Development and Testing of the Relational and Structural Components of Innovativeness Across Academia and Practice for Healthcare Progress Scale.

OBJECTIVE: Using data from 5 academic-practice sites across the United States, researchers developed and validated a scale to measure conditions that enable healthcare innovations. BACKGROUND: Academic-practice partnerships are a catalyst for innovation and healthcare development. However, limited theoretically grounded evidence exists to provide strategic direction for healthcare innovation across practice and academia. METHODS: Phase 1 of the analytical strategy involved scale development using 16 subject matter experts. Phase 2 involved pilot testing the scale. RESULTS: The final Innovativeness Across Academia and Practice for Healthcare Progress Scale (IA-APHPS) consisted of 7 domains: 3 relational domains, 2 structural domains, and 2 impact domains. The confirmatory factor analysis model fits well with a comparative fit index of 0.92 and a root-mean-square error of approximation of 0.06 (n = 477). CONCLUSION: As the 1st validated scale of healthcare innovation, the IA-APHPS allows nurses to use a diagnostic tool to facilitate innovative processes and outputs across academic-practice partnerships.

Developing Nurses and Interdisciplinary Teams in Caring Science.

This program evaluation assessed a caring science program's impact on nurse and interdisciplinary professionals' self-reported caring, compassion satisfaction, and intent to leave at an academic-affiliated community hospital. A 3-session program resulted in self-caring and intent to leave significant increases at 60 days post intervention. Findings demonstrated caring science interventions alone are insufficient to impact staff engagement and intent to leave. Further actions for organizational culture changes are discussed.

Reducing Hospital Admissions for Patients with Heart Failure by Implementing the Chronic Care Management Framework: A Cost, Quality and Satisfaction Improvement Project.

OBJECTIVE: To reduce the rate of hospital admissions, and increase the perception of coordinated care for patients with heart failure and associated co-morbidities through improvement of interdisciplinary communication. BACKGROUND: Heart failure patients with associated multi-morbidities and multiple provider visits are often left to navigate the health system independently. Limited provider to provider communication contributes to care fragmentation, unnecessary utilization and decreased satisfaction. METHODS: A nurse led complex care management improvement project imbedded care plans and formal and informal collaborative care conferences to improve interprofessional communication across the care continuum. RESULTS: Hospital admissions decreased by 62% and length of stay decreased by 73% (n = 47, p < .001). Using paired t-test, satisfaction questions improved post intervention, and one was statistically significant (p < 0.05). CONCLUSION: Improved communication strategies decreased hospital admissions and length of stay in one large Pacific Northwest health system. Days subject to readmission penalties decreased by 98% with a variance in pre-post charges of $615,000. IMPLICATION FOR NURSES: Nurses and nurse leaders play a significant role in achieving the Triple Aim and can be instrumental in developing small multidisciplinary teams targeting improved coordination across settings and sectors.

Student Interviews Exploring the Influence of the Coronavirus Pandemic on Graduate Nursing Education.

Introduction: Advanced practice nurses are needed to fill the primary healthcare gap in the United States. Advanced practice/graduate nursing students were profoundly affected by the coronavirus pandemic in ways that may impact their educational experience. Objective: The objective of this study was to explore the influence of the coronavirus pandemic on the educational experience of graduate nursing students. Methods: An exploratory descriptive qualitative study using semistructured video conferencing interviews of 11 graduate nursing students at one university in the United States was conducted during July 2020. Data were explored using theme analysis. Results: Four themes expressing the pandemic's impact on graduate student experience were identified: Alteration in human connections; Agility in action; Collaborative construction of change; and Metamorphosis emerging from disruption. The pandemic brought an alteration in how students connected with faculty, other students, and family. Many faculty and students responded with agility to the new mandates for social distancing. The students and faculty worked together to construct changes needed to provide the students with the required components of graduate education. These factors together created a metamorphosis in the functioning of the institution, breaking through hierarchical barriers in academia. Conclusion: The disruption in graduate nursing education due to the pandemic led to opportunities, including swift faculty innovation, a collaborative spirit between faculty and students, and new appreciation for connections with faculty and fellow students. Continuing intentional implementation of these opportunities would benefit students' experiences moving forward.

Graduate nursing student stressors during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic profoundly impacted graduate nursing students at work, home, and school. Stress can influence the ability to focus, study, and may delay continuation in graduate school. PURPOSE: The purpose of this study was to identify the stressors of graduate nursing students during the pandemic. METHOD: A prospective, descriptive, online survey design was used to identify graduate nursing student stressors during the pandemic at one educational institution in the United States. Questions related to employment, COVID-19 exposure, institutional support, future graduate plans were summarized for the total sample and stratified by program (MS, DNP, PhD). Changes in a total stress score were evaluated pre and post onset of the COVID-19 pandemic. RESULTS: A total of 222 graduate nursing students completed the survey. The vast majority of students were employed before the pandemic and a significant decrease in employment occurred during the pandemic (97.3% to 90.1%, p < .001). Overall stress increased (p < .001). The increased total stress was associated with students participating in clinical rotations (q = 0.024) and having a change in work hours (q = 0.022). CONCLUSIONS: Nursing schools need to address graduate student concerns during the pandemic, including having clear communication platforms and offering support services.

A Survey of Mental Health in Graduate Nursing Students during the COVID-19 Pandemic.

BACKGROUND: Elevated levels of stress, anxiety, and depression are common symptoms in graduate students pursuing a degree in the health care professions. The onset of the COVID-19 pandemic likely complicated these existing issues. PURPOSE: To confirm this hypothesis, researchers created a survey to examine the experiences of graduate nursing students during COVID-19. METHODS: Graduate nursing students (n = 222) completed the survey, which included 2 instruments: the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Events Scale (IES-R). RESULTS: Nearly 25% of students expressed moderate to extremely severe levels of negative emotional states on the DASS-21, and 23.8% of students scored within the area of clinical concern for the presence of posttraumatic stress disorder on the IES-R. CONCLUSIONS: Understanding levels of mental health and associated factors that may contribute to changes can assist administration, faculty, and staff in targeting resources and interventions to support graduate nursing students to continue their education.

Inconsistency in Faculty and Student Perceptions of DNP and PhD Leader Scholarly Activity.

OBJECTIVE: We aimed to quantify faculty and student perceptions of scholarly activities for doctor of nursing practice (DNP) and PhD leaders. BACKGROUND: The American Association of Colleges of Nursing describes DNP as a practice-focused degree and PhD as a research-focused degree. In 2016, the Council on Graduate Education for Administration in Nursing (now Association for Leadership Science in Nursing) published in the Journal of Nursing Administration sample practice objectives for DNP and research objectives for PhD leaders. METHODS: Using the published objectives, we surveyed faculty and students to quantify congruence with the publication and consistency within groups. The data informed intraprofessional education constructed using action research. RESULTS: There was low congruence between faculty and student responses with the article. PhD faculty had the least, and PhD students, the greatest, consistency in survey responses. CONCLUSIONS: Confusion exists within our faculty and students around differentiating PhD and DNP scholarly activities. Data supported need to clarify scholarly role boundaries through intraprofessional education.

Constructing Doctoral Leadership Scholarly Role Boundaries Through Intraprofessional Nursing Education.

We conducted an intraprofessional education pilot in which students created DNP/PhD leadership parameters through naturalistic classroom experience. Agile, participatory, action research methodology framed a project spanning 3 semesters. Students' multiple ways of knowing influenced a dynamic cycle of noticing, interpreting, acting, and reflecting. Faculty revised course content "in the moment" to meet unique student needs. Researchers analyzed data using qualitative, interpretive descriptive approach. Four key themes interpreted from intraprofessional education included (1) persistent evolutionary progression toward doctoral collaboration, (2) accelerating uptake of research- into-practice continuum, (3) intentional convergent/divergent curriculum, and (4) mutuality of leadership parameters.

Turning Health Systems Data Into Actionable Information.

Health systems produce vast amounts of complex, multidimensional data. Health systems nurse leaders, informaticians, and nurse researchers must partner to turn these data into actionable information to drive quality clinical outcomes. The authors review health systems in the era of big data, identify opportunities for health systems-nursing research partnerships, and introduce emerging approaches to data science education in nursing.

The Nursing Value Model: A Structured Approach to Measuring Nursing Care.

Value is defined as outcomes/cost of care [1]. Although nurses contribute significantly within the interdisciplinary care team, we struggle to measure the value of nursing care or the added value of each nurse caring for a patient. This presentation reveals findings of the Nursing Value Workgroup (Workgroup), a multi-year component of the Big Data and Nursing Knowledge Initiative [2]. Panelists will discuss: Construction of a common model to provide a basis for developing nursing business intelligence and analytics; development and publication of definitions and metrics for nursing value; creation of user stories to measure nurse sensitive phenomena; and establishment of a data warehouse to facilitate research. Initial findings from a multi-hospital study on pain management and value of care will be presented.

Flame retardant exposures in California early childhood education environments.

Infants and young children spend as much as 50h per week in child care and preschool. Although approximately 13 million children, or 65% of all U.S. children, spend some time each day in early childhood education (ECE) facilities, little information is available about environmental exposures in these environments. We measured flame retardants in air and dust collected from 40 California ECE facilities between May 2010 and May 2011. Low levels of six polybrominated diphenyl ether (PBDE) congeners and four non-PBDE flame retardants were present in air, including two constituents of Firemaster 550 and two tris phosphate compounds [tris (2-chloroethyl) phosphate (TCEP) and tris (1,3-dichloroisopropyl) phosphate (TDCIPP)]. Tris phosphate, Firemaster 550 and PBDE compounds were detected in 100% of the dust samples. BDE47, BDE99, and BDE209 comprised the majority of the PBDE mass measured in dust. The median concentrations of TCEP (319 ng g(-1)) and TDCIPP (2265 ng g(-1)) were similar to or higher than any PBDE congener. Levels of TCEP and TDCIPP in dust were significantly higher in facilities with napping equipment made out of foam (Mann-Whitney p-values<0.05). Child BDE99 dose estimates exceeded the RfD in one facility for children<3 years old. In 51% of facilities, TDCIPP dose estimates for children<6 years old exceeded age-specific "No Significant Risk Levels (NSRLs)" based on California Proposition 65 guidelines for carcinogens. Given the overriding interest in providing safe and healthy environments for young children, additional research is needed to identify strategies to reduce indoor sources of flame retardant chemicals.

Measuring direct nursing cost per patient in the acute care setting.

OBJECTIVE: The objective of the study was to measure the variability of direct nursing cost for similar patients and to examine the characteristics of nurses assigned to different types of patients. BACKGROUND: There is no standard method for measuring direct nursing cost by patient. METHODS: Deidentified data were collected from 3 databases for patients admitted from January 2010 through December 2012 on 1 medical/surgical unit in a large Magnet hospital. Direct nursing care time and costs were calculated from the nurse-patient assignment. RESULTS: Variability in nursing intensity (0.36-13 hours) and cost per patient day ($132-$1,455) was significant for similar patients. Higher cost nurses were not assigned sicker patients (F3, 3029 = 87.09, P < .001, R = 0.124). Mean (SD) nursing direct cost per day was $96.48 ($55.73). CONCLUSIONS: Standard measurement of nursing cost per patient could be benchmarked across hospitals and inform nursing administration care delivery decisions.

Resuscitation review to improve nursing performance during cardiac arrest.

The purpose of this study was to evaluate the effect of Resuscitation Review Simulation Education (RRSE) on improving adherence to hospital protocols and American Heart Association (AHA) resuscitation standards. Prior to implementing the RRSE on two nursing units, performance was evaluated during a simulated cardiac arrest using a mannequin and comparing performance against AHA algorithms. Performance was measured at two separate periods: preintervention and 3 months after the intervention. Both units improved overall scores after the RRSE.