Australian direct care nurses can make cost savings and improve health-care quality if they have access to meaningful data

Editoria

Nursing-sensitive indicators: A concept analysis

AIM: To report a concept analysis of nursing-sensitive indicators within the applied context of the acute care setting. BACKGROUND: The concept of ‘nursing sensitive indicators’ is valuable to elaborate nursing care performance. The conceptual foundation, theoretical role, meaning, use and interpretation of the concept tend to differ. The elusiveness of the concept and the ambiguity of its attributes may have hindered research efforts to advance its application in practice. DESIGN: Concept analysis. DATA SOURCES: Using ‘clinical indicators’ or ‘quality of nursing care’ as subject headings and incorporating keyword combinations of ‘acute care’ and ‘nurs*’, CINAHL and MEDLINE with full text in EBSCOhost databases were searched for English language journal articles published between 2000–2012. Only primary research articles were selected. METHODS: A hybrid approach was undertaken, incorporating traditional strategies as per Walker and Avant and a conceptual matrix based on Holzemer's Outcomes Model for Health Care Research. RESULTS: The analysis revealed two main attributes of nursing-sensitive indicators. Structural attributes related to health service operation included: hours of nursing care per patient day, nurse staffing. Outcome attributes related to patient care included: the prevalence of pressure ulcer, falls and falls with injury, nosocomial selective infection and patient/family satisfaction with nursing care. CONCLUSION: This concept analysis may be used as a basis to advance understandings of the theoretical structures that underpin both research and practical application of quality dimensions of nursing care performance

Building workforce capacity for complex care coordination: a function analysis of workflow activity

Background The care coordination workforce includes a range of clinicians who manage care for patients with multiple chronic conditions both within and outside a hospital, in the community, or in a patient’s home. These patients require a multi-skilled approach to support complex care and social support needs as they are typically high users of health, community, and social services. In Australia, workforce structures have not kept pace with this new and emerging workforce. The aim of the study was to develop, map, and analyse workforce functions of a care coordination team. Methods Workflow modelling informed the development of an activity log that was used to collect workflow data in 2013 from care coordinators located within the care coordination service offered by a Local Health Network in Australia. The activity log comprised a detailed classification of care coordination functions based on two major categories – direct and indirect care. Direct care functions were grouped into eight domains. A descriptive quantitative investigation design was used for data analysis. The data was analysed using univariate descriptive statistics with results presented in tables and a figure. Results Care coordinators spent more time (70.9%) on direct care than indirect care (29.1%). Domains of direct care that occupied the most time relative to the 38 direct care functions were ‘Assessment’ (14.1%), ‘Documentation’ (13.9%), ‘Travel time’ (6.3%), and ‘Accepting/discussing referral’ (5.7%). ‘Administration’ formed a large component of indirect care functions (14.8%), followed by ‘Travel’ (12.4%). Sub-analyses of direct care by domains revealed that a group of designated ‘core care coordination functions’ contributed to 40.6% of direct care functions. Conclusions The modelling of care coordination functions and the descriptions of workflow activity support local development of care coordination capacity and workforce capability through extensive practice redesigns

Implementing a Mobile Wireless Environment in a Hospital Ward: Encouraging Adoption by Nursing

Sophisticated technology is commonplace in most hospitals and increasingly mobile devices are being used in hospitals by clinical staff. Although the growth in mobile device usage in hospitals has the potential to contribute to better health and medical services delivery, nurses and doctors are still very reliant on paper-based information. Much of the research reported to date has focused on technical and design issues around mobile devices. Research that has focused on mobile device use in practice has tended to be from the perspective of doctors. This paper describes research which investigated key issues that arose as a result of the implementation of mobile wireless (MW) devices in a hospital ward from the perspective of the nursing staff. Although some of the nurses’ concerns related to technological aspects the main concerns focussed on access to, and security of the devices and organisational implementation problems they experienced. From the findings we have identified the factors that need to be addressed in the implementation environment for successful adoption of the technologies. Further, we propose a holistic approach to the introduction of MW technologies in hospital ward settings

Care coordination for chronic and complex health conditions: an experienced based co-design study engaging consumer and clinician groups for service improvement

Background: Evidence shows that engaging consumers and clinicians in development of health services creates a more responsive, integrated service that better meets the needs of consumers and the community of practice it serves. Further, consumer and clinician participation in service development processes can boost confidence and motivation levels in organisational employees and help foster clinical accountability. Objective: To see where consumers’ care experiences could be improved by better understanding where care coordination organisational systems needed improvement. Methods: Experienced based co-design informed an investigation of consumer and clinician experiences of a care coordination service and involved the sharing of those experiences across service employees in a series of iterative and feedback loops over eighteen months (July 2012 January 2014). Formal participants included care coordination clinicians (n=13) and consumers. Data from formal participants were collected during September-December 2012, consisting of consumer video-recorded and clinician audio-recorded interviews. Interview transcriptions were analysed to identify service “touch points”, being emotionally significant events related to key service aspects that connect or disconnect consumers and/or clinicians. Results: Results revealed that consumers highly valued the transdisciplinary skill base of the care coordination workforce, though service improvements were needed for transition support, quality discharge planning and conveying better understandings of care coordination activity both internally and externally. Conclusion: Incorporating consumer and clinician view-points about their experiences, including the production of a DVD, facilitated conversations across the entire service about care coordination provision and provided a catalyst for design improvement that may otherwise have been difficult to achieve. Some changes to the service were made such as improved client complaints processes, new roles for the care coordination service, and enlisting clinical staff to undertake motivational interviewing training to promote greater consumer self-management capacity. In this study, the user experience was given a platform within a larger healthcare workforce capability development project

Optimising medication data collection in a large-scale clinical trial

© 2019 Lockery et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective: Pharmaceuticals play an important role in clinical care. However, in community-based research, medication data are commonly collected as unstructured free-text, which is prohibitively expensive to code for large-scale studies. The ASPirin in Reducing Events in the Elderly (ASPREE) study developed a two-pronged framework to collect structured medication data for 19,114 individuals. ASPREE provides an opportunity to determine whether medication data can be cost-effectively collected and coded, en masse from the community using this framework. Methods: The ASPREE framework of type-to-search box with automated coding and linked free text entry was compared to traditional method of free-text only collection and post hoc coding. Reported medications were classified according to their method of collection and analysed by Anatomical Therapeutic Chemical (ATC) group. Relative cost of collecting medications was determined by calculating the time required for database set up and medication coding. Results Overall, 122,910 participant structured medication reports were entered using the type-tosearch box and 5,983 were entered as free-text. Free-text data contributed 211 unique medications not present in the type-to-search box. Spelling errors and unnecessary provision of additional information were among the top reasons why medications were reported as freetext. The cost per medication using the ASPREE method was approximately USD $0.03 compared with USD$0.20 per medication for the traditional method. Conclusion Implementation of this two-pronged framework is a cost-effective alternative to free-text only data collection in community-based research. Higher initial set-up costs of this combined method are justified by long term cost effectiveness and the scientific potential for analysis and discovery gained through collection of detailed, structured medication data

Enhancing Clinical Nurse Workflow through Redesign of Networked Wireless Laptop Computers

Nurses spend a substantial amount of their time documenting observations and care processes, leaving less time for patient-centred activities. This paper covers our study of the application of mobile-wireless laptop computers to clinical workflow within the nursing unit. An observational study design was used to explore ergonomic and functionality issues of networked wireless computers and to determine the practical utility of the networked wireless computer for clinical workflow processes. A small group of nurses were observed over a six-month period in using two laptops affixed to trolleys for access in wards and at beds. Four main purposes for the laptops were discovered: ward rounds, diagnostic information, team meetings and education. This paper covers various findings related to each of these purposes. Additionally, findings for ergonomics and functional design related to the laptops are described. For instance, the inclination towards a traditional mouse as opposed to a touch-pad mouse. We also discuss the application of our findings to future use of mobile-wireless laptop computers in the unit setting

Status of costing hospital nursing work within Australian casemix activity-based funding policy

Australia has a long history of patient level costing initiated when casemix funding was implemented in several states in the early 1990s. Australia includes, to some extent, hospital payment based on nursing intensity adopted within casemix funding policy and the Diagnostic Related Group system. Costing of hospital nursing services in Australia has not changed significantly in the last few decades despite widespread introduction of casemix funding policy at the state level. Recent Commonwealth of Australia National Health Reform presents change to the management of the delivery of health care including health-care costing. There is agreement for all Australian jurisdictions to progress to casemix-based activity funding. Within this context, nurse costing infrastructure presents contemporary issues and challenges. An assessment is made of the progress of costing nursing services within casemix funding models in Australian hospitals. Valid and reliable Australian-refined nursing service weights might overcome present cost deficiencies and limitations

Outcome detection using hospital activity data: Implications for development of nursing-sensitive quality monitoring and reporting in Australia (Commentary on Schreuders et al., Int. J. Nurs. Stud. 51 (3) (2014) 470-478)

This is a commentary of the article: Using linked hospitalisation data to detect nursing sensitive outcomes: A retrospective cohort study by Louise Winton Schreuders et. al published in the International Journal of Nursing Studies 51 (3) (2014) 470-47