Patricia D. Cunningham

Safeguarding patients: complexity science, high reliability organizations, and implications for team training in healthcare.

Serious events within healthcare occur daily exposing the failure of the system to safeguard patient and providers. The complex nature of healthcare contributes to myriad ambiguities affecting quality nursing care and patient outcomes. Leaders in healthcare organizations are looking outside the industry for ways to improve care because of the slow rates of improvement in patient safety and insufficient application of evidenced-based research in practice. Military and aviation industry strategies are recognized by clinicians in high-risk care settings such as the operating room, emergency departments, and intensive care units as having great potential to create safe and effective systems of care. Complexity science forms the basis for high reliability teams to recognize even the most minor variances in expected outcomes and take strong action to prevent serious error from occurring. Cultural and system barriers to achieving high reliability performance within healthcare and implications for team training are discussed.

Improving patient safety: patient-focused, high-reliability team training.

Healthcare systems are recognizing “human factor” flaws that result in adverse outcomes. Nurses work around system failures, although increasing healthcare complexity makes this harder to do without risk of error. Aviation and military organizations achieve ultrasafe outcomes through high-reliability practice. We describe how reliability principles were used to teach nurses to improve patient safety at the front line of care. Outcomes include safety-oriented, teamwork communication competency; reflections on safety culture and clinical leadership are discussed.

Aesthetic practice of labial reduction

As aesthetic labial reduction is becoming a more common practice, it is necessary to look at the state of the science, what we know, and, more importantly, what we do not know about this practice. This article reviews the literature to date on labial reduction and describes the concerns related to the lack of understanding of the outcomes associated with this procedure.

Vulnerable Populations: Drug Court Program Clients

Substance abuse and addiction are chronic conditions characterized by an inability to control ones urge to use mood- or mind-altering drugs. Recognition of the association between addictions and crime to support the addiction, along with the relapsing nature of addictions, presents treatment and management challenges for clinicians and frustration for patients and their families. Pressures to reduce the burgeoning jail population have resulted in collaboration between the treatment community and the court--a diversion program called drug court. This article reviews the drug court programs, the clients, and the processes of accountability that direct the progress toward sobriety in the drug court clients. It also argues that the drug court clients have unique health needs requiring interventions best suited for the recovering addict enrolled in a diversion program within the criminal justice system. Nurses have the ability to influence these systems and provide safety-net clinics to drug court clients through outreach, case finding, and culturally and linguistically appropriate care that can ultimately help this population to reach a higher level of wellness.

Educational intervention to increase detection of metabolic syndrome in patients at community mental health centers.

The prevalence of metabolic syndrome and associated illness is approximately double in individuals with mental illness compared with the general public. An educational intervention on metabolic syndrome was provided to mental health counselors, who performed intake assessments of patients newly admitted to two outpatient mental health facilities. Researchers of the current study first measured mastery of metabolic syndrome content following the educational intervention; they then conducted a chart audit on new admissions to measure changes in clinician behavior. Prior to the intervention, neither facility screened for metabolic syndrome at intake or referred patients with a body mass index (BMI) >25 for medical evaluation. A paired t test showed no significant difference in the educational pre-posttest scores; however, following the intervention, 53 of 132 patients had a documented BMI >25, and 47 of 53 patients were referred to a primary care provider for evaluation. The current studys findings suggest that mental health counselors who screen for metabolic syndrome and associated illnesses will increase the rate of detection of these chronic conditions.

A Comparison of Suboxone and Clonidine Treatment Outcomes in Opiate Detoxification

PURPOSE This retrospective quality improvement study was to evaluate if Suboxone therapy reduced the risk of terminating treatment against medical advice compared with the use clonidine in men aged 18--55 years. METHODS Data were collected through chart review for all opioid-addicted male clients admitted voluntarily to a community-based treatment center between July 1, 2009, and December 30, 2009. FINDINGS The chi-square test of independence between treatment completion and treatment noncompletion was found to be significant at the 5% critical level (P = .027) for Suboxone therapy. CONCLUSIONS Suboxone treatment decreased premature termination of opioid detoxification completion when compared with clonidine.

Identify bipolar spectrum disorders.

Patients with bipolar spectrum disorders commonly present with depressive symptoms to primary care clinicians. This article details bipolar spectrum disorder assessment, treatment, and treatment response. By intervening early in the course of depressive and hypomanic episodes, you can help decrease the morbidity and suffering associated with bipolar spectrum disorders.

APNA Board of Directors’ Column

Exciting news! Our nurse Janice has received a “tap on the shoulder” to move into a leadership position at her hospital. As a nurse manager, she has an incredible responsibility to ensure the safety of staff and patients. She seeks out education and resources that exemplify best practices and obtains recommendations from colleagues. She works with a nurse who is bullying another and helps to repair the relationship. She helps another nurse understand how to best partner with a patient that he was initially scared of. She also acts as an ambassador for psychiatric-mental health care to other areas of the hospital. She is consulted to debrief staff after an emergency room nurse is injured by a patient with mental health conditions, resulting in the nurse’s hospitalization. “We see these patients all the time,” says one nurse, “and we don’t know how to best care for them. I’m scared something like this will happen again.”