Increasing the capacity to provide compassionate care by expanding knowledge of caring science practices at a pediatric hospital.

BACKGROUND: The emotional aspects of patient care affect care givers' capacity to remain present, safe and caring. As demands increase and capacity decreases care providers are at risk for compassion fatigue (CF). LOCAL PROBLEM: Our organization treats children with complicated diagnoses. Nurses carry a heavy emotional burden due to prolonged exposure to suffering with chronically ill children, ethical dilemmas, and an onus to also care for the parents. METHODS: Our program highlights theory guided practices that honor the complexities of caring for others and creates opportunity for the care giver to slow down and prioritize how they care for themselves. INTERVENTIONS: Caritas Circles, a small group intervention program, was developed to offer a deeper exploration of Jean Watson's Caring Sciences practice and theory using intentional practices to pause, be present and find peace in the midst of caring for sick children. RESULTS: Quantitative and qualitative measures show improvement in care providers' ability to prioritize their own needs as they care for others. Care providers noted the need to have organizational support for resiliency, a connection to purpose as a care provider, and opportunity to let go of the emotional residue found in their role. CONCLUSIONS: Organizations can no longer afford to ignore the emotional labor that care givers experience. This program highlights the need for hospitals to prioritize this type of experiential intervention and offer time during work hours where providers are honored and cared for, so they can continue to care for patients and families.

Above, Beyond, and Over the Side rails: Evaluating the New Memorial Emergency Department Fall-Risk-Assessment Tool.

INTRODUCTION: Patient falls are a significant issue in hospitalized patients and financially costly to hospitals. The Joint Commission requires that patients be assessed for fall risk and interventions in place to mitigate the risk of falls. It is imperative to have a patient population/setting specific fall risk assessment tool to identify patients at risk for falling. The purpose of this study was to evaluate the reliability and validity of the 2013 Memorial ED Fall Risk Assessment tool (MEDFRAT) specifically designed for the ED population. METHOD: A two-phase prospective design was used for this study. Phase one determined the interrater reliability of the MEDFRAT. Phase two assessed the validity of the MEDFRAT in an emergency department (ED) within a 600-bed academic/teaching institution; Level II Trauma Center with >100,000 annual patient visits. RESULTS: The Memorial ED Fall Risk Assessment Tool was validated in this ED setting. The tool demonstrated positive interrater reliability (k=0.701) and when implemented with a falls prevention strategy and staff education demonstrated a 48% decrease in ED fall rate (0.57 falls/1000 patient visits) post implementation during the study period. DISCUSSION: The MEDFRAT, an evidenced based ED-specific fall risk tool was implemented on the basis of the risk factors consistently identified in the literature: prior fall history, impaired mobility, altered mental status, altered elimination, and the use of sedative medication. The Memorial ED Fall Risk Assessment Tool demonstrated to be a valid tool for this hospital system.

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.

Improving the assessment and treatment of pelvic inflammatory disease among adolescents in an urban children's hospital emergency department.

INTRODUCTION: Proper pelvic inflammatory disease (PID) assessment and treatment is essential in preventing ectopic pregnancies, repeated PID infections, infertility, chronic pelvic pain, and fetal death. This project measured the effectiveness of interventions directed toward the providers in the emergency department to facilitate a change in the assessment and treatment of PID. Two aims identified for the project included increasing the number of providers who recorded a correct diagnosis of PID in the chart and included a sexual history for female adolescents who presented to the emergency department with abdominal pain. An additional aim was to increase the percentage of adolescents who received the correct treatment for PID. METHODS: A quality improvement study using pre-post design and Plan-Do-Study-Act cycles over an 18-month period was conducted in the emergency department of an urban children's hospital. Assessment of adolescent female patients' history of recent sexual activity and correct diagnosis and treatment of PID were evaluated. Process improvement interventions consisted of PowerPoint presentations, educational materials, and Centers for Disease Control and Prevention (CDC) treatment guidelines posted in provider areas (Table 1), along with ongoing positive and corrective feedback to providers. RESULTS: A total of 602 patient records were reviewed (119 in the PID diagnosis and treatment arm and 483 in the obtaining sexual history arm). After process improvement interventions, correct PID diagnosis increased from 72% to 95% (z = 3.064, P = .00109, odds ratio [OR] = 7.08). Correct PID treatment increased from 39.3% to 79.3% (z = 4.190, P = .0000139, OR = 5.90). The percentage of providers who obtained a sexual history increased from 65% to 74.2% (z = 1.892, P = .02929, OR = 1.55). DISCUSSION: The study demonstrated a significant improvement in all 3 aims related to improved care of adolescents with PID. PowerPoint presentations and the physical presence of the CDC treatment guidelines in the provider treatment areas were instrumental for success. Nurses play a pivotal role in the implementation and success of quality improvement projects for improving patient outcomes.

Reducing indwelling urinary catheter use in the emergency department: a successful quality-improvement initiative.

INTRODUCTION: This quality-improvement project aimed to evaluate the effectiveness of implementing multidisciplinary education and deploying utilization tools aimed at reducing the inappropriate insertion of indwelling urinary catheters (IUCs) in the emergency department. Literature supports the use of decision support tools and education as proven techniques to reduce IUC use. Few studies have implemented a multidisciplinary approach involving the use of focus groups to understand the thought processes behind deciding to place an IUC. METHODS: Focus groups were used to understand the current practice for inserting an IUC in the emergency department. These data were then used to create a nursing-based IUC decision support tool and educational presentation regarding appropriate uses for IUCs. Live, in-person education sessions were given to emergency nurses, emergency medical technicians, physicians, and residents; in addition, electronic education was assigned to all emergency nurses and technicians. Seventy-eight percent of ED staff received some form of education regarding appropriate IUC insertion criteria. Physicians and residents also received an in-person presentation on the topic. A survey was sent to all emergency nurses and emergency medical technicians to assess actual practice changes. In addition, an IUC utilization and appropriateness audit was completed before and immediately after the interventions. RESULTS: The project resulted in a 25% decrease in the proportion of patients admitted to inpatient status with IUCs placed in the emergency department and a 9% decrease in the inappropriate use of IUCs. Staff surveys after education showed that staff members were more likely to document the reason for placing an IUC and to use alternatives to IUCs. CONCLUSIONS: The potential risks associated with IUCs often go overlooked by direct-care staff members. Educating staff and creating new standards and utilization tools have often been used to decrease the initial insertion of IUCs and to improve recognition of appropriate removal of IUCs. Using direct feedback from staff to develop the interventions led to a reduction in IUC insertions in the emergency department in the short-term, but long-term changes were not seen. The project results suggest that incorporating staff into the decision making and implementation will lead to long-term acquisition of knowledge and longer-term results. Ongoing regularly scheduled education refreshers need to be assessed for their potential to affect long-term change.

Intradermal lidocaine or bacteriostatic normal saline to decrease pain before intravenous catheter insertion: a meta-analysis.

PURPOSE: Anesthetics used to decrease pain during peripheral intravenous catheter insertion have been studied with equivocal results. This meta-analysis determined if lidocaine or bacteriostatic normal saline (BaNS) is more effective in reducing pain associated with peripheral intravenous catheter cannulation in adults. METHODS: PubMed, EMBASE, CINAHL, ProQuest Dissertation and Theses, and Web of Science databases were queried. Thirteen randomized controlled trials were analyzed. RESULTS: Mean sample was 119.9 (±82.0); combined N was 1,559. Mean effect size was z = 0.46 (confidence interval = 0.24-0.68) indicating lidocaine was more effective than BaNS in providing pain relief (P < .001). CONCLUSION: Cost-benefit issues and lidocaine drug shortages must be considered when making definitive practice recommendations.

Mapping the organization: a bibliometric analysis of nurses' contributions to the literature.

OBJECTIVE: The aim of this study was to map an academic hospital's nursing contributions to the literature using bibliometric methods. BACKGROUND: Nurse executives continue to search for ways to share knowledge gained in the clinical setting. Manuscripts from clinical nurses must increase to advance the science of nursing practice and nursing administration. METHODS: A search of electronic databases and curriculum vitae provided bibliographic data for University of Colorado Hospital (UCH) nurses from 1990 to 2012. Bibliometric techniques were used for publication counts and citation analysis. A review of the infrastructure supporting scholarly work was undertaken. RESULTS: A total of 191 journal articles, 9 books, 103 book chapters, 5 manuals, and 46 manual chapters were published by UCH nurses. Author productivity steadily increased. Citation analysis indicated that the works published were used by others. The h-index for UCH authors was 25. The hospital culture, interdisciplinary practice, and the role of the research nurse scientists had an impact on study results.

Nurse manager perceptions of role satisfaction and retention at an academic medical center.

OBJECTIVE: The aim of this study was to explore the perceptions of inpatient acute care nurse managers (NM) employed at an academic Magnet® hospital about factors that influence NM retention, including current work environment, satisfaction, work-life balance, sucssful NM traits, and personal development and educational needs. BACKGROUND: Nurse managers are challenged with increased workloads impacting their ability to implement all role components. METHODS: A qualitative descriptive study design used focus group methodology to explore perceptions of the NM role. RESULTS: Nurse managers identified staff recognition, support, peer relationships, collaboration, and ability to make positive change as factors influencing their decision to remain in the role. Burnout factors included workload issues, work-life imbalance, and difficulty sustaining positive relationships. Traits supporting success were communication, resiliency, integrity, and a visionary outlook. Suggestions for NM development and education were identified. CONCLUSIONS: Findings can be used to improve NM satisfaction, work-life balance, recruitment, retention, and succession planning.

Developing the Graduate Nurse Residency: An Oral History With Dr. Colleen Goode and Dr. Mary Krugman.

Health care organizations face the challenge of needing newly licensed nurses to fill positions and facilitate competent care for patients. Wide variation in graduate nurse orientation programs, a growing complexity of care, and high graduate nurse turnover rates led to the development of nurse residency programs. The historical perspectives of two nursing pioneers involved in the development of a national model for nurse residency programs provide context to the importance of creating a vision, providing leadership, and applying an evidence-based rationale to structure a series of learning and work experiences designed to support graduate nurses as they transition into their first professional nursing position. [J Contin Educ Nurs. 2022;53(4):171-177.].

Stories of the Heart: Illness Narratives of Veterans Living With Heart Failure.

Background: Illness narratives for veterans living with heart failure (HF) have been largely unexplored, yet HF is a significant and impactful illness affecting the lives of many veterans. Methods: This study used narrative inquiry to explore the domains of psychosocial adjustments using the model of adjustment to illness, including self-schema, world schema, and meaning. Results: Five illness narratives of veterans living with HF were cocreated and explored domains which were found across all the narratives explored in this study. Emergent themes included: uniqueness of the veteran experience and the social, historical, and cultural context of narrator and researcher. Conclusions: Veterans living with HF are a unique population who experience changes in their self-schema, world schema, and meaning through their illness experience. These findings have important implications for interdisciplinary health care research and clinical practice, providing important insight into how people live with chronic illness.

The Colorado Patient-Centered Interprofessional Evidence-Based Practice Model: a framework for transformation.

BACKGROUND: Evidence-based practice (EBP) models provide a framework to guide organizations and their clinicians to implement evidence-based policies, protocols, and guidelines. A historical review of evidence-based models is presented. The revised Colorado Patient-Centered Interprofessional EBP Model supports use of research evidence and nonresearch evidence and adopts a patient-centered approach to EBP. AIM: The purpose of this article is to present a framework that can be used to transform an organization and foster the use of evidence by interdisciplinary team members. APPROACH: An evidence-based intervention to decrease catheter associated urinary tract infections (CAUTI) is presented to show how the model is operationalized. The EBP model is supported by the five steps that clinicians should use as they identify a clinical problem, gather the evidence, and move the evidence into practice. Ideas for dissemination of new models to clinicians throughout the organization are presented.

Chronic disease self-care: A concept analysis.

The purpose of this concept analysis is to clarify and analyze the concept of self-care. Self-care is vital in the prevention, control, and management of chronic disease. It is substantially important in all aspects of health and all levels of care, and it is key to chronic disease management. Walker and Avant's (2011) method for concept analysis was used. A literature search was performed using the Cumulative Index to Nursing and Allied Health Literature, Psych INFO, Cochrane Library, Embase, Medline, and Google Scholar databases for relevant articles published between 2000 and 2020 using the search terms self-care, chronic illness, and chronic disease. A total of 22 articles were found for the final analysis. The three defining attributes of self-care include readiness, ability, and activity/practice. Similarly, antecedents (illness/treatment, health systems, and environment) and consequences (health status improvement and wellbeing-related, symptom management-related, cost reduction-related, and personal development-related) of self-care were derived from literature. Constructed cases were created to illustrate these aspects of self-care. Through this concept analysis, the complexity and breadth of the self-care concept are elucidated.

Health care providers' evaluations of family presence during resuscitation.

INTRODUCTION: The benefits of family presence (FP) during resuscitation are well documented in the literature, and it is becoming an accepted practice in many hospitals. There is sufficient evidence about health care provider (HCP) and family attitudes and beliefs about FP and little about the actual outcomes after family witnessed resuscitation. The purpose of this study was to evaluate FP at resuscitations. METHODS: A descriptive design was used to collect data at an academic medical center in the western U.S. There were 106 resuscitations during the study period. Family presence was documented on 31 (29%) records. One hundred and seventy-four health care provider names were listed on the resuscitation records, and 40 names (23%) were illegible or incomplete. The convenience sample of 134 HCPs was invited to complete an electronic survey and 65 (49%) responded. RESULTS: Respondents indicated that family members were able to emotionally tolerate the situation (59%), did not interfere with the care being provided to the patient (88%). In addition, team communication was not negatively affected (88%). A family facilitator was present 70% of the time, and it was usually a registered nurse (41%). Twenty-one narrative comments were summarized to reflect the following themes: 1) family presence is beneficial; 2) family presence is emotional; 3) a family facilitator is necessary. DISCUSSION: These study findings demonstrate that having families present during resuscitations does not negatively impact patient care, is perceived to benefit family members and that a dedicated family facilitator is an integral part of the process.

Normothermia and patient comfort: a comparative study in an outpatient surgery setting.

ASPAN guidelines for the prevention of unplanned perioperative hypothermia define normothermia as a core temperature between 36 and 38 degrees C and an acceptable level of warmth. Over a six-month period, more than 30% of the same-day surgery patients experienced hypothermic core temperatures on admission to the preoperative unit. The purpose of the study was to compare two preoperative warming methods (forced-air gowns vs traditional warmed cotton blankets) on oral body temperatures, and patients reported "thermal" comfort in ambulatory surgery patients. A repeated measures experimental design study included 150 subjects in Pre-op who were randomly assigned to either the control warmed blankets group or the experimental forced-air gown group. Oral temperatures and thermal comfort assessments were measured every 30 minutes while the patients were in Pre-op, and on admission and discharge from the Phase I PACU. There was no significant difference in postoperative temperature between the subjects warmed with blankets and the warm-air gowns. Subjects warmed with the warm-air gowns reported higher comfort scores after 30 minutes of warming than those warmed with blankets. The change in comfort score from baseline to 30 minutes post warming was greater in the warm-air gown group (P = .001), indicating that warm-air gowns contribute to patients' increased thermal comfort.

Attitudes toward and beliefs about family presence: a survey of healthcare providers, patients' families, and patients.

BACKGROUND: Although some healthcare providers remain hesitant, family presence, defined as the presence of patients' family members during resuscitation and/or invasive procedures, is becoming an accepted practice. Evidence indicates that family presence is beneficial to patients and their families. OBJECTIVES: To describe and compare the beliefs about and attitudes toward family presence of clinicians, patients' families, and patients. METHODS: Clinicians, patients' families, and patients in the emergency department and adult and neonatal intensive care units of a 300-bed urban academic hospital were surveyed. RESULTS: Surveys were completed by 202 clinicians, 72 family members, and 62 patients. Clinicians had positive attitudes toward family presence but had concerns about safety, the emotional responses of the family members, and performance anxiety. Nurses had more favorable attitudes toward family presence than physicians did. Patients and their families had positive attitudes toward family presence. CONCLUSIONS: Family presence is beneficial to patients, patients' families, and healthcare providers. As family presence becomes a more accepted practice, healthcare providers will need to accommodate patients' families at the bedside and address the barriers that impede the practice.

Mentoring Clinical Nurses to Write for Publication: Strategies for Success.

: Clinical nurses often find writing a challenge, but it's important to disseminate clinical practice initiatives that result in notable patient outcomes. Nurses have a responsibility to share what they do to improve patient care. The increased emphasis on the development and evaluation of evidence-based practice has made it necessary for nurses to share best practices that are associated with improved patient outcomes. We developed a six-month Writing for Publication workshop series designed to teach clinical nurses about the writing process and mentor them through the stages of preparing a manuscript to submit for publication. This successful program helped novice nurse authors become published professionals and had a great impact on our organization.

The Ventilated Patient's Experience.

BACKGROUND: Critically ill intensive care unit (ICU) patients often experience pain, anxiety, panic, fear, dyspnea, and distress related to mechanical ventilation. Patients' recollections vary from having little or no memory of actual events to having total recall. Few studies have examined family members' memories and congruence with patients' symptom report and nurse observation. OBJECTIVES: To describe the experience of the mechanically ventilated ICU patient. AIMS: (1) to explore patient and family memories of pain, anxiety, distress, and dyspnea following mechanical ventilation; (2) to determine if there is a correlation among nurse-documented pain assessment and patient- and family-reported pain intensity; and (3) to determine the level of patient and family satisfaction with care while on the ventilator. METHODS: This was a descriptive study design. A convenience sample of ICU patients (n = 84) and family members (n = 77) was interviewed. Medical record data abstraction included patient demographics, medication administration, and nurse assessment of pain and sedation. RESULTS: Most patient and family members reported memories of pain, anxiety/panic, nightmares or distress, and trouble breathing. Patients' perception of anxiety, nightmares, and dyspnea were moderately correlated with their pain perception (P = .000). Family members' memories of pain were correlated with nurse pain assessment behavioral scale ratings, but patients' memories of pain were not. Patients and family reported high satisfaction scores. CONCLUSION: Further inquiry of the patient's experience with mechanical ventilation, the use of a ventilation sedation management protocol, and the evaluation of effective communication tools such as the use of bedside reporting or patient communication boards is warranted.

Perspectives on practicing procedures on the newly dead.

UNLABELLED: Invasive procedures are commonly practiced and taught on newly deceased patients (the newly dead) in emergency and critical care settings. Justified by the claim of necessity for professional competence to provide lifesaving care, these procedures, commonly hidden from public and professional scrutiny, are frequently performed on the newly dead without consent from family or interested parties. OBJECTIVE: To describe older adults' beliefs about practicing and teaching lifesaving procedures on the newly dead and their belief about the requirement for consent for these procedures. METHODS: An exploratory, descriptive design used a seven-item Likert-type instrument with open-ended questions to gather data from a convenience sample of 100 adults in two metropolitan cities. RESULTS: The typical respondent was 74.5 years old (mean; range of 55-95 years), female (71%), and married (44.8%) or widowed (36.5%). Most respondents were high school graduates (94%), and 63% had some level of college education. The majority of the sample was white (75%), they were predominately Protestant (40%), and 72% reported their health as good to excellent. Most study participants believed that practicing or teaching lifesaving skills on a newly dead body is acceptable (54%), and that provision for consent is necessary (80%). Planning to donate organs and preferring an autopsy were associated with agreeing that using the newly dead body for skill practice was acceptable; preferring cremation was related to believing that consent for skill practice on the newly dead was not necessary. CONCLUSIONS: The participants in this study value the use of the newly dead to practice and teach lifesaving skills, and believe that consent for this practice is necessary.

Rural hospital web-based, evidence-based practice professional development: challenges and opportunities.

To provide quality patient care and achieve positive patient outcomes, it is widely recognized that organizations must develop a supportive environment that encourages individuals to practice from a research- and evidence-based framework. This article describes a Web-based professional educational program designed to teach principles of evidence-based practice to nurses in rural hospitals. Nurses working in staff development will find this useful for designing educational programs for staff in rural hospitals.