Music Eases Anxiety and Need for Sedation, Pain Medication for Patients on Ventilators

A study published online in the Journal of the American Medical Association reveals that listening to music can help soothe critically ill patients who are on ventilators, reducing their anxiety, need for pain medication and sedation. Reearchers conducted the trial with 373 ventilator patients in the ICU and found that those who listened to music for 80 minutes a day reduced their anxiety by nearly 20 points compared with those who did not.

The patients were divided into three groups: those who listened to white noise, those who chose music to listen to and those who received usual care, with neither intervention.  Being able to select the music they listened to also had an impact. Patients who chose their music and listened to it when they wanted to and for as long as they wanted required sedation less often that patients in the control or white noise group.

Most patients in the study had been intubated for respiratory failure or distress and all were alert and able to follow commands.

An INQRI-funded study led by Tracey Yap and Jay Kim found another use for music: reducing the incidence of pressure ulcers. The study used music to cue patients in long-term care facilities to move in order to avoid getting pressure ulcers. The music also cued staff to help to move those patients who couldn't move on their own. Dr. Yap blogged about the study and some unexpected results on the RWJF Human Capital blog for National Nurses Week.

Another INQRI-funded study, led by Michele Balas and William Burke, focused on helping critically ill patients on ventilators stay alert, calm and delirium-free. The researchers tested an intervention that used a nurse-led interprofessional team to implement a bundle of evidence-based practices related to communication, standardized care, and reducing sedation and the amount of time patients spent on a ventilator.

Nurse Staffing Ratios Can Affect Outcomes for Cardiac Patients

A study published online in JAMA Internal Medicine finds that hgher nurse-to-patient staffing ratios may improve survival rates for cardiac patients and help reduce the incidence of inhospital cardiac arrest. The study, led by Lena Chen of the University of Michigan, found that one factor that was constant in hospitals with higher survival rates and lower arrest rates was higher nurse staffing.

The study included more than 100,000 patients at 358 hospitals, it is reported on in Medpage Today.

Several INQRI studies have focused on the impact of nursing staffing on patient outcomes. A study led by Mary Blegen and Tom Vaughn found that higher nurse staffing levels reduce rates of infection, mortality due to congestive heart failure, failure to rescue, and prolonged hospital stays.

These findings support the need to address the nursing faculty shortage and the projected nursing shortage by preparing a larger, more diverse and more highly educated nursing workforce. The Bureau of Labor Statistics projects that by 2020, the nation will require an additional 1.2 million nurses to meet the need for health care. Developing that workforce is one goal of The Future of Nursing: Campaign for Action, which is working in all 50 states to advance nursing education, leadership and practice.

The Value-Added of Electronic Medical Records

An article in ADVANCE for Nurses looks at the ways in which health information technology is improving care, outcomes and nurses' work environments in health care settings around the country, particularly when that IT is built with nursing in mind.

At Baptist Health South Florida, patient barcodes allow nurses quick and easy access to their patients' full profiles. The barcodes have dramatically reduced wait time for pain medication and also helped to ensure that nurses know the exact doses and frequency of dosage for each of their patients' medications. Several INQRI studies have addresses nurses' role in medication management, including reducing medication errors and improving regimen adherence post hospital discharge.

Other uses of health IT, include automating the admissions process, so that when information on a patient is recorded during intake, that information is shared with other health care providers and hospital staff who may help provide care.

The article also discusses younger nurses' higher comfort level with information technology and ways that hospitals are successfully orienting new hires to their electronic medical records (EMR) systems and how schools of nursing are preparing students to use those records. A recent post on the RWJF Human Capital Blog by Ann Marie Mauro, an associate professor at NYU College of Nursing discusses how the college's simulation program also helps nursing students learn how to use EMR.

American Nurses Foundation Supports Nursing Research Into Bullying, Loneliness, Walking

Nursing research runs the gamut from investigations into nursing processes that affect patient care to testing whether seniors are better able to age in place if their homes are adapted to meet their needs. No matter, the topic, the body of research conducted by nurses continues to grow exponentially.

The latest issue of The American Nurse highlights the studies of three nurse researchers who have received grants from the American Nurses Foundation (ANF), including RWJF Nurse Faculty Scholar Laurie Theeke.

Theeke's research, funded by ANF and RWJF, involves exploring the emotions associated with loneliness, specifically among older adults living with chronic illness in Appalachia. She has found that older adults who scored high on a loneliness index felt stigma, sadness, anxiety, depression, anger, and fear. Theeke plans to test interventions that target specific components of loneliness. She suggests that further research might address whether people isolate themselves because of functional decline or whether isolation speeds that decline.

Other highlighted research studies explore how novice nurses cope with workplace bullying by nurse colleagues and whether safer walking areas influence health outcomes of low-income residents.

New Survey: Physicians, Nurse Practitioners Disagree on Nurses’ Role in Providing Primary Care

By Lori Melichar Gadkari, PhD, MA

Lori Melichar Gadkari, PhD, MA, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), in the Research and Evaluation Unit and the program officer for INQRI.

Yesterday the New England Journal of Medicine published the results of a study co-funded by the Robert Wood Johnson Foundation, Johnson & Johnson, and the Gordon and Betty Moore Foundation. “Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training.” The new study is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.

When asked how increasing the supply of nurse practitioners would potentially affect the United States health care system, the authors found that the majority of physicians (73%) said increasing the supply of primary care nurse practitioners (PCNPs) would lead to improvements in the timeliness of care. A much smaller majority of physicians (52%) said increasing the supply of PCNPs would lead to improvements in access to care for people in the country. 

However, the new survey found significant disagreement between primary care physicians and PCNPs about whether increasing the supply of PCNPs would improve patient safety and the effectiveness of care, and whether it would reduce costs. There was also a large professional divide about proposed changes to PCNPs’ scope of practice, putting PCNPs in leadership roles, and the quality of care that PCNPs provide.

Will Dr. Robot Open New Doors for Nurses?

By Olga Yakusheva, PhD and Richard C. Lindrooth, PhD

Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Both are INQRI grantees.

Technological innovation is rapidly transforming patient care. A new generation of innovations will potentially change the most fundamental aspect of the patient experience – patients’ interactions with physicians and nurses. The FDA recently approved the first autonomous telemedicine robot for use in acute care hospitals. Even more advanced technologies, some capable of processing up to tens of millions of pages of plain medical text per second, are being tested and may soon be used to diagnose conditions and recommend treatment, with limited input from clinicians.

This new technology has the potential to perform several tasks more efficiently than clinicians, albeit with some limitations. It can quickly and effectively sift through large amounts of information and, based on a complex set of guidelines, create a probability-weighted list of diagnoses and recommendations. The result will be purely evidence-based and free of human cognitive decision-making biases.  The technology can drastically speed diffusion of new research and guidelines through electronic dissemination, similar to automatic software updates, and make most novel treatment regimens instantly available to patients.

However, even the smartest technology may not perform well when guidelines require information that is not easily quantifiable, nor when decision-making requires patient-specific judgment. Furthermore, technology is unlikely to supplant humans in direct patient care, including procedures and tasks that require empathy and emotional support.

Nurses' Home Visits Decrease Postpartum Depression

Nurses' knowledge and skills can often serve patients well after they've been discharged from the hospital. A new study in the current issue of the Journal of Obstetric, Gynecologic and Neonatal Nursing finds an additional instance in which nurses can provide post-discharge care and improve outcomes for patients: reducing the incidence of postpartum depression in new mothers. The study findings were also reported in Advance for Nurses.

According to the study, led by June Andrews Horowitz at the William Connell School of Nursing at Boston College, nurses who visited new mothers and provided a sympathetic ear, assistance with referrals and help recognizing infants' cues were able to significantly improve mother-child interaction and symptoms of depression in the new mothers.

The nurses visited mothers in their homes at six weeks and three, six and nine months postpartum. Each visit lasted an hour.

An INQRI-funded study led by Linda Costa and Robert Feroli and published in the Journal of Nursing Quality Care, revealed that nurses who consulted with pharmacists and visited patients and their families at home post-discharge helped improve patients' adherence to their medication regimens.

The nurses conducted at-home interviews with patients about their medication, and observed whether patients had obtained the prescribed medication, how they were organizing their medication, how often they took it, and whether they obtained refills. They were also able to educate and coach patients about their medication and help them develop plans and systems to ensure they took the correct doses of medications at the correct intervals.