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ABSTRACT: Surveillance is a nursing intervention that has been identified as an important strategy in preventing and identifying medical errors and adverse events. The definition of surveillance proposed by the Nursing Intervention Classification is the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making. The term surveillance is often used interchangeably with the term monitoring, yet surveillance differs significantly from monitoring both in purpose and scope. Monitoring is a key activity in the surveillance process, but monitoring alone is insufficient for conducting effective surveillance. Much of the attention in the bedside patient safety movement has been focused on efforts to implement processes that ultimately improve the surveillance process. These include checklists, interdisciplinary rounds, clinical information systems, and clinical decision support systems. To identify optimal surveillance patterns and to develop and test technologies that assist critical care nurses in performing effective surveillance, more research is needed, particularly with innovative approaches to describe and evaluate the best surveillance practices of bedside nurses.
Critical Care Nurse 04/2012; 32(2):e9-18. · 1.08 Impact Factor
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ABSTRACT: Medical errors are common in intensive care units. Nurses are uniquely positioned to identify, interrupt, and correct medical errors and to minimize preventable adverse outcomes. Nurses are increasingly recognized as playing a role in reducing medical errors, but only recently have their error-recovery strategies been described.
To describe error-recovery strategies used by critical care nurses.
Data were collected by audio taping focus groups with 20 nurses from 5 critical care units at 2 urban university medical centers and 2 community hospitals on the East and West coasts of the United States. Transcript content was analyzed as recommended by Krueger and Casey.
Analysis of focus group data revealed that nurses in critical care settings use 17 strategies to identify, interrupt, and correct errors. Nurses used 8 strategies to identify errors: knowing the patient, knowing the "players," knowing the plan of care, surveillance, knowing policy/procedure, double-checking, using systematic processes, and questioning. Nurses used 3 strategies to interrupt errors: offering assistance, clarifying, and verbally interrupting. Nurses used 6 strategies to correct errors: persevering, being physically present, reviewing or confirming the plan of care, offering options, referencing standards or experts, and involving another nurse or physician.
These results reflect the pivotal role that critical care nurses play in the recovery of medical errors and ensuring patient safety. Several error-recovery strategies identified in this study were also reported by emergency nurses, providing further empirical support for nurses' role in the recovery of medical errors as proposed in the Eindhoven model.
American Journal of Critical Care 11/2010; 19(6):500-9. · 1.66 Impact Factor
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ABSTRACT: This project determined the effects of developing and implementing a preoperative instructional digital video disc (DVD) on patients' level of knowledge, preparedness, and perceived ability to participate in postoperative care activities. Content areas that were incorporated into the preoperative instructional DVD included: pain management, surgical drainage, vital signs, incentive spirometry, cough and deep breathe, chest physiotherapy, anti-embolism stockings/sequential compression device, ambulation, diet/bowel activity/urine output, and discharge. A system was created to ensure that patients consistently received the preoperative instructional DVD prior to surgery. The instructional media product was found to be effective in increasing pre-operative knowledge and preparedness of patients and their families. Nurses reported higher levels of knowledge and engagement among patients and their families related to postoperative activities.
Nursing Clinics of North America 04/2009; 44(1):103-15, xii. · 0.52 Impact Factor
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Anna Gawlinski
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ABSTRACT: Sparked by the Institute of Medicine's report titled Crossing the Quality Chasm, research-based decision making has been emphasized for improving care. Patients should receive care that is based on the best available scientific knowledge, and care should not vary from clinician to clinician or from place to place. Implementing research-based practices at the bedside is a complex endeavor. It is all too easy to discover that clinically important research findings are either not known by practitioners or not being used in actual practice. Efforts to instill and sustain research-based practices improve significantly when staff nurses are involved with the research from the start. Institutions that are effective in involving clinicians have built a foundation of infrastructures that enable processes for engaging clinicians to take place. What distinguishes effective from ineffective hospital nursing research and evidence-based practice programs is the presence of structures whereby processes can occur that (1) unleash the creativity of staff by securing their involvement early, (2) educate staff by involving them, (3) create internal expertise for research and evidence-based practice, and (4) ensure that patients experience principled implementation of research-based practices to improve their lives. This article describes infrastructures that can ensure and sustain research-based practices while unleashing the talent and creativity of clinicians as they question practice and ponder the merits of current research. Fostering participation in such clinical inquiry will summon professional growth, influence the lives of patients, and help each nurse develop a unique personal professional legacy.
American Journal of Critical Care 08/2008; 17(4):315-26; quiz 327. · 1.66 Impact Factor
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ABSTRACT: The development of premature infants may be altered due to exposure to high cumulative doses of the perinatal corticosteroid dexamethasone during critical growth periods. To compare child behavioral development of prematurely born infants who were exposed to higher perinatal steroids (PNS; >0.2 mg/kg) with that of infants exposed to lower PNS (<or=0.2 mg/kg), we used the Vineland Adaptive Behavioral Scales to assess school-age behavioral outcomes of a historical cohort of 45 prematurely born infants. Children who had received higher PNS treatment were more likely to have lower overall behavioral developmental scores, especially lower social skills (p < .05). Higher PNS plus higher severity of illness during the first day of life based on the Clinical Risk Index for Babies (p = .016) and lower birth head size (p = .015) were linked with poorer behavioral outcomes among participants. Nursing practice includes promotion of quality care and should include closer evaluation of cumulative steroid therapy, severity of illness, and promotion of long-term follow-up support for premature infants.
Journal of pediatric nursing 06/2008; 23(3):201-14.
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ABSTRACT: Animal-assisted therapy improves physiological and psychosocial variables in healthy and hypertensive patients.
To determine whether a 12-minute hospital visit with a therapy dog improves hemodynamic measures, lowers neurohormone levels, and decreases state anxiety in patients with advanced heart failure.
A 3-group randomized repeated-measures experimental design was used in 76 adults. Longitudinal analysis was used to model differences among the 3 groups at 3 times. One group received a 12-minute visit from a volunteer with a therapy dog; another group, a 12-minute visit from a volunteer; and the control group, usual care. Data were collected at baseline, at 8 minutes, and at 16 minutes.
Compared with controls, the volunteer-dog group had significantly greater decreases in systolic pulmonary artery pressure during (-4.32 mm Hg, P = .03) and after (-5.78 mm Hg, P = .001) and in pulmonary capillary wedge pressure during (-2.74 mm Hg, P = .01) and after (-4.31 mm Hg, P = .001) the intervention. Compared with the volunteer-only group, the volunteer-dog group had significantly greater decreases in epinephrine levels during (-15.86 pg/mL, P = .04) and after (-17.54 pg/mL, P = .04) and in norepinephrine levels during (-232.36 pg/mL, P = .02) and after (-240.14 pg/mL, P = .02) the intervention. After the intervention, the volunteer-dog group had the greatest decrease from baseline in state anxiety sum score compared with the volunteer-only (-6.65 units, P =.002) and the control groups (-9.13 units, P < .001).
Animal-assisted therapy improves cardiopulmonary pressures, neurohormone levels, and anxiety in patients hospitalized with heart failure.
American Journal of Critical Care 11/2007; 16(6):575-85; quiz 586; discussion 587-8. · 1.66 Impact Factor
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ABSTRACT: Practical strategies for preventing medication errors in pediatric patients are needed. Medication safety can be improved by assessing current practices, developing evidence-based interventions to improve such practices, evaluating the impact of new evidence-based innovations, and providing feedback to clinicians [20]. Nurses at the point of care are well positioned to identify and implement structures and processes to address medication errors so that the most preventable errors become a thing of the past.
Critical Care Nursing Clinics of North America 01/2007; 18(4):515-21.
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ABSTRACT: Some patients receiving mechanical ventilation experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech. Although the use of a communication board to enhance communication with such patients has been suggested, few descriptive or empirical studies have addressed the content and format of these devices or of patients' perspectives on decreasing frustration with communication.
The objectives of this study were: (1) to identify the perceived level of frustration of patients receiving mechanical ventilation while they attempt to communicate; (2) to determine patients' perceived level of frustration if a communication board had been used; and (3) to describe patients' perceptions of the appropriate content and format of a communication board.
Twenty-nine critically ill patients who were extubated within the past 72 hours were included in this descriptive study. Subjects participated in a 20- to 60-minute audiotaped interview consisting of questions about their perceived level of frustration when communicating with and without a communication board and their thoughts about the appropriate content and format of a board. Transcripts were analyzed by questions for meaning and overall themes.
Sixty-two percent (n = 18) of patients reported a high level of frustration in communicating their needs while receiving mechanical ventilation. Patients judged that their perceived level of frustration in communicating their needs would have been significantly lower (P < .001) if a communication board had been offered (29.8%) than if not (75.8%). Most patients (69%; n = 20) perceived that a communication board would have been helpful, and they also identified specific characteristics and content for a communication board. A communication board may be an effective intervention for decreasing patients' frustration and facilitating communication.
Most patients receiving mechanical ventilation experienced a moderate to a high level of frustration when communicating their needs. In this study, a communication board, if used patiently during mechanical ventilation, has been shown to alleviate frustration with communication. Patients have specific ideas about what terms and ideograms are useful for a communication board. Further research is needed to test the effects of a communication board and other methods of facilitating communication on outcomes such as satisfaction and anxiety of patients, adequate and appropriate management of pain, and length of mechanical ventilation time and hospital stay.
Applied Nursing Research 12/2006; 19(4):182-90. · 1.22 Impact Factor
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The Nurse Practitioner 09/2006; 31(8):12-3.
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ABSTRACT: The purpose of this study was to gain insight into how nurses recover medical errors in the emergency department (ED) setting.
The research method was of exploratory descriptive design with qualitative analysis. Subjects who signed the informed consent participated in one of four focus groups centering on nurse's role in recovering errors. Questions were asked during the focus groups to elicit information regarding nurse's role in the three phases of error recovery, namely, identifying, interrupting, and correcting the error.
Five themes emerged to describe methods used by nurses to identify errors in the ED setting. These themes included: surveillance, anticipation, double checking, awareness of the "big picture," and experiential "knowing." Five themes emerged as methods used to interrupt errors: patient advocacy, offer of assistance, clarification, verbal interruption, and creation of delay. The themes for correcting an error were assembling the team and involving leadership.
The results of this study provide preliminary evidence of the strategies used by ED nurses in the recovery of medical error. Further research is needed to generalize these findings to other ED settings. Knowledge of effective recovery strategies can ultimately be used to develop interventions for reducing medical error and improving patient safety.
Applied Nursing Research 06/2006; 19(2):70-7. · 1.22 Impact Factor
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Critical Care Medicine 03/2006; 34(2):579-80; author reply 580. · 6.33 Impact Factor
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ABSTRACT: Despite the scientific evidence that secondary prevention medical therapies reduce mortality in patients with established atherosclerosis, these therapies continue to be underused in patients receiving conventional care. To address this issue, the University of California, Los Angeles, Cardiovascular Hospitalization Atherosclerosis Management Program was implemented in 1994. This hospital-based system focused on initiation of antiplatelet therapy, beta-blocker, angiotensin-converting enzyme inhibitor, and statin therapy (irrespective of baseline low-density lipoprotein cholesterol) in conjunction with diet and exercise counseling in patients hospitalized with coronary artery and other atherosclerotic vascular disease. Preprinted orders, critical pathways, discharge forms, physician and nursing education, pocket cards, patient educational material, and treatment utilization reports facilitated program implementation. Statin use at the time of discharge increased from 6% before initiation of the program to 86% after the Cardiovascular Hospitalization Atherosclerosis Management Program was implemented (P < 0.001). Improved use of aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors was also observed. Importantly, in-hospital initiation of cardiovascular protective therapies had a dramatic effect on long-term treatment rates and patient compliance. The improved use of cardiovascular protective therapies was associated with a significant reduction in clinical events the first year after discharge: the death and nonfatal myocardial infarction rate decreased from 14.8% to 6.4% (odds ratio, 0.43; 95% confidence interval, 0.27-0.59; P < 0.01). These improved treatment rates have been sustained over an 8-year period. Compared with conventional care, the Cardiovascular Hospitalization Atherosclerosis Management Program has been associated with a significant increase in treatment utilization of evidence-based medications, more patients achieving low-density lipoprotein cholesterol less than 100 mg/dL, and improved clinical outcomes in patients hospitalized for cardiovascular disease. Hospital-based atherosclerosis treatment systems are an important step to help eliminate the cardiovascular treatment gap and dramatically reduce the death and disability caused by atherosclerotic vascular disease.
Critical pathways in cardiology 06/2003; 2(2):61-70.
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Mina Attin,
Suzette Cardin,
Vivien Dee,
Lynn Doering,
Dieula Dunn,
Kathi Ellstrom,
Virginia Erickson,
Maria Etchepare, Anna Gawlinski,
Theresa Haley,
Elizabeth Henneman,
Maureen Keckeisen,
Marcia Malmet,
Lisa Olson
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ABSTRACT: Pulse oximetry is a frequently used, noninvasive monitoring tool for assessing arterial blood oxygenation. Physicians, registered nurses, and respiratory therapists are responsible for the accurate interpretation of pulse oximetry data as part of the evaluation and management of acutely and critically ill patients.
(1) To evaluate the extent of current knowledge about pulse oximetry and (2) to increase clinicians' knowledge of research-based practices related to the appropriate use of pulse oximetry and interpretation of its results.
A test/survey of 17 true-false questions based on the research-based practice protocol of the American Association of Critical-Care Nurses was developed to evaluate current knowledge of pulse oximetry. A convenience sample of medical, nursing, and respiratory therapy staff was invited to complete the test/survey before and several months after an educational program to improve staff members' knowledge of pulse oximetry. The program included educational forums, policy changes, competency checklists, and verification of inclusion of research-based principles in orientation programs.
A total of 442 staff members completed the test/survey given before the educational program: 331 nurses, 82 physicians, and 29 respiratory therapists. The overall mean percentage of correct answers was 66%. Differences between disciplines were significant: respiratory therapists scored slightly higher (76%) than did nurses (64%) and physicians (66%) (P = .01). The scores on the test/survey given after the educational program increased significantly, from 66% to 82% (P < .01).
This educational project improved staff members' knowledge of pulse oximetry monitoring.
American Journal of Critical Care 12/2002; 11(6):529-34. · 1.66 Impact Factor
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The American Journal of Nursing 06/2002; Suppl:4-7. · 1.12 Impact Factor
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The American Journal of Nursing 04/2002; 102:4-7. · 1.12 Impact Factor
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ABSTRACT: Using steps in the Iowa Model of Evidence-Based Practice, nursing staff developed and piloted a standardized shift report tool on one medical-surgical unit in a large tertiary care hospital. Pilot outcomes showed shift reports with decreased frequency of missed information, fewer delays in shift starting time, and less use of overtime.
Medsurg nursing: official journal of the Academy of Medical-Surgical Nurses 20(5):255-60, 268.
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ABSTRACT: This article describes a unique model of implementing unit-based research teams to provide staff nurses with knowledge, skills, and mentoring. The essential elements of designing and conducting a research study are emphasized in an effort to improve nursing practice and the quality of patient care. The research education and practicum are incorporated into team meetings. This unique model provides greater efficiency and effectiveness of resources and allows for more interactive education than occurs in traditional models. Unit-based nursing teams learn together to design research studies, test hypotheses, and answer clinically relevant research questions, using the scientific process.
AACN Advanced Critical Care 22(3):190-200.
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ABSTRACT: The literature supports nursing interventions to maximize communication in mechanically ventilated patients, yet limited research exists on patients' perceptions of the helpfulness of health care practitioner interventions to enhance communication. In addition, the level of frustration experienced by these patients has not been reported. Thus, further research is necessary to examine patients' perspectives of the helpfulness of health care practitioner interventions that enhance communication of the mechanically ventilated patient.
This study describes the level of frustration experienced by mechanically ventilated patients and ascertains the helpfulness of methods used by health care practitioners to meet the communication needs of the mechanically ventilated patient.
A total of 29 critically ill patients, extubated within the last 72 hours, were included in this descriptive study using qualitative and quantitative methods. Subjects participated in an average 30-minute audiotaped interview session consisting of questions pertinent to their perceived level of frustration in communicating and the interventions practitioners used to meet their communication needs. Transcripts were analyzed by question and for overall themes.
It was found that 62% of patients (n = 18) reported a high level of frustration in communicating their needs while being mechanically ventilated. There was no significant difference between the duration of intubation and the level of frustration (Spearman r =.109, P =.573) or between the diagnosis and the level of frustration (P =.932). Patients who received anxiolytics (n = 23, 79% of the sample) had a lower level of frustration (mean 3.26) than those who did not receive anxiolytics (n = 6, 21% of the sample, mean 4.33). This difference trended toward significance (P =.084). Patients cited health care practitioner behaviors, characteristics, and attributes that both facilitated communication (kind, informative, and physically present at the bedside) and impeded their ability to communicate (mechanical, inattentive, and "absent" from the bedside). Patients reported problems and stresses associated with communication difficulties that can be alleviated by the health care practitioner.
Mechanically ventilated patients experience a high level of frustration when communicating their needs, and health care providers have a significant impact on the mechanically ventilated patient's experience. Further research is needed to explore and measure methods of facilitating communication that increase patient satisfaction, reduce patient anxiety, and obtain optimal pain management.
Heart and Lung The Journal of Acute and Critical Care 33(5):308-20. · 1.32 Impact Factor
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ABSTRACT: Approximately 44,000 patients die each year as a result of medical errors. Nurses play an important role in ensuring patient safety and preventing adverse outcomes. As frontline providers of care, nurses are in key positions to intercept a medical error before it affects a patient. The Eindhoven model for investigating a "near-miss" situation has been used successfully in the chemical industry to elucidate the concept of human recovery, that is, the ability of operators to detect, localize, and correct system faults. In this article, we propose applying the Eindhoven model to the clinical setting, in which nurses play the role of operators by identifying, interrupting, and correcting medical errors. After describing the model, we present clinical scenarios to illustrate how it can be applied. More research is needed to explicate the nurse's role in managing medical errors. Interventions to decrease medical errors require insight into strategies that frontline clinicians can use to identify and mitigate potentially harmful incidents. The Eindhoven model can help researchers, administrators, and clinicians to conceptualize the role for nurses in developing such interventions.
Journal of Professional Nursing 20(3):196-201. · 0.89 Impact Factor
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Anna Gawlinski
AACN Advanced Critical Care 18(3):320-2.
