Cynthia Padula

Group Cohesion and Nurse Satisfaction: Examination of a Team-building Approach

Objectives The purpose of this study was to determine the impact of a team-building intervention on group cohesion, nurse satisfaction, and turnover rates. Background Creating an environment that supports and retains nurses represents a formidable challenge for nursing leaders. Research related to strategies that positively impact the culture in which nurses practice, thus potentially improving nurse satisfaction and reducing turnover, is critically needed. Methods Registered nurses (RNs) employed on inpatient units in a 247-bed, private acute care Magnet teaching hospital participated in this quasi experimental preintervention and postintervention design. The RN-RN interaction subscale from the National Database of Nursing Quality Indicators Adapted Index of Work Satisfaction, the National Database of Nursing Quality Indicators Adapted Index of Job Enjoyment, the Group Cohesion Scale, and a facilitator-developed measure were completed preimplementation and postimplementation of unit-tailored intervention strategies, which took place over a 12-month period. Turnover rates were collected 6 month preintervention and postinter-vention. Results Improvement in group cohesion, RN-RN interaction, job enjoyment, and turnover was demonstrated. Conclusion Targeted, unit-based strategies can be an effective means of reducing turnover rates and improving group cohesion and nurse satisfaction.

Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults.

The purpose of the study was to determine the impact of a nurse-driven mobility protocol on functional decline. A nonequivalent control group design was used; the independent variable was mobility protocol and dependent variables were functional status and length of stay. Older adults who participated in a mobility protocol maintained or improved functional status and had a reduced length of stay. Practice implications include an emphasis on ambulation in hospitalized older adults.

Lessons learned from a lateral violence and team-building intervention.

BackgroundLateral violence is likely to exist in settings characterized by poor leadership and lack of clearly articulated roles, expectations, and processes that guide behavior. ObjectivesThe purposes of this process improvement project were to (1) identify and improve baseline levels of nurse satisfaction and group cohesion through planned unit-based interventions, (2) determine the effect of a team-building intervention on factors that impact cohesive team functioning, and (3) determine the effect of lateral violence training and communication style differences in improving team cohesion. MethodsThe sample consisted of registered nurses (RNs) from 4 diverse patient care areas, chosen on the basis of low scores on the National Database of Nursing Quality Indicators (NDNQI) RN-RN interaction subscale. A quasi-experimental pre–post intervention design without a control group was employed. The intervention focused on lateral violence and team building. A qualitative component focused on the impact of the intervention on overall group dynamics and processes. ResultsRN scores on the Group Cohesion Scale (P = .037) and the RN-RN interaction scores improved postintervention. Group sessions focused on building trust, identifying and clarifying roles, engaging staff in decision making, role-modeling positive interactions, and holding each other accountable. ConclusionsKey to a cohesive environment is an effective nurse manager able to drive and sustain change.

Prevention and Early Detection of Pressure Ulcers in Patients Undergoing Cardiac Surgery

Absence of pressure ulcers is increasingly being used as an indicator of quality nursing care, based on the premise that pressure ulcers are preventable. This retrospective study examined the occurrence, presentation, and timing of pressure ulcer development in 150 patients undergoing cardiac surgery. Pressure ulcer incidents were recorded in groups of patients who underwent surgery with use of a standard foam OR bed mattress; use of a fluid, pressure-reducing OR bed mattress; or use of a fluid, pressuring-reducing mattress after a comprehensive educational program on pressure ulcer prevention was presented to RNs. Tcers decreased when the fluid, pressure-reducing OR bed mattresses were used in conjunction with the comprehensive RN education program.

A breast navigator program: barriers, enhancers, and nursing interventions.

PURPOSE/OBJECTIVES to identify barriers to and enhancers of completion of breast cancer treatment from the perspective of participants in a breast health navigator program. RESEARCH APPROACH qualitative, using focus group methodology and telephone interview. SETTING two teaching hospital ambulatory cancer centers. PARTICIPANTS women enrolled in the breast navigator program, including patients who completed (n = 13) and did not complete (n = 1) breast cancer treatment. METHODOLOGIC APPROACH researchers used semistructured, open-ended questioning to guide the interviews and elicit identification of barriers to and enhancers of treatment. A flexible approach was used and the interviews were recorded. Content analysis was used to identify themes. MAIN RESEARCH VARIABLES perceived barriers and enhancers of breast cancer treatment. FINDINGS the most common theme was the value of the education and information received from the navigator. Several participants saw this as the essence of the role. Assistance with managing symptoms, access to financial and community resources, and the team approach were completion enhancers. CONCLUSIONS completion of breast cancer therapy and care can be improved by recognizing the value the nurse navigator role brings to the patient experience and enhancing that role. INTERPRETATION the intentional presence of the oncology nurse and the nursing emphasis on culturally appropriate education and care can be seen as key competencies of the navigator. As the concept of the navigation process is expanded to other cancers, oncology nurses are particularly well positioned to advocate for the navigator role as a nursing domain.

Prevention and Early Detection of Pressure Ulcers in Hospitalized Patients

Skin integrity is identified as a measure of nursing care quality, yet pressure ulcers (PU) are a major health problem. Increasingly, patients admitted to acute care hospitals are older and possess multiple risk factors for PU development. The primary goal of this quality improvement project was to improve PU prevention and management. A secondary goal was to improve nursing documentation of PU prevention and intervention strategies. A preintervention, intervention, postintervention design was employed; the intervention included formal and informal education. Data were collected in 2 phases; Phase I occurred in a critical care unit and Phase II occurred on a medical-surgical unit. Demographics, PU incidence, risk factors, and comorbidity data were collected, along with nursing specific data. The results of this quality improvement project suggest that educational programs improve nursing care and documentation, and they raise additional questions regarding the concept of “avoidable versus unavoidable” PU in high-risk populations. ■ Background

Effectiveness of 2 methods of chlorhexidine bathing.

The purposes of this study were to examine the impact of chlorhexidine on the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on an inpatient oncology unit, compare the cost of 2 chlorhexidine bath delivery methods, and evaluate nursing time and satisfaction to administer the baths. MRSA and VRE transmission rates decreased from those during the previous years. Costs associated with bathing increased, but time to administer the bath decreased with the chlorhexidine cloths, and nursing staff reported satisfaction with their use.

An evidence-based oral care protocol to decrease ventilator-associated pneumonia.

The purpose of this study was to examine the impact of 0.12% chlorhexidine rinses and an oral care protocol on ventilator-associated pneumonia rates. A quasi-experimental preintervention-postintervention design was used. The sample included all patients admitted to critical care and on mechanical ventilation at any time during the study period. Data were collected 6 months before and 12 months after intervention. Ventilator-associated pneumonia rates were reduced from 4.3 to 1.86 per 1000 ventilator-days during the study period, with an estimated cost avoidance of

Destination bedside: using research findings to visualize optimal unit layouts and health information technology in support of bedside care.

700 000 to

Impact of Lower Extremity Strengthening Exercises and Mobility on Fall Rates in Hospitalized Adults

798 000.