1

NURSING ANNUAL REPORT

22

KNOWLEDGE-BASED NURSING DRIVEN BY STANDARDS OF EXCELLENCE

Pictured: Laura Mansfield, MSN, RN, NEA-BC, Co-Chair of Nursing Research and Evidence-Based Practice Committee Jane Giganti, BSN, RN, CCRN, Clinical Nurse, Critical Care, Member of Nursing Research and Evidence-Based Practice Committee Lisa Summers-Gibson, MSN/Ed., RN, CDE, Co-Chair of Nursing Research and Evidence-Based Practice Committee

33

Dear Friends and Colleagues,

Welcome to our Nursing Annual Report for 2014. The past year has been extremely busy with our nursing journey to operational excellence and Magnet recognition. We submitted our Magnet application to the American Nurses Credentialing Center on April 1, 2015. We are very proud of our electronic document and the incredible work that it represents.

This year our Annual Report focuses on knowledge-based nursing practice that is driven by standards of excellence. So much work has taken place to advance new knowledge, innovation and improvements among our nurses. Most notable are the great strides we have made in advancing the educational levels of our nurses and the new frontiers we have explored with nursing research and Evidence-Based Practice projects.

In 2013, just over 90 registered nurses were enrolled in BSN, MSN and doctoral programs. In 2014, this number increased to 134 registered nurses. It is not a coincidence that as the education preparation of our clinical nurses has increased, patient mortality rates have decreased at Orange Regional. This remarkable patient outcome is consistent with the findings in recent multi-hospital research studies.

Also notable, is that Orange Regional has more clinical nurses than ever before participating in or conducting research studies or Evidenced-Based Practice projects. Since September 2012, 11 nursing research studies and five Evidence-Based Practice projects have been conducted. The hallmark sign of professional nursing practice is nursing research that produces new knowledge or confirms previous findings.

Orange Regional nurses are evolving and are becoming nurse researchers and scientists. Exploration and innovation afford them the ability to discover new passions and travel new territories. They put our values of honesty, integrity and transparency into action. With growth and new knowledge, our nurses are working to improve the health of our community.

Transformational Leadership. Structural Empowerment. Exemplary Professional Practice. New Knowledge, Innovation and Improvement.

Emulating the four distinct domains that comprise the foundation of Magnet designation, Orange Regional nurses are accountable for achieving outstanding care and service outcomes. Each day they are motivated to do what they do best. Our nurses are the essence of what it means to be Magnet.

I am so proud of our nursing team and, once again, congratulate them on an outstanding year.

Joanne Ritter-Teitel, PhD, RN, NEA-BC Vice President, Patient Care Services & Chief Nursing Officer

Pictured from L to R: Joanne Ritter-Teitel, PhD, RN, NEA-BC Charisse Fuller, BSN, RN Jean Lazio, BSN, RN, CMSRN, CRRN

4

Orange Regional Medical Center’s (ORMC) Nursing Research and Evidence-Based Practice (EBP) Committee embraces efforts to apply new nursing knowledge generated from scientific nursing research and EBP, which is drawn from a synthesis of the best available research, clinical expertise and patient preferences. Nursing research leads to new knowledge and innovation. EBP leads to higher quality care and better patient outcomes. Orange Regional nurses continually evaluate their current practice, innovate and ensure the application of the best research or evidence.

Currently, there are over 800 nurses practicing at Orange Regional, and as such are the largest professional group in our workforce. Nurses are well-positioned to play an important role in bringing the best research and evidence to patient care and practice. Nationally, only 10 percent to 15 percent of clinicians consistently apply EBP in their clinical care. The Orange Regional Nursing Research and EBP Committee is focused on educating our nursing staff on the importance of nursing research and EBP methodologies. Nurses are encouraged to question any practice that is

based in tradition and not on current evidence.

The Orange Regional Nursing Research and EBP Committee has adopted the Johns Hopkins Evidence-Based Practice model because of its comprehensive approach to the development of a clinical question, appraisal of the evidence and translation of the findings into practice. The implementation of EBP initiatives ensures that nurses continue to make a positive impact in nursing practice and achieve excellence in patient outcomes. Sharing the results of a practice change supported by evidence-based research promotes nursing practice advancement.

Disseminating new nursing knowledge and evidence through publication, poster sessions, research symposiums and conferences contributes significantly to knowledge gaps and the body of knowledge in nursing. It is our goal to promote standards of excellence in nursing by cultivating the spirit of inquiry, discovery, and to support nurses in disseminating their findings.

Written by: Lisa Summers-Gibson MSN/Ed., RN, CDE, Co-Chair of Nursing Research and Evidence-Based Practice Committee Laura Mansfield, MSN, RN, NEA-BC, Co-Chair of Nursing Research and Evidence-Based Practice Committee Pictured from L to R: Nursing Research and Evidence-Based Practice Committee: Maggie Swyka, RN, CPAN; Tonianne Motta, MSN, RN, CMSRN; Nicole Cerussi, RN; Gertrude Parks, LPN; Lisa Summers-Gibson, MSN/Ed., RN, CDE; Linda Dickman, RN, CPAN; Dianne Murphy, DNP, RN, CCRN; Jane Giganti, BSN, RN, CCRN; Laura King, DC, BSN, CMSRN; Aimee Luchejko, BSN, RN and Monica Reyes, BSN, CMSRN

NURSING RESEARCH AND EVIDENCE-BASED PRACTICE COMMITTEE

5

NURSING RESEARCH SCHOLAR IN RESIDENCE I am honored to be the Nursing Research Scholar in Residence at Orange Regional Medical Center since March of 2013. Nursing research has always been a passion of mine. As a Doctoral prepared Advanced Practice Nurse working as a Professor of Nursing at Mount Saint Mary College, I enjoy acting as the liaison between academia and Orange Regional’s nursing division. It is exciting to play a role in growing the knowledge base of nurses through research and Evidence-Based Practice (EBP).

As the Nursing Research Scholar in Residence, I work closely with the Nursing Research and EBP Committee. My primary goal is to guide nurses in both Evidence-Based Practice projects and nursing research studies. Nurses approach the Nursing Research and EBP Committee when they would like to conduct either an EBP project or a nursing research study. This is an opportunity for me to mentor other future nursing scientists. Mentoring includes assisting nurse investigators to prepare to present their research to the Institutional Review Board (IRB), which approves all research. The IRB has a very important role in protecting the rights and welfare of human subjects participating in research investigations.

Once the research or EBP project is completed, the dissemination of all findings is crucial to foster innovation and drive knowledge-based nursing. My mentoring also includes assisting nurses to prepare poster presentations, podium presentations and publications. It is amazing to view the nursing research and EBP projects displayed on poster presentations at the Orange Regional Medical Center annual nursing research event held during Nurses Week!

Since the inception of the Nursing Research and EBP Committee in September 2012, there have been 11 nursing research projects and five EBP projects conducted by nurses at Orange Regional. With so much innovation happening here, it is true that knowledge-based nursing is driven by standards of excellence.

Written by: Dianne Murphy, DNP, RN, CCRN Nursing Research Scholar in Residence Pictured: Dianne Murphy, DNP, RN, CCRN

6

CARING ARTS MODALITIES

The Caring Arts Modalities (CAM) Program incorporates concepts from Dr. Jean Watson’s Theory of Human Caring, Dr. Barbara Dossey’s Theory of Integral Nursing, and Dr. Marks and Ms. Hraniotis’s IDMA, CTAT, scientific and integrative health work. Together, this program provides rejuvenating non-medication approaches that harmonize the mind and body. Mind-body healing is a science. Science shows that when the body enters a state of deep rest and relaxation, harmful stress hormones are reduced; and when mind and body experience a peaceful, aesthetic environment, endorphins are released.

At Orange Regional Medical Center, 2 North Oncology nurses have been educated by Dr. Marks and Ms. Hraniotis and introduced to an original CAM Program designed to promote healing and enhance comfort and rest for Oncology patients. These therapies are used by nurses to initiate a transformative experience during a stressful workday. Dr. Marks is the principle investigator of a caring science nursing research study that examines nurses’ experiences with utilizing a theoretically guided nursing practice.

Nurses partner with patients and their families to create a soothing, healing environment that uses beautiful visual art images, soft lighting and music, positioning, relaxation, guided imagery, soothing light touch of hands, back and feet, and aromatherapy.

Nurses may use a specially designated room on the 2 North nursing unit, which is equipped with a comfortable chair, aroma therapy, soft lighting and music, and visual art imagery. The milieu of this room enables the nurse to provide a sense of rejuvenation and personal indulgence.

There are three research questions that this study seeks to address: 1. What are the Oncology patient’s experiences of nursing

care that utilize the theoretically guided approach to Oncology care?

2. Does CAM promote health, comfort and rest for Oncology patients?

3. What are the nurses’ transformative experiences for utilizing a theoretically guided nursing practice in Oncology care?

To evaluate the Program, a mixed method research study was conducted on 2 North with six nurses and 25 patients who participated in the CAM Program. Preliminary data analysis demonstrates a significant improvement in patient reports of comfort and rest.

Nurses who participated in a caring science approach using the CAM Program reported the opportunity to re-center themselves in the midst of a busy shift. Nurses also shared that caring for self and others in this manner created a tone of authentic presence and peacefulness that permeated the environment beyond the patient room into the unit culture. Nurses described a process of breaking through the emotional barriers of time and tasks that burden them. Reciprocity of caring was facilitated by participating in this caring science approach.

The Caring Arts Modalities Program for Oncology at Orange Regional is generously funded by the Corrine Feller Foundation.

Written by: Wendy Marks, DNS, NP, Principal Investigator and Consultant Holistic Health Consultants of the Hudson Valley

7

InternalFactorsCulture

Environment

Equipment Supplies

Staffing

Standards

RESEARCH • Experimental • Quasi-experimental • Non-experimental

NON-RESEARCH • Organizational Experience • Quality Improvement • Financial Data • Clinical Expertise • Patient Preference

There are multiple Evidence-Based Practice (EBP) models in the literature, all of which support and contribute to the quality and enhancement of the art and science of nursing. Orange Regional Medical Center has integrated the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model into its New Knowledge, Innovations, and Improvements practice. The JHNEBP model is described as:

A problem-solving approach to clinical decision-making within a health care organization that integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence, considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to care for the individual patient, patient population or system (Melnyk & Fineout-Overholt, 2011, p. 269).

Through the use of this EBP model, all clinical nurses are able to incorporate EBP into their nursing care. This fosters a culture of knowledge-based care and practice. The JHNEBP model urges clinical nurses to evaluate, pilot and promote EBP.

Orange Regional has adopted this EBP model to foster new knowledge, innovations and improvements on our journey to operational excellence and Magnet accreditation. For example, utilizing the EBP model, the nursing research and EBP Committee has strengthened the hospital’s bedside handover policy and procedure so as to create an exceptional healing environment for our patients and families. Our strengthened policy fosters patient/family involvement and ensures patient safety. The goal of EBP and its utilization within the nursing fabric of Orange Regional is the promotion of standards of excellence. While changes in nursing practice may be met with spirited inquiry, the benefits of change must be clearly communicated. At Orange Regional, the benefits of change include enhanced responsibility and the creation of a culture of inquiry. Our EBP model, which integrates the best available scientific evidence, encourages critical thinking, which leads to better outcomes for individual patients and the community we serve.

EVIDENCE-BASED PRACTICE

References: Melnyk, B.M. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

Written by: Tonianne Motta, MSN, RN, CMSRN, Clinical Nurse, Oncology Pictured: Veronica Bollati, RN, CMSRN, ONC, Clinical Nurse, 4 West

Johns Hopkins Nursing Evidence-Based Practice Model

ExternalFactorsLegislation

Quality Measures

Regulation

Standards

Practice

Education Research

8

Delirium is an acute change in consciousness that is accompanied by inattention and either a change in cognition or perceptual disturbance. Delirium is brain failure and should be treated as judiciously as any other organ failure. Unfortunately, delirium is usually regarded as either a normal response to illness or is described as one of the 25—30 different conditions otherwise named for delirium. There has been very little research in the past regarding the pathophysiology of delirium or the detrimental effects of this phenomenon. Delirium accounts for a higher mortality rate, cognitive impairment that lasts long after one’s hospitalization, post-traumatic stress disorders and an additional cost of care—up to 16 billion dollars annually.

As a critical care registered nurse at Orange Regional Medical Center, I chose to research delirium while pursuing a BSN in an EBP/Research class. I chose this topic because it is very interesting that some patients recover from sedation and life support neurologically intact while some patients become confused, agitated and restless for days afterward. During my research, I learned that delirium is not just about a patient suffering from confusion after sedation withdrawal but rather a complex syndrome that is poorly understood, has many causes and has an extremely high incidence in the critical care setting. Delirium monitoring is now an American Association of Critical-Care Nurses (AACN) practice alert and is also a part of the recommended guidelines from both the Society of Critical Care Medicine (SCCM) and the American College of Critical Care Medicine (ACCM).

With guidance from Orange Regional’s Nursing Research and EBP Committee and Lisa Summers-Gibson, MSN/Ed., RN, CDE, along with the endorsement and support from Nicole Sewell, BSN, RN, CCRN, Nurse Leader of the Medical Intensive Care Unit, I was able to conduct an EBP project that included: 1. A pre-test developed and distributed to evaluate the

knowledge base of the critical care staff regarding delirium, along with assessment and treatment;

2. A self-assessment survey distributed to evaluate the confidence of nurses regarding delirium and its assessment;

3. The development of a policy using the Awaking, Breathing, Coordination, Delirium and Early mobility (ABCDE) bundle. The ABCDE bundle coincides with the SCCM’s Pain Agitation Delirium (PAD) guidelines.

Furthermore, to assess delirium, new instruments were introduced to include the Confusion Assessment Method for ICU (CAM-ICU), the Richmond Agitation Sedation Score (RASS), and the Critical Care Pain Observation Tool (CPOT). All assessment tools were brought to the Information Technology Department for an EPIC build to ensure proper documentation within electronic health records.

The Intensive Care Unit’s clinical staff was offered five 2-hour classes on delirium, CAM-ICU, RASS, CPOT and the ABCDE bundle. The purpose of this practice change is to prevent and minimize Intensive Care Unit delirium. Future plans include having the tools in EPIC, completing a post-test to evaluate new knowledge and working on aspects of the ABCDE bundle that take time and interdisciplinary consideration in order to incorporate it into our practice.

MINIMIZING DELIRIUM IN THE INTENSIVE CARE UNIT

Written by: Jane Giganti, BSN, RN, CCRN, Clinical Nurse, Critical Care Pictured: Murali Krishna, MD, Pulmonary and Critical Care Attending Physician Jane Giganti, BSN, RN, CCRN, Clinical Nurse, Critical Care Nicole Sewell, BSN, RN, CCRN, Nursing Unit Director, MICU

9

BUILDING NEW KNOWLEDGE AND THE INSTITUTIONAL REVIEW BOARD Nursing research is a systematic investigation that includes the development, testing and evaluation of study questions that are designed to develop or contribute to new knowledge and innovation. Orange Regional nurses translate research findings to provide evidence-based care that promotes quality health outcomes for individuals and the community we serve. At Orange Regional, we have a growing passion for nursing research to enhance our foundation for standards of excellence. We are committed to protecting the rights of our patients during research studies.

An Institutional Review Board (IRB) is a committee that is formally designated to approve, monitor and review biomedical, behavioral and nursing research involving humans. The purpose of this review process is to ensure that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in a research study from any physical or psychological harm. Additionally, the ethics and methods of the research study are examined when considering whether or not research should be conducted.

All nursing research involving human subjects must be approved by the Orange Regional Medical Center IRB. Our IRB is composed of physicians, pharmacists, infectious disease staff, nursing staff and a community member. There are six voting members. Orange Regional’s IRB Chairman is Dr. Cleveland Lewis. As Co-Chair of the Nursing Research and EBP Committee, I am also a member of the IRB.

Since 2013, 11 nursing research projects have been approved by the IRB. The presentation by the nursing principal investigator is formal and involves an overview of the study, purpose, methodology and of how human subjects’ rights are protected. As our passion for nursing research and exploration grows, so does our expertise with the scientific method and protection of human subjects.

Written by: Laura Mansfield, MSN, RN, NEA-BC, Nursing Service Administrator, Emergency Department, Critical Care, Progressive Cardiac Unit, Behavioral Health, Dialysis and Centralized Telemetry Pictured: Laura Mansfield, MSN, RN, NEA-BC, Nursing Member of the Institutional Review Board Cleveland Lewis, MD, Chair of the Institutional Review Board

10

11

THE RELATIONSHIP BETWEEN MUSIC THERAPY AND SLEEP

Orange Regional Medical Center is actively developing its Nursing Research and Evidence-Based Practice (EBP) Committee. Conducting research and using EBP play an important role in growing our professional nursing practice environment and in improving patient outcomes. At Orange Regional, under the leadership of Laura Mansfield, MSN, RN, NEA-BC and Lisa Summers-Gibson, MSN/Ed., RN, CDE, our Nursing Research and EBP Committee has completed many research projects in 2014. The valuable information obtained through these nursing studies and projects helps to validate existing nursing knowledge and generates new knowledge that can be applied and used to influence clinical nursing practice.

One of the research projects at Orange Regional was a quasi-experimental study conducted by Laura L. King, DC, RN, BSN, CMSRN and Dianne Murphy, DNP, RN, CCRN, on the relationship between music therapy and sleep on Progressive Care Unit patients.

Inadequate sleep is common in an acute care setting such as a hospital. Many factors can influence sleep adversely, such as physiologic, environmental and psychological factors. At Orange Regional, we strive not only to keep our patients safe but to also provide an exceptional patient care experience. Making sure that a patient has a restful night’s sleep is part of nursing practice and is of the utmost importance in the healing process.

The purpose of this study was to determine whether music, as therapy at bedtime, improved sleep in patients on the Progressive Care Unit (PCU). As part of the study, other factors that can interfere with sleep were also investigated. These factors included noise in the hallway, beeping of IV pumps, nurses entering the room, phlebotomy, anxiety and pain.

Both PCUs at Orange Regional, 3 North and 3 South, were included in the study. The patients on 3 North (the intervention unit) were assigned to listen to music from the hospital’s C.A.R.E channel for 45 minutes before going to sleep for two consecutive nights. They were then asked the following morning to fill out a questionnaire and answer questions on how they had slept. The patients on 3 South (the control unit) were not assigned to listen to music. They filled out the same questionnaire and answered the same questions on how they had slept.

Data collection was completed for this study by clinical nurses on 3 North and 3 South, including Karen Huslinger, BSN, RN, CMSRN, Carolyn Whitbeck, RN and Heather Wilcox, RN. Having clinical nurses participate in research studies at the bedside is invaluable because it helps them understand the research process, translate the findings into practice and improve patient outcomes.

Preliminary results of the music study revealed significantly better sleep on 3 North (the intervention unit) when compared to 3 South (the control unit). Results also revealed that anxiety, staff talking and noise in the hall disturbed participants while they were trying to sleep.

In conclusion, the findings of the study contribute to the knowledge of the effectiveness of music on perceived sleep in the PCU. In the future, the C.A.R.E. music channel will be included in PCU nursing care and practice. In 2015, we look forward to further expanding our Nursing Research Committee and using the knowledge and insight gained to continually improve nursing practice, patient care and outcomes.

Writen by: Laura King, DC, BSN, CMSRN, Nursing Unit Director, 3 South, Co-Investigator Pictured: Dianne Murphy, DNP, RN, CCRN, Nursing Scholar in Residence, Principle Investigator Laura King, DC, BSN, CMSRN, Nursing Unit Director, 3 South, Co-Investigator

12

Pictured: Laura Mansfield, MSN, RN, NEA-BC, Nursing Service Administrator, Emergency Department, Critical Care, Progressive Cardiac Unit, Behavioral Health, Dialysis and Centralized Telemetry Deborah Hewitt, MBA, MSN, RN, NE-BC, Program Administrator, Professional Nursing Practice

13

SELECTING A NURSING DOCTORAL PROGRAM

The nursing profession is one of the most noble. The definition of Nursing from the American Nurses Association is “the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of individuals, families, communities, and populations” (ANA, 2015). In order to be considered a profession, nursing needs its own discreet body of knowledge discovered through nursing research. The expansion of knowledge about the science of nursing is key to providing better patient care, improving health and evaluating outcomes (IOM, 2010). Nursing research is generally conducted by nurses with doctoral degrees.

There are several doctoral degrees within nursing and they are all important in translating and creating new nursing knowledge. The focus here is on the two doctoral study degrees, which are the Doctorate of Nursing Practice (DNP) and the Doctorate of Philosophy in Nursing (PhD). “Doctoral programs prepare nurses to be experts within the profession, allowing them to assume leadership roles in a variety of academic and clinical settings” (Anderson, 2013). The DNP has a focus in Nursing Practice. The goal is to create nursing leaders in interdisciplinary health care teams by providing DNP students with the tools and skills necessary to translate evidence gained through nursing research into practice, improve systems of care and

measure outcomes of patient groups, populations and communities. A PhD is focused on nursing research. The goal is to prepare PhD student nurse scientists to develop new knowledge for the science and practice of nursing. Graduates will lead interdisciplinary research teams, design and conduct research studies and disseminate knowledge for nursing and related disciplines, particularly addressing trajectories of chronic illness and care systems.

Choosing a Nursing Doctoral Program that’s right for you can seem challenging. The first step is keeping your career trajectory in mind. Where do you want to go? Graduate-level education produces nurses who can assume roles in advanced practice, leadership, teaching and research. The next step is choosing an academic institution that not only satisfies your academic aspirations but is accredited and nationally recognized. Choose a program that meets your needs and learning style (online, brick and mortar, hybrid). When considering what a school has to offer, look at the mission and vision of the institution. The basic philosophy of the school should be one that is in line with your personal beliefs. Another important consideration is location and monetary cost. Nurse scientists are a critical link in the discovery and translation of knowledge. Once all of your information is gathered, weigh your options and pursue your dreams with the program that is right for you.

References:

American Nurses Association (n.d). What is nursing? Retrieved on April 20, 2015, from http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing

Anderson, C. (2013). Choosing a nursing graduate doctoral program. Retrieved on April 16, 2015, from http://www.petersons.com/graduate-schools/choosing-nursing-graduate-doctoral.aspx

IOM. (2010). The future of nursing leading change, advancing health. The National Academies Press.

Deborah Hewitt, MBA, MSN, RN, NE-BC Applicant for Doctorate of Nursing Practice Program

Laura Mansfield, MSN, RN, NEA-BC Applicant for Nursing PhD Program

NURSING MISSIONWe are caring nursing professionals driven by standards of excellence

who go above and beyond to provide an exceptional patient care experience.

Written by:

14

15

Lisa Summers-Gibson, MSN/Ed., RN, CDE PhD Nursing Student at Seton Hall University I am currently a PhD Candidate at Seton Hall University (SHU) in South Orange, New Jersey. I decided to attend SHU because I wanted to attend a brick-and-mortar school to benefit from the relationships with my professors and student co-hort. These relationships have proven to be extremely valuable in my academic journey. Additionally, SHU has a part-time program for working students, and I commute once a week to attend two classes each semester. I chose to pursue a PhD because I want to conduct research to contribute to new nursing knowledge. The PhD course of study at SHU involves coursework, a written and oral candidacy examination and original research for the dissertation phases.

The purpose of a candidacy examination is to test the student’s knowledge of a concept and to determine whether the student possesses the critical and analytical skills necessary for a scholarly career. My candidacy examination was on the concept of adult diabetes self-care. The oral examination consisted of an hour of questioning from a committee of three PhD professors. I am excited to have passed my written and oral candidacy examination and to move on to the next phase of my scholarly journey.

My research question is: What is the lived experience of adults with type 2 diabetes? I contemplated my research question for over a year. The synthesis and analysis from my candidacy examination led me to a qualitative research question. I am currently in the process of writing phase one of my dissertation, which consists of identifying gaps in knowledge and substantiating the significance of this research related to the nursing science of diabetes. In Fall 2015, I will defend my research topic to my dissertation committee before submitting to the SHU Institutional Review Board. At SHU, PhD students learn both quantitative and qualitative research and each research process adheres to a different scientific methodology. The program journey is laborious; however, it is rewarded with profound growth and development both personally and academically.

Sharon Geidel, DNP, RN, RN-BC Graduate of Doctorate of Nursing Practice Program My name is Sharon Geidel, DNP, RN-BC. I graduated from Capella University in March 2014 with my Doctorate in Nursing Practice (DNP). One of the requirements of a doctor of nursing practice student is to identify gaps in the current setting and advocate for change through Evidence-Based Practice (EBP). While in school, I was the nurse manager of an Operating Room. One day, I encountered a patient waiting to undergo bariatric surgery for weight loss. He had been voicing concerns about being hungry and wanted to get his surgery over with so he could have his coffee and buttered roll. Knowing that bariatric patients are not to eat anything solid (especially bread) after surgery, I gently reinforced pre-operative teaching with him. This patient interaction inspired my EBP project, which is required to satisfy the program requirements for a DNP.

By way of background, bariatric patients are required to have a psychological assessment as part of their insurance preauthorization process. However, they do not have to abide by the recommendations. At my hospital, the bariatric program’s psychiatrist offered an open-door policy for Cognitive Behavioral Therapy (CBT) for patients who were anticipated to struggle with a new diet regime. CBT is a form of therapy that helps change behaviors through reflective discussion and insight. This was another inspiration for my study.

My investigation began with a comprehensive literature review to learn if CBT had an impact on long-term weight loss in the bariatric patient population. I sought to compare weight loss in patients who have utilized CBT versus those who did not have CBT. My dissertation is entitled, “The Impact of Cognitive Behavioral Therapy (CBT) on Long-Term Weight Loss after Bariatric Surgery.” It helped to identify practice changes in the clinical setting. Following IRB approval, my EBP project included a comprehensive literature review and a retrospective, descriptive study of 299 bariatric surgery patients.

The findings of my project demonstrated that, after one year, 66 percent of patients who attended CBT on a regular basis sustained weight loss. Those who did not attend CBT-based support groups not only experienced weight gain, but repeated surgeries as well. From this newfound knowledge, I developed some practice changes that included the development and implementation of a bariatric screening tool, bariatric diet order sets, and CBT-based educational discharge brochures. Additionally, my findings demonstrated that comprehensive patient education improves patient satisfaction and prevents complications related to binging and overeating which result in returns to the Operating Room.

My doctoral study and EBP research enhanced my professional growth and development. As a DNP, I am now able to conduct EBP projects and research, which helps close the gaps in knowledge and positively impacts individuals in my practice setting and the community we serve.

Pictured: Sharon Geidel, DNP, RN, RN-BC, Nursing Unit Director of Oncology and Outpatient Infusion Lisa Summers-Gibson, MSN/Ed., RN, CDE, Nursing Professional Practice Educator

16

Orange Regional Medical Center Magnet Website Soon after we moved into our brand new hospital (the first stand-alone hospital built in New York state in 25 years), we began our journey to operational excellence and Magnet accreditation. While everything we planned was implemented with operational excellence in mind, the foothold of our work was the regeneration of our shared decision-making model into the Nursing Congress. This vibrant model is at the core of everything we do and supports the underpinnings of our success:• Aspirational leaders who motivate our staff to transform the practice environment;• Inviting staff to the “table” and ensuring their voice is heard;• Supporting staff to create innovative solutions to patient and practice challenges;• Using research and evidence;• Achieving and celebrating operational excellence

Magnet Recognition Program® Model ComponentsOrganizational OverviewOrange Regional Medical Center is committed to operational excellence as we fulfill our mission to enhance the health of our community. The growing number of honors, including the Healthgrades Patient Safety Excellence Award™, the National Research Corporation Path to Excellence Award and the US News Best Regional Hospital in the Hudson Valley Award, are testaments of this commitment. Our nursing service is pivotal in the success of Orange Regional, which strives to be a nationally recognized organization that improves the health of our community.

Transformational LeadershipAt Orange Regional, leaders inspire and motivate clinical nurses to reach above and beyond. We ensure that nurses have both a voice and a place at the table within the organization. Myriad opportunities to learn and grow attract nurses to a career at Orange Regional.

Structural EmpowermentThe Nursing department is the backbone of the organization. Nurses share in decision-making processes and participate in Nursing Congress, Inter-professional Committees and community outreach. They exhibit teamwork, collaboration and communication.

Exemplary Professional PracticeAt Orange Regional, our nursing professionals are driven by standards of excellence. Always putting patients and families first, they engage in each other’s success and invest in their work environment. They are caring nurses who utilize their knowledge and skills in providing exceptional patient care experiences.

New Knowledge, Innovations, ImprovementsOrange Regional nurses are researchers and scientists. Exploration and innovation afford them the ability to discover new passions and travel new territories. They put honesty, integrity and transparency into action. With growth and new knowledge, our nurses work to improve the health of our community and foster an impeccable healing environment.

To view the Magnet document, go to the ORMC Intranet, under Quick Links and in the bottom right box, click on Magnet Program. The username and password will come up – write this down. Click on the link titled Orange Regional Magnet Program Website. Enter the username and password. View the entire document by clicking on the left side of the page. For more information or answers to your questions, call Magnet Program Director, Jean Pozza, at 333-2145.

REACHING ABOVE AND BEYOND

Pictured from L to R: Jeanine Koehnken, RN, CNOR and Ralph Anderson, MD; Shannon Keesler, RN, CMSRN, CPAN and Jill Hunt, PA-C; and Sara Brown, RN

17

Academic Partners:BOCES-Orange/UlsterChamberlin CollegeColumbia University Dominican CollegeElmira CollegeMount Saint Mary CollegeNyack CollegePenn College of TechnologyUniversity of RochesterSacred Heart UniversitySUNY BuffaloSUNY DelhiSUNY OrangeSUNY PlattsburghSUNY Stony BrookSUNY Sullivan

Walden University

In 2014, Orange Regional served as a clinical site for 865 nursing students. 2014 BSN Graduates:Adams, MatthewBailey, JasonBendersirrie, CynthiaBermo, KathyBonner, StacyBrown, BethCintron, LauraColeman, Rose MarieDean, KimberleeDonaldson, KarenFerry, DarciGibson-Borrelli, AlbaliraGuerra, LauraKing, LauraLane, NancyLotz, RobertMackay, Christine MackayMoloney, IreneNazzaro, MariaPaulovici, HerminiaPhillips, JezzreelRath, NileysiRose, LisaSiciliano, ChristineSweeney, Geraldine

Wods, Carolyn 2014 MSN Graduates:Ensslin, Peggy

Heins, Deborah 2014 Doctorate Graduates:Geidel, Sharon - DNP

BSN Students in 2014:Acevedo, DeborahAdams, MatthewAlexander, Stefanie

Babcock, EliseBailey, JasonBaker, YolaniBark, CarolineBehrent, JenniferBennett, MarshaBermo, KathyBinkowski, SandraBlackwood-Hiller, KereenBollati, VeronicaBoniface, ZoeBonner, StacyBosland, KristyBowley, StevenBrewer, BridgetBrock, DebraCarpenter, JaclynCintron, Laura

Coleman, Rose MarieColon, DawnConroy, DanielContreras, GloriaCornman, GaryCossentino, MaryCroce, KorinneCron, MaryCurtis-Hamiton, DionneDean, KimberleeDickman, LindaDonaldson, KarenDonnelly, Mary LouDoty, KarenEckert, TheresaElliot, PatriciaErler, AliciaFayo, MargaretFerguson, JamieFerry, DarciFisher, Ann Marie

Flessa, KathleenFuncheon, MelissaGallagher, FabrisaGerlach, LorileeGibson-Borrelli, AlbaliraGiganti, JaneGildea, LindaGrady, TheresaGrahn, LorettaGraziano, Bonnie JoGrieb, VirginiaGuadaloupe, NicoleHadden, JenniferHall, KristinHarker, JenniferHehir, EvelynHenderson, MelissaIrizzary, Marie

Jablonski, KimberlyJollie, TammyJones-Clark, JasinthJuers, DanielleKeeley, KathleenKelly, SusanKing, LauraKlein, SarahKruger, TaraKuhens, KarinLane, NancyLanglitz, CatherineLauchaire, DawnLotz, RobertMackay, ChristineMaina, AngelaMaldonado, ClarissaManclow, JasonMarley, PatriciaMarquez, MarieMarshall, Dawn

Martin, DonnaMarvulli, AgnesMcMillan, SonyaMcNeil, DonaMoloney, IreneMonell, AlexandraMonti, VickieNazzaro, MariaNeidnig, MaureenNelson, JodiNichols, MaraniqueNivens, CarolO’Hern, HollyOram, CarolPajibo, DeckontiPalmer, StaceyPatzelt, AriennePaulovici, HerminiaPettus, DierdrePollaro, JenniferPumillo, AmandaRath, NileysiRemaley, RobinRivera, LisaRodriguez, SaraRose, DeniseRose, LisaRoth, KellyRyan, PatriceScheck, LauraSciliano, ChristineSemmeles, LisaShapiro, TeresaShormis, MarySiciliano, ChristineSiegel (Lochard), NicoleStubecki, DeborahSweeney, GeraldineSwift, JenniferSzulewski, DeborahTenorio, RobertaThirkield, SusanThorson, DeborahTice, SarahTownsend, ClaydeanValentin, RosaVinciguera, DianeVollano, TaraWeber, StuartWheeler, StephanieWhitbeck, CarolynWilcox, HeatherWilcox, PatrickWilcox, VictoriaWilson, ElisaWinchell, DanaWoods, CarolynWoods, KateWorden, Michele

As part of its Nursing Strategic Plan, Orange Regional is building an empowered nursing workforce that focuses on advancing education and new knowledge of Evidence-Based Practice, state of the art technology and innovation to achieve outstanding clinical outcomes.

BSN Growth vs. Inpatient Mortality Rates

50

40

30

20

10

0 2012 2013 2014BSN Rate 28.05 30.07 43.73IP Mortality Rate 2.45 1.98 1.64

5

4

3

2

1

0

******No statistical analysis was performed to determine valid or reliable relationships.The BSN Rate and Mortality Rate are accurate descriptive data points. 5/28/15

% In

patie

nt M

orta

lity

% B

SN

DISSEMINATING KNOWLEDGE

Pictured from L to R: Joanne Ritter-Teitel, PhD, RN, NEA-BC; Dianne Murphy, DNP, RN, CCRN; Laura King, DC, BSN, CMSRN; Charlene Wade, PhD, RN, NEA-BC; Monica DelRosso, BSN, RN, OCN; Elfriede Rose-Auinger, RN; Joyce Hill BSN, RN; Donna Martin, RN, CMSRN, ONC; Jamie Tropin, MSN, RN, CMSRN; Lisa Summers-Gibson, MSN/Ed., RN, CDE; Maggie Swyka, RN, CPAN; Theresa Eckert, RN, CMSRN and Laura Mansfield, MSN, RN, NEA-BC

Charlene Wade (May, 2014). Evidence-Based Practice on perioperative simulation techniques. Poster presentation at Orange Regional Medical Center’s Nurses Week, New York.

Jamie Tropin (April, 2014). Is there a relationship between reiki therapy and pain management? Presentation at Sigma Theta Tau International Alpha Mu Research Conference; (May, 2014) Poster presentation at Orange Regional Medical Center’s Nurses Week; (November, 2014) Poster presentation at 1199 Nursing Conference, New York.

Joanne Ritter-Teitel (May, 2014). Nurse mentors and protégés: Supporting our emerging leaders. Presentation at the Nursing Summit on Transformational Leadership in a New Healthcare Environment, New York.

Joyce Hill (May, 2014). Does certification for nurses in their specialty benefit the consumer? Poster presentation at Orange Regional Medical Center’s Nurses Week, New York.

Laura King & Dianne Murphy (April, 2014). The impact of music to promote sleep in progressive care unit patient. Presented at Sigma Theta Tau International Alpha Mu Research Conference; (May, 2014) Poster presentation at Orange Regional Medical Center’s Nurses Week, New York.

Lisa Summers-Gibson (May, 2014). Introduction on how to conduct nursing research. Poster presentation at Orange Regional Medical Center’s Nurses Week, New York.

Lisa Summers-Gibson (May, 2014). Introduction to Johns Hopkins Evidence-Based Practice model. Poster presentation at Orange Regional Medical Center’s Nurses Week; (November, 2014) Poster presentation at 1199 Nursing Conference, New York.

Lisa Summers-Gibson (September, 2014). Empowering RN to BSN through mentorship. Normet Future of Nursing Conference, New York.

Lisa Summers-Gibson & Laura Mansfield (May, 2014). Evidence-Based Practice on bedside handover. Poster presentation at Orange Regional Medical Center’s Nurses Week, New York.

Margaret Swyka & Charlene Wade (May, 2014). Evidence-Based Practice on nursing transporting patients out of the PACU. Poster presentation at Orange Regional Medical Center’s Nurses Week, New York.

Monica DelRosso, Elfriede Roze-Auinger & Charlene Wade (May, 2014). Evidence-Based Practice change in the care and maintenance of enteral feeding. Poster presentation at Orange Regional Medical Center’s Nurses Week, New York.

Romilda Canale (May, 2014). The impact of pre-warming on elective surgical patients. Poster presentation at Orange Regional Medical Center’s Nurses Week, New York.

Raizie Lutwak, Theresa Fay Conte & Cynthia Chapman (June, 2014). Unlocking the potential of AWHONN’s perinatal education orientation program (POEP). Poster presented at the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) National Conference, Florida.

Tracy Blum & Arienne Patzelt (May, 2014). Bowel Regimen. Poster presentation at National Association of Orthopedic Nurse, Nevada.

18

19Pictured: Matthew Adams, BSN, RN, CMSRN, Clinical Nurse, Operating Room

NURSING VISIONTo be a nationally recognized nursing organization that

improves the health of our community.

20

707 East Main Street | Middletown, New York 10940 | 845-333-1000 | www.ormc.org

A member of the Greater Hudson Valley Health System