Tag Archives: staff

Are there any valid instruments for assessing risk for violence in mental health patients and is use of these instruments associated with fewer incidents of assaults on staff by patients?

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Bottom line:  There is some limited evidence that use of risk assessment tools can predict violent behavior by patients and can be associated with  reduction in aggressive incidents.

A systematic review in JBI+ COnNECT (JBI Library of Systematic Reviews. 2009;7(6):175-223) identified one retrospective study (Kling, 2006) of a tool to assess inpatients for risk of violent behavior.  In PubMed this reference led to other studies, including an RCT (Abderhalden, 2008) and a pilot study (Fluttert 2011)

Kling, R., et al., Use of a violence risk assessment tool in an acute care hospital: effectiveness in identifying violent patients. AAOHN Journal, 2006. 54(11): p. 481-7. (Available in print at Health Sciences Center Library.)
Reviewed charts at 1 acute care hospital for 117 violent patients and 161 randomly selected, nonviolent patients admitted during the same period.  Compared findings of a risk assessment tool in these populations.  Tool had moderate senstivity (71%) and high specificity (94%).  Limitation – only 35% of the non-violent patients and 75% of the violent patients were evaluated using the tool.

Abderhalden C, et al. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial. Br J Psychiatry. 2008 Jul;193(1):44-50.
Cluster RCT randomized 14 psychiatric units to use of Swiss version of the Brøset Violence Checklist (BVC–CH) or usual care for patients admitted to these units.  RESULTS: Adjusted RR indicate 41% reduction in severe aggressive incidents and a 27% decrease in use of coercive measures.  There was no decrease in severity of aggressive incidents.

Fluttert FA, et al. The development of the Forensic Early Warning Signs of Aggression Inventory: preliminary findings toward a better management of inpatient aggression. Arch Psychiatr Nurs. 2011 Apr;25(2):129-37.
Describes development of a new risk assessment tool.

PubMed search:  “Inpatients/psychology”[mesh] AND “Violence/prevention and control”[mesh] AND assess*

Reviewed 4/18/14  AA

Does double checking by two registered nurses prior to injection of insulin or heparin reduce risk of medication errors?

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Bottom line:  There is little evidence to support or to refute the effectiveness of double-checking by nurses to reduce rates of medication errors.

Wimpenny P and Kirkpatrick P.  Roles and systems for routine medication administration to prevent medication errors in hospital-based, acute care settings: a systematic review.  JBI Library of Systematic Reviews. 2010;8(10):405-446.

Hughes RG and Blegen MA.  Medication administration safety.  In:  Patient Safety and Quality:  An Evidence-Based Handbook for Nurses.  AHRQ.  Updated April 2008.  http://www.ahrq.gov/qual/nurseshdbk/docs/HughesR_MAS.pdf
Start with the Policies, Procedures and Protocols section on p. 20.

O’Connell B et al.  Nurses’ attitudes to single checking medications:  before and after its use.  Inter J Nurs Practice.  2007; 13: 377-82.

Studies of errors reported by nurses that address double-checking:

Jarman et al.  Inter J Nurs Practice. 2002; 8: 330-335.  Survey of nurses reporting errors during period of single-checking and period of double-checking.  No significant difference in error rates between the two periods.

Stratton KM et al.  J Pediatr Nurs.  2004;19(6): 385.  Survey of nurses’ perceptions of factors associated with medication errors.  For 28% of the errors reported, nurses identified failure to double-check as a reason for the error.

Reviewed 4/14/2014 AA

What are the best practices and recommendations for managing flexible budgets and staffing?

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Guidelines/recommendations for staffing in CINAHL:  (MH “Personnel Staffing and Scheduling”) Limits:  practice guidelines, standards

If interested in staffing for specific area, such as critical care, just add that term to the search.

Tools, formulas, etc. for working with flexible budgets
Flexible budgets and staffing matrix.  In:  Nursing Management:  Principles and Practice (Gullatte M, ed.)  Pittsburgh:  Oncology Nursing Society, 2005.
You can review this book in the EUH Branch Library (see the Nursing shelf).
Lots of worksheets and helpful explanation.

Practical Guide to Finance and Budgeting, 2nd ed, edited by K. Waxman, 2008
Online book includes sections on budgeting methods,
Does not include much instruction, but does have a link, How to use the tools on the cd-rom, over on the left side of the page that may provide links to samples of forms, etc. that might prove helpful.

Reviewed 4/25/14  AA

What effect does standard clinical attire to help patients recognize different caregivers have on patient satisfaction?

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Search Methods
Searched PubMed and CINAHL for combinations of the following concepts:
dress OR attire OR uniforms
patient satisfaction
patient attitudes or perception
allied health personnel
patient care team
identification
nurse’s role

Search Results
Below are selected studies applying mostly to a general patient population. There are also studies about specific patient populations, such as behavioral health units.

PubMed
Relevant studies are in this PubMed collection.
These are observational studies of patient’s perception of nursing attire.

CINAHL
Title: An evidence-based approach to creating a new nursing dress code: a survey of patients reveal what nurses should — and shouldn’t — wear.
Authors: Windle L ; Halbert K ; Dumont C ; Tagnesi K ; Johnson K
Source: American Nurse Today (AM NURSE TODAY), 2008 Jan; 3(1): 17-9

Title: Dress code debate.
Authors: Kaser M ; Bugle LW ; Jackson E
Source: Nursing Management (NURS MANAGE), 2009 Jan; 40(1): 33-8
COMMENT: This small study included 20 patients and their family members and 12 nurses who represented children’s units. The preference of being able to distinguish nurses from other healthcare staff did come up in this study.

Title: Use of non-conventional nurses’ attire in a paediatric hospital: a quasi-experimental study.
Authors: Festini F ; Occhipinti V ; Cocco M ; Biermann K ; Neri S ; Giannini C ; Galici V ; de Martino M ; Caprilli S
Source: Journal of Clinical Nursing (J CLIN NURS), 2009 Apr; 18(7): 1018-26
COMMENT: Investigates parents and children’s (N=112) attitudes toward multi-colored v. white uniforms for nurses. Parents expressed preference for being able to distinguish nurses from other staff.

Title: True colors: more hospitals turn to standardized attire for nurses to better identify them to patients and to polish their professional image.
Authors: Gaskill M
Source: NurseWeek (15475131) (NURSEWEEK (S CENTRAL)), 2004 Oct 4; 11(21): 20-1

Reviewed and updated 4/16/2014

Is there evidence about the role of the unit clerk/coordinator in hourly rounding?

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Bottom line:  There is no published evidence documenting role of the unit clerk or coordinator in intentional or hourly rounding.

Details:  Searched Joanna Briggs, CINAHL, PubMed for combinations of these concepts.
hourly, intentional, comfort rounding, rounds, unit clerk, unit coordinator

Reviewed 4/11/2014 ldt

What are nurse retention rates at other emergency departments of teaching facilities and non-teaching facilities?

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Bottom line: 4.46% of RN staff nurses left their EDs in 2007. It took an average of 57 days to fill vacancies. Data is from a survey of 700+ emergency departments in the US. Private, not-for-profit, teaching hospitals accounted for 36% of institutions represented and private, not-for-profit, non-teaching hospitals accounted for 22%.

Couselman FL, et al. A study of the workforce in emergency medicine: 2007. Am J Emerg Med. 2009; 27: 691-700
The study was funded by American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, Emergency Medicine Foundation, Emergency Medicine Residents’ Association, ENA, GE Healthcare, and the Society for Academic Emergency Medicine.

Reviewed 4/21/2014 ldt