Expert Nurses Research Articles

Abstract TP396: Improving Documentation of Blood Pressure and Neurological Assessments in Post Alteplase Patients

Introduction: Patients who receive alteplase for acute ischemic strokes are at a high risk for conversion to a hemorrhagic stroke and must be monitored closely through frequent vital signs and neurological checks. Documentation of these measures was found to have a low compliance due to various factors such as a new electronic medical record (EMR) and lack of knowledge related to required documentation. Methods: A team was created to address this issue which included the Emergency Department Nurse Manager, a Clinical Nurse Expert, and the Stroke Program Director. Inservices were provided to the ED and Critical Care nursing staff. Daily review of all alteplase patients and chart audits were performed and real-time feedback was given to the staff and leadership caring for the patients. This real-time feedback allowed for corrections to be made if necessary and served as both an educational and accountability opportunity. The feedback was not limited to just missed opportunities but was also used to praise staff for complete documentation. Results: Concurrent monitoring of blood pressure and neurological checks was completed from September 2018 to June 2019 on all alteplase patients. The overall compliance of documentation for blood pressure checks improved from 88% to 93.1% and the compliance for the neurological checks improved from 81.5% to 85.7%. Conclusions: Providing real time feedback is an effective way to notify staff of both missed opportunities and successes. Overall, when the staff has a better understanding of what is required, the patients are given more comprehensive care.

Akıllı Bir Çoklu Model Arttırılmış Gerçeklik Uygulaması Ameliyat Öncesi Prosedür Becerilerinin Öğretilmesi

Despite the current essential rules to set up the surgical instruments on the mayo table, there is no standard implementation for this stage of the preoperative preparation. The nursing students do not have enough opportunity to gain experience because of the high-risk conditions and they faced a lack of feedback during their learning. This study introduces a smart multimodal augmented reality application which developed to solve these issues. 10-correct and 10-incorrect instrument arrangement of the expert nurses were used to train this system. During using this application, the learners become able to perform pre-operative operating room preparation procedures; then they can receive individual feedback about the suitability of their arrangements. Meta2 AR goggles used to provide gesture interaction. This study represents the interface, features and smart system structure of a multimodal AR.

"I train and mentor, they take them": A qualitative study of nurses' perspectives of neonatal nursing expertise and its development in Kenyan hospitals.

Aims and ObjectivesNeonatal inpatient care is reliant on experienced nursing care, yet little is known about how Kenyan hospitals foster the development of newborn nursing experience in newborn units.DesignA Qualitative ethnographic design.MethodsFace to face 29 in depth interviews were conducted with nurses providing neonatal care in one private, one faith based and one public hospital in Nairobi, Kenya between January 2017 and March 2018. All data were transcribed verbatim, coded in the original language and analysed using a framework approach.ResultsAcross the sectors, nurses perceived experience as important to the provision of quality care. They noted that hospitals could foster experience through recruitment, orientation, continuous learning and retention. However, while the private hospital facilitated experience building the public and faith‐based hospitals experienced challenges due to human resource management practices and nursing shortages.ConclusionHealth sector context influenced how experience was developed among nurses.ImplicationsNurturing experience will require that different health sectors adopt better recruitment for people interested in NBU work, better orientation and fewer rotations even without specialist nurse training.

Expertise among critical care nurses: A grounded theory study

ObjectivesExplore critical care nurses’ personal perceptions of expertise, expert performance and transition from novice to expert performer in clinical practice. DesignFollowing constructivist approach to grounded theory this investigation used qualitative open-ended interviews focused on the social construction of expertise in critical care nursing and the experiences of clinical practice that define that process. SettingA multi-site urban area in the southeastern United States. Participants10 certified critical care nurses, three males and seven females, with 10–30+ years of critical care experience. FindingsExperience and knowledge are the foundation of expertise and expert performance. The higher the acuity the more frequent the experience the greater the nurses’ aptitude and opportunity for learning and professional growth. It was also noted that self-actualisation was a major determinant in the development of expertise in critical care. ConclusionKey findings suggested that clinical experience and personal motivation combined with self-actualisation, the drive to maximise personal potential, determine critical care nurse’s trajectory towards professional excellence. Expert performance evolves over time. Knowledge acquisition and experience have an interdependent reciprocal relationship inferring that you cannot have one without the other. Social expectations and experiences have a direct impact on professional aptitude and development if expertise.

Development of an Educational Program to Acquire Palpation Skills from Expert Nurses when Locating a Venipuncture Site : A Pilot Study by Nursing Students’ Self-evaluations

Development of an Educational Program to Acquire Palpation Skills from Expert Nurses when Locating a Venipuncture Site : A Pilot Study by Nursing Students’ Self-evaluations

Comparison of the effect of electronic education and workshop on the satisfaction of nurses about Emergency Severity Index triage.

INTRODUCTION:Nurse educators need to develop the level of scientific and practical of the students with the goal of becoming expert nurses. However, the use of modern educational methods to raise the motivation and satisfaction of learners can help individuals achieve this goal. Therefore, the aim of this study was to investigate the effect of health education in emergency nurses about triage.METHODS:A two-group pool-blind experimental study was performed on seventy emergency nurses. Samples were randomly assigned into two groups: e-learning group (35 individuals = electronic education) and traditional group (35 = workshop education). The demographic questionnaire and the satisfaction questionnaire before and 2 weeks after the intervention in both groups were completed.RESULTS:Independent t-test showed that the satisfaction scores before intervention in both e-learning and traditional groups were not statistically significant, whereas there was a significant difference between two groups after 2 weeks after the intervention (P = 0/015).CONCLUSION:Using nursing professors' electronic education programs can increase the level of satisfaction and motivation in the nursing mothers. Therefore, the use of this new educational method is recommended by managers and educational planners as an effective teaching.

Nursing Students Learn to Handle Stress and to Prioritize in a Complex Context During Workplace Learning in Acute Internal Medicine Care - An Ethnographic Study.

IntroductionA common focus in many studies, in the short-term perspective, is to evaluate students’ workplace learning and its outcome. However, the outcome can be perceived differently depending on when it was evaluated. The aim of this study was to explore student nurses’ learning activities in an acute internal medicine unit and the nurses perceived learning outcome in a long-term perspective.Material and MethodsRepetitive ethnographic observations were performed in an internal medicine care unit at a teaching hospital in Sweden between 2011 and 2013. Four student nurses and supervisors were repetitively observed. Two years later retrospective interviews were performed with four nurses who had performed workplace learning, as students, in this unit during the observation period. An inductive comparative analysis involving all interviews and observational data was applied.ResultsThree themes were identified: To handle shifting situations – illustrating how student nurses learnt to adapt to shifting situations, to manage stress, to create structure and space for learning and to deal with hierarchies; To build relationships – illustrating how student nurses learnt to collaborate and to interact with patients; To act independently – illustrating how student nurses trained to act independently in the unit, took responsibility, and prioritized in this complex context.ConclusionLearning activities in a complex acute medical unit setting were characterized by a high workload and frequent stressful situations, and a demand on students to interact, to take responsibility, and to prioritize. To learn in such a stressful context, have in a long-term perspective, a potential to develop students’ embodied understanding of and in practice, making them more prepared to work and independently apply their nursing expertise in similar contexts as graduated nurses.

Primary care mental health: nurses' activities in the psychosocial care network.

to describe and analyze the role of expert nurses in mental health in the Family Health Strategy. a qualitative study, with 20 Basic Health Units nurses of Teresina, Piauí. The information was collected through semi-structured interviews from March to May 2017 and analyzed using the content analysis method. it was found that the conceptions of the mental health disease process were based on the biological model, there was little communication between mental health and basic network, nurses did not feel qualified to work mental health and there were few mental health actions in Primary Care. Final considerations: it becomes urgent to implement public policies that articulate mental health and Primary Care, raising awareness and continuing education for nurses.

Thoughts of Expert Nurses About Daily Life Assistance of Terminally-Ill Cancer Patients Considering Safety and Comfort

Thoughts of Expert Nurses About Daily Life Assistance of Terminally-Ill Cancer Patients Considering Safety and Comfort

Involvement of Expert Nurses during The Hospitalization of Patients Initially Admitted to The psychiatric Ward without Consent

Involvement of Expert Nurses during The Hospitalization of Patients Initially Admitted to The psychiatric Ward without Consent

TRANSLATION, TRANSCULTURAL ADAPTATION, VALIDATION OF THE HOLISTIC CRITICAL THINKING SCORING RUBRIC TO BRAZILIAN PORTUGUESE

Objective: translation, transcultural adaptation, and validation of the Holistic Critical Thinking Scoring Rubric, original from the United States, to Brazilian Portuguese. Method: methodological study comprising the following steps: translation by 3 independent translators, transcultural adaptation by a Committee of 6 Nurses Experts; and validation, with the participation, in the pre-test, of 30 academics and 3 teachers-evaluators of Nursing field. The validity and reliability of the tool were verified by Kappa test. Results: the Portuguese version of the tool obtained a Kappa test score of 0.82 in the pre-test group. There was strong significant agreement among the evaluators. Conclusion: The Brazilian version of the Holistic Critical Thinking Scoring Rubric is a valid and reliable tool to evaluate the holistic critical thinking of Nursing academics at different levels of training, especially using active teaching methodologies.

Validação de instrumento para registro da sistematização da assistência de enfermagem perioperatória

Objetivos: Construir e validar conteúdos de um instrumento para registro da sistematização da assistência de enfermagem perioperatória. Método: Estudo metodológico realizado em um hospital-escola do sul do Brasil que incluiu revisão de literatura, mapeamento cruzado entre observação não estruturada e taxonomias da North American Nursing Diagnosis Association para construção do instrumento e aplicação da técnica Delphi para validação, realizada entre novembro e dezembro de 2018. Disponibilizou-se formulário eletrônico a dez expertos para avaliação da objetividade, clareza/compreensão, aparência e exequibilidade dos conteúdos do instrumento, registrada em escala Likert. As respostas obtidas foram submetidas ao índice de validade de conteúdo (IVC), e escores ≥0,8 confirmaram a validação do conteúdo. Resultados: Os nove grupos de informações do instrumento foram avaliados por enfermeiros expertos. A média do IVC obtido entre todos os conteúdos foi de 0,92 na primeira rodada de validação. Os resultados demonstraram que a estratégia metodológica permitiu a construção de conteúdos que representam a necessidade clínica para os registros de enfermagem no período perioperatório. Conclusão: A implementação de instrumento validado contribui para uma prática de enfermagem mais segura e qualificada.

Construction and discussion of sensitive quality index of blood purification nursing

Objective To establish a sensitive quality index system for blood purification nursing, providing reference for the evaluation and monitoring of nursing safety quality in the blood purification room, and providing quality control targets and basis for nursing managers. Methods Set up a research team to analyze the patient data, nursing bad events, draw on the data of the National Nursing Quality Control Center and other research results of nursing experts at home and abroad. The research team conducted analysis and discussion, expert meeting consultation(discussed by professional nursing experts in Beijing and Inner Mongolia), expert letters, screening and final determination of nursing sensitive quality indicators. Results Finally, a set of 13 sensitive quality indicators for specialized care for blood purification was constructed, including 3 structural indicators, 10 outcome indicators and 100% effective recovery rates for the two rounds of expert questionnaires. The indicators for consultation are 0.12-0.17 and 0.10-0.14, respectively, and the expert authoritative coefficients are 0.786 and 0.807, respectively, which are statistically significant (P< 0.01). Conclusion The system of sensitive quality index of blood purification nursing is in conformity with the principles of science, reliability and practicality, and can be used as a tool for evaluating the quality of blood purification room nursing safety. Key words: Hemodialysis; Quality index; Delphi

Critical nursing and health care aide behaviors in care of the nursing home resident dying with dementia

BackgroundWith the aging of the population, dying with dementia will become one of the most common ways in which older adults will end their final years of life, particularly for those living in a nursing home. Though individuals living with dementia have complex care needs and would benefit from a palliative approach to care, they have traditionally not been recipients of such care. An important aspect of determining quality in end-of-life care is the identification of expert practices, processes or behaviors that may help achieve this care. However, for those living with dementia in nursing homes, we have a limited understanding of how to best support expert end of life care. To redress this gap in knowledge, the purpose of this study was to examine and describe expert care of the individual with dementia approaching death from the perspective of nurses and health care aides (HCAs) identified by their peers as having special expertise in caring for this population.MethodsA qualitative research design known as Interpretative Description was used to conduct the study. Expert nurses and HCAs were identified through a two-phase nomination process. Individual semi-structured interviews were conducted with consenting participants. Data were analyzed using constant comparative analysis to determine the key critical behaviors.ResultsAnalysis of data collected from expert nurses (n = 8) and HCAs (n = 7) revealed six critical behaviors when caring for residents dying with dementia. All nurses and HCAs unanimously endorsed that the overarching goal of care is similar for all residents who are actively dying; to achieve comfort. The six critical behaviors in caring for residents dying with dementia included: 1) recognizing and responding to changes in a resident’s pattern of behavior; 2) attending to the person; 3) working with the family; 4) engaging with others; 5) responding after the death has occurred; and 6) having a positive attitude toward care of the dying.ConclusionsThe critical behaviors described by nurses and HCAs in this study provides emerging evidence of best practices in care of those with dementia and their families, particularly near the end of life within the nursing home setting.

Development and Psychometric Testing of the Nurses’ Confidence Scale: Unique Families

ObjectiveTo develop and evaluate an instrument designed to measure the confidence of nurses in their ability to provide neutral, compassionate care to unique families in perinatal settings: the Nurses’ Confidence Scale: Unique Families. DesignProspective instrument development and psychometric study. SettingHealth system in the U.S. Mountain West region. ParticipantsConvenience sample of 62 perinatal/neonatal nurses. MethodsWe developed a two-part scale to measure the confidence of nurses in their ability to care for complex/nontraditional families, termed unique families. Part A was focused on nursing care behaviors for any unique family; Part B was focused on providing care to seven specific unique family populations. Five experts in perinatal nursing or adoption evaluated the scale’s content validity. To test the psychometric properties of the scale, we used item analysis, reliability analysis, and exploratory factor analysis. ResultsThe content validity index was 0.82. The Cronbach’s alpha coefficient estimate of internal consistency for Part A was .92. Principal component analysis resulted in two factors that explained 64% of the total variance: skills and resources (Cronbach’s alpha coefficient = .89) and awareness and sensitivity (Cronbach’s alpha coefficient = .87). Part B had a Cronbach’s alpha coefficient of .90. Parts A and B showed a strong positive relationship with one another (r = .77). The general self-efficacy measure was strongly and positively correlated with Part A (r = .81) and moderately and positively correlated with Part B (r = .48). ConclusionThe Nurses’ Confidence Scale: Unique Families is a new tool with which to measure the confidence of perinatal/neonatal nurses in providing sensitive, specific care to complex/nontraditional families. Results of our psychometric evaluation supported initial acceptable reliability and validity of the scale.

Methodology for the Start-up of a Pediatric Hematopoietic Stem Cell Transplant Unit (pHSCTU) in Middle-Income Countries (MICs): An Exportable Model?

Introduction: Blood or marrow transplantation (BMT) programs are largely insufficient to meet the growing need in MICs. Where BMT is not available families, charities or governments often seek for alternative programs, usually to send children abroad for BMT; this policy is associated with many drawbacks, including costs, and difficulties to manage transplant related complications after the patient return home. Evaluation of feasibility and sustainability plays a crucial role in the success of all cooperative projects but especially of high specialization ones. Materials and methods: In 2016 the first HSCTU inclusive of a pediatric section was developed in Iraqi Kurdistan at Hiwa Cancer Hospital of Sulaymaniah, thanks to a cooperative project funded by the Italian Agency for Development Cooperation and to the availability of professionals from specialized centers to train local personnel. After verifying with an appropriate grid that essential requirements were in place, a capacity building project was started. An intensive educational course was carried on initially and then, using a training on the job approach, all specific skills were set-up and/or implemented. A complete protocol handbook was created with involvement of the local staff; a staggered approach to the disease was chosen, starting from low risk diseases and moving later to high risk ones. After 3 years project the center is now completely autonomous; up to now they have been performed 158 transplants (autologous and allogeneic, both in adult and children) with results comparable with those of high-income countries (HICs). In a cohort of 26 pediatric patients with thalassemia the event free survival (EFS) is over 90% with a median follow up of 492 days. Next to this experience, in 2018 a new project has been activated in Paraguay, following a specific request from the pediatric hospital Ninos de Acosta Nu in Asuncion. The similar methodology has been applied. After documenting the feasibility, a 3 years project has been set-up, with an initial intensive educational course, followed by training on the job by experts in the field and also limited training of the local staff abroad. A six months continuously oversight by experienced nurses and periodically by expert physicians has been planned along with the continuous support through on line contacts; focused training in Europe on minimal residual disease, chimerism, apheresis and HLA typing has been scheduled. The first allogeneic transplant from matched sibling donor is planned in autumn 2019. Discussion: Based on our experience new centers should start with patients highly curable, low-risk matched sibling transplants, well-established context-appropriate protocols with minimal toxicity, proven high success rates and contained costs. If socio-economical context of the country and needs of the population allow to move to oncological patients, a staggered approach is suggested: from matched sibling donor transplant to mismatched ones. Minimal essential requirements for a pediatric BMT start-up activity may be affordable in many MICs, if health authorities and/or local charities/foundations are committed. This shall include good quality blood products (leuco-reduced or irradiated); drugs for conditioning regimens (busulphan, tiothepa, fludarabine, cyclophosphamide, melphalan), GVHD prophylaxis and treatment (methotrexate, thymoglobuline, cyclosporine, mycophenolate mofetil), infections control (broad spectrum antibiotics, one anti-mold drug, ganciclovir) and essential laboratory tests (at least cyclosporin levels and citomegalovirus copies count). Conclusion: The strategy described above requires the availability of expert BMT physicians and nurses willing to rotate periodically in MICs Units for training on the job and supervision. This model is replicable in different contexts, allows a fast development of BMT units in MICs, and in our opinion compares favorably with that of offering training to multiple professionals in specialized centers. Figure Disclosures No relevant conflicts of interest to declare.

A PILOT STUDY TO TEST METHODS FOR DATA COLLECTION ON NURSES CARING FOR RESIDENTS WITH DEMENTIA IN THE NURSING HOME

Nurses draw from their experiences and intuition to detect changes in patient condition, patterns of patient behaviors, and evidence of distress. In the nursing home setting, nurses care for residents with dementia and manage challenging behavioral and psychological symptoms of dementia (BPSD), and may rely on informed intuition to assess and capably respond to such behaviors. To date, no observational method has been developed to discern nurse-resident interactions that identify expert nurses who effectively address BPSD. It is not known if or how nurses in this setting use intuition to make clinical judgments and decisions to manage BPSD events. Using an ethogram approach, we developed an observational tool and spot interview method to discern BPSD events, background and proximal factors and nurse responses to BPSD. Pilot observations took place over three nursing shifts to identify nurse-resident interactions during BPSD events using the observation tool. Nurse-resident interactions were followed by spot interviews with each nurse to clarify their responses to BPSD. Semi-structured interviews were conducted with nurse participants to further develop an interview guide and identify elements of nurse intuition. The pilot study affirmed the feasibility of gaining access to facilities with residents with BPSD, of nurse comfort with field observation and interviews, and established preliminary construct validity of the “expert nurse.” Verification of the utility of this observation and interview method permit further examination of effective nurse engagement with nursing home residents with BPSD, informs our understanding of nurse intuition and permits further exploration of the broader context of BPSD.

THE IMPACT OF AN EDUCATION INTERVENTION: IMPROVING COMMUNICATION BETWEEN OLDER ADULTS AND HEALTH CARE PROVIDERS

As people age, ensuing physical and psychological problems can increase, which makes it paramount to be comfortable discussing medical needs with health care professionals, particularly in light of the danger associated with misunderstanding medication use and combining alcohol with prescriptions and/or over the counter medications (National Institute on Aging, 2018). National studies found that about 40 percent of adults ages 65 and older drink alcohol and often do not understand the dangers of combining alcohol with medications (National Institute for Alcohol and Alcohol Abuse, 2008). An educational intervention was developed with a team of expert physicians, nurses, pharmacists and social workers who work in gerontology to focus on improving communication and addressing alcohol and medication use for older adults. A randomized controlled trial was conducted to assess whether the educational intervention improved older adults’ comfort in communicating with their health care providers, as well as their knowledge of the concomitant use of alcohol and prescription and over-the-counter (OTC) medications. Results of a MANCOVA showed that those in the intervention group showed larger increases in scores on communication with their health providers and knowledge about the implications of combining alcohol with prescription drugs than those in the control group (Wilks’ Lamda=.808, F(3,76)=6.039, p=.001<.05). In addition, linear regression models showed that the intervention was significantly associated with participants’ knowledge of the implications of combining alcohol with prescription drugs. The coefficient across models was approximately 1.00, which represented a substantial increase given the average score of 6.5.

Extending the mental health expertise of school nurses: Evaluating a training programme

This paper reports an evaluation of a training programme to enhance the skills and confidence of school nurses in addressing mental health and emotional wellbeing issues among school children. The training was offered to school nurses and nursery nurses in one school health service in London. The evaluation drew on face-to-face semi-structured interviews with, and online contributions from, school health staff members. There was evidence of considerable satisfaction with training; of attitude change; of increased confidence, knowledge and skills in addressing mental health issues; and of changes in practice. The evaluation illustrates how, in a favourable context where staff feel respected and supported, well-designed training programmes can deliver changes in practice.

How to approach the difficult topic of death

Many nursing staff report feeling ill-prepared to discuss death with patients. Here, expert nurses share advice on supporting individuals when they receive bad news