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INTRODUCTION: Medication safety is an important health priority that focuses on preventing harm from medication-related events. Unsafe medication administration practices can lead to errors, which can cause avoidable injury (or harm) to patients. OBJECTIVES: This paper reports on an evidence implementation project conducted in a large tertiary hospital in Australia to improve nursing compliance with best practice recommendations for medication administration. METHODS: The project was guided by JBI's seven-phase approach to evidence implementation, using audit and feedback and a structured framework to identify barriers, enablers, and implementation strategies. RESULTS: The project resulted in improved compliance with best practice recommendations. This was achieved through multimodal strategies, including education, improved access to resources, and targeted feedback and discussion sessions to encourage culture and behavior change. CONCLUSIONS: The project improved nurses' medication administration practices, specifically in performing independent second checks. Collaborative efforts of the project leads facilitated the review of medication administration policy and the development of staff education resources. Patient engagement remains an area for improvement, along with the potential need for further ongoing medication education. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A237.
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AIM: To describe the pre-implementation context and implementation approach, for a clinician researcher career pathway. BACKGROUND: Clinician researchers across all health disciplines are emerging to radically influence practice change and improve patient outcomes. Yet, to date, there are limited clinician researcher career pathways embedded in clinical practice for nurses and midwives. METHODS: A qualitative descriptive design was used. DATA SOURCES: Data were collected from four online focus groups and four interviews of health consumers, nursing and midwifery clinicians, and nursing unit managers (N = 20) between July 2022 and September 2023. RESULTS: Thematic and content analysis identified themes/categories relating to: Research in health professionals' roles and nursing and midwifery, and Research activity and culture (context); with implementation approaches within coherence, cognitive participation, collective action and reflexive monitoring (Normalization Process Theory). CONCLUSIONS: The Pathway was perceived to meet organizational objectives with the potential to create significant cultural change in nursing and midwifery. Backfilling of protected research time was essential. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The Pathway was seen as an instrument to empower staff, foster staff retention and extend research opportunities to every nurse and midwife, while improving patient experiences and outcomes. IMPACT: Clinicians, consumers and managers fully supported the implementation of clinician researchers with this Pathway. The Pathway could engage all clinicians in evidence-based practice with a clinician researcher leader, effect practice change with colleagues and enhance patient outcomes. REPORTING METHOD: This study adheres to relevant EQUATOR guidelines using the COREG checklist. PATIENT OR PUBLIC CONTRIBUTION: Health consumers involved in this research as participants, did not contribute to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript.
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AIM: To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention. DESIGN: A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions. METHODS: We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact. RESULTS: Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information. CONCLUSION: Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists. RELEVANCE TO CLINICAL PRACTICE: Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change. REPORTING METHOD: We adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: We interviewed patients on study wards pre and post intervention.
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Comunicación , Pase de Guardia , Investigación Cualitativa , Pase de Guardia/normas , Humanos , Grupos Focales , Personal de Enfermería en Hospital/psicología , Femenino , Masculino , Adulto , Persona de Mediana EdadRESUMEN
BACKGROUND: Nurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients' bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost-benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries. METHODS: A stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses' education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and 'Code Blue' calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses' perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses' and medical officers' perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost-benefit analysis and post-trial process evaluation will also be undertaken. DISCUSSION: If effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022.
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AIMS: To investigate the scope of practice of nurse-led services for people experiencing homelessness, and the influence on access to healthcare. DESIGN: A scoping review. DATA SOURCES: On 20 November 2020, the following databases were searched: CINAHL, Embase, MEDLINE, PubMed and Scopus. REVIEW METHODS: Included studies focused on people experiencing homelessness aged 18 years and over, nurse-led services in any setting and described the nursing scope of practice. Studies were peer-reviewed primary research, published in English from the year 2000. Three authors performed quality appraisals using the mixed methods assessment tool. Results were synthesized and discussed narratively and reported according to the PRISMA-ScR 2020 Statement. RESULTS: Nineteen studies were included from the United States (n = 9), Australia (n = 4), United Kingdom (n = 4) and Canada (n = 2). The total participant sample size was n = 6303. Studies focused on registered nurses (n = 10), nurse practitioners (n = 5) or both (n = 4), in outpatient or community settings. The nursing scope of practice was broad and covered a range of skills, knowledge and attributes. Key skills identified include assessment and procedural skills, client support and health education. Key attributes were a trauma-informed approach and building trust through communication. Important knowledge included understanding the impact of homelessness, knowledge of available services and the capacity to undertake holistic assessments. Findings suggest that nurse-led care facilitated access to healthcare through building trust and supporting clients to access services. CONCLUSION: Optimized nursing scope of practice can facilitate access to healthcare for people experiencing homelessness. Key factors in enabling this include autonomy in nursing practice, organizational support and education. IMPACT: The broad range of skills, knowledge and attributes reported provide a foundation from which to design an educational framework to optimize the nursing scope of practice, thereby increasing access to healthcare for people experiencing homelessness.
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Personas con Mala Vivienda , Enfermeras Practicantes , Adolescente , Adulto , Accesibilidad a los Servicios de Salud , Humanos , Rol de la Enfermera , Alcance de la PrácticaRESUMEN
AIMS: To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient-centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover. DESIGN: Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention. METHODS: Pre-intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital-acquired complication data. RESULTS: Notable changes post-intervention included a shift to involve patients in bedside handovers, improved ward-level communication and culture, and an associated decrease in reported hospital-acquired complications. CONCLUSIONS: Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient-centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success. IMPACT: Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient-centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital-acquired complications. The intervention has been rolled out to a further five wards across two hospitals.
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Pase de Guardia , Comunicación , Humanos , Participación del Paciente , Seguridad del Paciente , Atención Dirigida al PacienteRESUMEN
Although produce prescription (PRx) programs have been shown to improve fruit and vegetable (FV) consumption, few studies have examined how economic constraints influence participant experience. We conducted a qualitative study of patient experience of a 3-month PRx program for hypertension (PRxHTN) including 3 safety-net clinics and 20 farmers' markets (FMs). We interviewed 23 PRxHTN participants using semistructured guides to understand their program experiences. Interviews were audio-taped, transcribed, and analyzed to identify a priori and emergent themes. PRxHTN participants completing qualitative interviews were mostly middle-aged (mean: 62 years) African American (100%) women (78%). Economic hardship as a barrier to maximum program participation and sustainability was a main theme identified, with three subthemes: (i) transportation issues shaped shopping and eating patterns and limited participant ability to access FMs to utilize PRxHTN vouchers; (ii) limited and unstable income shaped participant shopping and eating behavior before, during, and after PRxHTN; and (iii) participants emphasized individual-level influences like personal or perceived motivations for program participation, despite significant structural constraints, such as economic hardship, shaping their program engagement. Future PRx programs should bolster economic and institutional supports beyond FM vouchers such as transportation assistance, partnering with local food banks and expansion to local grocery stores offering year-round FV access to support sustained behavior change. Additionally, structural competency tools for providers may be warranted to reorient focus on structural influences on program engagement and away from potentially stigmatizing individual-level explanations for program success. These efforts have potential to enhance the translation of PRx programs to the needs of economically vulnerable patients who struggle to manage chronic illness and access basic nutrition.
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Comportamiento del Consumidor , Conducta Alimentaria , Frutas/economía , Verduras/economía , Negro o Afroamericano/estadística & datos numéricos , Femenino , Humanos , Hipertensión/dietoterapia , Masculino , Persona de Mediana Edad , Ohio , Pobreza/economía , Investigación CualitativaRESUMEN
BACKGROUND: Although research shows produce prescription (PRx) programs increase fruit and vegetable (FV) consumption, little is known about how participants experience them. OBJECTIVE: To better understand how participants experience a PRx program for hypertensive adults at 3 safety net clinics partnered with 20 farmers' markets (FMs) in Cleveland, OH. DESIGN: We conducted semi-structured interviews with 5 program providers, 23 patient participants, and 2 FM managers. PARTICIPANTS: Patients interviewed were mainly middle-aged (mean age 62 years), African American (100%), and women (78%). Providers were mainly middle-aged men and women of diverse races/ethnicities. INTERVENTION: Healthcare providers enrolled adult patients who were food insecure and diagnosed with hypertension. Participating patients attended monthly clinic visits for 3 months. Each visit included a blood pressure (BP) check, dietary counseling for BP control, a produce prescription, and produce vouchers redeemable at local FMs. APPROACH: Patient interviews focused on (1) beliefs about food, healthy eating, and FMs; (2) clinic-based program experiences; and (3) FM experiences. Provider and market manager interviews focused on program provision. All interviews were audio-taped, transcribed, and analyzed thematically. KEY RESULTS: We identified four central themes. First, providers and patients reported positive interactions during program activities, but providers struggled to integrate the program into their workflow. Second, patients reported greater FV intake and FM shopping during the program. Third, social interactions enhanced program experience. Fourth, economic hardships influenced patient shopping and eating patterns, yet these hardships were minimized in some participants' views of patient deservingness for program inclusion. CONCLUSIONS: Our findings highlight promises and challenges of PRx programs for economically disadvantaged patients with a chronic condition. Patient participants reported improved interactions with providers, increased FV consumption, and incorporation of healthy eating into their social networks due to the program. Future efforts should focus on efficiently integrating PRx into clinic workflows, leveraging patient social networks, and including economic supports for maintenance of behavior change.
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Dieta Saludable , Abastecimiento de Alimentos/economía , Frutas/economía , Promoción de la Salud/métodos , Verduras/economía , Negro o Afroamericano , Femenino , Humanos , Hipertensión/psicología , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Relaciones Profesional-Paciente , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Proveedores de Redes de Seguridad/métodosRESUMEN
Evidence that the learning gains of preschool fade as children transition into elementary school has led to increased efforts to sustain preschool advantages during this key transitional period. This study explores whether the observed benefits of sustainability practices for a range of child outcomes are explained and/or moderated by family and school mechanisms selecting children into experiencing these practices. Analyses of the Early Childhood Longitudinal Study-Birth Cohort revealed that both family and school factors predicted children's exposure to several PK-3 sustainability practices. PK-3 sustainability practices were associated with reading (but not math) gains and better interpersonal skills (but not fewer externalizing behaviors) following the transition into kindergarten. These links were not conditioned by the selection mechanisms. The findings highlight who is more likely to seek out (at the family level) or offer (at the school level) sustainability practices and how relevant they are to fighting preschool fadeout.
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AIM: To examine the influence of new graduate nurses' (NGNs) personal and situational factors on their satisfaction with the practice environment. BACKGROUND: Transitional support programmes are widely used to provide professional support for NGNs' transitioning-to-practice. However, little is known about whether personal characteristics and situational factors influence NGNs' satisfaction with the practice environment. METHODS: This was a cross-sectional survey. NGNs were surveyed approximately 8 weeks after commencement of the support programme. In addition to socio-demographic and situational data, two validated, standardised instruments were administered: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS). RESULTS: A total of 109 NGNs completed the survey. Three independent and significant predictors of NGNs' satisfaction were: (1) unit satisfaction (standardised beta, ß = 0.41); (2) satisfaction with the clinical supervision (ß = 0.31); and (3) assigned unit: critical-care areas (ß = -0.17), explaining 32.5% of the variance. Conclusion This study demonstrates the importance of clinical supervision and unit level support on satisfaction, and the need for additional support for NGNs assigned to critical-care areas. IMPLICATIONS FOR NURSING MANAGEMENT: The findings of this study suggest there are modifiable situational factors that influence NGNs' satisfaction with the practice environment, and allocating NGNs to critical-care areas on their first rotation should be avoided.
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Satisfacción en el Trabajo , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur , Supervisión de Enfermería , Encuestas y CuestionariosRESUMEN
BACKGROUND: Sleep disruption is common in inflammatory bowel diseases (IBD). However, studies demonstrating a similar prevalence in irritable bowel syndrome suggest that nighttime disruption due to diarrhea and abdominal pain may be key drivers of poor sleep quality. Whether inflammation is associated with poor sleep independently has not been examined previously. METHODS: This single-center study included subjects with IBD recruited to an ongoing prospective registry who completed a questionnaire assessing sleep quality and mood. Inflammatory marker levels [C-reactive protein (CRP), erythrocyte sedimentation rate] and clinical disease activity including nighttime disruption on the day of enrollment were obtained from the medical record. Logistic regression models were used to identify predictors of sleep quality. RESULTS: The study included 131 subjects (72 women) with a median age of IBD diagnosis of 25 years. Twenty-three subjects (19 %) had a high C-reactive protein level (≥8 mg/dL). Poor sleep was more common in those with high CRP levels than with normal values (70 vs. 39 %, p = 0.009). This association remained significant on multivariate analysis [Odds ratio (OR) 4.12, 95 % confidence interval (CI) 1.38-12.29]. Adjusting for the presence of nighttime disruption did not significant alter this association (OR 3.16, 95 % CI 1.01-9.90). High CRP correlated with poor sleep even in patients not experiencing nocturnal symptoms (n = 101, OR 4.89, 95 % CI 1.24-19.36). CONCLUSION: High CRP is associated with poor sleep quality in IBD independent of the presence of nighttime disruptions, suggesting that a relationship exists between circulating inflammatory markers and sleep.
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Proteína C-Reactiva/metabolismo , Enfermedades Inflamatorias del Intestino/complicaciones , Trastornos del Sueño-Vigilia/etiología , Adolescente , Adulto , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/sangre , Enfermedades Inflamatorias del Intestino/metabolismo , Masculino , Oportunidad Relativa , Factores de Riesgo , Sueño , Adulto JovenRESUMEN
BACKGROUND: Early life exposures may modify risk of inflammatory bowel diseases (IBD; Crohn's disease (CD), ulcerative colitis (UC)). However, the relationship between early life exposures and natural history of IBD has not been previously examined. METHODS: This single center study included patients with CD or UC recruited in a prospective IBD registry. Enrolled patients completed a detailed environmental questionnaire that assessed various early life environmental exposures. Our primary outcome was requirement for disease-related surgery in CD and UC. Logistic regression models defined independent effect of early life exposures, adjusting for potential confounders. RESULTS: Our study included 333 CD and 270 UC patients. Just over half were female with a median age at diagnosis of 25 years. One-third of the cohort had history of bowel surgery (31%) and nearly half had used at least one biologic agent (47%). Among those with CD, being breastfed was associated with reduced risk of CD-related surgery (34% vs. 55%), while childhood cigarette smoke exposure was associated with increased risk. On multivariate analysis, history of being breastfed (odds ratio (OR) 0.21, 95% confidence interval [CI] 0.09-0.46) and cigarette smoke exposure as a child (OR 2.17, 95% CI 1.10-4.29) remained independently associated with surgery. None of the early life variables influenced disease phenotype or outcome in UC. CONCLUSION: A history of being breastfed was associated with a decreased risk while childhood cigarette smoke exposure was associated with an increased risk of surgery in patients with CD. Further investigation to examine biological mechanisms is warranted.
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Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Progresión de la Enfermedad , Exposición a Riesgos Ambientales , Lactancia Materna , Colitis Ulcerosa/cirugía , Enfermedad de Crohn/cirugía , Femenino , Humanos , Masculino , Massachusetts/epidemiología , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Encuestas y Cuestionarios , Contaminación por Humo de Tabaco/efectos adversosRESUMEN
Practice development (PD) and knowledge translation (KT) have emerged recently as methodologies which assist advancement in gathering and using evidence in practice. For nursing to benefit from these methodologies there is a need to advance the dialogue between academia and the service sector concerning the use and further development of these methodologies as well as how we create the most effective partnerships between academia and practice. To advance this dialogue and to gain insights into the similarities and differences between KT and PD and between the academic and the service sectors, four conversations from different leaders in these sectors have been gathered and are presented here. These four discrete narratives are presented to showcase the diversity of sector contexts in relation to PD and KT methodologies. Narrative One focuses on some of the theoretical and policy issues related to creating partnerships between traditional "knowledge creation systems" (universities) and "knowledge utilization systems" Narrative Two discusses how a large school of nursing responded to the challenge of creating partnerships for practice development in an attempt to bridge the academic/service divide and produce benefits to both organisations. Narratives Three and Four describe the view of practice development from the service side. The final section of the paper presents an agenda for discussion and action based on the emerging set of principles.
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Difusión de Innovaciones , Enfermería Basada en la Evidencia , Desarrollo de Personal , Australia , Educación en Enfermería/organización & administración , Humanos , Relaciones Interinstitucionales , Práctica Profesional/organización & administración , Investigación Biomédica Traslacional/organización & administraciónRESUMEN
OBJECTIVES: To test the hypothesis that high and asymmetrical water content persists in infants with bronchopulmonary dysplasia (BPD) and that this is associated with nonuniform lung damage. STUDY DESIGN: Magnetic resonance imaging was used to assess lung water content in 20 infants and tissue injury in 35 infants of 23 to 33 weeks' gestational age (15 with severe BPD, 13 with mild BPD, and 7 without BPD). Relative proton density provided an index of water content and distribution. The location and extent of focal densities and cyst-like appearances indicating lung damage were defined. RESULTS: Proton density was significantly higher in dependent regions. Average proton density, proton density gradient, and severity of lung damage were greater in infants with severe BPD. Indicators of damage were greatest in dorsal lung regions. BPD was associated with a higher lung water burden and gravity-dependent atelectasis and/or alveolar flooding. Lesions were more common in dorsal lung regions in infants with severe lung damage. CONCLUSIONS: Infants with BPD have increased lung water and are susceptible to gravity-induced collapse and/or alveolar flooding in the dependent lung. Focal tissue damage appears to be distributed inhomogenously.
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Displasia Broncopulmonar/patología , Agua Pulmonar Extravascular , Pulmón/patología , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Respiración Artificial , Índice de Severidad de la EnfermedadRESUMEN
An increase in lung liquid may contribute to respiratory disease in preterm infants. Uneven distribution of lung liquid may cause heterogeneity in the lung disease seen in these infants. We used magnetic resonance imaging to investigate lung water content and distribution in 16 preterm (24-31 weeks) and 9 term infants in the first week of life. Images of lung parenchyma were examined and relative proton density quantified to give an index of lung water. Lung water content and distribution were compared between preterm and term infants, and in preterm infants regional signal distribution between dependent and nondependent lung on T1 weighted images was also compared after turning between prone and supine positions. Relative proton density was higher in preterm than in term lung (p < 0.008) and greater in dependent than in nondependent regions, particularly in the preterm (p < 0.001). Repositioning preterm infants rapidly redistributed signal intensities, with more even distribution lying prone than supine (p < 0.001). Small, low-signal regions were seen in the lung parenchyma in preterm but not in term infants, which may indicate peribronchial fluid or overdistension of compliant lung units. We conclude that lung water content is higher in preterm than in term infants and is associated with gravity-related changes consistent with dependent atelectasis.