RESUMO
BACKGROUND: Across the globe, family-integrated care (FICare) has become an evidence-based standard in which parents deliver the majority of infant care in the neonatal intensive care unit (NICU). Because of extensive barriers to parent presence, adaptations to FICare may be required for successful implementation. Family management theory may provide structure to the Parent Education of FICare and help nurses guide parents' skill development as equal care members. PURPOSE: To identify family management skills employed by NICU parents using the Self- and Family Management Framework (SFMF). METHODS: We conducted secondary analyses of qualitative interview data from NICU parents (n = 17) who shared their experiences of using family management skills to care for their infant. We categorized skills according to 3 main self- and family management processes: Focusing on Infant Illness Needs; Activating Resources; and Living With Infant Illness. RESULTS: Parents reported several family management skills currently identified in the SFMF, as well as new skills such as conflict management, power brokerage, and addressing resources related to social determinants of health. Parent activation of resources was critical to sustaining parent focus on the infant's illness needs. IMPLICATIONS FOR PRACTICE AND RESEARCH: By teaching skills that parents reported as helping them manage infant care, neonatal nurses may better facilitate parent integration into the care team. Future researchers can incorporate the skills identified in this study into the design of family management interventions that facilitate FICare implementation in the United States.
Assuntos
Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Lactente , Criança , Recém-Nascido , Humanos , Terapia Intensiva Neonatal , Pais/educação , Cuidado do LactenteRESUMO
AIMS: To examine the critical role that an academic clinical partnership played in the development and refinement of a family management intervention in the Neonatal Intensive Care Unit (NICU). BACKGROUND: Clinical-academic partnerships enable earlier infusion of implementation science principles into development of evidence-based interventions, yet partners often report difficulty leveraging resources, personnel and expertise to create beneficial outcomes for all. DESIGN: Longitudinal qualitative descriptive design. METHODS: To develop and refine the intervention, designated time was taken during meetings of the NICU's Parent Partnership Council (PPC), a committee comprised of nursing, physician and allied health leadership and former NICU parents. Partnership was also achieved by having bedside clinical nurses, in addition to medical and nursing students, participate as research team members. Qualitative data were collected via email, research team and Council meetings, and informal individual chats with key stakeholders (N = 25) and NICU mothers (N = 22). Qualitative data were analysed deductively using thematic analysis based on MacPhee's partnership logic model and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) model. The consolidated criteria for reporting qualitative research checklist guided our work. RESULTS: During Council meetings, the clinical-academic nurse, Director of Family-Integrated Care and Council members identified the need for a family management intervention, and worked together to develop and refine PREEMIE PROGRESS. Mothers found the intervention had numerous strengths and perceived a benefit knowing they helped future parents. CONCLUSIONS: This work was only possible by leveraging both the university's technology/research resources and the clinical expertise of the NICU staff and PPC. Co-authored presentations, publications and grant funding continued this NICU's legacy in family-centred care and helped shape the clinical-academic nurse's career. RELEVANCE TO CLINICAL PRACTICE: Clinical-academic partnerships can promote excellence in nursing practice, research and education through swifter knowledge translation and earlier infusion of implementation science principles into the development of evidence-based nursing interventions.
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Recém-Nascido Prematuro , Ciência Translacional Biomédica , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Pais , Pesquisa QualitativaRESUMO
BACKGROUND: The U.S. health care system faces increasing pressures for reform. The importance of nurses in addressing health care delivery challenges cannot be overstated. PURPOSE: To present a Nursing Health Services Research (NHSR) agenda for the 2020s. METHOD: A meeting of an interdisciplinary group of 38 health services researchers to discuss five key challenges facing health care delivery (behavioral health, primary care, maternal/neonatal outcomes, the aging population, health care spending) and identify the most pressing and feasible research questions for NHSR in the coming decade. FINDINGS: Guided by a list of inputs affecting health care delivery (health information technology, workforce, delivery systems, payment, social determinants of health), meeting participants identified 5 to 6 research questions for each challenge. Also, eight cross-cutting themes illuminating the opportunities and barriers facing NHSR emerged. DISCUSSION: The Agenda can act as a foundation for new NHSR - which is more important than ever - in the 2020s.
Assuntos
Atenção à Saúde/estatística & dados numéricos , Atenção à Saúde/tendências , Política de Saúde/tendências , Prioridades em Saúde/estatística & dados numéricos , Prioridades em Saúde/tendências , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/tendências , Previsões , Humanos , Estados UnidosRESUMO
AIM: To describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge. DESIGN: Analysis of nursing documentation generated as part of a randomized controlled trial evaluating the effect of a nurse home visit on healthcare re-use. METHODS: We analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial. Registered nurses documented concerns in structured fields and free-text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free-text visit notes were reviewed and exemplars illustrative of quantitative findings were selected. RESULTS: Overall, nurses documented at least one concern in 56% (N = 367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N = 58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N = 49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N = 56). Nurses completed referrals to other providers/services in 12% of visits (N = 78), most frequently to primary care providers. In 13% of visits (N = 85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation. CONCLUSION: Inpatient and community nurses and physicians should be prepared to reconcile and manage discharge medications, assess families' medication administration practices and anticipate social needs after paediatric discharge. IMPACT: Little empirical data are available describing concerns manifesting immediately after paediatric hospital discharge. Concerns about medication safety were most frequent followed by concerns related to housing and general safety. The results are important for clinicians preparing children and families for discharge and for community clinicians caring for discharged children.
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Assistência ao Convalescente/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Visita Domiciliar , Enfermeiros de Saúde Comunitária/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , OhioRESUMO
The provision of safe and effective nursing care to children is dependent upon pediatric nurse scientists creating knowledge that guides and directs day-to-day nursing practice. Current trends demonstrating steady decreases of pediatric nurses and inadequate numbers of PhD-prepared pediatric nurse scientists put the health of our children at risk. The purposes of this paper are to (1) summarize current health care demands in pediatrics, (2) present our concern that the number of pediatric nurse scientists is inadequate to generate foundational knowledge to guide pediatric nursing practice, (3) present our perspectives on factors influencing the number of pediatric nurse scientists, and (4) recommend specific actions for nursing leaders, nursing faculty, and professional nursing organizations to increase the depth and breadth of pediatric nursing science to meet current and future pediatric care needs.
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Educação de Pós-Graduação em Enfermagem/economia , Previsões , Pesquisa em Enfermagem , Enfermagem Pediátrica/tendências , Criança , Saúde da Criança , Atenção à Saúde , HumanosRESUMO
Missed nursing care is an emerging measure of front-line nursing care effectiveness in neonatal intensive care units (NICUs). Given Magnet® hospitals' reputations for nursing care quality, missed care comparisons with non-Magnet® hospitals may yield insights about how Magnet® designation influences patient outcomes. The purpose of this secondary analysis was to evaluate the relationship between hospital Magnet® designation and 1) the occurrence of nurse-reported missed care and 2) reasons for missed nursing care between NICU nurses employed in Magnet® and non-Magnet® hospitals. A random sample of certified neonatal intensive care unit nurses was invited to participate in a cross-sectional survey in 2012; data were analyzed from nurses who provided direct patient care (n=230). Logistic regression was used to model relationships between Magnet® designation and reports of the occurrence of and reasons for missed care while controlling for nurse and shift characteristics. There was no relationship between Magnet® designation and missed care occurrence for 34 of 35 types of care. Nurses in Magnet® hospitals were significantly less likely to report tensions and communication breakdowns with other staff, lack of familiarity with policies/procedures, and lack of back-up support from team members as reasons for missed care. Missed nursing care in NICUs occurs regardless of hospital Magnet® recognition. However, nurses' reasons for missed care systematically differ in Magnet® and non-Magnet® hospitals and these differences merit further exploration.
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Hospitais Especializados , Unidades de Terapia Intensiva Neonatal/normas , Erros Médicos/estatística & dados numéricos , Enfermagem Neonatal/normas , Qualidade da Assistência à Saúde , Adulto , Estudos Transversais , Feminino , Hospitais Pediátricos/normas , Hospitais Pediátricos/tendências , Humanos , Unidades de Terapia Intensiva Neonatal/tendências , Terapia Intensiva Neonatal/normas , Terapia Intensiva Neonatal/tendências , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Enfermagem Neonatal/tendências , Segurança do Paciente/estatística & dados numéricos , Medição de Risco , Estados UnidosRESUMO
AIMS: The aims of this study were: (1) to explore the family perspective on pediatric hospital-to-home transitions; (2) to modify an existing nurse-delivered transitional home visit to better meet family needs; (3) to study the effectiveness of the modified visit for reducing healthcare re-use and improving patient- and family-centered outcomes in a randomized controlled trial. BACKGROUND: The transition from impatient hospitalization to outpatient care is a vulnerable time for children and their families; children are at risk for poor outcomes that may be mitigated by interventions to address transition difficulties. It is unknown if an effective adult transition intervention, a nurse home visit, improves postdischarge outcomes for children hospitalized with common conditions. DESIGN: (1) Descriptive qualitative; (2) Quality improvement; (3) Randomized controlled trial. METHODS: Aim 1 will use qualitative methods, through focus groups, to understand the family perspective of hospital-to-home transitions. Aim 2 will use quality improvement methods to modify the content and processes associated with nurse home visits. Modifications to visits will be made based on parent and stakeholder input obtained during Aims 1 & 2. The effectiveness of the modified visit will be evaluated in Aim 3 through a randomized controlled trial. DISCUSSION: We are undertaking the study to modify and evaluate a nurse home visit as an effective acute care pediatric transition intervention. We expect the results will be of interest to administrators, policy makers and clinicians interested in improving pediatric care transitions and associated postdischarge outcomes, in the light of impending bundled payment initiatives in pediatric care.
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Doença Aguda/enfermagem , Serviços de Saúde da Criança/normas , Atenção à Saúde/normas , Serviços de Assistência Domiciliar/normas , Transferência de Pacientes/normas , Criança , Serviços de Saúde da Criança/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Visita Domiciliar , Humanos , Avaliação das Necessidades , Ohio , Aceitação pelo Paciente de Cuidados de Saúde , Alta do Paciente/normas , Transferência de Pacientes/organização & administração , Enfermagem Pediátrica/organização & administração , Enfermagem Pediátrica/normas , RetratamentoRESUMO
OBJECTIVE: To examine the association of missed oral feeding opportunities among preterm infants with achievement of full oral feedings and length of hospitalization. STUDY DESIGN: A secondary analysis of clinical trial data was conducted. Study infants included in the analysis (N = 89) were randomized to one of four standardized feeding progression approaches; detailed records on all feedings were maintained. The proportion of oral feeding opportunities reported as missed due to factors unrelated to the infant's clinical condition was calculated for each infant. RESULTS: The proportion of missed oral feeding opportunities per infant ranged from 0 to 0.12; 30 infants experienced one or more missed oral feeding opportunity. Each 1% increase in the proportion of missed oral feeding opportunities extended the time to achieve full oral feeding by 1.45 days (p = 0.007) and time to discharge by 1.36 days (p = 0.047). CONCLUSION: Preterm infants' missed oral feeding opportunities may adversely affect feeding outcomes and extend hospitalization.
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Nutrição Enteral/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal , Tempo de Internação/estatística & dados numéricos , Enfermagem Neonatal , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Alta do Paciente , Análise de Regressão , Fatores de TempoRESUMO
AIMS: The aims of this study are to describe: (1) the frequency of nurse-reported missed care in neonatal intensive care units; and (2) nurses' reports of factors contributing to missed care on their last shift worked. BACKGROUND: Missed nursing care, or necessary care that is not delivered, is increasingly cited as a contributor to adverse patient outcomes. Previous studies highlight the frequency of missed nursing care in adult settings; the occurrence of missed nursing care in neonatal intensive care units is unknown. DESIGN: A descriptive analysis of neonatal nurses' self-reports of missed care using data collected through a cross-sectional web-based survey. METHODS: A random sample of certified neonatal intensive care nurses in seven states was invited to participate in the survey in April 2012. Data were collected from nurses who provide direct patient care in a neonatal intensive care unit (n = 230). Descriptive statistics constituted the primary analytic approach. RESULTS: Nurses reported missing a range of patient care activities on their last shift worked. Nurses most frequently missed rounds, oral care for ventilated infants, educating and involving parents in care and oral feedings. Hand hygiene, safety and physical assessment and medication administration were missed least often. The most common reasons for missed care included frequent interruptions, urgent patient situations and an unexpected rise in patient volume and/or acuity on the unit. CONCLUSION: We find that basic nursing care in the neonatal intensive care unit is missed and that system factors may contribute to missed care in this setting.
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Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar , Segurança do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Gestão de Riscos/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Autorrelato , Estados Unidos , Adulto JovemRESUMO
AIM: We describe an innovative research protocol to test the role of missed nursing care as a mediator of the association between nurse workload and patient outcomes in the neonatal intensive care unit. BACKGROUND: Increases in nurses' workloads are associated with adverse patient outcomes in neonatal intensive care settings. Missed nursing care is a frequently hypothesized explanation for the association between workload and outcomes. Few studies to date have tested missed care as a variable that mediates the workload-outcomes relationship. DESIGN: We use a longitudinal, observational study design. METHODS: We will recruit approximately 125 nurses (80% of target population) providing direct patient care in one neonatal intensive care unit. Four, 6-week data collection cycles occur over 1 year. At the end of every shift, nurses report on their workloads and the frequency with which specific patient care activities were missed for each infant cared for during the shift. Infant-specific nurse reports of missed care are linked to shift-level infant outcomes data extracted from the electronic health record. Funding for the study began in July 2012; Research Ethics Committee approval was granted in December 2012. DISCUSSION: Missed care may explain the effects of nurse workload on patient outcomes. This research will generate preliminary evidence regarding the causal relationships among nurses' workloads, missed care and infant outcomes that we will confirm in a future multi-site study.
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Competência Clínica/normas , Enfermagem Neonatal/normas , Qualidade da Assistência à Saúde/normas , Carga de Trabalho , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/normas , Estudos Longitudinais , Avaliação de Resultados da Assistência ao Paciente , Segurança do PacienteRESUMO
INTRODUCTION: In 2019, the national average turnover rate of registered nurses in the United States was approximately 17.8%. Each percentage increase in turnover costs a hospital, on average, $270,800. Although burnout is a known contributor to nurses' turnover intention, few studies have examined the relationship between nurse burnout and turnover, and there is little data on this relationship in neonatal intensive care environments. The purpose of this study was to examine the relationship between nurse burnout and turnover among neonatal intensive care unit (NICU) nurses. STUDY DESIGN: A secondary analysis of data collected from an observational study involving 136 nurses in a 52-bed NICU from 2013 to 2014. METHODS: Multivariate logistic regression models were used to test for associations between measures of burnout and turnover. RESULTS: 16.9% of nurses turned over during the 11 months of the original study. Most nurses reported high (46%) to moderate (37%) levels of emotional exhaustion. Final models did not indicate a relationship between burnout and turnover. CLINICAL NURSING IMPLICATIONS: Although burnout has been associated with turnover intent among nurses, we did not observe an association between burnout and turnover among NICU nurses. Despite no direct relationship between burnout and turnover in the NICU, burnout may have other negative consequences. Nurse leaders should continue to prioritize reducing burnout among nursing staff to improve the well-being of the NICU nurse workforce.
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Esgotamento Profissional , Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem Hospitalar , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Satisfação no Emprego , Reorganização de Recursos Humanos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Missed nursing care is required care that is delayed, incomplete, or left undone during a nurse's working shift. Missed nursing care is most often studied in adult populations; however, it may have significant consequences in pediatric and neonatal care settings. The purpose of this integrative review is to describe missed nursing care in pediatric and neonatal nursing care settings. METHODS: SCOPUS and PubMed were used in the literature search. Multiple combinations of the keywords and phrases "missed nursing care," "pediatric," "neonatal," "care left undone," or "nursing care rationing" were used for the literature search. Missed nursing care is a relatively new topic as the first article on the subject was published in 2006; therefore, inclusion criteria were set to English articles published between January 1, 2006 and October 11, 2019 that reported on missed nursing care in pediatric and neonatal inpatient care settings. RESULTS: Fourteen articles met inclusion criteria. Missed nursing care in pediatric and neonatal nursing care settings is associated with workload, patient acuity, work environment, and nurse characteristics, and is related to prolonged hospitalization of preterm infants. CLINICAL IMPLICATIONS: Providing nurses with an adequate amount of resources and tools to avoid missed nursing care will continue to improve care delivery. Missed nursing care and related patient and nurse outcomes in diverse pediatric and neonatal samples remains an area for future research.
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Enfermagem Neonatal/normas , Cuidados de Enfermagem/métodos , Enfermagem Pediátrica/normas , Humanos , Unidades de Terapia Intensiva Neonatal/organização & administração , Enfermagem Neonatal/tendências , Cuidados de Enfermagem/normas , Cuidados de Enfermagem/tendências , Enfermagem Pediátrica/tendências , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricosRESUMO
BACKGROUND: The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. We sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions. METHODS: We sought qualitative input using focus groups and interviews from stakeholder groups: parents, primary care physicians (PCP), hospital medicine physicians, and home care registered nurses (RNs). A multidisciplinary team coded and analyzed transcripts using an inductive, iterative approach. RESULTS: Thirty-three parents participated in interviews. Three focus groups were completed with PCPs (n = 7), 2 with hospital medicine physicians (n = 12), and 2 with RNs (n = 10). Major themes in the explanation of increased reutilization included: appropriateness of patient reutilization; impact of red flags/warning sign instructions on family's reutilization decisions; hospital-affiliated RNs "directing traffic" back to hospital; and home visit RNs had a low threshold for escalating care. Major themes for improving design of the intervention included: need for improved postdischarge communication; individualizing home visits-one size does not fit all; and providing context and framing of red flags. CONCLUSION: Stakeholders questioned whether hospital reutilization was appropriate and whether the intervention unintentionally directed patients back to the hospital. Future interventions could individualize the visit to specific needs or diagnoses, enhance postdischarge communication, and better connect patients and home nurses to primary care.
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Assistência ao Convalescente , Serviços de Assistência Domiciliar , Enfermeiros de Saúde Comunitária , Alta do Paciente , Criança , Visita Domiciliar , HumanosRESUMO
Importance: Quality improvement initiatives demonstrate the contribution of reliable nursing care to gains in clinical and safety outcomes in neonatal intensive care units (NICUs); when core care is missed, outcomes can worsen. Objective: To evaluate the association of NICU nurse workload with missed nursing care. Design, Setting, and Participants: A prospective design was used to evaluate associations between shift-level workload of individual nurses and missed care for assigned infants from March 1, 2013, through January 31, 2014, at a 52-bed level IV NICU in a Midwestern academic medical center. A convenience sample of registered nurses who provided direct patient care and completed unit orientation were enrolled. Nurses reported care during each shift for individual infants whose clinical data were extracted from the electronic health record. Data were analyzed from January 1, 2015, through August 13, 2018. Exposures: Workload was assessed each shift with objective measures (infant-to-nurse staffing ratio and infant acuity scores) and a subjective measure (the National Aeronautics and Space Administration Task Load Index [NASA-TLX]). Main Outcomes and Measures: Missed nursing care was measured by self-report of omission of 11 essential care practices. Cross-classified, multilevel logistic regression models were used to estimate associations of workload with missed care. Results: A total of 136 nurses provided reports of shift-level workload and missed nursing care for 418 infants during 332 shifts of 12 hours each. When workload variables were modeled independently, 7 of 12 models demonstrated a significant worsening association of increased infant-to-nurse ratio with odds of missed care (eg, nurses caring for ≥3 infants were 2.51 times more likely to report missing any care during the shift [95% credible interval, 1.81-3.47]), and all 12 models demonstrated a significant worsening association of increased NASA-TLX subjective workload ratings with odds of missed care (eg, each 5-point increase in a nurse's NASA-TLX rating during a shift was associated with a 34% increase in the likelihood of missing a nursing assessment for his or her assigned infant[s] during the same shift [95% credible interval, 1.30-1.39]). When modeling all workload variables jointly, only 4 of 12 models demonstrated significant association of staffing ratios with odds of missed care, whereas the association with NASA-TLX ratings remained significant in all models. Few associations of acuity scores were observed across modeling strategies. Conclusions and Relevance: The workload of NICU nurses is significantly associated with missed nursing care, and subjective workload ratings are particularly important. Subjective workload represents an important aspect of nurse workload that remains largely unmeasured despite high potential for intervention.
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Enfermagem de Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva Neonatal/organização & administração , Terapia Intensiva Neonatal/organização & administração , Erros Médicos/estatística & dados numéricos , Enfermagem Neonatal/organização & administração , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Carga de Trabalho/estatística & dados numéricos , Enfermagem de Cuidados Críticos/estatística & dados numéricos , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/estatística & dados numéricos , Modelos Logísticos , Enfermagem Neonatal/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Estudos Prospectivos , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , AutorrelatoRESUMO
: media-1vid110.1542/5972296743001PEDS-VA_2018-0496Video Abstract BACKGROUND: Developing a research agenda that is focused on the priorities of key stakeholders may expedite implementation and dissemination. Our objective was to identify the highest-priority patient-safety research topics among pediatric clinicians, health care leaders, and families. METHODS: The Children's Hospitals Solutions for Patient Safety Network is a network of >100 children's hospitals working together to eliminate harm due to health care. Parents and site leaders responded to an open-ended, anonymous e-mail survey used to elicit research topics. A key stakeholder panel winnowed related topics and prioritized topics using Likert scale ratings. Site leaders and parents responded to a second anonymous e-mail survey and rated the importance of each topic. Health system executive interviews were used to elicit their opinions regarding top priorities for patient-safety research. RESULTS: The elicitation survey had 107 respondents who produced 49 unique research topics. The key stakeholder panel developed a final list of 24 topics. The prioritization survey had 74 respondents. Top-priority research topics concerned high reliability, safety culture, open communication, and early detection of patient deterioration and sepsis. During 7 qualitative interviews, health system executives highlighted diagnostic error, medication safety, deterioration, and ambulatory patient safety as priority areas. CONCLUSIONS: With this study, we take a first step toward a stakeholder-driven research agenda on the basis of the assumption that stakeholders are best positioned to determine what research will be used to address the problems of most concern to them.
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Pessoal de Saúde/normas , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/normas , Hospitais Pediátricos/normas , Segurança do Paciente/normas , Pesquisa/normas , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
Healthcare providers rely on historical data reported by parents to make medical decisions. The Hospital to Home Outcomes (H2O) trial assessed the effects of a onetime home nurse visit following pediatric hospitalization for common conditions. The H2O primary outcome, reutilization (hospital readmission, emergency department visit, or urgent care visit), relied on administrative data to identify reutilization events after discharge. We sought to compare parent recall of reutilization events two weeks after discharge with administrative records. Agreement was relatively high for any reutilization (kappa 0.74); however, this high agreement was driven by agreement between sources when no reutilization occurred (sources agreed 98%-99%). Agreement between sources was lower when reutilization occurred (48%-76%). Some discrepancies were related to parents misclassifying the site of care. The possibility of inaccurate parent report of reutilization has clinical implications that may be mitigated by confirmation of parent-reported data through verification with additional sources, such as electronic health record review.
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Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos , Pais/psicologia , Readmissão do Paciente/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Alta do Paciente/estatística & dados numéricosRESUMO
This cross-sectional study compares the health behaviors, mental health status, and preventive health care usage of health care support workers (HSWs) with clinicians and the general population.
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Comportamentos Relacionados com a Saúde , Saúde Mental , Humanos , Atenção à SaúdeRESUMO
INTRODUCTION: The NASA Task Load Index (NASA-TLX) is a subjective workload assessment scale developed for use in aviation and increasingly applied to healthcare. The scale purports to measure overall workload as a single variable calculated by summing responses to six items. Since no data address the validity of this scoring approach in health care, we evaluated the single factor structure of the NASA-TLX as a measure of overall workload among intenisive care nurses. METHODS: Confirmatory factor analysis of data from two studies of nurse workload in neonatal, paediatric, and adult intensive care units. Study 1 data were obtained from 136 nurses in one neonatal intensive care unit. Study 2 data were collected from 300 nurses in 17 adult, paediatric and neonatal units. Nurses rated their workload using the NASA-TLX's paper version. RESULTS: A single factor model testing whether all six items measured a single overall workload variable fit least well (RMSEAâ¯=â¯0.14; CFIâ¯=â¯0.91; TLIâ¯=â¯0.85). A second model that specified two items as outcomes of overall workload had acceptable fit (RMSEAâ¯=â¯0.08; CFIâ¯=â¯0.97; TLIâ¯=â¯0.95) while a third model of four items fit best (RMSEAâ¯=â¯0.06; CFIâ¯>â¯0.99; TLIâ¯=â¯0.99). CONCLUSION: A summed score from four of six NASA-TLX items appears to most reliably measure a single overall workload variable among intensive care nurses.
Assuntos
Carga de Trabalho/psicologia , Carga de Trabalho/normas , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários , Análise e Desempenho de Tarefas , Estados Unidos , United States National Aeronautics and Space Administration/organização & administração , Recursos Humanos , Local de Trabalho/psicologia , Local de Trabalho/normasRESUMO
Importance: Families often struggle after discharge of a child from the hospital. Postdischarge challenges can lead to increased use of urgent health care services. Objective: To determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. Design, Setting, and Participants: This Hospital-to-Home Outcomes (H2O) randomized clinical trial included 966 children and adolescents younger than 18 years (hereinafter referred to as children) admitted to general medicine services at a free-standing tertiary care children's hospital from May 11 through October 31, 2016. Data were analyzed as intention to treat and per protocol. Interventions: A postdischarge telephone call within 4 days of discharge compared with standard discharge. Main Outcomes and Measures: The primary outcome was the 30-day reutilization rate for urgent health care services (ie, unplanned readmission, emergency department visit, or urgent care visit). Secondary outcomes included additional utilization measures, as well as parent coping, return to normalcy, and understanding of clinical warning signs measured at 14 days. Results: A total of 966 children were enrolled and randomized (52.3% boys; median age [interquartile range], 2.4 years [0.5-7.8 years]). Of 483 children randomized to the intervention, the nurse telephone call was completed for 442 (91.5%). Children in the intervention and control arms had similar reutilization rates for 30-day urgent health care services (intervention group, 77 [15.9%]; control group, 63 [13.1%]; P = .21). Parents of children in the intervention group recalled more clinical warning signs at 14 days (mean, 1.8 [95% CI, 1.7-2.0] in the intervention group; 1.5 [95% CI, 1.4-1.6] in the control group; ratio of intervention to control, 1.2 [95% CI, 1.1-1.3]). Conclusions and Relevance: Although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, this method shows promise to bolster postdischarge education. Trial Registration: ClinicalTrials.gov Identifier: NCT02081846.