Sabrina Orique, PhD, RN, is a hematology/oncology clinical nurse specialist at Stanford Health Care. She serves as adjunct faculty for Fresno Pacific University in the MSN FNP program. Her program of research entails patient safety with a focus on delivery of nursing care. Her published work includes missed nursing care, situation awareness, and early recognition of clinical deterioration. She has a Bachelor of Science in Nursing and a Master of Science in Nursing from California State University, Fresno. She earned her PhD in nursing from the University of Missouri, Columbia and is a 2015 Robert Wood Johnson Foundation Future of Nursing Scholar. She is a member of the National Association of Clinical Nurse Specialists, Oncology Nursing Society, and Sigma Theta Tau. She is certified as an oncology nurse and advanced oncology clinical nurse specialist by the Oncology Nursing Certification Cooperation.
Clinical Assistant Professor, Medicine - Primary Care and Population Health
IMPROVING PATIENT SAFETY THROUGH STANDARDIZED CHEMOTHERAPY EDUCATION FOR INPATIENT ONCOLOGY NURSES
ONCOLOGY NURSING SOC. 2021
View details for Web of Science ID 000620349200079
MISSED NURSING CARE AMONG THE ONCOLOGY POPULATION
ONCOLOGY NURSING SOC. 2021: 82
View details for Web of Science ID 000620349200147
Incidence and Predictors of Nonventilator Hospital-Acquired Pneumonia in a Community Hospital
JOURNAL OF NURSING CARE QUALITY
2021; 36 (1): 74-78
Nonventilator hospital-acquired pneumonia (NV-HAP) is a common hospital-acquired condition that is amenable to basic nursing care interventions.The purpose of this study was to determine the incidence of NV-HAP in a California community hospital and to identify the patient and nursing care factors including missed nursing care associated with its development.A retrospective study identified possible NV-HAP cases with ICD-10 (International Classification of Diseases, Tenth Revision) codes and then validated cases using Centers for Disease Control and Prevention confirmatory criteria.The incidence of NV-HAP in our hospital was 0.64 cases per 1000 patient-days. Patient factors most strongly associated with NV-HAP were age (each year of increased age was associated with a 4% increased likelihood of developing NV-HAP) (OR = 1.04-1.07) and the presence of underlying disease, which reduced odds of developing NV-HAP by 36% (OR = 0.36; 95% CI, 0.12-0.98). Head-of-bed elevation reduced by 26% the odds of developing NV-HAP (OR = 0.26; 95% CI, 0.07-0.08).NV-HAP can be predicted and potentially prevented. Paradoxically, the presence of underlying disease was not positively associated with the development of NV-HAP in this study.
View details for DOI 10.1097/NCQ.0000000000000476
View details for Web of Science ID 000595905000017
View details for PubMedID 32079962
Perception of clinical deterioration cues among medical-surgical nurses
JOURNAL OF ADVANCED NURSING
2019; 75 (11): 2627-2637
To examine medical-surgical nurses' capacity and tendency to perceive cues indicating clinical deterioration and nursing characteristics influencing deterioration cue perception.Cross-sectional, explorative study design.Data were collected over 10 weeks between September-November 2017. Medical-surgical nurses completed an online survey consisting of a demographic questionnaire, the Occupational Fatigue, Exhaustion Recovery scale and 50 detection trials. Descriptive statistics and statistical tests were used to describe and interpret data.A significant association was found between nurses' capacity and tendency to perceive deterioration cues. As nurses' capacity to perceive deterioration cues increased, nurses were more likely to classify patient cues as indicators of deterioration. Fatigue, education, and certification were not identified as characteristics associated with deterioration cue perception. However, experience was observed to significantly influence nurses' capacity to perceive deterioration cues based on levels of skills acquisition.Study findings imply that future research should be directed at determining whether other individual factors and organizational system dynamics influence deterioration cue perception.To better understand how nurses perceive deterioration cues, this study integrated concepts from the Situation Awareness model and Signal Detection Theory. Novice, advanced beginner and competent nurses were found to have a lower capacity to perceive deterioration cues compared with proficient and expert nurses. With simulation increasingly being used as a primary teaching modality in nursing, the development of a simulation-based signal detection training intervention may be beneficial in enhancing deterioration cue perception.
View details for DOI 10.1111/jan.14038
View details for Web of Science ID 000483755600001
View details for PubMedID 31012138
The Effectiveness of Simulation on Recognizing and Managing Clinical Deterioration: Meta-Analyses
WESTERN JOURNAL OF NURSING RESEARCH
2018; 40 (4): 582-609
The purpose of these meta-analyses was to quantitatively synthesize the effectiveness of simulation on student nurses' and registered nurses' ability to recognize and manage clinical deterioration in the acute care setting. A search of the literature resulted in 22 reports and 19 studies meeting inclusion criteria. Four random-effects analyses were conducted to examine two-group posttest and single-group pre-posttest intervention effect sizes for knowledge and performance. A total of 41 effect sizes were calculated from the data extracted. The standardized mean difference ( d) for two-group posttest knowledge was d = 0.964 ( p = .001) and for performance was d = 1.382 ( p ≤ .001). The standardized mean difference for single-group pre-posttest knowledge was d = 1.231 ( p ≤ .001) and performance was d = 1.610 ( p ≤ .001). Findings indicate that simulation-based interventions have a positive effect on knowledge and performance. As simulation is increasingly used as a teaching modality in nursing, further research should aim to test standardized simulation-based education programs.
View details for DOI 10.1177/0193945917697224
View details for Web of Science ID 000429978200008
View details for PubMedID 28359188
Evaluating Situation Awareness: An Integrative Review
WESTERN JOURNAL OF NURSING RESEARCH
2018; 40 (3): 388-424
Situation awareness (SA) refers to the conscious awareness of the current situation in relation to one's environment. In nursing, loss or failure to achieve high levels of SA is linked with adverse patient outcomes. The purpose of this integrative review is to examine various instruments and techniques used to measure SA among nurses across academic and clinical settings. Computerized database and ancestry search strategies resulted in 40 empirical research reports. Of the reports included in the review, 24 measured SA among teams that included nurses and 16 measured SA solely in nurses. Methods used to evaluate SA included direct and indirect methods. Direct methods included the Situation Awareness Global Assessment Technique and questionnaires. Indirect methods included observer rating instruments and performance outcome measures. To have a better understanding of how nurses' make decisions in complex work environments, reliable and valid measures of SA is crucial.
View details for DOI 10.1177/0193945917697230
View details for Web of Science ID 000424055500007
View details for PubMedID 28367725
APRN-Conducted Medication Reviews for Long-Stay Nursing Home Residents
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
2018; 19 (1): 83-85
As part of the Missouri Quality Initiative (MOQI) to reduce hospitalizations for long-stay nursing home residents, this article describes reasons MOQI advanced practice registered nurses (APRNs) recommended medication order changes as part of their medication review process as well as the outcomes of their recommendations.Cross-sectional descriptive study of MOQI APRN-conducted medication reviews.Long-stay nursing homes participating in the MOQI project.Seventeen MOQI APRNs recorded medication reviews for 3314 long-stay residents residing in 16 Midwestern nursing homes over a 2-year period.APRNs conducted medication reviews and made recommendations for medication order changes to residents' medical providers.The MOQI medication review database was used to abstract data.There were 19,629 medication reviews recorded for 3314 residents during the 2-year period. Of the 19,629 reviews, 50% (n = 9841) resulted in recommended order changes of which 82% (n = 8037) of order changes occurred. More than two-thirds of recommendations were because of changes in the residents' plans of care. Other recommendations included adjusting and/or discontinuing medications that had the potential for harm.Resident care needs are dynamic, resulting in the need for frequent medication order changes. MOQI APRNs, because of their advanced pharmacological education and daily presence in the nursing home, are uniquely positioned to ensure residents' medications aligned with their overall goals of care while minimizing risk of harm.
View details for DOI 10.1016/j.jamda.2017.10.012
View details for Web of Science ID 000418688400015
View details for PubMedID 29191762
Quantifying Missed Nursing Care Using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey
JOURNAL OF NURSING ADMINISTRATION
2017; 47 (12): 616-622
The aim of this article is to describe the use of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data to measure missed nursing care and construct a missed nursing care metric.Missed nursing care varies widely within and between US hospitals. Missed nursing care can be measured utilizing the HCAHPS data.This cross-sectional study used HCAHPS data to measure missed care.This analysis includes HCAHPS data from 1125 acute care patients discharged between January 2014 and December 2014. A missed care index was computed by dividing the total number of missed care occurrences as reported by the patient into the total number of survey responses that did not indicate missed care. The computed missed care index for the organization was 0.6 with individual unit indices ranging from 0.2 to 1.4.Our methods utilize existing data to quantify missed nursing care. Based on the assessment, nursing leaders can develop interventions to decrease the incidence of missed care. Further data should be gathered to validate the incidence of missed care from HCAHPS reports.
View details for DOI 10.1097/NNA.0000000000000556
View details for Web of Science ID 000416831300008
View details for PubMedID 29135852
Missed Nursing Care and Unit-Level Nurse Workload in the Acute and Post-Acute Settings
JOURNAL OF NURSING CARE QUALITY
2016; 31 (1): 84-89
This study replicates previous research on the nature and causes of missed nursing care and adds an explanatory variable: unit-level nurse workload (patient turnover percentage). The study was conducted in California, which legally mandates nurse staffing ratios. Findings demonstrated no significant relationship between patient turnover and missed nursing care.
View details for DOI 10.1097/NCQ.0000000000000140
View details for Web of Science ID 000378245700015
View details for PubMedID 26121055
Critical Thinking and the Use of Nontraditional Instructional Methodologies
JOURNAL OF NURSING EDUCATION
2015; 54 (8): 455-459
The purpose of this study was to examine the relationship between critical thinking and the use of concept mapping (CM) and problem-based learning (PBL) during care plan development.A quasi-experimental study with a pretest-posttest design was conducted using a convenience sample (n = 49) of first-semester undergraduate baccalaureate nursing students. Critical thinking was measured using the Holistic Critical Thinking Scoring Rubric. Data analysis consisted of a repeated measures analysis of variance with post hoc mean comparison tests using the Bonferroni method.Findings indicated that mean critical thinking at phase 4 (CM and PBL) was significantly higher, compared with phase 1 (baseline), phase 2 (PBL), and phase 3 (CM [p < 0.001]).The results support the utilization of nontraditional instructional (CM and PBL) methodologies in undergraduate nursing curricula.
View details for DOI 10.3928/01484834-20150717-06
View details for Web of Science ID 000360156700007
View details for PubMedID 26230166