Rosemary L. Hoffmann

Utilizing bedside shift report to improve the effectiveness of shift handoff.

Handoff of patient information during shift report between nurses is a time of risk and liability. A quality improvement project was conducted on a 23-bed inpatient unit to measure the value of a bedside change-of-shift report in improving the effectiveness of shift report. Indicators including end-of-shift overtime, call light usage, nurse perceptions, and patient satisfaction were impacted by the change in process.

The Effects of Barriers on Health Related Quality of Life (HRQL) and Compliance in Adult Asthmatics who are Followed in an Urban Community Health Care Facility

This cross sectional descriptive study sought to identify perceived barriers to follow-up care for adult asthmatics who are followed in two community health care facilities. A second purpose of the study was to determine the effect of any barriers to Health Related Quality of Life (HRQL) and compliance in the sample. Thirty-four adults completed a demographic and health status survey, the MiniAQLQ and the EWash Access to Health Care Survey. “Long waiting time in provider’s office,” “someone had to miss work,” “cost of care too much, “and “long wait for an appointment” were the most prevalent perceived barriers in the sample. “Lack of transportation” was significantly associated with study participants who receive health care at one site or who stated the emergency room as their usual place of care. “Someone had to miss work” was significantly correlated with the following variables: employment, a higher annual household income, 1–2 daily medications for asthma, no overnight hospitalizations for asthma and no psychological co-morbidities. A higher reported HQOL was significantly correlated with study participants whose medical care needs were met and found access to local health care services. The only perceived barrier that was significantly correlated with compliance was study participants who “sometimes” had to reschedule an appointment with a health care provider due to “lack of transportation.” The present study suggests that strategies designed to decrease the perceived barriers might improve compliance with the treatment regime, thus decreasing costs, absenteeism, and lack of continuity.

From onsite to online: lessons learned from faculty pioneers.

As the demand for online courses grows, academic settings that do not offer this option risk losing potential students to universities that adopt more innovative approaches to education. Understanding strategies that will prepare faculty to meet the challenges associated with this transformation is essential to developing a quality online program. Most basic to this transition is the philosophic acceptance of online learning as an educational method equivalent to traditional didactic lecture. Because the knowledge and skills associated with navigating Web-based tools and resources are perceived as a barrier by many faculty, focused efforts must be undertaken to assess faculty learning needs and to provide formal and informal education related to recommended teaching strategies and available technology. Collaboration with course design experts and participation in faculty work groups will facilitate acceptance and promote a sense of involvement. Administrative support is also imperative to produce satisfactory student outcomes that meet the needs for accreditation agencies, certification, or higher education standards.

Homocysteine: the latest risk factor for heart disease.

Recent evidence has shown that homocysteine, a sulfur-containing amino acid, is a risk factor for cardiovascular disease (CVD) and may be one of the missing links in explaining the persistently high mortality associated with CVD. Critical care nurses need to be aware of the pathophysiology, treatment, and research regarding hyperhomocysteinemia and incorporate this knowledge into clinical practice.

Improving the Use of Evidence-Based Practice and Research Utilization Through the Identification of Barriers to Implementation in a Critical Access Hospital.

OBJECTIVE: This study explored the relationship between perceived barriers to research use and the implementation of evidence-based practice (EBP) among rural hospital nurses. BACKGROUND: The Institute of Medicine recommends that 90% of clinical decisions be evidence based by 2020. METHODS: This descriptive, quality improvement study used a convenience sampling of registered nurses (RNs). Participants completed multiple questionnaires. RESULTS: Overall the attitude toward EBP was positive. Nurses recognize the importance to their practice but identified a lack of educational preparation regarding the process of research utilization. CONCLUSION: Providing education on research process and supportive monitoring during implementation may increase compliance with EBP initiatives.

The prognosis for women after an acute myocardial infarction: recommendations for practice.

Women have different needs than men after a myocardial infarction. 1,2 Therefore, nursing care for women should be based on current research rather than research based on findings using the “male model.” This article examines research on the prognosis for women after a myocardial infarction and recommends practice changes for the critical care nurse based on these findings.

Creating Quality Online Materials for Specialty Nurse Practitioner Content: Filling a Need for the Graduate Nurse Practitioner.

Nurse practitioners are entering specialized areas of practice immediately after graduation from nurse practitioner (NP) education and certification and are finding employment in specialized areas such as oncology. Rapidly achieving a knowledge base in this highly specialized area of medicine coupled with the stress of the new nurse practitioner role can lead to a very difficult orientation and transition period. There are several methods to provide specialized education to NPs during their orientation period. Unfortunately, limitations such as a lack of motivated mentors, limited opportunities to practice the desired skill set or a lack of structure in regards to curriculum quality, and the learning needs of the new nurse hinder the NP’s transition to practice. In response to either inadequate or non-standardized orientation to the specialty role of the oncology NP (ONP), a web-enhanced educational tool, funded through the National Cancer Institute, was developed for use in the USA: Oncology Nurse Practitioner Web Education Resource (ONc-PoWER). The development of ONc-PoWER was based upon essential education for NPs new to cancer care, adult learning theory, Bloom’s Taxonomy, and foundations of quality online education. The five interactive web-based modules provide specialized education for the nurse practitioner new to oncology along with an on-site mentor to assist the NP in applying the course content to clinical practice.

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.

Update on transplant pharmacology: sirolimus.

Rapamune (Sirolimus), the latest immunosuppressant agent for solid organ transplants, is prescribed for induction therapy, refractory rejection, steroid withdrawal, and combination therapy. As the use of this agent increases among various transplant populations, it is essential for critical care nurses to be cognizant of the indications, pharmacodynamics, current research findings, side effects, and implications. This knowledge will ultimately improve patient education and outcomes in this ever-growing field of nursing.

Beta-blocker therapy for hypertension.

Hypertension has been linked to many diseases, including coronary heart disease, myocardial infarction, renal failure, and stroke. Treatment involves lowering blood pressure (BP) and altering the sequelae. Medications such as beta-blockers reduce BP and prevent complications such as ventricular remodeling, endothelial impairment, and renal insufficiency. This article describes the pathophysiology of hypertension, complications, and theories of primary hypertension. Critical care nurses will learn about the pharmacodynamics and latest research on beta-blocker therapy and critical decision making for patients taking these medications.