AACN News—July 2003—Practice

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Vol. 20, No. 7, JULY 2003


Congratulations to Research Grant Recipients

Evidence-Based Clinical Practice Grant

This program provides awards of $1,000 to stimulate the use of patient-focused data or previously generated research findings to develop, implement and evaluate changes in acute and critical care nursing practice.

The recipients of this grant for 2002 are:
Elisabeth Bradley, RN, APN, CCRN
Wilmington, Del.
Incorporation of Guided Imagery and Relaxation into the Care of Patients Undergoing Cardiac Catheterization: A Research Utilization Project

Vera Usinowicz, RN, MS, CCRN
West Milford, N.J.
Patients' Perceptions and Responses to Pain Related to Turning: Lessons Learned from AACN's Thunder Project II

The recipients of this grant for 2003 are:

Margo Halm, RN, MA, CCRN, CS
St. Paul, Minn.
Relationship Between Staffing Levels and Patient and Nurse Outcomes

Betty Thornell, RN, MS, CCRN
Austin, Texas
Understanding Barriers to Collaboration During Multidisciplinary Rounds

Grant proposals are accepted twice a year and must be received by either March 1 or Oct. 1.


End of Life/Palliative Care Small Projects Grant

This grant awards $500 to carry out a project focusing on end-of-life or palliative care outcomes in critical care.

The recipient of this grant for 2002 is:
Mary Ann Millman, RN, MSN, RCVT
Falls Church, Va.
Meeting Comfort Care Needs of Terminally Ill Patients During the Withdrawal of Ventilatory Support

The recipients of this grant for 2003 are:
Brutrinia Arellano, RN
Converse, Texas
Determining the Impact of End-of-Life Education Training on the Practices or Behaviors That Nurses Perceive

Cynthia Scott, RN
Houston, Texas
Attitudes and Practices of Pediatric Critical Care Physicians, Nurse Practitioners and Nurses Regarding End-of-Life Care in the PICU

Frances Simpson, RN, BSN, CCRN
Phlugerville, Texas
Family Satisfaction With Critical Care Experience Following Death of a Loved One

Applications for this grant are accepted twice a year and must be received by Jan. 15 or July 1.

AACN Critical Care Grant

This grant awards up to $15,000 to support research focused on one or more of AACN's research priorities.

The recipients of the AACN Critical Care Grant for 2003 are:

Lauren Sorce, RN, MSN, CCRN, CPNP
Park Ridge, Ill.
Does the Use of a Moisture Chamber Decrease the Incidence of Corneal Abrasions in Critically Ill Pediatric Patients?

Chris Winkleman, RN, PhD, CCRN
University Heights, Ohio
Selected Cytokines and Mobilization of ICU Patients: Is There a Relationship?

The annual application deadline for this grant is Feb. 1.

AACN Mentorship Grant

This $10,000 grant provides research support for a novice researcher with limited or no research experience to work under the direction of a mentor with expertise in the area of proposed investigation.

The recipient of this grant for 2003 is:
Louise Grondin, RN, MS, CS
Saline, Mich.
Identifying Predictors of Inpatient Cardiac Arrest

The annual application deadline for this grant is Feb. 1.

AACN Clinical Inquiry Grant

This grant provides awards of up to $500 for clinical research projects that directly benefit patients or families. Interdisciplinary projects are especially invited.

The recipients of this grant for 2001 are:
Donna Blakley, RNC, BSN
Cincinnati, Ohio
Post-Myocardial Infarction Patient Education Program Education

Melissa Hutchinson, RN, CCRN
Bothell, Wash.
Does the Addition of Glutamine and/or Poly-Unsaturated Fatty Acids to Enteral Feeding Reduce the LOS Infection and Ventilator Days in Critically Ill Patients with or Without ARDS

Jennifer Wagner, RN, BSN
Louisville, Ohio
The Lived Experience of Critically Ill Patients' Family Members During Cardiopulmonary Resuscitation

The recipient of this grant for 2002 is:

Kristen Sethares, RN
Marion, Mass
Supporting Self-Care Behaviors of Women With Heart Failure Through a Tailored Nursing Intervention

The recipients of this grant for 2003 are:
Colleen Gonzalez, RN, MSN
Peabody, Mass.
Visiting Preferences of Patients and Families

Debra Siela, RN, DNSc, CCNS, CCRN, CS, RRT
Bluffton, Ind.
The Effect of Positioning on Respiratory Parameters and Subjective Perceptions of Patients With Large Abdomens Who Are Receiving Mechanical Ventilation


Renee Twibell, RN, DSN
Munice, Ind.
An Exploration of Synergy in Novice Nurses Caring for Critically Ill Patients

The annual application deadlines for this grant are Jan. 15 and July 1.

AACN Certification Corporation Research Grant

This program, which is supported by AACN Certification Corporation, awards up to four grants of up to $10,000 each to fund research related to certified practice. Examples of eligible projects include studies that focus on continued clinical competency, the Synergy Model, the value of certification as it relates to patient care or nursing practice, certification concepts and educational preparation of certificants.

The recipient of this grant for 2003 is:

Paula A. Lusardi, RN, PhD, CCNS, CCRN
Longmeadow, Mass.
Certified Versus Non-Certified Practice as Revealed in Exemplars: a Qualitative Study

This grant is not funded for 2004.

AACN Clinical Practice Grant

This $6,000 grant supports research that is focused on one or more of AACN's clinical research priorities.

Receiving this grant for 2002 is:

RuthAnne Kuiper, RN, MN, CCRN
Mocksville, N.C.
Using the Outcome-Present-State Test Clinical Reasoning Model and the Self-Regulated Learning Model to Promote Reflective Practice With Nursing Students in Acute Care Clinical Settings

Oct. 1 is the annual application deadline for this grant.

AACN-Sigma Theta Tau Critical Care Grant

This $10,000 grant is cosponsored by AACN and Sigma Theta Tau International. The grant may be used to fund research for an academic degree.

Receiving the grant for 2003 is:

Richard B. Arbour, RN, MSN, CCRN, CNRN
Philadelphia, Pa.
Determining the Effectiveness of the Bispectral Index in Monitoring Sedation and Improving Outcomes in Critically Ill Patients

Oct. 1 is the annual application deadline for this grant.

Medtronic Physio-Control AACN Small Projects Grants

This program awards up to $1,500 to carry out projects that focus on aspects of acute myocardial infarction resuscitation, such as the use of defibrillation, synchronized cardioversion, noninvasive pacing or interpretative 12-lead electrocardiogram.

The recipient of this grant for 2002 is:

Diane L. Carroll, RN, PhD
Beverly, Mass.
Quality of Life in Patients at Three and Four Years After Insertion of an Implantable Cardioverter Defibrillator

The annual application deadline for this grant is July 1.

Moser Receives First $100,000 AACN-Philips Outcomes Grant

Debra K. Moser, RN, DNSc, FAAN, is the recipient of the first $100,000 AACN-Philips Medical Systems Outcomes for Clinical Excellence Research Grant. The award was announced at AACN's National Teaching Institute and Critical Care Exposition in May in San Antonio, Texas.

Her study is titled "Physiologic Behavioral Mechanisms Linking Depression with Increased Morbidity and Mortality in Patients with Heart Failure."
Cosponsored by Philips Medical Systems, this grant will be given every three years to support an experienced nurse researcher in conducting a clearly articulated nursing-focused research program.

This grant replaced the Critical Care Nursing Research Grant that Philips had funded since 1991. It will support studies that center on improved outcomes or system efficiencies in the care of acutely or critically ill individuals of any age in any clinical environment and relate directly to at least one of AACN's research priorities.
Philips' collaboration with AACN on research dates back two decades. Its original partnership was through Hewlett Packard and then Agilent Technologies.

In announcing the grant support last year, Joan Hodges, learning products manager at Philips, said, "Our company has a long history as a champion of critical care nursing research through AACN. Throughout the years, our commitment to research has always been founded on a vision that is entirely complementary with AACN in its support of nurses' optimal contributions to the care of critically ill patients and families."

Moser is professor and Gill chair of nursing at the University of Kentucky College of Nursing, Lexington. She is co-editor of the Journal of Cardiovascular Nursing.

Kathleen Puntillo (center) receives the
Distinguished Research Lecturer crystal
award in recognition of her selection as
the 2003 Distinguished Research Lecturer,
part of AACN's Circle of Excellence awards
program. On hand for the presentation were
AACN Research Work Group Chair Elaine
Steinke (left) and Philips Medical Systems
Learning Products Manager Joan Hodges.
Philips sponsored the Distinguished Research
ecture, which was presented at NTI 2003
in San Antonio, Texas.


Guzzetta to Deliver 2004 Distinguished Research Lecture at NTI in Orlando

Cathie E. Guzzetta, RN, PhD, HNC, FAAN, has been selected to present the AACN Distinguished Research Lecture at AACN's National Teaching Institute and Critical Care Exposition in May 2004 in Orlando, Fla.

Since coauthoring the textbook Critical Care Nursing: Body-Mind-Spirit in 1981, Guzzetta has authored or coauthored numerous books. She describes her mission as translating holistic, caring and healing concepts into concrete implications for nursing practice.

A critical care researcher for more than 20 years, Guzzetta is currently a nursing research consultant with Children's Medical Center of Dallas and director of Holistic Nursing Consultants, Dallas. Her federally funded study, titled "Effects of Relaxation and Music Therapy on Coronary Care Patients," paved the way for nurse researchers to seek National Institutes of Health money to investigate holistic interventions and integrate them at the bedside.

The Distinguished Research Lecturer Award honors a nationally known researcher who has made significant contributions to acute and critical care research. In addition, the recipient is known for publications, presentations and mentorship relevant to acute and critical care and is viewed as a consultant in his or her area of expertise.

Nominations for 2005 Lecture
Dec. 1 is the deadline to apply for the 2005 AACN Distinguished Research Lecturer Award. The recipient will present the Distinguished Research Lecture at the 2005 NTI in New Orleans, La.

The awardee receives a $1,000 honorarium and $1,000 toward NTI expenses and a crystal award. The lecture is sponsored by a grant by Philips Medical Systems.
For more information, contact Research Associate Dolores Curry at (800) 394-5995, ext. 377; e-mail, dolores.curry@aacn.org.

Practice Resource Network


Q: What are the standards for monitoring residuals in patients requiring enteral nutrition?

A: The AACN Procedure Manual, 4th Ed., addresses issues regarding patient monitoring and care during enteral nutrition. The recommendation is to aspirate residuals before every feeding or at least every eight hours. Residuals greater than 150 mL indicate decreased gastric mobility or emptying. Continued feeds with high residuals increase the risk of vomiting and aspiration. Residuals may be increased because of intolerance to enteral formulas, indicating a need for reevaluation of the formula. The manual also lists as a reportable condition residual greater than 125 mL for more than two hours.

The Protocol for Practice titled "Nutrition Support for the Mechanically Ventilated Patient" states that the residual volume must be greater than the flow rate of formula to be considered significant.

If you have a practice-related question, call AACN's Practice Resource Network at (800) 394-5995, ext. 217, or e-mail your question to practice@aacn.org.


Public Policy Update

Act Addresses Safe Care
Sen. Daniel Inouye (D-Hawaii) has introduced a bill that would amend Medicare provisions of the Social Security Act to, among other things, address nurse staffing issues.

The Safe Nursing and Patient Care Act of 2003 (S. 991) would:
� Require participating hospitals to adopt and implement a staffing system that provides for an adequate number of RNs on each shift and in each unit to ensure appropriate staffing levels for patient care.
� Provide for the reporting and release to the public of certain staffing information, including a daily posting of the current number of licensed and unlicensed nursing staff directly responsible for patient care for each shift and in each unit.
In addition to establishing record-keeping, data collection and evaluation requirements, the bill would provide for enforcement through civil monetary penalties and for whistleblower protections.

Ten states-Arkansas, Connecticut, Hawaii, Illinois, Iowa, Missouri, New York, Pennsylvania, Rhode Island and West Virginia-have proposed similar legislation.

AACN supports this bill and encourages its members to contact their congressional representatives to urge them to cosponsor this important legislation. Use the AACN Legislative Action Center.

Nurse Burnout Could Lessen Quality of Care
More than 50% of hospital nurses say that insufficient staffing is compromising patient care and contributing to nurse burnout, according to an American Federation of Teachers survey. Peter D. Hart Research Associates of Washington, D.C., interviewed 601 nurses by telephone for the survey, which was released during a nursing union news conference marking the beginning of National Nurses Week in Trenton, N.J., in May.

About 60% of the nurses surveyed said understaffing negatively impacts patient quality of care, and more than half of the surveyed nurses said understaffing was a "very" or "fairly" serious problem. The survey found that, though medical-surgical nurses said they should care for five patients at a time, they are responsible for eight patients on average. In addition, more than 50% of surgical nurses surveyed said they have considered leaving direct patient care in the past two years.

Funding for Nurse Education Programs Lags
Although the Nurse Reinvestment Act has been law for almost 10 months, funding is still an issue. In May, a bipartisan group of U.S. senators sent a letter to Sen. Arlen Specter (R-Pa.), chairman of the Senate Subcommittee on Labor, Health and Human Services and Education, requesting funding for nurse education programs. The letter, which was also sent to the subcommittee's ranking member, Sen. Tom Harkin (D-Iowa), asked for $175 million in 2004 fiscal year funds for Title VIII nurse education programs, including those established under the Nurse Reinvestment Act.

The senators noted that the nursing shortage demands action in the form of money. The Nurse Reinvestment Act, they wrote, builds on the existing Title VIII nurse education programs that allow nurses to repay loans via work. The programs also play a role in improving diversity among the nursing workforce and expanding opportunities for all nurses.

The senators' request comes seven months after a bipartisan group of U.S. representatives also lobbied for funding for the legislation. Rep. Lois Capps (D-Calif.), a registered nurse, and Rep. Edward Whitfield (R-KY) garnered bipartisan support in the House in support of allocating money to the training of new nurses and nurse educators.

A number of senators have rallied support for the programs, including Sen. Barbara Mikulski (D-Md.), who proposed an early amendment to establish funding for the Nurse Reinvestment Act after it passed without specific dollar figures. Congress earmarked $113 million for nursing programs from the 2003 fiscal year budget, a $20 million increase from 2002.

AACN supports not less than $175 million for Title VIII appropriations for FY2004. To contact your senators regarding funding, visit the AACN Legislative Action Center online.

CDC Issues Alert on Pox-Like Outbreak
As of mid-June, at least 19 people in three Midwestern states had contracted a disease related to smallpox, marking the first outbreak of the life-threatening illness in the U.S. The outbreak comes as the global epidemic of severe acute respiratory syndrome appears to be coming under control.

Concerned that the illness could spread, the Centers for Disease Control and Prevention issued a nationwide alert to doctors and public health officials to be on the lookout for more cases.

Known as monkeypox, the disease is caused by a virus in the same family as that which causes smallpox. The disease was apparently spread by rodents known as prairie dogs, which have become popular as pets. The symptoms of monkeypox are similar to smallpox: fever, headache, cough and an extremely painful rash of pus-filled sores that spreads across the body.

Because the disease has not been seen in this part of the world, the severity of the threat is unclear. All patients and infected animals have been isolated.
Authorities estimate that monkeypox has a mortality rate of between 1% and 10%, compared with a mortality rate of about 30% for smallpox. The monkeypox virus is believed to spread through physical contact with a sick person or infected animal, or through infected body fluids. However, health officials said it apparently is not as easily spread as the highly infectious smallpox virus.

Although monkeypox is untreatable, there is some indication that an antiviral drug may have some usefulness. The smallpox vaccine is believed to be protective against the monkeypox virus.

Grants Support Nursing Workforce Diversity
Health and Human Services Secretary Tommy Thompson recently announced the award of 16 grants totaling $3.5 million to support nursing education opportunities for minorities and other disadvantaged students. The Nursing Workforce Diversity grants will go to nursing schools and nonprofit organizations to fund scholarships or stipends, and preparation and retention activities for disadvantaged students, including those from racial and ethnic minority groups currently underrepresented among registered nurses.

The grants are funded through the HHS Health Resources and Services Administration.

Health Costs Continue to Rise
Growth in U.S. healthcare spending slowed slightly in 2002, climbing 9.6% compared with 10% the previous year, according to a study reported in the Health Affairs journal. However, costs continued to balloon at more than three times the rate of inflation. Premiums charged by health insurers and paid by consumers and employers climbed 15%, the biggest spike in at least a decade, the study found.

The study tallied spending by employers and private health insurance companies on hospital costs, prescription drugs and doctors' visits. Hospital, drug and doctor costs are widely seen as driving premium increases. However, the fact that insurers price premiums in anticipation of rises in these costs can cause discrepancies in the growth rates.

For the second consecutive year, hospital costs dominated the increase, accounting for 51% of the overall cost spiral.

The data are derived from samples from the Milliman USA health cost index, considered a bellwether of private health costs.


Public Policy Snapshot


New Standards for Blood Pressure

The National Heart, Lung, and Blood Institute has released new federal guidelines regarding blood pressure levels that put people at risk for high blood pressure later in life:

 
Normal Prehypertension Stage One Hypertension Stage Two Hypertension
Pressure
Systolic
Less than 120 120-139 140-159 More than 160
Diastolic Less than 80 80-89 90-99 More than 100
Treatment
Otherwise healthy None None Mostly diuretics; possibly other drugs Two-drug combo usually including diuretic
With other diseases None Treat diseases Multiple medications Multiple medications

For more information about these and other issues, visit the AACN Web site.

Submit Research, Creative Solutions Abstracts for NTI

AACN is inviting research and creative solutions poster abstracts for consideration for AACN's 2004 National Teaching Institute and Critical Care Exposition in Orlando, Fla.
In addition to the posters, four awards will be presented for oral research abstracts reflecting outstanding original research, replication research or research utilization. Each of these awards provides an additional $1,000 toward NTI expenses.

Sept. 1 is the deadline to submit the abstracts.

The application, as well as guidelines and resources are now available online.