[Improving the Surveillance Alarm Response Rate Among Nurses in the Internal Medicine Intensive Care Unit].

BACKGROUND & PROBLEMS: According to the Emergency Care Research Institute, "not responding to alarms" is a top-ten health-technology hazard that ranked first between 2008 and 2014. The failure of clinical nurses to respond to alarms in time due to lack of awareness, fatigue, or other cause represents a great threat to patient safety. Between August 2014 and August 2015, two patients in this unit died because the red alert on the physiological alarm surveillance system was not answered and dealt with promptly. PURPOSE: To raise the 10-second response rate to red alerts from 22% to 100% in order to enhance inpatient safety. METHODS: Establish standard operating procedures for alarms and for the handling of physiologic monitor devices when alarms sound; form a gatekeeper system; and arrange on-the-job training. RESULTS: The 10-second response rate to red alerts increased from 22% to 100% between November 2016 and November 2017. CONCLUSIONS: By following standard operating procedures, personnel now have a guide to respond to and handle red alerts comprehensively. Implementing the gatekeeper system also increased the team spirit of the unit and helped personnel appreciate the importance of cooperation in handling alarms. In addition, the functions of the physiologic monitor devices and the 10-second response rate for red alerts will be included in the annual quality control checklist of the unit for follow up, review, and further improvement.

[The effect of bundle care on central line associated bloodstream infection in a medical intensive care unit].

BACKGROUND & PROBLEMS: While the central line catheter is a common device used in intensive medical care, it is a frequent source of nosocomial infection. The central line associated bloodstream infection (CLABSI) rate at our medical ICU had increased steadily, with an average rate between January and May 2011 of .47%. We used a cross-team approach to implement bundle care as a strategy to reduce the CLABSI rate. PURPOSE: We designed a project to reduce the CLABSI rate below .3% in our ICU. RESOLUTION: This project was conducted between June 2011 and May 2012. Our strategy included providing a sterile towel, implementing maximal barrier precautions (head to toe), designing an illustration explaining how to use 2% CHG, establishing a procedures and care checklist, implementing quality assurance for procedures and care, and providing education on bundle care. RESULTS: The CLABSI rate reduced to .24% after project implementation. This result was below the target of .30%. CONCLUSIONS: We want to share this experience to help other hospitals and units improve critical care quality and to continue working to achieve a zero-tolerance infection rate.

[Relationships amongst work values, job characteristics and job involvement in "net generation" nurses].

BACKGROUND: Children of the so-called "net generation" began joining the nurse workforce from the mid-1990s. Studies on the characteristics of this generation have been done primarily outside of Taiwan, and results may not adequately reflect conditions in Taiwan due to cultural differences. PURPOSE: This study aimed to investigate the relationships amongst work values, job characteristics and job involvement in "net generation" nurses. METHOD: This study employed a cross-sectional design. A randomized sample of 370 nurses born between 1977 and 1985 working in a medical center or a community hospital in Southern Taiwan accepted our invitation to join this study. A structured questionnaire was used to collect data. RESULTS: (1) Variables including work values, job characteristics, head nurse leadership qualities, job structure and opportunities for in-service education all correlated significantly with job involvement. (2) Regression analysis showed work values, job characteristics, head nurse leadership and religious belief to be significant predictors of job involvement, explaining 22.6% of the variance. CONCLUSION: This study provides insights that may be of potential value to nursing administrators. We suggest that administrators adopt democratic management practices, build diverse learning methods, strengthen autonomy, completeness, and feedback, and provide appropriate work guidance for nurses to increase job involvement.

Role stress and job satisfaction for nurse specialists.

AIM: This paper is a report of a study to illustrate the unique relationship between role stress and job satisfaction and provide recommendations for advanced nursing practice in Taiwan. BACKGROUND: International literature has shown that work role-related stress experienced by staff nurses predicts role strain, which in turn influences job satisfaction and intention to leave the job. In this study, the direct relationship between role stress and job satisfaction of nurse specialists was examined after controlling for personality trait and personal characteristics. METHOD: In 2004 a convenience sample of 129 nurse specialists from five acute care teaching hospitals in Taiwan participated. They completed a questionnaire (response rate 81%) focusing on personal characteristics, the Five Factor Model of personality traits, role stress (i.e. ambiguity, conflict, overload, incompetence) and job satisfaction (i.e. professionalism, interaction, demand/reward, control/recognition). Data were analysed using hierarchical regression models. RESULTS: After controlling for personality traits and personal characteristics, role stress variables predicted 24.8% of the variance in job satisfaction. Role ambiguity (P < 0.001) and role overload (P < 0.01) were the best predictors, but role conflict was not statistically significant. Role stress explained statistically significant proportions of the variance for each component of job satisfaction: professionalism (10.6%), interaction (16.7%), demand/reward (27.1%) and control/recognition (18.5%). Role ambiguity predicted all four satisfaction components, role overload predicted demand/reward and role incompetence predicted interaction. CONCLUSION: Organizational restructuring and administrative support are recommended to address the issues raised. Appropriate training, sufficient communications and supportive legislation are required. Future research should be conducted to evaluate the impact of these interventions.