Improving Education and Training

of the Healthcare Team

Cathryn Bahe, Victoria Haros, Kei Zyrylle Mandanas,
Landrine Niyitanga, and Jaqueline Oregel

April 28, 2021

 OVERVIEW OF PATIENT CARE DELIVERY
SYSTEM

● Southern Arizona Veterans Administration Health Care

System (SAVAHCS) - Tucson, AZ
● Telemetry/ Medical-Surgical Unit - 3North
● 24-bed unit
● Includes staff nurses, patient care technicians (PCTs),
charge nurse, unit manager, unit clerk, pharmacist,
medical teams

Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
 Microsystem Model: Leadership

● Charge RN leads in Laissez-faire style

○ “Little or no control”
○ “Motivates by support when requested by the
group or individuals”
○ Communication flows upward and downward
● Supportive resource to unit staff

Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed., pp. 47). Philadelphia: Wolters Kluwer Health
 Microsystem Model: Organizational Culture
and Support
● Nurse Manager
○ Leads through democratic style
○ “Emphasis on ‘we’, less control
maintained, directed through
suggestions and guidance”
○ Promotes autonomy
○ Present during Code Blues and Rapid
Responses
○ Unit huddle conducted at the beginning
Johnson, J.K. (2001). Clinical microsystem
of day shift
assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/m
icrosystem_assessment.pdf
● New and training nurses are welcomed,
Marquis, B.L. & Huston, C.J. (2017). Leadership
roles and management functions in nursing: Theory
supported and educated by unit staff
and application (9th ed., pp. 47). Philadelphia:
Wolters Kluwer Health
 Microsystem Model: Staff and Patient Focus
of Healthcare Delivery
Nurse Focus Patient Focus
● Nurse recruiter hires new RNs ● Timely answer of call lights
● Nurse-patient ratio: 1:4 or 1:5 ● Ask about needs
● Charge nurse responsible for ● Address holistic needs
patients’ assignments ● Bedside shift reports
● RN-Transition-to-Practice ● Continuity of care
Residency Program ● Social workers on unit
○ Professional and educational
support for nurses.
U.S. Department of Veterans Affairs. (2020). RN transition-to-practice (RNTTP). Retrieved from
https://www.va.gov/NURSING/workforce/RNTTP.asp
Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model: Interdependence of Care Team
● Easily accessible
● Effective and respectful communication
● Feels appreciated and supported by staff
● Collaborative environment
● Team communication occurs in the patient’s room

Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
 Microsystem Model: Performance Results
● Performance outcomes measured on unit
- Central line associated bacterial
infections (CLABSIs)
- Catheter associated urinary tract
infections (CAUTIs)
- Falls
- Pressure ulcers
● Managers audit notes

Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model: Process for Healthcare Delivery
Improvement
● Daily chart audits
○ Initial skin assessments
○ Daily reassessment
● Cerner- transition to new charting
system
● Continuing education - ACLS,
telemetry certification, Unit/hospital
modules
● Unit huddles
Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
 Microsystem Model: Information
and Health Care Technology
Nurse Focus Patient focused
● Cerner charting system ● Call lights
● CPRS (documentation) ● Bedside
● BCMA (medication whiteboards
administration) ● Bedside phones
● Wireless phones ● Bed alarms
● COW (computer on ● My HealtheVet
wheels)
● Telemetry
 Specific Aspect Targeted for Improvement
Introducing integrative modalities for pain management
Education and training of nurses related to reliance on pharmacologic
treatments for pain management due to lack of implementation and
awareness of effective evidence based non-pharmacological practices

● Provides whole person care

● Meditation reduces angina related to Coronary Artery
Disease (CAD)
● Cold therapy is effective in relieving postoperative
pain from open heart surgery
● Massage therapy enhances patient satisfaction
Cevik, K , Ince, S , Pakiş Çetin, S , Tetik, Ö . (2020). Effect of Applying Cold Gel Pack to the Sternum Region on the Postoperative Pain after Open-Heart Surgery . Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi , 7(1) , 76-80 . DOI: 10.34087/cbusbed.63166
Miller, J., Dunion, A., Dunn, N., Fitzmaurice, C., Gamboa, M., Myers, S., . . . Gilmore, L. (2015). Effect of a Brief Massage on Pain, Anxiety, and Satisfaction With Pain Management in Postoperative Orthopaedic Patients. Orthopaedic Nursing, 34(4), 227–234. https://doi.org/10.10
Parry, M., Bjornnes, A. K., Clarke, H., Cooper, L., Gordon, A., Harvey, P., . . . Watt-Watson, J. (2017). Self-management of cardiac pain in women: an evidence map. BMJ Open, 7(11). https://doi.org/10.1136/bmjopen-2017-0185495
Integrative Nursing Principle

Integrative Principle # 5
● “Integrative nursing is informed by evidence and uses the
full range of therapeutic modalities to support/augment the
healing process, moving from least intensive and invasive
to more, depending on need and context.”
● Includes nonpharmacologic practices such as massage,
meditation, and cold therapy.

Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam Maimonides
medical journal, 6(2), e0016. https://doi.org/10.5041/RMMJ.10200
 PLAN FOR IMPROVEMENT:
0-1 months 2-4 months
● Planning period ● Implementation with
● Unit notified reminders
1-2 months
● Week 1: Introduction
● Week 2: Massage End of 4th month
● Week 3: Cold Compress ● Feedback and evaluation
● Week 4: Meditation ● Debrief on training
● Week 5: In-person educational
Meeting Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in
nursing: Theory and application (9th ed., pp. 47). Philadelphia: Wolters Kluwer Health
REFERENCES
Cevik, K , Ince, S , Pakis Cetin, S , Tetik, Ö . (2020). Effect of Applying Cold Gel Pack to the Sternum Region

on the Postoperative Pain after Open-Heart Surgery . Celal Bayar Üniversitesi Sağlık Bilimleri

Enstitüsü Dergisi , 7(1) , 76-80 . DOI: 10.34087/cbusbed.631665

Johnson, J.K. (2001). Clinical microsystem assessment tool. Retrieved from

https://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf

Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory

and application (9th ed., pp. 47). Philadelphia: Wolters Kluwer Health

Miller, J., Dunion, A., Dunn, N., Fitzmaurice, C., Gamboa, M., Myers, S., . . . Gilmore, L. (2015). Effect of a

brief Massage on Pain, Anxiety, and Satisfaction With Pain Management in Postoperative Orthopaedic

Patients. Orthopaedic Nursing, 34(4), 227–234. https://doi.org/10.10

REFERENCES
Parry, M., Bjornnes, A. K., Clarke, H., Cooper, L., Gordon, A., Harvey, P., . . . Watt-Watson,

J. (2017). Self-management of cardiac pain in women: an evidence map. BMJ Open,

7(11). https://doi.org/10.1136/bmjopen-2017-018549

U.S. Department of Veterans Affairs. (2020). RN transition-to-practice (RNTTP). Retrieved

from https://www.va.gov/NURSING/workforce/RNTTP.asp