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Biomedical subjects

Anna Gawlinski

Publications and source records attributed to Anna Gawlinski.

10 recordsLinked to original sources
PubMed2006

Strategies used by nurses to recover medical errors in an academic emergency department setting.

PURPOSE: The purpose of this study was to gain insight into how nurses recover medical errors in the emergency department (ED) setting. METHODS: The research method was of exploratory descriptive design with qualitative analysis. Subjects who signed the informed consent participated in one of four focus groups centering on nurse's role in recovering errors. Questions were asked during the focus groups to elicit information regarding nurse's role in the three phases of error recovery, namely, identifying, interrupting, and correcting the error. RESULTS: Five themes emerged to describe methods used by nurses to identify errors in the ED setting. These themes included: surveillance, anticipation, double checking, awareness of the "big picture," and experiential "knowing." Five themes emerged as methods used to interrupt errors: patient advocacy, offer of assistance, clarification, verbal interruption, and creation of delay. The themes for correcting an error were assembling the team and involving leadership. CONCLUSION: The results of this study provide preliminary evidence of the strategies used by ED nurses in the recovery of medical error. Further research is needed to generalize these findings to other ED settings. Knowledge of effective recovery strategies can ultimately be used to develop interventions for reducing medical error and improving patient safety.

Adaptation, Psychological↗
PubMed2006

Communication boards in critical care: patients' views.

BACKGROUND: Some patients receiving mechanical ventilation experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech. Although the use of a communication board to enhance communication with such patients has been suggested, few descriptive or empirical studies have addressed the content and format of these devices or of patients' perspectives on decreasing frustration with communication. OBJECTIVES: The objectives of this study were: (1) to identify the perceived level of frustration of patients receiving mechanical ventilation while they attempt to communicate; (2) to determine patients' perceived level of frustration if a communication board had been used; and (3) to describe patients' perceptions of the appropriate content and format of a communication board. METHODS: Twenty-nine critically ill patients who were extubated within the past 72 hours were included in this descriptive study. Subjects participated in a 20- to 60-minute audiotaped interview consisting of questions about their perceived level of frustration when communicating with and without a communication board and their thoughts about the appropriate content and format of a board. Transcripts were analyzed by questions for meaning and overall themes. RESULTS: Sixty-two percent (n = 18) of patients reported a high level of frustration in communicating their needs while receiving mechanical ventilation. Patients judged that their perceived level of frustration in communicating their needs would have been significantly lower (P < .001) if a communication board had been offered (29.8%) than if not (75.8%). Most patients (69%; n = 20) perceived that a communication board would have been helpful, and they also identified specific characteristics and content for a communication board. A communication board may be an effective intervention for decreasing patients' frustration and facilitating communication. CONCLUSIONS: Most patients receiving mechanical ventilation experienced a moderate to a high level of frustration when communicating their needs. In this study, a communication board, if used patiently during mechanical ventilation, has been shown to alleviate frustration with communication. Patients have specific ideas about what terms and ideograms are useful for a communication board. Further research is needed to test the effects of a communication board and other methods of facilitating communication on outcomes such as satisfaction and anxiety of patients, adequate and appropriate management of pain, and length of mechanical ventilation time and hospital stay.

Adolescent↗
PubMed2006

Standardizing IV infusion medication concentrations to reduce variability in medication errors.

Practical strategies for preventing medication errors in pediatric patients are needed. Medication safety can be improved by assessing current practices, developing evidence-based interventions to improve such practices, evaluating the impact of new evidence-based innovations, and providing feedback to clinicians [20]. Nurses at the point of care are well positioned to identify and implement structures and processes to address medication errors so that the most preventable errors become a thing of the past.

Adverse Drug Reaction Reporting Systems↗
PubMed2002

An educational project to improve knowledge related to pulse oximetry.

BACKGROUND: Pulse oximetry is a frequently used, noninvasive monitoring tool for assessing arterial blood oxygenation. Physicians, registered nurses, and respiratory therapists are responsible for the accurate interpretation of pulse oximetry data as part of the evaluation and management of acutely and critically ill patients. OBJECTIVES: (1) To evaluate the extent of current knowledge about pulse oximetry and (2) to increase clinicians' knowledge of research-based practices related to the appropriate use of pulse oximetry and interpretation of its results. METHODS: A test/survey of 17 true-false questions based on the research-based practice protocol of the American Association of Critical-Care Nurses was developed to evaluate current knowledge of pulse oximetry. A convenience sample of medical, nursing, and respiratory therapy staff was invited to complete the test/survey before and several months after an educational program to improve staff members' knowledge of pulse oximetry. The program included educational forums, policy changes, competency checklists, and verification of inclusion of research-based principles in orientation programs. RESULTS: A total of 442 staff members completed the test/survey given before the educational program: 331 nurses, 82 physicians, and 29 respiratory therapists. The overall mean percentage of correct answers was 66%. Differences between disciplines were significant: respiratory therapists scored slightly higher (76%) than did nurses (64%) and physicians (66%) (P = .01). The scores on the test/survey given after the educational program increased significantly, from 66% to 82% (P < .01). CONCLUSIONS: This educational project improved staff members' knowledge of pulse oximetry monitoring.

Clinical Competence↗
PubMedDate not supplied

Patients' reports of health care practitioner interventions that are related to communication during mechanical ventilation.

BACKGROUND: The literature supports nursing interventions to maximize communication in mechanically ventilated patients, yet limited research exists on patients' perceptions of the helpfulness of health care practitioner interventions to enhance communication. In addition, the level of frustration experienced by these patients has not been reported. Thus, further research is necessary to examine patients' perspectives of the helpfulness of health care practitioner interventions that enhance communication of the mechanically ventilated patient. OBJECTIVES: This study describes the level of frustration experienced by mechanically ventilated patients and ascertains the helpfulness of methods used by health care practitioners to meet the communication needs of the mechanically ventilated patient. METHODS: A total of 29 critically ill patients, extubated within the last 72 hours, were included in this descriptive study using qualitative and quantitative methods. Subjects participated in an average 30-minute audiotaped interview session consisting of questions pertinent to their perceived level of frustration in communicating and the interventions practitioners used to meet their communication needs. Transcripts were analyzed by question and for overall themes. RESULTS: It was found that 62% of patients (n = 18) reported a high level of frustration in communicating their needs while being mechanically ventilated. There was no significant difference between the duration of intubation and the level of frustration (Spearman r =.109, P =.573) or between the diagnosis and the level of frustration (P =.932). Patients who received anxiolytics (n = 23, 79% of the sample) had a lower level of frustration (mean 3.26) than those who did not receive anxiolytics (n = 6, 21% of the sample, mean 4.33). This difference trended toward significance (P =.084). Patients cited health care practitioner behaviors, characteristics, and attributes that both facilitated communication (kind, informative, and physically present at the bedside) and impeded their ability to communicate (mechanical, inattentive, and "absent" from the bedside). Patients reported problems and stresses associated with communication difficulties that can be alleviated by the health care practitioner. CONCLUSIONS: Mechanically ventilated patients experience a high level of frustration when communicating their needs, and health care providers have a significant impact on the mechanically ventilated patient's experience. Further research is needed to explore and measure methods of facilitating communication that increase patient satisfaction, reduce patient anxiety, and obtain optimal pain management.

Anti-Anxiety Agents↗
PubMedDate not supplied

A "near-miss" model for describing the nurse's role in the recovery of medical errors.

Approximately 44,000 patients die each year as a result of medical errors. Nurses play an important role in ensuring patient safety and preventing adverse outcomes. As frontline providers of care, nurses are in key positions to intercept a medical error before it affects a patient. The Eindhoven model for investigating a "near-miss" situation has been used successfully in the chemical industry to elucidate the concept of human recovery, that is, the ability of operators to detect, localize, and correct system faults. In this article, we propose applying the Eindhoven model to the clinical setting, in which nurses play the role of operators by identifying, interrupting, and correcting medical errors. After describing the model, we present clinical scenarios to illustrate how it can be applied. More research is needed to explicate the nurse's role in managing medical errors. Interventions to decrease medical errors require insight into strategies that frontline clinicians can use to identify and mitigate potentially harmful incidents. The Eindhoven model can help researchers, administrators, and clinicians to conceptualize the role for nurses in developing such interventions.

Drug Hypersensitivity↗
PubMedDate not supplied

Assessing outcomes in advanced practice nursing practice: the use of quality indicators and evidence-based practice.

Advanced practice nurses (APNs) impact both patient care and healthcare systems on a daily basis. Tracking and documenting the outcomes of APN practice have become essential, due partly to the emphasis on outcomes that has become a component of the majority of healthcare initiatives. This article outlines important aspects related to assessing outcomes and discusses the use of quality indicators to demonstrate outcomes of APN practice. Examples from clinical practice are provided in order to demonstrate that assessing the outcomes of APN practice can be incorporated into daily practice as part of ongoing initiatives. In delineating the outcomes of APN care, the value of APNs can be formally acknowledged.

Data Collection↗