We conducted a quality improvement project in order to evaluate the effect of nurse-to-nurse bedside "rounding" as a strategy to decrease hospital-acquired pressure ulcers (HAPU) in a surgical intensive care unit. We instituted weekly peer-to-peer bedside skin rounds in a 17-bed surgical intensive care unit. Two nurses were identified as skin champions and trained by the hospital's certified WOC nurse to conduct skin rounds. The skin champion nurses conducted weekly peer-to-peer rounds that included discussions about key elements of our patients' skin status including current Braden Scale for Pressure Sore Risk score, and implementation of specific interventions related to subscale risk assessment. If a pressure ulcer was present, the current action plan was reevaluated for effectiveness. Quarterly HAPU prevalence studies were conducted from January 2008 to December 2010. Nineteen patients experienced a HAPU: 17 were located on the coccyx and 2 on the heel. Ten ulcers were classified as stage II, 3 PU were stage IV, 5 were deemed unstageable, and 1 was classified as a deep tissue injury. The frequency of preventive interventions rose during our quality improvement project. Specifically, the use of prevention surfaces increased 92%, repositioning increased 30%, nutrition interventions increased 77%, and moisture management increased 100%. Prior to focused nursing rounds, the highest HAPU prevalence rate was 27%. After implementing focused nursing rounds, HAPU rates trended down and were 0% for 3 consecutive quarters.
Nurse residents are at greater risk of compassion fatigue compared to more experienced nurses. The amended 2015 Commission on Collegiate Nursing Education Standards of Entry-To-Practice Accreditation of Nurse Residency Programs require that residency programs include approaches to prevent compassion fatigue in their education experiences. This manuscript reports 6-month follow-up results of a longitudinal study in new graduate nurses that evaluated the influence of a four-hour resiliency intervention for compassion fatigue in two hospitals with nurse residency programs within an academic medical center system. We previously reported a statistically significant decrease in mean STS from baseline to 2-months (p < .001). Using a paired t-test, compassion satisfaction (CS) and the two elements of compassion fatigue (CF), secondary traumatic stress (STS) and burnout (BO), were measured against 6-month post-intervention. Prevalence and changes in mean scores were reported, suggesting that the results found at 2-month follow-up (n = 94) were sustained at 6-month follow-up (n = 34). The mean STS showed a statistically significant decrease from 2-months and 6-months (p < .001). A decrease in BO and mean increase in CS were not statistically significant, but were trending in a positive direction. As theorized, both STS and BO decreased from baseline to 2-months and 6-months after the-intervention, and CS increased. These results indicate that early compassion fatigue resiliency education may be helpful in increasing CS and lowering the symptoms of CF in nurse residents.
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