An Integrative Review of Team Nursing and Delegation: Implications for Nurse Staffing during COVID-19.

BACKGROUND: During the COVID-19 pandemic, providing care for critically ill patients has been challenging due to the limited number of skilled nurses, rapid transmission of the virus, and increased patient acuity in relation to the virus. These factors have led to the implementation of team nursing as a model of nursing care out of necessity for resource allocation. Nurses can use prior evidence to inform the model of nursing care and reimagine patient care responsibilities during a crisis. PURPOSE: To review the evidence for team nursing as a model of patient care and delegation and determine how it affects patient, nurse, and organizational outcomes. METHODS: We conducted an integrative review of team nursing and delegation using Whittemore and Knafl's (2005) methodology. RESULTS: We identified 22 team nursing articles, 21 delegation articles, and two papers about U.S. nursing laws and scopes of practice for delegation. Overall, team nursing had varied effects on patient, nursing, and organizational outcomes compared with other nursing care models. Education regarding delegation is critical for team nursing, and evidence indicates that it improves nurses' delegation knowledge, decision-making, and competency. LINKING EVIDENCE TO ACTION: Team nursing had both positive and negative outcomes for patients, nurses, and the organization. Delegation education improved team nursing care.

Os pais como pilares para a segurança do paciente em unidade neonatal / Parents as pillars for patient safety in a neonatal unit / Padres como pilares para la seguridad del paciente em una unidad neonatal

Objetivo: conhecer a experiência dos pais como estratégia de avaliação da qualidade da assistência de enfermagem. Método: pesquisa descritiva com abordagem qualitativa, desenvolvida na Unidade Neonatal de um Hospital do sul do Brasil. A coleta de dados foi realizada através de entrevistas, utilizando a técnica do incidente crítico (TIC), com 18 pais que estavam com seus filhos internados por 20 dias ou mais e que tinham previsão e plano de alta hospitalar. Após, os dados foram submetidos à análise de conteúdo. Resultados: a análise revelou fragilidades no cuidado prestado pela equipe de enfermagem em relação à administração de medicamentos, ao uso de equipamentos, à monitorização e ao posicionamento dos bebês, aos cuidados com a pele e à higiene de mãos. Conclusão: a experiência dos pais revelou elementos que integram a avaliação da assistência em enfermagem, destacando-os como pilares para a segurança do paciente.

Objective: to learn the parents' experience as a strategy for assessing the quality of nursing care. Method: in this qualitative, descriptive study at the Neonatal Unit of a hospital in southern Brazil, data were collected by critical incident (CI) interviews of 18 parents whose children had been hospitalized for 20 days or more, and whose discharge was scheduled and planned for. The data subsequently underwent content analysis. Results: data analysis revealed weaknesses in the care provided by the nursing staff as regards administration of medication, use of equipment, monitoring and positioning of babies, skin care and hand hygiene. Conclusion: The parents' experience revealed elements that enter into evaluation of nursing care, revealing parents to be mainstays of patient safety.

Objetivo: conocer la experiencia de los padres como estrategia para evaluar la calidad de la atención de enfermería. Método: en este estudio cualitativo y descriptivo en la Unidad Neonatal de un hospital en el sur de Brasil, los datos fueron recolectados por entrevistas de incidentes críticos (IC) de 18 padres cuyos hijos habían estado hospitalizados durante 20 días o más, y cuyo alta fue programada y planificada para. Los datos posteriormente se sometieron a análisis de contenido. Resultados: el análisis de datos reveló debilidades en la atención brindada por el personal de enfermería en lo que respecta a la administración de medicamentos, uso de equipos, monitoreo y posicionamiento de bebés, cuidado de la piel e higiene de manos. Conclusión: la experiencia de los padres reveló elementos que entran en la evaluación de la atención de enfermería, revelando que los padres son pilares de la seguridad del paciente.

Parada cardiorrespiratória na pandemia por coronavírus: revisão compreensiva da literatura / Cardiorespiratory arrest in a coronavirus pandemic: comprehensive literature review / Paro cardiorrespiratorio en una pandemia de coronavirus: revisión exhaustiva de la literatura

Objetivo: apresentar atualizações para a ressuscitação cardiopulmonar em pacientes suspeitos e confirmados com COVID-19. Método: revisão compreensiva da literatura, com síntese narrativa das evidências de diretrizes e recomendações da Organização Mundial de Saúde, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma e National Association of Emergency Medical Technicians. Resultados: as principais atualizações trazem informações sobre especificidades das manobras de ressuscitação cardiopulmonar; preparação do ambiente, recursos humanos e materiais, reconhecimento da parada cardiorrespiratória e ações iniciais; estratégias de ventilação e acesso invasivo da via aérea; ajustes do ventilador mecânico e manobras de ressuscitação cardiopulmonar em pacientes pronados. Considerações finais: profissionais de saúde envolvidos no atendimento à parada cardiorrespiratória de pacientes suspeitos e/ou confirmados com COVID-19 podem encontrar inúmeros desafios, portanto devem seguir com rigor o protocolo estabelecido para maximizar a efetividade das manobras de ressuscitação e minimizar o risco de contágio pelo vírus e sua disseminação.

Objective: to present updates for cardiopulmonary resuscitation in suspected and confirmed patients with COVID-19. Method: comprehensive literature review with narrative synthesis of the evidence of guidelines and recommendations from World Health Organization, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Results: the main updates bring information about the specifics of cardiopulmonary resuscitation maneuvers; preparation of the environment and human and material resources, recognition of cardiorespiratory arrest and initial actions; ventilation and invasive airway access strategies; mechanical ventilator adjustments and cardiopulmonary resuscitation maneuvers in patients in the prone position. Final considerations: health professionals involved in the care of cardiorespiratory arrest of suspected and/or confirmed patients with COVID-19 can face numerous challenges, so they must strictly follow the protocol established to maximize the effectiveness of resuscitation maneuvers and minimize the risk of contagion by the virus and its spread.

Objetivo: apresentar actualizaciones para la reanimación cardiopulmonar en pacientes sospechos os y confirmados con COVID-19. Método: revisión exhaustiva de la literatura con síntesis narrativa de la evidencia de guías y recomendaciones de la Organización Mundial de la Salud, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Resultados: las principales actualizaciones aportan información sobre los detalles de las maniobras de reanimación cardiopulmonar; preparación del medio ambiente y recursos humanos y materiales, reconocimiento de paro cardiorrespiratorio y acciones iniciales; estrategias de ventilación y acceso invasivo a las vías aéreas; ajustes del ventilador mecánico y maniobras de reanimación cardiopulmonar en pacientes en decúbito prono. Consideraciones finales: los profesionales de la salud involucrados en la atención del paro cardiorrespiratorio de pacientes sospechosos y/o confirmados con COVID-19 pueden enfrentar numerosos desafíos, por lo que deben seguir estrictamente el protocolo establecido para maximizar la efectividad de las maniobras de reanimación y minimizar el riesgo de contagio por el virus y supropagación.

Orientações de Desparamentação e Paramentação HUPE

The impact of implementing a pharmacy technician role as part of a nursing team in an acute admissions unit.

Background: The National Patient Safety Agency reported over 20 000 safety incidents over a 3-year period, including 68 severe harms and 27 deaths. Dose delays and omissions persistently contributed to more than 50% of the reported incidents. Methods: A pilot was designed and data were collected before and after to measure how these ward-based technician roles affected the reporting of omitted or delayed doses, time efficiency, cost implications and the general productivity of the ward. Results: Three months after the start of the pilot, omitted doses were reduced from 14% to 5% and no incidents of harm had been reported. The 'perfect medication ward round' with no interruptions lasted 23 min compared with the longest medication ward round which lasted 116 min and was interrupted 11 times. Conclusions: The pilot shows that the introduction of pharmacy technicians results in fewer omitted doses and also addresses persistent staffing issues by ensuring better use of nursing time.

Aplicación del Nursing Activities Score (NAS) en diferentes tipos de UCI's: una revisión integrativa / Application of Nursing Activities Score (NAS) in different types of ICUs: an integrating review / Aplicação do Nursing Activities Score (NAS) em diferentes tipos de UTI's: uma revisão integrativa

Objetivo: Comparar la carga de trabajo de enfermería medida por la Nursing Activities Score (NAS), entre la unidad de cuidados intensivos general de adultosy especializadas de quirúrgico, cardiología y trauma. Métodos: Realización de una revisión de la literatura del tipo integrativa. Búsqueda en las bases de datos BDENF, LILACS, MEDLINE, SCIELO, utilizando los descriptores enfermería, Unidad de Cuidados Intensivos, Carga de trabajo y Nursing Activities Score. Atendieron a los criterios de inclusión 20 artículos publicados en el periodo de 2007 a 2017. Resultados: Evidencian elevada carga de trabajo en UCI, tanto en UCIs general como en todas las especificidades citadas, las mismas con puntuación NAS > 50,00, destacando la UCI de trauma lo que se caracterizó con mayores marcadores 72,00 y 71,3. Conclusión: En gran parte de las investigaciones, la media de profesionales de enfermería calculada por la NAS es superior a la media de profesionales requerida por la legislación. Se observó que incluso en UCIs con la misma especificidad se perciben grandes diferencias en la media de la puntuación NAS, de esta forma, entendemos que a pesar de tener la misma especificidad, el perfil del paciente así como el de la institución tienen sus particularidades demandando tiempo de asistencia diferente y consecuentemente divergencias en el dimensionamiento

Objective: To compare the nursing workload measured by the Nursing Activities Score (NAS), between intensive care unit general adult ICU, and specialized surgical, cardiologic and trauma type. Methods: A literature review of the integrative type was carried out, searching the databases BDENF, LILACS, MEDLINE, and SCIELO, using the descriptors nursing, Intensive Care Unit, workload and Nursing Activities Score. They met the inclusion criteria 20 articles published in the period 2007 to 2017. Results: They show a high workload in the ICU, both in general ICUs and in all of the cited specificities, the same with a NAS score> 50.00, especially the trauma ICU, which was characterized with higher scores 72.00 and 71.3. Conclusion: In much of the research, the average number of nursing professionals calculated by the NAS is higher than the average number of professionals required by the legislation. It was observed that even in ICUs with the same specificity it was possible to perceive large differences in the mean of the NAS score, in this way, we understand that despite having the same specificity, the profile of the patient as well as that of the institution has its peculiarities requiring time to different assistance and consequently divergences in sizing

Objetivo: Comparar a carga de trabalho de enfermagem medida pelo Nursing Activities Score (NAS), entre unidade de terapia intensiva UTI geral adulto, e especializadas do tipo cirúrgica, cardiológica e trauma. Métodos: Foi realizada uma revisão de literatura do tipo integrativa, com busca nas bases de dados BDENF, LILACS, MEDLINE, e SCIELO, utilizando-se os descritores enfermagem, Unidade de Terapia Intensiva, carga de trabalho e Nursing Activities Score. Atenderam aos critérios de inclusão 20 artigos publicados no período de 2007 a 2017. Resultados: Evidenciam elevada carga de trabalho em UTI, tanto em UTIs geral quanto em todas as especificidades citadas, as mesmas com pontuação NAS > 50,00, destacando-se a UTI de trauma o que caracterizou-se com maiores escores 72,00 e 71,3. Conclusão: Em grande parte das pesquisas, a média de profissionais de enfermagem calculada pelo NAS é superior à média de profissionais requerida pela legislação. Observou-se que mesmo em UTIs com a mesma especificidade pôde-se perceber grandes diferenças na média do escore NAS, dessa forma, entendemos que apesar de possuir a mesma especificidade, o perfil do paciente assim como o da instituição tem suas particularidades demandando tempo de assistência diferente e consequentemente divergências no dimensionamento

Acute care nursing team members' perceptions of roles: Their own and each other's.

AIM: To examine registered nurses', licensed practical nurses' and health care aides' perceptions of their and each other's roles. BACKGROUND: Nursing team members' perceptions about their own and each other's roles affect how they understand their contributions to patient care and their work relationships and social status within health care organisations. There is a paucity of literature on how nursing team members perceive their roles and those of their colleagues. DESIGN: Secondary analysis of qualitative data using qualitative description. The parent study used grounded theory to examine nursing care for hospitalized older adults. METHOD: Conventional content analysis of interview transcripts and field notes from the original study. RESULTS: All nursing team members reported satisfaction from providing direct care. Registered nurses were uniquely responsible for leadership. Scope-of-practice changes contributed to role confusion and tension among team members. CONCLUSIONS: More research is needed to better understand how to support nursing teams learning about one another. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers could facilitate clarification about nursing roles and support effective role deployment.

Nursing teamwork in the care of older people: A mixed methods study.

Healthcare is increasingly complex and requires the ability to adapt to changing demands. Teamwork is essential to delivering high quality care and is central to nursing. The aims of this study were to identify the processes that underpin nursing teamwork and how these affect the care of older people, identify the relationship between perceived teamwork and perceived quality of care, and explore in depth the experience of working in nursing teams. The study was carried out in three older people's wards in a London teaching hospital. Nurses and healthcare assistants completed questionnaires (n = 65) on known dynamics of teamwork (using the Nursing Teamwork Survey) together with ratings of organisational quality (using an adapted AHRQ HSPS scale). A sample (n = 22; 34%) was then interviewed about their perceptions of care, teamwork and how good outcomes are delivered in everyday work. Results showed that many care difficulties were routinely encountered, and confirmed the importance of teamwork (e.g. shared mental models of tasks and team roles and responsibilities, supported by leadership) in adapting to challenges. Perceived quality of teamwork was positively related to perceived quality of care. Work system variability and the external environment influenced teamwork, and confirmed the importance of team adaptive capacity. The CARE model shows the centrality of teamwork in adapting to variable demand and capacity to deliver care processes, and the influence of broader system factors on teamworking.

The extent to which adequacy of staffing predicts nursing teamwork in hospitals.

AIMS AND OBJECTIVES: The purpose of this study was to examine the extent to which staffing adequacy predicts nursing teamwork, controlling for demographic and background variables. BACKGROUND: Findings from former studies indicate that hospital, unit and staff characteristics may be related to nursing teamwork, such as type of hospital and unit, role, gender, age, work experience, type of shift worked, shift length, number of working hours per week, overtime and staffing adequacy. Teamwork as well as staffing is identified as significant contributors to patient and staff safety in hospitals. However, the contribution of staffing to the quality of nursing teamwork is scarcely studied. DESIGN: This was a quantitative descriptive cross-sectional study using the paper-and-pencil questionnaire Nursing Teamwork Survey-Icelandic. METHODS: The study was conducted in 27 inpatient units in eight hospitals in Iceland with a sample of 925 nursing staff members. Participants were 567 registered nurses, practical nurses, unit secretaries and nurse unit managers. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for this paper. RESULTS: When controlling for unit type, role, experience on current unit and intent to leave, perceived adequacy of staffing alone explains up to 10% of overall teamwork. Unit type, role, years of experience on current unit and perceived staffing adequacy correlated significantly with overall teamwork. CONCLUSIONS: The findings of this study indicate that unit and staff characteristics, including perceived adequacy of staffing, are associated with and explain the variability in nursing teamwork on inpatient hospital units. The findings of this study provide important information for clinical nurses, nurse managers, policymakers and instructors in health care. RELEVANCE TO CLINICAL PRACTICE: The findings underline the importance of adequate staffing for nursing teamwork in inpatient hospital units.

Diabetic foot ulcer care: a concept analysis of the term integrated into nursing practice.

BACKGROUND: Diabetic foot ulcer care demonstrates a beneficial approach to overcoming problems in patients with diabetes. This approach is frequently given but is not always successfully implemented due to its fragmentation amid healthcare providers. What's more, there are a number of different understandings, interchangeable languages and an absence of uniformity overlapping terminologies of meaning for diabetic foot ulcer care. Therefore, analysing the concept of diabetic foot ulcer care is important to provide a wider nursing knowledge, synthesise a greater theoretical model and drive more effective care of diabetic foot ulcer. OBJECTIVE: This article aimed to analyse how the concept of diabetic foot ulcer care is clearly defined in the relevant evidence as it has several implications in nursing practice. METHOD: Walker and Avant's (1995) method of concept analysis was systematically used in this study. FINDINGS: Three critical attributes of diabetic foot ulcer care were determined consisting of assessment, intervention and evaluation. Constructed cases are also presented to differentiate the concept of diabetic foot ulcer care from other concepts. This concept analysis results in the critical attributes of diabetic foot ulcer care, defines an operational definition and describes common goals that improve clarity, consistency and understanding of the concept amid healthcare professionals along with researchers. CONCLUSION: Effective implementation of the concept of DFU care into clinical nursing practice may undoubtedly improve patient outcomes and prevent the complexities of DFU in the years to come. Future research needs to be developed for evaluating the current use of this concept.

The management of atrial fibrillation: An integrated team approach - insights of the 2016 European Society of Cardiology guidelines for the management of atrial fibrillation for nurses and allied health professionals.

The 2016 European Society of Cardiology guidelines for the management of atrial fibrillation recommends integrated care in the treatment of atrial fibrillation and follows a patient-centred, multidisciplinary team approach. Nurses and allied health professionals have a significant role to play in the management of chronic conditions such as atrial fibrillation, which is underlined by this guideline and the integrated care approach. In this article, members of the task force writing committee highlight significant evidence from this particular guideline as well as clinical implications for nurses and allied health professionals in their daily work with atrial fibrillation patients and their caregivers.

Patient safety: understanding human error in intensive nursing care.

OBJECTIVE: To analyze the active failures and the latent conditions related to errors in intensive nursing care and to discuss the reactive and proactive measures mentioned by the nursing team. METHOD: Qualitative, descriptive, exploratory study conducted at the Intensive Care Unit of a general hospital. Data were collected through interviews, participant observation and submitted to lexical analysis in the ALCESTE® software and to ethnographic analysis. RESULTS: 36 professionals of the nursing team participated in the study. The analysis originated three lexical classes: Error in intensive care nursing; Active failures and latent conditions related to errors in the intensive care nursing team; Reactive and proactive measures adopted by the nursing team regarding errors in intensive care. CONCLUSION: Reactive and proactive measures influenced the safety culture, in particular, the recognition of errors by professionals, contributing to their prevention, safety and quality care.

Improving the personalisation of care in a district nursing team: a service improvement project.

Service users can benefit in a variety of ways from a personalised approach to care. This service improvement project aimed to improve personalisation for patients being cared for by a community nursing team in the south of England. A plan, study, do, act (PDSA) approach to the project was undertaken with a community nursing team. Both quantitative and qualitative data showed improvement once the focus on personalisation had been improved. Patient and staff satisfaction scores improved and a documentation audit showed the focus on personalisation had increased. Qualitative data suggested that personalisation had also saved staff time, although this measurement was not included in the project. A focus on personalisation can be beneficial for staff and service users.

Le modèle de pratique des infirmières spécialistes cliniques aux Hôpitaux universitaires de Genève.

THE CLINICAL NURSE SPECIALIST PRACTICE MODEL AT GENEVA UNIVERSITY HOSPITALS.: A clinical nurse specialist practice model has been implemented at Geneva University Hospitals. It details the five dimensions of the function-clinical practice, coaching-consultation-guidance, research, leadership and collaboration, ethics-and its three spheres of influence-patients and their family, nursing teams, institutions. Arising from practice rather than the world of academia, it constitutes a tool to aid reflection among the nursing profession.

Nursing team communication in a medical ward.

OBJECTIVE: To describe the essential elements that make the nursing team communication process effective, and to analyze such elements in the light of two main theorists, Berlo and King. METHOD: This is a qualitative study of assistant convergent research approach. The data production technique was the semi-structured interview, with 25 nursing professionals from a public hospital. Data were analyzed with thematic content techniques. RESULTS: The main element of consolidation of the communication process and interpersonal relationship, with consequent interaction, is the dialogue, which is guided by emotions, feelings, and team integration. CONCLUSION: The communication process and the interpersonal relationship reach their objectives and the reciprocal understanding expected when there is effective dialogue, validated by the source and receiver of the processes, with consequent interaction.

Nursing team communication in a medical ward / Comunicación del grupo de enfermeros de una enfermería de clínica médica / A comunicação da equipe de enfermagem de uma enfermaria de clínica médica

ABSTRACT Objective: To describe the essential elements that make the nursing team communication process effective, and to analyze such elements in the light of two main theorists, Berlo and King. Method: This is a qualitative study of assistant convergent research approach. The data production technique was the semi-structured interview, with 25 nursing professionals from a public hospital. Data were analyzed with thematic content techniques. Results: The main element of consolidation of the communication process and interpersonal relationship, with consequent interaction, is the dialogue, which is guided by emotions, feelings, and team integration. Conclusion: The communication process and the interpersonal relationship reach their objectives and the reciprocal understanding expected when there is effective dialogue, validated by the source and receiver of the processes, with consequent interaction.

RESUMEN Objetivo: Describir los elementos esenciales que hacen que el proceso de un equipo de enfermería sea efectivo, y analizar tales elementos a la luz de dos teóricos relevantes, Berlo y King. Método: De naturaleza cualitativa, fue aplicado el método de la investigación convergente-asistencial. Datos producidos a partir de técnica de entrevista semiestructurada, con 25 profesionales de enfermería de un hospital público. Los datos fueron estudiados por análisis de contenido temático. Resultados: El principal elemento de consolidación del proceso de comunicación y de las relaciones interpersonales, con la consecuente interacción, se trata del diálogo, que es orientado por emociones, sentimientos e integración del equipo. Conclusión: El proceso de comunicación y las relaciones interpersonales alcanzan sus objetivos y el entendimiento recíproco esperado cuando existe diálogo efectivo, validado por la fuente y el receptor de los procesos, con la consecuente interacción.

RESUMO Objetivo: Descrever os elementos essenciais que tornam o processo de comunicação de uma equipe de enfermagem efetivo e analisar tais elementos à luz de dois teóricos principais, Berlo e King. Método: De natureza qualitativa, foi aplicado o método da pesquisa convergente-assistencial. A técnica de produção dos dados foi a entrevista semiestruturada, com 25 profissionais de enfermagem de um hospital público. Aos dados foram aplicadas as técnicas de análise de conteúdo temática. Resultados: O principal elemento de consolidação do processo de comunicação e do relacionamento interpessoal, com consequente interação, é o diálogo, sendo norteado por emoções, sentimentos e integração da equipe. Conclusão: O processo de comunicação e o relacionamento interpessoal alcançam seus objetivos e o entendimento recíproco esperado quando há diálogo efetivo, validado pela fonte e receptor dos processos, com consequente interação.

Leadership in Nursing Homes: Directors of Nursing Aligning Practice With Regulations.

Nursing homes use team nursing, with minimal RN presence, leaving the majority of direct care to licensed practical/vocational nurses (LPNs/LVNs) and unlicensed assistive personnel (UAP), including medication aides. The current article describes challenges faced by nursing home directors of nursing (DONs) leading and managing a team nursing approach, including consideration of scope of practice, delegation and supervision regulations, and related policy implications. A secondary data analysis was performed of qualitative data from a study to develop and test DON guidelines for delegation in nursing home practice. A convenience sample (N = 29) of current or previous DONs and other nursing home leaders with knowledge and expertise in the DON role participated in in-depth, guided interviews. The findings highlight a core concern to nursing licensure policy and regulation: knowledge and practice gaps related to scope of practice and delegation and supervision among DONs, RNs, and LPNs/LVNs, as well as administrators, and the role of nursing leaders in supporting appropriate delegation practices. The findings offer directions for research and practice in addressing challenges in aligning team nursing practices with regulatory standards as well as the related gaps in knowledge among DONs, administrators, and nursing staff. [Journal of Gerontological Nursing, 44(6), 10-14.].

A Nursing Leadership Immersion Program: Succession Planning Using Social Capital.

This article describes the inception and evolution of a 3-month immersion experience between hospital and nurse leaders where sociological principles were applied to support nurse leader succession. Unique to this program, the bedside nurse joins the nursing executive team full time to participate in all organizational leadership activities as part of the experience.