Journal of nursing care quality最新文献

Background: Older adult patients with COVID-19 and delirium experience higher rates of adverse outcomes. Early recognition of at-risk patients and implementation of management strategies improve outcomes, though understanding barriers to acute care nurses implementing these strategies is limited.

Purpose: This study's purpose was to understand the experiences of acute care nurses providing care to older adults with COVID-19 and delirium. Experiences explored included assessment, nursing management interventions, and barriers to care.

Methods: Purposive sampling to recruit nurses for semistructured focus groups was performed, and thematic analysis was generated by 4 members of the research team.

Results: Twenty-one nurses participated in focus groups. Thematic analysis revealed themes of increased patient social isolation, barriers to delirium assessment and prevention, increased staff demands, and stressful work environments.

Conclusion: Rich findings reveal the profound impact of the pandemic on assessment for delirium and implementation of strategies for prevention and management in older adult patients.

Background: With an increasing number of doctor of nursing practice (DNP) graduates, the volume of peer-reviewed journal publications among DNP-prepared nurses is rising.

Purpose: The primary aim of this study was to quantify, analyze, and categorize DNP-authored peer-reviewed journal publications.

Methods: A descriptive research design was used to analyze DNP-authored peer-reviewed journal publications in the WorldCat, EBSCO Discovery Service, and PubMed databases from 2011 through 2021.

Results: The 3839 journal publications included at least one DNP-prepared nurse author. There were 2495 (65%) publications with a DNP first author, 921 (24%) with a DNP solo author, and 2918 (76%) included publication collaboration. The majority of publications were practice- (40%), nursing- (17%), and education-focused (15%). Science translation in evidence-based practice and quality improvement publications accounted for 24%.

Conclusions: This study demonstrates the proliferation of DNP-authored peer-reviewed journal publications, which may indicate an increase in the number of nursing care quality initiatives occurring in the clinical setting.

Background: Clinicians are encouraged to use the Centers for Medicare & Medicaid Services early management bundle for severe sepsis and septic shock (SEP-1); however, it is unclear whether this process measure improves patient outcomes.

Purpose: The purpose of this study was to evaluate whether compliance with the SEP-1 bundle is a predictor of hospital mortality, length of stay (LOS), and intensive care unit LOS at a suburban community hospital.

Methods: A retrospective observational study was conducted.

Results: A total of 577 patients were included in the analysis. Compliance with the SEP-1 bundle was not a significant predictor for patient outcomes.

Conclusions: SEP-1 compliance may not equate with quality of health care. Efforts to comply with SEP-1 may help organizations develop systems and structures that improve patient outcomes. Health care leaders should evaluate strategies beyond SEP-1 compliance to ensure continuous improvement of outcomes for patients experiencing sepsis.

Background: Nursing home residents with end-stage renal disease (ESRD) are an understudied, yet growing population within nursing homes.

Purpose: To describe hospital transfers for nursing home residents diagnosed with ESRD and receiving hemodialysis.

Methods: Data were analyzed for residents with ESRD transferred to the hospital between October 2016 and September 2020 (n = 219). Descriptive statistics, bivariate analyses, logistic regression, and content analysis were used for analysis.

Results: Clinical factors associated with transfers included abnormal vitals, altered mental state, and pain. Other factors included lack of care planning and advance directives, provider communication, resident/family preferences, missing/refusing dialysis, and facility resources. The odds of an observation/emergency department only visit was 2.02 times larger when transferred from the dialysis clinic.

Conclusions: Advance care planning and coordinated care between nursing home and dialysis clinics are needed along with proactive planning when residents miss dialysis or experience a condition change at the dialysis clinic.

Background: Understanding patient perceptions of care coordination in primary care can help improve responsiveness to patients' needs, outcomes, and quality of care.

Purpose: The purpose of this study was to explore patient experiences and perceptions of care coordination in primary care.

Method: Interviews with 13 patients from 10 clinics were conducted and analyzed using directed content analysis.

Results: Three primary themes arose: care coordinators provide a gateway to accessing needed care; patients needed and valued the support and trusted advice of their care coordinators; and patients valued care coordinators' help with navigating, engaging, and educating them about their care.

Conclusions: Understanding what patients value in care delivery can help frame a vision for a more responsive approach in delivering primary care, as well as create a pathway to quality improvement, moving toward a truly patient-centered focus in primary care.

Background: Falls are a frequent occurrence in older adults in long-term care facilities.

Local problem: At our long-term care facility, the percentage of patients who fell increased from 45% in 2021 to 68% in 2022, indicating a need for an evidence-based solution.

Methods: We used an evidence-based quality improvement framework to pilot a tai chi exercise program.

Interventions: Residents were invited to participate in the Tai Ji Quan: Moving for Better Balance program for 12 weeks. Classes were 30 minutes long and included a 5-minute warm-up and 5-minute cooldown.

Results: Seventy-five residents participated in the tai chi program. There was a significant 32.3% reduction in falls ( P =.001). Residents' fall risk scores decreased 14% ( P < .001).

Conclusions: Implementing a tai chi exercise project may affect falls and decrease the overall fall risk.

Background: Postpartum hemorrhage (PPH) is a leading cause of maternity mortality in the United States. The Code Crimson project aimed to enhance PPH management by implementing a standardized intervention bundle to mitigate morbidity and mortality associated with PPH.

Local problem: At a large Philadelphia tertiary hospital, health disparities existed for severe maternal morbidity and mortality, and PPH was a significant factor.

Methods: A quality improvement design, using Plan-Do-Study-Act cycles and interrupted time series analysis, was undertaken.

Interventions: The Code Crimson project implemented a standardized bundle to manage PPH, including blood product administration and massive transfusion protocol activation.

Results: After implementing the Code Crimson bundle, there was a significant decrease in blood product use ( P < .001), with minor reductions in packed red blood cell administration over 4 units and mean blood loss.

Conclusions: The Code Crimson bundle effectively reduced blood product utilization for PPH treatment.