Part 1: Evidence-based facility design using Transforming Care at the Bedside principles.

An academic hospital used Transforming Care at the Bedside (TCAB) principles as the framework for generating evidence-based recommendations for the design of an expansion of the current hospital. The interdisciplinary team used the table of evidence-based data to advocate for a patient- and family-centered, safe, and positive work environment. A nurse project manager acted as liaison between the TCAB design team, architects, and facilities and design consultants. Part 2 of this series describes project evaluation outcomes.

Purposeful visits for hospitalized older adult patients.

Hospitalization can be an isolating and stressful experience for older adults who find themselves cut off from normal routines and social support systems. The Purposeful Visitation Program (PVP) provided structured interactions for hospitalized geriatric patients using volunteers trained to elicit discussion about recreation and leisure. The goal of the program was to improve patients' orientation, level of calmness, and mood through guided cognitively stimulating interactions. Between January and July 2010, seven volunteers were trained and provided the program to 98 older adults on a geriatric inpatient hospital unit of a large academic medical center. Ninety-nine percent of patients reported enjoying their volunteer visit, and 96% thought other patients would also benefit. Volunteers and staff observed improvements, primarily in patient mood, after visits. PVP represents a cost-effective method of providing structured, individualized, and stimulating social interactions for older adults in a hospital setting.

Lessons learned from the implementation of a bedside handoff model.

At the University of Colorado Hospital, nurse-to-nurse shift reports traditionally occurred in a conference room setting and consisted of nurse-to-nurse verbal communication. Evidence supports moving this information exchange to the patient bedside. This model of report improves clinical effectiveness, patient safety, nurse efficiency, and staff satisfaction. Bedside reporting empowers patients and families to ask questions and contribute to their plan of care and increases patient satisfaction. This article describes the process of implementing and evaluating a model of nurse-to-nurse bedside handoff report.

Culture change in infection control: applying psychological principles to improve hand hygiene.

Hand hygiene occurs at the intersection of habit and culture. Psychological and social principles, including operant conditioning and peer pressure of conforming social norms, facilitate behavior change. Participatory leadership and level hierarchies are needed for sustainable patient safety culture. Application of these principles progressively and significantly improved hand hygiene compared with the hospital aggregate control. Changes to hand hygiene auditing and response processes demonstrate ability to improve and sustain adherence rates within a clinical microsystem.

Outcomes of touch therapies during bone marrow transplant.

CONTEXT: The integration of complementary modalities into mainstream healthcare is gaining increasing emphasis. It is important, therefore, to document the effects of these interventions on patient outcomes. OBJECTIVE: To investigate the effects of Therapeutic Touch and massage therapy on the outcomes of engraftment time, complications, and perceived benefits of therapy during bone marrow transplant. DESIGN: Randomized clinical trial. PARTICIPANTS/SETTING: Subjects were adult patients on the bone marrow transplant unit of a large urban tertiary care center. INTERVENTIONS: Subjects were randomly assigned to 1 of 3 treatment groups: Therapeutic Touch (TT), massage therapy (MT), and a control group called the friendly visit (FV). Subjects (N = 88) were stratified by type of transplant (allogeneic or autologous). Twenty-seven subjects received MT; 31 received TT; and 30 received FV. Nurses with expertise in the 2 touch therapies administered them. The interventions of MT, TT, and FV were administered according to standarized protocols every third day beginning the day chemotherapy began until discharge from the program. OUTCOME MEASURES: Time for engraftment, complications, and patient perceptions of benefits of therapy were the main outcome measures. Analysis of variance and analysis of covariance were used to determine significant differences among the 3 groups with respect to time of engraftment. RESULTS: A significantly lower score for central nervous system or neurological complications was noted for subjects who received MT comppared with the control group; however, no differences were found among the 3 groups with respect to the other 10 complication categories or in the total mean score for complications. Patients' perception of the benefits of therapy (total score) was significantly higher for those who received MT compared with the FV control group. The mean scores on the comfort subscale were significantly higher for patients receiving both MT and TT compared with the FV control group. CONCLUSIONS: Massage therapy may be effective in altering the psychological and neurological complications associated with chemotherapy during bone marrow transplant. Both massage and Therapeutic Touch provide comfort to patients undergoing this challenging process.