Evaluation of Education and Patient Screening for Delirium Among Patients With Stroke: Knowledge, Confidence, and Patient Outcomes.

BACKGROUND: Clinical staff showed a knowledge deficit with identifying and managing delirium. The effect of a validated assessment tool and delirium education on staff knowledge and confidence and patient outcomes was analyzed. METHOD: A descriptive qualitative and quantitative pre- and postintervention study analyzed the demographics of patients with stroke and clinical outcomes pre- and postimplementation of an assessment tool and delirium staff education. RESULTS: Early and frequent delirium assessments, use of an assessment tool, a delirium order set, and education for clinical staff resulted in increased knowledge and confidence with identifying and managing patients with stroke, an increase in the number of patients with stroke discharged home, and decreased incidence of hospital-acquired urinary tract infection and pneumonia. CONCLUSION: Delirium education positively impacts staff knowledge and confidence with the identification and management of delirium. Patients with an acute stroke may benefit from early and frequent delirium assessments. Staff education, structured assessment frequency with a validated assessment tool, and specific interventions affect patient outcomes, such as infection rates and discharge level of care. [J Contin Educ Nurs. 2023;54(2):61-70.].

Evaluation of the effectiveness of the healthy heart tracker on heart failure self-care.

OBJECTIVE: We evaluated the effectiveness of a newly designed patient education booklet, the Health Heart Tracker (HHT), in promoting Heart Failure Self-Care (HFSC) behaviors compared to usual patient discharge handouts. METHODS: We conducted a quasi-experimental, comparative two-group study using patients admitted for HF to four intermediate care units. The HHT was instituted on two units; patients on the other units served as control. We analyzed HFSC measured prior to HF discharge education and at two and six weeks post discharge using repeated measures ANOVA. RESULTS: Eighty-four 84 patients completed the study. The sample was 72.6 (+ 12.9) years old, white (75%), educated, and retired (85.8%). All HFSC behaviors improved significantly over time, but there were no significant time by group interactions in HFSC maintenance, symptom perception, and confidence. A notable increase in HFSC management in the HHT group between baseline and 2 weeks was evident, but not sustained to 6 weeks. CONCLUSIONS: A focused, singular intervention in the form of a patient education booklet designed specifically to improve HFSC did not significantly improve self-care behaviors over time compared to a control group. PRACTICE IMPLICATIONS: More work is needed to determine optimal written resources for patients with HF.

Delayed Newborn First Bath and Exclusive Breastfeeding Rates.

OBJECTIVE: To develop an evidence-based practice project to evaluate the effect of delaying a newborn's first bath on exclusive breastfeeding rates at discharge. DESIGN: A pre- and post-implementation evaluation of the effect of delaying the first bath on exclusive breastfeeding rates at discharge. SETTING: A postpartum unit in a southern California community hospital. PARTICIPANTS: Breastfeeding dyads of women and newborns (>37 weeks gestational age) who were admitted to the postpartum unit. INTERVENTION/MEASUREMENTS: Postpartum nurses involved in the unit practice council, in collaboration with unit leadership, changed the newborn's first bath practice through development of a bathing guideline, nurse education, and mother education. Measurements of the practice change included time of the first bath and exclusive breastfeeding rates at discharge. RESULTS: We observed an increased time for the newborn's first bath from 6.88 hours to 13.71 hours (p ≤ .001). The number of times women chose not to bathe their newborns while in the hospital also increased by approximately seven times, from 0.16% to 1.1%. The rate of exclusive breastfeeding at discharge did not change significantly after implementation (p ≥ .05), regardless of when the first bath was given. CONCLUSION: Delaying a newborn's first bath was not associated with an increase in exclusive breastfeeding rates. More research is needed to determine the effect of bath times.

Noise Reduction in Progressive Care Units.

Uncontrolled noise in the hospital setting can have a negative physiological and psychological impact on patients and nurses. To reduce unit noise levels and create a quiet patient and nurse experience, an evidence-based practice project was conducted in 4 progressive care units in a community hospital. The Quiet Time Bundle implementation improved patient satisfaction and patient and nurse perceptions of noise even though the decrease in noise levels may not be discernible.

Implementation of Interdisciplinary Rapid Rounds in Observation Units.

Lack of collaboration and communication can lead to medical errors, increased length of stay, and diminished patient satisfaction. The purpose of this project was to improve nurse efficiency, interdisciplinary communication and collaboration, and patient satisfaction with the discharge process through Rapid Rounds. The results demonstrated that interdisciplinary communication and collaboration improved coordination of care, as evidenced by improved Press Ganey percentile rankings for readiness for discharge and speed of the discharge process, increased pharmaceutical interventions, and fewer phone calls to physicians.

Reading as a Nursing Intervention for Agitation in Patients With Anoxic Brain Injury.

PURPOSE: The purpose of this article is to describe and recommend reading as a nursing intervention for agitated patients with anoxic brain injury. DESIGN: The design of this study is a case report of the results from reading to an agitated patient with anoxic brain injury. METHODS: Observation of the effects of reading to an agitated patient. FINDINGS: Fifteen minutes of reading to an agitated patient during the evening hours had a calming effect. CONCLUSIONS: Reading to agitated patients is an additional nursing intervention with little risk and represents efficient, patient-centered care. CLINICAL RELEVANCE: Reading is a successful nursing intervention that has a calming effect on agitated patients.

A Journey to Improved Inpatient Glycemic Control by Redesigning Meal Delivery and Insulin Administration.

PURPOSE: The purpose of this quality improvement project was to redesign a hospital meal delivery process in order to shorten the time between blood glucose monitoring and corresponding insulin administration and improve glycemic control. DESCRIPTION: This process change redesigned the workflow of the dietary and nursing departments. Modifications included nursing, rather than dietary, delivering meal trays to patients receiving insulin. Dietary marked the appropriate meal trays and phoned each unit prior to arrival on the unit. The process change was trialed on 2 acute care units prior to implementation hospital wide. Elapsed time between blood glucose monitoring and insulin administration was analyzed before and after process change as well as evaluation of glucometrics: percentage of patients with blood glucose between 70 and 180 mg/dL (percent perfect), blood glucose greater than 300 mg/dL (extreme hyperglycemia), and blood glucose less than 70 mg/dL (hypoglycemia). RESULTS: Percent perfect glucose results improved from 45% to 53%, extreme hyperglycemia (blood glucose >300 mg/dL) fell from 11.7% to 5%. Hypoglycemia demonstrated a downward trend line, demonstrating that with improving glycemic control hypoglycemia rates did not increase. Percentage of patients receiving meal insulin within 30 minutes of blood glucose check increased from 35% to 73%. CONCLUSION: In the hospital, numerous obstacles were present that interfered with on-time meal insulin delivery. Establishing a meal delivery process with the nurse performing the premeal blood glucose check, delivering the meal, and administering the insulin improves overall blood glucose control. IMPLICATIONS: Nurse-led process improvement of blood glucose monitoring, meal tray delivery, and insulin administration does lead to improved glycemic control for the inpatient population.

Creating a Standardized Process to Meet Core Measure Compliance.

A standardized process to improve compliance with venous thromboembolism prophylaxis and hospital-based inpatient psychiatric services Core Measures was developed, implemented, and evaluated by a clinical nurse specialist team. The use of a 1-page tool with the requirements and supporting evidence, combined with concurrent data and feedback, ensured success of improving compliance. The initial robust process of education and concurrent and retrospective review follow-up allowed for this process to be successful.

An Educational Intervention to Increase Nurse Adherence in Eliciting Patient Daily Goals.

BACKGROUND: The literature suggests that nurse and patient collaborative goal setting demonstrates better patient outcomes. The SMART goal evaluation method (Specific, Measureable, Attainable, Relevant, and Timely) is a strategy to develop effective and measureable goals. PURPOSE: The purpose of this educational project was to improve nurse collaborative goal-setting skills. METHODS: A pre- and postevaluation of an educational intervention was accomplished by patient interviews and observation for adherence to obtaining patient daily goals. RESULTS: Results of nurse adherence in writing SMART collaborative goal setting increased from 11% preeducation to 63% posteducation. Patients' perceptions of feeling well informed by their nurses and physicians increased from 57% preeducation to 91% posteducation. CONCLUSION: Nurses continued to need reminding to collaborate with their patients, but their goal writing skills greatly improved. CLINICAL RELEVANCE: The results of this educational project demonstrated nurses' improved ability to cowrite collaborative patient goals which resulted in better informed patients.

Nurses' knowledge and comfort levels using the Physician Orders for Life-sustaining Treatment (POLST) form in the progressive care unit.

Many patients are admitted to the hospital with an active Physician Orders for Life-sustaining Treatment (POLST) Form; however, not all registered nurses (RNs) are familiar with the form or comfortable with initiating a discussion about end-of-life care. Evidence indicates that an education program increases RNs' knowledge and utilization of the POLST form. The purpose of this evidence-based practice project was to answer the question: among the RNs in a progressive care unit (PCU), does implementing a formal evidence-based practice POLST program compared to current practice increase RNs' knowledge and comfort level using the POLST form? A pre-post education survey was used. Results indicated a POLST education program increased PCU RNs' knowledge and comfort level in using the POLST form. It is recommended to include POLST form education for PCU RNs in workplace education programs.

The Impact of prehospital 12-lead electrocardiograms on door-to-balloon time in patients with ST-elevation myocardial infarction.

INTRODUCTION: Multiple strategies have been implemented to reduce door-to-balloon times. The purpose of this study was to compare door-to-balloon times between ST-elevation myocardial infarction (STEMI) patients who arrived at the emergency department by ambulance with a pre-hospital electrocardiogram (ECG), to those who self-transported and had an ECG on ED arrival. METHODS: This retrospective, comparative study evaluated differences in door-to-balloon times from October 2006 to December 2009 between STEMI patients that had a 12-lead ECG done in the ambulance prior to ED arrival and patients who self-transported and had an ECG on ED arrival. RESULTS: Of the 367 patients, 62% (n = 228) arrived by ambulance and 38% (n = 139) self-transported to the emergency department. Door-to-balloon times were 30 minutes less (P < .001) than patients who were self-transported. DISCUSSION: Door-to-balloon times can be reduced when chest pain patients are transported to the emergency department by ambulance. The paramedics are equipped to perform an ECG, thereby making a preliminary diagnosis of STEMI. The emergency department can them prepare for potential angioplasty or percutaneous coronary intervention. An opportunity exists for emergency nurses to educate the public about the importance of calling 911 for chest pain.

Evaluation of an inpatient heart failure screening tool.

Heart failure is increasing in incidence, prevalence, and mortality. The purpose of this study was to test the predictive accuracy of a screening tool to identify inpatients with heart failure. The tool demonstrated statistical significance for predictability, with 68.3% sensitivity, 86% specificity, and overall accuracy of 77.5%. The tool facilitated heart failure screening and subsequent implementation of evidence-based therapies.

Preparing community Level II neonatal intensive care unit nurses to deliver Level IIIA care.

The purpose of this quality initiative was to increase NICU nurse competency to meet the care needs of higher acuity infants. A multifaceted educational approach with individual bedside education, a clinical practicum, inservices, and case presentations was based on results from a needs assessment, observational feedback, and chart audits. Results of this educational intervention included increased nurse competency and a change in admission criteria to care for higher acuity infants without transporting them to another hospital miles away. As the admission criteria changed, the volume of higher acuity infants increased, and the nurses were able to maintain their competency in caring for these infants.

Physical attributes of endoscopy nurses related to musculoskeletal problems.

The purpose of this research study was to determine whether specific attributes of endoscopy nurses such as age, body mass, or height contribute to neck, shoulder, or back problems. Study participants included endoscopy nurses who physically assist with endoscopic procedures (hands-on assist). Participants with preexisting neck, shoulder, or back injury prior to employment in endoscopy were excluded. Study participants completed the Standardized Nordic Questionnaire. Results suggested that age or height of less than 68 inches were not contributing factors to neck, shoulder, or back problems. Nurses with a body mass index (BMI) of 25 or more had significantly more upper back problems in the past 12 months. Nurses with BMI of 25 or more and/or those who were taller than 68 inches had a significantly higher incidence of upper and lower back problems that prevented work in the previous 12 months and occurred within the previous 7 days. Nurses with a BMI of 25 or more and/or who are 68 inches or taller should be aware of their higher risk for upper and lower back problems, and adjustments need to be made to their work practice and environment.

The Healthy Skin Project: changing nursing practice to prevent and treat hospital-acquired pressure ulcers.

BACKGROUND: Hospital-acquired pressure ulcers are serious clinical complications that can lead to increased length of stay, pain, infection, and, potentially, death. The surgical progressive care unit at Sharp Grossmont Hospital, San Diego, California, developed the multidisciplinary Healthy Skin Project to decrease the prevalence of hospital-acquired pressure ulcers. METHODS: The previous treatment plan was reviewed and modified according to current evidence-based practice. The project consisted of 3 components: creation of a position for a unit-based wound liaison nurse, staff education, and involvement of the nursing assistants. The wound liaison nurse developed and conducted bimonthly skin audits, which revealed inconsistencies in clinical practice and documentation. Education for the staff was accomplished via a self-learning module, case presentations, and 1-on-1 training. In addition, a pressure ulcer algorithm tool was developed to demonstrate step-by-step wound management and documentation. RESULTS: From Spring 2003 through Summer 2006, the prevalence of hospital-acquired pressure ulcers ranged from 0.0% to 18.92%, with a mean of 4.85%. After implementation of the project, the prevalence decreased to 0.0% for 17 of 20 quarters, through 2011. CONCLUSION: Prevention and a multidisciplinary approach are effective in reducing the occurrence of hospital-acquired pressure ulcers.

Universal rapid screening for methicillin-resistant Staphylococcus aureus in the intensive care units in a large community hospital.

BACKGROUND: Health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections constitute a significant risk for hospitalized patients. This study evaluates the costs and effects of comprehensive and state-mandated MRSA screening for intensive care unit (ICU) patients and subsequent contact precautions on the rate of HA-MRSA. METHODS: A pre- and postimplementation study was conducted in a 24-bed medical intensive care unit (MICU) and a 15-bed surgical intensive care unit (SICU) at an acute care 536-bed community hospital. This study used computerized records for all patients admitted to ICUs. Costs were estimated from financial records. RESULTS: HA-MRSA infection rates did not decline after implementation of ICU screening. Regression analysis demonstrated that patients admitted from skilled nursing facilities, assisted living, and similar facilities were 12 times more likely to screen positive for MRSA as compared with patients admitted from home. The costs to identify each MRSA positive patient were $1,650 and $953 for comprehensive and state-mandated periods, respectively. CONCLUSION: In low prevalence hospitals without MRSA outbreaks, it is recommended that MRSA screening be conducted on patients admitted from skilled nursing and similar facilities because they are most likely to be colonized with MRSA. Results do not support mandates to conduct screening on all patients admitted to critical care units.

Staff practice, attitudes, and knowledge/skills regarding evidence-based practice before and after an educational intervention.

BACKGROUND: Today's clinicians have different levels of knowledge and skill related to evidence-based practice, depending on their educational background, level of experience, and interest. This multidisciplinary study assessed nurses' baseline and posteducation practice, attitudes, and knowledge/skills regarding evidence-based practice. METHODS: A descriptive pre- and postsurvey design study evaluated clinical staff's practice, attitudes, and knowledge/skills regarding evidence-based practice with the Clinical Effectiveness and Evidence-Based Practice Questionnaire. RESULTS: A total of 327 participants (24%) completed the presurvey and 282 (20%) completed the postsurvey. No statistically significant changes were found in practice, attitudes, and knowledge/skills after the online education. In the multivariate analysis, online education was not a significant predictor of practice, attitudes, or knowledge/skills regarding evidence-based practice; graduate educational degree, formal evidence-based practice classes, and registered nurse status were statistically significant positive predictors. CONCLUSION: Administering self-learning online modules may not be the most effective method for expanding evidence-based practice abilities and knowledge/skills of nurses.