navigating through chaos: CNs balancing multiple roles, maintaining a watchful eye, and working with and leading the healthcare team to keep patients safe. CNs have knowledge of patients, staff, and complex healthcare environments, putting them in opportune positions to influence patient safety.
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Lean Keng, Soon; AlQudah, Hani Nawaf Ibrahim
2017-02-01
To raise awareness of critical care nurses' cognitive bias in decision-making, its relationship with leadership styles and its impact on care delivery. The relationship between critical care nurses' decision-making and leadership styles in hospitals has been widely studied, but the influence of cognitive bias on decision-making and leadership styles in critical care environments remains poorly understood, particularly in Jordan. Two-phase mixed methods sequential explanatory design and grounded theory. critical care unit, Prince Hamza Hospital, Jordan. Participant sampling: convenience sampling Phase 1 (quantitative, n = 96), purposive sampling Phase 2 (qualitative, n = 20). Pilot tested quantitative survey of 96 critical care nurses in 2012. Qualitative in-depth interviews, informed by quantitative results, with 20 critical care nurses in 2013. Descriptive and simple linear regression quantitative data analyses. Thematic (constant comparative) qualitative data analysis. Quantitative - correlations found between rationality and cognitive bias, rationality and task-oriented leadership styles, cognitive bias and democratic communication styles and cognitive bias and task-oriented leadership styles. Qualitative - 'being competent', 'organizational structures', 'feeling self-confident' and 'being supported' in the work environment identified as key factors influencing critical care nurses' cognitive bias in decision-making and leadership styles. Two-way impact (strengthening and weakening) of cognitive bias in decision-making and leadership styles on critical care nurses' practice performance. There is a need to heighten critical care nurses' consciousness of cognitive bias in decision-making and leadership styles and its impact and to develop organization-level strategies to increase non-biased decision-making. © 2016 John Wiley & Sons Ltd.
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Variation in critical care services across North America and Western Europe.
Wunsch, Hannah; Angus, Derek C; Harrison, David A; Collange, Olivier; Fowler, Robert; Hoste, Eric A J; de Keizer, Nicolette F; Kersten, Alexander; Linde-Zwirble, Walter T; Sandiumenge, Alberto; Rowan, Kathryn M
2008-10-01
Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in eight countries. Retrospective review of existing national administrative data. We identified sources of data in each country to provide information on acute care hospitals and beds, intensive care units and beds, intensive care admissions, and definitions of intensive care beds. Data were all referenced and from as close to 2005 as possible. United States, France, United Kingdom, Canada, Belgium, Germany, The Netherlands, and Spain. Not available. None. No standard definition existed for acute care hospital or intensive care unit beds across countries. Hospital beds varied three-fold from 221/100,000 population in the United States to 593/100,000 in Germany. Adult intensive care unit beds also ranged seven-fold from 3.3/100,000 population in the United Kingdom to 24.0/100,000 in Germany. Volume of intensive care unit admissions per year varied ten-fold from 216/100,000 population in the United Kingdom to 2353/100,000 in Germany. The ratio of intensive care unit beds to hospital beds was highly correlated across all countries except the United States (r = .90). There was minimal correlation between the number of intensive care unit beds per capita and health care spending per capita (r = .45), but high inverse correlation between intensive care unit beds and hospital mortality for intensive care unit patients across countries (r = -.82). Absolute critical care services vary dramatically between countries with wide differences in both numbers of beds and volume of admissions. The number of intensive care unit beds per capita is not strongly correlated with overall health expenditure, but does correlate strongly with mortality. These findings demonstrate the need for critical care data from all countries, as they are essential for interpretation of studies, and policy decisions regarding critical care services.
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Leineweber, Constanze; Chungkham, Holendro Singh; Lindqvist, Rikard; Westerlund, Hugo; Runesdotter, Sara; Smeds Alenius, Lisa; Tishelman, Carol
2016-06-01
Nursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied. The aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction. Multilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied. Regarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied. We conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Using the Practice Environment Scale of the Nursing Work Index on Asian nurses.
Liou, Shwu-Ru; Cheng, Ching-Yu
2009-01-01
Researchers have used the Practice Environment Scale of the Nursing Work Index (PES-NWI) to examine the perception of practice environment among U.S. nurses in general; however, the scale has not been used to measure perceptions specifically among Asian nurses working in the United States, the largest group of international nurses in the nation. The purpose of this study was to test the reliability and the validity of the PES-NWI scale when applied to Asian nurses working in the United States. The study used a cross-sectional design with snowball sampling. Data from 230 Asian nurses who were born in Far Eastern countries and had worked at least 6 months in their current job at a U.S. hospital were analyzed, using Cronbach's alpha, item-total and interitem correlation, and factor analysis. The Cronbach's alpha for the PES-NWI was.96, and the item-total correlation coefficients ranged from.49 to.79. Five factors, which explained 59.12% of variance in the perception of practice environment, emerged: Nurse Participation and Development; Nurse Manager Ability, Leadership, and Support of Nurses; Nursing Foundations for Quality of Care; Staffing and Resource Adequacy; and Collegial Nurse-Physician Relations. Four derived factors were reconstructed, and one factor was renamed based on the meanings of scale items that were included in the factor. Study findings demonstrate that the PES-NWI is a reliable and a valid scale when applied to Asian nurses working in the United States. Findings also indicate that Asian nurses perceive practice environments differently than do American nurses, most likely due to dissimilar cultural beliefs. A better understanding of these differences may help develop more individualized support for Asian nurses as they adapt to working in the United States.
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Wireless technology in the ICU: boon or ban?
Gladman, Aviv S; Lapinsky, Stephen E
2007-01-01
Wireless communication and data transmission are playing an increasing role in the critical care environment. Early anecdotal reports of electromagnetic interference (EMI) with intensive care unit (ICU) equipment resulted in many institutions banning these devices. An increasing literature database has more clearly defined the risks of EMI. Restrictions to the use of mobile devices are being lifted, and it has been suggested that the benefits of improved communication may outweigh the small risks. However, increased use of cellular phones and ever changing communication technologies require ongoing vigilance by healthcare device manufacturers, hospitals and device users, to prevent potentially hazardous events due to EMI.
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[Noise level in a care and teaching hospital institution].
Mendoza-Sánchez, R S; Roque-Sánchez, R H; Moncada-González, B
1996-01-01
Noise in the environment is increasing over the years. Disturbances produced by noise are varied, some lead to serious health consequences. Noise level was registered in a teaching hospital. Levels in the wards were between 50 and 59 dB. In the Intensive Care Unit, main hallways and outpatients department levels were higher than 59 dB. Isolated peaks up to 90.0 dB (Pediatrics) were detected. The noise level recommended for a hospital is under 50.0 dB. We found that the principal source of noise came from the medical and nursing staff.