Podium and poster presentations from RRH Nursing Research and Evidence-Based Practice Day.
Held on November, 3 2023 at the College of Health Careers.
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Restraint Free in 2023
Lindsey Alfred, Kalani Dancoe, Tawo Ewa, Xiomara Figueroa, Willow Finch, Yusnavys Alfonso Flores, Jessica Jones, Kerry Lefebvre, Beka Naylor, Alyssa Umbrino, Jarvis McGrath, and Elizabeth Duxbury
This EBP project evaluated if in hospitalized adult patients on Sands 800 does the use of a restraint management bundle decrease the use of restraints during the inpatient admission compared to current restraint practices. In the SICU, restraint usage is an initial response instead of last intervention. This culture of care concerns nurses and providers. It was hypothesized that decrease restraint usage and time in restraints will allow the patient to remain safer by evaluating usage of restraint alternatives, cost savings, patient mobility, and clinical staff understanding of appropriate restraint usage.
The SICU was educated on the least restrictive device, which in this project was soft mitts. In-services and poster included the restraint wheel that provided alternatives to restraints. The team prioritized peer support and chart review. Restrained patients were reported to leadership daily with a focus on restraint use greater than 72 hours. Twice-daily audits verified orders and nursing documentation then were reported at shift change.
The RGH results showed 636 orders for non-violent restraint orders across 17 units with 96.7 average restraint time in hours June 1, 2023 to June 11, 2023. SICU restraint use decreased since the implementation of restraint education and restraint alternative wheel. Prior to implementation, 38 total patients restrained in March decreased to 28 restrained in August 2023. From the results, the hypotheses was supported. An increased availability of alternatives and types of alternatives as well as education for staff members would continue the culture change.
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Pre-Visit Planning in Primary Care
Suzanne Allman, Melissa Tillman, Breanne Thielges, Melissa Diaz, John Frewing, Susan Bopp, and Ozlem Kadar
Pre-visit planning is the process of collecting and organizing data prior to a patient appointment. The pre-visit planning process requires a team member to call the patient a week before the appointment through the use of a questionnaire form. This helps identify incomplete tests, screenings, immunizations and referrals that are currently outstanding. The pre-visit process results in scheduling needed appointments and lab work as well as gathering necessary information from the patient to streamline their upcoming visit. The use of pre-visit planning may result in improved patient satisfaction and decreased physician time with each patient visit.
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Standardization Tools in RRH Triage: A Nursing Based Review
Makayla Boff, Julie Voelkl, Cynthia Garofono, Colin Dewyea, and Heather Farren
Long wait times to be seen in outpatient clinics has led to an increase of triage messages for nurses within RRH. Could standardizing nursing triage protocol improve efficiency of patients care while building confidence and satisfaction among nurses? If protocols and standardizations tools are implemented to nursing staff then collectively we should see triage messages being answered in a more timely fashion, providing quicker care to patients as nurses will become more confident in the care they provide due to more precise guidelines being set out for them to follow.
Within RRH ambulatory offices surveys were created and distributed among the nursing staff. These surveys were created to get the baseline confidence/satisfaction of nurses. Results varied among nursing staff, some more confident than others. In addition, encounters from these offices were selected at random over the past 30 days between patients, nursing and support staff. From the encounters chosen at random, it showed the ones that used standardized protocols, such as smart phrases, resulted in more precise answers which led to less overall encounters regarding the topic at hand.
It was partially supported by fewer routing messages seen back and forth. Implementation protocols and standardizations tools should allow for quicker triage response time by nurses and will help build confidence in their practice. Distributing the survey to other RRH offices system wide to obtain feedback while continuing to look at random encounters will yield more data. At this time there is a lack of literature available.
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Are Non-Slip Socks the Best Way to Prevent Falls?
Grace Buonaugurio, Gabriella Coraggioso, Yana Gerasimovich, Alysia Negron, and Zara Reilly
The purpose of this Evidence Based Research Project was to examine if the common fall prevention intervention of patients wearing non-slip socks while in the hospital the most beneficial way to prevent inpatient falls? It was hypothesized that in hospitalized adults over the age of 65 the use of non-slip socks compared to other footwear would not decrease the risk of falls. To test this hypothesis, a literature review was conducted, and articles related to the specific intervention of non-slip socks on the hospitalized older adult and its effect on falls were reviewed.
Previous studies have associated mobilization in foot conditions other than shoes (slippers, sandals, socks, bare-feet and other ‘non-ideal’ foot conditions) with increased risk of falling. The poorer relative performance of non-slip socks do not represent an adequate alternative to well-fitting rubber soled footwear. From the literature reviewed, the results were inconclusive as to whether the use of non-slip socks is the best way to prevent falls among hospitalized adults. Non-slip socks do not possess the properties of adequate footwear, such as shoes from home, required to prevent patients from falling.
Footwear from home should be considered as an alternative to the use of non-slip socks. The interprofessional healthcare team should continue to promote individualized safety measures to prevent falls.
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Re-Evaluating Mobilization Practices and Their Impact on HAPIs
Erin Christopher, Mary Prochaska, Luna Pierre, Lindsay Santucci, Kenny Van Ryn, and Francheska Santiago
Hospital acquired pressure injuries (HAPIs) contribute to longer length of stay, poor clinical outcomes and increased healthcare costs.
A literature review showed that the implementation of visual cues to identify patients who require assistance with mobility and positioning in addition to the implementation of scheduled turn teams could have a positive health impact for the patients at RGH and reduce HAPIs incidence. Research suggests that educating unlicensed staff to recognize patient Braden Scale scores and to provide daily care based on risk factors for skin breakdown may lead to improved clinical outcomes.
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Standardizing ICU Nursing Shift Notes
Carmine D'Angelo, Jarvis McGrath, and Rebecca Gooch
The purpose of this project was to see if the standardization of a nursing shift note increased the communication of important patient information between nursing and provider teams. The attending physician in the cardiothoracic intensive care unit (CTICU) stated critical patient information between shifts was missing in handoffs and inconsistent nursing notes. Providers cannot easily read all forms of nursing documentation for a summary of what is pertinent to patients. It was hypothesized a standardized note for handoff would increase the information providers could review before rounds and decrease the omission of critical data.
A review of the literature was done on handoff standards in critical care. Use of standardized handoff notes reported improved communication on patients’ overall plan, decreased adverse patient events and medical errors. CTICU providers and nurses gave input on critical pieces of handoff communication. A CNS was consulted on components to make the note usable in other ICUs. A template was developed in the electronic medical record for standardized handoff information. CTICU nurses were educated to use the template instead of unformatted progress notes.
Initial compliance of template use was high and early reports from the provider team included improved communication, receiving more information, and improved patient care. Nurses reported satisfaction with ease of use. A standardized note improved communication between providers and nurses with consistent handoff information. This feasibility study has future implications in expanding the use of this note to other ICUs to formally collect data on its functionality, and impact on communication and patient care.
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Postoperative Deep Vein Thrombosis Prevention
Jaidin DeGraw, Carrie Elliott, Cailey Jeffery, Melina Leone, and Amber Mallory
The prevention of deep vein thrombosis (DVT) remains a primary concern for providers. While prophylactic heparin has been routinely prescribed, other forms of prevention such as early ambulation and pneumatic compression are now being used. This project sought to identify which method of DVT prophylaxis is more effective in providing safe patient care and reducing hospital stay. Based on the literature that was reviewed, the use of dual prophylactic measures may be more beneficial than a single preventative measure. As always, more research is warranted.
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Post Anesthesia Care Unit Comprehensive Safety Quality Improvement Project on De-Escalation of Patients
Mary Gaukler Giannavola, Basil George Verghese, and Deborah Maier
Background: Violence within the healthcare setting has risen significantly, and have crossed into areas where staff are less prepared to manage and deescalate challenging patient encounters. This lack of knowledge and confidence has led to increased staff stress, burn out, and can potentiate poor patient outcome.
Methods: A pre/post-simulation quality improvement project was performed within a tertiary hospital Post-Anesthesia Care Unit in Upstate New York to evaluate the effect of simulation on feelings of confidence preparedness in patient de-escalation with PACU nurses and patient care technicians. The project evaluation included the Thackrey’s Clinician Confidence in Coping with Patient Aggression (CCPA) Instrument, De-Escalation Aggressive Behavior Scale (EDABS), and a project-specific simulation evaluation tool.
Results: There was a statistically significant difference in the mean scores for the CCPA data pre and post across all questions. There was no correlation between length of being a RN (p < .498), length of working in the PACU (p < .492), or having any de-escalation training (p < .786), on the CCPA data. There was a statistically significant, moderate positive correlation between age and ability to protect yourself physically from an aggressive patient, r(98) = .592, p < .026. There was no other correlation with age and other CCPA questions.
Conclusion: Simulations can be successfully used to train, develop and improve staff confidence in patient de-escalation.
Implications: By implementing and combining de-escalation, on line training with high fidelity in situ simulation followed by a debrief, during orientation, should improve the level of confidence in the PACU prior to an escalated incident.
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Fateful Attraction: How to Create a Poster That Will Attract an Audience
Tami A. Hartzell
Creating a poster that will appeal to and engage the viewer takes practice and a basic knowledge of design and human nature. But first, you need to submit an abstract that will pass muster with the conference planning committee. This presentation will share techniques and guidance that have been identified both in the literature and personal experience as best practice for abstract submission and poster development. Join us and discover for yourself why less is more.
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Evidence-Based Practice Liaisons: Supporting EBP Across the Health System
Tami Hartzell and Susan Stell
The Evidence-Based Liaison Council was formed to sustain evidence-based practice (EBP) at Rochester Regional Health and to support an EBP culture using the Advancing Research and Clinical Practice through Close Collaboration Model (ARCC) (Melnyk & Fineout-Overholt, 2005). Committee members include nursing representatives from a variety of clinical settings and hospitals as well as interdisciplinary team members committed to using and bringing evidence-based practice to the bedside.
This poster highlights how EBP facilitates value-added care, improves clinician satisfaction, and enhances the patient experience. Sharing our accomplishments demonstrates the ways in which the Council has contributed to increasing nurses’ knowledge and use of evidence-based practice at Rochester Regional Health.
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Retention Among New Graduate RNs With and Without Transition to Practice Nurse Residency Programs
Grace Newman, Calie Ferraina, and Amanda Burling
Question: Does a structured nurse residency program affect the rate of retention among newly graduated RNs?
Hypothesis: A structured nurse residency program will impact the retention of new graduate RNs.
Methods: Articles reviewed for RN retention rates for nurses with and without nurse residency programs.
Results: Research supports that transition to practice (TTP) programs have been successful in new graduate RN retention rates. TTP programs help the new graduate develop skills to cope more effectively with their transition and lead to healthier, more balanced careers. Typical TTP programs were generally 12 months in length, had a dedicated program coordinator and a preceptor acting as a mentor. RNs participating in a nurse residency program provided by Vizient/AACN were shown to have a 90.4% retention rate when compared with the national average of 82.5%. Components of residency programs included leadership modeling, promoting well-being, resilience, and work-life balance. Tools used to support well-being included journaling, reflection, huddling, identifying a peer, finding joy in work, expressing gratitude and positivity.
Conclusion: Findings demonstrated an increase in resilience, highlighting the importance of providing a resiliency program for new graduate nurses. New graduate RNs staying beyond two years reported that a healthy work environment, a supportive workplace, and a sense of belonging all contributed to their decision to stay.
Implications: TTP programs are successful at increasing retention rates among new graduate RNs. Further work should focus on identifying the best TTP structure for use at Rochester Regional Health and promote a resiliency approach versus a theoretical task-layered approach.
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Virtual Distractions From Reality
Mary Grace Nichols, Meghan Guzda, Meghan Dougherty, Louise Toepper, and Bailey Hernandez
Patients in the pediatric emergency room are subject to many painful, stressful, and scary procedures which can lead to a frightened, nervous and uncooperative child. These same procedures can contribute to parental stress and lead to staff dissatisfaction as well. While the literature revealed a plethora of distraction techniques that are implemented in pediatric patients, our project explored studies that implemented virtual reality as a distraction technique across different ages and procedures.
Based on the evidence that was identified, a grant was recently obtained to implement virtual reality into our pediatric emergency department at Rochester General Hospital and we are now planning the implementation phase.
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Nurse Leadership Rounds with Lavender Aromatherapy and the Effect of Patient Satisfaction
Jessica Patnode and Maxine Fearrington
Question: The purpose of this study was to determine if offering patients a lavender-infused face cloth to daily nurse leader rounds would improve patient satisfaction scores by increasing the likeliness to recommend this facility score on our HCAHS survey.
Hypothesis: It was hypothesized that by adding lavender-infused face cloths to nurse leadership rounds would improve patient satisfaction scores.
Methods: This was a quasi-experimental study utilizing a convenience sample of hospitalized patients. Leader rounds took place in the afternoon and took approximately five minutes per patient. The control group received just leader rounding, and the intervention group also received a warm, moist lavender-infused face cloth at the conclusion of the rounds.
Results: The control group was substantially larger than the intervention group, they were not similar enough to detect a difference. Also, the satisfaction scores across the board were lower during the study period.
Conclusion: No detectable changes were found between groups.
Implications: The study should be repeated with a more attainable outcome goal. Also, more people will be needed to ensure adequate recruitment into the intervention group.
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Nurse Residency Program: Is this worth my time?
Gracie Puls, Sydney Wellspeak, Ashley Ernle, Cheryl McGee, and Sarah Glor
Question: The purpose of this evidence-based practice project was to determine in new graduate nurses, how does Nurse Residency Program versus traditional orientation effect confidence and competence in high risk/low volume procedures.
Hypothesis: It was hypothesized that Nurse Residency Program was superior to traditional orientation for improving confidence and competence in high risk/low volume procedures.
Methods: A literature review was conducted using CINAHL with key words “orientation”, “Nurse Residency Program”, “confidence”, “competence”, and “transition”.
Results: The results of the literature search identified two studies that utilized quantitative strategies and found statistically significant results favoring Nurse Residency Programs over orientation alone. Four studies used qualitative strategies identified several repeating themes, including enhanced learning, improved communication, competency, interprofessional relationships, and peer support/communication.
Conclusion: From the results obtained, it is concluded that the hypothesis was supported.
Implications: To further study this topic, data obtained from this cohort of Nurse Residency participants can be reviewed at the completion of the program.
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Nurse Led Mobility/Exercise Program
Elizabeth Schneider, Sarah Koopman, Marissa Sharp, Victoria Dempsey, Elizabeth Rudy, Melissa Combs, and Dena Chapman
Question: Can an individualized nurse led exercise/mobility program in hospitalized elderly, age 75 and older prevent functional decline, decrease LOS and prevent institutionalization to SNF?
Hypothesis: Current practice is one mobility champion for 3 or 4 inpatient medical surgical units to ambulate or mobilize patients in a 262/300 bed hospital (NWH/CSH). No formal exercise program is in place unless there is an order for PT. This current practice leaves elderly age 75 and older at risk for functional decline and adverse outcomes. It was hypothesized that a nurse driven mobility program in the patients care plan for mobile, non- mobile and bed bound patients can help maintain the patient’s pre admission level of function and decrease the incidence of functional decline that leads to increased LOS and /or discharge to SNF.
Methods: Patients age 75 or older included in the intervention group would receive mobility/exercised according to their level of function during hospitalization. Ambulatory Patients: Ambulation with/without assistive devices, with or without PCT or Nurse assist to occur twice a day. Increase distance as the patient tolerates. Sitting up in a chair or at the bedside unassisted for all meals (propping with pillows in a chair is allowed). Use of a bedside commode or bathroom for all bowel and bladder output (no bed pans). Non Ambulatory Patients: Use of the Stand Aid to do a series exercises with increasing repetitions and time as the patient tolerates. Use of the Stand Aid to do a series exercises with increasing repetitions and time as the patient tolerates. Standing in place. Sit to stands. Marching in place. Sitting in a chair at the side of the bed if no contraindications for all meals (propping is allowed if necessary). Assisted transfers to a bedside commode for all bowel and bladder output if not contraindicated (Use of stand aid or mechanical transfer aids allowed). Bed Bound/Unstable Patient: Knee bends. Leg lifts. Heel slides. Assisted sitting at the side of the bed or in a chair if not contraindication to increase trunk strength (propping is allowed if necessary).
Results: There have discussions to implement this intervention on a short term unit at CSH and to use retrospective chart review to compare LOS and transfer to SNF with patients age 75 or older. We have identified opportunities to expand the role and use of mobility champions. Opportunities to decrease the incidence of physical deconditioning and cognitive decline using individualized exercise programs in the patient’s treatment plan tailored to their needs have been identified as well.
Implications: Decreased incidence of adverse events during acute hospitalizations including morbidity and mortality may be avoided and maintaining preadmission level of function may decrease LOS, institutionalization, and transfer to SNF. Utilizing the 6 click mobility score may help in preventing functional decline. The literature suggests that acute hospitalizations are a major contributor to functional decline and disability in the elderly population. Functional decline occurs in the elderly at a rapid pace leading to adverse outcomes and increased length of stay that put them at greater risk for morbidity and mortality. This EBP was created to try and find a way to overcome functional decline and decrease overall risk to this age group during hospitalization.
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Eat Sleep Console for the Management of Neonatal Abstinence Syndrome
Michelle D. Slymon
Question: The purpose of the EBP project was to conduct a process and outcomes evaluation of the practice change to Eat Sleep Console (ESC) at a Baby-Friendly hospital.
Hypothesis: It was hypothesized that use of the ESC model of care to manage neonatal abstinence syndrome (NAS) would result in improved neonatal outcomes.
Methods: To test the hypothesis, an evaluation of ESC was conducted through a retrospective chart review and the Eat Sleep Console Nurse Questionnaire, which assessed the processes of care and nurses’ knowledge, attitudes, and perceptions of NAS. Neonates with NAS were compared pre-intervention (August 2019 to January 2021, n = 45) and post-intervention (February 2021 to July 2022; n =35). Average length of stay, NICU admission for NAS and total amount of morphine were compared between groups. The questionnaire was distributed to all permanent nurses on the postpartum unit and NICU in the fall 2022.
Results: Results showed improvement in neonatal outcomes pre- to post-intervention including a decreased need for NICU admission (44% vs 20%; p= .022) and number of morphine doses (12.33 vs 3.17; p=.045). Of the thirty-seven nurses who completed the full survey, approximately half (54%) agreed or strongly agreed they had enough knowledge about addiction to appropriately deal with mothers of infants with NAS.
Conclusion: From the results obtained, it is concluded that implementation of ESC results in positive neonatal outcomes.
Implications: To further study this topic, nurse-identified areas for improvement in NAS care practices require a plan of action for continued quality improvement.
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How to CRU: Submitting a Clinical Research Utilization Form
Susan Stell and Gwendolyn Williams
To increase nurses’ comfort level with applying research to nursing practice, the Clinical Research Utilization (CRU) Form was created. Most nurses in the Rochester Regional Health system are required to complete one CRU Form every year, and nurses who complete 2 are able to use their second CRU for the clinical ladder. This poster helps provides guidance for nurses who are submitting a CRU Form.
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The Big Picture: Use of Photography as Standard Documentation
Megan Tebo and Rhianon Lester
Photos of surgical wounds when included in documentation can assist the clinician in providing appropriate care and help engage the patient in their care. Incorporating photos into documentation provides a consistent timeline of wound changes and can help the clinician identify issues in a timely manner and may provide a method to involve the patient in their care. An additional benefit of wound photos is the prevention of potential legal issues as it demonstrates that the quality of care received is appropriate. If medical malpractice were to result, photos add to proper documentation.
When the decision is made to include wound photos in documentation, it is important to obtain informed consent prior to taking photos. Using facility owned equipment is recommended and policies will need to be developed.