Improving Communication and Response to Clinical Deterioration to Increase Patient Safety in the Intensive Care Unit.

BACKGROUND: In the critical care setting, early recognition of clinical decompensation is imperative to trigger prompt intervention and optimize patient outcomes. LOCAL PROBLEM: In a 20-bed surgical intensive care unit of an urban academic medical center, cases of clinical deterioration that highlighted opportunities to improve the communication process prompted a reassessment of health care provider roles and responsibilities. METHODS: A quality improvement initiative was implemented to enhance communication among intensive care unit clinical staff members, improve the timeliness of reporting clinical deterioration, and ensure implementation of timely, appropriate interventions to eliminate adverse outcomes. INTERVENTIONS: Nurses were surveyed to determine their perceptions of communication and collaboration among providers. Education was provided that focused on familiarizing nurses with clinical conditions necessitating direct notification of the attending surgical intensivist and included review of a case in which escalation of care did not occur. Multidisciplinary rounds were expanded to engage night-shift nurses in clinical discussions and decision-making. A template was created to document episodes of escalation in the electronic health record. RESULTS: Since implementation of the quality improvement interventions, no incidents of patient harm or death related to failure to escalate have occurred to date. A total of 16 episodes of escalation for clinical deterioration were documented in the electronic health record. Most nurses reported an increased level of confidence in understanding when to escalate concerns about clinical deterioration. CONCLUSION: Implementing a multimodal program to empower nurses to escalate clinical concerns directly to the attending physician eliminated adverse events related to failure to escalate.

Using a Delphi Survey to Develop Clinical Nursing Research Priorities Among Nursing Management.

OBJECTIVE: The aim of this study was to identify clinical nursing research priorities among nurse managers (NMs). BACKGROUND: Determining research priorities is the 1st step toward building a solid evidence base for clinical practice. NMs are well poised to identify research priorities, and yet, a literature review revealed a dearth of research priorities as determined by clinical NMs. METHODS: Using a Delphi survey, 38 NMs were queried at a large, urban hospital regarding critical priorities for nursing research. RESULTS: Critical priorities for clinical nursing research included nursing workforce/nursing workflow and communication (categorized as critical by 68% and 53% of NMs, respectively). Other important priorities focused on falls/patient safety/hospital-acquired infections, patient/family satisfaction, emergency preparedness, patient outcomes, and collaboration/interdisciplinary research. CONCLUSIONS: Because NMs are positioned to direct clinical research agendas, the results provide a critical guide for policy development surrounding nursing research. Directing research toward these identified topics will help build a solid evidence base for nurses and ultimately improve patient outcomes.

Emotional Intelligence of Nurse Managers: An Exploratory Study.

OBJECTIVE: The purposes of this study are to determine the level of emotional intelligence (EI) among nurse managers (NMs) in an academic medical center and determine the relationship of EI and demographic variables. BACKGROUND: Emotional intelligence is a concept that warrants further research in nursing because there is a huge gap in knowledge about nurse leaders' EI. METHODS: Data were collected from 38 NMs recruited from a large academic medical center in the Northeast. RESULTS: Mean EI scores among NMs were average. Nurse managers with less than 2 years of experience had statistically significant lower "using emotions" branch score and strategic EI. Nurse managers with a masters' degree in nursing scored significantly higher in using emotions branch score than did those with a masters' degree in a related field. CONCLUSION: Opportunities exist to enhance the EI of NMs.