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Background and purpose: The workplace plays a key role in impacting the health and well-being of employees at various levels, including physical, psychological, and social aspects of health. This study aims to identify the drivers of a healthy environment that promotes the well-being of women employed in hospitals. Materials & methods: This qualitative study used purposive sampling to recruit a total of 48 working women across a diverse range of participants with different job categories and socio-demographic statuses. These include clinical health (e.g., nurse, head nurse, practical nurse, supervisor, physicians); allied health (e.g., diagnostic services); public health (e.g., health promotion specialists); and administrative (e.g., hospital managers). Data was collected through semi-structured interviews and were analyzed using content analysis by creating codes, sub-themes, and themes. Results: Content analysis resulted in 31 key codes, that generated 12 sub-themes and 4 key themes. These include Advancing women's health through collaborative leadership; a Psychologically safe environment for women; Thriving for positive social connections; and Advancing holistic health for women. Discussion and Conclusion: Hospital managers and leaders play a pivotal role in creating supportive workplaces for women. They can significantly assist in prioritizing their psychological and social health through personalized approaches tailored to women's needs, positioning them as co-designers of their health and well-being. [ABSTRACT FROM AUTHOR]

Background: Although the nursing sector gains growing importance in an aging society, students representing the future workforce often show insufficient health. Acknowledging the health-enhancing effects of adequate physical activity, the educational system in Bavaria, Germany, has recently integrated the promotion of physical activity-related health competence (PAHCO) into the nursing curriculum. However, it cannot be assumed that PAHCO has sufficiently permeated the educational practices and routines of the nursing schools. Therefore, the goal of the present study is to examine and compare the effectiveness as well as implementation of different intervention approaches to address PAHCO in the Bavarian nursing school system. Methods: We randomly assign 16 nursing schools (cluster-based) to four study arms (bottom-up, top-down led by teachers, top down led by external physical activity experts, control group). Schools in intervention group 1 (IG-1) develop multicomponent inventions to target PAHCO via cooperative planning (preparation, planning, and implementation phase). Intervention groups 2 and 3 (IG-2, IG-3) receive both an expert-based intervention (developed through intervention mapping) via trained mediators to address PAHCO. External physical activity experts deliver the structured PAHCO intervention in IG-2, while teachers from the nursing schools themselves conduct the PAHCO intervention in IG-3. In line with a hybrid effectiveness implementation trial, we apply questionnaire-based pre-post measurements across all conditions (sample size calculation: nfinal = 636) to examine the effectiveness of the intervention approaches and, simultaneously, draw on questionnaires, interview, and protocol data to examine their implementation. We analyze quantitative effectiveness data via linear models (times-group interaction), and implementation data using descriptive distributions and content analyses. Conclusion: The study enables evidence-based decisions about the suitability of three intervention approaches to promote competencies for healthy, physically active lifestyles among nursing students. The findings inform dissemination activities to effectively reach all 185 schools of the Bavarian nursing system. Trial registration: Clinical trials NCT05817396. Registered on April 18, 2023. [ABSTRACT FROM AUTHOR]

Background: Jails annually incarcerate millions of people with health problems, yet jail healthcare services have not been well described. Objective: To describe jail healthcare staffing. Design: Phone-administered survey conducted October 2020 to May 2021. Setting: County jails in North Carolina, South Carolina, Georgia, and Alabama. Participants: Jail personnel "most knowledgeable" about jail healthcare. Main Measures: Weekly on-site healthcare coverage rate (hours per 100 incarcerated person-weeks [IPWs]) by personnel type; telemedicine rates and detention officers' healthcare duties. Key Results: Survey response rate was 73% (254/346). Among surveyed jails, 71% had on-site non-psychiatric providers (e.g., physicians, physician assistants) (median of 3.3 h per 100 IPWs); 90% had on-site nursing (median of 57.0 h per 100 IPWs) including 50% with on-site registered nurses (median of 25 h per 100 IPWs) and 70% with on-site licensed practical nurses (median of 52 h per 100 IPWs); 9% had on-site psychiatric providers (median of 1.6 h per 100 PWs). Telemedicine was used for primary care in 13% of jails (median 2.1 h per 100 IPW); for mental healthcare in 55% (median 2.1 h per 100 IPW); and for other specialties in 5% (median 1.0 h per 100 IPW). In 81% of jails, officers conducted medical intake and in 58% assessed urgency of medical requests (i.e., "sick call"). The number of officers' healthcare responsibilities increased inversely with weekly nursing coverage. Conclusions: Nearly 30% of surveyed jails routinely lacked on-site healthcare providers and in most other jails providers' on-site presence was modest. Jails relied heavily on LPNs and officers for care, resulting in missed opportunities for care and potentially endangering incarcerated persons. [ABSTRACT FROM AUTHOR]

Background: The healthcare sector's complexity requires competent nursing graduate leaders who can effectively lead upon entering their first workplace. Despite studies hinting at a link between leadership competency and nursing students’ readiness for practice, a direct correlation hasn't been fully explored. Aim: This study aims to examine leadership competencies among nursing graduates of Jordanian colleges and their readiness for practice, including the correlation between these variables. Design: A quantitative correlational method was employed, utilizing a 40-item questionnaire for leadership competency and the 22-item Casey-Fink survey for assessing graduates' readiness for practice. A convenience sample of 268 clinical nurse leaders (CNLs) supervising new graduates was selected. Results: The analysis, revealed a moderate presence of leadership competencies and readiness for practice. Pearson correlation coefficients indicated a strong positive relationship between graduates' leadership competencies and their readiness for practice. Conclusions: The study highlights the need to integrate nursing leadership skills into the curriculum and suggests early engagement with nursing bodies to enhance leadership and workplace readiness. It emphasizes a strategic educational approach to align academic and practical competencies in nursing. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to evaluate nurses' knowledge of selected statements in the use of compression therapy in phlebology according to selected characteristics of nurses. Material and methods: A cross-sectional study using a self-constructed 28-item questionnaire was conducted in 2023. Respondents included 330 nurses (103 practical, 179 general, and 48 general with specialization) from several dozen clinical workplaces in the Czech Republic. As part of the data analysis, descriptive, regression, and cluster analyses in an exploratory mode were applied. Results: The respondents obtained an average of 19 points on the 16 multiple-choice items in the knowledge test, which is a 49% success rate on the test. They were most successful in answering question 19, which focused on the symptoms of venous thrombosis, and least successful in answering question 14, which focused on the method of checking the pressure under the bandage. Work position had the greatest influence on the level of knowledge. Practical nurses scored almost 3 points more on the test and general nurses about 2 points more than specialized nurses. The respondents' post-graduate education also had a positive effect on their knowledge (in terms of factual and statistical significance). Conclusions: The results of the study show that there are major deficiencies in the application of compression therapy among the respondents. Improper compression can cause complications that can seriously harm the patient. Health care providers should provide mandatory training for nurses. [ABSTRACT FROM AUTHOR]

This study aimed to identify the ethical issues faced by home care physicians and nurses, and the support they require. It was conducted in collaboration with the Japanese Association for Home Care Medicine from November to December 2020. An e-mail was sent to 2785 physicians and 582 nurses who are members of the society, requesting their participation in a web-based survey targeting physicians and nurses with practical experience in home care; 152 physicians and 53 nurses responded. Home care physicians and nurses face ethical issues, some of which are that "the patient's wishes cannot be reliably understood owing to their impaired decision-making capacity" and "there is disagreement between the patient and their family members over the necessary healthcare." The respondents sought "experience with, and insight into, healthcare ethics" and "home care" from people with whom they would consult on ethical issues, but at the time of the actual consultation, those individuals were the main healthcare professionals involved with the patient. In addition, the respondents desired to have "multidisciplinary discussions in the community," "participation of healthcare ethics experts at meetings," and "meetings held by healthcare ethics experts" to discuss specific cases. Given these results and the history of healthcare ethics education in Japan—which has been implemented mostly for healthcare providers—we conclude that it is important for academic societies that offer healthcare ethics education to healthcare providers and regional core hospitals with ethics support resources to collaborate to provide ethics consultation services in the community. [ABSTRACT FROM AUTHOR]

Introduction and aims: The aim was to explore clinical decision support (CDS) use in the practice of primary healthcare nurses. The objectives were to recognize to what extent nurses (registered nurses, public health nurses, and practical nurses) use CDS, what factors were associated with the CDS used, what kind of organizational support nurses need, and what were nurses' views about CDS development needs. Methods: The study was conducted with a cross-sectional study design, using an electronic questionnaire developed for this purpose. The questionnaire contained 14 structured questions and nine open-ended questions. The sample consisted of randomly selected primary healthcare organizations (N=19) in Finland. Quantitative data were analyzed using cross-tabulation and Pearson's chi-squared test, and qualitative data with quantification. Results: A total of 267 healthcare professionals (age range 22-63 years) volunteered to participate. Participants were mainly registered nurses, public health nurses, and practical nurses (46.8, 24, and 22.9%, respectively). Overall, 59% of the participants had never used CDS. The majority (92%) found it necessary to develop nursing-specific content for CDS. The most commonly used features were medication recommendations and warnings (74%), reminders (56%), and calculators (42%). Half of the participants (51%) had not received training on the use of CDS. The older age of participants was associated with the feeling of not having enough training to use CDS (P=0.039104). Nurses felt that CDS was helpful in their clinical work and decision-making, promoting evidencebased practice, and narrowing the research-into-practice gap, improving patient safety and the quality of care, and helping those who are new in their work. Conclusion: CDS and its support structures should be developed from a nursing perspective to achieve the full potential of CDS in nursing practice. [ABSTRACT FROM AUTHOR]

Introduction: The self-management process in Diabetes Mellitus (DM) is essential to improve glycemic control. Currently, COVID-19 leading to a significant limitation in services and accessibility, especially regular support for diabetes patients. The utilization of DIMAS Mobile App is expected to be a support system to overcome these problems. This application has three menus such as health education containing information about diabetes, nutrition, medication, exercise, stress management, and foot care; self-care monitoring containing medication reminders, blood sugar and exercise records; and consultation with nurses. This study aimed to determine the effect of DIMAS (Diabetes Management Support) application on Diabetes Self-Management activities. Methods: Using an experimental study with One Group Pre-Posttest Design, the self-management activities were measured among 24 respondents after four weeks of intervention. The intervention was carried out with the DIMAS app and WhatsApp communication. Using the Summary of Diabetes Self-Care Activity (SDSCA) questionnaire, the data were analysed with one paired sample t-test using SPSS 22. Results: Statistically significant changes were observed between pre and post-intervention measures: DSM activities with SDSCA (p=0,000) and the level of knowledge (p=0,000). The results showed that the biggest change in self-care activity was foot care and exercise with the increase of scoring was 2.4 and 0.8 respectively. Respondents stated that the application was useful for reminding them to take medication and communicating with nurses. Conclusion: The application makes it easier for patients to keep connected with nurses despite being constrained by distance and provides practical benefits in nursing services at home. [ABSTRACT FROM AUTHOR]

Background: The long-term care (LTC) sector has been at the epicentre of COVID-19 in Canada. This study aimed to understand the impact that the Single Site Order (SSO) had on staff and leadership in four LTC homes in the Lower Mainland of British Columbia, Canada. Methods: A mixed method study was conducted by analyzing administrative staffing data. Overtime, turnover, and job vacancy data were extracted and analyzed from four quarters before (April 2019 – March 2020) and four quarters during the pandemic (April 2020 – March 2021) using scatterplots and two-part linear trendlines across total direct care nursing staff and by designation (i.e., registered nurses (RNs), licenced practical nurses (LPNs) and care aids (CAs)). Virtual interviews were conducted with a purposive sample of leadership (10) and staff (18) from each of the four partner care homes (n = 28). Transcripts were analyzed in NVivo 12 using thematic analysis. Results: Quantitative data indicated that the total overtime rate increased from before to during the pandemic, with RNs demonstrating the steepest rate increase. Additionally, while rates of voluntary turnover showed an upward trend before the pandemic for all direct care nursing staff, the rate for LPNs and, most drastically, for RNs was higher during the pandemic, while this rate decreased for CAs. Qualitative analysis identified two main themes and sub-themes: (1) overtime (loss of staff, mental health, and sick leave) and (2) staff turnover (the need to train new staff, and gender/race) as the most notable impacts associated with the SSO. Conclusions: The results of this study indicate that the outcomes due to COVID-19 and the SSO are not equal across nursing designations, with the RN shortage in the LTC sector highly evident. Quantitative and qualitative data underscore the substantial impact the pandemic and associated policies have on the LTC sector, namely, that staff are over-worked and care homes are understaffed. [ABSTRACT FROM AUTHOR]

Objectives: The WHO has recognized the importance of multidisciplinary education and recommended its promotion worldwide. In our medical school, students experience practical nursing training in their first year to promote multidisciplinary education. Herein, we clarified the learning experiences of medical students during a practical nursing training for enhancing multidisciplinary collaborative education. Methods: A questionnaire about nursing practice was conducted after training completion. Regarding attitudes during the training, the nurses in charge of shadowing evaluated the students, and the students also evaluated themselves. The survey results were analyzed qualitatively, and the attitude evaluation results quantitatively. Results: There were 76 students who provided informed consent, of whom 55 completed the survey. Three main learning areas were extracted from survey: Nursing treatment, support, and communication activities (7 categories), Nursing care for hospitalized patients (3 categories), Multidisciplinary collaboration through effective communication and coordination (2 categories). On the first training day, the scores of evaluation by others were higher than those of self-evaluation in 6 items. On the second day, the scores of self-evaluation were higher than those of evaluation by others in "Actively learning" and "Communicating appropriately with medical staff and patients." Conclusion: Through the training, students learned about Nursing treatment, support, and communication activities; Nursing care for hospitalized patients; and Multidisciplinary collaboration through effective communication and coordination. The training enabled the students to understand the doctors' roles in the clinical setting, and to reflect on what doctors should be. Leaning from nursing training is highly beneficial for medical students. [ABSTRACT FROM AUTHOR]

Higher vocational colleges need to use video system technology to transform teaching methods to transform ideological and political teaching into more vivid, more attractive and infectious forms, thereby effectively assisting students to actively learn. This article studies a video system based on machine learning and has developed a type of high vocational nursing course political teaching system. The system uses the principle of machine learning to build a learning early warning monitoring algorithm, and then, the performance and accuracy of the model are evaluated by using the algorithm. This article finds that the module can extract the hidden characteristics of traffic and is not affected by the knowledge. The design of the high vocational nursing course political teaching system is equipped with multiple modules such as video on-demand, management, interaction, and recording. Compared with the group comparison, it is very efficient to find that the high vocational nursing course political teaching system in this article is very efficient. This article studies machine learning technology and applies it to the construction process of high vocational nursing curriculum political teaching video systems. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to clarify the attitudes, behaviors, and learning experiences of first-year medical students participating in a nursing practice training aimed at enhancing their professionalism. Methods: A questionnaire survey was conducted among first-year medical students after their nursing practical training to understand their learning experiences. Descriptive statistics was performed for each questionnaire item. For free-text responses, descriptions were grouped by input data with similar content and meaning, and analyzed qualitatively. Others’ evaluation and self-evaluation were analyzed quantitatively. Results: Most students were actively engaged and fulfilled in the training. The free comments generated these categories: “nursing care,” “roles of nurses,” “patient impressions,” “multidisciplinary cooperation,” “communication,” and “what is required of physicians. On the first day, all items evaluated had higher mean scores in the others’ evaluation than in the self-evaluation. On the second day, for “maintains standards of personal appearance (including uniform, hair, and name tag),” the others’ evaluation means were higher than the self-evaluation means. T-tests showed a significant difference in “maintains standards of personal appearance (including uniform, hair, and name tag)” (t=-2.103, degrees of freedom [df]=71.104, p<0.05) and “attends to patients with a polite manner” (t=-2.087, df=74, p<0.05) for both the high and low groups. Conclusion: Greeting, appearance, communication skills, and attitude were found to be the important bases of attitude education in the nursing training ideally involving multidisciplinary professionals. The medical students were able to grasp what is required of doctors and objectively view such position from the viewpoints of nurses and patients. [ABSTRACT FROM AUTHOR]

The metabolic disorder of the wound microenvironment can lead to a series of serious symptoms, especially chronic wounds, which result in significant pain in patients. At present, there is no effective and widely used wound dressing. Therefore, it is important to develop new multifunctional wound dressings. Hydrogel is an ideal wound dressing for medical nursing because of its abilities to absorb exudate and maintain wound wetting, its excellent biocompatibility, and its ability to provide a moist environment for wound repair. Because of these features, hydrogel overcomes the shortcomings of traditional dressings. Therefore, hydrogel has high medical value and is widely studied. In this study, a biodegradable hydrogel based on polysaccharide was synthesized and used as a wound dressing. The swelling degree and degradability of hydrogel were characterized as the characteristics of the wound dressing. The results showed that the prepared hydrogel was degraded with trypsin and in the soil environment. Furthermore, the wound dressing can effectively inhibit the bacterial environment, promote the deposition of the collagen structure of the wound tissue, and accelerate the healing of the wound. The proposed hydrogel has value in practical medical nursing application. [ABSTRACT FROM AUTHOR]

Objective: to analyze nursing technicians' training in patient safety. Method: a convergent parallel mixed-methods study, where qualitative and quantitative elements were concomitantly implemented and equally prioritized, carried out in three technical colleges linked to a federal public institution in the Brazilian Northeast region. In the qualitative phase, semi-structured interviews were conducted with 24 professors and thematic analysis was applied. In the quantitative study, of the survey type, an instrument was used to screen terms about patient safety with 84 students. The results were combined during the general data interpretation, which was based on the Patient Safety Curricular Guide. Results: two thematic categories emerged: The professors' understanding about the theme of patient safety in nursing technicians' training; and Application and projection of the teaching of patient safety in nursing technicians' training. In the quantitative study, among the 46 screening terms, their identification in the theoretical-practical context predominated in Courses A and C, totaling 36 (78.3%) and 25 (54.3%), respectively. Theoretical teaching stood out in Course B, with 26 terms (56.5%). Conclusion: professional training of Nursing Technician students has a technical focus and does not fully contemplate patient safety issues in the teaching-learning process and, thus, constitutes a challenge for training institutions and professors alike. [ABSTRACT FROM AUTHOR]

Despite increasing reliance on licensed practical nurses (LPNs) to provide health services in schools, we do not know whether this is a cost-effective prevention strategy against student absenteeism. Therefore, we evaluated the costs and effectiveness of an LPN-based school nursing program for improving attendance and chronic absenteeism at a large, urban school district in the southeastern USA. We first identified a matched set of 46 elementary schools (23 nurse, 23 no-nurse) by using an optimal multilevel matching algorithm based on student- and school-level characteristics. We then conducted a cost-effectiveness analysis on the matched set, using the ingredients method to estimate societal costs and multilevel regression to estimate effects. The results indicated that despite substantial incremental costs of $68,228 per school, the presence of a full-time LPN was associated with at best negligible improvements, and at worst slight disimprovements, in attendance and chronic absenteeism. We recommend a careful review of the theory of change for LPN-based school nursing programs to clarify the specific inputs and activities that are expected to lead to improved student outcomes. Education agencies should develop explicit assignment, training, monitoring, and auditing plans to ensure LPNs are equitably distributed and that their activities are aligned with the theory of change. Education agencies should also explore whether expanded Medicaid billing can reduce their share of the nursing cost burden. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The WHO has recognized the importance of multidisciplinary education and recommended its promotion worldwide. In our medical school, students experience practical nursing training in their first year to promote multidisciplinary education. Herein, we clarified the learning experiences of medical students during a practical nursing training for enhancing multidisciplinary collaborative education. METHODS: A questionnaire about nursing practice was conducted after training completion. Regarding attitudes during the training, the nurses in charge of shadowing evaluated the students, and the students also evaluated themselves. The survey results were analyzed qualitatively, and the attitude evaluation results quantitatively. RESULTS: There were 76 students who provided informed consent, of whom 55 completed the survey. Three main learning areas were extracted from survey: Nursing treatment, support, and communication activities (7 categories), Nursing care for hospitalized patients (3 categories), Multidisciplinary collaboration through effective communication and coordination (2 categories). On the first training day, the scores of evaluation by others were higher than those of self-evaluation in 6 items. On the second day, the scores of self-evaluation were higher than those of evaluation by others in "Actively learning" and "Communicating appropriately with medical staff and patients.". CONCLUSION: Through the training, students learned about Nursing treatment, support, and communication activities; Nursing care for hospitalized patients; and Multidisciplinary collaboration through effective communication and coordination. The training enabled the students to understand the doctors' roles in the clinical setting, and to reflect on what doctors should be. Leaning from nursing training is highly beneficial for medical students. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to understand how the personal and professional resilience of Registered Practical Nurses working in long‐term care (LTC) homes in Ontario were impacted during the Coronavirus 2019 pandemic. Background: Registered Practical Nurses are primary regulated healthcare providers that have worked in Ontario LTC homes during the COVID‐19 pandemic. As frontline workers, they have experienced increased stress secondary to lockdowns, changing Ministry of Health recommendations, social isolation and limited resources. LTC homes experienced almost a third of all COVID‐19‐related deaths in Ontario. Understanding registered practical nurses' (RPNs) resilience in this context is vital in developing the programs and supports necessary to help nurses become and stay resilient in LTC and across a range of settings. Methods: Purposive sampling was used to recruit 40 Registered Practical Nurses working in LTC homes across Ontario for interviews. Charmaz's Grounded theory guided in‐depth one‐on‐one interviews and analyses completed between April to September 2021. Results: Registered Practical Nurse participants represented 15 (37.5%) private, and 25 (62.5%) public LTC homes across Ontario Local Health Integration Networks. Findings informed two distinct perspectives on resilience, one where nurses were able to maintain resilience and another where they were not. Sustaining and fraying resilience, presented as bimodal processes, was observed in four themes: 'Dynamic Role of the Nurse', 'Preserving Self', 'Banding Together' and 'Sense of Leadership Support'. Conclusion: Resilience was largely drawn from themselves as individuals. Resources to support self‐care and work‐life balance are needed. Additionally, workplace supports to build capacity for team‐based care practices, collegial support in problem‐solving and opportunities for 'connecting' with LTC nursing colleagues would be beneficial. Our findings suggest a role for professional development resources in the workplace that could help rebuild this workforce and support RPNs in providing quality care for older adults living in LTC. Patient or Public Contribution: Our research team included two members of the Registered Practical Nurses Association of Ontario, and these team members contributed to the discussion and design of the study methodology, recruitment, analysis and interpretation. Further, RPNs working in long‐term care during the COVID‐19 pandemic were the participants in this study and, therefore, contributed to the data. They did not contribute to data analysis or interpretation. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis procedures is considered as a supportive management for kidney failure. Nurses play a major role in hemodialysis procedures, because most of the complications facing patients during dialysis as hypotension, cramped muscles, and weak pulse, need nurses with knowledge and practical experience. The current study aimed to assess nurses' knowledge and practice about hemodialysis procedures. Methods: This is a cross-sectional study, which included 103 nurses who worked in dialysis centers in Khartoum State in Sudan, from February to May 2022. A selfadministered questionnaire and observational checklists were used to collect the data and was analyzed using the statistical program for social science (SPSS) version 23, the knowledge and practice score was calculated, and the mean was obtained. Results: The results of our study showed the mean scores of the participant knowledge 11.3, and practice 13.6, and also showed statistical significance regarding the relationship between the level of education and knowledge of nurses regarding hemodialysis procedure; p-value = 0.01. Conclusion: The study concluded that there is sufficient knowledge and practice of nurses in dialysis centers, and there is also a relationship between educational level and knowledge, so the study recommends conducting continuous training for nurses in dialysis centers. [ABSTRACT FROM AUTHOR]

Aim: We examined whether psychological empowerment was significantly associated with the organizational commitment of licensed practical nurses. Background: Healthcare organizations face unprecedented staffing challenges. This study provides insight into potential ways to ameliorate these issues. Methods: In early 2010, we distributed a 45‐item questionnaire, based on established measures of psychological empowerment and organizational commitment, to the entire population of active, full‐time licensed practical nurses throughout a Midwestern US state. Our sample consisted of 1165 respondents. Results: The results of our data analysis suggest that even after controlling for a range of potentially confounding variables, three subscales (meaning, self‐determination and impact) were positively and associated with organizational commitment. However, one subscale (competence) was negatively related to the outcome. Conclusions: The psychological empowerment dimensions of impact, meaning and self‐determination are associated with increased organizational commitment among licensed practical nurses. Implications for Nursing Management: Considering the profound staffing challenges facing the nursing profession—exacerbated by the current global pandemic and retirements—our findings provide nurse administrators with critical information to use in stemming the wave of nurses leaving the profession. [ABSTRACT FROM AUTHOR]

Burnout contributes to high turnover rates, medical errors, and poor patient satisfaction in geriatric nursing staff. Nurses' cognitive emotion regulation (ER) strategies are emerging as an important personal resource related to burnout that are modifiable with intervention. This study examined the association between cognitive ER strategies and burnout among geriatric nursing staff. Participants were 54 nurses (RNs, LPNs, CNA/UWs) with a mean age of 43.1 years (SD = 12.2), majority female (96.3%), and racially diverse: Black (20.4%), White (63.0%), and Other (13.0%). After controlling for CVs, cognitive ER strategies accounted for unique variance in depersonalization, but did not account for unique variance in emotional exhaustion or personal accomplishment. Rumination was associated with greater depersonalization, and greater refocus on planning was associated with lower depersonalization. Findings suggest that depersonalization may be most impacted by ER; however, other ER strategies may be important that were not included in the current study (e.g., experiential avoidance, mindfulness). Future research is needed with additional ER strategies and larger samples. Findings support the use of person-centered interventions, such as cognitive-behavioral and mindfulness-based techniques, to improve stress management and decrease depersonalization. [ABSTRACT FROM AUTHOR]

The enrolled nurse is the second-level regulated nursing role in Australia and internationally. Reports and research indicate that the nursing profession requires greater understanding of the role, so it can be utilised to its potential. To explore issues that may impact the EN role in the Australian nursing workforce. An integrative review. A seven-step framework was used to review scholarly papers, government documents, and grey literature. Three themes from 24 documents were identified: understanding the EN's scope of practice, standardised practice, and career development. A lack of understanding of their scope of practice creates role confusion and a lack of standardised practice, with an expected progression to become a registered nurse. These factors contribute to ENs' not feeling valued. The nursing profession do not understand the enrolled nurse role, and further work is required to value its place in the Australian nursing workforce. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore undergraduate nursing students' perception and attitude towards the Objective Structured Clinical Examination (OSCE). Methods: This cross-sectional descriptive study was conducted between April-May 2020 among undergraduate nursing students at the College of Nursing at Sultan Qaboos University, Muscat, Oman. Two self-administered questionnaires were utilised to obtain data on students' perception and attitude towards OSCE. Students' feedback on OSCE was collected using open-ended questions about OSCE strengths, weaknesses and recommendations for improvement. Survey responses were based on a fivepoint ordinal scale, ranging from strongly disagree to strongly agree. Students' feedback on OSCE was analysed as descriptive data by identifying the common themes and categorising them in groups. Results: A total of 160 students completed the study questionnaires. Most did not find the atmosphere of OSCE to be pleasant (66.3%) and preferred more modes of practical examination (40.6%). Moreover, 64.4% believed the time limitation to be inadequate. The data depict that 33.1% of the examinees deemed the OSCE more stressful than the full practical examination. In addition, a few students confirmed that the OSCE improved their communication skills and confidence in nursing skills. Conclusion: The findings of this study appear alarming in regard to students' perception regarding the overall process and validity of OSCE as an assessment method. Nursing educators must consider further evaluation and improvement of the OSCE in order to improve students' acceptance and appreciation of OSCE as an important form of clinical learning and assessment. [ABSTRACT FROM AUTHOR]

Long‐term care of older adults is currently suffering from a shortage of trained personnel and high turnover rates. Care work is poorly paid, demanding, increasingly time‐bound and both mentally and physically burdensome. In this study, we examined the individual, organisational and economic factors that predict professional care workers' intentions to leave their current employment, using the NORDCARE survey data (2015, N = 3801) collected in Denmark, Finland, Norway and Sweden. The respondents were mainly practical and assistant nurses. The analysis showed that the predictors of intentions to leave were similar in the four countries. The most consistent organisational predictors of leaving intentions were related to psychophysical burden and a lack of supervisor support. Younger age also predicted intentions to leave. To break the vicious circle of burdensome work and high turnover, care workers need sufficient resources and support to conduct their work properly. [ABSTRACT FROM AUTHOR]

Aim: To explore the occupational and personal life dimensions that have been impacted by the COVID‐19 pandemic for registered nurses (RN) and licensed practical nurses (LPN). Design Qualitative interpretive description approach. Methods: Between July and September 2020, a web‐based cross‐sectional study was conducted among RNs and LPNs in Quebec, Canada. Included in this survey was an open‐ended question allowing nurses to describe the occupational and personal life dimensions that were impacted by the COVID‐19 pandemic. Thematic analysis was used to interpret the qualitative data from this open‐ended question. Reporting followed the Standards For Reporting Qualitative Research (SRQR). Results: Of the 1860 survey respondents, 774 RNs and 43 LPNs responded to the open‐ended question (total n = 819). For the occupational dimension, six themes were identified: impacts of infection control on work, change in daily work tasks, offloading and reorganization of care, deterioration of working conditions, increased stress at work and issues related to the profession. For the personal dimension, four themes were found: impacts on the family, dealing with changes about leisure and personal life, impacts on physical and psychological health. Conclusion: Knowing the dimensions affected by the COVID‐19 pandemic could help to identifying appropriate interventions to support RNs and LPNs. Impact The COVID‐19 pandemic has significantly impacted the occupational and personal lives RNs and LPNs working in the Quebec healthcare system. More specifically, Quebec's nurses experienced a major reorganization of care generated by important government decisions. Knowing how the pandemic affected different life dimensions will help in the development of support adapted to nurses' realities. Even in a pandemic context, improvements in the work environment or appropriate support could lead to an improved psychological health for nurses. [ABSTRACT FROM AUTHOR]

Introduction: The increased use of life-sustaining measures in patients with poor long- and middle-term expected survival concerns health care providers regarding disproportionate care. The objective of this study was to report the prevalence of perceived inappropriate care among intensive care unit (ICU) staff physicians, training physicians, nurses, and practical nurses in a Brazilian public hospital. Methods: We conducted a cross-sectional study with the medical and nursing team of a 34-bed multidisciplinary ICU of a tertiary teaching hospital in Southern Brazil from January to July 2019. A total of 151 professionals completed an anonymous electronic survey. Results: The response rate was 49.5%. One hundred and eighteen (78.1%) respondents reported disproportionate care in the work environment. Nurses and practical nurses were less likely to receive formal training on end-of-life communication compared to physicians (10.6% vs. 57.6%, p < 0.001). Twenty-nine (28.1%) nurses and practical nurses vs. 4 (0.08%) physicians claimed that there were no palliative care deliberations in the ICU (p = 0.006). Of 48 senior and junior physicians, 43 (89.5%) believed that collaboration between physicians and nurses was good, whereas 58 out of 103 (56.3%) nurses and practical nurses disagreed (p < 0.001). Conclusion: This is the first survey on the perception of inappropriate care conducted in Latin America. The study included junior physicians and practical nurses working in a high-complexity medical center associated with the Brazilian public health system. Most health care providers perceived disproportionate care in their daily practice, regardless of their professional class. [ABSTRACT FROM AUTHOR]

Despite considerable research on nursing turnover, few studies have considered turnover among nurses working in home health care. Using novel administrative data from one of the largest home health care organizations in the United States, this study examined turnover among home health nurses, focusing on the role of schedule volatility. We estimated separation rates among full-time and part-time registered nurses and licensed practical nurses and used daily visit logs to estimate schedule volatility, which was defined as the coefficient of variation of the number of daily visits in the prior four weeks. Between 2016 and 2019, the average annual separation rate of home health nurses was over 30%, with most separations occurring voluntarily. Schedule volatility and turnover were positively associated for full-time nurses, but not for part-time nurses. These results suggest that reducing schedule volatility for full-time nurses could mitigate nursing turnover in home health care. [ABSTRACT FROM AUTHOR]

• Vaccine coverage differs by healthcare worker occupation, where physicians have highest coverage. • Sweden born have the highest and immigrants born in Europe have the lowest coverage. • Healthcare workers' vaccine hesitancy is an occupational hazard and a risk of nosocomial infection. Globally SARS-CoV-2 vaccine coverage varies among healthcare workers. Based on Swedish registers, data on vaccination status as of 31 October 2021 were analysed for all adults aged 35–64 years, 3 861 565 individuals, in Sweden by healthcare worker occupation group and region of birth. For both men and women vaccination coverage decreased in a graded manner by healthcare worker group with physicians having the highest coverage (96%), followed by registered nurses, licensed practical nurses, and nurse aides. Coverage also differed by region of birth for all groups of healthcare workers and non-healthcare workers with those born in Sweden with Sweden born parents having the highest coverage, and those born outside Sweden but within EU the lowest. The difference in vaccine coverage by region of birth among healthcare workers, regardless of whether it results from socioeconomic inequalities or sociocultural beliefs, puts them at a great occupational hazard and increased risk of nosocomial transmission. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 pandemic has overwhelmed the nursing workforce through tremendous pressure worldwide. Therefore, the Ministry of Education in many countries had transferred the education system to virtual learning. Thus, blackboard is currently the main tool for delivering education and enabling the interactions between teachers and students. Aims: The aim of this study is to explore nursing students' challenges in using Blackboard, and to explore the advantages and disadvantages of using blackboard among nursing students. Settings and Design: This study used a descriptive qualitative study design. The study collected eleven nursing students. Subjects and Methods: In-depth individual semi-structured interviews were used. Statistical Analysis: The data were analyzed using thematic analysis. Results: The results identified four themes: high student satisfaction in using backboard; the positive impact of using Blackboard; learning obstacles through using blackboard; and students' desire for in-class education instead of the blackboard platform. Conclusion: Blackboard, through its current characteristics and features, makes education easy and available to all students. However, students do not prefer blackboard in practical nursing subjects. [ABSTRACT FROM AUTHOR]

Objective: To describe the association between nursing home staff turnover and the presence and scope of infection control citations. Data Sources: Secondary data for all US nursing homes between March 31, 2017, through December 31, 2019 were obtained from Payroll‐Based Journal (PBJ), Nursing Home Compare, and Long‐Term Care: Facts on Care in the US (LTC Focus). Study Design: We estimated the association between nurse turnover and the probability of an infection control citation and the scope of the citation while controlling for nursing home fixed effects. Our turnover measure is the percent of the facility's nursing staff hours that were provided by new staff (less than 60 days of experience in the last 180 days) during the 2 weeks prior to the health inspection. We calculated turnover for all staff together and separately for registered nurses, licensed practical nurses (LPNs), and certified nursing assistants. Data Collection/Extraction Methods: We linked nursing homes standard inspection surveys to 650 million shifts from the PBJ data. We excluded any nursing home with incomplete or missing staffing data. Our final analytic sample included 12,550 nursing homes with 30,536 surveys. Principal Findings: Staff turnover was associated with an increased likelihood of an infection control citation (average marginal effect [AME] = 0.12 percentage points [pp]; 95% confidence interval [CI]: 0.05, 0.18). LPN (AME = 0.06 pp; 95% CI: 0.01, 0.11) turnover was conditionally associated with an infection control citation. Conditional on having at least an isolated citation for infection control, staff turnover was positively associated with receiving a citation coded as a "pattern" (AME = 0.21 pp; 95% CI: 0.10, 0.32). Conditional of having at least a pattern citation, staff turnover was positively associated with receiving a widespread citation (AME = 0.21 pp; 95% CI: 0.10, 0.32). Conclusions: Turnover was positively associated with the probability of an infection control citation. Staff turnover should be considered an important factor related to the spread of infections within nursing homes. [ABSTRACT FROM AUTHOR]

One reason that nursing homes are a primary source of COVID-19 infections and deaths in the United States may be that workers hold multiple jobs. We use 2010-2019 Current Population Survey data to document the rate of second jobholding among nursing and long-term care workers. On average, 6.41% of personal care and nursing aides and 6.23% of licensed practical nurses and registered nurses hold second jobs; second job holding rates are 35% and 32% higher than those of other workers, respectively. Both wages and hours in the primary job are negatively associated with the probability of holding a second job for personal care and nursing aides, while lower hours are more strongly correlated with a second job for registered nurses and licensed practical nurses. Many of these workers move across health settings from their first to second jobs, and 15% of second jobs for personal care and nursing aides are in other "essential" occupations. [ABSTRACT FROM AUTHOR]

Critical thinking frequently involves the ability to interpret information and make informed decisions based on such information, which usually includes foundational knowledge. (P1) ...the student must be made aware that in the critical thinking the nurse educator is a co I -learner. i (P2) The classroom environment needs to be one where there is mutual trust between the nurse educator and students and among students themselves. This means that foundational knowledge includes multiple factors that have been identified as being significant to the teaching and learning of CT, the ontological status of CT, and the purpose of their facilitated CT skills to explore contemporary educational experiences and to promote the fundamental principles of learning [[3], [24]]. [Extracted from the article]

• Peer interaction in an educational context differs from peer interaction in therapeutic contexts in its preference for advice giving. • Nursing students quote patient and their own voice differently when constructing themselves as morally and ethically reliable caregivers. • Nursing students construct their expert identity by using story-closing advice giving that reports knowing-how in ways that qualify them as competent group members. • In contexts where the competence of skillful self-representation is at stake, references to knowing-how take precedence over descriptions of knowing-that. This study analyzes the peer-advice produced by practical nursing students in a study circle in which advisors provide low-threshold support. Our videotaped and transcribed data make a case for a conversation analytic study to investigate the sequences of talk involving students who narrate conflictual care situations and present the necessity of care giving in the form of advice. The study presents two action types of peer-advice given by students. These two action types involve students who base their advice either on knowing-that or on their practical knowing-how. More concretely, we determine the interactional devices linked to the advising used in narratives, such as reported speech and its sequential adjacency to necessive zero-person constructions. Students use these devices to demonstrate their expertise as well as to construct themselves as morally and ethically reliable caregivers. In terms of implications, the study demonstrates that peer-interaction in a study circle among those who are quasi equals provides an appropriate environment to discuss the practical dilemmas encountered in high-conflict patient care situations and this enables students to achieve expert and successful learner status. [ABSTRACT FROM AUTHOR]

Background: The balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method.Methods: The Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019.Results: The WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019.Conclusion: The assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the association of Metabolic Syndrome and its components among Primary Health Care Nursing professionals in the state of Bahia, Brazil, according to professional category. Method: a cross-sectional, population-based and multicenter study conducted with 1,125 Nursing professionals. The independent variable was the professional category, dichotomized into technical and higher education levels. The outcome was Metabolic Syndrome following criteria from the National Cholesterol Education Program Adult Treatment Panel III based on anthropometric measurements and blood samples. The statistical analysis was performed by calculating the prevalence ratios and using Pearson's Chi-square test. Results: the prevalence of Metabolic Syndrome was higher in the technical level category (PR=1.64; CI=1.29 - 2.06; p≤0.01). When compared to Nurses, these professionals were older, had lower incomes, worked more on duty and performed less physical activity on a regular basis. Among the Nurses, the most prevalent component was altered cholesterol (40.5%) and among the Nursing Technicians/Assistants, it was abdominal obesity (47.3%). Conclusion: the association between the Nursing category and Metabolic Syndrome was evident, with higher occurrence among technical level professionals. [ABSTRACT FROM AUTHOR]

Aim: This study aims to examine, through the lens of the Job Demands‐Resources model, the influence of caring for COVID‐19 patients on nurse's perception of chronic fatigue, quality of care, satisfaction at work and intention to leave their organisation and the profession. Background: Studies have examined how fear of COVID‐19 contributes to the mental, physical and work adjustment among nurses. To date, few studies have been conducted examining how caring for patients with COVID‐19 contributes to work outcomes among nurses. Methods: This is a cross‐sectional survey involving 1705 frontline nurses and licensed practical nurses in Quebec, Canada. From these, 782 reported caring for COVID‐19 patients. Results: High chronic fatigue, poor quality of care, lower work satisfaction and higher intention to leave their organisation were found for nurses caring for COVID‐19 patients. Poorly prepared and overwhelmed nurses showed higher turnover intention than those well prepared and in control. Conclusions: There is an urgent need to provide support to nurses during the pandemic, with a long‐term strategy to increase their retention. Implications for Nursing Management: Nurse administrators play an important role in supporting their nurses during a pandemic in the form of education, training and policy development to positively impact quality of care and retention. [ABSTRACT FROM AUTHOR]

Background: Understaffing has been previously reported as a risk factor for central line-associated bloodstream infections (CLABSI). No previous study addressed the question whether fluctuations in staffing have an impact on CLABSI incidence. We analyzed prospectively collected CLABSI surveillance data and data on employee turnover of health care workers (HCW) to address this research question. Methods: In January 2016, a semiautomatic surveillance system for CLABSI was implemented at the University Hospital Zurich, a 940 bed tertiary care hospital in Switzerland. Monthly incidence rates (CLABSI/1000 catheter days) were calculated and correlations with human resources management-derived data on employee turnover of HCWs (defined as number of leaving HCWs per month divided by the number of employed HCWs) investigated. Results: Over a period of 24 months, we detected on the hospital level a positive correlation of CLABSI incidence rates and turnover of nursing personnel (Spearman rank correlation, r = 0.467, P = 0.022). In more detailed analyses on the professional training of nursing personnel, a correlation of CLABSI incidence rates and licensed practical nurses (Spearman rank correlation, r = 0.26, P = 0.038) or registered nurses (r = 0.471, P = 0.021) was found. Physician turnover did not correlate with CLABSI incidence (Spearman rank correlation, r = −0.058, P = 0.787). Conclusions: Prospectively determined CLABSI incidence correlated positively with the degree of turnover of nurses overall and nurses with advanced training, but not with the turnover of physicians. Efforts to maintain continuity in nursing staff might be helpful for sustained reduction in CLABSI rates. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the practical application of nursing management based on network cloud platform in patients with Mycoplasma pneumonia (MP) treated with dexamethasone and azithromycin. Methods: One hundred and twenty MP patients treated with dexamethasone and azithromycin in Xiang Yang No. 1 People's Hospital, Xiang Yang 441000, Hubei Province, China (January 2019 - January 2020) were equally and randomly assigned to groups A and B. Group B adopted routine nursing management, while group A adopted nursing management based on network cloud platform. The nursing work score, nursing management score, incidence of nursing disputes, patient treatment indices, complication rate (CR) and nursing satisfaction were determined and compared between the two groups. Results: Compared with group B, group A achieved notably higher nursing work score and nursing management score (p < 0.001), lower incidence of nursing disputes and CR (p < 0.05), better treatment indices (p < 0.001) and higher patient satisfaction with nursing (p < 0.05). Conclusion: Nursing management based on network cloud platform optimizes nursing management of MP patients treated with dexamethasone and azithromycin, and it comprehensively enhances nursing quality and nursing effect. [ABSTRACT FROM AUTHOR]

Background: Although much research has focused on nurses' retirement intentions, little is known about nurses who formally retire yet continue to practice, particularly in rural and remote settings where mobilization of all nurses is needed to assure essential health services. To optimize practice and sustain the workforce stretched thin by the COVID-19 pandemic, it is necessary to understand what it means for retired registered nurses (RNs) and licensed practical nurses (LPNs) to work after retirement. This study explored what nursing practice means for RNs and LPNs who have formally retired but continue to practice in rural and remote communities. Methods: A pan-Canadian cross-sectional survey conducted in 2014–2015 of nurses in rural and remote Canada provided data for analysis. Textual responses from 82 RNs and 19 LPNs who indicated they had retired but were occasionally employed in nursing were interpreted hermeneutically. Results: Retired nurses who continued to practice took on new challenges as well as sought opportunities to continue to learn, grow, and give back. Worklife flexibility was important, including having control over working hours. Nurses' everyday practice was inextricably tied up with their lives in rural and remote communities, with RNs emphasizing serving their communities and LPNs appreciating community recognition and the family-like character of their work settings. Conclusions: Retired nurses who continue to work in nursing see retirement as the next phase in their profession and a vital way of engaging with their rural and remote communities. This study counters the conventional view of retaining retired nurses only to combat nursing shortages and alleviate a knowledge drain from the workplace. Rural and remote nurses who retire and continue working contribute to their workplaces and communities in important and innovative ways. They can be characterized as dedicated, independent, and resilient. Transitioning to retirement in rural and remote practice can be re-imagined in ways that involve both the community and the workplace. Supporting work flexibility for retired nurses while facilitating their practice, technological acumen, and professional development, can allow retired nurses to contribute their joy of being a nurse along with their extensive knowledge and in-depth experience of nursing and the community. [ABSTRACT FROM AUTHOR]

Objective To describe common strategies and practice-specific barriers, adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation (ACO). Design This study used a multiple case study design. Purposive sampling was used to identify a diverse group of practices within the ACO. Data were collected from focus group interviews and workflow mapping. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. Data were cross-analysed by clinic and CFIR domains to identify common themes and practice-specific determinants of cancer screening implementation. Setting The study included eight rural primary care practices, defined as Rural-Urban Continuum Codes 5-9, in one ACO in the Midwestern United States. Participants Providers, staff and administrators who worked in the primary care practices participated in focus groups. 28 individuals participated including 10 physicians; one doctor of osteopathic medicine; three advanced practice registered nurses; eight registered nurses, quality assurance and licensed practical nurses; one medical assistant; one care coordination manager; and four administrators. Results With integration into the ACO, practices adopted four new strategies to support cancer screening: care gap lists, huddle sheets, screening via annual wellness visits and information spread. Cross-case analysis revealed that all practices used both visit-based and population-based cancer screening strategies, although workflows varied widely across practices. Each of the four strategies was adapted for fit to the local context of the practice. Participants shared that joining the ACO provided a strong external incentive for increasing cancer screening rates. Two predominant determinants of cancer screening success at the clinic level were use of the electronic health record (EHR) and fully engaging nurses in the screening process. Conclusions Joining an ACO can be a positive driver for increasing cancer screening practices in rural primary care practices. Characteristics of the practice can impact the success of ACO-related cancer screening efforts; engaging nurses to the fullest extent of their education and training and integrating cancer screening into the EHR can optimise the cancer screening workflow. [ABSTRACT FROM AUTHOR]

As the U.S. population ages and the demand for long-term care increases, an insufficient number of licensed practical nurses (LPNs) is expected in the nursing workforce. Understanding the characteristics of LPN participation in the workforce is essential to address this challenge. Drawing on the theory of boundaryless careers, the authors examined longitudinal employment data from LPNs in North Carolina and described patterns in LPN licensure and career transitions. Two career patterns were identified: (a) the continuous career, in which LPNs were licensed in 75% or more of the years they were eligible to be licensed and (b) the intermittent career, in which lapses in licensure occurred. Findings indicated that LPNs who made job transitions were more likely to demonstrate continuous careers, as were Black LPNs. These findings suggest the importance of organizational support for LPN career transitions and support for diversity in the LPN workforce. [ABSTRACT FROM AUTHOR]

Objective: To know the challenges faced by nursing technicians in the care of obese patients in inpatient units. Methods: Descriptive, exploratory study with a qualitative approach, guided by the tool Equater - Consolidated criteria for reporting qualitative research, conducted with 28 nursing technicians from public hospitals in the south of the country. Results: Three categories emerged: The physical overload of the nursing technician and patient safety; cooperation between the nursing team to provide care; the (un) available technologies for care. Conclusion: Caring for an obese patient is challenging. The number of professionals in the nursing team and the lack of equipment can influence the work process, and consequently compromise the safety of obese patients. Therefore, the importance of carrying out actions and strategies that contribute to safe and specific nursing care for obese patients in the most diverse realities. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) incidence in Los Angeles County, California, USA (5.7 per 100,000) is significantly higher than the U.S. national average (2.9 per 100,000). Directly observed therapy (DOT) is the preferred strategy for active TB treatment but requires substantial resources. We partnered with the Los Angeles County Department of Public Health (LACDPH) to evaluate the cost-effectiveness of AiCure, an artificial intelligence (AI) platform that allows for automated treatment monitoring. Methods: We used a Markov model to compare DOT versus AiCure for active TB treatment in LA County. Each cohort transitioned between health states at rates estimated using data from a pilot study for AiCure (N = 43) and comparable historical controls for DOT (N = 71). We estimated total costs (2017, USD) and quality-adjusted life years (QALYs) over a 16-month horizon to calculate the incremental cost-effectiveness ratio (ICER) and net monetary benefits (NMB) of AiCure. To assess robustness, we conducted deterministic (DSA) and probabilistic sensitivity analyses (PSA). Results: For the average patient, AiCure was dominant over DOT. DOT treatment cost $4,894 and generated 1.03 QALYs over 16-months. AiCure treatment cost $2,668 for 1.05 QALYs. At willingness-to-pay threshold of $150K/QALY, incremental NMB per-patient under AiCure was $4,973. In univariate DSA, NMB were most sensitive to monthly doses and vocational nurse wage; however, AiCure remained dominant. In PSA, AiCure was dominant in 93.5% of 10,000 simulations (cost-effective in 96.4%). Conclusions: AiCure for treatment of active TB is cost-effective for patients in LA County, California. Increased use of AI platforms in other jurisdictions could facilitate the CDC's vision of TB elimination. [ABSTRACT FROM AUTHOR]

Background: Understaffing has been previously reported as a risk factor for central line-associated bloodstream infections (CLABSI). No previous study addressed the question whether fluctuations in staffing have an impact on CLABSI incidence. We analyzed prospectively collected CLABSI surveillance data and data on employee turnover of health care workers (HCW) to address this research question. Methods: In January 2016, a semiautomatic surveillance system for CLABSI was implemented at the University Hospital Zurich, a 940 bed tertiary care hospital in Switzerland. Monthly incidence rates (CLABSI/1000 catheter days) were calculated and correlations with human resources management-derived data on employee turnover of HCWs (defined as number of leaving HCWs per month divided by the number of employed HCWs) investigated. Results: Over a period of 24 months, we detected on the hospital level a positive correlation of CLABSI incidence rates and turnover of nursing personnel (Spearman rank correlation, r = 0.467, P = 0.022). In more detailed analyses on the professional training of nursing personnel, a correlation of CLABSI incidence rates and licensed practical nurses (Spearman rank correlation, r = 0.26, P = 0.038) or registered nurses (r = 0.471, P = 0.021) was found. Physician turnover did not correlate with CLABSI incidence (Spearman rank correlation, r = −0.058, P = 0.787). Conclusions: Prospectively determined CLABSI incidence correlated positively with the degree of turnover of nurses overall and nurses with advanced training, but not with the turnover of physicians. Efforts to maintain continuity in nursing staff might be helpful for sustained reduction in CLABSI rates. [ABSTRACT FROM AUTHOR]

Background: Diabetes care remains suboptimal in First Nations populations. Innovative and culturally relevant approaches are needed to promote systematic and proactive organization of diabetes care for people living with diabetes on-reserve in Canada. The RADAR model is one strategy to improve care: an integrated disease registry paired with an electronic health record for local community healthcare providers with remote care coordination. We qualitatively assessed adoption and implementation of RADAR in First Nations communities in Alberta to inform its potential spread in the province.Methods: We used the RE-AIM framework to evaluate adoption and implementation of RADAR in 6 First Nations communities. Using purposeful sampling, we recruited local healthcare providers and remote care coordinators involved in delivering RADAR to participate in telephone or in-person interviews at 6- and 24-months post-implementation. Interviews were digitally recorded, transcribed, and verified for accuracy. Data was analyzed using content analysis and managed using ATLAS.ti 8.Results: In total, we conducted 21 semi-structured interviews (6 at 6-months; 15 at 24-months) with 11 participants. Participants included 3 care coordinators and 8 local healthcare providers, including registered nurses, licensed practical nurses, and registered dietitians. We found that adoption of RADAR was influenced by leadership as well as appropriateness, acceptability, and perceived value of the model. In addition, we found that implementation of RADAR was variable across communities regardless of implementation supports and appropriate community-specific adaptations.Conclusions: The variable adoption and implementation of RADAR has implications for how likely it will achieve its anticipated outcomes. RADAR is well positioned for spread through continued appropriate community-based adaptations and by expanding the existing implementation supports, including dedicated human resources to support the delivery of RADAR and the provision of levels of RADAR based on existing or developed capacity among local HCPs.Trial Registration: Not applicable to this qualitative assessment.  ISRCTN14359671 . [ABSTRACT FROM AUTHOR]

Introduction: In peacetime, it is challenging for Army Forward Resuscitative Surgical Teams (FRST) to maintain combat readiness as trauma represents <0.5% of military hospital admissions and not all team members have daily clinical responsibilities. Military surgeon clinical experience has been described, but no data exist for other members of the FRST. We test the hypothesis that the clinical experience of non-physician FRST members varies between active duty (AD) and Army reservists (AR).Methods: Over a 3-year period, all FRSTs were surveyed at one civilian center.Results: Six hundred and thirteen FRST soldiers were provided surveys and 609 responded (99.3%), including 499 (81.9%) non-physicians and 110 (18.1%) physicians/physician assistants. The non-physician group included 69% male with an average age of 34 ± 11 years and consisted of 224 AR (45%) and 275 AD (55%). Rank ranged from Private to Colonel with officers accounting for 41%. For AD vs. AR, combat experience was similar: 50% vs. 52% had ≥1 combat deployment, 52% vs. 60% peri-deployment patient load was trauma-related, and 31% vs. 32% had ≥40 patient contacts during most recent deployment (all P > .15). However, medical experience differed for AD and AR: 18% vs. 29% had >15 years of experience in practice and 4% vs. 17% spent >50% of their time treating critically injured patients (all P < .001). These differences persisted across all specialties, including perioperative nurses, certified registered nurse anesthetists, operating room (OR) techs, critical-care nurses, emergency room (ER) nurses, licensed practical nurse (LPN), and combat medics.Conclusions: This is the first study of clinical practice patterns in AD vs. AR, non-physician members of Army FRSTs. In concordance with previous studies of military surgeons, FRST non-physicians seem to be lacking clinical experience as well. To maintain readiness and to provide optimal care for our injured warriors, the entire FRST, not just individuals, should embed within civilian centers. [ABSTRACT FROM AUTHOR]

Background: Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective. Methods: This qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers. Results: A total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others' personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts. Conclusions: We identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies. [ABSTRACT FROM AUTHOR]