At Tipton, we are privileged to get a behind-the-scenes look at our client’s Sources of Evidence narratives for their Magnet® submissions. A painstaking amount of time and effort goes into sourcing, writing and editing these documents to help tell each organization’s unique story of nursing excellence.

We are excited to share some of the standout narratives we’ve encountered from the more than 250 Magnet-designated hospitals with whom we collaborate. These stories are much more than a part of the Magnet application process—they are a representation of the dedication that the healthcare organizations we work with commit to nursing excellence. In addition, they are a testimony to improved patient care at the hands of some of the best nursing teams in the nation.

Empowered to Take Action for Cancer Patients

In 2020, an increasing number of head and neck cancer patients at John Muir Health’s Walnut Creek Medical Center (WCMC) began developing rashes around their feeding tube sites. For patients, this brought further attention to their feeding tubes, which were already a source of emotional challenges for many patients as they managed the realities of their illness and treatments.

Recognizing this issue, Cristina Yaughn, BA, RN, OCN, clinical nurse, head and neck cancer nurse navigator, Radiation Oncology, and Jill Rossi, BSN, RN, clinical nurse, head and neck cancer nurse navigator, decided to investigate to better understand the cause of the rashes and the role clinical nurses could play in preventing feeding tube site contact dermatitis.

Their action aligned with John Muir Health’s WCMC professional practice model (PPM), which empowers nurses at all levels to have professional accountability and advances nursing excellence through core components of Evidence-Based Practice (EBP), Professional Development, Interdisciplinary Collaboration, Authentic Caring Relationships and Shared Decision Making.

John Muir Health further supports implementation of its PPM through its Evidence-Based Practice Fellowship. Citing the feeding tube rash issue, Cristina and Jill applied for and were accepted into the EBP Fellowship cohort for 2021.

Interventions: Identifying Evidence-Based Practices

Through the EBP fellowship program, Cristina and Jill received training and guidance in EBP to find actionable solutions to the feeding tube issue.

Using this information, Cristina and Jill considered the current patient flow, the literature they reviewed and the input from their interprofessional partners and made the decision to implement multi-modal educational interventions, in both English and Spanish, and to use the teach-back method to clarify and verify patient and family member understanding. They were also committed to move towards a patient education workflow that captured as many patients as possible, no matter where their feeding tube placement procedure occurred.

Implementing the New Process

In May 2021, Christina and Jill implemented the project plan. Every patient with a feeding tube received personalized education by either Cristina or Jill, including a video, feeding tube information packets, use of the teach-back method and written take-home instructions.

Almost immediately, the intervention produced results: the incidents of post-feeding tube placement contact dermatitis dropped by 34%!

“The head and neck cancer population is vulnerable to many toxicities,” Cristina says. “This [post-feeding tube placement contact dermatitis] is one that we could address quickly and with good results. We look forward to building on this work.”