Nurse Engagement: What are the Contributing Factors for Success?

The concept of nurse engagement is often used to describe nurses' commitment to and satisfaction with their jobs. In reality, these are just two facets of engagement. Additional considerations include nurses' level of commitment to the organization that employs them, and their commitment to the nursing profession itself. Because nurse engagement correlates directly with critical safety, quality, and patient experience outcomes, understanding the current state of nurse engagement and its drivers must be a strategic imperative. This article will discuss the current state of nurse engagement, including variables that impact engagement. We also briefly describe the potential impact of compassion fatigue and burnout, and ways to offer compassionate connected care for the caregiver. Such insight is integral to the profession's sustainability under the weight of demographic, economic, and technological pressures being felt across the industry, and is also fundamental to the success of strategies to improve healthcare delivery outcomes across the continuum of care.

Improving the patient experience: real-world strategies for engaging nurses.

Patients spend more time with nurses during an admission than with any other profession in the hospital. Nurses and their interactions with patients are central to shaping and improving the patient's experience. Patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, drives 30% of value-based purchasing (VBP) scores and incentive payments, as prescribed under the Patient Protection and Affordable Care Act. Hospital performance on the communication with nurses' domain within HCAHPS predicts performance on several other domains. In addition, nurses at the bedside have significantly lower engagement scores than nurses who are not involved in direct patient care. Considering the relationship between nurse engagement and patient experience and the relationship between patient experience and hospital success under VBP, pursuing strategies and tactics that will foster and sustain nurse engagement is critical for nurse executives.

Pediatric short bowel syndrome: redefining predictors of success.

OBJECTIVE: To determine predictors of survival and of weaning off parenteral nutrition (PN) in pediatric short bowel syndrome (SBS) patients. SUMMARY BACKGROUND DATA: Pediatric SBS carries extensive morbidity and high mortality, but factors believed to predict survival or weaning from PN have been based on limited studies. This study reviews outcomes of a large number of SBS infants and identifies predictors of success. METHODS: Multivariate Cox proportional hazards analysis was conducted on 80 pediatric SBS patients. Primary outcome was survival; secondary outcome was ability to wean off PN. Nonsignificant covariates were eliminated. P < 0.05 was considered significant. RESULTS: Over a mean of 5.1 years of follow-up, survival was 58 of 80 (72.5%) and 51 weaned off PN (63.8%). Cholestasis (conjugated bilirubin > or =2.5 mg/dL) was the strongest predictor of mortality (relative risk [RR] 22.7, P = 0.005). Although absolute small bowel length was only slightly predictive, percentage of normal bowel length (for a given infant's gestational age) was strongly predictive of mortality (if <10% of normal length, RR of death was 5.7, P = 0.003) and of weaning PN (if > or =10% of normal, RR of weaning PN was 11.8, P = 0.001). Presence of the ileocecal valve (ICV) also strongly predicted weaning PN (RR 3.9, P < 0.0005); however, ICV was not predictive of survival. CONCLUSIONS: Cholestasis and age-adjusted small bowel length are the major predictors of mortality in pediatric SBS. Age-adjusted small bowel length and ICV are the major predictors of weaning from PN. These data permit better prediction of outcomes of pediatric SBS, which may help to direct future management of these challenging patients.

Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition.

OBJECTIVE: The desire for evidence-based clinical guidelines for nutritional support of the preterm infant has been identified. Published evidence has not yielded clear guidelines about the best method of delivery, substrate use, or appropriate outcome measure to evaluate nutrition support. In addition, reports on research of nutrition support often fail to give the most rudimentary process necessary to improve quality in various unit settings. METHODS: The Vermont Oxford Network "Got Milk" focus group developed eight potentially better practices for nutrition support, implementation strategies for these practices, and a comprehensive appraisal process to measure nutrition outcome in preterm infants. RESULTS: After implementation of the potentially better practices, all participating institutions showed earlier initiation of nutrition support, earlier attainment of adequate energy intakes, reduced delay in reaching full enteral feeds, more consistent nutrition support practice, decreased length of stay, cost savings, and improved growth at time of discharge. CONCLUSIONS: Development and implementation of evidence-based better nutrition support practices in neonates led to improved nutrient intake and growth with reduced length of stay and related costs. Consistent, comprehensive, multidisciplinary appraisal of practice is an integral component of improving nutrition outcomes in the neonatal population.

Improving the blood product ordering to administration process.

UNLABELLED: A four-pronged approach to improving the blood product delivery system resulted in a significant decrease in the number of blood products ordered STAT, increased ability of the blood bank to fulfill STAT requests in a timely manner, and a significant decrease in the number of blood products outdated and discarded. KEYWORDS: blood products, performance improvement

An exploratory look at hand strength and hand size among preschoolers.

The purpose of this study was to develop an initial understanding about grip strength, pinch strength and hand size in normally developing 3-, 4-, and 5-year-old children. This study also investigated whether there were relationships among lowing variables: hand strength, hand size, age, and gender. A Jamar dynamometer was used to measure grip strength, and a Jamar pinch gauge was used to measure lateral pinch strength. The study population consisted of 81 preschool children from culturally an economically diverse communities in New York City. Hand strength and hand size were found to increase with each age level. The 5-year-olds were strongest in grip and pinch ability and had larger hands than the 3-year-olds and 4-year-olds. There was no statistically significant difference observed between the boys and the girls or the preferred hand in terms of hand strength.