Perspectives on Nurse Retention in Hospitals in the Netherlands:A Qualitative Study

Aim:To explore hospital nurses' perceptions of working conditions that affect their retention and to identify preconditions for retention across nursing subgroups and informants directly involved in the work that nurses do. Introduction. Understanding why nurses want to stay in their job is essential for hospitals to improve retention and develop policies to combat nursing shortages. Retention barriers are known, but mostly pre-COVID-19 and in specific nursing subgroups, while nursing teams are diverse in life phase, education, and expertise. Materials and Methods:A qualitative study with semistructured focus group interviews with nurses from different hospitals. We held interviews with nursing students and with newly graduated, experienced, specialized, and master-educated nurses. In addition, we held interviews with informants directly involved in the work that nurses do. Results:Three themes concerning the perceptions of working conditions and retention preconditions were identified among subgroups: (1) nurses finding their personal pathway, indicating work that fits individual challenges during the life course and work that matches personal motives and authority and control over professional practice; (2) constructive collaboration within the nursing team and with their manager and physicians; and (3) availability of supportive facilities, e.g., development, professionalization, working environment, and rewards. Conclusion:Elements for retention occur at individual, team, and organizational levels. Nurses find it important that their profession aligns with their personal pathway and are motivated by constructive collaboration in a stimulating team. They emphasized organizational support in realizing career tracks and in active participation in decision-making. These themes are consistent across subgroups and encompass multiple interacting elements. Implications for Nursing Management. By recognizing and understanding what takes place at these different levels, policymakers and managers can develop effective strategies to promote nurse retention and improve healthcare quality. While implementing and monitoring a broad retention program, managers must remain attentive to nurses' perceptions of retention preconditions amidst changing demographics and the impact of COVID-19.</p

The Population Genetics of Pseudomonas aeruginosa Isolates from Different Patient Populations Exhibits High-Level Host Specificity

Objective To determine whether highly prevalent P. aeruginosa sequence types (ST) in Dutch cystic fibrosis (CF) patients are specifically linked to CF patients we investigated the population structure of P. aeruginosa from different clinical backgrounds. We first selected the optimal genotyping method by comparing pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and multilocus variable number tandem-repeat analysis (MLVA). Methods Selected P. aeruginosa isolates (n = 60) were genotyped with PFGE, MLST and MLVA to determine the diversity index (DI) and congruence (adjusted Rand and Wallace coefficients). Subsequently, isolates from patients admitted to two different ICUs (n = 205), from CF patients (n = 100) and from non-ICU, non-CF patients (n = 58, of which 19 were community acquired) were genotyped with MLVA to determine distribution of genotypes and genetic diversity. Results Congruence between the typing methods was >79% and DIs were similar and all >0.963. Based on costs, ease, speed and possibilities to compare results between labs an adapted MLVA scheme called MLVA9-Utrecht was selected as the preferred typing method. In 363 clinical isolates 252 different MLVA types (MTs) were identified, indicating a highly diverse population (DI = 0.995; CI = 0.993–0.997). DI levels were similarly high in the diverse clinical sources (all >0.981) and only eight genotypes were shared. MTs were highly specific (>80%) for the different patient populations, even for similar patient groups (ICU patients) in two distinct geographic regions, with only three of 142 ICU genotypes detected in both ICUs. The two major CF clones were unique to CF patients. Conclusion The population structure of P. aeruginosa isolates is highly diverse and population specific without evidence for a core lineage in which major CF, hospital or community clones co-cluster. The two genotypes highly prevalent among Dutch CF patients appeared unique to CF patients, suggesting specific adaptation of these clones to the CF lung

Nurses' experience of maintaining their therapeutic relationship with outpatients with bipolar disorder and their caregivers during different stages of a manic episode : a qualitative study

PURPOSE: Caregivers often consult community mental health (CMH) nurses when they recognize prodromes of mania in the outpatient. The purpose of this study was to determine nurses' experiences of their therapeutic relationship and nursing interventions to outpatients and caregivers during different stages of mania. DESIGN AND METHODS: A qualitative study was conducted. Nine nurses were interviewed. FINDINGS: CMH nurses experienced dual loyalty when facing conflicting interests. They strived to stay connected to patients and caregivers with an open and nonjudgmental attitude. In euthymic episodes, nurses anticipated by developing good relationships with both and by making relapse prevention plan. PRACTICE IMPLICATIONS: Early involvement of caregivers in the treatment is recommended

Perspectives on Nurse Retention in Hospitals in the Netherlands:A Qualitative Study

Aim:To explore hospital nurses' perceptions of working conditions that affect their retention and to identify preconditions for retention across nursing subgroups and informants directly involved in the work that nurses do. Introduction. Understanding why nurses want to stay in their job is essential for hospitals to improve retention and develop policies to combat nursing shortages. Retention barriers are known, but mostly pre-COVID-19 and in specific nursing subgroups, while nursing teams are diverse in life phase, education, and expertise. Materials and Methods:A qualitative study with semistructured focus group interviews with nurses from different hospitals. We held interviews with nursing students and with newly graduated, experienced, specialized, and master-educated nurses. In addition, we held interviews with informants directly involved in the work that nurses do. Results:Three themes concerning the perceptions of working conditions and retention preconditions were identified among subgroups: (1) nurses finding their personal pathway, indicating work that fits individual challenges during the life course and work that matches personal motives and authority and control over professional practice; (2) constructive collaboration within the nursing team and with their manager and physicians; and (3) availability of supportive facilities, e.g., development, professionalization, working environment, and rewards. Conclusion:Elements for retention occur at individual, team, and organizational levels. Nurses find it important that their profession aligns with their personal pathway and are motivated by constructive collaboration in a stimulating team. They emphasized organizational support in realizing career tracks and in active participation in decision-making. These themes are consistent across subgroups and encompass multiple interacting elements. Implications for Nursing Management. By recognizing and understanding what takes place at these different levels, policymakers and managers can develop effective strategies to promote nurse retention and improve healthcare quality. While implementing and monitoring a broad retention program, managers must remain attentive to nurses' perceptions of retention preconditions amidst changing demographics and the impact of COVID-19.</p

Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis

BACKGROUND: Closed suction systems (CSS) are increasingly replacing open suction systems (OSS) to perform endotracheal toilet in mechanically ventilated intensive care unit patients. Yet effectiveness regarding patient safety and costs of these systems has not been carefully analyzed. OBJECTIVE: To review effectiveness of CSS and OSS, with respect to patient outcome, bacterial contamination, and costs in adult intensive care unit patients. DATA SOURCE: Search of MEDLINE, CINAHL, EMBASE, and Cochrane databases and a manual review of article bibliographies. STUDY SELECTION: Randomized controlled trials comparing CSS and OSS in adult intensive care unit patients were retrieved. DATA EXTRACTION/SYNTHESIS: Assessment of abstracts and study quality was performed by two reviewers. Data were combined in meta-analyses by random effect models. Fifteen trials were identified. No significant differences were found in incidences of ventilator-associated pneumonia (eight studies, 1,272 patients) and mortality (four studies, 1,062 patients). No conclusions could be drawn with respect to arterial oxygen saturation (five studies, 109 patients), arterial oxygen tension (two studies, 19 patients), and secretion removal (two studies, 37 patients). Compared with OSS, endotracheal suctioning with CSS significantly reduced changes in heart rate (four studies, 85 patients; weighted mean difference, -6.33; 95% confidence interval, -10.80 to -1.87) and changes in mean arterial pressure (three studies, 59 patients; standardized mean difference, -0.43; 95% confidence interval, -0.87 to 0.00) but increased colonization (two studies, 126 patients; relative risk, 1.51; 95% confidence interval, 1.12-2.04). CSS seems to be more expensive than OSS. CONCLUSIONS: Based on the results of this meta-analysis, there is no evidence to prefer CSS more than OSS

Infection prevention as a shared responsibility - improving the patient experience during contact isolation

Applied Ergonomics and Desig

Infection control link nurse programs in Dutch acute care hospitals; A mixed-methods study

Background: Infection control link nurse programs show considerable variation. We report how Dutch link nurse programs are organized, how they progress, and how contextual factors may play a role in the execution of these programs. Methods: This mixed-methods study combined a survey and semi-structured interviews with infection control practitioners, based on items of the Template for Intervention Description and Replication (TIDieR) checklist. Results: The Netherlands has 74 hospitals; 72 infection control practitioners from 72 different hospitals participated in the survey. Four of these infection control practitioners participated in interviews. A link nurse program was present in 67% of the hospitals; responsibility for 76% of these programs lied solely with the infection prevention and control team. The core component of most programs (90%) was education. Programs that included education on infection prevention topics and training in implementation skills were perceived as more effective than programs without such education or programs where education included only infection prevention topics. The interviews illustrated that these programs were initiated by the infection prevention team with the intention to collaborate with other departments to improve practice. Content for these programs was created at the time of their implementation. Infection control practitioners varied in their ability to express program goals and to engage experts and key stakeholders. Conclusions: Infection control link nurse programs vary in content and in set up. Programs with a clear educational content are viewed as more successful by the infection control practitioners that implement these programs

Nurse compliance with a protocol for safe injectable medication administration: Comparison of two multicentre observational studies

Objectives Medication administration errors with injectable medication have a high risk of causing patient harm. To reduce this risk, all Dutch hospitals implemented a protocol for safe injectable medication administration. Nurse compliance with this protocol was evaluated as low as 19% in 2012. The aim of this second evaluation study was to determine whether nurse compliance had changed over a 4-year period, what factors were associated over time with protocol compliance and which strategies have been implemented by hospitals to increase protocol compliance. Methods In this prospective observational study, conducted between November 2015 and September 2016, nurses from 16 Dutch hospitals were directly observed during intravenous medication administration. Protocol compliance was complete if nine protocol proceedings were conducted correctly. Protocol compliance was compared with results from the first evaluation. Multilevel logistic regression analyses were used to assess the associations over time between explanatory variables and complete protocol compliance. Implemented strategies were classified according to the five components of the Systems Engineering Initiative for Patient Safety (SEIPS) model. Results A total of 372 intravenous medication administrations were observed. In comparison with 2012, more proceedings per administration were conducted (mean 7.6, 95% CI 7.5 to 7.7 vs mean 7.3, 95% CI 7.3 to 7.4). No significant change was seen in complete protocol compliance (22% in 2016); compliance with the proceedings € hand hygiene' and € check by a second nurse' remained low. In contrast to 2012, the majority of the variance was caused by differences between wards rather than between hospitals. Most implemented improvement strategies targeted the organisation component of the SEIPS model. Conclusions Compliance with € hand hygiene' and € check by a second nurse' needs to be further improved in order to increase complete protocol compliance. To do so, interventions focused on nurses and individually tailored to each ward are needed

The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study

Abstract Background The application of hand hygiene (HH) and the use of non-sterile gloves (NSG) in daily care is highly intertwined. We aimed (1) to assess the combined application of HH and NSG among nurses and (2) to explore determinants that influence their ability to combine both measures in their care. Methods In a multi-methods study, we combined direct observations of care episodes with semi-structured interviews with nurses in two affiliated university hospitals. Topics were based on Flottorp’s checklist of determinants of practice. Results In total, we observed 205 care episodes and interviewed 10 nurses. Observations revealed that the combination of NSG and HH was correctly applied in 19% of care episodes in which a single procedure was executed, and in 2% of care episodes in which multiple procedures were performed. From the interviews, we found determinants that influenced compliance, covered mainly by three out of seven of Flottorp’s checklist domains. Nurses indicated that their knowledge of protocols was limited to HH and protocols were hardly ever actively consulted; visual reminders within their workplace were used as sources of information. Nurses’ behavior was primarily influenced by their ability to operationalize this information and their ability to integrate both infection prevention measures into their care. The intention to apply and combine HH and NSG use was influenced by their risk assessment of cross-contamination, by the urge to self-protect and gut feeling. The feasibility to execute HH and NSG protocols is influenced by the urgency and the complexity of the care episode. Conclusions The combined correct application with HH and NSG measures by nurses is low. Nurses are instructed in a fragmented way while in the day to day care HH and NSG use are highly intertwined. Operationalization and simplification of infection prevention protocols, in which instructions on both infection prevention measures are fused, should be considered. Strategies to improve practice should consider the power of habit and nurses urge to self-protect

Nature of adverse events with opioids in hospitalised patients: a post-hoc analysis of three patient record review studies

OBJECTIVE: Opioids are increasingly prescribed and frequently involved in adverse drug events (ADEs). The underlying nature of opioid-related ADEs (ORADEs) is however understudied. This hampers our understanding of risks related to opioid use during hospitalisation and when designing interventions. Therefore, we provided a description of the nature of ORADEs. DESIGN: A post-hoc analysis of data collected during three retrospective patient record review studies (in 2008, 2011/2012 and 2015/2016). SETTING: The three record review studies were conducted in 32 Dutch hospitals. PARTICIPANTS: A total of 10 917 patient records were assessed by trained nurses and physicians. OUTCOME MEASURES: Per identified ORADE, we described preventability, type of medication error, attributable factors and type of opioids involved. Moreover, the characteristics of preventable and non-preventable ORADEs were compared to identify risk factors. RESULTS: Out of 10 917 patient records, 357 ADEs were identified, of which 28 (8%) involved opioids. Eleven ORADEs were assessed as preventable. Of these, 10 were caused by dosing errors and 4 probably contributed to patients' death. Attributable factors identified were mainly on patient and organisational levels. Morphine and oxycodone were the most frequently involved opioids. The risk for ORADEs was higher in elderly patients. CONCLUSIONS: Only 8% of ADEs identified in our sample were related to opioids. Although the frequency is low, the risk of serious consequences is high. We recommend to use our findings to increase awareness among physicians and nurses. Future interventions should focus on safe dosing of opioids when prescribing and administering, especially in elderly patients