RESUMO
OBJECTIVES: To develop a system-based intervention including five components that target barriers to nurse-initiated patient ambulation. DESIGN: Pilot study of Mobilizing Older adult patients VIa a Nurse-driven intervention (MOVIN). SETTING: Twenty-six bed general medical unit. PARTICIPANTS: Nursing staff (registered nurses and certified nursing assistants) were recruited to participate in focus groups. MEASUREMENTS: Information on frequency and distance patients ambulated and nursing staff documentation of patient ambulation were retrieved from the electronic medical record. Regression discontinuity analysis was used to determine a difference between the preintervention and intervention periods in ambulation occurrence, ambulation distance, and percentage of numeric documentation of ambulation. Thematic analysis was used to analyze focus group interviews. RESULTS: A statistically significant increase in number of occurrences (t = 4.18, P = .001) and total distance (t = 2.75, P = .01) and a significantly higher positive slope in percentage of numeric documentation was found during the intervention than before the intervention. Thematic analysis identified three central categories (shifting ownership, feeling supported, making ambulation visible) that describe the effect of MOVIN on nursing staff behaviors and perceptions of the intervention. CONCLUSION: Decreasing loss of independent ambulation in hospitalized older adults requires new and innovative approaches to addressing barriers that prevent nurse-initiated patient ambulation. MOVIN is a promising system-based intervention to promoting patient ambulation and improving outcomes for hospitalized older adults.
Assuntos
Deambulação Precoce , Enfermagem Geriátrica/métodos , Limitação da Mobilidade , Caminhada , Atividades Cotidianas , Idoso , Atitude do Pessoal de Saúde , Deambulação Precoce/métodos , Deambulação Precoce/enfermagem , Deambulação Precoce/psicologia , Educação , Feminino , Grupos Focais , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem Hospitalar/psicologia , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Projetos Piloto , Melhoria de Qualidade , Caminhada/fisiologia , Caminhada/psicologiaRESUMO
A collaborative process that included geriatric assessments and audits was utilized to develop geriatric nursing competencies that were evidence based, relevant to the specific needs of the older adults cared for at a facility, and inclusive of appropriate resources for any staff nurse caring for an older adult anywhere in the hospital. This method of competency development could be utilized in the development of other population-specific nursing competencies.
Assuntos
Competência Clínica/normas , Avaliação Geriátrica , Enfermagem Geriátrica/educação , Adulto , Idoso , Educação Continuada em Enfermagem , Enfermagem Baseada em Evidências , Humanos , Desenvolvimento de Programas , Desenvolvimento de PessoalRESUMO
An interdisciplinary clinical improvement workgroup was formed at this academic medical center with the goal of reducing catheter-associated urinary tract infections (CAUTIs). In 2011, the CAUTI rate was noted to be 4.7 CAUTIs per 1000 catheter days. Rounding by 2 lead clinical nurse specialists revealed deficiencies in current practice, which were addressed with multifaceted strategies, including evidence-based indwelling urinary catheter and bladder management protocols, education of staff, reporting of data, and utilization of an icon in the electronic health record (EHR). After the implementation of these strategies, the CAUTI rate decreased and was noted to be 2.4 in February 2013. In addition to this, there was a downward trend line for catheter days.