In 1999, the Institute of Medicine estimated as many as 98,000 patients died each year in US hospitals as the result of medical errors. Five years later, another report estimated 195,000 people died unnecessarily. A recent study of patient safety in American hospitals concluded that 87% of Medicare deaths identified over a three-year period were "potentially preventable." The rapid response team (RRT) has been recommended as an effective strategy for reducing avoidable patient deaths as measured by patient safety indicator #4 (PSI#4), Death among surgical inpatients with treatable serious complications [formerly failure to rescue]. There is no research evidence to support the recommendation. The purpose of this exploratory research study was to describe RRT characteristics, determine RRT penetration, and measure PSI#4 (Death among surgical inpatients) rates among hospitals in a large metropolitan area hospital council. A retrospective, descriptive design was used during analysis of survey data collected from members of the hospital council and secondary analysis of administrative data submitted by the same hospitals to a regional data warehouse. All of the hospitals represented by survey submissions had implemented RRTs. The majority of teams was nurse-led and could be activated by a wide range of hospital staff and family members. The hospitals used evidence-based criteria for RRT activation. There was a downward trend in the regional PSI#4 rate from 2003 to 2008, which was not statistically significant, but may be considered clinically significant. Nurse administrators viewed RRTs as effectively supporting nursing care. This study provided a first look at RRTs in relation to an untested patient safety indicator that measured avoidable patient deaths. More research with a larger sample size with adequate power to support statistical analysis of differences in PSI #4 rates over time will provide evidence regarding relationships among hospital characteristics, RRT characteristics, and avoidable deaths among surgical inpatients. / text

Thesis (Ph. D.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains viii, 178 p. Vita. Includes abstract. Includes bibliographical references (p. 158-168).

Bakgrund: Sjuksköterskan upplever tidigt kontakt med döden och döendet. Oavsett om döden sker plötsligt eller varit väntad väcker den reaktioner som sjuksköterskan behöver hantera, samtidigt som den professionella yrkesrollen behöver upprätthållas. Syfte: Syftet var att beskriva sjuksköterskans erfarenheter av patienters död. Metod: Uppsatsen genomfördes som en allmän litteraturstudie med induktiv ansats. Tio artiklar valdes ut och bearbetades med hjälp av Forsberg och Wengströms innehållsanalys. Resultat: Resultatet bestod av tre kategorier: Känslomässiga upplevelser, Coping och Utmaningar. Resultatet visade att sjuksköterskor påverkades emotionellt när en patient de vårdat avled. Det framkom att ju djupare relationen var desto intensivare blev reaktionerna. Oerfarna sjuksköterskor upplevde att de hade brist på erfarenhet och utbildning när det gällde att hantera en patients död och känslorna som uppstod i samband med detta. För att hantera de känslomässiga upplevelserna använde sig sjuksköterskorna av olika copingstrategier, de mest framträdande var acceptans av döden, spirituella copingstrategier och stöd från arbetskamarater som upplevt samma situationer. Slutsats: Sjuksköterskor påverkas när patienter avlider, för att kunna bearbeta och hantera dessa känslor är coping ett betydelsefullt redskap. Sjukskötersor behöver mer stöd och utbildning för att känna sig trygga i mötet med döden samt för att öka förbredelserna inför patienters död. / Background: The nurse experiences early contact with death and dying patients. Regardless of whether the death occurs suddenly or expected, it evokes reactions that the nurse needs to deal with at the same time as the professional role needs to be maintained. Aim: The aim was to describe the nurse’s experiences of patients’ deaths. Method: The essay was designed as a general literature study with an inductive approach. Ten articles were selected and analysed using Forsberg and Wengström’s content analysis. Result: The result consisted of three main categories: Emotional experiences, Coping and Challenges. The results showed that nurses were emotionally affected when a patient they cared for died. It was presented that the deeper the relationship, the more intense the reactions were. Inexperienced nurses felt that they lacked experience and training in dealing with a patient’s death and the feelings that this entailed. In order to deal with the emotional experiences, the nurses used different coping strategies, the most prominent were acceptance of death, spiritual coping strategies and support from co-workers who experienced similar situations. Conclusion: Nurses are affected when patients die, in order to process and manage these emotions, coping is necessary. Nurses need more support and training to feel secure in the encounter with death and to increase the preparations for the death of patients.

Over 90,000 people die each year in Sweden, many of whom were in need of healthcare. Nurses are considered lacking education in grief management after the loss of a patient. The Swedish Healthcare System advocates continuity and that a relationship is created with the patient. In correlation with the death of a patient, the nurse may experience feelings of apathy, guilt and grief. The aim was to highlightfactors that affect the nurses’ experiences of managing grief following a patient’sdeath. The study was conducted as a general literature study with an inductive approach. The nurses’ grieving process was affected whether the cause of death wasexpected or unexpected. Furthermore, the relationship between nurse and patient could benefit the quality of the care but at the cost of making the grieving process more difficult. Nurses preferred informal support in managing the grief, and debriefing should be advocated. Grief is a human response in the loss of a relationship, and it is of importance that the nurse allows herself to grieve when a patient passes away. Finally, a lack of education regarding grief management wasnoted in the connection to a patient’s death, which is required for the nurse to maintain her own personal health and deliver high quality care. / I Sverige dör 90,000 människor varje år, en stor del av människorna var i behov av sjukvård. Sjuksköterskor anses sakna utbildning inom sorgehantering efter förlust av en patient. Den svenska sjukvården förespråkar kontinuitet och en relation skapas med patienten. I samband med en patients död kan sjuksköterskan uppleva känslor som apati, skuldkänslor och sorg. Syftet var att belysa faktorer som påverkar sjuksköterskors upplevelser av sorgebearbetning efter en patients död. Litteraturstudien genomfördes som en allmän litteraturstudie med induktiv ansats. Sjuksköterskornas sorgearbete påverkades av om dödsfallet var plötsligt eller väntat. Relationen mellan sjuksköterskan och patienten kunde gynna kvalitén på vården men gjorde även sorgeprocessen svårare. Sjuksköterskorna föredrog informellt stöd vid hantering av sorgen, och debriefing borde förespråkas. Sorg är en mänsklig reaktion vid förlust av en relation och det är av vikt att sjuksköterskan tillåter sig själv att sörja när en patient dör. Slutligen noterades en brist i utbildning kring sorgebearbetning i samband med patientens bortgång vilket krävs för att sjuksköterskan ska bibehålla den egna hälsan och ge vård av god kvalité.

Complex continuing care (CCC) is a healthcare setting where many patients die. Previous research has demonstrated that patient deaths can be meaningful and challenging for nurses. However, little knowledge exists regarding how the unique features of CCC influence nurses’ experiences in managing patient deaths. The objective of this study was to explore nurses’ experiences when patients die and their perceptions of support surrounding these experiences. Using interpretive description methodology, 13 memorable patient death experiences were explored in semi-structured interviews with licensed nurses (n=12) and nursing leaders (n=1). Criterion and theoretical purposeful sampling were used to develop a rich understanding of nurses’ experiences when patients die. Concurrent data collection and analysis uncovered five key intersubjective themes which described nurses’ experiences with individual deaths and how nurses’ experiences change overtime which included: (a) Professionally experiencing patients’ deaths: 'Engaging your left brain;’ (b) Personally experiencing patients’ deaths: ‘I’m a human being too;’ (c) Seeking resolution in the experience: ‘It was a good resolution;’ (d) Integrating professional and personal experiences: ‘Applying what you learn in your nursing life into your personal life and vice versa,’ and; (e) Supporting One Another in a Culture of Acknowledging Patients’ Deaths and Nurses’ Experiences: ‘They expect us just to take it, the nursing profession is like that.’ These findings suggest that nurses need support to facilitate the interpersonal and intrapersonal aspects of their experiences with patient death. This support should be grounded in a unit culture which openly accepts patient death and acknowledges nurses’ experience. Just-in-time education, peer mentorship and targeted support may further facilitate nurses’ ability to find resolution when patients die and support their on-going journey towards integrating death experiences in their lives and practice. / Thesis / Master of Science (MSc) / Complex continuing care (CCC) is a healthcare setting where many people die. Patient deaths can be difficult and sad for nurses. The goal of this study was to learn more about nurses’ experiences when patients die in CCC. Nurses were asked to share memories of when patients died in CCC. This study found that patient deaths influence nurses personally and professionally. Nurses with fewer death experiences were uncomfortable caring for dying patients. Feeling understood and having their experience recognized were meaningful ways that nurses wanted to be supported. It was very important to nurses that the deceased person was respected and nurses worried about patients’ family members. This research shows that nurses with fewer death experiences would benefit from unique education and support. It is important to support nurses by creating a culture that acknowledges death in CCC and nurses’ responses to patients’ deaths.

Every year, 2 million patients in the United States suffer with at least 1 hospital-acquired infection resulting in an estimated 99,000 deaths annually. The purpose of this exploratory single case study was to explore strategies healthcare managers in U.S. hospitals used to reduce hospital-acquired infections. The study included face-to-face, semistructured interviews with 5 healthcare managers from a hospital in Maryland who were successful in reducing these infections. The conceptual framework was human capital theory. Field notes, hospital documents, and transcribed interviews were analyzed to identify themes regarding strategies used by healthcare managers. The data analysis and coding process resulted in 5 major themes: use of HAI-related data; implementation of detailed cleaning method; implementation of define, measure, analyze, implement, and control; education and training of staff; and implementation of the Antimicrobial Stewardship Program. The findings from this study might benefit healthcare managers in implementing and sustaining successful strategies to reduce hospital-acquired infections. The implications for positive social change included reducing hospital-acquired infections, thereby leading to fewer hospitalization days for patients and a faster recovery time to return to normal life. Reducing hospital acquired infections might reduce patient deaths related to the infections.