Use of Design Thinking to Grow the Reach and Relevance of Evidence-Based Practice Education Across a Health Care System.

Evidence-based practice (EBP) skill building among clinical nurses is a priority for nurses in professional development because it is well known that this approach to clinical decision-making results in safe, cost-effective, person-centered care. Recent studies indicate widespread lack of self-reported competency in EBP skills among nurses, demonstrating the importance of prioritizing programs that meet clinical nurses' needs for EBP education. The goal of this design thinking project was to expand and diversify an EBP skill building program to provide more widespread accessibility across a multi-hospital health care system. The team followed the five-step human-centered design thinking process to empathize, define, ideate, prototype, and test an innovation. Based on end user feedback, a dual-track EBP educational program, with options for an intensive yearlong hybrid EBP Scholars program and a three-session skill building webinar series, was implemented. Design thinking provides a rich framework for incorporating end user feedback to generate innovations to address challenges in health care. [J Contin Educ Nurs. 2023;54(8):360-366.].

Best Practices to Verify Ongoing Placement of NG or OG Tube After Initial X-ray Confirmation.

BACKGROUND: Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death. AIMS: To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU. METHODS: The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits). RESULTS: Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, "OK to use" order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site. LINKING ACTION TO EVIDENCE: Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.

Evidence-Based Virtual Learning Experiences for the Clinical Nurse Leader Capstone.

BACKGROUND: The global COVID-19 pandemic resulted in abrupt changes in the delivery of health care and nursing education, particularly in highly affected areas of the country. PROBLEM: Many hospitals suspended nursing students' learning on-site due to concerns related to virus transmission and lack of clear guidance on safe and effective learning. This Model C Clinical Nurse Leader (CNL) direct entry MSN program needed to meet graduating students' capstone learning needs in a virtual format. APPROACH: A review of the literature along with CNL competencies and other American Association of Colleges of Nursing resources informed this evidence-based virtual capstone experience. OUTCOMES: Students achieved learning outcomes in a virtual format and reported high levels of satisfaction with learning activities. CONCLUSIONS: Virtual learning activities were essential at the height of the pandemic and may prove useful in other circumstances that limit clinical site availability. These activities can also complement in-person learning experiences.

Coping With the Unexpected in Childbirth: A Thematic Analysis.

This article reports original research that describes new mothers' experiences of birth and maternity care. Qualitative data were collected through a survey on birth satisfaction, which included space for women to provide comments about their birth and experience of care. Thirty-nine women provided comments that were analyzed using the thematic analysis method. Two themes emerged from the women's experiences: "Unexpected birth processes: expectations and reality" and "Coping with birth: the role of health-care staff." Participants described unexpected birthing processes, their experiences of care, and maternity care staff's contributions to coping with birth. Implications for practice for childbirth professionals include promotion of physiologic birth, respectful person-centered care during all phases of perinatal care, and the value of childbirth preparation.

The Effect of a Pet Therapy and Comparison Intervention on Anxiety in Hospitalized Children.

The purpose of this study was to evaluate the effect of a brief pet therapy visit and a comparison intervention on anxiety in hospitalized children. This quasi-experimental study compared state anxiety before and after structured research interventions in a convenience sample of children between the ages six and 17 (N = 93) in two groups. Participants were assigned to the pet therapy group or control group, based upon timing of data collection. Participants in each group received either a visit from the research assistant, therapy dog and handler, or from the research assistant for completion of a puzzle. The child's anxiety was measured using the State-Trait Anxiety Scale for Children (STAIC) S-Anxiety Scale before and after the visit and parents completed a brief background questionnaire. Intervention and comparison groups had no significant differences in key demographic factors or baseline anxiety level. While state anxiety decreased significantly in both groups, children in the pet therapy group experienced a significantly greater decrease in anxiety (p = .004). In addition, parents reported high levels of satisfaction with the pet therapy program. Study findings provide support for a brief pet therapy visit with a trained dog and handler as a tool decrease to anxiety in hospitalized children while promoting parent satisfaction. When resources for providing pet therapy visits are limited, clinicians may consider prioritizing children who are most affected by anxiety.

Professor in Residence: An Innovative Academic-Practice Partnership.

This article describes an academic-practice partnership between an American Nurses Credentialing Center Magnet®-designated hospital and an academic nurse educator that has increased the hospital's capacity for research, evidence-based practice, and support for nurses continuing their education. Through close collaboration with the full-time nurse researcher and members of the nursing education department, the professor in residence consults with clinical staff to support completion of research and evidence-based practice projects. The collaboration also has resulted in the development of a formal year-long mentoring program for clinical nurses in the area of evidence-based practice. Individual support and academic consults are offered to nurses enrolled in school to promote advancement of nurses' educational level. This collaboration has been beneficial for both the hospital and the university, increasing the capacity for scholarly activities for nurses in the hospital and serving as a forum for ongoing faculty practice and scholarship. J Contin Educ Nurs. 2017;48(12):552-556.

Understanding and Promoting Birth Satisfaction in New Mothers.

PURPOSE: The purpose of this study was to examine the impact of select maternal psychosocial and experiential factors on birth satisfaction of new mothers during early postpartum. STUDY DESIGN AND METHODS: This is a descriptive correlational study exploring the relationships among birth satisfaction, breastfeeding self-efficacy, and perceived stress in 107 new mothers in the first 4 days postpartum. Instruments used included the Birth Satisfaction Scale-Revised, the Perceived Stress Scale, the Breastfeeding Self-Efficacy Scale-Short Form, and a researcher-generated demographic form. Quantitative analysis included descriptive statistics, correlation, one-way Analysis of Variance, and multiple linear regression. RESULTS: Birth satisfaction was negatively correlated with perceived stress (r = -.299, p < .05) and positively correlated with feeling prepared for birth (rho = .243, p < .05) and breastfeeding self-efficacy (r = .226, p < .05). The predictive model for birth satisfaction was significant (R = .204, F [6, 99] = 4.225, p = .001), explaining approximately 20.4% of variance in birth satisfaction in the sample. CLINICAL IMPLICATIONS: Stress reduction and management, establishment of realistic expectations for labor and birth, and promotion of togetherness with newborn immediately after birth are nursing priorities to promote birth satisfaction.

Predictors of Breastfeeding Confidence in the Early Postpartum Period.

OBJECTIVE: To identify factors related to breastfeeding self-efficacy, an important psychological variable in sustained breastfeeding, in the postpartum period. DESIGN: Descriptive correlational study. SETTING: Data were collected on the mother-baby unit of an academic medical center in the Northeastern United States. PARTICIPANTS: This convenience sample (N = 107) was composed of women in the first 4 days postpartum and included nearly equal numbers of primiparas (49.5%, n = 53) and multiparas (50.5%, n = 54). METHODS: Participants completed the Perceived Stress Scale-10, Birth Satisfaction Scale-Revised, Breastfeeding Self-Efficacy Scale-Short Form, and a demographic questionnaire. Descriptive and inferential statistics were used to analyze the data. RESULTS: Breastfeeding self-efficacy was positively correlated with birth satisfaction, number of children, partner support of breastfeeding, intention to breastfeed, intention to breastfeed exclusively for 6 months, and feeling prepared for birth. Breastfeeding self-efficacy was greater in women with previous breastfeeding experience and lower in mothers of newborns who received in-hospital formula supplementation. A standard multiple linear regression explained approximately 38.5% of the variance in self-efficacy scores. CONCLUSION: Nurses can apply our findings to inform strategies to increase breastfeeding confidence, such as promoting birth satisfaction, involving partners in breastfeeding education, and limiting the use of in-hospital formula supplementation.

Health Care in the Community: Developing Academic/Practice Partnerships for Care Coordination and Managing Transitions.

The delivery of health care is quickly changing from an acute care to a community-based setting. Faculty development and mastery in the use of new technologies, such as high-definition simulation and virtual communities are crucial for effective student learning outcomes. Students' benefits include opportunities for hands-on experience in various patient care scenarios, realtime faculty feedback regarding their critical reasoning and clinical performance, interdisciplinary collaboration, and access to a nonthreatening learning environment. The results of this study provide some evidence of the benefits of developing faculty and nursing curricula that addresses the shift from an ilness-based, acute hospital model, to a community and population health-based preventive model.