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1.
Nephrol Nurs J ; 47(5): 457-460, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107718

RESUMO

Making a business case to match staffing-to-patient care needs sometimes requires new approaches. Partnering with departments outside of nursing proved successful in one acute hemodialysis department. Working with Lean Six Sigma teammates to define our workflow processes and utilizing the resulting data led to developing a business case, which gained the department 2.5 additional full-time equivalent registered nurses. A staffing template was created to evaluate ongoing patient volumes against current staffing. This staffing template can be used by any hemodialysis unit to aid in determining ongoing staffing requirements.


Assuntos
Unidades Hospitalares/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Diálise Renal/enfermagem , Gestão da Qualidade Total/métodos , Humanos
3.
Med Care ; 58(9): 785-792, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32732787

RESUMO

BACKGROUND: Telephone call programs are a common intervention used to improve patients' transition to outpatient care after hospital discharge. OBJECTIVE: To examine the impact of a follow-up telephone call program as a readmission reduction initiative. RESEARCH DESIGN: Pragmatic randomized controlled real-world effectiveness trial. SUBJECTS: We enrolled and randomized all patients discharged home from a hospital general medicine service to a follow-up telephone call program or usual care discharge. Patients discharged against medical advice were excluded. The intervention was a hospital program, delivering a semistructured follow-up telephone call from a nurse within 3-7 days of discharge, designed to assess understanding and provide education, and assistance to support discharge plan implementation. MEASURES: Our primary endpoint was hospital inpatient readmission within 30 days identified by the electronic health record. Secondary endpoints included observation readmission, emergency department revisit, and mortality within 30 days, and patient experience ratings. RESULTS: All 3054 patients discharged home were enrolled and randomized to the telephone call program (n=1534) or usual care discharge (n=1520). Using a prespecified intention-to-treat analysis, we found no evidence supporting differences in 30-day inpatient readmissions [14.9% vs. 15.3%; difference -0.4 (95% confidence interval, 95% CI), -2.9 to 2.1; P=0.76], observation readmissions [3.8% vs. 3.6%; difference 0.2 (95% CI, -1.1 to 1.6); P=0.74], emergency department revisits [6.1% vs. 5.4%; difference 0.7 (95% CI, -1.0 to 2.3); P=0.43], or mortality [4.4% vs. 4.9%; difference -0.5 (95% CI, -2.0 to 1.0); P=0.51] between telephone call and usual care groups. CONCLUSIONS: We found no evidence of an impact on 30-day readmissions or mortality due to the postdischarge telephone call program.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Telefone/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Recursos Humanos de Enfermagem no Hospital/organização & administração , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Fatores de Tempo
6.
Neurology ; 95(13): 583-592, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32732292

RESUMO

In response to the COVID-19 pandemic epicenter in Bronx, NY, the Montefiore Neuroscience Center required rapid and drastic changes when considering the delivery of neurologic care, health and safety of staff, and continued education and safety for house staff. Health care leaders rely on principles that can be in conflict during a disaster response such as this pandemic, with equal commitments to ensure the best care for those stricken with COVID-19, provide high-quality care and advocacy for patients and families coping with neurologic disease, and advocate for the health and safety of health care teams, particularly house staff and colleagues who are most vulnerable. In our attempt to balance these principles, over 3 weeks, we reformatted our inpatient neuroscience services by reducing from 4 wards to just 1, in the following weeks delivering care to over 600 hospitalized patients with neuro-COVID and over 1,742 total neuroscience hospital bed days. This description from members of our leadership team provides an on-the-ground account of our effort to respond nimbly to a complex and evolving surge of patients with COVID in a large urban hospital network. Our efforts were based on (1) strategies to mitigate exposure and transmission, (2) protection of the health and safety of staff, (3) alleviation of logistical delays and strains in the system, and (4) facilitating coordinated communication. Each center's experience will add to knowledge of best practices, and emerging research will help us gain insights into an evidence-based approach to neurologic care during and after the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Departamentos Hospitalares/organização & administração , Corpo Clínico Hospitalar/organização & administração , Neurologia/organização & administração , Pandemias , Pneumonia Viral , Assistência Ambulatorial , Betacoronavirus , Comunicação , Assistência à Saúde , Unidades Hospitalares/organização & administração , Hospitalização , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Neurologia/educação , Enfermagem em Neurociência , Recursos Humanos de Enfermagem no Hospital/organização & administração , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Telemedicina , Envio de Mensagens de Texto
7.
Ann Glob Health ; 86(1): 70, 2020 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-32676299

RESUMO

Background: In December 2019, early cases of COVID-19 were identified in Wuhan, China. By late January 2020, it was evident that COVID-19 was rapidly spreading and represented a national health emergency. In order to contain the spread of COVID-19, China adopted a centralized treatment plan by appointing designated hospitals in each region. Shantou Central Hospital is a Grade A Class A general hospital in Guangdong Province. It was appointed as a provincial COVID-19 designated treatment hospital on January 21, 2020, to provide all COVID-19-related treatments for the city of Shantou. The nursing department at Shantou Central Hospital is fully responsible for hospital nursing administration, nursing human resource management, nursing quality management, and all nursing tasks related to hospital medical care, nursing, teaching, scientific research, preventive healthcare, and so on. Objective: To summarize the role of nursing management in transforming a general hospital into a designated hospital for treatment of COVID-19 patients. Methods: We undertook a series of nursing management measures in the strategic phase and the implementation phase. Findings: Through a series of nursing management measures, all COVID-19 patients admitted to our hospital were cured and discharged. All non-COVID-19 patients and staff hospitalized during the same period were not infected with the virus. During this period, our hospital completed 7,466 operations. Hence, our nursing management measures were effective. Conclusions: Our efficient nursing management system, first of all, effectively mobilized all available manpower; secondly, up-skilled and trained personnel within a very short period of time; thirdly, provided reliable logistical support for front-line protection equipments; and finally, motivated nurses during this very difficult time to make a significant positive contribution to the fight against COVID-19 pandemic.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Hospitais Gerais/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Betacoronavirus , China/epidemiologia , Eficiência Organizacional , Humanos , Pandemias
9.
Arch Cardiol Mex ; 90(Supl): 94-99, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-595483

RESUMO

The SARS-CoV-2 or COVID-19 outbreak originated in China has reached Mexico. However, the scientific community, including nursing, has generated vertiginous evidence that can help make decisions in the care of the affected population. The purpose of this study is to describe the nursing experience before COVID-19 as a key point for the prevention, control and mitigation of the pandemic. Based on the recommendations issued by the Ministry of Health, the clinical evidence and the resources available in the health institutions, the disease prevention measures have been initiated and maintained both in the community and in the health institutions. The reconversion of hospitals and care protocols adapted to our context are trying to strengthen the control and mitigation of the disease.


Assuntos
Infecções por Coronavirus/enfermagem , Cuidados de Enfermagem/métodos , Pneumonia Viral/enfermagem , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Tomada de Decisões , Humanos , México/epidemiologia , Recursos Humanos de Enfermagem no Hospital/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
10.
Arch Cardiol Mex ; 90(Supl): 94-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32523143

RESUMO

The SARS-CoV-2 or COVID-19 outbreak originated in China has reached Mexico. However, the scientific community, including nursing, has generated vertiginous evidence that can help make decisions in the care of the affected population. The purpose of this study is to describe the nursing experience before COVID-19 as a key point for the prevention, control and mitigation of the pandemic. Based on the recommendations issued by the Ministry of Health, the clinical evidence and the resources available in the health institutions, the disease prevention measures have been initiated and maintained both in the community and in the health institutions. The reconversion of hospitals and care protocols adapted to our context are trying to strengthen the control and mitigation of the disease.


Assuntos
Infecções por Coronavirus/enfermagem , Cuidados de Enfermagem/métodos , Pneumonia Viral/enfermagem , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Tomada de Decisões , Humanos , México/epidemiologia , Recursos Humanos de Enfermagem no Hospital/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
14.
Nephrol Nurs J ; 47(2): 133-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32343087

RESUMO

Patient safety is an important foundation of high-quality care. Yet little is known regarding the effects of nursing indicators on patient safety in dialysis units. The purpose of this study was to examine interrelationships among registered nurse (RN) staffing, workload, nursing care left undone, and patient safety outcomes in hemodialysis settings. The sample consisted of 104 staff nurses who worked in hemodialysis facilities and completed a mailed survey. Low RN staffing, high RN workloads, and RN nursing care left undone were significantly associated with unsafe patient shift change periods and low safety ratings. Care left undone was an indirect pathway through which low RN staffing and high workloads impacted safety. Patient safety in hemodialysis units can be enhanced by ensuring adequate RN staffing and reasonable RN workloads, as well as redesigning responsibilities so RNs can complete necessary care activities.


Assuntos
Recursos Humanos de Enfermagem no Hospital/organização & administração , Segurança do Paciente , Admissão e Escalonamento de Pessoal , Diálise Renal/enfermagem , Carga de Trabalho , Pesquisas sobre Serviços de Saúde , Humanos
15.
Br J Nurs ; 29(7): 406-413, 2020 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-32279555

RESUMO

BACKGROUND: 'Hours per patient day' (HPPD) is an internationally recognised resourcing metric used to measure direct nursing care hours. However, hospitals often underestimate indirect time (unavailability) and specify unrealistic targets for planned unavailability ('headroom'). AIMS: To investigate the disparities between planned unavailability ('headroom') and actual staff unavailability. METHODS: Data were collected from the e-rostering systems of 87 NHS trusts. This was compared with published data from 35 roster policies. RESULTS: Many hospitals use headroom as a key performance indicator (KPI) and set targets for its components in their roster policies. This research highlights large variations in unavailability (15.8% to 33.6%) and lower variations in headroom (16-26%). CONCLUSION: Hospitals operationalise headroom around an idealised 'target' value. This may be detrimental. Compelling a unit with unavailability of between 28% and 30% to adopt an institution-wide headroom of 22% (for example) may, at best, increase spending on bank/agency staff, or, at worse, jeopardise patient safety.


Assuntos
Recursos Humanos de Enfermagem no Hospital/organização & administração , Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Segurança do Paciente , Admissão e Escalonamento de Pessoal/organização & administração , Humanos , Pesquisa em Avaliação de Enfermagem , Medicina Estatal/organização & administração , Reino Unido
16.
J Clin Nurs ; 29(13-14): 2466-2481, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32243030

RESUMO

AIM: To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients. BACKGROUND: Communication issues have been found to be among the main contributing factors of medication incidents, thus necessitating communication enhancement. DESIGN: A sequential exploratory mixed-method design. METHODS: Medication incident reports from Finland (n = 500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR's SRQR checklist was followed in reporting. RESULTS: Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n = 341), nurse-physician (41.6%; n = 208) and nurse-patient (9.6%; n = 48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n = 383). The most commonly identified issues were digital communication (68.2%; n = 341), lack of communication within a team (39.6%; n = 198), false assumptions about work processes (25.6%; n = 128) and being unaware of guidelines (25.0%; n = 125). Collegial feedback and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines. CONCLUSIONS: The interventions should be prioritised to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals and (f) encouraging patients to communicate about medication. RELEVANCE TO CLINICAL PRACTICE: Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.


Assuntos
Relações Interprofissionais , Erros de Medicação/prevenção & controle , Gestão de Riscos/métodos , Finlândia , Humanos , Recursos Humanos de Enfermagem no Hospital/organização & administração , Pesquisa Qualitativa
17.
J Clin Nurs ; 29(15-16): 2849-2862, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32320101

RESUMO

AIMS AND OBJECTIVES: To explore hospital nurses' experiences of enablers and barriers to apply the recommendations of a hospital delirium guideline, focusing on identification and nonpharmacological prevention and treatment. BACKGROUND: Nurses' application of delirium guidelines is important as they have a pivotal role in identifying, preventing and managing delirium. Research is sparse concerning barriers and enablers to nurses´ application of guideline recommendations on nonpharmacological prevention and treatment of delirium. DESIGN: Qualitative design using focus group and individual interviews. METHODS: Twenty-three nurses, nurse supervisors and senior staff nurses from four departments in a Danish 530-bed university hospital participated in the study. The interview guide was based on the Theoretical Domains Framework. Data were analysed using inductive content analysis. The COREQ checklist was used preparing the manuscript. RESULTS: The analysis identified four main categories concerning barriers and enablers to applying the recommendations of a delirium guideline: factors relating to employing the guideline, the individual nurse, collaboration and the context. Lack of identification of delirium and lack of preventive actions were prominent, with inter-related barriers such as lack of knowledge, lack of meaningfulness, lack of priority, lack of resources and working conditions, causing frustration and discouragement in the nurses. CONCLUSIONS: The study identified a wide range of barriers and enablers experienced by hospital nurses to the application of a delirium guideline, showing the complexity of delirium care and applying guidelines. RELEVANCE TO CLINICAL PRACTICE: Improving the identification, prevention and treatment for patients with delirium requires a determined and focused effort from all stakeholders, both clinicians, leaders and policymakers. Nurses, nurse leaders and educators must be aware of the barriers and enablers related to knowledge, attitudes and co-operation. Managers and policymakers must be aware of the organisational factors related to priority and working conditions.


Assuntos
Delírio/enfermagem , Gerenciamento Clínico , Recursos Humanos de Enfermagem no Hospital/organização & administração , Adulto , Feminino , Grupos Focais , Fidelidade a Diretrizes , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/psicologia , Pesquisa Qualitativa
18.
J Nurs Adm ; 50(4): 187-189, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32195911

RESUMO

Conducting high-quality research in hospitals can be challenging. Surveys are a cost-effective method to collect data and conduct research studies in hospitals. However, survey response rates can present a challenge to researchers. This article explores targeted techniques that can be used to maximize the survey response rates among nurses and nurse managers.


Assuntos
Enfermeiras Administradoras/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Projetos de Pesquisa/tendências , Participação dos Interessados/psicologia , Inquéritos e Questionários , Coleta de Dados , Hospitais , Humanos , Internet
19.
J Clin Nurs ; 29(13-14): 2275-2284, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32129530

RESUMO

AIMS: To evaluate healthcare practitioners' perceptions of the feasibility and acceptability of a communication tool, entitled the TRANSITION tool, to communicate with older patients during transition from acute care to a community setting. BACKGROUND: Transitional care for older patients is challenging due to their complex care needs and rapid care transitions. Research has identified effective models of transitional care. However, optimal communication between healthcare practitioners and older patients remains under-investigated. DESIGN: Exploratory descriptive qualitative design. METHODS: The methods are reported using the Consolidated Criteria for Reporting Qualitative Studies checklist. The setting comprised two acute medical wards in an urban hospital in Australia. Twenty-two nursing and allied healthcare practitioners used the TRANSITION tool to guide communication about transitional care with an older patient and then participated in an interview about their experience of using the tool. All data were thematically analysed. FINDINGS: Healthcare practitioners reported their perceptions that the TRANSITION tool was feasible and acceptable, and that they perceived the tool supported them to know what to ask and to find out information regarding their patient's transitional care needs. Some ward-based nurses reported their perception that transitional care was not their role. CONCLUSIONS: Findings emphasise transitional care as a continuing care process that requires effective communication between nurses and older patients in acute medical wards. RELEVANCE TO CLINICAL PRACTICE: Given shorter lengths of stay, complex care needs and slow recovery, ward-based nurses are vital in communicating with older patients about their transitional care needs. The TRANSITION tool may support communication between ward-based nurses and older patients to improve assessment and planning. Implementation of the tool will require a planned strategy to facilitate translation of the tool into routine practice of ward-based nurses to support their roles during older patients' care transitions.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Relações Profissional-Paciente , Cuidado Transicional/organização & administração , Adulto , Idoso , Atitude do Pessoal de Saúde , Austrália , Comunicação , Feminino , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
20.
Nurs Clin North Am ; 55(1): 109-120, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32005359

RESUMO

Development of clinical nurses in Magnet-designated organizations is enhanced through a commitment to shared governance principles, a relevant and visible professional practice model, and engagement of clinical nurses in shared decision making. Cultivating practice innovations and reward and recognition programs further assist to sustain this development and leads to growth of future leaders.


Assuntos
Enfermeiras Clínicas/organização & administração , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem no Hospital/organização & administração , Desenvolvimento de Pessoal/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cultura Organizacional
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