ND Research Abstracts and Summaries2018-01-04T13:43:45+00:00

ND Research Abstracts and Summaries

The collection of research information on this site are from abstracts submitted to our annual conference, and research stories submitted to our newsletter. Each submission includes contact information (if available) in order to encourage anyone interested in learning more about research projects or to develop collaborations to contact each other.

Please see our Statewide Research Directory for a list of researchers, topics and contact information.

Information about submitting abstracts for our annual conference can be found by clicking here.

2016 Annual Conference Abstracts

Graduate Nurses’ Preparedness for Clinical Practice

Preparedness of graduate nurses to provide safe, competent nursing care when they enter clinical practice is a significant concern for the profession because of the presenting and ongoing nursing shortage, increasing patient acuity, and growing complexities in health care systems. This qualitative master’s thesis was conducted to gain insights of graduate nurses, who were employed in varied acute care settings, regarding perceptions of preparedness to enter the nursing workforce.

A sample of 10 BSN prepared registered nurses who graduated from six nursing programs within two years and practiced for at least one year were interviewed. Findings of the study revealed that nursing education experiences could not completely prepare these graduates for their multifaceted roles and responsibilities as registered nurses. The participants emphasized distinct differences between their clinical roles as students and their professional roles as nurses. Practical experiences as registered nurses were described as invaluable learning opportunities that could not be replicated for students in academic settings. The participants recommended mentoring, more hands-on experiences as part of nursing education, and the need for students to develop lifelong learning skills to better prepare graduate nurses to assume professional roles and responsibilities.

The findings of this research supported the need for a collaborative approach among nurse leaders in academia, research, and practice settings to better prepare graduates to successfully navigate challenges associated with entry into professional nursing practice.

For further information about this study, please contact Nicole Hatzenbuhler, MSN, RN at nicole.hatzenbuhler@ndsu.edu.

University of North Dakota College of Nursing and Professional Disciplines Faculty Prepare Report: “North Dakota Nurse Practitioners 2017: Understanding the Workforce”

The well-known shortage of physicians has forced U.S. policy makers to look at the best way to care for the population, especially in regards to primary care.

Current literature has established the contributions of NPs to the primary care workforce and that these providers can likely assist in offsetting the primary care shortage. NPs can work independently in many states, including North Dakota, and are a significant addition to many interprofessional healthcare teams.

A workforce study completed in 2011 indicated only 35% of the states included any information regarding nurse practitioners (NPs) (Morgan, 2011). It is difficult to truly project future needs where there is no one source of provider data that encompasses all primary care provider types.

The goal of this study was to:

  1. Determine where the NPs are educated and where they are practicing.
  2. Provide an overview of ND NP educational program enrollment and costs, as well as current job openings for NPs in the state.
  3. Gather appropriate data to assist policy makers in ND to realize the full scope of the primary care workforce from the NP perspective.

Morgan, P. D. (2011). Physician assistants and nurse practitioners: a missing component in state workforce assessments. Journal of Interprofessional Care, 25(4), 252-257.

doi: 10.3109/13561820.2010.501917

The document is available at the following link: http://cnpd.und.edu/research-grants-management/cnpd-ndnpwfreport.pdf

Further information can be obtained by contacting:

Jana Zwilling APRN, MS, FNP-C  at jana.zwilling@und.edu

Rhoda Owens PhD, RN at rhoda.owens@und.edu

Photovoice: A Participatory Action Research Strategy Applied to Health and Environment on a Tribal Nation

Authors: Loretta Jean Heuer, RN, PhD, FAAN,1 Abby Gold, PhD,2 Mindy Anderson, DNP, RN,3 Mary Leff, MBA, MS,1 & Ella Young, Mount Siani Medical Student4 North Dakota State University School of Nursing,1 North Dakota State University Department of Public Health,2 Mount Sinai Medical School4

Contact: Loretta Heuer, loretta.heuer@ndsu.edu

Background: The influence of environmental factors on a population’s health has gained increased attention. The geography and infrastructure of rural and remote areas make residents prone to problems of poor nutrition and physical inactivity. Research demonstrates that holistic, community development approaches which draw on local resources are the future and these types of interventions will address health concerns while adopting activities that promote health and prevent disease.

Purpose: To explore the use of Photovoice as an educational strategy which fostered participants: • Awareness of environmental factors impacting health. • Application of concepts learned in the community and public health course. • Application of a specific research method.

Methods: Photovoice was used to enhance critical and intercultural dialogue in groups of community college students. Nineteen college students enrolled in a Community and Public Health Course participated in this study.

Results: Five (24%) were male and 14 (67%) were female. Their ages ranged from 16 to over 60 with the majority (86%) 16 to 39. Fifty-seven percent had college experience, five (24%) had graduated from high school, two (10%) had a GED. The four focus groups’ discussion centered on each participant describing what he/she saw in the five photos selected. Other participants in the focus group also reacted to each picture so mutual reflection could occur. The focus group session was audio recorded and later transcribed verbatim. The photographs and resulting focus group transcripts were analyzed for themes using a consistent comparison method applying a locus of control framework ranging from autonomy (“I can do something about this situation”) to reliance (“They should do something about this situation”).

Conclusions: Photovoice is a useful educational approach: • Helps students understand the role that environment plays in health. • Introduces research content, context and process. Students learned they had a voice in framing issues of concern to them.

Preventing Hospital Readmissions in the Elderly

Authors: Carey Haugen, University of North Dakota , Jenny Senti, Altru Health System, Karen Semmens, University of North Dakota

Contact: Carey Haugen, carey.haugen@und.edu

Background or Context: In North Dakota, 14% of our population is elderly (over age 65 years) with the vast majority of this group living at home. The elderly have more chronic diseases which results in high utilization and cost of the health care system. The elderly are also at increased risk of hospital readmission after an acute event.

Purpose: The purpose of this project is to design a program to reduce hospital readmissions for select chronic conditions in the elderly utilizing a Clinical Nurse Specialist (CNS) in the transition from hospital to home. Advanced education and clinical experience enable the CNS to effectively develop a plan of care and manage elderly patients with select resources to improve patient outcomes and reduce hospital readmissions.

Methods: Program development begins with a review of hospital readmissions for select chronic conditions in the elderly. A literature review will be completed. The CNS role will include development of tools to identify elderly at high risk for hospital readmission and appropriate multidisciplinary interventions which initiate in the hospital and continue to the patient’s home.

Results: This program is an ongoing pilot project which is phase one of a larger enterprise. This phase will concentrate on decreasing hospital readmission rates in the elderly. Phase two will involve expansion of services for the elderly to promote healthy aging in their home. Impact of each phase of the program will be determined.

Conclusion/Implications: This program has the potential to be pivotal in changing the cycle of declining health in the elderly population living at home. This design and implementation of high-quality CNS management can also identify interventions which will positively affect patient outcomes. Hospital and community involvement along with appropriate allocation of resources can promote and support healthy aging of the elderly in their home and decrease hospital readmissions.

Revisiting the Facts: Benefits of Advancing from RN to RN, BSN

Authors: Holly Sandhurst, Ed,D, RN, ND State University School of Nursing, Kathleen Swanson, DNP, RN North Dakota State University School of Nursing

Contact: Holly Sandhurst, holly.l.sandhurst@ndsu.edu

Background: The nursing profession has examined the appropriate level of entry into practice for nurses since the 1960s (American Nurses Association, 1965). Level of entry has been a controversial topic throughout the ensuing decades. Attention has refocused on this issue with the 2010 Institute of Medicine (IOM) Report, The Future of Nursing: Leading Change, Advancing Health, which called for a nursing workforce comprised of 80 percent baccalaureate- prepared nurses.

Purpose: The purpose of the presentation is to present data substantiating the need for baccalaureate-prepared nurses in order to improve quality of healthcare and to decrease healthcare costs. Nurses will be able to articulate and support the value of the baccalaureate level of education in transforming health care and outcomes.

Methods: The presentation was developed as a result of a literature review examining the effects of the baccalaureate-prepared nurse on patient outcomes.

Results: Landmark research studies examined almost 300 hospitals, about 300,000 patients and 23,000 nurses and associated an increased percentage of baccalaureate-prepared registered nurses with significantly decreased patient mortality rates (Aiken, Clarke, Cheung, Sloane, and Silber, 2003; Estabrooks, Midodzi, Cummings, Ricker and Giovanetti, 2005; Tourangeau, et al., 2006).With health care reform, nurses are being called upon to lead teams towards higher quality, safer practices, and more efficient care. Baccalaureate-prepared nurses are equipped for complex leadership positions. Despite agreement among national nursing and educator associations, progress in meeting the IOM’s recommendation to increase the percentage of baccalaureate nurses to 80% is slow. In 2014, only 43% NCLEX of candidates earned a baccalaureate degree (National Council of State Boards of Nursing, 2016).

Conclusions: The benefits of educating nurses to the baccalaureate level include improving patient outcomes, decreasing patient mortality, and decreasing healthcare costs, at a time when these issues are of national concern.

The Avoidance of the Trendelenburg Position to Treat Hypotension and is Commonly Used in Relation to Sedation.

Authors: Kristen Slette

Contact: Kristen Slette, kristen.slette@va.gov

Background or Context: The Trendelenburg position is a treatment commonly used to treat hypotension and consists of putting the patient with the head of the bed lowered 45 degrees. A side effect of the conscious sedation is hypotension.

Methods: The Evidence-Based Practice Committee conducted a review of the literature regarding the use of the Trendelenburg position.

Results: Studies show that the Trendelenburg position does not have a positive effect on blood pressure and there are negative effects of this position such as impairing pulmonary gas exchange and places patients at risk for aspiration. This position can also shift fluids adversely engorging the right ventricle, causing it to be dilated, which further reduces cardiac output and blood pressure. Evidence shows that this position does not prevent hypotension or increase blood pressure and is not useful in rescue efforts.

Conclusion/Implications: Change in practice to avoid placing patients in the Trendelenburg position in response to intra or post sedated adult patients to either prevent or treat hypotension. The outcome is improved patient care by preventing the harmful effects that can be associated with the Trendelenburg position. This would also promote patient centered care-by preventing the harmful effects of placing the patients in the Trendelenburg position. This practice promotes patient safety, thus improving the quality of care delivered to the patients.

Interactive Patient Care System: Engaging Patients to Achieve Patient Centered Care Goals

Authors: Sara Stetz, Crystal Nemer, Fargo VA Health Care System

Contact: Sara Stetz, sara.stetz@va.gov

Background: The VA has a strategic plan that focuses on patient- centered care with all initiatives. The Fargo VA Health Care System has embraced patient engagement and the experience through the GetWellNetwork (GWN) interactive patient care system.

Purpose: The Fargo VA Health Care System continues the journey toward a patient-centered care delivery model where the patient is a full member of the care team and is in charge of their care and planning outcomes. The GWN has provided the framework to achieve the goal of full patient engagement in care.

Methods: The Fargo VA Health Care System purchased the GWN to further enhance patient-centered care and encourage patients to become engaged in their healthcare decisions. Despite lacking an interface between the electronic health record and GetWellNetwork, staff devised best practice workflows to integrate GWN into daily routines. Through utilization of the quick care tool to prescribe patient education videos, frontline staff members are able to create a personalized interactive patient care experience. A design team identified four focus areas, based on Press Ganey (patient satisfaction survey) data, were: Pain, patient onboarding, patient satisfaction, and patient discharge.

Results: Outcomes include decreased readmission rate, enhanced patient education, and increased patient satisfaction scores as seen in fiscal year (FY) 15 data.

Conclusions/Implications for practice: • Patient engagement is enhanced by GWN interactive system, which will be further developed when integrated with the electronic medical record. • Patient satisfaction focus enables pro-active customer service and service recovery. • Technology enhances nursing’s ability to drive change for improved patient outcomes and patient satisfaction scores. • Staff nurses aligned work processes with patient centered care model for intentional patient engagement. • Technology enhanced existing work process. • System offers opportunity to strategically heighten patient satisfaction and patient experience.


Do Multiple Choice Exams in Nursing Education Measure Up? Utilizing Faculty Development to Improve Test Construction and Analysis

Authors: Wendy Kopp, NDSU Nursing at Sanford Health Bismarck, Jill Johnson, Assistant Professor of Practice NDSU Nursing at Sanford Health Bismarck

Contact: Wendy Kopp, wendy.kopp@ndsu.edu

Background: The American Association of Colleges of Nursing recognizes the need to enhance diversity in the nursing workforce. Despite the increase in diversity in the United States, minority nurses are inadequately represented, indicating that recruitment efforts of underrepresented groups in nursing education are important. Many of these minority nursing students are English as second language (ESL) students who often have difficulty with academic success due to difficulties with language. Both faculty and students report that multiple choice exams are a challenging task related to language for ESL nursing students.

Purpose: Multiple-choice exams are frequently used to assess student performance in nursing education. However, nurse educators often have inadequate instruction in constructing multiple choice questions (MCQs) resulting in exams with item-writing flaws such as linguistic/structural bias and cultural bias. To improve the quality of these exams and reduce item flaws, further training in item-writing is recommended. The purpose of this project was to increase faculty knowledge on the principles of creating and evaluating test items.

Methods: Three “brown-bag” lunch and learn faculty developments sessions were set up to address the educational needs of test writing and evaluation. Recorded webinars from NurseTim Incorporated were utilized through a statewide nursing organization fund.

Results: Using a retrospective post-then-pre design survey, faculty were asked to rate their knowledge on various questions related to test item construction and evaluation. Results revealed a convincing gain from pre to post knowledge on item writing and evaluation. The majority of faculty also indicated they are already applying or intend to apply the knowledge attained from the development sessions when constructing MCQs.

Conclusion/Implications: With the ability to develop MCQs free from common writing flaws, faculty can fairly and equitably assess student performance utilizing multiple choice exams. These exams would also support ESL students’ success, increasing a workforce that is more congruent with those seeking care.

Taking a Closer Look at Unintentional Injuries in America

Authors: Kevin Axtman, Jerome Differding, Sanford Health

Contact: Kevin Axtman, kkaxtman@hotmail.com

Background or Content: Unintentional injury or trauma is the leading cause of death in Americans aged 1-44. Right behind that is intentional injury in those aged 15-34. More Americans die from violence and injuries than from any other cause, non-communicable diseases and infectious diseases combined. The American Foundation for Suicide Prevention reports in 2013 (the most recent year for which full data was available), 41,149 deaths from suicide was reported, making it the 10th leading cause of death in the United States. Injuries killed more than 192,000 individuals in 2013, accounting for one person every three minutes.

Purpose: What are the contributing factors that contribute to intentional injuries in America

Methods: Data was analyzed utilizing the American College of Surgeon’s National Trauma Data Bank National Sample Program Results The most self-inflicted incidents were from cutting and piercings, followed by firearms. Injury Incidences Percentage Cutting/Piercing 1230 40.5 Firearm 1002 33.0 Fall 350 11.5 Suffocation 149 4.9 Motor Vehicle 68 2.2 Fire/Burn 40 1.3 Poisoning 23 0.8 Other 166 5.8

Conclusion/Implications: The most serious self-inflicted injuries result in hospitalization. Other less-severe self-inflicted injuries are treated in emergency departments, outpatient clinics or not at all. A somewhat surprising finding was that cutting and piercings ranked higher than firearms. Future research garners looking at regions in America and the time of year incidences occurred. By finding out the region, as well as the time of year, public service announcements may be broadcasted more frequently during those times to heighten and educate the population base, and to make them aware of the resources that are available. By using such means to educate the community and draw awareness, it may help curb the high rate of self-inflicted injuries.

The Role of Nursing in Early AV Fistula Placement of Chronic Kidney Disease Patients

Authors: Carey Haugen, University of North Dakota

Contact: Carey Haugen, carey.haugen@und.edu

Background or Context: The arteriovenous (AV) fistula has become the accepted permanent vascular access of choice providing the best patient outcomes for hemodialysis patients. Nationally the use of AV fistula has increased in the prevalent hemodialysis population however remains less than 20% in the 100,000 annual incident population despite national guideline recommendations.

Purpose: Fragmented care, delayed referral to a nephrologist, and lack of patient health literacy can result in late AV fistula placement. The purpose of this project was to identify the best evidence for nursing’s role to facilitate early AV fistula placement and to disseminate this information to medical personnel.

Methods: A detailed literature search and review of early AV fistula placement in chronic kidney disease (CKD) research articles was conducted. Research studies were compared using John’s Hopkins Nursing Evidence-Based Research Evidence Appraisal Tool. Available research data was synthesized in accordance with national guideline recommendations from Fistula First and National Kidney Foundation Kidney Disease Outcomes Quality Initiative.

Results: Results of this project revealed multivariate advantages and barriers to early AV fistula placement. Two themes emerged indicating how nursing may positively influence early AV fistula placement: development and involvement with pre-dialysis education programs; and a dedicated vascular access team to streamline the AV fistula insertion process.

Conclusion/Implications: The clinical practice struggle to meet national recommendations for early AV fistula placement may be successfully enhanced by quality improvement programs which center on education of patients and medical staff. Nursing needs to fully understand the complexity of early AV fistula placement to affect positive patient outcomes. Implications for nursing involve both nurses and advance practice nurses. Effective multidisciplinary education and communication between patient, family, nursing advocates, and providers is necessary to ensure early placement of an AV fistula in CKD patients.

Utilizing Social Marketing to Educate Nursing Students on Health Promotion

Authors: Lindsey Unterseher, NDSU at Sanford Health

Contact: Lindsey Unterseher, lindsey.unterseher@ndsu.edu

Background: In this day of technology, we see social media campaigns and the use of phone applications in place of educational brochures. Nurse use of social marketing has the attractive feature of combining traditional approaches to social change while using advancements in communication technology.

Purpose: Current nursing students are more technologically adept than past generations; they are accustomed to using it in their everyday life. Proficiency in technology is a major asset to their future practice. The Health Behavior Social Marketing Project was created to capitalize on this skill while encouraging active engagement in learning about health promotion.

Methods: Student groups created a 30-second video focused on a topic area from Healthy People 2020. Students were encouraged to be creative, interesting, and appropriate for the target population. Videos were required to have a clearly defined subject, factual information, an evident message, and high-quality picture/sound. In addition to the video, a summary of the social marketing strategy was submitted that gave students the opportunity to describe their efforts.

Results: 94.9 % of 152 students rated the enhancement of certain skills: creating a health promotion program; utilizing social media to promote health; forming a focused, clear message to guide health promotion; and working effectively with others. 98.9% agreed with the following statements: “this project allowed me to use my creativity”, “I had fun doing this project”, and “it was an effective way to reinforce health promotion”.

Conclusion: The Health Behavior Social Marketing Project enriched student learning on health promotion campaigns and using technology to further this endeavor. There is strong potential to grow this project from a single video to a semester-long social marketing campaign. This project helps students feel more confident in their creativity, knowledge, and resourcefulness thereby making the future generation of nurses more dynamic in their interactions with patients.

Oral Cares – A Best Practice Approach

Authors: Victoria Spofford, RN, Kendra Aakre, RN, Erin Wolters, BSN, Fargo VA Medical Center

Contact: Victoria Spofford, Victoria.Spofford@va.gov

Background or Context: Facility oral care has been included on all patient care plans without individualization based on patient assessment or diagnosis. It was identified that there was not a standardized approach to assess and document patient specific oral status or changing oral care needs. Many patients have comorbidities that warrant special oral cares, such as diabetes, dehydration, dysphagia, tracheostomies, oxygen use, and coagulation disorders. Patients may be receiving radiation therapy, chemotherapy or using medications that can damage the oral mucosa. Some patients are unable to perform proper oral cares independently.

Purpose: Evaluate the literature for evidence based practice and best practices related to oral cares; to include identifying oral care practice specific to patient diagnosis and condition of oral mucosa, and methods to identifying changing oral care needs of patients.

Methods: Utilizing a multiple disciplinary approach, which included the speech pathologist, dietitian, providers and nursing staff, the team collaborated to assess current practice and policy. A literature review was then conducted examining the evidence and the standards for special oral care needs and oral care assessments.

Results: Current hospital documentation and practice does not facilitate an individualized approach to oral cares. The research and literature review supports the need for a standardized approach in oral assessments and implementation of individualized oral plans of care. The evidence also supports consideration of patient diagnosis when establishing a plan for oral care.

Conclusion/Implications: The literature review findings provided strong evidence to change current facility policy and practice. Identified changes included the establishment of an assessment template to facilitate a standardized approach in the identification of patient oral care needs and an individualized plan of care based on the assessment.

Cultural Competence Levels for Students in Three Nursing Programs at One North Dakota School

Authors: Norma Kiser-Larson, PhD, RN Loretta Heuer, PhD, RN Misty Condiff, Ph.D., R.N. Mihaela “Ina” Cernusca, M.B.A. Kay Schwarzwalter. M.S. Miranda Halkini, M.Ed. James Deal, Ph.D. Amanda Nordick, M.S. Winta Yallew, Graduate Student, North Dakota State University

Contact: Norma Kiser-Larson, Norma.Kiser-Larson@ndsu.edu

Background or Context: With the change in demographics, it is imperative that nursing education programs and healthcare agencies focus on increasing cultural competence in the nursing workforce. Assessment of cultural competence levels at the start of each program will guide cultural competence education in the nursing programs.

Purpose: Assess cultural competence of students as they enter their respective programs.

Methods: A prospective, descriptive survey design was implemented using the Cultural Competence Model and Cultural Assessment instruments developed by Dr. Bacote. A total of 94 pre-licensure students completed the Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals-Student Version (IAPCC-SV) over two semesters. In addition to that, during one semester 33 LPN to BSN and 14 graduate students completed the Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals-Revised (IAPCC-R). Each instrument measures Cultural Competence which comprises the following constructs: Cultural Awareness, Cultural Knowledge, Cultural Skill, Cultural Encounters, and Cultural Desire. While total possible points for the Student Version is 80 and for the Revised version 100 points, both use the same terms for cultural competence levels. The lowest level is Culturally Incompetent, followed by Culturally Aware, Culturally Competent and Culturally Proficient.

Results: No students scored in the Culturally Incompetent level either semester. Culturally Aware students included 52.1% (49) pre-licensure; 70% (23) LPNs; and 85% (11) graduate students. Those scoring at the Culturally Competent level were 42.6% (40) pre-licensure; 30% (10) LPNs; and 15% (2) graduate students. Only pre-licensure students scored at the Culturally Proficient level 5.3% (5).

Conclusions/Implications: Findings of this study indicates areas of need for graduate and undergraduate nursing cultural education. Results were given to the Nursing Curriculum Committee and Graduate Council for their consideration in making curriculum changes or interventions.

Transforming Health Through Collaborative Partnerships

Authors: Pat Spier, Blue Cross Blue Shield of ND, RN Manager of PCMH Quality Program, Lacey Bergh, BSN, RN,NE-BC, PCMH CCE Director of Clinical Excellence and Quality for Blue Cross Blue Shield of ND

Contact: Pat Spier, patricia.spier@bcbsnd.com

Background: The American College of Physicians recently warned that the backbone of the nation’s health system, primary care, is at risk of collapse. It has been estimated that it would require an 18 hour work day for a primary care provider to manage the recommended preventative, chronic and urgent care needs of their patient panel.

Purpose: Over the past 5 years we have formed a collaborative effort between payer and provider groups to work together to improve both chronic and preventative care under the framework of a Patient Centered Medical Home care model. This type of model supports primary care and also encourages all team members to work to the top of their license and scope of practice.

Methods: • Combined payer and clinical data analytics to identify individual gaps in care and population health opportunities. • Financial support through an alternative payment model for practice transformation and additional clinical support for care coordination. • Regular feedback on quality data and outcomes. • Additional financial incentive for improved quality. • Learning collaborative to share best practices including process changes leading to improved quality outcomes.

Results: Comprehensive measurement improvement over 5 years across 23 clinics in ND • Diabetes improved 5% • Ischemic vascular disease improved 21% • Hypertension improved 10%. Preventative measurement: • Well child visits improvement over 9 months of 12%

Conclusions and implications: The primary care crisis has been likened to a death spiral. Transforming primary care through a PCMH model that engages a team and patients to improve their health along with building partnerships between payers and providers is necessary to stop this spiral and build a sustainable system that is attractive for providers and nurses to improve care for the patients we serve together!

Interdisciplinary Case-Study Events for Dietetics, Education, Exercise Science, Health Care Administration, Nursing, and Social Work Students: Enhancing Effective Communication Between Disciplines

Authors: Anderson, D., Ph.D, LNHA; Dahley, L., Ph.D, MSW; DeJong, J., PhD., FNP-BC; Gust, A., PhD; Langlie, T., MS; Larson, B., EdD, RD, FADA; Loberg, K., PhD., MSW; and Rydell, J., DNP Concordia College, Moorhead, MN 56562

Contact: Jennifer DeJong, dejong@cord.edu

Background/Context: From 2001 to present, the Institute of Medicine (IOM) published eight comprehensive reports on education of health professionals to address changes in the health care delivery system and the changes in the patient/clinician relationship. The Institute of Medicine Committee on Health Professions Education (IOM, 2003) focused on the need for team-based interdisciplinary education strategies as a means to reduce medical error and improve health care quality. In response to these recommendations, faculty arranged three unique experiences for students with majors in the health professions.

Purpose: The purpose of the interdisciplinary case-study events was to respond to the IOM recommendations and to foster effective communication between the professions of dietetics, education, exercise science, health care administration, nursing and social work.

Methods: During three, separate common meeting times, students from each discipline met in a common area to discuss their treatment plans. Groups consisted of one or two undergraduate students from each discipline. At the end of the hour of group discussion, a faculty member led students in concept mapping to identify priorities. Following the event, students were given ten minutes to complete an anonymous survey consisting of five Likert-scaled statements.

Results: Students reported a greater understanding of other professional roles following the experience. Students reported that their ability to work with diverse professionals was enhanced by the experience, and the majority of students reported that they agreed “exceptionally” that their role and voice was valued through this process.

Conclusions/Implications: Students going in to the health professions need to be educated to deliver patient-centered care as members of an interdisciplinary team. Students and faculty benefited from developing interdisciplinary case studies that emphasized listening, valuing other professionals’ roles, and working as a team to deliver evidence-based, patient-focused care.

The Effectiveness and Practicality of Isolating Methicillin-resistant Staphylococcus Aureus Carriers Without Active Infections

Authors: Mitchell Lehn, Med-Surg RN, Brittany Geffre, RN – Fargo VA Health Care System Tiffeny Longmire, RN – Fargo VA Health Care System Alice Safe, RN – Fargo VA Health Care System

Background/Context: Our facility currently utilizes a screening policy for every patient on three inpatient units for methicillin-resistant Staphylococcus aureus (MRSA) colonization. The facility has also implemented a “MRSA control bundle” that utilizes contact precautions for every MRSA carrier despite active infection status.

Purpose: MRSA infections can be an expensive and perplexing battle for many health care facilities in regards to prevention and treatment. A review of the literature was conducted on the topic of MRSA control to determine the necessity and effectiveness of this current policy of screening techniques and contact precautions for MRSA patients that are not actively infectious.

Methods: A literature review was conducted to collect the evidence needed to analyze current practice in regards to MRSA control. The Center for Disease Control and Prevention (CDC) was also consulted regarding the practice of contact precaution requirements and other hospital policies in regards to MRSA control. The review of literature focused on: 1) effectiveness of handwashing versus contact precautions in regards to MRSA control, 2) cost effectiveness of using contact precautions with all MRSA patients regardless of infection status, 3) current practice on MRSA swabbing and 4) current practice for treatment of actively infected MRSA patients and MRSA carrier patients.

Results: The literature and health care practice review remains in progress. The results will be evaluated and analyzed in February.

Conclusion/Implications: Analysis of the results will help determine if the current policy of MRSA control is effective and of value. The results will help guide the implementation of evidence based practices.

Evidence-based Recommendations for Intramuscular Injection Aspiration Practice

Authors: Heidi Houska, Lucy Kappel,  Kate Hoadley, Fargo VA

Contact: Heidi Houska, heidi.houska@va.gov

Background or Context: Current nursing practice is unclear as to whether aspiration is necessary while administering intramuscular injections.

Purpose: Review recommended practices in the administration of intramuscular injections and determine if it is safe to administer intramuscular injections if aspirating is not practiced. Review facility’s injection policy regarding current practice and evaluate whether change is needed to meet current evidence based practice recommendations.

Methods: The facility’s policy and evidenced-based literature were reviewed and a survey was conducted of LPN’s and RN’s working at the facility. The survey consisted of four questions: 1) Are you a registered nurse of a licensed practical nurse? 2) How many years have you been a practicing nurse? 3) Were you taught in school to aspirate during an IM injection? 4) In your current practice do you aspirate during an IM injection?

Results: Review of literature revealed that evidence base practice does not recommend aspiration for intramuscular or subcutaneous injections; except when using the dorsal gluteal site. Surveyed nurses, at the facility, yielded mixed results thereby validating the continued debate amongst nurses whether aspiration is necessary prior to administration of injections. Type of licensure held, education, and years of practice was not a factor regarding practice. It was determined the facility’s practice was not consistent with the recommendations from evidence-based practice literature.

Conclusion/Implications: Recommended change in the facility’s medication injection policy that aspiration is not necessary for injections; except when using the dorsal gluteal site. This evidence based practice be incorporated into the teaching of student nurses and newly employed nurses.

Bullying Affects the Entire Nursing Profession

Authors: Heidi Zweitzig, RN Fargo VA Health Care System

Contact: Heidi Zweitzig, heidi.zwetzig@va.gov

Perceptions of bullying among nurses in institutional settings are pertinent to organizations for a variety of reasons. Nurses are leaving the profession of nursing due to bullying that they are experiencing in the workplace. RNs and LPNs may perceive and experience bullying differently. This study regarding bullying was conducted in a medical center in a Midwestern state. The survey was optional to all RNs and LPNs currently employed in the institution. At time of the study, approximately 286 nurses were employed at the facility where the study was conducted, and 163 or 57% of the current nurses participated in the study. Originally, the RN and LPN groups were to be compared, but after data analysis it was discovered that there was not sufficient statistical differences to compare the groups separately. Instead, the groups were compared using two categories of responses: Any and Weekly/Daily. In the Any category, the top bullying behavior was “being ignored or excluded.” In the Weekly/Daily category the top bullying behavior was “being ordered to do work below your level of competence.” The data from this study will benefit healthcare institutions by identifying the top bullying behaviors and in creating educational tools to assist healthcare institutions in their efforts to decrease bullying behaviors.

Transformative Nursing Training – Assessing the Impact on Self-Care Practices of Nurses

Authors: Joyce Schmaltz, RN, VHA Medical Center Fargo

Contact: Joyce Schmaltz, joyce.schmaltz@va.gov

Background: In 2013, our medical center began a journey to transform form problem-based care to a patient centered care model focusing on whole health. As part of the journey, “Transformative Nursing Training (TNT)” education was provided to nursing staff. The foundation for the TNT program is Holistic Care. The course focused on teaching integrative therapies and the importance of one’s relationship to self, self-awareness, self-assessment, and self-care and how it impacts nursing practice. In March – June 2015, seventy-eight nurses participated in the four day TNT training program. Narrative feedback from nursing staff initially indicated the program had a positive impact on their self-care practices and enhanced their holistic approach to patient care.

Purpose: American Holistic Nurses Association states having a holistic nursing practice requires the integration of self-care and personal development activities into one’s life. The purpose of this study is to evaluate the impact of the TNT course on individual self-care and their approach to holistic nursing and if these practices have been sustained 6 – 8 months post training.

Methods: An online survey was sent out to all nursing staff who participated in the TNT training assessing current self-care practices impacting physical, psychological, emotional, spiritual, and workplace well-being.

Results: Current survey results are being evaluated and data analysis will be complete in February.

Conclusion/Implications: The results will help determined if the current method of training is effective in enhancing and sustaining self-care, will provide guidance in next steps as we move forward with future TNT classes for staff, and identify areas needing additional support to enhance self-care and holistic nursing practice.

Implementation of Standard Work for Blood Pressure Readings not at Goal in the Clinic Setting

Authors: Mary Hegseth, RN, Essentia Health Quality Manager

Contact: Mary Hegseth, mary.hegseth@essentiahealth.org

Background: Patients with Hypertension, Diabetes or IVD were leaving their appointments without a plan of care to reduce their elevated blood pressure. Also the West Region was unable to sustain BP compliance within these chronic disease metrics for Primary/Specialty care.

Purpose: To assure patients receive appropriate follow up/treatment plan for an elevated BP at the clinic visit according to evidenced based guidelines for Hypertension, Diabetes and IVD.

Methods: PDSA: What are we trying to accomplish? Assure patients leave the visit with BP at goal or a treatment plan and follow up is in place to address the elevated BP How will we know that a change is an improvement? Increase in number of patients with DM, IVD, and HTN who have a BP at goal What changes can we make that will result in an improvement? Using standard process at each visit for addressing elevated BP Utilize elevated BP Swimlane at time of rooming patient if BP is not at goal Utilize visual cue for rechecking BP on either schedule and/or exam room door Daily huddles focused on incoming patients with elevated BP Track the progress of follow up/treatment plan on patients who have left with elevated BP on flow boards at daily huddles West Region Ancillary “Nurse only Blood Pressure’ appointment guidelines

Results: Measurement period: December 2014-June 30 2015 BP compliance: HTN: increased 3% Diabetes: increased 1% IVD: increased 1%

Conclusions: The implementation of standard work has increased BP at goal up to 3% over the measurement period. Currently the West Region continues to sustain the increases with an additional 1% rise in IVD since June 2015. Standard work not only helps to meet a quality metric but it helps keeps our patients safe.

A Stroke Nurse Boot Camp: Improving the Confidence of Critical Access Hospital Nurses

Authors: Megan Tykwinski, Stroke Program Coordinator, Essentia Health Ahren Dosch, MSN, RN, SCRN: Essentia Health Julie Rosenberg, BSN, RN, LNHA: Essentia Health Marlee Hurtt, LPN: Essentia Health

Contact: Megan Carlblom, megan.carlblom@essentiahealth.org

Introduction: Critical access hospital (CAH) nursing staff are limited in resources and face many barriers in obtaining access to educational opportunities related to stroke care. In Minnesota and North Dakota there are a combined 115 CAHs. The tertiary hospital hosting the Stroke Nurse Boot Camp received 40 percent of their stroke patient population from CAH transfers in fiscal year 2015, demonstrating the need to ensure competency of staff in CAH facilities.

Purpose: Improved effectiveness of CAH nursing staff in providing confident and effective care for acute stroke patients following evidence based practice after completing a hands-on Stroke Nurse Boot Camp hosted at a Primary Stroke Center. Improved skills related to performing a National Institutes of Health Stroke Scale (NIHSS) and mixing and dosing of alteplase in an acute care setting.

Methods: Data measurement from a post-evaluation survey was used to assess the perceived effectiveness and knowledge learned at the Stroke Nurse Boot Camp. The training included: a mock stroke alert, lecture and open forum discussion on current stroke treatment guidelines as well as pathophysiology, live demonstrations of the NIHSS, alteplase mixing and dosing with participant return demonstrations, and open discussion on the continuum of care of stroke transfer patients.

Results: Data collected from the post-evaluation survey showed activity objectives were met by at least 90 percent of the 29 participants. Evaluations also revealed that participants increased their confidence when completing a NIHSS.

Conclusion: In conclusion, our results show that tertiary hospitals and designated stroke centers can partner with CAHs to improve the effectiveness of care provided to stroke patients by improving the confidence and skills of CAH nursing staff.

Behavioral Modifications in Hypertension Patients Living in Rural Communities

Authors: Tara Brandner, FNP, DNP-S, Ashley Medical Center

Contact: Tara Brandner, tbrandner04@gmail.com

Background: 70 million American adults are living with high blood pressure, yet only 52% have adequate control. Lifestyle modifications are effective in preventing and managing high blood pressure, but whether people with high blood pressure who live in rural areas change their lifestyles are not well understood.

Objectives: The purpose of the study is to assess lifestyle behaviors and associated factors among hypertensives living in rural communities. The goal for this study was to determine the current amount of exercise routinely performed by people with hypertension in rural communities. Barriers to exercise were also examined in addition to determining if there is a correlation between lack of resources in a rural setting and amount of exercise being performed. Dietary recommendations were evaluated to determine the correlation between meeting dietary recommendations and exercise.

Methods: A descriptive design was used to recruit a convenient sample of 142 participants with a diagnosis of hypertension who live in rural areas. Tools utilized were the Behavioral Risk Factor Surveillance System (BRFSS) through the Centers for Disease Control (CDC) and Barriers to Self-Care Scale Physical Activity Subscale (BSCS PAS). Participants completed a paper-pencil survey that assessed their current amount of exercise routinely performed and analyzed their dietary intake. Factors associated with exercise and dietary intake were also analyzed.

Results: Results will be finalized by February 2016.

Conclusions: Very few studies have examined behavioral modifications in the rural setting. This research will provide valuable information for further research regarding behavioral modifications in those living in rural settings with chronic diseases such as hypertension. It is imperative to first understand behaviors and associated factors before designing effective interventions to improve patients’ blood pressure control in rural settings.