Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 6 Articles
Background: Between 75 and 89% of residents living in long-term care facilities have limited mobility. Nurses as\nwell as other licensed and unlicensed personnel directly involved in resident care are in a key position to promote\nand maintain the mobility of care-dependent persons. This requires a certain level of competence. Kinaesthetics is a\ntraining concept used to increase nursing staff�s interaction and movement support skills for assisting caredependent\npersons in their daily activities. This study aims to develop and test an observation instrument for\nassessing nursing staff�s competences in kinaesthetics.\nMethods: The Kinaesthetics Competence (KC) observation instrument was developed between January and June\n2015 based on a literature review, a concept analysis and expert meetings (18). The pilot instrument was evaluated\nwith two expert panels (n = 5, n = 4) regarding content validity, usability and inter-rater agreement. Content validity\nwas assessed by determining the content validity index (CVI). The final instrument was tested in a cross-sectional\nstudy in three nursing homes in the German-speaking part of Switzerland between July 2015 and February 2016. In\nthis study nursing staff (n = 48) was filmed during mobilization situations. Based on this video data two observers\nindependently assessed nursing staff�s competences in kinaesthetics with the KC observation instrument. Inter-rater\nreliability and inter-rater agreement was evaluated using the intra-class correlation coefficient (ICC) and percentage\nof agreement. Construct validity was assessed by a discriminating power analysis. Internal consistency was\nevaluated using Cronbach�s alpha coefficient and item analysis.\nResults: The final version of the KC observation instrument comprised of four domains (interaction, movement\nsupport of the person, nurses� movement, environment) and 12 items. The final instrument showed an excellent\ncontent validity index of 1.0. Video sequences from 40 persons were analysed. Inter-rater reliability for the whole\nscale was good (ICC 0.73) and the percentage of inter-rater agreement was 53.6% on average. Cronbach�s alpha\ncoefficient for the whole instrument was 0.97 and item-total correlations ranged from 0.76 to 0.90. The construct\nvalidity of the instrument was supported by a significant discrimination of the instrument between nursing staff\nwith no or basic and with advanced kinaesthetics training for the total score and 3 of 4 subscales. Conclusions: The KC observation instrument showed good preliminary psychometric properties and can be used\nto assess nursing staff�s competences in mobility care based on the principles of kinaesthetics...
Background: Professional misconduct in healthcare, a (generally) lasting situation in which patients are at risk or\nactually harmed, can jeopardise the health and well-being of patients and the quality of teamwork. Two types of\nprofessional misconduct can be distinguished: misconduct associated with incompetence and that associated with\nimpairment. This study aimed to (1) quantify home-care nursing staff�s experiences with actual or possible\nprofessional misconduct; (2) provide insight into the difficulty home-care nursing staff experience in reporting\nsuspicions of professional misconduct within the organisation and whether this is related to the individual\ncharacteristics of nursing staff; and (3) show which aspects of professional practice home-care nursing staff consider\nimportant in preventing professional misconduct.\nMethods: A questionnaire survey was held among registered nurses and certified nursing assistants employed in\nDutch home-care organisations in 2014. The 259 respondents (60 % response rate; mean age of 51; 95 % female)\nwere members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare\nsettings.\nResults: Forty-two percent of the nursing staff in home care noticed or suspected professional misconduct by\nanother healthcare worker during the previous year, predominantly a nursing colleague. Twenty to 52 % of the\nnursing staff experience difficulty in reporting suspicions of different forms of incompetence or impairment. This is\nrelated to educational level (in the case of incompetence), and managerial tasks (both in the case of incompetence\nand of impairment). Nursing staff consider a positive team climate (75 %), discussing incidents (67 %) and good\ncommunication between healthcare workers (57 %) most important in preventing professional misconduct among\nnursing staff.\nConclusions: Suspicions of professional misconduct by colleagues occur quite frequently among nursing staff.\nHowever, many nursing staff members experience difficulty in reporting suspicions of professional misconduct,\nespecially in the case of suspected impairment. Home-care employers and professional associations should\neliminate the barriers that nursing staff may encounter when they attempt to raise an issue. Furthermore,\nadvocating a positive team climate within nursing teams, encouraging nursing staff to discuss incidents and\nfacilitating this, and promoting good communication between healthcare workers may be appropriate strategies\nthat help reduce professional misconduct by nursing staff....
Background: Systemic inflammatory response syndrome (SIRS) and sepsis are now frequently identified by\nobservations of vital signs and detection of organ failure during triage in the emergency room. However, there is\nless focus on the effect on patient outcome with better observation and treatment at the ward level.\nMethods: This was a before-and-after intervention study in one emergency and community hospital within the\nMid-Norway Sepsis Study catchment area. All patients with confirmed bloodstream infection have been\nprospectively registered continuously since 1994. Severity of sepsis, observation frequency of vital signs, treatment\ndata, length of stay (LOS) in high dependency and intensive care units, and mortality were retrospectively\nregistered from the patients� medical journals.\nResults: The post-intervention group (n = 409) were observed better and had higher odds of surviving\n30 days (OR 2.7, 95 % CI 1.6, 4.6), lower probability of developing severe organ failure (0.7, 95 % CI 0.4, 0.9),\nand on average, 3.7 days (95 % CI 1.5, 5.9 days) shorter LOS than the pre-intervention group (n = 472).\nConclusions: In a cohort with stable mortality rates, early sepsis recognition by ward nurses may have\nreduced progression of disease and improved survival for patients in hospital with sepsis...
Background: A core objective of the Australian health system is to provide high quality, safe health care that meets the\nneeds of all Australians. To achieve this, an adequate and effective workforce must support the delivery of care.\nWith rapidly changing health care systems and consumer demographics, demand for care is increasing and retention of\nsufficient numbers of skilled staff is now a critical priority to meet current and future health care demands. Nurses are\nthe largest cohort of professionals within the health workforce. Reducing the rates at which nurses leave the profession\nand supporting nurses to practice in their profession longer will have beneficial implications for the sustainability of a\nnursing workforce and, ultimately, to patient outcomes. The aim of the study was to describe and explain early career\nregistered nursesââ?¬â?¢ (ECRNs) experiences and support requirements during the first five years of practice for the purposes\nof identifying strategies that would support greater retention of ECRNs.\nMethods: A single case study design focused on early career registered nurses (ECRNs) working in a hospital\nand health service in northern Australia. The research team adopted Djukic et alââ?¬â?¢s definition of ECRNs as ââ?¬Å?RNs\nwho have practiced for less than 5 yearsââ?¬Â. Data was collected via three individual interviews and two focus\ngroups. Thirty-five ECRNs participated in the study.\nResults: Qualitative analysis of data generated during interviews and focus groups, identified the key themes of receiving\ncareer advice and choice or no choice. Analysis of study data in the context of the broader literature resulted\nin the researchers identifying six areas of focus for ECRN retention: 1) well-planned, supported and structured\ntransition periods; 2) consideration of rotation through different areas with a six month minimum for skills development;\n3) empowering decision making; 4) placement opportunities and choice in decisions of where to work; 5) career advice\nand support that considers ECRNsââ?¬â?¢ personalities and skills; and 6) encouragement to reflect on career choices.\nConclusions: Reducing turnover and improving retention relies on understanding the factors that influence nursesââ?¬â?¢\ndecisions to leave or remain within an organisation and the profession. Ensuring nurses in the current workforce remain\nengaged and productive, rather than leave the profession, is reliant on addressing factors that cause attrition and\nimplementing strategies that strengthen retention rates and workforce sustainability....
Background: The rationale behind this study is the increasing research on relationships between patient safety,\nevidence based practice and person centered care, and the growing interest in outcomes of surgical patients. The\naim of this study was to explore the safety climate and readiness to implement evidence-based and person\ncentered care as perceived by registered nurses in Swedish surgical care.\nMethods: The design was an exploratory, cross-sectional survey carried out in a national Swedish context. Data were\ncollected through the Safety Attitudes Questionnaire (SAQ ââ?¬â?? Short form) and the Context Assessment Index (CAI).\nResults: In total, 1570 questionnaires were distributed, of which 727 were returned, giving a response rate of 46.3 %.\nThe results revealed that in general, the safety climate in Swedish surgical care is positively related to readiness for\nevidence-based and person centered care, although specific management and cultural factors may be more sensitive\nand represent targets for improvement.\nConclusion: This study presents new knowledge regarding the safety climate and readiness to implement evidence\nbased practice and person centered care in general surgical wards in university hospitals and indicates important\nassociations between these two areas. While RNs generally reported positive job satisfaction and a good team work\nculture in their units, there were indications that improvements in organizational management are needed...
Background: The pressure in out-of-hours primary care is high due to an increasing demand for care and rising\nhealth-care costs. During the daytime, substituting general practitioners (GPs) with nurse practitioners (NPs) shows\npositive results to contribute to these challenges. However, there is a lack of knowledge about the impact during\nout-of-hours. The current study aims to provide an insight into the impact of substitution on resource use,\nproduction and direct health-care costs during out-of-hours.\nMethods: At a general practitioner cooperative (GPC) in the south-east of the Netherlands, experimental teams\nwith four GPs and one NP were compared with control teams with five GPs. In a secondary analysis, GP care versus\nNP care was also examined. During a 15-month period all patients visiting the GPC on weekend days were\nincluded. The primary outcome was resource use including X-rays, drug prescriptions and referrals to the\nEmergency Department (ED). We used logistic regression to adjust for potential confounders. Secondary outcomes\nwere production per hour and direct health-care costs using a cost-minimization analysis.\nResults: We analysed 6,040 patients in the experimental team (NPs: 987, GPs: 5,053) and 6,052 patients in the\ncontrol team. There were no significant differences in outcomes between the teams. In the secondary analysis, in\nthe experimental team NP care was associated with fewer drug prescriptions (NPs 37.1 %, GPs 43 %, p < .001) and\nfewer referrals to the ED (NPs 5.1 %, GPs 11.3 %, p = .001) than GP care. The mean production per hour was 3.0\nconsultations for GPs and 2.4 consultations for NPs (p < .001). The cost of a consultation with an NP was ââ??¬3.34 less\nthan a consultation with a GP (p = .02).\nConclusions: These results indicated no overall differences between the teams. Nonetheless, a comparison of type\nof provider showed that NP care resulted in lower resource use and cost savings than GP care.\nTo find the optimal balance between GPs and NPs in out-of-hours primary care, more research is needed on the\nimpact of increasing the ratio of NPs in a team with GPs on resource use and health-care costs....
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