Academic nursing leadership: Lessons learned during a pandemic: A qualitative research study.

BACKGROUND: In the wake of the pandemic and faculty shortage, strong academic nurse leaders (ANL) are needed to ensure quality education and professional standards are upheld while preparing future nurses. OBJECTIVES: This team explored experiences and perspectives of ANLs during the pandemic in order to better understand the difficulties they faced, their triumphs and failures, and lessons learned. DESIGN, SETTING AND PARTICIPANTS: This descriptive-exploratory qualitative study captured leadership experiences of 11 academic leaders from a large, urban, Midwestern college of nursing. METHODS: Three focus group sessions were conducted virtually using a structured question guide and content analysis of transcripts. RESULTS: Three themes emerged from analysis: Technology, Time and Change, and Well-being. Content analysis also revealed leadership strategies and "pearls of wisdom" offered by participants. CONCLUSIONS: ANLs faced many challenges during the pandemic that required them to remain steady and present, while practicing regular and effective communication to foster strong relationships. As higher education and healthcare environments develop more complexity and remain constantly changing, leaders must be strategic, emotionally intelligent, and innovative in their roles.

Nurses' Experiences Implementing e PED : An iPad Application to Guide Quality Discharge Teaching.

Quality discharge teaching prepares patients and families to transition safely from hospital to home. Technology can enhance and support quality discharge teaching by promoting patient family engagement during the transition. The purpose of this mixed methods study was to explore clinical nurses' experience with using Engaging Parents in Education for Discharge, an iPad application to guide quality discharge teaching. Twelve nurses at a large Midwestern Children's Hospital participated in small focus groups after use of the Engaging Parents in Education for Discharge application and completed a questionnaire on their perception of the acceptability and feasibility of the app. Findings revealed three themes: (1) development and deployment issues focused on the importance of training and support by the study team during implementation; (2) workflow integration centered on the importance of incorporating use of the app into current workflows and to preserve effective communication strategies with parents to optimize use in the healthcare setting; and (3) nurses perceived value in the use of the Engaging Parents in Education for Discharge app for beneficial scripting, questions on discharge topics often forgotten, and guidance for complex patients. Results of this study offer insight into key components for consideration when implementing and integrating technology to aid nursing practice.

Implementing Pediatric Transition Education Initiative During Inpatient Admissions in the Epilepsy Monitoring Unit.

BACKGROUND: Adolescents with epilepsy are a population with unique needs when addressing transition to adult care. Scheduled, non-emergent admissions to the Epilepsy Monitoring Unit (EMU) have not yet been utilized to improve transition education. METHODS: The overarching goal of this evidence-based practice project was to explore opportunities to enhance the transition education patients and families receive in the clinic setting by leveraging scheduled inpatient admissions for EEG monitoring to provide structured transition education. Twenty-one Neurology Clinic providers were surveyed about their perspectives on the transition process. Thirty-five adolescent patients (12-20 years old) received a pre-test regarding their condition, health maintenance and disease management, and a subsequent post-test measuring knowledge retention after education with a provider. Documentation in the electronic health record (EHR) using an institution created transition flowsheet and a standardized template was used to communicate through the EHR with the primary neurology team. FINDINGS: The effectiveness of the intervention was supported as 100% of patients demonstrated increased knowledge after transition education. Providers' knowledge and support of transition efforts increased regarding tools and guidelines for transition of adolescents to adult care. DISCUSSION: These results support the feasibility of providing transition education in the EMU with shared responsibility between inpatient and ambulatory providers. IMPLICATIONS FOR PRACTICE: Improved use of the transition flowsheet in the EMU and by ambulatory setting providers will enhance the process of transition. Discussion of self-management with adolescent patients during all phases of health care will encourage independence and promote successful transition to adult health care.

Engaging Parents in Education for Discharge (ePED): Evaluating the Reach, Adoption & Implementation of an Innovative Discharge Teaching Method.

PURPOSE: This paper describes the evaluation of the implementation of an innovative teaching method, the "Engaging Parents in Education for Discharge" (ePED) iPad application (app), at a pediatric hospital. DESIGN AND METHODS: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation. Three of the five RE-AIM elements are addressed in this study: Reach, Adoption, and Implementation. RESULTS: The Reach of the ePED was 245 of 1015 (24.2%) patient discharges. The Adoption rate was 211 of 245 (86%) patients discharged in the five months' study period. High levels of fidelity (89.3%) to Implementation of the ePED were attained: the Signs and Symptoms domain had the highest (93%) and Thinking Forward about Family Adjustment screen had the lowest fidelity (83.3%). Nurse themes explained implementation fidelity: "It takes longer", and "Forgot to do it." CONCLUSIONS: The ePED app operationalized how to have an engaging structured discharge conversation with parents. While the Reach of the ePED app was low under the study conditions, the adoption rate was positive. Nurses were able to integrate a theory-driven practice change into their daily routine when using the ePED app. IMPLICATIONS FOR PRACTICE: The rates of adoption and implementation fidelity support the feasibility of future hospital wide implementation to improve patient and family healthcare experience. Attention to training of new content and the interactive conversation approach will be needed to fully leverage the value of the ePED app. Future studies are needed to evaluate the maintenance of the ePED app.

Using the Engaging Parents in Education for Discharge (ePED) iPad Application to Improve Parent Discharge Experience.

PURPOSE: The purpose of this study was to evaluate the use of the Engaging Parents in Education for Discharge (ePED) iPad application on parent experiences of hospital discharge teaching and care coordination. Hypotheses were: parents exposed to discharge teaching using ePED will have 1) higher quality of discharge teaching and 2) better care coordination than parents exposed to usual discharge teaching. The secondary purpose examined group differences in the discharge teaching, care coordination, and 30-day readmissions for parents of children with and without a chronic condition. DESIGN/METHODS: Using a quasi-experimental design, ePED was implemented on one inpatient unit (n = 211) and comparison group (n = 184) from a separate unit at a pediatric academic medical center. Patient experience outcome measures collected on day of discharge included Quality of Discharge Teaching Scale-Delivery (QDTS-D) and care coordination measured by Care Transition Measure (CTM). Thirty-day readmission was abstracted from records. RESULTS: Parents taught using ePED reported higher QDTS-D scores than parents without ePED (p = .002). No differences in CTM were found between groups. Correlations between QDTS-D and CTM were small for ePED (r = 0.14, p 0.03) and non-ePED (r = 0.29, p < .001) parent groups. CTM was weakly associated with 30-day readmissions in the ePED group. CONCLUSION: The use of ePED by the discharging nurse enhances parent-reported quality of discharge teaching. PRACTICE IMPLICATIONS: The ePED app is a theory-based structured conversation guide to engage parents in discharge preparation. Nursing implementation of ePED contributes to optimizing the patient/family healthcare experience.

Facilitating Cultural Humility and Attunement for Nursing and Health Professions Students Through a Study Abroad Program in Kenya.

AIM: This qualitative descriptive study aimed to evaluate the role of a short-term interprofessional study abroad program in Kenya on beginning awareness of cultural humility. BACKGROUND: Students in the health care professions, including nursing, must learn to work effectively with diverse patient populations and provide culturally safe care. METHOD: Course assignments of 21 students were thematically analyzed to discover how students applied concepts of cultural attunement to learn cultural humility while interacting with people in rural and urban Kenya. RESULTS: Student narrations acknowledged all aspects of cultural attunement during the experience: the pain of oppression; acted with reverence; reported coming from a place of not knowing; engaged in acts of humility; engaged in mutuality; and reported attaining harmony, cooperation, and accord. CONCLUSION: Findings suggest a short-term community-focused study abroad experience can be a valuable tool for beginning stages of becoming culturally humble and providing culturally safe health care.

The Influence of a Developmental Disability on the Child's Weight-Related Behaviors: A Parent's Perspective.

PURPOSE: To examine the parent's perspective on how the child's diagnosis of a developmental disability, the weight-management support of the healthcare provider and parental self-care and role modeling influenced the child's weight-related behavior, (i.e. nutrition, physical and sedentary activity). DESIGN AND METHODS: This qualitative study, guided by Bronfenbrenner's Ecological System's Theory, used a one-on-one semi-structured telephone interview conducted with 15 parents of children 5-16 years of age with spina bifida or Down syndrome. Interviews were professionally transcribed and thematically analyzed. In addition, parents reported height and weight for themselves and their child. RESULTS: Three overarching themes within the context of how the child's diagnosis influenced the child's weight-related behaviors emerged: 1) Developmental Characteristics or Condition-Related Factors captured qualities of the child's condition and interactions with the healthcare system; 2) Social Consequences encompassed the influence of the diagnosis on relationships of the child and family members; and 3) Parenting Influences and Practices captured three types of responses including parent perceptions of the diagnosis, parenting behaviors, and parental self-care behaviors, each influencing the child's weight-related behaviors. CONCLUSIONS: Parents illuminated the social and medical challenges that the family encountered due to the child's diagnosis. These challenges directly and indirectly influenced the child's physical and sedentary activity and nutritional intake. Although challenges were present, the strength and determined attitudes of the families became apparent. PRACTICE IMPLICATIONS: The promotion of self-care and examination and validation of the emotional aspects of parenting a child with a disability may positively influence the child's weight-related behaviors.

The Teach Back Project: A System-wide Evidence Based Practice Implementation.

PURPOSE: Teach-back is an evidence-based strategy identified as a cornerstone intervention for improving communication during healthcare encounters. Evidence supports the use of teach back with patients and families to improve understanding of discharge instructions and supporting self-management. There is significant evidence that staff do not routinely use teach-back while communicating with patients and families. DESIGN AND METHODS: This evidence-based practice project examined the impact of a brief educational intervention for a multidisciplinary staff on knowledge of health literacy and the use of teach-back during patient-education. Clinical staff working at a 290 bed Magnet® designated Midwest pediatric healthcare organization attended a 45-60 min, standardized, instructor led interactive teaching session about the impact of low health literacy, the use of open ended questions and how to use teach-back with patients and families. Pre and post education surveys, and a one-year sustainability survey were administered. RESULTS: Over 300 multidisciplinary team members (including acute care, emergency room, and surgical nurses, dieticians, respiratory care practitioners and occupational and physical therapists) participated in the education and surveys. Both nurses and non-nurses demonstrated increased knowledge of the teach-back process and reported high rates of clarifying information and correcting misunderstandings when using teach back with patients and families. Qualitative data revealed clarifications are often about medications and skill-based treatments. CONCLUSIONS AND PRACTICE IMPLICATIONS: Teach-back is a valuable strategy that can improve the safety and quality of health care and supports the National Action Plan to Improve Health Literacy.

Development of a Self-Management Theory-Guided Discharge Intervention for Parents of Hospitalized Children.

BACKGROUND: Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self-management of their child's care at home after discharge. PROBLEM: No theory-based discharge intervention exists to guide pediatric nurses' preparation of parents for discharge. PURPOSE: To develop a theory-based conversation guide to optimize nurses' preparation of parents for discharge and self-management of their child at home following hospitalization. METHODS: Two frameworks and one method influenced the development of the intervention: the Individual and Family Self-Management Theory, Tanner's Model of Clinical Judgment, and the Teach-Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine-domain conversation guide for use in acute care pediatric hospitals. CONCLUSIONS: The theory-based intervention operationalized self-management concepts, added components of nursing clinical judgment, and integrated the Teach-Back method. CLINICAL RELEVANCE: Development of a theory-based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention.

Discharge Teaching, Readiness for Discharge, and Post-discharge Outcomes in Parents of Hospitalized Children.

PURPOSE: This study explored the sequential relationships of parent perceptions of the quality of their discharge teaching and nurse and parent perceptions of discharge readiness to post-discharge outcomes (parental post-discharge coping difficulty, readmission and emergency department visits). DESIGN/METHODS: In this secondary analysis of data from a longitudinal pilot study of family self-management discharge preparation, the correlational design used regression modeling with data from a convenience sample of 194 parents from two clinical units at a Midwest pediatric hospital. Data were collected on the day of discharge (Quality of Discharge Teaching Scale; Readiness for Hospital Discharge Scale), at 3weeks post-discharge (Post-Discharge Coping Difficulty Scale), and from electronic records (readmission, ED visits). RESULTS: Parent-reported quality of discharge teaching delivery (the way nurses teach), but not the amount of content, was positively associated with parent perception (B=0.54) and nurse assessment (B=0.16) of discharge readiness. Parent-reported discharge readiness was negatively associated with post-discharge coping difficulty (B=-0.52). Nurse assessment of discharge readiness was negatively associated with readmission; a one point increase in readiness (on a 10 point scale) decreased the likelihood of readmission by 52%. CONCLUSION: There is a sequential effect of quality of discharge teaching delivery on parent discharge readiness, which is associated with parent coping difficulty and child readmission. PRACTICE IMPLICATIONS: Efforts to improve discharge outcomes should include strategies to build nurse teaching skills for high-quality delivery of discharge teaching. In addition, routine nurse assessment of discharge readiness can be used to identify children at risk for readmission and trigger anticipatory interventions.

Lessons Learned: Newly Hired Nurses' Perspectives on Transition Into Practice.

This descriptive qualitative study explored data from debriefs of all newly hired nurses at 3, 6, and 12 months posthire during a newly designed transition-to-practice program at a pediatric hospital. Four major themes emerged: preceptors, education process, adaptation to the organization, and role transition. Supportive factors included staged orientation, limited preceptors, mentors, regular communication with leaders, and a culture of teamwork. Stressors included too many preceptors, mentorship needs, floating, communication challenges, and organizational changes.

Transition of Experienced and New Graduate Nurses to a Pediatric Hospital.

This study reports on the 3-, 6-, 12-, and 18-month outcomes of 118 newly hired registered nurses (RNs) who completed a 12-month transition-to-practice program at a pediatric hospital. Experienced RNs (n = 42) and new graduate RNs (n = 76) showed improved organization, prioritization, communication, and leadership skills over time. The experienced RNs reported better communication and leadership skills than the new graduate nurses. Results inform transition program development for both new and experienced nurses.

Using "teach-back" to promote a safe transition from hospital to home: an evidence-based approach to improving the discharge process.

The "teach-back" process is a comprehensive, interdisciplinary, evidence-based strategy which can empower nursing staff to verify understanding, correct inaccurate information, and reinforce medication teaching and new home care skills with patients and families. The Evidence-Based Practice Fellows at Children's Hospital of Wisconsin designed and implemented an educational intervention for nurses on "teach-back" which encouraged nurses to check for patients' and caregivers' understanding of discharge instructions prior to discharge. Pre and post survey data collected from nurses specifically demonstrated the positive effect "teach-back" could have on preventing medication errors while also simultaneously identifying areas for further study.

How to select the correct education strategy: when not to go online.

Screening for intimate partner violence is an important injury prevention strategy. Nurses who develop staff education, to promote screening, need to select a method that is sensitive to learners. Online learning, although convenient, is not well suited to sensitive topics such as screening for intimate partner violence. The purpose of this article is to describe a curriculum for intimate partner violence screening based on self-efficacy theory, which includes a hospital-produced video, a role play, and a discussion.

Evaluation of an intimate partner violence curriculum in a pediatric hospital.

OBJECTIVE: Intimate partner violence harms victims as well as families and communities. Many barriers account for limited intimate partner violence screening by nurses. The purpose of this study was to measure how participation in a curriculum about screening parents for intimate partner violence, at a pediatric hospital, affects a nurse's knowledge, attitudes, behaviors, and self-efficacy for intimate partner violence screening. METHODS: In this interventional, longitudinal study, data were collected before participation in an intimate partner violence screening curriculum, after participation, and 3 months later. The measurement tool was adapted from Maiuro's (2000) Self-efficacy for Screening for Intimate Partner Violence Questionnaire. RESULTS: Sixty-eight pediatric nurses completed all aspects of the study. At baseline, 18 (27%) nurses self-reported seeing a parent with an injury, and of those only 7 (39%) followed up with intimate partner violence screening. Factor analysis was performed on the baseline Self-efficacy for Screening for Intimate Partner Violence Questionnaire by using varimax rotation. Five factors were identified: conflict, fear of offending parent, self-confidence, appropriateness, and attitude. Only fear of offending parent was significantly different from times 1 to 3, indicating that nurses were less fearful after the training. Cronbach's alpha value for the total questionnaire at baseline was .85. Nurses reported significant improvement (baseline to 3-month follow-up) in several self-efficacy items. CONCLUSIONS: Participation in a 30-minute curriculum on intimate partner violence screening was associated with improvements in self-efficacy and significantly lower fear of offending parents 3 months after training. Nurses also showed improvement in the perception of resources available for nurses to manage intimate partner violence. Thirty-minute hospital-based curriculums that include victim testimonial video and practice role-playing to simulate parent interactions are recommended.