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A study is conducted to examine different hospital strategies associated with a faster door-to-balloon time during primary percutaneous coronary intervention. Results show that many specific hospital strategies are associated with a significant reduction in the door-to-balloon time during treatment.

Background: To reduce the risk of renal toxicity, urine specific gravity (SG) and pH (potential of hydrogen) parameters should be met before nephrotoxic chemotherapeutic agents are administered. The purpose of this study was to compare laboratory urine SG and pH values with those obtained with urine point-of-care (POC) testing methods commonly used when caring for children receiving nephrotoxic chemotherapeutic agents. Method: A method-comparison design was used to compare the values of three POC methods for SG (dipstick, automated dipstick reader, refractometer) and three pH (dipstick, automated dipstick reader, litmus paper) methods with laboratory analysis of 86 urine samples from 43 children hospitalized on a pediatric hematology oncology unit in a large academic medical center. The Bland–Altman method was used to calculate bias and precision between POC and laboratory values. Results: Except for the SG refractometer, bias values from Bland–Altman graphs demonstrated poor agreement between POC and laboratory urine SG and pH results. The precision values between these methods indicated overestimation or underestimation of hydration or urine pH status. Compared with laboratory methods, 31% of POC visual reading of dipstick SG values were falsely low—putting the patient at risk of not receiving necessary hydration and subsequent nephrotoxicity. Discussion: In conclusion, most POC urine testing methods for SG and pH are not accurate compared with laboratory analysis. Because laboratory analyses can take longer than POC methods to obtain results, clinicians need to collaborate with laboratory medicine to ensure that an expedited process is in place in order to prevent chemotherapy administration delays. [ABSTRACT FROM AUTHOR]

Context—Living donor liver transplant is a viable option for eligible persons in need of a liver transplant, but little is known about the hospitalization experience of patients undergoing hepatectomy for transplant donation. Objective—To explore the hospital experience of patients recovering from donor hepatectomy. Design—A qualitative interpretive descriptive design was used to understand the hospital experience of patients recovering from donor hepatectomy. Semistructured interviews, conducted before discharge, were audiotaped and transcribed verbatim. Coding was performed independently, then jointly by investigators to reach consensus on emerging themes. Setting—Major university hospital in the Northeastern United States. Sample—Adults (>18 years of age) whose primary language was English or Spanish and who could provide written informed consent. Results—The sample consisted of 15 participants who had a mean age of 34.6 years; half were women. Most were white and college educated. The relationship of the donors to recipients varied from immediate family to altruistic donors. “Getting used to being a patient” was the major theme that captured the patients' postoperative experience. Four subthemes explained the experience: regaining consciousness, all those tubes, expecting horrible pain, and feeling special and cared for. These were described in the context of an “amazing and impressive” transplant team. Conclusion—As healthy donors are getting used to being patients, these results provide clinicians with a deeper understanding of the transplant experience from the donor's perspective so that care can be tailored to meet their unique needs. [ABSTRACT FROM AUTHOR]

Purpose: Timely activation of the rapid response team (RRT) depends on nurses' willingness and ability to make the call. This study's purpose was to examine nurses' decision-making regarding RRT activation. The following questions were asked: (1) What are nurses' perceptions about their ability to call the RRT? (2) What triggers nurses' decision to call the RRT? (3) Who is involved in making the decision to call the RRT? (4) What factors are associated with nurses making the decision to call the RRT independently? Background: RRTs are activated to manage patients with deteriorating conditions to prevent cardiac and/or respiratory arrest. The decision to call the RRT is complex. Nurses' inability to make the decision to call the RRT independently leads to delays in lifesaving care. To our knowledge, no studies examining nurses' RRT decision-making have used multivariate analysis to adjust for covariates affecting this decision (ie, confidence to do so without validation from others, years of nursing experience, educational preparation). Method: A cross-sectional study design was used with a convenience sample of 245 medical-surgical nurses (mean age, 34.4 years; mean years in practice, 6.9) who worked 24 to 40 hours per week at a 1541-bed Magnet hospital. A 30-item electronic survey with 4-point Likert scale responses was created, and face validity was determined by a panel of experts. Institutional review board approval was received. Nurses' informed consent was indicated by survey completion. Statistically significant demographic, nurse perception, and RRT trigger variables (P < .10 in the bivariate analyses) were selected for entry in the logistic regression model to determine factors associated with the nurses' decision to call the RRT independently. Results: Although nurses reported feeling confident with independent RRT decisionmaking, they often consulted other nurses. Activating the RRT is an infrequent decision, which may create this need. Nurses should value their intuition and take action to call the RRT for assistance. Medical staff's lack of responsiveness to nurses' concerns is a powerful trigger for independent RRT activation by nurses, suggesting that efforts need to be made to improve collaborative planning to manage patients' urgent needs. [ABSTRACT FROM AUTHOR]

Purpose: Nurse preceptors who have high self-efficacy (SE) in their role positively influence their orientees' experiences. SE reflects a person's sense of confidence that one can organize and complete a behavior competently. The purpose of this study was to examine demographic characteristics and other factors (ie, performance accomplishment, including clinical leadership behaviors; vicarious experience; social persuasion; emotional) independently associated with critical care (CC) nurse preceptors' SE. Background/Significance: CC nurse turnover creates an unstable environment. The key to minimizing turnover is to provide an effective orientation by well-prepared preceptors who are confident serving in this role and use clinical leadership behaviors. Preceptors often receive little preparation. They may lack confidence, knowledge, or skill needed to facilitate orientees' learning, resulting in low preceptor SE. To our knowledge, there are no studies examining factors that shape CC preceptors' SE. Method: This study used a descriptive correlational design with a convenience sample of 104 CC preceptors from 16 CC areas of a large Magnet hospital. The study received human subjects approval. Nurses completed 3 study instruments via an electronic anonymous survey: The CC Preceptor Information Form, Patrick's Clinical Leadership Survey, and Parsons' Preceptor SE Questionnaire. Bivariate analysis was used to examine associations between the independent variables (eg, demographic, clinical leadership) and the dependent variable (ie, preceptors' SE). Multiple regression was used to adjust for variables; P ≤ .05 indicated a factor's independent association with preceptor SE. Results: Most (91%) of the sample were women; the mean age was 43 years and mean time serving as a preceptor was 12 years. Higher SE scores were associated with male sex (P = .01); older age (P = .02); 4 performance accomplishment factors: higher clinical leadership score (P < .001), feeling well prepared for the role (P < .001), attended leadership class (P = .01), and attended preceptor class (P = .03); and 1 emotional factor: lower anxiety about being a preceptor (P = .001). Factors independently associated with higher SE scores were higher clinical leadership score (P = .003), feeling well prepared for the role (P = .01), and less anxiety about being a preceptor (P = .001), explaining 34% of the variance in the model. Conclusion: This study adjusted for important factors influencing CC preceptors' SE. The results indicate several ways to enhance SE. CC nurse leaders need to communicate with new preceptors to determine how well prepared they feel before serving as a preceptor, offer opportunities for developing preceptor and clinical leadership skills, and examine situations that cause anxiety and intervene to minimize this distressing symptom. Ongoing measurement of preceptor SE may be warranted. [ABSTRACT FROM AUTHOR]

Yale-New Haven Hospital, in partnership with Voluntary Hospital Association (VHA Inc), launched the Women's Heart Advantage program in March 2001. Major program components implemented include (1) a comprehensive initial and ongoing internal communication program; (2) a health promotion initiative including a 24-hour, 7-days-a-week women's heart line staffed by nurses and an Internet health question-and-answer forum; (3) significant ongoing communication with nurses and physicians; (4) a community outreach effort to educate poor and minority women; and (5) an aggressive effort to secure financial partners to underwrite the cost of the program. Before launching the program, a telephone survey of 300 randomly selected New Haven County women ages 40 to 70 years was initiated in January 2001 and repeated in January 2002, 2003, and 2004. Findings include (1) the percentage of women who recognize heart disease as the number-one killer of women their age increased from 26% in 2001 to 59% in 2004, (2) the percentage of women who would call 9-1-1 or go directly to a hospital emergency department increased from 63% in 2002 to 83% in 2004, and (3) the percentage of women aware of recent Women's Heart Advantage program promotion grew from 33% in 2002 to 50% in 2004. Perhaps most importantly, the number of women with heart problems admitted through the hospital's emergency department increased from 1528 per year in 2001 to 1870 per year in 2004 (7.5% annual increase), whereas the number of men with heart problems admitted through the emergency department during the same time period has been relatively low (0.8% annual increase). By linking clinical, public health, and marketing expertise along with finding ways to partner with other organizations, the Women's Heart Advantage program bas contributed to remarkable changes in women's awareness, knowledge, and behaviors, suggesting a model for approaching similar health-related problems. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to explore the experience of retirement-age nurses and identify decision-making factors and innovations to enhance retention., Background: A national shortage of nurses has created challenges to preserving quality patient care and level of nursing competency and managing turnover costs., Methods: A qualitative study using focus groups was conducted of nurses 55 years or older who were working or recently retired. Data were audiotaped and transcribed verbatim, with content analysis used to code in an iterative process until consensus was reached., Results: The tension of balancing the love of patient care within a changing healthcare system was described. Patient acuity, competing roles, and the centrality of computers were stressors and integrally related. Flexibility in work schedules and new practice models were important to retirement decision making for work-life balance and retention., Conclusion: Passion for patient care dominated decisions to continue working. Innovations in practice models and scheduling offer opportunities to enhance the retention of experienced nurses., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)