High consequence infectious diseases training using interprofessional simulation and TeamSTEPPS.

BACKGROUND: The comfort level of health care workers to respond to an infectious disease outbreak or epidemic is likely directly related to the amount of education, training, and experience they have in responding to these events. METHODS: A quasi-experimental study evaluated health care workers' state anxiety, self-efficacy, and interprofessional teamwork when working with patients simulated to have a potentially high consequence infectious disease. RESULTS: Pretest-posttest 1 scores revealed a significant decrease in state anxiety (P < .0001) and an increase in self-efficacy (P < .0001). Overall state anxiety preintervention (pretest) to postintervention (posttest 3) significantly decreased (P = .0265). Overall TeamSTEPPS knowledge significantly increased (P < .0001) from baseline. CONCLUSIONS: Simulation exercises are an effective strategy to increase self-efficacy and decrease state anxiety for health care workers. Positive teamwork scores indicate that the subjects value interprofessional teamwork.

A demonstration project on the impact of safety culture on infection control practices in hemodialysis.

BACKGROUND: Infections among hemodialysis patients continues to be major causes of morbidity and mortality despite advances in the science of infection prevention. Many infections are potentially preventable, yet research suggests that evidence-based interventions are not uniformly practiced in dialysis settings. The purpose of the project was to reduce the risk of infection among hemodialysis patients in an outpatient dialysis clinic in upstate New York through the development of an enhanced patient safety culture. METHODS: A survey was used to assess the safety culture of a large outpatient dialysis program. A Comprehensive Unit-based Safety Program was instituted to enhance infection prevention practices. Evidence-based checklists and audit tools were used to track staff adherence to protocols. RESULTS: Scores on the survey were strongly correlated with bloodstream infection rates. Adherence to infection control standards improved when the End Stage Renal Disease Safety Program was implemented, with audits improving from 27%-82% of procedures performed correctly. Bloodstream infection rates decreased from 2.33-1.07 events per 100 patient months, and the standardized infection ratios decreased from 1.960-0.985 in the 12-months after implementation. CONCLUSIONS: The Comprehensive Unit-based Safety Program model and implementation of the safety program may be effective in improving the culture of safety and adherence to evidence-based practices in hemodialysis. Enhanced patient safety culture is correlated with improved patient outcomes.

Creation of a competency-based professional development program for infection preventionists guided by the APIC Competency Model: steps in the process.

BACKGROUND: Infection Preventionists have varying levels of educational preparation. Many have no prior experience in IP. The diversity makes design of professional development programs challenging. Recent surveys suggest that only about half of practicing IPs are board certified. There is an urgent need to employ competent IP's to drive improvement in patient outcomes. METHODS: This is a project that utilized the APIC Competency Model to create a professional development program characterizing three career stages. Methods included a review of literature on professional development; a survey of IP competence; an assessment of job descriptions and performance evaluations; and a crosswalk of IP competencies. RESULTS: The professional development program includes competency - based IP job descriptions and performance evaluations for each career stage; a professional portfolio; and a toolkit for supervisors. DISCUSSION: Participants agreed that application of the model resulted in tools which are more closely aligned with current roles for IPs; and increased satisfaction and motivation with the new program. CONCLUSION: Competent and knowledgeable IP's are crucial to optimizing efficacy of IPC programs. A professional development program has the potential to guide staff orientation, improve satisfaction and retention, improve patient outcomes and promote a positive trajectory in advancing practice.

Emergency Nurse Implementation of the Brief Smoking-Cessation Intervention: Ask, Advise, and Refer.

PROBLEM: Smoking is the single most avoidable risk factor for many health problems such as cardiovascular disease and pulmonary dysfunction. Emergency departments provide care for many patients who smoke. Patients who smoke and are discharged to home from emergency departments do not customarily receive smoking-cessation information. This project explored the feasibility and acceptability of a brief smoking-cessation intervention as part of emergency nursing practice. METHODS: This practice improvement project was conducted in a large midwestern emergency department. A review of data from 12 months before the project revealed a 17.6% prevalence of smoking among patients discharged from the emergency department with no patient having received smoking-cessation information, confirming the need for intervention. A survey of emergency nurse attitudes and learning needs indicated that nurses believed offering advice to quit was appropriate but that they had limited smoking-cessation training. A total of 83 nurses received training on an "Ask, Advise, Refer" protocol. RESULTS: Evaluation after training indicated that emergency nurses gained knowledge about brief smoking-cessation intervention methods, and 75.7% (n=74) felt adequately trained. During the 12-week intervention, data were collected on 7,465 emergency visits. Nurses advised all smokers to quit using the protocol, and 6.3% of patients accepted smoking-cessation referrals. IMPLICATIONS FOR PRACTICE: Emergency nurses felt comfortable performing the smoking-cessation intervention, suggesting that training was effective. Data indicated that patients were consistently advised to quit smoking. Results suggest that brief smoking-cessation interventions are feasible and acceptable in emergency settings. The training and protocol could be used in other emergency departments, and lessons learned can guide future efforts by emergency nurses to help patients quit smoking.

Preventing adolescent tobacco use and assisting young people to quit: population-, community-, and individually focused evidence-based interventions.

Tobacco use among adolescents is declining in the United States but remains a major public health problem in the United States and globally. The Healthy People 2020 model of determinants of health is useful in understanding the complex interaction of factors that help explain adolescent smoking-related behaviors. Nurses are well positioned to take leadership roles in health care settings, schools, and their own communities as well as at the state, national, and global levels in advocating for policies that prevent and treat adolescent tobacco use and the subsequent burden of disease in future populations.

Evidence for a new paradigm of the ministry of parish nursing practice using the nursing intervention classification system.

A national study of parish nurses used the Nursing Intervention Classification (NIC) Use Survey (3rd Ed.) to characterize parish nursing practice. The study categorized NIC interventions based on frequency of use by parish nurses. The majority of nursing interventions focused on the Behavioral Domain, which supports psychosocial functioning and facilitates lifestyle changes and the Coping Assistance Class, which includes spiritual support. Data provides evidence to further understand what parish nurses do in their daily practice, as well as clarifies the complexity and scope of this specialty practice. Findings confirm that parish nursing is a specialty nursing practice as well as a ministry. Objective descriptions of parish nurse practice, including the identification of the most commonly used parish nurse interventions, will assist in providing direction for defining the role of the parish nurse and providing a basis for reviewing the current content of parish nurse curriculum. The database, which uses a standardized nursing language, also provides evidence for a new paradigm of the ministry of parish nursing practice that is intelligible to other nurses, policy makers, and funders.

School of nursing sponsorship of a school-based health center: challenges and barriers.

School-based health centers (SBHCs) are a growing phenomenon in the United States and appear to be an ideal fit for school of nursing (SON) sponsorship. However, nationally only about 6% of existing SBHCs are sponsored by either an SON or a school of medicine. Sponsorship of health care in schools is consistent with the mission of university-based SONs, but also presents many challenges. Despite these challenges, the authors believe that the benefit to nursing students, faculty, and the profession far outweigh constraints. This article describes the many benefits that can occur when SONs create and maintain a SBHC in their own community. Extensive practical suggestions for how to overcome the barriers that constrain university faculty from developing service-oriented programs in the community are also emphasized.

Evaluation of school-based health center programs and services: the whys and hows of demonstrating program effectiveness.

Evaluation and dissemination of the outcomes of school-based health center (SBHC) services is essential for the continual growth and funding of SBHCs in the United States. Since their inception, SBHCs have been practice sites for nurse practitioners and have used interdisciplinary teams to provide care for underserved school-aged children. Early research and evaluation focused on describing the types of services and the quality of care provided. Supporters of SBHCs were anxious to demonstrate that the care provided was "as good as" care delivered in traditional primary care practices. Documentation of program impacts, such as changes in population health indicators or improved academic achievement, has been more elusive. Current evaluation priorities outlined by the National Assembly on School-Based Health Care include evaluation of mental health services using a new online tool; assessing productivity of SBHC staff; measuring quality; and attempts to link SBHC care with improved academic outcomes.

Estrogen plus progestin therapy: the cardiovascular risks exceed the benefits.

The surprising results of the Women's Health Initiative (WHI) reported in 2002 had a profound effect on women as well as health care practitioners. The WHI was the largest, randomized clinical trial designed to determine if postmenopausal hormone use prevented cardiovascular disease as well as other age-related disorders in women. While observational studies suggested that postmenopausal use of estrogen could decrease cardiovascular risk by 40% to 50%, the WHI demonstrated that use of continuous-combined estrogen plus progestin was not cardioprotective and was even associated with increased health risks. The estrogen alone trial of the WHI is still in progress, leaving practitioners and some women still in a dilemma. This article addresses the WHI in the context of other studies and discusses possible reasons for the unexpected results.