Influence of a Formal Mentor on Hospital-Based Nurse Research Resources and Outcomes.

ABSTRACT: Magnet® hospitals must conduct nursing research to maintain designation. Relationships between hospital research infrastructure, activities, and a designated nurse research mentor were explored in a large health system using survey methodology. Hospitals with a formal mentor reported more research resources (n = 23, m = 2.5) compared with those without (n = 16, m = 1.8, P < 0.001). Hospitals aspiring for Magnet may benefit from a doctorally prepared research mentor.

Modified early warning scoring (MEWS): evaluating the evidence for tool inclusion of sepsis screening criteria and impact on mortality and failure to rescue.

AIMS AND OBJECTIVES: To evaluate current research evidence reporting outcomes from modified early warning scoring system tools utilisation to prevent failure to rescue in hospitalised adult medical-surgical/telemetry patients. BACKGROUND: Early sepsis detection exhibits clinical significance to practitioners and patients. Thorough and timely clinical observations, along with a willingness of nurses to call for help, are pivotal to survival of hospitalised patients. This project examined effects of modified early warning scoring system tool usage on patient mortality and failure to rescue events in hospitalised adult medical-surgical/telemetry patients as reported in the literature. DESIGN: A comprehensive review and evaluation of published peer-reviewed literature was conducted. METHODS: Electronic databases searched included PubMed, MEDLINE, CINAHL, Cochrane Library of systematic reviews and Agency for Healthcare Research and Quality through 2014. RESULTS: Eighteen articles were identified for review. Evidence ratings included 6% (1) Level I, 44% (8) Level IV, 6% (1) Level V, 33% (6) Level VI and 11% (2) Level VII. Six reported mortality predictive value and/or reduction, three measured impact on emergency calls, and four reported impact on mortality and rapid response team utilisation. CONCLUSION: While modified early warning scoring system tools have been widely adopted and are recommended for utility in detection of inpatients at-risk for clinical deterioration, limited high-level data and no clinical trials linking use of modified early warning scoring system tool usage to robust outcomes were found. Established criteria for validating modified early warning scoring system criteria, organisational-specific reliability testing and multi-site trials are recommended. RELEVANCE TO CLINICAL PRACTICE: Development of all-cause illness screening tools, including sepsis, is imperative. The clinical picture may be quantified with scoring tools to assist nurses' clinical decision-making, thus leading to improved outcomes and decreased incidence of failure to rescue. Clinical outcomes of interest should be measured and reported in peer-reviewed literature to disseminate the impact on clinical outcomes.

Detecting blood transfusion reactions: What are vital signs anyway?

There is a lack of consistency in the scientific literature regarding what is included in vital signs and considered derangement in findings. We used vital signs during blood product administration as an exemplar to explore this controversy. Vital sign components varied across all studies when reviewed by a cohort of frontline nurses attempting to align institutional policy with current evidence. Only low-level data linking conventional approaches to vital sign monitoring for transfusion reaction detection were found.

Caring for COVID-19 infected patients admitted to redesignated coronavirus ICUs: Impact on nurse stress and burnout.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic globally impacted healthcare due to surges in infected patients and respiratory failure. The pandemic escalated nursing burnout syndrome (NBS) across the workforce, especially in critical care environments, potentially leading to long-term negative impact on nurse retention and patient care. To compare self-reported burnout scores of frontline nurses caring for COVID-19 infected patients with burnout scores captured before the pandemic and in non-COVID-19 units from two prior studies. METHODS: The descriptive study was conducted using frontline nurses working in eight critical care units based on exposure to COVID-19 infected patients. Nurses were surveyed in 2019 and in 2020 using Maslach Burnout Inventory (MBI), Well Being Instrument, and Stress-Arousal Adjective Checklist (SACL) instruments. Researchers explored relationships between survey scores and working in COVID-19 units. RESULTS: Nurses working in COVID-19 units experienced more emotional exhaustion (EE) and depersonalization (DP) than nurses working in non-COVID units (p= .0001). Pre-COVID nurse burnout scores across six critical care units (EE mean = 15.41; p= .59) were lower than burnout scores in the COVID-19 intensive care units (EE mean = 10.29; p= .74). Clinical significance (p= .08) was noted by an EE subscale increase from low prepandemic to moderate during the pandemic. CONCLUSION: Pinpointing associations between COVID-19 infection and nurse burnout may lead to innovative strategies to mitigate burnout in those caring for the most critically ill individuals during future pandemics. Further research is required to establish causal relationships between sociodemographic and work-related psychological predictors of NBS.

Implementation of a MEWS-Sepsis screening tool: Transformational outcomes of a nurse-led evidence-based practice project.

BACKGROUND: One in three patients who die in the hospital has sepsis. Alerting clinicians to early detection of high-risk patients before deterioration is a top health care priority. Modified Early Warning Scoring (MEWS) tools have assisted organizations in identifying at-risk patients at the first sign of subtle deterioration. AIM AND SETTING: In conjunction with an academic-clinical partner, we evaluated, revised and implemented a modified MEWS-Sepsis screening tool in an acute care facility. PARTICIPANTS: One hundred and thirty-nine direct-care nurses participated in tool evaluation. METHODS: Using a plan-do-study-act cycle of quality improvement, critical care scenarios from septic patient data were created and tested in a simulated setting. RESULTS: Upon implementation of the MEWS-Sepsis tool, the monthly risk-adjusted sepsis mortality rate immediately declined by 24%. The decline in mortality has been sustained from implementation to the present, spanning a 5-year period. CONCLUSIONS: The implementation of a MEWS-Sepsis screening tool contributed to early identification and implementation of time-sensitive interventions aimed at preventing sepsis-associated deaths. MEWS-Sepsis tools hold potential for scale-up and spreading out of evidence-based practice nursing innovations to transform care, improve patient outcomes, and save lives.