Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment.

BACKGROUND: Nurses have primary responsibility for many of the care processes and interventions intended to improve patients' health during hospital stays. Accordingly, missed nursing care can negatively impact patient safety and lead to negative clinical outcomes. Missed nursing care is standard care that is not completed, incomplete, or seriously delayed. PURPOSE: There is scant literature on nurse-reported missed care (NRMC) in Singapore. Identifying the prevalence of, types of, and reasons for missed care, including staff-related factors, is imperative to understanding the implications of missed care and identifying opportunities for improvement. METHODS: Ours is a correlation study of NRMC using convenience sampling. Nurses working on all inpatient units in an acute care hospital in Singapore were recruited to complete the MISSCARE survey, a quantitative tool measuring missed nursing care and the reasons for it. Descriptive statistics was applied to analyze demographics, types of NRMC, and reasons for NRMC. The Pearson χ2 test was used to analyze the correlation between demographics and satisfaction variables and NRMC. RESULTS: A total of 314 participants out of 1,944 eligible nurses (response rate, 16%) were recruited. The most commonly reported missed care activities were setting up meals for patients who can feed themselves (87.3%), ambulation (70.1%), attending interdisciplinary conferences (64.3%), providing emotional support to patients and/or family (58%), and turning patients every two hours (56.7%). The most cited reasons for missed care were inadequate number of staff (84.4%), caregiver not in unit or unavailable (76.1%), heavy admission and discharge activity (75.5%), urgent patient situations (74.2%), and unexpected rise in patient volume and/or acuity (73.2%). Younger age, greater experience in role and current unit, inadequate staffing and teamwork, low satisfaction with current role and with being a nurse, and planning to leave the current position were factors significantly associated with greater levels of missed care. CONCLUSION: This study demonstrated evidence of NRMC and its associated factors within the local setting. In addition to expanding nursing resources, analyzing nursing work processes, providing support for younger nurses, and improving nursing satisfaction are possible mitigating factors in preventing missed care. Strategies targeting workforce and resource management, greater support for new and younger nurses, and job satisfaction should be considered to address missed care.

Impact of a Bedside Activity Device on the Functional Status of Hospitalized Older Adults: A Randomized Controlled Trial.

BACKGROUND: Older adults may have difficulty maintaining their functional capabilities during hospitalization. This pilot study aimed to investigate the impact of a bedside activity device on the functional status of hospitalized older adults. METHODS: For this single-site randomized controlled trial, 48 participants were recruited between July 2019 and March 2021. Participants were randomized into one of two groups: the intervention group, which was given the use of a bedside activity device plus standard care, and the control group, which received standard care. Katz Index of Independence in Activities of Daily Living (Katz ADL) scores and Timed Up and Go (TUG) test times were used as indicators of functional status and were collected on admission (baseline) and at discharge.Mann-Whitney U and χ 2 tests were used to test for baseline similarities between groups. The Wilcoxon signed rank test was used to determine within-group pre-post changes in TUG and Katz ADL scores. The Mann-Whitney U test was used to determine between-group differences in TUG and Katz ADL change scores. RESULTS: Within-group pre-post analysis showed significant increases in Katz ADL scores in the intervention group and no significant changes in the control group. TUG times decreased significantly in the intervention group and increased significantly in the control group. Between-group analyses showed significant differences in both TUG and Katz ADL change scores. CONCLUSION: The use of the bedside activity device in addition to standard care may prevent functional decline and increase independence in performing basic ADLs.

Efficacy of the virtual reality-based stress management program on stress-related variables in people with mood disorders: the feasibility study.

This study aimed to investigate the effect of a VR-based stress management program on people with mood disorders. A quasi-experimental study was conducted in a tertiary hospital in Singapore, and a convenience sample of 22 was recruited. The program comprised three daily 1-hour sessions incorporating psychoeducation and VR-based relaxation practice. Participants who completed the program had significantly lowered subjective stress (t=6.91, p<0.001), depression (t=5.62, p<0.001), and anxiety (t=5.54, p<0.001); and increased skin temperature (F=17.71, p<0.001), perceived relaxation (F=26.20, p<0.001) and knowledge (F=13.77, p<0.001). Participants' feedback on the program was positive. Findings from this study contribute to improving clinical practice and serve as preliminary data to conduct more rigorous research in the future.

Efficacy of psychoeducation and relaxation interventions on stress-related variables in people with mental disorders: a literature review.

This paper aimed to critically review and summarize empirical evidence concerning the efficacy of psychoeducation or relaxation-based stress management interventions on stress-related variables in people with mental disorders. Electronic databases were used during the literature search. Thirteen articles that fulfilled the preset eligible criteria were included in the review. Findings indicated that psychoeducation and relaxation-based interventions mitigated stress and depression; and enhanced relaxation intensity and knowledge on stress management. However, mixed results were obtained on anxiety. In addition, interventions using virtual reality technology revealed positive effects on depression, relaxation intensity and anxiety. Limitations and recommendations for future research are discussed.

Nursing inter-shift handover process in mental health settings: a best practice implementation project.

AIMS: Nursing inter-shift handover remains an important traditional ritual in nursing. Timely and effective handover of critical information ensure continuity of patient care and safe delivery. This project took place in a tertiary mental health institution in Singapore. The project aims to (i) examine existing handover practices/process in the tertiary mental health institution; (ii) determine the strengths and limitations of the existing handover practice/process; and (iii) identify, implement and evaluate an evidence-based nursing inter-shift handover process to enhance patient safety and service delivery. METHODS: This project was conducted in three phases using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programmes. It was implemented over a period of 4 months from end of August 2011 to beginning of December 2011. Evidence-based strategies such as town hall meetings and education sessions that reinforce proper handover techniques and its importance were implemented to enhance the handover processes and practices in four acute admitting wards. Pre- and post-audit data were observed and recorded for each case handover during each inter-shift handover session in four acute admitting wards. RESULTS: The handover processes for 212 cases for four acute admitting wards were observed using the seven audit criteria. Post-implementation audit findings show that compliance rate had improved significantly for the four criteria: an improvement of 49% compliance rate in the use of standardised documentation during shift handover session; an increase of 74% compliance rate in proper identification of patient at the start of each case report; a 31% increase in proper handing over of significant patient's history; and 18% increased compliance in providing detailed observation of patients. CONCLUSION: This project had shown that handover sessions can be made effective by translating evidence into practice through ongoing evidence-based audit. Continuous evidence-based evaluation, identification and implementation of nursing inter-shift handover process are imperative to enhance patient safety and service delivery.

The effectiveness of mental health-related theoretical education and clinical placement in mental health settings in changing the attitudes of health care students towards mental illness: A systematic review.

BACKGROUND: People with mental illness are subject to stigma, which is the process of stereotyping, prejudice and discrimination. Patients' experience of discrimination from the health care community may be a barrier to help-seeking in mental illness. Mental health-related theoretical education and clinical placement in mental health settings during student years may reduce stigmatising attitudes towards mental illness. OBJECTIVES: The objective of the review was to synthesize the best available evidence regarding the effectiveness of mental health-related theoretical education and clinical placement in mental health settings in changing the attitudes of health care students towards mental illness. SEARCH STRATEGY: A three-step search strategy was utilized to find studies published in English from 2001 to 2010 (inclusive). An initial search of Medline and CINAHL was undertaken to identify keywords. Secondly, the keywords were used to search CINAHL, Medline, Scopus, PsycINFO (via OVID), ScienceDirect, Web of Science, Mednar, Proquest and TRIP. Thirdly, reference lists of the articles identified in the second stage were searched for other relevant studies. The final decision to include studies was made through the consensus of two independent reviewers. SELECTION CRITERIA: Articles were assessed by two independent reviewers for methodological validity using critical appraisal instruments adapted from the "Critical Review Form - Quantitative Studies" by Law et al. and JBI-MAStARI. Disagreements that arose between reviewers were resolved through discussion with a third reviewer. DATA COLLECTION AND SYNTHESIS: In total, 55 full text articles were retrieved from an initial 1957 search results. Twenty-six studies were found to have met all the inclusion criteria and were subjected to critical appraisal. Twenty-two were selected for inclusion and four were excluded. Of the 22 included studies, one was a randomised controlled trial, five were non-randomised controlled trials and 16 were before and after studies. Specific details about the study methods, interventions, participants, instruments used, and outcomes of significance to the review were extracted using a table developed by the reviewers. Statistical pooling was not appropriate due to the variety of instruments used to measure outcomes, thus the results of included articles were synthesized in narrative summary. MAIN RESULTS: Both mental health-related theoretical education and clinical placement in mental health settings are effective in changing the attitudes of health care students towards mental illness. CONCLUSIONS: Theoretical education in the form of videos, lectures, presentations delivered by people with mental illness and coursework are effective stigma reduction interventions. Clinical placement is more effective when combined with theoretical education. However, the effect of educational interventions may be transient. IMPLICATIONS FOR PRACTICE: Videos, lectures, presentations delivered by people with mental illness should form the basis of anti-stigma interventions. Educational interventions should be offered regularly to promote lasting change in attitudes. Mental health coursework and clinical placement must remain part of the corecurricula in health care courses. IMPLICATIONS FOR RESEARCH: There is a need to investigate the effectiveness of educational interventions using RCTs and longitudinal designs. Interventions which can produce more lasting change could be developed. More research can be done to investigate effects of interventions in other student groups and with regards to specific mental illnesses. Lastly, a "gold standard" for measuring attitudes needs to be developed.

A longitudinal study of advanced practice nursing in singapore.

This longitudinal study of the first cohort of APN interns provides information on aspects of the practice and on the development of their role from Singapore perspective. The APN role is a new one in Singapore, providing an opportune time to pioneer and define advanced practice nursing for the future. Longitudinal surveys will be conducted annually among this first cohort for 5 years to identify changes in role development over time. These results will be compared against those obtained from subsequent cohorts of APN interns in Singapore. Continued research into the role of the APN is needed to enhance role acceptance and development, and to ensure that the benefits of having APNs are attained.