Background: Trauma resuscitation is time sensitive and complex. Whole blood (WB) and blood components are standard treatments for trauma related hemorrhage, yet their nursing workload and transfusion time have not been well evaluated. Purpose: To assess feasibility of a simulation-based crossover trial and obtain preliminary estimates comparing nursing workload and transfusion completion time between WB and blood component administration. Methods: A randomized crossover pilot study using in situ simulation was conducted with experienced trauma nurses. Time-motion analysis measured transfusion completion time, and the National Aeronautical and Space Administration Task Load Index assessed workload domains. Results: Strong feasibility was demonstrated across recruitment, retention, adherence, and completion. WB was associated with significantly shorter transfusion time, lower overall workload and mental demand, less effort, and better perceived performance. Conclusions: These findings support the feasibility and justify a fully powered trial. WB may improve resuscitation efficiency and reduce cognitive burden, with potential implications for patient outcomes and nursing workflow.
Background: Adequate nurse staffing is essential for ensuring workforce well-being and patient safety. Imbalanced nurse-to-patient ratios contribute to burnout, job dissatisfaction, and turnover, which compromise care quality. Objective: This systematic review and meta-analysis evaluated the impact of nurse-to-patient ratios on nurse burnout, job dissatisfaction, intention-to-leave, and patient outcomes. Methods: A systematic search of PubMed, Scopus, and Web of Science identified cross-sectional studies examining nurse-to-patient ratios and related outcomes. Results: Eighteen studies involving 183 876 nurses from 4085 hospitals were included. Higher nurse-to-patient ratios increased the odds of burnout (OR: 1.08), job dissatisfaction (OR: 1.10), and intention-to-leave (OR: 1.09). Each additional patient per nurse increased mortality and readmission risks by 7% to 8%, with decreased perceived care quality. Conclusion: Higher nurse-to-patient ratios adversely affect nurses and patients. Ensuring adequate staffing is critical to prevent burnout and maintain safe, high-quality care.
Background: Hospital-acquired pressure injuries (HAPIs) remain a costly yet preventable threat to patient safety and quality of care. Evidence-based prevention strategies are essential to reduce incidence and support institutional goals. Objective: The purpose of this review was to synthesize evidence-based quality improvement interventions to prevent nondevice-related HAPIs in US hospital settings. Methods: Using the Whittemore and Knafl integrative review framework, a systematic search of 4 databases identified studies published between 2015 and 2023. Of 178 records screened, 10 studies met the inclusion criteria. Methodological quality was appraised using the Quality Improvement Minimum Quality Criteria Set. Results: Interventions were clustered into 4 categories: turn teams, documentation enhancements, protocol strategies, and interdisciplinary collaborations. Conclusion: HAPI prevention requires coordinated, system-level, interprofessional interventions with engaged leadership, and future research should emphasize sustainability, scalability, and fidelity using standardized quality improvement reporting frameworks.
BACKGROUND:Delayed patient discharge affects patient safety, care quality, and hospital flow. Criteria-led discharge (CLD) enables appropriately trained health care professionals to discharge selected patients against predefined clinical criteria, potentially improving timeliness. PURPOSE:The purpose of this updated systematic review was to assess outcomes including CLD safety, patient satisfaction, length of stay (LOS), and implementation factors. METHODS:A systematic review was conducted. CINAHL and Medline were searched from 2018 to 2025. RESULTS:Thirteen studies spanning adult and pediatric settings were included. CLD was consistently safe when supported by clear criteria, protocols, and safety-netting; readmission findings were mixed. Most studies reported reduced LOS, earlier discharge, and improved flow. Evidence on patient satisfaction was limited. Key facilitators included staff training, organizational support, and integration of CLD into routine processes. CONCLUSION:CLD is a safe intervention that improves discharge efficiency and LOS with growing applicability across nonelective pathways and potential scalability.
BACKGROUND:Oral complications significantly burden patients with head and neck cancer undergoing treatment. Despite the proven efficacy of evidence-based oral care protocols, clinical implementation remains inconsistent. This study employed the behavior change wheel framework to systematically analyze implementation barriers and facilitators from health care providers' perspectives. METHODS:A convergent mixed-methods design was used. Health care providers (n = 118) completed validated capability, opportunity, motivation-behavior surveys, and a subset (n = 28) participated in semi-structured interviews analyzed using theoretical domains framework (TDF)-informed thematic analysis. Self-reported adherence to the oral care bundle was measured using a visual analog scale. RESULTS:Physical opportunity barriers scored highest (M = 3.36, SD = 0.72), whereas reflective motivation showed the lowest barrier scores (M = 2.11, SD = 0.59). Environmental Context and Resources was the predominant TDF barrier domain (86%). Multiple regression showed that barrier scores significantly predicted self-reported adherence (β = -0.124, P < .001, R2 = 0.821). CONCLUSIONS:Physical opportunity barriers represent the primary implementation challenge. Multicomponent interventions targeting environmental restructuring, training, and enablement are recommended.
BACKGROUND:Avoidable medication errors involving inaccurate weight-based dosing in pediatric patients are a well-documented patient safety concern. LOCAL PROBLEM:Select patients receiving medications and fluids based on nonmeasured weights contributed to medication errors. METHODS:Using several Plan-Do-Study-Act (PDSA) intervention cycles, we aimed to increase the percentage of patients with a measured dosing weight within 12 hours of admission from a baseline of 18.5 % to greater than 75% within 6 months. INTERVENTIONS:PDSA cycles included awareness campaigns, education, and electronic health record enhancements to improve documentation and visualization of weight methods. RESULTS:Patients with documented measured weights used for dosing improved from 18.5% to 66.2%, demonstrating statistically significant improvements. CONCLUSIONS:Interventions are adaptable to other pediatric institutions and potentially to adult populations as well.
Background: A significant shortage of experienced nurses poses a major challenge in health care. Although evidence indicates that shared governance, a hallmark of Magnet organizations, supports nurse retention, gaps remain in understanding how psychological empowerment influences this relationship. Objective: The purpose of this study was to investigate predictive pathways among nurses’ perceptions of shared governance, psychological empowerment, and turnover intention, with psychological empowerment examined as a mediating mechanism. Methods: A total of 313 nurses from an integrated care system participated in a cross-sectional survey study. Data were analyzed using descriptive and inferential statistics. Results: Nurses’ perceptions of shared governance predicted turnover intention, with psychological empowerment partially mediating this relationship. The combined effects accounted for 24% of the variance in nurses’ turnover intention. Conclusions: Nurse leaders should invest in shared governance principles that foster psychological empowerment as an intentional leadership strategy to effectively reduce turnover intention.
BACKGROUND:The Veterans Health Administration Resident Competency Assessment (VHA RCA) item pool (N = 100) was developed to evaluate new graduate registered nurse (NGRN) competency to support nurse residencies and facilitate dynamic competency-based education. PURPOSE:The purpose of this work was to develop a parsimonious item bank for the VHA RCA through psychometric testing. METHODS:Classical Test Theory and Item Response Theory methods were used to analyze VHA RCA survey data from nurse residents (N = 542) at VHA medical centers (n = 81). RESULTS:Psychometric evidence demonstrated a unidimensional construct, good model fit, negligible differential item functioning, and acceptable construct validity. Seventy items were retained. Reliability coefficient estimates were >0.9 (Cronbach α = .987; Lambda-2 = .987; latent class reliability coefficient = .986). CONCLUSIONS:Obtained psychometric evidence supports validity and reliability of the calibrated VHA RCA. The VHA RCA is available for public use to assess NGRN competency and may be used to inform and improve the quality of nursing education, research, and practice.
