K Reedy's Blog: Evidence Based Article

K Reedy's Blog: Evidence Based Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440316/?report=classic The article I chose is a study done for the purpose of determin...

Evidence Based Article

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440316/?report=classic

The article I chose is a study done for the purpose of determining the relationship between missed nursing care and the frequency of hospital readmission.   The study was performed using data from 419 acute care hospitals in the US which included nurse staffing, patient data, and readmission of patients with heart failure within 30 days of discharge from the hospital.  The results of the study indicate that due to frequently missed nursing care and tasks left undone during the nursing shift, there is approximately one in five older patients with heart failure that are readmitted within 30 days of discharge. The study shows that frequently missed nursing care include; talking to and comforting patients, developing and updating care plans, and educating patients and families. 

The prevalence of missed care is linked to workloads, environments, nurse to patient ratio, inadequate resources available, and lack of time.  The study shows that nurses working in more favorable conditions are less likely to report missing care during their shift, which reduces the number of hospital readmission.

 

Some interventions that have improved nursing quality of care are better staffing ratios, technology improvements for documenting, monetary incentives, investments in staff development, and adequate managerial resources. 

I chose this article based on personal and professional reasons.  During my clinical experience this semester, I’ve seen how nurse to patient ratio seems to affect the quality of care that patients receive.  Many of the nurses I have worked with seemed to be overloaded with documentation and caring for several patients that required more direct care than they were able to give due to their ratio of patients to care for.  There were several occasions that the nurses were required to stay passed their scheduled shift to complete documentation.  I also learned a lot about time management in the hospital while caring for patients and trying to complete paperwork.  Hopefully, that will improve with time.  I also chose this article because of my personal experience with the nursing care of my mother.  She was in the SICU after a major surgery for over 3 weeks and did not have a good prognosis after the surgery.  I believe that her quality of care was directly related to the SICU nurses having a lower patient ratio than med-surge nurses.  She received thorough care from the SICU nurses and made it through an extremely complicated recovery.  She was transferred from SICU to a med surge floor and died of aspiration 3 days later.  There were several occasions during those 3 days that the nursing care was inadequate which could be due to the higher patient ratio.  That experience is one that drives me to give the best care I possibly can to the clinical patients that I have cared for.  

ISTAN

This week's Istan was quite eventful to say the least.  It definitely tested our critical thinking skills!

I completed trach suctioning, did a portion of the head to toe assessment, hooked up EKG leads and vital sign equipment, dispensed medication, and helped stabilize our patient's declining respiratory status.  My fellow team members also drew blood, corrected an armband error, administered oxygen with an Ambu bag, and all cared for a non verbal trach patient.

I learned several things from the simulation but the most important thing was to be more thorough in assessing Stan!  We missed a very critical key factor while caring for the patient.  I also learned different methods to getting information from non verbal/aphasic patients in the future.

I will definitely do a better job at assessing the patient from head to toe next time.  I will also communicate directly to the patient more.

I learned that when suctioning a trach paitent whose respiratory status is declining, you should go ahead and suction since that is most likely the reason they're stats are declining.  We were trying to get the SPO2 back up to 92% before suctioning which delayed the stats from improving.  I learned that when you take a verbal medication order (VORB) from a HCP, you have to enter the order in to the computer. I also learned the information needed to submit lab orders and that an error in lab labeling can be an automatic fire so it is imperative to get it correct for patient safety.

I learned from the classroom that one of the interventions for trach patients is to sit them up when they are SOB.  Normal vital sign ranges.  I also learned that 2 identifiers are required for patient identification.

Overall, it was a great learning experience.

-K. Reedy, FSCC SN

Hi Karen!!!