Summer is here! Nowhere is that more evident than the current temperatures in the Roanoke Valley. I had the privilege to attend the Climate, Health and Heat Symposium here at Carilion on Saturday, June 22. During this symposium, we heard from various experts on problems related to heat and health, especially for those in special populations, as well as the threat of rising temperatures on our communities. For more information, I would encourage you to check out Heat Ready Roanoke at https://planroanoke.org/heat-ready-roanoke/. The biggest ‘take home’ for me from this symposium is that there is so much we can do to support our communities through education and advocacy to both impact heat vulnerable areas and to impact our patient outcomes during heat events.
In this, the Spring issue of Within REACH, we want to remind you that Within REACH submissions are accepted on a rolling basis and that we accept stories and articles related to article critiques, human interest stories, literature reviews, evidence analysis, research, quality improvement, and proposed state or national legislation. Essentially, any story that aligns with our REACH professional model of practice is appropriate for peer review and publication. We would especially like to hear your potential Magnet stories! By publishing in Within REACH, we have a recorded source of studies with outcomes and contact information and there is the potential to collect other stories for our next Magnet survey!
CarilionNursingResearchEditorialBoard: Chris Fish-Huson, PhD, RN, CNE - Editor-in-Chief
Reviewers
Nancy Altice, DNP, RN, CCNS, ACNSBC
Desiree Beasley, MSN, RN, CCNS, CCRN
Sarah Browning, DNP, RN-BC
Charles Bullins, DNP, RN, AGACNPBC
Sarah Dooley, MPH, BSN, RN
Troy Evans, MSN, RN, CCRN, NHDPBC, NEA-BC
Cindy W. Hodges, MSN, RN-BC, FCN
James Ingrassia, MSN, RN
Pam Lindsey, MSN, RN
Lauren Miley, BSN, RN, PCCN
Laura Reiter, DNP, RN, CCRN, CNRN
Cindy Ward, DNP, APRN-CNS, RN-BC, CMSRN, ACNS-BC
RN 2
Collaboration!
In 2022 Carilion hospice started a focus on the need for GIP (General Inpatient Hospice) for patients who need aggressive symptom management at end of life. The program has grown into a team of 3 GIP RN's and 1 GIP SW. In addition to this dedicated team at RMH patients and families also benefit from the full hospice experience. These services include music and massage therapies, Veteran honoring ceremonies, End of Life Doula support, Chaplaincy and early bereavement. In March this team had the opportunity to provide services to a record breaking 30 patients and families. It is a blessing to have this service to care for the patients and families who may not make it home. So, Thank You and Congratulation's to Kaylyn (RN), Cheyenne (SW), Ryan (RN) and Kelli (RN)!
Commitment!
Due to the tremendous impact of NODA (No One Dies Alone) in CRMH’s Palliative Care Unit, the program has expanded to serve patients in the Cancer Care unit and the Emergency Department. Additionally, the program is expanding this Summer to Carilion New River Valley Medical Center under the coordination of Guest & Volunteer Services. At Tuesday’s training, nearly 75 prospective volunteers joined inperson and via Teams! An engaging and informative training will provide the foundational tools these volunteers need to begin their NODA journey.
Joseph Whiting, D.Min, M.Div Dr. Phyllis Whitehead, PhD. Alison Smoke, LCSW
By: Sarah E. Frewin, MSN, RN, PCCN
Article Reviewed: Watson, A.L., 2024. Nurses’ professional quality of life and self-care: A mixed-methods study. AmericanJournalofCriticalCare , 33 (1), 66-69.
Introduction:
Dr. Watson conducted a study to answer the question “Does an enhanced awareness of compassionate self-care activities among nursing professionals promote professional QOL?” (Watson, 2024, p.67). The profession of nursing has a high rate of burnout and compassion fatigue, leading to nurses leaving the profession. This was only exacerbated more with the Covid-19 pandemic. Some believe that if you can increase a nurse’s resiliency that it would help retain nurses. This study was an attempt to add more to the available current evidence
Critique:
Dr. Watson used a mixed method study design. This allowed her to obtain quantitative and qualitative data to answer her research question. Her intervention was a six week educational program with topics related to self-care. A new topic of self-care was presented each week. Evidence related to how the self-technique helped, was included in the education. Participants committed to applying the strategies throughout the study. The topics included nutrition, exercise, gratitude, resilience, and work-life balance.
The quantitative portion included data collected by surveys before and after the intervention. The survey used was a validated tool, named the Professional Quality of Life Scale (ProQOL). Using a validated tool adds rigor and allows others to replicate a study more easily. Her qualitative portion consisted of written free response regarding the intervention. This is a great method to capture data that is not on a survey tool, explore themes more in-depth, and understand the study topic better. (Gray & Grove, 2020a)
The study population consisted of 40 nurses and nursing assistants on medical-surgical and intensive care units. It was a convenience sample. Convenience sampling for study participants in a research study has pros and cons. The pros are that you can easily get participants from an area for your sample, and can be less costly. There are many cons. It is non-random, biased, and can make your findings overall, less significant. (Gray & Grove, 2020a)
Dr. Watson used an independent t-test to analyze her quantitative data. A t-test is used to determine statistical differences in the pre and post data. It compares the mean of two groups and helps determine if a treatment/intervention had an effect. This was an appropriate statistical analysis for her study because she used the same survey before and after, with the same participants, allowing direct comparison. She analyzed the written responses and grouped the responses into themes, which is appropriate for qualitative analysis. (Gray & Grove, 2020a)
Results:
The outcome of Dr. Watson’s study showed that there was no statically significant improvement in any of the categories of the ProQOL with incorporating the self-care techniques. Her qualitative portion of the study though, presented three themes that emerged from the content analysis of the nurses’ responses. Those themes were balance, wellness, and learning. The author concluded that the qualitative portion showed some evidence of improvement in the study participants’ professional quality of life.
Discussions and Implications:
While this study was needed to add to the body of evidence for interventions to increase nurse resiliency, it had some limitations. First, her sample size was small and it was conveniently obtained. She did not include a power analysis or confidence intervals which would have shown that the findings of her study were truly related to the intervention provided. The author listed using a paper
survey and manual submission of a packet was a possible barrier to obtaining a larger sample. There was a lack of detail about her qualitative process, which would help the reader feel more confident in the findings. Qualitative research has standards and processes, like quantitative research, to increase the validity of the findings.
Even though this study had some limitations, the findings did correlate with the current evidence available. Professional quality of life cannot be obtained from only self-care techniques. Professional quality of life comes from “a triad of organization support, a healthy work environment, and individual nurse resilience” (Watson, 2024, p.69).
Conclusion:
As a staff nurse, this article gives validity to my own personal experience that self-care techniques alone are not the answer to burnout and compassion fatigue. Despite instituting various self-care practices, I still found my professional quality of life was not optimal. I have seen many colleagues leave the profession of nursing due to burnout and unhealthy work environments. Organizational support beyond telling and helping the nurse to institute coping techniques is needed. Ensuring a healthy work environment, as supported by the American Association of Critical Care Nurses (AACN), is paramount. Support from our nursing leaders and hospital administrators is vital. Without these things, we will continue to lose more nurses.
Resources
Gray, J. R., & Grove, S. K. (2020a). Burns and Grove’s ThePracticeofNursingResearch- E-Book:Appraisal,Synthesis,andGenerationofEvidence.Elsevier Health Sciences.
Watson, A. L. (2024). Nurses’ Professional Quality of Life and Self-Care: A Mixed-Methods Study. AmericanJournalofCriticalCare , 33(1), 66–69. https://doi.org/10.4037/ajcc2024714
Title: “WilltheImplementation oftheControlledStimulus ProgramforAcquiredBrainInjury ImproveQualityOutcomesinthe Neuro-TraumaClinicalSettings”
Sarra Wildermuth: BSN, RN, CRMH CRMH 9M ICU –Unit Director
Kayla Frantz
Minna Hamalainen: MSN, RN, CRMH 9M PCU-Unit Director
Karyn Reese
(Mentors: Jennifer L. Bath, DNP, RN, AGCNS-BC, CBIS, TCRN, CEN and Ellen Harvey, DNP, APRN, ACNS-BC, CCRN, TCRN, SCRN, FCCM)
March 2024 - May 2024 (& past presentations not noted prior to this edition)
Bath, J. (2024, January 12-13). Transition to Practice for Clinical Nurse Specialists. [Oral presentation]. Virginia Association of Clinical Nurse Specialists New Tools for Your CNS Toolkit Conference. Lynchburg, VA.
Wolf, L. & Bath, J. (2024, January 12-13). Human Factors to Improve Provision of Care [Oral presentation]. Virginia Association of Clinical Nurse Specialists New Tools for Your CNS Toolkit Conference. Lynchburg, VA.
Bowser, S. (2024, February 24). Happy Nurses Have Happy Patients, How Carilion Clinic Utilizes Mindfulness and Code Lavender to Support Well Being. [Oral presentation]. Virginia Student Nurse’s Association 72nd Annual Convention. Virginia Beach, VA.
Bath, J. (2024, March 10). Trauma Boot Camp to Improve Knowledge, Skills, Confidence, and Frequency of Unplanned Intensive Care Admissions. [Oral presentation]. National Association of Clinical Nurse Specialists (NACNS) 2024 Annual Conference. New Orleans, LA.
Bond, D. (2024, March 10). Surgery and Trauma Opioid Project (STOP). [Oral presentation]. National Association of Clinical Nurse Specialists (NACNS) 2024 Annual Conference. New Orleans, LA.
Bond, D. (2024, March 12). Is Buprenorphine One of he Answers to the Opioid Crisis? [Oral presentation]. National Association of Clinical Nurse Specialists (NACNS) 2024 Annual Conference. New Orleans, LA.
Whitehead, P. (2024, March 10). A CNS Roadmap to Attaining Institutional Recognition as Advanced Practice. [Oral presentation]. National Association of Clinical Nurse Specialists (NACNS) 2024 Annual Conference. New Orleans, LA.
Whitehead, P. (2024, March 10). Pain Management Task Force. [Oral presentation]. National Association of Clinical Nurse Specialists (NACNS) 2024 Annual Conference. New Orleans, LA.
Whitehead, P. (2024, March 12). Hospice CTI Research Survey: Advanced Practice Providers Barriers and Delays in Care. [Oral presentation]. National Association of Clinical Nurse Specialists (NACNS) 2024 Annual Conference. New Orleans, LA.
Whitehead, P. (2024, March 10-13). The Role of the CNS in Pain Management: Updated Position Statement. 2024 National Association of Clinical Nurse Specialists Annual Conference. New Orleans, LA.
Whitehead, P. and Meyer, J. (2024, March 10-13). Hospice Certification of Terminal Illness (CTI) Research Survey: Advanced Practice Providers Barrier and Delays in Care. 2024 National Association of Clinical Nurse Specialists Annual Conference. New Orleans, LA.
Whitehead, P. (2024, March 10-13). A CNS Roadmap to attaining Institutional Recognition as Advanced Practice. 2024 National Association of Clinical Nurse Specialists Annual Conference New Orleans, LA.
Collins, L., & Slusser, C. (2024, April 8-11). INVIGORATE: A collaborative to creating nursing leadership empowerment. American Organization of Nurse Leaders 2024 Inspiring Leaders Conference. New Orleans, LA.
Bath, J. (2024, April 24-25) Interprofessional design of ED trauma bay: Using human factors and mockup simulation to improve architectural design layouts. Virginia Nurses Association, Virginia Nurses Foundation 2024 Spring Conference, Reengage, Reigniting Passion, Revolutionizing Practice. Virtual.
Bowser, S. (2024, April 24-25). Nurses as advocates. Virginia Nurses Association, Virginia Nurses Foundation 2024 Spring Conference, Re-engage, Reigniting Passion, Revolutionizing Practice. Virtual.
March 2024 - May 2024
Bath, Jen, MSN, RN, elected President of the Virginia Clinical Nurse Specialist Association.
Crouse, Kristin, MSN, RN, was awarded an award for Excellence in Nursing Professional Development at the 2024 Pathways to Knowledge Nursing Education Conference in Richmond VA.
Fish-Huson, Chris, PhD, RN, CNE, NASMCPT, has been selected by the United Way of Roanoke Valley as one of the 100 Community Heroes in the category of Health.
Harvey, Ellen, DNP, APRN, ACNS-BC, CCRN, TCRN, SCRN, FCCM, has been selected as an author for the Nursing Management of Adults with Severe Traumatic Brain Injury clinical practice guideline by the Clinical Practice Guidelines (CPG) Editorial Board and the American Association of Neuroscience Nurses (AANN).
Welcome S.O.A.R Nurse Externs
Lastweekwe welcomed &onboarded 84S.O.A.R. (seekingopportunities,aspirations,&results)NurseExternsto Carilionfrommorethan15 nursingprograms.45risingseniorsparticipatingin our 8weeksummerpathway&39 participatinginour flexpathway. Theseare our largestcohorts todate&Icannot thanktheunitleaders&nursementors enoughfortheir collaboration &commitmenttothisprogram. Weare soexcited towatchthemgrow throughthisjourney towardsbecoming futurenurses!If you seethemaround,pleasehelpthemfeel welcome &apartofourteamhereat Carilion!!
Contact Chris FishHuson with your ideas so that we can find funders to support you!
