Lived Experiences of ICU Nurses During COVID-19.

This qualitative, phenomenological study described ICU nurses' lived experiences caring for patients with COVID-19 while trying to engage in self-care and care for their families. Eleven ICU nurses shared their individual experiences working in a hospital ICU. Watson's theory of Caring Science guided the study to ensure a holistic interpretation of the data. Six themes and fifteen subthemes emerged, which revealed that ICU nurses faced barriers to self-care. The conclusion of the data analysis was that hospital leaders need to make Caring Science evident to ICU nurses during crises by trained Caritas coaches to build resilient frontline nurses through compassion.

Nurses' Ability to Recognize and Prevent Opioid-Induced Respiratory Depression: An Evidenced-Based Practice Project.

Opioids are the primary therapy for acute postoperative pain, despite being associated with opioid-induced respiratory depression (OIRD). The purpose of this study was to improve nurses' knowledge, confidence, and ability to recognize, prevent, and treat OIRD in postoperative inpatients and evaluate the feasibility of using the Pasero Opioid-Induced Sedation Scale (POSS). Registered nurses completed three tools: (1) an Opioid Knowledge Self-Assessment, which was administered pre- and post-education; (2) a Confidence Scale, which was administered pre- and post-education; and (3) a POSS Perceptions and Usability Scale that was administered post-education. Nurses were educated on the POSS and then immediately following the training practiced by undertaking a patient assessment using the instrument. They then completed the POSS Perceptions and Usability Scale to rate their perception of the feasibility of using the POSS. Between preeducation and posteducation, participant knowledge increased in the following areas: recognizing opioid-induced side effects, dose selection, risk factors for oversedation, and information to make clinical decisions. However, there was a drop in scores when asked about knowledge of who is at risk for opioid-related side effects. These findings support our conclusion that OIRD education improves nursing confidence and knowledge. There was significant agreement between the nurse and subject matter experts POSS scores, indicating that this tool is easy to use.

Experiences of Caregivers Caring for a Family Member Who Is Using Hemodialysis.

In this qualitative phenomenological study using a purposive sample, six caregivers of patients on hemodialysis were interviewed about their experiences of caring for a family member who uses hemodialysis. Six major themes and 12 subthemes were identified. Perceptions of caregivers are that caregiving is hard work and stressful; however, caregivers found the experience to be meaningful, even though the stress may interfere with their own health status. Study limitations include a small sample that may not represent the entirety of caregivers' perspectives. Implications for practice include developing informal and formal support systems and exercise programs that help this population manage the stress associated with caregiving for family members using hemodialysis.

Rehabilitation Nurses' Knowledge, Attitudes, and Behaviors for Preventing Urinary Tract Infections From Intermittent Catheterization.

PURPOSE: The aim of this study was to develop and examine the reliability of a survey to assess knowledge, attitudes, and behaviors (KAB) of rehabilitation nurses for preventing urinary tract infections in persons requiring intermittent catheterization. DESIGN: Cross-sectional survey with principal component analysis. METHODS: Survey development and administration based on national guidelines. FINDINGS: Principal component analysis produced three reliable components of KAB explaining 54.5% of response variance. Results indicate that nurses report adequate knowledge and training. Although the facility had an evidence-based online catheterization procedure, staff reported that the procedure was not helpful nor useable. Twenty-eight percent incorrectly identified the root cause of urinary tract infection, and 45% reported that other nurses always washed their hands. Barriers to using standard intermittent catheterization technique were staff, time, and patient variables. CONCLUSION: The modified survey is a reliable measure of KAB. CLINICAL RELEVANCE: The survey assists with identifying knowledge gaps, customizing education, and changing practice.

Improving Resident Oral Health and Adherence to a Ventilator-Associated Pneumonia Bundle in a Skilled Nursing Facility.

Ventilator-associated pneumonia (VAP) is common with mechanical ventilation. VAP bundles have improved outcomes in acute care and long-term acute care hospitals. This article reports on an implementation of a VAP bundle designed for a skilled nursing facility (SNF). The primary goal was to improve oral health, a significant factor for VAP, and improve SNF nurse adherence to the bundle. Improvements in oral health and adherence were demonstrated. Nurses had difficulty with adhering to maintaining the tracheostomy cuff seal.

Interprofessional Education and Team-Based Learning in a Research Methods Course.

This article describes team-based pedagogical strategies for a hybrid, four-credit research methods course with students from nursing, exercise, and nutrition science. The research problem of concussion in football, a socially relevant and controversial topic, was used to explore interprofessional perspectives and develop shared problem solving. The course was designed using permanent teams, readiness assurance, application exercises, and peer evaluation to facilitate student achievement of competencies related to interprofessional collaboration and research application. Feedback from students, faculty, and the Readiness for Interprofessional Learning Scale was used to evaluate the learning innovation.

Universal Pressure Ulcer Prevention Bundle With WOC Nurse Support.

PURPOSE: This study examined the effectiveness of a universal pressure ulcer prevention bundle (UPUPB) applied to intensive care unit (ICU) patients combined with proactive, semiweekly WOC nurse rounds. The UPUBP was compared to a standard guideline with referral-based WOC nurse involvement measuring adherence to 5 evidence-based prevention interventions and incidence of pressure ulcers. DESIGN: The study used a quasi-experimental, pre-, and postintervention design in which each phase included different subjects. Descriptive methods assisted in exploring the content of WOC nurse rounds. SUBJECT AND SETTING: One hundred eighty-one pre- and 146 postintervention subjects who met inclusion criteria and were admitted to ICU for more than 24 hours participated in the study. The research setting was 3 ICUs located at North Memorial Medical Center in Minneapolis, Minnesota. METHODS: Data collection included admission/discharge skin assessments, chart reviews for 5 evidence-based interventions and patient characteristics, and WOC nurse rounding logs. Study subjects with intact skin on admission identified with an initial skin assessment were enrolled in which prephase subjects received standard care and postphase subjects received the UPUPB. Skin assessments on ICU discharge and chart reviews throughout the stay determined the presence of unit-acquired pressure ulcers and skin care received. Analysis included description of WOC nurse rounds, t-tests for guideline adherence, and multivariate analysis for intervention effect on pressure ulcer incidence. Unit assignment, Braden Scale score, and ICU length of stay were covariates for a multivariate model based on bivariate logistic regression screening. RESULTS: The incidence of unit-acquired pressure ulcers decreased from 15.5% to 2.1%. WOC nurses logged 204 rounds over 6 months, focusing primarily on early detection of pressure sources. Data analysis revealed significantly increased adherence to heel elevation (t = -3.905, df = 325, P < .001) and repositioning (t = -2.441, df = 325, P < .015). Multivariate logistic regression modeling showed a significant reduction in unit-acquired pressure ulcers (P < .001). The intervention increased the Nagelkerke R-Square value by 0.099 (P < .001) more than 0.297 (P < .001) when including only covariates, for a final model value of 0.396 (P < .001). CONCLUSION: The UPUPB with WOC nurse rounds resulted in a statistically significant and clinically relevant reduction in the incidence of pressure ulcers.

Interprofessional evidence-based clinical scholar program: learning to work together.

St. Catherine University and North Memorial Medical Center conducted an Interprofessional Clinical Scholar Program (ICSP) involving five teams of staff, students, and faculty. The aim of the case study was to determine how the interprofessional teams implemented evidence-based projects. We triangulated data from interviews, field notes, and surveys to produce themes: learning to value interprofessional teams, working as a team, and being evidence-based practitioners. We found significant differences pre- and post-ICSP on the Attitudes Toward Interprofessional Teamwork and Education scale, t(14) = -5.48, p < .005, and the Terminology subscale of the Evidence-Based Practice Profile, t(15) = -4.04, p = .001. We found no change in scores on the Evidence-Based Practice Belief Scale, t(14) = -1.49, p = .156. The study supported predicted patterns of benefits from ICSP. Not all participants benefited because of variability in attendance.