Nurses' Perceptions of Barriers to Rapid Response System Activation: A Systematic Review.

BACKGROUND: The rapid response system (RRS) was designed to identify and intervene on patients exhibiting clinical deterioration in the non-critical-care setting but is not always effectively activated by nurses, leading to adverse patient outcomes. OBJECTIVES: The objective of this systematic review was to explore nurses' perceived barriers to RRS activation in the acute adult inpatient setting. METHOD: A systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist. Six different search terms were used in the following electronic databases: Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Healthsource: Nursing/Academic Edition, MEDLINE, and PubMed. Limiters applied to search methods included years 2007 to current, full text, scholarly (peer reviewed), and English language. This review was further limited to quantitative studies in the adult inpatient setting. RESULTS: The initial electronic database search yielded 149 articles. After duplicate exclusion, 87 article abstracts were reviewed for inclusion and eligibility, and a total of 8 articles were used for this systematic review. Themes to nurses' perceived barriers to RRS activation include RRS activator-responder interaction, physician influence, nurse education, and nurse experience. DISCUSSION: Nurses play a vital role in patient care by providing continuous surveillance and are the frontline for early detection including prompt intervention should a patient's condition deteriorate. Inconsistent RRS activation has been associated with negative patient outcomes. Exploring nurses' perceived barriers to RRS activation may contribute to interventions that lead to nurses appropriately activating the RRS and potentially decreasing adverse patient outcomes.

Challenges in Hospital-Associated Infection Management: A Unit Perspective.

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

Withdrawal of life-sustaining treatment: a case study.

Withdrawal of life support is an option for patients with prolonged mechanical ventilation when all attempts at weaning have failed and it is deemed futile to continue the therapy, when quality of life is unacceptable, or when it is perceived that the patient is suffering. The purpose of this article is to present the nursing aspects of managing an adult patient undergoing the withdrawal of mechanical ventilation as an end-of-life procedure. Withdrawal of mechanical ventilation is a complex and difficult process that requires meticulous planning and management. Conferences with the patient and the patient's family are critical to addressing emotional support and ensuring that everyone understands the process and is provided an opportunity to gather information. Clear communication with patients and their families can ensure that the process goes smoothly. Having an organized approach can ensure that patients experience a peaceful death and staff experience closure regarding the event.

Progressive care units: different but the same.

Progressive care units are increasingly common in hospitals in the United States. These units are often used to bridge the gap between intensive care units and medical-surgical units, with the goal of providing cost-effective, high-quality, safe care. Although progressive care units today may seem to provide care for a wide variety of patients, these patients do share certain typical features: they require a high intensity of nursing care and/or a high level of surveillance. Nurses working in progressive care units all must have certain basic competencies. Those core competencies have been identified and should form the basis for education and training of progressive care nurses.

Clinical nurse specialist orientation: ready, set, go!

BACKGROUND: Both novice and experienced clinical nurse specialists (CNSs) need a consistent orientation to ensure that all in the role have the same knowledge base from an agreed upon set of role expectations. PURPOSE: The purpose of this article was to describe an orientation process using the 3 spheres of CNS practice as the framework for a CNS competency validation tool that can be used in all practice specialties and settings. Additionally, the roles of CNS preceptor and CNS mentor are delineated. CONCLUSIONS: The orientation tool based on the spheres of influence provides a thorough and consistent orientation for CNSs and may also be used as an educational tool for leadership and other staff regarding the CNS role.

Staff nurses' experiences of a change in the care delivery model: a qualitative analysis.

This qualitative study describes the staff nurses' perspective of change in the care delivery model and skill mix in an intermediate care unit. Data were collected in interviews in focus groups with the registered nurses affected by the change. Two major themes emerged: (1) autonomy and control and (2) interdependence. The nurses emphasized an increased satisfaction (self and patient) with this model. This study confirmed that autonomy, control, connection with the patient, and peer and interdisciplinary support and respect are important for the staff nurse. These findings reinforced the value of involving the staff members in change and the importance of giving voice to their perspective through qualitative research.