11/27/17  Portland, OR

Leadership in nursing course leaves lasting benefits for cardiac patients.

Upon entering the OHSU 11k cardiac unit, it looks just like any other hospital floor: off-white walls, clean, mostly quiet. The farther in you get, you notice the laminated hearts on the walls. Each have a graphic that includes an EKG wave and the words 25 ft. on them in large font. Walking improves patient outcomes and decreases cost per patient by $1,000. Not only does increasing mobility decrease patient costs, it increases pain relief, reduces fatigue and reduces time on a ventilator, and decreases length of stay in the hospital. The hearts stuck to the walls increase motivation in patients and help staff log how far the patient walked that day.

Arely Vega Garcia, Bachelor’s with a major in nursing, ’16, and Leesa Crandell, Bachelor’s with a major in nursing, ’16, helped create this walking program through research, surveys, and collaborations with nurses, physical therapists, unit educators, and patients.

Vega Garcia said, “Mobility is sometimes overlooked. A lot of times, the number one priority is for the patient to make it to the next day. Few hospitals use feet to chart and that can help to know whether the patient was able to walk 50 vs. 150 feet that day.”

Winnie Licaycay, assistant professor, was the faculty for the leadership component of their project. “The Clinical Leadership course introduces students on how to be leaders in their own clinical practice. It exposes them to working with nurse leaders who influence their clinical practice and improve healthcare outcomes from a systems perspective.”

Licaycay loves working with students on these projects and said, “It was such a great pleasure working with Arely and Leesa who were both oozing with creativity and enthusiasm when they decided to take on this project. With their initiative and great rapport with their PPL (nurse leader preceptor) and 11k staff they started to move forward on this project.”

The students were matched up with the OHSU hospital, 11K- Cardiac unit and 7C, a smaller cardiac unit. Vega Garcia and Crandell were presented with a few potential options and ultimately helped to initiate a patient incentive program for walking the halls. It sounds pretty simple, but there are a lot of moving parts.

“It wasn’t easy getting buy-in from everyone,” Crandall said. “The nurses often have a packed schedule and they don’t feel like they have time to walk along with their patients.”

Photo: Leesa Crandell, left; Arely Vega Garcia right.

Vega Garcia said, “The first intervention to help with this time-constraint was to create a scavenger hunt. We used photos of the artwork around the unit and had patient specific goals attached to them.” Another intervention included a walking hour that would appeal to patients that are more social. It also reduced the pressure on nurses to walk with their patients throughout the day and concentrated that time in one short burst.

In order to get the word out about the walking hour, they presented at a unit-based nursing practice committee meeting, among other meetings, and included flyers on units and various places. In addition, they created education flyers in both English and Spanish and included one for the home specific patients, no longer in the hospital, which included a strengthening technique.

Crandell said she would take what she learned with her to her residency at Adventist Medical Center and apply it there. She said, “This had a huge impact on patient outcomes and nurse accuracy including motivation. It showed me how to create initiative and bridges and make a positive change.”

Vega Garcia is a resident with Legacy and also plans to apply what she learned in this leadership class to the work she does there.