Purpose: During multidisciplinary team rounding, the cardiovascular (CV) nurse coordinator noted opportunities in the nursing care provided to post-operative CV surgery patients. Inconsistencies with the standard of care were also observed. Additional observations included prolonged length of stay (LOS) secondary to post-operative ileus development while admitted to the unit. An education needs assessment of acute care nursing staff showed a lack of familiarity and perceived confidence in caring for adult post-operative CV surgery patients. The purpose of this evidence-based project was to improve the perceived confidence of acute care nurses when providing care to this population.
Description: Using the Iowa model, a team of key stakeholders including nurse educators, charge nurses, nurse manager/director, CV nurse coordinators, and quality improvement director was formed. The team identified the enhanced recovery after surgery (ERAS) cardiac protocol as an evidence-based framework to guide the care of the cardiac surgery patient. The CV nurse coordinator used ERAS cardiac protocol guidelines for pre-operative patient education, goal-directed fluid therapy, chest tube patency, nutrition, perioperative glycemic control, and early mobilization to create a one-hour evidence-based professional development activity for the nursing staff (Engelman et al., 2019; Gregory et al., 2020). Participants received nursing continuing professional development (NCPD) credit for participating in the entirety of the course.
Evaluation/outcome: Pre- and post-survey questions asked nurses to rate their perceived confidence with six key elements of post-operative nursing cardiac care on a five-point Likert scale. A two-tailed distribution and two-sample unequal variance (heteroscedastic) t-test were used to determine statistical significance between pre-intervention survey (n=43) and post-intervention survey (n=50) data. The significance level was set at (p < 0.05). Scores showed an average improvement of 0.1-0.6 points in perceived confidence for each nursing care element on the survey (p=0.008). Future plans include incorporation of class in new employee orientation and as needed for staff’s continuing professional development plan. The long-term goal is to evaluate the impact of nurses’ perceived confidence on patient experience and length of stay.
Evidence-based references
1. Engelman, D. T., ben Ali, W., Williams, J. B., Perrault, L. P., Reddy, V. S., Arora, R. C., Roselli, E. E., Khoynezhad, A., Gerdisch, M., Levy, J. H., Lobdell, K., Fletcher, N., Kirsch, M., Nelson, G., Engelman, R. M., Gregory, A. J., & Boyle, E. M. (2019). Guidelines for perioperative care in cardiac surgery. JAMA Surgery, 154(8). https://doi.org/10.1001/jamasurg.2019.1153
2. Gregory, A. J., Grant, M. C., Manning, M. W., Cheung, A. T., Ender, J., Sander, M., Zarbock, A., Stoppe, C., Meineri, M., Grocott, H. P., Ghadimi, K., Gutsche, J. T., Patel, P. A., Denault, A., Shaw, A., Fletcher, N., & Levy, J. H. (2020). Enhanced recovery after cardiac surgery (ERAS cardiac) recommendations: An important first step—But there is much work to be done. Journal of Cardiothoracic and Vascular Anesthesia, 34(1), 39–47. https://doi.org/10.1053/j.jvca.2019.09.002