Both researchers and research consumers need to reflect on the time frames involved in the evolution of various outcomes when assessing the validity of data linkages across time and units. For instance, in contrast to the lags between quality problems in care and evidence of their impact on outcomes such as infections and pressure ulcers, practice conditions will tend to have more immediately observable impacts on outcomes like falls with injury and most adverse drug reactions.
Recent legislation in California that introduced mandated nurse-to-patient ratios at the unit level provides an interesting context for studying the association of staffing and outcomes.
CalNOC has reported early comparisons of staffing and outcomes in medical-surgical and step-down units in 68 California hospitals during two 6-month intervals Q1 and Q2 of and Q1 and Q2 of before and after introduction of the ratios. Data were stratified by hospital size and unit type. On medical-surgical units, mean total RN hours per patient day increased by However, there were no statistically significant changes in the rate of patient falls or pressure ulcers on these units. Researchers have generally found that lower staffing levels are associated with heightened risks of poor patient outcomes.
Staffing levels, particularly those related to nurse workload, also appear related to occupational health issues like back injuries and needlestick injuries and psychological states and experiences like burnout that may represent precursors for nurse turnover from specific jobs as well as the profession. Associations are not identified every time they are expected in this area of research. Other aspects of hospital working conditions beyond staffing, as well individual nurse and patient characteristics, affect outcomes since negative outcomes are relatively uncommon even at the extremes of staffing and do not occur in every circumstance where staffing is low.
A critical mass of studies established that nurse staffing is one of a number of variables worthy of attention in safety practice and research. There is little question that staffing influences at least some patient outcomes under at least some circumstances. Future research will clarify more subtle issues, such as the preferred methods for measuring staffing and the precise mechanisms through which the staffing-outcomes relationship operates in practice.
Nurse executives and frontline managers make decisions about numbers of staff to assign to the various areas of their facilities. They also establish models of care to be used in caring for patients in terms of the constellation of nursing staff and distribution of responsibilities among professional nurses and other types of nursing staff. Policymakers want assurances that the nursing workforce in their jurisdictions is adequate; they also want to know whether or not regulatory intervention is necessary to ensure acceptable staffing levels and desirable patient outcomes.
The facility is considered a highly specialized hospital that primarily treats emergency cardiovascular conditions and trauma from accidents or violence. The ICU includes 31 hospital beds and is set up for clinical and surgical care. In total, there were 18 incidents reported and related to nursing care that occurred from January to March of The 18 reported incidents are associated with medication errors and the non-programmed withdrawal of therapeutic devices.
Given the homogeneity of the cases, the sample for root-cause analysis was composed of six cases: The six cases were selected through the accessibility of patient files and the available resources for data collection and to reach the study goal of publicizing the benefits of utilizing root-cause analysis as a tool for improving patient safety. The study was registered in a numbered book on page 42, which corresponds to the broadcasted approval certification registry, and was granted prior institutional authorization.
The study goals and procedures were explained in a detailed manner to the healthcare team, who handled the appointments and requested a signature of informed consent prior to the interviews. This first phase consists of decision-making regarding incidents for investigation based on the incident severity, the available resources, and the institutional learning potential 4.
In the current study, the analyzed incidents were selected by the researchers according to the greatest frequency of occurrence, the possibility of accessing the clinic patient registries, and the scientific evidence, thereby guaranteeing a greater potential for organizational learning. The group should include no more than three or four lead researchers 4. Thus, the present research group was composed of three investigators and two nurses from the institution's Quality and Risk Management Department.
This group complemented each other in research knowledge and incidence experience as well as in specific clinical knowledge and experience. This step consists of compiling and organizing all possible information, including a minimal complete clinical history, the protocols and procedures related to the incident, statements and immediate observations, interviews with those involved, and physical evidence e.
The data for performing the analysis was obtained through the patient clinical history; the requested clinical forms were gathered from the Medical Archives Service. The data related to the protocols and procedures, as well as to other relevant aspects, such as the shift-rotation rate and the availability of personnel, were obtained through interviews with the nursing team and through field observations. In this phase, using all of the information, it is possible to design the entire sequence of the facts and to compare them to events that actually occurred according to the policies, protocols, and procedures present in the service 4.
In the present study, the research investigator led discussions of how the events actually occurred versus how the events should have occurred. Identification of the unsafe acts and identification of the contributing factors. According to the methodology utilized in the London Protocol, once the sequence of facts that led to the incident is determined, the unsafe acts and contributing factors are separately identified.
An unsafe act is defined as conduct that occurs during the healthcare process by an action or omission of team members. Each unsafe act can be involved with one or more contributing factors, which may be related to the tasks and technology, the work environment, team factors, patients, individual factors, and the institutional context 4.
Once researchers have identified the unsafe acts that have led to incidents, they design the contributing factors related to each unsafe act using a fishbone diagram 4. The fishbone diagram, also known as the Ishikawa diagram or the cause-and-effect diagram, is one of the most utilized tools in action improvement and quality control in organizations as it enables grouping the causes of the phenomena that are expected to be improved. The fishbone diagram also enables graphically establishing a relationship between the detected problem and its possible causes, thereby enabling its visualization in an easier and more understandable manner From the contributing factors identified in this study, a series of recommendations was proposed to improve the identified weaknesses.
Each incidence was separately analyzed according to the London Protocol phases described in the method. However, due to the nature of this method, the events are presented in two categories: The medication-related incidences involved dosage omissions, medication errors, and dosage errors, and the incidences related to the self-withdrawal of therapeutic devices were associated with drainages, nasogastric catheters, and endotracheal tubes.
The first case involved dosage omission and medication error. In this case, a dose of antibiotics was not administered to a patient with a severe infectious condition due to the unavailability of venous access. The registries, interviews, and observations revealed that the patient had a single, peripheral venous access through which vasoactive drugs were administered, making it impossible to utilize this site for administering other medications.
This patient did not always have an adequate central venous route, even when receiving vasoactive drugs. In light of all of this information and case discussion, unsafe acts were identified as premature non-installation of a central venous route to a patient in serious condition utilizing vasoactive drugs with single, peripheral venous access. In light of the case analysis, the identified contributing factors were related to the tasks and technology i. The second case analyzed was due to medication error. In this situation, the patient was given a medication that was not prescribed for the medical indication.
The notification registries stated that the medication was suspended and not communicated. The interview and observations revealed that the medical indication is transcribed on individual cards for each patient and is utilized for personnel as a guide for medication administration.
Finally, consider professional variability, which relates to how nurses, physicians, and others practice and show up to work. The municipality has approximately , inhabitants, the urban agglomeration 1. Artificial flow can be managed to better meet the needs of unit and hospital staffing. Neonatal nursing is a subspecialty of nursing that works with babies conceived with an assortment of issues running from rashness, birth deserts, contamination, heart contortions, and careful issues. Or use the search field that already we provide. Add Item s to:.
The cards are not always updated throughout the shift because of time constraints. Therefore, insufficient communication among the nursing team and an excessive workload were identified as contributing factors Figure 1. This case was viewed as a dosage error. In the patient clinic form, it was stated that the medication dosage was modified for the same indication. The interviews and observations revealed that this change was not communicated and that the transcription card was not updated due to time constraints.
In the case analysis, the same contributing factors as in the previous case were identified Figure 1. Root-cause analysis of incidences related to the self-withdrawal of therapeutic devices. Australasian Emergency Nursing Journal ; Dzarr A et al A comparison between infrared tympanic thermometry, oral and axilla with rectal thermometry in neutropenic adults. European Journal of Oncology Nursing ; 13, Farnell S et al Temperature measurement: comparison of non-invasive methods in critical care.
Journal of Clinical Nursing ; Fulbrook P Core body temperature measurement: a comparison of axilla, tympanic membrane and pulmonary artery blood temperature. Intensive and Critical Care Nursing ; Giantin V et al Reliability of body temperature measurements in hospitalised older patients. Hamilton P, Price T The nursing process, holistic assessment and baseline observations. London: Mosby Elsevier. Lefrant J et al Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, inguinal methods versus pulmonary artery core method. Intensive Care Medicine ; 3, London: MHRA.
London: NICE. London: NMC. Pusnik I, Miklavec A Dilemmas in measurement of human body temperature.
Instrument Science Technology ; Robb P, Shahab R Infrared transtympanic temperature measurement and otitis media with effusion. International Journal of Pediatric Otorhinolaryngology ; 3, Edinburgh: SIGN. Journal of PeriAnesthesia Nursing ; 1, Sund-Levander M, Grodzinsky E Time for a change to assess and evaluate body temperature in clinical practice. International Journal of Nursing Practice ; 4, Sign in or Register a new account to join the discussion. You are here: Assessment skills. Measuring body temperature. Abstract Body temperature is one of the four main vital signs that must be monitored to ensure safe and effective care.
This article has been double-blind peer reviewed Scroll down to read the article or download a print-friendly PDF including any tables and figures. Key points Body temperature is one of the four main vital signs that must be monitored in a patient Wide variations in practice exist across the healthcare system for measuring body temperature Body temperature should be measured and recorded regularly with precision, consistency and diligence It is vital to measure temperature accurately as it has an impact on diagnosis and treatment Inaccurate temperature measurement may compromise patient safety.
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Otherwise it is like a Safety An Issue of Critical Care Nursing Clinics - E-Book 22 The Clinics Nursing - Organ Transplant An Issue of Critical Care Nursing Clinics. Safety GUEST EDITOR: Debora Simmons, RN, MSN, CCRN, CCNS CRITICAL CARE NURSING CLINICS OF NORTH ANMERICA CONSULTING RN, CNS Volume 22 - Number 2 - June boibranacphoho.cf Contributors GUEST EDITOR.
Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted. The need to improve the health care system is becoming increasingly evident as challenges related to both the quality and costs of care persist. As discussed in the preface, this study was undertaken to explore how the nursing profession can be transformed to help exploit these opportunities and contribute to building a health care system that will meet the demand for safe, quality, patient-centered, accessible, and affordable care.
It begins by describing a vision for a transformed system that can meet the health. The chapter then delineates the roles of nurses in realizing this vision. The third section explains why a fundamental transformation of the nursing profession will be required if nurses are to assume these roles. The final section presents conclusions. During the course of its work, the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine developed a vision for a transformed health care system, while recognizing the demands and limitations of the current health care system outlined above.