Cheryl Holly

A systematic review on the transfer of information during nurse transitions in care.

AIMS AND OBJECTIVES To examine the qualitative evidence on dynamics of knowledge transfer during transitions in care in acute care hospitals. BACKGROUND The most common transition between nurse care providers is the intershift handoff. As these handoffs tend to be time-consuming and costly, it is important to understand the dynamics of the transfer of information at this time and, by extension, improve quality and safety. DESIGN Systematic Review. METHODS Qualitative studies conducted between 1988 and 2012 were sought. A comprehensive four-stage search strategy identified 125 qualitative studies that met the inclusion criteria. Of these, 50 were retrieved for appraisal. Retrieved papers were assessed by two independent reviewers for methodological quality prior to inclusion in the review using a standardised critical appraisal instrument. RESULTS The final sample consisted of 29 qualitative studies. This represented more than 800 nursing handoffs and 300 nurse interviews. Sixteen categories were identified, which were then subjected to a meta-synthesis to produce a single comprehensive set of synthesised findings. CONCLUSION The evidence shows the handoff to be a complex, social interaction highly sensitive to context and cultural norms, an activity essential to multiple functions that extend beyond quality and safety. They are subject to wide variability in both the methods used and the kind of information that is handed off. Notably, the elucidation of the different ways in which individual nurses act as gatekeepers and influence patient care is a major finding of this review. RELEVANCE TO CLINICAL PRACTICE The results of this systemic review provide evidence that a consistent guideline may provide an optimal shift report given the findings of this review that information transferred may be random and variable, inconsistent and incongruent, inaccurate or absent.

A comprehensive systematic review of visitation models in adult critical care units within the context of patient‐ and family‐centred care

AIM The aim of this review was to appraise and synthesise the best available evidence on visitation models used in adult intensive care units in acute care hospitals and to explicate their congruence with the core concepts of patient- and family-centred care (PFCC). METHODS The review considered both quantitative and qualitative studies on visitation models developed within the PFCC model in adult intensive care units in acute care hospitals. The search strategy sought published and unpublished research papers limited to English for the years 1988 through 2009. An initial search of the Joanna Briggs Institute for Evidence-Based Nursing and Midwifery, the Cochrane Library, and PubMeds Clinical Inquiry/Find Systematic Review database was conducted, followed by an analysis of key words contained in the title, abstract and index terms. Following this, an extensive three-stage search was conducted using PubMed, CINAHL, HealthStar, ScienceDirect, Dissertation Abstracts International, DARE, PsycINFO, BioMedCentral, TRIP, Pre-CINAHL, PsycARTICLES, Psychology and Behavioural Sciences Collection, ISI Current Contents, Science.gov, Web of Science/Web of Knowledge, Scirus.com website. Included was a hand search of reference lists of identified papers to capture all pertinent material as well as a search of relevant worldwide websites and search engines, such as Google Scholar and the Virginia Henderson Library of Sigma Theta Tau International. Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using the appropriate critical appraisal instrument. RESULTS Findings from the qualitative studies were extracted and a synthesis conducted using the QARI (Qualitative Assessment and Review Instrument) software developed by the Joanna Briggs Institute. One synthesis revealed that visiting hours were seen as guidelines for the benefit of nurse and patient, rather than rules or policy. Due to the various types of designs in the available studies, it was not possible to pool quantitative research study results into a statistical meta-analysis. Because statistical pooling was not possible, the findings are presented in a narrative form. Following this, results are presented for their congruence with the principles of PFCC. CONCLUSION Flexible visiting policies provide the ability to incorporate the concepts of PFCC into practice. However, nurses believe that while visiting is beneficial to patients, open and/or flexible visiting hours are an impediment to practice and increase their workload. Recommendations for best practice were formulated based on the outcomes and include visiting hours should be used as guidelines, not rules, that allow flexibility dependent upon individual patient/family situation. With regard to congruence with PFCC, patient and family requests for information emerged as an unmet need that needs to be addressed.

Online teaching: challenges for a new faculty role.

This article discusses a number of challenges for faculty as they move into online teaching. These challenges involve the use of a constructivist approach in which faculty must function as facilitators or guides enacting transformative experiences with which learners feel confident and supported in working on their own and with each other rather than in more traditional teacher-centered roles. A unique challenge involves the application of classic educational philosophy to this method of teaching.

Acute Delirium: Differentiation and Care

The health care costs for patients with delirium were estimated to be more than double the costs for patients without delirium and potentially exceeded the costs for falls, diabetes mellitus, and hip fractures; yet the fluctuating nature of the condition makes it a difficult condition for health professionals to recognize and treat. The key, then, is in recognition and prevention.

Moving evidence to practice: reflections on a multisite academic-practice partnership.

ABSTRACTThis paper describes the challenges encountered by an academic team when working with clinical teams to translated knowledge for the purposes of quality improvement in multiple sites. The sites were four differing health care settings in a Northeastern US state: two acute care hospital sites (one rural, one urban), one visiting nurse service and one psychiatric specialty hospital were purposively chosen for the action research study. In conducting this study at these diverse sites the importance of developing relationships and trust, understanding the context and dealing with real world complexities were evident. We conclude with observations and recommendations on important elements for effective knowledge translation work.

The effectiveness of non-pharmacological multi-component interventions for the prevention of delirium in hospitalized older adult patients: a systematic review

Background:Delirium, an acute and fluctuating decline in attention and cognition, is a common problem in hospitalized older patients, resulting in poor clinical outcomes including functional decline, falls, nursing home placement, and death. Objective:The aim was to synthesize the best available evidence on non-pharmacological multi-component interventions for prevention of delirium in hospitalized non-intensive care older adults. Methods:Systematic review types of participants were adults hospitalized in a non-intensive care setting, 60 years and over, and identified as at risk for delirium or experiencing delirium. Types of intervention(s)/phenomena of interest. Studies considered evaluated non-pharmacological, multi-component interventions for the prevention of delirium in the hospitalized older adult when compared to usual care. Types of outcomes. Outcomes considered included incidence of delirium, duration of delirium, and severity of delirium. This review considered randomized controlled trials, controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, and case controlled studies. A three-step strategy was utilized to find both published and unpublished studies published in English between 1990 and 2013. The JBI Critical Appraisal Checklists for Randomized Control Trial/Pseudo-randomized Control Trial and Comparable Cohort/Case-Controlled Studies were used to assess methodological quality. Data were extracted using the standardized data extraction tools from JBI. Meta-analysis was conducted for the following outcomes: incidence of delirium, duration of delirium, and severity of delirium, including subgroup analysis. Results:Ten research articles were included. Patients who received multi-component interventions had 31% lower risk of developing delirium [(RR 0.69, at 95% CI 0.60, 0.78), p < 0.0001]. These interventions were found to lessen the duration and severity of delirium, although these findings were non significant. Discussion:The use of non-pharmacological, multi-component interventions in older patients in areas other than critical care can lower the risk of delirium. Conclusion:This systematic review provides Level 2 evidence on the effectiveness of non-pharmacological, multi-component interventions for the prevention of delirium in older patients in non-ICU settings.

Experiences of compassion fatigue in direct care nurses: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVES The objective of this qualitative systematic review is to examine available evidence on the experiences of direct care nurses of compassion fatigue (CF) within any nursing specialty or care setting. Specifically, this review will identify evidence on the following.

Strategies that reduce compassion fatigue and increase compassion satisfaction in nurses: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this quantitative systematic review is to determine effective strategies to reduce compassion fatigue and improve compassion satisfaction among nurses.

Experiences of HIV-infected adults and healthcare providers with healthcare delivery practices influencing engagement in primary healthcare settings: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this qualitative systematic review is to examine the experience and impact of health care delivery on health care engagement for adults infected with the human immunodeficiency virus receiving primary care. This review will identify and synthesize the best available evidence on health care structures, processes and practices that promote patient engagement in primary health care.The review question to be addressed is: What are the experiences of people living with human immunodeficiency virus (PLWH) and their health care providers with health care delivery processes and practices that impact engagement in primary health care settings (clinics, physician offices, and other community-based health care settings)? Specifically this review will compile evidence to illuminate health care system structures, provider practices, care delivery and programmatic processes that impact engagement in primary health care, as perceived by PLWH and their providers.

Families’ Experiences of Having an Adult Family Member in a Critical Care Area: A Systematic Review of Quantitative Evidence

The intention of this review is to examine what it is like to have a family member in a critical care area, and to use this information to generate recommendations for best practices, as an anticipated outcome. As such, this review intends to synthesize available knowledge about family needs so that conclusions can be drawn that: firstly, are directly relevant to practice; and secondly, provide an understanding of how family members report these experiences; and thirdly, determine the extent to which family needs are met and unmet. More specifically, the review seeks to: