A Vision for Excellence by Design

2019 ◽  
Vol 28 (4) ◽  
pp. 247-254 ◽  
Author(s):  
Patricia A. Hickey
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Health Care Systems ◽  
Well Being ◽  
Organizational Health ◽  
Critical Care Nurses ◽  
Team Members ◽  
Care Systems ◽  
Care Improvement ◽  
The Impact

Generating evidence for care improvement has characterized my program of research spanning 20 years. Six domains are highlighted to advance the science and practice of critical care nursing in today’s complex health care systems. Employee well-being and taking care of team members are key priorities for successful leaders. Understanding that patient and staff outcomes are inextricably linked strengthens the need for care environments to be healing and holistic for staff and patients. The American Association of Critical-Care Nurses’ Healthy Work Environment framework empowers staff and optimizes the experience for patients, their families, and care teams. Appropriate staffing, guided by contemporary acuity measurement, takes into account the cognitive workload and complexity of nursing. Committing to a culture of certification and ensuring staffing models with appropriately educated and experienced nursing staff will remain important. In the past decade, we have established the impact of these specific nursing characteristics on improved patient outcomes. Understanding the attributes of empathic and empowered teams is requisite for authentic leadership. Interventions to mitigate moral distress are necessary to foster moral resilience among critical care nurses. The challenge for the future will be to support organizational health through the coexistence of highly reliable processes and clinical innovation. Excellence is achieved when systems are designed to support professional practice and clinical teams and environments.

scholarly journals Critical Care Nurses’ Experiences During the COVID-19 Pandemic: A US National Survey

2021 ◽  
pp. e1-e7
Author(s):  
Jill L. Guttormson ◽  
Kelly Calkins ◽  
Natalie McAndrew ◽  
Jacklynn Fitzgerald ◽  
Holly Losurdo ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Moral Distress ◽  
Community Support ◽  
Well Being ◽  
The United States ◽  
Critical Care Nurses ◽  
Emotional Symptoms

Background Given critical care nurses’ high prepandemic levels of moral distress and burnout, the COVID-19 pandemic will most likely have a tremendous influence on intensive care unit (ICU) nurses’ mental health and continuation in the ICU workforce. Objective To describe the experiences of ICU nurses during the COVID-19 pandemic in the United States. Methods Nurses who worked in ICUs in the United States during the COVID-19 pandemic were recruited to complete a survey from October 2020 through early January 2021 through social media and the American Association of Critical-Care Nurses. Three open-ended questions focused on the experiences of ICU nurses during the pandemic. Results Of 498 nurses who completed the survey, 285 answered the open-ended questions. Nurses reported stress related to a lack of evidence-based treatment, poor patient prognosis, and lack of family presence in the ICU. Nurses perceived inadequate leadership support and inequity within the health care team. Lack of consistent community support to slow the spread of COVID-19 or recognition that COVID-19 was real increased nurses’ feelings of isolation. Nurses reported physical and emotional symptoms including exhaustion, anxiety, sleeplessness, and moral distress. Fear of contracting COVID-19 or of infecting family and friends was also prevalent. Conclusions Intensive care unit nurses in the United States experienced unprecedented and immense burden during the COVID-19 pandemic. Understanding these experiences provides insights into areas that must be addressed to build and sustain an ICU nurse workforce. Studies are needed to further describe nurses’ experiences during the COVID-19 pandemic and identify effective resources that support ICU nurse well-being.

scholarly journals Impact of the COVID-19 pandemic on radiologists

2020 ◽  
Vol 72 ◽  
pp. 177-180
Author(s):  
Ganesh Hegde ◽  
Christine Azzopardi ◽  
Patrick Hurley ◽  
Harun Gupta ◽  
Naga Varaprasad Vemuri ◽  
...  
Keyword(s):  
Health Care Systems ◽  
Continuing Professional Development ◽  
Well Being ◽  
Radiology Workflow ◽  
Protective Equipment ◽  
Ability To Work ◽  
Innovative Solutions ◽  
The World ◽  
Care Systems ◽  
The Impact

COVID-19 pandemic is one of the biggest crises faced by health-care systems in the recent times. The aim of this study was to assess the impact of the COVID-19 pandemic on radiology workflow, working pattern, training and continuing professional development (CPD) activities, as well as personal well-being of the radiologists during the pandemic. Material and Methods: Questionnaire designed to gather the opinions regarding the impact of the COVID-19 pandemic was distributed to radiologists throughout the world in electronic format. Anonymized responses were obtained and analyzed. Two hundred radiologists, working in 17 different countries, responded to our questionnaire. Majority of the respondents were from India (72.8%) and 70% of the them were in the age group of 25–45 years. About 80% of respondents felt that they were well protected or moderately well protected in terms of the personal protective equipment (PPE), however, most of them felt that the use of PPE had affected their ability to work. Similar number of radiologists felt that there was significant reduction in the radiology workload. More than half of the respondents felt that their working patterns were altered by the pandemic with drastic impact on teaching, CPD activities, and personal well-being. COVID-19 pandemic has had profound impact on the radiologists all over the world. Learning from the experiences of the first wave should be used to provide innovative solutions to some of the challenges posed to provide better radiology services, training, and improve the well-being of radiologists if we encounter a similar situation in the future. COVID-19 pandemic had significant impact on radiologists. Radiologists felt that they were well or moderately well protected with PPEs; however, PPEs affected their ability to work. Radiology workflow was significantly reduced in the pandemic with more radiologists working from home. COVID-19 pandemic had deleterious effect on radiologist’s well-being, education, and CPD activities.

Children: paying the price of Bolsonaro’s social policy reform in Brazil

2021 ◽  
Author(s):  
Rafael da Silva Barbosa ◽  
Gary Spolander ◽  
Maria Lúcia Teixeira Garcia
Keyword(s):  
Social Work ◽  
Health Care Systems ◽  
Well Being ◽  
Right Wing ◽  
Life Chances ◽  
The Social ◽  
Social Policy Reform ◽  
Care Systems ◽  
Life Journey ◽  
The Impact

The impact of social inequality on children has enormous implications for young people throughout their life journey by negatively impacting their health, well-being and life chances. Following the democratisation of Brazil, significant change resulted in improvements to the social welfare and health care systems, which had begun to address long-standing social and health problems. This article critically explores the implications of current retrograde right-wing populist political government policies for Brazilian children within the context of efforts to reduce income inequality and improve the life chances of children. While recognising the enormous challenges of poverty, racial discrimination, precarity and socio-economic conditions, social work has recognised that the enactment of the profession requires political engagement and action against all inequality in professional practice. The implications of retrogressive policy are explored, and the authors call upon the profession globally to recognise these structural socio-economic challenges and question whether social work can afford not to be engaged in seeking change.

Patient self-testing in chronic disease management

2020 ◽  
Vol 44 (2) ◽  
pp. 81-87 ◽  
Author(s):  
Maurice J. O’Kane
Keyword(s):  
Chronic Disease ◽  
Health Care Systems ◽  
New Technology ◽  
Glucose Monitoring ◽  
Well Being ◽  
Evidence Base ◽  
Self Testing ◽  
Care Systems ◽  
The Impact ◽  
Robust Evidence

AbstractChronic disease poses a major burden to patients and health care systems. This review considers how patient self-testing can contribute to the management of chronic disease. Self-testing can only confer benefit if it occurs in the context of an empowered patient who has the skills and training to translate test results into meaningful actions. The benefits may include improved clinical outcomes, greater patient convenience and improved psychological well-being; separately and together these may contribute to reduced costs of care. As self-testing may be expensive and burdensome to patients, it is important that its use in chronic disease is supported by a robust evidence base confirming its utility and efficacy. The design of studies to assess the impact of self-testing poses challenges for the researcher and the quality of evidence presented is often variable. Randomised controlled trials (RCTs) provide more robust evidence than observational studies; the intervention under study is not just self-testing but includes the educational support to allow patients to use results effectively. This review discusses the evidence base relating to patient self-testing in diabetes, anticoagulant monitoring and in renal transplant patients and in particular highlights the impact of new technology developments such as flash glucose monitoring in diabetes.

scholarly journals Barriers and values of moral distress among critical care nurses

2016 ◽  
Author(s):  
◽  
Melissa A. Wilson
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Formal Analysis ◽  
Critical Care Nurses ◽  
Nursing Program ◽  
Review Of Literature ◽  
Effective Interventions ◽  
Doctor Of Philosophy ◽  
Distress Scale ◽  
The Impact

This dissertation explores the presence of moral distress and effective interventions to lessen its impact on critical care nurses. Manuscript one was completed prior to entering the doctor of philosophy in nursing program but was instrumental in building the foundation for successive work within this dissertation. An exploratory, descriptive designed study was used to examine moral distress and identify situations in which nurse's experienced high levels of moral distress. Nurses completed a 38-item moral distress scale, a coping questionnaire, and indicated their preferred methods for institutional support in managing distressing situations. Manuscript two includes a formal analysis of the Moral Distress Theory and identified limitations in the existing theoretical model based on a review of literature. Finally, manuscript three is a study identifying barriers and values during moral distress situations that can be used to potentially target interventions aimed at lessening the impact of moral distress.

scholarly journals Yogic Interventions for Psycho-Physical Well-Being Under Covid-19 Times & After

2020 ◽  
Vol 15 (3) ◽  
pp. 80-88
Author(s):  
Nishtha Malik ◽  
Aditi Sharma
Keyword(s):  
Preventive Measures ◽  
Human Life ◽  
Health Care Systems ◽  
Belief System ◽  
Well Being ◽  
Emotional Challenges ◽  
Fresh Perspective ◽  
Care Systems ◽  
The Impact ◽  
Better Than

Health indeed is Wealth. The Corona Virus Pandemic has impacted the best health-care systems world-wide; even as the world grapples with the massive loss of human life causing pain to millions. The Pandemic is no more just a medical health challenge; it has thrown up spiritual and emotional challenges as it is affecting our belief system.  Prevention is Better than Cure is the mantra. Since, there is no allopathic medicine solution available; people are adopting various measures like social distancing and personal sanitization. There is an urgent need to assist the individuals to take all the preventive measures possible to boost their immunity, improve the respiratory system, and lessen the anxiety, stress, and depression. It can be difficult to not feel anxiety and sometimes panic over the coronavirus outbreak, with the onslaught of updates on news and social media.  Yoga has emerged as the perfect tool that an individual can follow to establish physical, mental, and spiritual balance to develop robust health and combat physical and emotional challenges. Yoga offers another path, a fresh perspective with which to deal with events that are beyond our control. The different asanas of yoga can help us to prevent COVID-19 by boosting our immune system and managing the stress that one is going through in this time of uncertainty. This study tries to specifically evaluate the impact of the preventive measures undertaken through Yoga practice. 126 respondents from different states of India were requested to perform yoga daily for 30 days. Significant changes were observed and are mentioned in detail. 

Values and self-perception of behaviour among critical care nurses

2021 ◽  
pp. 096973302199973
Author(s):  
Kaoru Ashida ◽  
Aki Kawakami ◽  
Tetsuharu Kawashima ◽  
Makoto Tanaka
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Cross Sectional Study ◽  
Critical Care Nurses ◽  
Working Environment ◽  
Self Perception ◽  
Cross Sectional ◽  
Team Members ◽  
The Difference ◽  
Tokyo Medical

Background: Moral distress has various adverse effects on nurses working in critical care. Differences in personal values, and between values and self-perception of behaviour are factors that may cause moral distress. Research aims: The aims of this study were (1) to identify ethical values and self-perception of behaviour of critical care nurses in Japan and (2) to determine the items with a large difference between value and behaviour and the items with a large difference in value from others. Research design: A nationwide, cross-sectional study was conducted. Participants and research context: We developed a self-administered questionnaire with 28 items, which was completed by 1014 critical care nurses in Japan. The difference between value and self-perception of behaviour was calculated from the score of each value item minus the score of each self-perception of behaviour item. The size of the difference in value from the others was judged by the standard deviation of each item. Ethical considerations: The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214, M2019-045). Results: The items with a large difference between value and behaviour sources were related to the working environment and decision-making support. The items with a large difference in value from others were related to hospital management and disclosure of information to patients. Discussion: Improving the working environment for nurses is important for reducing moral distress. Nurses are faced with a variety of choices, including advocating for patients and protecting the fair distribution of medical resources, and each nurse’s priorities might diverge from those of other team members, which can lead to conflict within the team. Conclusion: This study revealed items with particularly high risks of moral distress for nurses. The results provide foundational information that can guide the development of strategies to mitigate moral distress.

The impact of schizophrenic pathology on well-being and health care systems

1997 ◽  
Vol 42 (1) ◽  
pp. 62S
Author(s):  
Nicholas A. Keks
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Well Being ◽  
Care Systems ◽  
The Impact

scholarly journals Using evidence-based debriefing to combat moral distress in critical care nurses: A pilot project

2019 ◽  
Vol 9 (12) ◽  
pp. 1 ◽  
Author(s):  
Nicole M. Fontenot ◽  
Krista A. White
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Medical Center ◽  
Academic Medical Center ◽  
Pilot Project ◽  
Critical Care Nurses ◽  
Evidence Based ◽  
Self Awareness ◽  
Post Intervention ◽  
The Impact

Objective: Moral distress (MD) is a problem for nurses that may cause despair or disempowerment. MD can have consequences like dissatisfaction or resignation from the nursing profession. Techniques such as evidence-based debriefing may help nurses with MD. Creating opportunities for critical care nurses to debrief about their MD might equip them with the tools needed to overcome it. Measuring MD by using the Moral Distress Thermometer (MDT) could provide insight into how debriefings help nurses. The purpose of this pilot project was to examine the impact of evidence-based debriefing sessions on critical care nurses’ sense of MD.Methods: This pilot project used a quasi-experimental, one-group, before-during-after design. Critical care nurses (N = 21) were recruited from one unit at a large academic medical center. Four debriefing sessions were held every 2 weeks. Participants completed the MDT 2 weeks before the first session, at the end of each session they attended, and 1 month after the debriefing sessions.Results: In the pilot project, participants felt that debriefing was helpful by increasing their self-awareness, giving them time to commune with colleagues, and encouraging them to improve self-care habits; however, MDT scores did not change significantly when comparing pre with post intervention scores (t(12) = 0.78, p = .450).Conclusions: The use of debriefing may help nurses gain self-awareness of MD and it may offer nurses strategies to build moral resilience.

An Overview of Digital Health in the Transition of Pediatric to Adult Epilepsy Care

2020 ◽  
Vol 09 (04) ◽  
pp. 106-113
Author(s):  
Ysabeau Bernard-Willis ◽  
Emily De Oliveira ◽  
Shaheen E Lakhan
Keyword(s):  
Health Management ◽  
Digital Health ◽  
Health Care Systems ◽  
Well Being ◽  
Pediatric Care ◽  
Medical Mistrust ◽  
Patient Portals ◽  
Language Therapy ◽  
Adult Care ◽  
Care Systems

AbstractChildren with epilepsy often have impairments in cognitive and behavioral functioning which may hinder socio-occupational well-being as they reach adulthood. Adolescents with epilepsy have the added worry of health problems while starting the transition from family-centered pediatric care into largely autonomous adult care. If this transition is not appropriately planned and resourced, it may result in medical mistrust, nonadherence, and worsening biopsychosocial health as an adult. In recent years, there has been increased availability of digital health solutions that may be used during this stark change in care and treating teams. The digital health landscape includes a wide variety of technologies meant to address challenges faced by patients, caregivers, medical professionals, and health care systems. These technologies include mobile health products and wearable devices (e.g., seizure monitors and trackers, smartphone passive data collection), digital therapeutics (e.g., cognitive/behavioral health management; digital speech–language therapy), telehealth services (e.g., teleneurology visits), and health information technology (e.g., electronic medical records with patient portals). Such digital health solutions may empower patients in their journey toward optimal brain health during the vulnerable period of pediatric to adult care transition. Further research is needed to validate and measure their impact on clinical outcomes, health economics, and quality of life.

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