Task force 6: Code of conduct for staff and volunteer leadership.
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Advisory Committees↗
Biomedical subjects
Gayle R Whitman
Publications and source records attributed to Gayle R Whitman.
Outcomes research in advanced practice nursing selecting an outcome.
APNs should investigate outcomes that will enhance patient care and contribute to building nursing knowledge and science; however, APNs should also consider addressing and including into their daily activities outcomes that are of interest to governmental, accreditation, and not-for-profit groups. APNs can accomplish this in a number of ways within the numerous roles from which they practice. APNs practicing as clinical nurse specialists can incorporate these outcomes into hospital based quality improvement or management activities in which they already routinely initiate or participate. Additionally, in their roles as role model or educator they can provide their professional nursing colleagues with a clear understanding of these outcomes and their importance to patient care and the institution's success. And finally, in their role as acute care nurse practitioners, APNs can seek to measure and benchmark their own performance on many of these measures. Active participation in measuring, reporting, and improving the outcomes addressed within this article will help ensure that all patients achieve a minimum consistent level of quality outcomes. Of equal importance, however, is that by being active partners in achieving these outcomes, APNs will further enhance recognition of the vital role nursing plays in improving the quality of care provided to all Americans by our healthcare system.
Accreditation↗
Outcomes research: getting started, defining outcomes, a framework, and data sources.
As key providers of care and as participants in systems delivering care, APNs are in ideal positions to explore, identify, measure, and evaluate patient outcomes. This article has provided an overview of some of the basic knowledge and skills required to undertake outcome studies. Through the application of these basic principles, the beginning APN can start to explore patient outcomes via quality improvement activities. With mastery and expansion of these principles, the expert APN can easily progress into outcomes research studies, which provide substantive contributions to the outcomes research agenda.
Data Collection↗
Predictors and impact of atrial fibrillation after isolated coronary artery bypass grafting.
OBJECTIVE: Although an extensive number of studies have attempted to identify predictors of new-onset atrial fibrillation (AFIB) after coronary artery bypass grafting (CABG), a strong predictive model does not exist. Prior studies have included patients recruited from multiple centers with variant AFIB prevalence rates and those who underwent CABG in combination with other surgical procedures. Also, most studies have focused on pre- and perioperative characteristics, with less attention given to the initial postoperative period. The purpose of this study was to comprehensively examine pre-, peri-, and postoperative characteristics that might predict new-onset AFIB in a large sample of patients undergoing isolated CABG in a single medical center, utilizing data readily available to clinicians in electronic data repositories. In addition, length of stay and selected postoperative complications and disposition were compared in patients with AFIB and no AFIB. DESIGN: Retrospective, comparative survey. SETTING: University-affiliated tertiary care hospital. PATIENTS: Patients with new-onset AFIB who underwent isolated standard CABG or minimally invasive direct vision coronary artery bypass were identified from an electronic clinical data repository. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The prevalence of AFIB in the total sample (n = 814) was 31.9%. Predictors of AFIB included age (p =.0004), number of vessels bypassed (p =.013), vessel location (diagonal [p <.003] or posterior descending artery [p <.001]), and net fluid balance on the operative day (p =.015). Forward stepwise regression analysis produced a model that correctly predicted AFIB in only 24% of cases, with age (14%) and body surface area (9%) providing the most prediction. The incidence of embolic stroke was higher in AFIB (n = 8) vs. no AFIB (n = 4) patients, but stroke preceded AFIB onset in seven of eight cases. Subjects with AFIB had a longer stay (p =.0004), more intensive care unit readmissions (p =.0004), and required more assistance at hospital discharge (p =.017). CONCLUSIONS: Despite attempts to examine comprehensively predictors of new-onset AFIB, we were unable to identify a robust predictive model. Our findings, in combination with prior work, imply that it may not be feasible to predict the development of new-onset AFIB after CABG using data readily available to the bedside clinician. In this sample, stroke was uncommon and, when it occurred, preceded AFIB in all but one case. As anticipated, AFIB increased length of stay, and patients with this complication required more assistance at discharge.
Aged↗
The impact of staffing on patient outcomes across specialty units.
OBJECTIVE: Determine the relationships between nursing staffing and specific nurse-sensitive outcomes (central line blood-associated infection, pressure ulcer, fall, medication error, and restraint application duration rates) across specialty units (cardiac and noncardiac intensive care, cardiac and noncardiac intermediate care, and medical-surgical). BACKGROUND: A number of hospital-level studies have demonstrated that lower staffing levels are associated with higher adverse patient outcomes. However, insufficient insight into unit-level staffing relationships is available. Further unit-level inquiry is necessary to fully explicate the relationships between staffing and outcomes and to provide assistance to nurse administrators as they seek to develop blueprints for staffing plans that are linked to quality outcomes. METHODS: Secondary analysis of prospective, observational data from 95 patient care units (cardiac intensive care, n = 15; noncardiac intensive care, n = 7; cardiac intermediate care, n = 18; noncardiac intermediate care, n = 12, and medical-surgical, n = 43) across 10 acute care hospitals. RESULTS: No statistically significant relationships were found between central line infection and pressure ulcer rates and staffing across specialty units. Significant inverse relationships were present between staffing and falls in cardiac intensive care, medication errors in both cardiac and noncardiac intensive care units, and restraint rates in the medical-surgical units. CONCLUSIONS: Results from this study suggest that the impact of staffing on outcomes is highly variable across specialty units; however, when present, the relationships are inversely related with lower staffing levels, resulting in higher rates of all outcomes.
Accidental Falls↗
Resource utilization related to atrial fibrillation after coronary artery bypass grafting.
BACKGROUND: Studies of resource utilization by patients with new-onset atrialfibrillation after coronary artery bypass grafting have addressed only length of stay and bed charges. OBJECTIVE: To compare resource utilization between patients with new-onset atrial fibrillation and patients without atrialfibrillation after isolated coronary artery bypass grafting. METHODS: Retrospective review of clinical and administrative electronic databases for 720 subjects who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass in 25 months at one medical center The prevalence of atrial fibrillation was determined, and resource utilization in various hospital cost centers was compared between subjects with and without atrialfibrillation. RESULTS: The prevalence of new-onset atrial fibrillation was 33.1%. Compared with subjects without atrialfibrillation, subjects with atrialfibrillation had a longer stay (5.8 +/- 2.4 vs. 4.4+/-1.2 days, P<.001), more days receiving mechanical ventilation (P =.002) and oxygen therapy (P<.001), and higher rates of readmission to the intensive care unit (4.6% vs. 0.2%, P<.001). Subjects with atrial fibrillation also had more laboratory tests (P<.001) and more days receiving cardiac drugs, heparin, diuretics, and electrolytes. Subjects with atrialfibrillation had higher total postoperative charges ($57261 +/- $17101 vs. $50905 +/- $10062, P = .001), a mean difference of $6356. The mean differences were greatest for bed charges ($1642), laboratory charges ($1215), pharmacy ($989), and respiratory care ($582). CONCLUSION: The economic impact of atrialfibrillation after coronary artery bypass grafting has been underestimated.
Aged↗
Nursing-sensitive outcomes in cardiac surgery patients.
Achieving optimum patient outcomes has always been the primary focus of healthcare providers. The degree to which any healthcare discipline can impact outcomes varies since patient outcomes are multiple and diverse. As the measurement and reporting of outcomes has moved into the arena of public reporting, it has become essential for disciplines to be able to identify which outcomes they can either partially or completely influence. The focus of this article is to (1) identify what specific nursing-sensitive outcomes have been measured or monitored on cardiac surgery patients in the past and then (2) suggest potential next generation outcomes.
Activities of Daily Living↗
Measuring nurse-sensitive patient outcomes across specialty units.
In efforts to quantify the quality of care delivered to patients within their systems, nursing administrators are being called on to both privately and publicly report nursing-sensitive outcomes for their institutions. Accurate reporting with appropriate patient population or risk adjustment is essential if the reported outcomes are to provide meaningful data to consumers and providers. At present there are no effective mechanisms available that can sufficiently adjust nursing-sensitive outcomes to assure reliable reporting. This study suggests that specialty unit classification may be one method by which nursing-sensitive outcomes can be accurately reported.
Accidental Falls↗
Making the grade.
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Forms and Records Control↗
Measuring nursing activities using an ecological momentary assessment method.
The ecological momentary assessment method proved to be an effective and efficient method for conducting a study to assess nursing activities across a number of hospital settings and geographic distances. Nurse administrators and outcomes researchers who are seeking to measure and assess nurse activities should consider using this approach.
Efficiency, Organizational↗
What patient outcome should our outcomes management team measure?
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Humans↗