The role of clinical inertia in the treatment of patients with hypertension was assessed by evaluating health care providers' knowledge, attitudes, and clinical practices regarding hypertension management. A cross-sectional survey was conducted at the Forsyth Medical Group in North Carolina. Participants were physicians (N = 18, 10 sites) and support staff (N = 20, 12 sites), who were surveyed in 2006. Physician and support staff questionnaires consisted of 29 and 15 items, respectively, and were administered by trained interviewers. Though most physicians (94%) cited familiarity with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines and affirmed that hypertension management guidelines are relevant to their patients, no physicians interviewed routinely document patient hypertension management plans. Although 1 in 3 physicians cited the inability to devote enough time to patients for the discussion of hypertension management, physicians predominantly cited patient- and support-staff- related factors as most important to patients not attaining blood pressure (BP) goal. Patient lifestyle modification (89%), education (67%), and medication compliance (56%) were cited as the most important reasons for uncontrolled BP. Only one-third of physicians believe that clinical staff always obtain accurate BP measurements, and 61% believe that resistant hypertension is a reflection of inaccurate BP measurement. Many support staff claimed to be rushed when measuring patient BP, and 65% recommended BP competency training. Contradictions were evident between provider knowledge of hypertension management standards and how this knowledge is applied in clinical practice. Standardized collection of BP is critical to measuring clinical improvement in hypertension. Results are being utilized to develop clinical improvement initiatives including staff education and competency training.
AimsNeonatal death is not uncommon in tertiary neonatal intensive care. Though nurses are focussed on supporting parents through their loss, it is unclear how they are coping with this stress. We therefore aimed to explore the experiences of our nurses during end of life care (EOLC) to identify areas to support.MethodWe designed and conducted a 17-item paper-based survey between March and June 2015 exploring the views of nursing staff on their recent EOLC events.Results46 (94%) out of 49 nurses completed this survey. 78% of nurses gained knowledge from reading the unit’s bereavement guidelines, while 34% had attended formal training.Just over half reported being the named nurse for a dying baby, on at least one occasion in the past year. The average confidence rating in their role was 3.2 (scale of 1(low) to 5(high), SD 1.21) with a clear association between seniority and confidence (Figure 1).Abstract G415(P) Figure 1 Association between seniority and confidence ratingConfident nurses mentioned good consultant support, awareness of procedures and acknowledgement that there is ‘always more to learn’ as their secret for success, while less confident nurses mentioned lack of experience or training, and uncertainty about procedures being the main hurdles. The average confidence rating in providing culturally sensitive bereavement support was lower at 2.56 (SD 1.22).About 69% received support from a wide range of people and resources and rated this positively (mean 3.78, SD 1.23). (Table 1).Abstract G415(P) Table 1Sources of support for nursesCommon themes described include strong sense of sadness, frustration over unclear procedures, emotional affect lasting for a week, the value of debrief sessions and a sense of professional satisfaction.ConclusionsOur study highlights varied experiences and support needs of neonatal nurses in providing EOLC to babies and their families. Staff appeared to gain confidence with experience, good support and improved training opportunities. This could be achieved through on-the-job training by working closely with experienced staff or a family support worker, regular debrief sessions and improved access to unit guidelines. We propose to introduce these measures in our unit to support nursing staff to improve their confidence, wellbeing and job satisfaction.
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