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Nursing Surveillance in the Acute Care Setting: Latent Variable Development and AnalysisKelly, Lesly Ann January 2009 (has links)
The nursing profession has utilized a variety of terms to describe the work that nurses do, such as observing, monitoring, and critical thinking. Nursing surveillance is a term emerging in the research and clinical environment to describe the care, both seen and unseen, by professional registered nurses. It has been described as a complex, multi-dimensional concept that influences patient outcomes, yet little research has been done to examine the concept, how it is measured, and its role in outcomes.The surveillance process includes ongoing data collection, interpretation, and synthesis for decision making. This research proposes that nursing surveillance is comprised of five dimensions: actions, expertise, early recognition, intuition, and decision making. The purpose of this study is to examine the dimensions of nursing surveillance in the acute care setting.This study used a descriptive design to survey nurses on the dimensions of nursing surveillance. The survey consisted of four existing instruments measuring expertise, early recognition, intuition, and decision making, and one new instrument measuring activities associated with nursing surveillance. A content review panel was used to develop the new Nursing Surveillance Activities Scale. A sample of 158 medical-surgical nurses participated in completing the full Nursing Surveillance Survey.The goal of the analysis was to determine how well the dimensions represented the surveillance variable; however, based on sample size, revisions to the methods were made. Factor analysis was used to analyze each instrument's items and total representation of the variable. The instruments performed adequately in psychometric testing, and modifications were made so composite development could be achieved. The dimensions were factored as a composite variable and four of the five dimensions loaded onto a single variable, while the activities dimensions loaded separately. These results can be explained through a theoretical difference between the dimensions or limitations with the newly created Nursing Surveillance Activities Scale.This study identified a relationship between the four cognitive dimensions of nursing surveillance and their representation of the variable. Future research in nursing surveillance should analyze the role of the nursing surveillance variable, including the relationship to nursing outcomes.
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A comparative analysis of the effect of critical care nursing interventions on acute outcomes in patients with traumatic brain injuryWatts, Jennifer M. 01 January 2010 (has links)
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality among young children and adults. This primary injury initiates an inflammatory response that may lead to a secondary brain injury. Nursing care in the critical care setting supports prevention or reduction of secondary injury through control of intracranial pressure (ICP), mean arterial pressure (MAP), and the subsequent cerebral perfusion pressure (CPP). While secondary injury may be preventable, some nursing interventions may contribute to increased ICP and decreased CPP. Patients with increased ICP or decreased CPP are at risk for poor clinical outcomes. This literature review examined the effort of routine nursing care interventions on outcomes of TBI patients in the critical care setting. Eleven research articles studying head of bed elevation, head and neck positioning, turning, and spacing of patient care activities were the focus of the analysis. Results typically showed positive outcomes by elevating the head of the bed to thirty degrees. CPP was also maintained at thirty degrees, but showed varied results. ICP and CPP are best controlled with the head and neck in a neutral position. Turning patients is a routine nursing intervention that contributes to increased ICP in some positions in some patients. Most studies suggest ICP is lowest in the supine position and highest in the left lateral position, but differences in findings were noted. Providing basic nursing care interventions in close succession also may contribute to increases in ICP in some patients. Results from this review provide evidence to support the importance of assessing and planning care for each TBI patient individually. It is hoped that findings from this review will provide guidance for bedside nurses to improve clinical practice and drive future research to support best practices for care of patients who suffer TBI.
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Distribuição do tempo das enfermeiras: identificação e análise em unidade médico-cirúrgica / Nursery time distribution: identification and analysis in a medical-surgical unitBordin, Luiz Carlos 11 June 2008 (has links)
Diante do impacto da distribuição do tempo de trabalho da profissional enfermeira na determinação de parâmetros adequados para a operacionalização do processo de dimensionar pessoal de enfermagem, este estudo teve por objetivo identificar e analisar a distribuição do tempo de trabalho das enfermeiras em uma unidade de internação médico-cirúrgica. Trata-se de uma pesquisa de campo, prospectiva, de abordagem quantitativa, do tipo exploratório-descritiva, realizada em um Hospital geral, privado, de grande porte da cidade de São Paulo. Para a consecução dos objetivos da pesquisa considerou-se, como população estatística, as atividades de enfermagem realizadas pelas enfermeiras durante os turnos de trabalho. O tamanho da amostra e o período amostral foram estabelecidos a partir da determinação de critérios relacionados à probabilidade mínima de ocorrência das atividades realizadas pelas enfermeiras, bem como do número de enfermeiras por turno e do intervalo estipulado para a realização das observações das atividades executadas pelas enfermeiras. A identificação das atividades de enfermagem realizadas pelas enfermeiras ocorreu mediante solicitação de que cada enfermeira relacionasse, por escrito, as atividades executadas no cotidiano de trabalho da Unidade, que foram, posteriormente, categorizadas de acordo com um sistema padronizado de linguagem (NIC) e classificadas em intervenções de cuidado direto, intervenções de cuidado indireto, atividades associadas e de tempo pessoal. Os dados foram coletados no período de 15 a 19 de outubro de 2007, por quatro observadoras de campo, contratadas e treinadas especificamente, para a realização deste procedimento. Obteve-se 1032 amostras das atividades realizadas pelas enfermeiras, verificando-se que as intervenções e atividades de enfermagem que mais utilizaram o tempo de trabalho das enfermeiras foram Documentação (18,4%), Tempo Pessoal (17,8%), Supervisão (11,4%), Atividades Associadas (9,7%), Delegação (9,3%), Passagem do Plantão (4,8%), Apoio ao Médico (3,9%) e Cuidados na Admissão (3,1%). Observou-se que 50% do tempo das enfermeiras foram dedicados às intervenções de cuidado indireto, 22% às intervenções de cuidado direto de enfermagem, 18% às atividades de tempo pessoal e 10% às atividades associadas. Estes dados corroboram a indicação de pesquisadores que apontam a necessidade de serem considerados o tempo pessoal dos trabalhadores de enfermagem e a realização das atividades associadas nos métodos de dimensionamento de pessoal preconizados pelos órgãos oficiais. Com este estudo evidenciam-se perspectivas para a realização de novas investigações no sentido de contribuir para o aperfeiçoamento dos parâmetros relacionados à temática dimensionamento de pessoal de enfermagem em instituições hospitalares / The aim of this study was to identify and to analyze the work time distribution of nurses in a medical-surgical unit, considering the impact of the work time distribution of nurses to determine the adequate parameters for the process to measure nursery personnel .This is a prospective, quantitative, exploratory-descriptive type field research, conducted in a large, private, general hospital in the city of São Paulo. The activities performed by nursery personnel during work shifts were considered as statistical population to reach our objectives. Sample size and period were established after determining the criteria related to the minimum occurrence possibility of activities performed by the nurses, as well as the number of nursery personnel per shift and the specific interval to perform activities by the nurses. The identification of the nursing activities occurred by asking each nurse to write a report mentioning their daily activities at the Unit, which were later categorized in accordance with the standard language system (NIC) and classified as direct care and indirect care interventions, associated activities and personal time. Data were collected during the period from the 15th to the 19th of October, 2007, by four field observers, specifically hired and trained for this procedure. 1032 samples were obtained from the nurses\' activities. The nursing activities and interventions that most used work time of the nurses were: Documents (18,4%), Personal Time (17,8%), Supervision (11,4%), Associated Activities (9,7%), Assignment (9,3%), Shift Change (4,8%), Doctor\'s Support (3,9%) and Admission Care (3,1%). It was observed that 50% of the nurses\' time was dedicated to indirect care interventions, 22% to direct care nursing interventions, 18% to personal time activities and 10% to related activities. These data corroborated with the researcher\'s indication that showed the need to consider personal time of the nurse\'s work and the performance of associated activities within the methods of personnel measurement recommended by official institutions. New investigations are needed to contribute to the improvement of the parameters related to the nursing personnel measurement in hospital institutions
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Identifying Nursing Activities to Estimate the Risk of Cross-contaminationSeyed Momen, Kaveh 07 January 2013 (has links)
Hospital Acquired Infections (HAI) are a global patient safety challenge, costly to treat, and affect hundreds of millions of patients annually worldwide. It has been shown that the majority of HAI are transferred to patients by caregivers' hands and therefore, can be prevented by proper hand hygiene (HH). However, many factors including cognitive load, cause caregivers to forget to cleanse their hands. Hand hygiene compliance among caregivers remains low around the world.
In this thesis I showed that it is possible to build a wearable accelerometer-based HH reminder system to identify ongoing nursing activities with the patient, indicate the high-risk activities, and prompt the caregivers to clean their hands.
Eight subjects participated in this study, each wearing five wireless accelerometer sensors on the wrist, upper arms and the back. A pattern recognition approach was used to classify six nursing activities offline. Time-domain features that included mean, standard deviation, energy, and correlation among accelerometer axes were found to be suitable features. On average, 1-Nearest Neighbour classifier was able to classify the activities with 84% accuracy.
A novel algorithm was developed to adaptively segment the accelerometer signals to identify the start and stop time of each nursing activity. The overall accuracy of the algorithm for a total of 96 events performed by 8 subjects was approximately 87%. The accuracy was higher than 91% for 5 out of 8 subjects.
The sequence of nursing activities was modelled by an 18-state Markov Chain. The model was evaluated by recently published data. The simulation results showed that the high-risk of cross-contamination decreases exponentially by frequency of HH and this happens more rapidly up to 50%-60% hand hygiene rate. It was also found that if the caregiver enters the room with high-risk of transferring infection to the current patient, given the assumptions in this study, only 55% HH is capable of reducing the risk of infection transfer to the lowest level. This may help to prevent the next patient from acquiring infection, preventing an infection outbreak. The model is also capable of simulating the effects of the imperfect HH on the risk of cross-contamination.
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Identifying Nursing Activities to Estimate the Risk of Cross-contaminationSeyed Momen, Kaveh 07 January 2013 (has links)
Hospital Acquired Infections (HAI) are a global patient safety challenge, costly to treat, and affect hundreds of millions of patients annually worldwide. It has been shown that the majority of HAI are transferred to patients by caregivers' hands and therefore, can be prevented by proper hand hygiene (HH). However, many factors including cognitive load, cause caregivers to forget to cleanse their hands. Hand hygiene compliance among caregivers remains low around the world.
In this thesis I showed that it is possible to build a wearable accelerometer-based HH reminder system to identify ongoing nursing activities with the patient, indicate the high-risk activities, and prompt the caregivers to clean their hands.
Eight subjects participated in this study, each wearing five wireless accelerometer sensors on the wrist, upper arms and the back. A pattern recognition approach was used to classify six nursing activities offline. Time-domain features that included mean, standard deviation, energy, and correlation among accelerometer axes were found to be suitable features. On average, 1-Nearest Neighbour classifier was able to classify the activities with 84% accuracy.
A novel algorithm was developed to adaptively segment the accelerometer signals to identify the start and stop time of each nursing activity. The overall accuracy of the algorithm for a total of 96 events performed by 8 subjects was approximately 87%. The accuracy was higher than 91% for 5 out of 8 subjects.
The sequence of nursing activities was modelled by an 18-state Markov Chain. The model was evaluated by recently published data. The simulation results showed that the high-risk of cross-contamination decreases exponentially by frequency of HH and this happens more rapidly up to 50%-60% hand hygiene rate. It was also found that if the caregiver enters the room with high-risk of transferring infection to the current patient, given the assumptions in this study, only 55% HH is capable of reducing the risk of infection transfer to the lowest level. This may help to prevent the next patient from acquiring infection, preventing an infection outbreak. The model is also capable of simulating the effects of the imperfect HH on the risk of cross-contamination.
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Distribuição do tempo das enfermeiras: identificação e análise em unidade médico-cirúrgica / Nursery time distribution: identification and analysis in a medical-surgical unitLuiz Carlos Bordin 11 June 2008 (has links)
Diante do impacto da distribuição do tempo de trabalho da profissional enfermeira na determinação de parâmetros adequados para a operacionalização do processo de dimensionar pessoal de enfermagem, este estudo teve por objetivo identificar e analisar a distribuição do tempo de trabalho das enfermeiras em uma unidade de internação médico-cirúrgica. Trata-se de uma pesquisa de campo, prospectiva, de abordagem quantitativa, do tipo exploratório-descritiva, realizada em um Hospital geral, privado, de grande porte da cidade de São Paulo. Para a consecução dos objetivos da pesquisa considerou-se, como população estatística, as atividades de enfermagem realizadas pelas enfermeiras durante os turnos de trabalho. O tamanho da amostra e o período amostral foram estabelecidos a partir da determinação de critérios relacionados à probabilidade mínima de ocorrência das atividades realizadas pelas enfermeiras, bem como do número de enfermeiras por turno e do intervalo estipulado para a realização das observações das atividades executadas pelas enfermeiras. A identificação das atividades de enfermagem realizadas pelas enfermeiras ocorreu mediante solicitação de que cada enfermeira relacionasse, por escrito, as atividades executadas no cotidiano de trabalho da Unidade, que foram, posteriormente, categorizadas de acordo com um sistema padronizado de linguagem (NIC) e classificadas em intervenções de cuidado direto, intervenções de cuidado indireto, atividades associadas e de tempo pessoal. Os dados foram coletados no período de 15 a 19 de outubro de 2007, por quatro observadoras de campo, contratadas e treinadas especificamente, para a realização deste procedimento. Obteve-se 1032 amostras das atividades realizadas pelas enfermeiras, verificando-se que as intervenções e atividades de enfermagem que mais utilizaram o tempo de trabalho das enfermeiras foram Documentação (18,4%), Tempo Pessoal (17,8%), Supervisão (11,4%), Atividades Associadas (9,7%), Delegação (9,3%), Passagem do Plantão (4,8%), Apoio ao Médico (3,9%) e Cuidados na Admissão (3,1%). Observou-se que 50% do tempo das enfermeiras foram dedicados às intervenções de cuidado indireto, 22% às intervenções de cuidado direto de enfermagem, 18% às atividades de tempo pessoal e 10% às atividades associadas. Estes dados corroboram a indicação de pesquisadores que apontam a necessidade de serem considerados o tempo pessoal dos trabalhadores de enfermagem e a realização das atividades associadas nos métodos de dimensionamento de pessoal preconizados pelos órgãos oficiais. Com este estudo evidenciam-se perspectivas para a realização de novas investigações no sentido de contribuir para o aperfeiçoamento dos parâmetros relacionados à temática dimensionamento de pessoal de enfermagem em instituições hospitalares / The aim of this study was to identify and to analyze the work time distribution of nurses in a medical-surgical unit, considering the impact of the work time distribution of nurses to determine the adequate parameters for the process to measure nursery personnel .This is a prospective, quantitative, exploratory-descriptive type field research, conducted in a large, private, general hospital in the city of São Paulo. The activities performed by nursery personnel during work shifts were considered as statistical population to reach our objectives. Sample size and period were established after determining the criteria related to the minimum occurrence possibility of activities performed by the nurses, as well as the number of nursery personnel per shift and the specific interval to perform activities by the nurses. The identification of the nursing activities occurred by asking each nurse to write a report mentioning their daily activities at the Unit, which were later categorized in accordance with the standard language system (NIC) and classified as direct care and indirect care interventions, associated activities and personal time. Data were collected during the period from the 15th to the 19th of October, 2007, by four field observers, specifically hired and trained for this procedure. 1032 samples were obtained from the nurses\' activities. The nursing activities and interventions that most used work time of the nurses were: Documents (18,4%), Personal Time (17,8%), Supervision (11,4%), Associated Activities (9,7%), Assignment (9,3%), Shift Change (4,8%), Doctor\'s Support (3,9%) and Admission Care (3,1%). It was observed that 50% of the nurses\' time was dedicated to indirect care interventions, 22% to direct care nursing interventions, 18% to personal time activities and 10% to related activities. These data corroborated with the researcher\'s indication that showed the need to consider personal time of the nurse\'s work and the performance of associated activities within the methods of personnel measurement recommended by official institutions. New investigations are needed to contribute to the improvement of the parameters related to the nursing personnel measurement in hospital institutions
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