Exploring the Documentation of Delirium in Patients After Cardiac Surgery: A Retrospective Patient Record Study.

Delirium is a common disorder for patients after cardiac surgery. Its manifestation and care can be examined through EHRs. The aim of this retrospective, comparative, and descriptive patient record study was to describe the documentation of delirium symptoms in the EHRs of patients who have undergone cardiac surgery and to explore how the documentation evolved between two periods (2005-2009 and 2015-2020). Randomly selected care episodes were annotated with a template, including delirium symptoms, treatment methods, and adverse events. The patients were then manually classified into two groups: nondelirious (n = 257) and possibly delirious (n = 172). The data were analyzed quantitatively and descriptively. According to the data, the documentation of symptoms such as disorientation, memory problems, motoric behavior, and disorganized thinking improved between periods. Yet, the key symptoms of delirium, inattention, and awareness were seldom documented. The professionals did not systematically document the possibility of delirium. Particularly, the way nurses recorded structural information did not facilitate an overall understanding of a patient's condition with respect to delirium. Information about delirium or proposed care was seldom documented in the discharge summaries. Advanced machine learning techniques can augment instruments that facilitate early detection, care planning, and transferring information to follow-up care.

Identifying nurse managers' essential information needs in daily unit operation in perioperative settings.

Aim: To identify nurse managers' essential information needs in daily unit operation in perioperative settings. Design: Qualitative and quantitative descriptive design. Methods: The study consisted of (I) generation of an item pool of potential information needs, (II) assessment of the item pool by an expert panel and (III) confirming the essential information needs of nurse managers in daily unit operation with a survey (N = 288). Content validity index values were calculated for the assessments by expert panel and in the survey. Internal consistency of the final item pool was explored with Cronbach's alpha. The data were collected from 2011-2015. Results: During the study process, the number of essential information needs decreased from 92-41. The final item pool consisted of 12 subthemes, and they were categorized into four main themes: patient's care process, surgical procedure, human resources and tangible resources. The findings can be used to create a knowledge map for information system purposes.

The nurse manager's role in perioperative settings: An integrative literature review.

AIM: To describe the nurse manager's role in perioperative settings. BACKGROUND: The nurse manager's role is complex and its content unclear. Research in this area is scarce. We need to better understand what this role is to support the nurse manager's work and decision-making with information systems. EVALUATION: An integrative literature review was conducted in May 2018. Databases CINAHL, Cochrane, PubMed and Web of Science were used together with a manual search. The review followed a framework especially designed for integrative reviews. Quality of the literature was analysed with an assessment tool. Nine studies published between 2001 and 2016 were included in the final review. KEY ISSUE: The findings from the review indicate that the nurse manager's role requires education and experience, and manifests in skills and tasks. A bachelor's degree with perioperative specialisation is the minimum educational requirement for a nurse manager. CONCLUSION: Research lacks a clear description of the nurse manager's role in perioperative settings. However, the role evolves by education. More education provides advanced skills and, thereby, more demanding tasks. Information technology could provide useful support for task management. IMPLICATIONS FOR NURSING MANAGEMENT: These findings can be used to better answer the current and future demands of the nurse manager's work.

Information needs in day-to-day operations management in hospital units: A cross-sectional national survey.

AIM: To describe and compare shift leaders' important information needs by profession, unit, time of day and type of hospital. BACKGROUND: Professionals responsible for care provision in hospital units make ad hoc decisions about available resources to meet patient care needs but, currently, much effort is needed to obtain the necessary information to support decision making. METHODS: This survey was carried out in nine randomly chosen hospitals in Finland. Nurses and physicians responsible for day-to-day operations were eligible to participate (N = 873). The response rate was 65% (n = 570, including 453 nurses and 111 physicians). Data were collected in 2015-2016 using the Hospital Shift Leaders' Information Needs Questionnaire with 114 information need items. RESULTS: Shift leaders reported many real-time information needs. Nurses' important information needs concerned patients, personnel, and materials, and physicians' needs focused on patient care. Large mean differences existed in the needs between nurses and physicians, and imaging units when compared to other units. CONCLUSION: Real-time information systems for shift leaders should consider the needs of different users to support shared situational awareness and operational intelligence. IMPLICATIONS FOR NURSING MANAGEMENT: The important information-need items identified here may be used in designing and developing information systems that better support shift leaders' work in hospitals.

Assessing managerial information needs: Modification and evaluation of the Hospital Shift Leaders' Information Needs Questionnaire.

AIMS: The aims were (1) to evaluate the modified version of the Intensive Care Unit Information Need Questionnaire for the broader hospital setting, and (2) to describe the differences in respondents' managerial activities and information needs according to the position held by the respondent and the type of hospital unit. BACKGROUND: Information systems do not support managerial decision-making sufficiently and information needed in the day-to-day operations management in hospital units is unknown. METHODS: An existing questionnaire was modified and evaluated. Shift leaders, that is, the nurses and physicians responsible for the day-to-day operations management in hospital units were reached using purposive sampling (n = 258). RESULTS: The questionnaire ascertained the importance of information. Cronbach's α ranged from .85-.96 for the subscales. Item - total correlations showed good explanatory power. Managerial activities and information needs differed between respondents in different positions, although all shared about one-third of important information needs. The response rate was 26% (n = 67). CONCLUSIONS: The validity and reliability of the questionnaire were good. Attention should be paid to the positions of shift leaders when developing information systems. IMPLICATIONS FOR NURSING MANAGEMENT: The questionnaire can be used to determine important information when developing information systems to support day-to-day operations management in hospitals.

Decision-Making to Support Smooth Daily Unit Operation in Perioperative Settings.

Decision-making in daily unit operation in perioperative settings needs to be smooth. Decision support systems are mainly used as help in this situation. These systems reduce the possibility of risks caused by poor communication. But the decisions and dimensions of the decisions made by nurse manager are still unsolved. The aim of our study was to describe the timeframe of the decisions made by nurse managers in the daily unit operation in perioperative settings. The results indicated that nurse managers made operational and tactical decisions. These operational and tactical decisions happened coincide during the nurse managers shift. The nurse managers were repeatly interrupted in decision-making.

Nurse managers' decision-making in daily unit operation in peri-operative settings: a cross-sectional descriptive study.

AIM: To describe the tactical and the operational decisions made by nurse managers when managing the daily unit operation in peri-operative settings. BACKGROUND: 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. DESIGN: Descriptive cross-sectional design. METHOD: Data were collected from 20 nurse managers with the think-aloud method during the busiest working hours and analysed using thematic content analysis. RESULTS: 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. CONCLUSIONS: Decision-making was vulnerable to interruptions, which sometimes complicated the managing tasks. IMPLICATIONS FOR NURSING MANAGEMENT: The results can be used when planning decision support systems and when defining the nurse managers' tasks in peri-operative settings.

An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care.

The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22-67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review.