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Nursing

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24

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Start date: 2020Subject: search.filters.subject.Acute Hospital

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Now showing 1 - 4 of 4
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    One Chance to Get it Right: Exploring Perspectives and Experiences in Care Home Discharge Decision-Making in the Acute Hospital
    (Wiley, 2025-09-05) Stevenson, Gemma; Burton, Jennifer Kirsty; Shenkin, Susan D.; MacArthur, Juliet; McCormack, Brendan; Clare Halpenny; Rhynas, Sarah
    Background Discharge from acute hospital to new care home is a complex and life changing process often involving several key stakeholders in decision-making such as the older person, their significant person and members of the multidisciplinary team. There is limited research exploring the perspectives of these stakeholders, including factors that influence decision-making and how this is communicated. Objective This study explored how decisions are made to discharge older people directly from hospital to care home, considering the perspectives and experiences of those involved. Methods A case study design was used to explore the experiences of six older people admitted to acute hospital from home for whom discharge to care home was planned. Six datasets were formed, each comprising semi-structured interviews with the person, their significant person(s) (if applicable), multi-disciplinary professionals and review of health and social-work records. Datasets were analysed using an inductive thematic approach before cross-dataset analysis. Results Findings emphasised the complex and personal nature of decision-making. The older person was often keen to talk about their decision. Significant people highlighted the complexity of balancing risk and care needs. However, the magnitude of the decision to older people and their significant persons appeared to go underacknowledged by professionals. The hospital context was significant as a location for decision-making. Communication was integral to the experiences of those involved; however, uncertainty and lack of role clarity impacted this. Conclusions This study offers new insights into the complexity of discharge to care home from hospital. This life-changing decision requires greater recognition by professionals. Improved understanding of the process and well-developed communication is central to enhancing the experience for those involved. Implications for Practice The significance of this oftentimes final decision should not be underestimated. The findings indicate a clear need for interdisciplinary education about care home discharge, and the importance of professionals' availability and approachability throughout decision-making. Professionals are encouraged to recognise a shared responsibility for the provision of information and guidance, and create opportunities for open and supportive conversations with older people and their families to explore the decision and discuss their feelings.
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    Using a combined Lean and person-centred approach to support the resumption of routine hospital activity following the first wave of COVID-19
    (MDPI, 2022-02-27) Daly, Ailish; Teeling, Sean Paul; Garvey, Suzanne; Ward, Marie; McNamara, Martin
    The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated by a specific project team including the chief operation officer, allied therapy manager (encompassing health and social care professionals), infection prevention and control team, head of surgical services, clinical nurse managers, patient services manager and the head of procurement. Following our intervention, hospital services resumed successfully, with the initial service resumption meeting the organizational target of a 75% bed occupancy rate, while the number of resumed surgeries exceeded the target by 13%. Our outpatient visits recovered to exceed the attendance numbers pre-COVID-19 in 2019 by 10%. In addition, patient satisfaction improved from 93% to 95%, and importantly, we had no in-hospital patient COVID-19 transmission in the study period of July to December 2020.
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    A case study of a whole system approach to improvement in an acute hospital setting
    (MDPI, 2022-01-22) Ward, Marie E.; Daly, Ailish; McNamara, Martin; Garvey, Suzanne; Teeling, Sean Paul
    Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.
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    Designing and implementing an electronic nursing record to support compassionate and person-centred nursing practice in an acute hospital using practice development processes
    (SAGE, 2020-05-03) Hardiman, Michele; Connolly, Marie; Hanley, Sinead; Kirrane, Jackie; O'Neill, Winifred
    Background The complexity of nursing practice can pose challenges to the development of an e-record that meets all the requirements and standards whilst capturing the essence of the relationship between the nurse and his/her patients. Aims 1. Describe the process of designing the content of an electronic nursing record (e-record) specific to nursing in an Irish/UK context, using Practice Development (PD) methodology. 2. To share the learning of involving the end-user in the development of a person-centred e-nursing record. Methods Evidence-based PD methodologies, principles and evaluation tools were employed to involve end users in the development of a person-centred and evidence-based e-record. Results The results are limited to evaluation of the design process and reported using the SQUIRE guidelines for reporting quality improvement. Investing in time to involve end users in the design and implementation phase resulted in satisfaction and adoption of the e-record by nurses. Conclusions For nurses to be satisfied with the content and process flow of an e-nursing record it needs to include the relational and non-clinical aspect of nursing practice in addition to the clinical pre-set content. Involving the end user in a meaningful way supports a positive outcome.