Core Group Of Nurses Research Articles

Assessment and Documentation of Neuropsychiatric Symptoms in Hospitalized Patients with Dementia

<h3>Introduction</h3> Nursing assessment and documentation of neuropsychiatric symptoms (NPS) for patients with dementia are critical processes for symptom management, treatment and discharge planning. Lack of standardization and inadequate documentation may lead to poor symptom management, prolonged hospitalization, or denial of admission to care facilities following discharge. Nursing observations may become buried in the progress notes, which can make it difficult to provide appropriate clinical management. The purpose of this quality improvement (QI) project was to improve clinical management of dementia, by implementing an evidence-based protocol for standardized assessment and documentation of NPS, using the Neuropsychiatric Inventory-Questionnaire (NPI-Q). <h3>Methods</h3> This QI project was implemented over 12 weeks in late 2020 on a 14-bed inpatient behavioral health unit (BHU) with an average daily census of 1-2 patients with dementia. During the baseline phase (weeks 1-3), the clinical site representative (CSR) accessed Epic, the electronic health record, to capture information needed to anticipate staffing demands. A core group of nurses (n=9) were trained for proper NPI-Q administration and their competency was documented. During the implementation phase (weeks 4-12), registered nurses administered the NPI-Q at admission, discharge, and 3 times per week (Monday, Wednesday and Friday) between 4 pm and 5 pm. A paper version of the NPI-Q was used due to delays in programming the instrument into Epic. The CSR captured data for analysis, including age, gender, admission and discharge dates, plus an indication (Yes/No) of whether the NPI-Q was administered on admission and discharge and on each M-W-F during the hospitalization. These data were used to determine adherence to the protocol (whether each person with dementia received the prescribed number of NPI-Q assessments per hospitalization) and patient outcomes (improvements in NPI-Q total and domain scores from admission to discharge). <h3>Results</h3> During implementation weeks 4-12, only eight patients with dementia were admitted to the inpatient behavioral health unit. The average age of these patient was 73 years (range 65 to 85 years); gender was equally distributed. Their average length-of-stay was 7 days (range 1 to 12 days). Of these patients, 86% were assessed using the NPI-Q at admission, and 75% were assessed using the NPI-Q on the day of discharge. Seventy-four percent of patients received the targeted number of NPI-Q during their hospitalization. Additionally, 71% of patients who received both admission and discharge NPI-Qs had improved NPI-Q scores at discharge. <h3>Conclusions</h3> Using a structured, validated instrument is likely to improve assessment and documentation of NPS among patients with dementia in an inpatient BHU. Although the number of assessed patients was small, it appears that this practice change was well accepted by nurses, is sustainable, and may improve quality of care, as evidenced by improved NPI-Q scores from admission to discharge. <h3>Funding</h3> Not applicable.

A multi-faceted approach of a nursing led education in response to MERS-CoV infection.

BackgroundThe emergence of the Middle East respiratory syndrome-coronavirus (MERS-CoV) resulted in multiple healthcare associated outbreaks. In response, we developed a nurse-led program to screen and triage patients with MERS-CoV infection.MethodsA formal educational program was implemented to ensure a standardized approach to care planning and delivery. The essential skills that were included were the use of Personal Protective Equipment (PPE) including gown, gloves, head cover and N95 mask, hand hygiene, the practice of donning and doffing and the collection of MERS-CoV nasopharyngeal specimens.ResultsA core group of nurses were identified from high-risk units. The education program consisted of four skill-days. Nurses were assigned a pre-course work from Mosby’s Nursing Skills, an online skill module, donning and doffing of PPE, and the process for obtaining a nasopharyngeal swab. The skill lab incorporated multiple methods such group discussion, watching an on-line video, and a simulated demonstration and practice on a mannequin. In total, 450 nurses attended the Nasopharyngeal Skills Day and 1000 nurses received training. Donning and doffing PPE and N95 mask fit testing has become an annual mandatory competency requirement for staff in nursing and clinical services.ConclusionThe application of specified protocols minimizes the risks of cross infection, placing emphasis on patient and staff safety as well as expediting the patient to definitive treatment. Nurse educators have an instrumental role in training nurses and other healthcare providers on the specifics needed to identify, contain and manage patient presenting with MERS-CoV.

Implementing the Neonatal Assessment Nurse Role in the LDR: Improving Neonatal Outcomes While Supporting Family‐Centered Care

Paper Presentation Purpose for the Program Knowing the stabilization and bonding benefits of minimizing the separation of the mother–baby dyad at delivery, a nurse‐driven task force integrated the role of a neonatal assessment nurse (NAN) into the care delivery process. The task force discovered that inconsistent care practices, anecdotally reported by the medical providers, affected the quality of neonatal care and maternal satisfaction. The purpose of this project was to establish an innovative role designed to consistently provide transitional care at the mother's bedside for eligible newborns. Without funding to hire additional nurses into this position, a core group of nurses from all maternal child health units volunteered. Proposed Change Introduction of the NAN, as a dedicated clinical assignment, would positively facilitate the transition of life from fetus to neonate, decrease mother–neonate separation, increase rate of skin‐to‐skin contact, improve nurses’ perspective of neonatal care, decrease neonatal intensive care unit admissions, and improve maternal satisfaction. The NAN provides transitional care at the mother's bedside, thus changing the current practice of separating the infant from the mother to conveniently transfer the infant to where the work can be accomplished. Implementation, Outcomes, and Evaluation Hospital Institutional Review Board approval was obtained. Strategies for NAN success included detailed role description; patient care priorities; expectations when the labor and delivery room (LDR) had no neonatal patients; and a decisive evaluation plan for those infants requiring nonintensive yet supportive care and monitoring. A comprehensive process of didactic education and clinical orientation was individualized based on the nurse's expertise along the spectrum of neonatal care. Simulation scenarios served as teaching adjuncts and reinforced evidence‐based practices. The enthusiasm of the NAN‐identified nurses and creative staffing models developed by the maternal–child health units’ charge nurses ensured coverage for every shift, 7 days a week. The Caring Behaviors Inventory by Wu, Larrabee, and Putman (2006) was used before and after NAN to gain clinical nurses’ perspective about the care delivered to neonates who were less than 4 hours of age. This tool and survey, which focused on maternal perspective, were chosen because both aligned with the hospital's choice of Watson Caring Theory, which is the framework that currently guides our nursing practice. Implications for Nursing Practice The NAN role in the LDR presents an extended benefit of having a dedicated nurse to provide neonatal care in situations when transition time requires pulse oximeter monitoring and/or additional poststabilization assessments. With no literature available on this topic, publication of the positive results of this implementation plan will help others adopt similar roles specific to their settings.

The Use of the Clinical Resource Nurse to Solve the Eternal Dilemma of Financial Responsibility Versus Staffing Requirements

Professional Issues Poster Presentation Purpose for the Program This pilot quality improvement project provides data to support a creative option that involves the use of a clinical resource nurse to support units with high percentages of new‐to‐practice staff, and also improves nursing satisfaction, complies with new staffing guidelines set by a professional organization, and improves patient flow. Proposed Change A 2‐week pilot project of the clinical resource nurse (CRN) was implemented on a labor and delivery floor in an academic medical center with 772 beds. This concept was tested for five main reasons: (a) increased acuity, (b) new staffing guidelines, (c) high percentages of new to practice staff, (d) high percentages of nurse turnover rates, and (e) low nurse satisfaction scores. To implement the pilot project, an extra registered nurse (RN) was assigned as the clinical resource nurse on every shift (excluding weekends) resulting in over budgeting (one extra RN was needed from 7 a.m. to 7 p.m. and from 7 p.m. to 7 a.m.) for a 2‐week period. Implementation, Outcomes, and Evaluation A core group of nurses were selected to continue the role of CRN 24 hours per day, 7 days per week. A PowerPoint presentation was created as a resource for all staff, and education continued surrounding the daily responsibilities of this nurse by a clinical level IV nurse. During the trial period this role focused on the use of the CRN on the labor and delivery floor, but upon implementation the scope of this role was expanded to be a resource for the newly developed antepartum unit (APU). This requires the CRN to assess the APU every 4 hours and assist with admissions and overseeing the management of nursing care for patients. A preimplementation and postimplementation survey was given to 32 nurses based on the Likert scale. Results showed increased perceived quality of care provided to patients and increased feelings of having the necessary resources for help when they need them. Furthermore, the results showed an increased perception of improved quality of patient care with 50% of respondents rating their care as excellent posttrial as opposed to only 16% pretrial. A decrease in incident reports was also noted. Implications for Nursing Practice This pilot indicated that a CRN may be useful in areas with high rates of new‐to‐practice nurses. In the short period of time, nurses reported increased perceived quality of care along with resources needed for complex patients. Patient flow was improved as well as possible improved quality of care related to the decrease in incident reports filed.

Cutaneous Capnography in the PACU: Immediate Assessment of Respiratory Status Emerging From Anesthesia

The team met for one 6-hour day and one 3-hour day. The team developed a workplan andmet each month until the room opened. A core group of nurses from the PACU volunteered and were chosen to learn how to provide the care needed for pre-, intraand post-care. The PACU staff went to the CPC to learn how to pull sheaths and to learn about the supplies, process and monitoring. The core group of nurses also attended additional training to learn the new computerized documentation system. Standard operational procedures were developed. When the room construction was completed, the PACU and OR staff did rehearsals of the process. They walked through each step to ensure that when the first patient was scheduled for a procedure, the process would be smooth and safe. Evaluation and Outcomes: The first day and first patient’s procedure went safely and effectively. The OR and PACU staff truly worked as a team to provide excellent care. The vascular physicians were pleased with how smooth and on time the process was and continues to be.

The Trauma Charge Nurse in the Pediatric Emergency Department

Introduction: The trauma charge nurse role at a Level 1 Pediatric Hospital benefits the emergency department, the trauma patients, the trauma service, the hospital itself and the community. Methods: The trauma charge nurses (TCN) are emergency department (ED) nurses who have passed off a trauma module which is made up of individual learning units, simulated skills pass-off stations and hands-on bedside nursing care of trauma patients. The TCNs are staffed 24/7 in the ED to insure that there is an RN with a high level of clinical expertise available to take care of patients at all times. In addition to being a clinical resource to the ED, the TCN is the bedside nurse for all high acuity trauma patients and coordinates the mobilization and response of the hospital trauma team to care for all trauma patients in the ED. The TCN also acts as a liaison for the ED with the hospital trauma team for communicating changes in procedures, process improvement, etc. In addition to their duties in the hospital, the TCNs provide pediatric trauma education to EMS agencies and community safety fairs throughout the state. Results: The trauma charge nurse role in the emergency department has helped to improve the care of the trauma patients in this Level 1 Trauma Center since the roles inception 12 years ago. Although the TCN role was initially set up to give the trauma team a consistent core group of nurses in the ED caring for the trauma patients, the TCN role has benefitted the ED, the hospital and the community. Conclusion: The TCN role has strengthened the trauma program and the ED at this Level 1 Trauma Center. Rhonda Carter, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002

A Pioneer Nursing Genomics Staff Development Program

In 2001, a large Midwestern medical center determined that providing genomics education to all members of its health care team was a top priority. Two advanced practice nurses were selected to coordinate education for a diverse group of over 6000 nurses. A needs assessment conducted during an entry level genomics course revealed 82% of nurse attendees had no working knowledge of genomics but 83% considered genomics relevant to their clinical practice. Genomics education has been delivered using a variety of methods that prepares nurses in all practice settings to understand and clinically apply genomics information. Creation of a Nursing Genomics Interest Group has served to develop expertise in a core group of nurses using a ‘train the trainer’ approach which maximizes genomics education to all nursing specialties and strengthens the infrastructure for ongoing education. This presentation includes information on how to implement a nursing genomics staff development program and expand it in a logical and structured manner. Nurses are in a unique position to step forward to meet the burgeoning genomic education demands of patients and families. A structured nursing genomics staff development program can enhance capacity to provide state of the art health care within the profession of nursing.

Research Utilization in Critical Care: An Exemplar

The authors describe the process and outcome of implementing a research-based pain management protocol in four adult critical care units at a large, Midwestern tertiary care center. The project was initiated and directed by members of the divisional research committee. Strategies used to change practice included determining if pain management was a problem via quality assessment monitors, surveying nurses regarding their knowledge and attitude toward pain management, educating staff members about the research base for the practice change, using change champions in each unit, and developing a core group of nurses in each unit to facilitate the change. Outcomes of this research utilization project include a 41% decline in the number of patients in pain, a 44% decline in pain intensity, and improvement in nurses knowledge about pain.