HCPro.com - Nursing - DO NOT USE Top Stories

Web site spotlight: Nurses use iTouch and iPhones to communicate and stay connected

Fri, 20 Nov 2009 15:10:00 GMT

Sarasota (FL) Memorial Healthcare System plans to bring peace and quiet, along with improved healthcare, to its hospital by supplying Apple's iTouch to all its nurses.

Sarasota Memorial was approached by Voalte, a startup developing point-of-care communications company, to be part of a piloting program. Voalte uses mobile technology, specifically applications from Apple, to send pages and alerts. During the 60-day pilot program that started in June, Sarasota Memorial handed out 25 iPod Touches to nurses on one specific floor with the goal of reducing the amount of noise and inefficiency involved in paging nurses.

At any given time in Sarasota Memorial, one can hear an overhead page every three minutes, and when a patient is in pain and trying to recover, that can be an issue. However, during the pilot program, the one floor that had nurses using the iPod Touches reduced the number of pages in eight hours from 172 to 38, which pleased patients who appreciated the new quiet. Overall, the iPod Touches were receiving 4,000 messages a day.

Editor’s note: To read the rest of this article, visit “Nurses use iTouch and iPhone to Communicate and Stay Connected” found in the Reading Room at www.StrategiesForNurseManagers.com. Get a free trial membership that will give you 30 days to test drive all the exciting features on the Web site.

Ask the expert: What should be included in a professional portfolio?

Fri, 20 Nov 2009 15:00:00 GMT

This week, Barbara A. Brunt, MA, MN, RN, BC, discusses the use of professional portfolios and their place in measuring competencies.

Q: I would like to begin using portfolios as a tool to document achievement of particular competencies. What should be included in a portfolio?

A: Although portfolios currently are not widely utilized in the United States, they will become prevalent in the future. Portfolios enable individuals to keep a record of their personal and professional development, professional experiences, and qualifications.
The actual construction and organization of a portfolio varies depending on the individual and the organization’s requirements. A portfolio generally should include the following information:

Introduction
Details of professional experience, knowledge, and skills
Demonstration of achievement of required competencies
Testimonials, references, or samples of work

Developing a portfolio provides individuals with the opportunity to be creative and include materials unique to them. Examples could include reports, research data, educational programs designed, lesson plans, and other material, as well as photographs, articles, poems, or short stories.

Have a question for our experts? E-mail your queries to Editorial Assistant Casey Ramsdell at cramsdell@hcpro.com. See your name in print and find answers to your questions.

Tips from TSE: New accreditation decision: How will this affect 2010 surveys?

Fri, 20 Nov 2009 14:48:00 GMT

The Joint Commission has announced the adoption of a new accreditation decision for 2010, “Medicare Condition-Level Deficiency Follow-Up Survey,” which will be used when surveyors evaluate a facility with one or more condition-level deficiencies out of compliance.

These condition-level deficiencies refer to CMS’ Conditions of Participation (CoP). If a hospital receives this decision, it must address the deficient CoP, after which an on-site follow-up survey will be conducted.

This survey should not be confused with conditional accreditation decisions. According to Joe Cappiello, chair of Cappiello & Associates in Elmhurst, IL, this new accreditation decision is the result of continuing dialogue between The Joint Commission (formerly JCAHO) and CMS concerning The Joint Commission’s pending deeming application decision.

In addition to the news that an accreditation decision is coming, there will be new language in the conditional accreditation rules that indicate additional causes for this accreditation decision. Conditional accreditation occurs when an organization fails to resolve issues stemming from a provisional accreditation status or when the organization is in substantial noncompliance of mandated Joint Commission standards.

Editor’s note: This excerpt was adapted from the November issue of The Staff Educator. Discover all the benefits of subscribing to The Staff Educator!

HCTW news brief: Hospital educates staff on abandoned child law

Fri, 20 Nov 2009 14:38:00 GMT

Educators at an Alabama hospital are offering classes to teach their staff about the state’s Safe Haven Law and their policies on newborn abandonment. An emergency room nurse and nurse educator at Athens-Limestone Hospital, in Athens, decided to implement the educational program so staff was properly trained if they had to deal with a parent abandoning their child.

Alabama’s Safe Haven Law states that either parent can bring an infant, younger than 72 hours old, into any licensed hospital with an emergency room and leave the child. All the parent must do is declare that they are giving up the child. If a child has been abandoned, the hospital’s policy is to do a thorough physical check of the baby and then call the police.

There have been no cases of abandonment at the hospital in the past, but the hospital felt that their staff should know what to do if the situation ever arose. The law was enacted in 2000 and the nurse educator who teaches the class believes there have been about 23 children that have entered Alabama’s foster care system this way in the program’s first six years.

The Huntsville Times

Inside the news: Iowa nurses bust VAP with song

Tue, 17 Nov 2009 19:29:00 GMT

Nurses at the University of Iowa Hospitals and Clinics in Iowa City recently found a lighthearted way to educate caregivers about preventing ventilator-associated pneumonia (VAP): They filmed themselves dancing and singing about VAP prevention to the tune of the Ghostbusters theme song.

The creative nurses wrote new lyrics to the well-known ditty—sample lyrics include "Who you gonna call? VAP Busters!"—and included reminders for head of bed elevation, tooth cleaning with suctioning twice a day, and a daily sedation vacation.

The entertaining song can be viewed on YouTube.

The University of Iowa Hospitals and Clinics was redesignated as an ANCC Magnet Recognition Program® facility in 2008.

Source: University of Iowa Hospitals and Clinics

Inside the program: Nurses help needy families during holiday season

Tue, 17 Nov 2009 17:41:00 GMT

By Diane Gully, RN-BC

For the third consecutive year, the nurses at Montgomery Regional Hospital in Blacksburg, VA, came together to support the Montgomery County Christmas Store. The Christmas Store is an all-volunteer, community-wide nonprofit organization that assists low-income families during the Christmas season by providing a shopping experience characterized by choice and dignity. Customers must meet income qualifications to shop, and with rising unemployment rates, the need for the store is greater than ever.

Organizing the store for the shopping season is a huge task. In 1982 the store served just 267 people. Last year, it provided help to 1,400 families. The operation depends upon more than 2,000 volunteers throughout the year.

Nurses at Montgomery Regional have designated one Saturday each year as Make a Difference Day. They volunteer their time as a group to help set up for the shopping season. Additionally, many of these nurses return to work at the store during the actual shopping days. The nurses know that their support, as well as the support of other community members, ensures the Christmas Store will continue to operate for many more years to come.

Sally Bohland, board member of the Christmas Store, wrote to the nurses to thank them for their time. "Time is so precious, especially at this season, yet you [MRH nurses] share yours in order to make the holiday better for so many. We could not do it without you."

These nurses exemplify our hospital mission, which is caring for our community.

In the know: Treating patients with ADHD

Mon, 16 Nov 2009 11:36:00 GMT

Treatments for ADHD include medication management and behavioral treatment. Structuring a patient's environment and being consistent in your approach can be helpful. Here are some hints to use when working with children with ADHD:

Provide a schedule and routine in their day. Post the schedule where it can be readily seen.
Organize their belongings. Have a place for everything and keep everything in its place.
Write down important items that you want them to remember.
Provide consistent rules that they can understand and follow. When rules are followed are followed, give rewards, like praise, hugs, or high fives.

For more tips, check out HCPro's book, Stressed Out About Difficult Patients.

In the news: ICU nurses get less sleep, make more errors

Mon, 16 Nov 2009 11:20:00 GMT

Nurses who work in a hospital's intensive care unit (ICU) may get less sleep than other nurses, and therefore commit more errors on the job, reports UPI.com.

Researchers at Baylor College of Medicine in Houston studied the quality of sleep of ICU nurses and presented their findings recently in San Diego at the American College of Chest Physicians. They then compared the amount of sleep, and quality of sleep, to that of floor nurses.They also studied nurses' vigilance at the beginning and end of shifts.

Researches concluded from their finding that abnormal sleep may have had implications for patient safety.

Source: UPI.com.

Universal patient floor increases patient flow, decreases handoffs, improves patient safety

Fri, 13 Nov 2009 19:30:00 GMT

In 2007, Cedars-Sinai Medical Center in Los Angeles rolled out a “universal floor” during an expansion project. Cedars-Sinai’s innovation has since lowered wait times for patients being admitted from the ED and elsewhere, reduced the number of patient safety events, and increased staff member satisfaction.

A universal floor is one on which most patient consultations can take place. Rooms are created with multiple types of patient care in mind, and staff members are trained in many specialties to facilitate patients’ needs on one floor, reducing the need for patients to travel throughout the hospital.

The idea for developing a universal floor came at a time when the hospital was designing a new critical care tower. Staff members decided to trial the idea after hearing of the success of a universal floor at Methodist Hospital of Clarian Health in Indiana.
In addition to improving patient flow throughout the hospital and reducing patient safety errors, the universal floor has allowed staff members to spend more time with patients, making for a more comfortable patient stay.

Editor’s note: To read the rest of this article, visit: “Universal patient floor increases patient flow, decreases handoffs, improves patient safety” found in the Reading Room at www.strategiesfornursemanagers.com. Get a free trial membership that will give you 30 days to test drive all the exciting features on the Web site.

Ask an expert: How can orientation costs be cut without losing valuable content?

Fri, 13 Nov 2009 19:19:00 GMT

This week, Adrianne E. Avillion, DEd, RN, discusses how to calculate the cost of an orientation and make money-saving decisions.

Q: What are expenses we should consider when trying to cut orientation costs without losing educational value?

A: First you must determine what your orientation actually costs. By working with the human resources department, you should be able to gather data about your current program. You should consider: actual time spent delivering orientation, time spent interacting with managers, preceptors, human resources, and orientees and time spent preparing educational materials for orientation, including clerical assistance. You must also consider the cost of office supplies and travel costs.

Once you have determined your costs, the next step is cost analysis. Are there areas that are needlessly expensive? Can you reduce some of the paperwork or photocopying or even eliminate some facets of orientation? For example, are there “guest speakers” who rarely show up or who provide nonessential information? Look at costs related to “nice to know” versus “need to know” information. There are so many essential needs that it makes no sense to spend money on orientation components that are nonessential.
Here are some questions to get started:

Is it possible to substitute computer-based learning for some instruction and eliminate a portion of the endless stream of paperwork?
Can you use email instead of some paperwork exercises?
When you purchase DVDs, tracking systems, or other resources, are revisions and updates part of the purchase package? If not, do you purchase resources that have a reasonable shelf life?

It is also important to look at staff development and see if orientation overlaps with mandatory training and continuing education activities.

Have a question of our experts? E-mail your queries to Editorial Assistant Casey Ramsdell at cramsdell@hcpro.com. See your name in print and find answers to your questions.

Tips from TSE: Using virtual reality as an educational tool

Fri, 13 Nov 2009 19:09:00 GMT

The phrase “simulation modalities” may conjure up a variety of images. For example, some nursing staff development professionals think of a sophisticated training mannequin that produces computer-generated EKG printouts, responds to intubation efforts, and virtually behaves in ways similar to an actual patient. Others may think of an IV arm used solely for learning how to start IVs.

The point is, there is a wide range of simulation modalities, but many staff development specialists know of only a few, and still more are as of yet unaware of the vast potential for providing education via simulation.

One type is virtual reality, which is a computer-generated world that allows the learner or group of learners to experience various stimuli, often in a 3-D presentation. Learners typically wear head-mounted displays to receive visual and auditory cues. They can interact in the computer-generated world from various sites or be in a physical space in which they can interact with others

Virtual reality is a rapidly developing field and gives a true sense of realism. However, the creation of a complex virtual patient and treatment setting can be time-consuming and expensive. It requires a complete computer model of the patient environment; a way to track visual, audio, and touch fields; adequate hardware for all sensory modalities; and hardware to compute all models, track inputs, and produce outputs in real time

Editor’s note: This excerpt was adapted from the November issue of The Staff Educator. Discover all the benefits of subscribing to The Staff Educator!

HCTW news brief: Nurse phone calls can lower blood pressure, study says

Fri, 13 Nov 2009 19:01:00 GMT

A team of doctors and nurses at Duke University Medical Center have created an intervention that it believes can help lower patients’ blood pressure. The intervention lasted two years and included a do-it-yourself monitoring plan and bi-monthly phone calls from a nurse.

The Duke team studied more than 600 patients that were divided into four groups. The first group got the normal intervention of drugs and periodic doctor visits. The second was given home blood pressure monitoring devices and the training to use them, and the third was called at home by nurses to discuss healthy living options. The fourth group got a combination of two and three, benefiting from home blood pressure monitoring devices and the nurse calls.

Researchers found that the fourth group had the greatest blood pressure drop, with an 11% reduction on average. The patients who only monitored their blood pressure saw a 7.6% drop, and patients who got the phone calls alone recorded a 4.3% drop.

The team hopes the program will create curiosity in the medical field and said it would be able to begin implementation as soon as there was interest. The team has developed a training package and information, which they offer to public health clinics, hospitals, and doctors’ offices.

Source: The Wichita Eagle

Quick question for staff nurses: Participatory management style

Tue, 10 Nov 2009 13:51:00 GMT

One of the scariest aspects of a site visit for staff nurses is the prospect that appraisers will ask them a question they can't answer. Help nurses get over their fears by practicing responses to a variety of questions about the journey and what designation means to them. This will help them feel more confident that they can answer any question posed on the real site visit.

Here is this month's quick question for staff nurses:

Practice question: Why is horizontal and vertical communication essential to participatory management?

Hint: An ANCC Magnet Recognition Program® nursing environment engages all levels of nursing in decision-making. Therefore, these organizations enhance the quality of decision-making and gain buy-in from the involved nurses.

Source: Adapted from Ready, Set, Designation! HCPro's Guide for the ANCC Magnet Recognition Program®.

In the news: Massachusetts nurses rally to support staffing bill

Mon, 09 Nov 2009 11:49:00 GMT

The Massachusetts Statehouse held a hearing on November 6 about a bill to limit the number of patients a hospital nurse can care for at one time, reports The Daily News (Newburyport, MA).

Members of The Coalition to Protect Massachusetts Patients gathered with nurses in support of the bill, dubbed The Patient Safety Act. The bill would require the same ratios for all hospitals, which proponents say would help patients receive safer care. The bill also bans the practice of mandatory overtime and includes initiatives to increase nursing faculty and nurse recruitment

Delia O'Conner, CEO of the Anna Jaques Hospital (AJH) in Newburyport, MA, does not support the bill. O'Conner says such "one size fits all" bills aren't right for all hospitals, and would cause AJH to make job cuts. She argues that she would have to hire more nurses for night shifts, and most likely cut aide and transporter positions, which are there to help nurses.

Source: The Daily News.

In the know: NCLEX myths

Mon, 09 Nov 2009 11:04:00 GMT

The anxiety factor tied to the NCLEX lends itself to widespread rumors about how the exam works and speculation about changes in the testing protocol. The National Council of State Boards of Nursing (NCSBN) is the only reliable source of information to debunk these myths.

Current myths addressed by the NCSBN include the following:

MYTH: Some NCLEX questions require answers outside the scope of practice for nurses.
REALITY: All test questions have been reviewed and approved by the Exam Committee and are within the scope of nursing practice.

MYTH: Some candidates are randomly selected to receive the maximum number of questions regardless of performance on the exam.
REALITY: No candidate receives a preselected number of questions. The testing system gives questions until it has accurately determined the candidate's level of competence, then the test stops.

For more NCLEX tips, check out HCPro's book, Stressed Out About Nursing School.

Web site spotlight: Outsourcing discharge follow-up calls keeps nurses at the bedside

Fri, 06 Nov 2009 19:46:00 GMT

In the wake of the country's nurse shortage, many nurses are wearing more than one hat during the workday, often taking their attention away from caring for patients at the bedside. One activity stealing this time is the responsibility to place calls to patients who have been discharged and need follow-up clarification on discharge instructions and prescribed medication. Nurses struggle to find time for this task while attending to their current patients.

These calls clearly have their place. The U.S. Agency for Healthcare Research and Quality recently cited that 20% of patients have a "complication or adverse event" after leaving a hospital. Many avoidable errors are due to patients misunderstanding post-discharge instructions such as cleaning a surgical site or taking prescriptions in correct doses. Follow-up phone calls educate patients and can help prevent further complications. However, these calls can be time consuming for busy nurses.

Considering there is an average of 120 million ED discharges annually in the United States, let's assume healthcare organizations conduct follow-up calls with 40% of that population with an average call taking five minutes. This translates into at least 150 million minutes, or 104,166 days, on the phone reviewing post-discharge instructions-and that's for ED patients alone.

Editors note: To read the rest of this article, visit "Outsourcing discharge follow-up calls keeps nurses at the bedside" found in the Reading Room at www.StrategiesForNurseManagers.com. Get a free trial membership that will give you 30 days to test drive all the exciting features on the Web site.

Ask the expert: As a preceptor, how can I help new nurses overcome reality shock?

Fri, 06 Nov 2009 19:39:00 GMT

This week, Diana Swihart, PhD, DMin, MSN, CS, RN-BC, discusses how to determine what phase of reality shock a new nurse is in, and suggests ways to help staff members overcome it.

Q: As a preceptor, how can I help new nurses overcome reality shock and move forward with their day-to-day tasks?

A: New nurses enter their assigned practice settings eager to begin their new jobs, to meet their new colleagues, and to accept their new challenges. However, six months to a year later, disillusionment sets in and this may be when preceptees experience reality shock as they encounter change, conflict, and chaos associated with their new responsibilities.

Before you are able to help them, you must first determine which stage of reality shock they have. There are four phases to reality shock:

Honeymoon phase: Preceptees perceive the employment setting and their new coworkers positively, or through “rose colored glasses.”

Shock phase: Preceptees begin to encounter weaknesses, discrepancies, and inconsistencies in the work environment and their new colleagues.

Recovery phase: Preceptees begin to perceive the realities of the professional practice environment with a balanced view of both negative and positive aspects.

Resolution phase: Caution! Preceptees may adopt less than ideal values or beliefs to resolve the conflicts of values and find ways to 'fit in' with their coworkers.

After establishing which phase they are in, you can determine which ways to assist preceptees in overcoming their reality shock.

For a preceptee in the honeymoon phase, harness their enthusiasm for learning new skills and routines, be realistic but do not stifle their enthusiasm.
For a preceptee in the shock phase, listen attentively and model the ideals of professional nurses.
For a preceptee in the recovery phase, help them view situations realistically, and help them regain their sense of humor.
For a preceptee in the resolution phase, assist them in constructive and creative problem solving, and identify and manage any conflicts and confusions that persist.

Have a question for our experts? E-mail your queries to Editorial Assistant Sarah Kearns at skearns@hcpro.com. See your name in print and find answers to your questions.

Tips from TSE: Stroke education for patient care technicians

Fri, 06 Nov 2009 19:33:00 GMT

Designation as a stroke center requires that all clinical and nonclinical hospital employees receive training on how to recognize a stroke and take appropriate actions. This was the challenge JFK Medical Center, a 500-bed acute care and rehab facility in Edison, NJ, undertook in 2007 when it pursued designation as a comprehensive stroke center by the New Jersey Health and Senior Services and a primary stroke center by The Joint Commission.

Why do nonclinical staff members need stroke education? A security officer, for example, might encounter a patient or family member exhibiting behaviors consistent with stroke. The officer must be able to recognize the signs and symptoms of stroke and how to promptly summon qualified patient care providers.

Direct patient care providers need more in-depth education, depending on their roles and the amount of care they provide to stroke patients.

Educating an entire hospital is a daunting task. Donna Kozub, BSN, RN-BC, was assigned responsibility for educating non-licensed nursing department personnel, known as patient care technicians (PCT), in 2007.

Editor’s note: This excerpt was adapted from the November issue of The Staff Educator. Discover all the benefits of subscribing to The Staff Educator!

HCTW news brief: University of Phoenix introduces new immersive learning center

Fri, 06 Nov 2009 19:16:00 GMT

The University of Phoenix introduced its new, state-of-the-art SIM Man 3G "patient" mannequins last week as part of its new immersive learning-nursing center. The new learning center is part of the LPN and BSN degree programs, and the university plans to integrate it into other nursing degree programs as well.

Thanks to $400,000 in renovations, the 4,100-square-foot center combines critical thinking, immersive learning, and the use of simulation training to provide students with the opportunity to learn and develop skills they will need for a future in nursing.

SIM Man is operated by a lab technician or medical professional in a high-tech control room. A fully equipped, simulated-reality hospital room with four beds and patient monitors, a video monitoring system, and an observation and debriefing room for playing back recorded video allows students to gain hands-on experience through simulation training.

Source: Reuters.com