Social justice as an expression of caring through holistic admissions in a nursing program: A proposed conceptual model.

AIM: This paper presents HAR as an expression of caring to create social justice within nursing and achieve a workforce that is representative of those being served. BACKGROUND: The lack of diversity within the health professions has been expressly linked in the literature to health disparities among underrepresented and marginalized groups. RECOMMENDATIONS: Recognizing the value of diversity within healthcare has been the impetus for some health profession programs to use holistic admissions review (HAR) in the assessment and evaluation of applicant suitability. While current HAR recommendations in nursing broaden the lens on which criteria should be used to determine applicant suitability beyond standard academic metrics, existing models do not examine applicants' caring capacity. CONCLUSION: Given caring is the essence of nursing, the authors offer a guiding framework to supplement the American Association of Colleges of Nursing criteria for HAR and a model by which nursing applicants are evaluated on their capacity to care.

Reducing Pressure Injury Incidence Using a Turn Team Assignment: Analysis of a Quality Improvement Project.

PURPOSE: The purpose of this study was to analyze outcomes of a quality improvement project that evaluated a turning intervention for prevention of facility-acquired pressure injuries. DESIGN: A descriptive correlational study design examined the effectiveness of using a "turn team assignment" on pressure injury incidence and staff perceptions. SUBJECTS AND SETTING: The study sample comprised RNs and patient care associates assigned to provide care for patients admitted on the first or any subsequent day of hospitalization to a surgical intensive care unit at a Midwest inner-city teaching hospital. METHODS: Direct observation by expert clinicians occurred in 2-hour increments over a 14-day period using an 11-item, unit-designed process improvement tool. We collected information regarding cueing, concurrent turning, independent turning in lieu of the cue, staff support, and possible barriers to turning and repositioning. Staff perceptions were collected using an online tool via survey. The survey utilized a 14-item questionnaire, and a 5-point Likert Scale to identify staff perceptions and beliefs about the turn team intervention. Pressure injury occurrences were measured using data from our monthly prevalence study. RESULTS: Pressure injury occurrences declined from 24.9% to 16.8% over the data collection period. There was a strong positive correlation between verbal cueing and turning (r = 0.815; P < .05). Staff perceptions supported preintervention education (64.3%) and cueing (93%; 78%) as effective interventions in completing patient turning. CONCLUSIONS: Findings suggest that turn team assignments using verbal cueing are an effective intervention that decreases pressure injury occurrence. This intervention required no increase in staffing personnel, making this type of intervention reasonable and effective in improving frequency of repositioning and decreasing pressure injury prevalence rates.

Factors Influencing Registered Nurses' Decision to Activate an Adult Rapid Response Team in a Community Hospital.

BACKGROUND: One factor impacting patient outcomes in the acutely deteriorating patient is a delay by nursing staff to activate a rapid response team (RRT); however, a gap in knowledge exists concerning factors influencing activation of an RRT by nursing staff working in adult areas outside the medical-surgical and telemetry setting. OBJECTIVES: The purpose of this study was to examine beliefs and behaviors that influence registered nurses' decision to activate an adult rapid response team in a community hospital that includes 3 specialties: medical-surgical and telemetry, peripartum, and psychiatric areas. METHODS: One hundred sixty-three nurses were surveyed using a 17-item Likert-style instrument to assess registered nurses' beliefs and attitudes on and barriers to utilizing an RRT. RESULTS: The survey was analyzed yielding 3 factors: RRT barriers, RRT positive/intent to activate, and patient management beliefs. Barriers cited by other research to activate RRT including criticism by the team and perception that the RRT increases workload or reduces skills were not found to be influential considerations. A significant difference was found among the 3 specialty groups related to RRT positive/intent to activate (F2,159 = 6.09, P = .003) and patient management beliefs (F2,159 = 5.87, P = .003). A strong negative correlation was found between years of experience as an RN and RRT barriers (ρ161 = -0.250). DISCUSSION: Organizations should examine RRT activation delays particularly in the area of calls to covering physicians prior to RRT activations. Differences between specialty groups highlight the need for education across specialties on the recognition of the acutely deteriorating patient. The findings indicate that the inexperienced nurse requires support from experienced colleagues and temporary adjustments to workload during situations of acute deterioration of a patient.

Initial psychometric evaluation of the nursing quality and safety self-inventory.

Few instruments are available to measure nursing students' quality and safety competencies. The authors developed and tested the psychometric properties of the Nursing Quality and Safety Self-Inventory (NQSSI), an 18-item, self-rated instrument to measure nursing students' quality and safety knowledge, skills, and attitudes. All pre-licensure baccalaureate nursing students (N = 176) enrolled in a leadership and management course at a midwestern school of nursing completed the self-inventory. Construct validity was established with exploratory factor analysis using principal axis factoring with direct oblimin rotation. The instrument was found to be composed of two subscales, knowledge and attitudes, which explained 53.8% of total variance. The internal consistency coefficient (Cronbach's alpha) was 0.93 for the total inventory and ranged from 0.88 to 0.92 for the two subscales. Contrast validity and effectiveness of the NQSSI for measuring nursing students' self-rated quality and safety competencies was supported.

Integrating quality and safety competencies into undergraduate nursing using student-designed simulation.

The purpose of this study was to determine whether an innovative teaching approach, a student-led simulation, was effective in increasing students' quality and safety knowledge, skills, and attitudes in the six Quality and Safety Education for Nurses competency areas. The sample included students (N = 141) enrolled in a traditional and accelerated leadership course in the baccalaureate-nursing program at a midwestern public university during the fall 2009 semester. A quasi-experimental pretest and posttest design was used. Paired-samples t tests were used to analyze the data. Overall scores on the self-inventory in the traditional (p < 0.001) and accelerated (p = 0.011) groups significantly increased. Knowledge and safety test scores in both the traditional (knowledge: p < .001; safety: p = 0.028) and accelerated (knowledge: p = 0.027; safety: p = 0.03) groups increased significantly. The innovation significantly improved students' self-efficacy and knowledge related to the quality and safety competencies.