Implementation of an Assault Prevention Quality Improvement Initiative in an Urban Emergency Department.

BACKGROUND: Emergency department (ED) health care workers experience high rates of workplace violence (WPV). LOCAL PROBLEM: Patient-to-staff physical assaults at an urban, academic adult ED ranged between 1 and 5 per month, with a rate of 0.265 per 1000 patient visits. METHODS: A quality improvement initiative, guided by the Social Ecological Model framework that contextualized WPV in the ED setting, informed the development of a Risk for Violence Screening Tool (RVST) to screen adult patients presenting to the ED. INTERVENTIONS: Plan-Do-Study-Act cycles were utilized to implement a violence prevention bundle that incorporated the RVST, an alert system, and focused assault reduction strategies. RESULTS: Patient-to-staff physical assaults decreased to a rate of 0.146 per 1000 patient visits. CONCLUSIONS: Risk for violence screening, an alert system, and assault prevention strategies provide opportunities for nurse leaders to promote ED workplace safety.

Structured simulations improves students' knowledge acquisition and perceptions of teaching effectiveness: A quasi-experimental study.

AIMS: To determine the effect of adding structured simulation to a traditional classroom lecture format on students' knowledge acquisition and their evaluation of faculty teaching effectiveness, compared to traditional classroom lectures alone. BACKGROUND: There is a critical lack of high-quality clinical placements/experiences in nursing education, particularly in clinical specialty populations, such as paediatrics. Simulation has been shown to help students practice in a safe environment. However, less is known about the outcomes of embedding simulation in didactic class sessions or classroom lectures. Additionally, data on the impact of simulation as a teaching pedagogy on faculty teaching effectiveness is limited. DESIGN: Post-test, nonequivalent control group quasi-experimental study. METHODS: Students in two prelicensure nursing programs participated in a 10-week term paediatric nursing course taught by the same faculty member on two different campuses. The students at one campus, designated as the control group (n = 43), received four hours of traditional, lecture-only, instructions. The group at a second campus, the intervention group (n = 44), received the same lectures with added structured simulations. Students' knowledge acquisition and their evaluation of faculty teaching effectiveness were measured in both groups using the same standardised assessment measures. The CONSORT checklist was followed. RESULTS: Students' knowledge acquisition scores and their evaluation scores of faculty teaching effectiveness were significantly higher in the intervention (simulation) group compared to the control group. A significantly higher number of students in the simulation group scored above the national average Nursing Care of Children score as compared to students in the control group. CONCLUSIONS: Integrating simulation with didactic instruction enhanced students' knowledge acquisition and improved their opinion of faculty teaching effectiveness. RELEVANCE TO CLINICAL PRACTICE: Augmenting lecture with simulation may provide students with learning experiences that they may not have during clinical rotation due to a lack of paediatric clinical placement sites and differences between sites.

Family Caregiver Strain and Burden: A Systematic Review of Evidence-Based Interventions When Caring for Patients With Cancer.

BACKGROUND: Caregivers of patients with cancer experience high levels of caregiver-related strain and burden (CGSB). Cancer caregiving is complex and can change dramatically depending on the cancer trajectory. Often, this experience leads to poor health outcomes for the caregiver. OBJECTIVES: This review appraises the evidence on CGSB published from 2007 to October 2017. METHODS: 128 interventional studies found in PubMed® and CINAHL® were appraised and categorized based on the Oncology Nursing Society's Putting Evidence Into Practice schema. FINDINGS: Psychoeducation, supportive care/support interventions, and cognitive behavioral interventions are recommended to decrease CGSB. Caregiver skill training, couples therapy, decision support, mindfulness-based stress reduction, multicomponent interventions, and palliative care are likely to be effective. The evidence is not established for 13 interventions. Despite the proliferation of studies focusing on CGSB, studies with stronger designs and larger samples are needed.

An Integrative Review of Nurse-to-Nurse Incivility, Hostility, and Workplace Violence: A GPS for Nurse Leaders.

Bullying, lateral violence, and incivility are real phenomena in the nursing workplace and remain widespread across all care settings. The American Nurses Association recommends zero tolerance for any form of violence from any source and adopting evidence-based strategies to mitigate incivility and bullying. This integrative review examined the evidence regarding nurse-to-nurse incivility, bullying, and workplace violence for 4 nurse populations-student, new graduate, experienced, and academic faculty. Ganong and Cooper's review methodology structured the evidence synthesis. Twenty-one articles pertained to the clinical inquiry. The evidence consistently described the incidents, instigators, and targets of incivility/bullying, which contributes to 84 negative academic, organizational, work unit, and personal outcomes. A safe and just organizational culture demands a comprehensive systems-level approach to create civil environments. The evidence-based structures, processes, and recommendations serve as a Global Positioning System for practice and academic leaders to use in creating a healthy work environment where nurses are encouraged and empowered. The critical choices by nurse leaders will determine not only the future of 21st century professional nursing practice but how the public views the nursing profession for many years to come.

Researching in Collectivist Cultures: Reflections and Recommendations.

Commonalities are presented from the experiences of U.S. nurse researchers who conducted studies in India, Jordan, Aotearoa/New Zealand, and Trinidad and Tobago. While planning research, it is important to engage collaborators who are members of the culture to be studied to understand what are culturally appropriate aims and methods. It is also vital to observe cultural etiquette, especially while gaining entrée and collecting data. Issues related to data collection include timing it around local holidays and events, and adapting individualist methods for obtaining consent and data to be more respectful for those in a collectivist culture. Care must be taken to give back, to sharing findings, and insure sustainability for future research in the host culture. Based on these and other reflections, recommendations are offered to support investigators planning research in a culture that is not their own.

An Integrative Review of Pain Resource Nurse Programs.

Mismanaged pain challenges health care systems. In the early 1990s, pain resource nurse programs were developed by Ferrell and colleagues. Variations of the model have existed for more than 20 years. While results of these programs have been disseminated, conclusive evidence has not been examined via a synthesis of the literature. A structured systematic search using multiple databases was conducted for research studies published 2005-2012. The search identified 11 studies on effective use of a pain resource nurse and/or a pain resource nurse program. The results revealed wide variations existing in program design, research methodology, practice settings, and reported outcomes. Overall, the strength of the evidence on pain resource nurse programs was determined to range from low to moderate quality for making generalizable conclusions. However, 4 key elements were identified as integral to effective pain resource nurse programs and useful for the program design and development: leadership commitment and active involvement in embedding a culture of effective pain management throughout the organization; addressing staff-related and organization-related challenges and barriers to pain management; a combination of strategies to overcome these barriers; and collaborative multidisciplinary teamwork and communication. Specific recommendations are provided for program implementation. Although the evidence was inconclusive, useful information exists to create the design of effective pain resource nurse programs. Collaborative multisite studies on the long-term effects of pain resource nurse programs are recommended.

ACCULTURATION AS A PREDICTOR OF HEALTH PROMOTING AND LIFESTYLE PRACTICES OF ARAB AMERICANS: A DESCRIPTIVE STUDY.

A cross-sectional descriptive study was done using the Acculturation Rating scale of Arab Americans-II, and the Health Promotion and Lifestyle Profile II to assess the relationship between acculturation and health promotion practices among Arab Americans. Findings showed that attraction to American culture was the most important predictor of physical activity; whereas attraction to Arabic culture was the most important predictor of stress management and nutritional practices. Results suggest that, when demographics are controlled, acculturation predicts various health promotion practices in different patterns among members of this group. These findings contribute to a better understanding of acculturation's influence on immigrants' health promotion practices.

Validation of Arabic and English versions of the ARSMA-II Acculturation Rating Scale.

To translate and adapt the Acculturation Rating Scale of Mexican-Americans II (ARSMA-II) for Arab Americans. A multistage translation process followed by a pilot and a large study. The translated and adapted versions, Acculturation Rating Scale for Arabic Americans-II Arabic and English (ARSAA-IIA, ARSAA-IIE), were validated in a sample of 297 Arab Americans. Factor analyses with principal axis factoring extractions and direct oblimin rotations were used to identify the underlying structure of ARSAA-II. Factor analysis confirmed the underlying structure of ARSAA-II and produced two interpretable factors labeled as 'Attraction to American Culture' (AAmC) and 'Attraction to Arabic Culture' (AArC). The Cronbach's alphas of AAmC and AArC were .89 and .85 respectively. Findings support ARSAA-II A & E to assess acculturation among Arab Americans. The emergent factors of ARSAA-II support the theoretical structure of the original ARSMA-II tool and show high internal consistency.

The relationship between acculturation and general health of Arab Americans.

PURPOSE: To determine the relationship between acculturation and health status among Arab Americans in southern California. DESIGN: A cross-sectional survey with 297 adult Arab Americans used (a) a demographic and health survey, SF-36 Version-1, to assess physical and mental health and (b) the Acculturation Rating Scale for Arab Americans-II to assess acculturation. FINDINGS: Participants reported significantly better physical health and worse mental health compared to the published norm for the 1998 U.S. population. Better physical health was associated with demographic factors and bicultural identification; better mental health was associated with attraction to American culture. Attraction to American culture predicted alcohol use, whereas attraction to Arabic culture predicted cigarette smoking. CONCLUSION: Different patterns of association existed between acculturation and physical and mental health among Arab Americans. IMPLICATIONS: Findings suggest that acculturation is an important factor to consider in the well-being of Arab Americans, especially in their mental health.

Integrated heart failure telemonitoring system for homecare.

The integrated telemonitoring system (ITS) for homecare has been designed to improve quality of care as measured by increased nursing productivity, improved patients' clinical and behavioral outcomes and reduction of cost. The system incorporates managerial, organizational, operational and clinical tasks optimized for delivery of quality care through telemonitoring. A secure, multi-modal computer network that integrates homecare nurses, patients and those who care into one seamless environment has been developed. The network brings together a new generation of small, hand-held, wireless terminals used by nurses and patients with a HIPPA-compliant electronic patient record system at the caregiver's site. Wireless terminals use Gobi multi-standard networking technology for connectivity to any available wireless network. The unique features of ITS include a) picture recognition technology capable of extracting numeric data from in-home physiological signal monitor displays that include blood pressure, weight, oxygen saturation, transmission of lung sounds, and capturing echocardiography and electrocardiography data from mobile units; b) in-home caregiver-assisted interactive examinations of signs and symptoms that include visual impressions of ankle swelling, jugular vein distension measurement, and weight gain; c) video-conference capability, facilitating face-to-face two-way communication of nursing personnel with the patients. The ITS network has been designed to improve patients' clinical and behavioral outcomes, increase nursing productivity, and reduce the cost of homecare. Patients' co-operation and compliance has been achieved through use of easy-to-use videoconferencing terminals.