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.
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.
BACKGROUND: Prognostic assessments of the mortality of critically ill patients are frequently performed in daily clinical practice and provide prognostic guidance in treatment decisions. In contrast to several sophisticated tools, prognostic estimations made by healthcare providers are always available and accessible, are performed daily, and might have an additive value to guide clinical decision-making. The aim of this study was to evaluate the accuracy of students', nurses', and physicians' estimations and the association of their combined estimations with in-hospital mortality and 6-month follow-up.METHODS: The Simple Observational Critical Care Studies is a prospective observational single-center study in a tertiary teaching hospital in the Netherlands. All patients acutely admitted to the intensive care unit were included. Within 3 h of admission to the intensive care unit, a medical or nursing student, a nurse, and a physician independently predicted in-hospital and 6-month mortality. Logistic regression was used to assess the associations between predictions and the actual outcome; the area under the receiver operating characteristics (AUROC) was calculated to estimate the discriminative accuracy of the students, nurses, and physicians.RESULTS: In 827 out of 1,010 patients, in-hospital mortality rates were predicted to be 11%, 15%, and 17% by medical students, nurses, and physicians, respectively. The estimations of students, nurses, and physicians were all associated with in-hospital mortality (OR 5.8, 95% CI [3.7, 9.2], OR 4.7, 95% CI [3.0, 7.3], and OR 7.7 95% CI [4.7, 12.8], respectively). Discriminative accuracy was moderate for all students, nurses, and physicians (between 0.58 and 0.68). When more estimations were of non-survival, the odds of non-survival increased (OR 2.4 95% CI [1.9, 3.1]) per additional estimate, AUROC 0.70 (0.65, 0.76). For 6-month mortality predictions, similar results were observed.CONCLUSIONS: Based on the initial examination, students, nurses, and physicians can only moderately predict in-hospital and 6-month mortality in critically ill patients. Combined estimations led to more accurate predictions and may serve as an example of the benefit of multidisciplinary clinical care and future research efforts.
