Archive for the ‘Nursing research’ Category

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Paired Glucose Testing With Telehealth Support to Empower Type 2 Diabetes Patients

February 13, 2015

Jacob Molyneux, senior editor

bloodglucosetestingType 2 diabetes is challenging for those trying to meet blood glucose target ranges, often requiring one or more daily medications, increases in exercise, changes in eating habits, and self-monitoring of glucose level. Those who are willing and able to learn about factors affecting their glucose level and to make small daily efforts in one or more areas have the potential to radically improve their sense of control over their diabetes.

This month’s Diabetes Under Control column, “Better Type 2 Diabetes Self-Management Using Paired Testing and Remote Monitoring” (free until April 1), presents a successful story of patient engagement in diabetes self-management. It describes the case of a participant in a clinical trial who, with clinician support, incorporated paired glucose testing (self-testing before and after meals) and telehealth (remote patient monitoring, or RPM).

The article is easy to follow and gives a series of biweekly updates on the patient’s progress. Before the study starts, she’s not very engaged in self-management. For example, she’s only testing her own glucose level three to four times a month. To get a sense of how much more empowered she’s come to feel by week 12 of the protocol, consider this brief excerpt: Read the rest of this entry ?

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A Nursing Conference Focused on Quality and Safety, and a Big ‘What If?’

February 9, 2015

2015ANAQualityConferenceBanner600x100
By Maureen ‘Shawn’ Kennedy, AJN editor-in-chief

“What would quality in hospitals look like if health care institutions were as single-minded about serving clients as the Disney organization?”

Last week I attended the 2015 American Nurses Association Quality Conference in Orlando. The conference, which had its origins in the annual National Database of Nursing Quality Indicators (NDNQI) conference, drew close to 1,000 attendees. Here’s a quick overview of hot topics and the keynote speech by the new Secretary of the Department of Veterans Affairs, plus a note on an issue crucial to health care quality that I wish I’d heard more about during the conference.

Most sessions presented quality improvement (QI) projects and many were well done. There were some topics I hadn’t seen covered all that much, such as reducing the discomfort of needlesticks, enhancing postop bowel recovery, and promoting sleep. But projects aimed at preventing central line infections, catheter-associated urinary tract infections (CAUTIs), and pressure ulcers ruled the sessions. These of course are among the hospital-associated conditions that might cause a hospital to be financially penalized by the Centers for Medicare and Medicaid Services (CMS). The ANA also had a couple of sessions on preventing CAUTIs by means of a tool it developed in the Partnership for Patients initiative of the CMS to reduce health care–associated infections.

The keynote by Robert McDonald, the fairly new Secretary of the Department of Veterans Affairs, touted the services and resources available for the 9 million veterans who access care through the VA system. He surprised me and—if the murmuring I heard around me was any indication—a lot of others when he reported that patients in the VA system rated their care higher than did patients at general hospitals. The comment from an attendee: “Well, I guess it’s good once you get an appointment.”

He said the VA was “using the crisis of last year to move forward” and acknowledged that improving access was a priority, noting that the VA has hired 1,578 nurses since last year.

What if? It seemed appropriate that a meeting focused on quality took place at a venue known for its high quality customer focus. What would quality in hospitals look like if health care institutions were as single-minded about serving clients as the Disney organization? I’m not talking about the superficial attempts some hospitals implement, like valet parking or blazer-wearing patient service representatives. Read the rest of this entry ?

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System Barriers to RN Activation of Rapid Response Teams: New Evidence

February 6, 2015

By Sylvia Foley, AJN senior editor

Rapid response teams (RRTs) in acute care facilities are there to decrease mortality from preventable complications. But there is evidence that RRT systems “aren’t working as designed, particularly with regard to problems in the activation stage,” according to nurse researcher Jane Saucedo Braaten.

Figure 1. Five Domains of Cognitive Work Analysis and Corresponding Study Questions

Figure 1. Five Domains of Cognitive Work Analysis and Corresponding Study Questions (click image to enlarge)

Interested in how hospital system factors influence RNs’ activation behavior, Braaten decided to investigate further. She reports on her findings in this month’s CE–Original Research feature, “Hospital System Barriers to Rapid Response Team Activation: A Cognitive Work Analysis.” Here’s a summary.

Purpose: To use cognitive work analysis to describe factors within the hospital system that shape medical–surgical nurses’ RRT activation behavior.
Methods:
Cognitive work analysis offers a framework for the study of complex sociotechnical systems and was used as the organizing element of the study. Data were obtained from interviews with 12 medical–surgical nurses and document review.
Results: Many system factors affected participants’ activation decisions. Systemic constraints, especially in cases of subtle or gradual clinical changes, included a lack of adequate information, the availability of multiple strategies, the need to justify RRT activation, a scarcity of human resources, and informal hierarchical norms in the hospital culture. The most profound constraint was the need to justify the call. Justification was based on the objective or subjective nature of clinical changes, whether the nurse expected to be able to “handle” these changes, the presence or absence of a physician, and whether there was an expectation of support from the RRT team. The need for justification led to delays in RRT activation.
Conclusions: Although it’s generally thought that RRTs are activated without hesitation, this study found the opposite was true. All of the aforementioned constraints increase the cognitive processing load on the nurse. The value of the RRT could be increased by modifying these constraints—in particular, by lifting the need to justify calls, improving protocols, and broadening the range of culturally acceptable triggers—and by involving the RRT earlier in patient cases through discussion, consultation, and collaboration.

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Are Nurses Ready for Retirement? Apparently Not

January 5, 2015

By Shawn Kennedy, AJN editor-in-chief

Photo by Judy Schmidt/CDC

Photo by Judy Schmidt/CDC

If you ask many nurses in their sixties if they’re ready to retire, they may heartily say, “Yes, can’t wait.” But if the question is whether they are financially ready to retire, the answer may be quite different.

In their article in this month’s issue of AJN, “Preparing for Retirement in Uncertain Times” (free until the end of January), authors Shanna Keele and Patricia Alpert note that surveys reveal nurses to be unsure of how to begin preparing for retirement. A 2011 survey reported that “71% felt they were not saving enough for retirement”; another survey revealed that “59% of nurses do not know how to begin the retirement planning process” and most do not feel knowledgeable about investing and other related financial processes.

Keele and Alpert, who’ve conducted research around nurses’ readiness to retire, “explore the obstacles that nurses, especially female nurses, confront in planning and preparing for retirement. We outline steps nurses can take to begin the process; discuss various types of retirement accounts; and refer readers to helpful, free online resources.” There’s also a box that lists crucial steps to take if you’re getting a late start on retirement planning. Read the rest of this entry ?

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Nurses Reconsider Accepted Wisdom About Transfusion Catheter Size

December 17, 2014

By Betsy Todd, MPH, RN, CIC, AJN clinical editor.

Photo copyright Thinkstock.

Photo copyright Thinkstock.

Most of us have had the unhappy experience of replacing a patient’s perfectly good IV with a 19- or 20-gauge catheter in preparation for transfusion. The Question of Practice column in our December issue, “Changing Blood Transfusion Policy and Practice,” explores the rationale behind the long-time practice of using only large-bore catheters for blood transfusions.

After one patient’s particularly harrowing series of sticks to place a “large enough” catheter, a small team of oncology nurses asked themselves, “What evidence supports the use of a 20-gauge-or-larger catheter for blood transfusions?”

Most of these nurses had little experience with formal literature searches. Under the guidance of their clinical nurse specialist, they formulated a “PICOT” question (Population, Intervention, Comparison intervention, Outcome, and Time):

In adults receiving blood transfusions (P), what is the effect of using a smaller-than-20-gauge catheter (I) versus using a 20-gauge-or-larger catheter (C) on hemolysis or potassium level or both (O) within 24 hours of transfusion (T)? (Many of us were taught that a larger-bore catheter is necessary in order to prevent hemolysis during transfusion. Potassium is released when red blood cells rupture.)

The nurses set out to explore the literature and the guidelines of authoritative sources such as the Infusion Nurses Society. But they weren’t left to work on this question in their “spare time.” Their clinical nurse manager scheduled time off for the team’s work, set up meeting space, and even arranged for financial support for a poster presentation of their results. Read the rest of this entry ?

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‘Suppose a Client Went Out of His Room’: Study Explores RNs’ Use of Surveillance Technology in Residential Facilities

December 15, 2014

By Sylvia Foley, AJN senior editor

“If people are for instance walking around in the units, well, then they could do all sorts of things . . . ”—study participant

Table 2. Surveillance Devices and Their Use in the Selected Care Facilities

Table 2. Surveillance Devices and Their Use in the Selected Care Facilities

Surveillance technology in residential care facilities for people with dementia or intellectual disabilities has been touted both as a solution to understaffing and as a means to increasing clients’ autonomy. But it’s unclear whether surveillance technology delivers on its promises—and there are fears that its use could attenuate the care relationship. To explore how nurses and support staff actually use this technology, Alexander Niemeijer and colleagues decided to conduct a field study. They report on their findings in this month’s CE–Original Research feature, “The Use of Surveillance Technology in Residential Facilities for People with Dementia or Intellectual Disabilities.” Here’s a brief summary.

Methods: An ethnographic field study was carried out in two residential care facilities: a nursing home for people with dementia and a facility for people with intellectual disabilities. Data were collected through field observations and informal conversations as well as through formal interviews.
Results: Five overarching themes on the use of surveillance technology emerged from the data: continuing to do rounds, alarm fatigue, keeping clients in close proximity, locking the doors, and forgetting to take certain devices off. Despite the presence of surveillance technology, participants still continued their rounds. Alarm fatigue sometimes led participants to turn devices off. Though the technology allowed wandering clients to be tracked more easily, participants often preferred keeping clients nearby, and preferably behind locked doors at night. At times participants forgot to remove less visible devices (such as electronic bracelets) when the original reason for use expired.
Conclusions: A more nuanced view of the benefits and drawbacks of surveillance technology is called for. Study participants tended to incorporate surveillance technology into existing care routines and to do so with some reluctance and reservation. Client safety and physical proximity seemed to be dominant values, suggesting that the fear that surveillance technology will attenuate the care relationship is unfounded. A clear and well-formulated vision for the use of surveillance technology seems imperative to successful implementation.

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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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