Nursing surveillance and immediate jeopardy in Veteran Health Administration community living centers unannounced survey program 2018 to 2019.

BACKGROUND: The VA Community Living Center (CLC) Unannounced Survey Program aims to assess standards of care set by the government to protect residents. PURPOSE: To describe patterns of practice failures in nursing surveillance causing or having potential to cause immediate jeopardy, as defined by the Centers for Medicare and Medicaid Services. METHODS: Using CLC survey data consisting of 200 statements of deficiency (SODs) for 2018 to 2019, we collected a SOD sample (n = 20) of immediate jeopardy events. They were described using descriptive statistics and discourse content analysis. FINDINGS: We identified clinical events, their duration, work shift, and nursing skill mix for each SOD. Most to least common themes about failures in nursing surveillance were acquisition/transfer of information; decision-making; and early recognition of problems. DISCUSSION: Our analysis of nursing surveillance failures in CLC immediate jeopardy SODs provides insight into opportunities for registered nurses and the nursing skill mix to reduce avoidable harms.

Guardians of humanity? The challenges of nursing practice in the digital age.

Digital technologies have become a crucial factor in nursing. Given the fact that many tasks could also be done by robots or AI systems, the place for the nurse in this scenario is unclear. In what way and to what extent will the implementation of ever more sophisticated technology affect nursing practice? It is the aim of this paper to analyse the potential challenges of nursing practice in the digital age. The analysis is conducted through the lens of new materialism, a set of theoretical models that understand the relationship between humans and technology as dynamic and performative. According to this view, there is no prefixed essence of technology. Rather, the meaning of technology is enacted in concrete practice. The analysis shows that in past debates on technology use in nursing, the nurses' role has been defined as guardians of humanity, defending the patient against the dehumanizing effects of technology. This role has been transferred to the digital age, where it is the duty of nurses to cushion the negative effects of digital technology. As an alternative to this outdated role, nurses should be included in processes of technology design and policymaking. Enabling nursing professionals to shape the circumstances of a digitally enhanced holistic practice may empower their status within the healthcare system and also benefit the patient by contributing to a more person-centred care.

Leadership in Nursing Excellence: The Magnet Recognition® Journey Experiences in Europe.

Improving work conditions and the provision of high-quality care and patient safety is an issue in European hospitals. Inspired by a US program for nursing excellence, Magnet Recognition, a Belgian hospital shared their experiences by organizing a summer school in 2019 with nurses of 21 hospitals from 9 countries. This article explains the hospital's research program, the link between the journey and the content of the summer school, lessons learned, and the extent to which participants of European hospitals were interested in nursing excellence and Magnet designation.

Data Entry Automation Improves Cost, Quality, Performance, and Job Satisfaction in a Hospital Nursing Unit.

OBJECTIVE: An Automated Data Entry Process Technology tool was developed to free nurses from data entry tasks, thus creating time for patient care and other activities associated with improvements in performance and job satisfaction. BACKGROUND: Manually transferring data from patient measurement devices to electronic health records (EHRs) is an intensive, error-prone task that diverts nurses from patient care while adversely affecting job performance and employee satisfaction. METHODS: Performance improvement analytics were used to compare matched sets of manual and automated EHR data entries for 1933 consecutive vital signs records created by 49 RNs and certified nursing assistants in a 23-bed medical-surgical unit at a large tertiary hospital. Performance and quality effects were evaluated via nurses' responses to a postintervention survey. RESULTS: Data errors decreased from approximately 20% to 0; data transfer times were reduced by 5 minutes to 2 hours per measurement event; nurses had more time for direct patient care; and job satisfaction improved. CONCLUSION: Data entry automation eliminates data errors, substantially reduces delays in getting data into EHRs, and improves job satisfaction by giving nurses more time for direct patient care. Findings are associated with improvements in quality, work performance, and job satisfaction, key goals of nursing leaders.

Finding the fundamental needs behind resistance to care: Using the Fundamentals of Care Practice Process.

A person living with Alzheimer's disease (PA) can experience difficulty during bodily care and therefore may show resistance to care behaviours (RTCBs). Nurses must take a clinical approach to planning care that meets the person's needs. Therefore, it is necessary to identify training strategies for bedside nurses and nursing students. AIMS AND OBJECTIVES: To describe and discuss how the FOC practice process (FOC-PP) can help nurses understand PAs who show RTCBs during bodily care. BACKGROUND: Resistance to care behaviour phenomenon and the importance of bodily care as fundamental care are described. The FOC-PP enables nurses to apply the FOC framework in their practice. DESIGN: This discursive paper is based on the literature of the FOC framework and PP. METHOD: A clinical scenario that develops through the five stages of the FOC-PP. RESULTS: The scenario centres on Mrs. Emily Morgan, 81, who lives in a nursing home and is not receiving the bodily care that she needs. Camille, a nursing student, and her supervisor Florence collaborate with Mrs. Morgan's family to improve the quality of her care. Three particular aspects of nursing practice based on the FOC-PP are described: the critical thinking process, relational process and pedagogical process. CONCLUSION: The FOC-PP promotes holistic care centred on the person and his or her needs and encourages the nurse to use his or her skills and knowledge. All these dimensions are fundamental for high-quality nursing care. RELEVANCE TO CLINICAL PRACTICE: Mrs. Morgan's scenario enables us to perceive that the FOC-PP is very useful for nursing students and bedside nurses. However, given the amount of specific and diverse knowledge required by the FOC-PP, it is necessary to identify avenues for teaching them. Using clinical scenarios could facilitate the integration of the FOC-PP, with taking into account the specific characteristics of individual clients.

Impact of Kamishibai Card Process on Compliance With the Central Venous Line Maintenance Bundle.

BACKGROUND: The Kamishibai Card (K-Card) process is a storytelling methodology designed to help identify barriers and remove or redesign them. PURPOSE: The purpose of this study was to evaluate the effectiveness of the K-Card process for central venous line (CVL) maintenance bundle compliance in a pediatric intensive care unit. METHODS: A retrospective evaluation of the implementation of the K-Card process was performed using a pretest and posttest design. RESULTS: A total of 1003 central venous catheter maintenance observations were completed during the study period. A statistically significant change was noted in one element of the CVL maintenance bundle, tubing timed and dated. The most frequent cause for noncompliance with the CVL maintenance bundle was incomplete communication during handoff, followed by device associated factors (failure of device, use of device, and availability of device). CONCLUSIONS: The K-Card process had a positive impact on CVL maintenance bundle compliance in the study setting.

Improving Sepsis Bundle Implementation Times: A Nursing Process Improvement Approach.

BACKGROUND: Early recognition of sepsis in the emergency room (ER) has been shown to improve treatment intervention times and decrease mortality. LOCAL PROBLEM: Failure to recognize early signs and symptoms of sepsis in the ER has led to poor sepsis bundle completion times. METHODS: A comparison of preintervention and postintervention data was performed to determine whether sepsis bundle implementation times, mortality, and length of stay (LOS) improved. INTERVENTIONS: An ER Nurse Sepsis Identification Tool, leadership buy-in from key stakeholders, and systemic inflammatory response syndrome (SIRS) education were implemented. RESULTS: Postintervention, average bundle compliance time decreased 458 minutes (P < .001), average antibiotic administration time decreased 101 minutes (P < .001), overall sepsis mortality decreased 5.9% (P = .074), and there was no change to LOS. CONCLUSIONS: The implementation of an ER early sepsis identification tool, leadership buy-in, and SIRS education can lead to improved bundle implementation times in the ER.

Nursing practice in stroke rehabilitation: Perspectives from multi-disciplinary healthcare professionals.

In this qualitative, descriptive study, we explored the status of and factors related to nursing practice for stroke rehabilitation in China, considering the perspectives of multi-disciplinary healthcare professionals. Fifteen participants were interviewed in depth, followed by field observations at three healthcare institutions. Data were analyzed using ethnographic data analysis methods. Current nursing practice for patients with stroke emerged as a cultural domain that included nine patterns: coordination of nursing, basic nursing following nursing procedures, limited rehabilitation nursing care with varied functions, therapeutic function in rehabilitation care, the importance of nurses' involvement in rehabilitation, environments making rehabilitation nursing possible, inadequate staffing for the numerous clinical nursing practices, lack of effective communication with other healthcare professionals, and lack of policies regarding rehabilitation nursing practice. Nurses' role in stroke rehabilitation must be addressed by updating nursing practice. Further, stroke team leaders must recognize the constraints faced by nurses in fulfilling their stroke-rehabilitation roles.

Mapping nursing practices in rehabilitation units in Spain and the United Kingdom: A multiple case study.

Because of the crisis in the health sector with few employment opportunities, many Spanish nurses are looking for professional development abroad. No studies have mapped nursing practices across Europe. The aim of this research was to provide a comprehensive approach to understand nursing practices and features of the context in Spain and the United Kingdom within the rehabilitation unit and to discuss those practices from a patient safety point of view. Multiple case study design with thematic analysis was applied in this study. The methods for data collection were in-depth interviews, nonparticipant observations, and document analysis. Results were classified into six categories: resources, techniques and nursing procedures, patients' personal care, health education, documentation task, and attitudes and communication skills. This study concludes that differences exist between nursing practices despite both countries having similar nursing competences. In addition, the UK unit has a positive safety culture, recognizes that mistakes happen, and applies more barriers to avoid them. The study provides valuable information to help the decision-making process for Spanish nurses considering working in the UK.

Complexity Leadership in the Nursing Context.

Consolidation through mergers and acquisitions is occurring across health care as a strategic move to address the disruptive forces of complexity. While consolidation is improving the overall fitness and viability of health care organizations, it is having the opposite effect on the professionals working within them who are reporting increasing rates of burnout from ongoing complexity in the health care environment. This happens in all organizations that try to respond to complexity with traditional bureaucratic leadership approaches. What is needed is to replace bureaucratic leadership with the networked approach of complexity leadership. The idea is not to "do more with less" but to "do things better." In this article, we show how to do this by applying complexity leadership to the nursing context. Complexity leadership is a framework for enabling people and organizations for adaptability. It views leaders not as managerial implementers of top-down directives but as collaborators who work together to enhance the overall adaptability and fitness of the system. From a complexity leadership perspective, the role of nurse leaders should be not only to help the system run but also to help it run better by increasing organizational adaptability.

Albert Mieczyslaw Krapiec's theory of the person for professional nursing practice.

This article presents the works of great Polish philosopher, Mieczyslaw Albert Krapiec, whose creative output can be applied to professional nursing practice. Krapiec's philosophical heritage is extensive and encompasses many philosophical fields: metaphysics, philosophical anthropology, philosophy of law, philosophy of culture, philosophy of politics and philosophy of language. Krapiec created an original philosophical synthesis characterized by a realistic approach. In this paper, I present only one of several original philosophical concepts developed by Krapiec: the theory of the person based on seven essential characteristics, that is the ability for cognition, love, freedom, religion, legal subjectivity, completeness and dignity. I attempt to show how these personal characteristics correspond to various patient needs. I argue that the qualitative deficit of any personal characteristics indicated by Krapiec corresponds to a patient's real need that must be satisfied. I also stress that the skilful diagnosing of all-not only selected-qualitative deficits of characteristics can be defined as holistic care in the nursing profession.

Vital and enchanted: Jane Bennett and new materialism for nursing philosophy and practice.

Nursing theories are typically anthropocentric and emphasize caring for a person as a unitary whole. They maintain the dualisms of human-nonhuman, natural-social and material-ideal. Recent developments in nonhuman ontology question the utility of that approach. One important philosopher in this new materialism is political theorist Jane Bennett. In this paper, I explore Bennett's vital materialism and enchantment as two concepts arising from the nonhuman turn that should inform nursing philosophy. Vital materialism considers the lively power of matter to affect the world and be affected in relations. Enchantment refers to a sense of wonder and captivation with matter. While summarizing her important contributions, I also describe common criticisms and responses. I consider the human as an assemblage of matter as well as the agency or "thing power" of matter external to humans. This has implications for nursing thought and practice, and it can inform a more capacious research methodology. I also discuss how compassion fatigue or burnout and other professional issues may be seen as a form of disenchantment with the material world. I argue that embracing these and other elements of Bennett's new materialist philosophy can help nurses and other health professionals enrich their theories and practice to advance their disciplines and improve care for persons and populations.

Advancing nursing practice for improved health outcomes using the principles of perceptual control theory.

This article describes how an empirically supported theory of human behaviour, perceptual control theory, can be used to advance nursing practice and improve health outcomes for people who are accessing nursing care. Nursing often takes a pragmatic approach to the delivery of care, with an emphasis on doing what appears to work. This focus on pragmatism can sometimes take precedence over any consideration of the underlying theoretical assumptions that inform decisions to take one particular approach over another or the mechanisms through which nursing interventions have their effects. For nursing to develop as a profession, there needs to be an increased focus on the core principles that underpin the delivery of care. In addition to understanding what works, nurses must develop their understanding of how and why particular approaches work or do not work. Understanding the fundamental principles that underpin nurses' actions will lead to more efficient and effective approaches to the delivery of nursing care. It will also enable nurses to maximize those elements of their practice that are most beneficial for people and minimize other activities that either have little effect or actually lead to worse outcomes. In this article, we will propose that the phenomenon of control is fundamental to human health. Perceptual control theory provides a coherent theoretical framework that enables us to understand the phenomenon of control through a functional model of human behaviour. People are healthy when their neurochemical, physiological, biological, psychological and social states are all controlled satisfactorily. We will explain the implications of understanding health as control throughout the paper. From this perspective, we will argue that the aim of nurses and nursing should be to support people to maintain or recover control over those aspects of their lives that are important and meaningful to them.

Fondamentaux des soins : un cadre et un processus pratique pour répondre aux besoins physiques, psychosociaux et relationnels des personnes soignées.

Since 2008, an international group has been helping to promote a better response to the fundamental needs of individuals receiving care. This group provides a framework on the fundamentals of care that focuses on the relationship between the nurse, the individual being cared for, and his or her relatives, as well as on the response to the patient’s physical, psychosocial, and relational needs. A practice process supports the concrete application of this framework. The purpose of this discursive article is to present the French translation of the Fundamentals of Care Framework and its Practice Process. To begin with, the translation process will be briefly explained. Next, the Fundamentals of Care Framework and the stages in its Practice Process will be presented. To help the reader better understand the proposal, a clinical illustration will be used to present the situation of Mr. Perron, who is living with Alzheimer’s disease, and his spouse, who is his family caregiver. Finally, the article discusses the usefulness of the Fundamentals of Care Framework and its Practice Process in terms of the four main areas of the discipline of nursing : practice, management, training, and research. This article paves the way for the development of knowledge on the fundamentals of care in the French-speaking world.

Selecting and quantifying low-value nursing care in clinical practice: A questionnaire survey.

AIMS AND OBJECTIVES: To evaluate the opinion of hospital nurses on a group of recommendations aimed at reducing low-value nursing care and, based on these results, to detect low-value practices probably existing in the hospital. BACKGROUND: Low-value nursing care refers to clinical practices with poor or no benefit for patients that may be harmful and a waste of resources. Detecting these practices and understanding nurses' perceptions are essential to developing effective interventions to reduce them. METHODS: We conducted a survey in a tertiary hospital. STROBE guidelines were followed. The questionnaire appraised nurses' agreement, subjective adherence and perception of usefulness of a group of recommendations to reduce low-value nursing care from Choosing Wisely and other initiatives. Practices described in recommendations with an agreement over 70% and a subjective adherence under 70% were categorised as low-value practices probably existing in the hospital. RESULTS: A total of 265 nurses from eight areas of care participated in the survey. The response rate by area ranged between 2%-55%. From the 38 recommendations evaluated, agreement was 96% (95% confidence interval [95%CI], 95%-97%), median subjective adherence was 80% (95%CI, 80%-85%), and usefulness was 90% (95%CI, 89%-92%). Based on these results, we detected seven (0-15) low-value practices probably existing in our hospital, mostly on general practice, pregnancy care and wound care. CONCLUSIONS: We found a great understanding of low-value care between nurses, given the high agreement to recommendations and perception of usefulness. However, several low-value practices may be present in nursing care, requiring actions to reduce them, for instance, reviewing institutional protocols and involving patients in de-implementation. RELEVANCE TO CLINICAL PRACTICE: Hospitals and other settings should be aware of low-value practices and take actions to identify and reduce them. A survey may be a simple and helpful way to start this process.

Evaluation of Electronic Health Records on the Nursing Process and Patient Outcomes Regarding Fall and Pressure Injuries.

Digitalizing the nursing process has become a trend in medical care. The purpose of this study was to evaluate implementation of the Standardized Computerized Nursing Process Documentation System and patient outcomes. We analyzed hospitalized patients' electronic health record database with a total of 19 659 patients in 2015. The analysis focused on nurses' selection of nursing care plans for patients with a high risk of falls or pressure injuries through admission assessments. The effectiveness of implemented nursing care plans following falls or pressure injuries was explored. The results reveal that 55% of the hospitalized patients had a risk of falling, and 27.85% of patients were at risk of pressure injuries. Patients receiving nursing care plan who experienced falls or pressure injuries were significantly higher than those without a nursing care plan (P < .001). This study could not provide direct evidence for the effect of nursing care plans on reducing the incidence of falls and pressure injuries, which may be attributable to patient characteristics. Furthermore, an analysis on data from 2007 to 2017 using a run chart revealed that the mean incidence rate for pressure injuries decreased, whereas that for falls remained stable. The results indicate that the system did not increase the occurrence of such incidences.

Clarifying Role Expectations and Practice Standards Using a Clinical Nurse Leader Professional Practice Model Illustration.

BACKGROUND: Despite evidence of the positive impact of the clinical nurse leader (CNL) role, implementation of supplemental nursing roles has proven to be challenging due to unclear role explanations and organizational unfamiliarity. PROBLEM: Nurses practice in a dynamic environment and need to cope with the rapid pace of change in practice roles. Outside of the preparation of the CNL, many nursing professionals are not educated or prepared on the essential aspects the CNL role. APPROACH: A graphic illustration was developed to facilitate discussion and provide insight into the CNL role, with the aim of creating consensus on the CNL role functions and expectations. OUTCOMES: Following the implementation of the CNL practice model illustration, participants reported a significant improvement in their understanding and importance of the CNL role. CONCLUSIONS: Professional practice model illustrations may be beneficial in developing a consensus of practice.

Using Lean Six Sigma to Improve Controlled Drug Processes and Release Nursing Time.

BACKGROUND: Hospital controlled drug processes are established to adhere to legislation, with little consideration of efficiency of processes. LOCAL PROBLEM: A controlled drug process existed, where nurses requested a porter to collect a hand-written order; however, only 19% of drug orders were processed this way. Instead, an unscheduled, ad hoc process led to an average of 17 nurse journeys to pharmacy daily. We aimed to reduce nurse journeys to the pharmacy by 25% to release nursing time. METHODS: A pre-/postintervention design was used with Lean Six Sigma methods. INTERVENTIONS: A multifaceted intervention involved process redesign, increasing the frequency of a porter-led delivery service, amending delivery times to reflect times of greatest need, and streamlining checking requirements. RESULTS: Following implementation, there was a statistically significant 44% decrease in nurse journeys to pharmacy for drug collections, which was maintained after 18 months. CONCLUSIONS: Interprofessional collaboration improving hospital-wide processes can have significant benefits for the release of nursing time.

Relationship Between Control Over Nursing Practice and Job Satisfaction and Quality of Patient Care.

BACKGROUND: Control over nursing practice (CONP) in the work setting is associated with several positive consequences such as increased job satisfaction, support of teamwork, decreased patient mortality, and improved quality of care. PURPOSE: The purpose of this study was to examine the level of perceived CONP among Jordanian registered nurses (RNs) and determine its relationship with their job satisfaction and quality of patient care. METHOD: A descriptive, cross-sectional correlational design was used. A convenience sample of 230 RNs was recruited from 4 hospitals. RESULT: The RNs had a moderate level of perceived CONP. This control was positively correlated with their work satisfaction and perception of the quality of patient care that they delivered. CONCLUSION: Nurse managers should be encouraged to take into consideration nurses' perceived CONP to improve working conditions for nurses.

Is privacy a problem during bedside handovers? A practice-oriented discussion paper.

Bedside handover is the delivery of the nurse-to-nurse handover at the patient's bedside. Although increasingly used in nursing, nurses report many barriers for delivering the bedside handover. Among these barriers is the possibility of breaching the patient's privacy. By referring to this concept, nurses add a legal and ethical dimension to the delivery of the bedside handover, making implementation of the method difficult or even impossible. In this discussion article, the concept of privacy during handovers is being discussed by use of observations, interviews with nurses, and interviews with patients. These findings are combined with international literature from a narrative review on the topic. We provide a practice-oriented answer in which two mutually exclusive possibilities are discussed. If bedside handover does pose problems concerning privacy, this situation is not unique in healthcare and measures can be taken during the bedside handover to safeguard the patient. If bedside handover does not pose problems concerning privacy, privacy is misused by nurses to hide professional uncertainties and/or a reluctance toward patient participation. Therefore, a possible breach of privacy-whether a justified argument or not-is not a reason for not delivering the bedside handover.