Journal of nursing care quality最新文献

Background: Evidence is limited to the effects of shared governance (SG) and autonomy on nurse-sensitive indicators (NSIs).

Purpose: To explore the effects of SG, autonomy, and Magnet status on nurse and patient outcomes.

Methods: A cross-sectional survey study was conducted using a convenience sample of 404 nurses from 4 hospitals. Descriptive analyses of variance (ANOVAs), and path analysis were conducted to identify hypothesized associations and predictive pathways among study variables.

Results: Nurse managers reported higher perceptions of SG, autonomy, and satisfaction than staff nurses. SG and autonomy were significant predictors of patient falls and hospital-acquired pressure injuries. Nurses' autonomy, SG, and Magnet accreditation were significant predictors of nurse satisfaction.

Conclusions: Leadership support of SG and autonomous practice are key strategies to improve nurse satisfaction and NSI outcomes.

Background: Teamwork influences health care quality and patient safety. Yet, validated instruments for assessing teamwork in Colombia are lacking.

Purpose: The purpose of this study was to validate the Spanish version of the TeamSTEPPS-Teamwork Perceptions Questionnaire (T-TPQ-S) for the Colombian health care context.

Methods: The T-TPQ-S underwent translation, cultural adaptation, and comprehensive psychometric testing, including reliability and confirmatory factor analyses and item difficulty and discrimination analyses.

Results: The T-TPQ-S demonstrated high internal consistency and excellent fit to the theoretical model. Item discrimination was within expected ranges, with response thresholds displaying an ascending order. The tool better differentiated subjects with low and high teamwork perceptions.

Conclusions: The T-TPQ-S is an effective, reliable, and valid instrument for assessing teamwork perception among Colombian health care workers.

Background: Nearly half of American adults have hypertension (HTN), and non-Hispanic Black patients are diagnosed at a higher rate than others.

Local problem: Our local clinic population reflected disproportionate rates of uncontrolled HTN among Black patients.

Methods: A quality improvement pre-/postintervention design was used to evaluate an educational intervention to reduce blood pressure (BP) and improve self-monitoring of BP in Black patients using the Chronic Care Model.

Interventions: A team-based approach was used to redesign clinic workflows and patient education, prescribe self-paced videos from an electronic health record (EHR) patient portal, and provide home BP cuffs.

Results: Black participants (n = 79) improved viewing of prescribed videos (7.9% to 68.5%), knowledge scores (67.9 to 75.2), and mean systolic BP (-20.3 mm Hg; P > .001).

Conclusions: This team-based approach enhanced patient engagement, self-monitoring skills, EHR-reported BP, and overall BP control for a cohort of Black patients with uncontrolled BP.

Background: Accurate emergency department (ED) triage in the geriatric population is an important nurse-sensitive quality indicator; however, few quality indicators are verified for impact.

Purpose: To examine the relationship between triage accuracy in adults older than 65 years and Core Measures for acute myocardial infarction (AMI) and heart failure (HF).

Methods: A correlational approach was used to determine strength and direction of the relationship between variables.

Results: Strong positive correlations were found between triage accuracy and mortality for AMI and HF, as well as with 30-day hospital readmissions for AMI. A weak negative correlation was found between triage accuracy and 30-day hospital readmissions for HF.

Conclusions: Accurate triage can lead to a more effective care trajectory for patients, better adherence to Core Measures, and better outcomes. Accuracy in triage for AMI and HF is a valid indicator of ED quality care.

Background: Despite the increased awareness of social determinants of health (SDoH), integrating social needs screening into health care practice has not consistently occurred.

Local problem: No social needs screening using recommended standardized questions was available at an outpatient hemodialysis clinic.

Methods: Plan-Do-Study-Act cycles, based on the Model for Improvement, were used to implement the Core 5 SDoH screening tool, a staff referral process, and an evaluation of the implementation process.

Intervention: A standardized social needs screening tool and a staff referral process were implemented. An evaluation of the implementation process also occurred.

Results: Of 73 patients screened, 21 reported 32 unmet social needs; all received referrals to community resources. Nurses demonstrated high acceptance and usability of the tool and the referral process.

Conclusions: Implementing a standardized screening and referral process customized to clinical workflow enhanced the identification of social needs in patients undergoing hemodialysis.

Background: Dashboards visually display quality and safety data to aid nurses in making informed decisions.

Purpose: This systematic review evaluated quality improvement (QI) dashboard characteristics associated with interventions to improve patient outcomes and positive end-user evaluation.

Methods: Literature was searched from 2012 to 2022 in PubMed, CINAHL, Scopus, MEDLINE, and Google Scholar.

Results: Sixteen articles were included. Varied dashboard characteristics were noted, with mixed patient outcomes and end-user responses. Graphs and tabular presentations were associated with improved patient outcomes, whereas graphs were associated with end-user satisfaction. Benchmarks were noted with improved patient outcomes but not end-user satisfaction. Interactive dashboards were important for end users and improved patient outcomes.

Conclusion: Nurses can find dashboards helpful in guiding QI projects. Dashboards may include graphs and/or tables, benchmarks, and interactivity but should be useful, usable, and aligned to unit needs. Future research should focus on the use of quality dashboards in nursing practice.

Background: Health care requires a delicate equilibrium of nurse health safety and patient safety outcomes. Shift work can disrupt this balance, resulting in poor outcomes for staff and patients.

Problem: Limited evidence exists on nurses' perceptions of shift work, fatigue countermeasures use, and interest in risk-mitigating interventions.

Methods: An online survey of nurses was conducted. Survey questions assessed perceptions of shift work, use of fatigue countermeasures, and potential interventions.

Results: The participants perceived multiple differences between day and night shifts when asked about their ability to complete both work- and life-oriented tasks. Use of fatigue countermeasures was more common while working night shift. Potential interventions included the use of blackout curtains, an on-site exercise facility, consulting a nutritionist, and block scheduling.

Conclusions: Health care leaders should consider nurses' perceptions and interests when incorporating initiatives to mitigate the negative effects of shift work.

Background: Patient-controlled analgesia (PCA) pumps are complex medical devices frequently used for postoperative pain control. Differences in how nurses program PCA pumps can lead to preventable medication errors.

Purpose: To describe similarities and differences in how surgical nurses program PCA pumps.

Methods: We conducted a qualitative study using video reflexive ethnography (VRE) to film nurses as they programmed a PCA pump. We spliced and collated videos into separate clips and showed to nursing leaders for their deliberation and action.

Results: We found nurses ignored or immediately silenced alarms, were uncertain about the correct programming sequence, and interpreted how to load a syringe in the pump in multiple ways; in addition, the PCA pump design did not align with nurses' workflow.

Conclusions: VRE was effective in visualizing common challenges nurses experienced during PCA pump programming. Nursing leaders are planning several nursing process changes due to these findings.