Wisdom at Work: Retaining Experienced RNs and Their Knowledge: Case Studies of Top Performing Organizations

Presents seven case studies of top organizations in the healthcare sector and beyond and their proven and innovative strategies for retaining experienced workers. Identifies elements of success, best practices, and lessons for the nursing field overall

Aim High, Win Big: Optimizing the OR Nurse\u27s Skills to Improve Surgical Outcomes

Abstract Operating room nurses are constantly challenged with new surgical procedures and technology that affect the delivery of safe patient care. A deficiency in skill sets was identified among 50% of OR nurses in this microsystem. A structured scrub training program will improve the performance of novice and advanced beginner nurses to prevent the occurrence of adverse events. This program includes 320 hours of exposure to scrub the top ten procedures of two specialty services after the nurse learns how to circulate. The ability to circulate and scrub is an indication of high performance. It is expected that the OR nurse will independently circulate and scrub 60-80% of surgical procedures. An educational support team will guide the progress of the learners to ensure a successful transition. This evidence-based program will also apply non-technical skills using principles of AORN practice, TEAMSSTEPS, and SPLINTS that are effective in the recognition and prevention of surgical errors. High performance, teamwork, and collaboration must be integrated into the OR culture to sustain excellent work at all levels. Exemplary professional practice through transformational leadership is supported by the Magnet program at this facility to ensure that change is driven from the frontlines and best outcomes are delivered

Development of Evidence-Based Scenario with High Fidelity Simulation to Improve Nursing Care of Chest Pain Patients

Cardiovascular disease remains the leading cause of mortality in the United States, and a primary educational objective is to develop professional competency among nurses to ensure the provision of safe and effective care to the cardiac patient. Benner\u27s theory of novice-to-expert led to the development of an evidence-based scenario for the care of the patient with chest pain using risk-free high-fidelity simulation environments that focused on assessment, history taking, and communication, while evaluating improvements in the competency of nurses providing care to chest pain patients. Thirty-six nurses volunteered in the study. Feedback from nurse educators, which led to modifications to the scenario, preceptor evaluation of participants during simulation, and post simulation feedback of participants, were analyzed using an inductive and exploratory theme analysis. Participants reported they learned meaningful information but felt somewhat confused regarding the correct course of action when multiple events occurred simultaneously. Preceptors\u27 feedback identified participant failure to meet stated scenario expectations. Quantitative analysis of data, using one sample t test, compared the pre- and post-test scores measuring participant knowledge on assessment, history taking, and communication. Although knowledge scores increased, the difference was not clinically significant based on the negative feedback from both preceptor and participants. Accurate appraisal of nurses\u27 competency in assessment, history-taking, and communication skills is needed prior to exposure to simulation. Simulation scenarios may be more clinically significant when tailored to an individual participant\u27s competency levels

Applying psychological science to the CCTV review process: a review of cognitive and ergonomic literature

As CCTV cameras are used more and more often to increase security in communities, police are spending a larger proportion of their resources, including time, in processing CCTV images when investigating crimes that have occurred (Levesley & Martin, 2005; Nichols, 2001). As with all tasks, there are ways to approach this task that will facilitate performance and other approaches that will degrade performance, either by increasing errors or by unnecessarily prolonging the process. A clearer understanding of psychological factors influencing the effectiveness of footage review will facilitate future training in best practice with respect to the review of CCTV footage. The goal of this report is to provide such understanding by reviewing research on footage review, research on related tasks that require similar skills, and experimental laboratory research about the cognitive skills underpinning the task. The report is organised to address five challenges to effectiveness of CCTV review: the effects of the degraded nature of CCTV footage, distractions and interrupts, the length of the task, inappropriate mindset, and variability in people’s abilities and experience. Recommendations for optimising CCTV footage review include (1) doing a cognitive task analysis to increase understanding of the ways in which performance might be limited, (2) exploiting technology advances to maximise the perceptual quality of the footage (3) training people to improve the flexibility of their mindset as they perceive and interpret the images seen, (4) monitoring performance either on an ongoing basis, by using psychophysiological measures of alertness, or periodically, by testing screeners’ ability to find evidence in footage developed for such testing, and (5) evaluating the relevance of possible selection tests to screen effective from ineffective screener

Impact of Hospice Nurse Education on After-Hours Calls and Visits

Medicare-certified hospice home care agencies must provide a 24/7 on call system for after business hours patient concerns. An agency identified a problem with a high volume of after-hours hospice calls for symptom management. How these calls are handled impact patient and family outcomes and satisfaction. A literature review provided evidence that hospice nurse education and appropriate telephone support improves symptom management, enhances family support, provides a sense of security, reduces anxiety, and promotes comfort. Providing hospice nurse education on symptom management supported the goal of this evidence based practice (EBP) project to reduce the family/caregiver need for frequent on-call after-hour calls. Three modules from the End of Life Nursing Education Consortium (ELNEC) were presented with case studies to address pain and symptom management. Benner’s model From Novice to Expert and Larrabee’s Model for Evidence-Based Practice Change guided this EBP project. Twelve nurses started the EBP project, and six nurses completed all educational sessions and the pre and post quizzes. Questions were taken from ELNEC and the Hospice and Palliative Nurse Association Core Curriculum exams. Six hundred and sixty after-hours calls were analyzed before, during, and for three months after the educational sessions were completed. Five hospice nurses managed 90% of the 660 calls that were analyzed. All of them started the educational intervention; four of them completed the sessions and the post quiz. A paired-samples t test found no significant statistical difference between the pre and post quizzes (t(5) = 0.00, p \u3e .05). However, the mean number of after-hours phone calls decreased 22% with a 7.4% decrease in calls for symptom management after the educational initiative. Further application of this EBP project includes support for hospice nurse education for improving caregiver satisfaction on the new Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys

Fitting Things Together: A Grounded Theory Study of Clinical Judgment in Nursing

Safe and appropriate patient care hinges on the nurse\u27s skill in assessment and interpretation of data to support accurate clinical judgments; however, a review of nursing literature reveals the lack of an empirically derived theory of clinical judgment or methods to teach the skill. Progress has been limited because of the difficulties inherent in measuring cognitive work in complex practice environments, as well as the tendency of nursing authors and researchers to substitute a wide variety of terms for clinical judgment. Knowledge development in any discipline is hampered when terms are not clearly defined and the distinction between related concepts is blurred. The purpose of this study was to develop a substantive theory of clinical judgment in nursing to overcome the limitations of existing research. Classical ground theory was used to discover the process hospital based registered nurses with two to three years of clinical experience use to make clinical judgments as they provide care to patients in the course of a work shift. Semi-structured interviews were conducted with 15 nurses employed on a variety of inpatient nursing units in three Magnet® status teaching hospitals in the Midwestern United States. Data were analyzed using the constant comparison method. A substantive theory of clinical judgment emerged from the data, with the core category Fitting Things Together integrating additional categories that represent stages in the model, including Knowing, Anticipating, Prioritizing, Observing, Thinking, Catching Things, Figuring Out What\u27s Going On, and Determining What Needs to be Done. The theory that emerged in the study explains how each stage of the model contributes to knowing the patient and how each situation that requires clinical judgment provides an opportunity for learning at work. The substantive theory of the clinical judgment process that emerged from this study will facilitate research and measurement of clinical judgment in nursing practice and education and the design of strategies to teach the skill at various levels of clinical expertise

Emotional, cognitive, and postural adaptations to repeated postural threat exposure

This thesis investigated initial threat-induced changes in emotional, cognitive, and postural control measures and adaptation of these measures to repeated threat exposure in healthy young and older adults. Twenty-seven young and twenty-seven older adults stood on a platform under no threat and threat conditions. Postural threat was manipulated by altering the expectation of a temporally and directionally unpredictable mediolateral support surface translation during quiet standing. Regardless of age, participants were more anxious, reported broad changes in attention focus, and increased centre of pressure (COP) amplitude and frequency with first threat exposure. With early threat exposure, participants were less anxious and increased COP frequency. With repeated threat exposure, participants were less anxious, reported reductions in threat-induced changes in attention focus, and decreased high frequency COP displacements. These results suggest young and older adults demonstrate similar patterns of emotional, cognitive, and postural adaptations to initial and repeated threat exposure