Outcomes associated with postoperative delirium after cardiac surgery.

BACKGROUND: Delirium after surgery is a common condition that leads to poor outcomes. Few studies have examined the effect of postoperative delirium on outcomes after cardiac surgery. OBJECTIVES: To assess the relationship between delirium after cardiac surgery and the following outcomes: length of stay after surgery, prevalence of falls, discharge to a nursing facility, discharge to home with home health services, and use of inpatient physical therapy. METHODS: Electronic medical records of 656 cardiac surgery patients were reviewed retrospectively. RESULTS: Postoperative delirium occurred in 161 patients (24.5%). Patients with postoperative delirium had significantly longer stays (P < .001) and greater prevalence of falls (P < .001) than did patients without delirium. Patients with delirium also had a significantly greater likelihood for discharge to a nursing facility (P < .001) and need for home health services if discharged to home (P < .001) and a significantly higher need for inpatient physical therapy (P < .001). Compared with patients without postoperative delirium, patients who had this complication were more likely to have received zolpidem and benzodiazepines postoperatively and to have a history of arrhythmias, renal disease, and congestive heart failure. CONCLUSIONS: Patients who have delirium after cardiac surgery have poorer outcomes than do similar patients without this complication. Development and implementation of an extensive care plan to address postoperative delirium is necessary for cardiac surgery patients who are at risk for or have delirium after the surgery.

Analysis of critical laboratory value nurse-to-physician follow-up calls at a community hospital.

The reporting and treatment of critical laboratory values are vital to the provision of quality patient care. The purpose of this study was to identify the percentage of critical laboratory values not being reported by the nurse to the physician or properly documented in a small community hospital. Results showed that 77% of critical laboratory values reported were not properly documented as communicated to the physician regardless of hospital unit, laboratory specialty, or test.

Energizing the research enterprise at nonacademic health center schools of nursing.

Strategic redirection of a university's mission to focus on research is challenging. This article describes an approach to developing a culture of research in a school of nursing (SON) in a nonacademic health center university. Infrastructure changes and committed mentors were developed to move a dormant research culture into one characterized by a growing dynamism of camaraderie and espirit de corps about research and scholarly productivity. To sustain the momentum, a rapid mentor-faculty feedback loop was created so that within a 48-hour time frame, the mentor provided feedback to the faculty member. Timely and iterative feedback prompted discussions that led to more scientifically rigorous proposals and publications. Tailored approaches were adopted for junior and senior faculty. In the first academic year using this approach, publications increased by 144%, and grant proposal submissions increased by 169%, whereas presentations shifted toward more regional and national venues. The increased productivity was maintained over the next 2 years. Building and sustaining a culture of success in research require leadership and vigilance, infrastructure changes, and process-oriented initiatives.

Weight and symptom diary for self-monitoring in heart failure clinic patients.

BACKGROUND: For people with chronic heart failure, self-monitoring has been linked with improved body awareness and better communication with health professionals. Cognitive theory and the concept of somatic awareness help explain self-monitoring behaviors. This study compares the clinical and hospital outcomes of heart failure patients who are using and not using a diary to record weight, vital signs and, symptoms and evaluates the diary format. METHODS: All patients enrolling in an outpatient heart failure clinic were given a Heart Health Diary. Seventy patients used the diary and 54 did not. A review of these 124 patients (82 men and 42 women) was completed 6 months after enrollment. RESULTS: Diary nonusers were more likely to be younger women with a lower ejection fraction and worse functional status. Those using a diary had 35% and 47% more contacts via telephone and clinic, respectively. Both groups had significant functional and B-type natriuretic peptide improvement. If hospitalized after enrollment in the heart failure clinic, average length of stay for all hospital admissions for diary users decreased by 58% (P < .002) and average cost per case decreased by 56% (P < .011). Length of stay and cost per case did not significantly change for those not using diaries. CONCLUSION: Diary users showed evidence of improved clinical and hospital outcomes. Further investigation is needed to clarify the characteristics of a diary user and the effect of diary use on self-management and outcomes.

An evaluation of the nursing success program: reading comprehension, graduation rates, and diversity.

The Nursing Success Program was developed to enhance retention of baccalaureate nursing students. Reading comprehension scores are used to identify students who are at risk for failure and direct them into the retention program that addresses their skill deficits. To evaluate the program, the authors assessed reading comprehension, graduation rates, and ethnic diversity.

Developing and retaining expert learners: the Student Success Program.

The goal of the Student Success Program is to retain bright and capable nursing students by supporting them to become expert learners through enhancing their study, test taking, time and stress management, written and oral communication, and critical thinking skills. Students for whom English is a second language also receive instruction in accent reduction. Retention rates increased following implementation of the program. Recommendations for those considering implementing a retention program are addressed.