Evaluation of an Evidence-Based Care Bundle for Preventing Hospital-Acquired Pressure Injuries in High-Risk Surgical Patients.

The aim of this study was to evaluate the effectiveness of an evidence-based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi-experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure-relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P < .001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.

Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment.

BACKGROUND: Nurses have primary responsibility for many of the care processes and interventions intended to improve patients' health during hospital stays. Accordingly, missed nursing care can negatively impact patient safety and lead to negative clinical outcomes. Missed nursing care is standard care that is not completed, incomplete, or seriously delayed. PURPOSE: There is scant literature on nurse-reported missed care (NRMC) in Singapore. Identifying the prevalence of, types of, and reasons for missed care, including staff-related factors, is imperative to understanding the implications of missed care and identifying opportunities for improvement. METHODS: Ours is a correlation study of NRMC using convenience sampling. Nurses working on all inpatient units in an acute care hospital in Singapore were recruited to complete the MISSCARE survey, a quantitative tool measuring missed nursing care and the reasons for it. Descriptive statistics was applied to analyze demographics, types of NRMC, and reasons for NRMC. The Pearson χ2 test was used to analyze the correlation between demographics and satisfaction variables and NRMC. RESULTS: A total of 314 participants out of 1,944 eligible nurses (response rate, 16%) were recruited. The most commonly reported missed care activities were setting up meals for patients who can feed themselves (87.3%), ambulation (70.1%), attending interdisciplinary conferences (64.3%), providing emotional support to patients and/or family (58%), and turning patients every two hours (56.7%). The most cited reasons for missed care were inadequate number of staff (84.4%), caregiver not in unit or unavailable (76.1%), heavy admission and discharge activity (75.5%), urgent patient situations (74.2%), and unexpected rise in patient volume and/or acuity (73.2%). Younger age, greater experience in role and current unit, inadequate staffing and teamwork, low satisfaction with current role and with being a nurse, and planning to leave the current position were factors significantly associated with greater levels of missed care. CONCLUSION: This study demonstrated evidence of NRMC and its associated factors within the local setting. In addition to expanding nursing resources, analyzing nursing work processes, providing support for younger nurses, and improving nursing satisfaction are possible mitigating factors in preventing missed care. Strategies targeting workforce and resource management, greater support for new and younger nurses, and job satisfaction should be considered to address missed care.

Virtual reality interventions and the outcome measures of adult patients in acute care settings undergoing surgical procedures: An integrative review.

AIMS: To evaluate the different types of virtual reality (VR) therapy received by adult patients undergoing surgical procedures in acute care settings and the outcome measures, as well as to highlight the acceptability and feasibility of VR approaches among patients and healthcare workers. DESIGN: Whittemore and Knafl's integrative review method guided the analysis. DATA SOURCES: Searches were conducted in ScienceDirect, ProQuest, Wiley Online Library, Medline, PsycINFO and PubMed and Google Scholar from 2000 to June 2021. REVIEW METHODS: A systematic search on articles published in English was carried out with electronic databases and hand search references. Keywords searched included primary qualitative and quantitative studies that utilized VR therapy in surgical care settings. RESULTS: Eighteen articles were reviewed, which reported the use of two main strategies: guided and interactive imagery therapy. The findings identified: (i) patient-clinical outcome measures including the use of analgesics, vital signs, functional capacity and length of hospital stay; and (ii) patient-reported experience measures including pain, anxiety and satisfaction level. Comfort, age, knowledge and attitude were key factors influencing the acceptability of VR among the patients, whereas cost-effectiveness and infection control were two main factors affecting the feasibility of use among the health care workers. CONCLUSION: VR therapy demonstrated potential improvements in both the patient-clinical outcomes and patient-reported experiences of those undergoing surgical procedures. However, the findings were inconsistent, which required further research to explore and establish the effectiveness of using VR in the context of acute care settings. IMPACT: VR distraction has been increasingly used as a non-pharmacological method in managing pain, easing anxiety and optimizing other associated outcomes in patients undergoing surgical procedures. It is essential to examine the effectiveness of VR therapy on the adult patients' outcomes in acute care settings with surgical procedures, as well as its acceptability and feasibility of use.