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Effects of an Educational Program on Perceived Value and Barriers to Certification
ASPAN NATIONAL CONFERENCE ABSTRACTS Implications: These findings suggest that perianesthesia nurses can impact patient’s anxiety by changing the surgical environment. Further studies are needed showing its effectiveness with other high anxiety surgical populations.
EFFECTS OF AN EDUCATIONAL PROGRAM ON PERCEIVED VALUE AND BARRIERS TO CERTIFICATION Primary Investigator: Carol Pehotsky, MSN, RN, CPAN, ACNS-BC Cleveland Clinic, Cleveland, Ohio Co-Investigators: James F. Bena, MS, Shannon M. Morrison, MS, Nancy M. Albert, PhD, CCNS, CCRN, NE-BC, Victoria L. Butler, MS, RN, CNOR, FACHE, NE-BC
Background: It is unknown if self-study education increases value and decreases barriers toward certification. Purpose: Determine if perceptions toward certification change after participating in an education intervention. Methods: Perianesthesia nurses completed the Perceived Value of Certification (ÓCCI, 18 items, score range 1-4; , 3, higher value) and Perceived Barriers to Certification (13 items, score range 0-10; higher score, greater barriers) scales pre-post a 47-day self-study education program. Education included testing information, daily questions/answers regarding perianesthesia knowledge, and independent clinical study materials. Nurse demographics and scale scores were compared pre-post education using chi-square or Fisher’s exact tests (categorical data) or two-sample t-tests (continuous data). Results: Of 25 nurses that completed both pre and post scales, mean (SD) age was 42.2(8.7) years, level of experience was 17.8(10.3) years, and years as a Perianesthesia nurse was 11.1(7.7) years. Mean (SD) perceived value and barriers scores pre- vs. post-education were 2.9(0.6) vs. 3.0(0.5), p50.31 and 4.3(1.5) vs. 4.1(1.7), p50.44, respectively. There were no changes in factor scores (intrinsic and extrinsic factors, personal value, recognition from others and professional practice) from pre- to post-education, p values, 0.45-0.94. Barriers to certification were not associated with nurse demographics. In nurses aged $ 43 years and those with $ 17 years nursing experience, total perceived value for certification (p50.027), intrinsic value (p50.041) and personal value (p50.041) were higher than in younger and less experienced nurses. There were no differences in pre-education scores based on highest nurse education or workplace, post anesthesia care or same day surgery. Conclusions: Nurses’ perceptions of certification were slightly positive at baseline and remained unchanged after a self-study education intervention. Barriers to certification were moderately low and did not alter post-education. Selfstudy education was ineffective in altering perceptions of certification. Active education or other interventions may be needed to facilitate nurses’ desire to become certified.
PROSPECTIVE EVIDENCE ON THE USE OF CLINICAL INDICATORS AS DISCHARGE CRITERIA IN PERIANESTHESIA PHASE II RECOVERY Primary Investigator: Aletha Rowlands, PhD, RN, CNOR West Virginia University School of Nursing; Morgantown, West Virginia
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Co-Investigators: Raquel Evans, BSN, RN, Stacy Ross, BSN, RN, Tracy Underwood, BSN, RN, CPAN, Hassan Ramadan, MD, MSc, FACS
Introduction: Research demonstrates registered nurses who provide direct patient care are well poised to design systems and processes to accomplish the goals of safe quality care. However, many processes of patient care are richly steeped in tradition and are not evidence-based. Identification of the Problem: One long-standing tradition in our organization centers on discharging tonsillectomy patients using a “pre-specified period of time” (360 minutes). The presumption is using a “pre-specified time” provides ample opportunity for patients to recovery. This current practice has resulted in inefficiency, increased hospital cost, and a decrease in patient satisfaction. Purpose of the Study: We designed this study to determine “discharge-readiness” of tonsillectomy patients using clinical indicators. We hypothesized that discharge-readiness could be determined using clinical indicators. Methodology: A descriptive comparative approach was used to test the hypothesis. Using a convenience sample, patients (. 3 years) were recruited on the day of surgery. Although patients were discharged using the pre-specified time (comparison), discharge-readiness was determined. Data (45 data points) were collected on each patient’s progression (preoperative baseline, perianesthesia phase I and II, and a phone call 24-48 hours after discharge). Perianesthesia nurses recorded all data on the “Patient Information Form”. ASPAN’s Guidelines and Aldrete Score served as resources for clinical indicators. The study was approved by the Institutional Review Board and informed written consent for participation was obtained from all participants. Results: Descriptive statistics were used to analyze data from 93 patients. The sample included 47(50.5%) males and 46 (49.5%) females with ages ranging from three to 34 with a mean of 9.95 and SD of 7.005. The majority of participants were white (88/94.6%). The surgery length ranged from 14-125 minutes (mean 41.7; SD 20.702) and the recovery time includes: Phase 1: 44-246 minutes (mean 88.95; SD 38.410); and Phase II: 92-480 minutes (mean 256.28; SD 63.974). Discharge-readiness ranged from 84-481 minutes with a mean of 253.36; SD 79.001. Discharge-readiness “time” was less than the pre-specified time (360 minutes) for 77 (82.8%) patients. Of the 77 patients, no complications occurred after the documented discharge-readiness time. Discharge-readiness for 11(11.3%) patients’ was greater than the pre-specified time. Patients’ complications include pain, nausea, and vomiting. Five of the 11 patients needed to contact their surgeon after returning home for vomiting (4); pain (1); and slight bleeding (1). Of the five patients, none returned to the hospital (ED). Key data elements were missing on seven patients (5.4%) so we could not determine discharge-readiness. Discussion: Perianesthesia nurses were able to determine discharge-readiness for their patients. Of the 77(82.8%) patients whose discharge-readiness was less than the pre-specified time, no complications occurred. The discharge-readiness time for 11(11.3%) patients was greater than the pre-specified time. Patients’ Patients’ complications include pain, nausea, and
EFFECTS OF AN EDUCATIONAL PROGRAM ON PERCEIVED VALUE AND BARRIERS TO CERTIFICATION Primary Investigator: Carol Pehotsky, MSN, RN, CPAN, ACNS-BC Cleveland Clinic, Cleveland, Ohio Co-Investigators: James F. Bena, MS, Shannon M. Morrison, MS, Nancy M. Albert, PhD, CCNS, CCRN, NE-BC, Victoria L. Butler, MS, RN, CNOR, FACHE, NE-BC
Background: It is unknown if self-study education increases value and decreases barriers toward certification. Purpose: Determine if perceptions toward certification change after participating in an education intervention. Methods: Perianesthesia nurses completed the Perceived Value of Certification (ÓCCI, 18 items, score range 1-4; , 3, higher value) and Perceived Barriers to Certification (13 items, score range 0-10; higher score, greater barriers) scales pre-post a 47-day self-study education program. Education included testing information, daily questions/answers regarding perianesthesia knowledge, and independent clinical study materials. Nurse demographics and scale scores were compared pre-post education using chi-square or Fisher’s exact tests (categorical data) or two-sample t-tests (continuous data). Results: Of 25 nurses that completed both pre and post scales, mean (SD) age was 42.2(8.7) years, level of experience was 17.8(10.3) years, and years as a Perianesthesia nurse was 11.1(7.7) years. Mean (SD) perceived value and barriers scores pre- vs. post-education were 2.9(0.6) vs. 3.0(0.5), p50.31 and 4.3(1.5) vs. 4.1(1.7), p50.44, respectively. There were no changes in factor scores (intrinsic and extrinsic factors, personal value, recognition from others and professional practice) from pre- to post-education, p values, 0.45-0.94. Barriers to certification were not associated with nurse demographics. In nurses aged $ 43 years and those with $ 17 years nursing experience, total perceived value for certification (p50.027), intrinsic value (p50.041) and personal value (p50.041) were higher than in younger and less experienced nurses. There were no differences in pre-education scores based on highest nurse education or workplace, post anesthesia care or same day surgery. Conclusions: Nurses’ perceptions of certification were slightly positive at baseline and remained unchanged after a self-study education intervention. Barriers to certification were moderately low and did not alter post-education. Selfstudy education was ineffective in altering perceptions of certification. Active education or other interventions may be needed to facilitate nurses’ desire to become certified.
PROSPECTIVE EVIDENCE ON THE USE OF CLINICAL INDICATORS AS DISCHARGE CRITERIA IN PERIANESTHESIA PHASE II RECOVERY Primary Investigator: Aletha Rowlands, PhD, RN, CNOR West Virginia University School of Nursing; Morgantown, West Virginia
e45
Co-Investigators: Raquel Evans, BSN, RN, Stacy Ross, BSN, RN, Tracy Underwood, BSN, RN, CPAN, Hassan Ramadan, MD, MSc, FACS
Introduction: Research demonstrates registered nurses who provide direct patient care are well poised to design systems and processes to accomplish the goals of safe quality care. However, many processes of patient care are richly steeped in tradition and are not evidence-based. Identification of the Problem: One long-standing tradition in our organization centers on discharging tonsillectomy patients using a “pre-specified period of time” (360 minutes). The presumption is using a “pre-specified time” provides ample opportunity for patients to recovery. This current practice has resulted in inefficiency, increased hospital cost, and a decrease in patient satisfaction. Purpose of the Study: We designed this study to determine “discharge-readiness” of tonsillectomy patients using clinical indicators. We hypothesized that discharge-readiness could be determined using clinical indicators. Methodology: A descriptive comparative approach was used to test the hypothesis. Using a convenience sample, patients (. 3 years) were recruited on the day of surgery. Although patients were discharged using the pre-specified time (comparison), discharge-readiness was determined. Data (45 data points) were collected on each patient’s progression (preoperative baseline, perianesthesia phase I and II, and a phone call 24-48 hours after discharge). Perianesthesia nurses recorded all data on the “Patient Information Form”. ASPAN’s Guidelines and Aldrete Score served as resources for clinical indicators. The study was approved by the Institutional Review Board and informed written consent for participation was obtained from all participants. Results: Descriptive statistics were used to analyze data from 93 patients. The sample included 47(50.5%) males and 46 (49.5%) females with ages ranging from three to 34 with a mean of 9.95 and SD of 7.005. The majority of participants were white (88/94.6%). The surgery length ranged from 14-125 minutes (mean 41.7; SD 20.702) and the recovery time includes: Phase 1: 44-246 minutes (mean 88.95; SD 38.410); and Phase II: 92-480 minutes (mean 256.28; SD 63.974). Discharge-readiness ranged from 84-481 minutes with a mean of 253.36; SD 79.001. Discharge-readiness “time” was less than the pre-specified time (360 minutes) for 77 (82.8%) patients. Of the 77 patients, no complications occurred after the documented discharge-readiness time. Discharge-readiness for 11(11.3%) patients’ was greater than the pre-specified time. Patients’ complications include pain, nausea, and vomiting. Five of the 11 patients needed to contact their surgeon after returning home for vomiting (4); pain (1); and slight bleeding (1). Of the five patients, none returned to the hospital (ED). Key data elements were missing on seven patients (5.4%) so we could not determine discharge-readiness. Discussion: Perianesthesia nurses were able to determine discharge-readiness for their patients. Of the 77(82.8%) patients whose discharge-readiness was less than the pre-specified time, no complications occurred. The discharge-readiness time for 11(11.3%) patients was greater than the pre-specified time. Patients’ Patients’ complications include pain, nausea, and