Assessing pressure injury risk and prevention using the Braden mobility subscale

 Getting a pressure injury or ulcer whilst in hospital may cause debilitating physical effects, pain or even death. This research found that assessment of mobility alone compares well with the more commonly used and more complex risk assessment scales when used to identify person\u27s risk for developing a pressure sore

Factors Associated With Prolonged Length of Stay for Elective Hepatobiliary and Neurosurgery Patients: A Retrospective Medical Record Review

Background: Patients with prolonged length of hospital stay (LOS) not only increase their risks of nosocomial infections but also deny other patients access to inpatient care. Hepatobiliary (HPB) malignancies have some of highest incidences in East and Southeast Asia and the management of patients undergoing HPB surgeries have yet to be standardized. With improved neurosurgery techniques for intracranial aneurysms and tumors, neurosurgeries (NS) can be expected to increase. Elective surgeries account for far more operations than emergencies surgeries. Thus, with potentially increased numbers of elective HPB and NS, this study seeks to explore perioperative factors associated with prolonged LOS for these patients to improve safety and quality of practice. Methods: A retrospective cross-sectional medical record review study from January 2014 to January 2015 was conducted at a 1250-bed tertiary academic hospital in Singapore. All elective HPB and NS patients over 18　years old were included in the study except day and emergency surgeries, resulting in 150 and 166 patients respectively. Prolonged LOS was defined as above median LOS based on the complexity of the surgical procedure. The predictor variables were preoperative, intraoperative, and postoperative factors. Student\u27s t-test and stepwise logistic regression analyses were conducted to determine which factors were associated with prolonged LOS. Results: Factors associated with prolonged LOS for the HPB sample were age and admission after 5　pm but for the NS sample, they were functional status, referral to occupational therapy, and the number of hospital-acquired infections. Conclusion: Our findings indicate that preoperative factors had the greatest association with prolonged LOS for HPB and NS elective surgeries even after adjusting for surgical complexity, suggesting that patient safety and quality of care may be improved with better pre-surgery patient preparation and admission practices

Designing and Evaluating an Interactive Multimedia Web-Based Simulation for Developing Nurses' Competencies in Acute Nursing Care: Randomized Controlled Trial

10.2196/jmir.3853Journal of Medical Internet Research17

Light at the end of the tunnel: New graduate nurses' accounts of resilience: A qualitative study using Photovoice

Background: Resilience is the ability to overcome any stressful situation. The ability to bounce back is said to enable a person to emerge stronger, perform better, and become more confident and selfefficient. The new graduate nurses' journey is a stressful experience as they become immersed in the day-to-day work pressures. Objective: The study explored the new graduate nurses' accounts of resilience and the facilitating and impeding factors in building their resilience. Methods and Participants: A qualitative study using Photovoice was employed in this study and guided by the theory of Sense of Coherence. Nine new graduate nurses from one university and working for a year in one university-affiliated hospital in Singapore were interviewed and data was subjected to thematic analysis. Findings: Four themes emerged: (1) resilience is persevering and overcoming obstacles; (2) resilience is accepting one's responsibilities and fulfilling them; (3) resilience is adapting to new situations; and (4) resilience is taking control of own learning. The exhaustive account of their resilience is portrayed as “light at the end of the tunnel”. Conclusion: In spite of the stressful working environment and obstacles encountered as new graduate nurses, participants' resilience is built upon the comprehensibility, meaningfulness and management of any situation they face in their personal, spiritual and professional life. Future research is needed to objectively measure their level of Sense of Coherence and association with their level of resilience

Nutritional risk of cancer patients receiving chemotherapy in the ambulatory care setting: A prospective study

Background Cancer itself can alter the metabolic and physiologic of the body's nutritional needs. As a result, some patients experience some degree of weight loss before the start of the treatment. Aim The aim of the study was to determine at which chemotherapy treatment cycle patients with cancer begin to exhibit signs and symptoms of malnutrition. Methods A prospective descriptive correlational design was used to assess the nutritional risk of 111 patients with cancer receiving chemotherapy in the ambulatory setting. The data were collected by using a nutritional screening tool. Findings The prevalence of malnutrition risk was 45% in patients undergoing the first cycle of chemotherapy. Patients who received the first three cycles of chemotherapy were 2.62 times more likely to develop malnutrition than those who received seven or more cycles. The risk of developing malnutrition varies depending on the type of cancer, the types of chemotherapy regime, the number of chemotherapy cycles, body mass index and the stage of cancer. Conclusion The study found about half of the patients had developed signs and symptoms of nutritional risk at cycle one. Hence, nutritional support may be required even before the start of chemotherapy

Understanding the influence of resilience on psychological outcomes — Comparing results from acute care nurses in Canada and Singapore

Background: Building resilience among nurses is one of the ways to support and retain nurses in the profession. Prior literature which evaluated influence of resilience on psychological outcomes, were conducted in relatively homogeneous populations. It is of interest to evaluate whether relationships between resilience and psychological outcomes remain consistent across nations and among different nursing populations. Aim: To evaluate a theoretical model of the impact of resilience on burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS) by comparing results between nurses in Canada and Singapore. Method: A self-reported questionnaire consisting of questions on demographics, resilience (Connor-Davidson Resilience Scale), and psychological adjustment (Professional Quality of Life) was administered via an online survey. One thousand three hundred and thirty-eight nurses working in two Academic Medical Centres in Singapore responded to the online survey. Similar data was also collected from 329 nurses in Canada. Hypotheses were tested using structural equation modeling. Results: Resilience exerts a significant negative direct impact on STS, and a significant negative direct impact on BO. Additionally, resilience has a positive direct impact on compassion satisfaction. STS exerts a positive direct impact on BO while CS has a negative direct impact on BO. Conclusion: Current study affirmed significant associations between resilience and professional quality of life. Knowledge on resilience is key in informing design and implementation of resilience-building strategies that include professional development, and strengthening of interpersonal skills. A resilience-based approach will help reduce nurses' BO and STS while caring for their patients, and in turn reduce turnover

Designing and evaluating an interactive multimedia web-based simulation for developing nurses’ competencies in acute nursing care: randomized controlled trial

Background: Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice.Objective: This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care.Methods: Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants' clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool.Results: The clinical performance posttest scores of the experimental group improved significantly (

Assessing pressure injury risk using a single mobility scale in hospitalised patients: a comparative study using case-control design.

Background: Pressure injury is known to cause not only debilitating physical effects, but also substantial psychological and financial burdens. A variety of pressure injury risk assessment tools are in use worldwide, which include a number of factors. Evidence now suggests that assessment of a single factor, mobility, may be a viable alternative for assessing pressure injury risk. Aims: The aim of this study was to ascertain whether using the Braden mobility subscale alone is comparable to the full Braden scale for predicting the development of pressure injury. Methods: This study, a retrospective case-control design, was conducted in a large tertiary acute care hospital in Singapore. Medical records of 100 patients with hospital-acquired pressure injury were matched with 100 medical records of patients who had no pressure injury at a 1:1 ratio. Results: Patients who were assessed using the Braden mobility subscale as having 'very limited mobility' or worse were 5.23 (95% confidence interval (CI) 2.66-10.20) times more likely to develop pressure injury compared with those assessed as having 'slightly limited' mobility or 'no limitation'. Conversely, patients assessed using the Braden scale as having 'low risk' or higher were 3.35 (95% CI 1.77-6.33) times more likely to develop pressure injury compared with those assessed as 'no risk'. Using full model logistic regression analysis, the Braden mobility subscale was the only factor that was a significant predictor of pressure injury and it remained significant when analysed for the most parsimonious model using backward logistic regression. Conclusions: These findings provide the empirical evidence that using the Braden mobility subscale alone as an assessment tool for predicting pressure injury development is comparable to using the full Braden scale. Use of this single factor would simplify pressure injury risk assessment and support its use within busy clinical settings