Patricia R. Messmer

Enhancing nurse-physician collaboration using pediatric simulation.

PURPOSE The purpose of this study was to determine the level of nurse-physician collaboration during simulation training. METHODS A human patient simulator (HPS) of three mock codes with life-threatening scenarios in children, an understudied population, was used. A set of standardized measures and observational techniques were used to determine levels of nurse-physician collaboration and interaction on multiple dimensions found to improve patient outcomes. RESULTS High levels of group cohesion (GC) and collaboration and satisfaction with patient care decisions (CSPCD) were identified among both physicians and nurses. The male respondents, regardless of discipline, had significantly higher GC scores (p = .029) and significantly higher CSPCD scores (p = .005) than the female respondents. Although the nurses and physicians self-reported good collaboration following the scenarios, analysis of the videotapes revealed that collaboration improved over time. CONCLUSION The results of this study hold promise for this critical area of science that seeks to improve the outcomes of patients who experience life-threatening events.

ENHANCING KNOWLEDGE AND SELF-CONFIDENCE of Novice Nurses: The “SHADOW-A-NURSE” ICU Program

The nursing shortage in the United States has resulted in a need for newly graduated novice nurses to rapidly transition into the nursing workforce. Although some nursing schools provide clinical experience in the intensive care unit (ICU), many novice nurses are not confident about their skills in providing critical-care nursing. To assist novice nurses in rapidly transitioning into the ICU nurse role, an innovative internship program for novice nurses was designed and implemented. A pilot study was conducted to determine if working with experienced nurses in the ICU environment, in addition to formal education and skills training in critical-care nursing, enables novice nurses to effectively transition into the role of ICU nurse. Qualitative and quantitative results of the program after the second year are discussed.

Magnetism and the nursing workforce.

The focus of this chapter is to highlight practice exemplars and research findings related to the five components of the new Magnet Model®. A brief overview of the historical development and professional evolution of the American Nurses Credentialing Center (ANCC) Magnet Recognition Program® is presented followed by a brief overview of the original fourteen forces of magnetism. Content related to empirical practice-based research framed under the components of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation, and improvement; and empirical outcomes is presented and discussed. The authors provide key findings from scholarly publications and describe how the findings contribute to the creation of work environments based on the tenets of magnetism. The chapter concludes with a brief over of the ANCC Pathway to Excellence Program®.

Hispanic Parents' Perspective on Early PACU Visitation

Many reports indicate that family member presence in the PACU may decrease anxiety levels in both patients and family members. PACUs, nevertheless, often restrict family visitation because of the close proximity to ORs, complexity, and the fast-paced recovery environment. The purpose of this study was to determine the effect of parental presence on the anxiety levels of children ages 9 to 18, observed behavior of children ages 6 to 8, and reported parental anxiety in the pre- and postoperative periods. The quasi-experimental design used a sample of 72 parent-patient dyads, predominately Hispanic, who completed either the pediatric (9-12) or teenager/adult Speilberger State Anxiety forms. Forty (40) parents were placed in the PACU with their children, and 32 remained in the Waiting Room. PACU nurses coded observations of parents and observations of patients aged 6 to 8 years. FLACC or numeric pain scales scores were also collected. Results showed no difference in parental anxiety between those who were placed in the PACU or Waiting Room. Patients aged 13 to 18 with parents in-PACU had significantly lowered anxiety scores than patients with parents in-Waiting Room (t = 2.51, P = .02). Anxiety scores for younger children (9-12 years old) were not lowered postoperatively regardless of parent placement. Regardless of age, patients with parents in-PACU showed statistically significantly greater pain pre-operatively compared with patients with in-Waiting Room parents (t = 3.15, P = .002), but this difference disappeared postoperatively.

A Case–Control Study of Pediatric Falls Using Electronic Medical Records

&NA; The purpose of this study was to retrospectively review Humpty Dumpty Falls Scale (HDFS) scores using electronic medical records (EMR) reports at a pediatric hospital to determine characteristics related to falls, injuries, and performance of the HDFS tool. The specific research question was: Is there a significant difference in HDFS total scores between cases (children who fell) and controls (those who did not fall)? Results from 74 cases and 242 controls revealed the number of falls did not differ significantly between those who obtained high HDFS scores and those who obtained low scores. HDFS sensitivity was 57%, specificity was 39%. The pediatric patients who fell were mostly oriented and ambulating; falls with injury did not exceed 19%. Future case‐control studies should use larger sample sizes across multiple institutions with EMR capability.

Using nursing research projects to meet Magnet Recognition Program standards.

The American Nurses Credentialing Center Magnet Recognition Program recognizes facilities that demonstrate excellence in nursing services, development of a professional milieu and growth and development of the nursing staff. The Magnet program is based on the American Nurses Association’s Scope and Standards for Nurse Administrators, which serves as the evaluation framework for determination of Magnet recognition. The role of research and its impact on nursing practice is an important criterion. The authors describe how one medical center successfully used ongoing nursing research projects to highlight how the institution met the Magnet standards.

Standardizing the Bedside Report to Promote Nurse Accountability and Work Effectiveness

BACKGROUND This study evaluated bedside reporting from the nurses perspective regarding accountability, empowerment, work effectiveness, satisfaction, and communication. The aim was to examine the effects of an educational learning activity on bedside handoff reporting related to accountability and work effectiveness. The communication was used at change of shift between frontline nurses, with future interprofessional implementation. METHOD A demographic questionnaire, the Specht and Ramler Accountability Index-Individual Referent and the Conditions for Workplace Effectiveness Questionnaire-II were administered pre-posteducational (learning activity) intervention. Of 184 RNs, 104 completed the pretest, with only 73 of those completing the posttest. RESULTS Statistically significant differences were seen with empowerment, work effectiveness, communication, and nurse job satisfaction posttest; no statistically significant difference was found with accountability. The sample was ethnically diverse, with the majority being Latino pretest (n = 63, 55.8%) and posttest (n = 44, 60.3%). CONCLUSION For medical-surgical units, incorporating bedside reporting can increase nurse satisfaction, accountability, and positive outcomes. J Contin Educ Nurs. 2018;49(10):460-466.

Treatment of Sigmoid Volvulus by Deflation Versus Surgery: A Single SiteReport

Background: Although very common in developing regions like Africa, sigmoid volvulus (SV) has a much lower incidence in the West. There is a dearth of literature on the treatment of SV in countries with limited resources. This paper reports study results using a cohort of 200 SV patients in a low-income developing country. Objectives: The aim of this study was to identify the characteristics associated with length of hospital stay (LOS) in the largest sample of sigmoid volvulus patients drawn from a single site within a single year and to examine the effects of treatment complications and previous attacks of SV on LOS. Methods: Data from charts for a retrospective sample of 200 adult SV patients hospitalized in 2012 at Gondar University Hospital, Ethiopia, were statistically analyzed to determine LOS by patient characteristics and the effects of complications on LOS. Results: Among the 200 patients diagnosed with SV, the ratio of deflation to surgery was almost 2:1 ratio to surgery. The total patient days in the study were 856 days. Patients with LOS > 5 days accounted for 79% of patient days. Patients with a maximum LOS of 30 days accounted for 10.5% of total patient days. The shortest LOS (1.36 days) was among patients who underwent sigmoidoscopic decompression only and had no treatment complications. Complications associated with surgery accounted for 10.6 to 17.0 LOS days. Age, gender, gangrene and previous attacks were not significantly associated with surgery. Among the study patients, there were only five cases of failed deflation followed by surgery. All but five of the patients with gangrene had surgery. Shock, stroke, abscess, sepsis and surgery significantly prolonged LOS. Patients (66%) had not experienced previous attacks. SV affected middle aged men more than the elderly men. Females had an excess relative risk (RR=1.62) for surgery but was not statistically significant due to the small number of females (n=15) in the study. Conclusion: Deflation was an effective treatment modality, while surgery was performed only when indicated and only on the critical cases. Patients who are treated with deflation may avoid surgery which can be associated with additional complications. Avoidance of surgery and complications can substantially reduce LOS with subsequent and system costs.

Unaccompanied Hospitalized Children Nurses’ Search for Understanding

Purpose: To explore the experiences and feelings of pediatric nurses who care for hospitalized children that are unaccompanied by their parents. Design and Methods: This phenomenological study consisted of interviews with 12 pediatric nurses. Verbatim transcriptions were reviewed with participants and analyzed. Findings: Pediatric nurses viewed the circumstances of unaccompanied hospitalized children through the perspective of their own life-worlds. They used both cognitive and emotional constructs to describe the phenomenon. Nurses’ perceptions were affected by day-to-day contingencies of their life worlds which come through the four dimensions of space, mind/body, time, and relationships. These perceptions affected their assessment of parents’ situated contexts. Nurses’ assessments could lead to negative judgments of parents because they worried about ill effects on the unaccompanied children. Meanwhile,nurses often perceived that parents demonstrated trust when they relegated their child’s care to them. Conclusions: Pediatric nurses dealt with increased emotional work while remaining compassionate with their patients. Nurses indicated that they needed to understand their own life-worlds andthatparents’ day-to-day contingenciesmay affect parents’ ability to remain with their hospitalized children. Participants were aware of judgmental attitudes which could interfere with the development of therapeutic relationships with parents, and therefore, with hospitalized children.