Nurse Shares Results of Code Response Program, Nurse-Led Research Highlights Pandemic Burnout, and More

ICU monitor with several patients and code response team of doctor and nurses in background.

A clinical nurse specialist in Orlando, FL authors an article reporting the success of a code response program for nurses. A recent study shows that the COVID-19 pandemic and work-related stressors have caused many nurses who work in the nephrology setting to experience high levels of burnout, anxiety, and depression. Read on for this week’s nursing news and insights.

Nurse shares results of code response program

Andrea Paddock, MSN, APRN, ACCNS-AG, CCRN, a clinical nurse specialist who practices in Orlando, FL, has authored an article on the success of a program that helped nurses to respond better during code events through more timely use of defibrillation.

“Using Simulation to Improve Adherence to Get With The Guidelines Time to First Shock” details how nurses on staff at Orlando Health have improved their patient care and become empowered when responding to codes. The article was recently published in the December issue of Critical Care Nurse (CCN), the clinical practice journal of the American Association of Critical-Care Nurses.

The initiative was a response to discovering that the facility was 99% compliant or perfect with three of Get With The Guidelines® (GWTG) four metrics in 2018, but only 42% successful with administering the first shock in a timely manner.

Further analysis revealed that the intensive care unit (ICU) reported the highest number of delays in time to first shock beyond the two-minute window, otherwise known as a “fallout.” The ICU also lacked a standard process for managing code events.

Data for the following year found the time to first shock metric improved to 83%, with further improvement to 100% during the first six months of 2020.

“When seconds count, it’s important for everyone to instantly know their role as part of the response team, which can change for each code situation,” Paddock said in a prepared statement. “This project helped our hospital improve compliance with GWTG metrics and enhance our care for patients experiencing cardiopulmonary arrests. It’s become a foundation for code simulations and mock code education throughout the hospital.”

The project began with nurses and ICU physicians collaborating to develop a diagram of a patient room that identified primary and secondary roles for specific team members and defined the number of staff needed to respond to a cardiopulmonary arrest. A mock code simulation video was created and embedded in online education to demonstrate the proper role designations and execution displayed in the diagram.

A total of 40 ICU nurses were assigned to complete the new online education, which included electrocardiogram recognition and code documentation. The ICU learning specialist then worked one-on-one with individual nurses as needed.

The initiative then moved to structured code simulations, which included a pre-simulation discussion, three rapid-cycle simulations followed by a short debriefing, and a final conclusive debriefing at the end of the two-hour training session. The same scenario was used for each simulation, but participants were assigned to different roles, including the position of code leader, each time.

“A pre-simulation discussion and slow code walk-through were crucial elements to equipping participants with the knowledge to respond more appropriately during the simulation and translate that knowledge into practice,” Paddock said.

In addition to the initial evaluation survey, a post-intervention questionnaire was sent three months after the simulation to assess how the training had impacted participants’ knowledge, confidence, and overall clinical practice.

Related: Critical Care/Emergency Specialty CE Courses for Nursing Professionals

Nurse-led research highlights pandemic burnout

The COVID-19 pandemic and work-related stressors have caused many nurses who work in the nephrology setting to experience high levels of burnout, anxiety, and depression, according to a recent study. “Mental Health and Health-Related Quality of Life Among Nephrology Nurses: A Survey-Based Cross-Sectional Study” was led by Vicki Montoya, PhD, APRN, FNP-BC, and conducted by 14 additional experts.

Officials with the American Nephrology Nurses Association (ANNA) have reported that the study, which was aimed at gaining a better understanding of the mental, emotional, and physical challenges that nurses struggle with, was conducted through a survey held during the summer of 2020.

“As the pandemic unfolded in 2020, we were hearing about the enormous stresses nephrology nurses were facing,” said Dr. Montoya in a prepared statement. “We knew there were many workplace challenges before COVID-19, but the pandemic has clearly exacerbated these. And that raises many alarms, not only for nurses’ health, but for patient care and safety.”

Key findings of the study include:

  • 62% reported feeling burned out from work.
  • 47% reported symptoms of anxiety and 16% reported symptoms of major depressive episodes.
  • 56% said they were responsible for caring for patients with COVID-19 at some time during the pandemic, and 59% of that group had patients who died following diagnosed or suspected COVID-19.
  • Workload was identified as the main driver in anxiety and burnout, and 42% had voiced concerns to a supervisor about a workload that was too heavy.
  • Nurses younger than 65 years old were twice as likely to report feeling burnout, and 47% worried that their work was hardening their emotions.

According to the study’s authors, the challenges faced by healthcare providers due to the pandemic – as well as the demanding workplace environments of nephrology nurses – are well recognized. There is, however, “limited research exploring the well-being of nephrology nurses.” Increasingly throughout the COVID-19 pandemic, nephrology nurses have reported issues of heightened stress and strains on their overall well-being.

In addition, nephrology employers have reported experiencing mounting difficulties in recruiting nephrology nurses and widespread concerns about attrition. In recognition of this data gap, Dr. Montoya said the study authors sought to gather information directly from nephrology nurses about their health and wellness. Nearly 400 nurses were surveyed.

The authors also outlined strategies to help address anxiety and burnout. “Our findings point to the need for nephrology nurses to consider the long-term benefits of protecting their mental health through intentional strategies, such as self-care, group resiliency rounds, and counseling,” said Dr. Montoya.

Related: Boundaries and Burnout: Strategies for Nurses to Maintain Self

Views expressed here are those of the author and do not necessarily represent the views of Elite Learning or Colibri Group. Media referenced in this news round-up does not constitute an endorsement.

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