|
RNews CAPSULES
“The Methodist Hospital has long been known for its high standards of practice; however, there has never been a consistent set of standards in regards to nursing rounding established hospital-wide. Each unit has put their own rounding ideals into play,” said Kimberly Goode, senior customer research analyst at TMH. The hourly rounding was prompted by the largest, nationwide study ever conducted on call lights. The study, conducted by the Studer Group’s Alliance for Healthcare Research, was initiated to see what impact rounding hourly instead of rounding in a random practice would have on patient satisfaction and nurses’ daily operations. After just two weeks, hourly rounding cut down on call lights by 38 percent and resulted in the unintended improvement of clinical outcomes, reducing patient falls by 50 percent, for example. Mary Shepherd, RN, TMH Nursing Project and Magnet Program Director, said it is a common sense approach to patient care, but it is not always common practice. “Too many times we take for granted that the patient knows what we are doing when we enter their room. But these are non-clinical people who have no idea why we are asking them their name and birth date 30 times a day,” she said. “One concept of the hourly rounding program is to take the time to verbalize everything that we are doing, letting them know it is for their safety, for their benefit.” Hourly rounding involves practicing certain key behaviors with each patient every hour. They include explaining the hourly rounding schedule and tasks, scheduling key tasks to take place during the rounding, addressing the three most common reasons for call lights—pain, position, and bathroom needs, assessing additional comfort and environmental needs, letting the patient know when to expect the next visit and documenting the rounding activity. The Studer Group study found that by rounding hourly, nurses actually spent less time ping-ponging from room to room and the number of steps recorded on pedometers was cut down by 20 percent. At Methodist, the hourly rounding program will be phased in hospital-wide over the next few months. Survey find most critical-care RNs committed to their
work despite challenges
While most CCRNs are satisfied with their profession, there are serious challenges in improving healthy work environments for the country’s nurses. In the past year, 64 percent of CCRNs reported experiencing verbal abuse, and 22 percent reported physical abuse. Almost one out of five had experienced sexual harassment in the past year. Almost all of the physical abuse came from patients, while verbal abuse came from a combination of patients, patients’ families or significant others, or physicians. “A healthy work environment is the most critical aspect of retaining and recruiting nurses,” said Wanda Johanson, RN, MN, CEO of AACN. “That is why our top priority is AACN’s Healthy Work Environment Initiative, an in-depth and continued effort to engage nurses, employers and the nursing profession to recognize the urgency and importance of working to improve the environments in which nurses work. With this information, we can work together to implement workplace solutions to help nurses provide the best care for patients.” Nursing home costs climb significantly in 2006 As the average life expectancy increases, due in part to medical advancements and improved health care, the demand for nursing home beds will likely intensify. According to the Bureau of Labor Statistics, a healthy couple in their mid-60s have a 50 percent chance that one spouse will live beyond his or her 91st birthday. Communication board eases frustration of intubated patients The study, published in the November issue of Applied Nursing Research, found that 69 percent of intubated patients surveyed said that a communication board would have helped them better express their needs to hospital health care workers. Mechanically ventilated patients are unable to express their feelings and needs through verbal communication because the endotracheal tubes running through their vocal cords make speech impossible, contributing to their frustration and anxiety. As a result, the caregiver is forced to interpret patients’ non-verbal communication, such as mouthing, gesticulating, nodding and writing, all of which can be difficult for a critically ill patient. The study gauged patients’ opinion of the Vidatak EZ Board, a light, flexible communication board devised by Lance Patak, the study’s lead researcher and a critical-care nurse at the UCLA Cardiothoracic Intensive Care Unit. The board is organized in such a way that the patient can easily inform the caregiver of all of his or her conceivable needs. For example, the patient can communicate thirst, cold, hunger, anger or pain; wanting to sit up or exercise; wanting a pillow or a blanket; needing someone to clean his or her mouth or face, or simply wanting to say “thank you.” All require no more effort on the patient’s part than marking a box next to the appropriate selection with an attached erasable marker. The EZ Board is available in 16 languages, among them Spanish, Chinese, Korean, Vietnamese and Tagalog. Non-English versions of the board contain English translations of foreign terms. The study’s co-authors, in addition to Patak, include Anna Gawlinski, Lynn Doering and Jill Berg of UCLA; Ng Irene Fung of Kaiser Permanente, Los Angeles, and Elizabeth A. Henneman of the University of Massachusetts, Amherst. A research from the Gamma Tau Chapter of the Honor Society of Nursing, Sigma Theta Tau International, funded the study. “Community as school” program helps students
learn in non-traditional ways “The nursing home offers unique features ideal for alternative education such as separation from mainstream school culture, exposure to occupational careers and opportunities for students to learn through active engagement with older adults,” said Nancy Watson, director, The Elaine C Hubbard Center for Nursing Research on Aging. “Since the program began with 12 students in 1998, more than 100 have participated and there is a waiting list. Many students have gone on to work in long-term health care.” The program brings students to the nursing home from 8 a.m. to 2:30 p.m. five days a week for the semester in a nursing-home classroom for studies where they earn up to 10 credits toward their high school diploma in English, health, economics, government, mathematics and physical education. At the same time, the students develop partnerships with residents and perform service projects. They interact with residents through friendly chats, structured activities such as bingo and line dancing and working together with nursing-home residents on assigned class projects. The program fosters relationships by giving residents an opportunity to reminisce about their own experiences, gained during the Great Depression or World War II, for example, which reinforces learning. Internships give students a chance to try out career choices in nursing and other service-related positions. Service projects let students work on improvements to the nursing home, like painting and decorating dining areas, that the residents help plan. The “Community as School” program results show that over 69 percent of the 100 participating students have graduated or are on-track to graduate, compared to 40 percent from similar programs that are not nursing-home based. These students miss 40 percent fewer school days and receive 33 percent fewer discipline referrals, compared to their pre-participation levels in a traditional school setting. RNL |
Regular
rounds reduce call lights