The Verran Professional Governance Scale: Confirmatory and Exploratory Analysis.

This article describes psychometric testing and refinement of the Verran Professional Governance Scale (VPGS), which measures behaviors associated with professional governance. Phase 1 reduced the items on the scale based on floor and ceiling effects and redundancy of items. Phase 2 examined structural construct validity using exploratory (EFA) and confirmatory factor analysis (CFA). The final 22-item instrument demonstrates satisfactory internal consistencies and fit indices and significant positive correlation between the VPGS, job satisfaction, and control over nursing practice.

Selecting a theoretical framework to guide research on the COVID-19 pandemic impacts on nursing care delivery and the critical care work system (using Reed's Intermodern approach to theory critique).

Understanding the impact of COVID-19 on nursing care delivery in critical care work systems is urgently needed. Theoretical frameworks guide understanding of phenomena in research. In this paper, we critique four theoretical frameworks (Donabedian's Quality Model, the Quality Health Outcomes Model, the Systems Research Organizing Model, and the Systems Engineering (SEIPS) 2.0 Model) using (blinded) (2018) Intermodern philosophical perspective of nursing science. (blinded) (2018) Intermodern approach to theory critique was selected for its pragmatic perspective and focus on personal and professional health and wellbeing. The SEIPS 2.0 Model was ultimately selected to guide the study of the impact of the COVID-19 Pandemic on nursing care delivery in the critical care work systems.

Cardiovascular Consequences of Excessive Alcohol Drinking via Electrocardiogram: A Systematic Review.

ABSTRACT: There is a link between excessive alcohol drinking and an increased risk to develop cardiovascular disease, including alcoholic cardiomyopathy. This association warrants further research on the potential utility for the electrocardiogram (ECG) in the participatory management of the chronic consequences of alcohol use disorder (AUD). Our goal is to enhance understanding about the pernicious role alcohol plays on cardiac health using the ECG, an accessible, cost-effective, validated tool to inform novel targeted treatments for AUD. In this systematic review of human studies, we examine the relationship between abnormal clinically significant changes to ECG variables and excessive alcohol drinking with the goal of identifying key patterns specific to quantity of alcohol consumed. Three independent reviewers and one consensus reviewer, adhering to the PRISMA guidelines, conducted an initial review on studies published from database inception to April 19, 2019, using PubMed, Embase, CINAHL and COCHRANE databases. The initial search generated 2,225 articles. The final selected number included 153 original articles. This systematic review provides evidence of patterns of clinically significant changes to ECG variables as a consequence of excessive alcohol consumption. Future directions include investigating whether a real-time assessment, such as the ECG, in conjunction with other key behavioral and cardiac measures, can help clinicians and patients realize the progressive and insidious cardiac damage because of excessive alcohol consumption. This theory-guided nurse science review supports the development of personalized symptom monitoring to deliver tailored feedback that illuminate risk factors as a potentially transformative approach in the management of AUD.

Exploring the Stability of Communication Network Metrics in a Dynamic Nursing Context.

Network stability is of increasing interest to researchers as they try to understand the dynamic processes by which social networks form and evolve. Because hospital patient care units (PCUs) need flexibility to adapt to environmental changes (Vardaman, Cornell, & Clancy, 2012), their networks are unlikely to be uniformly stable and will evolve over time. This study aimed to identify a metric (or set of metrics) sufficiently stable to apply to PCU staff information sharing and advice seeking communication networks over time. Using Coefficient of Variation, we assessed both Across Time Stability (ATS) and Global Stability over four data collection times (Baseline and 1, 4, and 7 months later). When metrics were stable using both methods, we considered them "super stable." Nine metrics met that criterion (Node Set Size, Average Distance, Clustering Coefficient, Density, Weighted Density, Diffusion, Total Degree Centrality, Betweenness Centrality, and Eigenvector Centrality). Unstable metrics included Hierarchy, Fragmentation, Isolate Count, and Clique Count. We also examined the effect of staff members' confidence in the information obtained from other staff members. When confidence was high, the "super stable" metrics remained "super stable," but when low, none of the "super stable" metrics persisted as "super stable." Our results suggest that nursing units represent what Barker (1968) termed dynamic behavior settings in which, as is typical, multiple nursing staff must constantly adjust to various circumstances, primarily through communication (e.g., discussing patient care or requesting advice on providing patient care), to preserve the functional integrity (i.e., ability to meet patient care goals) of the units, thus producing the observed stability over time of nine network metrics. The observed metric stability provides support for using network analysis to study communication patterns in dynamic behavior settings such as PCUs.

Evaluating Changes in Caring Behaviors of Caritas Coaches Pre and Post the Caritas Coach Education Program.

OBJECTIVE: The aim of this study was to examine program effectiveness in changing Caritas leadership, self-caring behaviors, and perceptions of coworkers of participants who completed the Caritas Coach Education Program (CCEP). BACKGROUND: The CCEP has been a highly successful education program for individuals who wish to intellectually and experientially learn to teach, live, and practice human caring theory. METHODS: A pretest-posttest descriptive design was used to evaluate changes in perceptions of self-caring, caritas leadership, and coworker behaviors after completion of CCEP. RESULTS: The mean scores of all measures improved significantly. CONCLUSIONS: After completion of CCEP, participants demonstrated statistically significant changes in 3 caritas measures: leadership, coworker, and self-rating. Caritas Coach participants exhibited the greatest change in their self-caring scores.

Measurement of Patients' Perceptions of the Quality of Acute Stroke Services: Development and Validation of the STROKE Perception Report.

INTRODUCTION: Patients' perceptions of healthcare quality have become an important part of quality measurement. We explored patients' and family's lived experiences during acute stroke hospitalization to develop a quantitative instrument. METHODS: Focus groups were conducted using open-ended scripted questions. Interview data were coded and analyzed using an inductive approach to thematic analysis. Symmetric patient and family instruments were developed based on qualitative domains and serially refined to a set of 30 survey items, 12 stroke knowledge test items, and 5 subject demographic fields. Scales were evaluated for internal consistency reliability using Cronbach α; construct validity with exploratory factor analysis using principal components with varimax rotation was performed to determine the extent to which items in a scale measure the same underlying factor. Feasibility of an electronic cloud-based survey was also tested. RESULTS: Three main themes emerged: fast action to diagnose and treat stroke, genuine caring, and education to prevent and respond to stroke. A total of 1029 subjects completed the final instrument with no differences in perception found by race, ethnicity, or length of stay. Scales showed satisfactory internal consistency reliability (Cronbach α scores, .89-.94); factor loadings across each scale ranged from 0.55 to 0.87. Data entry by electronic pad was perceived by 77% to be more confidential than paper surveys; median score for difficulty was 4 ("easy to use"). CONCLUSION: The STROKE Perception Report enables understanding of patients' and family's beliefs about the quality of acute stroke care in essential new domains never explored before.

A model to evaluate data science in nursing doctoral curricula.

BACKGROUND: Building on the efforts of the American Association of Colleges of Nursing, we developed a model to infuse data science constructs into doctor of philosophy (PhD) curriculum. Using this model, developing nurse scientists can learn data science and be at the forefront of data driven healthcare. PURPOSE: Here we present the Data Science Curriculum Organizing Model (DSCOM) to guide comprehensive doctoral education about data science. METHODS: Our team transformed the terminology and applicability of multidisciplinary data science models into the DSCOM. FINDINGS: The DSCOM represents concepts and constructs, and their relationships, which are essential to a comprehensive understanding of data science. Application of the DSCOM identified areas for threading as well as gaps that require content in core coursework. DISCUSSION: The DSCOM is an effective tool to guide curriculum development and evaluation towards the preparation of nurse scientists with knowledge of data science.

Relationship of Staff Information Sharing and Advice Networks to Patient Safety Outcomes.

OBJECTIVE: The aim of this study was to compare information sharing and advice networks' relationships with patient safety outcomes. BACKGROUND: Communication contributes to medical errors, but rarely is it clear what elements of communication are key. METHODS: We investigated relationships of information-sharing and advice networks to patient safety outcomes in 24 patient care units from 3 hospitals over 7 months. Web-based questionnaires completed via Android tablets provided data to create 2 networks using ORA, a social network analysis application. Each hospital provided nurse-sensitive patient safety outcomes. RESULTS: In both networks, medication errors correlated positively with node count and average distance and negatively with clustering coefficient. Density and weighted density negatively correlated with medication errors and falls in both networks. Eigenvector and total degree centrality correlated negatively with both safety outcomes, whereas betweenness centrality positively related to falls in the information-sharing network. CONCLUSION: Technology-enabled social network analysis data collection is feasible and can provide managers actionable system-level information.

Nursing Unit Design, Nursing Staff Communication Networks, and Patient Falls: Are They Related?

PURPOSE:: The purpose of this research is to (1) investigate the impact of nursing unit design on nursing staff communication patterns and, ultimately, on patient falls in acute care nursing units; and (2) evaluate whether differences in fall rates, if found, were associated with the nursing unit physical structure (shape) or size. BACKGROUND:: Nursing staff communication and nursing unit design are frequently linked to patient safety outcomes, yet little is known about the impact of specific nursing unit designs on nursing communication patterns that might affect patient falls. METHOD:: An exploratory longitudinal correlational design was used to measure nursing unit communication structures using social network analysis techniques. Data were collected 4 times over a 7-month period. Floor plans were used to determine nursing unit design. Fall rates were provided by hospital coordinators. RESULTS:: An analysis of covariance controlling for hospitals resulted in a statistically significant interaction of unit shape and size (number of beds). The interaction occurred when medium- and large-sized racetrack-shaped units intersected with medium- and large-sized cross-shaped units. CONCLUSION:: The results suggest that nursing unit design shape impacts nursing communication patterns, and the interaction of shape and size may impact patient falls. How those communication patterns affect patient falls should be considered when planning hospital construction of nursing care units.

Informatics Solutions for Application of Decision-Making Skills.

Critical care nurses practice in a challenging environment that requires responses to patients with complex, often unstable health conditions. The electronic health record, access to clinical data, and Clinical Decision Support Systems informed by data from clinical databases are informatics tools designed to work together to facilitate decision-making in nursing practice. The complex decision-making environment of critical care requires informatics tools that support nursing practice through integration of current evidence with clinical data. Recommendations include continuing efforts toward the development of clinical decision support tools based on patient data that include predictive models to support increased patient safety.

Foot Massage, Touch, and Presence in Decreasing Anxiety during a Magnetic Resonance Imaging: A Feasibility Study.

OBJECTIVES: The purpose of the study was to determine (1) recruitment feasibility; (2) intervention adherence; (3) intervention acceptability; and (4) the preliminary effects of touch or foot massage interventions on anxiety during a magnetic resonance imaging (MRI). DESIGN: A quasi-experimental design was used. INTERVENTION: Foot massage and touch were the intervention groups and "presence" was the control group. SETTING: The study was conducted at the Center for Neurosciences, a freestanding facility, in southern Arizona. PARTICIPANTS: The sample (N = 60) was predominantly Caucasian (58.3%), married (55%), and college educated (43.3%). There were 39 females and 21 males. Fifty-three percent of the participants had an MRI head scan. OUTCOME MEASURES: Recruitment feasibility was the percentage of participants enrolled out of those screened. Adherence to foot massage and touch interventions was measured by the researcher's ability to apply full intervention for 20 min. Four factors measured participants' acceptance of the interventions as follows: (1) comfort; (2) acceptability of the length of the treatment; (3) perception of effectiveness; and (4) recommendation of treatment as part of routine MRI care. The MRI technologists' acceptability was measured by whether the intervention: (1) disrupted the workflow and (2) affected the length of the scan. State anxiety was assessed verbally by a single 10-point Likert type item. RESULTS: Recruitment feasibility was 78.2%. There were no barriers to the intervention protocol for 91.6% participants. The overall mean value of perceived effectiveness was 8.53, SD = 2.4 on a 10-point Likert type question. There was a significant difference among the three groups in terms of perceived effectiveness of the intervention F(2, 57) = 15.19, p < 0.001. Multilevel modeling documented that the foot massage intervention was a significant predictor of decreasing anxiety (ß = -1.35, SE = 0.63, p < 0.01). CONCLUSION: The use of foot massage or touch is feasible, acceptable by patients and technologists, and the use of foot massage was associated with lower state anxiety.

Nursing Unit Communication During a US Public Health Emergency: Natural Experiment.

BACKGROUND: In the second half of 2014, the first case of Ebola virus disease (EVD) was diagnosed in the United States. During this time period, we were collecting data for the Measuring Network Stability and Fit (NetFIT) longitudinal study, which used social network analysis (SNA) to study relationships between nursing staff communication patterns and patient outcomes. One of the data collection sites was a few blocks away from where the initial EVD diagnosis was made. The EVD public health emergency during the NetFIT data collection time period resulted in the occurrence of a natural experiment. OBJECTIVE: The objectives of the NetFIT study were to examine the structure of nursing unit decision-making and information-sharing networks, identify a parsimonious set of network metrics that can be used to measure the longitudinal stability of these networks, examine the relationship between the contextual features of a unit and network metrics, and identify relationships between key network measures and nursing-sensitive patient-safety and quality outcomes. This paper reports on unit communication and outcome changes that occurred during the EVD natural disaster time period on the 10 hospital units that had data collected before, during, and after the crisis period. METHODS: For the NetFIT study, data were collected from nursing staff working on 25 patient care units, in three hospitals, and at four data collection points over a 7-month period: Baseline, Month 1, Month 4, and Month 7. Data collection was staggered by hospital and unit. To evaluate the influence of this public health emergency on nursing unit outcomes and communication characteristics, this paper focuses on a subsample of 10 units from two hospitals where data were collected before, during, and after the EVD crisis period. No data were collected from Hospital B during the crisis period. Network data from individual staff were aggregated to the nursing unit level to create 24-hour networks and three unit-level safety outcome measures-fall rate, medication errors, and hospital-acquired pressure ulcers-were collected. RESULTS: This analysis includes 40 data collection points and 608 staff members who completed questionnaires. Participants (N=608) included registered nurses (431, 70.9%), licensed vocational nurses (3, 0.5%), patient care technicians (133, 21.9%), unit clerks (28, 4.6%), and monitor watchers (13, 2.1%). Changes in SNA metrics associated with communication (ie, average distance, diffusion, and density) were noted in units that had changes in patient safety outcome measures. CONCLUSIONS: Units in the hospital site in the same city as the EVD case exhibited multiple changes in patient outcomes, network communication metrics, and response rates. Future research using SNA to examine the influence of public health emergencies on hospital communication networks and relationships to patient outcomes is warranted.

Decision-making in nursing practice: An integrative literature review.

AIMS AND OBJECTIVES: To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). BACKGROUND: Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. DESIGN: PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. RESULTS: Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. CONCLUSIONS: Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. RELEVANCE TO CLINICAL PRACTICE: Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes.

Impact of Professional Nursing Practices on Patient/Nurse Outcomes: Testing the Essential Professional Nursing Practices Instrument.

Increasing patient and healthcare system complexity and the need to accurately measure the engagement of clinical nurses (CNs) in holistic, professional nursing practice indicates that an update to the Essentials of Magnetism instrument is needed. The purposes of this research were to critique and weight items, assess the value and psychometric properties of the newly constructed Essential Professional Nursing Practices (EPNP) instrument, and establish relationships between EPNPs and CN job, practice, and nurse-assessed patient satisfaction.

Designing a Virtual Simulation Case for Cultural Competence Using a Community-Based Participatory Research Approach: A Puerto Rican Case.

In this study, a community-based participatory research approach was used for developing content for a virtual simulation case. The virtual simulation case was designed to develop the cultural competence of prelicensure nursing students in caring for a Puerto Rican patient with diabetes. This article presents the method used to establish a Puerto Rican community advisory board to develop content for a virtual simulation case for cultural competency.

Evaluation of Authentic Human Caring Professional Practices.

OBJECTIVE: The aim of this study was to present an instrument and comparative database designed to evaluate patients' perceptions of caring behaviors of caregivers. BACKGROUND: Acute care leaders are under pressure to improve publicly reported patient satisfaction scores. Some nurse leaders have implemented professional practice environments based on human caring theory, whereas others have used scripting to standardize communication between staff and patients. METHODS: The Watson Caritas Patient Score (WCPS) is collected quarterly from a random sample of patients who are admitted to acute care hospital units. RESULTS: The WCPS was able to discriminate across unit types and hospitals. Items were related to publicly reported nursing communication scores. CONCLUSIONS: Participation in research based on human caring theory has given nurse leaders the opportunity to evaluate effectiveness of professional practice environments. It may provide the opportunity to focus staff communication with patients more authentically and in a way that enriches the experience for both.

The evolution and development of an instrument to measure essential professional nursing practices.

Nursing continues to evolve from a task-oriented occupation to a holistic professional practice. Increased professionalism requires accurate measurement of care processes and practice. Nursing studies often omit measurement of the relationship between structures in the work environment and processes of care or between processes of care and patient outcomes. Process measurement is integral to understanding and improving nursing practice. This article describes the development of an updated Essentials of Magnetism process measurement instrument for clinical nurses (CNs) practicing on inpatient units in hospitals. It has been renamed Essential Professional Nursing Practices: CN.

Revision and psychometric properties of the caring assessment tool.

Evaluation of the Caring Assessment Tool (CAT) is essential for its use in the monitoring and ongoing improvement of patient-nurse relationships. This descriptive, prospective study evaluated the dimensionality and internal reliability of the instrument in a sample of hospitalized adults. In addition, reduction of items was achieved, lessening clinical and administrative burden. Data were collected from 1,111 patients in 12 U.S. hospitals in 4 geographically distinct regions. A single factor explained 73% of the variance in the construct and the number of items was reduced to 27. Internal consistency remained high (a = .97). Patient-nurse relationship data were collected safely and efficiently from hospitalized patients using a paper-and-pencil approach. The CAT holds promise for providing acute care registered nurses with the information they need to deliver reliable patient-centered care.