Journal of nursing care quality最新文献

Background: Elastomeric half-mask respirators (EHMR) reduce health care workers' exposure to airborne hazards including bioaerosols but have primarily been used in the industrial setting.

Purpose: To assess health care workers' perceptions, attitudes, and experiences wearing EHMRs in a clinical environment.

Methods: Employees within a single health care system who wore the EHMR continuously during their shift completed an investigator developed survey. Descriptive statistics and thematic analysis were used.

Results: Of the 8273 EHMR "fit-tested" eligible employees, 1478 met inclusion criteria and participated. Respondents reported that they felt well protected with the EHMR and confident in their care and maintenance of the EHMR. Although skin changes developed, they were primarily managed by adjusting the straps. Clarity of communication was a concern across all respondents and disciplines.

Conclusions: The EHMR was preferred over reusing the N95 although clarity in communication was challenging.

Background: The use of remote visual monitoring (RVM) technology as a "telesitter" in hospitals can reduce falls and increase the efficiency of patient observation.

Purpose: This study aimed to examine RVM effectiveness as a strategy to decrease patient falls and investigate nurses' acceptance and perceived usefulness of RVM technology.

Methods: Remote visual monitoring was implemented within a health system in the Southeastern United States. Falls data 6 months prior to and postimplementation were analyzed, and 106 nurses completed a survey evaluating their acceptance of the RVM technology.

Results: There was a significant 39.15% reduction in falls with injury ( P = .006), and 70.6% of the RVM redirections were successful. Nurses' acceptance and perceived usefulness of RVM were moderate.

Conclusion: Implementing RVM has the potential to enhance patient safety by reducing falls with injuries and is considered acceptable and useful by nurses.

Background: Obesity commonly affects postsurgical pulmonary outcomes and is associated with increased oxygen usage, length of recovery and hospital stay, discharge to high levels of care, cost, morbidity, and mortality.

Local problem: No standardized pulmonary care bundle for obese patients after bariatric surgery was available in the postanesthesia care unit (PACU) at a hospital in Singapore.

Methods: This quality improvement project was a prospective, single-cohort, pre- and posttest intervention design with 151 patients recruited.

Interventions: Teaching and implementation of a modified nurse-led COUGH bundle was carried out on obese patients after their bariatric surgery.

Results: Postbariatric surgery patients with the nurse-led COUGH bundle had significantly less consumption of oxygen in the PACU and step-down units. The PACU and hospital length of stay were also reduced.

Conclusions: The modified nurse-led COUGH bundle can reduce patients' oxygen usage and hospital stay after their bariatric surgery.

Background/local problem: Hypertension is a major risk factor for heart diseases and stroke among Americans; only 25% have this under control nationwide.

Methods: This quality improvement project evaluated the outcomes of team-based care in hypertension control by registered nurses and certified nurse practitioners in a primary care setting. Pre/post-data analysis of blood pressure (BP) control, and BP knowledge, was done.

Intervention: The team provided education and counseling based on knowledge assessment during visits and used unattended automated blood pressure measurement (uAOBPM) techniques to measure BP.

Results: There was a significant reduction in systolic and diastolic BP control ( P < .001). There was a statistically significant increase in disease knowledge score pre- and postintervention ( P < .001).

Conclusion: The team-based care approach improved patients' BP control and knowledge of the disease. The uAOBPM technique could be incorporated into clinical settings for accurate BP measurements.

Background: Early detection of sepsis decreases mortality in hospitals, but recognition of sepsis is often delayed in skilled nursing facilities (SNFs).

Local problem: A local SNF in the northeastern United States sought to use a standardized sepsis pathway to prevent hospital readmissions due to sepsis.

Methods: A pre-/postimplementation design was used for this project. Outcome measures included sepsis detection and treatment, length of stay in the SNF, sepsis-related hospital transfer rate, mortality rate, and predictors of clinical outcomes.

Interventions: A SNF sepsis pathway was developed based on current sepsis detection tools. The pathway incorporated a sepsis screening tool and a sepsis bundle. Implementation of the pathway involved education of nurses and certified nursing assistants on the pathway.

Results: A total of 178 patients were included in data analysis (81 preimplementation and 97 implementation). Sepsis recognition increased from 56% to 86% ( P < .001), and sepsis-related hospital transfers decreased from 68% to 44% ( P = .07). Laboratory testing for lactate, white blood cell count, and blood cultures increased, and sepsis intervention rates significantly improved ( P < .001).

Conclusions: Implementing a modified SNF sepsis pathway accelerated identification of sepsis and improved clinical outcomes.

Background: Complementary pain management strategies are effective at reducing pain in postsurgical patients.

Local problem: Cardiac nurses at a large academic hospital reported inconsistent awareness of patient opioid utilization and poor implementation of complementary pain management strategies.

Methods: A pre/post-quality improvement project was conducted on 2 inpatient cardiac units. Outcomes included nursing staff's perceived knowledge, confidence, and use of complementary pain management strategies and knowledge of patient postsurgical opioid utilization through calculation of morphine milligram equivalence (MME).

Interventions: A comprehensive education program was implemented that included increased patient access to pain management resources, nurse education about complementary pain management strategies, and nurse education and access to MME calculations using a custom electronic health record application.

Results: Nursing staff's perceived knowledge, confidence, and use of complementary pain techniques increased. Patient opioid utilization findings were inconclusive.

Conclusions: Educational programs about complementary pain management offer promise to improve cardiac postsurgical patient care.

Background: Accidental falls are common among older adults and may lead to devastating consequences. One promising approach to reduce falls is to engage older adults in fall risk reduction through care management.

Purpose: This article describes the implementation by undergraduate nursing students of a 6-week interdisciplinary Fall Prevention Care Management (FPCM) intervention to improve the safety of older adults living in assisted living facilities.

Methods: A secondary qualitative descriptive analysis of narrative visit notes was conducted using the Meyer et al taxonomy to characterize fall prevention interventions with older adults.

Results: Individualized fall prevention interventions including motivational interviewing and care management supported clients' engagement with fall prevention by facilitating behavior change related to fall prevention, helping clients identify and reflect on meaning and/or perceptions related to fall prevention.

Conclusion: The FPCM project was acceptable, facilitated high fall risk older adults' engagement with fall prevention, and yielded many positive outcomes.

Background: Hand hygiene (HH) is the most effective way to prevent health care-associated infections; however, HH compliance rates continue to be suboptimal.

Purpose: To determine the effectiveness of video-assisted training and visual feedback with ultraviolet (UV) germ technology on nursing students' HH beliefs, practices, and compliance.

Methods: This study used a double-blind, posttest randomized controlled design. The experimental group received training, visual feedback with UV germ technology, and instructional videos.

Results: A total of 46 students were included in the study (experimental 21 and control 25). The mean score of the HH skills checklist of the experimental group was significantly higher than that of the control group ( P = .0001). The HH compliance rate was also higher in the experimental group (52.62%) compared with the control group (39.1%).

Conclusions: The training, visual feedback with UV germ technology, and instructional videos increased HH compliance rates in nursing students.

Background: Blood draw procedures can cause pain, fear, and anxiety in the pediatric population.

Purpose: To compare the effects of watching cartoons either with virtual reality (VR) or via a tablet on pain, fear, and anxiety during venous blood draw procedures in children.

Methods: A randomized controlled study was conducted with 159 children aged 5 to 12 years in the pediatric emergency unit. The 3 groups included cartoons with VR (n = 53) or a tablet (n = 53), and a control group (n = 53).

Results: Children in the 2 intervention groups had lower perceptions of pain, fear, and anxiety, with those watching cartoons via VR having the lowest perceptions.

Conclusions: Findings from this study showed a reduction in the perception of pain, fear, and anxiety in children who watched cartoons with VR or tablets during blood draw procedures. Nurses should consider using these nonpharmacological methods to reduce pain, fear, and anxiety, among pediatric patients.