1,721,016 research outputs found
Night work for hospital nurses and sickness absence: a retrospective study using routinely collected data
No full textHow long do nursing staff take to measure and record patients’ vital signs observations in hospital? a time-and-motion study
Full text linkIntroduction: Monitoring vital signs in hospital is an important part of safe patient care. However, there are no robust estimates of the workload it generates for nursing staff. This makes it difficult to plan adequate staffing to ensure current monitoring protocols can be delivered.
Objective: To estimate the time taken to measure and record one set of patient's vital signs; and to identify factors associated with the time required to measure and record one set of patient's vital signs.
Methods: We undertook a time-and-motion study of 16 acute medical or surgical wards across four hospitals in England. Two trained observers followed a standard operating procedure to record the time taken to measure and record vital signs. We used mixed-effects models to estimate the mean time using whole vital signs rounds, which included equipment preparation, time spent taking vital signs at the bedside, vital signs documentation, and equipment storing. We tested whether our estimates were influenced by nurse, ward and hospital factors.
Results: After excluding non-vital signs related interruptions, dividing the length of a vital signs round by the number of vital signs assessments in that round yielded an estimated time per vital signs set of 5 minutes and 1 second (95% Confidence Interval (CI) = 4:39-5:24). If interruptions within the round were included, the estimated time was 6:26 (95% CI = 6:01-6:50). If only time taking each patient's vital signs at the bedside was considered, after excluding non-vital signs related interruptions the estimated time was 3:45 (95% CI = 3:32-3:58). We found no substantial differences by hospital, ward or nurse characteristics, despite different systems for recording vital signs being used across the hospitals.
Discussion: The time taken to observe and record a patient's vital signs is considerable, so changes to recommended assessment frequency could have major workload implications. Variation in estimates derived from previous studies may, in part, arise from a lack of clarity about what was included in the reported times. We found no evidence that nurses save time when using electronic vital signs recording, or that the grade of staff measuring the vital signs influenced the time taken.
Conclusions: Measuring and recording vital signs is time consuming and the impact of interruptions and preparation away from the bedside is considerable. When considering the nursing workload around vital signs assessment, no assumption of relative efficiency should be made if different technologies or staff groups are deployed
Night work for hospital nurses and sickness absence: a retrospective study using electronic rostering systems
Full text linkThere is conflicting evidence on the effect of night work on sickness absence. Most previous studies used self-reporting to identify shift patterns and measure levels of sickness absence. In contrast, this study used objective data from electronic rosters to explore the association of nurses’ patterns of night work and sickness absence. This was a retrospective longitudinal study of nurse roster data from 32 general medical and surgical wards in a large acute hospital in England. We used data from 3 years and included both registered nurses and unregistered nursing assistants. We used generalized linear-mixed models to explore the association between night work and the subsequent occurrence of sickness absence. Of 601,282 shifts worked by 1944 nursing staff, 38,051 shifts were lost due to sickness absence. After controlling for potential confounders including proportion of long (≥12 h) shifts worked, proportion of overtime shifts, proportion of shifts worked in the past 7 days, and staff grade, we found that staff working more than 75% of their shifts in the past 7 days as night shifts were more likely to experience sickness absence (aOR = 1.12; 95% CI: 1.03–1.21), compared to staff working on day only schedules. Sub-group analysis found that an association between a high proportion of night shifts worked and long-term sickness (aOR = 1.31; 95% CI: 1.15–1.50), but not short-term sickness. Working high proportions of night shifts, likely representing permanent night work schedules, is associated with a higher risk of long-term sickness absence for nurses working in inpatient adult wards in acute hospitals. The higher sickness absence rates associated with permanent night shifts could result in additional costs or loss of productivity for hospitals. This study challenges the assumption that permanent night schedules maximize circadian adjustment and, therefore, reduce health problems
Why vital signs observations are delayed and interrupted on acute hospital wards: a multisite observational study
Full text linkBackground: vital signs monitoring is key to identifying deteriorating hospital patients. However, adherence to monitoring protocols is limited, with observations frequently missed or delayed. Previous studies of interruptions and delays to vital signs observations have been descriptive, with none attempting to conceptualise the types of tasks that are prioritised over vital signs observations.Objective: this paper aims to explore how nursing teams perform vital sign observations on acute hospital wards and conceptualises which types of work delay or interrupt them.Design: non-participant observational study.Setting(s): four hospitals in the south of England.Methods: eligible adult wards (surgical and medical) within each hospital were randomly sampled for inclusion. Four sets of two-hour daytime observation sessions were undertaken on each ward. Two observers recorded structured and unstructured observations (open comments, field notes) on a tablet with adapted QI Tool software. We collected data over 128 h, including 715 sets of vital signs observations and 1127 interruptions. We undertook a qualitative content analysis of interruptions and delays to planned vital signs observations using both structured and unstructured observations.Results: we identified eight reasons why vital signs were delayed or interrupted: fixed routines, staff availability, bundled care, proximity-related activities, collaborative care, patient inaccessible or unavailable, requests for or responses to time-critical activities, or limited context available. We propose a new concept of ‘temporal status.’ Flexible care (vital signs observations, ‘bundled care’ and ‘proximity-related care’) has a low temporal status so is delayed in favour of higher temporal status activities (fixed routines and time-critical care).Conclusions: our findings could explain why vital signs taken early in the morning and evening are least likely to be postponed, as there may be fewer competing tasks with a higher temporal status at these times. Our work also challenges binary conceptualisations of interruptions as ‘beneficial’ or ‘detrimental’, recognising the complexity of nursing care decisions on a moment-by-moment basis. Our new framework suggests the lower temporal status of vital signs observations (and other flexible care) means they are delayed by higher temporal status tasks during daytime shifts in acute hospitals, regardless of their clinical priority
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Are long nursing shifts on hospital wards associated with sickness absence? A longitudinal retrospective observational study
Full text linkObjective
To investigate whether working 12 hr shifts is
associated with increased sickness absence among registered nurses and
health care assistants.
Background
Previous studies reported negative impacts on nurses’
12 hr shifts; however, these studies used cross‐sectional techniques and
subjective nurse‐reported data.
Methods
A retrospective longitudinal study using routinely
collected data across 32 general inpatient wards at an acute hospital in
England. We used generalized linear mixed models to explore the
association between shift patterns and the subsequent occurrence of
short (<7 days) or long‐term (≥7 days) sickness absence.
Results
We analysed 601,282 shifts and 8,090 distinct episodes
of sickness absence. When more than 75% of shifts worked in the past
7 days were 12 hr in length, the odds of both a short‐term (adjusted
odds ratio = 1.28; 95% confidence index: 1.18–1.39) and long‐term
sickness episode (adjusted odds ratio = 1.22; 95% confidence index:
1.08–1.37) were increased compared with working none.
Conclusion
Working long shifts on hospital wards is associated
with a higher risk of sickness absence for registered nurses and health
care assistants.
Implications for Nursing Management
The higher sickness absence rates associated with long
shifts could result in additional costs or loss of productivity for
hospitals. The routine implementation of long shifts should be avoided.</p
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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