Nurses Perception: Effects of the New Sickle Cell Disease Program on the Management and Care Ofadults With Sickle Cell Disease Description of the relationship between extant literature and the hypothesis

Description of the research design

Description of research methodology

Description of study subjects

Description of Instrumentation or Treatment

Description of data collection procedures

Nurses Perception: Effects of the New Sickle Cell Disease Program on the Management and Care of Adults with Sickle Cell Disease.

The purpose of this research was to examine and assess the perception of the nurses who work with Sickle Cell Disease (SCD) patients and their experience on the newly structured SCD program at Yale New Haven Hospital (YNHH), which was opened on April 2012 and focuses on the treatment of adult SCD patients.

Aims: The overarching goal of this study was to examine nurse perceptions of their experiences with the SCD program at YNHH. The study had the following sub-goals:

1. Learning the perceptions of nurses working in a dedicated SCD unit on pain management for patients with Sickle Cell Disease.

2. Learning the perceptions of nurses working in a dedicated SCD unit on continuity of care for patients with Sickle Cell Disease.

3. Learning the perceptions of nurses working in a dedicated SCD unit on interdisciplinary communication related to the care of patients with Sickle Cell Disease.

Research Questions that framed the study: In addition to determine how the nurses perceived the SCD program, the study had to develop research questions that were focused on those questions. There were thirteen core research questions that framed the direction of the study. These thirteen core research questions were the questions that were targeted by the survey questions. They include the following questions: How well did the use of Patient Controlled Analgesia (PCA) improve the management of patients' pain? How well tiered oral dosing improve the management of patients' pain? Are patients expressing satisfaction with the use of PCA? Are patients satisfied with Tiered Oral Dosing? How well did the PCA pumps reduce nurses' time spent in medication administration activities? How significant is the reduction in noncompliant behavior of patients after the integrated care plans were implemented? How better equipped do nurses feel on dealing with escalating patients after having the education session on De-escalation was completed? How well did interdisciplinary rounds improve the nurses' knowledge about each patient's goals of care? Did interdisciplinary rounds improve nurses' involvement in decisions on goals of care? Did interdisciplinary rounds improve the patients' involvement in decisions on goals of care? Are interdisciplinary rounds improving patients' abilities to verbalize their goals of care? Does the SCD program/unit including specialized staff education and training provide the nurses the ability to successfully care for patients with SCD? Is the inpatient-outpatient cross coverage by Advanced Practice Registered Nurses improving patient continuity of care? Together, these thirteen questions formed the survey that was administered to the nurses.

Literature Review: Literature resources included the following articles:

Nurses' Attitudes and Practices in Sickle Cell Pain Management by Ardie Pack-Mabien, E Labbe, D. Herbert and J. Haynes, Jr.

Factors Affecting Hospital Staff Judgments About Sickle Cell Disease Pain by James Elander, Malgorzata Marczewska, Roger Amos, Aldine Thomas and Sekayi Tangayi

Race Matters: Perceptions of Race and Racism in a Sickle Cell Center by Stephen Nelson and Heather Hackman

A Video- Intervention to Improve Clinician Attitudes Toward Patients with Sickle Cell Disease: The Results of a Randomized Experiment by Carlton Haywood, Sopie Lanzkron, Mark hughes, Rochelle Brown, Michele Masa, Neda Ratanawongsa, and Mary Catherine Beach

Sickle Cell Disease: The Need for a Public Health Agenda by Hussain Yusuf, Michele Lloyd-Puryear, Althea Grant, Christopher Parker, Melissa Creary, and Hany Atrash

Barriers to Better Pain Control in Hospitalized Patients by Rebecca Drayer, Jessica Henderson and Marcus Reidenberg

A Review of the Literature on the Multiple Dimensions of Chronic Pain in Adults with Sickle Cell Disease by Lou Ella Taylor, Nancy Stotts, Janice Humphreys, Marsha Treadwell and Christine Miaskowski

Population Estimates of Sickle Cell Disease in the U.S. By Kathryn Hassell

Disability Among Individuals with Sickle Cell Disease by Mark Swanson, Scott Grosse and Roshni Kulkarni

Preventing Morbidity and Mortality from Sickle Cell Disease by Richard Olney

Research Design: This mixed-method descriptive study involved a survey conducted over a two-week period, which was administered to twenty six Registered Nurses (RN) who are currently working in the inpatient SCD unit. The study is descriptive...

The goal of the study was to assess the perception of nurses on the new SCD program, which opened on April 2012 in YNHH. The survey was developed for the purposes of the study and used a Likert scale to measure participant responses regarding nurse perception of the SCD program. The survey was created and reviewed by a multidisciplinary team composed of two Service Line Nursing Educators, two frontline registered nurses, Assistant Patient Services Manager, and Patient Services Manager. After development, the SCD Director and Director of Medicine Patient Services reviewed and approved the survey. The survey was the conducted anonymously over a two-year period. At the end of a two-week period, the data was collected, then analyzed by the YNHH Nursing Research director.
Reason for selecting this topic: The author has personal experience as an administrator-level employee at YNHH and has been involved with the SCD program since its April 2012 inception. Therefore, the author is aware of the challenges and successes that have been associated with the program. YNHH actively treats 150 or more adult patients with SCD each year, in a combination of inpatient and outpatient settings. In the past, inpatient care has been fragmented, challenging, and expensive. To help streamline the inpatient process, the administration created the Adult SCD program. The goal of the SCD unit was to provide a coordinated, structured multidisciplinary approach to caring for patients with SCD. As the Patient Service Manager of the Comprehensive Sickle Cell Medicine Unit, this study will help me to determine the overall perception of the frontline nursing staff on the effectiveness of the program. The results may be used as a validation of the effectiveness of the program as well as to identify areas of improvement.

Significance of research: The research is significant in that it will study the perceived efficacy of a nursing program at a specific hospital, allowing the administration to tailor the program to increase benefits based upon the study results. The results of the study can be shared with the YNHH as a performance improvement initiative. The study may also have utility beyond the SCD unit at YNHH; Sickle Cell Disease is a genetic disease that afflicts millions of people world-wide. If this program proves beneficial at YNHH, there is no reason that similar programs would not be beneficial at other hospitals.

Research Outcomes:

The data from this study will allow the identification of the nurses' perceptions on the specific areas of the SCD program that are working well and also to identify shortfalls in practice and to develop strategies to improve care. The study determined that the nurses' perceptions of the SCD were largely positive, although the survey did reveal information about areas where the nurses may have perceived possible room for improvement.

Stated assumptions/biases:

I have been working as the Patient Services Manager for the dedicated inpatient SCD unit for the past 18 months. Eighty percent of the registered nurses were novice when the unit opened. The leadership strategy that I implemented was transforming patient care (TPC). The focus of TPC is on a culture of safe and reliable care through TEAM- Teamwork, Excellence, Accountability and Mentorship. Before beginning the study, I was aware that the SCD had led to improvements in patient care, including improvements in patient's hospitalization and utilization patterns. There is a decrease in average length of stay from 12.5 days to 7.5 in the first 9 months of FY 2012 and continuing to FY 2013. ED visits decreased by 13% in the first 9 months of FY 2013 comparing to FY 2012. Inpatient discharges decreased by 25% and patient days decreased by 55% respectively in FY 2013. In addition, outpatient visits increased by 16% since the program was implemented. The recent YNHH Employee Engagement survey results that 75.9% of nursing staff working in the unit are engaged. The patient satisfaction report showed great outcomes in patient's experience. Anecdotal reports indicate greatly improved patient and staff satisfaction since implementation of the program. With all of these outcomes, I assumed that the nurses staff perceptions will be positive. In addition, I assumed that the registered nurses would be cooperative and willing to participate in this study and they were engaged and cooperative. I also realized that there were limited studies conducted about nurses perception on overall new adult SCD program.

Section I: Introduction

Sickle Cell Disease is a common disease that impacts millions of people worldwide. While it is a worldwide problem, its impact is felt disproportionately in different countries and among different subgroups. It is a genetically-linked disease, impacting people from certain populations at greater rates than people from other populations. Those at-risk populations have ancestors from Africa; the…