Measuring the Interprofessional Health of the Pediatric Cardiovascular Operating Room Work Environment.

Introduction: Pediatric cardiac surgery is complex and has significant risk, requiring interprofessional teamwork for optimal outcomes. Unhealthy work environments have been linked to poor patient outcomes, staff dissatisfaction, and intention to leave. We describe the interprofessional health of pediatric cardiovascular operating room (CVOR) work environments in the United States and the establishment of a healthy work environment (HWE) benchmark score. Methods: Utilizing the American Association of Critical Care Nurses Healthy Work Environments Assessment Tool (HWEAT), interprofessional staff from 11 pediatric CVORs were surveyed. Responses were aggregated, summarized, and stratified by role to examine differences. The following phase used an e-Delphi approach to obtain expert consensus on a benchmark target. Results: Across 11 centers, 179 (60%) completed surveys were reviewed. The interprofessional mean HWEAT score was 3.55 (2.65-4.34). Mean scores for each standard were within the "good" range. Participants reported the highest scores for effective decision-making, with a mean of 3.69 (3.00-4.20). Meaningful recognition scored lowest, mean 3.26 (2.33-4.07). When stratified, surgeons reported higher overall HWE scores (M = 3.79, SD = 0.13) than nurses (M = 3.41, SD = 0.19; P = 0.02, two-tailed). The proposed benchmark was 3.50. Conclusions: This is the first time the American Association of Critical Care Nurses HWEAT has been used to describe the interprofessional health of work environments in pediatric CVORs in the United States. The targeted benchmark can support pediatric CVOR improvement strategies. Creating and sustaining an HWE is an interprofessional opportunity to support high-quality patient outcomes and clinical excellence.

De-adopting low-value care: The missing step in evidence-based practice?

BACKGROUND: Low-value care provides little or no benefit to pediatric patients, has the potential to cause harm, waste healthcare resources, and increase healthcare costs. Nursing has a responsibility to identify and de-adopt low-value practices to help promote quality care. PURPOSE: 1) Describe the process of identifying and de-adopting low-value clinical practices guided by a conceptual model using a case study approach. 2) Identify facilitators and barriers to de-adoption practices, including levels of stakeholder engagement, organizational structures, and the quality of available scientific and non-scientific evidence. METHODOLOGY: An evidence-based practice (EBP) project investigating the efficacy of antihistamines in decreasing infusion reactions to infliximab identified a low-value practice within a pediatric infusion center. The Synthesis Model for the Process of De-adoption was then applied to guide the de-adoption of this low-value practice. Case study analysis highlighted facilitators and barriers to de-adoption efforts. CONCLUSIONS: The process for de-adopting care is an essential component of EBP and, as such, should be explicated through robust, standardized EBP processes and education. PRACTICE IMPLICATIONS: Nurses are best positioned to identify, assess and prioritize low-value practices and facilitate the de-adoption of low-value practice that impact pediatric patients and families. Models to support de-adoption and a focus on site-specific practices including a prepared nursing workforce, continuous evaluation of care processes and the use of resources to assess for contextual determinants facilitates success and sustainability of this essential EBP approach.

The Impact of Psychological Capital and Workplace Social Support on Pediatric Oncology Nurses' Post Traumatic Stress Disorder (PTSD) Symptomology.

Introduction: Work-related post traumatic stress disorder (PTSD) can develop in nurses. Pediatric oncology nursing is a potentially high-risk subspecialty for PTSD secondary to the nature of the work. This study aimed to describe the prevalence of PTSD symptomology and explore relationships between nurse psychological capital, workplace social supports, and PTSD symptomology in pediatric oncology nurses. Methods: The study utilized a cross-sectional correlational survey design. Pediatric oncology nurses working in direct patient care in the United States completed a demographics questionnaire, Psychological Capital Questionnaire (PCQ), Coworker Support Scale, Supervisor Support Scale, and the Post traumatic Checklist for Diagnostic and Statistical Manual of Mental Disorders (PCL-5). Descriptive and inferential statistics, including logistic regression models, were used to analyze data. A cutoff score of ≥31 on the PCL-5 was used to determine the prevalence of PTSD symptomology. Results: The sample included 424 nurses. The prevalence of PTSD symptomology was 13.4%. Work setting (inpatient), decreased coworker and leadership social support, and psychological capital were independently associated with PTSD symptomology. After controlling for covariates, only psychological capital was associated with PTSD symptomology. For a 1 unit decrease in PCQ score, pediatric oncology nurses were 4.25 times more likely to have PTSD symptomology. Discussion: PTSD prevalence rates in pediatric oncology nurses are aligned with rates found in other nursing specialties. Nurse psychological capital may play a protective role against PTSD symptomology. Implications for Future Research: Findings support PTSD as a serious workplace concern for nurses. Workplace programs that foster nurses' psychological capabilities should be considered to protect against the development of PTSD symptomology.

Keys to Success: A Professional Development Program to Support Care of Patients With Autism Spectrum Disorder.

Patients with autism spectrum disorder present with an extensive range of communication and social skills that require healthcare workers to have a comprehensive understanding of best practices for providing holistic care. This article presents the planning, curriculum development, implementation, and evaluation of a professional development program aimed at providing interprofessional staff with strategies and resources to use when caring for patients with autism spectrum disorder.

Pediatric Suicide Screening: A Review of the Evidence.

BACKGROUND: Suicide rates are increasing for youths and suicide is the second leading cause of death for 10-24 year olds. This evidence-based practice project critically reviews literature regarding the effectiveness of pediatric suicide screening. METHODS: A literature search was guided by the following question: In pediatric patients, does suicide screening at every health encounter compared to an annual screen increase clinician identification of patients at-risk. Ten articles met inclusion criteria and were critically appraised and synthesized. FINDINGS: Youths had high rates of suicidal ideation (SI), anxiety, and depression. Pediatric universal suicide screening identified SI in youths with both psychiatric and non-psychiatric medical complaints. Patients with chronic health conditions reported higher rates of mental health symptoms and SI. A specific suicide screening instrument should be used as general mental health screens likely miss youths at-risk for SI. The Ask Suicide-Screening Questions tool is an easy to use and highly sensitive instrument for detecting suicide risk in youths. DISCUSSION: Many youths that screen positive for SI do not have known mental health concerns and would have been missed if not asked directly. Universal screening for SI identifies at-risk youth and allows nurses and other providers to intervene. The need for universal screening across pediatric health care settings using brief, validated screening tools is paramount. APPLICATION TO PRACTICE: Nurses working in pediatric settings should champion universal screening for SI. Unit-based quality improvement projects using the Plan-Do-Study-Act change cycle provides a model for instituting universal screening for SI.

The Efficacy of Antihistamines in Preventing Reactions to Infliximab in Patients With Crohn Disease/Ulcerative Colitis: A Review of the Evidence.

Inflammatory bowel diseases, including Crohn disease and ulcerative colitis, are most often diagnosed during adolescence and young adulthood, with a rising incidence in pediatric populations. Infliximab is an effective treatment option for Crohn disease and ulcerative colitis. The most common adverse event with infliximab is an infusion reaction. Patients are often treated prophylactically with combinations of acetaminophen, intravenous steroid, and an antihistamine to prevent an infusion reaction. There is a high degree of practice variation regarding pretreatment for infliximab infusions, the efficacy of pretreatment with an antihistamine is unproven in preventing infusion-related reactions, and there is no national clinical standard. Unnecessary pretreatment in adolescence and young adulthood may be harmful, as this is a time to focus on developing self-care management skills. Antihistamine side effects including somnolence and dizziness may adversely affect adolescents and/or young adults' ability to complete schoolwork, drive, and transition toward autonomous management of their chronic illness. This report presents the findings of an evidence-based practice project reviewing the efficacy of pretreatment with an antihistamine in patients with Crohn disease and ulcerative colitis receiving infliximab. Practice implications are discussed.

Nursing science fellowship at Boston Children's Hospital.

INTRODUCTION: Clinical inquiry is vital to safeguard nursing practice and ensure optimal outcomes for our patients and families. The innovative Nursing Science Fellowship (NSF) was developed to provide structured mentorship for pediatric nurses by nurse scientists to design and conduct clinical inquiry generated from their practice. METHODS: Each fellow is paired with a nurse scientist mentor to receive support for timely project completion. Dedicated mentors guide the immersion of fellows in nursing science by providing them with didactic content detailing the process of clinical inquiry and bi-monthly one-on-one mentorship sessions. Throughout their journey, fellows learn the appropriate method by which to address their clinical inquiry question and complete a scholarly project that contributes to the science of nursing. On a quarterly basis, fellows share their progress and achievements with peers, mentors, and senior leadership. RESULTS: Since 2011, 84 fellows have enrolled in this two-year program. Sixty-two nurses have graduated from the NSF and 22 fellows are currently active. Collectively, the fellows have received 46 grants to support their projects. Twenty-one fellows have received promotions and 22 fellows have furthered their education in a masters, clinical or research doctorate program. There have been 78 external disseminations highlighting their clinical inquiry work, including poster and podium presentations and peer-reviewed published manuscripts. Lastly, there have been 26 new or updated clinical practices implemented across the enterprise as a result of completed projects. CONCLUSIONS: Combined these efforts have ensured a sustained commitment to advancing the science and practice of pediatric nursing.

Post-traumatic stress disorder in nurses: An integrative review.

AIMS AND OBJECTIVES: To synthesise literature regarding PTSD among nurses. Two objectives guided this review: (a) describe the prevalence of PTSD in registered nurses and (b) identify factors associated with nursing work-related PTSD. BACKGROUND: Post-traumatic stress disorder (PTSD) is a psychiatric disorder that can occur from direct or indirect exposure to traumatic events. Nurses are at risk of developing PTSD due to their indirect and/or direct exposure to traumatic situations while providing care to vulnerable patient populations. DESIGN: An integrative review. METHODS: A literature search was conducted in PubMed and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). Data extraction and quality assessment were independently performed by two reviewers. Data analysis procedures consisted of four concurrent activities: data reduction, data display, data comparison and conclusion drawing and verification. Conclusions were narratively synthesised and thematically presented by review objective using PRISMA guidelines. RESULTS: Twenty-four articles met criteria for review. One theme emerged from the synthesis of literature describing the prevalence of PTSD in nurses: All Over the Board. Authors reported vastly different PTSD prevalence rates across studies likely due to variability in measurement. Four themes emerged from the synthesis of factors that influence PTSD among nurses: The Workplace Matters, Relationships Matter, It Hurts to Care and Interpersonal Strengths. These overarching themes captured a multitude of factors that occur across three levels of influence: organisational, interpersonal and intrapersonal. CONCLUSIONS: This integrative review highlights PTSD as a growing concern in the nursing profession. The thematic analysis and associated subthemes provide a framework for the design of interventions to reduce the risk of PTSD symptom development among nurses working in inpatient settings. RELEVANCE TO CLINICAL PRACTICE: Multitargeted efforts directed at the organisational, interpersonal and intrapersonal factors identified in this review may help mitigate the harmful impact of PTSD and promote nurse well-being.

The Impact of Critical Reflective Inquiry Education on Experienced Nurses' Insights Into Practice.

Successful succession planning necessitates use of innovative strategies to encourage and support knowledge recovery and transfer. This quality improvement project evaluated the impact of a critical reflective inquiry workshop on experienced nurses' insights into practice. Nurses assessed written clinical narratives using the Critical Reflective Inquiry Assessment Tool before and after the workshop. Guided reflection led by nursing professional development practitioners fostered insight into practice, which is an essential step in supporting knowledge transfer to novice nurses.

Interprofessional Use and Validation of the AACN Healthy Work Environment Assessment Tool.

BACKGROUND: Health care work environments affect patient outcomes, staff satisfaction and retention, and organizational financial viability. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool (HWEAT) is a resource for patient care units and organizations to assess the work environment and track progress on their journey to excellence. OBJECTIVE: To validate interprofessional use of the AACN HWEAT across a large free-standing children's hospital. METHODS: The AACN HWEAT was administered to staff members across professional categories. Responses were averaged to achieve an overall score and a score for each standard included in the instrument. Nurses' and physicians' scores were further stratified. Test-retest reliability and internal consistency were assessed. Construct validity was measured by correlating the AACN HWEAT and the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (H-SOPS). RESULTS: Of 2621 AACN HWEAT surveys, 1030 (39.3%) were returned for review. The organization-wide HWEAT mean overall score was 3.58 (3.87 for physicians vs 3.54 for nurses, P= .02). Test-retest reliability was indicated by Spearman correlation coefficients of 0.50 to 0.68. Internal consistency was shown by a Cronbach α of 0.77 overall (range for standards, 0.77-0.81). Convergent validity between AACN HWEAT standards and AHRQ H-SOPS items was shown by correlation coefficients of 0.30 to 0.52. CONCLUSION: The AACN HWEAT was both reliable and valid, supporting its interprofessional use as an organizational measure. Active evaluation of health care environments is critical to achieving optimal patient outcomes.

Predictors of Nursing Graduate School Success.

Several factors influence success in nursing graduate school. This study collected retrospective data from students in a nursing graduate program to determine which factors predict success. Data were analyzed using a multiple regression analysis to predict success (i.e., graduation grade point average [GPA]) from student characteristics. The predictors were nursing course GPA, undergraduate science GPA, GPA upon admission to nursing graduate school, experience in a specialty, and the duration of that experience. Results indicate that admission, nursing, and undergraduate science GPA are more important for predicting success than previous experience. The predictors account for approximately 80 percent of the variance (R = .80).

Multilevel Influences on New Graduate Nurse Transition: A Literature Review.

New graduate nurses continue to experience difficulty in transitioning into practice. A literature review was conducted to identify factors that influence new graduate nurse transition. Data from 42 articles were extracted, and significant variables were synthesized from a social ecological perspective. Findings suggest that a complex interplay between intrapersonal, interpersonal, and organizational factors influence transition. A nursing professional development specialist plays a crucial role in implementing educational strategies that address factors across all three levels of influence.

Nurses' Use of Evidence-Based Practice in Clinical Practice After Attending a Formal Evidence-Based Practice Course: A Quality Improvement Evaluation.

This quality improvement project explored whether participation in an evidence-based practice (EBP) course influenced the use of EBP in day-to-day nursing practice. Data from two focus groups highlighted the impact of the EBP course, areas for further development, and potential barriers to the utilization of EBP. The authors found that educational offerings that remove barriers to EBP (knowledge and time) improve nurses' utilization of EBP. Ongoing professional development support is needed to foster the use of EBP in practice.

Preparing students for the emotional challenges of nursing: an integrative review.

A gap exists between how nurse educators teach nursing students to identify and manage the emotional challenges of nursing and nurses' experiences after they enter practice. An integrative review was conducted to synthesize the literature on how nurse educators prepare students for the emotional challenges of practice. The literature (n = 14) revealed that the concept "emotional challenges of nursing" lacks a clear definition and conceptual clarity. Reflection was a common element found in the educational approaches identified. Research was directed at qualitatively exploring students' subjective experiences, and most researchers did not address educational outcomes beyond subjective perceptions. Although the authors recognized the importance of teaching in the affective domain, research that used a quantitative experimental design (n = 1) was scarce. A research agenda, including intervention studies, is needed to support the development of evidence-based teaching pedagogies to prepare students for the emotional challenges of practice.

Public health nurses' contribution to maternal and infant health in Ireland.

As the health practitioners most closely involved with new mothers and babies, public health nurses in Ireland have an important contribution to make to the health of this population group.They deliver a service of preventative health care to mothers and babies that begins in the postnatal period. This paper considers the role of the public health nurse in maternal and infant health, and explores the notion that public health nurses are afforded the appropriate opportunities to contribute to the health of this population group. In order to reduce the health inequalities that are known to exist for new mothers and babies, the commitment of the health executive is needed for the development of a new model of delivering nursing services in the community.

The educational preparation: of nurses in Ireland.

The history and evolution of nurse education in Ireland has been similar to that of other countries. Initially conducted under the apprenticeship model established by Nightingale, it continued under this model for more than a century because the educational needs of nurses were seen as subordinate to the needs of the health service. The necessity for reform in nursing education was identified in a number of Irish government policy documents. One of the strongest arguments put forward for the future educational preparation of nurses stemmed from the Report of the Commission on Nursing in 1998. The recommendations of the report, implemented with the launch of the preregistration nursing degree program in 2002, set the stage for a new era in the education of nurses.

Older African Americans' attitudes and caregiving: is there a connection?

The purpose of this non-experimental descriptive study was to explore the attitudes of older (> or =50 years old) African Americans toward and their willingness to care for people with Acquired Immune Deficiency Syndrome (AIDS). Results from this study suggest that this population has generally tolerant (empathetic) attitudes towards people with AIDS (PWA). Knowing someone with AIDS has a positive correlation with a willingness to care for someone with AIDS. Those individuals who reported a willingness to care for someone with AIDS were more likely to have more tolerant attitudes towards PWA. Recognizing the influence of older African Americans' attitudes towards PWA and their subsequent willingness to care for this population will give direction for further advanced nursing actions and research. Specifically, it will help improve family involvement as a component of the patient's support network.

Atlantic Telehealth Knowledge Exchange.

Atlantic Canada has some of the earliest, most comprehensive, well-established networks, and innovative applications for telehealth in the country. The region offers a range of models for telehealth, in terms of management structure, coordination, funding, equipment, utilization, and telehealth applications. Collectively, this diversity, experience, and wealth of knowledge can significantly contribute to the development of a knowledge base for excellence in telehealth services. There is no formal process in place for the sharing of information amongst the provinces. Information sharing primarily occurs informally through professional contacts and participation in telehealth organizations. A core group of organizations partnered to develop a process for knowledge exchange to occur. This type of collaborative approach is favored in Atlantic Canada, given the region's economy and available resources. The Atlantic Telehealth Knowledge Exchange (ATKE) project centred on the development of a collaborative structure, information sharing and dissemination, development of a knowledge repository and sustainability. The project is viewed as a first step in assisting telehealth stakeholders with sharing knowledge about telehealth in Atlantic Canada. Significant progress has been made throughout the project in increasing the profile of telehealth in Atlantic Canada. The research process has captured and synthesized baseline information on telehealth, and fostered collaboration amongst telehealth providers who might otherwise have never come together. It has also brought critical awareness to the discussion tables of governments and key committees regarding the value of telehealth in sustaining our health system, and has motivated decision makers to take action to integrate telehealth into e-health discussions.