Integration of an APP-Led Supportive and Palliative Oncology Care Program: A Quality Improvement Project.

Patients with advanced cancer have been found to demonstrate severe symptoms and low quality of life at diagnosis; therefore, it is imperative that they have early access to palliative care services along the continuum of care. Oncology advanced practice providers are uniquely poised to serve as champions for primary palliative care integration within their practice. The purpose of this quality improvement project was to develop and implement an APP-led supportive and palliative oncology care (SPOC) program within routine cancer care. The project design utilized the Plan-Do-Study-Act (PDSA) methodology as the guiding framework for development, implementation, and analysis of the SPOC program. Across 49 participants, there were a total of 239 SPOC encounters during the studied period. Participants had a mean of 4.9 visits (SD = 3.5) with the APP. There was a high prevalence of patient-reported symptom burden, the most frequent of which included pain at 44 (90%), fatigue at 36 (74%), appetite loss at 29 (59%), and weakness at 27 (55%) instances. Ninety-four percent of participants (n = 46) had a structured and documented goals of care conversation with the APP during their participation within the program. A total of seven patients completed their advance directives while receiving SPOC care, which was a 25% completion rate. There was a significant demand for interdisciplinary resources (n = 136). Integration of SPOC principles into routine oncology practice is an opportunity to improve the patient and family experience while demonstrating the value of APPs at the clinical and organizational level.

Improving Critical Care Nurses Perceived Self-Efficacy in Providing Palliative Care: A Quasi-Experimental Study.

BACKGROUND: Palliative care is a service that focuses on quality of life and symptom management. It is particularly important for patients with chronic disease. Palliative care in general is an underutilized service for various reasons. Many nurses have only learned about palliative care from experience and express a need for more education. PURPOSE: This study focused on educating critical care nurses on palliative care through online training videos. This quasi-experimental study aims to determine if an online palliative care educational program improves critical care nurses' self-efficacy in providing palliative care. PROCEDURES: The study was conducted using a pre-survey and post-survey that was created with a validated tool called the Palliative Care Self-Efficacy Scale. In between the surveys, the respondents were directed to online education. MAIN FINDINGS: The overall Palliative Care Self-Efficacy Scale showed a median score of the Palliative Care Self-Efficacy Scale increased from pre education (Md=38) to post-education (Md = 43.5), z = -4.868, p <.001, with a large effect size (r = -.76). PRINCIPAL CONCLUSIONS: The majority of critical care nurses have received some form of palliative care education. Online resources similar to the VitalTalk videos and handouts provide added education and improve perceived self-efficacy in providing palliative care in both psychosocial and symptom management aspects of care. The data suggests that improvements to access to education can be done by employers. Further studies can be done to assess current access to palliative care education in undergraduate nursing programs.

PrEP Demographics and Disparity: The Race, Ethnicity, Gender Identity, Sex Assigned at Birth, Sexual Orientation and Age of Current PrEP Use.

PURPOSE: Identification of disparity in preexposure prophylaxis (PrEP) prescription by demographic group. DESIGN: Exploratory descriptive study. METHODS: Secondary data analysis of 1114 patients who received PrEP from Planned Parenthood League of Massachusetts (PPLM) between 2017 and 2020. FINDINGS: Persons of Asian racial-identity had a higher mean PrEP prescription than the other racial groups. Persons over 30 had a higher mean PrEP prescription than those 18-29. CONCLUSIONS: Discrepancy of PrEP prescription reveals opportunities to improve PrEP delivery. CLINICAL EVIDENCE: Providers of PrEP delivery and community health nurses can enhance delivery by better electronic medical charting regarding PrEP discussion and nonadherence.

The Perception of Preparedness in Undergraduate Nursing Students During COVID-19.

BACKGROUND: The purpose of this study was to explore the perception of preparedness in nursing students who transitioned to online and virtual learning platforms brought about by Coronavirus disease 2019 (COVID-19). DESIGN: Descriptive, correlational, nonexperimental research design. METHOD: Data collection was attained through Facebook groups using the Casey-Fink Readiness for Practice Survey and questions about comfort in nursing skills and multiple patient assignments. The sample size of 103 included nursing students and those with less than two years of experience. RESULTS: As school support during the transition increased, comfort in performing nursing skills improved. As the number of patients within a nurse's assignment increased, comfort decreased. Participants expressed a desire for more hands-on in person education and postgraduate support. With the reduction in clinical hours during COVID-19, Learning Techniques and Trials and Tribulations revealed diminished readiness. Low scores within the Trials and Tribulations subgroup impacted feelings of comfort when performing nursing skills independently. CONCLUSION: COVID-19 dramatically changed how undergraduate nurses were educated. The transition from live didactic instruction and in person clinical experience to online learning and simulated clinical experience impacted nursing students' readiness for practice. As this topic is still evolving, additional research will be needed to fully understand the impact on healthcare.

A Systematic Review Exploring Racial Disparities, Social Determinants of Health, and Sexually Transmitted Infections in Black Women.

OBJECTIVE: To explore and describe racial disparities, the role of social determinants of health, and individual risk behaviors among Black women as related to sexual health and/or sexually transmitted infections (STIs). DATA SOURCES: Electronic resource databases used were PubMed, CINAHL, and Google Scholar. Peer-reviewed articles published during 2010 to 2020 were considered. STUDY SELECTION: Thirty-two studies met the criteria and included data for a total of 18,904 Black women. DATA EXTRACTION: Data were extracted from each study using the subheadings author (year), purpose, design, sample demographics and setting, key measures, key findings, and quality assessment. In addition, PRISMA-E and PROGRESS-Plus guided data extraction to illustrate health inequity. DATA SYNTHESIS: Black women who were more likely to report having an STI over the course of their lifetime engaged in behaviors associated with greater risk, the most common of which were unprotected sex, disproportionate partner power, and substance abuse. The primary social determinants of health associated with increased risk were lower income and lower levels of education. Black women were less likely to discuss or feel comfortable discussing their sexual health with health care providers. By contrast, engagement in safe sexual practices stemmed from internal, social, and relationship factors. CONCLUSION: Identifying Black women who are at risk of contracting an STI is essential in driving clinical decision-making. Health care providers should be cognizant of the long-standing mistrust that Black women have of health care providers and, therefore, work to establish positive respectful and trusting relationships with open communication.

Spanish translation and cross-language validation of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form.

BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form is one of the most frequently used outcomes score for shoulder pathology. The patient report section of the ASES questionnaire (p-ASES) is easy to complete, can be quickly administered, and is applicable to a wide range of shoulder pathologies, yet a validated Spanish translation of this questionnaire does not currently exist for diverse Spanish-speaking populations. The purpose of this study was to translate and culturally adapt the patient report section of the ASES to Spanish and to assess its validity and reliability among a culturally diverse group of Spanish-speaking patients, typically seen in the United States. METHODS: The p-ASES Standardized Shoulder Assessment Form was translated into Spanish using a universal approach for translation and cultural adaptation of instruments. A total of 127 Spanish-speaking patients with shoulder pain were included in the study and asked to complete the Spanish translated p-ASES form, the Patient-Reported Outcomes Measurement Information System (PROMIS) v1.2 Physical Function SF 20a in Spanish and a demographics questionnaire. Construct validity was tested using correlational analysis between the Spanish translation of the p-ASES to the Spanish translation of the PROMIS v1.2 Physical Function Short Form 20a. Reliability was measured using both test-retest reliability and internal consistency (Cronbach α) in a subgroup of 27 patients who completed both surveys at a separate time point. RESULTS: The p-ASES demonstrated desirable convergent validity with the validated Spanish version of the PROMIS v1.2 Physical Function Short Form 20a with a strong correlation (r = 0.82, P < .04) for Spanish speakers. The Spanish translation of the p-ASES proved to be a reliable tool with a high degree of internal consistency across question items (α = 0.90). The Spanish p-ASES also demonstrated excellent test-retest reliability with a strong correlation (r = 0.87, P < .001) between time 1 and time 2. CONCLUSION: The Spanish p-ASES is both a valid and reliable tool for assessing shoulder function in Spanish-speaking patients from diverse cultural backgrounds and it demonstrates psychometric properties equivalent to those of the English-language version.

Exploring novice nurse practitioner job satisfaction.

BACKGROUND: With the continued increase in new nurse practitioners expected over the next 5 years and beyond, more individuals will experience nurse practitioner role transition. It is beneficial to nurse practitioners, patients, and the health care industry to understand factors relating to job satisfaction during role transition. PURPOSE: The purpose of this study was to contribute to the understanding of the transition period of new nurse practitioners by exploring demographics and job satisfaction during the first 6 months to 2 years of practice. METHODS: This nonexperimental quantitative study employed convenience sampling with survey methodology. Twenty-one Facebook groups/pages were posted on once a week for 6 weeks. Demographic information was collected, and personal experiences were measured with the Misener Nurse Practitioner Job Satisfaction Scale. RESULTS: Practice setting, formal orientation programs, and intent to leave current position were related to overall nurse practitioner job satisfaction during the transition period (p < .05). Satisfaction with time and benefits varied among demographic groups (p < .05). IMPLICATIONS FOR PRACTICE: Novice nurse practitioners are mostly satisfied in their new role. However, turnover intention in this population is high and orientation programs are lacking, warranting further study.

An exploratory descriptive study of compassion fatigue and compassion satisfaction: Examining potential risk and protective factors in advanced nurse practitioners.

BACKGROUND: Larger patient caseloads and increased workplace responsibility for nurse practitioners (NPs) may exacerbate factors leading to compassion fatigue (CF). PURPOSE: The purpose of this study is to analyze the rate of burnout in practicing NPs by looking at contributing factors that play a role in CF and compassion satisfaction (CS). METHODS: A NP social media platform was used to distribute a survey to a convenience sample of 208 NPs. Data included the Professional Quality of Life Scale V (ProQOL V) tool, demographic data, and protective factor questions. The data were dissected for CF and protective factors of CS. RESULTS: The relationship of mindfulness practices and levels of CS was statistically significant. The relationship between support from family, coworkers, and administration and levels of CS was also found statistically significant. A large association was found between the correlation of burnout and support from coworkers. IMPLICATIONS FOR PRACTICE: Findings showed an average to high level of CS with a low-to-average burnout rate among the NPs surveyed. There was a direct impact between the amount of support participants received from individual support systems and their level of CS. These findings could be beneficial for new NP graduates in establishing a sense of community while reducing the risk for burnout.

Outcomes Comparison of Enculturating Advance Directives Process at a Health System.

The Center for Medicare and Medicaid Services requires organizations to comply with the Patient Self-Determination Act by having processes that inform patients about their rights to execute an advance directive (AD) and engage in shared decision-making. The aim of this study was to compare AD data from a previous study (1999-2002) to a postenculturation (2011-2015) of a structured process for documented patient's preferences. Second, to conduct a descriptive, bivariate analysis of the enculturated structured ADs process during 2011 and 2015. This descriptive, comparative analysis included 500 random patients from four hospitals, and the enculturated descriptive analysis included 302 patients from six hospitals. Comparisons showed less no ADs and a greater institutional ADs post compared with pre (p < .05). Fifty-four percent of patients from 2011 to 2015 had an AD, and none of them had resuscitative measures when Do-Not-Resuscitate status was ordered. This enculturated process which includes education for health-care professionals and the community facilitates optimal patient, family-centered care.

Impact of Individual and Neighborhood Factors on Cardiovascular Risk in White Hispanic and Non-Hispanic Women and Men.

Cardiovascular disease (CVD) is the leading cause of mortality for adults in the US, regardless of ethnicity. A cross-sectional correlational design was used to describe and compare CVD risk and cardiac mortality in White Hispanic and non-Hispanic women and men. Data from 3,317 individuals (1,523 women and 1,794 men) hospitalized for non-cardiac causes during 2012-2013, and data from the 2010 United States Census were included. The sex-specific 10-year Framingham General Cardiovascular Risk Score (FRS-10) was used to estimate long-term risk for major cardiac events. Approximately three-quarters of the sample was White Hispanic. FRS-10 scores were generally low, but a high prevalence of risk factors not included in the standard FRS-10 scoring formula was seen. White Hispanic women had significantly lower estimated CVD risk scores compared to White Hispanic and non-Hispanic men despite higher non-FRS-10 risks. Neighborhood median household income had a significant negative relationship and Hispanic neighborhood concentration had a significant positive relationship with cardiac mortality. Hispanic concentration was the only predictor of estimated CVD risk in a multilevel model. CVD risk assessment tools that are calibrated for ethnic groups and socioeconomic status may be more appropriate for Hispanic individuals than the FRS-10. Neighborhood-level factors should be included in clinical cardiac assessment in addition to individual characteristics and behavioral risks. Researchers should continue to seek additional risk factors that may contribute to or protect against CVD in order to close the gap between estimated CVD risk and actual cardiac mortality for Hispanics in the US. © 2016 Wiley Periodicals, Inc.

Married State Preceptorship Model: Crossing the State Line in New Graduate Nurse Transition to Practice.

BACKGROUND: The transition to practice for new graduate nurses poses distinct challenges at the point of care. The complicated work environment necessitates a preceptorship model that maintains safety at all times. METHOD: This study used survey, focus groups, and interviews to assess the effects of the married state preceptorship model (MSPM) on the experiences and perceptions of the new nurses and preceptors in a hospital setting. RESULTS: The result validated the original findings from the new nurses' survey, indicating all (N = 28, 100%) of the new nurses found the MSPM to be beneficial, promote safety, and lessen anxiety, and 27 (96%) thought it helped them to assume a full patient load. The preceptors' survey revealed that 29 (97%) of the preceptors thought the MSPM promoted safety, 30 (100%) thought it boosted confidence, and 30 (100%) believed it meet the needs of the new nurses. CONCLUSION: The study showed same thematic saturation on partnership, critical thinking, learning, and transition. The change in culture has been strengthened in the replicate study referring to their acclimatization in the unit through the MSPM. J Contin Educ Nurs. 2016;47(11):511-517.

Point-of-Care Testing of Troponin Levels Compared With Automated Laboratory Evaluation: A Reliability Study.

Traditionally, troponin levels are measured in the blood using an automated laboratory protocol, but the use of a faster technology, the point-of-care (POC) testing of troponin levels, has shown promise in the effective differential diagnosis of cardiac injury. The purpose of this study was to compare the 2 methods. A total of 1567 patients were seen in the emergency department who were tested with both the POC iSTAT troponin and laboratory troponin from a secondary analysis of retrospective data collected between June 2012 and December 2012. The values for laboratory troponin varied between 0 and 30 with a mean and standard deviation of 0.060 ± 0.842 and the values for POC testing varied between 0 and 17.2 with a mean and standard deviation of 0.042 ± 0.492. The Bland-Altman analysis showed a systematic negative bias for the POC values compared with the laboratory troponin values. Lowering the POC cut-off value for troponin to 0.035 yielded 3 out of 4 better validity coefficients compared with those with the suggested manufacturer's cut-off value of 0.08 when predicting the gold standard. The POC troponin can be used to measure troponin level and similar diagnosis if the cut-off value for the POC troponin is lowered to 0.035 instead of the 0.08 suggested manufacturer's cut-off.

Clinical Partners' Perceptions of Patient Assignments According to Acuity.

Clinical partners (CPs) experienced disproportionate workloads related to patients' levels of acuity. This problem was addressed on a medical-surgical unit by developing patient acuity ratings and equitable acuity assignments for the CPs.

Evaluating the impact of medication cabinets in patients' rooms on a medical-surgical telemetry unit.

Results of a pre-post survey study designed to evaluate the impact of medication cabinets in patients' rooms on nurses' satisfaction with medication administration, medication charge accuracy, and errors are described.

Using the clinical information system implementation evaluation scale as a clinical implementation strategy.

The American Nurses Association mandates nursing informaticists to evaluate clinical system implementation processes. When implementing electronic documentation systems, the use of an evaluation tool aids in the identification of end-user concerns and recommendations, which leads to process improvement. At two community hospitals in South Florida, a Clinical Information System Implementation Evaluation Scale was used to evaluate nursing perceptions during the implementation of a new pediatric electronic documentation system (eDocumentation). The goals were to identify barriers and resistance, as well as opportunities to improve the implementation process, and thus gain acceptance among end users.

Ethical principles of informed consent: exploring nurses' dual role of care provider and researcher.

This article describes the ethical principles of autonomy, beneficence, and justice within the nurse researcher-participant relationship as these principles relate to the informed consent process for research. Within this process, the nurse is confronted with a dual role. This article describes how nurses, who are in the dual role of care provider and researcher, can apply these ethical principles to their practice in conjunction with the American Nurses Association's code of ethics for nurses. This article also describes, as an element of ethical practice, the importance of using participant-centered quality measures to aid informed decision making of participants in research. In addition, the article provides strategies for improving the informed consent process in nursing research. Finally, case scenarios are discussed, along with the application of ethical principles within the awareness of the dual role of the nurse as care provider and researcher.

Moral distress among healthcare professionals at a health system.

Moral distress is increasingly recognized as a problem affecting healthcare professionals. If not addressed, it may create job dissatisfaction, withdrawal from the moral dimensions of patient care, or even leaving the profession. Using the 21-Moral Distress Scale-Revised to assess moral distress, 323 surveys were received from 5 healthcare disciplines. The overall results showed that all disciplines experienced moderate to high actual moral distress, related to similar and/or different patient care situations.

Stabilizing and retaining a quality nursing work force through the use of the Married State Preceptorship Model.

BACKGROUND: The nursing shortage requires new graduate registered nurses (RNs) to work at the bedside, often leading to a shortened orientation period and increased stress. In the Married State Preceptorship Model (MSPM), the preceptor and the preceptee work together as the new graduate RN transitions to the bedside while maintaining safety and quality. This study explored first-year turnover rates of new graduate RNs and new graduate RNs' and preceptors' perceptions of the MSPM in transitioning new graduate RNs to practice. METHODS: Focus groups and surveys were used with 108 new graduate RNs and 100 preceptors. RESULTS: Four themes emerged for new graduate RNs: partnership, critical thinking, learning, and transition. A statistically significant decrease in turnover rates was seen with MSPM versus traditional precepting. Survey data found that new graduate RNs and preceptors perceived the MSPM as promoting safety and reducing anxiety. CONCLUSION: The MSPM allows organizations to retain a quality nursing work force focused on safety patient care by transitioning new graduate RNs into the practice setting.