Blockchain-IoT-Driven Nursing Workforce Planning for Effective Long-Term Care Management in Nursing Homes

Due to the global ageing population, the increasing demand for long-term care services for the elderly has directed considerable attention towards the renovation of nursing homes. Although nursing homes play an essential role within residential elderly care, professional shortages have created serious pressure on the elderly service sector. Effective workforce planning is vital for improving the efficacy and workload balance of existing nursing staff in today’s complex and volatile long-term care service market. Currently, there is lack of an integrated solution to monitor care services and determine the optimal nursing staffing strategy in nursing homes. This study addresses the above challenge through the formulation of nursing staffing optimisation under the blockchain-internet of things (BIoT) environment. Embedding a blockchain into IoT establishes the long-term care platform for the elderly and care workers, thereby decentralising long-term care information in the nursing home network to achieve effective care service monitoring. Moreover, such information is further utilised to optimise nursing staffing by using a genetic algorithm. A case study of a Hong Kong nursing home was conducted to illustrate the effectiveness of the proposed system. We found that the total monthly staffing cost after using the proposed model was significantly lower than the existing practice with a change of −13.48%, which considers the use of heterogeneous workforce and temporary staff. Besides, the care monitoring and staffing flexibility are further enhanced, in which the concept of skill substitution is integrated in nursing staffing optimisation.

ECMO During a Pandemic: A COVID-19 Quality Improvement Process

Extracorporeal membrane oxygenation is a modified form of cardiopulmonary bypass and a complex adult critical care therapy. No evidence appears to exist on sustaining relevant quality nursing standards during a pandemic. The aim for this quality improvement process was to address nursing provision in real time related to extracorporeal membrane oxygenation in a pandemic, providing fundamentals for future readiness. The Ishikawa fishbone diagram and a Plan-Do-Study-Act cycle were methods used. Process changes included implementation of a communication algorithm, an alternative nursing care model, increased nursing staffing and leadership visibility, use of perfusion services for nursing task support, and minimized nursing documentation. Changes applied were successful. We recommend increasing nursing staffing volume and support resources, applying a communication algorithm, and minimizing documentation requirements. These strategies are generalizable to other clinical nursing areas in similar pandemics or disasters.

Staff Shortage in German Intensive Care Units During the COVID-19 Pandemic - Not only a Sensed Dilemma: Results from a Nationwide Survey

Background: The surge in patients during the COVID-19 pandemic has exacerbated the looming problem of staff shortage in German ICUs possibly leading to worse outcomes for patients. Methods: Within the German Evidence Ecosystem CEOsys network, we conducted an online national mixed-methods survey assessing the standard of care in German ICUs treating patients with COVID-19. Results: A total of 171 German ICUs reported a median ideal number of patients per intensivist of 8 (interquartile range, IQR = 3rd quartile - 1st quartile = 4.0) and per nurse of 2.0 (IQR = 1.0). For COVID-19 patients, the median target was a maximum of 6.0 (IQR = 2.0) patients per intensivist or 2.0 (IQR = 0.0) patients per nurse. Targets for intensivists were rarely met by 15.2% and never met by 3.5% of responding institutions. Targets for nursing staffing could rarely be met in 32.2% and never in 5.3% of responding institutions.Conclusions: Shortages of staffing in the critical care setting are eminent during the COVID-19 pandemic and might not only negatively affect patient outcomes, but also staff wellbeing and healthcare costs. A joint effort that scrutinizes the demands and structures of our health care system seems fundamental to be prepared for the future.

Factors related to the implementation of Evidenced-based practice (EBP) of nursing staffing levels in Hospitals: A Literature Review

The implementation of Evidenced-based practice (EBP) was one of the factors in increasing the quality of health services as an ideal problem-solving approach. The ability of nurses to appliance EBP was influenced by many factors, not only on individual nurses consisting by the support of unit leader and colleague. The purpose of this study was to determine the factors associated with the implementation of EBP at the care room level establishing on the support of coworkers and nursing managers. This writing used a literature review study, from several databases namely PubMed, ProQuest, Google Scholar, and ScienceDirect with a limitation of the last 5 years. 17 journals met the inclusion criteria and the results of a literature review study show: eight journals conclude that the support of colleagues and authority in changing practices affects the implementation of EBP, 13 journals concluded the role of managerial nurses affects the implementation of EBP consisting of leadership support and mentorship including the lack of knowledge and skills of nursing leaders regarding EBP. Data from the collected and identified literature study clearly showed that EBP knowledge and skills of nursing leaders related to EBP are important factors in increasing the implementation of EBP but co-worker factors can be a supporter and also an obstacle to the implementation of EBP if it is not well managed.

Nurse Staffing and Nursing Home Deficiency of Care for Inappropriate Psychotropics Use in Residents With Dementia

Psychotropics use to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs) has been the focus of policy attention due to their adverse effects. We hypothesized that NHs with lower nursing staffing would have greater reliance on psychotropics use to control BPSD. A NH deficiency of care can be cited for inappropriate psychotropics use (F-tag 758). The association between the occurrence of F-758 tags and nurse staffing in residents with dementia was examined using the 2017-18 Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs). Staffing measures included nursing hours per resident day (HPRD) and registered nurse (RN) skill-mix. Generalized linear mixed models that included covariates (NH location, bed size, ownership, proportion of residents with dementia/depression/psychiatric disorders and with Medicare/Medicaid) estimated the magnitude of the associations. There were 1,872 NHs with F-758 tags indicating inappropriate psychotropics use for NH residents with dementia. NHs with greater RN and certified nurse assistant (CNA) HPRD had significantly lower odds of F-758 tags (OR=0.59 54, 95% CI=0.47 44-0.73 66; OR=0.87, 95% CI=0.77-0.99, respectively) and similar findings were found in NHs with greater RN skill-mix (OR=0.14 10, 95% CI=0.05 04-0.37 25). There were no significant associations between the occurrence of F-758 tags and licensed practice nurse and unlicensed nurse aide HPRD. This study found that RN and CNA staffing had inverse associations with inappropriate psychotropic use citations among residents with dementia. NHs with higher RN staffing ratios may be better able to implement alternatives to pharmacological approaches for BPSD. It is suggested that NHs be equipped with adequate nurse staffing levels to reduce unnecessary psychotropics use.

Appropriate Nurse Staffing Levels for U.S. Nursing Homes

US nursing homes are required to have sufficient nursing staff with the appropriate competencies to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident. Minimum nurse staffing levels have been identified in research studies and recommended by experts. Beyond the minimum levels, nursing homes must take into account the resident acuity to assure they have adequate staffing levels to meet the needs of residents. This paper presents a guide for determining whether a nursing home has adequate and appropriate nurse staffing. We propose five basic steps to: (1) determine the collective resident acuity and care needs, (2) determine the actual nurse staffing levels, (3) identify appropriate nurse staffing levels to meet residents care needs, (4) examine evidence regarding the adequacy of staffing, and (5) identify gaps between the actual staffing and the appropriate nursing staffing levels based on resident acuity. Data sources and specific methodologies are analyzed, compared, and recommended. The goal is to assist nursing home nurses and administrators to ensure adequate nursing home staffing levels that protect resident health, safety, and well-being.

Validation of an Instrument to guide Nursing Staffing in Obstetric Rooming in

ABSTRACT Objectives: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units. Method: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis. Results: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach’s alpha of 0.62, 0.85 and 0.89. Conclusions: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.