Management Strategies for COVID-19 in the General Ward of Cardiovascular Surgery: Experience From a Single Tertiary Hospital in China.

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory disease that threatens global health. During the pandemic period of COVID-19, the task for prevention in the general ward of cardiovascular surgery is fairly arduous. The present study intends to summarize our experience with infection control, including ward setting, admission procedures, personnel management, health education, and so on, to provide references for clinical management.

Exploring the Association Between Organizational Safety Climate, Failure to Rescue, and Mortality in Inpatient Surgical Units.

OBJECTIVE: To examine the association between organizational safety climate (OSC), in-hospital mortality (IM), and failure to rescue (FTR) in 2 hospitals, 1 with and 1 without crew-resource-management training. BACKGROUND: OSC is 1 of the most important organizational factors that promotes safety at work; however, there is a lack of research examining the relationship between OSC and patient deaths in hospitals. METHODS: We utilized a matched 2-group comparison of surgical patients and surveyed surgical staff to assess the relationship between OSC, FTR, and IM. RESULTS: The OSC assessment was completed by 261 surgical team members. A total of 1764 patients had at least 1 FTR complication; however, there was no association between OSC with FTR or IM for either hospital. CONCLUSIONS: Nurse leaders should remain vigilant in building work teams with strong hospital safety climates. More research is needed to explore the relationship between OSC and patient outcomes.

Pressure injury and risk in the inpatient paediatric and neonatal populations: A single centre point-prevalence study.

INTRODUCTION: Prevention and management of pressure injury is a key nurse-sensitive quality indicator. From clinical insights, pressure injury effects hospitalised neonates and children, however it is unclear how prevalent this is. The aim of this study was to quantify prevalence of pressure injury, assess skin integrity risk level, and quantify preventive interventions in both neonatal and child inpatient populations at a large children's hospital in the UK. METHODS: A cross-sectional study was undertaken, assessing the skin integrity of all children allocated to a paediatric or neonatal bed in June/July 2020. A data collection tool was adapted from two established pressure ulcer point prevalence surveys (EUPAP and Medstrom pre-prevalence survey). Risk assessment was performed using the Braden QD scale. RESULTS: Eighty-eight participants were included, with median age of 0.85 years [range 0-17.5 years), with 32 (36%) of participants being preterm. Median length of hospital stay was 11 days [range 0-174 days]. Pressure ulcer prevalence was 3.4%. The majority of participants had at least two medical devices, with 16 (18.2%) having more than four. Having a medical device was associated with increased risk score of developing pressure injury (odds ratio [OR] 0.03, 95% Confidence Interval [CI] 0.01-0.05, p = 0.02). Most children (39 (44%)) were reported not having proposed preventive measures in place aligned to their risk assessment. However, for those that did, 2 to 4 hourly repositioning was associated with a risk reduction on pressure damage (OR 0.13, 95% CI 0.03-0.23, p = 0.01). CONCLUSION: Overall, we found a low prevalence of pressure injury across preterm infants, children and young people at a tertiary children's hospital. Accurate risk assessment as well as availability and implementation of preventive interventions are a priority for healthcare institutes to avoid pressure injury.

Advancing evidence-based healthcare facility design: a systematic literature review.

Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.

Psychiatric nursing managers' attitudes towards containment methods in psychiatric inpatient care.

AIMS: This research was conducted to examine psychiatric nursing managers' attitudes towards containment methods. BACKGROUND: Nursing management is regarded as a key issue in the reduction of coercion and containment. However, there has been little research on managers' attitudes towards containment methods. METHODS: This descriptive, cross-sectional study utilized a survey design. Finnish inpatient psychiatric nursing managers (n = 90) completed the Attitudes to Containment Measures Questionnaire (ACMQ). The results were described with statistics, and the associations between attitudes and background variables were analysed using parametric tests. RESULTS: Psychiatric nursing managers had the most negative attitude towards net bed and mechanical restraint, and the most positive attitudes towards as necessary medication and intermittent observation. A few associations were discovered between attitudes and background variables such as gender and number of employees. CONCLUSIONS: In general, Finnish psychiatric nursing managers' attitudes towards containment methods seem to be quite negative, but more research is needed. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides fresh and unique data on the attitudes of psychiatric nursing managers towards containment methods. Managers' attitudes are important because of their ability to encourage investment in coercion reduction by nursing staff.

Patient safety from executive hospital management to wards: A qualitative study identifying factors influencing implementation.

AIM: To examine the journey of safety initiatives from executive hospital management to ward. BACKGROUND: Hospital management teams are often responsible for identifying safety priorities and ensuring delivery of these. METHOD: Naturalistic study design within a large NHS Hospital Trust. Using semi-structured interviews, focus groups and secondary data analysis, the study examines the implementation of safety initiatives. RESULTS: While hospital management developed five safety initiatives, only one of these (falls prevention) was actually seen to permeate all layers of the organisation. Other initiatives stopped one layer down. Both middle management and ward staff added to the list of initiatives developed, resulting in 16 priorities. A range of positive and negative influences to successful implementation are identified. CONCLUSIONS: Safety initiatives need positive reinforcement at all levels to be addressed appropriately. The research suggests that a model related to improvement science may prove useful in ensuring that priorities are addressed. IMPLICATIONS FOR NURSING MANAGEMENT: Care should be taken to ensure that safety initiatives are successfully implemented at all levels within an organisation. Identifying priorities with staff and sharing values and priorities are a key approach to leading such initiatives.

The effect of mindfulness-based training on stress, anxiety, depression and job satisfaction among ward nurses: A randomized control trial.

AIM: To assess the effect of a 4-week mindfulness-based training intervention on improving stress, anxiety, depression and job satisfaction among ward nurses. BACKGROUND: Previous literature showed that mindfulness-based training is useful for helping nurses cope with stress. METHOD: Nurses who have mild to moderate levels of stress, anxiety and depression identified from a teaching hospital were invited to a randomized control trial. The intervention group had a 2-hr Mindfulness-Based Training workshop, followed by 4 weeks of guided self-practice Mindfulness-Based Training website. Both the intervention group (n = 118) and the control group (n = 106) were evaluated pre- and post-intervention, and 8 weeks later (follow-up) using the Depression, Anxiety, and Stress Scale-21, Job Satisfaction Scale and Mindful Attention Awareness Scale. RESULTS: There was a significant effect over time on stress, anxiety, depression and mindfulness level (p < .05). Regarding the difference between the groups and interaction between time and group, there was a significant effect for anxiety (p = .037 p = .008) and job satisfaction (p < .001, p = .40), respectively, with moderate effect size for anxiety reduction (.465) and small for job satisfaction increment (.221). CONCLUSION: Mindfulness-Based Training is effective in improving anxiety and job satisfaction among nurses. CLINICAL IMPLICATIONS FOR NURSING MANAGEMENT: Mindfulness-Based Training can be included as hospital policy to reduce anxiety and increase job satisfaction among nurses.

Quality Improvement Initiative to Reduce Pediatric Intensive Care Unit Noise Pollution With the Use of a Pediatric Delirium Bundle.

OBJECTIVES:: Noise pollution in pediatric intensive care units (PICU) contributes to poor sleep and may increase risk of developing delirium. The Environmental Protection Agency (EPA) recommends <45 decibels (dB) in hospital environments. The objectives are to assess the degree of PICU noise pollution, to develop a delirium bundle targeted at reducing noise, and to assess the effect of the bundle on nocturnal noise pollution. METHODS:: This is a QI initiative at an academic PICU. Thirty-five sound sensors were installed in patient bed spaces, hallways, and common areas. The pediatric delirium bundle was implemented in 8 pilot patients (40 patient ICU days) while 108 non-pilot patients received usual care over a 28-day period. RESULTS:: A total of 20,609 hourly dB readings were collected. Hourly minimum, average, and maximum dB of all occupied bed spaces demonstrated medians [interquartile range] of 48.0 [39.0-53.0], 52.8 [48.1-56.2] and 67.0 [63.5-70.5] dB, respectively. Bed spaces were louder during the day (10AM to 4PM) than at night (11PM to 5AM) (53.5 [49.0-56.8] vs. 51.3 [46.0-55.3] dB, P < 0.01). Pilot patient rooms were significantly quieter than non-pilot patient rooms at night (n=210, 45.3 [39.7-55.9]) vs. n=1841, 51.2 [46.9-54.8] dB, P < 0.01). The pilot rooms compliant with the bundle had the lowest hourly nighttime average dB (44.1 [38.5-55.5]). CONCLUSIONS:: Substantial noise pollution exists in our PICU, and utilizing the pediatric delirium bundle led to a significant noise reduction that can be perceived as half the loudness with hourly nighttime average dB meeting the EPA standards when compliant with the bundle.

Severe community-acquired pneumonia in general medical wards: outcomes and impact of initial antibiotic selection.

BACKGROUND: Most international guidelines recommend empirical therapy for community-acquired pneumonia (CAP) to be based on site of care. Some patients with severe CAP are managed in general wards because of limited intensive care unit (ICU) bed or because of unrecognition of the pneumonia severity. Appropriate initial antibiotic treatment for severe CAP outside ICU has not yet been established. This study aimed to determine the prevalence and the impact of initial antibiotic selection on the outcomes of patients with severe CAP who were admitted and managing in general wards. METHODS: This prospective observational study included consecutive patients hospitalized for presumed CAP in general wards over a 1-year period. Severe CAP was identified using the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) criteria. Initial antibiotic treatment in the first 24 h were collected. The primary outcome was the rate of unfavorable outcome (composite outcome of treatment failure and in-hospital death). The secondary outcome was the number of hospital-free days assessed 30 days after enrollment into the study. RESULTS: There were 94 patients hospitalized with CAP of which 50 (53.2%) patients were compatible with severe CAP. An etiologic diagnosis was found in 43 (45.8%) patients. The most common pathogens identified in patients with severe CAP were Staphylococcus aureus (28.6%) and Klebsiella pneumoniae (28.6%), followed by Pseudomonas aeruginosa (17.9%). Patients with severe CAP had significantly more positive blood culture than patients with non-severe CAP (24% VS 4.5%; p = .008). Initial antibiotic treatment were discordant with the IDSA/ATS guidelines in 42% of all patients hospitalized with CAP, and 52% of patients with severe CAP. Multivariate analysis revealed that age (OR 1.1, 95% CI 1.01-1.1) and initial antibiotic treatment discordant to guidelines for severe CAP in ICU (OR 4.6, 95% CI 1.3-17.1) were independent risk factors of the unfavorable outcome of patients with severe CAP. Patients with unfavorable outcome had lower number of hospital-free days than patients with favorable outcome (5.2 ± 8 days VS 18 ± 7.1 days; p < .001). CONCLUSIONS: Patients with severe CAP outside ICU should be recognized for appropriate initial antibiotic selection to improve outcomes.

Concurrent Detection of Bacterial Pathogens in Hospital Roommates.

BACKGROUND: Some nurse-driven interventions have successfully reduced rates of healthcare-associated infections, though incidence remains unacceptably high. Bacterial contamination in patient rooms may be a source of exposure for patients and thus a target for future interventions; however, few studies have investigated the role of the patient room on organism acquisition. OBJECTIVES: The purpose of this study was to determine the incidence of concurrent detection of bacterial pathogens among patients sharing a hospital room. METHODS: We performed a retrospective network analysis using electronic administrative and clinical data collected from all patients admitted in 2006 through 2012 to four New York City hospitals, totaling 2,065 beds within 183 inpatient units. A computerized algorithm identified concurrent organism detection among roommates, defined as two patients who shared a room on at least 1 day and had a first positive culture for the same organism within 3 days following cohabitation. RESULTS: In total, 741,271 patient admissions were included. The algorithm identified 373 concurrent detection events: 158 (42%) in which the patients' first positive cultures were drawn after they were no longer sharing a room but within 3 days of cohabitation, 144 (39%) in which the patients' first positive cultures were drawn while they were still sharing a room but on different days, and 71 (19%) in which the patients' first positive cultures were drawn while they were sharing a room on the same day. DISCUSSION: Methods to improve environmental decontamination should be included as part of a comprehensive approach to infection prevention in hospitals. Nurses have an important role to play in the planning and implementation of interventions to reduce bioburden in the patient environment.

What's all that noise-Improving the hospital soundscape.

Hospital noise levels regularly exceed those recommended by the World Health Organization (WHO). It is uncertain whether high noise levels have adverse effects on patient health. High levels of noise increase patient sleep loss, anxiety levels, length of hospital stay, and morbidity rates. Staff conversation and auditory medical alarms are amongst the leading noise producing stimuli, with combinations of stimuli accounting for much of the high noise levels. The Hospital Consumer Assessment of Healthcare Providers and Systems survey shows a slight improvement in overall hospital noise levels in the United States, indicating a minor reduction in noise levels. Alarm ambiguity, alarm masking and inefficient alarm design contributes to a large portion of sounds that exceed the environmental noise level in the hospital. Improving the hospital soundscape can begin by training staff in noise reduction, enforcing noise reduction programs, reworking alarm design and encouraging research to evaluate the relative effects of noise producing stimuli on the hospital soundscape.

Horseshoe, Cockpit, and Dragonfly: Nurse Movement in Headwall Patient Rooms.

An exploratory, qualitative study conducted on 6 units in 4 hospitals featured field observations of 20 experienced nurses during complete 12-hour day and night shifts, followed by semistructured participant interviews. All patient rooms featured conventional headwall-type life support systems in which the head of the bed is against the wall where multiple electrical, gas, and communication utilities are located. Critical care nurses displayed repetitive movement patterns around the patient and the bed. Movement patterns observed varied according to room size, availability of supplies, and positions of fixed and/or mobile equipment, along with types and locations of documentation computers.

Room Design-A Phenomenological-Hermeneutical Study: A Factor in Creating a Caring Environment.

Medical technology has progressed tremendously over the last few decades, but the same development cannot be seen in the design of these intensive care unit environments. Authors report results of a study of evidence-based room design, emphasizing the impact on conveying a caring attitude to patients. Ten nonparticipant observations were conducted in patient rooms with 2 different designs, followed by interviews. The data were analyzed using a phenomenological-hermeneutical approach. The results did not reveal that it was obvious that redesigned spaces resulted in a more caring attitude. The meanings of caring displayed during nursing activities were interpreted by interpreting gazes. Some of the nursing staff had an instrumental gaze, interpreted as caring with a task-orientated approach, while others communicated their caring with an attentive and attuned gaze, where the needs of the patients regulated the working shift. The study findings indicated that caring may not be perceived when nurses use a task-oriented approach. However, when nurses practice a person-centered approach, using an attentive and attuned gaze, caring is conveyed. Caring in intensive care contexts needs to be assisted by a supportive environment design that cultivates the caring approach.

Is it possible to feel at home in a patient room in an intensive care unit? Reflections on environmental aspects in technology-dense environments.

This paper focuses on the patient's perspective and the philosophical underpinnings that support what might be considered optimal for the future design of the intensive care unit (ICU) patient room. It also addresses the question of whether the aspects that support at-homeness are applicable to ICU patient rooms. The concept of "at-homeness" in ICUs is strongly related to privacy and control of space and territory. This study investigates whether the sense of at-homeness can be created in an ICU, when one or more patients share a room. From an interdisciplinary perspective, we critically reflect on various aspects associated with conflicts surrounding the use of ICU patient rooms. Thus, from an architectural and a caring perspective, the significance of space and personal territory in ICU patient rooms is emphasized. Recommendations for further research are suggested. In conclusion, privacy and control are deemed to be essential factors in the stimulation of recovery processes and the promotion of well-being in situations involving severe illness or life-threatening conditions.

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 influence of air-dispersed essential oils from lemon (Citrus limon) and silver fir (Abies alba) on airborne bacteria and fungi in hospital rooms.

Airborne bacteria and fungi are an ongoing problem in hospitals. Because of the antimicrobial activities of essential oils (EOs) dispersion of EOs into the air may help to reduce this contamination. The aim of this study was to evaluate the efficacy of the dispersion of selected EOs in reducing the microbial contamination in two hospital wards. The study was carried out at two wards of a 1,227-bed acute-care hospital in Austria. The concentration of airborne bacteria and fungi was measured in patient rooms before and after dispersion of a mixture of Citrus limon EO and Abies alba EO. Before dispersion of the EOs in both wards the mean concentration of bacteria was in a typical range (123 colony forming units (CFU) m-3 and 104 CFU m-3) while the mean concentration of fungi differed substantially (155 CFU m-3 and 28 CFU m-3). After dispersion of the EOs, a reduction in both bacterial and fungal contamination was observed. In the first two hours the mean concentration of airborne bacteria and fungi was reduced by approximately 40% and 30%-60% respectively. The selected EO mixture is effective in reducing the microbial contamination of the indoor air.

Ward culture and staff relationships at hospital mealtimes in Australia: An ethnographic account.

Nutrition care is a fundamental component of quality health care provided to patients in hospital, yet little is known about the staff who deliver this care and their interrelationships, and how this impacts nutrition care. In this ethnographic study on two subacute wards, 67 h of fieldwork was conducted over 3 months to explore the relationships, roles, and responsibilities of those involved at mealtimes, and the influence on meal provision. Data were analyzed inductively and thematically. Three themes describing ward culture and staff relationships emerged: (i) defining mealtime roles and maintaining boundaries; (ii) balancing the need for teamwork and having time and space; and (iii) effective communication supports role completion and problem solving. Lack of appreciation of workflow enablers and barriers degraded working relationships between staff with and without central roles at mealtimes. The present study informs health-care organizations on building a culture that supports interprofessional collaboration in nutrition care in the subacute setting. All staff need to be aware of their and others' mealtime roles and responsibilities to support a coordinated approach.

Minority healthcare providers experience challenges, trust, and interdependency in a multicultural team.

BACKGROUND: The nursing community in the Nordic countries has become multicultural because of migration from European, Asian and African countries. In Norway, minority health care providers are recruited in to nursing homes which have become multicultural workplaces. They overcome challenges such as language and strangeness but as a group they are vulnerable and exposed to many challenges. PURPOSE: The aim is to explore minority healthcare providers, trained nurses and nurses' assistants, and their experiences of challenges when working in a multicultural team in a Norwegian context. RESEARCH METHOD: The study has a qualitative design, using narrative interviews, and a phenomenological-hermeneutic analysis method to explore the experiences of challenges in dementia care. ETHICAL CONSIDERATIONS: The study was approved by The Norwegian Regional Ethics Committee, and the Norwegian Social Science Data Services. PARTICIPATION AND RESEARCH CONTEXT: Five informants from different African, Asian and European countries participated in the study. The study was conducted in a Norwegian nursing home, in a dementia care unit. FINDINGS: The results show that minority health care providers experience and find meaning in being a member of a team, they overcome challenges, characterized by the interdependency in the team, appreciating new cultural experiences and striving to belong. They must overcome challenges such as language problems and the feeling of strangeness. DISCUSSION: The findings are discussed considering Løgstrup's ethic of proximity, the ethical demand of trust, and interdependency. The ethical demand is an answer to a common, transparent, unspoken agreement to be met, seen, and understood. CONCLUSION: The study shows that cooperation in a multi-professional and multi-ethnic team is important, and secures the quality of care to persons with dementia. Further research is necessary to examine the relation between a multi-ethnic staff and the patients experiencing dementia. Further research is necessary to examine ethnicity, the relation between a multi-ethnic staff, the patients experiencing dementia and next of kin.

Parents' Experiences of Support in NICU Single-Family Rooms.

PURPOSE: This study aimed to explore support for mothers and fathers in single-family rooms (SFRs) of a NICU. DESIGN: A qualitative descriptive design was employed. SAMPLE: A convenience sample of 15 parents (nine mothers, six fathers) were recruited from a Level III NICU. METHOD: During their infants' hospitalization, each parent recorded their thoughts and feelings regarding support whenever appropriate over a period of 48 hours using Handy Application to Promote Preterm infant happY-life (HAPPY), an android recording application. RESULTS: Parents felt supported when staff facilitated their learning in a collaborative manner, fostered their optimism, and provided situational assistance. Continuity and consistency of care and presence were important characteristics of supportive nursing care. Though SFRs offered privacy for parents to learn and to be with their infants, the design limited parental access to nursing and medical staff, which sometimes prevented parents from receiving adequate support and partaking in decision making concerning their infants' care.

Anticipated advantages and disadvantages of a move to 100% single-room hospital in Australia: A case study.

OBJECTIVES: There is an international policy trend for building government hospitals with greater proportions of single-occupancy rooms. The study aim was to identify advantages and disadvantages for patients and nursing staff of a pending move to 100% single-room hospital, in anticipation of the challenges for nurse managers of a different ward environment. This paper presents these findings, summarizing potential advantages and disadvantages as well as comparison with findings from similar studies in England. METHODS: Mixed method case study design was undertaken in four wards of a large hospital with multi-bed rooms. Three components of a larger study are reported here: nurse surveys and interviews, patient interviews of their experiences of the current multi-bedroom environment and expectations of new single-room environment. Integration was achieved via data transformation where results of the nursing staff survey and interviews and patient interviews were coded as narrative allowing for quantitative and qualitative data to be merged. RESULTS: Four constructs were derived: physical environment; patient safety and comfort; staff safety; and importance of interaction. CONCLUSION: There are important factors that inform nurse managers when considering a move to an all single-room design. These factors are important for nurses' and patients' well-being. IMPLICATIONS FOR NURSING MANAGEMENT: This study identified for nurse managers key factors that should be considerd when contributing to the design of a 100% single-room hospital. Nurses' voices are critically important to inform the design for a safe and efficient ward environment.