Journal of nursing care quality最新文献

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.

Background: Nurses play an essential role in the achievement of quality depicted by the Quintuple Aim to improve clinical outcomes, patient experience, equity, provider well-being, and reduction of costs. When quality gaps occur, practice change is required and is facilitated by quality improvement (QI) and implementation science (IS) methods. QI and IS research are required to advance our understanding of the mechanisms that explain how evidence is implemented and improvements are made.

Problem: Despite past efforts of the evidence-based practice and QI movements, challenges persist in sustaining practice improvements and translating research findings to direct patient care.

Approach: The purpose of this article is to describe the Synergy for Change Model that proposes that both QI and IS research and practice be used to accelerate improvements in health care quality.

Conclusions: Recognizing the synergy of QI and IS practice and research will accelerate nursing's contributions to high-quality and safe care.

Background: Traumatic injury survivors often experience negative health consequences, impacting recovery. No studies have assessed the feasibility of evaluating the resiliency of hospitalized trauma patients using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10).

Purpose: The purpose of this study was to determine the most efficient method to collect survey responses on the CD-RISC-10.

Methods: This cross-sectional study used a convenience sample of admitted patients with traumatic injury. Patients were randomized to complete the CD-RISC-10 using pen and paper, tablet, or workstation on wheels.

Results: Of the 161 patient surveys, the tablet-based survey took the shortest time to complete (2 minutes, 21 seconds), and the paper survey resulted in the lowest percentage of missed questions (0.5%). Trauma patients reported high levels of resiliency.

Conclusion: The CD-RISC-10 can be easily administered to trauma patients. Clinicians should balance efficiency and patient preferences when deciding on a survey collection method.

Background: Although patients' and care partners' perspectives on patient safety can guide health care learning and improvements, this information remains underutilized. Efforts to leverage this valuable data require challenging the narrow focus of safety as the absence of harm.

Purpose: The purpose of this study was to gain a broader insight into how patients and care partners perceive and experience safety.

Methods: We used a mixed-methods approach that included a literature review and interviews and focus groups with patients, care partners, and health care providers. An emergent coding schema was developed from triangulation of the 2 data sets.

Results: Two core themes-feeling unsafe and feeling safe-emerged that collectively represent a broader view of safety.

Conclusion: Knowledge from patients and care partners about feeling unsafe and safe needs to inform efforts to mitigate harm and promote safety, well-being, and positive outcomes and experiences.

Background: Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings.

Problem: A mechanism to continuously monitor the impact of this staffing change was not available.

Approach: Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics.

Outcomes: The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators.

Conclusion: The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.

Background: Oncology patients receiving chemotherapy are at a high risk for developing infections. Identifying factors that predict infection practices among these patients can help improve the quality of care provided.

Purpose: The purpose of this study was to evaluate the knowledge, attitudes, and practices related to infection prevention in oncology patients receiving chemotherapy.

Methods: A cross-sectional study was conducted among 170 patients with cancer.

Results: The majority of participants had a low to moderate level of knowledge, with high levels of attitude and practice related to infection prevention. Knowledge was a significant predictor of attitude and practice, while attitude was a predictor of infection prevention practices. Knowledge and attitude emerged as mutual predictors, which could explain 23% of the variation in practice toward infection prevention (R2 = 0.230, P = .00).

Conclusions: Findings indicated that both knowledge and attitude were powerful predictors of practice toward infection prevention.

Background: Minimizing patient falls and fall-related injuries within organizational constraints is a high priority for nurse leaders. The Centers for Medicare & Medicaid Services do not reimburse hospitals for fall-related expenditures. In-person sitters are used to prevent falls but are resource intensive and costly. Remote patient monitoring (RPM) may offer alternatives to in-person sitters to reduce fall-related harm.

Purpose: The efficacy of RPM to reduce patient falls and fall-related injuries was explored.

Methods: Electronic health record data were extracted from a 13-hospital integrated health care system. Incidence rate ratios were used to analyze the impact of RPM technology on falls and fall-related injuries.

Results: When used in conjunction with standard fall precautions, RPM reduced falls 33.7% and fall-related injuries 47.4%. Fall-related expenditures decreased $304 400 with a combined estimated savings systemwide of $2 089 600 annually.

Conclusions: RPM technology minimized falls and associated harm and improved patient safety, positively impacting hospital expenditures.