Improving Compliance With Protocol-Driven Care in Adult Traumatic Brain Injury Patients by Implementing an Electronic Clinical Compliance Monitoring Tool.

Traumatic brain injury (TBI) remains a major cause of death and disability each year in the United States. Implementation of preestablished evidence-based guidelines has been associated with a decrease in overall TBI mortality and disability. OBJECTIVES: An electronic clinical monitoring tool was developed for monitoring compliance with evidence-based TBI treatment protocols to improve the overall care and outcomes in this patient population. METHODS: This project was designed as a process improvement project. For the preimplementation cohort of TBI patients, aggregate compliance data (by patient) were obtained from the Brain Trauma Foundation Trial patient registry maintained at Conemaugh Memorial Medical Center for the time between 2011 and 2012. The postimplementation cohort includes all patients older than 18 years who have sustained a TBI requiring clinical monitoring devices. RESULTS: There was a statistical significance between groups; the TBI-2017 group demonstrated better compliance with anticonvulsant use and cerebral perfusion pressure maintenance. In addition, overall compliance was better in the TBI-2017 cohort compared with the TBI-2012 cohort. CONCLUSIONS: Traumatic brain injury-specific education and frequent assessments improved compliance between TBI-2012 and TBI-2017, resulting in a higher percentage in overall survivors in the latter group.

Teaching Workplace Interprofessional Communication to Undergraduate Nursing Students.

BACKGROUND: Patient safety may be compromised by ineffective communication. The American Association of Colleges of Nursing's Baccalaureate Nursing (BSN) Essentials state that effective communication skills are vital for nursing students to deliver safe patient care. METHOD: Faculty developed materials-including trigger videos-to teach nursing students effective communication in response to difficult workplace conversations. Students were surveyed after instruction and viewing scenarios demonstrating difficult conversations. Students prepared smartphone videos using scripting and received feedback from faculty and peers. RESULTS: Increased comfort in addressing difficult conversations was noted for communication following medication errors (p = .011) and bullying (p < .001) scenarios. Students were likely to report delegation issues (p < .001) yet were less sure about reporting medication errors (p < .001) or bullying (p < .001). Students were less likely to use avoidance in addressing bullying (p = .015) but were unsure if they would avoid addressing medication errors (p = .004). CONCLUSION: The project provided innovative strategies to teach effective communication to nursing students. [J Nurs Educ. 2019;58(9):538-542.].

Using Interactive Video-Based Teaching to Improve Nursing Students' Ability to Provide Patient-Centered Discharge Teaching.

BACKGROUND: Nursing students rarely are afforded the opportunity to provide discharge teaching in the acute care environment, especially at the sophomore level. METHOD: Three video modules were developed that presented examples of effective and ineffective education for patients with complex chronic conditions. Students viewed modules during postconference using portable technology. A training manual that included objectives, lesson plans, evidence-based teaching points, and a discussion model guided presentation. RESULTS: The modules were presented to 216 sophomore nursing students. Following course completion, 20 students and 10 faculty were randomly selected to participate in two focus groups. Students commented positively on the format and illustration of effective teaching. Faculty rated the teaching strategy positively and the format as easy to use. CONCLUSION: Interactive video modules can be used to foster patient teaching skills early in the nursing curriculum. Future studies are needed to evaluate the ability to transfer skills learned to the clinical setting. [J Nurs Educ. 2016;55(5):296-299.].

Prone Positioning of Patients With Acute Respiratory Distress Syndrome.

Effectively treating critically ill patients with acute respiratory distress syndrome (ARDS) is a challenge for many intensive care nurses. Multiple disease processes and injuries contribute to the complexity of ARDS and often complicate therapy. As a means of supportive care for ARDS, practitioners resort to rescue therapies to improve oxygenation and salvage the patient. The pathophysiology of ARDS and the use of prone positioning to improve pulmonary ventilation and oxygenation in ARDS patients are described. Educating nursing and medical staff on the use of prone positioning allows ease of patient placement with an emphasis on safety of both patients and staff. Scrupulous assessment of patients coupled with judicious timing of prone positioning expedites weaning from ventilatory support and contributes to positive outcomes for patients.