Incidence and Predictors of Nonventilator Hospital-Acquired Pneumonia in a Community Hospital.

BACKGROUND: Nonventilator hospital-acquired pneumonia (NV-HAP) is a common hospital-acquired condition that is amenable to basic nursing care interventions. PURPOSE: The purpose of this study was to determine the incidence of NV-HAP in a California community hospital and to identify the patient and nursing care factors including missed nursing care associated with its development. METHODS: A retrospective study identified possible NV-HAP cases with ICD-10 (International Classification of Diseases, Tenth Revision) codes and then validated cases using Centers for Disease Control and Prevention confirmatory criteria. RESULTS: The incidence of NV-HAP in our hospital was 0.64 cases per 1000 patient-days. Patient factors most strongly associated with NV-HAP were age (each year of increased age was associated with a 4% increased likelihood of developing NV-HAP) (OR = 1.04-1.07) and the presence of underlying disease, which reduced odds of developing NV-HAP by 36% (OR = 0.36; 95% CI, 0.12-0.98). Head-of-bed elevation reduced by 26% the odds of developing NV-HAP (OR = 0.26; 95% CI, 0.07-0.08). CONCLUSIONS: NV-HAP can be predicted and potentially prevented. Paradoxically, the presence of underlying disease was not positively associated with the development of NV-HAP in this study.

Perception of clinical deterioration cues among medical-surgical nurses.

AIM: To examine medical-surgical nurses' capacity and tendency to perceive cues indicating clinical deterioration and nursing characteristics influencing deterioration cue perception. DESIGN: Cross-sectional, explorative study design. METHODS: Data were collected over 10 weeks between September-November 2017. Medical-surgical nurses completed an online survey consisting of a demographic questionnaire, the Occupational Fatigue, Exhaustion Recovery scale and 50 detection trials. Descriptive statistics and statistical tests were used to describe and interpret data. FINDINGS: A significant association was found between nurses' capacity and tendency to perceive deterioration cues. As nurses' capacity to perceive deterioration cues increased, nurses were more likely to classify patient cues as indicators of deterioration. Fatigue, education, and certification were not identified as characteristics associated with deterioration cue perception. However, experience was observed to significantly influence nurses' capacity to perceive deterioration cues based on levels of skills acquisition. CONCLUSION: Study findings imply that future research should be directed at determining whether other individual factors and organizational system dynamics influence deterioration cue perception. IMPACT: To better understand how nurses perceive deterioration cues, this study integrated concepts from the Situation Awareness model and Signal Detection Theory. Novice, advanced beginner and competent nurses were found to have a lower capacity to perceive deterioration cues compared with proficient and expert nurses. With simulation increasingly being used as a primary teaching modality in nursing, the development of a simulation-based signal detection training intervention may be beneficial in enhancing deterioration cue perception.

The Effectiveness of Simulation on Recognizing and Managing Clinical Deterioration: Meta-Analyses.

The purpose of these meta-analyses was to quantitatively synthesize the effectiveness of simulation on student nurses' and registered nurses' ability to recognize and manage clinical deterioration in the acute care setting. A search of the literature resulted in 22 reports and 19 studies meeting inclusion criteria. Four random-effects analyses were conducted to examine two-group posttest and single-group pre-posttest intervention effect sizes for knowledge and performance. A total of 41 effect sizes were calculated from the data extracted. The standardized mean difference ( d) for two-group posttest knowledge was d = 0.964 ( p = .001) and for performance was d = 1.382 ( p ≤ .001). The standardized mean difference for single-group pre-posttest knowledge was d = 1.231 ( p ≤ .001) and performance was d = 1.610 ( p ≤ .001). Findings indicate that simulation-based interventions have a positive effect on knowledge and performance. As simulation is increasingly used as a teaching modality in nursing, further research should aim to test standardized simulation-based education programs.

Evaluating Situation Awareness: An Integrative Review.

Situation awareness (SA) refers to the conscious awareness of the current situation in relation to one's environment. In nursing, loss or failure to achieve high levels of SA is linked with adverse patient outcomes. The purpose of this integrative review is to examine various instruments and techniques used to measure SA among nurses across academic and clinical settings. Computerized database and ancestry search strategies resulted in 40 empirical research reports. Of the reports included in the review, 24 measured SA among teams that included nurses and 16 measured SA solely in nurses. Methods used to evaluate SA included direct and indirect methods. Direct methods included the Situation Awareness Global Assessment Technique and questionnaires. Indirect methods included observer rating instruments and performance outcome measures. To have a better understanding of how nurses' make decisions in complex work environments, reliable and valid measures of SA is crucial.

APRN-Conducted Medication Reviews for Long-Stay Nursing Home Residents.

OBJECTIVE: As part of the Missouri Quality Initiative (MOQI) to reduce hospitalizations for long-stay nursing home residents, this article describes reasons MOQI advanced practice registered nurses (APRNs) recommended medication order changes as part of their medication review process as well as the outcomes of their recommendations. DESIGN: Cross-sectional descriptive study of MOQI APRN-conducted medication reviews. SETTING: Long-stay nursing homes participating in the MOQI project. PARTICIPANTS: Seventeen MOQI APRNs recorded medication reviews for 3314 long-stay residents residing in 16 Midwestern nursing homes over a 2-year period. INTERVENTION: APRNs conducted medication reviews and made recommendations for medication order changes to residents' medical providers. MEASUREMENTS: The MOQI medication review database was used to abstract data. RESULTS: There were 19,629 medication reviews recorded for 3314 residents during the 2-year period. Of the 19,629 reviews, 50% (n = 9841) resulted in recommended order changes of which 82% (n = 8037) of order changes occurred. More than two-thirds of recommendations were because of changes in the residents' plans of care. Other recommendations included adjusting and/or discontinuing medications that had the potential for harm. CONCLUSION: Resident care needs are dynamic, resulting in the need for frequent medication order changes. MOQI APRNs, because of their advanced pharmacological education and daily presence in the nursing home, are uniquely positioned to ensure residents' medications aligned with their overall goals of care while minimizing risk of harm.

Quantifying Missed Nursing Care Using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey.

OBJECTIVE: The aim of this article is to describe the use of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data to measure missed nursing care and construct a missed nursing care metric. BACKGROUND: Missed nursing care varies widely within and between US hospitals. Missed nursing care can be measured utilizing the HCAHPS data. METHODS: This cross-sectional study used HCAHPS data to measure missed care. RESULTS: This analysis includes HCAHPS data from 1125 acute care patients discharged between January 2014 and December 2014. A missed care index was computed by dividing the total number of missed care occurrences as reported by the patient into the total number of survey responses that did not indicate missed care. The computed missed care index for the organization was 0.6 with individual unit indices ranging from 0.2 to 1.4. CONCLUSIONS: Our methods utilize existing data to quantify missed nursing care. Based on the assessment, nursing leaders can develop interventions to decrease the incidence of missed care. Further data should be gathered to validate the incidence of missed care from HCAHPS reports.

Missed Nursing Care and Unit-Level Nurse Workload in the Acute and Post-Acute Settings.

This study replicates previous research on the nature and causes of missed nursing care and adds an explanatory variable: unit-level nurse workload (patient turnover percentage). The study was conducted in California, which legally mandates nurse staffing ratios. Findings demonstrated no significant relationship between patient turnover and missed nursing care.

Critical Thinking and the Use of Nontraditional Instructional Methodologies.

BACKGROUND: The purpose of this study was to examine the relationship between critical thinking and the use of concept mapping (CM) and problem-based learning (PBL) during care plan development. METHOD: A quasi-experimental study with a pretest-posttest design was conducted using a convenience sample (n = 49) of first-semester undergraduate baccalaureate nursing students. Critical thinking was measured using the Holistic Critical Thinking Scoring Rubric. Data analysis consisted of a repeated measures analysis of variance with post hoc mean comparison tests using the Bonferroni method. RESULTS: Findings indicated that mean critical thinking at phase 4 (CM and PBL) was significantly higher, compared with phase 1 (baseline), phase 2 (PBL), and phase 3 (CM [p < 0.001]). CONCLUSION: The results support the utilization of nontraditional instructional (CM and PBL) methodologies in undergraduate nursing curricula.