Journal of nursing care quality最新文献

Background: Diarrhea during enteral nutrition may induce various complications and increase the nursing workload.

Local problem: The diarrhea rate in our intensive care units (ICUs) was 37.14% from May to July 2021. Nurses reported a moderate to heavy burden regarding care for those with diarrhea.

Methods: A pre-post implementation design was used to evaluate the impact of evidence-based interventions for diarrhea screening and prevention.

Interventions: A diarrhea risk screening tool and countermeasures were developed through an extensive literature review. Tools were integrated into the electronic health record system.

Results: The rate of diarrhea decreased from 37.14% to 17.33% ( P = .000). Nurse's compliance with practice standards increased for diarrhea assessment, risk factor screening, agent choice, and countermeasures provision ( P < .05).

Conclusions: The evidence-based tools developed for this project helped decrease the diarrhea rate in our ICUs.

Background: Evidence-based practice (EBP) is a major concept threaded throughout nursing education, yet competencies are not clearly identified in The Essentials.

Purpose: Nurse leaders'EBP competency expectations for professional practice were explored to inform competency-based education for students and practicing nurses. A secondary aim explored potential effects of misinformation on EBP.

Methods: Descriptive qualitative inquiry was performed with a focus group of 6 clinical nurse leaders.

Results: EBP expectations were identified, discriminating between novice entry level and advanced-level nurses. Participants emphasized asking questions, linking evidence to practice, and acknowledging that evidence changes over time. All advanced-level nurses were expected to apply, lead, and teach EBP. Post pandemic, nurses need to reclaim evidence-based practices, critically appraise evidence, and educate patients and families to address misinformation.

Conclusions: Information learned will inform competency-based EBP education for students and nurses in academic and clinical settings.

Background: Secure messaging (SM) is a communication feature within a patient portal that allows patients and clinical staff to exchange health-related information securely and confidentially.

Purpose: This study aimed to explore how pediatric clinical staff use SM, identify challenges in its implementation, and suggest quality improvements.

Methods: A descriptive quantitative study was administered using an online survey in a large health care system. The Task, User, Representation, and Function framework guided the research.

Results: The survey participants were moderately satisfied with the SM. Opportunities to design this system to be more efficient and maximize patient safety were identified.

Conclusion: Improving training and workflow can aid in incorporating SM into clinician's daily routines, focusing on enhancing user satisfaction. Future developments aimed at increasing usage and standardizing message content are crucial for encouraging adoption and ensuring patient safety.

Background: Frailty is independently associated with adverse patient outcomes after surgery. The current standards of postoperative care rarely consider frailty status.

Local problem: There was no standardized protocol to optimize specialized postoperative care for frail patients at an academic medical center.

Methods: A quasi-experimental pre-/postimplementation study design, using the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework, was utilized.

Interventions: A frailty-specific postoperative order set (FPOS) was developed, including tailored nursing care, activity levels, and nutritional goals.

Results: There were significant improvements in nurse's self-reported familiarity with frailty ( P = .003) and FPOS awareness ( P < .001). The number of orders for delirium prevention, elimination, nutrition, sleep promotion, and sensory support increased ( P < .001).

Conclusions: Implementing an FPOS showed improvements in nurse frailty knowledge, awareness, and order set utilization.

Background: Nuisance and false alarms distract clinicians from urgent alerts, raising patient safety risks.

Local problem: High alarm rates in a pediatric progressive care unit resulted in experiencing 180-250 alarms per day or 1 alarm every 3 to 4 minutes per clinician.

Methods: Through Plan-Do-Study-Act cycles, environmental, policy, and technology changes were implemented to decrease the average alarms/day/bed and percentage of time in alarm.

Interventions: Alarm settings tailored to patient needs using features embedded within the patient monitoring system were implemented and monitored with the assistance of alarm champions.

Results: The average number of alarms/day/bed decreased from 177.69 to 96.94 over the course of 10 years, a 45.45% reduction. The percentage of time in alarm decreased from 7.52% to 2.83%, a 62.37% reduction.

Conclusions: Arming clinicians with technology to analyze real-time clinical data made alarms meaningful and actionable, decreasing false alarms without compromising patient safety.

Background: Nurse-led interventions in ophthalmology care can enhance the overall patient experience while optimizing health care system efficiency.

Purpose: The purpose of this study was to investigate the impact of nurse-led interventions in ophthalmology care.

Methods: A comprehensive search was conducted across multiple databases for articles published from 2000 to 2023. Randomized controlled trials, quasi-experimental, and observational studies were included. Quality assessments were performed using the Cochrane Risk of Bias tool or Newcastle-Ottawa Scale, based on study design.

Results: Nineteen studies were included. Nurse-led interventions positively impacted patient outcomes, improved efficiency and resource utilization, enhanced patient satisfaction and adherence, maintained safety and efficacy, and demonstrated notable diagnostic accuracy. Included studies originated from different countries and employed diverse methodologies, offering a global perspective on nurse-led interventions in ophthalmology care.

Conclusion: The findings advocate for the integration of nurse-led strategies in routine practice to realize equitable, efficient, and patient-centered eye care.

Background: Synergistic opportunity exists between Magnet-aspiring environments and High Reliability Organization (HRO) cultures to elevate safety, quality, new knowledge, continuous improvement, hierarchical flattening, and frontline empowerment.

Local problem: Variation existed across a region's 15 hospitals regarding Magnet-readiness, leadership engagement, journey strategies, and resource capacity.

Methods: Quality improvement (QI) methodology and a hybrid-hub-spoke-model (HHSM) were used to support region-wide Magnet designation, improve patient outcomes, and advance nursing research.

Interventions: HRO strategies were used region-wide to strengthen implementation and enculturation of Magnet excellence infrastructure.

Results: Nine facilities achieved Magnet recognition. Magnet sites demonstrated significantly lower falls with injury ( P = .012), lower health care-associated infections and hospital-acquired pressure injuries than non-Magnet sites. Nursing research studies increased 223%.

Conclusions: Utilizing a HHSM and HRO strategies represent effective methods for supporting region-wide Magnet designation and continuous QI.