Stress Manifestations in Patients and Families after Critical Illness, Critical Care Unit (CCU)
Diane Hamilton, BSN, MN, DNP, RN, Clinical Nurse
Brenda Wilhite, BSN, RN, Clinical Nurse
Kimberly Hart, MSN, BA, RN, CCRN, Clinical Nurse
Purpose: The nursing research study tested whether critical care patients and their families who participate in journaling during the critical care stay, compared to those who do not journal, experience lower stress manifestations following the critical illness.
Implications: Of the 83 enrolled participants, contact was lost with 31 during the course of the study. Due to the small number participants with follow-up interviews, significant conclusions cannot be drawn. However, results show CCU patients and families who participate in journaling while in the CCU did report fewer stress manifestations in the short term, but did not find long-term benefit from journaling.
Future Studies: Research is needed with larger sample size.
Use of Aromatherapy to Prevent Post-Operative Nausea in the Post Anesthesia Care Unit (PACU) Setting
Jennifer Davis, MSN, RN, Clinical Nurse
Heather Braseth, BSN, RN, Clinical Nurse
Jason Hautala, RN, Clinical Nurse
Shannon Hubert, BSN, RN, Clinical Nurse
Maureen Olmos, RN, Clinical Nurse
Purpose: Of the 75 million surgeries performed yearly, Post-Operative Nausea (PON) and vomiting occurs in up to one third of these patients. Many patients experiencing PON do not experience relief from traditional anti-emetic medications and need access to other non-invasive options such as aromatherapy. This nursing improvement project tested patient response to inhalation (breathing in) of essential oils (aromatherapy) to decrease the nausea symptoms of our patients.
Implications: Of the 100 participants that completed the study, over 90% reported that the Aromatherapy helped relieve PON symptoms, over 90% stated their patient experience was more positive with aromatherapy, and over 95% would request QE in the future. Also with these participants, the nurses were able to demonstrate a 73% reduction of antiemetic medication use in the PACU setting.
Future Studies: As healthcare treatments change, healthcare leaders should explore improved evidence based practice options of caring for patients experiencing PON. Evidence suggests that use of aromatherapy alleviates PON symptoms, and improves patient satisfaction after surgery. This project findings are consistent with previous clinical studies and trials.
In-Person Constant Observation and Violence Reduction, Acute Care Units
Julie Jump, BSN, RN, Assistant Nurse Manager
Christina Case, MSN, RN-BC, Assistant Nurse Manager (PI)
Dawn Gadwa, RN, OCN, CMSRN, Clinical Nurse
Tammy Paarlberg, DNP, RN, CCRN, Nurse Manager
Cherisse Norberte, Pharmacy Resident
Melissa Bruce, MSN, Rn, Assistant Nurse Manager
Purpose: When a patient’s behavior interferes with care or endangers the patient or others, in-person constant observation may be required to maintain patient and staff safety. Many things can lead to a disruption in cognition and behavior for a patient including illness, medications, and a change in their routine and environment. At PSPH, we want to support patients and staff by helping these patients return to their baseline behavior and cognition as swiftly as possible. In this quality improvement project, an intervention bundle will be implemented to holistically address patient needs including medication optimization, behavioral support, and integration of our Avasure Telesys monitoring system to move patients toward recovery and a safe discharge. The “S.T.A.R.S.” intervention bundle implemented in this quality improvement project will include: Safety, Technology, Activity, Relief, and Surroundings.
Implications: Anticipated results from the intervention bundle include a reduction of in-person constant observation hours needed for patients, a reduction in length of stay, a reduction in violence by patients which sometimes happens when patients are confused and disoriented, and a reduction in fall rate.
Future Studies: With increasing demands for behavioral support and limited psychiatric resources, quality improvement projects will continue to be necessary in meeting the needs of our patient population while maintaining the safety of our caregivers.
Best Practice Guidelines for Vancomycin Infusion and IV Site Care
Angela Cannady, BSN, ONC, Clinical Nurse
Megan Pettibone, Pharmacist
Mai Nguyen, Pharmacist Resident
Sul Chae, Pharmacist Resident
Purpose: This is a Quality Improvement Project with a multifaceted intervention that could significantly improve prescribing, monitoring and safety outcomes for delivery of vancomycin through a peripheral intravenous catheter (PIV). This intervention will include current policy education and recommended order directions for a PIV vancomycin infusion rate of 10 mg/min. for pharmacy staff and providers. A nurse driven protocol will incorporate a vancomycin PIV decision tree for management of patients receiving vancomycin through peripheral intravenous access.
Implications: Evidence-based education and proper order entry for delivery of vancomycin through the PIV should improve outcomes for patients receiving this medication. Patients should experience less intravenous (IV) site pain, phlebitis, infiltrations and PIV site changes. This project will go live January 1, 2019, piloted on the 6th floor orthopedic unit.
The Relationship between Moral Injury (MI), Moral Resilience (MR) and the Healthy Work Environment (HWE) among ICU Nurses
Nicole Aaron, MSN, RN, NS, CCRN, NPD-BC, ICU Clinical Nurse Specialist, PSPH Site Principle Investigator.
Purpose: This multisite research study, under the direction of Sarah Sumner, MSN, RN, MPD-BC, CCRN, OCN, CHPN, PI, described the prevalence of MI among ICU nurses, and the relationships between MI, MR and HWE among ICU nurses.
Findings: There is a strong inverse relationship between MI and MR, and moderate inverse relationship between MI and HWE. The researchers also found that MI is higher among younger, newer nurses.
Implications: Findings suggest that strategies focused on improving moral resilience can support a reduction in moral injury in the ICU setting.
Future Studies: The study provides insights into the development of moral injury in the ICU setting, and how a healthy work environment and increased moral resilience serve as mitigators. However, additional research is needed to understand the effect of potential interventions.
FAST-5: A frontline nurse-designed tool to predict inpatient fall risk
Dawn Gadwa, BSN, RN, OCN, CMSRN
Crystal Billings, DNP, RN, LNC
Purpose: The study explored the accuracy of a new tool, FAST-5, versus usual care (Morse Fall Scale), to predict patient falls.
Findings: In this study, the FAST-5 tool more accurately predicted fall in the high-risk population compared to MFS (71% to 60%). Additionally, FAST-5 had a lower error ratio for low-risk patients, 6% compared to 18% with MFS.
Future Studies: Although more research is needed, the findings of the new tool show promise as a clinically relevant patient assessment tool to decrease patient falls in the hospital setting.
Perceived Barriers to Patient Mobilization Among Therapy and Nursing Acute Care Staff: A Multi-site Survey Study
Tiffanie Rampley, NEA-BC, CCRN-K, RN, PhD
Crystal Billings, DNP, RN, LNC
Danell Stengem, DNP, RN
Teresa Rangel, PhD, MSN, RN
Purpose: The objective of this study was to identify differences in perceived barriers to patient mobilization in acute care among therapy and nursing clinicians, and among hospitals of different sizes and types.
Findings: The researchers concluded that perceived barriers to patient mobilization exist among therapy and nursing acute care clinicians, with greater barriers noted among nursing staff for knowledge, attitudes and behaviors associated with patient mobility practices.
An Experience Sampling Analysis of the Impact of Video Monitoring Technology and In-Person Sitters on Nurse Burnout: The Moderating Effect of Nurse Commitment and Mediating Effect of Emotional Labor
Crystal Billings, DNP, RN, LNC. Billings collaborated with a team from University of Illinois, Chicago on this study.
Purpose: The study compared the use of video monitoring technology and in-person sitters. VMT is conceptualized as a resource gain for staff, whereas in-person sitter, resource loss.
Findings: The researchers found positive effects from video monitoring technology and negative effects of in-person sitters on emotional labor and emotional exhaustion.
Implications: These findings have implications for practice, in that accessible health care requires a motivated and well-trained nurse workforce of sufficient size, which can deliver high-quality service. It is hoped these findings help hospital systems make resource allocation decisions that positively impact a wide range of nurse outcomes.
Link to Article: An Experience Sampling Analysis of the Impact of Video Monitoring Technology and In-Person Sitters on Nurse Burnout: The Moderating Effect of Nurse Commitment and Mediating Effect of Emotional Labor - Donald Kluemper, Jiaqing Sun, Young Eun Lee, Sandy J. Wayne, Emily Anderson, Crystal M. Billings, Joel Koopman, Christopher C. Rosen, 2023 (sagepub.com)