Archive for the ‘Nursing research’ Category

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How Do RNs View Palliative Care for Hospitalized Older Adults? What a Study Reveals

November 17, 2014

By Sylvia Foley, AJN senior editor

“I think [palliative care is] also for that portion of the population that falls in the crack, in terms of, they’re not quite ready for the hospice thing but they’re not really ready for new aggressive chemo or anything else. … They’re in that vague no man’s land of where they fit in terms of services.”—study participant

Timely referral to palliative care could potentially benefit many seriously ill, hospitalized older adults. Such care not only offers relief from disease symptoms, but also helps patients and families to reach personal goals, reconcile conflicts, and extract meaning from their varied experiences. Yet those who might benefit are less likely to receive such care if their providers are unclear about the concept and how it differs from hospice care.

Table 5. Five Main Thematic Categories with Associated Subcategories

Table 5. Five Main Thematic Categories with Associated Subcategories

To learn more about how staff nurses understand and manage palliative care, nurse researcher Maureen O’Shea decided to conduct an exploratory study. She reports on the findings in this month’s CE–Original Research feature, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults.”

Here’s a quick overview. Read the rest of this entry ?

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Choosing Wisely: American Academy of Nursing Highlights Unnecessary Nursing Practices

October 24, 2014

The American Academy of Nursing (AAN) recently announced that it has joined the ABIM Choosing Wisely campaign with a list that focuses specifically on nursing interventions or practices that are not supported by evidence. The list is called Five Things Nurses and Patients Should Question. Here it is in short form—full explanations of the rationale for each item are available at the above link.

  1. Don’t automatically initiate continuous electronic fetal heart rate Screen Shot 2014-10-24 at 11.10.10 AMmonitoring during labor for women without risk factors; consider intermittent auscultation first.
  2. Don’t let older adults lay in bed or only get up to a chair during their hospital stay.
  3. Don’t use physical restraints with an older hospitalized patient.
  4. Don’t wake the patient for routine care unless the patient’s condition or care specifically requires it.
  5. Don’t place or maintain a urinary catheter in a patient unless there is a specific indication to do so.

The Choosing Wisely initiative encourages health care provider organizations to create their own lists of tests and procedures that may be overused, unsafe, or duplicated elsewhere. Using these lists, providers can initiate conversation with their patients to help them choose the most necessary and evidence-based care for their individual situations. The lists are not meant to be proscriptive, and also address situations where the procedures may be appropriate. Read the rest of this entry ?

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Planning Postdischarge Care with Cognitively Impaired Adults

October 15, 2014
McCauley

A patient performs the CLOX 1, a clock-drawing task used to assess patients for cognitive impairment. Photo by Ed Eckstein.

By Shawn Kennedy, AJN editor-in-chief

The transition from hospital to home can be fraught with pitfalls, especially if the patient in question is an older adult with multiple conditions and a not-so-prepared caregiver. The transitional care model, in which NPs coordinate care and provide follow-up care after discharge, has been shown to be successful in reducing hospital readmissions in this group of patients.

With Medicare levying penalties on hospitals with higher-than-average readmissions rates, the stakes aren’t just high for patients and their families. Might similar models of care also work with cognitively impaired adults?

In “Studying Nursing Interventions in Acutely Ill, Cognitively Impaired Older Adults,” a feature article in AJN‘s October issue (free until the end of October), Kathleen McCauley and colleagues from the University of Pennsylvania seek to answer this question, among others.

In the article, McCauley and colleagues describe the methodology and protocols used in their study, summarize their findings, and discuss some of the challenges in conducting research in the clinical setting. Among their findings is the important lesson that research involving cognitively impaired older adults must actively engage clinicians, patients, and family caregivers, as well as the need for hospitals to make cognitive screening of older adults who are hospitalized for an acute condition “a standard of care.” Read the rest of this entry ?

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AJN in October: Getting Inpatients Walking, Calciphylaxis, Nurses and Hurricane Sandy, More

September 30, 2014

AJN1014.Cover.OnlineAJN’s October issue is now available on our Web site. Here’s a selection of what not to miss.

Calciphylaxis is most often seen in patients with end-stage renal disease. “Calciphylaxis: An Unusual Case with an Unusual Outcome” describes the rare case of a patient diagnosed with calciphylaxis with normal renal function, and how the nursing staff helped develop and implement an intensive treatment plan that led to the patient’s full recovery. This CE feature offers 2.5 CE credits to those who take the test that follows the article. To further explore the topic, listen to a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

The adverse effects of bed rest. Prolonged periods of immobility can have adverse effects for patients, such as functional decline and increased risk of falls. “A Mobility Program for an Inpatient Acute Care Medical Unit” describes how an evidence-based quality improvement project devised for and put to use on a general medical unit helped mitigate the adverse effects of bed rest. This CE feature offers 2 CE credits to those who take the test that follows the article. Read the rest of this entry ?

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Study Clarifies How Staff Nurses Use Research in Practice

September 5, 2014

By Sylvia Foley, AJN senior editor

Most health care professionals agree that it’s important to apply research findings to real-life practice. Indeed, several studies have shown that nurses place a high value on doing just that. Yet numerous barriers continue to prevent or hamper the implementation of evidence-based practice (EBP).

Table 4. ‘Of the tools available to you at work and/or home, which tools do you use?’

Table 4. ‘Of the tools available to you at work and/or home, which tools do you use?’

To learn more, Linda Yoder and colleagues surveyed nearly 800 staff nurses in an acute care multihospital system. They sought to determine the extent to which these RNs used research findings in their practice; what types of knowledge they used; and what personal, professional, and organizational factors enhanced or hindered their use of research. In one of this month’s two CE features, “Staff Nurses’ Use of Research to Facilitate Evidence-Based Practice,” Yoder and colleagues report on their findings. Here’s a short summary.

Methods: A cross-sectional, descriptive, online survey design was used. The survey, which asked about use of research findings in practice and EBP participation, was placed on the hospital system intranet.
Results: The forms of knowledge that staff nurses reported relying on most were their personal experience with patients, conferences, hospital policies and procedures, physician colleagues, and nursing peers. Although a variety of resources were available for help in locating research and implementing EBP, respondents reported many of the same barriers that have been reported in other studies: lack of time, lack of resources, and lack of knowledge. Although their attitudes about research utilization and EBP were positive overall, respondents expected unit-based educators and clinical nurse specialists to collect and synthesize the research for them.
Conclusions: These findings are similar to those of other recent studies in this area. A great deal of work remains to be done if we are to inform, educate, and assist staff nurses in using research and implementing EBP. It may be unrealistic to expect bedside nurses to add these activities to their duties unless they are compensated for the time and have the support of master’s- or doctorally prepared nurses to serve as EBP coaches and champions.

The bigger picture. In closing, Yoder and colleagues call for a kind of climate change, stating, “We believe, as do others, that nurse leaders, managers, and educators have a responsibility to create a culture that supports EBP and research utilization.”

For more details, read the article, which is free online. And please weigh in and share your own experiences!


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Nursing Homes Need Nurses

September 4, 2014

By Amy M. Collins, managing editor

nursing home

Photo by Ulrich Joho, via Flickr.

Recently, the Association of Health Care Journalists (AHCJ) released updated nursing home inspection data, which is “derived from a large file that is split up for easier use by members.” (Members get a data set containing three years of the most severe deficiencies found during inspections, as well as current ratings assigned by the Centers for Medicare and Medicaid Services [CMS]. To register for membership and gain access to more detailed information, click here.)

A news release put out by AHCJ based on their analysis of these ratings isn’t pretty. The latest number of deficiencies recorded by the CMS (which range from “isolated incident of actual harm” to “widespread immediate jeopardy to resident health or safety”) has reached 16,806.

Medicare ratings themselves have also been called into question in a recent article suggesting that nursing homes with the highest ratings may be gaming the system. Despite these ratings being the gold standard in the industry, the data they are based upon on is largely self-reported by the nursing homes and not verified by the government. Often, details such as fines and other enforcement actions by the state, as well as complaints filed by consumers with state agencies, are left out.

Could part of the problem be there aren’t enough nurses in nursing homes? An article in the New York Times states that, in evaluating Nursing Home Compare, the American Association of Nurse Assessment Coordination estimates that at least 11.4% of nursing homes don’t have RNs available around the clock (since data is self-reported, this could be higher). Yet studies show that care is improved when there are more RNs in nursing homes. (We published a 2005 original research study that found that increasing the amount of time that RNs spend with long-stay nursing home residents reduces pressure ulcers, hospitalization, and urinary tract infections.)

Anecdotally, I can say that I am sometimes dismayed by what I’ve seen in the nursing homes my grandmother has been in. There always seems to be a lack of staff—and with so many residents these days suffering from varying levels of dementia and memory problems, staff are needed more than ever. I’ve spoken with nurses and nurses’ assistants working in these homes, and staff-to-resident ratio is always a common complaint of those working there. In my grandmother’s current home, residents are piling in by the dozen, while the number of staff seems to remain the same. Read the rest of this entry ?

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AJN’s September Issue: Anaphylaxis at School, Central Line Care, EBP, More

August 29, 2014

SeptemberAJN’s September issue is now available on our Web site. Here’s a selection of what not to miss.

It’s back-to-school time, and on our cover this month is a photo of Head Start nursing supervisor Travia Williams weighing a student in the program’s classroom at Cocoa High School in Brevard County, Florida. The program provides enrolled children with screening, physicals, and other health care services.

According to the National Association of School Nurses, a third of all school districts in the United States have reduced nursing staff and a quarter don’t have any nurses at all. Yet there is the potential for more emergencies in school now than ever, with school nurses treating increasingly complex medical conditions and chronic illnesses. For more on the important role school nurses play in handling these health emergencies, see the In Our Community article, “Emergency Anaphylaxis at School.” And don’t miss a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

Applying EBP to Practice. Despite the recognized importance of evidence-based practice (EBP), there continues to be a gap between the emergence of research findings and their application to practice. In this month’s original research article, “Staff Nurses’ Use of Research to Facilitate Evidence-Based Practice,” the authors used an online survey to determine to what extent RNs in an acute care multihospital system used research findings in their practice. Several barriers to such use were revealed, including lack of time and resources. This CE feature offers 3 CE credits to those who take the test that follows the article. Read the rest of this entry ?

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