Finding Your Voice: A Large-Scale Nursing Training in Speaking up and Listening Skills.

BACKGROUND: Training in speaking up skills for nursing professionals provides the groundwork for promoting a culture of curiosity and inquiry. At the foundation of speaking up is psychological safety for team members to disagree, offer alternative ideas, and ask questions. METHOD: A large-scale training session, Finding Your Voice: Speaking Up & Listening Skills, was designed and delivered to 1,306 nurses at an academic medical center. RESULTS: Most participants reported that the session met the training goals (97%). There was an increase in participants' confidence in speaking up (pretraining 69% ± 19%; posttraining 73% ± 15%; p < .0001), and listening (pretraining 68% ± 19%; post-training 74% ± 15%; p < .0001). Leaders showed greater increases in confidence in listening and responding to nurses speaking up (leaders 5.6% vs. nonleaders 4.2%, p < .00001). CONCLUSION: Nurses benefited from an interactive educational experience by practicing strategies for speaking up and listening. [J Contin Educ Nurs. 2024;55(6):309-316.].

Bracing for the Storm: One Health Care System's Planning for the COVID-19 Surge.

PROBLEM: University of Washington Medicine (UW Medicine), an academic health system in Washington State, was at the epicenter of the first outbreak of the COVID-19 pandemic in the United States. The extent of emergency activation needed to adequately respond to this global pandemic was not immediately known, as the evolving situation differed significantly from any past disaster response preparations in that there was potential for exponential growth of infection, unproven mitigation strategies, serious risk to health care workers, and inadequate supply chains for critical equipment. APPROACH: The rapid transition of the UW Medicine system to account for projected COVID-19 and usual patient care, while balancing patient and staff safety and conservation of resources, represents an example of an adaptive disaster response. KEY INSIGHTS: Although our organization's ability to meet the needs of the public was uncertain, we planned and implemented changes to space, supply management, and staffing plans to meet the influx of patients across our clinical entities. The surge management plan called for specific actions to be implemented based on the level of activity. This article describes the approach taken by UW Medicine as we braced for the storm.

Patterns of Hand Grip Strength and Detection of Strength Loss in Patients Undergoing Bone Marrow Transplantation: A Feasibility Study.

PURPOSE/OBJECTIVES: To determine the feasibility of measuring hand grip strength (HGS) daily in a population of recipients of bone marrow transplantation (BMT), to describe changes in strength measured by HGS, and to describe relationships between laboratory values (hematocrit, hemoglobin, and absolute neutrophil count) and HGS.
. DESIGN: Prospective, longitudinal, repeated measures, within subject.
. SETTING: Inpatient units at the University of Washington Medical Center in Seattle.
. SAMPLE: 33 patients admitted in preparation for BMT or for complications from BMT.
. METHODS: HGS measured on admission and daily.
. MAIN RESEARCH VARIABLES: HGS, absolute neutrophil count, hemoglobin, and hematocrit.
. FINDINGS: Participants found HGS testing to be relatively easy. Average time to complete testing was 7.2 minutes (SD = 1.95). Nineteen experienced 20% or greater decline in HGS during hospitalization, with nine experiencing decline during the conditioning phase. Age, gender, and hemoglobin correlated with HGS. Strength loss was more likely in those undergoing allogeneic compared to autologous BMT.
. CONCLUSIONS: A majority of patients experienced strength decline during BMT, with a subgroup declining during conditioning. A positive relationship existed between HGS and hemoglobin and hematocrit in participants admitted for conditioning for BMT.
. IMPLICATIONS FOR NURSING: Weakness increases risk for falls. Patients may experience as much as 50% strength loss during the course of hospitalization for BMT. Strength loss occurs in the conditioning phase for some patients.

Systems-based safety intervention: reducing falls with injury and total falls on an orthopaedic ward.

BACKGROUND: In-hospital falls can result in substantial morbidity and mortality and were declared "never events" by the Centers for Medicare & Medicaid Services in 2008. Interventions that were intended to reduce the incidence of falls based on patient risk factors have not been successful in the acute inpatient setting. We hypothesized that a systems-based fall-prevention program targeting high-risk situations would result in fewer falls with injury. METHODS: Falls that occurred in the prospective postintervention period were reviewed in real time with use of a clinical database that could be accessed by all physicians, nurses, aides, and therapists. Analysis of the hospital setting, patient factors, and circumstances associated with all falls occurring on the hospital's orthopaedic ward were evaluated during the preintervention study period. On the basis of the findings from this audit, four systems-based interventions were implemented. Prospective analysis of these interventions was then conducted. All falls were tracked by means of the clinical database and reviewed by the study investigators. The rates of falls with injury and total falls in the preintervention and postintervention periods were compared. RESULTS: The preintervention study period (May 1, 2007, to September 28, 2008) represented 11,082 patient days, during which time the fall with injury rate and total fall rate were 1.17 and 4.24, respectively, per 1000 patient days. The postintervention study period (September 29, 2008, to May 1, 2010) represented 12,267 patient days, during which time the fall with injury rate and the total fall rate were 0.41 and 2.53, respectively, per 1000 patient days. The reductions in the rates of falls with injury (p = 0.036) and total falls (p = 0.024) were significant. CONCLUSION: Utilization of a continuous quality improvement model to develop a systems-based fall-prevention program can be effective in reducing falls with injury and total falls in an acute inpatient setting. Despite a thoughtful, multidisciplinary, intensive approach to the problem, falls did occur. We believe that it is unrealistic to consider all falls to be preventable.

Enhancing medical-surgical nursing practice: using practice tests and clinical examples to promote active learning and program evaluation.

In a 14-week medical-surgical nursing review course, two teaching strategies are used to promote active learning and assess the transfer of knowledge to nursing practice. Practice tests and clinical examples provide opportunities for participants to engage in self-assessment and reflective learning and enhance their nursing knowledge, skills, and practice. These strategies also contribute to program evaluation and are adaptable to a variety of course formats, including traditional classroom, web conference, and online self-study.

Effect of a medical-surgical practice and certification review course on clinical nursing practice.

The purpose of this study was to describe the effects of participation in a medical-surgical certification and practice review course on the participants' clinical nursing practice. A descriptive survey was mailed to 119 nurses 4 months after the completion of the 2005 course. The majority responding agreed that participation in the course had a positive effect on their self-confidence, competence, leadership, and initiative. The written clinical examples demonstrated the efficacy of the course in the domains of knowledge acquisition and validation, enhancement of confidence, and the ability to contribute to collegial discussions. These results demonstrate successful achievement of the ultimate goal of staff education: to see nurses translate newly acquired knowledge into practice.

Use of serum and plasma glucose measurements as a benchmark for improved hospital-wide glycemic control.

OBJECTIVE: To demonstrate the benefit of an institutionally implemented glucose control intervention based on serum and plasma glucose values in the acute inpatient setting. METHODS: In a retrospective analysis, all serum and plasma glucose values from the laboratory information system database from 1999 through 2005 were used to assess implementation of 2 new hospital-wide intravenous and subcutaneous protocols aimed at lowering blood glucose values without increasing the number of hypoglycemic events. In our analysis, we used both a per-patient hyperglycemic index (HGI), an area-under-the-curve analysis, and hospital-wide geometric mean blood glucose to assess glucose control. Bedside capillary blood glucose measurements were not included. RESULTS: More than 630,000 serum and plasma glucose results were available for analysis. The percentage of results above the protocol target of 180 mg/dL decreased from 16.4% before the intervention to 10.0% after the intervention (P<.00001), and we found no change in the proportion of "critical" hypoglycemic results (<50 mg/dL). The hospital-wide geometric mean decreased significantly and coincided with a significant decrease in the fraction of patients with poor glucose control (based on the HGI) from 27.6% to 18.7% (P<.00001). The geometric mean blood glucose was found to be an excellent marker for the HGI (r2 = 0.99). CONCLUSION: We are the first to report improvements in glucose control over an extended period with use of both hospital-wide intravenous and subcutaneous insulin protocols in an academic hospital setting. Furthermore, hospital-wide mean blood glucose levels are excellent surrogates for the more comprehensive calculation of per-patient HGI.

New insulin infusion protocol Improves blood glucose control in hospitalized patients without increasing hypoglycemia.

BACKGROUND: Aggressive treatment of hyperglycemia in hospitalized patients can improve clinically important outcomes. At the University of Washington Medical Center a quality improvement project was conducted to develop and implement a standardized insulin infusion protocol for use throughout the institution. METHODS: The insulin infusion protocol was piloted on critical and non-critical care inpatient units. Safety and efficacy data were collected for a one-month period on each unit. RESULTS: A total of 156 patients were evaluated. The incidence of hypoglycemia was lower for the study group than the historical controls, as was the mean percentage of time patients were hyperglycemic, 15% +/- 2.3% vs. 33% +/- 2.6% for the critical care subgroup (p < .0001) and 18% +/- 2.4% vs. 56% +/- 2.3% for the non-critical care subgroup (p < .0001). CONCLUSIONS: The insulin infusion protocol better met the insulin requirements of our patients and achieved better glycemic control than previous protocols at the institution. In addition, there was no increase in hypoglycemia despite the use of the protocol in non-critical care units with higher patient-to-nurse ratios, suggests that insulin infusion therapy can be safely used outside of critical care units.

Building a medical-surgical certification review course: a blueprint for success.

Many nurses desire to become certified but may have difficulty finding the time and resources to prepare for the certification examination. A free, on-site, medical-surgical certification review course was developed to meet the education and support needs for nurses to earn certification. This article describes a blueprint for course development and implementation of a certification review course at an institution.

Morphological plasticity of white clover (Trifolium repens L.) in response to spatial and temporal resource heterogeneity.

Heterogeneity in resource distribution has been an important selective force shaping morphological plasticity in plants. When resources are patchily distributed, changes in morphology are assumed to affect placement of the resource-acquiring structures (roots and leaves) such that they enhance the plant's capacity for resource uptake. Morphological development of four white clover (Trifolium repens) genets was studied in two glasshouse experiments. In the spatial experiment, two substrates (potting soil and sand) were used to create the following discrete patch combinations, sand-sand, soil-sand, sand-soil, and soil-soil. Stolons grew across each combination and consecutive ramets from a given stolon permitted rooting in each substrate pair. In the temporal experiment, the two ramets were first rooted in sand only. After a predetermined period, the sand was replaced and the same substrate combinations created as in the spatial experiment. In each experiment, total developmental time within a given substrate combination was held constant. All measurements were conducted on the second (i.e., younger) of the ramet pairs. In the spatial experiment, ramets rooted in soil had significantly greater branching frequencies than ramets rooted in the sand substrate, regardless of genotype or the preceding substrate type. Ramets occupying the sand-sand combination had the lowest branching frequencies but branch production for the ramet rooted in sand was higher if the preceding ramet was rooted in soil. The substrate occupied by a preceding ramet had no influence upon branching propensity if a ramet was rooted in soil. There were no significant differences in branching frequencies between the sand and soil substrates in the temporal experiment. The relationship between branching and substrate thus depended upon whether a ramet was exposed to a given substrate type during its early development. In both experiments, branched ramets in the soil-soil combinations had significantly greater shoot mass than corresponding ramets in the sand-sand combinations. Internode length was significantly shorter in the soil versus sand combinations of the spatial experiment but was unaffected by substrate in the temporal experiment. Leaf area and stolon width showed significant genotype×treatment interactions in both experiments but no consistent trends were evident; petiole length was unaffected by substrate.