Archive for the ‘patient safety’ Category

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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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Too Tired to Nurse

December 8, 2014

By Shawn Kennedy, AJN editor-in-chief

by patchy patch, via flickr

by patchy patch, via flickr

Just about every nurse I know has been “asked” (or “guilted” or “mandated”) to work an additional shift on top of a grueling one. The worst such experience I ever had was having to work from midnight to 8 am after working a straight week of 4 pm to midnight shifts. I was exhausted, but someone had called in sick, leaving only two RNs and one aide for the 11-bed ED trauma unit.

I was so tired that at one point I found myself falling asleep while I was standing by a patient’s bed charting vital signs. I couldn’t remember the blood pressure reading I had obtained just moments before. It was good luck that I didn’t make an error—and had the good sense to have a colleague double-check medications I was readying (these were the old days, before unit dosing). Read the rest of this entry ?

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A Nurse’s Legal Duty to Discern Potential Harm and Protect Patients

November 7, 2014
Illustration by Janet Hamlin for AJN.

Illustration by Janet Hamlin for AJN.

By Jacob Molyneux, AJN senior editor

The November installment of AJN’s Legal Clinic column by nurse and attorney Edie Brous, “Lessons Learned from Litigation: The Nurse’s Duty to Protect,” describes a case in which nurses were held responsible for not adequately protecting a sedated patient from a sexually predatory physician. The case description begins this way:

NX was a young woman who underwent a laser ablation of genital warts at Cabrini Medical Center in New York City. While still under the effects of general anesthesia, she was transferred to a small, four-bed section of the recovery room. Shortly after her admission to the recovery room, the nurses admitted another patient to a bed two feet away from NX. The curtains were not drawn and there were no patients in the other two beds.

A male surgical resident, Andrea Favara, entered the recovery room wearing Cabrini scrubs and Cabrini identification. Residents were not directly assigned to the recovery room and were seldom called there. The nurses knew all of NX’s physicians but did not know Favara; he wasn’t one of NX’s physicians . . .

The details that follow are disturbing. After describing the case and the failure of nurses to confront this unknown physician or actively monitor his interactions with the patient, Brous sketches the ensuing legal machinations, as well as the ultimate decision of an appeals court. Some of the main take-home points for nurses are as follows: Read the rest of this entry ?

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AJN in November: Palliative Care, Mild TBI, the Ethics of Force-Feeding Prisoners, More

October 31, 2014

AJN1114.Cover.OnlineAJN’s November issue is now available on our Web site. Here’s a selection of what not to miss.

Palliative care versus hospice. For many seriously ill, hospitalized older adults, early implementation of palliative care is critical. These patients often require medically and ethically complex treatment decisions. This month’s original research article, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults,” found that staff nurses often confuse palliative and hospice care, a fact that suggests a need for increased understanding and knowledge in this area. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Mild traumatic brain injury (TBI) can have profoundly negative effects on quality of life and can negatively affect relationships with family and caretakers. This issue’s other CE feature, “Mild Traumatic Brain Injury,” reviews the most commonly reported signs and symp­toms of mild TBI, explores the condition’s effects on both patient and family, and provides direction for devel­oping nursing interventions that promote patient and family adjustment. Earn 2 CE credits by taking 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, in our iPad app, by tapping the icon on the first page of the article).

Medication safety. While preparing medications in complex health care environments, nurses are frequently distracted or interrupted, which can lead to medication errors. “Implementing Evidence-Based Medication Safety Interventions on a Progressive Care Unit,” an article in our Cultivating Quality column, describes how nursing staff at one facility implemented five medication safety interventions designed to decrease distractions and interruptions during medication preparation. Read the rest of this entry ?

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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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AJN’s August Issue: Preventing Pressure Ulcers, Strengths-Based Nursing, Medical Marijuana, More

August 1, 2014

AJN0814.Cover.OnlineAJN’s August issue is now available on our Web site. Here’s a selection of what not to miss.

Toward a new model of nursing. Despite the focus on patient-centered care, medicine continues to rely on a model that emphasizes a patient’s deficits rather than strengths. “Strengths-Based Nursing” describes a holistic approach to care in which eight core nursing values guide action, promoting empowerment, self-efficacy, and hope. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Decreasing pressure ulcer incidence. Hospital-acquired pressure ulcers take a high toll on patients, clinicians, and health care facilities. “Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment” describes how one of the world’s largest and busiest cardiac hospitals implemented several quality improvement strategies that eventually reduced the percentage of patients with pressure ulcers from 6% to zero. This CE feature offers 2.8 CE credits to those who take the test that follows the article. And don’t miss a podcast interview with the authors (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).

Read our Cultivating Quality column this month for another article on using evidence-based nursing practice to reduce the incidence of hospital-acquired pressure ulcers and promote wound healing. Read the rest of this entry ?

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