Exploring the State of the Science of the Nursing Hand-off Communication

Miscommunication that occurs during the exchange of information between healthcare providers accounts for approximately 80% of adverse events in the healthcare setting. Nurses devote 10% to 15% of the workday to the nurse-to-nurse hand-off communication. The hand-off itself has remained virtually unchanged for the past 20 years, although the process is prone to errors. The introduction of the electronic health record and mandates to decrease errors and improve patient outcomes has led to an influx of research on the nurse-to-nurse hand-off communication. This article provides a comprehensive synopsis of the hand-off and the state of science on nurse-to-nurse communication using hand-offs. In general, the use and implementation of standardized tools and the nurse's perception of and satisfaction with the hand-off communication have been researched extensively. A standardized hand-off tool increases nurse satisfaction with the structure and consistency of the hand-off. While electronic health record–related forms and devices are not utilized by nurses, communication patterns and communication behaviors can also influence the effectiveness of the hand-off message. The areas of memory, cognition, and content of the hand-off affect the transfer and recall of hand-off information. Continued research on hand-off communication is essential to ensure patient safety. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Benjamin J. Galatzan, MSN, RN, Helen & Arthur E. Johnson Beth El College of Nursing and Health Sciences, University of Colorado Colorado Springs, University Hall, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918 (bgalatzan@email.arizona.edu). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A Mobile Application for Patients With Heart Failure: Theory- and Evidence-Based Design and Testing

Self-care is vital for the successful management of heart failure. Mobile health can enable patients with heart failure to perform effective self-care. This article describes the theory-guided development and beta testing of a mobile application intervention to support self-care and increase symptom awareness in community-dwelling patients with heart failure. Ten participants entered physiologic data, answered qualitative questions about symptoms, and reviewed heart failure education within the HF App daily. Two validated instruments, the Self-care of Heart Failure Index and Heart Failure Somatic Awareness Scale, were administered both before and after the intervention, and results were compared using t tests. Results indicated that there were clinically significant changes from preintervention to postintervention in self-care scores in each subscale, with a statistically significant difference in the confidence subscale scores (P = .037). However, there were no statistically significant differences between preintervention and postintervention symptom awareness scores. These results indicate that incorporating mobile applications that comprise symptom monitoring, reminders, education, and the ability to track trends in physiologic data is most useful to assist individuals with heart failure to perform effective self-care. This research was supported in part by a research grant from Sigma Theta Tau International Honor Society of Nursing, Theta Kappa Chapter. The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Marva Foster, PhD, RN, CHSE, College of Nursing, University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, MA 02747 (mfoster1@umassd.edu). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Avoiding Obsolescence in Mobile Health: Experiences in Designing a Mobile Support System for Complicated Documentation at Long-term Care Facilities

This study examined staff perceptions of planned obsolescence during a transition from old to new handheld devices for long-term mobile healthcare. Questionnaires based on the technology acceptance model were used to evaluate perceived ease of use and usefulness. This study recruited 120 staff from 26 long-term care facilities who used the old device and 86 staff from nine of the 26 original facilities who used the new device. Although the new devices with advanced features scored significantly higher in acceptance ratings, users still expressed high acceptance of, satisfaction with, and willingness to use the old device, which featured an effective and carefully designed user interface. Usability design plays an essential role in preventing the obsolescence of mobile handheld technology. This study was supported by a grant from the Ministry of Science and Technology in Taiwan (ROC). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Polun Chang, PhD, Institute of Biomedical Informatics, National Yang-Ming University, Room 520, Library and Information Bldg, No 155, Sec 2, Li-Nong St, Beitou District, Taipei City 11221, Taiwan, ROC (polun@ym.edu.tw; ntuh.katherine@gmail.com). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Prevalence, Risk Factors, and Outcome of Chikungunya Encephalitis in Hospitalized Patients at Tertiary Care Center in Gujarat, India, During the 2016 Outbreak

Background India has experienced 2 major chikungunya viral (CHIKV) fever outbreaks over the last decade, with reportedly higher mortality during the 2006 outbreak. Methods This was a retrospective observational study conducted at a tertiary care center over a period of 4 months involving 110 hospitalized patients confirmed with CHIKV fever during the 2016 outbreak. Data on the proportion of patients with CHIK viral encephalitis (CHIK VE) and possible attributable risk factors were obtained from a retrospective chart review and data analysis using SPSS. Results Of 110 patients with confirmed CHIKV fever, 16 (14.6%) developed CHIK VE; 62.5% of the hospitalized patients with CHIK VE were older than 60 years. Patients with CHIK VE presented late to the hospital (4.9 ± 2.7 vs 2.9 ± 1.5, respectively, P = 0.00031) as opposed to those without encephalitis; 87.5% patients in the CHIK VE group required intensive care unit admission and had a prolonged hospital stay (9.2 ± 6.7 days vs 5.1 ± 4.2 days; odds ratio, 0.034; P = 0.001) compared with those in the nonencephalitis group. Patients in the extreme age groups were more vulnerable to CHIK VE compared with adults aged between 30 and 60 years, without a statistically significant difference. There was no statistically significant difference in the mean absolute lymphocyte count, globulin levels, total leukocyte counts, and underlying comorbidities between the 2 groups. Overall mortality with CHIK VE was 18.75%. Conclusions Large-scale studies are needed to validate the association of CHIK VE patients with probable risk factors, as it is associated with high mortality, based on the findings of the present study. Correspondence to: Atul K. Patel, MD, FIDSA, Infectious Diseases Clinic, VEDANTA Institute of Medical Sciences, Navarangpura, Ahmedabad 380009, India. E-mail: atulpatel65@gmail.com. The authors have no funding or conflicts of interest to disclose. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Setting the baseline to fight Gram-negative bacteraemia: the necessity of epidemiological insights

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Effects of retinopathy and chronic kidney disease on long-term mortality in type 2 diabetic inpatients with normal urinary albumin or protein: a retrospective cohort study

Objective

Normoalbuminuric chronic kidney disease (NA-CKD) is recognised as a distinct phenotype of diabetic kidney disease, but the role of diabetic retinopathy (DR) in predicting long-term mortality among these patients remains unclear. Here, we aimed to investigate the effects of DR and CKD on mortality in type 2 diabetic patients with normoalbuminuria.

Design

We conducted this study as a retrospective cohort study.

Setting

We collected clinical information from the medical records of a public medical centre in central Taiwan.

Participants

Patients with type 2 diabetes (n=665) who were hospitalised due to poor glucose control were consecutively enrolled and followed for a median of 6.7 years (IQR 4.1-9.6 years). Patients with either urinary protein excretion >150 mg/day or urine albumin excretion >30 mg/day were excluded.

Primary outcome measure

All-cause mortality served as the primary follow-up outcome, and the mortality data were obtained from the national registry in Taiwan.

Results

The patients with CKD and DR showed the highest mortality rate (log-rank p<0.001). The risks of all-cause mortality (HR 2.263; 95% CI 1.551 to 3.302) and cardiovascular mortality (HR 2.471; 95% CI 1.421 to 4.297) were significantly greater in patients with CKD and DR than in those without CKD or DR, after adjusting for the associated risk factors.

Conclusions

DR is an independent predictor for all-cause and cardiovascular mortality in type 2 diabetic inpatients with normoalbuminuria. Moreover, DR with CKD shows the highest risks of all-cause and cardiovascular mortality among these patients. Funduscopy screening can provide additive information on mortality in patients with type 2 diabetes, even among those with NA-CKD.

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Cohort profile: the Martinique Cancer Registry and the quality of life prostate cancer cohort (QoL Prostate-MQ): challenges and prospects for reducing disparities in the Caribbean

Purpose

Recording cancer data in cancer registries is essential for producing reliable population-based data for service planning, monitoring and evaluation. Prostate cancer (PCa) remains the most frequent type of cancer in terms of incidence and mortality in men in the Caribbean. The quality of life PCa cohort will assess quality of life and patient outcomes in Martinique using a digital platform for patient-reported outcome measures.

Participants

The Martinique Cancer Registry database is the largest clinical database among the French population-based cancer registries in the Caribbean, including more than 38 000 cancer cases, with 1650 new cancer cases per year, including 550 new PCa cases per year (2010–2014 latest period). In 2018, follow-up will include vital status, assessment of quality of life with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ) Core 30 and the Prostate cancer module QLQ-PR25. Urinary incontinence and erectile dysfunction recorded prior to treatment will be analysed 1 and 5 years after treatment.

Findings to date

The registry includes data on circumstances of diagnosis, clinical stage at diagnosis. For PCa, the registry includes blood prostate-specific antigen level at the time of diagnosis, Gleason score and primary treatment.

Future plans

Further studies will provide detailed data regarding the quality of diagnosis and management of patients with PCa in Martinique; analysing quality of care will be the next challenge.

Quality of life and patient outcomes will be evaluated using a digital platform for patient-reported outcome measurement and electronic records.

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