Evaluation of Education and Patient Screening for Delirium Among Patients With Stroke: Knowledge, Confidence, and Patient Outcomes.

BACKGROUND: Clinical staff showed a knowledge deficit with identifying and managing delirium. The effect of a validated assessment tool and delirium education on staff knowledge and confidence and patient outcomes was analyzed. METHOD: A descriptive qualitative and quantitative pre- and postintervention study analyzed the demographics of patients with stroke and clinical outcomes pre- and postimplementation of an assessment tool and delirium staff education. RESULTS: Early and frequent delirium assessments, use of an assessment tool, a delirium order set, and education for clinical staff resulted in increased knowledge and confidence with identifying and managing patients with stroke, an increase in the number of patients with stroke discharged home, and decreased incidence of hospital-acquired urinary tract infection and pneumonia. CONCLUSION: Delirium education positively impacts staff knowledge and confidence with the identification and management of delirium. Patients with an acute stroke may benefit from early and frequent delirium assessments. Staff education, structured assessment frequency with a validated assessment tool, and specific interventions affect patient outcomes, such as infection rates and discharge level of care. [J Contin Educ Nurs. 2023;54(2):61-70.].

Delayed Newborn First Bath and Exclusive Breastfeeding Rates.

OBJECTIVE: To develop an evidence-based practice project to evaluate the effect of delaying a newborn's first bath on exclusive breastfeeding rates at discharge. DESIGN: A pre- and post-implementation evaluation of the effect of delaying the first bath on exclusive breastfeeding rates at discharge. SETTING: A postpartum unit in a southern California community hospital. PARTICIPANTS: Breastfeeding dyads of women and newborns (>37 weeks gestational age) who were admitted to the postpartum unit. INTERVENTION/MEASUREMENTS: Postpartum nurses involved in the unit practice council, in collaboration with unit leadership, changed the newborn's first bath practice through development of a bathing guideline, nurse education, and mother education. Measurements of the practice change included time of the first bath and exclusive breastfeeding rates at discharge. RESULTS: We observed an increased time for the newborn's first bath from 6.88 hours to 13.71 hours (p ≤ .001). The number of times women chose not to bathe their newborns while in the hospital also increased by approximately seven times, from 0.16% to 1.1%. The rate of exclusive breastfeeding at discharge did not change significantly after implementation (p ≥ .05), regardless of when the first bath was given. CONCLUSION: Delaying a newborn's first bath was not associated with an increase in exclusive breastfeeding rates. More research is needed to determine the effect of bath times.

Nurses' knowledge and comfort levels using the Physician Orders for Life-sustaining Treatment (POLST) form in the progressive care unit.

Many patients are admitted to the hospital with an active Physician Orders for Life-sustaining Treatment (POLST) Form; however, not all registered nurses (RNs) are familiar with the form or comfortable with initiating a discussion about end-of-life care. Evidence indicates that an education program increases RNs' knowledge and utilization of the POLST form. The purpose of this evidence-based practice project was to answer the question: among the RNs in a progressive care unit (PCU), does implementing a formal evidence-based practice POLST program compared to current practice increase RNs' knowledge and comfort level using the POLST form? A pre-post education survey was used. Results indicated a POLST education program increased PCU RNs' knowledge and comfort level in using the POLST form. It is recommended to include POLST form education for PCU RNs in workplace education programs.

Feeling safe during an inpatient hospitalization: a concept analysis.

AIM: This paper aims to explore the critical attributes of the concept feeling safe. BACKGROUND: The safe delivery of care is a high priority; however; it is not really known what it means to the patient to 'feel safe' during an inpatient hospitalization. This analysis explores the topic of safety from the patient's perspective. DESIGN: Concept analysis. DATA SOURCES: The data bases of CINAHL, Medline, PsychInfo and Google Scholar for the years 1995-2012 were searched using the terms safe and feeling safe. METHODS: The eight-step concept analysis method of Walker and Avant was used to analyse the concept of feeling safe. Uses and defining attributes, as well as identified antecedents, consequences and empirical referents, are presented. Case examples are provided to assist in the understanding of defining attributes. RESULTS: Feeling safe is defined as an emotional state where perceptions of care contribute to a sense of security and freedom from harm. Four attributes were identified: trust, cared for, presence and knowledge. Relationship, environment and suffering are the antecedents of feeling safe, while control, hope and relaxed or calm are the consequences. Empirical referents and early development of a theory of feeling safe are explored. CONCLUSION: This analysis begins the work of synthesizing qualitative research already completed around the concept of feeling safe by defining the key attributes of the concept. Support for the importance of developing patient-centred models of care and creating positive environments where patients receive high-quality care and feel safe is provided.

Staff practice, attitudes, and knowledge/skills regarding evidence-based practice before and after an educational intervention.

BACKGROUND: Today's clinicians have different levels of knowledge and skill related to evidence-based practice, depending on their educational background, level of experience, and interest. This multidisciplinary study assessed nurses' baseline and posteducation practice, attitudes, and knowledge/skills regarding evidence-based practice. METHODS: A descriptive pre- and postsurvey design study evaluated clinical staff's practice, attitudes, and knowledge/skills regarding evidence-based practice with the Clinical Effectiveness and Evidence-Based Practice Questionnaire. RESULTS: A total of 327 participants (24%) completed the presurvey and 282 (20%) completed the postsurvey. No statistically significant changes were found in practice, attitudes, and knowledge/skills after the online education. In the multivariate analysis, online education was not a significant predictor of practice, attitudes, or knowledge/skills regarding evidence-based practice; graduate educational degree, formal evidence-based practice classes, and registered nurse status were statistically significant positive predictors. CONCLUSION: Administering self-learning online modules may not be the most effective method for expanding evidence-based practice abilities and knowledge/skills of nurses.

Is this the right patient? An educational initiative to improve compliance with two patient identifiers.

A rehabilitation nursing unit implemented an educational initiative to improve compliance with two patient identifiers. The education consisted of a poster presentation and then, 2 months later, a mandatory in-service education program. Compliance with two patient identifiers improved, although more improvement was demonstrated after the mandatory in-service. The results of this performance improvement project suggest that investing time and money in safety initiatives improves staff practice patterns.