Health Care Worker Perceptions of Gaps and Opportunities to Improve Hospital-to-Hospice Transitions.

Background: Care transitions from the hospital to hospice are a difficult time, and gaps during this transitions could cause poor care experiences and outcomes. However, little is known about what gaps exist in the hospital-to-hospice transition. Objectives: To understand the process of hospital-to-hospice transition and identify common gaps in the transition that result in unsafe or poor patient and family caregiver experiences. Design: We conducted a qualitative descriptive study using semistructured interviews with health care workers who are directly involved in hospital-to-hospice transitions. Participants were asked to describe the common practice of discharging patients to hospice or admitting patients from a hospital, and share their observations about hospital-to-hospice transition gaps. Setting/Subjects: Fifteen health care workers from three hospitals and three hospice programs in Portland, Oregon. Measurements: All interviews were audio recorded and analyzed using qualitative descriptive methods to describe current practices and identify gaps in hospital-to-hospice transitions. Results: Three areas of gaps in hospital-to-hospice transitions were identified: (1) low literacy about hospice care; (2) changes in medications; and (3) hand-off information related to daily care. Specific concerns included hospital providers giving inaccurate descriptions of hospice; discharge orders not including comfort medications for the transition and inadequate prescriptions to manage medications at home; and lack of information about daily care hindering smooth transition and continuity of care. Conclusion: Our findings identify gaps and suggest opportunities to improve hospital-to-hospice transitions that will serve as the basis for future interventions to design safe and high-quality hospital-to-hospice care transitions.

Survey Development: Caregivers Help Define a Tool to Measure Cultures of Care.

OBJECTIVE: The aim of this study was to develop an instrument that measures all healthcare staff's perceptions of a culture of caring. BACKGROUND: Healthcare organizations have increased their focus on cultures of caring within their staff to improve staff satisfaction and patient satisfaction. Nurses and physicians traditionally have been the focus in understanding caring cultures excluding non-direct care staff who do impact organizational culture. METHODS: An exploratory and partial confirmatory factor analysis was completed on 2 instruments that measure the perception of a caring culture in both direct care and non-direct care staff. RESULTS: Results demonstrate that both the direct and non-direct care instruments are valid and reliable measures for assessing a caring culture. CONCLUSIONS: The new 14-item clinical and new 10-item nonclinical staff caring assessment instruments will provide healthcare and nursing leaders with the ability to assess their culture through a direct and non-direct care perspective.

Improving End-of-Life Communications Using Technology-Assisted Continuing Education With Interprofessional Teams.

Registered nurses and social workers may have little experience engaging in end-of-life discussions. Technology-assisted continuing education (TACE) improves interprofessionals' capability and comfort with these difficult discussions. This study measured the impact of TACE on improving the capability and comfort of caregivers with end-of-life communication. Comfort and capability scores increased postintervention. This was the first dual site two-discipline pilot study to explore this TACE methodology.

Pediatric Delirium: Early Identification of Barriers to Optimize Success of Screening and Prevention.

INTRODUCTION: Pediatric delirium has a 25% prevalence rate in the pediatric intensive care unit. The purpose of this project was to evaluate the impact/effect of implementing nonpharmacologic nursing bundles on the incidence of pediatric delirium. It is not yet known whether or not bundles consistently reduce the incidence of delirium. METHOD: A nonpharmacologic nursing bundle was implemented for pediatric intensive care unit patients, 2 to 18years of age, admitted to an Arizona metropolitan children's hospital. Data were collected using the Cornell Assessment of Pediatric Delirium (CAP-D) screening tool. RESULTS: Control group scores and post-bundle CAP-D scores (mean = 5.57, standard deviation = 5.78 and mean = 7.10, standard deviation = 5.61, respectively) did not differ among the participants. Control participants required an intervention 26.7% of the time for delirium compared with 31.6% in the post-bundle population. No statistical significance was seen between the control group and the post-bundle CAP-D scores t(59) = 7.46; t(205) = 18.17 (p = .08, Fisher exact test). DISCUSSION: The use of nonpharmacologic bundles for delirium prevention have shown some promising results in helping with delirium reduction. Whether they consistently reduce the incidence has yet to be fully proven. This project shows that significant barriers exist when implementing them in a complex pediatric intensive care environment.

Embedding a Professional Practice Model Across a System.

Professional practice models (PPMs) are an integral part of any organization on the Magnet® journey, whether initial designation or redesignation. Through the journey, the PPM should become embedded within the nursing culture. Leadership at multiple levels is crucial to ensure successful adoption and implementation.

Take charge and change our healthcare system.

It is often said that no two days in nursing are the same. This means staff nurses and nurse managers understand how to work with unknowns. Nurses often make the best of any situation, calmly delivering measured care while advocating for what they know to be the best for their patients and staff.

Searching for the Holy Grail of Care Delivery Models.

Too often health care executives state the need for more research, knowledge, and information in staffing. Perhaps what we really need is education and support for innovation in operations. In looking for the holy grail of staffing solutions, focused attention will need to be placed on creating innovative care delivery models. Leaders who are tasked with developing innovative care delivery models must have a supportive environment and given time to be successful.

Strategies for Pursuing a Master's Degree.

Health care has become very complex and is in a constant state of change. As a result of the evolving change and increasing complexity, a more educated nursing workforce is needed (Dracup K. Master's nursing programs. American Association of Colleges of Nursing. 2015; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2010). It is now becoming necessary for registered nurses to earn an advanced degree to work at the highest level of their practice authority (Dracup K. Master's nursing programs. American Association of Colleges of Nursing. 2015; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2010.). Preparing to reenter college may be an overwhelming prospect for some registered nurses seeking an advanced degree. However, there are some simple strategies that may help sort out the many degree options, financial obligations, decisions about brick and mortar versus online learning, commitment to degree completion, and changing career paths. This article will provide the registered nurse valuable information that will assist in the exciting process of returning to college.

High Reliability and Excellence in Staffing.

Nurse staffing is a complex issue, with many facets and no one right answer. High-reliability organizations (HROs) strive and succeed in achieving a high degree of safety or reliability despite operating in hazardous conditions. HROs have systems in place that make them extremely consistent in accomplishing their goals and avoiding potential errors. However, the inability to resolve quality issues may very well be related to the lack of adoption of high-reliability principles throughout our organizations.

Why Nurse Staffing Matters: A Moral Imperative.

Safe nurse staffing is undeniably linked to patient safety and satisfaction, workforce satisfaction and safety, and cost savings. A nationwide mandate must be driven toward the use of electronic staffing and scheduling systems that take into consideration the patient's real-time specific needs This system must be matched to the most appropriate nurse with the ability to provide care safely for all the patients in his or her total assignments. These patient care assignments should be designed in partnership with managers and staff RNs. Only then will we reverse the trend of staffing-related patient deaths and injury in U.S. hospitals.

Reducing Length of Labor and Cesarean Surgery Rate Using a Peanut Ball for Women Laboring With an Epidural.

One strategy for reducing the primary cesarean surgery rate and length of labor is using a peanut-shaped exercise ball for women laboring under epidural analgesia. A randomized, controlled study was conducted to determine whether use of a "peanut ball" decreased length of labor and increased the rate of vaginal birth. Women who used the peanut ball (n = 107) versus those who did not (n = 91) demonstrated shorter first stage labor by 29 min (p = .053) and second stage labor by 11 min (p < .001). The intervention was associated with a significantly lower incidence of cesarean surgery (OR = 0.41, p = .04). The peanut ball is potentially a successful nursing intervention to help progress labor and support vaginal birth for women laboring under epidural analgesia.

Nursing's role and staffing in accountable care.

Nurse staffing in a world of health care reform and accountable care is uncertain and creates fear not only for the nurse leaders, but all RNs. As health care reform transforms the environment, so must the role and staffing of nurses. There is still not one right answer or agreed upon manner to nurse staffing of inpatient units. This leaves nurses free to imagine roles and staffing possibilities for the future across the continuum. Including all RNs in conversations, visioning, and problem solving for the future will best prepare the profession for our role in caring for our patients.

Development of a professional nursing framework: the journey toward nursing excellence.

To achieve Magnet recognition designation, an organization must demonstrate a framework for nursing practice. However, successfully incorporating and sustaining frameworks and theories into practice are not easy undertakings. The authors describe how leaders and staff in a healthcare system created and implemented a conceptual framework for nursing practice to guide nursing practice for the system.

Understanding research and evidence-based practice: from knowledge generation to translation.

Health care today requires an evidence-based environment where nurses deliver increasingly safer, higher-quality care. To obtain this environment, nurses must use the best evidence in their practice. As the largest deliverer of health care in the United States, nurses are vital in the participation of improving safety and quality care. Through research and evidence-based practice, all nurses can be leaders in promoting quality and safe care.

The Essentials of Magnetism for home health.

OBJECTIVE: The purpose of this study was to determine what home health nurses perceived to be the Essentials of Magnetism in the home healthcare setting. BACKGROUND: Research in the acute care setting has established relationships between organizational attributes, nurse satisfaction, and quality outcomes. However, little is known in the home health setting on the importance and the impact of these relationships. More research is needed to further understand the implications to home healthcare. METHODS: Registered nurses (N = 260) were asked to identify the top 10 attributes from the 37-item Dimensions of Magnetism instrument developed by Kramer and Schmalenberg. The top 10 Essentials of Magnetism attributes were obtained by tabulation of the number of respondents to each question. RESULTS: The results showed that 7 of the top 8 Essentials of Magnetism items chosen by the home health nurses (n = 106) were the same Essentials of Magnetism items chosen by acute care nurses in previous studies. A test-retest of the top 10 items revealed a high level of reliability (.77). CONCLUSION: Although the results demonstrate similar attributes as those identified in the acute care setting, noted differences need further review to understand their role in registered nurse satisfaction and quality.