Introduction: Communication is an essential part of nursing care. While conversations with patients mainly take place in patient rooms, the ward corridor is often used for communication between staff members and sometimes visiting family. As many patients suffer from hearing loss due to biological ageing, loud conversations between staff and patients which can be overheard in the corridor are no exception. The acoustic design of nursing wards should facilitate communication yet not compromise other tasks of the professional that take place here. Aim: To gain insight in the relation between the auditory environment in a hospital ward on nurses’ cognitive performance and quality of care. Materials and Methods: A three day observational study and a follow up literature study have been conducted in a Dutch hospital ward. Researchers shadowed a nurse during three full shifts and kept a log of activities and environmental aspects which were combined into a general overview of the shift. The literature study was conducted to support the findings from the observations. Results: Nursing consists of completing various tasks in the most efficient and patient-centered order. The biggest risks for patient safety and comfort seem to be medication errors and negligence. This is supported by Potter who introduced the term cognitive stacking in 2005. Voices and television sounds from patient rooms are loud and can be heard in the ward corridor. Ringing telephones and conversations between nurses and family are the most common sounds in the corridor. Literature findings suggest that interruptions of nursing care are an important aspect in medication errors and other care omissions. Most of these findings were, however, based on visual disruptions of the care process. In addition, while the distractive effects of background sounds have been investigated for a range of cognitive tasks, no such experiments are known for the cognitive stacking that is typical for nursing care and involves both the execution of several cognitive tasks and the decision-making of workflow priorities. Conclusions: The results lead to the hypothesis that auditory events influence nurses’ cognitive performance. Structured observations in multiple wards to quantify and analyze distractions are needed to strengthen this hypothesis.
OBJECTIVE: The objectives of the present study were to: (1) evaluate the effect of an educational course on competence (knowledge and clinical reasoning) of primary care physical therapists (PTs) in treating patients with knee osteoarthritis (KOA) and comorbidity according to the developed strategy; and (2) identify facilitators and barriers for usage.METHOD: The present research was an observational study with a pretest-posttest design using mixed methods. PTs were offered a postgraduate course consisting of e-learning and two workshops (blended education) on the application of a strategy for exercise prescription in patients with KOA and comorbidity. Competences were measured by questionnaire on knowledge (administered before and 2 weeks after the course), and a patient vignette to measure clinical reasoning (administered before the course and after a 6 month period of treating patients). Facilitators and barriers for using the strategy were assessed by a questionnaire and semi-structured interviews.RESULTS: Thirty-four PTs were included. Competence (knowledge and clinical reasoning) improved significantly (p < 0.01). Fourteen out of 34 PTs had actually treated patients with KOA and comorbidity, during a 6-month period. The strategy was found to be feasible in daily practice. The main barriers included the limited number of (self-) referrals of patients, limited number of reimbursed treatment sessions by insurance companies and a suboptimal collaboration with (referring) physicians.CONCLUSION: A blended course on exercise therapy for patients with KOA and comorbidity seems to improve PTs' competence through increasing knowledge and clinical reasoning skills. Identified barriers should be solved before large-scale implementation of exercise therapy can take place in these complex patients.
BACKGROUND: Increasing evidence indicates the potential benefits of restricted fluid management in critically ill patients. Evidence lacks on the optimal fluid management strategy for invasively ventilated COVID-19 patients. We hypothesized that the cumulative fluid balance would affect the successful liberation of invasive ventilation in COVID-19 patients with acute respiratory distress syndrome (ARDS).METHODS: We analyzed data from the multicenter observational 'PRactice of VENTilation in COVID-19 patients' study. Patients with confirmed COVID-19 and ARDS who required invasive ventilation during the first 3 months of the international outbreak (March 1, 2020, to June 2020) across 22 hospitals in the Netherlands were included. The primary outcome was successful liberation of invasive ventilation, modeled as a function of day 3 cumulative fluid balance using Cox proportional hazards models, using the crude and the adjusted association. Sensitivity analyses without missing data and modeling ARDS severity were performed.RESULTS: Among 650 patients, three groups were identified. Patients in the higher, intermediate, and lower groups had a median cumulative fluid balance of 1.98 L (1.27-7.72 L), 0.78 L (0.26-1.27 L), and - 0.35 L (- 6.52-0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77-0.95, P = 0.0047). Sensitivity analyses showed similar results.CONCLUSIONS: In a cohort of invasively ventilated patients with COVID-19 and ARDS, a higher cumulative fluid balance was associated with a longer ventilation duration, indicating that restricted fluid management in these patients may be beneficial. Trial registration Clinicaltrials.gov ( NCT04346342 ); Date of registration: April 15, 2020.
