Nurses' Perceptions of Caring at Work: Mixed-Methods Study, Quantitative Report.

OBJECTIVES: Study objectives were to explore nurses' perceptions of self-care, co-worker, and leader caring within healthcare work environments and assess reliability of 3 Watson Caritas Scores. BACKGROUND: Assessing caring in an organization where Watson's Theory of Human Caring guides nursing practice offers insight into the professional practice environment. METHOD: This study reports quantitative data from mixed-methods descriptive, cross-sectional survey of 1307 RNs at a large healthcare system. RESULTS: Mean scores were self = 5.46, co-worker = 5.39, and leader score = 5.53, and median scores were >5.6 (range, 1-7). All scales had a positive and significant correlation to likelihood to recommend the organization, with the largest being feeling cared for by leaders. Internal reliability of the 3 scales was ≥0.9. CONCLUSION: Nurse perceptions of caring may influence the organization's reputation. Assessing the perception of caring among nursing staff after the introduction and enculturation of this framework is needed. Results support psychometric value for 3 Watson Caritas Scores.

A Nurse-Led Implementation Science Specialist Program.

ABSTRACT: A well-known challenge in health care is integrating evidence into practice. Implementation science (IS) is a growing field that promotes the sustainable application of evidence-based practice (EBP) to clinical care. Health care organizations have an opportunity to support sustainable change by creating robust IS infrastructures that engage nurses in the clinical environment. Integrating IS into a nursing shared governance model is an ideal vehicle to empower direct care nurses to sustain EBP. Importantly, an IS infrastructure may also promote nurse retention and increase interdisciplinary collaboration. This article, the first in a series on applying IS, describes how a multisite health care organization developed a systemwide nurse-led IS Specialist program within a shared governance model.

Exploring nurses' perceptions of the barriers and facilitators that influence acceptance and use of remote visual monitoring technology.

AIM: Describe nurses' perceptions of the barriers and facilitators that influence acceptance and use of remote visual monitoring technology. BACKGROUND: Research has shown remote visual monitoring to be a useful patient safety intervention, yet nurses underutilize the technology. METHODS: Using a qualitative descriptive study design, we completed a conventional content analysis of focus group feedback from two nurse leader groups and two direct care nurse groups (n = 13 participants) to explore factors influencing nurses' perceptions and utilization of remote visual monitoring. RESULTS: Five main themes were identified: (1) Contextual human factors that impact nurse acceptance; (2) facilitators and barriers related to remote visual monitoring's functionality; (3) nurse leaders' role in maintaining device availability and efficient use; (4) nurse leaders' role in promoting adoption of the technology; and (5) nurse leaders' role in valuing nursing professional judgement. CONCLUSION: Findings indicate that nurse leaders can play a crucial role in direct care nurses' acceptance and use of remote visual monitoring technology. IMPLICATIONS FOR NURSING MANAGEMENT: In an era of limited staffing resources, remote visual monitoring has the potential to increase patient safety and decrease workload demands. Nurse leaders should identify barriers and facilitators to their nursing team's use of remote visual monitoring to promote the acceptance and use of technology that increases patient safety and cost-effectiveness of care.

Let's Talk About Racism: Strategies for Building Structural Competency in Nursing.

A major goal of Healthy People 2020 is healthy equity, or the attainment of the highest level of health for all groups of people. Yet, disparities based on race remain the most persistent and difficult to address. Getting at the root causes of disparities, inequities, and injustices is essential for health equity to become a reality. The authors elucidate the urgent need for the nursing profession (and all health care professions) to push beyond cultural humility to structural competency and shift the focus from individuals to institutions, systems, practices, and policies to address racism, bias, and discrimination as root causes of disparities and inequities in health, health care delivery, and health care outcomes.Through a case study approach, the authors demonstrate the need for faculty to contextualize learning to help integrate the necessary historic and contemporary drivers of racism, bias, and discrimination into health care. They discuss strategies for faculty to develop the knowledge, skills, and attitudes to teach about the importance of addressing structural racism and discrimination in health care. Through a "no shame, no blame" approach, the authors encourage faculty to develop the courage to engage with students, colleagues, other health care professionals, and communities in conversations about racism, bias, and discrimination.

Nurse care coordination and technology effects on health status of frail older adults via enhanced self-management of medication: randomized clinical trial to test efficacy.

BACKGROUND: Self-management of complex medication regimens for chronic illness is challenging for many older adults. OBJECTIVES: The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. DESIGN: This study used a randomized controlled trial with three arms and longitudinal outcome measurement. SETTING: Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area. METHODS: All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months. RESULTS: After covariate and baseline health status adjustment, time × group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time × group interactions were significant for the medplanner and control group comparisons. DISCUSSION: Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.

Empowerment interventions for older adults.

There has been much discussion regarding the need to empower older adults to make informed health decisions and to test interventions targeting empowerment to promote health among older adults. It has been suggested that an empowerment approach may nurture an older adult's participation in health care decisions and promote positive health outcomes. The purpose of this article is to report the findings of a critical review of published empowerment intervention studies with community-dwelling older adults. A descriptive literature review was conducted to examine how empowerment is conceptualized across interventions, the guiding theoretical frameworks, the outcomes measured, as well as the health outcomes of these interventions. Based on the findings from this review, recommendations for future empowerment intervention research with older adults as well as implications for practice are proposed.

Effects of phthalic anhydride modification on horseradish peroxidase stability and activity.

Phthalic anhydride (PA) modification stabilizes horseradish peroxidase (HRP) by reversal of the positive charge on two of HRP's six lysine residues. Native and PA-HRP had half-inactivation temperatures of 51 and 65 degrees C and half-lives at 65 degrees C of 4 and 17 min, respectively. PA-HRP was more resistant to dimethylformamide at room temperature and tetrahydrofuran at 60 degrees C and to unfolding by heat, guanidine chloride, EDTA, and the reducing agent tris(2-carboxyethyl)phosphine hydrochloride. Binding of the hydrophobic probe Nile Red to the native enzyme and to PA-HRP was similar. The kinetics of both HRPs with the substrates ABTS, ferrocyanide, ferulic acid, and indole-3-propionic acid were measured, as was binding of the inhibitor benzhydroxamic acid. Small improvements in the catalytic properties were detected.

Pseudo-outbreak of Mycobacterium fortuitum due to contaminated ice machines.

BACKGROUND: An almost 4-fold increase from normal baseline levels in the isolation of Mycobacterium fortuitum from respiratory tract specimens was observed. The majority of these isolates were obtained from patients residing on 1 of 2 wards, prompting an epidemiologic investigation. METHODS: In addition to patient specimens, environmental cultures were collected from various water sources on the 2 affected wards. Samples were also collected from uninvolved areas of the hospital. All specimens were cultured with use of a continuously monitored broth system for the isolation of mycobacteria. RESULTS: The respiratory tracts of 19 patients were colonized by M fortuitum. Surveillance cultures obtained from uninvolved areas of the hospital were either negative for mycobacteria or were colonized by M avium complex or M gordonae. Two ice machines, servicing the affected areas each, were colonized by M fortuitum in multiple cultures. CONCLUSIONS: The M fortuitum pseudo-outbreak was due to contaminated ice machines located on each of the affected units. After removal and replacement of the ice machines, the pseudo-outbreak resolved.