If just these two steps are implemented, there are considerable decreases in readmission and savings in the overall healthcare system. The more intense and robust the nursing intervention, the more cost savings (Andrietta, M
This technique has helped one hospital reduce readmission rates for CT by 12%. This method provides the opportunity to allow the patient to repeat back instructions or educational concepts in their own words; this allows the healthcare professional to assess patient understanding; then allows a way to rephrase and/or retrain when gaps are discovered (Bradke & Brinker, 2011)
Nurses need to educate patients on diet, recording weight and blood pressure, and suggesting alternatives in exercise. Doctors need to ensure that these patients come in for regular visits; 1 week, 4 weeks, monthly for the first 6 months, then quarterly for the next 24 months (Crowther, 2012)
Change Plan One model, the Rosswurm and Larabee, puts research utilization as a primary component of change management. It is a six step model that may be implemented once evidence is gathered and is really designed to be a three part change model: 1) Steps 1 and 2 -- Identification and link of issue; 2) Step 3 synthesizes the quantitative and qualitative research studies; 3) Steps 4-6 design and implement an action plan and include a way to continue with change management as the process (and environment) evolve (Hoeman, 2008, p
), other times it is treated with implanted devices, blood thinners, or medication. Heart failure in the developed world is relatively common due to more sedentary lifestyles, with about 2% of the population suffering from the disease, but 10-12% of those over 65 (McMurray & Pfeffer, 2005; Hines, Yu, & Randall, 2010)
6 -- Integrate and maintain Use evaluations, review of charts, patient statistics, and questionnaires to gauge effectiveness; adjust as necessary After one year, compile data and submit results; adjust teams as necessary, meet with budget committee to assess cost/benefit analysis. (Rosswurm & Larrabee, 1999) Summary Implementation would begin with forming a multidisciplinary committee; writing procedures; getting budgetary approval for those procedures; implementing test; informal evaluation after 3 months; 1st formal evaluation at the 6 and 12-month timeframe
2010). While this might seem a rather simplistic statement, a quantification of the effects of increasing boarding rates to match those of admitted rates shows a much greater reduction in the overcrowding than would linear equations would account for, and a greater efficacy in health outcomes as well (Bair et al
ER PICO PICO Question For patients boarding in the ER, does decreasing the time spent boarding as opposed to the current methods of continued boarding for patients lead to greater safety for patients in emergency rooms and lead to greater access to emergency care and more efficient throughput? The patient population that has been identified in this PICO question is patients boarded in an emergency department. Though this is not an ailment- or symptom-specific population, this is a distinct set of patients separate both from normal hospital populations and from other emergency department patients that do not end up boarding, as research has shown that boarding and crowding affect patients differently than crowding amongst non-boarding emergency department patients (McCarthy et al
On the opposite side, opponents are concerned about increased documentation, the loss of effective nursing time, and over-regulation of nursing activities by management (Hourly Rounding, 2012). Literature Review Summary - In general, most of the scholarly literature shows that hospital units that use hourly rounding decreased call light usage and patient falls (Berg, et al
The nurse's role is far more than simply an assistant, and requires the understanding and application of a large toolbox to deal with many different situations within the course of any given time period. (Borkowski, 2011)
, 2011). In fact, typical bed alarms tend to be relatively ineffective in preventing patient falls (Davis, et al
More often than not, nurses tend to act as the "moral agents" within the system because they are the locus of communication between the physician, the patient, and the family. The modern nurse leader must act with moral courage and conviction since "nursing leaders are responsible for creating cultures that support acts of courage in nursing… [because] these acts have the potential to increase nurse retention, promote patient comfort, relieve patient suffering, and enhance the reputation of the organization" (Edmonson, 2010)
In fact, typical bed alarms tend to be relatively ineffective in preventing patient falls (Davis, et al., 2011), while hourly rounding not only decreased falls, but improved patient satisfaction and awarness of safety issues (Ford, 2010; Hutchings, 2012)
Managerial commitment is vital to help keep staff motivated and to ensure a commitment to a common culture. Finally, rounding is a significant step to improving patient care and should be a hospital wide mandate, not simply used for critical or surgical care patients (Olrich, et al
); and working with colleges to assess gait, posture, imparied vision and hearing; evaluate risk for falls, watch for dementia, delirium, and/or stroke. Implicit in this is also the idea that patients can expect protection and advocacty from their healthcare professional (Schlinfz, 1998)
This is particularly frustrating in the post-surgical wards in which patients have a rather large continuum of procedures and resultant pain. Nursing research continues to look for non-invasive ways to improve or even augment pain management techniques, particularly if they can be put into place and require no pharmaceutical support (Bresler, 2010)
The use of GI, though, may help in all types of situations; from discomfort from a mild headache to the intense pain of cancer, and everything in between. These techniques work well with patients of all ages -- even the elderly report an increase in quality of life and well-being (Ferrell, B
, 2006) Using GI techniques at home 1-2 times per day for weeks shows a marked improvement in the ability to relax, manage pain, and perceive ways to work through the pain. Further, patients reported cutting back on pain medication, and feeling more empowered in managing their own pain control (Menzies, V
Further, the technique can easily be adapted to children even as young as five. Using breathing exercises and GI techniques, children had a significantly lower amount of days with pain and less missed activities (Weydert, J
All of these books (fiction and non-fiction) were viewed by the Island Trees school board review committee as "irrelevant, vulgar, immoral, in bad taste and educationally unsuitable" for students at the school. After the news broke in the press, the school board reiterated that these titles were "Anti-American, anti-Christian, anti-Semitic and just plain filthy" (Crutcher, 2007, Internet)