Research InterestsResuscitative Outcomes post cardiac arrest, Delirium, Leadership, Ethics, undergraduate clinical education Research PublicationsHouse, S., Giles, T., Whitcomb, J. (2009) Benchmarking to the International Pressure Ulcer Prevalence Survey, Journal of Wound, Ostomy and Continence Nursing JWOCN (May/Jun 2011, 38(3):254-259)
PURPOSE: Authors and team members from the naval medical center at portsmouth (NMCP), Virginia, obtained data on the prevalence and incidence of pressure ulcers (PUs) in our agency and compared them to national benchmark data as a basis for improving our wound care protocols.
SUBJECTS AND SETTING: health care facilities throughout the nation volunteered to participate in the data collection process for a multiday PU prevalence survey performed in February 2009, including nmcp. Each facility collected prevalence data during a preselected 24-hour period out of the 72-hour time frame selected by the national study.
METHODS: A standardized 1-page data collection form for each subject included demographic data, use of wound care protocols and pressure redistribution surfaces, PU stage and location, risk assessment using the braden scale for pressure sore risk, head-of-bed position, turning and repositioning, mobility, weight, incontinence, documentation of a PU within 24 hours of admission, device-related ulcers, and adequacy of documentation. Facility-specific data on a second form included braden scale score, bed type, use of pressure redistribution devices on the heels, hospital unit, turn schedule use, plastic brief use, presence of incontinence-associated dermatitis, and nursing documentation. Chart reviews were performed to determine hospital- versus non-hospital-acquired PU occurrence. Each PU was recorded separately and linked to its identifying stage.
RESULTS: The PU incidence of adults managed in acute care inpatient units at NMCP was 6.6% and the prevalence was 10%. The most common location of facility-acquired PUs was the heels (50%). In contrast, national benchmarking data found that the highest incidence of PUs occurred in the sacral region.
CONCLUSIONS: Benchmarking allows health care professionals to compare outcomes in their agencies to outcomes in comparable facilities. Identification of areas in which agency outcomes compare negatively to benchmark data should prompt implementation of quality improvement initiatives. National PU prevalence surveys provide a benchmark to evaluate an individual facility's care and treatment of patients at risk for pressure ulceration. The true benefit of participation in such surveys, however, is determined by local health care professionals' ability to use national data to improve clinical practice.
Whitcomb, J., and Roy, D. (2010) Evidence Based Practice for Family Presence and Visitation in the Adult Critical Care Department, Naval Medical Center Portsmouth. Nursing Research. 59(1):S32-S39, January/February
INTRODUCTION: The dissatisfaction of family members with a restrictive visiting policy in a combined intensive care and step-down unit provides an opportunity for staff to develop better ways to meet the needs of patients and their families. A review of the evidence-based practice (EBP) literature as the measure of significance indicated that less restrictive visitation policies enhance patient and family satisfaction and offer many physiologic and psychological benefits to the patient. OBJECTIVE: The purpose of this study was to determine whether a less restrictive visitation policy could be implemented in the adult critical care department of a naval medical center. METHODS: Staff was educated on the use of EBP, specifically the Iowa-based model, and a less restrictive visitation policy was developed and implemented. RESULTS: Evaluation of the postintervention survey findings revealed higher patient and family satisfaction. CONCLUSIONS: The findings from this EBP project suggest that a more open visitation policy is feasible in adult critical care units, with an increase in overall satisfaction of patients and their families with regard to their stay in the intensive care unit.
Whitcomb, J (2010) Functional Status versus Quality of Life: Where does the Evidence Lead Us? Advances Nursing Science, (Feb 2011, 34(2);97-105)
The interchangeable use of functional status with quality of life has led to various interpretations when discussing outcomes related to functional status. The literature revealed gaps in the measurement and blurred conceptualization of functional status. Given the prognostic importance of functional status measures, the results highlight the importance of developing a reliable and efficient means of obtaining a measure of functional status resulting in the advancement of nursing science. Having a clear and concise measure of functional status will enable clinicians to implement effect treatment plans that would lead to a faster recovery, higher level of functional status, and a greater well-being
Whitcomb, J., Seawright, J., Wadsworth, R., Flehan, A., Duncan, E., Easler, A., Echols, L. (2012) A retrospective Study Evaluating Response Time and Survival from a Cardiopulmonary Arrest: A Creative Inquiry Project with Undergraduate Nursing Students. Dimensions of Critical Care Nursing (Jan/Feb 2013, 32(1):50-53)
Cardiopulmonary arrest is a major health problem that claims lives daily in the United States. The adoption of a new standard of care or healthcare technology needs to be evaluated based on patient outcomes. This review focuses on this problem and possible solutions. This retrospective study reviews clinical characteristics of cardiac resuscitative events associated with "code blue" team response. Team-based investigations are led by a faculty mentor and typically span 2 to 4 semesters. Students take ownership of their projects and take the risks necessary to solve problems and get answers. This review indicates areas of concern that need to be improved to create better patient outcomes. Findings include that improved documentation will provide data elements for review analysis that then may be utilized to improve care related to cardiac arrest
Johnson, V., Whitcomb, J. Neuro/Trauma ICU Nurses' Perception of the Use of the FOUR (Full Outline of Unresponsiveness) Score versus the Glasgow Coma Scale (GCDS) When Assessing the Neurological Status of ICU Patients (2013), Dimensions of Critical Care Nursing (July/August 2013, 32(4):1-4)
INTRODUCTION: This study compares the Full Outline of Unresponsiveness (FOUR) Score scale with the Glasgow Coma Scale (GCS) when evaluating a patient's level of responsiveness in the neuro/trauma intensive care unit of a large medical center. This new scoring tool evaluates 4 functional categories: eye response, motor response, brainstem reflexes, and respiratory pattern. AIMS AND METHODS: A total of 57 patients 18 years or older were randomly selected as a convenience sample of those admitted to the neuro/trauma intensive care unit and were assessed using both the standard GCS and the FOUR Score scale. The raters then completed a short survey (43 completed) to compare the 2 tools. RESULTS: Rater agreement was very good with the FOUR Score scale and for the GCS; however, nurses favored the use of the FOUR Score scale (81.4%) over the GCS (0.00%) to assess the neurological responsiveness of their patients as the generally accepted assessment tool. CONCLUSION: The FOUR Score scale provides a reliable neurological assessment of intubated patients where the GCS does not differentiate patient status once intubated.
Whitcomb, J., Morgan, M., Irvin, T., Spencer, K., Turman, S., Boynton, L., Rhodes, C. (2013) A Pilot Study: Delirium in the Intensive Care Unit: Utilizing the Zeo Wireless Sleep Monitor for assessment. A Creative Inquiry Project with Undergraduate Nursing Students. Dimensions of Critical Care Nursing (Sept/Oct 2013, 32(5):266-270)
INTRODUCTION: Delirium continues to be a major issue in intensive care units (ICUs). Sedation and lack of rapid eye movement (REM) sleep could be important factors in the development of delirium. Improper sedation may interfere with a patient's sleep pattern, specifically time spent in REM sleep, and could be a contributor to the development of delirium. The research team has discovered through this pilot study that there is a possible correlation between sedation, disruptions, and sleep. The goal of our research was to determine the relationship between these variables using a sleep monitor to capture actual sleep activity compared with patient characteristics and real-time activity in the ICU environment. MATERIALS AND METHODS: This was a pilot study of 7 new patients, aged 65 years or older, who were intubated and sedated. Data on patient sleep cycles were collected using a wireless sleep monitor. A time sheet was placed outside each room to record time and type of interruption during nighttime hours (9 PM-6 AM). The patients were observed for 1 to 7 nights’ dependent on their length of stay in the ICU.RESULTS: Preliminary results demonstrated that, on average, between 9 PM and 6 AM, 48% remained awake (range, 8%-88%), 30% were in light sleep (range, 2%-50%), 18.5% were in REM (range, 2%-60%), and 3.4% were in a deep sleep (range, 0%-9%). Subject 1 remained awake 52% to 88% of the time during the entire admission of 7 days, had an Intensive Care Delirium Screening Checklist score of 5, and had a self-extubation; sedation ordered was Versed as needed. Subject 5 had no interventions done between 12 midnight and 4:50 AM, with the exception of turning once, and had an REM recorded of 60% on 1 night, which equals to 4 hours 49 minutes of rest. All patients with the exception of 1 were on fentanyl and Versed drips with varying dose adjustments throughout their admission. IMPLICATIONS: Preliminary results show that there is a relationship between lack of REM sleep and delirium. The pilot study was a useful model to demonstrate the need for further investigation in a larger population.
Huang, L, Whitcomb, J. Rising Drug Cost. Critical Connections. (Aug/Sep 2017,16(4):14)
Wilson, S., Whitcomb, J. Pharmacy Best Practices to Reduce Impact of Drug Shortages. Critical Connections (Oct/Nov 2017, 16(4):28)
Akuamoah-Boateng, K., Bethea, A., Griffiths, C., Whitcomb, J., Samanta, D., Lowson, S., Sessler, C. Current Infrastructure in Mitigating Burnout Syndrome. Advances in Critical Care Medicine (2020) 2(1)
Whitcomb J, Stanley L, Valentine K, Bush H, Wetsel M, Mejia S, Parker V, Higgs L, McFarlane A, Gonzales L, Mayfield M, Garrison A, Farmer K. Our commitment to the baccalaureate-RN bedside nursing role: Evaluating a Quality Metric of Undergraduate Nursing Academic and Clinical Learning Environment. (2021) International Journal for Human Caring 26(1)
Metcalf, A., Kitchens, D., Reddic, J., Liao, W., Whitcomb, J., Cull, J. Impact of Transfusing Packed Red Blood Cells Through a Rapid Infuser on Potassium Levels. Journal of Trauma Nursing (2022)
Buckley, M., Whitcomb, J. et al. Critical Care Pharmacy Practice Advancement Consensus Recommendations on Direct Patient Care Activities: Critical Care Practice and Research Network of the American College of Clinical Pharmacy (2022 in progress)
* 26, chapters, editorials, publications- not listed and 51 professional national and International presentations.
Honors and AwardsNorma J. Shoemaker Award for Critical Care Nursing Excellence SCCM 2018
National League of Nursing Constituent Excellence in Leadership Award 2016
Recognition Twenty Years CCRN Certified 2016
Presidential Citation, SCCM 2015-2021 (7 times)
Circle Of Excellence, AACN 2013
Clemson University Board of Trustees Award for Faculty Excellence 2012
Palmetto Gold Recipient SC 2012
Fellow of Critical Care Medicine (FCCM) 2012
Clemson University Board of Trustees Award for Faculty Excellence 2011
Hughes Career Achievement Award USD 2010
Rear Admiral Mary F. Hall Award, Education 2008
LinksEvidence Based Practice for Family Presence and Visitation in the Adult Critical Care Department, Naval Medical Center Portsmouth
Functional Status versus Quality of Life: Where does the Evidence Lead Us?
A retrospective Study Evaluating Response Time and Survival from a Cardiopulmonary Arrest: A Creative Inquiry Project with Undergraduate Nursing Students.
Neuro/Trauma ICU Nurses\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\' Perception of the Use of the FOUR (Full Outline of Unresponsiveness) Score versus the Glasgow Coma Scale (GCDS) When Assessing the Neurological Status of ICU Patients
A Pilot Study: Delirium in the Intensive Care Unit: Utilizing the Zeo Wireless Sleep Monitor for assessment. A Creative Inquiry Project with Undergraduate Nursing Students.
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