A B S T R A C TConceptual Framework: The Academic Center for Evidence-based Practice (ACE) Star Model was used to implement an evidence-based clinical practice guideline (CPG) in order to decrease ventilator-associated pneumonia (VAP) incidence rates and ventilator days. The goal was to interrupt person-to-person transmission of bacteria and bacterial colonization using low-cost, evidence-based strategies to prevent VAP.Discovery: Two geographically proximate medical centers, inclusive of five intensive care units located in the southwestern region of the United States had significant variations in their VAP rates.Evidence summary: Using the U.S. Preventive Services Task Force grading criteria, the results of 69 studies were used to establish a clinical practice guideline to prevent ventilator-associated pneumonia.Translation: A clinical practice guideline was developed for the prevention of VAP and included five nursing activities: (a) head-of-bed elevation; (b) oral care; (c) ventilator tubing condensate removal; (d) hand hygiene; and (e) glove use. The effect of the CPG, inclusive of an educational intervention, was measured using an observational, prospective, quasi-experimental design.Integration: A multidisciplinary education team developed a self-learning packet, educational materials, and storyboards for the staff as dissemination strategies. Strategies also included e-mail, one-on-one teaching with clinicians, and feedback on guideline adoption and VAP rate reports.Evaluation: Observation data were collected to evaluate adoption of the CPG while caring for 106 ventilated patients. VAP rates changed at both hospitals although the change was not statistically significant. Additionally, the ICU length of stay declined at both facilities, causing cost savings.Discussion: These results support the idea that adoption of evidence-based practices contributes to decreased VAP rates. For a successful program, ICU leaders should emphasize strategies that routinize adoption of evidence-based CPGs.
Healthcare organizations struggle with the best way to integrate new staff members, including novice and experienced nurses returning to practice, into the organization. One way of accomplishing this integration is mentoring. Mentoring is a process of guiding the development of another person. The methods used to mentor staff members can be influenced by the generation to which they belong. Each generation typically experiences different events that shape their expectations and responses. Consideration of the influence of these events can improve the effectiveness of the mentoring process.
Army Nurse Practitioners (NPs) provide immediate and lifesaving care during combat operations. The most recent conflicts of Operation Iraqi Freedom and Operation Enduring Freedom have seen an increasing number of NP deployments. The uniqueness of these conflicts has also seen NPs being used in nontraditional roles. This study surveyed 50 Army NPs with deployment experience to explore and elucidate their clinical practices in a combat environment. Over 70% reported seeing greater than 11 patients a day with the top three diagnoses of musculoskeletal/soft tissue (noncombat), spinal pain (mechanical, sciatica), and gastrointestinal complaints. Over 74% reported having a physician available for collaboration, but 50% reported providing independent emergency care and 58% treating life-threatening injuries. The NPs in this study report standard credentialing privileges with most care falling within this realm. However, a few report nontraditional roles such as hospital admitting privileges. This study adds to the growing body of knowledge on NP practice in a combat environment, which shows increased decision making and advanced clinical skills. NPs are battlefield multipliers who bring additional skills and abilities to the combat environment.
With the economic and market changes currently taking place, organizations cannot survive or prosper without quality employees. Key to employee loyalty, performance, and retention is the relationship between the leader, manager, and employee. Leaders are visionaries who make sure that the right things are done for the organization. Managers are in a position to make sure that things are done right within the organization. There are traits and qualities that good leaders and managers must possess to ensure organizational success. Displaying these characteristics will ensure that employees are taken care of, which will benefit both the employees and the organization.
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