Practice priorities for acute care nursing: A Delphi study.
Delphi study
acute nursing care
adverse events
patient safety
quality care
Journal
Journal of clinical nursing
ISSN: 1365-2702
Titre abrégé: J Clin Nurs
Pays: England
ID NLM: 9207302
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
18
09
2019
revised:
02
03
2020
accepted:
23
03
2020
pubmed:
13
4
2020
medline:
25
8
2020
entrez:
13
4
2020
Statut:
ppublish
Résumé
To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. Delphi Method. A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care. The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care.
Sections du résumé
AIMS AND OBJECTIVES
OBJECTIVE
To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus.
BACKGROUND
BACKGROUND
Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care.
DESIGN
METHODS
Delphi Method.
METHOD
METHODS
A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist.
RESULTS
RESULTS
High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care.
CONCLUSION
CONCLUSIONS
The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise.
RELEVANCE TO CLINICAL PRACTICE
CONCLUSIONS
This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care.
Types de publication
Journal Article
Langues
eng
Pagination
2615-2625Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Alper, E., O’Malley, T. A., Greenwald, J., Aronson, M. D., & Park, L. (2015). Hospital discharge and readmission. Retrieved from http://www.uptodate.com/contents/hospital-discharge-and-readmission
Andreasson, J., Eriksson, A., & Dellve, L. (2016). Health care managers' views on and approaches to implementing models for improving care processes. Journal of Nursing Management, 24(2), 219-227. https://doi.org/10.1111/jonm.12303
Australian Bureau of Statistics (2019). Health services: Patient experiences in Australia, 2018-19. Canberra, Australia. Retrieved from https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4839.0~2018-19~Main%20Features~Key%20findings~1.
Australian Commission on Safety and Quality in Health Care. (2017). National safety and quality health service standards, 2nd ed. Sydney, NSW: ACSQHC.
Australian Commission on Safety and Quality in Health Care. (2019). Avoidable Hospital Readmissions: Report on Australian and International indicators, their use and the efficacy of interventions to reduce readmissions. Sydney, NSW: ACSQHC.
Australian Institute of Health and Welfare (2016). Australia’s health 2016 (AUS 199). Retrieved from https://www.aihw.gov.au/reports/australias-health/australias-health-2016.
Baggoley, C., Owler, B., Grigg, M., Wellington, H., Monaghan, M., & Hartley-Jones, J. (2011). Expert panel review of elective surgery and emergency access targets under the national partnership agreement on improving public hospital services. Report to the Council of Australian Governments, 30.
Bleustein, C., Rothschild, D. B., Valen, A., Valatis, E., Schweitzer, L., & Jones, R. (2014). Wait times, patient satisfaction scores, and the perception of care. The American Journal of Managed Care, 20(5), 393-400.
Bornemann-Shepherd, M., Le-Lazar, J., Makic, M. B. F., DeVine, D., McDevitt, K., & Paul, M. (2015). Caring for inpatient boarders in the emergency department: Improving safety and patient and staff satisfaction. Journal of Emergency Nursing, 41(1), 23-29. https://doi.org/10.1016/j.jen.2014.04.012
Buchan, J., Twigg, D., Dussault, G., Duffield, C., & Stone, P. (2015). Policies to sustain the nursing workforce: An international perspective. International Nursing Review, 62(2), 162-170. https://doi.org/10.1111/inr.12169
Crawford, K., Morphet, J., Jones, T., Innes, K., Griffiths, D., & Williams, A. (2014). Initiatives to reduce overcrowding and access block in Australian emergency departments: A literature review. Collegian, 21(4), 359-366. https://doi.org/10.1016/j.colegn.2013.09.005
Dawson, A. J., Stasa, H., Roche, M. A., Homer, C. S., & Duffield, C. (2014). Nursing churn and turnover in Australian hospitals: Nurses perceptions and suggestions for supportive strategies. BMC Nursing, 13(1), 11. https://doi.org/10.1186/1472-6955-13-11
Forero, R., Man, N., Ngo, H., Mountain, D., Mohsin, M., Fatovich, D., … Hillman, K. (2019). Impact of the four-hour National Emergency Access Target on 30 day mortality, access block and chronic emergency department overcrowding in Australian emergency departments. Emergency Medicine Australasia, 31(1), 58-66. https://doi.org/10.1111/1742-6723.13151
Gan, T. J., Habib, A. S., Miller, T. E., White, W., & Apfelbaum, J. L. (2014). Incidence, patient satisfaction, and perceptions of post-surgical pain: Results from a US national survey. Current Medical Research and Opinion, 30(1), 149-160. https://doi.org/10.1185/03007995.2013.860019
Goodman, C. (2017). Conversation or consensus: using the Delphi technique to set priorities for ageing research and practice. Oxford University Press.
Ham, C., & Murray, R. (2015). Implementing the NHS five year forward view: Aligning policies with the plan. London: King's Fund.
Healy-Rodriguez, M. A., Freer, C., Pontiggia, L., Wilson, R., Metraux, S., & Lord, L. (2014). Impact of a logistics management program on admitted patient boarders within an emergency department. Journal of Emergency Nursing, 40(2), 138-145. https://doi.org/10.1016/j.jen.2012.12.008
Hooker, A. B., Etman, A., Westra, M., & Van der kam, W. J. (2018). Aggregate analysis of sentinel events as a strategic tool in safety management can contribute to the improvement of healthcare safety. International Journal for Quality in Health Care, 31(2), 110-116. https://doi.org/10.1093/intqhc/mzy116
Hughes, J. A., Cabilan, C., & Staib, A. (2017). Effect of the 4-h target on time-to-analgesia in an Australian emergency department: A pilot retrospective observational study. Australian Health Review, 41(2), 185-191. https://doi.org/10.1071/AH16025
Humphrey-Murto, S., & de Wit, M. (2019). The Delphi method-more research please. Journal of Clinical Epidemiology, 106, 136-139. https://doi.org/10.1016/j.jclinepi.2018.10.011
Humphrey-Murto, S., Varpio, L., Gonsalves, C., & Wood, T. J. (2017). Using consensus group methods such as Delphi and Nominal Group in medical education research. Medical Teacher, 39(1), 14-19. https://doi.org/10.1080/0142159X.2017.1245856
Jacques, T., Harrison, G. A., McLaws, M.-L., & Kilborn, G. (2006). Signs of critical conditions and emergency responses (SOCCER): A model for predicting adverse events in the inpatient setting. Resuscitation, 69(2), 175-183. https://doi.org/10.1016/j.resuscitation.2005.08.015
Jones, C. B., & Sherwood, G. (2014). The globalization of the nursing workforce: Pulling the pieces together. Nursing Outlook, 62(1), 59-63.
Jones, T. L., Hamilton, P., & Murry, N. (2015). Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. International Journal of Nursing Studies, 52(6), 1121-1137. https://doi.org/10.1016/j.ijnurstu.2015.02.012
Kaukonen, K. M., Bailey, M., Suzuki, S., Pilcher, D., & Bellomo, R. (2014). Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand. JAMA, 311(13), 1308-16.
Martinez, W., Lehmann, L. S., Hu, Y.-Y., Desai, S. P., & Shapiro, J. (2017). Processes for identifying and reviewing adverse events and near misses at an Academic Medical Center. Joint Commission Journal on Quality and Patient Safety, 43(1), 5-15. https://doi.org/10.1016/j.jcjq.2016.11.001
McPherson, S., Reese, C., & Wendler, M. C. (2018). Methodology update: Delphi studies. Nursing Research, 67(5), 404-410. https://doi.org/10.1097/NNR.0000000000000297
Merkley, B. R. (2016). Student nurse attrition: A half century of research. Journal of Nursing Education and Practice, 6(3), 71-75.
Moreno-Casbas, T., Martín-Arribas, C., Orts-Cortés, I., & Comet-Cortés, P. (2001). Identification of priorities for nursing research in Spain: A Delphi study. Journal of Advanced Nursing, 35(6), 857-863. https://doi.org/10.1046/j.1365-2648.2001.01923.x
NHS Digital (2017). NHS Digital annual report and accounts 2017 to 2018. Retrieved from https://digital.nhs.uk/about-nhs-digital/corporate-information-and-documents/nhs-digital-s-annual-reports-and-accounts/nhs-digital-annual-report-and-accounts-2017-to-2018
Nugent, R., Bertram, M. Y., Jan, S., Niessen, L. W., Sassi, F., Jamison, D. T., … Beaglehole, R. (2018). Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. The Lancet, 391(10134), 2029-2035. https://doi.org/10.1016/S0140-6736(18)30667-6
Oczkowski, S. J. W., Au, S., des Ordons, A. R., Gill, M., Potestio, M. L., Smith, O., … Fox-Robichaud, A. E. (2017). A modified Delphi process to identify clinical and research priorities in patient and family centred critical care. Journal of Critical Care, 42, 243-247. https://doi.org/10.1016/j.jcrc.2017.08.008
Organisation for Economic Co-operation and Development (2017). Health at a Glance 2017: OECD Indicators. Retrieved from http://dx.doi.org/10.1787/health_glance-2017-en
Puvaneswaralingam, S., & Ross, D. (2016). Improving the communication between teams managing boarded patients on a surgical specialty ward. BMJ Quality Improvement Reports, 5(1), u209186. w203750. https://doi.org/10.1136/bmjquality.u209186.w3750
Rafter, N., Hickey, A., Conroy, R. M., Condell, S., O'Connor, P., Vaughan, D., … Williams, D. J. (2017). The Irish National Adverse Events Study (INAES): The frequency and nature of adverse events in Irish hospitals-A retrospective record review study. BMJ Quality & Safety, 26(2), 111. https://doi.org/10.1136/bmjqs-2015-004828
Rutberg, H., Risberg, M. B., Sjödahl, R., Nordqvist, P., Valter, L., & Nilsson, L. (2014). Characterisations of adverse events detected in a university hospital: A 4-year study using the Global Trigger Tool method. British Medical Journal Open, 4(5), e004879. https://doi.org/10.1136/bmjopen-2014-004879
Sav, A., Kendall, E., McMillan, S. S., Kelly, F., Whitty, J. A., King, M. A., & Wheeler, A. J. (2013). ‘You say treatment, I say hard work’: Treatment burden among people with chronic illness and their carers in Australia. Health & Social Care in the Community, 21(6), 665-674. https://doi.org/10.1111/hsc.12052
Schmidt, K., Montgomery, L. A., Bruene, D., & Kenney, M. (1997). Determining research priorities in pediatric nursing: A Delphi study. Journal of Pediatric Nursing, 12(4), 201-207. https://doi.org/10.1016/S0882-5963(97)80002-4
Spence Laschinger, H. K., Zhu, J., & Read, E. (2016). New nurses’ perceptions of professional practice behaviours, quality of care, job satisfaction and career retention. Journal of Nursing Management, 24(5), 656-665. https://doi.org/10.1111/jonm.12370
Sri-On, J., Chang, Y., Curley, D. P., Camargo, C. A., Weissman, J. S., Singer, S. J., & Liu, S. W. (2014). Boarding is associated with higher rates of medication delays and adverse events but fewer laboratory-related delays. The American Journal of Emergency Medicine, 32(9), 1033-1036. https://doi.org/10.1016/j.ajem.2014.06.001
Sullivan, C., Staib, A., Khanna, S., Good, N. M., Boyle, J., Cattell, R., … Scott, I. A. (2016). The National Emergency Access Target (NEAT) and the 4-hour rule: Time to review the target. Medical Journal of Australia, 204(9), 354-354. https://doi.org/10.5694/mja15.01177
Victorian Department of Health and Human Services. (2017). Victorian Health Services Performance. Retrieved from http://performance.health.vic.gov.au/Home/Performance-Data-by-Hospital.
Vincent, J.-L., Einav, S., Pearse, R., Jaber, S., Kranke, P., Overdyk, F. J., … Hoeft, A. (2018). Improving detection of patient deterioration in the general hospital ward environment. European Journal of Anaesthesiology, 35(5), 325-333. https://doi.org/10.1097/EJA.0000000000000798
Wynendaele, H., Willems, R., & Trybou, J. (2019). Systematic review: Association between the patient-nurse ratio and nurse outcomes in acute care hospitals. Journal of Nursing Management, 27(5), 896-917. https://doi.org/10.1111/jonm.12764