Nursing management最新文献

Background: Workplace violence (WPV), particularly patient-on-worker, was a growing concern in acute care hospital settings. Patients with multiple comorbidities and a changing workforce created a complex health care environment, impacting nursing and patient safety.

Purpose: The organization offered nurses several WPV prevention training options but not a bundled strategy that included a patient violence risk assessment for use in the inpatient setting. There was no objective, standardized assessment for communicating among the interdisciplinary team to coordinate safety and care for patients optimally.

Methods: This quality improvement project used the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care as the translation science model. The Clinician Confidence in Coping with Patient Aggression (CCPA) survey measured nurses' confidence pre- and postintervention.

Results: Results indicated a statistically significant increase in nurses' confidence in dealing with patient aggression (P < .05) following the bundled WPV education.

Conclusions: Implementing a bundled WPV prevention education, including an evidence-based risk assessment tool, was a valuable addition to standard education for inpatient nurses.

Abstract: The authors designed a mnemonic to guide and support nurses' verbal communication about serious adverse occurrences (ASOs). Nurses' abilities and attitudes toward reporting safety concerns improved, which is consistent with high-reliability organizations' focus on the prevention of harm and protection of staff and patients.

Background: Suicide rates among nurses are high and often occur in the context of job-related problems.

Purpose: This study analyzed nurse suicides from 2021 to learn more about work-related stressors and inform actions to prevent nurse suicide.

Methods: Nurse suicide data from January to December 2021 were examined using deductive thematic reflexive content analysis. Nurse decedents who had job problems were identified through the National Violent Death Reporting System, which includes the decedent's law enforcement and coroner/medical examiner report.

Results: The sample consisted of 50 nurses who died by suicide. Seven themes identified in a previous study were replicated with modifications: chronic struggles, peri-job loss, trapped in a crisis, no way out, tipping point, finding a way out, and pandemic uncertainties. Mental health challenges remained common throughout these themes with the stress of the COVID-19 pandemic frequently noted as a contributor. The "trapped in crisis" theme was magnified, and more violent methods of completing suicide were noted within the "finding a way out" theme.

Conclusions: Nurse leaders could potentially decrease nurse suicide risk by creating actionable plans and programs to mitigate work-related stressors and support nurses during job transitions and crises.

Background: Pressure injuries significantly impact patient outcomes, length of stay, and health care costs. A 104-bed Pathway to Excellence®-designated hospital began to see a rise in its hospital-acquired pressure injuries (HAPIs).

Purpose: To decrease HAPIs utilizing the Pathway to Excellence framework.

Methods: A multidisciplinary pressure injury team (PIT) was formed to enhance prevention and treatment strategies. Interventions included weekly Wound Care Wednesdays to emphasize consistent photo documentation, enhanced admission assessments involving dual-nurse skin checks, and the development of a smart note within the electronic health record to streamline documentation. Unit-specific action plans and performance scorecards were implemented to foster accountability and transparency.

Results: The PIT's efforts led to better documentation of present-on-admission wounds and a 37.7% reduction in the HAPI rate from 2022 to 2024.

Conclusion: The PIT provides an adaptable framework, driven by the Pathway to Excellence standards, that can be used by other health care organizations seeking to reduce pressure injuries and promote sustained quality improvement.

Abstract: Administrative or house supervisors work to ensure patient safety, of which fall prevention is a critical component. However, many fall prevention interventions haven't adequately addressed underlying risk factors, which has contributed to continued high fall rates in health care settings. To make meaningful progress in fall prevention, thinking outside the box and adopting a more holistic approach are essential. Sharing fall stories during huddles and safety forums personalizes the incidents and emphasizes their significance, leading to risk identification and preventive measures.

Abstract: Health care organizations continue to face staffing constraints related to workforce shortages, forcing them to leverage technology to provide safe and cost-effective care with limited resources. This article describes how one campus in an academic health system decreased its fall rate through proactive assessment and the utilization of virtual technology. A multidisciplinary steering committee, a structured change management approach, staff education, and the integration of a Best Practice Advisory in the electronic health record supported adoption of virtual constant observation (VCO). In addition to improving patient fall rates, VCO positively impacted nursing staffing models and saved costs.

Background: Central line-associated bloodstream infections (CLABSIs) are a persistent threat to patient safety, contributing to significant morbidity, mortality, and health care costs. An acute cluster of three CLABSIs on a 25-bed Cardiovascular and Thoracic Surgery unit prompted an urgent response to address this critical safety issue.

Purpose: This nurse-led quality improvement (QI) initiative aimed to eliminate CLABSIs and establish a sustainable culture of zero harm on the unit by empowering frontline staff to lead evidence-based practice changes.

Methods: Guided by the Donabedian and Magnet® models, nurses conducted a root cause analysis and implemented a multifaceted intervention. Key strategies included innovative education, peer-to-peer validation of central line care, daily compliance monitoring, and enhanced patient engagement. CLABSI rates and bundle compliance data were tracked using run charts to monitor performance and guide continuous improvement.

Results: The initiative resulted in the complete elimination of CLABSIs on the unit. This achievement of a zero-infection rate was successfully sustained for more than 5 consecutive years.

Conclusions: Empowering frontline nurses to lead QI is a highly effective strategy for improving patient safety outcomes. This project demonstrates that a "culture of zero" is attainable through interprofessional collaboration, data-driven practices, and sustained leadership support. The initiative provides a replicable framework for other organizations seeking to eliminate health care-associated infections.