The Center for Nursing Research and Quality Outcomes

10 Year Anniversary Book of Research, Magnet Conference and Quality Improvement Project Abstracts, 2010-2020: Index. Cover and Table of Contents published separately.https://knowledgeconnection.mainehealth.org/annualreports/1010/thumbnail.jp

Spiritual/Religious Orientation and Moral Distress in Pulmonary Care Nurses: An Exploration of Ethical Norms, Moral Agency and Moral Resilience

Introduction • Nurses who provide care which they perceive as increasing suffering often experience moral distress (MD). • Response to MD is a key factor in nurse wellbeing and retention, and is widely studied in nurses. • Less research exists on foundations of moral belief and practice among nurses.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1045/thumbnail.jp

The Center for Nursing Research and Quality Outcomes

10 Year Anniversary Book of Research, Magnet Conference and Quality Improvement Project Abstracts, 2010-2020: Cover and Table of Contents. Index published separately.https://knowledgeconnection.mainehealth.org/annualreports/1009/thumbnail.jp

Predictors for Discharge After Robotic Hysterectomy – A Retrospective Analysis

Introduction: Hysterectomy is one of the most common surgeries performed in the United States with more than 600,000 procedures annually . It has been estimated that in 2011, there were more than 64,000 surgeries performed in an outpatient setting. The highest rate of 0.46% (464/100,000 adult women) has been reported in Maine. The average length of stay was 0.65 days for laparoscopic and 0.79 days for vaginal hysterectomies [1]. Traditionally, hysterectomies have been performed as an inpatient procedure to manage postoperative pain and monitor complications such as bleeding, anemia and return of bowel function. Development of minimally invasive surgery techniques with minimal blood loss, decreased postoperative pain and recovery time, and faster return of bowel function have, however, significantly shortened hospital stays [2]. The robotic surgical platform for minimally invasive surgery was approved by the American College of Obstetrics and Gynecology in 2005, and since then the number of these procedures has continually increased [3]. Today, the feasibility and safety of same-day discharges have been well established for patients undergoing minimally invasive hysterectomy after laparoscopic and robotic surgeries [4]. However, despite the reported positive findings, the percentage of patients who are discharged on the same-day vary from 16% to 90%. Reasons for post-operative hospital admission include nausea and vomiting, inadequate pain control, postoperative urinary retention, inadequate home support, and patient preference [2]. The purpose of this retrospective study was to identify and describe predictors for same-day and non-same-day discharge after robotic hysterectomy in a 637 licensed-bed Magnet® designated tertiary care teaching hospital

Impact of Bowel Management Guidelines on Documentation and Patient Outcomes in the Intensive Care Unit

Introduction • Bowel management (BM) is an inadvertently overlooked aspect of patient care for critically ill patients who have complex, immediate life-threatening health issues. • Bowel dysfunction is common with the reported incidence of diarrhea between 3.3%-78% and constipation between 20-83% • Studies suggest that BM guidelines can standardize care, improve documentation, and impact patient outcomes • Use of BM guidelines has remained low, probably influenced by clinicians’ resistance to change, resulting in small to moderate improvements and difficulties sustaining new practices • We anticipated that sustained changes require recognizing clinicians’ current practice, integrating modifications into existing workflow, and engaging staff to contribute to any proposed changeshttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1014/thumbnail.jp

Cardiovascular Service Line Chaplain at an Academic Medical Center: Creation, Implementation, and Establishment

Problem Statement: As health care providers and organizations have become complex and specialized, efforts to address the spiritual needs of patients and care team members are often absent. Background: Medical advances, life-saving treatments, and increased efficiency of patient care have all come at a cost to patients and health care providers. We appropriately measure our care team’s performance with disease- and procedure-specific data on morbidity and mortality. However, these measurements come at the risk of rewriting Hippocrates’ endeavor from “cure sometimes, relieve often, comfort always” to “cure always.” The suggestion that failure is not an option is an unattainable expectation with a high price, namely the spiritual distress of care team members, patients, and their families. In 2018, The Joint Commission addressed the issue of unmet spiritual needs, stating that these needs can be associated with greater emotional distress, pain, and anxiety; higher medical care costs; and poorer quality of life. Application: In 2015, the cardiovascular service line at an academic medical center implemented a spiritual care provider position to address the unmet spiritual needs of patients and care team staff. In this article, we describe (1) the evolution of the spiritual care provider’s role and (2) the impact of this resource on the healing of patients and as a support for the personal and professional well-being of health care providers

Changing the Surgical Residency: A Mixed-Methods Study of Residents’ and Faculty Experiences One Year After Implementation

Objective: To evaluate a reformed surgical residency curriculum aimed at addressing emerging practice models, enhancing residents’ educational experience, and improving the quality/continuity of patient care by reducing the service size and enhancing attending-resident interactions. Methods: A mixed-methods study of the surgical training program following curriculum reform including: 1) focus group and individual qualitative interviews with residents, attendings, nurses, and advanced practice providers to explore stakeholder perspectives on curriculum reform, 2) time study of surgical resident activities, and 3) quantitative assessment of surgical case logs. Results: Qualitative interviews demonstrated disparate knowledge and attitudes regarding the goals of the curriculum with emergence of several themes during transcript analysis including: Goals of the Change, Learning and Educational Value, Communication, Teamwork, Service, and Quality of Life. Both positive aspects of curriculum reform (e.g., improved focus on resident education and balance between educational and service activities, communication, and opportunity for direct feedback and observation) and negative ones (e.g., lack of role clarity, insufficient workforce) were identified. Despite limitations, the time study revealed variability in resident activities by post-graduate year with more time spent on indirect patient care activities in the early years and more time in the OR and one-on-one with attendings later. Quantitative analysis of surgical case logs, previously published, showed no significant decrease in number of cases for residents by either training level or role. Conclusions: This single-institution mixed methods study suggests that a reformed surgical residency curriculum improved residents’ educational experiences and the balance between educational and service activities without affecting operative volume. Multiple modalities of assessment are essential to identify the various positive and negative aspects of an educational intervention

The Burden Of Diarrhea: A Survey Of The Caregivers’ Opinions And Perceptions Of Workload In The Intensive Care Unit

In the literature, the prevalence of diarrhea in the Intensive Care Unit (ICU) has been reported to be 3.3-78%. The problem is significant to patients and also increases workload burden for ICU staff. Unfortunately, research on this topic is very limited; we found one single study on the impact that diarrhea has on nursing staff workload. Therefore, we conducted a retrospective chart review to describe the prevalence and impact of diarrhea in our organization. For the purposes of this study, we equated diarrhea with type 7 stools as defined in the Bristol Stool Form Scale. In January of 2018, we developed a bowel management guideline and rolled out the associated protocol in a multifaceted implementation process which included a variety of educational strategies. Toward promoting the use of the tool in practice, we sought to assess staff perceptions of the resources and time needed to manage diarrhea and bowel function with a survey that was administered to ICU staff in a 600 bed, level one trauma center. The purpose of this poster is to describe the findings from a survey to assess perceptions of workload after the implementation of the new bowel management guidelines

Improvement of Family Communication in the Perioperative Environment Utilizing Text Messaging

Text Messaging Technology Improves Patient Satisfaction for Communication with Nurses in Perioperative Care Unithttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2022/1023/thumbnail.jp

The Development and Implementation of an Obstetrical Triage Tool to Prioritize Patients and Track Process Times by Risk Categories.

Objective To develop an evidence-based tool with an electronic version for process time tracking for obstetric triage to standardize and prioritize care. Design Evidence-based, quality improvement project. Sample All women admitted for obstetric evaluation at a large medical center in northeastern United States between December 1, 2012 and August 31, 2013. Methods This quality improvement project started as an interdisciplinary collaboration to identify a problem with variability in the procedure and assignment of obstetric triage categories. A literature review showed that lack of a standardized tool to assess acuity, a clear definition of process time targets, and a method to provide feedback to clinicians were risks that compromised patient safety and quality of care. Implementation Strategies In November 2012, a paper version of a triage tool was developed based on modifications of acuity assessment instruments found in the literature. Color-coded triage categories (emergent = red, urgent = yellow, and nonurgent = green) were assigned from a brief standardized nursing assessment of presenting clinical symptoms. Nurses and physicians were educated about the triage tool, and triage guidelines were developed to support the interdisciplinary process. With assistance from the information technology department, an electronic version of the tool was created in Microsoft Excel to calculate triage process intervals and generate monthly tables and trend line graphs for performance metrics. Results Of the 2,588 women, 5% (n = 119) were categorized red, 77% (n = 2,004) were categorized yellow, and 18% (n = 465) were categorized green. A 5-minute target for arrival to triage times was met 86%, 73%, and 69% of the time for the red, yellow, and green categories, respectively (M = 3.6, 3.9, and 5.2 minutes). This represents a change from baseline of 75%, 78%, and 50%, respectively. Targets for time from provider notified to patient seen were 5, 30, and 60 minutes for the three categories, which were met 50%, 62%, and 73% of the time (M = 12.7, 18.2, and 21.7 minutes). The greatest admission times were between 1500 to 1900 hours (23%) and 1100 to 1500 hours (22%). Conclusion/Implications for Nursing Practice As a result, a triage nurse role was established within 2 months to facilitate timely screening to reduce process times and increase the number of patients meeting the performance targets. Staffing has been adjusted to cover the high admission times. Nurse-physician communication improved with the use of the standardized tool. Current activities are focused on developing policies, improving process targets through interdisciplinary teamwork, and integrating the triage categories in the electronic health record