Skin integrity preservation using a nurse-constructed silicone adhesive Foley catheter.

AIMS: Skin breakdown is common in the intensive care unit (ICU). This pilot evaluation aimed to determine whether a nurse-constructed urinary catheter securement device using a silicone adhesive could reduce the complications of blistering and other skin breakdowns in a high-risk ICU population with Foley catheters. DESIGN: A prospective, non-randomised performance improvement study using a convenience sample was carried out. SUBJECTS AND SETTING: The study sample consisted of 29 patients with urethral Foley catheters and any degree of thigh oedema in a surgical ICU at an academic quarternary medical center. METHODS: Patients were fitted with a standard acrylic-adhesive catheter securement device on one thigh and a nurse-constructed device on the contralateral thigh. At the beginning of each 12-hour shift, the nurse moved the Foley catheter from one securement device to the other; the nurse recorded the assessment findings at the end of the shift. RESULTS: The average age of the 29 patients was 61±16 (range 20-87) years. Visible skin compromise occurred in 21% of the time with the standard acrylic securement device; an equal percentage of men and women developed skin breakdown. Oedema status was a significant factor related to skin breakdown. There was no visible damage to the skin associated with the nurse-constructed silicone-adhesive device. CONCLUSIONS: A silicone adhesive urinary catheter securement device causes less skin damage than one with acrylic adhesive. One-step application, pain-free and atraumatic removal, and reliable securement are essential considerations in product development.

Pneumococcal Vaccination Practices in Patients With Multiple Sclerosis Receiving Anti-CD20 Monoclonal Antibodies After Pharmacy and Nursing Collaboration.

BACKGROUND: It is recommended that patients taking immunosuppressive anti-CD20 monoclonal antibodies (mAbs) receive pneumococcal vaccinations before their first dose to ensure optimal immune response. An initial medication use evaluation reviewed adherence to Centers for Disease Control and Prevention (CDC) pneumococcal immunization recommendations at the study site, and room for improvement was identified. The nursing team implemented workflow changes to increase nursing involvement in vaccination coordination, education, tracking, and administration. We sought to evaluate the impact of a nursing intervention on optimal pneumococcal vaccination administration rates in patients receiving anti-CD20 mAbs at a multiple sclerosis (MS) center. METHODS: We performed a single-center, retrospective, pre/post medication use evaluation. Inclusion criteria were older than 18 years with a diagnosis of MS and received their first anti-CD20 mAb infusion at the study site during the preintervention or postintervention time frame. RESULTS: We included 406 and 73 patients in the preintervention and postintervention studies, respectively. The nursing intervention significantly improved the percentage of patients receiving optimal pneumococcal vaccination before their first infusion from 58% to 84% and significantly reduced the number with unknown vaccination status from 17% to 3%. Patients who received optimal follow-up vaccination with 23-valent pneumococcal polysaccharide vaccine after optimal 13-valent pneumococcal conjugate vaccine administration improved from 9% to 56%. CONCLUSIONS: A nursing team intervention improved adherence to CDC pneumococcal immunization recommendations for patients receiving anti-CD20 mAb therapy. This project highlights the value of interdisciplinary team collaboration between health system specialty pharmacies and specialized nursing teams in the care of patients with MS.

Use of Diaries for Family Members of Intensive Care Unit Patients to Reduce Long-Term PTSD: A Pilot Study.

Many family members whose loved ones stay in the intensive care unit (ICU) have post-traumatic stress disorder (PTSD) after the hospitalization. A mixed-methods longitudinal randomized trial studying family members of medical ICU (MICU) patients was conducted. Participants were randomized into 2 groups (intervention and control). Post-traumatic stress symptoms checklist-14 scores for the intervention group trended downward over time, but no differences were detected in PTSD risk between the intervention and control groups. The ICU experience for family members is traumatizing. A simple gesture of providing ICU diaries for them to use during the ICU stay may help reduce their emotional burden and requires further investigation.

Mindfulness for Outpatient Oncology Nurses: A Pilot Study.

This prospective pre-/posttest pilot studied a mindfulness-based stress reduction (MBSR) intervention first, to reduce self-reported stress and improve compassion satisfaction; and second, to reduce physiological indices of stress. Even small interventions of MBSR before a shift effectively reduces the physiological indices of stress and may help reduce compassion fatigue and burnout in nurses.

Certification Circle: A Peer Support Model to Increase Certification Among Medical-Surgical Inpatient Nurses.

Professional certifications for nurses lead to improved patient satisfaction, fewer adverse events, and reduced nurse turnover rates. This study describes an initiative to increase professional certification at the medical-surgical service of an academic medical center. The solid organ transplant unit had a certification rate of 2%. Three registered nurses developed Certification Circle, which focused on the process of earning certification rather than a traditional knowledge-based review course, to increase the number of certified nurses on the unit. Clinical nurses conducted a prospective pilot study that used a pre-/posttest study design with convenience sampling for medical-surgical nurses. Participants were evaluated on their knowledge and confidence in taking the certification examination. Seven nurses earned certification, increasing the rate of certified nurses from one certified nurse to eight, a rate increase of 700%. Although the sample size was small, the dramatic increase in the certification rate shows that this initiative was a success. [J Contin Educ Nurs. 2021;52(10):468-470.].

Hospital-Based Research Internship for Nurses: The Value of Academic Librarians as Cofaculty.

With so few nurse scientists, it is important to increase the research activities of nurses. A nurse scientist and a librarian investigated if increasing library skills in a hospital-based research internship increases nurses' scholarship. Library-related content was added throughout the internship; interns were surveyed to measure specific skills. All interns improved their skills and valued librarians. Most interns conducted literature searches and utilized library resources. Research internships increased nurses' capacity for library-related skills.

Essential Oils to Reduce Postoperative Nausea and Vomiting.

PURPOSE: The purpose of this study was to determine if using essential oil products for adult patients reduced the need for antiemetics for postoperative nausea and vomiting (PONV). DESIGN: A prospective and retrospective cross-sectional design using a convenience sample. METHODS: Double blinded to the type of essential oil, subjects randomly selected a nasal inhaler containing peppermint, ginger, or a combination of both. A prophylactic dose was given preoperatively, and during the postoperative period nausea was assessed using verbal descriptive scale. FINDINGS: Overall 322 same day surgical patients were analyzed (control group [n = 179] and intervention group [n = 143]). The intervention group had a greater history of PONV but received fewer doses of antiemetics postoperatively compared with the control group. There was no significant difference in the effectiveness of the three types of inhalers. CONCLUSIONS: Aromatherapy demonstrated a statistically significant (P < .05) reduction in the need for antiemetics to treat PONV.

Patients' Perception of Stressful Events in the Intensive Care Unit After Cardiac Surgery.

BACKGROUND: Subjecting patients to stress has potentially detrimental effects on their physical and psychological recovery. OBJECTIVE: To identify stress-generating experiences that occur in an intensive care unit for patients after cardiac surgery. METHODS: A sample of 16 patients in a 14-bed cardiovascular intensive care unit at a university hospital in upstate New York completed a questionnaire (based on an established survey) asking them to rate 23 experiences on a Likert scale of 0 to 4. All patients were adults and had undergone coronary artery bypass graft surgery. After surgery, they were extubated and completed the questionnaire within 12 to 24 hours. RESULTS: Patients reported pain to be the most stressful experience, followed by presence of an endotracheal tube and sleeplessness. CONCLUSIONS: With pain, endotracheal intubation, and sleeplessness identified as highly distressing to patients, further research can be done to elicit interventions that could alleviate some of the stress involved with a postoperative stay in an intensive care unit.

A Quiet Firehouse: Reducing Environmental Stimuli Among Professional On-Duty Firefighters.

OBJECTIVE: Firehouse alarms are so loud that they cause a systemic response, similar to the flight-or-flight response. The purpose of the study was to reduce firehouse environmental stimuli to improve sleep quality and, thus, reduce cardiac burden. METHODS: The intervention included restricted unnecessary fire alarms, reduced light levels, and regulated temperature in the bunkroom. RESULTS: Among 24 firefighters, 11 completed the matched post-assessment. Six weeks after implementing the interventions, measures revealed the average lux level dropped from 0.75 to 0.19 lux, P < 0.05, and the presence of elevated blood pressure reduced from 86% to 15%, P < 0.05. CONCLUSION: Results support that reducing environmental stimuli in firehouses reduces blood pressure, which is much easier than targeting behavior change. RECOMMENDATIONS: On the basis of this pilot study, the practice of routinely activating unnecessary fire alarms in firehouse bunkrooms should be discouraged.