Thriving Through Calamity: Healthcare Worker Commitment During a Public Health Crisis.

OBJECTIVE: The study purpose was to generate theory to explain why some hospital staff chose to stay on the job during a prolonged public health crisis. BACKGROUND: The "great resignation" of 2021 created shortages across the healthcare industry. Why some healthcare staff chose to stay at work when coworkers were leaving in large numbers through retirement, transition to different careers, or perceived suddenly better clinical opportunities was not clear. METHODS: Qualitative Grounded Theory methods guided this research study. Sixteen healthcare workers participated in open-ended interviews that provided data to identify major concepts in an emerging model of commitment during crisis. RESULTS: A "Commit to Stay" model emerged showing 4 major influences including sense of personal agency, supportive organization, social connections at work, and external connections and influence. CONCLUSIONS: The Commit to Stay conceptual model can help guide nurse leaders as they grapple with supporting those who choose to stay at work in healthcare during intense, sustained healthcare crises.

The Impact of Coronavirus Disease 2019 Visitor Restrictions on the Attitudes of Emergency Department Staff.

INTRODUCTION: During the first 2 years of the pandemic, visitors for patients with COVID-19 were prohibited from emergency departments in the United States with few exceptions, leaving patients without their caregivers and advocates. Little is known about emergency nurses and nursing assistive personnel beliefs regarding this issue. Therefore, this study's purpose was to describe and assess relationships among emergency nursing and assistive personnel attitudes and perceptions regarding emergency department "no-visitor policies" for patients with COVID-19. METHODS: This institutional review board-approved observational study was conducted in a health care system in the Southwestern United States. Nursing personnel (n = 180; 21.74% response rate) working in 11 emergency departments completed the survey during the fall of 2021. Bivariate correlations and multivariable linear regression modeling were performed to explore relationships among survey questions. RESULTS: Most participants (61%) strongly/very strongly believed that restriction of visitors for patients with COVID-19 was necessary for the protection of staff and patients. In addition, 65% reported strongly/very strongly agreeing that it was unethical and 75% felt upset when these patients died alone. Most (81%) strongly/very strongly agreed that exemptions to the policy should be made in some cases, including imminent death. Respondents' recognition of patients' displeasure with visitor policy, recognition that a lack of visitors affected efficiency, and feeling upset when these patients died alone negatively predicted agreement that restriction was necessary. CONCLUSION: Although most participants favored visitation restrictions for patients with coronavirus disease 2019, their beliefs were complex. Navigating stringent visitation policies and vulnerable patients' needs can result in moral distress for ED personnel.

Impressions of Conventional Bedside Discharge Teaching Among Readmitted Heart Failure Patients.

OBJECTIVE: The purpose of this project was to report patient impressions of discharge teaching delivered by nurses among a population of heart failure (HF) inpatients. BACKGROUND: Heart failure readmissions are frequently attributed to the quality of discharge teaching delivered by nurses. METHODS: Thematic analysis, an atheoretical approach to the identification, organization, and analysis of themes in texts, was used to explore the data collected from patient interviews. RESULTS: Sixteen interviews were conducted with patients readmitted for HF on dedicated cardiac units. Six major themes were identified including: 1) recall of instructions; 2) comprehension; 3) teaching media; 4) follow-up; 5) role of caregivers; 6) mismatch between nurse and patient concerns; and 7) readmission stories. CONCLUSION: Discharge teaching could be improved by diminishing the volume of print materials distributed to HF patients, providing simple summaries of the most relevant advice, focusing on patient concerns more than the hospital agenda, and directly including home caregivers in teaching.

Relationship between sleep apnea and hospital readmission in rural and urban populations.

OBJECTIVES: The aims of this study were to evaluate geographic differences in obstructive sleep apnea (OSA) prevalence, to determine if readmissions were more likely among rural patients with OSA than others, and to model predictors, including diagnosed OSA, of 30, 60, and 90-day acute-care readmissions. DESIGN: This cohort study employed a secondary analysis of data extracted from the electronic health record shared by all hospitals in a north Texas healthcare system. SAMPLE: The sample consisted of records associated with 472,503 adult patients admitted to any of the study system's acute-care facilities from 2016 through 2019. MEASUREMENTS: Measurements consisted of case-level health information, including admissions, demographic variables, payors, diagnoses, screens, and physician orders. RESULTS: OSA was significantly related to hospital readmission when considered in isolation but did not significantly predict readmission when modeled with plausible covariates. Screening rates for OSA did not vary by geography. Differences in rural/urban-suburban OSA prevalence were not statistically significant. CONCLUSIONS: Findings contrast with previous suggestions that OSA plays an independent role in hospital readmissions or that rural resident may be disadvantaged regarding services that support the OSA diagnosis. Prevalence and screening rates were almost identical in urban and rural populations.

Women's and Nurses' Perceptions of Visitor Restrictions After Childbirth During the COVID-19 Pandemic.

OBJECTIVE: To examine the perceptions of labor and delivery (L&D) nurses and childbearing women in the postpartum period regarding a restricted visitor policy during the COVID-19 pandemic. DESIGN: Descriptive mixed-methods survey and open-ended questions. SETTING/LOCAL PROBLEM: One hospital in the southwestern United States. There is limited evidence regarding recently imposed visitor restrictions related to COVID-19. PARTICIPANTS: Individuals who were pregnant and self-identified as women who gave birth during October 2020 through March 2021 (n = 674) and L&D nurses (n = 47). INTERVENTION/MEASUREMENTS: Participants who had given birth with visitor restrictions completed an online survey, and L&D nurses completed a paper survey. RESULTS: Childbearing women had positive and negative views; they valued a more intimate familial bonding and recovery without visitors and appreciated decreased pressure to accommodate family/friends. They were also disappointed with sibling restrictions and were sad and frustrated with visitor limitations, especially in special circumstances (e.g., NICU admission or extended stays). Nurses expressed that visitor restrictions allowed more time for higher-quality nursing care/patient teaching and decreased distractions in emergencies, leading to safer care. Women and nurses reported that visitor restrictions allowed women more rest and relaxation as well as less worry and strain from juggling family and friends who wanted to visit, but they also identified that there was decreased family support when it was needed. CONCLUSION: Women's responses were mixed, with some preferring support from many visitors, while others appreciated the intimate focus of just their partner. Most nurses preferred fewer visitors but could empathize with women.

Birth, Postpartum, and Home Experiences of Individuals With Lower Extremity Nerve Injury.

OBJECTIVE: To explore birth and at-home postpartum experiences of individuals with lower extremity nerve injury (LENI) related to childbirth. DESIGN: Mixed-methods, descriptive, cross-sectional survey with open-ended questions. SETTING: Closed Facebook support group. PARTICIPANTS: Two hundred-thirty individuals who experienced LENI during childbirth. MEASUREMENTS: Two research team members developed the online LENI survey that incorporated suggestions from LENI support group leaders. We used descriptive statistics, linear regression, and Kaplan-Meier survival curves to summarize the quantitative data and used content analysis for open-ended items. RESULTS: We described labor, birth, and postpartum characteristics in our sample, including immediate and long-term LENI symptoms. Falls resulting from LENI were common in the hospital (55.6%) and at home (75.6%). At discharge home, respondents reported low confidence in their ability to care for themselves and their infants as well as high levels of dependence on others. There was an 89.6% prevalence of depression in the first month at home. Approximately 80% of participants rated their degree of healing at 5 years as 80% to 100% healed. Content analysis yielded six themes: (a) Grieving Loss of Current and Future Life; (b) Caregiver Responses That Helped or Hindered; (c) Being in Danger; (d) Experiencing Emotional Turmoil; (e) Dealing With Family, Marital, and Financial Difficulties; and (f) Finding Strength, Overcoming Obstacles, and Experiencing Personal Growth. CONCLUSION: Participants in our sample reported a very high rate of falls, anxiety, and depression at home. Nurses should recognize LENI symptoms, take action to prevent falls, and offer accurate information and referrals.

Cross-Sectional Study of Influences on Maternal Decisions Regarding Feeding Premature and Ill Neonates.

This cross-sectional study investigated the influences on feeding decisions made by mothers of infants admitted to neonatal intensive care units. The primary aims were to describe discrete influences on maternal behavior and to test Fishbein and Azjen's Theory of Planned Behavior in the neonatal intensive care unit (NICU) setting. The study included a convenience sample of 445 mothers in North Texas and Wisconsin. An investigator-designed tool was administered to subjects by research team members in the study units. Significant differences between minority and dominant racial groups emerged, which highlight known disparities in perinatal outcomes. Results supported the Theory of Planned Behavior and demonstrated predictors of exclusive breastfeeding at discharge including intention, race/ethnicity, length of stay in the NICU, and beliefs that the following factors influenced feeding decisions: having help with chores or childcare at home, talking with mothers in the NICU, having the NICU nurse help with feeding, and space for breastfeeding in the NICU. Incidental findings included the observation that mothers in the only NICU with private rooms were significantly more likely to report fatigue and to perceive that unit busyness, space, and privacy affected their feeding decisions, although there was no difference in breastfeeding at discharge between this NICU and others.

Effect of an Obstetric Hemorrhage Bundle on Clinical Outcomes and Clinician Perceptions.

OBJECTIVE: To examine the effect of an obstetric hemorrhage (OBH) safety bundle on health outcomes and to explore nurses' and physicians' perceptions of using the bundle. DESIGN: Descriptive longitudinal study, including review of electronic health records for 79,509 births, and clinician surveys. SETTING: Nine hospitals in the southwestern United States. PARTICIPANTS: 685 maternity nurses and 210 obstetricians. INTERVENTIONS/MEASUREMENTS: Retrospective and prospective data collection over 3.5 years to examine selected health outcomes before and after implementing an OBH bundle. A 10-item questionnaire was used to survey clinicians for their perceptions of bundle use. The Hospital Survey on Patient Safety Culture was used to explore nurses' views of the safety climate before and after bundle implementation. RESULTS: Statistically significant decreases in mean documented blood loss were observed with bundle use. Blood loss rates of less than 500 ml and greater than 1,000 ml increased, and blood loss rates of 500 to 1,000 ml decreased. Use of postpartum hemorrhage medications increased. When adjusted for multiple tests, there was no statistically significant difference in the rates of postpartum hysterectomies or ICU admissions or in length of stay. Clinicians' perceptions of bundle use were positive, with scores ranging from 6 to 8 on a scale of 1 to 10. However, Hospital Survey on Patient Safety Culture results indicated a decrease in nurses' perceptions of safety after bundle implementation. CONCLUSION: OBH bundles provide tools and guidance to improve perinatal care and outcomes. Our findings of lower mean blood loss, increased use of postpartum hemorrhage medications, and positive perceptions of the bundle differed from findings of previous studies. Nurses' perceptions of safety decreased, yet clinicians reported that care was safer with the OBH bundle. Nurses' commitment and collaboration are vital to the success of bundle implementation.

An Exploration of New Graduate Nurses' Transition to Specialty Practice.

New graduates' adjustment to high-acuity specialty areas was evaluated using qualitative methods in a hospital system that uses the Versant New Graduate Residency Program. Subjects were interviewed at baseline in person, answered interview questions at 6 months via computer, and were interviewed at 12 months in person. Twelve themes emerged from the interviews, reflecting intrinsic and extrinsic factors affecting new graduate nurse adjustment. Study results were used to evaluate the program and improve the program implementation.

Including Family Members in Rounds to Improve Communication in Intensive Care.

BACKGROUND: Family members frequently function as surrogate decision-makers in critical care settings. This role requires family to establish satisfactory communication with clinicians. LOCAL PROBLEM: Posthospital patient satisfaction with communication scores were lower than desired. Investigators assumed family member satisfaction with communication could influence patient satisfaction scores. METHODS/INTERVENTIONS: Including family members in multidisciplinary daily clinical rounds was implemented in a 22-bed neurointensive care unit (ICU). Family members who attended rounds were compared with those who did not. Changes in clinician time devoted to rounding were measured. RESULTS: The intervention increased time devoted to clinical rounds by 4 minutes per patient on average. Rounding dose correlated positively while depression correlated negatively with family satisfaction with communication. No harm, such as family member agitation, anxiety, or complaints, was found. CONCLUSIONS: Including family in rounding in the ICU appears safe and can improve family satisfaction with communication, but whether it influences patient satisfaction remains an open question.

The Effect of Catheter Length Placed Into the Vein on Peripheral Ultrasound-Guided Catheter Survival Time: A Prospective Observational Study.

INTRODUCTION: Establishing and maintaining peripheral intravenous access in patients with no visible or palpable veins can be arduous. Intravenous catheters placed with ultrasound do not survive as long as traditionally placed catheters. This study was performed to determine the relationship between the catheter length placed into the lumen of the vein using ultrasound and catheter survival. METHODS: This was a nonrandomized prospective observational study of admitted patients with difficult intravenous placement in 2017. Subjects had ultrasound-guided peripheral intravenous placement in the emergency department or intensive care unit. The main outcome was the time of catheter survival. Data were analyzed using descriptive statistics and Cox regression. RESULTS: A total of 98 patients with an average age of 63 years were enrolled. The total number of cases examined was 97 (N = 97), of which 29 intravenous catheters were removed for catheter-related problems (events). The mean (SD) survival time for catheters placed using ultrasound was 3,445 minutes (2,414) or 2.39 days. Peripheral catheter survival was not significantly related to the in-vein length of the catheter (X2 = 0.03, P = 0.86) nor was it significantly related to any of the covariates. DISCUSSION: The survival time of ultrasound-guided intravenous access doubled in the present study from 1674 minutes in a previous 2013 study. The results may have been due to clinician expertise and experience with the peripheral ultrasound-guided method and the use of updated equipment.

Pain Perception of a Structured Vascular Access Team Approach to Short Peripheral Catheter (SPC) Placement Compared to SPC Placement by Bedside Nurses.

This study investigates the use of a structured protocol by vascular access team (VAT) nurses compared with the practice of bedside nurses to minimize patient pain related to short peripheral catheter (SPC) insertion. During this quantitative study, 201 adults were randomly assigned to have their SPC placed either by the VAT or by bedside nurses. Results showed significantly lower pain scores with the VAT SPC placement (P = .026), and patients were significantly more likely to report the experience as better than their previous SPC placement experiences (χ = 7.8; P = .005). Therefore, the use of a VAT would be worthwhile to improve patient satisfaction.

Informing New Mothers about Newborn Screening Bloodspot Repositories during Postpartum Hospitalization.

PURPOSE: The primary goals of the study were to assess maternal knowledge and attitudes about the newborn screening bloodspot repository program in Texas and to evaluate the effect of a video about the bloodspot repository on the rate of parental permission to store infant bloodspots. DESIGN: This descriptive, comparative study used descriptive statistics, nonparametric tests, and multivariable analyses to describe the sample, compare groups, and determine associations between factors that influenced parents' decisions to permit state storage of infant bloodspots. RESULTS: There were 465 mothers in the study. Maternal knowledge about basic genetics and risks of genetic testing was poor, but mothers reported strong trust in the state to make good decisions about using genetic material for research. Race, ethnicity, and attitude toward research significantly influenced decisions to opt-in to the bloodspot storage program. Postpartum nurses provided the bulk of information about newborn screening and dried bloodspots, although 2/3 of respondents would have preferred to obtain this information prior to birth. CLINICAL IMPLICATIONS: Although postpartum nurses are the most common source of information about newborn screening, genuine informed consent for bloodspot storage is questionable. Information about newborn screening and bloodspot storage needs to be addressed in community venues prior to birth.

Perception of Caring Among Patients and Nurses.

BACKGROUND: Empirical evidence supports the contention that implementing caring nurse behaviors results in improved patient experience; however, previous studies find differences between patient and nurse perceptions of caring. SIGNIFICANCE: Good patient experience is positively related to desired clinical and financial outcomes. Nurse caring is a critical component in the patient experience. OBJECTIVE: The purposes of this project were to evaluate the congruency between nurse and patient perceptions of nurse caring in a long-term acute care hospital and to determine how much patient perception of nurse caring changes over time. METHOD: The study employed mixed methods using a triangulation strategy in which quantitative data from patients and qualitative data from nurses were collected simultaneously and compared for interpretation. RESULTS: Time affected patient perception of caring significantly. Patients and nurses disagreed about the extent to which nurses ask patients what they know about their illnesses, help them deal with bad feelings, and make them feel comfortable. CONCLUSION: Patients and nurses do not always agree about the quality of caring behaviors, but exposure to nurses over time positively affects patient perception of nurse caring.

Trial of Essential Oils to Improve Sleep for Patients in Cardiac Rehabilitation.

Objectives: The objective of this study was to determine if there was a significant difference between the sleep quality of patients who inhaled placebo and those who inhaled an aroma comprising a mixture of Lavandula x intermedia (Lavandin Super), Citrus bergamia (bergamot), and Cananga odorata (ylang ylang). Design: This was a randomized, double-blind crossover study, which compared a treatment with placebo. Settings/location: The study was conducted in an outpatient cardiac rehabilitation unit located in an urban, private nonprofit hospital in north Texas. Subjects: Participants included 42 adult patients referred to the rehabilitation service following hospitalizations by local cardiologists. Interventions: Cotton balls infused with a combination of lavender, bergamot, and ylang ylang or placebo were placed at subjects' bedsides for five nights. After a washout period, subjects crossed over to the other condition for five nights. Outcome measures: Participants completed the Pittsburgh Sleep Quality Index (PSQI) after treatment and placebo periods. Lower PSQI scores indicate better sleep quality. Results: The mean PSQI global score was statistically significantly lower when receiving the intervention oil (mean = 4.9) than the mean PSQI global score when receiving placebo (mean = 8). Duration of sleep and the time it took to fall asleep were no different between treatment groups, but patient-reported sleep quality was significantly better when participants were exposed to essential oils (χ2 = 4.5, p = 0.03) than when exposed to placebo. Although sleep efficiency (time asleep while lying in bed) was perceived as the same under both conditions, participants reported that they had to get up to use the bathroom significantly less often when exposed to the treatment than when exposed to placebo (t = -2.04, p = 0.05; Wilcoxon p = 0.05). Participants also reported that they had trouble sleeping because they felt too cold, which occurred significantly less often when exposed to the treatment than when exposed to placebo (t = -2.03, p = 0.05; Wilcoxon p = 0.05). Conclusions: Sleep quality of participants receiving intervention oils was significantly better than the sleep quality of participants receiving the placebo oil. Low-cost, nontraditional aromatherapy treatment is potentially effective for improving sleep quality among cardiac rehabilitation patients.

Predicting admissions for adult asthma exacerbations in North Texas.

OBJECTIVES: The purpose of this study was to provide a picture of asthma disparities and the contributions of social and environmental factors to asthma exacerbations in the north central region of Texas, where intense, rapid development is a feature of contemporary life. DESIGN AND SAMPLE: Cross-sectional analysis of data associated with 66 hospitals in the 8 counties containing and surrounding the Dallas/Fort Worth metropolitan area. Census blocks containing adult asthma patients admitted to emergency departments (ED) or inpatient units for asthma exacerbations in 2014. MEASURES: Data for secondary analysis were collected from the Dallas Fort Worth Hospital Council Foundation. RESULTS: Sex, family income, education, race, age of housing, speed, and traffic density on neighborhood roads affected asthma admissions. Proximity to urban drilling sites had only a small effect on admissions in this sample. Minorities were significantly more likely to obtain services in the ED than whites. CONCLUSIONS: Attributes associated with poor and underserved patients predicted asthma exacerbations in the target region. These are vulnerable patients who can ill afford further erosion of health care insurance or additional environmental insults.

Are genetics/genomics competencies essential for all clinical nurses?

In 2006, the American Nurses Association created a set of essential genetics and genomics (G/G) competencies for all RNs, regardless of academic preparation, practice setting, or specialty. However, more than half of the RNs practicing today received no prelicensure education on these G/G competencies. This study describes the current use of G/G nursing competencies in acute care hospitals and how nurses perceive them.

Evaluating the Use of High-Reliability Principles to Increase Error Event Reporting: A Retrospective Review.

OBJECTIVE: Assess the relationship between educating caregivers about high-reliability principles and reporting of potential adverse safety events. BACKGROUND: Persuading caregivers to report potential safety events is challenging. Learning high-reliability principles may help caregivers identify and report potential safety problems. METHODS: Event reports submitted by caregivers 6 months before and after high-reliability training were examined for event types, event significance, and shift when events occurred. χ Tests assessed relationships between variables. RESULTS: The number and type of caregiver event reports before and after training were not significantly different; however, clinical process error reports significantly decreased (χ = 9.251, P = .003). There was a significant difference in reports submitted by day and night shifts (χ = 5.942, P = .02). CONCLUSIONS: Trends suggest staff report actual, rather than potential, events regardless of training. Further research is needed to determine what motivates caregivers to report safety concerns.