Using a Sleep Protocol to Limit Sleep Interruptions on a Medical-Surgical Unit.

A quality improvement effort was designed to coordinate care in minimizing sleep interruptions to allow patients 6 or more hours of uninterrupted sleep. An interprofessional team developed a sleep protocol (HUSH) and coordinated care activities to reduce sleep interruptions on a 30-bed medical-surgical-telemetry unit. Changes in patient perceptions of noise and number of hours of restful sleep were compared before and after implementation. Results indicate a 9% improvement in quiet domain scores.

Relationships Among Nurse Manager Leadership Skills, Conflict Management, and Unit Teamwork.

OBJECTIVE: The aim of this study is to examine the relationships among staff nurse perceptions of their nurse manager (NM) leadership ability, conflict management, and team backup on medical-surgical units. BACKGROUND: Team backup, an important component of teamwork, is crucial to patient safety and outcomes. A threat to successful teamwork is ineffective conflict management. There is scant knowledge, however, about NM conflict management skills and unit teamwork through the concept of team backup. METHODS: Secondary analyses were conducted utilizing data previously collected from a sample of 257 staff nurses. A series of multiple regressions, including a mediation model, were estimated to determine relationships among variables. RESULTS: Positive relationships were substantiated among the variables of NM leadership ability, conflict management, and team backup. Staff nurse perceptions of NM leadership ability were a significant predictor of conflict management and team backup. CONCLUSION: Findings support the importance of the NM demonstrating skilled leadership and the ability to manage conflicts and to develop team backup. This study further highlights the importance of conflict management as a leadership competency.

Palliative Care Screening: Appraisal of a Tool to Identify Patients' Symptom Management and Advance Care Planning Needs.

BACKGROUND: The palliative care needs of hospitalized patients often go unmet, resulting in unrelieved symptoms and a lack of understanding about advance care planning. OBJECTIVES: This article analyzes the 10-item Palliative Assessment Screening Tool (PAST) to determine if the PAST aids in the identification of hospitalized patients with palliative care needs and facilitates completion of advance directives. METHODS: A systematic review of studies published from 2012-2016, as well as a retrospective chart review, were used to analyze the PAST. For this 12-week pilot study, all adult patients either admitted or transferred to a 24-bed medical-surgical oncology/orthopedic unit were assessed by the bedside nurse for their potential palliative needs. FINDINGS: Using the PAST seems to improve the identification of patients with palliative needs, leading to better management of symptoms. The PAST is also likely useful in facilitating the completion of advance directives, but this requires further study.

Operational Failures Detected by Frontline Acute Care Nurses.

Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.

Preparing Critical Care and Medical-Surgical Nurses to Open a New Hospital.

Building a new hospital is an exciting time. However significant planning is required to prepare staff to assume care of patients in an environment with new workflow changes and new equipment. The challenges of this advanced preparation are compounded when the opening of the new hospital includes the planned move of the inpatient census of patients from an existing hospital to the new hospital. Goals and objectives on the move day include patient and staff safety, with a seamless transition to the new environment. This article describes the experiences and strategies used by an adult inpatient department to successfully open a new hospital.

Student QSEN Participation During an Adult Medical-Surgical Rotation.

With the six QSEN competencies woven throughout the baccalaureate nursing curriculum, which includes high-fidelity simulation, the aim of this research was to uncover deficits in QSEN-related clinical opportunities. Pre-licensure BSN nursing students enrolled in a sophomore-level medical-surgical rotation augmented with 25 percent simulation were observed directly, with time-on-task for each QSEN competency recorded and tabulated. The students were found to spend little time addressing several of the six competency areas in both clinical and simulation settings. Fully integrated classroom, simulation, and clinical experiences need to be considered in an effort to offer a full spectrum of QSEN-based knowledge and skill theory and practice for pre-licensure nursing students.

Clinical Leadership: A Call to Action.

Clinical nurses are expected to assume leadership roles to enhance patient care and assure efficient work processes. Dimensions of clinical leadership and the essential knowledge and skills of the clinical leader are described.

Nurses' Perceptions of Role, Team Performance, and Education Regarding Resuscitation in the Adult Medical-Surgical Patient.

The purpose of this study was to explore nurses' perception of their roles, team performance, and educational needs during resuscitation using an electronic survey. Findings provide direction for clinical practice, nursing education, and future research to improve resuscitation care.