Dyadic interactions and physical and social environment in dementia mealtime care: a systematic review of instruments.

Using valid instruments to measure dyadic interactions and physical and social environment during mealtime care of persons with dementia is critical to evaluate the process, fidelity, and impact of mealtime interventions. However, the characteristics and quality of existing instruments remain unexplored. This systematic review described the characteristics and synthesized the psychometric quality of instruments originally developed or later modified to measure mealtime dyadic interactions and physical and/or social dining environment for people with dementia, on the basis of published reports between January 1, 1980 and December 31, 2020. We identified 26 instruments: 17 assessed dyadic interactions, one assessed physical environment, and eight assessed physical and social environment. All instruments were used in research and none in clinical practice. All instruments were observational tools and scored as having low psychometric quality, except for the refined Cue Utilization and Engagement in Dementia (CUED) mealtime video-coding scheme rated as having moderate quality. Reasons for low quality are the use of small samples compared with the number of items, limited psychometric testing, and inadequate estimates. All existing tools warrant further testing in larger diverse samples in varied settings and validation for use in clinical practice. The refined CUED is a potential tool for use and requires testing in direct on-site observations.

Recontamination of Healthcare Surfaces by Repeated Wiping with Biocide-Loaded Wipes: "One Wipe, One Surface, One Direction, Dispose" as Best Practice in the Clinical Environment.

The wiping of high-touch healthcare surfaces made of metals, ceramics and plastics to remove bacteria is an accepted tool in combatting the transmission of healthcare-associated infections (HCAIs). In practice, surfaces may be repeatedly wiped using a single wipe, and the potential for recontamination may be affected by various factors. Accordingly, we studied how the surface to be wiped, the type of fibre in the wipe and how the presence of liquid biocide affected the degree of recontamination. Experiments were conducted using metal, ceramic and plastic healthcare surfaces, and two different wipe compositions (hygroscopic and hydrophilic), with and without liquid biocide. Despite initially high removal efficiencies of >70% during initial wiping, all healthcare surfaces were recontaminated with E. coli, S. aureus and E. faecalis when wiped more than once using the same wipe. Recontamination occurred regardless of the fibre composition of the wipe or the presence of a liquid biocide. The extent of recontamination by E. coli, S. aureus and E. faecalis bacteria also increased when metal healthcare surfaces possessed a higher microscale roughness (<1 µm), as determined by Atomic Force Microscopy (AFM). The high propensity for healthcare surfaces to be re-contaminated following initial wiping suggests that a "One wipe, One surface, One direction, Dispose" policy should be implemented and rigorously enforced.

Hospital Environmental Effects on Sleep in Adults With Traumatic Brain Injury in Rehabilitation.

PURPOSE: The aim of this study was to describe sleep patterns of adults with traumatic brain injury and examine effects of environmental stressors (patient care activities and light) on patterns of sleep. DESIGN: A descriptive, correlational, explanatory design was used for this study. METHODS: Sixty-three subjects with traumatic brain injury (>18 years) on an acute traumatic brain injury rehabilitation unit wore an Actiwatch for 48 hours to collect light and sleep data. Patient care activity data were collected between 11 p.m. and 7 a.m. FINDINGS: Patient care activities and light occurred between 11 p.m. and 7 a.m. Nighttime sleep duration and sleep efficiency were explained by patient care activities, whereas light explained wake time after sleep onset. CONCLUSION: Patient care activities and light serve as environmental stressors that affect sleep. CLINICAL RELEVANCE: Results necessitate examining the need and timing of nursing care activities and light during nighttime. Findings provide a basis for policy changes that optimize sleep.

Social Determinants of Hallway Bed Use.

INTRODUCTION: Hallway beds in the emergency department (ED) produce lower patient satisfaction and inferior care. We sought to determine whether socioeconomic factors influence which visits are assigned to hallway beds, independent of clinical characteristics at triage. METHODS: We studied 332,919 visits, across 189,326 patients, to two academic EDs from 2013-2016. We estimated a logistic model of hallway bed assignment, conditioning on payor, demographics, triage acuity, chief complaint, patient visit frequency, and ED volume. Because payor is not generally known at the time of triage, we interpreted it as a proxy for other observable characteristics that may influence bed assignment. We estimated a Cox proportional hazards model of hallway bed assignment on length of stay. RESULTS: Median patient age was 53. 54.0% of visits were by women. 42.1% of visits were paid primarily by private payors, 37.1% by Medicare, and 20.7% by Medicaid. A total of 16.2% of visits were assigned to hallway beds. Hallway bed assignment was more likely for frequent ED visitors, for lower acuity presentations, and for psychiatric, substance use, and musculoskeletal chief complaints, which were more common among visits paid primarily by Medicaid. In a logistic model controlling for these factors, as well as for other patient demographics and for the volume of recent ED arrivals, Medicaid status was nevertheless associated with 22% greater odds of assignment to a hallway bed (odds ratio 1.22, [95% confidence interval, CI, 1.18-1.26]), compared to private insurance. Visits assigned to hallway beds had longer lengths of stay than roomed visits of comparable acuity (hazard ratio for departure 0.91 [95% CI, 0.90-0.92]). CONCLUSION: We find evidence of social determinants of hallway bed use, likely involving epidemiologic, clinical, and operational factors. Even after accounting for different distributions of chief complaints and for more frequent ED use by the Medicaid population, as well as for other visit characteristics known at the time of triage, visits paid primarily by Medicaid retain a disproportionate association with hallway bed assignment. Further research is needed to eliminate potential bias in the use of hallway beds. [West J Emerg Med. 2020;21(4)949-958.].

Practice priorities for acute care nursing: A Delphi study.

AIMS AND OBJECTIVES: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. BACKGROUND: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. DESIGN: Delphi Method. METHOD: A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. RESULTS: High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care. CONCLUSION: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. RELEVANCE TO CLINICAL PRACTICE: This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care.

Validity and consistency of an outpatient department user satisfaction rapid scale.

BACKGROUND: User satisfaction is key to define and assess the quality of care; however, there is no patient satisfaction rapid scale in Mexico. Our objective was to determine the validity and consistency of an outpatient department user satisfaction rapid scale (ERSaPaCE). METHOD: Comparative, observational, cross-sectional, prolective study. In phase 1, a rapid scale model was developed, which was submitted to experts in medical care for assessment; the instrument was pilot-tested in 10-patient groups, using as many rounds as required until it obtained 20 approvals. In phase 2, the resulting questionnaire and the Outpatient Service User Satisfaction (SUCE) scale were applied to outpatient department users. ERSaPaCE was reapplied by telephone 10 days later. Descriptive statistics, Cronbach's a, Spearman's correlation and intra-class correlation coefficient (ICC) were used. RESULTS: Two-hundred patients were recruited, out of which 53 % were aged 31-60 years; 51.5 % were women and 48.5 % men, all of them users of the outpatient services from 13 specialties. Cronbach's a for ERSaPaCE was 0.608, whereas ICC was 0.98 (p = 0.000). Convergent validity was 0.681 (p = 0.000) using Spearman's rho. CONCLUSION: ERSaPaCE was a valid and consistent instrument for the assessment of outpatient department user satisfaction.

ANTECEDENTES: La satisfacción del usuario es clave para definir y valorar la calidad de la atención, sin embargo, no existe una escala rápida de satisfacción del paciente en México. El objetivo fue determinar la validez y consistencia de la Escala Rápida de Satisfacción del Paciente de Consulta Externa (ERSaPaCE). MÉTODO: Estudio comparativo, observacional, transversal, prolectivo. En la fase 1 se elaboró un modelo de escala rápida, que se sometió a la valoración de expertos en atención médica; se realizaron pruebas piloto con 10 pacientes por ronda, tantas veces como fuera necesario hasta lograr 20 aprobaciones. En la fase 2 se aplicó el cuestionario resultante y la escala de Satisfacción del Usuario de Consultas Externas (SUCE) a usuarios de consulta externa; la ERSaPaCE se reaplicó telefónicamente siete a 10 días después. Se utilizó estadística descriptiva, a de Cronbach, Spearman y coeficiente de correlación intraclase (CCI). RESULTADOS: Se reclutaron 200 pacientes, 53 % con edad de 31 a 60 años, 51.5 % mujeres y 48.5 % hombres de la consulta externa de 13 especialidades; a de Cronbach de ERSaPaCE = 0.608, CCI = 0.98 (p = 0.000) y validez convergente = 0.681 (p = 0.000) por rho de Spearman. ­. CONCLUSIONES: ERSaPaCE fue un instrumento válido y consistente para evaluar la satisfacción del usuario de consulta externa.

Validez y consistencia de una escala rápida de satisfacción del paciente de consulta externa / Validity and consistency of an outpatient department user satisfaction rapid scale

Resumen Antecedentes: La satisfacción del usuario es clave para definir y valorar la calidad de la atención, sin embargo, no existe una escala rápida de satisfacción del paciente en México. El objetivo fue determinar la validez y consistencia de la Escala Rápida de Satisfacción del Paciente de Consulta Externa (ERSaPaCE). Método: Estudio comparativo, observacional, transversal, prolectivo. En la fase 1 se elaboró un modelo de escala rápida, que se sometió a la valoración de expertos en atención médica; se realizaron pruebas piloto con 10 pacientes por ronda, tantas veces como fuera necesario hasta lograr 20 aprobaciones. En la fase 2 se aplicó el cuestionario resultante y la escala de Satisfacción del Usuario de Consultas Externas (SUCE) a usuarios de consulta externa; la ERSaPaCE se reaplicó telefónicamente siete a 10 días después. Se utilizó estadística descriptiva, a de Cronbach, Spearman y coeficiente de correlación intraclase (CCI). Resultados: Se reclutaron 200 pacientes, 53 % con edad de 31 a 60 años, 51.5 % mujeres y 48.5 % hombres de la consulta externa de 13 especialidades; a de Cronbach de ERSaPaCE = 0.608, CCI = 0.98 (p = 0.000) y validez convergente = 0.681 (p = 0.000) por rho de Spearman. Conclusiones: ERSaPaCE fue un instrumento válido y consistente para evaluar la satisfacción del usuario de consulta externa.

Abstract Background: User satisfaction is key to define and assess the quality of care; however, there is no patient satisfaction rapid scale in Mexico. Our objective was to determine the validity and consistency of an outpatient department user satisfaction rapid scale (ERSaPaCE). Method: Comparative, observational, cross-sectional, prolective study. In phase 1, a rapid scale model was developed, which was submitted to experts in medical care for assessment; the instrument was pilot-tested in 10-patient groups, using as many rounds as required until it obtained 20 approvals. In phase 2, the resulting questionnaire and the Outpatient Service User Satisfaction (SUCE) scale were applied to outpatient department users. ERSaPaCE was reapplied by telephone 10 days later. Descriptive statistics, Cronbach’s a, Spearman’s correlation and intra-class correlation coefficient (ICC) were used. Results: Two-hundred patients were recruited, out of which 53 % were aged 31-60 years; 51.5 % were women and 48.5 % men, all of them users of the outpatient services from 13 specialties. Cronbach’s a for ERSaPaCE was 0.608, whereas ICC was 0.98 (p = 0.000). Convergent validity was 0.681 (p = 0.000) using Spearman’s rho. Conclusion: ERSaPaCE was a valid and consistent instrument for the assessment of outpatient department user satisfaction.

The role of the healthcare environment in the acquisition of infection.

Tracy Doherty, Assistant Director of Infection Prevention & Control, Our Lady of Lourdes Hospital, Drogheda, Co Louth, discusses the maintenance of a clean healthcare environment.

Evaluating and prioritizing hospital service quality.

PURPOSE: Hospital evaluations create competition between healthcare providers. In this study, a multi criteria decision-making (MCDM) method is used to evaluate criteria that affect hospital service quality. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: Criteria affecting hospital service quality are identified. Four Iranian public hospitals are evaluated using these criteria. Four hybrid methods, including modified digital logic-technique for order of preference by similarity to an ideal solution, analytical hierarchy process-technique for order of preference by similarity to an ideal solution, analytical hierarchy process-elimination and choice expressing reality and modified digital logic-elimination and choice expressing reality are used to evaluate hospital service quality. Results are aggregated using the Copeland method and final ranks are determined. FINDINGS: The four main criteria for evaluating hospital service quality are: environment; responsiveness; equipment and facilities; and professional capability. Results suggest that professional capability is the most important criterion. The Copeland method, used to integrate four MCDM hybrid methods, provides the final hospital ranks. PRACTICAL IMPLICATIONS: The criteria the authors identified and their weight help hospital managers to achieve comprehensive organizational growth and more efficient resource usage. Moreover, the decision matrix helps managers to identify their strengths and weaknesses. ORIGINALITY/VALUE: New and comprehensive criteria are proposed for hospital quality assessments. Moreover, a new hybrid MCDM approach is used to achieve final hospital rankings.

[Stem cell transplantation unit: Guidelines from the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC)]. / Unité de greffe : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).

Allogeneic hematopoietic cell transplantation (HCT) is part of the standard of care for many hematological diseases. Over the last decades, significant advances in patient and donor selection, conditioning regimens as well as supportive care of patients undergoing allogeneic HCT leading to improved overall survival have been made. In view of many new treatment options in cellular and molecular targeted therapies, the place of allogeneic transplantation in therapy concepts must be reviewed. Most aspects of HCT are well standardized by national guidelines or laws as well as by certification labels such as FACT-JACIE. However, the requirements for human resources, construction and layout of a unit treating patients during the transplantation procedure and for different complications are not well defined. Here, we describe the process of planning a transplant unit in order to open a discussion that could lead to more precise guidelines in the field of personnel and infrastructural requirements for hospitals caring for people with severe immunosuppression.

Trauma-Informed Care for Violently Injured Patients in the Emergency Department.

Violent traumatic injury remains a common condition treated by emergency physicians. The medical management of these patients is well described and remains an area of focus for providers. However, violently injured patients disproportionately carry a history of physical and psychological trauma that frequently affects clinical care in the emergency department. The alteration of our clinical approach, taking into consideration how a patient's previous experiences influence how he or she may perceive and react to medical care, is a concept referred to as trauma-informed care. This approach is based on 4 pillars: knowledge of the effect of trauma, recognition of the signs and symptoms of trauma, avoidance of retraumatization, and the development of appropriate policies and procedures. Using this framework, we provide practical considerations for emergency physicians in the delivery of trauma-informed care for violently injured patients.

Relationship Between Work Environments, Nurse Outcomes, and Quality of Care in ICUs: Mediating Role of Nursing Care Left Undone.

BACKGROUND: The mechanism of how work environments affect nurse outcomes and quality of care has not been studied in intensive care unit (ICU) settings. PURPOSE: The purpose was to investigate the effects of work environment on nurse outcomes and quality of care in ICUs, through the mediating effects of nursing care left undone. METHODS: This study used survey data from 459 nurses from 22 ICUs in 22 hospitals in China. Hierarchical logistic regression modeling was used to analyze the relationships and the mediating effects. RESULTS: Positive work environments were associated with lower nurse job dissatisfaction, less burnout, higher quality of care, and safer care. Adding nursing care left undone could reduce the effects of work environments, showing partial mediating effects of nursing care left undone. CONCLUSIONS: Cultivating supportive work environments serves as a strategy to reduce nursing care left undone, and to improve nurse outcomes and quality of care in ICUs.

Quiet Time Improves the Patient Experience.

BACKGROUND: A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. Improving quiet in the hospital for designated hours improves patient satisfaction. Such efforts have typically been the primary responsibility of the nursing staff. LOCAL PROBLEM: Two medical units with consistently low Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) "always quiet" scores were chosen for this study. METHODS: A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for quiet time (QT) and used HCAHPS "always quiet" scores as the primary outcome measure. INTERVENTIONS: The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels. RESULTS: Quiet scores improved on both units after 11 months. CONCLUSIONS: Noise in hospitals is often beyond the scope of nurse-driven improvement; however, a QT protocol led by nurses, developed by multiple stakeholders, and focused on changing expectations for quiet can lead to measurable improvements in patient perception of quiet.

The Relationship Between Practice Environment and Psychological Ownership in Advanced Practice Nurses.

Barriers in advanced practice nurses' work environment impede effective use in acute care settings, reduce job satisfaction, and increase intent to leave. Fostering psychological ownership for work through improved work design has increased satisfaction, motivation, and productivity, and lowered turnover in other fields, and may have similar effects for advanced practice nurses. This multilevel cross-sectional survey study examined the relationship between advanced practice nurse work environment and psychological ownership using data from a survey of advanced practice nurses and nurse executives in Florida hospitals. Barriers in scope of practice and exclusion from hospital governance were common. Advanced practice nurses reported good relations with physicians and moderate organizational climate but poor relations with administrators and limited control over work. Organizational climate had a strong positive relationship with psychological ownership. Fostering advanced practice nurse psychological ownership could improve job satisfaction and decrease turnover leading to increased effectiveness in acute care settings.

Observing the influence of the physical environment on family involvement in a rehabilitation setting.

INTRODUCTION: Health professionals and institutions need to understand how to facilitate family involvement within settings designed prior to the adoption of patient- and family-centered philosophies. This study sought to explore how the physical environment of an inpatient rehabilitation setting influenced family involvement in health care delivery. METHOD: We conducted this study on the inpatient acquired brain injury ward of a Canadian adult rehabilitation center. This study used a basic interpretive qualitative approach. We conducted observations of how the physical environment influenced the conversations, interactions, and activities, which were central to family involvement, in this setting. We used a systematic qualitative analysis method. This study received research ethics board approval prior to commencing. RESULTS: We conducted 26 2-hr observation sessions. Five sessions occurred in the morning, 17 in early and late afternoon, and 4 in the evening. Eighteen sessions occurred on a weekday and 8 on a weekend day. The following 6 categories emerged from the field data: (a) accessing health professionals, (b) awareness of family presence, (c) facilitating family presence, (d) facilitating patient-family activities, (e) providing information for families, and (f) facilitating family involvement in therapy. DISCUSSION: This study provided information to inform future discussions and strategies for facilitating family involvement within the existing physical environments of health care institutions. Initial steps should consider ways to help families feel welcomed, such as including additional seating in spaces, posting signage inviting families into spaces, having resources tailored to families readily available, and creating a visible sign-in/sign-out board for families. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Creating the Framework for a Healthy Practice Environment.

The link between healthy work environments and patient safety, nursing satisfaction, and quality outcomes is well established, yet many nurses work in environments that are unsafe and uncivil. What are the essential elements that contribute to a healthy practice environment? How can we create roles and working conditions that enable nurses to be fulfilled and happy in their careers? This month's Magnet Perspectives column explores the relationship between a healthy practice environment and better outcomes and examines how the Journey to Magnet Excellence® leads to higher nurse satisfaction and retention, improved interdisciplinary collaboration, excellent patient care, and exemplary patient results.