Journal of nursing care quality最新文献

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.

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.