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Nurse Informaticists Address Texas Ebola Case, EHR Design Questions

By Susan McBride, PhD, RN-BC, CPHIMS, professor and program director of the Masters in Nursing Informatics Program, Texas Tech University Health Sciences Center, and Mari Tietze, PhD, RN-BC, FHIMSS, associate professor and director, Interprofessional Health IT Program at Texas Woman’s University (TWU). The views expressed are those of the authors and don’t represent those of Texas Tech or TWU.

Silo_-_height_extension_by_adding_hoops_and_staves EHRs: information ‘siloes’ or interprofessional collaboration?

The recent Ebola case in Dallas—in which a patient was admitted to the hospital three days after he visited the ER exhibiting symptoms associated with Ebola and reporting that he’d recently traveled from West Africa—brought this global public health story close to home for many of us residing in the area. As has been widely reported, the patient died last week after nearly 10 days in the hospital.

An initial focus of media coverage was the suggestion that a failure of nursing communication had contributed to the release of the patient from the hospital on his first visit. Partly reflecting evolving explanations offered by the hospital, the media focus then shifted to a potential flaw in the hospital’s electronic health record (EHR) system, in which information recorded by a nurse about the patient’s travel history might not have been visible to physicians as well. […]

2016-11-21T13:03:43-05:00October 17th, 2014|digital health, infectious diseases, Nursing, nursing perspective, Public health|8 Comments
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Calciphylaxis: The Intriguing Case of Ms. W.

Ms. W. post-recovery, with her husband Ms. W. post-recovery, with her husband

By Sylvia Foley, AJN senior editor

“I survived, although I had been told that I’d eventually die from infection in the wounds.”

In one of this month’s two CE features, “Calciphylaxis: An Unusual Case with an Unusual Outcome,” Tina Wangen and colleagues report on the intriguing story of L.W., a 40-year-old patient who, aside from being female, had no other known risk factors for the disease. Here’s an overview of the article:

Calciphylaxis is most common in patients with end-stage renal disease, and hyperparathyroidism is often present as well. But several cases in patients with normal renal and parathyroid function have been reported; this article describes one such case. The etiology and pathophysiology of calciphylaxis aren’t well understood. There are many risk factors, and the reported median survival time is 2.6 months after diagnosis. The condition is characterized by isolated or multiple lesions that progress to firm, nonulcerated plaques and then to ischemic skin necrosis and ulceration.
In August 2010, a female patient arrived at the hospital with multiple deep, painful necrotic wounds. Given this patient’s presentation on admission, the nurses kept expecting the physicians to initiate end-of-life discussions with her and were surprised when this did not happen. After five days, the patient was diagnosed with calciphylaxis in the unusual presentation of […]

2017-07-27T14:44:29-04:00October 10th, 2014|Nursing, Patients|3 Comments
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Study Clarifies How Staff Nurses Use Research in Practice

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 […]

2017-07-27T14:44:50-04:00September 5th, 2014|Nursing, nursing perspective, nursing research|2 Comments
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How a Busy Hospital Reduced Its Rate of Hospital-Acquired Pressure Ulcers to Zero

By Sylvia Foley, AJN senior editor

A skin lesion monitoring form accompanies a patient. Photo courtesy of NHCH. A skin lesion monitoring form accompanies a patient. Photo courtesy of NHCH.

In 2009, when one of the world’s largest cardiac care hospitals experienced a spike in the number of surgeries performed and a corresponding rise in hospital-acquired pressure ulcers, many people were concerned. The hospital—Narayana Hrudayalaya Cardiac Hospital (NHCH) in Bangalore, India—soon initiated a program to address the problem, and nursing superintendent Rohini Paul was tasked with designing and implementing effective preventive strategies. In this month’s CE feature, “Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment,” Paul and colleagues describe what happened next. Here’s a brief overview.

Baseline data showed that, over the five-month observation period, an average of 6% of all adult and pediatric surgical patients experienced a pressure ulcer while recovering in the NHCH intensive therapy unit (ITU). Phase 1 implementation efforts, which began in January 2010, focused on four areas: raising awareness, increasing education, improving documentation and communication, and implementing various preventive practices. Phase 2 implementation efforts, which began the following month, focused on changing operating room practices. The primary outcome measure was the weekly percentage of ITU patients with pressure ulcers.
By July 2010, that percentage was reduced to zero; as of April 1, 2014, the hospital has maintained this result. Elements that contributed significantly to the program’s success and sustainability include strong leadership, nurse and physician involvement, an […]

2017-07-27T14:45:11-04:00August 8th, 2014|nursing perspective|7 Comments
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If She Yells ‘Help Me’ – Poster Therapy to Convey the Needs, Identity of an Ailing Parent

Joan Melton, MSN, lives in Indiana.

Photo by Ann Gordon, via Flickr Photo by Ann Gordon, via Flickr

I am a geriatric nurse practitioner and have also been the daughter to an ill, aging parent. I felt well trained for my professional role but struggled with the latter.

I joked that, despite my logical understanding of what was going on with my mother, it could be hard to accept her physical and functional changes, which sometimes seemed to fly in the face of logic. There were days Mom’s hospice nurses spent more time with me than with my mother. They’d sit and allow me to vent my frustration at watching my mother slowly leave me, at feeling overwhelmed and “losing my cool” with her, at not being able to practice the advice I’d so readily handed out to so many other families over the years, not being able to “fix it” and successfully comfort all of Mom’s fears and ailments 24 hours a day, seven days a week.

Yes, I know how unrealistic that last statement sounds. Thank goodness for hospice nurses, who reminded me that I was “the daughter” and did not need to be “the nurse practitioner.” They reminded me that as the daughter I had amazing insight no one else […]

2016-11-21T13:04:15-05:00July 23rd, 2014|Nursing, Patients|7 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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