Patient and nurse preferences for nurse handover - using preferences to inform policy: a discrete choice experiment protocol

Introduction Nursing bedside handover in hospital has been identified as an opportunity to involve patients and promote patient-centred care. It is important to consider the preferences of both patients and nurses when implementing bedside handover to maximise the successful uptake of this policy. We outline a study which aims to (1) identify, compare and contrast the preferences for various aspects of handover common to nurses and patients while accounting for other factors, such as the time constraints of nurses that may influence these preferences.; (2) identify opportunities for nurses to better involve patients in bedside handover and (3) identify patient and nurse preferences that may challenge the full implementation of bedside handover in the acute medical setting. Methods and analysis We outline the protocol for a discrete choice experiment (DCE) which uses a survey design common to both patients and nurses. We describe the qualitative and pilot work undertaken to design the DCE. We use a D-efficient design which is informed by prior coefficients collected during the pilot phase. We also discuss the face-to-face administration of this survey in a population of acutely unwell, hospitalised patients and describe how data collection challenges have been informed by our pilot phase. Mixed multinomial logit regression analysis will be used to estimate the final results. Ethics and dissemination This study has been approved by a university ethics committee as well as two participating hospital ethics committees. Results will be used within a knowledge translation framework to inform any strategies that can be used by nursing staff to improve the uptake of bedside handover. Results will also be disseminated via peer-reviewed journal articles and will be presented at national and international conferences

Parent escalation of care for the deteriorating child in hospital: A health-care improvement study

Objective: To evaluate the implementation of an intervention for parents to escalate care if concerned about their child's clinical condition. Design: Mixed-methods health-care improvement approach guided by the Theoretical Domains Framework. Methods: Implementation of the ‘Calling for Help’ (C4H) intervention was informed by previously identified barriers and facilitators. Evaluation involved audit, review of clinical deterioration incidents, interviews and focus groups. Setting: Australian specialist paediatric hospital. Participants: Convenience sample of 75 parents from inpatient areas during the audit, interviews with ten parents who had expressed concern about their child's clinical condition; five focus groups with 35 ward nurses. Main outcome measures: Parent awareness and utilization of C4H, parent and nurse views of factors influencing implementation. Results: Parent awareness of C4H improved to 35% (25/75). Parent concern was documented prior to 21/174 (12%) clinical deterioration events. All interviewed parents and nurses who participated in focus groups were positive about C4H. Parents preferred to be informed about C4H by nurses, but nurses described this as time-consuming and selectively chose parents who they believed would benefit most. Parents and nurses described frustrations with and trepidation in escalating care. Nurses had used C4H to expedite urgent medical review. Conclusions: There was an improvement in the level of parent awareness of C4H, which was viewed positively by parents and nurses alike. To achieve a high level of parent awareness in a sustainable way, a multifaceted approach is required. Further strategies will be required for parents to feel confident enough to use C4H and to address interprofessional communication barriers

Respiratory protection for healthcare workers in the workplace against novel H1N1 influenza A: letter report

"At the request of the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) the Institute of Medicine convened this committee to provide recommendations regarding the necessary respiratory protection for healthcare workers in their workplace against novel H1N1 influenza A (nH1N1). This report focuses on the scientific and empirical evidence regarding the efficacy of various types of personal respiratory protection technologies as one measure to protect healthcare workers against nH1N1. The committee concludes that an emphasis is needed on implementing a range of strategies across all levels of the hierarchy of controls to minimize risk and decrease the number of healthcare workers and other patients exposed to patients with suspected or confirmed nH1N1. The committee provides the following findings and recommendations and provides additional detail in the report that follows. " - p. 1-2Committee on Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, Board on Health Sciences Policy. ; Catharyn T. Liverman, Tracy A. Harris, M.E. Bonnie Rogers, and Kenneth I. Shine, editors.Outcome of the Workshop on Personal Protective Equipment for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A held August 12-13, 2009 in Washington, DCAvailable via World Wide Web in Open Book format or, though free registation, as an Acrobat .pdf file (524.3 KB, 69 p.).Includes bibliographical references (p. 30-36).IOM (Institute of Medicine). 2009. Respiratory protection for healthcare workers in the workplace against novel H1N1 influenza A: A letter report. Washington, DC: The National Academies Press

Accurate identification of hospital admissions from care homes; development and validation of an automated algorithm

Background: measuring the complex needs of care home residents is crucial for resource allocation. Hospital patient administration systems (PAS) may not accurately identify admissions from care homes. Objective: to develop and validate an accurate, practical method of identifying care home resident hospital admission using routinely collected PAS data. Method: admissions data between 2011 and 2012 (n = 103,105) to an acute Trust were modelled to develop an automated tool which compared the hospital PAS address details with the Care Quality Commission’s (CQC) database, producing a likelihood of care home residency. This tool and the Nuffield method (CQC postcode match only) were validated against a manual check of a random sample of admissions (n = 2,000). A dataset from a separate Trust was analysed to assess generalisability. Results:the hospital PAS was inaccurate; none of the admissions from a care home identified on manual check had a care home source of admission recorded on the PAS. Both methods performed well; the automated tool had a higher positive predictive value than the Nuffield method (100% 95% confidence interval (CI) 98.23–100% versus 87.10% 95%CI 82.28–91.00%), meaning those coded as care home residents were more likely to actually be from a care home. Our automated tool had a high level of agreement 99.2% with the second Trust’s data (Kappa 0.86 P < 0.001). Conclusions: care home status is not routinely or accurately captured. Automated matching offers an accurate, repeatable, scalable method to identify care home residency and could be used as a tool to benchmark how care home residents use acute hospital resources across the National Health Service

Manual restraint of adult psychiatric inpatients: a literature review

Relatively little is known about the prevalence of manual restraint to manage violent or challenging behaviour in hospital psychiatric services or the circumstances of its use. This review identified 45 empirical studies of manual restraint of adult psychiatric inpatients, mostly from the UK. On average, up to five episodes per month of manual restraint might be expected on an average 20 bed ward. Episodes last around ten minutes, with about half involving the restraint of patients on the floor, usually in the prone position. Manually restrained patients tend to be younger, male and detained under mental health legislation. Staff value restraint related training but its impact on nursing practice has not been evaluated. Research has tended to focus on official reports of violent incidents rather than manual restraint per se. Larger and more complex studies are needed to examine how manual restraint is used in response to different types of incident and in different service settings

Patient and nurse preferences for implementation of bedside handover: Do they agree? Findings from a discrete choice experiment

Objective: To describe and compare patients' and nurses' preferences for the implementation of bedside handover. Design: Discrete choice experiment describing handover choices using six characteristics: whether the patient is invited to participate; whether a family member/carer/friend is invited; the number of nurses present; the level of patient involvement; the information content; and privacy. Setting: Two Australian hospitals. Participants: Adult patients (n=401) and nurses (n=200) recruited from medical wards. Main outcome measures: Mean importance scores for handover characteristics estimated using mixed multinomial logit regression of the choice data. Results: Both patient and nurse participants preferred handover at the bedside rather than elsewhere (P<.05). Being invited to participate, supporting strong two-way communication, having a family member/carer/friend present and having two nurses rather than the nursing team present were most important for patients. Patients being invited to participate and supporting strong two-way communication were most important for nurses. However, contrary to patient preferences, having a family member/carer/friend present was not considered important by nurses. Further, while patients expressed a weak preference to have sensitive information handed over quietly at the bedside, nurses expressed a relatively strong preference for handover of sensitive information verbally away from the bedside. Conclusions: All participants strongly support handover at the bedside and want patients to participate although patient and nurse preferences for various aspects of bedside handover differ. An understanding of these preferences is expected to support recommendations for improving the patient hospital experience and the consistent implementation of bedside handover as a safety initiative

Mental health care and resistance to fascism

Mental health nurses have a critical stake in resisting the right-wing ideology of British fascism. Particularly concerning is the contemporary effort of the British National Party (BNP) to gain credibility and electoral support by the strategic re-packaging of a racist and divisive political manifesto. Evidence that some public sector workers are affiliated with the BNP has relevance for nursing at a series of levels, not least the incompatibility of party membership with a requirement of the Professional Code to avoid discrimination. Progressive advances, though, need to account for deep rooted institutionalized racism in the discourse and practice of healthcare services. The anomalous treatment of black people within mental health services, alongside racial abuse experienced by ethnic minority staff, is discussed in relation to the concept of race as a powerful social category and construction. The murder of the mentally ill and learning disabled in Nazi Germany, as an adjunct of racial genocide, is presented as an extreme example where professional ethics was undermined by dominant political ideology. Finally, the complicity of medical and nursing staff in the state sanctioned, bureaucratic, killing that characterized the Holocaust is revisited in the context of ethical repositioning for contemporary practice and praxis

Comparison of single trial back-projected independent components with the averaged waveform for the extraction of biomarkers of auditory P300 EPs

The independent components analysis (ICA) of the auditory P300 evoked responses in the EEG of normal subjects is described. The purpose was to identify any features which might provide the basis for biomarkers for diseases, such as Alzheimer’s disease. Single trial P300s were analysed by ICA, the activations were back-projected to scalp electrodes, many artefactual components were removed automatically, and the back-projected independent components (BICs) were first clustered according to their amplitudes and latencies. Then these primary clusters were secondarily clustered according to the columns of their mixing matrices, which clusters together those BICs with the same scalp topographies and, therefore, source locations. The BICs comprising the P300s had simple shapes, approximating half-sinusoids. Trial- to-trial variations in the BICs were found, which explain why different averages have been reported. Both positive- and also negative-going BICs were identified, some associated with known peaks in the P300 waveform. Artefact-free, single trial P300 waveforms could be constructed from the BICs, but these are probably of less interest than the BICs themselves. The findings demonstrate that neither averaged P300s, nor single trial P300s, are reliable as biomarkers, but rather it will be necessary to investigate the BICs present in a number of single trial realizations.peer-reviewe

Public subsidies and the recommendation of child vaccines among primary care physicians : a nationwide cross-sectional study in Japan.

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