Addressing health equity through a telehealth maternal-newborn home visit for nurse practitioner students.

ABSTRACT: This educational innovation describes the implementation and evaluation of a telehealth maternal-newborn home visit clinical experience for nurse practitioner students at an urban, private research university in the Midwest. The visits were conducted using the Family Connects evidence-based universal support program for families with newborns to evaluate each family's unique risks and to align their needs with available community resources. Students were prepared for the clinical experience through advanced practice didactic modules and simulation and then participated in the visits over a 2-week period. After the clinical opportunity, both students and community health nurse collaborators completed a survey about their experiences. The students reported feeling prepared to participate in the visits, that they were able to meet clinical objectives using telehealth, and learned about the community resources available for families with newborns. The nurses reported feeling prepared to collaborate with nurse practitioner students and that they benefitted from having a student participate in the visits. The experience prepared the students to meet the needs of a diverse patient population during the early postpartum/newborn period by providing newborn care advice, addressing access to health, assessing social determinants of health, and considering community resource referrals to reduce disparities and improve health equity. This article describes how a telehealth clinical experience addresses the American Association of Colleges of Nursing Essentials for advanced-level nursing students and provides recommendations for incorporating and evaluating telehealth clinical experiences in pediatric advanced practice education.

Feasibility and Impact of Physical Activity on Compassion Fatigue and Burnout Among Ambulatory Care Oncology Nurses.

BACKGROUND: Compassion fatigue (CF) and burnout are well described phenomena among oncology nurses. Physical activity (PA) has been shown to reduce CF and burnout. OBJECTIVES: The purpose of this pilot study was to determine the feasibility of promoting PA and assessing its impact on CF and burnout among RNs across three ambulatory care cancer clinics. METHODS: A convenience sample of nurses with varying roles were invited to participate. Feasibility was assessed by participant accrual and retention rates. CF and burnout were assessed at weeks 0, 6, and 12. The Yale Physical Activity Survey was used to obtain self-reported PA, and daily steps were tracked using participants' personal devices. FINDINGS: Stress scores decreased. Burnout scores demonstrated levels of low emotional exhaustion, moderate depersonalization, and moderate to high personal achievement. Leisurely walking increased significantly, and average daily step counts increased by 37% for weekdays, 10% for weekend days, and 29% for the total week.

An interdisciplinary approach to safe opioid prescribing and administration for surgical patients at an academic medical center.

AIM AND OBJECTIVES: To explore and understand the current practice, perceptions, and knowledge of general surgery trainees, advanced practice providers, and surgical nurses regarding opioid prescribing and administration. To this end, a novel opioid education and training was introduced to educate these practitioners on safe opioid practices in surgical patients. BACKGROUND: National awareness of the opioid epidemic has increased significantly in the last several years. However, there remain a disturbingly high number of opioid prescriptions written in the US indicating a need for improved provider and nurse education. This involves increasing awareness and understanding of national guidelines as well as implementing multi-modal therapy to treat pain. DESIGN: Pre-post-intervention quality improvement project. METHODS: An opioid education and training involving a morphine equivalent daily dosing calculator in the electronic medical record was provided to 26 surgical trainees, eight advanced practice providers and 97 surgical nurses in November 2019. Perceptions, current practice and knowledge were measured using a pre- and post-intervention survey (SQUIRE checklist). RESULTS: The survey results showed a positive clinical change in perception of opioid use in surgical patients following the intervention and a modest decrease in the average morphine equivalent daily dosing at discharge in general and transplant surgery patients. CONCLUSIONS: Effective pain management for surgical patients must be individualised. Safe opioid prescribing should involve an interdisciplinary approach with all members of the team undergoing assessment of their opioid knowledge and prescribing habits, easily accessible training tools and opioid calculators in the electronic medical record. RELEVANCE TO CLINICAL PRACTICE: Our initiative may provide useful information to settings that replicate use of a morphine equivalent daily dosing calculator in the electronic medical record. Utilisation of safe opioid prescribing tools in the electronic medical record and continuing education for providers and nurses can help ensure the safety of surgical patients.

Impact of COVID-19 on public health nursing student learning outcomes.

BACKGROUND: The COVID-19 pandemic has highlighted the importance of a strong, effective public health nursing workforce while also requiring public health nursing faculty to adapt teaching strategies as courses transitioned online. It is essential to understand how the pandemic-enforced transition from face-to-face to remote learning impacts student outcomes. The purpose of this paper is to compare student learning outcomes in a pre-licensure public health nursing course before, during, and after the transition to remote learning. METHODS: Descriptive statistics were computed for assignments, exams, and final course grades for three terms (Fall 2019, Spring 2020 and Fall 2020). RESULTS: Analysis showed statistically significant differences between terms for assignments and exams but not the final course grade. However, these differences were driven by small standard deviations rather than differences between mean scores demonstrating that there was actual little difference in student learning outcomes across terms. CONCLUSIONS: Authors suggest strategies to support consistent academic outcomes and future research needed understand student learning outcomes during the pandemic; ultimately building the public health nursing workforce necessary to address the current and future public health crises.

Barriers to the Use of Pain Prevention Techniques During Immunization.

INTRODUCTION: The purpose of this project was to identify barriers to the use of pain prevention techniques during immunization. METHOD: A national, voluntary survey was distributed to members of the National Association of Pediatric Nurse Practitioners in June 2019. RESULTS: The survey gathered information about the type of practitioner (pediatric nurse practitioner, family nurse practitioner, nurse, etc.), practice location (inpatient, primary care, specialty care, etc.), and patient population served and also included information regarding geographic location, socioeconomic status, insurance coverage, and immunization status as well as current practice information. Respondents identified the following barriers: time (22.4%), availability (17.5%), lack of knowledge (17%), staff support (14.1%), cost (12.1%), lack of resources (7.4%), safety concerns (4.7%), environmental factor (3.4%), and other (1.4%). DISCUSSION: The lack of pain prevention techniques is primarily because of availability, lack of knowledge and staff support, and cost. Proposed means to address these barriers include the development of a toolkit.

Mindfulness Workshops Effects on Nurses' Burnout, Stress, and Mindfulness Skills.

Burnout decreases work performance and quality of care and can result in medical errors, lower patient satisfaction, and higher rates of turnover. A study of 68 000 registered nurses showed that 35% of hospital nurses were experiencing symptoms of burnout. A systematic review identified that mindfulness-based interventions for health care professionals reduced stress and burnout and increased self-compassion and general health. However, the authors determined that more high-quality research is needed. This study examined the impact of a 4-hour workshop on burnout syndrome, perceived stress, and mindfulness skills. The objective of this study was to determine whether a 4-hour mindfulness workshop was effective in reducing burnout and perceived levels of stress and increasing mindfulness. Nurses at a Midwest academic medical center were recruited through e-mail to attend a 4-hour mindfulness workshop. Participants completed the Maslach Burnout Inventory-Human Service Survey, Perceived Stress Scale, and Cognitive and Affective Mindfulness Scale-Revised prior to the start of the workshop and 1 and 6 months after the workshop. The study design allowed for comparisons preintervention and postintervention. Of the 52 nurses who completed the baseline questionnaires, 94% were female with an average age of 38 years. Thirty-one percent completed the questionnaires at 1 month and 20 nurses at 6 months. At 1 month, nurses reported statistically significant decreased perceptions of stress (-2.31, P = .01) and emotional exhaustion (-4.78, P = .03). Mindfulness skills, personal accomplishment, and depersonalization improved but were not statistically significant. At 6 months, statistically significant findings included increased perceptions of mindfulness (2.50, P = .04), personal accomplishment (4.43, P = .04), and decreased emotional exhaustion (-6.21, P = .05). Perceptions of stress and depersonalization improved but were not statistically significant. In this study, nurses reported decreases in burnout and perceived stress and increases in mindfulness after attending a 4-hour mindfulness workshop. Further research is needed to determine the long-term impact of mindfulness-based training on nurses' burnout, stress, and mindfulness skills. The results of this study add to the body of literature that supports the benefits of mindfulness-based interventions.

Integrating the Social Determinants of Health into Nursing Practice: Nurses' Perspectives.

PURPOSE: The purpose of this study was to assess nurses' knowledge, perceived self-efficacy, and intended behaviors relative to integrating the social determinants of health (SDoH) into clinical practice. DESIGN AND METHODS: A cross-sectional study was completed with 768 nurses working in three hospitals within a large regional healthcare system located in the Midwest. Data were collected using an adapted 71-item SDoH Survey, which measured nurses' confidence in and frequency of discussing the SDoH with patients, general knowledge of the SDoH, familiarity with patients' social and economic conditions, and awareness of their institution's health equity strategic plan to achieve health equity. The institution's health equity strategic plan reflects the organization's commitment to improving the health of individuals and neighborhoods by addressing the SDoH known to influence health status and life expectancy. Finally, participants were asked to describe barriers to incorporating the SDoH into practice along with completing five demographic items. Descriptive statistics were used to describe the findings. FINDINGS: Of the 768 respondents, 63% had a baccalaureate degree in nursing and 33.1% reported more than 20 years in nursing. Fifty percent of respondents reported feeling more knowledgeable or confident in their ability to discuss access to care issues with patients compared to the other SDoH. Identified barriers to discussing the SDoH included insufficient time to address identified needs and unfamiliarity with internal and external resources. Respondents stressed the need for interdisciplinary education and collaboration along with more information on the role of social workers. CONCLUSIONS: Nurses are more confident in discussing certain determinants of health and could benefit from more skill development in discussing SDoH issues and stronger collaborative partnerships to address identified needs. CLINICAL RELEVANCE: Findings from the study have implications for supporting the educational and resource needs of front-line nurses employed in hospitals and health systems seeking to address broader societal issues influencing the health status and outcomes of patients and communities.

Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs.

OBJECTIVES: As part of an improvement program targeting ICU, a national collaborative was launched to help hospitals implement patient- and family-centered care engagement initiatives. DESIGN: Ten-month quality improvement collaborative. SETTING: Guided by a national patient and family advisory group, participating teams implemented an individual project including open visitation; integrating families on rounds; establishing a patient and family advisory committee; using patient and family diaries, among others. SUBJECTS: Sixty-three adult and PICU teams from both academic and community hospitals in 34 states participated. INTERVENTIONS: Monthly team calls, quarterly webinars, newsletters, an online eCommunity, and team reporting assignments were used to facilitate project implementation. MEASUREMENTS AND MAIN RESULTS: The Family Satisfaction with Care in the ICU 24 was used to assess family satisfaction. Clinician perceptions were assessed with the Institute for Patient- and Family-Centered Care Self-Assessment Inventory. Thematic analysis was used to explore narrative data captured from team reports of project barriers, facilitators, and the experience of participating in the collaborative. A total of 2,530 family member and 3,999 clinician surveys were completed. Postimplementation, family members reported statistically significant increases in overall family satisfaction, satisfaction with decision-making, and satisfaction with quality of care (Family Satisfaction with Care in the ICU mean score change range 0.83-1.24; p ≤ 0.027). Clinicians reported that opportunities for families to participate as members of the care team increased. Major barriers included lack of buy-in and ability to promote change in the clinical setting, managing the workload of implementation, and funding to support initiatives. CONCLUSIONS: A national collaborative format was useful to assist ICU teams to implement patient- and family-engagement initiatives. Enlisting stakeholder support, engaging unit-based champions, and highlighting benefits of family engagement can help ICU teams to promote family member involvement and engagement.