Patient Care
Simulation Training, Coaching, and Cue Cards Improve Delirium Care
A quality improvement study supports the use of multimodal education to enhance clinical practice for care of patients with delirium.
Nursing Self-Confidence
Evidence suggests that nursing confidence is a complex manifestation of the security felt within the care team and the comfort of one’s own professional abilities.4 Patients’ trust in the team caring for them is based on the confidence exuded by the team.8 In this way, nursing confidence can affect the patient-care team profoundly. Value is maximized when a nurse’s self-confidence engenders patient confidence and trust. Due to the varied patient load and complexity of subspecialty nursing care, it is hypothesized that bedside manuals/guidelines can be used to educate the subspecialty nurses on specific patient-related issues.
Nursing practice competence and confidence is vital to providing care for patients with complex postsurgical health care needs. Patient safety and outcome are paramount. This can be intimidating for newly qualified surgical subspecialty nurses who have not yet had experience with or adequate exposure to patients with complex postsurgical needs. Surgical nursing continuing education places an emphasis on adaptation to ever-changing specialized surgical procedures and postoperative patient care. Nevertheless, it is difficult for surgical subspecialty nurses to learn and retain all the possible complexities of individual cases and to confidently, appropriately, and safely care for patients especially when adverse events arise.
Recognizing that leadership is personal and not dependent on hierarchy, surgical subspecialty nurses may be better suited to specific bedside training and counseling.6,9 A key factor influencing nursing confidence is communication and collaboration with physicians.9 The role of the physician at VA medical facilities is no longer to be a commanding figure with complete medical autonomy; rather, a unified team of specialized practitioners collaboratively facilitate and deliver patient care.
There is no specific research detailing the use of bedside nursing guides in caring for postoperative patients. However, at VAPHCS, nurses created supplemental material regarding postoperative acute care of vascular surgery patients, which was found to be subjectively helpful in elevating nursing confidence. To the authors’ knowledge, no such supplemental information/guide exists for other specialty surgical services.
The surgical nursing guide created here detailed visuals of many common neurosurgical procedures performed at VAPHCS and included a prioritized checklist, which the 16 surgical subspecialty nurses could reference postoperatively. The authors hypothesized that this would enhance the nurses’ ability to efficiently manage specific situations while bridging communication gaps between surgical teams and nurses. The survey results agree with previous reports that suggested that the application of an adaptive leadership framework would empower nurses to deliver excellent patient-centered care, care that can be augmented with subspecialty nursing guides.7,10
Based on these results the authors propose that subspecialty surgical services consider use of a practical nursing guide for all surgical subspecialty nurses to reference, improve familiarity with procedures, and provide guidance to manage adverse events. Since implementing this reader-friendly paradigm within neurosurgical care, a nurse driven expansion has now included other subspecialty services at the VAPHCS with success.
Limitations
Survey responses have inherent bias and sampling error rates. The sample size for this survey was small. Data were grouped for data analysis. Competency and patient outcomes were not measured.
