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AIM AND OBJECTIVES The purpose of this study was to investigate which factors are associated with the quality of dementia care in acute care hospitals. BACKGROUND The number of people with dementia who are admitted to acute care hospitals is increasing. Improving the quality of dementia care in acute care hospitals is an important issue. Prior studies have demonstrated that not only knowledge and nursing experience, but also psychological factors and the nursing practice environment are related to high-quality care on general wards. DESIGN Cross-sectional hypothesis-testing design. METHODS Participants were nurses providing care to people with dementia at acute care hospitals. Questionnaires were distributed to 300 acute care hospitals in Japan, 10 copies each and 773 valid responses were received. Based on the hypothesis model, variables were tested using multiple regression analysis. The model described the relationship between quality of care, personal attributes and the nursing practice environment. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used. RESULTS Almost 90% of the study sample was female, the mean age was 37.4 ± 9.3 years, and the mean nursing experience was 14.0 ± 8.7 years. The results showed that nursing foundations for quality of care, staffing and resource adequacy, specialist consultation, promoting systematic recreation and exchange, knowledge, and feelings towards people with dementia were associated with the quality of dementia care in acute care hospitals. The adjusted coefficient of determination was 0.367. CONCLUSION This study identified factors associated with the quality of dementia care in acute care hospitals. Knowledge and feelings towards people with dementia are important, and the nursing practice environment plays an important role in improving the quality of dementia care. RELEVANCE TO CLINICAL PRACTICE Not only improving nurse's practical ability but also a supportive nursing practice environment enhances the quality of dementia care in acute care hospitals.

Objective: Examine the changes in service delivery Australian public sexual health clinics made to remain open during lockdown. Methods: A cross‐sectional survey designed and delivered on Qualtrics was emailed to 21 directors of public sexual health clinics across Australia from July‐August 2020 and asked about a variety of changes to service delivery. Descriptive statistics were calculated. Results: Twenty clinics participated, all remained open and reported service changes, including suspension of walk‐in services in eight clinics. Some clinics stopped offering asymptomatic screening for varying patient populations. Most clinics transitioned to a mix of telehealth and face‐to‐face consultations. Nineteen clinics reported delays in testing and 13 reported limitations in testing. Most clinics changed to phone consultations for HIV medication refills (n=15) and eleven clinics prescribed longer repeat prescriptions. Fourteen clinics had staff redeployed to assist the COVID‐19 response. Conclusion: Public sexual health clinics pivoted service delivery to reduce risk of COVID‐19 transmission in clinical settings, managed staffing reductions and delays in molecular testing, and maintained a focus on urgent and symptomatic STI presentations and those at higher risk of HIV/STI acquisition. Implications for public health: Further research is warranted to understand what impact reduced asymptomatic screening may have had on community STI transmission.

AIM AND OBJECTIVES To gain an understanding of palliative care need and service utilisation in adult inpatients. The objectives were to 1) Determine the size and characteristics of the population of adult inpatients who were appropriate for palliative care referral, 2) Establish what percentage of patients, who were appropriate for a palliative care referral, had been referred to and/or were receiving palliative care. BACKGROUND Internationally there is evidence of high levels of unmet palliative care need. Early access to palliative care is associated with improved outcomes including improved quality of life and reduced healthcare costs. DESIGN An observational point prevalence study was reported using the STROBE guidelines. METHODS Data were collected directly from inpatient medical records at a 578-bed tertiary private-not-for-profit hospital by three Registered Nurses on 3 June 2021. Palliative care need was assessed using the prognostic criteria for the 12 conditions outlined in the Gold Standards Framework. RESULTS A total of 270 inpatients met study inclusion criteria. At a hospital population level, 29% (n = 78) of adult inpatients could have benefitted from palliative care. Of the 78 patients assessed as meeting criteria for palliative care, 29% (n = 23) were currently receiving palliative care with a majority of patients 71% (n = 55) not receiving palliative care. CONCLUSIONS This study prospectively collected data and included all 12 conditions outlined in the Gold Standards Framework and found a high level of palliative care need. There was evidence of a high level of unmet palliative care need across conditions and treating specialities. RELEVANCE TO CLINICAL PRACTICE Estimates of palliative care need can be used to improve access to palliative care and assess operational requirements, including the staffing levels required to meet the level of palliative care need for adult inpatients.

AIM This study aimed to explore the perception of other healthcare professionals, including the doctors, physiotherapists and perfusionists, about the nurses' role and competencies in veno-venous extracorporeal membrane oxygenation. BACKGROUND Extracorporeal membrane oxygenation is considered as a challenging clinical activity that requires critical decision and rapid response from nurses, particularly in emergencies. It was observed that nurses are primarily responsible for bedside management of these patients, and teamwork was found helping the nurses to manage this high-acuity care. However, little is known on the perception of other healthcare professionals about the nurses' roles and competencies, which would contribute to further improvements in quality extracorporeal membrane oxygenation care. DESIGN This was a qualitative descriptive study. METHODS One-to-one in-depth interviews were conducted with nine healthcare professionals working in extracorporeal membrane oxygenation care in an adult intensive care unit of a general hospital in Kuwait. RESULTS Participants reported that nurses play critical and multiple roles and responsibilities in the insertion, maintenance, weaning, and retrieval of extracorporeal membrane oxygenation, plus providing general nursing care, and performed their roles competently. Heavy workload, less recognition and support, and individual differences in competence were reported as possible barriers to the nurses' performance. CONCLUSION Other healthcare professionals recognize continuous training, having experience, teamwork, and increased staffing as measures that can promote the nurses' role in extracorporeal membrane oxygenation.

Objective Nursing homes (NHs) are serving an increasing proportion of residents with cognitive issues (e.g. dementia) and mental health conditions. This study aims to: 1) implement unsupervised machine learning to cluster NHs based on residents' dementia and mental health conditions; 2) examine NH staffing related to the clusters; and 3) investigate the association of staffing and NH quality (measured by number of deficiencies and deficiency scores) in each cluster. Data sources 2009-2017 Certification and Survey Provider Enhanced Reporting (CASPER) were merged with LTCFocUS.org data on NHs in the United States. Study design Unsupervised machine learning algorithm (K-means) clustered NHs based on percent residents with dementia, depression, and serious mental illness (SMI, e.g. schizophrenia, anxiety). Panel fixed-effects regressions on deficiency outcomes with staffing-cluster interactions were conducted to examine the effects of staffing on deficiency outcomes in each cluster. Data extraction methods We identified 110,463 NH-year observations from 14,671 unique NHs using CAPSER data. Principal findings Three clusters were identified: low dementia and mental illnesses (Post-acute Cluster); high dementia and depression, but low SMI (Long-stay Cluster); and high dementia and mental illnesses (Cognitive-mental Cluster). From 2009-2017, the number of Post-acute Cluster NHs increased from 3074 to 5719, while number of Long-stay Cluster NHs decreased from 6745 to 3058. NHs in Long-stay/Cognitive-Mental Clusters reported slightly lower nursing staff hours in 2017. Regressions suggested the effect of increasing staffing on reducing deficiencies is statistically similar across NH clusters. For example, one hour increase in registered nurse hours per resident day was associated with -0.67 [standard error (SE) =0.11], -0.88 (SE = 0.12), and - 0.97 (SE = 0.15) deficiencies in Post-acute Cluster, Long-stay Cluster, and Cognitive-Mental Cluster, respectively. Conclusions Unsupervised machine learning detected a changing landscape of NH serving residents with dementia and mental illnesses, which requires assuring staffing levels and trainings are suited to residents' needs. This article is protected by copyright. All rights reserved.

BACKGROUND Food quality influences patient food satisfaction, which may subsequently affect food intake and recovery, influencing hospital costs. The present qualitative study aimed to gain an understanding of hospital staff/volunteers experiences of serving food in Ontario hospitals, perceptions of food quality and challenges to quality food provision. METHODS Sixteen Ontario hospitals participated. Semi-structured interviews (n = 64 participants) and focus groups (n = 24; 150 participants) were conducted. Transcripts were analysed using inductive thematic analysis. RESULTS Four themes emerged: (1) Providing Good Quality Food (e.g., attributes that comprise the construct of meal quality, patients' expectations and desires from meals); (2) Individualising the Food and Mealtime Experience (e.g., processes to identify and cater to patients' needs and preferences); (3) Acknowledging Organisational Constraints (e.g., staffing, budget, etc.); and (4) Innovating Beyond Constraints (e.g., identifying innovation within potential modifiable and unmodifiable organisational constraints). CONCLUSIONS Serving meals in hospital is complex because of organisational and patient factors; however, current efforts to serve quality food despite these complexities were uncovered in our investigation. Discussions highlighted current practices that promote food quality and strategies for improvement. Improving food quality and the hospital meal experience can support food intake and patient outcomes, as well as reduce waste and hospital associated costs. The findings can be used to support quality improvement measures aiming to serve high quality food that meets patients' expectations and nutritional needs.

Aims To understand how COVID-19 affected nurse staffing in intensive care units (ICUs) in England, and to identify factors that influenced, and were influenced by, pandemic staffing models. Design Exploratory qualitative study. Methods Semi-structured, online interviews conducted July-September 2020 with regional critical care leaders including policy leads (n = 4) and directors/lead nurses (n = 10) across critical care networks in England. Findings The six themes emerging from the framework analysis illustrate how the pre-pandemic ICU culture influenced ICU staffing models during the pandemic. Changes in staffing impacted on the workforce and the care delivered, whilst it was necessary to learn from, and adjust to, a rapidly changing situation. Variation across and between networks necessitated variation in responses. The overwhelming outcome was that the pandemic has challenged the central tenets of ICU nurse staffing. Conclusions Pandemic nurse staffing models resulted in changes to ICU skill-mix and staffing numbers. Factors such as the impact of nurse staffing on care practices and on the workforce need to be taken into account when developing and testing future nurse staffing models for ICU. The extent to which ICUs will return to former staffing models is not yet known but there seems to be an appetite for change. Impact In common with many countries, nurse staffing in English ICUs was adapted to address surge requirements during the COVID-19 pandemic. Findings highlight the challenge COVID-19 presented to pre-pandemic ICU nurse staffing guidelines, the impact on patient and staff well-being and the potential legacy for future staffing models. Study findings have implications for ICU nurse managers, researchers and policy makers: nurse staffing models need to be adaptable to the local context of care and future research should investigate the impact of different models on patients, staff and health service outcomes.

This study draws on institutional theory to investigate why and how staffing effectiveness varies across countries. Utilising data from multiple sources (Cranfield Network on Comparative Human Resource Management [CRANET], Global Leadership and Organisational Behaviour Effectiveness [GLOBE], World Economic Forum [WEF], Transparency International, Tightness-Looseness Index), it covers 2,918 organisations in 11 countries. Extending earlier research on comparative staffing that focuses on cultural or regulatory differences separately, our findings show that companies in different countries implement staffing practices in line with their normative (i.e., cultural), regulatory, and cognitive institutions. A second key finding shows that institutionally embedded staffing practices are associated with organisational turnover, thus challenging dominant universalist perspectives on staffing effectiveness. Finally, we shed light on a central yet understudied boundary condition of contextual perspectives on staffing by identifying the strength of institutional pressures (i.e., societal tightness-looseness) as a moderator of the relationships between national institutions, staffing, and turnover., NA

Aim This paper provides the main accomplishments of the Royal North Shore Hospital (RNSH) Pharmacy Department?s COVID-19 Pandemic Response Plan and key recommendations for other departments developing a remote model of care. Methods The overall objective was to preserve the active workforce by minimising staff-to-staff and staff-to-patient contact. The response plan involved splitting the department into teams, implementing a remote ward-based clinical pharmacy service, staff upskilling and optimising the physical environment. Results In April 2020, 1240 clinical tasks were completed remotely compared with 1254 tasks completed on site. In May 2020, 1700 tasks were completed offsite, compared with 1544 tasks onsite. The percentage of pharmacists rating themselves 5 out of 5 (very confident) in communicating over the phone increased from 34.8% prior to remote service delivery, to 60% after completion of the service. Counselling patients over the phone increased from 17.4% to 40% while providing remote clinical service increased from 26.1% to 80%. Discussion The paper provides key recommendations for other sites wanting to implement a remote model of care. There are details of recommendations for communication, adequate skill mix, upskilling, education, training, staff resilience, role expansion and administration. Conclusion The formation of a team hospital pharmacy department COVID-19 Pandemic Response Plan has provided assurance that a complete pharmacy service could continue in the event of reduced staffing. Intense, thoughtful, collaborative work was required in a short period of time to design an appropriate physical environment, create a remote working model of care, and to train and educate members of staff.

OBJECTIVE To describe the development of and key factors for sustaining a rural-based research team focussed on nutrition and dietetics. DESIGN A longitudinal embedded case study approach with data sourced from publicly available records and observations. Case study sub-units were developed into 3 phases with analysis using theoretical propositions and pattern matching. Quantitative data were descriptively analysed. SETTING University of Newcastle Department of Rural Health across 4 rural sites. PARTICIPANTS Publicly available data sources from existing team members. MAIN OUTCOME MEASURES Staffing levels, research supervision, internal and external grant outcomes and peer-reviewed journal publications. RESULT Academic staffing has increased by 4 full-time equivalent positions over 18 years, with 6 current higher-degree research students. Key factors identified in the development of a discipline-specific research workforce included staff higher degree by research completions, longevity of staff in research-active roles, immersive rural placements with a research component and collaborations with nationally competitive researchers. Rural pilot research projects, community connections, understanding of the local context and research networks were fundamental to establishing a viable team. CONCLUSION Systematically investing in research that is embedded in local communities will ensure sustainability and relevance, capacity building of existing staff and an ability to problem solve at the local level. Sustained and focussed investment is needed if the current rural research workforce is to develop towards a capacity that meets current demand.

Objective To identify factors affecting implementation of Geriatric Patient Aligned Care Teams (GeriPACT), a patient-centered medical home model for older adults with complex care needs including multiple chronic conditions (MCC), designed to provide them with comprehensive, managed and coordinated primary care. Data sources Qualitative data was collected from key informants at eight VA Medical Centers (VAMCs) geographically spread across the US. Study design Guided by the Consolidated Framework for Implementation Research (CFIR), we collected prospective primary data through semi-structured interviews with GeriPACT team members (e.g. physicians, nurses, social workers, pharmacists), leaders (e.g., executive leaders and middle managers), and other staff referring to the program. Data collection We conducted in-person, semi-structured interviews with 134 key informants. Interviews were recorded with permission and professionally transcribed. Transcripts were coded in NVIVO 11. We used directed content analysis to identify key factors affecting GeriPACT implementation across sites. Principal findings Five key factors affected GeriPACT implementation-5 CFIR constructs within two CFIR domains. Within the intervention characteristics domain, two constructs emerged: 1) the structure of the GeriPACT model, and 2) design, quality and packaging. In the inner setting domain, we identified three constructs: 1) available resources (e.g., staffing and space, and infrastructure and information technology; 2) leadership support and engagement, and 3) networks and communications including teamwork, communication and coordination. Conclusions Older Veterans with MCC have complex primary care needs requiring high levels of care management and coordination. Knowing what key factors affect GeriPACT implementation is critical. Study findings also contribute to the growing implementation science literature on applying CFIR to evaluate factors that affect program implementation, especially to aging research. Further studies on MCC-focused specialty primary care will help facilitate patient-centered care provision for older adults' complex health needs while also leveraging synergistic work across factors affecting implementation. This article is protected by copyright. All rights reserved.

Refereed/Peer-reviewed Aims: To compare levels of nurse burnout across eastern and western cultures, as well as examine the influence of burnout on patient safety cross-culturally. Design: Comparative cross-sectional study. Methods: Survey data were collected from nurses between August and October 2017 in Australia (n = 730) and between April and October 2019 in China (n = 1107). Variables included burnout (emotional exhaustion, depersonalization, personal accomplishment), nurse leadership and support, staffing and resource adequacy, and perceived patient safety. Data were analysed separately for each jurisdiction using bootstrapped hierarchical regressions, which tested the relationships between burnout indicators and patient safety, controlling for support resources. Results: Emotional exhaustion and depersonalization scores were significantly higher in the Australian sample compared with the Chinese sample. Australian participants reported significantly lower patient safety grades than Chinese participants and were less likely to agree that support resources were present in their current job. Separate regressions indicated that patient safety was significantly associated with staffing and resource adequacy, nurse leadership and support, and depersonalization among Australian participants (30% of variance explained in the final regression model), while staffing and resource adequacy, nurse leadership and support, personal accomplishment and emotional exhaustion predicted patient safety for Chinese participants (22% of variance explained in the final model). Conclusion: Australian nurses are at greater risk of burnout than Chinese nurses. Burnout dimensions are differentially associated with patient safety across cultures. Culturally relevant interventions may be more optimal than universal approaches for improving burnout and patient safety in nursing. Impact: This study increased understanding of cross-cultural differences in nurse burnout and the relationship with patient safety. Australian nurses were at greater risk of burnout than Chinese nurses. Emotional exhaustion, depersonalization and personal accomplishment influenced patient safety distinctively across the countries. These findings inform interventions designed to reduce nurse burnout and improve patient safety internationally.

Advocate Aurora Health, located in the north‐central United States, is the result of a merger between two large health care organizations in April 2018. The health care system comprises 26 hospitals, offers more than 500 sites of care, and employs 75,000 team members. This article discusses the effects that coronavirus disease 2019 had on the perioperative services departments while directors and site leaders were still managing the complexities of the merger. Included are strategies used to address the challenges created by the pandemic, special considerations based on level‐of‐care capacity, the effect that the hold on elective surgeries had on staffing assignments, the reactivation process when elective surgery resumed, and the importance of keeping the perioperative team members informed and safe. It also illustrates how facing the challenges caused by the pandemic helped to solidify the merger of the two health care organizations.

Aims and objectives This study aimed to understand how licenced practical nurses perceive their work environments across different work settings and to analyse the association between these nurses’ perceptions of their work environments and their intentions to stay employed at their current nursing unit. Design A cross‐sectional descriptive survey was conducted with Licensed Practical Nurses in Alberta, Canada. Methods The study population consisted of 598 licenced practical nurses. Survey measures included demographic information, the Perceived Work Environment‐Nursing Work Index, and an intention to stay scale. Descriptive statistics were calculated and mean scores for perceptions about the work environment were compared by work setting. The associations between perceived work environment and intention to stay were analysed using linear regression. Results Overall, licenced practical nurses rated their work environment as mixed, with statistically significantly lower scores in acute care settings. Nurse manager ability and adequate staffing and resources were the highest contributing variables.

Objective: This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. Design: This study had a meta-ethnography design. Data Sources: Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. Review Methods: A meta-ethnography was performed. Results: Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie ‘outside’ the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered. Conclusions: Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes. Patient or Public Contribution: A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings.

BACKGROUND The Centers for Medicare & Medicaid Services (CMS) Home Health Quality Reporting Program (HHQRP) uses performance measurement to spur improvements in home health agencies' (HHAs') quality of care. We examined quality improvement (QI) activities HHAs reported making to improve on HHQRP quality measures, and whether reported QI activities were associated with better measure performance. METHODS We used responses (N = 1052) from a Web- and mail-based survey of a stratified random sample of HHAs included in CMS Home Health Compare in October 2019. We estimated national adoption rates for 27 possible QI activities related to organizational culture, health information technology, care process redesign, provider incentives, provider training, changes to staffing responsibilities, performance monitoring, and measure-specific QI initiatives and technical assistance. We used multivariate linear regression to examine the associations between HHA characteristics and QI adoption, and between QI adoption and CMS Home Health Quality of Patient Care Star Rating. RESULTS HHAs reported implementing an average of 16 QI activities (interquartile range 11-19 activities). Larger HHA size was associated with adopting 1.6 additional QI activities (p

Aim The aim of this study was to investigate the processes through which personnel understaffing and expertise understaffing jointly shape near misses among nurses during the COVID-19 pandemic. Background Inadequate staffing is a chronic issue within the nursing profession, with the safety consequences of understaffing likely being exacerbated by the COVID-19 pandemic. Design This study used a three-wave, time-separated survey design and collected data from 120 nurses in the United States working on the frontline of the pandemic in hospital settings. Methods Participants were recruited through convenience sampling in early April 2020. Eligible nurses completed three surveys across a 6-week period during the COVID-19 pandemic from mid-April to the end of May 2020. Study hypotheses were tested with path analyses. Results/findings Results reveal that personnel understaffing and expertise understaffing jointly shape near misses, which are known to precede and contribute to accidents and injuries, through different mechanisms. Specifically, personnel understaffing led to greater use of safety workarounds, which only induced near misses when cognitive failures were high. Further, higher levels of cognitive failures appeared to be the result of greater expertise understaffing. Conclusion This study highlights the importance of addressing issues of understaffing, especially during times of crisis, to better promote nurse and patient safety. Impact This study was the first to examine the distinct mechanisms by which two forms of understaffing impact safety outcomes in the form of near misses. Understanding these mechanisms can help leaders and policymakers make informed staffing decisions by considering the safety implications of understaffing issues.

Aim To assess the beliefs, attitudes and knowledge of nurses, physicians and physiotherapists in a cardiovascular intensive care unit (CICU) on patient mobilization. Design Survey of CV healthcare providers in the CICU at two academic tertiary care hospitals. Methods The validated Patient Mobilization Attitudes and Beliefs Survey was distributed to CV providers. The survey is a 26‐item self‐administered questionnaire that assesses providers' perceived barriers in three domains: attitude, behaviour and knowledge. Results Participants (N = 142) completed the survey (nurses, N = 67, physicians, N = 59 and physiotherapists, N = 16; 155 eligible participants, 91.6% overall completion rate). Nurses had lower overall knowledge, attitude and behaviour barriers to mobilization than physicians, but higher than physiotherapists (all p

AIMS AND OBJECTIVES This study aimed to examine the effects of nurses' individual, professional and work environment characteristics on their job performance levels. BACKGROUND Nurses' job performance is important in the effective and efficient provision of health care. DESIGN A descriptive, cross-sectional study. The STROBE guidelines were used in this study. METHODS The sample of this descriptive, correlational and cross-sectional study comprised 370 nurses working at one private and two university hospitals in Turkey. A demographic information form, the Practice Work Environment Scale of the Nursing Work Index (PES-NWI) and the Nursing Job Performance Scale (JPS) were used to collect the data. Data were analysed using descriptive statistics, Spearman's correlation and multiple linear (stepwise) regression. RESULTS There was a significant and positive correlation between the scores on the PES-NWI and the JPS (r: 0.65, p

Introduction End-stage kidney disease causes significant morbidity, mortality, and reduced quality of life. Despite improvements in conventional hemodialysis, these problems persist. In-center nocturnal hemodialysis (INHD) has been shown to be beneficial in observational studies. This report outlines a 4-year renal network experience of INHD from the patient and frontline staff perspective. Methods Staff and patients' experiences of INHD were evaluated through two work streams. Work stream one: 12 patients who chose to stop INHD and 24 patients who chose to continue with INHD completed an anonymous survey. Work stream two: one-to-one interviews with 20 patients receiving INHD and seven staff working INHD shifts were conducted. Clinical incident reporting for conventional hemodialysis and INHD from April 2014 to December 2018 was reviewed. Findings Work stream one: Five themes were identified; facilities, time, health and well-being, sleep, and transport. A patient "starter pack" was developed and improvements to the dialysis unit were completed. Work stream two: Patient interviews demonstrated starter packs to aid sleep were well received; sleep itself was not a single reason to discontinue INHD. Staff indicated that their greatest concern was staffing levels; although staff-to-patient ratio remains unchanged, total numbers on INHD shifts were fewer, causing concern around less colleague availability for support during an emergency. Safety 363 clinical incidents were reported across all dialysis shifts; for conventional hemodialysis, a larger proportion were due to medical interventions, infection control, and transport; for INHD, most incidents centered around communication with patients and relatives, delays in patient transfer, and issues with medical equipment or facilities. Discussion Patients continue with INHD due to increased social time and perceived health benefits. Patient starter packs and adjustments to the dialysis unit may enhance sleep. This experience has optimized the design of the NightLife study; a randomized controlled trial evaluated the effect of INHD on quality of life.

This study aims to evaluate the cost of agents’ self‐routing in a service system with inbound and outbound customers. We assume that inbound customers arrive over time depending on the waiting time offered, while outbound customers can be contacted at all times. Furthermore, agents are in control of routing decisions and are aware of the state of the system. Accordingly, they decide whether to serve an inbound or outbound customer, or to idle. The system manager seeks to provide a suitable trade‐off between agents’ choice of serving inbound and outbound customers by incentivizing their actions through linear payouts. Hence, there arises a problem of determining the cost of agents’ self‐routing, which can be interpreted as a variant of the principal‐agent problem where the agents’ efforts are directed toward selecting their routing policy. Through a Markov decision process, we show that the agents’ optimal policy is a reservation threshold policy for inbound customers, and express the compensation parameters that minimize staffing cost. We conclude that motivating idling decisions through linear payouts incurs high costs. This justifies the current practice of using automated routing in call centers. Moreover, paying for idling cannot reduce staffing cost. However, discriminating between delayed and non‐delayed customers in the reward structure presents a high potential of reducing agents’ pay. Finally, in situations where agents do not know the status of their colleagues, our analysis argues in favor of not revealing the state of the system to them through delay announcements when the objective waiting time is low.

Information on the current practices and quantification of lymphedema service may be beneficial to promote and improve the current health care system. Therefore, this study aimed to describe the characteristics of lymphedema practitioners, and lymphedema patients' profiles, and provide a comprehensive picture of lymphedema service provision in Saudi Arabia. A cross‐sectional study design used an online survey to gather data. The survey included information about demographic and professional characteristics of lymphedema practitioners, lymphedema profiles, questions on the services provided, and perceived barriers in providing services. Eighteen lymphedema practitioners (38%) responded to the survey. Most of the respondents were physical therapists (94%), who had completed 135 hours of basic training course, and were certified as lymphedema therapists (89%). Most of these practitioners were in Riyadh (58%), Jeddah (25%), and Dammam (17%). About 75% of patients seen by practitioners had secondary lymphedema, predominately breast cancer‐related lymphedema (47%). The average number of lymphedema practitioners per service is three. The perceived barriers reported included an inadequate number of certified therapists (100%), difficulties with transportation and lack of financial support (each; 72%), and limited space for lymphedema practice/management (89%). The results suggest lymphedema practitioners provide reasonable services for lymphedema patients; however, services are still limited and needs are unmet. Therefore, more staffing is required to promote awareness of the condition and related services, to develop and implement appropriate educational strategies, and improve geographical and multidisciplinary coordination of the services in Saudi Arabia.

Aims & objectives This study aimed to explore the decision-making processes undertaken by critical care nurses when considering restraint to manage a patient with psychomotor agitation secondary to hyperactive delirium. Background Psychomotor agitation is frequently cited as clinical rationale for initiating chemical or physical restraint. Despite the presence of clinical guidance for restraint in critical care, wide variations in nursing and prescribing practice are evident. Nurses are the primary decision makers when initiating restraint, but little is known about this process and influencing factors. Design A pragmatic qualitative approach was used to explore critical care nurses' decision-making processes. Methods A 'think aloud' approach was undertaken. Audio-visual vignettes featuring simulated patients were used as stimulus to elicit decision-making processes from thirty critical care nurses and practitioners. The COREQ checklist was followed. Results Five themes relating to restraint were identified: Intrinsic beliefs and aptitudes; Handover and labelling; Failure to maintain a consistent approach; Restraint might be used to replace vigilance; The tyranny of the now. Conclusions Restraint was more frequent when staffing ratios were reduced below 1:1 and opportunities for vigilance reduced. Participants described physical and psychological exhaustion when caring for a patient with delirium and how this might lead to restraint to create 'space' for respite. Variations in practice were evident and restraint use appears rooted in custom and culture rather than objective assessment. Relevance to clinical practice The lack of pre-emptive management for hyperactive delirium and reduced staffing ratios lead to the decision to restrain to preserve safety in acute agitation. The struggle to manage agitated behaviour is associated with nurse burnout and reduced engagement with therapeutic management methods, suggesting the need for psychological and educational support for clinical staff. Delirium is an important and debilitating form of organ dysfunction which should be collaboratively managed by the multi-disciplinary team.

Background Despite the growing popularity of transnational education, there is a dearth of quantitative research regarding how transnational students experience higher education. Aims This comparative study sought to explore differences in educational experiences between transnational and onshore domestic students enrolled either at the Australian (domestic) or Singapore (transnational) campus of an Australian university. Sample and Methods An online survey gathered responses from 199 domestic students and 313 transnational students. Results Results indicated transnational students to be significantly lower than domestic students on social and academic integration, institutional commitment, and satisfaction. No group differences were found in persistence intentions. A series of regression analyses showed integration and commitment significantly predicted student persistence intentions, across both cohorts, beyond demographic and course characteristics. Conclusions This study offers several recommendations for how universities can better foster integration and commitment in their transnational students, including better funding the development of student societies and providing realistic course previews and career advice to students upon entry into their courses. Further, universities are encouraged to reconsider their transnational staffing models to provide more opportunities for academic support and student consultation beyond the classroom.

The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.

OBJECTIVES: To examine the effect of Hurricane Irma on staff-related financial expenditures and daily direct-care nurse staffing levels. DESIGN: Retrospective cohort study. SETTING: September 3(rd)-24(th), 2017 in the state of Florida, United States. Hurricane Irma made landfall on September 10(th), 2017. PARTICIPANTS: 653 nursing homes, 81 evacuated facilities and 572 facilities that sheltered-in-place. MEASUREMENTS: This study used data from Payroll-Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida’s health providers’ emergency reporting system. PBJ provided estimates of daily direct-care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. CASPER reported facility-level characteristics such as profit status, chain membership, and special care unit availability. Florida’s emergency reporting system identified evacuation status during Hurricane Irma. Linear mixed effects models were used to estimate the unique contribution of evacuation status on daily staffing increases over time from September 3(rd)-September 10(th). RESULTS: Among all facilities, we found significant increases in staffing for licensed practical nurses (p = .02) and certified nursing assistants (p < .001), but not for registered nurses (p = .10) before Hurricane Irma made landfall. From one week before landfall to two weeks after landfall (September 3(rd)-September 24(th)), an additional estimated $2.41 million was spent on direct-care nurse staffing. In comparison to facilities that sheltered-in-place, evacuated facilities increased staffing levels of all nurse types (all p < .001). At landfall, evacuated facilities spent an estimated $93.74 on nurse staffing per resident while facilities that sheltered-in-place spent $76.10 on nurse staffing per resident. CONCLUSION: Nursing homes face unprecedented challenges during hurricanes, including maintaining adequate direct-care nurse staffing levels to meet the needs of their residents. Nursing homes that evacuated residents had an increase in direct-care nurse staffing that was greater than that seen in nursing homes that sheltered-in-place.

INTRODUCTION Myanmar is a Low-Middle Income Country (LMIC) in South-East Asia. Over the last decade, reforms to the health system have included significant improvements in the delivery of radiation therapy services in both government and private-for-profit sectors. METHODS This review uses limited cancer registry data, observations from in-person visits, and data from key informants in Myanmar radiation therapy centres, to report on developments in radiation therapy services in recent years. RESULTS Rising national cancer incidence estimates presented in this article are supplemented with annual cancer case and radiation therapy course completion statistics from three hospital / regional contexts. Strategies which enabled the increased delivery of radiation therapy services are described. Data regarding the geographic locations of radiation therapy centres, their equipment and software inventories, is tabulated. The impact on clinical practice standards through upgraded equipment and software used for treatment planning and delivery is discussed. Clinical staffing at each centre is catalogued, role descriptions are given, and increases in staff numbers in recent years are documented. The present clinical and academic education challenges for radiation therapy staff and the importance of these issues for technical practice advancements are discussed. CONCLUSION Myanmar's successes and continued challenges in radiation therapy service delivery are emulated in other LMIC's. Strategic planning for new and existing radiation therapy centres, further staff increases and improved academic and clinical learning for radiation therapy staff should assist in meeting these challenges. Further international engagement could also enhance these processes.

Aims and objectives: To explore how newly qualified nurses’ work experiences are constructed through the interplay between self, workplace and home‐life influencing their retention.Background: Nurses are critical to achieving the goal of universal health coverage. However, shortages of nursing staff are endemic. Of particular concern, newly qualified nurses are more likely to leave the nursing workforce. The point of transition to working as a newly qualified nurse is a time of vulnerability. Most studies attempt to discover why nurses leave. This study uses the concept of job embeddedness to examine the experience of this transition and first two years of practice to understand what might help newly qualified nurses stay.Design: Qualitative approach using semi‐structured telephone interviews.Methods: Self‐selecting sample of nurses (n = 23) who participated 1‐year (n = 12) and 2 years (n = 11) post‐qualification. Participants were part of a larger longitudinal cohort (n = 867) study which has followed them since September 2013 when they entered nurse education in two Scottish universities. Thematic analysis was used to understand the interplay between organisation/workplace and the individual.Results: Three themes were developed: transition shock; workplace factors and work/life balance. Two further subthemes were developed: experience of support and belonging; and feeling unsupported and alienated. Eight participants had changed job or left, and two were looking to leave nursing.Conclusion: This study highlights how the experience of transition shock can be positively or negatively impacted by the workplace environment, and how in turn this impacts the home environment. Ultimately, this impacts retention of newly qualified nurses.Relevance to clinical practice: Having adequate support resources, such as staffing, supportive team morale, professional development and family‐friendly work environment, can create a work environment where they feel the purpose and meaningfulness of working as a nurse. This ‘job embeddedness’ can potentially enhance nurse retention. Reporting follows the COREQ checklist.

Aim Nurses are pivotal in caring for patients infected with COVID‐19. Little is known about experiences of nurses in maternity care during the pandemic. Therefore, this study aimed to describe nurses’ experiences of caring for perinatal women and newborns during the pandemic. Design A descriptive qualitative study was conducted. Methods Data were collected from August–November 2020 using focus group and in‐depth interviews. A total of 24 nurses working in maternity and newborn care units participated in the study. Content analysis method was used for data analysis. Results The participants’ clinical experience ranged from 6 months–26 years. Three major themes emerged as follows: “making every effort to prevent COVID‐19 infection,” “caring for perinatal women and newborns with COVID‐19 infection or suspected infection” and “job stress and professional growth during the pandemic.” Participants reported that they needed more support in terms of staffing and mental health.

BACKGROUND Care left undone is a worldwide problem for both the quality of health care and the safety of patients. In surgical nursing, care left undone is a critical issue arising from the intensive pace of work, invasive procedures and the pressure for efficiency. Previous knowledge about care left undone in surgical contexts is missing. OBJECTIVE To describe care left undone and its relationship to nursing and organisational characteristics in the surgical wards of regional and central hospitals in Estonia. METHODS A cross-sectional study with an online questionnaire took place from June to October of 2018. The target population (N = 570) consisted of nurses working in the surgical wards of two regional and three central hospitals at the time of the study. The data were analysed using descriptive statistics and Fisher's exact test. The open-ended questions were analysed with deductive content analysis. RESULTS Nursing care in the surgical wards was reported as having been left undone sometimes or often by 88% of the nurses. Most often, the documentation and evaluation of care plans (33%) were reported as undone and most rarely, disinfection measures were left undone (5%). Nurses with a shorter employment history left care undone more frequently, and when the number of patients per nurse increased, the amount of care left undone increased as well. More than half of the participants (59%) considered work organisation to be the cause of care left undone. CONCLUSIONS Work organisation and staffing in surgical wards require more attention at the management level, as nursing care left undone occurred to a significant degree in the investigated wards, and more than half of the nurses considered work organisation to be the reason for care left undone.

Aim This study aims to analyse the employment effect of reformed nurse staffing policy which is the “Integrated Nursing and Care Service” scheme that was introduced by the Korean government. Design Economic evaluation study focusing on employment effect. Method An input–output model was used to estimate the employment‐inducing effect of the new staffing policy. The analysed data of 26,381 beds, of 400 hospitals that are participated in the Integrated Nursing and Care Service scheme were retrieved from the Korean National Health Insurance claims database. Results The job‐creation effect of the new staffing policy was estimated to be 48.5 persons per USD 1 million expenditure, which means 28,154 persons were employed when USD 580.15 million expenditures was paid to the hospitals by the National Health Insurance Service. In addition, the policy had an employment‐inducing effect which is as high as 3.09~6.07 times higher than that of similar industries and all industries.

Purpose This study aimed to test the hypothesis model showing the relationship between nurses' individual and working characteristics, nursing work environment, subjective career success, job satisfaction, intent to leave, and professional commitment. Design and methods A cross-sectional and correlational design was utilized for the study. The study sample consisted of 604 nurses working in four hospitals in Istanbul, Turkey. Data were collected using the Nurse Information Form, Subjective Career Success Inventory, Practice Work Environment Scale of the Nursing Work Index, Job Satisfaction Global Item, Intent to Leave Subscale, and Professional Commitment Scale. Data were analyzed using descriptive and correlation analysis, and the hypothesis model was tested using structural equation modeling. Findings The hypothesis model that was established to test the antecedents and outcomes of subjective career success in nurses was acceptable and had a good fit. Having a master's degree, work schedule with rotating shifts (negative), good individual income, participation in hospital affairs, staffing and resource adequacy, and nurse-physician relations were significantly associated with the subjective career success of nurses. Subjective career success had a positive effect on job satisfaction and professional commitment and a negative significant effect on intent to leave in nurses. Conclusions This study revealed that human capital, objective career success, and some characteristics of the nursing work environment were significantly associated with nurses' subjective career success, and that increased subjective career success produced positive professional and organizational outcomes. Clinical relevance The results of this study, which revealed the antecedents and outcomes of nurses' career success, should be taken into consideration by managers who wish to retain a qualified nursing workforce.

Background Eliciting residents’ priorities for their care is fundamental to delivering person‐centred care in residential aged care facilities (RACFs). Prioritization involves ordering different aspects of care in relation to one another by level of importance. By understanding residents’ priorities, care can be tailored to residents’ needs while considering practical limitations of RACFs. Objectives To investigate aged care residents’ prioritization of care. Design A mixed‐methods study comprising Q methodology and qualitative methods. Setting and participants Thirty‐eight residents living in one of five Australian RACFs. Method Participants completed a card–sorting activity using Q methodology in which they ordered 34 aspects of care on a pre‐defined grid by level of importance. Data were analysed using inverted factor analysis to identify factors representing shared viewpoints. Participants also completed a think‐aloud task, demographic questionnaire, post‐sorting interview and semi‐structured interview. Inductive content analysis of qualitative data was conducted to interpret shared viewpoints and to identify influences on prioritization decision making. Results Four viewpoints on care prioritization were identified through Q methodology: Maintaining a sense of spirituality and self in residential care; information sharing and family involvement; self‐reliance; and timely access to staff member support. Across the participant sample, residents prioritized being treated with respect, the management of medical conditions, and their independence. Inductive content analysis revealed four influences on prioritization decisions: level of dependency; dynamic needs; indifference; and availability of staff. Conclusions Recommendations for providing care that align with residents’ priorities include establishing open communication channels with residents, supporting residents’ independence and enforcing safer staffing ratios.

Background: Pharmacy robotics have been implemented globally to create medication management efficiencies. However, translation to the Australian public hospital environment has not been evaluated. Aim: To evaluate the impact of introducing robotics in an Australian public hospital on pharmacy imprest and dispensary tasks. Method: A single-centred, prospective, longitudinal time in motion study was conducted in an Australian tertiary public hospital using mixed methods during robot implementation (phase 1, May 2016) and 15 months later (phase 2, August 2017). Time-stamped video footage of dispensary activities was collected, observed and analysed; Fitbit Zip anonymously tracked pharmacy assistant movement. Dispensing software (iPharmacy ) provided the location of stocked medication and electronic tracking databases provided imprest turnaround times (ethics approval: HREC/16/QGC/66, HREC/17/QGC/18). Results: Medication stored in the robot was limited to 46% (n = 20 771 full packs) of total pharmacy holdings (n = 45 437 full packs). At baseline, 774 orders were received in the dispensary over five days increasing by 13% to 887 in phase 2 (p

Introduction Hospitals were mandated to dramatically increase capacity during the Covid‐19 crisis in New York City. Conversion of non‐clinical space into medical units designated for Covid‐19 patients became necessary to accommodate this mandate. Methods Non‐clinical space was converted into medical units at multiple campuses of a large academic hospital system over 1 week. The conversion required construction to deliver basic care including oxygen supplementation. Creation of provider workspaces, handwashing areas, and colour‐coded infection control zones was prioritized. Selection criteria were created with a workflow to determine appropriate patients for transfer into converted space. Staffing of converted space shifted as hospitalizations surged. Results The unit was open for 18 days and accommodated 170 unique patients. Five patients (2.9%) required transfer to a higher level of care. There were no respiratory arrests, cardiac arrests, or deaths in the new unit. Conclusion Converting non‐clinical space to a medical unit was accomplished quickly with staffing, workflow for appropriate patients, few patients who returned to a higher level of care, and no respiratory or cardiac arrests or deaths on the unit.

Key Takeaways Early in 2020, when the severity of COVID‐19 became evident, US water utilities implementing conservation programs had to act quickly to determine how to mitigate changes in their conservation programs and staffing. Prioritization and collaboration helped utility staff settle into their new way of working, which included adapting to online connection with customers and each other. These adaptations might lead to permanent changes. Thanks in large part to the power of technology, many water conservation and customer education programs have continued, with interest and participation even increasing in some cases.