How and what staff nurses learn about the medical devices they use in direct patient care

Registered nurses (N = 323) working in a 500-bed tertiary care hospital in a large midwestern city were surveyed to determine what and how they initially learned about the medical devices they use, and the consequences of their use. The most frequently identified methods of initial learning were trial and error (taught self) and reading the user instruction manual. At least 90% of respondents indicated that when they first learned about the device they learned how to operate it and its purpose and function. Medical device use causes more than 75% of staff nurses to feel stressed; 11% had used a medical device that had harmed a patient. ©1995 John Wiley & Sons, Inc.     

Australian registered nurse medical device education: a comparison of simple vs. complex devices

As the primary users of medical devices in direct patient care, registered nurses must be competent both with simple and complex devices because any device improperly used can have serious consequences Results of a cross-sectional survey of registered nurses ( n = 238) working at a large South Australian tertiary care centre on units with high usage both of indwelling urethral (Foley) catheters and intravenous infusion pumps revealed that participants were significantly more likely to have learned to use the indwelling urethral (Foley) catheter in nursing school than they were to have learned how to use an intravenous infusion pump Participants differed significantly on most (13 of 17) items about what they learned, with nurses being more likely to learn various factors about the indwelling urethral catheter than the infusion pump Registered nurses were more likely to feel stressed when using an intravenous infusion pump than when using an indwelling urethral catheter, but were more likely to have used an indwelling urethral catheter that caused a patient harm than an intravenous infusion pump that caused a patient harm The most frequently identified reasons for incidents of patient harm resulting from use of an intravenous infusion pump were user error and inadequate device education The most frequently identified reasons for incidents of patient harm resulting from use of an indwelling urethral catheter were the patient's condition, particularly confusion, user error, equipment malfunction, and inadequate device education     

The use of medical equipment by Australian registered nurses

Summary

• ? Registered nurses in Australia are the primary users of medical equipment in the direct care of patients. The cross-sectional survey reported in this paper explores how and what registered nurses working in a large hospital in a South Australian city initially learn about the medical equipment they use in direct patient care, as well as the consequences of equipment use for both patients and staff.
• ? Equipment use had positive and negative aspects both for registered nurses and patients, the central issue of which was quality patient care. Inherent in this issue was knowledgeable and proficient device use, which, it is argued, hinges on equipment education.
• ? The two most frequently identified methods of initial learning were reading the user/instruction manual and consulting the policy and procedure manual. At least 90% of respondents indicated they initially learned how to operate equipment and its purpose and function.
• ? Medical equipment use caused nearly half the nurses to feel stressed, but only 9.4% had used medical equipment that had harmed a patient.

     

Promoting safe use of medical devices

Although patient safety initiatives in the clinical environment have focused primarily on medication errors to date, medical devices also contribute significantly to patient injuries and deaths. This article addresses the Food and Drug Administration's (FDA) efforts to promote safe use of medical devices by nurses at the point of care. The nurses with whom we have discussed the effects of medical devices, and also those surveyed by the medical device industry and professional nursing associations, are concerned about the profound effects, both desired and undesired, that medical devices have on patient outcomes. We believe that professional nurses, individually and through their professional associations, can help address these concerns by becoming aware of how to share their observations with the FDA and by working with their professional associations to develop position statements that focus on achieving safe and desired patient outcomes. In this article we will identify factors contributing to adverse events related to medical devices, address the need for more medical device adverse-event reporting, describe position statements that have already been made by some professional associations, and share insights regarding future directions along with ideas for educating staff to use medical devices safely.     

Designing devices to communicate effectively with intensive care nurses to prevent pressure injuries: A qualitative study

ObjectivesThe aim of this research was to identify “what” key design elements of a device for detecting hospital acquired pressure injuries should do and “how” these elements should function. The goal of the resulting design was to prompt intensive care unit nurses to intervene appropriately to reduce the incidence/severity of pressure injuries, while minimizing workflow disruptions.MethodsA mixed method study was performed in an intensive care unit, which included shadowing, interviewing, surveying and conducting focus groups with individuals knowledgeable about pressure injuries and related patient care. This study focused on identifying and prioritizing the needs/wants of nurses regarding devices aimed at detecting hospital acquired pressure injuries. These needs were then used as the foundation for designing key elements of such a device.FindingsIntensive care nurses indicated that a device for the early detection of pressure injuries should communicate information as real-time summaries about the severity of a skin issue in an easy-to-understand manner and provide reminders for them to take action when needed without unnecessarily interrupting their workflow.ConclusionThe findings regarding nurses’ needs will be useful for the future development of technologies/devices that help reduce the incidence/severity of hospital acquired pressure injuries. In turn, nurses may be more likely to use such a device to enhance patient care.     

End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment

OBJECTIVE: To describe the attitudes and practice of clinicians in providing sedation and analgesia to dying patients as life-sustaining treatment is withdrawn. STUDY DESIGN: Prospective case series of 53 consecutive patients who died after the withdrawal of life-sustaining treatment in the pediatric intensive care unit at three teaching hospitals in Boston. Data on the reasons why medications were given were obtained from a self-administered anonymous questionnaire completed by the critical care physician and nurse for each case. Data on what medications were given were obtained from a review of the medical record. RESULTS: Sedatives and/or analgesics were administered to 47 (89%) patients who died after the withdrawal of life-sustaining treatment. Patients who were comatose were less likely to receive these medications. Physicians and nurses cited treatment of pain, anxiety, and air hunger as the most common reasons, and hastening death as the least common reason, for administration of these medications. Hastening death was viewed as an "acceptable, unintended side effect" of terminal care by 91% of physician-nurse matched pairs. The mean dose of sedatives and analgesics administered nearly doubled as life-support was withdrawn, and the degree of escalation in dose did not correlate with clinician's views on hastening death. CONCLUSION: Clinicians frequently escalate the dose of sedatives or analgesics to dying patients as life-sustaining treatment is withdrawn, citing patient-centered reasons as their principle justification. Hastening death is seen as an unintended consequence of appropriate care. A large majority of physicians and nurses agreed with patient management and were satisfied with the care provided. Care of the dying patient after the forgoing of life-sustaining treatment remains underanalyzed and needs more rigorous examination by the critical care community.     

Registered nurses and unlicensed assistive personnel: an uneasy alliance

To meet challenges of continuing change in the health care industry and maintain organizational viability in increasingly competitive markets, the use of the registered nurse--unlicensed assistive personnel model is an undeniable reality that fills the void created by the current shortage of nurses and decreases the costs of providing patient care. Although much has been published about the need for nurses to delegate and supervise patient care-related activities, little has been written about the skills needed to do this effectively or how these skills may be learned. Academic and clinical educators must find ways to facilitate the development of delegation and supervision abilities as nurses increasingly work with nonprofessional staff. Continuing education is an effective way for nurses to learn the skills required by changing models of patient care delivery and evolving professional roles.     

A person centered nursing care intervention on a medical surgical unit

When a patient is admitted to a hospital, admission assessments are completed in the electronic medical record. There is minimal information about who the person is, what they liked to be called, favorite activity, and or past occupation to view. A communication board is visible to all caring for the patient. This pre-post design evaluated whether using “All About Me Board” (AAMB) could change workplace climate perception among 25 registered nurses (RN)s in a 28 bed medical surgical unit. RNs were asked to participate in a Person Centered Climate Questionnaire and were provided education about purpose and use of the AAMB, which were placed in each patient's room. Having the AAMB placed and visible in patient rooms provided healthcare providers personal information to assist in planning care with patients and family. Survey results were favorable in supporting a workplace environment where patients were empowered to participate in planning their care.     

GPS Devices in a Simulated Mass Casualty Event

Objective: The aim of this study was to assess the staff perception of a global positioning system (GPS) as a patient tracking tool at an emergency department (ED) receiving patients from a simulated mass casualty event. Methods: During a regional airport disaster drill a plane crash with 46 pediatric patients was simulated. Personnel from airport fire, municipal fire, law enforcement, emergency medical services, and emergency medicine departments were present. Twenty of the 46 patient actors required transport for medical evaluation, and we affixed GPS devices to 12 of these actors. At the hospital, ED staff including attending physicians, fellows and nurses working in the ED during the time of the drill accessed a map through an application that provided real-time geolocation of these devices. The primary outcome was staff reception of the GPS device as assessed via Likert scale survey after the event. The secondary outcomes were free text feedback from staff and event debriefing observations. Results: Queried registered nurses, attending physicians, and pediatric emergency medicine fellows perceived the GPS device as an advantage for patient care during a disaster. The GPS device allowed multiple-screen real-time tracking and improved situational awareness in cases with and without EMS radio communication prior to arrival at the hospital. Conclusion: ED staff reported that the use of GPS trackers in a disaster improved real-time tracking and could potentially improve patient management during a mass casualty event.     

The practices of expert psychiatric nurses: accompanying the patient to a calmer personal space

The focus of the care of potentially aggressive psychiatric patients has been on the use of seclusion and restraints. Recent concerns, however, about the potential for patient injury have made it imperative that nurses use alternative methods to calm patients who are escalating. Little is known about how expert nurses de-escalate the escalating patient. The purpose of this interpretive phenomenological study was to uncover and describe the knowledge embedded in the stories of psychiatric nurses who are skilled in the practices of de-escalating an escalating patient. Twenty registered nurses were interviewed using an unstructured format. The analysis of the data revealed that these nurses were skilled at noticing the patient, reading the situation and the patient, knowing where the patient was on the continuum, understanding the meaning of the behavior, knowing what the patient needed, connecting with the patient, and matching the intervention with the patient's needs.     

THE PRACTICES OF EXPERT PSYCHIATRIC NURSES: ACCOMPANYING THE PATIENT TO A CALMER PERSONAL SPACE

The focus of the care of potentially aggressive psychiatric patients has been on the use of seclusion and restraints. Recent concerns, however, about the potential for patient injury have made it imperative that nurses use alternative methods to calm patients who are escalating. Little is known about how expert nurses de-escalate the escalating patient. The purpose of this interpretive phenomenological study was to uncover and describe the knowledge embedded in the stories of psychiatric nurses who are skilled in the practices of de-escalating an escalating patient. Twenty registered nurses were interviewed using an unstructured format. The analysis of the data revealed that these nurses were skilled at noticing the patient, reading the situation and the patient, knowing where the patient was on the continuum, understanding the meaning of the behavior, knowing what the patient needed, connecting with the patient, and matching the intervention with the patient's needs.     

Problems with medical devices may be severely under-reported

The purposes of this study were to determine whether registered nurses are familiar with the Health Canada Medical Device Problem Report Form, and if so, how often they use it to report problems and concerns compared to how often they experience problems and concerns with medical devices. A survey was mailed to a random sample of 1,000 Ontario nurses to collect demographic information and to determine their familiarity with the aforementioned form, as well as the frequency with which they encounter problems/concerns with medical devices. Seventy-two and a half percent of the nurses reportedly have problems/concerns with medical devices at least yearly, yet 94.2% of them did not know that the Health Canada Medical Device Problem Report Form existed. Therefore, problems/concerns with medical devices encountered by registered nurses may be severely under-reported to Health Canada, contributing to an underestimate of the actual threat that devices pose to patient safety.     

Retired RNs: perceptions of volunteering

A qualitative study was done to explore the perceptions of volunteering among retired registered nurses (RNs) in Kansas. Participants were volunteers in formal nursing roles or were using their nursing knowledge and experience in non-nursing roles, such as church work. Regardless of the type of volunteer position, retired RNs reported that they use what they have learned as nurses when they volunteer. Volunteering benefits include enhanced self-worth, intellectual stimulation, reduced social isolation, and opportunities to help others. Increased paperwork, new technology, difficulty finding nursing-specific volunteer opportunities, resistance from health care organizations, and a lack of respect for what these nurses know are challenges and barriers to volunteering. Retired RNs have accumulated years of clinical nursing experience and can be helpful to employed nurses. Health care organizations should launch targeted efforts to recruit and utilize retired RN volunteers. Health care professionals who care for older adults should recommend volunteering as a healthful endeavor.     

Critical care nurses' attitude towards life-sustaining treatments in South East Iran

BACKGROUND: Life-sustaining treatments (LSTs) may prolong life but greatly decrease the quality of death. One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses. This study aimed to evaluate the attitude of critical care nurses towards life-sustaining treatments in South East Iran.METHODS: In this cross-sectional study, "Ethnicity and Attitudes towards Advance Care Directives Questionnaire" was used to investigate the attitude of 104 critical care nurses towards life-sustaining treatments in three hospitals affiliated to Kerman University of Medical Sciences.RESULTS:The findings of this study indicated that although a majority of critical care nurses (77%) did not have personal desire for use of LSTs including CPR and mechanical ventilation, they had moderately negative to neutral attitude towards general use of LSTs (2.95 of 5).CONCLUSIONS:These findings suggest that nurses' attitude towards LSTs can be changed by inclusion of specific courses about death, palliative care and life-sustaining treatments in undergraduate and postgraduate nursing curricula. Educating Muslim nurses about religious aspects of LSTs may also improve their attitudes.     

Use, misuse and non-use of health care assistants: understanding the work of health care assistants in a hospital setting

AIM(S): This study is concerned with understanding the work of non-registered nurses (health care assistants) in a UK hospital setting. BACKGROUND: There are increasing numbers of health care assistants employed by the National Health Service in the UK to support registered nurses providing nursing care. However, little is known about the make-up of the health care assistant workforce and the changing nature of their role. This study addresses some of these gaps in the research-based literature. METHODS: A single case study design using mixed methods (survey, interviews, participant observations, focus groups and documents) was used to generate an in-depth account of health care assistants' work in one organization. The study is built upon what health care assistants say they do, compared with what they actually do in practice. It explores how and whether the work of health care assistants is adequately supervised, tensions between the work of health care assistants and registered nurses and the subsequent effects on teamwork and patient care. FINDINGS: There are policy expectations associated with the work of health care assistants. However, this study reveals significant deviations from these goals. The workplace arena and the negotiations between health care assistants and registered nurses that take place within it, actively shape the health care assistants' work. Findings suggest dynamic patterns of use, misuse and non-use of the health care assistants as a resource to patient care. DISCUSSION AND IMPLICATIONS FOR PRACTICE: The changing roles of registered nurses have direct implications for the roles of health care assistants: as registered nurses take on extra duties and responsibilities they are conceding some of their role to health care assistants. This has implications for nurse managers. The competence of health care assistants to carry out nursing work needs to be reassessed and there also needs to be ongoing monitoring and supervision of their work to maximize, and further develop, their contribution to patient care and to ensure quality standards. Managers also need to be aware of the importance of workplace negotiations in the interpretation of formal policies and the subsequent shaping of health care assistants' work at the level of service delivery.     

Life with a left ventricular assist device: the patient's perspective.

BACKGROUND: Understanding the psychological experience of living with a life-sustaining device is necessary for developing individualized, supportive interventions for patients with a left ventricular assist device. OBJECTIVES: To describe patients' experiences with left ventricular assist devices, strategies for coping with prolonged hospitalization, and suggestions for individualized nursing interventions. METHODS: The phenomenology method of qualitative research was used. Data collection involved unstructured, open-ended interviews of 6 hospitalized subjects who had a pneumatic left ventricular assist device. RESULTS: Patients described coping strategies for prolonged hospitalization, including family support, religious convictions, and diversional activities. Data analysis suggests that critical care nurses can best support these patients by establishing trusting relationships, fostering independence, and incorporating humor into their care. CONCLUSIONS: Patients awaiting cardiac transplantation coped effectively with prolonged hospitalization with a life-sustaining device in place. Spirituality, humor, and strong family relationships contributed to their positive outlook.     

The Experience of New Graduate Registered Nurses as Managers of Pain

BackgroundBeginning their post-licensure clinical practice can be a challenging time for new registered nurses. Pain management is considered an essential responsibility for nurses, requiring pain management that is prompt, safe and effective. Research is needed to examine the experiences of new registered nurses as they adjust to their new role using what they have already learned about pain and pain management.PurposeTo examine the lived experiences of new registered nurses, who have been in the role less than a year, as they transition into their registered nurse role as a manager of pain utilizing what they have learned about pain and pain management in the undergraduate program and/or continuing professional development.DesignThis research was a phenomenological study in which interviews were audio-recorded and transcribed verbatim.Participants/SettingEight new graduate registered nurses employed less than a year at a 415-bed regional hospital were interviewed.MethodsContent analysis guidelines were used for the analyses of texts.ResultsThemes of navigating relationships, the practice of pain management and disconnect between school and real life were developed from the analyses of texts.ConclusionsKnowledge generated from this study can be used to better understand the experience of new graduate registered nurses regarding pain management and enhance pain management curricula in undergraduate nursing education and continuing professional development.