No abstract

Managers can use intergenerational differences to create a rich environment that bridges generational differences and fosters workforce cohesion.

Examples in this review provide important clues for addressing the negative effects of diffused responsibility. The onus is on nurses to personally enhance the ethics of their practice by surveying, pondering, and applying these concepts.

Objective: Mothers of neonatal intensive care unit (NICU) patients sometimes bring expressed milk that is blood tinged to the NICU. In certain instances, the blood contamination appears minimal, whereas in others, the milk is quite dark pink. We have observed inconsistencies in practice regarding whether or not to feed blood-tinged colostrum or milk to NICU patients. We know of no evidence that establishes best practice in this area, and thus we sought to determine attitudes of NICU professionals on which to base a potentially best practice.Study Design: We conducted a web-based anonymous survey of attitudes of NICU professionals at Intermountain Healthcare regarding feeding blood-tinged expressed milk to NICU patients. These professionals included neonatologists, neonatal nurse practitioners, NICU nurses, NICU dieticians and lactation consultants.Result: Survey results were returned from 64% (426 of 667) of those to whom it was sent. A total of 75% of respondents reported that their practice was NOT to feed the blood-tinged milk illustrated in the figure as sample 2, and nearly all respondents (98%) reported that they would NOT feed the milk illustrated as sample 3. The majority of the neonatologists (56%) and the lactation consultants (58%) recommended feeding moderately bloody milk (sample 2), whereas only 22% of the neonatal nurse practitioners (NNPs), NICU nurses and NICU dieticians recommended feeding such samples (<0.001). The most frequently selected reason for NOT feeding blood-tinged milk was that it would likely cause gastrointestinal upset and feeding intolerance (selected by 77%). The majority (87%) overestimated the amount of blood contaminating a milk sample (sample 3). Conclusion:As colostrum and human milk feedings can be of value to NICU patients, evidence should be assembled to document whether feeding blood-tinged samples indeed have the problems listed by the survey respondents. Such evidence is needed to enable informed decisions involving the benefits vs risks of feeding blood-tinged expressed milk to NICU patients.

Aim To establish the current state of the science about why nurses do or do not report being the victim of patient aggression, a form of type II workplace violence. This aim includes identifying and analysing current gaps in the literature. Background It is increasingly more common for patients to instigate aggressive acts towards nurses, leading to significant consequences. Nursing victims often do not report acts of patient aggression to others, making it difficult for health care leaders and researchers to address this challenge. Evaluation The review process involved searching five databases, using the PRISMA framework to reduce 355 records to 65 sources for review and synthesis. Key Issues The findings of this review highlight key takeaways about why nursing victims do not report episodes of patient aggression, which include their fears, attitudes and abilities related to reporting; and their perspective of the patient aggression event. Workplace environments are central to most of these factors, emphasizing the importance of nursing and other health care leaders to put systems in place that promote nurse reporting behaviours. Conclusions Patient aggression is a widespread problem with severe consequences. Review findings can inform future research while having practical relevance for health care leaders. Implications for Nursing Management Health care leaders need to consider how workplace structures, practices, and cultures can encourage or stifle nurse reporting behaviours. By understanding nurse reporting behaviours, processes can be developed to promote nursing victim reporting and deter patient aggression.

No abstract

Background Patients commonly display aggressive and violent behaviors toward nursing staff, contributing to severe consequences. Healthcare institutions must develop and implement systems addressing this global safety problem. Aim To improve clinical practice safety for inpatient acute care settings by providing healthcare teams throughout a large academic medical center with a Behavioral Emergency Response Team (BERT) program, that is, a system for reporting and de‐escalating aggressive patient encounters. Methods This descriptive quality improvement process took place within two inpatient acute care departments using simulation‐based training, patient safety rounds, and a BERT activation system. Participant groups included nursing personnel who completed a baseline survey (n = 302), telecommunication dispatchers (n = 20), BERT responders (n = 78), and bedside nursing staff (n = 43) recipients of BERT program resources. Methods included a baseline questionnaire, pre‐ and post‐intervention surveys, formal reports of aggressive patient encounters, documentation from patient safety rounds, and records of activated BERT responses. Data analysis included descriptive statistics, boxplots, and the Wilcoxon signed‐rank test. Results This project mitigated patient aggression episodes by successfully designing and implementing an evidence‐based BERT program. Findings suggested bedside nursing program participants felt more confident and capable of managing aggressive patient behaviors. A strong partnership between security officers and nursing staff limited the risk of harm to clinical staff by identifying and intervening with 41 potentially aggressive patients. Finally, formal reports of patient aggression episodes did not increase during this project, which may have indicated early prevention and detection of aggression while reflecting the broader problem of aggression under‐reporting in nursing. Linking Evidence to Action Healthcare organizations need to have robust systems to manage aggressive patient encounters. Comprehensive strategies for managing patient aggression include simulation‐based training, the use of BERT responders, and a strong partnership between nursing and security officer teams.

No abstract