Nursing knowledge captured in electronic health records.

PURPOSE: The purpose of this study was to describe the extent to which nursing assessment data was present in the electronic health record and linked to NANDA-I, NIC, and NOC. METHODS: This retrospective review used a descriptive approach to examine documentation in the electronic health records (EHR) of 10 hospitalized patients requiring cardiac surgery. A team of experts applied a Delphi consensus-building process to identify the supports and barriers for nursing documentation. FINDINGS: Collection of the health history was organized using Gordon's Functional Health Pattern (FHP) Framework. Seventy-five fields were noted for the entry of nursing assessment data of which 65 focused on health history data and 30 documented physical findings and observations. There were no references to the defining characteristics or etiologies with any of the diagnostic labels used. Care plans included the nursing diagnoses, goals of care, and interventions, although there was a lack of clear alignment between the assessment, NANDA-I, NIC, and NOC and the care plan. Progress note documentation addressed significant events in the patient's clinical course; however, these were not nursing problem or diagnosis focused. Four expert reviewers arrived at consensus regarding the supports and challenges impacting nurses' ability to document data depicting nursing's contribution to care using a FHP and standardized nursing language in the EHR. CONCLUSIONS: The EHR provides an opportunity to reflect nursing clinical judgment and make nursing care visible. These findings suggest there are challenges to capturing nurse focused data elements in the EHR. IMPLICATIONS FOR NURSING PRACTICE: This work has important implications for clinicians, educators, and administrators alike. EHR systems must accurately capture nurses' contribution to patient care to plan for resource allocation and quality care delivery. Ultimately, the development of standardized data sources reflecting the outcomes of nursing care will expand the opportunities to advance nursing knowledge.

The Experience of Animal Assisted Therapy on Patients in an Acute Care Setting.

Animal assisted therapy (AAT) programs are popular and there has been a proliferation of programs across settings. However, the research to support this intervention has not kept pace. This is particularly so for people who are hospitalized. This investigation aimed to explore the effects of the AAT dog visitation program on patients. A single group pre-post quasi-experimental design evaluated the effect of pet therapy on patients. Measures included salivary cortisol, anxiety, wellbeing, comfort, respiratory and heart rate. Analysis indicates a significant reduction in heart and respiratory rates p < .01 and level of anxiety p < .000 with improved levels of comfort and well-being p < .000. The salivary cortisol result was non-significant p = .623. This ATT dog program resulted in reduced anxiety levels and decreased heart and respiratory rates while improving subjective measures of comfort and wellbeing.

Human Milk Management Redesign: Improving Quality and Safety and Reducing Neonatal Intensive Care Unit Nurse Stress.

Human milk provides superior nutritional value for infants in the neonatal intensive care unit and is the enteral feeding of choice. Our hospital used the system engineering initiative for patient safety model to evaluate the human milk management system in our neonatal intensive care unit. Nurses described the previous process in a negative way, fraught with opportunities for error, increased stress for nurses, and the need to be away from the bedside and their patients. The redesigned process improved the quality and safety of human milk management and created time for the nurses to spend with their patients.

Exploring the sleep experience of hospitalized adult patients.

Interruptions in sleep for hospitalized patients have been correlated with decreases in immune function, changes in mental status, and increased stress levels. The purpose of this study was to explore patients' perceptions of their sleep experiences during hospitalization. Structured interviews were conducted with a convenience sample of patients who had spent three consecutive nights in the hospital. Data was analyzed by content analysis; three themes emerged from the data. The findings from this pilot study will lead to further research in nursing practice as it relates to supporting sleep and rest in hospitalized patients.

Energy therapies in oncology nursing.

OBJECTIVES: To review the published research related to the interventions of Reiki, Therapeutic Touch, and Healing Touch representing energy therapies in relation to oncology nursing. DATA SOURCES: Peer-reviewed literature. CONCLUSION: There is growing evidence that energy therapies have a positive effect on symptoms associated with cancer. While there is need for further research, it is clear that an appreciation for the value of research methods beyond the randomized control trial is important. IMPLICATIONS FOR NURSING PRACTICE: Energy therapies offer additional strategies for oncology nurses providing integrated nursing care to alleviate suffering and symptom distress of patients with cancer.

The effect of therapeutic touch on postoperative patients.

BACKGROUND: Therapeutic Touch (TT) is a complementary modality that has been demonstrated to reduce psychological distress and help patients to relax. It is unclear if there is an impact of TT on biobehavioral markers such as cortisol and natural killer cells (NKCs). There is some preliminary evidence that suggests relaxation may have positive effects on the immune system. PURPOSE: To test the efficacy of TT on pain and biobehavioral markers in patients recovering from vascular surgery. FRAMEWORK: The study was grounded in a psychoneuroimmunology framework to address how complementary therapies affect pain and biobehavioral markers associated with recovery in surgical patients. DESIGN: This was a between-subjects intervention study. SAMPLE: Twenty-one postoperative surgical patients. MEASURES: Measures of level of pain and levels of cortisol and NKCs were obtained before and after a TT treatment. RESULTS: Compared with those who received usual care, participants who received TT had significantly lower level of pain, lower cortisol level, and higher NKC level. CONCLUSIONS AND IMPLICATIONS: Evidence supports TT as a beneficial intervention with patients. Future research on TT is still needed to learn more about how it functions. However, there is evidence to support incorporating TT into nursing practice.

Creating a therapeutic and healing environment with a pet therapy program.

BACKGROUND: Hospitalized patients encounter stressors that impact their experience and recovery. There is a need for theoretically-based, empirically supported nursing interventions to create a therapeutic and healing environment that decrease stress and improve patients' experiences. PURPOSE: To determine whether pet therapy interventions improve physiological, behavioral and mood outcomes and experiences of hospitalized patients. METHODS: A single group pre-post-quasi-experimental design with mixed methods was used in 59 hospitalized patients. Paired t-tests were used to evaluate changes from baseline following a pet therapy intervention. Qualitative data were analyzed using content analysis. RESULTS: Compared with baseline, patients had significant decreases in pain, respiratory rate and negative mood state and a significant increase in perceived energy level. Quantitative and qualitative findings provide support for decreased tension/anxiety and fatigue/inertia and improved overall mood. CONCLUSIONS: Pet therapy is a low-tech, low-cost therapy that improved mood and was meaningful to hospitalized patients.

A fellowship program preparing students for employment as new graduate nurses in oncology nursing.

The Carol A. Ghiloni Oncology Fellowship Program (OFP), developed in 2001, provides an opportunity for student nurses between their junior and senior years in a baccalaureate program to learn about the role that nurses play in providing care to patients with cancer. To explore whether former fellows felt prepared for employment in oncology nursing after their fellowship experience, a focus group discussion with former student nurse oncology fellows was conducted. The discussion was audiotaped and transcribed. Content analysis of the transcripts revealed four key findings: OFP provides an opportunity to make informed career choices; OFP provides confidence-building experience; OFP provides an experience of preceptor role modeling; and OFP provides an opportunity to build relationships with staff, patients, and patients' families.

A randomized trial of standardized nursing patient assessment using wireless devices.

A complete and accurate patient assessment database is essential for effective communication, problem identification, planning and evaluation of patient status. When employed consistently for point-of-care documentation, information systems are associated with completeness and quality of documentation. The purpose of this paper is to report on the findings of a randomized, cross-over study conducted to evaluate the adequacy of a standard patient assessment module to support problem identification, care planning and tracking of nursing sensitive patient outcomes. The feasibility of wireless devices to support patient assessment data collection at the point-of-care was evaluated using wireless PDAs and tablet PCs. Seventy-nine (79) nurses from two patient care units at Massachusetts General Hospital (Boston, MA) were recruited into the study and randomized to complete patient assessment using wireless or paper devices. At the end of six weeks, nurses who where randomized to the paper assessment module were assigned to a device and those who used a device were assigned to paper for an additional six weeks. Impact was evaluated with regard to data capture, workflow implications and nurse satisfaction. Findings suggest that a standard patient assessment set promotes patient sensitive and quality data capture, which is augmented by the use of wireless devices.

Analysis of laboratory critical value reporting at a large academic medical center.

Reporting of laboratory critical values has become an issue of national attention as illustrated by recent guidelines described in the National Patient Safety Goals of the Joint Commission on Accreditation of Healthcare Organizations. Herein, we report the results of an analysis of 37,503 consecutive laboratory critical values at our institution, a large urban academic medical center. We evaluated critical value reporting by test, laboratory specialty, patient type, clinical care area, time of day, and critical value limits. Factors leading to delays in critical value reporting are identified, and we describe approaches to improving this important operational and patient safety issue.

An analysis of inpatient nursing communications needs.

The health care environment is communications and information intensive. Nurses especially have communications as part of their routine activities, yet little is known about specific nursing communications needs and technologies that might address these needs. This project analyzed the specific communications needs of nurses at Massachusetts General Hospital (MGH) in Boston, MA, through focus group meetings, nursing staff interviews, and direct observation of unit communications. Based on these data, an ideal requirements list for a nursing communication system was created. Data were also gathered and analyzed from units piloting cell phones as nursing communications tools. On non-cell phone units we found that the bulk of communication activity is from the front desk operations associate to the nurse through a sub-optimal overhead paging system that is often unclear or inaudible. The pilot of cellular phones has demonstrated improvements in nursing communications at MGH and there are indications that other emerging technologies will be better able to address the ideal communication needs of nurses.