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AimTo evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.MethodsA parallel eight cluster randomised controlled study was conducted in a major teaching hospital in Adelaide, Australia. Four wards were randomised to the intervention which comprised wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders. Control wards were blinded to the intervention. Structured direct observations of medication administration processes were conducted. The primary outcome was non-medication-related interruptions during individual medication dose administrations. The secondary outcomes were total interruption and multitasking rates. A survey of nurses' experiences was administered.ResultsOver 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications. At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed. Intervention wards experienced a significant reduction in non-medication-related interruptions from 50/100 administrations (95% CI 45 to 55) to 34/100 (95% CI 30 to 38). Controlling for clustering, ward type and medication route showed a significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards. A total of 88 nurses (38.8%) completed the poststudy survey. Intervention ward nurses reported that vests were time consuming, cumbersome and hot. Only 48% indicated that they would support the intervention becoming hospital policy.DiscussionNurses experienced a high rate of interruptions. Few were related to the medication task, demonstrating considerable scope to reduce unnecessary interruptions. While the intervention was associated with a statistically significant decline in non-medication-related interruptions, the magnitude of this reduction and its likely impact on error rates should be considered, relative to the effectiveness of alternate interventions, associated costs, likely acceptability and long-term sustainability of such interventions.

BackgroundRecent literature reviews lament the paucity of high-quality intervention studies designed to test safety culture improvement in hospitals. The current study adapts an empirically supported strategy developed for manufacturing companies by focusing on patient care and safety messages head nurses communicate during daily conversations with nurses.MethodsThe study was designed as randomised control trial coupled with before-after measurement of outcome variables. We randomly assigned 445 nurses working in 27 inpatient departments in a midsize hospital in Israel to experimental and control groups. Ten randomly chosen nurses in both groups filled a brief questionnaire referring to last conversation with head nurse. One month later, head nurses in the experimental group received individual feedback, comparing individual with mean hospital scores, coupled with self-set goals for the following feedback session. Head nurses in the control group received no feedback, except for a summary report by the end of intervention.ResultsPatient care messages increased by 16% and professional development messages by 12%, accompanied by 17% decline in nurse-blaming messages in the experimental group, remaining unchanged in the control group. Such changes led to statistically significant increase in patient care behaviours (17%), safety climate (13%), teamwork (9%) and supervisory leadership quality (18%). Rule-compliance messages and workaround behaviours remained unchanged in experimental and control departments.ConclusionsThese data support the utility of our intervention strategy for improving patient safety climate and resultant caring behaviours in healthcare organisations. The fact that our intervention used easy-to-deliver feedback requiring only two sessions minimised its organisational costs.

IntroductionEfforts to understand interruptions now span much of the last decade and a half. Often thought to negatively impact patient safety, some now acknowledge that interruptions may be beneficial and actually necessary for safety and high quality care. This study seeks a framework for differentiating between interruptions that are detrimental and those that are beneficial.MethodsA mixed-methods approach at a US Level 1 trauma centre included direct observation of 13 registered nurses (RNs), survey of 47 RNs, retrospective observation of hands-free communication devices, and modelling of observed interruptions to key performance measures.ResultsOn average, RNs were interrupted every 11 min, with 20.3% of their workload triggered by interruptions. While 85% of RNs agreed that interruptions place their patients at risk, only 21% agreed that all should be eliminated. During one 90-min period, 18 original events spawned 68 interruptions, 50 of these repeat messages. A statistical model, with patient measures of time and comfort, revealed that alarms and call lights returning RN's attention to the patient outside the patient room are beneficial, while interruptions in the patient room are generally detrimental. Triangulating the results, we present an emerging framework for differentiating between beneficial and detrimental interruptions based on the impact of interruptions on the RN's steady treatment and attention to the patient.ConclusionsA mixed-methods approach can help distinguish between detrimental and beneficial interruptions. While interruptions breaking the delivery of steady treatment and attention to the patient are detrimental, those returning the RN's focus to the patient, as well as those supporting patient-clinician and clinician-clinician communications are beneficial. This insight may be helpful to healthcare delivery teams tasked with improving interruption-laden processes.

OBJECTIVEThe objective of this study is to assess benefits of the acuity-adaptable (AA) care model in rural hospitals. BACKGROUNDThe AA model aims to provide care in the same space from admission to discharge regardless of acuity. Evidence is lacking to support claims that AA care will improve patient safety, increase nurse productivity, and improve patient/staff satisfaction in rural hospitals. METHODSPatients admitted to a rural intensive care unit (ICU) were allocated to an AA group or an ICU group. Patients in the AA group remained in the ICU room through discharge. Patients in the ICU group transferred out of ICU when acuity permitted. Patient anxiety, depression, and perception of emotional care were measured. Staff responses were assessed qualitatively. RESULTSAcuity-adaptable patients reported significantly more anxiety and less perceived emotional care than ICU patients. Intensive care unit nurses resisted caring for less acute patients. CONCLUSIONDisadvantages may outweigh benefits of AA care delivery in the rural ICU.

Objective: The aim of this study was to determine if nurses, using patient-centered care (PCC), affect patient satisfaction, perceptions of nursing care, and quality outcomes. Background: The Institute of Medicine proposed PCC as 1 of 6 national quality aims, whereas the Centers for Medicare and Medicaid Services highlighted integration of PCC as 1 of 12 actions for quality improvement. Methods: A total of 116 patients were randomized into an intervention (PCC) or control group. Patients who were to receive PCC were called before admission and cared for by nurses who trained to administer/practice PCC. Control patients received usual care. Both groups completed questionnaires and received postdischarge calls. Length of stay, falls, infections, and adverse events were measured to assess quality of care. Results: No significant differences were found between groups for length of stay, infection, falls, postoperative complications, quality of care, satisfaction level, or perceptions of nursing care. Conclusions: Patient-centered care did not affect patient's level of satisfaction or quality of care. However, findings yielded clinically relevant results regarding patient/staff responses.

The first resource to present the \"nuts and bolts\" of creating a successful nursing research program.This text provides a roadmap to develop and nurture a nursing research program in complex hospital environments.

Background: Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs. Objectives: To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone. Methods: Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries. Results: A total of 50% of nurses worked shifts of ≤8 hours, but 15% worked ≥ 12 hours. Typical shift length varied between countries and within some countries. Nurses working for ≥ 12 hours were more likely to report poor or failing patient safety [odds ratio (OR) = 1.41; 95% confidence interval (CI), 1.13–1.76], poor/fair quality of care (OR = 1.30; 95% CI, 1.10–1.53), and more care activities left undone (RR = 1.13; 95% CI, 1.09–1.16). Working overtime was also associated with reports of poor or failing patient safety (OR = 1.67; 95% CI, 1.51–1.86), poor/fair quality of care (OR = 1.32; 95% CI, 1.23–1.42), and more care left undone (RR = 1.29; 95% CI, 1.27–1.31). Conclusions: European registered nurses working shifts of ≥ 12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.

AIMTo explore how relational coordination, known to enhance quality and efficiency outcomes for patients and hospitals, impacts direct care nurse outcomes such as burnout, work engagement, and job satisfaction, addressing the “Quadruple Aim,” to improve the experience of providing care. BACKGROUNDHospitals are complex organizations in which multiple providers work interdependently, under conditions of uncertainty and time constraints, to deliver safe quality care despite differences in specialization, training, and status. Relational coordination—communicating and relating for the purpose of task integration—is known to improve quality, safety, and efficiency under these conditions, but less is known about its impact on the well-being of direct care providers themselves. METHODSSurveys measuring relational coordination among nurses and other types of providers as well as job-related outcomes in 5 acute care community hospitals were completed by direct care RNs. RESULTSRelational coordination was significantly related to increased job satisfaction, increased work engagement, and reduced burnout. CONCLUSIONSRelational coordination contributes to the well-being of direct care nurses, addressing the Quadruple Aim by improving the experience of providing care.

Objective: To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals. Study Selection: Twenty-eight studies reported adjusted odds ratios of patient outcomes in categories of RN-to-patient ratio, and met inclusion criteria. Information was abstracted using a standardized protocol. Data Synthesis: Random effects models assessed heterogeneity and pooled data from individual studies. Increased RN staffing was associated with lower hospital related mortality in intensive care units (ICUs) [odds ratios (OR), 0.91; 95% confidence interval (CI), 0.86-0.96], in surgical (OR, 0.84; 95% CI, 0.80-0.89), and in medical patients (OR, 0.94; 95% CI, 0.94-0.95) per additional full time equivalent per patient day. An increase by 1 RN per patient day was associated with a decreased odds ratio of hospital acquired pneumonia (OR, 0.70; 95% CI, 0.56-0.88), unplanned extubation (OR, 0.49; 95% CI, 0.36-0.67), respiratory failure (OR, 0.40; 95% CI, 0.27-0.59), and cardiac arrest (OR, 0.72; 95% CI, 0.62-0.84) in ICUs, with a lower risk of failure to rescue (OR, 0.84; 95% CI, 0.79-0.90) in surgical patients. Length of stay was shorter by 24% in ICUs (OR, 0.76; 95% CI, 0.62-0.94) and by 31% in surgical patients (OR, 0.69; 95% CI, 0.55-0.86). Conclusions: Studies with different design show associations between increased RN staffing and lower odds of hospital related mortality and adverse patient events. Patient and hospital characteristics, including hospitals' commitment to quality of medical care, likely contribute to the actual causal pathway.

OBJECTIVES:The aim of this study was to examine outcomes from 10 years of research on a post-baccalaureate new graduate nurse residency program and to report lessons learned. BACKGROUND:Transition to practice programs are recommended by the Future of Nursing report, the Carnegie Foundation study, the Joint Commission, and the National Council of State Boards of Nursing. METHODS:Data from new graduate residents who participated in the University HealthSystem Consortium/American Association of Colleges of Nursing residency from 2002 through 2012 are presented. Analysis of variance results from the Casey-Fink Graduate Nurse Experience Scale and outcomes from the graduate nurse program evaluation instrument are provided. RESULTS:Retention rates for new graduates in the residency increased considerably in the participating hospitals. Residents’ perception of their ability to organize and prioritize their work, communicate, and provide clinical leadership showed statistically significant increases over the 1-year program. CONCLUSION:The recommendations for new graduate nurse residency programs are supported by the findings.