Kamada, Ivone; Rocha, Semíramis Melani Melo
The general purpose of this investigation was to identify parent and nursing staff expectations regarding the nurse's role in Neonatal Intensive Care Units (NICU). A descriptive study was carried out using a qualitative approach and interviews were conducted at a NICU in the interior of the State of São Paulo. Results showed new expectations on the part of parents and professionals regarding the role of NICU nurses. The knowledge identified as necessary were a family-centered approach, interpersonal relations techniques, and differentiation between technology and scientific knowledge. The conclusion is that NICU nurses need to play a more incisive role in the nursing care process, adjusting the use of technological advances to human knowledge, particularly in the area of interpersonal relationships between family members and staff, which includes activities of continuing education, such as specialization courses.
Liaw, Jen-Jiuan; Chen, Shu-Yueh; Yin, Ying-Ti
Although advances in medical technology have increased the survival rate of preterm infants, science is no cure-all for these high-risk patients. A growing number of studies report that caregiving interventions cause physiological and behavioral distress in such infants. The results have prompted changes in caregiving practices, attempting to reduce stress and strengthen protection for the infants, in order to promote their stability and development in the neonatal intensive care unit (NICU) . This study uses qualitative research methods to grasp the richness and diversity of nurses' beliefs and experience in the taking care of preterm infants. Ten groups of questions explore how NICU nurses take care of premature infants, nurses' perspectives on cue-based care, and the extent to which NICU nurses practice cue-based care. The results generated three themes: (1) timely and skillful management of the preterm infants; (2) compassionate and holistic care for the infants and their highly stressed families; and (3) the relationship between good nursing care and meeting the needs of preterm infants, families, physicians, units, and the environment. It is apparent that the approach to care delivery in NICU practice is still clinical-based, and that there are some obstacles to the delivery of cue-based care. The reasons for this include lack of knowledge, incomplete collaboration with team members, and insufficient support from the administrative systems. To improve the quality of nursing care and preterm infant outcomes, it will be necessary to educate NICU nurses on cue-based care, to enhance collaboration among all team members, to reduce their non-nursing workload, and to re-design NICUs for optimal cue-based care.
Singh, Harpreet; Yadav, Gautam; Mallaiah, Raghuram; Joshi, Preetha; Joshi, Vinay; Kaur, Ravneet; Bansal, Suneyna; Brahmachari, Samir K
Neonatal period represents first 28 days of life, which is the most vulnerable time for a child's survival especially for the preterm babies. High neonatal mortality is a prominent and persistent problem across the globe. Non-availability of trained staff and infrastructure are the major recognized hurdles in the quality care of these neonates. Hourly progress growth charts and reports are still maintained manually by nurses along with continuous calculation of drug dosage and nutrition as per the changing weight of the baby. iNICU (integrated Neonatology Intensive Care Unit) leverages Beaglebone and Intel Edison based IoT integration with biomedical devices in NICU i.e. monitor, ventilator and blood gas machine. iNICU is hosted on IBM Softlayer based cloud computing infrastructure and map NICU workflow in Java based responsive web application to provide translational research informatics support to the clinicians. iNICU captures real time vital parameters i.e. respiration rate, heart rate, lab data and PACS amounting for millions of data points per day per child. Stream of data is sent to Apache Kafka layer which stores the same in Apache Cassandra NoSQL. iNICU also captures clinical data like feed intake, urine output, and daily assessment of child in PostgreSQL database. It acts as first Big Data hub (of both structured and unstructured data) of neonates across India offering temporal (longitudinal) data of their stay in NICU and allow clinicians in evaluating efficacy of their interventions. iNICU leverages drools based clinical rule based engine and deep learning based big data analytical model coded in R and PMML. iNICU solution aims to improve care time, fills skill gap, enable remote monitoring of neonates in rural regions, assists in identifying the early onset of disease, and reduction in neonatal mortality.
Wielenga, Joke M.; Smit, Bert J.; Unk, Karel A.
PURPOSE: To study the effect of introduction of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on nursing staff job satisfaction. SUBJECTS: Registered nurses, with specialist neonatal qualifications or in training, in a level III neonatal intensive care unit (NICU) in
McCarley, Renay Marie; Dowling, Donna A; Dolansky, Mary A; Bieda, Amy
The global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families. A systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU. Four PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses. Post-intervention data revealed a 9.5 percent decrease of consistent caregivers for infants in the NICU ≤ 28 days and a 2.3 percent increase of consistent caregivers for infants in the NICU ≥ 29 days. Although these findings did not meet the goal of the specific aim, a systematic process was created to assign bedside nurses to infants. Further PDSAs will be needed to refine the process to reach the aim.
Competências, sofrimento e construção de sentido na atividade de auxiliares de enfermagem em Utin Skills, suffering and construction of meaning in the activity of auxiliary nurses in the neonatal intensive care unit (NICU
Full Text Available O artigo trata das competências requeridas/ desenvolvidas nas atividades de auxiliares de enfermagem de uma Unidade de Terapia Intensiva Neonatal (Utin em articulação com a saúde dessas trabalhadoras (o sofrimento→prazer no trabalho. A perspectiva da ergologia orienta o esforço investigativo, incorporando outros referenciais, como os contidos nos estudos de Zarifian e Dejours. No plano metodológico, ainda tendo o ponto de vista da atividade como operador sintético, foram feitos levantamento e análise de documentos e visitas à Utin, operando-se com o dispositivo Encontros sobre o Trabalho, da Comunidade Ampliada de Pesquisa (CAP. Concluiu-se que o coletivo de auxiliares, protagonista do trabalho em análise, construiu um patrimônio de conhecimentos práticos sobre o seu trabalho e uma base minimamente eficaz de transmissão desse patrimônio. Fazendo uso da abordagem 'Psicodinâmica do Trabalho', ressaltou-se o caráter desafiante que o trabalho em UTI Neonatal apresenta, o que envolve saber lidar não só com o sofrimento dos neonatos como também o de mães e familiares, inclusive como forma de defesa contra seu próprio sofrimento, evitando um rumo patogênico. Observou-se, por fim, que é premente a demanda de qualificação formal por parte dessas trabalhadoras, o que propiciaria, dentre outros importantes benefícios, um maior reconhecimento social, com efeitos positivos sobre sua própria saúde.The article deals with vocational training and skills required in the activity of nursing staff in Neonatal Intensive Care Unit (NICU in conjunction with the 'body-self' and the health of these workers. It discusses the issue of jurisdiction in synergy with other issues relevant to her, as the ratio of service and suffering→pleasure working. The perspective of Ergology guides the investigative effort, incorporating other materials such as Zarifian and Dejours. At the methodological level, even taking the viewpoint of activity as
Winner-Stoltz, Regina; Lengerich, Alexander; Hench, Anna Jeanine; OʼMalley, Janet; Kjelland, Kimberly; Teal, Melissa
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.
A library class was designed and offered to new nurses from the Neonatal Intensive Care Unit at the Children's Hospital of Michigan between 2003 and 2005. The class was intended to increase their knowledge of quality health information resources and to assist them with their smooth transition to a new health care organization. The goal of the library training class was to develop the nurses' awareness and knowledge of the library services and online resources on the organization Intranet and to improve their skills in finding reliable information related to patient care, patient parent education, and research. An evaluation study was conducted to assess the effectiveness of the library class. Although the findings demonstrated strengths of the library class, they also revealed some areas for improvement. The data gathered resulted in a number of recommendations regarding library instruction design and evaluation.
Feeley, Nancy; Genest, Christine; Niela-Vilén, Hannakaisa; Charbonneau, Lyne; Axelin, Anna
When a newborn requires neonatal intensive care unit (NICU) hospitalization, parent and infant experience an unusual often prolonged separation. This critical care environment poses challenges to parent-infant closeness. Parents desire physical contact and holding and touching are particularly important. Evidence shows that visitation, holding, talking, and skin to skin contact are associated with better outcomes for infants and parents during hospitalization and beyond. Thus, it would be important to understand closeness in this context. The purpose of this study was to explore from nurses' perspective, what do parents and nurses do to promote parent-infant closeness or provoke separation. Qualitative methods were utilized to attain an understanding of closeness and separation. Following ethics approval, purposive sampling was used to recruit nurses with varying experience working different shifts in NICUs in two countries. Nurses were loaned a smartphone over one work shift to record their thoughts and perceptions of events that occurred or experiences they had that they considered to be closeness or separation between parents and their hospitalized infant. Sample size was determined by saturation (18 Canada, 19 Finland). Audio recordings were subjected to inductive thematic analysis. Team meetings were held to discuss emerging codes, refine categories, and confirm these reflected data from both sites. One overarching theme was elaborated. Balancing closeness and separation was the major theme. Both parents and nurses engaged in actions to optimize closeness. They sought closeness by acting autonomously in infant caregiving, assuming decision-making for their infant, seeking information or skills, and establishing a connection in the face of separation. Parents balanced their desire for closeness with other competing demands, such as their own needs. Nurses balanced infant care needs and ability to handle stimulation with the need for closeness with parents
One of our roles as nurse educators is to teach best practices related to patient care. However, have you ever stopped to think about what evidence supports your teaching strategies? Just as our patients deserve care that is based on the best available evidence, our learners also deserve education that is based on evidence.1-3 With so many advances in knowledge, technology, and even life itself, it is interesting that education has changed very little over the past 100 years. A study among 946 nurse educators documented that most teach the way they were taught.4 In addition, even after learning new strategies, educators often continue teaching in the manner they are most comfortable. However, this trend is beginning to change. Nurse educators are becoming increasingly aware of and willing to try new and innovative teaching strategies. Educators are also seeking out evidence-based teaching strategies and are becoming more involved in nursing education research.
SARWONO R. Sugeng Joko
Full Text Available Acoustics comfort in a room is one of the most important building physics aspect that should be observed. in public spaces like hospital, especially in an intensive care unit such as NICU. Researches on the acoustic conditions of NICU in Indonesia are still limited. The acoustical study conducted in this research is using objective, subjective, and simulation methods based on soundscape concept with the concern on the nurse’s perception. This research was conducted at a national hospital in Jakarta. According to National Standardization Agency of Indonesia (SNI and World Health Organization (WHO, the suitable sound pressure level (SPL for noise in patient’s room is 35 dBA. From the study, it was found that the equivalent SPL value exceeded the standard. Soundscape in NICU can be improve with the addition of curtain on the incubator’s side, installation of glass partition, and ceiling absorber in the nurse station area. The result of simulation showed that the SPL in the room decreased with average value 8.9 dBA for sound source alarm ventilator and 8.2 dBA for sound source medical officer conversations. And the speech transmission index (STI increased from “bad” to “good” range became “fair” to “excellent” range.
Martel, Sara; Ives-Baine, Lori
To qualitatively explore neonatal intensive care nurses' experiences with end-of-life photography as part of their bereavement support work with families. An Interpretive Phenomenological Analysis with data collected through a focus group (n = 6) and one semi-structured interview (n = 1) with neonatal nurses from a Level 3/4 NICU in a Canadian pediatric hospital. Participants' comfort with EOL photography developed over time through exposure to bereavement scenarios and positive experiences with families. Participants' experienced a feeling of pressure to balance the photography with clinical responsibilities and find the right time to introduce photography while being sensitive to family experiences. Participants experienced EOL photography as something tangible to give families and were satisfied knowing the images might play an important role in the family's healing after the NICU. All participants had come to value EOL photography as a positive and meaningful part of their work with bereaved families. Identified challenges related to balancing the practice with the unpredictable flow and demands of critical care and to developing an appreciation for and comfort with the photography as part of their healing and the families' healing. Findings contribute insight into care-provider experience that can inform best practices, training, and staff support for palliative and bereavement work in neonatal and pediatric settings. The findings suggest a need to support nurses emotionally and clinically in carrying out this photography as part of their care for families. Copyright © 2018 Elsevier Inc. All rights reserved.
郭惠子; 田红霞; 张宁
入住新生儿重症监护室(NICU)的早产儿成为患儿父母不可忽视的压力源.父母的情绪问题对早产儿的成长、发育及心理健康影响深远.积极有效的压力护理可以帮助患儿父母缓解压力、建立亲子关系并成功完成角色转换.NICU护理应将关注重点由疾病护理拓展到患儿及其父母整体护理.本文就早产儿父母压力护理措施进行综述.%The premature infant in neonatal intensive care unit (NICU) is the pressure source of their parents. Parents' emotional problems have a profound impact on the growth,development and mental health of their infants. Positive and effective pressure care can help parents relieve stress,establish parent-child relationship and successful complete the role transiting. The focus of NICU nursing care should be expanded to holistic nursing for the children and their parents. In this paper,the pressure nursing measures for premature infant's parents will be summarized.
This study tested the use of a developmentally supportive care (DSC) training program in the form of videotaped and personalized instruction to increase nurses' cognitive abilities for assessing preterm infant behavioral signals and offering supportive care. The study used a two-group pre-test post-test quasi-experimental repeated measures design. The participants were 25 NICU nurses, 13 in the intervention group, and 12 in the control group. An instrument developed for the purpose of the study was a video test that measured the effectiveness of the DSC training. The video test questionnaires were administered to the participants twice with an interval of four weeks. ANCOVA controlling the baseline scores was used for data analysis. In general, the results support the hypothesis that nurses' cognitive abilities were enhanced after the DSC training. The increase in nurses' cognitive abilities is the prerequisite for behavioral change, based on the assumptions of Bandura's Social Cognitive Learning Theory (Bandura, 1986). As nurses' cognitive abilities increased, it would be possible that nurse behaviors in taking care of these preterm infants might change. Therefore, the author recommends that in order to improve NICU care quality and the outcomes of preterm infants, the concepts of developmentally supportive care be incorporated into NICU caregiving practice by educating nurses.
Vitner, Gad; Nadir, Erez; Feldman, Michael; Yurman, Shmuel
The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. The process started with the department head's decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ISO 9001 is becoming a recommended tool to improve clinical service quality.
Chen, Lin; Huang, Li-Hua; Xing, Mei-Yuan; Feng, Zhi-Xian; Shao, Le-Wen; Zhang, Mei-Yun; Shao, Rong-Ya
To develop nursing-sensitive quality indicators consistent with current medical practices in Chinese neonatal intensive care units. The development of nursing-sensitive quality indicators has become a top priority in nursing management. To the best of our knowledge, there has been no objective, scientific and sensitive evaluation of the quality of neonatal intensive care unit nursing in China. A modified Delphi technique was used to seek opinions from experts about what should be used and prioritised as indicators of quality care in neonatal intensive care unit nursing. Based on a literature review, we identified 21 indicators of nursing-sensitive quality in the neonatal intensive care unit. Our group of 11 consultants chose 13 indicators to be discussed using the Delphi method. In October and November 2014, 39 neonatal intensive care unit experts in 18 tertiary hospitals spread across six provinces participated in two rounds of Delphi panels. Of the 13 indicators discussed, 11 were identified as indicators of nursing-sensitive quality in the neonatal intensive care unit: rate of nosocomial infections, rate of accidental endotracheal extubation, rate of errors in medication administration, rate of treatment for pain, rate of peripheral venous extravasation, rate of compliance with handwashing techniques, incidence of pressure ulcers, incidence of noise, the bed-to-care ratio, the proportion of nurses with greater than five years neonatal intensive care unit experience and incidence of retinopathy. The 11 neonatal intensive care unit nursing-sensitive indicators identified by the Delphi method integrated with basic Chinese practices provide a basis for nursing management and the monitoring of nursing quality. This study identified nursing-sensitive quality indicators for neonatal intensive care unit care that are suitable for current clinical practice in China. © 2016 John Wiley & Sons Ltd.
Fabbri, Giuliana; Panico, Manuela; Dallolio, Laura; Suzzi, Roberta; Ciccia, Matilde; Sandri, Fabrizio; Farruggia, Patrizia
Klebsiella pneumoniae is a frequent cause of infectious outbreaks in Neonatal Intensive Care Units (NICUs). The aim of this paper is to describe an outbreak occurred in a 13-bed NICU and the control measures adopted in order to interrupt the chain of transmission. We described the microbiological investigations, the NICU staff compliance to the infection control measures by means of a specifically designed check-list and the control measures adopted. Six cases of primary bloodstream infection...
Cleveland, Lisa Marie
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.
Full Text Available Abstract Background This study aimed to determine the occurrence of nosocomial infections (NIs, including infection rates, main infection sites, and common microorganisms. Patients included in the study were taken from a newborn intensive care unit (NICU, in a hospital in South Korea. Methods A retrospective cohort study was performed by reviewing chart. The subjects were 489 neonates who were admitted to the NICU, survived longer than 72 hours, and not transferred to another unit, between Jan. 1. 1995 to Sep. 30, 1999. NIs were identified according to the NNIS definition. Data were analyzed with descriptive statistics. Results Cumulative incidence rate for NIs was 30.3 neonates out of 100 admissions, with a total of 44.6 infections. The incidence density was average 10.2 neonates and 15.1 infections per 1000 patient days. The most common infections were pneumonia (28%, bloodstream infection (26%, and conjunctivitis (22%. Major pathogens were Gram-positives such as Staphylococcus aureus and coagulase-negative staphylococci. The factors associated with NI was less than 1500 g of birth weight, less than 32 weeks of gestational age, and less than 8 of apgar score. There's no statistical difference in discharge status between two groups, but hospital stay was longer in subjects with nosocomial infection than those without infection. Conclusion Although the distribution of pathogens was similar to previous reports, a high rate of nosocomial infection and in particular conjunctivitis was observed in this study that merits further evaluation.
Hallowell, Sunny G.; Spatz, Diane L.; Hanlon, Alexandra L.; Rogowski, Jeannette A.; Lake, Eileen T.
PURPOSE The provision of breastfeeding support in the neonatal intensive care unit (NICU) may assist a mother to develop a milk supply for the NICU infant. Human milk offers unique benefits and its provision unique challenges in this highly vulnerable population. The provision of breastfeeding support in this setting has not been studied in a large, multihospital study. We describe the frequency of breastfeeding support provided by nurses and examined relationships between NICU nursing characteristics, the availability of a lactation consultant (LC), and breastfeeding support. SUBJECTS AND DESIGN This was a secondary analysis of 2008 survey data from 6060 registered nurses in 104 NICUs nationally. Nurse managers provided data on LCs. These NICUs were members of the Vermont Oxford Network, a voluntary quality and safety collaborative. METHODS Nurses reported on the infants (n = 15,233) they cared for on their last shift, including whether breastfeeding support was provided to parents. Breastfeeding support was measured as a percentage of infants on the unit. The denominator was all infants assigned to all nurse respondents on that NICU. The numerator was the number of infants that nurses reported providing breastfeeding support. Nurses also completed the Practice Environment Scale of the Nursing Work Index (PES-NWI), a nationally endorsed nursing care performance measure. The NICU nursing characteristics include the percentages of nurses with a BSN or higher degree and with 5 or more years of NICU experience, an acuity-adjusted staffing ratio, and PES-NWI subscale scores. Lactation consultant availability was measured as any/none and in full-time equivalent positions per 10 beds. RESULTS The parents of 14% of infants received breastfeeding support from the nurse. Half of the NICUs had an LC. Multiple regression analysis showed a significant relationship between 2 measures of nurse staffing and breastfeeding support. A 1 SD higher acuity-adjusted staffing ratio was
Martin, A E; D'Agostino, J A; Passarella, M; Lorch, S A
Nurses provide parental support and education in the neonatal intensive care unit (NICU), but it is unknown if satisfaction and expectations about nursing care differ between racial groups. A prospective cohort was constructed of families with a premature infant presenting to primary care between 1 January 2010 and 1 January 2013 (N=249, 52% white, 42% black). Responses to questions about satisfaction with the NICU were analyzed in ATLAS.ti using the standard qualitative methodology. One hundred and twenty (48%) parents commented on nursing. Fifty-seven percent of the comments were positive, with black parents more negative (58%) compared with white parents (33%). Black parents were most dissatisfied with how nurses supported them, wanting compassionate and respectful communication. White parents were most dissatisfied with inconsistent nursing care and lack of education about their child. Racial differences were found in satisfaction and expectations with neonatal nursing care. Accounting for these differences will improve parental engagement during the NICU stay.
Doede, Megan; Trinkoff, Alison M; Gurses, Ayse P
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.
Full Text Available Klebsiella pneumoniae is a frequent cause of infectious outbreaks in Neonatal Intensive Care Units (NICUs. The aim of this paper is to describe an outbreak occurred in a 13-bed NICU and the control measures adopted in order to interrupt the chain of transmission. We described the microbiological investigations, the NICU staff compliance to the infection control measures by means of a specifically designed check-list and the control measures adopted. Six cases of primary bloodstream infections sustained by ampicillin/piperacillin-resistant Klebsiella pneumoniae were observed over a two-month period. One culture obtained from a 12% saccarose multiple-dose solution allowed the growth of Klebsiella pneumoniae. During the inspections performed by the Hospital Infection Control Team, using the check-list for the evaluation of the NICU staff compliance to the infection control measures, several breaches in the infection control policy were identified and control measures were adopted. In our case the definition of a specific check-list led to the adoption of the correct control measures. Further studies would be helpful in order to develop a standard check-list able to identify critical flows in the adhesion to the guidelines. It could be used in different NICUs and allow to obtain reproducible levels of infection control.
Fabbri, Giuliana; Panico, Manuela; Dallolio, Laura; Suzzi, Roberta; Ciccia, Matilde; Sandri, Fabrizio; Farruggia, Patrizia
Klebsiella pneumoniae is a frequent cause of infectious outbreaks in Neonatal Intensive Care Units (NICUs). The aim of this paper is to describe an outbreak occurred in a 13-bed NICU and the control measures adopted in order to interrupt the chain of transmission. We described the microbiological investigations, the NICU staff compliance to the infection control measures by means of a specifically designed check-list and the control measures adopted. Six cases of primary bloodstream infections sustained by ampicillin/piperacillin-resistant Klebsiella pneumoniae were observed over a two-month period. One culture obtained from a 12% saccarose multiple-dose solution allowed the growth of Klebsiella pneumoniae. During the inspections performed by the Hospital Infection Control Team, using the check-list for the evaluation of the NICU staff compliance to the infection control measures, several breaches in the infection control policy were identified and control measures were adopted. In our case the definition of a specific check-list led to the adoption of the correct control measures. Further studies would be helpful in order to develop a standard check-list able to identify critical flows in the adhesion to the guidelines. It could be used in different NICUs and allow to obtain reproducible levels of infection control.
Full Text Available Bacteremia continues to result in significant morbidity and mortality, particularly among neonates. There is scarce data on neonatal bacteremia in among Iranian neonates. In this study, we determined neonatal bacteremia isolates and their antibiotic resistance pattern in neonatal insensitive care unit at Beasat hospital, Sanandaj, Iran. During one year, all neonates admitted to the NICU were evaluated. Staphylococcal isolates were subjected to determine the prevalence of MRS and mecA gene. A total of 355 blood cultures from suspected cases of sepsis were processed, of which 27 (7.6% were positive for bacterial growth. Of the 27 isolates, 20 (74% were Staphylococcus spp as the leading cause of bacteremia. The incidence of Gram negative bacteria was 04 (14.8%. The isolated bacteria were resistant to commonly used antibiotics. Maximum resistance among Staphylococcus spp was against Penicillin, and Ampicillin. In our study, the isolated bacteria were 7.5 % Vancomycin and Ciprofloxacin sensitive. Oxacillin disk diffusion and PCR screened 35% and 30% mec a positive Staphylococcus spp. The spectrum of neonatal bacteremia as seen in NICU at Beasat hospital confirmed the importance of pathogens such as Staphylococcus spp. Penicillin, Ampicillin and Cotrimoxazol resistance was high in theses isolates with high mecA gene carriage, probably due to antibiotic selection.
Taysa Costa da Silva
Full Text Available Objective: To verify the main measures of care for the newborn in the neonatal intensive care unit. Method: This is an integrative review, in which, it is possible to identify, analyze and synthesize research results with the inclusion of experimental and non-experimental studies. A total of 133 articles were collected. After reading titles, exclusion criteria and reading resumes, 10 were left, in which the sample was composed. Results: The selected publications were placed in 3 thematic categories: The importance of knowledge in nursing care, to the internal NB in NICU; Nursing evaluation and care used for pain relief in NB; Main factors and adverse events that may lead to the hospitalization of the newborn and the increase of morbidity and mortality in an NICU. Conclusion: The analysis of the aforementioned study exposes the importance and main nursing care that can be administered in newborns in a NICU, so that the reduction of neonatal mortality can be provided. Descriptors: Neonatal Intensive Care Unit; Nursing care; Newborn.
Background Parents of infants hospitalized in the neonatal intensive care unit (NICU) find themselves in a situation of emotional strain. Communication in the NICU presents special challenges due to parental stress and the complexity of the highly technologized environment. Parents’ need for communication may not always be met by the NICU staff. This study aimed to describe strengths and weaknesses of parent–nurse and parent–doctor communication in a large level III NICU in Sweden in order to improve our understanding of parents’ communication needs. Methods Parents were asked to complete a survey consisting of sixteen questions about their experiences of communication with nurses and doctors in the NICU. In each question the parents evaluated some aspect of communication on a five- or six-point Likert scale. They also had the opportunity on each question to comment on their experiences in their own words. Data were analyzed using IBM SPSS Statistics 20.0 and qualitative manifest content analysis. Results 270 parents (71.4%) completed the survey. Parents generally rated communication with the staff in the NICU positively and appreciated having received emotional support and regular information about their child´s care. Although a large majority of the parents were satisfied with their communication with doctors and nurses, only about half of the parents felt the nurses and doctors understood their emotional situation very well. Some parents would have desired easier access to conversations with doctors and wanted medical information to be given directly by doctors rather than by nurses. Parents’ communication with the staff was hampered when many different nurses were involved in caring for the infant or when the transfer of information in connection with shift changes or between the maternity ward and NICU was poor. Parents also desired to be present during doctors’ rounds on their infant. Conclusions Training both doctors and nurses in communication
Random safety audits (RSA) have been shown to be effective in improving standards of clinical practice. 19 data collection audits were performed relating to hygiene, safe prescribing, oxygen pulse oximetry monitoring and documentation in keeping with the requirements of the new Medical Practitioners Act (MPA) 2007. Hygiene audits (range from 20\\/25 to 21\\/21 80%-100%) and safe prescribing audits (range from 23\\/25 to 25\\/25 86%-100%) achieved n=25 100% compliance with unit guidelines over a 3 month period. Compliance with oxygen pulse oximetry monitoring guideline limits improved from 4\\/27 (15%) to 9\\/16 (56%). Compliance with requirement and use of Physician IMC registration number in documentation was only 10\\/18 (56%). RSA\\'s led to improvements in hygiene and prescribing. Compliance with oxygen monitoring guideline limits highlighted the need for greater education. Awareness of legal requirements relating to documentation improved but this has not translated into a change in practice. RSA\\'s can facilitate real time quality improvement in daily clinical practice.
In this 14-month ethnographic study, I examined the emotional labor and coping strategies of 114, level-4, neonatal intensive care unit (NICU) nurses. Emotional labor was an underrecognized component in the care of vulnerable infants and families. The nature of this labor was contextualized within complex personal, professional, and organizational layers of demand on the emotions of NICU nurses. Coping strategies included talking with the sisterhood of nurses, being a super nurse, using social talk and humor, taking breaks, offering flexible aid, withdrawing from emotional pain, transferring out of the NICU, attending memorial services, and reframing loss to find meaning in work. The organization had strong staffing, but emotional labor was not recognized, supported, or rewarded. The findings can contribute to the development of interventions to nurse the nurse, and to ultimately facilitate NICU nurses' nurturance of stressed families. These have implications for staff retention, job satisfaction, and delivery of care.
Amin, Amee A; Vankar, Jagdish R; Nimbalkar, Somashekhar M; Phatak, Ajay G
To study the levels of perceived stress in Neonatal Intensive Care Unit (NICU) nurses and its association with professional quality of life domains viz. compassion satisfaction, burnout and secondary trauma. In this multicenter, cross sectional study, data was collected by surveying 129 nurses from nine NICUs across six cities of Gujarat, India using demographic questionnaire, Perceived Stress Scale (PSS14) and Professional Quality of Life Scale (ProQOL5) during July to September 2013. Descriptive statistics, correlation coefficient and multiple regression were used for analysis. The mean (SD) age of participants was 28.37 (8.20) y. Most were single, satisfied with salary benefits and reported 'good' to 'excellent' relationships at work. The mean (SD) duration of duty hours was 8.12 (0.76) h and 43.6% were attending to more than 4 patients/shift. The mean (SD) perceived stress level was 22.19 (7.17) [Range: 3 to 39]. High compassion satisfaction, high burnout, and high secondary traumatic stress were reported by 25 (19.4%), 30 (23.3%) and 30 (23.3%) nurses respectively. PSS14 was negatively correlated with compassion satisfaction (r = -0.28) and positively correlated with burnout (r = 0.43) and secondary traumatic stress (r = 0.24). Most of the nurses (91, 70.5%) were identified as perceiving moderate to high stress. Professional quality of life domains correlated with perceived stress. There is further need to study domains influencing NICU nurses' professional QOL. Identifying stress and QOL issues in NICU nurses can help formulate relevant policies.
Mohammad Mehdi Soltan Dallal
Full Text Available Background: In recent years, changing the infant feeding methods and the growing trend of use powdered infant formula (PIF has raised concern about quality and health assessment among them. These products are contaminated with various pathogenic bacteria such as Bacillus cereus which the presence of this bacteria in PIF is important because of consumer age group and virulence of this bacteria in PIF. The aim of this study was to determine the frequency of Bacillus cereus in powdered milk infant formula consuming in neonatal intensive care unit (NICU in Tehran hospitals in 2013-14. Material and Methods: In this cross-sectional study, 125 samples of powdered infant formula milk which were used in Neonatal Intensive Care Unit (NICU were surveyed during 8 month in 2014. Isolation and identification of microorganisms (including Bacillus cereus were carried out according to FDA standard protocol (FDA method on B. cereus selective agar (MYP Agar. Results: The results of present study showed that of 125 samples from of consumable powdered infant formula milk, 84 (67.2% samples were contaminated with B.cereus and also 18 (14.4% samples were contaminated by more than one B.cereus species. Conclusion: As regards pasteurization process is not effective on the spore of B.cereus., The spores of these bacteria can remain in PIF and can cause food poisoning in infants. For this purpose, more attention to quality control of production units and imported powder milk is recommended in Iranian infant foods.
Adaptação cultural e validação para a língua portuguesa da Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU Adaptación cultural y validación al idioma português del Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU Cultural adaptation and validation for the portuguese language of the Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU
Sandra Regina de Souza
Full Text Available OBJETIVO: Traduzir, realizar a adaptação cultural e validar a escala Parental Stress Scale:Neonatal Intensive Care Unit (PSS:NICU para a língua portuguesa. MÉTODOS: Utilizou-se o método descritivo de validação de instrumentos de medida, baseado nas etapas propostas por Guillemin et al. A análise da confiabilidade foi realizada por meio dos testes e retestes e da consistência interna. Na validação clínica, participaram 163 pais de recém-nascidos internados em Unidade de Terapia Intensiva Neonatal (UTIN. RESULTADOS: Os coeficientes de correlação intraclasse ficaram em torno de 0,70 mostrando boa estabilidade entre as duas avaliações. A análise fatorial pelo método de componentes principais utilizou os mesmos critérios da escala original, com rotação Varimax, com grau de variância adequado de 57,9%. Os maiores níveis de estresse dos pais foram obtidos na subescala "alteração do papel de pais". CONCLUSÃO: A PSS:NICU na versão em português é uma ferramenta válida e confiável para avaliação do estresse de pais com filho internado na UTIN.OBJETIVO: Traducir, realizar la adaptación cultural y validar la escala Parental Stress Scale:Neonatal Intensive Care Unit (PSS:NICU al idioma portugués. MÉTODOS: Se utilizó el método descriptivo de validación de instrumentos de medida, basado en las etapas propuestas por Guillemin et al. El análisis de la confiabilidad fue realizado por medio de los tests y retests y de la consistencia interna. En la validación clínica, participaron 163 padres de recién nacidos internados en una Unidad de Cuidados Intensivos Neonatal (UCIN. RESULTADOS: Los coeficientes de correlación intraclase quedaron alrededor de 0,70 mostrando buena estabilidad entre las dos evaluaciones El análisis factorial por el método de componentes principales utilizó los mismos criterios de la escala original, con rotación Varimax, con grado de varianza adecuado de 57,9%. Los mayores niveles de estrés de
Ingjerd G. Kymre
Full Text Available This article illuminates the essence of Neonatal Intensive Care Unit (NICU nurses’ attitudes in skin-to-skin care (SSC practice for preterm infants and their parents. Health care providers are in a unique position to influence the dynamic between infants and parents, and SSC affects both partners in the dyad. The design is descriptively phenomenological in terms of reflective lifeworld approach. Eighteen Swedish, Danish, and Norwegian nurses from NICUs offering varied possibilities and extents of SSC participated. NICU nurses’ attitudes in SSC practice are ambivalent. The nurses consider the sensory, wellness, and mutuality experiences to be primary and vital and enact SSC as much as possible. But “as much as possible” is a broad and varied concept, and their attitudes are ambivalent in terms of not always facilitating what they consider to be the optimal caring conditions. The source of NICU nurses’ ambivalent attitudes in SSC practice is a complex interplay of beliefs, norms, and evidence, which have a multidisciplinary basis. The ambivalent attitudes are, to a great extent, the result of the need to balance these multidisciplinary concerns. This needs to be acknowledged in considering SSC practice, as well as acknowledging that clinical judgments concerning optimal SSC depend on parents and infants unlimited access to each other, which NICU nurses can influence.
Pölkki, Tarja; Laukkala, Helena; Korhonen, Anne
Despite growing knowledge of parents' important role in their infants' pain management, the extent to which nurses in neonatal intensive care units (NICUs) provide guidance to parents on nonpharmacological methods is unclear. This study aimed to describe and compare the perceptions of parental guidance in using nonpharmacological pain-relieving methods among neonates in NICUs from the viewpoints of nurses and parents, and to examine the participants' demographics related to the guidance. A cross-sectional, descriptive, correlational study using questionnaire surveys was conducted. Eight NICUs of 5 university hospitals in Finland. A total of 427 participants, including 294 nurses and 178 parents. The participants indicated that the methods of touching and holding were the most commonly introduced strategies in infants' pain alleviation, as they were given as an alternative "nearly always/always" (nurses 91%, 87% and parents 61%, 58%, respectively). In contrast, music and breast-feeding were the less commonly introduced nonpharmacological methods (nurses 11%, 6% and parents 1%, 6%, respectively). A significant difference (p methods compared with parents. In addition, many demographic factors of the nurses, the parents, and their infants were related to the parental guidance. Our findings indicate that parental guidance should not be based on nurses' evaluations of their activities without taking into account parents' perspectives. When counseling parents to use nonpharmacological methods, neonatal nurses should actively interact with families and discuss parents' individual needs. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
As expectativas de pais e profissionais de enfermagem em relação ao trabalho da enfermeira em UTIN Las expectativas de los padres y profesionales de enfermería en relación al trabajo de la enfermera en UCIN Parents and nursing staff's expectations regarding the nurse's work in a NICU
ás incisiva de la enfermera en el cuidado de enfermería, sobre todo en las relaciones interpersonales entre familiares y el equipo; contemplando actividades de educación contínua a ejemplo del curso de especialización.The general purpose of this investigation was to identify parent and nursing staff expectations regarding the nurse's role in Neonatal Intensive Care Units (NICU. A descriptive study was carried out using a qualitative approach and interviews were conducted at a NICU in the interior of the State of São Paulo. Results showed new expectations on the part of parents and professionals regarding the role of NICU nurses. The knowledge identified as necessary were a family-centered approach, interpersonal relations techniques, and differentiation between technology and scientific knowledge. The conclusion is that NICU nurses need to play a more incisive role in the nursing care process, adjusting the use of technological advances to human knowledge, particularly in the area of interpersonal relationships between family members and staff, which includes activities of continuing education, such as specialization courses.
Taylor, Cheryl R; LaMar, Kimberly L
With advances in neonatal and obstetric care over the past few years, the number of premature, multiple-birth neonates entering NICUs has increased. As we have started to recognize the special bond that twins and higher multiples share, cobedding has emerged as an NICU practice. As with any change, the introduction of cobedding presents challenges in the NICU. Both the theoretical benefits anti the potential concerns are many. Although nursing staff and parents may be excited about the prospect of placing these infants in the same crib, careful investigation and planning are necessary for any new procedure. This article discusses the cobedding of multiples as implemented at the University of Michigan. As a new practice, cobedding warrants further research, especially regarding its proposed benefits and implementation in the NICU.
Hoang, Danthanh; Khawar, Nayaab; George, Maria; Gad, Ashraf; Sy, Farrah; Narula, Pramod
To increase the hand-washing (HW) duration of staff and visitors in the NICU to a minimum of 20 seconds as recommended by the CDC. Intervention included video didactic triggered by motion sensor to play above wash basin. Video enacted Centers for Disease Control and Prevention (CDC) HW technique in real time and displayed timer of 20 seconds. HW was reviewed from surveillance video. Swabs of hands plated and observed for qualitative growth (QG) of bacterial colonies. In visitors, the mean HW duration at baseline was 16.3 seconds and increased to 23.4 seconds at the 2-week interval (p = .003) and 22.9 seconds at the 9-month interval (p < .0005). In staff, the mean HW duration at baseline was 18.4 seconds and increased to 29.0 seconds at 2-week interval (p = .001) and 25.7 seconds at the 9-month interval (p < .0005). In visitors, HW compliance at baseline was 33% and increased to 52% at the 2-week interval (p = .076) and 69% at the 9-month interval (p = .001). In staff, HW compliance at baseline was 42% and increased to 64% at the 2-week interval (p = .025) and 72% at the 9-month interval (p = .001). Increasing HW was significantly associated with linear decrease in bacterial QG. The intervention significantly increased mean HW time, compliance with a 20-econd wash time and decreased bacterial QG of hands and these results were sustained over a 9-month period. © 2018 American Society for Healthcare Risk Management of the American Hospital Association.
Diers, Donna; Hendrickson, Karrie; Rimar, Joan; Donovan, Donna
Nursing units are social systems whose function depends on many variables. Available nursing data, combined with a theory of organizational diagnosis, can be used to understand nursing unit performance. One troubled unit served as a case study in organizational diagnosis and treatment using modern methods of data mining and performance improvement. Systems theory did not prescribe how to fix an underbounded system. The theory did suggest, however, that addressing the characteristics of overbounded and underbounded systems can provide some order and structure and identify helpful resources. In this instance, the data analysis served to help define the unit's problems in conjunction with information gained from talking with the nurses and touring the unit, but it was the theory that gave hints for direction for change.
McDonald, Katie; Rubarth, Lori Baas; Miers, Linda J
The purpose of this study was to describe the job satisfaction of neonatal intensive care unit (NICU) nurses in the Midwestern United States. The factors explored in job satisfaction were monetary compensation (pay), job stress, caring for patients in stressful situations, level of autonomy, organizational support, level of knowledge of the specialty, work environment, staffing levels, communication with physicians, communication with neonatal nurse practitioners, interdisciplinary communication, team spirit, and the amount of required "floating" to other nursing units. Participants were 109 NICU nurses working as either staff nurses (n = 72) or advanced practice nurses (n = 37). Of the participants, 96% worked in a level 3 NICU. A descriptive, correlational design was used to study job satisfaction among NICU nurses. Nurses were recruited at 2 regional NICU conferences in 2009 and 2010. The questionnaire was a researcher-developed survey consisting of 14 questions in a Likert-type response rating 1 to 5, with an area for comments. Descriptive statistics and correlations were used to analyze the resulting data. The majority of participants were moderately satisfied overall in their current position and workplace (mean ranking = 4.07 out of 5.0). Kendall's Tau b (TB) revealed that the strongest positive correlations were between organizational support and team spirit with overall job satisfaction (TB = 0.53). : The individual factors with the highest mean scores were caring for patients in a stressful situation, level of autonomy, and communication between nurses and neonatal nurse practitioners. This indicates that our population of NICU nurses feels most satisfied caring for patients in stressful situations (m = 4.48), are satisfied with their level of autonomy (M = 4.17), and are satisfied with the interdisciplinary communication in their units (m = 4.13). Nurses in the NICU are relatively satisfied with their jobs. The small sample size (n = 109) of Midwest NICU
Shimizu, Aya; Mori, Akiko
To evaluate maternal perceptions of family-centred support with hospitalised preterm infants and their relationship between mothers and nurses in the neonatal intensive care unit (NICU). Mothers who gave birth to preterm infants tend to suffer more stress and need individual support based on family-centred care. However, there may be a shortage of support for mothers to obtain parent-crafting skills before bringing their infants home. This cross-sectional study used path analysis and multiple group analysis to evaluate a structural equation model of the relationship between maternal perception based on family-centred support in parent-crafting training and the mothers-nurses collaboration. We analysed data from 98 mothers (valid response proportion, 41.0%) whose infants were hospitalised in the NICU of two types of perinatal centres in Japan. We used three revised standardised questionnaires in Japanese: Measure of Process of Care in the NICU (Neo-MPOC 20), Enabling Practice Scale in the NICU (Neo-EPS) and the author-developed Mother and Infant Questionnaire. Path analysis revealed that the relationship between mothers and nurses was linked to three factors related to the perinatal centres' support: consideration of parents' feelings, ability to deal with specific needs and coordination in dealing with situations that interact with provision of parent-friendly visual information. Separate path analyses for each perinatal centre showed the same pattern, although the standard coefficients were different. Maternal perceptions of family-centred support with hospitalised preterm infants promoted better collaboration between mothers and nurses to obtain parent-crafting skills at two types of perinatal units in Japan. Clear visual information materials might promote better maternal understanding of their infants, help in acquisition of parent-crafting skills and improve mother-nurse collaboration, with the result that mothers are better able to care for their infants
Hartz, Lacey E; Bradshaw, Wanda; Brandon, Debra H
To identify how the neonatal intensive care unit (NICU) environment potentially influences the microbiome high-risk term and preterm infants. Electronic databases utilized to identify studies published in English included PubMed, Google Scholar, Cumulative Index for Nursing and Allied Health Literature, and BioMedSearcher. Date of publication did not limit inclusion in the review. Two hundred fifty articles were assessed for relevance to the research question through title and abstract review. Further screening resulted in full review of 60 articles. An in-depth review of all 60 articles resulted in 39 articles that met inclusion criteria. Twenty-eight articles were eliminated on the basis of the type of study and subject of interest. Studies were reviewed for information related to environmental factors that influence microbial colonization of the neonatal microbiome. Environment was later defined as the physical environment of the NICU and nursery caregiving activities. Studies were characterized into factors that impacted the infant's microbiome—parental skin, feeding type, environmental surfaces and caregiving equipment, health care provider skin, and antibiotic use. Literature revealed that various aspects of living within the NICU environment do influence the microbiome of infants. Caregivers can implement strategies to prevent environment-associated nosocomial infection in the NICU such as implementing infection control measures, encouraging use of breast milk, and decreasing the empirical use of antibiotics.
Full Text Available Backgrounds & aim: Early diagnosis of developmental delays in children with high risk history of hospitalization in the intensive care unit is essential. Children with one or more risk factors before or around birth are more at risk for developmental delay. The aim of this study was to determine the evolution and history of premature children admitted to the neonatal intensive care unit. Methods: the present descriptive study was conducted on 80 premature children admitted to the neonatal intensive care unit of the Imam Sajad (AS hospital, Yasuj, Iran, with a history of developmental delay at the ages of 4, 6.12 months using the ASQ questionnaire. The questionnaire contains 30 questions including five fields such as communication, gross motor, fine motor, social-personal, problem solving. Along with questionnaire, other essential information were completed. The collected data were analyzed using Chi-square test. Results: among 80 patients, 43 cases (53.8 % were male, with an average weight of 1734.37+-445.50 gr. Regarding communication, gross motor, fine motor, social-personal, problem solving, the results were abnormal at the rate of 10, 30, 27.5, 23.8 and 23.8% respectively. There was no significant relationship found among different fields of development, birth weight, gestational age and Apgar score a significant relationship was found. A significant relationship between infants born through normal delivery and infants born via Caesarean section was realized (p<0.05. Conclusion: Despite the natural evolution, the majority of premature children with a history of NICU admission, a significant number have developmental disorder and need to consider early to avoid complications in the future.
Balion, Cynthia; Grey, Vijaylaxmi; Ismaila, Afisi; Blatz, Susan; Seidlitz, Wendy
Abstract Background Point of care (POC) glucose meters are routinely used as a screening tool for hypoglycemia in a neonatal setting. Glucose meters however, lack the same accuracy as laboratory instruments for glucose measurement. In this study we investigated potential reasons for this inaccuracy and established a cut off value for confirmatory testing. Methods In this prospective study, all patients in the neonatal intensive care unit who had a plasma glucose test ordered were eligible to ...
Hallowell, Sunny G; Rogowski, Jeannette A; Lake, Eileen T
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.
Full Text Available Abstract Background Point of care (POC glucose meters are routinely used as a screening tool for hypoglycemia in a neonatal setting. Glucose meters however, lack the same accuracy as laboratory instruments for glucose measurement. In this study we investigated potential reasons for this inaccuracy and established a cut off value for confirmatory testing. Methods In this prospective study, all patients in the neonatal intensive care unit who had a plasma glucose test ordered were eligible to participate. Demographic information, sample collection information (nine variables and a recent hematocrit value were recorded for each sample. Glucose measurements were taken at the bedside on the glucose meter (RN PCx as well as in the laboratory on both the glucose meter (LAB PCx and the laboratory analyzer (PG. Data were analyzed by simple and mixed-effects regression analysis and by analysis of a receiver operator characteristics (ROC curve. Results There were 475 samples analyzed from 132 patients. RN PCx values were higher than PG values (mean = 4.9%, while LAB PCx results were lower (mean = -5.2% than PG values. Only 31% of the difference between RN PCx – PG and 46% of the difference for LAB PCx – PG could be accounted for by the variables tested. The largest proportion of variance between PCx and PG measurements was explained by hematocrit (about 30% with a greater effect seen at glucose concentrations ≤4.0 mmol/L (≤72 mg/dL(48% and 40% for RN PCx and LAB PCx, respectively. The ROC analysis showed that for detection of all cases of hypoglycemia (PG Conclusion The large difference between glucose results obtained by PCx glucose meter compared to the laboratory analyzer can be explained in part by hematocrit and low glucose concentration. These results emphasize that the glucose meter is useful only as a screening device for neonatal hypoglycemia and that a screening cut off value must be established.
Balion, Cynthia; Grey, Vijaylaxmi; Ismaila, Afisi; Blatz, Susan; Seidlitz, Wendy
Point of care (POC) glucose meters are routinely used as a screening tool for hypoglycemia in a neonatal setting. Glucose meters however, lack the same accuracy as laboratory instruments for glucose measurement. In this study we investigated potential reasons for this inaccuracy and established a cut off value for confirmatory testing. In this prospective study, all patients in the neonatal intensive care unit who had a plasma glucose test ordered were eligible to participate. Demographic information, sample collection information (nine variables) and a recent hematocrit value were recorded for each sample. Glucose measurements were taken at the bedside on the glucose meter (RN PCx) as well as in the laboratory on both the glucose meter (LAB PCx) and the laboratory analyzer (PG). Data were analyzed by simple and mixed-effects regression analysis and by analysis of a receiver operator characteristics (ROC) curve. There were 475 samples analyzed from 132 patients. RN PCx values were higher than PG values (mean = 4.9%), while LAB PCx results were lower (mean = -5.2%) than PG values. Only 31% of the difference between RN PCx--PG and 46% of the difference for LAB PCx--PG could be accounted for by the variables tested. The largest proportion of variance between PCx and PG measurements was explained by hematocrit (about 30%) with a greater effect seen at glucose concentrations LAB PCx, respectively). The ROC analysis showed that for detection of all cases of hypoglycemia (PG < 2.6 mmol/L)(PG < 47 mg/dL) the PCx screening cut off value would need to be set at 3.8 mmol/L (68 mg/dL) requiring 20% of all samples to have confirmatory analysis by the laboratory method. The large difference between glucose results obtained by PCx glucose meter compared to the laboratory analyzer can be explained in part by hematocrit and low glucose concentration. These results emphasize that the glucose meter is useful only as a screening device for neonatal hypoglycemia and that a screening
Baernholdt, Marianne; Mark, Barbara A
The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Research in urban hospitals has found an association between the nurse work environment and job satisfaction and turnover rates, but this association has not been examined in rural hospitals. Rural and urban nursing units were compared in a national random sample of 97 United States hospitals (194 nursing units) with between 99 and 450 beds. Significant differences were found between hospital and nursing unit characteristics and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics and the work environment were found to have a significant influence on nurse job satisfaction and turnover rates. Job satisfaction and turnover rates in rural and urban nursing units are associated with both nursing unit characteristics and the work environment. Both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, such as creating better support services and a work environment that supports autonomous nursing practice. Rural hospitals can also improve the work environment by providing nurses with more educational opportunities.
Neonates, especially those in neonatal intensive care units (NICU), are at high risk for infection. And nosocomial infections are responsible for almost 50% of the deaths that occur beyond 2 weeks of age. Advances in neonatal intensive care have resulted in survival of more low birth weight and sick infants. On the other hand, infection control measures in NICU are hard to say that we established. Therefore it is often that infection control measure in NICU of our country is taken in original...
Sunil; Adarsh; Sahana; Prema; Tamil; Purushotham; Rajanish; Sebastain
OBJECTIVE : To study the mortality pattern in a level III neonatal intensive care unit (NICU)in a low resource teaching hospital. METHODS : A retrospective study was conducted over a period of three years from January 2011 to December 2013. The medical records of all babies who died after being admitte d to the NICU were reviewed. Survival was defined as the discharge of a live infant from the hospital. Data regarding...
Li, Pei-Chun; Chen, Wei-I; Huang, Chih-Ming; Liu, Ching-Ju; Chang, Hsiu-wen; Lin, Hung-Ching
To determine whether newborn hearing screening in a well-baby nursery (WBN) and neonatal intensive care unit (NICU) nursery: 1) meet three targeted, screening, referral, and diagnostic follow-up rates; 2) compare the average age of diagnosis for infants admitted to the WIN and NICU; and 3) determine prevalence of hearing loss in neonatal population; and 4) try to find a practical newborn hearing screening time algorithm to reduce refer rate in NICU. It examined 15,624 newborns in the WBN (13,676) and NICU (1948) screened for congenital HL using AABR. The variables analyzed in it were the screening rate, referral rate, follow-up rate, diagnostic rate and diagnostic age, prevalence rate, degrees of congenital bilateral HL. The study was approved by the hospital's institutional review board (13MMHISO23). The screening rates were 99.8% and 99.6% in the WBN and NICU groups, respectively, without significant difference. The referral rates were 0.7% and 2.8% in the WBN and NICU groups, with significant difference. Furthermore, the diagnostic follow-up rates were 76.7% and 89.1% in the WBN and NICU groups, without significant difference. The average initial diagnostic ages were 1.9 months and 3.8 months in the WBN and NICU groups, with significant difference. The prevalence of congenital bilateral hearing loss were 0.27% and 1.6% in the WBN and NICU groups, with significant difference. The screening, referral and follow-up rate in the WBN and NICU groups were equivalent to the quality indicators. For NICU group, screening and diagnostic follow up were performed later than those in WBN group; however the lower referral rate in our NICU group was successfully achieved in this study and can be applied clinically. The prevalence of congenital bilateral hearing loss was higher in the NICU group than in the WBN group.
Rossi, L A; Casagrande, L D
This ethnographic study aimed at understanding the cultural meaning that nursing professionals working at a Burns Unit attribute to the nursing process as well as at identifying the factors affecting the implementation of this methodology. Data were collected through participant observation and semi-structured interviews. The findings indicate that, to the nurses from the investigated unit, the nursing process seems to be identified as bureaucratic management. Some factors determining this perception are: the way in which the nursing process has been taught and interpreted, routine as a guideline for nursing activity, and knowledge and power in the life-world of the Burns Unit.
Atsalos, Christine; O'Brien, Louise; Jackson, Debra
This paper is a report of a longitudinal study to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership by exploring the experiences of the nurse leaders of nine Australian units as they attempted to develop their existing wards or units into recognized centres of nursing excellence. The concept of Clinical Development Unit (Nursing) in Australia originated in the British Nursing Development Unit movement, which has been widely credited with introducing innovative approaches to developing nurses and nursing. A network of nine Clinical Development Units (Nursing) was set up in a suburban area health service in Australia. The aim was to develop existing wards or units into centres of excellence by disseminating a new vision for Australian nurses that was based on the pioneering work of the British Nursing Development Unit movement. Principles of Heideggerian hermeneutic phenomenology provided a framework for the study. Nine Clinical Development Unit (Nursing) leaders participated in qualitative interviews from 1998 to 2002. These interviews were transcribed into text and thematically analysed. Despite attempts to implement a variety of measures to nurture these Clinical Development Units (Nursing) until they had become well established, the new Clinical Development Unit (Nursing) leaders were unable to maintain the Clinical Development Unit (Nursing) vision with which they had been entrusted. This paper discusses their reactions to the problems they faced and the new understandings they developed of their Clinical Development Unit (Nursing) role over time. The findings illuminate the difficulties involved in maintaining the commitment of all levels of staff and management when attempting to introduce new nursing projects.
Park, Mihyun; Jeon, Sang Hee; Hong, Hyun-Ja; Cho, Sung-Hyun
The complexity and variety of ethical issues in nursing is always increasing, and those issues lead to special concerns for nurses because they have critical impacts on nursing practice. The purpose of this study was to gather comprehensive information about ethical issues in nursing practice, comparing the issues in different types of nursing units including general units, oncology units, intensive care units, operating rooms, and outpatient departments. The study used a descriptive research design. Ethics/human rights issues encountered by nurses in their daily nursing practice were identified by using the Ethical Issues Scale. The study sample included 993 staff nurses working in a university hospital in South Korea. This study was approved by the University Institutional Review Board. Completed questionnaires were returned sealed with signed informed consent. The most frequently and disturbingly encountered issues across nursing units were "conflicts in the nurse-physician relationship," "providing care with a possible risk to your health," and "staffing patterns that limit patient access to nursing care." The findings of this study showed that nurses from different nursing units experienced differences in the types or frequency of ethical issues. In particular, intensive care units had the greatest means of all the units in all three component scales including end-of-life treatment issues, patient care issues, and human rights issues. Nurses experienced various ethical challenges in their daily practice. Of the ethical issues, some were distinctively and frequently experienced by nurses in a specific unit. This study suggested that identifying and understanding specific ethical issues faced by nurses in their own areas may be an effective educational approach to motivate nurses and to facilitate nurses' reflection on their experiences. © The Author(s) 2014.
... effectiveness of nurses who lacked the additional training. Two hundred and seventy-nine United States Air Force Nurse Corps Captains with management experience completed Kouzes and Posner's Leadership Practice Inventory-Self (LPI...
The purpose of this study was to examine perceived leadership effectiveness of nurses who attended the United States Air Force Nursing Service Management residence course with the perceived leadership...
Weis, J; Zoffmann, Vibeke; Greisen, G
To investigate the effect of the Guided Family-Centred Care intervention, developed by the lead author, on parental stress in a neonatal intensive care unit (NICU).......To investigate the effect of the Guided Family-Centred Care intervention, developed by the lead author, on parental stress in a neonatal intensive care unit (NICU)....
Schwirian, Patricia M.; Byers, Sandra R.
This paper discusses the microcomputer in clinical nursing research. There are six general areas in which computers have been useful to nurses: nursing notes and charting; patient care plans; automated monitoring of high-tech nursing units; HIS and MIS systems; personnel distribution systems; and education. Three alternative models for the conduct of clinical nursing research in a hospital are described. The first is a centralized model relying on the bureaucratic structure of the hospital. Second is a decentralized network of professional nurses and research support personnel woven together by a Clinical Nurse Researcher, and third is a dedicated clinical nursing research unit. Microcomputers have five characteristics which make them vital tools for nurse researchers: user-friendliness; environment friendliness; low cost; ease of interface with other information systems; and range and quality of software.
Lorenzini, Elisiane; Lorenzini, Elisiane; da Costa, Tatiane Costa; da Silva, Eveline Franco
This study was aimed to identify the knowledge of the nursing team of a Neonatal Intensive Care Unit (NICU) on infection control, identijfying the factors that facilitate or hinder the prevention and control of Healthcare Associated Infections (HICAI). A descriptive study using a qualitative research method conducted with three nurses and 15 nurse technicians, who work in a NICU of a charitable organization, in southern Brazil. It became evident that the nursing staff had great knowledge about the factors that facilitate the prevention and control of HCAI in NICU, the most important factor being proper hand hygiene. Among the factors that hinder infection prevention and control are to overcrowding and excessive workload. The efficient performance of the nursing staff is an important part of the strategy for prevention and control of HCAI.
Hall, Debra S
Workplace social support is a major characteristic related to the Job Demand-Control model of job stress. Organizational and managerial support have an effect on nurse satisfaction and burnout. The relationships between perceived supervisor support and measures of nurse occupation-related outcomes were investigated in 3 nursing units within an academic medical center. Nurses with greater levels of perceived supervisor support experienced more positive job outcomes and less negative outcomes, including less occupational stress, than nurses with less perceived supervisor support. Implications for refocusing the role of the nurse supervisor and its effect on multiple nursing occupation-related outcomes are discussed.
Hunter, James; Freer, Yvonne; Gatt, Albert; Reiter, Ehud; Sripada, Somayajulu; Sykes, Cindy; Westwater, Dave
The BT-Nurse system uses data-to-text technology to automatically generate a natural language nursing shift summary in a neonatal intensive care unit (NICU). The summary is solely based on data held in an electronic patient record system, no additional data-entry is required. BT-Nurse was tested for two months in the Royal Infirmary of Edinburgh NICU. Nurses were asked to rate the understandability, accuracy, and helpfulness of the computer-generated summaries; they were also asked for free-text comments about the summaries. The nurses found the majority of the summaries to be understandable, accurate, and helpful (pgenerated summaries. In conclusion, natural language NICU shift summaries can be automatically generated from an electronic patient record, but our proof-of-concept software needs considerable additional development work before it can be deployed.
Ko, Woonhwa; Kiser-Larson, Norma
Oncology nursing is often a source of substantial stress for nurses. Many nurses, particularly novice nurses, have inadequate preparation to care for patients at the end of life and their families. Unless nurses prevent or manage work-related stress by using effective coping strategies, oncology nursing staff will continue to suffer from burnout and compassion fatigue. The purpose of this article is to identify stress levels and stressful factors of nurses working in oncology outpatient units and to explore coping behaviors for work-related stress of oncology staff nurses in outpatient units. A descriptive, cross-sectional design was used to identify stress levels and stressful factors for outpatient oncology nurses, investigate differences in stress levels among nurses' demographic characteristics, and explore coping behaviors of the nurses. Study participants (N = 40) included RNs and licensed practical nurses who completed the Nursing Stress Scale, three open-ended questions, and a demographic questionnaire. The highest sources of stress were workload and patient death and dying. Demographic variables of age and work experience in nursing showed a significant positive relationship to work-related stress scores. The three most frequently used coping behaviors were verbalizing, exercising or relaxing, and taking time for self. Continuing education programs on stress management are highly recommended. Outpatient oncology nurses should be nurtured and supported through tailored interventions at multiple levels to help them find effective coping strategies and develop self-care competencies. Although younger and less experienced nurses had lower mean stress scores than older and more experienced nurses, the continuing education programs and tailored interventions would be helpful for all oncology nursing staff.
Full Text Available ABSTRACT: This study consisted in a bibliographic review, which goal was a survey of the main national literature that approaches the humanization in the surgical unit, identifying and demonstrating the needs and the importance of the nursing staff daily activities. The search was made selecting the key words and the period between 1985 and 2002, where 31 articles were selected. Analyzing them we discussed about the theme, classifying it in four stages that made sense to the humanization for the nursing assistance in the surgical unit, describing aspects of the nursing graduation releasing for humanization, making ethics considerations to the assistance and demonstrating the needs of the humanized care in the presence of the technological development. We concluded that the humanization of the nursing assistance in the surgical units is a challenge, however, the humanized care is possible and essential to the nursing practice, mainly in a technological environment like the surgical unit. KEYWORDS: Operating Room Nursing; Assistance; Ethics.
Fairchild, Roseanne Moody; Everly, Marcee; Bozarth, Lisa; Bauer, Renee; Walters, Linda; Sample, Marilyn; Anderson, Louise
This study reports perceptions of the continuing education (CE) needs of nursing unit staff in 40 rural healthcare facilities (10 hospitals and 30 long-term care facilities) in a rural Midwestern U.S. region from the perspective of nurse administrators in an effort to promote a community-based academic-practice CE partnership. Qualitative data collection involving naturalistic inquiry methodology was based on key informant interviews with nurse administrators (n=40) working and leading in the participating health care facilities. Major themes based on nurse administrators' perceptions of CE needs of nursing unit staff were in four broad conceptual areas: "Cultural issues", "clinical nursing skills", "patient care", and "patient safety". Major sub-themes for each conceptual area are highlighted and discussed with narrative content as expressed by the participants. Related cultural sub-themes expressed by the nurse administrators included "horizontal violence" (workplace-hospital and LTC nursing unit staff) and "domestic violence" (home-LTC nursing unit staff). The uniqueness of nurses' developmental learning needs from a situational point of view can be equally as important as knowledge-based and/or skill-based learning needs. Psychological self-reflection is discussed and recommended as a guiding concept to promote the development and delivery of relevant, empowering and evidence-based CE offerings for rural nursing unit staff. Copyright © 2012 Elsevier Ltd. All rights reserved.
Korhan, Esra Akn; Yönt, Gülendam Hakverdioğlu; Erdemir, Firdevs; Müller-Staub, Maria
The purpose of this study was to determine intensive care unit nurses diagnostic abilities and diagnoses that they provide. A vignette study was performed. The vignette contained a patient's history, treatment, and signs/symptoms of 18 nursing diagnoses based on NANDA-I as the criterion standard. Turkish intensive care unit nurses (N = 45) stated nursing diagnoses described by patient data in the vignette. The resulting nursing diagnoses were grouped into Gordon's Functional Health Patterns, and descriptive analyses were performed. One-way analysis of variance was used to detect possible differences in diagnostic abilities based on nurses' education levels. Nurses identified 14 nursing diagnoses. Four of the predetermined psychosocial nursing diagnoses were not identified. The highest percentage of diagnoses was risk for impaired skin integrity (62.2%) and impaired oral mucous membrane (60.0%). The lowest number of diagnoses was impaired verbal communication (2.2%). A statistically significant difference was found between the educational level of nurses and their abilities to determine nursing diagnoses (P < .05). The findings are important for nursing education. They demonstrate the need to focus on patients as complete human beings, covering not only biological aspects but also cultural and social values, as well as emotional and spiritual care needs.
Karanikola, Maria N K; Albarran, John W; Drigo, Elio; Giannakopoulou, Margarita; Kalafati, Maria; Mpouzika, Meropi; Tsiaousis, George Z; Papathanassoglou, Elizabeth D E
To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P intention to resign (r = 0.244, P intention of nurses to resign (r = -0. 209, P intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession. © 2013 John Wiley & Sons Ltd.
Magluta, Cynthia; Gomes, Maria A de Sousa Mendes; Wuillaume, Susana M
Clinical guidelines are tools that systematize scientific evidence and help to achieve proper care. Several difficulties are reported regarding the effective use, such as the shortcomings in the level of knowledge and attitudes by the professionals, the service structure and the preferences appointed by patients. An analysis of these difficulties was the objective of this study in the context of government Neonatal Intensive Care Units (NICU) in Brazil. A semi-structured survey was carried out with 53 managers (medical and nursing) of the 15 NICU in a convenient sample of two groups of government units in Brazil. The managers chose their answers from a list of difficulties to implement the guidelines based on the analytical model of Cabana and graded the difficulties found on a 5-point scale with no reference to quality. Respondents have reported several difficulties with the following priority: lack of professionals to provide care, being perceived as more critical within the nursing and physiotherapy crews, minor participation of professionals in the discussion process and inadequate infrastructure. The lack of acquaintance with the guidelines by the professionals has been reported by few of the surveyed. These findings show some common ground to literature pointing the importance of adequate infrastructure. Managers showed a low valuation of both the level of knowledge and the professionals' adhesion to the guidelines. © 2011 Blackwell Publishing Ltd.
Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid
of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders...... and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. RESULTS: Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context...
Full Text Available Background and context: Implementation of current research in practice is challenging for ward-based nursing staff. However, university-based nursing academics are seen as the research experts and are perhaps well placed to support clinical nursing research. The problem lies with the divide between practice and academia; universities often use the clinical environment as the place to conduct research but this is often not translated effectively into practice. The development of a nursing professorial unit for acute and critical care was undertaken to meet this challenge. The unit’s key aim is to develop, mentor and support a nursing research culture that is wholly situated within and driven by the requirements of the clinical environment. Aim: The aim of this article is to offer some insights as to how staff set about engaging with and developing the nursing professorial unit to support nursing research in our local hospital. Conclusions: The article highlights how an effective and coordinated approach to supporting clinical nursing research is possible. The nursing professorial unit has been successful in bridging the divide between academia and practice by using a non-university approach to supporting nursing research. Instead we have adopted the philosophy that practice is the sole driver for research and as academics our role is to support that position. Implications for practice: The adoption of the nursing professorial unit model for supporting clinical nursing research is beneficial in closing the divide between clinical practice and the university The continual presence of the academics in the clinical environment has had a positive impact on research development and implementation in practice The nursing professorial unit has become an integral part of the nursing culture in the hospital environment
DʼAgata, Amy L; McGrath, Jacqueline M
Advances in neonatal care are allowing for increased infant survival; however, neurodevelopmental complications continue. Using a complex adaptive system framework, a broad analysis of the network of agents most influential to vulnerable infants in the neonatal intensive care unit (NICU) is presented: parent, nurse, and organization. By exploring these interconnected relationships and the emergent behaviors, a model of care that increases parental caregiving in the NICU is proposed. Supportive parent caregiving early in an infant's NICU stay has the potential for more sensitive caregiving and enhanced opportunities for attachment, perhaps positively impacting neurodevelopment.
Nadolski, Charles; Britt, Pheraby; Ramos, Leah C
The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit's capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics. This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units. The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels. The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.
Navarro, V B; Stout, W A; Tolley, F M
Traditional service configuration with separate nursing units for outpatient and inpatient care is becoming ineffective for new patient care delivery models. With the new configuration of a combined nursing unit, it was necessary to rethink traditional reporting methodologies and calculation of hours of care. This project management plan is an initial attempt to develop a standard costing/productivity model for a combined unit. The methodology developed from this plan measures nursing care hours for each patient population to determine the number of full time equivalents (FTEs) for a combined unit and allocates FTEs based on inpatient (IP), outpatient (OP), and emergency room (ER) volumes.
Roberta Juliane Tono de Oliveira
Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.
Tono de Oliveira, Roberta Juliane; Vieira Hermida, Patrícia Madalena; da Silva Copelli, Fernanda Hannah; Guedes Dos Santos, José Luís; Lorenzini Erdmann, Alacoque; Regina de Andrade, Selma
Understand the conditions involved in the management of nursing care in emergency care units. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.
Krugman, Mary E; Sanders, Carolyn L
Nurse managers face significant pressures in the rapidly changing healthcare environment. Staying current with multiple sources of data, including reports that detail institutional and unit performance outcomes, is particularly challenging. A Nurse Manager Customized Profile was developed at a western academic hospital to provide a 1-page visual of pertinent data to help managers and director supervisors focus coaching to improve unit performance. Use of the Decisional Involvement Scale provided new insights into measuring manager performance.
Troy, Paul H
BACKGROUND: There is growing concern globally at the current flows of nurse migration, particularly from low-income to middle and high-income countries. Recruitment practices of many countries such as Ireland are thought to be fuelling this rate of migration. This paper aims to establish the perceptions and opinions of those involved in the recruitment process on their role in recruitment and the effects recruitment has on both source and destination countries. METHODS: A purposive sample of 12 directors of nursing, from major academic teaching hospitals in Dublin and hospitals in South Africa and the Philippines were recruited. Ten overseas nurses were also recruited. A phenomenological approach was used with semi-structured interviews as the data collection method. RESULTS: There were pronounced differences in opinions between the Irish and the overseas directors on recruitment and its effects on the health systems of the source countries. Difficulties in the retention of staff were highlighted by both groups of directors. Other findings included the language and cultural differences experienced by the overseas nurses. CONCLUSION: Recruitment of overseas nurses should not be left to the individual employer even in the presence of government guidelines. An international effort from all the involved parties is required to formulate a solution to this complex issue in order to protect both the health systems of individual countries and the nurse\\'s right to migrate.
Seo, Kumsook; Kim, Miyoung
Despite nurse practitioners' (NPs) professional identity having important implications for the confirmation of nursing practice characteristics, few studies have examined the professional identity of NPs overlaid with the immigrant experience. The aim of this study was to explore the career characteristics of Korean nurse immigrants who became NPs in the United States. Seven Korean NPs in the United States underwent in-depth interviews from August 2013 to May 2015. Content analysis was employed for data analysis. Five themes were identified regarding their professional identity as NPs: patient-centered thinking, responsibility for patient care, dedicated life, diligence, and feelings of achievement. Of these, patient-centered thinking appeared to be the overriding theme. The findings add to nursing knowledge about immigrant nurses and their abilities and striving to develop into new roles in nursing. The participants focused on listening, interpersonal relationships, and education in patient care, which helped differentiate their roles from those of other healthcare professionals. Nurse managers should consider the study findings when making policies to assist immigrant nurses to acculturate into practice, and there is a need for the development of educational materials to guide and promote the NPs' professional role. ©2017 American Association of Nurse Practitioners.
Oosterhouse, Kimberly J; Vincent, Catherine; Foreman, Marquis D; Gruss, Valerie A; Corte, Colleen; Berger, Barbara
Delirium, the most frequent complication of hospitalized older adults, particularly in intensive care units (ICUs), can result in increased mortality rates and length of stay. Nurses are neither consistently identifying nor managing delirium in these patients. The purpose of this study was to explore ICU nurses' identification of delirium, actions they would take for patients with signs or symptoms of delirium, and beliefs about delirium assessment and management. In this cross-sectional study using qualitative descriptive methods guided by the theory of planned behavior, 30 ICU nurses' responses to patient vignettes depicting different delirium subtypes were explored. Descriptive and content analyses revealed that nurses did not consistently identify delirium; their actions varied in different vignettes. Nurses believed that they needed adequate staffing, balanced workload, interprofessional collaboration, and established policy and protocols to identify and manage delirium successfully. Research is needed to determine if implementing these changes increases recognition and decreases consequences of delirium. ©2016 American Association of Critical-Care Nurses.
Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.
Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik
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
... needed, they can perform surgery or place casts. OSTOMY NURSE An ostomy nurse is a nurse with special training in ... stick out. Such an opening is called an ostomy. Ostomies are the result of surgery needed to ...
Luana Loppi Goulart
Full Text Available Severely injured patients with multiple and conflicting injuries present themselves to nursing professionals at critical care units faced with care management challenges. The goal of the present study is to evaluate nursing workload and verify the correlation between workload and the APACHE II severity index. It is a descriptive study, conducted in the Trauma Intensive Care Unit of a teaching hospital. We used the Nursing Activities Score and APACHE II as instruments. The sample comprised 32 patients, of which most were male, young adults, presenting polytrauma, coming from the Reference Emergency Unit, in surgical treatment, and discharged from the ICU. The average obtained on the Nursing Activities Score instrument was 72% during hospitalization periods. The data displayed moderate correlation between workload and patient severity. In other words, the higher the score, the higher the patient’s mortality risk. doi: 10.5216/ree.v16i2.22922.
Ayuso-Murillo, D; Colomer-Sánchez, A; Herrera-Peco, I
In this study researchers are trying to analyse the personality factors related to social skills in nurses who work in: Intensive Care Units, ICU, and Hospitalisation units. Both groups are from the Madrid Health Service (SERMAS). The present investigation has been developed as a descriptive transversal study, where personality factors in ICU nurses (n=29) and those from Hospitalisation units (n=40) were compared. The 16PF-5 questionnaire was employed to measure the personality factors associated with communication skills. The comparison of the personality factors associated to social skills, communication, in both groups, show us that nurses from ICU obtain in social receptivity: 5,6 (A+), 5,2 (C-), 6,2 (O+), 5,1 (H-), 5,3 (Q1-), and emotional control: 6,1 (B+), 5,9 (N+). Meanwhile the data doesn't adjust to the expected to emotional and social expressiveness, emotional receptivity and social control, there are not evidence. The personality factors associated to communication skills in ICU nurses are below those of hospitalisation unit nurses. The present results suggest the necessity to develop training actions, focusing on nurses from intensive care units to improve their communication social skills. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.
Happ, Mary Beth; Garrett, Kathryn; Thomas, Dana DiVirgilio; Tate, Judith; George, Elisabeth; Houze, Martin; Radtke, Jill; Sereika, Susan
Background The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured. Objectives To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit. Methods Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication. Results Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards). Conclusions Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials. PMID:21362711
undergone multiple advances that WMSN may fail to capture as workload. Beglinger (2006) stated, "Over the course of the past decade, the intensity of... advancement of the nursing profession by promoting high standards of nursing practice, promoting the welfare of nurses in the workplace, and by lobbying...shifts. At the opposite end of the spectrum, the neonatal intensive care unit ( NICU ) operated with 111.5 fewer RNs than was recommended for the
Gale, Gay; Franck, Linda S; Kools, Susan; Lynch, Mary
Despite numerous advances in the recognition, assessment, and management of pain in neonates over the past two decades, there has been limited improvement in the knowledge base regarding parental responses to their infant's pain. This study examined parents' views of their experiences observing and coping with their infant's pain in the neonatal intensive care unit (NICU). Twelve participants were recruited using purposive sampling from two groups: (a) parents who had infants currently receiving care in the NICU (n=6); and (b) parents whose infants had been discharged from the NICU and were enrolled in the outpatient follow-up clinic at each hospital (n=6). An exploratory, semi-structured format was used to interview parents individually (n=5) or in focus groups (n=7) regarding their infant's clinical course, infant pain experiences, and the parenting experience during and after the NICU stay. Thematic content analysis was used to develop conceptual categories. Two broad themes were identified: (a) infant pain as a source of parental distress and (b) relief of parental distress due to infant's pain.
Minnick, Ann F; Mion, Lorraine C; Johnson, Mary E; Catrambone, Cathy
To describe (1) the extent to which acute and intensive care units use the elements of nursing models (team, functional, primary, total patient care, patient-focused care, case management) and (2) the deployment of non-unit-based personnel resources. The lack of current data-based behavioral descriptions of the extent to which elements of nursing models are implemented makes it difficult to determine how work models may influence outcomes. Nurse managers of 56 intensive care units and 80 acute care adult units from 40 randomly selected US hospitals participated in a structured interview regarding (1) day-shift use of patient assignment behaviors associated with nursing models and (2) the availability and consistency of assignment of non-unit-based support personnel. No model was implemented fully. Almost all intensive care units reported similar assignment behaviors except in the consistency of patient assignment. Non-intensive care units demonstrated wide variation in assignment patterns. Patterns differed intra-institutionally. There were large differences in the availability and deployment of non-unit-based supportive resources. Administrators must recognize the differences in work models within their institutions as a part of any quality improvement effort. Attempts to test new work models must be rigorous in the measurement of their implementation.
Silvia Helena Henriques Camelo
Full Text Available Objective. The aim in this study was to identify how Intensive Care Unit nurses perceive professional competences in thecare team. Methodology. Qualitative multiple case study with an exploratory focus. The sample consisted of 24 nurses from Intensive Care Units (ICU at two large hospitals. To collect the information, direct observation and - structured, non-structuredand participant - interviews were used. Results. Ninety-six percent of the participants were women, 79% were less than 40 years old, and 63% possessed less than five years of professional experience in ICU. Data analysis revealed three study categories: teamwork as a nursing management tool, improving teamwork, and interpersonal communication for teamwork. Conclusion. At the ICU where the nurses work, a teamwork strategy is observed, which demands cooperation and participation by other disciplines.
Wiegerinck, Melanie M. J.; Danhof, Nora A.; van Kaam, Anton H.; Tamminga, Pieter; Mol, Ben Willem J.
To determine whether "neonatal intensive care unit (NICU) admission" is a valid surrogate outcome measure to assess neonatal condition in clinical studies. Retrospective study. Tertiary hospital in the Netherlands. Neonates admitted to NICU during a 10-year period. Inclusion was restricted to
Alkozei, Anna; McMahon, Erin; Lahav, Amir
This study examined whether particular maternal and infant factors can identify mothers at risk for increased stress upon admission to the neonatal intensive care unit (NICU). Eighty-five mothers of preterm infants (25-34 weeks gestation) were assessed using the Parental Stressor Scale (PSS:NICU) and the Edinburgh Postnatal Depression Scale (EPDS) within 3.24 ± 1.58 d postpartum. Hierarchical linear regression models were used to determine the extent to which maternal stress is influenced by individual factors. Fifty-two percent of mothers experienced increased stress (PSS:NICU score ≥3) and 38% had significant depressive symptoms (EPDS score ≥10). Stress related to alterations in parental role was the most significant source of stress among NICU mothers. Distance from the hospital and married marital status were significant predictors for stress related to alterations in parental role (p = 0.003) and NICU sights and sounds (p = 0.01), respectively. Higher stress levels were associated with higher depressive scores (p = 0.001). Maternal mental health factors, demographic factors, pregnancy factors and infant characteristics were not associated with increased stress. Elevated stress levels and depressive symptoms are already present in mothers of preterm infants upon NICU admission. Being married or living long distance from the hospital is associated with higher stress. Future work is needed to develop effective interventions for alleviating stress in NICU mothers and preventing its potential development into postnatal depression.
Full Text Available Introduction: Neonatal intensive care unit induces the high level of anxiety for mothers. The aim of this study was to evaluate the effectiveness of NICU orientation program on the anxiety of mothers who had preterm newborns hospitalized in NICU. Methods: This study was a randomized clinical trial (three parallel groups. Participants included 99 mothers with preterm newborns hospitalized in NICU of Al- Zahra hospital, affiliated to Tabriz University of Medical Sciences in 2015. Mothers were randomly assigned to one of three groups (film, booklet, and control. Mothers completed the State- Trait Anxiety Inventory before entering to the NICU, and then mothers in the experiment groups became familiar with the NICU environment through watching a film or reading booklet. After the first NICU visit, all mothers completed the STAI and Cattell's Anxiety Questionnaires. Data were analyzed using SPSS ver. 13 software. Results: There was no significant difference between three groups regarding state- trait anxiety before the intervention. After the first NICU visit, a significant reduction in maternal state anxiety was seen in the both experiment groups. There was no statistical significant difference regarding trait anxiety. Data obtained from Cattell's anxiety questionnaire after intervention, showed significant difference in state anxiety between groups. Conclusion: Employing film and booklet orientation strategy after preterm delivery can reduce the mother’s anxiety and beneficent for the mother, baby, family and health care system.
Parents of infants who are admitted to the neonatal intensive care unit (NICU) need to be empowered to improve bonding, attachment and care-giving skills. Neonatal nurses play a critical role in the empowerment of such parents, but often find it difficult due to a lack of clarity on how it has to be done. A qualitative contextual ...
Treherne, Stephanie C; Feeley, Nancy; Charbonneau, Lyne; Axelin, Anna
To discover parents' perceptions of closeness to and separation from their preterm infants in the NICU. Qualitative descriptive. Urban Level III NICU. Twenty parents of preterm infants in the NICU. After ethics approval, data were collected with a smartphone application created for this study. Parents recorded their descriptions of moments of closeness and separation over a 24-hour period in the NICU. Data were transcribed verbatim and content was analyzed. Five themes related to parents' perceptions of closeness and separation were identified: Having a role as a parent: Feeling autonomous and making decisions; Providing for and getting to know the infant: Feeding, holding, and interacting; Support from staff; Reluctantly leaving the infant's bedside; and NICU environment. Autonomy is a key element of a parent's perception of closeness. Staff in the NICU can facilitate autonomy by involving parents in the care of their preterm infants as much as possible to reinforce the parental role. Parents described leaving their infants' bedsides as very difficult. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.
Full Text Available Background: Weakness of curriculum development in nursing education results in lack of professional skills in graduates. This study was done on master's students in nursing to evaluate challenges of neonatal intensive care nursing curriculum based on context, input, process, and product (CIPP evaluation model. Materials and Methods: This study was conducted with qualitative approach, which was completed according to the CIPP evaluation model. The study was conducted from May 2014 to April 2015. The research community included neonatal intensive care nursing master's students, the graduates, faculty members, neonatologists, nurses working in neonatal intensive care unit (NICU, and mothers of infants who were hospitalized in such wards. Purposeful sampling was applied. Results: The data analysis showed that there were two main categories: “inappropriate infrastructure” and “unknown duties,” which influenced the context formation of NICU master's curriculum. The input was formed by five categories, including “biomedical approach,” “incomprehensive curriculum,” “lack of professional NICU nursing mentors,” “inappropriate admission process of NICU students,” and “lack of NICU skill labs.” Three categories were extracted in the process, including “more emphasize on theoretical education,” “the overlap of credits with each other and the inconsistency among the mentors,” and “ineffective assessment.” Finally, five categories were extracted in the product, including “preferring routine work instead of professional job,” “tendency to leave the job,” “clinical incompetency of graduates,” “the conflict between graduates and nursing staff expectations,” and “dissatisfaction of graduates.” Conclusions: Some changes are needed in NICU master's curriculum by considering the nursing experts' comments and evaluating the consequences of such program by them.
Introduction Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses’ competences. This study aimed to explain nurses’ competence in the ICCU. Methods This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012–2013. Interviews were recorded, transcribed verbatim, and analyzed by using the content-analysis method. Results The main categories were “clinical competence,” comprising subcategories of ‘routine care,’ ‘emergency care,’ ‘care according to patients’ needs,’ ‘care of non-coronary patients’, as well as “professional competence,” comprising ‘personal development,’ ‘teamwork,’ ‘professional ethics,’ and ‘efficacy of nursing education.’ Conclusion The finding of this study revealed dimensions of nursing competence in ICCU. Benefiting from competence leads to improved quality of patient care and satisfaction of patients and nurses and helps elevate nursing profession, improve nursing education, and clinical nursing. PMID:27382450
Aline Carniato Dalle Nogario
Full Text Available OBJECTIVEUnderstanding nursing actions in the practice of inpatient advocacy in a burn unit.METHODA single and descriptive case study, carried out with nurses working in a referral burn center in southern Brazil. Data were collected through focus group technique, between February and March 2014, in three meetings. Data was analysed through discursive textual analysis.RESULTSThree emerging categories were identified, namely: (1 instructing the patient; (2 protecting the patient; and (3 ensuring the quality of care.CONCLUSIONSThis study identified that the nurses investigated exercised patient advocacy and that the recognition of their actions is an advance for the profession, contributing to the autonomy of nurses and the effectiveness of patients' rights and social justice.
Martínez Lara, Concepción; Praena Fernández, Juan Manuel; Gil García, Eugenia
Clinical Management Unit (CMU) is currently set in the Andalusian health institutions as the model reference management. This management model aims to make all healthcare professionals a powerful idea: the best performance of health resources is performed to drive clinical practice using the least number of diagnostic and therapeutic resources. The CMU not only aims at saving money, in the Clinical Management Agreement  are measured all the dimensions that make up the UGC: research, training, clinical process, the portfolio of services, objectives, financial management and indicators to control and security. The CMU is to transfer more responsibilities to Health Care Professionals, involving them in the management of the Unit. The CMU sets new approaches that directly affect health professionals and presents advantages and disadvantages for the Doctors and the Nurses, involved in achieving excellence in care work. Nurse Practitioners shows expectant before the changes are generated in health institutions and appears a discussion of skills derived from the CMU. Some Nurses believe that the bur, den of care to which they are subjected in public institutions has increased since the onset of the CMU and yet others believe that they are motivated and rewarded for the results obtained with this model of management. In health institutions, some professionals are more motivated than others and this is found in the outcome of health care activity . Given the positive and negative perceptions that arise in the CMU Professional Nurses, it is considered appropriate to focus the objective of this work in the search for factors that influence job satisfaction of nurses in the CMU. There are few studies about the CMU  but are absent when linked with nursing, so the pursuit of scientific knowledge related to nursing management model based on Clinical and Quality Care can lead to establish new concepts around the nursing profession, a profession in which major changes are
Hunter, James; Freer, Yvonne; Gatt, Albert; Reiter, Ehud; Sripada, Somayajulu; Sykes, Cindy
Our objective was to determine whether and how a computer system could automatically generate helpful natural language nursing shift summaries solely from an electronic patient record system, in a neonatal intensive care unit (NICU). A system was developed which automatically generates partial NICU shift summaries (for the respiratory and cardiovascular systems), using data-to-text technology. It was evaluated for 2 months in the NICU at the Royal Infirmary of Edinburgh, under supervision. In an on-ward evaluation, a substantial majority of the summaries was found by outgoing and incoming nurses to be understandable (90%), and a majority was found to be accurate (70%), and helpful (59%). The evaluation also served to identify some outstanding issues, especially with regard to extra content the nurses wanted to see in the computer-generated summaries. It is technically possible automatically to generate limited natural language NICU shift summaries from an electronic patient record. However, it proved difficult to handle electronic data that was intended primarily for display to the medical staff, and considerable engineering effort would be required to create a deployable system from our proof-of-concept software. Copyright © 2012 Elsevier B.V. All rights reserved.
In response to increasing awareness of radiation as a possible occupational hazard, nursing personnel staffing a hospital CCU were monitored over a 3-year period to determine occupational exposure. Portable x-ray machines, fluoroscopic units, and patients injected with radiopharmaceuticals were all potential radiation sources on such a unit. Whole-body TLD badges, exchanged monthly, indicated no cumulative exposures over 80 mR during the entire study period. The minimal exposures reported do not justify regular use of dosimeters. Adherence to standard protective measures precludes most exposure to machine-produced radiation. Close, prolonged contact with a patient after an RVG study that utilizes /sup 99m/Tc may account for some exposure. The data indicate that radiation is not a significant occupational hazard for CCU nurses at this hospital; similar minimal exposures would be expected of other nonoccupationally exposed nursing personnel in like environments
Vinicia de Holanda Cabral
Full Text Available To identify the main nursing diagnostic titles used in the care of critically ill patients hospitalized in an Intensive Care Unit, verifying the presence thereof in the diagnoses of NANDA International’s Taxonomy II. Methods: descriptive and documental study, in which 69 medical records of patients aged over 18 years were consulted. Results: 22 nursing diagnostic titles were found; the most frequent was risk for infection (99.0%, risk for skin integrity (75.0% and risk for aspiration (61.0%. Most diagnoses were in the domains safety/ protection (43.0% and activity/rest (26.5%. Conclusions: authors identified the main nursing diagnostic titles used in the care of critically ill patients admitted to the Intensive Care Unit and the presence thereof in the diagnoses of NANDA International’s Taxonomy II.
To provide an overview of developmental and medical benefits of music therapy for preterm infants. Meta-analysis. Empirical music studies with preterm infants in the neonatal intensive care unit (NICU). Evidence-based NICU music therapy (NICU -MT ) was highly beneficial with an overall large significant effect size (Cohen's d = 0.82). Effects because of music were consistently in a positive direction. Results of the current analysis replicated findings of a prior meta-analysis and included extended use of music.(1) Benefits were greatest for live music therapy (MT ) and for use early in the infant's NICU stay (birth weight music listening for pacification, music reinforcement of sucking, and music pacification as the basis for multilayered, multimodal stimulation.
Watson, J'ai; Kinstler, Angela; Vidonish, William P; Wagner, Michael; Lin, Li; Davis, Kermit G; Kotowski, Susan E; Daraiseh, Nancy M
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.
Choi, JiSun; Boyle, Diane K
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
Gardner, Jane K; Thomas-Hawkins, Charlotte; Fogg, Louis; Latham, Carolyn E
nurses' perceptions of the dialysis work environment are important for nurse and patient outcomes in dialysis settings. Further research is needed to explore the predictive ability of the work environment for nurse and patient outcomes in hemodialysis units.
Effective leadership is arguably one of the most relevant indicators of a profession's advancement or lack thereof. The purpose of this article is to share the authors' personal views on the leadership competencies necessary for the nurse unit manager transitioning into the role for the first time. To identify these leadership ...
Darbon, Rémy; Dalphin, Catherine; Prieto, Nathalie; Cheucle, Éric
The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Roberta Juliane Tono de Oliveira; Patrícia Madalena Vieira Hermida; Fernanda Hannah da Silva Copelli; José Luís Guedes dos Santos; Alacoque Lorenzini Erdmann; Selma Regina de Andrade
Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency se...
Montezeli, Juliana Helena; Peres, Aida Maris; Bernardino, Elizabeth
Objective: To identify the management skills needed for this professional at an emergency care unit. Method: An exploratory descriptive qualitative study conducted with eight nurses in which semi-structured interviews with nonparticipating systematic observation were conducted; the data was processed by content analysis. Results: The categories which emerged from the content analysis served as a list of management skills necessary to their work at the emergency care unit: leadership, decision...
Faustino Eduardo dos Santos
Full Text Available Objective: To identify if nurses working in cardiac and general Intensive Care Units are subject to burnout, correlating it with demographic and occupational information. Methods: This is a descriptive exploratory, cross-sectional, prospective and correlational study utilizing quantitative resources. The sample was composed of 34 nurses who answered the Maslach and Jackson inventory (MBI-HSS, which consists of 22 questions plus a questionnaire on demographic and occupational data. The study was carried out at a large private hospital in the city of São Paulo, Brazil. Rresults: Of 34 nurses, nine had high emotional exhaustion, nine high depersonalization, ten had a high score of reduced professional accomplishment (decreased personal fulfillment at work. Most nurses presented alterations in more than one dimension regarding burnout. Cconclusions: The majority of nurses presented burnout and there was a positive correlation between burnout and the variables: sex, advanced professional degrees, time working in nursing, workload and working at more than one hospital.
Jeon, Sang Hee; Park, Mihyun; Choi, Kyungok; Kim, Mi Kyoung
The aims of this study were to evaluate the effect of an ethical leadership program (ELP) on ethical leadership, organizational citizenship behavior (OCB), and job outcomes of nursing unit managers (UMs) and to examine changes in staff nurses' perception about UMs' EL, OCB, job outcomes, and ethical work environments (EWEs) post-ELP. A quasi-experimental (pre- and post-test design) study conducted six-month intervention (ELP) using self-reported UM survey (n=44), and staff nurses (n=158) were randomly extracted by two steps. The Korean version of Ethical Leadership at Work for UMs' self-ethical leadership, the Ethical Leadership Scale for staff nurses' perceived ethical leadership, a 19-item OCB scale, and six dimensions of the medium-sized Copenhagen Psychosocial Questionnaire II for job outcomes and EWEs were administered at baseline and post-intervention. UMs' ethical leadership scores differed significantly over time in people orientation (p=0.041) and concern for ethical leadership sustainability (p=0.002) adjusting for UM experience duration and nursing unit type. Total mean and level of power-sharing of ethical leadership among UMs with leadership, OCB, job outcomes, and EWEs, significant improvement over time appeared only in EWEs' work influence level (p=0.007). This study provides useful information for clinical ELP development and examining the program's effect on leadership skills and followers' outcomes. Program facilitation relies on practical training methods, participant motivation, and assessment outcome designs by controlling clinical confounding factors. Findings have implications as an attempt for intervention to promote competencies related to ethical leadership of nursing unit managers. Copyright © 2017 Elsevier Ltd. All rights reserved.
Wlody, Ginger Schafer
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.
Regan, Anna; Howard, Ruth A; Oyebode, Jan R
Contrary to its original conceptualization, research has found that emotional demands do not lead to burnout in nurses. According to psychoanalytic theory, unconscious defense mechanisms may protect nurses from conscious awareness of work-related anxiety. This prevents self-report and may explain research findings. The maturity of defense style influences how anxiety is managed. Immature defenses prevent the conscious processing necessary for resolution of anxiety. Therefore, it is hypothesized that the use of immature defenses will lead to emotional exhaustion. This cross-sectional study used questionnaires to explore the defense mechanisms of 87 Intensive Therapy Unit nurses. Although the sample endorsed a predominantly mature defense style, the use of immature defenses predicted emotional exhaustion. Also, lower levels of reported stress associated with emotional demands predicted emotional exhaustion. Although this strongly implies the mediating role of immature defense mechanisms, the results were not statistically significant.
Mmamma, Mogale L; Mothiba, Tebogo M; Nancy, Malema R
Staff turnover of professional nurses remains a concern for public and private hospitals management because it has an impact on the morale of nurses and it may also lead to poor patient care. The objectives of this study were to explore and describe the experiences of nursing unit managers with regard to the turnover of professional nurses who were under their supervision. A qualitative, explorative, descriptive research design was used to determine the experiences of nursing unit managers related to the turnover of professional nurses. Data collection was done by using semi-structured one-to-one interviews with professional nurses .Two groups of participants were interviewed: Those working day duty (n = 9) and those working night duty (n = 3) who were at work on the anticipated days for data collection. The findings revealed that every unit was experiencing a shortage of professional nurses, which caused other nurses to work overtime with an inevitable increase in workload. That led to tiredness, conflict amongst professional nurses, job dissatisfaction, and absenteeism which compromised nursing care. This resulted in patient dissatisfaction and sometimes led to deaths that could have been prevented. It is recommended that staff turnover should be addressed by the hospital top management implementing several strategies. For example, top management could ensure that staff members work in a healthy environment with resources that they need during the provision of care, address the effects of the staff turnover, support the staff members and refrain from putting pressure on nursing unit managers whilst they are attending to problems.
Full Text Available Introduction: The patients’ families in intensive care units (ICUs experience excessive stress which may disrupt their performance in daily life. Empathy is basic to the nursing role and has been found to be associated with improved patient outcomes and greater satisfaction with care in patient and his/her family. However, few studies have investigated the nursing empathy with ICU patients. This study aimed to assess nursing empathy and its relationship with the needs, from the perspective of families of patients in ICU.Methods: In this cross-sectional study, 418 subjects were selected among families of patients admitted to ICUs in Tabriz, Iran, by convenience sampling, from May to August 2012. Data were collected through Barrett-Lennard Relationship inventory (BLRI empathy scale and Critical Care Family Needs Intervention (CCFNI inventories and were analyzed using descriptive and inferential statistical tests. Results: Findings showed that most of the nurses had high level of empathy to the patients (38.8%. There was also statistically significant relationship between nurses’ empathy and needs of patients’ families (p < 0.001. Conclusion: In this study we found that by increasing the nurse’s empathy skills, we would be able to improve providing family needs. Through empathic communication, nurses can encourage family members to participate in planning for the care of their patients. However, further studies are necessary to confirm the results.
Koch, Sven H; Weir, Charlene; Haar, Maral; Staggers, Nancy; Agutter, Jim; Görges, Matthias; Westenskow, Dwayne
Fatal errors can occur in intensive care units (ICUs). Researchers claim that information integration at the bedside may improve nurses' situation awareness (SA) of patients and decrease errors. However, it is unclear which information should be integrated and in what form. Our research uses the theory of SA to analyze the type of tasks, and their associated information gaps. We aimed to provide recommendations for integrated, consolidated information displays to improve nurses' SA. Systematic observations methods were used to follow 19 ICU nurses for 38 hours in 3 clinical practice settings. Storyboard methods and concept mapping helped to categorize the observed tasks, the associated information needs, and the information gaps of the most frequent tasks by SA level. Consensus and discussion of the research team was used to propose recommendations to improve information displays at the bedside based on information deficits. Nurses performed 46 different tasks at a rate of 23.4 tasks per hour. The information needed to perform the most common tasks was often inaccessible, difficult to see at a distance or located on multiple monitoring devices. Current devices at the ICU bedside do not adequately support a nurse's information-gathering activities. Medication management was the most frequent category of tasks. Information gaps were present at all levels of SA and across most of the tasks. Using a theoretical model to understand information gaps can aid in designing functional requirements. Integrated information that enhances nurses' Situation Awareness may decrease errors and improve patient safety in the future.
Lennan, E; Vidall, C; Roe, H; Jones, P; Smith, J; Farrell, C
This position statement has been formulated by nurses from the United Kingdom Oncology Nursing Society (UKONS) to provide guidance on the provision of nurse-led chemotherapy review clinics for adult patients. For the purposes of this statement, a nurse-led chemotherapy clinic is defined as one that conducts formal review (in a consultation room) before the decision to proceed and prescribe the next cycle of chemotherapy. This statement does not address the toxicity checks that take place imme...
Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid
Aims of this article were (a) to explore how parents of premature infants experience guided family-centred care (GFCC), and (b) to compare how parents receiving GFCC versus standard care (SC) describe nurse-parent communication in the neonatal intensive care unit....
Full Text Available Introduction: Infant hospitalization is stressful event for parent in NICU. Parents think that they have lost control because of unfamiliar environment. Therefore, stress management is very important in this period. The family as the main factor of strength and protection for infant is required as the bases of standard care in NICU. Therefore the aim of this study was to investigate stress management in Iranian NICU Parents. Methods: Using qualitative content analysis approach helped to collect and analysis data for open coding, classification, and theme abstraction. Twenty one parents with hospitalized neonates, physicians and nurses in the city of Isfahan were purposely recruited and selected for in-depth interviews. Results: The analyzed content revealed unique stress management approaches among the parents. The main themes were: 1 spirituality, 2 seeking information, 3 Seeking hope, 4 maintaining calm, 5 attachment to infant, and 6 communicating with the medical team Conclusion: Findings of this study highlights the importance of medical team’s attention to stressed parents who are trying to make adjustment or adapt to the hospitalization of their infant. A revised management approach to address the emotional needs of parents of neonates in Iran seems essential for improving communication with physicians and nurses. NICU Inf Parents ant Stress Qualitative content analysis
白岩, 義夫; 河合, 優年; 犬飼, 和久; 鬼頭, 秀行; 小川, 次郎
The purpose of this study was to determine the effect of illumination in a Neonatal Intensive Care Unit (NICU) on behaviors and behavioral states in preterm infants. The Ss were individually observed twice in a day for a period of one hour by a video recording system. The results showed that rates of awakening and eye-opening during the awake state were higher, and their eyes were opened more widely under the dark condition than the bright. The bright condition increased the rate of Behavior ...
Czarnecki, Michelle L; Hainsworth, Keri; Simpson, Pippa M; Arca, Marjorie J; Uhing, Michael R; Varadarajan, Jaya; Weisman, Steven J
Continuous opioid infusion (COI) remains the mainstay of analgesic therapy in the neonatal intensive care unit (NICU). Parent/nurse-controlled analgesia (PNCA) has been accepted as safe and effective for pediatric patients, but few reports include use in neonates. This study sought to compare outcomes of PNCA and COI in postsurgical neonates and young infants. Twenty infants treated with morphine PNCA were retrospectively compared with 13 infants treated with fentanyl COI in a Midwestern pediatric hospital in the United States. Outcome measures included opioid consumption, pain scores, frequency of adverse events, and subsequent methadone use. The PNCA group (median 6.4 μg · kg(-1) · h(-1) morphine equivalents, range 0.0-31.4) received significantly less opioid (P < 0.001) than the COI group (median 40.0 μg · kg(-1) · h(-1) morphine equivalents; range 20.0-153.3), across postoperative days 0-3. Average daily pain scores (based on 0-10 scale) were low for both groups, but median scores differed nonetheless (0.8 PNCA vs 0.3 COI, P < 0.05). There was no significant difference in the frequency of adverse events or methadone use. Results suggest PNCA may be a feasible and effective alternative to COI for pain management in postsurgical infants in the NICU. Results also suggest PNCA may provide more individualized care for this vulnerable population and in doing so, may potentially reduce opioid consumption; however, more studies are needed. © 2014 John Wiley & Sons Ltd.
Hughes, Ronda G; Bobay, Kathleen L; Jolly, Nicholas A; Suby, Chrysmarie
This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes. Secondary data analysis of unit-level data from 32 hospitals, where nursing units are grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Use of the discharges and transfers adjustment to midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Nurse managers should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements. © 2013 John Wiley & Sons Ltd.
Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie
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.
Cox, K B
Health care organizations face major changes, and these changes are likely to increase conflict in organizations. Although numerous studies have focused on conflict management, few have considered causes and effect of conflict in nursing units. The investigation tested a structural equation that examined the relationships among individual and contextual variables and intragroup conflict, job satisfaction, team performance effectiveness, and anticipated turnover. The nonrandom sample consisted of 141 nurses employed on 13 inpatient units at a state-supported, 597-bed academic medical centre in a southeastern city. Intragroup conflict was higher on smaller units with a higher ratio of RNs to total staff. Intragroup conflict was not associated with satisfaction with pay or anticipated turnover. In the final model, the unit morale and interpersonal relations dimension of team performance effectiveness was negatively associated with intragroup conflict and anticipated turnover, and positively associated with satisfaction with pay. High perceptions of unit morale and interpersonal relations buffered the effect of unit size and skill mix on intragroup conflict. Goodness of fit statistics indicated a good fit of the model to data. The findings have implications for nursing educators and administrators, and provide direction for future research.
Clarke, DJ; Holt, J
Abstract Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses' involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses' practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit t...
Lyndon, Audrey; Wisner, Kirsten; Holschuh, Carrie; Fagan, Kelly M; Franck, Linda S
To describe parents' perspectives and likelihood of speaking up about safety concerns in the NICU and identify barriers and facilitators to parents speaking up. Exploratory, qualitatively driven, mixed-methods design. A 50-bed U.S. academic medical center, open-bay NICU. Forty-six parents completed questionnaires, 14 of whom were also interviewed. Questionnaires, interviews, and observations with parents of newborns in the NICU were used. The qualitative investigation was based on constructivist grounded theory. Quantitative measures included ratings and free-text responses about the likelihood of speaking up in response to a hypothetical scenario about lack of clinician hand hygiene. Qualitative and quantitative analyses were integrated in the final interpretation. Most parents (75%) rated themselves likely or very likely to speak up in response to lack of hand hygiene; 25% of parents rated themselves unlikely to speak up in the same situation. Parents engaged in a complex process of Navigating the work of speaking up in the NICU that entailed learning the NICU, being deliberate about decisions to speak up, and at times choosing silence as a safety strategy. Decisions about how and when to speak up were influenced by multiple factors including knowing my baby, knowing the team, having a defined pathway to voice concerns, clinician approachability, clinician availability and friendliness, and clinician responsiveness. To engage parents as full partners in safety, clinicians need to recognize the complex social and personal dimensions of the NICU experience that influence parents' willingness to speak up about their safety concerns. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.
Pope, Diana S; Miller-Klein, Erik T
Hospitals have complex soundscapes that create challenges to patient care. Extraneous noise and high reverberation rates impair speech intelligibility, which leads to raised voices. In an unintended spiral, the increasing noise may result in diminished speech privacy, as people speak loudly to be heard over the din. The products available to improve hospital soundscapes include construction materials that absorb sound (acoustic ceiling tiles, carpet, wall insulation) and reduce reverberation rates. Enhanced privacy curtains are now available and offer potential for a relatively simple way to improve speech privacy and speech intelligibility by absorbing sound at the hospital patient's bedside. Acoustic assessments were performed over 2 days on two nursing units with a similar design in the same hospital. One unit was built with the 1970s' standard hospital construction and the other was newly refurbished (2013) with sound-absorbing features. In addition, we determined the effect of an enhanced privacy curtain versus standard privacy curtains using acoustic measures of speech privacy and speech intelligibility indexes. Privacy curtains provided auditory protection for the patients. In general, that protection was increased by the use of enhanced privacy curtains. On an average, the enhanced curtain improved sound absorption from 20% to 30%; however, there was considerable variability, depending on the configuration of the rooms tested. Enhanced privacy curtains provide measureable improvement to the acoustics of patient rooms but cannot overcome larger acoustic design issues. To shorten reverberation time, additional absorption, and compact and more fragmented nursing unit floor plate shapes should be considered.
Diana S Pope
Full Text Available Hospitals have complex soundscapes that create challenges to patient care. Extraneous noise and high reverberation rates impair speech intelligibility, which leads to raised voices. In an unintended spiral, the increasing noise may result in diminished speech privacy, as people speak loudly to be heard over the din. The products available to improve hospital soundscapes include construction materials that absorb sound (acoustic ceiling tiles, carpet, wall insulation and reduce reverberation rates. Enhanced privacy curtains are now available and offer potential for a relatively simple way to improve speech privacy and speech intelligibility by absorbing sound at the hospital patient′s bedside. Acoustic assessments were performed over 2 days on two nursing units with a similar design in the same hospital. One unit was built with the 1970s′ standard hospital construction and the other was newly refurbished (2013 with sound-absorbing features. In addition, we determined the effect of an enhanced privacy curtain versus standard privacy curtains using acoustic measures of speech privacy and speech intelligibility indexes. Privacy curtains provided auditory protection for the patients. In general, that protection was increased by the use of enhanced privacy curtains. On an average, the enhanced curtain improved sound absorption from 20% to 30%; however, there was considerable variability, depending on the configuration of the rooms tested. Enhanced privacy curtains provide measureable improvement to the acoustics of patient rooms but cannot overcome larger acoustic design issues. To shorten reverberation time, additional absorption, and compact and more fragmented nursing unit floor plate shapes should be considered.
Pope, Diana S.; Miller-Klein, Erik T.
Hospitals have complex soundscapes that create challenges to patient care. Extraneous noise and high reverberation rates impair speech intelligibility, which leads to raised voices. In an unintended spiral, the increasing noise may result in diminished speech privacy, as people speak loudly to be heard over the din. The products available to improve hospital soundscapes include construction materials that absorb sound (acoustic ceiling tiles, carpet, wall insulation) and reduce reverberation rates. Enhanced privacy curtains are now available and offer potential for a relatively simple way to improve speech privacy and speech intelligibility by absorbing sound at the hospital patient's bedside. Acoustic assessments were performed over 2 days on two nursing units with a similar design in the same hospital. One unit was built with the 1970s’ standard hospital construction and the other was newly refurbished (2013) with sound-absorbing features. In addition, we determined the effect of an enhanced privacy curtain versus standard privacy curtains using acoustic measures of speech privacy and speech intelligibility indexes. Privacy curtains provided auditory protection for the patients. In general, that protection was increased by the use of enhanced privacy curtains. On an average, the enhanced curtain improved sound absorption from 20% to 30%; however, there was considerable variability, depending on the configuration of the rooms tested. Enhanced privacy curtains provide measureable improvement to the acoustics of patient rooms but cannot overcome larger acoustic design issues. To shorten reverberation time, additional absorption, and compact and more fragmented nursing unit floor plate shapes should be considered. PMID:26780959
Casida, Jesus M; Crane, Patrick C; Walker, Tara L; Wargo, Lisa M
The leadership-culture phenomenon, a known explanatory construct for organizational performance, is understudied in nursing. Building on our previous work, we further addressed this knowledge gap through explorations of demographics and hospital variables which may have a significant influence on staff nurses' (SNs) perceptions of their nurse managers' (NMs) leadership and nursing unit culture. Furthermore, we explored the extent to which the NMs' leadership predicted specific cultures which typify nursing unit effectiveness. Using dissertation data provided by278 SNs, we found that SNs educated at the baccalaureate level or higher had favorable perceptions of their nursing unit performance and viewed their NMs' leadership differently than the SNs with diploma or associate degrees. The frequent portrayals of transformational (TFL) leadership behaviors (e.g., visionary) by the NMs were paramount in shaping culture traits which exemplify high performance outcomes. TFL leaders were more likely to shape unit cultures which are flexible and adaptive to the environmental challenges within and outside the nursing unit. Thus, the type of NMs' leadership and unit culture may provide an added value in explaining the performance level in patient care units which consequently affects the overall hospital/organizational outcomes. Implications for research and leadership practices are presented.
Full Text Available ABSTRACT Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP in Greek Coronary Care Units (CCUs. Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7. The most highly valued component of satisfaction was “Pay”, followed by “Task requirements”, “Interaction”, “Professional status”, “Organizational policies” and “Autonomy”. NAS, CNIS and TISS-28 were negatively correlated (p≤0.04 with the following work components: “Autonomy”, “Professional status”, “Interaction” and “Task requirements”. Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.
... with empathy so that you can feel supported. How can you build your confidence as a parent in the NICU? It's only ... of visits might give you the reassurance and boost you need. How can you manage emotions after delivery? New moms ...
Chang, Ann; Kicis, Jennifer; Sangha, Gurjit
High patient acuity, heavy workload, and patient deaths can all contribute to work-related stress for pediatric oncology nurses. A new leadership role, the clinical support nurse (CSN), was recently initiated on the oncology unit of a large Canadian pediatric hospital to support frontline staff and reduce some of the stresses related to clinical activity. The CSN assists nurses with complex patient care procedures, provides hands-on education at the bedside, and supports staff in managing challenging family situations. This study explores the effect of the CSN role on the nurses' work-related stress using the Stressor Scale for Pediatric Oncology Nurses. A total of 58 nurses participated in this study for a response rate of 86%. The results show that the intensity of work-related stress experienced by nurses in this study is significantly less (P < .001) on shifts staffed with a CSN compared with shifts without a CSN.
Mogale L. Mmamma
Full Text Available Background: Staff turnover of professional nurses remains a concern for public and private hospitals management because it has an impact on the morale of nurses and it may also lead to poor patient care. Objectives: The objectives of this study were to explore and describe the experiences of nursing unit managers with regard to the turnover of professional nurses who were under their supervision. Method: A qualitative, explorative, descriptive research design was used to determine the experiences of nursing unit managers related to the turnover of professional nurses. Data collection was done by using semi-structured one-to-one interviews with professional nurses .Two groups of participants were interviewed: Those working day duty (n = 9 and those working night duty (n = 3 who were at work on the anticipated days for data collection. Results: The findings revealed that every unit was experiencing a shortage of professional nurses, which caused other nurses to work overtime with an inevitable increase in workload. That led to tiredness, conflict amongst professional nurses, job dissatisfaction, and absenteeism which compromised nursing care. This resulted in patient dissatisfaction and sometimes led to deaths that could have been prevented. Conclusion: It is recommended that staff turnover should be addressed by the hospital top management implementing several strategies. For example, top management could ensure that staff members work in a healthy environment with resources that they need during the provision of care, address the effects of the staff turnover, support the staff members and refrain from putting pressure on nursing unit managers whilst they are attending to problems.
Sasaki, Hatoko; Yonemoto, Naohiro; Mori, Rintaro; Nishida, Toshihiko; Kusuda, Satoshi; Nakayama, Takeo
Although communication among health providers has become a critical part of improving quality of care, few studies on this topic have been conducted in Japan. This study aimed to examine the reliability and validity of the Intensive Care Unit Nurse-Physician Questionnaire (ICU N-P-Q) for use among nurses and physicians in neonatal ICUs (NICUs) in Japan. A Japanese translation of the ICU N-P-Q was administered to physicians and nurses working at 40 NICUs across Japan, which were participating in the Improvement of NICU Practice and Team Approach Cluster randomized controlled trial (INTACT). We used the principal components analysis to evaluate the factor structure of the instruments. Convergent validity was assessed by examining correlations between the subscales of Communication and Conflict Management of the ICU N-P-Q and the subscales and total score of the Nurse-Physician Collaboration Scale (NPCS). Correlations between the subscales of Communication and Conflict Management by correlation with scales that refer to performance, including Job Satisfaction and Unit Effectiveness, were calculated to test the criterion validity. In total, 2006 questionnaires were completed by 316 physicians and 1690 nurses. The exploratory factor analysis revealed 15 factors in the physicians' questionnaire and 12 in the nurses' questionnaire. Convergent validity was confirmed, except for 'Between-group Accuracy' and 'Cooperativeness' in the physicians' scale, and for 'Between-group Accuracy' and 'Sharing of Patient Information' in the nurses' scale. Correlations between the subscales of communication and outcomes were confirmed in the nurses' questionnaire but were not fully supported in the physicians' questionnaire. Although the psychometric property behaved somewhat differently by occupation, the present findings provide preliminary support for the utility of the common item structure with the original scale, to measure the degree and quality of communication and collaboration
Brownie, Sharon M; Hunter, Lyndal H; Aqtash, Salah; Day, Gary E
In 2009, the United Arab Emirates (UAE) established a Nursing and Midwifery Council with a mandate to develop standards for the registration and regulation of nursing and midwifery and to strengthen the nursing and midwifery workforce. Priorities included workforce Emiratization and the development of regulatory standards to support advanced and speciality nursing practice and new models of care-particularly for the management of noncommunicable diseases. This article provides background, context for, and best practice inputs to the effort to provide one unified framework of nursing regulation and licensure across the whole of the UAE. This article is intended for nurse leaders, policy makers, and regulators who are reviewing or developing nursing regulatory processes and advancing nursing workforce capacity building activities; and nurse educators and nurses wishing to work in the UAE. © The Author(s) 2015.
Pineda, Roberta G; Castellano, Alison; Rogers, Cynthia; Neil, Jeffrey J; Inder, Terrie
To determine factors associated with mothers' concern about infant development and intent to access therapy services following neonatal intensive care unit (NICU) discharge. Infant medical factors, magnetic resonance imaging results, neurobehavior at term, maternal factors, and maternal perceptions about developmental concern and intent to access therapy at NICU discharge were prospectively collected in 84 infants born premature (concern and intent to access therapy at NICU discharge. Decreased developmental concern was reported by mothers with more children (P = .007). Infant stress signs (P = .038), higher maternal education (P = .047), reading books (P = .030), and maternal depression (P = .018) were associated with increased developmental concern. More maternal education was associated with more intent to access services (P = .040). Maternal factors, rather than infant factors, had important associations with caregiver concern. In contrast, abnormal term neurobehavior and/or the presence of cerebral injury were not associated with caregiver concern about development.
Hille, E.T.; Straaten, H.L.M. van; Verkerk, P.H.; Straaten, I. van; Verkerk, P.; Hille, E.; Baerts, W.; Bunkers, C.; Smink, E.; Elburg, R. van; Kleine, M. de; Kok, J.H.; Ilsen, A.; Visser, D.; Steiner, K.; Vries, L.S. de; Weisglas-Kuperus, N.; Sprij, A.; Lopriori, E.; Brokx, J.; Gavilanes, D.; Geven, W.; Bos, A.
Aim: To determine the prevalence and independent relationship between hearing loss and risk factors in a representative neonatal intensive care unit (NICU) population. Methods: Automated auditory brainstem response (AABR) hearing screening has been introduced since 1998 in the Dutch NICUs. After a
Full Text Available Michael A Roche,1 Christine Duffield,1,2 Sofia Dimitrelis,1 Belinda Frew1 1Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, NSW, 2Clinical Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia Aim: To examine specific elements of nursing leadership linked to intention to leave, in public acute care hospitals. Background: Nurse turnover is a global issue receiving widespread attention due to prolonged and projected workforce shortages. Nurse management and leadership qualities have been associated with intention to leave and turnover of nurses. The role of the nurse unit managers in the retention of nurses is becoming increasingly important, particularly because of their strong influence on the quality and stability of the work environment. Methods: Data were collected from 62 medical, surgical, and mixed units across eleven public acute care hospitals in three Australian states (September 2008 to August 2010. A total of 1,673 nurses completed a nurse survey that included measures of intention to leave and leadership aspects of the practice environment. Analyses explored specific leadership characteristics that were associated with turnover intent. Results: The role of nursing unit managers was confirmed to be a major factor in nurses’ intention to remain or leave their current workplace. Nurses valued “human” skills more highly than other leadership characteristics, including their manager’s connection with nurses’ concerns, clarity, participation in decisions, and encouragement. Conclusion: Strong leadership qualities in the nursing unit manager have been associated with greater job satisfaction, reduced turnover intention among nursing staff, and improved patient outcomes. Nurse leaders need to be supported in an effort to retain nurses given ongoing workforce issues and to ensure high-quality patient care. Keywords: nurse
Lima, Elaine Cantarella; Bernardes, Andrea; Baldo, Priscila Lapaz; Maziero, Vanessa Gomes; Camelo, Silvia Helena Henriques; Balsanelli, Alexandre Pazetto
The goal of this study is to analyze nurses' leadership in intensive care units at hospitals in the state of São Paulo, Brazil, in the face of positive and negative critical incidents. Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses' behaviors. Among these situations they found: difficulty in the communication process; conflicts in the daily exercise of nurses' activities; people management; and the setting of high quality care targets. Researchers identified a mixed leadership model, leading them to the conclusion that nurses' knowledge and practice of contemporary leadership theories/styles are crucial because they facilitate the communication process, focusing on behavioral aspects and beliefs, in addition to valuing flexibility. This positively impacts the organization's results. Analisar a liderança do enfermeiro em Centros de Terapia Intensiva de hospitais localizados no interior do estado de São Paulo, diante de incidentes críticos positivos e negativos. Estudo exploratório, descritivo, realizado com 24 enfermeiros, que utilizou a Técnica do Incidente Crítico como referencial metodológico. Os resultados foram agrupados em 61 incidentes críticos distribuídos em categorias. Identificou-se que situações relacionadas à liderança interferem no comportamento do enfermeiro de Terapia Intensiva, dentre elas: dificuldade no processo de comunicação, conflitos existentes no dia a dia do exercício profissional, gerenciamento de pessoas e estabelecimento de metas para o alcance da assistência qualificada. Encontrou-se um modelo misto de liderança, o que permite concluir que o conhecimento e a prática dos enfermeiros acerca de teorias/estilos contemporâneos de liderança tornam-se fundamentais, pois
Lu, Yi; Cai, Hui; Bosch, Sheila J
This study examined how the spatial characteristics of patient beds, which are influenced by patient room design and nursing unit configuration, affect patients' perceptions about privacy. In the hospital setting, most patients expect a certain degree of privacy but also understand that their caregivers need appropriate access to them in order to provide high-quality care. Even veteran healthcare designers may struggle to create just the right balance between privacy and accessibility. A paper-based survey was conducted with 159 participants in Hong Kong-72 (45.3%) participants had been hospitalized and 87 (54.7%) participants had not-to document their selection of high-privacy beds, given simplified plans of eight nursing units. Two types of information, comprised of six variables, were examined for each bed. These include (1) room-level variables, specifically the number of beds per room and area per bed and (2) relational variables, including walking distance, directional change, integration, and control. The results demonstrate that when asked to identify high-privacy beds, participants selected beds in patient rooms with fewer beds per room, a larger area per bed, and a longer walking distance to the care team workstation. Interestingly, the participants having been hospitalized also chose beds with a visual connection to the care team workstation as being high in privacy. The participants with hospitalization experience may be willing to accept a bed with reduced visual privacy, perhaps out of a concern for safety.
Settle, Peggy Doyle
Nurses working in a newborn intensive care unit report that treatment decision disagreements for infants in their care may lead to ethical dilemmas involving all health-care providers. Applying Rest's Four-Component Model of Moral Action as the theoretical framework, this study examined the responses of 224 newborn intensive care unit nurses to the Nurses Ethical Involvement Survey. The three most frequent actions selected were as follows: talking with other nurses, talking with doctors, and requesting a team meeting. The multiple regression analysis indicates that newborn intensive care unit nurses with greater concern for the ethical aspects of clinical practice (p = .001) and an increased perception of their ability to influence ethical decision making (p = .018) were more likely to display Nurse Activism. Future research is necessary to identify other factors leading to and inhibiting Nurse Activism as these findings explained just 8.5% of the variance.
Ali Akbar Vaezi
Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.
Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.
Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.
Full Text Available Preterm infants are at greater risk for long-term morbidities, a problem representing also a growing public health concern. Early experiences can affect infants’ brain development, especially if conducted during critical periods of important growth. Early interventions involving parents in preterm infants care improve developmental outcomes for preterm infants, minimizing also the stress of the Neonatal Intensive Care Unit (NICU environment. Mother-infant separation and alteration of maternal care soon after birth can lead to a wide array of adverse physiological, emotional and behavioural consequences that can persist throughout life. It’s suggested that Maternal Vocal Intervention (MVI in NICU, as a specific form of environmental and interactional enrichment, as part of an individualized care and as a tool to involve families in early care of preterm infants, may be adopted by the health community as a standard of care. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA
Wang, Hsiang-Ling; Tsai, Yun-Fang
To explore nurses' knowledge and barriers regarding pain management in intensive care units. Pain is a common and treatable condition among intensive care patients. Quality care of these patients depends on the pain knowledge and pain management skills of critical care nurses. However, no single study has explored these nurses' knowledge of and perceived barriers to pain management in Taiwan. A cross-sectional study. Intensive care unit nurses (n = 370) were recruited from 16 hospitals chosen by stratified sampling across Taipei County in Taiwan. Data were collected on nurses' knowledge of pain management using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, on perceived barriers to pain management using a researcher-developed scale and on background information. The overall average correct response rate for the knowledge scale was 53.4%, indicating poor knowledge of pain management. The top barrier to managing pain identified by these nurses was 'giving proper pain prescription needs doctor's approval; can't depend on me'. Knowledge of pain management was significantly and negatively related to perceived barriers to pain management. In addition, scores for knowledge and perceived barriers differed significantly by specific intensive care unit. Knowledge also differed significantly by nurses' education level, clinical competence level (nursing ladder) and hospital accreditation category. Our results indicate an urgent need to strengthen pain education by including case analysis for intensive care nurses in Taiwan. Pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese nurses in intensive care units. © 2010 Blackwell Publishing Ltd.
Lindquist, Gay J.
Results of a national survey of baccalaureate nursing programs are presented concerning programs for study abroad, international exchange programs, and other approaches to internationalizing nursing curricula, including courses dealing with health care and nursing in foreign countries. (Author/MSE)
Farag, Amany A; Tullai-McGuinness, Susan; Anthony, Mary K
To describe and compare how nurses representing four age cohorts perceive their manager's leadership style and unit climate. The current workforce consists of nurses representing four generational cohorts. Nursing literature suggests that nurses from each age cohort think, behave and approach work differently. Limited empirical evidence, however, exists about how nurses from each age cohort perceive two aspects of their work environment: their managers' leadership style and unit climate. This cross-sectional, descriptive survey was conducted using a convenience sample of 475 registered nurses working in different inpatient units in three community non-magnet hospitals. Only nurses from Boomer and Gen-Xers had sufficient representation to be included in the data analysis. Nurses from the two main age cohorts did not differ in their perceptions of their manager's leadership style. Significant differences were found in two unit climate dimensions. The Gen-Xers had a less favourable perception of their unit climate related to warmth and belonging and administrative support. Nurse manager's might reflect on how they interact with different age cohorts; and to involve nurses from various age cohorts in the development of policies to create a flexible work environment.
Simpson, Kathleen Rice; Lyndon, Audrey; Wilson, Jane; Ruhl, Catherine
To solicit input from registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) on critical considerations for review and revision of existing nurse staffing guidelines. Thematic analysis of responses to a cross-sectional on-line survey question: "Please give the staffing task force your input on what they should consider in the development of recommendations for staffing of perinatal units." Members of AWHONN (N = 884). Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. Consistent themes identified included the need for revision of nurse staffing guidelines due to requirements for safe care, increases in patient acuity and complexity, invisibility of the fetus and newborn as separate and distinct patients, difficulties in providing comprehensive care during labor and for mother-baby couplets under current conditions, challenges in staffing small volume units, and the negative effect of inadequate staffing on nurse satisfaction and retention. Participants overwhelmingly indicated current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on significant changes that had occurred since 1983 when the original staffing guidelines were published. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
Profit, Jochen; Sharek, Paul J.; Kan, Peiyi; Rigdon, Joseph; Desai, Manisha; Nisbet, Courtney C.; Tawfik, Daniel S.; Thomas, Eric J.; Lee, Henry C.; Sexton, J. Bryan
Background and Objective Teamwork may affect clinical care in the neonatal intensive care unit (NICU) setting. The objective of this study was to assess teamwork climate across NICUs and to test scale level and item level associations with healthcare-associated infection (HAI) rates in very low birth weight (VLBW) infants. Methods Cross-sectional study of the association between HAI rates, defined as any bacterial or fungal infection during the birth hospitalization, among 6663 VLBW infants cared for in 44 NICUs between 2010 and 2012. NICU HAI rates were correlated with teamwork climate ratings obtained in 2011 from 2073 of 3294 eligible (response rate 63%) NICU health professionals. The relation between HAI rates and NICU teamwork climate was assessed using logistic regression models including NICU as a random effect. Results Across NICUs, 36 to 100% (mean 66%) of respondents reported good teamwork. HAI rates were significantly and independently associated with teamwork climate (OR [95% CI] 0.82 [0.73-0.92], p = 0.005), such that the odds of an infant contracting a HAI decreased by 18% with each 10% rise in NICU respondents reporting good teamwork. Conclusion Improving teamwork may be an important element in infection control efforts. PMID:28395366
Nelson-Brantley, Heather V; Park, Shin Hye; Bergquist-Beringer, Sandra
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.
Denyson Santana PEREIRA
Full Text Available The study aimed to assess occupational stressors among nurses working in urgent and emergency care facilities. It is a descriptive research developed in two public hospitals of different complexity degrees, with 49 nurses. Data were collected from June to September 2011. The Bianchi's Stress Scale, which is composed of six domains: Relationship, Unit functioning, Staff management, Nursing care, Unit coordination, and Work conditions was used to assess occupational stressors based on the regular activities performed by nurses. Data were analyzed by using descriptive statistics and Mann Whitney-U test. For the nurses working in the high complexity healthcare facility - hospital A the most stressful domain was Nursing care, while for those professionals working in the medium complexity healthcare facility - hospital B, Staff management was the most stressful domain. The nurses from hospital A perceived care-related activities as more stressful, while for those in hospital B administrative activities were considered more stressful.
In Lutheran Germany, parish nursing traditionally constituted the deaconesses' principal work. As "Christian mothers of the parish" they were charged with a wide spectrum of tasks, including nursing, social service, and pastoral care. At the center of the Christian understanding of nursing was the idea of nursing body and soul as a unity. This article analyzes the conception and transformation of Protestant parish nursing in the nineteenth and twentieth centuries in Germany and the United States, which developed very differently. In West Germany, parish nursing proved surprisingly resistant to modernization even in the face of upheavals of the 1960s, and in some places this traditional model survived as late as the 1980s and 1990s. In the United States, by contrast, an understanding of nursing rooted in the division of labor between care for body and care for soul had come to prevail by the 1920s and '30s, pushing out the German model of the parish deaconess altogether.
Stenner, Karen L; Courtenay, Molly; Cannons, Karin
Nurses make a valuable contribution to pain services and have the potential to improve the safety and effectiveness of pain management. A recent addition to the role of the specialist pain nurse in the United Kingdom has been the introduction of prescribing rights, however there is a lack of literature about their role in prescribing pain medication. The aim of this study was to develop a profile of the experience, role and prescribing practice of these nurses. A descriptive questionnaire survey. 192 National Health Service public hospital inpatient pain services across the United Kingdom. 161 qualified nurse prescribers were invited to participate, representing 98% of known nurse prescribers contributing to inpatient pain services. The survey was completed in November 2009 by 137 nurses; a response rate of 85%. Compared with nurse prescribers in the United Kingdom in general, participants were highly qualified and experienced pain specialists. Fifty-six percent had qualified as a prescriber in the past 3 years and 22% reported that plans were underway for more nurses to undertake a nurse prescribing qualification. Although all participants worked in inpatient pain services, 35% also covered chronic pain (outpatient) services and 90% treated more than one pain type. A range of pain medications were prescribed, averaging 19.5 items per week. The role contained a strong educational component and contributed to informing organisational policy on pain management. Prescribing was said to improve nurses' ability to promote evidence-based practice but benefits were limited by legislation on prescribing controlled drugs. Findings demonstrate that pain nurses are increasingly adopting prescribing as part of their advanced nurse role. This has implications for the development needs of pain nurses in the United Kingdom and the future role development of nurses in other countries. Copyright © 2011 Elsevier Ltd. All rights reserved.
Stein, Alice M.
Nursing history since 1853 is presented to identify issues in continuing nursing education, such as the influence of feminism and professionalism, changing constituencies, and philosophies in health care. (SK)
Mosallam, Rasha; Hamidi, Samer; Elrefaay, Manal
Given the difficulty in recruiting new nurses, it is imperative to retain those already in the profession. This cross-sectional study explored the relationship of demographic and work-related factors, burnout, conflict management and relationship between nurses and physicians on turnover intentions among ICU nurses in eight major hospitals in Alexandria, Egypt. Data on burnout, conflict management, nurse-physician communication, and turnover intention were collected by surveying 100 nurses in eight hospitals in Alexandria governorate. All nurses at the ICU of selected hospitals were approached (n=100) and a 47-item Likert scale questionnaire was administered to explore the factors affecting the turnover intention of ICU nurses in Alexandria. ICU nurses exhibited a mean score for turnover intention of 3.23 (mean score percentage 65.0%). There was a moderately positive statistically significant correlation between turnover intention and emotional exhaustion (r=0.29, Pturnover intention were emotional exhaustion and age. Nurses turnover intention at the ICU of the selected hospitals is high and is significantly associated with nurses' emotional exhaustion, poor nurse-physician communication, and nurses age.
Solberg, Marianne Trygg; Tandberg, Bente Silnes; Lerdal, Anners
To implement a didactic model for students specialising in intensive care nursing (n=12) and nurses working in neonatal intensive care units (NICU) (n=17). To evaluate nurse self-assessments following observation of children with congenital heart disease (CHD), before and after participation in the programme, as well as the usefulness of the programme. A pilot study with a pre- and post-test design, using self-administered questionnaires. The didactic model increased the number of clinical observations and assessments of physiological factors made by both students and NICU nurses during evaluation of children with suspected CHD. The majority of nurses reported that both participation in the programme and the didactic model were useful and they demonstrated high-level knowledge, according to Bloom's taxonomy for cognitive learning. In particular, subjects found that the literature provided and structured bedside guidance in the clinical setting assisted learning. Intensive care students and NICU nurses performed clinical observations and physical factor assessments more frequently after completing the programme, compared with baseline. We speculate that this didactic model may also be useful in other clinical settings. Copyright © 2011 Elsevier Ltd. All rights reserved.
Turkelson, Carman; Aebersold, Michelle; Redman, Richard; Tschannen, Dana
Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.
Sveinsdóttir, Herdís; Ragnarsdóttir, Erla Dögg; Blöndal, Katrín
The aim of this study was to investigate the associations between praise from nurse unit managers and job satisfaction, professional practice, workload, work climate and organizational commitment of nurses caring for surgical patients. Praise influences experiences of employees. Web-based, cross-sectional explorative survey design. A structured questionnaire was used to measure praise given by nurse unit managers as perceived by nurses (n = 383; 49% response rate) working with surgical patients. Data were collected between December 2009-January 2010. Several variables assessed the major concepts under study. Binary logistic regression analysis was employed to compare nurses who receive praise very rarely/rarely as compared with very often/rather often. Praise was received often/very often by 31·6% of participants. Compared with nurses receiving praise rarely/very rarely those who received it often/rather showed more job satisfaction, stated they had more opportunities to practice professionally, described a more positive work climate and were more committed to the organization such as being proud to work at and willing to make effort for the unit and hospital. There was no difference between the groups regarding workload. Main findings of the regression analysis were that nurses display their organizational commitment by not thinking about leaving the current workplace and those who value professional recognition are likelier to receive praise than their counterparts. Nurse unit managers should praise their staff in a realistic fashion. Such praise is cost-effective, takes short time, produces positive influences on members of their staff and may improve patient safety. © 2015 John Wiley & Sons Ltd.
Toole, Cheryl A; DeGrazia, Michele; Connor, Jean Anne; Gauvreau, Kimberlee; Kuzdeba, Hillary Bishop; Hickey, Patricia A
Neonatal intensive care units (NICUs) located in freestanding children's hospitals may exhibit significant variation in nursing and organizational characteristics, which can serve as opportunities for collaboration to understand optimal staffing models and linkages to patient outcomes. Adopting methods used by Hickey et al in pediatric cardiovascular critical care, the purpose of this study was to provide a foundational description of the nursing and organizational characteristics for NICUs located in freestanding children's hospitals in the United States. Clinical nurse leaders in NICUs located in freestanding children's hospitals were invited to participate in an electronic cross-sectional survey. Descriptive analyses were used to summarize nursing and organizational characteristics. The response rate was 30% (13/43), with 69.2% of NICUs classified as level III/IV and 30.8% classified as level II/III. Licensed bed capacity varied significantly (range, 24-167), as did the proportion of full-time equivalent nurses (range, 71.78-252.3). Approximately three-quarters of staff nurses held baccalaureate degrees or higher. A quarter of nurses had 16 or more years (26.3%) of experience, and 36.9% of nurses had 11 or more years of nursing experience. Nearly one-third (29.2%) had 5 or less years of total nursing experience. Few nurses (10.6%) held neonatal specialty certification. All units had nurse educators, national and unit-based quality metrics, and procedural checklists. This study identified (1) variation in staffing models signaling an opportunity for collaboration, (2) the need to establish ongoing processes for sites to participate in future collaborative efforts, and (3) survey modifications necessary to ensure a more comprehensive understanding of nursing and organizational characteristics in freestanding children's hospital NICUs.
Malak, Jaleh Shoshtarian; Safdari, Reza; Zeraati, Hojjat; Nayeri, Fatemeh Sadat; Mohammadzadeh, Niloofar; Farajollah, Seide Sedighe Seied
In recent years, the use of new tools and technologies has decreased the neonatal mortality rate. Despite the positive effect of using these technologies, the decisions are complex and uncertain in critical conditions when the neonate is preterm or has a low birth weight or malformations. There is a need to automate the high-risk neonate management process by creating real-time and more precise decision support tools. To create a collaborative and real-time environment to manage neonates with critical conditions at the NICU (Neonatal Intensive Care Unit) and to overcome high-risk neonate management weaknesses by applying a multi agent based analysis and design methodology as a new solution for NICU management. This study was a basic research for medical informatics method development that was carried out in 2017. The requirement analysis was done by reviewing articles on NICU Decision Support Systems. PubMed, Science Direct, and IEEE databases were searched. Only English articles published after 1990 were included; also, a needs assessment was done by reviewing the extracted features and current processes at the NICU environment where the research was conducted. We analyzed the requirements and identified the main system roles (agents) and interactions by a comparative study of existing NICU decision support systems. The Universal Multi Agent Platform (UMAP) was applied to implement a prototype of our multi agent based high-risk neonate management architecture. Local environment agents interacted inside a container and each container interacted with external resources, including other NICU systems and consultation centers. In the NICU container, the main identified agents were reception, monitoring, NICU registry, and outcome prediction, which interacted with human agents including nurses and physicians. Managing patients at the NICU units requires online data collection, real-time collaboration, and management of many components. Multi agent systems are applied as
Marilia Moura Luvisotto
Full Text Available Objectives: To identify the administrative and nursing care activities most performed by nurses in clinical/surgical units and to determine which are most and least pleasant to them. Methods: A descriptive-exploratory field study, with a quantitative approach and with a sample made up of 40 nurses working in clinical/surgical units who answered a three-part questionnaire composed of identification data and characterization of the professional; a list of nursing and administrative activities for the nurse to grade according to the numbers: “0 = I do not perform it”, “1 = I perform it occasionally”, “2 = I perform it often”, “3 = I perform it daily”; two open-ended questions, in which the nurse listed the activities he/she enjoyed the most and the least. Results: The administrative activities most performed by the nurses were: changing work shifts, preparing employee daily task charts and managing tests; the most performed nursing care activities were related to the stages of the Nursing Care Systematization and the interaction with the multi-professional team; the most enjoyable activities were direct patient care, patient evaluation and implementation of the systematization; the least enjoyable activities were administrative and bureaucratic routines, justification of complaints/problem-solving and preparation of employee task charts. Conclusion: Compared to administrative activities, nursing activities were performed most during the daily routine of the nurse, and the most enjoyable activities were those related to patient care, according to the opinions of the professionals.
Burton, Christopher R; Fisher, Andrea; Green, Theresa L
Internationally the stroke unit is recognised as the evidence-based model for patient management, although clarity about the effective components of stroke units is lacking. Whilst skilled nursing care has been proposed as one component, the theoretical and empirical basis for stroke nursing is limited. We attempted to explore the organisational context of stroke unit nursing, to determine those features that staff perceived to be important in facilitating high quality care. A case study approach was used, that included interviews with nurses and members of the multidisciplinary teams in two Canadian acute stroke units. A total of 20 interviews were completed, transcribed and analysed thematically using the Framework Approach. Trustworthiness was established through the review of themes and their interpretation by members of the stroke units. Nine themes that comprised an organisational context that supported the delivery of high quality nursing care in acute stroke units were identified, and provide a framework for organisational development. The study highlighted the importance of an overarching service model to guide the organisation of care and the development of specialist and advanced nursing roles. Whilst multidisciplinary working appears to be a key component of stroke unit nursing, various organisational challenges to its successful implementation were highlighted. In particular the consequence of differences in the therapeutic approach of nurses and therapy staff needs to be explored in greater depth. Successful teamwork appears to depend on opportunities for the development of relationships between team members as much as the use of formal communication systems and structures. A co-ordinated approach to education and training, clinical leadership, a commitment to research, and opportunities for role and practice development also appear to be key organisational features of stroke unit nursing. Recommendations for the development of stroke nursing
Collet, J; de Vugt, M E; Schols, J M G A; Engelen, G J J A; Winkens, B; Verhey, F R J
Working in long-term care is seen as a stressful, physically and mentally demanding occupation, and thus, nursing staff are at risk for work and stress-related diseases. In older patients, psychiatric illnesses often occur in combination with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nurses is unknown. Nursing staff working on specialized units for patients with combined care needs experience high levels of self-efficacy in combination with strong feelings of self-rated competence. Although levels of burnout are relatively low, mental healthcare nursing staff is more at risk for burnout when working in specialized settings for patients with combined care needs than nursing home staff working in specialized settings for these patients. Nursing staff characteristics, such as years of working experience and age, seem more important in relation to staff well-being than patient characteristics in specialized settings for combined care needs. Staff well-being might benefit from specializing care, so that patients with similar care needs are placed together and care is focused. The presence of specialized care units for older patients with combined care needs can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training. Introduction In older patients, psychiatric illnesses frequently exist in tandem with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nursing staff is unknown. To investigate whether care characteristics of patients with combined care needs are related to the mental well-being of nursing staff. Well-being of nursing staff was studied within a larger exploratory observational cross-sectional study that examined the differences and similarities of specialized combined care units
Laudert, S; Liu, W F; Blackington, S; Perkins, B; Martin, S; Macmillan-York, E; Graven, S; Handyside, J
The purpose of the Vermont Oxford Neonatal Quality Improvement Collaborative 2005 was to explore improvements related to the physical environment of the newborn intensive care unit (NICU) in order to optimize the neurodevelopmental outcome of newborns. Five centers were involved in a focus group examining NICU environmental design and its impact on the neurodevelopmental outcome of the neonate. Using an evidence-based approach, the group identified 16 potentially better care practices. This article describes the implementation approaches for some of these practices. The practice areas include tactile stimulation, providing early exposure to mother's scent, minimizing exposure to noxious odors, developing a system for noise assessment of the NICU acoustic environment, minimizing ambient noise in the infants environment, and preservation of sleep. Approaches to implementation were center specific. Optimizing neurodevelopment of the newborn was the desired goal, but this outcome is difficult to measure with a limited number of subjects over a short study period. Many of the changes although intuitively beneficial are difficult to measure. Education of all participants was considered essential to the process of implementation. The process of collaborative quality improvement is useful in identifying ways to optimize the physical environment of the NICU to improve the neurodevelopmental outcome of the neonate.
Alexandre Pazetto Balsanelli
Full Text Available 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.
Luiz Felipe Sales Maurício
Full Text Available ABSTRACT Objective: assess the autonomy, control over environment, and organizational support of nurses' work process and the relationships between physicians and nurses in critical care units. Method: cross-sectional study conducted with 162 nurses working in the intensive care units and emergency service of a university hospital. The workers' satisfaction with their work environment was assessed using Brazilian Nursing Work Index - Revised, translated and adapted for the Brazilian culture. Results: average age was 31.6 ± 3.9 years; 80.2% were women; 68.5% Caucasians and 71.6% worked in intensive care units. The nurses considered autonomy (2.38 ± 0.64 and their relationship with physicians (2.24 ± 0.62 to be characteristics of the work environment that favored professional practice. Control over environment (2.78 ± 0.62 and organizational support (2.51 ± 0.54, however, were considered to be unfavorable. No statistically significant differences were found between the units based on the scores obtained by the professionals on the Brazilian Nursing Work Index - Revised. Conclusion: autonomy, relationship between physicians and nurses, and organizational support were considered by the units to be characteristics that favored nurses' professional practices. On the other hand, control over environment and organizational support were considered unfavorable.
Full Text Available Introduction: Clinical competence of nurses working in the neonatal intensive care units together with advancements in medical science and technology increased the survival rate of newborns that need specialized care. To ensure the quality of care and provide the safety of patients, evaluating the clinical competence of nurses seems necessary. This study aimed to evaluate the clinical competence of nurses in the neonatal intensive care units. Methods: In this cross-sectional study, 117 nurses working in the neonatal intensive care units of the hospitals affiliated to Tehran University of Medical Sciences were selected by census method. The research tool was Development of Competency Inventory for Registered Nurses questionnaire which completed by self-assessment. The mean clinical competence scores of participants categorized into 3 levels: weak: 273. Data were analyzed by SPSS version 13 using the Pearson correlation coefficient, t-test and Chi-square test. Results: The highest levels of competence were related to critical thinking and research attitude and interpersonal relationships, and the lowest level was related to training and mentoring. There was a direct statistically significant relationship between marital status, employment status, level of interest in working in the neonatal intensive-care units and the clinical competence of nurses. Conclusion: Since the clinical competence of nurses in the Neonatal Intensive Care Units is vital, some variables such as interest in the nursing profession, employment status, the neonatal intensive theoretical and practical training courses and the amount of overtime working hours should be taken into consideration.
Cox Sullivan, Sheila; Norris, Mitzi R; Brown, Lana M; Scott, Karen J
To examine the nurse manager perspective surrounding implementation of unit level shared governance in one Veterans Health Administration facility. Nursing shared governance is a formal model allowing nursing staff decision-making input into clinical practice, quality improvement, evidence-based practice and staff professional development. Unit level shared governance is a management process where decision authority is delegated to nursing staff at the unit level. Convenience sampling was used to recruit ten nurse managers who participated in face-to-face semi-structured interviews. Data were analysed using content analysis and constant comparison techniques. Demographic data were described using descriptive statistics. The participants included seven female and three male nurse managers with seven Caucasian and three African American. Participant quotes were clustered to identify sub-themes that were then grouped into four global themes to describe unit level shared governance. The global themes were: (1) motivation, (2) demotivation, (3) recommendations for success, and (4) outcomes. These research findings resonate with previous studies that shared governance may be associated with increased nurse empowerment, self-management, engagement, and satisfaction. These findings reflect the need for nurse managers to promote and recognize staff participation in unit level shared governance. © 2017 John Wiley & Sons Ltd.
Lagerwey, M D
Using historical discourse analysis, this study provides a thematic analysis of writings of nursing and birth control as found in The Birth Control Review from 1917 to 1927. The author contrasts this publication with the official journal of the American Nurses Association, the American Journal of Nursing from the same years to explore nursing voices and silences in early birth control stories. In dialogue with social contexts, nursing endeavors and inactivity have played important yet conflicting roles in the birth control movement in the United States. Nursing writings from the early twentieth century reflect eugenic beliefs, national fears of immigrants, and ambivalence about women's roles in society and the home. Nurses simultaneously empowered women to choose when to become pregnant and reinforced nativist and paternalistic views of the poor.
Alfred, Danita; Yarbrough, Susan; Martin, Pam; Mink, Janice; Lin, Yu-Hua; Wang, Liching S
Globalization is a part of modern life. Sharing a common set of professional nursing values is critical in this global environment. The purpose of this research was to examine the professional values of nursing students from two distinct cultural perspectives. Nurse educators in Taiwan partnered with nurse educators in the United States to compare professional values of their respective graduating nursing students. The American Nurses Association Code of Ethics served as the philosophical framework for this examination. The convenience sample comprised 94 Taiwanese students and 168 US students. Both groups reported high scores on an overall measure of values. They did differ substantially on the relative importance of individual items related to advocacy, competence, education, self-evaluation, professional advancement, and professional associations. Global implications for the collaborative practice of nurses from different cultures working together can be improved by first recognizing and then attending to these differences in value priorities.
Swathi, S; Ramesh, A; Nagapoornima, M; Fernandes, Lavina M; Jisina, C; Rao, P N Suman; Swarnarekha, A
The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to "sustain a culture of silence in NICU during nonemergency situations" (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The "culture of silence" reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a "noisy culture" prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints.
Full Text Available Healthcare workers suffer from work-related or occupational stress. This can lead to severe distress, burnout or physical illness, and finally to decrease quality of work life and services provision. Nurses must be aware of retential stressors, because they add to the cumulative effect of other stressful events. Holmes and Rahe both found a relationship between life change unit as stressors and health changes. This research reported here aims to measure the life change units as stressors among Iranian Hospitals Nurses by LCU rating. A cross - sectional, descriptive and analytical study was conducted among 389 nurses working in 15 teaching hospitals in Tehran, Iran. The respondents were asked to select each of 54 events that cause stress ranked in order of their life change units developed by Holmes and Rahe as stress scale. Before beginning the main study, the reliability and coincidental validity was performed. All data were analyzed using SPSS for windows version 18, t-test, Anova statistical methods. Approximately, half of the nurses associated major mortgage, foreclosure of mortgage or loan. More than 50% of the Iranian nurses had 150-300 and more than 300 LCU rating which had the chance to expose to extremely serious risk to health.Iranian hospitals nurses suffer from stress that caused by Life Change Units organizational factors such as change in the financial state, change in the work environment and major mortgage. We recommend to Iranian nursing policy-makers to choose strategies to help nurses cope effectively with workplace stressors. Nursing managers and / or nursing management should develop strategies to address and improve the quality of working conditions for nurses in the hospitals. Providing educational and career prospects can contribute to decrease nurses occupational stress level, the maintaining their work ability.
Santos, Ana Paula de Souza; Silva, Maria de Lourdes Costa da; Souza, Nilba Lima de; Mota, Gabriela Miranda; França, Débora Feitosa de
OBJECTIVES: to elaborate the Nursing Diagnoses of newborns with sepsis in a neonatal intensive care unit and characterize the profile of the neonates and their mothers.METHOD: a cross-sectional and quantitative study, with a sample of 41 neonates. A physical examination and consultation of the hospital records were undertaken, using an instrument. The elaboration of the Nursing Diagnoses followed a process of diagnostic inference and was based on the North American Nursing Diagnosis Associati...
Chen, Chiao-Min; Lin, Kai-Hui; Su, Hsiu-Ya; Lin, Mei-Hsiang; Hsu, Chu-Ling
Nesting and positioning is a common nursing skill used in the developmental care of premature infants. This skill maintains premature infants in a comfortable position, facilitates the monitoring of stable vital signs, and enables spontaneous motor activity for normal neuromuscular and skeletal joint function. This project was designed to improve nursing staff cognition and skills regarding nesting and positioning for premature infants in the NICU. Strategies used in this project were: develop an infant position assessment tool; record a demonstration video about nesting and positioning skills to provide learning efficacy among the nursing staff; and modify an education program for new nurses. After implementation, nurse cognition regarding premature infant nesting and positioning increased from 58.3% to 92.3%. The rate of correct technique use similarly rose from 63.3% to 91.4%. This is a valid intervention for improving the correctness of nesting and positioning in nursing care. This project standardized education in terms of nesting and positioning practice goals and enhanced quality care for premature infants.
In December 2013, the first cases of the most recent outbreak of Ebola virus disease (formerly known as Ebola hemorrhagic fever) emerged in the West African nation of Guinea. Within months the disease had spread to the neighboring countries of Liberia and Sierra Leone. The international humanitarian aid organization Médecins Sans Frontières (MSF; known in English as Doctors Without Borders) soon responded by sending staff to set up treatment centers and outreach triage teams in all three countries. In August 2014, the World Health Organization declared the outbreak an international public health emergency.In September 2014, the author was sent by MSF to work as a nurse in an Ebola treatment unit in Liberia for five weeks. This article describes her experiences there. It provides some background, outlines the practices and teams involved, and aims to convey a sense of what it's like to work during an Ebola outbreak and to put a human face on this devastating epidemic.
Manning, Vicki; Jones, Alan; Jones, Pamela; Fernandez, Ritin S
The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants' perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month follow-up surveys were observed in the participants' confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy.
Gifford, Blair D; Zammuto, Raymond F; Goodman, Eric A
Turnover rates for hospital nurses have been increasing in recent years, which is partially a result of increasing pressure on nurses from higher productivity expectations in a managed care environment. Improving nurse retention is a difficult challenge to managers since the bureaucratic cultural norm of hospitals, with its hierarchical structures, rules, and regulations, and heavy emphasis on measurement of outcomes and costs, may not be the culture most conducive to enhancing nurses' job satisfaction and commitment. Accordingly, this study investigates the relationships between unit organizational culture and several important job-related variables for nurse retention in the labor and delivery units of seven hospitals. Data analysis shows that unit organizational culture does affect nurses' quality of work life factors and that human relations cultural values are positively related to organizational commitment, job involvement, empowerment, and job satisfaction, and negatively related to intent to turnover. These findings suggest that although increasing recruitment of nurses and improved compensation and benefits strategies may offset hospital nurse shortages in the short term, improving quality of work life may be a more practical and long-term approach to improving hospital nurse retention.
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.
Kauppi, Wivica; Proos, Matilda; Olausson, Sepideh
Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step-down unit. The aim of this study was to explore general ward nurses' experiences of caring for patients being discharged from an ICU. Data were collected from focus groups and in-depth interviews with a total of 16 nurses from three different hospitals in Sweden. An inductive qualitative design was chosen. The analysis revealed three themes that reflect the challenges in nursing former ICU patients: a vulnerable patient, nurses' powerlessness and organizational structure. The nurses described the challenge of nursing a fragile patient based on several aspects. They expressed feeling unrealistic demands when caring for a fragile former ICU patient. The demands were related to their own profession and knowledge regarding how to care for this group of patients. The organizational structure had an impact on how the nurses' caring practice could be realized. This evoked ethical concerns that the nurses had to cope with as the organization's care guidelines did not always favour the patients. The structure of the organization and its leadership appear to have a significant impact on the nurses' ability to offer patients the care they need. This study sheds light on the need for extended outreach services and intermediate care in order to meet the needs of patients after the intensive care period. © 2018 British Association of Critical Care Nurses.
Brødsgaard, Anne; Larsen, Palle; Weis, Janne
REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify how parents of premature infants in neonatal intensive care units (NICUs) and nurses perceive their partnership.The review questions are: how do parents of premature infants and nurses perceive their partnership during...
Leadership within nursing is receiving unprecedented focus and development. This reflective narrative explores the nature of leadership, termed scholarly leadership, by an academic and a clinical leader of a Nursing Development Unit. The narrative explores the characteristics of such leadership and highlights how it empowered a nursing team to further reach its potential. Two areas, patient-centered care and the characteristics of practice, are focused upon to highlight the leadership style that the clinical leader adopted. The paper concludes by suggesting what structural and systems changes need to be put in place in order to bring about change.
Ernst, Katherine M; McComb, Sara A; Ley, Cathaleen
To qualitatively investigate the medical-surgical nurse shift handoff as a process within the workflow of the exchanging nurses. Specifically, this study sought to identify the ideal handoff, ways the handoff deviated from ideal, and subsequent effect on nursing care. The functions as well as information content of the handoff have been studied. However, typical studies look at the handoff as an isolated activity utilising nurse perceptions as the primary measure of quality. Semi-structured focus groups were conducted to discuss nurses' perspectives on ideal handoffs, ways handoffs deviate from the ideal including frequent and significant deviations and the effects on subsequent care. Twenty-one medical-surgical nurses participated in one of five audio-taped focus group sessions. Three sessions were conducted at hospital A; two sessions at unaffiliated hospital B. The general inductive approach was used to analyse verbatim transcripts. Transcript segments relevant for answering the research questions were coded as ideal or not ideal. Conceptual themes were then developed. Two major themes were identified: teams/teamwork and constructing and communicating a shared understanding of the patients' conditions. The importance of nurse preparatory activities was revealed including the incoming nurses reading patients' health records and outgoing nurses rounding on patients. The impact of shared expectations was identified across the team, where teams include, in addition to the two nurses, the electronic health record, other hospital staff and patients/families with a bedside handoff. New potential nurse-centred process and outcome measures were proposed. Evaluating handoffs by their effect on the nursing performance both during and after the handoff offers a new framework to objectively assess handoff effectiveness. The handoff is a process which may significantly affect the incoming nurse's transition into and administration of nursing care. © 2018 John Wiley & Sons
Full Text Available Workplace violence is present in many work sectors, but in the area of mental health, nurses have a higher risk due to the close relationship they have with users. This study analyzed hostile user statements against nursing professionals of Mental Health Services and Emergency Units in Health Service (MHS hospitals in Murcia, Spain, and determined the frequency of exposure to the different violent user behaviors. The study was carried out with a sample of 518 nursing professionals from four hospital services: Mental Health, Emergency Units, Medical Hospitalization, and Maternal-and-Child. The nursing staff of Mental Health and Emergency Units was the most exposed to violence. Non-physical violence was more frequent in Emergency Units, whereas physical violence was more frequent in Mental Health. Among the consequences of exposure to non-physical violence are workers’ emotional exhaustion and the presence of psychological distress.
Almeida,Sônia Regina Wagner de; Sasso,Grace Teresinha Marcon Dal; Barra,Daniela Couto Carvalho
Abstract OBJECTIVE Analyzing the ergonomics and usability criteria of the Computerized Nursing Process based on the International Classification for Nursing Practice in the Intensive Care Unit according to International Organization for Standardization(ISO). METHOD A quantitative, quasi-experimental, before-and-after study with a sample of 16 participants performed in an Intensive Care Unit. Data collection was performed through the application of five simulated clinical cases and an evalua...
Full Text Available Introduction. The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. Aim. The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? Material and Methods. The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation and 3.697 time-schedule measurements were carried out. Results. The total nursing time was 4125.79 min. (68.76 hours, that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ2=16945.8, P<0.001 between the nurses’ workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. Conclusions. The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs.
Chant, Clarence; Mustard, Mary; Thorpe, Kevin E; Friedrich, Jan O
Paper-based nomograms are reasonably effective for achieving glycemic control but have low adherence and are less adaptive than nurses' judgment. To compare efficacy (glucose control) and safety (hypoglycemia) achieved by use of a paper nomogram versus nurses' judgment. Prospective, randomized, open-label, crossover trial in an intensive care unit in postoperative patients with glucose concentrations greater than 8 mmol/L. Consenting nurses with at least 1 year of experience were randomized to use either their judgment or a validated paper-based nomogram for glucose control. After completion of 2 study shifts, the nurses used the alternative method for the next 2 study shifts. Glucose target level and safety and efficacy boundaries were the same for both methods. The primary end point was area under glucose time curve per hour. Thirty-four nurses contributed 95 shifts of data (44 nomogram-directed, 51 nurse-directed). Adherence to the nomogram was higher in the nomogram group than hypothetical adherence in the nurse-directed group for correct adjustments in insulin infusion (70% vs 37%; P unit where nurses generally accepted the need for tight glucose control, nurse-directed control was as effective and as safe as nomogram-based control.
One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age-shift is two-fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be 'younger' than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the 'pool' of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility.
Mackle, Diane; Nelson, Katherine
This study explored the role of the research nurse in New Zealand (NZ) Level III intensive care units (ICU). Little was known about this role in NZ prior to this study. To describe the role and responsibilities of NZ ICU research nurses. A qualitative, descriptive approach, using semi structured interviews was used. The study was conducted in six Level III ICUs throughout NZ that employed a research nurse. Interviews were conducted with research nurses (n = 11), principal investigators (n = 6) and nurse managers (n = 6), and the findings were triangulated. The views across all ICUs and stakeholders were generally similar, with differences only being in some operational areas. This study found that the primary role of the research nurse was trial management, where they coordinated all elements of trial conduct. Almost half of the research nurses were involved in trial design through their positions on management committees. Research nurses also played a vital role in patient and trial advocacy, and they bridged the knowledge gap by bringing research to staff nurses, patients and their families. The majority of research nurses reported to a nursing line manager, and had an informal accountability to the PI. The role of NZ ICU research nurses is similar to their international counterparts. This study provides clarity about the research nurse role and showcases their key contribution in ensuring that NZ ICUs undertake high quality research, thus contributing to potential improvements for future patients' outcomes. Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
Ko, Yu Kyung
To identify the degree of group cohesion and social support of nurses in special and general units in hospitals in Korea, and to compare group cohesion and social support between the two groups. The level of commitment nurses have to their organizations has been shown to correlate with work group cohesion and social support. The participants were 1751 nurses who were working in Korean hospitals. Data were collected using a structured questionnaire and were analysed using SAS. The statistical methods included: descriptive statistics, t-test, anova and Pearson's correlation coefficients. Group cohesion of nurses on special wards was significantly higher than for nurses on general wards. No significant difference was found between types of units in terms of social support. The degree of group cohesion was significantly different in terms of the respondents' clinical experience, position, religion, job satisfaction, number of supportive superiors and number of supportive peers. A statistically significant correlation was found between group cohesion scores and degree of social support. Hospital management can accomplish their goals more effectively through knowledge of the level of group cohesion, superior support and peer support for nursing staff in accordance with unit specialty. © 2011 The Author. Journal compilation © 2011 Blackwell Publishing Ltd.
Tastan, Sevinc; Iyigun, Emine; Ayhan, Hatice; Hatipoglu, Sevgi
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.
Yönt, Gülendam Hakverdioğlu; Korhan, Esra Akin; Dizer, Berna; Gümüş, Fatma; Koyuncu, Rukiye
Nurses are more likely to face the dilemma of whether to resort to physical restraints or not and have a hard time making that decision. This is a descriptive study. A total of 55 nurses participated in the research. For data collection, a question form developed by researchers to determine perceptions of ethical dilemmas by nurses in the application of physical restraint was used. A descriptive analysis was made by calculating the mean, standard deviation, and maximum and minimum values. The nurses expressed (36.4%) having difficulty in deciding to use physical restraint. Nurses reported that they experience ethical dilemmas mainly in relation to the ethic principles of nonmaleficence, beneficence, and convenience. We have concluded that majority of nurses working in critical care units apply physical restraint to patients, although they are facing ethical dilemmas concerning harm and benefit principles during the application.
Daniela Couto Carvalho Barra
Full Text Available OBJECTIVE To analyze the usability of Computerized Nursing Process (CNP from the ICNP® 1.0 in Intensive Care Units in accordance with the criteria established by the standards of the International Organization for Standardization and the Brazilian Association of Technical Standards of systems. METHOD This is a before-and-after semi-experimental quantitative study, with a sample of 34 participants (nurses, professors and systems programmers, carried out in three Intensive Care Units. RESULTS The evaluated criteria (use, content and interface showed that CNP has usability criteria, as it integrates a logical data structure, clinical assessment, diagnostics and nursing interventions. CONCLUSION The CNP is a source of information and knowledge that provide nurses with new ways of learning in intensive care, for it is a place that provides complete, comprehensive, and detailed content, supported by current and relevant data and scientific research information for Nursing practices.
Paula Pedroso Peninck
Full Text Available Sepsis is defined as a clinical syndrome consisting of a systemic inflammatory response associated to an infection, which may determine malfunction or failure of multiple organs. This research aims to verify the application of implementation of sepsis algorithm by nurses in the Intensive Care Unit and create an operational nursing assistance guide. This is an exploratory, descriptive study with quantitative approach. A data collection instrument based on relevant literature was elaborated, assessed, corrected and validated. The sample consisted of 20 intensive care unit nurses. We obtained satisfactory evaluations on nurses’ performance, but some issues did not reach 50% accuracy. We emphasize the importance of greater numbers of nurses getting acquainted and correctly applying the sepsis algorithm. Based on the above, an operational septic patient nursing assistance guide was created, based on the difficulties that arose vis-à-vis the variables applied in research and relevant literature.
McCreaddie, M; Kuzemski, D; Griffiths, J; Sojka, E M; Fielding, M; Al Yateem, N; Williams, J J
This article identified, critically analysed and synthesized the literature on international nursing and midwifery research capacity building and standards. The United Arab Emirates is heavily dependent up on expatriate nurses. Only 4% of nurses working within the country are Emirati. The nation is therefore committed to developing nurses and nursing as a profession. The United Arab Emirates' Nursing and Midwifery Council was formed in 2009 and initially focused on regulation, education and specialization. This review was undertaken to inform the work of the Council's newly established Scientific Research Sub-Committee. A rapid narrative review was conducted using the Cumulative Index of Nursing and Allied Health Literature database, key words, Boolean operators, parameters and a journal-specific search. An inclusion/exclusion criterion was identified. The search provided 332 articles with 45 included in the final review. The literature on nursing research 'standards' and 'capacity building' is diverse and inconsistent across continents and in approaches. Nursing research has evolved to varying degrees across the globe. Nevertheless, irrespective of the locale, there are similar problems encountered in growing research, for example nursing faculty shortage, lack of collaborative research, funding. There are also specific challenges in the Middle East and North Africa region. The review was constrained by time and access. There are specific challenges for the United Arab Emirates. However, the country is well placed to learn from the experiences of colleagues elsewhere. Time and commitment is required to build the solid foundations necessary to ensure robust, sustained growth. Identifying research capacity as both a process and outcome at the outset may also assist. Further, it may be prudent to consider initiating a Gulf Coast Countries' collaborative approach to building research capacity to harness scare resources and create a larger critical mass. © 2017
Godby, Tyler; Saldanha, Sarah; Valle, Jazmine; Paul, David P; Coustasse, Alberto
Nursing home residents across the United States rely on quality care and effective services. Nursing homes provide skilled nurses and nursing aides who can provide services 24 hours a day for individuals who could not perform these tasks for themselves. Not-for-profit (NFP) versus for-profit (FP) nursing homes have been examined for utilization and efficacy; however, it has been shown that NFP nursing homes generally offer higher quality care and generate greater profit margins compared with FP nursing homes. The purpose of this research was to determine if NFP nursing homes provide enhanced quality care and a larger profit margin compared with FP nursing homes. Benefits and barriers in regard to financial stability and quality of care exist for both FP and NFP homes. Based on the findings of this review, it is suggested that NFP nursing homes have achieved higher quality of care because of a more effective balance of business aspects, as well as prioritizing resident well-being, and care quality over profit maximization in NFP homes.
Beck, Mary S; Doscher, Mindy
The current study described RN and patient care technician (PCT) communication in centralized and hybrid decentralized workstation designs using hands-free communication technology and infrared locator badge technology to facilitate communication. New construction of an oncology unit provided the opportunity to compare staff communication in two different workstation designs. Observations and questionnaires compared nurse and PCT communication in the two-unit designs. Descriptive statistics were used to analyze the differences. The hybrid decentralized unit had increased use of hands-free communication technology and hallway communication by nurses and PCTs, and increased patient room communication by nurses. Perceptions of communication between nurses and PCTs and congruency of priorities for care were similar for both units. The locator badge technology had limited adoption. Replacement of nurse workstations with new construction or remodeling impact staff communication patterns, necessitating that nurse leaders understand the impact of design and technology on communication. [Journal of Gerontological Nursing, 44(4), 17-22.]. Copyright 2018, SLACK Incorporated.
Full Text Available The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians. Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to “sustain a culture of silence in NICU during nonemergency situations” (core category. The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The “culture of silence” reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a “noisy culture” prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs
Veenema, Tener Goodwin; Lavin, Roberta Proffitt; Griffin, Anne; Gable, Alicia R; Couig, Mary Pat; Dobalian, Aram
Climate change, human conflict, and emerging infectious diseases are inexorable actors in our rapidly evolving healthcare landscape that are triggering an ever-increasing number of disaster events. A global nursing workforce is needed that possesses the knowledge, skills, and abilities to respond to any disaster or large-scale public health emergency in a timely and appropriate manner. The purpose of this article is to articulate a compelling mandate for the advancement of disaster nursing education within the United States with clear action steps in order to contribute to the achievement of this vision. A national panel of invited disaster nursing experts was convened through a series of monthly semistructured conference calls to work collectively towards the achievement of a national agenda for the future of disaster nursing education. National nursing education experts have developed consensus recommendations for the advancement of disaster nursing education in the United States. This article proposes next steps and action items to achieve the desired vision of national nurse readiness. Novel action steps for expanding disaster educational opportunities across the continuum of nursing are proposed in response to the current compelling need to prepare for, respond to, and mitigate the impact of disasters on human health. U.S. educational institutions and health and human service organizations that employ nurses must commit to increasing access to a variety of quality disaster-related educational programs for nurses and nurse leaders. Opportunities exist to strengthen disaster readiness and enhance national health security by expanding educational programming and training for nurses. © 2017 Sigma Theta Tau International.
Estabrooks, Carole A; Morgan, Debra G; Squires, Janet E; Boström, Anne-Marie; Slaughter, Susan E; Cummings, Greta G; Norton, Peter G
Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η², and ω²), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A
partnership with the New York University Rory Meyers College of Nursing. Abstract. Effective ... approach to leadership that has the potential to create a work environment defined ... rules, and seek and follow direction, whereas a leader.
Paganini, Maria Cristina; Bousso, Regina Szylit
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
Rochefort, Christian M; Clarke, Sean P
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.
Rouse, Ruby A
The aim of the present study was to analyse reactions to ineffective leader participation in an intensive care unit (ICU). Critical examination of leadership failures helps identify nurse manager behaviours to avoid. An online survey collected data from 51 interacting healthcare providers who work in an intensive care unit. Participants reported dissatisfaction with nurse leaders who were perceived as absent or ill prepared. Participants categorized intensive care unit productivity and morale as moderate to low. Multiple regression suggested the best predictor of perceived unit productivity was supervisor communication; the best predictor of employee morale was perceived leader mentoring. Intensive care unit nurses reported wanting active participation from their leaders and expressed dissatisfaction when supervisors were perceived as absent or incompetent. Ineffective leader participation significantly correlated with lower employee perceptions of productivity and morale. Senior managers should recruit and develop supervisors with effective participation skills. Organizations primarily concerned about productivity should focus on developing the communication skills of nurse leaders. Units mainly concerned with employee morale should emphasize mentorship and role modelling. Formal assessment of nurse leaders by all intensive care unit team members should also be used to proactively identify opportunities for improvement.
Hojat, M; Nasca, T J; Cohen, M J; Fields, S K; Rattner, S L; Griffiths, M; Ibarra, D; de Gonzalez, A A; Torres-Ruiz, A; Ibarra, G; Garcia, A
Inter-professional collaboration between physicians and nurses, within and between cultures, can help contain cost and insure better patient outcomes. Attitude toward such collaboration is a function of the roles prescribed in the culture that guide professional behavior. The purpose of the study was to test three research hypotheses concerning attitudes toward physician-nurse collaboration across genders, disciplines, and cultures. The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered to 639 physicians and nurses in the United States (n = 267) and Mexico (n = 372). Attitude scores were compared by gender (men, women), discipline (physicians, nurses), and culture (United States, Mexico) by using a three-way factorial analysis of variance design. Findings confirmed the first research hypothesis by demonstrating that both physicians and nurses in the United States would express more positive attitudes toward physician-nurse collaboration than their counterparts in Mexico. The second research hypothesis, positing that nurses as compared to physicians in both countries would express more positive attitudes toward physician-nurse collaboration, was also supported. The third research hypothesis that female physicians would express more positive attitudes toward physician-nurse collaboration than their male counterparts was not confirmed. Collaborative education for medical and nursing students, particularly in cultures with a hierarchical model of inter-professional relationship, is needed to promote positive attitudes toward complementary roles of physicians and nurses. Faculty preparation for collaboration is necessary in such cultures before implementing collaborative education.
Tabanejad, Zeinab; Pazokian, Marzieh; Ebadi, Abbas
This review focuses on the impact of liaison nurse in nursing care of patient after ICU discharge on patient's outcomes, compared with patients that are not taken care of by liaison nurses. The role of the ICU liaison nurse has transpired to solve the gap between intensive care unit and wards. Therefore, we aimed to review the outcomes of all studies in this field. A systematic review of intervention studies between 2004 and 2013 was undertaken using standard and sensitive keywords such as liaison nurse, intensive care unit, and patient outcomes in the following databases: Science direct, PubMed, Scopus, Ovid, Oxford, Wiley, Scholar, and Mosby. Then, the articles which had the inclusion criteria after quality control were selected for a systematic review. From 662 retrieved articles, six articles were analyzed in a case study and four articles showed a statistically significant effect of the liaison nurse on the patient's outcomes such as reducing delays in patient discharge, effective discharge planning, improvement in survival for patients at the risk for readmission. Liaison nurses have a positive role on the outcomes of patients who are discharged from the ICU and more research should be done to examine the exact function of liaison nurses and other factors that influence outcomes in patients discharged from ICU.
Malloy, M H
Home births attended by certified nurse midwives (CNMs) make up an extremely small proportion of births in the United States (home deliveries compared with certified nurse midwife in-hospital deliveries in the United States as measured by the risk of adverse infant outcomes among women with term, singleton, vaginal deliveries. United States linked birth and infant death files for the years 2000 to 2004 were used for the analysis. Adverse neonatal outcomes including death were determined by place of birth and attendant type for in-hospital certified nurse midwife, in-hospital 'other' midwife, home certified nurse midwife, home 'other' midwife, and free-standing birth center certified nurse midwife deliveries. For the 5-year period there were 1 237 129 in-hospital certified nurse midwife attended births; 17 389 in-hospital 'other' midwife attended births; 13 529 home certified nurse midwife attended births; 42 375 home 'other' midwife attended births; and 25 319 birthing center certified nurse midwife attended births. The neonatal mortality rate per 1000 live births for each of these categories was, respectively, 0.5 (deaths=614), 0.4 (deaths=7), 1.0 (deaths=14), 1.8 (deaths=75), and 0.6 (deaths=16). The adjusted odds ratio (95% confidence interval) for neonatal mortality for home certified nurse midwife attended deliveries vs in-hospital certified nurse midwife attended deliveries was 2.02 (1.18, 3.45). Deliveries at home attended by CNMs and 'other midwives' were associated with higher risks for mortality than deliveries in-hospital by CNMs.
Duffield, Christine; Roche, Michael; O'Brien-Pallas, Linda; Catling-Paull, Christine; King, Madeleine
Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated.
Al-Yateem, N; Al-Tamimi, M; Brenner, M; Altawil, H; Ahmad, A; Brownie, S
Globally, nurses are undertaking expanded and more specialized roles in healthcare planning and service delivery in response to changing patterns and levels of health service demand. This means the nursing profession is increasingly considered as leaders in health service policy, research and practice. The United Arab Emirates has strengthened nursing governance and practice by establishing a Nursing and Midwifery Council and increasing the activity of nursing specialization, service leadership and research. This study aimed to identify clinically relevant research priorities to facilitate nursing contributions to evidence-based care and strengthening health services in the country. A two-stage Delphi study design was used. The first round involved 783 participants. The second round involved 1116 participants, as more clinical settings were accessed. In total, 58 research priorities across a variety of nursing specialties (paediatrics, emergency care, intensive care, labour and maternity care, operating theatre and long-term care) were identified as highly important. These identified priorities will guide a more informed programme of research in each nursing specialty, with the aim of strengthening the evidence base to improving outcomes for patients and their families in the United Arab Emirates. The findings provide guidance on key areas for nurses to focus research contributions to enhance evidence-based care and strengthen health systems. The identified priorities may also guide researchers in academic institutions to conduct research informed by current, clinically relevant issues. The findings may help inform funders and policymakers to support allocation of funding to research that has potential to contribute to enhancing nursing care in specialist areas. © 2017 International Council of Nurses.
Aydon, Laurene; Hauck, Yvonne; Zimmer, Margo; Murdoch, Jamee
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
Choi, Yun Jeong; Lim, Ji Young; Lee, Young Whee; Kim, Hwa Soon
The purpose of this study was to develop visions of nursing service, nursing strategies and key performance indicators (KPIs) for an intensive care unit (ICU) based on a Balanced Scorecard (BSC). This study was undertaken by using methodological research. The development process consisted of four phases; the first phase was to develop the vision of nursing in ICUs. The second phase was to develop strategies according to 4 perspectives of a BSC. The third phase was to develop KPIs according to the 4 perspectives of BSC and the final phase was to combine the nursing visions, strategies and KPIs of ICUs. Two main visions of nursing service for ICUs were established. These were 'realization of harmonized professional nursing with human respect' and 'recovery of health through specialized nursing' respectively. In order to reach the aim of developing nursing visions, thirteen practical strategies and nineteen KPIs were developed by four perspectives of the BSC. The results will be used as objective fundamental data to attain business outcomes for the achievement of nursing visions and strategies of ICUs.
Lusignani, Maura; Giannì, Maria Lorella; Re, Luca Giuseppe; Buffon, Maria Luisa
To assess the frequency, intensity and level of moral distress perceived by nurses working in medical, surgical and intensive care units. Moral distress among nurses compromises their ability to provide optimal patient care and may cause them to leave their job. A cross-sectional questionnaire survey of 283 registered nurses was conducted to evaluate the frequency, intensity and levels of moral distress. A revised version of the Moral Distress Scale (MDS-R) was used. The highest level of moral distress was associated with the provision of treatments and aggressive care that were not expected to benefit the patients and the competency of the health-care providers. Multivariate regression showed that nurses working in medical settings, nurses with lower levels of experience working in medical, surgical or intensive care settings, and nurses who intend to leave their job experienced the highest levels of moral distress. The present study indicates that nurses experience an overall moderate level of moral distress. Gaining further insight into the issue of moral distress among nurses and the clinical situations that most frequently cause this distress will enable development of strategies to reduce moral distress and to improve nurse satisfaction and, consequently, patient care. © 2016 John Wiley & Sons Ltd.
Helth, Theresa Dall; Jarden, Mary
-depth, semi-structured interviews with five fathers of premature infants in the NICU, Copenhagen University Hospital, Hvidovre Hospital, Denmark. Findings: Three themes emerged: 1) “The competent parenthood”. 2) The paternal role and the division of roles between the parents. 3) Balance between working life......Abstract Aim: To explore how fathers of premature infants experience and potentially benefit from using the skin-to-skin (STS) method during their infants’ admission to the neonatal intensive care unit (NICU). Methods, participants and setting: Hermeneutic phenomenological qualitative study. In...... and time spent with the infant. Conclusion: STS enhances the fathers’ ability to play a caring role in their infant’s life. Fathers consider themselves less important, as compared to the mother in relation to their infant. STS enhances an understanding of their own role as a father. Health professionals...
Seo, Bo Kyeong
Drawing on fieldwork in a neonatal intensive care unit (NICU) in Chiang Mai during 2010 and 2012, I examine neonatal care as a contingent entanglement of technological and ethical relationships with vulnerable others. Along the continuum of universal antenatal and delivery care, neonatal medicine becomes a normative part of reproductive health care in Chiang Mai. As the NICU opens its door to sick newborns whose belonging to kinship and the nation-state is uncertain, neonatal care requires deliberate practices to incorporate them into life-sustaining connections. By tracing medical staff's effort to be accountable to their fragile patients, I show that withdrawing of intensive care is relational work that requires affective involvement and distancing through commensality, prosthetic extensions, and karmic network. This specific mode of care, which is premised on the combination of unconditional openness and careful detachment, offers insight into a possible enactment of hospitality within biomedical institutions.
O'Donovan, Aine; Gijbels, Harry
Self-harm in the absence of suicidal intent is an underexplored area in psychiatric nursing research. This article reports on findings of a study undertaken in two acute psychiatric admission units in Ireland. The purpose of this study was to gain an understanding of the practices of psychiatric nurses in relation to people who self-harm but who are not considered suicidal. Semistructured interviews were held with eight psychiatric nurses. Content analysis revealed several themes, some of which will be presented and discussed in this article, namely, the participants' understanding of self-harm, their approach to care, and factors in the acute psychiatric admission setting, which impacted on their care. Recommendations for further research are offered.
Özsaban, Aysel; Acaroglu, Rengin
As delirium in intensive care unit (ICU) patients is a serious problem that can result in increased mortality and morbidity, routine delirium assessment of all ICU patients is recommended. The severity, duration and outcome of the syndrome are directly related to nurses' continuous assessment of patients for signs and symptoms of delirium. However, studies indicate that very few nurses monitor for delirium as a part of their daily practices. The aim of this study was to identify current practices and perceptions of intensive care nurses regarding delirium assessment and to examine the factors that affect these practices and perceptions. A descriptive, correlational study design was used. Data were collected from five Turkish public hospitals using a structured survey questionnaire. The study sample comprised 301 nurses who agreed to participate. Data were analysed using descriptive statistics. More than half of the nurses performed delirium assessments. However, the proportion of nurses who use delirium assessment tools was quite low. Almost all of the nurses perceived delirium as a problem and serious problem for ICU patients. The patient group least monitored for delirium was that of unconscious patients. Statistically significant differences were found in the proportion of nurses who assessed delirium symptoms and whose care delivery system was patient-centred and perceived delirium as a serious problem. While a majority of ICU nurses perceived delirium as a problem and serious problem, the proportion of those who perform routine delirium assessments was less. It was found that delirium assessment practices of nurses were affected from their perceptions of delirium and the implementation of patient-centred care delivery. It is essential to develop strategies to encourage ICU nurses to perform delirium assessments through the use of delirium assessment tools. © 2015 British Association of Critical Care Nurses.
Dr. A.L. van Staa; O.K. Helder; J.C.M. Verweij
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
Loft, Mia I; Poulsen, Ingrid; Esbensen, Bente A
AIMS AND OBJECTIVES: To explore nurses' and nurse assistants' beliefs, attitudes and actions related to their function in an inpatient stroke rehabilitation unit. BACKGROUND: Several attempts have been made to describe nurses' roles and functions in inpatient neurorehabilitation. However, current...... understandings of the contributions that nurses and nurse assistants make to neurorehabilitation remain sparse. DESIGN: Descriptive, interpretive qualitative study. METHODS: Participant observations were conducted during 1 month in a stroke rehabilitation unit at a university hospital in the Capital Region...... stroke rehabilitation. We obtained insights into nursing staff's beliefs and attitudes about rehabilitation-as well as their own role and function-and furthermore how the latter affects their actions in daily practice. RELEVANCE TO CLINICAL PRACTICE: The nursing role and function are still not clearly...
Light Irin, C; Bincy, R
Stress in nurses affects their health and increases absenteeism, attrition rate, injury claims, infection rates and errors in treating patients. This in turn significantly increases the cost of employment in healthcare units. Proper management of stress ensures greater efficiency at work place and improved wellbeing of the employee. Therefore, a pre-experimental study was conducted among 30 Critical Care Unit nurses working inMedical College Hospital, Thiruvananthapuram, (Kerala) to assess the effect of stress management interventions such as Job Stress Awareness, Assertiveness Training, Time Management, andProgressive Muscle Relaxation on job stress. The results showed that caring for patients, general job requirements and workload were the major sources of stress for the nurses. The level of severe stress was reduced from 60 percent to 20 percent during post-test. The Stress Management Interventions were statistically effective in reducing the stress of nurses at p<0.001 level.
Le Blanc, Pascale M.; Schaufeli, Wilmar B.; Salanova, Marisa; Llorens, Susana; Nap, Raoul E.
P>Aim. 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. Background. Recent empirical studies in the field of work and organizational
Russell, Elizabeth; Hawkins, Jenna; Arnold, Kara A
Self-scheduling programs are an increasingly popular strategy utilized by employers to address the individual and organizational challenges resulting from employee work-life imbalance among the nursing workforce. Certain key components will ensure buy-in and support from staff when self-scheduling programs are developed.
Wheeler, Rebecca M; Foster, Jennifer W
This study compared the perspectives of internationally educated nurses (IENs) and registered nurses (RNs) educated in the United States regarding participation in hospital governance structures and professional advancement. Nurses' participation in hospital governance is reported to contribute to empowerment. No research has examined how IENs' perceptions about participation in governance compared with those of U.S. RNs. Semistructured interviews were held with 82 nurses in 2 urban hospitals. Forty nurses were reinterviewed to follow up on themes. Internationally educated nurses and US RNs shared similar perspectives. Nurses in both samples did not value participation in governance, lacked guidance about how to advance, and preferred to at the bedside. Strategies to encourage nurses to participate in and value governance and professional advancement opportunities should be explored and adopted.
Stayer, Debbie; Lockhart, Joan Such
Despite reported challenges encountered by nurses who provide palliative care to children, few researchers have examined this phenomenon from the perspective of nurses who care for children with life-threatening illnesses in pediatric intensive care units. To describe and interpret the essence of the experiences of nurses in pediatric intensive care units who provide palliative care to children with life-threatening illnesses and the children's families. A hermeneutic phenomenological study was conducted with 12 pediatric intensive care unit nurses in the northeastern United States. Face-to-face interviews and field notes were used to illuminate the experiences. Five major themes were detected: journey to death; a lifelong burden; and challenges delivering care, maintaining self, and crossing boundaries. These themes were illuminated by 12 subthemes: the emotional impact of the dying child, the emotional impact of the child's death, concurrent grieving, creating a peaceful ending, parental burden of care, maintaining hope for the family, pain, unclear communication by physicians, need to hear the voice of the child, remaining respectful of parental wishes, collegial camaraderie and support, and personal support. Providing palliative care to children with life-threatening illnesses was complex for the nurses. Findings revealed sometimes challenging intricacies involved in caring for dying children and the children's families. However, the nurses voiced professional satisfaction in providing palliative care and in support from colleagues. Although the nurses reported collegial camaraderie, future research is needed to identify additional supportive resources that may help staff process and cope with death and dying. ©2016 American Association of Critical-Care Nurses.
Piedrafita-Susín, A B; Yoldi-Arzoz, E; Sánchez-Fernández, M; Zuazua-Ros, E; Vázquez-Calatayud, M
Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. Twenty seven articles for review were selected, most of them qualitative studies (n=16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units' nurses. This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Full Text Available Graduate nursing education in the United States is undergoing major transformations, as a result of factors both within nursing and in the larger society.OBJECTIVE: In this paper the authors examine the trends and factors that are influencing the changes, especially in doctoral education, for both nurse scientist and advanced practice preparation.CONCLUSION: The paper provides a background that serves as context, it gives an overview of the PhD and the DNP degrees, focusing on the recent changes and identifying the most compelling issues and concerns, ending with a series of recommendations.
Fleiszer, Andrea R; Semenic, Sonia E; Ritchie, Judith A; Richer, Marie-Claire; Denis, Jean-Louis
To describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines (BPG) program on inpatient units. Several factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. A qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability. Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements. As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities. © 2015 John Wiley & Sons Ltd.
Valls-Matarín, J; Salamero-Amorós, M; Roldán-Gil, C
To evaluate and assess the nursing workload (NW) scales by means of three scales and to determine the theoretical and real nurse/patient relationship in a polyvalent ICU. Cross-sectional descriptive study between July 2012 and June 2013 in patients over 18 years old, for which 3 nurses quantified, in randomized days, the NW by the Nursing Activities Score (NAS), Nine Equivalents Manpower Score (NEMS) and Valoración de Cargas de Trabajo y Tiempos de Enfermería (VACTE). Efficiency parameters of nursing resources were calculated: "work utilization ratio" (WUR), "level of care" operative (LOCop) and planned (LOCp). Data on demographics, length of stay and number of nurses were collected. 720 records were collected. The mean age was 64 (13.6) years. 73% were male and the median of length of stay was 3 (1-12) days. 60% were admitted for medical causes. The average total score was: NAS: 696.8 (111.6), NEMS: 311.8 (55.3) and VACTE: 4,978 (897.7). The required number of nurses according to NAS was 7 and 6,7 according to NEMS and VACTE. The actual average was 5.5. On all 3 scales the WUR was >1 and LOCop was 1.6 pacients/nurse. The LOCp was 2 patients/nurse. Assessing NW allows to know the reality of each unit. According to the scales and efficiency parameters of the nursing resources used, there is a shortage of nurses in relation to the work generated. NAS reflects more parameters of NW. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Kleinpell, Ruth; Barden, Connie; Rincon, Teresa; McCarthy, Mary; Zapatochny Rufo, Rebecca J
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.
Masselink, Leah E; Jones, Cheryl B
Since the 1980s, U.S. policy makers have used immigration policy to influence the supply of nurses by allowing or restricting the entry of internationally educated nurses (IENs) into the U.S. workforce. The methods pursued have shifted over time from temporary visa categories in the 1980s and 1990s to permanent immigrant visas in the 2000s. The impact of policy measures adopted during nursing shortages has often been blunted by political and economic events, but the number and representation of IENs in the U.S. nursing workforce has increased substantially since the 1980s. Even as the United States seeks to increase domestic production of nurses, it remains a desirable destination for IENs and a target market for nurse-producing source countries. Hiring organizations and nurse leaders play a critical role in ensuring that the hiring and integration of IENs into U.S. health care organizations is constructive for nurses, source countries, and the U.S. health care system. Copyright © 2014 Elsevier Inc. All rights reserved.
Mibu, Kiyo; Yatabe, Tomoaki; Yamasaki, Fumiyasu; Kitagawa, Hiroyuki; Munekage, Masaya; Namikawa, Tsutomu; Hanazaki, Kazuhiro
The introduction of a color liquid-crystal display (LCD) on a novel artificial pancreas (STG-55, Nikkiso Co. Ltd. Tokyo, Japan) allowed nurses to more easily monitor changes in patients' blood glucose levels, compared to the previous model (STG-22). This study was conducted to examine the hypothesis that the STG-55 provided nurses with a feeling of security due to the introduction of the LCD screen. A questionnaire survey was conducted 6 months after the STG-55 was introduced (Survey 2012), among intensive care unit (ICU) nurses who had used both the STG-22 and the STG-55 for patient glycemic control. The results were then compared with the results from a questionnaire survey that was conducted after the STG-22 was introduced (Survey 2006). All ICU nurses (n = 19) responded to Survey 2012, and 95% of these nurses had responded to Survey 2006 (n = 19). After the introduction of the STG-22, 11 nurses (58%) reported becoming conscious of anxiety regarding hypoglycemia when they performed conventional glucose control with the sliding scale method. This anxiety awareness increased significantly (19 nurses, 100%; p survey indicate that all ICU nurses became conscious of anxiety regarding the risk of hypoglycemia when using the conventional sliding scale method after the introduction of the STG-55. However, the respondents were not satisfied with the STG-55, due to difficulties encountered during blood withdrawal.
Benoit, Britney; Semenic, Sonia
To explore manager, educator, and clinical leader perceptions of barriers and facilitators to implementing Baby-Friendly practice in the neonatal intensive care unit (NICU). Qualitative, descriptive design. Two university-affiliated level-III NICUs in Canada. A purposive sample of 10 medical and nursing managers, nurse educators, lactation consultants, and neonatal nurse practitioners. In-depth, semistructured interviews transcribed and analyzed using qualitative content analysis. Participants valued breastfeeding and family-centered care yet identified numerous contextual barriers to Baby-Friendly care including infant health status, parent/infant separation, staff workloads and work patterns, gaps in staff knowledge and skills, and lack of continuity of breastfeeding support. Facilitators included breastfeeding education, breastfeeding champions, and interprofessional collaboration. Despite identifying numerous barriers, participants recognized the potential value of expanding the Baby-Friendly Hospital Initiative (BFHI) to the NICU setting. Recommendations include promoting BFHI as a facilitator of family-centered care, interdisciplinary staff education, increasing access to lactation consultants, and establishing a group of NICU champions dedicated to BFHI implementation. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
Tkach, Jean A.; Loew, Wolfgang; Pratt, Ron G.; Daniels, Barret R.; Giaquinto, Randy O.; Winter, Patrick M.; Li, Yu; Dumoulin, Charles L. [Cincinnati Children' s Hospital Medical Center, Imaging Research Center, Department of Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Hillman, Noah H.; Jobe, Alan H.; Kallapur, Suhas G.; Merhar, Stephanie L.; Ikegami, Machiko; Whitsett, Jeffrey A. [Perinatal Institute, Cincinnati Children' s Hospital Medical Center, Division of Neonatology and Pulmonary Biology, Cincinnati, OH (United States); Kline-Fath, Beth M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)
Transporting premature infants from a neonatal intensive care unit (NICU) to a radiology department for MRI has medical risks and logistical challenges. To develop a small 1.5-T MRI system for neonatal imaging that can be easily installed in the NICU and to evaluate its performance using a sheep model of human prematurity. A 1.5-T MRI system designed for orthopedic use was adapted for neonatal imaging. The system was used for MRI examinations of the brain, chest and abdomen in 12 premature lambs during the first hours of life. Spin-echo, fast spin-echo and gradient-echo MR images were evaluated by two pediatric radiologists. All animals remained physiologically stable throughout the imaging sessions. Animals were imaged at two or three time points. Seven brain MRI examinations were performed in seven different animals, 23 chest examinations in 12 animals and 19 abdominal examinations in 11 animals. At each anatomical location, high-quality images demonstrating good spatial resolution, signal-to-noise ratio and tissue contrast were routinely obtained within 30 min using standard clinical protocols. Our preliminary experience demonstrates the feasibility and potential of the neonatal MRI system to provide state-of-the-art MRI capabilities within the NICU. Advantages include overall reduced cost and site demands, lower acoustic noise, improved ease of access and reduced medical risk to the neonate. (orig.)
Tkach, Jean A.; Loew, Wolfgang; Pratt, Ron G.; Daniels, Barret R.; Giaquinto, Randy O.; Winter, Patrick M.; Li, Yu; Dumoulin, Charles L.; Hillman, Noah H.; Jobe, Alan H.; Kallapur, Suhas G.; Merhar, Stephanie L.; Ikegami, Machiko; Whitsett, Jeffrey A.; Kline-Fath, Beth M.
Transporting premature infants from a neonatal intensive care unit (NICU) to a radiology department for MRI has medical risks and logistical challenges. To develop a small 1.5-T MRI system for neonatal imaging that can be easily installed in the NICU and to evaluate its performance using a sheep model of human prematurity. A 1.5-T MRI system designed for orthopedic use was adapted for neonatal imaging. The system was used for MRI examinations of the brain, chest and abdomen in 12 premature lambs during the first hours of life. Spin-echo, fast spin-echo and gradient-echo MR images were evaluated by two pediatric radiologists. All animals remained physiologically stable throughout the imaging sessions. Animals were imaged at two or three time points. Seven brain MRI examinations were performed in seven different animals, 23 chest examinations in 12 animals and 19 abdominal examinations in 11 animals. At each anatomical location, high-quality images demonstrating good spatial resolution, signal-to-noise ratio and tissue contrast were routinely obtained within 30 min using standard clinical protocols. Our preliminary experience demonstrates the feasibility and potential of the neonatal MRI system to provide state-of-the-art MRI capabilities within the NICU. Advantages include overall reduced cost and site demands, lower acoustic noise, improved ease of access and reduced medical risk to the neonate. (orig.)
Akard, T F; Duffy, M; Hord, A; Randall, A; Sanders, A; Adelstein, K; Anani, U E; Gilmer, M J
Legacy-making, actions or behaviors aimed at being remembered, may be one strategy to enhance coping and improve grief outcomes for bereaved parents and siblings. While legacy interventions have been developed and tested in pediatric and adult populations, legacy activities specific to bereaved parents in the neonatal intensive care unit remain unexplored. This study explored bereaved parents' perceptions of a digital storytelling legacy-making intervention for parents after the death of an infant. Six bereaved mothers and fathers participated in a focus group interview three to 12 months after the death of an infant in the NICU. A semi-structured interview guide with open-ended questions was used to obtain parent self-reports. Qualitative content analysis identified emerging themes. Four major themes emerged regarding participants' perceptions of a legacy intervention: (a) parents' willingness to participate in a legacy intervention, (b) parents' suggestions for a feasible intervention, (c) parents' suggestions for an acceptable intervention, and (d) parents' perceived benefits of legacy-making. Participants reported that a legacy-making intervention via digital storytelling would be feasible, acceptable, and beneficial for NICU parents. Study results support the need and desire for legacy-making services to be developed and offered in the NICU.
Tkach, Jean A; Hillman, Noah H; Jobe, Alan H; Loew, Wolfgang; Pratt, Ron G; Daniels, Barret R; Kallapur, Suhas G; Kline-Fath, Beth M; Merhar, Stephanie L; Giaquinto, Randy O; Winter, Patrick M; Li, Yu; Ikegami, Machiko; Whitsett, Jeffrey A; Dumoulin, Charles L
Transporting premature infants from a neonatal intensive care unit (NICU) to a radiology department for MRI has medical risks and logistical challenges. To develop a small 1.5-T MRI system for neonatal imaging that can be easily installed in the NICU and to evaluate its performance using a sheep model of human prematurity. A 1.5-T MRI system designed for orthopedic use was adapted for neonatal imaging. The system was used for MRI examinations of the brain, chest and abdomen in 12 premature lambs during the first hours of life. Spin-echo, fast spin-echo and gradient-echo MR images were evaluated by two pediatric radiologists. All animals remained physiologically stable throughout the imaging sessions. Animals were imaged at two or three time points. Seven brain MRI examinations were performed in seven different animals, 23 chest examinations in 12 animals and 19 abdominal examinations in 11 animals. At each anatomical location, high-quality images demonstrating good spatial resolution, signal-to-noise ratio and tissue contrast were routinely obtained within 30 min using standard clinical protocols. Our preliminary experience demonstrates the feasibility and potential of the neonatal MRI system to provide state-of-the-art MRI capabilities within the NICU. Advantages include overall reduced cost and site demands, lower acoustic noise, improved ease of access and reduced medical risk to the neonate.
Marziale, Maria Helena Palucci; Hong, Oi Saeng; Morris, Judy A; Rocha, Fernanda Ludmilla Rossi
Cross-sectional exploratory research developed to outline the roles and functions of occupational health nurses (OHNs) in Brazil and compare them with those in the United States. The sample consisted of 154 Brazilian occupational health nurses. First, the instrument Job Analysis Survey of Occupational Health Nursing Practice was translated into Portuguese, followed by data collection and data analysis, comparing the results of the proposed study in Brazil with the findings of a job delineation study conducted in the United States. It was found that most were women, white, between 41 and 50 years of age and working primarily at hospitals or medical centers as clinicians and managers/administrators. Besides, it was found that most Brazilian OHNs spend more time in managerial roles, followed by consultant and educator responsibilities while, in the United States, OHNs spend significantly more time in education/advisory roles.
Profit, Jochen; Sharek, Paul J; Kan, Peiyi; Rigdon, Joseph; Desai, Manisha; Nisbet, Courtney C; Tawfik, Daniel S; Thomas, Eric J; Lee, Henry C; Sexton, J Bryan
Background and Objective Teamwork may affect clinical care in the neonatal intensive care unit (NICU) setting. The objective of this study was to assess teamwork climate across NICUs and to test scale-level and item-level associations with health care-associated infection (HAI) rates in very low-birth-weight (VLBW) infants. Methods Cross-sectional study of the association between HAI rates, defined as any bacterial or fungal infection during the birth hospitalization, among 6,663 VLBW infants cared for in 44 NICUs between 2010 and 2012. NICU HAI rates were correlated with teamwork climate ratings obtained in 2011 from 2,073 of 3,294 eligible NICU health professionals (response rate 63%). The relation between HAI rates and NICU teamwork climate was assessed using logistic regression models including NICU as a random effect. Results Across NICUs, 36 to 100% (mean 66%) of respondents reported good teamwork. HAI rates were significantly and independently associated with teamwork climate (odds ratio, 0.82; 95% confidence interval, 0.73-0.92, p = 0.005), such that the odds of an infant contracting a HAI decreased by 18% with each 10% rise in NICU respondents reporting good teamwork. Conclusion Improving teamwork may be an important element in infection control efforts. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Daniel Aragão Machado
Full Text Available ABSTRACT Objective: To measure the levels of stress, anxiety, and depression of nurses working in ICUs, relating them to levels of attention before and after 24 hours. Method: An observational, quantitative, analytical study with 18 nurses undergoing an inventory of stress, anxiety, and depression, as well as assessment of attention levels and psychomotor functioning. Results: Sixty-one percent showed positive for stress. Depression was observed in 33%; and anxiety in 99.9%. A strong correlation between stress and depression (ρ = 0.564 with p <0.05 and anxiety (ρ = 1 with p <0.05 was observed. There was a weak correlation between stress and task execution time in M2 (ρ = 0.055 for TMT A, a fact that did not occur in M0 (ρ = -0.249. Conclusion: The study shows that the workload of the nurses working in 24-hour shifts in the ICU is correlated with high levels of stress, decreases in the attention process, and psychomotor decline.
Stotts, Angela L; Evans, Patricia W; Green, Charles E; Northrup, Thomas F; Dodrill, Carrie L; Fox, Jeffery M; Tyson, Jon E; Hovell, Melbourne F
Secondhand smoke exposure (SHSe) threatens fragile infants discharged from a neonatal intensive care unit (NICU). Smoking practices were examined in families with a high respiratory risk infant (born at very low birth weight; ventilated > 12 hr) in a Houston, Texas, NICU. Socioeconomic status, race, and mental health status were hypothesized to be related to SHSe and household smoking bans. Data were collected as part of The Baby's Breath Project, a hospital-based SHSe intervention trial targeting parents with a high-risk infant in the NICU who reported a smoker in the household (N = 99). Measures of sociodemographics, smoking, home and car smoking bans, and depression were collected. Overall, 26% of all families with a high-risk infant in the NICU reported a household smoker. Almost half of the families with a smoker reported an annual income of less than $25,000. 46.2% of families reported having a total smoking ban in place in both their homes and cars. Only 27.8% families earning less than $25,000 reported having a total smoking ban in place relative to almost 60% of families earning more (p < .01). African American and Caucasian families were less likely to have a smoking ban compared with Hispanics (p < .05). Mothers who reported no smoking ban were more depressed than those who had a household smoking ban (p < .02). The most disadvantaged families were least likely to have protective health behaviors in place to reduce SHSe and, consequently, are most at-risk for tobacco exposure and subsequent tobacco-related health disparities. Innovative SHSe interventions for this vulnerable population are sorely needed.
Razieh, Shahrokhi; Somayeh, Ghafari; Fariba, Haghani
Nurses are one of the most influential factors in overcoming the main challenges faced by health systems throughout the world. Every health system should, hence, empower nurses in clinical judgment and decision-making skills. This study evaluated the effects of implementing Tanner's reflection method on clinical decision-making of nurses working in an intensive care unit (ICU). This study used an experimental, pretest, posttest design. The setting was the intensive care unit of Amin Hospital Isfahan, Iran. The convenience sample included 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). This clinical trial was performed on 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). The nurses were selected by census sampling and randomly allocated to either the case or the control group. Data were collected using a questionnaire containing demographic characteristics and the clinical decision-making scale developed by Laurie and Salantera (NDMI-14). The questionnaire was completed before and one week after the intervention. The data were analyzed using SPSS 21.0. The two groups were not significantly different in terms of the level and mean scores of clinical decision-making before the intervention (P = 0.786). Based on the results of independent t-test, the mean score of clinical decision-making one week after the intervention was significantly higher in the case group than in the control group (P = 0.009; t = -2.69). The results of Mann Whitney test showed that one week after the intervention, the nurses' level of clinical decision-making in the case group rose to the next level (P = 0.001). Reflection could improve the clinical decision-making of ICU nurses. It is, thus, recommended to incorporate this method into the nursing curriculum and care practices. Copyright © 2018. Published by Elsevier Ltd.
Aagaard, Hanne; Storm, Ida; Klitgaard, Jeannett
and revealed tree overall themes. These themes indicate that besides struggling with grief related to the loss of one infant, the parents were challenged by the medical discourse, the lack of staff continuity and space to develop parenthood. This case study emphasizes how the loss of a premature twin......The aim of this case study was to generate a deeper understanding of parents’ experiences of losing one twin in the NICU. In an in-depth interview the parents told their story of giving birth to twins born extremely preterm and shortly after losing one of them. A thematic analysis was conducted...... reinforced the parents’ need of an understandable dialogue with a team of nurses. Furthermore the nurses have to offer a close partnership and create the necessary space for parents to develop parenthood while simultaneously dealing with the unexpected and traumatising circumstances related to the loss...
Mª Cristina Pascual Fernández
Full Text Available When the patients are in the end-of-life, the cares would focus to favor a good death, for that reason the nursing staff must know how to integrate the death like a part of the life, being avoided that produces anxiety to them before the possibility of taking part its own fears to the death. The core of nursing staff in intensive care units is to maintain life of their patients, reason why the end-of life in them is not easy or natural.Objective: Evaluate the death anxiety levels in intensive care nursing staff.Material and method: An observational study was conducted descriptive cross hospital adult and Paediatric ICU General University Gregorio Marañón Hospital, through survey to nurses and auxiliary nurses of those units.The anxiety inventory was used to Death (Death Anxiety Inventory [DAI] for the assessment of anxiety before death. Outcomes: Paediatric ICU nurses have higher levels of anxiety that the adult ICU as well as the less experienced professionals and those declared not feel trained in the subject.Conclusions: Experience and the training are key elements that help professionals face to death, from management we must ensure that patients in stage terminal are served by professionals with this profile.
Full Text Available Patient’s satisfaction is crucial for a hospital, and nursing as an integral part of health care in hospitals also determine the level of patient’s satisfaction. At the order of the clinic nurses deal directly with the public as their client. A direct relationship between the nurse and the client need a behaviour that can be accepted by the whole society. Caring as one of the basic values of nursing, is a phenomenon that affects the way to think, feel and relate to others. This study aimed to analyze the relationship between the nurses caring with patient’s satisfaction by using cross sectional design. Population of this study was patients who were treated in Internal Medicine Unit of Dr. Soetomo Hospital in November 2015. The sample size was 75 people, who were selected by simple random sampling technique. Data collection was done by filling out the questionnaire, then anayzed by using Chi-square test. Results showed 57.33% of the patients gave judgment of satisfactory to nurse caring behaviour and 42.67% gave a good assessment. 62.67% of the patients said they were satisfied with the caring services. There was a significant relationship between nurses caring with patient satisfaction.
Clairton Marcos Citolino Filho
Full Text Available Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%, the lack of harmony (77.6% or stress of any member of staff (67.3%, lack of material and/or equipment failure (57.1%, lack of familiarity with the emergency trolleys (98.0% and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1% are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.
Sônia Regina Wagner de Almeida
Full Text Available Abstract OBJECTIVE Analyzing the ergonomics and usability criteria of the Computerized Nursing Process based on the International Classification for Nursing Practice in the Intensive Care Unit according to International Organization for Standardization(ISO. METHOD A quantitative, quasi-experimental, before-and-after study with a sample of 16 participants performed in an Intensive Care Unit. Data collection was performed through the application of five simulated clinical cases and an evaluation instrument. Data analysis was performed by descriptive and inferential statistics. RESULTS The organization, content and technical criteria were considered "excellent", and the interface criteria were considered "very good", obtaining means of 4.54, 4.60, 4.64 and 4.39, respectively. The analyzed standards obtained means above 4.0, being considered "very good" by the participants. CONCLUSION The Computerized Nursing Processmet ergonomic and usability standards according to the standards set by ISO. This technology supports nurses' clinical decision-making by providing complete and up-to-date content for Nursing practice in the Intensive Care Unit.
Siva Saranappa; Madhu; Ritesh
BACKGROUND : Advances in perinatal and neonatal care have significantly reduced neonatal mortality rates and have benefited preterm infants admitted to neonatal intensive care units. Analysis of care practices can provide insights into how care practices might be changed to improve outcomes. OBJECTIVE : 1. To study the disease pattern , outcome and factors contributing to mortality of the newborns admitted to the Neonatal Intensive Care Unit (NICU) of a tertia...
Bloom, J R; Alexander, J A; Nuchols, B A
The objective of this exploratory study was to assess the effects of four nurse staffing patterns on the efficiency of patient care delivery in the hospital: registered nurses (RNs) from temporary agencies; part-time career RNs; RN rich skill mix; and organizationally experienced RNs. Using Transaction Cost Analysis, four regression models were specified to consider the effect of these staffing plans on personnel and benefit costs and on non-personnel operating costs. A number of additional variables were also included in the models to control for the effect of other organization and environmental determinants of hospital costs. Use of career part-time RNs and experienced staff reduced both personnel and benefit costs, as well as total non-personnel operating costs, while the use of temporary agencies for RNs increased non-personnel operating costs. An RN rich skill mix was not related to either measure of hospital costs. These findings provide partial support of the theory. Implications of our findings for future research on hospital management are discussed.
Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis
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.
Dr. Nagla Hamdi Kamal Khalil El- Meanawi
Full Text Available Abstract Background Cardiopulmonary resuscitation one of the most emergency management the nurse has a pivotal role and should be highly qualified in performing these procedures. The aim of the study is to assess performance of nurses during Cardio pulmonary resuscitation for patient with cardiac arrest In Intensive Care Unit and Cardiac Care Unit at the Alexandria main university hospital. To answer the question what are the most common area of satisfactory and area of neglection in nurses performance during Cardio Pulmonary Resuscitation. The sample consists of 53 staff nurses working in Intensive care unit amp cardiac care unit at Alexandria main university hospital. The tools of data collection were structured of questionnaire sheet and observational cheek list. The results showed that unsatisfactory performance between nurses in both units. The study concluded that all nurses need to improve their performance during cardiopulmonary resuscitation for patient with cardiac arrest it is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care. The study recommended that continuous evaluation of nurses knowledge and performance is essential the optimal frequency with which CPR training should be implemented at least every 6 months in order to avoid deterioration in nurses CPR knowledge and skills.
O'Neill, Catherine S; Yaqoob, Maryam; Faraj, Sumaya; O'Neill, Carla L
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.
Vinicius Lino de Souza Neto
Full Text Available Objective: To define the profile of nursing diagnoses of hospitalized patients at an infectious diseases unit.Methods: This is a descriptive study based on the quantitative approach conducted at an infectious diseases unit in Paraiba, Brazil, from January to February 2014. The data collection instrument was based on the Theory of Basic Human Needs by Wanda de Aguiar Horta, followed by the classification system CIPE(r version 2.0 to construct the diagnoses.Results: Data analysis resulted in 36 nursing diagnoses statements, with a higher prevalence of impaired food intake, cachexia, impaired spontaneous bladder elimination, impaired oral cavity hygiene, exposure to contamination, rapid heart rate, insomnia, drug abuse, alcohol and tobacco abuse, social isolation, acceptance and fear.Conclusions: The identification of a diagnostics profile is critical to guide nursing interventions.
Emee Vida Estacio
Full Text Available In this article, we explore the experiences of racial microaggression among migrant nurses in the United Kingdom. Eleven migrant nurses kept a reflective diary for 6 weeks to record and reflect on their experiences of living and working in the United Kingdom. The diary entries were then thematically analyzed. The results suggest that migrant nurses experienced racial microaggression from patients and colleagues through racial preferences and bullying. Institutional racism also hindered their opportunities for further training and promotion. As a result, some experienced feelings of anger, frustration, and even paranoia. Despite the negative consequences of racial microaggression on their emotional well-being, incidents were downplayed as trivial because of their vague and subtle nature. To encourage better multicultural interactions in the workplace, supportive organizational infrastructures need to be in place to enhance diversity awareness and to improve mechanisms for reporting and dealing with cases of racial microaggression.
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.
Ghorbani, Azam; Sadeghi, Leila; Shahrokhi, Akram; Mohammadpour, Asghar; Addo, Mary; Khodadadi, Esmail
Nosocomial infections are considered a major risk factor in hospital wards, and hand hygiene is the first step in their control. An observational study was conducted in 2015 with 200 nurses working in intensive care units in teaching hospitals of Tabriz, Iran. Data were collected by using the Hand Hygiene Observation Tool questionnaire. The researchers monitored nurses' opportunities for hand hygiene during the 8-week period from February 3-April 4, 2015. A total of 1,067 opportunities occurred for hand hygiene before and after wearing gloves. The results show that hand hygiene compliance before wearing gloves is poor among nurses who work in intensive care units (14.8%). Therefore it is necessary to conduct effective interventions through continuing education programs to improve hand hygiene compliance. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Full Text Available OBJECTIVE: To analyse the perception of psychosocial factors and mental workload of nurses who work in intensive care units. It is hypothesised that nurses in these units could perceive psychosocial risks, manifesting in a high mental work load. The psychosocial dimension related to the position's cognitive demands is hypothesised to mostly explain mental work load. METHOD: Quantitative study, with a descriptive, cross-sectional, and comparative design. A total of 91% of the intensive care unit populations of three Chilean hospitals was surveyed, corresponding to 111 nurses. The instruments utilised included (A a biosociodemographic history questionnaire; (b the SUSESO-ISTAS 21 questionnaire; and (c the Mental Work Load Subjective Scale (ESCAM, in Spanish. RESULTS: In total, 64% and 57% of participants perceived high levels of exposure to the psychosocial risks Psychosocial demands and Double shift, respectively. In addition, a medium-high level of overall mental load was observed. Positive and significant correlations between some of the SUSESO-ISTAS 21 and ESCAM dimensions were obtained. Using a regression analysis, it was determined that three dimensions of the psychosocial risk questionnaire helped to explain 38% of the overall mental load. CONCLUSION: Intensive care unit nurses felt that inadequate psychosocial factors and mental work overload existed in several of the tested dimensions.
Cleveland, Lisa M; Horner, Sharon D
To explore the experiences of Mexican-American mothers who have had infants in the neonatal intensive care unit (NICU). A convenience sample of 15 English-speaking, Mexican-American women was interviewed. The study used an exploratory qualitative approach. Data collection was conducted through audiotaped, transcribed, semistructured, individual interviews and field notes. The 5 normative cultural values for Latino families-(1) simpatia, (2) personalismo, (3) respeto, (4) familismo, and (5) fatalismo-were used as a sensitizing framework to guide data interpretation. The women's discussions of their NICU experiences clearly reflect the 5 normative Latino cultural values. Positive and negative exemplars of these values are provided as evidence. These findings can be used to inform nursing care provided for Mexican-American mothers and their infants by assisting nurses to customize care to meet the cultural needs of this population.
Souza Neto, Vinicius Lino de; Andrade, Lidiane Lima de; Agra, Glenda; Costa, Marta Miriam Lopes; Silva, Richardson Augusto Rosendo da
Objective: To define the profile of nursing diagnoses of hospitalized patients at an infectious diseases unit.Methods: This is a descriptive study based on the quantitative approach conducted at an infectious diseases unit in Paraiba, Brazil, from January to February 2014. The data collection instrument was based on the Theory of Basic Human Needs by Wanda de Aguiar Horta, followed by the classification system CIPE(r) version 2.0 to construct the diagnoses.Results: Data analysis resulted in 3...
Vergadi, Eleni; Bitsori, Maria; Maraki, Sofia; Galanakis, Emmanouil
Urinary tract infection (UTI) is a common bacterial infection in childhood with favourable outcome. However, the recent emergence of UTI caused by multidrug-resistant pathogens, such as carbapenem-resistant Enterobacteriaceae (CRE), has become a great concern worldwide. CRE are mainly responsible for nosocomial infections and community-onset CRE infections in healthy individuals are rare. In this study, we report a series of infants without substantial genitourinary abnormalities that were admitted with community-onset urinary tract infections (UTIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) and we discuss their aetiology. We retrospectively reviewed the medical records of nine infants who presented from community to the paediatric ward with CRKP urinary tract infections, as well as all affected neonates of a concomitant CRKP outbreak that occurred in the neonatal intensive care unit (NICU) in a tertiary hospital (period from April 2009 to July 2012). We further retrieved all culture-proven CRKP infections of any site from 2007 to 2015 in our paediatric department. Over a 33-month period, nine infants, all males, aged 0.9-19.3 (median 4.0) months, were admitted to the Department of Paediatrics with UTI caused by CRKP. Three of them were diagnosed with urinary tract abnormalities but only one had vesicoureteral reflux (VUR), which was a UTI-associated one. History revealed that they had all been hospitalised in the same NICU during a concurrent long-lasting CRKP outbreak for a median of 17 (2-275) days and thereafter presented with CRKP UTI 15 to 207 (median 41) days after NICU discharge. The antibiotic susceptibility and phenotypic characteristics were identical among all isolates in NICU and the paediatric ward. The summary Figure shows a timeline of NICU hospitalisation indicative of its duration and subsequent CRKP UTI of study participants is presented. These cases illustrate that UTI caused by multidrug-resistant pathogens does not
Full Text Available Nosocomial infections which are considered as the primary indicator of the quality of care in hospitals, cause to prolong hospitalization at intensive care unit and hospital, increase morbidity, mortality, and the cost of treatment. Although only 5-10% of the patients are treated in the intensive care units, 20-25% of all nosocomial infections are seen in these units. Preventing nosocomial infections in intensive care units is a process started at the patient acceptance to unit that requires an interdisciplinary team approach of intensive care staffs’ and Infection Control Committee members.Intensive care nurses who are in constant contact with patients have important responsibilities in preventing nosocomial infections. Intensive care nurses should be aware that the nosocomial infections can be prevented. They should have current knowledge about universal precautions related to prevention and control of infections, which are accepted by the entire world and they reinforce this knowledge by practice and should provide the most effective care to patients.In this article, nursing practices for prevention of nosocomial infections in intensive care units are discussed based on universal precautions.
Allen, Lilian A
The purpose of this study was to explore the experiences of internationally educated nurses in management positions in United States health care organisations to understand the obstacles and support these individuals' experience when pursuing and working in managerial roles. Although internationally educated nurses are an integral part of the US health care industry, few work in managerial roles. Little is known about the experiences of internationally educated nurses who do obtain management positions. In this qualitative, phenomenological study, seven internationally educated nurses who were managers in Chicago, Illinois, responded to open-ended interview questions. Supervisors contributed to the participants' acceptance of management positions. The participants experienced challenges such as cultural differences, language, and communication. Despite these challenges, the participants had positive working relationships with staff and supervisors. Further, the participants had opportunities for education and professional growth. Internationally educated nurses benefit from participating in organisational committees. They face challenges related to work responsibilities, cultural differences and communication but can succeed in management roles through developing strategies to overcome the challenges and through receiving support from staff, colleagues and supervisors. More internationally educated nurses may obtain managerial positions if supervisors provide encouragement and support. © 2018 John Wiley & Sons Ltd.
Nursing shortages in the United States have underscored the need for foreign nurse recruitment. The major population of foreign nurse recruits has long been Asian. When employing foreign nurses, fair employment practices and quality of care must be ensured; however, few empirical studies were found on this topic. Thus, the purpose of this article is to synthesize the extant literature about Asian nurses' work experiences in and adaptation to the U.S. health care system. The author searched four major bibliographic databases, as well as the ProQuest Dissertation and Thesis Database and analyzed eight empirical studies based on four predetermined inclusion criteria. The major themes identified in the selected scholarly works were: (a) overcoming language barriers, (b) dealing with discrimination, (c) adopting U.S. nursing practices, (d) adjusting to U.S. social customs, (e) becoming accustomed to U.S. culture, and (f) reconciling work ethics. Additional research studies, using both quantitative and qualitative approaches, are necessary to gain in-depth knowledge related to this phenomenon.
Nazari, Fateme; Mirzamohamadi, Mojtaba; Yousefi, Hojatollah
One of the main causes of stress in the lives of people is their jobs. Occupational stress is causing a wide range of significant issues in health and community services. Nursing is the most stressful profession in the health services. Massage therapy is one way of coping with stress. This study was conducted to determine the effect of massage therapy on stress in nurses. This study was a clinical trial on 66 male and female nurses working in intensive care units (dialysis, ICU, and CCU) of Isfahan University of Medical Sciences, Iran, in 2013. Participants were selected according to the aims and inclusion criteria of the study. Then, they were randomly divided into experimental and control groups. The Occupational Stress Inventory (OSI) (Osipow and Spokane, 1987) was completed by participants of the two groups before, immediately after, and 2 weeks after the intervention. General Swedish massage was performed on participants of the experimental group for 25 min in each session, twice a week for 4 weeks. Data were analyzed by descriptive and inferential statistics [Chi-square, t-test, and repeated measures analysis of variance (ANOVA)] using SPSS software. Results showed that the difference in overall mean occupation stress scores between experimental and control groups 2 weeks after the intervention was significant (P < 0.001). According to the results, it is recommended that massage, as a valuable noninvasive method, be used for nurses in intensive care units to reduce their stress, promote mental health, and prevent the decrease in quality of nursing work life.
Cook, N R; Phillips, B N; Sadler, D
The Tidal Model has been implemented in Rangipapa, a regional secure mental health forensic unit in New Zealand. A phenomenological study was undertaken to obtain reflective description of the nursing care experience from the perspective's of four Registered Nurses and four Special Patients. Five major themes were identified that appeared to capture the experiences of the participants. The themes show changes to the unit's unique culture and values following implementation of the model. These changes engendered a sense of hope, where nurses felt they were making a difference and patients were able to communicate in their own words their feelings of hope and optimism. Levelling was experienced as an effect emerging from individual and group processes whereby a shift in power enhanced a sense of self and connectedness in their relationships. These interpersonal transactions were noted by the special patients as being positive for their recovery. This enabled effective nurse-patient collaboration expressed simply as working together. The participants reported a feeling of humanity, so that there was a human face to a potentially objectifying forensic setting. Implications arising from this study are that the use of the model enables a synergistic interpersonal process wherein nurses are professionally satisfied and patients are validated in their experience supporting their recovery.
Harris, John Alexander; Castle, Nicholas George
Obesity is increasing among people residing in nursing homes, and resident obesity substantially affects services needed, equipment and facilities provided, and morbidity in this setting. The purpose of this article is to describe the scope and depth of evidence regarding the impact of obesity among nursing home residents in the United States. A systematic literature review was performed in PubMed, EMBASE, CINAHL, and Web of Science databases as well as additional hand-searched documents. Included articles were published from 1997 to March 2017. The characteristics and content of the included articles were systematically reviewed and reported. Twenty-eight studies met inclusion criteria for review. The median study size was 636 residents (interquartile range 40-11,248); 18 (64%) studies were retrospective and 10 (36%) were prospective in nature. Ten (36%) studies examined medical and functional morbidity, 10 (36%) examined health system effects, and 5 (18%) examined the risk of admission to nursing homes. Most studies found that obesity poses serious issues to resident health and the provision of health care, as well as broad health system and nursing challenges in the provision of high-quality nursing home care and services. Although obesity affects about one in four nursing home residents in the United States, relatively limited evidence exists on the complex challenges of obesity for their residents and their care. A continued focus on resident quality of life, health system improvement, and nursing best practices for properly caring for individuals with obesity is needed. © The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Wu, Stacey; Singh-Carlson, Savitri; Odell, Annie; Reynolds, Grace; Su, Yuhua
To examine the experiences of compassion fatigue, burnout, and compassion satisfaction among oncology nurses in the United States and Canada. . Quantitative, descriptive, nonexperimental. . Online survey with members from the Canadian Association of Nursing Oncology and the Oncology Nursing Society. . 486 American and 63 Canadian practicing oncology nurses. . The Professional Quality of Life (ProQOL) scale, version 5, and modified Abendroth Demographic Questionnaire were administered through FluidSurveys™, an online data collection instrument. Chi-square tests of independence were used to investigate associations between demographic characteristics, health, personal stressors, and work-related characteristics to experiences of compassion fatigue, burnout, and compassion satisfaction. Compassion fatigue was measured using the subscales of secondary traumatic stress and burnout. . Compassion fatigue, burnout, and compassion satisfaction. . Demographic characteristics were similar in American and Canadian participants, and both cohorts reported comparable levels of compassion fatigue, burnout, and compassion satisfaction. Perception of team cohesiveness within the workplace environment was found to be significant for both groups, as indicated by significant relationships in all three subscales of secondary traumatic stress, burnout, and compassion satisfaction in the ProQOL. . Healthy and supportive work environments are imperative to nurses' health, well-being, and satisfaction. Improvements in the workplace can help prevent negative sequelae, as well as improve health outcomes for patients and nurses, decrease nurse turnover, and reduce healthcare expenditures. . Findings can be used to implement institutional changes, such as creating policies and guidelines for the development of preventive interventions and psychosocial support for nurses.
Elder, N C; Brungs, S M; Nagy, M; Kudel, I; Render, M L
It is unknown if successful changes in specific safety practices in the intensive care unit (ICU) generalize to broader concepts of patient safety by staff nurses. To explore perceptions of patient safety among nursing staff in ICUs following participation in a safety project that decreased hospital acquired infections. After implementation of practices that reduced catheter-related bloodstream infections in ICUs at four community hospitals, ICU nurses participated in focus groups to discuss patient safety. Audiotapes from the focus groups were transcribed, and two independent reviewers categorised the data which were triangulated with responses from selected questions of safety climate surveys and with the safety checklists used by management leadership on walk rounds. Thirty-three nurses attended eight focus groups; 92 nurses and managers completed safety climate surveys, and three separate leadership checklists were reviewed. In focus groups, nurses predominantly related patient safety to dangers in the physical environment (eg, bed rails, alarms, restraints, equipment, etc.) and to medication administration. These areas also represented 47% of checklist items from leadership walk rounds. Nurses most frequently mentioned self-initiated "double checking" as their main safety task. Focus-group participants and survey responses both noted inconsistency between management's verbal and written commitment compared with their day-to-day support of patient safety issues. ICU nurses who participated in a project to decrease hospital acquired infections did not generalize their experience to other aspects of patient safety or relate it to management's interest in patient safety. These findings are consistent with many adult learning theories, where self-initiated tasks, combined with immediate, but temporary problem-solving, are stronger learning forces than management-led activities with delayed feedback.
Pecanac, Kristen E; Schwarze, Margaret L
Nurses and surgeons may experience intra-team conflict during decision making about the use of postoperative life-sustaining treatment in the intensive care unit due to their perceptions of professional roles and responsibilities. Nurses have a sense of advocacy-a responsibility to support the patient's best interest; surgeons have a sense of agency-a responsibility to keep the patient alive. The objectives were to (1) describe the discourse surrounding the responsibilities of nurses and surgeons, as "advocates" and "agents," and (2) apply these findings to determine how differences in role responsibilities could foster conflict during decision making about postoperative life-sustaining treatment in the intensive care unit. Articles, books, and professional documents were explored to obtain descriptions of nurses' and surgeons' responsibilities to their patients. Using discourse analysis, responsibilities were grouped into themes and then compared for potential for conflict. Ethical considerations: No data were collected from human participants and ethical review was not required. The texts were analyzed by a surgeon and a nurse to minimize profession-centric biases. Four themes in nursing discourse were identified: responsibility to support patient autonomy regarding treatment decisions, responsibility to protect the patient from the physician, responsibility to act as an intermediary between the physician and the patient, and the responsibility to support the well-being of the patient. Three themes in surgery discourse were identified personal responsibility for the patient's outcome, commitment to patient survival, and the responsibility to prevent harm to the patient from surgery. These responsibilities may contribute to conflict because each profession is working toward different goals and each believes they know what is best for the patient. It is not clear from the existing literature that either profession understands each other's responsibilities
Lindley, Lisa C; Held, Mary L; Henley, Kristen M; Miller, Kathryn A; Pedziwol, Katherine E; Rumley, Laurie E
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.
Magno Conceição Merces
Full Text Available Backgound and Objectives: Nursing has an important role in urinary tract infection prevention and control. Urinary catheters insertion represents the local topography with the highest rate of hospital infection. Foley catheter placement is performed solely by the nurse and requires aseptic techniques during its performance, thus preventing risks to the patients. The study aimed to evaluate the training of nurses on Foley catheter insertion and point out limits and possibilities of this practice in patients at the Intensive Care Unit (ICU of Hospital Geral do Interior da Bahia (HGIB. Methods: This was a qualitative, exploratory and descriptive study. Data collection was carried out through semi-structured interviews. After data analysis, two categories were evaluated, namely: the training of nurses on Foley catheter insertion in ICU patients and the limits and possibilities of Foley catheter insertion practice by nurses in ICU patients. Bardin analysis was used for data analysis. Results: The study shows that the nurse’s practice on Foley catheter insertion in ICU patients is based on the use of aseptic techniques for urinary tract infection prevention, theoretical and practical knowledge on Foley catheter insertion in ICU patients, knowledge on urinary tract infections and associations with catheter insertion, whereas the limits and possibilities of Foley catheter insertion practice by nurses are understood through measures to minimize the risk of hospital infection caused by long-term catheter use in the ICU. Nurses point out that the risks of hospital infection are inherent to long-term catheter use. This is an important fact, as the knowledge or its absence may constitute a limit or possibility for Foley catheter insertion practice by the nurse in ICU patients. Conclusion: Nurses must seek the systematization of knowledge, which warrants support for the team, as well as information, safety and prompt care, allowing the reduction of urinary
Protestant Deaconess Motherhouses emerged as a German nursing organization in the nineteenth century to be later exported to many other countries including the United States. The motherhouse principle could not be simply transferred without being adapted to the situation prevailing in each of those countries. The essay investigates the conception and transformation of Protestant nursing by comparing a West German and American deaconess motherhouse each in their particular context. It shows that the deaconesses in the United States developed their own, more scientifically oriented understanding of nursing and were therefore more open to the rationalization of nursing than their West German counterpart.
Celma Vicente, Matilde; Ajuria-Imaz, Eloisa; Lopez-Morales, Manuel; Fernandez-Marín, Pilar; Menor-Castro, Alicia; Cano-Caballero Galvez, Maria Dolores
This paper shows the utility of a NIC standardized language to assess the extent of nursing student skills at Practicum in surgical units To identify the nursing interventions classification (NIC) that students can learn to perform in surgical units. To determine the level of difficulty in learning interventions, depending on which week of rotation in clinical placement the student is. Qualitative study using Delphi consensus technique, involving nurses with teaching experience who work in hospital surgical units, where students undertake the Practicum. The results were triangulated through a questionnaire to tutors about the degree of conformity. A consensus was reached about the interventions that students can achieve in surgical units and the frequency in which they can be performed. The level of difficulty of each intervention, and the amount of weeks of practice that students need to reach the expected level of competence was also determined. The results should enable us to design better rotations matched to student needs. Knowing the frequency of each intervention that is performed in each unit determines the chances of learning it, as well as the indicators for its assessment. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Bahnsen, Iben Bøgh; Braad, Mette; Lisby, Hanne
the stay at ICSU in their final clinical placement. Moreover, students spent a considerable amount of time an basic nursing tasks during their stay at the ICSU; skills already acquired earlier in their education programme. Conclusion: Staying in an ICSU improved inter-professional collaboration skills......Background: Length of hospitalization is reduced demanding effective and timely interventions from all health professions. In an Inter-professional Clinical Study Unit (ICSU) students have the opportunity to develop inter-professional competencies. Nevertheless some nursing students have commented...... that staying in an ICSU is an interruption in their final clinical placement with limited learning possibilities. Aim: The aim of the study was to explore nursing students´perceptions of taking part in an ICSU Methods: The study was qualitative with explorative, decriptive and interpretative aspects. Data were...
Berg, Gina M; LoCurto, Jamie; Lippoldt, Diana
The aim of this study is to examine the stages of concern (self, task, and impact) and usability (trust, perceived usefulness, and ease of use) shifts experienced by nurses adopting new technology. Patient care processes in critical care units can be disrupted with the incorporation of information technology. New users of technology typically transition through stages of concern and experience shifts in acceptance during assimilation. Critical care nurses (N = 41) were surveyed twice: (1) pre, immediately after training, and (2) post, 3 months after implementation of technology. From presurvey to postsurvey, self-concerns decreased 14%, whereas impact concerns increased 22%. Furthermore, there was a 30% increase in trust and a 17% increase in perceived usefulness, even with a 27% decrease in ease of use. Adoption of new technology requires critical care nurses to adapt current practices, which may improve trust and perceived usefulness yet decrease perceptions of ease of use.
Luo, H B; Wang, X T; Tang, B; Zhu, Z N; Guo, H L; Li, Z Z; Sun, J H; Liu, D W
Objective: To investigate doctors' and nurses' perceptions and implementation of delirium management in intensive care unit. Methods: A total of 197 doctors and nurses in 2 general ICUs and 3 special ICUs at Peking Union Medical College Hospital finished a self-designed questionnaire of delirium management. Results: There were 47 males and 150 females, 43 doctors and 154 nurses who participated in the survey.One hundred and twenty five participators were from general ICU and the others from special ICU. The ICU staff had a significant difference on the perceptions and implementation of delirium management( P delirium assessment" ( P delirium management,especially in special ICUs. Delirium management should be included as a routine care in ICU to improve patients' outcome.
... baby's progress? Is wi-fi access available for smartphones and other devices? Can we use our cellphones ... you also want to allow periods of undisturbed sleep. Let your baby set the pace for your ...
Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project.
Blöndal, Katrin; Zoëga, Sigridur; Hafsteinsdottir, Jorunn E; Olafsdottir, Olof Asdis; Thorvardardottir, Audur B; Hafsteinsdottir, Sigrun A; Sveinsdóttir, Herdis
The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses' attitudes as measured by the Families Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses' attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration. © The Author(s) 2014.
van Beek, Adriana P A; Wagner, Cordula; Spreeuwenberg, Peter P M; Frijters, Dinnus H M; Ribbe, Miel W; Groenewegen, Peter P
The behaviour of individuals is affected by the social networks in which they are embedded. Networks are also important for the diffusion of information and the influence of employees in organisations. Yet, at the moment little is known about the social networks of nursing staff in healthcare settings. This is the first study that investigates informal communication and advice networks of nursing staff in long-term care. We examine the structure of the networks, how they are related to the size of units and characteristics of nursing staff, and their relationship with job satisfaction. We collected social network data of 380 nursing staff of 35 units in group projects and psychogeriatric units in nursing homes and residential homes in the Netherlands. Communication and advice networks were analyzed in a social network application (UCINET), focusing on the number of contacts (density) between nursing staff on the units. We then studied the correlation between the density of networks, size of the units and characteristics of nursing staff. We used multilevel analyses to investigate the relationship between social networks and job satisfaction of nursing staff, taking characteristics of units and nursing staff into account. Both communication and advice networks were negatively related to the number of residents and the number of nursing staff of the units. Communication and advice networks were more dense when more staff worked part-time. Furthermore, density of communication networks was positively related to the age of nursing staff of the units. Multilevel analyses showed that job satisfaction differed significantly between individual staff members and units and was influenced by the number of nursing staff of the units. However, this relationship disappeared when density of communication networks was added to the model. Overall, communication and advice networks of nursing staff in long-term care are relatively dense. This fits with the high level of cooperation
Yücel, Şebnem Çinar; Eşer, Ismet; Güler, Elem Kocaçal; Khorshid, Leyla
This research was carried out to find out the nursing diagnoses in patients who have mechanical ventilation support in a respiratory intensive care unit. The study was conducted with 51 evaluations of critically ill adult patients who underwent invasive and non-invasive mechanical ventilation therapy in 2008. Data collection was based on Gordon's 11 Functional Health Patterns, and nursing diagnoses were determined according to North American Nursing Diagnosis Association-International (NANDA-I) Taxonomy II. The nursing diagnoses were determined by two researchers separately. The consistency between the nursing diagnoses defined by the two researchers was evaluated by using Cohen's kappa (κ). Forty men (78.4%) and 11 women (21.6%) whose mean ages were 70.19 (SD = 8.96) years were included in the study. Nineteen subgroups of nursing diagnoses about safety/protection domain, and 15 subgroups about activity/rest domain were seen at different rates in the patients. There was a statistically significant difference between mechanical ventilation via tracheostomy or endotracheal tube and decreased cardiac output (d.f. = 1, χ(2) = 4.760, P = 0.029). The relationship between the length of time under mechanical ventilation and impaired physical mobility was considerably significant (d.f. = 3, χ(2) = 24.459, P = 0.000). It was found out that there was a high degree of agreement (96.8%) between the nursing diagnoses defined by the two researchers separately (κ = 0.936, SE = 0.08). © 2011 Blackwell Publishing Asia Pty Ltd.
Full Text Available Background and objective: In the nursing profession, there are numerous factors which altogether cause occupational stress and as a result occupational exhaustion in nurses and decrease the quality of patient care. Regarding the importance of this issue which influences the health indices of the society, this study investigates the effect of progressive muscle relaxation on the occupational stress of nurses.Materials and Methods: This semi-experimental and before-after study was conducted using progressive muscle relaxation intervention on 33 nurses in special treatment (ICU and CCU and emergency units through simple sampling in Yazd in 2012. To assess occupational stress,Toft-Anderson questionnaire was used. The procedure of applying relaxation in a practical way was given to nurses in pamphlets and questionnaires were filled before and two weeks after the intervention. Analysis was done using SPSS.16 software and T-test.Results: The average total score of stress in nurses before and after the intervention was determined as – 28.12±43.74 and 52.12±04.72 respectively and this difference was not statistically significant (39.0>p. However, in the dimensions of nurses’ workload (/0>p 03 and t=2.27 and patients’ suffering and death, these scores were significantly different (0001.0>p and t=3.94.Conclusion: This study showed that applying progressive muscle relaxation technique as a method of emotion-focused coping cannot be effective in the reduction of occupational stress in nurses.
Miquel Capó Rn, I
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.
Fuentelsaz-Gallego, C; Moreno-Casbas, T; Gómez-García, T; González-María, E
To know if there are differences between the critical care units and the medical-surgical care units regarding the perception of the nurses working in National Health System hospitals about their work environment, burnout level and job satisfaction. A cross-sectional study was conducted with 6,417 nurses from the medical-surgical care units and with 1,122 nurses from critical care units of 59 Spanish hospitals with more than 150 beds. Socio-demographic, job satisfaction, perception of work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI questionnaire]) and burnout measured with the Maslach Burnout Inventory (MBI) data were collected. The PES-NWI showed differences in 4 out of its 5 factors. It showed better values in medical-surgical units in all the factors, except for Staffing and resource adequacy (P<.001), where critical care units showed a mean level of agreement of 2.41 versus 2.19 for the medical-surgical units. Regarding burnout, this was higher in the medical-surgical care units (P=.039) where 23% (952) of the nurses had high levels. Job satisfaction was lower in the critical care units (P=.044) with 70% (578) of nurses being very or strongly satisfied. The opinion of the nurses, working in critical care units about their hospital is unfavorable. They showed lower levels of burnout than those working in medical-surgical units. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.
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.
Full Text Available Recently, new staffing rules for neonatal nurses in intensive care units (ICU were issued in Germany, using categories of care of the British Association of Perinatal Medicine as blueprint. Neonates on intensive care require a nurse-to-patient ratio of 1:1, on intensive surveillance (high dependency care of 1:2. No requirements exist for special care, transitional care, and pediatric ICU patients. Using these rules, nursing staff requirement was calculated over a period of 31 consecutive days once a day in a combined pediatric and neonatal ICU of a metropolitan academic medical center in south-west Germany. Each day, 18.9±0.98 patients (mean±standard deviation were assessed (14.26±1.21 neonatal, 4.65±0.98 pediatric. Among neonates, 9.94±2.56 received intensive therapy, 3.77±1.85 intensive surveillance, and 0.65±0.71 special care. Average nursing staff requirement was 12.10±1.81 full time equivalents (FTE per shift. Considering additional pediatric patients in the ICU and actual nursing staff availability (8.97±0.87 FTE per shift, this ICU seems understaffed.
Kranidiotis, Georgios; Ropa, Julia; Mprianas, John; Kyprianou, Theodoros; Nanas, Serafim
To investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards euthanasia. ICU physicians and nurses deal with end-of-life dilemmas on a daily basis. Therefore, the exploration of their stances on euthanasia is worthwhile. This was a descriptive quantitative study conducted in three ICUs in Athens. The convenience sample included 39 physicians and 107 nurses. Of respondents, 52% defined euthanasia inaccurately, as withholding or withdrawal of treatment, while 15% ranked limitation of life-support among the several forms of euthanasia, together with active shortening of the dying process and physician - assisted suicide. Only one third of participants defined euthanasia correctly. While 59% of doctors and 64% of nurses support the legalization of active euthanasia, just 28% and 26% of them, respectively, agree with it ethically. Confusion prevails among Greek ICU physicians and nurses regarding the definition of euthanasia. The majority of staff disagrees with active euthanasia, but upholds its legalization. Copyright © 2015 Elsevier Inc. All rights reserved.
Su, Amanda; Lief, Lindsay; Berlin, David; Cooper, Zara; Ouyang, Daniel; Holmes, John; Maciejewski, Renee; Maciejewski, Paul K; Prigerson, Holly G
Deaths in the intensive care unit (ICU) are increasingly common in the U.S., yet little is known about patients' experiences at the end of life in the ICU. The objective of this study was to determine nurse assessment of symptoms experienced, and care received by ICU patients in their final week, and their associations with nurse-perceived suffering and dignity. From September 2015 to March 2017, nurses who cared for 200 ICU patients who died were interviewed about physical and psychosocial dimensions of patients' experiences. Medical chart abstraction was used to document baseline patient characteristics and care. The patient sample was 61% males, 70.2% whites, and on average 66.9 (SD 15.1) years old. Nurses reported that 40.9% of patients suffered severely and 33.1% experienced severe loss of dignity. The most common symptoms perceived to contribute to suffering and loss of dignity included trouble breathing (44.0%), edema (41.9%), and loss of control of limbs (36.1%). Most (n = 9) remained significantly (P dignity (AOR 3.15). Use of feeding tube was associated with severe loss of dignity (AOR 3.12). Dying ICU patients are perceived by nurses to experience extreme indignities and suffer beyond physical pain. Attention to symptoms such as dyspnea and edema may improve the quality of death in the ICU. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.
Meire Cristina Novelli e Castro
Full Text Available Abstract Objective: To identify the severity and workload of nursing with adult patients seeking admission to an Intensive Care Unit (ICU. Methods: A cross-sectional study with a quantitative, exploratory and prospective approach was performed, developed in a hospital in the state of São Paulo. Demographic data on patients were collected, the Simplified Acute Physiology Score III (SAPS III was applied to assess the severity of patients and the Nursing Activities Score (NAS was used to evaluate nursing workload, between July and August 2014. Results: The overall mean score of the SAPS III was 30.52 ± 18.39 and that of the NAS was 58.18 ± 22.29. The group of patients admitted to the ICU showed higher severity and higher workload of nursing compared to non-admitted patients. Non-admitted patients had an NAS of 53.85. Conclusion: The nursing workload in patients who were not admitted to the ICU was also high. The evaluation of workload in other contexts where patients are seriously ill is important. The workload assessment in other contexts where severely ill patients are found is evident.
Calikusu Incekar, Mujde; Balci, Serap
Noise, an environmental stimulus, is especially important in the neurobehavioral development of newborns and brain development of infants at high risk. Conditions in the neonatal intensive care units (NICUs) may cause certain sensory stimuli that are not appropriate for the development of newborns, especially preterm infants. This study was conducted in order to determine noise levels in the NICU and to evaluate the effect of training provided for noise control. This study was conducted as a pretest-posttest quasiexperimental design between September and November 2014 in a 30-bed NICU of a tertiary hospital in Istanbul. A sample group consisting of 30 people (26 nurses, 4 care workers). Noise measurement devices were used in the Training Program of Noise Control. Of the health professionals, 96.7% were women, 86.7% were nurses, and 63.3% were university graduates. Some 36.7% of the health professionals had worked within the unit for more than 5 years. Noise measurements of full implementations were made over three 24-h periods. Noise measurements were taken before and after the training on Monday, Friday, and Sunday. Noise levels after training diminished in all three measurements, and the decrease was found statistically significant (P Noise Control Training for health professionals who work in NICUs is an effective way of reducing noise. We recommend that this training should be given to NICU health professionals and noise levels should be determined through measurements at specific times. © 2017 Wiley Periodicals, Inc.
da Silva, Jorge Luiz Lima; Soares, Rafael da Silva; Costa, Felipe dos Santos; Ramos, Danusa de Souza; Lima, Fabiano Bittencourt; Teixeira, Liliane Reis
To evaluate the prevalence of burnout syndrome among nursing workers in intensive care units and establish associations with psychosocial factors. This descriptive study evaluated 130 professionals, including nurses, nursing technicians, and nursing assistants, who performed their activities in intensive care and coronary care units in 2 large hospitals in the city of Rio de Janeiro, Brazil. Data were collected in 2011 using a self-reported questionnaire. The Maslach Burnout Inventory was used to evaluate the burnout syndrome dimensions, and the Self Reporting Questionnaire was used to evaluate common mental disorders. The prevalence of burnout syndrome was 55.3% (n = 72). In the quadrants of the demand-control model, low-strain workers exhibited a prevalence of 64.5% of suspected cases of burnout, whereas high-strain workers exhibited a prevalence of 72.5% of suspected cases (p = 0.006). The prevalence of suspected cases of common mental disorders was 27.7%; of these, 80.6% were associated with burnout syndrome (stress levels - active work (OR = 0.26; 95%CI = 0.09 - 0.69) and passive work (OR = 0.22; 95%CI = 0.07 - 0.63) - were protective factors for burnout syndrome. Psychosocial factors were associated with the development of burnout syndrome in this group. These results underscore the need for the development of further studies aimed at intervention and the prevention of the syndrome.
Maria Nathália da Silva Souza
Full Text Available Background e Objectives: The quality of hospital care provided to the patient and the safety of their stay at the site triggered discussions around the world after the analysis of epidemiological studies conducted in the USA that concluded the high rate of adverse events in the hospital setting Caused by professional error, with that the theme gained strength and motivated discussions about the care models applied to the patients. Therefore the research was aimed at evaluating the knowledge of the Nursing Team of the Intensive Care Unit sector of a public hospital in Recife-PE on the International Patient Safety Goals. Methods: A cross-sectional study with descriptive quantitative approach was carried out from June to August 2016. Data collection was performed through a semi-structured questionnaire that addressed the social and professional aspects of the respondents. The studied variables: gender, age, professional category and training time. The data were analyzed in epiinfo software version 3.2.2. Results: The sample consisted of 50 professionals, 18% of whom were Nurses and 82% were Nursing technicians. Most respondents scored more than 50% of questions about international patient safety goals and had more than one employment relationship. Conclusion: It was verified that the lack of training, work overload and more of an employment relationship can contribute to a precarious professional assistance. KEYWORDS: Patient Safety. Nursing. Safety Management. Intensive Care Units
Armellino, Donna; Quinn Griffin, Mary T; Fitzpatrick, Joyce J
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.
Dean, Tania D; Cross, Wendy; Munro, Ian
In Adult Mental Health Inpatient Units, it is not unexpected that leadership of Associate Nurse Unit Managers contributes to successful implementation of smoke-free policies. In light of challenges facing mental health nursing, and limited research describing their leadership and the role it plays in addressing smoke-free policy implementation, the aim of this study is to explore Associate Nurse Unit Managers perspectives' regarding the implementation of smoke-free policies, which were introduced on 1 July, 2015. Individual in-depth semi-structured interviews were undertaken six months post the implementation of smoke-free policies. In this qualitative descriptive study, six Associate Nurse Unit Managers working in a Victorian public Adult Mental Health Inpatient Unit, were asked eight questions which targeted leadership and the implementation and enforcement of smoke-free policies. Associate Nurse Unit Managers provide leadership and role modeling for staff and they are responsible for setting the standards that govern the behavior of nurses within their team. All participants interviewed believed that they were leaders in the workplace. Education and consistency were identified as crucial for smoke-free policies to be successful. Participants acknowledged that the availability of therapeutic interventions, staff resources and the accessibility of nicotine replacement therapy were crucial to assist consumers to remain smoke-free while on the unit. The findings from this research may help to improve the understanding of the practical challenges that Associate Nurse Unit Manager's face in the implementation of smoke-free policies with implications for policies, nursing practice, education and research.
Hetland, Breanna; Guttormson, Jill; Tracy, Mary Fran; Chlan, Linda
Critical care nurses are responsible for administering sedative medications to mechanically ventilated patients. With significant advancements in the understanding of the impact of sedative exposure on physiological and psychological outcomes of ventilated patients, updated practice guidelines for assessment and management of pain, agitation, and delirium in the intensive care unit were released in 2013. The primary aim of this qualitative study was to identify and describe themes derived from critical care nurses' comments regarding sedation administration practices with mechanically ventilated patients. This is a qualitative content analysis of secondary text data captured through a national electronic survey of members of the American Association of Critical-Care Nurses. A subsample (n = 67) of nurses responded to a single, open-ended item at the end of a survey that evaluated nurses' perceptions of current sedation administration practices. Multiple factors guided sedation administration practices, including individual patient needs, nurses' synthesis of clinical evidence, application of best practices, and various personal and professional practice perspectives. Our results also indicated nurses desire additional resources to improve their sedation administration practices including more training, better communication tools, and adequate staffing. Critical care nurses endorse recommendations to minimise sedation administration when possible, but a variety of factors, including personal perspectives, impact sedation administration in the intensive care unit and need to be considered. Critical care nurses continue to encounter numerous challenges when assessing and managing sedation of mechanically ventilated patients. Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
Diefendorff, James M; Erickson, Rebecca J; Grandey, Alicia A; Dahling, Jason J
Emotional labor theory has conceptualized emotional display rules as shared norms governing the expression of emotions at work. Using a sample of registered nurses working in different units of a hospital system, we provided the first empirical evidence that display rules can be represented as shared, unit-level beliefs. Additionally, controlling for the influence of dispositional affectivity, individual-level display rule perceptions, and emotion regulation, we found that unit-level display rules are associated with individual-level job satisfaction. We also showed that unit-level display rules relate to burnout indirectly through individual-level display rule perceptions and emotion regulation strategies. Finally, unit-level display rules also interacted with individual-level dispositional affectivity to predict employee use of emotion regulation strategies. We discuss how future research on emotional labor and display rules, particularly in the health care setting, can build on these findings.
Full Text Available This study was conducted to determine classifications for the planimetric design efficiency of certain public hospitals by developing a fuzzy logic algorithm. Utilizing primary areas and circulation areas from nursing unit floor plans, the study employed triangular membership functions for the fuzzy subsets. The input variables of primary areas per bed and circulation areas per bed were fuzzified in this model. The relationship between input variables and output variable of design efficiency were displayed as a result of fuzzy rules. To test existing nursing unit floors, efficiency output values were obtained and efficiency classes were constructed by this model in accordance with general norms, guidelines and previous studies. The classification of efficiency resulted from the comparison of hospitals.
Acevedo-Nuevo, M; González-Gil, M T; Solís-Muñoz, M; Láiz-Díez, N; Toraño-Olivera, M J; Carrasco-Rodríguez-Rey, L F; García-González, S; Velasco-Sanz, T R; Martínez-Álvarez, A; Martin-Rivera, B E
To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
‘Jading’ is a process of exhaustion in which apathy and cynicism replace the drive to be responsive and caring. ‘Burnout’ a term first coined in the psychology literature in 1974 was based on Graham Greene’s novel ‘A Burnt-Out Case1. It is the umbrella description for disengagement in the workplace setting characterised by withdrawal, denial and inefficiency. There is an alienation from the pressures of work. Marshall and Kasman2 defined it as ‘the loss of motivation for creative thought’. It is the opposite of engagement which is associated with energy and optimism. People who experience all 3 symptoms- emotional exhaustion, negative attitude towards patients, reduced sense of personal accomplishment- have the greatest degree of burnout. It doesn’t get better by being ignored. These processes have serious consequences for the individual involved and the hospital that they work in. The doctor underperforms and the Unit becomes dysfunctional There is decreased quality of care, increased absenteeism, and high staff turnover. There is an inability to make decisions and a failure to set priorities.
Turnipseed, David L.; Turnipseed, Patricia H.
Questionnaires completed by 129 U.S. nurses and 71 from the Philippines revealed higher levels of emotional exhaustion and feelings of personal accomplishment in the United States. The Filipino work environment was rated higher for supervisor support, autonomy, control, and innovation. U.S. nurses reported greater work pressure. (SK)
Jakimowicz, Samantha; Perry, Lin; Lewis, Joanne
To systematically review the literature describing factors perceived by nurses as impacting the provision of patient-centred nursing in the intensive care unit. Patient-centred nursing in critical care differs from other healthcare areas, and the aggressive curative environment of the ICU has potential to compromise some of its elements. Understanding critical care, nurses' perceptions of promoting and deterrent factors may inform development of strategies to support effective patient-centred nursing and job satisfaction in this workforce. An integrative literature review. Whittemore and Knafl's method was used with "best-fit" framework synthesis. CINAHL, PsycINFO, Medline and EMBASE were searched for 2000-2016 literature using search terms drawn from the ICU patient-centred framework. In total, 3,079 papers were identified, with 23 retained after applying eligibility criteria. Five themes were identified: Nurse identity; Organisation; Communication; Relationships; and Ideology of ICU. Almost every theme and related categories referred to factors acting as barriers to patient-centred nursing in the ICU; only four referred to supports/facilitators. Findings showed that provision of patient-centred nursing may be compromised by some factors of the critical care environment, and illustrate the challenges and complexity of providing effective patient-centred nursing in this environment. Findings should be applied to address barriers and to enhance facilitators of effective patient-centred nursing in critical care. The emotional and physical demands of critical care nursing are major considerations; supporting these nurses to fulfil their challenging role may empower them in their professional quality of life and provide a basis for workforce retention as well as delivery of effective patient-centred nursing. Measures to enhance patient-centred nursing could promote critical care nurses' job satisfaction and workforce retention, and be applied more broadly and
Pain is a global health issue with poor assessment and management of pain associated with serious disability and detrimental socio economic consequences. Pain is also a closely associated symptom of the three major causes of death in the developed world; Coronary Heart Disease, Stroke and Cancer. There is a significant body of work which indicates that current nursing practice has failed to address pain as a priority, resulting in poor practice and unnecessary patient suffering. Additionally nurse education appears to lack focus or emphasis on the importance of pain assessment and its management. A three step online search process was carried out across 71 Higher Education Institutes (HEIs) in the United Kingdom (UK) which deliver approved undergraduate nurse education programmes. Step one to find detailed programme documentation, step 2 to find reference to pain in the detailed documents and step 3 to find reference to pain in nursing curricula across all UK HEI websites, using Google and each HEIs site specific search tool. The word pain featured minimally in programme documents with 9 (13%) documents making reference to it, this includes 3 occurrences which were not relevant to the programme content. The word pain also featured minimally in the content of programmes/modules on the website search, with no references at all to pain in undergraduate pre-registration nursing programmes. Those references found during the website search were for continuing professional development (CPD) or Masters level programmes. In spite of the global importance of pain as a major health issue both in its own right, and as a significant symptom of leading causes of death and illness, pain appears to be a neglected area within the undergraduate nursing curriculum. Evidence suggests that improving nurse education in this area can have positive impacts on clinical practice, however without educational input the current levels of poor practice are unlikely to improve and unnecessary
Full Text Available Background: Emotion and how people manage it is an important part of personality that would immensely affect their health. Investigations showed that emotional intelligence is significantly related to and can predict psychological health. Objective: To determine the effect of teaching emotional intelligence to intensive care unit nurses on their general health. Methods: This randomized clinical trial (registered as IRCT201208022812N9 was conducted on 52 of 200 in intensive care unit nurses affiliated to Shiraz University of Medical Sciences. They were recruited through purposeful convenience sampling and then randomly categorized into two groups. The intervention group members were trained in emotional intelligence. Bar-on emotional intelligence and Goldberg's general health questionnaires were administered to each participant before, immediately after, and one month after the intervention. Results: While the mean score of general health for the intervention group decreased from 25.4 before the intervention, to 18.1 immediately after the intervention and to 14.6 one month later, for the control group, it increased from 22.0, to 24.2 and to 26.5, respectively (p<0.001. Conclusion: Teaching emotional intelligence improved the general health of intensive care unit nurses.
Vedana, Kelly Graziani Giacchero; da Silva, Danielle Maria; Ventura, Carla Aparecida Arena; Giacon, Bianca Cristina Ciccone; Zanetti, Ana Carolina Guidorizzi; Miasso, Adriana Inocenti; Borges, Tatiana Longo
Physical restraint in psychiatric units is a common practice but extremely controversial and poorly evaluated by methodologically appropriate investigations. The cultural issues and professionals' perceptions and attitudes are substantial contributors to the frequency of restraint that tend to be elevated. Aim In this qualitative study, we aimed to understand the experiences and perceptions of nursing staff regarding physical restraint in psychiatric units. Through theoretical sampling, 29 nurses from two Brazilian psychiatric units participated in the study. Data were collected from 2014 to 2016 from individual interviews and analyzed through thematic analysis, employing theoretical presuppositions of symbolic interactionism. Physical restraint was considered unpleasant, challenging, risky, and associated with dilemmas and conflicts. The nursing staff was often exposed to the risks and injuries related to restraint. Professionals sought strategies to reduce restraint-related damages, but still considered it necessary due to the lack of effective options to control aggressive behavior. This study provides additional perspectives about physical restraint and reveals the need for safer, humanized and appropriate methods for the care of aggressive patients that consider the real needs and rights of these patients. Copyright © 2017 Elsevier Inc. All rights reserved.
Cleary, Michelle; Hunt, Glenn E; Horsfall, Jan; Deacon, Maureen
Acute inpatient mental health units are busy and sometimes chaotic settings, with high bed occupancy rates. These settings include acutely unwell patients, busy staff, and a milieu characterised by unpredictable interactions and events. This paper is a report of a literature review conducted to identify, analyse, and synthesize ethnographic research in adult acute inpatient mental health units. Several electronic databases were searched using relevant keywords to identify studies published from 1990-present. Additional searches were conducted using reference lists. Ethnographic studies published in English were included if they investigated acute inpatient care in adult settings. Papers were excluded if the unit under study was not exclusively for patients in the acute phase of their mental illness, or where the original study was not fully ethnographic. Ten research studies meeting our criteria were found (21 papers). Findings were grouped into the following overarching categories: (1) Micro-skills; (2) Collectivity; (3) Pragmatism; and (4) Reframing of nursing activities. The results of this ethnographic review reveal the complexity, patient-orientation, and productivity of some nursing interventions that may not have been observed or understood without the use of this research method. Additional quality research should focus on redefining clinical priorities and philosophies to ensure everyday care is aligned constructively with the expectations of stakeholders and is consistent with policy and the realities of the organisational setting. We have more to learn from each other with regard to the effective nursing care of inpatients who are acutely disturbed.
Stikes, Reetta; Arterberry, Katheryn; Logsdon, M Cynthia
To describe how participation in the Sigma Theta Tau International Maternal-Child Health Nurse Leadership Academy positioned the authors to lead an interdisciplinary team through implementation and evaluation of a change project related to patient education based upon national health literacy standards. The project goal was to improve patient satisfaction with nurse communication and preparation for hospital discharge. Quality improvement. Mother/-baby unit of an academic medical center serving a high percentage of patients of a minority population and underserved clients. The five- step intervention included (a) review of current health literacy standards, (b) formation of an infrastructure for development and evaluation of existing patient education materials, (c) assessment of patient education materials currently in use, (d) assessment of literacy level and learning styles of new mothers, and (e) provision of continuing education to increase knowledge of nurses as patient teachers and of health literacy. Mean scores of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in the domains of patient satisfaction with nurse communication and discharge information were used to measure patient satisfaction with health communication. Patient satisfaction with nurse communication increased from 75.9% to 84.6%. Satisfaction with discharge information increased from 84.6% to 98.6%. The leadership academy successfully positioned the authors to guide an interdisciplinary team through development of a process to meet the education and communication needs of patients and improve their health literacy. As a result, a positive effect was noted on patient satisfaction with health communication. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
Pallaro, Audrey; Polzin, Karine
Collaborative work forms part of the well-treatment and improvement of quality of care approach. It is also of benefit to the medical and paramedical teams. Within the parent-child unit of Libourne hospital, the midwife and child health nurse collaborate throughout the pregnancy, and especially during the post-partum period. The teams work together notably around the care of "high-risk" births and in particular when the newborn is hospitalised in a kangaroo care unit. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Jette, A M; Becker, M C
Directors of undergraduate programs in nursing, physical therapy, and occupational therapy in the United States and Canada were surveyed to determine the amount and perceived adequacy of the current degree of classroom and clinical exposure to the rheumatic diseases. One hundred ninety-one (73%) of the 262 mailed questionnaires were returned. Results indicate that regardless of the actual degree of rheumatologic classroom exposure, directors in all three disciplines view current amounts as adequate. A larger proportion views levels of clinical exposure as inadequate. In general, the Canadian programs had a greater emphasis on rheumatology than their United States counterparts.
Freudenthal, A.; Van Stuijvenberg, M.; Van Goudoever, J.B.
Noise is a direct cause of health problems, long-lasting auditory problems and development problems. Preterm infants are, especially, at risk for auditory and neurocognitive development. Sound levels are very high at the neonatal intensive care unit (NICU) and may contribute to the frequently
Freudenthal, A.; van Stuijvenberg, M.; van Goudoever, J. B.
Noise is a direct cause of health problems, long-lasting auditory problems and development problems. Preterm infants are, especially, at risk for auditory and neurocognitive development. Sound levels are very high at the neonatal intensive care unit (NICU) and may contribute to the frequently
Freudenthal, A.; Van Stuijvenberg, M.; Van Goudoever, J.B.
Noise is a direct cause of health problems, long-lasting auditory problems and development problems. Preterm infants are, especially, at risk for auditory and neurocognitive development. Sound levels are very high at the neonatal intensive care unit (NICU) and may contribute to the frequently
Tabanejad, Zeinab; Pazokian, Marzieh; Ebadi, Abbas
Background: This review focuses on the impact of liaison nurse in nursing care of patient after ICU discharge on patient’s outcomes, compared with patients that are not taken care of by liaison nurses. The role of the ICU liaison nurse has transpired to solve the gap between intensive care unit and wards. Therefore, we aimed to review the outcomes of all studies in this field. Methods: A systematic review of intervention studies between 2004 and 2013 was undertaken using standard and sensitiv...
Abuidhail, Jamila; Al-Motlaq, Mohammad; Mrayan, Lina; Salameh, Taghreed
Many international studies in the field of neonatal nursing have identified parental stress, coping difficulties, support issues, and various other experiences that are related to the birth of a preterm infant. However, no studies have assessed the interrelated issues of parental stress, social support, satisfaction, and nursing support in neonatal intensive care units (NICUs) in Jordan. This study describes the lived experiences, needs in relation to care, and support systems of parents whose neonates were admitted to the NICU. A qualitative design using a phenomenological approach was used to explore the experiences of Jordanian parents who gave birth to neonates in the NICU setting. Participants were recruited from the NICUs of government, teaching, and private hospitals. Data were collected using semistructured interviews that were conducted with parents in a suitable place. Ten participants were interviewed: eight mothers and two fathers. After interviews were transcribed, the methodology suggested by van Manen (1990) was used to analyze the data. The shock, worry, and anxiety experienced by parents; the influences of NICU admission on the experiences of parents and families; the information and assistance required and received by parents from healthcare professionals; and the emotions and satisfaction of parents were the main themes that emerged from the study to reflect the lived experience of parents of neonates in the NICU. The parents in this study were satisfied with the healthcare process in the NICUs, even when this care did not fulfill their expectations or needs for their infants. Nurses in the NICUs must develop interventions and strategies that minimize the stress experienced by parents and that support the emotional capacity of parents to deal with this stressful situation.
Neill, Sara; Haithcock, Sarah; Smith, P. Brian; Goldberg, Ronald; Bidegain, Margarita; Tanaka, David; Carriker, Charlene; Ericson, Jessica E.
Purpose Reduction of bloodstream infections (BSI) has emerged as an important patient safety goal. Implementation of central line insertion bundles, standardized line care protocols, and health care provider education programs have reduced BSI in neonatal intensive care units (NICUs) around the country. The ability of large tertiary care centers to decrease nosocomial infections, including BSI, has been demonstrated. However, long-term BSI reductions in infants are not well documented. We sought to demonstrate that a low incidence of BSI can be maintained over time in a tertiary care NICU. Subjects 6,790 infants admitted to a large, tertiary care NICU between 2005 and 2013. Design Retrospective intervention study. Methods A staged, multifaceted infection prevention plan was implemented beginning in October 2007 under nursing leadership. The incidence of BSI was determined annually for 2005-2013. Results Baseline BSI incidence for infants admitted to the NICU was 5.15 and 6.08 episodes per 1,000 infant-days in 2005 and 2006, respectively. After protocol implementation, the incidence of BSI decreased to 2.14/1,000 infant-days and 2.44/1,000 infant-days in 2008 and 2009, respectively. Yearly incidence remained low over the next 4 years and decreased even further to 0.20-0.45 infections/1,000 infant days. This represents a 92% decrease in BSI over a period of >5 years. Conclusions Implementation of a nursing-led comprehensive infection control initiative can effectively produce and maintain a reduction in the incidence of BSI in infants at a large tertiary care NICU. What this study adds Long term reductions in neonatal BSI are possible with implementation of a multidisciplinary team approach and strong nursing leadership. PMID:25915573
Nowrouzi, Behdin; Giddens, Emilia; Gohar, Basem; Schoenenberger, Sandrine; Bautista, Mary Christine; Casole, Jennifer
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.
Kiymaz, Dilek; Koç, Zeliha
To determine individual and professional factors affecting the tendency of emergency unit nurses to make medical errors and their attitudes towards these errors in Turkey. Compared with other units, the emergency unit is an environment where there is an increased tendency for making medical errors due to its intensive and rapid pace, noise and complex and dynamic structure. A descriptive cross-sectional study. The study was carried out from 25 July 2014-16 September 2015 with the participation of 284 nurses who volunteered to take part in the study. Data were gathered using the data collection survey for nurses, the Medical Error Tendency Scale and the Medical Error Attitude Scale. It was determined that 40.1% of the nurses previously witnessed medical errors, 19.4% made a medical error in the last year, 17.6% of medical errors were caused by medication errors where the wrong medication was administered in the wrong dose, and none of the nurses filled out a case report form about the medical errors they made. Regarding the factors that caused medical errors in the emergency unit, 91.2% of the nurses stated excessive workload as a cause; 85.1% stated an insufficient number of nurses; and 75.4% stated fatigue, exhaustion and burnout. The study showed that nurses who loved their job were satisfied with their unit and who always worked during day shifts had a lower medical error tendency. It is suggested to consider the following actions: increase awareness about medical errors, organise training to reduce errors in medication administration, develop procedures and protocols specific to the emergency unit health care and create an environment which is not punitive wherein nurses can safely report medical errors. © 2017 John Wiley & Sons Ltd.
Subhani, Muhammad T; Kanwal, Ifrah
In this article, we describe a digital photo scrapbooking project as a standard of care for the parents of infants admitted in a neonatal intensive care unit (NICU). Photographs were taken from birth until discharge or expiry at special moments during the infant's hospitalization and used to create a digital scrapbook with daily notes by the parents. The scrapbook and original photos were provided on a CD at discharge or at expiry. Parents and their families unanimously appreciated the photos and the opportunity to record their thoughts, and considered the CDs as a lifetime treasure. Digital photo journaling could be implemented as a standard of care at other institutions with a commitment from the nursing and ancillary staff of the NICU and labor and delivery department, with possible support from volunteers.
Włodarczyk, Dorota; Pawliszewska, Anna
Working at intensive care unit (ICU) is one ot the most difticult and taxing nursing speciaites. It demans not only extensive knowledge and professional skills but also specific personality temperamental dispositions. The aim of the study was to verify if typeA behavior (TAB) is a predictor ofburnout and job satisfaction in ICU nurses and if this effect still exists after controlling for selected demographic and job characteristics. The study group consisted of 99 nurses (77 women), aged 24-58 (mean (M) = 32.33; standard deviation (SD) = 8:81) working at ICU. The following tools were used: to measure TAB - Type A Behavior Survey BWZ by Wrzesniewski; job burnout - the Oldenburg Burnout Inventory OLBI by Demerouti et al.; and job satisfaction - the Job Satisfaction Scale by Zalewska. The results of hierarchical regression analyses showed that after controlling for selected demographic and job characteristics, tendency for aggressibn was a predictor of higher exhaustion, disengagement and lower job satisfaction. Achievement striving and tendency to dominate were related to higher job satisfaction and lower exhaustion, respectively. Significant predictors of professional functioning were also: duty work system, place of living and gender. The results of the study.confirmed that all 3 content features of TAB were significant predictors of job functioning of ICU nurses. They also indicate that considering TAB in the context of individual adjustment to the environment of the job at ICU would be a valuable direction forfuture research.
Rostamabadi, Akbar; Zamanian, Zahra; Sedaghat, Zahra
Work ability is a crucial occupational health issue in health care settings where a high physical and psychosocial work capacity is required and a high risk of disabling injuries and illnesses is predictable. This study aims to examine the association between the work ability index (WAI) and individual characterizations, workload, fatigue, and diseases among intensive care units' (ICUs') nurses. The study sample included 214 nurses selected by a random sampling method from a target population consisting of 321 registered nurses working in eight ICUs. Multiple linear regression analysis was used to test the association between WAI scores and each of the independent variables. Results of multivariate analysis revealed a strong and negative association between WAI scores and diseases (B=-5.82, 95% CI=-7.16, -4.48, Pindex (BMI) was significantly and inversely associated with WAI scores. A significant and negative association was also found between WAI scores and dimensions of MFI-20, such as general fatigue (B=-0.31, 95% CI=-0.53, -0.09, P=0.005) and physical fatigue (B=-0.44, 95% CI=-0.65, -0.23, Pwork environment characterized by a well-structured preventive attitude toward controlling diseases, and a well-designed organizational framework toward increasing the level of performance and motivation, reducing the level of fatigue, as well as reducing the workload, is necessary to promote work ability among ICUs' nurses.
Kudchadkar, Sapna R; Beers, M Claire; Ascenzi, Judith A; Jastaniah, Ebaa; Punjabi, Naresh M
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 noise in single-patient rooms (33%) than in multipatient rooms (79%; P pediatric intensive care unit environment for promoting patients' sleep and the nurses' own work experience. ©2016 American Association of Critical-Care Nurses.
Mooneyhan, Esther L.; And Others
Results of a national survey of undergraduate and graduate nursing programs to determine the extent of curriculum content and faculty training in international health issues are reported. The importance of this aspect of nursing education is discussed. (MSE)
Van Bogaert, Peter; Adriaenssens, Jef; Dilles, Tinne; Martens, Daisy; Van Rompaey, Bart; Timmermans, Olaf
To study the impact of role, job- and organizational characteristics on nurse managers' work related stress and well-being such as feelings of emotional exhaustion, work engagement, job satisfaction and turnover intention. Various studies investigated role-, job- and organizational characteristics influencing nurse-related work environments. Research on nurse managers' related work environments define influencing factors, but, a clear understanding of the impact of nurse-managers' work-environment characteristics on their work related stress and well-being is limited. A cross-sectional design with a survey. A cross-sectional survey (N = 365) was carried out between December 2011-March 2012. The questionnaire was based on various validated measurement instruments identified by expert meetings (e.g. staff nurses, nurse managers and executives and physicians). Hierarchical regression analyses were performed using emotional exhaustion, work engagement, job satisfaction and turnover intentions as outcome variables. Study results showed one out of six nursing unit managers have high to very high feelings of emotional exhaustion and two out of three respondents have high to very high work engagement. Hierarchical regression models showed that role conflict and role meaningfulness were strong predictors of nursing unit managers' work related stress and well-being, alongside with job- and organizational characteristics. Several risk factors and stimulating factors influencing nurse unit managers' work related stress and well-being were identified. Further challenges will be to develop proper interventions and strategies to support nursing unit managers and their team in daily practice to deliver the best and safest patient care. © 2014 John Wiley & Sons Ltd.
Carmona-Guirado, A J; Escaño-Cardona, V; García-Cañedo, F J
39 year old woman, pregnant for 31+5 weeks, who came to our intensive care unit (ICU) referred from the emergency department of the hospital, having swollen ankles, headache and fatigue at moderate effort. We proceeded to take blood pressure (158/96 mmHg) and assess lower limb edema. The fetal heart rate monitoring was normal. Knowledgeable and user of healthy guidelines during her pregnancy, she did not follow any treatment. Single mother, she worried about her fetus (achieved through in vitro fertilization), her mother offered to help for any mishap. We developed an Individualized Care Plan. For data collection we used: Rating 14 Virginia Henderson Needs and diagnostic taxonomy NANDA, NOC, NIC. Nursing diagnoses of "fluid volume excess" and "risk of impaired maternal-fetal dyad" were detected, as well as potential complications such as eclampsia and fetal prematurity. Our overall objectives (NOC) were to integrate the woman in the process she faced and that she knew how to recognize the risk factors inherent in her illness. Nursing interventions (NIC) contemplated the awareness and treatment of her illness and the creation of new healthy habits. The work of nursing Maternal ICU allowed women to help maintain maximum maternal and fetal well-being by satisfying any of her needs. Mishandling of the situation leads into a framework of high morbidity and mortality in our units. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Tomazoni, Andréia; Rocha, Patrícia Kuerten; de Souza, Sabrina; Anders, Jane Cristina; de Malfussi, Hamilton Filipe Correia
OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units. METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121. RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument. CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units. PMID:25493670
With the advances of technology and treatment in the field of neonatal care, researchers can now study how the brains of preterm infants are different from full-term infants. The differences are significant, and the outcomes are poor overall for premature infants as a whole. Caregivers at the bedside must know that every interaction with the preterm infant affects brain development-it is critical to the developmental outcome of the infant. The idea of neuroprotection is not new to the medical field but is a fairly new idea to the NICU. Neuroprotection encompasses all interventions that promote normal development of the brain. The concept of brain-oriented care is a necessary extension of developmental care in the NICU. By following the journey of 26-week preterm twin infants through a case study, one can better understand the necessity of brain-oriented care at the bedside.
Choi, Eun Ha; Kim, Eun-Kyung; Kim, Pil Bong
EDUCATIONAL LEADERSHIP OF NURSING UNIT MANAGERS ON TEAM EFFECTIVENESS: Mediating Effects of Organizational Communication Satisfaction. This study identifies the effects of the educational leadership of nursing unit managers on team effectiveness and the mediating effects of organizational communication satisfaction; it highlights the importance of educational leadership and organizational communication and provides the data needed to enhance the education capacity of managers. The participants were 216 nursing unit managers of staff nurses at a tertiary hospital located in C Region, South Korea, and nurses who had worked for more than six months at the same hospital. This study was conducted using questionnaires on educational leadership, team effectiveness, and organizational communication satisfaction. Data analysis was performed with a t-test, ANOVA, Scheffé, Pearson's correlation coefficient, and simple and multiple regression analyses using SPSS version 23.0. Mediation analysis was tested using Baron and Kenny's regression analysis and a Sobel test. The mean score for the educational leadership of nursing unit managers was 3.74(±0.68); for organizational communication satisfaction, 3.14(±0.51); and for team effectiveness, 3.52(±0.49). Educational leadership was significantly positively correlated with team effectiveness and organizational communication satisfaction. Organizational communication satisfaction demonstrated a complete mediating effect on the relationship between educational leadership and team effectiveness (β=.61, pcommunication satisfaction among nurses; this supports the idea that educational leadership can contribute to team effectiveness. This suggests that the educational leadership and communication capacity of nursing unit managers must be improved to enhance the performance of nursing organizations. Copyright © 2018. Published by Elsevier B.V.
Alessandra Bassalobre Garcia
Full Text Available Objective: to understand the strategies used by nursing technicians in order to face the occupational suffering in an emergency room. Methods: qualitative study carried out in an emergency room of a high complexity hospital located in the north of Paraná state. Data were collected through semi-structured interviews with 12 nursing technicians. The analysis relied on content analysis procedures. Results: respondents revealed as individual strategies to face suffering: try not to get involved with the patient; separation between professional and personal life; and spirituality/religion as support for coping. The collective strategies described by respondents included: action planning for unexpected events in this unit; creating a supportive environment; and attempt to obtain recognition of headship. Conclusion: individual and collective strategies were used consciously by workers and should be encouraged by managers to face the occupational suffering.
Fernandes, Maria I D; Moreira, Isabel M P B
This research aims to identify the ethical issues perceived by intensive care nurses in their everyday practice. It also aims to understand why these situations were considered an ethical issue and what interventions/strategies have been or are expected to be developed so as to minimize them. Data were collected using a semi-structured interview with 15 nurses working at polyvalent intensive care units in 4 Portuguese hospitals, who were selected by the homogenization of multiple samples. The qualitative content analysis identified end-of-life decisions, privacy, interaction, team work, and health-care access as emerging ethical issues. Personal, team, and institutional aspects emerge as reasons behind the experience of these issues. Personal and team resources are used in and for solving these issues. Moral development and training are the most significant strategies.
De Meester, K; Das, T; Hellemans, K; Verbrugghe, W; Jorens, P G; Verpooten, G A; Van Bogaert, P
Analysis of in-hospital mortality after serious adverse events (SAE's) in our hospital showed the need for more frequent observation in medical and surgical wards. We hypothesized that the incidence of SAE's could be decreased by introducing a standard nurse observation protocol. To investigate the effect of a standard nurse observation protocol implementing the Modified Early Warning Score (MEWS) and a color graphic observation chart. Pre- and post-intervention study by analysis of patients records for a 5-day period after Intensive Care Unit (ICU) discharge to 14 medical and surgical wards before (n=530) and after (n=509) the intervention. For the total study population the mean Patient Observation Frequency Per Nursing Shift (POFPNS) during the 5-day period after ICU discharge increased from .9993 (95% C.I. .9637-1.0350) in the pre-intervention period to 1.0732 (95% C.I. 1.0362-1.1101) (p=.005) in the post-intervention period. There was an increased risk of a SAE in patients with MEWS 4 or higher in the present nursing shift (HR 8.25; 95% C.I. 2.88-23.62) and the previous nursing shift (HR 12.83;95% C.I. 4.45-36.99). There was an absolute risk reduction for SAE's within 120h after ICU discharge of 2.2% (95% C.I. -0.4-4.67%) from 5.7% to 3.5%. The intervention had a positive impact on the observation frequency. MEWS had a predictive value for SAE's in patients after ICU discharge. The drop in SAE's was substantial but did not reach statistical significance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Scott, R A
Clinical nurse specialists (CNSs) frequently adapt to meet the challenging and changing needs of patients, families, nurses, physicians, and institutions, thus creating an advance practice role that is problematic in definition and description. The two dilemmas associated with CNSs have been role confusion and ambiguity, and the inability to explicate CNSs' value in economic terms. The purpose of this study was to describe the roles, activities, skills, and the cost-saving and revenue-generating activities of Master's-prepared nurses who function in traditional CNS roles in the United States. A descriptive research design was employed, using Role Theory as a framework to guide the study. The tool used to measure CNS practice included a 68-item instrument. It was pretested and used in two pilot studies. Content validity was supported by three experienced CNSs who were, at the time, in a doctoral nursing program. Instrument reliability was 0.89. Surveys were mailed to all individuals who subscribed (n = 2379) to the Clinical Nurse Specialist Journal. From the convenience sample, 724 CNSs participated, providing a margin of error of +/- 4 percentage points with a 99% confidence level. Regarding the five role components, CNSs reported (listed from most frequently to least frequently) spending time in the role of expert practitioner, educator, consultant, administrator, and researcher. Most of the activities listed in each of the roles were typical of CNS practice. Of the advanced practice roles, the two with the most surprising results were the expert practitioner and administrator roles. The results indicated a trend toward performing advanced skills that have been in the past considered solely medical practice and toward increasing administrative responsibilities. A small number of CNSs were able to identify cost-saving and revenue-generating activities, including the monetary value of the activity.
Drennan, Vari; Davis, Kathy; Goodman, Claire; Humphrey, Charlotte; Locke, Rachel; Mark, Annabelle; Murray, Susan F; Traynor, Michael
This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$''social enterprise$''mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors.
Lin, Tzu-Ching; Lin, Huey-Shyan; Cheng, Su-Fen; Wu, Li-Min; Ou-Yang, Mei-Chen
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.
Lim, Ji Young; Kim, Mi Ja; Park, Chang Gi
Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.
Ménétré, S; Weber, M; Socha, M; Le Tacon, S; May, I; Schweitzer, C; Demoré, B
In hospitals, the nursing staff is often confronted with the problem of the preparation and administration of drugs for their pediatric patients because of the lack of indication, pediatric dosage, and appropriate galenic form. The goal of this study was to give an overview of the nurses' preparation habits in pediatric units and highlight their daily problems. This single-center prospective study was conducted through an observation of the nursing staff during the drug preparation process in medicine, surgery and intensive care units. We included 91 patients (55 boys and 36 girls), with an average age of 6.3 years (youngest child, 10 days old; oldest child, 18 years old). We observed a mean 2.16 drug preparations per patient [1-5]. We collected 197 observation reports regarding 66 injectable drugs and 131 oral drugs (71 liquid forms and 60 solid forms). The majority of these reports concerned central nervous system drugs (63/197), metabolism and digestive system drugs (50/197), and anti-infective drugs (46/197). The study highlights the nurses' difficulties: modification of the solid galenic forms, lack of knowledge on oral liquid form preservation or reconstitution methods, withdrawal of small volumes, and vague and noncompliant labeling. This study led to the creation of a specific working group for pediatrics. This multidisciplinary team meets on a regular basis to work toward improving the current habits to both simplify and secure drug administration to hospitalized children. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Ballangrud, Randi; Hall-Lord, Marie Louise; Hedelin, Birgitta; Persenius, Mona
To implement a simulation-based team training programme and to investigate intensive care nurses' evaluations of simulation used for team training. Simulation-based training is recommended to make health care professionals aware of and understand the importance of teamwork related to patient safety. The study was based on a questionnaire evaluation design. A total of 63 registered nurses were recruited: 53 from seven intensive care units in four hospitals in one hospital trust and 10 from an intensive care postgraduate education programme. After conducting a simulation-based team training programme with two scenarios related to emergency situations in the intensive care, the participants evaluated each simulation activity with regard to: (i) outcome of satisfaction and self-confidence in learning, (ii) implementation of educational practice and (iii) simulation design/development. Intensive care nurses were highly satisfied with their simulation-based learning, and they were mostly in agreement with the statements about self-confidence in learning. They were generally positive in their evaluation of the implementation of the educational practice and the simulation design/development. Significant differences were found with regard to scenario roles, prior simulation experience and area of intensive care practice. The study indicates a positive reception of a simulation-based programme with regard to team training in emergency situations in an intensive care unit. The findings may motivate and facilitate the use of simulation for team training to promote patient safety in intensive care and provide educators with support to develop and improve simulation-based training programmes. © 2013 British Association of Critical Care Nurses.
Full Text Available Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs. Aim: The study was aimed to survey prevalent enteral nutrition practices in the trauma intensive care unit, nurses′ perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 1 trauma center, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India. The study design used an audit. Materials and Methods: Sixty questionnaires were distributed and the results analyzed. A database was prepared and the audit was done. Results: Forty-two (70% questionnaires were filled and returned. A majority (38 of staff nurses expressed awareness of nutrition guidelines. A large number (32 of staff nurses knew about nutrition protocols of the ICU. Almost all (40 opined enteral nutrition to be the preferred route of nutrition unless contraindicated. All staff nurses were of opinion that enteral nutrition is to be started at the earliest (within 24-48 h of the ICU stay. Everyone opined that the absence of bowel sounds is an absolute contraindication to initiate enteral feeding. Passage of flatus was considered mandatory before starting enteral nutrition by 86% of the respondents. Everyone knew that the method of Ryle′s tube feeding in their ICU is intermittent boluses. Only 4 staff nurses were unaware of any method to confirm Ryle′s tube position. The backrest elevation rate was 100%. Gastric residual volumes were always checked, but the amount of the gastric residual volume for the next feed to be withheld varied. The majority said that the unused Ryle′s tube feed is to be discarded after 6 h. The most preferred (48% method to upgrade their knowledge of enteral nutrition was from the ICU protocol manual. Conclusion: Information generated from this study can be helpful in identifying nutrition practices that are lacking and may be used to review and revise enteral feeding
Hall, R Whit
Painful procedures in the neonatal intensive care unit are common, undertreated, and lead to adverse consequences. A stepwise approach to treatment should include pain recognition, assessment, and treatment, starting with nonpharmacologic and progressing to pharmacologic methods for increasing pain. The most common nonpharmacologic techniques include nonnutritive sucking with and without sucrose, kangaroo care, swaddling, and massage therapy. Drugs used to treat neonatal pain include the opiates, benzodiazepines, barbiturates, ketamine, propofol, acetaminophen, and local and topical anesthetics. The indications, advantages, and disadvantages of the commonly used analgesic drugs are discussed. Guidance and references for drugs and dosing for specific neonatal procedures are provided. Copyright © 2012 Elsevier Inc. All rights reserved.
Ganz, Freda DeKeyser; Ofra, Raanan; Khalaila, Rabia; Levy, Hadassa; Arad, Dana; Kolpak, Orly; Ben Nun, Maureen; Drori, Yardena; Benbenishty, Julie
The purpose of this study was to determine whether there was a change in the oral care practices of intensive care unit (ICU) nurses for ventilated patients after a national effort to increase evidence-based oral care practices. Descriptive comparison of ICU nurses in 2004-2005 and 2012. Two convenience national surveys of ICU nurses were collected in 2004-2005 (n = 218) and 2012 (n = 233). After the results of the initial survey were reported, a national effort to increase awareness of evidence-based oral care practices was conducted that included in-service presentations; publication of an evidence-based protocol in a national nursing journal; publication of the survey findings in an international nursing journal; and reports to the local press. A repeat survey was conducted 7 to 8 years later. The same survey instrument was used for both periods of data collection. This questionnaire included questions about demographic and personal characteristics and a checklist of oral care practices. Nurses rated their perceived priority level concerning oral care on a scale from 0 to 100. An evidence-based practice (EBP)[O4] score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the evidence. The EBP score, priority score, and oral care practices were compared between the two samples. A regression model was built based on those variables that were associated with the EBP score in 2012. There was a statistically significant increase in the use of EBPs as shown by the EBP score and in the perceived priority level of oral care. Increased EBPs were found in the areas of teeth brushing and oral assessment. Decreases were found in the use of non-evidence-based practices, such as the use of gauze pads, tongue depressors, lemon water, and sodium bicarbonate. No differences were found in the use of chlorhexidine, toothpaste, or the nursing documentation of oral care practices. A multiple regression model was
Lee, Ya-Wen; Dai, Yu-Tzu; McCreary, Linda L
To examine the relationships between quality of work life (QWL) and nurses' intention to leave their unit (ITLunit), organisation (ITLorg) and profession (ITLpro). The high turnover rate among nurses presents a major challenge to health care systems across the globe. QWL plays a significant role in nurses' turnover. A descriptive cross-sectional survey design was conducted via purposive sampling of 1283 hospital nurses and administering the Chinese version of the Quality of Nursing Work Life scale (C-QNWL), a three-ITL-type scale questionnaire, and a demographic questionnaire for individual- and work-related variables. Descriptive data, correlations, and ordinal regression models were analyzed. QWL predicted ITLpro and ITLorg better than ITLunit. Three QWL dimensions (work arrangement and workload, nursing staffing and patient care, and work-home life balance) were significantly predictive of all three ITL measures. However, the dimension of teamwork and communication was only predictive for ITLunit, not for ITLorg and ITLpro. Different patterns of QWL dimensions are predictive of ITLunit, ITLorg, and ITLpro. The study provides important information to nurse administrators about the aspects of QWL that most commonly lead nurses to leave their units, organisations, and even the profession itself. © 2013 John Wiley & Sons Ltd.
Almeida, Sônia Regina Wagner de; Sasso, Grace Teresinha Marcon Dal; Barra, Daniela Couto Carvalho
Analyzing the ergonomics and usability criteria of the Computerized Nursing Process based on the International Classification for Nursing Practice in the Intensive Care Unit according to International Organization for Standardization(ISO). A quantitative, quasi-experimental, before-and-after study with a sample of 16 participants performed in an Intensive Care Unit. Data collection was performed through the application of five simulated clinical cases and an evaluation instrument. Data analysis was performed by descriptive and inferential statistics. The organization, content and technical criteria were considered "excellent", and the interface criteria were considered "very good", obtaining means of 4.54, 4.60, 4.64 and 4.39, respectively. The analyzed standards obtained means above 4.0, being considered "very good" by the participants. The Computerized Nursing Processmet ergonomic and usability standards according to the standards set by ISO. This technology supports nurses' clinical decision-making by providing complete and up-to-date content for Nursing practice in the Intensive Care Unit. Analisar os critérios de ergonomia e usabilidade do Processo de Enfermagem Informatizado a partir da Classificação Internacional para as Práticas de Enfermagem, em Unidade de Terapia Intensiva, de acordo com os padrões da InternationalOrganization for Standardization (ISO). Pesquisa quantitativa, quase-experimental do tipo antes e depois, com uma amostra de 16 participantes, realizada em uma Unidade de Terapia Intensiva. Coleta de dados realizada por meio da aplicação de cinco casos clínicos simulados e instrumento de avaliação. A análise dos dados foi realizada pela estatística descritiva e inferencial. Os critérios organização, conteúdo e técnico foram considerados "excelentes", e o critério interface "muito bom", obtendo médias 4,54, 4,60, 4,64 e 4,39, respectivamente. Os padrões analisados obtiveram médias acima de 4,0, sendo considerados "muito bons
Osman, Ibrahim H; Berbary, Lynn N; Sidani, Yusuf; Al-Ayoubi, Baydaa; Emrouznejad, Ali
The appraisal and relative performance evaluation of nurses are very important and beneficial for both nurses and employers in an era of clinical governance, increased accountability and high standards of health care services. They enhance and consolidate the knowledge and practical skills of nurses by identification of training and career development plans as well as improvement in health care quality services, increase in job satisfaction and use of cost-effective resources. In this paper, a data envelopment analysis (DEA) model is proposed for the appraisal and relative performance evaluation of nurses. The model is validated on thirty-two nurses working at an Intensive Care Unit (ICU) at one of the most recognized hospitals in Lebanon. The DEA was able to classify nurses into efficient and inefficient ones. The set of efficient nurses was used to establish an internal best practice benchmark to project career development plans for improving the performance of other inefficient nurses. The DEA result confirmed the ranking of some nurses and highlighted injustice in other cases that were produced by the currently practiced appraisal system. Further, the DEA model is shown to be an effective talent management and motivational tool as it can provide clear managerial plans related to promoting, training and development activities from the perspective of nurses, hence increasing their satisfaction, motivation and acceptance of appraisal results. Due to such features, the model is currently being considered for implementation at ICU. Finally, the ratio of the number DEA units to the number of input/output measures is revisited with new suggested values on its upper and lower limits depending on the type of DEA models and the desired number of efficient units from a managerial perspective.
Full Text Available Background and Objective: Caring is the core of nursing however, different individules have different perceptions of it. Continuous assessment and measurement of caring behaviors results in the identification of their problems. The careful planning of interventions and problem solving will improve care. The aim of this study was to identify nurses' perception of caring behaviors in the intensive care units. Materials and Method: In this descriptive-analytic study, 140 nurses were selected from intensive care units of hospitals affiliated to Lorestan University of Medical Sciences, Iran, using the census method in 2012. The data collection tool was the Caring Behaviors Inventory for Elders (CBI-E. This questionnaire consisted of two parts including demographic information and 28 items related to care. Face and content validity of the Persian version of the questionnaire were provided by professionals, and after deletion of 4 items a 24-item questionnaire was provided. Cronbach's alpha coefficient was calculated to assess reliability (&alpha = 0.71. Data were analyzed using SPSS software version 18 and descriptive-analytic statistics (Kruskal-Wallis test and Mann-Whitney test. Results: Based on the findings, nurses paid more attention to the physical–technical aspects (95.71 ± 12.76 of care in comparison to its psychosocial aspects (75.41 ± 27.91. Nurses had the highest score in care behavior of "timely performance of medical procedures and medication administration". Conclusion: Since nurses paid more attention to the technical aspects of care than its psychosocial aspects, by providing nurses with a correct perception of care, patients can be provided with needs-based care. This will increase patient satisfaction with nursing care, and indirectly result in the positive attitude of patients and society toward the nursing profession and its services. Moreover, nursing education officials can use these results to assist nurses in meeting
Vanessa da Silva Neves Moreira Arakaki
Full Text Available AbstractIntroduction The high-risk newborns may require long periods of hospitalization until they reach clinical stability for hospital discharge. Avoiding babies to be in only one body position may be an effective way to cause respiratory and neuro-psycho-motor benefits, comfort and preventing pressure ulcers.Objectives This study investigated the impact of physiotherapy/nursing integration in update on body positioning of the newborn in the Neonatal Intensive Care Unit.Methods A questionnaire was administered to nurses and nursing technicians of the neonatal unit of Maternity School of UFRJ and nurses of the Advanced Course in Neonatal Nursing from the same institution. Two classes were taught by the physical therapist of the sector and the questions answered before and after these lessons. It was also a brief characterization of professional participants of the study. We used the Student's t test to compare the correct answers before (PRE and after (POST the classes, considering p < 0.05.Results There was a significant increase in the degree of knowledge of nurses and nursing technicians when compared the responses before (nurses: 68.8%; technicians: 70.1% and after classes (nurses: 78.4 %; technicians: 88.9%. The nurses were less than five years of graduated (45% and little time of professional experience in neonatology (60%. Forty-seven percent of technicians had less than five years of training and 82% had less than 10 years of experience.Conclusion The use of training by the nursing staff was significant, showing the importance of multidisciplinary approach and the integration of knowledge in the search for a humanized and effective care.
Northrup, Thomas F; Green, Charles; Evans, Patricia W; Stotts, Angela L
The neonatal intensive care unit (NICU) is an ideal setting to intervene with an under served population on secondhand smoke exposure (SHSe). Unfortunately, attrition may compromise outcomes. Baseline characteristics associated with intervention and follow-up attendance were investigated in mothers who participated in a novel SHSe prevention study designed for households with a smoker and a NICU-admitted infant. Intervention participants received two motivational, NICU-based counseling sessions; usual care participants received pamphlets. Home-based follow-up assessments occurred at 1, 3 and 6 months. Sociodemographic, smoking history, and psychosocial factors were analyzed. Mothers from households with greater numbers of cigarettes smoked and fewer children had higher odds of both intervention and follow-up attendance. Maternal smoking abstinence (lifetime), more adults in the home and higher perceived interpersonal support were also associated with higher odds of follow-up visit completion. Innovative strategies are needed to engage mothers in secondhand smoke interventions, especially mothers who smoke, have lower levels of social support and have greater childcare responsibilities.
Full Text Available Preterm birth is associated with painful procedures during the neonatal intensive care unit (NICU stay. Full-term newborns can also experience pain, following surgery. These procedures can have long-lasting consequences. It has been shown that children born preterm show pain responses and cardiac alterations. This study aimed to explore the heart rate reactivity to pain in 107 subjects born either preterm or full-term who were between 7 and 25 years old at testing. We also evaluated the effect of pain experienced at birth, as represented by a longer NICU stay, time under ventilation, and surgery at birth. Participants were asked to immerse their right forearm in 10°C water for 2 minutes. Electrocardiograms were recorded at baseline and during the immersion procedure. Full-term subjects showed a stable increase in heart rate throughout the procedure, whereas preterm ones showed a strong increase at the beginning, which decreased over time. Also, preterm and full-term subjects who experienced pain at birth showed higher resting heart rate, stronger sympathetic activity, and lower cardiac vagal activity. Our study demonstrated a long-term impact of a long NICU stay and surgery at birth on cardiac autonomic activity. This could lead to impaired reactions to pain or stress in later life.
Younas, Ahtisham; Sundus, Amara
Nursing is predominantly a female profession and caring has been considered an attribute of female nurses, which could imply a noncaring image of male nurses. To determine patients' experiences and satisfaction from care provided by male nurses in a private hospital in Islamabad, Pakistan. This cross-sectional study included a purposive sample of 50 patients admitted to medical surgical units for at least 2 days and who had at least three professional interactions with a male nurse. The Newcastle Satisfaction with Nursing Scale was used for data collection. Descriptive statistics were used for data analysis. The total score for experience and satisfaction was 81 and 51, respectively. A statistically significant difference existed between experience and satisfaction scores of male and female participants, indicating that males were more pleased and satisfied with their experience of receiving care from male nurses compared to the female participants. The male nurses were concerned for their patients, they were knowledgeable about the patients' condition and care, and provided them with clear explanations of the medical and nursing procedures. However, they seem to lack interpersonal relationship with patients and did not take initiative in understanding their patients. © 2017 Wiley Periodicals, Inc.
Maurício, Luiz Felipe Sales; Okuno, Meiry Fernanda Pinto; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Belasco, Angélica Gonçalves Silva; Batista, Ruth Ester Assayag
assess the autonomy, control over environment, and organizational support of nurses' work process and the relationships between physicians and nurses in critical care units. cross-sectional study conducted with 162 nurses working in the intensive care units and emergency service of a university hospital. The workers' satisfaction with their work environment was assessed using Brazilian Nursing Work Index - Revised, translated and adapted for the Brazilian culture. average age was 31.6 ± 3.9 years; 80.2% were women; 68.5% Caucasians and 71.6% worked in intensive care units. The nurses considered autonomy (2.38 ± 0.64) and their relationship with physicians (2.24 ± 0.62) to be characteristics of the work environment that favored professional practice. Control over environment (2.78 ± 0.62) and organizational support (2.51 ± 0.54), however, were considered to be unfavorable. No statistically significant differences were found between the units based on the scores obtained by the professionals on the Brazilian Nursing Work Index - Revised. autonomy, relationship between physicians and nurses, and organizational support were considered by the units to be characteristics that favored nurses' professional practices. On the other hand, control over environment and organizational support were considered unfavorable. evaluar la autonomía, el control sobre el ambiente, el soporte organizacional del proceso de trabajo de los enfermeros y las relaciones entre médicos y enfermeros, en unidades críticas. estudio transversal realizado en 162 enfermeros de las unidades de terapia intensiva y del servicio de emergencia de un hospital universitario. La evaluación de la satisfacción del profesional con el ambiente de trabajo fue realizada utilizando el Brazilian Nursing Work Index - Revised, traducido y adaptado para la cultura brasileña. el promedio de edad fue 31,6 ± 3,9 años, 80,2% eran mujeres, 68,5% blancos y 71,6% trabajaban en la unidad de terapia intensiva. Los
Mason, Virginia M; Leslie, Gail; Clark, Kathleen; Lyons, Pat; Walke, Erica; Butler, Christina; Griffin, Martha
Preparation for replacing the large proportion of staff nurses reaching retirement age in the next few decades in the United States is essential to continue delivering high-quality nursing care and improving patient outcomes. Retaining experienced critical care nurses is imperative to successfully implementing the orientation of new inexperienced critical care nurses. It is important to understand factors that affect work engagement to develop strategies that enhance nurse retention and improve the quality of patient care. Nurses' experience of moral distress has been measured in medical intensive care units but not in surgical trauma care units, where nurses are exposed to patients and families faced with sudden life-threatening, life-changing patient consequences.This pilot study is a nonexperimental, descriptive, correlational design to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses' work engagement. This is a partial replication of Lawrence's dissertation. The study also asked nurses to describe sources of moral distress and self-care strategies for coping with stress. This was used to identify qualitative themes about the nurse experiences. Jean Watson's theory of human caring serves as a framework to bring meaning and focus to the nursing-patient caring relationship.A convenience sample of 26 of 34 eligible experienced surgical intensive care unit trauma nurses responded to this survey, indicating a 77% response rate. Twenty-seven percent of the nurses scored high, and 73% scored average on compassion satisfaction. On compassion fatigue, 58% scored average on burnout and 42% scored low. On the secondary traumatic stress subscale, 38% scored average, and 62% scored low. The mean moral distress situations subscale score was 3.4, which is elevated. The mean 9-item Utrecht Work Engagement Scale total score, measuring work engagement, was 3.8, which is considered low
Kim, Hyun Sook; Yeom, Hye-Ah
To describe the spiritual well-being and burnout of intensive care unit nurses and examine the relationship between these factors. This was a cross-sectional descriptive study. The participants were 318 intensive care unit recruited from three university hospitals in South Korea. The survey questionnaire included demographic information, work-related characteristics and end-of-life care experience, along with the Spiritual Well-Being Scale and Burnout Questionnaire. The data were analysed using descriptive statistics, t-tests, ANOVA with Scheffé test and a multiple regression analysis. The burnout level among intensive care unit nurses was 3.15 out of 5. A higher level of burnout was significantly associated with younger age, lower education level, single marital status, having no religion, less work experience and previous end-of-life care experience. Higher levels of spiritual well-being were associated with lower levels of burnout, even after controlling for the general characteristics in the regression model. Intensive care unit nurses experience a high level of burnout in general. Increased spiritual well-being might reduce burnout among intensive care unit nurses. Younger and less experienced nurses should receive more attention as a vulnerable group with lower spirituality and greater burnout in intensive care unit settings. Copyright © 2017 Elsevier Ltd. All rights reserved.
Schmidt, Denise Rodrigues Costa; Paladini, Márcia; Biato, Cleonice; Pais, Juliana Domingues; Oliveira, Adelaine Rodrigues
This descriptive-correlational and cross-sectional study aimed to evaluate the quality of working life (QWL) and the presence of burnout among nursing professionals working at Intensive Care Units. The sample was composed of 53 nursing professionals from a university hospital located in the city of Londrina-PR, Brazil. Three instruments were used for data collection: socio-demographic and professional characterization, Visual Analogue Scale for QWL and Maslach Burnout Inventory. Data was collected from April to August, 2009. Among the participants, most were auxiliary nurses (52.8%), women (66.0%) and married (67.9%). The average age was of 42.4 years. Regarding assessment of QWL, the average score obtained for the total sample was 71.1 (SD=15.5), showing that workers were satisfied with their QWL. The average for Emotional Exhaustion, Depersonalization and Personal Accomplishment dimensions was 11.4 (SD=7.7), 4.6 (SD=4.1) and 25.0 (SD=5.9), respectively. The QWL for the total sample showed significant association only with Emotional Exhaustion (p=0.000).
Full Text Available Objectives: Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. Materials and Methods: This descriptive study was performed on 60 nursing staff in the intensive care unit (ICU for poisoned patients in Imam Reza (p hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire. Studied scales included perceived importance and novelty of educational meeting, matching with professional and educational needs, illustration of practical and knowledge weaknesses and strength and finally satisfaction in holding regular workshops annually. Two, half day workshops were held and various items were taught with various methods. The knowledge of participants was assessed by pretests and post-tests consisting of 12 items related to workshop topics. The impact of these educational meetings was evaluated and the results were analyzed by the SPSS software. Results: According to the results, workshops improved awareness of nurses about their weakness and strength points, professional knowledge and their interest and attention; likewise all participants had the same opinion about a strong need to hold similar workshops more than once and preferably 2 to 3 times annually. Conclusion: It seems that short educational courses in small groups for reviewing the old data and recent findings in the context of critical care are useful in order to promote the knowledge and skills of ICU staff in taking care of poisoned patients
Shattell, Mona; Bartlett, Robin; Beres, Kyle; Southard, Kelly; Bell, Claire; Judge, Christine A; Duke, Patricia
The inpatient environment is a critical space for nurses and patients in psychiatric settings. In this article, we describe nurses' and patients' perceptions of the inpatient environment both before the removal of a Plexiglas enclosure around a nurses' station and after its removal. Nurses had mixed feelings about the enclosure, reporting that it provided for confidentiality and a concentrated work space but also acknowledged the challenge of the barrier for communication with their patients. Patients unanimously preferred the nurses' station without the barrier, reporting increased feelings of freedom, safety, and connection with the nurses after its removal. It is important to consider the implications of environmental decisions in inpatient settings in order to promote a healthy workplace and healing environment for all community members. © The Author(s) 2015.
Despins, Laurel A
This study examines what prompts the intensive care unit (ICU) nurse to go to the patient's bedside to investigate an alarm and the influences on the nurse's determination regarding how quickly this needs to occur. A qualitative descriptive design guided data collection and analysis. Individual semi-structured interviews were conducted. Thematic analysis guided by the Patient Risk Detection Theoretical Framework was applied to the data. Four specialty intensive care units in an academic medical center. ICU nurses go the patient's bedside in response to an alarm to catch patient deterioration and avert harm. Their determination of the immediacy of patient risk and their desire to prioritize their bedside investigations to true alarms influences how quickly they proceed to the bedside. Ready visual access to physiological data and waveform configurations, experience, teamwork, and false alarms are important determinants in the timing of ICU nurses' bedside alarm investigations. Copyright © 2017 Elsevier Ltd. All rights reserved.
Grob, Silvia; Bläuer, Cornelia; Frei, Irena Anna
Women with gynaecological cancer face various physical, social and emotional challenges concerning their health. Existing research shows that case management can improve patient satisfaction and reduce readmission rates. Although nurse case management was introduced on a gynaecological oncology unit in a Swiss university hospital in 2013, little is known about the experiences of female patients on a unit that uses this model of care. The aims were to explore women's experiences and to gain deeper understanding about hospital-based nurse case management on a gynaecological oncology unit and to qualitatively evaluate the concept of nurse case management. Sound research knowledge suggests that experiences are best explored with a qualitative research design. Ten participant interviews were conducted and inductively analysed between September 2014 and May 2015 as described by the thematic analysis method. Ethical approval was obtained, and the women signed a consent form. The first theme was named continuous relationship, with the nurse case manager as contact person and trusted partner. Study participants explained that friendliness and being present were essential qualities of nurse case management. Secondly, an essential support for women dealing with the situation of gynaecological cancer was described in the theme sharing information. The organisation of rehabilitation and other services by the nurse case management defined the third theme coordinating care. Trust was seen as the basis of the continuous relationship, marked by friendliness and presence of the nurse case manager. The helpful approach of persons practicing nurse case management made dealing with the situation of illness easier for women with gynaecological cancer. Coordination of information between the nurse case management and other healthcare services could be improved. Further evaluation is suggested to explore effects of the concept on family members. © 2017 Nordic College of Caring Science.
Park, Mihyun; Cho, Sung-Hyun; Hong, Hyun-Ja
To identify the prevalence and perpetrators of workplace violence against nurses and to examine the relationship of work demands and trust and justice in the workplace with the occurrence of violence. This study employed cross-sectional data from a 2013 nurse survey conducted at a university hospital in Seoul, South Korea. The study sample included 970 female nurses from 47 nursing units, including general, oncology, intensive care units (ICUs), operating rooms, and outpatient departments. The second version of the medium-sized Copenhagen Psychosocial Questionnaire (COPSOQ II) was used to measure work demands (i.e., quantitative demands, work pace, and emotional demands), trust and justice, and violence. Relationships among those variables were examined by conducting multiple logistic regression analyses with multilevel modeling. The 12-month prevalence of verbal abuse (63.8%) was highest, followed by threats of violence (41.6%), physical violence (22.3%), and sexual harassment (19.7%), but bullying had the lowest prevalence (9.7%). Physical violence, threats of violence, and verbal abuse occurred most frequently in ICUs, whereas sexual harassment and bullying were highest in operating rooms. The main perpetrators were patients, followed by physicians and patients' families. Nurses perceiving greater work demands and less trust and justice were more likely to have been exposed to violence. The prevalence and perpetrators of violence varied considerably among nursing units. Greater work demands and less trust and justice were associated with nurses' experiences of violence. Adequate work demands and a trusted and just work environment may reduce violence against nurses. In return, reduction of violence will contribute to creating a better nursing work environment. © 2014 Sigma Theta Tau International.
Tchouaket, Eric; Dubois, Carl-Ardy; D'Amour, Danielle
The aim of this study was to assess the economic burden of nurse-sensitive adverse events in 22 acute-care units in Quebec by estimating excess hospital-related costs and calculating resulting additional hospital days. Recent changes in the worldwide economic and financial contexts have made the cost of patient safety a topical issue. Yet, our knowledge about the economic burden of safety of nursing care is quite limited in Canada in general and Quebec in particular. Retrospective analysis of charts of 2699 patients hospitalized between July 2008 - August 2009 for at least 2 days of 30-day periods in 22 medical-surgical units in 11 hospitals in Quebec. Data were collected from September 2009 to August 2010. Nurse-sensitive adverse events analysed were pressure ulcers, falls, medication administration errors, pneumonia and urinary tract infections. Descriptive statistics identified numbers of cases for each nurse-sensitive adverse event. A literature analysis was used to estimate excess median hospital-related costs of treatments with these nurse-sensitive adverse events. Costs were calculated in 2014 Canadian dollars. Additional hospital days were estimated by comparing lengths of stay of patients with nurse-sensitive adverse events with those of similar patients without nurse-sensitive adverse events. This study found that five adverse events considered nurse-sensitive caused nearly 1300 additional hospital days for 166 patients and generated more than Canadian dollars 600,000 in excess treatment costs. The results present the financial consequences of the nurse-sensitive adverse events. Government should invest in prevention and in improvements to care quality and patient safety. Managers need to strengthen safety processes in their facilities and nurses should take greater precautions. © 2017 John Wiley & Sons Ltd.
Full Text Available Background: Working at intensive care unit (ICU is one of the most difficult and taxing nursing specialties. It demands not only extensive knowledge and professional skills but also specific personality-temperamental dispositions. The aim of the study was to verify if type A behavior (TAB is a predictor of burnout and job satisfaction in ICU nurses and if this effect still exists after controlling for selected demographic and job characteristics. Material and Methods: The study group consisted of 99 nurses (77 women, aged 24–58 (mean (M = 32.33; standard deviation (SD = 8.81 working at ICU. The following tools were used: to measure TAB – Type A Behavior Survey BWZ by Wrzesniewski; job burnout – the Oldenburg Burnout Inventory OLBI by Demerouti et al.; and job satisfaction – the Job Satisfaction Scale by Zalewska. Results: The results of hierarchical regression analyses showed that after controlling for selected demographic and job characteristics, tendency for aggression was a predictor of higher exhaustion, disengagement and lower job satisfaction. Achievement striving and tendency to dominate were related to higher job satisfaction and lower exhaustion, respectively. Significant predictors of professional functioning were also: duty work system, place of living and gender. Conclusions: The results of the study confirmed that all 3 content features of TAB were significant predictors of job functioning of ICU nurses. They also indicate that considering TAB in the context of individual adjustment to the environment of the job at ICU would be a valuable direction for future research. Med. Pr. 2015;66(2:213–224
Carrillo-García, C; Ríos-Rísquez, M I; Martínez-Hurtado, R; Noguera-Villaescusa, P
The objective was to determine the work stress level among nursing staff in the Intensive Care Unit of a university hospital and to analyse its relationship with the various sociodemographic and working variables of the studied sample. A study was designed using a quantitative, descriptive and cross-sectional approach. The target population of the study was the nursing staff selected by non-random sampling. The instrument used was the Job Content Questionnaire. Data analysis was performed using SPSS 20. The mean, ranges and standard deviation for each of the variables were calculated. A bivariate analysis was also performed on the social and occupational variables of the sample. The participation rate was 80.90% (N=89). The mean of the Social support dimension was 3.13±0.397, for the Psychological demands at work dimension it was 3.10±0.384, with a mean of 2.96±0.436 being obtained for the Control over the work dimension. In the analysis of sociodemographic and work variables of the sample, only the professional category was significant, with nurses recording higher values in perception of job demands and control over their work compared to nursing assistants. In conclusion, there is a moderate perception of work stress in the analysed group of professionals. Among the sources of stress in the workplace was the low control in decision-making by practitioners, as well as the need to continually learn new things. On the other hand, the support received from colleagues is valued positively by the sample. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Montoya Tamayo, D P; Monsalve Ospina, T P; Forero Pulido, C
To comprehend the meaning nurses give to family confrontation, from their experiences while patients are in adult intensive care units in Medellin 2013. A qualitative research study was carried out using a phenomenological approach and theoretical convenience sampling of subjects was used. Interviews with open questions were conducted with nurses that worked in different intensive care units in the city of Medellin, with more than one year of experience in these units. The information was coded and categorised to perform the analysis, and some concept maps were created for the final report. This study showed that nurses focus their care on the critical patient and not on the patient's family. They considered that there is family confrontation when its members comprehend the processes that are carried out in the intensive care unit, and can contribute to the patient's care, while if families do not have confrontations, it is because they do not understand the process, or feel desperate or are absent. The interventions that nurses consider must be done to help in the family confrontation are: information, interdisciplinary support, visits, and companionship. For the nurses, family confrontation means that family members understand, comprehend, accept, know, bear and go on with the situation; therefore, they can make good decisions regarding the patient's care in the adult intensive care units. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Real, Kevin; Fay, Lindsey; Isaacs, Kathy; Carll-White, Allison; Schadler, Aric
This study utilizes systems theory to understand how changes to physical design structures impact communication processes and patient and staff design-related outcomes. Many scholars and researchers have noted the importance of communication and teamwork for patient care quality. Few studies have examined changes to nursing station design within a systems theory framework. This study employed a multimethod, before-and-after, quasi-experimental research design. Nurses completed surveys in centralized units and later in decentralized units ( N = 26 pre , N = 51 post ). Patients completed surveys ( N = 62 pre ) in centralized units and later in decentralized units ( N = 49 post ). Surveys included quantitative measures and qualitative open-ended responses. Patients preferred the decentralized units because of larger single-occupancy rooms, greater privacy/confidentiality, and overall satisfaction with design. Nurses had a more complex response. Nurses approved the patient rooms, unit environment, and noise levels in decentralized units. However, they reported reduced access to support spaces, lower levels of team/mentoring communication, and less satisfaction with design than in centralized units. Qualitative findings supported these results. Nurses were more positive about centralized units and patients were more positive toward decentralized units. The results of this study suggest a need to understand how system components operate in concert. A major contribution of this study is the inclusion of patient satisfaction with design, an important yet overlooked fact in patient satisfaction. Healthcare design researchers and practitioners may consider how changing system interdependencies can lead to unexpected changes to communication processes and system outcomes in complex systems.
Drury, Peta; McInnes, Elizabeth; Hardy, Jennifer; Dale, Simeon; Middleton, Sandy
The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence-based practice (EBP) and readiness for change. Overall Nurse Managers reported high-level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP. © 2015 John Wiley & Sons Australia, Ltd.
Ribeliene, Janina; Blazeviciene, Aurelija; Nadisauskiene, Ruta Jolanta; Tameliene, Rasa; Kudreviciene, Ausrele; Nedzelskiene, Irena; Macijauskiene, Jurate
Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety. We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses' and midwives' opinion about patient safety issues. The overall response rate in the survey was 100% (n = 233). The analysis of the dimensions of safety on the unit level showed that the respondents' most positive evaluations were in the Organizational Learning - Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions. On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork
Iheduru-Anderson, Kechinyere C; Wahi, Monika M
Successful transition to practice of internationally educated nurses (IENs) can critically affect quality of care. The aim of this study was to characterize the facilitators and barriers to transition of Nigerian IENs (NIENs) to the United States health care setting. Using a descriptive phenomenology approach, 6 NIENs were interviewed about their transitional experiences in the United States. Thematic methods were used for data analysis. The three major themes identified from the participants' stories were "fear/anger and disappointment" (FAD), "road/journey to success/overcoming challenges" (RJO), and "moving forward" (MF). The FAD theme predominated, including experiences of racism, bullying, and inequality. The RJO theme included resilience, and the MF theme encompassed personal growth. NIENs face personal and organizational barriers to adaptation, especially fear, anger and disappointment. Future research should seek to develop a model for optimal adaptation that focuses on improving both personal and organizational facilitators and decreasing barriers.
Garcia, Alessandra Bassalobre; Dellaroza, Mara Solange Gomes; Haddad, Maria do Carmo Lourenço; Pachemshy, Luiza Rita
This study aimed to reveal the main aspects of the work process and feelings of pleasure experienced by nursing technicians who work at an emergency unit in Paraná, Brazil. The theoretical basis is the psychodynamics of work. This is a qualitative and descriptive study. Data were collected and analyzed using a semi-structured interview and the content analysis technique. Subjects were selected using a snowball sampling. Important aspects of the work process were revealed such as the unpredictability of working in an emergency unit, the impact of team work, and the comprehensive care model as a precursor to humanized care. Pleasure originates from the acknowledgement of their work either by the working subject him/herself by patients or society; and from the team work, realized by the cooperation among professionals. Feelings of pleasure are linked to the acknowledgment of their work, which should be valued since gratification contributes to the psychological health of workers.
Epstein, Elizabeth Gingell; Sherman, Jessica; Blackman, Amy; Sinkin, Robert A
Effective provider-parent relationships are essential during critical illness when treatment decisions are complex, the environment is crowded and unfamiliar, and outcomes are uncertain. To evaluate the feasibility of daily Skype or FaceTime updates with parents of patients in the neonatal intensive care unit (NICU) and to assess the intervention's potential for improving parent-provider relationships. A pre/post mixed-methods approach was used. NICU parent participants received daily Skype or FaceTime updates for 5 days and completed demographic and feasibility surveys. Parents also completed Penticuff's Parents' Understanding survey before and after the intervention. Nurses and physicians completed feasibility surveys after each update. Twenty-six parents were enrolled and 15 completed the study. More than 90% of providers and parents perceived the intervention to be reliable and easy to use, and about 80% of parents and providers rated video and audio quality as either excellent or good. Frozen screens and missed updates due to scheduling problems were challenges. Two of the 4 subscores on the Parents' Understanding survey improved significantly. Qualitative data favor the intervention as meaningful for parents. Real-time videoconferencing via Skype or FaceTime is feasible for providing updates for parents when they cannot be present in the NICU and can be used to include parents in bedside rounds. Videoconferencing updates may improve relationships between parents and the health care team. ©2015 American Association of Critical-Care Nurses.
Full Text Available Background: Patient and parent satisfaction is a significant indicator for the evaluation of quality of care in healthcare systems. This study aimed to evaluate the effect of sociodemographic characteristics on the satisfaction of the parents of newborns admitted in neonatal intensive care units (NICUs in maternity and infant disease hospitals. Methods: This descriptive study was conducted on 113 mothers with infants admitted in the NICU of a state hospital in Turkey during April 1-September 30, 2013.Data were collected using sociodemographic questionnaire and Pediatric Quality of Life Inventory (PedsQL healthcare satisfaction scale. Data analysis was performed using descriptive statistics (mean and percentage, T-test, Mann-Whitney U test, and Kruskal-Wallis test. Results: In this study, mean score of maternal satisfaction with NICU services was 65.66±20.01. No statistically significant differences were observed between maternal age, PedsQL satisfaction subscales, and total score of satisfaction. Moreover, statistically significant associations were observed between the following variables: maternal training and total satisfaction, employment status and subscales of PedsQL, technical skills and general satisfaction, and social security status and emotional support. However, no statistically significant differences were observed between the sociodemographic characteristics of newborns, total score of satisfaction, and mean scores of PedsQL satisfaction subscales in mothers. Conclusion: According to the results of this study, level of maternal satisfaction with NICU services was higher than the international average. Therefore, it is recommended that NICU nurses offer sufficient emotional support for both mothers and neonates in this unit and allow mothers to stay with their infants during hospitalization. Furthermore, it is suggested that training programs be implemented on effective communication skills between nurses and patients.
Sveinsdóttir, Herdís; Blöndal, Katrín; Jónsdóttir, Heiður Hrund; Bragadóttir, Helga
NUMs' job description in Icelandic hospitals has been revised and now also includes managerial and financial responsibilities. To describe the actual work activities of nurse unit managers (NUMs) in surgical and internal medicine services as self-documented and reflected in their job description. Prospective exploratory study. The study's setting was the largest hospital in Iceland. Data were collected over 7 days from NUMs working on surgical and medical units with an activity diary listing five domains and 41 activities: 'management and planning' (seven activities), 'staff responsibility (seven activities), 'direct clinical work' (five activities), 'service' (12 activities) and 'other' (nine activities). The managers' spent most of their time within the 'other' domain (32% of their time), then the next significant amount of time on 'management and planning' and 'clinical nursing' (19%), and the least amount of time on 'service' (14%). All reported working on two or more activities simultaneously. NUMs made erroneous estimations approximately half of the time about the domain they spent most of their time in and their satisfaction with their work each day varied greatly. The work of NUMs is highly diverse, including undefined miscellaneous tasks and clinical work beyond their job description. © 2017 Nordic College of Caring Science.
Wang, Wenru; Kong, Amelia Wai Man; Chair, Sek Ying
The aim of this study is to explore the relationship between job stress and coping strategies of Hong Kong nurses working in an acute surgical unit. This is a descriptive correlational study. Data were collected from 98 Hong Kong surgical nurses using the Nursing Stress Scale and the Jalowiec Coping Scale. Results showed that workload (M = 15.36), lack of support (M = 13.32), and inadequate preparation (M = 12.33) are the most common stressors for Hong Kong surgical nurses. The most frequent strategies used by nurses to cope with stress can be characterized as evasive (M = 19.23), confrontive (M = 17.46), and optimistic (M = 15.81), all of which are also rated as the most effective strategies in reducing stress levels. Only the confrontive, optimistic, supportant, and emotive coping strategies reveal significant correlations (p stress levels of nurses, whereas the evasive, fatalistic, palliative, and self-reliant strategies showed no significant correlation with stress levels (p > .05). Recognizing the impacts of job-related stress and making use of effective coping methods play a vital role in reducing nurse's stress. A change in leadership styles from the managerial level and reallocation of manpower may help reduce job stress. The use of confrontive and optimistic coping strategies in reducing job-related stress for surgical nurses should be advocated and promoted in their daily work. Copyright © 2011 Elsevier Inc. All rights reserved.
Siirala, Eriikka; Peltonen, Laura-Maria; Lundgrén-Laine, Heljä; Salanterä, Sanna; Junttila, Kristiina
To describe the tactical and the operational decisions made by nurse managers when managing the daily unit operation in peri-operative settings. Management is challenging as situations change rapidly and decisions are constantly made. Understanding decision-making in this complex environment helps to develop decision support systems to support nurse managers' operative and tactical decision-making. Descriptive cross-sectional design. Data were collected from 20 nurse managers with the think-aloud method during the busiest working hours and analysed using thematic content analysis. Nurse managers made over 700 decisions; either ad hoc (n = 289), near future (n = 268) or long-term (n = 187) by nature. Decisions were often made simultaneously with many interruptions. Ad hoc decisions covered staff allocation, ensuring adequate staff, rescheduling surgical procedures, confirmation tangible resources and following-up the daily unit operation. Decisions in the near future were: planning of surgical procedures and tangible resources, and planning staff allocation. Long-term decisions were: human recourses, nursing development, supplies and equipment, and finances in the unit. Decision-making was vulnerable to interruptions, which sometimes complicated the managing tasks. The results can be used when planning decision support systems and when defining the nurse managers' tasks in peri-operative settings. © 2016 John Wiley & Sons Ltd.
Patey, Andrea M; Curran, Janet A; Sprague, Ann E; Francis, Jill J; Driedger, S Michelle; Légaré, France; Lemyre, Louise; Pomey, Marie-Pascale A; Grimshaw, Jeremy M
Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA. We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses' behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social
Monroe, Todd; Pearson, Frances
For more than a century, the US nursing profession has been aware of substance abuse problems among its practitioners and student nurses but has generally dealt with the issue by taking disciplinary action rather than pursuing nonpunitive options. The latter course would allow more healthcare providers, following successful rehabilitation, to…
Da Silva Britto, Eliane; Pimenta Carvalho, Ana Maria
Based on Lazarus and Folkman’s theory about stress and coping, this research aimed at answering questions related to how nurses, who work in two specialized units of a general hospital, evaluate their working environment, their health and how they manage with stressing situations. In the unit of infectious diseases, the nurses’ evaluation of their working environment did not surpass the limits of what is considered as acceptable. In the unit of hematological alterations, the results showed hi...
Graves, Janessa M; Postma, Julie; Katz, Janet R; Kehoe, Leanne; Swalling, Eileen; Barbosa-Leiker, Celestina
Among research-focused nursing doctoral (PhD) programs in the United States, the traditional dissertation format has recently given way to a series of publication-ready manuscripts, often bookended by introduction and conclusion chapters. To help programs make decisions about the use of these formats, this study undertook a national survey of programs offering PhDs in nursing. The purpose of this study was to explore the advantages and disadvantages of the traditional format versus manuscript option for dissertations among nursing PhD programs in the United States. Cross-sectional census survey of U.S. nursing PhD programs. A web-based survey was administered to all U.S. nursing PhD programs. Respondents indicated formats offered, factors contributing to decisions of which formats to offer, and lessons learned. Descriptive statistics and inductive content analyses were used for analysis. Of 121 eligible institutions, 79 provided eligible responses (66.7%). The majority (59%) offered both formats; 11% offered the manuscript option only, and 24% offered the traditional format only. Faculty support (or lack thereof) contributed to adoption (or not) of the manuscript option. Respondents' approaches to the manuscript option (e.g., number of papers) and advice are summarized. Manuscript option dissertations are commonly offered and provide benefits to students and faculty; however, thoughtful implementation is critical. Programs need to agree upon clear expectations and have graduate school support (e.g., formatting). Faculty need mentorship in advising manuscript option students who choose to use this format, and the time and support. Finally, students need additional writing skills that could be provided through coursework or via individual work with mentors. As nursing education continues to expand further into doctoral research, programs must examine dissertation formats in order to both prepare future nurse scholars and disseminate nursing research that is critical
Farzi, Sedigheh; Moladoost, Azam; Bahrami, Masoud; Farzi, Saba; Etminani, Reza
One of the goals of nursing is providing safe care, prevention of injury, and health promotion of patients. Patient safety in intensive care units is threatened for various reasons. This study aimed to survey patient safety culture from the perspective of nurses in intensive care units. This cross-sectional study was conducted in 2016. Sampling was done using the convenience method. The sample consisted of 367 nurses working in intensive care units of teaching hospitals affiliated to Isfahan University of Medical Sciences. Data collection was performed using a two-part questionnaire that included demographic and hospital survey on Patient Safety Culture (HSOPSC) questionnaire. Data analysis was done using descriptive statistics (mean and standard deviation). Among the 12 dimensions of safety culture, the nurses assigned the highest score to "team work within units" (97.3%) and "Organizational learning-continuous improvement" (84%). They assigned the least score to "handoffs and transitions"(21.1%), "non-punitive response to errors" (24.7%), "Staffing" (35.6%), "Communication openness" (47.5%), and "Teamwork across units" (49.4%). The patient safety culture dimensions have low levels that require adequate attention and essential measures of health care centers including facilitating teamwork, providing adequate staff, and developing a checklist of handoffs and transitions. Furthermore, to increase reporting error and to promote a patient safety culture in intensive care units, some strategies should be adopted including a system-based approach to deal with the error.
Welch, Martha G; Hofer, Myron A; Stark, Raymond I; Andrews, Howard F; Austin, Judy; Glickstein, Sara B; Ludwig, Robert J; Myers, Michael M
While survival rates for preterm infants have increased, the risk for adverse long-term neurodevelopmental and behavioral outcomes remains very high. In response to the need for novel, evidence-based interventions that prevent such outcomes, we have assessed Family Nurture Intervention (FNI), a novel dual mother-infant intervention implemented while the infant is in the Neonatal Intensive Care Unit (NICU). Here, we report the first trial results, including the primary outcome measure, length of stay in the NICU and, the feasibility and safety of its implementation in a high acuity level IV NICU. The FNI trial is a single center, parallel-group, randomized controlled trial at Morgan Stanley Children's Hospital for mothers and their singleton or twin infants of 26-34 weeks gestation. Families were randomized to standard care (SC) or (FNI). FNI was implemented by nurture specialists trained to facilitate affective communication between mother and infant during specified calming interactions. These interactions included scent cloth exchange, sustained touch, vocal soothing and eye contact, wrapped or skin-to-skin holding, plus family-based support interactions. A total of 826 infants born between 26 and 34 weeks during the 3.5 year study period were admitted to the NICU. After infant and mother screening plus exclusion due to circumstances that prevented the family from participating, 373 infants were eligible for the study. Of these, we were unable to schedule a consent meeting with 56, and consent was withheld by 165. Consent was obtained for 150 infants from 115 families. The infants were block randomized to groups of N = 78, FNI and N = 72, SC. Sixteen (9.6%) of the randomized infants did not complete the study to home discharge, 7% of those randomized to SC and 12% of FNI infants. Mothers in the intervention group engaged in 3 to 4 facilitated one- to two-hour sessions/week. Intent to treat analyses revealed no significant difference between groups in
Coombs, Maureen; Fulbrook, Paul; Donovan, Sarah; Tester, Rachel; deVries, Kay
With end-of-life (EOL) central to the nursing role in intensive care, few studies have been undertaken to explore EOL care in the context of New Zealand (NZ) intensive care nursing. To investigate NZ intensive care nurses' experiences of, and attitudes towards EOL care. Sequential mixed methods study using cross sectional survey with follow-on focus groups. NZ intensive care nurses (N=465) across four large tertiary intensive care units (ICUs) were contacted to complete a 43-item web-based survey. A follow-on focus group was conducted in each of the sites to explore specific aspects of the survey findings. 203 fully completed surveys were returned (response rate 44%) from the four ICUs. Over half of nurses surveyed (55%, n=111) disagreed that withholding and withdrawing life support treatment were ethically the same. 78% (n=159) of nurses stated that withholding treatment was ethically more acceptable than withdrawing it. Whilst nurses generally supported reducing inspired oxygen to air for ventilated patients at EOL (71%, n=139) this was also an area that demonstrated one of the highest levels of uncertainty (21%, n=41). Just under a quarter of respondents were also uncertain about the use of continued nutritional support, continued passive limb exercises and use of deep sedation during EOL. The 18 nurses who participated in follow-on focus groups detailed the supportive, culturally sensitive, collaborative environment that EOL was conducted in. However diverse opinions and understandings were held on the use of passive limb and use of fluids at EOL. Whilst results from this NZ study broadly align with European studies, uncertainty about specific areas of EOL practices highlight that further guidance for nurses is required. Copyright © 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid
To evaluate and adjust systematic implementation of guided family-centred care in a neonatal intensive care unit. Family-centred care is valued in neonatal intensive care units internationally, but innovative strategies are needed to realise the principles. Guided family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication. Qualitative and quantitative data were used to monitor participatory implementation of a systematic approach to training and certification of nurses delivering guided family-centred care. Systematic implementation of guided family-centred care included workshops, supervised delivery and certification. Evaluation and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders and nonguided-family-centred-care-trained nurses. An adjusted framework for guided family-centred care implementation was successful in overcoming barriers and promoting facilitators. Insights gained from our pioneering work might help nurses in a similar context to reach their goals of improving family-centred care. © 2014 John Wiley & Sons Ltd.
Watkins, Terri; Whisman, Lynn; Booker, Pamela
Evaluate continuous vital sign surveillance as a tool to improve patient safety in the medical/surgical unit. Failure-to-rescue is an important measure of hospital quality. Patient deterioration is often preceded by changes in vital signs. However, continuous multi-parameter vital sign monitoring may decrease patient safety with an abundance of unnecessary alarms. Prospective observational study at two geographically disperse hospitals in a single hospital system. A multi-parameter vital sign monitoring system was installed in a medical/surgical unit in Utah and one in Alabama providing continuous display of SpO2, heart rate, blood pressure and respiration rate on a central station. Alarm thresholds and time to alert annunciations were set based on prior analysis of the distribution of each vital sign. At the end of 4 weeks, nurses completed a survey on their experience. An average alert per patient, per day was determined retrospectively from the saved vital signs data and knowledge of the alarm settings. Ninety-two per cent of the nurses agreed that the number of alarms and alerts were appropriate; 54% strongly agreed. On average, both units experienced 10·8 alarms per patient, per day. One hundred per cent agreed the monitor provided valuable patient data that increased patient safety; 79% strongly agreed. Continuous, multi-parameter patient monitoring could be performed on medical/surgical units with a small and appropriate level of alarms. Continuous vital sign assessment may have initiated nursing interventions that prevented failure-to-rescue events. Nurses surveyed unanimously agreed that continuous vital sign surveillance will help enhance patient safety. Nursing response to abnormal vital signs is one of the most important levers in patient safety, by providing timely recognition of early clinical deterioration. This occurs through diligent nursing surveillance, involving assessment, interpretation of data, recognition of a problem and meaningful
Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth
experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing...
Welch Martha G
Full Text Available Abstract Background The stress that results from preterm birth, requisite acute care and prolonged physical separation in the Neonatal Intensive Care Unit (NICU can have adverse physiological/psychological effects on both the infant and the mother. In particular, the experience compromises the establishment and maintenance of optimal mother-infant relationship, the subsequent development of the infant, and the mother's emotional well-being. These findings highlight the importance of investigating early interventions that are designed to overcome or reduce the effects of these environmental insults and challenges. Methods This study is a randomized controlled trial (RCT with blinded assessment comparing Standard Care (SC with a novel Family Nurture Intervention (FNI. FNI targets preterm infants born 26-34 weeks postmenstrual age (PMA and their mothers in the NICU. The intervention incorporates elements of mother-infant interventions with known efficacy and organizes them under a new theoretical context referred to collectively as calming activities. This intervention is facilitated by specially trained Nurture Specialists in three ways: 1 In the isolette through calming interactions between mother and infant via odor exchange, firm sustained touch and vocal soothing, and eye contact; 2 Outside the isolette during holding and feeding via the Calming Cycle; and 3 through family sessions designed to engage help and support the mother. In concert with infant neurobehavioral and physiological assessments from birth through 24 months corrected age (CA, maternal assessments are made using standard tools including anxiety, depression, attachment, support systems, temperament as well as physiological stress parameters. Quality of mother-infant interaction is also assessed. Our projected enrolment is 260 families (130 per group. Discussion The FNI is designed to increase biologically important activities and behaviors that enhance maternally
Welch, Martha G; Hofer, Myron A; Brunelli, Susan A; Stark, Raymond I; Andrews, Howard F; Austin, Judy; Myers, Michael M
The stress that results from preterm birth, requisite acute care and prolonged physical separation in the Neonatal Intensive Care Unit (NICU) can have adverse physiological/psychological effects on both the infant and the mother. In particular, the experience compromises the establishment and maintenance of optimal mother-infant relationship, the subsequent development of the infant, and the mother's emotional well-being. These findings highlight the importance of investigating early interventions that are designed to overcome or reduce the effects of these environmental insults and challenges. This study is a randomized controlled trial (RCT) with blinded assessment comparing Standard Care (SC) with a novel Family Nurture Intervention (FNI). FNI targets preterm infants born 26-34 weeks postmenstrual age (PMA) and their mothers in the NICU. The intervention incorporates elements of mother-infant interventions with known efficacy and organizes them under a new theoretical context referred to collectively as calming activities. This intervention is facilitated by specially trained Nurture Specialists in three ways: 1) In the isolette through calming interactions between mother and infant via odor exchange, firm sustained touch and vocal soothing, and eye contact; 2) Outside the isolette during holding and feeding via the Calming Cycle; and 3) through family sessions designed to engage help and support the mother. In concert with infant neurobehavioral and physiological assessments from birth through 24 months corrected age (CA), maternal assessments are made using standard tools including anxiety, depression, attachment, support systems, temperament as well as physiological stress parameters. Quality of mother-infant interaction is also assessed. Our projected enrolment is 260 families (130 per group). The FNI is designed to increase biologically important activities and behaviors that enhance maternally-mediated sensory experiences of preterm infants, as well as
Li, Xiao-Ying; Lee, Shoo; Yu, Hua-Feng; Ye, Xiang Y; Warre, Ruth; Liu, Xiang-Hong; Liu, Jian-Hong
Denying parents access to their infant in the Neonatal Intensive Care Unit (NICU) is a standard practice in most hospitals across China. Visitation is not usually permitted or may be strictly limited, and NICU care for most neonates is provided by health-care professionals with little participation of the parents. An exception to this rule is the level 2 "Room-In" ward in Qilu Children's Hospital, Shandong University, where parents have 24-hour access to their infants and participate in providing care. This retrospective cohort study compared the outcomes of infants who were admitted to the NICU and remained there throughout their stay (NICU-NICU group, n=428), admitted to the NICU and then transferred to the Room-In ward (NICU-RIn group, n=1018), or admitted straight to the Room-In ward (RIn only group, n=629). There were no significant differences in the rates of nosocomial infection, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity between the NICU-NICU and NICU-RIn groups. The rate of necrotizing enterocolitis was significantly lower in the NICU-RIn group (P=0.04), while weight gain and duration of hospital stay were significantly higher (both Pneonatal care in China.
Full Text Available Background and Objectives: High prevalence of work-related musculoskeletal disorders, especially in jobs such as nursing which covers tasks like patients' repositioning, has attracted great attentions from occupational healthcare experts to necessitate the knowledge of ergonomic science. Therefore, this study was performed aiming at ergonomic relationship during work in nursing staff of Intensive Care Unit (ICU with operating room. Materials and Methods: In this descriptive-analytical study (cohort, fifty personnel of ICU staff and fifty of operating room staff were selected through a census method and were assessed using tools such as Nordic questionnaire and Rapid Entire Body Assessment (REBA standards in terms of body posture ergonomics. The obtained data were analyzed by SPSS software and Chi-Square test after collection. Results: The most complaints were from the operating room group (68% and ICU staff (60% for the lumbar musculoskeletal system. There was a significant relationship between the total REBA scores of body, legs, neck, arm, force status, load fitting with hands and static or dynamic activities in the operating room and ICU staff groups (P < 0.05. In operating room and ICU groups, most subjects obtained score 11–15 and very high-risk level. Conclusion: Nurses working at operating room and ICU ward are subjected to high-risk levels and occupational injuries which is dramatically resulted from inappropriate body posture or particular conditions of their works. As a result, taking corrective actions along with planning and identifying ways will help prohibiting the prevalence of disorders in the future.
Kadivar, Maliheh; Mosayebi, Ziba; Asghari, Fariba; Zarrini, Pari
The challenging nature of neonatal medicine today is intensified by modern advances in intensive care and treatment of sicker neonates. These developments have caused numerous ethical issues and conflicts in ethical decision-making. The present study surveyed the challenges and dilemmas from the viewpoint of the neonatal intensive care personnel in the teaching hospitals of Tehran University of Medical Sciences (TUMS) in the capital of Iran. In this comparative cross-sectional study conducted between March 2013 and February 2014, the physicians' and nurses' perceptions of the ethical issues in neonatal intensive care units were compared. The physicians and nurses of the study hospitals were requested to complete a 36-item questionnaire after initial accommodations. The study samples consisted of 284 physicians (36%) and nurses (64%). Content validity and internal consistency calculations were used to examine the psychometric properties of the questionnaire. Data were analyzed by Pearson's correlation, t-test, ANOVA, and linear regression using SPSS v. 22. Respecting patients' rights and interactions with parents were perceived as the most challenging aspects of neonatal care. There were significant differences between sexes in the domains of the perceived challenges. According to the linear regression model, the perceived score would be reduced 0.33 per each year on the job. The results of our study showed that the most challenging issues were related to patients' rights, interactions with parents, communication and cooperation, and end of life considerations respectively. It can be concluded, therefore, that more attention should be paid to these issues in educational programs and ethics committees of hospitals.
Mack, Deborah S; Epstein, Mara M; Dubé, Catherine; Clark, Robin E; Lapane, Kate L
United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening. Copyright © 2018 Elsevier Inc. All rights reserved.
Zhang, Xiao-Chun; Huang, De-Sheng; Guan, Peng
Objectives The shortage of qualified nurses is one of the critical challenges in the field of healthcare. Among the contributing factors, job burnout has been indicated as a risk factor for the intention to leave. The purpose of this study was to provide a better understanding of the local status and reference data for coping strategies for intensive care unit (ICU)-nurse burnout among Liaoning ICU nurses. Design Observational study. Setting 17 ICUs from 10 tertiary-level hospitals in Liaoning, China. Participants 431 ICU nurses from 14 ICUs nested in 10 tertiary-level hospitals in Liaoning, China, were invited during October and November 2010. Primary measures Burnout was measured using the 22-item Chinese version of Maslach Burnout Inventory-Health Service Survey (MBI-HSS) questionnaires. Results 14 ICUs responded actively and were included; the response rate was 87.7% among the 486 invited participants from these 17 ICUs. The study population was a young population, with the median age 25 years, IQR 23–28 years and female nurses accounted for the major part (88.5%). 68 nurses (16%) were found to have a high degree of burnout, earning high emotional exhaustion and depersonalisation scores together with a low personal accomplishment score. Conclusions The present study indicated a moderate distribution of burnout among ICU nurses in Liaoning, China. An investigation into the burnout levels of this population could bring more attention to ICU caregivers. PMID:24948747
Full Text Available Background: Cytomegalovirus is the most prevalent cause of congenital infections and the most important cause of congenital deafness. Which it's spread is about 0.64% of all birth which differ based on geolocation, race and socioeconomically situations. This proposal accomplished in the end of July until middle of February 2014 with the goal of studying Cytomegalovirus infection distribution among newborns who are hospitalized in Bushehr Shohadaye Khalij Fars hospital NICU. Material & Method: 80 urine samples were collected between July until February 2014 in NICU of Bushehr Khalij Fars hospitalized neonates. Samples were tested by PCR method on urine samples to find if they are infected by cytomegalovirus. Results: Mean age of neonates was 30.59±9.30 days. Only one newborn under 30 days had Cytomegalovirus and 11 cases older than 30 days had positive reaction. The relation between age and CMV seropositivity was statistically valid (p<0.05.this means only 1.2% of newborns are CMV and 55% are older than 1 month. Conclusion: The pattern of CMV seropositivity shows that most infections may be acquired from environment. According to low prevalence of congenital CMV infection, there is no need to introduce preventive methods and following present guidelines is enough.
Maria Francisca Colella-Santos
Full Text Available The aim was to describe the outcome of neonatal hearing screening (NHS and audiological diagnosis in neonates in the NICU. The sample was divided into Group I: neonates who underwent NHS in one step and Group II: neonates who underwent a test and retest NHS. NHS procedure was automated auditory brainstem response. NHS was performed in 82.1% of surviving neonates. For GI, referral rate was 18.6% and false-positive was 62.2% (normal hearing in the diagnostic stage. In GII, with retest, referral rate dropped to 4.1% and false-positive to 12.5%. Sensorineural hearing loss was found in 13.2% of infants and conductive in 26.4% of cases. There was one case of auditory neuropathy spectrum (1.9%. Dropout rate in whole process was 21.7% for GI and 24.03% for GII. We concluded that it was not possible to perform universal NHS in the studied sample or, in many cases, to apply it within the first month of life. Retest reduced failure and false-positive rate and did not increase evasion, indicating that it is a recommendable step in NHS programs in the NICU. The incidence of hearing loss was 2.9%, considering sensorineural hearing loss (0.91%, conductive (1.83% and auditory neuropathy spectrum (0.19%.
Saiede Masomeh Tabaeian
Full Text Available Introduction: Ventilator-associated pneumonia (VAP is the most common infection in the intensive care unit, and has many side effects such as increased mortality, increased length of hospital stay, and increased health costs. This study aimed to evaluate the compliance with the standards for prevention of VAP by nurses in the intensive care units. Materials and Methods: In this descriptive cross-sectional study, 120 nurses in 11 intensive care units of hospitals affiliated to Isfahan university of Medical Sciences, Iran, were assessed for 4 months from July to October 2014. The implementation of all measures for the prevention of VAP was investigated through observation and using a checklist. Results: The mean compliance with the standards for the prevention of VAP in the intensive care unit by the nurses was 56.32%; analysis of variance test showed significant difference between the hospitals (P < 0.001. Disposable ventilator circuit was performed for all patients; however, reviewing the patient readiness for separation from the ventilator was not conducted on a daily basis. Conclusions: Compliance with the standards for the prevention of VAP in the intensive care units was relatively acceptable; however, it still requires serious attention by the officials with training and sensitization of nurses in implementing preventive measures, especially through the provision of clinical guidelines and related protocols.
Ríos Rísquez, M Isabel; Martínez Cano, Fuensanta; Sabuco Tebar, Emiliana; Lozano Alguacil, Ester; Mateo Perea, Ginés
To determine whether the intent of career mobility is associated with the frequency of job stressors and burnout syndrome experienced by emergency nurses. to assess perceived frequency of job stressors and burnout syndrome prevalence and its possible association with demographic and occupational values of the sample analyzed. We performed a cross-sectional study. We used a survey of sociodemographic and occupational variables, and two validated questionnaires: the "Nursing Stress Scale" validated by Escriba et al. (1999) and the Inventory to assess Burnout Syndrome (MBI-GS, Schaufeli et al., 1996). The total Stress score mean was 32.88 +/- 12.67. There was a Burnout prevalence of 2.34%, while 23.4% of the sample expressed high levels of cynicism/depersonalization. The frequency of job stressors was significantly associated with burnout syndrome dimensions. The frequency of stressors and intention of career mobility were significant predictors of emotional exhaustion and cynicism, while the fixed night shift was associated with lower professional efficacy. This study shows a moderate frequency of job stressors in the unit analyzed, and a low prevalence of Burnout Syndrome. The intention to leave or career mobility is an important predictor of burnout process, so it should be something to take into account by human resource managers, in order to prevent the development of the burnout process in health organizations.
Vega, Paula Vega; Rodriguez, Rina González; Galdamez, Natalie Santibáñez; Molina, Camila Ferrada; Orellana, Javiera Spicto; Villanueva, Antonia Sateler; Melo, Jose Bustos
Objective To know the levels of Burnout Syndrome and perception of grief support in nursing teams of oncology and pediatric intensive care in public hospitals in Chile. Method A study of descriptive cross-sectional design. The Maslach Burnout Inventory and the Grief Support Health Care Scale were applied to university-level and technical nursing professionals between March and November 2015. An analysis to compare the means was performed with use of the Student's t-test, and the level of significance was set at 5%. Results The study included 153 professionals. Results show 4% of professionals have Burnout Syndrome (BS) and 89% are at risk of having it. Oncology professionals are at higher risk as they present higher levels of emotional exhaustion and lower levels of personal fulfillment. Half of professionals have a high level of perception of grief support, which is greater in the oncology team. Conclusion Professionals working in pediatric oncology units are at increased risk of Burnout Syndrome and grief support may be a mediating factor in this process.
Rassouli, Maryam; Zamanzadeh, Vahid; Ghahramanian, Akram; Abbaszadeh, Abbas; Alavi-Majd, Hamid; Nikanfar, Alireza
Although nurses acknowledge that spiritual care is part of their role, in reality, it is performed to a lesser extent. The purpose of the present study was to explore nurses' and patients' experiences about the conditions of spiritual care and spiritual interventions in the oncology units of Tabriz. This study was conducted with a qualitative conventional content analysis approach in the oncology units of hospitals in Tabriz. Data were collected through purposive sampling by conducting unstructured interviews with 10 patients and 7 nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control. Three categories emerged from the study: (1) "perceived barriers for providing spiritual care" including "lack of preparation for spiritual care," "time and space constraints," "unprofessional view," and "lack of support"; (2) "communication: A way for Strengthening spirituality despite the limitations" including "manifestation of spirituality in the appearances and communicative behaviors of nurses" and "communication: Transmission of spiritual energy"; and (3) "religion-related spiritual experiences" including "life events as divine will and divine exam," "death as reincarnation," "trust in God," "prayer/recourse to Holy Imams," and "acceptance of divine providence." Although nurses had little skills in assessing and responding to the patients' spiritual needs and did not have the organizational and clergymen's support in dealing with the spiritual distress of patients, they were the source of energy, joy, hope, and power for patients by showing empathy and compassion. The patients and nurses were using religious beliefs mentioned in Islam to strengthen the patients' spiritual dimension. According to the results, integration of spiritual care in the curriculum of nursing is recommended. Patients and nurses can benefit from organizational and clergymen's support to cope with spiritual distress. Researchers should
D'Amour, Danielle; Dubois, Carl-Ardy; Tchouaket, Eric; Clarke, Sean; Blais, Régis
Ensuring the safety of hospitalized patients remains a major challenge for healthcare systems, and nursing services are at the center of hospital care. Yet our knowledge about safety of nursing care is quite limited. In fact, most earlier studies examined one, or at most two, indicators, thus presenting an incomplete picture of safety at an institutional or broader level. Furthermore, methodologies have differed from one study to another, making benchmarking difficult. The aim of this study was to describe the frequencies of six adverse events widely considered in the literature to be nursing-sensitive outcomes and to estimate the degree to which these events could be attributed to nursing care. Cross-sectional review of charts of 2699 patients hospitalized on 22 medical units in 11 hospitals in Quebec, Canada. The events included: pressure sores, falls, medication administration errors, pneumonias, urinary infections, and inappropriate use of restraints. Experienced nurse reviewers abstracted patients' charts based on a grid developed for the study. Patient-level risk for at least one of these six adverse events was 15.3%, ranging from 9% to 28% across units. Of the 412 patients who experienced an event, 30% experienced two or more, for a total of 568 events. The risk of experiencing an adverse event with consequences was 6.2%, with a unit-level range from 3.2% to 13.5%. Abstractors concluded that 76.8% of the events were attributable to nursing care. While the measurement approach adopted here has limitations stemming from reliance on review of documentation, it provided a practical means of assessing several nursing-sensitive adverse events simultaneously. Given that patient safety issues are so complex, tracking their prevalence and impact is important, as is finding means of evaluating progress in reducing them. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.
Spooner, Amy J; Aitken, Leanne M; Corley, Amanda; Chaboyer, Wendy
Despite increasing demand for structured processes to guide clinical handover, nursing handover tools are limited in the intensive care unit. The study aim was to identify key items to include in a minimum dataset for intensive care nursing team leader shift-to-shift handover. This focus group study was conducted in a 21-bed medical/surgical intensive care unit in Australia. Senior registered nurses involved in team leader handovers were recruited. Focus groups were conducted using a nominal group technique to generate and prioritise minimum dataset items. Nurses were presented with content from previous team leader handovers and asked to select which content items to include in a minimum dataset. Participant responses were summarised as frequencies and percentages. Seventeen senior nurses participated in three focus groups. Participants agreed that ISBAR (Identify-Situation-Background-Assessment-Recommendations) was a useful tool to guide clinical handover. Items recommended to be included in the minimum dataset (≥65% agreement) included Identify (name, age, days in intensive care), Situation (diagnosis, surgical procedure), Background (significant event(s), management of significant event(s)) and Recommendations (patient plan for next shift, tasks to follow up for next shift). Overall, 30 of the 67 (45%) items in the Assessment category were considered important to include in the minimum dataset and focused on relevant observations and treatment within each body system. Other non-ISBAR items considered important to include related to the ICU (admissions to ICU, staffing/skill mix, theatre cases) and patients (infectious status, site of infection, end of life plan). Items were further categorised into those to include in all handovers and those to discuss only when relevant to the patient. The findings suggest a minimum dataset for intensive care nursing team leader shift-to-shift handover should contain items within ISBAR along with unit and patient specific
Grøthe, Å; Biong, Stian; Grov, E K
Admission of a cancer patient to a palliative unit when near the final stage of their disease trajectory undoubtedly impacts their relatives. The aim of our study was to illuminate and interpret relatives' lived experiences of health personnel's provision of care in a palliative ward. A phenomenological/hermeneutic approach was employed that was inspired by the philosophical tradition of Heidegger and Ricoeur and further developed by Lindseth and Nordberg. The perspectives of the narrator and the text were interpreted by highlighting relatives' views on a situation in which they have to face existential challenges. The analysis was undertaken in three steps: naïve reading, structural analysis, and comprehensive understanding, including the authors' professional experiences and theoretical background. Six subthemes appeared: the dying person, the bubble, the sight, the cover, the provision for children's needs, and the availability of immediate help. These components were further constructed into three themes: the meaning of relating, the meaning of action, and the meaning of resources. Our comprehensive understanding of the results suggests that the most important theme is "acting with dedication and expertise." The following aspects are crucial for relatives of cancer patients hospitalized in a palliative ward: time and existence, family dynamics, and care adjusted to the situation. Our study results led to reflections on the impact of how nurses behave when providing care to patients during the palliative phase, and how they interact with relatives in this situation. We found that cancer patients in a palliative unit most appreciate nurses who act with dedication and expertise.
Full Text Available Background Although health services are designed and implemented to improve human health, the errors in health services are a very common phenomenon and even sometimes fatal in this field. Medical errors and their cost are global issues with serious consequences for the patients’ community that are preventable and require serious attention. Objectives The current study aimed to identify possible nursing errors applying human error identification in systems tool (HEIST in the intensive care units (ICUs of hospitals. Patients and Methods This descriptive research was conducted in the intensive care unit of a hospital in Khuzestan province in 2013. Data were collected through observation and interview by nine nurses in this section in a period of four months. Human error classification was based on Rose and Rose and Swain and Guttmann models. According to HEIST work sheets the guide questions were answered and error causes were identified after the determination of the type of errors. Results In total 527 errors were detected. The performing operation on the wrong path had the highest frequency which was 150, and the second rate with a frequency of 136 was doing the tasks later than the deadline. Management causes with a frequency of 451 were the first rank among identified errors. Errors mostly occurred in the system observation stage and among the performance shaping factors (PSFs, time was the most influencing factor in occurrence of human errors. Conclusions Finally, in order to prevent the occurrence and reduce the consequences of identified errors the following suggestions were proposed : appropriate training courses, applying work guidelines and monitoring their implementation, increasing the number of work shifts, hiring professional workforce, equipping work space with appropriate facilities and equipment.
Young-Mee Ahn, RN, PhD
Conclusion: Environmental modifications of the nursery setting, particularly its remote location to the NICU, could improve mothers' perception of full-term neonates. NICU mothers, as the principal care- givers, may suffer from culturally-grounded, psychoemotional disturbances after giving birth to a sick infant, which may not be applicable to fathers. The quality of family-centered care in the NICU environment, parental role alteration, and the condition of infants need to be improved to decrease parental stress in the NICU. Fathers may have significant potential in caring for mothers and sick infants during the transition to parenthood. Education for NICU parents should be done for both mothers and fathers in the acute postpartum period.
Spetz, Joanne; Ash, Michael; Konstantinidis, Charalampos; Herrera, Carolina
We estimate the impact of unionisation on the wage structure of hospital-employed registered nurses in the USA. We examine whether unions have an effect on wage differences associated with race, gender, immigration status, education and experience, as well as whether there is less unexplained wage variation among unionised nurses. In the past decade, there has been resurgence in union activity in the health care industry in the USA, particularly in hospitals. Numerous studies have found that unions are associated with higher wages. Unions may also affect the structure of wages paid to workers, by compressing the wage structure and reducing unexplained variation in wages. Cross-sectional analysis of pooled secondary data from the United States Current Population Survey, 2003-2006. Multivariate regression analysis of factors that predict wages, with models derived from labour economics. There are no wage differences associated with gender, race or immigration status among unionised nurses, but there are wage penalties for black and immigrant nurses in the non-union sector. For the most part, the pay structures of the union and non-union sectors do not significantly differ. The wage penalty associated with diploma education for non-union nurses disappears among unionised nurses. Unionised nurses receive a lower return to experience, although the difference is not statistically significant. There is no evidence that unexplained variation in wages is lower among unionised nurses. While in theory unions may rationalise wage-setting and reduce wage dispersion, we found no evidence to support this hypothesis. The primary effect of hospital unions is to raise wages. Unionisation does not appear to have other important wage effects among hospital-employed nurses. © 2010 Blackwell Publishing Ltd.
Darcy, Ashley E; Hancock, Lauren E; Ware, Emily J
To examine the baseline acoustic environment in several mid-Atlantic region neonatal intensive care units (NICUs) and investigate the perceived factors contributing to noise levels in these NICUs. Quantitative data were collected from 3 urban, mid-Atlantic level IIIB and level IIIC NICUs. Qualitative data were collected via interview from 2 RNs employed in each of the study NICUs. This was an exploratory descriptive study utilizing a mixed-methods approach. A quantitative method was used for sound-level data collection, and a qualitative method was utilized during interviews with nurses to examine perceptions of factors contributing to noise. Ambient sound levels, measured in decibels, were taken at 5-minute intervals over a 2-hour period during both day and night shifts in a central location at each NICU. In addition, nurses were interviewed using a standardized interview questionnaire, and these interviews were then reviewed to determine themes regarding perceived factors contributing to sound levels. Hourly mean sound levels in each NICU ranged from 53.9 dB to 60.6 dB, with no statistically significant difference between noise levels recorded on day shift versus night shift, and no statistically significant difference among sites. Qualitative data showed that nurses' believed day shift to be louder than night shift and many perceived their own NICU as "pretty quiet." Key contributing factors to increased sound levels were stated as monitors or alarms, performing invasive procedures, presence of family, nurses or doctors giving report or rounds, and ringing phones. Noise levels were found to be above the American Academy of Pediatrics-recommended 45-dB level and often louder than the 50-dB level, which should not be exceeded more than 10% of the time. The recommended impulse maximum of 65 dB was also exceeded. Environmental Protection Agency recommendations for hospitals include sound levels no louder than 35 dB on night shift; this standard was also violated
Darcy, Ashley E; Hancock, Lauren E; Ware, Emily J
To examine the baseline acoustic environment in several mid-Atlantic region neonatal intensive care units (NICUs) and investigate the perceived factors contributing to noise levels in these NICUs. Quantitative data were collected from 3 urban, mid-Atlantic level IIIB and level IIIC NICUs. Qualitative data were collected via interview from 2 RNs employed in each of the study NICUs. This was an exploratory descriptive study utilizing a mixed-methods approach. A quantitative method was used for sound-level data collection, and a qualitative method was utilized during interviews with nurses to examine perceptions of factors contributing to noise. Ambient sound levels, measured in decibels, were taken at 5-minute intervals over a 2-hour period during both day and night shifts in a central location at each NICU. In addition, nurses were interviewed using a standardized interview questionnaire, and these interviews were then reviewed to determine themes regarding perceived factors contributing to sound levels. Hourly mean sound levels in each NICU ranged from 53.9 dB to 60.6 dB, with no statistically significant difference between noise levels recorded on day shift versus night shift, and no statistically significant difference among sites. Qualitative data showed that nurses' believed day shift to be louder than night shift and many perceived their own NICU as "pretty quiet." Key contributing factors to increased sound levels were stated as monitors or alarms, performing invasive procedures, presence of family, nurses or doctors giving report or rounds, and ringing phones. Noise levels were found to be above the American Academy of Pediatrics--recommended 45-dB level and often louder than the 50-dB level, which should not be exceeded more than 10% of the time. The recommended impulse maximum of 65 dB was also exceeded. Environmental Protection Agency recommendations for hospitals include sound levels no louder than 35 dB on night shift; this standard was also violated
Prates, Daniele de Oliveira; Silva, Ana Elisa Bauer de Camargo
to analyze the interruptions experienced by nursing professionals while undertaking care activities. an observational study undertaken in two intensive care units. Two nurses observed 33 nursing professionals for three hours. The data were recorded in real time, using a semistructured instrument. after 99 hours of observation of 739 activities, it was identified that 46.82% were interrupted, resulting in 7.85 interruptions per hour. On average, the interruptions compromised 9.42% of the nursing professionals' worktime. The activities geared towards indirect care of the patient suffered the highest number of interruptions (56.65%), with the nursing records being the activity interrupted most. The principal source of the interruptions was external, coming from the health professionals (51%), and the main causes were those related to the patients (34.70%) and to interpersonal communication (26.47%). the activity of nursing suffers a high number of interruptions, mainly caused by the health professionals themselves, indicating that the work environment needs to undergo interventions aiming to reduce the risk of compromising of the professional's performance and to increase the patients' safety. analisar as interrupções experienciadas por profissionais de enfermagem durante realização de atividades assistenciais. estudo observacional realizado em duas unidades de tratamento intensivo. Dois enfermeiros observaram 33 profissionais de enfermagem, por três horas. Os dados foram registrados em tempo real, usando um instrumento semiestruturado. após 99 horas de observação de 739 atividades, foi identificado que 46,82% sofreram interrupções, perfazendo 7,85 interrupções por hora. As interrupções comprometeram, em média, 9,42% do tempo de trabalho dos profissionais de enfermagem. As atividades direcionadas ao cuidado indireto do paciente foram as que sofreram maior número de interrupções (56,65%), sendo o registro de enfermagem a atividade mais interrompida. A
Kim, Young Mee; Kang, Seung Wan; Kim, Se Young
This research was an empirical study designed to identify precursors and interaction effects related to nurses' patient identification behavior. A multilevel analysis methodology was used. A self-report survey was administered to registered nurses (RNs) of a university hospital in South Korea. Of the questionnaires, 1114 were analyzed. The individual-level factors that had a significantly positive association with patient identification behavior were person-organization value congruence, organizational commitment, occupational commitment, tenure at the hospital, and tenure at the unit. Significantly negative group-level precursors of patient identification behavior were burnout climate and the number of RNs. Two interaction effects of the person-organization value congruence climate were identified. The first was a group-level moderating effect in which the negative relationship between the number of RNs and patient identification behavior was weaker when the nursing unit's value congruence climate was high. The second was a cross-level moderating effect in which the positive relationship between tenure at the unit and patient identification behavior was weaker when value congruence climate was high. This study simultaneously tested both individual-level and group-level factors that potentially influence patient identification behavior and identified the moderating role of person-organization value congruence climate. Implications of these results are discussed.
Bartlett, Kenneth; Kang, Dae-seok
This study examines the relationship between employee attitudes towards training and organizational commitment among a sample of nurses in New Zealand and the United States. Results show that perceived access to training, training frequency, motivation to learn from training, benefits of training, and supervisory support for training were…
Mafuba, Kay; Gates, Bob; Cozens, Maria
The aim of this study was to explore how public health policy in the United Kingdom was reflected in community intellectual disability nurses' (CIDNs)' job descriptions and person's specifications. The role of CIDNs has evolved due to policy changes. As these roles evolve, job descriptions and person specifications are important in highlighting…
van der Putten, M. J. G.; Wetzels, R. B.; Bor, H.; Zuidema, S. U.; Koopmans, R. T. C. M.
Objectives: To assess the differences in antipsychotic drug prescription rates in residents with dementia in dementia special care units (SCUs) of Dutch nursing homes, considering the differences in patient characteristics. Method: As part of the Waalbed-II study, the data on antipsychotic drug use
Full Text Available Patient safety in the Neonatal Intensive Care Unit (NICU environment is an under-researched area, but recently seems to get high priority on the healthcare quality agenda worldwide. NICU, as a highly sensitive and technological driven environment, signals the importance for awareness in causation of mistakes and accidents. Adverse events and near misses that comprise the majority of human errors, cause morbidity often with devastating results, even death. Likewise in other organizations, errors causes are multiple and complex. Other high reliability organizations, such as air force and nuclear industry, offer examples of how standardized/homogenized work and removal of systems weaknesses can minimize errors. It is widely accepted that medical errors can be explained based on personal and/or system approach. The impact/effect of medical errors can be reduced when thorough/causative identification approach is followed by detailed analysis of consequences and prevention measures. NICU’s medical and nursing staff should be familiar with patient safety language, implement best practices, and support safety culture, maximizing efforts for reducing errors. Furthermore, top management commitment and support in developing patient safety culture is essential in order to assure the achievement of the desirable organizational safety outcomes. The aim of the paper is to review patient safety issues in the NICU environment, focusing on development and implementation of strategies, enhancing high quality standards for health care.
Nimbalkar, Archana S; Dongara, Ashish R; Phatak, Ajay G; Nimbalkar, Somashekhar M
Neonates receiving care in intensive care units are highly likely to experience pain due to investigations and/or treatments carried out by the health care providers. Neonates are a vulnerable population because they are unable to vocalize their pain. Unaddressed and mismanaged pain can not only affect the child's comfort, but also may alter the development and cognitive abilities of the child in a later part of his/her life. Therefore it is entirely the caregiver's responsibility to accurately assess and manage neonatal pain. We assessed and compared the knowledge and attitudes regarding neonatal pain among the nurses posted in the various units of a pediatric department [pediatric ward, pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU)]. An appropriately modified Knowledge and Attitudes Survey Regarding Pain questionnaire was consensually validated, pretested, and then administered to the nursing staff of the pediatric department at a department at a hospital in Gujarat. Data were entered in Epi-Info and analyzed with the use of SPSS 14.0. The questionnaire was administered to 41 nurses working in the Department of Pediatrics, and the response rate was 97.5%. Mean age of the nurses in the study sample was 25.75 years (SD 5.513). The mean total score of the participants was 8.75 out of 17 (SD 2.549), which was unsatisfactory. The mean correct answer rate was 49.67% among the staff of NICU and 48.67% among the pediatric ward and PICU staff. The attitudes among the nurses were assessed. It was concluded that the nurses lack knowledge and that their attitudes also were hindering pain management. One of the barriers identified by the nurses was that physicians do not prescribe analgesics for managing neonatal pain. So not only the nursing staff, but all of the caregivers involved in neonatal care may be lacking in knowledge and hold perceptions and attitudes that hamper neonatal pain management. Copyright © 2014 American Society for Pain
Al-Yateem, Nabeel; AlYateem, Sami; Rossiter, Rachel
A competent transcultural health care service has been identified as essential for the delivery of safe health care in the United Arab Emirates (UAE) and the Kingdom of Saudi Arabia (KSA) and indeed internationally. Delivery of contextually informed educational programs to new employees forms an important component of achieving this requirement. Nurse educators have an essential role in identifying the cultural and religious knowledge needed by new employees and in designing programs to address these needs. The objective of this article was to explore the cultural and religious educational needs of overseas nurses working with Muslim patients in the KSA and the UAE as derived from the experience of nurses themselves. Written narratives from nurses employed to work primarily with Muslim nurses were analyzed using a qualitative descriptive methodology. In the UAE and the KSA context, and perhaps for nurses working with Muslim-Arabic patients worldwide, the culturally and religiously specific topics that need to be a component of preemployment education include the basic Islamic principles (5 daily prayers, Ramadan fasting, Zamzam water, and time management skills to accommodate religious practices within care); Kinship and Social Factors (family structure, gender-related issues, and social support system); and Basic Arabic language skills.
Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B
Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.
Ventilator-associated pneumonia (VAP) is the leading cause of death with hospital-acquired infections, and preventing it is one of the Saving Lives initiatives ( Department of Health 2007 ). This article discusses the implementation of a purpose-designed VAP care bundle in a children's intensive care unit and examines the unique role of nurses in the management of the change process. A nurse-led VAP education, implementation and surveillance programme was set up. Nurse education was paramount, as nursing staff acceptance and involvement was a key feature. A multi-method training strategy was implemented, providing staff with multiple training opportunities and introducing VAP project education as a routine part of staff induction. Bundle compliance was monitored regularly and graphs of the results produced quarterly; feedback proved to be useful in keeping staff informed and engaged in VAP reduction. Comparison of VAP incidence before and after introduction of the care bundle showed a reduction after its implementation. With a co-ordinated, multidisciplinary approach, VAP care bundles can result in significant and sustained reductions in VAP rates in the paediatric intensive care unit. Effective co-ordination and leadership is crucial to successful implementation of the VAP bundle, and nurses are well placed to undertake this role.
Susan J. Armstrong
Full Text Available 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
Seonyoung Yun, MSN, RN
Conclusion: These findings indicate that the better the nursing work environment, the less workplace bullying nurses will experience. Further research needs to be done to identify factors that influence bullying in the nurses and to develop an intervention that prevents workplace bullying.
Machado, Cidália; Sousa, Pedro Jácome
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.
Simons, Sherri Lee
The staff nurses' immediate manager directly influences an NICU's ability to attract and retain professional nurses. This makes it especially important that nurse executives and administrators identify opportunities to better meet the needs of their nurse managers and measure the impacts of their decisions. Data about front-line manager turnover need to be measured, reported, and examined. No longer can organizations afford to view managers as another expense; they are an asset on the balance sheet. Strategic planning for the recruitment and retention of nurse managers will be vital both to an organization's healthy bottom line and to the quality of its patient care.
Gardner, J M
Perinatal death is a crisis for midwives and nurses as well as for bereaved parents and extended families. Surveys and interviews conducted in the United States, England, and Japan described the needs and responses of nurses and midwives as they coped with their own feelings while caring for bereaved parents. Results emphasized common needs of caregivers for increased knowledge, mentored experience, communication skills, and personal support to confidently provide sensitive care to families. Although need for education regarding cultural-specific care was revealed, participants identified helpful strategies of care for bereaved parents that could extend and improve care universally.
Objectives: This study compares the Social Engagement and Interactive Occupation of residents with dementia in two Irish nursing homes, before and after conversion to a household model environment. The changes were an open plan design and a functioning unit kitchen, supported by a homemaker role and operational policies which reduced task-based work in favour of person-centred care offering choice. Method: A snapshot observation method was used to obtain quantitative data of resident activity using the Assessment Tool for Occupation and Social Engagement (ATOSE). Residents were assessed for four hours, on seven different weekdays, over a six-week period both pre- and post-renovation. The exception to this was the assessment of the traditional model unit (TMU) for Nursing Home 1 which was reduced to four days due to the early start of the building work. Results: The results were consistent for both nursing homes and data were aggregated. Residents spent more time in the communal living spaces and were more likely to be active and engaged in the household model units (HMUs) compared to the TMUs. Using the independent t-test, these changes were found to be highly significant (p < 0.001). Conclusion: Creating an HMU increased the Interactive Occupation and Social Engagement of residents in the communal areas of the two nursing homes. The physical environment change, in conjunction with supportive staff procedures and organizational initiatives, improved the well-being of residents with dementia. The outcomes must be viewed in context with financial implications.
Full Text Available Introduction: Performance assessment instrument will be problematic when it is not representative in describing the competency because it is not obvious indicators and inappropriate performance standard to nursing’s task. The purpose of this study is to develop nurses’ performance assessment instrument based on the web from multi sources assessment inpatient unit at SMC Hospital. Methods: This study had two phases. The first phase was an explanatory overview of the performance assessment system using questionnaires completed by 53 respondents of nurses, selected by purposive sampling. Instrument development based on FGD with six decision makers in the hospital. Validity was tested by Pearson Product Moment Correlation and reliability of instrument’s was tested by alpha Cronbach. The second phase was socialization and instrument test to observe the quality of instrument using a questionnaire by 47 respondents and recommendations made by 8 participants of FGD. The samples were selected by purposive sampling technique. Performance assessment system was moderate at 58.49%. All questions which aimed to measure the performance of nurses were valid and reliable. The quality of nurses’ performance assessment instruments based on the web was a good category, which was functionality: 81.60; reliability: 78.16; efficiency: 80.85; usability: 81.70 and portability: 81.70. Results: The result was a web-based assessment format, scoring with Likert scale, resource assessment by the direct supervisor which was a multisource evaluator, the development of performance graph, and confidentiality of data on the database server. Discussion: Recommendations for hospital is to make policy based on the final value of the performance assessment by the supervisor which was multisource feedback and it needs a global writing on a form of performance assessment result.
Heidari, Haydeh; Hasanpour, Marzieh; Fooladi, Marjan
Background: In recent years significant medical science advances have been made in the field midwifery and infant care. The premature, low birth weight and ill infants are admitted to the technologically advanced NICU for care and they often require long-term stay. This study addresses parental experiences with the infant care in NICU, explores their concerns regarding nursing supports for parents and offers nurses? perspectives on performing duties. Materials and Methods: A qualitative induc...
Hayne, Arlene N; Gerhardt, Clara; Davis, Jonathan
Solutions to the nursing shortage in North America include the recruitment of international nurses. This descriptive study examines strategies to facilitate the cultural adaptation, job satisfaction, and perception of role and social support of a group of recruited Filipino nurses. Instruments used were the Nursing Work Index-Revised Edition and Occupation Stress Inventory-Revised Edition. Results indicated that the investment in promoting the well-being of recruits in both social and work contexts positively benefits job satisfaction and spills over into related areas of satisfaction and positive adaptation. The literature study also focuses on areas of cultural competence in the context of transcultural nursing.
Sato, Shinichi; Ishida-Nakajima, Wako; Ishida, Akira; Kawamura, Masanari; Miura, Shinobu; Ono, Kyoichi; Inagaki, Nobuya; Takada, Goro; Takahashi, Tsutomu
Electrocardiogram (ECG) and impedance pneumography (IPG), the most widely used techniques for cardiorespiratory monitoring in the neonatal intensive care unit (NICU), have the disadvantage of causing skin damage when used for very premature newborn infants. To prevent skin damage, we designed a new piezoelectric transducer (PZT) sensor. To assess the potential of the PZT sensor for cardiorespiratory monitoring in the NICU. The PZT sensor was placed under a folded towel under a neonate to detect an acoustic cardiorespiratory signal, from which heart rate (HR) and breathing rate (BR) were calculated, together with simultaneous ECG/IPG recording for 1-9 days for long and brief (1-min) assessment. The brief assessment showed average correlation coefficients of 0.92 +/- 0.12 and 0.95 +/- 0.02 between instantaneous HRs/BRs detected by the PZT sensor and ECG/IPG in 27 and 11 neonates examined. During the long assessment, the HR detection rate by the PZT sensor was approximately 10% lower than that by ECG (82.6 +/- 12.9 vs. 91.8 +/- 4.1%; p = 0.001, n = 27), although comparable (90.3 +/- 4.1 vs. 92.5 +/- 3.4%, p = 0.081) in approximately 70% (18/27) of neonates examined; BR detection rate was comparable between the PZT sensor and IPG during relatively stable signal conditions (95.9 +/- 4.0 vs. 95.3 +/- 3.5%; p = 0.38, n = 11). The PZT sensor caused neither skin damage nor body movement increase in all neonates examined. The PZT sensor is noninvasive and does not cause skin irritation, and we believe it does provide a reliable, accurate cardiorespiratory monitoring tool for use in the NICU, although the issue of mechanical-ventilation noise remains to be solved. Copyright 2010 S. Karger AG, Basel.
Araújo, Thamiris Ricci de; Menegueti, Mayra Gonçalves; Auxiliadora-Martins, Maria; Castilho, Valéria; Chaves, Lucieli Dias Pedreschi; Laus, Ana Maria
to calculate the cost of the average time of nursing care spent and required by patients in the Intensive Care Unit (ICU) and the financial expense for the right dimension of staff of nursing professionals. a descriptive, quantitative research, using the case study method, developed in adult ICU patients. We used the workload index - Nursing Activities Score; the average care time spent and required and the amount of professionals required were calculated using equations and from these data, and from the salary composition of professionals and contractual monthly time values, calculated the cost of direct labor of nursing. the monthly cost of the average quantity of available professionals was US$ 35,763.12, corresponding to 29.6 professionals, and the required staff for 24 hours of care is 42.2 nurses, with a monthly cost of US$ 50,995.44. the numerical gap of nursing professionals was 30% and the monthly financial expense for adaptation of the structure is US$ 15,232.32, which corresponds to an increase of 42.59% in the amounts currently paid by the institution. calcular o custo do tempo médio de assistência de enfermagem despendido e requerido pelos pacientes internados em Unidade de Terapia Intensiva (UTI) e o dispêndio financeiro para adequação do quadro de profissionais de enfermagem. pesquisa descritiva, quantitativa, na modalidade de estudo de caso, desenvolvida na UTI de pacientes adultos. Utilizou-se o índice de carga de trabalho - Nursing Activities Score; o tempo médio de assistência despendido, requerido e o quantitativo de profissionais requerido foram calculados por meio de equações e, a partir desses dados, e de valores da composição salarial dos profissionais e tempo mensal contratual, calculou-se o custo da mão de obra direta de enfermagem. o custo mensal do quantitativo médio de profissionais disponível foi de US$ 35.763,12, correspondendo a 29,6 profissionais, e o requerido para 24 horas de cuidado é de 42,2 profissionais de
Ellis, Peggy A
This article describes nurse faculty workload policies from across the nation in order to assess current practice. There is a well-documented shortage of nursing faculty leading to an increase in workload demands. Increases in faculty workload results in difficulties with work-life balance and dissatisfaction threatening to make nursing education less attractive to young faculty. In order to begin an examination of faculty workload in nursing, existing workloads must be known. Faculty workload data were solicited from nursing programs nationwide and analyzed to determine the current workloads. The most common faculty teaching workload reported overall for nursing is 12 credit hours per semester; however, some variations exist. Consideration should be given to the multiple components of the faculty workload. Research is needed to address the most effective and efficient workload allocation for nursing faculty.
Differences and similarities of motivating and demotivating factors of emergency nursing care in rural and urban emergency units â A study of selected rural and urban emergency units in the Volta Region of Ghana
Confidence Alorse Atakro
Full Text Available Objective: The objective of this study was to explore differences and similarities of motivating and demotivating factors of emergency nursing care in selected rural and urban emergency units in the Volta Region of Ghana. Materials and methods: This study was conducted at selected rural and urban emergency units in the Volta Region of Ghana. The study utilised qualitative exploratory descriptive design. Purposive sampling technique was employed in selecting emergency units and nurses. Data were collected through semi-structured interviews of 30 nurses. Data saturation was determined after interviewing 30 participants. Data analysis was done through qualitative content analysis. Results: Twenty-six (26 out of a total of thirty (30 participants were between the ages of twenty-five (25 and twenty-nine (29. Nurses working in the emergency units studied general nursing at the Nurses Training Colleges (NTCs. None of the respondents studied emergency nursing as a degree programme. Twenty four (24 out of thirty (30 participants had worked for about two years in emergency units. Four thematic categories that represented differences and similarities of motivating and demotivating factors for nurses in rural and urban emergency units were extracted from data. The thematic categories are: a Support from hospital management for provision of material resources; b Task shifting to nurses; c Stimulant for learning; d Interpersonal relations. Discussions: Evidence available in this study suggests that there are differences as well as similarities of motivating and demotivating factors within emergency units of rural and urban settings in the Volta Region of Ghana. Differences in resource allocation and task shifting was identified. Stimulating environments of emergency unit for learning and excellent interpersonal relations were found to be common motivations for both rural and urban emergency unit nurses. Keywords: Motivating, Demotivating, Emergency
Christie, A.; Robertson, I.
Aim: To supplement previous surveys analysing provision of interventional radiology (IR), in-hours (IH) and out-of-hours (OOH), by specifically surveying the level of nursing support provided. Materials and methods: A web-based questionnaire was distributed to all British Society of Interventional Radiology (BSIR) members. This addressed several aspects of radiology nursing support for IR procedures, both IH and OOH. Results: Sixty percent of respondents indicated that they have a formal OOH service. Of these, all have a dedicated nursing rota, with the vast majority operating with one nurse. IH, 77% of respondents always have a scrubbed nurse assistant, but this reduces to 40% OOH. IH, 4% never have a scrubbed radiology nurse assistant, which rises to 25% OOH. IH, 75% of respondents always have a radiology nurse dedicated to patient monitoring, but this reduces to 20% OOH. IH, 3% never have a radiology nurse dedicated to patient monitoring, which rises to 42% OOH. Conclusion: A significant disparity exists in the level of IR nursing support between IH and OOH. The majority of sites provide a single nurse with ad hoc additional support. This is potentially putting patients at increased risk. Radiology nurses are integral to the safe and sustainable provision of IR OOH services and a greater focus is required to ensure adequate and safe staffing levels for 24/7 IR services. - Highlights: • A significant disparity exists between the level of nursing support provided in-hours and OOH. • This applies to both the availability of a nurse to scrub and to monitor the patient. • Having a dedicated 24/7 nursing rota is mandatory to providing a deliverable OOH service.
Sonia R. B D'Souza; Leslie Edward Lewis; Vijay Kumar; Ramesh Bhat Y; Jayashree Purkayastha; Hari Prakash
Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU). However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To determine and describe the ambient noise levels in the acute NICU of a tertiary referral hospital. Material and Methods...
Hasanpour, Marzieh; Alavi, Mousa; Azizi, Fatemeh; Als, Heidelise; Armanian, Amir Mohmmad
The birth of an infant requiring hospitalization in the neonatal Intensive Care Unit (NICU) uniformly is reported to be stressful for parents and family members. This study aimed to determine parent-staff communication in the NICU and its relationship to parent stress. Two hundred and three Iranian parents with preterm infants hospitalized in the NICU participated in this descriptive-correlational study. The participants were selected by the quota sampling method. Data collected included a three-part: questionnaire, the first part covered demographic parent and infant information, the second was the Parent-Staff Communication Scale (the score of which ranged from 0 to 180), and the third was the Parental Stress Scale (the score of which ranged from 0 to 102). Descriptive and inferential statistics including the Pearson's correlation coefficient test were applied to the data, using SPSS software Version 16. This study revealed that fathers and mothers' stress and communication scores were almost comparable and both higher than expected. The total mean score of the two main variables, i.e., parent-staff communication and parental stress were, respectively, 100.72 ± 18.89 and 75.26 ± 17.6. A significant inverse correlation was found between parental stress and parent-staff communication scores ( r = -0.144, P = 0.041). Based on this study finding showed that better parent-staff communication is related to lower parent stress scores, it is recommended that nurses and physicians receive specific skill training for the establishment of effective parent-staff communication. It is anticipated that such improved staff skills will help decrease parent stress and therewith likely promote parent and infant health in the NICU.
Siddiqui, Maimoona; Bukhari, Ahmed S; Shamael, Ibrahim; Shah, Zubana A; Maken, Neil
Objective To obtain the perception of nurses on the use of Facebook as a learning tool. Materials & methods We conducted a pilot observational study in which data were collected through a detailed course evaluation and feedback survey questionnaire. Twelve stroke care nurses were enrolled in a stroke course specifically designed to provide participants with information and knowledge about stroke unit nursing care. Firstly, a closed Facebook group consisting of the participants and facilitators was created. An activity in accordance with the course content was posted in the group daily. Before the start of the course, a pre-course test was conducted. The four-week course culminated in a graded written examination. Its results were compared with the pre-course test. A detailed feedback questionnaire was given to the participants at the end of the course, which was specifically designed to elicit perceptions of nurses about the use of Facebook as a learning tool. Results Of the 12 enrolled nurses, 10 completed the certification and the post-course feedback evaluation. Facebook was used by all participants as a platform to view and study the course contents. The timing of the course activities was rated "very good" by three and 'good' by six of 10 participants. However, one of the major issues faced by five participants was problematic internet access. The overall rating of the course was "very good" by five participants, "good" by three, and "satisfactory" by two of 10 participants. The post-course test showed that nine of 10 candidates passed with scores >70% compared to only two candidates getting scores >50% in the pre-course test. Conclusion Facebook use enabled participants to study the material when their schedule permitted them. The online teaching and facilitation were ideal for our full-time stroke unit nurses as reflected by their improved post-course test results.
Ganz, Freda DeKeyser; Endacott, Ruth; Chaboyer, Wendy; Benbinishty, Julie; Ben Nun, Maureen; Ryan, Helen; Schoter, Amanda; Boulanger, Carole; Chamberlain, Wendy; Spooner, Amy
Quality ICU end-of-life-care has been found to be related to good communication. Handover is one form of communication that can be problematic due to lost or omitted information. A first step in improving care is to measure and describe it. The objective of this study was to describe the quality of ICU nurse handover related to end-of-life care and to compare the practices of different ICUs in three different countries. This was a descriptive comparative study. The study was conducted in seven ICUs in three countries: Australia (1 unit), Israel (3 units) and the UK (3 units). A convenience sample of 157 handovers was studied. Handover quality was rated based on the ICU End-of-Life Handover tool, developed by the authors. The highest levels of handover quality were in the areas of goals of care and pain management while lowest levels were for legal issues (proxy and advanced directives) related to end of life. Significant differences were found between countries and units in the total handover score (country: F(2,154)=25.97, p=studied. The total score was higher when quality of care might be deemed at greater risk (if the nurses did not know the patient or the patient was expected to die), indicating that nurses were exercising some form of discretionary decision making around handover communication; thus validating the measurement tool. Copyright © 2014. Published by Elsevier Ltd.
Gallagher, Ann; Bousso, Regina Szylit; McCarthy, Joan; Kohlen, Helen; Andrews, Tom; Paganini, Maria Cristina; Abu-El-Noor, Nasser Ibrahim; Cox, Anna; Haas, Margit; Arber, Anne; Abu-El-Noor, Mysoon Khalil; Baliza, Michelle Freire; Padilha, Katia Grillo
Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses' end-of-life (EoL) decision-making practice across cultures. To understand nurses' EoL decision-making practices in ICUs in different cultural contexts. We collected and analysed qualitative data using Grounded Theory. Interviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine. Semi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine). They were purposefully and theoretically selected to include nurses having a variety of characteristics and experiences concerning end-of-life (EoL) decision-making. The study used grounded theory to inform data collection and analysis. Interviews were facilitated by using key questions. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EoL decision-making practices in the ICU. Ethical approval was granted in each of the participating countries and voluntary informed consent obtained from each participant. The core category that emerged was 'negotiated reorienting'. Whilst nurses do not make the 'ultimate' EoL decisions, they engage in two core practices: consensus seeking (involving coaxing, information cuing and voice enabling); and emotional holding (creating time-space and comfort giving). There was consensus regarding the core concept and core practices employed by nurses in the ICUs in the five countries. However
Dithole, Kefalotse; Sibanda, Sambulelwe; Moleki, Mary M; Thupayagale-Tshweneagae, Gloria
Mechanical ventilation is a necessary procedure for patients with a range of illnesses and conditions. Mechanical ventilation affects voice production, leaving patients unable to communicate their needs with nurses and family. The communication difficulty causes distress, frustration, and anger if not attended to. This structured review sought to identify communication challenges which exist between nurses and mechanically ventilated patients in intensive care units (ICU) and hence explore possible solutions to improve these communication challenges. A electronic search of MEDLINE, CINAHL, and PsycINFO was conducted to identify relevant literature on nurse-patient communication challenges in the ICU published between January 2005 and December 2014. Studies meeting the inclusion criteria were retrieved in full, reviewed, and study quality assessed. Six studies were identified for inclusion in the review. Analysis identified five core influences on communication in the ICU: patient's consciousness level, nature of nurse-patient interactions, communication methods, staff skills and perceptions, and the intensive care physical environment. An evidence-based and multifactorial communication intervention encompassing staff skills development and training, development of relevant patient materials or devices and collaborations with relevant health professionals like speech and language therapists has the potential to improve nurse-patient communication in the ICU and hence improve patient outcomes. © 2016 Sigma Theta Tau International.
Punshon, Geoffrey; Endacott, Ruth; Aslett, Phillippa; Brocksom, Jane; Fleure, Louisa; Howdle, Felicity; Masterton, Morven; O'Connor, Anita; Swift, Adrian; Trevatt, Paul; Leary, Alison
United Kingdom prostate cancer nursing care is provided by a variety of urology and uro-oncology nurses. The experience of working in multidisciplinary teams (MDT) was investigated in a national study. The study consisted of a national survey with descriptive statistics and thematic analysis. A secondary analysis of a data subset from a UK whole population survey was undertaken (n = 285) of the specialist nursing workforce and the services they provide. Data were collected on the experience of working in the MDT. Forty-five percent of the respondents felt that they worked in a functional MDT, 12% felt that they worked in a dysfunctional MDT, and 3.5% found the MDT meeting intimidating. Furthermore, 34% of the nurses felt that they could constructively challenge all members of the MDT in meetings. Themes emerging from open-ended questions were lack of interest in nonmedical concerns by other team members, ability to constructively challenge decisions or views within the meeting, and little opportunity for patients' wishes to be expressed. Despite expertise and experience, nurses had a variable, often negative, experience of the MDT. It is necessary to ensure that all participants can contribute and are heard and valued. More emphasis should be given to patients' nonmedical needs.
Cyrol, Katharina; Fröhlich, Martin R; Piatti, Francesca; Imhof, Lorenz
Background: Family members of people dying in the intensive care unit (ICU) are exposed to many stress factors and they often do not experience involvement in End-of-Life (EoL) situations. For example, they criticize a low degree of participation in patients care, delayed or incomplete information and lack of privacy. Even nursing staff is facing various obstacles in EoL situations in ICUs. Aim: This study investigates strategies used by ICU nursing staff in German-speaking Switzerland to increase family members participation in situations at the end of life. Method: Data was collected by conducting 12 semi-structured interviews using an approach based on Grounded Theory. A model was developed to explain nursing strategies for family involvement in EoL situations in the ICU. Conclusions: Nurses provide personal space and tranquillity for family members and allow them to be present at any time. Against this background, they support family members and enable them to say goodbye consciously to a loved one. Subsequent work should examine the effectiveness of the strategies described, particularly in terms of stress reactions displayed by family members in the aftermath of EoL situations. In practice, family members should be provided space for privacy. The entire healthcare team is recommended to identify and pursue common values and objectives. Moreover, intradisciplinary exchange and mentoring need to be encouraged. In order to prepare future nursing staff for EoL situations in the ICU, recognizing and promoting their educational skills is mandatory.
Friedman, Joshua; Friedman, Susan Hatters; Collin, Marc; Martin, Richard J
To characterise neonatal intensive care unit (NICU) staff perceptions regarding factors which may lead to more challenging staff-parent interactions, and beneficial strategies for working with families with whom such interactions occur. A survey of 168 physician and nursing staff at two NICUs in American teaching hospitals inquired about their perceptions of challenging parent-staff interactions and situations in which such interactions were likely to occur. From a medical perspective, staff perceptions of challenging interactions were noted when infants had recent decompensation, high medical complexity, malformations or long duration of stay in the NICU. From a psychological/social perspective, a high likelihood of challenging interactions was noted with parents who were suspicious, interfere with equipment, or parents who hover in the NICU, express paranoid or delusional thoughts, repeat questions, perceive the staff as inaccessible, are managing addictions, or who require child protective services involvement. Frequent family meetings, grieving opportunities, education of parents, social work referrals, clearly defined rules, partnering in daily care and support groups were perceived as the most beneficial strategies for improving difficult interactions. This study delineates what staff perceive as challenging interactions and provides support for an educational and interventional role that incorporates mental health professionals. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Skeens, Kristen; Logsdon, M Cynthia; Stikes, Reetta; Ryan, Lesa; Sparks, Kathryn; Hayes, Pauline; Myers, John; Davis, Deborah Winders
Parents of infants hospitalized in the neonatal intensive care unit (NICU) frequently need guidance to prepare them for the care and health promotion of their child after hospital discharge. The health literacy of the parents should be considered so that education can be tailored to meet their needs. It is also important to understand the parents' preferences for how, and from whom, they receive education. The purpose of this study was to identify health literacy levels of parents of infants in an NICU and preferences for who they want to provide them with education. An exploratory, descriptive design was used to assess participant health literacy and preferences for obtaining child health information. Only mothers (no fathers) with babies in the NICU were available to complete the survey. Mean participant age was 26.4 years (SD = 6.7). Participants had a mean Rapid Estimate of Adult Literacy in Medicine, Revised, score of 5.64 (SD = 2.4), indicating a low level of health literacy. Questions regarding when to administer medication were correctly answered by 69% of participants. Proper medication dosage was understood by 92% of participants; however, only 30% were able to correctly convert measurements. One-on-one discussions with a physician were the preferred source of health information for 80% of participants. The current exploratory study provides new information that will help inform the development of future studies and increase awareness of nurses regarding health literacy and the specific types of skills for which parents need the most help.
Abad-Corpa, Eva; Delgado-Hito, Pilar; Cabrero-García, Julio; Meseguer-Liza, Cristobal; Zárate-Riscal, Carmen Lourdes; Carrillo-Alcaraz, Andrés; Martínez-Corbalán, José Tomás; Caravaca-Hernández, Amor
To implement evidence in a nursing unit and to gain a better understanding of the experience of change within a participatory action research. Study design of a participatory action research type was use from the constructivist paradigm. The analytical-methodological decisions were inspired by Checkland Flexible Systems for evidence implementation in the nursing unit. The study was carried out between March and November 2007 in the isolation unit section for onco-haematological patients in a tertiary level general university hospital in Spain. Accidental sampling was carried out with the participation of six nurses. Data were collected using five group meetings and individual reflections in participants' dairies. The participant observation technique was also carried out by researchers. Data analysis was carried out by content analysis. The rigorous criteria were used: credibility, confirmability, dependence, transferability and reflexivity. A lack of use of evidence in clinical practice is the main problem. The factors involved were identified (training, values, beliefs, resources and professional autonomy). Their daily practice (complexity in taking decisions, variability, lack of professional autonomy and safety) was compared with an ideal situation (using evidence it will be possible to normalise practice and to work more effectively in teams by increasing safety and professional recognition). It was decided to create five working areas about several clinical topics (mucositis, pain, anxiety, satisfaction, nutritional assessment, nauseas and vomiting, pressure ulcers and catheter-related problems) and seven changes in clinical practice were agreed upon together with 11 implementation strategies. Some reflections were made about the features of the study: the changes produced; the strategies used and how to improve them; the nursing 'subculture'; attitudes towards innovation; and the commitment as participants in the study and as healthcare professionals. The
Oxenbøll-Collet, Marie; Egerod, Ingrid; Christensen, Vibeke
of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. Methods: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide. Five focus groups with nurses (n=20) and four with physicians......-ICU screening affected nursing care, clinical judgment and professional integrity; (2) Instrument reliability: nurses and physicians expressed concerns about CAM-ICU assessment in non-sedated patients, patients with multi-organ failure or patients influenced by residual sedatives/opioids; and (3) Clinical...... consequence: after CAM-ICU assessment, physicians lacked evidence-based treatment options, and nurses lacked physician acknowledgment and guidelines for disclosing CAM-ICU results to patients. Conclusion: In this study, ICU nurses and physicians raised a number of concerns regarding the use of the CAM...
Vogus, Timothy J; Sutcliffe, Kathleen M
Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on the joint benefits of safety organizing and other contextual factors that help foster safety. Although we know that organizational practices often have more powerful effects when combined with other mutually reinforcing practices, little research exists on the joint benefits of safety organizing and other contextual factors believed to foster safety. Specifically, we examined the benefits of bundling safety organizing with leadership (trust in manager) and design (use of care pathways) factors on reported medication errors. A total of 1033 RNs and 78 nurse managers in 78 emergency, internal medicine, intensive care, and surgery nursing units in 10 acute-care hospitals in Indiana, Iowa, Maryland, Michigan, and Ohio who completed questionnaires between December 2003 and June 2004. Cross-sectional analysis of medication errors reported to the hospital incident reporting system for the 6 months after the administration of the survey linked to survey data on safety organizing, trust in manager, use of care pathways, and RN characteristics and staffing. Multilevel Poisson regression analyses indicated that the benefits of safety organizing on reported medication errors were amplified when paired with high levels of trust in manager or the use of care pathways. Safety organizing plays a key role in improving patient safety on hospital nursing units especially when bundled with other organizational components of a safety supportive system.
Mahmoud Al Kalaldeh
Full Text Available Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures.Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals and private sectors (two hospitals were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined.Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment. Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses.Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels. A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition.
Andolhe, Rafaela; Barbosa, Ricardo Luis; Oliveira, Elaine Machado de; Costa, Ana Lúcia Siqueira; Padilha, Katia Grillo
Objective To investigate emotional stress, coping and burnout among nursing staff and their association with biosocial factors and characteristics of work in Intensive Care Units (ICU). Method This was a cross-sectional study, conducted in eight ICUs at a teaching hospital in the city of São Paulo, Brazil, in October 2012. Biosocial data and information about the professionals' work was gathered, and they were given the Scale of Occupational Stress, Scale of Occupational Coping, List of Signs and Symptoms of Stress and the Maslach Burnout Inventory. Results The study sample consisted of 287 subjects, predominately women, with partners and children. Most professionals presented moderate stress levels and control as a coping strategy (74.47% and 79.93%, respectively), and burnout was present among 12.54%. Factors associated with stress were related to working conditions. The most prevalent protective factors were having a partner, working in the clinical ICU and liking work, while adequate amount of sleep was a protective factor for burnout. Conclusion Control of the working environment and adequate sleep are decisive and protective factors in dealing with situations of occupational stress.
Burton, Christopher R; Duxbury, Joy; French, Beverley; Monks, Rob; Carter, Bernie
In the light of concerns about the wider social and economic value of the PhD training programme, this article discusses the challenges being directed primarily at the traditional doctoral programme of study. While the PhD is primarily concerned with the student making an original contribution to knowledge, the value-added component of the doctoral research degree needs to respond to the needs of a wider market of purchasers, and to meet practice and policy requirements for research leadership. The United Kingdom Research Councils (UK GRAD, 2001. Joint Skills Statement of Skills Training Requirements. Available at http://www.grad.ac.uk/downloads/documents/general/Joint%20Skills%20Statementpdf. (last accessed 1st April 2008.) suggest a range of seven skill domains over and above research design and management that should be offered to students. The seven domains are research skills and techniques, participation in the research environment, research management, personal effectiveness, communication, networking and team working, and career management. This article develops and extends these skill domains for the current healthcare context and considers how these should guide the development and evaluation of the value-added components of doctoral research degree programmes in nursing. The challenges that these issues present to academic departments are also discussed. Our conclusion is that PhD research training needs re-visioning and broadening so that the students' experience includes these value-added components.
Priscilla Caetano Guerra
Full Text Available Abstract OBJECTIVE To assess sleep, quality of life and mood of nursing professionals of pediatric intensive care units. METHOD Quantitative, cross-sectional and descriptive study. Professionals grouped by morning, afternoon and evening shifts were assessed by means of the instruments: Morningness-Eveningness Questionnaire; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Generic questionnaire for the assessment of quality of life (SF-36; Beck Depression Inventory; Beck Anxiety Inventory; State-Trait Anxiety Inventory. RESULTS Sample consisted of 168 professionals, with prevalence of neutral typology (57.49%. There was no statistical significance regarding sleep, despite scores showing a poor quality of sleep and excessive daytime sleepiness for the three shifts. Quality of life did not reveal any statistical significance, but in the field "social role functioning" of the evening shift, a lower score was observed (p<0.007. There was no statistical significance regarding levels of anxiety and depression. CONCLUSION The results suggest that these professionals may present sleeping problems, but they do not have lower scores of quality of life or mood disorders. Likely explanations for these findings may include an adaptation to their work type over time and the fact that working with children is rewarding.
Full Text Available To investigate the teaching of antimicrobial stewardship (AS in undergraduate healthcare educational degree programmes in the United Kingdom (UK.Cross-sectional survey of undergraduate programmes in human and veterinary medicine, dentistry, pharmacy and nursing in the UK. The main outcome measures included prevalence of AS teaching; stewardship principles taught; estimated hours apportioned; mode of content delivery and teaching strategies; evaluation methodologies; and frequency of multidisciplinary learning.80% (112/140 of programmes responded adequately. The majority of programmes teach AS principles (88/109, 80.7%. 'Adopting necessary infection prevention and control precautions' was the most frequently taught principle (83/88, 94.3%, followed by 'timely collection of microbiological samples for microscopy, culture and sensitivity' (73/88, 82.9% and 'minimisation of unnecessary antimicrobial prescribing' (72/88, 81.8%. The 'use of intravenous administration only to patients who are severely ill, or unable to tolerate oral treatment' was reported in ~50% of courses. Only 32/88 (36.3% programmes included all recommended principles.Antimicrobial stewardship principles are included in most undergraduate healthcare and veterinary degree programmes in the UK. However, future professionals responsible for using antimicrobials receive disparate education. Education may be boosted by standardisation and strengthening of less frequently discussed principles.
Twycross, Alison; Roderique, Lynda
The results of several studies suggest that gaps remain in nurses' knowledge about pain in children, and particularly regarding pain assessment, analgesic drugs, and nondrug methods, suggesting a need to explore the pain content of preregistration nursing curricula. Over the past decade, the way nurse education is delivered has changed with the advent of the internet and the use of virtual learning environments. This study, therefore, explored the depth and breadth of pain content in 3-year preregistration pediatric nursing courses across the U.K. as well as ascertaining how this content is delivered. The leads for pediatric nursing at all 56 U.K. higher education institutions running the 3-year preregistration pediatric nursing course were e-mailed a questionnaire. Participants were asked to indicate whether topics are covered in the program, and if so how it was delivered. Results suggest that preregistration pediatric nursing courses in the U.K. do not always equip students to manage pain effectively in clinical practice. There appears to be limited content on pain in nursing curricula, with several institutions not covering key topics. Most teaching is delivered face to face with limited workbooks and virtual learning activities. Further research is needed in this area to ascertain the impact of this on the quality of care provided. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Sipes, Carolyn; Hunter, Kathleen; McGonigle, Dee; West, Karen; Hill, Taryn; Hebda, Toni
Information technology use in healthcare delivery mandates a prepared workforce. The initial Health Information Technology Competencies tool resulted from a 2-year transatlantic effort by experts from the US and European Union to identify approaches to develop skills and knowledge needed by healthcare workers. It was determined that competencies must be identified before strategies are established, resulting in a searchable database of more than 1000 competencies representing five domains, five skill levels, and more than 250 roles. Health Information Technology Competencies is available at no cost and supports role- or competency-based queries. Health Information Technology Competencies developers suggest its use for curriculum planning, job descriptions, and professional development.The Chamberlain College of Nursing informatics research team examined Health Information Technology Competencies for its possible application to our research and our curricular development, comparing it originally with the TIGER-based Assessment of Nursing Informatics Competencies and Nursing Informatics Competency Assessment of Level 3 and Level 4 tools, which examine informatics competencies at four levels of nursing practice. Additional analysis involved the 2015 Nursing Informatics: Scope and Standards of Practice. Informatics is a Health Information Technology Competencies domain, so clear delineation of nursing-informatics competencies was expected. Researchers found TIGER-based Assessment of Nursing Informatics Competencies and Nursing Informatics Competency Assessment of Level 3 and Level 4 differed from Health Information Technology Competencies 2016 in focus, definitions, ascribed competencies, and defined levels of expertise. When Health Information Technology Competencies 2017 was compared against the nursing informatics scope and standards, researchers found an increase in the number of informatics competencies but not to a significant degree. This is not surprising
Tian, Xi-Ke; Zhao, Xiao-Yu; Zhang, Li-de; Yang, Chao; Pi, Zhen-Bang; Zhang, Su-Xin
To reduce the cost of the catalyst for direct ethanol fuel cells and improve its catalytic activity, highly ordered Ni-Cu alloy nanowire arrays have been fabricated successfully by differential pulse current electro-deposition into the pores of a porous anodic alumina membrane (AAMs). The energy dispersion spectrum, scanning and transmission electron microscopy were utilized to characterize the composition and morphology of the Ni-Cu alloy nanowire arrays. The results reveal that the nanowires in the array are uniform, well isolated and parallel to each other. The catalytic activity of the nanowire electrode arrays for ethanol oxidation was tested and the binary alloy nanowire array possesses good catalytic activity for the electro-oxidation of ethanol. The performance of ethanol electro-oxidation was controlled by varying the Cu content in the Ni-Cu alloy and the Ni-Cu alloy nanowire electrode shows much better stability than the pure Ni one.
Tian Xike; Zhao Xiaoyu; Yang Chao; Pi Zhenbang; Zhang Lide; Zhang Suxin
To reduce the cost of the catalyst for direct ethanol fuel cells and improve its catalytic activity, highly ordered Ni-Cu alloy nanowire arrays have been fabricated successfully by differential pulse current electro-deposition into the pores of a porous anodic alumina membrane (AAMs). The energy dispersion spectrum, scanning and transmission electron microscopy were utilized to characterize the composition and morphology of the Ni-Cu alloy nanowire arrays. The results reveal that the nanowires in the array are uniform, well isolated and parallel to each other. The catalytic activity of the nanowire electrode arrays for ethanol oxidation was tested and the binary alloy nanowire array possesses good catalytic activity for the electro-oxidation of ethanol. The performance of ethanol electro-oxidation was controlled by varying the Cu content in the Ni-Cu alloy and the Ni-Cu alloy nanowire electrode shows much better stability than the pure Ni one
Min, Ari; Scott, Linda D; Park, Chang; Vincent, Catherine; Ryan, Catherine J; Lee, Taewha
This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors. Copyright © 2018 John Wiley & Sons, Ltd.
Full Text Available Background: Enterobacter cloacae is a rod-shaped, gram-negative bacillus, from the family of Enterobacteriaceae. It is an opportunistic pathogen and causes disease in plants and humans (premature and immunocompromised persons of all age groups. The goal of this study was to isolate and determine antimicrobial susceptibility pattern of Enterobacter cloacae strains isolated from consumed powdered infant formula (PIF milk in Neonatal Intensive Care Unit (NICU ward. Material and Methods: In this cross-sectional study, a total of 125 consumed powdered infant formula milk in NICU ward were surveyed. Isolation and Identification of microorganisms was carried out according to FDA method. Antimicrobial susceptibility test was performed using the standard disc diffusion method based on CLSI (2011 recommendations. Results: Enterobacter cloacae was isolated from 2 (1.6% of 125 PIF milk samples. The results showed that isolated strains are sensitive to most antibiotics. All isolates were resistant to amoxicillin. Conclusion: Since the infant formula (PIF samples are unsterile products and contamination could occure during different steps, it is imperative to prepare the infant formula milk foods according to the manufacturer’s instruction and in an aseptic condition. Contamination of PIF only could be reduced or prevented by monitoring the critical control points and taking appropriate action during the processing.
Hobbs, Janice E; Tschudy, Megan M; Hussey-Gardner, Brenda; Jennings, Jacky M; Boss, Renee D
When families transition from the neonatal intensive care unit (NICU) to the home, they become responsible for their infant's daily medical needs. Though neonatology physicians prepare families for hospital discharge, it is unclear how much clinicians understand about how their teaching and instructions translate into home care. The goal of this study was to evaluate the influence of a home visiting program on neonatology fellows' understanding of family needs soon after hospital discharge. Neonatology fellows conducted a home visit for an infant recently discharged. Before the visit, fellows reviewed their original discharge instructions, along with information about the family's neighborhood. During the home visit, fellows reviewed their discharge planning with families and discussed any challenges experienced. Afterwards, fellows completed a semi-structured interview; these transcriptions were manually coded for themes. Fellows identified several common women/family discharge challenges. These challenges fall into four domains: (1) inadequate discharge preparation, (2) medicalization of the home, (3) family adjustment to new "normal," and (4) the relevance of social context to discharge planning. Most (90%) fellows reported the home visit experience would affect their future NICU discharge practices and all agreed that home visits should be a part of neonatology training. Home visits allowed neonatology fellows to examine how their discharge preparation did, or did not, meet the family's needs. Incorporating home visits into neonatology training could help fellows learn about the relevance of social and community factors that are difficult to assess in the inpatient setting. © 2017 Wiley Periodicals, Inc.
Full Text Available At a campus in a low socioeconomic (SES area, our University allows enrolled nurses entry into the second year of a Bachelor of Nursing, but attrition is high. Using the factors, described by Yorke and Thomas (2003 to have a positive impact on the attrition of low SES students, we developed strategies to prepare the enrolled nurses for the pharmacology and bioscience units of a nursing degree with the aim of reducing their attrition. As a strategy, the introduction of review lectures of anatomy, physiology and microbiology, was associated with significantly reduced attrition rates. The subsequent introduction of a formative website activity of some basic concepts in bioscience and pharmacology, and a workshop addressing study skills and online resources, were associated with a further reduction in attrition rates of enrolled nursing students in a Bachelor of Nursing
Wheeler, R M; Foster, J W; Hepburn, K W
US healthcare facilities have addressed nursing shortages in part by recruiting internationally educated nurses (IENs), and studies suggest IENs may make up a significant percentage of the nursing workforce in urban hospitals. Despite the economic recession of 2008-2012, international nurse migration is expected to continue. Little is known about IENs in the southeastern USA, and no studies have compared their perspectives to those of their US counterparts. The purpose of this study was to gain a deeper understanding about the experiences of IENs compared to those of US registered nurses (RNs) practising in two urban hospitals in southeastern USA. This study involved two rounds of semi-structured interviews of 82 IENs and US RNs. Interviews focused on themes relating to education, barriers to practice, intent to stay in nursing and IENs' migration experiences. Most IENs interviewed migrated to the USA after 1990 to join their family and do not plan to return to their home countries to practise. Most IENs initially received their Associate Degree in Nursing; many have obtained their Bachelor of Science in Nursing degree. IENs and newly licensed US RNs faced similar barriers when they began practising in the USA, but IENs faced additional challenges adjusting to the attitudes of US patients, the perceived lack of respect for nurses and delivering total patient care. IENs would benefit from orientation regarding the cultural differences in the USA. In other ways, their challenges are similar to those of US RNs; policies regarding education, recruitment and retention could target both groups together. © 2013 The Authors. International Nursing Review © 2013 International Council of Nurses.
Full Text Available Background: One of the goals of nursing is providing safe care, prevention of injury, and health promotion of patients. Patient safety in intensive care units is threatened for various reasons. This study aimed to survey patient safety culture from the perspective of nurses in intensive care units. Materials and Methods: This cross-sectional study was conducted in 2016. Sampling was done using the convenience method. The sample consisted of 367 nurses working in intensive care units of teaching hospitals affiliated to Isfahan University of Medical Sciences. Data collection was performed using a two-part questionnaire that included demographic and hospital survey on Patient Safety Culture (HSOPSC questionnaire. Data analysis was done using descriptive statistics (mean and standard deviation. Results: Among the 12 dimensions of safety culture, the nurses assigned the highest score to “team work within units” (97.3% and “Organizational learning-continuous improvement” (84%. They assigned the least score to “handoffs and transitions”(21.1%, “non-punitive response to errors” (24.7%, “Staffing” (35.6%, “Communication openness” (47.5%, and “Teamwork across units” (49.4%. Conclusions: The patient safety culture dimensions have low levels that require adequate attention and essential measures of health care centers including facilitating teamwork, providing adequate staff, and developing a checklist of handoffs and transitions. Furthermore, to increase reporting error and to promote a patient safety culture in intensive care units, some strategies should be adopted including a system-based approach to deal with the error.
Williams, Kristen G; Patel, Kayla T; Stausmire, Julie M; Bridges, Christy; Mathis, Mary W; Barkin, Jennifer L
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