my nearly 20 years of experience as a registered nurse, I’ve learned that
simple steps make a significant difference. Fast-paced clinical settings make
the procedures and protocols that all medical staff are familiar with
incredibly important. Proactive steps, as simple as remembering to always wipe
down all patient areas and keep them clear of unnecessary or unused supplies,
have the ability to keep both patients and medical staff safer.
nurses, patient safety is fundamental to what we do. It’s the first thing that
we think about when we get up in the morning, and the last thing we think about
before we go to bed. But no matter what your role in the organization, patient
safety must be the priority.
This is especially true when caring for patients with chronic
diseases, who are at an even higher risk given their weakened immune systems. At Lung Health Institute, we
specialize in treating patients with chronic lung disease, such as COPD and emphysema,
and we’re proud to have earned The Joint Commission Gold Seal of Approval® for
ambulatory health care accreditation.
Because we are continually evaluated, this recognition reflects our longstanding
commitment to The Joint Commission’s National Patient Safety Goals focus on
identifying patients correctly, using medicines safely, preventing infection
and providing appropriate treatment.
that vetted protocols and procedures are in place across your organization
is the first step to providing the safest environment possible for your
patients. Formal accreditation is a great way to ensure this exists, but
you should also revisit and review your procedures regularly. Health care is dynamic, and these
processes need to constantly evolve along with the industry.
At any stage of the process in your organization, here are a few tips that nurses caring for patients with chronic disease should follow to ensure the safest environments:
- Never stop learning: Best practices and industry
standards are always changing, so you should strive to stay on top of the
latest and greatest. I would recommend getting involved with local or national
nursing organizations and attending any relevant conferences.
- Lend a helping hand: With more young nurses in
the field than ever before, experienced nurses need to lead by example, taking
the extra time to demonstrate the right procedures and protocols can go a long
- Open the doors of
Patients are often scared when in a health care setting and taking the time to
ask them questions about not only how they’re feeling physically — but mentally
— can ensure you’re adjusting treatment plans appropriately and collaborating
with physicians in real time to problem solve. A safe environment for patients
takes into account both their physical and mental health.
- Slow down and think: It’s incredible how many
errors can be prevented by taking the time to think, without rushing through your
- Speak up: If you’ve observed standards
and protocols and think something could be done differently, say so. Real life
experiences help shape and create the best processes, and every operation is
unique and should be tailored appropriately. Following a challenging situation,
take the time to debrief with your peers — those more experienced and less
experienced than you. Talk about what happened, and how you can work together
to make it better or more efficient moving forward. Update procedures and
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.
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.
An assistant professor at the University of Nevada Las Vegas is doing all that she can to help pregnant women get screened for perinatal depression. Marcia Clevesy, DNP, has been working at a Las Vegas clinic to improve screenings and documentation on a local level, particularly for postpartum depression.
Perinatal depression is the occurrence of a major or minor
depressive episode during pregnancy or up to one year after childbirth, and
affects as many as one in seven mothers. This term also includes postpartum
depression (PPD), a common complication that occurs after childbirth. But routine screenings for these occurrences is
not standard for most health care providers.
Recently, the U.S. Preventive Services Task Force published
a recommendation to provide or refer pregnant women with an increased risk of
perinatal depression to interventions. But while this report has just been released,
Dr. Clevesy has been working to progress research and care for those with PPD,
especially early on in pregnancy.
“It is important for a focus to be placed on detecting perinatal depression early on to prevent complications,” Dr. Clevesy shared with the UNLV News Center. “The earlier we can identify maternal depression the better, because we are then able to get patients into therapy and treatment sooner.”
Opening Up A National Discussion
Dr. Clevesy’s work has major positive impact both locally
and nationally, especially as discussions of mental health overall are becoming
more common and more open throughout the United States. As more people open up
about their mental health in media and online, women are feeling more
comfortable and secure discussing their own concerns and issues with their
healthcare providers, allowing Clevesy and her colleagues to help strengthen
their work in the Las Vegas area.
“I’ve been a women’s health nurse practitioner for many years, and want to continue to elevate the standard of PPD screening beyond simply asking patients if they’re depressed,” Dr. Clevesy told the UNLV News Center. “In collaboration with Dr. Tricia Gatlin, associate dean for undergraduate affairs at the School of Nursing, I recently implemented a system for providers at a local clinic to use an existing, reliable and validated screening tool — the Edinburgh Postnatal Depression Scale (EPDS) — to screen for PPD as a means of promoting best practice among the maternal-child population.”
Dr. Clevesy also shared that since implementing the new
system, PPD screening documentation rates have nearly doubled. Dr. Clevesy’s
work is crucial for enlisting more Las Vegas health care providers to provide depression
screenings for their pregnant patients, whether they use her screening tool or not.
“One tool is not necessarily preferred over the other. What matters is that health care providers are using a validated tool to effectively screen and promote a discussion regarding depression symptoms,” Dr. Clevesy said. “This assessment should start at the beginning of pregnancy and continue into the postpartum period.”
When treating a patient with Chronic Obstructive Pulmonary Disease (COPD), the physical symptoms are usually easy to see. The psychological impacts, like depression and anxiety, are there too, but they can be more difficult to identify. That’s why it is critical for the nurses and other health care providers caring for these patients to have a better understanding of what they are experiencing – both physically and mentally – in order to guide the best possible care.
Because little research exists on the emotions and feelings a patient faces while living with this chronic disease, I set out to learn more. My findings from a series of interviews with severe (stage IV) COPD patients published in The Journal for Nurse Practitioners uncovered some of these “hidden symptoms” of COPD, shedding light on the mental struggles COPD patients must face every day. Additionally, I found that some health care providers can do more to lessen this burden for the patient.
I believe there are steps that nurses can take to ensure that they’re addressing all of the symptoms of COPD:
- Help Patients Make Sense of the Diagnosis: Many of the patients in the study spoke about being confused when they first experienced symptoms of COPD. They knew something was wrong when they started to experience breathlessness, one of the most common symptoms of COPD, but they didn’t fully understand what caused it. As you can imagine, it’s easy to feel afraid when you don’t know what is happening to your body. It’s our job to help educate our patients about their condition, communicating with their physician and offering recommendations beyond just telling them to quit smoking or to use an inhaler.
- Take the Time to Ask Thoughtful Questions: Once diagnosed, many patients are overwhelmed with feelings of guilt, fear and hopelessness. Specifically, severe COPD is often met with increased anxiety about the end of life, and many patients in the study admitted having a difficult time accepting that this is how they were spending their last years. They also often had a hard time being optimistic about the future. It is important to let patients know that they are not alone and encourage them to share anything they may be feeling. This will ultimately help us provide the best possible care and treatment.
- Connect Patients to a Support System: The patients in my research were brave enough to share their stories, and I know there are many more patients out there struggling with similar emotions and feelings. There are many resources that we can offer these patients in order to improve their quality of life, including social support groups, end of life planning, and counseling.
Changing perceptions of risk could improve compliance with infection-control measures
It’s often said that knowledge is power. But a new study finds that when it comes to nurses’ compliance with infection-control measures, it’s more appropriate to say attitude is everything.
The study, published in the American Journal of Infection Control, examines the relationship between infection-control compliance, knowledge, and attitude among home healthcare nurses. Researchers surveyed 359 home healthcare nurses in the U.S., and evaluated their knowledge of best practices in relation to their compliance with infection-control measures.
Over 90% of nurses self-reported compliance for most of the measured behaviors. The researchers also found there was not a direct correlation between knowledge of infection-control practices and compliance with those practices. However, there was a relationship between the level of compliance and the participants’ favorable attitude toward infection control.
“This study tells us that knowledge is not enough,” said one of the lead authors, Jingjing Shang, PhD, of Columbia University School of Nursing in New York City. “Our efforts to improve compliance need to focus on ways to alter nurses’ attitudes and perceptions about infection risk.”
The authors suggest that efforts to improve compliance with infection-control practices should focus on strategies to alter perceptions about infection risk. Changes should start on an organizational level, and seek to create a culture of positivity in relation to infection-control compliance.
Among other takeaways from the study:
- Protective equipment lapses: While most of the participants reported compliance on most issues, many reported lapses when it came to wearing protective equipment; only 9% said they wear disposable face masks when there is a possibility of a splash or splatter, and 6% said they wear goggles or eye shields when there is a possibility of exposure to bloody discharge or fluid
- A culture of “presenteeism:” Presenteeism, coming into work despite being sick, has become a patient safety issue over the last few years, especially as it relates to infection control; only 4% of participants felt it was easy for them to stay at home when they were sick, which could be a major contributor to rates of infection
- Hand hygiene is still an issue: 30% of respondents failed to identify that hand hygiene should be performed after touching a nursing bag, which could transport infectious pathogens as nurses travel between patients
“Infection is a leading cause of hospitalization among home healthcare patients, and nurses have a key role in reducing infection by compliance with infection-control procedures in the home care setting,” Shang said.
This story was originally posted on MedPage Today.