Practice priorities for acute care nursing: A Delphi study

Abstract

Aims and objectives To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. Background Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. Design Delphi Method. Method A three‐round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. Results High patient acuity or complexity, as well as inadequate bed space on wards, are “very high” risks that occur “often” and “very often,” respectively. The pressure to admit patients, delayed medical review and patient boarding are all “high” risks that occur “often.” Though only occurring “sometimes,” inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a “very high” risk to patient care. Conclusion The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system‐wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. Relevance to clinical practice This study provides a description of the challenges that face acute care nursing in the provision of safe and high‐quality care.

Exploring the challenges of patient flow in acute hospital settings: a Delphi study

“…The expert panel identified challenges that occurred from admission to patient discharge 6 . First, the number and skill mix of staff and delayed transfer of patient to the appropriate unit due to lack of bed availability is seen as a challenge.…”

“…The purpose of the study 6 was to describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards. The study conducted electronic Delphi (e-Delphi) method research following approval from appropriate research ethics committee.…”

“…All the thirty participants completed rounds 1 and 2 while 12 nurses completed round 3. This Consensus-building process utilized content analysis to arrive at 5 broad challenges 6 .…”

“…The frequency and level of risk that may impact on safety and quality of care varies and ranged from low to high risk that either occurred rarely or frequently 6 . The expert panel identified patient boarding resulting from unpredictable admission rates and complex care needs as a high risk which posed a challenge to staffing levels and bed occupancy 6 .…”

“…The frequency and level of risk that may impact on safety and quality of care varies and ranged from low to high risk that either occurred rarely or frequently 6 . The expert panel identified patient boarding resulting from unpredictable admission rates and complex care needs as a high risk which posed a challenge to staffing levels and bed occupancy 6 . Patient boarding resulting from limited bed availability exposes patients from a specialty to delayed investigations and doctor's review, prolonged waiting time and multi-professional suboptimal communication 2,3,6 .…”