Esther Chipps

Workplace bullying in the OR: Results of a descriptive study.

This study describes the incidence of workplace bullying among perioperative RNs, surgical technologists, and unlicensed perioperative personnel in two academic medical centers. The study sought to determine whether the demographic variables of gender, ethnicity, hospital, years of experience on the unit, years in the profession, and job title predict the experience of workplace bullying; whether a relationship exists between workplace bullying and emotional exhaustion; and whether bullying is associated with perceptions of patient safety in the OR. The cross-sectional design included perioperative nurses, surgical technologists, and unlicensed perioperative personnel (N = 167). Fifty-nine percent of the study participants reported witnessing coworker bullying weekly, and 34% reported at least two bullying acts weekly. Having ones opinion ignored is the most common bullying act, with 28% of respondents experiencing being ignored. Differences in the experience of bullying can be found between hospitals and among ethnicities. Emotional exhaustion also was correlated with bullying. The participants did not perceive bullying as affecting patient safety.

Registered nurses' judgments of the classification and risk level of patient care errors.

As frontline clinicians, nurses play a critical role in mitigating patient harm, recovery from health care errors, and overall improvement of patient safety. This cross-sectional study asked nurse respondents to make judgments about the classification and severity of errors in 4 clinical vignettes. Our results showed that agreement about error classification and associated risk among registered nurses is less than optimal. Further research is needed to advance our understanding of how nurses working in complex patient care situations can improve their ability to recognize subtle cues to facilitate early recognition of potential errors.

The Burden of Disease in Those With Serious Mental and Physical Illnesses

BACKGROUND: Clients with severe mental illness are known to have higher morbidity than the general population, but little is known about their perception of disease burden. OBJECTIVE: This study examined the disease burden in a cohort of community-dwelling persons diagnosed with severe mental illness. STUDY DESIGN: This was a descriptive study that included: interviews, measures of blood pressure, height and weight, and chart audits from 109 volunteers. RESULTS: Mean scores on the Medical Outcomes Study Short Form–12 (MOS SF-12) were compared by gender and five chronic illnesses. The participants had lower scores on the physical (PCS) and mental (MCS) health components of the MOS SF-12 than the general population. Participants with depression, hypertension, arthritis, diabetes, and chronic lung disease scored lower than the general population on the PCS and MCS. CONCLUSION: This study suggests that clients with severe mental illness and physical health problems experience a greater disease burden than do their counterparts in the general population.

Impact of the implementation of an alcohol withdrawal guideline on patients with burn injuries.

Purpose: The purpose of this study was to determine the impact of implementation of evidence-based alcohol withdrawal syndrome (AWS) guideline using the Clinical Institute Withdrawal Assessment of Alcohol Scale-Revised scale on care and outcomes of burn patients with comorbid alcohol use and on physician and nurse documentation of alcohol screening, education, and referral. Design: A retrospective medical record review of burn patients (n = 428) was completed. Data were collected on admissions 1 year before implementation of the alcohol withdrawal guideline and 1 year after implementation. Data collection included alcohol use, use of benzodiazepines, sitter use, restraint use, total body surface area, inhalation injury, previous alcohol withdrawal, length of stay, and physician and nurse documentation. Setting: A Midwestern academic medical center with an American Burn Association and the American College of Surgeons verified burn center. Methods: A multidisciplinary team developed evidence-based practice guidelines for the treatment of AWS. Treatment of AWS was evaluated before and after implementation of the new guidelines. Results: Burn severity and inhalation injury were associated with patients at risk for alcohol abuse. There was no difference in the experience of alcohol withdrawal after guideline implementation. Documentation in the medical record of alcohol use, abuse, or previous withdrawal improved after implementation of the guideline. Conclusion: Screening and treatment of alcohol abuse in the burn patient are still less than ideal. Implications: Greater efforts should be directed at managing alcohol withdrawal. An advance practice nurse can make an important contribution.

Outcomes of an Oral Care Protocol in Postmechanically Ventilated Patients

BACKGROUND Oral care is standard practice to prevent hospital-associated infections while patients are intubated and in the intensive care unit. Following extubation and transfer, infections remain an important risk for patients, but less attention is paid to oral care. Few studies have assessed the impact of oral care in recently extubated acutely ill patients. AIMS To develop an evidence-based oral care protocol for hospitalized patients and determine the impact of this protocol on health outcomes in recently extubated patients. METHODS In this randomized controlled trial, subjects were randomized to usual care or an intervention protocol that included tooth brushing, tongue scraping, flossing, mouth rinsing, and lip care. Major outcome measures were the revised THROAT (R-THROAT; oral cavity assessment) and overall prevalence of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus on oral cultures. RESULTS Seventy-four subjects were randomized. As measured by the R-THROAT, oral cavity health improved over time in both groups, but the intervention group demonstrated significantly more improvement than the control group (R-THROAT score improved by 1.97 intervention vs. 0.87 control; p = .04). Two categories, tongue and mouth comfort, demonstrated the most significant improvement. There was no difference in MSSA/MRSA colonization between the groups at the conclusion of the study. Overall, subjects in the intervention group were more satisfied with their protocol than subjects in the usual care group. LINKING EVIDENCE TO ACTION This study offers an important evaluation of an oral care protocol after extubation. Results demonstrated improvement in the oral cavity assessment with the designed oral care protocol. Patients expressed a preference for the intervention protocol, which included a battery-operated toothbrush, higher-quality toothpaste and mouth rinse, tongue scraper, floss, and lip balm. The implementation of an oral care protocol specifically addressing patients in the immediate postintubation is essential.

Exploring Nurses' Perception of Dynamic Patient Events.

OBJECTIVE: The study aim was to describe nurses’ perceptions of dynamic patient events (DPEs) impact on workflow and patient care. BACKGROUND: The process of determining optimal nurse staffing has challenged nurse leaders for decades. METHODS: This study took place on 3 inpatient units in 3 hospitals at a large academic medical center. A qualitative design that included focus groups composed of RNs with a minimum of 1-year experience was used. RESULTS: The most commonly identified DPEs were patient travel, code blues, rapid emergency response events, and requirement for an unplanned 1-on-1 sitter. The impact of DPEs influences the nurse’s perception on job satisfaction, workflow, patient’s safety/satisfaction, and delayed/missed care. CONCLUSION: It is incumbent upon nursing leaders to understand DPEs and anticipate how these events impact nursing workload, staffing, and care delivery.

Examining the Roles and Competencies of Nurse Leaders, Educators, and Clinicians With a Doctor of Nursing Practice at an Academic Medical Center

Background: As the nursing profession has gained experience with Doctor of Nursing Practice (DNP) graduates, it is important to examine the integration, operationalization, and contributions of the DNP-prepared nurse within healthcare systems. Administrators and leaders must have a clear vision of how DNP graduates will contribute within and outside of their organizations. Objectives: This article describes the outcomes of a workgroup comprised of DNP-prepared staff at a large academic medical center. The overarching goal of this group was to examine current practices of our DNP-prepared staff and make recommendations regarding roles and practice to the senior nursing leadership. Methods:A crosswalk comparing the current job descriptions of our DNP-prepared nurse leaders, nurse practitioners, clinical nurse specialists, and nurse educators with the core competencies of The Essentials of Doctoral Education for Advanced Nursing Practice as outlined by the American Association of Colleges of Nursing was completed. Results: Strategies and tactics to enrich current practice and build leadership capacity were identified. Conclusions: DNP-prepared nurses must continue to document their contributions to the healthcare setting. Implications for Nursing: DNP-prepared nurses in the health-care setting must work collaboratively with their senior nursing leaders to seek opportunities to increase their visibility within their organizations, and increase their scholarly output.

Subjective and Objective Estimation of Physical Activities on the Lower Extremities for Inpatient Staff Nurses and Their Lower Extremity Musculoskeletal Discomfort

Registered nurses have a higher incidence rate of work-related musculoskeletal disorders (MSDs) compared with the overall rate for MSDs in the U.S. Attention has been on back pain in nurses, but the lower extremities are also a frequent site of discomfort in nurses, though only a few studies have reported on this problem, investigations of risk factors are limited, and reports of successful interventions are primarily anecdotal. Studies in other populations have identified prolonged time on one’s feet as a risk factor for various lower extremity problems. This study aims to determine the prevalence of hospital inpatient staff nurses’ lower extremity discomfort and to subjectively and objectively quantify lower extremity physical activities exposure during work, specifically walking, standing, and sitting, and examine any interaction with type of unit or shift, in order to begin to describe the physical loading of the lower extremities in this type of nursing work.

Demystifying nursing Research at the Bedside

NURSING RESEARCH IS NO LONGER solely the purview of nursing faculty in academia. Inquiry and science are fundamental to raising the bar in nursing practice, improving the patient experience, and enhancing patient outcomes. Acute care hospital environments provide excellent settings for clinical nurs

A Pilot Study of Responses to Suctioning Among Neonates on Bubble Nasal Continuous Positive Airway Pressure

Background: Maintenance of a patent airway while the neonate is on nasal continuous positive airway pressure (nasal CPAP) requires vigilant monitoring and oral/nasopharyngeal suctioning. Currently, no evidence-based guidelines for safe suctioning in neonates while on bubble nasal CPAP have been published. Purpose: (1) To characterize the clinical and behavioral responses of neonates on bubble nasal CPAP in a level III neonatal intensive care unit following routine oral and nasopharyngeal suctioning. Methods: This pilot study has a 1-sample within-subject repeated-measures design in which neonates (N = 16) served as their own control. Data on a neonates physiological and behavior measures (heart rate, respiratory rate, oxygen saturation [SaO2], and Premature Infant Pain Profile [PIPP] score) were collected before, during, and after the completion of suctioning sequence. Finding/Results: A total of 16 neonates with a mean gestational age of 29.76 weeks and an average day of life of 3.4 were enrolled. The infants heart rates did not differ significantly (P = .51) across the suctioning sequence. There were no statistical significant changes in the average respiratory rate across the suctioning sequences (P = .79). SaO2 demonstrated a drop between baseline and after each suctioning (P < .001). The PIPP score demonstrated a precipitous increase throughout the procedure (P < .001). On average, it took 9.5 seconds (SD = 4.9) to complete the suctioning sequences. Implications for Practice: Our results suggest that the guideline tested is safe and tolerated by infants. Implications for Research: This guideline should be tested in a larger sample and with neonates on other nasal CPAP systems.