Search

Background: ICU nurses often report that timely informational and supportive resources would ease distress for clients and providers alike., Objectives: This pilot study was aimed to explore the role of a comprehensive information and support programme in enhancing the work environment, task performance and reducing emotional distress amongst ICU nurses., Research Methodology/design: Through a mixed quantitative and qualitative design, nurses were invited to complete self-report questionnaires (n=25) and to participate in focus groups (n=7) prior to (T1) and 6 weeks after the implementation of the supportive programme (T2)., Results: Measures of physical and mental effort were found to be significantly lower (t=2.45, p=0.02) at post test (T2). Statistical trends towards significance were observed for higher performance satisfaction (t=1.70, p=0.10) and lower emotional distress (t=2.00, p=0.06) at T2. Focus group data revealed that nurses felt more supported in their work, had more satisfaction with work tasks accomplished and felt more emotionally supported with the programme being in place., Conclusions: Preliminary data from this pilot study suggest that a comprehensive information and support programme designed to support nurses in the ICU can enhance well being and workplace related factors. Work is currently underway to document the program's impact on family members in the ICU. Future studies should document further how and when similar programme contribute to enhance the workplace for other ICU staff., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This article describes how a series of patient satisfaction surveys on a palliative care unit were used to help influence the care provided to patients and their families. Innovative interventions aimed at addressing areas of lower satisfaction identified in the initial survey are described. The results from a follow-up survey provided the opportunity to evaluate whether our interventions were effective in improving patient satisfaction and highlight new areas of concern needing to be addressed.

Background: Informational support to family members of ICU patients has significant potential for reducing their psychological distress, enabling them to better cope and support the patient., Objectives: To describe family member perception of informational support, anxiety, satisfaction with care, and their interrelationships, to guide further refinement of a local informational support initiative and its eventual evaluation., Methodology/design: This cross-sectional descriptive correlational pilot study collected data from a convenience sample of 29 family members using self-report questionnaires., Setting: 22-bed medical-surgical intensive care unit of a 659-bed university affiliated teaching hospital in Montreal, Quebec, Canada., Results: Mean informational support, assessed with a modified version of the CCFNI (Molter and Leske, 1983), was 55.41(SD=13.28; theoretical range of 20-80). Mean anxiety, assessed with the State Anxiety Scale (Spielberger et al., 1983) was 45.41 (SD=15.27; theoretical range of 20-80). Mean satisfaction with care, assessed using Androfact (Version 4.0, 2001), was 83.09 (SD=15.49; theoretical range of 24-96). A significant positive correlation was found between informational support and satisfaction with care (r=0.741, p<.001). No significant relationships were noted between informational support and anxiety nor between satisfaction with care and anxiety., Conclusion: Findings are related to the ultimate objectives of refining a local informational support initiative and its eventual evaluation, and in so doing, are of more widespread interest to others striving to make evidence based improvements to the care of similar populations., (Copyright 2009 Elsevier Ltd. All rights reserved.)

This qualitative study explored the meaning of quality of life (QOL) from the perspective of palliative care patients by examining their lived experiences and their perceptions of what contributes to their QOL. Ten in-patients--five women and five men--took part in in-depth, semi-structured interviews. When asked about their QOL, they spoke about three distinct aspects: the meaning of a quality life at this stage in their illness trajectory, the experience of living with the illness, and factors that contributed to their QOL. Patients' approach to life, illness life, and ideal quality life were found to create a sphere of influence that shaped their end-of-life experience. At the heart of living a quality end of life for these patients was their ability to "do the things that I usually do," "be helpful to others," and "live in a caring environment," The findings highlight the importance of understanding each of these factors: patients' approach to life, illness life, and ideal quality of life, and what they mean to patients in order to tailor interventions to enhance their QOL.

At the end of 2007, Medicare reported the increase in medical imaging costs overtook increases in pharmaceutical costs for the first time. Imaging costs accounted for a 20% increase, while pharmaceuticals accounted for just 10%. There are two common areas where imaging costs impact overall healthcare spending: unnecessary exams and operational management. This article does not suggest alternatives to today's imaging management practices. It provides economic information, which may be valuable to imaging managers who want to gauge the costs of operating their own departments to what is going on in the industry.

The holding area, as the patient's first introduction to the surgical suites, has the potential to set the tone for the entire surgical experience. To identify targets for improvement efforts in the holding area, a convenience sample of 51 surgical patients completed a 12-item patient satisfaction survey developed using Androfact before discharge from hospital. Results reveal 5 aspects that fall below the desired benchmark satisfaction rate of 80%: staff holding personal conversations in the patients' presence, being offered distraction materials while waiting, pleasantness of the physical environment, reassurance that family members would be kept up-to-date during the surgical procedure, and comfort to provide personal information without worrying that others were listening. Discussion of findings indicates priorities for improvement efforts in the holding area.

Cardiology patients have important learning needs. A 21-item patient satisfaction questionnaire was mailed to 384 cardiology patients 1 week after discharge. Satisfaction ratings indicated that the 161 respondents were satisfied with their care: however, they wanted more information regarding the management of their symptoms and activity level at home. Nurses' interviews revealed that they assessed the availability of follow-up care upon discharge. The results suggest that patients are not satisfied with the information they receive before discharge. Also, nurses and patients have different perceptions about the information patients need. These differences need to be taken into consideration when designing discharge teaching interventions.

Objectives: To compare the effects of nurse case management with usual care provided to community-dwelling frail older people in regard to quality of life, satisfaction with care, functional status, admission to hospital, length of hospital stay, and readmission to emergency department., Design: Randomized controlled trial., Setting: University hospital and two proximal community health centers., Participants: 427 frail older people (> or = 70 years of age and at risk for repeated hospital admissions) discharged home from the emergency department., Experimental: Nurse case management, which consisted of coordination and provision of healthcare services by nurses, both in and out of hospital, for a 10-month period., Control: Usual care, which varied by healthcare provider and community health center., Measurements: Outcomes were assessed 10 months post-randomization by telephone and/or home interview and by medical record review. Questionnaires included the SF-36, CSQ-8, and OARS., Results: No significant differences were found in quality of life, satisfaction with care, functional status, admission to hospital, or length of hospital stay. Nurse-case-managed older adults were readmitted to the emergency department significantly more often than their usual care counterparts., Conclusions: Frail older people receiving nurse case management are more likely to use emergency health services without a concomitant increase in health benefits.

A simple phone call was the impetus for a group of hospitals in northern New Jersey to create a consortium that would meet their collective need to supply continuing education credits for their RTs. Many of the seven original member-hospitals had eliminated continuing education reimbursement and other resources were unavailable. Yet hospital RTs still needed to fulfill American Registry of Radiologic Technologists (ARRT) requirements. The mission of the consortium was to provide a variety of topics that would meet the criteria for continuing education credits, as mandated by the ARRT. The idea was so simple, the seven original hospital members wondered why they hadn't thought of it earlier. If each member hospital offered a three-credit seminar, collectively the consortium could offer 21 credits per year for their employees, more than enough to meet ARRT requirements. The group gave itself a name--Northern New Jersey Council for Continuing Education--and quickly began to create a policy and procedure manual. It came up with basic rules for attendance, voting privileges and a goal for expanding its membership. The newly created manual detailed member responsibilities and instructions for holding seminars. The manual outlined responsibilities for collecting fees, registration, attendance and certification. The consortium agreed on a consistent format for advertising, letterhead and certificates for seminars. Each member was required to submit a course outline for the consortium's approval, which allowed a variety of both technical and nontechnical topics. Some members organized their own seminars, after submitting an application to the ASRT for approval. Others worked with various vendors who were happy to provide a seminar to a group of customers, rather than to individual customers. After three years, the consortium has proved beneficial to all involved. Most of all, it has met the members' goal of providing continuing education with limited resources.

Objective: To determine predictors of 2-year post-hospitalization mortality in a cohort of elderly hospitalized patients originally assembled to assess the impact of a Geriatric Consultation Team (GCT)., Design: Two-year follow-up of an inception cohort., Setting: University-affiliated tertiary care VA Medical Center., Patients: One hundred sixty-seven veterans age 75 or older discharged following hospitalization on medical, surgical, or psychiatry services but not intensive care units., Intervention: None specifically studied here though cohort was previously part of randomized control trial of a Geriatric Consultation Team., Measurement: Mortality during 2 years of post-hospitalization follow-up., Results: Two-year post-hospitalization mortality was 28 percent with no difference between the original GCT and control groups. For the entire sample, age, mental status, admission or discharge ADLs (but not change in ADL status), number of admission problems, number of discharge diagnoses, and discharge site were significant predictors of mortality in univariate analysis. Only discharge ADLs and discharge site remained significant in multivariate analysis., Conclusion: Measures of ADLs during hospitalization are stronger predictors of mortality following hospitalization than disease diagnoses. Impaired ADLs and placement other than at home are significant predictors of mortality, suggesting that the decision for nursing home placement contains other independently predictive information within it and/or that the subsequent nursing home period produces excess mortality. As had been indicated in short-term follow-up, there was no survival advantage for the Geriatric Consultation Group.

Treatment options for patients with ovarian cancer who have failed systemic and intraperitoneal (ip) cisplatin-based chemotherapy are limited. We conducted a phase I clinical study of ip thiotepa in patients with refractory ovarian cancer to determine the maximum tolerated dose (MTD). Ten patients were given 39 courses of thiotepa (median number of courses per patient, 3.5; range, 1-10+). All patients had received prior ip cisplatin; 7 also had received iv cisplatin, and 5 had three or more prior regimens. Thiotepa (30-80 mg/m2) was given ip in 2 liters normal saline every 4 weeks. The therapy was well tolerated. There was no vomiting, stomatitis, alopecia, or peritonitis. The dose-limiting toxicity was myelosuppression. With repeated doses, patients had a delayed marrow recovery and required a 1- to 2-week delay in treatment. Six patients had stable disease (duration 2-14+ months; median duration 5 months); 1 patient had a 50% decrease in CA-125 level, and 1 patient with no measurable disease remained clinically disease-free. In summary, ip thiotepa had clinical activity in heavily pretreated patients with refractory ovarian cancer with disease stabilization seen in 6 of 9 evaluable patients and a partial response seen in 1 patient. Myelosuppression was the only toxicity encountered. A dose of 60 mg/m2 ip is recommended for phase II studies.

As part of a prospective, randomized, controlled study of the effectiveness of a geriatric consultation team, we examined compliance by the house staff with recommendations made by the team. Recommendations were formulated for 185 patients, aged 75 years or older, who were randomized into intervention (n = 92) and control (n = 93) groups. In the control group, only 27.1% of the actions that would have been recommended by the team were implemented independently by the house staff. Problems commonly neglected included polypharmacy, sensory impairment, confusion, and depression. In the intervention group, overall compliance was 71.7%. Highest compliance occurred for recommendations addressing instability and falls (95.0%) and discharge planning (94.3%). We conclude that a geriatric consultation team contributes substantial additional input into the care of older patients. Furthermore, relatively high compliance can be achieved with recommendations made by a geriatric consultation team, thereby overcoming the first barrier to the establishment of such a service.

As part of a controlled clinical trial of a geriatric consultation team (GCT), we investigated whether a GCT could affect the incidence of hospital-acquired complications in elderly patients. One hundred eighty-five patients, aged 75 years and older, were randomized into an intervention (N = 92) and a control (N = 93) group. Members of the intervention group received a GCT consultation and were routinely followed up throughout their hospitalization. The incidence of hospital-acquired complications for the entire study population was 38%. The type and rate of hospital-acquired complications in the intervention and control groups were not significantly different. Functional status on admission and admission to the psychiatry service were predictive for the occurrence of a hospital-acquired complication. In a broadly selected population such as this, the intensity of care available through a GCT was unable to reduce the occurrence of hospital-acquired complications. However, since this is only one aspect of a GCT function, and others may be of great importance, such aspects, and more targeted populations, must be evaluated before final conclusions can be reached about GCT efficiency.