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.
Future Directions
Despite specific surgical specialty postoperative patient care training, an overall lack of confidence can persist. A physician-created neurosurgical nursing guide that detailed the most common neurosurgical procedures, expected postoperative care, and potential emergencies was shown to improve nursing confidence. Collaborative (physician and nursing leaders) QI projects, such as described here; development of specific surgical specialty initiatives designed to improve confidence and quality; and nurse-physician communication and teamwork could lead to improved patient satisfaction and outcome.
The costs associated with developing and using bedside nursing guides are relatively low, and efficiency can be considered high. Competency improvement could be measured by creating a specialty-specific case scenario question bank. Effects on patient satisfaction and outcome could be measured by a patient satisfaction survey. Improvements in beside catastrophe management could be prospectively tracked; for example, rates of mismanagement of mobility status, emergent transfers to the intensive care unit, or poor wound care could be compared pre- and postfamiliarization with a subspecialty guide.
Conclusion
Familiarization with the VAPHCS neurosurgical nursing guide had a positive impact on the confidence of medical-surgical nurses caring for neurosurgical patients. Medical-surgical nurses were more comfortable taking care of neurosurgical patients; they felt the guide helped improve skills and noted improved knowledge regarding involvement of physician oversight. Although objective parameters were not assessed, improvement in nursing confidence in general leads to improved overall nurse-physician communication and patient management. A further study might target objective parameters associated with guide usage, such as changes in the number of emergencies or calls to physicians regarding management.
Acknowledgments
The authors thank Andy Rekito, MS, for illustrative assistance.
