Keys to Success: A Professional Development Program to Support Care of Patients With Autism Spectrum Disorder.

Patients with autism spectrum disorder present with an extensive range of communication and social skills that require healthcare workers to have a comprehensive understanding of best practices for providing holistic care. This article presents the planning, curriculum development, implementation, and evaluation of a professional development program aimed at providing interprofessional staff with strategies and resources to use when caring for patients with autism spectrum disorder.

Exploring the Charge Nurse Role Transition: A Qualitative Study of the Novice's Perspective.

The novice charge nurse role transition is not well understood. This article reports on a qualitative descriptive study of the novice charge nurse role transition. Rubin and Rubin's responsive interviewing was used. Fourteen novice charge nurses participated in Zoom interviews. Thematic analysis revealed three phases: taxiing to the runway , takeoff , and reaching cruising altitude , each with distinct themes. Nursing professional development practitioners can use these findings to better understand and support new charge nurses through this transition.

A Unique Lens: Understanding What Nurses Are Best Positioned to Assess About Residents.

Background: Resident feedback is generally elicited from attending physicians, although nurses can also provide feedback on distinct domains. Physicians may be hesitant to accept feedback from nurses if they perceive that nurses are being asked about areas outside their expertise. Understanding specific resident behaviors that nurses are best suited to assess is critical to successful implementation of feedback from nurses to residents. Objective: To understand specific resident behaviors nurses are uniquely positioned to assess from the perspectives of both nurses and residents. Methods: We performed a qualitative study using thematic analysis of 5 focus groups with 20 residents and 5 focus groups with 17 nurses at a large free-standing children's hospital in 2020. Two reviewers developed a codebook and subsequently analyzed all transcripts. Codes were organized into themes and subthemes. Thematic saturation was achieved prior to analyzing the final transcript. Results: We identified 4 major themes. Nurses are positioned to provide feedback: (1) on residents' interprofessional collaborative practice; (2) on residents' communication with patients and their families; and (3) on behalf of patients and their families. Within each of these, we identified subthemes noting specific behaviors on which nurses can provide feedback. The fourth theme encompassed topics that may not be best suited for nursing feedback-medical decision-making and resident responsiveness. Conclusions: Nurses and residents described specific resident behaviors that nurses were best positioned to assess.

Strengthening Healthy Work Environment Outcomes Via Interprofessional Direct Care Champion Roles.

OBJECTIVE: To provide an organization-wide, systematic approach to creating and sustaining healthy work environments (HWEs) through frontline interprofessional staff education and coaching engagement. BACKGROUND: HWE has been an overarching concept in the organization's nursing professional practice model since 2014; however, few practice settings routinely translated survey findings to improve the work environment's health via local interprofessional direct care team members. METHODS: The program used a participatory approach where HWE champions committed to participate in centralized professional development activities and local quality improvement initiatives to bolster the health of area work environments. RESULTS: Fifty-one champions representing 44 practice settings participated in the professional development program. Mean HWE scores for all standards increased from year 1 to 2, with 15 practice settings seeing categorical improvement. Meaningful recognition and true collaboration were the standards most often targeted for improvement. CONCLUSION: The HWE champion role appears to be a promising strategy for engaging frontline interprofessional staff in the assessment and implementation of initiatives to improve the health of work environments.

GOLD in Practice: Chronic Obstructive Pulmonary Disease Treatment and Management in the Primary Care Setting.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Early detection and appropriate treatment and management of COPD can lower morbidity and perhaps mortality. Clinicians in the primary care setting provide the majority of COPD care and are pivotal in the diagnosis and management of COPD. In this review, we provide an overview of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 report, with a focus on the management of COPD in the primary care setting. We discuss the pathophysiology of COPD; describe COPD risk factors, signs, and symptoms that may facilitate earlier diagnosis of COPD; and reinforce the importance of spirometry use in establishing the diagnosis of COPD. Disease monitoring, as well as a review of the 2020 GOLD treatment recommendations, is also discussed. Patients and families are important partners in COPD management; therefore, we outline simple steps that may assist them in caring for those affected by COPD. Finally, we discuss nonpharmacological treatment options for COPD, COPD monitoring tools that may aid in the evaluation of disease progression and response to therapy, and the importance of developing a COPD action plan on an individualized basis.

Strategies to Reduce Errors Associated with 2-Component Vaccines.

The high incidence of error reports received by the US Food and Drug Administration (FDA) involving 2-component vaccines led to collaboration between the United States Pharmacopeia (USP) and the Institute for Safe Medication Practices (ISMP). This collaborating group sought to further understand errors associated with all 2-component vaccines (i.e. vaccine components provided by the manufacturer in physically separate containers) and to provide safe practice strategies for storing, preparing, dispensing, and administering these vaccines as intended. Fourteen available 2-component vaccines were identified. The ISMP National Vaccine Errors Reporting Program (VERP) and the FDA Vaccine Adverse Event Reporting System (VAERS) were searched from the initiation of each respective reporting system through December 31, 2019. The three vaccines with the most reported reconstitution errors in the VERP and VAERS are Menveo® (meningococcal), Pentacel® (DTaP, Polio, Haemophilus influenzae type b), and ActHIB® [H. influenzae type b (Hib)]. Manufacturers should design labeling and packaging of vaccines to provide ease of storage and fail-safe preparation to prevent 2-component vaccine errors. Implementing risk reduction strategies, such as training healthcare professionals and affixing storage bin labels, remind healthcare professionals to mix the 2-components and facilitate appropriate administration.

Cultivating evidence-based practice through mentorship.

BACKGROUND: Nurses' use of evidence-based practice (EBP) improves patient outcomes through provision of optimal patient care. AIM: The Evidence-Based Practice Mentorship Program (EBPMP) is a self-directed, year-long immersion program implemented for staff nurses to experience the EBP process with close mentor support. The aim of this program is to bolster a culture of EBP at a single large pediatric quaternary care hospital in the Northeast. RESULTS: A total of 81 nurses across 4 cohorts participated in this organization wide program from 2016 to 2019. To date the program has produced 46 internally and externally disseminated EBP projects. Of the graduates, 7-nurse mentees have become formal EBPMP mentor's, 3 have applied and been accepted into the organizational based Nursing Science Fellowship to carry out clinical inquiry projects to fill important literary gaps, and 6 have received promotions or career advancements. Most importantly, graduates have anecdotally reported that program participation inspired deeper critical reflection of patient care. SUMMARY: Utilizing mentorship to facilitate EBP was a key educational strategy for the busy mentors and mentees, as many of the nurse participants were direct care providers. This self-directed program resulted in a high project completion rate leading to continued organizational support for the program, which is now in its fourth year.

Tiotropium Respimat Efficacy and Safety in Asthma: Relationship to Age.

BACKGROUND: Data are limited on the differential response to long-acting bronchodilators in older versus younger adults with asthma. OBJECTIVE: To determine whether the response to tiotropium Respimat differed in older versus younger patients with asthma. METHODS: Post hoc analyses of 4 randomized, double-blind, placebo-controlled studies in adults with asthma were carried out. Two studies compared tiotropium Respimat 5 µg once daily with placebo, both added to high-dose inhaled corticosteroid (ICS) plus long-acting ß2-agonist (ie, severe asthma). The other 2 evaluated tiotropium Respimat 2.5 or 5 µg once daily, salmeterol 50 µg twice daily, or placebo, all added to medium-dose ICS (moderate asthma). Data were analyzed in 2 pools: (1) severe and (2) moderate asthma. Efficacy end points: trough and peak FEV1; trough forced vital capacity; Asthma Control Questionnaire total score and responder percentage, all at week 24. One set of analyses was performed with age as a continuous covariate; the second was conducted in categories less than 40, 40 to 60, and more than 60 years, with treatment-by-age subgroup interaction P values obtained. Safety was analyzed in age categories. RESULTS: Across the age categories, treatment-by-age subgroup interaction P values for trough FEV1 were .13 and .77 for patients with severe and moderate asthma, respectively, not indicating significant impact of age on overall treatment effect, with this observation replicated in the 2 continuum analyses. The other end points (including safety) were also not impacted by age. CONCLUSIONS: Once-daily tiotropium Respimat add-on to ICS or ICS/long-acting ß2-agonist therapy was effective and well tolerated in patients with asthma independent of age.

Developing nurse leaders: Toward a theory of authentic leadership empowerment.

AIM: The aim of this article is to present a theoretical synthesis of the theory of authentic leadership and the theory of structural empowerment. The new middle-range theory, Theory of Authentic Leadership Empowerment (TALE), is meant to be used as a guide for the professional development of nurses into leadership roles. BACKGROUND: The Institute of Medicine's Future of Nursing Report calls for nurses across all levels and settings, to develop leadership skills to address the ever-growing complexities in health care. However, the best approach to developing nurse leaders is not known. DESIGN: Walker and Avant's method for theory synthesis was used. The two theories were critically appraised from a philosophical and theoretical perspective. Then the theories were synthesized by nesting structural empowerment concepts into authentic leadership to arrive at the proposed TALE. RESULTS: TALE highlights how a nurse's individual history, personal values, ethics, and the organization's structure interact and influence the development of leaders who are authentic. CONCLUSIONS: TALE offers nurse leaders, nursing professional development practitioners, and other stakeholders concerned with developing authentic leaders a holistic theoretical framework to understand leadership development at the individual level while also accounting for the importance of contextual influences.

The Impact of Critical Reflective Inquiry Education on Experienced Nurses' Insights Into Practice.

Successful succession planning necessitates use of innovative strategies to encourage and support knowledge recovery and transfer. This quality improvement project evaluated the impact of a critical reflective inquiry workshop on experienced nurses' insights into practice. Nurses assessed written clinical narratives using the Critical Reflective Inquiry Assessment Tool before and after the workshop. Guided reflection led by nursing professional development practitioners fostered insight into practice, which is an essential step in supporting knowledge transfer to novice nurses.

Interprofessional Use and Validation of the AACN Healthy Work Environment Assessment Tool.

BACKGROUND: Health care work environments affect patient outcomes, staff satisfaction and retention, and organizational financial viability. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool (HWEAT) is a resource for patient care units and organizations to assess the work environment and track progress on their journey to excellence. OBJECTIVE: To validate interprofessional use of the AACN HWEAT across a large free-standing children's hospital. METHODS: The AACN HWEAT was administered to staff members across professional categories. Responses were averaged to achieve an overall score and a score for each standard included in the instrument. Nurses' and physicians' scores were further stratified. Test-retest reliability and internal consistency were assessed. Construct validity was measured by correlating the AACN HWEAT and the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (H-SOPS). RESULTS: Of 2621 AACN HWEAT surveys, 1030 (39.3%) were returned for review. The organization-wide HWEAT mean overall score was 3.58 (3.87 for physicians vs 3.54 for nurses, P= .02). Test-retest reliability was indicated by Spearman correlation coefficients of 0.50 to 0.68. Internal consistency was shown by a Cronbach α of 0.77 overall (range for standards, 0.77-0.81). Convergent validity between AACN HWEAT standards and AHRQ H-SOPS items was shown by correlation coefficients of 0.30 to 0.52. CONCLUSION: The AACN HWEAT was both reliable and valid, supporting its interprofessional use as an organizational measure. Active evaluation of health care environments is critical to achieving optimal patient outcomes.

Migration and survival of Atlantic salmon Salmo salar smolts in a large natural lake.

An investigation with acoustic telemetry of the passage of Salmo salar smolts through a large natural lake found heavy mortality occurred at the river-to-lake confluences (mean 31.2% km-1 ), but was lower in the main body of the lake (mean 2.4% km-1 ). Predation was a significant pressure on emigrating smolts as tagged pike Esox lucius aggregated at river-to-lake confluences during the peak of the smolt run. Tagged smolts mainly emmigrated into the lake in the late evening after dusk, possibly as a predator-avoidance behaviour.

Office Spirometry in Primary Care for the Diagnosis and Management of COPD: National Lung Health Education Program Update.

The use of office spirometry was recommended by the National Lung Health Education Program (NLHEP) consensus conference in 1999 for detection and management of COPD. Since that time, spirometry utilization has increased, but its role in the diagnosis of COPD is still evolving. This update reviews the role of spirometry for screening and case finding in COPD as well as for asthma. Spirometry has been used for disease management in patients with airway obstruction, with varying results. The diagnostic criteria for COPD using spirometry have also evolved in the past 17 years, with differences arising between the Global Initiative for Chronic Obstructive Lung Disease and NLHEP recommendations. More sophisticated spirometers as well as new reference equations are widely available. Standardization guidelines from the American Thoracic Society/European Respiratory Society published in 2005 provide a robust framework for performing and interpreting spirometry, but clinicians still need hands-on training and meaningful feedback to perform high-quality spirometry in the office setting.

Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients.

Acute respiratory compromise describes a deterioration in respiratory function with a high likelihood of rapid progression to respiratory failure and death. Identifying patients at risk for respiratory compromise coupled with monitoring of patients who have developed respiratory compromise might allow earlier interventions to prevent or mitigate further decompensation. The National Association for the Medical Direction of Respiratory Care (NAMDRC) organized a workshop meeting with representation from many national societies to address the unmet needs of respiratory compromise from a clinical practice perspective. Respiratory compromise may arise de novo or may complicate preexisting lung disease. The group identified distinct subsets of respiratory compromise that present similar opportunities for early detection and useful intervention to prevent respiratory failure. The subtypes were characterized by the pathophysiological mechanisms they had in common: impaired control of breathing, impaired airway protection, parenchymal lung disease, increased airway resistance, hydrostatic pulmonary edema, and right-ventricular failure. Classification of acutely ill respiratory patients into one or more of these categories may help in selecting the screening and monitoring strategies that are most appropriate for the patient's particular pathophysiology. Standardized screening and monitoring practices for patients with similar mechanisms of deterioration may enhance the ability to predict respiratory failure early and prevent its occurrence.

Appraisal of lens opacity with mometasone furoate/formoterol fumarate combination in patients with COPD or asthma.

BACKGROUND: Long-term corticosteroid use may increase cataract risk. The Lens Opacities Classification System (LOCS) III ranked lens opacities as Class 1: 0.5-0.9 unit; Class 2: 1.0-1.4 units; or Class 3: ≥1.5 units in clinical trials of combined mometasone furoate and formoterol (MF/F) administered by metered-dose inhaler (MDI). We examined retrospectively shifts in lenticular opacity in patients with chronic obstructive pulmonary disease (COPD) or asthma. METHODS: We analyzed pooled LOCS III data from two COPD studies and separately analyzed LOCS III data from an asthma study. COPD subjects were randomized to twice daily MF/F 200/10 µg, MF/F 400/10 µg, MF 400 µg, F 10 µg, and placebo; asthma subjects were randomized to MF/F 200/10 µg, MF/F 400/10 µg, fluticasone propionate/salmeterol (FP/S) 250/50 µg, and FP/S 500/50 µg. Lenticular opacity changes were analyzed post hoc for proportions of subjects with LOCS III grade increases ≥0.5, ≥1.0, or ≥1.5 units at weeks 26 and 52. RESULTS: Proportions of subjects in the COPD studies with Class 1 (≥0.5 unit), 2 (≥1.0 unit), or 3 (≥1.5 units) increases in LOCS III at week 26 (N = 1675) ranged from 15.5 to 18.6%, 3.3-6.0%, and 0.9-2.2%, respectively. At week 52 (N = 1085), proportions of active-treated subjects with Class 1, 2, or 3 increases in LOCS III ranged from 26.6 to 28.9%, 6.3-10.7%, and 2.6-5.9%, respectively. Treatment differences in lenticular shifts were generally small and nonsignificant in the asthma study. CONCLUSION: No clinically relevant trends were observed in the LOCS III assessment of lenticular shifts during treatment of COPD and asthma patients, although further study may be needed to confirm the findings presented here. In these trials, MF/F effects on lens opacity were not observed. (Clinicaltrials.gov numbers: NCT00383435, NCT00383721, and NCT00379288.).

Efficacy and safety of a fixed-dose combination of mometasone furoate and formoterol fumarate in subjects with moderate to very severe COPD: results from a 52-week Phase III trial.

BACKGROUND: A clinical trial of mometasone furoate/formoterol fumarate (MF/F) administered via a metered-dose inhaler in subjects with moderate to very severe chronic obstructive pulmonary disease (COPD) investigated the efficacy and safety of a fixed-dose combination of MF/F. METHODS: This multicenter, double-blind, placebo-controlled trial had a 26-week treatment period and a 26-week safety extension. Subjects (n = 1055; ≥40 years) were current or ex- smokers randomized to twice-daily treatment with inhaled MF/F 400/10 µg, MF/F 200/10 µg, MF 400 µg, F 10 µg, or placebo. The coprimary endpoints of the trial were mean changes from baseline in forced expiratory volume in 1 second (FEV(1)) over 0-12 hours (AUC(0-12) FEV(1)) with MF/F versus MF, and in morning predose FEV(1) with MF/F versus F. Key secondary endpoints were quality of life (Saint George's Respiratory Questionnaire [SGRQ]), symptom-free nights, and partly stable COPD at 26 weeks, as well as time to first COPD exacerbation. RESULTS: Significant improvements in FEV(1) AUC(0-12) occurred at endpoint with MF/F 400/10 and MF/F 200/10 versus MF 400 (P ≤ 0.007). Significant bronchodilation occurred in 5 minutes with MF/F, and serial spirometry demonstrated sustained FEV(1) improvements with MF/F over the treatment period. Significant improvements in morning predose FEV(1) occurred with both MF/F doses, and these effects were further investigated by excluding results for subjects whose morning FEV(1) data were collected >2 days after the last dose of study treatment. Improvements in SGRQ total scores surpassed the minimum clinically important difference of at least 4 units with MF/F 400/10. MF/F 400/10 significantly reduced the time-to-first COPD exacerbation. Similar proportions of subjects in all five treatment groups reported treatment-emergent adverse events. Rates of pneumonia were low (≤1.0%) across treatment groups. CONCLUSION: MF/F 400/10 µg twice daily was shown to be an effective therapy for patients with moderate to very severe COPD, and both MF/F 400/10 µg twice daily and MF/F 200/10 µg twice daily were well tolerated.