Malissa A Mulkey, DaiWai M Olson, Sarah Misrahi, Sonya R Hardin
This project aimed to identify patients who had experienced a stroke and were at risk for delirium earlier, and implement evidence-based protocols to reduce overall length of stay and mortality. Nurses were motivated to perform screening and implement strategies that benefit patients who had experienced acute stroke. Results suggest early identification and treatment of delirium, use of prevention strategies, and treatment of the underlying etiology can improve patient outcomes and reduce cost of care.
{"title":"Delirium Screening of Patients on a Neuroscience Step-Down Unit.","authors":"Malissa A Mulkey, DaiWai M Olson, Sarah Misrahi, Sonya R Hardin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This project aimed to identify patients who had experienced a stroke and were at risk for delirium earlier, and implement evidence-based protocols to reduce overall length of stay and mortality. Nurses were motivated to perform screening and implement strategies that benefit patients who had experienced acute stroke. Results suggest early identification and treatment of delirium, use of prevention strategies, and treatment of the underlying etiology can improve patient outcomes and reduce cost of care.</p>","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9718572/pdf/nihms-1848439.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35257008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Negative behaviors often are directed toward nursing staff in verbal or physical assaults. Nursing staff on non-psychiatric units may not be prepared to manage such situations and need additional support. Behavioral Emergency Response Teams (BERTs) have been effective in supporting nursing staff faced with patients exhibiting these behaviors.
{"title":"Using a Behavioral Response Team on Non-Psychiatric Nursing Units.","authors":"Deborah Dahnke, Malissa A Mulkey","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Negative behaviors often are directed toward nursing staff in verbal or physical assaults. Nursing staff on non-psychiatric units may not be prepared to manage such situations and need additional support. Behavioral Emergency Response Teams (BERTs) have been effective in supporting nursing staff faced with patients exhibiting these behaviors.</p>","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10181858/pdf/nihms-1848437.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9501734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Agitation is a symptom of many medical and psychiatric disorders that can manifest along a spectrum of severity. Agitation often delays treatment onset, potentially impacting morbidity and mortality, and may require emergency interventions. Management of acute agitation centers around three main goals: early recognition and treatment of the underlying etiology, rapid control of the behavior, and prevention of harm to the patient and personnel. Nurses should increase use of validated techniques, including frequent and sufficient reality orientation, validation therapy, and strategies that improve the individual's quality of life.
{"title":"Calming the Agitated Patient: Providing Strategies to Support Clinicians.","authors":"Malissa A Mulkey, Cindy L Munro","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Agitation is a symptom of many medical and psychiatric disorders that can manifest along a spectrum of severity. Agitation often delays treatment onset, potentially impacting morbidity and mortality, and may require emergency interventions. Management of acute agitation centers around three main goals: early recognition and treatment of the underlying etiology, rapid control of the behavior, and prevention of harm to the patient and personnel. Nurses should increase use of validated techniques, including frequent and sufficient reality orientation, validation therapy, and strategies that improve the individual's quality of life.</p>","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171292/pdf/nihms-1697787.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39067000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-13DOI: 10.4324/9781003076391-15
Inouye, Dyck, Alessi, Balkin, Siegal, Horwitz
WHY: Delirium is present in 10%-31% of older medical inpatients upon hospital admission and 11%-42% of older adults develop delirium during hospitalization Delirium is associated with negative consequences including prolonged hospitalization, functional decline, increased use of chemical and physical restraints, prolonged delirium post hospitalization, and increased mortality. Delirium may also have lasting negative effects including the development of dementia within two years (Ehlenbach et al., 2010) and the need for long term nursing home care (Inouye, 2006). Predisposing risk factors for delirium include older age, dementia, severe illness, multiple co-morbidities, alcoholism, vision impairment, hearing impairment, and a history of delirium. Precipitating risk factors include acute illness, surgery, pain, dehydration, sepsis, electrolyte disturbance, urinary retention, fecal impaction, and exposure to high risk medications. Delirium is often unrecognized and undocumented by clinicians. Early recognition and treatment can improve outcomes. Therefore, patients should be assessed frequently using a standardized tool to facilitate prompt identification and management of delirium and underlying etiology. BEST TOOL: The Confusion Assessment Method (CAM) is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately in both clinical and research settings. The CAM includes four features found to have the greatest ability to distinguish delirium from other types of cognitive impairment. There is also a CAM-ICU version for use with non-verbal mechanically ventilated patients (See Try This: ® CAM-ICU). VALIDITY AND RELIABILITY: Both the CAM and the CAM–ICU have demonstrated sensitivity of 94-100%, specificity of 89-95% and high inter-rater reliability (Wei, Fearing, Eliezer, Sternberg, & Inouye, 2008). Several studies have been done to validate clinical usefulness. STRENGTHS AND LIMITATIONS: The CAM can be incorporated into routine assessment and has been translated into several languages. The CAM was designed and validated to be scored based on observations made during brief but formal cognitive testing, such as brief mental status evaluations. Training to administer and score the tool is necessary to obtain valid results. The tool identifies the presence or absence of delirium but does not assess the severity of the condition, making it less useful to detect clinical improvement or deterioration. FOLLOW-UP: The presence of delirium warrants prompt intervention to identify and treat underlying causes and provide supportive care. Vigilant efforts need to continue across the healthcare continuum to preserve and restore baseline mental status. (2010). Association between acute care and critical illness hospitalization and cognitive function in older adults.based geriatric nursing protocols …
{"title":"Confusion Assessment Method (CAM)","authors":"Inouye, Dyck, Alessi, Balkin, Siegal, Horwitz","doi":"10.4324/9781003076391-15","DOIUrl":"https://doi.org/10.4324/9781003076391-15","url":null,"abstract":"WHY: Delirium is present in 10%-31% of older medical inpatients upon hospital admission and 11%-42% of older adults develop delirium during hospitalization Delirium is associated with negative consequences including prolonged hospitalization, functional decline, increased use of chemical and physical restraints, prolonged delirium post hospitalization, and increased mortality. Delirium may also have lasting negative effects including the development of dementia within two years (Ehlenbach et al., 2010) and the need for long term nursing home care (Inouye, 2006). Predisposing risk factors for delirium include older age, dementia, severe illness, multiple co-morbidities, alcoholism, vision impairment, hearing impairment, and a history of delirium. Precipitating risk factors include acute illness, surgery, pain, dehydration, sepsis, electrolyte disturbance, urinary retention, fecal impaction, and exposure to high risk medications. Delirium is often unrecognized and undocumented by clinicians. Early recognition and treatment can improve outcomes. Therefore, patients should be assessed frequently using a standardized tool to facilitate prompt identification and management of delirium and underlying etiology. BEST TOOL: The Confusion Assessment Method (CAM) is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately in both clinical and research settings. The CAM includes four features found to have the greatest ability to distinguish delirium from other types of cognitive impairment. There is also a CAM-ICU version for use with non-verbal mechanically ventilated patients (See Try This: ® CAM-ICU). VALIDITY AND RELIABILITY: Both the CAM and the CAM–ICU have demonstrated sensitivity of 94-100%, specificity of 89-95% and high inter-rater reliability (Wei, Fearing, Eliezer, Sternberg, & Inouye, 2008). Several studies have been done to validate clinical usefulness. STRENGTHS AND LIMITATIONS: The CAM can be incorporated into routine assessment and has been translated into several languages. The CAM was designed and validated to be scored based on observations made during brief but formal cognitive testing, such as brief mental status evaluations. Training to administer and score the tool is necessary to obtain valid results. The tool identifies the presence or absence of delirium but does not assess the severity of the condition, making it less useful to detect clinical improvement or deterioration. FOLLOW-UP: The presence of delirium warrants prompt intervention to identify and treat underlying causes and provide supportive care. Vigilant efforts need to continue across the healthcare continuum to preserve and restore baseline mental status. (2010). Association between acute care and critical illness hospitalization and cognitive function in older adults.based geriatric nursing protocols …","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70619840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachel French, Matthew D McHugh, Eileen Lake, J Margo Brooks Carthon
An understudied aspect of the opioid crisis with implications for nursing is care of hospitalized surgical patients with chronic opioid use. Care needs of these patients are not well understood. This systematic review identified salient care needs and explored the role of nursing in meeting these needs.
{"title":"A Systematic Review of Care Needs for Surgical Patients with Chronic Opioid Use.","authors":"Rachel French, Matthew D McHugh, Eileen Lake, J Margo Brooks Carthon","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>An understudied aspect of the opioid crisis with implications for nursing is care of hospitalized surgical patients with chronic opioid use. Care needs of these patients are not well understood. This systematic review identified salient care needs and explored the role of nursing in meeting these needs.</p>","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8168975/pdf/nihms-1636080.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38974907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T he Nurses' Health Study was begun in 1976 with the establishment of a cohort of 120,700 women aged 30-55 and was principally designed to assess risk factors for breast cancer. Cohort members initially resided in 11 geographically dispersed states representing the Northeast (Massachusetts, Connecticut, New York, New Jersey, Pennsylvania, Maryland), Northcentral (Ohio, Michigan), the West (California) and the South (T exas, Florida); although the majority of participants still reside in the original 11 states, members of the cohort currently live in all 50 states. T hese women report on exposures and disease outcomes every two years and follow-up in the cohort has been maintained at a level of better than 90% through 1990. Qeios · Definition, February 2, 2020
{"title":"Nurses' Health Study","authors":"","doi":"10.32388/eewxwj","DOIUrl":"https://doi.org/10.32388/eewxwj","url":null,"abstract":"T he Nurses' Health Study was begun in 1976 with the establishment of a cohort of 120,700 women aged 30-55 and was principally designed to assess risk factors for breast cancer. Cohort members initially resided in 11 geographically dispersed states representing the Northeast (Massachusetts, Connecticut, New York, New Jersey, Pennsylvania, Maryland), Northcentral (Ohio, Michigan), the West (California) and the South (T exas, Florida); although the majority of participants still reside in the original 11 states, members of the cohort currently live in all 50 states. T hese women report on exposures and disease outcomes every two years and follow-up in the cohort has been maintained at a level of better than 90% through 1990. Qeios · Definition, February 2, 2020","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69629896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shelia Y Ross, Sarah Roberts, Helen Taggart, Carl Patronas
This quality improvement project focused on improving patient education and patient satisfaction, and reducing all-cause 30-day readmissions. A 72-hour discharge follow-up telephone call was completed in patients discharged home with diagnosis of stroke.
{"title":"Stroke Transitions of Care.","authors":"Shelia Y Ross, Sarah Roberts, Helen Taggart, Carl Patronas","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This quality improvement project focused on improving patient education and patient satisfaction, and reducing all-cause 30-day readmissions. A 72-hour discharge follow-up telephone call was completed in patients discharged home with diagnosis of stroke.</p>","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36561559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Total knee arthroplasty (TKA) affects patients' lives in many ways. In this descriptive qualitative study, effects of knee problems were identified as influential on patients' decisions during the preopera- tive period. Patients also stated they experienced difficulties postop- eratively that were unique to TKA.
{"title":"The Patient's Experience in Total Knee Arthroplasty: Past-Now-Future.","authors":"Hale Turhan Damar, Bilik Özlem","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Total knee arthroplasty (TKA) affects patients' lives in many ways. In this descriptive qualitative study, effects of knee problems were identified as influential on patients' decisions during the preopera- tive period. Patients also stated they experienced difficulties postop- eratively that were unique to TKA.</p>","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36561560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Janet T Crimlisk, Margaret M Grande, Gintas P Krisciunas, Kim V Costello, Eduarda G Fernandes, Martha Griffin
A nurse residency program was designed to train a large group of new graduate nurses hired into multiple specialty areas. The program included a generalist 1 month 5 day/week clinical orientation followed by specialty clinical orientation with ongoing generalist education. Retention rate after 1 year was 91%.
{"title":"Nurse Residency Program Designed for a Large Cohort of New Graduate Nurses: Implementation and Outcomes.","authors":"Janet T Crimlisk, Margaret M Grande, Gintas P Krisciunas, Kim V Costello, Eduarda G Fernandes, Martha Griffin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A nurse residency program was designed to train a large group of new graduate nurses hired into multiple specialty areas. The program included a generalist 1 month 5 day/week clinical orientation followed by specialty clinical orientation with ongoing generalist education. Retention rate after 1 year was 91%.</p>","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36561556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Healthcare providers typically use opioids to treat postoperative pain. Use of intravenous ibuprofen and acetaminophen as adjuncts to opioids is evaluated for potential to reduce opioid use and improve postoperative pain management.
{"title":"The Use of Intravenous Ibuprofen and Intravenous Acetaminophen in Surgical Patients and the Effect on Opioid Reduction.","authors":"Tracy M Kwan, Marisa Sullivan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Healthcare providers typically use opioids to treat postoperative pain. Use of intravenous ibuprofen and acetaminophen as adjuncts to opioids is evaluated for potential to reduce opioid use and improve postoperative pain management.</p>","PeriodicalId":18507,"journal":{"name":"Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36561566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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