The nurse wellbeing self-assessment supports the model of leadership influence for health professional wellbeing.

BACKGROUND: Despite emerging evidence of effective strategies for reducing burnout among health professionals, health professional burnout continues increasing. PURPOSE: A systematic Model of Leadership Influence for Health Professional Wellbeing is presented suggesting steps to measurably improve wellbeing by managing or mitigating stressors that generate burnout. METHOD: This paper examines (a) the psychometric properties of the Nurse Wellbeing Self-Assessment's (NWSAT)© four 10-item scales and (b) whether and how the Model of Leadership Influence can apply NWSAT results to reduce burnout. Using nurse survey data (N = 1,394) from one large eastern US healthcare system, the four NWSAT scales are psychometrically evaluated. FINDINGS: Predictive tests demonstrate the fit of the Model of Leadership Influence by documenting associations between NWSAT and burnout. All four NWSAT scales are strongly and inversely associated with burnout. DISCUSSION: Leaders can use NWSAT to systematically implement and evaluate a variety of strategies to improve staff wellbeing in one or more domains of NWSAT to manage or mitigate specific stressors that may otherwise contribute toward burnout.

Application of the model of leadership influence for health professional wellbeing during COVID-19.

BACKGROUND: Nurse burnout is a top patient safety concern. Workplace stress and burnout results in high turnover rates, costs, and lessened productivity and quality care. Although the relationship of burnout to patient outcomes and communication has been proposed, there is little available in terms of a theoretical framework to guide leaders in developing a comprehensive and effective approach to promoting wellbeing and reducing burnout. PURPOSE: This paper demonstrates a theoretical application of the Model of Leadership Influence for Health Professional Wellbeing to support staff wellbeing by developing targeted approaches that address the four dimensions of whole person wellbeing. METHOD: Published literature from the COVID-19 pandemic is used for context to demonstrate the use of the model. FINDINGS: The model can be used to facilitate exploration and navigation of the complex issues surrounding burnout and wellbeing. DISCUSSION: Leaders may find the model can be a useful tool to promote staff wellbeing.

Pain management consultation for acute pancreatitis: impact on length of stay and opioid utilization.

Aim: The purpose of the study was to understand the impact of a pain management consult for acute pancreatitis patients on their inpatient length of stay, morphine milligram equivalences (MMEs) and pancreatitis severity. Materials & methods: Adult patient data were extracted from the electronic health records from 1 October 2016 to 31 December 2018. Results & conclusion: Of 277 patients with a single acute pancreatitis hospitalization, 23 had a pain consultation (treatment group), whereas 254 did not (control group). There were statistically significant differences in median length of stay, median MME total and median MME per day between the treatment and control groups with comparable severity and pain scores (6.8 vs 3.1 days, 196.5 vs 33.8 MMEs, 30.9 vs 12.1 MMEs, respectively, p < 0.0001). This study emphasizes the complexity of pain management and the importance of further research in the field.

Examination of the Moderating Effect of Race on the Relationship between Vitamin D Status and COVID-19 Test Positivity Using Propensity Score Methods.

INTRODUCTION: With a well-established role in inflammation and immune function, vitamin D status has emerged as a potential factor for coronavirus disease-2019 (COVID-19). OBJECTIVE: The purpose of this study was to evaluate the moderating effect of race on the relationship between vitamin D status and the risk of COVID-19 test positivity, and to compare propensity score (PS) model results to those obtained from classical bivariate and multivariable models, which have primarily comprised the literature to date. METHODS: Electronic health record (EHR) data from TriNetX (unmatched n = 21,629; matched n = 16,602) were used to investigate the effect of vitamin D status, as measured by 25-hydroxyvitamin D [25(OH)D], on the odds of experiencing a positive COVID-19 test using multivariable logistic regression models with and without PS methodology. RESULTS: Having normal (≥ 30 ng/mL) versus inadequate 25(OH)D (< 30 ng/mL) was not associated with COVID-19 positivity overall (OR = 0.913, p = 0.18), in White individuals (OR = 0.920, p = 0.31), or in Black individuals (OR = 1.006, p = 0.96). When 25(OH)D was analyzed on a continuum, a 10 ng/mL increase in 25(OH)D lowered the odds of having a positive COVID-19 test overall (OR = 0.949, p = 0.003) and among White (OR = 0.935, p = 0.003), but not Black individuals (OR = 0.994, p = 0.75). CONCLUSIONS: Models which use weighting and matching methods resulted in smaller estimated effect sizes than models which do not use weighting or matching. These findings suggest a minimal protective effect of vitamin D status on COVID-19 test positivity in White individuals and no protective effect in Black individuals.

Brief Mindfulness Practice Course for Healthcare Providers.

OBJECTIVE: The aim of this study was to examine the short-term and sustained effect on well-being, burnout, and mindful awareness of an abbreviated mindfulness practice course designed for nurses and other healthcare professionals. BACKGROUND: Most mindfulness programs are impractical for frontline healthcare providers because of the intensive, off-site initial training and prolonged practice commitment. A psychiatric nurse educator developed a brief training program tailored for healthcare providers. METHODS: Two institutional review board-approved studies examined the abbreviated mindfulness practice course for healthcare providers: the first, a single-group pretest-posttest design with 25 nursing employees in an academic medical center, and the second, a randomized controlled trial with 83 healthcare professionals. RESULTS: Significant improvement in mindful awareness and at least 1 indicator of burnout were demonstrated. Improvements in quality of life were noted with nurses. CONCLUSIONS: Findings support the short-term and sustained impact of this brief mindfulness curriculum on mindful awareness, quality of life, and aspects of burnout for healthcare professionals.

A Longitudinal Study of the Impact of Schwartz Center Rounds on Moral Distress.

Moral distress occurs when moral integrity is compromised and can affect any healthcare professional. This study examined the impact of Schwartz Center Rounds (SCRs) on moral distress using a longitudinal, quasi-experimental design to examine SCR attendees from 2015 to 2019. Data were collected via a 2-part survey composed of demographics and Moral Distress Thermometer (MDT) readings before rounds and immediately after rounds. Most participants experienced either no change in moral distress (50.6%) or a decrease in moral distress (33.7%) after attending one of the SCRs. Participants who worked with adult populations had higher moral distress after participation for most topics. An increase in moral distress was associated with a longer time in the current position. Fifty percent of the physicians had a decrease in their moral distress immediately after the rounds. Schwartz Center Rounds is a promising approach to foster high-functioning teams while promoting wellness and mitigating moral distress among employees.

Pediatric and Neonatal Tracheostomy Caregiver Education with Phased Simulation to Increase Competency and Enhance Coping.

PURPOSE: Infants and children with medically complex needs depend on their caregivers for activities of daily life and specialized care of various devices they need to survive. Caregiver education is a primary goal in discharge planning to ensure safe, competent home care for these medically fragile children. Standard of care is bedside teaching. The Family Tracheostomy Program complements traditional training with a phased process of simulation. The purpose of this QA/QI project was to increase caregiver competency and decrease anxiety level for pediatric tracheostomy care through simulation training. METHOD: For two years, the pediatric and neonatal intensive care units trained twenty caregivers of new tracheostomy patients with the supplementation of simulation to standard bedside training. Using a five-point rating scale, caregivers completed pre- and post- tests for separate skills and scenario training sessions. RESULTS: Skills scores were hypothesized to increase after simulation training. In a small sample (n = 20), scores increased from pre-test (µ = 11.45, SD = 4.88) to post-test (µ = 22.6, SD = 2.01). This change was significant (t(19) = 10.78, p < 0.001). Scenario scores were hypothesized to increase after simulation training. In another small sample (n = 15), scores increased from pre-test (µ = 23.40, SD = 7.11) to post-test (µ = 28.73, SD = 2.31). This change was significant (t(14) = 3.78, p < 0.001). CONCLUSION: Simulation as a complement to bedside caregiver education increased caregiver competency and decreased anxiety levels for these samples. PRACTICE IMPLICATIONS: Organizations caring for neonatal and pediatric tracheostomy patients might consider providing additional support with a phased method of simulation as part of caregiver education.

The Nurse Manager's Experience of Moral Distress.

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood. We conducted a qualitative descriptive study with 19 nurse managers from 5 healthcare institutions in Virginia. Interview data were analyzed using a directed content analysis, as the structural components of the moral distress phenomenon are already known. Participants suffered moral distress when they were unable to achieve or maintain effective unit function and felt caught in the middle between their units' and employees' needs and organizational directives. System-level causes of moral distress are common among nurse managers. Future research should involve measurement of moral distress among nurse managers and exploration of effective interventions.

Bras for Breast Support After Sternotomy: Patient Satisfaction and Wear Compliance.

BACKGROUND: For women undergoing median sternotomy, especially those with a bra cup size C or larger, breast support can reduce pain, wound breakdown, and infection. This study addressed a gap in research, identifying the best bra after sternotomy in terms of patient satisfaction and wear compliance. OBJECTIVES: To evaluate larger-breasted women's satisfaction and compliance with wearing 3 commercially available front-closure bras-with a hook-loop closure (the hospital's standard of care), a zipper closure, or a hook-eye closure-after cardiac surgery. METHODS: This study used a posttest-only, 3-group randomized controlled design. A convenience sample of participants were sized and randomly assigned a product that was placed immediately postoperatively. Participants agreed to wear the bra at least 20 h/d until the provider cleared them for less wear. At inpatient day 5 or discharge, and at the follow-up outpatient visit, subjects completed investigator-developed surveys. Data were analyzed from 60 participants by using the χ2 test and Kruskal-Wallis analysis of variance; also, patterns were identified within written comments. RESULTS: Participants were most satisfied with the hook-eye front-closure product before (P = .05) and after (P = .02) discharge. Participants recommended the hook-eye and zipper products over the hook-loop bra (H = 8.39, P = .02). Wear compliance was strongest in the group wearing the hook-eye bra. CONCLUSIONS: The hook-eye closure product had the most satisfaction and greatest wear compliance, and it received the highest recommendation. A practice change was made to fit and place the hook-eye bra in the operating room immediately after surgery.

Reducing Waste in the Clinical Setting.

Nurses have the capacity and opportunity to alter their organization's environmental footprint. This article addresses how they can strengthen efficiency and environmental sustainability initiatives in their facilities by engaging in, monitoring, and supporting environmentally friendly clinical practices and programs at the point of care. Included are practical tips and examples of projects in which nurses identified sources of waste-the relaundering of unused linens; disposal of unused products; and improper sorting of pharmaceutical waste, recycling, and regulated medical waste-and realized significant cost savings as well as improved efficiency and environmental sustainability.

Successful grant applications: Follow the 4 F's.

All nurses have the potential to influence the healthcare industry and the nursing profession through research, but preparing a grant application can be intimidating. This article addresses the process of writing and developing successful grant proposals.

Audit and Feedback: A Quality Improvement Study to Increase Pneumococcal Vaccination Rates.

The purpose of this quality improvement study was to explore the impact of audit and feedback on the pneumococcal immunization rate for at-risk adults in ambulatory settings. Study findings support the hypothesis that timely, individualized audit and feedback can have a positive impact on immunization rate; generalized feedback that did not provide actionable information did not have the same impact. The difference between the interventions was significant, χ (1, N = 1993) = 124.7, P <.001.

Evaluation of metal impurities in foods preserved with sodium lactate.

The public is being bombarded by the media almost dailywith real and potential food health concerns leadingto a public sentiment that questions the vulnerability and quality of our food. Sodium lactate is a food-grade product that in recent years has been used in bioremediation to stimulate microbial growth and contaminant breakdown processes. In previous work, impurities including arsenic and chromium were discovered to be present in the sodium lactate concentrate. The study described in this article was performed to determine whether arsenic and chromium were at detectable levels, posing a potential concern in food products preserved with sodium lactate available to the general public. A pilot sampling of three sodium-lactate-preserved food products was obtained from a local market and used to determine the commercial laboratory's detection and reporting limits for arsenic and chromium for these food products. Once these limits were established, a random sampling and analyses of 17 food products was performed. Arsenic was not reported above the detection limits in either the pilot or subsequent study, but chromium was detected at concentrations up to 0.30 parts per million in a pilot test sample and lower concentrations in the subsequent study. This study suggests that the sodium lactate in the sampled products was diluted enough for the arsenic concentration to be below the laboratory detection limit. Chromium was detected and may be an unaccounted source of chromium in diets of vulnerable populations.

Use of PHN competencies and ACHNE essentials to develop teaching-learning strategies for generalist C/PHN curricula.

This paper provides a useful tool for the undergraduate community/public health nursing (C/PHN) faculty member to design courses and learning activities, and to interpret C/PHN education needs to undergraduate curriculum committees and administrators. Specifically, this paper provides a tangible bridge between the Public Health Nursing Competencies (Quad Council of Public Health Nursing Organizations, 2004) and the Association of Community Health Nursing Educators (ACHNE) Essentials of Baccalaureate Education (2000) for both didactic and clinical learning experiences. The tables may be used in multiple ways, including curriculum monitoring and improvement, course development and instructional design, clinical practice planning, and as a foundation for evaluation of conceptual learning and practice competence for the C/PHN generalist. Because C/PHN experiences in undergraduate education are unique and context based, the tables exemplify how two key guiding documents mutually frame the C/PHN educational experience supported by specific learning activities. Further, at a minimum, MSN preparation as a C/PHN specialist is clearly necessary for the teaching and learning of baccalaureate curricular components of C/PHN.

Innovations in community-based nursing education: transitioning faculty.

The health-care climate is changing rapidly and in ways that challenge the abilities of professionals who provide health care. Nursing educators are preparing professional nurses who can think critically, use sound clinical judgment, and participate as full partners in shaping health-care delivery and policy. Therefore, many schools of nursing, including five schools of nursing whose experiences are synthesized in this article, are revising their curricula to a community-based nursing perspective. Strategies to assist faculty in the transition to a community-based nursing curriculum include using change theory, creating a supportive environment, reducing tension and isolation, and evaluating. Potential challenges during transition include addressing grief and loss, overcoming the tedium of curricular development, moving the revision along while allowing opportunities for faculty input and consensus building, exploring alternative pedagogies, managing faculty workload and qualification issues, and preparing for transition. Outcomes include a more complete understanding of the community client as a partner in the delivery of health care, increased visibility and role modeling to potential future candidates for health careers, cultural transformations within a university, and promotion of the overall health of a community.

Behaviors of older men living in the community. Correlates producing active composure.

The correlates of active composure behaviors for older veteran men living in the community were investigated to identify this aspect of the complex domain of health behavior. Cox's (1982) Interaction Model of Client Health Behavior was used to frame this investigation. The independent variables were age, education, race, marital status, children, siblings, income, spiritual well-being, functional status, motivation, health conceptions, and loneliness. The dependent variable was Schwirian's (1992) active composure, conceptualized as activities producing rest, relaxation, and anxiety and stress reduction. The sample was male veterans (N = 184) older than 65 who were not living in an institution. A multiple regression model explained 49% of the variance in active composure. Race, income, religious aspect of spiritual well-being, instrumental activities of daily living, and loneliness were significant predictors. Results suggest that nurses may find these correlates helpful in facilitating the identification of risk status and developing active composure self-care strategies for older men living in the community.