Nurses' perception of single-occupancy versus multioccupancy rooms in acute care environments: an exploratory comparative assessment.

Health care design professionals, planners, and administrators cite the advantages of private patient rooms, including reduction of hospital-acquired infections, reduction of patient stress levels, and facilitation of nurses' and health care workers' efficiency [e.g., Ulrich, R. (2003). Creating a healing environment with evidence-based design. Paper presented at the American Institute of Architects, Academy of Architecture for Health virtual seminar-Healing environments; Ulrich, R., Quan, X., Zimring, C., Joseph, A., & Choudhary, R. (2004). The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime-opportunity. ]. A review of the literature revealed that operating costs are reduced in single-patient rooms compared with multioccupancy rooms due to reduction in transfer cost, higher bed occupancy rates, and reduction in labor cost. In addition, single rooms can positively impact patients' hospital experience through increased privacy, better interaction between family and staff, and reduced noise and anxiety. This pilot study focused on nurses' perception of the advantages and disadvantages of single-occupancy versus multioccupancy patient rooms in medical-surgical units in four hospitals in the northwest. A majority of respondents in the four hospitals favored single rooms over double-occupancy rooms for the majority of the 15 categories, including the following: appropriateness for patient examination, interaction with or accommodation of family members, and lower probability of dietary mix-ups. Future studies need to carefully examine the objective measures of patient care variables (e.g., incidents of medication errors, opportunities for surveillance), patient outcomes (e.g., recovery rate, falls), and implications of room occupancy on operating costs.     

A comparison study of nursing care quality in different working status nursing staffs: An example of one local hospital

To reduce costs, many hospitals are trying to adopt strategies to contract out their nursing workforce. The purpose of this study is to compare the quality of health care among the following three categories of nursing workforces in public hospitals: outsourced nurses, permanently employed nurses and contracted nurses compensated based on hours worked. The research sample included 300 patients cared for by 78 nurses in insurance wards in a local public hospital. Four methods were used to evaluate care quality. They included examining medical records, interviewing nurses, observing, and interviewing patients. The study found the best care quality was delivered by permanently employed nurses followed by that delivered by contracted nurses. The worst care quality was delivered by outsourced nurses employed by agency companies contracted to the public hospital. Care quality dimensions that were statistically significant among three categories of nurses included total quality of nursing care, nursing care planning, nursing instruction, and nursing evaluation.     

Critical Care Nurses' Experiences: “A Good Relationship with the Patient is a Prerequisite for Successful Pain Relief Management”

There is a lack of studies describing how critical care nurses experience assessing and treating pain in patients receiving postoperative care in an intensive care unit (ICU). The aim of this study was to describe those experiences. Qualitative personal interviews with six critical care nurses in an ICU in northern Sweden were conducted during 2009. The interview texts were subjected to qualitative content analysis, which resulted in the formulation of one theme and four categories. It was important to be able to recognize signs of pain in patients unable to communicate verbally. In older patients, anxiety could be interpreted as an indication of pain. Pain was primarily assessed by means of a visual analog scale. Being unable to treat pain successfully was experienced as failing in one's work. Pharmacologic treatment was always the first choice for relief. The environment was experienced as a hindrance to optimal nursing care, because all postoperative patients shared a room with only curtains between them. The work of assessing and treating pain in patients receiving postoperative care is an important and frequent task for critical care nurses, and knowledge in the field is essential if the patients are to receive optimal nursing care and treatment. Patients cared for in an ICU might benefit from nonpharmacologic treatment. Being without pain after surgery implies increased well-being and shorter hospitalization for the patient.     

Swedish ambulance nurses' experiences of nursing patients suffering cardiac arrest

Effective pre‐hospital treatment of a person suffering cardiac arrest is a challenging task for the ambulance nurses. The aim of this study was to describe ambulance nurses’ experiences of nursing patients suffering cardiac arrest. Qualitative personal interviews were conducted during 2011 in Sweden with seven ambulance nurses with experience of nursing patients suffering cardiac arrests. The interview texts were analyzed using qualitative thematic content analysis, which resulted in the formulation of one theme with six categories. Mutual preparation, regular training and education were important factors in the nursing of patients suffering cardiac arrest. Ambulance nurses are placed in ethically demanding situations regarding if and for how long they should continue cardio‐pulmonary resuscitation (CPR) to accord with pre‐hospital cardiac guidelines and patients’ wishes. When a cardiac arrest patient is nursed their relatives also need the attention of ambulance nurses. Reflection is one way for ambulance nurses to learn from, and talk about, their experiences. This study provides knowledge of ambulance nurses’ experiences in the care of people with cardiac arrest. Better feedback about the care given by the ambulance nurses, and about the diagnosis and nursing care the patients received after they were admitted to the hospital are suggested as improvements that would allow ambulance nurses to learn more from their experience. Further development and research concerning the technical equipment might improve the situation for both the ambulance nurses and the patients. Ambulance nurses need regularly training and education to be prepared for saving people's lives and also to be able to make the right decisions.     

Senior Streaming Assessment Further Evaluation after Triage zone: A novel model of care encompassing various emergency department throughput measures

Objective: Access block (AB) and hospital overcrowding adversely affect ED functionality. ED throughput measures have been described in the literature with positive impacts on key performance indicators (KPIs) – time to first seen, did‐not‐wait rates, off‐stretcher times for ambulances and ED length of stay figures. In this study, we aimed to assess the impact of a new model of care, the Senior Streaming Assessment Further Evaluation after Triage (SAFE‐T) zone concept on ED performance indicators and statistical outcomes. Methods: We implemented a model of care at our tertiary hospital ED amalgamating multiple ED throughput interventions. These interventions included dynamic transition waiting room concept, early senior ED physician assessment and decision‐making, early streaming, acute‐care bed quarantining and ED short stay and observation units. The principal intervention was the SAFE‐T zone. End‐point data were compared for similar periods (77 days) of 2010 and 2011 with and without the new model of care. Results: In total, 11 408 and 11 845 patients were included in the study periods pre‐ and post‐intervention, respectively. Time to physician KPI improved from 72.5% to 84.1%. Did‐not‐wait rates dropped from 10.7% to 9.6% (P= 0.02) and off‐stretcher times for ambulances KPI improved from 74.5% to 79.5% (P < 0.001). ED length of stay dropped most significantly for Australasian Triage Scale categories 3 and 4 (14.3% and 11.8%, P‐values <0.001). These results were achieved despite worsened AB and hospital bed‐occupancy rates during the intervention period (+3.9% and +6.7%). Conclusions: The SAFE‐T zone model of care involving multiple ED throughput measures achieved improvements in ED performance despite AB and hospital overcrowding.     

A person centered nursing care intervention on a medical surgical unit

When a patient is admitted to a hospital, admission assessments are completed in the electronic medical record. There is minimal information about who the person is, what they liked to be called, favorite activity, and or past occupation to view. A communication board is visible to all caring for the patient. This pre-post design evaluated whether using “All About Me Board” (AAMB) could change workplace climate perception among 25 registered nurses (RN)s in a 28 bed medical surgical unit. RNs were asked to participate in a Person Centered Climate Questionnaire and were provided education about purpose and use of the AAMB, which were placed in each patient's room. Having the AAMB placed and visible in patient rooms provided healthcare providers personal information to assist in planning care with patients and family. Survey results were favorable in supporting a workplace environment where patients were empowered to participate in planning their care.     

Providing a "good death": critical care nurses' suggestions for improving end-of-life care.

BACKGROUND: Providing appropriate end-of-life care has become a primary concern of nurses and the public. The highly technological critical care environment may not facilitate such care. OBJECTIVE: To collect suggestions from critical care nurses for improving end-of-life care in intensive care units. METHODS: A geographically dispersed, random sample of 1409 members of the American Association of Critical-Care Nurses was sent a 72-item survey on perceptions of end-of life care. The survey included a request for suggestions on ways to improve end-of life care. RESULTS: Of the 861 critical care nurses who responded to the survey, 485 offered 530 suggestions for improving end-of-life care. Providing a "good death" was the major theme; specific suggestions included ways to help ensure death with dignity and peace. Barriers to providing good deaths included nursing time constraints, staffing patterns, communication challenges, and treatment decisions that were based on physicians' rather than patients' needs. Suggestions for providing a good death included facilitating dying with dignity; not allowing patients to be alone while dying; managing patients' pain and discomfort; knowing, and then following, patients' wishes for end-of-life care; promoting earlier cessation of treatment or not initiating aggressive treatment at all; and communicating effectively as a health-care team. Educational initiatives for professionals and the public were also suggested. CONCLUSIONS: Implementation of specific suggestions provided by experienced critical care nurses might increase the quality of end-of-life care, facilitating a good death for intensive care patients.     

Comparison of nurse competence in different hospital work environments

AIM: This study examines nurses' perceptions of competence in different university hospital work environments. BACKGROUND: Nurses' self-recognition of own level of competence is essential in maintaining high standards of care. The demands for nurse competence may vary between work environments. However, there are very few studies that compare nurse competence in different hospital work environments. METHODS: We analysed self-assessments of competence of 593 Registered Nurses working in wards, emergency/outpatient or intensive care units or in operation rooms. The instrument used was a pretested 73-item questionnaire consisting of seven competence categories. The level of competence was assessed on a Visual Analogue Scale (VAS) scale of 0-100 and the frequency of using items of competencies in clinical practice was assessed on a four-point scale. RESULTS: Nurses reported their overall level of competence as good. They felt most competent in the categories of Managing situations, Diagnostic functions and Helping role (VAS-means 68-69), and least competent in Ensuring quality category (VAS-mean 56). Operation room nurses compared with other nurses reported lower level of competence and lower frequency of using items of competencies in several competence categories. In general, the self-assessed level of competence was greater the higher the frequency of using of competencies. Correlations between both age and length of work experience and the self-assessed overall level of competence were positive. CONCLUSIONS: Nurse competence profiles differed in both the level of and in frequency of using competencies between work environments. Context-specific knowledge of nurse competence from real work life situations provides direction on how to structure work environments and staff development interventions to provide qualified care.     

Hospital experiences of young adults with congenital heart disease: divergence in expectations and dissonance in care.

BACKGROUND: Despite increasing survival for adults with congenital heart disease, little is known about hospitalization for young adult patients with this disease and for their families. Because of the complexity of the disease and its management during the life span, young adults are often hospitalized on both pediatric and adult units during a stay in the hospital. OBJECTIVES: To explore the experience of hospitalization of young adults with congenital heart disease, the experience of their families, and the views of the nurses who cared for these patients and to generate substantive theory on interactions between patients, patients' families, and nurses. METHODS: Semistructured interviews and naturalistic observations were conducted with young adults with congenital heart disease (mean age, 28.6 years), their family members, and nurses who cared for the patients during hospitalization (N=34). Dimensional analysis was used to analyze interviews and field notes from observations. RESULTS: A grounded theory was derived, explaining how the hospital context and relationships between patients, patients' families, and nurses affect patients' hospital experiences. Expectations differed among the groups, leading to dissonance in care, as exemplified by role confusion and power struggles over control of care. This dissonance resulted in interpersonal conflict, distrust, anxiety, and dissatisfaction with the care and caring experiences. CONCLUSIONS: Changes in hospital units, a better understanding of the healthcare needs of young adults with congenital heart disease, and acknowledgment of the expertise of patients and patients' families are needed to improve nursing care for these patients and their families.     

ED Crowding Is Associated with Variable Perceptions of Care Compromise

Objectives The authors measured the association between emergency department (ED) crowding and patient and provider perceptions about whether patient care was compromised. Methods This was a cross‐sectional study of patients admitted from the ED and their providers. Surveys of patients, nurses, and resident physicians were linked. The primary outcome was agreement or strong agreement on a five‐item scale assessing whether ED crowding compromised care. Logistic regression was used to determine the association between the primary outcome and measures of ED crowding. Results Of 741 patients approached, 644 patients consented (87%); 703 resident physician surveys (95%) and 716 nursing surveys (97%) were completed. A total of 106 patients (16%), 86 residents (12%), and 173 nurses (24%) reported that care was compromised by ED crowding. In 252 cases (35%), one or more respondents reported that care was compromised. There was poor agreement over whose care was compromised. For patients, independent predictors of compromised care were waiting room time (odds ratio [OR], 1.05 for each additional 10‐minute wait [95% confidence interval {CI} = 1.02 to 1.09]) and being surveyed in a hallway bed (OR, 2.02 [95% CI = 1.12 to 3.68]). Predictors of compromised care for nurses included waiting room time (OR, 1.05 for each additional 10‐minute wait [95% CI = 1.01 to 1.08]), number of patients in the waiting room (OR, 1.05 for each additional patient waiting [95% CI = 1.02 to 1.07]), and number of admitted patients waiting for an inpatient bed (OR, 1.08 for each additional patient [95% CI = 1.03 to 1.12]). For residents, predictors of compromised care were patient/nurse ratio (OR, 1.39 for a one‐unit increase [95% CI = 1.09 to 1.20]) and number of admitted patients waiting for an inpatient bed (OR, 1.14 for each additional patient [95% CI = 1.10 to 1.75]). Conclusions ED crowding is associated with perceptions of compromised emergency care. There is considerable variability among nurses, patients, and resident physicians over which factors are associated with compromised care, whose care was compromised, and how care was compromised.     

A qualitative content analysis of nurse-patient communication in Iranian nursing

Fakhr‐Movahedi A., Salsali M., Negharandeh R. & Rahnavard Z. (2011) A qualitative content analysis of nurse–patient communication in Iranian nursing. International Nursing Review 58 , 171–180 Background: Communication is the source of patients' health promotion, and nurses cannot do their duties without communicating with patients. Nurses with good communication skills have a great role in alleviating the stressful identity of hospitalization for both patients and their families. Aim: To explore cultural and contextual factors influencing nurse–patient communication according to lived experiences of Iranian nurses and patients. Methods: The participants in this qualitative study consisted of eight bachelor's degree nurses and nine patients hospitalized in surgical and medical wards of a referral teaching hospital in Tehran, Iran. Data were gathered through unstructured and semi‐structured interviews as well as observations. The data were analysed using a content analysis approach. Findings: The data analysis revealed the following theme that encompassed nurse–patient communication in Iranian nursing: ‘a patient‐centred attitude in the shadow of mechanistic structure’. This theme consisted of three categories: (1) communication as the essence of nursing care, (2) reactive communication and (3) difficulties of nurse–patient communication. Conclusion: In spite of the nurses' and patients' belief in the importance of communication, in practice each party's role in communication leaves much to be desired. This is because of some structural and socio‐cultural factors that hinder effective communication. More attention should be paid by policy makers to remove factors that hinder the nurse–patient communication process.     

Methodological and cultural challenges met in domiciliary care

The experiences, feelings and reflections of a team of home care nurses and doctors were collected with an informal interview, asking two simple questions: why are we working in home care? What are the differences between home and hospital care? Most nurses discover home care and the different role of the patient and the family at home. Communication and motivation are essential for an high quality of care. The involvement of the family that takes part to the care of the patient, often with a winder role than doctors and nurses, requires a different relationship and specific skills. The real epidemiology and story of home care can be described with numbers (of patients cared for, of their problems) but also with stories (perceptions, feelings, beliefs...) of people cared for and of the professionals that care for them.     

End-of-life care in intensive care units: family routines and environmental factors

The purpose of this study was to describe family care routines and to explore environmental factors when patients die in Swedish intensive care units (ICUs). The main research questions were: what are the physical environmental circumstances and facilities when caring for patients in end‐of‐life and are there any routines or guidelines when caring for dying patients and their families? A questionnaire was sent to 79 eligible Swedish ICUs in December 2003, addressed to the unit managers. The response rate was 94% (n = 74 units). The findings show that, despite recommendations highlighting the importance of privacy for dying ICU patients and their families, only 11% of the respondents stated that patients never died in shared rooms in their ICU. If a patient dies in a shared room, nurses strive to ensure a dignified good‐bye by moving the body to an empty room or to one specially designated for this purpose. The majority (76%) of the units had waiting rooms within the ICU. The study also revealed that there is a need for improvements in the follow‐up routines for bereaved families. Many units reported (51%) that they often or almost always offer a follow‐up visit, although in most cases the bereaved family had to initiate the follow‐up by contacting the ICU. Guidelines in the area of end‐of‐life care were used by 25% of the ICUs. Further research is necessary to acquire a deeper knowledge of the circumstances under which patients die in ICUs and what impact the ICU environment has on bereaved families.     

Elderly patients' use of hospital-based emergency services

Past studies have shown in many instances that elderly people are represented in the hospital emergency room in proportion to their distribution in the population. It is possible, though, that elderly patients in the emergency room are using different types of resources than individuals of a younger age. Samples of two hospital emergency room users were selected in 1981 and in 1986. Patients aged 25 years or older were included in the study. The dependent variable was the extent to which patients used resources available at the hospital emergency room only or at alternative emergency medical services in the community. The effect of age on the use of resources in the hospital emergency rooms was estimated separately for those who were transported to the emergency room by ambulance and for those who were not. Age had an effect on use of resources under both conditions, regardless of the patients' gender, time of the visits, availability of alternative sources of emergency care, and diagnostic categories. The role of the hospital emergency room is to address medical care needs of specific segments of the population in special circumstances. Elderly emergency room patients are indeed one of these specific segments with very special needs.