Mary Ann Friesen

BSN completion barriers, challenges, incentives, and strategies.

OBJECTIVE: The objectives of this study were to explore RN perceptions regarding barriers/challenges and incentives/supports for BSN completion and identify recommendations to increase RN BSN completion. BACKGROUND: The Institute of Medicine’s 2011 The Future of Nursing report recommended the proportion of RNs with a BSN increase to 80% by 2020. METHOD: This qualitative study included 41 RNs who participated in 1 of 6 focus groups based on their BSN completion status. RESULTS: Primary themes were sacrifices, barriers/challenges, incentives/supports, value, how to begin, and pressure. Primary BSN completion barriers/challenges were work-life balance and economic issues. Incentives/supports identified were financial compensation, assistance from employer and academic institution, and encouragement from family. Institutional strategies recommended for increasing BSN completion rates were improved access to education and financial support facilitated by collaboration between hospitals and academic institutions. CONCLUSIONS: Exploring RN barriers/challenges and incentives/supports for BSN completion can lead to implementation of institutional strategies, such as tuition reimbursement and academic collaboration.

Developing a patient-centered ISHAPED handoff with patient/family and parent advisory councils.

Our hospital system used Lean strategies to develop a new process for the change-of-shift bedside handoff titled ISHAPED (I = Introduce, S = Story, H = History, A = Assessment, P = Plan, E = Error Prevention, and D = Dialogue). Several teams collaborated with a Parent Advisory Council and a Patient/Family Advisory Council to design a study to explore patient perceptions of the handoff. The findings from the study along with recommendations from the councils were used to develop education modules on implementing patient-centered handoffs.

Promoting caring-healing relationships: bringing healing touch to the bedside in a multihospital health system.

New legislative mandates, evaluation metrics, and patient demand have led acute care organizations to expand their patient-centered care model to include the use of complementary therapies. One multihospital health system is offering Healing Touch training to nurses who will provide Healing Touch to self, colleagues, and patients, promoting a caring-healing consciousness.

Findings From a Pilot Study: Bringing Evidence‐Based Practice to the Bedside

Background To translate research supporting inpatient care outcomes and provide evidence-based care, registered nurses (RNs) need continuing education and mentoring support to adopt evidence-based practice (EBP). Aims The aim of this study was to assess a demonstration project intended to pilot and evaluate a structured EBP education with mentoring innovation for nurses in a multihospital system. Methods Nurses from five units in five hospitals were included in an education with mentoring innovation to implement the Johns Hopkins Nursing Evidence-Based Practice Model and the Advancing Research and Clinical practice through close Collaboration (ARCC) Model. To determine outcomes, the EBP beliefs scale (EBPB) and implementation scale (EBPI) were administered before and after the education with mentoring innovation. Eighty-three RNs completed both preintervention surveys. A total of 57 RNs completed the postintervention surveys. In addition, qualitative data were obtained from focus groups involving 24 participants. Findings Statistical analysis indicated positive movement toward EBP in project participants. Qualitative analysis revealed perceived successes and challenges involved with implementing an evidence-based program, provided logistical lessons learned, and indicated that nurses at all levels of practice require mentoring and coaching to foster EBP sustainment. Linking Evidence to Action The engagement of nurses in this project supported professional development and clinical application of evidence at the point of care. The pilot projects outcome informed a decision by health system administrators to fund more nurse driven EBP projects in the five hospitals. This innovative program provides a replicable structure for deployment and appraisal of EBP nursing model implementation.BACKGROUND To translate research supporting inpatient care outcomes and provide evidence-based care, registered nurses (RNs) need continuing education and mentoring support to adopt evidence-based practice (EBP). AIMS The aim of this study was to assess a demonstration project intended to pilot and evaluate a structured EBP education with mentoring innovation for nurses in a multihospital system. METHODS Nurses from five units in five hospitals were included in an education with mentoring innovation to implement the Johns Hopkins Nursing Evidence-Based Practice Model and the Advancing Research and Clinical practice through close Collaboration (ARCC) Model. To determine outcomes, the EBP beliefs scale (EBPB) and implementation scale (EBPI) were administered before and after the education with mentoring innovation. Eighty-three RNs completed both preintervention surveys. A total of 57 RNs completed the postintervention surveys. In addition, qualitative data were obtained from focus groups involving 24 participants. FINDINGS Statistical analysis indicated positive movement toward EBP in project participants. Qualitative analysis revealed perceived successes and challenges involved with implementing an evidence-based program, provided logistical lessons learned, and indicated that nurses at all levels of practice require mentoring and coaching to foster EBP sustainment. LINKING EVIDENCE TO ACTION The engagement of nurses in this project supported professional development and clinical application of evidence at the point of care. The pilot projects outcome informed a decision by health system administrators to fund more nurse driven EBP projects in the five hospitals. This innovative program provides a replicable structure for deployment and appraisal of EBP nursing model implementation.

The Effects of Healing Touch on Pain, Nausea, and Anxiety Following Bariatric Surgery: A Pilot Study

CONTEXT Given the growth in the number of bariatric surgeries, it is important for healthcare practitioners to maximize symptom management for these patients, including the option of complementary therapies such as Healing Touch. OBJECTIVE A quasi-experimental study was conducted to determine the feasibility of a Healing Touch intervention for reducing pain, nausea, and anxiety in patients undergoing laparoscopic bariatric surgery. DESIGN Following surgery, a nurse administered the Healing Touch intervention once daily. Study participants reported levels of pain, nausea, and anxiety immediately before and after the Healing Touch intervention using separate numeric rating scales. RESULTS Significant decreases in pain, nausea, and anxiety were observed immediately following the intervention on post-operative days one and two, and in pain and anxiety on post-operative day three compared with pre-intervention levels. These findings indicate that the Healing Touch intervention is feasible and acceptable to patients undergoing bariatric surgery, and significantly improved pain, nausea, and anxiety in these patients.

Examination of the Perceptions of Registered Nurses Regarding the Use of Healing Touch in the Acute Care Setting

Given the current transformation of traditional health care to provide more integrative and complementary modalities, health systems are implementing new programs and services to meet consumer and provider needs. One such integrative modality, Healing Touch, with a foundation in holistic nursing, is a gentle therapy that uses touch to promote health and well-being by balancing the human energy system. This article describes the perceptions of registered nurses regarding the implementation of a Healing Touch training program at a multihospital health system. Five themes were identified: benefit to the patient, benefit to the nurse, holism beyond task orientation, integrating Healing Touch into acute care, and barriers and challenges. Nurses recognize the importance of creating caring-healing relationships and a holistic approach to care. Training in Healing Touch provides one avenue for nurses and health care providers to provide compassionate care.

Caring, Connecting, and Communicating: Reflections on Developing a Patient-Centered Bedside Handoff

A multihospital health system improved the nursing change of shift report process by bringing it to the bedside using a new process and tool referred to as ISHAPED (Introduction, Story, History, assessment, Plan, error Prevention, and Dialogue). Using a caring-science perspective, the process was optimized by gaining input from hospitalized patients and parents, and the Parent and the Patient & Family Advisory Councils. This input facilitated development of a more caring-focused nursing education on change of shift report through ISHAPED bedside handoffs, thus promoting more patient-centered care.

Examination of the Use of Healing Touch by Registered Nurses in the Acute Care Setting

Acute care nursing is currently undergoing unprecedented change, with health systems becoming more open to nonpharmacological approaches to patient care. Healing Touch (HT) may be a valuable intervention for acute care patients. Research has shown that HT helps both the patient and the caregiver; however, no study to date has examined the impact that the education of nurses in and their use of HT have on daily care delivery in the acute care setting. The purpose of the current qualitative study was to examine the use of HT by registered nurses in the acute care setting during their delivery of patient care, as well as the impact of education in and use of HT on the nurses themselves. Five themes were identified: (1) use of HT techniques, processes, and sequence; (2) outcomes related to HT; (3) integration of HT into acute care nursing practice; (4) perceptions of HT, from skepticism to openness; and (5) transformation through HT. Education in HT and delivery of this modality by nurses in the acute care setting provide nurses with a transformative tool to improve patient outcomes.

Evidence-Based Practice: Video-Discharge Instructions in the Pediatric Emergency Department

Problem: While a high quality discharge from a Pediatric Emergency Department helps caregivers feel informed and prepared to care for their sick child at home, poor adherence to discharge instructions leads to unnecessary return visits, negative health outcomes, and decreased patient satisfaction. Nurses at the Inova Loudoun Pediatric ED utilized the Johns Hopkins Model of Evidence Based Practice to answer the following question: Among caregivers who have children discharged from the ED, does the addition of video discharge instructions (VDI) to standard written/verbal discharge instructions (SDI) result in improved knowledge about the childs diagnosis, treatment, illness duration, and when to seek further medical care? Methods: A multidisciplinary team reviewed available evidence and created VDI for three common pediatric diagnoses: gastroenteritis, bronchiolitis, and fever. Knowledge assessments were collected before and after delivery of discharge instructions to caregivers for both the SDI and VDI groups. Results: Analysis found that the VDI group achieved significantly higher scores on the post test survey (P < .001) than the SDI group, particularly regarding treatment and when to seek further medical care. After integrating the best evidence with clinical expertise and an effective VDI intervention, the team incorporated VDI into the discharge process. Implications for Practice: VDI offer nurses an efficient, standardized method of providing enhanced discharge instructions in the ED. Future projects will examine whether VDI are effective for additional diagnoses and among caregivers for whom English is not the primary language.

Exploration of Portal Activation by Patients in a Healthcare System

A study of patient portal utilization was conducted at a not-for-profit healthcare system in Northern Virginia. The healthcare system serves more than 2 million people each year. The encounters with the portal included 461 700 different patients occurring between July 2014 and June 2015. Univariate analysis and multivariable logistic regression indicated associations between patient portal activation and predictive factors. Multiple findings emerged: patient portal activation was greater for English-speaking patients; differences in portal activation were observed by patient age; and patients who had an identified primary care provider were more likely to use the portal. The implications were that patients who have limited English skills and have economic challenges may be less engaged. This review demonstrates the importance of understanding the population using a patient portal and provides insight for future development on how to engage patients to interact with their providers through the portals.