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1.
Orthop Nurs ; 39(5): 340-352, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956277

RESUMO

BACKGROUND: As the number of patients with orthopaedic conditions has risen continuously, hospital-based healthcare resources have become limited. Delivery of additional services is needed to adapt to this trend. PURPOSE: The purpose of this study was to describe the current literature of computer- and telephone-delivered interventions on patient outcomes and resource utilization in patients with orthopaedic conditions. METHODS: The systematic review was conducted in January 2019. The standardized checklist for randomized controlled trials was used to assess the quality of the relevant studies. A meta-analysis was not possible due to heterogeneity in the included studies, and a narrative synthesis was conducted to draw informative conclusions relevant to current research, policy, and practice. RESULTS: A total of 1,173 articles were retrieved. Six randomized controlled trials met the inclusion criteria, providing evidence from 434 individuals across four countries. Two studies reported findings of computer-delivered interventions and four reported findings of telephone-delivered interventions. The patients who received both computer- and telephone-delivered interventions showed improvements in patient outcomes that were similar or better to those of patients receiving conventional care. This was without any increase in adverse events or costs. CONCLUSION: Computer- and telephone-delivered interventions are promising and safe alternatives to conventional care. This review, however, identifies a gap in evidence of high-quality studies exploring the effects of computer- and telephone-delivered interventions on patient outcomes and resource utilization. In future, these interventions should be evaluated from the perspective of intervention content, self-management, and patient empowerment. In addition, they should consider the whole care journey and the development of the newest technological innovations. Additionally, future surgery studies should take into account the personalized needs of special, high-risk patient groups and focus on patient-centric care to reduce postdischarge health problems and resource utilization in this population.

2.
J Adv Nurs ; 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32488895

RESUMO

AIMS: To determine whether nurse staffing and nursing workload are associated with multiple organ failure and mortality. DESIGN: A cross-sectional study. METHODS: This study was conducted in a single tertiary-level teaching hospital during 2008-2017. The association between nurse staffing, nursing workload and prognosis was determined using daily nurse-to-patient ratios, Therapeutic Intervention Scoring System scores, Intensive Care Nursing Scoring System scores and Intensive Care Nursing Scoring System indexes. In addition, the timing of intensive care unit admission was considered. Multiple organ failure was defined according to the Sequential Organ Failure Assessment score. RESULTS: During the study period, 10,230 patients were included in the final analysis. Generally, the mean daily highest Therapeutic Intervention Scoring System score and Intensive Care Nursing Scoring System score were significantly higher in patients with multiple organ failure and in non-survivors. The proportion of understaffing was significantly more common in patients with multiple organ failure than in those without. The mean daily lowest nurse-to-patient ratio and the mean daily highest Intensive Care Nursing Scoring System index did not differ between survivors and non-survivors. The levels of nursing associated with workload and understaffing were at their worst on weekends. CONCLUSIONS: The proportion of understaffing and increased nursing workload are associated with multiple organ failure, demonstrating that an adequate level of nurse staffing in relation to patient complexity is a prerequisite for the availability and quality of critical care services. The proportion of understaffing did not differ between survivors and non-survivors. IMPACT: This is the first study that evaluates nurse staffing and nursing workload as potential risk factors for multiple organ failure and mortality. There is a need to ensure that intensive care units are consistently staffed based on real patient needs, 7 days a week and that personnel and services are available at all times for high-risk patients.

3.
J Telemed Telecare ; : 1357633X20917868, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32316837

RESUMO

INTRODUCTION: As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement. METHODS: A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes. RESULTS: Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence. DISCUSSION: Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation.

4.
J Adv Nurs ; 76(6): 1436-1448, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32133684

RESUMO

AIM: To describe a randomized controlled trial (RCT) protocol that will evaluate the effectiveness of a digital patient journey (DPJ) solution in improving the outcomes of patients undergoing total hip and knee arthroplasty. BACKGROUND: There is an urgent need for novel technologies to ensure sustainability, improve patient experience, and empower patients in their own care by providing information, support, and control. DESIGN: A pragmatic RCT with two parallel arms. METHODS: The participants randomized assigned to the intervention arm (N = 33) will receive access to the DPJ solution. The participants in the control arm (N = 33) will receive conventional care, which is provided face to face by using paper-based methods. The group allocations will be blinded from the study nurse during the recruitment and baseline measures, as well as from the outcome assessors. Patients with total hip arthroplasty will be followed up for 8-12 weeks, whereas patients with total knee arthroplasty will be followed up for 6-8 weeks. The primary outcome is health-related quality of life, measured by the EuroQol EQ-5D-5L scale. Secondary outcomes include functional recovery, pain, patient experience, and self-efficacy. The first results are expected to be submitted for publication in 2020. IMPACT: This study will provide information on the health effects and cost benefits of using the DPJ solution to support a patient's preparation for surgery and postdischarge surgical care. If the DPJ solution is found to be effective, its implementation into clinical practice could lead to further improvements in patient outcomes. If the DPJ solution is found to be cost effective for the hospital, it could be used to improve hospital resource efficiency.

5.
J Clin Nurs ; 29(13-14): 2338-2351, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32222001

RESUMO

AIMS AND OBJECTIVES: To identify opportunities for gamification in the elective primary fast-track total hip and knee arthroplasty journey in order to support patients' health-related behaviour. BACKGROUND: Gamification provides an opportunity to increase engagement in a given health behaviour and, eventually, the possibility of reaching improved outcomes through continued or consistent behaviour. DESIGN: A secondary analysis. METHODS: Semi-structured interviews were conducted with 20 healthcare professionals in a single joint-replacement centre in Finland during autumn 2018. NVivo software was used for deductive and inductive coding. The open codes were also calculated. The consolidated criteria for reporting qualitative research were followed. RESULTS: Gamification opportunities were identified related to six dimensions: accomplishment, challenge, competition, guided, playfulness and social experience. Based on the frequencies of the coded content, most opportunities for gamification can be identified in the context of personalised counselling, monitoring and social support. CONCLUSIONS: Several opportunities for gamification were identified and quantified. While various needs and limitations need to be considered when developing digital gamified solutions and more research into the effectiveness of such solutions will be required, the current study opens possible future avenues for exploring the use of gamification in lower limb joint replacement journey and other specialisms. RELEVANCE TO CLINICAL PRACTICE: This study provides an important insight into healthcare professionals' views of the current state of the total hip and knee arthroplasty journey and the potential for its development. In addition, it pinpoints the biggest opportunities for gamified services in the context of personalised counselling, monitoring and social support. Despite the focus of this secondary analysis being on the arthroplasty journey, the findings can also be generalised in other surgical journeys.

8.
J Clin Nurs ; 29(3-4): 567-582, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31769559

RESUMO

AIMS AND OBJECTIVES: To explore how satisfied patients are with the process of treatment and care and to identify the experiences that patients perceive during elective primary fast-track total hip and knee arthroplasty journey. BACKGROUND: Greater satisfaction with care has predicted better quality of recovery, and patient experience has been positively associated with patient safety and clinical effectiveness. However, a little is still known about how patients experience their treatment and care. DESIGN: A qualitative interview study. METHODS: The study was conducted among 20 patients in a single joint replacement centre during 2018. Patient satisfaction was measured using a numerical rating scale. Patients' experiences were identified through qualitative semi-structured interviews which were analysed using an inductive content analysis method. The COREQ checklist was used (Supporting Information). RESULTS: The mean numerical rating scale score for overall satisfaction was 9.0 (SD 1.1) on a scale from 0-10. The patients' experiences were grouped under eight main categories that were derived from the qualitative data in the analysis: (a) patient selection, (b) meeting the Health Care Guarantee, (c) patient flow, (d) postdischarge care, (e) patient counselling, (f) transparency of the journey, (g) communication and (h) feedback. CONCLUSIONS: The findings suggest that patients are highly satisfied after an elective primary fast-track total hip and knee arthroplasty. However, closer analysis of the patients' experiences reveals challenges and suggestions on how they could be solved, often involving digital technologies. RELEVANCE TO CLINICAL PRACTICE: As the number of total joint arthroplasties grows, patients and their families need to take ever greater responsibility, for their own care from advance preparation to rehabilitation. The findings of the study can be used to organise work, improving patient-clinical communication, fostering engagement and improving patient centredness. In addition, the results pinpoint the issues on how the patient experience could be improved.


Assuntos
Artroplastia de Quadril/psicologia , Artroplastia do Joelho/psicologia , Satisfação do Paciente , Adaptação Psicológica , Idoso , Artroplastia de Quadril/reabilitação , Artroplastia do Joelho/reabilitação , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
10.
J Orthop Surg Res ; 14(1): 294, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484536

RESUMO

BACKGROUND: Fast-track and outpatient arthroplasty methodologies combine evidence-based clinical features with organizational optimization resulting in a streamlined pathway from admission to discharge and beyond. This qualitative study explored perceived problems of healthcare professionals during fast-track hip and knee arthroplasty. METHODS: Semi-structured interviews were conducted with four surgeons, two anesthesiologists, ten nurses, and four physiotherapists. An inductive content analysis was used to analyze the data. NVivo qualitative data analysis software was used. RESULTS: Analysis of the data revealed eight main categories of problems: patient selection, referrals, meeting the Health Care Guarantee, patient flow, homecare, patient counseling, transparency of the journey, and receiving feedback. In addition, problems related to information flows and communication, responsibilities between different stakeholders, and existing information systems were identified. CONCLUSIONS: The study revealed that healthcare professionals perceived several problems during the fast-track journey that reduce its effectiveness and make it more difficult to meet the Health Care Guarantee. Problems could be alleviated by changing internal and external organizational practices, as well as by developing new information and communication technologies that would provide up-to-date communication channels for healthcare professionals and patients. In addition, new collaboration mechanisms should be developed in order to solve the problems that occur across different organizations.


Assuntos
Artroplastia de Quadril/normas , Artroplastia do Joelho/normas , Atitude do Pessoal de Saúde , Pessoal de Saúde/normas , Percepção , Pesquisa Qualitativa , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Inquéritos e Questionários , Fatores de Tempo
11.
J Clin Nurs ; 28(23-24): 4434-4446, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31408555

RESUMO

AIMS AND OBJECTIVES: To examine the lived experience of healthcare professionals providing care for patients with total hip and knee arthroplasty and to understand healthcare professionals' proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey. BACKGROUND: There is little evidence in nursing literature to indicate how to develop new eHealth services to support surgical care journeys. Evidence is particularly lacking regarding the development of eHealth solutions. DESIGN: This was a qualitative interview study. METHODS: Semi-structured interviews were conducted with four surgeons, two anaesthesiologists, ten nurses and four physiotherapists in a single joint replacement centre during autumn 2018. The data were analysed using an inductive content analysis method. NVivo qualitative data analysis software was used. The COREQ checklist for qualitative studies was followed. RESULTS: Our research addressed the gap in evidence by focusing on the four main parts of the patient journey in the selected context. Analysis of the data revealed nine main categories for the proposed eHealth needs: eligibility criteria, referrals, meeting the Health Care Guarantee, patient flow, postdischarge care, patient counselling, communication, transparency of the journey and receiving feedback. In addition, the requirements and further development needs for eHealth solutions were generally identified. CONCLUSIONS: From the point of view of healthcare professionals, eHealth solutions have huge potential in supporting the elective primary fast-track hip and knee arthroplasty journey. However, it is important to acknowledge that these needs may be very different depending on the technological and organisational environment in question. RELEVANCE TO CLINICAL PRACTICE: More effective use of information and communication technologies is needed for organisational optimisation resulting in a streamlined pathway, better access to healthcare services, improved outcomes and an improved patient experience. These results can be used in the development of new eHealth solutions to support surgical care journeys and patient education.


Assuntos
Artroplastia de Quadril/enfermagem , Artroplastia do Joelho/enfermagem , Pessoal de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde , Telemedicina/organização & administração , Procedimentos Clínicos/organização & administração , Feminino , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa
12.
Am J Infect Control ; 47(9): 1065-1070, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30987795

RESUMO

BACKGROUND: Considerable discrepancies have been observed in the implementation of strategies to liberate patients from mechanical ventilation. The aim of this study was to describe critical care nurses' knowledge of and self-reported and documented adherence to lung-protective ventilation, daily sedation interruption, and daily assessment of readiness to extubate and evaluate how these practices differ between patients with and without ventilator-associated pneumonia and between survivors and nonsurvivors. METHODS: The survey was conducted in a tertiary-level hospital in Finland from October 2014 to June 2015. Actual adherence was evaluated based on documentation of performed practices. RESULTS: A total of 86 critical care nurses responded to the survey, and 85 patients were followed. The levels of knowledge of and self-reported adherence to low tidal ventilation were 84.5% and 90.2%, respectively, and the median tidal volume was at a target level in 74.4% of patients. Regarding daily sedation interruption, the level of knowledge was 85.7%, the level of self-reported adherence was 77.3%, and documented adherence was 33.3%. The levels of knowledge and self-reported adherence regarding spontaneous breathing trials were 61.9% and 71.6%, respectively. Adherence to lung-protective ventilation, daily sedation interruption, and daily assessment of readiness to extubate did not differ between patients with (n = 20) and without (n = 65) ventilator-associated pneumonia and between survivors (n = 55) and nonsurvivors (n = 30). CONCLUSIONS: Lung-protective ventilation, including low-tidal ventilation and avoidance of high inspiratory plateau pressures, was well implemented and adhered to. The levels of knowledge and self-reported adherence versus documented adherence regarding daily sedation interruption and spontaneous breathing trial demonstrated insufficient implementation of local guidelines. There was no effect on the outcome.


Assuntos
Gerenciamento Clínico , Fidelidade a Diretrizes , Enfermeiras e Enfermeiros/psicologia , Competência Profissional , Respiração Artificial , Desmame do Respirador/métodos , Idoso , Feminino , Finlândia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Centros de Atenção Terciária
13.
J Hosp Infect ; 101(3): 257-263, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30529704

RESUMO

BACKGROUND: Nurse understaffing and increased nursing workload have been associated with increased risk of adverse patient outcomes and even mortality. AIM: To determine whether nurse staffing and nursing workload are associated with ventilator-associated pneumonia and mortality. METHODS: This prospective, observational cohort study was conducted in a single tertiary-level teaching hospital in Finland during 2014-2015. The association between nurse staffing, nursing workload and prognosis was determined using daily nurse-to-patient ratios, Therapeutic Intervention Scoring System and Intensive Care Nursing Scoring System scores, and Intensive Care Nursing Scoring System indices. Ventilator-associated pneumonia was defined according to the Centers for Disease Control and Prevention criteria. FINDINGS: Evaluable data was available for 85 patients. The overall ventilator-associated pneumonia and 28-day mortality rates were 23.5% and 35.3%, respectively. Nurse staffing, measured as the daily lowest nurse-to-patient ratio (P = 0.006) and median Intensive Care Nursing Scoring System index (P = 0.046), were significantly lower in patients with ventilator-associated pneumonia. In addition, nursing workload, measured as median scores obtained by the Therapeutic Intervention Scoring System (P = 0.009) and Intensive Care Nursing Scoring System (P = 0.03), was significantly higher in infected patients. The median (P = 0.02) and daily highest (P = 0.03) Intensive Care Nursing Scoring System scores were significantly higher in non-survivors. CONCLUSIONS: Lower nurse staffing and increased nursing workload are associated with ventilator-associated pneumonia and mortality, demonstrating that adequate staffing is a prerequisite for the availability and quality of critical care services.


Assuntos
Mão de Obra em Saúde/estatística & dados numéricos , Enfermeiras e Enfermeiros , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Carga de Trabalho/estatística & dados numéricos , Adulto , Idoso , Feminino , Finlândia/epidemiologia , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/mortalidade , Prognóstico , Estudos Prospectivos , Análise de Sobrevida , Centros de Atenção Terciária
14.
Am J Infect Control ; 46(9): 1051-1056, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29573832

RESUMO

BACKGROUND: Although evidence-based practices are known to improve the quality of care, making it cost-efficient and improving clinical results, barriers to transferring research into clinical practice have hindered this process. AIMS: To evaluate critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. MATERIAL AND METHODS: In 2015, we conducted an institution-specific, cross-sectional study in a 26-bed adult mixed medical-surgical intensive care unit (ICU) in Finland using quantitative survey of knowledge and self-reported adherence with qualitative gathering of barrier data. A pre-validated multiple-choice Ventilator Bundle Questionnaire was distributed to all registered nurses who were direct care providers (n = 155). RESULTS: The final response rate was 55.5% (n = 86), and 47.2% (n = 34) of respondents had more than 10 years of ICU experience. The levels of knowledge and self-reported adherence were 71.1% and 65.8% of the total score, respectively. The level of knowledge was higher among respondents who had received in-service education about ventilator bundle compared with respondents who had not received in-service education (27.0 vs 24.0 [P = .012]). Less experienced nurses reported significantly higher adherence than nurses with more ICU experience (29.0 vs 25.0 [P = .034]). The correlation between knowledge and adherence scores was low (ρ 0.48 [P <.001]). The most well-known and adhered-to guidelines described patient positioning, daily chlorhexidine-based oral care, and strict hand hygiene. The least-known guidelines and those least adhered to described respiratory equipment, management of sedation and analgesia, and practices prior to and during endotracheal suctioning. The main barriers were related to the nurse respondents (e.g., lack of education [25.9%]), environment (e.g., role ambiguities [36.4%] and inadequate resources [21.1%]), and patients (e.g., patient discomfort [4.8%] and fear of adverse effects [4.6%]). CONCLUSIONS: Self-reported adherence did not correlate with knowledge and was not related to work experience. Most of the barriers toward evidence-based guidelines indicated a need for changes that are beyond the control of individual nurses.


Assuntos
Atitude do Pessoal de Saúde , Cuidados Críticos/métodos , Fidelidade a Diretrizes , Conhecimentos, Atitudes e Prática em Saúde , Controle de Infecções/métodos , Enfermeiras e Enfermeiros/psicologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Adulto , Estudos Transversais , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Pacotes de Assistência ao Paciente/métodos , Competência Profissional , Inquéritos e Questionários
15.
Infect Control Hosp Epidemiol ; 38(8): 983-988, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28612697

RESUMO

BACKGROUND In 2013, the Centers for Disease Control and Prevention released a novel surveillance concept called the "ventilator-associated event," which focused surveillance on objective measures of complications among patients that underwent invasive ventilations. OBJECTIVE To evaluate the concordance and possible differences in efficacy (ie, disease severity and outcomes) between 2 surveillance paradigms: (1) infection-related ventilator-associated complications (iVAC) and (2) on conventional ventilator-associated pneumonia (VAP). DESIGN Prospective, observational, single-center cohort study. PATIENTS This study included 85 adult patients that received invasive ventilation for at least 2 consecutive calendar days in a 22-bed, adult, mixed medical-surgical intensive care unit in Finland between October 2014 and June 2015. RESULTS Among these patients, 9 (10.1 per 1,000 days of mechanical ventilation) developed iVAC (10.6%) and 20 (22.4 per 1,000 days of mechanical ventilation) developed conventional VAP (23.5%). The iVAC indicators were most often caused by atelectasis and fluid overload. Compared with patients with conventional VAP, patients with iVAC had significantly worse respiratory status but no other differences in disease severity or outcomes. CONCLUSIONS The incidence of conventional VAP was >2-fold that of iVAC, and the surveillance paradigms for VAP and iVAC capture different patterns of disease. Our results suggest that this novel surveillance concept, although based on objective measures of declining oxygenation, actually identified deteriorations of oxygenation due to noninfectious causes. Infect Control Hosp Epidemiol 2017;38:983-988.


Assuntos
Pneumonia Associada à Ventilação Mecânica/epidemiologia , Adulto , Idoso , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estudos Prospectivos , Respiração Artificial/efeitos adversos
16.
Nurs Crit Care ; 22(3): 161-168, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28093837

RESUMO

BACKGROUND: Implementation of evidence-based oral care protocols, nurse education programmes and assessment tools may reduce the risk of developing ventilator-associated pneumonia by increasing critical care nurses' knowledge and skills in adhering to current oral care recommendations. AIMS: To evaluate the longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on critical care nurses' knowledge and skills in adhering to current oral care recommendations. DESIGN: A randomized controlled trial with repeated measurements. METHOD: The data for the study were collected in a single academic centre in a 22-bed adult, mixed, medical-surgical intensive care unit in Finland from February 2012 to March 2014. The effectiveness of simulation education was evaluated through the validated Ventilator Bundle Questionnaire and Observation Schedule at baseline (n = 30) and 24 months (n = 17) after simulation education. Data were analysed using a linear mixed model and intention-to-treat analyses. RESULTS: During the study period, the average knowledge score in the intervention group increased significantly (44·0% to 56·0% of the total score) in the final post-intervention measurement (pt = 0·51, pg = 0·002, pt*g = 0·023). However, single-dose simulation education with structured debriefing and verbal feedback had no impact on critical care nurses' skill scores. CONCLUSION: Single-dose simulation education had only a minimal effect on critical care nurses' knowledge and skills in adhering to current oral care recommendations. Despite increased awareness, there was no significant difference in oral care practices between the study groups after simulation education. RELEVANCE FOR CLINICAL PRACTICE: The need for regularly repeated educational sessions with theoretical training and practical exercises and direct feedback is evident. Certain aspects of oral care, such as prevention of microaspiration of oropharyngeal secretions and moistening of oral mucosa and lips, require more reinforcement than others.


Assuntos
Competência Clínica , Enfermagem de Cuidados Críticos/educação , Higiene Bucal/educação , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Treinamento por Simulação/métodos , Centros Médicos Acadêmicos , Adulto , Cuidados Críticos/métodos , Avaliação Educacional , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade
17.
Am J Infect Control ; 45(1): 83-85, 2017 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-27639755

RESUMO

We evaluated the longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on critical care nurses' endotracheal suctioning knowledge and skills. To do this we used an experimental design without other competing intervention. Twenty-four months after simulation education, no significant time and group differences or time × group interactions were identified between the study groups. The need for regularly repeated educational interventions with audiovisual or individualized performance feedback and repeated bedside demonstrations is evident.


Assuntos
Intubação Intratraqueal/métodos , Competência Profissional , Treinamento por Simulação/métodos , Sucção/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
18.
Am J Infect Control ; 44(6): 625-30, 2016 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-26899529

RESUMO

BACKGROUND: To evaluate how critical nurses' knowledge of and adherence to current care hand hygiene (HH) guidelines differ between randomly allocated intervention and control groups before and after simulation education in both a simulation setting and clinical practice during a 2-year follow-up period. It was hypothesized that intervention group knowledge of and adherence to current HH guidelines might increase compared with a control group after simulation education. METHODS: A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Oulu, Finland. Thirty out of 40 initially randomized critical care nurses participated in the baseline measurements; of these, 17 completed all the study procedures. Participants' HH adherence was observed only in high-risk contact situations prior to and postendotracheal suctioning events using a direct, nonparticipatory method of observation. Participants' HH knowledge was evaluated at the end of each observational session. RESULTS: The overall HH adherence increased from a baseline value of 40.8% to 50.8% in the final postintervention measurement at 24 months (P = .002). However, the linear mixed model did not identify any significant group (P = .77) or time-group interactions (P = .17) between the study groups after 2 years of simulation education. In addition, simulation education had no impact on participants' HH knowledge. CONCLUSIONS: After a single simulation education session, critical care nurses' knowledge of and adherence to current HH guidelines remained below targeted behavior rates.


Assuntos
Terapia Comportamental/métodos , Educação Médica/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Higiene das Mãos/métodos , Controle de Infecções/métodos , Enfermeiras e Enfermeiros , Treinamento por Simulação/métodos , Adulto , Cuidados Críticos , Feminino , Finlândia , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
19.
Am J Infect Control ; 44(4): 387-93, 2016 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-26708025

RESUMO

BACKGROUND: Critical care nurses' knowledge and skills in adhering to evidence-based guidelines for avoiding complications associated with intubation and mechanical ventilation are currently limited. We hypothesized that single simulation education session would lead to a long-lasting higher level of skills among critical care nurses. MATERIAL AND METHODS: A randomized controlled trial was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland during the period February 2012-March 2014. Thirty out of 40 initially randomized critical care nurses participated in a 24-month follow-up study. Behavior and cognitive development was evaluated through a validated Ventilator Bundle Observation Schedule and Questionnaire at the baseline measurement and repeated 3 times during simulation and real-life clinic settings. RESULTS: After simulation education, the average skills score increased from 46.8%-58.8% of the total score in the final postintervention measurement (Ptime < .001, Ptime × group = .040, and Pgroup = .11). The average knowledge scores within groups did not change significantly. The average between-group difference in skills scores was significant only at the measurement taken at 6 months (P = .006). CONCLUSIONS: Critical care nurses' skills in adhering to evidence-based guidelines improved in both groups over time, but the improvements between the study groups was significantly different only at 6 months and was no longer evident after 2 years following a single simulation education.


Assuntos
Educação em Enfermagem/métodos , Intubação Intratraqueal/métodos , Respiração Artificial/métodos , Treinamento por Simulação/métodos , Adulto , Feminino , Finlândia , Seguimentos , Fidelidade a Diretrizes , Humanos , Unidades de Terapia Intensiva , Masculino
20.
Am J Infect Control ; 42(4): 381-4, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24679564

RESUMO

BACKGROUND: There is a current lack of valid and reliable instruments that can be used to examine critical care nurses' knowledge and skills in adhering to ventilator bundles. The aim of this study was to develop and psychometrically test a ventilator bundle questionnaire (VBQ) and ventilator bundle observation schedule (VBOS). METHODS: The VBQ and VBOS consisted of a list of pharmacologic and nonpharmacologic nurse-led interventions taken from the literature and supported by various levels of evidence. After content validation, stability and equivalence reliabilities of the VBOS were determined in a randomly selected sample of critical care nurses from a single academic center in Finland. RESULTS: The final VBQ contained 49 multiple-choice questions, and the VBOS had 86 dichotomous items, whose overall content validity ranged from 0.99 to 1.0. The overall intraclass correlation coefficient of the VBOS ranged from 0.93 to 1.0. CONCLUSIONS: The VBQ and VBOS have acceptable psychometric properties and could be used to objectively assess whether evidence-based guidelines regarding ventilator bundles are being used in clinical practice. Further testing with diverse samples is needed to strengthen the validity and reliability of these instruments.


Assuntos
Atitude do Pessoal de Saúde , Fidelidade a Diretrizes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Controle de Infecções/métodos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Competência Profissional , Adulto , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Inquéritos e Questionários , Adulto Jovem
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