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Done well, ward rounds (WRs) promote effective, safe care and collaboration; but WR quality varies. An improvement-focused appreciative inquiry (AI) into a large intensive care unit’s WR practices identified a pivotal axis of collaboration between the most senior medical role (the consultant) and the bedside nurse (BSN). This paper examines that axis of interprofessional collaboration (IPC) to deepen understanding of its implications. Data included ethnographic observations, interviews, and co-constructed AI with groups of staff. Four key concepts emerged from cyclical interpretive analysis: “need,” “presence,” “ability” and “willingness.” BSNs and consultants needed the interprofessional WR to enable their work; WR effectiveness was affected by whether they were both present, then able and willing to participate in IPC. BSN presence was necessary for effective and efficient IPC between these key roles. Indirect contributions, based on prior exchanges with colleagues or through written notes, reduced the joint problem-solving through discussion and negotiation that characterizes IPC to less efficient asynchronous interprofessional coordination. Factors affecting “presence,” “ability” and “willingness” are discussed alongside potential mitigations and acknowledgment of asymmetric power. Appreciative examination of interprofessional WRs identified mechanisms supporting and undermining effective WR IPC and the centrality of consultants’ and BSNs’ collaboration.

The nursing shortage is no longer a crisis but an epidemic and it is being exacerbated by burnout and compassion fatigue. This burnout and compassion fatigue are stemming from a loss of resilience and inability to cope. The COVID-19 pandemic has further intensified these issues. A safe, efficient, and effective intervention is needed to help improve well-being and resiliency among healthcare workers. The purpose of this project was to implement a flash therapy technique pilot program to evaluate resiliency and well-being of healthcare professionals caring for patients with COVID-19. A pilot program consisting of two flash therapy sessions was implemented on a COVID-19 unit targeting Registered Nurses and Licensed Practical Nurses. The results of a well-being scale were measured pre and post intervention. Results show that flash therapy can improve well-being, which in turn has been shown to increase resiliency. Utilizing and/or hiring counselors/therapists to implement this type of therapy on each unit is a safe, efficient, and effective means to improving well-being while decreasing burnout and compassion fatigue.

Background Bundled consent, the practice of obtaining anticipatory consent for a predefined set of intensive care unit procedures, increases the rate of informed consent conversations and incorporation of patients’ wishes into medical decision-making without sacrificing patients’ or surrogates’ understanding. However, the adoption rate for this practice in academic and nonacademic centers in the United States is unknown. Objective To determine the national prevalence of use of bundled consent in adult intensive care units and opinions related to bundled consent. Methods A random sample of US hospitals with medical/surgical intensive care units was selected from the AHA [American Hospital Association] Guide. One intensive care unit provider (bedside nurse, nurse manager, or physician) from each hospital was asked to self-reportuse of per-procedure consent versus bundled consent, consent rate for intensive care unit procedures, and opinions about bundled consent. Results Of the 238 hospitals contacted, respondents from 100 (42%) completed the survey; 94% of respondents were nurses. The prevalence of bundled consent use was 15% (95% CI, 9%–24%). Respondents using per-procedure consent were more likely than those using bundled consent to self-report performing invasive procedures without consent. Users of bundled consent unanimously recommended the practice, and 49% of respondents using per-procedure consent reported interest in implementing bundled consent. Results Bundled consent use is uncommon in academic and nonacademic intensive care units, most likely because of conflicting evidence about the effect on patients and surrogate decision makers. Future work is needed to determine if patients, family members, and providers prefer bundled consent over per-procedure consent.

Management program on nursing staff leading role and compliance to follow safety measures is an important component help to protect nursing staff from work related risks. Goal of safety program is to keep staff nurses safe and lead them toward safety actions, so they can help them to gain knowledge, and skills to deliver safe and quality care. So, the aim of this study was to determine the effect of management program on nursing staff leading role and compliance to follow safety measures at intensive care units. Study was conducted at all ICUs of Tanta Emergency Hospital. The total number of study sample was (n=100) nursing staff working in ICUs at Tanta Emergency Hospital, including charge nurses (n=30) and bedside nurses (n=70). Twoo tools were used for the collection of data: (1) Nursing Staff Performance Scale and (2) Nursing Staff Knowledge Questionnaire. The results of this study revealed that minority (26.7%) of charge nurses showed satisfactory level of practice for leading role pre-program, improved to be majority (86.7%) post-program. Few (41.4%) bedside nurses had satisfactory level of total compliance to follow safety measures practice pre-program, improved to majority (88.6%) post-program. Nursing staff (48%) had poor level of total knowledge pre-program, but the majority (92%) showed good level of total knowledge post program. Conclusion: Nursing staff knowledge and practice on leading role and compliance to follow safety measures in ICUs at Tanta Emergency Hospital were low, change nurses leading role and bedside nurse's compliance practice improved after implementation of needed program. Therefore, the study recommended that conduct regular training programs, workshops and seminars for nursing staff to refresh their knowledge, skills and experiences related to leading role and safety measures.

BACKGROUND: Bedside rounding involving both nurses and physicians has numerous benefits for patients and staff. However, precise quantitative data on the current extent of physician–nurse (MD–RN) overlap at the patient bedside are lacking. OBJECTIVE: This study aimed to examine the frequency of nurse and physician overlap at the patient beside and what factors affect this frequency. DESIGN: This is a prospective, observational study of time-motion data generated from wearable radio frequency identification (RFID)-based locator technology. SETTING: Single-institution academic hospital. MEASUREMENTS: The length of physician rounds, frequency of rounds that include nurses simultaneously at the bedside, and length of MD–RN overlap were measured and analyzed by ward, day of week, and distance between patient room and nursing station. RESULTS: A total of 739 MD rounding events were captured over 90 consecutive days. Of these events, 267 took place in single-bed patient rooms. The frequency of MD–RN overlap was 30.0%, and there was no statistical difference between the three wards studied. Overall, the average length of all MD rounds was 7.31 ± 0.58 minutes, but rounding involving a bedside nurse lasted longer than rounds with MDs alone (9.56 vs 5.68 minutes, P < .05). There was no difference in either the length of rounds or the frequency of MD–RN overlap between weekdays and weekends. Finally, patient rooms located farther away from the nursing station had a lower likelihood of MD–RN overlap (Pearson’s r = –0.67, P < .05). CONCLUSION: RFID-based technology provides precise, automated, and high-throughput time-motion data to capture nurse and physician activity. At our institution, 30.0% of rounds involve a bedside nurse, highlighting a potential barrier to bedside interdisciplinary rounding.

Nurses are expected to participate in research and scholarly inquiry; despite ongoing attempts, the practice-research gap continues to be fraught with significant barriers. System strategies have not addressed concerns at the individual nurse level. Given the implications on quality and safety, focusing on identification of individual nurse strategies should be an important focus of attention for nursing leaders and researchers. This article seeks to describe barriers, potential solutions, and implications for nurse leaders.

Documentation at the bedside is still often initiated on paper before being entered in electronic charts, even after implementing electronic health records (EHRs). This 2-step process is time-consuming, a potential source of error, and hinders the use of real-time information. We developed the “Bedside mobility” smartphone application to facilitate bedside documentation in the EHR. Objective This study aims to evaluate the impact of our app in 2 wards of a teaching hospital with a pre-post design. Materials and methods The duration and location of all documentation activities were recorded using a time motion study. Results Using the app significantly decreased the duration of EHR documentation per hour of observation by 4.10 min (P = 0.003), while the time spent interacting with patient increased by 1.45 min although not significantly. Also, in the intervention period, the average duration of uninterrupted documentation episodes increased by 0.27 min (P = 0.16) and the uninterrupted interaction with patient increased by 8.50 min (P = 0.027). Discussion By reducing the fragmentation of documentation workflow, decreasing the overall EHR documentation time and allowing nurses to spend more time with their patients, app use led to potential higher quality of care and higher patient satisfaction and may help maintain a smoother workflow. Conclusion Our mobile app has the potential to positively impact bedside nurses’ clinical workflow and documentation, as well as patient–provider communication and relationship.

Given the complexity of high-acuity health care, designing an effective clinical note template can be beneficial to both document patient care and clarify how telemedicine is used. We characterized documented interactions via a standardized note template between bedside intensive care unit (ICU) providers and teleintensivists in 2 Veterans Health Administration ICU telemedicine support centers. All ICUs linked to support centers and providing care from October 2012 through September 2014 were considered. Interactions were assessed based on initiation site, bedside initiator, contact type, and patient care change. Of 14 511 ICU admissions with teleintensivist access, teleintensivist interaction was documented in 21.6% (N = 3136). In particular, contacts were primarily initiated by bedside staff (74.4%), use increased over time, and of contacts resulting in changes in patient care, most were initiated by a bedside nurse (84.3%). Given this variation, future research necessitates inclusion of utilization in evaluation of Tele-ICU and patient outcomes.

The purpose of this project was to determine if bedside intensive care unit (ICU) nurse buy-in to the Family Hospital Elder Life Program (HELP) protocol was sufficient to make implementation feasible at one county hospital in West Texas. Surveys were anonymous with ballot box collection being available to the bedside ICU nurses for one week each. Questions were based on literature findings of expected outcomes, identified barriers and facilitators, Calgary Family Intervention Method framework domains, and the Centers for Disease Control and Prevention Framework for program evaluation. Outcome measures were taken from the stated aims of the project and evaluated from paired baseline and summative survey questions. Survey participation was approximately half of nurses employed in the studied ICU. Analysis of the surveys showed a positive perception of family presence decreasing patient delirium symptoms, and a positive perception of the Family HELP protocol. The results described a high perception of family members as partners in care and high intention to implement the Family HELP protocol, indicating strong support of a full implementation of the protocol. The high level of bedside nurse buy-in present in this study has large implications for successful implementation of the Family HELP protocol in the near future, with sustainability and continued use supported by potential inclusion of the task in the electronic health record charting.

Since 2010, health care organizations have rapidly adopted telemedicine as part of their health care delivery system to inpatients and outpatients. The application of telemedicine in the intensive care unit is often referred to as tele-ICU. In telemedicine, nurses, nurse practitioners, physicians, and other health care professionals provide patient monitoring and intervention from a remote location. Tele-ICU presence has demonstrated positive outcomes such as increased adherence to evidence-based care and improved perception of support at the bedside. Despite the successes, acceptance of tele-ICU varies. Known barriers to acceptance include perceptions of intrusiveness and invasion of privacy.

Objective: Diabetic management process requires nurses with expert knowledge and patient care skills. This study was carried out to identify nurses’ diabetic care approaches and their post graduate education needs in order to develop a “Basic Diabetes Patient Care Education Program” in a university hospital in Turkey. Methods: The descriptive study, using the survey technique, was carried out in a university hospital with 87 bedside nurses who were caring for diabetic patients. Investigators developed data collection tool consisting of closed ended questions and opportunities for open-ended responses. Results: Among the 87 nurses, 88.5% were staff nurses, and 11.5% were nurse managers. The mean age was 27.41 ± 4.82 and years of professional experience was 6.86 ± 4.23. The 41.4% of nurses stated that they were caring for 1-2 patients with diabetes per week and 72.4% of nurses stated that they had attended an educational session about diabetes after graduation. The 95.4% of nurses reported a need for a continuous education program for diabetes patient care. Medication regimen (69.0%) and special care applications such as wound care (54.0%) were the most needed educational requirements. There were no difference in educational needs based on basic education or years of professional experience (p>0.05). Conclusions: Nurses caring for patients with diabetes should be supported by orientation, in-service education and continuing education programs. Additionally, the placement of patient care courses for chronic diseases, like diabetes, into the core curriculum of nursing schools would be useful in responding to actual patient care and family needs. © 2015, Professional Medical Publications. All rights reserved.

Approximately a quarter of medication errors in the hospital occur at the administration phase, which is solely under the purview of the bedside nurse. The purpose of this study was to assess bedside nurses' perceived skills and attitudes about updated safety concepts and examine their impact on medication administration errors and adherence to safe medication administration practices. Findings support the premise that medication administration errors result from an interplay among system-, unit-, and nurse-level factors.

To determine the reliability of an objective measure of pain, agitation and sedation using the Neonatal Pain, Agitation and Sedation Scale (N-PASS) compared with nursing bedside assessment.Neonates admitted in neonatal intensive care unit over a 6-month period were eligible. Pain and sedation were assessed with N-PASS, and a subjective questionnaire was administered to the bedside nurse.A total of 218 neonates were eligible (median: gestational age 34.6 weeks, age at assessment 7 days). N-PASS pain score correlated significantly with both nurses' pain score (Spearman coefficient (r)=0.37; P0.001) and agitation score (r=0.56; P0.001). N-PASS sedation score correlated with nurses' sedation score (r=-0.39; P0.001). Adjusting for gestational age, day of life, intrauterine drug exposure and use of high frequency ventilation only slightly attenuated the correlations (r=0.36, 0.55 and -0.31, respectively).The N-PASS captures nursing assessment of pain, agitation and sedation in this broad population and provides a quantitative assessment of subjective descriptions that often drives patient therapy.

Background Bedside nurses comprise the largest personnel group in a hospital and are intimately familiar with a patient’s day to day clinical status. They can be an effective group to engage and empower to assist with hospital-wide Clostridium difficile infection (CDI) reduction efforts. The objective of this study was to evaluate the impact of a nursing driven intervention bundle on CDI rates at a 365-bed community hospital. Methods Daily nursing led CDI and invasive line assessment rounds were implemented in April 2017. Nurses were empowered through a pre-approved protocol to place symptomatic patients in isolation and order a test for C. difficile. Additionally, patient care rounds that included nursing leadership, the antibiotic stewardship program physician director, infection preventionist and bedside nurses were conducted three times weekly. During these rounds, all Foley catheters, central lines, and CDI cases were discussed and a root cause analysis was performed for healthcare-associated infections (HAIs). CDI standardized infection ratio (SIR) was the primary metric tracked to assess outcome and trends by quarter over a two year period were evaluated. Results CDI SIR rates for the two full quarter after program implementation (July to September 2017 and October to December 2017) declined by 27.8% and 51%, respectively when compared with matching quarters from 2016 (Figure 1). Overall calendar year 2016 rates were similar to 2017 rates, but this was due to a significant increase in CDI incidence in first quarter 2017. Conclusion A formalized program for CDI reduction that incorporated the bedside nurse, nursing leadership, infection prevention, and the ASP team was effective in reducing CDI rates as measured by SIRs for the two quarters after full program implementation when compared with 2016 baseline rates. Figure 1. SIRS comparison by quarter (2016–2017). Disclosures All authors: No reported disclosures.

Daily checklists are shown to improve outcomes and adherence to quality measures in ICU care however completion of them consistently throughout institutions varies. Patients’ loved ones are more present in the ICUs than in previous decades and can be a valuable resource for both information and use as a prompter for a daily checklist. In conjunction with the bedside nurse and health care providers, patients and their loved ones can add to the successful use of a daily ICU rounding checklist.

Rapid response systems (RRSs) are one of the first organisation-wide, patient-focused systems to be developed to prevent potentially avoidable deaths and serious adverse events such as cardiac arrests. RRSs identify seriously ill and at-risk patients and those whose condition is deteriorating, using abnormal vital signs and observations that trigger an urgent response by staff who are able to deal with any medical emergency. RRS teams also respond to staff concern--any bedside nurse or doctor who is concerned about his or her patient can seek assistance. RRSs require the support of the whole hospital. This includes resources, educational programs and agreed ways of evaluating RRS effectiveness. RRSs may reduce deaths by up to one-third and cardiac arrests by up to 50%.

The objective of this study was to describe the experience of caring for individuals at the end of life by five nurses working in curative care units. Semi-structured interviews were conducted to gain a better understanding of the meaning nurses give to this experience. The analysis of results, based on Giorgi’s phenomenological method (1997), highlighted a central meaning: it is a human experience fraught with paradoxes where the bedside nurse feels both privileged to be accompanying these individuals at the end of their lives and torn between the medical priority given to curative care and the lesser priority given to palliative care. This study offers relevant options for nurse managers wanting to improve these nurses’ work environment and the quality of care for individuals at the end of life.

Purpose. To test the sensitivity, specificity, and usefulness of the Dutch Fatigue Scale (DUFS), which is based on NANDAs defining characteristics of fatigue. Methods. A cross-sectional design was used among domiciliary patients (N = 213) with chronic heart failure (n = 138) and with breastfeeding postpartum women (n = 75). Findings. Calculations of the sensitivity and specificity of the DUFS, comparisons of the average DUFS sumscores between both nonfatigued and fatigued subjects, as well as between patients with chronic heart failure and postpartum women, and correlation coefficients performed with sociodemographic factors (age, gender, education) demonstrate acceptable psychometric properties. Conclusions. The DUFS is a reliable and valid measurement tool for the assessment of fatigue. Practice Implications. Accurate recognition of the existence and extent of fatigue must precede interventions. Easy to use, reliable tools for the bedside nurse are invaluable assets to practice. Search Terms: Fatigue, measurement of fatigue, psychometric testing

The tele–intensive care unit (tele-ICU) uses sophisticated telemedicine technology and a remote team of critical care experts, including nurses, to provide continuous monitoring, assessment, and interventional services to a large number of patients across multiple ICUs. This new practice environment offers experienced critical care nurses an opportunity for career and knowledge expansion while reducing some of the physical and emotional risks encountered at the bedside. The role of the tele-ICU is still evolving but focuses on 4 areas of responsibility: performing virtual rounds, managing patient alerts, providing ICU support, and coaching or providing teaching moments. The transition from the bedside into the tele-ICU role can be complex as tele-ICU nurses encounter ICU acceptance barriers and a lack of or a change in professional identity. A formal orientation program focused on competency is necessary for the successful transition from bedside nurse to tele-ICU nurse.

Approximately 7 million people in the United States each year experience traumatic brain injury, the leading cause of death from injury in this country. The initial traumatic event, often described as the primary injury, and the pathophysiologic sequelae, the secondary injury, are the themes of this article. Primary injuries to the extracranial and intracranial structures will be discussed, as well as the secondary injuries that occur minutes to days after the initial insult. It is critical that the bedside nurse clinician understand these concepts to anticipate potential complications and plan appropriate interventions with the multidisciplinary team. The goal of these interventions is to prevent the devastating effects of secondary injury.

Background We hypothesized that bedside nurses perceive significant variability in the pediatric intensivist thresholds for approaching a family about withdrawal/limitation of life-sustaining therapy. Methods All nurses working in four university-affiliated medical-surgical pediatric intensive care units staffed by 11, 7, 6, and 5 intensivists with 36, 18, 10, and 8 beds were sent three mailings of a survey asking questions about intensivist decisions for withdrawal/limitation of life-sustaining therapy. Responses were tabulated; chi-square compared results among centers; a p < 0.05 after Bonferroni correction was significant. Results The response rate was 205 of 415 (49%); 152 of 205 (74%) disagreed with the statement that each of the intensivists had the same threshold for approaching a family to suggest withdrawal/limitation of life-sustaining therapy, with no significant difference between centers. Also, 110 of 205 (54%) and 119 of 205 (58%) disagreed with the statement that each intensivist has the same threshold of the patient's chance for survival or projected quality of life when making a decision to withdraw/limit life-sustaining therapy with no significant difference between centers. The threshold to suggest withdraw/limit life-sustaining therapy based on chance of survival or projected quality of life differs between intensivists by at least 10% according to 113 of 184 (61%) and 121 of 184 (66%) nurses; the two larger centers had significantly higher difference among intensivists for projected quality of life. Fifty-five of 200 (27%) disagreed with the statement that they would have equal confidence in each intensivist accepting a recommendation for withdrawal/limitation of life-sustaining therapy for their own child, with no difference between centers. Conclusions Bedside pediatric intensive care unit nurses in this multicenter Canadian study perceive wide variability in intensivist thresholds for approaching a family to suggest withdrawal/limitation of life-sustaining therapy.

(1999) Can J Gastroenterol 13, 147. Fox M, Molesky M, Van Aerde JE . , et al. . Changing parenteral nutrition administration sets every 24 h versus every 48 h in newborn infants. . Mar; . : . –51 . [OpenUrl][1][PubMed][2][Web of Science][3] QUESTION: In newborn infants, does changing total parenteral nutrition fluid administration sets (TASs) every 48 hours, rather than every 24 hours, increase the rate of contamination of infusates (amino acid plus dextrose solution [AADS] or lipid emulsion)? Randomised (allocation not concealed), blinded (unclear), controlled trial. A neonatal intensive care unit in Edmonton, Alberta, Canada. 166 infants who received total parenteral nutrition during a 12 month period. Infusate samples from 148 infants (89%) (mean gestational age 32.8 wks, mean birth weight 2036 g, mean postnatal age 12.9 d) were included in the analysis. 53 infants were allocated to have their TAS changed every 24 hours. 113 infants were allocated to have their TAS changed every 48 hours. The TAS was changed by the bedside nurse assigned to the infant's care. For both groups, bags containing AADS were changed daily, whereas lipid emulsion bottles were changed with … [1]: {openurl}?query=rft.jtitle%253DCanadian%2Bjournal%2Bof%2Bgastroenterology%2B%253D%2BJournal%2Bcanadien%2Bde%2Bgastroenterologie%26rft.stitle%253DCan%2BJ%2BGastroenterol%26rft.aulast%253DFox%26rft.auinit1%253DM.%26rft.volume%253D13%26rft.issue%253D2%26rft.spage%253D147%26rft.epage%253D151%26rft.atitle%253DChanging%2Bparenteral%2Bnutrition%2Badministration%2Bsets%2Bevery%2B24%2Bh%2Bversus%2Bevery%2B48%2Bh%2Bin%2Bnewborn%2Binfants.%26rft_id%253Dinfo%253Apmid%252F10203434%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10203434&link_type=MED&atom=%2Febnurs%2F3%2F1%2F9.atom [3]: /lookup/external-ref?access_num=000079751400010&link_type=ISI

WHEN Florence Nightingale founded the school at St. Thomas's Hospital seventythree years ago, her ideal was to train executives to assume the responsibility of teaching health through the medium of the bedside nurse. For nearly three-quarters of a century, the trail blazed by her has been the one that we have developed into a common highway. For some time, however, changes have been coming about which seem to indicate that we may have hurried by quite a few points of vantage for new trails to even greater usefulness. We have been adventurers, geographically speaking; we have penetrated the far corners of the earth, most of us as transmitters of the same ideal. The pioneering period of purely technical nursing is over; the creative period of nursing is just beginning. Adventuring has turned to the intellectual field. On the achievement of a new type of pioneer, nursing is already being appraised. Whether it suits us temperamentally or not, we are all being forced to explore new fields.

T HE popular concept of the nurse has, in part, developed from the idealized picture of Florence Nightingale-the devoted, self-sacrificing, and generous person, who caters to the ill with no thought of herself. How far this concept is from reality is obvious at first glance. Nurses-like any other professional group-represent a cross section of humanity. Some nurses are personally ambitious; some are irritable, cross, or frustrated. A nurse may be interested in caring for just one sex or one age group; she may like caring for groups of patients, or prefer caring for just one patient. While one nurse wants to be in a position of authority and give orders-to organize and direct-another may look upon her career simply as a stepping stone to marriage. Other nurses are personally dedicated to their life's work, and happy in their role as helpers of the sick. The word nurse refers to a member of a profession-to an individual who has completed a certain course of training, and not to a kind of person. This fact is frequently forgotten not 'only by patients and doctors, but also by the nurses themselves. The traditional public concept of the nurse is the bedside nurse. Yet this concept is no more correct than the one that describes a doctor as a bearded gentleman sitting up all night in some lonely farm house watching over a sick child. Just as a doctor may be the head of a public health department, a research worker, or a Dr. Brill is chairman of the Department of Psychiatry, School of Medicine, University of California at Los Angeles.