Demonstration Projects Build Respect, Impact

A second round of demonstration projects between UF Health nurses and UF College of Nursing faculty ended recently. But, in many cases, the projects showed enough positive outcomes in hospital patients that continued study and protocol changes are possible.  

The projects also forged collegial bonds between hospital nurses and college faculty, bridging clinical and academic practice.  

Projects were submitted by UF Health nurses at Shands and Jacksonville and after a review process were assigned a College of Nursing advisor who would help guide the study.  

The projects ranged from studying the effect of aromatherapy on the reduction of anxiety in preoperative surgery patients to diabetes self-management education and support. One project garnered global attention and led to an invitation to the 35th International Nursing Research Congress in Singapore.  

UF Health wound care nurses Randy Brian and Cindy Westbrook and UF Nursing Clinical Associate Professor Sandra Citty, PhD, RN, APRN-BC, evaluated how wound care management of large-bore cannula sites helped lessen site deterioration, keeping patients connected to life-saving heart-lung machines. The project sought to formalize a standard of care for the wounds.    

Laurie Duckworth, PhD, APRN, FNP-C, FAAN, clinical professor, and Jennifer Pruitt, RN, MSN, CNM, ARNP are directors of nursing research for UF Health and helped oversee the demonstration projects.  

Duckworth said there was a great response to the projects. Bedside nurses came forward with innovative ideas and were paired with a college faculty member, allowing them to feel valued and supported.  

“The nurses felt they had someone coaching them through the steps,” Duckworth said. “It’s a beautiful thing and has enhanced the relationship between the College of Nursing faculty and UF Health bedside nurses. Bedside nurses and clinical faculty see a pathway forward to receive funding and engage in research at the bedside, and that changes the culture.”    

Snuggle Up  

UF Health Shands nurse Elizabeth de Paula Fonseca, RN, and UF Nursing Assistant Professor Marion Bendixen, PhD, MSN, RN, IBCLC, worked on developing a standardized protocol for rewarming hypothermic newborns.  

de Paula Fonseca applied for a demonstration project after noticing a lack of guidelines for rewarming cold newborns.   

“It really varied from nurse to nurse as far as what method they would use to rewarm the baby, how often they would recheck temperature, or if they did any other assessment,” she said. “When we did a retrospective analysis, we really saw it was all over the place.”   

The project established guidelines for rewarming, including skin-to-skin rewarming as the first preference, frequent temperature checks, and blood glucose assessments, as studies showed a link between hypothermia and low blood sugar, which can cause metabolic acidosis, increasing the risk of sepsis and death.  

“Skin-to-skin rewarming has shown to be effective. It also has the added benefit of the mother bonding with their baby,” de Paula Fonseca said.  

During the three-month study, skin-to-skin rewarming went from 30% to 73%, and the average time to rewarm a baby to normal temperature dropped from 59 minutes to 47 minutes.   

Also, 92% of the hypothermic babies had a blood glucose assessment within one hour of the event, up from 55%. An unexpected outcome was that only two of the 70 babies showed signs of low blood sugar.   

“We’re not sure why. There is a link between hypothermia and hypoglycemia. We would like to look into that,” she said.  

They hope UF Health will implement standard protocols for hypothermic babies based on their project.  

Pressure Drop   

Bonnie Wiley, RN, a wound and ostomy nurse at UF Health Jacksonville, hates HAPIs. Despite their cheerful-sounding acronym, HAPI stands for Hospital Acquired Pressure Injury.  

The wounds can be devastating to a patient, causing pain, and infection, and may lead to death. It also impacts a hospital’s bottom line as insurance companies do not cover the treatment of the wounds, and they can potentially expose facilities to patient lawsuits.   

One of the most effective ways to prevent a pressure wound is to turn high-risk patients every two hours. Wiley found during a chart review that sometimes turns were missed.   

Wiley and UF Health Jacksonville Clinical Nurse Scientist Deborah Brabham, PhD, RN, CNE, proposed implementing a two-nurse turn team in two hospital units. The team would turn high-risk patients every two hours. An alarm clock was installed at the nurse’s station. It even allowed the nurses to record personal messages and songs to avoid alarm fatigue.    

After three months, the units using turn teams reported two pressure wounds in 240 patients, compared with seven in the three months prior. They also saw pressure wounds heal in seven patients who came into the hospital with injuries.  

“We’re very happy with the outcome,” Wiley said. “At this time, three units have taken it upon themselves to start the turn teams on their own because they heard of the results we had. It’s been fun to experience synergistic collaboration on the campuses. One of my favorite parts was hearing about the other projects and getting excited about being a part of UF Health.”  

Crafting Workshops  

UF Health Shands Nurse Manager Joanne McNeil, RN, saw firsthand the impact of COVID-19 on nurses’ psyches.   

“It’s like we lost some of ourselves,” McNeil said. “The environment became more challenging post-COVID. We got into a task mode. How can you get yourself back from tasking to where you can be proactive? The whole idea was how do we empower the nurse? How do we get them to have job satisfaction?”  

With the help of UF Nursing Clinical Assistant Professor Bryce Catarelli, DNP, APRN, FNP-C, they recruited nearly 40 nurse managers from UF Health Shands for a workshop series exploring their work responsibilities and possibly customizing certain aspects to create a better work environment.   

The workshops included group activities, developing self-care routines, and time management strategies.  

The workshops were based on job crafting, where employees redesign their jobs to fit their needs, interests, and strengths.    

“Job crafting is nothing new, it’s just never been done with nursing,” said Catarelli.  

The project was titled “ENGAGE: Empowering Nurse Leaders to Grow and Garner Enthusiasm.”  

“The workshops involved a lot of self-reflection. You had some tears,” McNeil said.  

After the workshops 63% of those who attended intended to stay in their position, up from 59% before the workshops.   

“It may not sound like a significant change, but that is two or three nurse leaders who did not intend to stay,” Catarelli said.  

McNeil and Catarelli have presented the project at several conferences and were featured on the Shift Change Radio Hour show on WMBT-FM.   

While the projects have officially closed, that doesn’t mean the work comes to a halt.   

“We don’t want to stop the momentum,” Pruitt said. “Some are still analyzing results. Some are in the dissemination process. They still have conferences where they will present. Some are looking for other funding sources.”  

UF Health will soon begin accepting submissions for the Research & Innovation Fellowship where nurses can submit project ideas and can start the development process.   

“When we do get a renewal of the demonstration project funding, we will be ready to rock and roll with new studies,” Pruitt said. “The relationships we have built between the College of Nursing and UF Health will continue. Those relationships don’t end when this phase of the demonstration projects ends.”