2021 Poster Presentations


Rounding and Quick Access Education to Reduce Catheter-Associated Urinary Tract Infections

Identification: P34

Background: Catheter-associated urinary tract infections (CAUTI) increase morbidity, longer lengths of stay, and higher health care costs. Best practices recommend assessing the need for indwelling urinary catheters (IUC), implementing evidence-based maintenance interventions, and removing catheters no longer indicated.

Problem: The Centers for Disease Control and Prevention (2020) reported CAUTI prevalence decreased 7% nationally. Unfortunately, the acute care division of a tertiary medical center experienced a 167% increase in CAUTI from 2018 to 2019, with the trend continuing into 2020.

Methods and interventions: The project was implemented on two inpatient surgical units that accounted for 65% of the acute care division’s CAUTI rates over a 36-month period. An organizational needs assessment was conducted using a fishbone diagram and SWOT analysis to determine areas of focus for interventions. The assessment revealed a lack of knowledge of the nurse-driven protocol (NDP) and variation in CAUTI maintenance practices among units and individual nurses. To understand nurses’ knowledge of CAUTI prevention interventions and use of NDP, a baseline survey was administered to identify educational needs of staff. Survey data affirmed staff understood elements of the maintenance bundle, but only 12% of respondents could explain the NDP process. Survey response data informed the development of a badge buddy with a quick response (QR) code that contained educational resources on CAUTI maintenance bundle practices and NDP outlined in the hospital policy. Using a smartphone, the nurse could access the QR code to obtain just-in-time education. Best practices, established in the literature, were adapted and used to create CAUTI champions. Acting as unit experts and resources, champions were educated on prevention techniques. Unit CAUTI champions rounded on patients weekly, auditing maintenance bundle adherence. Champions also collaborated with assigned nurses to determine if IUC were indicated. If no indication was identified, the nurse either removed the IUC using the NDP or requested a discontinue order from the provider. Educational handouts and monthly CAUTI rates were disseminated to increase adherence to bundle interventions. Bundle audit data was abstracted from a cloud-based system and reviewed monthly for commonly missed interventions, and implementation strategies were adjusted to improve practice. Unit-specific CAUTI rates, maintenance bundle adherence, IUC utilization ratio, NDP utilization, nurse satisfaction with access to educational resources, and knowledge improvement of CAUTI prevention were measured.

Results: The project aim was to reduce CAUTI rates, improve adherence of the catheter maintenance bundle, and enhance knowledge and use of the NDP. CAUTI rate decreased from 1.29 to 0.64, with a risk ratio of 0.3 on the exposed surgical units compared to the unexposed acute care units. The mean maintenance bundle adherence rate was 67% and NDP use increased 2%.

Conclusions: The project was designed to enhance quality care through the standardization of CAUTI prevention practices and staff education. The data reflects a positive effect on reduction in CAUTI rates and increased NDP use.

1. Centers for Disease Control and Prevention. (2020). 2019 National and State Healthcare-Associated Infections Progress Report. https://www.cdc.gov/hai/data/portal/progress- report.html#2018


Bridging the Gap from Student Nurse to Practicing Nurse: Transition into Practice Program (TIPP)

Identification: P35

Purpose: The purpose of our program is to assist nurses in transitioning from the student nurse role to practicing nurse. The leap from student nurse to practicing nurse can be very difficult. The transition from academia to the practice setting can be overwhelming both to a new nurse as well as the preceptor. As novices begin their career, they are faced with learning how to practice nursing, using critical skills, learning policies, and becoming familiar with new technology and procedures. The first year is recognized as period of extreme stress. Many organizations are revisiting the need for residency programs to bridge the gap between school and practice setting. One solution
is a nurse residency program. The pros and cons of residency program need to be evaluated with both short- and long-term results. According to RN Work Project, 17.9% of nurses left within the first year of starting their first job. Organizations are tasked with the evaluation of cost of turnover verses cost of a residency program. Findings from the RN Work Project (a 10-year longitudinal study, completed in 2016), as well as the Louisiana’s 2019 Nursing Workforce Demand Report were reviewed. Historical data for the organization related to retention and turnover were examined. Based on the findings the team embarked on developing a residency program for novice nurses.

Description: A nursing team was formed led by a nurse educator to address the on-boarding of new nurses. A literature review was conducted related to Patricia Benner’s “Novice to Expert Nursing Theory” and the pros and cons of residency programs. The practice transition accreditation program (PTAP) accreditation by the ANCC guideline
for nurse residency programs were reviewed and incorporated into the program. This accreditation sets the global standard for residency programs that transition registered nurses into new practice settings.

This program aligns with the mission and values of our organization. The program was designed as a 12-month foundational program offering support, education, and training to assist in the transition to a competent registered nurse. Completion of knowledge exams and confidence surveys are assigned throughout the program. Surveys are re-assigned at various times during the 12 months to evaluate the efficacy of the program and assist with seminar topics. The program involved classroom, simulation, and computer-based training. Sessions are facilitated by professional development director, clinical educators, or subject matter experts. During the 12-month residency, each nurse resident will complete and present an evidence-based project. Residents are encouraged to support quality indicators and other processes that can be improved when choosing topics for the evidence-based practice projects. Projects are presented during the completion ceremony at the end of the program.

Evaluation and outcomes: In 2020-2021, there are approximately 223 nurse residents enrolled in the program, of which 49 will be set to graduate the program in February and 45 in July 2021. This program has resulted in increased nurse retention and nurse satisfaction.


A Training Program of Patient Care Assistant Interns for Medical-Surgical Units

Identification: P36

Unlicensed assistive personnel (UAP) are individuals who are trained to assist registered nurses in patient care. Titles include patient care assistant, patient care technician, health care assistant, personal care assistant, and nurse aide. The United States Bureau of Labor Statistics (2019) identifies the 1.5 million individuals that provide basic personal care in hospitals and long-term care facilities as nursing assistants.
Approximately 405,000 nursing assistants are employed in general medical and surgical hospitals. Nursing assistants are integral members of the health care team who show workforce sustainability. Their projected job growth is 8% from 2019 to 2029, faster than
all other occupations (BLS, 2019). Nursing assistants, as part of the medical-surgical interprofessional team, are also front-line leaders in direct patient care. Recruiting high-caliber nursing assistants is vital to maintaining a dependable nursing workforce in caring for medical-surgical patients. A 3-week training program was implemented at an academic medical center to provide newly hired patient care assistant (PCA) interns the knowledge, skills, and abilities needed to positively impact nursing quality indicators when caring for acute and chronically ill patients on medical-surgical units. PCAs are usually hired with the requirement that they hold the certified nursing assistant (CNA) credential. The PCA intern program is for those individuals without the CNA credential and are trained to become PCAs on various medical-surgical units. The training course is a system-based curriculum that focuses on the prevention of six nursing quality indicators that PCAs can directly impact in providing optimal patient care, including fall prevention, hospital-acquired pressure injury prevention, and prevention of catheter-associated urinary tract infections and central line-associated bloodstream infections. The 3-week training program consists of classroom, simulation, and clinical education. A written test and skills return demonstration test completes the 3-week training program. The PCA internship is three months in length after the 3-week training program, which includes unit orientations with PCA preceptors. The program was implemented in March 2020 with a pilot group of five PCA interns. 29 PCA interns have completed the training since April 2021. A focus group who completed the initial PCA intern training program was formed to understand their perception of job training and
determine best strategies to promote recruitment of high-caliber PCAs. PCA interns perceive their training as informative with effective learning of rationale for patient cares and they recommend the program. The focus group identified strategies to recruit high- caliber PCAs. These strategies include seeking individuals who are self-motivated, willing to learn, and humble. A bonus of this training is the program satisfies the requirements for a state’s CNA challenge where individuals may take the CNA exam without completing a CNA state-approved course. Currently 26 of the 29 PCAs who have completed the training work in various medical-surgical areas including cardiology, oncology, trauma, and rehabilitation units. Nursing assistants are essential front-line health care providers. Recruiting and retaining a high-caliber UAP staffing force is imperative to positively impacting patient safety and quality patient outcomes on medical-surgical units.

  • Naomi King, DNP, RN, CMSRN, Education Specialist, The University of Kansas Health System

Evaluating the Effectiveness of Virtual Mindfulness-Based Stress Reduction

Identification: P37

Purpose: To evaluate the effectiveness of virtual delivery of mindfulness-based stress reduction on stress, anxiety, burnout, and mindfulness.

Background/significance: Stress and burnout are prevalent in health care, which can negatively impact clinician well-being and the quality of the health care provided. Mindfulness-based stress reduction (MBSR) has been shown to decrease stress and burnout. This waitlist control study evaluates the effectiveness of the virtual delivery of
MBSR content. The objective of this study is to evaluate the effectiveness of a virtually presented, 8-week MBSR program in decreasing perceived stress, anxiety, and burnout while increasing mindfulness. Stress and burnout in clinicians are prevalent, which negatively impacts clinician well-being, interpersonal relationships, team effectiveness, retention, and patient outcomes.1 Clinicians with higher stress and burnout have rated themselves lower in safety related to impaired attention, memory, and cognitive function.2 Researchers have demonstrated that increasing mindfulness and resilience mitigates stress and burnout, limits the negative sequelae, and improves patient outcomes.3,4 The effectiveness of virtual training for MBSR has not been thoroughly studied.

Design/methods: The study employs a pre-/post-, waitlist control group methodology without randomization. Participants were recruited from an 8-hospital health system in the Southeastern United States to participate in an 8-week MBSR course facilitated by instructors trained at the University of Massachusetts Center for Mindfulness in Medicine. The intervention cohort attended training in the fall of 2020, and the control group attended in the winter of 2021. The researched hoped to enroll 25 participants each cohort, for an anticipated sample size of 50. A $25 gift card incentive was available to participants that complete the study. Outcomes measured included mindfulness, stress, anxiety, and burnout pre-, during, and post-training.

Results: The results included measures of the Mindfulness Attention Awareness Scale (MAAS), Maslach Burnout Inventory (MBI), Perceived Stress Scale (PSS), and General Anxiety Disorder-7 (GAD-7). The four listed scales were measured at the beginning of the first MBSR class, and after the final (eighth) class. The PSS was also measured during the class on the fifth week of the 8-week course. Information was collected from both the intervention and control cohorts and compare to determine the effectiveness of the virtual training.

Conclusion/practical implications: The study provides information regarding the efficacy of virtual MBSR courses. This information is of practical importance in this era of the worldwide COVID-19 pandemic for two reasons: 1) health care provider stress is even higher as a result of the pandemic and the critical nature of the disease for hospitalized patients and 2) the need to social distance to prevent the spread of the SARS-CoV2 virus may prohibit in-person classes. The need to care for our caregivers is well-documented and mindfulness-based interventions can serve as practical tools to prevent burnout, excess stress, and possibly post-traumatic stress disorder in clinicians.


The Impact of Mindfulness Training on Stress and Burnout During the First Six Months of Practice

Identification: P38

Purpose: To determine the effect of integrating mindfulness training into an existing nurse residency program on stress, burnout, and mindfulness.

Significance/background: Anxiety, stress, and burnout are endemic in the health care profession. Lyndon (2016) estimated the prevalence of burnout in health care providers at 50-70%. Researchers have demonstrated that increasing mindfulness and resilience could mitigate stress and burnout, limit the adverse sequelae, and improve both the workplace environment and patient outcomes (Perla et al., 2017; van den Riet, Levett-Jones, & Aquino-Russell, 2018). Gilmartin et al. (2018) demonstrated that even brief mindfulness practices were associated with favorable changes in stress, anxiety, and burnout in acute care providers. Moreover, transition to practice can be associated with stress and anxiety for newly licensed nurses (Boehm & Tse, 2013).

Description: This scholarly project assesses the impact of integrating mindfulness training into a large system nurse residency program for newly licensed nurses by offering four 1-hour-long interactive learning activities along with tools, reminders, and a log for self-practice throughout their first six months of practice. Burnout, stress, and
mindfulness were measured via an online survey at the beginning of the February 2020 residency cohort with repeat measures at three and six months. Validated assessment tools used: burnout – Physician Work-Life Study’s Single Item (PWLSSI) (Dolan et al., 2015) and the Oldenburg Burnout Inventory (OBI) (Demerouti, 2008); stress - The Perceived Stress Scale (PSS) (Cohen, Kamarck, & Mermelstein, 1983); and mindfulness - The Mindfulness Attention and Awareness Scale (MAAS) (Brown
& Ryan, 2003). The surveys were completed anonymously online, and there was minimal risk to the participants in this improvement project. The outcome measures were analyzed using an unpaired t-test comparing scores from a non-intervention cohort and the intervention cohort.

Evaluation/outcome: The scores were compared for stress, burnout, and mindfulness scales were compared at pre-program and post-program (6 months). Pre-program, there was no significant difference between cohorts for PSS, WLSSI, or the MAAS. There was a significant difference in the OBI scores. MAAS scores were higher pre-program for the intervention cohort than the non-intervention cohort, and there was a significant difference between the non-intervention and intervention cohorts on all three areas at post-program. Perceived stress was higher for the non-intervention cohort compared to the intervention cohort. Burnout was higher for the non-intervention cohort
compared to the intervention cohort. Finally, mindfulness was lower for the non-intervention cohort compared to the intervention cohort.

Given the COVID-19 pandemic, this was a timely intervention that appears to have help mitigate stress and burnout for this population while increasing their mindfulness. Therefore, mindfulness training will be fully integrated in the nurse residency program for future cohorts and possible added to other curricula. Outcome measures will continue to be tracked and the mindfulness training adjusted based on stress measures and resident feedback.


Introducing New Graduate Nurses into the Float Pool

Identification: P39

Purpose: The aim and purpose of this project was to evaluate the implementation of a pathway to introduce new graduate nurses to float pool nursing. This included plans for orientation, nursing skills, development of a strong foundation, and positive exposure to the floating experience to determine if nurse resident satisfaction with the floating experience can be increased, in comparison to a traditional medical-surgical nurse resident. Potential benefits included nurse retention, established training pathway for nurse residents to begin their career in a variety of units, building a fluid team of competent nurse residents that can provide general care in an acute care setting, opportunities to practice skills and procedures more than once, and development of confidence in nursing practice.

Currently, there is not enough evidence to support or determine the best practice recommendations to establish and introduce graduate nurses (GN) into the float pool. The goal of this implementation was to increase nurse retention rates within the organization, improve GN satisfaction and flexibility with the floating experience, and increase available staffing resources.

Description: Two groups of nurse residents were enrolled in a 16-week guided orientation plan (intervention). Group 1 included three graduate residents and group 2 included two graduate nurses. Both groups completed a guided orientation for a total of 16 weeks. Inclusion criteria included new graduate nurses that were hired into the nurse residency program and were matched with the float pool.

A pathway to introduce five nurse residents into float pool nursing during October 2020 of the nurse residency program was established and hard wired. This pathway included a guided orientation plan with educator and leadership support, development of a strong foundation, proficiency in nursing skills, and positive exposure to the floating experience. Each group had an anchor unit where they oriented for a period of six weeks. Upon completion of the six weeks, they rotated through four different specialty every two weeks. The final two weeks of orientation were with a float pool nurse.

Evaluation/outcome: Questions related to nurse satisfaction and commitment were asked. In comparison to the traditional medical-surgical nurse resident, the float pool nurse resident scored 3.53 while the medical-surgical nurse resident score 3.49 for the initial assessment. For the 6-month assessment, the medical-surgical nurse resident scored 3.13 while the float pool nurse resident scored 3.32. Although both groups decreased, the float pool nurse resident maintained a higher satisfaction over their medical-surgical counterpart. In relation to having opportunities to practice skills and procedures on time (organizing priority), the traditional medical-surgical nurse resident scored a 2.80 while the float pool nurse resident scored 2.88.

Analysis of the initial and 6-month survey is promising for the program and plans to expand for another year are in place. Additional data for the 1-year mark will return around November 2021. At that point, further evaluation and appraisal will be required to assess the overall retention, satisfaction, and comfortability of the float pool nurse resident in the floating environment.


Patient-Family Engagement: A Quality Improvement Project to Reduce Falls

Identification: P40

Objective: Decrease falls (unplanned decent of a patient to the floor that may or may not result in physical injury) related to family and/or visitors assisting patients with toileting needs.
Background and situation: Each year, somewhere between 700,000 to 1,000,000 people in the United States fall in the hospital. Research shows that close to one-third of falls can be prevented (AHRQ, 2020). 55% of falls in a 3-month period on a medical- surgical oncology unit were related to family members attempting to assist with patient toileting without calling for help from trained staff members. The unit was unable to reach the NDNQI benchmark during this quarter with highest monthly fall rate of 3.92 falls per 1000 patient days.

Program description: A PICO question was developed, and information was disseminated to staff via SBAR communication tool. Staff scripting was created as an ice breaker to engage families in the fall prevention strategies including calling for trained staff to get the patient out of bed. Charge nurses were trained to note patients with families for more detailed rounding.
Methods: Retro chart review showed a high level of family involvement in care for this population of cancer diagnosis, palliative care, or end-of-life patients. SBAR and scripting signature sign-off sheets were collected showing education was read by the staff.
Results: In a 6-month period, after the patient engagement with the staff, there was 1 fall, and the fall was not related to the family involvement. After the 1st fall, the subsequent 7 months were with a fall rate of 0.00 per 1000 patient days, successfully meeting the benchmark for the next 2 quarters.

Conclusion: Engaging patients' families in fall in individualized fall prevention strategies can reduce patient falls and increase staff comfort with discussing patients' fall risk and fall prevention plan.


The Impact of a Nursing-Driven, Multimodal Approach to Fall Reduction in Neurosurgical Population

Identification: P41