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Content Article
Burnout in nursing: a theoretical review (5 June 2020)
Patient Safety Learning posted an article in Staff safety
Workforce studies often identify burnout as a nursing ‘outcome’. Yet, burnout itself—what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients—is rarely made explicit. Dall'Ora et al. aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout. -
Content ArticleSecond harm is the added psychological distress from an inadequate response by healthcare providers in response to medical errors or neglect. This inadequate response may require patients to seek counselling. The counselling needs of patients who have experienced second harm have received limited research attention. This Q methodology study addresses this gap in knowledge in order to further inform counselling practice.
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Content ArticleThe Joint Commission implemented medication management titration standards in 2017, with revisions in 2020. Researchers surveyed critical care nurses about their experiences with medication titration, use of clinical judgment when titrating, nurses’ scope and autonomy, and their moral distress. Of 781 respondents, 80% perceived the titration standards caused delays in patient care and 68% reported suboptimal care, both of which significantly and strongly predicted moral distress.
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Content ArticleThe aim of this study was to derive a comprehensive list of nursing-sensitive patient outcomes (NSPOs) from published research on nurse staffing levels and from expert opinion. The authors identified strong evidence for a significant association between nurse staffing levels and NSPOs. The results may guide researchers in selecting NSPOs they might wish to prioritise in future studies.
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Content ArticleThe national surgical site infection (SSI) surveillance service in England collates and publishes SSI rates that are used for benchmarking and to identify the prevalence of SSIs. However, research studies using high-quality SSI surveillance report rates that are much higher than those published by the national surveillance service. This variance questions the validity of data collected through the national service. The aim of this study from Tanner et al. was to audit SSI definitions and data collection methods used by hospital trusts in England.
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Content ArticleThis study from Harris et al. estimated the effect of prompt admission to critical care on mortality for deteriorating ward patients. They found that prompt admission to critical care leads to lower 90-day mortality for patients assessed and recommended to critical care.
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Content ArticleDaily safety briefings, also referred to as “huddles,” are conducted within hospitals in efforts to minimize errors and improve patient safety. These briefings are intended to be quick, efficient, and meaningful to health care workers. The purpose of this research is to assess current and perceived best practices related to safety huddles in health-system pharmacy departments, including timing, location, persons involved, and topics covered.
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Content ArticleThis nationwide study of over 1 million births in the English NHS between 2015 and 2017, published in The Lancet, has found large inequalities in pregnancy outcomes between ethnic and socioeconomic groups in England. The findings from Jardine et al. suggest that current national programmes to make pregnancy safer, which focus on individual women's risk and behaviour and their antenatal care, will not be enough to improve outcomes for babies born in England. The authors say that to reduce disparities in birth outcomes at a national level, politicians, public health professionals, and healthcare providers must work together to address racism and discrimination and improve women's social circumstances, social support, and health throughout their lives.
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Content ArticleHealthcare workers have had the longest and most direct exposure to COVID-19 and consequently may suffer from poor mental health. Quintana-Domeque et al. conducted one of the first repeated multi-country analysis of the mental wellbeing of medical doctors at two timepoints during the COVID-19 pandemic to understand the prevalence of anxiety and depression, as well as associated risk factors. Rates of anxiety and depression were highest in Italy (24.6% and 20.1%, June 2020), second highest in Catalonia (15.9% and 17.4%, June 2020), and lowest in the UK (11.7% and 13.7%, June 2020). Across all countries, higher risk of anxiety and depression symptoms were found among women, individuals below 60 years old, those feeling vulnerable/exposed at work, and those reporting normal/below-normal health.
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Content ArticleGlobally, children have been profoundly affected by the COVID-19 pandemic in many ways. While the majority of children with acute COVID-19 infection experience mild illness and fully recover, many go on to experience Long Covid. Long Covid is clinically identified by experience of persistent (and sometimes different) symptoms for several months after the acute infection (even in children who were asymptomatic). There is currently no agreed consensus on the case definition of Long Covid, but real-world data from American health insurance firms and the UK Office for National Statistics report that children may experience intestinal symptoms, pain, breathlessness, cognitive dysfunction and post-exercise malaise. The current understanding of the natural history, diagnostics and treatments of Long Covid is limited, meaning the medical model in isolation is not helpful. Michael Fanner and Elaine Maxwell in this paper explores how health visitors and school nurses are ideally placed to case-find children with Long Covid and co-produce child and family-centred care.
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Content ArticleIn this study the authors characterised the dynamics of SARS-CoV-2 transmission within a hospital setting, identifying key differences across the two pandemic waves, as well as the relative contribution of different groups and hospital locations to within-hospital transmission. They found the prevention and control measures that evolved during the COVID-19 pandemic may have had a significant impact on reducing infections between healthcare workers, but were insufficient during the second wave to prevent a high number of patient-to-patient transmissions. As hospital-acquired cases appeared to drive most onward transmissions, more frequent and rapid identification and isolation of these cases will be required to break hospital transmission chains in subsequent pandemic waves.
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Content ArticleCholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. This study from MacFadyen et al. reviewd laparoscopic cholecystectomy in the United States from 1989 to 1995. A total of 114,005 cases were analysed and 561 major bile duct injuries (0.50%) and 401 bile leaks from the cystic duct or liver bed (0.38%) were recorded. Based on this review of laparoscopic cholecystectomies, the authors found that the morbidity and mortality rates are similar to open surgery. In addition, the rate of bile duct injuries and leaks is higher than in open cholecystectomy. Furthermore, bile duct injuries can be minimised by lateral retraction of the gallbladder neck and careful dissection of Calot's triangle, the cystic duct-gallbladder junction, and the cystic duct-common bile duct junction.
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Content ArticleThere is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. Maben et al. explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. The study found that staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms.
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Content ArticleOman’s healthcare system has rapidly transformed in recent years. A recent Report of Quality and Patient Safety has nevertheless highlighted decreasing levels of patient safety and quality culture among healthcare professionals. This indicates the need to assess the quality of care and patient safety from the perspectives of both patients and healthcare professionals. This study from Al-Jabri et al. aimed to examine (1) patients’ and healthcare professionals’ perspectives on overall quality of care and patient safety standards at two tertiary hospitals in Oman and (2) which demographic characteristics are related to the overall quality of care and patient safety.
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Content ArticleThis systematic review and meta-analysis from Mazzone et al. confirms that proficiency-based progression training in comparison to conventional or quality assured training improved trainees' performances, by decreasing procedural errors and procedural time, while increasing the number of correct steps taken when compared to standard simulation-based training.
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Content ArticleLong-COVID refers to a variety of symptoms affecting different organs reported by people following Coronavirus Disease 2019 (COVID-19) infection. To date, there have been no robust estimates of the incidence and co-occurrence of long-COVID features, their relationship to age, sex, or severity of infection, and the extent to which they are specific to COVID-19. The aim of this study from Taquet et al. is to address these issues.
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Content ArticleA new BMJ Open study from Grimmond et al. compared global warming potential of hospitals converting from single-use sharps containers to reusable sharps containers. The study reveals that, on average, the 40 NHS trusts studied when converting from single use to reusable sharps containers reduced their sharps waste stream carbon footprint by 84%.
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Content ArticleIncreasingly, healthcare organisations are using the unique perspective of patients and families to drive organisational change. As recipients of care, patients and families are well-positioned to add immense value as equal partners in efforts to advance healthcare quality. However, what is important is not just the engagement of patients in quality improvement, but how one engages them. Even with the best intentions, it is the ‘how’ that can be most challenging, as most recommendations end at high-level concepts, leaving quality improvement teams wondering how to most effectively engage their patients and families in a tangible and concrete way. A multidisciplinary team at a large health system undertook a quality improvement initiative utilising the ‘Plan-DoStudy-Act’ methodology for continuous quality improvement.
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Content ArticleZiebland et al. consider what might be learned from the unintended, apparently unanticipated, consequences of the use of digital health (including alternatives to face to face consultations, electronic medical records, use of apps and online monitoring) in primary care.
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Content ArticleFor over a decade, the preoperative timeout procedure has been implemented in most paediatric surgery units. However, the impact of this intervention has not been systematically studied. This study from Muensterer et al. evaluates whether purposefully introduced errors during the timeout routine are detected and reported by the operating team members. The study found that errors in the timeout routine go unnoticed by the team in almost half of cases. Therefore, even if preoperative timeout routines are strictly implemented, mistakes may be overlooked. Hence, the timeout procedure in its current form appears unreliable. Future developments may be useful to improve the quality of the surgical timeout and should be studied in detail.
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Content ArticleThis article in Age & Ageing describes a quality improvement project at Leeds Teaching Hospitals Trust (LTHT) that aimed to achieve timely Parkinson’s disease medication administration.
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Content ArticleClinical guidelines advise GPs in England which patients need urgent referral for suspected cancer. This study in BMJ Quality & Safety used linked primary care, secondary care and cancer registration data to assess: how often GPs follow the guidelines on cancer referral whether certain patients are less likely to be referred how many patients were diagnosed with cancer within one year of non-referral. The study included patients who presented for the first time with blood in the urine, breast lump, difficulty swallowing, iron-deficiency anaemia and post-menopausal or rectal bleeding during 2014–2015. The authors found that the majority of patients presenting with common possible cancer symptoms were not being referred by GPs in line with clinical guidelines. They also found that a significant number of these patients went on to develop cancer within a year, and suggest that improvement is needed in the cancer diagnosis process.
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Content ArticleThis systematic review published in BMJ Global Health looks to identify the nature, frequency and causes of long-COVID symptoms by reviewing data from existing research studies into long-COVID. It aims to regularly synthesise evidence on long-COVID characteristics to help improve long-term outcomes. From the data provided by 39 studies, the review found that: long-COVID affects both patients who were hospitalised and those managed in the community patients with long-COVID display a wide range of symptoms including weakness, general malaise, fatigue, concentration impairment and breathlessness research currently available on long-COVID is vulnerable to bias, so caution should be used when interpreting data. The authors also identify areas where further research is needed to help define long-COVID symptoms, identify risk factors for different populations and assess the impact of variants of concern and vaccination on long-term outcomes.
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Content ArticleThis research by the Nuffield Trust, commissioned by NHS England and NHS Improvement, explores the business case for overseas recruitment and looks at the factors that attract or deter nurses from choosing to work in the UK. With a current NHS nursing vacancy rate of 10% and ambitious national goals to expand the workforce, recruiting nurses from overseas is an essential part of the picture. In this research, the authors look at the costs and benefits of overseas recruitment and present their findings as a briefing paper, research report and review on factors that attract or deter staff from moving to the UK.
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Content ArticleThis report by Charles River Laboratories looks at the results of a survey of more than 1,500 Americans conducted in May 2021 by The Harris Poll. The survey showed that 64% respondents believed that closer collaboration between industry organisations would lead to higher quality healthcare. The report contains data on: patient views about the state of the US healthcare system how much patients know about drug and vaccine development processes patient attitudes towards the US Food & Drugs Administration (FDA) how the COVID-19 pandemic has increased collaboration in healthcare.
