Nurses' perceptions of their knowledge and barriers to ambulating hospitalized patients in acute settings.

PURPOSE: The purpose of this study was to understand nurses' knowledge and perceptions of the importance of patient ambulation in acute care hospital settings. The data obtained from this survey will be used to create improvement initiatives that address patient ambulation. METHOD: An exploratory, cross-sectional study using a self-administered survey was conducted in two different hospital sites, and was completed by 192 nurses. A modified version of the validated and reliable tool entitled "Missed Nursing Care Survey" was used. Multivariate regressions were used to determine the relationship of demographic and workplace variables to nurses' knowledge and perceptions regarding acute adult-inpatient ambulation. RESULTS: The primary factors interfering with ambulating patients were inadequate number of staff (both clerical and nursing), urgent patient situations, and unexpected rises in patient volume and/or acuity on the unit. Small associations were found between knowledge of ambulation and years of experience, and shift worked. CONCLUSION: Study findings add to the body of knowledge by providing insight into what variables influence urban nurses' knowledge and perceptions of barriers faced when ambulating acute adult-inpatients in acute hospitalized settings. The study results can be used to develop strategies and improvement initiatives that address acute adult-inpatient ambulation in acute settings and address the perceived barriers to this process. The ultimate goal is to improve the quality of care delivered, improve patient outcomes, and promote patient well-being. Implication for nursing practice, research and education will be discussed.

Emergency department diagnosis of upper extremity deep venous thrombosis using bedside ultrasonography.

A 27-year-old man presents to the emergency department with a 1-day history of severe right upper extremity pain and swelling. The patient's status is post open reduction internal fixation for a left tibial plateau fracture, which was complicated by methicillin-sensitive Staphylococcus aureus osteomyelitis. A peripherally inserted central catheter (PICC) line was subsequently placed for intravenous antibiotic therapy. Emergency department bedside ultrasound examination of both the right axillary vein and subclavian vein near the PICC line tip revealed deep venous thrombosis of both veins. Bedside upper extremity vascular ultrasonography can assist in the rapid diagnosis of upper extremity deep venous thrombosis in the emergency department.