Examining the meaning of the language used to communicate the nursing hand-off.

The miscommunication and inconsistent recall of patient information due to cognitive lapses that occur during the hand-off between healthcare providers account for 80% of sentinel events in acute care. Cognitive lapses are a consequence of the nurse experiencing cognitive overload, which impedes the nurse's ability to recall relevant information during and after the hand-off communication. The primary cognitive and human factor contributing to cognitive overload in the hand-off is language. The purpose of this study was to examine the meaning of the language used to communicate the nurse-to-nurse change of shift hand-off occurring at bedside and nonbedside on a medical-surgical unit in an urban medical center. A qualitative descriptive design was used. The sample was 10 audio-recorded hand-offs (five bedside and five nonbedside), with a total of 19 nurses participating. A natural language process program was used to analyze the data. The hand-off is a narrative story centered on communicating patient information delivered with a high degree of confidence. The hand-off is focused on past and current events with minimal focus on future or anticipated events. The drive to communicate is minimally based on concern, fear, or danger. There is a difference in the language used to communicate the nursing hand-off message at bedside as compared to the nonbedside hand-off.

Nurse-Led Mobility Program: Driving a Culture of Early Mobilization in Medical-Surgical Nursing.

BACKGROUND: Hospitalized medical-surgical patients are at risk for adverse health outcomes due to immobility. Despite well-documented consequences, low mobility is prevalent. LOCAL PROBLEM: In a 547-bed hospital, medical-surgical patients were mobilized less frequently than expected. Physical therapists were inappropriately consulted 22% of the time for routine mobility of patients. A preimplementation survey of registered nurses indicated a lack of knowledge and confidence to safely mobilize patients. METHODS: This quality improvement project implemented a nurse-led mobility program in an effort to increase early mobilization, reduce physical therapy referrals for routine mobility, and reduce the sequelae of immobility. INTERVENTIONS: The Bedside Mobility Assessment Tool and standardized interventions were implemented on 5 medical-surgical units. RESULTS: Postimplementation, nurse-led patient mobilizations increased by 40%, inappropriate physical therapy orders decreased 14%, and no significant change in patient falls or pressure injuries was noted. CONCLUSION: A nurse-led mobility program was effective in increasing safe, early mobilization of patients and improving the culture of mobility.

A Daily Goals Tool to Facilitate Indirect Nurse-Physician Communication During Morning Rounds on a Medical-Surgical Unit.

Interprofessional bedside rounds are essential for patient-centered care. However, it may be difficult for nurses to round with physicians on medical-surgical units. Using a daily goals tool for indirect rounds improved nurse-physician communication and interprofessional care for patients.

Experiences of Nurses Who Care for Women After Fetal Loss.

OBJECTIVE: To examine the experiences of, meaning for, and personal consequences for obstetric, emergency, and surgical nurses caring for women after fetal death and to determine how these nurses use Swanson's caring processes in providing such care. DESIGN: Four focus groups. SETTING: Two hospitals within the same health care system. PARTICIPANTS: Registered nurses (N = 24) working in the obstetric, surgery, or emergency departments. METHODS: Swanson's Theory of Caring guided focus group questions that were audiotaped and transcribed verbatim. Data were analyzed using a continuously emergent process of data collection, data reduction, data display, and interpretation. RESULTS: All participants demonstrated all of Swanson's caring processes but used them preferentially according to situational exigencies and level of rapport with each woman. Nurses had positive and negative feelings associated with caring for women after fetal loss. CONCLUSIONS: Obstetric nurses provided relatively equal focus on all processes in the Theory of Caring except Maintaining Belief. Surgical and emergency department nurses focused primarily on the caring processes of Knowing and Doing For. The negative feelings reported by nurses mirror some emotions commonly associated with compassion fatigue. More research is needed to determine whether nurses caring for mothers experiencing fetal loss are at risk for compassion fatigue. Research is also needed to identify strategies and interventions to help nurses so they may continue to give the best care possible to these very vulnerable families without detriment to themselves.

Photo Identification on a Medical-Surgical Unit Improves Communication Resulting in Positive Patient Outcomes.

Creating an environment that allows for ease of communication is imperative to meet the demands of health care that is focused on quality, safety, and outcomes. As a way to improve the communication between and identification of nursing staff by the interprofessional team, a process was created to aide in timely identification and communication between health care members. Enhanced communication can result in an increase in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for patient satisfaction in responsiveness, communication with nurses, and bathroom help.

Hyperglycemia in the Hospital Setting.

Nurses who understand contributing factors to insulin action and uncontrolled glucose and insulin action can assist in promoting optimal care. Common barriers to glucose control and current best practices in the acute care setting are reviewed.

Untangling Polypharmacy in Older Adults.

Polypharmacy, the use of five or more medications at one time, is increasingly prevalent in older adults. The nurse's role in education, care coordination, communication, and regular medication recon- ciliation is vital to improve outcomes.