Innovative Strategies for Palliative Care in the Intensive Care Unit.

Palliative care is interdisciplinary care that addresses suffering and improves the quality of care for patients and families when patients are facing a life-threatening illness. Palliative care needs in the intensive care unit include communication regarding diagnosis and prognosis, goals-of-care conversations, multidimensional pain and symptom management, and end-of-life care that may include withdrawal of mechanical ventilation and life support. Registered nurses spend the greatest amount of time with patients and families who are facing death and serious illness, so nurses must be armed with adequate training, knowledge, and necessary tools to address patient and caregiver needs and deliver high-quality, patient-centered palliative care. Innovative approaches to integrating palliative care are important components of care for intensive care nurses. This article reviews 2 evidence-based practice projects, a serious illness support tool and the 3 Wishes Project, to add to the palliative care toolkit for registered nurses and other team members.

Assessing geographic disparities in mental health research participation.

BACKGROUND: Large geographic health disparities are well-documented within the U.S. Although approximately 60 million Americans-or roughly 20% of the total U.S. population-live in rural areas, rural residents may be less likely to participate in health research, including mental health research, due to multiple barriers. This retrospective analysis evaluated the urbanity and rurality of inpatient research participants and potential research participants over a five-year period at the Experimental Therapeutics and Pathophysiology Branch (ETPB), NIMH-NIH (Bethesda, Maryland), which conducts experimental medicine and neurobiological research in mood disorders. METHODS: Participant and potential participant zip codes were converted to Rural Urban Commuting Area (RUCA) codes (1-3 urban, 4-10 rural). These results were compared with each other and with U.S. population data. RESULTS: The analysis included 182 research participants and 1864 potential research participants; the former were admitted to an in-person research unit and the latter were screened by phone or online. ETPB research participants had an urban residence rate of 93.4% and a rural residence rate of 6.6%. Potential ETPB research participants had an urban residence rate of 90.9% and a rural residence rate of 9.1%. In comparison, the U.S. urban residence rate is 80% and the rural rate is 20%. CONCLUSION: At the ETPB, both research participants with mood disorders admitted to an in-person research unit and potential research participants screened online or by phone from rural areas were under-represented relative to participants from more urban areas. Further study of research recruitment barriers in rural areas of the U.S is needed.

Strategies for successfully completing a DNP final project.

ABSTRACT: Completion of a final project is an essential component of Doctor of Nursing Practice programs. Strategies for successful project planning, implementation, and evaluation are outlined, from identifying an evidence-based practice or quality improvement project, advisor, and practice mentor through completion, presentation, and dissemination of your work.

A Stakeholder Evaluation of an RN-to-BSN Academic Progression Program.

OBJECTIVE: The aim of this study was to evaluate programmatic elements supporting BSN attainment by employed nurses holding associate degrees or diplomas, using a stakeholder involvement approach. BACKGROUND: Studies have associated higher percentages of baccalaureate-prepared nurses with improved clinical outcomes. Since 2013, the study organization supported an RN-to-BSN requirement with an academic progression benefit program and achieved an 80% BSN goal by 2021. METHODS: The Centers for Disease Control and Prevention's Framework for Program Evaluation was used. A mixed methods approach was orchestrated by a stakeholder team to explore use and importance of programmatic elements, and motivators and barriers for degree attainment, using an online survey and focus groups. RESULTS: Respondents revealed a significant association between BSN degree attainment and financial assistance and perceived importance of financial assistance and educational fairs. CONCLUSIONS: Validating organizational tactics is important for achieving increased numbers of baccalaureate-prepared nurses and supportive of the cost-effective use of resources.

Incorporating TeamSTEPPS training to improve staff collaboration in an academic level I emergency and trauma center.

BACKGROUND: Seamless communication and coordinated teamwork is paramount in high stakes clinical practice settings, such as the emergency department (ED), to prevent medical errors and ensure high quality patient care delivery. Ineffective communication in this fast-paced environment can be detrimental for patient outcomes and staff collaboration. PURPOSE: The purpose of this project was to evaluate the effect of TeamSTEPPS® training (Team strategies and Tools to Enhance Performance and Patient Safety), an evidenced based communication-training toolkit, on staff perception of teamwork and communication in an academic Level I Emergency and Trauma Center. METHODS: A prospective, single group, pre-post design with a convenience sample was employed. The sample consisted of thirty-five clinical staff members, including registered nurses (RNs) and patient care technicians (PCTs), recruited from an academic Level I Emergency and Trauma Center. A pre-intervention T-TPQ (TeamSTEPPS® teamwork and Perceptions Questionnaire) measuring staff perception of teamwork and collaboration was administered followed by a one-hour TeamSTEPPS® education session from freely-available published materials. Three weeks later, a post-intervention T-TPQ was administered. A paired samples t-test and Wilcoxon signed-rank test was used to analyze changes in scores from pre-post-test for outcome measures. RESULTS: 23 females and 12 males with a mean age of 30 years and 9 years of experience participated. T-TPQ scores showed a mean of 121.4 pre-training and mean of 128.2 after training. Paired t-test demonstrated overall pre-intervention (mean = 3.52, SD ±â€¯0.5) and post-intervention (mean = 3.78, SD = 0.4) scores were significantly improved overall (-0.29 to -0.13, p < 0.001). CONCLUSION: TeamSTEPPS® was an effective communication collaboration program to improve teamwork and communication perceptions in the ED suggesting that an evidence-based multifaceted, multimedia instructional toolkit may promote a collaborative culture of effective communication and teamwork. Long term effects of TeamSTEPPS® training in the ED requires further study.

Multimodal Education Program to Improve Nurses' Knowledge and Confidence on Delirium Recognition in a Surgical-Trauma Intermediate-Care Setting.

BACKGROUND: High incidence of delirium in hospitalized patients has been reported in the United States and is significantly associated with increased morbidity and mortality. The lack of knowledge and confidence in performing delirium assessment (KCDA) has led to significant underrecognition of delirium by nurses regardless of evidence-based education intervention. OBJECTIVE: The purpose of this study was to determine the effectiveness of a multimodal educational program (MEP) to enhance nurses' KCDA. METHODS: A MEP including an online didactic with a video-simulation and 1:1 bedside coaching with delirium screening (DS) was conducted in the surgical intermediate-care unit of an academic medical center. A quasi-experimental pre- and post-test design was used. RESULTS: Of 23 nurses, the majority were <41 years old (73.9%) and had at least a bachelor of science in nursing degree (78.3%) with <6 years of experience (60.9%). The overall KCDA scores and the performance of DS improved significantly after the MEP (p < .001). A positive correlation was noted between the changes of the KCDA scores (p = .009). CONCLUSIONS: The MEP demonstrated improvement in nurses' KCDA. The MEP should focus on an individualized learning approach with a targeted patient population, using current delirium screening tools. IMPLICATIONS FOR NURSING: Educational programs are recommended in either an orientation or continuing education program on nursing units. This is also recommended for use in other academic centers that encompass similar clinical settings and could possibly be considered for use in other disease processes.

Educational Intervention to Improve Delirium Recognition by Nurses.

BACKGROUND: Delirium poses increased morbidity and mortality risks for hospitalized patients. Underrecognition by health care providers contributes to poor outcomes for patients. Little has been published about methods used to teach health care providers how to screen for delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). OBJECTIVE: To evaluate the effectiveness of a multimodal educational intervention for nurses in the medical intensive care unit to improve their knowledge and skills regarding delirium and delirium recognition. METHODS: An educational intervention was done in the medical intensive care unit of an academic medical center. Effectiveness was evaluated via a quasi-experimental design and using preintervention and postintervention assessments. Procedural correctness of performing the CAM-ICU delirium screening also was measured. RESULTS: Nurses participated in 1 small-group session (n = 34). Fifteen sessions were conducted from June to September 2016, and assessments were completed before and after the intervention. The sample consisted of predominantly nurses with a bachelor's degree (56%) who had 1 to 5 years' experience (59%). Mean scores overall and on the knowledge subscale differed significantly (P < .001) from before to after the intervention. No correlation was found between demographic groups and score differences. Seventy-nine percent of participants used the tool correctly after the intervention. CONCLUSIONS: The educational intervention provided for these nurses further validated published reports of the benefits of an educational program about delirium. The content of the educational intervention should be targeted for the setting, the risk factors for the patient population in question, and the specific delirium screening tool used.

Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment.

Cancer-related fatigue (CRF) has deleterious effects on physical, social, cognitive, and vocational functioning, and causes emotional and spiritual distress for patients and their families; however, it remains under-recognized and undertreated. This article critically reviews and integrates the available empirical evidence supporting the efficacy of pharmacologic and nonpharmacologic treatment approaches to CRF, highlighting new evidence since 2007 and 2009 Putting Evidence Into Practice publications. Interventions that are recommended for practice or likely to be effective in improving fatigue outcomes include exercise; screening for treatable risk factors; management of concurrent symptoms; yoga; structured rehabilitation; Wisconsin ginseng; cognitive-behavioral therapies for insomnia, pain, and depression; mindfulness-based stress reduction; and psychoeducational interventions such as anticipatory guidance, psychosocial support, and energy conservation and activity management. This information can be applied to improve the management of CRF, inform health policy and program development, shape the design of clinical trials of new therapies for CRF, and drive basic and translational research.