Research

Apply Now for STTI Psi Chapter-at-Large Research Grants

Grant applications are being accepted for the 2009 Psi Chapter-at-Large research grants, which are designed to encourage nurses to contribute to the advancement of nursing through research. Grants of up to $1500 will be awarded and are based on the quality of the proposed research, the future promise of the applicant, and the applicant's research budget. Applications from novice researchers who have received no other national research funds are encouraged and will receive preference for funding, other aspects being equal.

Applications are due December 15, 2008. For more information, download the grant application instructions (Word DOC file) and the application (Word RTF file). Return completed applications to:

STTI-Psi Chapter
c/o Monica Jarrett
Box 357266
University of Washington
Seattle WA, 98195-7266

Utilization of a Pathway-Based Reporting Tool for an Efficient Handoff Communication in a Telemetry Unit

C. Hayes; T. Santos; N. Lansberry
University of Washington; WA
Poster

Purpose: Under-utilization of the clinical pathway and inconsistent communication of patient needs during handoff prompted creation of a pathway-based reporting tool. Goals included improved communication between shifts of patient progress, increased nursing satisfaction and decreased length of stay.

Description: The written narrative handoff report among nurses in our telemetry unit was inadequate to communicate progress and barriers to discharge for cardiac surgery patients. A staff nurse and cardiac surgery nurse practitioner developed a two-part reporting tool in April 2006. The reporting tool was designed to reflect the continuum of the cardiac surgery clinical pathway. One page displays patient information such as date of surgery, pertinent medical history, discharge planning needs and barriers, and care norms for cardiac surgery patients. A second page organizes the standard assessments, nursing care, and expected progression of recovery per post-op day based on the clinical pathway. Since key assessments and outcomes specific to the postoperative day are marked systematically, the tool streamlines workflow at the beginning of the shift and facilitates handoff at the end of shift. It also has a column for shift-to-shift write-in entry by nurses. The reporting tool facilitates assessment of patient progress and development of the daily plan of care, including referrals to other disciplines. It also aids the float or novice nurse in understanding the postoperative plan of care.

Evaluation/Outcomes: An informal survey of new nurses, float nurses, and experienced nurses supported that the reporting tool improved communication of patients’ needs to other shifts, and increased knowledge of the expected clinical pathway, particularly for new nurses. Average LOS for uncomplicated cardiac surgery patients has improved.

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Leadership in Advanced Nursing Practice: Maximizing Health, Celebrating Collaboration and Promoting Innovation

Nancy E. Lansberry, member of Sigma Theta Tau Psi Chapter-at-Large, is the Nurse Care Coordinator with the Cardiology and Cardiac Surgery teams at the University of Washington Medical Center. Part of Nancy’s role is to help coordinate safe, effective and timely discharge of patients with a focus on patients who have special needs at the time of discharge. Nancy and her colleague Joycelyn Nelson will be presenting the displayed poster at a international conference in Toronto, Canada this September.

Poster

Purpose: As a 450 bed regional medical center, we are challenged with coordination of complex hospital discharges for high acuity patients. This abstract highlights an innovative Advanced Practice Nurse (APN) directed multidisciplinary process for holistic coordination of care.

Description: In summer 2007, APNs collaborated with Social Work administration and led the development of a hospital-wide service available for difficult discharge planning. This service draws upon expertise within Nursing, Social Work, Rehabilitation, Spiritual, Medicine, Pharmacy, Nutrition, Financial, Utilization Management, Ethics, Risk Management, Psychiatry, and Administration. These standing members are available to meet weekly to support primary care teams with discharge strategies for any inpatient encountering overwhelming obstacles. Open discussion produces creative solutions to advance patients toward a state of discharge readiness and formulates plans for disposition. APNs screen referrals, coordinate and lead meetings, support progress of the plan and evaluate the effectiveness of the planning process.

Summary: In six months, APNs coordinated 16 challenging cases. Common obstacles prompting referrals include prolonged hospitalization, inconsistent care goals, complex arrangements, legal or risk management issues affecting plan, and multiple readmissions. Collaboration has produced resourceful outcomes such as: patient-centered care plans, internal quality improvements, improved team communication and goal setting, and successful coordination of cross-country hospital-to-hospital transfers. APNs will conduct a six-month evaluation of participant’s perceptions of team success in communication, collaboration and coordination of patient care.

Conclusion: APN clinical expertise and knowledge of internal and external systems cultivates communication and problem solving for complicated hospitalized patients. APN directed practice collaboration transitions care to recovery.

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Evaluation of the Combat Medic Skills Validation Test

Eileen A. Hemman EdD, RNBC
CV (PDF file)

Purpose: Statistically it has been proven that getting care within the first hour of injury drastically increases a casualty’s chance of survival. Since 90% of all combat deaths occur on the battlefield away from any type of medical treatment facility, the first responders on the battlefield, the Army’s combat medics, determine the cost, in life or limb, to the American War fighters.

As the Army transformed itself into a lighter, faster, and leaner force, it was determined that a new kind of medic (91W) capable of deployment within 96 hours with high degree of competency in a broad array of emergency care skills was required. In June 2002, the Semi-Annual Combat Medical Skills Validation Test (SACMS-VT) became the policy for evaluating the beginning level competency of the Army’s new combat medic. No known formal psychometric testing was done prior to its implementation. Therefore, the purpose of this study was to determine the validity and reliability of the SACMS-VT.

Design: This study employed psychometric theory as a conceptual framework using a measurement testing design. Lynn’s content validity index (CVI) methodology was used to determine validity. Intra-rater, inter-rater, and test-retest methods were used to determine reliability.

Sample: All combat medics in Ft. Lewis units scheduled for deployment to Iraq within 6-12 months and meeting the study’s inclusion criteria were scheduled for testing. A total of 67 soldiers were scheduled, 13 were no-shows, and 1 declined to participate (n = 53). Eight subjects agreed to be re-tested. Subjects were primarily Caucasian males with an average age of 22 years, 1½ years of Army experience, E4s (83%) and below, assigned to the Cavalry Regiment (99%), and within 7 months since their initial EMT certification.

Method(s): a) Validity - A multidisciplinary panel of eight experts was recruited to rate the 19 skills on the SACMS-VT and their corresponding performance steps for relevance to beginning level combat medic competency. A 4-point Likert scale was used. If more than three experts disagreed on the items (< .75) it was deemed not valid. b) Reliability - Three high fidelity simulation-testing rooms, a centralized control center, and standardized problem-based scenarios were developed and used for subject testing. Sessions were taped for later review. All available subjects initially tested were contacted within 4-6 months for retesting. Three primary raters were used. Twenty-five inter-rater assessments and ten intra-rater assessments were completed.

Analysis & Findings: Validity - Performance skills with a CVI < .75 were needle chest decompression, combitube® insertion, and AED (automatic external defibrillator). The skill of splinting was recommended for addition to the SACMS-VT. Reliability – There was high intra and inter-rater agreement on performance steps and skills with the exception of Bleeding/Shock Management, spinal immobilization (supine), and extraction. The average medics’ score on the SACMS-VT was 68%. Subjects tested better on the medical skills than the trauma skills. When retested, there was significant improvement (t = 3.268, df = 7, p < .014, two tailed) in test results.

Conclusions/Recommendations: The results support the validity and reliability of the SACMS-VT as an instrument to determine beginning level combat medic competency. The skills with lower validity were related to the raters’ perception of medics’ ability and may change when test score are improved. High reliability may be related to the expertise of the raters in this study and may change when raters of varying skill levels are used. It is highly recommended that the critical item passing criteria be used for training only and that the critical item designation be used for training only. For testing purposes, critical items should be if the medic increases a casualty’s injuries during treatment or causes death through inaction or wrong action.

Implications: More research is needed to determine the combat medical readiness of 91Ws Army wide, as this subject population was characteristically novice medics with little experience.

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Factors Affecting Parents’ Ability to Visit Infants in the Neonatal Intensive Care Unit

Thongsouy Sitanon
University of Washington

Chair of the Supervisory Committee
Professor Susan T. Blackburn
Department of Family and Child Nursing

When infants are in the neonatal intensive care unit (NICU), parents may have difficulty visiting their infants due to internal or external factors especially when the infant is hospitalized for a long period. Understanding these factors may help decrease parental barriers and encourage parental visits in the NICU.

Purpose: The purpose of this study was to describe factors, which affect parents’ ability to visit their infants in a NICU.

Method: A cross sectional descriptive study was used. Forty-one biological parents, 30 mothers and 11 fathers of sick infants in the NICU participated in this study. Parents were 15 to 39 years old (Median = 30) and most of them (97.6 %) were married. Each parent was separately interviewed and audiotaped using the structured interview. Factors affecting parents’ ability, including internal and external factors, were described using descriptive statistics and qualitative analysis.

Findings: Almost all internal factors such as parental gender, age, financial considerations, health problems, and feeling had most effects on parents’ ability to visit. Marital status and other children at home did not have any effect, which may be because most parents were married and parents had other family members taking care of other children at home while visiting.

In terms of external factors, even though most infants did not have severe medical problems, parents tended toward visit infrequently when their infants had more medical problems. NICU appearance, health care personnel, and hospital policy also had a high effect on parental visits. Especially, the hospital policy encouraged parents to frequently visit because of recent changes that allowed parents to visit 24 hours a day.

Implications: Both internal and external factors affect parents’ ability to visit their infants in the NICU. Neonatal nurses can develop intervention strategies to support and enhance parental visitation after identifying what factors encourage or impede visitation.

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Attitudes Regarding Pain and Pain Management among Entry-Level Nursing Students

Ruth L. Schaffler, PhD, ARNP
Assistant Professor, School of Nursing
Pacific Lutheran University

Presented at the 17th International Nursing Research Congress Focusing on Evidence-Based Practice Advancing Knowledge, Community and Evidence-Based Practice Globally through Collaboration Montréal, Québec, Canada 19-22 July, 2006

Pain is a universal human experience and is a primary reason people seek health care; however, undertreatment of pain has been reported in the literature as a significant clinical problem for more than three decades. Researchers have concluded that nurses have inadequate knowledge of pain assessment, are misinformed about opioids, and have inappropriate attitudes about pain and pain management that lead to the undertreatment of pain. An underlying question was whether those misconceptions are acquired in nursing school or whether they are present when students enroll in nursing programs.

The purpose of this quasi-experimental study was to compare attitudes regarding pain and pain management among entry-level nursing students. Eighty-nine students were recruited from two baccalaureate nursing programs and divided into control and experimental groups. An educational intervention relating to pain was provided to the experimental group. Ajzen’s (1991) Theory of Planned Behavior (TPB) served as the theoretical framework to determine attitudes about pain and to predict whether nursing students would administer opioid analgesics to patients experiencing pain.

The survey instruments were the Pain Survey and the Pain Management Survey developed by Edwards et al. (2001). Descriptive and inferential statistics were used to analyze and compare pretest and posttest data. Results indicated that students have misconceptions about pain and the administration of opioid analgesics similar to the general population. Overall attitudes toward pain and pain management were fairly positive among both groups however, scores improved among the experimental group after the intervention. The TPB constructs accurately predicted nursing students’ intentions to administer opioid analgesia.

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Planning for Informatics Support of Nursing — What Five Years of Data Can Tell Us

Michael Beebe, RN, DNS, MSc and Randy Grekowicz, RPh, MBA

Popular and clinical literature has been chronicling the increasing movement of health care agencies to electronic means to capture information about the care given to patients. Since nurses generally represent the largest user group in any health care setting, attention should be given to supporting nurses as they move towards the electronic health record and electronic documentation of medication administration.

For the last eight years our agency has had a completely electronic health record for all in-patients and out-patients. For the last five years we have electronically documented all inpatient medication administration. During this time we have been collecting data relating to user assistance calls to our clinical support group.

In this study we will report on data collected from calls by all users to the clinical support team in a large VA medical center with more than 3,500 users, with approximately 20% nurses and student nurses. Over a five month period in 2005 we recorded 668 calls, with approximately 20% missing data. Nurses represented 33% of those calls.

We have found that the largest single source of help calls is difficulty with user sign-on to our various electronic systems. With so many different systems and because of patient data privacy requirements, users will have at least three different sets of log-on codes with some having even more codes.

This information, along with other results from this study, could assist nurse managers and planners in building support systems that facilitate nurses in their use of electronic documentation systems. Such information could prove valuable to agencies that are planning implementation of electronic health records. Our own anecdotal experience has taught us that providing adequate support before and during system implementation can go a long way towards achieving a successful implementation of electronic health record systems.

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