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Purpose This study aimed to compare the impact of an electronic health record (EHR)–integrated perpetual inventory management system (EIMS) versus a traditional inventory management system (TIMS) on inventory accuracy, visibility, and turnover in a large academic tertiary hospital. Methods The quasi-experimental study was conducted over 12 months (a 6-month preimplementation period and a 6-month postimplementation period, with an 11-month washout period) at Houston Methodist Hospital. The EIMS was implemented following the use of a TIMS. A total of 114 matched inventory items from both systems were identified and compared. The primary outcome was inventory accuracy, calculated as cycle count accuracy. The secondary outcomes were inventory visibility and monthly inventory turnover rate. Results Analysis demonstrated a 6.02% absolute increase in inventory accuracy (P < 0.001) with use of the EIMS versus the TIMS. After adjusting for inflation, there was an increase in the captured cost of goods sold from $4.16 million to $5.16 million. The monthly inventory value, adjusted for inflation in the prices of studied inventory items, increased from $2.05 million to $2.33 million. The monthly inventory turnover rate increased from 2.03 to 2.23 turns per month (P = 0.305) when comparing data for the pre- and postimplementation periods. Inventory visibility increased from 133 inventory items to 264 inventory items after EIMS implementation, indicating a 98% visibility increase compared to preimplementation levels. Conclusion This study found that implementing an EIMS significantly increased pharmacy inventory accuracy and inventory visibility, which are essential for optimizing patient care and pharmacy financial management. [ABSTRACT FROM AUTHOR]

Background: The context of care determines and organizes practices through its structures and guiding principles. It is sometimes a space that generates tension and multiple choices, variable in the provision of different care and uncertain in its duration. We can consider that the construction of the comfort process does not only depend on the will of its actors and the situation itself, but is also conditioned by the professional, cultural, and social context in which it is inserted. This article is part of a doctoral study in the field of comfort in a palliative care unit, and these are some of the partial results that emerged. Design: Qualitative study using ethnographic approach. Methods: We conducted semistructured interviews with 18 patients at the end of life and their matched significant family members (18) and 21 health professionals. We also conducted a participant observation of care situations. Results/discussion: The context of action, where meanings and practices are learned, is linked to a certain identity that is related to practical, contextual knowledge, linked to a collective and to a feeling of belonging. The relationship between the various factors that shape the Care Context in the palliative care unit studied, constitute the three domains of this topic, specifically: the integrative and inclusive environment, the conceptions of care, and the inclusive factors of organizational culture. Conclusion: The specific context was determinant as a supporting axis for comfort in this palliative care unit. The context of care, where objects and provisions support the construction of the comfort process as an entity that integrates culture, established conceptions of care, allowing the deepening of knowledge. [ABSTRACT FROM AUTHOR]

Background: Falls are themost frequent accident experienced by inpatients in hospitals. As falls affect patient outcomes, high fall risk factors should be studied to prevent falls and improve patient safety. However, the relationship between hospital unit characteristics and fall risk has never been assessed. Purpose: This studywas designed to identify the unit characteristics significantly related to fall risk. Methods: A cross-sectional study was conducted on the medical records of patients hospitalized in a Japanese academic hospital between 2018 and 2019. This study quantified unit activities and utilizedDiagnosis Procedure Combination data to examine unit characteristics related to falls based on unit day. Results: Data on 16,307 patients were included in the analysis, and 355 unit days were certified as fall events. Based on patient condition and medical treatment, the results identified antineoplastic injections, radiation therapy, aseptic treatment room, and functional status of partly assisted transfers,meals, and oral care as unit characteristics associated with increased fall events. Decreased nursing time per patient at night (odds ratio [OR] = 0.75, p = .04) and higher numbers of partially assisted transfer patients were also identified as unit characteristics associated with higher fall incidence rates (OR = 5.56, p = .01). Conclusions: The results of this study are expected to assist nurses to predict falls based on unit characteristics; reducing nursing time in the units was found to be a factor associated with higher fall risk. Nursemanagersmust understand the unit-related fall risk factors, appropriately assign nurse staffing numbers, and demonstrate nursing leadership to prevent falls in their units. [ABSTRACT FROM AUTHOR]

Low health literacy (LHL) significantly impacts patients' ability to participate actively in their healthcare. Registered nurses (RNs) play a crucial role in identifying LHL and addressing patient knowledge gaps and skill deficits. This correlational study examined the relationship between RNs' predictions of patients' health literacy levels (HLL) and the actual HLL of a predominately Hispanic patient population. In addition, personal factors (i.e., demographics) were analyzed to determine their influence on the nurse's predictions and patients' HLL. Data were collected from 84 participant patient–nurse couplets admitted to a medical-surgical unit in a rural setting located on the United States–Mexico border. In addition to demographic information collected via survey, RNs were asked to predict their patient's health literacy abilities while the Newest Vital Sign, a health literacy assessment tool, was deployed to determine the actual HLL of patients participating in the study. Data were analyzed using descriptive statistics, t -tests, and chi-square tests while a Spearman correlational model was used to examine the relationship between predicted HLL and actual HLL. Finally, a logistic regression model was used to analyze the relationship between personal factors and HL data for RNs and patients. Analysis of the data revealed that RNs consistently overestimated patients' abilities, as evidenced by the disparity between patients' actual HLL (mean 1.71) and predicted HLL (mean 4.26) by RNs, with a moderately strong positive relationship (rs =.418). Notably, higher academic preparation and years of experience did not enhance the RNs' ability to identify LHL while the highest level of education completed was the only statistically significant predictor of adequate health literacy in the patient population sampled. These findings emphasize the need to prioritize effective health literacy education in RN academic preparation and clinical practice to support the detection of LHL when a standardized health literacy assessment tool is not utilized in the clinical setting. By recognizing the presence of LHL, healthcare professionals can better support patients' needs and bridge the knowledge gap, ultimately improving patient outcomes. [ABSTRACT FROM AUTHOR]

Safewards reduces conflict and containment on adult inpatient wards but there is limited research exploring the model in Children and Young People (CYP) mental health services. We investigated whether Safewards can be successfully implemented on twenty CYP wards across England. A process and outcomes evaluation was employed, utilizing the Integrated Promoting Action on Research Implementation in Health Sciences (i-PARiHS) framework. Existing knowledge and use of Safewards was recorded via a self-report benchmarking exercise, verified during visits. Implementation of the 10 Safewards components on each ward was recorded using the Safewards Organizational Fidelity measure. Data from 11 surveys and 17 interviews with ward staff and four interviews with project workers were subject to thematic analysis and mapped against the four i-PARiHS constructs. Twelve of the 20 wards implemented at least half of the Safewards interventions in 12 months, with two wards delivering all 10 interventions. Facilitators and barriers are described. Results demonstrated Safewards is acceptable to a range of CYP services. Whilst implementation was hindered by difficulties outlined, wards with capacity were able and willing to implement the interventions. Results support the commissioning of a study to evaluate the implementation and outcomes of Safewards in CYP units. [ABSTRACT FROM AUTHOR]

Aim: To gain staff feedback on the implementation and impact of a novel ambulatory monitoring system to support coronavirus patient management on an isolation ward. Design: Qualitative service evaluation. Methods: Semi‐structured interviews were conducted with 15 multidisciplinary isolation ward staff in the United Kingdom between July 2020 and May 2021. Interviews were audio‐recorded, transcribed and analysed using thematic analysis. Findings: Adopting Innovation to Assist Patient Safety was identified as the overriding theme. Three interlinked sub‐themes represent facets of how the system supported patient safety. Patient Selection was developed throughout the pandemic, as clinical staff became more confident in choosing which patients would benefit most. Trust In the System described how nurses coped with discrepancies between the ambulatory system and ward observation machines. Finally, Resource Management examined how, once trust was built, staff perceived the ambulatory system assisted with caseload management. This supported efficient personal protective equipment resource use by reducing the number of isolation room entries. Despite these reported benefits, face‐to‐face contact was still highly valued, despite the risk of coronavirus exposure. Conclusion: Hospital wards should consider using ambulatory monitoring systems to support caseload management and patient safety. Patients in isolation rooms or at high risk of deterioration may particularly benefit from this additional monitoring. However, these systems should be seen as an adjunct to nursing care, not a replacement. Implications for the Profession and/or Patient Care: Nurses valued ambulatory monitoring as a means of ensuring the safety of patients at risk of deterioration and prioritizing their workload. Impact: The findings of this research will be useful to all those developing or considering implementation of ambulatory monitoring systems in hospital wards. Reporting Method: This manuscript follows the Consolidated criteria for Reporting Qualitative Research (COREQ) guidelines with inclusion of relevant SQUIRE guidelines for reporting quality improvement. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Background: Unsafe patient events not only entail a clinical impact but also lead to economic burden in terms of prolonged hospitalization or unintended harm and delay in care delivery. Monitoring and time‐bound investigation of patient safety events (PSEs) is of paramount importance in a healthcare set‐up. Objectives: To explore the safety incident reporting behaviour and the barriers in a hospital set‐up. Methods: The study had two sections: (a) Retrospective assessment of all safety incidents in the past 1 year, and (b) Understanding the barriers of safety reporting by interviewing the major stakeholders in patient safety reporting framework. Further root cause analysis and failure mode effect analysis were performed for the situation observed. Results were statistically analyzed. Results: Of the total of 106 PSEs reported voluntarily to the system, the highest reporting functional group was that of nurses (40.57%), followed by physicians (18.87%) and pharmacists (17.92%). Among the various factors identified as barriers in safety incident reporting, fear of litigation was the most observed component. The most commonly observed event was those pertaining to medication management, followed by diagnostic delay. Glitches in healthcare delivery accounted for 8.73% of the total reported PSEs, followed by 5.72% of events occurring due to inter‐stakeholder communication errors. 4.22% of the PSEs were attributed to organizational managerial dysfunctionalities. Majority of medication‐related PSE has moderate risk prioritization gradation. Conclusion: Effective training and sensitization regarding the need to report the patient unsafe incidents or near misses to the healthcare system can help avert many untoward experiences. The notion of 'No Blame No Shame' should be well inculcated within the minds of each hospital unit such that even if an error occurs, its prompt reporting does not get harmed. [ABSTRACT FROM AUTHOR]

This descriptive study was carried out to investigate the relationship between the attitudes of nurses working at a university hospital towards older people and their compassion levels. The sample of the study comprised 432 nurses working at a university hospital. The data were collected using a Personal Information Form, the University of California at Los Angeles Geriatrics Attitudes Scale, and the Compassion Scale. In the analysis of the data, frequencies, percentages, arithmetic mean values, tests for the significance of the difference between two mean values, the Kruskal-Wallis test, and Pearson's correlation test were used. The attitudes of the participants towards older adults were positive (47.18 ± 6.40), and their compassion levels were high (4.08 ± 0.41). There was a significant positive correlation between the participants' mean scores on the University of California at Los Angeles Geriatrics Attitudes Scale and the Compassion Scale (r = 0.313). The participants had positive attitudes towards elderly individuals and high compassion levels. As the participants' compassion levels increased, so did their mean University of California at Los Angeles Geriatrics Attitudes Scale scores. Gender, length of service, working unit, status of living with an older person, and compassion were identified as predictors of University of California at Los Angeles Geriatrics Attitudes Scale scores. The use of methods likely to increase compassion in nurses' education and professional life may increase their perception of attitudes towards older age and thus ensure that older people receive quality healthcare. [ABSTRACT FROM AUTHOR]

Aim: Partnered Pharmacist Medication Charting (PPMC) in patients admitted under general medical units has been shown to reduce medication errors. The aim of this study is to evaluate the impact of the PPMC model on medication errors in patients admitted under cancer units in Victorian hospitals. Methods: A prospective cohort study comparing cohorts before and after the introduction of PPMC was conducted. This included a 2-month pre-intervention phase and 3-month intervention phase. PPMC was implemented during the intervention phase as new model of care that enabled credentialed pharmacists to chart all admission medications, including pre-admission or new medications and cancer therapies, in collaboration with the admitting medical officer. The proportion of medication charts with at least one error was the primary outcome measure. Results: Seven health services across Victoria were included in the study. The majority of health services were using paper-based prescribing systems for oncology. Of the 547 patients who received standard medical medication charting, 331 (60.5%) had at least one medication error identified compared to 18 out of 416 patients (4.3%) using the PPMC model (p < 0.001). The median (interquartile range) inpatient length of stay was 5 (2.9–10.6) days in pre-intervention and 4.9 (2.9–11) days in intervention (p = 0.88). In the intervention arm, 42 patients had cancer therapy charted by a pharmacist with no errors. Conclusions: PPMC was successfully scaled into cancer units as a collaborative medication safety strategy. The model was associated with significantly lower rates of medication errors, including cancer therapies. PPMC should be adopted more widely in cancer units in Australia. [ABSTRACT FROM AUTHOR]

Background: Palliative care, which aims to alleviate physical and emotional distress from cancer, is underutilized in many African healthcare systems. Therefore, there is a lack of data on the need and utilization of palliative care services among women with breast cancer in Ethiopia. Objectives: The goal of this study was to identify the level of need and utilization of palliative care services and identify associated factors among women in an oncology department of Hawassa comprehensive and specialized hospitals. Design: Hospital-based cross-sectional study. Methods: A total of 121 women age ⩾18 years old with breast cancer participated from 1 August to 30 October 2021. A hospital-based consecutive sampling technique was used. Data regarding the need and utilization of palliative care services were collected via questionnaire and interview, entered using EpiData 4.6.0.6, and analyzed by SPSS version 25. Variables with p < 0.25 were considered for multivariate analysis, and those with p < 0.05 indicate an association with palliative care utilization. Result: Seventy-two (59.5%) had worse utilization of palliative care services, with higher odds in rural areas (adjusted odds ratio = 11.82). Conclusion: The study findings indicated that more than half of the study participants had worse utilization of palliative care services, with rural living being a contributing factor. [ABSTRACT FROM AUTHOR]

Background: Delirium is a serious neuropsychiatric syndrome with adverse outcomes, which is common but often undiagnosed in terminally ill people. The 4 'A's test or 4AT (www.the4AT.com), a brief delirium detection tool, is widely used in general settings, but validation studies in terminally ill people are lacking. Aim: To determine the diagnostic accuracy of the 4AT in detecting delirium in terminally ill people, who are hospice inpatients. Design: A diagnostic test accuracy study in which participants underwent the 4AT and a reference standard based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The reference standard was informed by Delirium Rating Scale Revised-98 and tests assessing arousal and attention. Assessments were conducted in random order by pairs of independent raters, blinded to the results of the other assessment. Setting/participants: Two hospice inpatient units in Scotland, UK. Participants were 148 hospice inpatients aged ⩾18 years. Results: A total of 137 participants completed both assessments. Three participants had an indeterminate reference standard diagnosis and were excluded, yielding a final sample of 134. Mean age was 70.3 (SD = 10.6) years. About 33% (44/134) had reference standard delirium. The 4AT had a sensitivity of 89% (95% CI 79%–98%) and a specificity of 94% (95% CI 90%–99%). The area under the receiver operating characteristic curve was 0.97 (95% CI 0.94–1). Conclusion: The results of this validation study support use of the 4AT as a delirium detection tool in hospice inpatients, and add to the literature evaluating methods of delirium detection in palliative care settings. Trial registry: ISCRTN 97417474. [ABSTRACT FROM AUTHOR]

The ward round (WR) is an important opportunity for interprofessional interaction and communication enabling optimal patient care. Pharmacists' participation in the interprofessional WR can reduce adverse drug events and improve medication appropriateness and communication. WR participation by clinical pharmacists in Australia is currently limited. This study aims to explore what is impacting clinical pharmacists' participation in WRs in Australian hospitals. A self-administered, anonymous national survey of Australian clinical pharmacists was conducted. This study describes the outcomes from qualitative questions which were analyzed thematically in NVivo-2020 according to Braun and Clarke's techniques. Five themes were constructed: "Clinical pharmacy service structure", "Ward round structure", "Pharmacist's capabilities", "Culture" and "Value". A culture supportive of pharmacist's contribution with a consistent WR structure and flexible delivery of clinical pharmacy services enabled pharmacists' participation in WR. Being physically "absent" from the WR due to workload, workflow, and self-perception of the need for extensive clinical knowledge can limit opportunities for pharmacists to proactively contribute to medicines decision-making with physicians to improve patient care outcomes. Bidirectional communication between the interprofessional team and the pharmacist, where there is a co-construction of each individual's role in the WR facilitates consistent and inter-dependent collaborations for effective medication management. [ABSTRACT FROM AUTHOR]

Structured Interdisciplinary Bedside Rounds (SIBR) is a standardized, team-based intervention for hospitals to deliver high quality interprofessional care. Despite its potential for improving IPC and the workplace environment, relatively little is known about SIBR's effect on these outcomes. Our study aimed to assess the fidelity of SIBR implementation on an inpatient medicine teaching unit and its effects on perceived IPC and workplace efficiency. We conducted a quasi-experimental study with 88 residents and 44 nurses at a large academic medical center and observed 1308 SIBR encounters over 24 weeks. Of these 1308 encounters, the bedside nurse was present for 96.7%, physician for 97.6%, and care manager for 94.7, and 64.7% occurred at the bedside. Following SIBR implementation, perceived IPC improved significantly among residents (93.3% versus 67.9%, p <.024) and nurses (73.7% versus 36.0%, p <.008) compared to before implementation. Moreover, residents perceived greater workplace efficiency operationalized as being paged less frequently with questions by nurses (20.0% versus 49.1%, p =.01). No statistically significant improvements were reported regarding burnout, meaning at work, and workplace satisfaction. Our implementation of SIBR significantly improved perceived IPC and workplace efficiency, which are two important domains of healthcare quality. Future work should examine the impact of SIBR on patient-centered outcomes such as patient experience. [ABSTRACT FROM AUTHOR]

Aim: The study aims to analyse the principal causes of patients' care calls and compare differences before and after inpatient beds' technological modernization in a surgical breast oncological ward. Design: A prospective observational study was conducted under the STROBE guidelines. Data were collected from June to September 2022. Methods: Statistical analyses were performed to compare each reason for care calls, by shifts and pre and post‐inpatient bed modernization. Results: Two thousand five hundred and fifty‐nine care request calls were analysed during the 202 observed shifts. The most frequent reason was related to the requests for positions. Conclusion: Technological modernization of the beds has not led to effective—positive—changes; on the contrary, it seems at first glance to show an upward trend in calls above all in the short period after the changes. Implications for the profession and/or patient care: What problem did the study address? By analysing the principal causes of care calls and comparing the differences before and after inpatient beds' technological modernization, this study evaluates if inpatient gear or device modernization can impact care call requests.What were the main findings? The results show that the most frequent reasons for care calls were position, possession and other. These findings seem not superimposable; the hypothesis supported by the international literature in which the causes relating to potty and pain were found among the main reasons.Where and on whom will the research have an impact? These results could impact the care organizational area in nursing care and could improve care quality, patient satisfaction and safety. Reporting Method: This prospective observational study was conducted following STROBE guidelines. Patient or Public Contribution: After adequate information (presentation, design methods and objectives), all unit healthcare staff agreed to collaborate in the study. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to examine the relationship between various factors and self-perceived transformational leadership among a sample of Filipino nurse managers (NMs). BACKGROUND: Transformational leadership plays a crucial role in promoting positive outcomes in healthcare settings, particularly for NMs. Understanding the factors that influence NMs' self-perceived transformational leadership is essential for improving leadership practices and enhancing organizational effectiveness. METHODS: A cross-sectional research design was used to collect data from 260 NMs using standardized measures. RESULTS: Employment status, the number of units managed, the type of hospital employment, psychological distress, and job satisfaction were factors that significantly influenced their leadership perceptions. CONCLUSION: By addressing the identified factors, nursing organizations can create an environment that promotes effective leadership practices, ultimately enhancing patient outcomes, staff satisfaction, and overall organizational performance. [ABSTRACT FROM AUTHOR]

Introduction and objective: Constipation is a common complication following spinal surgery that can result in distension, abdominal pain, infection, and even intestinal perforation. This study reports on an evidence-based implementation project to reduce the incidence of constipation in spinal surgery wards. Methods: The project was conducted in the spinal surgery ward of a general tertiary hospital in Changsha City, China, from March to August 2022. We used the JBI Implementation Framework and the JBI Model of Evidence-Based Healthcare for audits and feedback. Data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. Seven audit criteria were developed based on the best practice recommendations summarized by JBI. A baseline audit was conducted with 20 nurses and 50 patients in the spinal surgery ward, and a follow-up audit was conducted using the same sample size and setting. Results: The baseline audit revealed compliance below 46% for five of the seven criteria. Strategies developed to address poor compliance included educating nurses and patients, developing a post-operative constipation risk assessment sheet, organizing stakeholder focus group meetings, establishing a constipation management routine, and effective empowerment of nurses. The follow-up audit showed positive compliance results, with the highest rate for Criterion 7 (100%) and the greatest increase for Criterion 2 (from 0% to 78%). Furthermore, the incidence of post-operative constipation decreased from 48% to 16%. Conclusion: The project improved compliance with audit criteria, reduced the incidence of constipation, and enhanced the efficiency of quality management in the spinal surgery ward. http://links.lww.com/IJEBH/A186 [ABSTRACT FROM AUTHOR]

Introduction and objectives: Ninety percent of maternal deaths are attributed to postpartum hemorrhage, with 50% being preventable. Annually, University of Mississippi Medical Center staff have more than 20,000 obstetrical encounters and deliver thousands of infants, with ∼75% being high-risk. The mother/baby unit, 3 Wiser, experienced two postpartum hemorrhages in August 2022. Post-event debriefings revealed opportunities for improvement. This project aimed to promote evidence-based practices regarding the prevention and management of postpartum hemorrhage in 3 Wiser. Methods: The project was guided by the JBI Model of Evidence-Based Healthcare and used the JBI Practical Application of Clinical Evidence System together with the Getting Research into Practice audit and feedback strategy. Four evidence-based practices were selected as audit criteria. After baseline audits were conducted, strategies to improve compliance with evidence-based practices were implemented. Finally, a follow-up audit was conducted, and the results of both audits were compared. Results: The baseline audits revealed 84% average compliance with the four evidence-based practices. Strategies to improve compliance included a simulation for nursing staff with a review of postpartum hemorrhage policies and skills. The post-implementation audit revealed 98% average compliance with the four evidence-based practices, a 14% increase from the baseline audit. Conclusions: This evidence implementation project utilized a clinical audit process, which led to improvements in practice related to the prevention and management of postpartum hemorrhage in the inpatient postpartum unit. [ABSTRACT FROM AUTHOR]

Background. Thrombocytopenia is the second most common hematological disorder in pregnancy after anemia worldwide and affects 7-8% of all pregnancies. Pregnant women with thrombocytopenia have complications of excessive bleeding during or after childbirth, exudation at the cesarean section, and neonatal thrombocytopenia. Therefore, the main aim of this study was to assess the magnitude of thrombocytopenia and its associated factors among pregnant women attending the Antenatal Care Service Unit of Wachemo University Nigist Ellen Mohammed Comprehensive Specialized Hospital Hosanna, Southern Ethiopia. Materials and Methods. A cross-sectional study was conducted from June 1 to August 30, 2022, involving 209 consecutive pregnant women who came to the hospital during the study period for antenatal care follow-up. Sociodemographic, reproductive, and other clinical data were collected using a structured questionnaire. A four-milliliter venous blood specimen was collected for complete blood analysis and peripheral blood smear. The data were analyzed by using SPSS version 25. Descriptive statistical analysis and bivariate and multivariate logistic regression analyses were performed. A P value ≤0.05 was considered to indicate statistical significance. Results. The overall magnitude of thrombocytopenia among pregnant women was 14.8% (95% CI: 10, 19.6). The prevalence of mild, moderate, and severe thrombocytopenia was 77.4%, 16.1%, and 6.5%, respectively. Multivariate logistic regression revealed that rural residence (AOR = 2.6 and 95% CI = 1.02, 7.12), cigarette smoking (AOR = 8.4 and 95% CI = 1.86, 38), anemia (AOR = 8.3 and 95% CI = 2.7, 25.6), and alcohol consumption (AOR = 8.2 and 95% CI = 2.17–31) were significantly independent factors associated with the development of thrombocytopenia. Conclusion. The magnitude of thrombocytopenia in this study was 14.8%. Rural residence, cigarette smoking, alcohol consumption, and anemia were significantly associated with thrombocytopenia. Therefore, the platelet count should be routinely determined during antenatal care visits for proper diagnosis and to minimize bleeding during and/or after childbirth. [ABSTRACT FROM AUTHOR]

Objective: To explore, in scientific publications, the Nursing assistance provided to critically-ill or potentially serious adult patients hospitalized in wards. Method: An integrative review carried out in November 2022 in the Web of Science, PubMed, Biblioteca Virtual em Saúde, Scopus and EMBASE databases, using the following string: "nursing AND critical care AND patients' rooms OR ward OR infirmary AND adult OR middle aged OR aged OR aged, 80 and over". Results: Of the 4,596 studies found, 19 original articles published between 2017 and 2022 were included. Their contents were grouped into two categories: "Barriers for the care to be provided to acute patients in wards" and "Opportunities to improve care quality". Conclusion: From this review it was possible to extract possible barriers and potentialities for advancing care for critically-ill patients in wards, which can serve as a starting point for health teams to rethink the practice and create strategies aimed at solving barriers and at implementing care improvements. [ABSTRACT FROM AUTHOR]

Introduction: With advances in the treatment of Pediatric Hematology-Oncology (PHO) patients, the survival of patients are increasing day by day. However, Healthcare-Associated Infections (HAI) is still a significant cause of mortality and morbidity in this group of patients. This study aimed to evaluate the rates of HAI in patients who were hospitalized in Uludag University Medical Faculty PHO Clinic during the 4-year study period. Materials and Methods: HAI was diagnosed according to the CDC (Center for Disease Control and Prevention) 2008 criteria. We recorded the number of patients admitted, the number of patients with HAI, the total number of HAI episodes, and the length of stay in hospital. We calculated HAI rate and HAI density (per 1000 patient-days). Results: During the four years, 3069 hospitalizations were recorded in 607 PHO patients (5.05 admissions per patient). 38.6% of the patients were female, and 61.4% male. The mean age was 100.8 ± 63.6 months. The mean duration of hospitalization was 14 ± 17.16 days. A total of 232 HAI episodes were recorded in 141 hospitalizations. HAI rate was 7.5%, and HAI density was 5.36/1000 patient-days. Conclusion: The HAI rates in our PHO unit were comparable to those of developed countries and lower than those of developing countries and prior results from our country. [ABSTRACT FROM AUTHOR]

Background Hospital patients with behavioural and psychological symptoms of dementia (BPSD) are vulnerable to a range of adverse outcomes. Hospital-based Special Care Units (SCUs) are secure dementia-enabling environments providing specialised gerontological care. Due to a scarcity of research, their value remains unconfirmed. Objective To compare hospital based SCU management of BPSD with standard care. Design Single-case multiple baseline design. Setting and participants One-hundred admissions to an 8-bed SCU over 2 years in a large Australian public hospital. Methods Repeated measures of BPSD severity were undertaken prospectively by specialist dementia nurses for patients admitted to a general ward (standard care) and transferred to the SCU. Demographic and other clinical data, including diagnoses, medication use, and care-related outcomes were obtained from medical records retrospectively. Analysis used multilevel models to regress BPSD scores onto care-setting outcomes, adjusting for time and other factors. Results When receiving standard care, patients' BPSD severity was 6.8 (95% CI 6.04–7.64) points higher for aggression, 15.6 (95% CI 13.90–17.42) points higher for the neuropsychiatric inventory, and 5.8 (95% CI 5.14–6.50) points higher for non-aggressive agitation compared to SCU. Patients receiving standard care also experienced increased odds for patient-to-nurse violence (OR 2.61, 95% CI 1.67–4.09), security callouts (OR 5.39 95% CI 3.40–8.52), physical restraint (OR 17.20, 95% CI 7.94–37.25) and antipsychotic administration (OR 3.41, 95% CI 1.60–7.24). Conclusion Clinically significant reductions in BPSD and psychotropic administration were associated with SCU care relative to standard ward care. These results suggest more robust investigation of hospital SCUs, and dementia-enabling design are warranted. [ABSTRACT FROM AUTHOR]

Background: The main objective was to test whether the Renal Angina Index (RAI), calculated on patient admission to the pediatric intensive care unit (PICU), is associated with the risk of acute kidney injury (AKI) based on the Kidney Disease: Improving Global Outcomes (KDIGO) (stage ≥ 2) in 72 h. The specific aim was to analyze the performance of the RAI at a specialized oncology PICU. Methods: Retrospective cohort study involving two pediatric intensive care units located within a general hospital and an oncology hospital. Children aged ≥ 3 months to < 18 years admitted to the intensive care units in 2017 with a length of stay ≥ 72 h were included. Results: The sample included 249 patients, of which 51% were male (127 patients), with median age of 77 months, and mean ICU stay of 5 days. Of the total admissions, 141 were clinical (57%) and 108 surgical. The rate of AKI was 15% and death rate within 30 days was 13%. Having a positive RAI on admission showed a statistically significant association with AKI at Day 3 (OR = 18.5, 95%CI = 4.3 – 78.9, p < 0.001) and with death (OR = 3.9, 95%CI = 1.6 – 9.9, p = 0.004). The accuracy of the RAI in the cancer population was 0.81 on the ROC curve (95%CI 0.74, 0.88). Conclusions: The RAI is a useful tool for predicting AKI and death in critically ill children, including in oncology units. [ABSTRACT FROM AUTHOR]

Background and Objectives: Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries. Methods: The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing "fall alert" signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS. Results: The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P= .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P= .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = -0.13 [95% CI, -0.53 to 0.27], P= .52). Conclusions: This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts. [ABSTRACT FROM AUTHOR]

Purpose/aim: With an ageing population and an increase in fragility fractures of the hip (FFH), the role of an anaesthetist is evolving to include more peri-operative care. A post-anaesthesia high-care unit (PAHCU) should enhance care in post-operative patients. To our knowledge, there are no studies that have investigated the effect of a PAHCU admission on post-operative outcomes after FFH. This study aimed to compare post-operative outcomes of FFH patients admitted to PAHCU versus a standard post-operative orthopaedic ward (POOW). Methodology: A retrospective cohort study was conducted on adult patients with FFH who underwent surgery between January 2019 and December 2020 at our institution. Data were sourced from electronic medical records. SPSS version 28 was used to analyse data. Results: A total of 231 patients were included. The PAHCU group (n = 35) displayed a higher burden of chronic illness and higher peri-operative risk scores as compared to the POOW group (n = 196). Median time to mobilize (TTM) in PAHCU was 84 h vs. 45 h in POOW group (p = 0.013). Median length of stay (LOS) in PAHCU was 133 h vs. 94 h in POOW (p = 0.001). The in-hospital mortality was 2.9% (n = 1) for PAHCU and 3.6% (n = 7) for POOW (p = 1). The 30-day mortality was 11.8% (n = 4) for PAHCU and 10.1% (n = 19) in POOW. Conclusion: PAHCU admission resulted in delayed time to surgery and TTM, together with prolonged LOS, compared to those managed in POOW. However, these mortality rates remained comparable in both groups. This study contributes valuable insights into post-operative care of FFH patients in a resource-poor setting. [ABSTRACT FROM AUTHOR]

Background: Achieving efficient throughput of patients is a challenge faced by many hospital systems. Factors that can impede efficient throughput include increased ED use, high surgical volumes, lack of available beds, and the complexities of coordinating multiple patient transfers in response to changing care needs. Traditionally, many hospital inpatient units operate via a fixed acuity model, relying on multiple intrahospital transfers to move patients along the care continuum. In contrast, the acuity-adaptable model allows care to occur in the same room despite fluctuations in clinical condition, removing the need for transfer. This model has been shown to be a safe and cost-effective approach to improving throughput in populations with predictable courses of hospitalization, but has been minimally evaluated in other populations, such as patients hospitalized for traumatic injury. Purpose: This quality improvement project aimed to evaluate implementation of an acuity-adaptable model on a 20-bed noncritical trauma unit. Specifically, we sought to examine and compare the pre- and postimplementation metrics for throughput efficiency, resource utilization, and nursing quality indicators; and to determine the model's impact on patient transfers for changes in level of care. Methods: This was a retrospective, comparative analysis of 1,371 noncritical trauma patients admitted to a level 1 trauma center before and after the implementation of an acuity-adaptable model. Outcomes of interest included throughput efficiency, resource utilization, and quality of nursing care. Inferential statistics were used to compare patients pre- and postimplementation, and logistic regression analyses were performed to determine the impact of the acuity-adaptable model on patient transfers. Results: Postimplementation, the median ED boarding time was reduced by 6.2 hours, patients more often remained in their assigned room following a change in level of care, more progressive care patient days occurred, fall and hospital-acquired pressure injury index rates decreased respectively by 0.9 and 0.3 occurrences per 1,000 patient days, and patients were more often discharged to home. Logistic regression analyses revealed that under the new model, patients were more than nine times more likely to remain in the same room for care after a change in acuity and 81.6% less likely to change rooms after a change in acuity. An increase of over $11,000 in average daily bed charges occurred postimplementation as a result of increased progressive care–level bed capacity. Conclusions: The implementation of an acuity-adaptable model on a dedicated noncritical trauma unit improved throughput efficiency and resource utilization without sacrificing quality of care. As hospitals continue to face increasing demand for services as well as numerous barriers to meeting such demand, leaders remain challenged to find innovative ways to optimize operational efficiency and resource utilization while ensuring delivery of high-quality care. The findings of this study demonstrate the value of the acuity-adaptable model in achieving these goals in a noncritical trauma care population. This quality improvement project evaluated implementation of an acuity-adaptable model on a 20-bed noncritical trauma unit, examining the pre- and postimplementation metrics for throughput efficiency, resource utilization, and nursing quality indicators, as well as the model's impact on patient transfers for changes in level of care. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the spiritual care needs of cancer patients receiving chemotherapy. A cross-sectional descriptive design was used to analyze a total of 104 patients at a university hospital in Turkey. The data were collected using the Spiritual Care Needs Scale. The mean age of the patients participating in the study was 61.0 (10.2). It was determined that 31.7% of the patients stated that the concepts of spirituality and spiritual care are related to religion and worship. As a result, it was found that the patients receiving chemotherapy had high-spiritual care needs. The dimensions in which the spiritual needs of the patients were remarkably high were belief and spiritual practices, being in peace and security, the love and support of their relatives and being informed about health. The spiritual care need score of the patients increased significantly with marital status (p = 0.001), having children (p = 0.002), having a chronic disease (p = 0.04) and having an undergraduate/graduate level education (p = 0.01). Nurses should be aware of patient's spiritual needs, plan patient-specific spiritual care practices, conduct more studies on the effects of spiritual care on the patient and family and create guidelines for spiritual care practices in patients receiving chemotherapy in Turkey. [ABSTRACT FROM AUTHOR]

Objectives: A working group conducted a survey on the use of the principle of buffer space (BS), which in case of emergencies, could benefit healthcare settings. The aim of the preliminary investigation is to define new research lines in hospitals' functional design. Background: The global experience of the COVID-19 pandemic highlighted challenges faced by hospitals when responding promptly to emergencies, including spatial reorganization and suspension of ordinary medical activities for ensuring adequate management of the emergency surge of patients. Methods: The group designed questionnaires to be administered to healthcare staff and healthcare designers aimed at understanding varied conceptions and features of BSs. Content across the two surveys overlapped significantly, allowing for direct comparisons of responses, while also including tailored questions in relation to the respective experience and skills of the two groups of respondents. Results: 102 healthcare professionals and 56 designers took part to the survey. Analysis of the responses permitted for initial recommendations regarding BS typology including (a) proximity to the emergency department (ED), intensive care units (ICUs), and inpatient wards (IWs); (b) location within hospitals but separate from other medical areas; (c) need for independent access; (d) organizational and spatial features similar to ED, ICUs, and IWs; (e) existing as a fully flexible operational space; and (f) BS bed capacity to be approximately 12% of ED beds. Conclusions: Although the analysis is related to the Italian context, the expansion of this preliminary research to alternate healthcare facilities and geographic areas is necessary for reaching a wide consensus by different professionals on this field. It serves as a starting point for future investigations regarding the implementation of BS in hospital settings. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to extend original research and identify operational and space-related requirements for specialization from the perspectives of nursing behavior and process. Background: Studies related to the specialty of different nursing units have been widely conducted in nursing science, while few studies have explored the specialized requirements for the physical environments of nursing units in different departments. Method: Questionnaire survey data were collected from 125 nurses in 11 clinical departments, and nurse shadowing (approximately 68 hr) was conducted in four clinical departments. Results: The questionnaire survey showed that satisfaction with care activity, visibility, and physical environment within the existing nursing unit environment was rated differently among different departments of nursing units. However, nurses in different groups of age, education, work experience, and position indicated no statistically significant difference. Behavioral observations demonstrated that the spatial and temporal distributions of activities, spatial linkages, and communication patterns varied in distinct departments. Conclusion: This research found that nurses in different departments had different evaluations of satisfaction and environmental characteristics. It also explains the differences in nursing work behaviors and processes found in various departments and sheds light on specialized requirements from the behavior perspective. The findings could help optimize the design of efficient and satisfactory nursing units in different departments. [ABSTRACT FROM AUTHOR]

Eligible persons with HIV infection can receive client-centered case management to coordinate medical and social services. Novel mobile health interventions could improve effective case management and retention in care, an important goal to help end the HIV epidemic. Using a hybrid type I effectiveness-implementation design, we assessed whether access to bidirectional, free-draft secure text messaging with a case manager and clinic pharmacist could improve client satisfaction and care retention in a Southern academic HIV clinic. Sixty-four clients enrolled between November 2019 and March 2020, had a median age of 39 years, and were mostly male, single, and African-American. Heavy app users texted over 100 times (n = 6) over the course of the 12-month intervention while others never texted (n = 12). App usage peaked during months of clinic closure due to COVID-19. Most participants reported high satisfaction with the app and planned continued usage after study completion. Changes in clinic retention and virologic suppression rates were not observed, a result confounded by practice changes due to COVID-19. High usage and satisfaction of free-draft text messaging in case-managed HIV clients supports inclusion of this communication option in routine HIV clinical care. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses often encounter traumatic events in their clinical practice.Trauma can have both negative effects, such as post‐traumatic stress disorder and positive effects, such as growth and positive emotions.Posttraumatic growth is beneficial for nurses, as it contributes to positive mental health outcomes and increases life satisfaction. What the paper adds to existing knowledge?: Our study confirms that nurses commonly experience posttraumatic growth after being exposed to traumatic events, and the level of growth is moderate.We have identified individual, work‐related, and social and organizational factors that may influence the occurrence of posttraumatic growth among nurses. What are the implications for practice?: Our findings provide valuable insights for interventions aimed at promoting posttraumatic growth among nurses. It is crucial to consider individual factors, work‐related factors, and social and organizational factors when designing these interventions. By addressing these factors, healthcare professionals can support nurses in coping with trauma and facilitate their posttraumatic growth. Introduction: While the negative effects of trauma on nurses have been well‐documented, it is equally important to focus on ways to promote posttraumatic growth (PTG) among nurses. Aim: This study aims to explore the levels and related factors of PTG among nurses. Method: A comprehensive search was conducted across nine databases up to 26 December 2022. The pooled mean score for PTG was calculated and presented with a 95% confidence interval. Subgroup and meta‐regression analyses were performed to identify potential moderators of PTG among nurses. Results: A total of 55 studies, involving 35,621 nurses from 11 countries and regions, were included in this review. The pooled scores of the PTG indicated that nurses experienced a moderate level of PTG (55.69, 95% CI: 50.67–60.72). Discussion: Nurses commonly experience PTG following exposure to traumatic events, with a moderate level of PTG. Our systematic review highlights the potential determinants of PTG among nurses, including individual, work‐related, and social and organizational factors. Implications for Practice: Targeting these factors in interventions can provide nurses with the necessary resources and support to effectively cope with stress and trauma, and potentially facilitate PTG. [ABSTRACT FROM AUTHOR]

Aim: To explore barriers and facilitators that influence adherence to evidence‐based guidelines for peripheral intravenous catheter care in different hospital wards. Design: Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. Method: Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC‐miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. Results: The PIVC‐miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. Conclusion: This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. Implications for the Profession and/or Patient Care: Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. Impact: The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. Reporting Method: The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). Patient or Public Contribution: A patient representative has been involved in planning this study. [ABSTRACT FROM AUTHOR]

Aim: To investigate barriers to healthcare professionals recognizing and managing delirium in hospitalized older people. Design: A mixed‐methods systematic review. PROSPERO ID: CRD42020187932. Data Sources: MEDLINE, EMBASE, PsycINFO and CINAHL were searched (2007 to February 2023). Review Methods: Included studies focused on healthcare professionals' recognition and management of delirium for patients aged 65 years and over in a hospital ward or emergency department. Enhancing rigour, screening of results was conducted independently by two researchers. Qualitative and quantitative data were tabulated separately and grouped. Data were compared to identify similarities and differences. All studies were quality appraised. Results: 43 studies were included; 24 quantitative, 16 qualitative and three mixed‐methods. Data synthesis highlighted synergy between qualitative and quantitative findings. Barriers were reflected in six themes: (1) healthcare professionals' knowledge and understanding; (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints. Conclusions: Of significance, for older adults in hospital experiencing delirium, there is variability in whether and how well it is recognized and managed. To prevent adverse outcomes best practice guidance for screening, recognizing, diagnosing and managing delirium in older people needs to be agreed and disseminated widely. Supporting healthcare professionals to care for this patient population using an integrated approach is essential, how to involve and communicate with patients and their family and friends, how to recognize and manage delirium for patients with additional needs, e.g., those living with dementia and/or a learning disability. Hospitals need to have policy and guidance in place for the recognition and management of delirium in older adults presenting to a ward or to an emergency department. An IT infrastructure is needed that integrates assessments and care management plans in patient electronic records and makes them accessible within and across teams in hospital, primary and community care settings. Patient or Public Contribution: There was no patient or public contribution to this systematic review. Implications for the Profession and Patient Care: Healthcare professionals can be better supported to be able to recognize and manage delirium during an acute hospital stay for older adults. This includes maximizing best care for those patients living with dementia, involving families and friends to help understand patients' baseline status and changes and supporting families and friends during this process. Of significance, attention to hospital IT infrastructures is warranted, integrating screening, assessment and care management plans in patients' electronic records and making these accessible to healthcare professionals caring for this patient population across care settings. Impact: What problem did the study address? Delirium is a common condition experienced by older hospitalized patients, but it is consistently under‐recognized which has implications for patient and organization outcomes. To help address this, understanding barriers to healthcare professionals recognizing and managing delirium for this patient population is paramount. What were the main findings? Barriers to healthcare professionals recognizing and managing delirium for this patient population were synthesized in six themes: (1) healthcare professionals' knowledge and understanding, (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints. Where and on whom will the research have an impact? The findings of this original systematic review can contribute to hospital policy and protocol for the recognition and management of delirium in older patients. The findings can meaningfully contribute to workforce professional development for practitioners caring for older people during an acute hospital stay and for practitioners in primary and community settings involved in the follow‐up of patients post hospital discharge. For researchers, the findings indicate several research recommendations including investigating the impact of an education programme for nurses and other healthcare professionals on the recognition and management of the condition and understanding and investigating how best to support delirium‐related distress experienced by patients and their families and practitioners. Reporting Method: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (Page et al., 2021). [ABSTRACT FROM AUTHOR]

Background: Volunteers have always been integral to hospice and palliative care. However, their roles have been left relatively undefined and broad. Aim: This study aims to examine the role of hospice volunteers in German inpatient hospice and palliative care. The question we seek to answer is: What do hospice volunteers contribute to everyday life in inpatient hospice and palliative care units? Methods: We undertook a multicenter, on-site qualitative interview study, utilizing problem-centered interviews with 16 volunteers from five inpatient hospice units and one hospital palliative care unit. Interviews were analyzed using grounded theory. Results: Analysis of the interviews revealed three typical characteristics of how hospice volunteers' describe their own role: (1) performing small acts of kindness, (2) creating a family-like atmosphere, (3) expecting emotional experiences. A common theme across all categories is the emphasis on spontaneous actions and personal experiences. The process of dying becomes an experience interpreted by volunteers as enriching, as a gift, as a "teacher". Conclusion: Granting hospice volunteers freedom to act spontaneously and intuitively benefits hospice and palliative care delivery. Organizations should leave sufficient room for spontaneity in order to involve volunteers effectively. Open and unstandardized roles facilitate dynamic work practices. [ABSTRACT FROM AUTHOR]

This retrospective study assessed the effectiveness and impact of implementing a Modified Early Warning System (MEWS) and Rapid Response Team (RRT) for inpatients admitted to the general ward (GW) of a medical center. This study included all inpatients who stayed in GWs from Jan. 2017 to Feb. 2022. We divided inpatients into GWnon-MEWS and GWMEWS groups according to MEWS and RRT implementation in Aug. 2019. The primary outcome, unexpected deterioration, was defined by unplanned admission to intensive care units. We defined the detection performance and effectiveness of MEWS according to if a warning occurred within 24 h before the unplanned ICU admission. There were 129,039 inpatients included in this study, comprising 58,106 GWnon-MEWS and 71,023 GWMEWS. The numbers of inpatients who underwent an unplanned ICU admission in GWnon-MEWS and GWMEWS were 488 (.84%) and 468 (.66%), respectively, indicating that the implementation significantly reduced unexpected deterioration (p <.0001). Besides, 1,551,525 times MEWS assessments were executed for the GWMEWS. The sensitivity, specificity, positive predicted value, and negative predicted value of the MEWS were 29.9%, 98.7%, 7.09%, and 99.76%, respectively. A total of 1,568 warning signs accurately occurred within the 24 h before an unplanned ICU admission. Among them, 428 (27.3%) met the criteria for automatically calling RRT, and 1,140 signs necessitated the nursing staff to decide if they needed to call RRT. Implementing MEWS and RRT increases nursing staff's monitoring and interventions and reduces unplanned ICU admissions. [ABSTRACT FROM AUTHOR]

Background. Nurses are one of the largest and costliest groups in healthcare organizations; therefore, it is important to comprehend their scope of practice. Aim. To contribute to the improvement of nursing resource management in medical-surgical and Intensive Care Units by identifying factors that influence the scope of nursing practice. The hypothesis was that the activities carried out by nurses in medical-surgical units and intensive care units are influenced by individual and job-related factors, with job characteristics having an additive and moderating effect on individual characteristics. Materials and Methods. Cross-sectional correlational design to test the relationship between the individual and job characteristics on the nursing scope of practice measured by the Actual Scope of Nursing Practice (ASCOP) questionnaire. The sample consisted of 270 nurses. Linear mixed effects models analysis (LME) was used with the aleatory effect of the intensive care unit (ICU). Results. Belonging to the ICU decreased the scope of practice of nurses. We found a statistically significant effect of psychological demand, practice environment, role ambiguity, and growth need strength on the scope of nursing practice. The models explained a variance up to 24%. Conclusions. Although the survey results revealed the existence of broader scope of practice levels in Spanish hospital units than in the original Canadian study, the use of scope of nursing practice remains suboptimal. Higher levels on the psychological demand, the practice environment and in the individual growth need strength were related with a broader scope of practice. Otherwise, role ambiguity negatively affected the scope of practice. Implications for Nursing Management. This article provides an analysis of the impact of individual and job-related characteristics on the nursing scope of practice. It serves as a valuable resource for both managers and nurses, offering insights to improve nurses' working conditions and obtain more efficient workforces. [ABSTRACT FROM AUTHOR]

Bladder and bowel poststroke dysfunctions negatively impact patients' health. Stroke-related characteristics associated to these dysfunctions are poorly known. This study aims to estimate the prevalence of new-onset poststroke bladder and bowel dysfunctions, characterize their associated factors, and describe the dysfunctions' clinical approach. Cross-sectional study including 157 patients admitted to a single hospital's stroke unit with a first-ever stroke, during 3 months. An 18-item questionnaire was applied to assess dysfunctions pre and poststroke. The McNemar test was used to compare pre and poststroke prevalence. A logistic regression was used to estimate associations (OR, 95% CI) between individual characteristics and new-onset dysfunctions. We had 113 (72%) respondents. There was a significant increase in the prevalence of bladder and bowel dysfunctions poststroke (p < 0.001). Higher stroke severity was significantly associated with both new-onset poststroke bladder and bowel dysfunctions (OR = 15.00, 95% CI [4.92,45.76] and OR = 5.87,95%CI [2.14,16.12], respectively). Total anterior circulation strokes, cardioembolic strokes, and lower functionality at discharge were also significantly associated with both dysfunctions. Thirteen patients (11.5%) reported that health professionals addressed these dysfunctions. Poststroke bladder and bowel dysfunctions are highly prevalent. Being aware of their epidemiology helps draw attention to patients at higher risk of developing these dysfunctions, enhancing the rehabilitation process. Poststroke bladder and bowel dysfunctions are highly prevalent and under-recognised consequences of stroke. Being aware of their epidemiology and associated factors may help identify patients at higher risk of developing these dysfunctions. It is necessary to raise clinical awareness to ensure a more efficient diagnostic and therapeutic approach, enhancing patients' rehabilitation process, quality of life and lowering collateral societal burden. [ABSTRACT FROM AUTHOR]

Background: Providing care to children with cancer is one of the most challenging areas of ethical care for nurses. Few studies have addressed nurses' perception of the barriers to giving ethical care in oncology departments. Thus, it is essential that the ethical challenges in caregiving as perceived by oncology nurses be investigated. Objective: The present study was conducted to investigate the ethical challenges as perceived by nurses in pediatric oncology units in the south of Iran. Research design: The present study is a qualitative work of research with a conventional content analysis design. Data were collected via individual semi-structured interviews. The collected data were analyzed using the qualitative content analysis method. Participants and research context: The participants were 21 nurses from pediatric oncology units in state hospitals who were selected by purposeful sampling. Sampling continued until the data were saturated. The study lasted from April to October 2022. Findings: Three main themes, promoting psychological safety in the children, respect for the dignity of the children, and expansion of support for families, and nine subthemes were extracted from the data. Ethical considerations: The study's protocol was approved by the Research Ethics Committee of the University of Medical Sciences and ethical principles were followed throughout the study. Discussion and conclusion: From the nurses' perspective, the major ethical challenges in providing ethical care in pediatric oncology units were reducing tension toward promoting the patients' psychological safety, showing respect for the identity and dignity of the children with cancer, and expanding support of the patients' families. By creating the right cultural and professional context and establishing proper protocols, healthcare policymakers and administrators can take effective steps toward eliminating the barriers to providing ethical care. [ABSTRACT FROM AUTHOR]

Background: Chemosensory changes that occur during chemotherapy can significantly impact food enjoyment, quality of life and recovery. Aim: To investigate chemosensory changes reported by oncology patients during chemotherapy. Methods: A mixed-method cross-sectional study design was used to explore 100 cancer patients' experiences of chemosensory changes during chemotherapy. All patients completed a questionnaire assessing their taste and smell preferences. A purposive sample of 30 patients underwent a semi-structured interview to elicit their thoughts on their experienced chemosensory changes. Descriptive statistics and themes were examined. Findings: The mean age of the sample was 50.56 years, and the majority of participants were female. The most stated taste alteration was bitter, while altered food preferences were also commonly experienced. Furthermore, most patients experienced unpleasant odours around food, while some experienced these odours even when food was not present. Overall, five themes were identified: changes in taste, changes in smell, changes in social life, altered comfort and food preferences. Conclusion: Chemosensory changes related to cancer and its treatment impact a person's nutrient intake, food-related behaviours, quality of life and treatment response. Patients who experience chemotherapy-associated chemosensory changes require specialised nutritional therapy to increase their eating-related pleasure. As part of the nutritional assessment, chemosensory alterations should be evaluated regularly. [ABSTRACT FROM AUTHOR]

Background: In 2014, the National University Hospital of Iceland (NUHI) merged a mixed‐risk birth unit and a midwifery‐led low‐risk unit into one mixed‐risk unit. Interprofessional preventative and mitigating measures were implemented since there was a known threat of cultural contamination between mixed‐risk and low‐risk birth environments. The aim of the study was to assess whether the NUHI's goal of protecting the rates of birth without intervention had been achieved and to support further development of labor services. Methods: A retrospective cohort study of all women who had singleton births at NUHI birth units in two 2‐year periods, 2012–2013 and 2015–2016. The primary outcome variables, birth without intervention, with or without artificial rupture of membranes (AROM), were adjusted for confounding variables using logistic regression analysis. Secondary outcome variables (individual interventions and maternal and neonatal complications) were analyzed using descriptive statistics, t test, and Chi‐square test. Results: The rate of births without interventions, both with and without AROM, increased significantly after the unit merger and accompanying preventative measures. The rates of AROM, oxytocin augmentation, episiotomies, and epidural analgesia decreased significantly. The rate of induction increased significantly. There were no significant differences in maternal or neonatal complication rates. Conclusions: Interprofessional preventative measures, implemented alongside a mixed‐risk and low‐risk birth unit merger, can increase rates of births without interventions in a mixed‐risk hospital setting. However, it is necessary to maintain awareness of the possible effects of a mixed‐risk birth environment on the use of childbirth interventions and examine the long‐term effects of preventative measures. [ABSTRACT FROM AUTHOR]

A symptom-triggered therapy protocol was initiated for treatment of alcohol withdrawal syndrome, with observed decreases in length of stay, transfers to higher level of care, and benzodiazepine use, proving it more effective and safer in managing patients than fixed-schedule dosing. [ABSTRACT FROM AUTHOR]

Aim: Childhood cancers are life-threatening diseases which are universally distressing and potentially traumatic for children and their families at the time of diagnosis, during treatment, and beyond. Materials and Methods: Thirty-nine child patients between the ages of 0-18 years receiving treatment in a pediatric oncology hospital for various pediatric cancers who consented to participate in this study were recruited. The participants were assessed via Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition/KSADS-PL-DSM-5 for ages 6-18 by a trained and certified child and adolescent psychiatrist. The clinical assessments of patients aged 0-5 years were completed by a trained child and adolescent psychiatrist in agreement with the DSM-5 and the standard principles of psychiatric interview for the pediatric population. The previous and current psychiatric diagnoses of the participants were recorded. The Quality-of-Life Scale for Children was administered to the participants and their caregivers at the first interview and at the 6th month of follow-up. Results: While no significant differences were observed in the quality of life of children with a novel pediatric cancer diagnosis and children with cancer recurrence/ongoing treatment per their own reports, the parents reported significant improvement in the quality of life of those children who had a novel cancer diagnosis after six months. Conclusion: The parents’ and their children’s reports were highly correlated, and this association remained significant in multiple linear regression analyses for both the initial interviews and the follow-ups. The parents’ reports on their children’s quality of life appear to be reliable in accurately predicting their children’s quality of life in the clinical setting. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking prevalence is high in China, and healthcare workers are important for tobacco control. This study aimed to determine the smoking status, cognition of tobacco hazards, and smoking cessation-related knowledge among respiratory healthcare workers, and to explore their ability to provide smoking cessation assistance. METHODS A cross-sectional study was conducted in 2021 among 1028 respiratory healthcare workers from 89 hospitals in Fujian Province, China. A self-designed electronic questionnaire was used to collect data on smoking status, knowledge of smoking hazards, and smoking cessation knowledge. Descriptive statistics were calculated for all questions. Logistic regression analysis was used to explore the relationship between awareness of the tobacco control goals of Healthy China 2030 and demographic characteristics. RESULTS Among the healthcare workers surveyed, 3.4% were smokers, all of whom were male. Most respondents (99.4%) were aware of smoking as a cause of lung cancer, but awareness of smoking as a cause of non-respiratory cancer was lower. The awareness rate of smoking cessation support was high (>90%), but only 40.0% of participants were aware of the Healthy China 2030 tobacco control targets. Male (HR=2.16; 95% CI: 1.69-2.80) and participation in the cessation clinic (HR=1.47; 95% CI: 1.10-1.96) were associated with higher awareness of the targets. CONCLUSIONS Respiratory healthcare workers in Fujian Province demonstrated a high level of awareness regarding behavioral and pharmacotherapy support for smoking cessation. In order to enable healthcare workers to play a more active role in tobacco control, there is a need to increase public awareness of smoking cessation services in Fujian Province. [ABSTRACT FROM AUTHOR]

Background: Inpatient hyperglycaemia is common and associated with poor outcomes such as increased mortality and prolonged hospital stay. This study aimed to determine the prevalence of inpatient hyperglycaemia and glycaemic control in Putrajaya Hospital, Malaysia. Secondary objectives were to compare the length of stay (LOS), 30-day readmission rate, and death between controlled and uncontrolled glycaemic groups. Methods: This cross-sectional study was conducted between 1 July and 31 December 2019 among patients in medical wards who had a blood glucose (BG) level of > 7.8 mmol/L and stayed in the wards for ≥ 24 h. We retrieved information on demographics, diabetes history and BG profiles. The definition of controlled glycaemic status is when ≥ 80% of BG readings were between 4.0 mmol/L and 10.0 mmol/L during the hospital stay. Results: The prevalence of inpatient hyperglycaemia was 55.2%. There were 841 patients who met the eligibility criteria; their mean age was 60 (13.8) years old. Most (79.4%) of the patients were Malay and 53.9% were male. There were 452 (53.7%) patients in the uncontrolled group. They were younger and admitted with more kidney complications compared to those in the controlled group. The median LOS for both groups was 3 (2) days. The uncontrolled group showed a higher percentage of readmission within 30 days (7.5% versus 4.6 %) and death during admission (3.3% versus 1.6 %) (P = 0.100 and P = 0.082). Conclusion: The prevalence of inpatient hyperglycaemia was high. More than half of them had uncontrolled BG. Both groups had a similar average length of stay. The 30-day readmission rate and death during admission were higher in the uncontrolled group, although statistically not significant. [ABSTRACT FROM AUTHOR]

Background: Redeployment in health care can have a negative impact on the mental wellbeing of staff. Advanced planning and provisions for wellbeing support for health professionals has been recommended following previous pandemics. At the authors' institution nurses were redeployed overnight from a specialist cystic fibrosis ward to a COVID-19 high-dependency unit. Aim: To evaluate nurses' wellbeing following this redeployment during the first wave of the COVID-19 pandemic. Method: A mixed online survey, consisting of both open and closed questions, based on literature, preliminary results of the Impact of COVID-19 on the Nursing and Midwifery Workforce (ICON) study and staff feedback. This was sent to 28 nurses to explore their feelings and experiences of redeployment to a COVID-19 environment. Purposive sampling was used to select study participants while thematic analysis and descriptive statistics were used to analyse the data. Findings: The survey had an 86% response rate. Using thematic analysis three key themes emerged: redeployment anxiety, lack of organisational preparedness and newfound teamworking. More than half (57%) of respondents expressed anxiety and concern when told of their redeployment; 52% reported that they did not receive adequate support from senior staff and management. However, 74% reported that they felt their nursing was positively influenced by support and teamwork from those in patient-facing roles. Twenty-five percent reported that they were looking for a new job or leaving their current role. Conclusion: This study examines the effects that redeployment to a COVID-19 environment has had on nurses. It highlights the need for further improvement to ensure redeployed staff are supported to safeguard their mental wellbeing. [ABSTRACT FROM AUTHOR]

Background: Concurrent administration of vancomycin and piperacillin/tazobactam (VAN+PTZ) may increase the risk of acute kidney injury (AKI) in hospitalized patients. Comprehensive characterization of VAN+PTZ associated AKI and recovery patterns remains lacking in previous reports. Objective: To compare the incidence of AKI associated with VAN+PTZ compared to either cefepime (CEF) or meropenem (MER) with VAN in adult general ward patients. Methods: A multicenter, retrospective, propensity score cohort study was conducted in non-critically ill adult patients. Included patients were concurrently administered VAN+PTZ or VAN+CEF/MER. Patients developing AKI ≤48 hours following combination therapy were excluded. The primary endpoint was to compare the incidence of AKI between study groups. Multivariable Cox regression modeling in predicting AKI was also conducted. Results: A total of 3199 patients met inclusion criteria and were evaluated. The incidence of AKI in VAN+PTZ and VAN+CEF/MER groups were 16.4% and 8.7%, respectively (P <.001). The onset to AKI was 1.8 days earlier with VAN+PTZ compared to VAN+CEF/MER (P <.001). Multivariable prediction model showed concomitant VAN+PTZ was identified as an independent risk factor of developing AKI (HR 2.34, 1.82-3.01, P <.001). The VAN+PTZ group experienced significantly higher rates of severe AKI (stage II or III) compared to the VAN+CEF/MER group (P =.002). No differences in the AKI recovery patterns were found between study groups. Conclusions: Concomitant VAN+PTZ in adult general ward patients was independently associated with an increased risk of AKI overall. More severe AKI was also associated with VAN+PTZ. [ABSTRACT FROM AUTHOR]

Will-to-live is defined as the psychological expression of one's commitment to life and the desire to continue living. It is an important indicator of subjective wellbeing. This study aimed to assess the will-to-live in frail older hospitalized patients and nursing home residents as well as to evaluate its association with physical frailty, tiredness of life, depression and wish-to-die. Between March and September 2021, we interviewed 186 older adults in six nursing homes and two acute geriatric wards across Belgium. Will-to-live was assessed using a single-item numeric rating scale from 0 to 5. A linear regression analysis was performed to assess the association between will-to-live and frailty (Clinical Frailty Scale) with adjustment for age, gender and setting. Mann-Whitney U test was used to evaluate the association between will-to-live and depression, tiredness of life and wish-to-die. Mean age was 85 (± 6.2) years. Mean score on the Clinical Frailty Scale was five (± 1.5) and four on the will-to-live (± 1.3). No statistical significant association was found between will-to-live and age (p = 0.991), gender (p = 0.272), setting (p = 0.627) and frailty (p = 0.629). Multiple linear regression showed no significant association with Clinical Frailty Scale (p = 0.660), after adjustment for age, gender and setting. Will-to-live was negatively associated with tiredness of life (p = 0.020) and wish-to-die (p < 0.001), but not with depression (p = 0.186). Both nursing home residents and older hospitalized patients expressed a strong or very strong will-to-live. Will-to-live was not associated with physical frailty as measured by the Clinical Frailty Scale. Nursing home residents with a weak will-to-live were more likely to have depressive symptoms. Most nursing home residents with a wish-to-die had also a low will-to-live, although some residents had both a high will-to-live and wish-to-die. [ABSTRACT FROM AUTHOR]

Background: Hospital medication errors are frequent and may result in adverse events. Data on non-prescription of regular medications to emergency department short stay unit patients is lacking. In response to local reports of regular medication omissions, a multi-disciplinary team was tasked to introduce corrective emergency department (ED) process changes, but with no additional financing or resources. Aim: To reduce the rate of non-prescription of regular medications for patients admitted to the ED Short Stay Unit (SSU), through process change within existing resource constraints. Methods: A pre- and post-intervention observational study compared regular medication omission rates for patients admitted to the ED SSU. Included patients were those who usually took regular home medications at 08:00 or 20:00. Omissions were classified as clinically significant medications (CSMs) or non-clinically significant medications (non-CSMs). The intervention included reinforcement that the initially treating acute ED doctor was responsible for prescription completion, formal checking of prescription presence at SSU handover rounds, double-checking of prescription completeness by the overnight SSU lead nurse and junior doctor, and ED pharmacist medication reconciliation for those still identified as having regular medication non-prescription at 07:30. Results: For the 110 and 106 patients in the pre- and post-intervention periods, there was a non-significant reduction in the CSM omission rate of −11% (95% CI: −23 to 2), from 41% (95% CI: 32-50) to 30% (95% CI: 21-39). Conclusion: Non-prescription of regular CSMs for SSU patients was not significantly reduced by institution of work practice changes within existing resource constraints. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the concordance of eating disorders (EDs) diagnoses within a multidisciplinary team in a specialized hospital unit dedicated to the medical care of ED. Methods: The study analyzed data from 608 female patients who sought consultation at the Eating Disorders Referral Center between 2017 and 2021. The diagnoses were established according to the DSM‐5 criteria by endocrinologists, psychiatrists, and finally confirmed or discussed within a monthly multidisciplinary consensus meeting (MCM). Fleiss' Kappa tests were conducted to assess inter‐raters' agreement. Results: Overall, substantial agreement was observed between endocrinologists and psychiatrists and the MCM. A more detailed analysis revealed variations in agreement across different disorders. Certain EDs demonstrated substantial agreement (e.g., anorexia nervosa restrictive subtype), while others approached near‐perfect agreement (e.g., binge‐eating disorder). In contrast, agreement was fair to poor for anorexia nervosa binge‐purge subtype (ANBP) and slight for other specified feeding and ED. A period of temporary disagreement was noted for ANBP, partially attributed to practitioner turnover. An improvement in interdisciplinary agreement was observed for all ED diagnoses by the end of the study period. Discussion: Variations or lower levels of inter‐rater agreement may stem from atypical cases that fall on the border between two diagnoses or complex cases, as well as fluctuating symptoms. The progress observed throughout the study can be attributed in part to interdisciplinary learning, particularly facilitated by the MCM. The findings underscore the significance of striving for optimal concordance among different medical specialties to enhance patient care in ED treatment. Public Significance: This study scrutinizes the agreement levels of ED diagnoses among endocrinologists and psychiatrists within a multidisciplinary team at an Eating Disorders Referral Center. While substantial overall agreement was achieved, disparities or lower agreement levels were evident for certain diagnoses such as anorexia nervosa binge‐purge subtype. However, collaborative meetings led to a progressive enhancement in agreement over time. This research underscores the crucial role of a multidisciplinary team working collectively to ensure precise diagnoses and improved care for patients with EDs. [ABSTRACT FROM AUTHOR]

Background: Pulmonary embolism (PE) is a life‐threatening disease where preemptive anticoagulation is recommended by guidelines for patients with intermediate to high pretest risk of PE. Aims: The primary objective of our study was to describe the use of preemptive anticoagulation from the emergency department (ED) or inpatient wards stratified by risk assessment score. Methods: We performed a retrospective observational cohort study of consecutive patients undergoing computed tomography pulmonary angiography (CTPA) for investigation of PE. Patients were classified as either ED patients or hospital ward patients based on where the CTPA was requested. The pretest risk of PE was calculated using the Revised Geneva Score (RGS) and patients were divided into low and intermediate to high risk. Results: A total of 392 consecutive patients who underwent CTPA at Monash Health were reviewed. There were 108 (27.6%) patients who were categorised as low risk (RGS 0–3) and 284 (72.4%) categorised as intermediate to high risk (RGS >3). There were 29 (7.4%) patients overall who received preemptive anticoagulation. Diagnostic yield of CTPA in the ED was low, with only four of 144 (2.8%) CTPA scans positive for PE. The yield of CTPA was higher in ward patients, with 63 of 248 (25.4%) being diagnostic of PE. Conclusions: The use of preemptive anticoagulation for suspected PE was uncommon and was not influenced by the pretest probability of PE as determined by a validated clinical prediction tool. This may reflect concerns regarding haemorrhagic complications without any clear evidence of benefit. Diagnostic yield of CTPA performed in the ED was low. [ABSTRACT FROM AUTHOR]