1. Brady, Darcie M. DNP, MSN, RN
  2. Issue Editors
  3. Fox, Patricia MSN, RNC-NIC
  4. Issue Editors

Article Content

This issue is filled with discussions about the many challenges that managers and leadership face in both large and small health care facilities. Each of these articles addresses some facet of improving patient outcomes, nursing process, or quality improvement across the patient care areas from how to reduce medication errors to prevent anxiety in pediatric surgical patients to how to survive night shift. Each article addresses, in a unique way, a manager or leader can help promote quality and safety at the bedside.


The first article is from Iran by Nasrabadi, Peyravi, and Valiee, "Nurses' Error Management in Critical Care Units: A Qualitative Study," which discusses the risks of medication errors in critical care units and how nurses and management deal with those errors. Findings show that regardless of nurse expertise, medication errors occur at an alarming rate and those errors are stressful for the nurse and potentially dangerous for the patient and that management is largely unaware of how to help handle this problem. This article discovered that nurses have various strategies in identifying an error, preventing errors, and reporting errors and further discusses how management has an important role in developing a safe process for nurses to report medication errors and discusses various possible ways to accomplish that.


AL-Sagarat, AL-Oran, and Moxham present the importance of "Preparing the Family and Children for Surgery." This is very frightening situation for both children and their families, one that has the potential to create increased anxiety, especially if children are not developmentally able to process the circumstances. This literature search goes into detail discussing the special needs of children before, during, and after surgery, as well as how to help parents cope. There authors reference many resources discussing the different factors contributing to stress such as unfamiliar environment, strange equipment, and painful procedures, as well as the strategies nurses can use to help understand the emotional and psychological needs of children in the preoperative setting.


In the third article, "Clinical Simulation Learning in Critical Care," by Hudgins, the popular and increasingly used method of simulation learning is case studies. Nursing schools have become increasingly competitive, and ensuring quality nursing graduates is a concern for schools as well as the hospitals that hire them. Creating clinical competency and critical thinking skills is essential before a nurse has the clinical capability to care for a patient in the critical care setting. This article is a review of 2 nursing groups in a simulation setting and the lessons learned while developing and evaluating the success of the simulation. Discussion is around setting up the clinical setting, equipment needed learning and evaluation procedure, and feedback methods.


Heart failure is a serious issue and one that creates an ongoing problem for health systems across the United States. Heart failure is an increasingly difficult health care problem for patients to manage and is often the cause of 30-day readmissions that has a large financial impact on health systems. Readmissions are something that management and leadership teams in health systems seek to avoid. The study "Improving Clinical Outcomes for Patients With Class III Heart Failure" by Shapiro, Bires, Waterstram-Rich, and Cline retrospectively compared 120 patient charts, 60 with an implanted pacemaker device and 60 without an implanted device, with the prevalence of 30-day readmission rates to determine which method provided a better clinical outcome. This article potentially has an impact on how health systems could care for patients with class III heart failure and how future advances in health care will potentially impact patient outcomes and financial health of health systems.


Depression is a health concern that is often associated with other morbidities such as coronary heart disease. DiSante, Bires, Cline, and Waterstram-Rich seek to determine in the article, "An Analysis of the Prevalence of Depression Post-Myocardial Infarct," if depression is underdiagnosed in patients who have had a myocardial infarction and if undiagnosed depression can alter the clinical outcome of a patient who has suffered from a myocardial infarction. In this study, 24 patient charts were examined and evaluated on the PHQ-9 Patient Depression Questionnaire. The results were surprising and warrant further studies on the subject.


Finding reliable tools to help track and monitor practice has been an ongoing challenge at medical facilitates throughout the country. "Implementing iRound: A Computer-Based Auditing Tool" by Brady describes how one health system brought in a computer-based auditing tool called iRound to help address this issue. iRound is a product from the Advisory Board Company that allows data collection in real-time using any computer device. The program provides a way to collect and examine collected data in a variety of areas: patient experience, leader rounding, staff recognition, and performance improvement practices. This information can then be used to track and identify prospective areas for improvement. Brady's article gives an overview of how the tool was selected, adopted, and implemented in the hospital setting.


Critical care areas have seen many changes in the area of patient visitation. Emphasis is placed on patient- and family-centered care (PFCC) that encourages patients and families to be more involved with the patient experience and care. Kozub, Scheler, Necoechea, and Byrne explain in their article, "Improving Nurse Satisfaction With Open Visitation in an Adult ICU," that intensive care unit (ICU) nurses sometimes have conflicts associated with patient visitation and patient care. Through the unit practice council, one ICU initiated a performance improvement project to address nurse satisfaction related to PFCC and incorporate consistent clinician practices to improve visitation issues. Developing strategies improved nursing autonomy and helped make the transition to PFCC a little smoother.


Night shift nursing can affect the natural chronobiology of the body. In "Simple Strategies for Surviving the Night Shift," Crooks shares how working night shift can affect lifestyle, cause physical changes, and introduce added stressors to a night shift nurse's life. This can prove challenging and an area of frustration for the night shift nurse. Crooks' article provides helpful lifestyle strategies that nurses can utilize when addressing the issues associated with being a night shifter.


Critical care patients are at a higher risk for central line-associated bloodstream infections (CLABSIs). The Joint Commission and the Centers for Medicare & Medicaid Services (CMS) have set guidelines and goals for CLABSI reduction. Those facilities not meeting the 2017 goal may be subject to reimbursement penalties from the CMS. In "Central Venous Access: The Missed Patient Safety Goal," Herring explores clinical practice techniques and factors that influence the incidence of CLABSIs in the ICU. Herring provides specific information on the costs and challenges that hospitals face when trying to address the complicated issues associated with ICU patients and CLABSIs.


In "Factors Influencing Weaning Older Adults From Mechanical Ventilation: An Integrative Review," Stieff, Lim, and Chen use an integrative review methodology to explore the factors influencing the weaning of older adults from mechanical ventilation in ICUs. The statistics for older ventilated patients are severe. Older adults comprise greater than 40% of ICU patients and of those, 50% die within 30 days of admission. In the review findings, the authors share that severity of illness, not chronological age, is more of a determinant for successful ventilator weaning, and determining the factors that influence weaning older adults from mechanical ventilation and aligning best practices will improve outcomes for this high-risk patient population. They also agree that more studies are needed to help determine what factors affect ventilator weaning in older adults.


-Darcie M. Brady, DNP, MSN, RN


-Patricia Fox, MSN, RNC-NIC


Issue Editors