The Effectiveness of Healthcare System Resilience during the COVID-19 Pandemic: A Case Study.

Introduction: The outbreak of the COVID-19 pandemic was a period of uncertainty and stress for healthcare managers due to the lack of knowledge (about the transmission of the virus, etc.) and also due to the lack of uniform organisational and treatment procedures. It was a period where the ability to prepare for a crisis, to adapt to the existing conditions, and to draw conclusions from the situation were of critical importance to keep ICUs (intensive care units) operating. The aim of this project is to compare the pandemic response to COVID-19 in Poland during the first and second waves of the pandemic. This comparison will be used to identify the strengths and weaknesses of the response, including challenges presented to health professionals and health systems and ICUs with COVID-19 patients according to the European Union Resilience Model (2014) and the WHO Resilience Model (2020). The WHO Resilience model was suitable to the COVID-19 situation because it was developed based on this experience. Methods: A matrix of 6 elements and 13 standards assigned to them was created using the EC and WHO resilience guidelines. Results: Good governance in resilient systems ensures access to all resources without constraints, free and transparent flow of information, and a sufficient number of well-motivated human resources. Conclusions: Appropriate preparation, adaptation to the existing situation, and effective management of crisis situations are important elements of ensuring the resilience of ICUs.

The Usability of IT Systems in Document Management, Using the Example of the ADPIECare Dorothea Documentation and Nurse Support System.

BACKGROUND: In 2016, an IT system was developed at MUL for the documentation of nursing practice. Preparing nursing students for the implementation of eHealth solutions under simulated conditions is crucially important for achieving the digital competencies necessary for health care systems in the future. Scientific evidence demonstrates that the use of an IT system in clinical practice shortens the time required for the preparation of documentation, increases the safety of clinical decisions and provides data for analysis and for the creation of predictive models for the purposes of HB HTA. METHODS: The system was created through the cooperation of an interprofessional team at the Medical University of Lódz. The ADPIECare system was implemented in 2016 at three universities in Poland, and in 2017 a study of its usability was conducted using a questionnaire made available by Healthcare Information and Management Systems Society, "Defining and Testing EMR Usability MASTER V2 Final" on 78 nurses-students of MA in Nursing at Medical University of Lódz. FINDINGS: Over 50% of the surveyed nurses indicated the usability of the system for the "effectiveness of documentation" variable. The same group of respondents had a positive attitude towards patient care planning with the use of the assessed system. In the opinions of the examined parties, positive opinions predominated, such as, e.g., "the system is intuitive", "the system facilitates work", "all patient assessments are in one place", and "the time needed for data entry would be shortened".

The Influence of Nurse Education Level on Hospital Readmissions-A Cost-Effectiveness Analysis.

Background: Readmissions are adverse, costly, and potentially preventable. The study aimed to evaluate the cost-effectiveness of reducing readmissions resulting from missed care, depending on the level of education of nurses, from the perspective of the service provider. Methods: We calculated missed care resulting in additional readmissions based on the longitudinal study conducted between 2012 and 2014, as well as readmissions that could have been potentially prevented by adding a 10% increase in hours of nursing care provided by BSN/MSc nurses for 2014. The cost-effectiveness analysis (CEA) was performed to calculate the cost-effectiveness of preventing one hospitalization in non-surgical and surgical wards by increasing the number of nursing hours provided by BSN/MSc nurses. Cost−benefit analysis (CBA) was performed, and the CBR (cost−benefit ratio) and BCR (benefit−cost ratio) were calculated. Results: Increasing the number of hours of nursing care (RN) by 10% decreased the chance for an unplanned readmission by 11%; (OR = 0.89; 95% CI: 0.78−1.01; p = 0.08) in non-surgical wards and 43% (OR = 0.57; 95% CI: 0.49−0.67; p < 0.001) in surgical wards. In non-surgical wards, the number of readmissions that were preventable with extra hours provided by BSN/MSc nurses was 52, and the cost-effectiveness ratio (CER) was USD 226.1. The number of preventable readmissions in surgical wards was 172, and the CER was USD 54.96. In non-surgical wards, the CBR was USD 0.07, while the BCR was USD 1.4. In surgical wards, the CBR was USD 0.02, and the BCR was USD 4.4. Conclusions: The results of these studies broaden the understanding of the relationship among nursing education, patient readmission, and the economic outcomes of hospital care. According to the authors, the proposed intervention has an economic justification. Hence, the authors recommend it for approval by the service provider.

Nursing Care Plan for a Newborn with the Defect of Congenital Gastroschisis in the Postoperative Period Using ICNPTM and the Dedicated Software.

BACKGROUND: Congenital defect gastroschisis manifests as a defect in the sheath in the intestine of the newborn, which is not covered by the hernia sac. In this case, the priority task of the neonatal nurse is to diagnose patient care problems quickly and accurately. Choosing the correct care plan elements has a significant impact on shortening the duration of hospitalization, reducing the number and severity of complications, and preventing their recurrence. The purpose of this study was to formulate a care plan for a newborn with diagnosed congenital defect gastroschisis in the postoperative period, using the International Classification for Nursing Practice (ICNPTM) within the nursing documentation and decision support system, the "ADPIECare Dorothea" software. METHODS: After a review of the relevant literature and nursing documentation, a case study of a newborn with the congenital defect gastroschisis was described. A care plan was prepared using ICNP and the "ADPIECare" software. RESULTS: It was possible to organize and standardize care plans to provide consistent and comprehensive professional nursing care. The system supporting nursing decisions suggested interventions personalized for the nursing diagnoses and to the patient needs. CONCLUSIONS: Our findings can help to optimize the nurse's work organization to improve health care quality, outcomes, and effectiveness.

Cost-Effectiveness Analysis of Improving Nurses' Education Level in the Context of In-Hospital Mortality.

(1) Background: an assessment of the cost-effectiveness of employing an increased number of nurses with higher education from the perspective of the service provider. (2) Methods: Based on a year-long study results and data collected from a large hospital, we conducted of the costs of preventing one death. The study involved intervention by 10% increase in the percentage of nursing care hours provided by nurses with higher education. The measure of health effects was the cost of avoiding one death (CER). The cost-effectiveness analysis (CEA) was used as the evaluation method. (3) Results: The cost of employing a larger percentage of nurses with higher education amounts to a total of amounts to a USD 11,730.62 an increase of 3.02% as compared to the base costs. The estimated number of deaths that could be prevented was 44 deaths. Mortality per 1000 patient days was 9.42, mortality after intervention was 8.41. The cost of preventing one death by the 10% increase in BSN/MSN NCH percentage in non-surgical wards USD 263.92. (4) Conclusions: increasing the percentage of care hours provided by nurses with tertiary education is a cost-effective method of reducing in-hospital mortality.

Increased Accessibility to Primary Healthcare Due to Nurse Prescribing of Medicines.

Since January 2016, nurses and midwives in Poland have had the right, with some restrictions, to prescribe medicines. Consequently, Polish patients received the same opportunity as in other countries worldwide: easier access to certain health services, i.e., medical prescribing. The aim of this study was to assess the impact of structural changes which increased the nurses' competences on the accessibility to prescription visits for patients receiving primary healthcare on the example of Medical and Diagnostic Centre (MDC), and to discuss the general trend of legal changes in nursing profession regulations. We performed a detailed analysis of the data on the MDC patient population in Siedlce who received at least one prescription written by a general practitioner and/or a nurse/midwife in the years 2017-2019.The largest number of prescription visits made by nurses concerned patients aged 50-70 years, as this age range includes the largest number of patients with chronic diseases who need continued pharmacological treatment originally administered by doctors. An increasing tendency for prescription visits made by nurses was recorded, with a simultaneous downward trend in the same type of visits undertaken by doctors at MDC. Nurses' involvement in prescribing medications as a continued pharmacotherapy during holiday seasons results in patients having continuous access to medication. An upward trend was also observed in the number of medications prescribed by nurses per patient. Structural changes in the legal regulations of the nursing profession improve patients' access to prescription visits under primary healthcare. Further research is recommended to evaluate the dynamics of these trends and the impact of newly introduced nursing competences on the accessibility of prescription visits for patients.

Continuous professional development of nurses and ICNP® introduction in Poland.

OBJECTIVES: The aim of the study was to explore Polish nurses' readiness to use the International Classification for Nursing Practice (ICNP®) as part of continuous professional development and life-long learning. MATERIAL AND METHODS: The study included 772 nurses, divided into 2 study groups. The first group comprised those who had participated in a course enhancing the knowledge and improving skills in the use of ICNP® terminology (N = 457). The second group comprised people who had not yet attended such a course (N = 315). RESULTS: In the pre-course group, education correlated significantly with a general knowledge of ICNP® and its components, as the answers to 9 out of 13 questions revealed (p > 0.05). In the postcourse group, such a correlation was observed in the answers to all the questions except the following: "Is it possible to implement ICNP® in your place of work?" (ρ = 0.066, p = 0.137). Statistically significant differences were found when it comes to the correlation of all 13 questions and the results with the overall level of knowledge of ICNP®. A higher level of agreement with the questions and a higher level of knowledge were observed in the post-course group. However, this did not apply to the following question: "Is it possible to implement ICNP® in your place of work?" (Z = -0.06, p = 0.955, r = 0.002). CONCLUSIONS: Effective pre- and postgraduate education prepares nurses for working with ICNP® terminology. In fact, IT tools, implemented into the education process, could help to develop skills and the understanding of how nurses can use ICNP® in the nursing process. There are some obvious difficulties with the practical implementation of ICNP® into clinical practice. Int J Occup Med Environ Health. 2020;33(3):353-63.

In-hospital mortality as the side effect of missed care.

AIM: The aim of the study was to assess the influence of the number of hours of daily nursing care for NHPPD in medical departments on missed care and the correlation between NHPPD and in-hospital mortality. BACKGROUND: Patient mortality can be a consequence of missed care as it correlates with the nurse-patient ratio. One of the methods to measure missed care is the Nursing Hours per Patient Day rating. METHODS: The study sample included 44,809 patients including 971 deaths in 8 wards. The influence of nursing hours, nursing education, and the percentage of patients' classification on in-hospital mortality were evaluated with backward stepwise linear regression. RESULTS: One hour added to the average NHPPD in medical departments was related to a decrease in mortality rate by 6.8 per 1,000 patient days and a lower chance for the emergence of unplanned death by 36%. CONCLUSIONS: The number of NHPPD and the percentage of professional nurses are factors influencing missed care and in-hospital mortality. IMPLICATIONS FOR NURSING MANAGEMENT: The severe consequences of missed care, that is mortality, and the correlation between in-hospital mortality, nursing education and nursing-patient ratio, which are indicators of care quality, are arguments for maintaining adequate staffing levels to avoid missed care.

Work patterns and a tendency among Polish nurses to leave their job.

BACKGROUND: Work patterns are important factors in employees' decisions to change their job or leave their profession. The majority of nurses in Poland are women who play other social roles besides work. For this reason, satisfaction with their work patterns including input into work schedules, has a particularly significant impact on considering the idea of quitting their job. MATERIAL AND METHODS: The study was conducted in 2008-2011 in 8 out of 10 higher education institutions which train nurses. Data obtained from 1045 questionnaires collected from a total of 1049 respondents from 3 randomly selected higher education institutions was used in this research paper. The relationship between the qualitative features and dichotomus quality features under examination was assessed using univariate and multivariate logistic regression models. RESULTS: The results of the univariate logistic regression indicate that the risk of quitting increases to the highest extent with a mixed work pattern; it is lower for 12/24 h, and slightly lower for 2 day/night shifts. CONCLUSIONS: A pattern with a single day shift was adopted as the reference level to reduce the risk of Polish nurses' quitting their job. Med Pr. 2018;70(2):145-53.

Evaluation of chosen determinants of the positive practice environments (PPE) at Polish nursing wards.

BACKGROUND: At many Polish hospitals, insufficient attention is given to positive work environment. In many cases nurses, similarly to the representatives of other professional groups, are not provided with facilities or tools to perform their professional tasks in safe conditions. The aspects of recruitment and retention of employees are often ignored. The aim of this study has been to assess the chosen determinants of work environment of nurses in Poland using the concept of the Positive Practice Environments (PPE). MATERIAL AND METHODS: The survey was carried out from 2008 to 2011 among 1049 nursing students of 3 randomly selected public medical universities that provided nursing education at the graduate level of the Master of Science. All the people qualified for the study group were practising nurses or midwives. The Polish Nursing Association coordinated the project, obtained the tool, translated it and adjusted it to the Polish conditions. The areas covered in the survey were: a place of employment, selected physical and social elements influencing the work conditions, and biographical information. RESULTS: Access to as many as 8 factors identified as attributes of friendly environments was found unsatisfactory by over 50% of the nurses. For the purpose of objective assessment, the results were compared with the results obtained in the group of nurses in England. CONCLUSIONS: The majority of the surveyed nurses were not satisfied with their work environments. Polish nurse managers should ensure that aspects of recognized attributes of friendly, positive practice environments for nurses are established to support nurses' satisfaction as a pre-condition for patients' safety.