Developing, implementing, and evaluating a professional practice model.

This article describes how The Compass, a professional practice model (PPM), was developed through clinical nurse involvement, review of literature, expert opinion, and an innovative schematic. Implementation was supported through a dynamic video account of a patient story, interwoven with The Compass. Postproject evaluation of PPM integration demonstrates opportunities for professional nursing development and future planning.

Implementing the 2005 American Heart Association guidelines, including use of the impedance threshold device, improves hospital discharge rate after in-hospital cardiac arrest.

OBJECTIVE: To determine the impact of the 2005 American Heart Association cardiopulmonary resuscitation (CPR) guidelines, including use of an impedance threshold device (ITD), on survival after in-hospital cardiac arrest. METHODS: Two community hospitals that tracked outcomes after in-hospital cardiac arrest pooled and compared their hospital discharge rate before and after implementing the 2005 American Heart Association CPR guidelines (including ITD) in standardized protocols. In CPR we used the proper ventilation rate, allowed full chest-wall recoil, conducted continuous CPR following intubation, and used an ITD. We compared historical control data from a 12-month period at St Cloud Hospital, St Cloud, Minnesota, to data from a subsequent 18-month intervention phase. We compared historical control data from a 12-month period at St Dominic Hospital, Jackson, Mississippi to a subsequent 12-month intervention phase. 507 patients received CPR during the study period. Patient age and sex were similar in the control and intervention groups. RESULTS: The combined hospital discharge rate for patients with an in-hospital cardiac arrest was 17.5% in the control group (n=246 patients), which is similar to the national average, versus 28% in the intervention group (n=261 patients) (P=.006, odds ratio 1.83, 95% CI 1.17-2.88). The greatest benefit of the intervention was in patients with an initial rhythm of pulseless electrical activity: 14.4% versus 29.7% (P=.014, odds ratio 2.50, 95% CI 1.15, 5.58). Neurological function (as measured with the Cerebral Performance Category scale) in survivors at hospital discharge was similar between the groups. CONCLUSIONS: Implementation of improved ways to increase circulation during CPR increased the in-hospital discharge rate by 60%, compared to historical controls in 2 community hospitals. These data demonstrate that immediate care with improved means to circulate blood during CPR significantly reduces hospital mortality from inhospital sudden cardiac arrest.

Using research to determine support for a policy on family presence during resuscitation.

National guidelines and professional organizations have recommended allowing family presence during resuscitation and bedside invasive procedures. Studies found that only 5% of critical care units have written policies. Periodic requests by family members prompted the creation of a task force, including nurses, physicians, and respiratory therapists, to develop this controversial policy. Before development, a research study of healthcare personnel attitudes, concerns, and beliefs toward family presence during cardiopulmonary resuscitation and bedside invasive procedures was done. This descriptive and correlational study showed support for family presence by critical care and emergency department nurses. Findings revealed both support and non-support for families to be present during resuscitative efforts. Providing family presence as an option offers an opportunity for reluctant healthcare team members to refuse their presence and an opportunity for those who support family presence to welcome the family.