Nursing Update 2007 - 2008 - Yale-New Haven Hospital

SICU nurses take evidencebased
approach to care
Surgical Intensive Care Unit (SICU) nurses are
taking a fresh look at how they provide patient
care with the help of an evidence-based practice
committee. Quarterly, the committee analyzes
the literature on topics selected by SICU nursing
staff and then assists the staff in applying the
findings to their practice.
The SICU’s innovative approach has been so
successful it earned SICU nurses Rick O’Connor,
B.S.N., R.N., and Zachary Krom, B.S.N., R.N., the
opportunity to present the results of the
committee’s work at Sigma Theta Tau’s 18th
International Conference in Vienna, Austria, last
summer. More locally, they are expanding their
important work into other YNHH intensive care
units.
The committee uses the hospital’s chosen model
of incorporating research into practice, the Iowa
Model, which provides a guide for clinical decision-making
and details regarding implementation.
The model includes both the practitioner
and organizational perspectives.
One significant result of the committee’s research
in the SICU is further reinforcement of encouraging
family visitation during resuscitative and
invasive procedures, such as CPR and chest tube
insertions. In cases where both caregivers and
the family are comfortable, families are invited to
stay in their loved one’s room as a nurse or social
worker talks them through the experience. Krom
and O’Connor’s research found that families who
witness efforts to save a loved one’s life are appreciative
to be part of the process. In addition, this
practice can provide a greater sense of closure for
those who are grieving.
Study examines charge nurse
and decision-making
The personality traits of charge nurses do not
always mix with those of physicians – in fact,
the two can be polar opposites, according to a
study conducted by Victoria Dahl Vickers, R.N.,
M.B.A., who was recently named coordinator of
regulatory readiness, and Eija Faulkner, learning
and development consultant in the hospital’s
Institute for Excellence. They presented their
findings last year at the National Nursing Staff
Development Organization’s annual convention
in Atlanta.
Vickers and Faulkner assessed nurses at Yale-
New Haven Hospital with the help of the
Myers-Briggs personality model, typically used
by career counselors. Out of 149 nurses who
participated, 98 identified “feeling” as their
decision-making preference mode, which is the
opposite of physicians, who tend to use a “thinking”
mode to make decisions, Vickers explained.
The second part of the survey dealt with conflict
resolution, using the Thomas Kilman Conflict
Mode Instrument, a leading instrument used to
assess conflict-handling styles. Asked to describe
their conflict resolution style, most nurses expressed
a preference for avoiding conflict.
Vickers and Faulkner, who are using their findings
in training sessions for nurses, say awareness
of how nurses relate to colleagues is useful
because it can help them make adjustments and
perform more efficiently when working as part
of a team.
Nurses play key role
on successful diabetes team
For patients with diabetes, the evidence is
increasingly clear that aggressive management
of blood glucose can reduce complications
from illness or surgery, lower rates of infection
and shorten hospital stays. At Yale-New Haven,
nurses on Connecticut’s first full-time multidisciplinary
diabetes team play a key role in keeping
glucose levels down.
The team—a joint effort between YNHH and
Yale School of Medicine—includes physicians
and caregivers collaborating with primary care
teams to control blood sugar and educate patients
about their diabetes before discharge.
Last year, the team presented 11 months of data
on its work and earned the top prize in research
for Yale-New Haven Hospital at the annual 2007
Joseph A. Zaccagnino Patient Safety and Clinical
Quality Conference.
Among the team’s findings: Glucose is better
controlled when patients receive either a continuous
insulin infusion with frequent monitoring,
or a basal bolus correction regimen, an
approach that imitates normal physiology by
using a fast-acting (bolus) insulin with each meal
and a long-acting (basal) insulin once or twice a
day. Two nurses, Helen Psarakis, A.P.R.N., and
Gael Ulisse, A.P.R.N., contributed to the project
team’s findings and success.
We developed our evidence-based practice committee because
we want nurses to keep searching for the best ways to care
for patients. Research turns up new information all the time,
and nurses need to have this information available to them.
With more data and research behind their practice, nurses can
make better choices and that improves care overall.”
— Zachary Krom, R.N., Surgical Intensive Care Unit
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