Tina Weitzel

Delirium Prevention for Cognitive, Sensory, and Mobility Impairments

The purpose of this study was to determine the effectiveness of a protocol designed to prevent delirium in hospitalized elders with the risk factors of dementia and/or vision, hearing, and/or mobility impairments. A group of 80 patients with risk factors hospitalized before the protocol was implemented was matched with a group of 80 patients admitted after the implementation of the protocol. Records of patients in both groups were reviewed to identify patients with delirium. A significant reduction in delirium, from 37.5% to 13.8%, occurred in the elders receiving the protocol.

The Sh-h-h-h Project: nonpharmacological interventions.

Promoting rest and sleep is integral to the profession of nursing. The Sh-h-h-h Project, a nonpharmacological program designed to enhance rest and sleep, was implemented on a hospital medical unit. Nursing assistants provided patients with various modalities to improve sleep, including back rubs, warm drinks, blankets warmed in a blanket warmer, aromatherapy, relaxation music, and earplugs. Additional interventions were taken to reduce noise. The outcomes of the Sh-h-h-h Project are reported here, with patients indicating improved sleep quality and quantity.

A model of nurse assistant care to promote functional status in hospitalized elders.

After completing 20 hours of classes on promoting the functional status of hospitalized elders, the certified nursing assistants on this medical unit participated in developing a new model of care delivery. Discharge destination (home or nursing home) and length of stay were compared for patients pre- and post-implementation. Length of stay decreased by 2.4 days (p = .0007), and there was a significant increase in the number of elders who were able to return home (p = .024).

Preventing Nosocomial Pneumonia: Routine oral care reduced the risk of infection at one facility

AJN September 2006 Vol. 106, No. 9 72A H ospital-acquired pneumonia is the second most common nosocomial infection in the United States, with an estimated mortality rate of 20% to 33%. It has been associated with longer hospital stays, high mortality rates, and higher health care costs. Although generally associated with mechanically ventilated patients, hospital-acquired pneumonia also occurs with alarming frequency in nonventilated patients. Sopena and colleague found a mean incidence of three cases per 1,000 hospital admissions and 64% of study subjects were on general medical units. The most common causes of hospital-acquired pneumonia are microaspiration of bacteria colonizing oropharyngeal secretions and aspiration of secretions from the esophagus or elsewhere in the gastrointestinal tract. Several researchers have examined interventions to reduce the incidence of ventilator-acquired pneumonia in the ICU. Schleder and colleagues implemented an oral-care protocol, including visual assessment and provision of oral care every two to four hours for adult ICU patients, which resulted in a decline in the ventilator-acquired pneumonia rate from 5.6 to 2.2 per 1,000 ventilator days. Similarly, Simmons-Trau and colleagues implemented a protocol for mechanically ventilated patients that focused on “head of bed” elevation, patient mobility, and providing oral care every two hours. The researchers documented a 33% reduction in adult ventilator-acquired pneumonia rates. There is evidence that nursing interventions can have an impact on preventing pneumonia in some health care settings. Yoneyama and colleagues studied oral care and the incidence of pneumonia in 417 residents in 11 nursing homes during a two-year study. The intervention group received assistance with oral care after every meal. Dentures were brushed daily and cleaned weekly in both groups. The group receiving oral care after each meal had 15% fewer febrile days and a lower incidence of pneumonia compared to the control group. Prevention of hospitalacquired pneumonia should focus on decreasing the risk of aspiration and “preventing colonization of the respiratory tract.” Essential nursing interventions that support these goals include strict adherence to handwashing routines and the use of gloves, elevating the head of the bed for patients at risk for aspiration, and providing routine oral care to all patients.

Nursing research week: promoting staff nurse awareness of research activities through a week long celebration.

Nursing Research Week was developed and implemented by staff nurses who comprise the Nursing Research Council of a Midwest hospital. Multiple activities based on the literature and designed to appeal to staff nurses with diverse interests and knowledge of research were included. The process of development of the activities and the participants’ evaluation are shared.

Helping hands: CNAs in elder care.

One facilitys functional model of care for hospitalized elders focuses on improving nutrition, toileting, and promoting mobility.

From nursing home to hospital and back again: an educational program to improve care for hospitalized nursing home patients.

Hospital nurses have little knowledge of the geriatric syndromes and the processes of caregiving in nursing homes. This lack of knowledge is a barrier to continuity of care for patients admitted to hospitals from nursing homes. An educational program, including both classroom and clinical components, was designed to help bridge this gap. A plan for dissemination to other hospital staff was developed by the 15 nurses who participated.