Nursing Satisfaction Survey Research Articles

Study on the value of KMC combined with blue light irradiation in improving the therapeutic effect of neonatal jaundice

ABSTRACT Neonatal jaundice is a common problem that affects newborns. We aim to investigate the effect of Kangaroo Mother Care (KMC) combined with blue-light irradiation on enhancing the therapeutic effect in the treatment of neonatal jaundice. From May 2020 to August 2022, 89 neonates with pathological jaundice and their mothers were selected as participants. All neonates received blue-light irradiation. The participants were divided into two groups: 46 neonates cared for by KMC as the research group (RG) and 43 neonates receiving routine nursing as the control group (CG). The first lactation time, first breastfeeding duration, and scores of Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) before and after nursing were recorded and compared between the groups. Pre- and post-interventional total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels of both groups of newborns were measured, and the time of jaundice resolution, first defecation, and meconium yellowing were recorded. Neonatal adverse reactions (ARs) during treatment were counted, and a nursing satisfaction survey was conducted at discharge. KMC group mothers had earlier lactation and longer first breastfeeding durations (P < 0.05). Both groups’ SAS and SDS scores decreased post-nursing, with greater improvement in the KMC group (P < 0.05). KMC group newborns had lower bilirubin levels and faster resolution of jaundice and meconium yellowing, with fewer adverse reactions and higher nursing satisfaction (P < 0.05). KMC can effectively improve the efficacy of blue light irradiation in the treatment of neonatal jaundice, and promote the healthy development of newborns and the efficiency of maternal breastfeeding.

Effect of Empowering Education on Refined Nursing of Patients with Internal Double J Tubes after Surgery for Ureteral Stricture

Objective: To investigate the effect of the theory of enabling education on the fine management of patients with internal double J tubes after ureteral stricture. Methods: Eighty patients with built-in double J tubes after ureteral stricture were selected from the urology department of a grade a hospital in Guangzhou. The patients were divided into control group and observation group by random number method, with 40 patients in each group. The control group received refined nursing after surgery, while the observation group received refined nursing including the theory of empowerment education after surgery on the basis of the control group. Results: After the intervention, the observation group had a higher standard rate of quality indicators, higher self-efficacy score than the control group (P ≤ 0.05), lower scores of ureteral stent-related symptoms, urinary system symptoms, pain symptoms, total health status, job performance, additional problems and total scores than the control group (P ≤ 0.05), and statistically significant differences were found in the total health status dimension and total scores (P ≤ 0.01). The nursing satisfaction survey, the scores of clinical nursing, health education, psychological counseling and nurse-patient communication were all higher than those in the control group (P ≤ 0.05), and the differences in health education and nurse-patient communication were statistically significant (P ≤ 0.01). Conclusion: The theory of enabling education can improve patients’ self-nursing level, promote the implementation of refined nursing quantitative indicators and nursing measures, relieve the poor symptoms of ureteral stricture patients, and improve patients’ satisfaction with nursing work.

The impact of replacing peripheral intravenous catheters when clinically indicated on infection rate, nurse satisfaction, and costs in CCU, Step-Down, and Oncology units

A practice change of replacing peripheral intravenous (PIV) catheters when clinically indicated was implemented concurrent with a new PIV chlorhexidine securement dressing and existing IV care bundle to prevent the risk of infection. The purpose of this study was to examine the impact of replacing PIV catheters when clinically indicated on infection rates, nurse satisfaction, and costs in 3 high-risk, vulnerable hospital populations (Critical Care, Step Down, and Oncology units). A retrospective review of 473 medical records, 737 peripheral IV sites, and 2 nursing surveys were completed after the practice change. Data were gathered related to PIV 1) catheter dwell times, 2) phlebitis rates, 3) catheter-related bloodstream infection rates, 4) skin tears related to the new PIV dressing, 5) costs, and 6) a nurse satisfaction survey. The average PIV dwell time was 7 days with a 3% phlebitis rate. Findings showed no catheter-related bloodstream infections and 2 (0.27%) skin tears. Cost savings of $17,100.00 in PIV supplies occurred one year after the practice change. Nurse satisfaction with the new dressing was 94.2%, with a 17-month sustainment of satisfaction. The impact of the practice change and new dressing had positive quality outcomes on infection rate, nurse satisfaction, and costs in 3 vulnerable hospital populations.

Implementation of hospital wide dysphagia screening in a large acute tertiary teaching hospital

Purpose: There are no examples in the literature of successful long-term hospital-wide implementation of nurse-led dysphagia screening. This article aims to describe strategies used to implement hospital-wide dysphagia screening in a large acute tertiary teaching hospital in Australia. It reports on compliance, accuracy and nursing staff satisfaction using the validated Royal Brisbane and Women’s Hospital Dysphagia Screening Tool (RBWH DST).Method: A retrospective observational study of audit data was conducted to examine hospital-wide compliance and accuracy of dysphagia screen completion. A nursing staff survey measured staff satisfaction. Implementation included: (1) utilisation of validated tool (RBWH DST); (2) key stakeholder engagement and strong governance; (3) policy development; (4) education; and (5) review and monitoring processes.Result: Audits conducted over a 9-year period (n = 3726) showed an average hospital-wide compliance rate of 74% and an accuracy rate of 82%. A nurse satisfaction survey (n = 109) showed high levels of satisfaction associated with using the RBWH DST.Conclusion: The RBWH DST was implemented in a large acute tertiary teaching hospital with acceptable compliance and accuracy rates and favourable nursing staff satisfaction. Further study is required to objectively evaluate patient health and cost benefits associated with using the RBWH DST.

Effects of stroke unit model in patients with ischemic stroke

Objective To analyze the changes in blood lipids, serum visfatin and adiponectin in patients with ischemic stroke before and after implementation of stroke unit mode, and to explore the effects of this nursing mode on the prognosis and functional recovery of patients. Methods A total of 128 patients with ischemic stroke in the Neurology Department of Nanyang Nanshi Hospital from March 2016 to June 2017 were selected as the research objects. According to the order number, they were divided into the observation group and the control group, with 64 cases in each group. 7 patients fell off, 3 from the observation group and 4 from the control group. The control group was given routine rehabilitation nursing in Neurology Department, while the observation group was given stroke unit rehabilitation nursinig mode. All the objects were evaluated for exercise function, living ability and nursing satisfaction using National Institute of Health Stroke Scale (NIHSS) , Fugl-Meyer Assessment (FMA) , Barthel Index (BI) and a self-designed nursing satisfaction survey. Results There were no statistical significance in the differences of serum total cholesterol (TC) , triglyceride (TG) , visfatin and adiponectin levels between the two groups before the intervention (P>0.05) . After the intervention, the values of TC, TG and visfatin of the observation group were all lower than those of the control group, however the adiponectin level was higher. All the differences were statistically significant (P 0.05) . The score of NIHSS of the observation group was lower than that of the control group after the intervention, but the scores of FMA and BI were higher (P<0.001) . The satisfaction of nursing quality, nursing attitude, nurse patient relationship and health knowledge awareness in the observation group were significantly higher than those of the control group (P<0.05) . Conclusions Stroke unit mode can improve blood lipid and reduce visfatin, increase adiponectin content and improve neurological function in patients with ischemic stroke, so as to improve living ability and motor function of patients. Key words: Dyslipidemias; Ischemic stroke; Stroke unit; Visfatin; Sdiponectin

Effect of positive psychological intervention on psychological status and quality of life in patients undergoing thoracic surgery operation

Objective To establish the screening condition of psychological intervention for patients in department of chest surgery and to explore the effect of psychological intervention on mental status and quality of life of patients undergoing operation. Methods Firstly, 30 healthy citizens and 30 patients undergone thoracic surgery were selected used simple random sampling method from October 2015 to December 2016. The Quality of Life Assessment Table (SF-36) and 90 Symptom Self-assessment Tables (SCL-90) were used respectively to obtain the ROC curve analysis of each total score. The respective values of them were obtained. Secondly, according to the cut-off value, 90 eligible patients were selected and randomly divided into control group and observation group, 45 cases in each group. The control group was given general care, and the intervention group received positive psychological intervention nursing for 2 weeks. Before and after intervention, all patients underwent SF-36 and SCL-90 scores, and the nursing satisfaction survey was done before the end of the study. Results The ROC curve analysis showed that the patients with SF-36 total score less than 570.55 had poorer quality of life, and the patients with SCL-90 total score more than 13.21 had poor mental status. After the intervention, the SF-36 score in emotional function, social function, the overall health of the two groups had no statistical difference (P>0.05) , other indicators of the intervention group were better than the control group, and there were statistical differences (P 0.05) , other indicators of the intervention group were better than the control group, and there were statistical differences (P<0.05) . Conclusions The patients undergoing chest surgery with SF-36 total score less than 570.55 and SCL-90 total score more than 13.21 need positive psychological nursing intervention, and positive nursing intervention has a positive impact on the quality of life and psychological status of such patients. Key words: Thoracic surgery operation; Quality of life; Psychological state; Psychological nursing; Positive psychological intervention

Developing Interventional Radiology Anticoagulation Guidelines: Process and Benefits †.

We created, posted, and updated radiology department anticoagulation guidelines and identified various steps in the process, including triggering events, consensus building, legal analysis, education, and distribution of the guidelines to nurses and clinicians. Supporting data collected retrospectively, before and after implementation, included nursing satisfaction survey results and the number of procedure cancellations. After the guidelines were developed and posted, significantly fewer procedures were cancelled, nursing satisfaction was higher, and radiologists performed procedures with less variability. Anecdotally, radiologists had fewer queries about anticoagulation. The development and dissemination of radiologic procedure anticoagulation guidelines should be considered as a departmental quality improvement project.

Improved Arrangement and Capacity for Medication Transactions: A Pilot Study to Determine the Impact of New Technology on Medication Storage and Accessibility.

Purpose: A new-generation automated dispensing cabinet (ADC) deployment is described. Methods: A single-center retrospective-prospective pilot product performance study was conducted, and prospective nurse satisfaction survey and pharmacy technician product performance feedback survey were performed to determine the impact of new technology on medication storage and accessibility. The study measured efficiency of the 9:00 am medication pull for nursing users, assessment of nursing perceptions of medication administration pre- and postinstallation of the cabinetry, pharmacy technician perceptions of working with the cabinetry, and assessment of the efficiency of the pharmacy technician restock process. Results: In total, 2981 total nursing medication retrieval processes for the 9 am standard medication administration time (SMAT) time were analyzed: 1321 in the preoptimization phase and 1660 in the postoptimization phase. Analysis of the mean time per transaction confirmed a significant improvement from 10.5 to 10.3 seconds per transaction (P = .026) in the postoptimization configuration. The modified assessment of nursing satisfaction survey demonstrated increased satisfaction with many aspects of the new-generation cabinetry. Pharmacy technician survey data highlighted beneficial aspects of the device, while restock data showed an increase in the time spent restocking the cabinet from 11.5 seconds in the preoptimization phase compared with 21.3 seconds in the postoptimization phase (P < .0001). Conclusion: ADC installation and inventory optimization had a statistically significant improvement in the mean time per nursing transaction. Nursing and pharmacy technician surveys demonstrated a trend of enhanced satisfaction with the platform.

Impact of Medication Dose Tracking Technology on Nursing Practice.

Objective: The impact of providing nursing staff access to data collected through a medication dose tracking technology (MDTT) web portal was investigated. Methods: A quasi-experimental, nonrandomized, pre-post intervention study was conducted in the Cardiothoracic Intensive Care Unit (CTICU) at Duke University Hospital. The change in the number of medication requests per dispense routed to the pharmacy electronic health record (EHR) in-basket was analyzed pre and post web portal access. Other endpoints included the number of MDTT web portal queries per day by nursing staff, change in nursing satisfaction survey scores, and technician time associated with processing medication requests pre and post web portal access. The pre web portal access phase of the study occurred from June 1, 2014 to August 31, 2014. The post web portal access phase occurred from October 1, 2014 to December 31, 2014. Results: An 11.4% decrease in the number of medication requests per dispense was exhibited between the pre and post web portal access phases of the study (0.0579 vs 0.0513, respectively; p < .001). Pre and post surveys showed a significant improvement in nurses' satisfaction regarding access to information on the location of medications (p = .009). Additionally, CTICU nursing staff utilized the MDTT web portal for 3.21 queries per day from October 1, 2014 to December 31, 2014. Conclusion: Providing nurses access to data collected via an MDTT decreased the number of communications between nursing and pharmacy staff regarding medication availability and led to statistically significant improvements in nursing satisfaction for certain aspects of the medication distribution process.

Determinants of nurse satisfaction using insulin pen devices with safety needles: an exploratory factor analysis.

BackgroundA paucity of data exists to examine nurses’ satisfaction with the use of insulin pens with safety needles in hospitalized patients with diabetes. We investigated major determinants of nurses’ preference of the method of insulin administration in the context of a General Hospital in Northern Italy.MethodsConsecutive patients admitted to three hospital units of different care intensity requiring insulin received insulin therapy through either the vial/syringe method (October to December 2012) or pen/safety needles with dual-ended protection method (January to March 2013). Before the implementation of insulin pens, floor nurses received a specific training program for proper insulin pen injection technique including individual testing of the devices (pen/safety needles). At the end of the study, nurses completed the Nursing Satisfaction Survey Questionnaire. Cronbach’s alpha was used to determine the internal consistency and reliability of the questionnaire. Major determinants of satisfaction were investigated through an exploratory factor analysis. The association between each retained factor and time spent to teach patients how to self-inject insulin with pen devices was also investigated.ResultsFifty-three out of 60 nurses (mean age ± SD 36.2 ± 8.5 years, 85 % women, 57 % with 10+ years of working experience) returned the questionnaire. Internal consistency of the questionnaire was satisfactory (Cronbach’s alpha > 0.9). Three months after their introduction, about 92 % of nurses considered pen devices an “improvement” over the vial/syringe method. Two factors explained 85 % of nurses’ satisfaction, one related to convenience and ease of use, and the other to satisfaction/time spent for dose preparation and administration. The latter factor was inversely correlated with time spent on patients’ training tasks.ConclusionsNurses’ satisfaction with pen devices was higher than previously reported, possibly reinforced by safety needles with dual-ended protection. Perceived workload was a major determinant of nurse satisfaction using pen devices with safety needles. To facilitate the introduction of insulin pens in the hospital setting, it should be specifically addressed during training programs in the switch-over period.

Effect of different investigation methods on collection and satisfaction rates of patient satisfaction questionnaires

Objective To investigate the best investigation method of nursing satisfaction to the inpatients,to get accurate information,and improve the quality of first level quality control of department for nursing management measures to provide reliable basis and improve nursing work.Methods We used the nursing quality questionnaire by nursing department and the department co-designed to investigate patients' satisfaction to nursing care from October 2011 to June 2012.In different time,the satisfaction surveys were conducted by head nurse,the nurse on duty and the primary nurse respectively.The t test was applied to compare the difference of measurement data; and the Chi-squared test to enumeration data.There was statistical significant difference when P ＜ 0.05.Results The collection and satisfaction rates of patient satisfaction questionnaires in the primary nurse were 95.17％,98.9％,and there was statistical significant difference to the head nurse and the nurse on duty (P ＜ 0.05).Conclusion The discharged patients' satisfaction survey conducted by primary nurse was a better method in nursing satisfaction survey,and it can improve the recovery and satisfaction rate obviously. Key words: Satisfaction survey; Recovery rate; Satisfaction rate

Job stress and job satisfaction among new graduate nurses during the first year of employment in Taiwan

Nurse graduates are leaving their first employment at an alarming rate. The purpose of this study was to explore the relationships between job stress, job satisfaction and related factors over time among these nurses. This study applied a longitudinal design with three follow-ups after nurse graduates' first employment began. Using convenience sampling, participants were 206 new graduates from a university. The Work Environment Nursing Satisfaction Survey and the Clinical Stress Scale were used in this study. Results indicated that job stress remained moderate across three time points. Participants working 12 h shifts exhibited less job stress. Job satisfaction significantly increased in the twelfth month. Participants working 12 h shifts had a higher degree of job satisfaction. Job stress was negatively correlated with job satisfaction. The 12 h work shifts were related to job stress and job satisfaction. These results implied that health-care administrators need to provide longer orientation periods and flexible shift schedules for new graduate nurses to adapt to their work environment.

Impact of Homecare Electronic Health Record on Timeliness of Clinical Documentation, Reimbursement, and Patient Outcomes

Homecare is an important and effective way of managing chronic illnesses using skilled nursing care in the home. Unlike hospitals and ambulatory settings, clinicians visit patients at home at different times, independent of each other. Twenty-nine percent of 10,000 homecare agencies in the United States have adopted point-of-care EHRs. Yet, relatively little is known about the growing use of homecare EHRs. Researchers compared workflow, financial billing, and patient outcomes before and after implementation to evaluate the impact of a homecare point-of-care EHR. The design was a pre/post observational study embedded in a mixed methods study. The setting was a Philadelphia-based homecare agency with 137 clinicians. Data sources included: (1) clinician EHR documentation completion; (2) EHR usage data; (3) Medicare billing data; (4) an EHR Nurse Satisfaction survey; (5) clinician observations; (6) clinician interviews; and (7) patient outcomes. Clinicians were satisfied with documentation timeliness and team communication. Following EHR implementation, 90% of notes were completed within the 1-day compliance interval (n = 56,702) compared with 30% of notes completed within the 7-day compliance interval in the pre-implementation period (n = 14,563; OR 19, p <. 001). Productivity in the number of clinical notes documented post-implementation increased almost 10-fold compared to pre-implementation. Days to Medicare claims fell from 100 days pre-implementation to 30 days post-implementation, while the census rose. EHR implementation impact on patient outcomes was limited to some behavioral outcomes. Findings from this homecare EHR study indicated clinician EHR use enabled a sustained increase in productivity of note completion, as well as timeliness of documentation and billing for reimbursement with limited impact on improving patient outcomes. As EHR adoption increases to better meet the needs of the growing population of older people with chronic health conditions, these results can inform homecare EHR development and implementation.

Implementing an Acuity-Adaptable Care Model in a Rural Hospital Setting

This study examined the effects of an acuity-adaptable care model in a rural hospital setting on nurse satisfaction, patient satisfaction, patient safety, and quality indicators (events, falls, and medication errors), patient length of stay (LOS), and worked hours per patient-day (WHPPD). Acuity-adaptable care models have been implemented as a nursing strategy to improve workflow through the elimination of unit-to-unit patient handoffs. However, to our knowledge, this model of care has not been studied in a rural hospital setting. A descriptive, comparative design with repeated measures was utilized for this study. A professional nurse survey was created to measure staff satisfaction; separate t tests for percentages were utilized to evaluate patient satisfaction and patient safety/quality indicators. Financial data were examined to perform the analysis of patient LOS and WHPPD. The nurse satisfaction survey demonstrated a decrease in weekly floating and cancellations due to low census. There was a statistically significant improvement in patient satisfaction for overall rating and willingness to recommend the hospital. No significant difference was noted in patient quality indicators or LOS; however, there was a favorable trend for all events and medication errors. This study also found a decrease in WHPPD, with a corresponding salary expense reduction reported. Acuity-adaptable units may be a viable strategy for rural facilities.

Use of Telemedicine to Improve Glycemic Management in a Skilled Nursing Facility: A Pilot Study

The objective of this study was to evaluate the feasibility of using telemedicine to improve glycemic control (reduce episodes of hypoglycemia and severe hyperglycemia) for residents with diabetes in a skilled nursing facility. This randomized pilot study enrolled residents with diabetes (n=23; mean age, 83 years; 91% insulin-treated) and compared usual care (control; n=11) with usual care plus weekly/biweekly teleconsultations with an endocrinologist (n=12) for up to 6 months. A nurse and dietitian from the skilled nursing facility were at all televisits. Residents who were able and willing attended the televisits. Family members were also invited and occasionally were present. The endocrinologist reviewed glucose levels from point-of-care glucose meter downloads, dietary intake, medications, and medical status and recommended changes in glycemic therapy as needed. Measurements included glucose levels from point-of-care glucose meter downloads, hemoglobin A1c (A1c) levels, and a nurse satisfaction survey. Results showed that 7 of 10 insulin-treated intervention subjects had basal doses reduced (18-69%) compared with 2 of 11 control subjects (reduced 10% and 25%, respectively). There was a decrease in percentage of intervention participants with episodes of hypoglycemia (<80 mg/dL) over the previous month from baseline (42%) to end of study (22%) versus a rise in the control group (from 36% to 45%) and less hyperglycemia (>400 mg/dL) (intervention, from 33% to 22%; control, from 22% to 55%). There were no end-of-study A1c values >8.0% in the intervention group versus 44% in controls. Nursing staff at the skilled nursing facility expressed high satisfaction. Results suggest that telemedicine diabetes consultations to skilled nursing facilities can improve glycemic management.

Feasibility of screening hospitalized patients for palliative care.

176 Background: The National Comprehensive Cancer Network (NCCN) Palliative Care (PC) Guideline recommends screening all oncology patients for PC, and to call a consult when the referral criteria are met. There are no data on the feasibility or impact of following this recommendation. Methods: Design: Prospective observational study. From 11/1/10 to 1/31/11, floor nurses screened all admissions under the two teams (“Team A” and “Team B”) of the Gastrointestinal Oncology (GIO) service at Memorial Sloan-Kettering Cancer Center. Team A patients were also evaluated by the referral criteria. Endpoints: Patients screened ‘positive’ if they had any of the clinical situations nominated in the Guideline. A PC consult was triggered on Team A patients who met the referral criteria. Team B patients got PC consults based on clinical judgment. Outcomes: screening rates, nursing satisfaction survey, clinical and operational metrics. Results: 90% (228 of 254) admissions were screened, typically taking &lt; 5 minutes. Both teams’ patients were seriously ill (Table 1a), and it is no surprise 75% (170 of 228) screened positive and that 68% (60 of 87) of screen-positive Team A patients met the referral criteria. Screening generated more consults on Team A than Team B (47 vs. 15 p&lt;0.0001), and they were referred earlier (Table 1b). Nurses (response rate 50%) rated screening as quick and simple but not very helpful. Conclusions: Screening for PC was feasible and sustainable, increasing access to specialist services. The value to a comprehensive cancer center of markedly increasing PC consults through implementation of guidelines needs to be evaluated in well-designed trials. [Table: see text]

The Effect of a Family Support Intervention on Physician, Nurse, and Family Perceptions of Care in the Surgical, Neurological, and Medical Intensive Care Units

Many patients in the intensive care unit (ICU) have predictable medical and discharge outcomes, but some trajectories are marked with medical uncertainty. Stressed family-surrogates receive multiple medical updates from a variety of personnel. These circumstances can lead to confusion, which may result in conflicts and dissatisfaction with care. This study examined the effects of adding a family support coordinator to the surgical, neurological, and medical ICUs on family, physician, and nurse satisfaction with communication and care. A quasi-experimental design was conducted in 2 sequential phases (baseline and intervention). The data sources were 2 surveys: (1) Family Satisfaction Survey and (2) Nurse and Physician Perception and Satisfaction Survey. Family Satisfaction Survey data, a combined data set, were collected in the 3 ICUs. Nurse and Physician Perception and Satisfaction Survey data were collected from the attending physicians and critical care nurses in the medical and neurological ICUs. Results show that family ratings of satisfaction with ICU team communication and care generally increased as a result of the intervention. Overall, physician and nurse perceptions of communication and care did not change as a result of the intervention.

Feasibility of screening hospitalized cancer patients for palliative care.

9094 Background: The National Comprehensive Cancer Network Palliative Care (PC) Guideline recommends screening all oncology patients for PC needs, and to call a PC consult when referral criteria are met. There are no data on the feasibility or impact of this approach. The aim of this pilot study was to assess the feasibility of PC screening in patients admitted to a comprehensive cancer center (CCC). Methods: Design: Observational study. From 11/1/10 to 1/31/11, floor nurses screened all patients the day after admission under the two teams (“Team A” and “Team B”) of the Gastrointestinal Oncology Service at Memorial Sloan-Kettering Cancer Center. Team A patients were also evaluated by the referral criteria. Endpoints: Patients screened ‘positive’ if they had advanced disease and any of the clinical situations nominated in the Guideline. The referral criteria triggered PC consults in Team A patients; clinical judgment triggered Team B consults. Outcomes: Screening rates, nursing satisfaction survey, clinical and operational metrics. Results: Ninety percent (229 of 254) of admissions were screened. Both Teams’ patients were seriously ill (see Table), and it was no surprise that 63% (145 of 229) screened positive. Survey respondents (response rate 50%) rated screening as simple, quick and helpful, although nurses scored the extent of disease wrong in 16%. Sixty eight percent (55 of 780) of Team A patients who screened positive met the referral criteria. This generated more consults on Team A, but the effect on key outcomes was not significant (n.s.). Conclusions: Screening for PC was feasible in this setting, but is a challenging concept in terms of reliability, validity and timing. The value to a CCC of increasing PC access via referral criteria needs evaluation in well-designed trials. [Table: see text]

Effect of a Computerized Insulin Dose Calculator on the Process of Glycemic Control

Glycemic control is important to patients' outcomes. However, the process of maintaining glycemic control is risk laden and labor intensive for nurses. To examine the effects of using a computerized insulin dose calculator to facilitate management of glycemic control for critically ill cardiac patients. A prospective randomized controlled trial was conducted with a sample of 300 intensive care patients, 141 randomized to the calculator group and 159 in the control (paper protocol) group. A convenience sample of 44 intensive care nurses responded to a nurse satisfaction survey. A significantly higher percentage of glucose measurements were in the target range in the calculator group than in the control group (70.4% [SD, 15.2%] vs 61.6% [SD, 17.9%], Z = -4.423, P < .001), and glucose variance was significantly less in the calculator group (35.5 [SD, 18.3] mg/dL vs 42.3 [SD, 21.2] mg/dL, Z = -3.845, P < .001). Fewer hypoglycemic events occurred in the calculator group (7 vs 18), although this difference was not statistically significant. Nurse satisfaction was higher for the calculator group than for the control group (8.4 [SD, 1.4] vs 4.8 [SD, 2.4], Z = -5.055, P < .001). Nurses' deviation from the protocol was also less in the calculator group than in the control group. Management of glycemic control and nurse satisfaction were improved with use of the dose calculator. Improving nurses' processes of care may improve nurses' use of time and patient care overall. Studies with larger sample sizes over time are needed to determine these relationships.

Staff Autonomy and Decision Making in Large Stem Cell Transplant Clinic

Nurses in the Stem Cell Transplantation Clinic (SCT) and the Apheresis Center of a large cancer center participated in the National Database of Nursing Quality Indicators (NDNQI) RN satisfaction survey. Although scores for Decision-Making, defined as the “opportunity to participate in administrative decision-making” and Autonomy, defined as “freedom in the workplace to make important decisions” were comparable to other institutions, nurse leaders were surprised they were not higher. Because nurses in the clinic work very independently and participate in developing standard operating procedures (SOPs) and meet regularly with the multidisciplinary team, the results were unexpected. In an effort to gain greater understanding of nurses' perceptions and opinions, quarterly autonomy rounds were established. The intent of the rounds with leaders was to provide a platform to discuss practice and operational issues that were satisfiers and dissatisfies. Bringing leaders of both areas and staff together was also a venue for resolving issues, refining processes and surfacing other concerns. Through autonomy rounds, issues such as repeated double and triple booking of appointments, resulting in long waits for the patients, and nurses feeling “caught in the middle”, began to surface and could be addressed. The outcome of this ongoing process has been positive. The Chairman and Medical Directors of both units have asked the nurses to participate with multidisciplinary teams to develop best practices. Nurses will also be involved in tracking variances of SOPs, trending them, providing that feedback to the team, and participating in necessary revisions. Leaders are looking forward to the next NDNQI Nurse Satisfaction survey results as another measure of expected success of the process.