RESUMO
PURPOSE/OBJECTIVES: The aim of the project was to discern whether a collaborative, consultative-rich, clinical nurse specialist-led project could increase completion rates of a patient health questionnaire for depression and a generalized anxiety disorder questionnaire with appropriate referrals in adult patients in the ambulatory and hospital settings of a robust cardiovascular surgery practice before cardiovascular surgery. DESCRIPTION OF PROJECT: The Define, Measure, Analyze, Improve, Control implementation methodology guided this quality improvement project. The workflow was analyzed in collaboration with stakeholders, and barriers to and facilitators of questionnaire completion were identified. Interpreter services partnerships were enhanced and used for patients with a preferred language other than English. Weekly data analysis assessed ongoing questionnaire completion rates. OUTCOME: Documented completion rates of questionnaires improved across ambulatory and hospital settings by 15%. Patients with a preferred language other than English had an 80-percentage-point increase in documented questionnaire completion. CONCLUSION: Clinical nurse specialists are poised to lead projects because of their use of the collaborative and consultative core competencies. A formal electronic health record report was established for monitoring outcomes. Embedding questionnaire administration within the standard workflow of ambulatory and hospital staff makes administering questionnaires preoperatively a sustainable practice in both settings.
Assuntos
Enfermeiros Clínicos , Adulto , Humanos , Enfermeiros Clínicos/psicologia , Liderança , Saúde Mental , Inquéritos e QuestionáriosRESUMO
A screening tool utilized by nurses at a critical point in the discharge planning process has the potential to improve caregiver decisions and enhance communication. The Early Screen for Discharge Planning-Child version (ESDP-C) identifies pediatric patients early in their hospital stay who will benefit from early engagement of a discharge planner. This study used a quasi-experimental, non-equivalent comparison group design to evaluate the impact of the ESDP-C on important outcomes related to discharge planning. Findings from the study provide preliminary evidence that the integration of the ESDP-C into the pediatric discharge planning process may be clinically useful.
Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Técnicas de Apoio para a Decisão , Alta do Paciente/tendências , Readmissão do Paciente/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos , Humanos , Tempo de Internação , Masculino , Seleção de Pacientes , Estudos Prospectivos , Melhoria de Qualidade , Medição de Risco , Fatores Sexuais , Fatores de TempoAssuntos
Anticoagulantes/uso terapêutico , Hidrocarboneto de Aril Hidroxilases/genética , Testes Genéticos , Oxigenases de Função Mista/genética , Varfarina/uso terapêutico , Anticoagulantes/efeitos adversos , Citocromo P-450 CYP2C9 , Relação Dose-Resposta a Droga , Predisposição Genética para Doença , Humanos , Vitamina K Epóxido Redutases , Varfarina/efeitos adversosRESUMO
BACKGROUND: Postoperative pain and anxiety are common in cardiac surgery patients. Studies have suggested that music can decrease anxiety in hospitalized patients. Primary Study Objective This study focused on the efficacy and feasibility of special music, which included nature sounds, for pain and anxiety. METHODS/DESIGN: In this randomized controlled trial, postoperative cardiovascular surgery patients were randomly assigned to a music group to receive 20 minutes of standard postoperative care and music twice daily on postoperative days 2 through 4 or to a control group to receive 20 minutes of standard care with a quiet resting period twice daily on postoperative days 2 through 4. SETTING: Cardiovascular surgical unit of Saint Marys Hospital, Rochester, Minnesota. PARTICIPANTS: One hundred patients completed the study (music group, n = 49; control group, n = 51). Intervention The music was delivered through CD players in the patients' rooms. PRIMARY OUTCOME MEASURES: Pain, anxiety, satisfaction, and relaxation were evaluated from visual analog scales. RESULTS: Data showed a significant decrease in mean (SD) pain scores after the second session of day 2 for the music group (change, ?1.4 [1.4]) compared with the control group (change, ?0.4 [1.4]) (P = .001). Mean relaxation scores improved more at the first session of day 2 for the music group (change, 1.9 [2.7]) compared with the control group (change, 0.3 [2.9]) (P = .03). The music group also showed lower anxiety and increased satisfaction overall, but these differences were not statistically significant. No major barriers to using the therapy were identified. CONCLUSION: Recorded music and nature sounds can be integrated into the postoperative care of cardiovascular surgery patients. The recordings may provide an additional means for addressing common symptoms of pain and anxiety while providing a means of relaxation for these patients.
Assuntos
Ansiedade/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/reabilitação , Musicoterapia/métodos , Natureza , Dor/prevenção & controle , Cuidados Pós-Operatórios/métodos , Adaptação Psicológica , Adulto , Idoso , Análise de Variância , Ansiedade/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor/métodos , Satisfação Pessoal , Período Pós-Operatório , Som , Estresse Psicológico/prevenção & controle , Resultado do TratamentoRESUMO
Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Cardiac surgery patients undergo long procedures and commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects of massage therapy for alleviation of pain, tension, and anxiety, we studied the efficacy and feasibility of massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study (massage, n=62; control, n=51). Patients receiving massage therapy had significantly decreased pain, anxiety, and tension. Patients were highly satisfied with the intervention, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important component of the healing experience for patients after cardiovascular surgery.