Bedside nursing consultation and nursing diagnoses in people with diabetes mellitus / Consulta a beira do leito e os diagnósticos de enfermagem em pessoas com diabetes mellitus

Objetivo: Identificar o perfil sociodemográfico, clínico e os diagnósticos de enfermagem pessoas com diabetes mellitus estabelecidos em consultas de enfermagem à beira do leito. Método: Estudo observacional descritivo, realizado em 2017 com 37 participantes, amostra não probabilística, em unidade de clínica médica ou cirúrgica de um hospital escola do sul do Brasil. Variáveis do estudo: dados sociodemográficos, clínicos e diagnósticos de enfermagem da North American Nursing Diagnosis Association, submetidos à estatística descritiva simples. Resultados: 89,21% dos participantes diabéticos tipo 2; tempo médio de diagnóstico de 9,6 anos; 70,2% hipertensos; 56,7% tabagistas; 16,2% insulinodependentes; 32,4% faziam uso de açúcar refinado; 59,45% associavam dois ou mais carboidratos na mesma refeição. Os diagnósticos mais frequentes: Risco de glicemia instável (97,37%), Risco de infecção (97,37%), Conhecimento deficiente (81,58%), Estilo de vida sedentário (60,53%), Controle ineficaz da saúde (60,53%). Conclusão: A identificação do perfil e dos diagnósticos de enfermagem possibilita melhor planejamento de enfermagem.

Effect and Nursing Satisfaction of Bedside Nursing Combined with Detail Nursing in Clinical Nursing of Gastroenterology Department

Objective. The purpose of the study was to investigate the therapeutic effect and nursing satisfaction of bedside nursing combined with detail nursing in the gastroenterology department. Methods. 112 patients with gastrointestinal diseases admitted to our hospital from November 2018 to November 2019 were selected as the study subjects and randomly divided into a research group (n = 56) and reference group (n = 56). The reference group received routine clinical nursing, while on this basis, the research group received bedside nursing combined with detail nursing. After that, the clinical nursing effects of the two groups were compared. Results. There were no significant differences in sex ratio, age, BMI, smoking history, drinking history, marital status, and disease types between the two groups ( P > 0.05 ). The VAS scores in the two groups after intervention were significantly lower than those before intervention ( P < 0.01 ), and the VAS scores in the research group after intervention were significantly lower than those in the reference group ( P < 0.01 ). The nursing ability, nursing skills, and nursing responsibility in the research group were significantly higher than those in the reference group ( P < 0.01 ). There were no significant differences between the two groups in the number of patients who were satisfied and needed improvement ( P > 0.05 ). Besides, the number of very satisfied cases in the research group was significantly higher than that in the reference group ( P < 0.05 ), and the number of unsatisfied cases was significantly lower than that in the reference group ( P < 0.05 ). The total incidence of clinical adverse events in the research group was significantly lower than that in the reference group ( P < 0.01 ). The gastrointestinal diseases related knowledge scores after intervention were significantly higher than those before intervention ( P < 0.01 ), and the gastrointestinal diseases related knowledge scores after intervention in the research group were significantly higher than those in the reference group ( P < 0.01 ). The GQOLI-74 scores after intervention in the two groups were significantly higher than those before intervention ( P < 0.01 ), and the GQOLI-74 scores after intervention in the research group were significantly higher than those in the reference group ( P < 0.01 ). Conclusion. The application of bedside nursing mode combined with detail nursing in gastrointestinal diseases can effectively reduce patients’ pains, as well as the incidence of clinical adverse events, and improve patients’ life quality, with definite curative effect, which is worthy of promotion and application.

Abstract 46: An Innovative Approach to the Bedside Nursing Swallow Screening Tool: Can Be Used as a Trigger for an Inpatient Cognitive Evaluation to Improve Timeliness of Post-Discharge Cognitive Therapy Referrals

Background: According to the American Heart Association, a formal assessment of cognitive dysfunction caused by stroke is a level I recommendation. However, cognitive evaluation is often missed or overlooked in the inpatient setting. When and who performs the assessment is not well-defined. Stroke nurses can corroborate with clinicians in completing the Montreal Cognitive Assessment (MoCA) 8.1, a validated tool for assessing cognitive function in stroke patients. Purpose: The purpose of this study was to evaluate the process of using the bedside nursing swallow screen (NSS) as a trigger for an inpatient cognitive evaluation by the Speech Therapist (ST). This study was also used to determine if post-discharge cognitive therapy referrals were placed based on the MoCA scores. Methods: All STs completed the required MoCA certification. The new process was implemented in October 2019. Data were analyzed from October 2019 through March 2020. NSS was performed on newly admitted stroke patients. If failed, an ST consult was ordered for a dysphagia evaluation. However, if passed, a cognitive evaluation consult was triggered by the RN. MoCA was completed within 24 hours. The total possible score is 30; a score of 26 or above is considered normal. A MoCA score of 25 or less, prompted a post-discharge cognitive therapy referral. Results: 229 patients were assessed, all of whom had an NSS completed. 120 (52.4%) passed the NSS, of which 85 (71%) completed a MoCA evaluation. 42 (49.4%) scored 25 or less, of which 35 (83.3%) were referred for a post-discharge cognitive therapy. 7 (17%) had no referral, of which 4 (57%) were discharged home to self-care; 2 (29%) discharged to other healthcare facility; and 1 (14%) left against medical advice. Conclusions: Repurposing the NSS as a standardized tool to trigger an inpatient MoCA evaluation was innovative, practical and efficient. Timely post-discharge cognitive therapy referrals were also evident on MoCA scores of 25 or less.

Abstract WP438: Monthly Patient Stroke Education Prevalence Rounds Increase Nursing Engagement While Positively Affecting Quality Patient Outcomes

Background and Purpose: Understanding stroke and factors in the prevention of stroke are fundamental in improving quality outcomes and patient healthcare compliance. Daily individualized patient education is an accreditation requirement, and as a certified stroke center the goal is to exceed national care standards for patients with stroke. Documentation of daily individualized patient education compliance was found to be below the required expectations with initial audits. Bedside nurses were surveyed on documentation requirements of every stroke patient, and a knowledge gap was identified. The purpose of this quality initiative was to improve compliance of daily individualized stroke education and increase bedside nursing accountability and engagement in the care of stroke patients. Methods: The quality initiative consisted of a monthly one day snapshot of daily stroke education documentation compliance (average n=34). Results are shared with executive nursing leadership, unit managers and bedside nurses. Stroke Champions facilitate one-on-one education with their nursing peers when opportunities for improvement of required stroke education have been identified. This nurse driven collaboration was augmented with daily education reminders during unit huddles, patient stroke education posters on the unit, and caregiver award recognition for those nurses with high compliance. Results: Significant improvements in documentation of daily individualized stroke education were found following the stroke prevalence education initiative. A pre-initiative audit was conducted 4th quarter of 2015, revealing compliance was at 65%. After implementation, 2016 compliance improved to an overall 86%; 2017 was 84%; 2018 was 90% and the first half of 2019 remains at 90%. Conclusions: In conducting monthly stroke prevalence rounds, nurse driven collaboration has shown significant improvements in consistently documenting daily individualized stroke education, therefore increasing required patient stroke education compliance and producing the potential for better outcomes for patients.

Implementation pilot of a novel electronic bedside nursing chart: a mixed-methods case study

The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P&lt;0.05) and increased mean time spent at the bedside (from 21 to 28min h−1; P&lt;0.0001); reductions in patient-reported missed care and nurses’ walking distances were not significant. Qualitative themes included: (1) inconsistent expectations (perceptions about potential vs actual functionality and benefits of the technology); (2) decisional conflict between managers and end-user nurses (discordance between governance decisions and clinical operations; 30% of beds were closed and six of the eight trained nurse ‘super-users’ were moved from the pilot ward); and (3) workflow effects (ergonomic set-up of the digital interface). This study highlights the complex challenges of implementing and examining the effects of technology to support nursing care. Shared understanding of the technology goals and project scope in relation to nursing care and flexible and adaptive project and contingency planning are fundamental considerations. Complexity, unpredictability and uncertainty of ‘usual business’ are common confounders in acute hospital settings. What is known about the topic?Although much has been written about the implementation of electronic records into hospital systems, there is little research evaluating the effect of information technology systems that support the complex clinical decision making and documentation required to meet nurse and patient needs at the point of care. What does this paper add?This study highlights the potential to reduce missed care through better nursing workflow. Contributing factors to low nurse adoption of new technology have been identified, including inconsistent expectations and goals for the design of systems to support quality nursing care, incongruous decision making in design, adaptation and implementation processes and constrained physical workability in relation to nursing workflow. What are the implications for practitioners?The design of information systems to support nursing work requires a shared understanding of ‘good practice’ for high-quality nursing care that is consistent with theories of nursing practice, best evidence and professional practice standards. Recognition of effective and ineffective sociotechnical interactions that occur during complex nursing processes can help avoid ‘disruption without benefit’ and ‘amplification of errors already in the system’ during acute care technology implementation. Ongoing dynamic input from individuals and groups with different expertise and perspectives, as well as iterative, generative processes for moving towards a shared goal, are critical for effective and efficient implementation.