Because of the expense associated with hospital admissions, the use of observation status has grown. One of the most consistently measured outcomes in observation is the patient length of stay (LOS). Research supports the positive impact that nurse practitioners (NP) have on LOS when added to other service lines that could be applied to observation. Banner Desert Medical Center (BDMC) is currently attempting to decrease their observation LOS. Adding acute care nurse practitioners (ACNP) to the care delivery model is a potential intervention. The purpose of this project was to develop an executive summary to inform staff of current evidence that supports the addition of ACNPs to observation. Then, via a survey, the project aimed to determine the level of staff support by identifying the Transtheoretical Model of Change (TTM) Stage of Change and to recommend appropriate stage-matched interventions for staff based on TTM processes of change. The 10 Likert scale survey questions were adapted from two validated TTM surveys. The final question asked for the pros and cons of the intervention to determine the Decisional Balance (DB). The registered nurse (RN) cohort demonstrated consistently strong support for the proposed intervention with an average mean response of 6.57 on affirmative questions and a correspondingly low average mean of 2.2 on negative questions. When compared to the RN cohort, the physician cohort had lower mean responses with an average of 4.29 on every affirmative, a higher average mean response of 3.85 on the negatively worded questions. The DB for RNs was 19 pros to two cons. The DB for physicians was eight cons to three pros. These finding reflect that nurses are in the Preparation Stage of Change and are ready to move forward with adding ACNPs. An appropriate stage-matched intervention for registered nurses would be the development of change teams. In contrast, the physician cohort is in the Precontemplation stage and is not ready to proceed with adding ACNPs. Appropriate stage-matched interventions for physicians would include facilitating consciousness-raising activities such as an open forum to communicating information about the proposed change and to explore concerns and questions regarding the intervention.

Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement.

No description available.

Bakgrund: Smärta är den mest vanliga orsaken till varför patienter söker vård och innebär lidande för patienten. Varje patient är unik med sina egna behov som behöver bemötas genom anpassning av deras vård. Sjuksköterskan har ett ansvar att lindra patientens lidande genom en god omvårdnad som grundas i den mellanmänskliga relationen. I den akuta vårdverksamheten är sjuksköterskans roll att bemöta patienter, utföra smärtskattning och smärtbehandling samt utvärdera behandling. Syfte: Att beskriva sjuksköterskors perspektiv på faktorer som påverkar den mellanmänskliga relationen vid smärtbehandling i akut vårdverksamhet. Metod: Litteraturbaserad studie där datamaterialet består av 14 kvalitativa vetenskapliga artiklar. Resultat: Ur analysen identifieras tre kategorier; Sjuksköterskerelaterade faktorer, Patientfaktorer och Organisatoriska faktorer med sju underkategorier. Slutsats: Sjuksköterskans kompetens identifierades som den största främjande faktorn. Begränsad tid för god omvårdnad identifierades som den största hindrande faktorn. / Background: Pain is the most common reason why patients seek care and it causes suffering to the patient. Each patient is unique with their own needs that need to be met through adaptation of care. The nurse has a responsibility to alleviate the patient's suffering by providing good care based on the interpersonal relationship. In acute care setting the nurse's role is to treat the patient, to assess the patient’s pain, carry out pain treatment and evaluate treatment. Aim: To describe nurses' perspective on factors that affect the interpersonal relationship in the context of pain treatment in an acute care setting. Method: A literature study based on 14 articles with qualitative approach. Results: From the analysis three main categories were identified; Nurse factors, Patient factors and Organizational factors with seven subcategories. Conclusion: The nurse's competence was identified as the biggest promoting factor. Limited time for good care was identified as the biggest hindering factor.

Bakgrund: Demenssjukdom drabbar allt fler individer globalt varje år. Antalet demensdiagnostiserade individer förväntas dessutom öka kraftig som en konsekvens av ökad livslängd. Demenssjukdom är obotligt och individen blir progressivt sämre under sjukdomsförloppet. Sjuksköterskor inom slutenvårdskontext kan hamna i svåra omvårdnadssituationer med demensdiagnostiserade patienter. Därtill kan sjukdomssymtom som identitetsförlust, förvirring och kommunikationssvårigheter medföra ytterligare svårigheter till omvårdnadssituationerna. Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors erfarenheter av att vårda personer med demenssjukdom inom somatisk slutenvård. Metod: För genomförandet av denna litteraturstudie användes kvalitativ studiedesign samt innehållsanalys för analysering av data. Tolv vetenskapliga artiklar, alla med kvalitativ ansats, utgjorde studiens resultat. Samtliga artiklar var funna på Cinahl och PubMed samt kvalitetsgranskade med SBU:s kvalitetsgranskningsmall för kvalitativa studier. Resultat: Två huvudteman identifierades av studiernas resultat; ”Upplevelsen av ökad arbetsbelastning” och ” Organisatoriska brister”. Ur huvudtemana framstod således följande underteman; ”Känslan av frustration och av att inte vara tillfreds”, ” Ökade arbetskrav och stress”, ”Bemanning och tid”, ”Opassande vårdmiljö”, ” Behov av kunskap” och till sist ” Att få rätt information om patienten”. Konklusion: Sjuksköterskorna upplevde ofta svårigheter vid omvårdnadssituationer av demensdiagnostiserade patienter. Svårigheterna visade sig bli mer markanta vid otillräcklig tid och bemanning under vårdsituationerna. Därutöver visades miljöanpassning och kunskapsförbättring vara nödvändigt för att minska förändring av demenspatientens extroverta beteende och öka möjligheterna till att kunna utföra personcentrerad vård. / Background: Dementia affects more and more individuals globally every year. The number of individuals diagnosed with dementia is also expected to increase considerably because of the increased life expectancy of the population. Dementia is incurable and the individual progressively worsens during the disease. Nurses in the inpatient care context can end up in difficult nursing situations with dementia patients. In addition, disease symptoms such as loss of identity, confusion and communication difficulties can lead to additional difficulties in the nursing  situations. Aim: This literature study aims to explore nurses’ experiences of caring for people with dementia in somatic hospital care.                 Method: For the execution of this literature study, a qualitative study design and integrated content analysis were used for analysis of data. Ten scientific articles, all with a qualitative approach, constituted the results of the study. All articles were found on Cinahl and PubMed and were reviewed for quality with SBU's quality review template for qualitative studies. Results: Two main themes were identified by the results of the studies; "The experience of increased workload" and "Organizational shortcomings". From the main themes thus emerged the following sub-themes; "The feeling of frustration and of not being satisfied", "Increased work demands and stress", "Staffing and time", "Inappropriate care environment", "Need of knowledge" and "Getting the right information about the patient". Conclusion: The nurses often experienced difficulties in nursing situations of dementia-diagnosed patients. The difficulties proved to be more pronounced with insufficient time and staffing during the care situations. In addition, environmental adaptation and knowledge improvement were shown to be necessary to reduce changes in the dementia patient's extroverted behavior and increase the opportunities to be able to perform person-centered care.

Bakgrund: Omvårdnadsarbetet på akutmottagningar innefattar, utöver vårdande av allvarliga skador och livshotande sjukdomstillstånd, omhändertagande av patienter i livets slutskede. Sjukhus har påvisade kvalitetsbrister i vården vid livets slutskede. Den sista vårdtiden påverkar patienters och anhörigas lidande och livskvalitet. Syfte: Studiens syfte var att beskriva sjuksköterskors upplevelser av att vårda patienter i livets slutskede på akutmottagningar. Metod: Allmän kvalitativ litteraturöversikt på åtta kvalitativa och tre mixade vetenskapliga artiklar. Resultat: Utifrån analyserade artiklar framställdes fyra kategorier som beskriver sjuksköterskors upplevelser av vård i livets slutskede på akutmottagningar; Yttre aspekter som inte går att påverka, Anhörigas inverkan på vården, Samverkan och kommunikationen är betydelsefull och Det komplexa med omvårdnaden. Diskussion: Sjuksköterskors arbete påverkas negativt av hög arbetsbelastning och underbemanning. Akutmottagningars miljö utgör ett strukturellt hinder för sjuksköterskor att bedriva god omvårdnad i livets slutskede. Trots försök till inkorporering av patient och anhöriga i omvårdnaden kvarstår upplevelser av att de inte vårdas efter sina egna önskningar. Slutsats: Vård i livets slutskede är inte optimalt på akutmottagningar. Begränsad avskildhet, underbemanning, okunskap och anhöriga påverkar omvårdnaden. God kommunikation, avskildhet och tid krävs för att kunna erbjuda god omvårdnad. Trots bristerna kan sjuksköterskor främja en god död på akutmottagningar. / Background: Nurses’ work in emergency departments includes caring for serious injuries and life-threatening illnesses as well as caring for patients in the end-of-life. Hospitals have quality deficiencies in end-of-life care. End-of-life care affects patients and relatives suffering and quality of life. Aim: The aim of this study was to describe nurses' experiences of caring for patients at the end-of-life in emergency departments. Method: General qualitative literature review of eight qualitative and three mixed articles. Result: Four categories regarding nurses' experiences of caring for patients at the end of life in emergency departments evolved: External factors that cannot be influenced, Relatives impact on the care, The interaction and communication is important and The complexity of nursing. Discussion: Nurses' work is negatively affected by high workloads and understaffing. The work environment is an obstacle for nurses to provide good end-of-life care. Despite attempts to incorporate relatives and patients, they are not cared for according to their own wishes. Conclusion: End-of-life care is not optimal in emergency departments. Limited privacy, understaffing and lack of knowledge have negative effects on nursing. Good communication and privacy are required to offer good care. Despite this, nurses can promote a good death at emergency departments.

Bakgrund: Från internationell forskning framkommer att det finns kunskap om hur sjuksköterskor som arbetar på vårdavdelningar inom akutvården upplever omvårdnaden av patienter i livets slutskede. Dock finns sparsamt med forskning inom detta område i en svensk kontext. Syfte: Studiens syfte var att belysa hur sjuksköterskor som arbetar på vårdavdelningar inom akutvården upplever omvårdnaden av patienter i livets slutskede. Metod: Studien har en empirisk design med kvalitativ ansats. Samtalsintervjuer med fyra legitimerade sjuksköterskor genomfördes och analyserades med hjälp av modifierad innehållsanalys, editing analysis style, enligt Malterud (2009). Resultat: Ur analysen utkristalliserades tre kategorier vilka beskriver hur sjuksköterskan, inom den akuta kontexten, upplever omvårdnaden av patienter i livets slutskede: Godtycklig anpassning, Den obarmhärtiga omvårdnadsverkligheten och Den goda omvårdnaden – En önskedröm? Slutsats: Analysens resultat vittnar om att sjuksköterskans beslutsautonomi är hotad i omvårdnaden av patienter i livets slutskede inom den akuta kontexten, att sjuksköterskan har svårt att leva upp till kraven i omvårdnaden som dessa patienter har rätt till samt att sjuksköterskan saknar närhet till patienten. Detta innebär att hon inte alltid kan göra gott och därmed riskerar att skada patienten, vilket leder till att rättvisa i omvårdnaden inte alltid kan skipas i en kontext som delas av den kurativa och den palliativa patienten. I en ytterligare tolkning menas att den palliativa patientens människovärde kränks. Klinisk betydelse: En konsekvens av studien är att rekommendera vårdavdelningar inom akutvården att vidta åtgärder som förbättrar sjuksköterskans möjligheter att utföra en tillfredställande omvårdnad av patienter som avslutar livet inom denna vårdkontext. / Background: International research indicates that there is knowledge of nurses’ perceptions of palliative nursing care in wards in acute care settings. However, there is little research in this field in a Swedish context. Aim: The aim of this study was to elucidate nurses’ perceptions of palliative nursing care in wards in acute care settings. Method: The study has an empirical design with a qualitative approach. Interviews with four registered nurses were analyzed using the modified content analysis, editing analysis style, by Malterud (2009). Results: From the analysis three categories emerged which describe how the nurse, within the emergency context, experience the caring of patients near end of life: Arbitrary adaption, The unmerciful nursing reality and The good care – A utopia? Conclusion: The result of the analysis showed that the nurse decision-making autonomy is threatened in the care of patient in palliative care in the acute context, that the nurse finds it difficult to live up to the demands of the care that these patients are entitled to and that the nurse lacks closeness to the patient. This means that the nurse cannot always do good and risks to harm the patient, which leads to that justice cannot always be guaranteed in a context that is shared by the curative and the palliative patient. In a further interpretation the dignity of the palliative patient is violated. Clinical significance: A consequence with the study is to recommend wards in acute care settings to take actions to improve nurses’ ability to perform an adequate nursing care of patients who end life within this context.

Bakgrund: Vid forskningsgenomgång framkom det i internationell forskning att det finns kunskap om sjuksköterskans arbetsbelastning, om stressfaktorer på arbetsplatsen och dess negativa påverkan på sjuksköterskans hälsa. Sjuksköterskan upplever en stark arbetsrelaterad stress, där tidspress och hög arbetsbelastning är återkommande fenomen på akutvårdsavdelningar. En kunskapsbrist råder kring sjuksköterskans upplevda hälsa, specifikt i relation till hennes upplevda möjlighet att ge god omvårdnad. Syfte: Studiens syfte var att undersöka sjuksköterskans upplevda hälsa i relation till hennes upplevda möjlighet att ge god omvårdnad i en akutvårdskontext. Metod: Enkätundersökning av empirisk deskriptiv design med kvantitativ ansats. Resultat: Utifrån sjuksköterskornas skattning av hälsa och god omvårdnad sorterades frågorna in i rubrikerna: sjuksköterskans upplevda hälsa, omvårdnadens atmosfär, sjuksköterskans upplevda möjlighet att underhålla omvårdnadens kvalitet och stressorer i arbetsmiljön. Slutsats: Studien illustrerar ett gott exempel på sjuksköterskans upplevelse av hälsa och upplevelse av god omvårdnad i relation till varandra och KASAM. Sjuksköterskan kan ha en hög KASAM eller låg KASAM beroende på hög begriplighet och hanterbarhet men låg meningsfullhet, eller låg begriplighet och hanterbarhet men hög meningsfullhet. Det vill säga att en sjuksköterska väl kan ha god hälsa utan att hon har relation till god omvårdnad om begriplighet och hanterbarhet finns. Likaså kan sjuksköterskan uppleva avsaknad av hälsa med att detta är i relation till att uppleva god omvårdnad om meningsfullhet finns. Klinisk betydelse: Det krävs en insikt om vad relationen hälsa och välmående hos sjuksköterskan, satt i sammanhang med huvuduppgiften, det utförda omvårdnadsarbetet, egentligen kräver. / Background: Internationally, there is an existing knowledge about nurses’ workload, stress factors in workplaces and its negative impact on nurses’ health. In acute care settings, the nurses experience a strong work-related stress, where time pressure and heavy workload are recurring phenomena. A lack of knowledge exists about the nurse's perceived health, specifically in relation to her experienced ability to provide good care. Aim: The aim of this study was to examine nurses’ experienced health, in relation to her experienced ability to provide good nursing, in acute care settings. Method: A survey of empirical descriptive design with quantitative approach. Result: Based on nurses' estimates of health and good nursing, the questions were arranged under the following headlines: experienced health – good nursing, lack of health – absence of nursing, experienced health – absence of nursing and lack of health – good nursing. Conclusion: The study is a good example of the relation between a nurse's experienced health, her cognition of well performed nursing and sense of coherence. The nurse may have a high or low sense of coherence due to high comprehensibility and manageability but low meaningfulness, or low comprehensibility and manageability but high meaningfulness. Due to high comprehensibility and manageability the nurse can experience good health, but it may not be related to good nursing. The nurse can also experience a lack of health but perform good nursing, due to high meaningfulness. Clinical significance: The study indicates that it requires an understanding for the relation between health and well-being of the nurses, put in context with the main task, the nursing.

In response to the needs of patients, coupled with nursing workforce predictions and the pressure of cost containment, a shift to a new team nursing model of care has been seen in Canada and Australia. Today's patients require multiple resources, nurses with additional skillsets and vast amounts of experience during their hospital stays, and a team of nurses can meet these needs. This project explored the experiences and perspectives of nurses during the implementation of a team nursing model of care on a 32-bed, inpatient, cardiology floor in southern Ontario. The purposes of this project were to conduct a formative evaluation of the pilot unit implementation and make recommendations for future units who will implement this change in model. The project tracked all nurses on the pilot unit, from frontline nurses to those of influence and authority. Guided by an action research framework and a qualitative approach, nurses' experiences were explored through observations and analysis of organizational reports. These data were triangulated and further validated with evidence from the current literature. Major themes included the need for clear definitions of roles and responsibilities, a strong organizational support system, and the recognition that team nursing was more than a division of tasks but was a shift in culture to that of shared responsibility and accountability for all patients. These findings have implications for positive social change by informing the work of those in the health care setting, illuminating the benefits of team-based nursing.

During the last several decades, venous thromboembolism (VTE) has been identified as a preventable health condition. The gaps in clinical practice have led to an increased incidence of VTE. The lack of using existing evidence-based VTE prevention guidelines in practice has limited the implementation of VTE risk assessment stratifications and affected the appropriateness and timeliness of addressing pharmacologic and mechanical prophylaxis. The purpose of the scholarly project was to educate practitioners on existing VTE prevention practice guidelines. The practice-focused question explored whether an educational learning activity on evidence-based VTE prevention guidelines improved the awareness, knowledge, and compliance with existing evidence-based VTE guidelines of practitioners that assess and treat patients at risk for VTE. The theoretical framework for the project was Lewin's change process theory. A total of 38 participants comprised registered nurses (82%), physicians (5%), nurse practitioners (2%), and nonclinical personnel (11%). A program evaluation was provided to determine the effectiveness of the project. The findings showed that practitioners participated in the learning activity to improve knowledge (48%), increase VTE awareness (43%), and would change the management and treatment of patients at risk for VTE (39%). Hospitalized patients at risk for VTE can benefit from the results of this project through a change in clinical practice that might decrease the incidence of VTE and potentially bring about social change by reducing the number of preventable deaths.