Teaming with students and a Sacred Cow Contest to make changes in nursing practice

Many current nursing traditions and practices were developed over time by nurses who used a trial and error method of research. Nursing has passed along these practices through nursing education programs and in the policies and procedures established by hospitals. Do these practices have sound scientific principles behind their use, or are they just traditions that are difficult to change? This article explores the experience of one educator trying to make changes in the attitudes of students toward research and suggests how this process can be applied in the day-to-day practice of staff nurses.     

A neonatal home intravenous antibiotic therapy program

Home intravenous therapy offers many benefits for children as well as adults. Infants less than 1 month old may also benefit from home I.V. therapy. Neonates are a unique group of home I.V. therapy recipients, and providing safe home I.V. therapy for them requires changes in standard home I.V. policies and procedures.     

Policies and procedures: a tool to support the implementation of clinical guidelines?

OBJECTIVES: To explore the use of policies and procedures as a tool to support the implementation of clinical guidelines and to determine the relationship between organizational support and stability with nurses' perception of policy change. DESIGN: Secondary analysis of qualitative and quantitative data collected in the post-intervention phase of the study entitled Evaluation of the Dissemination and Utilization of Best Practice Guidelines by Registered Nurses in Ontario. SETTING: Eleven agencies across Ontario, Canada. PARTICIPANTS: Fifty nursing staff, 32 nurse administrators and 22 clinical resource nurses (90% response) participated in semi-structured interviews. A total of 316 randomly selected nursing staff from 23 participating units in 11 agencies completed questionnaires (65% response). METHODS: Qualitative data from semi-structured interviews were examined to determine whether participants had modified their policies and procedures as part of the implementation of clinical guidelines. Using SPSS 11.0 for Windows, the authors assessed, using independent t-tests, the relationship between the perception of modification of policies and procedures and the perceptions of organizational support an organisational stability. RESULTS: While modifications to policies and procedures were made at each agency as part of the implementation of clinical guidelines, 27% of staff disagreed that modifications had been made. Nursing staff who agreed that changes had been made to policies and procedures were significantly more likely to report positive organizational support for clinical guideline implementation. CONCLUSION: Findings suggest the need to increase nursing staffs' awareness of changes to policies and procedures during clinical guideline implementation. Furthermore, results indicate that organizational support may have a positive influence on modifications to policies and procedures that are guided by research-based clinical guideline recommendations.     

Protection procedures and preventions against the spread of coronavirus disease 2019 in healthcare settings for nursing personnel: Lessons from Taiwan

BackgroundSince coronavirus disease 2019 was first discovered, at the time of writing this article, the number of people infected globally has exceeded 1 million. Its high transmission rate has resulted in nosocomial infections in healthcare facilities all over the world. Nursing personnel account for nearly 50% of the global health workforce and are the primary provider of direct care in hospitals and long-term care facilities. Nurses stand on the front line against the spread of this pandemic, and proper protection procedures are vital.ObjectivesThe present study aims to share the procedures and measures used by Taiwan nursing personnel to help reduce global transmission.Review methodsCompared with other regions, where large-scale epidemics have overwhelmed the health systems, Taiwan has maintained the number of confirmed cases within a manageable scope. A review of various national and international policies and guidelines was carried out to present proper procedures and preventions for nursing personnel in healthcare settings.ResultsThis study shows how Taiwan's health system rapidly identified suspected cases as well as the prevention policies and strategies, key protection points for nursing personnel in implementing high-risk nursing tasks, and lessons from a nursing perspective.ConclusionsVarious world media have affirmed the rapid response and effective epidemic prevention strategies of Taiwan's health system. Educating nurses on procedures for infection control, reporting cases, and implementing protective measures to prevent nosocomial infections are critical to prevent further outbreaks.     

Nurses' beliefs about family involvement in a children's hospital.

Children's hospitals throughout North America have implemented many changes during the past 15 years. In recognition of the central role of parents in the lives of their children, policies and procedures have been implemented to enable parents to participate in various aspects of their children's care. However, the extent to which attitudes of nurses have changed to support a more active parental role is less evident. In a project to formulate a philosophy of nursing for a children's hospital, 22 nurses were asked a wide range of questions about nursing and family-centered care. Although all nurses expressed explicit support for the concept of family-centered care, some of their practices and beliefs suggested otherwise. This article describes their responses and suggests recommendations for future research, education, and nursing practice.     

我国二级医院护理工作状况的综合评价

目的 调查我国不同地理区域二级医院护理工作状况差异,为相关护理政策制订、区域间护理人力资源配置等提供依据.方法 运用综合评价对我国二级医院护理工作状况进行评价,采用问卷调查法对我国7个地理区域的936名二级医院护士长进行调查.结果 华北、华东地区护理工作状况最好,西南、东北、华南地区次之,华中、西北地区最差.结论 各地理区域护理工作状况差别较大,相关护理政策的制订与具体工作的开展等应考虑区域差异.     

Use of nursing practice research findings

Fourteen nursing research findings that meet the Conduct and Utilization of Research in Nursing (CURN) Project (1982) criteria for clinical use were identified from research journals and CURN publications. Data collected from 216 practicing nurses in small, medium, and large hospitals were analyzed to determine their awareness of, persuasion about, and use of the findings. The majority of nurses were aware of the average innovation, were persuaded about it, and used the average innovation at least sometimes. Use of the innovations had no relationship to hospital policies or procedures concerning the nursing research findings.     

Supportive nursing care around breast cancer surgery: an evaluation of the 1997 status in The Netherlands

This study aimed to assess nurses' involvement in the supportive care of patients with recently diagnosed breast cancer in Dutch hospitals. A questionnaire used to evaluate various aspects of nursing care for breast cancer patients was sent to the surgical nursing teams in all 120 Dutch hospitals that provide surgical treatment for these patients. Nursing care was defined to be optimal if it met the following criteria: (a) Specialized nursing support is provided to all patients during admission and in the outpatient departments both before and after surgery. (b) A protocol is in place outlining standard nursing procedures for breast cancer patients. (c) Formal communication about each breast cancer patient exists between the nurses involved. On the basis of this definition, it was found that optimal nursing care was provided in only 6% of the hospitals. Nursing care fell short mainly in the outpatient setting. This shortcoming also was recognized by most respondents, and many were already planning improvements. Nurses had varying opinions about their responsibility to provide the patient with information about the disease and its treatment, and consensus was lacking. In summary, nursing care for newly diagnosed breast cancer patients in Dutch hospitals needs improvement, especially in the outpatient setting.     

Antineoplastic vesicant extravasation

The administration of antineoplastic drugs is an almost-daily responsibility of the I.V. nurse, and the possibility of extravasation is ever-present. The nurse's thorough knowledge of these drugs, including their actions, side effects, and the appropriate interventions in the event of an extravasation, is essential to providing optimal I.V. care to patients. This article is based on the extravasation management policies and procedures of Spartanburg Regional Medical Center, Spartanburg, S.C.     

Visiting hours policies in New England intensive care units: strategies for improvement

OBJECTIVE: Dying patients often feel isolated and alone, and restricted visiting hours in the intensive care unit (ICU) has been shown to increase anxiety and dissatisfaction in both critically ill patients and their families. Unrestricted visiting has been identified as a top-ten need by families of patients in the ICU. Because emotional distress experienced by patients and families may persist well beyond the ICU stay, an open visiting policy, by meeting the needs of patients and families, may improve the quality of end-of-life care in the ICU. This two-part study included a survey to determine the visiting hours policies of New England-area hospital ICUs, and nursing focus groups to describe challenges and barriers that nursing staff working in an open ICU have experienced and to provide solutions that will facilitate implementation of an open visiting hours policy. DESIGN: Two-part study: survey and focus groups. SETTING: ICUs in New England and one medical ICU in a tertiary care hospital. SUBJECTS: Registered nurses employed in medical ICUs. INTERVENTIONS: Adult ICUs in the six New England states were located using a library listing of all regional hospitals. A telephone questionnaire interview was used to ascertain visiting hours policies in each ICU. Six focus-group sessions were conducted with nursing staff who work in an urban, northeastern ICU with 8 yrs of experience with an unrestricted visiting hours policy. MEASUREMENTS AND MAIN RESULTS: A total of 171 hospitals completed the questionnaire (96%). From all ICUs surveyed, 62 (32%) had unrestricted, open visiting hours. Out of these, 57 (92%) were medical ICUs or mixed medical/surgical ICUs. Nursing staff identified three major areas of concern with an open visiting hours policy: space, conflict, and burden. Strategies for resolution that are either employed or advocated by nursing staff are described. CONCLUSIONS: The majority of ICUs in New England have restricted visiting hours. Only one third of ICUs have open visiting policies. Nursing concerns with an unrestricted ICU were identified and solutions were offered that may provide guidance for other ICUs considering adopting an open visiting hours policy.     

Changing culture in interventional areas to promote patient safety

During the past decade, physicians have begun to perform an increasing number of interventional procedures in various locations outside the traditional OR. Changes in technology and practice have generated the need for a paradigm shift about perioperative practice because these interventional areas have become perioperative centers of care in which patients undergo operative and other invasive procedures. Physicians, nursing staff members, support staff members, and administrators in these interventional areas must consider perioperative practice standards, institutional policies, state practice acts, and regulatory and accreditation requirements when creating policies and procedures. Personnel must be familiar with AORN standards and recommended practices and understand the perioperative practice guidelines related to nurse staffing in invasive procedure areas. Advanced practice nurses and other leaders must use evidence-based research as the basis for policy and procedure changes.     

Paying hospitals on the basis of nursing intensity: policy and political considerations

Some believe that explicit incorporation of nursing intensity into hospital payment systems would lead hospitals to increase the use of nursing resources. But 25 years of Medicare provider payment policies, followed increasingly by Medicaid programs and private insurers, means that any incorporation of measures of nursing intensity into payment systems needs to be consistent with concepts of prospective payment. But the main impact of such a step would be to increase equity among hospitals with different case mixes and blunt incentives to specialize in diagnosis-related groups with relatively low nursing intensity. Issues of the role of nurses in hospitals and the intensity of nursing resources used in care are more likely to be influenced by quality reporting and pay for performance than by incorporating nursing intensity into a prospective payment system.     

Still attractive after all these years? Magnet hospitals in a changing health care environment

This paper examines the research base for 'magnet hospitals'--hospitals that have a good reputation for recruitment and retention of registered nurses. It also assesses the extent to which the concept of the magnet hospital continues to have relevance to nursing in the United Kingdom (UK). The study reviews previous research, examines recent trends in nursing employment, and reports on case studies conducted as fieldwork research. The early research on magnet hospitals, conducted in the 1980s in the United States of America (USA), is reassessed in the light of subsequent cost containment driven changes in the USA nursing labour market and in the organization of USA hospitals. Many of these changes have impacted on nursing staff, with increases in workload, and with changes in skill mix, particularly as a result of increased use of care assistants. Similar developments have been happening in the UK. The paper examines the extent to which the concept of the magnet hospital can retain validity in this changing health care environment. Case studies in 14 USA magnet hospitals were conducted in 1997. The results highlight that, as a result of hospital reorganization and merger, some of these hospitals no longer exhibit core characteristics of 'magnetism', whilst others have retained these characteristics despite organizational change. The paper concludes by cautioning that the concept of the magnet hospital continues to have a relevance to the management of nursing resources, but that the research base, with some notable exceptions, continues to be weak and that there is a need for monitoring and a process of re- accreditation to maintain a 'live' register of magnet hospitals.     

某市公立医院护理管理者反映问题的调查分析

目的 调查分析某市公立医院护理管理中存在的问题,为完善公立医院护理管理政策提供信息依据.方法 调查某市5所公立医院的76名护理部主任(副主任),科室、病区护士长(副护士长),了解护理管理中存在的问题,对调查数据进行频数分析和加权频数分析.结果 该市公立医院护理管理者反映的依次排在前5位的问题是护理人员缺乏(13.66%)、护士长缺乏系统的管理知识(11.08%)、护理人员工资低(10.56%)、护士素质低(7.64%)和护理工作范围外的事务多(7.53%),占全部类别问题加权总频数的50.47%,需优先解决.结论 排在加权全序位频数表中前5位的问题是需要优先解决的问题,着重解决护理人员缺乏这一首要问题,能有效促进其他问题的解决.公立医院应完善人力资源制度和护理管理制度建设,提高护理管理水平.