...AN INDEPENDENT VOICE FOR NURSING Work Engagement, Moral Distress, Education Level, and Critical Reflective Practice in Intensive Care Nurses nuf_237 256..268 Lisa A. Lawrence, PhD, RN Lisa A. Lawrence, PhD, RN, Instructional Faculty, Nursing Department, Pima Community College, Tucson, AZ Keywords Critical reflective practice, education level, moral distress, registered nurse, work engagement Correspondence Lisa A. Lawrence, PhD, RN, Nursing Department, Pima Community College, Tucson, AZ E-mail: llawrence@pima.edu AIM. The purpose of this study was to examine how nurses’ moral distress, education level, and critical reflective practice (CRP) related to their work engagement. The study is relevant to nursing, given registered nurse (RN) documented experiences of job-related distress and work dissatisfaction, and the nursing shortage crisis. A better understanding of factors that may enhance RN work engagement is needed. METHODS. A non-experimental, descriptive, correlational design was used to examine the relationships among four variables: moral distress, education level, CRP, and work engagement. The sample included 28 intensive care unit RNs from three separate ICUs in a 355-bed Southwest magnet-designated hospital. RESULTS. There was a positive direct relationship between CRP and work engagement, a negative direct relationship between moral distress and work engagement, and CRP and moral distress, together, explained 47% of the variance in work engagement. Additionally...
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...University School of Nursing Research Methods N307-01 Dr. Carla Gene Rapp Apr 20, 2005 Research Proposal Table of Contents 2 Introduction……………………………………………………………………………….3 Review of the Literature…………………………………………………………………..4 Purpose……………………………………………………………………………………8 Methods……………………………………………………………………………………9 Design and research questions…………………………………………………….9 Sample……………………………………………………………………………..9 Survey instrument……………………………………………………..…………10 Research procedures……………………………………………………………..10 Informed consent and IRB approval……………………………………………..11 Strengths and Weaknesses……………………………………………………………….11 Timeline and Cost Considerations……………………………………………………….12 Conclusion……………………………………………………………………………….13 Concept Model………………………………………………………………..Appendix A Sample Questions……………………………………………………………..Appendix B References……………………………………………………………………………….18 Research Proposal Research Proposal Introduction Intensive care units (ICUs) were designed to provide highly skilled, lifesaving nursing care to viable patients with acute illnesses or injuries. Patients with chronic and/or terminal illness were not expected to be admitted to these units, with the possible exception of acute exacerbations of reversible complications. Patients whose care needs changed from curative to palliative were intended to be transferred out of critical care to patient care environments more suited to end-of-life care. However, as more patients become “chronically critically ill”, critical care nurses are being asked...
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... September 2014 Abstract Background: Re-admissions back to the ICU is a growing problem in the United States which is of concern especially since these patients have higher in hospital mortality rates as well as longer inpatient length of stays. The objective of this study is to measure the incidence and determine the predictors of re-admissions to the Adult Intensive Care Unit. Methods: Medline (1946-present) was searched using combinations of the following search terms ‘Intensive Care Units’ OR ’Critical Care’ AND ‘Patient re-admissions’. The searches were limited to abstracts in English language between 1990 and 2014. This search was then narrowed to ‘core clinical journals’ to increase the quality of the articles but this limitation cut the number of articles down to 2/3rd and even though these articles were saved under a separate folder, eventually all 91 articles were included in the final search. The term ‘Intensive Care Units’ were narrowed to include only ‘burn’, ‘coronary’ and ‘respiratory’ care units. The CINAHL and Cochrane Database search failed to reveal any relevant results. Results: My search generated 33 articles and their review shed light on a few recurrent themes identified as being the reason for early re-admissions. Premature discharge, time gaps between reaching the wards and being seen, lack of attention by ward nurses, lack of experience of medical staff in the wards were some of the themes...
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...me in this essay, I will be discussing about how my nursing managers practice transformational leadership in this reflection essay to motivate me to improve me as a better critical thinking registered nurse in EMD. Description This unfortunate incident happened in my work area, where patient with critical conditions receive treatment, Patient Acuity Category (PAC) 1. It was a busy shift and there were dozens of critical cases coming in...
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...questions……. …….……………………………………………………………….…...6 Methods…………………….…………………………………………………………………..…4 Design …………………………………..………………………………………………….7 Intervention ……………..……………………………..………………………………….. 7 Sample/Setting …………………….…………………………..……………………………7 Power analysis …………………………………..…………….……………………………8 Instrumentation ...............................................................................................................…...8 Data collection ……………………………………..………….……………………………8 Statistics and data analysis …………………………………………………………….…...9 Expected results …………………………………………………………………………………..9 References cited………………………………………………………………………………….10 Appendix A………………………………………………………………………………………13 Appendix B………………………………………………………………………………………14 Appendix C………………………………………………………………………………………15 Appendix D………………………………………………………………………………………16 Ventilator associated pneumonia and chlorhexidine use in the traumatic brain injured patient Ventilator associated pneumonia (VAP), is defined as, a nosocomial pneumonia that develops more than 48 hours following endotrachial intubation and mechanical ventilation, and is a common and serious intensive care unit (ICU) complication. VAP causes noteworthy morbidity, mortality, amplified hospital costs, and increased utilization of healthcare resources, prolonged time for ventilator support, as well as lengthened ICU and hospital stay (Caruso, 2009). Antibiotics (ATBs) have traditionally been...
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...Patient-Centered Care and Communication in Critical Care Pikes Peak Community College Patient-Centered Care and Communication in Critical Care Introduction Communication is a key component in nursing care. As nurses we must communicate with our patient’s, patients’ families, and a wide variety of healthcare team members. Communication can be vital to patient’s lives, informative to physicians, and calming or educational to families. The communication method, or theme, that a nurse uses as part of her care can positively, or negatively, affect every aspect of patient care. Communication plays a huge role in the way I care for patients and their families. Without positive, supportive communication I would have a very difficult time building a trusting relationship with my patients. My nursing career goal is to one day become a critical care nurse. I chose this article to further educate myself about affective communication and how I can apply this knowledge in a critical care setting. As a nurse working in the Intensive Care Unit, communication has a critical role in patient-centered care. The objective of this study was to perform a qualitative analysis of nurses’ communication behaviors to develop interventions that will improve patient-centered communication in the critical care setting. The theoretical model of patient-centered care contains five domains. The five domains include: the biopsychosocial perspective; the patient-as-person; sharing power and responsibility;...
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...there were 499,331 deaths registered in England and Wales, a rise of 3.1% compared with 2011. Almost half of these occurred in National Health Service Hospitals. (Office for National Statistics, 2012). These figures indicate a substantial amount of individuals dying in a hospital setting each year, therefore a large proportion of patients will be receiving some form of care prior to and at death (Blackwell 2010 p.1). Numerous research studies have been carried out by theorists identifying the impact of bereavement on different individuals. The earliest thorough study of grief and loss developed from Freud with his classic paper ‘Mourning and Melancholia’ (Freud 1917 cited in Payne et al 1999). Freud believed that for the bereaved to detach from the deceased one must work through their grief by reviewing memories and thoughts of the deceased (Ellman 2010). Other theorists have recently identified death and the importance of understanding it. 'Death is a natural progression from life. Most nurses will be exposed to the physical and emotional effects of this experience as they care for a dying patient. The nurse is taught how to provide support for the patient and family as they proceed through the stages of grief. Often, however the nurse may not realise his or her own need to grieve'. (Brosche 2003 p. 173). Although nurses try to remain professional whilst at work, once they are home and the uniform is removed , emotions that were kept at bay...
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...PRACTICE BENCY GNANASIGHAMANI AMERICAN SENTINEL UNIVERSITY Introduction Medical and health care is one of the most dynamic human disciplines, and large amounts of money are spent annually on high-quality and sophisticated research, resulting in an exponential growth in health care literature. Regularly, new and more effective medicines, medical devices, and procedures are invented. One major objective behind all these efforts is to help doctors, nurses, and medical technicians provide the best possible care and treatment to patients. In addition to using traditional and well-established procedures and practices, health care practitioners are adopting innovative interventions that are based on best practices as well as solid research-based evidence. Evidence-based practice is one such technique and is quickly gaining popularity due to its potential to effectively handle clinical issues and provide better patient care (ANA 2003). Implementation of Evidence Based Practice places additional demands on nurses to apply credible evidence to individual client situations through searching related evidence, using clinical judgments, and considering client values and system resources. To effectively apply the Evidence Based Practice process, in addition to the basic skills required to undertake nursing work, a nurse must have the ability to: identify knowledge gaps, formulate relevant questions, conduct an efficient literature search,...
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...Agency Nurse Orientation: A Case for Change EBT1-Task 3 Western Governors University A1) Procedure Nationwide there are currently 16,000 certified nursing homes caring for 1.4 million residents (Zhao & Haley, 2011). Due to high nurse turnover rates and persistent staffing shortages, many nursing homes utilize nurse staffing agencies to meet staffing needs. Holliswood Care Center (HCC), a 300 bed nursing home, with five residential floors, located in Hollis, New York is not exempt from such staffing challenges. In fact, according to Yves Pascal, Director of Nursing (DNS) at HCC, “Usually, 2-3 LPN’s per shift are required daily” (Y. Pascal, personal communication, December 15, 2013). Agency nurses are approved to work at HCC once they submit a current physical and complete an in-house facility orientation. During this orientation, agency nurses receive New York State mandated in-services, such as patient abuse and HIPPA. The nurses also receive specific instruction regarding emergency procedures, medication policy, employee conduct and procedures. However, specific unit policies and procedures, location of specific supplies are not included in the general orientation. Upon completion of the orientation, the agency nurse receives no further orientation or precepting. Thus when an agency nurse enters HCC for their first shift they are functioning independently and with limited knowledge. This is clearly a problem, which varies in degree of potential...
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...Journal of Intensive Care Medicine http://jic.sagepub.com/ The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Carrie S. Sona, Jeanne E. Zack, Marilyn E. Schallom, Maryellen McSweeney, Kathleen McMullen, James Thomas, Craig M. Coopersmith, Walter A. Boyle, Timothy G. Buchman, John E. Mazuski and Douglas J. E. Schuerer J Intensive Care Med 2009 24: 54 originally published online 17 November 2008 DOI: 10.1177/0885066608326972 The online version of this article can be found at: http://jic.sagepub.com/content/24/1/54 Published by: http://www.sagepublications.com Additional services and information for Journal of Intensive Care Medicine can be found at: Email Alerts: http://jic.sagepub.com/cgi/alerts Subscriptions: http://jic.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://jic.sagepub.com/content/24/1/54.refs.html >> Version of Record - Jan 14, 2009 OnlineFirst Version of Record - Nov 17, 2008 What is This? Downloaded from jic.sagepub.com at UNIV OF THE INCARNATE WORD on April 15, 2013 Original Research The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Journal of Intensive Care Medicine Volume 24 Number 1 January/February 2009 54-62 # 2009 SAGE Publications 10.1177/0885066608326972 http://jicm.sagepub...
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... In 2005, the American Nurses Association House of Delegates resolved to disseminate recent research findings on the relationship between work hours, fatigue and errors. Dr. Ann Rogers presented the results of her study “The Working Hours of Hospital Staff Nurses and Patient Safety” published in Health Affairs, July/August 2004. Her study followed 393 registered nurses working over 5,317 shifts. Each nurse tracked hours worked, time of day worked, overtime, days off, sleep/wake patterns, errors and near misses. According to Dr. Rogers, fatigue results in: * Forgetfulness * Slowed reaction time * Diminished decision making * Reduced vigilance * Apathy, lethargy * Impaired communication. Delivery of health care requires higher cognitive functions – judgment, logic, complex decision-making, memory, vigilance, information management and communication skills. Fatigued workers try ineffective solutions to problems and neglect activities deemed non-essential. Sleep research indicates that most people need at 7.5-8 hour of sleep each night. Nurses in the study averaged 6.8 hours of sleep. Long hours, and the impact of competing priorities in personal lives impact getting adequate rest prior to working. In more than half the shifts, nurses were unable to take breaks due to shift demands. Findings included correlation among work duration, overtime, number of hours worked and reported errors and near errors. Regardless of the scheduled shift length...
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...EDUCATION Critical thinking and analysis: a model for written assignments Sharon L Edwards W hat is critical analysis? In the author’s personal experience this question has been answered by the following statement: ‘It is being critical of the literature.’ However, this does not answer the question. A literature search also failed to provide any information on critical analysis. The justification for developing a model for critical analysis, however, was not solely the lack of available literature. Other reasons included: to provide a definition of the terms; and to help both educationalists and students interpret the concepts involved. Nurse educationalists and nursing students lack a clear understanding of the critical processes and this could severely diminish the profession’s ability to articulate issues that are imperative to the advancement of nursing practice in the future. This article recommends a model of critical analysis that can be used by students and educationalists. It suggests that critical thinking and analysis are interrelated and complementary, but not synonymous. It gives examples of the model’s components in order to clarify their meaning. The model will hopefully give students a premise on which to base their assignments, and nurse educationalists will be able to incorporate it into their teaching practice. It will also provide an element of reality to critical analysis which will prevent it from becoming so abstract and idealistic as to render...
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...Implementation of an Evidence-Based Protocol Over the past decade there has been a growing focus on quality improvement including moving from a traditional intuition-based paradigm to evidence-based practice (EBP) (Eizenberg, 2011). There is an increase in consumer demand for quality and cost-effective health care and this has created a greater emphasis on EBP. EBP is essential for promoting excellence in health care (Koehn & Lehman, 2008). Clearly aligned to evidence-based practice, the integration of protocol-based care into care delivery has been evident in the development of service protocols as an approach to implementing standards (Rycroft-Malone, Fontenla, Bick, & Seers, 2008). In the article chosen for this paper the surgical intensive care unit (SICU) did not have a protocol for rewarming postoperative general surgical patients. Why research is valid and applicable to nursing practice Improving and maintaining high quality patient care through developing and implementing clinical protocols is an important part of the health care system. One goal of nursing should always be to provide the best care with the least amount of complications. Faster rewarming of postoperative SICU patients prevent the complication of hypothermia. The selected article reviews results from a study done to determine the quickest way to rewarm a postoperative general surgical patient. It also reviews the development of a rewarming protocol and the compliance rates of protocol use. The...
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...NRS 433V Introduction to Nursing Research February 11, 2012 Shahin E. S. M., Dassen T., & Halfens R. J. G. (2009). Incidence, prevention and treatment of pressure ulcers in intensive care patients: A longitudinal study. International Journal of Nursing Studies 46: 413–421 Introduction Pressure ulcers refer to damage that occurs to the skin of a patient. Pressure, shear and friction are among the known causes (Shahin, Dassen & Halfens, 2009). Pressure ulcers mostly affect the lower part of the body, the elderly and patients with spinal injuries (Shahin et al, 2009). They are expensive to treat, require long periods of time and numerous treatments to heal. As a result, the cost incurred is very high and ranks among one of the most expensive ailments in the world to treat (Shahin et al, 2009). Background of the Study It is estimated that around 13% of patients in the ICU develop pressure ulcers (Shahin et al, 2009). “Pressure ulcers are the third most expensive disorder after cancer and cardiovascular diseases” (Shahin et al, 2009, p.414). This study looks into the prevalence of pressure ulcers in ICU patients, the factors related to it, and the treatment measures. Overcoming the problem of pressure ulcers is vital especially among critically ill patients who are at the most risk of developing pressure ulcers (Shahin et al, 2009). Educating nurses can reduce the occurrence of pressure ulcers. Nutrition, good skin care, early recognition of pressure...
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...Patient Services/Intensive Care Nurses/Compassion Fatigue Intervention/BESt 173 Best Evidence Statement (BESt) Date: July 17, 2013 Title: Decreasing Compassion Fatigue* among Pediatric Intensive Care Nurses Using Self-Care Skills* and Compassion Fatigue Training* Clinical Question: P (Population/Problem) I (Intervention) C (Comparison) O (Outcome) Among pediatric intensive care nurses does functional knowledge of compassion fatigue and the practice of self-care skills, compared to not, demonstrate less compassion fatigue? Definitions for terms marked with * may be found in the Supporting Information section. Target Population for the Recommendation: Nurses working in pediatric intensive care settings who provide direct patient care Recommendation: It is recommended that nurses working in pediatric intensive care settings receive training that includes compassion fatigue awareness, coping strategies, stress management, relaxation techniques and self-care interventions to decrease the level of compassion fatigue experienced in the work environment (Marine, Ruotsalainen, Serra, & Verbeek (2009) [1a]; Gunusen, & Ustun (2010) [2a]; Kravits, McAllister-Black, Grant, & Kirk (2010) [4a]; Meadors & Lamson (2008) [4a]). Discussion/Synthesis of Evidence related to the recommendation: The evidence referred to a variety of concepts related to the manifestation of compassion fatigue, including burnout, emotional exhaustion, and workplace stress. The concepts...
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