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Errors in decision making and communication play a key role in poor patient outcomes. Safe patient care requires effective decision making during interdisciplinary communication through communication channels. Research on factors that influence nurse and physician decision making during interdisciplinary communication is limited. Understanding influences on nurse and physician decision making during communication channel selection is needed to support effective communication and improved patient outcomes. The purpose of the study was to explore nurse and physician perceptions of and decision-making processes for selecting interruptive or noninterruptive interdisciplinary communication channels in medical-surgical and intermediate acute care settings. Twenty-six participants (10 RNs, 10 resident physicians, and six attending physicians) participated in semistructured interviews in two acute care metropolitan hospitals for this qualitative descriptive study. The Practice Primed Decision Model guided interview question development and early data analysis. Findings include a core category, Development of Trust in the Communication Process, supported by three main themes: (1) Understanding of Patient Status Drives Communication Decision Making; (2) Previous Interdisciplinary Communication Experience Guides Channel Selection; and (3) Perceived Usefulness Influences Communication Channel Selection. Findings from this study provide support for future design and research of communication channels within the EHR and clinical decision support systems. A comprehensive patient assessment is essential for safe patient care. Patient assessment frameworks for nurses are generally restricted to patients who already have altered vital signs and are at risk of deterioration, or to specific risks or body systems such as falls, pressure injury and the Glasgow Coma Score. Comprehensive and structured evidence-based nursing assessment frameworks that consider the whole patient and extend beyond vital signs, specific risks and single systems are not routinely used in inpatient settings but are important to establish early risks for patient deterioration.
The aim of this review was to identify nursing assessment tools or frameworks used to holistically assess hospitalized patients and to identify the impact of these tools on patient and health service outcomes.
A scoping literature review was conducted. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Dissertations and Thesis, Embase and Scopus were databases used in the search. The initial search was conducted in August 2021 and repeated in November 2022. No date parameters were set. The Participants, Concept, Context (PCC) framework was used to guide the development of the research question and consolidate inclusion and exclusion criteria. The PRISMA-ScR Checklist Item was followed to ensure a methodologically sound checklist was used.
Ten primary research studies evaluating six nursing assessment frameworks were included. Of the five nursing assessment frameworks, none were explicitly designed for general ward nursing, but rather the emergency department or specific patient cohorts, such as oncology. Four studies reported on reliability and/or validity; two reported on patient outcomes and four on staff satisfaction.
Evidence-based nursing patient assessment frameworks for use in general inpatient wards are lacking. Existing assessment tools are largely designed for specific patient cohorts, specific body systems or the already deteriorating patient.
A framework to enable a structured approach to patient assessment in this environment is needed for patient safety, consistency in assessment, nursing staff enablement and confidence to escalate care. Routine systematic nursing assessment could also aid timely patient escalation.
What problem did the study address? This study addresses the lack of evidence-based nursing assessment frameworks for use in hospitalized patients. The impact of this is that it highlights the need for an evidence-based, whole of patient assessment framework for use by nurses for patients admitted to a ward environment.
What were the main findings? This review identified limited comprehensive, patient assessment frameworks for use in general ward inpatient areas. Those identified were not validated for this patient cohort and are aimed at patients already deteriorating.
Where and on whom will the research have an impact? This review has the potential to impact future research and patient care. It highlights that most research is focussed on processes to detect and escalate care for the already deteriorating patient. There is a need for an evidence-based routine nursing assessment framework for patients admitted to a ward environment to promote positive patient outcomes and prevent deterioration.
This review contributes to existing knowledge of nursing patient assessment frameworks, yet it also highlights several gaps. Currently, there are no known, validated, holistic, structured nursing patient assessment frameworks for use in general ward inpatient settings. However, areas that do use such assessment frameworks (e.g. the emergency department) have shown positive patient outcomes and staff usability. Hospitalized ward patients would benefit from routine, structured nursing assessments targeting positive patient outcomes prior to the onset of deterioration.
Objetivo principal: Analizar la influencia del contacto piel con piel (CPP) en el éxito de la lactancia materna exclusiva (LME) hasta los 6 meses de vida. Metodología: Estudio analítico descriptivo y prospectivo, realizado mediante entrevista directa con 500 puérperas seleccionadas por muestreo de casos consecutivos. Resultados principales: Cuando se realizó el CPP de manera ininterrumpida la LME a los 6 meses de vida fue del 17,40% y la de lactancia artificial del 12,60%. En los casos en que no se realizó, eran mayores las tasas de lactancia artificial (10,80%) frente a las de LME (4,40%). Las variables con mayor influencia en el éxito de la lactancia materna exclusiva a los 6 meses de vida, el tipo de alimentación en hijos anteriores y el tipo de alimentación al alta hospitalaria. Conclusión principal: Se deben evitar rutinas hospitalarias que interrumpan el CPP así como procurar que al alta hospitalaria la LME esté correctamente establecida.
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