Search

A retrospective chart review was conducted of CBCT images captured between November 2019 and April 2021 on patients who underwent dental implant placement and had a periodontal charting. The buccal and lingual bone thickness around the implants was measured as an average of three measurements taken from the buccal and lingual aspects of implants. Implants with peri-implantitis were placed in Group 1, and implants with peri-implant mucositis or good peri-implant health were placed in Group 2. Wilcoxon rank sum test was used to compare the differences between the bone thicknesses of the groups. In total, 93 CBCT radiographs were screened, and 15 CBCT images with both an implant and corresponding periodontal charting were analyzed. Of the 15 implants examined, 5 presented with peri-implantitis (33%), 1 with peri-implant mucositis, and 9 with good peri-implant health. Within the limitations of this study, buccal bone thickness averaging ≥ 1.10 mm or midlingual probing depths ≥ 3.4 mm correlates with a more favorable peri-implant response. Larger studies are needed to substantiate these findings. [ABSTRACT FROM AUTHOR]

Within our hospital network, the PINCH acronym (Potassium, Insulin, Narcotics, Chemotherapeutics, Heparin) designates high‐risk medications. As per local guidelines, double‐checking is mandated at the point of administration. This retrospective audit aimed to assess nursing and midwifery staff's ability to recognise PINCH medications by examining their adherence to double‐signing protocols, serving as an indicator of double‐checking. The analysis included overall compliance proportions, categorised by PINCH class and further stratified based on location, specialty, and staffs' level of training. An analysis of the first thousand PINCH medication administrations from 1 January 2023 was conducted, spanning four sites within our hospital network. Data sourced from the Electronic Medication Record system were refined to include one medication per patient per day, totalling 200 administrations per PINCH category. The results revealed that 896 (89.6%) out of 1000 medication administrations were co‐signed, with narcotics showing a co‐signature rate of 100%, followed by potassium at 99%, heparin at 98%, insulin at 97.5%, and chemotherapeutics at 53.5%. Among the orders lacking co‐signature, 90% pertained to chemotherapeutics and the remaining 10% were distributed across other categories. Stratifying by location showed 28 (17.6%) out of 159 administrations in a subacute setting lack co‐signature, compared to 76 (6%) from 841 in an acute setting. Compliance rates were highest in specialty medicine at 94.3%, followed by surgical at 86.2%, general medicine 84.5%, women and children's and mental health units at 83.3% each, and continuing care at 82.2%. Notably, enrolled nurses exhibited the highest level of compliance with co‐signatures. Future research could explore the impact of educational strategies on the administration of high‐risk medications. Ethical approval was granted by the Eastern Health Office of Research and Ethics (Reference no: QA23‐075‐101 386) and the study conforms to the Australian Statement on Ethical Conduct in Human Research. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions High variations in serially measured blood pressures (BPs) portend a variety of adverse clinical events including dementia, cardiovascular sequelae and frailty. In this study, systolic blood pressure variability (BPV) was examined for its association with fall frequency and time to next fall among older adults living in nursing homes.BP values and falls over time were extracted from medical records of nursing home residents aged ≥65 years over a 10‐month period. BPV was measured as the standard deviation of 17 to 20 systolic values, and its correlation with falls and time to next fall were evaluated according to quartile values.One hundred patient charts were analyzed with nearly 2000 BP data points. All older adults had at least one fall incident. Higher BPV was related to more falls, shorter time between the first and second fall and fewer average days between falls. Subgroups of high BP and different diagnoses affected this association between BPV and falls.People who fall often show a high variability in BP; as the number of falls increases, the BPV also increases. This study suggests that BPV may be marker for patients who might benefit from more aggressive application of fall reduction strategies. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Patients discharged from Australian hospitals require a list of current medications at the point of discharge, which is commonly in the form of a Patient Friendly Medication List (PFML). Furthermore, the provision of an Interim Medication Administration Chart (IMAC) reduces the number of medication administration delays and omissions for patients discharged to residential aged‐care facilities. To increase the adoption of PFMLs and IMACs, a new process was developed for creating PFMLs and IMACs directly from the discharge prescription in the Electronic Medical Record (EMR). This retrospective pre‐ and post‐intervention audit aimed to evaluate 1 year of PFML and IMAC generation from three acute metropolitan hospitals, prior to and after transitioning from pharmacy dispensing software to EMR‐generated documents. Despite similar hospital activity, the transition to EMR‐generated PFMLs and IMACs was associated with a 157% increase in PFML provision (7930 vs 20 373), a 220% increase in IMAC provision (1569 vs 5022) and a 99% reduction in the number of items typed into the pharmacy dispensing software that did not require supply (−59 171/year). Discharge dispensary turnaround times were lower in the post‐intervention period (36 min vs 30 min, p < 0.01). In conclusion, the transition to EMR‐generated PFMLs and IMACs was associated with increased provision of these documents, reduced data entry for items not required to be supplied, decreased risk of transcription errors and shortened time taken for the hospital pharmacy to process discharge items. This project was exempt due to the local policy requirements that constitute research by the Eastern Health Office of Research and Ethics (Reference no: QA21‐094). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's Ethical considerations in quality assurance and evaluation activities and met local requirements for an audit or quality assurance activity. [ABSTRACT FROM AUTHOR]

Objectives: to assess and compare nurse burnout related to the use of E-based versus paper-based nursing documentation, identify the effectiveness of E-nursing documentation in improving the quality hospitalized patients' care, and to explore and compare the relationship between burnout and the quality of hospitalized patient care. A comparative, analytical descriptive approach was used. Methods: The current study employed the analytical-descriptive approach which seeks for verifying the effectiveness of electronic nursing documentation in improving the quality of hospitalized patients' care. A convenient sample of patient records and nurses from two purposefully selected hospitals, one uses electronic nursing documentation (King Fahad Medical City) and the other uses paper nursing documentation (Alsulayl general hospital), KSA. Tools: A- The Maslach burnout inventory to assess burn out among nurses in both hospitals, B- The Cat-ch-Ing instrument for assessing quality and quantity of nursing documentation and C- a structured patient survey tool. Results: There were differences in burnout in favor of paper-based documentation, and statistically significant differences were found between the study sample users of E- documentation and paper documentation on the quality of hospitalized patients' care in favor of e-nursing documentation at P (0.01), a negative correlative relationship was found between all burnout dimensions and the overall degree of burnout and the quality of hospitalized patients' care. Conclusion: Use of Electronic nursing documentation was of great value on patient outcomes, and nurses' burnout. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to investigate the relationship between Hungarian nursing students’ career choices and nursing professionalism in the context of sex and gender roles. Design: A cross-sectional study. Methods: The study, conducted between March 2023 and June 2023, employed a combination of a self-developed questionnaire and validated measurement instruments (Bem Sex Role Inventory 12 – BSRI-12; Nurse Professional Competence Scale – NPC Scale; 10-item Gender Role Beliefs Scale – GRBS). Statistical analysis was performed using SPSS software. The sample consisted of 252 BSc nursing students in Hungary (53 males, 199 females). Results: It was found that most students surveyed exhibited feminine traits (n = 84) and adhered to traditional gender roles (n = 132). Statistical analysis demonstrated significant associations between nursing students’ gender roles (p = 0.004), adherence to traditional gender roles (p < 0.000), and levels of nursing professionalism. Notably, an androgynous gender role correlated with heightened nursing professionalism (p < 0.001). Additionally, career choice motivations were influenced by sex, gender role, and individual perceptions of gender roles. Conclusion: A diversity of gender roles which influence individuals’ future careers in nursing was identified. Different motivating factors play a role in male and female nursing students’ career choices, knowledge of which would be useful in student recruitment in order to reduce nursing staff shortages. [ABSTRACT FROM AUTHOR]

The Continuity of Care Report (CCR) is a fundamental document for ensuring high-quality healthcare and a smooth transition between different levels of care. The aim of this study was to evaluate the impact of optimizing the CCR to improve its completion rate by hospital nurses and its review by primary care nurses. To achieve this, a retrospective observational study was conducted on patients discharged from the University Hospital of La Plana de Vila-real during two three-month periods, one prior to the CCR improvement (2022) and one after (2023). No increase in the completion rate for the CCR was observed following its optimization (p = 0.226). However, a statistically significant improvement was noted in the percentage of reports reviewed (p > 0.001), increasing from 4.4% (n = 49) in 2022 to 30.5% (n = 327) in 2023. These results indicate that the optimization of the Continuity of Care Report enhances the communication between specialized care and primary care professionals. [ABSTRACT FROM AUTHOR]

Objectives This study was performed to examine the content of decision-making support and patient responses, as documented in the nursing records of individuals with cancer. These patients had received outpatient treatment at hospitals that met government requirements for providing specialized cancer care. Methods Nursing records from the electronic medical record system (in the subjective, objective, assessment, and plan [SOAP] format), along with data from interviews, were extracted for patients receiving outpatient care at the Department of Internal Medicine and Palliative Care and the Department of Breast Oncology. Data analysis involved simple tabulation and text mining, utilizing KH Coder version 3.beta.07d. Results The study included 42 patients from palliative care internal medicine and 60 from breast oncology, with mean ages of 70.5 ± 12.2 and 55.8 ± 12.2 years, respectively. Decisions most frequently regarded palliative care unit admission (25 cases) and genetic testing (24 cases). The assessment category covered keywords including (1) “pain,” “treatment,” “future,” “recuperation,” and “home,” as terms related to palliative care and internal medicine, as well as (2) “treatment,” “relief,” and “genetics” as terms related to breast oncology. The plan category incorporated keywords such as (1) “treatment,” “relaxation,” and “visit” and (2) “explanation,” “confirmation,” and “conveyance.” Conclusions Nurses appear crucial in evaluating patients’ symptoms and treatment paths during the decision-making support process, helping them make informed choices about future treatments, care settings, and genetic testing. However, when patients cannot make a decision solely based on the information provided, clinicians must address complex psychological concepts such as disease progression and the potential genetic impact on their children. Further detailed observational studies of nurses’ responses to patients’ psychological reactions are warranted.

Background: Serious illnesses, such as cancer, bring the threat of loss of health and life closer. This may compromise spiritual well‐being. Addressing patients' spirituality is essential in nursing care. Therefore, nursing records should reflect, clarify, and enable spiritual‐care follow‐up. Aim: The aim of this study is to explore how spiritual care is expressed in nursing records in cancer care. Method: This study adopted a hermeneutic approach, and a qualitative content analysis was used to explore the nursing records of 43 inpatients with cancer from Norway. Ethical approval was obtained, and the privacy of the patients and healthcare professionals was safeguarded in line with the applicable legislation. Results: Spiritual care was rarely reported in the nursing records (i.e., the nursing care plans and the progress notes). However, traces of spiritual care appeared in the records of everyday nursing. Four themes emerged from the analysis: (1) relieving life pain and mitigating loss, (2) facilitating faith support, (3) welcoming family and friends, and (4) sustaining normality and sharing joy. Conclusions: This study showed that the nursing records of cancer care seldom expressed spiritual care concerning patients' life pain, loss, or faith support. Increasing nurses' competencies in mapping, documenting, and attending to spiritual care, as well as overcoming the limitations of documentation systems, could help address the spiritual needs of cancer patients. [ABSTRACT FROM AUTHOR]

The global prevalence of prediabetes is expected to reach 8.3% (587 million people) by 2045, with 70% of people with prediabetes developing diabetes during their lifetimes. We aimed to classify community‐dwelling adults with a high risk for prediabetes based on prediabetes‐related symptoms and to identify their characteristics, which might be factors associated with prediabetes. We analyzed homecare nursing records (n = 26,840) of 1628 patients aged over 20 years. Using a natural language processing algorithm, we classified each nursing episode as either low‐risk or high‐risk for prediabetes based on the detected number and category of prediabetes‐symptom words. To identify differences between the risk groups, we employed t‐tests, chi‐square tests, and data visualization. Risk factors for prediabetes were identified using multiple logistic regression models with generalized estimating equations. A total of 3270 episodes (12.18%) were classified as potentially high‐risk for prediabetes. There were significant differences in the personal, social, and clinical factors between groups. Results revealed that female sex, age, cancer coverage as part of homecare insurance coverage, and family caregivers were significantly associated with an increased risk of prediabetes. Although prediabetes is not a life‐threatening disease, uncontrolled blood glucose can cause unfavorable outcomes for other major diseases. Thus, medical professionals should consider the associated symptoms and risk factors of prediabetes. Moreover, the proposed algorithm may support the detection of individuals at a high risk for prediabetes. Implementing this approach could facilitate proactive monitoring and early intervention, leading to reduced healthcare expenses and better health outcomes for community‐dwelling adults. [ABSTRACT FROM AUTHOR]

The Continuity of Care Report (CCR) is a fundamental document for ensuring high-quality healthcare and a smooth transition between different levels of care. The aim of this study was to evaluate the impact of optimizing the CCR to improve its completion rate by hospital nurses and its review by primary care nurses. To achieve this, a retrospective observational study was conducted on patients discharged from the University Hospital of La Plana de Vila-real during two three-month periods, one prior to the CCR improvement (2022) and one after (2023). No increase in the completion rate for the CCR was observed following its optimization (p = 0.226). However, a statistically significant improvement was noted in the percentage of reports reviewed (p > 0.001), increasing from 4.4% (n = 49) in 2022 to 30.5% (n = 327) in 2023. These results indicate that the optimization of the Continuity of Care Report enhances the communication between specialized care and primary care professionals.

Background. Paediatric patients in Australia experience lengthy wait times for Primary and Allied Healthcare Service (PAHCS) appointments. This results in a lack of satisfaction and adverse health outcomes. However, very few studies have explored wait times for appointments with PAHCSs in Australia. This study explored the length of wait time and associated barriers to timely access to paediatric PAHCSs in Australia. Methods. The scoping review followed PRISMA‐ScR guidelines for Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. We comprehensively searched for relevant studies from five databases, including Scopus, Emcare, Medline (via Ovid), CINAHL, and Google Scholar in August 2023 without any time limitations. Studies that reported qualitative findings on the wait times and associated barriers to timely accessing to PAHCSs were selected in this scoping review. We performed a reflexive thematic analysis using NVivo software in this review. Results. A total of seven studies out of ninety‐one retrieved records were eligible to be included in this review. Studies show that Australian children, in general, had to wait more than one year for health assessments and interventions in PAHCSs. The long waiting times were perceived as frustrating and worrying by caregivers of children. Several overarching themes related to the barriers of timely accessing to paediatric PAHCSs in Australia were identified, such as strict appointment criteria for children, disparity between demand and provision, parental unawareness, and inadequate public funding in rural PAHCSs. Conclusion. Australian paediatric patients are severely burdened with long wait times for appointments with PAHCSs, primarily, due to the poor government initiatives in rural PAHCSs. This study suggested that the criteria for booking an appointment in PAHCSs need to be simplified. Besides, adequate public health funding and the provision of resources are required in rural PAHCSs. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic significantly impacted emergency department (ED) operations and patient care. Understanding its effects on nursing processes, triage accuracy, and wait times is pivotal for optimizing outcomes. Objectives: This study aimed to analyze the differences in nursing processes, triage accuracy, and wait times before and during the COVID-19 pandemic. Design: A retrospective cohort study. Methods: The study analyzed 224 electronic medical records from a single ED, with 120 records from the pre-pandemic period (January 2019–February 2020) and 104 records from the pandemic period (March 2020–March 2021). Dependent variables included missed nursing care per validated scales, triage accuracy per Emergency Severity Index, and wait times for nursing triage and physician examination. Independent factors encompassed sociodemographic, clinical characteristics, and organization dynamics. Results: Sociodemographic and clinical profiles were comparable between periods. Triage accuracy remained high except for older patients. Nursing triage wait times differed little, yet physician examination and urgent case waits decreased amidst the pandemic. Nursing documentation completeness, such as recording patient status and mental state, augmented during this crisis period. Conclusion: This evaluation identified differences in triage accuracy, wait times, and documentation completeness before and during the COVID-19 pandemic period at a single institution. Patient age and clinical status influenced some metrics. Lessons from comparing precrisis benchmarks to intra-pandemic nursing performance may guide pandemic preparedness strategies. Further research is warranted to optimize emergency processes and outcomes during public health emergencies, as well as examine strategies through multicenter investigations comparing prepandemic to intra-pandemic performance to provide broader insights into challenges and inform efforts to bolster emergency care through future crises. [ABSTRACT FROM AUTHOR]

Background: The study aim was to elucidate the effect of the 2024 Noto Peninsula earthquake on outpatient chemotherapy treatment of cancer survivors at Kanazawa Medical University Hospital (KMUH), Japan. Methods: Medical and nursing records for January 4–31, 2024, from KMUH were retrospectively collected, and data for 286 participants were analyzed. Results: Of the 286 participants, 95.1% were able to attend their first scheduled appointment. Of the 12 (4.2%) who could not attend because of the earthquake, 7 (58.3%) rescheduled their appointments. A total of 8 participants (2.8%) were unable to attend their second scheduled appointment in January, despite being able to attend their first appointment; 3 (37.5%) of these participants reported that they were unable to attend their appointments because of the effect of the earthquake. Chemotherapy was not administered to 53 (18.5%) participants who did attend, mainly owing to neutropenia, progressive disease, rash, and anemia. Evacuation information was available for 25 participants (8.7%); of these, 8 (28.6%) evacuated to their homes, 7 (25.0%) to public shelters, and 4 (14.3%) to apartments near the hospital. Disaster status information was obtained from 62 participants (21.7%), and indicated experiences such as home damage, water outages, and relying on transportation assistance from family to attend appointments. Conclusions: Most cancer survivors receiving chemotherapy at KMUH were able to maintain outpatient visits. However, a few could not attend because of the earthquake. Further studies are needed to provide more detailed information on the effect of disasters on cancer survivors and the potential factors underlying non-attendance at medical appointments. [ABSTRACT FROM AUTHOR]

Children with medical complexity have medical fragility, chronic disease, technology dependence, and high healthcare use. Their transition to adult health care at age 18 involves medical and social elements and follows no standardized process. Our goal was to improve transition readiness in children with medical complexity using a transition intervention within a Complex Care program. All children with medical complexity aged 14 to 18 were included in this quality improvement (QI) project (n = 54). We conducted a pre- and post-intervention chart review to assess transition outcomes and implemented a transition intervention for 6 months, which included an age-stratified checklist, charting template, and transition rounds. Before the intervention, 72% of 17- to 18-year-old patients had documented transition discussions, which increased to 86%. Patients with a family physician increased as well (61% to 73% for 17- to 18-year-olds). Three transition education rounds were held. The intervention increased transition readiness, provided tools to facilitate transition, and created a forum for conversation. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes. METHODS: We extracted nursing notes across inpatient units at 2 hospitals for 2019: a pediatric tertiary care center and a community-based hospital. We used a workflow for narrative data processing using a natural language processing (NLP) assisted manual review process performed by domain experts (a nurse and a physician). We trained the NLP models on the tertiary care center data and validated it on the community hospital data. Finally, we applied these surveillance methods to real-time data for 2022 to assess reporting completeness of new cases. RESULTS: We used 70 981 notes from the tertiary care center for model building and internal validation and 19 332 notes from the community hospital for external validation. The final community hospital model sensitivity was 96.8% (95% CI 90.6% to 100%) and a specificity of 47.1% (39.6% to 54.6%) compared with manual review. We identified 31 HAV episodes in July to December 2022, of which 26 were reportable in accordance with the hospital internal criteria. Only 7 of 26 cases were reported by employees using the self-reporting system, all of which were identified by our surveillance process. CONCLUSIONS: NLP-assisted review is a feasible method for surveillance of under-reported HAV episodes, with implementation and usability that can be achieved even at a low information technology-resourced hospital setting. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence and clustering of NANDA‐International nursing diagnoses in patients assisted by pre‐hospital emergency teams. Design: Retrospective descriptive study of electronic record review. Methods: Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two‐step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. Results: Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six‐cluster solution (n = 26.788) was found. Five clusters had a single high‐prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co‐occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). Conclusion: Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre‐hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. Implications for the profession and/or patient care: Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre‐hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre‐hospital clinical setting. Impact: What problem did the study address? There are different models of pre‐hospital emergency care services.The use of standardized nursing languages in the pre‐hospital setting is not homogeneous.Studies on NANDA‐I nursing diagnoses in the pre‐hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA‐I nursing diagnoses in the pre‐hospital care setting.Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance.Patients attended by pre‐hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre‐hospital setting, increasing the evidence of individualized and standardized care plans for pre‐hospital care. Reporting method: STROBE checklist has been used as a reporting method. No Patient or Public Contribution: Only patients' records were reviewed without further involvement. [ABSTRACT FROM AUTHOR]

Aim(s) Design Methods Results Conclusion Impact Patient Contribution To evaluate the incidence of skin‐related complications attributable to incontinence‐associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care.Multicenter quality improvement study.Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines.Three hundred and eighty‐one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown.The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention.Significant negative outcomes are associated with UI patients. External female urinary catheters are a non‐invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD‐related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown.Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care. [ABSTRACT FROM AUTHOR]

Aims Design Results Conclusion Implication for the Profession and/or Patient Care Reporting Method Patient or Public Contribution Our study aimed to (1) validate the accuracy of nursing mobility documentation and (2) identify the most effective timings for behavioural mapping.We monitored the mobility of 55 inpatients using behavioural mapping throughout a nursing day shift, comparing the observed mobility levels with the nursing charting in the electronic health record during the same period.Our results showed a high level of agreement between nursing records and observed mobility, with improved accuracy observed particularly when documentation was at 12 PM or later. Behavioural mapping observations revealed that the most effective timeframe to observe the highest levels of patient mobility was between 10 AM AND 2 PM.To truly understand patient mobility, comparing nursing charting with methods like behavioural mapping is beneficial. This comparison helps evaluate how well nursing records reflect actual patient mobility and offers insights into the best times for charting to capture peak mobility. While behavioural mapping is a valuable tool for auditing patient mobility, its high resource demands limit its regular use. Thus, determining the most effective times and durations for observations is key for practical implementation in hospital mobility audits.Nurses are pivotal in ensuring patient mobility in hospitals, an essential element of quality care. Their role involves safely mobilizing patients and accurately charting their mobility levels during each shift. For nursing practice, this research underscores that nurse charting can accurately reflect patient mobility, and highlights that recording the patient's highest level of mobility later in the shift offers a more precise representation of their actual mobility.Strobe.No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this narrative review is to explore the advantages and limitations of VHs in delivering healthcare, including access to specialized professionals, streamlined communication, efficient scheduling, integration of electronic health records, ongoing monitoring, and support, transcending geographical boundaries, and resource optimization. Methods: Review of literature. Results: The national healthcare systems are facing an alarming rise in pressure due to global shifts. Virtual hospitals (VH) offer a practical solution to numerous systemic challenges, including rising costs and increased workloads for healthcare providers. VH also facilitate the delivery of personalized services and enable the monitoring of patients beyond the conventional confines of healthcare settings, reducing the reliance on waiting medicine carried out in doctors' offices or hospitals. Conclusion: VH can mirror the conventional healthcare referral system. [ABSTRACT FROM AUTHOR]

The beta-lactam antibiotics are some of the safest and best-tolerated antibiotic agents; however, many patients have reported allergies against penicillin. All beta-lactam antibiotics are only restrictively prescribed for these patients and alternative antibiotics are increasingly given, which carries the risk of negative clinical results and socioeconomic sequelae; however, over 95% of patients who reported an allergy to penicillin show a negative result in the allergy tests for penicillin and this antibiotic can safely be prescribed. The use of sensitive and specific instruments for identification of false penicillin allergies should be an important topic within the framework of antibiotic stewardship. Anesthesists can play a central role in the reduction of the enormous individual and public health burden associated with the classification of penicillin allergy by taking an appropriate medical history and a risk stratification for the identification of patients with a penicillin allergy. This overview article presents a possible delabelling algorithm within the framework of the clarification of a beta-lactam antibiotic allergy. The focus is on a structured allergy anamnesis using the penicillin allergy, five or fewer years ago, anaphylaxis/angioedema, severe cutaneous adverse reaction (SCAR) and treatment required for allergy episode (PEN-FAST) score. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to assess the appropriateness of penicillin allergy (PenA) assessment conducted by clinical teams and to review the safety of subsequent exposure of these patients to penicillin. Methods: Opportunistic, prospective observational study of usual clinical care, between 16 May 2023 and 14 August 2023, of inpatients with a PenA and requiring antibiotics, in a 750-bed hospital in England. To assess the appropriateness of management, PenA patients prescribed penicillins were grouped into risk categories using a validated antibiotic allergy assessment tool: eligible for de-label on history alone (direct de-label; DDL), eligible for direct oral challenge (DOC), high risk or unable to obtain history. Results: Of the 123 patients admitted with a PenA (or sensitivity record) and exposed to a penicillin, data were collected for 50. Their PenA records were grouped follows: eligible for DDL 34 (68%), eligible for DOC 11 (22%), high risk 4 (8%) and unable to obtain history 1 (2%). In 14/50 (28%) patients there was no evidence of a current PenA assessment in the medical notes. Conclusions: Using the allergy risk tool, most patients with PenA records were exposed to penicillin appropriately. However, patients meeting high-risk criteria were also exposed to penicillin when the tool excluded them. PenA assessment needs to be carried out with appropriate training and governance structures in place. [ABSTRACT FROM AUTHOR]

Objective: Acute agitation in pediatrics is commonly encountered in hospital settings, can contribute to significant physical and psychological distress, and management is highly varied in practice. As such, the development of a standardized pharmacologic guideline is paramount. We aimed to develop a novel clinical pathway (CP) for management of acute agitation for all hospitalized pediatric patients in Canada. Methods: Healthcare professionals in Canada with expertise in treating and managing pediatric agitation formed a working group and developed a CP through conducting a literature review, engaging key partners, and obtaining interdisciplinary consensus (iterative real-time discussions with content experts). Once developed, the preliminary CP was presented to additional internal and external partners via multiple grand rounds and a webinar; feedback from participants guided final CP revisions. Results: The working group created a pediatric inpatient CP to guide pharmacologic management of agitation and serve as an easy-to-use clinical and educational resource with three complementary sections including: 1) a treatment algorithm, 2) a quick reference medication chart, and 3) two supporting documents, which provide a general overview of non-pharmacologic strategies prior to CP implementation and an illustrative scenario to accompany the medication chart to ensure effective utilization. Conclusions: This is the first CP to standardize pharmacological treatment and management of acute agitation in children in inpatient settings in Canada. Although further research is warranted to assess implementation and support process improvement, the CP can be adapted by individual institutions to assist in prompt pharmacological management of pediatric agitation to potentially improve outcomes for patients, families, and healthcare professionals. [ABSTRACT FROM AUTHOR]

Purpose: To assess the quality of the nursing process in Romania by evaluating nursing documentations with the quality of diagnoses, interventions and outcomes (Q‐DIO) measurement instrument. Methods: A quantitative cross‐sectional research design was employed using probabilistic sampling to select nursing documentations from a Romanian university hospital. The data were analyzed using the Q‐DIO measurement instrument. Findings: Low quality levels of nursing process documentation were found. The Q‐DIO subscale "Nursing diagnoses as process" (assessment) revealed a mean = 1.36 (SD 0.52) of maximum 2. Nurses collected lots of data but did not use these to state nursing diagnoses. "Nursing diagnoses as product" showed inaccurate diagnoses; mean = 1.24 (SD 0.48) of maximum 4. Nursing interventions were planned and documented, but their impact on the etiology of nursing diagnoses was low; mean = 0.76 (SD 0.18). The quality of nursing outcomes mean was 0.57 (SD 0.29). Nurses failed making connections between nursing assessment, diagnoses, interventions, and outcomes, and standardized nursing languages (SNLs) were not used. Statistically significant differences were found among all Q‐DIO sub‐concepts except for "Nursing diagnoses as process." Conclusions: The documentation was structured but did not support the nursing process and its documentation, and SNLs were not implemented. There was an underutilization of data to state nursing diagnoses, and nursing interventions were mostly ineffective, leading to low nursing outcomes. Implications for nursing practice: This study provides new insights on the nursing process and its documentation in Romania and a baseline for future research. Policymakers, administrators, and educators should consider educating nurses to use standardized nursing languages and apply the Advanced Nursing Process. [ABSTRACT FROM AUTHOR]

The current bleep communication system between nurses and interns on-call in most Irish hospitals has been linked with interruption in patient care, disruption to workflow, inefficiency, increased burden and stress to the on-call health staff. A new electronic system was introduced in a University Hospital to replace and eliminate bleep usage during on-call hours. An Intern on-call task electronic template was generated using Microsoft Excel Spreadsheet. This electronic system enabled users to review and respond to requests placed by nursing healthcare staff. This project initially underwent a trial process in three wards for a period of two weeks in June 2023. Interns and nurses were asked to fill a survey before and after introduction of the system. The project was implemented across all wards in August 2023 and a secondary survey was obtained. In addition, the spreadsheets were analysed retrospectively. During the trial, twenty-six interns and twenty nurses were surveyed before and after implementation of the electronic system. Interns satisfaction rate was 73% and stress was reported to be reduced by 65%. Notably, 57% of interns reported a reduction in workload and the number of bleeps was reported to be as <10 by 42%. Nurses reported a decrease in the number of bleeps they needed to send overall by 65% and by 55% for repeated jobs. Workload was reported to be increased by 15% by nurses. However, exactly half of the nurses were unhappy with the new system and stress levels were unchanged. This project has shown promising results, efficient and clear communication was noted with an overall positive feedback and satisfaction rate by doctors. However, as evident, from a nursing perspective further work is needed to further progress into a system that can benefit both parties involved. • Using an electronic system to replace bleeps showed promising results. • Positive feedback and satisfaction rate were reflected by on-call doctors. • Moderate reduction in workload and stress was reported by on-call doctors. • The electronic system is simple, cost-effect and sustainable. [ABSTRACT FROM AUTHOR]

Background: Unfractionated heparin (UFH) is a high-risk medication that can cause bleeding and/or thrombotic complications if not managed appropriately. Between January and July 2019, our institution experienced a high number of patient safety events related to UFH infusion for the treatment of venous thromboembolism (VTE). Purpose: The aim of this quality improvement (QI) initiative was to prevent these safety events by improving compliance with our institution's nurse-driven VTE UFH infusion protocol. Methods: Baseline data for patients on the VTE UFH protocol were collected to identify improvement opportunities. Compliance with eight standards of care related to the VTE UFH infusion protocol was measured. Time to first therapeutic activated partial thromboplastin time (aPTT) was recorded to assess the benefit of improved compliance. Interventions: Institutional policy updates were made to clarify the management of UFH infusions and documentation in the electronic health record. A multidisciplinary workgroup implemented order set changes, nursing communication orders, UFH infusion reports, and a nursing education module to promote compliance with the protocol. Results: The overall rate of compliance with the VTE UFH infusion protocol increased from 79.4% at baseline to 85.2% following implementation of the QI initiative, and the median time to first therapeutic aPTT decreased from 831.5 minutes to 808 minutes over the same period. Conclusions: A multidisciplinary initiative to address improvement opportunities in a nurse-driven UFH protocol for VTE treatment increased compliance with the protocol and decreased the time to first therapeutic aPTT. The authors describe a quality improvement initiative to reduce patient safety events related to unfractionated heparin (UFH) infusions by increasing compliance with their institution's venous thromboembolism UFH protocol. [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: Nurses constitute a significant portion of the health care workforce, playing a crucial role in enhancing the quality of hospital services, particularly in the context of nursing documentation to ensure the precise recording of patient information in accordance with established standards. This study examines the factors associated with implementing nursing documentation in a psychiatric hospital. Methods: This cross-sectional study was conducted in June 2023 in a psychiatric hospital in Indonesia. A convenience sampling method was employed to recruit 144 nurses working in the hospital. Data collection methods encompassed supervision questionnaires, Unified Motive Scales (UMS), and observation sheets used for recording nursing care activities. Data analysis involved the chi-square test and multiple logistic regression. Data analysis was performed with a significance level set at 0.05 and a CI of 95%, utilizing STATA 13. Results: We found significant associations between nursing documentation and supervision techniques (p = 0.01), need for power (p = 0.001), and need for affiliation (p = 0.002). Notably, the need for power emerged as the most influential factor in nursing documentation (odds ratio [OR] = 8.46; 95% CI, 3.53-20.28). Conclusion: These findings underscore the importance of supervision techniques, power needs, and affiliated needs in the context of nursing documentation. The statistically significant associations between these factors emphasize their role in ensuring accurate and comprehensive record-keeping within health care settings. Particularly noteworthy is the substantial influence of the need for power, with a high OR, suggesting that addressing power dynamics may be an essential strategy for improving nursing care documentation practices.

Aim: Investigate the influence of organizational intelligence on the development of soft skills and the overall thriving of nurses at Alexandria Main University Hospital in Egypt. Design: A cross-sectional descriptive design following STROBE guidelines examined the relationship between organizational intelligence, soft skills, and nurses' thriving. Methods and tools: Data were collected from 740 nurses working across critical care units using structured questionnaires. The questionnaires assessed organizational intelligence, soft skills, and thriving at work. Sociodemographic characteristics, including age, gender, education, and nursing experience, were also collected. Statistical analyses were used to analyze the data, including ANOVA, t-tests, Pearson correlation, and stepwise regression. Results: The findings revealed nurses' positive perceptions of organizational culture and documentation skills. However, areas such as measures and rewards and staff relations and communication indicated opportunities for improvement. Nurses reported high vitality levels but needed more learning opportunities at work. Significant correlations were found between demographic variables, organizational intelligence, soft skills, and thriving. Organizational intelligence demonstrated a robust positive relationship with both soft skills and thriving. Age, gender, education, and experience significantly influenced nurses' soft skills and thriving. Conclusion: The study highlights the importance of organizational intelligence in enhancing nurses' professional capabilities and well-being. Addressing demographic factors and fostering a supportive work environment is crucial for optimizing nursing practice and organizational effectiveness. Nursing implications: Insights from this study can inform targeted interventions and policy decisions to enhance nursing practice, organizational development, and healthcare outcomes in Egypt. Fostering organizational intelligence and soft skills among nurses can improve patient care, increase job satisfaction, and overall organizational success. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your awareness of the risk of neutropenic sepsis in patients receiving anticancer treatment • To acknowledge the importance of staff education on neutropenic sepsis and its timely management • To recognise the importance of patient education regarding the prompt reporting of adverse effects. Neutropenic sepsis is a potentially life-threatening complication of systemic anticancer therapy and must be recognised and treated rapidly. National guidance recommends, among other things, that patients with suspected neutropenic sepsis receive intravenous antibiotics within one hour of presentation. Initial observations, assessment and investigations are key to inform management. This article discusses the findings of a service evaluation conducted in a cancer unit in Northern Ireland to assess the initial management of patients with suspected neutropenic sepsis against the targets set by national guidance. The authors identify areas of optimal practice and areas for improvement, and make recommendations on how to enhance the management of neutropenic sepsis, notably through staff education. [ABSTRACT FROM AUTHOR]

This study sought to evaluate the perceptions of pressure injury (PI) management staff regarding skin failure (SF). Additionally, an analysis of influencing factors based on the collected data was conducted to establish a foundation for targeted SF training. A descriptive, cross‐sectional survey was undertaken in October–November 2023, utilising a convenience sampling method involving selected management staff of PI from 16 provinces in China. A total of 501 nursing participants were included, exhibiting an overall perception level that was moderately low. Although the majority were aware of the possibility of SF (n = 417, 83.23%), only 60% reported an understanding of the fundamentals of SF, with the lowest level of comprehension observed in differentiating between SF and PI (n = 212, 42.31%). Overall attitudes were generally positive. Regarding behaviour, active learning was more prevalent (n = 340, 67.86%), but training is less (n = 287, 57.29%). Family education (n = 401, 80.04%) and nursing record monitoring (n = 426, 85.03%) demonstrated better behaviour. Further analysis revealed that training (t = 13.937, p < 0.001) and professional title (F = 4.681, p = 0.010) had a significant effect on participants' perceptions. These findings underscore that there remains a substantial lack of perception about SF amongst participants. Overall, participants exhibited a positive attitude towards SF, highlighting the need for future improvements in SF training. [ABSTRACT FROM AUTHOR]

Background: In Singapore, where drug use is a highly stigmatized and criminalized issue, there is limited understanding of the challenges faced by individuals, particularly sexual minority men, in their journey towards recovery from substance dependence or addiction. This qualitative study aimed to investigate the driving forces behind drug use, the factors contributing to drug cessation, and the elements influencing the recovery process. Methods: Data were extracted from clinical records provided by The Greenhouse Community Services Limited between January 2020 to May 2022. These records encompassed information from four distinct forms: the intake assessment, progress notes, case closing summary, and the care plan review. Thematic analysis was employed to identify and categorize recurring themes within the data. Results: Data from beneficiaries (n = 125) were analyzed and yielded a series of themes related to facilitators of drug use, motivations to cease drug use, and managing one's ongoing recovery. Within the facilitators of drug use, two sub-themes were identified: (a) addressing trauma and triggers and (b) managing emotions. Additionally, managing one's recovery was marked by four significant sub-themes: (a) uncovering personal identities, (b) losing motivation and drive, (c) overcoming obstacles, and (d) preparing for aftercare. Conclusions: The study contributes valuable insights into the dynamics of ongoing recovery management, offering potential avenues for interventions that could enhance support for individuals in their journey to overcome substance dependence. Enhancing psychoeducation and fostering peer support have the potential to facilitate the recovery process. Clearly, a holistic approach is needed to address these complex issues that cuts across our societies. [ABSTRACT FROM AUTHOR]

This study focused on the heterogeneity in progress notes written by physicians or nurses. A total of 806 days of progress notes written by physicians or nurses from 83 randomly selected patients hospitalized in the Gastroenterology Department at Kagawa University Hospital from January to December 2021 were analyzed. We extracted symptoms as the International Classification of Diseases (ICD) Chapter 18 (R00–R99, hereinafter R codes) from each progress note using MedNER-J natural language processing software and counted the days one or more symptoms were extracted to calculate the extraction rate. The R-code extraction rate was significantly higher from progress notes by nurses than by physicians (physicians 68.5% vs. nurses 75.2%; p = 0.00112), regardless of specialty. By contrast, the R-code subcategory R10–R19 for digestive system symptoms (44.2 vs. 37.5%, respectively; p = 0.00299) and many chapters of ICD codes for disease names, as represented by Chapter 11 K00–K93 (68.4 vs. 30.9%, respectively; p < 0.001), were frequently extracted from the progress notes by physicians, reflecting their specialty. We believe that understanding the information heterogeneity of medical documents, which can be the basis of medical artificial intelligence, is crucial, and this study is a pioneering step in that direction. [ABSTRACT FROM AUTHOR]

Background: Accuracy of medication charts on admission to hospital has previously shown that inadvertent omission of therapy was the most common discrepancy, accounting for 40% to 60% of errors. Partnered Pharmacist Medication Charting (PPMC) has shown to reduce medicationrelated problems. Objective: The aim of this study was to evaluate the implementation of Pharmacist Medication Charting (PMC), a derivative of PPMC, in a maternity and gynecological hospital. The occurrence of medication omission identified by the pharmacists was assessed and the pharmacist interventions involving PMC analyzed. Methods: The pharmacist interventions documented from 1st July 2022 to 30th June, 2023 were evaluated using PowerBI for data and trends on the Medication-Related Problems (MRPs) identified, occurrence of PMC, common medications charted by the pharmacists and the pharmacist recommendation and action following the identification of MRPs. Results: A total of 4898 pharmacy interventions was documented in the 12-month period. Of the total interventions documented, 1321 (26.97%) were related to pharmacist medication charting. Of all the interventions related to PMC, 53.29% involved pharmacists charting medications for the continuation or initiation of over-the-counter medications, 13.32% involved pharmacist partnered charting of Prescription Only Medications and Controlled Medications with medical staff, and 33.3% were referred to a credentialled pharmacist for PMC service. With regards to action taken following interventions involving PMC, 1065 (80.62%) were resolved following PMC. Common medications charted by the pharmacists include: macrogol and docusate laxatives (288), pregnancy multivitamin containing iron, iodine and folate (169), colecalciferol (133), iron (127), asthma inhaler (99), paracetamol and ibuprofen (88), nicotine (38), calcium (29), folic acid (26), and pantoprazole (15). Conclusion: Our study demonstrated that hospital pharmacists contribute to the reduction of MRPs, and PMC enables pharmacist to address prescribing omission and conditions untreated in the hospital. This study also reflects skills enhancement in practice for clinical pharmacists and resulted in successful implementation of PMC. [ABSTRACT FROM AUTHOR]

Background Pressure injuries, commonly referred to as pressure ulcers (PUs) represent a localised damage to the skin and the underlying tissue due to the persistent application of pressure or pressure combined with shear. The aging demographic in developed countries and the rising incidence of chronic diseases calls for a concerted effort to enhance PU management. For that we need epidemiological studies to understand the magnitude of the problem, and they are scarce in the primary care settings. Aim The study aims to characterise the patients' suffering from PUs in our healthcare facilities, categorise the wounds based on their location, type, source of origin and duration of treatment. The information gathered will serve as a valuable reference point in devising strategies to enhance care and optimise cost saving. Methods This observational, non-randomised, cross-sectional study enrolled 54 primary care patients with PUs in the area covered by ACeS Póvoa de Varzim/Vila do Conde (ACeS PVVC), primary healthcare facility in Northern Portugal, conducted during the month of January of 2019. Results/ findings The study enrolled 54 patients, with a gender distribution of 35.2% males and 64.8% females. The mean age of participants was 82.63±9.92 years. Almost all 96.3% received their treatment at home, and 1.9% in the ambulatory (outpatient) setting. The mean number of pressure ulcers per patient was 1.47±0.73. A total of 29.6% presented with Stage II pressure ulcers, 29.6% with Stage III and 38.9% with Stage IV or unstageable. Conclusions/ implications for clinical practice The findings of this study serve as a catalyst for further discussion about the effective management of pressure ulcers at the organisational level. The development of effective strategies for assessment, prevention, and intervention for homecare patients requires a comprehensive understanding of the occurrence of pressure ulcers within the community. [ABSTRACT FROM AUTHOR]

The full potential for electronic health record systems in facilitating a positive transformation in care, with improvements in quality and safety, has yet to be realised. There remains a need to reconceptualise the structure, content and use of the nursing component of electronic health record systems. The aim of this study was to engage and involve a diverse group of stakeholders, including nurses and electronic health record system developers, in exploring together both issues and possible new approaches to documentation that better fit with practice, and that facilitate the optimal use of recorded data. Three focus groups were held in the UK and USA, using a semi-structured interview guide, and a common reflexive approach to analysis. The findings were synthesised into themes that were further developed into a set of development principles that might be used to inform a novel electronic health record system specification to support nursing practice. [ABSTRACT FROM AUTHOR]

This scoping review focuses on how the caregiving experience of unpaid carers of persons with schizophrenia (CPSs) is understood in the literature. One hundred and eighteen studies were included. Publications have steadily increased over the past two decades. Most studies were derived from India, the UK, and China and were quantitative research. Financial problems, disruption to social life, and family relationships were commonly evaluated to be objective burdens, while care recipients relapsing, CPSs suffering from violence from care recipients, and experiencing discrimination were identified as subjective burdens. The effectiveness of care services and the positive feelings and physical impacts of CPSs need to be further discussed. [ABSTRACT FROM AUTHOR]

There have been an increased number of patients boarding in the emergency department (ED) who often experience delays in receiving nonurgent medications not typically stocked in the ED automated dispensing cabinets (ADC). To describe a quality improvement project designed to decrease the amount of time it takes nursing staff to obtain patient-specific medications for patients boarding in the ED at a community hospital. Prior to this quality improvement project, standard practice was for pharmacy staff to send all medications to the ED based on inpatient cart fill lists, resulting in a 24-hour supply being sent at 1 time. Medications that were not immediately due were often misplaced by ED staff as there was no standard location to store them. A separate location for each examination room in the ED was created in 1 central ADC to store patient-specific medications. Pharmacy staff were instructed to load medications directly into the ADC for expected long-term behavioral health boarders. Nursing staff were instructed to place future doses in the newly created locations and were educated on how to locate medications utilizing the electronic medication administration record. ED nursing staff timed how long it took them to obtain medications for 40 boarding patients before and after implementation of the quality improvement initiatives. The postimprovement intervention decreased the amount of time it took to obtain medications for forty ED boarding patients by 66%, from an average of 37.7 minutes at baseline to 12.9 minutes postintervention. This was a statistically significant improvement via an unpaired t -test (P < 0.0001 with a 95% CI from 15.3 to 34.47). This was rechecked after 1 year and the improvement was sustained. A multidisciplinary team-based quality improvement initiative was successful in reducing the time it took to obtain medications for ED boarding patients. [ABSTRACT FROM AUTHOR]

Background and Purpose: To evaluate the nurse documentation compliance, pressure injury compliance, and fall prevention compliance before and after implementing an oncology acuity tool (OAT) at a specialized cancer center in Jordan. Methods: A mixed methods design was used. A qualitative approach was employed using a semistructured interview with 15 nurses selected by purposive sampling. In contrast, the quantitative approach included pre- and postdata obtained to identify the role of adopting the OAT in improving nursing documentation and applying fall and pressure injury-prevention precaution measures. Results: The thematic analysis developed seven themes, including oncology acuity score (OAS) and assignment processes, OAS and patient outcomes, OAS and nurse outcomes, limitations of the OAT, driving forces, restraining forces, and recommendations or suggestions. The results showed significant improvements in nursing documentation (p =.0385), application of pressure injury (p ≤.00001), and falling precaution measures (p ≤.00001). Conclusion: Nurse assignment, nursing compliance, and patients' and nurses' outcomes improved after utilizing the OAT. [ABSTRACT FROM AUTHOR]

Background: Nursing documentation is an essential component of nursing practice and has the potential to improve patient care outcomes. Poor documentation of nursing care activities among nurses has been shown to have negative impacts on healthcare quality. Objective: To assess the nursing documentation practice and its associated factors among nurses working in the North Shewa Zone public hospitals, Ethiopia. Method: An institution-based cross-sectional study was conducted at the North Shewa Zone public hospitals. A simple random sampling technique was used to select 421 nurses. A pretested, structured, self-administered questionnaire was used to gather the data. Data were entered into Epi Data version 3.1, and SPSS version 25 was used for further analysis. Binary logistic regressions were performed to identify the independent predictors of nursing documentation practice. Adjusted odds ratio was calculated and a p-value less than 0.05 with 95% confidence interval (CI) was considered as statistically significant. Result: A total of 421 respondents took part, giving the survey a 100% response rate. The overall good practice of nursing care documentation was 51.1%, 95% CI (46.6, 55.8). In addition, 43.2%, 95% CI (38.5, 48.0) and 35.6%, 95% CI (30.9, 40.1), of nurses had good knowledge of and favorable attitudes toward nursing care documentation. Availability of operational standards for nursing documentation [adjusted odds ratio (AOR) = 1.76; 95% CI: 1.18, 2.64], availability of documenting sheets (AOR = 1.51; 95% CI: 1.01, 2.29), and a monitoring system (AOR = 1.61; 95% CI: 1.07, 2.41) were significantly associated with nursing care documentation practice. Conclusion: Nearly half of nursing care was not documented. The practice of nursing care documentation was significantly influenced by the availability of operational standards, documenting sheets, and monitoring systems. To improve the documentation practice, a continuous monitoring system and access to operational standards and documenting sheets are needed. [ABSTRACT FROM AUTHOR]

Objective: To explore the process of implementing medical orders by clinical nurses, and identify specific areas of concern in the implementation process, and uncover strategies to address these concerns. Background: The implementation of medical orders is a crucial responsibility for clinical nurses, as they bear legal accountability for the precise implementation of directives issued by medical practitioners. The accurate implementation of these orders not only shapes the quality and safety of healthcare services but also presents numerous challenges that demand careful consideration. Method: This study employed a qualitative design using a grounded theory approach to construct a comprehensive theoretical framework grounded in the insights and experiences of nurses operating within the hospital settings of Iran. The study encompassed 20 participants, comprising 16 clinical nurses, two nurse managers, and two specialist doctors working in hospital settings. The selection process involved purposeful and theoretical sampling methods to ensure diverse perspectives. Data collection unfolded through in-depth, individual, semi-structured interviews, persisting until data saturation was achieved. The analytical framework proposed by Corbin and Strauss (2015) guided the process, leading to the development of a coherent theory encapsulating the essence of the study phenomenon. Findings: The primary finding of the study underscores the significance of 'legal threat and job prestige' highlighting diverse repercussions in case of errors in the implementation of medical orders. At the core of the investigation, the central variable and the theory of the study was the 'selective and tasteful implementation of orders to avoid legal and organizational accountability.' This indicated a set of strategies employed by the nurses in the implementation of medical orders, encapsulated through three fundamental concepts: 'accuracy in controlling medical orders,' 'untruth documentation,' and 'concealment of events. The formidable influence of legal threats and job prestige was further compounded by factors such as heavy workloads, the doctor's non-compliance with legal instructions for giving verbal orders, the addition of orders by the doctor without informing nurses, and pressure by nursing managers to complete documentation. The resultant psychological distress experienced by nurses not only jeopardized patient safety but also underscored the intricate interplay between legal implications and professional standing within the healthcare framework. Conclusion: Alleviating staff shortages, enhancing the professional rapport between doctors and nurses, offering legal support to nursing staff, implementing measures such as recording departmental phone conversations to deter the non-acceptance of verbal orders, fostering an organizational culture that embraces nurse fallibility and encourages improvement, and upgrading equipment can ameliorate nurses' apprehensions and contribute to the safe implementation of medical orders. [ABSTRACT FROM AUTHOR]

Aims: To describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks. Design: Retrospective study. Methods: The study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single‐Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs. Results: Patients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care. Conclusions: The inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes. Implications for the profession and/or patient care: HL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge. Patient or Public Contribution: No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection. [ABSTRACT FROM AUTHOR]

This paper presents a new approach called EmbedHDP, which aims to enhance the evaluation models utilized for assessing sentence suggestions in nursing care record applications. The primary objective is to determine the alignment of the proposed evaluation metric with human evaluators who are caregivers. It is crucial due to the direct relevance of the provided provided to the health or condition of the elderly. The motivation for this proposal arises from challenges observed in previous models. Our analysis examines the mechanisms of current evaluation metrics such as BERTScore, cosine similarity, ROUGE, and BLEU to achieve reliable metrics evaluation. Several limitations were identified. In some cases, BERTScore encountered difficulties in effectively evaluating the nursing care record domain and consistently providing quality assessments of generated sentence suggestions above 60%. Cosine similarity is a widely used method, but it has limitations regarding word order. This can lead to potential misjudgments of semantic differences within similar word sets. Another technique, ROUGE, relies on lexical overlap but tends to ignore semantic accuracy. Additionally, while BLEU is helpful, it may not fully capture semantic coherence in its evaluations. After calculating the correlation coefficient, it was found that EmbedHDP is effective in evaluating nurse care records due to its ability to handle a variety of sentence structures and medical terminology, providing differentiated and contextually relevant assessments. Additionally, this research used a dataset comprising 320 pairs of sentences with correspondingly equivalent lengths. The results revealed that EmbedHDP outperformed other evaluation models, achieving a coefficient score of 61%, followed by cosine similarity, with a score of 59%, and BERTScore, with 58%. This shows the effectiveness of our proposed approach in improving the evaluation of sentence suggestions in nursing care record applications. [ABSTRACT FROM AUTHOR]

Background: Nursing care documentation, which is the record of nursing care that is planned for and delivered to individual patients, can enhance patient outcomes while advancing the nursing profession. However, its practice and associated factors among Ethiopian nurses are not well investigated. Objective: To assess the level of nursing care documentation practice and associated factors among nurses working at public hospitals in Ethiopia. Methods: An institutional-based cross-sectional study was conducted from May 1 to 30, 2022. A total of 378 nurses and corresponding charts were randomly selected with a multistage sampling technique. Self-administered structured questionnaires and structured checklists were used to collect data about independent variables and nurses' documentation practice, respectively. Epi Data 4.6 was used for data entry and SPSS version 25 for analysis. Descriptive statistics and binary logistic regression analysis have been employed. The STROBE checklist was used to report the study. Results: In this study, 372 nurses participated, and 30.4% (95% confidence interval [CI]: 26%–35%) of them had good nursing care documentation practice. Adequate knowledge about nursing care documentation(adjusted odds ratio [AOR] = 4.16, 95% CI: [2.36–7.33]), favorable attitude toward nursing care documentation (AOR = 3.43, 95% CI: [1.85–6.36]), adequacy of documenting sheets (AOR = 2.02, 95% CI: [1.14–3.59]), adequacy of time (AOR = 3.85, 95% CI: [2.11–7.05]), nurse-to-patient ratio (AOR = 2.78, 95% CI: [1.13–6.84]), and caring patients who had no stress, anxiety, pain, and distress (AOR = 3.56, 95% CI: [1.69–7.52]) were significantly associated with proper nursing care documentation practices. Conclusion: Nursing documentation practice was poor in this study compared to the health sector transformation in quality standards due to the identified factors. Improving nurses' knowledge and attitude toward nursing care documentation and increasing access to documentation materials can contribute to improving documentation practice. [ABSTRACT FROM AUTHOR]

Background: Systems of across the world have developed and implemented patient rights policies to protect and improve the provider-patient relationship. The Patient Charter of Ghana was developed in 2002 to improve service quality and protect patients' rights. However, it is not yet known whether those at the frontline of healthcare delivery can read and understand the contents of the charter. While studies have explored the socioeconomic and institutional level factors related to awareness and knowledge of the Patient Rights Charter, there is a lack of literature on its readability and comprehensibility among nurses. This study assesses nurses' knowledge of the Patient Rights Charter and associated literacy-related factors. Method: An exploratory cross-sectional design and quantitative methods were used to collect data on knowledge, comprehension, and readability of the Patient Rights Charter. 205 nurses from four district hospitals in the Central Region were recruited using proportional and total enumeration sampling. Data were collected using structured questionnaires and were processed using SPSS (version 26) and an online text readability consensus calculator (version 2.0). Descriptive and inferential statistical analyses were performed, and data were presented using simple frequencies, readability statistics, and regression output. Results: The results show the charter is written at a higher reading grade level; Flesch-Kincaid Grade Level (13.36), Simple Measure of Gobbledygook (11.57), and Coleman-Liau Readability Index (14.2). The average reading grade level score was 14. The Gunning Fox Index (15.40) and the Flesch Reading Ease Score (34%) show the patient charter is difficult to read and will require at least 14 years of education to be able to read. 87.3% of nurses were able to read and comprehend the charter. Very few (8.3%) read at frustration level. Nurses' actual comprehension of the charter was the only significant predictor of knowledge of the charter. Conclusion: Comprehension of the patient charter is an important predictor of its knowledge. The results emphasize the need to enhance the readability and comprehensibility of the charter for providers. Hospitals can stimulate nurses' knowledge of the charter by simplifying the charter's language and deliberately educating nurses on its content. [ABSTRACT FROM AUTHOR]

COVID-19 has a range of complications, from no symptoms to severe pneumonia. It can also affect multiple organs including the nervous system. COVID-19 affects the brain, leading to neurological symptoms such as delirium. Delirium, a sudden change in consciousness, can increase the risk of death and prolong the hospital stay. However, research on delirium prediction in patients with COVID-19 is insufficient. This study aimed to identify new risk factors that could predict the onset of delirium in patients with COVID-19 using machine learning (ML) applied to nursing records. This retrospective cohort study used natural language processing and ML to develop a model for classifying the nursing records of patients with delirium. We extracted the features of each word from the model and grouped similar words. To evaluate the usefulness of word groups in predicting the occurrence of delirium in patients with COVID-19, we analyzed the temporal changes in the frequency of occurrence of these word groups before and after the onset of delirium. Moreover, the sensitivity, specificity, and odds ratios were calculated. We identified (1) elimination-related behaviors and conditions and (2) abnormal patient behavior and conditions as risk factors for delirium. Group 1 had the highest sensitivity (0.603), whereas group 2 had the highest specificity and odds ratio (0.938 and 6.903, respectively). These results suggest that these parameters may be useful in predicting delirium in these patients. The risk factors for COVID-19-associated delirium identified in this study were more specific but less sensitive than the ICDSC (Intensive Care Delirium Screening Checklist) and CAM-ICU (Confusion Assessment Method for the Intensive Care Unit). However, they are superior to the ICDSC and CAM-ICU because they can predict delirium without medical staff and at no cost. [ABSTRACT FROM AUTHOR]

This study evaluated the effectiveness of nursing case management on self-care, clinical outcomes, and quality of life in community-dwelling older adults with poorly controlled type 2 diabetes in Thailand. The research employed a quasi-experimental, single-group, pretest – posttest design. Methods: Twenty-three participants participated in a 12-week nursing case management program, which was tailored to the individual's needs and abilities, as well as their family, community, and healthcare context. Self-care behaviors increased significantly (p =.000) after implementation of the case management program, while waist circumference, fasting capillary blood glucose, and hemoglobin A1c decreased significantly (p =.001, p =.000, p =.003, respectively) from pre-intervention values. Quality of life was significantly better after the program (p =.000) than before. Results suggest that implementing tailored nursing case management could increase self-care behaviors and quality of life while decreasing waist circumference, fasting capillary blood glucose, and hemoglobin A1c in community-dwelling older adults with poorly controlled type 2 diabetes. The effectiveness of nursing case management depends on the healthcare context, the training and expertise of case managers, as well as the patient's needs and preferences. Furthermore, the availability of families and communities can influence the nursing case management outcomes. [ABSTRACT FROM AUTHOR]