Mary Beth Modic

Leadership and nurse retention: the pivotal role of nurse managers.

As the link between executives and bedside nurses, nurse managers assume roles that bridge both organizational and professional goals. Nurse retention is one of the many responsibilities that characterize the nurse managers work. To better understand the pivotal role of nurse managers, the authors describe the views of 32 nurse managers regarding their roles and the characteristics they need to promote retention.

Approach to the adult hospitalized patient on an insulin pump

Patients on continuous subcutaneous insulin infusion, or insulin pumps, are increasingly seen in hospitals. Inpatient providers need to have a working knowledge of insulin pumps to be able to decide, in conjunction with the patient whenever feasible, whether or not pump use is to be continued in the hospital, to assist patients in adjusting insulin doses via continuous subcutaneous insulin infusion, to transition patients to multiple daily subcutaneous insulin dosing as appropriate, and to prevent or manage problems that might arise from improper handling of the insulin pump. Clinical vignettes with key points and strategies for patient care are discussed in this article.

Diabetes teaching is not for the faint of heart: are cardiac nurses up to the challenge?

Background:Patient education of self-care is an integral component of nursing care. Promoting self-care is important for patients with diabetes because day-to-day decision making has a tremendous impact on health. Purpose:To examine diabetes knowledge of nurses working on medical cardiology and cardiovascular surgical intermediate care units. Methods:In this prospective, cross-sectional, correlational study, 90 registered nurses working on medical cardiology and cardiovascular surgical units completed a 20-item survey on diabetes survival skill education. Correlational and comparative statistics were used to analyze data. Results:Subjects (N = 90) were more often female (n = 73; 83.0%) and worked full time (n = 76; 84%); mean (SD) RN experience was 5.6 years (SD, 7.6 years). Total mean score on the Diabetes Survival Skills Knowledge Test (DKSST) was 10.4 (SD, 2.6), reflecting 50% mastery of diabetes survival skill content. Test scores were higher in nurses with greater general comfort in teaching patients about diabetes (P =.04), more years of experience as a nurse (P =.004), more years of work at the current workplace (P <.001), and more years in their current work unit (P <.001). By age, nurses in the oldest quartile (≥37 years) had higher DKSST content area scores in oral glucose-lowering agents (P =.02) and symptom management (P =.01) and had a trend toward higher overall DKSST score (P =.06) and score on blood glucose self-monitoring (P =.06). Sex, formal education level, work commitment, and previous diabetes education were not associated with higher DKSST scores. Conclusion:Nurses knowledge and comfort related to diabetes survival skill teaching were low. The strongest correlate of higher DKSST score was length of time as a nurse. Because previous education and other nurse characteristics were not associated with higher test scores, nurse educators and advanced practice nurses must modify education delivery modalities to improve retention of information used in the delivery of patient education about diabetes survival skills.

A diabetes management mentor program: outcomes of a clinical nurse specialist initiative to empower staff nurses.

Purpose: The purpose of this project was to enhance the knowledge of the bedside nurse in diabetes management. A forum for ongoing support and exploration of clinical problems, along with the distribution of educational tools were the components of this program. Background: Diabetes accounts for 30% of patients admitted to the hospital. It has become more challenging to manage as the treatment choices have increased. There are a number of researchers who have identified nurse and physician knowledge of diabetes management principles as suboptimal. Description of the Innovation: Staff nurses are educated for a role as a Diabetes Management Mentor and are expected to educate/dialogue with peers monthly, model advocacy and diabetes patient education skills, facilitate referrals for diabetes education, and direct staff to resources for diabetes management. Outcomes: Diabetes Management Mentors feel more confident in their knowledge of diabetes and their ability to resolve clinical issues as they arise. Conclusion: The Diabetes Management Mentor role is another avenue for nurses to refine their clinical knowledge base and acquire skills to share with colleagues while remaining at the bedside. Implications: The clinical nurse specialist is expertly prepared to foster the professional development of bedside nurses while simultaneously making a positive impact on disease management. Opportunity for future investigation includes efficacy of teaching tools on diabetes mastery, the effect of clinical nurse specialist mentoring on a select group of bedside nurses, and the Diabetes Management Mentor’s impact on prevention of near-miss events.

Perceived knowledge and self-confidence of pediatric nurses as patient educators.

Patient education is an integral component of nursing care. Patient education has been associated with favorable patient outcomes but may be difficult if resources are unavailable, “teachable moments” are unrecognized, or if self-confidence of the nurses providing the education is low. Using the theoretical model developed by the authors and focusing on the delivery of patient/family education, we examined pediatric nurses’ perceptions about patient/family education in the hospital setting. A 20-item questionnaire that explored factors affecting teaching behaviors of 54 pediatric nurses in an acute care hospital setting was completed. Results from this study suggest that pediatric nurses’ confidence was disorder-specific. Nurses were confident providing education about common disorders (asthma, pneumonia, and bronchiolitis) and less confident providing education about less common disorders (oncology, cardiac). The barrier to providing education identified most often was lack of written materials. Findings from this study can be used to develop teaching resources for nurses and to plan educational programs specific to less common pediatric problems.

The Pain Experience of Patients Hospitalized With Inflammatory Bowel Disease: A Phenomenological Study.

Pain is personal, subjective, and best treated when the patients experience is fully understood. Hospitalization contributes to the physical and psychological complications of acute and chronic pain experienced by patients with inflammatory bowel disease (IBD). The purpose of this qualitative phenomenological study was to develop an understanding of the unique experience of pain in hospitalized patients with an admitting diagnosis of IBD and related care or surgery. Following institutional review board approval, purposeful sampling was used to recruit 16 patients (11 female, 5 male, mean age 41.8 years) from two 36-bed colorectal units of a large academic medical center in the Midwest. Individual, audio-recorded interviews were conducted by a researcher at each participants bedside. Recordings and transcripts were systematically reviewed by the research team using Van Manens approach to qualitative analysis. Subsequently, 5 major themes were identified among the data: feeling discredited and misunderstood, desire to dispel the stigma, frustration with constant pain, need for caregiver knowledge and understanding, and nurse as connector between patient and physician. Hospitalized patients with IBD have common issues with pain care. Nurses caring for them can provide better pain management when they understand these issues/themes. Further research into the themes discovered here is recommended.

A Leadership Education and Development Program for Clinical Nurses

OBJECTIVE:The Leadership Education and Development (LEAD) Program was designed to transform care at the bedside by empowering clinical nurses as leaders. BACKGROUND:The heart of LEAD was enhancing communication skills of clinical nurses with clinical colleagues and, most importantly, patients and families. Key concepts of leadership/management were included: personal awareness, personal leadership skills/abilities, leading change, leading others individually and in teams, enhancing the patient/provider experience, and the leadership role in outcomes management. METHODS:A quantitative, longitudinal, survey design was used with 2 cohorts. The program consisted of six 4-hour sessions for 3 to 6 months. Leadership practices were measured before program implementation, at the end of the program, and 3 months after program completion. RESULTS:There were significant increases in leadership practices sustained 3 months after program completion. A range of other outcome measures was included. CONCLUSIONS:There is a need for additional leadership development programs for clinical nurses.

Do We Know What Our Patients With Diabetes Are Eating in the Hospital

Diabetes is one of the most prevalent diagnoses seen in hospitalized patients in the United States, accounting for ∼ 38% of all patients admitted to hospitals.1 Research on the benefits of glucose control in the hospital setting has focused primarily on critically ill cardiovascular patients.1–5 Hyperglycemia has been linked to immunosuppression, increased coagulapathies, increased infection rates, endothelial dysfunction, and prolonged lengths of hospitalizations.2,6 A diabetic population is at greater risk for developing complications if glucose levels are not controlled. Improved glycemic control is dependent on establishment of glycemic targets, adjustment of diabetes medication regimens (including insulin), monitoring of glucose trends, and assessment of eating behaviors. Accordingly, to understand glycemic control in the hospitalized population, it is important to examine meal consumption, as well as pharmacological therapies.7 Unfortunately, eating patterns and actual nutritional intake are not well understood for this population.2 Thus, the aim of this study was to explore meal consumption patterns of hospitalized patients with diabetes. The research questions included: 1. What is the average daily meal consumption of hospitalized patients with diabetes receiving subcutaneous insulin therapy? 2. Is there a difference between actual meal consumption and estimated nutritional requirements in hospitalized patients with diabetes? 3. What factors affect meal consumption in hospitalized patients with diabetes? ### Setting and sample Investigators recruited a convenience sample of patients from two medical and two surgical units in a large, urban, tertiary care facility in the Midwest. Adult patients diagnosed with type 1 or type 2 diabetes, > 20 years of age, who were receiving subcutaneous insulin were included. Patients receiving steroid therapy, oral glucose-lowering agents, tube feedings, parenteral nutrition, or pre-packaged kosher meals and those who could not understand English were excluded. The study took place from July to November 2007 with approval of the institutional review board. ### Study design Dietitians …

Does an Insulin Double-Checking Procedure Improve Patient Safety?

OBJECTIVE: The aim of this study was to examine the effectiveness of a subcutaneous insulin double-checking preparation intervention on insulin administration errors. BACKGROUND: Insulin accounts for 3.5% of medication-related errors. The Joint Commission and Institute for Safe Medication Practices recommend a 2-nurse double-checking procedure when preparing insulin. METHODS: This study used a randomized, controlled, nonblinded, intent-to-treat methodology. RESULTS: In total, 266 patients were enrolled, and over 4 weeks of data collection, there were 5238 opportunities for insulin administration. Overall, 3151 insulin administration opportunities had no errors; the double-checking group had more no-error periods than usual care. Of error types, wrong time was predominant, but less prevalent in the double-checking group. Omission errors were uncommon and occurred less in the double-checking group. CONCLUSIONS: The subcutaneous insulin double-checking preparation procedure led to less insulin administration errors; however, timing errors were most prevalent and are not resolved with double-checking interventions.

Caring Behaviors: Perceptions of Acute Care Nurses and Hospitalized Patients with Diabetes

Caring behaviors Perceptions of acute care nurses and hospitalized patients with diabetes Purpose The purpose of this study was to examine the perceptions of caring behaviors that influence the patient experience in acute care nurses and hospitalized patients with diabetes. Background Nurses are the caregivers who render most of the direct care patients receive while they are hospitalized. Understanding what patients perceive as caring behaviors is essential in tailoring nursing interventions to meet patient needs. Data sources Data collection occurred at a 1,200 bed, nonprofit academic medical center located in the Midwest. Description Sixty-four nurses and 54 patients with diabetes were queried about their experience with diabetes caring behaviors. Conclusion Nurses consistently reported providing caring behaviors more frequently than patients reported receiving them. Implications This study has implications for understanding the patient experience in the hospital setting specifically related to patient education. Providing patient education is an important caring intervention that directly affects the patient experience. However, none of the patients in this study identified this as a caring behavior used by nurses.