Background Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon. Aim The aim of this study is to describe the prevalence and patterns of nursing ...care left undone across European hospitals and explore its associations with nurse-related organisational factors. Methods Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study. Results Across European hospitals, the most frequent nursing care activities left undone included ‘Comfort/talk with patients’ (53%), ‘Developing or updating nursing care plans/care pathways’ (42%) and ‘Educating patients and families’ (41%). In hospitals with more favourable work environments (B=−2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone. Conclusions Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.
Recruiting into the manager role is one of the most difficult positions to fill. Once the manager is hired great attention needs to be given to onboarding into this role. Quite often we are faced ...with managers who have never managed before, are excellent clinicians, but have never lead a team or department. Adding a specialty as Oncology can be quite challenging not only for the novice manager, but also the seasoned manager. How to create structured educational onboarding experiences with a changing environment presents barriers needing to be overcome. Too often events take precedence over the manager able to take the time out for learned experiences, and not place into the fire before having the skills to manage the crisis. Developing an onboarding and mentoring format involves an oncology interdisciplinary team to coordinate learning experiences that will be added value to this role. This team includes physicians, social work, human resources, administrators, operations, and ancillary departments, all who interact with this role. This presentation will review onboarding of an oncology nurse managers for both inpatient and outpatient units. Barriers will be reviewed, and solutions presented. Holding accountable other disciplines to support will be outlined and strategies to support this effort. Highlighting will be the importance of commu- nication, written documentation, engagement of Vice President to this process and how the onboarding must include nursing staff members. Also discussed will be defining what mentorship means and how current nurse managers need to be educated on how to effectively mentor new managers, how to provide constructive feedback, outline written plans and how to arrange structured time to review progress. tion of and how to navigate problem solving, arrange for additional experiences and support overall onboarding process are skills needing support for managers and resources and processes to assist will be reviewed. reviewed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Exposure to hazardous drugs (HDs) poses many significant risks to healthcare workers. Side effects range from gastrointestinal and respiratory complaints to infertility and miscarriages. Research has ...shown that HD contamination can spread from pharmacy areas and administration areas to other clinical and non-clinical locations within the healthcare facility. As a part of a comprehensive HD plan, the United States Pharmacopeia chapter 800 (USP ) recommends regular surface wipe testing to assess vulnerabilities in compounding and administration and highlight areas for improvement. Sequential wipe testing was performed in an ambulatory comprehensive cancer center to test for HD residue in 4 pharmacy compounding areas and 2 administration areas. Tested drugs included paclitaxel, 5-FU, cyclophosphamide, methotrexate, and doxorubicin. Testing occurred between December 2020 and June 2021 and was performed at baseline, 3 months and at 6 months using the sampling technique specified by ChemoGLO. The authors sampled the interior of a biological safety cabinet (BSC), air grate of BSC, floor in front of the BSG, floor of the personal protective equipment (PPE) doffing area in the compounding room, and the mixing bin for staging items needed for sterile HD compounding. In the administration area, the legs of one marked IV pole was tested along with the handle of a designated telephone at a nursing station. The identical locations and procedures were used by the authors for all 3 testing periods. The majority of the IV HD compounding, and all administrations were performed using the GhemoLock GSTD. Test number one revealed two areas above the level of detection (LOD); the mixing bin (5FU) and the IV pole (paclitaxel). Tests 2 and 3 were below the LOD for all drugs in all areas. USP requires a 4-step cleaning/decontamination process for sterile compounding of HDs. The process was not utilized consistently for the mixing bins and could explain initial HD residue. Decontamination frequency was increased after the first results. While the IV pole was wiped down with an antimicrobial cloth between each patient, the legs were not included in the cleaning procedure, nor is it known how long the paclitaxel contamination had been there. This project demonstrated effectiveness of the CSTD and the need for improvement in cleaning the IV poles. Process changes and cleaning products are currently being discussed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The GOVID 19 pandemic led many healthcare organizations to adopt a remote workforce model for employee safety. A multidisciplinary committee formed to ensure the work environment was productive and ...satisfying for staff. Both clinical and nonclinical positions were included in the project. The purpose of this workgroup was to assess the feasibility for remote work for cancer hospital positions. The workgroup aimed to develop virtual teams to support patient centered care, leadership, communication, and social cohesion as contributors to virtual success. This workgroup identified and clarified hospital clinical and administrative roles with necessary technologies suitable for successful implementation by remote staff. Administrative and clinical managers were surveyed to assist with role clarification, software needs, and potential implementation costs. Team members collaborated with hospital ITS department on project requirements leading to the development of a standard technology bundle and budget. Another team created a Tips & Tricks resource for common software applications used off-site. Staff demonstrated success in full and hybrid models of remote work. Productivity measures provided metrics with objective outcomes for each remote work role. A distributed employee satisfaction survey revealed a return rate of 63/1174 (5%). Positive comments included preference for hybrid work model, economic savings, decreased commuting time, increased work efficiency, and enhanced work/life balance. Challenges included technology, connectivity issues, and decreased social interactions. Remote healthcare was new to most employees and managers. There was a learning curve related to knowledge and technology gaps. The committee was able to combine efforts with the technology department to develop best practices for remote staff which allowed them to provide the best possible care to patients. The multidisciplinary workgroup was able to provide recommendations to hospital leadership regarding training and required resources. These recommendations were accepted and implemented and remote employees were able to have access to technology and equipment that was not previously available. Recommendations presented by the workgroup allowed remote employees to work at the highest functioning level without compromised patient care. As staff continue to transition to remote work or are newly hired into roles where remote work is appropriate, a standard bundle of necessary equipment and resources allows for a more smooth transition and onboarding process.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Assessing the right number and type of nursing staff to meet patient care needs is fundamental to inpatient care. Correctly identifying specific patient care needs per shift and equally balancing ...nursing workload increases nurse satisfaction and optimizes resources needed to provide appropriate levels of care. Subjective acuity grading results in perception of unbalanced assignments, increased nursing workload, frustration, and inaccurate representation of patient needs per shift on a stem cell transplant (SCT) inpatient unit. The goal of this project was to develop and implement an objective acuity tool to accurately define patient acuity based on specific needs and care required for SCT patients, appropriately balance nursing workload, and increase nurse satisfaction with patient acuity in their assignments. Observation and pre-survey feedback on the existing process and tool supported the need for a more defined grading approach. An objective acuity tool was designed to the needs of the SCT population. Educational materials were created for staff in-services and a bulletin board was displayed in the break room. Paper copies of the tool were completed by every nurse and collected each shift by the charge nurse. The total number for acuity was utilized by the charge nurse when creating assignments. Revisions were made based on staff feedback and a post survey was completed following initial roll out. 87% of staff perceived the objective acuity tool as accurately reflecting their patient care needs, compared to 26% with the subjective tool. 74% of staff felt there was an equal distribution and balanced nursing workload, compared to 26% with the subjective tool. 65% satisfaction with the patient acuity in assignments was also seen, an increase of 45%. The development and implementation of an objective patient needs-based acuity tool was successful on the SCT inpatient unit, with 97% of staff feeling the new acuity tool has been beneficial, and 94% rating they would like to continue using the tool. Literature supports the use of a tailored tool in specialized patient populations for it more accurately reflects necessary levels of care and leads to improved patient outcomes. Since the SCT population comes with its own specific set of needs that creates complexity in care, it is vital that they are accurately represented to provide the safest and highest quality nursing care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
At Karmanos Cancer Center nursing care is delivered using the principles of the Relationship-Based care model. One of the principles in the model is care of self; one way organizations can promote a ...caring environment is by providing self-care initiatives through education. The COVID pandemic has placed additional stressors on staff not only at work, but also at home. Staff expressed an interest in learning more about self-care and requested additional information. At the time, the organization/unit did not have self-care specific information available for the staff. The purpose of this process improvement project was to provide staff resources on self-care initiatives and heighten the awareness of the importance of self-care. A wellness board was created next to the time clock for staff to view. The wellness board has areas to place information related to mindfulness, exercise, and healthy eating with a goal of changing out information monthly. Once created all staff were educated on development and purpose of the wellness board through email communication. The wellness board is updated by various members of the team and all team members are encouraged to add information they find helpful. After the wellness board was created, the staff were encouraged to discuss self-care throughout the day. Some staff have found the board helpful, but unfortunately it has not been as engaging as originally thought. It has been difficult to have additional staff members providing resources for the board as originally thought. The placement of the board is being evaluated to see if it includes all staff (including those that do not punch in with a time clock). Other units throughout the healthcare system are also looking at the use of a wellness board. Self-care is an important part of an oncology nurse's day especially as they deal with the complexity of care related to GOVID and restrictions. A wellness board is a method to be able provide education related to self-care and can easily be replicated in other areas. With proper placement the wellness board can encourage staff to think about wellness and how it can easily be integrated into their busy lives. The wellness board can also promote an environment in which the staff feel supported and valued by leadership and other colleagues.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Tennessee Oncology is a multi-site practice with more than 30 locations across Tennessee and northern Georgia. Tennessee Oncology has a high percentage of patients with implanted central venous ...access devices (ports). These devices were routinely accessed for reasons beyond chemo-immunotherapy infusions, including but not limited to blood draws, supportive care medications administration, and scans. Time studies completed in 2020 showed that port access for blood collection increased the time to obtain lab results by 7 minutes per draw. In some cases, delays up to 45 minutes occurred if troubleshooting was required during the access. An increase in incidence of compromised specimen integrity due to the presence of flush solution or other medications in the lumen or from poor specimen collection technique was also seen. This was quantified through number of hemolyzed specimens, increased/inaccurate clotting times, and diluted sam- pies. Impaired specimen integrity impacted the providers' ability to make accurate treatment decisions and caused treatment delays because of repeat collection and processing. A review of literature supported the process change by validating an increased risk of central line associated bloodstream infections (GLABSI) with repeated/frequent port access. Risk for catheter associated clots was also a consideration for making a change. To increase efficiency of patient throughput and reduce port access frequency, the decision was made to pilot transitioning lab specimen collection from the port to venipuncture or fingerstick. The goals of the pilot were to expedite lab results and reduce risk for GLABSI and clot formation by reserving port use for infusion therapy. Each clinic was tasked with shifting the port access from the laboratory staff to nursing staff in the infusion suite. Patients were only accessed after the determination was made to proceed with treatment. Data was gathered throughout the transition on compliance with the change, patient time through the clinics and integrity of lab specimens. The outcome of the pilot was positive. Some clinics were able to reduce total port draws by as much as 20% in the first four months and preliminary data showed improved efficiency of workflows in the clinics. The pilot was extended into an enterprise-wide process change. It is projected that ongoing data collection will show impact on quality and efficiency of care and a reduction in port complications across the practice.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background
Previous studies on bedside handovers have identified nurse‐related barriers and facilitators for implementing bedside handovers, but have neglected the existing ward’s nursing care system ...as an important influencing factor.
Aims
To determine the association between the existing nursing care system (i.e., decentralized, two‐tier, or centralized) on a ward and the barriers and facilitators of the bedside handover.
Methods
Structured individual interviews (N = 106) on 14 nursing wards in eight hospitals were performed before implementation of bedside handovers. The structured interview guide was based on a narrative review. Direct content analysis was used to determine the nursing care system of a ward and the degree to which barriers and facilitators were present. Pearson’s Chi‐square analysis was used to determine whether there were associations between the nursing care systems concerning the presence of barriers and facilitators for implementing bedside handovers.
Results
Twelve barriers and facilitators were identified, of which three are new to literature: the possible loss of opportunities for socializing, collegiality, and overview; head nurse’s role; and role of colleagues. The extent to which barriers and facilitators were present differed across nursing care systems, with the exception of breach of confidentiality (barrier), and an existing structured handover (facilitator). Overall, nurses working in decentralized nursing care systems report fewer barriers against and more facilitators in favor of using bedside handovers than nurses in two‐tier or centralized systems.
Linking Evidence to Action
Before implementing bedside handovers, the context of the nursing care system may be considered to determine the most effective process to implement change. Based on these study findings, implementing bedside handovers could be more challenging on wards with a two‐tier or centralized care system.
Correlates and predictors of missed nursing care in hospitals Bragadóttir, Helga; Kalisch, Beatrice J; Tryggvadóttir, Gudný Bergthora
Journal of clinical nursing,
June 2017, 2017-Jun, 2017-06-00, 20170601, Letnik:
26, Številka:
11-12
Journal Article
Recenzirano
Odprti dostop
Aims and objectives
To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals.
Background
A recently identified ...quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted or significantly delayed, indicating an error of omission. Former studies point to contributing factors to missed nursing care regarding hospital, unit and staff characteristics, perceptions of staffing adequacy as well as nursing teamwork, displayed in the Missed Nursing Care Model.
Design
This was a quantitative cross‐sectional survey study.
Methods
The samples were all registered nurses and practical nurses (n = 864) working on 27 medical, surgical and intensive care inpatient units in eight hospitals throughout Iceland. Response rate was 69·3%. Data were collected in March–April 2012 using the combined MISSCARE Survey‐Icelandic and the Nursing Teamwork Survey‐Icelandic. Descriptive, correlational and regression statistics were used for data analysis.
Results
Missed nursing care was significantly related to hospital and unit type, participants’ age and role and their perception of adequate staffing and level of teamwork. The multiple regression testing of Model 1 indicated unit type, role, age and staffing adequacy to predict 16% of the variance in missed nursing care. Controlling for unit type, role, age and perceptions of staffing adequacy, the multiple regression testing of Model 2 showed that nursing teamwork predicted an additional 14% of the variance in missed nursing care.
Conclusions
The results shed light on the correlates and predictors of missed nursing care in hospitals. This study gives direction as to the development of strategies for decreasing missed nursing care, including ensuring appropriate staffing levels and enhanced teamwork.
Relevance to clinical practice
By identifying contributing factors to missed nursing care, appropriate interventions can be developed and tested.
Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and ...implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date.
A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach.
Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability).
At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.
PDF
