Competency validation for cross-training in surgical services

Cross-training is a cost-effective means of maximizing the potential of staff members and available resources. The responsibility to provide quality patient care should not be compromised by cross-training efforts. Surgical services department staff members at Deaconess-Nashoba Hospital, Ayer, Mass, developed a competency validation project for nurses involved in the cross-training program. They accomplished this by implementing current nursing standards and practices and promoting continuity of patient care through the preoperative, intraoperative, and postoperative phases. Perioperative nurses and health care facilities have the responsibility to provide safe, effective, and efficient care to all patients. By assessing competencies for perioperative nurses, staff members can enhance their commitment to caring for their profession and their communities.     

Radiation safety

Nursing and radiology staff members can have a difficult time coexisting and communicating as they strive to provide quality care for patients. Misconceptions about safe radiologic practice within the practice of perioperative nursing occur because members of these professional fields are unfamiliar with each other's knowledge and practice guidelines. This article provides an overview of radiologic practice and safety.     

Building a successful risk-based competency assessment model

The requirement to verify and ensure the competency of staff members to perform their assigned duties is here to stay. This article describes a model for decision making about competency assessment frequency. Implementation of the model should be accompanied by a systematic review of learning needs and performance improvement data. Education sessions designed to address identified learning needs or to support performance improvement activities should occur before or concurrent with competency assessment. The result is a cost-effective, efficient use of resources to accomplish the goal of ongoing assessment and improvement of staff competency. When staff member competency improves, the likelihood of a positive patient outcome increases. Our model provides a structured, defensible mechanism to link competency assessment with improvements in patient care quality.     

Back pain and its correlates among workers in family care

This study is based on the empirical fact that among nurses large variations occur not only in clinical competency but also in individual productivity. The article proposes that competency-based targeted staff development programs can improve productivity as well as nursing performance. Research presented here shows that the nurses on units using targeted staff development increased the time spent on professional and direct care and reduced nonprofessional and indirect care tasks in comparison to nurses on the control nursing unit.     

Education and training in residential dementia care in Australia: needs, provision and directions

This paper summarises existing education and training in dementia for aged care workers in Australia. The majority of aged care workers have no formal qualifications, while those with formal qualifications are mostly from a nursing background. Only half of nursing staff have attended any dementia care training. Existing training is either service based and provided in-house or by private consultants, or tertiary institution based and provided by academics and professional educators. There is considerable in-service and one-off service-based training being provided around Australia, but few of these training exercises are linked to competency standards or staff appraisal. While there are some formal courses addressing training in dementia care available in every state of Australia, the emphasis on dementia care within generalist tertiary institution courses for aged care workers varies considerably.     

Diminished hyperaemic response of the hepatic artery to portal venous occlusion (the buffer response) in Asian hybrid minipigs: a comparison of the response to that observed in dogs

This study is part of a larger study of the effect of integrity-promoting care in a Swedish nursing home ward. Compared with assessments on a control ward, improvements were found in the patients' behaviour and in the quality of care after a three-month intervention period. This paper reports on parts of a questionnaire survey on the nursing staff's opinions of their working conditions and demented patients. Most staff members on both the intervention ward and the control ward found their jobs meaningful, engaging and stimulating, but they also felt that they had a heavy work-load. Most of the staff members experienced mental strain because of the patients' disturbed behaviour. Many did not think that the care on their ward would have been good enough for their own close relatives, if they had been suffering from dementia. Only slight changes were found in the staff members opinions after the intervention.     

Etiology of dependence in older nursing home residents during morning care: The role of staff behavior.

In an observational-operant design study with 17 staff members and 36 elderly nursing home residents, sequential observations of resident–staff interactions were recorded daily during morning care over a 23-day period. Results suggest that independent behavior in self-maintenance care is not maintained by staff behavior but perhaps by intrinsic reinforcers or reinforcing agents other than staff, whereas dependent behavior is directly maintained by staff reinforcement. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing practice to primary nursing

Primary nursing is now seen as popular method of delivering nursing care. The process of introducing this system requires prior planning, involving all members of nursing staff. A change in philosophy, culture and roles occurs with the introduction of primary nursing. Evaluation of this change is necessary, to determine if it is beneficial both to patients and the multidisciplinary team.     

Role orientation in novice home healthcare nurses

The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.     

The spiritual needs of pediatric patients and their families

Holistic perioperative nursing care of children and their families includes assessing their spiritual needs and identifying interventions that help them achieve spiritual comfort. This is achieved by therapeutic listening and by facilitating children's and family members' access to clergy members of their practice of religious rites and rituals. Perioperative nurses have a unique opportunity and responsibility to assess children's or family members' spiritual needs and to intervene on their behalf. This article describes the opportunities a surgical liaison nurse may have to intervene on the behalf of family members during children's perioperative experiences.     

Using registry nurses: coping with cost and quality issues

If a nursing service uses agency nurses to help cope with staff shortages, the nursing administrator must manage the cost and quality of care delivered by these nurses. The authors describe their hospital's system for using agency nurses. The components of their system--an orientation program, contracts with the agencies, and systematic performance evaluation--can be used or adapted in other institutions.     

Impact of a CareMap and case management on patient satisfaction and staff satisfaction, collaboration, and autonomy

The purpose of this research was to evaluate the effect of a CareMap and nursing case management on patient satisfaction and staff job satisfaction, collaboration, and autonomy. The patients who had a CareMap and a nurse case manager were more satisfied with their care. The multidisciplinary staff who worked on the experimental unit had increased job satisfaction and nurses who applied and were selected for case management positions had higher levels of collaboration and increased autonomy. Multidisciplinary team members who developed the CareMap also had higher levels of collaboration than other multidisciplinary staff on the experimental unit and their job satisfaction with quality of care increased under this new care delivery system.     

Development of an ostomy competency

Staff educators and staff nurses developed an ostomy competency, with the guidance and expertise of the advanced practitioner and enterostomal nurse at a large teaching hospital. The competency improved the quality of care for surgical ostomy patients. Care was standardized and staff nurses' clinical knowledge was enhanced. Following the sessions, staff nurses verbalized increased confidence in working with patients with ostomies and demonstrated increased autonomy and problem-solving abilities. No variances in educational aspects of care were noted on clinical pathways.     

Sharing our world: perioperative nurses have the vision

1. Perioperative nurses must bridge the information gap and eliminate public misconceptions about surgery and OR nursing. Fear of the unknown realm of surgery and televised inaccuracies about surgical procedures magnify the lack of awareness of health care consumers about surgery and the holistic nursing care perioperative nurses provide for their patients. 2. There is a national need for more aggressive general promotion of health care awareness and education. This need can be successfully facilitated at the grassroots level with minimal efforts from members of our surgical departments. 3. One effective way to solve this problem is to invite health care consumers into our facilities.     

Cultural competence: a priority for performance improvement action

An increase in diversity that has been accompanied by a sharp decrease in white Caucasian "mainstream" culture has made cultural competence a priority in nursing performance improvement. Each culturally diverse group defines health and illness differently. Most have a long and well-established tradition of folk health beliefs and practices, which strongly impact members' reactions to American standards of care--an influence on both patient satisfaction and treatment compliance. This article describes the culture--health care relationship and lists 10 indicators for measuring cultural competency. It presents a practical, systemwide model for the improvement of nursing care quality through enhanced cultural competency and lists resources, which can be used to both support and improve cultural competency throughout an integrated health care system.     

Quantitation of change in the medullary compartment in renal allograft by ultrasound

PURPOSE: This study was completed to determine the current knowledge and documentation patterns of nursing staff in the prevention of pressure ulcers and to identify the prevalence of pressure ulcers. METHODS: This pre-post intervention study was carried out in three phases. In phase 1, 67 nursing staff members completed a modified version of Bostrom's Patient Skin Integrity Survey. A Braden Scale score, the presence of actual skin breakdown, and the presence of nursing documentation were collected for each patient (n = 43). Phase II consisted of a 20-minute educational session to all staff. In phase III, 51 nursing staff completed a second questionnaire similar to that completed in phase I. Patient data (n = 49) were again collected using the same procedure as phase I. RESULTS: Twenty-seven staff members completed questionnaires in both phase I and phase III of the study. No statistically significant differences were found in the knowledge of the staff before or after the educational session. The number of patients with a documented plan of care showed a statistically significant difference from phase I to phase III. The number of patients with pressure ulcers or at risk for pressure ulcer development (determined by a Braden Scale score of 16 or less) did not differ statistically from phase I to phase III. CONCLUSION: Knowledge about pressure ulcers in this sample of staff nurses was for the most part current and consistent with the recommendations in the Agency for Health Care Policy and Research guideline. Documentation of pressure ulcer prevention and treatment improved after the educational session. Although a significant change was noted in documentation, it is unclear whether it reflected an actual change in practice.     

Development of a perioperative nursing diagnoses flow sheet

Traditionally, health care professionals in the preoperative, intraoperative, and postoperative phases of care have used perioperative records that focus on the technical aspects of the care provided (eg, blood pressure, pulse measurements; equipment used) and leave room for only short narratives to document nursing care. Such formats often do not document the multitude of activities or interventions perioperative nurses provide. The question raised at the DePaul Health Center, St Louis, was: "Where do we document our nursing diagnoses and plan of care?" The response was to create a nursing diagnosis task force that investigated the feasibility of a form professional nurses could use in all phases of patient care. This investigation led to the development, implementation, and universal use of a perioperative nursing diagnoses flow sheet within the surgical services department.     

The nurse as coach in care of the dying

Nurses' inability to articulate many aspects of their work leads to its invisibility, a problem compounded in home-based palliative care where the nurse's work is rarely seen by others. A staff development exercise was undertaken which aimed to assist specialist palliative care nurses to articulate their relationships with patients to members of the inter-disciplinary team. The process was specifically aimed at understanding patients' and families' refusals to receive psycho-social care from other team members. It explores, through four narrative vignettes, the tension between nursing and non-nursing roles when patients refuse non-nurse care. At the centre of this tension are the issues inherent in nursing roles which frequently sit at the boundaries of other health practitioners.     

Perioperative nurse practitioners

Perioperative nursing roles are evolving in response to health care reform, technological developments, and changing opportunities for advanced practice nursing. One response to these changes is the development of the perioperative nurse practitioner role. The perioperative base for this new advanced practice role is described in this article. The advanced practice role is effective in other specialty settings and can be developed readily in a variety of surgical settings. This role requires a master's degree in nursing to provide the academic and practice preparation for clinical decision making and patient management in the perioperative setting. Future opportunities for perioperative advanced practice nursing are discussed.