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Background: Apparent overconfidence and underconfidence in clinicians making clinical judgements could be a feature of evaluative research designs that fail to accurately represent clinical environments. Objectives: To test the effect of improved realism of clinical judgement tasks on confidence calibration performance of nurses and student nurses. Design: A comparative confidence calibration analysis. Settings: The study was conducted in a large university of Northern England. Methods: Ninety-seven participants rated their confidence - using a scale that ranged from 0 (no confidence) to 100 (totally confident) on dichotomous clinical judgements of critical event risk. The judgements were in response to 25 paper-based and 25 higher fidelity scenarios using a computerised patient simulator and clinical equipment. Scenarios, and judgement criteria of 'correctness', were generated from real patient cases. Using a series of calibration measures (calibration, resolution and over/underconfidence), participants' confidence was calibrated against the proportion of correct judgements. The calibration measures generated by the paper-based and high fidelity clinical simulation conditions were compared. Results: Participants made significantly less accurate clinical judgements of risk in the high fidelity clinical simulations compared to the paper simulations (P = 0.0002). They were significantly less confident in high fidelity clinical simulations than paper simulations (P = 0.03). However, there was no significant difference of over/underconfidence for participants between the two simulated settings (P = 0.06). Participants were no better calibrated in the high fidelity clinical simulations than paper simulations, P = 0.85. Likewise, participants had no better ability of discriminating correct judgements from incorrect judgements as measured by the resolution statistic in high fidelity clinical simulations than paper simulations, P = 0.76. Conclusions: Improving the realism of simulated judgement tasks led to reduced confidence and judgement accuracy in participants but did not alter confidence calibration. These findings suggest that judgemental miscalibration of confidence in nurses may be a systematic cognitive bias and that simply making scenarios more realistic may not be a sufficient condition for correction. [ABSTRACT FROM AUTHOR]

Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources. [ABSTRACT FROM AUTHOR]

Abstract Background: Tape blisters are common complications in the peri-lesional area of the surgical incision, forming below the layer of dressing adhesive applied and causing numerous complications for patients. Objectives: The purpose of this study was to investigate the incidence of the phenomenon, and to identify and quantify the main prognostic factors associated. Design: Multicentric, prognostic prospective cohort study. Setting: Shoulder Orthopaedic surgery, General surgery, Advanced Oncology therapies, Gastro-entero mininvasive surgery and Endocrine surgery. Participants: One thousand and two patients who underwent chest, abdominal, upper limb and joint laparotomic surgery consecutively admitted to the surgical units involved, were included. Methods: Data regarding individual and patient care variables, such as intrinsic (e.g. age and gender) and extrinsic (e.g. surgery type and time) data were collected. A multivariate logistic regression model was used to identify the variables which independently influenced the onset of the tape blister. Results: In the multivariate analysis, patients who underwent chest (Odds Ratio = 8.99, 95% CI 5.33–15.13), and upper limb and joint surgery (Odds Ratio = 2.09, 95% CI 1.22–3.58) were more likely to develop tape blisters in the postoperative period, At the same time, having drainage (Odds Ratio = 1.98, 95% CI 1.11–3.53), being female (Odds Ratio = 1.56, 95% CI 1.01–2.44) and having a high Body Mass Index (BMI) score (Odds Ratio: 1.06, 95% CI 1.02–1.11) were also predictors of tape blister formation. Conclusions: A higher BMI score, chest, upper limb and joint surgery, female gender and the presence of drainage were predictive factors of the tape blister event while, in contrast with the literature, the type of dressing used in this study was not significantly associated with the event. [ABSTRACT FROM AUTHOR]

Background The association between poor staffing conditions and negative patient safety consequences is well established within hospital nursing. However, many studies have been limited to nurse population level associations, and have used routine data to examine relationships. As a result, it is less clear how these relationships might be manifested at the individual nurse level on a day-to-day basis. Furthermore, personality may have direct and moderating roles in terms of work environment and patient safety associations, but limited research has explored personality in this context. Objective To further our understanding of these associations, this paper takes a within-person approach to examine nurses’ daily perceptions of staffing and patient safety. In addition, we explore the potential role of personality factors as moderators of daily level associations. Method We recruited eighty-three hospital nurses from three acute NHS Trusts in the UK between March and July 2013. Nurses completed online end-of-shift diaries over three–five shifts which collected information on perceptions of staffing, patient–nurse ratio and patient safety (perceptions of patient safety, ability to act as a safe practitioner, and workplace cognitive failure). Personality was also assessed within a baseline questionnaire. Data were analysed using hierarchical linear modelling, and moderation effects of personality factors were examined using simple slopes analyses, which decomposed relationships at high and low levels of the moderator. Results On days when lower patient–nurse ratios were indicated, nurses reported being more able to act as a safe practitioner ( p = .011) and more favourable perceptions of patient safety ( p = <.001). Additionally, when staffing was perceived more favourably, nurses reported being more able to act as a safe practitioner ( p = <.001), more favourable perceptions of patient safety ( p = <.001) and experienced less workplace cognitive failure ( p = <.001). Conscientiousness and emotional stability emerged as key moderators of daily level associations between staffing and patient safety variables, with many relationships differing at high and low levels of these personality factors. Conclusion The findings elucidate the potential mechanisms by which patient safety risks arise within hospital nursing, and suggest that nurses may not respond to staffing conditions in the same way, dependent upon personality. Further understanding of these relationships will enable staff to be supported in terms of work environment conditions on an individual basis. [ABSTRACT FROM AUTHOR]

Objectives Evidence suggests that pregnancy-related anxiety is more strongly associated with maternal and child outcomes than general anxiety and depression are and that pregnancy-related anxiety may constitute a distinct concept. However, because of its poor conceptualization, the measurement and assessment of pregnancy-related anxiety have been limited. Efforts to analyze this concept can significantly contribute to its theoretical development. The first objective of this paper was to clarify the concept of pregnancy-related anxiety and identify its characteristics and dimensions. The second aim was to examine the items of current pregnancy-related anxiety measures to determine the dimensions and attributes that each scale addresses, noting any gaps between the current assessment and the construct of the concept. Design A concept analysis was conducted to examine the concept of pregnancy-related anxiety. Data sources To obtain the relevant evidence, several databases were searched including MEDLINE, PsycINFO, EBSCO's SocINDEX, Psychological and Behavioral Sciences Collection, CINAHL, SCOPUS, and EMBASE. Review methods A modified approach based on Walker and Avant (Strategies for theory construction in nursing. 5th ed; 2011) was used. Qualitative or quantitative studies published in English that explored or examined anxiety during pregnancy or its dimensions prospectively or retrospectively were included. Results Thirty eight studies provided data for the concept analysis. Three critical attributes (i.e., affective responses, cognitions, and somatic symptoms), three antecedents (i.e., a real or anticipated threat to pregnancy or its outcomes, low perceived control, and excessive cognitive activity, and four consequences (i.e., negative attitudes, difficulty concentrating, excessive reassurance-seeking behavior, and avoidance behaviors) were identified. Nine dimensions for pregnancy-related anxiety were determined, and a definition of the concept was proposed. The most frequently reported dimensions included anxiety about fetal health, fetal loss, childbirth, and parenting and newborn care. The content of five scales was analyzed to determine the attributes and dimensions measured by each tool. Our findings suggest that the Pregnancy-Related Anxiety Scale tapping five dimensions of pregnancy-related anxiety and the Pregnancy Outcome Questionnaire with six items pertaining to the consequences of pregnancy-related anxiety can respectively be considered the most useful tools for assessing the existence and severity of the concept. Conclusions The critical attributes of pregnancy-related anxiety are similar to those defined for anxiety disorders. However, the behavioral consequences of pregnancy-related anxiety appear to apply only some women and may serve as important indicators of the severity of the condition. Current tools are useful instruments to determine whether the concept exists and to capture selected domains of pregnancy-related anxiety. A tool that includes all dimensions of the concept and examines the severity of pregnancy-related anxiety is needed. [ABSTRACT FROM AUTHOR]

Background Nurses are often portrayed as possessing specific traits and dispositions associated with care and empathy. The assumption has been that possessing these traits makes nurses competent, engaged, and well suited to their job. This proposition has been mostly normative, and few studies have investigated how this plays out empirically. Objective The aims of this study were to investigate (a) whether possessing a personality trait related to empathy and care was more common among nursing students than students in teaching and social work programs and (b) whether nursing students possessing an affirming personality trait judged themselves to be more suited to their future work – understood as commitment to the profession – than students in teaching and social work. Design A cross-sectional survey design was used. Participants and setting All first-year students attending seven Norwegian universities and university colleges were invited to participate in the study. Of the 1675 students who participated in the survey, 527 were nursing students, 668 were students in teaching, and 480 were social work students. A response rate of 65 percent was achieved. Methods The survey was conducted by Oslo and Akershus University College in the autumn of 2012. Data collection methods included both a paper-and-pencil questionnaire and an online survey. Instruments used included Blau's Career Commitment Scale and Orlinsky and Rønnestad's Interpersonal Adjective Scale. Analysis of variance and regression analysis were performed on the data. Results Nursing students did not differ from students in teaching and social work programs in terms of the degree of affirming personality trait. Furthermore, the regression analysis revealed an equally strong association between having an affirming personality trait and being committed to the profession among all these student groups. Conclusion The results of this study indicate that the narrative of nursing students as individuals who possess a special personality characteristic does not entirely reflect reality. [ABSTRACT FROM AUTHOR]

Background: Longer life expectancy and changes in family patterns in Western societies have increased the need for professional caregivers to the elderly. A detailed understanding of job resources, especially of job control, may help preserve eldercare workers' work-related well-being. Objectives: The aim of the present study was to determine optimal levels of job control for eldercare workers' work-related well-being. Design: Cross-sectional (Study 1) and longitudinal (Study 2) data were used to assess the linear and non-linear relations between job control and eldercare workers' work-related well-being. As indicators of well-being, irritation was examined cross-sectionally, whereas burnout and engagement were used in the longitudinal study. In both studies, demographic variables and time pressure were included as controls. In Study 2, results were additionally controlled for baseline levels of the outcome variables. Participants: Study participants were recruited from the nursing staff of 10 publicly ?nanced nursing homes for the elderly (Study 1) and from 18 privately and 20 publicly ?nanced nursing homes for the elderly (Study 2). In both studies, eldercare workers (i.e., registered nurses, orderlies, and nursing assistants) were invited to answer paper-pencil questionnaires. In Study 1, 606 persons followed this invitation (response rate: 65%). In Study 2, 591 persons provided data on both measurement points (response rate: 35% of Time 1 participants). The samples of both studies were predominantly female and between 20 and 65 years of age. Methods: Hierarchical multiple regressions with linear and quadratic terms were conducted. Results: Curvilinear effects of job control were found in both studies. In Study 1, low as well as high levels of job control were associated with higher levels of irritation compared to medium levels of job control. The longitudinal data from Study 2 supported these results. Eldercare workers with higher and lower levels of job control reported a higher tendency to depersonalize care recipients and a lower tendency to feel dedicated to, absorbed by and vigorous at work than those with medium levels of job control. Conclusions: Higher levels of job control are not necessarily advantageous for work-related well-being of eldercare workers. [ABSTRACT FROM AUTHOR]

Background: Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to 'engage' and 'empower' ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the 'engagement' of the clinical teams who participate and vice-versa. Objective: This paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the 'work engagement' of the nurses and ward teams involved. Design/methods: Using the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national 'Productive Ward' initiative in Ireland and compared them to a control group of similar size and matched (as far as ispossible) on variables such as ward size, employment grade and clinical specialty area. Results: 338 individual datasets were recorded, n = 180 (53.6%) from the Productive Ward group, and n = 158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (±standard deviation) in the Productive group was 4.33 (±0.88), and 4.07 (± 1.06) in the control group, representing a modest but statistically significant between-group difference (p = 0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (p < 0.001, general linear model) and (for the most part), to its components, with both clerical and nurse manager grades, and the elderly specialist areas, exhibiting substantially higher scores. Conclusions: The findings demonstrate how QI activities, like those integral to the Productive Ward programme, appear to positively impact on the work engagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of 'engagement' in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement. [ABSTRACT FROM AUTHOR]

Abstract: Background: Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously. Objective: This study aimed to test the effect of the SAFE or SORRY? programme on the incidence of three adverse events (pressure ulcers, urinary tract infections and falls). This paper describes Part I of the study: the effect on the incidence of adverse events. Design: A cluster randomised trial was conducted between September 2006 and November 2008. After a three-month baseline period the intervention was implemented followed by a nine-month follow-up period. Settings: Ten wards from four hospitals and ten wards from six nursing homes were stratified for institute and ward type and then randomised to intervention or usual care group. Participants: During baseline and follow-up, patients (≥18 years) with an expected length of stay of at least five days, were asked to participate. Methods: The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for the three adverse events. A multifaceted implementation strategy was used for the implementation: education, patient involvement and feedback on process and outcome indicators. The usual care group continued care as usual. Data were collected on the incidence of adverse events and a Poisson regression model was used to estimate the rate ratio of the adverse events between the intervention and the usual care group at follow-up. Results: At follow-up, 2201 hospital patients with 3358 patient weeks and 392 nursing home patients with 5799 patient weeks were observed. Poisson regression analyses showed a rate ratio for the development of an adverse event in favour of the intervention group of 0.57 (95% CI: 0.34–0.95) and 0.67 (95% CI: 0.48–0.99) for hospital patients and nursing home patients respectively. Conclusion: This study showed that implementing multiple guidelines simultaneously is possible, which is promising. Patients in the intervention groups developed 43% and 33% fewer adverse events compared to the usual care groups in hospitals and nursing homes respectively. Even so, more research is necessary to underline these results. Trial registration: clinicaltrials.gov, number NCT00365430. [Copyright &y& Elsevier]

Abstract: Background: As the prevalence of heart failure (HF) rises sharply, the costs related to the care of these patients increases in parallel. Considering the already limited resources and manpower, in the future the demand for care may exceed the supply. Therefore, health care systems are encouraged to develop innovative strategies to deal with the burden of HF to improve the quality of care in order to medical outcomes and patients’ quality of life. For that reason new management systems – such as telemonitoring – have to be explored. Objectives: This paper outlines the study protocol of a tailor-made telemonitoring program in ambulant patients with HF. Design and methods: A prospective randomised controlled trial is carried out at 3 hospitals in the South-Limburg area in the Netherlands. Primary outcome measures are hospital admissions and cost-effectiveness. Secondary outcomes are effects on therapy compliance, level of disease specific knowledge and quality of life. Also determinants are studied of most and less benefited patients in the intervention group. Power calculation: It is estimated that 390 patients have to be included in the study, with 185 in each arm. Results: Inclusion started in September 2007 with a follow-up time of 12 months. First results are expected at the end of 2010. [Copyright &y& Elsevier]

Emergency Department attendance is increasing internationally, of which a significant proportion could be managed in general practice. In England, policies backed by substantial capital funding require such patients attending Emergency Departments be directed or 'streamed' to General Practitioners working in or parallel to Emergency Departments. However, evidence for streaming is limited and the processes of streaming patients attending Emergency Departments to General Practitioners lacks exploration. This paper explores streaming to General Practitioners in and alongside Emergency Departments at ten sites across England. It highlights positive streaming practice, as well as issues that may contribute to poor streaming practice, in order to inform future service improvement. A longitudinal qualitative study was conducted with data collected between October 2017 and December 2019 across 10 case study sites throughout England as part of a broader mixed methods study. 186 non-participant observations and 226 semi-structured interviews with 191 health professionals working in Emergency Departments or related General Practitioner Services were thematically analysed in relation to streaming processes and experiences. Six interconnected themes influencing streaming were identified: implementing and maintaining structural support; developing and supporting streaming personnel; implementing workable and responsive streaming protocols; negotiating primary/secondary care boundaries; developing and maintaining interprofessional relationships and concerns for patient safety. Streaming was considered central to the success of General Practitioners in/parallel to Emergency Departments. The importance of the skills of streaming nurses in delivering an optimal and safety critical service was highlighted, as was the skillset of General Practitioners and interprofessional relationships between streamers and General Practitioners. There was no distinct streaming model or method associated with good streaming practice to General Practitioners in/alongside Emergency Departments, instead factors for success were identified and key recommendations suggested. 'Inappropriate' streaming was identified as a problem, where patients streamed to General Practitioners in or parallel to Emergency Departments required Emergency Department management, or patients suitable for General Practitioner care were kept in the Emergency Department. Despite adopting differing methods, commonalities across case sites in the delivery of good streaming practice were identified, leading to identification of key recommendations which may inform development of streaming services. Study Registration: ISRCTN51780222. Tweetable abstract : Workplace culture and the skillset of streamers and General Practitioners is crucial to streaming of patients to General Practitioners in Emergency Departments [ABSTRACT FROM AUTHOR]

Despite increasing international awareness of the impact of cancer on young adults, to date there has been limited in-depth research to understand their experiences following a diagnosis using a qualitative and longitudinal perspective. To explore the impact of cancer on young adults' evolving sense of self and identity over one year from the time of diagnosis. In addition, to contribute further to an understanding of innovative research methods used to examine this experience. This was a longitudinal narrative study using visual methods and a psychosocial lens. Narrative was used to re-present experiences over time. Recruitment was from a Principal Treatment Centre for Teenagers and Young Adults with Cancer and a Cancer Centre for Adults in the United Kingdom. Total population sampling was used over a six-month period, recruiting 18 young adults aged between 16 and 30, one to three months from a diagnosis of bone cancer, lymphoma or leukaemia. In depth, free association narrative interviews at three-time points over a year were undertaken. Photographs were used to help with story-telling. Extensive reflexive field notes, debriefing and the use of a psychosocial research group, also formed data sources. Forty interviews were conducted with 18 participants: eight took part in three interviews, six in two interviews and four in one interview. Analysis focused on the holistic 'case' of the individual temporally. In-depth, visual images were analysed from discussion in the narrative text. Through memoing, coding and comparison, themes were developed across all cases and a conceptual framework developed. The conceptual framework illustrates the renegotiation of self over time through narrative. This was 'biographically' during young adult development and across 'cancer time'; through the core components of: the inner world, (psyche, emotion and coping); self as embodied; self as relating to others, and self as relating to place. Stories indicated that there was a constant inter- relationship over time between the renegotiation of identity and adaption of biography. The focus in this paper is on 'the temporality of cancer' through the first year from diagnosis, and the juxtaposed process of managing biographical and developmental milestones. The importance of developing health care and research which enables narrative and the patient's voice has been highlighted. It emphasises the need for professionals to 'be with' and 'walk alongside' through the intensity of a biographically and identity changing illness. Using longitudinal narrative, visual & psychosocial methods to describe the impact of a diagnosis of cancer on young adults' sense of biography and identity. [ABSTRACT FROM AUTHOR]

Newly graduated nurses have comparatively high levels of occupational stress. Previous studies have evaluated stress across this population as a whole; however, little is known about potentially different occupational stress responses among new nurses and the impact of demographic and work-related characteristics on occupational stress responses. To determine differences in occupational stress levels of newly graduated nurses at different time points during the first 3 years of practice; to identify potential subgroups of nurses who perceive different occupational stress levels over time; and to evaluate differences in identified subgroups based on demographic and work-related characteristics. An observational longitudinal study. Four tertiary hospitals in Shanghai were selected randomly using a computer-generated random number table. All 343 newly graduated nurses employed in the selected hospitals were invited to participate. The inclusion criteria were (1) newly graduated without nursing experience, excluding nursing internship; (2) current employment in in-patient departments/ICU/operation room; and (3) consented to participate. A total of 152 participants met criteria and completed all four points of data collection. Participants completed an annual paper survey. Occupational stress levels were measured using the Job Stress Scale for Newly Graduated Nurses. Occupational stress scores at different time points were compared using latent growth modeling. Group-based trajectory modeling was performed to identify subgroups of occupational stress trajectory. ANOVA and Fisher's exact test were conducted to examine the differences of demographic characteristics between classes. The entire sample of newly graduated nurses experienced a significant decrease in occupational stress during the first three years. The best-fitting group-based trajectory model described three distinctive trajectories: low occupational stress (19.1% of sample); medium occupational stress (67.1%) and high occupational stress (13.8%). The low occupational stress subgroup had a higher proportion of nurses from Shanghai, and the majority were employed as contact- based nurses. In comparison, the high occupational stress subgroup had the largest proportion of nurses from other provinces (outside of Shanghai), almost half of participants were employed as "bianzhi" nurses, and the majority reported to be assigned preceptor by shift. Newly graduated nurses perceived occupational stress differently over time. Identified subgroups with different demographic characteristics have significantly different perceptions of occupational stress over the first three years of practice and future intervention programs such as peer-support programs or a standardized preceptorship should be tailored to meet the unique needs of these different subgroups. [ABSTRACT FROM AUTHOR]