Good care, good science: leveraging frontline staff for quality.

Health care is changing by moving from volume-based care to quality-based care according to the US Department of Health and Human Services. Although hospitals have been required to report data and the results have been publically reported for some time, the frontline nurse was not aware of the impact of the federal government regulations and how this would refocus and re-center care that is provided. Nursing leaders need to provide the context for this culture shift and support the efforts of the frontline nurses by connecting the evidence of the quality indicators to quality care they provide. Linking good care and good science provides the vehicle for setting this stage.

A curriculum designed to decrease barriers related to scholarly writing by staff nurses.

Demonstrating professional development outcomes, such as scholarly publication, is critical as nurse leaders guide organizations seeking recognition as centers of excellence. However, personal and situational barriers often prevent staff nurses from achieving scholarly publication. This project tested a workshop and mentoring approach to decrease publication barriers with staff nurses in 2 community hospitals. Self-efficacy principles guided the curriculum that resulted in a statistically significant improvement in staff nurse perception of successful scholarly publication endeavors.

Resource use in decompensated heart failure by disease progression categories.

The purpose of this study was to quantify the total hospital resource use for decompensated heart failure according to disease progression categories. Clinical and cost information was obtained from an electronic data repository and chart review. During the 1-year period from June 2002 to June 2003, qualified patients were categorized based on disease progression as (1) new onset, (2) known heart failure, or (3) readmission. The primary outcome variables were total hospital resource use and resource use by services. Analysis of variance, Scheffé analysis for pairwise comparisons, and chi-square analysis were performed to determine differences among groups. Total hospitalization costs are similar whether it is a new diagnosis of heart failure, known diagnosis, or readmission. Among the 3 categories, 5 services contained statistically significant differences in costs (P<.05): echocardiography, electrophysiology, neurodiagnostic, nuclear cardiology, and pharmacy. Careful analysis of hospital resource use by services for heart failure patients provides opportunities for institutional cost containment.

To pump or not to pump?

Coronary artery bypass grafting is performed on the beating heart and thus requires the use of cardiopulmonary bypass. To avoid the complications associated with cardiopulmonary bypass, off-pump bypass (OPB) is viewed as a desirable alternative. Technological advancements have made OPB a viable option in an expanding population of patients. As a result, the number of OPB surgeries performed annually in the United States has increased. Critical care nurses are increasingly likely to provide care for patients after off-pump surgery. The differences between on-pump and OPB surgeries affect the postoperative nursing care requirements. While there are many common aspects of postoperative cardiac care for these 2 groups of surgical patients, there is a need to focus on the unique aspects of care for OPB patients. Despite promising short-term results in OPB patients, questions surrounding this procedure remain. Studies are under way to determine long-term graft patency.

B-type natriuretic peptide testing for detection of heart failure.

The incidence of heart failure (HF) is on the increase with the aging population. Heart failure can manifest as either systolic or diastolic dysfunction. Systolic dysfunction causes impaired ventricular contractility with an ejection fraction of less than 45%. In contrast, diastolic dysfunction is evidenced by impaired ventricular relaxation and an ejection fraction greater than 45%. The diagnosis of HF is challenging with patients who present with acute dyspnea and a history of chronic obstructive pulmonary disease or pneumonia. The pathophysiology of HF and the resulting compensatory mechanisms involve a complex neuroendocrine response that includes a release of natriuretic peptides including B-type natriuretic peptides (BNPs). Elevation of BNP is in response to ventricular wall stress and volume overload from HF. BNP promotes natriuresis, diuresis, and vasodilitation and therefore counteracts some of the deleterious effects of the neuroendocrine response in HF Recently, a new laboratory test for BNP has been developed to assist in rapid identification of patients with HF. Research studies have shown that BNP testing assists in differentiating between cardiac and pulmonary causes of acute dyspnea and could be used to evaluate effectiveness of therapy and as a predictor for length of stay and readmission.