Registered Nurses Assignment-Workload for Teaching Hospitals in Kenya: Utilizing the Research Brief with Annotated Bibliography Approach.

Nursing is important in quality and safety of hospital care and in patients' perceptions of their care. There seems to be a close association between patient safety, undergraduate nursing students' learning with nurse staffing levels in Kenya. The Ministry of Health as well as the Ministry of education does not yet support changing nurse workforce standards for teaching medical institutions. This research brief targeted the nursing units of two teaching hospitals in Kenya. Purpose:  There are a lot on staffing issues in research that could be applied in Kenya and nurses might be interested in a staff-understandable review of what has been researched.  This brief sought to: establish the relationship between nurse workload and nurse-sensitive patient safety outcome indicators. This review focuses on the staffing issue on the effect of workload on patient outcomes or staff outcomes. The search spanned period of between 2003 and 2013. Conclusion: Nurse managers ought to implement staffing processes that align staff skills and competencies with prioritized patient needs supported on a shift-to-shift basis. A fair and balanced patient assignment increases nurse satisfaction in their daily work. Keywords: Nursing ratios, RN workload, Patient safety, Research brief, RN assignment, Kenyan nurse

Take one

Take One was published every two weeks and focused on short news items and announcements "for the people of University Hospital.

Development and psychometric testing of the clinical leadership needs analysis (CLeeNA) instrument for nurses and midwives

Aim: The aim of this study is to report the development and psychometric testing of the clinical leadership needs analysis instrument (CLeeNA). Background: Limited emphasis is placed on the clinical leadership needs of nurses and midwives that are fundamental to supporting the delivery of high quality, safe patient care. Methods: A development and validation study of CLeeNA was undertaken using cross-sectional data. A sample of 324 registered nurses and midwives completed the questionnaire using a 7-point adjectival scale. Principal component analysis was conducted to explore scale grouping of items (n = 103 items). Results: Principal component analysis, item reduction and parallel analysis on the items of the instrument resulted in seven factors consisting of 56 items. These factors were identified as: Staff and Care Delivery; Technology and Care Initiatives; Self and Team Development; Standards of Care; Financial and Service Management; Leadership and Clinical Practice; Patient Safety and Risk Management. Conclusion: The identified factors are reflective of an ever-changing health care environment. Implications for Nursing Management: Potentially, after further testing, this instrument could be used by nursing management and educators to measure clinical leadership needs, inform the design of clinical leadership training programmes and provide valuable information about health care leadership development

H.B. 600: Ohio\u27s Bill of Rights for Nursing Home Patients

Nursing home residents are among the most helpless individuals in our society; their dependence on institutions for food, shelter, and personal care has cost them control over their own lives. “Because of the vulnerability of the aged population of the nursing home and the fact that most of them will reside in these homes for the rest of their lives, society bears a special obligation to ensure that the quality of their care is satisfactory and their treatment humane.” Ohio has responded to this obligation by enacting H.B. 600, which is directed at improving the care of Ohio nursing home residents. Acclaimed as model legislation, H.B. 600 “[e]numerates thirty rights of nursing home patients concerning safety, treatment, privacy, civil rights, restraints, smoking and drinking, information, financial affairs, transfer and discharge, [and] grievances …” H.B. 600 was necessary because federal and state regulations have heretofore largely failed to ensure humane treatment9 of all nursing home residents, whose special needs and rights have often been sacrificed to administrative convenience, efficiency, and economy. Consequently, residents have suffered abuses, neglect, and crass commercialism, which have been widely publicized and documented. The Patients’ Bill of Rights was enacted after considerable debate and revision. Upon ratification, this legislation enumerated thirty specific rights guaranteed to Ohio nursing home residents as well as concrete implementation and enforcement provisions

Conceptualising a model to guide nursing and midwifery in the community guided by an evidence review

Background: Successful models of nursing and midwifery in the community delivering healthcare throughout the lifespan and across a health and illness continuum are limited, yet necessary to guide global health services. Primary and community health services are the typical points of access for most people and the location where most care is delivered. The scope of primary healthcare is complex and multifaceted and therefore requires a practice framework with sound conceptual and theoretical underpinnings. The aim of this paper is to present a conceptual model informed by a scoping evidence review of the literature. Methods: A scoping evidence review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Databases included CINAHL, MEDLINE, PsycINFO and SocINDEX using the EBSCO platform and the Cochrane Library using the keywords: model, nursing, midwifery, community, primary care. Grey literature for selected countries was searched using the Google ‘advanced’ search interface. Data extraction and quality appraisal for both empirical and grey literature were conducted independently by two reviewers. From 127 empirical and 24 non-empirical papers, data extraction parameters, in addition to the usual methodological features, included: the nature of nursing and midwifery; the population group; interventions and main outcomes; components of effective nursing and midwifery outcomes. Results: The evidence was categorised into six broad areas and subsequently synthesised into four themes. These were not mutually exclusive: (1) Integrated and Collaborative Care; (2) Organisation and Delivery of Nursing and Midwifery Care in the Community; (3) Adjuncts to Nursing Care and (4) Overarching Conceptual Model. It is the latter theme that is the focus of this paper. In essence, the model depicts a person/client on a lifespan and preventative-curative trajectory. The health related needs of the client, commensurate with their point position, relative to both trajectories, determines the nurse or midwife intervention. Consequently, it is this need, that determines the discipline or speciality of the nurse or midwife with the most appropriate competencies. Conclusion: Use of a conceptual model of nursing and midwifery to inform decision-making in primary/community based care ensures clinical outcomes are meaningful and more sustainable. Operationalising this model for nursing and midwifery in the community demands strong leadership and effective clinical governance

Utilisation of publicly financed dental and optical services in Ireland – Baseline analysis for the Hippocrates Model. ESRI Survey and Statistical Report Series 99.

This report analyses the types of data available on dental and optical services in a community setting and considers how these might be incorporated into the Hippocrates Model. The Hippocrates Model provides estimates and projections of healthcare demand, capacity and expenditure for a range of Irish health and social care services

Codesigning a Measure of Person-Centred Coordinated Care to Capture the Experience of the Patient: The Development of the P3CEQ

Background: Person-centred coordinated care (P3C) is a priority for stakeholders (ie, patients, carers, professionals, policy makers). As a part of the development of an evaluation framework for P3C, we set out to identify patient-reported experience measures (PREMs) suitable for routine measurement and feedback during the development of services. Methods: A rapid review of the literature was undertaken to identity existing PREMs suitable for the probing person-centred and/or coordinated care. Of 74 measures identified, 7 met our inclusion criteria. We critically examined these against core domains and subdomains of P3C. Measures were then presented to stakeholders in codesign workshops to explore acceptability, utility, and their strengths/weaknesses. Results: The Long-Term Condition 6 questionnaire was preferred for its short length, utility, and tone. However, it lacked key questions in each core domain, and in response to requests from our codesign group, new questions were added to cover consideration as a whole person, coordination, care plans, carer involvement, and a single coordinator. Cognitive interviews, on-going codesign, and mapping to core P3C domains resulted in the refinement of the questionnaire to 11 items with 1 trigger question. The 11-item modified version was renamed the P3C Experiences Questionnaire. Conclusions: Due to a dearth of brief measures available to capture people’s experience of P3C for routine practice, an existing measure was modified using an iterative process of adaption and validation through codesign workshops. Next steps include psychometric validation and modification for people with dementia and learning difficulties.</p

Does patient self-management education of primary care professionals improve patient outcomes : a systematic review

Background: Patient self-management support is recognised as a key component of chronic care. Education and training for health professionals has been shown in the literature to be associated with better uptake, implementation and effectiveness of self-management programs, however, there is no clear evidence regarding whether this training results in improved health outcomes for patients with chronic conditions. Methods: A systematic review was undertaken using the PRISMA guidelines using the Cochrane Library, PubMEd, ERIC, EMBASE, CINAHL, PsycINFO, Web searches, Hand searches and Bibliographies. Articles published from inception to September 1st, 2013 were included. Systematic reviews, Meta-analysis, Randomized controlled trials (RCTs), Controlled clinical trials, Interrupted time series and Controlled before and after studies, which reported on primary care health professionals' continuing education or evidence-based medicine/education on patient self-management for any chronic condition, were included. A minimum of two reviewers participated independently at each stage of review. Results: From 7533 abstracts found, only two papers provided evidence on the effectiveness of self-management education for primary healthcare professionals in terms of measured outcomes in patients. These two articles show improvement in patient outcomes for chronic back pain and diabetes based on RCTs. The educational interventions with health professionals spanned a range of techniques and modalities but both RCTs included a motivational interviewing component. Conclusions: Before and up to 2 years after the incorporation of patient empowerment for self-management into the WONCA Europe definition of general practice, there was a scarcity of high quality evidence showing improved outcomes for patients as a result of educating health professionals in patient self-management of chronic conditions.Peer reviewe