Developing Empathy in Emergency Nurses Using Hearing Voices Simulation.

Background: Many health professionals report feeling uncomfortable talking with patients who hear voices. Patients who hear voices report feeling a lack of support and empathy from emergency nurses. A local emergency department reported a need for training for nurses in the care of behavioral health patients. Objective: The aim of this study is to implement a quality improvement project using a hearing voices simulation. Empathy was measured using the Toronto Empathy Questionnaire, and a post-intervention survey was used to evaluate emergency nurses' perception of the professional development session. Methods: The quality improvement project included the implementation of a hearing voices simulation with emergency nurses. A paired t-test was used to determine the differences in the nurses empathy levels pre-and post-simulation. Qualitative data was collected on the nurses' experience during the simulation debriefing. A Likert-style questionnaire was used to collect data on the nurses' evaluation of the simulation. Results: The results of the hearing voices simulation were a statistically significant increase (p < .00) in empathy from baseline (M = 47.95, SD = 6.55) to post-intervention empathy scores (M = 48.93, SD = 6.89). The results of the post-simulation survey indicated that nurses felt that the hearing voices simulation was useful (n = 100; 98%) and helped them to feel more empathetic toward patients who hear voices (n = 98; 96%). Conclusions: Using a hearing voices simulation may help emergency nurses feel more empathetic toward the behavioral health patients who hear voices. Implications for Nursing: Through the implementation of a hearing voices simulation, clinical staff educators can provide support to staff nurses in the care of behavioral health patients.

Engaging Stakeholder Advisors Around Health-Related Social Needs Research, Policy, and Practice Priorities.

As health care systems invest significant resources to address social needs associated with poor health such as food, financial, and housing insecurity, many eligible patients are still not obtaining the resources they need. The recently initiated PURPLE Project (Promoting Understanding in Social Needs Research Projects by Listening and Engaging) engages stakeholder advisors to help address 2 challenges: (1) many patients do not accept offered assistance, and (2) of patients who accept assistance, less than half have their needs addressed. This article presents the team's engagement with local advisors, garnering real-life insights from patients with social needs, staff and leadership in public health, health care, and community service organizations. The team shares these organizations' priorities and recommendations and how these can be applied to these major challenges. This article can assist others in the social care arena who seeks to involve local partners as advisors to improve practices and policies in addressing social needs.

Nurse-led hospital-to-community care, clinical outcomes for people living with HIV and health-related social needs.

AIMS: To evaluate whether patients with HIV enrolled in Linkage to Care (hospital-based only) or Linkage to Care Plus (nurse-led hospital-to-community transitional care) programmes fare better on clinical outcomes; and to investigate how factors such as substance use, mental health or health-related social needs contribute to these outcomes. BACKGROUND: Social determinants of health contribute to poor HIV outcomes such that only 57% of people living with HIV have achieved the goal of viral suppression nationally, and 50% are retained in clinical care. The programmes evaluated here aimed to increase HIV appointment attendance, retention in care, viral suppression and decrease acute care utilization and mitigate social needs via hospital-to-community transitional support. DESIGN: A retrospective observational cohort study. METHODS: We conducted a retrospective patient chart review abstracting data over three time periods between 2017 and 2020 to conduct this longitudinal programme evaluation. RESULTS: Both programmes had meaningful effects on increasing HIV appointment attendance and viral suppression; Linkage to Care Plus experienced the largest gains. Older age was associated with viral suppression, and housing insecurity and mental health conditions were associated with increased emergency department utilization. CONCLUSION: Hospital-only and nurse-led hospital-to-community transitional care programmes can positively influence HIV care outcomes. There is a need for enhanced attention and accountability related to health-related social needs, especially housing, and mental and behavioural health, to end the HIV epidemic. IMPACT: Globally, we are striving to end the HIV epidemic with evidence-informed interventions. The nurse-led hospital-to-community and the hospital-only interventions evaluated here improved HIV outcomes with most gains realized by the nurse-led transitional care model. Integrating lessons from these programmes, with increased attention and accountability for addressing social needs, can improve practice and policies to achieve programmatic and national goals related to HIV and other diseases, and more critically, to meet the goals of the people we serve. PATIENT OR PUBLIC CONTRIBUTION: Patients, staff and leadership at the University of Maryland Institute of Human Virology JACQUES Initiative and University of Maryland Medical Center THRIVE clinic contributed to the design and implementation of the programmes and informed the programme evaluation study.

Nursing Students' Perceptions of a Community Health Street Outreach Experience: Thematic Analysis.

BACKGROUND: There has been increased focus within nursing to address social determinants of health (SDOH), and nurse educators are urged to integrate SDOH into the curriculum, strengthen community and public health (CPH) clinical experiences, and provide service-learning opportunities. Therefore, student feedback was sought for a CPH clinical experience involving street outreach. METHOD: Two groups of nursing students conducted street outreach with unstably housed individuals in an urban area in the eastern United States. Focus groups and thematic analysis were conducted. RESULTS: Students expressed high levels of satisfaction with the experience. The following themes were identified: Influence of Prior Experiences, Transformational Experience, and Making a Difference. Following the CPH experience, the majority of students reported they were considering working in CPH nursing. CONCLUSION: Engaging in street outreach and similar experiences has the potential to improve nursing students' perceptions of CPH clinical experiences and prepare them for careers in CPH nursing. [J Nurs Educ. 2022;61(7):394-397.].

A Quality Improvement Project on Agitation Management in the Emergency Department.

INTRODUCTION: Agitation is common in the emergency department. When agitation is not detected early, patients can become aggressive and violent, potentially leading to restraint use and subsequent injury. The goals of the project were early detection and management of patient agitation, reduction of restraint use in the emergency department, and determination of the usability of the Behavioral Activity Rating Scale. METHODS: This quality improvement project was assessed using a pre- and posttest single unit design, comparing 4 months of postimplementation data to historic controls at the same time of year in the previous year. The intervention was implementing the Behavioral Activity Rating Scale in the ED electronic medical record. Data were collected through retrospective chart review and nurse survey. From September through December of both 2017 and 2018, data were collected on restraint use. The 4-month 2018 data collection period included measures of Behavioral Activity Rating Scale documentation and the System Usability Scale survey for nurses to measure ease of usability of the Behavioral Activity Rating Scale. RESULTS: The Behavioral Activity Rating Scale was documented frequently (n = 4 867 documentations) by emergency nurses to assess patients with behavioral health and medical complaints (n = 780). Nurses identified 18 episodes of violent behavior in behavioral health patients on the Behavioral Activity Rating Scale (2.31%) and applied restraints 18 times. The most common chief complaints for patients who were identified as violent was suicidal ideation (n = 6; 33.33%). In 2017, there were 20 episodes of restraint use during the same time period, a nonsignificant difference (χ2 = 0.72; P = 0.40). However, only 2 patients were kept in restraints longer than 1 day in 2018 compared with 8 in 2017. Emergency nurses found the Behavioral Activity Rating Scale to be usable in the structured usability assessment (µ = 83.46; SD = 11.73). DISCUSSION: The Behavioral Activity Rating Scale is a usable tool for emergency nurses to assess for patient agitation. With the incorporation of agitation management interventions, the ED team can potentially manage agitation before violence occurs. Further studies are needed on the use of agitation or aggression assessment tools for managing patient behavioral activity such as aggression in the emergency department.

An interdisciplinary street outreach program to engage vulnerable neighbors in care.

Those experiencing poverty, homelessness, or behavioral health disorders are difficult to engage and maintain in health care services. These vulnerable populations experience unique barriers to engagement in health care services, which fuel health inequity. We need innovative approaches to address this need. This paper discusses the reciprocal relationship between a community center and a local university, which led to a street outreach program that provides a dynamic interprofessional experience for nursing, medical, and social work students and helps connect vulnerable populations to care. Over 12 weeks, students interacted with 127 neighbors. The most common interventions used were as follows: support and encouragement, health teaching, providing medical supplies, and/or referrals to the community center to meet with case management and/or attend the nurse-run public health clinic. The encounters often resulted in neighbors' goals being met, neighbors' planning to use the community outreach center (COC) in the future, and neighbors leaving the encounter with a plan to manage their health.

Two Nursing Outreach Interventions to Engage Vulnerable Populations in Care.

People experiencing substance use disorders, homelessness, mental health conditions, or poverty often have difficultly engaging in healthcare services particularly prevention services. This brief report describes two nursing interventions implemented by nursing students that aim to empower vulnerable populations and draw them into care using empathetic and patient-centered approaches. The first intervention uses street outreach with naloxone training in an area of Baltimore experiencing a high rate of overdose deaths. The second uses home or street outreach to link people living with HIV to HIV care.

Emotional Work of Neonatal Nurses in a Single-Family Room NICU.

OBJECTIVE: To describe the emotional work of neonatal nurses in a single-family room NICU. DESIGN: Qualitative interpretive description. SETTING: A single-family room NICU in the mid-Atlantic region of the United States. PARTICIPANTS: Fifteen nurses who worked in the single-family room NICU. METHODS: Data were collected from 110 hours of direct observation and 11 interviews over a 6-month period. We focused on emotional demands using triangulation between interviews and observations to identify themes. Conceptualization of emotional work informed interpretation. RESULTS: Four themes emerged: Parents Living on the Unit, Isolation of Infants in Rooms, Nurses' Ability to Form Bonds and Establish Trust With Parents, and Sheltering Nurses and Parents From Stressful Events on the Unit. Parents living on the unit and the isolation of infants in private rooms increased the emotional work of nurses. Forming trust and bonds with parents and sheltering parents and themselves from stressful events on the unit decreased nurses' emotional work. CONCLUSION: Care should be taken in NICU design because unit layout can affect the emotional work of nurses. Understanding how neonatal nursing practice is affected by unit layout can help nurses and those who design NICUs to create and promote optimal practice environments.

Neonatal Intensive Care Unit Layout and Nurses' Work.

Neonatal intensive care units (NICUs) remain one of the few areas in hospitals that still use an open bay (OPBY) design for patient stays greater than 24 hr, housing multiple infants, staff, and families in one large room. This creates high noise levels, contributes to the spread of infection, and affords families little privacy. These problems have given rise to the single-family room NICU. This represents a significant change in the care environment for nurses. This literature review answers the question: When compared to OPBY layout, how does a single family room layout impact neonatal nurses' work? Thirteen studies published between 2006 and 2015 were located. Many studies reported both positive and negative effects on nurses' work and were therefore sorted by their cited advantages and disadvantages. Advantages included improved quality of the physical environment; improved quality of patient care; improved parent interaction; and improvements in nurse job satisfaction, stress, and burnout. Disadvantages included decreased interaction among the NICU patient care team, increased nurse workload, decreased visibility on the unit, and difficult interactions with family. This review suggests that single-family room NICUs introduce a complex situation in which trade-offs occur for nurses, most prominently the trade-off between visibility and privacy. Additionally, the literature is clear on what elements of nurses' work are impacted, but how the built environment influences these elements, and how these elements interact during nurses' work, is not as well understood. The current level of research and directions for future research are also discussed.

Race as a predictor of job satisfaction and turnover in US nurses.

AIM: The purpose of this analysis is to determine US minority nurses' job satisfaction and turnover using three outcome variables: job dissatisfaction; change of jobs; and intent to quit. BACKGROUND: A balanced nursing workforce is essential for supporting a racially diverse nation. Understanding minority nurses' job satisfaction is the first step in achieving this balance. METHODS: A secondary data analysis was conducted using the 2008 National Sample Survey of Registered Nurses. The association between race and job satisfaction was examined using logistic regression. RESULTS: Black nurses were more likely to intend to quit than white ones (OR = 1.46, 95% CI = 1.31-1.64), as were Hispanics (OR = 1.35, 95% CI = 1.18-1.55). Asians were less dissatisfied (OR = 0.69, 95% CI = 0.57-0.84), and less likely to have changed jobs (OR = 0.71, 95% CI = 0.60-85) or intend to quit (OR = 0.84, 95% CI = 0.75-0.95) than white nurses. CONCLUSIONS: This analysis demonstrated that black and Hispanic nurses are more likely to intend to quit, even while controlling for dissatisfaction. The reasons for this, and the increased job satisfaction demonstrated by Asian nurses, are directions for future research. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should endeavour to create a workplace free of discrimination. Efforts to increase the job satisfaction of all nurses are of equal importance.

Black Jobs Matter: Racial Inequalities in Conditions of Employment and Subsequent Health Outcomes.

African-Americans shoulder an excessive burden of unemployment, precarious employment, and low paying jobs in the United States, which may help explain why they experience some of the worst health outcomes among U.S. citizens. This paper presents a conceptual framework describing this phenomenon. The social determinants of health as described by this framework include racism, social and public policy formation, socioeconomic status, and conditions of employment. The intermediate determinants of health, which include the ability to afford health behavior, depression and addiction, environmental exposures, and access to primary care, are informed by conditions of employment, which leads to poor health outcomes for African-Americans. This paper will explore in detail these relationships.

Experience of insomnia, symptom attribution and treatment preferences in individuals with moderate to severe COPD: a qualitative study.

Persons with chronic obstructive pulmonary disease (COPD) are known to have poor sleep quality. Acceptance of and adherence to therapies for sleep problems may depend on how the person with COPD regards the source of his sleep problem, yet little is known about their attribution as to the cause of these sleep symptoms. The objective of this study was to describe the subjective sleep complaints of individuals with COPD along with their attributions as to the cause of these symptoms, and their treatment preferences for insomnia. Three focus groups were conducted (N=18) with participants who have moderate to severe COPD. Focus group data were transcribed, compared and contrasted to identify themes of attribution. Participants reported difficulty falling asleep, staying asleep, and daytime sleepiness. They attributed their sleep problems primarily to their pulmonary symptoms, but also poor air quality (thick humid air) and death anxiety when awake during the night. There was no clear preference for type of treatment to remedy this problem (medication, cognitive therapy), although they indicated that traveling to the clinic was difficult and should be avoided as much as possible. These data suggest that environmental manipulation to improve air quality (eg, air conditioning) and modifications to reduce death anxiety could be beneficial to persons with COPD. In-person multi-session therapy may not be acceptable to persons with moderate to severe COPD, however internet-based therapy might make treatment more accessible.