- 2013 NACNS Annual Conference: Clinical Nurse Specialists Leading Innovations for Healthcare Change.
- An in-depth orientation. Preparing new part-time clinical instructors from the. It is no secret that there is a current shortage of nursing faculty.
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Speculate on the feasibility of these programs to solve the program. New Delhi Statement - 1990- formalized the need to. Independent Institute 100. Liberal Education for Liberal Democracy By Ross. Objectives of the Faculty. Objectives of the Technical Mathematics/Aas Programs. Participating in the orientation and training of new Traveling.
Clinical Nurse Specialists Leading Innovations for Healthcare Change. Ambulation at 3 Versus 6 Hours Post- Femoral Artery Hemostasis in the Percutaneous Coronary Intervention Patient. Warfield, Karen T, Mayo Clinic, Minnesota. Objective: To investigate the (1) patient's perceived back pain, (2) overall discomfort related to bed rest, and (3) the safety and efficacy of reducing the duration of post- PCI bed rest from 6 to 3 hours. Significance/Background: Prolonged bed rest after femoral artery sheath removal following percutaneous coronary intervention (PCI) is associated with discomfort. Previous studies have shown that reducing bed rest time after coronary angiography reduces discomfort without increasing complications, but the effect of reducing bed rest in to less than 4 hours in post- PCI patients who have received significant anticoagulation and received GP IIb/IIIa inhibitors prior to PCI has not been adequately studied.
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The importance of education is. Mikel Hand, University of Southern Indiana. Formalized new-faculty orientation programs are not a luxury but rather a crucial necessity to recruit and retain.
Methods: Two hundred forty- nine patients, including those receiving GP IIb/IIIa inhibitors, undergoing PCI utilizing 5. F or 6. F sheaths from the femoral access site were randomized to either 3 (n = 1. Perceptions of back pain and over- all discomfort were measured by the Mc. Gill Pain Questionnaire- Short Form and the visual analog scale.
Findings/Outcomes: At 3 hours after hemostasis, 3. Six patients developed a hematoma > 5 cm. From 3 to 6 hours after hemostasis, 2.
Patient randomized to 6 hours of bed rest experienced significantly more pain: visual analog scale (P = . Pain Rating Index (P = . Present Pain Index (PPI) (P = .
One patient (randomized to 3 hrs bed rest) had a hematoma at this point. After ambulation a hematoma > 5 cm was observed in 1 patient in each of the 2 treatment groups (P > . Rebleeding occurred in 2 (1. P > . 9. 9). Conclusions: Bed rest time following PCI via femoral access using 5. F or 6. F sheaths can be safely reduced from 6 to 3 hours with improvement in patient comfort.
Further studies are needed to extend these results that early ambulation may be a safe alternative to prolonged bed rest for a subset of PCI patients. Implications: With the results of this research study a standardized practice change was implemented across the institution minimizing the length of bed rest post- PCI. Patients verbalized increased satisfaction with early mobility as well as a decrease in complaints of overall discomfort. With the earlier mobility dismissal from the hospital was also obtained sooner. An Electronic Decision Support Rule for Identification and Automatic Ordering of Heart Failure Education. Schad S, Chua Patel C, Griebenow L, Loth A, Mayo Clinic, Rochester, Minnesota.
Problem: Providing heart failure (HF) discharge instruction is 1 performance metric that is required by Centers for Medicare & Medicaid Services. These metrics are publicly reported, are tied to reimbursement, and are within the domain of Nursing. Patients with HF often have multiple co- morbidities. These complex patients may be found on multiple units throughout our hospitals. Inpatient nurses are challenged to identify these patients in efforts to provide quality patient care and prepare the patient for self- care after discharge. Despite multiple education sessions given to nurses regarding importance of HF discharge instructions, metric defects continue. Design: A team led by clinical nurse specialists, and an Informatics Nurse Specialist, explored a systematic way to assist nurses to identify the patients with heart failure, validate diagnosis with the team, educate, and document HF discharge instructions.
The team designed an electronic decision support tool (Echo and Auto- order Blaze Rules) that auto- orders required education, if the patient records indicate: (1) left ventricular ejection function < 4. HF on the patient problem list. The rule initiates when a nurse opens the plan of care. When HF is on the problem list, a pop up alert is presented to the nurse noting, HF education was automatically ordered.
The nurse then completes and documents HF education per discretion of the nurse. Description of Methods: Four nursing units were piloted in this quality improvement project: medical telemetry cardiology, medical oncology, vascular telemetry and a medical neurology unit. The team met with pilot units' leadership to introduce the project, answer questions and gain support. Metrics were identified and the team met weekly to review reports and validated functionality of the rule. Feedback was given to the pilot units on a weekly basis. After the 4 week pilot, nurses were electronically surveyed to gain understanding of their workflow and usability of the rule.
Findings/Outcomes: The Echo Blaze rule was triggered in 4. The Auto Order Blaze Rule was triggered in 3. HF discharge instructions were not completed on approximately 3 discharged patients. There was a 4. 8% response rate to the nurse survey (n = 1.
The nurses were highly satisfied with the Blaze Rules as they served as an automatic reminder to complete HF discharge instructions. One problem identified was duplication of HF education orders. Conclusions: Nurses found the decision support rule for HF was successful in reminding them to provide HF discharge instructions when appropriate. It is 1 system enhancement to promote and improve compliance with the core measure.
Heart Failure Discharge Instructions. Implications: HF metric defects for patient discharge instructions occur over numerous nursing units. HF decision support rules are 1 method nurses can utilize in assisting with identifying HF patients when they are in the hospital with multiple comorbidities.
This identification approach for the multidisciplinary team enhances the ability to meet this metric and may be transferrable in meeting similar requirements in other chronic conditions. An Evaluation of the Use of Mock Code Skills Stations in the Neonatal Intensive Care to Increase Nursing Confidence During Code Situations. Holub PA, Rady Children's Hospital, San Diego, California. Purpose: The purpose of this project was to evaluate nurses' confidence levels during code situations by reevaluating the use of neonatal mock code skills stations, and to compare the results of last year's data to the data collected this year. Significance: JCAHO has recommended that institutions implement team training, clinical drills, and debriefings to alleviate problems during codes. The neonatal intensive care unit (NICU) mock code committee developed a model to improve nurses' confidence during code situations.
The training model that resulted in increased nursing confidence during codes in the NICU is now a hospital wide initiative to increase the number of mock codes, and establish mock code skills training. Design: The mock code skills stations were designed to provide neonatal nurses with education related to code situations. Each skills station was designed to focus on a particular nursing responsibly during a code. The theory being that practicing these skills will increase the confidence level of the nurse during a code. Methods: The NICU unit based mock code committee developed and facilitated the mock code skills stations. During the course of a week nurses rotated through 4 mock code skills stations, and were then signed off on a mock code competency.
A pre and post Likert- like scale self- assessment questionnaire was used to determine the nurses' confidence level both before and after attending the mock code skills stations. Outcomes: A total of 1. The results of the pre- and post- self- assessment questions were analyzed using the Wilcoxon signed rank test.
The data analysis showed that the mock code skills stations increased nurses' confidence in their skills. Conclusions: The results of the mock code station self- assessment showed that the participants continue to feel more confident after participating in mock code skills stations. After the development of the NICU Mock code committee the number of unit based mock code has increased. Implications: The use of mock code skills stations are a valuable training tool, and can be used to increase the confidence of nursing staff during a code. The mock code skills stations in the NICU have been utilized as the framework for hospital wide mock code training. Within the next few months we plan to incorporate high- fidelity code simulations in the NICU, and continue to measure the nurses' confidence levels. The unit CNS will use this data to assist the unit based mock code committee in reevaluating the education plan.
The unit based mock code committee will continue and provide additional training for the neonatal nursing staff. An Innovated Approach to Optimizing Adolescent Transition to Adult Healthcare. Cerns SA, Froedtert Hospital, Milwaukee, Wisconsin; Rich C, Medical College of Wisconsin, Milwaukee; Mc. Cracken C, Froedtert Hospital, Milwaukee, Wisconsin. Significance: Unique challenges exist for young adults with sickle cell disease (SCD) transitioning their healthcare from pediatric to adult care environments.
Key challenges include moving from family- centered care to patient- centered care; social and financial independence; navigating a complex healthcare system and anxiety related to new healthcare providers. Background: Pediatric to adult transition issues are well published in current literature.
Targeted transition programs for young adults living with chronic disease support structured transition plans. In a large academic medical center, young adults with SCD transitioning care from a children's hospital expressed strong concerns in understanding of responsibilities, expectations, and ability to navigate an adult healthcare setting. Additionally, healthcare providers expressed challenges related to inadequate preparation for young adults being admitted to the adult hospital.
Design: An academic medical center interdisciplinary team collaborated with a children's hospital in developing a young adult transition program.