2008 National Teaching Institute Creative Solutions Abstracts

Bratcher L, Madrid P; AACN Chapter Advisory Team

Purpose: AACN Chapters face many challenges from member recruiment and hurricane recovery to missing officers. Through a case study approach, this poster presentation will remind chapter leaders that the Chapter Advisory Team, more specifically their Regional CAT, is there to help on many levels. Description: What is a CAT and when should you call? One chapter has a treasurer that has gone missing with the financial books and account information. Who are you going to call for help? The CAT! A chapter president is suspected of inappropriate use of chapter funds. Who is the board going to call? The CAT! A chapter is having very poor attendance at their monthly meetings. Who are you going to call for help with a needs assessment? The CAT! Some chapters struggle through the hard times while others fold under and disappear from National’s radar. The Chapter Advisory Team wants chapter leaders to know that they are here to help the chapter successfully get back on its feet. How do they do that? They are available to help in many different ways from advice to site visits, interpretation of rules and regulations, mediation, help with strategizing and just good old fashion cheerleading. The CATs do this by helping the chapters focus on and infuse AACN mission, vision, values, and key initiatives. A chapter is promoting AACN initiatives through a certification dinner. Who are you going to call? The CAT! CATs like to celebrate, too! Evaluation and Outcomes: The chapters leaders will learn what a CAT is and when they should call. Chapter leaders will learn that the CAT is available to help them in any situation, good or bad. bratcl@shands.ufl.edu

Ward J, Scruth-Chavez E, Yokum C, Rossie J, O’Leary-Kelley C; South Bay Chapter, CA

Purpose: Awareness of and education about healthy work environments (HWE) for bedside nurses, educators, and nurse managers within the San Jose, California area is a South Bay Chapter goal. Chapters are truly neutral territory not belonging to any particular hospital, clinic or work setting. Description: The South Bay Leadership Team reflects our membership, which is composed of critical care nurses, acute care nurses, nurse managers and nurse educators from community and county hospitals, HMO organizations, government and teaching hospitals and clinics of the South Bay. We all share a commitment to creating and maintaining an HWE for nurses. We planted the seed in November 2006 with a CEU class highlighting awareness and offering solutions to the moral distress-surrounding end of life situations. In the summer of 2007, we secured grant money from the Chaplaincy of El Camino Hospital in Mountain View, CA. With these funds and through collaboration with the chaplain and the nurse manager of the CCU we watered the seed we had planted. We were able to offer another class of HWE and have funds left over to honor nursing leadership. Our seed had grown into a small sapling. The CEU class in November 2007, “Creative Tools to Revitalize Nurses and Promote Healthy Work Environments” was completely funded through the grant money. The class included 2 speakers from AACN’s HWE speaker Web site. Every participant received a copy of AACN’s “Standards for Establishing and Sustaining HWE.” Evaluation and Outcomes: Thirty nurses attended the first class in 2006; in 2007 there were 37. Fifteen nurse leaders came for food and networking and gave us positive feedback about our Leadership Night. Class participants ranked both classes very high in content, speakers, and usefulness in their jobs. We as a Chapter are excited. We look to the future for new possibilities and opportunities for collaboration and promotion of healthy work environment. jqrward@sbcglobal.net

Lucas G, Leas L; Heart of Illinois Chapter-AACN; Peoria, IL

Purpose: Attendance and participation in the Heart of Illinois Chapter-AACN programs in 2000 had decreased to 5 members at chapter programs and attendance at the annual spring conference had only 30 participants. Description: Because of declining interest in chapter programs, a concentrated effort to produce quality education programs using noted speakers, both nurses and physicians, was implemented. After surveying the educators and/or managers of critical care and acute care areas of Peoria’s regional hospitals, the chapter addressed trauma, surgical, medical, and neuroscience critical care as the main areas of interest and need for education. Acute trauma and critical care became and is now the focus of the annual spring conference. Two Saturday Critical Care Brunches were developed to attract those that could not attend programs during the weekdays. The Fall Brunch focuses on Surgical & Medical Critical Care and the January Brunch focuses on Neuroscience Acute and Critical Care. Between each of these yearly programs, dinner education programs with speakers are offered to members when the opportunity arises. In 2006, an additional conference with a nationally recognized speaker was initiated. Speakers, from different healthcare backgrounds and locations, allowed for programs that highlighted both established and new technologies, techniques, and viewpoints to validate and enhance nursing practice. Evaluation and Outcomes: The chapter’s program rosters show the annual spring conference now has 250 to 290 participants each year and the Critical Care Brunches now have 85 to 135 participants. Evaluations are very positive, with suggestions that are noted and implemented. Registrations confirm that in addition to the desired increased regional attendance, an unexpected positive outcome is the increase in participants from outside the Peoria region. galucas@att.net

Asleson A; Rum River Chapter; MN

Purpose: As a new chapter, the Rum River Chapter was looking for an efficient means of spreading the news about our annual educational event. Use of the internet allowed us to not only spread the word about our chapter and our educational events, but also to collect fees and keep track of enrollees. Description: The first step was selecting an internet provider outside the AACN chapter site. This allowed for more control of the functionality of our site and fewer limitations on space. Selection of a web hosting site was through trial and error; 3 sites were attempted before finding the one we currently have (which also provides us with our own domain name). Use of paypal allowed our chapter to accept not only checks but also credit card payments for our annual educational event (our third annual event is scheduled for this upcoming April). Registrations were accepted through our Web site as well as via snail mail. For those registering online payment was made via Paypal at the time of registration; with a Paypal payment registrants were able to pay via credit card. Evaluation and Outcomes: This method has been used for 2 events, and for both events the ratio was about 50/50 between online and mail registrations. One of the most positive feedbacks we received about the event was the ability to register online and pay by credit card. Drawbacks include the difficulty linking the Paypal payment to the registration form and the fee paid to Paypal for each transaction (although we consider the fee well worth it for the convenience). Amy.Asleson@Allina.com

Artuso C, Timmerman R, Keith J; Providence Alaska Medical Center; AK

Purpose: The location and size of Alaska provides challenges in meeting educational needs among nurses. The purpose of this project was to maximize resources through collaboration, offering certification review courses to nurses and promoting success on both PCCN and CCRN certification examinations. Description: In June 2006, Providence Health System Alaska received a HRSA grant, designed to provide resources for evidence-based practice and onsite preparation, testing and recertification for nurses. In May, 2007, the South Central Alaska Chapter of AACN was rechartered and identified goals including the provision of educational programs, certification review courses, and joint nursing research. Providence Health Care systems sponsored one successful PCCN review in the spring of 2007. The individuals who developed this review were the founders of the South Central Alaska Chapter. An opportunity to share resources and achieve objectives was recognized. The chapter would provide an excellent forum for advertising, reaching members in remote locations, and expert faculty. The organization could subsidize advertising, hospital contacts and mailing lists, conference space and refreshments. A decision was made to offer both PCCN and CCRN reviews, funded by the grant, in the fall of 2007. The chapter planned their annual fall conference to coincide with the CCRN review, allowing participants to maximize their investment and earn up to 30 contact hours. The conference topics focused on evidence-based practice, and featured national faculty. Evaluation and Outcomes: PCCN and CCRN reviews are scheduled for October 2007. Registrations include nurses from all regions in Alaska. Both programs have validated success in completion of the certification examinations, and also provide opportunities for ongoing continuing education, maximizing the investment for nurses who must travel distances to attend any program. Written evaluations of both programs will be used to evaluate outcomes, in addition to exam success. christie.artuso@providence.org

Hirsch R, Vitez I, DeStefano L; Greater Long Beach-Orange County Chapter, CA

Purpose: Nursing practice based on evidence improves patient outcomes. Chapter members reported significant barriers that prevent them from incorporating research findings into their practice. The Greater Long Beach-Orange County Chapter developed a unique journal club format to reduce these barriers. Description: In 2002, the Chapter initiated a monthly journal club to engage acute and critical care nurses from local hospitals in discussion of research findings. The monthly topics were selected based on clinical relevance, educational assessment, and articles suggested by members. The monthly Journal Club meetings take place at the same time and place in a local restaurant with vendor-sponsored dinners. Methods to decrease the inherent barriers related to critiquing academic research included a chapter led critique and review of research finding themes. This method decreased anxiety related to lack of skills to critique or synthesize the literature and difficulties interpreting the findings by many nurses. Chapter facilitated discussion of complex research by placing less emphasis on interpretation of statistics and research methodologies and focused on adaptation of findings into clinical practice. The confidential, nonthreatening, supportive environment promoted open, frank discussion and diminished intimidation. The use of research in everyday practice is promoted by simplification of complex research topics and promotes replacing practice based on tradition with practice based on evidence and results in positive patient outcomes. Evaluation and Outcomes: Over a 5-year period, the monthly journal club attendance increased from 4 members in 2002 to 50 members currently and continues to grow. Several members travel more than 50 miles to attend. A community subgroup was established to review sedation protocols prompted by a journal club topic. The Board of Directors received numerous member anecdotal accounts of the influence meetings have played in their professional lives. hirsch_rosemarie@sac.edu

Crawford I, Campbell K; Chelsea Community Hospital, MI

Purpose: Nothing seems more fundamental than to provide safe care in our ICU. Four years ago we joined a statewide initiative, partnering with Johns Hopkins to improve the safety in our unit. Our goal was to develop a plan to ensure the provision of safe care in our ICCU. Description: All of our staff viewed the “Josie King” video to foster staff engagement. The Josie King story tells of the death of a young girl following a tragic series of medical errors and miscommunications. Through specific bundling of tasks, we amended care following a defined blueprint for evidence-based practice. We educated the staff by posters, articles, and Power Point presentation. In order to have a culture of safety we have to be able to work in an environment that fosters open communication that addresses system, not human failure. We conducted annual safety attitude questionnaires (SAQ), solicited safety concerns from staff and patients and implemented improvements, based on team input. A team was developed to review evidence-based practice and CDC guidelines in order to tailor a bundle for insertion of central lines and prevention of ventilator-associated pneumonia that was appropriate for our ICCU. Improving communication is one of the most difficult challenges in safety and quality. Therefore, a team developed a “Daily Goal and Rounds” sheet to facilitate communication, helping the team focus on our patient’s needs, and improve efficiency and effectiveness of staff. Evaluation and Outcomes: Achieving and sustaining a culture of safety in our ICCU is measured by our annual response rate and feedback to the SAQ. In addition, our ICCU established a method for tracking central line infections and instituted a hospital initiative to decrease line infections house wide. By promoting a culture of safety, we improved our processes that ultimately raised the safety of our practice. Ultimately, we ranked #1 in Patient Safety in our state. icrawford@cch.org

Mossburg S, Wavelet J, Hughes B; Inova Mount Vernon Hospital, VA

Purpose: The intent of the Nursing Residency Program (NRP) at Inova Mount Vernon Hospital (IMVH) is to transition new graduate nurses into the work environment through increasing their knowledge, skills and perception of competence. The NRP incorporates tenets of the AACN’s Healthy Work Environments. Description: The previous orientation program at IMVH was not adequately preparing new graduates to work in a critical care environment. To remedy the situation, a Nursing Residency Program was created, which implemented the following: 1. Increased orientation time. 2. Clinical experiences in related hospital areas. 3. Weekly classes to integrate knowledge from ECCO into practice. 4. Teaching practices using active learning principles. The Residency is a 3-phase program lasting for 1 year. The first phase focuses on introduction to the hospital, nursing, and basic skills. Curriculum during phase I includes review of systems, review of clinical skills, professional development, and regulatory preparation. The second phase is the Critical Care Fellowship, with the incorporation of regular meetings with the Master Preceptor to review content from ECCO and ask questions. The third phase is ongoing support and education, which focuses on practice after orientation is completed. Evaluation and Outcomes: Three primary outcomes are being evaluated. 1. Knowledge: ECCO module tests and the Basic Knowledge Assessment Test (BKAT). 2. Skills: validated performance of skills (Core Curriculum for Critical Care Nursing, 2006). 3. Perceived competence: Casey-Fink Graduate Nurse Experience Survey©. All new graduates have met testing and competency requirements. In December, data will be collected to evaluate perception of competence.