Factors associated with practice readiness among newly qualified nurses in their first two years of practice.

BACKGROUND: Newly graduated nurses undergo stress and role adjustment as they transition into practice during the first year and continue to struggle beyond the first year. Determining their practice readiness can aid in the development of interventions to facilitate workplace readiness for nurses in their first two years entering the nursing profession. OBJECTIVES: To examine (i) extent of practice readiness of new nurses in their role; and (ii) associations between nurses' practice readiness and demographic and occupational variables, and reasons for choosing nursing profession. DESIGN: A cross-sectional study. SETTINGS AND PARTICIPANTS: A total of 445 registered nurses who graduated within the last two years and working in an academic medical centre in Singapore. METHODS: Participants completed an online questionnaire with questions from Casey-Fink Readiness for Practice Survey and questions related to key competencies for future practice. RESULTS: More than half (57.5 %) identified at least three skills and procedures which they were uncomfortable performing independently as they transition into the clinical practice, including: (i) responding to emergency (ii) tracheostomy care; and (iii) chest tube care. The top three reasons for choosing nursing as a career were: (i) nursing is a stable industry (54.2 %); (ii) I want to help people (52.1 %); and (iii) able to work anywhere in the world (44.3 %). Nurses were most concerned with areas of trials and tribulations (42.5 %) and clinical competency (36.6 %). When compared to nurses in their first-year post-graduation, those working in their second year reported more confidence in the ability to problem solve (p = 0.003), care for a person who is dying (p = 0.004), and less difficulties in prioritizing care needs (p = 0.04). They also perceived themselves as a good problem solver (p = 0.03). CONCLUSIONS: It is critical to continue supporting nurses' practice readiness beyond their first year of practice in their confidence and development of skills of higher complexity.

Socio-economic and environmental factors associated with community-acquired pressure injuries: A mixed method study.

AIMS: To: (1) report on the prevalence of community-acquired pressure injuries (CAPIs) in patients admitted into the acute care setting; (2) examine the socio-economic and home environment associated with CAPIs; and (3) understand the challenges of caring for patients with CAPIs at home. METHODS: This mixed-method study recruited patients admitted with CAPIs in the acute care hospital between March 2021 to June 2022. The hospital's pressure injury (PI) database was used to screen patients admitted with CAPIs. A purposive sample of CAPI patients and their caregivers participated in this study. A cross-sectional survey study was first performed to examine the prevalence of CAPIs and the socio-economic and home environment factors. Semi-structured interviews were conducted to understand the caregivers' challenges in caring for patients with CAPIs at home. RESULTS: The CAPI prevalence was reported at 1.1 % during the study period (1039 had CAPIs out of 97 912 patients admitted to the hospital). A total of 70 caregivers and patients consented to participate in the study. The mean age of patients was 84.2 (SD = 10.4) years old; 68.6 % (n = 48) were females. Majority presented with a deep tissue injury (DTI) (37.1 %; n = 26) or unstageable PI (31.4 %; n = 22). More than half of the patients had alternating air mattresses at home (54.3 %; n = 38), and only 10 % (n = 7) had positioning wedges and used a sliding sheet for turning. The mean age of the caregivers was 43.4 years old (SD = 13.1), and 84.3 % (n = 59) were female. Continuous data were summarised using means and standard deviations, and categorical data were summarised using frequencies and percentages. Logistic regression found no significant socio-demographic and clinical predictors of patients having PI stages 2, 3, and 4 compared to patients with DTI and unstageable PI. Challenges to caring for PI at home included high financial burden, physical limitations, and personal challenges in CAPIs management. CONCLUSION: CAPIs are prevalent among older patients admitted to the acute care setting. Understanding the influence of socio-economic factors is crucial for developing comprehensive strategies to mitigate the occurrence and impact of PIs. Ongoing support and education to the caregivers in the community is essential to address the reported challenges in PI care.

Evaluation of an Evidence-Based Care Bundle for Preventing Hospital-Acquired Pressure Injuries in High-Risk Surgical Patients.

The aim of this study was to evaluate the effectiveness of an evidence-based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi-experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure-relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P < .001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.

Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment.

BACKGROUND: Nurses have primary responsibility for many of the care processes and interventions intended to improve patients' health during hospital stays. Accordingly, missed nursing care can negatively impact patient safety and lead to negative clinical outcomes. Missed nursing care is standard care that is not completed, incomplete, or seriously delayed. PURPOSE: There is scant literature on nurse-reported missed care (NRMC) in Singapore. Identifying the prevalence of, types of, and reasons for missed care, including staff-related factors, is imperative to understanding the implications of missed care and identifying opportunities for improvement. METHODS: Ours is a correlation study of NRMC using convenience sampling. Nurses working on all inpatient units in an acute care hospital in Singapore were recruited to complete the MISSCARE survey, a quantitative tool measuring missed nursing care and the reasons for it. Descriptive statistics was applied to analyze demographics, types of NRMC, and reasons for NRMC. The Pearson χ2 test was used to analyze the correlation between demographics and satisfaction variables and NRMC. RESULTS: A total of 314 participants out of 1,944 eligible nurses (response rate, 16%) were recruited. The most commonly reported missed care activities were setting up meals for patients who can feed themselves (87.3%), ambulation (70.1%), attending interdisciplinary conferences (64.3%), providing emotional support to patients and/or family (58%), and turning patients every two hours (56.7%). The most cited reasons for missed care were inadequate number of staff (84.4%), caregiver not in unit or unavailable (76.1%), heavy admission and discharge activity (75.5%), urgent patient situations (74.2%), and unexpected rise in patient volume and/or acuity (73.2%). Younger age, greater experience in role and current unit, inadequate staffing and teamwork, low satisfaction with current role and with being a nurse, and planning to leave the current position were factors significantly associated with greater levels of missed care. CONCLUSION: This study demonstrated evidence of NRMC and its associated factors within the local setting. In addition to expanding nursing resources, analyzing nursing work processes, providing support for younger nurses, and improving nursing satisfaction are possible mitigating factors in preventing missed care. Strategies targeting workforce and resource management, greater support for new and younger nurses, and job satisfaction should be considered to address missed care.

Memories of nursing in Singapore - an oral history approach.

Background: Documentation of the voices of nurses provided valuable insight and a greater understanding of the nursing experience in Singapore. Aim: To record nurses' experiences of journey of nursing profession in the acute care setting in Singapore from the early days of formalisation of nursing education to today's practice as a profession with various specialisation and career tracks. Method: An oral history research approach was adopted, with purposive and snowball sampling to recruit nurses (both current and retired) who had trained in Singapore from 1956 which marked the beginning of the founding of the School of Nursing to current. Interviews were conducted with an interview guide. Thematic analysis was utilised to analyse the audio-recorded data. Results: The 54 participants with a range of 10-54 years of nursing experience were interviewed and they completed their nursing training between 1952 and 2006. Four themes were generated: essence of nursing, inevitable changes across nursing profession, resilience and future outlook in nursing. Conclusions: Understanding the experiences of these nurses generated an in-depth understanding of the personal, social and historical events that were at play in fostering today's nursing practice. With the evolution of the roles in nursing, compassion in current practice needs to be re-evaluated. Continuous learning is essential to meet the needs of the changing healthcare landscape.

A prospective study on the wound healing and quality of life outcomes of patients with venous leg ulcers in Singapore-Interim analysis at 6 month follow up.

Venous leg ulceration results in significant morbidity. However, the majority of studies conducted are on Western populations. This study aims to evaluate the wound healing and quality of life for patients with venous leg ulcers (VLUs) in a Southeast Asian population. This is a multi-centre prospective cohort study from Nov 2019 to Nov 2021. All patients were started on 2- or 4-layer compression bandage and were reviewed weekly or fortnightly. Our outcomes were wound healing, factors predictive of wound healing and the EuroQol 5-dimensional 5-level (EQ-5D-5L) health states. Within our cohort, there were 255 patients with VLU. Mean age was 65.2 ± 11.6 years. Incidence of diabetes mellitus was 42.0%. Median duration of ulcer at baseline was 0.30 years (interquartile range 0.136-0.834). Overall, the median time to wound healing was 4.5 months (95% confidence interval [CI]: 3.77-5.43). The incidence of complete wound healing at 3- and 6-month was 47.0% and 60.9%, respectively. The duration of the wound at baseline was independently associated with worse wound healing (Hazard ratio 0.94, 95% CI: 0.89-0.99, P = .014). Patients with healed VLU had a significantly higher incidence of perfect EQ-5D-5L health states at 6 months (57.8% vs 13.8%, P < .001). We intend to present longer term results in subsequent publications.

Impact of a Bedside Activity Device on the Functional Status of Hospitalized Older Adults: A Randomized Controlled Trial.

BACKGROUND: Older adults may have difficulty maintaining their functional capabilities during hospitalization. This pilot study aimed to investigate the impact of a bedside activity device on the functional status of hospitalized older adults. METHODS: For this single-site randomized controlled trial, 48 participants were recruited between July 2019 and March 2021. Participants were randomized into one of two groups: the intervention group, which was given the use of a bedside activity device plus standard care, and the control group, which received standard care. Katz Index of Independence in Activities of Daily Living (Katz ADL) scores and Timed Up and Go (TUG) test times were used as indicators of functional status and were collected on admission (baseline) and at discharge.Mann-Whitney U and χ 2 tests were used to test for baseline similarities between groups. The Wilcoxon signed rank test was used to determine within-group pre-post changes in TUG and Katz ADL scores. The Mann-Whitney U test was used to determine between-group differences in TUG and Katz ADL change scores. RESULTS: Within-group pre-post analysis showed significant increases in Katz ADL scores in the intervention group and no significant changes in the control group. TUG times decreased significantly in the intervention group and increased significantly in the control group. Between-group analyses showed significant differences in both TUG and Katz ADL change scores. CONCLUSION: The use of the bedside activity device in addition to standard care may prevent functional decline and increase independence in performing basic ADLs.

Knot the Best Scenario: A Case of a Knotted Nasogastric Tube.

ABSTRACT: Nasogastric tubes are widely used in clinical practice for enteral nutrition, medication administration, and gastric decompression. Common complications of their use-such as tube blockage, displacement, and accidental removal-are well described in the literature. However, knotting-a complication that occurs when a knot forms in the nasogastric tube in situ-is rare. This report presents the case of a nasogastric tube that became knotted, causing difficulty in its removal. Key takeaways from this case are discussed, among them that more emphasis should be placed on safe nasogastric tube removal in practitioner training to better prevent such complications in the future.

Sensitivity and specificity of three screening tools for frailty in hospitalized older adults.

AIM: To determine the test accuracy, including sensitivity, specificity, positive predictive value, negative predictive value and area under curve, of three frailty screening tools in identifying the risk of frail outcomes among hospitalized older patients. DESIGN: Prospective longitudinal study. METHODS: The screening tools [Frail-PPS (Frail-Physical, Psychological and Social), Frailty Assessment Measure (FAM), and Identification of seniors at-risk hospitalized patients (ISAR-HP)] were administered by ward nurses to patients aged 65 years and older within 24 h of admission to an acute hospital. Sensitivity, specificity, positive predictive value, negative predictive value and area under curve analysis of the three tools in the context of three frail outcomes, (a) functional decline at three months after discharge-defined as a decline of at least one point on the Katz Index, (ii) requiring a full-time caregiver upon discharge, and (iii) death by three months after discharge, was assessed. RESULTS: Of 366 patients enrolled in the study, 78 (21.3%) experienced one or more frail outcomes, with 65 (17.76%) experiencing functional decline, 61 (16.67%) requiring a full-time caregiver upon discharge and 8 (2.19%) dying by three months. Frail-PPS had sensitivity 12.5% to 31.4% and specificity 91.2% to 94.8%, varying by the considered frail outcome. Similarly, FAM had sensitivity 12.5% to 29.4% and specificity 90.9% to 94.1%, and ISAR-HP had sensitivity 2.9% to 19.2% and specificity 92.2% to 99.1%. positive predictive value of the FAM, Frail-PPS and ISAR-HP ranged from 3.0 to 45.5%, 3.1 to 50.0% and 3.9 to 23.6% respectively, while their negative predictive value ranged from 87.1% to 97.9%, 87.7% to 97.9% and 92.2% to 99.4% respectively. The area under curve values were moderate for the Frail-PPS (0.56 to 0.75), FAM (0.58 to 0.70) and ISAR-HP (0.71 to 0.77) for the three outcomes. CONCLUSIONS: With high specificity and negative predictive values, as well as low sensitivity, FAM and Frail-PPS may be beneficial in identifying older individuals who are not frail, minimizing unnecessary further assessment and intervention.

The effectiveness of a hydrocolloid crusting method versus standard care in the treatment of incontinence-associated dermatitis among adult patients in an acute care setting: A randomised controlled trial.

INTRODUCTION: Incontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis due to prolonged exposure of the skin to moisture induced by urine or/and faeces. The main principles when treating IAD involves protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating skin infections. This study aimed to evaluate the effectiveness of the hydrocolloid crusting method (HCM) versus the standard care method (SCM) in treating IAD. METHOD: A randomised controlled trial was conducted in an acute tertiary hospital in Singapore between August 2019 to September 2021. Using computer-generated numbers, patients were randomised into either HCM or SCM treatment groups. HCM treatment involved cleansing the affected area with a pH-neutral non-rinse moisturising cleanser, and the application of alternate layers of hydrocolloid powder, and non-sting film barrier spray (repeated three times during each use). Patients in the SCM treatment group received the same cleanser followed by a 30% zinc oxide barrier cream. IAD was assessed daily for up to seven days by the wound care nurses using the IAD severity tool. The primary outcome of the study was the mean difference in IAD score per day between both methods. RESULTS: Forty-four patients were eligible and recruited (22 in HCM; 22 in SCM). Patients in both groups were comparable in age and gender. IAD Category 2 was more predominant in both methods. The most common location of IAD was at the perianal skin and diarrhea related to gastroenteritis was the most prevalent cause of IAD. More patients in the SCM group (n = 12; 54.5%) had their IAD healed within seven days compared to HCM, (n = 7; 31.8%) group. However, the average decrease in IAD scores per day for both methods were found to be similar. CONCLUSION: HCM can be considered as a treatment of IAD along with the use of SCM. A skin care regimen should include effective cleansing, skin protection, and moisturization in IAD management.

The effectiveness of radiofrequency scanning technology in preventing retained surgical items: An integrative review.

AIMS AND OBJECTIVES: To synthesise evidence on the effectiveness of radiofrequency (RF) scanning technology as an adjunct to manual counting protocols in preventing retained surgical items (RSIs) in the operating room. BACKGROUND: Despite the implementation of rigorous manual counting protocols, RSIs remain one of the most common reported sentinel events in operating theatres that lead to adverse patient outcomes. DESIGN: An integrative review. METHODS: This review was guided by the Whittemore and Knafl (2005) framework. A literature search using CINAHL, MEDLINE, ProQuest, PubMed, and Scopus with key search terms related to RSIs and RF was applied to select English articles from January 2011 till August 2021. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was utilised for study quality assessment while reporting of review was guided using the PRISMA checklist. RESULTS: A total of 15 peer-reviewed articles were included, enabling the knowledge on the RF scanning technology to be grouped into four themes, namely: detection accuracy of RF scanning technology, real-time detection of surgical items using RF identification, the impact of the RF scanning technology for detecting RSIs on patient safety, and cost-analysis of integrating the RF scanning technology in operating theatres. CONCLUSION: Radiofrequency scanning technology is effective in preventing RSIs with significant cost-savings. Perioperative leaders should develop a multidisciplinary process to evaluate and select the most appropriate RF scanning technology as part of their patient safety programs. However, future studies with a larger sample size and robust research design, such as randomised controlled trial, should be considered to enhance the generalisability and rigour of evidence. RELEVANCE TO CLINICAL PRACTICE: This review contributes to perioperative personnel's education/training of staff on using RF scanning technology to prevent RSIs. The cost-effectiveness analysis enables the healthcare leaders to decide on the selection of appropriate RF technology.

Evaluation of Care Outcomes of Patients Receiving Hyperkalemia Treatment With Insulin in Acute Care Tertiary Hospital Emergency Department.

INTRODUCTION: Treatment of hyperkalemia using intravenous insulin can result in severe hypoglycemia, but regular blood glucose monitoring is not standardized. This study aimed to (i) explore the demographics of adult patients receiving hyperkalemia treatment and (ii) identify the incidence rate of hypoglycemia and associated demographic or clinical characteristics. METHODS: A descriptive design with prospective data collection was used. This study recruited 135 patients who received hyperkalemia treatment in the emergency department. Structured blood glucose monitoring was conducted at 1, 2, 4, and 6 hours after receiving intravenous insulin. Univariate analyses of association between demographic and clinical variables and hypoglycemia outcome were performed. RESULTS: There were 31 hypoglycemic events, with 11.9%, 7.4%, 2.2%, and 1.5% occurring at the 1, 2, 4, and 6 hours after treatment. The logit regression showed no significantly increased risk of hypoglycemia in terms of the demographic and clinical variables. DISCUSSION: The variation in blood glucose response observed in this study combined with the high incidences of hypolycaemia indicated the need for frequent and longer duration of monitoring for patients who were being treated for hyperkalaemia with IDT.

Maggot debridement therapy in the tropics - Preliminary outcomes from a tertiary hospital.

This paper aimed to describe the clinical outcomes and patients' acceptance of Maggot debridement therapy (MDT) at a tertiary hospital in Singapore. Patients with non-viable tissue (NVT) covering at least 25% of wound bed on lower limbs and/or unable to tolerate sharp debridement at the bedside were recruited between January and August 2021. Sterile medical-grade maggots of Lucilla Cuprina were used. Wound specialist nurses assessed the size and wound to determine the type of MDT, either Baggots or free-range larvae (FRL), and the number of maggots required prior to commencement of therapy. Wound sites were measured and photographed at multiple time points: before the start of MDT therapy, during the wound review at 48 or 72 h after each cycle of MDT and completion of therapy. Three patients received Baggot therapy, while the remaining 11 received FRL therapy. The mean age for patients receiving Baggot and FRL were 78.3 (SD = 10.6) and 63.6 (11.4), respectively. Each patient received three cycles of MDT treatment on average. The most common type of wound was ray amputated toe wounds (n = 8), while the most common wound aetiology was arterial ulcerations (n = 12). A reduction of NVT was observed in 11 out of 14 patients, and ten of these 11 patients achieved successful debridement (at least 25% reduction in NVT). Five out of 14 patients had to undergo amputation within the same admission due to poor wound healing, and 60% of these five patients failed to achieve successful debridement. MDT was quite well-accepted by the patients, and they felt some improvement in their wounds. MDT can facilitate wound healing through successful debridement and potentially reduce the need for amputation. Further research needs to be done regarding the type of MDT that is optimal to use in tropical countries with high humidity.

Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore.

AIM: One of the greatest challenges in responding to the COVID-19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs. DESIGN: A descriptive cross-sectional design was adopted in this study. METHODS: Health care workers (N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care; and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training. RESULTS: PPE-related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high-risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non-acute 23.8%) and COVID-19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h (SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask-induced acne (40.4%) and burning/pain (24.5%). Some 31.3% expressed that PPE-related side effects had negatively affected their work. The odds of having PPE-associated side effects was higher in women (OR 2.10, 95% CI [1.29-03.42], p = .003) and those working in high-risk wards (OR 3.12, 95% CI [2.17-4.60], p < .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being 'highly confident' of overall PPE protection. CONCLUSIONS: Prevention and management of PPE-related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission. IMPACT: The high incidence of PPE-associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE-related side effects.

Right siting of complex acute wound management---preliminary study of teleconsultation wound services between acute and primary care in Singapore.

This study aimed to provide preliminary evidence on feasibility of the inaugural use of teleconsultation between acute hospitals and primary care for acute wound management in Singapore. Post-surgical patients with carbuncle wounds, perianal abscess wounds or surgical abdominal dehiscence wounds were recruited from an acute hospital. Instead of receiving their follow up care at the acute care tertiary hospital, patients were given the option to receive their care at primary care facilities instead, supported by teleconsultation wound services provided by wound care nurses from the hospital. The following outcome measures were collected: number of care sessions required (until wound healed), readmissions or referrals back to hospital, cost (patient's and healthcare provider's perspective), patients' and nurses' satisfaction. In total, 18 patients were recruited and completed the study (teleconsult group = 5; tertiary care clinic group = 13). The mean age (SD) of patients were 63.2 (SD 11.5) years old in the teleconsult group and 47.9 years old (SD 11.5) in the tertiary care clinic group. There were 7 female (54%), and 6 male (46%) in the tertiary care clinic group whereas teleconsult group consisted of male only (n = 5). Most had carbuncle wounds (teleconsult group: n = 4; 80%); tertiary care clinic group: (n = 10; 77%). For patients with carbuncle wounds, the average number of care sessions required were 21 and 33 for the tertiary care clinic and teleconsult respectively. None of the patients in the teleconsult group were referred back to the tertiary care hospital. All 16 nurses (n = 6 from acute care hospital, n = 10 from polyclinics) who participated in the feedback survey cited convenience, ease of tracking wound sizes, and closer collaboration between the acute care and primary care nurses as advantages of the service. Wound teleconsultation is feasible and potentially cost savings for patients with acute complex wounds.

Effectiveness of an integrated three-mode bed exit alarm system in reducing inpatient falls within an acute care setting.

AIM: To examine the effectiveness of an integrated three-mode bed exit alarm system in reducing inpatient falls within an acute care hospital setting in Singapore. METHOD: A retrospective before-and-after study design was adopted. RESULTS: Our results revealed that the use of bed exit alarms are associated with a reduction in falls incidence. CONCLUSION: Bed exit alarm systems are associated with reduced fall incidence. Nonetheless, for an institution to benefit from the technology, there will be a need to take into account the effects of "alarm fatigue", ability of nurses to respond in time to alarms, and selection of right alarm mode/limits based on the patient's profile.

Factors to Consider in the Use of Vital Signs Wearables to Minimize Contact With Stable COVID-19 Patients: Experience of Its Implementation During the Pandemic.

The COVID-19 pandemic has created a huge burden on the healthcare industry worldwide. Pressures to increase the isolation healthcare facility to cope with the growing number of patients led to an exploration of the use of wearables for vital signs monitoring among stable COVID-19 patients. Vital signs wearables were chosen for use in our facility with the purpose of reducing patient contact and preserving personal protective equipment. The process of deciding on the wearable solution as well as the implementation of the solution brought much insight to the team. This paper presents an overview of factors to consider in implementing a vital signs wearable solution. This includes considerations before deciding on whether or not to use a wearable device, followed by key criteria of the solution to assess. With the use of wearables rising in popularity, this serves as a guide for others who may want to implement it in their institutions.

Audit of the appropriateness and accuracy of fluid intake and output monitoring: experience in a tertiary hospital.

BACKGROUND: The current practice of fluid intake and output monitoring for hospitalised patients in one local acute care tertiary hospital was unclear and inconsistent. Inaccurate fluid balance monitoring and poor documentation can result in poor clinical outcomes. AIM: To provide an overview of the current practice of ordering, monitoring and documentation of patient fluid intake and output during hospitalisation. METHODS: Electronic charts of 2199 adults were reviewed for appropriateness and accuracy of monitoring and documentation of the fluid balance records. Data retrieved for each patient included: (1) Was daily fluid balance monitoring clinically indicated? (2) Was daily fluid balance monitoring prescribed by the doctors or initiated by the nurses? (3) Was the daily fluid balance documentation accurate for the entire admission? FINDINGS: Of the reviewed patients, 68% were on fluid balance monitoring, of whom 31% were prescribed by medical teams and 69% were nurse-initiated. Among patients who were receiving fluid balance monitoring, 78% were clinically indicated (35% prescribed by doctors), and 22% had no clinical indications (18% prescribed by doctors). Overall, documentation accuracy of the intake and output charts was 77%, with 100% accuracy in the oral and intravenous fluid intake, and 21% accuracy in the output documentation. Among the inaccurate documentation of monitoring with no quantifiable amount, 'void in toilet' was the most inaccurately documented (93.3%). CONCLUSIONS: It is vital to address the current disparities in hospital practice, which include prescribing fluid balance monitoring for patients without a clinical indication and documenting incomplete or poor quality information in patients' intake and output charts. Future quality improvement and research work is needed to improve patient safety and outcomes.

A flexible multiplexed immunosensor for point-of-care in situ wound monitoring.

Chronic wounds arise from interruption of normal healing due to many potential pathophysiological factors. Monitoring these multivariate factors can provide personalized diagnostic information for wound management, but current sensing technologies use complex laboratory tests or track a limited number of wound parameters. We report a flexible biosensing platform for multiplexed profiling of the wound microenvironment, inflammation, and infection state at the point of care. This platform integrates a sensor array for measuring inflammatory mediators [tumor necrosis factor-α, interleukin-6 (IL-6), IL-8, and transforming growth factor-ß1], microbial burden (Staphylococcus aureus), and physicochemical parameters (temperature and pH) with a microfluidic wound exudate collector and flexible electronics for wireless, smartphone-based data readout. We demonstrate in situ multiplexed monitoring in a mouse wound model and also profile wound exudates from patients with venous leg ulcers. This technology may facilitate more timely and personalized wound management to improve chronic wound healing outcomes.

Employing serious game for assessing knowledge of blood transfusion procedure among nurses: A qualitative evaluation and feedback improvement study.

BACKGROUND: Employing serious game for assessing nurses' blood transfusion knowledge and skill competency has gained interest among nurse educators worldwide. However, its acceptance by nurses has not been fully explored. AIM: To explore the registered nurses' experiences using serious game for nursing skills competency and gather feedback to improve the quality of learning using serious game. SETTING: Acute tertiary hospital in Singapore. PARTICIPANTS: Registered nurses in inpatient settings. METHODS: This qualitative evaluation and feedback improvement study was conducted in an acute tertiary hospital in Singapore between September 2019 and November 2019. Registered nurses who had completed the blood transfusion knowledge and skills competency via the serious game platform were invited to participate in this study. Individual face-to-face interviews using a semi-structured questionnaire were conducted. All interviews were audio-recorded and transcribed verbatim. Data analysis was performed inductively using the Braun and Clarke's six-step of thematic analysis. RESULTS: A total of 11 registered nurses were interviewed from a variety of clinical areas including medical and surgical wards, and intensive care units. The mean age of the participants was 28 years old. The majority of participants were females (81.8%), with their years of experience ranging from 1 to 13 years. Each interview took between 20 and 30 min. Three themes were identified: (1) novel learning experience; (2) varying levels of appreciation towards the serious game; and (3) navigating the interface and technical issues. CONCLUSION: Employing serious game for nursing skills competency is considered acceptable by the nurses in this sample population. Compared to the traditional modes of competency assessment, the serious game is innovative and stimulates learning. Nevertheless, more rigorous efforts are needed to improve the interface and technical issues to enhance the user learning experience. Future versions of the serious game will need to be more accessible and intuitive for all levels of nursing staffs.