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HEADLINES

Nursing2018 covers the latest news in nursing and healthcare. See what's making headlines this month!

Monday, November 5, 2018

American Heart Association publishes updated CPR, ECC guidelines

​The American Heart Association announced on Monday updated guidelines for CPR and Emergency Cardiovascular Care (ECC).

The 2018 AHA Focused Updates on Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) were published in cooperation with the International Liaison Committee on Resuscitation. They include the following:

• Amiodarone or lidocaine may be considered for ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) that is unresponsive to defibrillation. These drugs may be particularly useful for patients with witnessed arrest, for whom time to drug administration may be shorter.

• Lidocaine has been added to the ACLS Cardiac Arrest Algorithm and the ACLS Cardiac Arrest Circular Algorithm for treatment of shock-refractory VF/pVT.

• The routine use of magnesium for cardiac arrest is not recommended in adult patients. Magnesium may be considered for torsades de pointes (i.e. polymorphic VT associated with long QT interval).

• There is insufficient evidence to support or refute the routine use of a beta blocker early (within the first hour) after return of spontaneous circulation (ROSC).

• There is insufficient evidence to support or refute the routine use of lidocaine early (within the first hour) after ROSC. In the absence of contraindications, the prophylactic use of lidocaine may be considered in specific circumstances (such as during emergency medical services transport) when treatment of recurrent VF/pVT might prove to be challenging.

• While there are no changes to the depiction of sequences and therapies from the 2015 PALS algorithm, some minor edits have been made to the PALS Cardiac Arrest Algorithm in 2018 to be consistent with language in the ACLS Cardiac Arrest Algorithm.

There were no product changes and no new materials required as part of the updates, but the AHA offered the following guidance for training ACLS and PALS providers.

• Instructors may allow students to practice using either amiodarone or lidocaine during CPR in ACLS, ACLS EP, and PALS courses, consistent with the student's local protocol.

• For testing purposes, AHA Instructors will continue to use the ACLS and PALS Skills Testing Checklists and the Skills Testing Critical Skills Descriptors.

The AHA and ILCOR said last year it would begin updating AHA guidelines for CPR and ECC annually. Before 2017, the guidelines had been updated every 5 years.

Click here to view the updated guidelines in full.

Tuesday, July 24, 2018

Keep your bag high and dry

By Stephanie Williams, RN, former case manager

​My patient shouted and snapped the fingers of her free hand as I performed a fingerstick blood glucose test, but her efforts were fruitless. Her plump tabby cat, Stuffins, had gingerly stepped onto my nursing bag, which was on the floor at my feet. The cat patted it down with his paws, peered directly into my eyes, and peed. Naturally, that was the end of my poor bag.

I knew all about the importance of hand hygiene, but to me, "bag technique" was just the skilled way in which I brought all my groceries from my trunk to the kitchen in one trip. It wasn't until joining my second agency as a home healthcare nurse that orientation videos taught me never to set my bag on the floor. Instead, it should be placed on an elevated surface covered with a water-resistant drape—or, if no suitable surface is available, hung from a door knob.

Putting this new skill into practice right away helped me slow down and greet my patients more personally as I put down a drape and take out my equipment. Our agency also had a policy of cleaning our equipment in front of the patient before use. During this process, patients might start telling me about an issue they've been having, or maybe about the pie their neighbor dropped off the night before.

My favorite part of "bag technique" is the reminder it gives me that, much like hiking and camping etiquette, I'm expected to leave no trace of my visit in my patients' home. That includes unwanted germs from the outside. It also shows my patients that I'm mindful of my commitment to their care and protection.

If not for Stuffins and his discerning bladder, I wouldn't have such a great anecdote to share with colleagues and nurses I train for home visits. Learn from my mistake. Keep your bag high and dry.

Tuesday, August 22, 2017

Being prepared for the unexpected


​Guest editor: Aguida Dasilva, BSN, RN-BC, clinical nurse at Good Samaritan Hospital in Suffern, N.Y.

It's common for RNs to witness family disagreements involving end-of-life decisions. Arguments at these times only add to the stress of losing a loved one. In my experience as a clinical nurse in an acute-care setting, I've encountered many families with similar circumstances.

Ongoing education is needed regarding end-of-life matters to promote the importance of appointing a proxy at early age.1 In addition, educating healthcare personnel on the subject will help them assist their patients and families in discussing these issues before life-limiting illness occurs. Planning advance directives should begin before advanced age is reached. Advance directives should be discussed routinely with patients at the primary care provider's office. Research shows that patients are very receptive when a physician introduces the subject to them.2 Also, advance directive discussions shouldn't be limited to people with a terminal disease or geriatric patients.2

Healthcare has come a long way in recognizing the needs for improvement in this area, but we still have a long way to go to improve relevant education. With appropriate training, we can slowly break the taboo involving discussing advance directives. Planning for the future will help avoid unnecessary disagreement and distress when saying goodbye to a loved one.

REFERENCES

1. Ryan D, Jezewski MA. Knowledge, attitudes, experiences, and confidence of nurses in completing advance directives: a systematic synthesis of three studies. J Nurs Res. 2012;20(2):131-141.

2. Morhaim D, Pollack K. End-of-life care issues: a personal, economic, public policy, and public health crisis. Am J Public Health. 2013;103(6):e8-e10.

3. Abarshi E, Echteld M, Donker G, Van den Block L, Onwuteaka-Philipsen B, Deliens L. Discussing end-of-life issues in the last months of life: a nationwide study among general practitioners. J Palliat Med. 2011;14(3):323-330. ​


Tuesday, July 11, 2017

Positive patient experiences start with a smile

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Guest editor: Tina Keeler, MSN, RN, Western Michigan University, Bronson School of Nursing in Kalamazoo, Mich.

Not so long ago, healthcare was primarily rendered in the home. Mothers and midwives attended the sick, and physicians were only called for emergencies. People came to hospitals with life-threatening illnesses, but the rest was taken care of at the kitchen sink.

As modern medicine advanced, hospitals began to emerge as a place of health and care instead of death and dying. Today, people seek out hospitals for a multitude of reasons: to celebrate a birth, to grieve a death, to replace a joint, to fix a gut, to repair damage done, or to prevent future injury.

Patients will have some sort of an experience when they come to the hospital. The question we need to ask ourselves is: What can we do to ensure their experience is a positive one?

Patient experiences are based on interactions with nurses and other staff that patients encounter while in the hospital. For example, Betty came to the ED with abdominal pain and is now having blood drawn. The nurse gives the scripted greeting, but is mechanical and minimally interactive. Even though the nurse has a professional manner and flawless technique, Betty perceives the experience as negative. Why? Her perception was that the nurse's demeanor was cold and uncaring. In reality, the nurse was focused on trying to follow protocol and not break sterile technique or contaminate the specimen. Although the service rendered was adequate, it didn't exceed the patient's expectations. What could the nurse have done better to create a positive patient experience?

First impressions are key, so smile and make a connection. Try starting a friendly conversation: "Oh, I see your name is Betty. My mother's name is Betty. She was named after her favorite aunt. Does yours have a special meaning?" While preparing to draw the blood specimen, the patient is probably secretly sizing up the nurse, who appears young. "Have you done this before?" the patient nervously asks. The nurse smiles once again and explains that she's done this many times before. She then compliments the patient on her lovely veins. "I wish more of my patients had vessels like yours. That would surely make my job easier," she says. The patient nervously adds, "But I've been told my veins roll and I'm a difficult stick." Once again, the nurse smiles and says, "Oh, then I have a special way to hold your arm to help prevent that from happening." Then she demonstrates the technique. The patient is put at ease and her experience is markedly better.

We, as nurses, need to expand the dialogue on patient experiences beyond rendering excellent clinical care. How can we engage patients and families to build positive healthcare experiences? By focusing on creating connections, starting with a smile!   

Wednesday, June 7, 2017

The human connection

​Summer Reading Series 2017.jpg

Guest editor Susan Newman, MSN, RN, PCCN, is a clinical nurse at St. Elizabeth Healthcare in Edgewood, Ky.

"Heather, I'm so glad you're back today! Bill was trying to get out of bed when I got here, and he nearly fell going to the bathroom. He doesn't remember why he's here."

Scenes like this are common with older adult patients, who may become confused at night when hospitalized. Having an established relationship with the patient and his or her family allows the nurse to quickly provide reassurance, review possible causes, and act as indicated. The human connection is central to the nurse-patient relationship and a core value of the nursing profession. Each person involved contributes unique qualities to this relationship and, to some extent, is changed by the human interaction. The nurse's concern for the patient's well-being as an individual, rather than as a job-related means to an end, reflects this professional commitment. Nursing practice models, which promote nursing continuity of care, value this connection.

In the acute care setting, patients often see multiple caregivers from many different disciplines over the course of even 1 day. Both patients and nurses benefit from staffing patterns that promote continuity of care. A nurse who's familiar with the patient's unique health situation, preferences, and progress lessens anxiety and promotes trust. Because stress can produce unhealthy hormonal responses, this human connection can foster healing. For the nurse, continuity provides the opportunity to assess improvement and adjust interventions in response to the patient's changing status.

As economics have become the driving force of healthcare today, pressure mounts to manage costs associated with nursing in all possible ways. One strategy that's been put forth involves much greater reliance on dedicated contingency staffing, or float pools. At a national nursing conference, a presenter endorsed the value of an RN staffing pattern consisting of only 60% core nurses assigned to each unit as regular staff members.1 A large float pool consisting primarily of new graduate nurses, would provide 40% of the nursing care to patients under this staffing model.

Employing float pool RNs as an increasing proportion of the overall workforce increases the possibility that nurse-patient relationships will be based only on a brief encounter (12, 8, or even 4 hours). In such a setting, nurses expend more time familiarizing themselves with the patient's medical problems and the tasks to be completed during the assigned time interval. Nurses have little opportunity to recognize and build on progress or to detect subtle changes needing early intervention. Patient education also falters in float pool settings.

Because of the unpredictable and variable nature of the workload in hospitals, adjusting nursing resources per patient load is a necessity for many reasons, including safety, nurse satisfaction, and economic factors. But historically, measuring nursing cost and the impact of nursing care on patient outcomes has been a struggle, and this remains true today.  

Nursing researchers are developing sophisticated techniques to collect and analyze data contained in electronic medical records to develop tangible measures of the impact of nursing continuity.2 Evidence-based staffing will be key to linking individual patients and nurses.3 Patient satisfaction scores also affect the financial success of healthcare institutions, and nursing care that recognizes the individual patient is key to positive values. As professionals, we nurses must clearly articulate the value of our profession and support efforts to validate the impact of nursing care.

References

1. Schwedhelm K, Schweikert R. (October 9, 2015). Healthy Work Life Balance: Staffing a Medical Surgical Unit. Lecture presented in American Nurses' Credentialing Center Magnet Conference 2015, Atlanta.

2. Stifter J, Yao Y, Lodhi MK, et al. Nurse continuity and hopsital-acquired pressure ulcers: a comparative analysis using an electronic health record "Big Data" set. Nurs Res. 2015;64(5):361-371.

3. Birmingham SE. Evidence-based staffing: the next step. Nurse Leader 2010;8(3):24-26, 35.​