34^th Euro Nursing & Medicare Summit October 07-08, 2019 | Madrid, Spain

Venue: Rafael Hoteles forum Alcala

Biography:

Zenaida Carbon RN, BSN, CCRN is a Charge nurse of an extremely busy cardiovascular intensive care @ John Muir Medical Center Concord, California :over 300 open heart surgery/year; a robust transaortic valve (TAVR)  program; cardiac assist device (impella) ;IABP;CRRT therapies . Over 31 years of clinical nursing experience; 29 dedicated to critical care. She is a Mentor, trainer; ACLS/BLS instructor; Cardiac care course instructor; IABP trainer/instructor; administrative nursing supervisor. She is an Ambassador for American Association of Critical Care Nurses. She has worked as Director of Nursing at Windsor Rosewood.

Abstract:

Purpose:

To decrease the length of stay for patients who are extubated within 3 hours following cardiovascular surgery. To sustain above United States of America national benchmark extubation time. To improve early mobilization of patients after cardiovascular surgery.

Relevance/Significance:

Endotracheal intubation and mechanical ventilation are required treatment modalities during major surgical procedures, and are maintained in the early post-operative period until the patient is able to support his own respiration. While they are essential forms of treatment, they pose risk for iatrogenic complications and must be discontinued as soon as possible to prevent barotrauma, ventilator-associated respiratory infection, and discomfort. 

Early extubation following cardiovascular surgery has been a goal for almost two decades, although the time for extubation changed many times through the years.  In the 1990’s, mechanical ventilation was continued through the night and patients were extubated early on the morning of post-op day 1.  Soon after, the Society of Thoracic Surgeons encouraged clinicians to discard concerns about extubating patients in the middle of the night, and recommended a more aggressive goal of extubation within 12 hours.  More recently the extubation goal has been reduced to the current standard of 6 hours.

The Cardiovascular Surgery Performance Improvement Committee meets monthly to evaluate clinical practices and improve outcomes for patients undergoing cardiac surgery. The interprofessional group is comprised of surgeons, anesthesiologists, clinical nurses, nurse leaders, respiratory therapists (RT), case managers, cardiac educators and quality management nurses.  During informal discussions between a thoracic surgeon and the clinical nurse charge nurses in the Cardiovascular ICU (CVICU), they decided to focus their efforts on practice changes that would enable some patients to reach an even more aggressive goal: extubation within 3 hours post-surgery. 

Extubating early has tremendous benefits to our patients.John Muir Health CVICU has a routine of having the patient dangle at the bedside 3 hours after extubation as tolerated.

The following morning, all patients with no activity restrictions are out of bed in bedside chair starting at six am. The CVICU staff in collaboration of the lift team gets every one up in bedside chair for at least 1-2 hours as tolerated.

Activity is then tailored to get out of bed around meal times 3x per day even if patients are not eating as of yet.

Early mobility has the benefits of: facilitating chest drainage out into the chest tubes thereby decreasing the amount of time the chest tubes are left in the chest cavity, thereby decreasing the discomfort of the patient.

RN and assistance of physical therapists, patients are ambulated in the hallways using cardiac walker while still in the CVICU ; decreasing the overall length of stay.

Strategy and Implementation:

July, 2017 – Initial practice changes

• Education of staff - The unit Charge Nurses lead daily quality and safety “shift huddles” with the staff, and used these huddles to educate staff about the new goal, solicit input for alterations in practice that would assist with earlier extubation, and to share their experience when practice changes were tried.
• Feedback to anesthesiologist – The anesthesiologist’s phone numbers were distributed to the clinical nurses.  If the patient is unable to be extubated within 3 hours, the clinical nurse sends a text to the anesthesiologist to inform him/her of the reason for the inability to extubate.  In this way the anesthesiologist receives timely feedback about the patient’s ability to be extubated.
• Data tracking by clinical nurses – Nurses tracked information about each patient: name, medical record number, date of procedure, surgeon, anesthesiologist, nurse and respiratory therapist, and extubation time.  Space was provided for the clinical nurse to add comments about the reasons the patient could not meet the 3 hour extubation goal.
• Communication of anticipated extubation time to all staff – Upon arrival to the room, the patient’s nurse or the RT writes the anticipated extubation time on the patient’s white board.  This alerts all care providers to the target time, and encourages everyone on the team to work toward the same goal.

August, 2017 – Additional practice changes initiated

• Extubation kits stocked – Previously, when staff determined that a patient was ready for extubation, the RT would need to leave the room to collect three simple items: a chux, 10cc syringe for balloon deflation, and a nasal cannula.  In practice, extubation was often delayed because the RT who left the room was side-tracked and asked to perform another task elsewhere in the unit. The team remedied this by changing the room preparation process, and placing these items in the room when it was prepped to accept the patient from surgery.  This small change ensured that the items necessary for extubation were present when needed, allowing extubation to proceed without any delay.
• Medications – The group encouraged the use of intravenous Acetaminophen for management of pain. This drug is quite effective in relieving pain and is advantageous in this population because it does not cause the drowsiness or respiratory depression that is characteristic of an opiate.
• Acquisition of two cardiac walkers – To make walking a post op cardiac surgery patient and maintain sternotomy precautions; CVICU manager and director were asked to purchase cardiac walkers for the unit. Cardiac walkers are equipped with padded arms adjustable to patient’s’ height.

Evaluation/Outcomes:

The graph below demonstrates the success of this unit-level project that was initiated and led by the three charge nurses in the CVICU.The daily discussions they held during huddles provided opportunity for repetitive reinforcement of best practices and facilitated participation by all staff, which produced sustained and steady improvement. The early extubation project, with leadership by the charge nurses and participation by nursing, respiratory therapy and physicians represents an improved outcome associated with an interprofessional quality improvement activity, led (or co-led) by a clinical nurse.

As of December 2018, out of 245 patients were extubated below three hour target time. We are below the national benchmark of 6 hours.

Patients have an average of 4-5 days stay for their cardiac surgery instead of 7-10 days.

Implications for Practice:

These practice changes can be adopted by any critical care unit to increase the percentage of patients who can be extubated earlier, reducing patient discomfort and reducing the risk for complications associated with mechanical ventilation.
 

Patients are ambulating in the CVICU instead of waiting to get to step down increasing early mobilization of post cardiac surgery patients, decreasing the overall hospital stay from 7-10 days to 4-5days.

Biography:

Masoud Ghaffari joined the Benedictine University Department of Nursing and Health in August 2017 as a tenure-track, assistant professor. His academic journey began with studying Medical Technology (B.Sc), followed by Medicine (MD-FMG), Community Health Education/Promotion (M.Ed.) with focus on sexuality education and drug abuse prevention, BSN/MSN with focus on nursing administration, and PhD in Education with focus on learning and development. In addition to his medical and clinical background, he is an academically trained Nursing Administrator. He was trained and worked in diverse healthcare arena including acute care hospital, long-term and rehabilitative care, and assisted living. He designed, implemented, and evaluated health promotion programs related to sexuality education and drug abuse prevention for the college students.

Abstract:

Introduction: Effective health care in the 21^st century will require holistic leadership. Nursing as the nation’s largest healthcare professional group has a major role in the development and structuring of a more effective healthcare system. Creating and leading an intelligent organization needs intelligent leaders ↔ managers ↔ followers. Intelligent organizations are able to optimize their intellectual capital. Intellectual capital is not one’s finite asset but a collective infinite organization’s wisdom. Working environment in general, and health care organizations, in particular, are rapidly and nonlinearly changing. This requires a paradigm shift in the way we have explored the process of leadership. Considering leadership as a process and not a product, future nurse leaders need to be nurtured in a learning environment where innovation and creativity are encouraged, supported, and valued.

Purpose: The purposes of this study were to explore MSN Administrative track nursing students’ perceptions of: 1) an intelligent leader, and 2) an intelligent organization.

Design & Method: The University IRB granted permission to conduct the study. A purposive sample of nineteen students was selected to participate in this study (N=19; female n=18, and male n=1). Participants ranged in age from 28-48 years. All the participants were employed and performed at different levels of managerial and leadership positions. An interpretative description qualitative method was used.

Results: Eight themes emerged from this study. Drawn from the themes, “an Intelligent Model of Leadership and Organization” is developed. Two theories guided interpreting the data: Trinity Paradigm of Intelligence and Caring Theory.

Summary and Implications: the Intelligent Leadership Model (ILM) is a unique leadership style which capitalizes on its essence (interdependence), supports and strengthens strategic alliances, and promotes interdependence among healthcare team members, organizations, and systems. Transformational leadership (TL) is one of the most important components of Magnet award program. Magnet accreditation and transformational leadership make a difference for nurses and healthcare facilities in terms of improved patient and organizational outcomes, among other benefits. ILM provides a more holistic approach to achieve those goals and outcomes by starting from self-mastery and goes beyond TL style.

Biography:

Pasqua Spinelli received her PhD from Capella University and her undergraduate Nursing degrees from Adelphi University, Garden City, New York. She currently is the Family Psychiatric Mental Health Nurse Practitioner in an outpatient setting on Long Island, New York. She also is a Legal Nurse Consultant and Sexual Assault Nurse Examiner.

Abstract:

Statement of the Problem: The lack of access to psychiatric services in health care has been a constant challenge for decades, resulting in significant delays to treatment with consequences in reduced quality of care, low patient satisfaction, poor patient outcomes, reduction in the workforce and higher costs (National Council for Behavioural Health, 2017). According to a March, 2017 report from the National Council of Behavioural Health (NCBH), a national shortage of psychiatrists is about to spiral out of control, with 77% of U.S. counties reporting a severe psychiatrist shortage. Emergency departments have seen an increase of psychiatric patients in the last couple of years. This trend is related to the lack of access to mental health providers. Urgent care is defined as health care provided for the treatment of acute illness or injury that is not life threatening (Urgent Care Association of America [UCAOA], 2011). Methodology & Theoretical Orientation: In December 2017, a Psychiatric NP led urgent care office was implemented. After a year of collecting data from a retrospective chart review, 49 patients were seen from December 2017- December 2018 for urgent mental health issues. Findings & Conclusion & Significance: After a year of collecting data from a retrospective chart review, 49 patients were seen from December 2017- December 2018 for urgent mental health issues. Two patients required police intervention to be taken to hospital for inpatient admission due to an active suicidal plan. As part of a solution in alleviating overcrowded EDs for patients with life threatening needs, urgent care centres serve as a viable alternative (UCAOA, 2011). The Psychiatric Nurse Practitioner in an urgent care setting is educationally prepared to provide comprehensive psychiatric management to patients and most importantly effective in decreasing Emergency Room visits and in addition increases patient satisfaction and patient safety. Recommendations are made for adding urgent care centres to address psychiatric issues.

Biography:

Song Wang is a PhD candidate at West China School of Nursing in Sichuan University. Before his PhD candidate, he was a Nursing teacher at Bengbu Medical College, Anhui Province, PR China. His research focuses on chronic disease nursing and cancer care. He has published more than ten papers in reputed Chinese journals.

Abstract:

Telephone follow-up has been widely used to improve anticoagulant treatment compliance of patients with heart valve replacement in recent years, however, its effect remains unclear. The purpose of this study was to objectively evaluate the effect of telephone follow-up, in order to provide a theoretical reference for the extended care of discharged patients with heart valve replacement.

We searched the literature about randomized controlled trials(RCTs) and/or clinical controlled trials of evaluating the effect of telephone follow-up on anticoagulant treatment compliance in patients with heart valve replacement from PubMed, OVID, EBSCO, EMBASE, CINAHL, Cochrane Library, CNKI, and SinoMed. Two researchers independently extracted and assessed the relative data. Meta-analysis was performed using RevMan5.0 software.

A total of eleven articles were included. Our results showed that, compared with the control group, the intervention group had higher average scores in the aspects of medication adherence, regular review adherence, reasonable diet adherence, and self-monitoring adherence(P<0.05); and higher proportions of patients with good medication adherence, higher ratios of patients with regular review, higher percentages of patients with reasonable diet, and higher proportions of patients doing self-monitoring(P<0.05); and lower incidence of bleeding and embolism(P<0.05). 

Telephone follow-up may significantly enhance anticoagulant treatment compliance in patients with heart valve replacement and reduce the incidence of complications such as bleeding and embolism. Furthermore, telephone follow-up is convenient, economical and can result in good effects rapidly, therefore, it is worth popularizing and applying. However, as the available relevant researches are limited, more rigorously designed RCTs with large samples are required.

Biography:

Hamid Najmeh urrently works at the Department of Psychology, Shahid Chamran University of Ahvaz. Najmeh does research in Developmental Psychology, Health Psychology and Clinical Psychology. Their most recent publication is 'Effectiveness of Interpersonal Psychotherapy on Decreasing the Burnout of Women on the Verge of Divorce in Ahvaz.

Abstract:

Aims: Sexual satisfaction, love and interest are one of the most important factors for a desirable and satisfactory life. This research was conducted to study the efficacy of cognitive behavior therapy based on religious believes on life satisfaction and mutual interest in the women hypoactive sexual desire disorder.

Materials and methods: Among women hypoactive sexual desire disorder that referred to Retirees center in Ahvaz, 30 couples were chosen as the sample.

Findings: The results revealed that in the posttest with control of pretest, there was a significant difference between couples of experimental and control group in life satisfaction and mutual interest. In the follow-up, the difference between two groups was significant.

Conclusion: In general results showed that cognitive behavioral therapy based on religious believes have a positive effect on life satisfaction and mutual interest. These findings support the role of affective factors on the sexual performance of men and women and emphasis on considering these factors in the therapeutic protocols.

Keywords: cognitive behavior therapy based on religious believes, mutual interest, life satisfaction, hypoactive sexual desire disorder

Biography:

Gila Lavy is a nurse for the past 26 years. She has completed her B.A in nursing in 1992, M.A in Health System Mangement in 1996 and  Practitioner Diabetes Nurse from 2019. Gila Lavy is currently managing the diabetes (Pediatrics and adults) nursing staff in Assaf Harofeh Medical Center. In addition she is also a certified Medical Clown. Gila Lavy has a colomn in the  Israel diabetes Association newspaper, And  has been Organizing and lecturing  in many medical conference in Israel and worldwide.

Abstract:

Backround:
Diabetes has been declared by the WHO as a world epidemic. One of the most common complications of diabetes is diabetic foot, which can include infections, diabetic neuropathy, ulcers of the foot and osteomyelitis which may lead to amputation. It is estimated that a quarter of diabetic patients will develop diabetic ulcers during their lifetime, and that between six to eight of 1000 diabetics every year will experience an amputation of the foot or a part of it.  Complications of the diabetic foot can be prevented in approximately 85% of cases with proper training and care.  Unfortunately, even when the standard guidelines by the medical staff are provided, more than 65% of patients will  develop various complications of the diabetic foot.  Research on training strategies have proven that a method which appeals to the multisensory aspects of the individual, is more effective in the teaching and learning process of understanding, absorption and internalization of the material provided.

Project Objective:
The project objective is- building a creative and experiential training process and technique to teach the guidelines of maintaining healthy feet and preventing the diabetic foot. The training process should appeal to a diverse audience and engage the patient in a multisensory method: an educating video clip by combining a musical show, and lecture.

Method:
First, the musical clip was written and composed including video presentation and choreography by a clinical nurse who specializes in diabetes, as well as volunteering as a medical clown. Through her expertise and experience, special attention was given to the learning content that was provided in the video clip.

The medical clowns were selected, due to their approach to various types of populations, and their success in communicating through verbal as well as non-verbal communication. In the video clip, the medical clowns appeal effectively to their audience in all languages and to all ages. By the use of humor, which is known to eliminate barriers and antagonism, an experiential training process was created, which encouraged patients to adopt the "rules" of care. The clip was pretested with a number of diabetic patients to assess their reaction to the clip, and to ascertain that all the messages in the health clip were clearly communicated. 

In the present, as a motivational strategy for diabetic patients, the clip is screened in the waiting rooms of diabetic clinics and diabetic foot clinics.

It is well known that in Israel there are many types of populations and cultures. In order to reach as many diabetic patients as possible, and with the knowledge that humor is considered  a universal language, the clip has been translated into several languages.  Our future plan, is to make the Diabetic Foot Clip available to all Medical Centers, and to incorporate the video health clip into the guidance and training programs that are provided to diabetic patients.

Conclusions:
Diabetes is a chronic and progressive illness which may lead to serious complications if left untreated. As health care professionals, we believe that it is of utmost importance to teach our patients how to manage their illness through a positive motivational approach and with confidence, as positivity is most effective in helping the patient adhere to treatment.

The innovative diabetic foot video clip is highly effective, teaching important health behaviors and preventive measures through creativity and humor while engaging the patient in a multisensory way. The clip leaves the patient with a smile, and encourages self-motivation and continued health care.  

Biography:

Rassin Michal is the coordinator of the nursing research unit in Asaf  Harofe Medical Center. Rassin research focuses on secondary victim, breaking bed news, values clarification and developing nursing assessment tools. Rassin sarves as a member of the editorial board magazine “The Nurse in  Israel”. She is also works as the coordinator of  the accreditation processes in Asaf  Harofe Medical Center. As part of the job Dr Rassin is responsible for implementing and monitoring the processes related to safety and quality assurance in the care for patient.

Abstract:

Medication errors may be a critical event for the patients and caregivers involved. The performance of an erring worker might be detrimental in the private and organizational life. This situation is known as the "secondary victim". The aim of our research was to examine the influence of the medication errors, on the mental and functional state of the erring caregiver and to compare the findings of the study held in 2005 to those in 2018. In-depth interviews were conducted with 40 erring nurses. The data were analyzed using content analysis. The research findings show that severe emotional consequences commenced immediately after the incident and continued for several days. They were expressed by fear, anxiety, self-blame, shame etc. The participants' reactions were grouped as: "Taking responsibility", "Why did this happen to me" "Dilemma - whether to tell the patient and his family" "Fear of punishment". The ongoing emotional distress that characterized some of the participants was similar to PTSD. The main differences between the findings of the study after more than a decade were the perception of the organization as investigative rather than blameful, which enabled better functioning. In light of these findings, it is recommended that workplaces should offer a support mechanism for the secondary victim, regardless of the risk management investigation procedures. Awareness to this issue should be encouraged and initiatives to support secondary victims should be promoted so that staff members are informed on the issue and the available resources to support them.

Biography:

Charmion Patton has completed his EdD at the age of 56 years from Grand Canyon University School of Doctoral Studies. She is the director of Human Resources, at a Healthcare System. She has worked in the field of Human Resources and Organizational Leadership for several years and lends her expertise as a consultant on subjects related to Human Capital Management and Communications          

 

Abstract:

The purpose of this study was to examine levels of patient satisfaction based on the communication effectiveness of nurses and organizational performance ratings identified from the HCAHPS database of acute care hospitals in Northern California. Three theories supported the foundation of this study, which are King’s Theory of Goal Attainment, Latham and Locke’s expectancy theory, and Bass’s transactional to transformational leadership model. The sample consisted of acute care facilities in the Northern California. The quantitative study followed a correlational design with analysis using a multiple linear regression. The results showed that communications with nurses, communication about medicines, and discharge instructions significantly predict overall hospital rating as measured by HCAHPS scores in acute care hospitals in Northern California F(3,117) = 96.81, p < .001, R2 = .71. The results also showed that communications with nurses, communication about medicines, and discharge instructions, significantly predict willingness to recommend as measured by HCAHPS scores in acute care hospitals in Northern California F(3,117) = 55.59, p < .001, R2 = .58. The data showed 71% variability in overall hospital rating and 58% variability in willingness to recommend the facility. This study provided significant clarity regarding impact of patient satisfaction, organizational performance on willingness to recommend, and overall hospital rating within these facilities in the specified region.

Biography:

Hong-rui Shi is a nursing phD candidate who is on her first year in West China School of Nursing in Sichuan University in China. She focuses her research on geriatric nursing and nursing education.

Abstract:

BACKGROUND

A majority of nurses struggled with a negative emotion of anger, doubt, fear or anxiety, uncomfortable in the face of death and dying. However, little is known about nursing students in China. Our study was to investigate the attitudes toward death and demands of death education of nursing undergraduates, and to provide reference for promoting death education in medical colleges.

METHODS

A total of 1000 nursing undergraduates who were from four medical colleges in Shanxi were selected by stratified random sampling method from May to November 2017. Death Attitude Profile-Revised(DAP-R-C) was used to assess the attitudes toward death. A self-developed questionnaire was used to investigate the demands of death education.

RESULTS

The average score of students’ attitudes toward death was 2.82±0.40. The average score of students’ demands of death education was 4.20±0.55. Of the 1000 nursing students, 902 (90.2%) students considered there should be courses on death education. A total of 865(95.9%) students believed courses should be provided in school period, of which 374(43.2%) students assumed the course should be elective course. 345 (39.9%) students thought that death education should be taught in their sophomore year, the duration was about 18 to 27 class hours. Their favorite teaching methods included classroom teaching, video demonstration, experience teaching, scenario simulation, and case analysis.

CONCLUSIONS

Nursing undergraduates had a negative attitude towards death. The demands of death education is high. Required or elective courses of death education with varied teaching methods may be a good choice for nursing undergraduates.