Caring for Visually Impaired Patients in the Hospital: A Multidisciplinary Quality Improvement Project.

BACKGROUND: People with low vision or blindness may experience anxiety, fear, and depression-sometimes severe-as a result of the challenges encountered when they seek medical care. Such patients deserve, and health care professionals must provide, equal opportunities to participate in and benefit from their health care in a safe environment. A search of the literature yielded information on the needs of visually impaired people but failed to find a comprehensive program that health care facilities could use to meet the needs of this vulnerable population. This gap in the literature on visually impaired patients (VIPs) and implications for their care led us to conduct focused meetings with this population. OBJECTIVE: The specific aims of this quality improvement (QI) project were to determine the needs of hospitalized VIPs, develop educational and other resources that would help clinicians and ancillary hospital staff in their interactions with VIPs, and assemble a toolbox of useful materials for VIPs themselves. METHODS: A VIP care team identified the needs of VIPs as reported in the literature and in personal meetings with visually impaired people in the community. The team also surveyed interdisciplinary hospital staff members to determine their experience in caring for VIPs as well as their educational needs, and then developed strategies and educational modules to help clinicians and ancillary staff members accommodate the unique needs of VIPs in accordance with the Americans with Disabilities Act of 1990. The team also assembled a VIP toolbox that contained several items useful to VIPs themselves. Supplementary information tailored to the function of each hospital department (such as nursing, admissions, environmental services, dietary, and radiology) was also provided to help staff members improve VIPs' hospital experience. RESULTS: The hospital's interdisciplinary staff members participated in an education program to improve their care of VIPs. Before the program, only 23.6% of 161 staff members reported having received education on caring for VIPs. After the program, however, 56.4% of 140 staff members reported having received such education. Former patients requested bracelets and room identifiers that would alert staff members to VIPs' needs, and the team provided these. The team also introduced a braille version of the hospital menu and provided VIP toolboxes at each nursing station that contained many useful daily care items. CONCLUSIONS: VIPs have specific needs when hospitalized. Patients' and staff members' responses to this QI project were overwhelmingly positive; both groups were appreciative of the newly implemented initiatives to meet the special needs of the visually impaired.

Validity and reliability of sleep promotion questionnaire and predictors of quality of care.

BACKGROUND: Sleep disturbance is common among hospitalized patients. However, sleep promotion is not a high priority for most healthcare providers, which potentially impacts quality of care. Due to a paucity of validated tools to assess sleep promotion, little is known about the relationship between sleep promotion and quality of care. This study was conducted to assess the validity and reliability of a newly-developed instrument, the Sleep Promotion Questionnaire, and to examine sleep promotion as a predictor of quality of care. The Sleep Promotion Questionnaire includes dimensions of attitude, control, unit norms, intention, and behavior that are associated with sleep promotion. METHODS: A total of 302 nurses participated in an online survey. The survey included the initial 36-item Sleep Promotion Questionnaire, a quality of care question, Caring Behavior Inventory, and Professional Quality of Life scale. An exploratory factor analysis was performed to determine the factor structure of the Sleep Promotion Questionnaire. The internal consistency reliability as well as the convergent and divergent validities was assessed. Pearson's correlations and hierarchical multiple regression procedures were performed to explore the predictors of perceived quality of care. RESULTS: Exploratory factor analysis of the Sleep Promotion Questionnaire yielded 28 items in five subscales, comprising Attitude, Control, Unit Norms, Sleep-aid Intention, and Behavior. Convergent and divergent validities were supported (r = 0.37; r = -0.38, respectively). The Cronbach's alphas of internal consistency reliabilities of the Sleep Promotion Questionnaire subscales ranged from 0.70 to 0.89. Regression models showed that sleep-promoting Unit Norms was the only significant predictor of perceived quality of care among both ICU and non-ICU nurses (ß = 0.40; ß = 0.28, respectively). CONCLUSION: The Sleep Promotion Questionnaire appears to be a reliable and valid instrument with satisfactory psychometric properties for assessing sleep promotion, and it seems that having unit norms conducive to sleep promotion may positively impact the quality of care. However, further studies are needed to confirm these results.