Nurses' perception of the nursing process and its relationship with leadership / Percepción de los enfermeros sobre el proceso de enfermería y su relación con el liderazgo / Percepção dos enfermeiros sobre o processo de enfermagem e sua relação com a liderança

ABSTRACT Objectives: to describe Nurses' perception of the Nursing Process and its relationship with leadership. Methods: action research conducted between September/2021 and April/2022 with nurses from a medium-sized hospital in southern Brazil. The data investigated, one of the stages of the method, was collected using the Focus Group technique and submitted to Strategic Focus Analysis. Results: three categories emerged from the organized and analyzed data, namely: Nursing Process: a tool that qualifies nursing care; Conditions that weaken the Nursing Process; and Strategies that enhance the Systematization of Nursing Care. Final Considerations: the perception of the Nursing Process and its relationship with leadership are not always understood as complementary themes. Although they recognize that the Nursing Process is sometimes imposed as normative, nurses do not perceive the importance of the role of the leader, who is considered a key player in conducting and boosting the Systematization of Nursing Care.

RESUMEN Objetivos: describir la percepción de los Enfermeros sobre el Proceso de Enfermería y su relación con el liderazgo. Métodos: se trata de una investigación-acción realizada entre septiembre de 2021 y abril de 2022 entre enfermeros de un hospital de medio porte del sur de Brasil. Los datos investigados, una de las etapas del método, fueron recolectados mediante la técnica de Grupo Focal y sometidos al Análisis Focal Estratégico. Resultados: los datos organizados y analizados resultaron en tres categorías, a saber: Proceso de Enfermería como herramienta que cualifica los cuidados de enfermería; Condiciones que debilitan el Proceso de Enfermería; y Estrategias que potencian la Sistematización de los Cuidados de Enfermería. Consideraciones Finales: la percepción del Proceso de Enfermería y su relación con el liderazgo no siempre se toma en cuenta como tema complementario. Aunque los Enfermeros reconocen que el Proceso de Enfermería se impone a veces como normativo, no perciben la importancia del papel del líder, considerado como un actor clave para conducir y dinamizar la Sistematización de los Cuidados de Enfermería.

RESUMO Objetivos: descrever a percepção dos Enfermeiros sobre o Processo de Enfermagem e a sua relação com a liderança. Métodos: pesquisa-ação conduzida entre setembro/2021 e abril/2022 com enfermeiros de um hospital de médio porte do sul do Brasil. Os dados investigados, uma das etapas do método, foram coletados por meio da técnica de Grupo Focal e submetidos à Análise Focal Estratégica. Resultados: dos dados organizados e analisados resultaram três categorias, quais sejam: Processo de Enfermagem: ferramenta qualificadora da assistência de enfermagem; Condições que fragilizam o Processo de Enfermagem; e Estratégias que potencializam a Sistematização da Assistência de Enfermagem. Considerações Finais: a percepção de Processo de Enfermagem e a sua relação com a liderança nem sempre são apreendidos como temas complementares. Embora reconheçam que o Processo de Enfermagem é, por vezes, imposto como normativo, os Enfermeiros não percebem a relevância da função do líder, considerado ator-chave na condução e dinamização da Sistematização da Assistência de Enfermagem.

Development, Validation, and Implementation of a Guideline to Improve Clinical Event Debriefing at a Level-I Adult and Level-II Pediatric Trauma Center.

OBJECTIVE: Clinical event debriefing is recommended by the American Heart Association and the European Resuscitation Council, because debriefings improve team performance. The purpose here was to develop and validate tools needed to overcome barriers to debriefing in the emergency department. METHOD: This quality improvement project was conducted in 4 phases. Phase 1: Current evidence related to debriefing in the emergency department was reviewed and synthesized to inform an iterative process for drafting the debriefing guideline and instrument for documentation. Phase 2: Content Validity Index of the tools was evaluated by obtaining ratings of items' clarity and relevance from 5 national experts in 2 rounds of review. On the basis of experts' feedback, tools were revised, and a Facilitators' Guide was created. Phase 3: The validated debriefing tools were implemented. Phase 4: Debriefing facilitators completed a survey about their experience with using the new tools. RESULTS: The Content Validity Index of 71 debriefing tool items (guideline, instrument, Facilitators' Guide) was 0.93 and 0.96 for clarity and relevance, respectively. Of the 32 debriefings conducted during the first 8 weeks of implementation, 53% described patient safety concerns, and 97% described recommendations to improve performance. Most (94%) facilitators agreed that the guideline clarified debriefing requirements. CONCLUSION: The use of debriefing tools validated by computation of the Content Validity Index led to the identification of safety threats and recommendations to improve care processes. These tools can be used in ED settings to promote team learning and aid in identifying and resolving safety concerns.

Early integration of palliative care for outpatients with advanced cancer in general practice: how is the situation?-a cohort study.

BACKGROUND: Compared with standard care alone, early integration of specialist palliative care in the treatment of patients with advanced cancer offers significant benefit with respect of symptom control, healthrelated quality of life and survival. The early integration of specialist palliative care means that patients receive palliative care concurrent with, or shortly after, the diagnosis of advanced cancer. METHODS: Using data from 2015 compiled from a large German statutory health insurance company (AOK Baden-Wuerttemberg) which insures 3.87 million people, we evaluated how many patients were identified with advanced metastatic cancer and at what point in time, if ever, general practitioners referred them to a specialist palliative home care team. The data were collected exclusively from general practices in the BadenWürttemberg province of Germany. Patients with advanced cancer where identified using all ICD-10 codes for cancer and the ICD-10 codes for metastases. Patients receiving care from a palliative care team were identified using the codes 01425 or 01426 of the German medical fee schedule. RESULTS: We identified 3,535 patients diagnosed with advanced cancer as having palliative care needs. 669 (18.9%) of these were referred to a specialist home care team. Of these, 302 (45.1%) where referred to a palliative care team on the day they were diagnosed but 367 (54.9%) were referred only at a later point in time. Two hundred and six (30.8%) patients had a delayed referral after 8 weeks or more and 153 (22.9%) after more than 12 weeks. CONCLUSIONS: Over half of the cancer patients in general practice who are referred for specialist palliative care are done so very late. General practitioners appear to need encouragement for the early integration of palliative care for patients with advanced cancer and to initiate early referrals to palliative care teams.

Huddles and their effectiveness at the frontlines of clinical care: a scoping review.

BACKGROUND: Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research. METHODS: A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts. RESULTS: Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%). DISCUSSION: Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes. STUDY REGISTRATION: This scoping review was registered with the Open Science Framework on 18 January 2019 ( https://osf.io/bdj2x/ ).

Problemas farmacoterapéuticos asociados a la nutrición parenteral total detectados en el seguimiento farmacoterapéutico y su impacto económico / Drug-therapy problems associated with total parenteral nutrition detected in pharmaceutical care practice and their economic impact

Introducción: La nutrición parenteral total es la administración de los nutrientes requeridos por vía intravenosa. No es un método libre de complicaciones. El químico farmacéutico en el área asistencial por medio del seguimiento farmacoterapéutico puede aportar a la mejora de la terapia nutricional de un paciente con nutrición parenteral total.Objetivo: Detectar los problemas farmacoterapéuticos asociados a la nutrición parenteral total a través del seguimiento farmacoterapéutico en pacientes y los ahorros de las intervenciones farmacéuticas generados en una clínica de tercer nivel en Barranquilla-Colombia.Método: Se realizó un estudio evaluativo, cuasi-experimental, ambiespectivo en 109 pacientes con prescripción de nutrición parenteral total en una clínica de tercer nivel de la ciudad de Barranquilla, durante 6 meses.Resultados: Se detectaron un total de 81 problemas relacionados con los medicamentos durante la fase de estudio, de los cuales el 75,31% fueron del tipo de dosis pauta y/o duración no adecuada. 20 problemas relacionados con los medicamentos se convirtieron en resultados negativos asociados a los medicamentos, de estos, el 55% fueron del tipo inefectividad cuantitativa. Fueron realizadas 81 intervenciones, con un porcentaje de aceptación de 93,83% (76), de las intervenciones aceptadas se lograron resolver 67 problemas, 5 intervenciones no fueron aceptadas y 14 problemas no pudieron ser resueltos debido a distintos factores. En cuanto a los ahorros generados, se alcanzó la cifra de $ 12.751.595 COP en seis meses de desarrollo del estudio.Conclusión: La identificación del perfil del paciente y los riesgos asociados al soporte nutricional ayudarán a generar un impacto económico para la institución y clínico en el paciente teniendo una visión integral de los problemas farmacoterapéuticos asociados. (AU)

Introduction: Total parenteral nutrition is the administration of the nutrients that an individual requires intravenously. It is not a method free of complications. The Pharmacist in care area through pharmacotherapeutic monitoring can contribute to the improvement of the nutritional therapy of a patient with Total parenteral nutrition. Objective: To detect pharmacotherapy problems associated with total parenteral nutrition through pharmacotherapy follow-up in patients and the savings from pharmaceutical interventions generated in a third level clinic in Barranquilla-Colombia.Methodology: It was performed an evaluative study with a quasi-experimental methodological design of ambyespective type, in relation to the time of collection of the data, in 109 patients prescribed with total parenteral nutrition in a third level clinic located in Barranquilla Colombia, in the period between November-December 2018 and January-May 2019.Results: A total of 81 drug related problem were detected during study phase, of which 75,31% were dose type and/or inadequate duration. 20 drug related problem became into negative outcome medications, of these, 55% were quantitative ineffectiveness type. 81 interventions were performed, with an acceptance percentage of 93,83% (76), of these accepted interventions, 67 problems were solved, 5 interventions were not accepted and 14 problems could not be solved due to different factors. Regarding the savings generated, the figure of $12.751.595 COP was reached in six months of study development.Conclusion: The identification of the patient’s profile and the risks associated with nutritional support will help generate an economic impact for the institution and clinician on the patient by having a comprehensive view of the associated pharmacotherapeutic problems. (AU)

Identifying Palliative Patients in General Practice: Focusing on the Place of Death and the Vital Role of Specialized Home Palliative Care: An Observational Study.

Objectives: Specialist palliative care was introduced into the German health care system for patients at the end of life. The primary objective of this study was to assess whether the provision of specialist home palliative care (SHPC) for outpatients increased the likelihood of patients dying at home. Methods: We studied data collected in 2015 from a German statutory health insurance company covering 3.872 million people. We evaluated how many patients were identified as needing palliative care and whether these patients were able to stay at home until death. The data were ascertained from general practices in Baden-Wuerttemberg, a part of Germany. Palliative care patients were identified using the International Classification of Diseases (ICD)-10 code Z51.5 or the assigned medical billing code of the German fee schedule. Patients receiving care from an SHPC team were identified using the billing codes 01425 or 01426. Adjusted odds ratios were calculated for the place of death with multivariable logistic regression. Results: We found 21,190 (0.55%) palliative patients in the whole population. Of these, 19,507 (92.05%) patients received general palliative care and 1683 (7.95%) patients received specialist palliative care. Mortality rate across all patients was 1.08% (41,800) and mortality rate of palliative patients was 44.08% (9494). In total, 19,833 (47.5%) of the general population died in hospitals, as opposed to only 2208 (23.2%) among palliative patients. Further analysis revealed that of those palliative patients receiving SHPC, 160 (13.3%) died in hospitals as opposed to 2048 (24.7%) of those receiving general care. The probability of dying at home increases already with the label "palliative patient" and gets stronger if care is provided by a specialist palliative care team. Conclusion: Most palliative patients are able to die at home. Palliative care teams are responsible for a small part of these patients. Despite the high symptom burden in this group, most are able to die at home.

Gastrostomy Tube Feeding in Children With Developmental or Acquired Disorders: A Longitudinal Comparison on Healthcare Provision and Eating Outcomes 4 Years After Gastrostomy.

BACKGROUND: Studies on long-term feeding and eating outcomes in children requiring gastrostomy tube feeding (GT) are scarce. The aim of this study was to describe children with developmental or acquired disorders receiving GT and to compare longitudinal eating and feeding outcomes. A secondary aim was to explore healthcare provision related to eating and feeding. METHODS: This retrospective cohort study reviewed medical records of children in 1 administrative region of Sweden with GT placement between 2005 and 2012. Patient demographics, primary diagnoses, age at GT placement, and professional healthcare contacts prior to and after GT placement were recorded and compared. Feeding and eating outcomes were assessed 4 years after GT placement. RESULTS: The medical records of 51 children, 28 boys and 23 girls, were analyzed and grouped according to "acquired" (n = 13) or "developmental" (n = 38) primary diagnoses. At 4 years after GT placement, 67% were still using GT. Only 6 of 37 (16%) children with developmental disorders transferred to eating all orally, as opposed to 10 of 11 (91%) children with acquired disorders. Children with developmental disorders were younger at the time of GT placement and displayed a longer duration of GT activity when compared with children with acquired disorders. CONCLUSIONS: This study demonstrates a clear difference between children with developmental or acquired disorders in duration of GT activity and age at GT placement. The study further shows that healthcare provided to children with GT is in some cases multidisciplinary, but primarily focuses on feeding rather than eating.

Liderança transformacional e a eficácia grupal: o papel mediador dos comportamentos de suporte / Transformational leadership and team effectiveness. The mediator role of supportive behaviors

O objetivo deste estudo foi analisar o papel mediador dos comportamentos de suporte na relação entre a liderança transformacional e quatro critérios da eficácia da equipe (designadamente, o desempenho, a viabilidade, a qualidade da experiência grupal e os processos de melhoria). Conduziu-se um estudo empírico com uma amostra composta por 653 participantes de 117 equipes de diferentes setores de atividade (e.g., indústria, proteção civil, consultoria), onde foram testadas as relações previstas. Os resultados mostraram um efeito direto positivo da liderança transformacional nos comportamentos de suporte, assim como dos comportamentos de suporte na eficácia da equipe (nomeadamente, no desempenho, na viabilidade, na qualidade da experiência grupal e nos processos de melhoria). Além disso, foi igualmente identificado um efeito mediador dos comportamentos de suporte na relação entre a liderança transformacional e os quatro critérios da eficácia da equipe. Implicações para a investigação, para a prática profissional e pistas para futuras pesquisas foram apresentadas.

The aim of the present study was to analyse the mediator role of supportive behaviours in the relationship between transformational leadership and four team effectiveness criteria: performance, viability, quality of group experience, and improvement processes. An empirical study was conducted with a sample of 653 participants from 117 teams from different professional practice sectors (e.g., industry, civil protection, and consultancy), in which these relationships were tested. The results showed a positive direct effect of transformational leadership on supportive behaviours and on team effectiveness (including performance, viability, quality of the group experience, and improvement process). Furthermore, the present study also identified the mediator effect of supportive behaviours on the relationship between transformational leadership and the four team effectiveness criteria considered. Implications for research and professional practice were discussed, and suggestions for further studies were offered.

Preparation and Evolving Role of the Acute Care Nurse Practitioner.

Acute care nurse practitioners (ACNPs) are increasingly being employed as members of critical care teams, an outcome driven by increasing demand for intensive care services, a mandated reduction in house officer hours, and evidence supporting the ability of ACNPs to provide high-quality care as collaborative members of critical care teams. Integration of adult ACNPs into critical care teams is most likely to be successful when practitioners have appropriate training, supervision, and mentoring to facilitate their ability to practice efficiently and effectively. Accomplishing this goal requires understanding the educational preparation and skill set potential hires bring to the position as well as the development of an orientation program designed to integrate the practitioner into the critical care team. Pediatric ACNPs are also commonly employed in critical care settings; however, this commentary focuses on the adult ACNP role.

Team functioning in hospice interprofessional meetings: An exploratory study of providers' perspectives.

Interprofessional collaboration is the foundation of hospice service delivery. In the United States, hospice agencies are required to regularly convene interprofessional meetings during which teams review plans of care for the patients and families they serve. A small body of research suggests that team functioning could be significantly enhanced in hospice interprofessional meetings; however, systematic investigation of this possibility has been limited to date. The purpose of this qualitative study was to better understand the experiences and perspectives of hospice providers who regularly participate in interprofessional meetings as a first step toward improving teamwork in this setting. We interviewed 24 hospice providers and conducted a template analysis of qualitative data to identify barriers and facilitators to effective team functioning in interprofessional meetings. Participants recognised the ways meetings supported high-quality, holistic patient and family care but voiced frustrations over meeting inefficiencies, particularly in light of caseloads they perceived as overly demanding. Time constraints were often viewed as prohibiting the inclusion of interprofessional content and full participation of all team members. Findings suggest that modifications to interprofessional meetings such as standardising processes may enhance meeting efficiency and team functioning.

Adverse safety events in patients with Chronic Kidney Disease (CKD).

INTRODUCTION: Chronic kidney disease (CKD) confers a higher risk of adverse safety events as a result of many factors including medication dosing errors and use of nephrotoxic drugs, which can cause kidney injury and renal function decline. CKD patients may also have comorbidities such as hypertension and diabetes for which they require more frequent care from different providers, and for which standard, but countervailing treatments, may put them at risk for adverse safety events. Areas covered: In addition to the well-known agents such as iodinated radiocontrast, antimicrobials, diuretics and angiotensin converting enzyme (ACE) inhibitors which can directly affect renal function, safety considerations in the treatment of common CKD complications such as anemia, diabetes, analgesia and thrombosis will also be discussed. Expert opinion: Better outcomes in CKD may be achieved by alerting care providers to the special care needs of kidney patients and encouraging patients to self-manage their disease with the decision support of multidisciplinary patient care teams.