Operational Failures Detected by Frontline Acute Care Nurses.

Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.

Evaluation of the built environment: staff and family satisfaction pre- and post-occupancy of the Children's Hospital.

OBJECTIVE: To evaluate and compare the impact of an existing and newly built hospital environment on family and staff satisfaction related to light, noise, temperature, aesthetics, and amenities, as well as safety, security, and privacy. BACKGROUND: The United States is engaged in an unprecedented healthcare building boom driven by the need to replace aging facilities, understand the impact of the built environment on quality and safety, incorporate rapidly emerging technologies, and enhance patient- and family-centered care. More importantly, there is heightened attention to creating optimal physical environments to achieve the best possible outcomes for patients, families, and staff. METHODS: Using a pre-post descriptive survey design, all nursing, social work, therapy staff, and families on selected inpatient units were invited to participate. A demographic form and Family and Staff Satisfaction Surveys were developed and administered pre- and post-occupancy of the new facility. RESULTS: Pre/post mean scores for staff satisfaction improved on all survey subscales with statistically significant improvement (p < .05) in most areas. The most improvement was seen with layout of the patient room, natural light, storage and writing surfaces, and comfort and appeal. Family satisfaction demonstrated statistically significant improvement on all subscales (p ≤ .01), especially for natural light, quiet space, parking, and the child's room as a healing environment. CONCLUSIONS: Families and staff reported greater satisfaction with the newly built hospital environment compared to the old facility. Study results will help guide future architectural design decisions, attract and retain staff at a world-class facility, and create the most effective healing environments.

Bridging the gap: A comparison of the professional nursing values of students, new graduates, and seasoned professionals.

Given the significant and widespread changes in the health care system, generational diversity and the resulting differences in values present a challenge for the nursing profession. A three-group comparative design was used to compare the professional nursing values held by nursing students, new graduates, and seasoned practitioners, utilizing the Nursing Professional Values Scale (Weis & Schank, 2000) developed from the American Nurses Association Code of Ethics. Findings revealed greater similarities than differences across the three groups; the notion that experience is necessary to develop professional values was not supported. Significant differences were seen across groups related to their knowledge regarding the code of ethics and its relevance to practice. Strategies to bridge the gap in value orientation between education and practice are offered as a means to strengthen professional commitment and maintain the viability of the profession.

Defining an evidence-based work environment for nursing in the USA.

AIMS: To describe and compare staff nurses' perceptions of their real and ideal work environment in a tertiary paediatric facility; to provide administrators with research evidence for identifying areas for improvement. BACKGROUND: The workforce shortage of hospital nurses is a global problem having an impact on the financial resources and efficient operations of an organisation and the quality of care delivered to patients. A direct relationship exists between job satisfaction, retention, turnover and elements of the nurses' work environment. Research identifying specific elements of the current work setting that are in conflict with nurses' views of their preferred practice milieu can help define an evidence-based work environment for nursing. DESIGN AND METHODS: Using a descriptive survey design, a convenience sample of 385 nurses on five inpatient units and the float team completed two forms (real and ideal) of the work environment scale. The work environment scale consists of 10 subscales within three dimensions: relationship, personal growth and system maintenance and change. RESULTS: A consistent pattern was seen across all units with reported high levels of involvement, peer cohesion, task orientation and managerial control. Scores for work pressure and autonomy were moderate-high and physical comfort, supervisor support, clarity and innovation were moderate. Overall, highest scores were reported for involvement and lowest for physical comfort. Significant differences were found between real and ideal subscale scores suggesting that staff were able to identify areas for improvement. CONCLUSIONS: Despite moderate work pressure, staff affirmed a highly positive work environment on their units. Specific areas in their current work setting that were not congruent with their preferred work environment were identified and targeted for change. RELEVANCE TO CLINICAL PRACTICE: Understanding dimensions of the nurses' work environment needing improvement and involving staff in making and evaluating change supports an evidence-based environment to attract and retain qualified staff.

An education initiative to increase staff knowledge of Institutional Review Board guidelines in the USA.

Health-care professionals and researchers often lack a clear understanding of the role and function of an Institutional Review Board (IRB) and few have received formal education regarding IRB guidelines, policies, and procedures. The purpose of this study was to develop an initiative to educate staff concerning fundamental IRB guidelines and to assess the retention of the information from the educational intervention with a pretest and post-test. Using a descriptive survey design, 643 professional staff were contacted by email and asked to complete an online survey. Thereafter, staff received a "10 Second IRB Update" every 2 weeks for 6 months, after which the initial survey was repeated. Although there was a slight improvement in the pretest/post-test scores for some groups, no statistically significant differences were seen. Anecdotally, staff expressed enthusiasm about the initiative, stating the updates were very effective and a great teaching tool. The findings emphasize the need to continue to explore creative approaches to education regarding IRB policies and procedures.

Perceived nursing work environment of acute care pediatric nurses.

Nurse job satisfaction is a complex phenomenon and includes elements of the work environment. The purpose of this study was to evaluate nurses' perception of their real (current) and ideal (preferred) work environment in a pediatric tertiary care setting. Using a descriptive survey design, a convenience sample of staff nurses from three inpatient units was surveyed using the Work Environment Scale (WES) by Moos (1994). The WES consists of 10 subscales characterizing three dimensions: Relationship, Personal Growth, and System Maintenance and Change. Overall, nurses affirmed a highly positive and supportive work environment on their units. Non-significant findings between the real and ideal scores for the Involvement and Managerial Control subscales suggest that staff are concerned about and committed to their work, and satisfied with their managers' use of rules and procedures. Statistically significant differences between selected real and ideal subscale scores will help target intervention strategies to enhance the nursing work environment.

Reducing parenting stress in families with irritable infants.

BACKGROUND: Caring for an infant with unexplained, persistent crying is one of the most stressful events for new parents. Infant irritability, also referred to as infantile colic, occurs in 10-25% of all infants and is the most common parental concern reported in the first year of life. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a home-based nursing intervention in reducing parenting stress in three groups of families with irritable infants, using data from a larger evaluation study. METHODS: A two-site, randomized clinical trial was conducted with 121 infants and their parents. Infants were randomized to a treatment or a control group. A third group of infants (n = 43) was added as a posttest-only comparison. The level of parenting stress was measured by the Parenting Stress Index (PSI) at baseline, after the 4-week intervention, and at the 8-week follow-up visit. RESULTS: A repeated measures analysis of variance (ANOVA) was used to compare the two groups across the three time points (baseline, immediately after the 4-week intervention, and at the 8-week follow-up visit). The results revealed a reduction in total parenting stress over time for both the treatment and control groups. Mothers in the treatment group reported reduced parenting stress on the parent-child dysfunctional interaction subscale (p = .04). Total parenting stress scores were found to be significantly higher for mothers in the posttest-only group (p = .009). CONCLUSION: Initial parenting stress levels were high in all participants. Parent feedback at the exit interview indicated that the nurse visits for data collection were also viewed as helpful in reducing the stress level associated with parenting these irritable infants. This home-based program was perceived as helpful in improving the interactions between parents and their irritable infants.

Effectiveness of an intervention for colic.

An intervention for infant irritability or colic was evaluated in a randomized clinical trial. A total of 121 full-term irritable infants (2 to 6 weeks old) were randomized to routine care or the home-based intervention program. A third group (n=43) of irritable infants were entered into a post-test-only group. Following the 4-week intervention, the treatment group infants cried 1.7 hours less per day than the infants in the control group (p=0.02). The findings support the emerging view of infant colic as a behavioral pattern that is responsive to environmental modification and structured cue-based care.

An intervention program for families with irritable infants.

PURPOSE: To describe and evaluate a home-based nursing intervention program, the REST routine, which incorporates the use of infant behavior assessment, pattern recognition, individualized infant schedules, specific management strategies, and parent education and support. STUDY DESIGN AND METHOD: A two-site clinical trial was conducted on 164 healthy full-term infants with excessive unexplained irritability or colic. Infants between the ages of 2 to 6 weeks were randomized to routine care or a home-based intervention program (n = 121). A third group (n = 43) of infants too old at entry for randomization (mean age = 10.4 weeks) were entered into a posttest-only group. RESULTS: Infants in the REST routine treatment group cried 1.3 hours per day on average following the intervention program as compared to the control group crying 3 hours per day (p = .02). Infant irritability was resolved (< 1 hour) in 62% of the treatment group while only in 29% of the control group at the time of the 8-week follow-up visit (p = .04). CLINICAL IMPLICATIONS: Families in both the treatment and control groups reported benefiting from a nurse visiting in their home to inquire about their infant and their well-being. Options for individualizing the program for those most in need of intensive home visiting and other delivery modes for the intervention are areas for further investigation.

Characteristics and role functions of advanced practice nurses in a tertiary pediatric setting.

ISSUES AND PURPOSE: To describe the characteristics and role functions of Advanced Practice Nurses (APNs) in a tertiary pediatric setting. DESIGN AND METHODS: This descriptive survey design used a convenience sample (N = 39) of APNs at The Children's Hospital in Denver. A 56-item survey asked participants to define their role by rating how often they performed various primary and specialty care functions. RESULTS: Findings validated the notion that APNs combine expert knowledge and practice skills into a holistic framework to provide sick children and their families with a full range of comprehensive services across a variety of settings. APNs work collaboratively with physicians and other professionals and are an excellent resource for students. PRACTICE IMPLICATIONS: Describing and characterizing how APNs contribute to and enhance the delivery of care help to clarify and authenticate the scope of practice of the pediatric acute care APN.

Current beliefs and management strategies for treating infant colic.

INTRODUCTION: The purpose of this study was to describe the current beliefs about the etiology of colic as well as current management approaches used by pediatric health care providers. METHOD: An open-ended, short- answer survey concerning beliefs about the etiology and treatment of colic was conducted at major National Association of Pediatric Nurse Associates and Practitioners and American Academy of Pediatric meetings. The two groups of providers surveyed, pediatric nurse practitioners (PNPs) (n = 216) and pediatricians (n = 215), were similar in age and years of practice. RESULTS: PNPs were more likely to define colic as "excessive crying." No differences were found in the beliefs regarding etiology of colic. Pediatricians reported seeing more colicky infants per month. A strong relationship existed between etiology and primary treatment approach. Statistically significant differences were found between PNPs and pediatricians in approaches to management of colic. DISCUSSION: Colic remains a prevalent and mysterious malady, with a critical need for more evidence-based treatment protocols. Differences in approaches used by providers were found, with PNPs more likely to use behavioral and environmental approaches to treatment.

STAT! A four-step approach to nursing recruitment and retention in a tertiary pediatric setting.

Recruiting nurses in today's health care environment is more challenging than ever before. A four-step, long-term strategic approach to nursing recruitment and retention was developed and implemented at The Children's Hospital (TCH) in Denver. STAT! Student and Employee Recruitment, Teaching the Specialty, Active Mentorship, and Time to Listen, denotes the urgency and significance of the current nursing shortage crisis and the need for immediate intervention to a critical health care problem. A combined effort within and across departments has led to the program's success, and new strategies continue to be designed and implemented to attract and retain the best and the brightest.