- Email: [email protected]
006–Interdisciplinary Preoperative “Nuss Bar” Education Class
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EDUCATION of shared governance and leadership. The Advancing Practice and Education Council (AP/E) of the PPM was given the task of implementing an ongoing Neuroscience Education Initiative (NEI) on a busy inpatient unit. The unique aspect of the process was empowering nurses to have a voice in determining the best way to deliver education given their busy schedules. A team of leaders created an NEI to efficiently educate their nurses. The team struggled with having the resources to set up and maintain attendance at the inpatient services because of lack of structure and other more pressing priorities on the unit. The AP/E council strategized to create a way to infuse training into the intense day of the bedside nurse. The NEI incorporated various methods of teaching into several educational sessions for the individual nurse to explore. The initiative provided the staff nurse with the ability to attend an educational session for a shortened period. Five educational topics were scheduled over a 6-week period at various times to ensure participation from all nurses. Examples of the creative teaching methods include introductory neurology class, return demonstration of assessments, poster review, learning stations, inpatient services from the outpatient neurology team, and resource sheets about relevant neurological diagnoses or procedures. A survey was completed to evaluate the overall effectiveness of the NEI. Evaluations showed that nurses were highly satisfied with the teaching methods. The goal of the AP/E council is to continue to explore innovative methods of teaching the bedside staff so that knowledge is efficiently transferred and effectively applied to patient care. Future considerations for the NEI include providing CD-ROM education for off shifts and weekends, including electroencephalogram technologists and nursing assistants into the sessions as well as sharing the implementation of the initiative with various units within the hospital. 006—Interdisciplinary Preoperative bNuss BarQ Education Class Betsy Colbeth, MSN, RN Mary Thistlewood, BSN, RN Terri Woodward, RN CNS Julie Coy, MS, RN, CPNP Mark Popenhagen, PsyD Bethany McDowell, TR Stephanie Skirka, BSN, RN Randi Price, PNP, RN Justina Kashman, BSN, RN Jane Stephens, BSN, RN Kacie LaRock, PT Linda Sholar, PT, The Children’s Hospital, Denver, CO Clinical staff on 3 North at The Children’s Hospital, Denver, CO, had noticed that children undergoing minimally invasive repair of pectus excavatum (MIRPE) often felt unprepared for the extent of the surgical procedure and the amount of pain and pressure and experienced an extended recovery period after discharge. Postoperative concerns included constipation, which contributes to postoperative nausea and vomiting and can prevent advancement of the treatment plan. Anecdotal evidence suggested that families also felt unprepared for care of the child at home and were unprepared for the length of recovery, including disrupted sleep patterns and slow return to school and other normal activities. Staff nurses reported frustration with inconsistent postoperative orders secondary to multiple physician preferences. A multidisciplinary team (surgical services, staff nursing, Acute Pain Service, physical therapy, clinical psychology, and Child Life/Therapeutic Recreation) collaborated on the development of a patient–parent preoperative class designed to address surgical preparation and recovery issues and improve patient outcomes. A postoperative care path was also developed. The class includes physical and psychological preparation for the surgery, pre- and postoperative diet, education of the surgical process, discussion of pain management including medications typically used, psychological coping skills, exercises, and resumption of activities. Packets of information containing postoperative exercises, Nuss Bar information, and anticipated activity timeline of hospitalization stay are given to participants. Participants are encouraged to attend the class within 1 month prior to the surgery date. Although current nursing care of MIRPE patients at The Children’s Hospital is consistent with the recognized standard of care (Smith, 2004), a comprehensive literature review revealed support for an evidence-based pathway yet indicated only one other similar program for this patient population (Swoveland, Medvick, Kirsch, Thompson, & Nuss, 2001). Increased patient education and enhancement of consistent postoperative nursing care contribute to optimal outcomes. The class and care path have been implemented recently, and a future study is being developed. It will employ a nonexperimental design to evaluate the effects of the class–care path to optimize outcomes for GI function, pain management, and resumption of usual physical and social activities. The results of this will have potential implications for care not only of this specific surgical population but also of the educational design used to optimize outcomes in general. Collaboration of a multidisciplinary team is inherent to the provision of successful family-centered care.
007 — Getting Diabetic Education Under Control on the Pulmonary-Adolescent Unit. Dilcia Courtney, RN, Anh Mac, BSN, RN, Rhonda Wolfe, BSN, RN, Shelly Nalbone, MS, RN, CPNP, Michelle Reedy, BSN, RN, CPN, Elizabeth Shrout, BSN, RN, CPN, Texas Children’s Hospital, Houston, TX Purpose: Advancing technology, higher patient acuity, and higher patient census require today’s nurses to multitask and prioritize differently than in the past. Most nurses inherently possess a desire to be at the bedside, providing direct patient care.
Nurses have reported frustration when called away from these duties to interpret assessment data and documentation or find equipment. The Unit Practice Council (UPC) on the Pulmonary/Adolescent unit of a major children’s hospital recognized that this issue was occurring frequently with staff on their unit. Method: The UPC representatives performed an initial review of current practice, using a Performance Improvement Data Collection Tool, to identify potential areas of improvement. This review established baseline performance data related to the documentation on the diabetic flow sheet. Findings: The data collection showed inconsistency of documentation among staff and supported the UPC’s belief that nurses were repeatedly contacted by their physician colleagues to interpret information, delaying the nurse from performing critical nursing duties. The group provided educational sessions with all licensed and unlicensed staff members related to proper documentation on the diabetic flow sheet. After completion of the educational sessions, performance data were again collected and reviewed. The group found that performance had improved in all areas. This improved performance also allows physician colleagues to base decisions on complete documentation. Conclusion: Empowered by the progress and results, the UPC joined a multidisciplinary initiative looking at insulin therapy in the hospital setting. The group has developed a tool for nursing staff that will delineate critical teaching points and streamline the education and home care needs to eventually improve outcomes and length of stay for patients with diabetes. Future plans include working with pharmacy leaders and Clinical Nurse Specialists to develop an online educational offering for nursing and other disciplines on the care of the patient receiving insulin therapy. 008 — Spreading Our Wings Around the World: Online Nursing Grand Rounds Independent Study. Paul Gittens, BBA, Jill Guilfoile, MEd, BSN, RN, Anne Longo, MBA, BSN, RN-BC, Cincinnati Children’s Hospital, Cincinnati, OH Nursing Grand Rounds (NGR) has been in existence at Cincinnati Children’s Hospital Medical Center (CCHMC) for more than 30 years. The objective is to continue to bring up-to-date information in 1-hour monthly educational sessions using various formats to reach pediatric nurses working/living all over the world. NGR provides for nurses’ professional growth and development, suggesting positive patient and family outcomes based on the nurses applying the knowledge learned from NGR. Each NGR is available in the following formats: ! ! ! ! ! !
Live in the classroom at selected CCHMC locations Live via the intranet Live via the Internet Independent Study via the intranet Independent Study via the Internet Videotaped and shown via public-access television
The purpose of revamping the independent study offering was to create an innovative method of offering free, easily accessible, educational opportunities available for nursing contact hours. Potential evaluation tools were reviewed to ensure the capability of effectively delivering an evaluation tool, posttest, and certificate of completion via the CCHMC intranet and Internet Web sites. A tool was developed, which includes responses designed to obtain demographic information, Likert scale questions, multiple-choice and true/false questions for the posttest, and open-ended questions. Since beginning the online process, there has been a 35% increase in the number of participants, including nurses from Duke University, University of Chicago, and Seattle, WA, who found NGR via the Internet. Lessons learned included adding a brequiredQ field to capture demographics and exploring the possibility of offering accompanying handouts. 009 — Preceptor Forums: Inspiring Excellence. Katherine Hanlon, BSN, RN, Children’s Hospital of Orange County, Orange, CA bPreceptor ForumsQ was a project developed to improve the quality of the preceptor– orientee mentorship at Children’s Hospital of Orange County. Preceptors are an integral part of the role transition from novice nurse to professional nurse. Preceptors not only acclimate new nursing graduates to hospital policy but also are exemplars of living the hospital’s mission—to nurture, advance, and protect the health and wellbeing of children. Preceptors, on a one-to-one basis, assist the new nurse in developing his or her knowledge and skill base that is unique to the practice of pediatric nursing, and preceptors provide the motivation and support for new nurses to function independently and successfully in their respective units. In the past, at our hospital, there was little institutional provision for preceptors to cultivate their preceptor skills other than a 1-day optional training session. As a result, bPreceptor ForumsQ was created as an ongoing educational and professional development opportunity for preceptors. The preceptors meet four times during the 6-month new graduate orientation. In these forums, the preceptors share new and innovative teaching strategies. These meetings have improved communication among unit-based preceptors and, eventually, among hospital-wide preceptors, created an environment that promotes and supports ongoing education, integrated evidencebased practice policies, and fostered an environment of collegiality. The hospital
EDUCATION of shared governance and leadership. The Advancing Practice and Education Council (AP/E) of the PPM was given the task of implementing an ongoing Neuroscience Education Initiative (NEI) on a busy inpatient unit. The unique aspect of the process was empowering nurses to have a voice in determining the best way to deliver education given their busy schedules. A team of leaders created an NEI to efficiently educate their nurses. The team struggled with having the resources to set up and maintain attendance at the inpatient services because of lack of structure and other more pressing priorities on the unit. The AP/E council strategized to create a way to infuse training into the intense day of the bedside nurse. The NEI incorporated various methods of teaching into several educational sessions for the individual nurse to explore. The initiative provided the staff nurse with the ability to attend an educational session for a shortened period. Five educational topics were scheduled over a 6-week period at various times to ensure participation from all nurses. Examples of the creative teaching methods include introductory neurology class, return demonstration of assessments, poster review, learning stations, inpatient services from the outpatient neurology team, and resource sheets about relevant neurological diagnoses or procedures. A survey was completed to evaluate the overall effectiveness of the NEI. Evaluations showed that nurses were highly satisfied with the teaching methods. The goal of the AP/E council is to continue to explore innovative methods of teaching the bedside staff so that knowledge is efficiently transferred and effectively applied to patient care. Future considerations for the NEI include providing CD-ROM education for off shifts and weekends, including electroencephalogram technologists and nursing assistants into the sessions as well as sharing the implementation of the initiative with various units within the hospital. 006—Interdisciplinary Preoperative bNuss BarQ Education Class Betsy Colbeth, MSN, RN Mary Thistlewood, BSN, RN Terri Woodward, RN CNS Julie Coy, MS, RN, CPNP Mark Popenhagen, PsyD Bethany McDowell, TR Stephanie Skirka, BSN, RN Randi Price, PNP, RN Justina Kashman, BSN, RN Jane Stephens, BSN, RN Kacie LaRock, PT Linda Sholar, PT, The Children’s Hospital, Denver, CO Clinical staff on 3 North at The Children’s Hospital, Denver, CO, had noticed that children undergoing minimally invasive repair of pectus excavatum (MIRPE) often felt unprepared for the extent of the surgical procedure and the amount of pain and pressure and experienced an extended recovery period after discharge. Postoperative concerns included constipation, which contributes to postoperative nausea and vomiting and can prevent advancement of the treatment plan. Anecdotal evidence suggested that families also felt unprepared for care of the child at home and were unprepared for the length of recovery, including disrupted sleep patterns and slow return to school and other normal activities. Staff nurses reported frustration with inconsistent postoperative orders secondary to multiple physician preferences. A multidisciplinary team (surgical services, staff nursing, Acute Pain Service, physical therapy, clinical psychology, and Child Life/Therapeutic Recreation) collaborated on the development of a patient–parent preoperative class designed to address surgical preparation and recovery issues and improve patient outcomes. A postoperative care path was also developed. The class includes physical and psychological preparation for the surgery, pre- and postoperative diet, education of the surgical process, discussion of pain management including medications typically used, psychological coping skills, exercises, and resumption of activities. Packets of information containing postoperative exercises, Nuss Bar information, and anticipated activity timeline of hospitalization stay are given to participants. Participants are encouraged to attend the class within 1 month prior to the surgery date. Although current nursing care of MIRPE patients at The Children’s Hospital is consistent with the recognized standard of care (Smith, 2004), a comprehensive literature review revealed support for an evidence-based pathway yet indicated only one other similar program for this patient population (Swoveland, Medvick, Kirsch, Thompson, & Nuss, 2001). Increased patient education and enhancement of consistent postoperative nursing care contribute to optimal outcomes. The class and care path have been implemented recently, and a future study is being developed. It will employ a nonexperimental design to evaluate the effects of the class–care path to optimize outcomes for GI function, pain management, and resumption of usual physical and social activities. The results of this will have potential implications for care not only of this specific surgical population but also of the educational design used to optimize outcomes in general. Collaboration of a multidisciplinary team is inherent to the provision of successful family-centered care.
007 — Getting Diabetic Education Under Control on the Pulmonary-Adolescent Unit. Dilcia Courtney, RN, Anh Mac, BSN, RN, Rhonda Wolfe, BSN, RN, Shelly Nalbone, MS, RN, CPNP, Michelle Reedy, BSN, RN, CPN, Elizabeth Shrout, BSN, RN, CPN, Texas Children’s Hospital, Houston, TX Purpose: Advancing technology, higher patient acuity, and higher patient census require today’s nurses to multitask and prioritize differently than in the past. Most nurses inherently possess a desire to be at the bedside, providing direct patient care.
Nurses have reported frustration when called away from these duties to interpret assessment data and documentation or find equipment. The Unit Practice Council (UPC) on the Pulmonary/Adolescent unit of a major children’s hospital recognized that this issue was occurring frequently with staff on their unit. Method: The UPC representatives performed an initial review of current practice, using a Performance Improvement Data Collection Tool, to identify potential areas of improvement. This review established baseline performance data related to the documentation on the diabetic flow sheet. Findings: The data collection showed inconsistency of documentation among staff and supported the UPC’s belief that nurses were repeatedly contacted by their physician colleagues to interpret information, delaying the nurse from performing critical nursing duties. The group provided educational sessions with all licensed and unlicensed staff members related to proper documentation on the diabetic flow sheet. After completion of the educational sessions, performance data were again collected and reviewed. The group found that performance had improved in all areas. This improved performance also allows physician colleagues to base decisions on complete documentation. Conclusion: Empowered by the progress and results, the UPC joined a multidisciplinary initiative looking at insulin therapy in the hospital setting. The group has developed a tool for nursing staff that will delineate critical teaching points and streamline the education and home care needs to eventually improve outcomes and length of stay for patients with diabetes. Future plans include working with pharmacy leaders and Clinical Nurse Specialists to develop an online educational offering for nursing and other disciplines on the care of the patient receiving insulin therapy. 008 — Spreading Our Wings Around the World: Online Nursing Grand Rounds Independent Study. Paul Gittens, BBA, Jill Guilfoile, MEd, BSN, RN, Anne Longo, MBA, BSN, RN-BC, Cincinnati Children’s Hospital, Cincinnati, OH Nursing Grand Rounds (NGR) has been in existence at Cincinnati Children’s Hospital Medical Center (CCHMC) for more than 30 years. The objective is to continue to bring up-to-date information in 1-hour monthly educational sessions using various formats to reach pediatric nurses working/living all over the world. NGR provides for nurses’ professional growth and development, suggesting positive patient and family outcomes based on the nurses applying the knowledge learned from NGR. Each NGR is available in the following formats: ! ! ! ! ! !
Live in the classroom at selected CCHMC locations Live via the intranet Live via the Internet Independent Study via the intranet Independent Study via the Internet Videotaped and shown via public-access television
The purpose of revamping the independent study offering was to create an innovative method of offering free, easily accessible, educational opportunities available for nursing contact hours. Potential evaluation tools were reviewed to ensure the capability of effectively delivering an evaluation tool, posttest, and certificate of completion via the CCHMC intranet and Internet Web sites. A tool was developed, which includes responses designed to obtain demographic information, Likert scale questions, multiple-choice and true/false questions for the posttest, and open-ended questions. Since beginning the online process, there has been a 35% increase in the number of participants, including nurses from Duke University, University of Chicago, and Seattle, WA, who found NGR via the Internet. Lessons learned included adding a brequiredQ field to capture demographics and exploring the possibility of offering accompanying handouts. 009 — Preceptor Forums: Inspiring Excellence. Katherine Hanlon, BSN, RN, Children’s Hospital of Orange County, Orange, CA bPreceptor ForumsQ was a project developed to improve the quality of the preceptor– orientee mentorship at Children’s Hospital of Orange County. Preceptors are an integral part of the role transition from novice nurse to professional nurse. Preceptors not only acclimate new nursing graduates to hospital policy but also are exemplars of living the hospital’s mission—to nurture, advance, and protect the health and wellbeing of children. Preceptors, on a one-to-one basis, assist the new nurse in developing his or her knowledge and skill base that is unique to the practice of pediatric nursing, and preceptors provide the motivation and support for new nurses to function independently and successfully in their respective units. In the past, at our hospital, there was little institutional provision for preceptors to cultivate their preceptor skills other than a 1-day optional training session. As a result, bPreceptor ForumsQ was created as an ongoing educational and professional development opportunity for preceptors. The preceptors meet four times during the 6-month new graduate orientation. In these forums, the preceptors share new and innovative teaching strategies. These meetings have improved communication among unit-based preceptors and, eventually, among hospital-wide preceptors, created an environment that promotes and supports ongoing education, integrated evidencebased practice policies, and fostered an environment of collegiality. The hospital