A Tale of 2 Units: Lessons in Changing the Care Delivery Model.

In response to patient care quality and satisfaction concerns, a hospital determined the need to change the care delivery model on some inpatient units. Two pilot units adopted 2 different models of care. The authors describe the change project, successful outcomes, and lessons learned.

Advancing Nursing Research in Hospitals Through Collaboration, Empowerment, and Mentoring.

Meeting the Magnet Recognition Program® requirements for integrating research into practice can be daunting, particularly for nonacademic hospitals. The authors describe 1 healthcare system's approach to advancing nursing research in 5 hospitals through collaboration with a local university school of nursing and development of an infrastructure to support, empower, and mentor clinical nurses in the conduct of research. Outcomes include completed research, presentations, publications, practice change, and professional development.

Compassion Fatigue in Pediatric Nurses.

Compassion fatigue in nursing has been shown to impact the quality of patient care and employee satisfaction and engagement. The aims of this study were to determine the prevalence and severity of compassion fatigue among pediatric nurses and variations in prevalence based on respondent demographics using a cross-sectional survey design. Nurses under 40 years of age, with 6-10 years of experience and/or working in a medical-surgical unit had significantly lower compassion satisfaction and higher levels of burnout. Secondary traumatic stress from caring for children with severe illness or injury or end of life was a key contributor to compassion fatigue.

Wacky Wednesday: use of distraction through humor to reduce preoperative anxiety in children and their parents.

PURPOSE: The purpose of this study was to determine the effect of distraction through humor on anxiety among children having outpatient surgery, and their parents. DESIGN: Quasi-experimental design using a nonrandomized control group. METHODS: The study assessed preoperative anxiety in child-parent dyads. The control group received usual care. The intervention group received the "Wacky Wednesday" (WW) intervention in which they entered an environment where employees were dressed in "wacky" attire and children and parents were provided with gifts and costume items. Anxiety scores, heart rate, and blood pressure were collected from patients and parents in both groups on admission and just before transfer to surgery. FINDINGS: Children who arrived for surgery on WW had significantly lower anxiety scores on admission than children in the control group. In addition, children and parents who received the WW intervention had significantly lower anxiety scores just before surgery than those in the control group. CONCLUSIONS: Humor and distraction are effective with children and parents in relieving preoperative anxiety.

Verbal abuse of pediatric nurses by patients and families.

OBJECTIVE: The purpose of this study was to determine the extent to which nurses practicing in a pediatric hospital encounter verbal abuse by patients and families and their reactions to this abuse. BACKGROUND: Verbal abuse, the most common type of workplace violence against nurses results in declining morale and job satisfaction, and can negatively impact nurse turnover and quality of patient care. METHODS: The study employed a concurrent triangulation strategy using mixed methods. The 162 nurses who volunteered completed a 3-part questionnaire, and a subgroup participated in one of three focus groups. RESULTS: Eighty-two percent of subjects reported verbal abuse an average of 4 times per month. The majority of these continued to think about the incident for a few hours (25%), a few days (36%), or a week or more (12%). Nearly half reported feeling angry or powerless and 14% said they thought of leaving their position. CONCLUSIONS: The findings of this study described the nature and scope of the problem, and prompted improvement in processes and education to support nurses.

Developing and implementing a nursing professional practice model in a large health system.

A large healthcare system was challenged to develop a nursing professional practice model that would apply to and be understood by nurses at all levels and across all entities of the organization. A team was convened, composed of direct care nurses, educators, clinical nurse specialists, Magnet program directors, managers, and directors, representing 5 hospitals, the organization institute for nursing, and system support services. The group drafted a model describing nursing across the organization. The draft model was vetted in nursing governance councils across the entity. The model includes a theoretical framework; a mission, vision, and values; elements of professional practice; internal accountabilities; and nursing outcomes. Nurses learned about the model through Web-based and face-to-face training, through participation in a professional practice model blog and group discussions.

Understanding stress in the operating room: a step toward improving the work environment.

Job-related stress is an important factor predicting staff satisfaction and position turnover among nursing staff, particularly in the operating room. The purpose of this study was to examine the perceived amount of stress elicited by events in the perioperative environment, the frequency of those events, and the impact of those events on the perceived stress of operating room nurses (ORNs) and operating room technologists (ORTs). The Survey on Stress in the OR instrument, which was used to query the subjects, exhibited high internal consistency of all items. The findings indicated that the ORNs and the ORTs exhibited remarkable similarities between stressful events perceived as high and low impact. The two groups agreed that the highest impact stressful event was "pressure to work more quickly." Using the results of this study, OR administrators may be able to redesign the OR environment to minimize the impact of stressful events and thereby improve job satisfaction and minimize nursing staff turnover.

Implementing a virtual journal club in a clinical nursing setting.

Healthcare practice is increasingly focused on delivering care that is based on published research evidence. Staff development nurses can institute journal clubs to teach nursing staff critical appraisal of research articles and ways to translate research findings into clinical practice. Unfortunately, attending meetings regularly is often a challenge for nurses, and relatively few have the knowledge and expertise to adequately critique research articles. One way to bridge the limitations of accessibility and limited research expertise of journal club members is to establish a virtual journal club. This article describes one hospital's experience with developing a virtual journal club.

Virtual journal club connects evidence to practice: an analysis of participant responses.

Advancing evidence-based practice in hospitals can be a challenge. To address this issue, a virtual journal club (VJC) was developed using available intranet technology. Research manuscripts are posted along with professional critiques and discussion questions. Comments from nurse VJC participants are reviewed by the hospital's nursing research council and analyzed for practice implications. Recommendations for practice change derived from the analysis are forwarded to the appropriate decision-making body for consideration. This process closes the loop ensuring that the VJC not only exposes the nursing staff to scientific evidence to support changing their practice but also may lead to institutional policy changes that are based on best practice evidence in the literature. The authors discuss the VJC and the outcomes of an evaluation project.

Comparison of Web-based and face-to-face training concerning patient education within a hospital system.

The authors examined education records of 1,661 registered nurses from four affiliated hospitals who attended either a 1-hr face-to-face instructor-led training program, an instructor-facilitated Web-based training program, or an independent Web-based training program to fulfill a training requirement concerning patient education. The authors compared post-test results, course evaluation results, and costs and also developed a demographic profile of nurses' preferences for Web-based and face-to-face learning options. There was no significant difference in course effectiveness or satisfaction between the training methods studied; however, because of the large number of nurses who selected Web-based training, it was the most cost-effective alternative.

Crossing Boundaries to Advance Nursing Research Education.

Nursing professional development specialists may find it challenging time and cost-wise to meet the educational needs of nurses in the areas of research and evidence-based practice amidst competing education priorities. Furthermore, it may be difficult to find presenters with the necessary knowledge and expertise to do so. Collaboration among local hospitals to provide a high-quality research education program can advance scholarly work within the community and can help each organization meet selected Magnet® requirements in an economical way.

Nurses' perceptions of family presence during resuscitation.

BACKGROUND: Although strong evidence indicates that the presence of a patient's family during resuscitation has a positive effect on the family, the practice is still controversial and is not consistently implemented. OBJECTIVES: To explore nurses' experience with resuscitation, perceptions of the benefits and risks of having a patient's family members present, and self-confidence in having family presence at their workplace. Differences in demographic characteristics and relationships between nurses' perceptions of self-confidence and perceived risks and benefits of family presence were evaluated. METHODS: The study was descriptive, with a cross-sectional survey design. A convenience sample of 154 nurses working in inpatient and outpatient units at an urban hospital were surveyed. The 63-item survey included 2 previously validated scales, demographic questions, and opinion questions. RESULTS: Nurses' self-confidence and perceived benefit of family presence were significantly related (r = 0.54; P < .001). Self-confidence was significantly greater in nurses who had completed training in Advanced Cardiac Life Support, had experienced 10 or more resuscitation events, were specialty certified, or were members of nurses' professional organizations. Barriers to family presence included fear of interference by the patient's family, lack of space, lack of support for the family members, fear of trauma to family members, and performance anxiety. CONCLUSIONS: Changing the practice of family presence will require strengthening current policy, identifying a team member to attend to the patient's family during resuscitation, and requiring nurses to complete education on evidence that supports family presence and changes in clinical practice.