Journal of nursing care quality最新文献

Background: Virtual care technology including artificial intelligence (AI) may augment nursing functions creating flexibility in staffing that reduces workforce shortages and enhances patient safety.

Local problem: A health system experienced nursing workforce shortages and patient safety concerns.

Methods: Quality improvement methodology was used to evaluate the impact of implementing virtual care technology with AI.

Interventions: Virtual patient observation (VPO) with AI and virtual nurse (VN) technology were implemented. Nursing assistants served as virtual observers, while registered nurses functioned as VNs, managing patient admissions, discharges, and education.

Results: Unwitnessed in-room patient fall rates decreased 59% and median sitter hours were reduced by 91%. Patient experience and nurse perceptions of patient safety, workforce flexibility, and well-being improved. The program saved 63 hours per month of bedside nurse time.

Conclusions: Nurse leader sponsorship of VPO with AI and VN to augment nursing functions offers a solution to improve patient safety and workforce flexibility.

Background: Variability in developmental care implementation in the neonatal intensive care unit (NICU) highlights the need to explore barriers to care delivery, yet few studies addressed these challenges.

Purpose: Drawing from NICU literature, this integrative review identifies barriers to implementing developmental care with premature infants.

Methods: A systematic search of CINAHL and PubMed (2014-2024) was conducted, yielding 2 qualitative and 5 quantitative studies.

Results: Thematic analysis revealed 3 key barriers based on the theory of planned behavior: attitude, subjective norm, and perceived control.

Conclusions: To improve developmental care, a multi-pronged approach engaging stakeholders is recommended. Future research should apply rigorous implementation science methods to overcome these barriers.

Background: Multiple sclerosis (MS) is a chronic and unpredictable condition requiring continuous learning and self-management. Since learning myopia involves a tendency to focus on immediate concerns at the expense of long-term goals, it can hinder disease management.

Problem: Patients with MS often prioritize short-term symptom relief over proactive disease education and adherence to disease-modifying therapies. This focus on the immediate challenges complicates efforts to foster sustained learning, further compounded by widespread misinformation about MS management.

Approach: This article applies a thermodynamic framework integrating rational, emotional, and spiritual capacities to overcome learning myopia.

Outcomes: The article demonstrates how nurses can facilitate informed decision-making, resilience, and long-term adherence, mitigating the impacts of learning myopia.

Conclusions: Addressing learning myopia through the thermodynamic approach empowers patients to manage MS effectively, improving quality of life.

Background: Central line-associated bloodstream infection (CLABSI) is a preventable complication of central venous catheters (CVC) that can result in prolonged hospitalization, increased cost, and mortality.

Local problem: CLABSI rates in a solid organ transplant unit were above the National Database of Nursing Quality Indicators target.

Methods: Evidence-based CLABSI prevention interventions were implemented using the Plan-Do-Study-Act process.

Interventions: A stepwise approach was used to implement CVC maintenance bundle pole cards, chlorhexidine gluconate (CHG) bathing treatments, and Kamishibai card (K-card) door tag processes for all patients with CVCs.

Results: The unit achieved and sustained >90% compliance with both CHG bathing treatments and K-card door tag processes. The CLABSI rate decreased from 2.15 to 0.41, an 81% reduction.

Conclusions: CLABSI reduction in a transplant unit can be achieved through the systematic implementation of evidence-based practices.

Background: Hand hygiene is recognized as an effective way to prevent health care-associated infections (HAIs). However, there is limited attention to patient hand hygiene (PHH).

Purpose: The purpose of this systematic review was to summarize evidence, interventions, and outcomes of PHH before meals.

Methods: Literature was searched from 1999 to 2024 in 4 databases. The Grading of Recommendations, Assessment, Development, and Evaluation was used to appraise the strength of evidence.

Results: Ten reports were included in the review. Five categories of PHH interventions were identified: direct observation, reminders, education, policy change, and bundles of more than one intervention. There is insufficient evidence to establish a direct causal link between PHH before meals and a reduction in HAIs.

Conclusions: The limited and moderate level of evidence highlights a significant gap in understanding PHH. Hand hygiene is a fundamental infection prevention strategy that warrants additional research in hospitalized patient populations to determine the clinical efficacy and causal effects on HAIs.

Background: Due to advancements in cardiovascular intervention technologies, transesophageal echocardiography (TEE) is increasingly used. In Japan, nurse practitioners are being integrated into specialized procedures, including TEE, under physician supervision to address physician shortages and improve patient safety.

Methods: Consecutive patients undergoing TEE at our outpatient clinic from July 2022 to June 2023 were included, with baseline characteristics, procedural details, and outcomes retrospectively collected.

Results: A total of 186 patients were included in the study. A significant decrease in blood pressure was observed in 124 patients (68.5%), with 19 patients requiring treatment through infusion loading. Desaturation (SpO 2  < 90%) was observed in 105 patients (57.7%). No significant differences in hypotension or hypoxia incidence were found between elderly and younger patients or among TEE indications.

Conclusions: TEE procedures were safely performed under the assistance of nurse practitioners, demonstrating effective management of the procedural risks associated with this diagnostic technique.

Background: Timely recognition, diagnosis, and treatment of ST-segment elevation myocardial infarctions (STEMIs) are critical for patient survival.

Local problem: Our door-to-balloon (D2B) times, a key quality metric, were increasing.

Methods: The DMAIC (Define, Measure, Analyze, Improve, Control) framework was used for this quality improvement project to determine gaps in care and to improve efficiency.

Interventions: We streamlined STEMI patient care models, eliminating unnecessary steps, codifying throughput pathways, and improving interdepartmental communication.

Results: Median D2B times decreased from 62.5 to 57 minutes in patients initially seen at the acute care facility and from 116 to 114 minutes in patients who transferred to our facility. We observed no increase in the number of patients arriving at the cardiac catheterization laboratory before the room or team were ready.

Conclusions: A nurse-led quality improvement project that includes nurses directly involved in the care of patients can achieve real improvements in quality of care.