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Background: As yet there is no firm evidence about the types of intervention that can reduce emergency room revisits. However, the literature on emergency room revisits suggests patient difficulties with managing their health problems and treatments after discharge may play a role. Objectives: We carried out a randomized trial of an emergency department-based nursing intervention, but results showed no reduction in revisits (primary outcome). This paper describes the secondary outcomes of the trial: patient perceptions of continuity of care, illness perceptions, self-care capacities, psychological symptoms and medication adherence 30 days after emergency room discharge. Design: Randomized, controlled trial. Settings: The trial was conducted in the emergency department of a tertiary cardiac hospital in Montreal, Canada between November 2007 and March 2010. Participants: The study involved 203 patients, including 108 in the experimental group and 95 in the control group. Methods: The intervention included one nurse patient encounter before discharge and two phone calls in the 10 days after discharge. Participants provided data 30 days post-discharge on secondary outcomes potentially related to emergency department revisits. Results: Although, as previously reported, the intervention had no impact on the primary outcome of emergency department revisits, the present study demonstrated a significant positive effect on patients’ perceived continuity of care (p = .033), self-care capacities (p = .037), anxiety (p = .007) and depressive symptoms (p = .043), and the illness perceptions treatment control subscale (p = .037). No differences were found for other illness perception subscales or medication adherence (all p’s > .05). Conclusion: Although the intervention did not influence emergency department revisits it did improve secondary outcomes, suggesting pathways for future research. [ABSTRACT FROM AUTHOR]

Background: The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence. Objective: This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict. Design: A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments. Results: We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work- family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part. Conclusion: These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling. [ABSTRACT FROM AUTHOR]

Abstract: Background: As cardiovascular diseases have become the leading cause of death in many countries including China, nurses are increasingly required to be abreast of technological advances and the skills necessary to manage this increasing health care problem. Chinese nurses are under pressure to provide skilled electrocardiography monitoring, and be sufficiently skilled to detect myocardial ischemia and infarction, in this large patient population. This presents a challenge for the nursing profession in China, particularly for nurses working in coronary care in a country where advancement has been so rapid, yet little research has been conducted or reported in the literature. Objectives: The two main objectives were: to explore the demographic and educational factors that affect the use of ST-segment monitoring and correct electrode placement by CCU/ICU nurses in China; and to explore the factors both individual and institutional that affect monitoring and lead placement. Methods: A self-administered questionnaire was distributed to nurses in 126 randomly selected tertiary hospitals, which were stratified into three homogeneous regions across China. The instrument examined demographics, information about hospitals, electrocardiogram devices, current practice patterns and perceptions toward monitoring and lead placement. Data from 734 nurses and 59 nurse managers from 59 hospitals were analyzed using t-tests, ANOVA, Chi-square test and logistic regression. Results: Electrocardiogram monitoring was used to detect myocardial ischemia by 43.7% of respondents, and 35.1% selected leads according to electrocardiogram or angiography findings. Most (70%) agreed that monitoring for acute coronary syndrome was important, while 39.2% did so, and 15.7% were able to identify correct placement. Logistic regression revealed a significant relationship between the uses of ST-segment monitoring and number of hospital beds, continuing education and a belief in its use and ease of use. Correct electrode placement was significantly correlated with respondents from university hospitals, hospitals with more acute coronary syndrome admissions and more independent thinking nurses. Conclusions: Despite best practice evidence, less than half of the sample used electrocardiogram monitoring to detect myocardial ischemia and the majority could not identify correct electrode placement, while ST-segment monitoring was not used routinely. This paper highlights the need for improvements in education both in universities and hospitals and discussion addresses conventions in units, which inhibit development of nurses’ skills. [Copyright &y& Elsevier]