Shifting Nursing Care Models as a Solution for the Increasing Demand on Intensive Care Unit Beds During a Pandemic: A Case Study.

AIM: An option appraisal of different nursing care delivery models was presented, which were made in between the first and second COVID-19 waves. The authors wanted to inform colleagues on involving nursing care delivery models in the problem-solving process during a pandemic. LOCAL PROBLEM: In the pre-COVID-19 hospital practice, the nursing care delivery model of primary nursing was applied in the intensive care unit (ICU). However, during the COVID-19 pandemic, this situation could not be upheld because of the increased need for ICU beds and the shortages of available ICU nurses. METHODS: This study used the literature of an ongoing systematic review on nursing care delivery models and expert meetings between the authors and nursing staff. RESULTS: One standard nursing care delivery model and 3 alternative nursing care delivery models were discussed and compared in this case study. Theoretically, a modular system of team nursing seemed the better model to use during a pandemic. This model leads to an equal distribution of expertise and social distancing between experts. Compared with the other models, a strategic reserve can be created. CONCLUSION: This case study should be primarily considered as an example on how rethinking and reorganizing the nursing care delivery model could contribute to an enlarged, qualitative capacity, which needs to be organized in a short time span.

Unanticipated admission after ambulatory surgery in the pediatric population: a single-center retrospective analysis.

INTRODUCTION: The incidence of adverse events in day surgery is an important quality indicator. This retrospective study investigated factors independently associated with unanticipated admission of pediatric patients after ambulatory surgery. PATIENTS AND METHODS: Ambulatory pediatric patients requiring unanticipated admission between January 2016 and December 2018 were compared to ambulatory pediatric patients who were discharged home after a planned surgery. Demographic data, organizational data, American Society of Anesthesiologists (ASA) classification, type of surgery, type of anesthesia, length of surgery, time of completion of the surgery, campus site, and season were collected in both groups. The reason for unexpected admission was classified according to four subtypes: anesthetic, medical, social/organizational and surgical reason, respectively. Multivariate logistic regression was used to identify independent factors associated with unanticipated admission. RESULTS: From a total of 4235 pediatric patients, 78 children (1.9%) required unanticipated admission. The reasons for admission were anesthetic n = 29 (37.3%), surgical n = 20 (25.6%), medical n = 16 (20.5%) and social/organizational n = 13 (16.6%). Age <2 years (odds ratio [OR] 3.005, 95% confidence interval (CI) 1.500-6.018; ASA class 2 (OR 2.144; 95% CI 1.193-3.852); ASA class 3 (OR 11.617; CI 5.698-23.685); length of surgery >2 h (OR 3.056; CI 1.829-5.107); completion of surgery > 2:30 PM (OR 3.507; CI 1.854-6.633) and campus site (OR 3.628; CI 1.991-6.610) were factors significantly associated with unanticipated admission. CONCLUSION: Children are less likely to be admitted after ambulatory surgery when preoperatively carefully selected and when prioritized considering age, general health condition and invasiveness of the surgery.

Analysis of ergonomic occupational accidents and near misses in a large Belgian university hospital.

INTRODUCTION: Health-care organizations are facing a high burden of ergonomic occupational accidents, and prevention is a continuous point of interest. In this manuscript, we describe the characteristics of ergonomic accidents in a large Belgian university hospital and discuss the value of near misses. METHODS: Combining databases, we identified the frequency [number of accidents × 106 hours worked per year], severity (number of days off work × 103 hours worked per year), and profile of the victims of occupational ergonomic accidents (with absence from work) or incidents or near-misses (without absence from work). Ergonomic accidents and incidents include slips, trips, falls, injurious body movements, overexertion, and handling heavy weights. RESULTS: In a period of 23 years, we noticed a significant decrease in the frequency of ergonomic accidents (from about 7 to about 4 standard units), without changes in the severity. The decrease in the frequency of accidents is mirrored by an increase in the frequency of incidents (from about 4 to about 6 standard units). Female and older employees are more vulnerable to accidents, and the frequency was between two and four times higher for employees mostly involved in manual tasks compared to employees mostly involved in managerial tasks. The profile of the victims and the causes of accidents and incidents were identical. CONCLUSION: Although it is premature to assume a cause-consequence relationship between incidents and accidents, it is tempting to speculate that the increased ratio of the frequencies of incidents over accidents might be one of the variables reflecting the adequacy of preventive measures and the growth of safety behavior.

Are internship experiences during a pandemic related to students' commitment to nursing education? A cross-sectional study.

BACKGROUND: The predominate role of internships on the retention of nursing students highlights the need to monitor internship experiences during a healthcare crisis like CoViD-19. OBJECTIVES: To explore the relation between internships experiences during a pandemic and student nurses' commitment or intention-to-leave the nursing program; as well as the relation between internship experiences and commitment or intention-to-leave the nursing program. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study using a sample of 1.079 nursing students from18 nursing schools in Flanders, Belgium. Students from all study years were eligible to participate. METHODS: Online self-reporting survey during the first CoViD-19 wave (April-May 2020). Regression analyses were used to explore the association with students' commitment or intention-to-leave. RESULTS: Students reported high levels of study commitment (4.06; SD 0.66; range 1-5), and an overall low intention-to-leave (1.64; SD 0.83; range 1-5). No difference in commitment or intention-to-leave were seen between students who did or did not had internship experience during CoViD-19 period. Need-supportive experiences - indicating that students felt competent, related to the team, and could be themselves on internship - coincided with high commitment. Conversely, need-frustrating experiences - indicating that students felt insecure, unrelated, and controlled by the nursing team - increased intention-to-leave nursing education. Students who felt pressured for an internship during the first wave of the CoViD-19 crisis, had more doubts to continue nursing education, and an increased chance on drop-out. CONCLUSIONS: We recommend nursing schools to assess student's motivation when making a substantiated decision concerning internships during a health crisis, as facing an imposed or subjective mandatory decision to go into clinical practice might lead to less commitment to the study program. For both teacher and staff mentors it is deemed important to discuss the internship climate with the student, in order to early identify need-frustrating issues during internship.

Patient perspectives on electronic health record accessibility and patient participation: a questionnaire survey.

Objectives To explore patient perceptions on personal comfort with participation in their own care process and on support of this patient participation through electronic health record (EHR) accessibility. Methods Explorative quantitative questionnaire study in ambulatory patients visiting the departments of General Internal Medicine or Head, Neck and Maxillo-Facial Surgery of a Belgian tertiary referral center. Results Patients were recruited by convenience sampling of 438 out of the total of 1270 patients visiting either one of these departments within a time period of two weeks. Overall response rate was 97.3% (n = 426; 45.3% male; mean age 42.5 ± 15.4 years). Most patients (89.7%) indicated a desire to make healthcare decisions in partnership with their physician. They were in need of transparent and comprehensible health information. The EHR was perceived as a suitable and effective means to inform patients about their health and to increase involvement in care and treatment (77.6%). Furthermore, access to the EHR was perceived to result in a more effective communication transfer between physician and patient (65.5%), increased patient compliance (64.3%), and satisfaction (57.4%). Conclusion Patients indicate a desire for proactive participation in their individual care process. They felt that medical record accessibility could support decision-making and assist in managing and coordinating individual and personalized care choices.

Intraorganizational Communication and Job Satisfaction Among Flemish Hospital Nurses: An Exploratory Multicenter Study.

Intraorganizational communication affects job satisfaction and turnover. The goal of this study was to explore relationships between communication and job satisfaction, intention to leave, and burnout among Flemish hospital nurses. A multicenter questionnaire study was conducted in three hospitals using the Communication Satisfaction Questionnaire, the Turnover Intention subscale of the Questionnaire on the Experience and Evaluation of Work, and the Maslach Burnout Inventory. A visual analog scale measured job satisfaction. The mean job satisfaction score was 7.49/10 (±1.43). Almost 7% of nurse participants (93/1,355) reported a high intent to leave, and 2.9% of the respondents (41/1,454) had a score indicative of burnout. All dimensions of communication were associated with job satisfaction. A low score on any dimension of communication satisfaction, except "Relationship With Employees," was associated with higher intent to leave and burnout. Study findings support the need for management interventions to enhance efficient communication and ensure high-quality care and patient safety.

The patient perspective on the effects of medical record accessibility: a systematic review.

BACKGROUND: Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement. OBJECTIVES: To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient-physician relationship and quality of medical care. METHODS: Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords 'medical record', 'patient record', 'communication', 'patient participation', 'doctor-patient relationship', 'physician-patient relationship' between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality. RESULTS: Out of 557 papers screened, only 12 studies qualified for the systematic review. Only a minority of patients spontaneously request access to their medical file, in contrast to frequent awareness of this patient right and the fact that patients in general have a positive view on open visit notes. The majority of those who have actually consulted their file are positive about this experience. Access to personal files improves adequacy and efficiency of communication between physician and patient, in turn facilitating decision-making and self-management. Increased documentation through patient involvement and feedback on the medical file reduces medical errors, in turn increasing satisfaction and quality of care. Information improvement through personal medical file accessibility increased reassurance and a sense of involvement and responsibility. CONCLUSION: From the patient perspective medical record accessibility contributes to co-management of personal health care.

The effectiveness of an e-learning course on medication calculation in nursing students: a clustered quasi-experimental study.

AIM: To evaluate the effectiveness of an e-learning course compared with a face-to-face lecture on medication calculation. BACKGROUND: The current knowledge on medication calculation of nursing students and nurses is insufficient to provide safe care. DESIGN: A stratified-clustered quasi-experimental study. METHODS: A random selection of nursing schools were allocated to the e-learning course (intervention group) (seven schools; 189 students) or face-to-face lecture (control group) (six schools, 222 students). Students in both groups completed a validated medication calculation test (maximum score: 16) prior to the course (T0), immediately after the course (T1) and 3 months later (T2). A linear mixed model was used for data analysis. RESULTS: Medication calculation skills improved significantly more by the face-to-face lecture than e-learning course. Students in both groups significantly improved in medication calculation skills immediately after the course (T1) and 3 months later. The results flattened at T2 with a significant decline in the intervention group between T1 and T2 and a non-significant decline in the control group. Based on a subgroup analysis, improvement in medication calculation skills at T2 could only be observed in vocational-level (sub degree) nursing students receiving a face-to-face course. CONCLUSIONS: Both medication calculation courses had a positive effect on medication calculation skills. Students receiving traditional face-to-face lecture improved significantly more than the students receiving the e-learning course.

Recurrent changes in the work environment, job resources and distress among nurses: a comparative cross-sectional survey.

BACKGROUND AND OBJECTIVES: Occupational stress in nursing has frequently been considered in nursing literature. The operationalization of job demands in different work settings and its relation to distress have been discussed to identify significant interactions with job resources. In this study, job demands were defined as recurrent changes in the work environment of nurses (i.e. changing colleagues, supervisors, workplaces, working hours and tasks). In particular, we focused on the 'negative appraisal' (i.e. 'threat') of these changes. The interaction between 'threat' and job resources (i.e. timing control, method control and supervisor support) and its relation to distress among Registered Nurses was examined. METHODS: The study was part of a larger cross-sectional survey among 7863 (response rate 51%) employees belonging to 10 general hospitals in Belgium. The results are based on self-administered questionnaires of 1094 Registered Nurses employed in intensive care units (ICU) (n = 416) and surgery/medical wards (non-ICU) (n = 678). General Linear Modelling was used to test the moderating effects. RESULTS: In both study samples, 'threat' was positively associated with distress (P < 0.001). However, in contrast with non-ICU nurses, ICU nurses only considered 'supervisor support' as a significant moderator in the positive relationship between 'threat' and distress (P = 0.023). 'Timing and method control', instead of supervisor support, moderated this relation among non-ICU nurses (P = < 0.001 and 0.018, respectively). CONCLUSION: These findings provide additional evidence to consider negative appraisal of recurrent changes as occupational specific stressor in nursing. Moreover, the buffering effects which were found between 'threat' and the measured job resources in relation to distress, and the difference of these interactions in ICU and non-ICU health care settings, confirmed the suggestion to consider particular job characteristics in job stress research. Finally, the findings of our study may be of importance for nursing administrators who are dealing with distress among nurses.

Impact of recurrent changes in the work environment on nurses' psychological well-being and sickness absence.

AIM: This paper is a report of a study of how the occurrence and appraisal of recurrent changes in the work environment of hospital nurses affect psychological well-being (i.e. job satisfaction, eustress and distress) and absence through illness. BACKGROUND: Many researchers have demonstrated the impact of major organizational changes on employees' psychological well-being, but only a few have focused on the permanent consequences in work conditions. In a contemporary healthcare setting, an increased number of recurrent operational changes has become a normal characteristic of nurses' work environment. Specific work situations have frequently been associated with occupational stress, whereas employees' appraisal of recurrent changes as stressors and their relation to psychological well-being and health outcomes (i.e. sickness absence) have been dismissed. METHODS: A cross-sectional questionnaire survey was conducted in 2003 with 2094 Registered Nurses in 10 general hospitals. Logistic regressions were used to investigate the impact on psychological well-being and prospectively measured rates of sickness absence (frequency and duration). RESULTS: The occurrence of changes in the work environment (in the past 6 months) had had a negative impact on staff psychological well-being. Nurses who had been confronted with changes scored statistically significantly higher for distress. Changes appraised as threatening were negatively related to job satisfaction and eustress, and positively related to distress and sickness absence (frequency and duration). Changes appraised as challenging were positively related to job satisfaction and eustress but had no impact on distress and sickness absence. CONCLUSION: Future research should take into consideration the impact of the occurrence and appraisal of recurrent changes in the work environment of healthcare employees (i.e. Registered Nurses) on psychological well-being and sickness absence. This should also be considered by managers when dealing with these nursing workforce issues.