Evaluation of lay health workers on quality of care in the inpatient setting.

AIMS: To evaluate the impact of a lay health worker support role in the inpatient setting. BACKGROUND: Healthcare systems are facing critical nursing and nurse assistant staffing shortages. These disciplines can be challenging to recruit and retain, leading healthcare leaders to identify innovative staffing models. Whereas lay health workers have been used in the community and low-income setting, there is scant evidence of their use in the inpatient setting. We implemented a lay health worker role, called Patient Attendant Service Aides (PASAs), on two medical/surgical units at a community hospital. METHODS: A pre/post-implementation design was used for this study. An online survey was provided to nurses, nursing assistants, and PASAs on the two medical/surgical units to assess their satisfaction and perceptions of the role. Nursing quality metrics, patient satisfaction, and nursing and nursing assistant turnover were evaluated before and after implementing the role. RESULTS: The online survey showed that nurses and nursing assistants felt that PASAs helped offload their workload, allowing them to focus on nursing-related tasks. PASAs felt supported by the team and believed they were making a meaningful contribution to the unit. There were slight improvements in patient satisfaction, although not significant. There was a significant improvement in nursing turnover on Unit A, from 71.1% to 21.6% (p = 0.009). CONCLUSIONS: This is one of the first studies to evaluate the use of lay health workers in the inpatient setting; we found this role to be a feasible way to offload tasks from clinical staff. This role may serve as a pathway for workforce development, as several PASAs are now enrolled in nursing assistant training. Nurse managers may consider using lay health workers in the inpatient setting as they face severe clinical staff shortages.

Febrile Neutropenia: Improving Care Through an Oncology Acute Care Clinic.

BACKGROUND: Patients with cancer are at risk for oncologic emergencies, including febrile neutropenia (FN). Timely treatment of FN can prevent complications. Providing this care in the outpatient setting has been shown to be safe and effective. OBJECTIVES: This project implemented and evaluated a new process using an outpatient acute care clinic (ACC) to manage FN in patients with hematologic cancer. The aims were to reduce the time from fever identification to antibiotic administration, decrease emergency department (ED) visit rates, and evaluate patient satisfaction. METHODS: Using a pre-/postimplementation design, an interprofessional team was educated about a new process of caring for patients with hematologic cancer and FN at an outpatient ACC using a comprehensive algorithm. FINDINGS: 31 patients participated in the project (15 pre- and 16 postimplementation). Time to antibiotic administration decreased from 144.88 minutes to 63.69 minutes. Participant visits to the ED decreased by 2.33 times per month on average. Overall, patients were satisfied with the ACC. These findings support using a dedicated outpatient ACC for patients with FN receiving hematology care.

Surrogacy and the law in the UK.

Surrogacy is a method of assisted reproduction in which a woman bears a child on behalf of a couple or individual with the intention of handing over care of the child to the intending parent(s) at or soon after birth. The law surrounding surrogacy is complex for healthcare professionals, surrogates and intending parent(s) to navigate. This review article summarises the laws and potential legal complications of surrogacy in the UK. While altruistic surrogacy is permitted, commercial surrogacy is outlawed in this country. Both traditional and gestational surrogacy may be performed and UK law now also permits surrogacy for same sex couples, unmarried couples and single individuals as intending parent(s). Legal parenthood of the child is transferred from the surrogate to the intending parent(s) via application for a parental order between 6 weeks and 6 months after birth. Legal complications include time restrictions for parental order applications and breaches of reasonable payments to surrogates.

A scoping review on the nurse scientist role within healthcare systems.

BACKGROUND: The role of the nurse scientist in the clinical setting is not well defined, which contributes to variability in role implementation, scope, administration, funding, and affiliation across healthcare sites. AIMS: The aim of this scoping review was to identify attributes of the clinical nurse scientist role and its operationalization in the clinical setting through available evidence. METHODS: A comprehensive, computerized search of the literature in PubMed, Medline, and CINAHL was conducted in early May 2020 by a medical research librarian and repeated in July 2021 and April 2022. The 5-step framework described by Arskey and O'Malley guided the review methodology. Two reviewers conducted an independent screen of all articles, followed by a full-text review of eligible articles by two independent reviewers each using a standardized data extraction template. Themes were then organized and synthesized using descriptive content analysis from the included articles. RESULTS: A final sample of 55 full-text articles were included in the review. Overall, the findings suggest that the nurse scientist role in a clinical setting can be challenging to implement in complex healthcare environments. Successful models include the nurse scientist in a leadership role, alignment of research with institutional priorities, and strong support from senior leadership. LINKING EVIDENCE TO ACTION: Findings suggest that standardized guidelines are lacking to govern the implementation of the nurse scientist role in the clinical setting. To succeed, the nurse scientist role must be valued and supported by organizational leaders. Further, access to resources to build infrastructure must be provided. The magnitude and scope of individual organizational support can be tailored based on the resources of the institution; however, the foundation of having institutional leadership support is critical to role success of the clinical nurse researcher.

Using an Electromagnetic Guidance System for Placement of Small-Bowel Feeding Tubes to Reduce Feeding Start Times.

BACKGROUND: Cardiothoracic surgery patients have an increased risk for aspiration and may require enteral access for nutrition. LOCAL PROBLEM: In a cardiothoracic intensive care unit, feeding start times were delayed because of scheduling conflicts with support services. An electromagnetic device (Cortrak 2 Enteral Access System, Avanos Medical) was introduced to allow advanced practice providers (nurse practitioners and physician assistants) to independently establish postpyloric access and reduce dependence on ancillary services. METHODS: A quality improvement study was performed. Pre- and postimplementation data included order time, service arrival, tube placement time, tube positioning, and feeding start times for 207 placements. Pre- and postimplementation surveys were conducted to evaluate advanced practice provider satisfaction with enteral tube placement practices. RESULTS: Feeding start time for initial placement decreased by 35.5% (15.6 hours to 10 hours); for subsequent placement, by 55.2% (15.5 hours to 7.0 hours). Assistance by support services decreased by 80.4% (before implementation, 100 of 100 placements [100%]; after implementation, 21 of 107 placements [19.6%]; P < .001; ϕ = 0.815). Overall, advanced practice provider satisfaction increased. Most participants said that using the electromagnetic device was faster, nutrition was delivered sooner, and implementation was a valuable practice change. CONCLUSIONS: Using an electromagnetic device decreased feeding start times, reduced the need for support services, and increased advanced practice provider satisfaction with small-bowel feeding tube placement practices.

Pes Anserinus Bursitis: A Case Report.

Pes anserinus bursitis is a differential diagnosis for knee pain, that may be misdiagnosed. Without proper physical examination and thorough history taking, the diagnosis of pes anserinus may be delayed. We present a case report of this condition, involving both primary care and the emergency department. This case illustrates one possible presentation of this condition, and also demonstrates the risks of overreliance on imaging modalities in primary care, without also performing a proper physical examination of musculoskeletal presentations. The teamwork between physiotherapists and clinicians, in this case, highlights the value of a multidisciplinary team in sports medicine. This case report lends evidence that pes anserinus bursitis should be considered as a possible diagnosis for knee pain and emphasises the importance of physical examination.

Injuries and Fatalities Related to Freediving: A Case Report and Literature Review.

This case report and literature review aim to explore the range of injuries sustained in the sport of freediving. The case report involves a 37-year-old patient who sustained a pneumothorax secondary to freediving. We conducted the literature review to analyse the injuries associated with freediving. We used the combination of search terms 'freediving", "injuries", and "breath-hold diving" on the database PubMed®. A total of 40 studies were eligible for inclusion in this review. The search revealed a wide range of ophthalmological, pulmonary, neurological, ear, nose, and throat injuries, along with several fatalities. Freediving is a sport performed in extreme environments and, if undertaken by inexperienced, untrained, or competition divers, can lead to severe injury or even death. However, the risk of damage can be reduced by performing it responsibly with the appropriate training and by using proper safety measures. Future research is warranted into the psychological, physiological, and economic benefits of freediving at both individual and community levels.

Program Evaluation of an Early Nurse Intervention Team.

BACKGROUND: Many hospitals have implemented early rapid response teams to improve detection of patients at risk for decline. However, formal evaluation of these programs is rare. OBJECTIVE: To evaluate the Early Nurse Intervention Team program at a large community hospital in the southeastern United States. METHODS: A retrospective evaluation was performed of unplanned intensive care unit transfers, hospital length of stay, length of stay index, ventilator days, and mortality in 2 patient groups: those with and those without an Early Nurse Intervention Team nurse present. RESULTS: There was a marked decline in unplanned intensive care unit transfers as the Early Nurse Intervention Team nurse staffing increased. There were no significant interaction or main effects for length of stay, length of stay index, ventilator days, or mortality between the 2 groups. CONCLUSIONS: This study showed a positive impact of implementation of an Early Nurse Intervention Team program, with significant savings given the cost of unplanned intensive care unit transfers.

Accelerated HE digitalisation: Exploring staff and student experiences of the COVID-19 rapid online-learning transfer.

In the UK, the first 'lockdown' of the COVID-19 pandemic necessitated a rapid shift to online learning and digital technologies in Higher Education (HE). While the situation was unprecedented, extant literature on online learning suggested there would be challenges, opportunities, and benefits to this transition, and we sought to understand these via a case study of one UK HEI department at this time. To draw out in-depth and nuanced accounts of this (at time of investigation-unstudied) scenario, qualitative data were collected via semi-structured online interview or written reflection. To explore, identify and understand the experiences from both sides, and with a diverse sample, we purposively recruited both staff (n = 10) and students (n = 12), from various roles and backgrounds, including those with additional learning and/or mental health needs. The 'bricolage' data were analysed inductively, utilising a latent reflexive approach, and organised into a framework around five core themes: 'methods and means of engagement'; 'learning maintenance, destruction and construction'; 'remote education and resource accessibility and literacy'; 'support and communication'; and 'life and learning: responses, adaptations and impacts'. Within these, a range of challenges, successes and, most importantly, future learning and innovation outcomes were identified by staff and students, particularly relevant to working with and supporting students with additional needs in the online learning forum. These discoveries informed a set of practical recommendations, provided here in Box 1, for (rapid implementation of) online learning (in times of stress).

The impact of nurse staffing on falls performance within a health care system: A descriptive study.

AIM: The purpose of this study was to examine the impact of nurse staffing on inpatient falls performance across a multi-hospital system. BACKGROUND: Evidence to support which staffing variables influence fall performance so that health care organizations can better allocate resources is lacking. METHOD: A descriptive study design was used to analyse the impact of nurse staffing and falls performance, with units dichotomized as either high or low performing based on national benchmarking data. The impact was evaluated using 10 nurse staffing variables. RESULTS: A total of nine units were included (five high and four low performing). Higher performing units showed less use of sitters and travellers, had fewer overtime hours worked by nurses, and employed more expert-level clinical nurses and combined nursing assistant/health unit coordinator positions, than lower performing units. CONCLUSION: Findings provide evidence of how staffing variables affect a unit's falls performance. While significant relationships were found, further evaluation is needed to explore the relationship of staffing variables and quality outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers may consider trying to reduce use of sitters and travellers, and utilize innovative staffing models, such as using combined nursing assistant/health unit coordinator positions, to help improve their falls performance.

Engaging advanced practice nurses in evidence-based practice: An e-mentoring program.

BACKGROUND: Mentoring is highly valued in the nursing profession and essential to building an evidence-based practice (EBP) culture. However, many organizations have a limited number of EBP mentors, who have limited non-clinical time to engage in mentoring. AIMS: This project aimed to test whether an e-mentoring approach to nursing inquiry could enhance EBP beliefs (EBPB), increase EBP Implementation (EBPI), and improve Organizational Culture and Readiness for System-Wide Implementation of EBP (OCRSIEP). METHODS: A pre-experimental pilot intervention project was implemented utilizing a pretest-posttest design with Advanced Practice Registered Nurses' (APRNs) in clinical practice. The OCRSIEP, EBPB, and EBPI scales were used to measure organizational readiness for EBP implementation, individual beliefs regarding the value of EBP, and the extent to which nurses integrate scientific evidence into their clinical practice, respectively. The Wilcoxon-Signed Rank test was used to analyze the difference between pretest and posttest scores of an EBP E-mentoring program. A post-hoc analysis was performed to calculate effect sizes. [Correction added on 13 May 2022, after first online publication: The Methods section was revised to add additional details.] RESULTS: Eleven APRNs completed the pretest and posttest surveys. When comparing the pre-and post-intervention scores, the median EBPB scores increased from 61 (IQR: 56-69) to 70 (IQR: 64-73), median EBPI scores increased from 13 (IQR: 7-33) to 20 (IQR: 13-31), and median OCRSIEP scores increased from 88 (IQR: 73-97) to 99 (IQR: 90-113). LINKING EVIDENCE TO ACTION: A 12-week Nurse Inquiry E-mentoring Program can leverage the small number of EBP mentors in an organization to improve EBPB. A program lasting longer in duration may also significantly improve EBPI and OCRSIEP scores. By utilizing technology and leveraging economies of scale, exponentially more nurses can be mentored to create and enhance an EBP culture.

The effect of a nurse manager's authentic leadership intervention on nurses' well-being: A single unit QI project.

INTRODUCTION: Nurse well-being is at the forefront of nursing leadership's focus, particularly with the impact of the ongoing COVID-19 pandemic. Nurse managers, as authentic leaders, should understand their role in supporting the spectrum of nurse well-being. At the negative end of well-being, leaders must address staff burnout as it increases nurse turnover, shortage of nurses, and poor patient outcomes. PURPOSE: The specific aim for this quality improvement (QI) project was to implement a program that could guide a nurse manager of a single inpatient unit on how to improve well-being in their nursing staff as measured by: (a) improved well-being scores to a composite score of 3.5 or greater as indicated by follow-up Culture Pulse surveys distributed in 2021; and (b) reduced absenteeism among nursing staff by 18%. RESULTS: Five surveys identical to the organization's work culture survey, that measures well-being, were sent to staff each month starting in January 2021 and ending in May 2021. The average composite score from all five surveys was 2.8, indicating an overall improvement. Absenteeism was reduced during implementation by 39%. DISCUSSION: This QI project guides nurse managers in the evidence-based interventions that can promote well-being in their staff.

Surrogacy and the law in the UK.

Surrogacy is a method of assisted reproduction in which a woman bears a child on behalf of a couple or individual with the intention of handing over care of the child to the intending parent(s) at or soon after birth. The law surrounding surrogacy is complex for healthcare professionals, surrogates and intending parent(s) to navigate. This review article summarises the laws and potential legal complications of surrogacy in the UK. While altruistic surrogacy is permitted, commercial surrogacy is outlawed in this country. Both traditional and gestational surrogacy may be performed and UK law now also permits surrogacy for same sex couples, unmarried couples and single individuals as intending parent(s). Legal parenthood of the child is transferred from the surrogate to the intending parent(s) via application for a parental order between 6 weeks and 6 months after birth. Legal complications include time restrictions for parental order applications and breaches of reasonable payments to surrogates.

Gender in healthcare: a practical approach.

Transgender law is complex and developing. Increasing general practitioner referrals for gender dysphoria without sufficient resources for specialist units have left gaps in transgender healthcare. Surveys repeatedly find transgender patients have lower satisfaction with healthcare experiences, stating doctors have a poor understanding of their needs. Meanwhile, waiting times for referrals remain high.This review article outlines UK laws and guidelines relevant to trans healthcare, including practical advice for clinicians. Current issues are explored, including the referral process for gender dysphoria.Transgender law is continually evolving; currently, individuals require a diagnosis of gender dysphoria to legally change gender. However, the gender on NHS records can be changed without legally changing gender.Clinicians may find support from the General Medical Council for this area. Specifically, guidance exists for including trans patients in screening programmes relevant to their assigned sex at birth. Similarly, advice exists for ensuring the privacy of patients' gender history.

Reforming DoLS: liberty protection safeguards.

From April 2022, current Deprivation of Liberty Safeguards (DoLS) will be replaced by Liberty Protection Safeguards (LPS). This review article outlines key information about these changes for patients, carers and healthcare professionals, for whom a deprivation of liberty may be relevant.Deprivation of liberty occurs within healthcare settings when someone's freedoms are limited in order to meet their care needs and lack capacity to consent to these arrangements. DoLS, enacted in 2009, ensured that patients deprived of liberties in care settings have similar rights to patients held under the Mental Health Act 1983. However, DoLS have been extensively criticised and considered unfit for purpose, therefore are being replaced by LPS.LPS intend to provide a more robust protection to a wider group of vulnerable people. This includes changes to patient age, transferability between a wider range of care settings, a reduced number of assessments for authorisation and less frequent reauthorisations.

Critical Care Transport of the Temporary Portable Ventricular Support Device.

OBJECTIVE: Cardiogenic shock is a critical emergency for which ventricular support devices (VSDs), such as the Impella (AbioMed Inc, Danvers, MA), are placed. Many referring facilities cannot provide cardiac intensive care. This requires a regional approach to the care of patients with VSD. Critical care transport to the regional center is needed and requires specialty trained personnel. As the need for specialty trained personnel increases, appropriate utilization of the personnel needs to be considered. This study illustrates the effective transport and successful management of Impella patients in the transport environment by a downsized specialty trained critical care team. METHODS: A retrospective chart review explored critical care transports of patients with Impella devices over a 73-month period. Our goal was to show that with training, protocols, and guidelines a downsized critical care team can effectively transport these high-risk, low-frequency patients. RESULTS: Forty-seven VSD transports occurred within 13,823 transports during the study period. Twenty-seven included an Impella device only. Thirteen were completed by a downsized team. One hundred percent of the transport resulted in the patient having perfusing rhythms and blood pressures at the receiving facility. CONCLUSION: VSDs can be successfully transported between hospitals with small specialty trained critical care transport teams using air or ground assets.

Physical Activity: A Feasibility Study on Exercise in Men Newly Diagnosed With Prostate Cancer.

BACKGROUND: Physical activity (PA) has been shown to improve patient-centered care for cancer-related symptoms, treatment-related side effects, and health-related quality of life. OBJECTIVES: This feasibility study aimed to explore PA preferences and changes in functional capacity and symptoms during a two-week self-prescribed PA intervention prior to treatment in men newly diagnosed with prostate cancer. METHODS: Men newly diagnosed with prostate cancer were recruited from a community hospital, part of an academic comprehensive cancer center in the southeastern United States. An individualized PA intervention prescription was developed using baseline measures. Baseline and two-week measures consisted of functional capacity, PA participation, and symptom impact. Descriptive statistics and t tests were used. FINDINGS: Thirteen men aged an average of 66.14 years (SD = 6.82) participated. Participants significantly improved functional capacity. Most common PAs were walking (n = 9) and yard work (n = 6).

Homecare Encounters: An Organizational Response to Innovative Care for Patients Undergoing Hematopoietic Stem Cell Transplantation During COVID-19.

BACKGROUND: Healthcare delivery has been significantly changed because of the COVID-19 pandemic. Patients undergoing hematopoietic stem cell transplantation (HSCT) are vulnerable to infections because of their immunocompromised status. The risk of nosocomial infection may be reduced by providing care to patients at home. OBJECTIVES: This article describes one cancer center's approach for delivering safe patient care through homecare encounters, the benefits of home care for HSCT, and future directions. METHODS: Patients received detailed information on home encounters. Advanced practice providers visited patients daily and then returned to the clinic to formulate a plan of care with the interprofessional care team. Transplantation RNs visited patients on the same day to provide the prescribed care. FINDINGS: Based on evaluations from 32 patients and 12 providers, the results indicated that home care was safe, feasible, and beneficial for patient care post-HSCT during the COVID-19 pandemic.