Nursing Turbulence in Critical Care: Relationships With Nursing Workload and Patient Safety

2020 ◽  
Vol 29 (3) ◽  
pp. 182-191
Author(s):  
Jennifer Browne ◽  
Carrie Jo Braden
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Full Range ◽  
Operational Definition ◽  
Nursing Workload ◽  
Turbulence Scale ◽  
Safety Risk ◽  
Care Relationships

Background Increased nursing workload can be associated with decreased patient safety and quality of care. The associations between nursing workload, quality of care, and patient safety are not well understood. Objectives The concept of workload and its associated measures do not capture all nursing work activities, and tools used to assess healthy work environments do not identify these activities. The variable turbulence was created to capture nursing activities not represented by workload. The purpose of this research was to specify a definition and preliminary measure for turbulence. Methods A 2-phase exploratory sequential mixed-methods design was used to translate the proposed construct of turbulence into an operational definition and begin preliminary testing of a turbulence scale. Results A member survey of the American Association of Critical-Care Nurses resulted in the identification of 12 turbulence types. Turbulence was defined, and reliability of the turbulence scale was acceptable (α = .75). Turbulence was most strongly correlated with patient safety risk (r = 0.41, n = 293, P < .001). Workload had the weakest association with patient safety risk (r = 0.16, n = 294, P = .005). Conclusions Acknowledging the concepts of turbulence and workload separately best describes the full range of nursing demands. Improved measurement of nursing work is important to advance the science. A clearer understanding of nurses’ work will enhance our ability to target resources and improve patients’ outcomes.

Sociotechnical Issues of Tele-ICU Technology

2011 ◽  
pp. 225-240 ◽  
Author(s):  
Peter Hoonakker ◽  
Kerry McGuire ◽  
Pascale Carayon
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Virtual Teams ◽  
Life Quality ◽  
Quality Of Work Life ◽  
Icu Patients ◽  
Care Services ◽  
Video And Audio

Intensive care units (ICUs) are highly complex organizations where lives are hanging by a thread. Approximately 400,000 to 500,000 people die each year in American ICUs. The highly complex environment and large responsibilities put a burden on ICU staff including physicians and nurses. Research has shown that ICU physicians and nurses report high levels of workload and burnout that are related to lower quality of care provided to ICU patients and patient safety problems. Furthermore, there is a shortage of ICU personnel. In the past decades, the number of critical care beds has increased while the number of hospitals offering critical care services has decreased. Telemedicine may be one solution to deal with the shortage of ICU personnel. The tele-ICU technology represents the application of telemedicine in ICUs: ICU patients are monitored remotely by physicians and nurses trained in critical care. Recent estimates show that a nurse in the tele-ICU environment can monitor as many as 50 ICU patients in different ICUs, using the most recent telemedicine technology that provides access to patient information as well as video and audio links to patient rooms. The physicians and nurses in the tele-ICU collaborate with the physicians and nurses in the ICUs in what can be considered virtual teams. We know little about how the virtual team characteristics affect communication and trust between the participating members of the team. Furthermore, we know little about how the technological environment of the tele-ICU may affect the physicians and nurses’ workload and possibly burnout, and how this may affect quality of care and patient safety. In this chapter we describe the ICU and tele-ICU from a sociotechnical perspective, and examine how organizational factors may affect the jobs of nurses in the tele-ICU, and possible consequences for quality of work life, quality of care and patient safety.

Sociotechnical Issues of Tele-ICU Technology

2011 ◽  
pp. 1879-1895 ◽  
Author(s):  
Peter Hoonakker ◽  
Kerry McGuire ◽  
Pascale Carayon
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Quality Of Care ◽  
Virtual Teams ◽  
Life Quality ◽  
Quality Of Work Life ◽  
Icu Patients ◽  
Care Services ◽  
Video And Audio

Intensive care units (ICUs) are highly complex organizations where lives are hanging by a thread. Approximately 400,000 to 500,000 people die each year in American ICUs. The highly complex environment and large responsibilities put a burden on ICU staff including physicians and nurses. Research has shown that ICU physicians and nurses report high levels of workload and burnout that are related to lower quality of care provided to ICU patients and patient safety problems. Furthermore, there is a shortage of ICU personnel. In the past decades, the number of critical care beds has increased while the number of hospitals offering critical care services has decreased. Telemedicine may be one solution to deal with the shortage of ICU personnel. The tele-ICU technology represents the application of telemedicine in ICUs: ICU patients are monitored remotely by physicians and nurses trained in critical care. Recent estimates show that a nurse in the tele-ICU environment can monitor as many as 50 ICU patients in different ICUs, using the most recent telemedicine technology that provides access to patient information as well as video and audio links to patient rooms. The physicians and nurses in the tele-ICU collaborate with the physicians and nurses in the ICUs in what can be considered virtual teams. We know little about how the virtual team characteristics affect communication and trust between the participating members of the team. Furthermore, we know little about how the technological environment of the tele-ICU may affect the physicians and nurses’ workload and possibly burnout, and how this may affect quality of care and patient safety. In this chapter we describe the ICU and tele-ICU from a sociotechnical perspective, and examine how organizational factors may affect the jobs of nurses in the tele-ICU, and possible consequences for quality of work life, quality of care and patient safety.

scholarly journals The Effect of An Educational Program on Nurses’ Practices Regarding The Implementation of Patient Care and Safety Measures During Nasogastric Tube Feeding in The Critical Care Units in Syria

2021 ◽  
Vol 17 (29) ◽  
pp. 59
Author(s):  
Yaser Adnan Abo Jeesh ◽  
Elham Fath-Elalium Mohammed Khalid ◽  
Ishraqa Mohammed Ahmed Elbashier
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Intensive Care ◽  
Quality Of Care ◽  
High Risk ◽  
Patient Care ◽  
Educational Program ◽  
Safety Measures ◽  
Before And After

The intensive care unit (ICU) is considered a high- risk area in the hospital because of the severity of injuries and the high liability of occurrences associated with ICU. Critically ill patients are at high risk for actual or potential life-threating health problems. Moreover, critical care nurses must develop their knowledge, skills, and safe practice in acute areas where patients require more detailed observation or intervention to deliver safe and effective care. Objectives: This study aimed to assess the effect of an educational program on nurses’ practices regarding the implementation of patient care and safety measures during enteral feeding. Design: The quasi-experimental design was used in this study. Methods: The study was conducted from June to September 2020. All registered nurses who were working in the intensive care units during the period of data collection comprised the sample. Based on the nurses’ needs regarding the condition of their competencies during the initial assessment, we developed and designed the educational program. This program consists of two parts: theory and practical. The program contains workshop (8 hours) per day and educational pamphlet handout. The workshop consists of PowerPoint presentations, group discussions, and training scenarios. Results: This study was carried out with 48 nurses working in the previous intensive care units. The nurses’ score were improved after the program regarding to nurses’ age, qualification, and experience. The overall study found a statistically significant relationship of this procedure before and after the implementation of the educational program (p<0.001). Conclusion: There has been remarkable and variation improvement of nurses performance after they received the education program. The results show that a statistically significant difference was found before and after implementing the program regarding the nurses’ age, qualification, and experience. It is recommended to pay more attention to these nurses by helping them to improve their knowledge and practices in all nursing interventions. Furthermore, it is necessary to improve nurses’ awareness regarding the quality of care and patient safety. It was also found that the poor knowledge and practice and its complications have a negative impact on the quality of care and patient safety. 

scholarly journals A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

2021 ◽  
Vol 12 (02) ◽  
pp. 199-207
Author(s):  
Liang Yan ◽  
Thomas Reese ◽  
Scott D. Nelson
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Controlled Trials ◽  
Clinical Pharmacists ◽  
Randomized Controlled ◽  
The Impact

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.

Value-based dentistry: Putting the patient first

2016 ◽  
Vol 7 (3) ◽  
pp. 126-129 ◽  
Author(s):  
Sreenivas Koka ◽  
Galya Raz
Keyword(s):  
Risk Management ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Dental Care ◽  
Time Cost ◽  
Safety Risk ◽  
The Cost ◽  
Over Time

What does ‘value’ mean? In the context of dental care, it can be defined as the quality of care received by a patient divided by the cost to the patient of receiving that care. In other words: V =Q/C, where Q equals the quality improvement over time, which most patients view in the context of the outcome, the service provided and safety/risk management, and C equals the financial, biological and time cost to the patient. Here, the need for, and implications of, value-based density for clinicians and patients alike are explored.

Relationship Between Performance Measurement and Accreditation: Implications for Quality of Care and Patient Safety

2005 ◽  
Vol 20 (5) ◽  
pp. 239-252 ◽  
Author(s):  
Marlene R. Miller ◽  
Peter Pronovost ◽  
Michele Donithan ◽  
Scott Zeger ◽  
Chunliu Zhan ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Performance Measurement

scholarly journals Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

2015 ◽  
Vol 8 (6) ◽  
pp. 75 ◽  
Author(s):  
Mu'taman Jarrar ◽  
Hamzah Abdul Rahman ◽  
Mohammad Sobri Don
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Health Plan ◽  
Care Service ◽  
Health Care Service ◽  
Working Environment ◽  
Annual Reports ◽  
Related Factors ◽  
Global Initiatives

<p><strong>BACKGROUND &amp; OBJECTIVE:</strong> Demand for health care service has significantly increased, while the quality of healthcare has become both a national and an international priority. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia.</p><p><strong>DESIGN:</strong> A narrative review of the literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) and the MOH Annual Reports in Malaysia were reviewed.</p><p><strong>RESULTS: </strong>The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10<sup>th</sup> Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors.</p><p><strong>CONCLUSION: </strong>There is no single intervention of optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.</p>

scholarly journals Adjustment of oxygen use by means of pulse oximetry: an important tool for patient safety

2010 ◽  
Vol 8 (4) ◽  
pp. 449-455 ◽  
Author(s):  
Telma de Almeida Busch Mendes ◽  
Paola Bruno de Araújo Andreoli ◽  
Leny Vieira Cavalheiro ◽  
Claudia Talerman ◽  
Claudia Laselva
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Physical Therapy ◽  
Confidence Interval ◽  
Pulse Oximetry ◽  
Patient Care ◽  
Physical Therapists ◽  
Severe Damage ◽  
Margin Of Error

ABSTRACT Objective: To assess patient's level of oxygenation by means of pulse oximetry, avoiding hypoxia (that causes rapid and severe damage), hyperoxia, and waste. Methods: Calculations were made with a 7% margin of error and a 95% confidence interval. Physical therapists were instructed to check pulse oximetry of all patients with prescriptions for physical therapy, observing the scheduled number of procedures. Results: A total of 129 patients were evaluated. Hyperoxia predominated in the sectors in which the patient was constantly monitored and hypoxia in the sectors in which monitoring was not continuous. Conclusions: Professionals involved in patient care must be made aware of the importance of adjusting oxygen use and the risk that non-adjustment represents in terms of quality of care and patient safety.

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