Decision-making in an emergency department: A nursing accountability model

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Introduction Nurses that work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design Data were analysed, codified and triangulated using qualitative ethnographic content analysis. Participants and research context This research is set in a large emergency department in the Midlands area of England. Data was collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies Ethical considerations Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations amongst the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen

In-reach specialist nursing teams for residential care homes : uptake of services, impact on care provision and cost-effectiveness

Background: A joint NHS-Local Authority initiative in England designed to provide a dedicated nursing and physiotherapy in-reach team (IRT) to four residential care homes has been evaluated.The IRT supported 131 residents and maintained 15 'virtual' beds for specialist nursing in these care homes. Methods: Data captured prospectively (July 2005 to June 2007) included: numbers of referrals; reason for referral; outcome (e.g. admission to IRT bed, short-term IRT support); length of stay in IRT; prevented hospital admissions; early hospital discharges; avoided nursing home transfers; and detection of unrecognised illnesses. An economic analysis was undertaken. Results: 733 referrals were made during the 2 years (range 0.5 to 13.0 per resident per annum)resulting in a total of 6,528 visits. Two thirds of referrals aimed at maintaining the resident's independence in the care home. According to expert panel assessment, 197 hospital admissions were averted over the period; 20 early discharges facilitated; and 28 resident transfers to a nursing home prevented. Detection of previously unrecognised illnesses accounted for a high number of visits. Investment in IRT equalled £44.38 per resident per week. Savings through reduced hospital admissions, early discharges, delayed transfers to nursing homes, and identification of previously unrecognised illnesses are conservatively estimated to produce a final reduction in care cost of £6.33 per resident per week. A sensitivity analysis indicates this figure might range from a weekly overall saving of £36.90 per resident to a 'worst case' estimate of £2.70 extra expenditure per resident per week. Evaluation early in implementation may underestimate some cost-saving activities and greater savings may emerge over a longer time period. Similarly, IRT costs may reduce over time due to the potential for refinement of team without major loss in effectiveness. Conclusion: Introduction of a specialist nursing in-reach team for residential homes is at least cost neutral and, in all probability, cost saving. Further benefits include development of new skills in the care home workforce and enhanced quality of care. Residents are enabled to stay in familiar surroundings rather than unnecessarily spending time in hospital or being transferred to a higher dependency nursing home setting

Evaluation of the organisation and delivery of patient-centred acute nursing care

In 2002, a team of researchers from the School of Nursing, University of Salford were commissioned by Bolton Hospitals NHS Trust to evaluate the delivery and organisation of patient-centred nursing care across the acute nursing wards within the Royal Bolton Hospital. The key driver for the commissioning of this study arose from two serious untoward incidents that occurred in the year 2000. Following investigation of both these events the Director of Nursing in post at that time believed that poor organisation and delivery of care may have been a contributory factor. Senior nurses in the Trust had also expressed their concern that care may not be organised in a way that made best use of the skills available

Nurses\u27 Job Satisfaction in Northwest Arkansas

During the month of October 2013, approximately 450 registered nurses working at a hospital in Northwest Arkansas were surveyed. All registered nurses were included in the study and were given the survey with instructions to complete it and return it within 30 days. A modified version of the McCloskey/Mueller Satisfaction Scale by Tourangeau was utilized, evaluating factors as they related to job satisfaction such as control and responsibility, scheduling, professional opportunities, praise and recognition, balance of family and work, relationship with coworkers, salary/vacation/benefits, maternity leave/child care, care delivery, social contact, research opportunities, and decision making. These variables were all rated individually using the scale of seven factors. Ninety-three were returned, giving a response rate just over twenty percent, 20.67%. Of the 93 returned, 14 were incomplete, approximately 15.1%. After receiving the surveys, the data was entered into an excel spreadsheet. Demographics such as gender, employment status, were given numeric values. Analyses were completed using the IBM SPSS Statistics version 20. Demographics were analyzed along with factors affecting job satisfaction and factors affecting likelihood to remain at the hospital or in their current position. The only two statistically significant subscales included satisfaction with work conditions and supervisor support and satisfaction with collegial relationships and support. When grouped as likely or unlikely to remain working at the current hospital until retirement, 39 of the 80 RNs (49%) who responded to this item did not intend to stay until retirement. From these findings, the hospital will be able to improve retention strategies. The limitations of this study were that a better response rate would have been achieved had we been able to mail out the surveys and a reminder to return them after a certain amount of time, as well as the fact that the median age of those surveyed was 28 years, so it was unrealistic to ask if they planned on staying until retirement. Overall, a great deal can be taken away from this study and used to improve nursing turnover in this particular hospitals and in hospitals elsewhere

Nurses worth listening to

[Executive Summary]: In 2001 the University of Southern Queensland (USQ) in conjunction with the Queensland Nurses’ Union (QNU) undertook a study of enrolled and registered nurse and assistant-in-nursing members. In Queensland, registered nurses (RNs) and enrolled nurses (ENs) are qualified to practice nursing and are licensed by the Queensland Nursing Council (QNC), an independent body responsible for the setting and maintaining of nursing standards in the State. Although not licensed by the QNC Assistants in Nursing (AINs) work within a nursing model of care. These workers may also have other titles such as Personal Care Assistants or Carers. Regardless of their title, they work under the direct or indirect supervision of a RN. The study was confined to nurses employed in the public sector (acute hospitals, community health), the private sector (acute hospitals and domicillary nursing) and the aged care sector (government and non-government). In 2004 a similar study was conducted. The major findings of the 2004 study were that nurses believed: • nursing is emotionally challenging and physically demanding • their workload is heavy and that their skills and experience as a professional nurse are poorly rewarded (remunerated or recognised) • work stress is high and morale is perceived to be poor and, similar to 2001, deteriorating • there are insufficient staff in their workplace and that the skill mix is inadequate • the majority of nurses are unable to complete their work to their level of professional satisfaction in the time available. While there were some changes between 2001 and 2004 (some could be seen as improvements, others deteriorations), the overwhelming impression one has, especially from the qualitative data, is of a workforce frustrated and unable to provide safe and quality care to their patients/clients within the time allocated

Implementation of TeamSTEPPS

This scholarly project focused on implementing Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in an emergency room (ER). The aim of TeamSTEPPS is to improve patient outcomes by educating healthcare professionals on communication and teamwork skills. TeamSTEPPS teaches healthcare professionals leadership skills, shared mental models, mutual trust, and closed loop communication. The purpose of the scholarly project was to improve teamwork and communication. The study method was descriptive analysis of 51 pre and posttest questionnaires, specifically looking for increased knowledge of TeamSTEPPS tools. The participants included: ER physicians, ER nurses, ER certified nursing assistants/health unit coordinators, a pharmacy technician, public safety officers, and patient revenue management organization (PRMO). Further research is needed to evaluate how to significantly increase staff knowledge on TeamSTEPPS tools in a class setting

Decreasing Caregiver Stress

Stress is both critical and personal experience and has significant effects on caregivers’ physical, mental, and social well-being. The nature of caregiving and the responsibility to work and serve individuals at their illness conditions are very personal encounters that often result in adverse effects on the health and well-being of caregivers (Frederick, 2016). A decrease in stress experience can lead to the satisfaction of caregiver roles and improvement of patient’s quality of life (Choi, Jisun & Boyle, Diane, 2013; Yada, Nagata, & Inagaki, 2014). This scholarly project determined that evidence-based stress management interventions have decreased the perceived stress in caregivers. The scholarly project identified low levels of stress among research participants, and how evidence-based interventions decreased caregiver stress by increasing their knowledge and awareness of evidence-based stress management interventions. The results of this scholarly project agree with the literature that caregiver stress experience can be decreased through the implementation of evidence-based stress management interventions (Blom, Zarit, Groot Zwaaftink, Cuijpers, & Pot, 2013). It is significant to implement evidence-based stress management interventions to decrease perceived stress among caregivers

Developing a patient measure of safety (PMOS)

Background: Tools that proactively identify factors that contribute to accidents have been developed within high-risk industries. Although patients provide feedback on their experience of care in hospitals, there is no existing measure which asks patients to comment on the factors that contribute to patient safety incidents. The aim of the current study was to determine those contributory factors from the Yorkshire Contributory Factors Framework (YCFF) that patients are able to identify in a hospital setting and to use this information to develop a patient measure of safety (PMOS). Methods: Thirty-three qualitative interviews with a representative sample of patients from six units in a teaching hospital in the north of England were carried out. Patients were asked either to describe their most recent/current hospital experience (unstructured) or were asked to describe their experience in relation to specific contributory factors (structured). Responses were coded using the YCFF. Face validity of the PMOS was tested with 12 patients and 12 health professionals, using a 'think aloud' approach, and appropriate revisions made. The research was supported by two patient representatives. Results: Patients were able to comment on/identify 13 of the 20 contributory factors contained within the YCFF domains. They identified contributory factors relating to communication and individual factors more frequently, and contributory factors relating to team factors, and support from central functions less frequently. In addition, they identified one theme not included in the YCFF: dignity and respect. The draft PMOS showed acceptable face validity. Discussion: Patients are able to identify factors which contribute to the safety of their care. The PMOS provides a way of systematically assessing these and has the potential to help health professionals and healthcare organisations understand and identify, safety concerns from the patients' perspective, and, in doing so, make appropriate service improvements