Communication With Physicians as a Mediator in the Relationship Between the Nursing Work Environment and Select Nurse Outcomes in Jordan

PurposeTo test whether communication mediated relationships among nursesâ work environments and nurse outcomes of job satisfaction and intent to stay.DesignThis study used a crossâ sectional, quantitative survey design to query 650 nurses who worked in three hospitals in Jordan.MethodsWe used Arabic versions of valid, reliable instruments measuring the nursing work environment, nurse perceptions of communication with physicians, intent to stay, and job satisfaction. Mediation analysis was used to test hypotheses.FindingsA total of 582 questionnaires were returned (89.5% response rate). Nurse perceptions of communication with physicians mediated the relationship between the nursing work environment and job satisfaction in medical, surgical, and critical care units. Nurse perceptions of communication with physicians mediated the relationship between the nursing work environment and intent to stay in all but maternity and â otherâ units.ConclusionsDepending on the nurse outcome, communication was a significant mediator for various unit types. These results may be related to the type of work that is done in each unit and the influence of patient care. Communication is one of many mechanisms that can specify how a positive nursing work environment can contribute to nursesâ job satisfaction and intent to stay.Clinical RelevanceA potential solution to the nursing shortage in Jordan emerges by identifying communication with physicians as a mediator in the relationship between the work environment and selected nurse outcomes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146637/1/jnu12417_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146637/2/jnu12417.pd

Jordanian Nursing Work Environments, Intent to Stay, and Job Satisfaction

PurposeThe purpose of this study was to examine associations among the nursing work environment, nurse job satisfaction, and intent to stay for nurses who practice in hospitals in Jordan.DesignA quantitative descriptive crossâ sectional survey design was used.MethodsData were collected through survey questionnaires distributed to 650 registered nurses (RNs) who worked in three hospitals in Jordan. The selfâ report questionnaire consisted of three instruments and demographic questions. The instruments were the Practice Environment Scale of the Nursing Work Index (PESâ NWI), the McCain Intent to Stay scale, and Quinn and Shepard’s (1974) Global Job Satisfaction survey. Descriptive statistics were calculated for discrete measures of demographic characteristics of the study participants. Multivariate linear regression models were used to explore relationships among the nursing work environment, job satisfaction, and intent to stay, adjusting for unit type.FindingsThere was a positive association between nursesâ job satisfaction and the nursing work environment (t = 6.42, p < .001). For each oneâ unit increase in the total score of the PESâ NWI, nursesâ average job satisfaction increased by 1.3 points, controlling for other factors. Overall, nurses employed in public hospitals were more satisfied than those working in teaching hospitals. The nursing work environment was positively associated with nursesâ intent to stay (t = 4.83, p < .001). The Intent to Stay score increased by 3.6 points for every oneâ unit increase in the total PESâ NWI score on average. The highest Intent to Stay scores were reported by nurses from public hospitals.ConclusionsThe work environment was positively associated with nursesâ intent to stay and job satisfaction. More attention should be paid to create positive work environments to increase job satisfaction for nurses and increase their intent to stay.Clinical RelevanceHospital and nurse managers and healthcare policymakers urgently need to create satisfactory work environments supporting nursing practice in order to increase nursesâ job satisfaction and intent to stay.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135980/1/jnu12265_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135980/2/jnu12265.pd

Unique Factors Rural Veterans’ Affairs Hospitals Face When Implementing Health Care‐Associated Infection Prevention Initiatives

Purpose Health care‐associated infection (HAI) is costly to hospitals and potentially life‐threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans’ Affairs (VA) hospitals and the unique factors they face in implementing these practices. Methods This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. Findings We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system. Conclusions Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI‐related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102110/1/jrh12024.pd

Interprofessional team interactions about complex care in the ICU: pilot development of an observational rating tool

Abstract Background The awakening and breathing coordination, delirium, and early mobility (ABCDE) bundle is a multicomponent complex intervention that improves outcomes for critically ill adults yet is inconsistently implemented. Effective interprofessional team function (how the team interacts) is key to ABCDE delivery but little is known about how to measure team interactions. The purpose of our study was to examine the reliability of an observational rating tool to assess team interactions about ABCDE in one ICU. Results We pilot tested and evaluated reliability of an observational rating tool to assess team interactions about ABCDE. Two independent raters used this tool in one medical ICU over 4 weeks during morning rounds. We examined which ABCDE components were addressed, which team members initiated interactions, and which participated in interactions about ABCDE. We evaluated inter-rater reliability using Cohen’s kappa statistic and data from interprofessional team interactions for 23 patients. We demonstrated moderate to substantial reliability for whether breathing, coordination, delirium or early mobility were addressed (k = 0.48–0.78) and slight to fair reliability for which team members initiated interactions about ABCDE (0.18–0.40). Reliability was low for whether Awakening was addressed (k = −0.07) and for which team members initiated interactions about awakening (k = 0.05). Conclusions Our study provides pilot evidence of reliability of an observational rating tool to assess interprofessional team interactions about ABCDE. Future work should further test and modify this tool to gain an understanding of how to use team interactions to improve ABCDE delivery.http://deepblue.lib.umich.edu/bitstream/2027.42/134632/1/13104_2016_Article_2213.pd

Effect of COVID-19 on the implementation of a multifaceted intervention to improve teamwork and quality for hospitalized patients: A qualitative interview study

BACKGROUND: Healthcare organizations made major adjustments to deliver care during the COVID pandemic, yet little is known about how these adjustments shaped ongoing quality and safety improvement efforts. We aimed to understand how COVID affected four U.S. hospitals\u27 prospective implementation efforts in an ongoing quality improvement initiative, the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) project, which implemented complementary interventions to redesign systems of care for medical patients. METHODS: We conducted individual semi-structured interviews with 40 healthcare professionals to determine how COVID influenced RESET implementation. We used conventional qualitative content analysis to inductively code transcripts and identify themes in MAXQDA 2020. RESULTS: We identified three overarching themes and nine sub-themes. The three themes were (1) COVID exacerbated existing problems and created new ones. (2) RESET and other quality improvement efforts were not the priority during the pandemic. (3) Fidelity of RESET implementation regressed. CONCLUSION: COVID had a profound impact on the implementation of a multifaceted intervention to improve quality and teamwork in four hospitals. Notably, COVID led to a diversion of attention and effort away from quality improvement efforts, like RESET, and sites varied in their ability to renew efforts over time. Our findings help explain how COVID adversely affected hospitals\u27 quality improvement efforts throughout the pandemic and support the need for research to identify elements important for fostering hospital resilience

Using Incident Reports to Assess Communication Failures and Patient Outcomes

Introduction Communication failures pose a significant threat to the quality of care and safety of hospitalized patients. Yet little is known about the nature of communication failures. The aims of this study were to identify and describe types of communication failures in which nurses and physicians were involved and determine how different types of communication failures might affect patient outcomes. Methods Incident reports filed during fiscal year 2015–2016 at a Midwestern academic health care system (N = 16,165) were electronically filtered and manually reviewed to identify reports that described communication failures involving nurses and physicians (n = 161). Failures were categorized by type using two classification systems: contextual and conceptual. Thematic analysis was used to identify patient outcomes: actual or potential harm, patient dissatisfaction, delay in care, or no harm. Frequency of failure types and outcomes were assessed using descriptive statistics. Associations between failure type and patient outcomes were evaluated using Fisher's exact test. Results Of the 211 identified contextual communication failures, errors of omission were the most common (27.0%). More than half of conceptual failures were transfer of information failures (58.4%), while 41.6% demonstrated a lack of shared understanding. Of the 179 identified outcomes, 38.0% were delays in care, 20.1% were physical harm, and 8.9% were dissatisfaction. There was no statistically significant association between failure type category and patient outcomes. Conclusion It was found that incident reports could identify specific types of communication failures and patient outcomes. This work provides a basis for future intervention development to prevent communication-related adverse events by tailoring interventions to specific types of failures

Redesigning Systems to Improve Teamwork and Quality for Hospitalized Patients (RESET): Study Protocol Evaluating the Effect of Mentored Implementation to Redesign Clinical Microsystems

Background: A number of challenges impede our ability to consistently provide high quality care to patients hospitalized with medical conditions. Teams are large, team membership continually evolves, and physicians are often spread across multiple units and floors. Moreover, patients and family members are generally poorly informed and lack opportunities to partner in decision making. Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of a single intervention. We believe these interventions represent complementary and mutually reinforcing components of a redesigned clinical microsystem. Our specific objective for this study is to implement a set of evidence-based complementary interventions across a range of clinical microsystems, identify factors and strategies associated with successful implementation, and evaluate the impact on quality. Methods: The RESET project uses the Advanced and Integrated MicroSystems (AIMS) interventions. The AIMS interventions consist of 1) Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interprofessional Rounds, 4) Unit-level Performance Reports, and 5) Patient Engagement Activities. Four hospital sites were chosen to receive guidance and resources as they implement the AIMS interventions. Each study site has assembled a local leadership team, consisting of a physician and nurse, and receives mentorship from a physician and nurse with experience in leading similar interventions. Primary outcomes include teamwork climate, assessed using the Safety Attitudes Questionnaire, and adverse events using the Medicare Patient Safety Monitoring System (MPSMS). RESET uses a parallel group study design and two group pretest-posttest analyses for primary outcomes. We use a multi-method approach to collect and triangulate qualitative data collected during 3 visits to study sites. We will use cross-case comparisons to consider how site-specific contextual factors interact with the variation in the intensity and fidelity of implementation to affect teamwork and patient outcomes. Discussion: The RESET study provides mentorship and resources to assist hospitals as they implement complementary and mutually reinforcing components to redesign the clinical microsystems caring for medical patients. Our findings will be of interest and directly applicable to all hospitals providing care to patients with medical conditions. Trial Registration: NCT03745677. Retrospectively registered on November 19, 2018

The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study

BACKGROUND: Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients\u27 various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients\u27 just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients\u27 transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. OBJECTIVE: We aim to assess oncology patients\u27 perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. METHODS: A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants\u27 perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants\u27 technology acceptance through bivariate correlation analyses and multiple logistic regressions. RESULTS: Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). CONCLUSIONS: In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care

Using A3 thinking to improve the STAT medication process

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107994/1/jhm2222.pd