SHOULD I STAY OR SHOULD I GO-A rapid qualitative study of principal deteriorating factors experienced by nurses relating to their intentions to leave their current position in a medical hospital department.

BACKGROUND: High nurse turnover in hospitals is a worldwide problem with dire consequences for patient care such as increased mortality and a decrease in patient safety. A specific effort to retain nurses is urgently needed due to the many vacant nursing positions, especially across the Medical hospital departments. AIM: To identify the principal deteriorating factors experienced by nurses relating to their intentions to leave the medical department at a university hospital. METHODS: A rapid qualitative research methodology was used. Participants comprised 22 registered nurses employed in five university hospital medical department units. The Rigorous and Accelerated Data Reduction (RADaR) technique was therefore used for data collection through qualitative semi-structured interviews and analysis. COREQ was used for reporting the study. RESULTS: The RADaR analysis detected a downward spiral of five principal deteriorating factors influencing nurses' intentions to leave their position in the medical department. The factors were resignations from several nursing colleagues combined with too few and inexperienced nurses present during shifts, additional tasks assigned, a management refraining from improving the problematic issues, leading to decisive consequences for patient care and a declining feeling of professional care. CONCLUSIONS: The lack of nurses in the department caused missed nursing care, which affected the nurses' job satisfaction and intentions to leave their positions. Future research initiatives must focus on evaluating successful interventions to maintain the nurses in the positions. Further knowledge, is also needed, to investigate how we can change the downward spiral to a story of retention success.

Understanding Facilitators and Challenges to Care Transition in Cardiac Rehabilitation: Perspectives and Assumptions of Healthcare Professionals.

Cardiac rehabilitation is an essential part of treatment for patients with cardiovascular disease. Cardiac rehabilitation is increasingly organized outside hospital in community healthcare services. However, this transition may be challenging. The aim of this study was to examine assumptions and perspectives among healthcare professionals on how facilitators and challenges influence the transition from hospital to community healthcare services for patients in cardiac rehabilitation. The study followed the Interpretive Description methodology and data consisted of participant observations and focus group interviews. The analysis showed that despite structured guidelines aimed to support the collaboration, improvements could be made. Facilitators and challenges could occur in the collaboration between the healthcare professionals, in the collaboration with the patient, or because of the new reality for patients when diagnosed with cardiovascular disease.

The content, dissemination and effects of case management interventions for informal caregivers of older adults: a systematic review.

OBJECTIVES: To investigate and describe the content, dissemination and effects of case management interventions for informal caregivers of older adults, focusing on outcomes related to patients' activities of daily living, nutrition assessment, pain measurement, depression, length of stay and to caregivers' satisfaction and difficulties. DESIGN: This systematic review was based on the Preferred Reporting Items for Systematic. Reviews and Meta-Analysis of studies that evaluate healthcare interventions (PRISMA) statement. DATA SOURCES: PubMed, CINAHL, and EMBASE were searched in September 2013 using a two-step search strategy combining an electronic search with a search in the reference lists. The search strategy was structured using the study inclusion criteria built on PICOS. REVIEW METHODS: Studies were reviewed by title, abstract and full-text by both authors. Duplicates and studies not meeting the inclusion criteria were excluded. Data was extracted from the eligible studies using narrative synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was employed to rate the quality of the evidence. RESULTS: Seven studies (5 RCTs) including a total of 6956 patients over the age of 65 and their informal caregivers (spouses, family members, and close relatives) all in community-care settings were found eligible and included in the review. The assessment for risk of bias in the seven studies indicated variations in the study quality from very low (n=4), to low (n=1) and moderate (n=2) due to lack of randomisation, blinding, transparency and not following intention to treat. A case management approach was claimed in four studies and the remaining three studies used a psycho-educational intervention with core components of case management consistent with the literature. Significant effects of case management interventions were seen on patients' time to institutionalisation, municipal care costs and emotional health when informal caregivers were involved. A significant effect was also found on informal caregivers' decrease in depressive symptoms over time. CONCLUSION: Research of case management interventions for informal caregivers is very limited. This review identifies knowledge about case management as an intervention for informal caregivers to older patients, suggesting strengths and weaknesses for future interventions when informal caregivers are involved. PROSPERO registration: CRD42014007462.