The impact of a stress-reducing protocol on the quality of pre-anaesthesia in cats.

INTRODUCTION: Transport to the clinic is a major source of stress for cats. The process involves being put into a carrier, driven in a car and handled. Cats are therefore removed from the safe-haven of their territory and experience many stressful stimuli and interactions. METHODS: In the present study, 31 cats were transported to the clinic following a low-stress transport protocol and compared with a control group of 36 cats whose owners did not follow the protocol. This protocol involved preparing a cat carrier basket with F3 pheromone and keeping it covered and stable during the car journey from the home to the clinic. Pre-anaesthesia information was recorded for cardiac rate, respiratory rate, tolerance to handling, time for sedation to be achieved and dose of propofol required for induction and endotracheal intubation. RESULTS: The group exposed to the low-stress transport protocol took less time to reach sedation and needed a lower dose of propofol for induction than the control group. CONCLUSION: These results suggest that, in cats, pre-anaesthetic and induction requirements are influenced by lower-stress transport and handling.

Investigating emergency nurses' beliefs and experiences with patient handling in the emergency department.

BACKGROUND: Patient handling policy intends to decrease the risk of musculoskeletal injury for nurses. Many factors influence nurses' adherence to patient handling policy, including the context in which the activities take place. The aim of this study was to investigate emergency nurses' beliefs and experiences with patient handling in the emergency department. METHODS: A phenomenological approach was used to explore the participants' experience of patient handling in the ED. Focus group interviews were held in a Victorian emergency department. The interviews were audio-recorded, transcribed, and the data were analysed using thematic analysis. RESULTS: Five interviews were held with 40 nurse participants. Four themes were identified that described participants beliefs and experiences of patient handling: 'Putting the patient first' describes participants prioritisation of patient safety over their own; 'Patient -related challenges' describes the patient factors (e.g. language, mobility, size) that make patient handling more difficult; 'Staff knowledge' of policy and procedure; and 'Inadequate resources' which describes the physical and human resource limitations that made patient handling more difficult. CONCLUSIONS: Issues with equipment, education and patient handling culture are widespread, and this study reaffirms the importance of considering context in developing interventions to improve practice. Introduction of a Safe Patient Handling Program in the ED, that addresses multiple barriers simultaneously, may improve adherence to policy, and reduce the risk of musculoskeletal injury in emergency nurses.

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.

Inter-rater reliability of direct observations of the physical and psychosocial working conditions in eldercare: An evaluation in the DOSES project.

The aim of the study was to develop and evaluate the reliability of the "Danish observational study of eldercare work and musculoskeletal disorders" (DOSES) observation instrument to assess physical and psychosocial risk factors for musculoskeletal disorders (MSD) in eldercare work. During 1.5 years, sixteen raters conducted 117 inter-rater observations from 11 nursing homes. Reliability was evaluated using percent agreement and Gwet's AC1 coefficient. Of the 18 examined items, inter-rater reliability was excellent for 7 items (AC1>0.75) fair to good for 7 items (AC1 0.40-0.75) and poor for 2 items (AC1 0-0.40). For 2 items there was no agreement between the raters (AC1 <0). The reliability did not differ between the first and second half of the data collection period and the inter-rater observations were representative regarding occurrence of events in eldercare work. The instrument is appropriate for assessing physical and psychosocial risk factors for MSD among eldercare workers.

Social Network Analysis of peer-specific safety support and ergonomic behaviors: An application to safe patient handling.

This study applied Social Network Analysis (SNA) to test whether advice-seeking interactions among peers about safe patient handling correlate with a higher frequency of equipment use. Patient-care workers (n=38) at a community hospital in Oregon nominated peers they would consult for advice regarding safe patient handling. Results show a positive correlation between identifying more peers for safe patient handling advice and using equipment more frequently. Moreover, nurses with more reciprocal advice seeking nominations used safe patient handling equipment more frequently. However, employees who would be more consulted about safe patient handling by their peers did not use equipment more frequently than nurses with fewer nominations. Despite the small sample size, the magnitude of the adjusted regressions coefficients ranged between 3 to 4 standard deviations. These results suggest that having more or reciprocal sources of peer-based support may trigger ergonomic related behaviors such as frequent utilization of equipment.

Examining the Factor Structure and Reliability of the Safe Patient Handling Perception Scale: An Initial Validation Study.

PURPOSE: Perceiving imminent safe patient handling and movement (SPH&M) dangers may reduce musculoskeletal (MSK) injuries for nurses in the workplace. The purpose of this study is to develop and validate the 17-item Safe Patient Handling Perception Scale (SPHPS) as an evaluation instrument assessing perceptual risk of MSK injury based on SPH&M knowledge, practice, and resource accessibility in the workplace. METHODS: Data were collected from a convenience sample (N = 117) of nursing employees at a Veteran Affairs Medical Center. Factor analysis identified three factors: knowledge, practice, and accessibility. FINDINGS: The SPHPS demonstrated high levels of reliability, supported by acceptable alpha scores (SPHM knowledge [α = .866], SPHM practices [α = .901], and access to SPHM resources [α = .855]), in addition to the relatively low standard error of measurement scores (SEM). CONCLUSION: The study outcomes suggest that the SPHPS is a valid and reliable tool that can measure participants' perceived risk factors for MSK injuries.

Identifying research needs for wheelchair transfers in the built environment.

PURPOSE: The purpose of this study is to describe the results of focus groups held during the Independent Wheelchair Transfer (IWT) Workgroup. The aims were to facilitate exchange of ideas on (1) the impact of the built environment on the wheelchair transfer process within the community (i.e. moving from wheelchair to and from other surfaces (e.g. furniture, toilet seat, bath bench, car seat) to participate in daily activities), (2) wheelchair users' needs during transfers in the built environment, and (3) future research directions. METHOD: Live web-based conferencing using Adobe Connect technology (Clarix Technologies, Inc., Pittsford, NY) was utilized to conduct three focus groups composed of experts in the field of assistive technology. Investigators independently reviewed focus group meeting transcripts and used qualitative methods to identify main themes. RESULT: Thirty-one experts in assistive technology and related fields participated in focus groups. Nine main themes were found including the effect of transfer skills training, space considerations in the built environment, wheelchair configuration, and the interaction between the built environment, user preferences, and transfer techniques. All groups raised issues about the transfer process in areas of the built environment with limited access, the effect of wheelchair users' transfer techniques, and user preferences during transfers. CONCLUSIONS: The area of independent transfers is multi-faceted and several factors require consideration when contemplating environmental changes to improve accessibility for wheelchair users. Obvious opportunity exists for research which could lead to advances in transfer technology, environments, and techniques for wheelchair users. Implications for Rehabilitation Tremendous opportunities for research collaborations in the field of assistive technology: To develop new terminology to describe wheelchair transfers. To improve the design of the built environment for wheelchair users. To investigate wheelchair transfer training techniques.

An integrated practice approach to mobility care for older people.

Mobility is important to older people in nursing homes and residential facilities since it contributes to their health and quality of life. Many residents in such facilities require some form of assistance to move and accomplish activities of daily living. Therefore, nurses and healthcare assistants should have the knowledge and skills to provide effective mobility care. This article discusses three important aspects of mobility care: safety, mobility optimisation and person-centred approaches to care. Safety is important as residents and staff are at risk of injury during mobility care. Mobility optimisation is essential to ensure residents maintain their independence. Person-centred approaches to care are central to providing an integrated approach to mobility care.

The emergent relevance of care staff decision-making and situation awareness to mobility care in nursing homes: an ethnographic study.

AIM: To explore mobility care as provided by care staff in nursing homes. BACKGROUND: Care staff regularly assist residents with their mobility. Nurses are increasingly reliant on such staff to provide safe and quality mobility care. However, the nature of care staff decision-making when providing assistance has not been fully addressed in the literature. DESIGN: A focused ethnography. METHOD: The study was conducted in four nursing homes in Melbourne, Australia. Non-participant observations of residents and staff in 2011. Focus groups with 18 nurses, care and lifestyle staff were conducted at three facilities in 2012. Thematic analysis was employed for focus groups and content analysis for observation data. Cognitive Continuum Theory and the notion of 'situation awareness' assisted data interpretation. FINDINGS: Decision-making during mobility care emerged as a major theme. Using Cognitive Continuum Theory as a guide, nursing home staff's decision-making was described as ranging from system-aided, through resident- and peer-aided, to reflective and intuitive. Staff seemed aware of the need for resident-aided decision-making consistent with person-centred care. Habitual mobility care based on shared mental models occurred. It was noted that levels of situation awareness may vary among staff. CONCLUSION: Care staff may benefit from support via collaborative and reflective practice to develop decision-making skills, situation awareness and person-centred mobility care. Further research is required to explore the connection between staff's skills in mobility care and their decision-making competence as well as how these factors link to quality mobility care.

Estimated energy expenditure of nursing assistants in long term care.

UNLABELLED: Ergonomic research on nursing work has focused primarily on the biomechanical analysis of patient handling tasks. Few studies have addressed the intensity of a full day of nursing work as measured by changes in heart rate and energy expenditure. OBJECTIVE: A pilot study was conducted between August 2009 and May 2010 to examine the intensity of performing nursing assistant work in long term care settings and to assess the usefulness of heart rate monitoring as a measure of work intensity. The residents of the facilities were physically dependent adults. The settings had floor-based mechanical lifting devices available and no-lift policies that restricted workers from lifting. PARTICIPANTS: Eight women between the ages of 19 and 54 from two facilities participated in this study. METHODS: A wearable recorder allowed unobtrusive heart rate monitoring while nursing assistants worked their usual shift. Continuous heart rate monitoring for a full shift provided an estimation of energy expenditure. RESULTS: The data suggest that the nursing assistants worked at a moderate level yet were within the safe work intensity level recommended by NIOSH [32]. CONCLUSIONS: The information provides preliminary baseline data for nursing assistants who work with physically dependent adults using floor-based lifts in a no-lift environment.

Work-related activities associated with injury in occupational and physical therapists.

OBJECTIVE: The purpose of this study was to examine work activities associated with work-related injury (WRI) in occupational and physical therapy. PARTICIPANTS: 1,158 occupational and physical therapists in Wisconsin responded to a mailed survey, from a total of 3,297 OTs and PTs randomly selected from the State licensure list. METHODS: The study used a cross-sectional, survey design. Participants reported information about WRI they sustained between 2004 and 2006, including the activities they were performing when injured. Investigators analyzed 248 injury incidents using qualitative and quantitative analysis. RESULTS: Data were examined across OT and PT practice in general, and also by practice area. Manual therapy and transfers/lifts were associated with 54% of all injuries. Other activities associated with injury were distinct to practice area, for example: floor work in pediatrics; functional activities in acute care; patient falls in skilled nursing facilities; and motor vehicle activities in home care. CONCLUSIONS: Injury prevention activities must address transfers and manual therapy, but also must examine setting-specific activities influenced by environment and patient population.

Evaluation of ceiling lifts: transfer time, patient comfort and staff perceptions.

Mechanical lifting devices have been developed to reduce healthcare worker injuries related to patient handling. The purpose of this study was to evaluate ceiling lifts in comparison to floor lifts based on transfer time, patient comfort and staff perceptions in three long-term care facilities with varying ceiling lift coverage. The time required to transfer or reposition patients along with patient comfort levels were recorded for 119 transfers. Transfers performed with ceiling lifts required on average less time (bed to chair transfers: 156.9 seconds for ceiling lift, 273.6 seconds for floor lift) and were found to be more comfortable for patients. In the three facilities, 143 healthcare workers were surveyed on their perceptions of patient handling tasks and equipment. For both transferring and repositioning tasks, staff preferred to use ceiling lifts and also found them to be less physically demanding. Further investigation is needed on repositioning tasks to ensure safe practice.

[Epidemiology of unpleasant experiences in conscious critically ill patients during intensive care unit stay].

OBJECTIVE: To survey the incidences of psychological and physiological unpleasant experiences in conscious critically ill patients during their intensive care unit (ICU) stay, and investigate the inducing factors. METHODS: A two-month consecutive nationwide investigation was prospectively performed in 31 academic hospital ICUs. An in-person questionnaire interview to each conscious patient was performed by specific trained staff from RMC-ROMIT Healthcare Consulting Company within 2 days after the patient was transferred from ICU. RESULTS: Two hundred and thirty-four cases were interviewed in this survey. One hundred and sixty-three of the 234 patients (69.6%) appeared psychological unpleasant experience. The ratio of patients with physiological unpleasant experience was as high as 97.0%, and 74.8% of whom were with serious physiological unpleasant experiences. The incidence of serious physiological unpleasant experiences was markedly higher in patients with than without psychological unpleasant experience (46.5% vs. 86.5%). The difference was shown to be statistical significant (P < 0.01). The percentage of patients complained of ICU noise and medical or nursing manipulations not tolerable was 65.8% and 74.8%, respectively. Compared with the tolerable cases, the incidences of psychological and physiological unpleasant experiences were significantly increased in those patients (P < 0.05 or P < 0.01). Acute physiology and chronic health evaluation II (APACHE II) score was the independent high risk factor inducing psychological unpleasant experience through multiple factor analysis [odds ratio (OR) = 1.070, 95% confidence interval (CI) = 1.020-1.130, P < 0.05]. Age was the high risk factor inducing physiological unpleasant experience (OR = 0.936, 95% CI = 0.879-0.998, P < 0.05). In addition, adequate sedation significantly reduced the incidence of the psychological and physiological unpleasant experiences. CONCLUSION: A high incidence of unpleasant experience is found in conscious critically ill patients during their ICU stay. Patients with psychological unpleasant experiences are with higher possibility of occurring physiological unpleasant experiences. The data show that APACHE II score is the independent high risk factor inducing psychological unpleasant experiences. ICU environment, noise for instance, and medical or nursing manipulations are closely related with the incidence of psychological and physiological unpleasant experiences. Meanwhile, adequate sedation is one of the effective methods to reduce the incidences of them.