Implementation and Evaluation of a Standardized Nurse-Administered Assessment of Functional and Psychosocial Issues for Patients in Acute Care.

BACKGROUND: Increasingly, adults presenting to healthcare facilities have multiple morbidities that impact medical management and require initial and ongoing assessment. The interRAI Acute Care (AC), one of a suite of instruments used for integrated care, is a nurse-administered standardized assessment of functional and psychosocial domains that contribute to complexity of patients admitted to acute care. AIM: This study aimed to implement and evaluate the interRAI AC assessment system using a multi-strategy approach based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. METHODS: This nurse-led quality improvement study was piloted in a 200-bed public hospital in Brisbane, Australia, over the period 2017 to 2018. The interRAI AC is a set of clinical observations of functional and psychosocial domains, supported by software to derive diagnostic and risk screeners, scales to measure and monitor severity, and alerts to assist in care planning. Empirical data, surveys, and qualitative feedback were used to measure process and impact outcomes using the RE-AIM evaluation framework (Reach, Efficacy, Adoption, Implementation, and Maintenance). RESULTS: In comparison to usual practice, the interRAI assessment system and supporting software was able to improve the integrity and compliance of nurse assessments, identifying key risk domains to facilitate management of care. Pre-implementation documentation (630 items in 45 patient admissions) had 39% missing data compared with 1% missing data during the interRAI implementation phase (9,030 items in 645 patient admissions). Qualitative feedback from nurses in relation to staff engagement and behavioral intention to use the new technology was mixed. LINKING EVIDENCE TO ACTION: Despite challenges to implementing a system-wide change, evaluation results demonstrated considerable efficiency gains in the nursing assessment system. For successful implementation of the interRAI AC, study findings suggest the need for interoperability with other information systems, access to training, and continued leadership support.

El valor de las enfermeras en tiempos de COVID: una mirada desde la Salud Pública / The value of nurses in times of COVID: a Public Health perspective

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El valor de las especialidades enfermeras. Una visión hacia el futuro / The value of specialist nurses. A vision for the future

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Mortality Risk in Homebound Older Adults Predicted From Routinely Collected Nursing Data.

BACKGROUND: Newer analytic approaches for developing predictive models provide a method of creating decision support to translate findings into practice. OBJECTIVES: The aim of this study was to develop and validate a clinically interpretable predictive model for 12-month mortality risk among community-dwelling older adults. This is done by using routinely collected nursing assessment data to aide homecare nurses in identifying older adults who are at risk for decline, providing an opportunity to develop care plans that support patient and family goals for care. METHODS: A retrospective secondary analysis of Medicare and Medicaid data of 635,590 Outcome and Assessment Information Set (OASIS-C) start-of-care assessments from January 1, 2012, to December 31, 2012, was linked to the Master Beneficiary Summary File (2012-2013) for date of death. The decision tree was benchmarked against gold standards for predictive modeling, logistic regression, and artificial neural network (ANN). The models underwent k-fold cross-validation and were compared using area under the curve (AUC) and other data science metrics, including Matthews correlation coefficient (MCC). RESULTS: Decision tree variables associated with 12-month mortality risk included OASIS items: age, (M1034) overall status, (M1800-M1890) activities of daily living total score, cancer, frailty, (M1410) oxygen, and (M2020) oral medication management. The final models had good discrimination: decision tree, AUC = .71, 95% confidence interval (CI) [.705, .712], sensitivity = .73, specificity = .58, MCC = .31; ANN, AUC = .74, 95% CI [.74, .74], sensitivity = .68, specificity = .68, MCC = .35; and logistic regression, AUC = .74, 95% CI [.735, .742], sensitivity = .64, specificity = .70, MCC = .35. DISCUSSION: The AUC and 95% CI for the decision tree are slightly less accurate than logistic regression and ANN; however, the decision tree was more accurate in detecting mortality. The OASIS data set was useful to predict 12-month mortality risk. The decision tree is an interpretable predictive model developed from routinely collected nursing data that may be incorporated into a decision support tool to identify older adults at risk for death.

Explanatory approach to the grounding of the professional nursing practice

Introduction: In the current health care environment, the needs of the population provided the perfect opportunity for nurses to (re)define their practice and professional career. Within this framework, this study aimed thus at identifying the bases that are underlying the practice, as well as the factors that stimulate or jeopardise the quality of care and a practice that is consistent with the desired grounding. Method: Qualitative study with a phenomenological nature carried out in 19 public hospitals in mainland Portugal with the participation of 56 nurses. The tool used for collecting data was a semi-structured interview. Results: Regarding the factors that stimulate or jeopardise the quality of care a prac-tice that is consistent with the desired grounding, we could highlight features that were perfectly integrated in the triad structure, process and result. In relation to "structure", we could point out the following: organizational resources, human and material resources, service organization, nursing sustainment practices and organization of nursing care. Concerning "process", we could analyse: decision-making process, guiding principles for the professional practice, scientific methodology of health care service, health care documentation process, communication process, collaborative practice and management practice. In what concerns "result", the features were less evident in the participants' speech, and more stressed among clients and nurses. Conclusion: The explanatory approach to the grounding of the professional nursing practice, outlined in a three-dimensional perspective, makes clear the theoretical framework that grounds the practice, as well as the factors in hospital environment, that stimulate or jeopardise the quality of the nursing care

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Standard Operational Protocols in professional nursing practice: use, weaknesses and potentialities / Protocolos Operacionales Patrón en la práctica profesional de enfermería: utilización, fragilidades y potencialidades / Protocolos Operacionais Padrão na prática profissional da enfermagem: utilização, fragilidades e potencialidades

ABSTRACT Objective: to evaluate the use of Standard Operational Protocols (SOPs) in the professional practice of the nursing team based on the theoretical framework of Donabedian, as well as to identify the weaknesses and potentialities from its implementation. Method: Evaluative research, with quantitative approach performed with nursing professionals working in the Health Units of a city of São Paulo, composed of two stages: document analysis and subsequent application of a questionnaire to nursing professionals. Results: A total of 247 nursing professionals participated and reported changes in the way the interventions were performed. The main weaknesses were the small number of professionals, inadequate physical structure and lack of materials. Among the potentialities were: the standardization of materials and concern of the manager and professional related to patient safety. Conclusion: The reassessment of SOPs is necessary, as well as the adoption of a strategy of permanent education of professionals aiming at improving the quality of care provided.

RESUMEN Objetivo: Evaluar la utilización de los Procedimientos Operacionales Patrón (POP) en la práctica profesional del equipo de enfermería, con base en el referencial teórico de Donabedian, bien como identificar las fragilidades y potencialidades a partir de su implantación. Método: Pesquisa evaluativa, con abordaje cuantitativa realizada con profesionales de enfermería actuantes en las Unidades de Salud de un municipio de São Paulo, compuesta por dos etapas: análisis documental y posterior aplicación de cuestionario a los profesionales de enfermería. Resultados: Participaron 247 profesionales de enfermería que han mencionado cambios en la manera de ejecución de las intervenciones estudiadas. Las principales fragilidades apuntaron para el número reducido de profesionales, inadecuación de la estructura física y ausencia de materiales. Entre las potencialidades se destacaron: la estandarización de los materiales y la preocupación del gestor y del profesional relacionada a la seguridad del paciente. Conclusión: La reevaluación de los POP es necesaria, bien como la adopción de la estrategia de educación permanente de los profesionales visando la mejoría de la cualidad de la asistencia prestada.

RESUMO Objetivo: avaliar a utilização dos Procedimentos Operacionais Padrão (POP) na prática profissional da equipe de enfermagem, com base no referencial teórico de Donabedian, bem como identificar as fragilidades e potencialidades a partir da sua implantação. Método: Pesquisa avaliativa, com abordagem quantitativa realizada com profissionais de enfermagem atuantes nas Unidades de Saúde de um município paulista, composta por duas etapas: análise documental e posterior aplicação de questionário aos profissionais de enfermagem. Resultados: Participaram 247 profissionais de enfermagem que referiram mudanças na forma de execução das intervenções estudadas. As principais fragilidades apontaram para o número reduzido de profissionais, inadequação da estrutura física e ausência de materiais. Entre as potencialidades destacaram-se: a padronização dos materiais e a preocupação do gestor e do profissional relacionada à segurança do paciente. Conclusão: A reavaliação dos POP é necessária, bem como a adoção da estratégia de educação permanente dos profissionais visando à melhoria da qualidade da assistência prestada.

Standard Operational Protocols in professional nursing practice: use, weaknesses and potentialities.

OBJECTIVE: to evaluate the use of Standard Operational Protocols (SOPs) in the professional practice of the nursing team based on the theoretical framework of Donabedian, as well as to identify the weaknesses and potentialities from its implementation. METHOD: Evaluative research, with quantitative approach performed with nursing professionals working in the Health Units of a city of São Paulo, composed of two stages: document analysis and subsequent application of a questionnaire to nursing professionals. RESULTS: A total of 247 nursing professionals participated and reported changes in the way the interventions were performed. The main weaknesses were the small number of professionals, inadequate physical structure and lack of materials. Among the potentialities were: the standardization of materials and concern of the manager and professional related to patient safety. CONCLUSION: The reassessment of SOPs is necessary, as well as the adoption of a strategy of permanent education of professionals aiming at improving the quality of care provided.

Capturing Functional Independence Measure (FIM®) Ratings.

PURPOSE: The aim of the study was to identify interventions to capture admission functional independence measure (FIM®) ratings on the day of admission to an inpatient rehabilitation facility. DESIGN: A quantitative evidence-based practice quality improvement study utilizing descriptive statistics. METHODS: Admission FIM® ratings from patients discharged in June 2012 (retrospective review) were compared to admission FIM® ratings from patients discharged in June 2014 (prospective review). The logic model was utilized to determine the project inputs, outputs, and outcomes. FINDINGS: Interventions to capture admission FIM® ratings on the day of admission are essential to accurately predict the patient's burden of care, length of stay, and reimbursement. Waiting until Day 2 or Day 3 after admission to capture the admission FIM® assessment resulted in inflated admission FIM® ratings and suboptimal quality outcomes. CONCLUSION/CLINICAL RELEVANCE: Interventions to capture admission FIM® ratings on the day of admission were successful at improving the quality of care, length of stay efficiency, and accurately recording admission FIM® ratings to determine the patient's burden of care.

Las representaciones sociales como marco para comprender las respuestas humanas en el cuidado enfermero / Representações sociais como um quadro para a compreensão das respostas humanas nos cuidados de enfermagem / Social representations as a framework for understanding human responses in nursing care

Las repuestas humanas son complejas y dependen de manera relevante de las condiciones sociales, culturales, económicas y políticas de los contextos micro, meso y macro en los que las personas se desenvuelven. El profesional de enfermería requiere desarrollar una perspectiva epistémica, filosófica y metodológica que le posibilite comprender que las maneras en que las personas se posicionan frente a los procesos salud-enfermedad no derivan exclusivamente de una decisión personal, sino también de una postura colectivamente construida. El objetivo del ensayo es reflexionar sobre las aportaciones que hace la teoría de las representaciones sociales (RS) a la comprensión de la complejidad de las respuestas humanas frente al cuidado. Para la construcción del ensayo se revisaron las aportaciones de autores clásicos a la teoría de las RS, estos aportes se reflexionan desde experiencias del cuidado de la salud. Se identifica que este marco teórico posibilita explicar la diversa complejidad y variabilidad de las respuestas humanas de las personas frente a los procesos de salud y enfermedad, y de los contextos sociales e históricos en que los sujetos y su grupo social se desarrollan (AU)

Respostas humanas são complexas e de-pendem fortemente das condições sociais, culturais, económicos e políticos do micro, meso e macro em que as pessoas vivem contextos. A enfermeira precisa desenvolver uma perspectiva epistemológica, filosófica e metodológica que lhe permite compreender as maneiras pe-las quais as pessoas estão posicionados con-tra processos de saúde-doença não derivam exclusivamente de uma decisão pessoal, mas também uma postura construído coletivamente. O objetivo deste artigo é refletir sobre as contribuições feitas pela teoria das representações sociais (RS) para a compreensão da com-plexidade das respostas humanas a cuidados humanos. Eles foram revistos contribuições clássicas para a teoria da RS autores refletem suas contribuições são baseadas em experiên-cias de cuidados de saúde. Identificou-se que este quadro teórico permite explicar a comple-xidade e variabilidade das respostas humanas de pessoas processos de saúde e doença, e contextos sociais e históricos nos quais os indiví-duos que enfrentam variados e desenvolver seu grupo social (AU)

Human responses are complex and are based on how relevant social, cultural, eco-nomic and political micro, meso and macro in which people operate contexts conditions. The nurse needs an epistemological, philosophical and methodological perspective that allows him to understand the ways in which people are positioned against health-disease processes depend not only on a personal decision but a posture collectively built. The aim is to reflect on the contributions made by the theory of social representations (RS) to understanding the complexity of human responses to human care. For the construction of the document the contributions of classic authors to the theory of RS, these contributions reflect from the experiences of health care were recovered. It identifies possible that this theoretical frame-work to explain the complexity and variability of human responses of people facing processes of health and disease, and social and historical contexts in which subjects and develop their social group (AU)

Incidencia de flebitis asociada a catéteres centrales de inserción periférica en UCI adultos: implementación de un protocolo para enfermería / Phlebitis incidence associated to peripherally inserted central catheters in adults ICU: implementation of a nursing protocol

Justificación: La flebitis es una de las complicaciones mas frecuentes de los Catéteres Centrales de Inserción Periférica. La evidencia científica sobre la utilidad de las escalas de medición para el diagnostico de flebitis es escasa. Objetivos: Comparar la incidencia de flebitis antes y después de la implementación de un protocolo. Material y métodos: Estudio de cohortes retrospectivo en 159 pacientes ingresados en UCI, a los que se les ha colocado un PICC, en dos periodos equivalentes de dos años consecutivos, Periodo 1 (n=59); frente a un grupo del Periodo 2 (n=100) en el que se aplicó un nuevo protocolo para el diagnóstico y manejo de flebitis (definición de flebitis, aplicación de la Visual Infusion Phlebitis Score y valoración continua). Resultados: El riesgo de ser diagnosticado de flebitis fue significativamente menor en el P2 (OR: 0.09, I.C.95% 0.01-0.52) Conclusiones: La incorporación del protocolo redujo un 90% los diagnósticos de flebitis (AU)

Phlebitis incidence related to peripherally inserted central catheters (PICCs): New nursing protocol application. Phlebitis is one of the most common complications of peripherally inserted central catheters (PICCs). The scientific evidence about the utility of measuring scales to phlebitis diagnosis is very limited. Objectives: To compare phlebitis incidence rate before and after the introduction of a new protocol. Materials and Methods: Retrospective cohort study in 159 patients admitted to the intensive care unit (ICU) for two years. First we assess phlebitis in 59 patients (group 1). After that we apply a new protocol to identify phlebitis with visual score and continuous evaluation to 100 patients (group 2) Results: The probability of being diagnosed of phlebitis is significantly smaller in intervention group (OR: 0.09; 95% C.I.: 0.02-0.57). Conclusions: Protocol application reduced the diagnosis of phlebitis in 90% (AU)

Pain, Genes, and Function in the Post-Hip Fracture Period.

Post-hip fracture generalized pain can lead to a progressive decline in function and greater disability. The purpose of this study was to explore the factors that influence pain among older adults post-hip fracture, including genetic variability, and evaluate whether pain directly or indirectly influenced upper and lower extremity function. This was a secondary data analysis using data from the first 200 participants in a Baltimore Hip Study (BHS), BHS-7. Assessments were done at 2 months post-hip fracture and included age, sex, marital status, education, cognitive status, comorbidities, body mass index (BMI), upper and lower extremity function, single nucleotide polymorphisms (SNPs) from 10 candidate genes, and total areas of pain and pain intensity. Model testing was done using the AMOS statistical program. The full sample included 172 participants with an average age of 81. Fifty percent were female and the majority was Caucasian (93%). Model testing was done on 144 individuals who completed 2 month surveys. Across all models, age, cognition, and BMI were significantly associated with total areas of pain. Thirty SNPs from five genes (BDNF, FKBP5, NTRK2, NTRK3, and OXTR) were associated with areas of pain and/or pain intensity. Together, age, cognition, BMI, and the SNP from one of the five genes explained 25% of total areas of pain and 15% of pain intensity. Only age and cognition were significantly associated with lower extremity function, and only cognition was significantly associated with upper extremity function. The full model was partially supported in this study. Our genetic findings related to pain expand prior reports related to BDNF and NTRK2.

Fenomenología: una visión investigativa para enfermería / Fenomenologia: uma visão para a pesquisa em enfermagem / Phenomenology: a vision for nursing research

La disciplina de enfermería necesita identificarse con una filosofía que le permita otorgar un sentido interpretativo a los fenómenos sociales o individuales; y la investigación cualitativa ofrece la metodología necesaria para llevar a cabo la interpretación de los significados bajo un análisis crítico y reflexivo. El objetivo del presente trabajo fue reflexionar sobre diferentes tradiciones filosóficas en torno a la fenomenología, al explorar los pensamientos de Edmund Husserl, Martin Heidegger y Alfred Schütz. Se realizó un ensayo teórico cuyo insumo literario se obtuvo de repositorios y fuentes de datos electrónicas, se incluyeron artículos publicados de los años 2010 al 2014, se utilizaron combinaciones de ocho palabras clave y se excluyeron aquellos artículos que no mencionaron el enfoque teórico de los filósofos de interés. Se concluye que las tres perspectivas filosóficas plantean una estrategia metodológica factible de ser utilizada dentro de la investigación cualitativa en enfermería, ya sea bajo la escuela descriptiva de Husserl, la postura interpretativa de Heidegger o la visión social de Schütz (AU)

The discipline of nursing needs to identify with a philosophy that allows give an interpretive sense of social or individual phenomena; and qualitative research provides the necessary methodology to perform the interpretation of the meanings under a critical and reflective analysis. The aim of this study was to reflect on different philosophical traditions around phenomenology, exploring the thoughts of Edmund Husserl, Martin Heidegger and Alfred Schütz. A theoretical essay whose literary input was obtained from repositories and electronic data sources was conducted, published in the years 2010 to 2014 were included combinations of eight key words were used and those items not mentioned the theoretical approach of philosophers were excluded Of interest. It is concluded that the three philosophical perspectives pose a feasible methodological strategy to be used in qualitative research in nursing, either under the descriptive school of Husserl, Heidegger interpretive stance or the social vision of Schütz (AU)

A disciplina de enfermagem precisa identificar-se com uma filosofia que permite dar um sentido interpretativo dos fenômenos sociais ou individuais; e pesquisa qualitativa fornece a metodologia necessária para realizar a interpretação dos significados sob uma análise crítica e reflexiva. O objetivo deste estudo foi refletir sobre diferentes tradições filosóficas em torno de fenomenologia, explorando os pensamentos de Edmund Husserl, Heidegger e Alfred Martin Schütz. Um ensaio teórico cuja entrada literária foi obtida a partir de repositórios e fontes de dados eletrônicos foram realizadas, publicado nos anos de 2010 a 2014 foram incluídos foram utilizadas combinações de oito palavras-chave e esses itens não mencionou a abordagem teórica de filósofos foram excluídos juros. Conclui-se que as três perspectivas filosóficas representam uma estratégia metodológica viável para ser utilizado na pesquisa qualitativa em enfermagem, seja sob a escola descritiva de Husserl, Heidegger postura interpretativa ou a visão social de Schütz (AU)

The Future of Gero-Oncology Nursing.

OBJECTIVES: To project the future of gero-oncology nursing as a distinct specialty, framed between analysis of current challenges and explication of prospective solutions. DATA SOURCES: Peer-reviewed literature, policy directives, web-based resources, and author expertise. CONCLUSION: Oncology nursing faces several challenges in meeting the needs of older people living with cancer. Realigning cancer nursing education, practice, and research to match demographic and epidemiological realities mandates redesign. Viewing geriatric oncology as an optional sub-specialty limits oncology nursing, where older people represent the majority of oncology patients and cancer survivors. The future of gero-oncology nursing lies in transforming oncology nursing itself. IMPLICATIONS FOR NURSING PRACTICE: Specific goals to achieve transformation of oncology nursing into gero-oncology nursing include assuring integrated foundational aging and cancer content across entry-level nursing curricula; assuring a gero-competent oncology nursing workforce with integrated continuing education; developing gero-oncology nurse specialists in advanced practice roles; and cultivating nurse leadership in geriatric oncology program development and administration along with expanding the scope and sophistication of gero-oncology nursing science.

An evidence-based review of the rectovaginal examination during well-woman visits.

BACKGROUND AND PURPOSE: Women's health promotion and disease prevention has experienced considerable transformation over the past decade. This includes introduction of the Human Papillomavirus (HPV) vaccination, updated recommendations for mammography screening, Papanicolaou smear and HPV testing, and pelvic examinations. Despite significant literature about these subjects, one area that has not been reviewed is the rectovaginal examination (RVE). This article will examine available evidence regarding the RVE and make evidence-based recommendations that nurse practitioners (NPs) can integrate into practice METHODS: An electronic search was completed using PubMed, CINAHL, National Guideline Clearinghouse, and Cochrane Data Bases. Medical Subject Heading terms and keywords included Physical Examination, Vagina, Rectum, Digital Rectal Examination, Gynecological Examination, and Rectovaginal Examination in combination with Well-Woman, Screening, and Pelvic Examination. CONCLUSIONS: Available literature shows the RVE to have low sensitivity in detecting uterosacral nodularity, rectal compression, cervical involvement of endometrial cancer, and colorectal cancer. IMPLICATIONS FOR PRACTICE: This critical review of available literature found no evidence to support the use of the RVE in well-woman visits. NPs should limit the use of the RVE to patients presenting with rectovaginal or pelvic complaints.

[The prison nurse: analysis of the evolution of the legislative framework]. / L'infermiere in carcere: analisi dell'evoluzione legislativa.

The evolution of the role of prison nurses through the Italian legislation is presented, analyzing the implication of the transfer of competences from the Law ministry to the National Health Service. Until 60 years ago scarce attention was paid to the health of prisoners and only in the years 70' nurses were formally included in the staff of the prisons.

Development and implementation of an educational support process for electronic nursing admission assessment documentation.

Educating nurses in use of the electronic health record nursing admission assessment using e-learning alone may not yield best results. Use of a hybrid instructional method of e-learning followed by a brief (20-minute) slide presentation with face-to-instruction significantly improved nursing documentation.

Oral assessment and nursing interventions among Nigerian nurses-knowledge, practices and educational needs.

BACKGROUND: Assessment of oral condition, oral care, and informing the attending doctor of unusual oral findings for possible consultation or referral to a dentist are the advocated roles of hospital nurses. The objective of the study was thus to assess the roles of Nigerian nurses in the assessment of oral conditions of hospitalized patients. METHODS: This questionnaire-based cross-sectional survey of all nurses caring for hospitalized patients in the University of Benin Teaching Hospital was conducted in the first half of 2010. RESULTS: Of the 384 studied participants, 94.3% considered oral care as an important aspect of nursing care and 73.4% had oral health component in their nursing school curriculum. A total of 80.7% reported suspicious and abnormal findings in hospitalized patients to the attending doctor. Amongst the respondents, 38.0% reported ability to conduct good oral tissue examination. Only 28.1% demonstrated good knowledge of common oral diseases. Three-quarters (73.4%) thought that it is compulsory for nurses to assess the oral condition of hospitalized patients. The 67.7% and 21.9% of the respondents did the assessment on admission and discharge respectively. The majority (90.1%) desired training on oral care of hospitalized patients. CONCLUSION: There is a need to improve the skill and competence of nurses in the assessment of oral condition to make them a substantive partner in the oral care of hospitalized patients.