A hospital recreation room quality improvement intervention.

PURPOSE: Patients with extended hospital admissions had no recreation facilities in the ward. They were often confined to spaces around their beds, using the ward corridor for rehabilitation. The purpose of this paper is to outline a quality improvement (QI) intervention-provision of a recreational space for long-stay patients. DESIGN/METHODOLOGY/APPROACH: An exploratory quantitative pre-, post-test design was utilised, and executed in three phases: patients, visitors and staff survey to explore recreation and comfort needs and preferences; store room refurbishment; and patient, visitor and staff satisfaction with the recreation room. FINDINGS: Overall, 77 questionnaires were completed (n=49 staff; n=28 patient/visitor). Almost two-thirds (64.7 per cent; n=11) of patients had a stay greater than six weeks. Insufficient private space and concerns about disturbing other patients were identified as barriers to taking part in activities. Consequently, a store room was refurbished as a recreation room (9.0 m × 6.0 m) and furnished in three distinct areas. Following refurbishment, over 90 per cent (n=24) of respondents agreed that there was a suitable space where patients could "go and chat" and spend time with family and visitors or speak to the healthcare team. PRACTICAL IMPLICATIONS: The physical environment in acute hospitals is seldom prioritised. Needs-based QI projects can improve patient hospital experiences. ORIGINALITY/VALUE: This case study highlights how nursing staff can be informed by patients' and families' needs and preferences, and initiate QI projects that improve patient hospital experiences.

Describing the implementation of an innovative intervention and evaluating its effectiveness in increasing research capacity of advanced clinical nurses: using the consolidated framework for implementation research.

BACKGROUND: Despite advanced nursing roles having a research competency, participation in research is low. There are many barriers to participation in research and few interventions have been developed to address these. This paper aims to describe the implementation of an intervention to increase research participation in advanced clinical nursing roles and evaluate its effectiveness. METHODS: The implementation of the intervention was carried out within one hospital site. The evaluation utilised a mixed methods design and a implementation science framework. All staff in advanced nursing roles were invited to take part, all those who were interested and had a project in mind could volunteer to participate in the intervention. The intervention consisted of the development of small research groups working on projects developed by the nurse participant/s and supported by an academic and a research fellow. The main evaluation was through focus groups. Output was analysed using thematic analysis. In addition, a survey questionnaire was circulated to all participants to ascertain their self-reported research skills before and after the intervention. The results of the survey were analysed using descriptive statistics. Finally an inventory of research outputs was collated. RESULTS: In the first year, twelve new clinical nurse-led research projects were conducted and reported in six peer reviewed papers, two non-peer reviewed papers and 20 conference presentations. The main strengths of the intervention were its promptness to complete research, to publish and to showcase clinical innovations. Main barriers identified were time, appropriate support from academics and from peers. The majority of participants had increased experience at scientific writing and data analysis. CONCLUSION: This study shows that an intervention, with minor financial resources; a top down approach; support of a hands on research fellow; peer collaboration with academics; strong clinical ownership by the clinical nurse researcher; experiential learning opportunities; focused and with needs based educational sessions, is an intervention that can both increase research outputs and capacity of clinically based nurses. Interventions to further enhance nursing research and their evaluation are crucial if we are to address the deficit of nurse-led patient-centred research in the literature.

Importance and use of correlational research.

BACKGROUND: The importance of correlational research has been reported in the literature yet few research texts discuss design in any detail. AIM: To discuss important issues and considerations in correlational research, and suggest ways to avert potential problems during the preparation and application of the design. DISCUSSION: This article targets the gap identified in the literature regarding correlational research design. Specifically, it discusses the importance and purpose of correlational research, its application, analysis and interpretation with contextualisations to nursing and health research. CONCLUSION: Findings from correlational research can be used to determine prevalence and relationships among variables, and to forecast events from current data and knowledge. In spite of its many uses, prudence is required when using the methodology and analysing data. To assist researchers in reducing mistakes, important issues are singled out for discussion and several options put forward for analysing data. IMPLICATIONS FOR PRACTICE: Correlational research is widely used and this paper should be particularly useful for novice nurse researchers. Furthermore, findings generated from correlational research can be used, for example, to inform decision-making, and to improve or initiate health-related activities or change.

Febrile neutropenia risk assessment tool: improving clinical outcomes for oncology patients.

PURPOSE: To develop, implement and evaluate the effectiveness of a nurse-led risk assessment tool to reduce the incidence of febrile neutropenia (FN) and evaluate the nurse's role in FN risk assessment in a hospital-based oncology unit. METHODS AND SAMPLE: A FN risk assessment tool was developed, implemented and evaluated. A comparative prospective observational chart review was undertaken to evaluate the tool. Clinical data were collected from 459 patients' records from August 2008 through July 2009. Patients had no intervention during the first six months (n = 233). Patients in the following six months (n = 226) had the FN risk assessment completed and appropriate granulocyte-colony stimulating factor prescribed. A self-questionnaire was utilised to evaluate the nurses' role in FN risk assessment. KEY RESULTS: The incidence of FN was reduced by 52% (p = 0.02). Hospital days, dose reductions and treatment delays were reduced. Nurses felt they were the most appropriate person to carry out the assessment. CONCLUSIONS: Through consistent risk assessment, nurses could determine which patients were at high risk of developing FN leading to significant reduction in life-threatening infections, hospitalisations, dose reductions and delays. Nurses can be confident and competent in decision-making to reduce life-threatening infections through the use of an FN risk assessment tool.

Injecting drug users, sex workers and men who have sex with men: a national cross-sectional study to develop a framework and prevalence estimates for national HIV/AIDS programmes in the Republic of Serbia.

OBJECTIVE: The aim of this study was to develop a framework and best estimates of prevalence for the most at risk populations (MARPs) for HIV/AIDS to include sex workers (SW), men who have sex with men (MSM) and injecting drug users (IDUs) in order to evaluate national HIV/AIDS programmatic targets across the Republic of Serbia. DESIGN: A national, cross-sectional study and direct enumeration, multiplier and benchmark methods with integrated bio-behavioural surveys, capture/recapture and methods with Wald and Clopper-Pearson CIs were used. SETTING: This study was carried out in the three largest cities and main regions of Serbia, the capital city, Belgrade, (population 1 639 121 persons), the Vojvodina region with main city Novi Sad (population 335 701) and the rest of Serbia with main city Nis (population 257 867). PARTICIPANTS: A total of 1301 respondents from the defined MARPs completed the survey in the 2009/2010 period across the three cities. PRIMARY OUTCOME MEASURES: Estimates of the hidden numbers at risk of HIV/AIDS. RESULTS: It was estimated that there were 1775-6027 SW between 18 and 49 years in Serbia in 2009. For MSM, national estimates for 2009 ranged from 20 789 to 90 104 individuals aged between 20 and 49 years. For IDU, a possible range of 12 682-48 083 individuals aged between 15 and 59 years in 2009 was estimated. CONCLUSIONS: For service planning across Central and Eastern Europe, it is important to highlight how credible estimates can be achieved and compared with numbers within HIV/AIDS-prevention programmes. Within needle exchange programmes, only 5.4-20.5% of the estimated population was observed and this proportion was lower within methadone treatment data. Results have implications for future IDU treatment and HIV incidence and spread across all populations at risk.

Prevalence of frailty-related risk factors in older adults seen by community nurses.

AIMS: To describe the frequency of four frailty-related risk factors in a cohort of older adults visited by community nurses in Dublin, Ireland. BACKGROUND: The Irish public health nursing service allows for both professional and self referral. Risk factors examined were suspected cognitive impairment, nutritional and fall risk, and activities of daily living dependence. DESIGN: Retrospective cross-sectional clinical audit. METHODS: The study incorporated a retrospective clinical audit of files (N = 120) obtained from community nursing visits over 9 months in 2009-2010. A chi-square analysis tested for association between each risk factor and oldest age, living alone, professional referral to the nursing service, and presence of formal home support. RESULTS: Findings revealed a cohort prevalence of suspected cognitive impairment at 16·4%. Risk of malnutrition and risk of a fall were 20·2% and 30·8%, respectively. The cohort was dependent in activities of daily living at a rate of 23·5%. Participants dependent in activities of daily living were less likely to live alone and were more likely to have referred themselves to community nursing. Associations between the four frailty-related risk factors and receiving formal home support were not significant. CONCLUSION: This study results suggest that dependency in activities of daily living (an outcome of frailty) is strongly associated with a decreased likelihood of living alone and increased likelihood of referring oneself to community nursing services. Further research is necessary to examine how frailty screening in the referral process may enhance identification of older adults' community nursing needs in Dublin, Ireland.