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26th Annual Greater Pittsburgh NURSING RESEARCH CONFERENCE

Pittsburgh Marriott North100 Cranberry Wood DriveCranberry Township, PA 16066April 24, 2015

TABLE OF CONTENTS

Agenda ............................................................................ 4

Conference Sponsors ..................................................... 5

2015 Planning Committee ........................................... 7

Keynote Address ............................................................ 8

Podium Presentation Abstracts ................................... 9

Poster Displays ............................................................ 21

Notes ............................................................................. 23

PurposeTo provide an opportunity for nurses to learn the mechanics of the research process through interactions with experienced nurse researchers. The conference focuses on research that is relevant to clinical practice, administration, and education.

Objectives • Discuss the relationship of evidence based practice and excellence in care to patients and

families. • Identify strategies to foster a spirit of inquiry among clinicians. • Network with colleagues about nursing research practice. • Use knowledge gained to develop clinical research studies. • Create an environment that fosters participation of beginning nurse researchers. • Promote collaborative efforts for research in the professional nursing community. • Describe the relationship between evidence based practice bundles and patient quality outcomes.

PURPOSE AND OBJECTIVES

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AGENDA7 a.m. | Registration / Continental breakfast

8 a.m. | Welcome and introduction

8:15 a.m. | Keynote address / Question and answer sessionSister Rosemary Donley , Ph.D., APRN, FAANProfessor of Nursing and the Jacques Laval Chair for Justice for Vulnerable PopulationsDuquesne University

9:30 a.m. | Break / Poster viewing

10 a.m. | Breakout Session A Breakout Session B

11 a.m. | Breakout Session C Breakout Session D

Descriptive Research and Evidence-based Practice

• Impact of Tobacco Cessation Resource Education on Knowledge and Resource Utilization - Jillian Lackner, Timothy Cline, Catherine Grant, Mary Jo Cerepani, Valerie Kogut

• Does Skin-to-Skin Care vs. Traditional Infant Care Affect the mother-Baby Couplet Stabilization and Feeding After Birth?- Lynn Kramer

• Therapeutic Non-Pharmacological Interventions and PRN Psychotropic Medication Administration Practices of Mental Health RNs- Donna Leckey

Collaboration and Surgical Care• Does Gender and Time Since

Lung Transplantation Affect Caregiver Stress?- Ji Yeon Choi, Marissa Simon, Jane Haines

• Coordinated Care for the Neurosurgical Spine Patient Decreases Infection Rates- Anita Soltez

• Improving OR Efficiencies by Forming Inter-Professional Relationships- Linda Dudas, Karen Dailey, Jonathan Waters

End of Life and Quality of Life• Are Nurses Assessing Pain in

Pediatric Palliative Care Patients? - Lindsey Metzger

• Quality of Life within the First Year following Lung Resection: A Comparison- Kathleen G. Hopkins

• Phenomenological Study of African American Women and Cultural Influences in End-of-Life Care- Jacqueline M. Ruple

Innovation and Technologies• Sleep and Use of Technology

in Adolescents- Maria Petrisko

• Effect of Simulation Technology with Medication Calculation- P. Maria Flavin

• Intraosseous Device Utilization: An Innovative Practice Change Within the Emergency and Critical Care Departments- Elizabeth Tedesco

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HOSPITALS• Allegheny General Hospital • Children’s Hospital of Pittsburgh

THANK YOU TO OUR CONFERENCE SPONSORS

Noon | Lunch

1 p.m. | Poster Winners Announcement• GPNRC 2013 grant winners – Donna Kaltenbaugh Malchano, Amy Lukanski,

Jennifer Thurheimer, Yun Jiang• Announcement of 2015 scholarship winners

2:15 p.m. | Break

2:30 p.m. | Patient-Centered Care• Patient-Centered Care: Health Literacy and Teach-Back Assessment

- Teresa Faykus, Donna Bazan, Jessica Bell, Melanie Haddox, Heather Hyre, Sarah Kasserman

• Relationship Between Nursing Empowerment and Patient Outcomes- Deborah Stagon

• Partnering with Patients for Improved Outcomes- Brenda Shaffer

3:30 p.m. | Closing remarks / Evaluations

RESEARCH • Magee-Womens Hospital Evidence-Based

Research Council• Veterans Research Foundation of Pittsburgh

• The Western Pennsylvania Hospital• University of Pittsburgh Medical Center

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THANK YOU TO OUR CONFERENCE SPONSORSSCHOOLS OF NURSING

• California University of Pennsylvania Department of Nursing

• Carlow University School of Nursing• Chatham University School of Nursing• Duquesne University School of Nursing• Indiana University of Pennsylvania

Department of Nursing and Allied Health • LaRoche College Division of Nursing

• Penn State University School of Nursing, New Kensington Campus

• Robert Morris University School of Nursing• Slippery Rock University• University of Pittsburgh School of Nursing• Waynesburg University Department of

Nursing• Sigma Theta Tau, International, Inc

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2015 PLANNING COMMITTEE

Kelly Starver, DNP, MS, RN Committee ChairpersonVeterans Research Foundation Of Pittsburgh

Ji Yeon Choi, PhD, RN University of Pittsburgh School of Nursing

Kristy Chunta, PhD, RN, ACNS, BC, CMC Indiana University of Pennsylvania

Susan Simms, PhD, RN, CRRN Allegheny Health Network West Penn Hospital

Susan Cooley, MNEd, PMH, CNS-BC VA Pittsburgh Healthcare System

Donna M. Weyant MSN, RN, CPNUPMC Children’s Hospital of Pittsburgh

Mildred Jones, PhD, RN, CS Carlow University School of Nursing

Janet Knott, DNP, RN,CNE Pennsylvania State University- New-Kensington Suzanne Palko, MSN, RN-C California University of Pennsylvania

Michele Prior, MSN, RNWest Penn Allegheny Health System

Janice Sarasnick, RN, MSN Robert Morris University School of Nursing

Chad Rittle, DNP, MPH, RNChatham University

Jennifer J. Wasco, MSN, BSN, RNChatham University

Linda Stumpf, PhD, RN, NHA La Roche School of Nursing

Melanie Turk, PhD, RN Duquesne University School of Nursing

Kimberly Whiteman, DNP, RN Waynesburg University School of Nursing

Mary Ann Thurkettle PhD, RNSlippery Rock University

Mary Zabielski, PhD, RNC-OB, C-EFM Magee-Womens Hospital of University of Pittsburgh Medical Center

AcknowledgementsKimberly GrahamVA Pittsburgh Healthcare SystemVisual Information Specialist

Norman Zlotorzynski, BSVA Pittsburgh Healthcare SystemHealth Science Specialist

Brianna Iannarelli, BSNRobert Morris University

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Keynote SpeakerSister Rosemary Donley, PhD, APRN, FAANProfessor, Jacques Laval Chair for Social JusticeSchool of NursingDuquesne University School of Nursing

Education:PhD, Higher Ed / Public Health, University of Pittsburgh, 1972MNEd, Medical Nursing, University of Pittsburgh, 1966Diploma, Nursing, Pittsburgh Hospital, 1961Certificate, Primary Care, The Catholic University of America, 1998BSN, Nursing, St. Louis University, 1963

KEYNOTE ADDRESS

Sister Rosemary Donley, a Sister of Charity of Seton Hill, is a Professor of Nursing and the Jacques Laval Chair for Justice for Vulnerable Populations at Duquesne University School of Nursing. Sr. Rosemary Donley received a diploma from the Pittsburgh Hospital School of Nursing and holds a B.S.N. summa cum laude from St. Louis University and a MNEd and a PhD from the University of Pittsburgh. She is a certified adult nurse practitioner with clinical and research interests directed to improving the lives of vulnerable people.

Sr. Rosemary describes her life in nursing as a wonderful adventure. She has served as President of the National League for Nursing and Sigma Theta Tau International Honor Society of Nursing. She is a past Senior Editor of Image: The Journal of Nursing Scholarship. She has over 110 publications and has presented papers throughout the United States, Kenya, Spain, The People’s Republic of China, Puerto Rico, the Philippines, Guam, Japan, Korea, Taiwan, Hong Kong, Brazil, Argentina, Germany, Israel, Canada, Russia, Azerbaijan, Georgia and Armenia. She has also participated in numerous seminars, panel discussions, and workshops in the United States.

She has worked with the U.S. Army and Navy Medical Commands; has served on the peer review panel of Tri-Service Nursing Research group and NIH’s P-CORI study section. She has been a member of the faculty for the Tri-

Service Nursing Research grant camps and the Department of Veterans Affairs’ Special Medical Advisory Group. In 2013, she was appointed to the Board of Directors of the Commission of Graduates of Foreign Nurse Schools (CGFNS).

Her work has been recognized by her colleagues. She is a member of the Institute of Medicine and the American Academy of Nursing. She was named a Robert Wood Johnson Health Policy Fellow. She is the recipient of seven honorary degrees and received the Nell J. Watts Lifetime Achievement in Nursing Award. In 2006, she was named a living legend by the Academy of Nursing, in 2009, she was awarded the Elizabeth Seton Medal from Seton Hill University. Oakland Catholic High School named her a Leading Lady in 2013.

At Duquesne University, she holds the Jacques Laval Chair for Justice for Vulnerable Populations and teaches graduate seminars in health policy and social justice. She also plans national symposium on social justice for vulnerable populations, currently the fifth annual symposium: Social Justice, for Vulnerable Populations: The Face of the mentally ill person. In 2014, she received honorable mention as a leader in advocacy by the Association for Community–Affiliated Health Plans for her work with vulnerable populations and was awarded second place by the Catholic Press Association for an article published in May/June 2013 Health Progress on Catholic Tradition and Veterans’ Care.

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PODIUM PRESENTATION ABSTRACTS

Does Skin to Skin Care versus traditional infant care (swaddling, baby in incubator affect the mother-baby couplet stabilization and feeding after birth?Lynn Kramer, RN, IBCLC – Magee-Womens Hospital of UPMC

Purpose: Many births at Magee-Womens Hospital of UPMC included separation of the mother-baby couplet for routine admission procedures,

resulting in delays in maternal newborn bonding and breastfeeding. The World Health Organization (WHO) recommend mothers and newborns have skin-to-skin contact immediately

Impact of Tobacco Cessation Resource Education on Knowledge and Resource Utilization in Adult Hospital Employees Who Use Tobacco ProductsJillian Lackner, RN, BSN, DNP Student; Timothy Cline, PhD; Catherine Grant, DNP, FNP-BC; Mary Jo Cerepani, DNP, FNP-BC, CEN; Valerie Kogut, MA, RD, LDN – University of Pittsburgh School of Nursing and UPMC Health Plan

Introduction: Research shows that tobacco cessation programs in the workplace are effective, but less is known about how to increase employee enrollment in programs. This quality improvement initiative took place during implementation of a smoke-free shift policy at two campuses of a hospital affiliated with a large healthcare system.

Purpose: To develop and implement tobacco cessation resource educational sessions for hospital employees who use tobacco, and determine impact of sessions on tobacco cessation resource knowledge, interest in tobacco cessation, and tobacco cessation resource utilization.

Intervention: Seventeen 30-minute educational sessions were provided over the course of three months, to 51 total participants. Each session included a pretest regarding tobacco cessation resource knowledge and interest in cessation, then a 20-minute PowerPoint presentation, followed by a posttest. Follow-up surveys were emailed to session participants 30 days after the session they attended to determine if participants enrolled in and/or

utilized health plan tobacco cessation programs.

Evaluation and Outcomes: Based on results of pre- and post-tests, tobacco cessation resource knowledge level increased significantly among session participants (p = 0.000). Of the 51 participants, 38 responded to the follow-up survey. Ten participants (27.0%) reported enrolling in a tobacco cessation program since attending a session. Four participants (10.5%) reported calling a health coach for a single session to assist with tobacco cessation. Only 1.5 percent of other hospital employees, excluding the hospital where the educational sessions took place, enrolled in health plan tobacco cessation programs.

Implications for Practice: Results of this project helped to inform more effective strategies for increasing utilization of health plan behavior change resources, such as brief sessions focused on resource education. Continued quality improvement work is a worthy cause in the realm of tobacco cessation, as tobacco cessation among hospital employees can help to decrease costs for employers, and achieve a healthier work environment.

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PODIUM PRESENTATION ABSTRACTS

Therapeutic Non-pharmacological Interventions and PRN Psychotropic Medication Administration Practices of Mental Health RNsDonna Leckey MS, RN – Carlow University

The purpose of this scholarly project was to determine what non-pharmacological interventions are used by mental health RNs prior to or in lieu of administering PRN psychotropic medication to manage anxiety and agitation in adult psychiatric hospitalized patients. Another aim of this project was to determine what factors influence mental health RNs’ decisions to administer PRN psychotropic medications. The conceptual framework was Peplau’s theory of interpersonal relations in nursing which focuses on the interpersonal process and therapeutic relationship that develops between the nurse and patient. This was a descriptive study utilizing a quantitative design.

Data were obtained from a convenience sample of 20 registered nurses (RNs) employed in an inpatient psychiatric unit on one hospital unit in a mid-Atlantic state. Following IRB approval, RNs were asked to complete two survey-type self-reporting tools. The Nursing Intervention Tracking Form and Nursing Survey developed by the researcher were used to collect the data. Information from the Nursing Intervention Tracking Forms was analyzed using STATA to determine frequency distributions.

Findings from this study revealed that non-pharmacological interventions successfully resolved problems more than 1/3 of the time and may prevent the use of PRN psychotropic

after vaginal birth [1]. With initiation of early skin to skin care, we project a decrease in mother-baby separations and improved outcomes in breastfeeding initiation and newborn stabilization after birth.

Intervention: A computer learning program on skin to skin care with post-test examination was developed and administered to the nurses. The program included the benefits of skin to skin care for mother and baby, instructions on care, teaching instructions for breastfeeding, and safety concerns. Use of skin to skin care and breastfeeding initiation times were additionally recorded by the Newborn Admission Nurse.

Outcomes: 78 nurses completed the post test, the mean score was 95%. The number of patients using skin to skin care with breastfeeding initiation times within the first hour of life increased from 31% in 2013 to 67% in 2014. Surveyed nurses report greater success with breastfeeding initiation, normalization of infant temperature, heart and respiratory rate, and bonding with mother-baby couplets.

Implication: Nurses reported decreased breastfeeding issues, decreased newborn hypothermia, respiratory distress, and enhanced parental bonding. The researched benefits of skin-to-skin for the infant include: stabilization of the baby’s heart rate, regular breathing pattern, improved oxygen saturation levels, increased sleep time, weight gain after birth, decreased crying, successful breastfeeding episodes, and earlier discharge. Skin to skin care may provide an opportunity to translate research to a future era which reports reduced hospital stays and increased parental involvement.

References:Haxton, D.,Gingras,L. , Kelly,L. Implementing Skin-to-Skin Contact at Birth Using the Iowa Model. Nursing for Women’s Health, 2012. 16(3): 220-230.

Ferber, S. The Effects of Skin to Skin (kangaroo care) Shortly after Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized Controlled Trial. Pediatrics, 2004 4(113), 858-865.

Gallingan, M. Proposed Guidelines for Skin-Skin Treatment of Neonatal Hypothermia. Maternal Child Nursing, 2006 5(31), 298-304.

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medications. The non-pharmacological intervention used that had the highest percentage of PRN psychotropic medications not given was distraction. The most common factor influencing RNs’ decisions to administer PRN psychotropic medications was a high level of anxiety persistent after non-pharmacological interventions were used.

The findings from this study create questions as to whether RNs documented every encounter

they used non-pharmacological interventions. The results of this study reinforce the importance of RNs using non-pharmacological interventions to manage patients’ anxiety and agitation and may contribute to the knowledge base associated with identifying factors influencing mental health RNs’ decisions to administer PRN psychotropic medications in hopes that this knowledge may lead to changes in practice.

PODIUM PRESENTATION ABSTRACTS

Does gender and time since lung transplant affect caregiver stress and anxiety? Ji Yeon Choi, PhD, RN, Marissa Simon, SN; Jane Haines, DNP, RN, CMSRN – University of Pittsburgh School of Nursing

Introduction/Rationale: The literature has documented relationships between caregiver health and patient health. Prior studies have reported that female caregivers are more stressed and anxious. The study purpose was to assess the level of stress and anxiety by gender and over time in post-lung transplant caregivers.

Methods: The study was a single group longitudinal design. 83 caregivers (59 females, 24 males) of lung transplant recipients recruited from a large university teaching hospital in Southwestern PA completed the Perceived Stress Scale (PSS) and the State Trait Anxiety Scale at three points during and after hospitalization of their significant other. Eligibility criteria included; 1) primary caregiver for a lung transplant recipient, 2) 30-80 years of age, and 3) able to read, write, and speak English.

Results: All subjects had scores for the three tools that were above the normed group scores for their age group. . There was a significant correlation between perceived stress level and time since transplant. The longer the caregiver was involved post-transplant care, the higher the self-reported stress levels (P=0.005). State anxiety and Trait anxiety did not show significant correlation.

Conclusions: Findings show that all subjects had stress and anxiety scores above the normed means at all three data collection points, indicating that this sample is more anxious and stressed than the general population. This study revealed that both sexes are equally stressed and anxious., Results showed that increased length of stay correlated with increased levels of stress, There is a need for frequent assessment and support of caregivers by the health care team.

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Group Scores

Sex Number Mean Standard Deviation Sig. 2 tailedBaseline PSS Male 20 18.60 7.29383 .436

Female 56 20.23 8.224114 week PSS Male 14 15.86 8.36529 .615

Female 46 17.00 7.096168 week PSS Male 12 14.58 9.39495 .522

Female 42 16.31 7.81958Baseline State Anxiety

Male 21 44.33 11.63758 .503Female 56 42.18 12.80072

4 week State Anxiety

Male 14 38.64 10.39680 .765Female 45 37.49 13.09341

8 week State Anxiety

Male 12 40.83 14.65254 .855Female 42 40.00 13.60954

Baseline Trait Anxiety

Male 21 40.33 10.57513 .542Female 55 38.73 10.10034

4 week Trait Anxiety

Male 12 37.92 10.11262 .686Female 43 38.49 10.93350

8 week Trait Anxiety

Male 13 38.15 12.39520 .636Female 42 36.40 11.34828

PODIUM PRESENTATION ABSTRACTS

Results

Sex Number Mean Standard Deviation Sig. 2 tailedBaseline PSS Male 20 20.05 9.023 .829

Female 50 19.60 7.3714 week PSS Male 14 15.71 8.042 .617

Female 46 16.85 7.1838 week PSS Male 12 15.25 9.910 .640

Female 44 16.52 7.843Baseline SAS Male 20 44.70 12.097 .223

Female 50 40.56 12.9464 week SAS Male 14 38.79 10.371 .766

Female 45 37.64 13.0048 week SAS Male 12 39.58 15.353 .841

Female 44 40.50 13.528Baseline TAS Male 20 40.50 11.223 .272

Female 50 37.42 10.2124 week TAS Male 12 37.58 10.247 .763

Female 43 36.51 10.9498 week TAS Male 12 38.08 12.852 .676

Female 44 36.48 11.421

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Improving OR Efficencies by Forming Inter-professional Team RelationsLinda Dudas, RNC, MSN, CNL; Karen Dailey, RNC, MSN; Jonathan Waters, MD – Magee-Womens Hospital of UPMC

Purpose of Project: A multidisciplinary approach was taken to create an environment where the surgical obstetric patient can receive cohesive inter-professional care in a large, university hospital birth center. The literature shows that improvement in communication is a means for improving patient safety. Individuals are connected most closely within their own professional groups; however, intergroup communication for the purposes of solving work-related problems potentially contributes to quality patient care.

Description of Intervention: A proposal was developed using an inter-professional team of obstetric, anesthesia, and surgical specialists to care for the obstetric surgical patient.

A change in culture was needed for this group to work as a collaborative team to improve patient safety and satisfaction as well as OR efficiencies.

Implementation Quality initiatives included: 1. A core OR/Pre-Post/PACU nursing team

PODIUM PRESENTATION ABSTRACTSCoordinated Care for the Neurosurgical Spine Patient Decreases Infection RatesTherese Dawson, MSN, RN, CNRN; Anita Soltez, MSN, RN; Melanie Smith, MSN, RN, CNRN

– UPMC Presbyterian University Hospital

The incidence of Surgical Site Infections (SSIs) has been attributed to poor mortality outcomes and increased cost. The Center for Disease Control and Prevention estimates SSI rates to be 2.7%, with spine surgery as high as 15%. Reducing SSI for the spine patient requires quality processes. Through implementation of a care coordination algorithm supporting best practices to prevent neurosurgical post-operative spine infection, an overall 22% reduction in SSI for neurosurgical spine patients in one year was realized.

A spike in the incidence of SSI within the neurosurgical spine patient population (8.1%) was noted as an area for improvement. A multidisciplinary workgroup was formed to evaluate all phases of the patient surgical experience. The focus of the workgroup was on coordinating care to prevent infection in the neurosurgical spine surgery patient population.

Several areas of opportunity were quickly identified and a timeline created to address key interventions for standardization along

the continuum of the patient experience. These included pre-op protocols for bathing with chlorhexidine for five days before surgery, and nasal swab screening for staph aureus. A positive culture resulted in nasal mupiricin orders to subdue the presence of staph aureus. In the operative phase there was a decreased utilization of immediate use sterilization and standardization of the type of back dressing used. Finally, in the post-operative phase, the timing and type of dressing was standardized, as well as education to patient and families regarding care of their incision and skin.

In a value-based purchasing environment, where quality and cost must consider the patient experience and outcome, the reduction of surgical site infection is imperative. Nurses have an essential role to facilitate evidence based interventions that promote a quality comprehensive patient experience from pre-surgery through discharge to home.

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PODIUM PRESENTATION ABSTRACTS2. Daily “Huddle” of all team stakeholders is

held at 6:45am to discuss the day’s scheduled cases, and potential cases.

Evaluation and Outcomes: Since the initiation of the quality initiatives there has been a significant decrease in the amount of service recovery reported by patient relations. Room turnover time has been decreased from 45 minutes to 14 minutes. Obstetrical Surgical Services on-time rate for first case of the day has increased from 8% to 80% and the on-time rate for all cases has increased from 28% to 64%.

Implications for nursing practice: The implementation of this project continues to guide the inter-professional team to focus as a collaborative group on patient safety, patient satisfaction, and OR efficiencies. The reward of improved OR on-time statistics and increased patient satisfaction has encouraged the team to continue to strive for improvement.

Are nurses assessing pain in pediatric palliative care patients? Lindsay Metzger, SN – University of Pittsburgh School of Nursing

Background: Pain is one of the most prevalent experiences in pediatric hospitalizations, especially for patients in palliative care. Palliative care is indicated for patients experiencing life-limiting or life-threatening conditions to provide pain and symptom relief, and improve quality of life. Pain as the “fifth vital sign” is imperative to diagnose medical conditions, determine plans of care, and prescribe medication regimens. Standards of care exist, although pain is inadequately assessed. The Symptoms Management Model guided this research.

Objective: To examine the frequency of documented nursing pain assessments in pediatric palliative care patients.

Methods: A sample of 50 patients was selected from a five year retrospective chart review, comprised of patients 2 to 16 years treated by palliative care services from a large children’s hospital in western Pennsylvania. Patients were selected based on highest overall mean pain scores and a

minimum of 100 pain assessments. Moderate (4-6) and severe (7-10) pain scores were examined for pain reassessment within one and two hours. Simple percentages were calculated.

Results: There was a significant difference for the age of diagnosis between the sample and the parent sample p <.001 and the age at referral to palliative care p=.001; no differences were found between gender, race or length of palliative care service. The sample was 52% female, 84% Caucasian, and mean time on palliative care service was 1.8 years. The mean pain score was 3.1 and the range of mean pain scores was 1.1-7.1. Reassessment of pain was documented within one hour for 41.5% of patients and within two hours for 62.9% of patients with moderate and severe pain scores.

Conclusions: Nursing pain reassessment documentation in pediatric palliative care patients is suboptimal. Attempts have been made to establish pain management standards, but implementation has not been successful.

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Phenomenological study of African American women and cultural influences in end-of-life care planning decisionsJacqueline M. Ruple, DHA, CRNP

The purpose of this qualitative phenomenological study was to explore whether cultural influence effects end-of-life care planning among African American women. The conclusion that resulted from this study proposed that understanding the lived experiences of cultural influence on African American women’s end-of-life care planning could lead to understanding among family members, friends, and medical professionals

of the necessity for education development, specifically concerning the effect of cultural influence on end-of-life care plan communication.

Throughout this qualitative phenomenological study, a modified van Kaam method of analysis by Moustakas (1994) implemented along with the use of NVivo software, researchers explored the lived experiences of six African American

PODIUM PRESENTATION ABSTRACTSQuality of life within the first year following lung resection: a comparison of thoracotomy and video-assisted thoracic surgery Kathleen G. Hopkins, PhD, RN – Carlow University

Introduction: In 2014, it was estimated that newly diagnosed cases of lung and bronchus cancer would exceed 220,000 and over 150,000 deaths. Although, in early stage lung cancer thoracotomy/lobectomy often remains the treatment of choice and there are about 82,000 pneumonectomies or lobectomies performed each year.

Purpose: The purpose of the study was to investigate the post-operative quality of life (QoL) following video-assisted thoracic surgery (VATS) and conventional thoracotomy.

Methods: Using the Theory of Unpleasant symptoms Model, this study recruited ninety-seven consecutive patients whom agreed to participate in the study. Forty-four patients had thoracotomies and 53 patients had thoracoscopic resections. All patients were clinically staged ( I – IIIA) and consented between August 2010 and December 2012. Participants were given 2 self-report standardized instruments [and the 0 to 10 Numeric Pain Assessment Scale (NAS). The instrument Hospital Anxiety and Depression Scale (HADS) and Functional Assessment of

Cancer Therapy-Lung (FACT-L) have been shown to be historically reliable and valid measures. This study was approved by the Institutional Review Board.

Results: There were no statistically significant demographic, pain (p = 0.429), HADS (p=.953) or quality of life differences (FACT-L p=.779) between the thoracoscopic or thoracotomy groups. VATS and thoracotomy patients had a mean pain level of 1.6 and 2.0 out of a 10 point pain scale, respectively. For the FACT-L questionnaire, VATS patients scored a mean of 106.4 ± 20.9 compared to 102.9 ± 23.3 for thoracotomy (p = 0.580).

Conclusion: While VATS offers an advantage in regards to perioperative outcomes, VATS and thoracotomy patients will have the same quality of life outcomes.

Implications for Nursing Practice: Regardless of the type of surgery, all patients should be screened for pain, anxiety, depression and quality of life.

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Sleep and Use of Technology in AdolescentsMaria Petrisko, BS; Ann E. Johannson, BSN; Christine A. Feeley, PhD, RN; and Eileen R. Chasens, PhD, RN

Purpose/Theoretical Framework: Acquiring the recommended 9 hours of sleep is challenging for adolescents. The homeostatic sleep model suggests that changes in circadian rhythm cause a sleep phase delay with difficulty initiating sleep in this age group. The purpose of this study is to describe sleep patterns and the association of technology with nighttime sleep and daytime function in adolescents.

Methods: The design was a secondary analysis of data from the 2011 Sleep and Technology Poll. The nationwide survey included questions on demographics, sleep duration (weekday/weekend), subjective sleepiness (Epworth Sleepiness Scale [ESS]), insomnia symptoms, technology use, mood, school performance, and frequency of driving while drowsy.

Results: The sample (N=204; 13-19 years) was balanced by gender (53% male), primarily Caucasian (62.7%), and had short sleep duration on weeknights (mean = 7.3 hours ± 1.3). Approximately 40% responded “home/ school duties” did not allow adequate weeknight sleep (“adequate sleep”

group = 7.9 hours ± 1.3; “inadequate sleep” group = 7.5 hours ± 1.1, p=.029). Adolescents with “inadequate sleep” had increased subjective sleepiness, increased insomnia symptoms (p-values <.05), and used significantly more technology devices (p=.031). In the hour before sleep, adolescents with “inadequate sleep” texted, played video games, used the internet, and did homework on the computer more frequently (p<.05). Male adolescents played significantly more video games; females texted significantly more often (p-values <.01). Over a third of the adolescents with “inadequate sleep” reported major impact on their mood and school work. Among adolescent drivers (n=101), those with “inadequate sleep” reported more frequently driving while drowsy (p<.05).

Conclusion/Implications: Many adolescents receive insufficient sleep on weeknights. Those with more frequent use of technology before bedtime often experienced inadequate sleep and impaired daytime function. Implications for nursing practice include the need to evaluate adolescents’ sleep habits and to encourage restriction of technology during the hour prior to bedtime.

PODIUM PRESENTATION ABSTRACTSwomen living in the greater Pittsburgh, Pennsylvania area. The analytical synthesis of textural data revealed seven themes: (a) meaning of end-of-life planning to the participant; (b) lack of discussion concerning end-of-life care planning with medical professionals, (c) discussion with family members on end-of-life care planning, (d) lack of understanding of the meaning of end-of-life care planning, (e) shortcomings in relation to religious/spiritual practices which may impede end-of-life care

planning, (f) difficulty and discomfort in regards to discussions about end-of-life planning, and (g) lack of end-of-life discussions with friends. This research study recommends that studying end-of-life care planning could potentially spark an increased commitment to communicating greater knowledge and understanding of end-of-life care planning to other cultures while also helping medical professionals to understand cultural influences in regards to communication with patients, family members and friends.

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PODIUM PRESENTATION ABSTRACTSThe Effect of Simulation Technology Among Undergraduate Nursing Students Performing Medication Calculation SkillsP. Maria Flavin, DNP, MSN, RN – Carlow University

Medication errors play a role in substantial morbidity, mortality, and costs to the healthcare system. Despite the increased attention to medication errors during the past decade, the incidence of medication errors has remained unchanged. The use of clinical simulation in nursing education can gain momentum from the collective experience of nurse educators who are testing this pedagogy across a broad range. Simulation technology is a way to improve undergraduate nursing student’s knowledge of medication drug calculation without harming live patients.

This evidence-based project focused on simulation technology learning in medication calculation skills. Eleven third year level undergraduate baccalaureate nursing students participated in weekly workshops for 7 weeks with medication calculations via simulation

technology learning. Prior to and after the simulation technology learning for medication calculation skills, students were asked to complete a medication calculation quiz and a pre and post assessment self- reported workshop evaluation tool. A t-test was performed to compare pre and post mediation quiz scores, indicating all the students improved on their medication calculation quiz scores.

The outcomes indicated that the nursing students improve their medication calculation quiz scores by 37%. The pre and post assessment self-reported workshop evaluation tool was compared utilizing a Wilcoxon signed-rank test. This evidence-based practice project demonstrated that utilization of simulation technology learning with medication calculation skills was extremely successful as a teaching innovation for nursing students.

Intraosseous Device Utilization: an Innovative Practice Change within the Emergency and Critical Care DepartmentsElizabeth Tedesco, MSN, RN, CEN, PHRN; Kimberly Whiteman, PhD

Purpose: Intraosseous (IO) access is a valuable technique that increases the quality of healthcare in the emergency department (ED). The purpose of this project was to implement and evaluate current evidence-based best practices for the use of the EZ-IO® vascular device by emergency department nurses.

Description of Intervention: An interprofessional team was formed to evaluate the current literature on IO device use and make recommendations for practice, which included IO insertion by the nurse during emergency resuscitation. Comprehensive education about insertion and maintenance

of IO access was provided to the ED nurses. ED physicians were included in the planned change. The continuity and safety of care was ensured by providing education to the critical care nurses within the cardiac catheterization lab, ICUs, and post anesthesia care areas on the device maintenance and removal.

Evaluation/Outcomes: Outcomes assessed included successful insertions, ease of use by the practitioner, insertion time, appropriate use of the IO device, practitioner knowledge and comfort level with the IO device, and adverse events. Over a six month post implementation period, 8 insertions were performed by Emergency Department RN’s,

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Patient-Centered Care: Health Literacy and Teach-Back AssessmentTeresa Faykus, DNP, RN, CNE – Associate Professor of Nursing, West Liberty University; Donna Bazan, RN – Performance Improvement Coordinator, East Ohio Regional Hospital; BSN Student Participants: Jessica Bell, Melanie Haddox, Heather Hyre, Sarah Kasserman

Purpose: To assess the health-literacy of self-managed heart failure (HF) patients, compare the level of patient-literacy to the project hospital’s current heart failure education packet, and re-assess patients’ understanding of self-management education post-discharge.

Background: Health literacy assessment, teach-back, and post-discharge communication are best practice strategies for 30-day readmission prevention.

Intervention: Student nurses completed a REALM-SF health-literacy assessment, a teach-back education session, and a post-discharge phone call for patients that were admitted to the hospital with a primary or secondary diagnosis of heart failure and were admitted from a home setting. The goal was to enroll 30 patients or as many as were available within a three month period. For comparison of health literacy, a random 50 patients were assessed with the REALM-SF form as well.

Evaluation: Descriptive data includes aggregated health-literacy levels, congruency of health literacy

and current heart failure written information, commonly misunderstood topics during teach-back session and during post-discharge phone calls, and readmission rates of the enrolled patients.

Outcomes: Twenty-four patients were enrolled within a three month period. Of the enrolled participants, 95% scored 7-8 grade or high school level of reading which was consistent with the current heart failure education packet. The least understood concepts with teach-back sessions remained the least understood with post-discharge phone calls. Only 1 of 24 enrolled participants were readmitted with primary heart failure.

Implications: This data will guide future development of written patient information.

Commonly misunderstood self-care information will guide improvements in teaching and teach-back foci. For this hospital, self-managed heart failure patients do not seem to be the problem for 30-day readmissions. Future projects should focus on those heart failure patients being readmitted within 30 days from skilled nursing facilities.

PODIUM PRESENTATION ABSTRACTSwith an overall success rate of 75%. The 2 missed insertions were by user error and not feeling comfortable with the device. Of all patients

identified with the use of the device left the emergency department to an inpatient acute

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PODIUM PRESENTATION ABSTRACTSRelationship Between Nursing Empowerment and Patient OutcomesDeborah Stagon, MSN, RN

Research questions: 1. What relationship exists between

perceived nursing empowerment within an organization and nursing satisfaction?

2. What relationship exists between nursing satisfaction and retention within the organization?

3. What relationship exists between nursing satisfaction and retention and patient outcomes?

Theoretical framework: Kanter’s theory of structural empowerment contends structural factors such as, information, support, resources, and opportunity have a strong influence on attitudes and behaviors of employees within an organization.

Methods: A correlational quantitative secondary analysis of existing data. Data included 2012 National Database of Nursing Quality Indicators (NDNQI) from six trauma units. Patient satisfaction data from Hospital Consumer Assessment of Healthcare Providers and Systems and Press Ganey was used. Falls and hospital acquired illness data were obtained for the same time period as the NDNQI survey. Data was analyzed utilizing Pearson correlation.

Findings: Correlations were found between the variables nursing autonomy and nursing satisfaction of

nurse manager (.511), nursing autonomy and nursing satisfaction of CNO (.916), nursing decision making and nursing satisfaction of nurse manager (.729), and nurse decision making and nursing satisfaction of CNO (.972). A (.670) correlation was demonstrated between the variables nursing decision making and RN intent to remain in unit. Correlations were demonstrated between the variable hospital acquired illness and the variables nursing autonomy (.466) and nursing decision making (.491). Correlations were demonstrated between the variable patient pain control and the variables nursing autonomy (-.486) and nursing decision making (-.321), between the variable nursing attention to needs and the variables nursing autonomy (-.370) and nursing decision making (-.244), and between the variables nursing autonomy and courtesy of nursing (-.446).

Implications for nursing practice: The results build foundation for open dialogue between the patient units regarding best practice within the units to promote nursing empowerment and patient satisfaction and outcomes.

Reference: Kanter, R. M. (1977). Men and women of the corporation (1993 ed.). New York, NY: Basic Books.

Partnering with Patients for Improved Outcomes Brenda Shaffer, DNP, RN, NE-BC, FNP-BC – VA Pittsburgh Healthcare System

Purpose: The growing epidemic of chronic disease is bankrupting the US domestic economy. The cost of managing chronic disease is greater than $1.5 trillion annually. A fraction of the US budget is spent on prevention and health promotion, despite the evidence that prevention

has been proven to reduce chronic disease burden. By focusing on patient-centered care, this collaborative process allows patients and their healthcare teams to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.

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PODIUM PRESENTATION ABSTRACTSDescription: The focus of Primary Care is to enhance the patient experience by applying principles of disease prevention and behavioral change appropriate to diverse populations. By involving patients in medical decision making and self-management, transformational integration will result forming a highly functional team that concentrates on patients’ goals and needs. Based on this plan, strategies were developed that were focused on patient-centered care. For example, because patients wanted to spend more time with their provider, prevention calls were initiated by the licensed practical nurses (LPN) and health care technicians (HCT) to complete a majority of clinical reminders that are required to be completed at each visit. Additionally, using interventions related to Motivational Interviewing and TEACH have allowed staff to effectively work with the patients to determine the focus of the patients’ health goals. This allows for the patient to be the driver of his care with the support of his primary care team.

Evaluation and outcomes: Since the initiation, patients have been able to spend their visit with their provider. This telephone work has decreased the time seen by the LPN or HCT to 5-10 minutes as opposed to 20 minutes with the LPN or HCT. Additionally, no show rates have decreased as the patients are reminded of their visits through the calls. When the patients are unable to attend the scheduled appointment, opened slot are created for improved access. Also the use of telephone access has increased allowing for more efficient use of time by staff.

Implications for Nursing Practice: By recognizing the importance of listening to the opinions of patients such as with the prevention calls, focus on patient choice is demonstrated. Additionally, use of telephone care streamlines screening of the patients by the staff allowing for more time spent with providers and the opportunity for patient education regarding their healthcare concerns.

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POSTER DISPLAYS

Decreasing Central Line Associated Bloodstream Infections (CLABSI) in the Medical Intensive Care UnitCarla Baxter RN, BSN – UPMC Presbyterian

Detection Of Early Warning Signs of Physiological Decline: The Utility Of A Simulation Based Training To Improve Patient Outcomes In Mental HealthCulley M. Charlie, MSN, Clinical Nurse Educator

CAUTION: Catheter-Associated Urinary Tract InfectionsBelinda Clark, RN; Nancy Clinton, RN; Trinh M. Pham, RN

Care Coordination through Interventional ProceduresTherese Dawson, MSN, RN, CNRN; Kate Spiering, MSN, RN, CNRN; Melanie Smith, MSN, RN, CCRN – UPMC Presbyterian

EBP: Implementation of American Heart Association Guidelines for Blood Pressure Measurements in Obese Hospitalized PatientsCynthia Dayen, AD, RN-BC

Parish Nurse’s Role in Diabetes ManagementJessica Devido, RN, MSN, CPNP; Dorothy Mayernik, RN, MSN, FAAN; Willa Doswell, RN, PhD, FAAN; Betty Braxter, PhD; Jan Dorman, PhD, MS; Martha Terry, BA, MA, PhD; Denise Charron-Prochownik, PhD, RN, CPNP

Behavior Based Pain Assessments in Intubated and Sedated PatientsJulia Dixon-Ernst RN, BSN, CCRN – UPMC Presbyterian

The Impact of a Therapeutic Nurse-Patient Relationship with the Use of Effective Communication to Reduce the Incidence of Falls in Patients Age 65 and OlderRaegan Dobbins, SN; Kathleen Riley, SN; Jordan Huffman, SN; Alyssa Ignat, SN

Acute Event RecognitionMichelle Elske, MSN, RN-BC; Grinetta Elston, MSN, RN; Dawn A. Muse MSN, RN-BC – VA Pittsburgh Healthcare System

Undergraduate Nursing Student Research InterestsRebecca Findle, SN; Julius Kitutu, PhD, MSc, MEd; Maura McCall, MSN, RN – University of Pittsburgh

Reducing Blood Culture Contamination Rates in an Emergency Department at a Tertiary HospitalNancy M. Jankowski, BSN, RN

A Health Application for Self-Monitoring and Decision Support after Lung TransplantationYun Jiang, PhD(c), MS, RN

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POSTER DISPLAYSImproving Efficiency of WorkflowWilliam Kegg, BSN, RN – Chatham University

Evidence-Based Practice Project to Implement and Evaluate the Impact of the Designated Education Unit Model for Senior Nursing Students’ Intensive Care Clinical ExperienceLinda Koharchik, DNP, RN; Madelyn Gibson Antonich, MPM, RN; Yvonne Weideman, DNP, RN; Karen Jacob, PhD, RN – Duquesne UnivesityDenise Petras, DNP, RN; Catherine Witsberger, MSN, RN – UPMC Presbyterian Hospital Kimberly Brooks, MSN, RN – Magee-Womens Hospital of UPMC

Eating Habits in People With Serious Mental IllnessesMaddie Lepore, SN; Heeyoung Lee PhD PMHNP-BC – University of Pittsburgh

Parental Preparedness for NICU Infant Post-Discharge Care: Implementation of an Educational Program Developed from the Iowa Model of Evidence Based Practice Susan Moore, RN- BSN (c) – Carlow University

Implementing Hand Hygiene Resources in Wellspring Drop-in CenterSarah Patrick, SN; Janeen Rohall, SN – Carlow University

A work-sampling assessment of the nursing delivery of palliative care in ambulatory cancer centersJennifer Pavone, RN, BSN, DNP – Candidate, University of Pittsburgh; Yael Schenker, MD, MAS – UPMC Division of General Internal Medicine; Heidi Donovan, RN, PhD – University of Pittsburgh; Margaret Rosenzweig, PhD, CRNP-C, AOCN, FAAN

Use of an Education Module to Improve Outcomes Associated with Insertion of an Intrauterine Pressure Catheter (IUPC)Vivian Petticord, MSN, RNC, CNL; David Streitman, MD; Edward Sandy, MD, MBA; Hyagriv Simhan, MD; Dennis English, MD, MMM; Lisa Manetta MHA, BSN, RN, NE-BC, CPHQ

Subcutaneous Infusion: An Effective Method of Pain Control Brenda Shaffer, DNP, RN, NE-BC, FNP-BC – VA Pittsburgh Healthcare System

Knowledge, Self-efficacy, Beliefs and Practices in Engaging in Physical Activity Counseling in Undergraduate Nursing StudentsLucille Ann Sowko, MSN, PhD, MEd

Patient and Family Satisfaction Following Emergency Obstetric CrisisKaren Stein, RN, BSN, MSED – Magee-Womens Hospital of UPMC

A Collaborative Practice Culture of Competence in the Care of the Pre-Operative Surgical PatientShannon Wishart, MSN, RN; Jaime Martin, MSN, CRNP; Elaine Wolford, MSN, RN; Kimberly Confer, MSN, RN, CAPA

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NOTES

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