How does the length of day shift affect patient care on older people's wards? A mixed method study

BackgroundInternationally, studies have focused on whether shift length impacts on patient care. There are also ongoing concerns about patient care for older people in hospital. The study aim was to investigate how length of day shift affects patient care in older people’s hospital wards.Objectives1) To explore how length of day shift affects patient care in older people’s wards; 2) To explore how length of day shift affects the quality of communication between nursing staff and patients/families on older people’s wardsDesignA mixed method case study.SettingsThe study was based on two older people’s wards in an acute hospital in England. One ward was piloting two, overlapping 8 h day shifts for 6 months while the other ward continued with 12 h day shifts.Participants and methodsQualitative interviews were conducted with 22 purposively recruited nursing staff (17 registered nurses; 5 nursing assistants). An analysis of patient discharge survey data was conducted (n = 279). Twenty hours of observation of nursing staff’s interactions with patients and families was conducted, using an adapted version of the Quality of Interaction Schedule (301 interactions observed), with open fieldnotes recorded, to contextualise the observations.ResultsThere were no statistically significant differences in patient survey results, or quality of interactions, between the two wards. There were three overall themes: Effects of day shift length on patient care; Effects of day shift length on continuity of care and relationships; Effects of day shift length on communication with patients and families. Nursing staff believed that tiredness could affect care and communication but had varied views about which shift pattern was most tiring. They considered continuity of care was important, especially for older people, but had mixed views about which shift pattern best promoted care continuity. The difficulties in staffing a ward with an 8 h day shift pattern, in a hospital that had a 12 h day shift pattern were highlighted. Other factors that could affect patient care were noted including: ward leadership, ward acuity, use of temporary staff and their characteristics, number of consecutive shifts, skillmix and staff experience.ConclusionsThere was no conclusive evidence that length of day shift affected patient care or nursing staff communication with patients and families. Nursing staff held varied views about the effects of day shift length on patient care. There were many other factors identified that could affect patient care in older people’s wards.     

How does spirituality affect physical health? A conceptual review

Spirituality is thought to have a beneficial impact on physical health and mortality, yet experimental findings are mixed in their support of this assumption. This article examines the most persuasive experimental evidence that spiritual beliefs influence physical health and explores the mediating factors that may explain how this connection operates.     

How does culture show? A case study of an international and interprofessional course in palliative care

Research shows slow improvement of the care of dying persons and their significant others. One of the reasons for that is the lack of palliative care education as an integral part of health professionals' undergraduate education. The paper discusses an attempt to develop innovative forms of palliative care education: an international, interprofessional and IT-supported undergraduate course for Swedish and Slovenian students of nursing, medicine, occupational therapy, physiotherapy, psychology and social work, which has been developed jointly by the two authors. One of the aims of the course has been to address differences in professional and national cultures relevant to quality in palliative care. The development and pilot implementation phases of the course were analysed qualitatively, using evaluation materials from students and teachers and from an external evaluation study. The results show that the interprofessional approach in the course enabled students to get to know other professions, as well as enabling them to work together as a team and resolve conflicts. Cultural differences between Sweden and Slovenia were not very pronounced, yet they came to the fore regarding teamwork and relationships between professions, as well as in respect of the “right thing” to do in relation to patient’ problems.     

How does blood glucose control with insulin save lives in intensive care?

Patients requiring prolonged intensive care are at high risk for multiple organ failure and death. Insulin resistance and hyperglycemia accompany critical illness, and the severity of this "diabetes of stress" reflects the risk of death. Recently it was shown that preventing hyperglycemia with insulin substantially improves outcome of critical illness. This article examines some potential mechanisms underlying prevention of glucose toxicity as well as the effects of insulin independent of glucose control. Unraveling the molecular mechanisms will provide new insights into the pathogenesis of multiple organ failure and open avenues for novel therapeutic strategies.     

How does postpartum depression affect breastfeeding?

PURPOSE: To examine patterns of exclusive breastfeeding, combination feeding, and exclusive bottle-feeding among a sample of women identified at 2-4 weeks postpartum with positive PPD symptoms. STUDY DESIGN AND METHODS: The sample included 122 women who were part of a larger study testing an intervention for promoting maternal-infant interaction among women with elevated PPD symptoms. Data were collected during three postpartum home visits. Demographic and feeding pattern data were described. Variables related to and predictors of feeding pattern were analyzed. The sample was compared to a random sample of postpartum women in New England. RESULTS: Severity of depression was not significantly related to breastfeeding. Older maternal age, living with a partner, and higher income were positively related to breastfeeding. Compared to a random sample, the level of exclusive breastfeeding was significantly lower in this sample than the level of combination feeding. CLINICAL IMPLICATIONS: Nurses should be involved in screening all prenatal and postpartum women for PPD symptoms, particularly when they present with breastfeeding difficulties, and refer for treatment when appropriate. For breastfeeding mothers, PPD treatment must include consideration of therapeutic options as well as implications for the breastfeeding relationship. When appropriate treatment for PPD is being considered, thought should be given to the importance and value of breastfeeding to the mother.     

How does information influence hope in family members of traumatic coma patients in intensive care unit?

Aims. To assess the interplay between hope and the information provided by health care professionals. Background. Earlier research learned that hope is crucial for relatives of traumatic coma patients. Also it has been reported that the need for information is extremely important for relatives of critically ill patients. Design. A qualitative approach according to the ‘grounded theory’ method with constant comparison was used. Method. We held 24 in‐depth interviews with 22 family members of 16 patients with traumatic coma. Data processing and data analysis took place in a cyclic process wherein the induction of themes was alternated by confrontation with new material. Results. Family members of traumatic coma patients want information that is as accurate as possible, provided by doctors and nurses in an understandable manner and leaving room for hope. At first, family members can do no more than passively absorb the information they receive. After some time, they actively start working with information and learn what to build their hope on. In this way, concrete hope evolves and seems to be strongly determined by information. Information that is more positive than warranted is not appreciated at all. It leads to false hope and once its real nature becomes apparent, to increased distress and loss of trust in the professionals. Conclusion. The process of hope is crucial in coping with traumatic coma and information can facilitate this process. Relevance to clinical practice. If professionals, especially nurses, keep the process in mind that family members go through in handling information, they can not only facilitate this process but also help them to establish realistic hope.     

Guiding patients' family members through an intensive care unit: difficulties of lack of systematization?

The purpose of this study was to analyse the problematic situation experienced by nurses at the moment of guiding the relatives of patients in an ICU. Therefore, seven (7) nurses who worked in this unit, which belonged to a general, public and training hospital in the city of S?o Paulo, were interviewed. The results have shown that the period of guiding brings anxiety and stress to the nurses, originated by the critical patient's condition, as well by the deficiency of conduts and in the systematization of this activity in the unit. Based on the results it was proposed the creation of na assistance plan. That includes the guiding to the family and the elaboration of a written instrument of orientation.     

Emergency department use: Is frequent use associated with a lack of primary care provider?

Objective

To determine if having a primary care provider is an important factor in frequency of emergency department (ED) use.

Design

Analysis of a central computerized health network database.

Setting

Three EDs in southern New Brunswick.

Participants

All ED visits during 1 calendar year to an urban regional hospital (URH), an urban urgent care centre (UCC), and a rural community hospital (RCH) were captured.

Main outcome measures

Patients with and without listed primary care providers were compared in terms of number of visits to the ED. A logistic regression analysis was used to determine factors predictive of frequent attendance.

Results

In total, 48 505, 41 004, and 27 900 visits were made to the URH, UCC, and RCH, respectively, in 2009. The proportion of patients with listed primary care providers was 36.6% for the URH, 37.1% for the UCC, and 89.4% for the RCH. Among ED patients at all sites, frequent attenders (4 or more visits to an ED in 1 year) were significantly more likely (59.6% vs 45.1%, P < .001) to have listed primary care providers. Other factors that predicted frequent use included attendance at a rural ED, female sex, and older age.

Conclusion

This study characterizes attendance rates for 3 EDs in southern New Brunswick. Our findings highlight interesting differences between urban and rural ED populations, and suggest that frequent use of the ED might not be related to lack of a listed primary care provider.     

Toys--friend or foe? A study of infection risk in a paediatric intensive care unit

Toys are an established part of the hospital experience for the child and family. They are seen as a source of comfort and security and form part of the child-friendly environment. However, they can also act as a source of healthcare associated infection which can be harmful to children, especially those who are in intensive care environments. This small-scale study was conducted in a paediatric intensive care unit at a large teaching hospital and involved swabbing those toys that had been brought in by families and those that were provided by the hospital. Findings show that 85 per cent of the toys harboured viable bacteria, which could be damaging to the child's health. Recommendations for practice are identified to ensure that toys remain a component of the child's hospitalisation yet are safe in relation to the transmission of infections not just in PICU but in all paediatric settings.     

How do nurses manage their work under time pressure? Occurrence of implicit rationing of nursing care in the intensive care unit: A qualitative study

ObjectivesThe aim of this study was to explore the experience of intensive care unit nurses under time pressure and the occurrence of implicit rationing under time pressure.MethodsIn-depth audio-recorded interviews were conducted with 18 intensive care unit nurses. Colaizzi seven-step analysis of phenomenological data was used.FindingsThree themes emerged from the analysis: the influence of internal and external environments, perceived differences in time pressure, and broad coping styles.ConclusionsUnder the influence of various factors, including continuous or intermittent time pressure, nurses employ strategies to deal with the pressure. Sometimes, these strategies allow them to complete all their necessary work. However, with the increase in time pressure, sometimes some work that must be done is changed into work that should be done in the consciousness of nurses. In such cases, nurses choose the strategy of implicit rationing to deal with time pressure.