When transplant cardiologists at the Debakey Heart and Vascular
Center at Houston Methodist Hospital, began to use percutaneously placed
axillary intra-aortic balloon pumps (PAxIABPs) in 2007, there was one problem.
Not with the procedure, which would act as a bridge to heart transplants. But
rather, with the nursing care that would take place after. When CICU nurses
searched for literature on the subject, there was one problem.
There wasn’t any.
The procedure was so new, so no patient care protocols existed. So they developed them. And now an article about the problems and solutions developed by the nurses is out.
Frederick R. Macapagal, BSN, RN, CCRN, RN, Cardiac Intensive Care Unit, Houston Methodist Hospital, was a part of that team and is a lead researcher on the article. What follows is an edited version of our interview with him
Q: Were you on the original team that discovered that no nursing literature existed on PAxIABPs in 2007?
I was part of the team at Houston Methodist Hospital that
searched the literature in 2007 and did not find any nursing articles about
caring for patients with PAxIABPs. Medical journals had a few articles about
similar procedures, but they focused on the surgical intervention with nothing
about nursing care.
Since this was a relatively new procedure, the lack of
nursing articles was not surprising. Our protocols were developed over time,
using evidence-based nursing care and lots of “learning by doing.” After about
10 years of developing, reevaluating, and taking care of more than 100 patients
with PAxIABPs who are awaiting heart transplant, our staff has become more
competent and comfortable taking care of these patients.
Q: Explain how the
nursing and medical teams collaborated to develop these protocols. Did you work
together to determine what to try and what not to? Please explain.
The cardiologists informed us about the new procedure and
what the change meant for the patients. They gave us parameters and guidelines
on what to do and not to do to take care of the balloon pump and the insertion site.
Overall, the doctors trusted the nursing staff to figure out how to walk these
patients safely and provide the care needed at the bedside. The
multidisciplinary team of nurses, doctors, physical therapists, and ancillary staff
collaborated to devise interventions to mitigate the problems that arose and
incorporate them into the standard of practice.
Q: How did you decide
how to develop and implement clinical practice guidelines if there was no
previous literature with evidence-based practice backing it?
We did not have a choice. Our patients with intra-aortic
balloon pumps needed us to find a way to get them moving. Our patients needed to
walk to keep up their strength while waiting for a transplant, and we had to
develop our own nursing care protocols based on existing evidence-based
practices in order to safely incorporate walking and mobilizing into their care.
Q: What are the
resulting clinical practice guidelines that reflect nursing care practice and
The mobility guidelines we developed address issues such as where
patients walk within the cardiac care unit, for how far, and how long. We
defined the number of staff who need to walk with the patient, based on each
one’s individual strength. The guidelines also cover how often laboratory tests
and x-rays need to be completed. For example, laboratory tests such as complete
blood count and basic metabolic panel are obtained every other day to minimize
blood loss and the need for blood transfusions. On the other hand, chest
radiographs are obtained every day to determine the PAxIABP position.
Our nursing team also developed a PAxIABP repositioning kit so
that transplant cardiologists can perform simple repositioning of the PAxIABP
at the bedside as needed. This kit
contains sterile gloves, masks, surgical cap, stabilization device adhesive,
CHG scrub stick, and a prepackaged central catheter dressing kit. The kit,
stored in a clear plastic bag, is hung on a pole attached to the IABP console
for easy access.
Q: The article lists
some really interesting morale boosters used. Why are these so important to patients
in these situations?
Our pre-heart transplant patients with IABPs wait anywhere
from a few days to months for a donor heart. Anyone would get depressed with waiting
for so long under such stress. So the nursing staff came up with different ways
of helping our patients cope.
We consider these patients part of the CCU family and treat
them as such. We call them by their first names, chat with them about anything
and everything whenever we pass by their rooms, and get to know their family
and other visitors. We celebrate birthdays, anniversaries, holidays, and other
special occasions. We’ve found ways for patients to enjoy the occasional
home-cooked meal, have their pets come for a visit, and more, in an effort to
keep their spirits lifted.
Our patients from 10 years ago regularly come to our unit
when they are in town, chat with us, and offer to visit with current patients
who might need a pep talk and some cheering up. Patients appreciate the extra
effort we put into making their stay with us enjoyable.
Q: What else is important
about the nursing protocols for patients with PAxIABPs?
We started with existing evidence-based practice, but our journey didn’t end there. Whenever a challenge arose, we found solutions to address the situation. We documented each lesson learned and worked through the unique challenges encountered with our patients. We gained confidence throughout this process in our ability to innovate and improve the care we provide to all of our patients. We hope that this article helps other nurses who are caring for patients with PAxIABPs or who may do so in the future. In addition, we hope it inspires nurses to trust in their abilities to be innovative and courageous as they strive to provide the best care for their patients.
To learn more about the protocols, visit https://www.aacn.org/newsroom/nurses-develop-protocols-for-patients-with-paxiabps.
A nurse manager position is a career path that can be as
equally rewarding as it is challenging. The decisions made by the nurse manager
can drastically impact the staff on the unit. Attending important meetings,
hiring staff, leading change, and addressing ongoing staff development and
accountability are just a few examples of what a nurse manager does. If you
find these daily tasks are of interest in your career path, then a nurse
manager job might be right for you. Other responsibilities include not being
afraid to take ownership of a decision while having the confidence and
knowledge to feel comfortable making a decision and dealing with the
Ultimately, the decisions a nurse manager makes affects the
whole staff and there will undoubtedly be those who disagree with the decision.
The nurse manager must move forward confidently to earn the trust and respect
of their staff and have the ability to influence colleagues. If you currently
find your colleagues coming to you for help and they respond well to your
decisions, you might have the personality and the natural ability to influence
your colleagues for the better. This ability is a vital skill for any nurse
manager to have.
Every decision in health care impacts numerous other individuals. Maybe you find that you have the ability to see how one decision impacts another and possess the forethought to better manage patient workflow. The ability to know and understand how a unit functions as part of the whole hospital is also a crucial skill for a nurse manager.
A successful nurse manager must be a dynamic influencer and nursing expert. If you find the role intriguing and possess these skills, you might find the nurse manager role to be a perfect fit!
For more information on leadership roles in nursing check out DailyNurse.com, MinorityNurse.com, or other useful resources available to medical professionals on springerpub.com.
The George Washington University (GW) has launched a new program to help leaders in the School of Nursing who want to show faculty how they can incorporate real-life health care simulations into their lesson plans. The school plans to roll out a series of new simulation programs this year through a newly launched program called GW Nursing Simulation Initiatives.
The programs will help faculty across the world better teach students how to work with mannequins and live patient actors who can provide students with real-life experiences in the nursing field. The new initiative was launched after the nursing school’s second annual simulation conference in March. Most of the programs will be headquartered on the Virginia Science and Technology Campus where the nursing school’s flagship building recently added 12 private exam rooms and two acute care rooms.
GW Nursing Dean Pamela Jeffries tells GWHatchet.com, “When we create this safe, non-threatening environment and immerse students in a simulation, it replicates a real clinical environment—it’s safe, they’re not going to harm patients.”
Two types of simulation training will be offered—“immersions” and “intensives”. Immersion sessions will start in July and include “best practices” for directors of simulation centers, technicians, and teachers. Intensive programs will launch in the fall and feature lessons on including simulations in curriculum and incorporating simulations across professions. Participants will learn how to properly oversee students working with mannequins, control rooms, and cameras.
To learn more about GW Nursing’s newly launched program to train faculty in simulation practices, visit here.
From New Years’ Day 2019 through April 11th, the United States has reported 555 cases of measles in 20 states—the second largest measles outbreak reported since the disease was eliminated in 2000. Keep reading to learn the 10 things nurses need to know about the measles outbreak:
1. Measles is brought into the U.S. by travelers who’ve been in foreign countries where the disease is prevalent—countries in Europe, Asia, Africa, and the Pacific. It is then spread in U.S. communities via contact with pockets of unvaccinated populations.
2. Measles outbreaks, defined as three or more reported cases, are currently ongoing in Rockland County New York, New York City, New Jersey, Washington state, Michigan, and the counties of Butte County California. In addition, new cases have recently been identified in New York’s Westchester and Sullivan counties.
3. Once a person is exposed to the measles virus, it may take up to two weeks before symptoms begin to show. A person is contagious four days before the tell-tale rash appears and for four days after. Measles is an airborne virus that can be shed by those infected long before the symptoms arise.
4. There is no available antiviral therapy to cure measles—only supportive therapy for the symptoms, among which are those similar to the common cold: fever, cough, runny nose, sore throat, followed by conjunctivitis and body rash. Measles can sometimes lead to more serious and life-threatening complications such as pneumonia and encephalitis.
5. New York City Mayor Bill de Blasio has declared a health emergency in the neighborhood of Williamsburg, Brooklyn and is mandating unvaccinated residents to become vaccinated. Those not complying could receive violations and fines of $1,000.
6. Mayor de Blasio has sent a team of “disease detectives” into the Hasidic Community in the Williamsburg neighborhood of Brooklyn, where nearly half of the U.S. cases reported are identified.
7. Coincidentally, the New York State Nurses Association just reached an agreement with the NYC Hospital Alliance to hire more nurses to fill vacancies and add new positions.
8. Detroit is urging those Michiganders vaccinated prior to 1989 to receive a booster vaccination.
How Nurses Play a Role
9. The role of nurses in these outbreaks is education and the promotion of vaccination.
10. It is critical that frontline health care professionals are vaccinated themselves in order to prevent the further spread of the virus, particularly when treating those patients infected by the disease.
The Audie L. Murphy Memorial Veterans Affairs Hospital in San Antonio, Texas has achieved designation as a Pathway to Excellence® organization by the American Nurses Credentialing Center (ANCC). It is the first VA in Texas to be designated as a Pathway to Excellence® organization and the fifth VA in the nation.
The Pathway to Excellence international designation is awarded based on characteristics known as “The Pathway to Excellence Criteria.” For an organization to earn this distinction, it must successfully undergo a thorough review documenting foundational quality initiatives in creating a positive work environment — as defined by nurses and supported by research. These initiatives must be present in the facility’s practices, policies, and culture. Nurses in the organization verify the presence of the criteria through participation in a confidential online survey. Receiving this designation validates the professional satisfaction of nurses at ALMMVH and identifies the facility as one of the best places to work. ALMMVH exceeded scores in 27 out of 28 categories in the Pathway to Excellence Nurse Survey.
“This designation represents the dedication and commitment to nursing excellence,” said Valerie Rodriguez- Yu, MSN, RN, NEA-BC, associate director for Patient Care Services. “Audie L. Murphy staff wanted this prestigious recognition and worked arduously to achieve success as a team. I am extremely proud of each and every one and I congratulate them on achieving The Pathway to Excellence for the first time. We could not have achieved this award without the overall dedication and commitment to excellence for our Veterans, their families and the community.”
“VA is driven by its commitment to nursing excellence and to a positive work environment which translates to good patient outcomes for Veterans,” said Christopher Sandles, director, South Texas Veterans Health Care System. “This success story confirms to our Nation’s heroes that San Antonio VA nurses know their efforts are supported by executive leadership locally and nationwide.”
This story was originally posted on VAntage Point.
Four distinct types of anti-vaccination content seen in Facebook posts
Anti-vaccination messages on Facebook could be divided into four distinct themes: trust, alternative, safety, and conspiracy, according to researchers who analyzed comments posted in response to a pediatrics clinic’s pro-vaccination video.
A small sampling of these messages on Facebook found that “anti-vaxxers” had qualitatively different types of arguments that cater to a wide variety of audiences, reported Brian Primack, MD, of the University of Pittsburgh School of Medicine, and colleagues.
However, the one commonality was that all were distrustful of physicians and the medical community, the authors wrote in Vaccine.
The World Health Organization (WHO) lists “vaccine hesitancy” as one of its 10 threats to global health in 2019, and indeed, Primack and colleagues cited the “considerable rise in the rate of nonmedical exemptions from school immunization requirements” in the U.S.
They noted that while prior research has focused on either anti-vaccination content on Twitter, comments in response to celebrity posts, and Facebook groups, the characteristics of individuals posting anti-vaccination content on Facebook has not been thoroughly examined.
“We want to understand vaccine-hesitant parents in order to give clinicians the opportunity to optimally and respectfully communicate with them about the importance of immunization,” Primack said in a statement. “If we dismiss anybody who has an opposing view, we’re giving up an opportunity to understand them and come to a common ground.”
Primack and colleagues examined the profiles of 197 individuals who posted anti-vaccination comments on a Pittsburgh pediatrics practice’s Facebook page in response to a video promoting the vaccine against HPV. These were among “thousands” posted over a period of 8 days considered anti-vaccination, “which we defined as being either (1) threatening (e.g., ‘you’ll burn in hell for killing babies’) and/or (2) extremist (e.g., ‘you have been brainwashed’),” the group explained.
Among the 197 randomly chosen for analysis (“in order to feasibly conduct in-depth quantitative assessment”), they found a large majority of these commenters were women, and almost 80% were parents. About 30% reported an occupation and a little under a quarter reported a post-secondary education. Of the 55 individuals whose political affiliation could be determined, 56% identified as supporters of Donald Trump, while 11% identified as supporters of Bernie Sanders.
There were 116 individuals who had at least one public anti-vaccination post from 2015-2017, with posts about “educational material,” or claims that doctors are uneducated and parents need to educate themselves were the most popular (73%), followed by “media, censorship, and ‘cover up'” or the suggestion that pharmaceutical manufacturers, government, and physicians deliberately fail to disclose adverse vaccine reactions (71%) and “vaccines cause idiopathic illness,” claiming kids who are not vaccinated get less illness (69%).
The four overarching themes were more specifically:
- Trust: emphasizing suspicion about the scientific community, concerns about personal liberty
- Alternatives: focusing on chemicals in vaccines, use of homeopathic remedies over vaccination
- Safety: perceived risks and concerns about vaccination being immoral
- Conspiracy: that government “hides” information that anti-vaccination groups believe to be facts
Co-author Beth Hoffman, BSc, also of the University of Pittsburgh, said that these groups “caution against a blanket approach to public health messages that encourage vaccination.”
“Telling someone in the ‘trust’ subgroup that vaccines don’t cause autism may alienate them because that isn’t their concern to begin with. Instead, it may be more effective to find common ground and deliver tailored messages related to trust and the perception [that] mandatory vaccination threatens their ability to make decisions for their child,” she said in a statement.
Limitations to the data include that these only reflect commenters who responded to a single pro-vaccination video, and do not necessarily reflect “broader discussions of anti-vaccination issues on Facebook.” Demographic data was self-reported, and could not be authenticated, they noted.
The authors disclosed no conflicts of interest.
This story was originally posted on MedPage Today.