Journal of Doctoral Nursing Practice最新文献

Background: The Center for Disease Control and Prevention (CDC) reported 26.9 million individuals a diabetes diagnosis rate of 9.4% in the United States had diabetes in 2018, equivalent to 8.2% of the population (CDC, 2020). Key government organizations have developed clinical quality indicators (CQIs) to ensure patients receive adequate care. The CQIs for comprehensive diabetes care are complex and often indicate a gap-in-care among vulnerable populations.

Objective: To evaluate if the availability of point-of-care (POC) hemoglobin A1c (HbA1c) testing in a mobile clinic increases CQIs adherence in vulnerable populations.

Methods: This evidence-based clinical practice change project (EBCPCP) focused on improving diabetic CQIs in vulnerable populations by implementing POC HbA1c testing on a federally qualified health centers (FQHC) mobile clinic.

Results: The results, 125 individuals having received HbA1c results, indicate having POC HgbA1c testing available on the mobile unit increased HbA1c testing. No patients had an HbA1c lab completed prior to the availability of POC testing.

Conclusion: The availability of POC testing on a mobile clinic increases access to HbA1c for vulnerable populations which improves practice outcomes and increased CQI adherence.

Implications for nursing: The results of this EBCPCP indicate POC testing increases access to diagnostics and care.

Background: When a child becomes critically ill and hospitalized in intensive care, this can be emotionally and physically traumatic for parents.

Objective: The purpose of the initiative was to utilize a stress screening tool to quantify parental stress and examine the use of family support services as a way to impact stress scores.

Methods: The Family Stress Thermometer (FST) was introduced and parents were asked to circle their stress level at up to three time points. Along with recorded stress scores, resources accessed were documented, how often it was utilized, and parental suggestions that might ease stressors recorded.

Results: The results indicate the FST accurately recorded elevated stress levels in parents with critically ill children, analysis showed a statistically significant decrease in the stress levels of parents over time.

Conclusions: This project appears to validate parental distress levels as a modifiable risk factor.

Implications for nursing: The FST was cost-effective and easy to administer. As part of comprehensive plans of care for families, interprofessional teams can work to design support services that meet individualized needs of parents with critically ill children. Partnering with parents to quantify their stress and responding to their needs will insure the likelihood of this happening.

Background: In the main operating rooms of a large academic hospital there was a report of 408 count discrepancies in 2015-2016 and 13 incidences of retained surgical items (RSIs). There was a lack of a consistent and standardized surgical count process among nurses.

Objectives: To reduce count discrepancies by 25%, prevent RSIs, and improve the compliance of the perioperative nursing team regarding the surgical count process.

Methods: An evidence-based quality improvement project with a sample of 455 surgical procedures and 118 nurses. Data collection occurred over an eight-week period in 2018 using a Plan-Do-Study-Act (PDSA) methodology to study the effectiveness of the utilization of the Association of periOperative Registered Nurses (AORN) practice guidelines for the prevention of RSIs.

Results: The inclusion of risk reduction strategies such as the utilization of an AORN guideline whiteboard to record surgical items and the identification of high-risk items for retained device fragments or high-risk surgical items for RSIs resulted in the reduction of incorrect surgical counts by 71.43%, with no incidence of RSIs. Further, nurse compliance on surgical count practices improved significantly, F (5, 46) = 2.47, p = .046, PES = .21.

Conclusion: The implementation of the AORN guidelines for perioperative surgical count practices by the perioperative nursing team provided an improved surgical count process.

Implication for nursing: A system approach to performance improvement is needed to prevent RSIs.