The people in your neighborhood: impact of physician cohorting on nursing units.

In a study exploring the impact of a new physician practice model on staff's perceptions of their work environment, no statistically significant differences were found; however, some interesting results were obtained. Nurses should strive to improve working relationships not only with nurses and physicians, but also with members of the entire health care team and system.

Improving outcomes with therapeutic hypothermia.

Therapeutic hypothermia appears to be effective in limiting the trauma resulting from ischemia as well as reducing reperfusion injury.

A novel approach to improving current research awareness: a Web-based Nursing Research Journal Watch.

The Nursing Research Education Committee, part of the Nursing Research Council in a large tertiary care healthcare system, was developed to engage direct care nurses in research activities. This article describes several programs undertaken to meet this goal and details the most current: the development of a Web-based service, the Nursing Research Journal Watch. This innovative service was designed to raise staff awareness of nursing research. Staff development educators will learn how the Nursing Research Journal Watch was developed, launched, and evaluated for consideration in their own institutions.

A study of perioperative hyperglycemia in patients with diabetes having colon, spine, and joint surgery.

Patients with diabetes often have impaired wound healing and an increased rate of postoperative complications with surgery. Most research has focused on the effect of hyperglycemia in the postoperative period, but there is limited evidence to guide blood glucose (bG) control throughout the perioperative period. This retrospective study explored the effect of hyperglycemia in the PACU on postoperative complications, length of stay (LOS), and in-hospital mortality in patients with diabetes undergoing spine, colon, or joint surgery. Findings revealed that the total LOS for patients with a PACU bG >200 mg/dL was significantly longer than for patients with a maximum bG of 140 to 200 mg/dL. Further, the rate of total complications increased significantly as bG levels increased. More prospective, controlled studies on the management of perioperative hyperglycemia are recommended for consideration.

Upgrading the American Association of Critical-Care Nurses' evidence-leveling hierarchy.

In August 2008, the American Association of Critical-Care Nurses' (AACN's) Evidence-Based Practice Resource Work Group met to review current AACN Practice Alerts and to identify new Practice Alerts to be created. The work group was also tasked with reassessment of the grading system used by AACN that evaluates evidence associated with the Practice Alerts and other AACN resources. This article details the effort of this national volunteer work group, specifically highlighting the development of the new AACN evidence-leveling hierarchy system.

Correlation between the Sedation-Agitation Scale and the Bispectral Index in ventilated patients in the intensive care unit.

BACKGROUND: Oversedation masks neurologic changes and increases mortality/morbidity, whereas undersedation risks prolonged stress mobilization and patient injury. In situations such as deep sedation/analgesia, the Bispectral Index (BIS) has potential use as an adjunct to clinical assessment of sedation to help determine depth of sedation. Determining the correlation between clinical and BIS measures of sedation will help to determine the correct role of BIS in intensive care unit (ICU) practice settings. OBJECTIVE: To evaluate the correlation between the clinical assessment of sedation using the Sedation-Agitation Scale (SAS) and the assessment using BIS in ventilated and sedated ICU patients. METHODS: ICU patients requiring mechanical ventilation and sedation were monitored using the SAS and BIS. Nurses initiated event markers with BIS at the time of SAS assessment but were blinded to BIS scores. RESULTS: Data were collected on 40 subjects generating 209 paired readings. Moderate positive correlation between BIS and SAS values was shown with a Spearman Rank coefficient r value of .502 and an r(2) of .252 (P < .0001). Wide ranges of BIS scores were observed, especially in very sedated patients. Strong positive correlation was noted between BIS and electromyography with an r value of .749 (P < .0001). Age and gender significantly influenced BIS/SAS correlations. CONCLUSION: In situations in which the clinical assessment is equivocal, BIS monitoring may have an adjunctive role in sedation assessment. BIS values should be interpreted with caution, however, because electromyography activity and other factors seem to confound BIS scores. More research is necessary to determine the role of BIS monitoring in ICU practice.

Influence of organizational characteristics and caring attributes of managers on nurses' job enjoyment.

AIM: This paper is a report of a study to investigate the effect of organizational characteristics and perceived caring attributes of managers on nurses' job enjoyment. BACKGROUND: Job satisfaction was the outcome of several studies about organizational or professional practice environments. Study variables predicted 30-60% of the variance in job satisfaction. Job enjoyment, the affective dimension of job satisfaction and manager caring were not variables in previous studies. METHODS: We recruited a convenience sample of Registered Nurses (n = 731) employed by a large healthcare system in the mid-Atlantic region of the United States of America. Participants were primarily staff nurses, female, white, full-time employees and 41 years of age or older. Most had a baccalaureate degree in nursing and 4.5% had an advanced practice license. Participants were surveyed in 2005 using Lake's Practice Environment Scale of the Nursing Work Index, Nyberg's Caring Assessment Scale, the Job Enjoyment Subscale of the Atwood and Hinshaw Job Satisfaction Scale and a demographic data form. Descriptive statistics were used to explore the study variables. Data were analysed using multiple regression. RESULTS: Nursing foundations for quality of care, nurse manager ability, leadership and support of nurses, staffing and resource adequacy and collegial nurse-physician relations explained 30.6% of the variance in job enjoyment. Age, area of practice and job type explained an additional 5.4%. CONCLUSION: Quantitative measures did not identify a majority of the variables associated with job enjoyment. Research using a qualitative and quantitative methodology with different practice samples may reveal other variables that influence job enjoyment.

Riding the research roller coaster: what went right, what went wrong?

Evidence-based practice drives nursing procedures and standards of care. Supporting practice with valid research can be a challenge. After identifying a knowledge- and problem-focused trigger, a group of WOC nurses began a research journey. Our purpose was to determine the effectiveness of the rectal trumpet compared to the fecal collector in maintaining skin integrity in patients with fecal incontinence. The methodology included a convenience sample of 100 patients randomized to rectal trumpet or fecal collector versus standard care. Data were collected on signs of increased skin breakdown or healing, stool leakage around device, dislodgement, and discomfort from device. This article will reveal our journey in conducting this clinical research. After many challenges, the study was terminated, but the experiences and lessons learned during our efforts were invaluable. Even well-planned studies can encounter problems that prevent completion. It is important to evaluate these problems so that lessons can be learned and shared. This is our roller coaster ride in the research world.

Research needs assessment: nurses' knowledge, attitudes, and practices related to research.

This manuscript demonstrates how one institution used research background information to recommend the use of two survey studies on nurses' knowledge, attitude, and practice related to research as a needs assessment tool to develop research education. The survey results provided in this manuscript helped the staff development specialist members of the nursing research committee develop an organized approach to education development that targeted nurses who need research education. The committee is planning for the future incorporation of research skills into the new nurses' orientation program.

Clinical comparison of automatic, noninvasive measurements of blood pressure in the forearm and upper arm with the patient supine or with the head of the bed raised 45 degrees: a follow-up study.

BACKGROUND: Noninvasive measurement of blood pressure in the forearm is used when the upper arm is inaccessible and/or when available blood pressure cuffs do not fit a patient's arm. Evidence supporting this practice is limited. OBJECTIVE: To compare noninvasive measurements of blood pressure in the forearm and upper arm of medical-surgical inpatients positioned supine and with the head of the bed raised 45 degrees . METHODS: Cuff size was selected on the basis of forearm and upper arm circumference and manufacturers' recommendations. With a Welch Allyn Vital Signs 420 Series monitor, blood pressures were measured in the forearm and then in the upper arm of 221 supine patients with their arms resting at their sides. Patients were repositioned with the head of the bed elevated 45 degrees and after 2 minutes, blood pressures were measured in the upper arm and then the forearm. Starting position was alternated on subsequent subjects. RESULTS: Paired t tests revealed significant differences between systolic and diastolic blood pressures measured in the upper arm and forearm with patients supine and with the head of the bed elevated 45 degrees . The Bland-Altman procedure revealed that the distances between the mean values and the limits of agreement were from 15 to 33 mm Hg for individual subjects. CONCLUSIONS: Noninvasive measurements of blood pressure in the forearm and upper arm cannot be interchanged in medical-surgical patients who are supine or in patients with the head of the bed elevated 45 degrees .

Clinical comparison of automatic, noninvasive measurements of blood pressure in the forearm and upper arm.

BACKGROUND: When the upper arm (area from shoulder to elbow) is inaccessible and/or a standard-sized blood pressure cuff does not fit, some healthcare workers use the forearm to measure blood pressure. OBJECTIVE: To compare automatic noninvasive measurements of blood pressure in the upper arm and forearm. METHODS: A descriptive, correlational comparison study was conducted in the emergency department of a 1071-bed teaching hospital. Subjects were 204 English-speaking patients 6 to 91 years old in medically stable condition who had entered the department on foot or by wheelchair and who had no exclusions to using their left upper extremity. A Welch Allyn Vital Signs 420 series monitor was used to measure blood pressure in the left upper arm and forearm with the subject seated and the upper arm or forearm at heart level. RESULTS: Pearson r correlation coefficients between measurements in the upper arm and forearm were 0.88 for systolic blood pressure and 0.76 for diastolic blood pressure (P < .001 for both). Mean systolic pressures, but not mean diastolic pressures, in the upper arm and forearm differed significantly (t = 2.07, P = .04). A Bland-Altman analysis indicated that the distances between the mean values and the limits of agreement for the 2 sites ranged from 15 mm Hg (mean arterial pressure) to 18.4 mm Hg (systolic pressure). CONCLUSIONS: Despite strict attention to correct cuff size and placement of the upper arm or forearm at heart level, measurements of blood pressure obtained noninvasively in the arm and forearm of seated patients in stable condition are not interchangeable.