Fluidized Positioner to Prevent Occipital Pressure Injury: A Quality Improvement Project.

PURPOSE: The purpose of this quality improvement project was to determine if head immobilization, pressure redistribution for the occiput, and offloading of pressure from craniotomy incisions could be improved by utilizing fluidized positioners instead of pillows previously used as the standard of care. The second purpose was to determine cost savings for the organization. PARTICIPANTS AND SETTING: Eight patients with head trauma and craniotomy in a surgical intensive care unit (SICU) and cardiovascular intensive care unit (CVICU) from a level 1 trauma center in the Southeast region of the United States participated over a 6-month period. APPROACH: The project comprised educating staff including nurses, nursing assistants, supervisors, and care managers, and implementation of the head positioner from July 2018 to December 2018. Staff from the SICU and CVICU, a step-down unit, and a neurological ICU were also educated on the fluidized positioner, because patients were transferred to these units when stable. All patients who underwent craniotomy surgery were placed on the fluidized positioner postoperatively until immobilization and offloading were no longer required. OUTCOME: During the initial 6-month evaluation period, no new pressure injuries or incisional trauma occurred in the 8 patients. The economic impact to treat one hospital-acquired unstageable pressure injury was estimated at $78,722. Because no new occipital pressure injuries occurred in the 8 patients placed on the fluidized head positioner, the hospital potentially saved $629,776. IMPLICATION FOR PRACTICE: Findings from the project suggest that implementation of a fluidized positioner can redistribute pressure to the occiput, offload craniotomy incision sites, and prevent pressure injuries.

The Lived Experiences of Persons With Ostomies Attending a Support Group: A Qualitative Study.

PURPOSE: The purpose of this study was to describe the lived experiences of patients with ostomies participating in a support group. DESIGN: Qualitative, descriptive, phenomenological study. SUBJECT AND SETTING: Fifteen adults with different types of ostomies were recruited from support groups in the state of Georgia. METHODS: Semistructured interviews were digitally audio-recorded and transcribed verbatim. Analyses of data were performed using Parse's 5-step thematic analysis. RESULTS: Four major themes and 10 subthemes emerged from the interviews: (1) theme 1-support group gives hope and changes lives, with 2 subthemes of increased knowledge and provided new knowledge and allows open communication; (2) theme 2-changes in body image had 2 subthemes, some things are different and everyone is the same; (3) theme 3-I am not alone resulted in 4 subthemes of feeling of belonging, willingness to be helped, being supported, and developing lifelong relationships; and (4) theme 4-being independent manifested 2 subthemes including confidence in rejoining society, and building confidence and decreased shame. CONCLUSION: We found that participation in an ostomy support group allowed individuals with ostomies to function at more advanced levels than they were before participating in the support group. The lived experiences were characterized by hope, willingness to live fully again, participating in different activities, and making new friends. Participants shared their positive experiences with others who were experiencing the same problems they once experienced. These findings add to and support the body of knowledge related to the interactions between nurses and individuals with ostomies as well as the care needed to ensure a safe discharge from the acute care facility. New knowledge gained may help in the improvement of the education provided during hospitalization. Providing this information will equip patients and families with a better understanding of and methods to care for their new ostomies and develop an acceptance of their new health status.