RESUMO
Improving work conditions and the provision of high-quality care and patient safety is an issue in European hospitals. Inspired by a US program for nursing excellence, Magnet Recognition, a Belgian hospital shared their experiences by organizing a summer school in 2019 with nurses of 21 hospitals from 9 countries. This article explains the hospital's research program, the link between the journey and the content of the summer school, lessons learned, and the extent to which participants of European hospitals were interested in nursing excellence and Magnet designation.
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Liderança , Processo de Enfermagem/normas , Recursos Humanos de Enfermagem Hospitalar/normas , Europa (Continente) , Humanos , Qualidade da Assistência à SaúdeRESUMO
BACKGROUND: Poor adherence to medications is a significant problem that leads to increased morbidity, mortality, and health care costs. Recommended approaches to address medication adherence vary, and existing practice guidelines are unclear. PURPOSE: This review evaluated clinical practice guidelines designed to help health care providers address patients' medication adherence. METHOD: Multiple search methods were used to identify national or international guidelines addressing medication adherence. We included guidelines published in English, as well as guidelines with an English-language summary or translation. RESULTS: We identified 23 guidelines of varying detail and quality. Recommendations were categorized as assessment strategies (n = 20 guidelines); educational strategies (n = 18); behavioral strategies (n = 17); therapeutic relationship, communication, and provider factors (n = 19); and addressing outside influences/co-morbidities (n = 10). CONCLUSION: Future guidelines should be more clearly guided by research findings and comparative effectiveness methods. When implemented, guidelines will facilitate health care providers and health systems in supporting optimal adherence and improved health outcomes.
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Adesão à Medicação , Administração dos Cuidados ao Paciente , Guias de Prática Clínica como Assunto , Humanos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Educação de Pacientes como Assunto , Relações Profissional-Paciente , Melhoria de QualidadeAssuntos
Doenças Cardiovasculares/enfermagem , Doenças Cardiovasculares/prevenção & controle , Enfermagem Baseada em Evidências , Sociedades de Enfermagem/organização & administração , Especialidades de Enfermagem/organização & administração , Saúde Global , Educação em Saúde/tendências , Humanos , Papel do Profissional de Enfermagem , Guias de Prática Clínica como Assunto , Prevenção Primária/tendênciasRESUMO
OBJECTIVES: This study investigated Belgian hospital nurses' perceptions on work environment and workforce issues, quality of care, job satisfaction and professional decision making. METHODS: All eligible nurses in a selection of 22 hospitals received the BELIMAGE questionnaire for a total of 13,958 potential respondents. Of these, 9941 returned study materials (response rate=71.2%) of which 9638 were valid and useable for statistical analysis (valid response rate=69.1%). RESULTS: The study identified several areas of tension in the nursing profession. The commitment to being competent providers of quality care was remarkably strong among the nurses, but they also perceived the barriers in the work environment to be multiple and complex. Concerns about the quality of leadership and management, insufficient staff, time demands and stressful work environment are experienced as obstacles in providing good nursing care. Four out of ten nurses (39.2%) would not choose nursing again as a career and more than half of the nurses (54.3%) have contemplated leaving the profession at some point in time. CONCLUSIONS: To effectively tackle the professional and workforce issues in nursing, investments should focus on redesigning a work environment that supports nurses in providing comprehensive professional care.
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Atitude do Pessoal de Saúde , Ambiente de Instituições de Saúde , Recursos Humanos de Enfermagem Hospitalar/psicologia , Local de Trabalho/psicologia , Adulto , Bélgica , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Estudos Transversais , Tomada de Decisões Gerenciais , Feminino , Ambiente de Instituições de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Hospitais Gerais , Humanos , Satisfação no Emprego , Liderança , Masculino , Papel do Profissional de Enfermagem/psicologia , Pesquisa Metodológica em Enfermagem , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Supervisão de Enfermagem/normas , Cultura Organizacional , Admissão e Escalonamento de Pessoal/normas , Competência Profissional/normas , Qualidade da Assistência à Saúde/organização & administração , Apoio Social , Inquéritos e Questionários , Gerenciamento do Tempo , Local de Trabalho/organização & administraçãoRESUMO
This paper reports data on the professional self-image of 9638 nurses employed in 22 Belgian general hospitals with the goal of identifying problems affecting recruitment and retention. Nurses reported having a positive self-image. Most were proud to be a nurse and considered themselves competent health professionals having great responsibility. Although they reported that an ideal practice requires effective teamwork, supportive management, societal recognition, and sufficient time to perform their duties, they also felt that these essential conditions were absent in daily practice.
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Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem Hospitalar/psicologia , Competência Profissional/normas , Autoimagem , Adulto , Bélgica , Comunicação , Comportamento Cooperativo , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Gerais , Humanos , Relações Interprofissionais , Masculino , Papel do Profissional de Enfermagem/psicologia , Pesquisa em Administração de Enfermagem , Pesquisa Metodológica em Enfermagem , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Seleção de Pessoal , Reorganização de Recursos Humanos , Percepção Social , Apoio Social , Valores Sociais , Inquéritos e Questionários , Local de Trabalho/organização & administração , Local de Trabalho/psicologiaRESUMO
OBJECTIVES: To examine which interventions healthcare professionals use to support patients with taking medicines and their perceptions about the effectiveness of those actions. DESIGN: Cross-sectional multinational study. SETTING: Online survey in Austria, Belgium, England, France, Germany, Hungary, The Netherlands, Poland, Portugal and Switzerland. PARTICIPANTS: A total of 3196 healthcare professionals comprising doctors (855), nurses (1047) and pharmacists (1294) currently registered and practising in primary care and community settings. PRIMARY OUTCOME: Responses to the question 'I ask patients if they have missed any doses of their medication' for each profession and in each country.Secondary outcome: Responses to 50 items concerning healthcare professional behaviour to support patients with medication-taking for each profession and in each country. RESULTS: Approximately half of the healthcare professionals in the survey ask patients with long-term conditions whether they have missed any doses of their medication on a regular basis. Pharmacists persistently report that they intervene less than the other two professions to support patients with medicines. No country effects were found for the primary outcome. CONCLUSIONS: Healthcare professionals in Europe are limited in the extent to which they intervene to assist patients having long-term conditions with medication adherence. This represents a missed opportunity to support people with prescribed treatment. These conclusions are based on the largest international survey to date of healthcare professionals' management of medication adherence.
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Pesquisas sobre Atenção à Saúde , Pessoal de Saúde , Adesão à Medicação , Atenção Primária à Saúde , Adulto , Estudos Transversais , Europa (Continente) , Feminino , Humanos , Masculino , Papel do Profissional de Enfermagem , Farmacêuticos , Papel do MédicoRESUMO
OBJECTIVES: The objectives of this study were to determine the perceptions of European physicians, nurses, and pharmacists about the extent of nonadherence by patients in their country relative to their perception of nonadherence by their own patients, and to investigate the occurrence of optimistic bias about medication adherence. The study explored a key cognitive bias for prevalence and likelihood estimates in the context of health care professionals' beliefs about patients' use of medicines. METHODS: A cross-sectional online survey of 3,196 physicians (855), nurses (1,294), and pharmacists (1,047) in ten European countries (Austria, Belgium, England, France, Germany, Hungary, the Netherlands, Poland, Portugal, and Switzerland) was used. RESULTS: Participants differed in their perceptions of the prevalence of medication adherence initiation, implementation, and persistence present in their own patients with a chronic illness in comparison to patients with a chronic illness in general. Health care professionals demonstrated optimistic bias for initiation and persistence with medicine taking, perceiving their own patients to be more likely to initiate and persist with treatment than other patients, but reported significantly lower prevalence of medication adherence levels for their own patients than for patients in general. This finding is discussed in terms of motivational and cognitive factors that may foster optimistic bias by health care professionals about their patients, including heightened knowledge of, and positive beliefs about, their own professional competence and service delivery relative to care and treatment provided elsewhere. CONCLUSION: Health care professionals in Europe demonstrated significant differences in their perceptions of medication adherence prevalence by their own patients in comparison to patients in general. Some evidence of optimistic bias by health care professionals about their patients' behavior is observed. Further social cognitive theory-based research of health care professional beliefs about medication adherence is warranted to enable theory-based practitioner-focused interventions to be tested and implemented.
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Cardiologia , Doenças Cardiovasculares/enfermagem , Enfermeiros Clínicos/organização & administração , Especialidades de Enfermagem/organização & administração , Bélgica/epidemiologia , Cardiologia/educação , Cardiologia/organização & administração , Doenças Cardiovasculares/epidemiologia , Certificação/organização & administração , Bacharelado em Enfermagem/organização & administração , Educação de Pós-Graduação em Enfermagem/organização & administração , Previsões , Necessidades e Demandas de Serviços de Saúde , Humanos , Programas Nacionais de Saúde/organização & administração , Enfermeiros Clínicos/educação , Papel do Profissional de Enfermagem , Assistência Progressiva ao Paciente/organização & administração , Sociedades de Enfermagem/organização & administração , Especialidades de Enfermagem/educaçãoRESUMO
AIMS AND BACKGROUND: We report on the development and implementation of a critical pathway for patients with chest pain making use of action research. METHODS: Firstly the population to be included in the pathway was defined and a coordinator was assigned. Secondly a multidisciplinary workgroup for the development of the pathway was instated. The actual development of the pathway consisted of four major steps: (1) evaluation of the current process of care for the chest pain unit (CPU) patients, (2) evaluation of medical evidence and practice in other hospitals, (3) optimization of the process and (4) actual drafting of the pathway. Finally the pathway development was followed by the implementation of the pathway. RESULTS: A chest pain critical pathway could be successfully developed, leading to (1) a triage flowchart based on the European Society of Cardiology guidelines categorizing patients in different risk groups; (2) CPU and hospital standing orders and protocols for the management of the different risk groups; (3) revision of physician and nursing medical records; and (4) development of admission and discharge brochures for patients and family admitted to the CPU. CONCLUSION: To our best knowledge this paper is the first to report on the use of action research to develop a critical pathway for patients with symptoms suggestive of an acute coronary syndrome admitted to a chest pain unit. Our experience suggests that it can serve as a means to reach the objective of conceiving and implementing an evidence-based pathway into everyday clinical practice.
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Dor no Peito/diagnóstico , Procedimentos Clínicos/organização & administração , Pesquisa sobre Serviços de Saúde , Equipe de Assistência ao Paciente/organização & administração , Bélgica , Gerenciamento Clínico , Tratamento de Emergência , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Gestão da Qualidade Total , TriagemRESUMO
Introduction It is widely recognised that many patients do not take prescribed medicines as advised. Research in this field has commonly focused on the role of the patient in non-adherence; however, healthcare professionals can also have a major influence on patient behaviour in taking medicines. This study examines the perceptions, beliefs and behaviours of healthcare professionals-doctors, pharmacists and nurses-about patient medication adherence. Methods and analysis This paper describes the study protocol and online questionnaire used in a cross-sectional survey of healthcare professionals in Europe. The participating countries include Austria, Belgium, France, Greece, The Netherlands, Germany, Poland, Portugal, Switzerland, Hungary, Italy and England. The study population comprises primary care and community-based doctors, pharmacists and nurses involved in the care of adult patients taking prescribed medicines for chronic and acute illnesses. Discussion Knowledge of the nature, extent and variability of the practices of healthcare professionals to support medication adherence could inform future service design, healthcare professional education, policy and research.
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OBJECTIVE: To compare length of stay (LOS), clinical and psychological outcomes, and patient satisfaction before and after implementation of a chest pain critical pathway. DESIGN: A pre- and post-test quasi-experimental design. SETTING: The Chest Pain Unit (CPU) of the Antwerp University Hospital. PATIENTS: Patients admitted to the CPU with symptoms suggestive of an acute coronary syndrome older than 18 years. INTERVENTIONS: Implementation of a critical pathway focusing on implementation of the guidelines for the management of chest pain. MAIN OUTCOME MEASURES: Patient satisfaction, length of stay and anxiety were evaluated. RESULTS: The median LOS of intervention subjects was almost 4 hours shorter than that of control subjects (without, P = 0.04, or with propensity correction, P = 0.019). The overall patient satisfaction with CPU care of the intervention group was significantly higher than that of the control group (without, P < 0.001, or with propensity correction, P < 0.001). Differences in anxiety and occurrences of major adverse cardiac events between the groups were not statistically significant. CONCLUSION: A critical pathway can effectively and safely reduce LOS, increase patient satisfaction, and improve adherence to the guidelines for managing patients with chest pain. Anxiety is not statistically significantly reduced by this intervention.
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Dor no Peito/diagnóstico , Dor no Peito/terapia , Procedimentos Clínicos , Idoso , Ansiedade/diagnóstico , Distribuição de Qui-Quadrado , Feminino , Fidelidade a Diretrizes , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Satisfação do Paciente , Qualidade da Assistência à Saúde , Fatores de Risco , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
The chest pain unit (CPU) provides a service for patients at moderate-to-low risk for acute coronary syndrome (ACS). Although the number of CPUs has continued to grow worldwide, little has been written on the specific role and contribution of nursing in CPUs. The stay of patients in the CPU can be divided into six stages: triage, diagnosis, treatment, observation/monitoring, discharge, and follow-up. CPU nurses are in a unique position to promote evidence-based practice during all of these stages. Deeper insight into the unique role of nurses in CPUs will promote understanding of what type of knowledge, skills, and attitudes are required to provide the services that will contribute to improved quality of care for chest pain patients.