Volume 10│Issue 3│October 2019 Carilion Medical Center, 1906 Belleview Ave, Roanoke, VA 24014 http://chsweb.carilion.com/nursserv/NursW eb.html nursingresearch@carilionclinic.org (540)266 -6216
Do you have the brain power to Fall into Research? Monica Coles, DNP, RN-BC, ACNS-BC, CDP - CRMH Nursing Professional Practice, Member Carilion Nursing Editorial Board It is that time of the year when we fall back in time, a time for leaf senescence, fruit-ripening, bird and insect migration, and induction of hibernation and dia-pause. It is a time when we plan lessons for back to school, explore the differences between sweet corn, field corn, and Indian corn, take hayrides, drive across the parkway to see the changing leaves, make pumpkin rolls and Halloween costumes, ponder about what we are thankful for, and prepare our Thanksgiving menu. Have you ever had cause to wonder what effect, if any, the Fall or any other season has on brain activity? Do you think there might be a correlation to certain times of the day with having the ability to think more clearly? Results of research conducted at Sunnybrook Health Science Center at the University of Toronto suggest Fall is the season when our brains do their best work 1. Over the course of a year, the reasoning and concentration of 3,353 participants was tested throughout Canada, France and the U.S. The findings designated late summer and early fall, as times when memory is enhanced, allowing for clearer focus, improved thinking skills, and better concentration, all of which lead to greater productivity, whereas cooler months can cause inactivity1. While there is no rationale about why we work better in warmer months, previous research revealed serotonin levels fluctuate with the seasons, as do some brain proteins that are involved in learning1. A study conducted in Belgium in 2016 discovered the performance of like cognitive tasks differed depending on the season2. Brain functioning was measured during all four seasons. Participants would spend four-and-a-half days in a lab safeguarded from weather conditions and sunlight. They then had their brains scanned while performing certain cognitive task requiring focus, as well as another memory-based task. While their scores were the same throughout, their focus in the fall was greater than their focus in the winter 2. Productivity can also be affected by time of day1. As research suggests, we perform at our highest level of productivity in the late morning when our body temperatures start to rise. Our attentiveness, and remembrance increase gradually after waking up and most people become preoccupied from noon until 4 p.m., according to researchers at Pennsylvania State University3. This study also found our concentration starts to diminish after eating a meal, so we get tired around 2 p.m. With this revelation, take in the evolution of fall beauty and allow the relaxation and “good mood” area in the brain (the medial orbitofrontal cortex) to activate your thoughts and ideas, and Fall into research. *References available on page 3
~ Monica
Carilion Clinic Roanoke Campus
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Do You Have the Brain Power to Fall into Research Monica Coles, DNP, RN-BC, ACNS-BC, CDP References for Cover Article & Nursing Research Council Subcommittees At Work 2019 Carilion Nursing Research Conference - Registration is Open Nursing Research Conference Agenda Time is of the Essence: Decreasing Unplanned Extubations Pam Flinchum, ASN, RN, RT(R); Kathleen Hayes, BSN, RN, CCRN; Donna Bond, DNP, RN, CCRN, AE-C, CTTS Telling Your Professional Story: The CV, Biographical Sketch, Brief Bio, and Resume Kimberly Carter, PhD, RN, NEA-BC Standard Supply Pyxis Gem Indino, MN, RN; Kayla Duncan, RN; Tesalee Gentles, BSN, RN; Megan Ridgeway, RN; Rosetta Robertson, BSN, RN; Jodi Wilson, RN Article Review: Preventing Surgical Site Infections Related to Abdominal Drains in the Intensive Care Unit Robin Woody, BSN, RN Instillation of Hope: A Carilion Clinic Hospice Story Sharon Parker, BSN, RN; Sarah Browning, DNP, RN-BC The Use of Aromatherapy as Treatment for Nausea & Vomiting Sarah Dannhardt, 4th Year Nursing Student at JMU & 2018-2019 Carilion Nursing Research Intern
RECOGNITION/EVENTS 19 Within REACH Timeline 20
Recognition
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Conference Corner Virginia Nurses Foundation Gala & Awards Ceremony
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Nursing Research Summer Interns Citations & Recognitions See Where Our Nurses Have Travelled!
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2019 Nursing Research Classes - Information Additional Nursing Research Class Information
Carilion Nursing Research Editorial Board: Kim Carter, PhD, RN, NEA-BC - Editor-in-Chief Michele Kosinski, DNP, MBA, RN - Co-Editor Deirdre Rea, MSN, RN, PMH-BC - 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
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(Continued from page 1)
Do you have the brain power to Fall into Research? Monica Coles, DNP, RN-BC, ACNS-BC, CDP - CRMH Nursing Professional Practice References 1. Lim, A.S.P., Gaiteri, C., Yu, L., Sohail, S., Swardfager, W., Tasaki, S., Schneider, J.A., Paquet, C., Stuss, D.T., Masellis, M., Black, S.E., Hugon, J., Buchman, A.S., Barnes, L.L., Bennett, D.A., De Jager, P.L., (2018). Seasonal plasticity of cognition and related biological measures in adults with and without Alzheimer disease: Analysis of multiple cohorts. PLoS Med; 15(9): e1002647. https://doi. org/10.1371/journal.pmed.1002647 2. Meyer, C., Muto, V., Jaspar, M., KussĂŠ, C., Lambot, E., Chellappa, S.L., Degueldre, C., Balteau, E., Luxen, A., Middleton, B., Archer, S. N., Collette, F., Dijk, D.J., Phillips, C., Maquet, P., & Vandewalle, G., (2016). Seasonality in human cognitive brain responses. Proceedings of the National Academy of Sciences;113 (11) 3066-3071. https://doi: 10.1073/pnas.1518129113 3. Evans, M., Kelley, P., & Kelley, J. (2017). Identifying the best times for cognitive functioning using new methods: Matching university times to undergraduate chronotypes. Frontiers in human neuroscience, 11, 188. https://doi:10.3389/fnhum.2017.00188
NURSING RESEARCH COUNCIL SUBCOMMITTEES AT WORK! EBP Culture/Education Subcommittee
Week of the Nurse & Communicating Unit Based Work
Nursing Research Council Engagement
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REGISTRATION IS OPEN! To register go to our hub on Inside Carilion: https://www.insidecarilion.org/hub/nursing-research-evidence-based-practice/all-activity/carilion-nursing-researchconference
OR Go to carilionclinic.org/conferences and click on Nursing Research .
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Time is of the Essence: Decreasing Unplanned Extubations in Critical Care Pamela Flinchum, ASN, RN, RT(R); Kathleen Hayes, BSN, RN, CCRN; Donna Bond, DNP, RN, CCRN, AE-C, CTTS (Mentor) - CRMH 7S ICU, CRMH Nursing Professional Practice Background Unplanned extubation (UE) is defined as the inadvertent removal of an endotracheal tube from a mechanically ventilated patient1. This can be either intentional by the patient, or accidental when providing patient care. Adverse events related to UE include, but are not limited to the following: death, hemodynamic instability, respiratory distress, bronchospasm, laryngeal bleeding/edema, pneumonia, prolonged hospital stay, and increase cost. Literature confirms that most unplanned extubations are preventable1-4 . While most articles identified risk factors for UE without reviewing interventions to decrease unplanned extubations5-8, two papers identified interventions to reduce unplanned extubation, including focusing on improving communication skills between the interdisciplinary team9,10. Six percent of mechanically intubated patients had an UE at Carilion Roanoke Memorial Hospital (CRMH) in 2016 and 2017 (Table 1). At the time of this study, there were no local data available on the time frames from when the patient is awake and able to be extubated to the time of actual extubation. The purpose of this research study was to determine if improved communication during the mechanical ventilator weaning process between Respiratory Care Practitioners (RCP), Registered Nurses (RN), and providers would result in decreased wait time between when the patient being ready to be extubated and decrease unplanned extubations. Design This IRB-approved study used a quasi-experimental two-group nonequivalent comparison group design. Study objectives were to: 1. Determine the current time frame (wait time) from when the patient is ready to be extubated (weaning parameters documented) to the time of extubation, for both planned and unplanned extubations. 2. Implement a collaborative approach by utilizing a low-tech communication tool to record and document times. 3. Determine whether specific clinical patient data will affect the time from when the patient is ready to be extubated to the time of extubation, for both planned and unplanned extubations. The study population included patients over the age of 18, intubated with an endotracheal tube, and receiving mechanical ventilation in the four of the seven CRMH intensive care units: 7 South Intensive Care Unit, 9 South Medical Surgical Intensive Care Unit, 10 Mountain Surgical Intensive Care Unit and 8 Mountain Medical Intensive Care Unit. Method The intervention (low tech communication tool) contained information of date/time that the provider was notified that the patient was ready to be extubated. Patients who received the intervention were matched by gender, age, ethnicity, diagnosis who did receive the low-tech communication tool and received usual care. Data collection included an Electronic Medical Record review of patients hospitalized from December 2017 to March of 2018. Data collected included demographics (MRN, age, gender, ethnicity) admission diagnosis, length of time on mechanical ventilation, intensive care unit & hospital length of stay, and the home nursing unit. Findings A total of 334 patients receiving mechanical ventilation were eligible and screened for inclusion to the study (Figure 1). Forty-three patients received the intervention with the low-tech communication tool. These
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patients were matched to a similar group of 43 patients who did not receive the low-tech communication tool and received usual care. Patients in both groups were found to be waiting an average of 3.5-4 hours from either passing weaning parameters or notification of readiness for extubation to the time of extubation (Table 1). The time difference between the intervention and comparison groups was similar. In addition, 19% of patients did not have documented weaning parameters in the EMR. There were less unplanned extubations in the comparison group than in the intervention group. Implications for practice While this study did not decrease the wait time for patients being ready to be extubated to extubation time, or decrease the number of unplanned extubations, an extended wait time for patients to be extubated without regards to provider notification was identified. The communication in the intervention group took place face to face between either the Registered Respiratory Therapist or the Registered Nurse and the provider, documented with the low-tech communication tool. The usual care was documentation of the weaning parameters in the EMR with no notification. The provider had to obtain the results with no prompts. This information had not been available before this study and was presented to the critical care committee and escalated to executive leadership in late fiscal year 2018. As a result of organizational awareness of the issue, overall UE percentages decreased for the units that participated in the project as well as the overall organization percentage. Conclusion While this study did not produce immediate results, collaborative and parallel persistence by the research team and other healthcare disciplines has improved patient outcomes related to unplanned extubations by decreasing the percentage in half. The overall hospital UE percentage has decreased from 6% of intubated patients before the study to a current percentage of 3% (Table 2). In the 7S ICU, the home base of the study team, the unplanned extubation percentage decreased dramatically (from 5% to 1%). Further review is needed to see if the wait time for extubation has decreased from the pre-study levels. This study also resulted in the approval of a flowsheet to be added into the EMR to document patient extubation readiness, time provider contacted, and the extubation time, facilitating the ability to monitor extubation wait times. More work is needed to identify barriers for extubating mechanical ventilated patients. Figure 1. Study Enrollment Process
* Continued on next page
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References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
McNett, M. & Kerber, K. 2015. Unplanned extubations in the ICU: Risk factors and strategies for reducing adverse events. The Journal of Clinical Outcomes Management, 22(7), 303-311. Jarachovic, M., Mason, M., & Kerber, K. 2011. The role of standardized protocols in unplanned extubations in a medical intensive care unit. American Association of Critical Care Nurses, 20(40), 304-311. Silva, P. & Fonseca, C. 2012. Unplanned endotracheal extubations in the intensive care unit: Systematic review, critical appraisal, and evidence-based recommendations. Society of Critical Care Anesthesiologists, 114(5), 1003-1014. Burns, S., Fisher, C., Tribble, S., Lewis, R., Merrel, P., Conanway, M., & Bleck, T. 2012. The relationship of 26 clinical factors to weaning outcome. American Journal of Critical Care Nurses, 21(1), 52-58. Uy, A., Ramos, E., Rivera, A., Maghuyop, N., Suratos, C., Miguel R., Gaddi, M., & Zaldivar, J. 2019. Incidence, risk factors, and outcomes of unplanned extubation in adult patients in a resource-limited teaching hospital in the Philippines: A cohort study. Revisita Brasileira de Terapis Intensiva, 31(1), 79-85. Lin, P., Chen, C., Chiu, H., Tai, H., Lee, D., & Lai, R. 2019. Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit: A STROBE-compliant case-control study. Medicine, 98(11), e14841. Cosentino, C., Fama, M., Foa, C., Bromuri, G., Giannini, S., Saraceno, M., Spagnoletta, A., Tenkue, M., Trevisi, E., & Sarli, L. 2017. Unplanned extubations in intensive care unit: evidences for risk factors. A literature review. Acta Biomedica, 88(5S), 55-65. Chuang, M., Lee, C., Chen, Y., Huang, S., & Lin, I. 2015. Revisiting unplanned endotracheal extubation and disease severity in intensive care units. PLOS ONE, 10(10): e0139864. https://doi.org/10.1371/journal.pone.0139864. Chao, C., Lai, C., Chan, K., Cheng, K., Ho, C., Chen, C., & Chou, W. 2017. Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units: A 15-year experience. Medicine, 96(27), e6877. Chai, P., Santos, D., Tan, T., Leong, C., & Foo, D. Clinical quality improvement: eliminating unplanned extubation in the CCU. International Journal of HealthCare Quality Assurance, 26(7), 642-52.
Table 1
Table 2
*Editor’s Note: This study was completed as part of the Carilion Nursing Research Fellowship
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Telling Your Professional Story: The CV, Biographical Sketch, Brief Bio, and Resume Kimberly F. Carter, PhD, RN, NEA-BC - Senior Director, Nursing Research, EBP & Excellence Throughout your career, you may be asked to share your accomplishments and professional achievements. Sometimes nurses are asked to share a resume, and other times the request may be for a biographical sketch or a CV. Each has a different intent for documenting a successful career. The purpose of this paper is to (1) distinguish between a CV, biographical sketch, brief bio, and resume, (2) highlight important sections to include for each, and (3) provide suggestions for making your work stand out above the others. A CV (curriculum vita, vita) chronicles a career as it unfolds over time. A CV is like a career journal, so that all the information is in one place and immediately accessible. New information is added as it occurs, but former information also remains. Therefore, a CV can become many pages; the longer and more active the career, the more pages the CV will be. From the CV, you may abbreviate and pull out current information for a biographical sketch or resume. There is no standard format or structure, or even headings, that are universally expected for a CV. However, contact information, education, certifications, work experience, publications, presentations, grants, awards, and professional contributions are frequently included on a CV. A CV may also include student mentoring, committee membership and leadership, community service, professional volunteering, or other relevant sections. It is helpful to date the last page of the CV so that you can keep track of the most current version should you ever print the CV. A biographical sketch (biosketch) is most commonly used for grant applications, often using a standard template. A biosketch is usually limited to 4 pages and commonly has specifically required format and content to include. An example of a biosketch used by the National Institutes of Health (and used in modified version by Carilion Research and Development Office for RAP grants) is at https://grants.nih.gov/ grants/forms/biosketch.htm. The content of the biographical sketch focuses on the grant or purpose of the project for which the biographical sketch has been requested. Common sections of a biographical sketch include contact information, education, a personal statement of qualifications for the project, relevant positions and honors, relevant professional contributions, and funding support. Different from a biosketch, but frequently requested, especially for introductions, is a brief biography or brief bio. Typically, no longer than ½ to 1 double spaced page, a brief bio provides a synopsis of the information in a CV or biographical sketch in a conversational narrative. Education, recent work experience, credentials, and sometimes something more personal like hobbies or something interesting about you, are often included in a brief bio. A resume is used to provide current and specifically tailored information for a particular need (such as a job application or highlighting qualifications for a particular assignment or project). Resumes are typically no more than 2 pages, and most often include contact information, education, certifications, work experience, and professional contributions and achievements. Creativity is more often seen in resumes for format and structure to reflect the personality of the person that it is about, and content is determined by the goal of the document. There are many websites with samples, and templates, and even services that can be purchased to create the resume for you. As with any important document, remember also to save a back-up copy somewhere. Whether it is a CV, biographical sketch, brief bio, or resume, what is important is that the document is an honest reflection of your professional career. By keeping your CV current, you always will have at hand the information that you need for whatever professional summary document is needed. These documents make it easier for you to showcase your exceptional work and professional career.
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Standard Supply Pyxis™ Gem Indino, MN, RN; Kayla Duncan, RN; Tesalee Gentles, BSN, RN; Megan Ridgeway, RN; Rosetta Robertson, BSN, RN; Jodi Wilson, RN - CRMH 7 West Background of the Problem Supply Pyxis™ is a work area with potential for improvement to support efficiency and time management for nurses. Supply Pyxis™ is not systematic or standardized between nursing units, resulting in nurses spending unnecessary time searching for supplies or dealing with clutter. New nursing staff are especially challenged by the lack of standardization and organization in the supply Pyxis™. Nursing practice in acute care setting demands a high degree of multitasking and intense cognitive workloads. Despite the demanding workload, nurses must maintain patient safety in the presence of multiple system inefficiencies. Hendrich and colleagues (2008), suggest that improvements - such as unit organization and design as well as changes in workflow and technology - could make a great difference in how nurses spend their time and their ability to deliver care safely. Considering the large number of new nursing staff, and travelers, the potential for inefficiency and time-wastage is high. By adopting standardized Pyxis™, a structural design is communicated to everyone in the unit or facility. Goal Statement The purpose of this EBP project was to improve Supply Pyxis™ on 7 West by organization and standardization, to enhance nursing performance and efficiency. Additionally, the goal of this project was to develop a blueprint for use across units to improve Supply Pyxis™ standardization. Methods Nurses and supportive staff on the PCUs on 7M, 7W, 8S, 8W and 9S were surveyed between October 1, 2018 through January 4, 2019. Survey responses informed the need for Supply Pyxis™ improvements. Due to the complexity of reorganization, the process was piloted on one unit, and on May 10, 2018, the Pyxis™ supply reorganization was piloted on 7 West. A postimplementation survey was distributed to 7W staff one-month post implementation. 71 staff responded to the pre-survey, and 12 staff responded to the post-survey. Intervention/Initiative/Activities In collaboration with Materials Management, a structural design where supplies are grouped based on use was formulated. To do this, each supply was classified: (1) IV Kits & Syringes (2) Tubings & Fluids (3) Dressings (4) Respiratory & Gastro-intestinal (GI), and (5) Daily Care. The most important supply to be re-stocked in the pyxis was identified. Reorganizing an entire Pyxis™ is a complex and time-consuming process. It consists of listing all supplies, prioritizing the most needed and grouping them, comparing its size to its stock level ensuring it will fit in the bins, and manually encoding each supply in the computer system. This requires a collaborative approach between nursing and the Materials Management Department staff. The group spent 5 days to come up with a blueprint design of one pyxis. The actual reorganization of supplies took 8 hours by 3 people.
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Outcomes The survey was repeated one month after implementation, reflecting positive improvements: Table 1.
Survey Question It is easy to search specific supplies in Pyxis It is difficult to familiarize with the supply arrangement There is a need to organize or standardize Pyxis Average minutes wasted looking for specific supplies in Pyxis Best way to arrange supplies is based on use Post-intervention efficiency
Pre-Intervention 25%
Post-Intervention 100%
70%
25%
93%
100%
3-6 minutes
1-3 minutes
85%
100%
n/a
Is more improvement needed on the design/arrangement of Pyxis?
n/a
100% are more efficient with the re-structured pyxis. 25% more improvement needed
Impact on Patient Care and Nursing Practice Nurses and assistive staff reported that Supply Pyxis™ reorganization improved efficiency and saved time. Replication of this work on other units may benefit more nurses throughout the system, while considering unit-specific needs. For example, most Progressive Care Units (PCUs) have a 5-cabinet supply. For PCUs with only 4 cabinets, the Respiratory, GI and Daily Care Cabinets may be combined. For units with 6 or more cabinets, ADLs may take 2 or 3 cabinets depending on the need of the unit. The proposed Supply Pyxis™ standardized design may be created for any clinical area wishing to improve efficiency and performance. It is important to involve the staff who use the Supply Pyxis™ to create the best implementation for the individual unit. Effective implementation of the design requires an understanding of how to arrange supply based on use and efficient placement, Moreover, supplies must be updated based on the current needs of the unit. The authors of this paper are happy to assist other units in establishing a revised Supply Pyxis™ blueprint to improve quality and efficiency in their unit. When using this design, nurses can quickly simplify and arrange supply, recommend alternatives, and contribute to efficiency. An up-front commitment by the unit of staff to time away from direct patient care to focus on the unit’s Pyxis™ Reorganization and Standardization will be a long-term investment in overall efficiency and reduced interruptions for the staff. Reference Hendrich, A., Chow, M., Skierczynski, B., & Zhenqiang, L. 2008. A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3), 25-34. *Editor’s Note: This study was completed as a Nurse Residency Project
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Article Review: Preventing Surgical Site Infections Related to Abdominal Drains in the Intensive Care Unit Robin Woody, BSN, RN - 10M ICU Article Reviewed Orth, K. 2018. Preventing Surgical Site Infections Related to Abdominal Drains in the Intensive Care Unit. Critical Care Nurse, 38(4), 20–26. doi:10.4037/ccn2018254. Introduction This article explores possible nursing interventions to prevent Surgical Site Infections (SSIs) related to postsurgical drains. With focus on preventing staphylococcus aureus infections, assessing the postsurgical drain, selecting a dressing, maintaining drain patency, and assessing when to discontinue a drain. Background SSIs following abdominal procedures are reported by hospitals throughout the United States. Orthe (2018) reports that according to data published by the Centers for Disease Control and Prevention, nearly every U.S. hospital continues to report SSIs following abdominal procedures. These infections are classified by purulent drainage from the site, or presence of a fever, pain at the surgical site, or abscess. Stressing the importance of nursing interventions in preventing SSIs is crucial in lessening hospital costs and the patient’s length of stay. There are many different types of drains that are placed to attempt to decrease SSIs, but unfortunately, these drains can serve as the perfect host for infection if not properly maintained. This article specifically addresses nursing interventions for maintaining negative pressure drains. Interventions for Preventing SSIs Standard Precautions: It is important for nurses and all healthcare providers to wash their hands, either using soap and water or an alcohol solution, before and after coming in contact with a patient. Frequent washing of the hands, changing gloves, using personal protective equipment, discarding single using items, and cleaning multi use items, can prevent the spread of pathogens that are likely to cause SSIs. Prophylactic Suppression of S aureus: S aureus is the most common pathogen that is often the part of a person’s normal flora, but it can also be obtained during a hospital stay and lead to infections at surgical sites. Since S aureus does not cause infection, unless it colonizes and exceeds 1 million organisms, it is paramount to practice standard precautions, reinforce the importance of daily CHG baths, and applying mupirocin to those who have a positive culture, will help reduce patient’s risk of acquiring an SSI. Postsurgical Drain Assessment: This article poses many questions that are important for the nurse and the healthcare provider to ask themselves when assessing a postsurgical abdominal drain. Based on the answer to these questions and whether or not the nurse suspects an infection, will help to select the appropriate nursing intervention.
Selection of the Postsurgical Drain Dressing: Maintenance of a sterile dressing at the site for 24 to 48 hours is part of postprocedural care. Areas should be cleansed with CHG and a new dressing should be applied using sterile technique if the dressing is saturated or loose. The appropriate dressing should allow the site to stay clean and slightly moist. If after 48 hours the site has no exudate, the dressing may be taken off, and the site may remain open to air. If redness and exudate are present, the area should be cleansed and a semipermeable membrane and sterile dressing should be placed on top. If infection is suspected, a wound culture should be obtained, then the exudate should be cleansed and a hydrocolloid or an absorptive dressing should be placed. Dressing changes should be avoided until the dressing becomes saturated. Small discs that contain CHG, like biopataches, may also be placed at drain sites to further reduce the occurrence of SSIs.
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Maintaining Drain Patency: Postsurgical drains are placed at an anastomosis to evacuate fluid from the surgical site to prevent leakage, which in turn prevents infection. If a drain can properly remove fluid from the abdominal cavity that is being retained, this can help reduce SSIs. Techniques to maintain patency should be performed regularly. Flushing the Drainage Catheter: If output has stopped or has significantly decreased, flushing should be performed with 0.9% sodium chloride. An order should always be obtained from a physician before doing so. Once done flushing and fluid has been noted, ensure that negative pressure is maintained. Imaging may need to be obtained to ensure proper placement and function of the drain, if resistance, leakage, or pain is noted when flushing. Maintaining Negative Pressure of Collection Bulbs: This article noted that compressing the bulb by squeezing both sides with a fist, generated more negative pressure than pushing the bottom of the drain towards the top. Stripping the Drainage Tubing: Stripping is the act of gripping the drainage tubing between the thumb and forefinger at the site closest to the patient, to prevent the formation of clots. Once the nurse grips the tubing, the thumb and forefinger should move down the tubing towards the collection chamber. Nurses should limit stripping to when a clot is suspected or at the physician’s request. Preventing Kinks: Kinks can form easily and can cause complications if not identified. Each time a patient is turned or they ambulate, a drain should be checked for kinks. Stasis of wound exudate can cause SSIs; therefore, it is important to check for kinks in the drain tubing. Drainage Assessment Emptying the Drainage Reservoir: A negative pressure system reservoir should be emptied before filling, or at least once a shift. A physician should be notified if the nurse notes a change in color, consistency, and odor of the drainage. For example, a significant increase in output, darkening color, or increasing odor are all significant findings that should be relayed to the physician. When recapping, swab the top of the securement port with alcohol, and apply negative pressure. Indications to Discontinue Drainage Catheter: If a blockage has been ruled out and the amount of drainage has decreased over several days and output clears, relay these findings to the physician. Removing surgical drains as soon as indicated can decrease the number of SSIs. Conclusion This article stresses the importance of the nurse to routinely assess, practice drain maintenance, and communicate with the physician, and thus remove the drain when indicated, to prevent the occurrence of SSIs of abdominal drains. Implication for Practice On 10 MTN surgical ICU, we see these negative pressure drains regularly. If we follow the steps for assessing and maintaining negative pressure drains mentioned in this article, we can prevent SSIs. We can also use similar guidelines to prevent other HAIs, such as CLABSIs.
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Instillation of Hope: A Carilion Clinic Hospice Story Sharon Parker, BSN, RN & Sarah Browning, DNP, RN-BC - Carilion Clinic Home Care and Hospice In late 2018, the Carilion Roanoke Hospice team experienced a perfect storm of high patient acuity, cumulative patient loss, an escalating census, transition of the team’s Medical Director and 43% nursing staff turnover. This scenario, combined with 2018 Staff Engagement data drivers specific to workload and staffing, led the Roanoke Hospice leadership team to evaluate ways to promote work life harmony and employee retention. As an outreach toward staff support, a member of the Employee Assistance Program (EAP) shared the concept of "Instillation of Hope" (IOH) with the Hospice team and challenged them to identify ways they instill hope individually and collectively. IOH is a psychotherapy concept by Irvin Yalom, an American psychiatrist, that focuses on creating a sense of optimism especially when all hope seems lost1. When staff sense that there is no hope, it directly affects their sense of well-being and compassion, and impacts patient interaction2. After compiling a list of suggestions, the team adopted and implemented very creative IOH approaches to courageously address compassion fatigue and frustration in a season of intense transition. The intent of our IOH initiative is two-fold; staff report an increased sense of hope and well-being, and the benefits of IOH are mirrored in improved staff engagement and retention data. Since the inception of IOH in January 2019, Carilion Roanoke Hospice has experienced 0% staff turnover. Employee Engagement 2019 survey results (on a scale of 0-5) reflect a 1.28 positive gain in Workload/Staffing, a 0.66 positive gain in Adequacy of Resources & Staffing and a 0.59 positive gain in Work Life Balance as compared to 2018. (Figure 1) Staff satisfaction is also subjectively measured in staff meetings, 1:1 sessions, and small group discussion.
To address staff’s compassion fatigue specifically, the Chaplain and Bereavement Coordinator now offers special bereavement rituals once a month. During one bereavement ritual, staff were provided Mandalas and encouraged to select colors reflective of a former patient experience and to share their thoughts with the team. Additionally, upon learning of a patient’s death, the Chaplain now sends an email update to the team - asking them to pause and honor the patient. This simple act creates a virtual connection with the
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team (who is often in the field) and promotes a sense of unity and connection as everyone reflects on the life of this individual. The hospice nurses, clinical team leader and hospice manager met and continue to meet on a regular basis to identify and implement new staffing models. EAP representatives met with the team once a month to discuss perceived challenges and to brainstorm creative solutions. Staff from EAP, as well as Kuru Mindfulness Instructor Laurie Seidel, MSN, RN, taught the team how to incorporate mindful breathing techniques. As a constant reminder of self-care, a large wall art stencil with the words "Just Breathe" was strategically placed on the wall in the middle of the hospice office. During a three-month timeframe, the hospice massage therapist offered 15-minute massages with music and aromatherapy twice a month on team meeting days to lessen stress and fatigue. Since the staff spends considerable time in their vehicles, car essential oil diffusers were secured for staff to benefit from calming (lavender) or energizing (peppermint) aromatherapy when traveling from patient to patient. Several staff have commented that the diffuser is symbolic of IOH and the support they feel from leadership to promote self-care. Music therapy provided another outlet. Music was creatively infused into staff meetings – on Valentine’s Day we provided homemade heart-shaped cookies, and our board certified music therapist treated the team to a beautiful love song on her acoustic guitar. Off-site team building events such as hosting a going away party for the team’s former Medical Director and gathering for after hour foodie get-togethers and sports outings uplift staff and promote cohesiveness. The implementation of these simple measures has had a profound effect on the Hospice team; they are infused with hope because they have addressed their fears and anxieties courageously and have gained tangible ways to minimize stress and process cumulative loss. The team continues to consciously explore ways to incorporate ritual and symbolism and find joy daily - to entertain possibilities and promote restoration. The following quote from a hospice staff member captures the essence of the IOH initiative. “I think the best and most important aspect of ‘Instillation of Hope’ is the effort, and what it communicates to our staff. Despite the fact that we can’t all attend each ‘offering/event’, the effort communicates that we take self-care seriously, it acknowledges the particular challenges involved with end-of-life care, it affirms the importance of the work we do, and it promotes team-bonding through social events or sharing/ processing our grief at designated bereavement rituals.” This IOH endeavor reaffirms the value of listening to staff and providing a safe environment to share ideas and explore solutions. It also confirms that having the courage to implement simple measures with great intention can profoundly influence staff morale. We have learned that we must consider the staffing and financial impact of each idea. From this, we realized the need to start small – to use what you have and start where you are. Above all, we learned that to sustain this initiative we must incorporate ideas of front-line staff to keep the program meaningful and relevant. References 1. Gawne-Kelnar, G. (2010, September). Finding Hope: ‘The Instillation of Hope’ in Therapy and in Life. (Web log post) Psych Central. Retrieved from https://blogs.psychcentral.com/therapist-within 2. Mulcahy, L. (2018, September). New ways to support your hospice caregivers. Multibriefs.com. Retrieved from http://exclusive.multibriefs.com
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The Use of Aromatherapy as Treatment for Nausea and Vomiting Sarah Dannhardt, 4th Year Nursing Student at James Madison University; 2018 and 2019 Carilion Nursing Research Intern. Introduction In recent years it has become more common to treat nausea and vomiting with complementary therapies instead of pharmacologic measures, and as the desire for self-care remedies becomes more popular there has been an increase in aromatherapy products sold in the United States (Manion & Widder, 2017). Aromatherapy with essential oils has been studied for its effect on nausea and vomiting, especially oils such as peppermint, lavender, and ginger. Oils are frequently used, whether they are inhaled from diffusers, gauze pads, or oil burners; however, aromatherapy with substances other than essential oils has proven to be effective as well. In the following studies, the use of aromatherapy in decreasing nausea and vomiting was tested on multiple patient types with varying scents and techniques.
Search Strategy The articles evaluated in this review were found using a HERO database search. The inclusion terms were “aromatherapy” and “nausea treatment”. Journal articles discussing aromatherapy as nausea treatment were included for various patient types, including but not limited to ED patients, cancer patients, and postoperative patients. Articles on aromatherapy treatment for other symptoms such as pain were excluded, as well as articles that were not written in English or were not available as full text through the Carilion Health Science Library. After reviewing the available research, six articles that met the necessary requirements were selected and used for this review. Findings Post-operative patients frequently experience nausea and vomiting after awakening. This is a consistent issue, and it is estimated that 75 million patients suffer from post-operative nausea and vomiting (PONV) each year (Johnson et al., 2016). In an attempt to find new treatment options for PONV, numerous studies have tested the effectiveness of aromatherapy on this condition. Lee and Shin’s 2013 study exclusively tested ginger’s efficacy in reducing PONV, and their research indicated the therapy was beneficial for patients. As part of their study, an aromatherapy necklace containing ginger oil was placed around patient’s necks once they returned from the PACU. Each patient’s level of nausea and vomiting was evaluated 6, 12, and 24 hours after wearing the necklace. Results indicated that patients with the ginger necklace had significantly lower PONV than patients with the placebo, and the most drastic decrease occurred after 6 hours of wearing the necklace (Lee & Shin, 2013). A 2019 study by Karaman et al. was implemented to determine which essential oils were the most effective in reducing the nausea and vomiting experienced by post-operative patients. This study used gauze pads saturated with oils from ginger, lavender, and rose. After assessing their nausea level, the patients inhaled the scent from the gauze pads for five minutes and were reassessed 15 and 40 minutes later to determine their nausea level. The study found that lavender and ginger oil were effective in reducing PONV, but the rose oil had no significant effects on the subjects (Karaman et al., 2019). Collectively, these studies found that ginger was the most useful oil tested but other essential oils such as lavender can also be helpful for PONV. The previous studies focus on the use of aromatherapy with post-operative patients, but aromatherapy may be effective for other types of patients as well. For example, cancer patients can experience nausea and vomiting as side effects of chemotherapy. In a study by Stringer and Donald, an aromatherapy tool called the ‘Aromastick’ was given to cancer patients experiencing nausea (2011). The Aromastick is a small inhaler similar to a Vicks® VapoInhaler™ that comes with a blank wick, which allows each wick to be saturated with a personalized combination of oils specific to the patient. Once the wicks were prepared, the cancer patients were instructed to hold the Aromastick 6 inches below their nose and breathe deeply whenever they suffered from nausea. After using the Aromasticks for one week, 47% of the patients found them to be helpful in settling nausea (Stringer & Donald, 2011). Even though this product is not overwhelmingly effective, this inhaler offers an option for nausea treatment that can be easily used by patients at all times without requiring tools such as oil diffusers and burners.
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Yet another population of patients that suffers from nausea and vomiting are women in the early stages of pregnancy. Morning sickness can become a persistent problem that interferes with womenâ&#x20AC;&#x2122;s personal and work lives, as well as negatively affecting prenatal nutrition and potentially decreasing maternal weight gain (Lee, Lee, & Lim, 2004). This pressing issue led to Ghani and Ibrahimâ&#x20AC;&#x2122;s 2013 trial that tested aromatherapy in pregnant women. During this study women were selected from antenatal clinics and asked to use essential oils twice a day before napping and sleeping. They were instructed to place drops of lavender and peppermint oil on an oil burner and breathe in the scent for at least 20 minutes. The women recorded any morning sickness that occurred during the next three days, and it was found that both nausea and vomiting decreased by the third day of use; however, the women rated the treatment as overall being more useful in reducing nausea (Ghani & Ibrahim, 2013). While this study did not demonstrate a high effectiveness in decreasing vomiting, it does show that aromatherapy can be helpful in lessening the nausea caused by morning sickness. Another study evaluated the effects of 4 days of inhalation aromatherapy with peppermint oil on nausea and vomiting severity in pregnancy in a single-blind trial of 56 pregnant women between 6-20 weeks of gestation (Joulaeerad, Ozgoli, Hajimehdipoor, Ghasemi, & Salehimoghaddam, 2018). Both the intervention and control group experienced significant decreased nausea and vomiting (p<.001), but there were no statistically significant differences between groups, suggesting a possible psychological effect of the intervention itself. While essential oils are often the most recognized form of aromatherapy, other substances can be used as well. This is demonstrated in a study of Emergency Department patients complaining of nausea who were given isopropyl alcohol as the aromatherapy inhalant (April et al., 2018). Along with using a different scent, this study took a unique perspective because it combined aromatherapy with antiemetic medication. The patients involved in this research were given 5 mL of oral ondansetron or a placebo solution combined with a medical pad soaked in isopropyl alcohol or a placebo. All possible combinations of these treatments were used with patients receiving the oral dose followed by deep breaths of the saturated medical pad. The study found that all groups inhaling isopropyl alcohol experienced a decrease in nausea, and the combination of oral ondansetron with inhaled isopropyl alcohol led to the greatest relief from nausea (April et al., 2018). This study offers insight into a different type of aromatherapy, and it shows that even without antiemetic medication, inhaling isopropyl alcohol can be helpful for nauseous patients. Most of the subjects for research on aromatherapy as nausea treatment are patients at home or in certain patient areas. To determine whether or not aromatherapy could be an effective treatment in acute care settings, Johnson et al. (2016) implemented nurse-delivered aromatherapy at 10 hospitals in Wisconsin. After completing online training, nurses were allowed to use aromatherapy as a treatment for patients with nausea, pain, or anxiety when the nurse felt it would be a therapeutic option. Data from the study shows that ginger oil was the most effective in treating nausea, and while it was less effective, mandarin oil could also decrease nausea. The patients in the study who received nurse-delivered aromatherapy as part of their care had a statistically significant decrease in nausea, indicating this type of treatment can be useful for patients in the acute care environment (Johnson et al., 2016). Limitations The research in this review supported aromatherapy as a nausea treatment, but each study was limited. It can be difficult to accurately know the shelf life of the oils (Karaman et al.). A change in odor was the only indication a new bottle was needed, and no other controls existed to ensure the oils had not expired. Most studies in this review are limited by designs absent of strong control, especially when research was collected on patients using treatments at home. Another restraint of aromatherapy is the challenging task of blinding patients, because the differing scents of oils or alcohol cannot sufficiently be disguised. For example, it was immediately apparent to patients if they smelled lavender oil compared to a placebo of water, which would lack a noticeable scent. At the conclusion of all these articles the need for more research is recognized, specifically the necessity for larger sample sizes, more controls, and studies that have longer durations. These studies indicate aromatherapy can be useful, but more research is required before it can be considered an effective option for all patients.
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Conclusion Aromatherapy is not a newly discovered treatment, but recent public interest has led to research on the efficacy of its products. In the articles discussed above, aromatherapy alleviated symptoms for a significant amount of patients despite the limitations of the studies. If the interest in aromatherapy continues, more research is required to determine how to make therapies more controlled and effective. Once more is known about this treatment, it could be a breath of fresh air for many nauseous patients - or a breath of lavender, perhaps? References • April, M., Oliver, J., Davis, W., Ong, D., Simon, E., Ng, P., & Hunter, C. 2018. Aromatherapy versus oral ondansetron for antiemetic therapy among adult emergency department patients: A randomized controlled trial. Annals of Emergency Medicine, 72(2), 184-193. • Ghani, R., & Ibrahim, A. (2013). The effect of aromatherapy inhalation on nausea and vomiting in early pregnancy: A pilot randomized controlled trial. Journal of Natural Sciences Research, 3(6). • Karaman, S., Karaman, T., Tapar, H., Dogru, S., & Suren, M. (2019). A randomized placebo-controlled study of aromatherapy for the treatment of postoperative nausea and vomiting. Complementary Therapies in Medicine, 42, 417-421. • Joulaeerad, N., Ozgoli, G., Hajimehdipoor, H., Ghasemi, E., & Salehimoghaddam, F. 2018. Effect of Aromatherapy with Peppermint Oil on the severity of nausea and vomiting in pregnancy: A single-blind, randomized, placebo-controlled trial. Journal of Reproduction & Infertility, 19(1), 32-38. • Johnson, J., Rivard, R., Griffin, K., Kolste, A., Joswiak, D., Kinney, M., & Dusek, J. (2016). The effectiveness of nurse-delivered aromatherapy in acute care setting. Complementary Therapies in Medicine, 25, 164-169. • Lee, J. I., Lee, J. A., & Lim, H. (2004). Morning sickness reduces dietary diversity, nutrient intakes, and infant outcome of pregnant women. Nutrition Research, 24(7), 531-540. • Lee, Y., & Shin, H. (2017). Effectiveness of ginger essential oil on postoperative nausea and vomiting in abdominal surgery patients. The Journal of Alternative and Complementary Medicine, 23(3), 196200. • Manion, C., & Widder, R., (2017). Essentials of essential oils. American Society of Health-System Pharmacists, 74(9), e153-e162. • Stringer, J., & Donald, G. (2011). Aromasticks in cancer care: An innovation not to be sniffed at. Complementary Therapies in Clinical Practice, 17, 116-121.
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Community! Carmen Nolen, FNP-C, MSN, CCRN Carilion Clinic Cardiothoracic Surgery Finding Better Ways Recognition Carmen is a nurse practitioner for Carilion Cardiothoracic surgery at CRMH who is being recognized for “finding a better way” to serve our patients. Carmen was caring for a non-English speaking patient who had undergone surgery. Upon discharge, Carmen noticed the patient was having extensive difficulties understanding their medicine regimen. She purchased a medication pill box that used sun and moon pictures to help aid this patient in understanding when to take their medication. Based on Carmen’s innovated way of assisting our patients, Carilion has developed their own logo’d medication box to assist other patients with similar issues. Way to go Carmen!
Commitment! Paige Perkins, BSN, RN Carilion Stonewall Jackson Hospital Intensive Care Unit VHHA Virginia Speak of for Safety Award In 2017, Virginia Hospital and Healthcare Association (VHHA) launched a new initiative called “Virginians Speak up for Safety Award.” The program acknowledges the efforts of individuals and teams within Virginia hospitals who speak up to prevent potential harm to patients and other staff members. Two award recipients are recognized each quarter. Congratulations to Paige Perkins, BSN from CSJH for being selected as a recipient of this award for the 2nd quarter 2019. Paige was recognized by fellow staff as an outstanding nurse and dedicated advocate for patient safety.
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Commitment! Carilion Franklin Memorial Hospital Surgical Services Go Clear Award™ CFMH has earned the Gold Level Go Clear Award™ for its achievement in eliminationg hazardous smoke from its surgical procedures. The Go Clear Award™ is presented by the Association of perioperative Registered Nurses (AORN) to recognize health care facilities that have committed to providing increased surgical patient and health care worker safety by implementing practices that eliminate smoke caused by the use of lasers and electrosurgery devices during surgery. CFMH earned its award by undergoing comprehensive surgical smoke education and testing and for providing the medical devices and resources necessary to evaluate surgical smoke during all smoke-generating procedures.
Curiosity! .Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN Clinical Nurse Specialist - Carilion Trauma Services TEACH Health Professions Education Research Scholars Program (HERS) Jen was accepted into the 2nd class of the TEACH Health Professionals Education Research Scholars Program. This program is sponsored by the Teaching Excellence Academy for Collaborative Healthcare (TEACH). Enrollment is limited to a small cohort each year to ensure a meaningful experience for participants. The goal of the curriculum is to produce excellent education researchers in the health professions, through didactic and experimental sessions. In addition, participants will complete a mentored education research project of peer-reviewed quality. Congratulations Jen on being the only nurse accepted as a 2019-2021 HERS participant!
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Curiosity!
l-r: Dr. Michael Rothman; Brandie Bailey; Stuart Ramsey
Brandie Bailey, DNP, RN, NEA-BC Unit Director - CRMH 9S ICU Research Publication Award TRENDS 2019, The Rothman Index Customer Conference Brandieâ&#x20AC;&#x2122;s DNP project was to determine if an Early Warning System (the Rothman Index) had an impact on patient outcomes. Her passion for providing the best care possible for Carilionâ&#x20AC;&#x2122;s patients allowed her to advance nursing practice using the Rothman Index and become the recipient of the 2019 Research Publication Award at the Trends 2019 Conference.
Commitment! Carilion Clinic Rothman Index Award Trends 2019, The Rothman Index Customer Conference Carilion used RI Analytics to track ICU bounce-backs, and through their analysis of this data created a new care delivery process that resulted in a 50% reduction in bounce backs. They continue to use the tool to monitor sustainment of these results. Additionally, this organization has used RI Analytics to demonstrate reduction in code blues and ICU length of stay. They also incorporate the use of analytics to support nursing research work.
l-r: Heather Bramblett; Brandie Bailey, Abronique Berger, Andrew Green; Dr. Michael Rothman
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Compassion! Phyllis Whitehead, PhD, APRN, ACHPN, RN-BC Clinical Nurse Specialist, CRMH Palliative Care Schwartz Center National Compassionate Caregiver of the Year Award - Honorable Mention Phyllis was awarded Honorable Mention for the 2019 Schwartz Center National Compassionate Caregiver of the Year (NCCY) Award. The nomination and award signifies that she is dedicated to making compassion central to the healthcare experience and that she is part of a distinguished group of recognized caregivers across the nation.
Compassion!
Top Row, l-r: Erin Casey; Tammy Mitchell, Dr. William Rea; Cindy Ward. Bottom Row l-r: James Ingrassia, Deirdre Rea; Jamie Sizemore; Donna Sebastian. No photo available - Catherine Lane
The Hope Team Tammy Mitchell, MSN, RN; Cindy Ward, DNP, RNBC, CMSRN, ACNS-BC, Deirdre Rea, MSN, PMHCNS, RN-BC; Dr. William Rea; Donna Sebastian, BSN, RN; Erin Casey, MA; James Ingrassia, MSN, RN; Jamie Sizemore; Catherine Lane, LCSW Schwartz Center National Compassionate Caregiver of the Year Award - Honorable Mention Carilionâ&#x20AC;&#x2122;s Hope Team was one of the many worthy teams and individual caregivers nominated for this award. They exemplify what compassionate care is all about by demonstrating extraordinary empathy for their patients and their families. The teamâ&#x20AC;&#x2122;s nomination signifies that they are dedicated to making compassion central to the healthcare experience and that they are part of a distinguished group of recognized caregivers across the nation.
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14th Annual Virginia State Simulation Alliance Conference, Williamsburg, VA Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN and Dan Freeman, MSN, RN represented their team in Williamsburg at the Great Wolf Lodge & Conference center with their project titled, Advanced Nurse Training: Impact on Trauma Team Attitudes and Performance. This conference presents a statewide platform for individuals and organizations committed to integrating simulation into healthcare education and practice.
43rd Annual Hospice & Palliative Care Conference of The Carolinas Center, Greenville, SC Johnathan Phillips was accepted as a podium presenter for this September 2019 conference in Greenville, SC. This conference is designed exclusively for hospice and palliative care professionals. His presentation Assessing Palliative Care and End-of-Life Educational Needs of Registered Nurses Working with Adult Inpatients supported the need for all nurses regardless of setting to expand their knowledge base regarding palliative care. Johnathanâ&#x20AC;&#x2122;s conference travel was funded by a Carilion Nursing Research Nightingale Award.
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15th Annual American Association of Heart Failure Nurses Meeting, Austin, TX Renee Gerow, MSN, RN presented her poster titled, Early cardiac rehab to reduce heart failure readmissions in Austin, TX in June. Renee and Nancy Altice, DNP, RN, CCNS, ACNS-BC 2017 Fellowship project has been accepted for presentation at 5 conferences in 2018-2019, (AACVPR, Carilion Research Day, VACVPR & VNA) and was also published in the Journal of Cardiopulmonary Rehabilitation and Prevention in 2018. Congratulations Renee and Nancy!
Respiratory Nursing Society 29th Annual Education Conference, Roanoke, VA Donna Bond, DNP, RN, CCNS, AE-C, CTTS, CRMH Clinical Nurse Specialist presented at our very own Hotel Roanoke at the RNSIC conference in August. Her study titled, They are breathing aren’t they? Why counting respiratory rate is important”, was developed to “identify opportunities for accurate monitoring and recording of respiratory rate, to support better use of data in our PeraTrend™ Early Warning System and best outcomes for patient care”.
Virginia Nurses Association (VNA) Fall Conference, Short Pump, VA Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC, Clinical Nurse Specialist presented her team’s poster titled, Nursing Burnout with Substance Using Inpatients: A New Hope at the 2019 VNA conference, whose theme this year was Mind Matters, Improving Mental Healthcare Delivery Across Settings. The conference encouraged nurses to provide effective healthcare without considering the mental health of the individual. In addition to presenting her team’s poster, Cindy also was chosen for a Rapid Session presentation for this same study.
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Virginia Nurses Foundation Leadership Excellence Awards
Kim Carter, PhD, RN, NEA-BC Award Recipient VNF Nurse Researcher “ Kim assisted with developing, testing, and approving the CLEAR model, which provides a useful framework for navigating the decision making and resources necessary to answer important clinical questions. She has authored or co-authored 36 peer-reviewed papers and book chapters, and she has presented or co-authored presentations at national and international conferences. Her enthusiasm for disseminating knowledge is contagious, and she inspires and supports colleagues to take risks and get outside their comfort zone to present and publish their work”. ~ Nominated by Christina Monk
(Kim Carter, PhD, RN, NEA-BC - on right)
Brandie Bailey, DNP, RN, NEA-BC—- - 9S ICU Award Recipient VNF Nurse Manager/Director “Brandie has contributed to providing safe environments for patients and staff, working collaboratively to impact the patient experience and discharge planning. She worked with senior nurse leaders to create a new position and orientation plan for float RNs to include all Carilion Clinic sites and also developed the Admission/Discharge RN team. Brandie also led an initiative to update defibrillators, ensuring they were up to date with the latest evidence based practice, saving the organization approximately $3 million.” Brandie Bailey, DNP, RN - center
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Arielle Watkins, BSN, RN, CCRN - 8M ICU Award Recipient VNF Direct Patient Care Leader Patient Safety
Arielle Watkins, BSN, RN, CCRN - on right
“Arielle is very involved in the unit’s leadership council which reviews safety issues. She is also the chair of the Education Council and is responsible for education coordination on a monthly basis. Arielle was recruited for nursing input by our pulmonary hypertension specialist physicians and pharmacist to assist in writing the hospital—wide nursing education for PCU and step-down nurses, which has important information needed to care for patients receiving Remodulin®.” ~ Nominated by Christina Monk
Carilion Clinic—Roanoke Campus Recognition 4th Magnet® Designation Pam Lindsey, Carilion Magnet Program Director and Kim Carter, Senior Director of Nursing Research were present at the VNF Gala for the recognition of Carilion Clinic Roanoke Campus’s 4th Magnet® Designation. “Consumers rely on Magnet designation as the ultimate credential for high quality nursing. Magnet® is the leading source of successful nursing practices and strategies worldwide”. ~ from the VNF Gala Program
Pam Lindsey, MSN, RN (center); Kim Carter, PhD, RN, NEA-BC (on right)
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Virginia Nurses Foundation Leadership Excellence Awards & Magnet Award Nominees MAGNET AWARDS: Collette Carver, DNP, APRN, FNP-BC, NEA-BC Senior Director Family & Community Medicine Sharon Parker, BSN, RN – Home Health & Hospice Manager LEADERSHIP EXCELLENCE AWARDS: Director Patient Care Leader Patient Safety • Emily Codrea, BSN, RN, CCRN – CTL NTICU • Cheyanne Spradlin, BSN, RN – Preceptor 8S PCU Direct Patient Care Leader Patient Experience • Savanna Eckrote, RN – 8S PCU • Heather Moreno, RN – CTL 6M VICU • Michelene Morin, BSN, RN – 10M ICU Nurse Manager/Director • Nicole Hale, BSN, RNC-OB, C-EFM – Unit Director – Mother/ Baby • Annie Phillips Smith, MSN, RN – Unit Director - 10W Med/ Surg • Patricia Kingery, MSN, RN - Unit Director - Oncology Chief Nursing Officer • Veronica Stump, MA, BSN, RN, NEA-BC – CNO/Nursing Senior Director – CGMH **Carilion Clinic, Roanoke Campus was recognized for their 4th Magnet® Designation (2018)
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l-r: Pam Lindsey, MSN, RN; Rebekah Draper, MSN, RN, CPN (RUC)
Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN
l-r: Arielle Watkins; Kim Carter; Brandi Bailey, Savanna Eckrote, Pam Lind-
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INTERNS!
Laura Kate Jennings arrived this summer for her first experience as a Nursing Research Intern. She is a graduate student at Liberty University studying public health and epidemiology. Her main interest is epidemiologic research and community outreach and education. Laura Kate graduated from the University of Virginia in May 2018 with a bachelor’s degree in biology and bioethics. This summer not only did she work for the Nursing Research department, but she also coached a high school swim team and taught swimming lessons to young children. In her spare time, Laura Kate loves to read books, drink coffee and binge watch crime shows on Netflix! About her summer with Nursing Research she said, “I have enjoyed my summer working on research data entry, literature reviews and various other projects.” Her goal is to continue her education and gain an eventual PhD in Epidemiology or related public health field. Best of Luck Laura Kate! Fun Fact! Laura Kate’s mom is our very own Clinical Nurse Specialist in CVI, Cathy Jennings!
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Welcome back Sarah! Sarah Dannhardt came back for her second Nursing Research Summer Internship. Sarah began her senior year as a nursing student this fall at James Madison University. She is the Vice President of the JMU Nursing Student Association and a member of several other organizations, including the Red Cross and Catholic Campus Ministry. Sarah is interested in working in either the NICU or in the perioperative field and hopes to pursue these specialties after graduation. Her goal is to eventually work as a travel nurse before going back to school and advancing her career as a nurse educator or leader. This summer she was able to assist us with several research projects, including studies on diabetes protocols, nurse moral distress, and nurse burnout rates. Sarah wrote a research paper on the use of aromatherapy for nausea treatment that is published in this October Within REACH and will be presented at our November Nursing Research Conference. At the end of her internship she said, “I’m going to miss my fabulous work mamas and hanging out in nursing administration, but I’m so excited to get back to JMU for my last year of nursing school. I can’t wait to see what the next year holds!” Good Luck Sarah!
Nina Amato is from Buffalo, NY and is a Senior at Roanoke College. She is majoring in Psychology. This summer was her first internship with Nursing Research. Nina worked on several projects, constructing spreadsheets entering and managing data. Nina was involved with data pertaining to Admin/Discharge, Restraints, Fecal Management and Pain Management. She is a member of the Chi Omega Sorority at Roanoke College. After her internship was completed, she traveled to India with her mom to work with impoverished children in the school setting. After graduation, Nina will be continuing her education as she applies to nursing school. She plans to return to Buffalo to practice nursing. Keep making a difference Nina!
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June 2019 - October 2019 Whitehead, P., Carter, K. April 9, 2019. Exploring nurse manager moral distress: Moving from collegial conversations to a collaborative research study. Omega Zeta Chapter of STTI Research Day, Harrisonburg, VA
Davenport, P., Griffiths, N. April 10-11, 2019. An international perspective: The role of Command Centers to tackle operational variation and integrate large not-for-profit multihospital health systems. Health Service Journal Provider Summit, Nottingham, England. Mitchell, T., Casey, Erin. July 11, 2019. Patients come first - The Hope Floor. VHHA Communications - Patients Come First Podcast: https://www.vhha.com/communications/patients-comefirst-tammy-mitchell-and-erin-casey/
https://soundcloud.com/user-51117823/vhha-patientscome-first-podcast-tammy-mitchell-and-erin-casey https://www.blubrry.com/ patients_come_first/45845269/patients-come-firstpodcast-tammy-mitchell-and-erin-casey/ Harvey, E., Peters, K., Wright, A., Bath, J., Freeman, D., Hamill, M., Meadows, G., Flinchum, M., Collier, B. July 30-31, 2019. Advanced Nurse Training: Impact on trauma team attitudes and performance. 14th Annual Virigina State Simulation Alliance Conference, Simulation in Healthcare, Williamsburg, VA
Bath, J. August 16, 2019. Just breathe...Chest Trauma in the Pulmonary System. Respiratory Nursing Society 29th Annual Education Conference, Roanoke, VA Collins, L. August 29, 2019. Dysphagia & Stroke: To PEG or Not to PEG. Carilion Stroke Conference, Roanoke, VA
Ward, C., Mitchell, T. September 26-29, 2019. Effects of behavioral intervention team on registered nurse burnout. Academy of MedicalSurgical Nurses, 28th Annual Convention, Chicago, IL Phillips, J. September 9-11, 2019. Assessing palliative and end-of-life educational needs of registered nurses working with adult inpatients. The Carolinas Centerâ&#x20AC;&#x2122;s 43rd Annual Hospice & Palliative Care Conference, Greenville, SC Ward, C., Mitchell, T. September 20-21, 2019. Nursing burnout with substance using inpatients: A New Hope. 2019 Virginia Nurses Association (VNA) Fall Conference, Short Pump, VA (Rapid Fire Presentation) Lucas, A. September 25, 2019. Early Identification Sepsis: Role of the CNS. National Association of Clinical Nurse Specialists (NACNS) webinars, Roanoke, VA Bailey, B. September 26-27, 2019. Using the Rothman Index for Research. PeraHealth Trends 2019, The Rothman Index Conference, Baltimore, MD
Bond, D., Robinson, D. August 16-17, 2019. They are breathing aren't they? Why counting respiratory rate is important. Respiratory Nursing Society 29th Annual Education Conference, Roanoke, VA
Foster, M., Pydah, S., Carter, K. April 9, 2019. Pain management through art and relaxation. Carilion Research Day, Roanoke, VA.
Carter, K. August 16, 2019. Every Breath You Take: Research, Question, Improve. Respiratory Nursing Society 29th Annual Education Conference, Roanoke, VA
Bond, D., Robinson, D. August 16-17, 2019. They are breathing aren't they? Why counting respiratory rate is important. Respiratory Nursing Society 29th Annual Education Conference, Roanoke, VA
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Carter, K., Bogue, R. August 29, 2019. Strategies to Minimize Nurse Burnout and Emotional Exhaustion: Finding the Balance. Carilion Clinic Stroke Conference, Roanoke, VA Girani, L., Allen, A., Behnisch, J., Peters, K., Hodges, S., Bond, D. September 19, 2019. When You Need to Vent - Ventilator associated pneumonia in the Emergency Department. Women Building Bio 4th Annual Regional Conference, Fairfax, VA Ward, C., Mitchell, T. September 20-21, 2019. Nursing burnout with substance using inpatients: A New Hope. 2019 Virginia Nurses Association (VNA) Fall Conference, Short Pump, VA Bond, D., Robinson, D. September 26-29, 2019. They are breathing arenâ&#x20AC;&#x2122;t they? Why counting respiratory rates is important. 28th Academy of Med -Surg Nurses Annual Convention, Chicago, IL. Parkhurst, A., Gibson, K. October 14-16, 2019. Nursing staff satisfaction on quality of care using a FIM-based acuity tool. American Medical Rehabilitation Providers Association (AMRPA) 2019 Fall Educational Conference & Expo, San Diego, CA
Howe, K., Collier, B., Bath, J., Lagoy, J., Criss, T., Faulks, E., Lollar, D., Bower, K., Locklear, T.,Matos, M., Nussbaum, M., Hamil, M. July 19, 2019. The 2 faces of intentional self-inflicted injury: High in-hospital mortality, low postdischarge mortality, but high readmission rates. Official Journal of the Society of Univeristy Surgeons, Central Surgical Association and the American Association of Endocrine Surgeons. Surgery 166(4):580-586, October 2019, doi: 10.1016/j.surg.2019.04.037 Whitehead, P., Keating, S., Gammaludin, S., Kye, K. August 2019. End-of-life care in persons with severe mental illness: A review of research outcomes.Palliative Care: The Role and Importance of Research in Promoting Palliative Care Practice, Volume 2. Hauppauge, NY: Nova Science Publishers, Inc. ISBN: 978-1-53616-199-1 Whitehead, P., Dahlin, C. 2019. (Editors) Compendium of Nursing Care for Common Serious Illnesses, 3rd Edition. ISBN: 978-1-934654-56-9
Practical Applications of Nursing Inquiry
Bath, J. 2019. Neurological Disorders. Compendium of Nursing Care for Common Serious Illnesses, 3rd Edition. ISBN: 978-1-934654-56-9
Parkhurst, A., Carter, K. April 2019. Carilion Foundation grant awarded for Improving patient education through best practice using technology. Award amount: $16,583.
Whitehead, P. September 2019. Phyllis was awarded Honorable Mention for the 2019 Schwartz Center National Compassionate Caregiver of the Year (NCCY) Award. The nomination and award signifies that she is dedicated to making compassion central to the healthcare experience and that she is part of a distinguished group of recognized caregivers across the nation. Mitchell, T., Ward, C., Rea, C., Rea, W., Sebastian, D., Casey, E., Ingrassia, J., Sizemore, J. September 2019. The Hope Team was awarded Honorable Mention for the 2019 Schwartz Center National Compassionate Caregiver of the Year (NCCY) Award. The nomination and award signifies that they are dedicated to making compassion central to the healthcare experience and that they are part of a distinguished group of recognized caregivers across the nation. Bailey, B. September 26-27, 2019. Awarded the Research Publication Award at the PeraHealth Trends 2019 The Rothman Index Conference.
Carilion Clinic. September 26-17, 2019 Awarded the PeraTrend Analytics Award at the PeraHealth Trends 2019 The Rothman Index Conference.
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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 Springs
Greenville
Lake Buena Vista
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Practical Applications of Nursing Inquiry
REGISTER IN CORNERSTONE FOR ONE OF OUR additional RESEARCH CLASSES! *********** Data: Practical Applications for Healthcare NR-CE377L November 8, 2019 9:00am-12:00pm ************* Keep an eye out for our 2020 dates for these classes which have already been held in 2019:
Courageous Editing and Compassionate Critique NR-CE192L Creating Professional Posters Workshop NR-CE238L
Open Mentored Writing Lab NR-CE037L Poster Development Class NR-CE238L Pre-Nursing Research Fellowship Brainstorm Sessions NR-CE354L
Need editorial or financial support to present your work at a national nursing conference? Contact Nursing Research & EBP for: • Assistance with writing your abstract • Poster development • Financial support through Nightingale grants. nursingresearch@carilionclinic.
Carilion Clinic Roanoke Campus