ABSTRACT
The purpose of this study was to examine nurses' experience of quality care for hospitalized patients with a history of opioid use disorder or self-injection of opioids and whether hospital, unit, or nurse characteristics impacted experiences of quality care. A secondary aim of the study was to understand how nurses' experiences of quality care for this population have been impacted by the COVID-19 pandemic. The Institute of Medicine's Six Domains of Health Care Quality were used to define quality care in this study. A national sample of 179 nurses completed an online survey regarding their experiences caring for patients with opioid use disorders. The majority of the participants were staff nurses who worked in emergency departments, critical care units, or mother baby units. Only 41.9% of the participants had received education regarding substance use disorders from their employers, and even less had participated in harm reduction education. Only 45% of the nurses had knowledge regarding harm reduction strategies for this population. The participants experienced a low number of restrictive safety measures and an average number of adverse events and effective care interventions when caring for patients with opioid use disorders. The nurses rated quality care and satisfaction as average. Correlation and linear regression analysis suggested trends in nurse, hospital and unit characteristics that are associated with nurses' experiences caring for this population;substance use disorder education, harm reduction education, and unit type were most often associated with nurses' experiences. Content analysis of open-ended questions regarding equity, patient-centeredness, timeliness and the impact of COVID-19 on experiences of quality care supported quantitative findings in the study and provided insight into the nurses' experiences. The findings in this study contribute to current evidence regarding the need for standardized hospital policies and practices aimed at improving quality care for patients with opioid use disorders. These policies and practices should incorporate harm reduction strategies that are patient-centered and evidence-based. Hospitals and nursing schools should provide education aimed at reducing stigma and improving care for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Background: The Covid-19 pandemic caused over 38,900 deaths in the state of Ohio with a cumulative hospitalization (March 2020-July 2022) of approximately 119,500. The pandemic propelled novice nurses to quickly demonstrate knowledge and skills of high crisis patient care, such as Advance Life Support (ALS) events. This forced organizations to rapidly deploy educational interventions to support the novice nurse's delivery of high-quality emergent patient care delivery. The literature supports simulation to improve the novice nurses' self-confidence yet, the literature remains unclear regarding how simulation enhances knowledge and skill performance, especially during a pandemic. Methods: Using an experimental randomized controlled, longitudinal, pre-test, post-test design, this study examined the effects of adding an on-line Advance Life Support (ALS) patient scenario module to the current ALS program when exploring participant training experience, knowledge, and skill of the required ALS concepts (initiating cardiopulmonary resuscitation, ECG rhythm recognition, pharmacology, and team communication) during high crisis patient care situations. A convenience sample (N=27) of novice nurses who are employed at a Mid-Western health system were randomly assigned to control and intervention groups. Both groups completed a demographic questionnaire followed by participation in a video-taped, ALS high fidelity simulation and debrief for evaluation of baseline knowledge and skill performance at baseline and at three months. Between the simulations (1 month) the intervention group received the same written clinical update as the control group, plus an independent on-line patient scenario of ALS concepts. Qualitative descriptors of the novice nurse's experience of participating in high crisis simulations were explored. Results: Nine participants completed this study. Quantitative descriptive statistics for trends noted, at baseline, both the control and intervention groups scored low (Control 25% n=4;Intervention 67% n=5) for the skills of "Initiating high quality CPR).". Post intervention, the control group missed CPR resuming in less than 10 seconds after defibrillating at 150-200 joules. When assessing the participants practice areas the control group had 3 of the 4 participants in the ICU and 1 in the Progressive Care units. This missed skill item could be contributed to the oversaturation of codes, coupled with the mental exhaustion form the pandemic, could lead to missed care even during practiced repetitive skills. Quantitative data trends for knowledge and skill coupled with the participant attrition rate of 67% (n=18) led to the exploration of the experience of novice nurses participating in ALS cardiac arrest training during a pandemic. Three qualitative descriptors emerged by examining the transcripts from the simulation debriefs for all simulations: team collaboration, mental distress, and increased confidence to incorporate new skills. Conclusions: On-line independent patient scenarios provided reinforcement of ALS knowledge and skill concepts. Critical knowledge and skill team communication principles may not be reinforced when providing patient care. Simulation debriefs allow the novice nurses to apply fundamental concepts in a safe learning environment. Novice nurses need scaffolding of knowledge to grow and maintain their knowledge, skill, and confidence. Future education experiences should be designed to allow for frequent dosing of simulations with structured debriefs. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Through the use of virtual simulations (VS) in nursing education, nursing students are exposed to a variety of clinical scenarios that may potentially improve their learning of competencies, increase their self-efficacy, and enhance their future clinical performance. Despite limited quantitative research incorporating evidence-based strategies such as prebriefing and debriefing as part of the VS experience, this educational technology continues to gain popularity. In 2020, the use of VS in the nursing curriculum exponentially increased when the global COVID-19 pandemic impacted traditional in-person clinicals, laboratory, and human patient simulation (HPS) experiences. Associate Degree Nursing (ADN) programs have benefited from the use of VS. Among the various types of programs that educate prelicensure nursing students, ADN programs prepare the greatest number of students, educate more culturally and academically diverse students, and are challenged to prepare competent nurse graduates within a short curriculum timeframe. The researcher aimed to explore the effect of the Virtual Simulation Paired Prebriefing-Debriefing (VSPPD) strategy on ADN students' self-efficacy perceptions and VS performance concerning the care of patients experiencing a myocardial infarction (COPE-MI). Guided by the National League for Nursing (NLN) Jeffries Simulation Theory (JST) and principles of Bandura's self-efficacy theory, this quasi-experimental, two-group (intervention group and control group), pretest and post-test educational intervention study examined five research questions: 1) What is the effect of the Virtual Simulation Paired Prebriefing-Debriefing (VSPPD) strategy on Associate Degree Nursing (ADN) students' self-efficacy perceptions concerning the care of patients experiencing an MI? 2) What is the effect of the VSPPD strategy on VS performance scores? 3) What is the correlation between students' self-efficacy perceptions and VS performance scores? 4) What is the influence of selected demographic variables on students' self-efficacy perceptions concerning the care of patients experiencing an MI? 5) What is the influence of selected demographic variables on students' VS performance scores? Implemented with a third-semester, five-credit, advanced medical-surgical nursing course in the ADN curriculum, the VSPPD strategy aimed to positively influence nursing students' self-efficacy for performing cognitive, practical, and affective COPE-MI nursing skills and VS performance scores through students' participation in a paired prebriefing-debriefing and repeated completion of the same VS scenario preceded and followed by structured briefing conversations. The VSPPD strategy was developed by the researcher based on the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM, constructs of the JST, and the NLN vSim for Nursing Curriculum Integration Guide for Faculty. The effectiveness of this educational strategy was measured by the Care of Patients Experiencing a Myocardial Infarction Self-Efficacy Tool (COPE-MI SET©), the Virtual Simulation Survey (VSS), and students' VS performance scores. Data analysis results for the five research questions support the effectiveness of the VSPPD educational strategy on students' COPE-MI self-efficacy perceptions (in the cognitive, psychomotor, and affective domains) and VS performance scores. Results also support that there is a positive correlation between students' COPE-MI self-efficacy perceptions and VS performance scores. While sample size limitation was a concern, this study also provided evidence that the VSPPD strategy caused positive changes in students' COPE-MI self-efficacy perceptions and VS performance scores regardless of students' age, previous experience with video or computer gaming, or previous healthcare work experience. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
The issue of new graduates prematurely exiting the profession has a long- standing, complicated history in nursing. Current retention is further complicated by the COVID-19 pandemic. The state of the global workforce and transition shock theory situate this issue. Ray's theory of bureaucratic caring frames the analysis with proposed recommendations for individual nurses, healthcare organizations, and academia. The sociocultural and political domains of Ray's theory offer guidance for nurse leaders in academic and practice settings. The importance of a collaborative relationship between academic and practice settings is vital to mitigate the phenomenon of early exit of new graduates. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Increased global activity has resulted in increased complexity in decision making for leaders. Complex decision is explored in nurse leaders in pandemic environments such as Covid-19. The purpose of this constructivist grounded theory study is to explore the lived experiences of nurse leaders during COVID-19, specifically in the areas of allocating scarce resources and managing bias within the workplace. Qualitative data were collected using semi-structured open-ended interviews. The overarching research questions explore, how decision making is experienced during resource allocation in conditions of extreme scarcity during Covid-19, and how bias is managed in self and others during clinical decision making involving extreme scarcity of resources. Nurses are taught to focus on patients and patient care. However, concerns for provider safety may affect patient care. Themes that emerged in the data include prioritization of nurse leaders' own safety in care decisions. Advocacy emerges as being synonymous with patient care. Additionally, bias is described in avoidance behavior associated with provider safety concerns. Nursing decision making associated with resource allocation during Covid-19 is portrayed in the Provider Crisis Decision Making model. This emerging theory describes areas of concern in nurse leadership decision making during Covid-19. The Provider Crisis Decision Making model is an organizational leadership tool intended to improve patient care and provider well-being in crisis environments and during pandemics. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
The COVID-19 pandemic impacted the education of nursing students across the world. Nursing students were unable to care for patients with COVID-19 at the beginning and potentially throughout nursing school depending on the facility and nursing school restrictions. It was not known how the participation in a high-fidelity simulation will impact the confidence level of nursing students in the care of patients with COVID-19. A mixed methods phenomenological qualitative and survey design was utilized to determine the confidence level of nursing students after participation in a high-fidelity simulation of a patient diagnosed with COVID-19. A convenience sample of fifteen participants completed the research study from a population of second year nursing students at a community college in Northwest Arkansas. The data were collected from focus groups both before and after participation in a high-fidelity simulation and a questionnaire that was completed after participation in a high-fidelity simulation. The interview data were analyzed using NVivo after being transcribed into a Microsoft Word document. The questionnaire data were transferred into a Microsoft Excel spreadsheet and the mean and standard deviation were calculated. The theme related to the impact of participation in a high-fidelity simulation was the importance of communication. The themes related to concerns in caring for patients with COVID-19 was contracting the disease, care, and long-term effects. The theme related to preparation to care for COVID-19 was that the participants felt better prepared to care for patients. The participants of the pilot and research study stated that the participants had improved confidence in caring for patients with COVID-19 after participation in a high-fidelity simulation.Keywords: nursing education, nursing students, COVID-19, high-fidelity simulation, confidence level. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Skilled nursing facilities (SNFs) across the United States strive to provide a high quality of care for their residents. Person-centered care is often seen as a domain of quality of care as it individualizes care to the resident. Along with attending to care needs, direct care professionals (DCPs) must navigate aspects of their workplace environment, such as staff burnout and engagement, that influence the quality of care provided. Additionally, recently SNFs have experienced the impact of the coronavirus disease 2019 (COVID-19) pandemic, which was an unprecedented event that produced challenges for SNFs and influenced care practices due to increased regulations and change in social interactions and safeguards. Therefore, the aim of the current study was to examine multiscale influences on the quality of care in SNFs (e.g., person-centered approaches, workplace characteristics), reflecting the long-term goal to improve quality of care and resident outcomes in SNFs.An exploratory mixed methods approach was utilized for data collection, analysis, and interpretation. Eleven SNFs in Iowa were recruited for this study. The recruited SNFs represented varied SNF characteristics (e.g., bed count, staffing hours) and Accountable Care Organization (ACO) affiliation was also considered during recruitment. Administrators from the SNFs participated in interviews (N=11), during which the researcher gauged perceptions of person-centered care (PCC), staff burnout and engagement, management and leadership principles, views of resident outcomes, and staff training. DCPs completed surveys (N=83) to assess perceptions of PCC, staff burnout, and engagement. Additionally, Centers for Medicare and Medicaid Services data were utilized to assess SNF characteristics (e.g., profit status, bed count) and Minimum Data Set resident outcomes (e.g., falls, urinary tract infections).The impact of the COVID-19 pandemic on SNFs constituted the primary focus in the first study. Results indicated resident outcomes that were worse than the national average increased from 2019 to 2020 and then decreased from 2020 to 2021. Slopegraphs were employed to provide visualizations of trends in resident outcomes over time. Thematic analysis revealed administrators reported SNFs were impacted by the pandemic by staff concern regarding COVID-19, financial strain, resident isolation, new regulations and protocols, and staffing challenges (e.g., turnover, shift coverage). DCPs reported SNFs were impacted by the pandemic by limited or no family/friend visits;required masks and personal protective equipment (PPE);resident death;staffing challenges;and resident isolation. Lastly, DCPs reported that the COVID-19 pandemic impacted their day-to-day work and burnout a great deal;however, overall DCPs reported low to moderate feelings of burnout. Care practices, regulations and policies, staffing issues, and establishing a new normal are important implications based on the findings from this study.Identifying associations between resident outcomes and PCC, burnout, engagement, and SNF characteristics was the focus of the second study. Results indicated PCC was positively correlated with engagement and negatively correlated with burnout. Scatterplots produced visualizations of trends between resident outcomes and PCC, burnout, and engagement. Themes from administrators and DCPs were identified surrounding common contributors to burnout (e.g., low wages, short staffing), factors influencing staff engagement (e.g., events, providing one-on-one care), and implementation of PCC (e.g., care planning, involving the resident). Lastly, clustering of SNFs that were associated with PCC, burnout, engagement, and resident outcomes were discerned based on profit status, Accountable Care Organization affiliation, and bed count. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic brought many challenges to patient care delivery. The need for social distancing and relaxing of federal and state telemental health regulations paved the way for widespread adoption of direct-to-consumer (DTC) ambulatory mental health video visits. Methods: We present cases that demonstrate the use of video visits across 6 clinical areas, each serving a unique population of patients, in a large behavioral health system. The benefits and limitations of this modality are illustrated in children, adults, and older adults with mood disorders, anxiety disorders, intellectual disability, substance use disorders, neurocognitive disorders, and schizophrenia. Results: Although telephone visits were acceptable and necessary to serve some patients, there are many advantages to video visits in providing best patient care. Education and support for telemental health-delivered to both patients and clinicians-is critical to the success of the DTC model. Conclusions: DTC telemental health is a widespread clinical tool used during the COVID-19 pandemic. Because this model has many strengths and advantages compared with traditional telemental health delivered in a clinic, regulators and insurers should be open to its continued use post-pandemic when clinically appropriate. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
The Researcher in an Applied Clinical Psychology program interacted with a panel of physicians that considered the importance of building a rapport in a workshop designed to understand and develop skills in a diverse field. It includes feedback from physicians as a way to refine the final product;feedback that was instrumental in making it possible to ask and receive additional information in which improved the effectiveness of the final product. Scientific evidence of the importance of rapport-building specifically relating to effective patient care was shown. The methodology and the design of the model formulated and developed to show how effective patient care skills can be learned and used by all clinicians relating different cultures by understanding diversity and the necessity thereof. The theoretical aspects of the clinical field relating to rapport building was discussed and researched with the panel members. This topic was followed by a discussion regarding research results. Lastly, the training model was presented. Theories related to rapport building and information from the panel members received contributed to information all clinicians can use for future skill development. Hence, further showing how vital rapport building is a necessity to relating to patients during and after the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Patients with mental illness receive care in acute medical facilities for medical and acute psychiatric problems. Non-psychiatric nurses are responsible for the care of patients with mental illness regardless of their training in psychiatric nursing skills. The purpose of this study was to inform the nursing profession and nursing education of the needs of non-psychiatric nurses in caring for patients with mental illness. This study also sought to discover non-psychiatric nurses' experiences during the COVID-19 pandemic. This research study used qualitative descriptive phenomenology to explore the research phenomenon. Eight participants were interviewed virtually using a semi-structured interview guide with interview prompts to explore participants' lived experiences. Data analysis was accomplished using Colaizzi's (1978) seven-step analysis method. Findings from the first research question revealed five themes with an overarching theme of barriers to caring for patients with mental illness. A significant barrier in caring for patients with mental illness was the lack of mental health resources. In some cases, patients were housed in the emergency department for extended periods of time as the staff searched for a psychiatric facility that would accept the patient. Nurses and nursing leaders need to take an active role in educating legislators and policymakers on the need for improved funding for psychiatric services and the significant issue resulting from using the emergency department as an entry point for mental health treatment. This study added to the literature on evidence-based strategies to inform the nursing profession and nursing education in nursing care for patients with iv mental illness. Findings from this study indicated multiple strategies that support non-psychiatric nurses in caring for this population. This study also explored the stressors and perceived preparation of non-psychiatric nurses working during the COVID-19 pandemic. The study findings indicated a nurse's responsibility to enforce visitation restrictions during the pandemic, even for patients who did not have COVID-19, was a major stressor, potentially resulting in moral distress for the nurses caring for patients during the pandemic. Also consistent with the literature on nurses caring for patients during the COVID-19 pandemic was the concern for the short- and long-term effects of psychological stress, anxiety, burnout, exhaustion, and depression. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Remember the pots hammered by spoons from high Manhattan windows, and parades of cars and pick-up trucks holding dear the medical professionals responding to covid-19. This book is part of that chorus, that march, to express appreciation for the giving of care. And beyond doctors and nurses, bless their hearts, to mothers caring for their babies, for captains for their teams, for the soon-to-be widowers for their wives and teachers for their students, but also for the ranchers for their cattle and the contemplative world for our environment. This is a book to think more closely of the support for care, individual as it so often will be, to be woven more closely together in a paradigm of care. Care is always prominent. Care for others, of the family, care for those of the tribe, care for animals and homes and gardens and properties, self-care. And the purse. Even without teaching, compensation, or legislation, care survives, but even with these helpings, it falls short of the need. We live in a crisis of care. Thinking explicitly and beyond health care. There is no mechanism of state and conscience that delivers care to all the venues of need, and seldom in the amounts needed. The reservoirs of care are far from empty, but at a mark that needs topping up. There is need for care advocacy, a care ethic, a paradigm. This book is about that paradigm. A care paradigm may bring comfort and recovery more fully to the people and organic creations of the world. The paradigm hears the moan of indifference. It draws upon the eyes of the heart. The paradigm is about how we see the need for care. The care paradigm, the grand beholding, is manifest in how we provide for others, how we nurture them, give succor, how we are disposed, and are not, to sacrifice to relieve their hurt. It is not only caring for those visibly needing care, unable to care for themselves, but caring for all. It is having a disposition that the hurts, large and small, that all of us carry, arouse concern and appreciation from and for each individual, the community and the world. (PsycInfo Database Record (c) 2022 APA, all rights reserved)