FONE survey on nursing research resources.
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Florida↗
Biomedical subjects
Jacqueline F Byers
Publications and source records attributed to Jacqueline F Byers.
Data-driven graduate curriculum redesign: a case study.
This article discusses the use of Knowles' adult learning theory as the framework for a curriculum redesign within the leadership and management track of a master's of science in nursing program. Health care executives within the university service area were surveyed regarding their organizational needs for advanced practice nurses. A second survey was mailed to a sampling of all RNs in the university service area. In response to perceived community needs, the curriculum of the leadership and management track was redesigned to allow for role specialization within the program. In addition, the university has an infrastructure to support distance learning and an experienced staff able to support distributive learning, providing wide geographical access to students in distant locations.
Adult↗
A multisite survey of suctioning techniques and airway management practices.
BACKGROUND: Ventilator-associated pneumonia, common in critically ill patients, is associated with microaspiration of oropharyngeal secretions and may be related to suctioning and airway management practices. OBJECTIVES: To describe institutional policies and procedures related to closed-system suctioning and airway management of intubated patients, and to compare practices of registered nurses and respiratory therapists. METHODS: A descriptive, comparative, multisite study of facilities that use closed-system suctioning devices on most intubated adults was conducted. Nurses and respiratory therapists who worked at the sites completed surveys related to their practices. RESULTS: A total of 1665 nurses and respiratory therapists at 27 sites throughout the United States responded. The typical respondent had at least 6 years' experience with patients receiving mechanical ventilation (61%) and a baccalaureate degree or higher (54%). Most sites had policies for management of endotracheal tube cuffs (93%), hyperoxygenation (89%) and use of gloves (70%) with closed-system suctioning, and instillation of isotonic sodium chloride solution for thick secretions (74%). Only 48% of policies addressed oral care and 37% addressed oral suctioning. Nurses did more oral suctioning and oral care than respiratory therapists did, and respiratory therapists instilled sodium chloride solution more and rinsed the suctioning device more often than nurses did. CONCLUSIONS: Policies vary widely and do not always reflect current research. Consistent performance of practices such as wearing gloves for airway management and maintaining endotracheal cuff pressures must be evaluated. Collaborative, research-based policies and procedures must be developed and implemented to ensure best practices for intubated patients.
Adult↗
Bacterial growth in secretions and on suctioning equipment of orally intubated patients: a pilot study.
BACKGROUND: Contamination of equipment, colonization of the oropharynx, and microaspiration of secretions are causative factors for ventilator-associated pneumonia. Suctioning and airway management practices may influence the development of ventilator-associated pneumonia. OBJECTIVES: To identify pathogens associated with ventilator-associated pneumonia in oral and endotracheal aspirates and to evaluate bacterial growth on oral and endotracheal suctioning equipment. METHODS: Specimens were collected from 20 subjects who were orally intubated for at least 24 hours and required mechanical ventilation. At baseline, oral and sputum specimens were obtained for culturing, and suctioning equipment was changed. Specimens from the mouth, sputum, and equipment for culturing were obtained at 24 hours (n=18) and 48 hours (n=10). RESULTS: After 24 hours, all subjects had potential pathogens in the mouth, and 67% had sputum cultures positive for pathogens. Suctioning devices were colonized with many of the same pathogens that were present in the mouth. Nearly all (94%) of tonsil suction devices were colonized within 24 hours. Most potential pathogens were gram-positive bacteria. Gram-negative bacteria and antibiotic-resistant organisms were also present in several samples. CANCLUSIONS: The presence of pathogens in oral and sputum specimens in most patients supports the notion that microaspiration of secretions occurs. Colonization is a risk factor for ventilator-associated pneumonia. The equipment used for oral and endotracheal suctioning becomes colonized with potential pathogens within 24 hours. It is not known if reusable oral suction equipment contributes to colonization; however, because many bacteria are exogenous to patients' normal flora, equipment may be a source of cross-contamination.
Adult↗
The effect of a critical pathway on patients' outcomes after carotid endarterectomy.
BACKGROUND: In 1996, an integrated plan of care was implemented to improve quality of care for patients undergoing elective carotid endarterectomy. Goals were to reduce length of stay, costs, number of preoperative and intensive care unit admissions, and use of diagnostic procedures yet maintain good outcomes. OBJECTIVES: To determine whether use of the integrated plan of care met the goals. METHODS: Data on financial and process outcomes, use of angiographic diagnostic procedures, and demographics were retrieved from the hospital's database for all patients who had elective carotid endarterectomy without cerebral infarction. RESULTS: A total of 783 patients met inclusion criteria: 129 before implementation of the plan of care, 66 during the 6-month transition, and 588 after implementation. Preoperative angiography was done in 32% of patients before implementation, 11% during the transition, and 4% after implementation. Percentages of patients admitted to the intensive care unit were 77% before implementation, 24% during transition, and 9% after implementation. Mean lengths of stay were 2.93 days before implementation, 2.12 days during transition, and 1.68 days after implementation. Costs per case were $7798 before implementation, $5750 during transition, and $5387 after implementation. Analysis of variance revealed significant differences between groups in total length of stay (P = .001), preoperative length of stay (P<.001), and costs (P<.001). CONCLUSION: Use of the integrated plan of care reduced length of stay, costs, admissions to intensive care units, and use of cerebral angiography. Use of the plan improved resource utilization while maintaining quality of care.
Adult↗
Suctioning techniques and airway management practices: pilot study and instrument evaluation.
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Adult↗
A quasi-experimental trial on individualized, developmentally supportive family-centered care.
OBJECTIVE: To evaluate the impact of individualized, developmentally supportive family-centered care on infant physiological variables, growth, behavioral stress cues, return to sleep state, medical and developmental progress, complications, resource utilization, parental perception of the neonatal intensive-care unit experience, and overall parental satisfaction. DESIGN: Quasi-experimental, repeated measures design. SETTING: Developmental and a control nursery in a 78-bed, level II/III neonatal intensive-care unit. PARTICIPANTS: A convenience sample of 114 premature infants and their parents. INTERVENTIONS: Control group infants received the routine neonatal intensive-care unit standard of care. Experimental infants received routine care plus the addition of individualized, developmentally supportive family-centered interventions. MAIN OUTCOME MEASURES: Between groups, there were no statistically significant differences in demographic factors, days to medical or developmental milestones, length of stay, or direct cost/case. Repeated measures analysis of variance determined that at every point of data collection, the average number of baseline, activity, and postactivity stress cues were lower in the developmentally supportive group. Infants in the developmental group had 8% less sedatives/narcotics and 15% less vasopressors costs than the control group. There were no differences in complication rates, parental perceptions of the neonatal intensive-care unit experience, or parental satisfaction between groups. CONCLUSIONS: Preterm infants who received developmentally supportive family-centered care demonstrated fewer behavioral stress cues and comparable short-term outcomes and resource utilization than infants who received routine care.
Analgesics, Opioid↗
Co-bedding versus traditional bedding of multiple-gestation infants in the NICU.
This study was part of a large departmental performance improvement initiative to implement and evaluate developmental and family-centered care as "best practice" in the neonatal intensive care unit (NICU). The goal was to evaluate the safety, effect on infant clinical and developmental outcomes, and maternal satisfaction of co-bedding of multiple-gestation infants compared to traditionally bedded infants/mothers. A secondary purpose was to evaluate co-bedding and American Academy of Pediatrics-recommended "back to sleep" behaviors in the same infants/mothers after discharge. A retrospective, comparative, descriptive design was used. Chart reviews and mailed written surveys were used to collect study data. Findings showed no significant differences in demographic variables or clinical and developmental outcomes between the total traditionally bedded and co-bedded groups. All mothers reported positive experiences with the NICU. Co-bedding may promote maternal bonding and has no negative clinical or developmental outcomes. Once policies and education are in place, parents should be offered the option to co-bed multiple-gestation infants in the NICU. There is a performance improvement opportunity regarding the education provided to parents of multiple-gestation infants before discharge on the "back to sleep" recommendations.
Benchmarking↗
Research provides the MEAT for quality improvement.
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Evidence-Based Medicine↗
Noise and the premature infant: physiological effects and practice implications.
Premature infants in the neonatal intensive-care unit often are exposed to continuous loud noise. This excess auditory stimulation creates negative physiological responses, such as increased heart and respiratory rates and decreased oxygen saturation. Modifying the neonatal intensive-care unit to reduce noise levels provides an environment more conducive to maturation and recovery from illness. This article reviews the literature addressing the pathophysiology and physiological changes of the premature infant in response to stress and discusses practice interventions for decreasing noise levels in the neonatal intensive-care unit. These interventions include installing sound absorbing materials and minimizing conversations of the staff.
Attention Deficit Disorder with Hyperactivity↗
Sound level exposure of high-risk infants in different environmental conditions.
PURPOSES: To provide descriptive information about the sound levels to which high-risk infants are exposed in various actual environmental conditions in the NICU, including the impact of physical renovation on sound levels, and to assess the contributions of various types of equipment, alarms, and activities to sound levels in simulated conditions in the NICU. DESIGN: Descriptive and comparative design. SAMPLE: Convenience sample of 134 infants at a southeastern quarternary children's hospital. MAIN OUTCOME VARIABLE: A-weighted decibel (dBA) sound levels under various actual and simulated environmental conditions. RESULTS: The renovated NICU was, on average, 4-6 dBA quieter across all environmental conditions than a comparable nonrenovated room, representing a significant sound level reduction. Sound levels remained above consensus recommendations despite physical redesign and staff training. Respiratory therapy equipment, alarms, staff talking, and infant fussiness contributed to higher sound levels. CONCLUSION: Evidence-based sound-reducing strategies are proposed. Findings were used to plan environment management as part of a developmental, family-centered care, performance improvement program and in new NICU planning.
Child Development↗
The effects of harp music in vascular and thoracic surgical patients.
CONTEXT: Music has been used in the acute clinical care setting as an adjunct to current treatment modalities. Previous studies have indicated that some types of music may benefit patients by reducing pain and anxiety, and may have an effect on physiological measures. OBJECTIVE: To evaluate the scientific foundation for the implementation of a complementary therapy, harp playing. The research questions for this pilot study were: Does live harp playing have an effect on patient perception of anxiety, pain, and satisfaction? Does live harp playing produce statistically and clinically significant differences in physiological measures of heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation? DESIGN: A prospective, quasiexperimental, repeated measures design was used with a convenience sampling. SETTING: Orlando Regional Medical Center, Orlando Fla. PATIENTS: Subjects wer eligible for the study if they were postoperative and admitted to a hard-wired-bedside-monitored room of the Vascular Thoracic Unit within the 3 days of the study period. INTERVENTION: A singl e20-minute live harp playing session. MAIN OUTCOME MEASURES: Visual analog scales (VAS) were used to measure patient anxiety and pain. Patient satisfaction was measured with a 4-item questionnaire. Physiological measures (heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation) were recorded from the bedside monitor. METHODS: Visual analog scales (VAS) were completed just before harp playing, 20 minutes after harp playing was started, and 10 minutes after completion. Patient satisfaction with the experience was measured with a 4-item questionnaire. Physiological measures (heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation) were recorded from the bedside monitor at baseline (5 minutes before study setup), at zero, 5, 10, 15, and 20 minutes after harp playing began, and at 5 and 10 minutes after harp playing stopped. RESULTS: Seventeen patients were used in this study, with a retrospective power of .91. Results indicate that listening to live harp music has a positive effect on patient perception of anxiety (P=.000), pain (P=.000) and satisfaction. Live harp playing also produced statistically significant differences in physiological measures of systolic blood pressure (P=.046), and oxygen saturation (P=.011). Although all values over time trended downward, the changes of other variables were not adequate to achieve statistical or clinical significance. CONCLUSION: Subjects in this study experienced decreased pain and anxiety with the harp intervention, and slight reductions in physiologic variable values. It is not possible in this study to determine if the results were due to the harp music, the presence of the harpist and data collector, or both. Future research is recommended using a control group and comparison of live versus recorded harp music with a wider variety of diagnoses and procedures.
Adult↗