Systematic Review of Burnout in US Nurses.

Nurses experience high levels of burnout, and this has become a major factor in recruitment and retention of nurses. Several factors have been associated with burnout, but it is not clear which factors are the most significant predictors. Understanding the most prevalent factors that are associated with burnout will allow for the development and implementation of interventions to ameliorate and/or reduce burnout in the nursing workforce.

The Effect of Burnout on Quality of Care Using Donabedian's Framework.

Donabedian's framework offers a model to evaluate the relationship between patient outcomes, influenced by clinical care delivery structures and processes. Applying this model proposes that adequate and appropriate structures and processes within organizations are necessary to realize optimal outcomes; it is imperative that leadership focuses on those structures and processes to reduce the risk of burnout. Current research cannot determine whether burnout causes decreased quality or working in a setting with decreased quality causes burnout. The follow-up question is whether curtailing burnout will improve quality or whether improving quality of care will reduce provider burnout?

The Influence of Leadership Style and Nurse Empowerment on Burnout.

The levels of burnout nurses experience continue to increase with resultant negative impacts on the nursing work environment, patient outcomes, and the retention of qualified nurses. Nurse leaders are essential in developing and fostering positive work environments that retain an empowered and motivated workforce. Research indicates that positive and relational leadership styles can improve nurses' job satisfaction, organizational commitment, and retention while concurrently reducing emotional exhaustion and burnout.

Factors Associated with Burnout in the United States Versus International Nurses.

Nurse burnout is a serious global problem that is associated with adverse job factors. In this article, research on burnout as measured by the Maslach Burnout Inventory is reviewed from 2000 to 2019, specifically analyzing job factors associated with nurse burnout and comparing US with international findings. Most of the reviewed articles found a significant relationship between nurse burnout and a nurse's intention to leave their job, job stress, nurse satisfaction, and workplace violence. There were very few articles reporting on research done in the United States, whereas most of them described international research. Recommendations on how to decrease the risk of nurse burnout are summarized.

Assessing dosing errors in legacy and low dose tip ENFit® syringes.

WHAT IS KNOWN AND OBJECTIVE: To avoid misconnections between different medical devices, a unique standardized design of connectors (ENFit® ) for enteral medical devices has been developed. It was expected that the syringes with these connectors will replace the pre-existing syringes, henceforth referred to as legacy syringes. However, the changes in the connector's design led to concerns regarding dosing errors for low volume syringes (≤2 ml). Therefore, novel low dose tip (LDT) syringes were designed to address these concerns. These LDT syringes can connect with the standardized ENFit® male connectors. Only a few studies have investigated dosing errors, and findings have largely been mixed. The objective of this report was to calculate the contributions of unavoidable dosing errors for LDT syringes, compare with legacy syringes and to suggest strategies to optimize dose accuracy for enteral applications. METHODS: Studies performed with a limited number of syringes to date may not reflect the actual diversity of dosing error that can occur across syringe orientations, batches, manufacturers, medications, etc. A computer-aided design software SolidWorks® was used to calculate the dosing errors in 0.5 and 1.0 ml legacy syringe connectors and were compared with dosing errors in LDT syringe connectors with the same nominal volume. Influence of orientation during delivery, spillage and flushing on dosing error was also investigated. RESULTS AND DISCUSSION: For 0.5 and 1.0 ml LDT syringes, in absence of medication in the moat area, the maximum dosing error will be ±5% when delivering 100% of nominal volume, which is also equal to the dosing error in 0.5 and 1.0 ml slip tip legacy syringes. However, with medication present in moat area, and with syringe reused during flushing, the LDT dosing error can range from 1% to 18% and 28% to 35% for 1.0 and 0.5 ml syringes, respectively. The corresponding dosing error for legacy syringes would be when the same syringe is used for flushing or when syringe disengages pointing vertically up. The corresponding dosing errors for legacy syringes could range from -7 to 12% and -9% to 19% for 1.0 and 0.5 ml syringes, respectively. Dosing errors for legacy and LDT syringes increase as the nominal capacity of syringe reduces, or when the dose delivered is lower than the nominal capacity of the syringe. WHAT IS NEW AND CONCLUSION: For LDT syringes, dosing errors can be reduced by clearing the moat area of the syringe and by using a new syringe for flushing post-delivery of medication. For legacy syringes, dosing errors can be minimized by ensuring the female connector points up during disengagement from the syringe post-medication administration, and by using a new syringe for flushing.

Human-centered design strategies in family and staff preparation for neonatal care.

OBJECTIVE: This paper describes human-centered design strategies used to develop solutions for neonatal intensive care unit (NICU) patients, families, and staff in preparation for transition from an open bay (OB) NICU to a single-family room (SFR) NICU. HUMAN-CENTERED DESIGN: Through a series of user group meetings, an interdisciplinary team of NICU families, administrators, providers, nurses, and other care team members (CTMs) collaborated with design professionals to create and carry out their vision for the new NICU. This process, which spanned the design, construction, and transition planning phases of the project, enabled stakeholders at the Medical University of South Carolina in Charleston, South Carolina (USA) to seek solutions for integrating patient and family-centered care into the fabric of its new facility and to redesign the care experience. RESULT: From this work, new opportunities for family and staff engagement emerged. CONCLUSIONS: Continuous end-user involvement led to targeted preparation for neonatal care.

Is the Medicines and Healthcare products Regulator Agency (MHRA) guidance on sodium valproate acceptable to women of childbearing age?

BACKGROUND: The UK Medicines and Healthcare products Regulatory Agency (MHRA) published guidelines restricting the use of sodium valproate in women of childbearing age unless they consented to the pregnancy prevention programme (PPP), receiving counselling by an epilepsy specialist, or meeting exclusion criteria. METHODS: We contacted every woman of childbearing age on valproate for epilepsy in NHS Tayside (122). RESULTS: Seventeen out of 122 (13.9%) responded to the initial invitation to attend, and 25 out of 122 (20.4%) responded to a letter sent to their GP. Twenty-five attended, 21 completed a consent form, seven switched to another drug and three attended to express dissatisfaction with the MHRA guidance. There were 53 patients identified with learning difficulties. Consent was only taken from three patients, with carers declining to sign consent because the patient was not sexually active. CONCLUSION: Our study suggests that patients and carers do not wish to stop valproate or engage in PPP despite being made aware of MHRA guidance.

Endometriosis: An Unusual Cause of Bilateral Pneumothoraces.

A 27-year-old female presented to the emergency department with sudden onset shortness of breath. A diagnosis of bilateral catamenial pneumothoraces was made following chest radiograph. Catamenial pneumothorax is a recurrent spontaneous pneumothorax that occurs in 90% of affected women 24-48 hours after the onset of their menstruation; 30-50% of cases have associated pelvic endometriosis. Symptoms can be as simple as chest pain or as severe as the presentation of this patient who was initially found to be in significant respiratory distress.

Keeping It Contemporary: Ensuring Dynamism in an Online Population Health Course.

BACKGROUND: Population health is a dynamic area that nurses must grasp to meet the demands of the evolving health care system. Staying current on public health priorities, health policies, and population health analytic approaches poses a challenge for nurse educators. METHOD: This article describes strategies used by nurse educators in a prelicen-sure population health course for student engagement on contemporary population health issues and highlights opportunities to develop skills and build competencies to lead population health initiatives. RESULTS: Innovations in course content, assignments, and evaluation strategies are useful in training nurses to thrive in health care systems addressing population health. Strategies to remain current on developments in the field promote population health competencies. CONCLUSION: Prelicensure nursing students can attain knowledge and skills in population health to prepare them to lead population health initiatives, analyze population-level data, provide care coordination, support complex patient groups, and optimize the use of research to promote evidence-based care. [J Nurs Educ. 2019;58(1):53-56.].

Rising Sea Levels: Helping Decision-Makers Confront the Inevitable.

Sea-level rise (SLR) is not just a future trend; it is occurring now in most coastal regions across the globe. It thus impacts not only long-range planning in coastal environments, but also emergency preparedness. Its inevitability and irreversibility on long time scales, in addition to its spatial non-uniformity, uncertain magnitude and timing, and capacity to drive non-stationarity in coastal flooding on planning and engineering timescales, create unique challenges for coastal risk-management decision processes. This review assesses past United States federal efforts to synthesize evolving SLR science in support of coastal risk management. In particular, it outlines the: (1) evolution in global SLR scenarios to those using a risk-based perspective that also considers low-probability but high-consequence outcomes, (2) regionalization of the global scenarios, and (3) use of probabilistic approaches. It also describes efforts to further contextualize regional scenarios by combining local mean sea-level changes with extreme water level projections. Finally, it offers perspectives on key issues relevant to the future uptake, interpretation, and application of sea-level change scenarios in decision-making. These perspectives have utility for efforts to craft standards and guidance for preparedness and resilience measures to reduce the risk of coastal flooding and other impacts related to SLR.

Quality Measures: A Stakeholder Analysis.

For quality measures, confusion and discontentment have increased, as availability of electronic data and data collection tools has expanded. We examined current issues with quality measures across 4 stakeholder groups: developers, regulators/endorsers, data collectors, and consumer advocates. There are missing quality measures, issues with data quality and purpose, questionable usability of electronic health records, and an increased measurement burden and cost. Policymakers, administrators, health care professionals, and consumers need to collaborate on measure development and selection.

Integrating Substance Use Content in an "Overcrowded" Nursing Curriculum.

Various factors have compelled nurse educators to address the lack of substance use-related content in nursing curriculum. Initiatives to add this content are often met with resistance because of an already crowded curriculum. This article describes a 4-phase process that guided the integration of this specialty content into a prelicensure nursing curriculum and a master's level advanced practice nursing curriculum. Lessons learned and recommendations from those experiences are provided to guide nurse educators undertaking similar efforts.

Diversifying the Health-Care Workforce Begins at the Pipeline: A 5-Year Synthesis of Processes and Outputs of the Scholarships for Disadvantaged Students Program.

The case for a more diverse health-care workforce has never been stronger given the rapidly changing demographics of the United States and the continued underrepresentation of certain racial and ethnic groups across the health professions. To date, progress toward diversifying the health-care workforce has been and continues to be deterred by a mix of factors at the societal, institutional, and individual levels. Since the 1970s, the Federal government has invested resources in initiatives that support the training and development of the existing workforce as well increase the supply of new health professionals-particularly those from underrepresented minority groups and/or from disadvantaged backgrounds. However, limited studies have been published detailing the processes, outputs and, where available, outcomes of such investments across multiple years. This article describes how the Health Resources and Services Administration's Bureau of Health Workforce used retrospective case study methodology to evaluate processes and outputs associated with the Scholarships for Disadvantaged Students program-an over US$40 million annual Federal investment aimed at offsetting tuition costs for health professions students from disadvantaged backgrounds-over a 5-year period. Lessons learned and recommendations for strengthening the program's design and requirements are provided.

Improving Competence and Confidence With Evidence-Based Practice Among Nurses: Outcomes of a Quality Improvement Project.

Evidence-based practice (EBP) is an integral part of quality patient care, reduction in practice variation, and increased nursing autonomy. Yet, EBP is not a consistent standard in many organizations. Although many barriers to EBP have been cited, this project focused on poor knowledge of the EBP process and a lack of available EBP mentors or experts. A bundled set of educational interventions to improve the EBP confidence and self-efficacy of nurses was developed and implemented. Comparison of pre/post data showed improvement in all categories and questions. Committee members expressed greater confidence with the process and comfort level with leading EBP projects following the intervention. The educational bundle used in this project can serve as a model for others looking to develop competent EBP mentors within their organization.

Deficiency in the Heat Stress Response Could Underlie Susceptibility to Metabolic Disease.

Heat treatment (HT) effectively prevents insulin resistance and glucose intolerance in rats fed a high-fat diet (HFD). The positive metabolic actions of heat shock protein 72 (HSP72), which include increased oxidative capacity and enhanced mitochondrial function, underlie the protective effects of HT. The purpose of this study was to test the ability of HSP72 induction to mitigate the effects of consumption of a short-term 3-day HFD in rats selectively bred to be low-capacity runners (LCRs) and high-capacity runners (HCRs)-selective breeding that results in disparate differences in intrinsic aerobic capacity. HCR and LCR rats were fed a chow or HFD for 3 days and received a single in vivo HT (41°C, for 20 min) or sham treatment (ST). Blood, skeletal muscles, liver, and adipose tissues were harvested 24 h after HT/ST. HT decreased blood glucose levels, adipocyte size, and triglyceride accumulation in liver and muscle and restored insulin sensitivity in glycolytic muscles from LCR rats. As expected, HCR rats were protected from the HFD. Importantly, HSP72 induction was decreased in LCR rats after only 3 days of eating the HFD. Deficiency in the highly conserved stress response mediated by HSPs could underlie susceptibility to metabolic disease with low aerobic capacity.

Revising the Scope and Standards for Nurse Administrators.

In the fall of 2013, the American Nurses Association began the process of redesigning the scope and standards for the nurse administrator. This article provides a synthesis of the top 10 changes in the new Scope and Standards for Nurse Administrators that are being reviewed for approval. These changes reflect the continuing evolution of practice for nurses serving as leaders across the United States.

Increasing Efficiency in Evaluation of Chronic Cough: A Multidisciplinary, Collaborative Approach.

Chronic cough is the most common reason for medical office visits in the United States. The typical patient has coughed more than 8 years and seen many specialists. This quality improvement project is an ambulatory clinic redesign to deliver efficient, patient-centered care with interspecialty collaboration. Methodology included the Institute for Healthcare Improvement collaborative model focused on Lean/Six Sigma and ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) Change Management. Interventions targeted education to referring providers, implementation of software changes, building a collaborative interdepartmental scheduling decision tree, and an interclinic dashboard enhancing communication and decision support. Outcome measures compare group resource utilization, evidenced by the total number of specialist referrals for same indication of chronic cough (International Classification of Diseases, Ninth Revision: 786.2), and length of time to complete evaluation. A retrospective review of 165 medical records yielded 2 groups, "current care" (n = 67) and "intervention" (n = 68). The number of specialist referrals per patient was reduced in the intervention group (M = 1.22, SD = 0.48) compared with the current care group (M = 3.33, SD = 1.02). Length of itinerary was reduced in the intervention group (M = 11.90, SD = 12.13, GM = 6.82) compared with the current care group (M = 126.93, SD = 158.13, GM = 54.8). Multidisciplinary collaboration, communication, coordinating diagnosis, and management of multifactorial conditions, such as chronic cough, are associated with lower costs and decreased utilization of health care resources.