A Mixed-Method Study on Nurses’ Assessment of Post-Stroke Depressive Symptoms

Background: Stroke is the second leading cause of death in the world and the leading cause of death in China. Post-stroke depression is prevalent, affecting approximately one third of stroke survivors at any given time. However, the depressive symptoms of stroke patients are often overlooked in clinical practice. Objective: The aim is to investigate the knowledge, attitudes, and practice status of nurse clinicians on the assessment of post-stroke depressive symptoms and explore the influencing factors, so as to provide empirical evidence for clinical education related to Post-Stroke Depression (PSD) and the development of nursing clinical pathways for screening. Methods: A self-designed questionnaire is used to survey 298 nurse clinicians in Guangdong Province of China. 12 nurses and nurse managers among the study subjects are purposefully invited to participate in semistructured interviews for in-depth discussion about factors affecting the status of assessment. Results: The total scores of the survey of clinical nurses assessing poststroke depression are (84.76±13.255). The scores of knowledge, attitude, and practice of the survey are (25.08±8.975), (33.33±5.483), and (26.35±6.719) respectively. The results of multiple linear regression analysis show that predominate influencing factors of knowledge include position and whether appropriate training is offered by the employer. Nurses’ attitudes toward assessment are influenced by where they worke. Influencing factors for the practice of assessing PSD symptoms include nurses’ positions, participation in training, knowledge level, and attitudes. Conclusion: The total scores of nurse clinicians in assessing the symptoms of PSD are below average. The current practice needs to be improved.

THE RELATIONSHIP BETWEEN CAREER LADDER AND NURSES JOB SATISFACTION AT A HOSPITAL

Background: Career ladder is given to nurses to encourage and maintain professional development and practice of nursing. Career ladder has an impact on raising clinical levels, promotion opportunities, competency complexity, rewards and recognition. In this study, the career ladder has started by mapping and conducting, credentials and competency assessment at the levels of pre Nurse Clinicians, Nurse Clinicians Level I and Nurse Clinicians Level II. Almost half of the nurses were dissatisfied (47.2%) with their career development.Aims: This study was to analyzed the relationship between the career ladder and nurses’ job satisfaction.Methods: This study was a quantitative correlational study with a cross-sectional approach. There were 108 nurses as samples selected using consecutive sampling techniques. These respondent who met the inclusion criteria came from Inpatient Room, (i.e VVIP, VIP, Class I, Class 2/3, Ophthalmology Inpatient), Polyclinic, Chemotherapy Unit, NICU (Neonatal Intensive Care Unit), ICU (Intensive Care Unit), Hemodialysis, Emergency room and COT (Centra Operation Theater). Data were analyzed using the Spearman test.Results: There was a significant relationship between career ladder (p=0.000) and nurse’ job satisfaction. The nurse were satisfied with her career development related to implementation of career ladder. Besides, career ladder allowed to be promoted as the heads of the rooms. Rewards and recognition of nurses’ competencies through job promotion affected nurses’ satisfaction.Conclusion: Career ladder affects nurse satisfaction. Nurses can advance their careers through a career promotion, competencies, rewards and recognition from other health professionals. Support from nurse manager is needed as a form of mentoring and evaluation of nurse performance in the career ladder. Keywords: career ladder, job satisfaction, nurses

Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007–2015) or TNCs (2015–2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.

Improving National Trauma Data Bank® coding data reliability for traumatic injury using a prospective systems approach

Trauma centers manage an active Trauma Registry from which research, quality improvement, and epidemiologic information are extracted to ensure optimal care of the trauma patient. We evaluated coding procedures using the Relational Trauma Scoring System™ to determine the relative accuracy of the Relational Trauma Scoring System for coding diagnoses in comparison to the standard retrospective chart-based format. Charts from 150 patients admitted to a level I trauma service were abstracted using standard methods. These charts were then randomized and abstracted by trauma nurse clinicians with coding software aide. For charts scored pre-training, percent correct for the trauma nurse clinicians ranged from 52 to 64 percent, while the registrars scored 51 percent correct. After training, percentage correct for the trauma nurse clinicians increased to a range of 80–86 percent. Our research has demonstrated implementable changes that can significantly increase the accuracy of data from trauma centers.