NURSING TECHNOLOGY SUPPORTING FAMILY INVOLVEMENT IN CRITICALLY ILL PATIENTS: A SYSTEMATIC REVIEW

Background: Family involvement in the care of critically ill patients positively impacts treatment outcomes and patient well-being. Nursing technology has become an essential tool in facilitating family engagement   Aims: This study aims to conduct a systematic review of nursing technology that supports family involvement in critically ill patients. Methods: This article utilized a systematic review method. Articles were assessed using the JBI Critical Appraisal Checklist. The instruments were the JBI Critical Appraisal Checklist for Randomized Controlled Trials and the JBI Critical Appraisal Checklist for Cohort Studies. Literature from the past five years was obtained from four databases: Science Direct, Scopus, Springer Link, and ProQuest. Results: Out of 148 articles, 15 were analyzed. Various technologies (such as web-based platforms, tablets, SMS tools, and video conferencing) were used to provide information, enhance decision-making, and provide virtual access to family conferences. Although interventions varied, "Information sharing" and "Activation and participation" were most commonly implemented in the family involvement model. In studies that discussed the components of family involvement more comprehensively, interventions allowed for information adjustment through two-way communication and active family participation in the decision-making process. Conclusion: Based on the findings of this systematic review, it can be concluded that nursing technology has great potential in supporting family involvement in critically ill patients. This technology can significantly improve family well-being, communication, and decision-making. Further research can focus on a deeper understanding of the emotional impact experienced by families of critically ill patients due to the use of technology

Standardizing the Bedside Shift Report: Improving Communications and Promoting Patient Safety

PROBLEM: Nursing shift reports are integral to nursing as they allow for the transfer of critical information and responsibility of patient care from one nurse to another. Ineffective communication during shift-to-shift reports can contribute to gaps in patient care and breaches in patient safety, including medication errors, falls, and sentinel events. The greatest risk of communication breakdown is during transitions in care. CONTEXT: St. Louise Regional Hospital, a small community hospital, consisting of an eight-bed medical-surgical intensive care unit lacked structure in how handoff should occur and had variances in shift handoffs. Observation of the shift handoff at the nurses’ station revealed many communication gaps that have shown negative impacts on patient safety and outcomes. The improvement project described in this paper focused on evidence-based practices that support the benefits of bedside shift and implementations of standardized handoff tools. INTERVENTION: Intervention included an education in-service for unit managers, educational coordinators, and staff nurses to emphasize the important benefits of bedside shift report. MEASURES: The three components for evaluating improvement include outcome, process, and balancing measures to determine whether the improvement project has had the desired impact. The outcome measure expected to yield the following: direct observation of nurses during bedside report to calculate how often is being done, monitor for decrease in overtime due to more efficient shift-to-shift bedside reports, and a review of risk management reports observing for effect on the number and severity of medication errors. RESULTS: The outcome measure is to increase the nurses’ compliance with bedside shift report in the intensive care unit to at least 80% within six months of implementation. CONCLUSION: With the proposed change, bedside shift report will addresses all the safety hazards by reducing adverse events, such as medical errors, patient falls at shift change, and sentinel events. Bedside shift report improves patient safety, enhances the quality of care, improves patient and nurse satisfaction, decrease unnecessary healthcare expenditure, and saves time

Would You Know What to Do? A framework for thinking about design ethics developed in response to the creation of a digital tool that facilitates end-of-life decsion making.

Master of DesignArt and DesignUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/156118/1/DeepBlue_Keelean_2018_Mdes_Thesis.pd

‘The Going Digital Study’ – The implementation of electronic patient records in a paediatric tertiary hospital: Understanding the benefits and challenges for patients, parents and staff and the practical, ethical and legal implications

BACKGROUND: The Going Digital Study uniquely captured the experiences of all user groups before and after digital transformation of Great Ormond Street Hospital for Children (GOSH) whilst implementing an electronic patient record (EPR) system with a tethered patient portal in April 2019. This was critical and core to GOSH becoming a digital hospital, with benefits anticipated, yet challenges for all. AIM: To investigate the practical, ethical and legal considerations of implementing an EPR in a children’s tertiary hospital involving three stakeholder groups: children and young people (CYP), parents and staff. METHODS: A three phase, concurrent mixed methods, pre/post study design was utilised including both quantitative (survey) and qualitative (World Café workshops/interviews/focus group) data collection, analysis and synthesis. A systematic review of the literature was also conducted and was key to informing the examination of the experiences of users of an electronic patient record system in a children’s hospital setting and interpretation of the findings. RESULTS: Despite the challenges experienced by all stakeholders, including ethical and legal issues associated with CYP and parents accessing health data for the first time through the patient portal, meaningful portal access can be achieved from the age of 12 years of age. Families need support accessing health information via the portal. Clinicians need to have early conversations with parents about truth-telling and sharing diagnoses and/or prognoses, supporting families through the process of disclosure. Staff need prolonged support to balance clinical demands during implementation of and adjustment to the new clinical system, whilst continuing care provision and managing families’ expectations. CONCLUSION: Implementation and transition to an EPR system with a tethered patient portal is complex and takes time to embed. Setting realistic expectations and involving all stakeholders at all stages is paramount if benefits for all are to be fully realised. Managing this change process well, with prolonged engagement over time with all stakeholders, is essential if future utility is to be achieved. This requires an inclusive culture, in which the voice of all children and young people and parents is valued, and enabled through investment of appropriate resources, with equity of access a key priority

Longer-Term Psychiatric Inpatient Care for Adolescents

This open access book describes the theoretical underpinnings and operational aspects of delivering longer-term inpatient psychiatric care to adolescents experiencing severe, unremitting mental illness. The authorship is drawn from the multidisciplinary team that supports the Walker Adolescent Unit, located in Sydney, Australia. The book begins with an account of the planning and development of the unit, an examination of the physical environment, and the adaptations that have been made to ensure its functionality. There follows a consideration of the therapeutic milieu. The book describes clinical processes such as admission and discharge planning, formulation and case review. There is information about the specific roles of professionals and the therapies that they provide. The book describes the steps taken to maintain and enhance the physical wellbeing of patients. There are chapters dedicated to governance, and to training and education. The final chapter describes how the unit responded to challenges created by the COVID-19 pandemic

Sex trafficking in Nepal: A qualitative study of process and context. Abstract.

Thousands of Nepalese girls are trafficked to India and other neighbouring countries every year, primarily for sex work and the majority return to Nepal after spending a years in sex trade. The sub‐group of Nepalese girls who become involved in sex work via trafficking are the focus of this paper. The aim of this study was to increase understanding regarding the context of sex trafficking, the methods and means of trafficking, living conditions in brothels and survival strategies among trafficked girls. We conducted 33 in‐depth interviews in early 2013 with returned trafficking survivors (n=14) and policy‐makers, people working in trafficking related NGOs/INGOs (n=19) in Nepal. All 14 trafficking survivors were recruited in Nepal through the NGO working on trafficking field. The young girls trafficked from Nepal to India in this study were typically unmarried, illiterate and very young (8 to 14 years at the time of trafficking). The key methods of trafficking were false marriage, fake job offer, and abduction. Among the 14 respondents, some had spent one month and others nearly 5 years in Indian brothels. Respondents were either rescued, escaped or released by brothel owners. Four out of 14 were HIV positive. Most policy makers mentioned that poverty, unemployment and illiteracy are the causes behind the trafficking of young girls. The anti‐trafficking interventions need to be considered at a) community level before movement has begun; b) urban centres which are both source and transitory centres for trafficking; c) trafficking level when girls are highly mobile and when they are in brothels; and d) return from trafficking as girls to m ove back into the community

The Development of a Patient Portal for Use During Hospitalization: Pediatric Registered Nurses' Perspectives

Patient portals are innovative digital health technologies that are impacting nursing practice. A patient portal is an electronic tool that allows patients and parents to access personal health information. There has been a recent focus to implement patient portal technology when children are hospitalized. This manuscript style thesis examines pediatric registered nurses (RNs) perspectives of new technology including patient portals and its impact on nursing care. The first manuscript is a thematic literature review that was conducted to determine pediatric health care providers perceptions of patient portal implementation. Five articles were included in the analysis and only two articles focused exclusively on health care providers views. Four themes summarize the pediatric practitioner’s experiences with a portal technology: The Benefits of the Patient Portal; Impact on Provider Workload; User-Friendliness of the Patient Portal; and Health Care Providers Needs with Portal Implementation. Pediatric RNs voices are limited in currently published research. Therefore, the second manuscript is an interpretive description study conducted to explore pediatric RNs perspectives of new technology, including a proposed patient portal, on patient care. A total of 10 nurses participated in a semi-structured individual interview. Six themes represent the RNs views of new technology, including a proposed patient portal, and the impact on nursing care during a child’s hospitalization. The first three themes: Standing in Both Worlds, Reshaping the Care Triad, and Needing Support embody the nurses’ views on the implementation of technology in the pediatric inpatient units they work. The RNs previous experience with health technology implementation informs their perspectives of a new portal technology and its potential impact on patient care. The last three themes encompass the RNs views on the development of a patient portal: Improving Family Centred Care, Connecting with Care, and Anticipating Nursing Implications. Overall, the RNs are anticipating a positive impact the portal can have on the hospital experience for children and their family members. Even though the nurses report a feeling of standing in both worlds in regards to technology and its varied implementation, they are still optimistic. The RNs are also bringing awareness to the impact of all the new technology, not just a single piece, on patient care and the art of nursing. The integrated discussion provides recommendations to a larger ongoing study and discusses the impact on nursing practice, education, and research. Recruiting and involving pediatric RNs can take considerable time and effort but they can provide valuable insight and feedback on new technology, including patient portals, which may result in more sustained use.

Collecting resilience points for a smooth transition to adult healthcare services:co-creating a playful resource for Spina Bifida.

Background: The transition of young people with a disability or a chronic health condition, from paediatric to adult focused health and social care services, in Scotland, is known to be difficult. There is a significant body of evidence to suggest that a transition should start early, be holistic and inclusive, as well as structured to build essential capabilities and promote resilience. The nurse led project, reported here, was set to create a playful mechanism for meaningful interactions between young people, families and healthcare professionals involved in the transfer of care. Methodology: Salutogenic theory and efforts to enhance a ‘sense of coherence’ guided developments of a collaborative boardgame entitled ‘The Young Heroes’. Through participatory design and the ecological framing of resilience, the captured lived experience of adults with spina bifida who already transitioned to adult care, was used to enhance developments. Playtests with a range of stakeholders was used to further hone and validate the tool. Results: Seeking to co-create a tool to support effective transitions, enabled a team to craft and test a transition game that is easily accessible, inclusive, and sufficiently adaptable to fit different settings, communities and cultures. The open licence grants others a free access to download, play and adapt this game so it could be further used, enhanced and validated. <br/