Semester Wrap Up

            Well, I can’t believe the semester is already coming to an end and my project is still in full swing! It’s crazy to think how fast this past semester has flown by. With that being said, it’s time to provide a summery of my project thus far.

            After getting off to a slow start, things started to pick up rather quickly. Due to scheduling conflicts, problems gaining computer access, and evolving project goals, I wasn’t able to really get going on my project until about the beginning of October.

            Once we had decided on which screening tools to use and had finished compiling our collection packet, we gained our IRB approval and I was “off and running”. Our goal was to collect data on about 50 patients over the age of 65 and then begin analyzing the data. During the data collection, I tried as best as I could to follow the patients from the time they arrive in the ER until they are either discharged or admitted to a unit. While they are in the ER, I documented any medications they received, medications they are currently taking, as well as any invasive procedures performed. The main documentation that I did was doing the cognitive assessments on the patients every hour to try and monitor for changes in mental status.

            Monitoring for changes in mental status is very important especially when caring for elderly patients in an ER setting because if the underlying cause is not treated then they have an incredibly high risk of returning to the ER, which leads to overcrowding, decreased quality of care, and increased health care costs.

            There has been quite a lot of research done on how to monitor for cognitive changes on patients in an ICU setting, but not so much in an ER setting. What we are finding is that the instruments that are commonly used in the ICU actually are not ideal for an ER setting; there needs to be more objective tools used that have a scale to show cognitive change.

            So far, we are about halfway done with the data collection process and are starting to enter the data into an analyzing software program so that we can start sifting through all of our results, which is VERY exciting! I have learned so much from this project and I am so grateful for the experience.

            Even though the semester is coming to an end, my project is really just getting started and I continue to look forward to updating you all on the status of it!  

Approaching the Halfway Point: It's All Downhill from Here!

Hello all! Well, since I posted last, my semester has really started winding down to an end, which is actually really hard to believe because it seems like it just started! My honors project that I’ve been keeping you updated on however, is reaching its half waypoint. Which is about where I thought it would be at this point, so we’re staying on track. Over the past week and a half I’ve continued to assess patients over 65 years in the ER and gather collection data.

            The biggest obstacle I’ve faced over the past couple of weeks is conveying myself with a sense of purpose in the ER; I know this sounds like a silly concept, but when it gets crazy down there, the last thing the majority of the staff and patients are worried about is a nursing student trying to gather data for a quality improvement study (and rightfully so). Regardless of the chaos, I still have to be persistent and vigilant to perform the cognition screens and collect the data. Speaking with as much conviction as I can muster has helped with this.

            Something interesting that’s happened over the past couple weeks was I saw my first “code” situation where a patient stopped breathing. I saw the rapid response team come flying in with the crash cart not far behind them; as a nurse-in-training, I could feel the adrenaline in the nurses (and in myself!). Standing outside of the patients room observing, the tension and nervous anticipation you could feel was almost electric; it made the hair on the back of your neck stand on edge, your palms sweat, and your skin tingle. Even though I wasn’t actively involved with the rapid response, I can see why being able to “work a code” as a nursing student is a once in a life time experience and one worth sharing!

            Over Christmas break, I think we should be about done with our data collection and can finalize the data entry process. The week after Thanksgiving we will start entering our data into analyzing software to give us an idea of where our progress is at the half waypoint, which will be very interesting to see!

            I know that my project got off to a slow start, but at this point I am so excited about the direction it’s heading, the experiences I’m gaining, and all of the doors it is opening for me as well as for the future of patient care. 

Full Moon in the ER

            Hello everyone! Last night I was back in the ER again, and we tried something a little bit different with our project; instead of screening only older adults presenting with confusion or delirium, we decided that we would do a convenience sample and screen every older adult in the ER that was over the age of 65 so that we can determine the prevalence of mental status change as well as determine which screen works the best.

            But so far, no one screen has worked the best; I believe this is because every patient is different and their situations and conditions are unique, so the test that worked for patient 1, might not be the best one to use for patient 2 even though they appear to be presenting the same way.

            This is a very important discovery, because often times only one screening tool is used and many cases of delirium and/or confusion are missed. Also, we added a 4^th screening tool called the TRST tool, which is a good indicator of patients that may return to the ER because of a history of falls, trouble with medication adherence, and difficulties with instrumental activities of daily living.

            We did about 5 screens last night and they went very well! It was a little crazy in the ER last night, I’m not sure if it was because of the full moon or Halloween…but it was very busy and fast paced. It was a lot of fun though! I plan on going back to the ER on Friday to continue with my project. 

Off Week

            Hey guys! Not much to update you on this week, as it was an off-week for me in the ER. Although I miss being active in my research, it was also fabulous to have a week to catch up with some school work since a lot of my assignments have somehow caught up with me this semester! I’ll be back in the ER next week though, so be sure and stay tuned for more updates and stories about my experiences!

Modifications and Encouragement

            Hello again! This past week has been very busy for me and for our research project! As you already know, last week was the pilot for our data collection form, which showed me areas in our form that needed to be modified in order for the collection of data and the script I use to be more fluid and user-friendly.

            Modifying the data collection form was a LOT easier said than done! The first thing that I did with our form, was turn it into a packet by consolidating all of the screening tools into one document. This sounds simple, but the saved forms that I had, couldn’t be copied and pasted into my new document due to their formatting, so I had to type up all of the forms manually. Which again may sound simple, but trying to manually figure out proper spacing and font size, etc. is a pretty tedious task, especially for the “technologically impaired”, such as myself! In addition to putting all of the screening tools in one place, I made some changes to the patient information section. Although I did not get a chance to test out my revised collection packet this week, I can already imagine how much better it will work for us, and for the future members of the health care team that may adopt our screening tools.

            On a side note about my project, I helped out with some of the activities at the UAB School of Nursing Alumni Weekend, and when talking with some of the more “seasoned” nurses there about my project, I was surprised at all of the interest and encouragement they all had for my project; all of them said that monitoring for cognitive changes in the elderly is so important in actual practice and that they were thrilled that I was pursuing this topic. Hearing the praise from these nurses that I aspire to be, really meant the world to me and made me excited all over again for my project and the opportunities and experiences I’m gaining because of it. 

A snapshot of how "organized" the modification process was