An Integrative Review of the Barriers and Facilitators to Nurse Engagement in Quality Improvement in the Clinical Practice Setting.

BACKGROUND: Nurse engagement in quality improvement (QI) improves health care quality and outcomes but is typically low in clinical settings. PURPOSE: An integrative review was conducted to identify facilitators and barriers of nurse engagement in QI. METHODS: This integrative review was conducted using an electronic search of databases with search terms specific to nursing engagement in QI. The Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide was used to rate quality and level of evidence. RESULTS: Nine articles met the criteria for review. Top barriers were leadership, education and training, resource constraints, data, culture, and time. Top facilitators were leadership, education and training, culture, mentors, and champions. CONCLUSION: High-quality literature exploring barriers and facilitators of nurse engagement in QI is lacking. Research is needed to examine the degree to which these barriers and facilitators impact engagement and how they can be addressed to increase it.

Life concerns and perceptions of care in adolescents with mental health care needs: a qualitative study in a school-based health clinic.

Health clinics within schools are designed to provide comprehensive care to the student population. Little research has been conducted to identify how effectively school-based health clinics are meeting the mental health needs of adolescents. This qualitative study explored the perceptions of mental health needs of 18 inner-city teens between 12 to 18 years of age with diagnosed behavioral or mental health issues. A single, face-to-face, semi-structured interview was used to examine students' concerns and attitudes toward their health care needs and services. Results revealed concern for their personal and family relationships, education and vocational goals, health maintenance, and financial independence. Most pressing resource needs related to their ability to receive health maintenance and coping skills and to adapt to complex life challenges they faced in their urban neighborhood. Participants remarked that if the clinic did not identify their needs for mental health care, they would most likely have not received services. When mental health care needs were identified, individual counseling was used to support dialogues for optimal mental and physical health.

Children's views of their adaptation to type 1 diabetes mellitus.

When a family learns their child has insulin-dependent type 1 diabetes mellitus, or type 1 diabetes, shock and anxiety are quickly followed by the reality of the demands of managing the condition. Demands include injections or continuous insulin infusion, blood glucose monitoring 2 to 4 times a day, regimented meal planning, and intensive planning of daily activities. Like many chronic illnesses, type 1 diabetes can have long-term effects on the child and family. Health providers must offer support in a number of ways. To determine the best way to approach children with diabetes mellitus, this study examined children's perceptions of their adaptation to type 1 diabetes. Recognizing children's own perceptions is critical for long-term understanding and management. The children in this study had overall positive self-perceptions and good attitudes toward illness. Even though many adults perceive diabetes mellitus in children as an overwhelming experience, the children's attitudes in this study were very positive.

Advances in assessment, diagnosis, and treatment of hyperthyroidism in children.

The thyroid gland is responsible for regulating multiple complex metabolic processes that affect most organs. Physical growth and cognitive development are dependent on proper levels of thyroid hormone. This article will review common challenges in the diagnosis of hyperthyroidism in children, the approaches to treatment, and the nursing interventions guided toward child and family responses to thyroid disease. A comparison of signs and symptoms of hypothyroidism and hyperthyroidism is also included. The nursing interventions addressed in the article integrate the biological, psychological, social, and environmental stresses and adaptations necessary to cope with hyperthyroid disease.