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2.
Clin Nurse Spec ; 36(1): 20-28, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34843191

RESUMEN

PURPOSE: The purpose of this clinical nurse specialist-led initiative was to reduce catheter-associated urinary tract infection rates to less than 1 infection per 1000 catheter days, to reduce catheter device utilization, and to improve staff adherence to documentation requirements on a traumatic brain injury rehabilitation unit. DESCRIPTION OF THE PROJECT: Catheter-associated urinary tract infections are costly hospital-acquired infections increasing length of stay and morbidity for patients. Following an education intervention, a best practice initiative was implemented. Staff performance based on electronic health record documentation, infection rates, and device utilization were compared before and after a bundle of interventions including education, staff competency, simulation, and audits. OUTCOMES: Catheter-associated urinary tract infection rates were reduced from 16.67 to 0 per 1000 catheter days and device utilization ratio from 0.122 to 0.056 per patient day. The unit maintained zero infections upon project completion. Following initiative implementation, documentation improved related to urinary catheter necessity, daily care interventions, patient education, and urine output. CONCLUSION: This initiative resulted in reductions in device utilization and catheter infection rates, which were maintained following project completion. Adherence to documentation audit criteria also improved.


Asunto(s)
Infecciones Relacionadas con Catéteres , Infección Hospitalaria , Enfermeras Clínicas , Infecciones Urinarias , Infecciones Relacionadas con Catéteres/prevención & control , Humanos , Cateterismo Urinario/efectos adversos , Catéteres Urinarios , Infecciones Urinarias/prevención & control
3.
Clin Nurse Spec ; 35(6): 303-313, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34606210

RESUMEN

PURPOSE: This quality improvement project created a guide for critical care providers transitioning patients to comfort measures only encouraging communication, collaboration, and shared decision making; ensuring management of patients' end-of-life symptoms and needs; and enhancing provider satisfaction by improving structure and consistency when transitioning patients. DESCRIPTION OF THE PROJECT: Interviews conducted with staff in intensive care units revealed opportunities to improve structure and processes of transitioning patients at the end of life. A subcommittee of experts designed a checklist to facilitate interdisciplinary conversations. Impact on provider satisfaction and symptom management was assessed. Presurveys circulated used a Research Electronic Data Capture tool. A checklist was implemented for 3 months, and then postsurveys were sent. Charts were audited to identify improvement in symptom management and compared with retrospective samples. OUTCOMES: Clinical improvements were seen in communication (12%), collaboration (25%), shared decision making (22%), and order entry time (17%). In addition, 72% agreed the checklist improved structure and consistency; 69% reported improved communication, collaboration, and shared decision making; 61% felt it improved knowledge/understanding of patient needs; and 69% agreed it improved management of patient symptoms. CONCLUSION: After checklist implementation, staff felt more involved and more comfortable, and reported more clarity in transitioning patients; no improvement in patient outcomes was realized.


Asunto(s)
Lista de Verificación , Enfermería de Cuidados Críticos/organización & administración , Personal de Enfermería en Hospital/psicología , Comodidad del Paciente/organización & administración , Satisfacción Personal , Comunicación , Toma de Decisiones Conjunta , Humanos , Unidades de Cuidados Intensivos , Relaciones Interprofesionales , Investigación en Evaluación de Enfermería , Mejoramiento de la Calidad
4.
Clin Nurse Spec ; 30(6): E1-E6, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27753675

RESUMEN

PURPOSE/OBJECTIVES: An efficient but comprehensive documentation system is essential for reducing nursing workload and ensuring adequate time for direct patient care. A "focus" is a nursing diagnosis or patient problem. The purpose of this project is to review and revise the focuses in the electronic charting system and to develop new focuses for documentation of clinical pathways. In addition, this project evaluated the impact of these changes on time required for documentation and nurse satisfaction. BACKGROUND/RATIONALE: In 2012, a large hospital in Taiwan implemented a self-developed electronic charting system that had 217 focuses in the database. Staff reported low job satisfaction and too much time on documentation. Three major issues were identified, including repetitious and redundant documentation, incorrect templates, and an incomprehensive database. DESCRIPTION: A clinical nurse specialist devised quality improvement project was implemented on one 50-bed surgical unit. Forty-one focuses were revised and 13 new focuses were developed for clinical pathways. The implementation of new focus templates enhanced evidence-based practice and prevented redundant documentation. Focus templates also incorporated nursing policies and/or patient education materials. Two outcome indicators, time spent documenting and nurse satisfaction, were evaluated 3 months after implementation. OUTCOMES: Documentation time decreased by 60% (from 138.5 to 55.8 hours) per week. The median documentation time per patient per day decreased from 18.4 minutes to 9.3 minutes. Average scores for satisfaction in usability, content, functionality, and effectiveness were increased. CONCLUSION: Evidence-based focus templates used for documentation can reduce documentation time and increase nurse satisfaction. Clinical nurse specialists play an important role in leading the development of quality improvement projects while improving work efficiency.


Asunto(s)
Registros Electrónicos de Salud , Satisfacción en el Trabajo , Registros de Enfermería , Personal de Enfermería en Hospital/psicología , Humanos , Taiwán , Carga de Trabajo
5.
Dimens Crit Care Nurs ; 35(5): 268-76, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27487752

RESUMEN

PURPOSE/OBJECTIVES: The aims of this study were to develop, implement, and evaluate the impact of early intensive care unit (ICU) nurse-led family meetings on nurse-family communication, family decision making, and satisfaction of family members. BACKGROUND: Intensive care unit nurses are in an ideal position to meet family needs, and family members may cope better with the crisis of an ICU admission if consistent honest information is provided by nurses; however, there are no early ICU family meetings led by bedside nurses. METHODS: This quality improvement project was implemented in a 10-bed neuroscience ICU over a 3-month period. A convenience sample of 23 nurses participated in the project. Following development of a communication protocol to facilitate nurse-led meetings, the nurses received education and then implemented the protocol. Thirty-one family members participated in the project. Family members were surveyed before and after the meetings. RESULTS: Mean meeting time was 26 (SD, 14) minutes. Following implementation of the meetings, findings demonstrated that families felt that communication improved (P = .02 and P = .008), they had appropriate information for decision making allowing them to feel in control (P = .002), and there was an increase in family satisfaction (P = .001). CONCLUSION: Early ICU nurse-led family meetings were feasible, improved communication between ICU nurses and family members, facilitated decision making in ICU families, and increased satisfaction of family members.


Asunto(s)
Unidades de Cuidados Intensivos , Enfermeras y Enfermeros , Relaciones Profesional-Familia , Enfermería de Cuidados Críticos , Familia , Humanos
6.
Air Med J ; 35(3): 138-42, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27255875

RESUMEN

OBJECTIVE: Airway assessment and management are vital skills for the critical care transport provider. Nurses and paramedics often enter a transport program with limited or no exposure to airway management. Many programs lack a structured curriculum to show skill competence. Optimal methods in the development of airway management competence and the frequency of training needed to maintain skills have not been clearly defined. Because of this lack of standardization, the actual level of competence in both new and experienced critical care transport providers is unknown. METHODS: A pretest, post-test repeated measures approach using an online curriculum combined with a deliberate practice model was used. Competence in airway management was measured using 3 evaluation points: static mannequin head, simulation scenario, and the live patient. RESULTS: A convenience sample of critical care transport providers participated (N = 9). Knowledge improvement was significant, with a higher percentage of participants scoring above 85% on the post-test compared with the pretest (P = .028). Mean scores in completion of the airway checklist pre- versus postintervention were significantly increased on all 3 evaluation points (P < .001 for all comparisons). Significant changes were noted in the response profile evaluating participants' confidence in their ability to verbalize indications for endotracheal intubation (P < .05). CONCLUSION: The development of a standardized, blended learning curriculum combined with deliberate simulation practice and rigorous assessment showed improvements in multiple areas of airway assessment and management.


Asunto(s)
Manejo de la Vía Aérea , Técnicos Medios en Salud/educación , Cuidados Críticos , Enfermería de Urgencia/educación , Transporte de Pacientes , Manejo de la Vía Aérea/métodos , Competencia Clínica , Cuidados Críticos/métodos , Curriculum , Humanos , Transporte de Pacientes/métodos
7.
J Nurs Educ ; 55(3): 155-9, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26926216

RESUMEN

BACKGROUND: This study evaluated the effectiveness of the Culturally Competent Nursing Modules (CCNMs) developed by the U.S. Office of Minority Health on improving the cultural competence levels of undergraduate nursing students. METHOD: Students completed the CCNMs over a 2-week period, and their pre- and posttraining cultural competence was assessed using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised tool. RESULTS: The CCNMs were effective in increasing the cultural competence of the nursing students (pretest mean = 68.44 ± 6.58; posttest mean = 79.06 ± 7.99; t(17) = 7.44; d = 10.61; 95% confidence interval = 7.60, 13.62; p < .001). Before training, 89% of the students were culturally aware and 11% were culturally competent. After training, 22%, 67%, and 11% were culturally aware, culturally competent, and culturally proficient, respectively. CONCLUSION: The CCNMs training program is effective and should be incorporated into nursing curricula.


Asunto(s)
Competencia Cultural , Bachillerato en Enfermería , Curriculum
8.
Orthop Nurs ; 35(2): 108-17; quiz 118-9, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27028687

RESUMEN

Patient satisfaction with pain management has increasing importance with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores tied to reimbursement. Previous studies indicate patient satisfaction is influenced by staff interactions. This single-group pre/post design study aimed to improve satisfaction with pain management in older adults undergoing total joint replacement. This was a single-group pre-/posttest design. Nurse (knowledge assessment) and patient (American Pain Society Patient Outcomes Questionnaire Revised [APS-POQ-R], HCAHPS) responses evaluated pre- and postimplementation of the online educational program. Nurse focus group followed intervention. Nurses' knowledge improved significantly (p < .006) postintervention. HCAHPS scores (3-month average) for items reflecting patient satisfaction improved from 70.2 ± 9.5 to 73.9 ± 6.0. APS-POQ-R scores did not change. Focus group comments indicated need for education regarding linkages between pain management and patient satisfaction. Education on linkages between patient satisfaction and pain management can improve outcomes; education on strategies to further improve practice may enhance ability to achieve benchmarks.


Asunto(s)
Personal de Enfermería en Hospital/educación , Manejo del Dolor/enfermería , Dimensión del Dolor/enfermería , Satisfacción del Paciente/estadística & datos numéricos , Adulto , Anciano , Artroplastia de Reemplazo/enfermería , Competencia Clínica , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Relaciones Enfermero-Paciente , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/psicología , Encuestas y Cuestionarios , Adulto Joven
10.
Clin Nurse Spec ; 30(2): 101-5, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26848900

RESUMEN

PURPOSE: The purpose of this project was to develop, implement, and evaluate a teaching tool for self-assessment of surgical incisions after laparotomy surgery. BACKGROUND: Hospitalized patients have an increased level of acuity and are discharged earlier. Shorter length of stay limits the nurses' ability to provide comprehensive discharge instructions and validate understanding of surgical incision care. DESCRIPTION: Two sets of discharge instructions, 1 with text only and 1 with text and pictures plus a mirror, were provided to patients after laparotomy surgery. A total of 60 patients were recruited over a 3-month period. The first 30 patients received standard discharge instructions (text only). The next 30 patients received discharge instructions using the new program and a handheld mirror to assist with visualization of the incision. A follow-up telephone questionnaire was completed on day 7 after surgery to assess patients' ability to inspect their incision for infection and determine comprehension with discharge instructions. OUTCOME: Patients receiving the revised program had improvement in comprehension of instructions, felt that instructions were clearly stated, and were confident in their ability to identify normal healing versus a surgical site infection (SSI) and about notifying physicians. Compared with the text-only group, the text, picture, and mirror group using the teaching program (text, pictures, and mirror) felt more confident on self-assessment to identify SSI. CONCLUSION: The revised teaching program (text and pictures) and use of a handheld mirror improved patient confidence in self-assessing an incision and increased ease in detecting an SSI. IMPLICATIONS: Clinical nurse specialists can influence patient outcomes. Discharge instructions that include text and pictures plus a mirror should be part of a comprehensive packet for patients asked to assess an incision.


Asunto(s)
Laparotomía , Alta del Paciente , Educación del Paciente como Asunto/métodos , Autocuidado/psicología , Infección de la Herida Quirúrgica/diagnóstico , Adulto , Comprensión , Femenino , Estudios de Seguimiento , Conocimientos, Actitudes y Práctica en Salud , Humanos , Laparotomía/efectos adversos , Persona de Mediana Edad , Enfermeras Clínicas , Relaciones Enfermero-Paciente , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería , Mejoramiento de la Calidad/organización & administración , Autoeficacia
11.
Geriatr Nurs ; 36(1): 9-14, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25660190

RESUMEN

This pilot study evaluated effects of a video-guided T'ai Chi group intervention on center of balance (COB) and falls efficacy, using a one arm, pre/post design. Thirty-two participants began the study, 17 completed pre- and post-testing and 15 were lost to follow-up. Outcomes were compared for the 17 participants who completed pre- and post-testing and subgroups based on session attendance. Irrespective of session attendance, participant COB scores improved. There was a significant negative correlation between number of sessions attended and pre and post scores on the fall efficacy (fear of falling) measure, indicating those with higher fear of falling were less likely to complete the study. Older participants were also less likely to continue participation. Findings indicate potential benefits of T'ai Chi in improving COB (a fall risk factor) among community-dwelling older adults. However, those with greater potential benefit (higher fear scores, older participants) were less likely to continue participation.


Asunto(s)
Accidentes por Caídas/prevención & control , Evaluación Geriátrica/métodos , Equilibrio Postural/fisiología , Taichi Chuan/organización & administración , Grabación en Video , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Vida Independiente , Masculino , Análisis Multivariante , Cooperación del Paciente/estadística & datos numéricos , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud
12.
Crit Care Nurs Q ; 33(2): 117-25, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20234200

RESUMEN

There are many changes occurring within the healthcare system today, bringing forth multiple challenges for nurses. Changes in reimbursement for hospitals and staffing shortages are impacting the ways that nurses are delivering care. During these changing times, it is essential that healthcare providers strive to maintain high-quality care and patient safety. Utilizing evidence-based practice (EBP) to guide the delivery of care is one way to ensure that high-quality outcomes are achieved. EBP is one of the driving forces to improve clinical practice and ensure patient safety within the healthcare system. The clinical nurse specialist is very instrumental in facilitating quality care and implementing EBP within the healthcare setting. Through the development of a multidisciplinary committee, the clinical nurse specialist can lead professional nurses in the implementation of EBP and facilitate practice changes to improve patient outcomes.


Asunto(s)
Atención a la Salud/organización & administración , Enfermería Basada en la Evidencia/organización & administración , Hospitales Universitarios , Enfermeras Clínicas , Rol de la Enfermera , Desarrollo de Programa , Protocolos Clínicos , Humanos
13.
Nurs Clin North Am ; 44(3): 315-25, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19683093

RESUMEN

Heart disease is the number one cause of death among women. Although 450,000 women die annually from heart disease, this fact is unknown to many women. Because heart disease is frequently preventable, increasing awareness of personal risk and preventative measures is a key element of health care for women. Nurse clinicians can evaluate, educate, and counsel women regarding their risk for this pervasive disease and promote behavior changes that will decrease that risk. Research evidence supports that lifestyle behaviors are the cornerstone of heart disease prevention. This article presents current evidence for the prevention of heart disease related to dietary intake, physical activity, weight management, smoking cessation, blood pressure control, and lipid management. Guidelines for implementing findings in clinical practice are discussed.


Asunto(s)
Cardiopatías/prevención & control , Rol de la Enfermera , Prevención Primaria/métodos , Salud de la Mujer , Práctica Clínica Basada en la Evidencia , Ejercicio Físico , Conducta Alimentaria , Femenino , Promoción de la Salud/métodos , Cardiopatías/epidemiología , Cardiopatías/etiología , Humanos , Hiperlipidemias/complicaciones , Hiperlipidemias/prevención & control , Hipertensión/complicaciones , Hipertensión/prevención & control , Estilo de Vida , Anamnesis , Enfermeras Clínicas/organización & administración , Evaluación en Enfermería , Obesidad/complicaciones , Obesidad/prevención & control , Educación del Paciente como Asunto , Examen Físico , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Factores de Riesgo , Cese del Hábito de Fumar
14.
Dimens Crit Care Nurs ; 25(5): 205-8, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17003577

RESUMEN

Ventilator-associated pneumonia is the second most common hospital-acquired infection in medical intensive care units in the United States. Prevention of ventilator-associated pneumonia must be regarded as one of the most important issues in critical care and it has already become one of the core intensive care unit performance measures proposed by the Intensive Care Advisory Panel of the Joint Commission on Accreditation of Healthcare Organizations. This article focuses on prevention strategies which can be applied by critical care nurses during daily care.


Asunto(s)
Control de Infecciones/métodos , Neumonía Asociada al Ventilador/prevención & control , Respiración Artificial/enfermería , Humanos , Neumonía Asociada al Ventilador/fisiopatología , Factores de Riesgo
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