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Patients with Head and Neck Cancers (HNC) are a diverse group with complex educational and support needs. Literature suggests HNC patients often experience fragmented care. These patients would therefore benefit from standardized education to address disease-specific stressors including treatments, symptoms, speaking and swallowing difficulties, and nutrition which can affect quality of life. Treatments are often multidisciplinary and multimodal, adding to the potential for inconsistent education, misunderstanding of the education leading to confusion, and missed information. Given these complexities, literature suggests the majority of HNC patients prefer written information about their diagnosis and treatment. The HonorHealth Oncology Navigation (HON) team identified an education gap for this patient population. The HON team and our Oncology Certified Registered Dietician developed an evidence-based Head and Neck Cancer Education Guide. The development of standardized, comprehensive, and understandable written information removes potential barriers of inconsistent education or misunderstanding leading to patient confusion. The receipt of written information encourages patients to actively participate in their care. Across many studies, patients requested education and support for managing treatment-related side effects, maintaining health during treatment, and achieving a healthy lifestyle after treatment. The Head and Neck Cancer Education Guide focuses on disease-specific topics including treatment side effects management, nutrition goals and recipes, feeding tube guidelines, and survivorship recommendations. Written information reinforces verbal education provided during one-on-one consults. It also improves understanding and recall. The Oncology Nurse Navigation (ONN) team implemented a workflow to provide individualized educational counseling and standardized written information to newly diagnosed HNC patients with the goal of increasing the rate of ONN consults by 20%. Baseline data was collected between November 2019 and February 2020 for a subset of newly diagnosed HNC patients. Between March and May 2020, the HON team and Registered Dietician developed the educational guide and prioritized ONN consults for newly diagnosed patients. The post-intervention data was collected between June and October 2020. At baseline, 60% of HNC patients met with an ONN to review diagnosis, treatment, potential side effects, and nutritional support. Post-intervention, the rate was 100%. The HON team identified and closed education gaps for HNC patients. These efforts aligned evidence-based recommendations with internal processes which can improve patient care.

To evaluate an education intervention to decrease restraint use in patients in a Trauma Intensive Care Unit (TICU) and to evaluate nurses’ perceptions regarding restraints. To measure restraint use pre/post-intervention and to measure nurses’ perceptions of restraint use. Pre/post-intervention design to collate incidences of delirium and restraints pre/post-intervention. Data reporting nurses’ views and preferences were collected pre-intervention. Patients were assessed by nursing on admission and every shift with the Confusion Assessment Method for TICU. Restraint use was measured in a 24-hour period. Nurses’ perception of restraints was measured using Perceptions of Restraint Use Questionnaire (PRUQ). A statistically significant difference was demonstrated in restraint use before and after the educational intervention. Mean and standard deviation for restraints per 1000 patient days pre-intervention was 314.1 (35.4), post-intervention 237.8 (56.4) (p=0.008). Mean PRUQ overall, 3.57 (range 1–5) indicated that nurses had positive attitudes towards restraints in certain circumstances. The primary reasons for using restraints were: “protecting patients from falling out of bed”, 37 (72.5%), and “protecting patients from falling out of chair”, 34 (66.7%). This study demonstrates that a low risk educational intervention aimed at use of an alternative device use can reduce restraint use.

Evaluate change in practice and beliefs regarding delirium among nurses, pharmacists, respiratory therapists and physicians in a trauma intensive care unit. Descriptive pre and post-design at a Level One Trauma Center. Education on causes of delirium, risk factors, strategies to prevent delirium and routine screening. Change in practice and beliefs regarding delirium. McNemars test measured the differences between pre- and post-questionnaires comparing the proportion of staff changed their responses in one direction to those who went in the opposite direction. Changes in “Delirium is largely preventable”, were statistically significant (p=0.035). Haldol was the medication of choice for treating delirium, with an increase in use (p=0.062) post-intervention. The majority of participants believed a high percentage of patients experience delirium in a trauma intensive care. The two most frequent medical complications associated with delirium pre-questionnaire was over sedation 8 (22%) and falls 9 (24%) and in post-questionnaire, over sedation 12 (26%) and falls 13 (28%). An educational intervention emphasising the importance of screening for delirium, risk factors for delirium and approaches to decrease the incidence of delirium can improve identifying and correctly treating delirium in a critical care setting. An educational program had concrete results in respondents' knowledge about delirium.

Evaluate change in ventilator associated pneumonia (VAP) and nurse's attitudes, beliefs post implementation of an evidence based practice (EBP) oral hygiene protocol. Descriptive pre and post test design in two critical care units in a Level One Trauma Community Hospital. Oral hygiene protocol data was reanalysed to examine effects in medical surgical and trauma subgroups. Oral care practices, attitudes and beliefs among nurses, and VAP rates according to Centers for Disease Control and Prevention guidelines. Trauma rates increased from 6.4% to 10.0% (p=0.346), and medical/surgical rates decreased from 3.3% to 1.0% (p=0.042). Results revealed changes in nurses’ beliefs regarding pre-admission colonisation (p=0.027) and having adequate training. Nurses’ perception of facility support improved, by having suitable equipment and readily available supplies. Foam swabs with moisture agents at 4hours or less was 88.6% and toothbrush use at 12hours or less was 71%, with significant changes in frequency of oral care post intervention. Trauma patients present with unique characteristics which compromise oral care. Understanding risk and prognostic factors, mechanisms of transmission and systemic inflammatory response are important when implementing EBP protocols. Nurses’ attitudes, beliefs are important, and staff adherence considered when initiating EBP changes.