Nevada RNformation - March 2011

More documents

Recommendations

Info

Page 8 • Nevada RNformation March, April, May 2021 Research & EBP Corner Nursing Application of Light Sedation for Mechanically Ventilated Patients Mary Bondmass, Ph.D., RN, CNE This RNF feature presents abstracts of research and evidence-based practice (EBP) projects completed or spear-headed by nurses or student nurses in Nevada. The focus is on new evidence (i.e., research) or the translation of evidence (i.e., EBP) in Practice, Education, or Research. Submissions are welcome and will be reviewed by the RNF editorial board for publication; send your abstract submission in a similar format used below to mary.bondmass@unlv.edu Kelsey Swanson, DNP(c) University of Nevada, Reno Featured EBP in this edition is Kelsey Swanson’s DNP project. Kelsey has been a cardiac ICU nurse for five years. She is currently completing her DNP at Orvis School of Nursing at the University of Nevada Reno. Kelsey is in the Adult Gerontology Acute Care Nurse Practitioner Track and will be graduating in May. An abstract of her final project is below. Kelsey intends to pursue a career as a hospitalist NP. Background: Patients with acute respiratory failure are routinely cared for in intensive care units (ICUs). Decompensation in respiratory status can be related to a primary pulmonary etiology or secondary to another acute illness. Many of these patients require the use of a ventilator to maintain adequate oxygenation. Historically, the use of pharmacologic sedatives in intubated patients has been common practice. Growing evidence suggests that these medications extend intubation duration, hospital lengths of stay, delirium, and long-term cognitive and mood disorders (Peitz et al., 2013). Literature supports the use of analgosedation, which focuses on pain management before sedation in mechanically ventilated patients (Devlin et al., 2018). New research and literature are available that condones the use of lighter sedation of mechanically ventilated patients. Traditional sedation practices have been shown to be harmful to patients as they are linked to poor short-term and long-term patient LUNGS BURNING? IT’S YOUR VAPE. Text “Start My Quit” to 855-891-9989. Free, confidential help. Just for teens to quit vaping. This ad is supported by the Nevada State Department of Health and Human Services and the Washoe County Health District. outcomes. Intubation times and ICU length of stay are prolonged with heavy sedation (Treggiari et al., 2009). Heavy sedation puts patients at risk for further complications. Cognitive function and mood disorders can also be negatively impacted by deep sedation in mechanically ventilated patients (Treggiari et al., 2009). Purpose/Methods: This project aimed to advocate and collaborate on behalf of the nursing discipline in a quality improvement initiative. "Sedation Light" refers to medication changes to achieve the desired Richmond Agitation and Sedation Score (RASS) of -1 to +1, as well as the clinical challenges associated with this change. “Sedation Light” utilizes fentanyl, propofol, and dexmedetomidine. This project worked to improve nursing care and moral related to “Sedation Light." Specifically, his project aimed to work with an interdisciplinary team and implement evidencebased changes to improve nursing care related to "Sedation Light." This project provided support, education, and advocacy for nursing throughout this transition in sedation practices to change nursing culture. Adult learning theory (Knowles, 1973) and Kolcaba’s theory of comfort (Krinsky et al., 2014) guided this project's implementation. A special interest group of “Sedation Light Implementation Champions” (SLIC) was assembled under the DNP student's leadership. This group served as a resource for nursing staff and was available on most shifts. SLIC supported nursing staff during shift work and advocated for appropriate application of sedation light flow sheets compiled by pharmacy. SLIC was closely involved with education and supportive efforts for staff nurses. Education for nursing staff was a primary component of this DNP project. Education was key to nurse endorsement of reducing sedation in mechanically ventilated patients. Numerous forms of education were offered to allow nurses to choose which format is most beneficial to them. Presentations of analgosedation, pain and sedation assessment, and long-term effects of heavy sedation were presented in unit staff meetings. Pamphlets and tip sheets were created, and SLIC completed in-services. These individual or small group learning sessions allow for an intimate discussion of challenges specific to individual patients. Troubleshooting has been available through these in-services and can help make bedside nurses feel supported in their challenges. A unit reference binder for “Sedation Light” was also created. It contains several original studies for nurses curious about the efficacy of reduced sedation. This literature can often be difficult and lengthy to read. For that reason, there are condensed articles explaining the benefits of light sedation, easy-to-read PADIS guidelines, and copies of "Sedation Light" flowsheets. These quick references allow for prompt location of applicable information and return to regular nursing duties. Offering extensive studies and condensed tip sheets allow nurses to seek the level of knowledge they desire without overwhelming. Results: This project resulted in an order set that decreased variability in sedation drugs used. Implementing a facility-wide policy to support the efforts of "Sedation Light" was a primary objective of this DNP project, and this objective was accomplished. Qualitative data related to “Sedation Light” was collected during daily ventilator rounds. These data include Richmond Agitation and Sedation Score (RASS), standardized sedation awakening trials (SAT), spontaneous breathing trials (SBT), and mobility as it relates to sedation strategies. Early on in this project, in April 2019, all patients that qualified for a SAT had one done. In February 2020, 79% of patients qualified for a SAT, and 74% completed them. In July 2020, 86% of patients were eligible for SAT, but only 74% had an SAT. From this data set, even fewer patients are having these SATs paired with an SBT. The best month of paired SAT and SBT performance is April of 2019, where 57% of eligible patients received an SAT and SBT. Conclusion/Implication for Practice: This project aimed to directly change nursing culture and implement scholarly literature and research into practice. Creating a culture change related to sedation levels in mechanically ventilated patients is invaluable for patient outcomes. The nursing discipline must realize its responsibility to evolve practice in the clinical setting. The nursing discipline has valuable input for quality improvement initiatives. Nurses should seek involvement in large practice changes, even when initiated by other disciplines. Interdisciplinary collaboration is key to organizational success and improved patient outcomes. Abbreviated References Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., …, Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, Agitation/Sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873. doi:10.1097/CCM.0000000000003299 Knowles, M. S. 1. (1973). The adult learner: A neglected species. Houston [Tex.]: Gulf Pub. Co. Krinsky, R., Murillo, I., & Johnson, J. (2014). A practical application of Katharine Kolcaba's comfort theory to cardiac patients. Applied Nursing Research, 27(2), 147-150. doi:10.1016/j.apnr.2014.02.004 Peitz, G. J., Balas, M. C., Olsen, K. M., Pun, B. T., & Ely, E. W. (2013). Top 10 myths regarding sedation and delirium in the ICU. Critical Care Medicine, 41(9 Suppl 1), S46-S56. doi:10.1097/CCM.0b013e3182a168f5 Treggiari, M. M., Romand, J., Yanez, N. D., Deem, S. A., Goldberg, J., Hudson, L., Heidegger, C., & Weiss, N. S. (2009). Randomized trial of light versus deep sedation on mental health after critical illness. Critical Care Medicine, 37(9), 2527-2534. doi:10.1097/CCM.0b013e3181a5689f
March, April, May 2021 Nevada RNformation • Page 9 Support the Next Generation of NV Nurses Iris Isabel Martinez Karen Nava The Nevada Nursing Student Association (NVNSA) is holding their 3rd Annual Virtual Conference on Saturday, May 29th, from 8 a.m. to 2 p.m., and you are absolutely welcome to join the next generation of NV nurses! This year's convention motto is "No limits to success," and we hope students leave the conference empowered and eager to start their nursing careers! We will offer the first NVNSA Conference scholarship to a nursing student, and the funds raised from registration fees will help supplement this scholarship. For the first time, we will be inviting high school students to learn more about the life of a nursing student and the beauty of the nursing profession. The conference will include a resilience key-note speaker, an NCLEX review, a guest panel of hospital recruiters, resume and interview advice, nursing vendors, raffle prizes, and much more! How to Support NVNSA: 1. Join us on May 29th: Your presence will inspire students because we look up to you. At a certain point in our lives, we have interacted with a nurse or nurse(s) who have changed our lives. NVNSA and its members would be honored to include you in our conference. The registration fee for RN’s is $25. Register Here! 2. Donate to NVNSA: We kindly welcome all donations. If you would like to donate, please email conference.nvnsa@gmail.com that way, we can adequately thank you at the conference and spotlight you in our virtual convention booklet. 3. Please write an article for our 2021 Virtual Convention Booklet: The beauty of nursing includes a lifetime of learning and the opportunity to engage with different specialties and providers. With that being said, if you would like to write an article regarding the nursing profession or even an article to support students, we would love for you to please reach out. We will be happy to include your article in the convention booklet and our website! Please email conference.nvnsa@gmail.com for more information. 4. Follow us on Social Media: Stay up to date with all things NVNSA via our social media platforms: @nevadansa on Instagram & @ NVStudentNurses on Facebook. Sponsorship Plans: Professional nursing organizations, hospital recruiters, nursing schools (undergraduate and graduate), companies, and vendors are encouraged to engage with the future generation of Nevada nurses. A highlight of our conference is allowing exhibitors to advertise their services and network with students. If your organization/company is interested in participating in the conference, please register at the following link: http://events.r20. constantcontact.com/register/event?llr=vuz87kdab&oei dk=a07ehl4fow20bd79667. Kobe Bryant once said, “The most important thing is to try and inspire people so that they can be great in whatever they want to do,” the NVNSA team strives to uplift one another and provide as much guidance, wisdom, and opportunities as possible because we all are a team. Nursing is not an individual profession. Nursing requires teamwork, trust, and the ability to know that you are not alone and that you can ask for help. This conference serves as a "New Grad RN Bootcamp," a "Get to know the nursing profession," but most importantly, this conference is meant to serve as a reminder that there is NO LIMIT TO SUCCESS!
Page 1 and 2: March 2021 • Volume 30 • Number
Page 3 and 4: March, April, May 2021 Nevada RNfor
Page 7: March, April, May 2021 Nevada RNfor
Page 23: March, April, May 2021 Nevada RNfor

Nevada RNformation - March 2011

Create successful ePaper yourself

Delete template?

Save as template?