Why the University of Saint Mary? EBP is one way to keep nurse's knowledge up to date, enhance clinical judgment, and augment the existing provider-client decision-making process.
Nursing grand rounds can be developed on the basis of an intriguing case and supported through evidence-based practice. Participation of bedside nurses should be encouraged in an effort to mentor and support professional development.
With the evolution of nursing as a profession, nursing research and evidence-based practice have also advanced significantly. As many hospitals are in pursuit of or have obtained Magnet accreditation, nursing grand rounds NGRs have seen a resurgence.
NGRs are a presentation given by nurses who share nursing care and focus on a particular case or group of cases. NGRs offer a venue for nurses to meet the objectives of the Magnet initiative through teaching and professional development.
Although NGRs have been cited in the literature since the s, 1 not much work has been published in this area.
Some consider that NGRs may have descended from medical grand rounds. Medical journals have addressed the lack of attendance at medical grand rounds that use a lecture-by-expert format.
It further allows nurses to extrapolate nursing care measures that colleagues can apply to their nursing practice. The purpose of this article is to describe the development of NGRs guided by a clinical nurse specialist CNS at a large, tertiary-care hospital and to provide a template for implementation of NGRs at other hospitals.
Previous Section Next Section Background Our organization began considering pursuing accreditation from the American Nurses Credentialing Center as a Magnet hospital for providing nursing excellence and quality care.
Through discussions with staff, it became apparent that our nurses needed ways to translate Magnet concepts to the daily practice of nursing. As critical care nurses, we are participatory and engage in dynamic processes. We are not passive learners. The strategy to refocus on the how and why of nursing would have to embrace the active style of critical care nurses.
As we considered how to generate excitement in the uniqueness of nursing and engage bedside nurses in the process, NGRs surfaced as a strategy. Regardless of the topic, the attendance at these offerings was paltry, with most of the attendees being management team members, not bedside nurses.
NGRs have existed in various forms for several decades. Some publications have also suggested that regularly scheduled educational opportunities for nurses are associated with increased professionalism and improved outcomes for patients.
Furlong et al 11 identified their NGRs as an opportunity for nursing expertise to be shared, a process that promoted professional development. For all of these reasons, we decided to try NGRs as a tool to enhance nursing practice. We anticipated doing the bulk of the work for the first presentation while providing a role model for and coaching the bedside nurses.
Surprisingly, the nurses quickly embraced the case study concept and took ownership of the presentation. The CNSs became consultants and mentors to the bedside nurses who had cared for the patient being presented in the case study. In her textbook From Novice to Expert, 12 Patricia Benner describes the expert nurse as providing nursing care without necessarily breaking down the steps of that nursing care.
Bedside critical care nurses provide expert care as evidenced by beneficial outcomes for patients. Benner describes the use of exemplars to share expert knowledge and assist nurses to move through the 5 levels of skill acquisition: It is a tertiary care center of nearly beds within the highly integrated ProMedica Health Care System.
The development of NGRs at TTH grew out of a desire to engage bedside critical care nurses in presenting interesting or complicated cases that challenged or rejuvenated their clinical practice and expertise in some manner. With support from the administrative nursing director of critical care and chief nursing officer, the first step taken was to identify the goals for NGRs and the general design of the presentations.
For TTH, the original goals centered on recognition of staff members who demonstrated expertise in the management of a critical care patient, encouragement of professional development, and presenting NGRs as an opportunity for learning.
The first NGRs presentation was delivered in a case study format and highlighted a fascinating case of a year-old mother of 4 who had severe sepsis and multiorgan failure. We actively recruited 2 nurses from the coronary intensive care unit to be the first presenters.
These 2 nurses created a strong PowerPoint presentation that highlighted the perspectives of an experienced critical care nurse and a new graduate nurse on the nursing management and emotional strain in dealing with such a highly complicated and challenging case.
The administrative nursing director set an attendance goal of 30 nurses for the first NGR.
The CNSs implemented several strategies to ensure achievement of this goal. The topic, time, and location were publicized several weeks in advance. Each nursing manager had 4 tickets to the presentation.NCLEX & Other Exams.
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