Finding the right direction: the importance of open communication in a governance model of nurse management

Change and its management is a widely researched and documented activity. Yet amidst this plethora of literature there is little that looks at the central tenets of the change process: exemplar setting; communication and executive guidance. The nursing management system at King Faisal Specialist Hospital and Research Centre agreed to change direction and embrace the concept of shared governance to bring about equality and parity in decision making. This process demanded that the nursing executive gave direction by providing an example of how shared governance could be actuated. This paper argues how shared governance is a viable alternative management structure for nursing practice and details how the organisation implemented it through open and honest communication.     

A Rapid Quality Control Initiative to reduce the incidence of urinary tract infection in the paediatric intensive care patient--Part one

Urinary tract infection is one of the common bacterial infections in children and can lead to substantial morbidity. If the infection results in renal scarring, various long-term risks include hypertension and renal insufficiency. Nosocomial urinary tract infections (NUTI) in children occur with varying frequency with approximately 60–80% of these infections being strongly correlated with urethral instrumentation. This paper presents stage one of a Rapid Quality Control Initiative to reduce the incidence of NUTI in the paediatric patient at King Faisal Specialist Hospital and Research Centre.     

Planning and problem solving. Strategy for opening an oncology/chemotherapy unit.

The world-wide nursing shortage is resulting in institutions all over the world recruiting nurses from other countries with varying nursing skill levels and cultural backgrounds. The purpose of this article is to provide a framework for international institutions to adopt, to ensure continued quality care for oncology patients. At King Faisal Specialist Hospital & Research Centre (KFSH&RC) in Riyadh, Saudi Arabia, nurses have been recruited from over 25 different countries. Many of these nurses have never cared for oncology patients or given chemotherapy. A framework combining the strategies of planning and problem-solving was utilized to operationalize this unit in a multicultural setting. Cultural variants related to caring for Saudi patients by a multinational work force with differing cultural backgrounds as well as differing educational programs for nurses was reviewed in terms of their impact on staffing an oncology unit. An oncology/chemotherapy certification course was developed to document the competency of these multinational nurses to administer chemotherapy and to provide safe quality care to oncology patients.     

Palliative care in Saudi Arabia: a brief history

The palliative care service started at the King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia over a decade ago by Dr. Isbister is slowly expanding. Excellent facilities for investigations and curative treatment are available in the hospital, and these are useful when supportive facilities are needed. Nevertheless, there are problems. Most of the staff is western, and this is a hindrance when psychosocial and spiritual support is needed by Saudi patients. Patients have poor facilities for follow-up in between outpatient visits every month. The team has overcome the problem of poor availability of opioids, but these essential drugs are not available to the patients at the national level. Educational and research services have begun.     

Palliative Care in Saudi Arabia

The palliative care service started at the King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia over a decade ago by Dr. Isbister is slowly expanding. Excellent facilities for investigations and curative treatment are available in the hospital, and these are useful when supportive facilities are needed. Nevertheless, there are problems. Most of the staff is western, and this is a hindrance when psychosocial and spiritual support is needed by Saudi patients. Patients have poor facilities for follow-up in between outpatient visits every month. The team has overcome the problem of poor availability of opioids, but these essential drugs are not available to the patients at the national level. Educational and research services have begun.     

Implementation of the World Health Organization 'analgesic ladder' in Saudi Arabia

The European School of Oncology recently sponsored a symposium at the King Faisal Specialist Hospital in Saudi Arabia entitled 'The modern management of advanced cancer: how to help your patients'. During this symposium, a workshop was organized in order to address the problem of 'the availability and the distribution of narcotics' for patients with advanced symptomatic cancer in the Kingdom of Saudi Arabia. Many country-wide problems were identified including the lack of specific information, religious acceptance and education for patients, health care professionals and government, the availability of medications and access to palliative care. It was suggested that clear protocols for the acceptance of patients into palliative care programmes, the prescribing and delivery of medication, and their availability throughout the country, be established. The goal of allowing patients with advanced cancer to die with dignity and without pain was identified as a worthy one and one that would be appreciated not only by patients themselves but by their relatives, carers, religious leaders and government. The workshop discussed some of the ways of trying to achieve this goal, and its conclusions are reported here.     

Mycobacterial infection after renal transplantation--report of 14 cases and review of the literature

During a nine-year period, 14 cases of mycobacterial infection (tuberculosis) developed in 403 renal transplant recipients at the King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia, an incidence of 3.5 per cent. The annual incidence of tuberculosis was about 50 times higher than that in the general population. Infection was disseminated in nine (64.3 per cent), pulmonary in four (28.6 per cent), and genitourinary in 1 (7.1 per cent). In one patient tuberculosis was transmitted by the donor's kidney. The clinical manifestations were often ill-defined and not different from that in the normal host. Cultures from all patients grew Mycobacterium tuberculosis; concomitant infection with other organisms was present in five patients (35.7 per cent). Two of 18 patients (group 1) with positive pretransplant tuberculin skin test developed tuberculosis after transplantation (11 per cent), and neither received isoniazid prophylaxis; three of 70 patients (group 2) with negative skin tests developed tuberculosis after transplantation (4.3 per cent). The difference between the two groups was not statistically significant. Review of all published cases of mycobacterial infections in renal transplant recipients revealed 130 cases. Tuberculosis was disseminated in 38.7 per cent, pulmonary in 40.2 per cent, cutaneous in 12 per cent, and miscellaneous in 9.4 per cent. Atypical mycobacteria were responsible for 29 per cent of disseminated infections, 8 per cent of pulmonary infections and all cases of cutaneous and articular tuberculosis. Invasive procedures were needed to establish the diagnosis in 21 of 33 disseminated cases but in only three of 47 cases of pulmonary tuberculosis (p less than 0.0001). The mortality rate from disseminated disease was 37 per cent and from all other forms of tuberculosis was 11 per cent (p less than 0.005). These findings (1) confirm the higher incidence of tuberculosis in renal transplant recipients, compared to the general population; (2) suggest that pretransplant skin testing probably has little value in identifying patients at risk; (3) show that disseminated tuberculosis is common after renal transplantation and requires invasive procedures for diagnosis; (4) confirm that the donor kidney may be an important source of infection; and (5) indicate that concomitant infection with other organisms is common.     

Program development: role of the clinical nurse specialist in implementing a fast-track postanesthesia care unit

Advanced practice nurses are involved in many aspects of program development as part of their roles. This can involve such things as developing programs for staff and family education, organizing system-wide quality assurance programs, or implementing new care programs. One unique aspect of the advanced practice nurse's role is the ability to serve as a change agent and implement new models of care. Although all advanced practice nurses can be involved in program development, the role of the Clinical Nurse Specialist lends itself to devoting dedicated services for implementing programmatic change in the clinical setting. This article describes the role of the Clinical Nurse Specialist in implementing an evidence-based, fast-track postanesthesia care unit.     

Evidence-based policy and procedures: an algorithm for success

Evidence-based practice is defined as the use of current best evidence by clinicians when making patient care decisions. Barriers to an evidence-based practice are well identified in the literature and significantly impact the use of research findings in practice. A key feature of a practice environment that supports and promotes the use of best evidence is requiring clinical practice policies and procedures to be evidence-based. The authors describe the structure and process developed to facilitate evidence-based policies and the outcomes of the initiative.     

An up close and personal look at Saudi Arabia (Jeddah and Riyadh): history, culture, and health care.

Saudi Arabia was one of the greatest travel destinations that I have had the opportunity to experience. I made this pilgrimage to Jeddah and Riyadh, and was truly welcomed into the kingdom. After almost three years of caring for those precious gems (the five surviving babies of the famous Saudi Arabian Septuplets) born July 2001 in the Georgetown University Hospital in Washington, DC, I was issued a visa and asked to serve as the Nurse Escort in taking these babies home. Through a detailed glimpse of everyday life, I was privileged to enter an arena of not only forming lifelong friendships, but exploring how a country so difficult to gain entry, is also a land of astonishing natural beauty. A visit to that famous King Faisal Hospital made me a believer that Saudi Arabia has one of the best medical facilities in the Middle East, with well-trained nurses and physicians, who many are from other countries, including the United States. Observing health care professionals providing competent nursing and medical care in that environment was unique, because it evolved a culture based on an amalgam of religion and politics.     

Surgical site verification: A through Z.

Performing the correct procedure on the correct patient has always been of prime importance to all health care providers. For the past six years, it has been a patient safety initiative priority of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Before JCAHO took the lead in this arena, however, health care facilities handled this issue with individualized policies and procedures. This became problematic because physicians practice in multiple institutions that could have conflicting policies, which could confuse the issue. This case study presents the evolution of the surgical side marking and site verification policy at St Joseph's Wayne Hospital, Wayne, NJ. It has been a painful process, requiring numerous policy rewrites with updated information as prescribed by JCAHO. Enforcing physician compliance and continually re-educating nurses with each new JCAHO change proved challenging. The marking of surgical sides and verification of all sites, however, has proven to be a collaborative effort with safe patient outcomes as the shared goal.     

Lake Region Hospital: case study in rural hospital intravenous therapy updating

Rural hospitals, like large metropolitan hospitals, are constantly facing the challenge of updating and revising their patient care policies and procedures. Using information and guidelines formulated by professional nursing societies, rural hospitals keep pace with fast changing technological advances. During the past year-and-a-half, Lake Region Hospital (LRH) has worked hard to improve its I.V. policies and procedures. The guidance available through the Intravenous Nursing Society (INS) and the INS Network System has been central to these improvements. These changes were instituted by the I.V. resource nurse at LRH in collaboration with a multidisciplinary team. This paper describes these changes in a nursing process format.     

Pre-operative patient preparation in the prevention of surgical site infections

In 1999 the Ontario Ministry of Health and Long-Term Care granted funding to St. Mary's General Hospital for a Regional Cardiac Care Center. In July 2003 the cardiac surgery program opened. During the program-planning phase, protocols and procedures related to patient preparation for cardiac surgery were developed. OBJECTIVE: To share policies, protocols and patient teaching tools developed from research driven, evidenced based standards of practice. To complete a one-year review (January to December 2004) and assess the compliance rates with pre-operative patient preparation procedures on all Coronary Artery Bypass Graft (CABG) cardiac surgery patients. DESIGN: Retrospective chart review. SETTING: 191 bed community-based Regional Cardiac Care Centre. PARTICIPANTS: All adult patients undergoing Coronary Artery Bypass Graft (CABG) surgery from January 1st 2004 to December 31st 2004. ANALYSIS: Compliance rate following patient education related to pre-operative washes, assessing completion of pre-operative washes, and location of clipping relative to the Cardiovascular Operating Room (CVOR). CONCLUSION: A team of Registered Nurses was able to effectively implement policies and protocols within a cardiac surgery program that meet the recommended standards of care of the Centers for Disease Control and Prevention (CDC), Operating Room Nurses Association of Canada (ORNAC) and Safer Health Care Now! Initiative. A retrospective chart review has demonstrated that staff consistently apply and document care in accordance with the developed pre-operative wash and hair clipping protocols.     

Diabetes care delivery in the community

Specialist nurses and practice nurses were asked about the future care and management of Type 2 diabetes. Consensus was high on issues such as audit, evidence-based practice, experience and record keeping. There were differences in opinion about nurse prescribing, teamwork, professional responsibility and education/training.     

北京协和医院成人新型冠状病毒感染实用诊疗建议(2023)

随着我国疫情防控措施的科学调整,新型冠状病毒感染患者尤其是重症、危重症患者的救治成为医务人员现阶段的工作重点。疫情发生以来,北京协和医院在新型冠状病毒感染救治方面积累了较多经验,在结合众多国际循征医学证据的基础上,新型冠状病毒感染诊疗多学科专家组编写了《北京协和医院成人新型冠状病毒感染实用诊疗建议(2023)》。秉承循证、简洁、临床可操作的原则,本诊疗建议对目前最新研究证据进行整合,对于缺乏循证医学证据的关键临床问题,结合北京协和医院一线临床工作经验和专家意见给出一定推荐,旨在提升医务人员对新冠病毒感染及其危重症的认识,提高患者救治水平。     

Implementing the Critical Care Pain Observation Tool using the Iowa Model

Utilization of the Iowa Model of evidence-based practice (EBP) helps to facilitate change in nursing care. This was observed when an alteration in pain-rating assessment scales needed to be implemented at St. Joseph's Hospital Health Center in Syracuse, NY Research showed that the Critical Care Pain Observation Tool (CPOT) was psychometrically sound in assessing pain in the nonverbal (unconscious, unresponsive, and sedated) intensive care unit patient population. Successful implementation of a CPOT pilot program in the surgical intensive care unit at St. Joseph's was undertaken using the Iowa Model of EBP. Application of the Iowa Model provided a systematic framework for changing nursing practice by incorporating critical thinking, clinical inquiry and judgment, multidisciplinary collaboration, and facilitation of learning. As evidenced by implementation of the CPOT, organizational implementation of EBP using the Iowa Model positively impacts change across an entire healthcare continuum through the improvement of patient care processes.     

'Working from the inside': an infrastructure for the continuing development of nurses' professional clinical practice

AIM: This paper describes how the nursing executive of a tertiary referral facility revisited their management structures and responsibilities to create a new, sustainable infrastructure that supports research and education at the core of nursing practice and not at the periphery. BACKGROUND: Nursing executive and senior management groups are charged with the ultimate responsibility of ensuring the highest possible quality nursing care within their facility. In the current health care climate the aim for best practice conflates with evidence-based practice that can be notoriously difficult to achieve due to the many barriers to integrating research findings into practice. KEY ISSUES: Research and education activities have been established as fundamental to core business under a simple evidence-based practice model. CONCLUSION: The value of a synthesis between the clinical areas with the nursing education and research division has been recognized to better achieve the goal of improved services.     

Jordan palliative care initiative: a WHO Demonstration Project

A model for pain relief and palliative care for the Middle East has been established in Jordan. King Hussein Cancer Centre (KHCC) in Amman is now a truly comprehensive cancer center as it includes palliative care for inpatients, outpatients, and patients at home. This is especially important in a country and a region where over 75% of the cancer patients are incurable when diagnosed. To support effective palliative care delivery, there have been many significant changes in Jordan between 2001 and 2006. Regulations governing opioid prescribing have been changed to facilitate effective pain management. The national opioid quota has been increased. Cost-effective, generic, immediate-release morphine tablets are being produced in Jordan. Intensive, interactive bedside training courses for doctors, nurses, and clinical pharmacologists have started to overcome opiophobia and motivate health care professionals to take up palliative care as a profession. "Champions" for palliative care have emerged who are leading the development of palliative care in Jordan's health care systems and starting to support neighboring countries to develop pain relief and palliative care. While before 2003, fewer than 250 patients per year received palliative care, by 2006 more than 800 patients per year were receiving pain relief and palliative care through the KHCC and Al Basheer Hospital. The achieved changes and the unusually rapid and effective institutionalization of palliative care serve as a model for other countries in the Middle East region as to what should be done and how.     

北京协和医院新型冠状病毒感染基层诊疗建议(2023)

随着疫情防控政策的科学调整，越来越多的临床医生尤其基层医生已面临接诊新型冠状病毒感染患者的情形。北京协和医院秉承“以人为本、全人照顾”的理念，依据世界卫生组织等国际指南、国家卫生健康委员会最新发布的《新型冠状病毒感染诊疗方案(试行第十版)》及《关于对新型冠状病毒感染实施“乙类乙管”总体方案》，坚持循证、简明、临床可操作的原则，编写了《北京协和医院新型冠状病毒感染基层诊疗建议(2023)》。对于目前尚缺乏循证医学证据的关键临床问题，结合北京协和医院一线工作经验及多学科专家意见，给出了相应诊疗建议。本诊疗建议强调在社区筛查重症高危人群，并尽早予以药物以及加强营养、心理治疗、睡眠支持等非药物干预，构筑家庭、社区、医院三道防线，以期实现“保健康、防重症”的总体目标。