Determination of Nursing Care Times Based on the Perroca Patient Classification Instrument in the Inpatient Oncology Unit: A Mixed Method Study.

OBJECTIVES: The aim of this study was to determine the daily nursing care times of hospitalized inpatient oncology unit patients according to degree of acuity using the Perroca Patient Classification tool. DATA SOURCES: This study used a mixed method sequential explanatory design. The "Nursing Activity Record Form" and "Perroca Patient Classification Instrument" were used for quantitative data collection, and direct observation was performed for 175 hours via time-motion study. Descriptive statistics, between-group comparison, and correlation analysis were used for data analysis. Using a semistructured questionnaire, qualitative data were collected from individual in-depth interviews with seven nurses who participated in the quantitative part of the study. Qualitative data were analyzed by thematic analysis. The reporting of this study followed GRAMMS checklist. CONCLUSIONS: As a result of the integration of quantitative and qualitative data, daily nursing care duration was determined as 2 to 2.5 hours for Type 1 patients, 2.6 to 3.5 hours for Type 2 patients, 3.6 to 4.75 hours for Type 3 patients, and 4.76 to 5.5 hours for Type 4 patients. The findings showed that in an inpatient oncology unit, nursing care hours increased as patients' Perroca Patient Classification Instrument acuity grade increased; thus, the instrument was discriminative in determining patients' degree of acuity. IMPLICATIONS FOR NURSING PRACTICE: Nurse managers can utilize this study's results to plan daily assignments that are sensitive to patient care needs. The results can also help nurse managers to identify relationships between nurse staffing and patient outcomes at the unit level, as well as to develop ways to analyze such relationships.

Missed nursing care: A cross-sectional and multi-centric study from Turkey.

AIM: The aim of this study is to explore the extent of missed nursing care in Turkey and identify its predictors. DESIGN: This was a descriptive, cross-sectional, multicentre study. METHODS: A total of 477 nurses working in seven public hospitals participated in this study from March to July 2019. The survey included two components: a personal and professional characteristics data form and the MISSCARE survey. RESULTS: The study revealed that emotional support, patient bathing and ambulation were the most frequently missed nursing care activities. An inadequate number of assistive personnel and staff, along with an unexpected increase in patient volume, were identified as the primary reasons for missed nursing care. Of the 21 missed nursing care activities, nine predictive models showed statistical significance (p < 0.05). Factors such as the type of unit, years of work experience, working hours, number of patients cared for in a shift and intention to leave the unit were found to be significant predictors of seven missed nursing care activities (p < 0.05). CONCLUSION: This study found that numerous variables influence each care activity, which suggests the need to devise more targeted and specific strategies to minimize missed nursing care. Thorough investigation into the impact of these strategies on each care activity is essential.

Problemas e intervenções de enfermagem identificados na consulta de enfermagem a pessoas que vivem com HIV / Nursing problems and interventions identified in the nursing consult for people living with HIV / Problemas e intervenciones de enfermería identificados en la consulta de enfermería para personas que viven con VIH

Objetivo: identificar os problemas e as respectivas intervenções registrados pelos profissionais de enfermagem no primeiro atendimento de pessoas que vivem com HIV em um Serviço de Atendimento Especializado de um Centro Municipal de Saúde. Método: trata-se de um estudo descritivo, quantitativo, retrospectivo e documental. Em um universo de 300 pacientes admitidos em 2021, foram incluídos 110 prontuários de ambos os sexos e adultos. Resultados: em 88,5% das consultas, os enfermeiros registraram problemas de natureza biológica/física e 91,6% das intervenções foram solicitações de exames laboratoriais. Em 47,3% não havia conexão entre o problema de enfermagem e a intervenção. Conclusão: os principais problemas e as intervenções identificadas durante a consulta de enfermagem estão relacionados com os aspectos físicos e biológicos das pessoas que vivem com HIV, demonstrando que o cuidado de enfermagem ainda está centrado em um paradigma biomédico e que urge ser superado.

Objective: to identify the problems and their interventions registered by nursing professionals in the first nursing consult of people living with HIV in a Specialized Care Service of a Municipal Health Center. Method: this is a descriptive, quantitative, retrospective and documentary study. In a universe of 300 medical records admitted in 2021, 110 patients of both sexes and adults were included.Results: in 88.5% of the consultations, nurses registered biological/physical problems and 91.6% of the interventions were requests for laboratory tests. In 47.3% there was no connection between the nursing problem and the intervention. Conclusion: the main problems and interventions identified during the nursing consultation are related to the physical and biological aspects of people living with HIV, demonstrating that nursing care is still attached to a biomedical paradigm and that it urgently needs to be overcome.

Objetivo: identificar los problemas y sus intervenciones registradas por los profesionales de enfermería en la primera consulta de enfermería de personas que viven con VIH en un Servicio de Atención Especializada de un Centro Municipal de Salud. Método:se trata de un estudio descriptivo, cuantitativo, retrospectivo y documental. En un universo de 300 historias clínicas admitidas en 2021, se incluyeron 110 pacientes de ambos sexos y adultos. Resultados: en el 88,5% de las consultas, las enfermeras registraron problemas biológicos/físicos y el 91,6% de las intervenciones fueron solicitudes de pruebas de laboratorio. En el 47,3% no hubo conexión entre el problema de enfermería y la intervención. Conclusión: los principales problemas e intervenciones identificados durante la consulta de enfermería están relacionados con los aspectos físicos y biológicos de las personas que viven con VIH, demostrando que el cuidado de enfermería todavía está apegado a un paradigma biomédico y que necesita ser superado con urgencia.

Satisfacción con la calidad de atención en pacientes en hemodiálisis de un hospital de Sonora / Satisfaction with quality of care in patients on hemodialysis in a hospital in Sonora

Introducción: la satisfacción con la calidad en la atención de enfermería por parte del paciente es el resultado de la relación profesional entre la enfermera y el paciente. Objetivo: evaluar la satisfacción con la calidad en la atención de enfermería de los pacientes de hemodiálisis de un hospital de especialidades en Sonora. Metodología: estudio cuantitativo, observacional, descriptivo, transversal y prospectivo, realizado mediante la aplicación del cuestionario SERVQHOS-E, que consta de 16 ítems y una encuesta de opinión y sirve para medir la satisfacción del paciente y la calidad percibida de la atención de enfermería. El análisis de datos se hizo con estadística descriptiva, frecuencias relativas y absolutas. Resultados: se estudiaron 146 pacientes. En cuanto a percepción de la calidad de la atención de enfermería, 99.3% estuvieron satisfechos y solo 0.7% estuvieron insatisfechos. En relación con la satisfacción global, el 100% se manifestaron satisfechos y 99.3% de los pacientes recomendaría el servicio. Conclusión: los pacientes con hemodiálisis de un hospital de especialidades en Sonora se encuentran satisfechos.

Introduction: Patient satisfaction with the quality of nursing care is the result of the professional relationship between nurse and patient. Objective: To assess patient satisfaction with hemodialysis as relates to the quality of nursing care in a specialty hospital in Sonora. Methodology: observational, descriptive, cross-sectional and prospective study, which was carried out using the SERVQHOS-E questionnaire, which consists of 16 items and one survey and measures the patient satisfaction and the perceived quality about nursing care. Data analysis was completed through descriptive statistics, relative and absolute frequencies. Results: 146 patients were studied. Concerning the perceived quality of nursing care, 99.3% were satisfied and only 0.7% reported dissatisfaction. Regarding global satisfaction, 100% of patients expressed satisfaction with their stay and 99.3% would recommend the services received to others. Conclusion: Hemodialysis patients at a specialty hospital in Sonora are satisfied.

Analysis of the Nursing Effect of Respiratory Critical Illness Based on Refined Nursing Management.

In order to improve the nursing effect of respiratory critical illness, this paper combines the refined nursing method to explore the nursing plan of respiratory critical illness. Moreover, this paper uses the variable control method to explore the effects of nursing management, combines the hospital patient samples to conduct a controlled trial analysis, and conducts sample grouping according to the random grouping method. The patients in the control group are managed by traditional nursing management methods, the patients in the test group are managed by refined nursing management methods, and other conditions are basically the same. In addition, the experiment process variable control is carried out according to the mathematical statistics method, and the reasonable statistics and data processing are carried out. Through the comparison method, we can see that the refined management method proposed in this paper has a good effect in the nursing of respiratory critical illness.

Selected predictors of parental satisfaction with child nursing care in paediatric wards in Poland-Cross-sectional study.

BACKGROUND: Assessment of parental satisfaction with child nursing is the key issue in evaluation of the care quality, enabling the adjustment of the services provided to the needs and expectations of recipients, and thus ensuring safety and achieving better long-term health effects. AIM: Assessment of parental satisfaction with child nursing in paediatric wards including its determinants. MATERIAL AND METHODS: The study covered 1030 parents of children hospitalised in paediatric and surgical wards of seven hospitals of different levels of health security in Poland. The Polish adaptation of the Empathic standardised questionnaire for assessment of the level of parents' satisfaction with nursing care, developed by Latour et al. and the self-constructed summary of socio-demographic data were applied in the study. RESULTS: More than 90% of respondents expressed high level of satisfaction with nurses' Availability, the lowest, but still high score of respondents' satisfaction was observed for Parental Participation. The highest satisfaction was observed among the parents of children at the preschool, early school and puberty stage, admitted to the hospital on the elective basis, referred for diagnostic assessment and with the length of hospital stay less than 7 and longer than 28 days. Achieving preschool age was the strongest factor which increased assessment of satisfaction in most domains. CONCLUSIONS: There is a need for optimising nursing care especially in the area of parental participation. The nursing care' quality improvement plan in paediatric departments should focus particularly on early childhood patients and their parents who are the most critical in satisfaction' assessment.

Nursing home care under Medicaid managed long-term services and supports.

OBJECTIVE: To measure the impact of Medicaid managed long-term services and supports (MLTSS) on nursing home (NH) quality and rebalancing. DATA SOURCES/STUDY SETTING: This study analyzes secondary data from annual NH recertification surveys and the minimum dataset (MDS) in three states that implemented MLTSS: Massachusetts (2001-2007), Kansas and Ohio (2011-2017). STUDY DESIGN: We utilized a difference-in-difference approach comparing NHs in border counties of states that implemented MLTSS with a control group of NHs in neighboring border counties in states that did not implement MLTSS. Sensitivity analyses included a triple-difference model (stratified by Medicaid payer mix) and a within-state comparison. We examined changes in six NH-level outcomes (percentage of low-care NH residents, facility occupancy, and four NH quality measures) after MLTSS implementation. DATA COLLECTION/EXTRACTION METHODS: For each state, all freestanding NHs in border counties were included, as were NHs in neighboring counties located in other states. Information on low-care residents was aggregated to the NH level from MDS data, then combined with Online Survey Certification and Reporting (OSCAR) and Certification and Survey Provider Enhanced Reporting (CASPER) data. PRINCIPAL FINDINGS: MLTSS had no statistically significant effects on NH quality outcomes in Massachusetts or Kansas. In Ohio, MLTSS led to an increase of 0.21 nursing hours per resident day [95% CI: 0.03, 0.40], and a decrease of 1.47 deficiencies [95% CI: -2.52, -0.42] and 9.38 deficiency points [95% CI: -18.53, -0.24] per certification survey. After MLTSS, occupancy decreased by 1.52 percentage points [95% CI: -2.92, -0.12] in Massachusetts, but increased by 3.17 percentage points [95% CI: 0.36, 5.99] in Ohio. We found no effect on low-care residents in any state. Findings were moderately sensitive to the choice of comparator group. CONCLUSION: The study provides little evidence that MLTSS reduces quality of care, occupancy, or the percentage of low-care residents in NHs.

Patient Mix Optimization in Admission Planning under Multitype Patients and Priority Constraints.

Hospital beds are one of the most critical medical resources. Large hospitals in China have caused bed utilization rates to exceed 100% due to long-term extra beds. To alleviate the contradiction between the supply of high-quality medical resources and the demand for hospitalization, in this paper, we address the decision of choosing a case mix for a respiratory medicine department. We aim to generate an optimal admission plan of elective patients with the stochastic length of stay and different resource consumption. We assume that we can classify elective patients according to their registration information before admission. We formulated a general integer programming model considering heterogeneous patients and introducing patient priority constraints. The mathematical model is used to generate a scientific and reasonable admission planning, determining the best admission mix for multitype patients in a period. Compared with model II that does not consider priority constraints, model I proposed in this paper is better in terms of admissions and revenue. The proposed model I can adjust the priority parameters to meet the optimal output under different goals and scenarios. The daily admission planning for each type of patient obtained by model I can be used to assist the patient admission management in large general hospitals.

Structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia in Japan: A cross-sectional study.

Schizophrenia is a disorder characterized by psychotic relapses. Globally, about 15%-30% of patients with schizophrenia discharged from inpatient psychiatric admissions are readmitted within 90 days due to exacerbation of symptoms that leads to self-harm, harm to others, or self-neglect. The purpose of this study was to investigate the structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. A new questionnaire was developed to assess the extent to which respondents delivered in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. This study adopted a cross-sectional research design. The survey was conducted with the new questionnaires. The participants were registered nurses working in psychiatric wards. Item analyses and exploratory factor analyses were performed using the new questionnaires to investigate the structure of in-hospital nursing care leading to reduction in early readmission. Stepwise regression analyses were conducted to examine the factors predicting in-hospital nursing care leading to reduction in early readmission. Data were collected from 724 registered nurses in Japan. In-hospital nursing care leading to reduction in early readmission was found to consist of five factors: promoting cognitive functioning and self-care, identifying reasons for readmission, establishing cooperative systems within the community, sharing goals about community life, and creating restful spaces. In-hospital nursing care leading to reduction in early readmission was predicted by the following variables: the score on the nursing excellence scale in clinical practice, the score on therapeutic hold, and the participation of community care providers in pre-discharge conferences. Japanese psychiatric nurses provide nursing care based on these five factors leading to reduction in early readmission. Such nursing care would be facilitated by not only nurses' excellence but also nurses' environmental factors, especially the therapeutic climate of the ward and the participation of community care providers in pre-discharge conferences.

Risk assessment and management among frontline nurses in the context of the COVID-19 virus in the northern region of the Kingdom of Saudi Arabia.

OBJECTIVE: This study aimed to assess the post-contact risk of nurses who provide care for patients diagnosed with COVID-19. METHODS: This investigation employed a quantitative-descriptive design. The study sample was comprised of the frontline nurses in the COVID-19 center hospitals in the northern part of Saudi Arabia. Snowball sampling was used, resulting in 80 frontline nurses. A survey using a self-administered questionnaire in a Google form was employed to collect the data, which was collected from May 20 through June 25, 2020. RESULTS: Some of the study participants were reported to have a history of both staying in the same household with each other (35%) and of traveling with a confirmed COVID-19 patient (20%). These participants were considered as community exposed to COVID-19. There were 8.8% who were classified as high risk due to failure in removing and replacing personal protective equipment (PPE); 6.3% were at high risk for not performing hand hygiene before and after touching COVID-19 patients, and 5% did not follow the recommended guidelines in performing hand hygiene after touching the patients' surroundings. In addition, 3.8% of the participants had an accident related to biological material, such as with splashes of biological fluid (in the eyes). These nurses were classified as high risk for COVID-19 virus infection, CONCLUSION: This study identifies practices that need improvement in combatting this virus. Since policies and guidelines may not always be optimal in all settings, a tailor-fitted guideline is appropriate. Nurse leaders, for example, need to establish an infection control system that provides real-time monitoring and facilitates immediate correction for nurses. Doing so will provide the nurses with a continuous awareness of predisposing themselves to acquiring the virus.

The nurse's work in the context of COVID-19 pandemic.

OBJECTIVE: Reflect on the work experienced by the nurse in coping with the COVID-19 pandemic in a public hospital of the State of Rio Grande do Norte. METHODS: Reflective essay based in the professional experience in a public reference hospital for the care of patients affected by COVID-19 in the State of Rio Grande do Norte. Results were organized in two empirical categories, which emphasize potentialities and barriers in the nurse's work in the face of the COVID-19, presented by means of Ishikawa diagram. RESULTS: Two categories emerged from the experiences: Nursing leadership in organizing health services to face COVID-19; and the performance of nursing care management in the COVID-19 pandemic. FINAL CONSIDERATIONS: It is necessary to value the nurse's work in all its attributes, as well as strengthen the interdisciplinary work processes, which collaborate to overcome the crisis caused by the pandemic.

Effect of advanced nursing care on psychological disorder in hypertensive retinopathy of pregnancy: A protocol of systematic review.

BACKGROUND: This study will assess the effect of advanced nursing care (ANC) on psychological disorder (PD) in hypertensive retinopathy of pregnancy (HTRP). METHODS: This study will search electronic databases from inception to the present (Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, CNKI, and Chinese Biomedical Literature Database), and other sources. All literature sources will be searched without limitations to language and study status. All eligible case-controlled study (CCS) will be included in this study. Two authors will independently carry out literature selection, data collection, and study quality assessment. Any confusion will be solved by a third author through discussion. Statistical analysis will be conducted using RevMan 5.3 software. In addition, a narrative synthesis will be elaborated if it is necessary. RESULTS: This study will summarize most recent high quality evidence to appraise the effect of ANC on PD in HTRP. CONCLUSION: The results of this study will seek to identify the effect of ANC on PD in HTRP among pregnancy population. OSF REGISTRATION: osf.io/hgp93.

Validation and Psychometric Assessment of the Practice Environment Scale of the Nursing Work Index in the Portuguese Hospital Context.

BACKGROUND: The nursing work environment has an impact on patient safety outcomes and its measurement should be a regular practice. PURPOSE: To assess the reliability and construct validity of the Practice Environment Scale of the Nursing Work Index in the Portuguese context. METHODS: An exploratory factor analysis followed by a confirmatory factor analysis to assess model adjustment quality was performed with a sample of 3,686 nurses. RESULTS: The final solution for the exploratory factor analysis comprised 26 items and five factors (56.6% of the total variance). The confirmatory factor analysis, after refinement, showed a stable factor structure. CONCLUSIONS: The final model showed good construct validity and high reliability, which supports the decision to exclude the items that are not essential to the construct being measured.

OB Nest randomized controlled trial: a cost comparison of reduced visit compared to traditional prenatal care.

BACKGROUND: Traditional prenatal care includes up to 13 in person office visits, and the cost of this care is not well-described. Alternative models are being explored to better meet the needs of patients and providers. OB Nest is a telemedicine-enhanced program with a reduced frequency of in-person prenatal visits. The cost implications of connected care services added to prenatal care packages are unclear. METHODS: Using data from the OB Nest randomized, controlled trial we analyzed the provider and staff time associated with prenatal care in the traditional and OB Nest models. Fewer visits were required for OB Nest, but given the compensatory increase in connected care activity and supplies, the actual cost difference is not known. Nursing and provider staff time was prospectively recorded for all patients enrolled in the OB Nest clinical trial. Published 2015 national wages for healthcare workers were used to calculate the actual labor cost of providing either traditional or OB Nest prenatal care in 2015 US dollars. Overhead expenses and opportunity costs were not considered. RESULTS: Total provider cost was decreased caring for the OB Nest participants, but nursing cost was increased. OB Nest care required an average of 160.8 (+/- 45.0) minutes provider time and 237 (+/- 25.1) minutes nursing time, compared to 215.0 (+/- 71.6) and 99.6 (+/- 29.7) minutes for traditional prenatal care (P < 0.01). This translated into decreased provider cost and increased nursing cost (P < 0.01). Supply costs increased, travel costs declined, and overhead costs declined in the OB Nest model. CONCLUSIONS: In this trial, labor cost for OB Nest prenatal care was 34% higher than for traditional prenatal care. The increased cost is largely attributable to additional nursing connected care time, and in some practice settings may be offset by decreased overhead costs and increased provider billing opportunities. Future efforts will be focused on development of digital solutions for some routine nursing tasks to decrease the overall cost of the model. TRIAL REGISTRATIONS: ClinicalTrials.gov Identifier: NCT02082275 .

Reframing Holistic Patient Care in Nursing Homes Through the Lens of Relational Autonomy.

In nursing facilities, patient autonomy is more effective when it is reframed under the rubric of relational autonomy. Through this lens, patients, family, and staff, especially nurses, can share conversations that lead to effective decision-making that acknowledges the needs of the whole person within the nexus of the institutional setting.

Nursing documentation of symptoms is associated with higher risk of emergency department visits and hospitalizations in homecare patients.

BACKGROUND: Nurses often document patient symptoms in narrative notes. PURPOSE: This study used a technique called natural language processing (NLP) to: (1) Automatically identify documentation of seven common symptoms (anxiety, cognitive disturbance, depressed mood, fatigue, sleep disturbance, pain, and well-being) in homecare narrative nursing notes, and (2) examine the association between symptoms and emergency department visits or hospital admissions from homecare. METHOD: NLP was applied on a large subset of narrative notes (2.5 million notes) documented for 89,825 patients admitted to one large homecare agency in the Northeast United States. FINDINGS: NLP accurately identified symptoms in narrative notes. Patients with more documented symptom categories had higher risk of emergency department visit or hospital admission. DISCUSSION: Further research is needed to explore additional symptoms and implement NLP systems in the homecare setting to enable early identification of concerning patient trends leading to emergency department visit or hospital admission.

First do no harm: practitioners' ability to 'diagnose' system weaknesses and improve safety is a critical initial step in improving care quality.

Healthcare systems across the world and especially those in low-resource settings (LRS) are under pressure and one of the first priorities must be to prevent any harm done while trying to deliver care. Health care workers, especially department leaders, need the diagnostic abilities to identify local safety concerns and design actions that benefit their patients. We draw on concepts from the safety sciences that are less well-known than mainstream quality improvement techniques in LRS. We use these to illustrate how to analyse the complex interactions between resources and tools, the organisation of tasks and the norms that may govern behaviours, together with the strengths and vulnerabilities of systems. All interact to influence care and outcomes. To employ these techniques leaders will need to focus on the best attainable standards of care, build trust and shift away from the blame culture that undermines improvement. Health worker education should include development of the technical and relational skills needed to perform these system diagnostic roles. Some safety challenges need leadership from professional associations to provide important resources, peer support and mentorship to sustain safety work.

Concept of error and nature of nursing error detectors in military hospitals: a qualitative content analysis.

BACKGROUND AND OBJECTIVES: Nursing errors can cause irreparable consequences. Understanding the concept of error and the nature of nursing error detectors can significantly reduce this type of errors. The present study was conducted to explain the concept of error and the nature of nursing error detectors in military hospitals. MATERIALS AND METHODS: The present study was conducted on eight nurses working in different wards of military hospitals using a qualitative approach to content analysis proposed by Graneheim and Lundman. Data were collected through in-depth semistructured interviews. FINDINGS: 'The concept of error' and 'the nature of error detectors' in military hospitals were the two main categories extracted from data analysis. The present findings showed that the nature of errors in military hospitals is inevitable, a threat to job position and bipolar. Nurses use different resources to identify errors, including personal, environmental and organisational factors of detection. DISCUSSION AND CONCLUSION: Given the military nature of the study hospitals, organisational factors of detection played a key role in identifying errors. Moreover, given the perception of military nurses of errors, they were not inclined to personal detectors. The managers of military hospitals are therefore recommended to pursue a justice-oriented and supportive culture to help nurses play a more active role in identifying errors.