De-Escalation Training to Medical-Surgical Nurses in the Acute Care Setting.

Violence is increasing on medical-surgical units as a "silent epidemic." This quality improvement project employs a small non-experimental, single-group, pre- and post-test design (N = 11) to determine the effectiveness of de-escalation training on medical-surgical nurses' confidence levels when dealing with agitated patients. Regardless of age, education, or years of experience, scores improved for each question on Thackrey's (1987) Confidence in Coping with Patient Aggression Instrument after implementing Ten Domains of De-escalation by Richmond et al. (2012). A paired-sample two-tailed t-test significantly increased from Time 1 pre-test (M = 49.82, SD = 10.11) to Time 2 post-test (M = 72.82, SD = 14.41), t(10) = 4.46, p <.001. The mean increase was 23.00 [95% CI, 11.51-34.49]; d = 1.84 indicating a large effect size (Pilot, 2010). A sensitivity analysis (Wilcoxon Signed Rank Test) showed a median difference among the matched pairs with a significant increase in confidence levels post-training, z = -2.847, p <.004. The median score increased from the pre-test (Md = 51) to the post-test scores (Md = 71) (Pallant, 2013).

Assessment of a Chronic Disease Self-Management Program to Increase Physical Activity of Adults With Severe Mental Illness.

Individuals with severe mental illness (SMI) experience excessive co-morbidities and early mortality. Self-management programs have the potential to increase physical activity levels of individuals with SMI and reduce the incidence of co-morbidities. The purpose of this quality improvement project was to assess a chronic disease self-management program (CDSMP) to increase physical activity of adults with SMI measured by daily steps tracked with a pedometer. Results of data analysis indicated no statistically significant difference in steps across the six-week program. However, findings suggested that individuals with SMI are capable of using a pedometer and tracking steps on a daily basis.

Leading Healthcare Change Across the Care Continuum: An Interview With Dr Kenneth Rempher.

Kenneth Rempher, PhD, MBA, CENP, RN, is the chief nursing officer for the University of Iowa (UI) Hospitals and Clinics. In his 20-year career, he has distinguished himself as a visionary healthcare leader. Colleagues describe Dr Rempher as a strong, transformational leader, guiding the UI enterprise through a time of uncertainty and change. This interview by the CGEAN provides insight to his leadership style, successes, and ideas on the future of care delivery.

Nursing Administration Research Priorities: Findings From a Delphi Study.

OBJECTIVE: The aim of this study is to determine the priorities for nursing administration research (NAR) in the United States. BACKGROUND: Previously known as the Council of Graduate Educators in Administrative Nursing, CGEAN provides an avenue for researchers and educators focused on NAR to partner, dialogue, obtain funding resources, and present their findings at a biennial International Nursing Administration Research Conference (INARC). In late 2013, with a goal of building consensus, CGEAN convened an INARC postconference to initiate the process of establishing critical NAR priorities for the future. METHODS: Data from a 3-staged Delphi study were used to identify relevant research topics and determine administrative research priorities. RESULTS: Eight final categories of NAR were determined. CONCLUSIONS: This study found economic valuing of nursing and designing effective future healthcare delivery systems to be high priorities for NAR.

Application of CGEAN's Research Priorities: PhD, DNP Scholarship.

The Accountable Care Act of 2010 is stimulating rapid transformations of healthcare systems. The shift from a focus on providing healthcare in a closed system to improving the health of communities demands rapid innovation by nurse leaders. Nurse leaders prepared at the doctorate of nursing practice level and PhD-prepared nursing health services researchers are needed to develop and evaluate best practices as they emerge. This column expands on the findings from CGEAN's Delphi study.

Establishing the Content Validity of an Early Extubation Protocol: A Quality Improvement Project for Improving Early Extubation of Coronary Artery Bypass Graft Patients.

Introduction: Patients undergoing coronary artery bypass graft surgery will require intubation and the use of mechanical ventilation during and after surgery. It is well accepted that early extubation is associated with not only positive patient outcomes but also organizational outcomes as well. Patients who are not extubated early are at risk for complications associated with prolonged intubation. The literature supports the use of protocol aid with early extubation. The goal and expected outcome of this project is to establish the usability of an early extubation protocol by assessing its appropriateness for use in the postoperative cardiac surgical adult patient. Methods: For the purpose of establishing content validity of an early extubation protocol, 2 protocols were chosen from the literature. Fifteen cardiac surgery experts were invited to select the protocol they felt was most appropriate for use in this patient population. These reviewers were then asked to further analyze the protocol based on a 5-question survey. Their response was used to calculate a scale-content validity index (S-CVI) and an item-content validity index (I-CVI). Results: Twelve of 15 experts participated in the project. The content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI) and (b) S-CVI. The means were established for each item. Content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI: 0.75-1.00); and the S-CVI/average = 0.92. Cronbach's alpha was estimated to establish reliability (0.972). Conclusion: Selecting an appropriate protocol to be used in this patient population is the first step in implementing an effective early extubation process. The results highly suggest that the content of this protocol is quite relevant in this patient population. It is hoped that this will set the stage for early extubation in postoperative cardiac surgery patients.

Nursing Education: A Solution to Healthcare's Gordian Knot?

The Patient Protection and Affordable Care Act is dramatically increasing the complexity of the healthcare industry. In order to respond to the call for increased access and improved quality at lower costs, healthcare executives need new competencies to develop innovative solutions to complex problems. This column identifies and compares a few of the new nursing leadership competencies needed to current academic curricula.

Nursing administration research: an evolving science.

The nature and focus of nursing administrative research have evolved over time. Recently, the research agenda has primarily reflected the national health policy agenda. Although nursing research has traditionally been dominated by clinical interests, nursing administrative research has historically addressed the interface of reimbursement, quality, and care delivery systems. This article traces the evolution of nursing administrative research to answer questions relevant to scope, practice, and policy and suggests future directions.

An assessment of the alignment between graduate nursing leadership education and established standards.

The increasing complexity of healthcare systems is driving changes in the academic preparation of nurse leaders. The number of doctorate of nursing practice programs has increased. Leaders in the Council on Graduate Education for Administration in Nursing (CGEAN) were interested in learning how graduate nursing leadership programs have responded. An electronic survey was administered to CGEAN members to understand the emphasis of their graduate curricula. Results demonstrate good alignment between academic programs, American Association of College of Nursing essentials, and American Organization of Nurse Executives competencies.

The Baltimore Buprenorphine Initiative: understanding the role of buprenorphine in addressing heroin addiction in an urban-based community.

Adequate drug treatment for substance users continues to be a challenge for most U.S. cities. To address heroin addiction in Baltimore, the Baltimore Buprenorphine Initiative was implemented as a joint project to promote individualized, patient-centered buprenorphine therapy in conjunction with behavioral treatment to accelerate recovery from opioid addiction. The purpose of this analysis was to explore differences in recovery trajectories predicting length of stay and use this information to predict characteristics that influence an individual's ability to remain in the Baltimore Buprenorphine Initiative program. The sample consisted of 1,039 subjects enrolled in the program between January 2008 and June 2009. The regression modeling determined that age, income, employment, and higher level of treatment were significant predictors of length of stay in the recovery program. The findings of this study have practical implications for the design and implementation of heroin addiction programs. The research indicates that focusing on these specific predictive variables early in the program design phase could increase recovery success rates as measured by length of stay.

Crossing our quality chasm: continuing the case for graduate preparation of nurse managers and leaders.

The previous CGEAN Perspectives column compared the Baccalaureate Essentials document with American Nurses Credentialing Center (ANCC) and American Organization of Nurse Executives (AONE) certification examination content for nurse managers and concluded that the baccalaureate curriculum lacks the depth of content needed for today's frontline nurse leaders. This article continues the discussion by comparing the Master's Essentials document with ANCC and AONE nurse manager-level certification content to evaluate if a master's graduate education prepares nurses for the competencies of these management roles.

Crossing our quality chasm: heeding the case for graduate preparation of nurse managers and leaders.

As outlined by the Institute of Medicine's Future of Nursing, it is expected that nurses in direct care will be baccalaureate prepared. What then should be the expectation for educating nurse managers? This article compares the Baccalaureate Essentials with the American Nurses Credentialing Center and American Organization of Nurse Executives certification examination content for nurse managers to evaluate if baccalaureate education prepares these leaders for management roles in order to provide additional support for graduate education of nurse managers.

Data analytics: making the most of input with strategic output.

In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, the authors will describe data analytics and explore the potential for data analytics in meaningful use implementation to enhance executive decision making.

Medication reconciliation across the continuum of care: a meaningful use mandate.

In this department, the authors highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, Drs Wilson, Murphy, and Newhouse discuss use of information technology to support the process of medication reconciliation as mandated by Meaningful Use Stage 2 and The Joint Commission.

Improving care transitions through meaningful use stage 2: continuity of care document.

In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demon strate innovative approaches to organizational problems. In this article, the authors describe the elements of continuity of care documentation, how sharing information can improve the quality and safety of care transitions and the implications for nurse executives.

Patients' access to their health information: a meaningful-use mandate.

This department highlights topics in nursing outcomes, research, and evidence-based practice relevant to nurse administrators. In this article, the authors describe patient access to personal health information as it relates to the meaningful-use requirement, technologies that have been used to enhance patient engagement, and the nursing leadership implications.

Students' experiences with military nurses as faculty.

The United States Army Nurse Corps (ANC) and the University of Maryland School of Nursing (UMDSON) formed a partnership to address the nursing faculty shortage. Six ANC officers served as full-time faculty at the UMDSON for a 2-year period. Given that the student experience is central to the context of learning, the purpose of this study was to describe the experience of the students who interacted with ANC officers. Using a descriptive phenomenological approach, 14 nursing students participated in open-ended, in-depth, audiotaped interviews. Although the students had preconceived ideas about ANC officers as faculty, following engagement with the officers, the students reported many positive attributes of having ANC officers as clinical instructors and an enlightened understanding of the role of the military in today's world. The findings of this study indicate that the use of ANC officers is a plausible solution to the ongoing nursing shortage.

Understanding the social and economic contexts surrounding women engaged in street-level prostitution.

Prostitution involves the exchange of sexual services for economic compensation. Due to the sexual promiscuity surrounding prostitution, women involved in prostitution constitute a high-risk group for contracting and transmitting STDs, including HIV. Prostitution is not only a public health concern, but also an economic one. Cities throughout the United States spent an average of $7.5 to $16 million per year enforcing prostitution laws and addressing negative outcomes associated with prostitution. Thus, women involved in prostitution are a cause for concern from both public health and economic perspectives. However, little is known about why women remain in this type of behavior given the risks prostitution presents, and even less is known about how to intervene and interrupt the complex cycle of prostitution. Thus, the purpose of this study was to understand what factors contribute to a woman's decision to remain in prostitution. A series of interviews were conducted with 12 women engaged in street-level prostitution. Results of the study revealed that drug use not only spurs entry into prostitution, but also contributes to the tenure of prostitution. Further, social support and economic stability are plausible reasons for women remaining in prostitution. These findings lead us to recommendations for policy and program development. Women involved in prostitution are a highly marginalized population, rarely recognized as individuals with life histories. Understanding why women remain in prostitution is important, because until these determinants are known, intervention programs designed to interrupt the cycle, and ultimately prevent prostitution, cannot be formulated.