Intensivist perceptions of family-centered rounds and its impact on physician comfort,staff involvement,teaching, and efficiency

Purpose

Our goal was to examine intensivists' perception of comfort, staff satisfaction, teaching, and efficiency with family-centered rounds (FCR).

Materials and methods

Surveys were sent to intensivists at Emory University. Responses of physicians that participate in FCR were compared with those who do not. Survey questions were developed using a 5-point Likert scale with 1 representing a negative response and 5 being positive.

Results

Of 46 surveys sent, there were 31 responses (response rate, 67%). Seventeen responses were from adult intensivists and 14 from pediatric. Sixteen respondees (52%) participate in FCR, whereas 15 respondents (48%) do not. There is a significant difference in physician comfort with the practice with an average score of 4.4 + 1.0 for those who participate and 2.7 + 1.7 for those who do not (P= .002). There is also a significant difference in the perception of the impact of FCR on staff. Those who participate feel that it has a significantly greater positive impact on staff's involvement during rounds with an average score of 3.6 + 1.2 vs an average score of 2.3 + 1.2 for those who do not practice FCR (P= .003). Those who participate in FCR have significantly more positive perception on its impact on patient outcomes with an average score of 3.8 + 1.1 compared with an average score of 2.9 + 1.3 for those who do not participate in FCR (P= .05). There are no significant differences in perceptions on teaching and efficiency among participants and nonparticipants in FCR.

Conclusions

Participation in FCR is associated with an increase in perceived physician comfort, positive impact on staff involvement, and positive impact on patient outcome. Concerns over teaching and efficiency remain.     

Hemodialysis of HIV-positive patients: impact on organization and staff

Hemodialysis of HIV-positive patients poses a new challenge to dialysis facilities. Organizations need to address treatment options, staffing issues, and occupational risks as programs for treatment of these individuals are developed. This article presents an overview of these concerns and one facility's experience.     

护理管理人员与护士联合查房在连续午、夜间查房模式中的应用

目的探讨护理管理人员与护士联合查房在连续午、夜间查房模式中的应用效果。方法将各科推荐的综合素质较高的护理骨干参与到护士长等护理管理人员中,按照护理部统一排班及查房内容与管理要求,每天进行午、夜查房。结果实行联合连续午、夜查房模式后,护理质控综合得分、患者满意度及护理人员满意度均高于实施前,护理不良事件发生数低于实施前,差异均有统计学意义（t=3．19,x2=4．69,7．85,10．37;P〈0．05或P〈0．01）。结论实行联合连续午、夜查房模式,杜绝了护理管理盲区,保证了护理管理的连续性与安全性,强化了护理人员人人参与护理管理的意识,促进了护理质量持续改进与提高。减轻了护士与护理管理人员的工作压力,取到了优势互补的协同作用。同时,促进学习,使一大批护理人员得到锻炼,为护理人才储备了后备力量。     

Palliative cancer patients and their families on the Internet: motivation and impact

Increasingly, palliative patients and their families are going online. A series of cases are presented to explore the reasons they go online and the effects of their online activity, both harmful and beneficial. This paper highlights the need to take this growing phenomenon and its effects on patient care seriously, and identifies key areas that need to be explored further.     

Relocation: the impact on staff nurses

To stay competitive in the marketplace, many hospitals are renovating their physical plants to a more hotel-like appearance. Others are downsizing their units, reflecting the decreased demand for acute care beds. As these changes are made, patients and nurses are temporarily relocated to other places in the institution. How does this relocation of nurses impact their professional functioning and self-esteem? Based on their study of four groups of nurses who were relocated, the authors discuss their recommendations for making relocation a positive experience.     

Opinions of families,staff, and patients about family participation in care in intensive care units

PurposeThe aims of the study were to assess opinions of caregivers, families, and patients about involvement of families in the care of intensive care unit (ICU) patients; to evaluate the prevalence of symptoms of anxiety and depression in family members; and to measure family satisfaction with care.Materials and MethodsBetween days 3 and 5, perceptions by families and ICU staff of family involvement in care were collected prospectively at a single center. Family members completed the Hospital Anxiety and Depression Scale (HADS) and a satisfaction scale (Critical Care Family Needs Inventory). Nurses recorded care provided spontaneously by families. Characteristics of patient-relative pairs (n = 101) and ICU staff (n = 45) were collected. Patients described their perceptions of family participation in care during a telephone interview, 206 ± 147 days after hospital discharge.ResultsThe numbers of patient-relative pairs for whom ICU staff reported favorable perceptions were 101 (100%) of 101 for physicians, 91 (90%) for nurses, and 95 (94%) for nursing assistants. Only 4 (3.9%) of 101 families refused participation in care. Only 14 (13.8%) of 101 families provided care spontaneously. The HADS score showed symptoms of anxiety in 58 (58.5%) of 99 and of depression in 26 (26.2%) of 99 family members. The satisfaction score was high (11.0 ± 1.25). Among patients, 34 (77.2%) of 44 had a favorable perception of family participation in care.ConclusionsFamilies and ICU staff were very supportive of family participation in care. Most patients were also favorable to care by family members.     

Core components in the care of immigrants with psychoses: a Delphi survey of patients, families, and health-care staff

The aim of the present study was to identify core components in the care of immigrants with psychosis in Sweden. Experts (n=43) from different perspectives (immigrants, families, and health-care staff) were assembled and used to score the importance of statements regarding components in the care for a person with psychosis in three questionnaire rounds. After each round, the opinions were consolidated and compared to identify whether consensus was reached. Consensus was reached about the importance of being treated on equal terms, regardless of country of birth. Staff interest and respect, shown in different ways of understanding, was valued. Consensus could not be reached on approximately half of the statements, of which four tended to be ranked towards unimportant. Those included that staff should have specific cultural knowledge or that the patient should be allowed to decide whether to be cared for by male or female staff. Nor was it regarded as important to identify a person's religious or ethnic background. The results illustrate the importance of fundamental psychiatric nursing, which should enable nurses to identify and meet the basic needs of all patients, regardless of country of origin. Areas for which consensus was not reached illustrate a future challenge for health-care staff to identify situations when cultural clashes could appear. Staff should have strategies to accomplish cultural negotiations to build an effective treatment alliance with the patient, as well as the family, to meet individual needs.     

Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes

Aim  The aim of this study was to examine the influence of empowering work conditions and workplace incivility on nurses' experiences of burnout and important nurse retention factors identified in the literature.
Background  A major cause of turnover among nurses is related to unsatisfying workplaces. Recently, there have been numerous anecdotal reports of uncivil behaviour in health care settings.
Method  We examined the impact of workplace empowerment, supervisor and coworker incivility, and burnout on three employee retention outcomes: job satisfaction, organizational commitment, and turnover intentions in a sample of 612 Canadian staff nurses.
Results  Hierarchical multiple linear regression analyses revealed that empowerment, workplace incivility, and burnout explained significant variance in all three retention factors: job satisfaction ( R ² = 0.46), organizational commitment ( R ² = 0.29) and turnover intentions ( R ² = 0.28). Empowerment, supervisor incivility, and cynicism most strongly predicted job dissatisfaction and low commitment ( P  < 0.001), whereas emotional exhaustion, cynicism, and supervisor incivility most strongly predicted turnover intentions.
Conclusions  In our study, nurses' perceptions of empowerment, supervisor incivility, and cynicism were strongly related to job satisfaction, organizational commitment, and turnover intentions.
Implications for nursing management  Managerial strategies that empower nurses for professional practice may be helpful in preventing workplace incivility, and ultimately, burnout.     

Vulnerable prisoners: Dementia and the impact on prisoners,staff and the correctional setting

The aim of this paper is to increase awareness and highlight the need for prisoner’s early identification of dementia and recommend support strategies within the Australian correctional setting. The number of older people is increasing within the correctional setting, causing a corresponding increase in the number of prisoners with dementia. These older prisoners are at greater risk of developing cognitive impairment and dementia which increases their vulnerability in the correctional environment including their interactions with both correctional services staff and other prisoners. Correctional settings have not been designed for older prisoners or those with dementia, which poses problems for physical and psychological health. People who have encounters with the criminal justice system are generally in poorer physical and mental health than the general population. Identifying dementia in the early stages provides opportunities to initiate strategies and supports to slow the progression. However being incarcerated increases the likelihood of not being identified with dementia until the later stages of the disease process, which significantly reduces opportunities for early intervention.     

The impact of systems redesign on staff, patient, and financial outcomes

OBJECTIVES: The purpose of this study was to measure the impact of a change initiative using the strategies of inpatient bed consolidation and patient population reaggregation on staff, patient, and financial outcomes. BACKGROUND: Bed consolidation and patient population reaggregation are extensively used strategies in the hospital industry. However, the state of science as it relates to these two strategies is limited, with no studies measuring the effect of bed consolidation, patient reaggregation, or both in isolation of multiple other concurrent care model changes. METHODS: An exploratory, single case, longitudinal field study design with embedded levels of analysis was used for the study. The impact associated with the reaggregation and consolidation of the acute inpatient system of care was evaluated at the organization, the acute inpatient nursing unit, and the individual nursing staff member levels. This article reports the outcomes found at both the nursing unit level and the staff member level on three general medicine nursing units. Baseline nursing unit-level data are reported from fiscal year 1994-1995 and the first half of fiscal year 1995-1996 (July 1995 through December 1995); data from January 1996 through June 1996 reflect the planning phase of the project. Outcomes related to the change process are reported from the time period January 1996 through June 1997. Staff perceptions of multiple variables were measured at five different data points over a 2-year period. Both quantitative and qualitative data were collected. RESULTS: Unit-level cost and hours per patient day (HPPD) increased during or immediately after the merger of major patient populations on two of the study units; no significant variation was found in medication errors or patient falls. The quantitative and qualitative data analysis of the nursing staff member surveys revealed a nursing staff that was dissatisfied with many aspects of their job, worried about job security, had low morale, and had many concerns about the quality of care provided to patients. CONCLUSIONS: This study suggests that consolidation and reaggregation strategies may cause an increase in costs and HPPDs, at least on a short-term basis. Also, these strategies may have a significant effect on the morale and job satisfaction of unit-level nursing. In light of these findings, on-going testing of the efficacy of consolidation and patient reaggregation strategies in improving quality and cost outcomes is essential.     

Clinical nursing rounds, part 4: Teaching rounds for nurses

Clinical rounds are being introduced in the Dudley Group of Hospitals to improve patient care, involve patients and improve communication. There are four types of rounds, Matrons rounds, Nurse Management Rounds, Patient Comfort rounds and Teaching rounds. This article describes Teaching rounds and is the final article in the series of four. Nurses and midwives learn in a variety of ways: through courses and accredited programmes, seminars, conferences, self-directed study and so on. One of the most effective ways, however, is to participate in special clinical teaching rounds. These are aimed at all learners, whether pre-registration students or qualified staff. Their aim is to learn from direct patient contact with facilitation from an experienced nurse teacher. In this article an account is given of how a Professor of Nursing linked to a hospital Trust uses this approach to teach and evaluate nursing care and is the last in the series of four on clinical nursing rounds. It is felt the rounds are particularly useful in developing clinical practice, evidence-based care, understanding patients and the conditions they experience, while linking theory and practice.