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To help reduce potentially devastating outcomes from spinal complications and venous thromboembolism, it is essential for the bedside nurse to have a comprehensive understanding of risk factors and assessments. The orthopedic nurse carries a responsibility for accurately assessing, documenting, and mobilizing the team when abnormal changes occur. Nurses act as patient advocates. The bedside nurse must communicate with the physician. If a patient or family sues the health care team, after a careful screening of the case for merit, the legal process begins. A health care provider should never give in to the temptation to alter medical records.

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.

An extremely premature 9-day-old female infant in the NICU developed 2 circular lesions on her back. The lesions quickly progressed to a necrotic ulcer. ### Prenatal and Birth Histories ### Presentation At 9 days of age, the infant’s bedside nurse noted 2 small lesions on her lower back; one was 1 cm in diameter, and the other was slightly smaller. The lesions initially had a red raised border with a white center (Fig 1A), but over 24 hours, the centers of the lesions became black (Fig 1B). Figure 1. A. Initial appearance of circular cutaneous lesion on right flank of extremely premature infant. B. Right flank lesion that evolved to central necrosis over a 24-hour period. ### Vital Signs ### Physical Examination (10 days of age)

The intensive care unit (ICU) is a complex amalgam of physical and cognitive workflows of its various personnel. The ICU team is compiled of persons with widely varying scopes of practice, levels of experience, roles, and responsibilities. Basic categories of personnel include bedside nurse, charge nurse, resident, advanced practice provider, pharmacist, nutritionist, fellow, attending, and consultant. Together, team members must collaborate to learn about and stabilize the critically ill patient, diagnose clinical states, plan and execute treatment, and monitor illness and recovery. The disparate geography and workflow of each individual guarantees that communication between team members will be complex. Issues of collaboration, teamwork, communication, and workflow are therefore paramount.

As a nurse who cares for mesothelioma patients, diet and nutrition have been an important part of my daily care and assessment of my patient. Over the 12 years that I have worked as a nurse, I have watched and learned the types of nutrition that best facilitate healing in patients recovering from surgery, chemotherapy, and radiation. As a healthcare professional, I quickly learned that an individual’s diet and nutrition was not only the key to one’s overall health and well-being but how they would respond to their disease process. This chapter addresses the nutritional challenges mesothelioma patients are faced with while offering practical solutions based on my personal experience as a bedside nurse caring for surgical patients and as a nurse coordinator to mesothelioma patients going through all aspects of treatment.

Neurological concerns in the neonate presenting as abnormal electrical activity in the brain can be difficult to identify, yet may have profound lifelong sequelae. Traditional video EEG is the gold standard for diagnosis, but is usually outside the scope of most neonatal providers to interpret. The development of amplitude-integrated electroencephalography (aEEG) gives neonatal providers a unique bedside opportunity to trend and interpret real-time neurologic activity to better care for the infants in the NICU. However, the interpretation is only as reliable as the information the monitor provides. It is critical for the nursing staff to correctly place aEEG monitor leads, assess for proper function, and troubleshoot potential concerns. Based on published information plus my own experiences working with aEEG monitors as well as teaching its use to almost 200 staff nurses in two Level III/IV NICUs, I will present a concise, approachable guide covering lead placement, troubleshooting, and basic interpretation.

Hypoxic-ischemic encephalopathy (HIE) is a potentially devastating complication related to events in the prenatal and/or intrapartum period that lead to a depressed infant, or worse, a stillbirth. Prompt recognition of risk factors for HIE is required, followed by rapid delivery of the infant to ensure an optimal outcome. Clinical indicators can be applied to determine which infants are at risk of compromised long-term developmental outcomes and are helpful in guiding bedside care. Cooling is the standard of care when complications from HIE are expected, but it has not eliminated the sequelae in all cases. Novel adjuncts to cooling are being developed, with a common theme of neuroprotection. This article will focus on key aspects of clinical care that are important for the bedside nurse to recognize and understand, and will present information on the current standard of care, as well as provide insight into future directions that are currently under investigation.

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.

For the bedside nurse identifying at-risk neonates for development of early-onset sepsis is a challenge. The ambiguity of clinical presentation can easily be overlooked, resulting in delayed treatment of this vulnerable population. Adding to this dilemma is inconsistent implementation of screening criteria used by health providers to identify at-risk neonates, resulting in lost opportunities of early identification and treatment. This article discusses the current approach to and the nurse's role in early-onset sepsis.

Bedside nurses require excellent observational and assessment skills. Being knowledgeable about common diseases that often affect the population is essential; however, it is often more challenging to be informed about life-threatening conditions that rarely develop. Such is the case with mesenteric ischemia, a rare but complicated condition, which is difficult to diagnose, carries a degree of mortality of about 40%-70%, and is more common in people older than 50 years. Mesenteric ischemia requires that nurses be aware of the different etiologies and presentations of this uncommon disease to alert physicians of changes in a patient's condition and detect clues that may assist with an accurate and prompt diagnosis. Being educated about the diagnostic procedures, possible outcomes, and anticipated care and needs of patients affected by this medical complication is imperative to maintain the health status and well-being of these patients and their families.

Postoperative management of pediatric patients with non-ruptured appendicitis is highly variable and often includes an overnight stay in the hospital. We implemented a criteria-based postoperative protocol designed to eliminate postoperative antibiotics and facilitate timely discharge by utilizing the bedside nurse to evaluate for readiness for discharge.We collected data on all patients with non-ruptured appendicitis at our institution following protocol implementation (May 1, 2012 to April 30, 2013) and compared them to a control group.580 patients were treated for non-ruptured appendicitis (285 prior protocol, 295 new protocol). Following implementation of our protocol, there was an overall reduction in length of stay from 40.1 (SD 27.5) to 23.5 (SD 20.8)h, and total cost of care per patient also decreased from $5783 (SD $2501) to $4499 (SD $1983) (p0.001). There was no change in hospital readmission rate (1.1% prior protocol, 1.4% new protocol) or postoperative abscess rate (0.8% prior protocol, 0.3% new protocol).Our new protocol reveals the value of eliminating postoperative antibiotics and leveraging the continuous availability of the bedside nurse in the determination of readiness for discharge.

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.

We have been doing bedside nurse handovers for years (news online, 2 May) and it's absolutely what everyone should be doing. How anyone can hand a patient over to the next shift without actually being in front of them is beyond me.

The overall rate of serious morbidity from the laparoscopic sleeve gastrectomy (LSG) is 3.8 %, and 30-day mortality rate is 0.1 % [1]. Complications unique to LSG include staple line leaks and stricture or obstruction of the gastric lumen. The bedside nurse must also be vigilant for complications that can present in all surgical patients including bleeding, DVT/PE, and infectious processes.

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.

Developmentally appropriate positioning is a core component of the Universe of Developmental Care Model, which was created to optimize neurodevelopmental outcomes of preterm infants (Adv Neonatal Care 2008;8(3):141-147). Neurodevelopmental positioning has been shown to have a direct effect on bone and joint development (Eur J Paediatr Neurol 2004;8:321-343; Phys Ther 2009;89(12):1354-1362; Phys Ther 1984;64:1874-1882) promote self-regulation/sleep (Early Hum Dev 2007;83:433-442; J Adv Nurs 2009;65(10):2239-2248) and to reduce pain responses (J Adv Nurs 2009;65(10):2239-2248; J Perinatol 2007;27(suppl):S48-S74) in preterm infants. The Infant Positioning Assessment Tool (Koninklijke, Philips Electronics, NV) was developed to standardize best positioning practice in neonatal intensive care unit (Newborn and Infant Nursing Reviews 2010;10(2):104-106). Failure to properly support the premature musculoskeletal system has been shown to have long-term deleterious effects on sensory and motor development.(J Perinatol 2007;27:S20-S28). Nurses at a level IIIB midwest neonatal intensive care unit had experienced various training opportunities aimed at improved positioning consistency; however, foot/leg deformity, torticollis, and plagiocephaly persisted. The purpose of this article is to describe how using the Infant Positioning Assessment Tool paired with one-to-one bedside education can improve positioning consistency across shifts and experience.

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%.

Delirium and dementia are common problems in the acute care setting that make it a challenge for the bedside nurse to give the care needed to these patients.

Rapid advances in technology have led to the use of radiographic technology for therapeutic interventions. This article is an all-inclusive procedure guide for the imaging nurse as well as the bedside nurse caring for the patient before or after the procedure. Key aspects of the nurse's functions are educating the patients to gain their cooperation and improve their understanding of the procedure and post-procedure expectations, physiologic monitoring, and administering sedation and analgesia. Ultrasonographic guided compression repair is a safe, cost-effective first approach to treatment for many femoral artery pseudoaneurysms and does not affect possible surgical intervention if the ultrasonographic guided compression repair attempt fails.

Today’s critical care nurses are faced with numerous challenges related to the complexity of critical illness, the rapidity of changing technology, and the comprehension and application of scientific advances related to the treatment of critical illness. The past decade has provided the bedside nurse with an overwhelming body of literature regarding wound healing and the inflammatory/immune system response during critical illness. A myriad of risk factors, such as advanced age, oxygen and perfusion imbalances, diabetes mellitus, obesity, pharmacologic agents, malnutrition, infection, radiation, and immunocompetence may negatively affect wound healing in the critically ill patient. This article discusses the physiology of wound healing and risk factors that may impede wound healing in the critically ill patient.

This article, the first in the new DCCN department for acute-care nurse practitioners, clinical nurse specialists, and advanced practice nurses, focuses on the pharmacodynamics of propofol. The advanced practice nurse working in the ICU is likely to institute propofol protocols, teach staff about the drug, and collaborate with the bedside nurse on the patient's outcome to this treatment.

Increased understanding of the effects of ischemia on the myocardium has led to advances in the field of myocardial protection during cardiac surgery. These advances, combined with improved surgical techniques, have contributed to the success of cardiac surgery and the ability to revascularize high-risk populations. The most common technique used to protect the myocardium is cardioplegia administration. Although it is the surgeon's responsibility to decide on solution composition, temperature, and direction of delivery, it is the bedside nurse who monitors the patient after surgery. Armed with knowledge about the essential concepts of myocardial protection, the critical care nurse will be prepared to care adequately for the patient after cardiac surgery.

Serial, consistent, and well-documented neurological assessments are the most important aspect of nursing care for the pediatric neurosurgical patient. Subtle changes in the neurological assessment may first be noted by a bedside nurse. Keen observation skills and the ability to extract information about a patient’s baseline level of neurological function from the parents or primary caregivers are essential. The nurse’s response to assessment changes is essential to the prevention of secondary neurological sequelae and other complications associated with neurological disorders [11]. These potential complications include, among others, inability to protect the airway, immobility, endocrine disorders related to central hormonal dysregulation, impaired communication, and behavioral issues [20].

Percutaneously inserted central venous catheters (PICCs) have been used to provide central venous access for more than 25 years. Although these lines initially were placed by physicians, currently there are many adult, pediatric, and neonatal nurse-based PICC teams. This article describes the inception and growth of 1 team which, during the last 14 years, has placed more than 3400 catheters and trained more than 50 bedside nurses to insert PICCs. It highlights the development of the team, including details of how team members were selected and trained. Management of ongoing issues was handled by a self-directed nurse team organized into a committee structure composed of an oversight committee and education, guideline, qualifications, and quality improvement subcommittees. This team set and achieved the goals of training bedside nurses to place PICCs, providing consistent management of PICCs, and closely monitoring outcomes.

NURSExpert, a comprehensive expert system which integrates several specialized knowledge-based systems into a single tool for organizing patient care, is described. NURSExpert is composed of several highly specialized components that work together in the patient care activity. N-CAREPLAN BUILDER assists in the development of patient care plans. N-INSTRUCT is a computer-based learning system that extends nurse education to the bedside. N-INTERACTION assesses the possibility of interactions between various aspects of a patient's course of treatment (i.e. drug-drug, drug-IV, drug-lab, and drug-food). N-ACUITY assists in determining unit staffing requirements based on required patient care needs. NURSExpert is designed to be integrated into the computing environment of the typical hospital information system. In such a design, critical patient data including admissions, discharges, transfers, laboratory test results, and pharmacy orders can be made available to NURSExpert for use in its decision-making process. >

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.

There is a need for review and updates for all clinicians involved in the care of Percutaneous Coronary Intervention (PCI) patients because of rapid technological advances in PCI therapy. Traditionally, post PCI patients were monitored in critical care units however, with shortened hospital stays, budgetary restraints, and a lack of available beds, post PCI care has shifted to nurses within the community hospitals. Following evaluation of a learning needs assessment survey which was distributed to the community hospitals within the Champlain Local Health Integrated Network (LHIN), it was determined that there was a gap in the learning needs for nurses caring for patients with vascular related complications post femoral PCI. The objective of this education project, is to provide the necessary information to help nurses develop the critical thinking and clinical judgement necessary to monitor for potential vascular related complications. This information would be delivered in the form of a pocket size laminated algorithm card in accordance with Best Practice Guidelines for the care of PCI patients to prevent vascular related complications. The algorithm would provide the clincal staff nurse with guidelines, and an increased knowledge base around the potential vascular related complications associated with PCI, and what actions to take should they occur. This resource will facilitate knowledge transfer and improve the quality of patient care by standardizing practices among all clinical staff nurses within the Champlain LHIN, reducing vascular related complications and improving patient outcomes.

Nurses in an eighteen bed multi-disciplinary Paediatric Intensive Care Unit (PICU) have helped to develop a bedside computer system which automatically records the patient’s physiological variables such as heart rate, blood pressure, and respiratory rate from the bedside monitor on a minute to minute basis and graphically displays this information on a bedside microcomputer. The graphic display of this detailed information facilitates the astute observation of patterns and trends in the patient’s physiological status (Figure 1).

The nursing staff of a Coronary Care Unit (CCU) are not only concerned with the day to day data on individual patients, they also need to know longer term characteristics of the case group they care for- Both bedside and administrative staff want to know such things as the average age of the patients admitted to the unit, the average stay in the unit, the workload at any time, the mortality rate and much more. Such information is not only time-consuming and tedious to collect but the analyses of the results are normally only available at a much later date and are seldom easiliy accessible to the bedside nurse. In addition, using personnel without critical care training to collect and evaluate the data does not often improve the reliability of results. We now feel that we have found a solution to a number of these problems which puts a very powerful tool in the hands of bedside and administrative staff alike. Both can now obtain immediate answers to many of the questions about our unit which have previously too often remained unanswered due to lack of relevant information.