Esther Lee

Magnet Journey: A Quality Improvement Project—Implementation of Family Visitation in the PACU

PURPOSE Over the years, patient- and family-centered care has been a focus of many researchers in the postanesthesia care unit (PACU) setting. Despite evidence pointing to the benefits and positive outcomes of partnering with family in patient care in pediatric and adult PACUs, this practice has not gained popularity in the adult PACUs of many hospitals. The purpose of this project was to test and validate the benefits of including families as partners in care in the PACU. DESIGN A pre/post exploratory design using survey methodology was used. METHODS Survey questionnaires were administered to patients, family, and nursing staff before and after the implementation of a patient visitation program. FINDINGS Patient and family satisfaction increased after implementation of the family visitation program. Nursing satisfaction with and openness to family visitation also increased. CONCLUSIONS Results provide the evidence base to implement an open visitation policy that has been made permanent as a standard of care practiced in all the PACU sites throughout the health system.

An Educational Plan for Nursing Staff in the Procedural Treatment Unit of the Sulpizio Cardiovascular Center

Professional education for health practitioners is a continuum which commences with the first year professional school until the cessation of a professional career. This article draws on the theories and models developed by experts in curriculum design, teaching, and learning evaluation to better understand the intricacies and challenges of instructional design. Selected models, in particular Malcolm Knowles and the World Health Organization report served as a compass and benchmark to illuminate, guide, and evaluate the impact, process, contents, and outcomes of an educational program for the stakeholders. The aim of this educational program is to ensure that learners develop the knowledge, skills, and attitudes to deliver competent and quality patient-centered care. Multimodal teaching strategies are essential to meet the diverse needs of staff. Utilization of technology such as intranet and mobile applications helps to deliver educational content in a cost-effective manner. Program evaluation determines the effectiveness of teaching and helps to define ongoing needs of staff.

The Arduous and Challenging Journey of Improving Patient Safety and Quality of Care

The 20th century has seen dramatic improvements in quality, efficiency, and productivity of the industrial, manufacturing, and selected service sectors through the redesign of the management and production processes. Moreover, the health care sector, plagued by overuse, underuse, and misuse of care remained a laggard in adopting needed changes to improve quality, effectiveness, and delivery. The change agent may have been the 2001 report by the Institute of Medicine, which shocked the collective conscience of the industry with the revelation of the alarming statistics of death owing to preventable medical errors. A variety of methodologies have since been adopted by the health care sector with mixed successes. However, scant attention has been given to the historical significance of Florence Nightingale pioneering quality management in nursing care over a century ago with her use of statistics to influence health care decisions, to enhance quality care delivery, and to improve facility design. This article addresses the abstract concept of quality, its illusive nature, and multidimensionality from different perspectives in health utilization and delivery. It presents a survey of the various quality management theories and models and their variance, which have attracted the attention of the health sectors as potential saviors of the beleaguered health industry afflicted by the quality crisis.

Obstructive Sleep Apnea: Emphasis on Discharge Education After Surgery

&NA; In the United States, the prevalence of obstructive sleep apnea (OSA) in the adult population is increasing. More than half of the surgical patients with OSA are predisposed to increased incidence of perioperative complications. Based on the recent evidence, obstructive events are at the highest on the third day after surgery, which predisposes them for postoperative complications. The American Society of Perianesthesia Nurses recommends that discharge education on OSA should be provided after surgery to patients diagnosed with OSA to promote continuous positive airway pressure (CPAP) compliance and self‐care behaviors at home. However, CPAP adherence is poor. The purpose of this evidence‐based practice project is to evaluate the effectiveness of discharge education on OSA for increasing CPAP compliance after surgery among adult surgical patients diagnosed with OSA, who use CPAP.

Reimagine Health Care Leadership, Challenges and Opportunities in the 21st Century

Purpose This paper spotlights human capital management, digital technology, and costs control as issues that healthcare leaders will face in redesigning the health care ecosystem in the 21st century. Design The paper was designed to highlight the attributes that make effective leaders. It addresses how nursing leadership can take a lead to redesign the 21st Century health care system, supported by case examples. Methods An expansive literature review was done using MEDLINE, SAGE, Google Scholar, and University of California San Diego Library Catalogs. The selections criteria include recent publications in English within and outside the healthcare industry. Findings Health leadership is viewed as paramount to productivity, capacity and meeting new challenges. Conclusions Effective nursing leadership in a healthcare organization correlates with staff job satisfaction, retention, turnover and quality of care. Nursing leadership development must be supported by appropriate level of educational preparedness, and requisite set of competencies and skills.

Descriptive Characteristics of Obstructive Sleep Apnea Patients at Risk of Longer Post-Operative Hospital Stay

Introduction/Identification of the problem: Approximately 60% of all surgeries in the United States are performed in the ambulatory setting, involving over 53 million procedures in 34 million patients annually. The most common distressing symptoms in ambulatory surgery (AS) are pain and nausea. Other distressing symptoms are fatigue, sore throat, problems in wound healing and mobility. Patients’ experience of symptoms at home during recovery is more profound than clinicians expect, lasts longer, and interferes with the ability to return to normal activities. The concept of a mobile application that can be accessed by the patient or caregiver has received positive feedback from recent AS patients. Purpose: To determine the feasibility of an mHealth self-management program, the Postoperative Care at Home (POCAH), to decrease postoperative symptom distress. Methodology: This is a single-blind, two-group randomized, controlled trial stratified by knee and shoulder surgical procedures (N540). Patients completed baseline information at enrollment and completed a patient diary for 5 days including an evaluation of the use of an iPad for information delivery to access the PoCAH app. Phone interviews at 2 and 4 weeks assessed the recovery trajectory and outcomes using previously validated questionnaires. With a significance level of .05 and 20 subjects per group, the power of the repeatedmeasures analysis of variance F test to detect significant group or interaction effects will be at least 80%, assuming a large effect size. Results: Data analysis is in process. We will report demographics and clinical characteristics as well as an assessment of differences between groups on symptoms, quality of life, perceived self-efficacy, and healthcare resource use to determine feasibility of the mHealth app. Discussion: We are very interested in the delivery of information to patients after surgery via mobile app and whether that affects symptoms, quality of life, perceived self efficacy, and healthcare use. Conclusion/Implications for perianesthesia nurses and future research: Gaps in knowledge of the home trajectory of care for ambulatory patients still exists. We recommend further research to develop appropriate intervention strategies for this population including the use of mHealth apps.

Globalization of Health Service: Sharing of Best Practices in Perianesthesia Nursing Care, a Case Study of Cross-Border Institutional Collaboration

&NA; Healthcare is a global concern among all nations and nursing is a global profession as evidenced by the flow of healthcare professionals across international boundaries. With English as the language of science and commerce and post‐colonial influence in domestic healthcare practice and training, many former Anglo‐speaking colonial settlements become parts of an expansive market for health human resources migration. The movement of health personnel mainly flows from low and medium income countries to high income countries to sustain their health systems. The resulting brain drain adversely impacts a source countrys health system, leading the World Health Organization to declare global health migration as the biggest health threat of the 21st century. This report illustrates how an overseas health network achieves its goals of developing clinical and management excellence through an international exchange program. The provider institution also fulfills its mission of contributing to a more balanced, equitable and healthier world.