Review Of:. “A Quantitative Assessment Of Patient And Nurse

In every profession there are changes that propel how tasks are done; nursing is no stranger to this. One of the biggest changes that have come into nursing’s daily events is how report hand-offs are being done. Gone are the days of taped report that each off going nurse must tape about each patient and the oncoming nurse must listen to. Nurses are now being encouraged to move their report to the bedside, in front of the patient (Trossman, 2007). It is very important to know how this can affect the patient and even the nurse’s schedule. With every change, there are positives and negatives that can finalize the decision to keep or forego

The emphasis on improving bedside reporting is crucial today, when it is more than ever necessary for the health care institutions to operate at higher efficiency levels. In the absence of bedside reporting, nurses are frustrated as they spend 40 minutes reviewing patient data; patients also get frustrated (Ostermeier and Clair, 2008). Bedside reporting has the ability to improve nurse and patient satisfaction and support the overall quality of the medical act.

Traditionally, nursing shift-to-shift reports were organized methods of communication between only the oncoming and leaving nurse, designated to a location such as the central nursing station or nook of a hallway. Shift reports can be considered the foundation of how the day is going to plan out because it introduces the patient, diagnoses, complications, medications, consults, upcoming test and the entire plan of care. These reports are full of complicated and vital information and while set in certain locations that are vulnerable to interruptions, such as the nursing station, medical errors and miscommunication are more likely to be made. The Joint Commission’s 2009 and 2010 National Patient Safety Goals (Joint Commission, 2015) included two patient safety standards, first to encourage patients to be involved in their health care plan and second, to implement a standardized communication process for handoff reports between providers. Soon after in 2013, The Agency for Healthcare Research and Quality under the United States Department of Health and Human Services introduced a set of strategies to improve patient engagement along with safety and quality in patient care. Within these strategies the new method of nurse bedside shift report was developed, which suggests nurses to conduct shift-to-shift reports at bedside in the room of each patient, rather than out of the room. The benefits of this new method were

The sample size was large enough since it brought together 2,545 nurses, from different nursing units. In addition, the selection of four different hospitals ensured that there was no bias and that any similarity in research findings could be considered as part of the study’s objectives (Brewer, 2006, p. 650).

Bedside shift reporting, is it necessary? Baker (2010) states that is has its benefits, from patient safety, increased patient involvement and staff teamwork, ownership and accountability.” (Baker, 2010) To promote stronger engagement, Agency for Healthcare Research and Quality developed the Guide to Patient and Family Engagement in Hospital Quality and Safety for bedside reporting. (AHRQ, 2013)

Nursing-sensitive indicators are defined by the American Nursing Association (ANA) as “indicators that reflect the structure, process and outcomes of nursing care” (ANA, 2014). These indicators help define how nursing care is given by measuring the amount of nursing staff, skill level of the nursing staff, and the education level of nursing staff. These indicators depict the quality of care provided to patients and the outcomes of the care provided. Careful tracking of these indicators provides evidence for keeping current practices or for implementing new policy and procedures. A formal set of indicators measuring the impact nursing interventions have on patient care was not implemented until 1998 (Montalvo, I. (2007). With the establishment of the National Database of Nursing Quality Indicators (NDNQI), hospitals and other care settings are able to assess how nursing interventions impact patient outcomes, quality of care, and the overall work environment in health care facilities. Nursing-sensitive indicators are a quality improvement measure used to determine how the quality of nursing care is evaluated in hospitals and other healthcare facilities. Nurse sensitive indicators allow healthcare facilities to evaluate how the care they are providing is following evidence-based practices and how they can improve their practices to achieve better patient outcomes. The American Nurses Association is promoting these indicators as the definitive standards for patient care

2. Some of the ways in which these processes can be implemented include the development of new indicators to ensure that the contribution of nursing to patient care is at an optimal level. One way to accomplish this is by a review of peer-reviewed literature to determine the indicators that prove nursing sensitive, as well as to determine the reliability of information currently available on such indicators. On a less theoretical level, topic experts can also be approached for discussion on measurement issues and additional information to support theoretical reports and analysis. Patient risk level could be the focus of such discussion. After a plan for data collection and reports have been drawn up, comments from participating facilities can be invited regarding the feasibility of data collection methods, as well as for suggestions on additional methods to collect data and information, as well as how to implement processes.

Nursing theorist, Imogene King’s theory of goal attainment can be applied to bedside reporting. One major concept of King’s theory listed by McEwen & Wills (2011) is nursing; a process of action, reaction, and interaction whereby nurse and client share information about their perceptions in the nursing situation. The nurse and client share specific goals, problems, and concerns and explore means to achieve a goal (p. 163). When mutual goals have been identified, means have been explored, and nurse and client agree on means to achieve goals, transactions will be made, and goals achieved (Lane-Tillerson, 2007). Once the patient’s goal(s) are achieved then

National Council of State Boards of Nursing (NCSBN) (2014a). Consensus model implementation status. Retrieved from https://www.ncsbn.org/5397.htm

The impact of report on practice particularly in primary care is very huge. Over the past decades, we have realized, with every passing decade, nursing has become an increasingly integral part of the healthcare services, so that a future without large numbers of nurses is highly impossible to envision. We have also witnessed the drastic changes and advancement that have happened in the field of nursing over the past decades. Nurses have to change their current health care practice in order to meet the growth and also the goals of the IOM report.

This paper will address and evaluate the research problem itself, the design of the study, the sample, how the data is collected, its limitations, and its findings. Furthermore, how does this study impact the overall nursing process?

I will methodically analyze all parts of the study to assess the validity of the article, by contrasting and comparing the information provided, with previous literature. I will try to make sure that recommendations provided by the authors are congruous with nursing practice and beneficial to the advancement of it. I will as much as possible provide in depth detail of previous studies on the same topic that either support or contradict the analysis provided by this study and its authors.

Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily’s observations showed that she was: tachycardic, hypotensive, tachypnoeaic, had an oxygen saturation level of 88% and was becoming confused and drowsy. It became apparent that Lily had become hypovolaemic. The hypovolaemic shock seen in this patient was of a particular critical nature due to the fact that her dialysis treatment had moved her rapidly through the first two stages of shock with her compensatory mechanisms failing very quickly (Tait, 2012). It was also much harder to identify the early signs of

with recommendations for changes needed in nursing. This was a response for the need to assess

By focusing on overall patient care and satisfaction many areas patients are surveyed on can be improved. Once a performance standard is selected staff must develop a plan for improvement. The first step would be to research as many sources as possible to find the best evidence based practices that would work for the specific facility. This can be divided into two the two categories of direct nursing care and indirect nursing care. Direct nursing care would include implementing hourly rounding, adequate nursing staff and SBAR communication. Indirect nursing care includes availability of technology such as wireless communication, real time locating, wireless monitoring, and electronic medical records. The second step would contain education of the staff on what is to be implemented and why. The why is important for nurses to overcome any barriers that might be encountered. While nursing practice has grown based on evidence Vanhook (2009) explains the greatest barriers to evidence based practice, such as difficulty interpreting findings, limited time, and misunderstanding of research itself, and how to overcome these barriers. With phase one and two completed facilities can move forward with implementation and evaluation.