Effectiveness of nursing rounds in the Intensive Care Unit on workplace learning

Objectives: To evaluate the implementation of a regular Nursing Round as an educational strategy for workplace learning in an intensive care unit with a single room environment. Research design: A multiple methods design was used. Fifty-four Nursing Rounds were observed and nurses (n = 40) completed bespoke evaluative surveys. Structured observational data and open-ended survey responses were submitted to content analysis and descriptive statistics were used to analyse survey findings. Results: Nursing Rounds involved a diverse range of participants, most frequently nurses. The content most frequently discussed included empirical clinical issues where nurses decided on nursing care actions to address these issues. The most frequently observed outcome of Nursing Rounds was knowledge translation. Nursing Rounds were perceived to positively influence application of evidence in practise, identification of areas for practise improvement and ability to communicate clinical information. Two categories emerged from analysis of open-ended survey questions; (1) ‘Positive learning environment’, where nurses described Nursing Rounds as a social learning experience; and (2) ‘Impediments to Nursing Rounds’, including difficulty attending Nursing Rounds due to competing priorities. Conclusion: Nursing Rounds enabled evidence-based learning that enhanced inter-disciplinary collaboration. Further investigation may be required to understand how to enable nurses to attend more frequently, and generate a more holistic, evidence-based discussion

Nurses’ Perceived Barriers to Bedside Handover and Their Implication for Clinical Practice

Background and Rationale: Bedside handover during the change of shift allows nurses to visualize patients and facilitate patient participation, both purported to improve patient safety. But, bedside handover does not always occur and when it does, it may not involve the patient. Aim: To explore and understand barriers nurses perceive in undertaking bedside handover. Methods: A cross-sectional survey was administered to 200 nurses working on medical wards, recruited from two Australian hospitals, one private and one public. As part of the survey, there was one open-ended question asking about perceived barriers to bedside handover. Content analysis was used to analyze data. Barriers were assessed using a determinant framework. Results: The open-ended question was answered by 176 (88%) participants. Three categories were identified. First, censoring the message showed nurses were concerned about patients and third-parties hearing sensitive information. In the second category, disrupting the communication flow, nurses perceived patients, family members, other nurses and external sources, interrupted the flow of handover and increased its duration. Finally, inhibiting characteristics demonstrated that individual patient and nurse views or capabilities hindered bedside handover. Barriers to bedside handover were determined to relate to individual nurse factors, patient factors, social, political and legal factors, and guideline factors. Linking Evidence to Action: Suggestions for enhancing bedside handover include debunking nurses’ misconceptions, reflecting on nurses’ viewpoints, using active educational approaches, and promotion of legal requirements to heighten nurses’ confidence dealing with sensitive information. Regular patient rounding, and standardized handover may enable patient involvement in handover. Finally, reviewing the local context to ensure organizational processes support bedside handover is recommended

Older patient and family discharge medication communication: A mixed-methods study.

RATIONALE, AIMS, AND OBJECTIVES: Medication discrepancies place patients discharged from hospital at risk of adverse medication events. Patient and family participation in medication communication may improve medication safety. This study aimed to examine older medical patient and family participation in discharge medication communication. METHODS: Two-phased mixed-methods study. Data were collected from July 2018 to May 2019. Phase 1 comprised observations and a questionnaire of 30 patients pre-hospital discharge. Phase 2 involved telephone interviews with 11 patients and family members post-hospital discharge. Phase 1 analysis included descriptive statistics and deductive content analysis. Inductive content analysis was used in Phase 2. Phase 1 and 2 findings were integrated. RESULTS: For Phase 1, observational data were deductively coded against the "continuum of patient participation"; information-giving was the most frequent level of participation observed on the continuum, followed by information-seeking, shared decision making, non-involved, and finally autonomous decision making. For descriptive statistics, written communication tools, noise, and interruptions were frequently observed during medication communication. In Phase 2, three categories were found about how patients and families participate, and the factors influencing their participation: (a) obtaining comprehensive medication information; (b) preferred approaches for receiving information; and (c) speaking about medications in hospital. Integrated findings showed that written communication tools and routine hospital tasks may promote, while lack of family presence and environmental factors may hinder medication communication. Patients' and families' role in medication communication ranged from asking questions to influencing decisions, and was enhanced by health care professionals' patient-centred communication. CONCLUSIONS: More active patient and family participation could be achieved by encouraging them to identify medication-related problems. To create a climate for patient and family participation, health care professionals should use written communication tools, capitalize on participation opportunities during routine hospital tasks, and use patient-centred communication

Participatory Governance and Healthcare. Opportunities and Perils

Since the 1990s, public policy has made incremental transformations towards greater involvement of common citizens in policymaking. The vast body of literature on healthcare service co-production and patient empowerment testifies to the persistent relevance of participatory ideas and practices in the healthcare debate. This chapter analyzes participation through the lens of an interpretative approach to public policy. It discusses the macro, meso and micro connections between participation and the evolution of contemporary democracies. Secondly, it explores the dilemmas and unintended consequences that result from using participation as the ultimate justification for policy interventions. Finally, it highlights the potential depoliticizing effect of participatory procedures on decisions about collective problems and social goals

Individualised care and related concepts

The aim of this chapter is to describe and analyse significant evidence of individualised care as related to other concepts, such as care and caring behaviours, patient participation in care, patient satisfaction, nurse satisfaction, patient autonomy, patient empowerment and quality of life. This chapter is based mainly on the results of two international research projects (Care and Individualised Care Projects) that have explored individualised care in relation with caring behaviours and patient satisfaction. Patients were asked to give their own opinion of what they mean by individualised care as well as their experience about the care they received, whether they felt that it was actually individualised according to their own needs and preferences. The results provided evidence that patients and nurses have different perceptions of individualised care, suggesting that both patients’ and nurses’ evaluations are needed to deliver care according to each individual patient’s needs, experiences, behaviours, feelings and perceptions. Other relations are also discussed through smaller-scale studies performed in different countries which underline the internationality and the challenges of exploring the individualised care concept. This chapter could provide useful information to nursing managers and policymakers on introducing nursing approaches and practices based on individualised care so as to improve quality of care, enhance patient dignity, keep people safe and consequently increase patients’ satisfaction