The Impact of Patient and Family Advisors on Critical Care Nurses' Empathy.

OBJECTIVE: The objective of this study was to determine if patient and family advisors' (PFAs) collaboration in an educational program could increase the empathy levels of intensive care unit (ICU) nurses. BACKGROUND: Data suggest that nurse empathy is on the decline. Ensuring that nurses consistently empathize with patients and families helps create positive patient experiences. METHODS: Thirty nurses participated in a PFA-designed educational intervention using simulation-based role playing. The Toronto Empathy Questionnaire (TEQ) was used to measure empathy before and after the intervention. RESULTS: The TEQ empathy scores increased significantly after nurses completed the PFA-designed educational program. Younger nurses (<30 years) improved on average 3.03 ± 3.6 points compared with older nurses (>30 years), who improved, on average, only 0.43 ± 2.06 points (t24.4 = 2.46, P = .021). For the changes in TEQ scores from preintervention to postintervention, age was significantly associated with improvements in TEQ scores. CONCLUSIONS: Patient and family advisors can positively impact empathy among ICU nurses.

Improving Clinical Alarm Management: Guidance and Strategies.

This article focuses on the type of problems that lead to false or nonactionable clinical alarms and the type of data that can help identify which of these alarms are most prevalent in specific units in healthcare facilities. The process of identifying necessary data is first described, as this activity will drive later choices on capturing data. This article also discusses how to use the data collected in alarm reports to help determine which alarms should be targeted first for improved management in a pilot environment. Suggestions are provided on how to reduce false and nonactionable alarm signals and how to monitor to ensure no untoward consequences occur from new alarm default settings. The information provided here can be individualized to hospitals and units to enhance alarm management with physiological monitor alarms. It also can be adapted to reduce nonactionable alarm signals occurring from other medical devices.

Please release me: restraint reduction initiative in a health care system.

A quality improvement initiative was undertaken to reduce restraint use in 4 acute care hospitals within a single health system. A variety of initiatives and interventions were used including the following: implementation of multidisciplinary rounds on restrained patients, increased availability of restraint alternatives, development of unit-based restraint champions, and education of both staff and health care providers about restraints. The health care system has maintained a quarterly restraint prevalence rate of less than 2.26% with 1 variant.

Impact of CPR Quality and Adherence to Advanced Cardiac Life Support Guidelines on Patient Outcomes in In-Hospital Cardiac Arrest.

BACKGROUND: Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes. OBJECTIVES: To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest. METHODS: An observational study was conducted using prospectively collected data from a convenience sample. Cardiopulmonary arrest forms and medical records were evaluated at an academic medical center. Adherence to resuscitation guidelines was measured with the ZOLL R Series monitor/defibrillator using RescueNet Code Review software. The primary outcome was patient survival. RESULTS: Of 200 cases, 37% of compressions were in the recommended range for rate (100-120/min) and 63.9% were in range for depth. The average rate was above target 55.7% of the time. The average depth was above and below target 1.4% and 34.7% of the time, respectively. Of the 200 patients, 125 (62.5%) attained return of spontaneous circulation. Of those, 94 (47%) were alive 24 hours after resuscitation. Fifty patients (25%) were discharged from the intensive care unit alive and 47 (23.5%) were discharged from the hospital alive. CONCLUSIONS: These exploratory data reveal overall survival rates similar to those found in previous studies. The number of pauses greater than 10 seconds during resuscitation was the one consistent factor that impacted survival. Despite availability of an audiovisual feedback system, rescuers continue to perform compressions that are not at optimal rate and depth.