Effectiveness of an interprofessional ambulatory care model on diabetes: evaluating clinical markers in a low-income patient population.

The purpose of this study was to determine whether a new ambulatory care model, interprofessional collaborative care-coordinated team model (interprofessional model), based on the Wagner Care Model improved clinical indicators in a low-income population. This study was a retrospective 12-month pre-post (n = 204) and propensity matched (n = 171) comparative study of the interprofessional model in a primary clinic for patients with type 2 diabetes. Secondary data were collected from June 2014to February 2017 in an academic medical centre in a large Midwestern city. Findings demonstrated statistically and clinically significant improvement in A1C in both the pre/post arm of the study (↓ 0.8%) and the intervention/propensity matched arm (↓ 0.53%). Within the intervention group, there was a significant decrease in weight in the pre/post arm with 55% of cases losing weight, whereas 45% did not lose weight (p = .02). Diastolic blood pressure less than 90 also significantly improved in the pre/post arm of the study (10.1% n = 18, versus 3.9%, n = 7, p = .04). The interprofessional model showed that an ambulatory healthcare redesign incorporating an interprofessional team approach to optimise the health of this type 2 diabetes patient population can be effective. This study demonstrates the importance of using interprofessional collaborative practice teams to guide healthcare and improve patient outcomes.

Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

Using an academic-community partnership model and blended learning to advance community health nursing pedagogy.

This article describes a model of teaching community health nursing that evolved from a long-term partnership with a community with limited existing health programs. The partnership supported RN-BSN students' integration in the community and resulted in reciprocal gains for faculty, students and community members. Community clients accessed public health services as a result of the partnership. A blended learning approach that combines face-to-face interactions, service learning and online activities was utilized to enhance students' learning. Following classroom sessions, students actively participated in community-based educational process through comprehensive health needs assessments, planning and implementation of disease prevention and health promotion activities for community clients. Such active involvement in an underserved community deepened students' awareness of the fundamentals of community health practice. Students were challenged to view public health from a broader perspective while analyzing the impacts of social determinants of health on underserved populations. Through asynchronous online interactions, students synthesized classroom and community activities through critical thinking. This paper describes a model for teaching community health nursing that informs students' learning through blended learning, and meets the demands for community health nursing services delivery.

Burnout and coping strategies of polytrauma team members caring for veterans with traumatic brain injury.

OBJECTIVE: The aims of this national study were to (1) examine the extent of job burnout among VA Polytrauma team members engaged in the diagnosis and treatment of traumatic brain injury (TBI); and (2) identify their coping strategies for dealing with job-related stress. DESIGN: A cross-sectional sample of 233 VA Polytrauma team members completed the Maslach Burnout Inventory (MBI) and identified strategies for coping with work stress as part of an online survey. RESULTS: VA Polytrauma team members experience moderate levels of emotional exhaustion, but low levels of depersonalization and high levels of personal accomplishment. Moreover, 24% of participants reported high levels of emotional exhaustion, which may be a precursor to job burnout. Participants who reported caring for veterans with TBI ≥50% of their time experienced higher levels of emotional exhaustion than those who spent <50% of their time (p ≤ 0.001). Five major thematic categories related to coping strategies emerged from the data: (1) connecting with others, (2) promoting a healthy lifestyle, (3) pursuing outside interests, (4) managing work environment and (5) maintaining positive thinking. CONCLUSION: Polytrauma team members caring for Veterans with TBI may be at risk for job burnout.

Practice makes perfect: tips for successful institutional review board submissions.

As the nursing profession seeks to develop evidence-based practice, nurses are being encouraged to embark on research in their institutions. Staff nurses and nurse clinicians often struggle with the process of obtaining institutional review board approval for their projects. When classes are available, the focus is frequently on informing nurses about the federal regulations for protection of human subjects. This article addresses practical strategies for addressing these regulations from the perspective of both the individual nurse and the nursing leader.

Time out.

This biannual department, sponsored by the Council on Graduate Education for Administration in Nursing (CGEAN), provides information updates to nurse leaders on educational trends, issues, and research important for effective health system administration. The CGEAN Web site can be accessed at http://www.cgean.org.

Leveraging technology for research.

One of the most exciting promises of technology lies in the potential to support research on complex questions through the capture, maintenance and analysis of large data sets. This is especially true in cases where research involves multiple contextual variables such as organizational research. The possibilities for increasing our scope and reaching to global proportions when designing research projects is within reach. This paper reports the results of research conducted within the United States and yields useful lessons for application in other settings and countries.

Collaboration: education-service affiliation agreement.

This biannual department, sponsored by the Council on Graduate Education for Administration in Nursing (CGEAN), provides information updates to nurse leaders on educational trends, issues, and research important for effective health system administration. CGEAN's Web site can be accessed at (http://cgean.org).

Creating a safety culture through the application of reliability science.

The discussion of patient safety in delivering healthcare services is an important topic given the current state of the healthcare system. The current organizational cultures of many healthcare organizations do not support a culture of patient safety and do not employ a specific framework in delivering safe, reliable patient care. This article discusses the principles of reliability science and the use of these principles in creating a culture of patient safety. Recommendations are made for nursing involvement in creating a change in healthcare organization culture, and implementation steps are presented for nurse managers who are interested in applying the principles of reliability science to create a culture of patient safety on their units.

Toward a new future for healthcare and nursing practice.

The healthcare trends described in this article will eventually lead to transformation of healthcare delivery and nursing practice. The nursing profession needs to be proactive in creating new models of care delivery and in redefining the work of nursing. The authors describe 2 examples of emerging models and principles for the creation of future models, related leadership challenges for nurse executives, and strategies for leading change. Ensuring that changes in care delivery models lead toward a desired future that fulfills nursing's social contract is a mandate for nursing leaders.