Interprofessional Evidence-Based Strategies to Enhance Provider and Patient Interactions During Electronic Health Record Use.

The purpose of this study was to develop and disseminate evidence-based interprofessional strategies to enhance provider-patient interactions, including ethical issues, that arise during electronic documentation. An interprofessional simulation scenario was implemented with students, and strategies developed were then used to train hospital staff. Nurses reported being significantly more likely to use the interprofessional strategies after completing the program. Interprofessional simulation and training is an effective method to address challenges that arise during electronic health record use.

Pilot Testing the Clinically Aligned Pain Assessment (CAPA) Measure.

BACKGROUND: Pain is one of the most common symptoms experienced by patients in acute care hospitals and acutely ill patients experience both acute and chronic pain. Unrelieved pain can have a profound negative impact on individuals' functional status, well-being, quality of life, and satisfaction with care. For providers, managing pain can be challenging. While the numeric rating scale is widely accepted and used, it measures only pain intensity. CAPA® pain assessment offers an alternative approach in which providers have a conversation with patients about pain and how it impacts five key areas. AIMS: The purpose of this pilot project was to evaluate provider and patient satisfaction with the CAPA® measure as compared to a numeric rating scale when evaluating patients' experience with pain. DESIGN: A mixed methods qualitative design was employed. SETTING: This study was conducted at a 247-bed community teaching hospital in Providence, RI. PARTICIPANTS: The target sample included patients admitted to the study units and providers who delivered care to patients on the study units and used the numeric rating scale and the CAPA® method of assessment. METHODS: In focus groups, nurses and physicians were asked about satisfaction with evaluating patients' pain with the numeric rating scale as compared to CAPA®. During a one-to-one interview, patients were asked to describe their impressions of the two assessment measures. RESULTS: Nurses, physicians, and patients were satisfied that CAPA® effectively evaluated pain and provided more information about pain than the numeric rating scale. CONCLUSIONS: CAPA® is recommended as a supporting assessment to evaluate patients' pain experience in acute care.

Nurses' Perception of the Impact of Electronic Documentation on the Nurse-Patient Relationship.

BACKGROUND: While there are many benefits of electronic medical record documentation, the presence of a computer may adversely affect provider-patient interaction. PURPOSE: The purpose of this project was to examine staff nurses' perception of the impact of electronic documentation in the presence of the patient on the nurse-patient relationship. METHODS: A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses. RESULTS: Nurses identified benefits and challenges to electronic medical record documentation as well as strategies used to maintain therapeutic relationships and communication. Numerous nurses commented that documenting with their back to the patient had a negative impact on the nurse-patient relationship and communication. CONCLUSIONS: Both novice and expert nurses identified strategies that they used to ensure they were "maintaining the connection" to patients during electronic medical record documentation.

Leader Influence, the Professional Practice Environment, and Nurse Engagement in Essential Nursing Practice.

OBJECTIVE: The purpose of this study was to examine relationships between leaders' perceived influence over professional practice environments (PPEs) and clinical nurses' reported engagement in essential professional nursing practice. BACKGROUND: There is little empirical evidence identifying impact of nurse leader influence or why nursing leaders are not perceived, nor do they perceive themselves, as influential in healthcare decision making. METHODS: A nonexperimental method of prediction was used to examine relationships between engagement in professional practice, measured by Essentials of Magnetism II (EOMII) tool, and nurse leaders' perceived influence, measured by Leadership Influence over Professional Practice Environment Scale (LIPPES). A convenience sample of 30 nurse leaders and 169 clinical nurses, employed in a 247-bed acute care Magnet® hospital, participated. RESULTS: Findings indicated that leaders perceived their influence presence from "often" to "always," with mean scores of 3.02 to 3.70 on a 4-point Likert scale, with the lowest subscale as "access to resources" for which a significant relationship was found with clinical nurses' reported presence of adequate staffing (P < .004). Clinical nurses reported more positive perceptions in adequacy of staffing on the EOMII when nurse leaders perceived themselves to be more influential, as measured by the LIPPES, in collegial administrative approach (P = .014), authority (P = .001), access to resources (P = .004), and leadership expectations of staff (P = .039). Relationships were seen in the outcome measure of the EOMII scale, nurse-assessed quality of patient care (NAQC), where nurse leaders' perception of their authority (P = .003) and access to resources (P = .022) positively impacted and was predictive of NAQC. CONCLUSIONS: Findings support assertion that nurse leaders are integral in enhancing PPEs and their influence links structures necessary for an environment that supports outcomes.

Prevention of Medical Device-Related Pressure Injuries Associated With Respiratory Equipment Use in a Critical Care Unit: A Quality Improvement Project.

Medical devices have been identified as an extrinsic risk factor for development of pressure injuries, with as many as 30% to 70% of medical device-related pressure injuries resulting from respiratory equipment. This article describes a quality improvement project undertaken to reduce the occurrence of respiratory device-related pressure injuries in a critically care unit. Multiple actions were implemented to achieve this goal. Respiratory therapists were trained to document occurrences on a daily basis, and apparent cause analyses were conducted on each occurrence. An interdisciplinary team conducted biweekly rounds on patients with respiratory devices and consulted other professionals as indicated. Nurses and respiratory therapists attended an evidence-based, collaborative, educational offering and completed a measure of team functioning before the program and at the end of the study period. The occurrence rates of respiratory device-related pressure injuries were reduced over the project period, and these changes were sustained over the subsequent 12 months.

Knowing 'something is not right' is beyond intuition: development of a clinical algorithm to enhance surveillance and assist nurses to organise and communicate clinical findings.

AIMS AND OBJECTIVES: To develop a clinical algorithm to guide nurses' critical thinking through systematic surveillance, assessment, actions required and communication strategies. To achieve this, an international, multiphase project was initiated. BACKGROUND: Patients receive hospital care postoperatively because they require the skilled surveillance of nurses. Effective assessment of postoperative patients is essential for early detection of clinical deterioration and optimal care management. Despite the significant amount of time devoted to surveillance activities, there is lack of evidence that nurses use a consistent, systematic approach in surveillance, management and communication, potentially leading to less optimal outcomes. Several explanations for the lack of consistency have been suggested in the literature. DESIGN: Mixed methods approach. METHODS: Retrospective chart review; semi-structured interviews conducted with expert nurses (n = 10); algorithm development. RESULTS: Themes developed from the semi-structured interviews, including (1) complete, systematic assessment, (2) something is not right (3) validating with others, (4) influencing factors and (5) frustration with lack of response when communicating findings were used as the basis for development of the Surveillance Algorithm for Post-Surgical Patients. CONCLUSION: The algorithm proved beneficial based on limited use in clinical settings. Further work is needed to fully test it in education and practice. RELEVANCE TO CLINICAL PRACTICE: The Surveillance Algorithm for Post-Surgical Patients represents the approach of expert nurses, and serves to guide less expert nurses' observations, critical thinking, actions and communication. Based on this approach, the algorithm assists nurses to develop skills promoting early detection, intervention and communication in cases of patient deterioration.

Empowering the development of a nurse-driven protocol.

Results from a research project examining nurses' knowledge of diabetes empowered direct-care nurses to develop a hypoglycemia protocol, increasing accountability for the care provided and helping move from tradition-based to evidence-based practice.

An evidence-based oral care protocol to decrease ventilator-associated pneumonia.

The purpose of this study was to examine the impact of 0.12% chlorhexidine rinses and an oral care protocol on ventilator-associated pneumonia rates. A quasi-experimental preintervention-postintervention design was used. The sample included all patients admitted to critical care and on mechanical ventilation at any time during the study period. Data were collected 6 months before and 12 months after intervention. Ventilator-associated pneumonia rates were reduced from 4.3 to 1.86 per 1000 ventilator-days during the study period, with an estimated cost avoidance of $700,000 to $798,000.

The brave new world of GEC evaluation: the experience of the Rhode Island Geriatric Education Center.

In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the increased accountability requirements. The evaluation focused on RIGEC's series of continuing education, day-long workshops for health and social service professionals, the completion of all seven of which leads to a Certificate in Interdisciplinary Practice in Geriatrics.

Destination bedside: using research findings to visualize optimal unit layouts and health information technology in support of bedside care.

This study explored the impact of unit design and healthcare information technology (HIT) on nursing workflow and patient-centered care (PCC). Healthcare information technology and unit layout-related predictors of nursing workflow and PCC were measured during a 3-phase study involving questionnaires and work sampling methods. Stepwise multiple linear regressions demonstrated several HIT and unit layout-related factors that impact nursing workflow and PCC.

Effectiveness of 2 methods of chlorhexidine bathing.

The purposes of this study were to examine the impact of chlorhexidine on the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on an inpatient oncology unit, compare the cost of 2 chlorhexidine bath delivery methods, and evaluate nursing time and satisfaction to administer the baths. MRSA and VRE transmission rates decreased from those during the previous years. Costs associated with bathing increased, but time to administer the bath decreased with the chlorhexidine cloths, and nursing staff reported satisfaction with their use.

Same-handed and mirrored unit configurations: is there a difference in patient and nurse outcomes?

OBJECTIVE: Despite growing awareness that hospital design can impact meaningful outcomes, the same-handed medical-surgical inpatient unit configuration has not been empirically investigated. This study measured differences in patient and nurse outcomes between the same-handed and mirrored unit configurations. BACKGROUND: It has been hypothesized that the same-handed unit configuration may contribute to operational efficiencies, fewer adverse events, and reduced noise levels. METHODS: A natural experiment of 8 medical-surgical inpatient units used 2 questionnaires developed for the study. The first questionnaire was available to registered nurses. The second was available to the nurses' patients. RESULTS: Compared with participants on the mirrored unit configuration, participants on the same-handed unit configuration reported lower noise levels, better sleep quality, more frequent approaches to patients' right side, and improved satisfaction with organization of the workspace at patients' bedsides. The increased right-side approach was related to fewer instances of patients catching themselves from falling. CONCLUSION: The same-handed unit configuration benefits patient experience, patient safety, and operational outcomes. Before renovation or new construction of units, nurse executives should consider the advantages of a same-handed unit configuration.

Impact of lower extremity strengthening exercises and mobility on fall rates in hospitalized adults.

Preventing falls in acute care hospitals is a major challenge, and achieving positive outcomes has remained elusive. The purpose of this study was to examine the impact of lower extremity strengthening exercises and mobility on fall rates and fall rates with injury. A nonequivalent control group design was used. Subjects on the intervention unit received targeted lower extremity strengthening exercises and ambulation using a nurse-driven mobility protocol; subjects on the control unit received ambulation alone. One assisted fall occurred on the intervention unit.

A breast navigator program: barriers, enhancers, and nursing interventions.

PURPOSE/OBJECTIVES: to identify barriers to and enhancers of completion of breast cancer treatment from the perspective of participants in a breast health navigator program. RESEARCH APPROACH: qualitative, using focus group methodology and telephone interview. SETTING: two teaching hospital ambulatory cancer centers. PARTICIPANTS: women enrolled in the breast navigator program, including patients who completed (n = 13) and did not complete (n = 1) breast cancer treatment. METHODOLOGIC APPROACH: researchers used semistructured, open-ended questioning to guide the interviews and elicit identification of barriers to and enhancers of treatment. A flexible approach was used and the interviews were recorded. Content analysis was used to identify themes. MAIN RESEARCH VARIABLES: perceived barriers and enhancers of breast cancer treatment. FINDINGS: the most common theme was the value of the education and information received from the navigator. Several participants saw this as the essence of the role. Assistance with managing symptoms, access to financial and community resources, and the team approach were completion enhancers. CONCLUSIONS: completion of breast cancer therapy and care can be improved by recognizing the value the nurse navigator role brings to the patient experience and enhancing that role. INTERPRETATION: the intentional presence of the oncology nurse and the nursing emphasis on culturally appropriate education and care can be seen as key competencies of the navigator. As the concept of the navigation process is expanded to other cancers, oncology nurses are particularly well positioned to advocate for the navigator role as a nursing domain.

Lessons learned from a lateral violence and team-building intervention.

BACKGROUND: Lateral violence is likely to exist in settings characterized by poor leadership and lack of clearly articulated roles, expectations, and processes that guide behavior. OBJECTIVES: The purposes of this process improvement project were to (1) identify and improve baseline levels of nurse satisfaction and group cohesion through planned unit-based interventions, (2) determine the effect of a team-building intervention on factors that impact cohesive team functioning, and (3) determine the effect of lateral violence training and communication style differences in improving team cohesion. METHODS: The sample consisted of registered nurses (RNs) from 4 diverse patient care areas, chosen on the basis of low scores on the National Database of Nursing Quality Indicators (NDNQI) RN-RN interaction subscale. A quasi-experimental pre-post intervention design without a control group was employed. The intervention focused on lateral violence and team building. A qualitative component focused on the impact of the intervention on overall group dynamics and processes. RESULTS: RN scores on the Group Cohesion Scale (P = .037) and the RN-RN interaction scores improved postintervention. Group sessions focused on building trust, identifying and clarifying roles, engaging staff in decision making, role-modeling positive interactions, and holding each other accountable. CONCLUSIONS: Key to a cohesive environment is an effective nurse manager able to drive and sustain change.

Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults.

The purpose of the study was to determine the impact of a nurse-driven mobility protocol on functional decline. A nonequivalent control group design was used; the independent variable was mobility protocol and dependent variables were functional status and length of stay. Older adults who participated in a mobility protocol maintained or improved functional status and had a reduced length of stay. Practice implications include an emphasis on ambulation in hospitalized older adults.

A home-based nurse-coached inspiratory muscle training intervention in heart failure.

People with heart failure (HF) are living longer but with disabling dyspnea that erodes quality of life (QOL). Decreased strength of inspiratory muscles (IMs) may contribute to dyspnea in HF, and inspiratory muscle training (IMT) has been shown to improve the strength of IMs. The purpose of this study was to determine the effects of a 3-month nurse-coached IMT program. Bandura's Self-Efficacy Theory directed nursing interventions. This randomized controlled trial employed an experimental group (IMT) and a control group (education). Data were collected during six home visits. Outcome measures included maximal inspiratory pressure, perceived dyspnea, self-efficacy, and health-related QOL. Significant differences in PI(max), dyspnea, and respiratory rate were found. Implications for further research and practice are discussed.

Change in fruit and vegetable intake over 24 months in older adults: results of the SENIOR project intervention.

PURPOSE: We test the efficacy of an intervention based on the transtheoretical model to increase the intake of fruits and vegetables and to describe differences in psychosocial variables based on the achievement of the 5 A Day Program target. DESIGN AND METHODS: This study is a randomized controlled trial comparing a 12-month fruit and vegetable intervention to a control condition with a 12-month follow-up. Participants included 1,277 community-residing persons who were 60 years of age or older; 834 provided dietary data at all three time points and are included in our outcome analyses. RESULTS: The intervention group increased intake by 0.5 to 1.0 serving more than the control group over 24 months as measured by the NCI Fruit and Vegetable Screener and the 5 A Day Program screener. The majority of the participants (58%) perceived that they maintained 5 or more servings per day for 24 months. These maintainers had a higher intake at each time point for all dietary measures and differed from those who failed to progress (11%) for most transtheoretical model variables. IMPLICATIONS: The intervention was effective in increasing the intake of fruits and vegetables in older adults. Those who maintained their level of perceived intake as 5 or more servings per day consumed 2-4 servings per day more than those who failed to progress.

Inspiratory muscle training: integrative review of use in conditions other than COPD.

Inspiratory muscle training (IM training) is a technique that is designed to improve the performance of the respiratory muscles (RMs) that may be impaired in a variety of conditions. Interest in IM training has expanded over the past two decades, and IM training has been used in an increasingly wide range of clinical conditions. However, the benefits of IM training continue to be debated, primarily because of methodological limitations of studies conducted to date. The focus of this article is to provide a critical review of IM training research in conditions other than chronic obstructive pulmonary disease for which it has been used, including asthma, bronchiectasis, cystic fibrosis, pre- and postsurgery, ventilator weaning, neuromuscular diseases, and chronic heart failure. Emphasis is placed on what has been learned, remaining questions, future applications, and significance to practice.