The Effect of an Educational Intervention on Nurses' Knowledge, Perception, and Use of Nursing Presence in the Perioperative Setting.

PURPOSE: Explore the effect of a nursing presence educational intervention on nurse circulators' perceptions, knowledge, and use of nursing presence with patients undergoing surgical procedures. DESIGN: One group, pretest-posttest design. METHODS: Nursing presence is an intentional-reflective way of being with patients that was operationalized using four domains (Attention-to-Environment, Interaction Quality, Focus-of-Energy, and Active Engagement). Data collection involved observations of participants in practice and completion of surveys to examine 34 randomly selected nurse circulators' knowledge, perception, and use of nursing presence before and after participating in a nursing presence educational intervention. Dependent t tests and McNemar tests were used to examine relationships between the independent and three dependent variables - knowledge, perceptions, and use of nursing presence. FINDINGS: The educational intervention significantly enhanced participants' nursing presence knowledge, but not perceptions, which were very high at baseline. Participants' significantly increased their use of 3 of 4 nursing presence domains with the exception of the Attention-to-Environment domain, which is related to promoting a healing environment. CONCLUSIONS: Lack of attention to promoting a healing environment by the surgical team created a barrier to circulators' ability to successfully use all four nursing presence domains. Embracing nursing presence as a practice framework involves cooperation from the surgical team and a shift in perioperative environment from a chaotic to healing one.

Using a teach-back intervention significantly improves knowledge, perceptions, and satisfaction of patients with Nurses' discharge medication education.

BACKGROUND: Evidence indicates that patients desire medication information, but clinicians often fail to teach this information in an understandable way. Teach-Back promotes effective clinician-patient communication and enhances medication adherence, satisfaction with education, and hospital experiences. AIMS: This study examined effects of a nurse-led Teach-Back intervention, Teaching Important Medication Effects (TIME), compared with usual care on patients' knowledge, experiences, and satisfaction with medication education before and after discharge. The aims were to examine patients' priority learning needs, group differences in new medication knowledge before and after discharge, and post-discharge experience and satisfaction with medication instruction. METHODS: A longitudinal pretest/post-test, 2-group design was used with 107 randomly selected medical-surgical patients from an academic hospital. After receiving medication instructions, patients were interviewed before and within 72 h after discharge. Bivariate analyses were used to assess group differences in demographic and outcome variables. RESULTS: Usual care (n = 52) and TIME (n = 55) groups' characteristics were equivalent. Knowing new medication names and side effects were top learning priorities. Medication side effect knowledge was better in TIME versus usual care groups at discharge (94.3% vs. 72.5%, p = .003) and follow-up (93.9% vs.75.8%, p = .04). TIME positively influenced patients' medication education experiences; specifically, nurses always explained why a new medication was needed and its side effects. TIME was associated with patients being very satisfied with nurses' education versus usual care (97% vs. 46.9%, p < .001). LINKING EVIDENCE TO ACTION: TIME was significantly and positively associated with knowledge of new medication side effects over time and experiences and satisfaction with nurses' medication education. Teach-Back was effective in educating patients about new medications. It is an essential approach for patient education, requiring clinicians to confirm patients' retention and understanding of new information with each encounter.

Nurses' Perceptions of Barriers to Out-of-Bed Activities Among Patients Receiving Mechanical Ventilation.

BACKGROUND: Delays in early patient mobility are common in critical care areas. Oral intubation with mechanical ventilation is negatively associated with out-of-bed activities. OBJECTIVES: To explore nurses' mobility practices for patients with oral intubation and mechanical ventilation and identify barriers related to patient, nurse, and environment-of-care factors specific to this population. METHODS: In this cross-sectional, descriptive study in a medical intensive care unit, mobility was defined as standing, sitting in a chair, or walking. A total of 105 patients who met predefined mobility criteria and their 48 nurses were enrolled. Nurses were interviewed about mobility practices at the ends of shifts. Descriptive statistics summarized nurse and patient characteristics and mobility barriers. RESULTS: Patients were deemed ready to begin mobility within a mean (SD) of 41.5 (34.8) hours after oral endotracheal intubation. Two-thirds of nurses reported that they never or rarely got these patients out of bed. Only 12.4% of patients had a clinician's activity order. Common patient-related barriers were uncooperative behavior (21.9%) and active medical issues (15%), even in patients who met mobility criteria. Nurse-related barriers were concerns for patient safety, specifically falls (14.3% of patients) and harm (9.5%). The environment of care posed very few barriers; nurses rarely mentioned that lack of help (13.3% of patients) or lack of clinician's activity order (5.7%) impeded mobility. CONCLUSIONS: Mobility practices were nonexistent in these patients despite patients' being deemed ready to begin out-of-bed activities. Nurses must be attentive to their unit's mobility culture to overcome these barriers.

Comparison of Point-of-Care Testing Methods and Laboratory Analysis for Assessing Urine Specific Gravity and pH of Children Undergoing Chemotherapy.

BACKGROUND: To reduce the risk of renal toxicity, urine specific gravity (SG) and pH (potential of hydrogen) parameters should be met before nephrotoxic chemotherapeutic agents are administered. The purpose of this study was to compare laboratory urine SG and pH values with those obtained with urine point-of-care (POC) testing methods commonly used when caring for children receiving nephrotoxic chemotherapeutic agents. METHOD: A method-comparison design was used to compare the values of three POC methods for SG (dipstick, automated dipstick reader, refractometer) and three pH (dipstick, automated dipstick reader, litmus paper) methods with laboratory analysis of 86 urine samples from 43 children hospitalized on a pediatric hematology oncology unit in a large academic medical center. The Bland-Altman method was used to calculate bias and precision between POC and laboratory values. RESULTS: Except for the SG refractometer, bias values from Bland-Altman graphs demonstrated poor agreement between POC and laboratory urine SG and pH results. The precision values between these methods indicated overestimation or underestimation of hydration or urine pH status. Compared with laboratory methods, 31% of POC visual reading of dipstick SG values were falsely low-putting the patient at risk of not receiving necessary hydration and subsequent nephrotoxicity. DISCUSSION: In conclusion, most POC urine testing methods for SG and pH are not accurate compared with laboratory analysis. Because laboratory analyses can take longer than POC methods to obtain results, clinicians need to collaborate with laboratory medicine to ensure that an expedited process is in place in order to prevent chemotherapy administration delays.

Keeping Nurses Engaged in Nursing Professional Governance During the COVID-19 Pandemic:: Nursing Professional Governance Structure at Yale New Haven Hospital.

In 2020, during the COVID-19 pandemic, nursing professional governance (NPG) clinical nurse leaders at Yale New Haven Hospital developed an innovative way to engage nurses in their practice. Utilizing an electronic platform, NPG leaders established a way to harvest best practices, innovations, and resources from clinical nurses and reputable sources to share with all nurses in every practice area. Support for NPG leaders to have dedicated time for this work accelerated the process and allowed them to engage with nursing leaders to enhance communication and support clinical nurses. This work demonstrated the value of NPG during a time of crisis.

"Finding the Balance": A Qualitative Study of the Experience of Nurses and Patients with Diabetes on an Insulin Pump in the Hospital.

PURPOSE: The purpose of this study was to explore experiences of hospitalized patients as they transition insulin pump self-management from home to hospital and the experience of nurses caring for them. Patients are often more knowledgeable about the pump than their nurses, which could lead to undiscovered challenges. Little is known about the hospital experience related to insulin pump therapy from nurses' and patients' perspectives. METHODS: A qualitative approach with interpretive descriptive design and purposive sampling was used. Eligible patients were ≥18 years of age, able to read and speak English, and admitted to non-ICU settings ≥20 hours. Eligible nurses cared for at least 1 patient using an insulin pump. Patients and nurses were interviewed separately. Interviews were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative method. Coding was performed independently and jointly to reach consensus on emerging themes. RESULTS: Hospitalized patients and nurses had an array of perceptions highlighting challenges and adaption to "finding the balance" in managing diabetes when patients wore their insulin pumps. There were 4 interrelated themes representing a continuum of trust to lack of trust, control versus lack of control, effective communication to limited communication, and staff knowledge to lack of knowledge. CONCLUSIONS: Results of this study provide valuable insights into the challenges for both patients and nurses. A standardized approach to caring for this population is necessary. These findings can inform the development of nursing education programs and policies aimed at improving their experiences.

Incidence, Timing, and Factors Associated with Postoperative Nausea and Vomiting in the Ambulatory Surgery Setting.

PURPOSE: To examine incidence, timing, and factors associated with postoperative nausea and vomiting (PONV) in patients recovering in the ambulatory postanesthesia care unit (PACU). DESIGN: Descriptive correlational, cross-sectional. METHODS: Data were collected prospectively, including patient, surgery, anesthesia, and postoperative factors associated with PONV. Independent predictors of nausea were determined using logistic regression. FINDINGS: In 139 randomly selected patients, 10.8% had nausea and 2.9% vomited. On arrival to the PACU, 3 patients had nausea, which increased incrementally to 10 during the next 90 minutes, declining to 3 by 150 minutes. These patients had significantly more hydration and longer PACU stays. Fifty-three percent had nausea at discharge. Younger age and gastroesophageal reflux disease were significantly and independently associated with nausea. CONCLUSIONS: PONV is relatively infrequent, but remains a distressing problem resulting in negative surgical experiences and increased cost. Future research is warranted to examine gastroesophageal reflux disease as a novel risk factor.

Factors Associated With Timely Blood Glucose Testing and Insulin Administration in Patients Receiving Mealtime Insulin Coverage in Medical Surgical Units.

Purpose The purpose of the study was to identify the rate and factors associated with timely mealtime capillary blood glucose (CBG) testing and insulin coverage in hospitalized patients with diabetes. Methods A descriptive-correlational design was used with a random sample of patients (n = 77) and nurses (n = 36) on a medicine and a neuroscience unit of a large Magnet hospital. After written consent was obtained, post-meal patient and nurse interviews were conducted to collect information about patient, nurse, and situational factors known to influence timely mealtime diabetes care. Results Timely CBG testing occurred on 85.7% of the patient participants, and 71.4% received timely insulin coverage. Timely CBG testing was associated (unadjusted) with telling the patient care associate to obtain a finger stick (FS) prior to meals and patient off the unit during mealtime. The odds of having insulin administered on time was significantly and independently associated with the nurse caring for fewer patients, patients waiting for insulin prior to eating, and patients knowing pre-meal FS was high. Conclusions One situational factor and 2 patient factors were independently associated with timely insulin coverage prior to meals. Interventions aimed at raising staff awareness of these factors and providing tailored education to patients may improve the odds of having insulin administered on time.

An infrastructure to advance the scholarly work of staff nurses.

The traditional role of the acute care staff nurse is changing. The new norm establishes an expectation that staff nurses base their practice on best evidence. When evidence is lacking, nurses are charged with using the research process to generate and disseminate new knowledge. This article describes the critical forces behind the transformation of this role and the organizational mission, culture, and capacity required to support practice that is based on science. The vital role of senior nursing leaders, the nurse researcher, and the nursing research committee within the context of a collaborative governance structure is highlighted. Several well-known, evidence-based practice models are presented. Finally, there is a discussion of the infrastructure created by Yale-New Haven Hospital to advance the scholarly work of the nursing staff.

Cardiac rehabilitation barriers and opportunities among women with cardiovascular disease.

Cardiac rehabilitation is a key component of the comprehensive care of the 79.4 million adults in the United States with one or more forms of cardiovascular disease. Only a fraction of eligible candidates complete cardiac rehabilitation and women are at a significantly higher risk for underutilizing this safe and effective secondary prevention intervention. This article reviews the complex array of barriers to cardiac rehabilitation, with a focus on those factors that are unique to women. The Healthcare Utilization Model is used as a theoretical framework to categorize these barriers into environmental, physician, and patient level categories. These barriers, although challenging for both patients and healthcare professionals, provide opportunities for change. Actionable evidence-based recommendations for healthcare professionals include making changes in health policy, using proven performance improvement methodologies to increase referral and enrollment, using interdisciplinary models of communication, and enhancing cardiac rehabilitation program attributes reflective of women's preferences and needs.