Journal of nursing care quality最新文献

Background: The Clinical Nurse Leader (CNL) is a skilled clinician qualified in outcomes-based practice and quality improvement. Publications describe the CNL training, integration, and outcomes. However, CNL practice development and its impact has not been fully explored.

Purpose: This review aimed to synthesize existing literature related to CNL practice development and identify what influences on the care environment and nursing care outcomes.

Methods: An integrative literature review was conducted in 5 bibliographic databases for sources published in English from January 2012 to March 2023.

Results: Fifteen publications identified 3 interrelated themes of CNL practice, outcomes, and practice development. Staff development needs were identified across various levels of expertise.

Conclusion: There is a need to further explore CNL practice development and how it can impact the care environment and care outcomes.

Background: Nursing quality indicators (NQIs) are essential for evaluating and managing care, yet few validated NQIs exist for emergency nursing. The dynamic nature of this field demands specific, validated indicators.

Purpose: The purpose of this review was to identify NQIs in adult emergency nursing using Donabedian's quality categories (structure, process, outcome) and explore their validation.

Methods: A scoping review was conducted including articles from 2010 to February 2023, using the Cumulative Index to Nursing and Allied Health Literature and Medline (Ovid) databases.

Results: Among 936 screened articles, 18 were included, identifying 85 NQIs across structure (n = 14), process (n = 45), and outcome (n = 26) in emergency nursing. However, the validation of these NQIs was limited.

Conclusions: NQIs evaluate emergency nursing quality, primarily in process assessment. Future work should validate the NQIs identified in this review for adult emergency nursing and search for potential new ones.

Background: New graduate nurses are traditionally not recruited for home health care (HHC).

Local problem: Due to staffing shortages, a HHC agency was interested in hiring graduate nurses, but there was concern about associated risks.

Methods: The purpose of this quality improvement project was to develop a nurse residency program to safely transition graduate nurses to the HHC setting. After initial program design, analysis using a failure mode effects analysis (FMEA) was conducted, and risk mitigation strategies were applied.

Results: The overall risk of onboarding graduate nurses in HHC was reduced by 42% after applying harm reduction tactics identified from the FMEA.

Conclusion: The FMEA was found to be a useful tool to prospectively identify areas of concern and apply harm reduction tactics prior to nurse residency implementation.

Background: While clinicians routinely observe issues with safety and quality, they may not always speak up and intervene. Peer feedback supports nurses to speak up about errors or near misses and actively improve nursing care quality. Effective peer feedback requires addressing barriers to speaking up.

Purpose: The purpose of this mixed methods study was to evaluate a'brain-friendly'peer feedback program´s effect on clinical nurses´ perceptions of peer review.

Methods: Nurses were surveyed before and after the implementation of a peer feedback program that integrated social cognitive neuroscience principles. Open comments were analyzed using thematic analysis.

Results: Responses to nearly half of survey questions improved. Thematic analysis identified institutional and personal barriers to peer feedback use, revealing the personal and social complexity of speaking up.

Conclusions: Social cognitive neuroscience may enhance peer feedback programs. Research using immersive qualitative methods is needed to better understand factors supporting or impeding peer feedback.

Background: Supervised group exercise may have greater health benefits than no exercise or exercise alone.

Purpose: The purpose of this systematic review and meta-analysis was to investigate the effectiveness of supervised group-based exercise on the risk of falls among community-dwelling older adults compared to no exercise or exercise alone.

Methods: Four databases were searched up to March 1, 2024 for eligible randomized controlled trials.

Results: Seventeen randomized controlled trials were eligible for this meta-analysis. Meta-analyses showed that compared with no exercise, supervised group-based exercise had a significant effect on preventing falls, injurious falls, and fall-related fractures. Compared with exercise alone, supervised group-based exercise significantly reduced falls and injurious falls.

Conclusions: Moderate-quality evidence suggests that compared with no exercise or exercise alone, supervised group-based exercise is more effective at preventing falls among community-dwelling older adults.

Background: Continuous glucose monitoring (CGM) can decrease hypoglycemic events and health care costs; however, barriers and facilitators that influence CGM use are unknown.

Purpose: The purpose of this study was to evaluate hypoglycemic events and cost outcomes after CGM implementation and describe associated barriers and facilitators.

Methods: A mixed-methods study design was used to evaluate CGM implementation on 2 pulmonary units within an academic health center. Hypoglycemic events were evaluated before and after CGM implementation, and nurses were interviewed about facilitators and barriers that influence CGM use.

Results: Hypoglycemic events decreased from a rate of 0.0906 per 1000 patient days to 0.0503 postimplementation, P < .0001. A $105 766 cost avoidance was recognized. Barriers and facilitators to CGM use are described.

Conclusions: Findings support CGM implementation, while uniquely contributing financial impact and device use barriers and facilitators. Hospitals may consider CGM use to improve timely identification and treatment of hypoglycemia.