Clinical Nurse Specialist

NACNS Newsletter: President’s Message No abstract available

Professional Citizenship No abstract available

Publication: Creating a Culture Where Ethical Practices Are the Norm No abstract available

Pharmaceutical Advertising: The Cost for Fantasy Over Reality Evidence for the Prescribing Clinical Nurse Specialist No abstract available

Prophylactic Antibiotic Therapy for Chronic Obstructive Pulmonary Disease No abstract available

Nurse Researchers Move to the Cloud: Protecting Sensitive Data in Cloud-Based Storage Environments No abstract available

CLINICAL NURSE SPECIALIST PRACTICE INTERVENTIONS FOR SECOND VICTIMS OF ADVERSE PATIENT EVENTS Background: Second-victim impact describes emotional suffering that occurs secondary to an adverse patient event and occurs in approximately half of all healthcare providers. Immediate intervention is needed to reduce consequences including nursing turnover, job absenteeism, repeat adverse events, professional burnout, and posttraumatic stress. Purpose: To provide clinical nurse specialists a summary of second-victim impact secondary to adverse patient events, a review of associated negative outcomes, and clinical nurse specialist practice recommendations. Recommendations: Clinical nurse specialist nursing interventions include implementation of validated screening tools, identification of healthcare providers at high risk of second-victim impact, recognition of signs of second-victim impact, facilitating supportive clinical debriefings, providing supporting dialogue, and mentorship through stages of recovery and the institutional response. Clinical nurse specialist organization/system interventions to reduce the consequences of second-victim impact include supporting a culture of safety, leading organizational improvement, as well as advocating for education and support for second victims on the national level. Conclusions: Clinical nurse specialists have the potential to mitigate the effects of second-victim impact associated with adverse patient events and secondary complications through use of evidence-based practice interventions.

Clinical Nurse Specialist–Facilitated Collaborative Skin Assessments for Respiratory Care Devices Purpose/Aim: To evaluate a collaborative skin assessment intervention between respiratory therapists and registered nurses. Design: A quality improvement design was used to determine feasibility of a collaborative skin assessment. Methods: The collaborative skin assessment intervention included skin assessments, documentation of findings, and use of a treatment guideline for patients using a respiratory care device. Perceptions of the collaborative intervention and pressure injury numbers were measured after a 2-month intervention period. Results: Respiratory therapists and registered nurses reported satisfaction with the collaborative intervention; stating it was best practice and could prevent respiratory care device–related pressure injuries. However, timing the skin assessment together was difficult. One device-related pressure injury occurred during the intervention period. Conclusions: Respiratory therapists and nurses should partner to perform skin assessments under respiratory devices each shift and develop a plan of care to prevent skin injury. Protocol orders to prevent and treat skin alterations found under respiratory care devices and a dedicated area in the medical record to document skin assessments may be helpful to support efforts to prevent injuries. Additionally, as a result of these efforts, pressure injuries specific to endotracheal tubes declined greater than 50% in 2 critical care units in the year following this quality improvement project.

Clinical Nurse Specialist–Led Implementation of an Early Discharge Protocol After Cardiac Surgery Purpose/Aims Current practice in Korean medical institutions executes prolonged average length of stay post–cardiac surgery, imposing higher risks of mortality and morbidity, along with administrative issues resulting in long waiting lists for future cardiac surgery. The purpose of this article is to develop and evaluate an early discharge protocol after cardiac surgery led by clinical nurse specialist in a Korean medical institution. Description of the Project/Program The project of implementing early discharge protocol seeks to provide an efficient delivery system for patients who are undergoing cardiac surgery. To evaluate the efficacy of this project, a group of cohorts administered with early discharge protocol was compared against the control group for their length of hospital stay, adverse complications, and clinical outcomes such as postoperative mortality and morbidity. Outcomes The early discharge protocol group had a decreased hospital length of stay by 30% (P < .05) compared with the control group under the conventional discharge protocol while maintaining patient safety and minimizing exposure of patients to further risks of mortality and morbidity. Conclusion Clinical nurse specialist–led early discharge protocol in patients who received cardiac surgery decreases length of stay, thus minimizing exposure of patients to further risks of mortality and morbidity.

Fecal Occult Blood Tests: Valuable for Screening, Wasteful for Diagnostics Purpose/Objectives The purpose of this program was to deimplement the use of fecal occult blood tests (FOBTs) for hospitalized patients. Description of the Project/Program We used a multipronged multidisciplinary approach to deimplement the use of FOBT, including physician-nurse collaborations, data-based poster displays, and a review of test utilization and patient cost throughout all facilities. Outcome Despite a downward trend in FOBT orders for hospitalized patients over 3 years, the inappropriate use of FOBT remains a cause of unnecessary delays of diagnostic workups and patient care and excess costs ranging from US $22 000 to $41 000 annually for each hospital. Conclusion Clinical nurse specialists can question the empirical origin and patient outcomes associated with clinical practice and are positioned to assess and champion deimplementation processes.