The effect of different care delivery models in a hospital setting on patient- and nurse-related outcomes: A systematic review with narrative synthesis.

AIM: To synthesize and assess the effectiveness of different care delivery models in a hospital setting, taking into account patient- and nurse-related outcomes. DESIGN: A systematic review with narrative synthesis in which a comparison was made between different care delivery models. METHODS: The search string consisted of four clusters: 'nursing', 'care delivery models', 'hospital setting' and 'quantitative research designs'. Four electronic databases were searched from the inception of the databases to January 2023: Medline, Embase, CINAHL and Web of Science. RESULTS: In total, 19 studies were included in the systematic review. The most commonly compared care delivery models were functional nursing to primary nursing (n = 6), patient allocation to team nursing (n = 4), team nursing to primary nursing (n = 3) and functional nursing to modular nursing (n = 3). Only one randomized crossover trial was found, other included studies were pretest-posttest designs or quasi-experimental designs. The implementation of a nursing care delivery model was the study intervention. The following aspects of the intervention were not reported or inadequately described by the majority of the authors; tailoring of an intervention, modifications to an intervention and the adherence or fidelity to the intervention. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. Due to a high heterogeneity in outcome measures between the studies, a meta-analysis of the included studies was not possible. All included studies had a high risk of overall bias. CONCLUSION: This systematic review found mixed evidence, inconsistent reporting of certain elements of the interventions, high heterogeneity in outcome measures and low methodological quality. Although this systematic review could not answer which nursing care delivery model is the most effective or most promising, other important findings from this review may inform future research. IMPACT: There are differences in care delivery model descriptions and a lack of agreement on the strengths and weaknesses of the care delivery models. No clear-cut answer can be given about the effect of different care delivery models in a hospital setting on patient- and nurse-related outcomes. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. This review can support the development of future care delivery redesign strategies. REPORTING METHOD: The systematic review was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Integrating Sensor Technology in Disposable Body-Worn Absorbent Products: A Qualitative Study to Define User Profile, (Technical) Criteria, Conditions, and Potential Benefits.

PURPOSE: The purpose of this study was to define the user profile, (technical) criteria, conditions, and potential benefits of the integration of sensor technology in disposable body-worn incontinence materials. DESIGN: Qualitative study using a framework method. SUBJECT AND SETTING: The sample included residents with incontinence, nurses, and decision-makers in a selection of Flemish nursing homes (Belgium). METHODS: Semistructured interviews were performed between June and August 2020. The interviews with nurses included open-ended questions focusing on the user profile, (technical) criteria, conditions, and potential benefits of the integration of sensor technology in disposable body-worn incontinence materials. The interviews with decision-makers were supplemented with questions about purchase cost and other economic criteria (such as reimbursement). Interviews with residents included questions about wearing comfort. Interviews were tape-recorded and transcribed verbatim. Data were analyzed using a framework method. RESULTS: The user profile was defined as (1) residents with cognitive impairment and (2) residents who are bedridden or are severely limited in mobility. The following (technical) criteria emerged from the analyses: a small, thin, and oval/circular sensor, an adaptable or in front attachment of the sensor on the absorbent product, a real-time indication of the absorbent product's saturation, leakage detection, liquid stool detection, the automatic recording of incontinence-related data, a durable sensor easy to disinfect, and receiving notifications on a wearable device. Conditions included a stable connection between the wearable device and the sensor, accurate measurements, user-friendly system, comprehensible training, affordability, and data protection. Potential benefits included workload reduction, increased comfort for residents and staff, more person-centered care, increased quality of care, less skin damage and economic (eg, less costs due to less excessive absorbent product changes), and/or environmental (e.g. less waste) gains. CONCLUSION: Study findings identified the user profile, (technical) criteria, conditions, and potential benefits of the integration of sensor technology in disposable body-worn incontinence materials. Respondents reported problems with changing routines and skepticism about the sensor's accuracy. Based on findings from this study, we recommend involving representatives of all relevant stakeholders in the design of sensor technology to ensure users' needs and increase the use of sensor technology. Comprehensive education is recommended to inform nurses, residents, and their family members on the importance and benefits of the technology and to aid overcoming barriers to use (skepticism, resistance to new technologies, and changing care routines). Study findings also indicate that the sensor technology cannot replace the existing voiding programs; rather it should be an addition to routine continence care.

An exploration of nursing home residents' experiences of a non-powered static air mattress overlay to prevent pressure ulcers.

Pressure ulcers are injuries to the skin and underlying tissue and are associated with a negative impact on well-being and health-related quality of life. This explorative, qualitative study aimed to explore the true meaning of elderly nursing home residents' perspectives and critical success factors when implementing a new non-powered static air mattress overlay to prevent pressure ulcers. Individual, loosely structured interviews were conductedin 12 nursing homes in Flanders, the Northern region of Belgium, a convenience sampling of 14 nursing home residents were selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair-bound, aged >65 years, and use of an alternating air pressure mattress previous to the application of the non-powered static air mattress overlay. Interviews were conducted in the participants' personal rooms between June 2017 and March 2018. Interviews included broad, open-ended questions, to invite and encourage participants to openly discuss their perspectives and experiences. Participants were interviewed once during the 14-day observation period between day 3 and day 14. All interviews were audio-recorded and fully transcribed by an experienced transcriber. Interviews were read several times to reveal emerging patterns and were marked with codes into NVivo 10 qualitative data analysis software. During the process, (sub) themes were discussed by the authors until a consensus was reached. Three main themes emerged from the analysis process: rest and sleep; mobility; and discomfort and pain associated with the use of the support surface. Themes were divided into multiple subthemes: motion, noise, sensation, repositioning, and transfer in and out of bed. Through interviews, critical success factors associated with the implementation were identified, including the lack of information and time needed to evaluate the functionality and effects of a new mattress overlay. Implementation of a non-powered static air mattress overlay to prevent pressure ulcers has a far-reaching impact on nursing home residents' experiences. This study provides insight into the true meaning of patients' perspectives by focusing on learning from the patients' experiences that provide valuable information for healthcare professionals and other stakeholders.

Prevention of pressure ulcers with a static air support surface: A systematic review.

The aims of this study were to identify, assess, and summarise available evidence about the effectiveness of static air mattress overlays to prevent pressure ulcers. The primary outcome was the incidence of pressure ulcers. Secondary outcomes included costs and patient comfort. This study was a systematic review. Six electronic databases were consulted: Cochrane Library, EMBASE, PubMed (Medline), CINAHL (EBSCOhost interface), Science direct, and Web of Science. In addition, a hand search through reviews, conference proceedings, and the reference lists of the included studies was performed to identify additional studies. Potential studies were reviewed and assessed by 2 independent authors based on the title and abstract. Decisions regarding inclusion or exclusion of the studies were based on a consensus between the authors. Studies were included if the following criteria were met: reporting an original study; the outcome was the incidence of pressure ulcer categories I to IV when using a static air mattress overlay and/or in comparison with other pressure-redistribution device(s); and studies published in English, French, and Dutch. No limitation was set on study setting, design, and date of publication. The methodological quality assessment was evaluated using the Critical Appraisal Skills Program Tool. Results were reported in a descriptive way to reflect the exploratory nature of the review. The searches included 13 studies: randomised controlled trials (n = 11) and cohort studies (n = 2). The mean pressure ulcer incidence figures found in the different settings were, respectively, 7.8% pressure ulcers of categories II to IV in nursing homes, 9.06% pressure ulcers of categories I to IV in intensive care settings, and 12% pressure ulcers of categories I to IV in orthopaedic wards. Seven comparative studies reported a lower incidence in the groups of patients on a static air mattress overlay. Three studies reported a statistical (P < .1) lower incidence compared with a standard hospital mattress (10 cm thick, density 35 kg/m3 ), a foam mattress (15 cm thick), and a viscoelastic foam mattress (15 cm thick). No significant difference in incidence, purchase costs, and patient comfort was found compared with dynamic air mattresses. This review focused on the effectiveness of static air mattress overlays to prevent pressure ulcers. There are indications that these mattress overlays are more effective in preventing pressure ulcers compared with the use of a standard mattress or a pressure-reducing foam mattress in nursing homes and intensive care settings. However, interpretation of the evidence should be performed with caution due to the wide variety of methodological and/or reporting quality levels of the included studies.

Static Air Support Surfaces to Prevent Pressure Injuries: A Multicenter Cohort Study in Belgian Nursing Homes.

PURPOSE: The aim of this study was to investigate the incidence and risk factors for developing pressure injuries (PIs) in patients placed on a static air support surfaces: mattress overlay, heel wedge, and seat cushion. DESIGN: Multicenter cohort study. SUBJECTS AND SETTING: The sample comprised 176 residents; their mean age was 87 (SD = 6.76) years; their mean Braden Scale score was 14 (SD = 2.54). The study was performed on a convenience sample of 6 nursing homes in Belgium. METHODS: Data were collected on 23 care units. The primary outcome measure, cumulative PI incidence (category [stage] II-IV) over a 30-day observation period, was calculated. Pressure injury occurrence was defined according to the 2014 European and US National Pressure Injury Advisory panels, Pan Pacific Pressure Injury Alliance classification system. RESULTS: The PI incidence for category (stage) II-IV was 5.1%. Six residents (3.4%) developed a category II PI, and 3 (1.7%) developed a category III PI; no category IV ulcers occurred. No significant risk factors for category II-IV PIs were identified using multivariate logistic regression. Time of sitting in a chair was found to be a risk factor for development of nonblanchable erythema (category I PI) (odds ratio = 21.608; 95% confidence interval [CI], 20.510-22.812; P = .013). The median time to develop a category II-IV PI was 16 days (interquartile range = 2-26). The interrater reliability between the observations of the researcher and nurses on-site was almost perfect (0.86; 95% CI, 0.81-0.91). CONCLUSION: We found a low incidence of PIs when using a static air overlay mattress for patients at risk in a nursing home population. Static air support surfaces, alongside patient-tailored patient repositioning protocols, should be considered to prevent PIs in this patient population.

Effect of a backboard on chest compression quality during in-hospital adult cardiopulmonary resuscitation: A randomised, single-blind, controlled trial using a manikin model.

INTRODUCTION: Chest compression quality during in-hospital resuscitation is often suboptimal on a soft surface. Scientific evidence regarding the effectiveness of a backboard is scarce. This single-blinded manikin study evaluated the effect of a backboard on compression depth, rate and chest recoil performed by nurses. Sex, BMI, age and clinical department were considered as potential predictors. METHODS: Using self-learning, nurses were retrained to achieve a minimal combined compression score at baseline. This combined score consisted of ≥70% compressions with depth 50-60 mm, ≥70% compressions with complete release (≤5mm) and a mean compression rate of 100-120 bpm. Subsequently, nurses were allocated to a backboard or control group and performed a two-minute cardiopulmonary resuscitation test. The main outcome measure was the difference in proportion of participants achieving a combined compression score of ≥70%. RESULTS: In total 278 nurses were retrained, 158 nurses dropped out and 120 were allocated to the backboard (n = 61) or control group (n = 59). The proportion of participants achieving a combined compression score of ≥70% was not significantly different (p = 0.475) and suboptimal in both groups: backboard group 47.5% (backboard) versus 41.0% (control). Older age (≥51 years) was associated with a lower probability of achieving a combined compression score >70% [OR = 0.133; 95% confidence interval (CI), 0.037-0.479; p = 0.002]. CONCLUSION: Using a backboard did not significantly improve compression quality in our study. Important decay of compression skills was observed in both groups, highlighting the importance of frequent retraining, particularly in some age groups.

A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents.

BACKGROUND: Pressure ulcers are a global issue and substantial concern for healthcare systems. Various types of support surfaces that prevent pressure ulcer are available. Data about the effectiveness and cost of static air support surfaces and alternating air pressure mattresses is lacking. OBJECTIVES: To compare the effectiveness and cost of static air support surfaces versus alternating air pressure support surfaces in a nursing home population at high risk for pressure ulcers. DESIGN: Prospective, multicentre, randomised controlled clinical, non-inferiority trial. SETTING: Twenty-six nursing homes in Flanders, Belgium. PARTICIPANTS: A consecutive sample of 308 participants was selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair bound, aged > 65 years, and use of an alternating air pressure mattress. METHODS: The participants were allocated to the intervention group (n = 154) using static air support surfaces and the control group (n = 154) using alternating air pressure support surfaces. The main outcome measures were cumulative incidence and incidence density of the participants developing a new category II-IV pressure ulcer within a 14-day observation period, time to develop a new pressure ulcer, and purchase costs of the support surfaces. RESULTS: The intention-to-treat analysis revealed a significantly lower incidence of category II-IV pressure ulcer in the intervention group (n = 8/154, 5.2%) than in the control group (n = 18/154, 11.7%) (p = 0.04). The median time to develop a pressure ulcer was significantly longer in the intervention group (10.5 days, interquartile range [IQR]: 1-14) than in the control group (5.4 days, [IQR]: 1-12; p = 0.05). The probability to remain pressure ulcer free differed significantly between the two study groups (log-rank X²â€¯= 4.051, df = 1, p = 0.04). The overall cost of the mattress was lower in the intervention group than in the control group. CONCLUSIONS: A static air mattress was significantly more effective than an alternating air pressure mattress in preventing pressure ulcer in a high-risk nursing home population. Considering multiple lifespans and purchase costs, static air mattresses were more cost-effective than alternating air pressure mattresses.