Intensive Care Unit Sleep Promotion Bundle: Impact on Sleep Quality, Delirium, and Other Patient Outcomes.

BACKGROUND: High-quality sleep is important for optimal patient recovery. Sleep deprivation during hospitalization may lead to poor patient outcomes. OBJECTIVE: To examine whether implementation of a sleep promotion bundle in the intensive care unit affects rates of delirium and agitation, restraint use, and length of stay. METHODS: An evidence-based sleep promotion bundle was developed and implemented in 2 intensive care units in a 1025-bed level I trauma teaching hospital. Deidentified data from the electronic health record were obtained for patients hospitalized before and during the intervention. Data included scores on the Confusion Assessment Method for the Intensive Care Unit, Richmond Agitation-Sedation Scale, and Glasgow Coma Scale; restraint use; and hospital and intensive care unit length of stay. RESULTS: A total of 137 patients during the preintervention period and 149 patients during the intervention period were hospitalized in the intensive care units and met inclusion criteria. A 9-percentage-point decrease in the incidence of delirium from before to during the intervention was found, although it was not statistically significant (P = .07). Significant reductions were found in both intensive care unit (P = .04) and hospital (P = .03) length of stay. A significant decrease was found in Richmond Agitation-Sedation Scale high scores for patients requiring mechanical ventilation (P = .03). No significant differences were found in Richmond Agitation-Sedation Scale low scores, Glasgow Coma Scale scores, or restraint use. CONCLUSIONS: Critical care nurses are in an optimal position to implement evidence-based sleep promotion measures. Further research on sleep promotion bundles is needed.

A cross-sectional study of Hispanic and Latina/o/x/e individuals' acute coronary syndrome symptom knowledge, attitudes, and beliefs.

BACKGROUND: Little attention has been placed on language proficiency as a potential variable affecting ACS symptom knowledge, attitudes, and beliefs. OBJECTIVES: To compare the ACS symptom knowledge, attitudes, and beliefs of Hispanic and Latina/o/x/e individuals proficient in English and in those only proficient in Spanish. Secondary aims were to determine if there were differences in ACS symptom knowledge, attitudes, or beliefs based on participants' previous exposure to ACS symptom information and to evaluate instrument characteristics of the new Spanish version of the ACS Response Index. METHODS: This cross-sectional, comparative study included participants (N = 99) from a community-based clinic in Illinois. Knowledge, attitudes, and beliefs related to ACS symptoms were measured using the ACS Response Index. RESULTS: The average participant was 39.8 (SD 15.6) years of age, female (n = 56, 56.6 %), and had a high school education or less (n = 61, 61.6 %). Participants correctly classified a mean 57.5 % (SD 12.8) of symptoms and had mean attitude and belief scores of 12.1 (SD 3.3) and 17.5 (SD 2.9), respectively. There were no significant differences in knowledge, attitudes, and beliefs based on language proficiency. However, there were some statistically significant differences for knowledge and attitude scores based on exposure to ACS symptom information. The ACS Response Index (Spanish Version) also demonstrated favorable internal consistency. CONCLUSIONS: Overall knowledge, attitude, and belief scores were modest in this sample. Higher knowledge and attitude scores were observed for some types of ACS information exposure, supporting the importance of future educational efforts in this population.

The Effect of Music on Postoperative Agitation, Pain, and Opioid Use among Patients Undergoing Total Knee Replacement.

BACKGROUND: Postoperative pain and agitation is an ongoing issue among patients undergoing total knee replacement (TKR). Use of complementary therapies such as music may improve outcomes when combined with medical therapy. AIM: The purpose of this quality improvement (QI) initiative was to evaluate postoperative use of classical music among adult patients who have undergone TKR on reported agitation, pain, and opioid use. DESIGN: A prospective evidence-based QI initiative. SETTING: A midwestern hospital post-anesthesia care unit. PARTICIPANTS: Postoperative patients who had undergone TKR. METHODS: Classical piano music was played postoperatively using an MP3 device. Adult patients who were undergoing TKR were consecutively offered music during their recovery period in the PACU. Agitation was measured using the Richmond Agitation Sedation Score (RASS). Patient perceived pain was measured on a scale of 0-10 with 0 being no pain and 10 being extreme pain. Opioid use was measured using the morphine milligram equivalents (MME). FINDINGS: A total of (n=40) patients received music and (n=50) patients received standard care without music. RASS was significantly lower in the music group than in the baseline non-music group X2 (1, N = 89) = 17.8, p < .001. Patient reported pain scores were significantly lower in the music group, 3.98(SD = 2.71), compared to the baseline non-music group, 6.27(SD = 2.60). Opioid use was also significantly decreased in the music group to MME 9.51(SD = 8.62) compared to the baseline non-music group 13.38 (SD = 9.71). CONCLUSION: Music is an effective nonpharmacologic intervention in decreasing agitation, pain, and opioid use among patients undergoing TKR. These findings provide evidence for nurses to incorporate music as an adjunctive approach to enhance the patient's experience and improve outcomes.

Increasing teachers' confidence during health emergencies: A hands-on quality improvement program led by the school nurse.

INTRODUCTION: One in four school-age children has a chronic health condition, with approximately 6% of them having multiple chronic health conditions. These students are at an elevated risk of individual health emergencies during school hours. While teachers receive online training to assist in these emergencies, they lack practicing with rescue medications. METHODS: We developed a Quality Improvement (QI) program that had a) a live presentation; b) a hands-on workshop to practice using rescue medications for allergies, asthma, seizures, and diabetes; c) fliers with first-aid guidelines; and d) a web-based reference toolkit. Teachers' confidence and knowledge were measured using the Learning Self-Efficacy Scale and a knowledge questionnaire with a pre- and post-intervention survey. We also assessed their clinical skills using the rescue medications. RESULTS: 129 teachers took part in this QI program. We collected 95 pre- and 81 post-surveys, with 47 matched. We saw statistically significant increases in confidence, as well as in the individual cognitive, affective, and psychomotor domains. Teachers also increased their overall knowledge. Collaterally, other district-wide improvements developed. CONCLUSION: This evidence-based, hands-on QI program provided teachers the opportunity to put into practice clinical skills, increasing their confidence to help students when experiencing an individual health emergency. Furthermore, changes beyond the primary goal of this QI program were implemented, highlighting the lead role of the registered nurse as the public health advocate. IMPLICATION TO PRACTICE: Laypeople benefit from hands-on training to learn clinical skills. This program serves as a basis for improving health emergencies preparedness in schools.

The Heart Failure Patient Foundation Position Statement on Research and Patient Involvement.

BACKGROUND: Heart Failure (HF) is a growing global public health problem affecting approximately 64 million people worldwide. OBJECTIVES: The Heart Failure Patient Foundation developed a position statement to advocate for adult patients with HF to be an active participant in research and for HF leaders to integrate patients throughout the research process. METHODS: A review of the literature and best practices was conducted. Based on the evidence, the HF Patient Foundation made recommendations regarding the inclusion of adult patients with HF throughout the research process. RESULTS: Healthcare clinicians, researchers and funding agencies have a role to ensure rigorous quality research is performed and implemented into practice. Inclusion of adult patients with HF throughout the research process can improve the lives of patients and families while advancing HF science. CONCLUSIONS: The HF Patient Foundation strongly advocates that patients with HF be involved in research from inception of the project through dissemination of findings to improve patient outcomes.

Examination of Nursing Staffs' Perceptions of the COVID-19 Vaccine Using the Health Belief Model.

BACKGROUND: The coronavirus (COVID-19) pandemic profoundly impacted patient care across the United States. OBJECTIVE: To examine nursing staffs' perceptions of the COVID-19 vaccine using the Health Belief Model (HBM) as a theoretical framework. METHODS: A cross-sectional, anonymous, web-based survey was completed by practicing nursing staffs throughout the United States. Analyses involved descriptive and comparative statistics. RESULTS: Of the 294 nursing staff who completed surveys, 50% were between 18 and 37 years of age, and 73.1% were registered nurses, with 49.3% employed in a hospital setting. Nursing staff reported their primary reason for vaccination was concern for others (mean: 84.44; SD: 28.26), vaccine prevents spread (mean: 81.85; SD: 28.94), and own health (mean: 79.63; SD: 30.0). Influencing factors that predicted vaccination included age, Wilks' Λ = 0.76, F(32, 919.86) = 2.20, p < .001, η2partial = 0.066, and the vaccine mandate, Wilks' Λ = 0.63, F(8, 249) = 18.61, p < .001, η2partial = 0.374. CONCLUSION: Nursing staffs' perceptions using the HBM as a theoretical framework provided insight into their decisions to receive the COVID-19 vaccine. Further research is warranted to examine nurses' attitudes and factors that influence their decision-making regarding vaccination.