Patricia K. Tuite

Expanding Acute Care Nurse Practitioner and Clinical Nurse Specialist Education Invasive Procedure Training and Human Simulation in Critical Care

Programs educating advanced practice nurses (APNs), including acute care nurse practitioners (ACNPs) and clinical nurse specialists (CNSs) may struggle with the degree to which technical and cognitive skills necessary and unique to the care of critically ill patients should be incorporated within training programs, and the best ways these skills can be synthesized and retained for clinical practice. This article describes the critical care technical skills training mechanisms and use of a High-Fidelity Human Simulation (HFHS) Laboratory in the ACNP and CNS programs at the University of Pittsburgh School of Nursing. The mechanisms for teaching invasive procedures are reviewed including an abbreviated course syllabus and documentation tools. The use of HFHS is discussed as a measure to provide students with technical and cognitive preparation to manage critical incidents. The HFHS Laboratory, scenario development and implementation, and the debriefing process are discussed. Critical care technical skills training and the use of simulation in the curriculum have had a favorable response from students and preceptors at the University of Pittsburgh School of Nursing, and have enhanced facultys ability to prepare APNs.

Simulator technology as a tool for education in cardiac care.

Assisting nurses in gaining the cognitive and psychomotor skills necessary to safely and effectively care for patients with cardiovascular disease can be challenging for educators. Ideally, nurses would have the opportunity to synthesize and practice these skills in a protected training environment before application in the dynamic clinical setting. Recently, a technology known as high fidelity human simulation was introduced, which permits learners to interact with a simulated patient. The dynamic physiologic parameters and physical assessment capabilities of the simulated patient provide for a realistic learning environment. This article describes the High Fidelity Human Simulation Laboratory at the University of Pittsburgh School of Nursing and presents strategies for using this technology as a tool in teaching complex cardiac nursing care at the basic and advanced practice nursing levels. The advantages and disadvantages of high fidelity human simulation in learning are discussed.

Cardiac Health: Primary Prevention of Heart Disease in Women

Heart disease is the number one cause of death among women. Although 450,000 women die annually from heart disease, this fact is unknown to many women. Because heart disease is frequently preventable, increasing awareness of personal risk and preventative measures is a key element of health care for women. Nurse clinicians can evaluate, educate, and counsel women regarding their risk for this pervasive disease and promote behavior changes that will decrease that risk. Research evidence supports that lifestyle behaviors are the cornerstone of heart disease prevention. This article presents current evidence for the prevention of heart disease related to dietary intake, physical activity, weight management, smoking cessation, blood pressure control, and lipid management. Guidelines for implementing findings in clinical practice are discussed.

The role of the clinical nurse specialist in facilitating evidence-based practice within a university setting.

There are many changes occurring within the healthcare system today, bringing forth multiple challenges for nurses. Changes in reimbursement for hospitals and staffing shortages are impacting the ways that nurses are delivering care. During these changing times, it is essential that healthcare providers strive to maintain high-quality care and patient safety. Utilizing evidence-based practice (EBP) to guide the delivery of care is one way to ensure that high-quality outcomes are achieved. EBP is one of the driving forces to improve clinical practice and ensure patient safety within the healthcare system. The clinical nurse specialist is very instrumental in facilitating quality care and implementing EBP within the healthcare setting. Through the development of a multidisciplinary committee, the clinical nurse specialist can lead professional nurses in the implementation of EBP and facilitate practice changes to improve patient outcomes.

A process for instituting best practice in the intensive care unit

Goals of health care are patient safety and quality patient outcomes. Evidence based practice (EBP) is viewed as a tool to achieve these goals. Health care providers strive to base practice on evidence, but the literature identifies numerous challenges to implementing and sustaining EBP in nursing. An initial focus is developing an organizational culture that supports the process for nursing and EBP. An innovative strategy to promote a culture of EBP was implemented in a tertiary center with 152 critical care beds and numerous specialty units with diverse patient populations. A multi-disciplinary committee was developed with the goal to use evidence to improve the care in the critical care population. EBP projects were identified from a literature review. This innovative approach resulted in improved patient outcomes and also provided a method to educate staff on EBP. The committee members have become advocates for EBP and serve as innovators for change to incorporate evidence into decision making for patient care on their units.

Prevention of ventilator-associated pneumonia: what nurses can do.

Ventilator-associated pneumonia is the second most common hospital-acquired infection in medical intensive care units in the United States. Prevention of ventilator-associated pneumonia must be regarded as one of the most important issues in critical care and it has already become one of the core intensive care unit performance measures proposed by the Intensive Care Advisory Panel of the Joint Commission on Accreditation of Healthcare Organizations. This article focuses on prevention strategies which can be applied by critical care nurses during daily care.

Overcoming nursing barriers to intensive care unit early mobilisation: A quality improvement project

OBJECTIVES To increase adherence with intensive care unit mobility by developing and implementing a mobility training program that addresses nursing barriers to early mobilisation. DESIGN An intensive care unit mobility training program was developed, implemented and evaluated with a pre-test, immediate post-test and eight-week post-test. Patient mobility was tracked before and after training. SETTING A ten bed cardiac intensive care unit. MAIN OUTCOME MEASURES The training programs efficacy was measured by comparing pre-test, immediate post-test and 8-week post-test scores. Patient mobilisation rates before and after training were compared. Protocol compliance was measured in the post training group. RESULTS Nursing knowledge increased from pre-test to immediate post-test (p<0.0001) and pre-test to 8-week post-test (p<0.0001). Mean test scores decreased by seven points from immediate post-test (80±12) to 8-week post-test (73±14). Fear significantly decreased from pre-test to immediate post-test (p=0.03), but not from pre-test to 8-week post-test (p=0.06) or immediate post-test to 8-week post-test (p=0.46). Post training patient mobility rates increased although not significantly (p=0.07). Post training protocol compliance was 78%. CONCLUSION The project successfully increased adherence with intensive care unit mobility and indicates that a training program could improve adoption of early mobility.

Increasing the Cultural Competence Levels of Undergraduate Nursing Students

BACKGROUND This study evaluated the effectiveness of the Culturally Competent Nursing Modules (CCNMs) developed by the U.S. Office of Minority Health on improving the cultural competence levels of undergraduate nursing students. METHOD Students completed the CCNMs over a 2-week period, and their pre- and posttraining cultural competence was assessed using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised tool. RESULTS The CCNMs were effective in increasing the cultural competence of the nursing students (pretest mean = 68.44 ± 6.58; posttest mean = 79.06 ± 7.99; t(17) = 7.44; d = 10.61; 95% confidence interval = 7.60, 13.62; p < .001). Before training, 89% of the students were culturally aware and 11% were culturally competent. After training, 22%, 67%, and 11% were culturally aware, culturally competent, and culturally proficient, respectively. CONCLUSION The CCNMs training program is effective and should be incorporated into nursing curricula.

Evaluation of a Surgical Site Discharge Teaching Tool Using Pictures and a Mirror.

Purpose: The purpose of this project was to develop, implement, and evaluate a teaching tool for self-assessment of surgical incisions after laparotomy surgery. Background: Hospitalized patients have an increased level of acuity and are discharged earlier. Shorter length of stay limits the nurses’ ability to provide comprehensive discharge instructions and validate understanding of surgical incision care. Description: Two sets of discharge instructions, 1 with text only and 1 with text and pictures plus a mirror, were provided to patients after laparotomy surgery. A total of 60 patients were recruited over a 3-month period. The first 30 patients received standard discharge instructions (text only). The next 30 patients received discharge instructions using the new program and a handheld mirror to assist with visualization of the incision. A follow-up telephone questionnaire was completed on day 7 after surgery to assess patients’ ability to inspect their incision for infection and determine comprehension with discharge instructions. Outcome: Patients receiving the revised program had improvement in comprehension of instructions, felt that instructions were clearly stated, and were confident in their ability to identify normal healing versus a surgical site infection (SSI) and about notifying physicians. Compared with the text-only group, the text, picture, and mirror group using the teaching program (text, pictures, and mirror) felt more confident on self-assessment to identify SSI. Conclusion: The revised teaching program (text and pictures) and use of a handheld mirror improved patient confidence in self-assessing an incision and increased ease in detecting an SSI. Implications: Clinical nurse specialists can influence patient outcomes. Discharge instructions that include text and pictures plus a mirror should be part of a comprehensive packet for patients asked to assess an incision.

Recognition and Management of Shock in the Pediatric Patient

Shock continues to be a challenge for health care professionals because shock is not a single pathologic process but a complex series of interrelated events. After respiratory failure, shock is the second most common cause of death in children. The etiology of shock can be classified into three major categories: hypovolemic, cardiogenic, and distributive shock (septic shock). Despite the etiology of the shock state, if left untreated, the overwhelming response of the body to the inadequate perfusion is death. The key to successful management and treatment of shock is early recognition and rapid intervention.