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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.

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.

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.

Background Institutional objectives for clinical ladder program (CLP) implementation often focus on improving job satisfaction, retention rates, and patient outcomes. Local inconsistency in CLP implementation seemed to be contributing to decreased job satisfaction and nurse retention rates. Purpose The aim of this study was to use current evidence and prevailing perceptions of bedside nurses and nurse managers to refine an existing CLP. Methods Pretest/posttest design was used to evaluate differences in perceptions of existing CLP (baseline) and perceptions 6 months after CLP refinements were initiated (post). Results Baseline perceptions of CLP implementation were significantly different for bedside nurses and managers. Bedside nurses were more dissatisfied than nurse managers. Perceptions became more similar across groups as initiatives were implemented to improve CLP understanding and as CLP implementation became more consistent across the organization. Conclusions Targeted strategies tailored to increase understanding and consistent CLP implementation can be effective in improving CLP satisfaction and increasing bedside nurse professional behaviors.

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.

Medical technology has rapidly decreased the time and cost required to sequence, visualize, and analyze an individual's genome since the Human Genome Project (HGP) ended in April of 2003. The resulting real-time implementation and expanded use of genetic testing in clinical practice, especially in the NICU, has often left ethicists playing catch-up and providing reactive guidance rather than proactive guidance, and nurses struggling to understand their role in resolving associated legal, ethical, and social concerns. This article provides proactive guidance concerning some of the common ethical issues that are manifest in the application of genomics in the NICU as well as practical resources for navigating these conversations with parents and families. Clinical scenarios illustrate key points of consideration for NICU nurses engaged with challenging issues related to genomics in the NICU.

Nurses with high self-efficacy are more engaged in interprofessional collaboration. The Bedside Nurse Leadership Development program, along with bedside nurses leading the interprofessional team during rounds, had a positive impact on several Task-Specific Self-Esteem Scale leadership questions over time.

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.

Lack of collaboration between care teams and patients/families has been associated with delayed discharge from the hospital. In this study, we determine whether patients' awareness of the estimated date of discharge (EDD) was associated with a decrease in delayed discharge, and determine the factors associated with a delayed discharge. A total of 221 patients admitted to the General Medicine service between July and September 2014 were included in the study. Estimated date of discharge was identified within 36 hours of admission. The bedside nurse communicated this EDD to the patient/family. Patients were interviewed to identify whether they were aware of their EDD. Bedside nurses were interviewed to identify barriers to discharge. In our study, 49.8% of the patients had a delayed discharge. Patients who were aware of their EDD were less likely to have a delayed discharge (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.1-0.6], p < .001). Patients who were discharged on Saturday or Sunday (OR, 4.8 [95% CI, 1.7-14.6], p < .001) and patients who were waiting for physicians' consult (OR, 4.5 [95% CI, 1.6-14.4], p = .007) were more likely to have a delayed discharge. Early identification of the EDD and communicating it with the care team and the patient/family, mobilizing resources for safe weekend discharges, and creating efficient process for consultations might decrease delayed discharges.

Today’s bedside nurse communicates with patients in an environment that incorporates a wide variety of technology, from simple instruments such as a penlight to complex devices including cellphones, interactive computers, and computerized intravenous pumps. This is an excellent time to examine communication between the nurse and patient in today’s fast-paced, technologically driven environment. Orlando’s theory of the dynamic nurse-patient relationship provides a theoretical framework for understanding that communication. The proposed model affords a visual demonstration to assist in teaching communication.

An ultrasound-guided peripheral intravenous (UGPIV) quality improvement project occurred in an 849-bed tertiary care hospital with a goal to reduce the use of central lines, in particular, peripherally inserted central catheters (PICCs). Since implementation, PICCs have decreased by 46.7% overall, and 59 nurses in-hospital are competent in placing UGPIVs. Placement of UGPIVs by the bedside nurse is a key initiative in decreasing PICC use and, potentially, infections.

Nurses on the front lines of palliative care are frequently presented with ethically challenging situations involving the use of palliative sedation and increasing opioids at the end of life. The doctrine of double effect is an ethical principle dating back to the 13th century that explains how the

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.

This poster aims to outline the strategies used to engage staff while running a complex research trial on the ward. Prior to the start of the study the needs of ward and research staff were assessed and a number of plans put in place. Training packages were designed and delivered. A poster was displayed showing the responsibilities of different teams. An information folder was created and kept on the ward with contact numbers, details about the research study and treatment plans. Once the study completed a de-brief was organised, all staff had the opportunity to feedback their experiences. From this feedback plans were put in place to prepare for the next patient. This included; assessing the impact of the trial on the patient and family and assessing if psychological support is required early on. Consider the amount of potential interventions on the patient and whether these can be grouped or limited. Creating a flow sheet that allows the bedside nurse the autonomy to make decisions and follow a plan. Ensuring staff have further training sessions at away days and induction to build on their knowledge. Displaying a research board in the staffroom with updates on the study. Ward staff to run sim sessions related to speciality patients. Nursing ratios of research patients to be agreed ahead of time to allow ward staff to allocate appropriately. Research and ward rotas to be shared so that nurses know ahead of time. Overall the strategies in place aid better communication between teams and ensure the patient journey is a positive one. Even though this was paramount at the start of the study the feedback demonstrated that more efforts between both teams were required. Various styles and methods of communication will be beneficial in engaging ward staff and realising the research hospital vision.

The potential for harm to patients related to initiation and maintenance of continuous dialysis therapy by the bedside nurse led to the development of a novel method to educate nurses new to the skill of continuous renal replacement therapy. [ J Contin Educ Nurs. 2019;50(2):59–60.]

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.

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.

Objective We hypothesized that nurses would benefit from the fellowship model traditionally used to engage physicians in clinical research. The Neuroscience Nursing Research Center (NNRC) fellowship program was created as a model for engaging nurses at all levels of clinical practice to become active in clinical research. Background The NNRC was established in 2013 as a novel approach to promote bedside nurses as primary investigators in clinical research. Methods The NNRC developed 4 pathways to nursing research success: research fellowship, student-nurse internship, didactic training, and research consultation. Results Fellows have enrolled more than 900 participants in 14 studies. Nurses have presented more than 20 abstracts at 12 conferences and submitted 11 manuscripts for publication. The NNRC has provided research training to more than 150 nurses. Conclusions The NNRC program is successful in engaging nurses in research. It shows promise to continue to develop nursing research that is applicable to clinicians and thus improve patient care.

Although technology over the past several decades has enabled improved neuroimaging and advanced noninvasive and invasive neuromonitoring, the role of the bedside nurse conducing ongoing neurologic examination is still a foundational element of neuromonitoring. Ongoing neurologic monitoring by the bedside nurse in the neuroscience intensive care unit is variable and guided by little evidence or data. When neurologic monitoring through clinical examination is possible, data obtained from multimodal monitoring should be interpreted in the context of the neurologic examination. The bedside nurse plays a crucial role in conducting ongoing neurologic examinations.

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.

In my dissertation, I discuss the problematic of feedback in a leadership of medical non- doctor personnel and in directing its working performance. My aim was to comprehend and elucidate the process of feedback between superior and subordinate personnel, specifically between bedside nurses/assistive personnel and a charge nurse. As a secondary objective, I decided to investigate potential areas for improvement in leading management and to suggest possible advancements, which could contribute to more effective directing of work performance through the use of feedback. The dissertation is divided into two parts, theoretical and empirical. In the first theoretical part, I begin with defining the meaning of feedback. Following, I introduce topics that include: feedback in social communication, feedback in the process of directing work performance and work motivation. In the second empirical part, I present research conducted with the use of qualitative methodology, where the reader can view the discussed problematic from the perspective of subordinate (bedside nurses/assistive personnel) and superior (charge nurses) personnel. Key words: feedback, social communication, work performance, medical non-doctor personnel, bedside nurse, assistive personnel, healthcare, nursing, work motivation