Organizational and Practice Outcomes of a Post-Baccalaureate Registered Nurse Residency Program.

A nurse residency for newly licensed registered nurses is best practice. A novel model for transitioning new nurses is a 1-year, postbaccalaureate residency that is rotation based with protected time for supervised clinical and didactic learning. After 10 years with this program, a summative evaluation found that retention rates for 1, 2, 3, and 5 years after program completion were 93%, 83%, 73%, and 82%, respectively, higher than similar programs in the literature.

Supporting the Safe Use of the Dorsogluteal Intramuscular Injection Site: An Evidence-Based Quality Improvement Project.

Introduction: Administering intramuscular (IM) injections is common in the adult mental health patient care setting, using the deltoid, vastus lateralis, ventrogluteal, or dorsogluteal site. Mental health nurses frequently use the dorsogluteal site to administer short and long-acting IM injections as specified in the drug package insert or because of patient agitation. However, the site is often not recommended due to the potential risk of nerve injury.

Outcomes of an Interprofessional Patient Safety Fellowship Program.

Background: Interprofessional training for patient safety is essential in developing leaders and advocates who are versed in patient safety science and interprofessional collaboration. We describe an interprofessional patient safety fellowship program and its outcomes over 8 years.

Methods: Programmatic data were reviewed and a survey was sent to all program graduates with a known email address (N = 18).

Implementing daily chlorhexidine gluconate (CHG) bathing in VA settings: The human factors engineering to prevent resistant organisms (HERO) project.

Background: Daily use of chlorhexidine gluconate (CHG) has been shown to reduce risk of healthcare-associated infections. We aimed to assess moving CHG bathing into routine practice using a human factors approach. We evaluated implementation in non-intensive care unit (ICU) settings in the Veterans Health Administration.

Implementing and Sustaining Bedside Shift Report for Quality Patient-Centered Care.

Background: Two evidence-based practice projects and an innovative model provided best evidence and a framework for the implementation and sustainment of a bedside shift report (BSR) quality improvement project.

Problem: Without a standardized BSR process, there was a lack of Veteran involvement in care planning decisions and nurse dissatisfaction related to missed communication of pertinent patient information.

Approach: Facilitators and barriers were identified and addressed during planning.

Development and Implementation of a Model for Research, Evidence-Based Practice, Quality Improvement, and Innovation.

Background: Our medical center nursing council evaluated its current evidence-based practice (EBP) model and decided to consider alternatives.

Problem: No models were inclusive of major nursing activities, such as EBP and quality improvement (QI) projects and research studies.

Approach: A model was developed, meeting the criteria of accessibility, ease of use, and reflective of professional practice activities: EBP and QI projects, research studies, and innovation.

Registered Nurses' Self-Assessed Knowledge of Evidence-Based Practice and Research: Moving Forward With New Information.

By 2020, most clinical decisions should be supported by best evidence. Therefore, nurses need institutional support and education about evidence-based practice (EBP) and research. The aim of this study was to describe nurses' self-assessed knowledge of EBP and research.

Preparing Family Caregivers to Recognize Delirium Symptoms in Older Adults After Elective Hip or Knee Arthroplasty.

Objectives: To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers.

Design: Mixed-method, pre-post quasi-experimental design.

Setting: A Midwest Veterans Affairs Medical Center and a nonprofit health system.

Engaging Nursing Staff in Research: The Clinical Nurse Specialist Role in an Academic-Clinical Partnership.

Purpose: The purpose of this article is to describe the processes of exploring and implementing an academic-clinical study, engaging nursing staff in research, and maintaining their enthusiasm within the context of an academic-clinical research partnership.

Description: The core competencies of the clinical nurse specialist (CNS) role address evidence-based practice, quality improvement, and research. Studies and exemplars of the CNS role in the literature illustrate expert practitioner and facilitator of evidence-based practice, but less attention is given to methods used by the CNS to engage staff in clinical research.

Vancomycin-resistant Enterococcus co-colonization rates with methicillin-resistant Staphylococcus aureus and Clostridium difficile in critically ill veterans.

A prospective study was conducted to identify risk factors for vancomycin-resistant Enterococcus, including co-colonization with methicillin-resistant Staphylococcus aureus and Clostridium difficile infection in patients admitted to the intensive care unit in 2 Veterans Affairs facilities. Methicillin-resistant Staphylococcus aureus and Clostridium difficile infection co-colonization were significant risk factors for vancomycin-resistant Enterococcus colonization. Further studies are needed to identify measures for preventing co-colonization of these major organisms in veterans.

Developing a Web-Based Nursing Practice and Research Information Management System: A Pilot Study.

Many hospital information systems have been developed and implemented to collect clinical data from the bedside and have used the information to improve patient care. Because of a growing awareness that the use of clinical information improves quality of care and patient outcomes, measuring tools (electronic and paper based) have been developed, but most of them require multiple steps of data collection and analysis. This necessitated the development of a Web-based Nursing Practice and Research Information Management System that processes clinical nursing data to measure nurses' delivery of care and its impact on patient outcomes and provides useful information to clinicians, administrators, researchers, and policy makers at the point of care.

Intermittently delivered IV medication and pH: reevaluating the evidence.

The Infusion Nurses Society's Infusion Nursing Standards of Practice has treated pH as a critical factor in the decision-making process for vascular access device selection, stating that an infusate with a pH less than 5 or greater than 9 is not appropriate for short peripheral or midline catheters. Because of the Standards, drug pH is not an uncommon factor driving the decision for central vascular access. In this era of commitment to evidence-based practice, the pH recommendation requires reevaluation and a critical review of the research leading to infusate pH as a decisional factor.

Regional differences in vancomycin-resistant Enterococcus colonization rates in critically ill veterans.

Screening for vancomycin-resistant Enterococcus (VRE) has not been universally implemented within the Department of Veterans Affairs (VA). A prospective study was conducted to identify the admission prevalence rate of VRE in patients admitted to the intensive care unit in 2 VA facilities. Significant regional differences were found between the 2 facilities.

The relationship of nurses' professional characteristics to levels of clinical nursing expertise.

Many hospitals are searching for guidelines for professional practice models, which are a requirement for Magnet recognition. This study was undertaken to determine the professional nursing characteristics that may contribute to the development of clinical nursing expertise. Experience as an RN was found to be highly correlated with initial level of expertise.

Respiratory depression in adult patients with intravenous patient-controlled analgesia.

Patient-controlled analgesia (PCA) has been widely implemented to provide better pain relief and increased patient satisfaction with relatively few side effects. However, patients using intravenous (i.v.

Certification. Hospital versus national standards.

"Certification" and "credential" are frequently used terms in nursing. How these terms are used and what they mean to nursing practice is the focus of this article. Definitions, history, and application of these concepts are explored.

Patients with long-term vascular access devices: care and complications.

Orthopaedic nurses will be dealing with more long-term vascular access devices, such as tunneled catheters, implanted ports, and peripherally inserted central catheters as antibiotic and other supportive intravenous therapy is administered over longer periods. Caring for patients with these devices requires an understanding of the purpose and design of the device, use and maintenance of the catheter or port, and actions to take if complications arise. Knowing the cause and response to the most common clinical problems, such as infection, occlusion, and thrombosis, will help in problem solving and support a variety of teaching strategies for patients.

Racial perspectives on kidney transplant donors and recipients.

Prior to undertaking a campaign to increase organ donation, demographic patterns of kidney recipients and donors were examined for our transplant center--the city and state in which it is located (Detroit and Michigan respectively). From 1984 to 1986 there were 964 kidney recipients in Michigan; 28% were black and 69% were white, whereas only 13% of the population in Michigan is black. As has been shown elsewhere in the United States, blacks have more end-stage renal disease than whites and thus require renal transplantation more often.