Brigham nurses showcased the breadth and depth of their research at the inaugural Karsh Nursing Scholars Day, an event that celebrated nurses’ contributions to science and health care. On May 30, nurses presented posters and demonstrations throughout the hospital, sharing case studies, analyses, innovations and more. Here is a sampling of the nearly 55 topics presented on electronic posters throughout the main campus.
A Lung Transplant Class
In November 2018, Catherine Masse, BSN, RN, PCCN, and Maureen Tapper, MSN, RN, PCCN, embarked on a journey to help educate their peers who care for lung transplant recipients. Patients who have had a lung transplant require unique care — their needs and medications are distinct from patients who have undergone other types of thoracic surgery. Masse and Tapper, together with a lung transplant inpatient nurse coordinator, a pharmacist, and a professional development manager, developed a three-hour educational class for their nursing peers, covering the pre-lung transplant process, medications, post-operative nursing care and patient education. Following the course, nurses scored 20 percent higher on a test of their knowledge and self-reported confidence levels increased by 59 percent. All reported an increase in knowledge, confidence and competence in taking care of lung transplant patients.
“The care for our patients is complex, and we want both the nurses and the patients to feel knowledgeable and confident about their post-operative care,” said Tapper. “We’re gratified to see the results so far.”
As a next step, Masse and Tapper want to survey outpatient transplant coordinators to determine if the class has improved patients’ readiness for discharge.
Studying Breastfeeding Outcomes
Most full-term babies who need nutritional supplementation to breast milk are given infant formula, but nurse investigators wanted to explore whether giving pasteurized donor human milk (PDHM) may influence breastfeeding outcomes for mothers and babies. PDHM is supplied by mothers who can produce more milk than their child needs. PDHM is generally given to premature infants, but Jennifer Riley, RN, IBCLC, a lactation consultant on Postpartum, CWN 9 & 10, and colleagues established a pilot study to examine the practice of provide the option of supplementation with PDHM to mothers of full-term infants, a practice started at BWH in 2013. With 39 mother-infant pairs enrolled in the study, the team found that those who opted for PDHM to participate had lower body mass index and higher rates of intending to breastfeed. Mothers who supplemented with formula and those who supplemented with PDHM did not have differing breastfeeding outcomes one month after leaving the hospital, but mothers in both groups reported lower confidence in their ability to achieve their breastfeeding goals.
“Based on our findings, we’d like to start an outpatient lactation program to support mothers after they leave the hospital,” said Riley.
A Case Study in Desensitization
Donna-Marie Lynch, NP, knew that the outlook for her patient was bleak. A 58-year-old woman who had been receiving treatment for cutaneous T cell lymphoma, the patient had developed a bad reaction to the drug that was keeping her alive. Stopping treatment would mean the return of painful, debilitating skin lesions, but continuing it could put her at risk of losing all her skin and possibly her life. Coming to the Brigham for desensitization treatment was a longshot but her last hope.
“It was a risk, but we knew there was no other choice — this patient had no other treatment options available,” said Lynch.
With the help of the Brigham’s team, the patient was given a fraction of the dosage of the cancer treatment — not enough to provoke an allergic reaction. Over the course of 30 treatments, the care team incrementally increased the dosage, finally reaching a level that could contain the cancer without putting the patient at risk of an adverse reaction.
Improved Visit Compliance via Virtual Visits
For patients with a seizure disorder such as epilepsy, getting to and from appointments can be a major hurdle, but follow-up care is crucial to their safety and well-being.
Erin Farina, RN, and colleagues in the Division of Epilepsy offered virtual visits, prioritizing patients with frequent appointment no-shows or cancellations. Although the no-show rate was not impacted, there was an overall improvement in virtual visit cancellation rates as compared to office visits. Furthermore, subjective data indicates the value of a virtual visit option, as patients expressed it eases their stress around their ability to get to appointments. Providers also noticed improved compliance.
“People are starting to open up their minds to virtual visits,” said Farina. “We are probably one of the first practices to roll this out to our patients with epilepsy.”
Sounding the Alarm
When an alarm sounds in a patient care unit, it could signal an urgent need, but past studies have found that as many as 90 percent of the alarms that go off in a given hospital unit are false, leading to alarm fatigue.
“I always remind my peers, even when we’re tired of hearing the same alarm go off again and again, we can never ignore it — the one time you do will be the time when it’s a true emergency,” said Cynthia Scherer, BSN, RN.
Scherer, along with Mary Cote, MSN, RN, PCCCN, and colleagues want to help decrease the number of so-called nuisance alarms so that nurses can be more sharply focused on the ones that signal an emergency. To do so, they are getting a baseline reading on the number of alarms that go off in the cardiac surgery and cardiology intermediate care units, trialing new software designed to decrease the number of alarms and surveying nurses about whether this intervention is useful or cumbersome.
“We’re continuing to look for new innovations that can help us combat the problem of alarm fatigue,” said Cote.