Diane Wrobleski - Academia.edu (original) (raw)

Papers by Diane Wrobleski

Research paper thumbnail of New Functions for New Demands

American School University, 1995

Research paper thumbnail of Determining the Need for a Pregnancy Test in the Emergency Department for a Complaint of Abdominal Pain Based on Recorded Patient History

Research paper thumbnail of Determination of Relationships among Patient Satisfaction, Pain Intensity and Expectations of Pain Management

Research paper thumbnail of Factors Affecting Postoperative Pain Relief in Patients Undergoing Colorectal and General Surgery

Research paper thumbnail of Simulation-based team training and debriefing to enhance nursing and physician collaboration

Journal of continuing education in nursing, 2014

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded... more HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at https://villanova.gosignmeup.com/dev_students.asp?action=browse&main=Nursing+Journals&misc=564. In order to obtain contact hours you must: 1. Read the article, "Simulation-Based Team Training and Debriefing to Enhance Nursing and Physician Collaboration," found on pages 297-303, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track...

Research paper thumbnail of Discharge planning rounds to the bedside: a patient- and family-centered approach

Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses

Discharge planning rounds done at the bedside is an effective patient-centered approach to discha... more Discharge planning rounds done at the bedside is an effective patient-centered approach to discharge planning and does not take any longer than traditional rounds apart from the patient and caregiver. Bedside rounds may decrease patient utilization of health care resources after discharge.

Research paper thumbnail of Bedside nurse-to-nurse handoff promotes patient safety

Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses

Nurse-to-nurse beside handoff allows the oncoming nurse to visualize the patient and ask question... more Nurse-to-nurse beside handoff allows the oncoming nurse to visualize the patient and ask questions of the previous nurse. It encourages pateints to be involved actively in their care and allows standardized communication between nursing shifts. Patient handoff between nurses at shift change has been an important process in clinical nursing practice, allowing nurses to exchange necessary patient information to ensure continuity of care and patient safety. Bedside handoff allows the patient the ability to contribute to his or her plan of care. It also allows the oncoming nurse an opportunity to visualize the patient and ask questions. This is critical in meeting the Joint Commission's 2009 National Patient Safety Goals. It encourages patients to be involved actively in their care and it implements standardized handoff communication between nursing shifts. Bedside handoff promotes patient safety and allows an opportunity for patients to correct misconceptions. A convenience sample ...

Research paper thumbnail of Perioperative Care of Patients Undergoing Bariatric Surgery

Mayo Clinic Proceedings, 2006

The epidemic of obesity in developed countries has resulted in patients with extreme (class III) ... more The epidemic of obesity in developed countries has resulted in patients with extreme (class III) obesity undergoing the full breadth of medical and surgical procedures. The popularity of bariatric surgery in the treatment of extreme obesity has raised awareness of the unique considerations in the care of this patient population. Minimizing the risk of perioperative complications that contribute to morbidity and mortality requires input from several clinical disciplines and begins with the preoperative assessment of the patient. Airway management, intravenous fluid administration, physiologic responses to pneumoperitoneum during laparoscopic procedures, and the risk of thrombotic complications and peripheral nerve injuries in extremely obese patients are among the factors that present special intraoperative challenges that affect postoperative recovery of the bariatric patient. Early recognition of perioperative complications and education of the patient regarding postoperative issues, including nutrition and vitamin supplementation therapy, can improve patient outcomes. A suitable physical environment and appropriate nursing and dietetic support provide a safe and dignified hospital experience. This article reviews the multidisciplinary management of extremely obese patients who undergo bariatric surgery at the Mayo Clinic.

Research paper thumbnail of Patients Who Complete Advance Directives and What They Prefer

Mayo Clinic Proceedings, 2007

To determine health care preferences expressed by patients in advance directives (ADs) and to ide... more To determine health care preferences expressed by patients in advance directives (ADs) and to identify characteristics of patients who completed them. A computer-generated random sample of 500 patients was selected from the 25,865 (margin of error, +/- 4.34%) unique patients who submitted ADs to Mayo Clinic Rochester between January 1, 2004, and July 1, 2005. After excluding 24 (4.8%) patients who had submitted documents related to financial and property matters instead of ADs, we analyzed the contents of the 476 ADs and the demographic features of the patients to whom the documents belonged. The median (range) age of the patients at the time they signed their respective ADs was 67 (19-97) years. Of the 476 study patients, 409 (91.3%) were high school graduates; 339 (71.2%) had submitted a combined AD, which has features of a living will and a health care power of attorney; 434 (91.2%) had designated a health care agent; and most had granted the agent powers to consent for procedures (340 [78.3%]), to access information (327 [75.3%]), and to withhold and withdraw life-sustaining treatments (337 [77.6%]). Most patients expressed a desire for pain control (308 [64.7%]). For the clinical situations of dying or permanent unconsciousness, most patients explicitly expressed a preference to avoid "general life support" (371 [77.9%]) but did not explicitly address common life-sustaining treatments, including cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, blood transfusion, and artificial nutrition and hydration (if they did, nearly all expressed a preference to avoid the treatments). In ADs submitted to our institution, most patients designated a health care agent and granted the agent broad decision-making powers. Although most expressed a desire to avoid "general life support" if dying or permanently unconscious, few expressed preferences regarding specific life-sustaining treatments. Patients, clinicians, and others who use ADs, and investigators contemplating research involving ADs, might find these results informative.

Research paper thumbnail of Enhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training

Mayo Clinic Proceedings, 2011

N early a decade has passed since the Institute of Medicine released its seminal report To Err is... more N early a decade has passed since the Institute of Medicine released its seminal report To Err is Human: Building a Safer Health System. 1 The report described the US health care system as a decade or more behind other high-risk industries in its attention to ensuring basic safety. One recommendation was that Congress should create a center for patient safety within the Agency for Healthcare Research and Quality (AHRQ). The AHRQ was asked to set standards, communicate with members about safety, and develop training programs that create a culture of safety across disciplines. 1 The AHRQ supports simulation research through its patient safety program, recognizing that "simulation in health care creates a safe learning environment that allows researchers and practitioners to test new clinical processes and to enhance individual and team skills before encountering patients." 2 OBJECtIvE: To determine whether interdisciplinary simulation team training can positively affect registered nurse and/or physician perceptions of collaboration in clinical decision making. PARtICIPANtS AND MEtHODS: Between March 1 and April 21, 2009, a convenience sample of volunteer nurses and physicians was recruited to undergo simulation training consisting of a team response to 3 clinical scenarios. Participants completed the Collaboration and Satisfaction About Care Decisions (CSACD) survey before training and at 2 weeks and 2 months after training. Differences in CSACD summary scores between the time points were assessed with paired t tests. RESuLtS: Twenty-eight health care professionals (19 nurses, 9 physicians) underwent simulation training. Nurses were of similar age to physicians (27.3 vs 34.5 years; p=.82), were more likely to be women (95.0% vs 12.5%; p<.001), and were less likely to have undergone prior simulation training (0% vs 37.5%; p=.02). The pretest showed that physicians were more likely to perceive that open communication exists between nurses and physicians (p=.04) and that both medical and nursing concerns influence the decision-making process (p=.02). Pretest CSACD analysis revealed that most participants were dissatisfied with the decisionmaking process. The CSACD summary score showed significant improvement from baseline to 2 weeks (4.2 to 5.1; p<.002), a trend that persisted at 2 months (p<.002). CONCLuSION: Team training using high-fidelity simulation scenarios promoted collaboration between nurses and physicians and enhanced the patient care decision-making process.

Research paper thumbnail of Interview with a cruise ship nurse

Journal of Emergency Nursing, 1996

Research paper thumbnail of Using Evidence to Enhance the Recovery of Patients Undergoing Colorectal Surgery: Part 1

The Journal of Continuing Education in Nursing, 2011

This is the first part of a three-part series describing how an enhanced recovery clinical pathwa... more This is the first part of a three-part series describing how an enhanced recovery clinical pathway uses a multidisciplinary team to reduce postoperative stress and complications, improve recovery, and decrease hospital length of stay without affecting patient safety for patients undergoing colorectal surgery. This part discusses patient education and discharge planning. Next month, pain and postoperative nausea and vomiting will be discussed.

Research paper thumbnail of Crohn’s Disease and Ulcerative Colitis

The Journal of Continuing Education in Nursing, 2008

This column discusses the prevalence, symptoms, and treatment of Crohn's disease and ulcerati... more This column discusses the prevalence, symptoms, and treatment of Crohn's disease and ulcerative colitis and the role nurses play for these patients.

Research paper thumbnail of Necrotizing Pancreatitis: Pathophysiology, Diagnosis, and Acute Care Management

AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 1999

Research paper thumbnail of Aeromedical training of flight nurses on fixed wing air ambulance transport services

Air Medical Journal, 1994

Research paper thumbnail of Training of flight nurses on fixed-wing air ambulance services

Air Medical Journal, 1996

Introduction: The purpose of this study was to determine the background of fixed-wing air ambulan... more Introduction: The purpose of this study was to determine the background of fixed-wing air ambulance nurses, what level of training they receive before assignment as a flight nurse, and how closely supervised these fixed-wing air ambulance programs are by their medical directors. Methods: In 1993, a retrospective statistical questionnaire was sent to 113 fixed-wing air ambulance programs. Chief flight nurses for all 113 fixed-wing air ambulance transport companies were requested to complete a written survey consisting of 17 multiple choice and fillin-the-blank questions about previous experience, flight nurse qualifications, and content covered in therr rnrtral training program. Results: Of 113 surveys, 72 (64%) re-tion, as well as increased involvement of medical directorship in fixed-wing air ambulance services.

Research paper thumbnail of Fast-track Colorectal Surgery Program Reduces Hospital Length of Stay

Clinical Nurse Specialist, 2010

This study compared outcomes of a fast-track postoperative program implemented for patients under... more This study compared outcomes of a fast-track postoperative program implemented for patients undergoing laparoscopic colorectal surgery on 2 surgical units to patients receiving traditional postoperative care following laparoscopic colorectal surgery prior to implementation of the fast-track program. The primary aim was to determine if there was a significant difference in length of stay and 30-day readmission rates between the 2 groups. The secondary aim was to examine whether patients on the fast-track program were able to successfully tolerate early diet, early ambulation, and minimal use of drains. The study was conducted at a large Midwestern hospital. A retrospective medical record review was done on 100 patients who underwent laparoscopic colorectal surgery on the fast-track program for data pertaining to the research questions. Additionally, a medical record review was done for comparison on 100 matched controls based on age, sex, surgeon, and surgical procedure who received traditional postoperative care following laparoscopic colorectal surgery. A statistical significant difference of 1 day was found between patients receiving traditional care and patients on the fast-track program. Readmission rates between the 2 groups were not statistically significantly different. : Overall, patients undergoing laparoscopic colorectal surgery on a fast-track program discharged 1 day sooner than patients on traditional recovery programs. Patients successfully followed the fast-track program. Fast-track programs in colorectal surgery reduce length of stay and could be considered for other surgical populations.

Research paper thumbnail of Patients Who Complete Advance Directives and What They Prefer

Mayo Clinic Proceedings, 2007

To determine health care preferences expressed by patients in advance directives (ADs) and to ide... more To determine health care preferences expressed by patients in advance directives (ADs) and to identify characteristics of patients who completed them. A computer-generated random sample of 500 patients was selected from the 25,865 (margin of error, +/- 4.34%) unique patients who submitted ADs to Mayo Clinic Rochester between January 1, 2004, and July 1, 2005. After excluding 24 (4.8%) patients who had submitted documents related to financial and property matters instead of ADs, we analyzed the contents of the 476 ADs and the demographic features of the patients to whom the documents belonged. The median (range) age of the patients at the time they signed their respective ADs was 67 (19-97) years. Of the 476 study patients, 409 (91.3%) were high school graduates; 339 (71.2%) had submitted a combined AD, which has features of a living will and a health care power of attorney; 434 (91.2%) had designated a health care agent; and most had granted the agent powers to consent for procedures (340 [78.3%]), to access information (327 [75.3%]), and to withhold and withdraw life-sustaining treatments (337 [77.6%]). Most patients expressed a desire for pain control (308 [64.7%]). For the clinical situations of dying or permanent unconsciousness, most patients explicitly expressed a preference to avoid &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;general life support&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (371 [77.9%]) but did not explicitly address common life-sustaining treatments, including cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, blood transfusion, and artificial nutrition and hydration (if they did, nearly all expressed a preference to avoid the treatments). In ADs submitted to our institution, most patients designated a health care agent and granted the agent broad decision-making powers. Although most expressed a desire to avoid &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;general life support&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; if dying or permanently unconscious, few expressed preferences regarding specific life-sustaining treatments. Patients, clinicians, and others who use ADs, and investigators contemplating research involving ADs, might find these results informative.

Research paper thumbnail of New Functions for New Demands

American School University, 1995

Research paper thumbnail of Determining the Need for a Pregnancy Test in the Emergency Department for a Complaint of Abdominal Pain Based on Recorded Patient History

Research paper thumbnail of Determination of Relationships among Patient Satisfaction, Pain Intensity and Expectations of Pain Management

Research paper thumbnail of Factors Affecting Postoperative Pain Relief in Patients Undergoing Colorectal and General Surgery

Research paper thumbnail of Simulation-based team training and debriefing to enhance nursing and physician collaboration

Journal of continuing education in nursing, 2014

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded... more HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at https://villanova.gosignmeup.com/dev_students.asp?action=browse&main=Nursing+Journals&misc=564. In order to obtain contact hours you must: 1. Read the article, "Simulation-Based Team Training and Debriefing to Enhance Nursing and Physician Collaboration," found on pages 297-303, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track...

Research paper thumbnail of Discharge planning rounds to the bedside: a patient- and family-centered approach

Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses

Discharge planning rounds done at the bedside is an effective patient-centered approach to discha... more Discharge planning rounds done at the bedside is an effective patient-centered approach to discharge planning and does not take any longer than traditional rounds apart from the patient and caregiver. Bedside rounds may decrease patient utilization of health care resources after discharge.

Research paper thumbnail of Bedside nurse-to-nurse handoff promotes patient safety

Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses

Nurse-to-nurse beside handoff allows the oncoming nurse to visualize the patient and ask question... more Nurse-to-nurse beside handoff allows the oncoming nurse to visualize the patient and ask questions of the previous nurse. It encourages pateints to be involved actively in their care and allows standardized communication between nursing shifts. Patient handoff between nurses at shift change has been an important process in clinical nursing practice, allowing nurses to exchange necessary patient information to ensure continuity of care and patient safety. Bedside handoff allows the patient the ability to contribute to his or her plan of care. It also allows the oncoming nurse an opportunity to visualize the patient and ask questions. This is critical in meeting the Joint Commission's 2009 National Patient Safety Goals. It encourages patients to be involved actively in their care and it implements standardized handoff communication between nursing shifts. Bedside handoff promotes patient safety and allows an opportunity for patients to correct misconceptions. A convenience sample ...

Research paper thumbnail of Perioperative Care of Patients Undergoing Bariatric Surgery

Mayo Clinic Proceedings, 2006

The epidemic of obesity in developed countries has resulted in patients with extreme (class III) ... more The epidemic of obesity in developed countries has resulted in patients with extreme (class III) obesity undergoing the full breadth of medical and surgical procedures. The popularity of bariatric surgery in the treatment of extreme obesity has raised awareness of the unique considerations in the care of this patient population. Minimizing the risk of perioperative complications that contribute to morbidity and mortality requires input from several clinical disciplines and begins with the preoperative assessment of the patient. Airway management, intravenous fluid administration, physiologic responses to pneumoperitoneum during laparoscopic procedures, and the risk of thrombotic complications and peripheral nerve injuries in extremely obese patients are among the factors that present special intraoperative challenges that affect postoperative recovery of the bariatric patient. Early recognition of perioperative complications and education of the patient regarding postoperative issues, including nutrition and vitamin supplementation therapy, can improve patient outcomes. A suitable physical environment and appropriate nursing and dietetic support provide a safe and dignified hospital experience. This article reviews the multidisciplinary management of extremely obese patients who undergo bariatric surgery at the Mayo Clinic.

Research paper thumbnail of Patients Who Complete Advance Directives and What They Prefer

Mayo Clinic Proceedings, 2007

To determine health care preferences expressed by patients in advance directives (ADs) and to ide... more To determine health care preferences expressed by patients in advance directives (ADs) and to identify characteristics of patients who completed them. A computer-generated random sample of 500 patients was selected from the 25,865 (margin of error, +/- 4.34%) unique patients who submitted ADs to Mayo Clinic Rochester between January 1, 2004, and July 1, 2005. After excluding 24 (4.8%) patients who had submitted documents related to financial and property matters instead of ADs, we analyzed the contents of the 476 ADs and the demographic features of the patients to whom the documents belonged. The median (range) age of the patients at the time they signed their respective ADs was 67 (19-97) years. Of the 476 study patients, 409 (91.3%) were high school graduates; 339 (71.2%) had submitted a combined AD, which has features of a living will and a health care power of attorney; 434 (91.2%) had designated a health care agent; and most had granted the agent powers to consent for procedures (340 [78.3%]), to access information (327 [75.3%]), and to withhold and withdraw life-sustaining treatments (337 [77.6%]). Most patients expressed a desire for pain control (308 [64.7%]). For the clinical situations of dying or permanent unconsciousness, most patients explicitly expressed a preference to avoid &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;general life support&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (371 [77.9%]) but did not explicitly address common life-sustaining treatments, including cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, blood transfusion, and artificial nutrition and hydration (if they did, nearly all expressed a preference to avoid the treatments). In ADs submitted to our institution, most patients designated a health care agent and granted the agent broad decision-making powers. Although most expressed a desire to avoid &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;general life support&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; if dying or permanently unconscious, few expressed preferences regarding specific life-sustaining treatments. Patients, clinicians, and others who use ADs, and investigators contemplating research involving ADs, might find these results informative.

Research paper thumbnail of Enhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training

Mayo Clinic Proceedings, 2011

N early a decade has passed since the Institute of Medicine released its seminal report To Err is... more N early a decade has passed since the Institute of Medicine released its seminal report To Err is Human: Building a Safer Health System. 1 The report described the US health care system as a decade or more behind other high-risk industries in its attention to ensuring basic safety. One recommendation was that Congress should create a center for patient safety within the Agency for Healthcare Research and Quality (AHRQ). The AHRQ was asked to set standards, communicate with members about safety, and develop training programs that create a culture of safety across disciplines. 1 The AHRQ supports simulation research through its patient safety program, recognizing that "simulation in health care creates a safe learning environment that allows researchers and practitioners to test new clinical processes and to enhance individual and team skills before encountering patients." 2 OBJECtIvE: To determine whether interdisciplinary simulation team training can positively affect registered nurse and/or physician perceptions of collaboration in clinical decision making. PARtICIPANtS AND MEtHODS: Between March 1 and April 21, 2009, a convenience sample of volunteer nurses and physicians was recruited to undergo simulation training consisting of a team response to 3 clinical scenarios. Participants completed the Collaboration and Satisfaction About Care Decisions (CSACD) survey before training and at 2 weeks and 2 months after training. Differences in CSACD summary scores between the time points were assessed with paired t tests. RESuLtS: Twenty-eight health care professionals (19 nurses, 9 physicians) underwent simulation training. Nurses were of similar age to physicians (27.3 vs 34.5 years; p=.82), were more likely to be women (95.0% vs 12.5%; p<.001), and were less likely to have undergone prior simulation training (0% vs 37.5%; p=.02). The pretest showed that physicians were more likely to perceive that open communication exists between nurses and physicians (p=.04) and that both medical and nursing concerns influence the decision-making process (p=.02). Pretest CSACD analysis revealed that most participants were dissatisfied with the decisionmaking process. The CSACD summary score showed significant improvement from baseline to 2 weeks (4.2 to 5.1; p<.002), a trend that persisted at 2 months (p<.002). CONCLuSION: Team training using high-fidelity simulation scenarios promoted collaboration between nurses and physicians and enhanced the patient care decision-making process.

Research paper thumbnail of Interview with a cruise ship nurse

Journal of Emergency Nursing, 1996

Research paper thumbnail of Using Evidence to Enhance the Recovery of Patients Undergoing Colorectal Surgery: Part 1

The Journal of Continuing Education in Nursing, 2011

This is the first part of a three-part series describing how an enhanced recovery clinical pathwa... more This is the first part of a three-part series describing how an enhanced recovery clinical pathway uses a multidisciplinary team to reduce postoperative stress and complications, improve recovery, and decrease hospital length of stay without affecting patient safety for patients undergoing colorectal surgery. This part discusses patient education and discharge planning. Next month, pain and postoperative nausea and vomiting will be discussed.

Research paper thumbnail of Crohn’s Disease and Ulcerative Colitis

The Journal of Continuing Education in Nursing, 2008

This column discusses the prevalence, symptoms, and treatment of Crohn's disease and ulcerati... more This column discusses the prevalence, symptoms, and treatment of Crohn's disease and ulcerative colitis and the role nurses play for these patients.

Research paper thumbnail of Necrotizing Pancreatitis: Pathophysiology, Diagnosis, and Acute Care Management

AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 1999

Research paper thumbnail of Aeromedical training of flight nurses on fixed wing air ambulance transport services

Air Medical Journal, 1994

Research paper thumbnail of Training of flight nurses on fixed-wing air ambulance services

Air Medical Journal, 1996

Introduction: The purpose of this study was to determine the background of fixed-wing air ambulan... more Introduction: The purpose of this study was to determine the background of fixed-wing air ambulance nurses, what level of training they receive before assignment as a flight nurse, and how closely supervised these fixed-wing air ambulance programs are by their medical directors. Methods: In 1993, a retrospective statistical questionnaire was sent to 113 fixed-wing air ambulance programs. Chief flight nurses for all 113 fixed-wing air ambulance transport companies were requested to complete a written survey consisting of 17 multiple choice and fillin-the-blank questions about previous experience, flight nurse qualifications, and content covered in therr rnrtral training program. Results: Of 113 surveys, 72 (64%) re-tion, as well as increased involvement of medical directorship in fixed-wing air ambulance services.

Research paper thumbnail of Fast-track Colorectal Surgery Program Reduces Hospital Length of Stay

Clinical Nurse Specialist, 2010

This study compared outcomes of a fast-track postoperative program implemented for patients under... more This study compared outcomes of a fast-track postoperative program implemented for patients undergoing laparoscopic colorectal surgery on 2 surgical units to patients receiving traditional postoperative care following laparoscopic colorectal surgery prior to implementation of the fast-track program. The primary aim was to determine if there was a significant difference in length of stay and 30-day readmission rates between the 2 groups. The secondary aim was to examine whether patients on the fast-track program were able to successfully tolerate early diet, early ambulation, and minimal use of drains. The study was conducted at a large Midwestern hospital. A retrospective medical record review was done on 100 patients who underwent laparoscopic colorectal surgery on the fast-track program for data pertaining to the research questions. Additionally, a medical record review was done for comparison on 100 matched controls based on age, sex, surgeon, and surgical procedure who received traditional postoperative care following laparoscopic colorectal surgery. A statistical significant difference of 1 day was found between patients receiving traditional care and patients on the fast-track program. Readmission rates between the 2 groups were not statistically significantly different. : Overall, patients undergoing laparoscopic colorectal surgery on a fast-track program discharged 1 day sooner than patients on traditional recovery programs. Patients successfully followed the fast-track program. Fast-track programs in colorectal surgery reduce length of stay and could be considered for other surgical populations.

Research paper thumbnail of Patients Who Complete Advance Directives and What They Prefer

Mayo Clinic Proceedings, 2007

To determine health care preferences expressed by patients in advance directives (ADs) and to ide... more To determine health care preferences expressed by patients in advance directives (ADs) and to identify characteristics of patients who completed them. A computer-generated random sample of 500 patients was selected from the 25,865 (margin of error, +/- 4.34%) unique patients who submitted ADs to Mayo Clinic Rochester between January 1, 2004, and July 1, 2005. After excluding 24 (4.8%) patients who had submitted documents related to financial and property matters instead of ADs, we analyzed the contents of the 476 ADs and the demographic features of the patients to whom the documents belonged. The median (range) age of the patients at the time they signed their respective ADs was 67 (19-97) years. Of the 476 study patients, 409 (91.3%) were high school graduates; 339 (71.2%) had submitted a combined AD, which has features of a living will and a health care power of attorney; 434 (91.2%) had designated a health care agent; and most had granted the agent powers to consent for procedures (340 [78.3%]), to access information (327 [75.3%]), and to withhold and withdraw life-sustaining treatments (337 [77.6%]). Most patients expressed a desire for pain control (308 [64.7%]). For the clinical situations of dying or permanent unconsciousness, most patients explicitly expressed a preference to avoid &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;general life support&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (371 [77.9%]) but did not explicitly address common life-sustaining treatments, including cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, blood transfusion, and artificial nutrition and hydration (if they did, nearly all expressed a preference to avoid the treatments). In ADs submitted to our institution, most patients designated a health care agent and granted the agent broad decision-making powers. Although most expressed a desire to avoid &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;general life support&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; if dying or permanently unconscious, few expressed preferences regarding specific life-sustaining treatments. Patients, clinicians, and others who use ADs, and investigators contemplating research involving ADs, might find these results informative.