Volume 11│Issue 2│June 2020 Carilion Medical Center, 1906 Bel leview Ave, Roanoke, VA 24014 https://www.insidecarilion.org/hub/nursing -research-evidence-based-practice nursingresearch@carilionclinic.org (540)266 -6216
COVID-19 Resources Kim Carter, PhD, RN, NEA-BC - Nursing Research & EBP Since mid-March, every Carilion employee has been impacted by the Coronavirus (COVID-19)/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Some units honed in on best practice for safety of patients and staff. Other units closed due to low census, with nurses picking up new roles, such as Protective Safety Officer or Communication Liaison for Virtual Visitation. Some staff have taken PTO or have been furloughed. Others have had a cut in pay while maintaining full-time work expectations. Nurses have also assumed the role of surrogate family member for patients due to visitation restrictions. Beyond work, nurses have been challenged to keep their families safe, serve as educator for their children and care provider for family members, or sacrifice time with families as they social distance. The reality is that we are doing what nurses and healthcare professionals have done long before COVID-19 and will continue to do long after COVID-19. The trick is to access accurate and reliable information for something that we do not completely understand. People have become adept at accessing current COVID-19 statistical information. Regular emails from Steve Arner, Executive Vice President, provide updated Carilion data. Current state level COVID-19 statistics are available with regularly updated information and interactive maps through the Virginia Department of Health https:// www.vdh.virginia.gov/coronavirus/?utm_source=CE&utm_campaign=6fbff7a4a3-Coronavirus-March18_COPY_01&utm_medium=email&utm_term=0_fbff100fb0-6fbff7a4a3- and the Virginia Hospital and Healthcare Association https://www.vhha.com/communications/virginia-hospital-covid-19-data-dashboard/. National level statistics are at: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html COVID-19 has sparked practice advances and innovations. To keep up with rapidly evolving advances, new outlets for best practice information have emerged. Carilion provides current information and resources to employees at the Coronavirus Management Hub at https://insidecarilion.org/hub/coronavirus-management. Publons provides postacceptance prepublication papers at: https://publons.com/publon/?order_by=date (simply select Browse, Publications, and then search “Coronavirus” or COVID-19. Publons works best with Chrome or Firefox). The Ohio State University Fuld Institute for EBP provides a repository for Evidence-Based COVID-19 Resources at https://fuld.nursing.osu.edu/ covid19resources. The American Nurses Association has a COVID-19 Resource Center at https://www.nursingworld.org/coronavirus?utm_campaign=261605%20COVID-19% 20MKT&utm_medium=email&_hsmi=87531007&_hsenc=p2ANqtz_nBX9HrwAFQ_nxj_L5JTG85hMcZNM5vMMlUcsFvM9BW_K6kLbhNmWSQv4uKHJuk17OPHxx&utm_content=8753 1007&utm_source=hs_email. The World Health Organization provides global information, such as travel advice and myth-busters, as well as how to prepare workplaces for COVID-19, advocacy for human rights, parenting and violence against women, and myth-busters at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-forpublic. We are blessed to live at a time where reliable, current information is available at our fingertips. As we continue to navigate this pandemic experience, may you stay healthy, informed, and at peace. These resources will help you access the tools and information that you need to provide the best care for patients.
~ Kim Carilion Clinic Roanoke Campus
Page 2
Within REACH
ARTICLES/NOTIFICATIONS 1 COVID-19 Resources Kim Carter, PhD, RN, NEA-BC
3 4
2020 Carilion Nursing Research Conference Information Practical Tips for Moral Resilience Phyllis Whitehead, PhD, APRN/CNS, ACHPN, RN-BC, FNAP
7
Article Review: Distress Debriefings after Critical Incidents: A Pilot Project Robin Woody, BSN, RN, CCRN
9
Reflections from Ohio State University, Fuld Institute, EBP Immersion Attendees Kim Carter, PhD, RN, NEA-BC; Desiree Beasley, MSN, RN, CCRN, CCNS; Christina Monk, MSN, RN, NEA-BC; Laura Reiter, MSN, RN, CCRN, CNRN
13 Healthcare with a Human Touch Award Winners RECOGNITION/EVENTS 14 TRINETX Liveâ„¢ Information 15 iTHRIV Information 16 Recognition 18 Conference Corner 20 Citations & Recognition 22 See Where Our Nurses Have Travelled!! 23 Carilion Nursing Research Classes information 24 VNA 2020 Fall Conference Information
Carilion Nursing Research Editorial Board: Kim Carter, PhD, RN, NEA-BC - Editor-in-Chief Michele Kosinski, DNP, MBA, RN - Co-Editor Deirdre Rea, DNP, RN-BC, PMH-CNS - Co-Editor Reviewers Nancy Altice, DNP, RN, CCNS, ACNS-BC Desiree Beasley, MSN, RN, CCRN, CCNS Ann Beheler, ADN, RN Sarah Browning, DNP, RN-BC Molly Clemons, RN, ONC Monica Coles, DNP, RN-BC, ACNS -BC Sarah Dooley, MPH, BSN, RN Christine Fish-Huson, MSN, RN Shanna Flowers, MA Donna Goyer, BSN, RN, CPAN, CAPA
Cindy W. Hodges, BSHS, RNC, FCN James Ingrassia, MSN, RN Pam Lindsey, MSN, RN Margaret Perry, MSN, RN-BC Diana Talmadge, RN Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC Vivian Wilson, BSN, RN, CCRP Britmarie Witkowski, MPH
Page 3
Practical Applications of Nursing Inquiry
Watch for future announcements about alternative virtual options for the Nursing Research Conference!
Page 4
Within REACH
Practical Tips for Moral Resilience Phyllis Whitehead, PhD, APRN/CNS, ACHPN, RN-BC, FNAP - Clinical Ethicist, Clinical Nurse Specialist Palliative Care/Pain Management During these times of COVID-19, nurses and other clinicians throughout the world are faced with many ethical dilemmas such as PPE shortages, limited COVID-19 testing, and staffing challenges. Such situations can lead to moral distress. Moral distress is defined as “the experience of being seriously compromised as a moral agent in practicing in accordance with accepted professional values and standards”1 (p. 488). Moral distress occurs when we feel that we cannot do the perceived right action resulting in our moral integrity being compromised 2,3. Moral distress results in significant physical and emotional stress, which contributes to feelings of loss of integrity and dissatisfaction with the work environment4. Research demonstrates that moral distress may contribute to staff leaving the work setting and profession5. It can affect relationships with patients and coworkers and the quality, quantity, and cost of care. Moral resilience is the important ability of nurses to cultivate a sense of well-being and growth in response to moral and ethical challenges that they face in their stressful and rapid-paced work environments6,7. Carilion supports the moral resilience of staff in part through the Moral Distress Consult Service. Established in 2016, this service offers approximately 12 consults each year. Anyone can contact the Consult Service. However, we find that the following process works well to navigate a distressing situation toward moral resilience: If you are experiencing moral distress, please discuss the following questions with your unit director or you may reach out to Dr. Whitehead: • • • •
What issue would you like to discuss? What is the background, who is involved, what has been done to help already? (If you have a unit example). What would you hope to gain from the session? What days/times are best for staff to have a facilitated session?
Once discussed with Dr. Whitehead, the unit director/manager will schedule a convenient date and time for the consult. The consult date and time is shared with staff so everyone who is interested in attending is invited. See box 1 on page 6 for more helpful information. Upon receipt of a consult request, the Moral Distress Consult Service will work with the manager to schedule a consult. During the consult, trained facilitators provide a 45-60 minute session in an open, safe forum to address issues related to any situation causing moral distress – end-of-life care, cultural issues, communication, treatment choices, etc. – or ways to prevent moral distress by dealing with power or personality conflicts based on issues of concern on the unit. The facilitator will work with the staff to develop action plans for decreasing moral distress on the unit or service. Moral distress Consult Service facilitators have specific education and background. The facilitators have attended Moral Distress Consultation training provided by the University of Virginia and have facilitated over 50 consults since 2016. Facilitators at Carilion are: • •
Mark Swope, PhD, Director of Bioethics Phyllis Whitehead, PhD, APRN, ACHPN, RN-BC, FNAP, Clinical Ethicist/Palliative Medicine Clinical Nurse Specialist
Page 5
Practical Applications of Nursing Inquiry
Dr. Mark Swope
Dr. Phyllis Whitehead
In addition to Carilion’s resources, many professional organizations provide helpful information and tools to support healthy work environments. These important resources would be valuable to nurses seeking to cultivate a healthier workplace for their unit: • • • •
•
Healthy Work Environment (American Nurses Association): https:// www.nursingworld.org/practice-policy/work-environment/ Healthy Practice Environment Advocacy Guide (Academy of Medical-Surgical Nurses): https://www.amsn.org/practice-resources/healthy-practice-environment Healthy Work Environments (American Association of Critical Care Nurses): https:// www.aacn.org/nursing-excellence/healthy-work-environments Healthy Perioperative Practice Environment: Patient & Workplace Safety (Association of perioperative Registered Nurses): https://www.aorn.org/guidelines/clinical-resources/ position-statements Healthy Work Environment in the Emergency Care Setting (Emergency Nurses Association): https://www.ena.org/docs/default-source/resource-library/practiceresources/position-statements/healthyworkenvironment.pdf?sfvrsn=a4170683_14
For more information about moral distress, moral resilience, and the Carilion Moral Distress Consult Service, contact Phyllis Whitehead at pbwhitehead@carilionclinic.org (540-521-6048). References 1. Varcoe C., Pauly B., Webster G., & Storch J. (2012). Moral distress: tensions as springboards for action. HEC Forum, 24(1), 51-62.2. 2. Hamric, A.B.& Blackhall, L.J. (2007). Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med, 35, 422-429. 3. Hamric, A.B., Borchers, C.T. & Epstein, E.G. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research, 2, 1-9. 4. Jameton, A. (1993). Dilemmas of moral distress: moral responsibility and nursing practice. AWHONNS Clin Issues Perinat Womens Health Nurs, 4(4), 542-551. 5. Whitehead, P.B., Herbertson, R.K., Hamric, A.B., Epstein, E.G., & Fisher, J.M. (2015). Moral distress among healthcare professionals: Report of an institution-wide survey. Journal of Nursing Scholarship, 47(2), 117-125. 6. Holtz, H, Heinze, K, & Rushton C. (2018). Interprofessionals' definitions of moral resilience. Journal of Clinical Nursing. 27(3-4), 488-494. doi: 10.1111/jocn.13989. 7. Rushton, C.H. & Carse, A. (2016). Towards a new narrative of moral distress: Realizing the potential of resilience. The Journal of Clinical Ethics, 27(3), 214-218. *See additional information next page
Page 6
Within REACH
Box 1. Strategies to consider when you experience an ethically and/or morally challenging situation: •
•
•
• •
•
•
• •
•
•
•
Get the whole story. Encourage others to do so as well Speak up. Encourage dialogue If seen as risky, that’s the first problem to tackle Focus on the ethical dimensions of care What we ought to do? Which obligation is primary? What are the goals of care? Have they changed? Do they need to change? Debrief Situations with a goal of preventing the recurrence of a similar case What could we have done differently? How can we anticipate next time? Include entire interprofessional team Interprofessional education on moral distress Nurture the expectation of collaboration Target unit/service practices that improve communication: Interprofessional rounds Unit/service conferences Family meetings Develop Proactive Systems & Processes Early, frequent, consistent communication with patients and families Clear articulation of health team goals Team speaks with one voice Develop institutional resources that are: Available Known Sanctioned Develop policies/guidelines encouraging team collaboration, ethics consultation, provider continuity Identify the moral distress sources operating in your unit/division/service and target interventions there Then, extend to the organization if the problems are system-generated Initiate Ethics and/or Moral Distress Consults To reduce moral distress levels among staff To provide an interprofessional avenue for frank discussion and problem solving in morally distressing situations To assist staff in developing strategies to address barriers to high-quality patient care To empower staff to raise concerns Identify your ethical/moral distress Providing inadequate or harmful pain management EOL futile care challenges Poor teamwork and challenging communication issues Work on strategies to improve your teamwork and communication.
Reference (Holtz, 2018; Rushton, 2016; Varcoe, 2012; Whitehead, 2015)
Page 7
Practical Applications of Nursing Inquiry
Article Review: Distress Debriefings After Critical Incidents: A Pilot Project Robin Woody, BSN, RN, CCRN - Preceptor, 10M ICU Article Reviewed: Appleton, Kerry P., et al. 2018. Distress Debriefings After Critical Incidents: A Pilot Project. AACN Advanced Critical Care, 29(2), 213-220., doi:104037/aacnacc2018799 Introduction Nurses may experience moral distress when they act in a manner that goes against their personal and professional values, compromising their moral integrity. A common source of moral distress may occur when the nurse must inflict needless pain and suffering or provide end of life interventions that are medically nonbeneficial. Moral distress occurs frequently in adult and pediatric critical care units, because the care for this patient population is more complex. Moral distress can put a nurse at risk for burnout, compassion fatigue, and moral injury. Background This article focuses on an evidence-based education pilot project that introduced a new technique of distress debriefings (DDs) following critical incidents (CI). CIs are traumatic and powerful events that start a crisis response. There are a lot of varying opinions regarding what staff see as critical incidents. For this article, the events that the staff identified as critical were sexual abuse of a child, and cardiac and respiratory arrest. DDs focused on the emotional response to a CI. The DD included any staff member taking care of a patient or patient’s family. A DD could be recommended by a charge nurse or requested by a staff member, should be no longer than 20 minutes, and occurred in 3 phases: the introduction phase, exploration phase, and information phase. In the introduction phase, the facilitator discussed the purpose of the debriefing, established ground rules, and garnered support for staff. In the exploration phase, the facilitator asked open-ended questions and monitored conversation to make sure it stays on topic with the debriefing. Most of the time was spent in this phase. The information phase was the last phase where information was shared by the facilitator to the team. It summarized the DD and reflected on the goals of the debriefing. The unit charge nurses facilitated DDs within 8 hours of a CI and before the end of the shift. The Project The aim of the project was to improve the external work environment to lessen the gravity of the negative psychological effects on nurses after a distressing experience. There were 3 phases of the pilot: Phase 1 involved a needs assessment that was sent to pediatric ICU (PICU) staff to evaluate a foundational level of moral distress and burnout and to determine if the DD intervention was necessary. Phase 2 focused on training PICU staff to carry out the DDs and to provide instruction on debriefings. Phase 3 focused on carrying out the DDs in the PICU and evaluating PICU nursing staff perception of the DDs after critical incidents. Phase 1: This project was carried out in a children’s hospital among the nursing education, simulation, and ethics departments. The goal of the project was to develop an intervention that addressed moral distress and burnout in PICU staff. PICU nurses were given a survey assessing moral distress and burnout. There were also questions regarding job and personal satisfaction related to being a nurse. The Burnout Self-Test showed that 100% of the nurses surveyed were experiencing signs of burnout. 86% of those surveyed were also willing to participate in moral distress and burnout training.
Page 8
Within REACH
Phase 2: A 4-hour training course was developed to provide instruction and to support the learning objectives. The DD training sessions started by having the charge nurse participants reflect on traumatic events and CIs that they had experienced. The participants were also provided with information on moral distress and burnout. Then the participants had the opportunity to lead a DD after a simulated incident. Feedback was provided immediately following the simulation by instructors and fellow participants. At the end of the DD training, participants were asked to complete a course evaluation. Most participants felt that the experience was helpful, but also uncomfortable. Phase 3: After the training, 4 pilot DDs were carried out in the PICU. The facilitator completed an evaluation after each DD. This evaluation asked the facilitator to provide background information on and a summary of the DD. The project found that the facilitators rated on a 5-point scale that the DD was ‘helpful’ to ‘very helpful’. Participants were divided on the timing of the DD: 50% felt it was not held soon enough and 50% felt it was held at the right time. The main reasons that a DD was not held soon enough were if a CI happened at shift change or if there was not enough staff available. Findings Based upon the pilot feedback, the DD training and was adapted then offered to other hospital units. Several challenges were noted during the project expansion beyond the PICU. First, with more DD participants, it was difficult to delineate equal roles within the simulation. Simulation processes also had to be revised to include case studies instead of traditional simulation scenarios. The case studies involved actual patient experiences on the units where DDs were being performed. Lastly, it was noted that each session brought unique challenges and different energy and stories from participants; therefore, facilitators had to adapt to meet the engagement from the participants. After the DD training, participants were given a survey. Of the 65 participants, 52 (80%) completed the survey. 100% of those that completed the survey found that the simulation experience was helpful. Most participants reported that they would be able to facilitate a DD, and they felt a sense of empowerment about having a new skill to support nurses. The authors also found that the most important lessons learned from completing the DDs were psychological safety needs to be considered, the correct environment for training needs to be established, and content should be customized based on needs. Conclusion The investigators in this project found that nurses are willing to receive education on DDs and that they felt it was beneficial. While there was still room for improvement, nurses felt empowered to have a new skill to use to help cope with distressing critical care situations. Moral distress and burnout have a direct effect on staff satisfaction, patient outcomes, and finances of the institution; therefore, it is vital that hospital systems, healthcare providers, and nurse leaders implement effective interventions for CIs. Implication for Practice Critical care nurses experience CIs daily. This article offers a strategy that could be replicated to help decrease moral distress and ultimately decrease burnout. DD trainings could be implemented to mitigate distress encountered by critical care nurses. Conducting a needs assessment would be an important first step to identify and define moral distress at Carilion and provide a foundation for DD training. The end goal would be improved ethical environment for the critical care units.
Page 9
Practical Applications of Nursing Inquiry
Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare
EBP Immersion - OnSite A Deep Dive Education Experience for Clinicians, Leaders & Faculty March 2-6, 2020
REFLECTIONS FROM ATTENDEES:
KIM CARTER,PhD, RN, NEA-BC Senior Directior of Nusing Research, EBP & Excellence At the 2019 Carilion Nursing Research Conference, Dr. Lynn Gallagher-Ford suggested that Carilion consider sending representatives to one of the Ohio State EBP Immersion experiences. I was invited to attend as both a participant and Co-facilitator, and it was an honor to attend as part of a 4-member Carilion team. As a co-facilitator, I worked with other individuals at my table to provide support as they developed their PICOT questions and conducted their EBP analysis and synthesis. I also participated in the daily debriefings, which gave me insight into the faculty’s teaching strategies. Beyond the EBP specific content, I was very impressed with their best practices as teachers and curriculum designers. Much of what I learned was like what we already have in place at Carilion. But the synthesis table and process were new, and I am eager to integrate that part of the process into our EBP toolkit. I have already shared this information with several Carilion nurses who are conducting EBP reviews. If you would like more information about how to analyze and synthesize – and how to present this information in a very usable format – please let me know! This is something that we can do virtually – COVID-19 can’t stop EBP!
*Continued on next page
Page 10
Within REACH
DESIREE BEASLEY, MSN, RN, CCRN, CCNS Acute Care Clinical Nurse Specialist Carilion New River Valley Medical Center I was offered the opportunity in March to attend the Evidence Based Practice Immersion at Ohio State University with three of my Carilion colleagues. It was an inspiring, motivating and informational week! I was not sure what to expect, but by the end of the week, I was eager to answer more of my burning questions. Through the week, each step of the EBP process was broken down and worked through using our personal PICOT question. Each PICOT question was critiqued by others to ensure we were not asking a leading question, meaning we thought we already “knew” the answer and to help identify search terms. My PICOT question was, “In multi-institutional systems, how do communication practices impact staff satisfaction with communication?”. This Immersion helped me solidify the EBP process and become more comfortable in not only writing my PICOT question but evaluating the evidence. Since being back, I have caught myself asking others “what does the evidence show?” when they come to me with a question or solution to an identified problem. If we spent a little more time in reviewing the literature to help answer our questions, we may spend less time with trial and error ideas in the long run. The answers to our questions may already be out there! We just need to be brave enough to ask and disciplined enough to allow the literature to tell us the answer.
Page 11
Practical Applications of Nursing Inquiry
CHRISTINA MONK, MSN, RN, NEA-BC Nursing Practice Administrator In early March I had the opportunity and pleasure to participate in the Helene Fuld Health Trust National Institute for Evidence-based Practice Immersion program with Dr. Kim Carter, Laura Reiter and Desiree Beasley. It was an intense, thus the name Immersion, week-long program that focused on putting the evidence into practice. Our team is prepared to infuse the lessons learned there throughout Carilion Clinic. I can sum up the whole week in one-word: BOW. Yes, that’s right, BOW. Now I have you wondering what that means. It stands for (B)-based (O)-on (W)-what. We owe it to our patients to base all our decisions on evidence. We learned a technique on synthesizing the literature that culminates into evidence that can be used to guide our nursing practice. There is an abundance of literature out there, but without a thorough search, critical appraisal, and systematic synthesis of that literature to guide our decisions, we can still put things into practice that aren’t evidenced based. One or two articles does not mean something is evidenced based. If you are making decisions without being able to say what it’s based on, then you are just throwing spaghetti on a wall and seeing what sticks. As your nursing practice administrator, I must ensure our practice provides the safest care. The Immersion program equipped me with tools that I have already used and will continue to use moving forward. The PICOT question that I used at the Fuld Immersion was: In clinical nursing does a Professional Development Practice Model Improve Nurse Competency? My search strategy included the following terms: clinical nurse AND best strategies for professional development AND competence or competency or competencies or skills (Limits: published since 2000 and peer reviewed). This search yielded 32 articles, including one duplicate, but these were not relevant. Utilizing the same PICOT question, but revising my search strategy using different MeSH terms, turned out to be fruitful. This was another important technique that I learned at the Fuld. The second search strategy yielded 65 articles. Five were relevant to my PICOT question and were included in critical appraisal and synthesis. The results showed the following key elements that need to be put into practice for professional development and competency: •
• • • •
Work environment support needed (modified assignment, preceptor, opportunities to learn) Preceptors need formal training Variable methods of education needed (didactic, self-reflection, simulation) Competency develops over time Learning at the bedside assisted with assimilation
Next, I will be putting into place steps to implement the above elements into practice across Carilion Clinic. Writing about the evidenced based practice findings to an audience that can assist with implementing the above key elements is step one. I’m excited to incorporate the key elements into practice, and I’m equally excited to help grow this evidenced based culture at Carilion Clinic. If you find me often asking you the question, based on what, now you know why!
*Continued on next page
Page 12
Within REACH
LAURA REITER, MSN, RN, CCRN, CNRN Nurse Residency and Engagement Coordinator Evidence-based practice. It’s what decisions should be based on and what should drive our practice as nurses. But, does it? For many of my 30+ years of nursing practice, when I asked “Why?” we did something a certain way I would be given the same response…. “Because we’ve always done it that way and it works!” Somewhere along the way that stopped being the right answer. In March 2020, I attended an evidence-based practice (EBP) immersion sponsored by the FULD Institute for EBP at Ohio State University. This week-long immersion into EBP de-mystified the process of using evidence to promote best practice. It revealed that a simple question becomes the foundation of evidence-based practice; who, what, where, when, and why become the first step in assuring that our nursing practice is driven by best practice and not simply age-old practice. During this week-long experience each participant asked a question that related to their practice and then followed a six-step process to find the answer. We conducted a search of literature to find high quality research articles and synthesized the results to make evidence-based practice recommendations. My PICOT question was related to nurse burnout, which is an increasingly important topic in recent years. Through a review of the literature, I found several research articles supporting mindfulness-based stress reduction programs as a successful intervention for impacting nurse burnout. While the immersion lasted a week, and that might seem like a long time to devote to an EBP project, the majority of that time was spent on in-depth instruction and open discussion to assure that participants really understood the EBP process and reasons behind it. At the end of our time we each presented an EBP practice change recommendation knowing that it was an abbreviated version, one completed within the limitations of time. Moving forward, I would like to take what I have learned and duplicate the process with a more refined approach and make EBP recommendations to positively impact the burnout experience of nurses at our organization. When enough strong quality research provides the answer to our questions, it becomes CLEAR that our practice should reflect that answer. We are fortunate to work in an organization whose mission is to improve the health of the communities we serve and that supports us in finding the best ways to do it. We have a department of nursing research and evidence-based practice with resources and tools to guide us. From the CLEAR model to classes and workshops, we have all the support that we need to answer our questions. This immersion solidified my resolve to be a mentor for EBP, to support other nurses in answering questions to assure that we are living up to our mission and vision of being “committed to a common purpose of better patient care, better community health and lower cost”.
Page 13
Practical Applications of Nursing Inquiry
Page 14
Within REACH
TriNetX enables researchers to analyze patient populations and perform “what-if� analyses in real-time. Researchers are presented with aggregate views, but each data point in the Carilion TriNetX dataset can be traced to Epic inpatient, emergency and outpatient encounters, including diagnoses, medications, procedures, lab results, and vital signs. This enables researchers to develop virtual patient cohorts that can be re-identified, with appropriate permissions, for retrospective data analysis or potential recruitment into a clinical trial. Best of all, what previously took days to weeks to determine, can now be done in minutes. The TriNetX Analytics platform combines longitudinal clinical data with powerful, self-service analytics, making it the fastest and easiest method for creating real-world evidence. Reports and interactive visualizations may be created to explore patient populations, support publications, and generate grant-based research.
For more information or questions, contact: HART@carilionclinic.org or go to portal.ithriv.org
Page 15
Practical Applications of Nursing Inquiry
The CTSA supported iTHRIV portal aggregates available research resources across the iTHRIV collaborative for accessibility and collaboration. Portal.ithriv.org utilizes your institution’s credentials for access, providing you with a personalized view of upcoming events, information and opportunities. The portal is organized around the concepts of Learn, Propose, Conduct and Connect for topic browsing, while also offering searching functionality. The institutionally “crowd-sourced” resources are constantly being updated with the latest information on funding sources, educational events and collaborative opportunities. Favorite the resources you reference frequently for quick access!
For more information or questions, contact: HART@carilionclinic.org or go to live.trinetx.com
Page 16
Within REACH
Commitment! CRMH 7S CCU Nursing Staff Unit Director - Sarah Henshaw AACN Beacon Award for Excellence - Silver Level 7 South CCU at Carilion Roanoke Memorial successfully received the SILVER level AACN Beacon Award for Excellence. This is their 3rd redesignation. They received a Bronze Level in 2010 and a Silver Level in 2016. The Beacon Award for Excellence honors individual units that distinguish themselves by improving every facet of patient care. Beacon awardees set the standard for excellence in patient care environments. The award signifies a positive and supportive work environment with greater collaboration between colleagues and leaders, higher morale and lower turnover.
Collaboration! CRMH 7M PCU Nursing Staff Unit Director - Suzanne Bowser Highest Patient Experience HCAHPS Score For Unit Cleanliness Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a patient survey required by the Centers of Medicare and Medicaid Services for all hospitals in the US. Patients provide feedback on their experience in specific areas. HCAHPS serve as the voice of the patient. The government provides reimbursement based on results - so, excellent survey performance keeps the hospital financially strong. Congratulations to the nursing staff on 7M PCU, along with EVS frontline caregiver Mr. Chris Godwin for the incredible collaboration and teamwork!
Page 17
Practical Applications of Nursing Inquiry
Collaboration! CRMH 9S PCU Nursing Staff Unit Director - Beverly Morris Positive Change HCAHPS Patient Experience For Unit Cleanliness Congratulations to another CRMH unit for being recognized with a HCAHPS Patient Experience award. This recognition was for Positive Change in unit cleanliness. Through collaboration with their EVS frontline caregiver Mr. Jose Gutierrez and amazing teamwork, this group was able to achieve great success!
Commitment! Troy Evans, BSN, RN, CCRN, AACN CRMH Unit Director - 6M ICU Congratulations on passing the AACN Certification for National Healthcare Disaster Professionals (NHDP-BC). The ANCC National Healthcare Disaster Professional board certification examination is a competency based interprofessional entry level examination that provides a valid and reliable assessment of the knowledge, skills and competencies of healthcare professionals relevant to all phases of the disaster preparedness, mtigiation, response and recovery cycles. The goal is to promote successful outcomes for the public, disaster responders, and healthcare professionals involved in a disaster. Troy attended a week long healthcare training ni Alabama earlier this year through FEMA. He has since successfully sat for the AACN Board Certification Exam.
Page 18
Within REACH
National Association of Clinical Nurse Specialists (NACNS), Indianapolis, IN Even though the Coronavirus caused the early ending of the March 2020 NACNS 25th anniversary conference this year in Indianapolis, IN, four of Carilion’s clinical nurse specialists represented our organization as presenters on topics such as respiratory compromise, nursing burnout, moral distress, patient preferences about serious illness and advanced nurse training impact on trauma team attitudes and performance. The focus of the conference was Transforming Healthcare and despite challenging circumstances, the strength of character required to be a CNS was clearly evident the week of the conference, as the CNS family pulled together to make the event a success.
Donna Bond, DNP, RN, CCNS, AE-C, CTTS, FCNS
Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC
Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN Phyllis Whitehead, PhD, APRN, ACHPN, RN-BC, FNAP
Page 19
Practical Applications of Nursing Inquiry
4th Annual Carilion Quality Conference, Roanoke, VA Staff at Carilion Giles Memorial Hospital pharmacy, Performance Improvement, Med-Surg unit, Case Management and Hospital Administration came together and presented their poster (see below) at the 4th Annual Carilion Quality Conference on March 5, 2020. There were 320 attendees at the conference and 12 posters were presented. Their poster was awarded most Outstanding Poster at the conference.
Front row (left-right): Ashleigh Deskins; Beth Hedrick; Dr. Kevin Yates; Amanda Terry; Kristie Williams, Dr. Suzy Kramer. Back row (left-right): Jennifer Bailey; Christina Salazar; Beverly Steffey. Not shown: Dr. Jennifer Bennett-Grube, Dr. Amy Westmoreland; Drema Gautier
With travel bans in place, we know you are unable travel to conferences and present your important work. But the Carilion Nursing Research Department can assist you with publishing your work! Our experts can assist with preparing and submitting your manuscript. Contact the Nursing Research Department at 540-266-6216 or email elassenat@carilionclinic.org to schedule an appointment to discuss publishing your work.
Page 20
Within REACH
March 2020 - June 2020 Bailey, J., Westmorland, A., Terry, A., Yates, K., Bennett-Grube, J., Steffey, B., Gautier, D., Williams, K. March 5, 2020. Improving patient transitions of care - A3 Collaborative A team based approach. 4th Annual Carilion Clinic Quality Conference, Roanoke, VA *Winner of the Outstanding Poster Award at the conference. Bath, J. March 10-13, 2020. Advanced Team Training: Impact on Trauma Team Attitudes and Performances. NACNS Annual Conference, Indianapolis, IN Wohlford, S. April 18, 2020. 2020 Building resilient communities in the face of a changing climates. 2020 Protecting Human Health in a Changing Climate, UVA, Charlottesville, VA *Accepted to present, conference was cancelled due to COVID-19. Whitehead, P., Swope, M. April 29, 2020. Ethical decision making in the midst of a pandemic. Virginia Nurses Association Free COVID-19 Web Series. Rea, D. May 7, 2020. Choosing Resilience.Virtual presentation to the Virginia Chapter of the American Psychiatric Nursing Association. Bond, D. May 4-7, 2020. Assessment of Respiratory Rate: A Literature Review. American Association of Critical Care Nurses - National Teaching Institute 2020 Conference, Indianapolis, IN. *Accepted to present, conference was cancelled due to COVID-19. Wohlford, S. May 12, 2020. Innovative nursing strategies to drive climate action. CleanMed 2020, Orlando, FL. *Accepted to present, conference was cancelled due to COVID-19. Rea, D. June 4, 2020. Mental Health Effects of the Covid-19 Pandemic. Virtual presentation to the National Association of Clinical Nurse Specialists.
Jatta, M. June 10-12, 2020. Using carbon dioxide as a tracer gas to determine air changes per hour in ambulances. Association for Professionals in Infection Control & Epidemiology (APIC) National Conference, Phoenix, AZ. *Accepted to present, conference was cancelled due to COVID-19.
McCormick, J. March 28-April 1, 2020. Malignant hypothermia simulations: Keeping staff cool during MH crisis & OR orientation: Bridging the gap from classroom to OR with simulation. AORN Global Surgical Conference & Expo, Anaheim, CA. *Accepted for a poster presentation, conference was cancelled due to COVID-19. Hodges, D. April 26-30, 2020. A strategy to improve professional practice: A lesson from an immunization project. 39th ASPAN National Conference, Denver, CO. *Accepted for a poster presentation, conference was cancelled due to COVID-19. Jatta, M. June 10-12, 2020. Using carbon dioxide as a tracer gas to determine air changes per hour in ambulances. *Accepted for a poster presentation, conference was cancelled due to COVID-19.
Gerow, R., Altice, N. March 2020. Early cardiac rehab to reduce heart failure readmissions. Heart & Lung: The Journal of Acute and Critical Care, 49 (2), 211-211. Matthews, J., Whitehead, P., Ward, C., Kyner, M., Crowder, T. May 2020. Florence Nightingale: Visionary for the role of Clinical Nurse Specialist. The Online Journal of Issues in Nursing, 25(2), 1-11.
Page 21
Wohlford, S., Esteves-Furentes, N., Carter, K. June 2020. Reducing waste in the clinical setting. American Journal of Nursing 120(6), 48-55. *Winner of the 2019 Nurse Faculty Scholars/AJN Mentored Writing Award.
CRMH 7S CCU Nursing Staff. April 2020. 7S CCU at Carilion Roanoke Memorial Hospital (CRMH) successfully received the Silver level AACN Beacon Award for Excellence. This is their 3rd redesignation, being awarded Bronze Level in 2010 and Silver level in 2016. CRMH 7M PCU Nursing Staff. April 2020. 7M PCU at Carilion Roanoke Memorial Hospital (CRMH) received the Highest Patient Experience HCAHPS Score for Unit Cleanliness. CRMH 9S PCU Nursing Staff. April 2020. 9S PCU at Carilion Roanoke Memorial Hospital (CRMH) received the Positive Change Patient Experience HCAHPS Score for Unit Cleanliness. Carilion Roanoke Memorial Hospital & Carilion New River Valley Medical Center. May 2020. Both Carilion Roanoke Memorial & Carilion New River Valley Medical Center received the Partner for Change Award from Practice Greenhealth, the nations leading organization dedicated to environmental sustainability in health care.
Practical Applications of Nursing Inquiry
Page 22
Within REACH
“The World is a book, and those who do not travel read only a page.” – Saint Augustine United Kingdom
Nottingham
Natl. Harbor, MD Williamsburg
Palm
Anaheim
Greenville
Lake Buena Vista
Page 23
Practical Applications of Nursing Inquiry
Page 24
Within REACH
Page 25
Practical Applications of Nursing Inquiry
Follow us on our Nursing Research & EBP hub at Inside Carilion for updated information about: • • • •
Nursing Research Classes for 2021! Nursing Research Fellowship for 2022! Virtual presentations from your peers! Copies of our Within REACH publication!
Login to Inside Carilion/Departments & Services/Nursing Research & Evidence Based Practice/Highlights
Need editorial support to publish your work? Contact Nursing Research & EBP for: • Assistance with writing your abstract • Peer review • Manuscript submission nursingresearch@carilionclinic.org
Carilion Clinic Roanoke Campus