Kathleen S. Oman

Health Care Providers' Evaluations of Family Presence During Resuscitation

INTRODUCTION The benefits of family presence (FP) during resuscitation are well documented in the literature, and it is becoming an accepted practice in many hospitals. There is sufficient evidence about health care provider (HCP) and family attitudes and beliefs about FP and little about the actual outcomes after family witnessed resuscitation. The purpose of this study was to evaluate FP at resuscitations. METHODS A descriptive design was used to collect data at an academic medical center in the western U.S. There were 106 resuscitations during the study period. Family presence was documented on 31 (29%) records. One hundred and seventy-four health care provider names were listed on the resuscitation records, and 40 names (23%) were illegible or incomplete. The convenience sample of 134 HCPs was invited to complete an electronic survey and 65 (49%) responded. RESULTS Respondents indicated that family members were able to emotionally tolerate the situation (59%), did not interfere with the care being provided to the patient (88%). In addition, team communication was not negatively affected (88%). A family facilitator was present 70% of the time, and it was usually a registered nurse (41%). Twenty-one narrative comments were summarized to reflect the following themes: 1) family presence is beneficial; 2) family presence is emotional; 3) a family facilitator is necessary. DISCUSSION These study findings demonstrate that having families present during resuscitations does not negatively impact patient care, is perceived to benefit family members and that a dedicated family facilitator is an integral part of the process.

Evidence-based policy and procedures: an algorithm for success.

Evidence-based practice is defined as the use of current best evidence by clinicians when making patient care decisions. Barriers to an evidence-based practice are well identified in the literature and significantly impact the use of research findings in practice. A key feature of a practice environment that supports and promotes the use of best evidence is requiring clinical practice policies and procedures to be evidence-based. The authors describe the structure and process developed to facilitate evidence-based policies and the outcomes of the initiative.

The Colorado Patient-Centered Interprofessional Evidence-Based Practice Model: A Framework for Transformation

BACKGROUND Evidence-based practice (EBP) models provide a framework to guide organizations and their clinicians to implement evidence-based policies, protocols, and guidelines. A historical review of evidence-based models is presented. The revised Colorado Patient-Centered Interprofessional EBP Model supports use of research evidence and nonresearch evidence and adopts a patient-centered approach to EBP. AIM The purpose of this article is to present a framework that can be used to transform an organization and foster the use of evidence by interdisciplinary team members. APPROACH An evidence-based intervention to decrease catheter associated urinary tract infections (CAUTI) is presented to show how the model is operationalized. The EBP model is supported by the five steps that clinicians should use as they identify a clinical problem, gather the evidence, and move the evidence into practice. Ideas for dissemination of new models to clinicians throughout the organization are presented.

A Palliative Care Needs Assessment of Rural Hospitals

BACKGROUND Palliative care services are lacking in rural hospitals. Implementing palliative care services in rural and remote areas requires knowledge of available resources, specific barriers, and a commitment from the hospital and community. OBJECTIVE The purpose of the study was to determine awareness, knowledge, barriers, and resources regarding palliative care services in rural hospitals. METHODS A descriptive survey design used an investigator-developed needs assessment to survey 374 (40% response rate) health care providers (chief executive officers, chiefs of medical staff, chief nursing officers, and social worker directors) at 236 rural hospitals (<100 beds) in seven Rocky Mountain states. RESULTS Significant barriers to integrating palliative care exist: lack of administrative support, mentorship, and access to palliative care resources; inadequate basic knowledge about palliative care strategies; and limited training/skills in palliative care. Having contractual relationships with local hospices is a key facilitator. Respondents (56%) want to learn more about palliative care, specifically focusing on pain management, communication techniques, and end-of-life care issues. Webinar and online courses were suggested as strategies to promote long distance learning. CONCLUSIONS It is imperative for quality of care that rural hospitals have practitioners who are up to date on current evidence and practice within a palliative care framework. Unique challenges exist to implementing palliative care services in rural hospitals. Opportunities for informing rural areas focus around utilizing existing hospice resources and relationships, and favoring Web-based classes and online courses. The development of a multifaceted intervention to facilitate education about palliative care and cultivate palliative care services in rural settings is indicated.

Reducing Indwelling Urinary Catheter Use in the Emergency Department: A Successful Quality-Improvement Initiative

INTRODUCTION This quality-improvement project aimed to evaluate the effectiveness of implementing multidisciplinary education and deploying utilization tools aimed at reducing the inappropriate insertion of indwelling urinary catheters (IUCs) in the emergency department. Literature supports the use of decision support tools and education as proven techniques to reduce IUC use. Few studies have implemented a multidisciplinary approach involving the use of focus groups to understand the thought processes behind deciding to place an IUC. METHODS Focus groups were used to understand the current practice for inserting an IUC in the emergency department. These data were then used to create a nursing-based IUC decision support tool and educational presentation regarding appropriate uses for IUCs. Live, in-person education sessions were given to emergency nurses, emergency medical technicians, physicians, and residents; in addition, electronic education was assigned to all emergency nurses and technicians. Seventy-eight percent of ED staff received some form of education regarding appropriate IUC insertion criteria. Physicians and residents also received an in-person presentation on the topic. A survey was sent to all emergency nurses and emergency medical technicians to assess actual practice changes. In addition, an IUC utilization and appropriateness audit was completed before and immediately after the interventions. RESULTS The project resulted in a 25% decrease in the proportion of patients admitted to inpatient status with IUCs placed in the emergency department and a 9% decrease in the inappropriate use of IUCs. Staff surveys after education showed that staff members were more likely to document the reason for placing an IUC and to use alternatives to IUCs. CONCLUSIONS The potential risks associated with IUCs often go overlooked by direct-care staff members. Educating staff and creating new standards and utilization tools have often been used to decrease the initial insertion of IUCs and to improve recognition of appropriate removal of IUCs. Using direct feedback from staff to develop the interventions led to a reduction in IUC insertions in the emergency department in the short-term, but long-term changes were not seen. The project results suggest that incorporating staff into the decision making and implementation will lead to long-term acquisition of knowledge and longer-term results. Ongoing regularly scheduled education refreshers need to be assessed for their potential to affect long-term change.

Nurse manager perceptions of role satisfaction and retention at an academic medical center.

OBJECTIVE: The aim of this study was to explore the perceptions of inpatient acute care nurse managers (NM) employed at an academic Magnet® hospital about factors that influence NM retention, including current work environment, satisfaction, work-life balance, sucssful NM traits, and personal development and educational needs. BACKGROUND: Nurse managers are challenged with increased workloads impacting their ability to implement all role components. METHODS: A qualitative descriptive study design used focus group methodology to explore perceptions of the NM role. RESULTS: Nurse managers identified staff recognition, support, peer relationships, collaboration, and ability to make positive change as factors influencing their decision to remain in the role. Burnout factors included workload issues, work-life imbalance, and difficulty sustaining positive relationships. Traits supporting success were communication, resiliency, integrity, and a visionary outlook. Suggestions for NM development and education were identified. CONCLUSIONS: Findings can be used to improve NM satisfaction, work-life balance, recruitment, retention, and succession planning.

Mapping the organization: a bibliometric analysis of nurses' contributions to the literature.

OBJECTIVE: The aim of this study was to map an academic hospital’s nursing contributions to the literature using bibliometric methods. BACKGROUND: Nurse executives continue to search for ways to share knowledge gained in the clinical setting. Manuscripts from clinical nurses must increase to advance the science of nursing practice and nursing administration. METHODS: A search of electronic databases and curriculum vitae provided bibliographic data for University of Colorado Hospital (UCH) nurses from 1990 to 2012. Bibliometric techniques were used for publication counts and citation analysis. A review of the infrastructure supporting scholarly work was undertaken. RESULTS: A total of 191 journal articles, 9 books, 103 book chapters, 5 manuals, and 46 manual chapters were published by UCH nurses. Author productivity steadily increased. Citation analysis indicated that the works published were used by others. The h-index for UCH authors was 25. The hospital culture, interdisciplinary practice, and the role of the research nurse scientists had an impact on study results.

The Ventilated Patient's Experience.

Background:Critically ill intensive care unit (ICU) patients often experience pain, anxiety, panic, fear, dyspnea, and distress related to mechanical ventilation. Patients’ recollections vary from having little or no memory of actual events to having total recall. Few studies have examined family members’ memories and congruence with patients’ symptom report and nurse observation. Objectives:To describe the experience of the mechanically ventilated ICU patient. Aims: (1) to explore patient and family memories of pain, anxiety, distress, and dyspnea following mechanical ventilation; (2) to determine if there is a correlation among nurse-documented pain assessment and patient- and family-reported pain intensity; and (3) to determine the level of patient and family satisfaction with care while on the ventilator. Methods:This was a descriptive study design. A convenience sample of ICU patients (n = 84) and family members (n = 77) was interviewed. Medical record data abstraction included patient demographics, medication administration, and nurse assessment of pain and sedation. Results:Most patient and family members reported memories of pain, anxiety/panic, nightmares or distress, and trouble breathing. Patients’ perception of anxiety, nightmares, and dyspnea were moderately correlated with their pain perception (P = .000). Family members’ memories of pain were correlated with nurse pain assessment behavioral scale ratings, but patients’ memories of pain were not. Patients and family reported high satisfaction scores. Conclusion:Further inquiry of the patient’s experience with mechanical ventilation, the use of a ventilation sedation management protocol, and the evaluation of effective communication tools such as the use of bedside reporting or patient communication boards is warranted.

Lessons Learned From the Implementation of a Bedside Handoff Model

At the University of Colorado Hospital, nurse-to-nurse shift reports traditionally occurred in a conference room setting and consisted of nurse-to-nurse verbal communication. Evidence supports moving this information exchange to the patient bedside. This model of report improves clinical effectiveness, patient safety, nurse efficiency, and staff satisfaction. Bedside reporting empowers patients and families to ask questions and contribute to their plan of care and increases patient satisfaction. This article describes the process of implementing and evaluating a model of nurse-to-nurse bedside handoff report.

Dissemination of the Five Wishes Advance Directive at Work

Advance directives are invaluable resources during life-threatening situations, yet are often not even completed by nurses. Having a personal advance directive may make it easier for nurses to begin the delicate work of talking about end-of-life care decisions with patients. The purpose of this study was to determine if offering the Five Wishes advance directive to RNs will affect personal advance directive completion and ultimately impact patient advance directive completion. Preintervention data showed that 84% of nurses did not have an advance directive. Reasons stated included too young and too healthy to need it now. Postintervention, 58% totally and 28% partially completed the Five Wishes advance directive; 14% did not complete it at all. The most difficult aspect of completing an advance directive was “what kind of medical care I want and I don’t want.” RNs believed the experience of completing an advance directive would be useful in their clinical practice (mean, 4.32 [SD, 0.75]). Ninety-nine percent of participants would recommend the use of the Five Wishes. The intervention had no impact on patient advance directive completion. While Five Wishes education to nurses may increase their knowledge and attitudes about advance directive, advance directive completion by nurses is thought to be difficult and time-consuming.