Monday, July 30, 2007

E-Journal Club #9

Rogers, Ann E., Wei-Ting Hwang, Linda D. Scott, Linda H. Aiken, and David F. Dinges, “The Working Hours of Hospital Staff Nurses and Patient Safety”, Health Affairs Vol. 23/4, July/August 2004: pp202-212.

“The use of extended work shifts and overtime has escalated as hospitals cope with a shortage of registered nurses (RNs). Little is known, however, about the prevalence of these extended work periods and their effects on patient safety. Logbooks completed by 393 hospital staff nurses revealed that participants usually worked longer than scheduled and that approximately 40 percent of the 5,317 work shifts they logged exceeded twelve hours. The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week.”

This is the Research Council’s journal club article for August and very timely. I have been in nursing long enough to recall a time when we all changed to twelve hour shifts. I should say “back” to twelve hour shifts, because twelve hour shifts appeared early on in the history of nursing. I wonder why they changed to eight hour shifts?
In the past few years, I’ve also noticed a trend toward some of the staff working more extra shifts. Some of the staff actually works enough extra shifts to qualify as working a “second job”. I have been amazed at their stamina, because I work part time and find that exhausting. I also know these are the staff that management favors for their flexibility and are therefore building up bonus points when in fact management should be worried about the rate of errors this article alludes to.

EVERYONE IS WELCOME! Please join us at the next Nursing Research Journal Club on Wednesday, August 8, 12:00 pm-1:00 pm, Sr. Frances Dunn Building, Classroom I.

Monday, July 16, 2007

E-Journal Club #8

Lokk, Johan, PhD; Arnetz, Bengt, MD, PhD, “Work Site Change and Psychosocial Well-being among Health Care Personnel in Geriatric Wards – Effects of an Intervention Program”, Journal of Nursing Quality Assurance, July, 2002 Vol16(4) pp.30-38

"The study evaluated the effect of a change of work site and organization on work environment and psychosocial parameters; the change involved health care personnel at a geriatric hospital. Another aim of this study was to evaluate the effects of a structured psycho-educational intervention program. The study found few changes in the indices of interest on the experimental and control wards. There were, however, significant improvements in social climate, goal quality, and independence of work on the control ward. The investigators postulated that too much external support hampers a group's ability to actively cope with change and might actually lower a group's ability and self-esteem. In order to achieve successful organizational change, psychosocial intervention programs for personnel must be performed by a well-informed, well-chosen, and experienced counselor who is well tailored to the local organization."

I was looking for an article that would focus on the apprehension some of the staff in the hospital have regarding the move in October of this year to a new “wing”. Many of our staff members are new graduates, just trying to cope with learning all the details that your first year brings.
I remember the opening of the third critical care unit here at this hospital not too long ago, and the chaos (stress) that ensued until the small details of where everything is was brought under control. And this “wing” is completely new in design and physical orientation. The visitor waiting room is directly across from the nursing station. How will that work out?

Monday, July 02, 2007

E-Journal Club #7

Lindgren, Vicki A. MSN, RN,CCRN “Caring for Patients on Mechanical Ventilation”, American Journal of Nursing, May 2005, Vol 105/5; pp 50-59.

Summary: “This article addresses several integral areas of care, including weaning from mechanical ventilation, preventing ventilator-associated pneumonia, providing nutritional support, managing anxiety, timing tracheostomy, preventing aspiration and promoting sleep.”

Here is another example of why I like the AJN. This article, although it does not present new research, displays the current abundant research on the subject of mechanical ventilation in critical care. At the end of each section, she highlights “Best nursing practice”, and includes the references to important guidelines and their web addresses.

When Victoria Randazzo first began to develop her sedation protocol ideas here at St. Joseph's, she gathered many of the great articles published on this subject, including many listed at the end of this article. They began the foundation of what she wanted to accomplish and why.

As we continue to use research and evidence based practice, we begin to ask questions of our nursing practice. It is comforting to know that much of what we do is based on current research and a multidisciplinary approach to the answer.