Becoming Grayson

Spring Workshop – Embrace Action

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Spring Workshop – Embrace Action

Presented By Dr. Debra Thorp, Morgan Rock, RN and Jennifer Bourgoine, RN
Attended and written by Cheryl Langford.

The first set of speakers were all from Park Nicollet and worked at the Transgender Clinic and Services in Minneapolis. There were 15 pages as a handout of the power point presentation and we did not get through everything. Two of the goals were to help the attendees learn appropriate terminology and the meaning of LGBTQIA, as well as understand the continuum of gender identity and sexual health. L is for Lesbian, G is for Gay, B is for Bisexual, T is for Transgender, Q is for Queer or Questioning, I is for Intersex, A is for Asexual/Ally/Advocate.

Another goal was to help us understand what transgender is NOT. Transgender is a newer term, but throughout history and across cultures, there have been gender choices. Transgender is not a disease and not a choice.

Sex is the identification given at birth, male or female. Gender is how an individual perceives themself and what they call themselves. Gender identify can be the same or different from one’s sex assigned at birth. Gender Dysphoria is a condition where a person experiences discomfort or distress because there is a mismatch between their biological sex and gender identity.[/vc_column_text][/vc_column][vc_column width=”1/3″][vc_widget_sidebar sidebar_id=”main-sidebar”][/vc_column][/vc_row]

Opioid Crisis In America

Do you have Moral Courage?

Vaginal Mesh

Healing Touch in a Hospital Setting

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Healing Touch in a Hospital Setting

Presented at the AORN of Twin Cities Fall Workshop, November 4th, 2017
By Greg Falvey, RN, BSN, BC HTP-A
Article written by Stacy Johnson

The objectives of the presentation were to describe Healing Touch (HT), incorporate evidence based practice, describe the relevance to nursing and include personal stories. HT is an energy therapy. Healing touch practitioners consciously use their hands in a heart-centered and intentional way to enhance, support and facilitate physical, emotional, and spiritual health and self healing.

Healing Touch utilizes light or near-body touch to clear, balance and energize the human energy system in an effort to promote healing for the whole person, mind, body and spirit. The goal of HT is to accelerate the patient’s own healing processes by restoring balance in the energy system of the patient and of the environment. HT can be incorporated in Holistic nursing practice. Using their hands in an intentional way, an HT practitioner can affect a patient’s energy field to promote self-healing and well-being.

Nursing literature describes many benefits of HT to patients. HT may provide the nurse with another resource that can be used in conjunction with pharmacologic therapy to decrease pain and anxiety for postoperative Total Knee patients. In this study, HT was used to promote relaxation, accelerate wound healing, diminish depression, and increase a patient’s sense of well-being. Clients reported a statistically significant reduction of stress after HT, and one month after surgery, 95% of the HT group felt their pain was adequately controlled, compared with 87% of the group that received standard therapy during their hospital stay.

Another study aimed at improving physical and psychological symptoms caused or arising from energy imbalances in the body. Reported benefits of HT include: reducing anxiety, increasing relaxation, decreasing pain, diminishing depression, and increasing a sense of well-being. While no significant decrease in the use of pain or anti-emetic medication was observed (many of which were scheduled), significant differences were noted in anxiety scores and length of hospital stay compared to the control group.

Our presenter works as the night shift RN in a metro hospital PACU. When there are no patients in the PACU, he assists in other units in the hospital. He has been trained as an HT practitioner, and his manager approves his use of HT as an integrative therapy. He presented personal stories where he has been able to improve care to patients using HT. Examples included reducing patient’s fear and anxiety related to surgery and more effective pain control.

Following the presentation, several HT practitioners and HT students were present to provide HT to the workshop attendees. All volunteers were able to experience a healing touch session.

 

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No Foley-ing Around: Preventing CAUTI in Surgery Patients

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No Foley-ing Around: \

Preventing CAUTI in Surgery Patients

Presented at the AORN of Twin Cities Fall Workshop, November 4th, 2017
By Stacy Johnson, MS, APRN, CNS, CNOR, CNS-CP & Ellie Carter, CLS, MPH, CIS Infection Preventionist
Article written by Stacy Johnson

This presentation discussed the impact of catheter-associated urinary tract infection (CAUTI) on patients and hospitals and the methods implemented in perioperative services by Abbott Northwestern Hospital (ANW), part of Allina Health, to reduce CAUTI in surgery patients.

Urinary tract infections cause 40% of hospital acquired infections. Most of these infections are due to urinary catheters. Up to 25% of hospital inpatients are catheterized. CAUTI can lengthen a patient’s hospital stay, cause pain, restrict ambulation and even lead to death. Healthcare costs related to CAUTI are increased $0.4-0.5 billion nation-wide. CAUTI identified in ICU and on med/surg units are reportable to the CDC. CAUTI reduction is an Allina-wide priority.

On any given day, a majority of Foley catheters in patient use in the hospital are inserted in surgery. The number of Foley catheters placed in the perioperative care areas (pre-op, intra-op, and PACU) was determined. Data collection identified CAUTI developing within 5 days of insertion, and these “5-day CAUTIs”/1000 Foley catheters inserted in surgical services *1000 was used to determine the rate. 27% of all CAUTIs in the hospital were identified within 5 days of insertion in surgery.

Improving Insertion Asepsis:
ANW performed an assessment of 24 RNs inserting a Foley catheter into a manikin. These RNs represented a broad range of nursing experience. 1 out of 24 attempts were observed to be aseptically inserted. These results were not unlike insertion assessment results at other hospitals nation-wide. The Minnesota Hospital Association identified establishment of criteria for catheter insertion, and use of 2- person insertion technique, having a “buddy” assist and monitor for breaks in asepsis, in their “Cut CAUTI Bundle” practices. Starting in the ICU, RN CAUTI Champions provided training to review best practices for catheter insertion, including 2- person insertion technique, with one RN using a step by step aseptic insertion checklist.

Surgery nurses were engaged as CAUTI Champions to participate in a team to collaborate with the hospital CAUTI reduction efforts. To reduce CAUTI in surgery patients, the strategy aimed at improving insertion technique to prevent breaks in asepsis, and reduce unnecessary placement of catheters. CAUTI Champions elected to teach a standard insertion technique for all Foley catheters inserted in the perioperative setting. Three standard practices for surgery were established to enhance aseptic technique:

  • Use of sterile surgical blue towels to define the sterile field.
  • A 2-person team for indwelling catheter insertion, using surg techs as the “buddy” for observing aseptic insertion and assistance to the RN.
  • Securement of the device in the OR to minimize urethral tears during positioning and transfer.

A video was filmed in the OR to engage staff in perioperative services and facilitate training the new standard practices. Mandatory return demonstration using a simulation model was required for all perioperative nurses. CAUTI data specific to surgical services insertion technique was shared with the surgery teams at staff meetings.

Perioperative Bladder Assessment Protocol
At the same time, to reduce unnecessary Foley catheter insertions, orthopedic surgeons approved a perioperative bladder assessment protocol for patients having total hip and knee joint surgery. Over 1200 total joint surgeries were performed each year with routine Foley catheter insertion. The total joint protocol aligned with CDC guidelines to use urinary catheters only as necessary, rather than routinely. Bladder scanning devices were purchased for use in surgery. Educational sessions were conducted to train nursing staff on use of bladder ultrasound scanning (BUS) devices.

  • CAUTI Champions helped to facilitate communication and promote use of the total joint surgery bladder management protocol.
  • Pre-Op RNs screened patients presenting for total joint surgery for risk factors for urinary retention and need for Foley catheter.
  • Patients mobilized in pre-op area to void prior to procedure and a post void residual BUS performed.
  • Time of last pre-operative void and the amount of post void residual documented and communicated to OR RN.
  • End of procedure, BUS assessment for urinary retention was performed by intra op RN.
  • Intermittent straight catheter algorithm followed by OR and PACU RNs.

Outcomes:
The communication between the perioperative units and patient bladder management awareness was increased. The “5-day CAUTI” rate in patients with a Foley catheter inserted in the surgery department decreased from 1.94 to 1.44 the first year after implementation of the 2-person technique. The annual goal to reduce CAUTI by 20% was achieved. The implementation of the bladder management protocol has been successful, reducing the number of Foley catheter use in patients on the orthopedic inpatient unit.

More recently, there has been an increase in CAUTI rates in patients having their Foley catheter placed in surgery. A CAUTI Clinical Action Team (CAT) was implemented to continue to investigate CAUTI cases, review charts for trends, and continue to audit practice and champion best practices. The success of the perioperative bladder assessment protocol is now well established. Surgeon groups are reviewing the protocol for use in other surgical populations.[/vc_column_text][/vc_column][vc_column width=”1/3″][vc_wp_custommenu nav_menu=”11″][/vc_column][/vc_row]