Non-invasive Cardiac Output Monitoring:

Using Nursing Grand Rounds to Provide Continuing Education to Hospital-based Nurses

Ellice Hayek, BSN, MSN Student
Louise Aurilio, PhD., RN, YSU Graduate Faculty Mentor
Youngstown State University Nursing Department

BACKGROUND

PROCEDURE

DISCUSSION

In the case of hemodynamic instability, injury to major organs within the body is
likely to occur (Stucchi, Poli, & Fumagalli, 2006). When treating a patient experiencing
hemodynamic instability, hemodynamic monitoring may be used to guide
appropriate treatment (Busse, Davison, Junker, & Chawla, 2013). Historically,
adequate hemodynamic measurements could only be obtained through invasive
measures such as the pulmonary artery catheter (Squara et al., 2007). However,
recent developments by Cheetah Medical (2013a) have led to the introduction of a
non-invasive cardiac-output monitor (NICOM). The NICOM is quickly becoming the
instrument of choice for obtaining hemodynamic parameters. Inadequate knowledge
of its clinical applicability, in combination with a lack of understanding of NICOM
technology may lead to ineffective use of the multidisciplinary evidence-based
assessment tool.

1. Identify roles

The NGR presentations were a success. Although exact attendance records have yet
to be reported, per observation healthcare members from all disciplines including
physicians, nurses (RNs, CNS), and respiratory therapists were present. At this time,
presenter evaluations are undergoing thorough analysis. Based on the results,
changes to the program may be executed to promote successful learning of the
attendees.

Planning Committee: Consisted of two nurse planners with the responsibility of ensuring
CE criteria was followed, an LPN committee member, and an RN committee member.

Faculty/Presenter/Author: Consisted of a physician with expertise in the content being

presented.

2. Collaborate

Member of planning committee and faculty/presenter/author met and determined ideal

objectives and outline of content.

3. Develop

Presentation developed based on chosen objectives and content.

4. Submit

Presentation objectives, content outline, references, and presenter bibliographies

submitted for CE approval under direction and review of planning committee.

5. Present

AIMS
The need for an educational event was identified, but the modality for providing
effective education remained without support. A review of the literature revealed the
benefits of using an active teaching method, such as nursing grand rounds (NGR), for
educating hospital based nurses (Lin, Lin, Chen, & Lin, 2014). NGR provides an
opportunity for healthcare providers from various specialties within the hospital to
attend the educational event, and encourages time for discussion and application of
newly acquired knowledge (Armola et al., 2010). A synthesis of this information
supported the use of NGR to increase the knowledge and skills of nurses working in
acute care settings. Thus, the purpose of this project was to develop a continuing
nursing education (CE) presentation to be presented at Nursing Grand Rounds. The
presentation consisted of a brief overview of hemodynamic monitoring and
demonstrated appropriate utilization of NICOM technology.

After approval granted, the NGR presentation was held twice for hospital-based
employees. CE credit of 0.5 contact hours was awarded to all attendees.

6. Evaluate

Evaluation forms were passed out to all those who attended the presentation. At this time,
analysis of the evaluation forms is in process.

LESSONS LEARNED
Successfully developing a CE program is highly dependent upon effective
communication between all members of the planning committee and presenters.
Ample time is needed for proper development of a CE program. Dependent upon
the accrediting body used, generally four to six weeks are needed for processing
the CE application.
Timely and universal advertisement of the CE presentation is important to ensure
all hospital employees have an equal opportunity to attend.

OBJECTIVES

FUTURE PLANS

The presentation was developed to address the following objectives:

The CE program will be available for two years. At this point in time future plans
include the following:

1. Discuss clinical indications for performing hemodynamic monitoring

2. Demonstrate the use of non-invasive cardiac output monitoring

1. Unit based in-services

2. Professional Practice Council presentation