AACN News—April 2000—Practice

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Vol. 17, No. 4, APRIL 2000

Geriatric Corner: Keep Your Patient-Teaching Materials Up-to-Date

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) takes patient and family education (PF) standards seriously, because patient-teaching deficiencies have been among the top 15 findings in healthcare facility surveys for several years.

For example, PF.2.1 says clients and/or, when appropriate, their families must have their learning needs, abilities, learning preferences, and readiness to learn assessed. PF.2.1.1 says education assessments should, when indicated, include cultural and religious practices, emotional barriers, desire and motivation to learn, physical and/or cognitive limitations, language barriers, and the financial implications of care choices. PF.2.2.3 says hospitals should instruct clients and/or family on food/drug interactions, as well as nutrition interventions and modified diets.

Do older patients have different needs when it comes to patient teaching? The answer is no. Older patients must be assessed along the standards set out by the JCAHO, such as those mentioned above. Are your patient-teaching materials up-to-date? Are they in large print? Are they in an easy-to-read format? Do they avoid long, technical instructions?

Following are some excellent patient-education resources:
1-800 Numbers for Patient Support

Academic Journal Directory

Administration on Aging

Advance Directives International
American Association of Retired Persons
Gerontological Nursing Resources on the World Wide Web
The GeroWeb Virtual Library on Aging

Healthweb-Geriatrics and Gerontology

UTMB Center on Aging

The John A Hartford Foundation: Institute for Geriatric Nursing
National Institute on Aging

AACN will continue to provide age-related practice information, and wants to hear your suggestions or about changes that you made to your practice because of information you read in this “Geriatric Corner.” Did you find that having practical information regarding the care of the older adult useful? Is there a specific topic or concern that you would like to see featured here?

Contact AACN Clinical Practice Specialist Justine Medina, RN, MS, at (800) 394-5995 ext. 401; fax, (949) 448-5520; e-mail, Justine.Medina@aacn.org.

Practice Resource Network: Frequently Asked Questions

Q:Does AACN have any resources to help develop preceptors to train newly hired ICU nursing staff?

A:A preceptor is an experienced and competent staff nurse, who has received formal training to function in this capacity. The primary roles of a preceptor are as staff nurse role model, as socializer of the new employee into the workgroup and as educator.

The Joint Commission on the Accreditation of Healthcare Organizations Human Resource Standards require that healthcare institutions provide a staff orientation program that offers initial job development and information to new employees, as well as an assessment of employees’ competency to perform the responsibilities of their position.

AACN recently released the revised From Staff Nurse to Preceptor, which includes an instructor’s manual containing valuable information for those designing and implementing preceptor development programs. The manual provides the instructor with practical information on how to teach the content and assist nurses in developing the knowledge, skills and attitude that are important for preceptors. A preceptor handbook, which is a resource for the individual staff nurse who is learning to be a preceptor, is also available.

The instructor’s manual (Item #120500) can be purchased for $27 for AACN members ($45 for nonmembers). The preceptor handbook (Item #120550) is priced at $8 for members ($11 for nonmembers).

Both resources can be ordered by calling (800) 899-AACN (2226), or online at http://www.aacn.org.

Apply for Nursing Research Grants

The deadlines to apply for several nursing research grants are approaching. Following is information
about these grants:

American Nurses Foundation Research Grant
This $5,000 award is given annually to support critical care nursing research. Sponsored by AACN, this grant must be relevant to critical care nursing practice.

The program is designed for either a beginning nurse researcher or an experienced nurse researcher who is entering a new field of study.
The principal investigator must be an RN who has obtained at least a baccalaureate degree in nursing. The proposed study may be used to meet the requirements of an academic degree.

Application materials and instructions are available from ANF, (202) 651-7298, or by clicking on the ANF link from the AACN Web site at http://www.aacn.org. Applications must be received at ANF by May 1, 2000.

Medtronics Physio-Control-AACN Small Projects Grant
Cosponsored by Medtronics Physio-Control and AACN, this grant awards up to $1,500 to a qualified individual who is carrying out a project that focuses on aspects of acute myocardial infarction, resuscitation or sudden cardiac death, such as the use of defibrillation, synchronized cardioversion, noninvasive pacing and interpretative 12-lead electrocardiogram.

To be eligible, the applicant must be an active or affiliate member of AACN, who is not currently conducting a study funded by an AACN research grant.

To obtain application materials and instructions, call (800) 899-AACN (2226), or visit the research section of the AACN Web site at http://www.aacn.org.

Applications must be received by July 1, 2000.

AACN Clinical Inquiry Grants
These grants, funded by an anonymous donor, support projects that address one or more AACN research priority and that link to AACN’s vision.

Selected projects will receive up to $250 each.

The principal investigator in the proposed study must be an RN, a current member of AACN, employed in a clinical setting and directly involved in patient care.

To obtain application materials and instructions, call (800) 899-AACN (2226), or visit the research section of the AACN Web site at http://www.aacn.org.

Applications must be received by July 1, 2000.

Agilent Technologies-AACN Critical Care Nursing Research Grant
Cosponsored by Agilent Technologies and AACN, this grant supports research conducted by a critical care nurse.

The total of $35,000 includes $33,000 for research and $2,000 for travel expenses associated with presentations of the study findings. The recipient may use up to $3,000 of the research award to purchase a personal computer, utility software and printer to support the study. Computer-related expenses should be included and justified in the project budget.

The grant is intended to support a well-defined, well-described research project. The award selection will be based upon the scientific merit of the project; scientific and professional background of the applicant; adequacy of facilities and resources available for the research; originality; and potential benefits to the care of critically ill patients.

The preferred topic for this grant is the information technology requirements of patient management in critical care. Because this grant is intended to support research that has direct clinical application to critical care nursing practice, proposals for basic science or animal studies are not eligible. Reviewers’ comments will not be provided to applicants.

To be eligible, the applicant must be both an RN and an active AACN member. The grant can be used to fund research associated with an
academic degree.

To obtain application materials and instructions, call (800) 899-AACN (2226), or visit the research section of the AACN Web site at http://www.aacn.org.

The Power of One: Patient Confidentiality: Is It Ever OK to Tell?
By Lisa Pettrey, RN, MS

William is a 19-year-old male who was admitted to the ICU after receiving several gun shot wounds in a drive-by shooting. His hospital stay was uneventful, and Cindy, his primary nurse, is making preparations for his discharge to home. William will still require care of his abdominal wounds. Medicaid will not pay for home nursing visits, because William lives with his mother, who can provide this care.

The healthcare team is aware that William has been determined to be HIV-positive. However, his mother is unaware of his HIV status, and he is adamant that she must not be told. He tells Cindy that he is concerned his mother would “disown” him if she knew he was actively homosexual. Do Cindy and the other members of the healthcare team have an ethical obligation to inform William’s mother of his HIV status?

Critical care nurses are commonly presented with this type of dilemma. Confidentiality is based on the principle of autonomy, or allowing individuals to control the flow of information about themselves. Caregivers have an obligation to work to reduce the patient vulnerability that is experienced as a result of disease or injury. Violating confidentiality would increase their vulnerability in an already vulnerable situation. This is an extension of the principle of beneficence. The principle of fidelity, or “keeping faith” with another, is an important dimension of the caregiver’s role. Is breaching confidentiality ever ethically acceptable? Only if the following conditions are met: 1) an imminent threat of serious and irreversible harm exists; 2) breaching the confidentiality is the only alternative to avoiding that threat; 3) the harm done by breaching the confidentiality and the harm being avoided by breaching the confidence are assessed as similar.1

How do these principles and ideas apply to this case? As nurses, we are fortunate that we never have to act alone. The “power of one” guides us to advocate for our patients and their issues. Cindy may be the best person to identify the issue and coordinate the forum for discussion.

Because patient care dilemmas such as this should be addressed with other members of the healthcare team, resources such as ethics committees can be invaluable. Nurses can be creative in looking for “win-win” alternatives. Can the social worker, case manager or community health coordinator become involved to brainstorm other options for home care? Can further discussion with William persuade him to disclose this information to his mother, offering assistance with this disclosure and family support or counseling? If no alternative is found, the discussion must center on determining the seriousness of the threat or harm if confidentiality is not breached. Although contracting HIV is clearly a serious harm, is the risk to the mother imminent? If the mother is educated about using universal precautions, provided with gloves and observed closely by William, would the threat be minimized? Cindy could also assess the level of exposure to blood or secretions that would be involved in the wound care. On the other hand, does William’s mother have a right to be warned of possible harm to herself if she accepts this duty? A home health nurse would certainly be given the HIV status information. Does William’s mother have the same right, because she is assuming the same function? As is often true with respect to ethical dilemmas, both sides could be ethically justified. Only team discussion and support can assist Cindy in resolving this issue in William’s particular case.

Of even greater concern than patient scenarios like this one are the more common breaches of confidentiality that happen daily in the healthcare environment. Carelessness and indiscretion are observed in elevators, offices and cafeterias. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) clearly mandates against breaches in patient’s confidentiality verbally, in written form or through information systems. Protecting patient rights is a challenge in any institution. Estimates are that as many as 100 healthcare professionals have legitimate access to a patient’s medical record, even during a fairly routine hospital stay.2 How many of us have said that we would never want to be a patient in our hospital, because we fear that we would have no control over others’ invasion into our privacy, whether intentional or unintentional? This is an area in which each of us can make a tremendous difference by assisting in creating environments where a patient’s confidentiality is respected. All nurses can use the “power of one” to advocate for their patients’ right to privacy and control over what they want others to know. Our patients are counting on us.

1. Fleck, L and Angell, M. Case Studies. Hastings Center Report, November-December 1991; p. 39-40.
2. Siegler, M. Confidentiality in medicine: a decrepitcConcept. N Engl J Med, 1982; 307:1518-1521.

Lisa Pettrey is manager of clinical outcomes at Grant/Riverside Methodist Hospital, Columbus, Ohio. She is a member of the AACN Ethics Integration Work Group.

Share Outcome Data and Tools Demonstrating the Value of APNs
By Tom Ahrens, RN, DNS, CCRN, CS

Advanced Practice Nurses (APNs) are often concerned about job security. In many circumstances, the reason is confusion about the APN role and how it impacts patient outcomes and healthcare costs within a facility or medical group. Communicating the positive influence APNs have on patient outcomes is essential to ensuring that APN positions are supported and valued.

AACN recognizes that APNs are struggling to demonstrate this value to their managers and administrators. In addressing this issue, the Advanced Practice Work Group is developing a database of information on ways that APNs have affected patient outcomes and healthcare costs. An extensive review of current literature is in progress to identify outcome measures and tools that have been used to assess APN impact.
APNs who have developed or used an outcome measure or tool to gauge this impact are encouraged to share it with AACN. These resources will then be compiled and evaluated for established reliability, validity and use by AACN members. The Advanced Practice Work Group is also seeking information about creative approaches that APNs have used to measure the impact of their care on patients, families, other staff or costs.

This information will be used to develop an online Outcomes database, which members can access for their own use. Send information to Clinical Practice Specialist Kim Brown, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 448-5559. Direct questions about this project to Brown at (800) 394-5995, ext. 339; e-mail, kim.brown@aacn.org.

Tom Ahrens is a clinical nurse specialist at Barnes-Jewish Hospital, St. Louis, Mo.

Submit Your Research or Creative Solutions Abstracts for NTI 2001

Submit your research and research abstracts or your creative solutions abstracts for AACN’s National Teaching Institute™ and Critical Care Exposition in 2001 in Anaheim, Calif. Sept. 1, 2000, is the deadline for submissions.

Presenters of selected abstracts receive a $75 reduction in NTI registration fees. All other expenses are the responsibility of the presenter, who can be either the first author or a designate of the author. NTI 2001 is scheduled for May 19 through 24.

Following is information about these abstracts:

Abstracts can focus on any aspect of critical care nursing research including reports of research studies or reports of research utilization. Only abstracts of completed projects will be accepted.

Abstracts reporting research studies must address the purpose; background and significance; methods; results; and conclusions.

Creative Solutions
Abstracts should focus on specific strategies and practice innovations that are used by nurses to solve difficult, unique or interesting problems in patient care, nursing practice, nursing management or nursing education. The creative solution must have been implemented, with outcomes evaluated.

Abstracts must address the purpose of the project and include a description of the creative solution, as well as evaluation and outcomes.

Accepted abstracts will be designated either as an oral presentation or as a poster presentation.

To obtain abstract forms, call (800) 899-AACN (2226), or visit the research area of the AACN Web site at http://www.aacn.org.

Write a CE Article for AACN News

AACN is seeking nurses or other healthcare professionals who are interested in submitting articles to be published as continuing education offerings in AACN News and on the AACN Web site, or for use as a monograph.

Suggested topics include domestic violence, AIDS/HIV to meet state relicensure requirements (e.g. Florida), telemetry and progressive care issues, pain management, sedation, neuromuscular blockade, case management, invasive and noninvasive monitoring and renal patient care, as well as JCAHO compliance-related articles that address competency and skill validation programs, tools or best practices.

Send abstracts to M. Martineau, Education Resource Specialist, AACN, 101 Columbia, Aliso Viejo, CA 92656. Additional information is available by calling (949) 362-2000, ext. 361.

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