Short peripheral intravenous catheter (PIVC) failure is a common complication that is generally underdiagnosed. Some studies have evaluated the factors associated with these complications, but the ...impact of care complexity individual factors and nurse staffing levels on PIVC failure is still to be assessed. The aim of this study was to determine the incidence and risk factors of PIVC failure in the public hospital system of the Southern Barcelona Metropolitan Area.
A retrospective multicentre observational cohort study of hospitalised adult patients was conducted in two public hospitals in Barcelona from 1st January 2016 to 31st December 2017. All adult patients admitted to the hospitalisation ward were included until the day of discharge. Patients were classified according to presence or absence of PIVC failure. The main outcomes were nurse staffing coverage (ATIC patient classification system) and 27-care complexity individual factors. Data were obtained from electronic health records in 2022.
Of the 44,661 patients with a PIVC, catheter failure was recorded in 2,624 (5.9%) patients (2,577 5.8% phlebitis and 55 0.1% extravasation). PIVC failure was more frequent in female patients (42%), admitted to medical wards, unscheduled admissions, longer catheter dwell time (median 7.3 vs 2.2 days) and those with lower levels of nurse staffing coverage (mean 60.2 vs 71.5). Multivariate logistic regression analysis revealed that the female gender, medical ward admission, catheter dwell time, haemodynamic instability, uncontrolled pain, communication disorders, a high risk of haemorrhage, mental impairments, and a lack of caregiver support were independent factors associated with PIVC failure. Moreover, higher nurse staffing were a protective factor against PIVC failure (AUC, 0.73; 95% confidence interval CI: 0.72-0.74).
About 6% of patients presented PIVC failure during hospitalisation. Several complexity factors were associated with PIVC failure and lower nurse staffing levels were identified in patients with PIVC failure. Institutions should consider that prior identification of care complexity individual factors and nurse staffing coverage could be associated with a reduced risk of PIVC failure.
Introduction Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early ...deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients’ electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 0.9% pressure ulcers; 1,217 0.7% falls and 1,236 0.7% aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular fragility, extreme weight, uncontrolled pain, male sex, length of stay and admission to a medical ward. High-tech hospital admission was associated with an increased risk of adverse events and a reduced risk of in-hospital mortality. The area under the ROC curve for both outcomes was > 0.75 (95% IC: 0.78–0.83). Conclusions Several care complexity individual factors were associated with adverse events and in-hospital mortality. Prior identification of complexity factors may have an important effect on the early detection of acute deterioration and on the prevention of poor outcomes.
Objective
To identify and classify the barriers and facilitators of the individualisation process of the standardised care plan in hospitalisation wards.
Background
The administration of ...individualised care is one of the features of the nursing process. Care plans are the structured record of the diagnosis, planning and evaluation stages of the nursing process. Although the creation of standardised care plan has made recording easier, it is still necessary to record the individualisation of the care. It is important to study the elements that influence the individualisation process from the nurses' perspective.
Design
Qualitative study with the grounded theory approach developed by Strauss and Corbin.
Methods
Thirty‐nine nurses from three hospitals participated by way of theoretical sampling. In‐depth interviews were conducted, as well as participant observation, document analysis and focus group discussion. The analysis consisted of open, axial and selective coding until data saturation was reached. EQUATOR guidelines for qualitative research (COREQ) were applied.
Results
For both barriers and facilitators, three thematic categories emerged related to organisational, professional and individual aspects. The identified barriers included routines acquired in the wards, the tradition of narrative records, lack of knowledge and limited interest in individualisation. The identified facilitators included holding clinical care sessions, use of standardised care plan and an interface terminology, the nurse's expertise and willingness to individualise.
Conclusion
The individualisation process of the standardised care plan involves multiple barriers and facilitators, which influence its degree of accuracy.
Relevance to clinical practice
Implementing strategies at an organisational level, professional level and individual level to improve the way the process is carried out would encourage individualising the standardised care plan in a manner that is consistent with the needs of the patient and family; it would improve the quality of care and patient satisfaction.
Aim
To understand the individualization process of the standardized care plan (SCP) that nurses design for hospitalized patients.
Background
To apply the nursing process, it is advisable to use SCP ...to standardize the diagnosis, planning and evaluation stages. However, the fundamental element of this methodology is the individualization of the care plan.
Design
A qualitative study, framed within the constructivist paradigm and applying the Grounded Theory method, in accordance with Strauss and Corbin's approach.
Methods
Multicentre study. Theoretical sampling with maximum variation will be used. The data collection will consist of: in‐depth individual interviews, participant observation, document analysis, focus group, and the questionnaires for Critical Thinking Assessment in relation to clinical practice and Nursing Competency Assessment for hospital nurses. The qualitative data will be analysed according to the constant comparative method of Strauss and Corbin's Grounded Theory, which involves performing open, axial and selective coding. The questionnaire results will be used to make a qualitative analysis that will consist of a triangulation between the level of critical thinking, level of expertise and record of the individualization process performed by the nurses. This protocol was approved in July 2015.
Discussion
By knowing the possible stages used in the individualization of a SCP, together with the elements that facilitate or hinder said individualization and nurses’ attitudes and experiences regarding this phenomenon, it could help direct improvement strategies in the standardization and individualization process. In addition to recommendations for teaching and research.
目的
了解护理人员为住院患者设计的标准化护理计划(SCP)的个体化程序。
背景
为了适应护理过程,建议使用标准化护理计划来规范诊断、规划和评价阶段。然而,本方法的基本要素是护理计划的个体化。
设计
根据施特劳斯和科尔宾方法,在建构主义范式框架下,应用扎根理论方法进行定性研究。
方法
多中心研究。将采用最大变化的理论抽样。资料收集将包括:深度个人访谈、参与观察、文献分析、焦点小组以及针对临床实践的批判性思维评估问卷调查和医院护士的护理能力评估。定性数据将根据施特劳斯和科尔宾扎根理论的常量比较法,进行分析,其中包括执行开放、轴向和选择性的编码。问卷调查结果将用来进行定性分析,其中包括评判性思维水平、专业知识水平与护士负责的个体化程序记录之间的三角测量。本方案于2015年7月获得批准。
讨论
通过了解标准化护理计划之个体化的潜在阶段,以及促进或阻碍个体化的因素和护士对这种现象的态度和经验,除了可为教学和研究提供建议,还有助于对标准化和个性化过程中的改进策略提供指导。
Aim
The aim of this study was to develop and validate the Nursing Intensive‐Care Satisfaction Scale to measures satisfaction with nursing care from the critical care patient's perspective.
Background
...Instruments that measure satisfaction with nursing cares have been designed and validated without taking the patient's perspective into consideration. Despite the benefits and advances in measuring satisfaction with nursing care, none instrument is specifically designed to assess satisfaction in intensive care units.
Design
Instrument development.
Methods
The population were all discharged patients (January 2013 ‐ January 2015) from three Intensive Care Units of a third level hospital (N = 200). All assessment instruments were given to discharged patients and 48 hours later, to analyse the temporal stability, only the questionnaire was given again. The validation process of the scale included the analysis of internal consistency, temporal stability; validity of construct through a confirmatory factor analysis; and criterion validity.
Results
Reliability was 0.95. The intraclass correlation coefficient for the total scale was 0.83 indicating a good temporal stability. Construct validity showed an acceptable fit and factorial structure with four factors, in accordance with the theoretical model, being Consequences factor the best correlated with other factors. Criterion validity, presented a correlation between low and high (range: 0.42‐0.68).
Conclusions
The scale has been designed and validated incorporating the perspective of critical care patients. Thanks to its reliability and validity, this questionnaire can be used both in research and in clinical practice. The scale offers a possibility to assess and develop interventions to improve patient satisfaction with nursing care.
Aims and objectives
To evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in‐patients from a model of care needs based on ...variables easily measured by nurses.
Background
There are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited.
Design and methods
A case–control study. A specific form of data collection was designed to include the risk factors for delirium commonly identified in the literature and the care needs evaluated from the comprehensive nursing assessment based on the Virginia Henderson model of care needs. We studied 454 in‐patient units in a basic general hospital. Data were collected from a review of the records of patients’ electronic clinical history.
Results
The areas of care that were significant in patients with delirium were dyspnoea, problems with nutrition, elimination, mobility, rest and sleep, self‐care, physical safety, communication and relationships. The specific risk factors identified as independent predictors were as follows: age, urinary incontinence, urinary catheter, alcohol abuse, previous history of dementia, being able to get out of bed/not being at rest, habitual insomnia and history of social risk.
Conclusions
Comprehensive nursing assessment is a valid and consistent strategy with a multifactorial model of delirium, which enables the personalised risk assessment necessary to define a plan of care with specific interventions for each patient to be made.
Relevance to clinical practice
The identification of the risk of delirium is particularly important in the context of prevention. In a model of care based on needs, nursing assessment is a useful component in the risk assessment of delirium and one that is necessary for developing an individualised care regime.
Aim
To assess the ability of the patient main problem to predict acuity in adults admitted to hospital wards and step‐down units.
Background
Acuity refers to the categorization of patients based on ...their required nursing intensity. The relationship between acuity and nurses' clinical judgment on the patient problems, including their prioritization, is an underexplored issue.
Method
Cross‐sectional, multi‐centre study in a sample of 200,000 adults. Multivariate analysis of main problems potentially associated with acuity levels higher than acute was performed. Distribution of patients and outcome differences among acuity clusters were evaluated.
Results
The main problems identified are strongly associated with patient acuity. The model exhibits remarkable ability to predict acuity (AUC, 0.814; 95% CI, 0.81–0.816). Most patients (64.8%) match higher than acute categories. Significant differences in terms of mortality, hospital readmission and other outcomes are observed (p < .005).
Conclusion
The patient main problem predicts acuity. Most inpatients require more intensive than acute nursing care and their outcomes are adversely affected.
Implications for nursing management
Prospective measurement of acuity, considering nurses' clinical judgments on the patient main problem, is feasible and may contribute to support nurse management workforce planning and staffing decision‐making, and to optimize patients, nurses and organizational outcomes.
Professionals that work in neonatal units need to identify the strengths and weaknesses of the premature infant who is in the transition process from feeding through a gastric tube to oral feeding. ...The main aim of this study was to validate the Oral FEeding Assessment in premaTure INfants (OFEATINg) instrument. A psychometric validity and reliability study was conducted in Neonatal Intensive Care Units of two public, metropolitan, university hospitals. The study population were premature infants at a postconceptional age of 31-35 weeks. The study included evaluation of the reliability, convergent, discriminant and construct validity, sensitivity and specificity of the OFEATINg instrument. A total of 621 feedings of 56 preterm infants were evaluated. Confirmatory factor analysis identified 3 factors and 13 indicators with a good fit to the model. Cronbach's alpha coefficient was 0.78. The instrument showed high indices of inter-rater reliability (Pearson 0.9 and intraclass correlation coefficient 0.95). The OFEATINg scale is a valid and reliable instrument for evaluating the readiness for oral feeding of preterm infants. It may enable clinicians to evaluate the physiological and behavioral abilities involved in the oral feeding process and help them make decisions related to the transition to full oral feeding.Clinical trial registration: This study was prospectively registered at the two Institutional review boards.
Aim
To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit‐clusters.
Background
Relationships among acuity, nurse staffing and ...workforce, missed nursing care and patient outcomes are not completely understood.
Method
Descriptive design with data from four unit‐clusters: medical, surgical, combined and step‐down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse‐sensitive outcomes.
Results
Patient acuity in general (medical, surgical and combined) floors is similar to step‐down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit‐clusters, and average missed nursing care is 21%. Patient outcomes vary among unit‐clusters.
Conclusion
Patient acuity is similar among unit‐clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit‐clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards.
Implications for Nursing Management
Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.
Abstract Aim Describe the activity of hospital emergency departments (EDs) and the sociodemographic profile of patients in the eight public hospitals in Spain, according to the different triage ...levels, and to analyse the impact of the SARS‐CoV‐2 pandemic on patient flow. Design An observational, descriptive, cross‐sectional and retrospective study was carried out. Method s Three high‐tech public hospitals and five low‐tech hospitals consecutively included 2,332,654 adult patients seen in hospital EDs from January 2018 to December 2021. Hospitals belonging to the Catalan Institute of Health. The main variable was triage level, classified according to a standard for the Spanish structured triage system known as Sistema Español de Triaje. For each of the five triage levels, a negative binomial regression model adjusted for year and hospital was performed. The analysis was performed with the R 4.2.2 software. Results The mean age was 55.4 years. 51.4% were women. The distribution of patients according to the five triage levels was: level 1, 0.41% ( n = 9565); level 2, 6.10% ( n = 142,187); level 3, 40.2% ( n = 938,203); level 4, 42.6% ( n = 994,281); level 5, 10.6% ( n = 248,418). The sociodemographic profile was similar in terms of gender and age: as the level of severity decreased, the number of women, mostly young, increased. In the period 2020–2021, the emergency rate increased for levels 1, 2 and 3, but levels 4 and 5 remained stable. Conclusion More than half of the patients attended in high‐technology hospital EDs were of low severity. The profile of these patients was that of a young, middle‐aged population, mostly female. The SARS‐CoV2 pandemic did not change this pattern, but an increase in the level of severity was observed. Impact What problem did the study address? There is overcrowding in hospital EDs. What were the main findings? This study found that more than half of the patients attended in high‐technology hospital EDs in Spain have low or very low levels of severity. Young, middle‐aged women were more likely to visit EDs with low levels of severity. The SARS‐CoV2 pandemic did not change this pattern, but an increase in severity was observed. Where and on whom will the research have an impact? The research will have an impact on the functioning of hospital EDs and their staff. Patient or Public Contribution Not applicable.
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