Nurse educators believe that their graduates are well-prepared for entry level positions in nursing. In the acute healthcare setting, new graduates are placed on virtually every type of nursing unit, including critical care. Employers have developed formal orientations to familiarize new graduate nurses new with the institution and its policies and procedures and to teach the things employers believe new RNs need to know but do not, either because they were never taught the material or they have not retained it. The purposes of this project were to (a) examine the evidence relative to a disconnect between nursing education and nursing practice, (b) design a formal residency program for new graduates based on the evidence, and (c) implement and evaluate the residency program. Based on the evidence, a 16-week new nurse residency was developed in which Residents were each assigned both a Preceptor and Mentor to assist their progress. Weekly educational offerings were targeted at specific competency deficits identified by Residents, Preceptors and Mentors at the beginning of the residency program. Seven out of the original 10 Residents completed the Residency. Pre-residency, the Residents were very confident of their clinical skills and abilities and this was unchanged post-residency. The Preceptors and Mentors were much less confident of the clinical skills and abilities of the Residents pre-residency. Post-residency, the confidence level of the Preceptors and Mentors was improved, but significantly so only for the Mentors. It is imperative that nursing administrators be aware of the discrepancy between the confidence new nurses have in their own skills and the perceptions of the nurses who work side by side with them on a daily basis. Residencies for new graduate nurses are costly. Nursing administrators must make the determination if the benefits outweigh the costs. They may find the results of not having a residency are far more costly.

Standards of practice for hospital electrocardiogram monitoring were recommended in 2004 by the American Heart Association; however they are not widely followed. Many nurses monitor in a single lead regardless of diagnosis and are unable to differentiate wide QRS complex tachycardias. The purpose of this project was to evaluate the effectiveness of an interactive web-based education program combined with unit-based collaborative learning activities on both telemetry staff nurses‘ knowledge of dysrhythmias and their monitoring practices for patients at risk for wide QRS complex tachycardias. This interventional, one group before-and-after cohort study design consisted of four components: interactive web-based educational program with a pretest and posttest, unit-based collaborative activities, competency skills validation, and patient audits of electrode placement and lead selection at baseline, six weeks, and 18 weeks. There were 34 nurses who consented to participate, 16 started the program, and nine finished all the components. The pretest scores ranged from 0 – 60% with median of 36.5%. The posttest scores ranged from 47 – 93% with median of 80%. The Wilcoxon Signed Ranks test showed a significant difference between the pretest and posttest scores (p = .008). The patient audit results did not indicate significant differences in proportions of correct electrode placement and correct lead selection between baseline, 6 weeks, and 18 weeks. The program was effective in increasing nurses‘ knowledge about dysrhythmias; however, it was not effective in changing monitoring behavior. More research is needed to see if this type of program is more effective if it involves all the staff on the unit who are responsible for monitoring, and if additional strategies are used, such as unit champions and group rewards.

Recent studies show that more than one-third of U.S. adults (over 72 million people) were obese in 2005–2006. This includes 33.3% of men and 35.3% of women. Obesity is a primary factor in the development of metabolic syndrome, a condition that places individuals at high absolute risk of mortality and morbidity. The use of a nutritionally balanced diet aimed at weight reduction has the potential to decrease the prevalence of obesity, therefore reducing the incidence of metabolic syndrome and its consequences. The purpose of this project was to investigate whether individual nutrition counseling would improve the outcomes of patients with metabolic syndrome. A transdisciplinary team of faculty and graduate students from nutrition and nursing served as consultants and educators at a clinic for the uninsured in a southeastern city in the United States. This study was a one-group before-and-after design, with baseline data obtained on patients prior to the practice change. The study ran for six months. The intervention was an evidence-based practice change incorporating intensive dietary program for 19 patients with metabolic syndrome and an evaluation of the effect of that change on lipoproteins, glucose, blood pressure, weight, and waist circumference. Although there were no positive changes in weight or waist circumference, the participants did enjoy a significant decrease in blood pressure, fasting glucose and plasma lipids. None of these changes were significantly associated with the dietary intervention. Based on the most current evidence, the most effective way to reduce risks associated with metabolic syndrome is weight reduction, adequate nutrition, and exercise.

Proper handwashing is one of the simplest, most affordable and effective means of stopping the spread of infection. Due to the close proximity of children in schools and child care settings, there is a high risk for the spread of infectious disease. The purpose of this project was to improve handwashing behaviors of three to six year old children in a community school setting by implementing an evidence based multi-activity handwashing education program. The objective was to increase understanding of the relationship between germs and handwashing, as well as increase the frequency and correct technique procedure of handwashing behavior in children in the community. The evidence based handwashing education program was implemented over several weeks and included multiple activities that were found in the literature to be effective. These activities included a lecture and presentation, a return demonstration, a Glo Germ™ training device, and a video and story on handwashing. The results of the statistical analysis found that the program was effective in increasing both the frequency and correct technique procedure of the children. Most parents (80%) reported that they noticed an increase in how often their child washes his/her hands. A majority of parents (83%) noticed an increase in the duration of how long their child washes his/her hands; a larger majority (90%) noticed a decrease in how often they needed to prompt their child to wash his/her hands. Nurses working collaboratively with other disciplines in the community can implement evidence based practice handwashing education programs in a variety of public child care settings. The effects of the handwashing programs may significantly decrease child healthcare costs associated with prescriptions, visits to the provider, hospital admissions and emergency room visits and influence positive health promotion behaviors in children. Implementing affordable and effective handwashing education programs can lead to a reduction in infectious diseases, absenteeism, antibiotic resistance and health care costs. By fostering positive health promotion practices, such as proper handwashing behaviors in children, habits may be instilled that carry into adulthood. These habits can increase the health of a child and the community.

Proper collection of blood cultures is needed to identify pathogens causing serious infections and direct appropriate antibiotic therapy. Blood culture contamination can lead to longer hospital stays, incorrect antibiotic treatment, additional testing, and overall increased costs for the patient and hospital. Blood culture collection technique is the most important factor affecting contamination rates. The purpose of this project was to determine the effect of simulation reinforcement of blood culture collection processes on the rate of contamination of blood cultures drawn by nurses in a community medical center emergency department. This one-group before-and-after cohort study utilized a convenience sample of 50 nurses who collect blood cultures on adult clients. Each participant completed a pretest, attended a simulation in-service class, and completed a posttest immediately after the simulation and again one-month later. There was significant knowledge gained from pretest to immediate posttest, with no significant decrease in knowledge at I-month post-intervention. The 3-month blood culture contamination rate was 3.26% prior to the intervention, 4% during the intervention period, 3.7% after the intervention, and 2% in months 4 aI1d 5 postintervention. The use of simulation in the professional development of practicing nurses has the potential to improve clinical practice performance and patient outcomes.

Metabolic syndrome is a serious health problem in the United States. The presence of metabolic syndrome significantly increases the risk of developing type II diabetes and cardiovascular disease by producing a prothrombic state. The prothrombic state that results from the clustering of several independent cardiovascular risk factors within one individual increases the risk of micro and macro vascular changes and eventually to end organ damage. There is considerable evidence to support the serious nature of this medical condition. Medications used to treat the hypertension, diabetic, and dyslipidemia components of metabolic syndrome can be a significant drain on the monthly budget of individuals and families, especially if they do not have health insurance. Diet and exercise programs have been shown to be effective in reducing adiposity and decreasing insulin resistance. These changes in lifestyle may be adjuncts or a low cost alternative to expensive medications for some individuals. The purpose of this project was to identify the effect of an intensive dietary and exercise program on patients with metabolic syndrome. This study even with a small sample size (n = 5) showed that waist size, systolic blood pressure, diastolic blood pressure, and high density lipoprotein levels were trending towards levels that would remove the patient from the diagnosis of metabolic syndrome. The greatest benefit for the general population would result from intervention prior to a diagnosis of hypertension and diabetes and with medication naïve individuals. Early intervention would decrease the cost of medical treatment and hospitalizations.

The growing presence of electronic anesthesia record keeping and perioperative informatics systems is contributing to a database of valuable information that can significantly improve patient care and patient outcomes. Efforts such as the National Surgical Quality Improvement Project and the Surgical Care Improvement Project have analyzed quality measures that directly correlate to patient outcomes. Several of these quality indicators are influenced by the performance of anesthesia providers’ activities in the perioperative period. These programs promote timely administration of preoperative antibiotics. One of their guidelines states that preoperative antibiotic should be given within an hour prior to surgical incision. Surgical site infections are the most common postoperative complication. Reducing postoperative complications can reduce health care costs, and postoperative morbidity and mortality rates. The purpose of this project was to utilize an electronic feedback mechanism to improve anesthesia providers’ documentation of timely preoperative antibiotic administration. Electronic feedback reminders in the form of screensaver dashboards displaying updated departmental timely antibiotic percentage metrics for the day, the past week, and the past month were displayed for 16 weeks. Text messages were delivered once a week for 6 weeks showing an anesthesia providers’ prior average one week on time antibiotic along with an equivalent department on time average. The measures were effective in improving the documentation of timely antibiotic administration.

Background: Emerging evidence suggests that interactive CE activities will have the most effect in terms of knowledge and practice. Using technology to provide interactivity via computer-based applications is as effective an educational strategy as traditional education formats. Methods: A randomized controlled trial was conducted to test the effectiveness and satisfaction of educational activities provided within an online community of practice(CoP) on nurse practitioner (NP) knowledge and practice behavior. The online interactive website combined certified continuing education, professional forum, Ask-the-Experts, national guideline links, patient education tools, and professional resources. A Two-Group Control Group design was used. Study participants were assessed on knowledge and practice behavior prior to and after the six month study. Results: A sample of 66 NPs was randomly assigned to an online education only control group (n=33) or a CoP group (n=33). NPs in both groups had similar pretest knowledge assessment scores: 46% (control) vs. 49% (CoP), and pretest clinical vignette scores: 51%(control) vs. 57% (CoP). After the intervention, there was no significant increase in the posttest scores of the CoP group at 6 months compared with the posttest scores of the control group (knowledge assessment: 67% vs. 60%, p =.17; clinical vignettes: 67% vs. 74%, p =.28). Conclusions: The pilot test did not demonstrate that the intervention (CoP access) had a more positive effect on knowledge or clinical performance than access to online CE activities alone. It did however confirm the effectiveness of online education in improving knowledge.

Diabetes is a condition that is primarily self-managed and lifestyle modifications such as diet, exercise, and weight management are necessary to reduce morbidity and mortality. Motivation to implement lifestyle modifications through self management is an integral part of disease management and studies have shown group medical visits are more effective than individual appointments in this patient population. The purpose of this project was to develop, implement and evaluate an evidencebased group medical visit program for up to a maximum of 8 adult patients with type 2 diabetes in a family practice setting for six months. Seven participants with abnormal A1C results accepted the invitation to attend group medical visits. Here surrounded by peers with the same diagnosis, they were able to learn and discuss methods to self manage their type 2 diabetes. At the conclusion post survey results indicate positive change in some lifestyle behaviors and improvement with hemoglobin A1C. However there was no improvement in weight management. A cost analysis reveals group medical visits may generate a small profit when compared to individual visits. Group medical visits may offer an effective means to motivate patients to make lifestyle change to reduce risk.

Current procedures for cleaning anesthesia airway equipment have been reported to be ineffective. The potential for cross-contamination from some airway equipment to a patient has been documented in several studies. In order to prevent potential infections, it should be ascertained as to why all anesthesia providers are not using disposable laryngoscope blades. The purpose of this evidence based project is to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade before and after an in-service program designed to increase the use of disposable blades will be determined. Once Institutional Review Board (IRB) approval and written consent were obtained, anesthesia providers were asked to complete an anonymous one page questionnaire on their knowledge and practice regarding disposable laryngoscope blades. Immediately following the completion of the questionnaire, participants were given an investigator developed article to read. Participants completed the same anonymous questionnaire 3 months following the pre-intervention questionnaire. Inventory of the disposable laryngoscope blades were collected at the start of the project, at one month, and then again at three months. A total of 12 anesthesia providers participated in the evidence based practice project. An increased number of providers stated that they felt disposable laryngoscope blades were easy to use at the completion of the project and there was an increased use of disposable laryngoscope blades. At post-intervention, anesthesia providers described performance (25%) as their reason for not using the disposable laryngoscope blade which was down from the start of the project (60%). A single proportion Z-Test showed that the 23% increase in use of disposable laryngoscope blades after the intervention was statistically significant (Z=2.046, p=0.041). This evidence based project has shown that despite initial apprehension, a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades which should translate to improved patient outcomes.