The nurse station
4405767
Using Systems Theory to Examine Patient and Nurse Structures, Processes, and Outcomes in Centralized and Decentralized Units
Objectives: This study utilizes systems theory to understand how changes to physical design structures impact communication processes and patient and staff design related outcomes. Background: Many scholars and researchers have noted the importance of communication and teamwork for patient care quality. Few studies have examined changes to nursing station design within a systems theory framework. Method: This study employed a multimethod, before and after, quasi experimental research design. Nurses completed surveys in centralized units and later in decentralized units (N 26pre, N 51post) Patients completed surveys (N 62pre) in centralized units and later in decentralized units (N 49post) Surveys included quantitative measures and qualitative open ended responses. Results: Patients preferred the decentralized units because of larger single occupancy rooms, greater privacy/confidentiality, and overall satisfaction with design. Nurses had a more complex response. Nurses approved the patient rooms, unit environment, and noise levels in decentralized units. However, they reported reduced access to support spaces, lower levels of team/mentoring communication, and less satisfaction with design than in centralized units. Qualitative findings supported these results. Nurses were more positive about centralized units and patients were more positive toward decentralized units. Conclusion: The results of this study suggest a need to understand how system components operate in concert. A major contribution of this study is the inclusion of patient satisfaction with design, an important yet overlooked fact in patient satisfaction. Healthcare design researchers and practitioners may consider how changing system interdependencies can lead to unexpected changes to communication processes and system outcomes in complex systems.
HERD
Kevin Real Lindsey Fay Kathy B Isaacs Allison Carll-White Aric D Schadler
11523895
[A comparative study of the physical conditions of elderly people with care needs receiving rehabilitation services from a nurse or a physiotherapist from a visiting nurse service station]
PURPOSE The purpose of this study was to examine the roles of rehabilitation by a nurse, comparing the attributes of utilization of care services and physical conditions of elderly people receiving rehabilitation services from a nurse or a physiotherapist. METHOD Two hundred and fifty four care receivers at the Saiseikai visiting nurse service station, Shiga Prefecture, were interviewed by a nurse or a physiotherapist. They were divided into two groups: 1) receivers of rehabilitation services by a nurse (RRSN group) and 2) receivers of rehabilitation services by a physiotherapist (RRSP group) The subjects were matched for gender and age, and 36 participants for each of the two groups were included in the analysis. Level of dementia, activities of daily living (ADL; Barthel Index) instrumental activities of daily living (IADL) the Glasgow Coma Scale (GCS) and use of visiting services were assessed in the interview. Analysis of variance and the chi2 test were used to compare values for the two groups. RESULTS Level of dementia in the RRSN group was significantly severe than in the RRSP group (P<0.05) The number of patients who are required to be treated with visiting medical services was significantly more in the RRSN group (P<0.05) Physical status in the RRSN group was significantly lower for ADL, GCS than in the RRSP group. IADL of males in the RRSN group was significantly lower. CONCLUSIONS Thus, we conclude that it is important for nurses to make opportunities to visit elderly people with physiotherapists to assess their physical conditions.
[Nihon koshu eisei zasshi] Japanese journal of public health
Akiko Matsuda Miwako Kunori
205198027
Multicenter randomised trial on home based telemanagement to prevent hospital readmission of patients with chronic heart failure.
BACKGROUND Chronic heart failure (CHF) remains a common cause of disability, death and hospital admission. Several investigations support the usefulness of programs of disease management for improving clinical outcomes. However, the effect of home based telemanagement programs on the rate of hospital readmission is still unclear and the cost effectiveness ratio of such programs is unknown. The aim of the study was to determine whether a home based telemanagement (HBT) programme in CHF patients decreased hospital readmissions and hospital costs in comparison with the usual care (UC) follow up programme over a one year period. METHODS AND RESULTS Four hundred sixty CHF patients (pts) aged 57+ 10 years were randomised to two management strategies: 230 pts to HBT programme and 230 pts to UC programme. The HBT pts received a portable device, transferring, by telephone, a one lead trace to a receiving station where a nurse was available for interactive teleconsultation. The UC pts were referred to their primary care physicians and cardiologists. The primary objective of the study was one year hospital readmission for cardiovascular reasons. During one year follow up 55 pts (24% in HBT group and 83 pts (36% in UC group had at least one readmission (RR=0.56; 95% CI: 0.38 0.82; p=0.01) After adjusting for clinical and demographic characteristics, the HBT group had a significantly lower risk of readmission compared with the UC group (HR=0.50, 95% CI: 0.34 0.73; p=0.01) The intervention was associated with a 36% decrease in the total number of hospital readmissions (HBT group: 91 readmissions; UC group: 142 readmissions) and a 31% decrease in the total number of episodes of hemodynamic instability (101 in HBT group vs 147 in UC group) The rate of hearth failure related readmission was 19% (43 pts) in HBT group and 32% (73 pts) in UC group (RR=0.49, 95% [CI] 0.31 0.76; p=0.0001) No significant difference was found on cardiovascular mortality between groups. Mean cost for hospital readmission was significantly lower in HBT group (euro 843+ 1733) than in UC group (euro 1298+ 2322) 35% p<0.01) CONCLUSIONS This study suggests that one year HBT programme reduce hospital readmissions and costs in CHF patients.
International journal of cardiology
Amerigo Giordano Simonetta Scalvini Emanuela Zanelli Ugo Corra Giancarlo Longobardi V A Ricci Paola Baiardi Fulvio Glisenti
13089350
Telecare for Diabetes, CHF or COPD: Effect on Quality of Life, Hospital Use and Costs. A Randomised Controlled Trial and Qualitative Evaluation
Objectives To assess the effect of telecare on health related quality of life, self care, hospital use, costs and the experiences of patients, informal carers and health care professionals. Methods Patients were randomly assigned either to usual care or to additionally entering their data into a commercially available electronic device that uploaded data once a day to a nurse led monitoring station. Patients had congestive heart failure (Site A) chronic obstructive pulmonary disease (Site B) or any long term condition, mostly diabetes (Site C) Site C contributed only intervention patients they considered a usual care option to be unethical. The study took place in New Zealand between September 2010 and February 2012, and lasted 3 to 6 months for each patient. The primary outcome was health related quality of life (SF36) Data on experiences were collected by individual and group interviews and by questionnaire. Results There were 171 patients (98 intervention, 73 control) Quality of life, self efficacy and disease specific measures did not change significantly, while anxiety and depression both decreased significantly with the intervention. Hospital admissions, days in hospital, emergency department visits, outpatient visits and costs did not differ significantly between the groups. Patients at all sites were universally positive. Many felt safer and more cared for, and said that they and their family had learned more about managing their condition. Staff could all see potential benefits of telecare, and, after some initial technical problems, many staff felt that telecare enabled them to effectively monitor more patients. Conclusions Strongly positive patient and staff experiences and attitudes complement and contrast with small or non significant quantitative changes. Telecare led to patients and families taking a more active role in self management. It is likely that subgroups of patients benefitted in ways that were not measured or visible within the quantitative data, especially feelings of safety and being cared for. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12610000269033
PloS one
Timothy Kenealy Matthew Parsons A P B Rouse Robert Neil Doughty Nicolette F Sheridan Jennifer K Harre Hindmarsh Sarah C Masson Harry Rea
12550623
Central station data displays: an experimental evaluation of observer performance
Abstract16 experienced ICU nurses monitored simulated central station VDU displays for the occurrence of ectopic beats and for signs of deterioration in general cardiovascular status. Each period of monitoring lasted for 1 h, and on separate occasions each nurse monitored 1, 2, 4 or 6 displays simultaneously. For primary clinical tasks, the data showed that the nurses' performance improved with each test. The identification of ventricular ectopic beats (VEBs) improved within the 1 h of each test except when 6 screens were being viewed simultaneously, with a similar result for the identification of deterioration of cardiovascular status. The nurses showed a marked preference for analogue signals over digits for the identification of VEBs. The highest priority clinical task was the identification of deteriorating cardiovascular status. When this task was performed efficiently less attention was given to minor tasks, and the nurse rated herself as very tired.
Intensive Care Medicine
A D Crew S Old Angus Craig G D Unsworth P C Fletcher
11461438
Centralized vs. Decentralized Nursing Stations: Effects on Nurses' Functional Use of Space and Work Environment
Objective: Evidence based findings of the effects of nursing station design on nurses' work environment and work behavior are essential to improve conditions and increase retention among these fundamental members of the healthcare delivery team. The purpose of this exploratory study was to investigate how nursing station design (i.e. centralized and decentralized nursing station layouts) affected nurses' use of space, patient visibility, noise levels, and perceptions of the work environment. Background: Advances in information technology have enabled nurses to move away from traditional centralized paper charting stations to smaller decentralized work stations and charting substations located closer to, or inside of, patient rooms. Improved understanding of the trade offs presented by centralized and decentralized nursing station design has the potential to provide useful information for future nursing station layouts. This information will be critical for understanding the nurse environment "fit." Methods: The study used an exploratory design with both qualitative and quantitative methods. Qualitative data regarding the effects of nursing station design on nurses' health and work environment were gathered by means of focus group interviews. Quantitative data gathering techniques included place and person centered space use observations, patient visibility assessments, sound level measurements, and an online questionnaire regarding perceptions of the work environment. Results: Nurses on all units were observed most frequently performing telephone, computer, and administrative duties. Time spent using telephones, computers, and performing other administrative duties was significantly higher in the centralized nursing stations. Consultations with medical staff and social interactions were significantly less frequent in decentralized nursing stations. There were no indications that either centralized or decentralized nursing station designs resulted in superior visibility. Sound levels measured in all nursing stations exceeded recommended levels during all shifts. No significant differences were identified in nurses' perceptions of work control demand support in centralized and decentralized nursing station designs. Conclusions: The "hybrid" nursing design model in which decentralized nursing stations are coupled with centralized meeting rooms for consultation between staff members may strike a balance between the increase in computer duties and the ongoing need for communication and consultation that addresses the conflicting demands of technology and direct patient care.
HERD
Terri Zborowsky Lou Bunker-Hellmich Agneta Morelli Mike O'Neill
205765687
Effects of room environment and nursing experience on clinical blood pressure measurement: an observational study
Objective This study aimed to examine the effects of measurement room environment and nursing experience on the accuracy of manual auscultatory blood pressure (BP) measurement. Materials and methods A training database with 32 Korotkoff sounds recordings from the British Hypertension Society was played randomly to 20 observers who were divided into four groups according to the years of their nursing experience (i.e. =10 years, 1 9 years, nursing students with frequent training, and those without any medical background; five observers in each group) All the observers were asked to determine manual auscultatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) both in a quiet clinical assessment room and in a noisy nurse station area. This procedure was repeated on another day, yielding a total of four measurements from each observer (i.e. two room environments and two repeated determinations on 2 separate days) for each Korotkoff sound. The measurement error was then calculated against the reference answer, with the effects of room environment and nursing experience of the observer investigated. Results Our results showed that there was no statistically significant difference for BPs measured under both quiet and noisy environments (P>0.80 for both SBP and DBP) However, there was a significant effect on the measurement accuracy between the observer groups (P<0.001 for both SBP and DBP) The nursing students performed best with overall SBP and DBP errors of 0.8+ 2.4 and 0.1+ 1.8 mmHg, respectively. The SBP measurement error from the nursing students was significantly smaller than that for each of the other three groups (all P<0.001) Conclusion Our results indicate that frequent nursing trainings are important for nurses to achieve accurate manual auscultatory BP measurement.
Blood pressure monitoring
Meng Zhang Xuemei Zhang Fei Chen Birong Dong Aiqing Chen Dingchang Zheng
1150489
[Comparison of waste anesthetic gases in operating rooms with or without an scavenging system in a Brazilian University Hospital]
BACKGROUND AND OBJECTIVES Occupational exposure to waste anesthetic gases in operating room (OR) without active scavenging system has been associated with adverse health effects. Thus, this study aimed to compare the trace concentrations of the inhaled anesthetics isoflurane and sevoflurane in OR with and without central scavenging system. METHOD Waste concentrations of isoflurane and sevoflurane were measured by infrared analyzer at different locations (near the respiratory area of the assistant nurse and anesthesiologist and near the anesthesia station) and at two times (30 and 120minutes after the start of surgery) in both OR types. RESULTS All isoflurane and sevoflurane concentrations in unscavenged OR were higher than the US recommended limit (2 parts per million) regardless of the location and time evaluated. In scavenged OR, the average concentrations of isoflurane were within the limit of exposure, except for the measurements near the anesthesia station, regardless of the measurement times. For sevoflurane, concentrations exceeded the limit value at all measurement locations and at both times. CONCLUSIONS The exposure to both anesthetics exceeded the international limit in unscavenged OR. In scavenged OR, the concentrations of sevoflurane, and to a lesser extent those of isoflurane, exceeded the recommended limit value. Thus, the OR scavenging system analyzed in the present study decreased the anesthetic concentrations, although not to the internationally recommended values.
Revista brasileira de anestesiologia
Leandro Gobbo Braz Jose Reinaldo Cerqueira Braz Guilherme Aparecido Silva Cavalcante Katina M Souza Lorena M C Lucio Mariana G Braz
21801962
Accuracy of blood loss estimations among anesthesia providers.
Research regarding the accuracy of estimating blood loss by anesthesia providers has been limited, generally consisting of small sample sizes with conflicting findings. We conducted a prospective study using a convenience sample of 91 anesthesia providers: 36 Certified Registered Nurse Anesthetists (CRNAs) 48 student registered nurse anesthetists (SRNAs) and 7 anesthesiologists. We applied a known volume of moulage (theater) blood to items at 4 stations and asked each participant to estimate the amount of blood present at each station. Descriptive and inferential statistical analyses were performed. Multivariate regression analysis was conducted to evaluate the association of estimation errors with covariates (provider training, gender, ethnicity, years of education, and years of anesthesia experience) We found no difference in the mean error of blood loss estimation based on provider training, gender, ethnicity, education, or experience. Although no statistically significant differences in blood loss estimations existed among provider groups, CRNAs had smaller mean errors than anesthesiologists in all 4 stations and smaller mean errors than SRNAs in 3 of 4 stations. Accuracy of estimating blood loss, measured by mean error, was not related to type of provider training, years of education or experience, gender, or ethnicity. Anesthesia providers may not estimate blood loss accurately.
AANA journal
Ashleigh R Adkins Doohee Lee D J Woody William A White
28160943
Back to the future: An online OSCE Management Information System for nursing OSCEs.
BACKGROUND The Objective Structured Clinical Examination (OSCE) is an established tool in the repertoire of clinical assessment methods in nurse education. The use of OSCEs facilitates the assessment of psychomotor skills as well as knowledge and attitudes. Identified benefits of OSCE assessment include development of students' confidence in their clinical skills and preparation for clinical practice. However, a number of challenges exist with the traditional paper methodology, including documentation errors and inadequate student feedback. OBJECTIVES To explore electronic OSCE delivery and evaluate the benefits of using an electronic OSCE management system. To explore assessors' perceptions of and attitudes to the computer based package. DESIGN This study was conducted using electronic software in the management of a four station OSCE assessment with a cohort of first year undergraduate nursing students delivered over two consecutive years (n=203) in one higher education institution in Ireland. A quantitative descriptive survey methodology was used to obtain the views of the assessors on the process and outcome of using the software. METHODS OSCE documentation was converted to electronic format. Assessors were trained in the use of the OSCE management software package and laptops were procured to facilitate electronic management of the OSCE assessment. Following the OSCE assessment, assessors were invited to evaluate the experience. RESULTS Electronic software facilitated the storage and analysis of overall group and individual results thereby offering considerable time savings. Submission of electronic forms was allowed only when fully completed thus removing the potential for missing data. The feedback facility allowed the student to receive timely evaluation on their performance and to benchmark their performance against the class. CONCLUSIONS Assessors' satisfaction with the software was high. Analysis of assessment results can highlight issues around internal consistency being moderate and examiners variability. Regression analysis increases fairness of result calculations.
Nurse education today
Pauline Meskell Eimear Burke Thomas J B Kropmans Evelyn Byrne Winny Setyonugroho Kieran M Kennedy