Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses最新文献

Abstract: Catheter-associated urinary tract infections (CAUTIs) continue to be a concern in health care. According to the Agency on Healthcare Research and Quality, the cost associated with a single CAUTI is estimated to be $13,793 on average but can be as high as $29,743. Decreasing CAUTIs through preventative strategies will benefit both the patient and the healthcare organization. There were limited studies utilizing 2% and 4% chlorhexidine gluconate (CHG) as an intervention for CAUTI prevention. There was also an insufficient research about indwelling catheters, also known as a Foley catheters, and use of CHG during bathing and indwelling catheter care outside intensive care and CHG benefits relating to indwelling catheter care. To address this issue, we developed and implemented a quality improvement project in an inpatient rehabilitation facility for patients requiring indwelling catheters by integrating Food and Drug Administration-approved CHG products to determine the effectiveness of using 2% versus 4% CHG during bathing and indwelling catheter care to decrease CAUTI occurrences. We observed two CAUTIs for the unit using 4% CHG and zero CAUTIs using the 2% CHG. CAUTIs were associated with chronic renal calculi, missed opportunities with bowel care management, and knowledge deficits of supplemental staff members.

Purpose: Many fall risk assessment tools exist. However, few of these fall risk assessment tools have been tested in the acute rehabilitation setting. The purpose of our study was to compare the accuracy of the Hendrich II Fall Risk Model (HIIFRM) and Sunnyview Test Scale in predicting falls. We also identified factors associated with falls in the rehabilitation patient.

Design and methods: In this retrospective cohort study, we extracted electronic health record data from two acute inpatient rehabilitation units and compared the predictive validity of the HIIFRM and the Sunnyview Test Scale.

Results: Our sample included 134 fallers and 1,667 nonfallers. The HIIFRM and the Sunnyview Test Scale had similar predictive performance with area under the receiver operating characteristic curve (AUC) of .62 and .60, respectively.

Conclusion: The HIIFRM and the Sunnyview Test Scale had poor performance (AUC < .70) predicting falls in this acute rehabilitation setting. Using a fall risk assessment tool alone does not consider unique risk factors and makes implementation of individualized prevention interventions challenging. Nurses need a framework to use individualized factors to determine high fall risk. Further research is needed to clarify variables specific to the inpatient rehabilitation population.

Clinical relevance: Current fall risk assessment tools are inadequate in the inpatient rehabilitation setting; an individualized fall prevention plan is recommended to ensure patient safety.

Purpose: The aim of this study was to assess the usability of a cloud-based home healthcare monitoring platform (CHHM).

Design: A proof of concept using a simulated client scenario was used in this study.

Methods: Using a mixed-methods approach, a convenience sample of 14 nursing students was used to assess the usability of CHHM during a simulation. Students engaged in evaluation using two questionnaires: the Post-Study System Usability Questionnaire (Usability Questionnaire) and a researcher-developed questionnaire incorporating qualitative responses.

Results: The overall mean score of the Usability Questionnaire was 2.91, with the range of 7, indicating the usability of the platform. The Usability Questionnaire was negatively scored, with 1 being the best. The means of the two subscales, System Usefulness (2.77) and Information Quality (3.26), illustrated the platform's solid performance. The Interface Quality subscale mean was 2.94, indicating a lower level of satisfaction. Qualitative data from the researcher-developed questionnaire indicated that participants found the platform straightforward, clear, and user-friendly, with the potential to enhance practice.

Clinical relevance: This platform may enhance rehabilitation nurses' ability to monitor clients at home.

Conclusion: The CHHM can support and enhance the delivery of home health care by enabling continuous remote monitoring. By incorporating user-centered design principles, cloud-native architecture, and wearable sensors, we demonstrated a proof of concept and laid the foundation for further platform development.

Background: Most critical thinking assessment tools are resource intensive and require significant time and money to administer. Moreover, these tools are not tailored to evaluate critical thinking skills among inpatient rehabilitation facility (IRF) nurses. This pilot study explores the efficacy of using short videos to evaluate critical thinking for nurses working in an IRF.

Methods: We developed and filmed 3 clinical scenarios representative of common IRF events that require critical thinking on behalf of the nurse. Thirty-one IRF nurses participated in the study and independently scored their own critical thinking skills using a visual analog scale. Using the same scale, nurse managers and assistant managers who worked closely with the nurses also rated the critical thinking ability of each nurse. The nurse then viewed and responded in narrative form to each of the 3 videos. A scoring rubric was used to independently evaluate the critical thinking skills for each nurse based on the nurses' responses.

Results: Nurses rated their own critical thinking skills higher than mangers rated them (m = 85.23 vs 62.89). There was high interrater reliability for scoring video 1k (0.65), video 2k (0.90), and video 3k (0.84).

Conclusion: The results demonstrate efficacy for further study of low-cost alternatives to evaluate critical thinking among neuroscience nurses providing IRF care.

Purpose: The purpose of this study was to understand the novel experience of a rehabilitation specialty hospital conversion to acute medical/COVID-19 patient care from the perspective of rehabilitation nurses.

Design: A descriptive qualitative study was conducted.

Methods: Thirty-six nurses employed by the rehabilitation specialty hospital were invited to participate. Narrative data were collected via an online survey and were analyzed using a conventional content analysis approach.

Results: Fifteen (42%) of those eligible participated. The overarching descriptor of the rehabilitation nurses' experiences was "we did what we had to do." Three primary descriptors emerged: challenged, conflicted, and compromised. Communication from leadership prominently informed the conversion experience.

Clinical relevance to the practice of rehabilitation nursing: Expecting rehabilitation specialty nurses to care for a different patient population is an important consideration and requires leadership to understand the distinctive characteristics of the specialty and its approach to care.

Conclusions: Addressing the impact on nursing staff in any disaster requires listening and communicating to provide needed support. Recognizing the characteristics of nursing specialties, the need for self-care among nursing staff and the salience of effective communication are essential during specialty hospital conversions.

Purpose: Patient falls are an ongoing challenge in the rehabilitation setting largely because of falls being common among patients during mobility. Rehabilitation nursing staff are responsible for mobilizing patients whenever they are not in therapy, yet are often not trained to carry out complex mobilization techniques in the way therapy staff are.

Methods/results: The integration of therapy-led mobility clinics into nursing staff orientation, along with change-of-shift safety huddles, was successful as a fall prevention strategy on one acute inpatient rehabilitation unit.

Conclusions: Nursing leadership should leverage therapy expertise in the rehabilitation setting to educate nursing staff on complex mobilization techniques for improved patient outcomes.