ABSTRACT
Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.
Subject(s)
Efficiency, Organizational , Equipment Failure/statistics & numerical data , Nursing Staff, Hospital/organization & administration , Quality Improvement , Critical Care , Cross-Sectional Studies , Humans , Medical-Surgical Nursing/organization & administration , Nurses , Nursing Staff, Hospital/education , Patient Safety , Prospective StudiesABSTRACT
Research shows that healthcare providers' palliative care training and their misconceptions impact the delivery of care. As a result, the need for continuing education with adequate training is paramount to improve their knowledge and confidence in addressing the needs of patients and families facing serious illnesses. A pre-experimental static-group comparison design was used to determine if there was a significant difference in perceived competency and knowledge between healthcare providers who participated in a palliative care training programme and those who did not. A non-randomised sample of healthcare providers were administered a questionnaire to assess perceived competence and knowledge. Responses from 388 participants revealed a significant association between perceived competency and knowledge scores. The authors concluded that participation in a palliative care programme makes a significant difference in the healthcare provider's knowledge. However, further exploration is necessary to deduce the underlying reason for the negative association between perceived competency and knowledge.
Subject(s)
Attitude of Health Personnel , Clinical Competence , Inservice Training , Palliative Care , Florida , Humans , Surveys and QuestionnairesABSTRACT
Clinical partners (CPs) experienced disproportionate workloads related to patients' levels of acuity. This problem was addressed on a medical-surgical unit by developing patient acuity ratings and equitable acuity assignments for the CPs.
Subject(s)
Nursing Assistants/organization & administration , Nursing Staff, Hospital/organization & administration , Patient Acuity , Personnel Staffing and Scheduling/organization & administration , Workload , Attitude of Health Personnel , HumansABSTRACT
The collaborative support model for the graduate nurse is a proactive approach to supporting all aspects of nursing during the 18-week orientation. Weekly meetings include the unit manager, clinical learning educator, unit clinician, registered nurse (RN) resident, and preceptor. Weekly assessment tools containing goals are created and reviewed by the RN resident and preceptor. Learning needs are then addressed by the team. Because the support model was fully implemented, residents have been able to complete the training program successfully, demonstrating confidence, critical thinking, and a strong skill set. The most rewarding outcome has been the link with management, the clinical learning educator, clinicians, and staff.
Subject(s)
Cooperative Behavior , Inservice Training/methods , Interprofessional Relations , Nursing Staff/education , Staff Development/methods , Humans , Inservice Training/organization & administration , Models, Educational , Nursing Staff/organization & administration , Staff Development/organization & administrationABSTRACT
The purpose of this qualitative study was to explore the responses of people with late-stage Alzheimer's disease (AD) to a creative bonding intervention (CBI). The CBI consisted of simple art activities. Guided by Reed's self-transcendence theory, research questions were "Will persons with late-stage AD show evidence of self-transcendence during the CBI?" and "Will persons with late-stage AD show evidence of well-being during the CBI?" Twelve CBI sessions, documented by videotape and field notes, were conducted with four participants. Themes emerged within two clusters: trusting/thirsting/following and choosing/connecting/reminiscing. An overarching category of "cocooning" described participants' world during the CBI as they displayed evidence of self-transcendence and well-being. The CBI is a strategy that can be implemented by staff families, and volunteers. Nurses are positioned to provide transformation leadership for implementation of creative approaches during care of people with late-stage AD, but administrative and financial support are needed.
Subject(s)
Alzheimer Disease/nursing , Alzheimer Disease/rehabilitation , Models, Nursing , Rehabilitation Nursing/methods , Aged , Humans , Qualitative ResearchABSTRACT
In reaching the goal for standardized, quality care, a not-for-profit healthcare system consisting of seven institutional entities is transforming nursing practice guidelines, patient care workflow, and patient documents into electronic, online, real-time modalities for use across departments and all healthcare delivery entities of the system. Organizational structure and a strategic plan were developed for the 2-year Clinical Transformation Project. The Siemens Patient Care Document System was adopted and adapted to the hospitals' documentation and information needs. Two fast-track sessions of more than 100 nurses and representatives from other health disciplines were held to standardize assessments, histories, care protocols, and interdisciplinary plans of care for the top 10 diagnostic regulatory groups. Education needs of the users were addressed. After the first year, a productive, functional system is evidenced. For example, the bar-coded Medication Administration Check System is in full use on the clinical units of one of the hospitals, and the other institutional entities are at substantial stages of implementation of Patient Care Documentation System. The project requires significant allocation of personnel and financial resources for a highly functional informatics system that will transform clinical care. The project exemplifies four of the Magnet ideals and serves as a model for others who may be deciding about launching a similar endeavor.
Subject(s)
Documentation , Electronic Health Records/organization & administration , Hospital Information Systems/organization & administration , Medication Systems, Hospital/organization & administration , Nursing Records , Point-of-Care Systems/organization & administration , Clinical Governance , Critical Pathways , Decision Making, Organizational , Diagnosis-Related Groups , Diffusion of Innovation , Documentation/methods , Florida , Humans , Multi-Institutional Systems/organization & administration , Nurse's Role , Nursing Informatics/education , Nursing Informatics/organization & administration , Patient Care Planning , Patient Care Team , Philosophy, Nursing , Practice Guidelines as TopicABSTRACT
The purpose of this study was to determine the degree of agreement between nursing home staff and families in assessing the needs of cognitively impaired nursing home residents. A convenience sample of 36 family members of nursing home residents with cognitive impairment and the nurses assigned to those patients was recruited from three nursing homes. The Nurse and Resident Perceptions Questionnaire, adapted from Lindgren and Linton (1991), was used to assess functioning in activities of daily living, physiologic, and psychosocial areas. Significant differences were found for eight items of physiologic and psychosocial functioning: difficulties with chewing, swelling of feet, orthopnea, weakness, easy bruising, recognition of people, lack of privacy, and boredom. Nurses rated all these areas less problematic than did the family members. Collaborative efforts of family members and nurses are needed to develop effective plans of care for these problems of nursing home residents with cognitive impairment.
