Reflections from the frontline of nursing on acute patient deterioration.

AIMS: To describe medical-surgical nurses' reflections on their experiences with patient deterioration. BACKGROUND: An extensive body of knowledge exists regarding optimal responses to acute patient deterioration within a hospital environment. Much less attention has focused on the profound psychological and emotional impact these experiences of unexpected deterioration can have on nurses who provided the supportive or rescue care. A triggering event, such as patient deterioration, or direct questioning about these experiences, can lead nurses to reflect further on the situation. Engaging in reflection is believed to enhance learning and improve clinical judgement when future complex situations arise. Findings related to nurses' reflective practice when recalling previous situations with deteriorating patients are limited. This gap in the literature provided the basis for the current project. DESIGN: A qualitative descriptive design. METHODS: Twenty medical-surgical nurses were interviewed in 2018. The nurses were recruited through purposive sampling. Semi-structured telephone interviews explored nurses' experiences of a patient deterioration. Conventional content analysis with iterative coding and categorising and theme development was used for data analysis. FINDINGS: Three themes emerged as participants reflected on their experiences. The themes were, Enduring frustration and regret, Feeling deeply responsible for and to the patient and Making sense of what happened. CONCLUSIONS: Medical-surgical nurses who care for acutely deteriorating patients can experience lasting emotional, psychological and physical concerns that often go unrecognised and untreated. Furthermore, nurses with this background commonly reported their perceived increased risk for workplace distress. RELEVANCE TO CLINICAL PRACTICE: Findings from this study are important for nurses, healthcare administrators and leaders, and patients. Participating in a rescue attempt often has a negative impact on nurses' perception of workplace stress and on persistent concerns about nurses' mental and physical health. The findings can be useful in informing additional studies about the phenomenon. Findings also can inform the exploration of workplace design. Organisations should assess for factors influencing workplace stress, develop strategies to mitigate the presence of workplace stress and foster nurses' well-being so they can respond to future scenarios of patient deterioration, while maintaining their physical and mental health. PATIENT OR PUBLIC CONTRIBUTION: This study did not include any patient or public input.

Role of Stigma for Health Care Professionals With Nonmedical Substance Use.

BACKGROUND: Stigma toward those with non-medical substance use may present as anticipated, perceived, enacted, or internalized stigma. OBJECTIVE: The purpose of the study was to describe the role of stigma on health care professionals with non-medical substance use, from the perspective of treatment providers. Soliciting information about stigma from treatment providers is a unique perspective lacking in current literature. METHODS: A qualitative descriptive design was used with semi-structured interviews of treatment providers (N = 16) in Colorado. Inductive content analysis was used to identify concepts and themes across interviews. RESULTS: Findings showed that stigma is a major concern and a barrier for health care professionals seeking substance use treatment. Nurses and physicians demonstrate shame and guilt (internalized stigma) around their substance use. These professionals also experience fear around their reputation (perceived stigma) and challenges around re-entry to the workforce after treatment (anticipated stigma). CONCLUSIONS: The awareness of existing stigma as well as internalized stigma impacts how health care professionals approach treatment, recovery, and returning to work.

Frontline Nurses' clinical judgment in recognizing, understanding, and responding to patient deterioration: A qualitative study.

BACKGROUND: Early warning systems and rapid response teams have been widely implemented in hospitals worldwide to facilitate early recognition and response to patient deterioration. Unfortunately, evidence suggests that these interventions have made little impact on unexpected cardiac or respiratory arrest, hospital mortality, unplanned admission to intensive care units, or hospital length of stay. These programs depend on nurses recognizing at risk patients and initiating a timely response. Although physiologic abnormalities commonly precede serious adverse events, nurses often fail to recognize or respond effectively. Clinical judgment is a critical component in the effective response to deterioration, yet little is known about factors that influence nurses' clinical judgment in these situations. Noticing, interpreting, and responding are aspects of clinical judgment and are essential to preventing further patient deterioration and serious adverse events. OBJECTIVE: To describe medical-surgical nurses' perceptions of factors that influenced their clinical judgment in situations of patient deterioration. DESIGN: A qualitative descriptive design using individual, semi-structured interviews. Tanner's Clinical Judgment Model served as the framework for interview questions and data analysis. PARTICIPANTS: A purposive sample of 20 medical-surgical registered nurses were recruited from 10 adult medical-surgical units at an academic medical center hospital in the United States. METHODS: Telephone interviews occurred between March and July 2018. A directed approach to content analysis was used to code the transcribed data and identify themes. RESULTS: Eight themes related to each aspect of clinical judgment emerged from the analysis: Knowing the patient, Experience matters, Lots of small points where the system can fail, Making sense of the data, Something doesn't go together, Caught in the middle, Culture of teamwork, and Increased nursing workload. An overarching theme was Nurses' keen sense of responsibility. Findings revealed that factors within the nurse, the patient, and the work environment influence each component of noticing, interpreting, and initiating an effective response to deteriorating patients. CONCLUSIONS: Findings have implications for health care systems regarding interventions to support timely recognition and response to deterioration. Nurses' clinical judgment and factors that influence each aspect (noticing, interpreting, and responding) should be a key consideration in organizational efforts to improve the overall response to patient deterioration. Research is needed to enhance understanding of the contextual factors that impact nurses' clinical judgment to inform interventions to support timely recognition and response.

A Creative Action Plan for Mental Wellness: Tools for Primary Care in Rural and Underserved Settings.

Primary care settings have many opportunities to support patients who have anxiety and/or depression, but resources are often scarce. Our faculty team developed an education tool to support mental health awareness and provide suggested wellness activities. Health-care professionals from various disciplines and settings have demonstrated eagerness to use this tool with patients and with health-care students to improve resilience and mental wellness.

African American and Latinx Adolescents' Perspectives of Nursing as a Career Choice.

BACKGROUND: Ensuring a diverse nursing workforce that closely represents the diversity of the population is imperative for culturally competent and equitable care. To accomplish this, purposeful and strategic programs need to be integrated into secondary education. The purpose of this qualitative descriptive study was to explore the perceptions and attitudes about the nursing profession among African American and Latinx adolescents. METHOD: Four focus group sessions were conducted, and content analysis of the focus group narratives was completed. RESULTS: The majority of the 33 participants were female and 57% were Latinx. The three themes are Nursing Is a Caring Profession But…; Formation of Ideas About Nursing Often Come From Family, Friends, and the Media; and Deterrents to Pursuing Nursing. CONCLUSION: To decrease health disparities, nursing must address its lack of diversity. Based on these findings, our school of nursing has implemented a summer program for adolescents. [J Nurs Educ. 2019;58(9):519-524.].

The Kansas Nurse Leader Residency Program: Building Nurses' Capacity to Lead Change.

As nurses engage as partners in addressing complex healthcare issues, it is increasingly important to develop nurse leaders. Many nurses need expanded knowledge and training to lead change. The purpose of this article is to describe an innovative statewide nurse leadership residency program to prepare new nurse leaders in four specialty areas. Suggestions are offered for continued advancement of leadership training for RNs across specialty roles and settings.

Advancing Nursing Education: BSN Completion Messaging Materials for Associate Degree Program Nursing Faculty.

AIM: This project developed a comprehensive set of bachelor of science in nursing (BSN) completion messaging materials that associate degree in nursing (ADN) faculty can use to advise and encourage students to complete the BSN. BACKGROUND: The Future of Nursing report calls for increasing the proportion of baccalaureate-prepared nurses to 80 percent by 2020. Faculty who teach in ADN programs have opportunities to advise students in advancing their nursing education yet often lack information to guide these conversations. METHOD: After development of BSN completion messaging materials, the products were evaluated by faculty from two Kansas ADN programs. RESULTS: ADN faculty positively evaluated the format and content of the messaging materials. They appreciated having a variety of customizable resources to share with students in group and individual sessions. CONCLUSION: Next steps include disseminating the messaging materials to ADN programs and practice-based nursing leaders to guide education conversations about academic progression of ADN-prepared nurses.

Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement.

BACKGROUND: Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. OBJECTIVE: To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. SETTING: Participants were recruited from a university hospital-based WMC in Pennsylvania. METHODS: This qualitative descriptive study used purposive sampling and inductive content analysis. RESULTS: A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. CONCLUSION: Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes.

Kansas nurse leader residency programme: advancing leader knowledge and skills.

AIMS: To evaluate the effectiveness of the Kansas Nurse Leader Residency (KNLR) programme in improving nurses' leadership knowledge and skills and its acceptability, feasibility and fidelity. BACKGROUND: The Future of Nursing Report (Institute of Medicine, 2011) calls for nurses to lead change and advance health. The 6-month KNLR programme was developed by the Kansas Action Coalition to support nurses' leadership development. METHODS: Nurses (n = 36) from four nursing specialties (acute care, long-term care, public health and school health) participated in the programme. The adapted Leader Knowledge and Skill Inventory was used to assess leadership knowledge and skills. Programme acceptability, feasibility and implementation fidelity also were evaluated. RESULTS: The programme completion rate was 67.7% (n = 24). Programme completers had significantly improved self-assessed and mentor-assessed leadership knowledge and skills (p < .05). These post-programme gains were maintained 3 months after programme completion. CONCLUSIONS: The KNLR programme effectively improved leadership knowledge and skills and was positively evaluated by participants. The implementation of the KNLR programme using a hybrid format of in-person sessions and online modules was feasible across four specialty areas in both rural and urban regions. IMPLICATIONS FOR NURSING MANAGEMENT: The next steps include the development of an advanced programme. Residency programmes for new nurse leaders are critical for successful transition into management positions.

Fatigue in Type 2 Diabetes: Impact on Quality of Life and Predictors.

Fatigue is a persistent symptom, impacting quality of life (QoL) and functional status in people with type 2 diabetes, yet the symptom of fatigue has not been fully explored. The purpose of this study was to explore the relationship between fatigue, QoL functional status and to investigate the predictors of fatigue. These possible predictors included body mass index (BMI), Hemoglobin A1C (HbA1C), sleep quality, pain, number of complications from diabetes, years since diagnosis and depression. Forty-eight individuals with type 2 diabetes (22 females, 26 males; 59.66±7.24 years of age; 10.45 ±7.38 years since diagnosis) participated in the study. Fatigue was assessed by using Multidimensional Fatigue Inventory (MFI-20). Other outcomes included: QoL (Audit of Diabetes Dependent QoL), and functional status (6 minute walk test), BMI, HbA1c, sleep (Pittsburg sleep quality index, PSQI), pain (Visual Analog Scale), number of complications, years since diagnosis, and depression (Beck's depression Inventory-2). The Pearson correlation analysis followed by multivariable linear regression model was used. Fatigue was negatively related to quality of life and functional status. Multivariable linear regression analysis revealed sleep, pain and BMI as the independent predictors of fatigue signaling the presence of physiological (sleep, pain, BMI) phenomenon that could undermine health outcomes.

Strategies for Building Advocacy Skills Among Undergraduate and Graduate Nursing Students.

BACKGROUND: Nursing faculty are challenged to create learning experiences that both reflect the complexities of the current health care system and are relevant. Experiential learning opportunities should promote engagement in health care that extends beyond direct patient care to advocacy in larger systems. METHOD: To meet this challenge, faculty developed course assignments for students at baccalaureate, master's, and doctoral levels in which students worked with state Action Coalitions to implement the Institute of Medicine Future of Nursing report's eight recommendations. With faculty guidance, student teams developed and implemented projects or conducted research to assist the coalitions in their grassroots initiatives. RESULTS: Students at all program levels reported high levels of satisfaction and engagement with these unique projects. Students reported understanding the importance of the Future of Nursing recommendations and intended to continue participating in statewide initiatives. CONCLUSION: Experiential learning opportunities at all program levels can engage students in learning more about advocacy, health care trends, and leadership.

Infected Lives: Lived Experiences of Young African American HIV-Positive Women.

This hermeneutic phenomenological study explored the lived experiences of young African American HIV-infected women. Eleven women between the ages of 21 and 35 participated. One pattern, Infected Lives, and three themes--Living Alone With HIV, Living With Unresolved Conflicts, and Living With Multiple Layers of Betrayal--emerged. The pattern and themes portray the very complex and challenging experiences faced by these young women living with HIV infection. They have experienced isolation, abandonment, betrayal, and discrimination in their interpersonal and social systems. They often dealt with conflicts of hope and anguish in the relationships with their children, and portraying strength, while feeling fragile. These complexities negatively influence the ability to fully engage in self-care activities. Implications for future research include further investigation about the experiences of psychological distress experienced post-diagnosis, development and evaluation of holistic nursing interventions, and evaluative research on mass media educational campaigns to reduce HIV-related stigma.

The Initiative to Move Toward a More Highly Educated Nursing Workforce: Findings from the Kansas Registered Nurse Workforce Survey.

The Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, recommends increasing the proportion of registered nurses (RNs) with a baccalaureate in nursing (BSN) to 80% by 2020. Kansas lacks a central mechanism to collect current data on the RN workforce; therefore, detailed information about the RN workforce, including current educational level, is unknown. The purposes of the survey were to (a) describe the Kansas RN workforce, (b) examine the relationship between nursing education and employment, (c) compare and contrast the workforce to other states and national data and (d) discuss implications of strategic planning and policy making for nursing education. The on-line Kansas RN Workforce Survey link was sent to 44,568 RNs by e-mail, and the response rate was 15.6% (n = 6,948). The survey consisted of 34 questions on demographics, education, licensing, and employment. Kansas RNs were predominately women (92%) and Caucasian with an average age of 47.7 years. Approximately 46.3% of RNs obtained a BSN as their initial education. Analysis of highest level of nursing education showed that 60.5% of Kansas RNs were at least baccalaureate prepared, with 14.9% obtaining a master's degree or higher. More than 50% of RNs worked in hospitals as staff nurses. RNs with advanced education were more likely to be employed, tended to work in academic settings or ambulatory clinics, and were more likely to be faculty or in management/leadership positions. Overall, the Kansas RN workforce is closer to reaching the 80% baccalaureate-prepared goal recommended by the Future of Nursing report than has been reported. Educational level was closely related to RNs' choices of work settings and positions. Additional work such as promoting academic progression needs to continue to build a more highly educated RN workforce.

Living in the Everydayness of HIV Infection: Experiences of Young African-American Women.

The purpose of this Heideggerian phenomenological study was to explore the lived experiences, including spiritual and self-care practices, of young African-American women infected with the human immunodeficiency virus. One theme, "Living in the Everydayness of HIV" and implications for nurses will be discussed.

Exploring leadership roles, goals, and barriers among Kansas registered nurses: a descriptive cross-sectional study.

OBJECTIVES: The Institute of Medicine's Future of Nursing report advocates for full nurse leader representation across multiple settings to address current challenges in our health care system. The purpose of this study was to examine nursing leadership development needs among Kansas registered nurses (RNs). METHODS: Data were collected through an online survey and analyzed using quantitative and qualitative methods. RESULTS: Nearly 1,000 Kansas RNs participated. Most reported holding one or more leadership positions. Prevalent leadership goals were health care organization volunteer administrative roles. The most frequently identified barrier to developing leadership roles was time constraints. Many wanted to develop skills to serve on a board, 20% were interested in personal leadership development, and 19% in policy development. CONCLUSIONS: Based on the findings, the Kansas Action Coalition leadership team is developing programs to address the leadership needs of Kansas RNs. By building capacity in advanced leadership roles, RNs will be better prepared serve as full partners and lead efforts to promote the health of Kansans.

Teaching Confirmatory Factor Analysis to Non-Statisticians: A Case Study for Estimating Composite Reliability of Psychometric Instruments.

Texts and software that we are currently using for teaching multivariate analysis to non-statisticians lack in the delivery of confirmatory factor analysis (CFA). The purpose of this paper is to provide educators with a complement to these resources that includes CFA and its computation. We focus on how to use CFA to estimate a "composite reliability" of a psychometric instrument. This paper provides guidance for introducing, via a case-study, the non-statistician to CFA. As a complement to our instruction about the more traditional SPSS, we successfully piloted the software R for estimating CFA on nine non-statisticians. This approach can be used with healthcare graduate students taking a multivariate course, as well as modified for community stakeholders of our Center for American Indian Community Health (e.g. community advisory boards, summer interns, & research team members). The placement of CFA at the end of the class is strategic and gives us an opportunity to do some innovative teaching: (1) build ideas for understanding the case study using previous course work (such as ANOVA); (2) incorporate multi-dimensional scaling (that students already learned) into the selection of a factor structure (new concept); (3) use interactive data from the students (active learning); (4) review matrix algebra and its importance to psychometric evaluation; (5) show students how to do the calculation on their own; and (6) give students access to an actual recent research project.

An analysis of partnership performance: the St. Johns Mercy Medical Center-Saint Louis University School of Nursing dedicated education unit project.

The purpose of this article is to analyze the St. Johns Mercy Medical Center (SJMMC)-Saint Louis University School of Nursing (SLUSON) dedicated education unit (DEU) project for partnership effectiveness. The DEU, an innovative and collaborative academic-service partnership, reconceptualizes the role of the faculty and staff nurse in the clinical educational process. In a DEU, the staff nurse provides the clinical instruction to the student, and the faculty member coaches the staff nurse on the teaching-learning process. Rather than explore the effectiveness of the DEU as an innovative clinical pedagogy, this article analyzes the relationship between the academic and service institutions for strategic effectiveness. The analysis is based on themes found across three successful and distinct academic partnerships and other evaluative models from business, government, and alliance research. The themes and models provide the frameworks needed to analyze the SJMMC-SLUSON academic-service partnership for structure, process, and outcomes. This analysis can serve as a guide for the development of academic-service partnership practices to facilitate successful, sustainable, and replicable partnerships that benefit both institutions.

Common themes in clinical education partnerships.

The concurrent nursing and faculty shortages continue to be critical issues for the nation's health care system. As academic nursing programs struggle with maintaining and increasing enrollment in the midst of a faculty shortage, one solution is to expand the faculty's capacity through innovative academic-service partnerships. Schools and clinical partners identified as having implemented innovative partnerships were invited to participate in this descriptive study. Site visitations to schools in Florida and Texas were conducted to gain in-depth knowledge of the clinical education model, the academic-service partnership, and the strengths and challenges associated with planning, implementing, and sustaining programs. Four underlying features were common across the successful implementation: supportive relationships, goodness of fit, flexibility, and communication. Consideration of the four features will be useful as nursing programs and their clinical partners are developing, implementing, and evaluating new models for increasing educational capacity and lessening the nursing shortage.

A theory-based Self-Care Talk intervention for family caregiver-nurse partnerships.

Family caregivers need assistance with information, support, and advice from nurses and other health care professionals to successfully meet the demands of caregiving. Self-Care TALK (SCT) is a theory-based nursing intervention designed to improve the health and well-being of older adult spouse caregivers. The Self-Care for Health Promotion in Aging Model (S-CHPA) provides a framework for development of SCT. Key to implementation of the SCT intervention is partnership building between nurses and caregivers, which is fostered through relational conversations. In this article, the model and intervention are described, and an individual example is provided to show the application of the model in practice. Implications for practice and research are explored.