Impact of COVID-19 on nursing time in intensive care units in Belgium.

INTRODUCTION: The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE: To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN: This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING: Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS: The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4). CONCLUSIONS: Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.

Paradoxical Impact of a Patient-Handling Intervention on Injury Rate Disparity Among Hospital Workers.

OBJECTIVES: To test whether a comprehensive safe patient-handling intervention, which successfully reduced overall injury rates among hospital workers in a prior study, was differentially effective for higher-wage workers (nurses) versus low-wage workers (patient care associates [PCAs]). METHODS: Data were from a cohort of nurses and PCAs at 2 large hospitals in Boston, Massachusetts. One hospital received the intervention in 2013; the other did not. Using longitudinal survey data from 2012 and 2014 plus longitudinal administrative injury and payroll data, we tested for socioeconomic differences in changes in self-reported safe patient-handling practices, and for socioeconomic differences in changes in injury rates using administrative data. RESULTS: After the intervention, improvements in self-reported patient-handling practices were equivalent for PCAs and for nurses. However, in administrative data, lifting and exertion injuries decreased among nurses (rate ratio [RR] = 0.64; 95% confidence interval [CI] = 0.41, 1.00) but not PCAs (RR = 1.10; 95% CI = 0.74,1.63; P for occupation × intervention interaction = 0.02). CONCLUSIONS: Although the population-level injury rate decreased after the intervention, most improvements were among higher-wage workers, widening the socioeconomic gap in injury and exemplifying the inequality paradox. Results have implications for public health intervention development, implementation, and analysis.

Impact of California's safe patient handling legislation on musculoskeletal injury prevention among nurses.

BACKGROUND: This study evaluated the impact of California's safe patient handling (SPH) legislation on musculoskeletal injury prevention among hospital nurses. METHODS: Two serial cross-sectional surveys were conducted using postal and online questionnaires in statewide random samples of California registered nurses in 2013 and 2016. Analysis included hospital nurses who performed patient handling (n = 254 and n = 281, respectively). RESULTS: In 2016, there were significant improvements in nurses' knowledge of a SPH policy in their hospital (87%), receipt of annual SPH training (73%), and availability of lift equipment (80%); 33% perceived their hospital's SPH programs as excellent or very good. Significant prevalence reduction was observed for work-related musculoskeletal symptoms (61% vs 52%; Adjusted Prevalence Ratio = 0.78, 95% CI 0.66-0.91). CONCLUSIONS: Our findings indicate the significant role of SPH legislation with positive impacts on SPH policies and programs at the hospital level and on musculoskeletal health outcomes at the worker level.

Translational Acceleration, Rotational Speed, and Joint Angle of Patients Related to Correct/Incorrect Methods of Transfer Skills by Nurses.

Currently, due to shortages in the nursing faculty and low access to actual patients, it is difficult for students to receive feedback from teachers and practice with actual patients to obtain clinic experience. Thus, both evaluation systems and simulated patients have become urgent requirements. Accordingly, this study proposes a method to evaluate the nurse's transfer skill through observation from the patient. After verifying the proposed method, it will be integrated with a robotic patient as a future work. To verify if such an evaluation is practical, a checklist comprising 16 steps with correct and incorrect methods was proposed by the nursing teachers. Further, the evaluation parameters were determined as translational acceleration, rotational speed, and joint angle of patient. Inertial sensors and motion capture were employed to measure the translational acceleration, rotational speed, and joint angle. An experiment was conducted with two nursing teachers, who were asked to carry out both correct and incorrect methods. According to the results, three parameters reveal the difference for a patient under correct/incorrect methods and can further be used to evaluate the nurse's skill once the thresholds are determined. In addition, the applicability of inertial sensors is confirmed for the use of robot development.

Changing the Perceptions of a Culture of Safety for the Patient and the Caregiver: Integrating Improvement Initiatives to Create Sustainable Change.

Evidence indicates that chances for a successful patient mobility program, prevention of pressure injury and falls, and safe patient handling are enhanced when an organization possesses an appropriate culture for safety. Frequently, these improvement initiatives are managed within silos often creating a solution for one and a problem for the others. A model of prevention integrating early patient mobility, preventing pressure injuries and falls while ensuring caregiver safety, is introduced. The journey begins by understanding why early mobility and safe patient handling are critical to improving overall patient outcomes. Measuring current culture and understanding the gaps in practice as well as strategies for overcoming some of the major challenges for success in each of these areas will result in sustainable change.

Integrating a Standardized Mobility Program and Safe Patient Handling.

Early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, and improves muscle strength and functional independence. At the University of Michigan, we have turned the tides by creating a structured process to get our patients moving while keeping them and our staff safe through the use of a standardized mobility protocol that incorporates the components of safe patient handling. Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria. The protocol incorporates safe patient handling and mobility preassessment guidelines, mobility standards, equipment guidelines, and documentation tools. The activities are grounded in the evidence and well thought out to prevent complications, promote mobilization, and prevent patient and staff injuries. This article will discuss a how a tertiary care facility incorporated a safe patient-handling initiative into an existing mobility program and operationalized it across a health care system to keep our patients and staff safe.

Reducing Intensive Care Unit Staff Musculoskeletal Injuries With Implementation of a Safe Patient Handling and Mobility Program.

The purpose of this safety initiative was to reduce work-related injuries through the implementation of a safe patient handling and mobility (SPHM) program in a medical intensive care unit. An SPHM program was implemented on a critical care medicine unit in February of 2017. Nursing and assistive personnel completed education via hands-on and online educational modules regarding SPHM equipment and techniques and an SPHM policy. All staff were expected to follow SPHM practices. Critical care medicine unit nursing leadership and unit-based SPHM peer coaches rounded to ensure staff compliance with the program. A 1-year evaluation demonstrated a reduction of 86% in work-related injuries. In 2016, there were 7 injuries while in 2017, only 1 injury occurred. Lost and restricted days away from work were reduced by 54% or from a total of 112 days in 2016 to 52 days in 2017. The implementation of an SPHM program in a medical intensive care unit appears to be highly effective at reducing health care worker injuries. More research is needed to identify the best and most effective ways to provide care to our most critical patients. Positive behaviors from the staff regarding the SPHM program have helped reduce injuries and lost workdays.

Incorporating Safe Patient-Handling Techniques to Mobilize Our Most Complex Patients on Extra Corporeal Membrane Oxygenation.

Historically, patients supported on extra corporeal membrane oxygenation were thought to be too unstable to engage in early mobility but are at increased risk for deconditioning from prolonged immobilization due to the nature of illness, numerous cannulas, equipment, and hemodynamic and respiratory instability along with heavy sedation/analgesia or paralysis. This article will discuss the specific considerations that should be employed to keep the patient and the staff safe while providing mobility to patients on extra corporeal membrane oxygenation.

A Nurse-Led Mobility Program on an Acute Rehabilitation Unit.

Rehabilitation assists patients with return to baseline activities of daily living after catastrophic events or long hospitalizations. In an effort to increase mobility episodes in the rehabilitation patient, a nurse-led mobility program was suggested. This allows the rehabilitation nurse to participate in the improvement of mobility for rehabilitation patients by mobilizing the patients safely during hours in which physical therapy is not available. The purpose of this project was twofold: (1) Can additional mobility episodes improve outcomes in the rehabilitation patient? (2) How can safe patient handling principles be applied to the rehabilitation patient?

Nurses and nursing assistants decision-making regarding use of safe patient handling and mobility technology: A qualitative study.

AIM: This study explored decision-making regarding use of safe patient handling and mobility (SPHM) technology among registered nurses (RN) and nursing assistants (NA). BACKGROUND: Lifting injuries are common among healthcare workers. Despite development of standards for SPHM, the introduction of regulation for monitoring access to SPHM technology, and implementation of education programs and process improvements, threat of injury remains a concern. Although access to SPHM equipment is associated with decreased workplace injuries, access alone does not guarantee use. Questions remain concerning how healthcare workers make decisions to use SPHM equipment, and how they weigh decisions against personal safety. METHODS: A qualitative descriptive study was conducted. Data collection consisted of four 60min focus groups. Two focus groups consisted of all RNs (n=14) and two consisted of all NAs (n=11). Each focus group was audiotaped and transcribed verbatim. Transcripts were coded, repeating concepts identified, and codes collapsed into themes and subthemes. RESULTS: Qualitative analysis revealed three major themes: barriers to use, perceived risk, and coordination of care. Barriers to use include subthemes of physical barriers, knowledge and skill, and unit culture. Perceived risk includes patient risk and perceived risk to self. Coordination of care includes patient factors and characteristics, assessment of patient needs and abilities, and interprofessional collaboration. CONCLUSIONS: These findings provide new knowledge about the complexity of decision making among care providers in the use of SPHM technology. Interprofessional team approaches to patient assessment and care are important components of confident decision making in use of SPHM technology.

Back School programme for nurses has reduced low back pain levels: A randomised controlled trial.

AIMS AND OBJECTIVES: (i) To examine patient lifting techniques used by nurses, and (ii) to evaluate an effectiveness of the Spine Care for Nurses programme in chronic nonspecific low back pain syndrome reduction and the execution of proper patient lifting techniques. BACKGROUND: Millions of nurses around the world suffer from occupational-related chronic nonspecific low back pain (chronic nonspecific low back pain syndrome). Generally, low back pain in nurses is a result of increased pressure on the spine and can be associated with improperly conducted patient lifting techniques. METHODS: A randomised controlled trial was conducted among 137 nurses with chronic nonspecific low back pain syndrome. Participants were randomised into an experimental and control group (experimental group n = 67, control group n = 70). Nurses in the experimental group attended the Spine Care for Nurses programme for 3 months. The programme consisted of didactic education, spine-strengthening exercises and education on safe patient handling techniques. The control group only received a brief written lifestyle guidance. The Zebris WinSpine Triple Lumbar examination was used to analyse nurses' patient lifting techniques (horizontal and vertical lifting). The lumbar pain intensity was measured with a 0-100 visual analogue scale. RESULTS: The pre-intervention average chronic nonspecific low back pain syndrome intensity score on visual analogue scale decreased from 49.3 to the postintervention score of 7.5. The correct execution of vertical lifting techniques in the experimental group increased from 8.91%-97.01% (control group: 8.57% pre-intervention test and postintervention test 11.42%). The horizontal patient lifting technique pre-intervention increased from 10.44%-100% correct execution in the experimental group (control group: pre-intervention test 10.00% and postintervention test 11.42%). CONCLUSION: The Spine Care for Nurses programme significantly reduced chronic nonspecific low back pain syndrome and increased the number of properly executed horizontal and vertical patient lifting techniques in nurses. RELEVANCE TO CLINICAL PRACTICE: We recommend that healthcare organisations should consider the implementation of regular Spine Care for Nurses programmes as successful low back injury prevention programmes.

Creando un ambiente de empoderamiento en las unidades de cuidados intensivos: de la contención a la movilización / Creating an environment of empowerment in the intensive care units: From containment to mobilisation

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How can I help older people in hospital get home sooner and prevent deconditioning?

Concerns about the complications of prolonged bed rest were raised as far back as 1947 ( Asher 1947 ). Hospital stays are associated with iatrogenic infections, medication errors, increased risk of delirium and side effects of prolonged bed rest ( Inouye and Charpentier 1996 , Covinsky et al 2011 ).

The nurse who could lift.

This month, we celebrate nurses for their dedication to patient well-being and safety. The American Nurses Association has declared National Nurses Week 2017, May 6-12, the "Year of the Healthy Nurse." This special Nurses Week tribute reminds us that although patient health and safety is the goal of every nurse, it's important to remember our own health as well.

Effects of patient-handling and individual factors on the prevalence of low back pain among nursing personnel.

BACKGROUND: Patient-handling is one of the main tasks of nursing personnel; it imposes compressive and shear forces on nurses' lower spine. The aim of this study was to determine the prevalence of Low Back Pain (LBP), risk factors in the incidence of such disorders, and patient handling risk assessment among nursing personnel. METHODS: This study was carried out on 243 randomly selected nursing personnel who played a role in handling the patients (58 wards). Patient Transfer Assessment Instrument (PTAI) checklists alongside Standardized Nordic Musculoskeletal Questionnaires (NMQ) were used for data collection. The statistical analyses such as independent t-test and Chi-Square test were used. RESULTS: Prevalence of LBP among nursing personal was 69.5% in the previous 12 months. Significant correlations were found among age, working hours per week, work experience, BMI, gender and shift-work. Results of PTAI index assessment revealed that more than 90% of subjects were in medium and severe risks of LBP. PTAI index scores were significantly associated with LBP (P < 0.05). CONCLUSION: PTAI index is regarded as an efficient tool for risk level classifications and identification of effective factors on LBP incidence among nursing personnel involved in patient transfer. In this regard and for the aim of ergonomic intervention towards the reduction of LBP incidence among nurses, the modification of improper factors which are identified in PTAI index such as the use of advanced patient handling equipment, increase in work posture guidance and work arrangements, can be mentioned.

Pressure Ulcer Risk and Prevention Practices in Pediatric Patients: A Secondary Analysis of Data from the National Database of Nursing Quality Indicators®.

Little is known about pressure ulcer prevention practice among pediatric patients. To describe the frequency of pressure ulcer risk assessment in pediatric patients and pressure ulcer prevention intervention use overall and by hospital unit type, a descriptive secondary analysis was performed of data submitted to the National Database for Nursing Quality Indicators® (NDNQI®) for at least 3 of the 4 quarters in 2012. Relevant data on pressure ulcer risk from 271 hospitals across the United States extracted from the NDNQI database included patient skin and pressure ulcer risk assessment on admission, time since the last pressure ulcer risk assessment, method used to assess pressure ulcer risk, and risk status. Extracted data on pressure ulcer prevention included skin assessment, pressure-redistribution surface use, routine repositioning, nutritional support, and moisture management. These data were organized by unit type and merged with data on hospital characteristics for the analysis. The sample included 39 984 patients ages 1 day to 18 years on 678 pediatric acute care units (general pediatrics, pediatric critical care units, neonatal intensive care units, pediatric step-down units, and pediatric rehabilitation units). Descriptive statistics were used to analyze study data. Most of the pediatric patients (33 644; 89.2%) were assessed for pressure ulcer risk within 24 hours of admission. The Braden Q Scale was frequently used to assess risk on general pediatrics units (75.4%), pediatric step-down units (85.5%), pediatric critical care units (81.3%), and pediatric rehabilitation units (56.1%). In the neonatal intensive care units, another scale or method was used more often (55% to 60%) to assess pressure ulcer risk. Of the 11 203 pediatric patients (39%) determined to be at risk for pressure ulcers, the majority (10 741, 95.8%) received some kind of pressure ulcer prevention intervention during the 24 hours preceding the NDNQI pressure ulcer survey. The frequency of prevention intervention use among those at risk ranged from 99.2% for skin assessment to 70.7% for redistribution surface use. Most pediatric patients are being assessed for pressure ulcer risk, but the implementation of interventions to prevent pressure ulcers among children needs to be improved. Future qualitative research should be conducted to determine how and when clinical judgment is used to assess pressure ulcer risk and the type of pressure-redistribution surfaces used among younger pediatric patients.

Perceptions of Nursing and Physical Therapy Students Toward Peer-Led Interprofessional Education in Manual Handling.

Perceptions of first-semester BSN students (N = 220) who received education on patient moving and handling skills from either fourth-year physical therapy/physiotherapy student peer teachers (n = 8) or regular nurse educators were obtained via validated scales and focus groups. There was a significant increase in the mean scores of items concerning communication skills in both groups, with increased scores for all items in the peer-led group. The teaching skills of physical therapy/physiotherapy student peers were evaluated highly by the nursing students.