Nursing workload and staff allocation in an Italian hospital: a quality improvement initiative based on nursing care score

Aim: To develop, implement, and evaluate a Nursing Care Score (NCS) system, built into the electronic health record, to optimize nursing workload and staff allocation. Design: A quality improvement (QI) initiative with a pre- and post-implementation design was conducted by an interprofessional team in the 33-bed cardio-thoracic unit of a 72-bed hospital in Palermo, Italy. Methods: A seven-phase process was used to develop, implement, and evaluate the NCS, which lists 53 nursing work tasks, each assigned a score from 1.5 to 5.0. The nurse-to-patient ratio on all shifts was determined by the NCS. Nurse satisfaction with both the existing system and the NCS workload system was assessed. Descriptive statistics and McNemar's test were used to analyze the data. Results: At pre-implementation, 92.5% of nurses reported that the existing system was not effective, 87.5% reported it did not enable them to provide adequate nursing care, and 20.0% believed that workload was fairly distributed. At post-implementation, 75.0% of nurses reported that the NCS system was effective (p = 0.0348), 85.0% reported that the NCS system enabled them to provide adequate care, and 85.0% believed that workload was fairly distributed. An NCS score of 65 ± 5 was found to distribute workload most fairly. Conclusion: An automatic electronic operating system to generate a daily workload report based on the NCS was successfully implemented and evaluated. The NCS provided relevant information to guide nurse managers in defining nurse-to-patient ratio and determining staff allocation. Nurses were satisfied with the NCS system. The steps used to develop, implement, and evaluate the NCS system may be transferable to other units and other hospitals

Improving Physical Activity and Function in Overweight and Obese Older Adults with Osteoarthritis of the Knee: A Feasibility Study

Osteoarthritis of the knee, a prevalent condition in older adults, can impact physical function and ability to perform physical activity. This randomized controlled trial examined the effects of a 6-month self-efficacy-based, individually delivered, lower-extremity exercise and fitness walking intervention with 6-month follow-up on physical activity and function. The 26 subjects were mostly older (M = 63.2 years, SD = 9.8), White (83%), obese (BMI M = 33.3, SD = 6.0) women (96%). Physical activity was measured by diaries. Physical function was measured by the 6-minute walk, Short Physical Performance Battery (SPPB), and WOMAC Physical Function subscale. Exercise self-efficacy was assessed by a questionnaire. Results showed significant increases in self-reported performance of lower-extremity exercise and participation in fitness walking, distance in the 6-minute walk, and SPPB scores from baseline to 6-month follow-up with a trend for improvement in self-efficacy. Results suggest that the intervention was feasible, acceptable, and improved physical activity and function

THE USE OF GUM CHEWING IN POSTOPERATIVE CARE OF PATIENTS WITH ABDOMINAL SURGERY: DEVELOPING AN EVIDENCE-BASED CLINICAL PROTOCOL -PART II

Abstract Aim: The aim of this paper is to develop an evidence-based clinical protocol for the use of gum chewing in postoperative care to reduce the risk of paralytic postoperative ileus in patients who have undergone abdominal surgery. Methods: A clinical question (For adult patients who have undergone abdominal surgery, does the use of gum chewing postoperatively reduce the risk of paralytic postoperative ileus in comparison with the usual care regimen?) was formulated, a population and setting were defined, and the databases OVID Medline®, CINAHL, and PubMed were searched for relevant material. Six data-based research articles were chosen for review: four randomized controlled trials and two meta-analyses. Finally, the articles were critically appraised to generate evidence on which to base the clinical protocol. Results: The development team created a detailed description of the clinical protocol as well as a protocol algorithm to assist clinicians in determining patient eligibility. In addition, protocol implementation and evaluation plans were proposed. Conclusion: An evidence-based clinical protocol was developed to provide a template for identification of patients eligible for gum chewing, implementation, and evaluation of this intervention to reduce the risk of paralytic postoperative ileus after abdominal surgery

THE USE OF GUM CHEWING IN POSTOPERATIVE CARE OF PATIENTS WITH ABDOMINAL SURGERY: DEVELOPING AN EVIDENCE-BASED CLINICAL PROTOCOL -PART I

Abstract Aim: The aim of the paper was to search for evidence that the use of gum chewing in the postoperative care of patients who had undergone abdominal surgery decreases the risk of paralytic postoperative ileus by significantly reducing the time to first flatus and time to first bowel movement. Methods: A literature review of selected meta-analyses and randomized control trials (RCT) was conducted to find the evidence that the use of gum chewing in the postoperative care of patients who had undergone abdominal surgery decreases the risk of paralytic postoperative ileus expressed as the time to first flatus and time to first bowel movement. The following databases were searched: OVID Medline®, CINAHL, and PubMed. The search focused on material published in English in peer-reviewed journals between the years 2002 and 2012. Weighted mean difference was the effect size abstracted from the meta-analyses of gum chewing on time to first flatus and time to first bowel movement. From the RCT, Cohen's d effect sizes were calculated to determine the strength of the gum chewing intervention on time to first flatus and time to first bowel movement. Forest plots were created to present the effect sizes from the RCT. Results: Four randomized controlled trials and two meta-analyses were selected and critically appraised. All six studies concluded that gum chewing has a statistically significant and very large to medium effect on time to first flatus and time to first bowel movement. Based on the effect sizes, the conclusion was drawn that chewing gum during the postoperative period leads to a clinically significant reduction in time to passage of first flatus and time to first bowel movement. Conclusion: Strong evidence supports the use of gum chewing in postoperative care of patients who have undergone abdominal surgery to reduce the risk of paralytic postoperative ileus

Pain Management Strategies in Patients with Knee Osteoarthritis and Hypertension: Use, and Differences in Pain and Arthritis Pain Self-Efficacy

Background: Chronic pain caused by knee osteoarthritis has a negative impact on patients’ quality of life. The prevalence of hypertension is high among patients with knee osteoarthritis, and usage of pain medications can increase patients’ blood pressure. Purpose: 1) Describe characteristics of pain and non pharmacological pain management strategies used by participants with knee osteoarthritis and hypertension in daily life; 2) Categorize pain management strategies and assess frequency and patterns of strategies patients used; and 3) Examine the effectiveness of pain management strategies on pain, and their relationship with pain self-efficacy. Method: This secondary analysis of data from a randomized controlled trial used qualitative and quantitative methods to address the aims. Seventy individuals from the 6-month intervention arm were included in this study. Qualitative data for Aims 1 and 2 were collected by semi-structured interview. Quantitative data for Aim 3 included participants’ knee pain, bodily pain, and pain self-efficacy, measured by Western Ontario and McMaster Universities Osteoarthritis Index, Short Form-36v2 Bodily Pain subscale, and Arthritis Pain Self-efficacy subscale, respectively, at baseline, immediate post-intervention, and 6 months post-intervention. Constant comparative and content analyses were used in Aims 1 and 2, respectively, to describe and summarize pain and pain management strategies that participants used. Linear mixed modeling was used in Aim 3 to assess differences in pain and pain self-efficacy for pain management strategies over time. Results: On average, participants employed five pain management strategies. The most commonly used strategies were practicing physical self-care activities, performing psychological self-care activities, being active, changing position, and avoiding overuse. Pain management strategies were categorized into treatment strategies only and both preventative and treatment strategies. Participants who only used treatment strategies reported significantly lower bodily pain (b=-7.94, p=.017) compared with participants who used both preventative and treatment strategies. A mediating effect of self-efficacy on the association between pain management strategies and pain was not found. Conclusion: Participants used multiple pain management strategies to control pain, and treatment strategies were favored, which health care providers can recommend to patients. Health care providers can suggest preventative strategies that are evidenced-based and that patients find effective to control their pain

Nursing workload and staff allocation in an Italian hospital: a quality improvement initiative based on nursing care score

Aim: To develop, implement, and evaluate a Nursing Care Score (NCS) system, built into the electronic health record, to optimize nursing workload and staff allocation. Design: A quality improvement (QI) initiative with a pre- and post-implementation design was conducted by an interprofessional team in the 33-bed cardio-thoracic unit of a 72-bed hospital in Palermo, Italy. Methods: A seven-phase process was used to develop, implement, and evaluate the NCS, which lists 53 nursing work tasks, each assigned a score from 1.5 to 5.0. The nurse-to-patient ratio on all shifts was determined by the NCS. Nurse satisfaction with both the existing system and the NCS workload system was assessed. Descriptive statistics and McNemar's test were used to analyze the data. Results: At pre-implementation, 92.5% of nurses reported that the existing system was not effective, 87.5% reported it did not enable them to provide adequate nursing care, and 20.0% believed that workload was fairly distributed. At post-implementation, 75.0% of nurses reported that the NCS system was effective (p = 0.0348), 85.0% reported that the NCS system enabled them to provide adequate care, and 85.0% believed that workload was fairly distributed. An NCS score of 65 ± 5 was found to distribute workload most fairly. Conclusion: An automatic electronic operating system to generate a daily workload report based on the NCS was successfully implemented and evaluated. The NCS provided relevant information to guide nurse managers in defining nurse-to-patient ratio and determining staff allocation. Nurses were satisfied with the NCS system. The steps used to develop, implement, and evaluate the NCS system may be transferable to other units and other hospitals