600 Nursing Standard of Practice: Assessment & Assistance with Bedside Escharotomy

Introduction An escharotomy is an emergent procedure to treat circumferential, full-thickness burns. If left untreated, distal ischemia, compartment syndrome, respiratory failure, tissue necrosis, or death may occur. This procedure involves an incision through areas of eschar to release pressure within the affected compartment. An escharotomy may be performed at the bedside under sterile conditions by an experienced provider with the assistance of the nursing staff. The assisting nurse must have knowledge of the technique, purpose, and associated complications of the procedure. Nursing responsibilities may include pre-/post-procedure care, assessment, assistance with required equipment, patient teaching, & documentation. Methods Extensive literature review was conducted to identify the existence of nursing standards of practice regarding assessment and assistance with bedside escharotomy. A 20-question survey was sent to burn center nursing staff to evaluate inconsistencies in nursing knowledge and practice during bedside escharotomy. Results Information gathered via literature review revealed no consensus among U.S. burn centers in nursing standard of practice for a bedside escharotomy. Survey results further demonstrated inconsistencies in nursing knowledge and practice. Notable results from the survey included variance in post-procedure assessments, provider presence and skill level, dressing intervention, & obtaining informed consent prior to procedure. Conclusions A procedure was developed to standardize nursing practice during bedside escharotomy. This procedure outlines required supplies and preparation of equipment, implementation of nursing assessment and assistance, special considerations & complications, patient teaching, and required documentation. Images were included in the procedure for reference. Nursing staff received education regarding the purpose and utilization of the procedure. The procedure is available electronically to all health system employees. Future plans include reevaluation of staff knowledge and utilization of the procedure. Applicability of Research to Practice Development of a standard bedside escharotomy nursing procedure has the potential to improve level of knowledge, consistency in practice, and patient outcomes. Continued utilization and evaluation of this standard of practice supports the need for a consensus among U.S. burn centers.

Abstract TP358: Implementing Post Neuroendovascular Procedure Nursing Care With Transradial Access

Neurointerventionalists (NIR) are adopting conversion from transfemoral access (TFA) to transradial access (TRA) due to the safety, cost and patient satisfaction benefits seen in cardiology. Implementation of TRA requires specific nursing knowledge, skill competency and protocols to assure positive patient outcomes. A team approach including NIR, cardiology and nursing was used to coordinate safe patient management. Preparation began with RN education regarding advantages of the TRA vs TFA including less vascular complications, a more easily compressible location, earlier ambulation, less site pain, and earlier discharge. Identifying the patient recovery area was crucial to assure proper nursing ratios necessary to provide surveillance needed for deflation of pressure device and observation for bleeding or other complications. Specific care post NIR procedure was modeled using existing cardiac protocol. The process begins with nursing in the NIR suite and proceeds to recovery area where the pressure device is progressively deflated until hemostasis is achieved and removed by the RN. The removal protocol is clearly described and mapped in the Radial Post Procedure Checklist (RPPC), which follows physician orders and includes instruction for VS, NV and neuro checks, pulse oximetry on accessed hand, and pressure band deflation after 60 minutes for diagnostics and 90 minutes after an intervention by releasing 3 cc every 15 minutes. RPPC provides reinflation directions if bleeding is observed. RN proficiency with pressure band was achieved through instruction, practice and correlation with anatomy. Patient instructions for complications and restrictions were provided to the discharging areas. Although recovering TRA NIR patients requires new knowledge and skills, we have successfully cared for 105 in the past 6 months; one pressure band placed incorrectly over the ulnar artery was readily identified. Administration has supported a safe nursing ratio during the deflation phase with patient flow identified for procedures performed off hours. Transradial access for NIR patients can be successfully implemented with nursing education, written protocols, proper patient placement flow maps, and patient teaching.

Using simulated patients as a learning strategy to support undergraduate nurses to develop patient-teaching skills

Background:An increase in the number of patients with long-term conditions has required a greater focus on nurse-led educational interventions to enable patients to develop self-management strategies. However, patient education is frequently taken for granted, and nurses sometimes consider that their undergraduate training does not prepare them to participate in effective patient teaching.Aim:The study aimed to formatively evaluate a simulated role-play scenario facilitated with third-year nursing students to support the development of patient-teaching skills.Method:The study combined two approaches to simulation, using high-fidelity and mid-fidelity simulation scenarios sequentially. This enabled students (n=20) to apply the communication strategies learnt to both a skills-based procedural situation and a patient-teaching simulation. A five-item pro forma with four open questions and one closed question was used for formative evaluation.Findings:The results indicated that using a simulated patient to practise patient-teaching skills was perceived by the students to be a valuable method of learning that they could transfer to clinical practice.Conclusion:The findings suggested that facilitating learning with a simulated patient is useful in replicating authentic verbal and practical interactions with a patient in practice.

EDUCAÇÃO EM SAÚDE AO FAMILIAR CUIDADOR DE ADOECIDOS EM CUIDADOS PALIATIVOS ONCOLÓGICOS DOMICILIARES

Objetivo: analisar de que forma é desenvolvida pelo enfermeiro a educação em saúde ao familiar cuidador de adoecidos em cuidados paliativos oncológicos domiciliares. Método: pesquisa descritiva com abordagem qualitativa realizada com 10 familiares cuidadores de adoecidos pelo câncer cadastrados no Serviço de Assistência Domiciliar do Hospital Ophir Loyola. Resultados: emergiram duas categorias denominadas: Experiência da educação em saúde para o familiar cuidador e Educação em saúde no domicílio: atuação do enfermeiro no ensino do cuidado ao adoecido e autocuidado para o familiar cuidador. Conclusão: o presente estudo constatou uma fragilidade na assistência de enfermagem acerca da realização da educação em saúde voltada para o autocuidado do referido cuidador. Identificamos que o mesmo tem procurado executar assistência necessária ao enfermo, ensinando ao familiar cuidador os cuidados básicos a serem dispensados ao adoecido, porém, não orientam o autocuidado ao cuidador.Descritores: Educação em saúde; Cuidados Paliativos; Assistência Domiciliar.HEALTH EDUCATION TO THE FAMILY CAREGIVER OF DISEASED CANCER PATIENTS IN PALLIATIVE HOME CAREObjective: analyze how the nurse develops the health education to the familiar caregiver of patients with palliative oncological domiciliary care. Method: descriptive research with a qualitative approach performed with 10 family caregivers of cancer patients registered in the Ophir Loyola Hospital Home Care Service. Results: two categories emerged called: Experience of health education for the family caregiver and Health education at home: nurse’s role in teaching care for the sick and self-care for the family caregiver. Conclusion: the present study found a fragility in nursing care about the accomplishment of health education aimed at self-care of the referred caregiver. We have identified that the latter has sought to perform the necessary assistance to the patient, teaching the family caregiver the basic care to be given to the sick person, but they do not guide the self-care of the caregiver.Descriptors: Health Education; Palliative Care; Home Nursing.EDUCACIÓN EN SALUD AL CUIDADOR FAMILIAR DE LOS ENFERMOS EN CUIDADOS PALIATIVOS ONCOLOGICOS DOMICILIARIOSObjectivo: analizar cómo se desarrolla por el enfermero la educación en salud a los cuidadores familiares de los enfermos en cuidados paliativos domiciliarios. Método: investigación descriptiva con enfoque cualitativo realizada con 10 cuidadores familiares de enfermos por lo cáncer registrados en el Servicio de Atención Domiciliaria del Hospital Ophir Loyola. Resultados: Dos categorias surgieron, denominadas: Experiencia de la educación en salud para el cuidador familiar y Educación en salud en el domicilio: la actuación del enfermero en la enseñanza del cuidado al enfermo y autocuidado de los cuidadores familiares. Conclusión: El presente estudio encontró una debilidad en la asistencia de enfermería en cuanto la realización de la educación en salud orientada al autocuidado del cuidador. Identificamos que los mismos han tratado de realizar la asistencia necesaria a los enfermos enseñando al cuidador familiar la atención básica que debe darse al enfermo, pero no enseñan el autocuidado a los cuidadores.Descriptores: Educación en salud; Cuidados paliativos; Asistencia Domiciliaria.

Patient Satisfaction With Caring at a District Hospital in Malawi

PURPOSE: The purpose of this study was to investigate and understand patient satisfaction with caring at a district hospital in Malawi. MATERIALS & METHODS: The study used a mixed methods design, employing the sequential explanatory strategy. A total of 120 adult patients completed a survey questionnaire (phase one), and of these, two patients were followed up with individual interviews (phase two). RESULTS: Data were analyzed using statistical procedures, thematic analysis and an integration process of quantitative and qualitative findings. Highest patient satisfaction (90.6%; M=4.53; SD=0.879) occurred with nurses’ presence; while lowest satisfaction (37.4%; M=1.87; SD=1.710) was seen with patient teaching. Patients’ lived experiences revealed that nurses’ demonstration of presence and professional proficiency were critical to caring. UNIQUE CONTRIBUTION TO THEORY, PRACTICE AND POLICY: To enhance improved caring, there was a need for nurses to increase personal presence, promote patient involvement in decision-making, and demonstrate competent confidence.