Journal of nursing care quality最新文献

Background: Transfusion of blood components has long been considered lifesaving therapy. While blood transfusion may be clinically indicated as a treatment option for some patients, the benefits of transfusion in asymptomatic, hemodynamically stable patients are questionable.

Problem: Blood component transfusion is routinely used as a default therapy when not clinically indicated, increasing the risk of poor patient outcomes, adverse events, pressures on blood supply and availability, and increased health care costs.

Approach: Nurses have the responsibility to advocate for patients and reduce/avoid unnecessary blood transfusion through the implementation of patient blood management (PBM). The PBM paradigm includes treatment of anemia, minimizing blood loss and bleeding, optimization of coagulation, and employing true patient-centered decision making.

Conclusions: PBM should become the standard of care with the goal of improving health care quality and patient outcomes while using the multidisciplinary team for its implementation. As advocates for their patients, nurses can play a major role in the development, implementation, and promotion of PBM.

Background: Hospitals use traveling clinical staff (TCS) to fill personnel shortages. Although this approach may help improve staffing ratios, it is not without risk.

Purpose: The interdisciplinary team conducted an integrative literature review to determine best practices for promoting safe patient care delivery by TCS.

Methods: Using the Johns Hopkins Evidence-Based Practice model, the authors performed an integrative literature review, including appraisal of quality, synthesis of themes, and best-evidence recommendations.

Results: The final synthesis included 16 articles. Evidence demonstrated the importance of preemployment screening, standardized onboarding and orientation, and optimizing the integration of TCS into the work environment.

Conclusion: Hospitals should use these recommendations when incorporating TCS into their teams.

Background: Registered nurses (RNs) are attuned to health care quality and safety concerns but may lack competency in quality improvement (QI) to advance care quality.

Purpose: To describe frontline acute care RNs' self-efficacy in QI competencies, evaluate differences based on educational attainment, and evaluate relationships based on years of RN experience.

Methods: The study used a descriptive, quantitative, correlational, comparative cross-sectional survey design to evaluate RNs' self-efficacy in QI competency using the 2021 American Association of Colleges of Nursing The Essentials : Core Competencies for Professional Nursing Education .

Results: Frontline RNs' overall QI self-efficacy showed variability in knowledge, skills, and attitudes, with no relationship between self-efficacy and years of RN experience, nor difference based on educational attainment.

Conclusions: Insufficient self-efficacy signals the need for further QI focus in nursing education, nursing practice, and health care policy to harness RNs' ability to advance care outcomes.

Background: Despite strong evidence of improved patient outcomes, clinicians have been slow to adopt health literacy practices.

Purpose: To identify facilitators and barriers to implementing health literacy practices into clinical care.

Methods: Stakeholders (N = 40) completed surveys of acceptability, appropriateness, feasibility, conviction, and confidence with teach-back practices. Using the Consolidated Framework for Implementation Research (CFIR), interviews (n = 12) were conducted and analyzed.

Results: Most reported high acceptability, appropriateness, and feasibility, but low confidence in using teach-back. Facilitators included leadership engagement and relative advantage. Barriers were related to compatibility due to time and workflow constraints. The CFIR-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool was applied to select implementation strategies.

Conclusions: The CFIR framework along with the CFIR-ERIC Matching Strategy Tool helped the research team select strategies likely to yield successful implementation and sustained use of health literacy practices.

Background: Postoperative nausea and vomiting (PONV) affects 30% of surgical patients undergoing anesthesia. PONV is a substantial cause of increased length of stay, cost of care, and unanticipated patient admission and readmission.

Local problem: Seventy percent of patients received PONV prophylaxis; PONV assessment was performed in only 63% of patients in this hospital system.

Methods: A standardized PONV preoperative assessment checklist and a best practice advisory (BPA) were implemented in our electronic medical record (EMR) and charting system. Anesthesia providers and postanesthesia care unit (PACU) nurses completed training on patient management for PONV, including preoperative assessment and BPA use.

Results: The PONV preoperative assessment achieved high adoption, and providers followed its recommendations in more than 90% of cases. During the 6-month implementation phase, PONV rates decreased from 56% to 43.6%.

Conclusions: Implementing a standardized, electronic PONV preoperative risk assessment checklist and a BPA effectively reduced PONV rates in this hospital system.

Background: Many hospital quality indicators, including falls, worsened during the COVID-19 pandemic. Patients hospitalized with COVID-19 may be at risk for falling due to the disease itself, patient characteristics, or aspects of care delivery.

Purpose: To describe and explore falls in patients hospitalized with COVID-19.

Methods: We pooled data from 107 hospitalized adult patients who fell between March 2020 and April 2021. Patients who fell had a current, pending, or recent diagnosis of COVID-19. We analyzed patient characteristics, fall circumstances, and patient and organizational contributing factors using frequencies, the chi-square test, and Fisher's exact test.

Results: Patient contributing factors included patients' lack of safety awareness, impaired physical function, and respiratory concerns. Organizational contributing factors related to staff and the isolation environment.

Conclusions: Recommendations for managing fall risk in patients hospitalized with COVID-19 include frequent reassessment of risk, consideration of respiratory function as a risk factor, ongoing patient education, assisted mobility, and adequate staff training.

Background: Missed nursing care (MNC) negatively impacts the quality of patient care. There may be a relationship between the nursing practice environment (NPE) and MNC; however, this relationship has not been examined in developing countries during the COVID-19 pandemic.

Purpose: To determine the relationship between the NPE and MNC during the COVID-19 pandemic.

Methods: A cross-sectional study of 300 participants was conducted in 4 teaching hospitals in Iran. Data were collected using a demographic and clinical form, the Nursing Professional Practice Environment Questionnaire, and MISSCARE survey and analyzed using structural equation modeling.

Results: The hypothesized model was well fit, showing that 1 unit improvement of the NPE domains of patient-centered care , effective leadership , and policy transparency decreased MNC by 0.18, 0.12, and 0.05, respectively.

Conclusion: The model confirmed the association between the dimensions of the NPE and MNC. These findings can assist health policymakers and nursing managers in improving the NPE.

Background: The progression of patients through a hospital from admission to discharge can be slowed by delays in patient discharge, increasing pressure on health care staff. We designed and piloted the Discharge Today tool, with the goal of improving the efficiency of patient discharge; however, adoption remained low.

Purpose: To close this implementation gap, we deployed and evaluated a 4-part implementation strategy bundle.

Methods: We measured the success of implementation by evaluating validated implementation outcomes using both quantitative and qualitative methods, grounded in Normalization Process Theory.

Results: The implementation strategies used were effective for increasing use of the Discharge Today tool by hospital medicine physicians and advanced practice providers during both the active and passive implementation periods.

Conclusions: While the implementation strategies used were effective, qualitative findings indicate that limitations in the functionality of the tool, alongside inconsistent use of the tool across clinical staff, continued to inhibit adoption.