Managing information, interaction and team building in nurse shift-change handovers

Whilst there is a wealth of literature on medical handovers, discourse analytic work based on recorded interactional data on these pivotal speech events in health care is less prevalent. This case study of a shift-change nursing handover at a UK hospital Medical Assessment Unit (MAU) takes a microanalytical perspective on nurses’ talk and interaction, which enables us to examine its structural and functional complexity at utterance level. Our methodological approach comprises observations, one semi-structured interview with senior nursing staff (and many informal conversations with various staff), and in total twelve audio-recordings of interactions during, and around, the twice-daily shift-change handovers. By adopting ‘a multiple goals in discourse’ perspective and the framework of activity analysis, we demonstrate the nurses’ interactional management of multiple discourse and activity roles and pursuance of goals that transcend the medically and institutionally crucial transmission of information. This shows the nurses’ orientation to the handover task as not only a structured institutionally regulated event, but also one that tolerates more spontaneous activities that can potentially contribute to team cohesion and staff well-being.

Patient Experience in Obstetrics in a Military Patient Satisfaction Survey: Findings and Recommendations for Improvement

ABSTRACT Introduction This study examines the care experience of obstetric patients within the Military Health System and compares them to those of medical and surgical care patients. Specifically, the study seeks to (1) examine how obstetric inpatient experience ratings differ from medical and surgical inpatient experience ratings, (2) understand specific aspects of care that drive overall experience ratings within this population, (3) test whether adherence to nursing practices such as hourly rounding and nurse leader visits affect experience ratings, and (4) describe ways that patient experience information can be presented to healthcare providers to improve performance. Materials and Methods Data for this study include Military Health System patient experience survey data (based on the Hospital Consumer Assessment of Healthcare Providers and Systems) collected from 2011 through 2019. Analysis includes data collected from 338,124 patients aged 18 years and older. Our analysis involved z-test comparisons of patient experience measure scores, trend analysis, logistic regression-based driver analysis, and correlations. Results Obstetric ratings are generally lower than those of medical and surgical patients; however, they have been improving at a slightly faster rate year over year. Effective nurse communications with patients are a particularly strong driver for improving their overall care experiences, and practices like hourly nurse rounding, nurse leader visits, and nurse–patient shift change conversations are positively correlated with obstetric patient experience ratings. Conclusions This study contextualizes how obstetric inpatient experience ratings differ from those of medical and surgical care patients. Healthcare administrators and policymakers should be aware that obstetric patients may have unique needs and expectations that lead to patient experience ratings differing from those of medical and surgical patients. Effective nurse–patient communications, hourly rounding, nurse leader visits, and nurse–patient shift change conversations could be strategies used to improve obstetric experience ratings.

Utilization of Hydraulic Completion Units in the Delaware Basin

In conjunction with the industry and basin-wide paradigm shift to drilling and completing extended laterals, Matador Resources Company (the operator) made significant plans in 2018 that would focus activity toward wells with laterals greater than one-mile. One operational hurdle to overcome in this shift change was the effective execution of removing frac plugs and sand at increased depths during a post-stimulation frac plug millout. Utilization of coiled-tubing units (CTUs) had been proven to be a successful millout method in one-mile laterals, but not without risk. Rig-assisted snubbing units coupled with workover rigs (WORs) provided for less risk with higher pulling strength capabilities and the ability to rotate tubing, but would often require operational time of up to twice that of typical coiled-tubing unit millouts. The stand-alone, rigless Hydraulic Completion Unit (HCU) was ultimately tested as a solution and proved to alleviate risks in extended lateral millouts while providing operational time and cost comparable to coiled-tubing units. The operator has since performed post-stimulation frac plug millouts on ~45 horizontal wells in the Delaware Basin using HCUs. The majority of these wells carried lateral lengths of over 1.5 miles. Results and benefits observed by the operator include but are not limited to the list below: 1.) Ability to safely and consistently reach total depth (TD) on extended laterals through increased snubbing/pickup force and the HCU's pipe rotating ability 2.) Ability to pump at higher circulation rates in high-pressured wells (>3,500 psi wellhead pressure) to assist in effective wellbore cleaning 3.) Smaller footprint which allows for the utilization of two units simultaneously on multi-well pads 4.) Time and cost comparable to a standard coiled-tubing millout, particularly on multi-well pads.

On importance of new group therapy for decrease of agitation during the critical period of nursing shift changes on an acute psychiatric inpatient floor

Background: Agitation is a significant challenge to mental healthcare. This project aims to examine the effects of implementing an interactive mental flexibility group to decrease incidences of agitation in the inpatient psychiatric population during nursing shift change.Methods: This observational study, conducted on the acute inpatient psychiatric unit of an academic hospital in Central NY, USA. This 23-bed unit admits psychiatric patients from the E.D. and local hospitals. The art-based interactive group was implemented during the critical period of nursing shift change, which is known for having an increased agitation due to caregiver changes. We tracked group attendance, incidences of agitation, and as-needed medication administration for agitation. We administered a Likert-type scale to rate emotions before and after each session.Results: We observed a dramatic decrease in as needed medications for agitation 1 month prior to group (n = 576) compared to 3 months during group (n = 120). The new group constitutes a significant decrease in agitation incidents. Patients indicated an increase in happiness (mean = 0.46, SD = 0.978), decrease in sadness (mean = 0.44, SD = 1.078), and decrease in anger (mean = 1.15, SD = 1.984).Conclusions: Our project indicates that the patients and staff well receive interactive group sessions in an acute psychiatric unit. The group sessions helped to decrease agitation and medication administration.Future directions: We recommend the utilization of interactive mental flexibility groups on acute psychiatric units to promote emotional regulation, especially during nursing shift change.

CONSTRUÇÃO DE UM INSTRUMENTO DE PASSAGEM DE PLANTÃO

Objetivo: descrever a construção de um instrumento de passagem de plantão utilizando a metodologia SBAR (Situation-Background- Assessment-Recommendation). Método: trata-se de estudo metodológico para construção de um instrumento de passagem de plantão em uma enfermaria de gastroenterologia cirúrgica. Foi realizada uma revisão bibliográfica abrangente sobre a metodologia SBAR. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da instituição cenário da pesquisa. Resultados: os itens constantes do instrumento foram: dados de identificação do paciente que incluíram: data, leito, nome, idade sexo, data de admissão; indicadores: sistema de classificação de paciente, presença de acompanhante; Situação (S): diagnóstico médico e diagnósticos de enfermagem; Breve história (B): alergias, co-morbidades, histórico cirúrgico, isolamento/precauções e barreiras para a comunicação; Avaliação (A): sinais vitais, alimentação, eliminações, curativos, drenos, cateteres e medicamentos; Recomendação (R): interconsultas, intervenções de enfermagem e intercorrências. Conclusão: O instrumento contribui para a padronização da passagem de plantão dos profissionais de enfermagem.Descritores: Gerenciamento da prática profissional, Estudos de validação, Sistema de comunicação no hospital, Equipe de enfermagem.CONSTRUCTION OF A SHIFT CHANGE INSTRUMENTObjective: to describe the construction of a shift change instrument using the SBAR (Situation-Background-Assessment-Recommendation) methodology. Methodolgy: this is a methodological study for the construction of an instrument of a shift change in a surgical gastroenterology ward. A comprehensive bibliographic review was done on the SBAR methodology. The Research Ethics Committee of the scenario research institution approved the study. Results: the items included in the instrument were: patient identification data that included: date, bed, name, age, sex, date of admission; indicators: patient classification system, presence of companion; Situation (S): medical diagnosis and nursing diagnoses; Background (B): allergies, comorbidities, surgical history, isolation / precautions and barriers to communication; Assessment (A): vital signs, nutritional aspects, eliminations, dressings, drains, catheters and medications; Recommendation (R): interconsultations, nursing interventions and intercurrences. Conclusion: The instrument contributes to the standardization of nurses’ change of shift.Descriptors: Practice management, Validation studies, Hospital communication systems, Nursing team.CONSTRUCCIÓN DE UN INSTRUMENTO DE PASO DE PLANTÓNObjetivo: describir la construcción de un instrumento de paso de turno utilizando la metodología SBAR (Situation-Background-Assessment- Recommendation). Método: se trata de un estudio metodológico para la construcción de un instrumento de paso de turno en una enfermería de gastroenterología quirúrgica. Se realizó una revisión bibliográfica exhaustiva sobre la metodología SBAR. El estudio fue aprobado por el Comité de Ética en Investigación de la institución escenario de la investigación. Resultados: los ítems constantes del instrumento fueron: datos de identificación del paciente que incluyeron: fecha, lecho, nombre, edad sexo, fecha de admisión; indicadores: sistema de clasificación de pacientes, presencia de acompañante; Situación (S): diagnóstico médico y diagnósticos de enfermería; Breve historia (B): alergias, comorbilidades, histórico quirúrgico, aislamiento / precauciones y barreras para la comunicación; Evaluación (A): signos vitales, alimentación, eliminaciones, curativos, drenajes, catéteres y medicamentos; Recomendación (R): interconsultas, intervenciones de enfermería e intercurrencias. Conclusión: El instrumento contribuye a la padronización de los cambios de turno de los profesionales de enfermería.Descriptores: Gestión de la práctica profesional, Estudios de validación, Sistemas de comunicación en hospital, Grupo de enfermeira.