American Journal of Nursing最新文献

Improving systems of care for at-risk individuals.

Background: Continuous video monitoring programs have been found to reduce inpatient falls and 1:1 sitter use in the short-term acute care hospital setting. But the impact and potential benefits of such programs in the long-term acute care hospital (LTACH) setting are still unknown.

Purpose: The goal of this study was to track the implementation of a continuous video monitoring program in an LTACH setting and evaluate its impact on inpatient falls and 1:1 sitter use, as well as on associated costs.

Methods: A prospective observational cohort study design was used. Prospective data were collected from patients who were admitted to an LTACH in the northeastern United States and subsequently enrolled in a continuous video monitoring program during the 20-month period of February 1, 2021, through September 30, 2022. Primary outcome measures, including inpatient falls and 1:1 sitter hours, were then compared to 20 months of historical data, from June 1, 2019, through January 31, 2021, which were collected through chart review.

Results: Following development and implementation of the continuous video monitoring program, the mean rate of inpatient falls decreased significantly, from 17.2 falls per month in the historical reference period to 12.9 falls per month during the study period (P = 0.02). Similarly, the mean number of 1:1 sitter hours decreased from 1,428 hours per month during the reference period to 140 hours per month during the study period (P < 0.001); when converted to full-time equivalents (FTEs), this translated to a decrease from 8.2 1:1 sitter FTEs during the reference period to 0.8 1:1 sitter FTEs in the study period. Cost analysis indicated that the reduced labor costs and fall rate during the study period led to estimated total cost savings of over $3.2 million.

Conclusions: Both patients and the hospital benefited from the implementation of the continuous video monitoring program. Continuous video monitoring was found to be a cost-effective way to reduce inpatient falls, decrease 1:1 sitter use, and improve patient safety in the LTACH setting.

Developing a mindset that leads to impactful and meaningful change.

Benefits of trainings and consistent debriefings.

Background: There are currently unprecedented threats to the nursing workforce, including burnout and stress, which contribute to low job satisfaction, inadequate staffing, and decreasing retention rates. Virtual nursing is a possible solution to address many of these issues. Although this is a well-established staffing model in the ICU, it is newer to other hospital-based settings, and there are no current best practices for implementing virtual nursing in the non-ICU setting.

Purpose: The purpose of this integrative review was to address the following question: What are best practices for implementing virtual nursing in the inpatient, non-ICU setting?

Methods: An evidence-based practice team at The Johns Hopkins Health System in Baltimore, Maryland, performed a systematic review of the available research and nonresearch literature, guided by the Johns Hopkins Evidence-Based Practice model. Reviewers searched PubMed, CINAHL, Embase, and Cochrane using search terms related to "virtual nursing" and "inpatient." All evidence underwent an independent screening and appraisal process to generate a synthesis of existing information and create best-evidence recommendations.

Results: The initial search yielded 327 unique records, six of which were included in the final review (one quasi-experimental study and five quality improvement projects). The evidence was limited but provided some guidance on the scope and skills of the virtual nurse, such as concrete clinical skills and soft skills (such as communication and interpersonal skills); the needs of the bedside nurse and patients, such as education and communication norms; and operational concerns for leadership and other health care providers, such as creating standardized workflows and establishing metrics for success.

Conclusions: Despite the growing prevalence of virtual nursing, there is limited information on its use in the non-ICU hospital setting. Although there is some evidence to inform the skills and scope of the virtual nurse, the impact of virtual nursing on the bedside nurse, patient priorities, leadership implications, and considerations for all staff, more information is needed. Rigorous implementation science research should be conducted in parallel with the development of virtual nursing programs to contribute to the state of the evidence and provide much-needed guidance on this quickly developing technology.