An Inpatient Rehabilitation Interprofessional Care Pathway for Traumatic Hip Fracture: A Pilot Quality Improvement Project

Background: Each year over 300,000 older adults are hospitalized for hip fracture. The impact of the cost of hip fracture on the US health care system is estimated to be as high as $9 billion, with the typical cost of a hip fracture episode around$30,000. Formalized pathways have been developed and successfully utilized for many patient presentations, including hip fracture, in the acute setting. Although this research is important to the comprehensive care of the elderly hip fracture patient, very little research exists that outlines evidence-based best-practice for patients in the post-acute recovery period. Purpose: The primary aim of this project was to develop an evidence-based, comprehensive, coordinated, and interprofessional care pathway for hip fracture patients in the acute rehabilitation setting to improve the percentage of patients discharging to community settings by 20% from current baseline by the end of the pilot period. Methods: The design of this project was an observational cohort study. Descriptive statistics will be used to compare intervention groups to controls, including frequencies and distributions. Results: The hip fracture tool itself had inconclusive results, the impacts of the effects on team work and enhanced coordination of the care team was realized through reducing institutionalized days for hip fracture patients in acute rehabilitation

Training healthcare assistants working in adult acute inpatient wards in Psychological First Aid: An implementation and evaluation study.

WHAT IS KNOWN ON THE SUBJECT: Healthcare assistants are untrained and unregistered frontline staff but are expected to be proactive in preventing and responding to 'untoward' incidents quickly and efficiently when working within adult acute inpatient psychiatric settings. Healthcare assistants should be trained to provide enhanced care to service users residing in acute psychiatric settings. To date, a training programme in Psychological First Aid has not been expended in such a setting with nonregistered staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: The study demonstrates that training healthcare assistants in Psychological First Aid is useful in improving their confidence in caring for service users, therapeutic engagement with service users and ward culture in general. WHAT ARE THE IMPLICATIONS FOR PRACTICE: A training programme in Psychological First Aid for healthcare assistants to enhance ward culture can be implemented in different practice environments. Psychological First Aid is harmonious with nursing values and provides healthcare assistants with a relevant, useful and easily understood toolkit to apply in acute psychiatric settings. ABSTRACT: Introduction Healthcare assistants working within adult acute inpatient psychiatric settings are untrained and unregistered, however, they can contribute to quality service if they receive some training. Psychological First Aid training has never been expended in these settings, so this study intends to fill this gap in the existing evidence with this category of healthcare personnel. Aim The aim of this study was to introduce and evaluate first aid training for healthcare assistants. Method A pre/post design was adopted to gather data using questionnaires and interviews. The groups of participants included 16 healthcare assistants trained in Psychological First Aid, a sample of service users and four ward managers. Results Post-training, (a) healthcare assistants and service users ranked the therapeutic milieu of the ward more favourably, (b) the self-efficacy of the healthcare assistants increased, and the number of 'untoward' incidents decreased, and (c) health care assistants' confidence in their skills was high. The ward manager interviews post-training revealed four themes: (a) staff utilization of new skills and renewed enthusiasm, (b) calmer atmosphere on the ward and staff togetherness, (c) confidence and reflection on practice and (d) therapeutic engagement. Discussion Training healthcare assistants is useful in improving staff confidence, therapeutic engagement with service users and ward culture in general. Implications for practice Techniques and skills learnt are relevant and useful to healthcare assistants and provide an easily understood toolkit that is harmonious with nursing values. If executed correctly, the training can enhance practice and care outcomes and the overall service user experience

Nursing Students\u27 Self-Efficacy and Attitude: Examining the Influence ofthe Omaha System In Nurse Managed Centers

Self-efficacy, or confidence, as an outcome behavior has been identified as influencing nursing job satisfaction and retention. Clinical learning environments and teaching strategies that build and support perceived self-efficacy are critical aspects of preparing new nurses for their entry and continuing role as professional nurses in today\u27s information-intensive data-management healthcare environment. The purpose of this pre-test post-test study is to measure, using the C-scale (Grundy, 1992), nursing students\u27 self-efficacy to perform patient assessment in Nurse Managed Centers (NMC) after one semester of using the Omaha System documentation framework. Nursing students\u27 attitudes of preparation for using Standardized Nursing Languages (SNL) in the future was also examined. Bandura\u27s (1977, 19986) theoretical model of self-efficacy provided the conceptual framework. Students\u27 overall self-efficacy scores increased significantly over the 12 week study. Use of the Omaha System \u27prepared a little\u27 to \u27very prepared\u27 90% of student nurses for future use of SNL. Continued use of the Omaha System documentation framework in Nurse Managed Center clinicals as a tool for understanding SNL is recommended.

Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

A Nurse-Led Delirium Prevention Program for Hospitalized Older Adults

Background: Delirium, an acute decline in cognition and attention, is a common and severe problem for hospitalized older adults, with incidence rates ranging from 11% to 56%, and 1.5 to 4.0-fold increased risk of death. Despite its multifaceted nature, delirium is preventable in 30% to 40% cases. A California academic community hospital experienced a higher incidence of delirium (30% to 40%) in adult non-critical care units as compared to delirium rates (11% to 29%) in similar hospital settings. The higher rates of delirium were believed to be due to fragmented, inconsistent, and non-individualized delirium care. Purpose/Objectives: The purpose of this evidence-based, quality improvement project was to determine whether a nurse-led Delirium Prevention Bundle (DPB) when compared to usual care, reduces delirium incidence in hospitalized geriatric patients. Method: The project was a two-group, pre-post design using the nurse-led DPB educational intervention for nurses. The project was implemented in two stages: 1) an educational session for nurses on completing the DPB including the Delirium Risk Factor Identification (DRFI) tool, targeted delirium prevention strategies (based on the Hospital Elder Life Program), and nursing documentation; and 2) the DPB implementation on a 26-bed geriatric unit at a 250-bed academic community medical center. Baseline data on delirium incidence rates were collected on eligible patients on the geriatric unit for one month before the intervention and prospectively on patients who were eligible following the educational intervention. Demographic data on eligible patients and unit nursing staff as well as nurse knowledge of delirium and adherence to the DPB were collected. Statistical analyses included descriptive statistics, t-tests, and chi-square test. Results: implementation of nursing education of the DPB, the addition of the DRFI tool, and documentation template in the hospital Electronic Health Record, was effective in reducing delirium incidence rate from 16% to 14% (p =<.001) and improving documentation compliance from <1% to 17%. Nurse delirium knowledge was also improved significantly (pre-test mean 80.0, post-test mean 94.3, p=.029). Conclusion: Nursing education utilizing the DPB is an effective approach in increasing nurse awareness of preventive care for delirium and decreasing incident delirium in this population

Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative

Background: despite major policy initiatives in the United Kingdom to enhance women's experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought. Methods: a Continuous Quality Improvement (CQI) approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset. Results: questionnaires were received from 68 (46%) of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women's physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required. Conclusions: this was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their feedback on whether revisions were pragmatic and achieved anticipated improvements in care quality. Their initial involvement ensured priority areas for change were identified and implemented. Their subsequent feedback highlighted further important areas to address as part of CQI to ensure best quality care continues to be implemented. Our findings could support other maternity service organisations to optimise in-patient postnatal services

Telehealth Wound Applications: Barriers, Solutions, and Future Use by Nurse Practitioners

Telehealth applications are an emerging technology in a new era of health care system technologies. Although telehealth technologies, including a number of different applications, are used by various members of the health care team, nurse practitioners (NPs) utilize them for a variety of patient issues across healthcare settings. The Indiana University-Purdue University Fort Wayne Computer Science Department has recently developed a wound scanning application, WoundView for nurse practitioners to utilize in different healthcare settings. Such telehealth mobile applications are used in clinics, home health, rural, and remote settings where a physician may not be readily available. However, there are obstacles with the current practice of using telehealth technologies such as a dire need for evidence-based research that supports attainable solutions for these barriers. Extensive, ongoing research will allow NPs to anticipate an immense mainstream implementation of telehealth applications in the very near future