Within Reach Newsletter December 2019 Conference Edition

Within REACH -

CONFERENCE EDITION Volume 10│Issue 5│December 2019

Carilion Medical Center, 1906 Belleview Ave, Roanoke, VA 24014 http://chsweb.carilion.com/nursserv/NursW eb.html nursingresearch@carilionclinic.org (540)266 -6216

What do you gain from attending a conference?

Pam Lindsey, MSN, RN, ACNS-BC - Carilion Magnet Program Director There are many benefits to attending a professional conference for the organization and the attendee. This past October 28, staff from the Carilion Clinic Roanoke Campus were awarded the opportunity to attend the largest nursing conference in the US. The ANCC Magnet® Conference has an average attendance of 10,000+nurses representing 502 Magnet® designated organizations and celebrating more than 100 recently new designated/redesignated Magnet organizations. Carilion Clinic Roanoke Campus received their 4th designation award on the 1st day of this magnificent conference.

Although this was a great reason to attend, there are also benefits associated with the conference that impact the organization and all employees that were not in attendance.

A big reason to go to conferences is to meet with likeminded people and industry peers. Conferences bring together people from all different geographical areas who share a common goal, and they are a great way to build or expand your professional network.

You can expand your knowledge and find solutions to problems. You will hear a lot of things that are new to you and things that validate the processes that you have in place. You can speak to presenters one-onone about what they are working on from new techniques, new types of equipment, and unpublished data.

You can present your ideas and work to others. It is good practice in talking about what you do with a variety of people from similar, related and/or completely different areas of nursing. Presenting will make you more confident about the work that you do and gives you a new perspective about your work. At a conference you could get feedback on your work from people who have never seen it before and may provide a new insight. It is also a good way for people to meet you.

Attending conferences has a two-fold benefit. You may learn things outside of your area of expertise, but conferences also have many sessions for professional development and career advice. When you go to a conference, the attendees are united by a single broad topic with multiple sub-topics.

So, what did you gain from attending a conference? We all have our own reasons for attending but in my opinion, conference attendance dramatically enhances both your professional and personal development, as well as providing you with tools and skills that cannot be taught in house or online. The focused nature of learning at a conference allows you to dig deeper with the understanding of your topic of interest.

Sharing your experience with your unit and coworkers allows all employees to benefit from the greatness of conference attendance. This special conference edition provides abstracts, seminars, and take-aways from Carilion participants at the 2019 National Magnet® Conference, the Carilion Nursing Research Conference and many more, so that you may also share in the experience!

~ Pam

Carilion Clinic Roanoke Campus

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Index Page Introduction - Pam Lindsey, MSN, RN.........................................................................................

1

Table of contents.........................................................................................................................

2

Introducing Carilion Editorial Board ...........................................................................................

3

2019 ANCC Magnet® Conference (i) Magnet® introduction ......................................................................................... (ii) Welcome to Orlando, FL ................................................................................... (iii) Introducing our Magnet® Presenter.................................................................... (iv) Magnet® Session Highlights .............................................................................. (v) Magnet® Keynote Speakers .............................................................................. (vi) Congratulations! 4th Magnet® Designation........................................................ (vii) Magnet® Highlights............................................................................................. (viii) 2020 Magnet Conference - Save the Date.........................................................

5 6 7 8 26 28 29 30

2019 Carilion Nursing Research Conference (i) Conference Summary ........................................................................................ (ii) Keynote Speaker ............................................................................................... (iii) Panel Presenters ............................................................................................... (iv) Poster Presenters .............................................................................................. (v) Conference Snapshots........................................................................................ (vi) Conference Reflections....................................................................................... (vii) Conference Abstracts........................................................................................

31 32 33 34 39 40 42

Additional Conference Attendance (i) Conference reviews ............................................................................................ (ii) Conferences and other events ............................................................................

56 63

*Editorial Board Members

1. Donna Goyer, BS, RN, CPAN, CAPA - Perioperative Specialist, CRMH OR Services 2. Sarah Dooley, MPH, BSN, RN - Director, Women’s Quality & Patient Safety 3. Desiree Beasley, MSN, RN, CCRN, CCNS - Clinical Nurse Specialist, CNRVMC Nursing Administration 4. Vivian Wilson, BSN, RN, CCRP - Clinical Research Nurse III, Clinical Research Coordinators 5. James Ingrassia, MSN, RN - Preceptor, CRMH 5 West Med/Surg 6. Cindy Hodges, RNC, BSHS, FCN - Perioperative Specialist, CRMH OR Services 7. Monica Coles, PhD, RN - Clinical Nurse Specialist, Nursing Professional Practice 8. Michele Kosinski, DNP, MBA, RN - Clinical Team Leader , CRMH 8S PCU Radius 9. Deirdre Rea, MSN, RN - Director, Carilion Connect 10. Shanna Flowers, MA - Volunteers Manager, Guest Services Administration 11. Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC - Clinical Nurse Specialist, Nursing Quality & Patient Safety 12. Sarah Browning, DNP, RN - Director, System Operations & Support, Carilion Community Based Services 13. Nancy Altice, DNP, RN, CCNS, ACNS-BC - Clinical Nurse Specialist, CVI Medicine 14. Christine Fish-Huson, PhD. RN - Research Associate, Carilion Nursing Research/Assistant Professor, Radford Carilion 15. Britmarie Witkowski, MPH - Infection Preventionist, Carilion Infection Control 16. Ann Beheler, ADN, RN - Pediatric Medicine, Jefferson Clinic, Carilion Pediatrics 17. Kim Carter, PhD, RN, NEA-BC, Senior Director, Nursing Research & EBP/Editor, Within REACH 18. Margaret Perry, MSN, RN - Senior Human Resource Consultant, Clinical Staff Teaching/Associate Editor, Within REACH

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Introducing our Carilion Nursing Editorial Board *See identification previous page

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The purpose of the Carilion Nursing Editorial Review Board is to promote the dissemination of research and evidence-based practice consistent with the mission and values of Carilion Clinic. Editorial Review Board members provide mentorship and editorial feedback, encourage submissions, and promote dissemination of Carilion EBP and research through a variety of approaches. Carilion Nursing Editorial Review Board Charter

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Join us as we celebrate our visit to the ANCC National Magnet Conference in Orlando, FL

2019 MagnetÂŽ Conference Center

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Carilion Roanoke Campus Awarded our 4th Magnet ® designation ! In pursuit of #5 Carilion Clinic Roanoke Campus was designated a Magnet® facility for the fourth time in 2018 by the American Nurses Credentialing Center (ANCC). First earned in 2003, our Magnet® designation recognizes excellence and professionalism in nursing and is widely accepted as nursing’s highest honor. It was created to advance three goals:

1. Promote quality in an environment that supports professional practice.

2. Recognize excellence in the delivery of nursing services to patients.

3. Provide a mechanism for the dissemination of best practices in nursing.

Living Magnet® Even before we earned Magnet® designation we knew that we lived by Magnet® principles; it’s one of the main reasons why we began the Magnet® journey. And, we continue to live Magnet® every day.

Magnet® designation is a testament to the incredible passion for nursing shown by our staff at all levels of the organization. The commitment, compassion, and hard work of everyone at Carilion make achievements like this possible. We don’t need awards and recognition to know our nurses are providing the highest quality patient care, but it’s an honor when national organizations agree. On October 18, 2018 we received notification from ANCC Magnet ® of our 4th designation. We are now in the second year of pursuing our 5th Magnet® designation!

In addition, ANCC announced in 2018 that Carilion Clinic Roanoke Campus was awarded an exemplar. Citing extraordinary achievement in internal dissemination of research and new knowledge, through a variety of strategies such as this Within REACH publication. It is rare for an organization to receive an exemplar and it is a testament to the extraordinary work of the Nursing Research Council and the staff in the Carilion office of Nursing Research EBP & Excellence.

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l-r: Rebecca Bishop; Annie Phillips Smith

l-r: Kim Carter; Shelly Feazell; Barbara Boggs; Alyne Abbott

l-r: Linda Siar; Rebecca Bishop

Front row, l-r: Rebecca Bishop; Chris Monk. Back row: l-r: Rose Etienne; Carla Hazelwood

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Introducing Carilion’s Presenter at the 2019 National MagnetŽ Conference Burnout, Exhaustion, and Communication: Nurses Living the Balance Kimberly Carter, PhD, RN, NEA-BC - Carilion Clinic Nursing Research; Richard Bogue, PhD, FACHE - University of Iowa Hospital & Clinics, Iowa City, IA

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Session Highlights

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Session Title:

Reviewer: Dottie Cook, BSN, RN Co-Chair: Nursing Quality Council

Speaker & Organization: Shonna Bracco, DNP, RN, NEA-BC & Rebecca Calhoun, MSN, RN-BC, SCRN, NEA-BC

Unit: 7S ICU Baylor Scott & White Medical Center Temple, TX

Session Highlights: This medical center was a 640 bed, Level 1 Trauma Center. Important elements: •

#silentnomore “Say Something (We Won’t Give Up on You)” ZDoggMD.com https://www.youtube.com/watch?v=-ZGpp0wESxw

•

Patient/Visitor behavioral events underreported, only 1 out of 45 reported and that one was reported because the staff was injured.

•

Focused on reporting - increased reporting events from 8-20/30 per month.

•

Took a multidisciplinary approach.

•

Pilot units and bundle signs.

•

“No violence” signs posted in every room and lobby.

•

One hand activation alarms for staff.

Take-Away for Carilion: Support NO VIOLENCE. “No violence” signs in every room and lobby. One hand activation alarms for staff, that also prevented falls at the presenter’s organization.

Work with legal department regarding the development of signs.

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Session Title:

Speaker & Organization: Reviewer: Barbara Boggs, MSN, RN, CCRN Co-Chair Nursing Research Council

Unit: CRMH Nursing Support Services

Melissa Joy Pennington, BSN, RN-BC Carol Grove, MSN, RN, NEA-BC Meritus Medical Center Hagerstown, MD

Session Highlights: In 2017, nurses from Meritus Medical Center shared their concerns regarding the increase in workplace violence within their facility. These concerns led to the development of a Workplace Violence Forum. The steps developed and taken by this forum include: •

• • • •

•

Heightened security: badging visitors, metal detection, partnership with Washington County Sheriffs’ Department to place a deputy in the Emergency Department, 18.5 FTE security officers added, ensured security changes were communicated to the community.

Emphasis on staff safety: updated patients’ rights and responsibilities pamphlet, signage placed throughout facility, expansion of violence prevention training.

Emergency Department Behavioral Health area renovated.

Staff engagement: no trespass notice policy developed by security, “Hospitals Against Violence” campaign featured on CNN, improved campus lighting.

Increased awareness of staff caring for prisoners: confidentiality status applied to all hospitalized prisoners, security rounding on correctional/police officers sitting with prisoners Disruptive Behavioral Contracts: contract reviewed with disruptive patient/visitor by management and security, not bedside nurse.

During the first month of enhanced security, nearly 1000 items were confiscated including knives, razor blades, box cutters, guns, bullets, scissors, Mace and power saws, with violent incidents dropping from over 2.5 per 1000 patient/visitor days to less than one.

Take-Away for Carilion: If something makes you feel uneasy or in danger, report it. Reporting concerns leads to awareness.

Awareness leads to prevention.

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Session Title:

Speaker & Organization: Reviewer: Bethany Hammond, BSN, RN Unit: CRMH 11S Pediatric ICU

Lydia Lopez, MPA, BSN, RN, NEA-BC & Margaret Morales, MA, APRN, ACNS, NEA-BC

Mount Sinai Downtown NY New York, NY

Session Highlights: The nurses of this institution worked diligently to stop violence against their employees on their psychiatric unit. The staff attempted to stop violence before it started, by using a check list (Broset Violence Checklist—a Nurse-Driven Individualized Crisis Prevention Plan) to try and predict when patients would become violent. They also had all staff take de-escalation classes to try and help patients calm down before they were upset. All patients were screened on admission to help look for ways they could help patients stay calm should issues arise after admission.

Both conference presenters were nurse leaders and subject matter experts with regards to nursing professional development and behavioral health nursing.

Take-Away for Carilion: I think workplace violence at Carilion is a big issue, and that we could look into ways of mitigating violence against staff, by utilizing the checklist. Also, screening patients for things that help calm them down before they get upset could be beneficial.

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Session Title:

Speaker & Organization: Reviewer: Dasia Patterson, BSN, RN

Unit: CRMH 8M ICU

Patricia DeMellopine, MSN, RN, CNS & Jackie Keane, MSN, RN-BC

El Camino Hospital Mountain View, CA

Session Highlights: •

El Carrino Hospital started a LGBTQ Healthcare Equality Committee to help raise cultural awareness.

•

Committee used the Healthcare Equality Index (HEI) (a national, publicly reported benchmark tool) to define goals.

•

Committee provided education and resources to staff and patients.

•

Sexual orientation and gender identity (SOGI) and “preferred name” tool was implemented.

Take-Away for Carilion: Our Information and Technology council has acknowledged the need for cultural awareness and addressed the needs of our LGBTQ patients with the SOGI implementation. We can look for ways to acknowledge LGBTQ patients and staff, such as community participation and evaluating human resource policies to ensure equality. A 2nd Carilion Reviewer Bethany Hammond, suggested Carilion Clinic participate in the Healthcare Equality Index scoring to see how we measure up, which allows us to know where we stand and how we can improve.

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Session Title:

Speaker & Organization: Reviewer: Kim Bolling, BSN, RN, CCRN Unit: 6S ICU

Angela M. Kinser, BSN, RN & Heidi M. Schmittgens, MSN, RN-BC

Missouri Baptist Medical Center St. Louis, MO

Session Highlights: This was a presentation from a Missouri hospital that had a turnover rate of 28.3% for first year nurses in 2015. About 1/3 of the nightshift nurses were new grads and about 40% of the nightshift nurses had less than 3 years of experience. A Night Resource nurse program was piloted and due to the feedback, engagement scores and staff turnover rates being impacted; this was adopted by the administration of the hospital. The concept was that they had a few experienced nurses that worked nightshift who served as a resource for all new grads and nurses with fewer than 3 years of experience. These nurses were not scheduled to staff a unit for 1 of their 3 (12 hr) shifts each week. They would serve as a resource for the nurses. They carried a code/rapid pager and a phone dedicated to this role so that any new nurse that needed some assistance could reach out to them and they could respond to alerts to help if needed. This nurse was obviously an experienced RN. This team created a database that tracked nurses on each unit, that included their schedules, what they were checked off to do (skills or specialized equipment) and had an area for feedback where the unit preceptors and managers could communicate concerns, needs and follow-up. These nurses served as mentors when working in this role, or even while working beside these newer nurses when they staffed the units. Through the valuable work of this team, the turnover rate decreased, feedback from the newer nurses, preceptors and managers was more positive, and employee engagement scores were better.

Take-Away for Carilion:

With most of the newer nurses going to nightshift throughout the hospital, this is an excellent use of resources to help our nurses who have completed orientation but are still developing skills and confidence. This also created a great resource for preceptors and managers to get constructive feedback in relation to the staff, but also to the effectiveness of the orientation process. There were some changes that were made to the orientation processes based on feedback and trends that were able to be tracked through the database. Not only did this help the newer staff, this also helped the more experienced nurses on the units to feel more comfortable when there were nights with a majority of newer nurses staffing the units to relieve some of the stress of increased responsibility to the staff, patients, and the care they had to provide to the patients. One other take-away from this session was that the overall teamwork and morale on the units was better also, which creates a better environment for the patients, families and staff.

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Session Title:

Speaker & Organization: Reviewers: Kim Manning, ADN, RN-BC Bobby Dingus, BSN, RN, CCRN Unit: CRMH 10M PCU

Eric E. Griffin, MSN, RN, CEN & Christine E. Klucznik, DNP, RN

Baystate Medical Springfield, MA

Session Highlights: Results of Baystate Medical Center’s Nurse Satisfaction Survey were low. They were able to leverage the Magnet culture and engage clinical nurses to meet the 2019 Magnet application’s EP2EO RN satisfaction site visit eligibility requirement. A large retreat was held with staff to discuss engagement results and potential solutions using the World Cafe style.

Definition of World Cafe Conversations: An easy to use method creating a living network of collaborative dialogue around questions that matter in service to real work.

Below is a list of solutions that were developed to improve survey results: •

Realizing nurses did not understand questions of engagement survey - education was provided to resolve this issue and worked with vendor to make questions easier to understand.

•

They explored the meaning of staff engagement and what it meant for the nurses.

•

Created Pop-up Cafes around the hospital to allow nurses a quiet place to take the survey.

•

Addressed nursing shortage/matrix allowing overstaffing with approval of administration for staff to be able to attend team events/retreat

•

Team Building Retreat

•

CNO shadowed nurse for their shift to better understand concerns/hurdles.

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Nurses got involved on a Task Force to improve nurse satisfaction.

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Increased leadership visibility and being deliberate about recognition.

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Developed a Night Council to engage night shift and identify night shift specific problems

•

RN/RN networking to understand frustrations and dynamics of other units.

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Session Title:

Speaker & Organization: Reviewers: Jennifer Martin, DNP, RN, NEA-BC Dottie Cook, BSN, RN Unit: Carilion Clinical Informatics & CRMH 7S ICU

Jane Fusilero, MSN, MBA, RN, NEA-BC & Sheila Ferrall, MSN, RN, AOCN

Moffitt Cancer Center & Research Institute Tampa, FL

Session Highlights: Documentation in the electronic health record can be frustrating for nurses, especially when the information collected seems redundant or doesn’t add value. This organization, a 206 bed cancer center with 399,000+ outpatient visits, developed a strategy to engage clinic nurses and interprofessional team members in streamlining electronic admission documentation processes by identifying what information is essential. Here are some of the focuses of that strategy: •

Worked with their stand alone EMR vendor to review the content with oncology consortium.

•

Removed admission questions that were linked to other processes. Found questions that multiple staff were asking but not linked in EMR and linked those questions.

•

Found questions that could not be determined as required and removed. Identified what information was essential.

•

Evaluated access - how many clicks to complete.

•

Analyzed what content went to other disciplines - dietary, care management triggered consults.

•

Some question content were asked in different ways - in different locations/facilities standardized question/content.

•

Many of these center’s patients were seen first in outpatient setting and most of the question content was completed there - ensured these were linked to admission content so data did not have to be repeated.

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Session Title:

Speaker & Organization: Reviewer: Cathy Jennings, DNP, RN, ACNS-BC Unit: Cardiovascular Surgery

Hannah Entwistle, BSN, RN, CCRN University of Maryland Medical Center/ Baltimore

Session Highlights: UMMC is a three-time Magnet designated academic medical center, the flagship of a 13hospital University of Maryland Medical System which has affiliated Schools of Medicine and Nursing. Two Baltimore campuses include over 1,000 patient beds and 11 critical care units.

This presentation outlined a focused effort to improve retention of experienced RNs. Lack of experience clearly can impact patient outcomes. Nationally, RNs with 1-5 years’ experience have high turnover rates of 22-23%, and in the UMMC Medical ICU, those with 1-3 years’ experience had the highest rates of turnover. In response, they developed cardiac, stroke, and MICU fellowship programs with the goal of increasing nurse satisfaction/engagement, promoting professional development and empowerment, decreasing knowledge gaps, and improving retention. The speaker reviewed the process for developing the Fellowships, which included a needs assessment and gaining necessary approvals before beginning. In this competitive 18-month program that requires formal application, Fellows receive high level instruction by content experts (executive leaders, critical care MDs, APNs, SON faculty, clinical educators). Applicants must have more than 1 year of experience, be in good standing, have ACLS and CRRT certifications, and manager approval to apply. Those selected attend monthly 4-hour classes and complete an EBP/PI project. Eight to twelve Fellows are accepted into the program in each cohort, which is highly personalized to make each Fellow feel valued and special. 83% of Fellows successfully completed the Fellowship. Using validated survey tools completed at baseline, 6, 12, and 18 months post-Fellowship, they have seen steady increases in Fellows’ personal meaningfulness of job and mastery of skills necessary for the job. Fellows have also grown in their belief that their workplace is an empowering environment that allows them to accomplish work effectively. They “feel like going to work” at the start of their shift, and find the job challenging and inspiring. 100% of Fellows recognized an improved and more advanced level of knowledge post-Fellowship and recommended the Fellowship to a colleague.

In addition, they felt able to discuss materials with their peers and act as a clinical resource on their units, and 67% felt that the Fellowship impacted their decisions to stay on their current unit. MICU RN turnover rates fell from 14.04% to 10.52% from 2017-2018 (the speaker did not describe concurrent efforts that may have impacted the decreased rate).

Recognizing their CNS mentor for her help, the presenter also recognized tremendous support from UMMC Nursing leadership and the key role of a Fellowship coordinator. Of note, 100% of MICU staff have at least a BS/BA degree, with 16% having a master’s degree. 68% of the staff are 30 years of age or younger.

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Session Title:

Speaker & Organization: Reviewer: Lisa Girani, BSN, RN Unit: CRMH Emergency Department

Gray Woerly, BSN, RN, CPEN & Fidelity Dominguez, BSN, RN, CPEN

Children’s Hospital Colorado Aurora, CO

Session Highlights: The presenters spoke about improving the flow of patients in their pediatric ED. The department implemented the use of a Flow RN, quick registration, and radio communication between charge nurses and the Flow RN. The ED instituted a push vs pull mentality, which required a culture change for the staff. The Flow RN would facilitate patient flow, place waiting room patients, and thoughtfully place high acuity patients so as not to overwhelm one section of the ED. In addition, the Flow RN would place EMS patients, and facilitate dispositions. The Flow RN would keep awareness of each RN workload, as well as the team workload. They also matched provider work flow to RN staffing and planned staffing for the surges which occur in the ED.

Take-Away for Carilion: Carilion Emergency Department could take a look at some of these innovative ideas, especially with the future move of the ED to the new tower once completed.

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Session Title:

Speaker & Organization: Reviewer: Pam Flinchum, RT(R)CT, RN

Rob Szapor, MBA, BSN, RN, SCRN

Unit: Nursing Quality & Safety

AtlantiCare Atlantic City, NJ

Session Highlights: Rob Szapor stated that various U.S. programs for CMS track and report OR penalize/ incentivize hospitals based on 30-day readmission measures. He further noted that a study

by Lichtman (2010) estimated 90% of readmissions accounted for $17.4 billion in Medicare expenditures (51% of total stroke cost). Mr. Szapor went on to outline considerations regarding avoidable 30 day readmissions: •

Dr. Fadi Nahab1 defines avoidable readmissions as being related to 4 causes 

Lack of early outpatient follow-up



Delay in palliative care consultation



Lack of clear discharge instructions



Incomplete evaluation

(1. Nahab, F., Takesaka, J., Mailyan, E., Judd, L., Culler, S., Webb, A., Frankel, M., Choi, D., Helmers, S. (2012). Avoidable 30-Day Readmissions Among Patients With Stroke and Other Cerebrovascular Disease. Neurohospitalist, 2(1): 7–11 )

Take-Away for Carilion: Since attending the presentation: • Stroke is not currently on the HRRP penalty list, but it certainly does contribute to the whole-house all cause rate, which is part of our value-based purchasing score.

• A quick look at Vizient shows length of stay (observed) better than comparison group and readmissions slightly under comparison group.

• Carilion has started developing a system to follow our stroke population. This will follow the patient after discharge until seen by neurology.

• Working on clear standard discharge instructions for stroke patients • Carilion has changed the order sets to include palliative care consult if NIHSS >30

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Session Title:

Speaker & Organization: Reviewer: Shelly Feazell, BSN, PCCN, SCRN Chair of Nursing Research Council

Carrie Redick, MSN, RN, CCRN & Leontine Powell, BSN, RN, CPAN

Unit: CRMH 12 West

Morristown Medical Center Morristown, NJ

Session Highlights: This session focused on “Trifecta of Leadership”. Leaders need to have ability to inspire, hold people accountable, and have emotional intelligence. They also discussed the 5 F’s - Firm, Friendly, Fair, Failure, and Fire. Leaders need to be firm, friendly, and fair, but if someone is failing then firing may be the only option.

The presenters noted that leaders cannot be afraid of failure, because failure is inevitable at some point in everyones lives.

Their recommendation for inspiring and motivating staff included focusing on what is great, being confident and courageous, and providing a vision by discussing common goals and discussing the projected results of said goals.

Take-Away for Carilion: • • •

• •

Recommend doing hard evaluations first to get them out of the way.

Zero tolerance for incivility because these people will bring down everyone else.

Suggest leader do first tier of interview where they discuss qualifications, requirements of job, etc. The staff should do second tier of interview and ask about hobbies and what they like to do in their spare time to see if they have common interests.

Potential hires need a shadow day.

Recommended getting staff out of work on time because millennials really value leaving on time and are more likely to stay at their job; noted this will increase return on investment.

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Session Titles:

Speaker & Organization: Reviewer: Stephanie Defilippis, BSN, RN, OCN Unit: Carilion Infusion Center

1. Athena Lendvay, BSN, RN, OCN El Camino Health, Mountain View, CA & 2. Ann Marie Moynihan, MS, APRN, NP, ONC Lagnone Orthopedic Hospital, New York, NY

Session Highlights: At the Magnet® conference, I was able to sit in on a session called “Post-op Pain: Interventions that Work”. There were two different speakers. The first speaker was Athena Lendvay, who is a nurse at El Camino Health in Mountain View, CA. She was speaking on the use of evidence-based practice using the ERAS protocol for post-op recovery. The findings found that they were able to decrease their opioid use by 58%, their anti-emetic use by 61%, and 13% decreased length of stay. This was an exciting session, because we are currently already using the ERAS protocol within the Carilion’s system with our gyn onc and colorectal population. This means that we are already using the best practice in our OR, as well as when the patient is placed in their hospital room.

The second part of this session was by speaker, Ann Marie Moynihan, from NYU Langone Orthopedic Hospital in New York, NY. Hers was an innovative session where they tried to implement using as little opioids as possible after orthopedic surgeries. They started out by telling their patient’s pre-operatively that having zero pain is not a realistic expectation. There will always be discomfort, but there may not be a need to take an opioid for pain. They focused a lot on education before the surgery hoping the patient would understand that Tylenol or Ibuprofen would be enough to help the discomfort. Just because they had a surgery did not mean they needed to have an opioid to treat their pain. The day before their surgery they instructed them to take a Tylenol, meloxicam, and aspirin. After surgery they would be discharged with Ultram for breakthrough pain with the instructions to only take if Tylenol did not help the pain first. Their average pain scores dropped a tenth of a point after they implemented this practice.

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Session Title:

Speaker & Organization: Reviewer: Bobby Dingus, BSN, RN, CCRN

Wendy Palma, BSN, RN, CCRN, CN-IV & Jessie Reich, MSN, RN, ANP-BC

Hospital of the University of Pennsylvania, Philadelphia, PA

Unit: CRMH 10M PCU

Session Highlights: “Learn how nurses at all levels partnered to improve the work environment and patient care by prioritizing nurse wellness and renewal.” ~ ANCC 2019 Magnet® Conference Digital Program

•

Penn Medicine Employee Benefits included full access to Penn Provider, walk-in clinic available for on-site for staff and adult dependents.

•

Developed an Office of Well-being.   

Registered Dietician Financial Consults Meditation groups or 1:1 Sessions

•

Nurse Ethicist is on the governing body. Their job is to infuse ethics throughout the organization.

•

Provision 5 of the ANA Code of Ethics for Nurses states, “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.”

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Session Title:

Speaker & Organization: Reviewer: Pam Lindsey, MSN, RN Unit: Nursing Administration/Magnet Program/Shared Governance Director

Session Highlights:

Anna Folk, MSN, RN, CPN & Morgan Klutz, BSN, RN, CEN, PHRN, TCRN

Lehigh Valley Hospital/Lehigh Valley Health Network Allentown, PA

Professional Governance supports the idea that nurses are professionals and have governance over their practice. Professional Governance is founded on partnership, equality, accountability and ownership. There are many misconceptions based on what professional governance is. Professional governance is not a committee, it is a council. Committees have discussions and councils act and make decisions. Professional governance is very important and gives power and voice to the frontline staff.

Professional Governance is built on the desire to support purposeful work and a healthy work environment. Utilizing the priorities of professional governance improves nurse engagement and can have a positive impact on nurse retention. There are six components of a council; Clinical Practice, Quality, Research, Professional Excellence, Collegial Review and Recognition, and Operations.

There are many benefits of Professional Governance; less burnout, increased job satisfaction, high quality of care and patient safety, and professional growth.

The keys to successful Professional Governance are making decisions, staff driven, and accountability.

Each council provides input and sets outcome goals. The members are the change-makers in the work place and are professionals taking action. The work of the council is purposeful, and evidence driven.

Staff driven governance brings the power of the profession to those who practice. Involvement in governance is expected and is not by invitation. The structure of professional Governance is built to be sustainable through the years. Professional Governance is seen as a decision-making group, not a work group.

Accountability and Empowerment are at the core of successful Professional Governance. Accountability is secured by staff producing results, facilitates partnerships for sharing decisions, and allows for evaluation of role performance. Empowerment is paramount to the success of the professional governance structure. Nurses who feel empowered will be agents of change and improve job satisfaction.

Managers are critical to the success of Professional Governance and must embrace their role in professional governance. Managers are responsible to help create success, develop staff leaders (mentor staff) help staff evaluate, change and adapt, and facilitate decision making.

Although Shared Governance has been a part of Carilion Clinic for many years we have to ask ourselves the question, “What does our model of Professional Governance look like?” According to Tim Porter O’Grady, “The model of professional governance you start with will not be (should be) the model you end up with. Allow what you design to be the baseline for the future. Conspire for a better future.”

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Session Title:

Speaker & Organization: Emily Hirsch, MSN, MHA, RNC-NIC Reviewer: Linda Siar, ADN, RN, CTL

Unit: CRMH Nursery

University of Pittsburgh Medical Center Hamot Erie, PA

Session Highlights: “Women’s heroin use has increased 100% compared to men. A Women’s Recovery Program to address a Woman’s specific needs has improved outcomes for women and their children.”

Opioid-dependent pregnant women are at risk for: lack of prenatal care, poor nutrition, social service needs, prostitution and severe depression. Providing these women with a place to go has improved their medical needs, helped them to develop and provided the social services support they needed. UPMC Hamot’s Recovery Center Model includes a Certified Recovery Specialist, Case Manager, In-patient and Out-patient drug/alcohol program, individual/group counseling and mental health counseling and services. They educate pregnant clients regarding infant safety/supplies, smoking cessation, and OB hospital length of stay, Neonatal Abstinence Syndrome screening, etc. Postdelivery, they assist mom with postpartum follow-up and birth control, provide education on nutrition, make sure they follow-up with their PCP, as well as provide counseling/addiction services and case management services.

UPMC Hamot’s Recovery Center offers incentives at 1, 2, 3, 6, 9, and 12 month. The incentives are usually in the form of infant items, cleaning supplies, games and kid’s items.

Women need supportive environments and positive feedback to build their confidence.

Take-Away for Carilion: Establish a recovery program for our drug-addicted moms. We have already begun with the opening of our NAS intermediate nursery last Sept. Now, moms need a program to encourage and help them and their children succeed.

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Session Title:

Speaker & Organization: Reviewer: Jennifer Martin, DNP, RN, NEA-BC Unit: Nursing Informatics

1.Lynn Newberry, DNP, RN, CEN, NE-BC 2. Rachel Start, MSN, RN, NE-BC 3. Curlissa Mapp, MSN, RN, APRN, ACNSBC 1. ANCC - Silver Spring, MD 2. Rush Oak Park Hospital - Oak Park, IL 3. Emory Healthcare - Atlanta, GA

Session Highlights: Physician burnout was related to nursing not clarifying our role in ambulatory. Physician has led and still primarily leads patient assessment, patient education, etc. Nursing needs to clarify our role in Ambulatory. Strengthening primary care service delivery is key to achieving Triple AIM (population health, experience of care, per capita cost).

Organizations must participate in benchmarking for ambulatory to be able to build a data set to support decisions related to what is nurse sensitive in ambulatory. (It took almost 20 years to determine what inpatient nurse sensitive indicators were).

A general overview of ambulatory specific items is provided in the new Magnet manual.

Reminder the benchmark used MUST be the benchmark at the highest level possible (national, state) EP21EO Inpatient and outpatient categories Do Not have to match/align between inpatient and ambulatory.

Organizational examples: •

CNO provided written statement on why Magnet® for ambulatory areas.

•

Clarity of nurse alignment/dotted line to CNO

Take-Away for Carilion: • Need strong nurse leaders in ambulatory.

• Emory Healthcare’s Professional Practice model is shared between disciplines across the organization.

• Ambulatory EBP - encourage, foster ambulatory research/EBP projects and highlight contributions to organization.

• Many organizations struggle with ambulatory consistency • Important to show nursing and CNO oversight of nursing practice - visual needs to be in organizational charts, peer review, etc.

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Session Titles:

Speaker & Organization: Reviewer: Kim Carter, PhD, RN, NEA-BC Unit: Nursing Research

Session Highlights 1:

1. Katie Gonzolez, MSN, RN-BC & Krystal Hanrahan, MS, MSPH, RN, CMSRN Northwest Memorial Hospital Chicago, IL 2. Ashley Peacock MSN, RN-BC, NEA-BC & Rachael D. Elmore BSN, RNC-MNN North Kansas City Hospital, North Kansas City, MO

This organization added happiness culture to their strategic plan. This culture began with the Nurse Residency program with incorporation of a happiness workshop focusing on resilience, compassion fatigue, self-care, and happiness strategies.

Additionally, a 21 Day Happiness Challenge using journaling (describe the happiest moment of your day), acts of gratitude, letters to self, why the graduate picked nursing and the organization shared back in 6 months, and other approaches to promote new nurse happiness. They hold Transition into Practice (TIP) meetings focusing on positivity, stress relief, gratitude, self-awareness, meditation, and relaxation.

All employees are provided $200 to spend for wellness (apps, workout or meditation items, etc,).

Outcomes: Nurse friendliness (Press Ganey) scores increased, as well as likelihood to recommend.

Turnover went from 17.5 to 14.6, well below median scores.

Take-Away for Carilion: Consider adding wellbeing, happiness, joy in work, or similar concept to Carilion strategic plan with expanded approaches throughout system to promote this culture.

Session Highlights 2: Journal clubs improve skills for EBP and research design, create enthusiasm about nursing professional development, and develop the spirit of professional practice inquiry building on the premise that “if we stay where we are, we fall behind�. The electronic structure for the journal club was implemented because the traditional model led to leadership participation only, whereas the asynchronous, learnerled, just in time electronic format allowed for more diverse participation.

Process: Six journal club articles are available per year (every other month via Survey Monkey open text with the link sent by the CNO).

Article selection based on hot topics (such as workplace violence). The Hopkins tools are used to analyze, using approximately 8 questions about the articles. A knowledge check is built in. Questions are also focused related to application to practice. Points in the career ladder program are available (for every 3 journal club participation = 1 point). Responses are evaluated by leaders, if thoughtful responses, then a certificate is provided for career ladder. Responses are aggregated and then shared with the club and the education department if applicable.

Outcomes include: increased research points in career ladder program, increased literature reviewed, increased EBP desire and improved ability to link research to patient care.

Take-Away for Carilion: This is worth consideration for management by the Nursing Research & EBP Council.

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2019 Magnet® Conference KEYNOTE SPEAKERS!

Gretchen Rubin New York Times bestselling author, blogger, speaker and podcaster.

About Gretchen.......

Gretchen Rubin is the author of several books exploring human nature in order to try and understand how we can live our lives better. She is one half of an award-winning podcast, where she discusses good habits and happiness with her sister Elizabeth. She’s known for her ability to distill and convey complex ideas with humor and clarity, in a way that’s accessible to a wide audience.

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Charles Kunkle Award-winning Author, Speaker, Consultant, and Leader of the “No Time to Care� Movement.

About Charles.......

In 2005, Charles was asked to speak after a fatal shooting rocked St. Mary Medical Center. Charles gained international recognition for passionately speaking about the fatal events that occurred in the emergency department of St. Mary Medical Center.

Since then, he has dedicated his career to helping others within healthcare to develop work cultures that are healthy and happy.

Leon Logothetis Global adverturer, motivational speaker & philanthropist.

About Leon.......

In a previous life, Leon was a broker in London where he felt uninspired and chronically depressed. He gave it all up for a life on the road. This radical life change was inspired by the inspirational movie The Motorcycle Diaries. He explains that the inner rebel tells you that your life is yours. Anything you dream of is possible. Anything. The fuel for this potential is simple: Kindness and harnessing the power of human connection. Leon travels the globe giving life changing gifts along the way, all while relying on the kindness of strangers.

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CONGRATULATIONS CARILION CLINIC ROANOKE CAMPUS! 4th ANCC Magnet® Redesignation

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Annie Phillips-Smith

Bobby Dingus

CONFERENCE HIGHLIGHTS

Jennifer Martin

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ANCC 2020 ÂŽ Magnet Conference

The largest nursing conference in the United States is bigger and better than ever! Don't miss out on this energizing, inspiring, fun-filled event!

October 7-9, 2020

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Carilion Nursing Research CONFERENCE SUMMARY November 7, 2019

198 Registered Attendees 19 Poster Presenters 13 Podium/Panel Presenters 16 Vendors 1 Keynote Speaker

Record number of attendees!

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Keynote Lynn Gallagher-Ford, PhD, RN, NE-BC, DPFNAP, FAAN Role Senior Director of the Helene Fuld National Institute for Evidencebased Practice in Nursing & Healthcare at Ohio State University Presentation AM: EBP - What It Is and How You Do It! PM: Building a Culture of EBP

Keynote Speaker

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AROMATHERAPY SESSION I Nursing Work - Related Stress in the ICU and Aromatherapy: A Systemic Review Kalyn O’Conner, BSN, RN; Taylor Brogan, BSN, RN, CCRN; Sandra Hubbard. BSN, RN CRMH 9M NTICU

AROMATHERAPY SESSION II New Aromatherapy Approaches for Patients Linda Siar, ADN, RN - CRMH Nursery Sarah Dannhardt, Student James Madison University School of Nursing

l-r: Kalyn O’Conner; Taylor Brogan, Sandra Hubbard

l-r: Sarah Dannhardt, Linda Siar

l-r: Sarah Dannhardt; Linda Siar; Kayln O’Conner; Taylor Brogan; Sandra Hubbard

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Poster Presentations

Measuring levels of preparation for decision-making and patient satisfaction in a breast cancer support group.

Catherine Hagan, MSN, BA, RN, CBCN; Erica Lewis, PhD, RN Carilion Breast Diagnostic Center; James Madison University

Catherine Hagan

Transitioning NAS care out of the NICU. Claudia Newton, MSN, RN; Amanda Allen, MSN, RN, CPN - CRMH NICU

Amanda Allen

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Nurse burnout with substance using inpatients: A new hope.

Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC; Tammy Mitchell, MSN, RN, NE-BC Carilion Nursing Quality & Safety, CRMH 5 West

Cindy Ward

The effect of implementing symptom feedback into psychiatric care at a non-profit clinic.

Deirdre Rea, MSN, PMH-CNS, RN-BC, (DNP [c]) - James Madison University DNP Program

Deirdre Rea

Falls reduction program and clinical pathway for mature adult inpatients James Wood, MSN, RN, PCCN; Sherry Stanley, MSN, RN; Kim Carter, PhD, RN, NEA-BC CNRVMC Trauma Services, Carilion Nursing Research James Wood

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Poster Presentations Benefits of physical exercise interventions on reducing sensory and improving social behavior in pediatric autism spectrum disorder.

Ryleigh Smith, PNP-BC; Mary Riley, CPNP - Carilion Children’s Pediatric Neurology/Pediatric Developmental Clinic l-r: Ryleigh Smith; Mary Riley

Concept mapping: Student perceptions of the nursing process with the use of a concept map assignment Paula Tate, MSN, RN; Christine FishHuson, PhD, RN; Carol Bailey, MSN, RN - Radford Carilion University

l-r: Carol Bailey; Paula Tate; Christine Fish-Huson

Accuracy of counted respiratory rate, opioid administration and impact on early warning systems.

Donna Bond, DNP, RN, CCNS, AE-C, CTTS; Deborah Robinson, AS, RRT, ACCS, MA, MCC, DMin Carilion Nursing Professional Practice, Carilion Respiratory Therapy Donna Bond - facing away

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Additional Poster Presentations Employer opportunities to ameliorate barriers to RN-BSN program enrollment: Findings from a multi-organizational survey Vivian Wilson, BSN, RN, CCRP; Stephanie Defilippis, BSN, RN; Kim Carter, PhD, RN, NEA-BC - Carilion Research & Development; Carilion Infusion Center; Carilion Nursing Research Improving care transitions through risk reduction with machine learning support Mary Colette Carver, DNP, APRN, FNP-BC, NEA-BC; Nate Jones, MHA; Dan Djuric, Data Analyst; Caroline Butt, BSN, RN; Carla Markham, MSN, RN - Carilion Department of Family & Community Medicine, Carilion Health Analytics Research Team (HART) The Eye’s Have It Adegbenga Bankole, MD; Kristen Wood, CRMA; Stacy Hall, CNA Cariion Clinic Rheumatology An academic partnership to decrease inpatient falls on a cardiovascular progressive care unit through interprofessional rounding Dedra Pennington, MSN, RN; Jeannie Garber, DNP, RN, NEA-BC; Evelyn Rubongoya, MSN, RN; Sandra Sayre, MSN, APRN-BC, BSN, EMT-B - Radford Carilion University, James Madison University, CRMH 7S Surgical PCU, Carilion Cardiovascular Institute 10 Mountain Surgical ICU CAUTI CUSP Project Brenda Epperly, BSN, RN, CCRN; Carl Beggarly, ADN, RN; Robert Dingus, BSN, RN; Rita Donahue, ADN, RN; Kayla Frantz, BSN, RN; Carolyn Kiefer, BSN, RN, CIC; Amy Lucas, MSN, RN, CCNS, CCRN-K; Margaret Perry, MSN, RN-BC; Kimberly Waldeck, MSN, RN, NE-BC - CRMH 10M ICU Embracing recovery: The impact of the lived experience on inpatient psychiatric care Erin Casey, MA, CPRS; Lisa Dishner, MSN, MHA, RN-BC, NEA-BC, PRS - Child & Adolescent Rehab, Mental Health Community Health The effectiveness of yoga therapy in reducing anxiety and depression for individuals with substance abuse use disorders being treated in an acute care hospital Nancy Harvey, MSN, FNP-BC, MS, C-IAYT; Kim Carter, PhD, RN, NEA-BC; Tammy Mitchell, MSN, RN - CRMH 9M NTICU, Carilion Nursing Research, CRMH 5 West

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Additional Poster Presentations Comfort and knowledge analysis of neuro-trauma intensive care clinicians pre/post education intervention and implementation of a palliative care screening instrument Rachel Bryant, DNP, FNP-C, RN, ACHPN; Kathryn Reid, PhD, RN, FNP-C; Kenneth White, PhD, ACNP-BC, ACHPN, FACHE, FAAN; Phyllis Whitehead, PhD, APRN/CNS, ACHPN, RN-BC - Carilion Hospice Strategies to minimize nurse burnout and emotional exhaustion: Finding the balance Kim Carter, PhD, RN, NEA-BC; Richard Bogue, PhD, FACHE - Carilion Nursing Research, University of Iowa College of Nursing Predictors of 30-day readmissions after cardiac surgery Samantha Hall, BSN, RN, CCRN; Cathy Jennings, DNP, RN, ACNS-BC; Ellen Rachel Lockhart, MS; Eunyoung Lee, PhD, RN, DNP, ANP/ACNP, FAHA - CRMH 6S ICU

Katie Hayes

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2019 NURSING RESEARCH CONFERENCE SNAPSHOTS!

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REFLECTIONS FROM THE 2019 CARILION NURSING RESEARCH CONFERENCE

Reviewer: Vivian Wilson, BSN, RN, CCRP Unit: Carilion Research & Development

Conference Highlights: How the Carilion Nursing Research and Evidence-based Practice Conference has affected my practice: Being an old school nurse, I did not have Nursing Research and EBP as part of my curriculum while in school way back in the 1970’s. After my first Carilion Nursing Research and EBP conference in 2014, I was hooked. I’ve done three projects since but only my most recent RNBSN study made it all the way to a podium presentation at the 2019 conference. This was a monumental step for me. We are now putting a poster together for this study and have submitted a poster abstract for the Magnet 2020 conference in Atlanta, as well as plan for poster presentation at Carilion Research Day April 2020, WON May 2020 and possibly other conferences including the Virginia Nursing Association conference in Sept. 2020. This conference made a huge difference in my nursing practice and I venture to say I’m not alone. We need local conferences to help stimulate and motivate nurses to branch outside their comfort zone and achieve goals they never thought possible. The Nursing Research and Evidence Based Practice (EBP) conference was that for me

(l-r: Tina Bryant; Vivian Wilson, Dottie Cook)

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Reviewer: Cindy Hodges, RNC, BSHS, FCN Unit: CRMH OR Services

Conference Highlights: Have you ever thought about attending the Carilion Nursing Research Conference? Are you thinking of applying for CAP? Wanting to change practice? Wanting to learn more? or wanting to learn about Evidenced Base Practice? If you are, then you need to plan to attend the Carilion Nursing Research Conference next year. We have had many excellent presenters over the years; however, this year was the best by far for me. Our speaker was Lynn Gallagher Ford. If you have not heard her or do not know who she is, “research” her. You will learn so much…

Lynn presented at the November conference this year, and I will have to say that she inspired every nurse in the room to embrace and practice EBP. We as nurses, need to practice by EBP and need to decrease the myths of doing projects, policies or delivering care by saying or hearing “because we have always done it that way”. As a nurse, are you satisfied with saying or hearing the above? YOU can change your practice. YOU can be inspired too.

So, I encourage you to attend our research conferences and If your answers to any of the above questions are “maybe”, “yes”, or “most definitely”, then you need to attend. Remember, to change our practice we must be inventive, advanced, be curious, assess and be ready to change. We look forward to seeing you at our future conferences. Once you attend, you will be like me: inspired, ready to make a change and do what is right for our patients

l-r: Cindy Hodges, Jen Bath (at the 2018 Nursing Research Conference)

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Carilion Clinic Nursing Research CONFERENCE ABSTRACTS November 7, 2019

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Bringing nurses back to the bedside: Admission discharge nurses’ impact on throughput, patient satisfaction and nurse satisfaction.

Brandie Bailey, DNP, RN, NEA-BC - 9S ICU; Michelle Clements, MSN, RN, NP-C - CRMH Resource Pool; Brooke Garrity, BSN, RN, CCRN - 9S ICU; Christine Lawson, BSN, RN - CRMH Resource Pool; Brandon Jones, MSN, RN, CEN, NEA-BC - Carilion Patient Experience; Mariana Salamoun, MA, BS - Health Analytics Research Emergency Department over-crowding and bed shortages have become a normal occurrence for acute care hospitals.

Nursing leadership struggles to meet the demands of patient influx while trying to keep nursing staff engaged and efficient while battling turnover and burnout. The nurse turnover rate in the United States is 14.6%. Consequently, the cost of replacing a nurse can exceed $59,000. The purpose of this study was to determine if the implementation of the Admission Discharge Registered Nurse (ADRN) will improve throughput, nursing satisfaction and patient satisfaction on inpatient units. The floating ADRN role was implemented in May 2017 as a creative solution to throughput pressures and increased workload on the bedside nurse. This study examined the personal practice of bedside nursing related to admissions and discharges on high activity units, time management skills, documentation barriers and patient satisfaction scores related to the utilization of admission/ discharge nurses. This study determined whether there was a relationship between the utilization of the ADRN and length of stay (LOS), discharges before noon, nurse satisfaction, education level, years of experience, and patient satisfaction scores.

This study was a non-equivalent pre/post quasi-experimental design. Research was conducted at a Level 1 trauma center and teaching facility. IRB approval was obtained. Pre-intervention and post-intervention data were collected from the electronic health record for the 5 high-utilization inpatient units to determine a baseline and effectiveness of the role. Patients with a LOS > 25 days were excluded. In addition, a survey was completed by inpatient nurses to better understand nurse perception and satisfaction with the ADRN role. Nurses working in a direct patient care role in an acute care setting had the option to participate in the survey. The survey was conducted using Redcap. Overall length of stay for 5 units decreased from 4.56 days to 4.30 days post intervention (p<0.0001). Statistically significant findings included, 8W (6.13 days to 5.14 days post-intervention), 11W (4.94 days to 4.62 days post-intervention) and 8SPCU (4.77 days to 4.32 days post-intervention). Discharge efforts before noon increased overall from 14.17% to 15.98% (p<0.0001). 8SPCU specifically increased from 14.05% to 20.86% (p<0.0001). Patient satisfaction scores in the categories of admission, speed of admission, courtesy of person admitting, discharge, discharge readiness, speed of discharge process and discharge instructions all increased 1-2.5% post-intervention.

As determined by the satisfaction survey, more than 55% of nurses were overall very satisfied with the ADRN process of completing admissions, discharges and transfers on their unit. Nurses rated ADRN utilization as positively impacting patient care, throughput and adequately preparing patients for discharge. This project has shown impact in the areas of patient satisfaction regarding discharge and admissions process, improved throughput on high turnover inpatient units and improved nurse satisfaction. The implementation of the ADRNs could decrease workload on the inpatient nurse and assist with the stresses of high-acuity patients in the ever-fluctuating environment of acute care. The ADRNs demonstrate the effective use of resources and have the opportunity to impact additional areas such as follow-up appointments, discharge risk identification and readmissions.

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Letting loose: Reducing restraint use in neurotrauma ICU (NTICU) Rachel Denny, BSN, RN, CCRN, CTL; Shannen Plaster, BSN, RN, CCRN; Ellen Harvey, DNP, RN, ACNS-BC, CCRN, FCCM - Mentor (2018 Carilion Nursing Research Fellowship) Physical restraint use in acute care settings is associated with poor patient outcomes. Risks associated with physical restraints in acute care patients are soft tissue injury, nosocomial infections, delirium, complications of immobility and death.

Joint Commission standards emphasize nurse assessment of the restrained patient and use of alternative methods. The purpose of this study was to determine if: 1) use of an evidence-based restraint decision support tool safely reduces use of restraints in a neurotrauma patient population, and 2) relationships exist amongst registered nurse (RN) characteristics and confidence in use of the restraint decision wheel (RDW). This IRB approved quasi experimental pretest- post-test-intervention design was conducted on a 12 bed NeuroTrauma Intensive Care Unit (NTICU) at a level one trauma center.

The study intervention used Hurlock-Chorostecki and Kielbâ&#x20AC;&#x2122;s decision-making wheel to assist nurses in assessment of behavior, device, and independence levels to determine if a patient should be restrained. During implementation, restraint use and device dislodgement were monitored. Restrained adult (18 and over) patients admitted to the NTICU and RNs practicing in NTICU comprised the convenience samples. Nurse confidence in restraint use was measured before and after implementation of the RDW. Nurse characteristics analyzed included: age, gender, highest level of professional education, certification, years of neurologic nursing experience, total years nursing experience and primary shift worked. For the restrained patient sample, the following demographic data were compared three months prior to three months following RDW implementation: age, gender, ICU admission diagnosis, traumatic and nontraumatic brain injury present, dementia, alcohol and substance abuse, and tobacco history.

The data showed that there were no statistical differences (p<0.05) in patient characteristics or impact of patient characteristics on mean time (in minutes) in restraints pre vs. post. Patients without delirium (negative CAM-ICU score) spent significantly more total mean time restrained (in minutes) in post vs. pre study periods (p=0.0326). There were no statistical differences (p>0.05) pre to post study phase in use of wrist, ankle and mitt restraints. In both the pre and post data collection brain injured patients were found to be restrained longer and with more restrictive modalities.

In conclusion, the trend showed that the restraint decision wheel is not effective in brain injured patients which is clinically significant. There were also no observational differences in RN characteristics or confidence noted pre to post. Awareness of restraint use did increase.

Limitations included charting errors, low RN participation in confidence surveys and wide ranges for restraint times which altered averages. This study was the first to explore use of a RDW in a neurotrauma population. Additional research with a larger sample size in a diverse setting is needed to draw conclusions.

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The effect of implementing symptom feedback into psychiatric care at a non-profit clinic Deirdre Rea, MSN, PMH-CNS, RN-BC, DNP[c]; Jeannie Garber, DNP, RN, NEA-BC - James Madison University Background Healthcare is moving toward a value-based system with reimbursement based on performance. Charitable organizations providing health services need to demonstrate positive outcomes for continued grant funding. The literature has established that Measurement-Based Care (MBC) is an evidence-based practice that can significantly improve patient outcomes and objectively document success. While many providers state that they agree, studies show that most do not utilize MBC in their own practices citing lack of time, and a belief that their clinical judgment supersedes a measurement tool. The purpose of this quality improvement study is to establish MBC in a charity clinic, proactively report scores to providers, assess for treatment response and explore provider perceptions of MBC impact on care.

Methods The study entails an explanatory mixed methods design with a pre-test/post-test quantitative measurement and a semi-structured qualitative interview with providers following data collection.

The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) patient self-report measurement tools for depression and anxiety will be implemented at each visit and scores embedded in a new electronic health record at a charity-based mental health clinic.

Baseline scores will be compared with scores at 3 months with care as usual. During months 3 through 6, scores will be actively reported to providers biweekly. Score comparisons will be performed from baseline and 3 months to the 6-month scores observing for percentage of change.

Qualitative questions will explore usefulness of MBC and effectiveness of the proactive reporting.

Results Dependent t-tests will be performed to look for differences in the means at the measurement points. A repeated measures ANOVA will be used to test the effect of non-exposure to exposure of scores over time. Qualitative data will be recorded verbatim, coded, and reviewed for themes and sub-themes until saturation with pattern identification and the generation of theory. One prior study found providers rarely used patient self-report information at baseline but almost always used the information at follow-up, finding the information highly useful for treatment decisions.

Conclusion An office process that assists with routine collection of patient data and consistently reports it to providers can increase buy-in and facilitate adoption of MBC to guide treatment decisions and produce objective evidence of positive outcomes. Successful change may be obtained by removal of identified barriers.

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Neonatal Abstinence Scoring - Does the shortened Finnegan tool rival the gold standard?

Sandra Chitwood, RN; Carly Gathje, BSN, RN - CRMH 12 South Mother/Baby; Phyllis Whitehead, PhD, APRN, CNS, ACHPN, RN-BC - Mentor (2018 Carilion Nursing Research Fellowship) Objective In newborns suspected of having intrauterine exposure to opioids, does the Simplified Finnegan tool yield the same results as compared with the gold standard Finnegan tool?

Design IRB approved retrospective quasi-experimental non-equivalent comparison group study to compare scores from two scoring tools, the “gold standard” Finnegan tool and the Simplified Finnegan tool.

Setting 30 bed postpartum unit at an academic medical center including a 5-bed transitional nursery providing neonatal abstinence syndrome care.

Patients/Participants 55 newborns and infants (27 female (49.1%), 28 male (50.9%)) diagnosed with neonatal abstinence syndrome evaluated between June 1, 2018, and December 31, 2018.

Methods 1443 standard Finnegan assessments were extracted retrospectively from de-identified infants’ electronic charts and converted into the simplified tool for comparison in this study. The standard Finnegan assessments were extracted by a designated health analytics research team. Data was analyzed using McNemar’s test of agreement to determine if the standard and simplified tools yielded equal above threshold (score >= 10) ratings for infants. Above threshold indicates need for higher level of nursing intervention. Secondary analyses included descriptive statistics and paired t-tests on individual symptom data.

Results The standard Finnegan scoring indicated infants were above threshold for 142 of our study assessments. For 74 (52.11%) of these assessments, the simplified tool classified the infants below threshold, a significant disagreement (p<0.0001) between the tools. Paired t-tests indicated that significant factors (p<0.005 for each) in the disagreement included: crying, respiratory rate, sleep, stools, tremors disturbed, and tremors undisturbed.

Implications for nursing practice The current or gold standard Finnegan tool, designed in 1975, assesses and scores infants identified with Neonatal Abstinence Syndrome and has been used in the healthcare setting unrivaled. Although a shorter tool may disturb the infant less, this study indicates that replacing the standard tool with the simplified tool would result in inaccurate assessments of infant needs for further nursing intervention.

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Spiritual care practices of APRNs: A multi-national snapshot Beth Dekoninck, DNP, NP-C, APRN-BC - Averett University Introduction/Background This presentation will examine findings from a multi-national study on the spiritual care practices of advanced practice registered nurses (APRNs).

The literature demonstrates that the majority of APRNs do not provide spiritual care for their patients past inquiring about religious preference.

Various explanations are noted in the literature such as lack of time, lack of training/preparation, decreased productivity, and fear of rejection. In contrast, the literature is replete with evidence that patients are open to spiritual care, especially when very ill, but they will not bring it up to the provider. Spiritual care is necessary in order to provide holistic patient care, yet APRNs are rarely educated on the performance of spiritual care in their graduate programs.

PICOT question What are the spiritual care practices of APRNs in the United States and parts of Western Europe?

What barriers do APRNs perceive related to providing spiritual care?

Methods This multi-national study examined spiritual care practices of APRNs in England, Germany, Austria, Switzerland and the United States. The study also sought to address what types of spiritual care was provided to patients, barriers to providing spiritual care, training in spiritual care as well as demographics of respondents such as years in practice, age, education and gender. The prospective, descriptive study used a 41item questionnaire distributed by email with the assistance of APRN professional organizations and graduate schools in the United States and the aforementioned countries.

Findings/Results/Discussion Findings of this study included the following: Two thirds of participants reported engaging in spiritual care practices regularly; the majority of participants did not received content on spiritual care in their educational programs; European APRNs were more likely to perform spiritual care assessments than Americans; and reticence and worry over political correctness were 2 common barriers to spiritual care. A common theme that emerged was APRNs do not feel they were prepared to provide spiritual care while in their graduate programs.

Implications for Practice With the advancement of the nurse practitioner role across the globe, it is evident that educational programs have an opportunity to be intentional about including spiritual care education in nurse practitioner programs. Furthermore, APRNs need to be encouraged and feel empowered to provide spiritual care for their patients so that holistic care is truly a hallmark of advanced practice nursing care.

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Is saving lives enough? Unmasking PTSD in ICU survivors Samantha Delieto, BSN, RN, CCRN; Breanna Kawa, BSN, RN, CCRN - CRMH 8M ICU; Donna Bond, DNP, RN, CCNS-BC, SE-C, CTTS - Mentor (2018 Carilion Nursing Research Fellowship) The ICU is a wildly unfamiliar place to all but those who work there. The human psyche does not go unscathed. Since 1987 thousands of studies have emerged regarding ICU stays and PTSS (post-traumatic stress syndrome). A 2015 meta-analysis found that PTSS occurred in a wide range (4-62%) of ICU survivors and were associated with worsened quality of life. Although research has been conducted on the long-term effects of ICU care on patients, the data is inconsistent.

This study asked the question: What is the prevalence of PTSS following an ICU admission at CRMH? There were 3 objects: to quantify the occurrence of PTSS across a 5-month period, to assess for any relationship between nursing interventions and the development of PTSS, and to identify variables for further research studies that could reduce the prevalence of PTSS at CRMH. ds: This study was prospective and non-experimental in nature and used a descriptive design. Patients were screened for inclusion and exclusion criteria across a 5-month period.

Within 1 week of extubation, consent was obtained, and the ICU-M instrument was administered.

The ICU-M instrument was developed to assess memory after being treated in an ICU. Participants who scored positive on the ICU-M tool were contacted two weeks later to complete the IES-R. The IES-R instrument uses a Likert scale and series of questions to identify individuals at risk for PTSS. Data was extracted from the EMR to assess for any relationship between high IES-R scores and demographic data or ICU interventions.

Findings/Results: 16 patients completed the ICU-M tool. Data analysis revealed that 78% of our patients felt anxious and frightened while in the ICU. 42% felt that people were trying to hurt them. 71% remember being confused. 29% remember being in pain. 50% experienced hallucinations.

9 patients remembered light, and only 5 remembered periods of darkness. Of the 16 who completed the ICU-M, 3 completed the IES-R, of whom 0 scored in a manner that was concerning for PTSS.D iscussion/Conclusion: With lengthy interviewing processes, and low follow up rate, the 5-month research period was not effective in producing a satisfactory sample size. We continue to meet patients with anecdotal evidence of PTSS who did not participate in our study. Therefore, we do not feel our study is representative of the entire population. The study of PTSS following ICU stays at RMH will continue until better understanding and a larger sample size met.

Nursing Implications Despite a small sample size, rich insight was gained into what our patients experience while in the ICU. By hearing, and sharing, their stories, we hope that nursing practice in the ICU may become less harsh on the psyche, more compassionate, and more empathetic. We hope to rekindle a passion in nurses to respect each patient as a person, and to do everything in our power to protect their psyche while they are under our care.

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Nursing work-related stress in the ICU and aromatherapy: A systemic review Taylor Brogan, BSN, RN, CCRN; Sandra Hubbard, BSN, RN; Kalyn Oâ&#x20AC;&#x2122;Conner, BSN, RN - CRMH 9M NTICU , Kim Carter, PhD, RN, NEA-BC - Mentor (2019 EBP Fellowship) Introduction/Background Nationally, nursing staff are experiencing a crisis of burnout, compassion fatigue, emotional and mental exhaustion and disengagement. According to Hume (2018) thirty-four percent of nurses in the United States are experiencing burnout. These factors all lead to a decrease in overall well-being that impacts only only the health of nurses but also affects their ability to provide high quality patient care (Hume 2018). A study recently revealed a link between poor nursing well-being and an increased risk for medical errors (Melnyk et al., 2018).

Stress and loss of well-being can lead to depression, less resilience, job dissatisfaction, and an increase risk of adopting unhealthy coping mechanisms such as alcohol abuse and smoking (Hume, 2018). On the Neuro Trauma Intensive Care Unit (NTICU) at Carilion Roanoke Memorial Hospital (CRMH), an overall trend of nursing burnout, job dissatisfaction and poor staff retention has become apparent. In order to improve the morale and environment on the NTICU, different strategies for improving staff well-being have become the focus of conversation.

PICOT question In ICU nurses, what is the effect of essential oil aromatherapy with peppermint, lavender, lemon, and bergamot on work-related stress?

Methods This was an EBP concentration to examine current literature and practice surrounding aromatherapy. Using the CLEAR Model of research, this team reviewed literature related to the essential oils peppermint, lavender, lemon, and bergamot, to evaluate possible effects on nursesâ&#x20AC;&#x2122; feelings of well-being. The team also examined relevant Carilion policies for consistency with best practice related to aromatherapy.

Findings/Results Multiple studies supported a relationship between aromatherapy with the above oils and reductions in work-related stress and boosting mood among nurses. However, there is very minimal published literature to date.

Discussion/Conclusions There is evidence to support a positive correlation between peppermint, lemon, and lavender aromatherapy and stress reduction. There was limited evidence for bergamot use. Limitations included the lack of literature and bias toward positive findings, small sample sizes, a wide variety of assessment tools used in the studies, and other stress relief practices utilized by the study participants.

Nursing implications More research is needed to explore implementing aromatherapy for the reduction of stress among staff members; especially focused on essential oils peppermint, lavender, and lemon to help reduce stress in clinical staff. This team also recommends reviewing, revising and clarifying current Carilion policies for consistency and relevance to diffused aromatherapy.

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Aromatherapy to reduce patient nausea- Literature Review Linda Siar, RN, CTL - CRMH 12S Nursery; Sarah Dannhardt SN, James Madison University; Cindy Hodges, RN, BSHS, FCN - CRMH OR Services

Literature Review • Used HERO database • Key Terms: “aromatherapy”, “nausea treatment” • Exclusions: treatment of symptoms other than nausea, not written in English • Six articles reviewed Findings Aromatherapy research with post-op patients has shown: • Oil of ginger necklace reduced post-op nausea and vomiting.

• Oil of lavender effective for post-op nausea and vomiting.

• Oil of rose had no significant effect.

• • • •

• • •

Findings with Special Populations Aromastick reduced nausea in 47% subjects receiving chemotherapy.

Lavender and peppermint oil twice daily: nausea and vomiting decreased in pregnant women with morning sickness Isopropyl alcohol reduced nausea in ED patients in randomized, blinded, placebo-controlled trial.

Ginger oil (and to a lesser degree, Mandarin oil) had statistically significant effect in treating nausea at 10 Wisconsin hospitals.

Limitations Insufficient control and sample diversity Unpowered sample sizes Settings primarily limited to home environment

*For complete literature review go to our October Within REACH publication on Inside Carilion: https://issuu.com/carilionclinic/docs/ within_reach_publication_-_oct_2019_final Limited hard copies available. Contact Nursing Rsearch - elassenat@carilionclinic.org

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• • •

• • • •

Key Findings from Hines, Steels, Chang, & Gibbons, 2018 Aromatherapy for treating postoperative nausea and vomiting Cochrane Database of Systemic Reviews No studies reported adverse effects.

All participants in both treatment and control reported high satisfaction with care.

Isopropyl alcohol aromatherapy:  Time to 50% relief faster (3 studies, 176 patients)  Subjects less likelly to require rescue anti-nausea drugs (4 studies, 291 subjects)  Not more likely to be free of nausea Peppermint oil: No effect (4 studies, 115 subjects) Overall, aromatherapy not effective in reducing nausea at >3 minutes (6 studies, 241 subjects) More subjects who received aromatherapy were nausea-free at end of treatment (4 studies, 193 subjects) Fewer aromatherapy subjects required anti-nausea medications (7 studies, 609 subjects)

(Hines S, Steels E, Chang A, Gibbons K. Aromatherapy for treatment of postoperative nausea and vomiting. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD007598. DOI: 10.1002/14651858.CD007598.pub3.)

• • • • • • •

Summary of Mallt & Parks 2018 Aromatherapy: A Non-pharmacological intervention for post-op nausea and vomiting study Presented at 2018 ANCC National Magnet Conference Used combination of aromatherapy: Peppermint, Lavender, Ginger and Spearmint Nurse driven Convenient and quick to use Can be used as often as needed Decrease anti-emetic drug use (60%) Increase patient satisfaction Safe and effective - can be used at home

Drug Cost

Aromatherapy Cost

Zofran: ~ $10-$20.00

Three Day Tab: ~ $5.00

Compazine: ~ $184.00

Inhaler: ~ $7.00

Promethazine: ~ $23.50-$34.10

Six month inhaler: ~ $17.50

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Nurse well-being and burnout: A follow-up study Kim Carter, PhD, RN, NEA-BC - Nursing Research; Mark Greenawald, MD - Carilion Family Medicine, Roanoke/Salem; David Musick, PhD - VTC Associate Dean for Faculty Affairs Introduction/Background Maslach & colleagues (2016) characterize burnout as â&#x20AC;&#x153;a prolonged response to chronic emotional and interpersonal stressors on the jobâ&#x20AC;?, with dimensions of emotional exhaustion, cynicism, and professional inefficacy.

The presence of and risk factors for burnout in nurses have been studied for decades, and the impact on personal quality of life, physical and mental health, quality of care, and staff turnover is well documented. What is less understood are the best approaches to promote well-being and diminish professional burnout for nurses. This study addresses these knowledge gaps by surveying Carilion Clinic nurses to understand burnout, thriving, engagement, intent to leave, depression, professional fulfillment, sleep, and open-ended questions. The information will be compared to a similar 2016 survey to trend rates and correlates of nurse burnout. Study results will support development, implementation, and evaluation of interventions to promote nurse well-being at Carilion Clinic that can lead to implementation research.

PICOT question What is the current state of Carilion nurse well-being, and how does the 2019 survey results compare to burnout and well-being documented in 2016? What do Carilion nurses recommend to reduce burnout and improve well-being?

Methods The IRB determined this study to be exempt research. The survey tool included the Maslach Burnout Inventory, Burnout-Thriving Index, and Engagement and Intent to leave, PHQ-2 Depression Screening, Stanford Professional Fulfillment Index, and investigator-developed measures of demographics, engagement, intent to leave, sleep and fatigue, and open-ended questions. The approximately 10-minute survey was administered in May and June 2019 via Survey Monkey with four reminders. Participants received an information sheet about the study, and contact information was provided for questions or concerns. Data were analyzed with descriptive, parametric and nonparametric methods, and thematic analysis of qualitative data.

Findings/Results At the time of abstract submission, 55% of all Carilion RNs and LPNs completed the survey.

Results are being analyzed, and findings will be reported.

Discussion/Conclusions This study reflects an innovative exploration of the associations between burnout, well-being, engagement, and other correlates.

Nursing implications In addition to advancing knowledge related to burnout and wellness generally, this study will be instrumental in guiding the development of interventions to improve quality of life for nurses, paving the way for future evaluation of outcomes of these potential interventions.

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Employer opportunities to ameliorate barriers to RN-BSN program enrollment: Findings from a multi-organizational survey.

Vivian Wilson, BSN, RN, CCRP - Carilion Research & Development; Stephanie Defilippis, BSN, RN - Carilion Infusion Center; Kim Carter, PhD, RN, NEA-BC Presentation Description Healthcare organizations in many parts of the US are struggling to meet the goal of 80% baccalaureate prepared RNs by 2020. Findings related to the employerâ&#x20AC;&#x2122;s opportunities to ameliorate challenges and barriers to enrolling in an RN-BSN program from a survey of RNs from two major health care systems in Central/SW Virginia (Carilion and UVA).

Implications for nursing leaders, managers, educators, and nurses considering a BSN will be presented with potential solutions to reduce barriers and develop support mechanisms for RNs seeking a BSN. Abstract The Institute of Medicine (2010) recommended an 80% baccalaureate prepared RN workforce by 2020. While there is an abundance of literature that reports the challenges that RNs encounter when contemplating another degree, much of this work was done prior to the proliferation of online education programs. Even less is known about the perspective of the RN regarding what employers can do to support them in their quest for the BSN. The purpose of this study is to advance our understanding of the prospective RN-BSN studentâ&#x20AC;&#x2122;s needs that can be supported by the employer. This mixed methods multi-organizational study incorporates survey methodology of RNs from two major health care systems in Central/SW Virginia (Carilion and UVA). Findings focus on social, economic, educational, and other layers of support. Implications for nursing leaders, managers, educators, and nurses considering a BSN will be presented with potential solutions to reduce barriers and develop support mechanisms for RNs seeking a BSN.

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Second victim: Support for the healthcare team Tara Chitwood, DNP, RN, CCRN - Radford Carilion University; Neely Conner, LCSW, LSATP, CEAP, PCC - Carilion EAP Introduction/Background Many healthcare institutions have implemented second victim support programs (SVSP), but there are no published findings on the effectiveness of the programs. It is vital to have published findings of successful SVSP content, implementation, and evaluation for healthcare organizations to have supportive services and positive outcomes for second victims. This project will evaluate a SVSP using the Second Victim Experience and Support Tool (SVEST).

Purpose A tertiary health system in Southwestern Virginia developed and implemented SVSP in spring 2014. Evaluation of the SVSP had not been performed. The purpose of the project was two-fold: 1) to evaluate the effectiveness of a SVSP and 2) to describe how support services affect health team members’ desire to remain in their profession after an experience with an adverse event or medical error.

Methods Program evaluation used survey research to conduct a simultaneous pre-post survey on healthcare team members that were referred to the support program. The evaluation used a demographic questionnaire and the SVEST survey, plus four additional items. The survey was sent anonymously to 307 healthcare team members who had received a referral after an adverse event or medical error. Data was collected over four weeks. Thirty-nine healthcare team members responded to the survey. Out of 39 responses, 16 responses met the inclusion criteria.

No statistical significance was found in pre-post survey data in the dimensions of physical support, colleague support, supervisor, institutional support, and professional self-efficacy or the variable of absenteeism after receiving support. Statistical significance was found in the dimensions of psychological distress and the variable, job retention after receiving support. Fifteen out of 16 respondents rated their experience with the SVSP as moderately to extremely satisfied. Three qualitative questions were added to the post-survey. Survey respondents reported they stayed in their positions because of the supportive environment. One respondent reported that the support they received, “prevented me from ending my life.”

Unexpected findings.

Respondents utilized support more if contacted by phone rather than email. Comparison of the 11 respondents that did not use support to the post support scores of the 16 respondents that used support found statistical significance in institutional support, turnover intention, and absenteeism. All respondents that received support had clinical significance in psychological distress, colleague support, and supervisor support.

Discussion/Conclusions SVSP help health care team members with second victim symptoms cope and stay in their positions. This program is effective; most respondents were greater than satisfied with the support they received. Utilization of the SVSP was significant in decreasing psychological symptoms and increasing job retention. Timely connection with SVSP showed improved outcomes. Improved advertising and knowledge that professional counselors were available at all hours is needed.

Continued on next page......

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Nursing implications Thirty-eight percent of respondents were nurses. Increased education about second victim symptoms and available support services after an adverse event is crucial. Utilization of support from colleagues and professional support services promotes resilience and longevity in the professional. Support to nurses after an adverse event has found to increase patient safety by maintaining clinical competence thus preventing future errors.

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Nursing burnout with substance using inpatients: A new hope Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC - Nursing Quality & Safety; Tammy Mitchell, MSN, RN, NE-BC - CRMH 5 West Purpose Patients with conditions associated with substance use disorder (SUD) can exhibit incivil behaviors that are challenging for inpatient unit nurses. This project explored the impact of an SUD treatment pathway on RN burnout, retention, engagement, patient experience, and number of police calls.

Significance Little literature is reported about the effect of negative relationships with patients on nurses' job satisfaction or burnout. Specifically, there is a literature gap about acute care nurses caring for patients with SUD and nurses’ burnout.

Implementation A psychiatrist, licensed clinical social worker and peer recovery specialists provided substance use therapy and support during admission for medical conditions. The team members participate in the unit’s daily multidisciplinary team meetings, providing insight and expertise for patients with SUD. The Maslach Burnout Inventory for Medical Personnel measured emotional exhaustion, depersonalization, and personal accomplishment at pre-implementation in July 2018 and again at 3, 6, and 9 months post-implementation. Pre and post-intervention data for nursing turnover, staff engagement, patient experience, and the number of hospital police calls were compared.

Outcomes With a 58% response rate, the within factor repeated measures ANOVA for sum of scores for emotional exhaustion (p=0.0133) indicated decreased burnout at each survey postimplementation. There was no difference in depersonalization and personal accomplishment.

There was a 36% decrease in RN transfers and voluntary RN turnover. The hospital’s 2019 staff engagement survey results are pending. There was a slight increase in the percentage of patients responding “always” to the patient experience questions related to communication with nurses, response of hospital staff, and staff worked together to care for you. The number of calls to hospital police during 7P – 7A increased post-implementation.

Implications for Practice Further research is needed to determine the long-term implications of the pathway on nursing burnout. Limitations of the study were the small sample size and presence of other challenging long-term non-pathway patients.

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Carilion Nurses Sharing their Knowledge

l-r: Allison Parkhurst; Kara Gibson

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Reviewer: Allison Parkhurst, BSN, RN Unit: Carilion Inpatient Rehabilitation Services

American Medical Rehabilitation Providers Association (AMRPA) Fall Educational Conference & Expo San Diego, CA

Poster Presentation: Nursing Staff Satisfaction on Quality of Care Using a FIM-Based Acuity Tool

Conference Highlights:

The AMPRA conference focused on many of the regulatory changes occurring in Rehabilitation over the past year, and anticipated needs going forward. Many of these changes have been positive for reimbursements in the short term. The industry is looking to continue to encourage CMS and Congress to review the unique needs of our specialty practice. The interactive poster presentations yielded good traffic and feedback. Many providers were very interested in ways to reduce nursing burnout and increase job satisfaction and asked probing questions regarding my poster about nursing staff satisfaction and acuity tools for staffing.

*Conference travel funded in part by Carilion Nursing Research Nightingale Award

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Reviewers: Allison Parkhurst, BSN, RN Kara Gibson, ADN, RN Unit: Carilion Inpatient Rehabilitation Services

Reach 2019: Association of Rehabilitation Nurses (ARN) Conference Columbus, OH

Poster Presentation: Nursing Staff Satisfaction on Quality of Care Using a FIM-Based Acuity Tool

Conference Highlights:

The ARN conference in Columbus OH was a nursing-specific conference and had many topics ranging from disease-specific practice to falls to huddles and rounding. Many inpatient rehab facilities are facing the same problems we face on our unit. I have been able to bring some falls interventions ideas back to our facility and am presenting them to the PSG falls committee next week. Kara and I received an overall 4.56 of 5-star rating of our poster based on feedback from 156 evaluations, which is exciting.

We are working with our unit leadership team going forward with the results we have received from our frontline staff.

*Conference travel funded in part by Carilion Nursing Research Nightingale Award

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Reviewers: Donna Bond, DNP, RN, CCNS, AE-C, CTTS Deborah Robinson, RRT, ACCS Unit: Carilion Nursing Professional Practice; Carilion Respiratory Services

28th Academy of Medical-Surgical Nurses Annual Convention Chicago, IL Poster Presentation: They are breathing, aren’t they?

Why counting respiratory rate is important.

Conference Highlights: I attended this conference and presented a poster on my research on respiratory rate-“Accuracy of counted respiratory rate, Opioid administration, and impact on early warning systems”. The agreement from the attendees that respiratory rate is not counted was discouraging, but not unexpected and supported by my research. The most important information I found was that not all patients who are receiving PCA medication are monitored with end tidal CO2. It is a national recommendation from the pain societies to monitor end tidal CO2 for patients receiving medication through a PCA infusion.

I was also fortunate to have a preview of our keynote nursing research conference speaker, Dr. Lynn Gallagher-Ford, on the findings from her study of AMSN members beliefs, competencies, and ability to implement evidenced -based practice on their units.

Conor Cunneen was the keynote speaker and spoke on the power of the gift of GAB. GAB stands for Goals, Attitude, and Behavior. He was an excellent speaker who provoked several thoughts about goal directed behavior. I would recommend this conference to all Medical Surgical nurses to update their knowledge and invigorate their practice.

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Reviewer: Samantha Hall, DNP, FNP-BC, CCRN Unit: Critical Care Surgery

American Heart Associations Scientific Sessions 2019 Philadelphia, PA Poster Presentation: Predictors of 30-day readmissions after cardiac surgery

Conference Highlights: The AHA conference was the largest conference I have attended in my nursing career. I was so impressed with the variety of information within the conference, and I was only there for 1 day! I spent a majority of my time in the State of the Art Cardiovascular Care sessions. These sessions covered new guideline updates, advances in cardiovascular care including genetics and technology advances.

One of the lectures I attended was about the Apple Heart Study (conducted at Stanford) and how Apple watches are being used to monitor patients for irregular heart rhythms, including AFib. The results of this trial will lay the foundation for further utilization of smart watches and devices to help identify and/or monitor our patients with previously unknown/undiagnosed AF. This may be potentially valuable in the post-cardiac surgery patients where AF is not an uncommon occurrence.

As nurses, being aware of this technology can help us in the future to guide our patients on how they can best utilize such devices for their health benefits. Patients have been using smart phone and/or watches to help monitor eating habits, track weight, etc. How cool is it that now they may (on their own and with the guidance from a provider) be able to identify irregular heart rhythms at their fingertips and seek help earlier?!

This was only one of the many sessions that were so educational. This was such a cool experience and I highly recommend it to anyone that has the opportunity to attend in the future. *Conference travel funded by Carilion Nursing Research Nightingale Award

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Reviewer: Christine Fish-Huson, PHD, RN Unit: Carilion Nursing Research & Radford University Carilion

International Neuroscience Nursing Symposium Austin, TX Poster Presentation: Concept mapping: Student perceptions of the nursing process with the use of a concept map assessment Session Highlights: The International Neuroscience Nursing Symposium held in Austin, Texas addressed nursing research from basic-translational to ongoing clinical trials in the field of neuroscience. Oral presentations were brief and dynamic with over 20 nurse researchers from the United States, South America, Germany, and England completing 15 minute presentations on their research findings. Topics included the problem of post-traumatic stress disorder in military veterans, neurologic disease in Western Kenya, pharmacogenomics in mental health treatment, and other topics in Stroke and Traumatic Brain Injury care.

One topic of potential interest to Carilion nurses is the problem of caregiver burden and stroke survivors. We know that family caregivers are at risk for poor health outcomes yet we do not know what best practice is in interventions to improve health outcomes of both the caregiver and their stroke survivor. Research suggests providing interventions that combine skill building education with psychosocial education may result in better outcomes for both the caregiver and the stroke survivor. Further, the method of providing this education (written versus oral) may impact that outcome (Bakas et al., 2015).

Reference: Bakas, T., Austin, J. K., Habermann, B., Jessup, N. M., McLennon, S. M., Mitchell, P. H., â&#x20AC;Ś Weaver, M. T. (2015). Telephone assessment and skill-building kit for stroke caregivers: A randomized controlled clinical trial. Stroke, 46(12), 3478â&#x20AC;&#x201C;3487. https://doi.org/10.1161/STROKEAHA.115.011099

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EVENT & 2020 CONFERENCE REMINDERS: Feb 20-21 - Virginia Patient Safety Summit, Richmond, VA April 1-3 - TraumaCon - Society of Trauma Nurses, Atlanta, GA (Online registration available until April 1, 2020) April 7 or April 21 Tentative dates (TBD): Carilion Clinic Research Day April 15-18 - American Academy of Ambulatory Care Nursing (AAACN) 45th Annual Conference, Chicago, IL April 22 VNA Spring Conference, Richmond, VA - (*Registration Deadline April 12, 2020) May 11: Week of the Nurse, Art & Science of Nursing Showcase (Call for posters deadline March 4, 2020) October 7-9, National ANCC Magnet Conference - Atlanta, GA - Call for Abstracts CLOSED. October 21-25 - AMSN 29th Annual Conference, Westgate Las Vegas, Las Vegas, NV - (Poster Abstracts due by May 15, 2020)

Need assistance with conference travel for your presentation?

Go to our hub on Inside Carilion and review the information available regarding our Nightingale Award Fund! https://www.insidecarilion.org/hub/nursing-research-evidence-based-practice/all-activity/ conference-travel-funding • • • •

If approved, provides up $1700.00/yr for conference travel/registration costs.

Individuals are eligible for funding bi-annually, not to exceed $1700.00/ yr.

This $1700.00 is PER PROJECT, regardless of the number of nursing staff presenting.

Application available on our hub, see the link above.

FOR ALL THINGS NURSING RESEARCH & EVIDENCE BASED PRACTICE.....

CONTACT THE : NURSING RESEARCH DEPARTMENT AT 540-266-6216

OR VISIT OUR NURSING RESEARCH & EVIDENCE BASED PRACTICE HUB ON INSIDE CARILION: https://www.insidecarilion.org/hub/nursing-research-evidence-basedpractice

You Can Find information on:

Conference Travel Funding!