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Secrets of Hallstead House
\"Macy Stoddard had hoped to ease the grief of losing her parents in a fiery car crash by accepting a job as a private nurse to the wealthy and widowed Alexandria Hallstead. But her first sight of Hallstead House is of a dark and forbidding home. Shey quickly finds its winding halls and shadowy rooms filled with secrets and suspicions. Alex seems happy to have Macy's help, but others on the island, including Alex's sinister servants and hostile relatives, are far less welcoming. Watching eyes, veiled threats ... slowly, surely, the menacing spirit of Hallstead Island closes in around Macy. And she can only wonder if her story will become just one of the many secrets of Hallstead House...\" p. [4] of cover.
Book
The Future of Nursing
The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system.
At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year.
Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care.
In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
eBook
IMPLEMENTATION OF A UNIT-BASED NURSE WELL-BEING \SUNSHINE\ COMMITTEE TO IMPROVE NURSE RECOGNITION & RETENTION
Significance & Background: In Spring 2023, the 2023 Jefferson Employee Survey revealed concerning results for our unit-specific nursing scores, with only 61% for \"recognition\" and 50% for \"intent to stay,\" both falling below healthcare benchmarks and hospital averages. Recognizing the critical importance of nurse retention and motivation, we sought to address these issues by implementing a designated nurse well-being committee. Purpose: Our goal was to foster a culture of recognition, enhance team bonding, and improve overall job enjoyment. Interventions: In April 2023, we established the \"Sunshine Committee,\" which focused on initiatives to promote recognition and teamwork. Key strategies included frequent staffrecognition celebrations for both professional milestones- such as graduating with advanced degrees or passing certification exams-and personal achievements, like significant birthdays or family milestones. We also created bulletin boards to highlight nurses' fun facts and accomplishments, allowing patients to connect with our team. Additionally, we organized team-bonding events, such as holiday giftexchanges and community fundraising activities, while ensuring that new nurses received a warm welcome to the unit. Results: After 16 months of implementing these interventions, we conducted a follow-up survey in August 2024. The results were encouraging: the recognition score improved significantly to 83%, reflecting a 22% increase from 2023, while the intent to stay score rose to 61%, marking an 11% improvement. These findings suggest that our initiatives positively impacted nurses' feelings of recognition and their intent to remain in the unit. Discussion: In conclusion, the Sunshine Committee's efforts have yielded measurable improvements in key indicators of nurse satisfaction. Moving forward, we aim to maintain this momentum by continuing to solicit dynamic feedback from our colleagues. This ongoing input will help us refine our initiatives and identify new strategies that can further enhance the work environment, ensuring that our nursing stafffeels valued and supported
Journal Article
The man in the window
Since he was disfigured in a fire sixteen years ago, recluse Louis Malone has remained hidden from the prying eyes of his neighbors in the small town of Waverly. Across town, Iris Shula, a lonely and unlovely nurse, knows at thirty-seven it is unlikely that her Prince Charming will ever appear. But Iris is about to learn how wrong she is. When Louis accidentally falls out of his second-story window, these two kindred souls are brought together. What unfolds is a most unlikely love story. One that will make you laugh and that will break--and remake--your heart.
Book
CREATING A STREAMLINED WORKFLOW FOR EQUITABLE PATIENT DISTRIBUTION IN AN OUTPATIENT INFUSION CENTER
Significance & Background: Our new Cancer Center officially opened its doors on May 16, 2023. The Infusion Center is a critical component of this facility, integrating two previously distinct infusion units: (1) one unit specializes in chemotherapy and immunotherapy, and the second infusion unit focuses on blood transfusions, non-oncologic infusions, and community-based infusion orders. As patient volume and treatment complexity have increased, the existing workflow has proven insufficient to meet the growing demands of the Infusion Center. Purpose: This stract to outline the development of a sustainable workflow that ensures a fair and efficient distribution of patients among nursing staff throughout the day. Interventions: To tackle the identified challenges, we established distinct roles within the Infusion Center, including Charge Nurse, Triage Nurse, and Pod Leads. An Electronic Daily Patient Assignment template was created to assist the Charge Nurse in patient assignments, allowing real-time visibility for all staff. Additionally, we implemented an acuity tool to evaluate not only the complexity of treatments but also the level of care required and the specific needs of each patient. Recognizing the importance of communication, we established group chats (e.g, DLDCCC Charge Nurses) within the EPIC system to facilitate seamless communication among nurses and other departments, addressing messages sent to staff who are on leave or off the unit. Results: After one (1) year of implementing the new workflow, a survey was conducted to assess its effectiveness. The results indicated that nurses reported improved efficiency and satisfaction with the new system. Discussion: The introduction of the new workflow and clearly defined roles has resulted in a more organized and equitable distribution of patient care responsibilities. Positive feedback from the survey suggests that these changes have enhanced the overall functioning of the Infusion Center, enabling nurses to deliver high-quality care while effectively managing their workloads. Ongoing analysis and adjustments will be crucial to ensure continued success and adaptability as patient needs evolve.
Journal Article
Our Lady of Alice Bhatti
The patients of the Sacred Heart Hospital for All Ailments are looking for a miracle, and healer Alice Bhatti may be just what they need.
Book
TAXANE TITRATION: TAILORED FOR BETTER OUTCOMES
Significance & Background: The Dana Farber Cancer Institute (DFCI), Boston, MA, conducted a project to evaluate the benefits of taxane titration to reduce hypersensitivity reactions (HSRs). They concluded that the patient group with titrated taxanes had significantly less taxane related HSRs than the non-titrated patient group. Outpatient Infusion Quality Team (OIQT) decided to implement our own quality project and attempt to replicate their project outcomes. Taxanes are at greatest risk of causing HSRs during the first and second lifetime exposures. HSRs need immediate care and can interfere with the continuation of preferred treatment. Currently, our infusion nurses use different approaches of slow titration to prevent HSR. In preparation for this project, a literature review was conducted and identified no published standardized recommendations for taxane titrations to prevent HSRs. DFCI came to the same conclusion and stated they used a desensitization protocol developed by their allergy team. We trialed the DFCI protocol to standardize our administration guidelines for all taxanes given in infusion. Purpose: The goal was to determine if a standardized gradual infusion rate titration would decrease the incidence and severity of immediate HRSs during the first two exposures to taxanes. Interventions: Education was created by the OIQT and presented to the infusion nurses at a staff meeting. The charge nurses and preceptors served as resources for any questions encountered throughout implementation. Any HSRs to taxanes were documented in the medical record and occurrence report (OR) system so the OIQT could track outcome data. Results: A key objective addressed by the DFCI project was to \"prime\" the administration tubing with medication, so the titration volume was drug, not saline. It was hypothesized that desensitization would be more reliable if the taxane was delivered from the initiation of the infusion via slow titration. We contacted the IV tubing manufacturer to verify recommended prime volumes. A three-month baseline review of ORs revealed four documented HSRs with the first and/or second taxane cycles. The OIQT chose to match the same timeframe for the quality project. Outcome data identified zero HSRs to taxanes when using the standardized titration method. Discussion: The project demonstrated similar outcomes to our peers, utilizing a standardized titration protocol results in a decrease in HSRs during first and second exposures to taxanes.
Journal Article
