Behavioral Crisis Management: A Quality Improvement Pilot for Improving Teamwork in a Primary Care Pediatric Setting.

INTRODUCTION: Children with behavioral escalations in the primary care office may pose safety risks to themselves and others. Interprofessional teams utilizing crisis resource management (CRM) skills more successfully manage behavioral crises. The purpose of this quality improvement (QI) pilot project was to improve team performance during a behavioral crisis in pediatric primary care, as well as evaluate learner satisfaction with the curriculum. METHOD: We implemented an evidence-based curriculum using simulation and didactic techniques in primary care offices within a pediatric network. Using a one group pre-post design, we evaluated roles, communication, and patient-centered care with the KidSIM Team Performance Scale. Utilizing a post intervention survey, learner feedback was elicited regarding learning environment, facilitators and barriers to learning, skill of facilitator, and usability and applicability of content. FINDINGS: 101 interprofessional participants attended one of eight educational sessions. KidSIM Team Performance Scale results demonstrated statistically significant improved total team performance in a simulated behavioral crisis (Z = -2.52, p = 0.012). Post simulation evaluation demonstrated positive feedback about the program, content and facilitators. DISCUSSION: This pilot QI project demonstrated that a curriculum using behavioral simulation scenarios and CRM principles can improve teamwork in an interprofessional primary care office. Additionally, participants overwhelmingly indicated satisfaction with the curriculum. APPLICATION TO PRACTICE: Ensuring staff have the appropriate skills to manage behavioral health crises facilitates safer and more effective patient care, enhances patient-centered care and solidifies a positive staff approach in the pediatric ambulatory setting.

Oncology Nurse Practitioner Web Education Resource(ONc-PoWER): An Evaluation of a Web-Enhanced Education Resource for Nurse Practitioners Who Are New to Cancer Care.

The nurse practitioner (NP) new to an advanced role in a specialty practice may find the orientation period challenging while expanding his or her professional knowledge base. The Oncology Nurse Practitioner Web Education Resource (ONc-PoWER), a web-enhanced continuing education program, provides training for both the oncology NP (ONP) new to cancer care (i.e., within the first year) and his or her on-site mentor. The Oncology Nurse Practitioner Web Education Resource promotes essential didactic and skills development via five modules. A total of 103 dyads (i.e., a new ONP and his or her mentor) were recruited from 27 states to participate in ONc-PoWER, and 79 dyads completed surveys to evaluate the program. Data were collected between April 2012 and October 2016. We observed statistical significance (p = .000) between pre- and post-program self-assessment of cancer care knowledge and confidence in delivering cancer care among ONPs. Moreover, mentors rated the program favorably. Mentor agreement concerning whether or not the ONPs were able to successfully perform 30 core clinical skills ranged from a low of 93% to a high of 100%. Furthermore, mean scores of the course satisfaction survey demonstrate that each ONc-PoWER objective either met or exceeded learner expectations.

Improving the Use of Evidence-Based Practice and Research Utilization Through the Identification of Barriers to Implementation in a Critical Access Hospital.

OBJECTIVE: This study explored the relationship between perceived barriers to research use and the implementation of evidence-based practice (EBP) among rural hospital nurses. BACKGROUND: The Institute of Medicine recommends that 90% of clinical decisions be evidence based by 2020. METHODS: This descriptive, quality improvement study used a convenience sampling of registered nurses (RNs). Participants completed multiple questionnaires. RESULTS: Overall the attitude toward EBP was positive. Nurses recognize the importance to their practice but identified a lack of educational preparation regarding the process of research utilization. CONCLUSION: Providing education on research process and supportive monitoring during implementation may increase compliance with EBP initiatives.

Creating Quality Online Materials for Specialty Nurse Practitioner Content: Filling a Need for the Graduate Nurse Practitioner.

Nurse practitioners are entering specialized areas of practice immediately after graduation from nurse practitioner (NP) education and certification and are finding employment in specialized areas such as oncology. Rapidly achieving a knowledge base in this highly specialized area of medicine coupled with the stress of the new nurse practitioner role can lead to a very difficult orientation and transition period. There are several methods to provide specialized education to NPs during their orientation period. Unfortunately, limitations such as a lack of motivated mentors, limited opportunities to practice the desired skill set or a lack of structure in regards to curriculum quality, and the learning needs of the new nurse hinder the NP's transition to practice. In response to either inadequate or non-standardized orientation to the specialty role of the oncology NP (ONP), a web-enhanced educational tool, funded through the National Cancer Institute, was developed for use in the USA: Oncology Nurse Practitioner Web Education Resource (ONc-PoWER). The development of ONc-PoWER was based upon essential education for NPs new to cancer care, adult learning theory, Bloom's Taxonomy, and foundations of quality online education. The five interactive web-based modules provide specialized education for the nurse practitioner new to oncology along with an on-site mentor to assist the NP in applying the course content to clinical practice.

The Certified Clinical Nurse Leader in Critical Care.

Challenges of the current health system in the United States call for collaboration of health care professionals, careful utilization of resources, and greater efficiency of system processes. Innovations to the delivery of care include the introduction of the clinical nurse leader role to provide leadership at the point of care, where it is needed most. Clinical nurse leaders have demonstrated their ability to address needed changes and implement improvements in processes that impact the efficiency and quality of patient care across the continuum and in a variety of settings, including critical care. This article describes the role of the certified clinical nurse leader, their education and skill set, and outlines outcomes that have been realized by their efforts. Specific examples of how clinical nurse leaders impact critical care nursing are discussed.

Evaluation of a Surgical Site Discharge Teaching Tool Using Pictures and a Mirror.

PURPOSE: The purpose of this project was to develop, implement, and evaluate a teaching tool for self-assessment of surgical incisions after laparotomy surgery. BACKGROUND: Hospitalized patients have an increased level of acuity and are discharged earlier. Shorter length of stay limits the nurses' ability to provide comprehensive discharge instructions and validate understanding of surgical incision care. DESCRIPTION: Two sets of discharge instructions, 1 with text only and 1 with text and pictures plus a mirror, were provided to patients after laparotomy surgery. A total of 60 patients were recruited over a 3-month period. The first 30 patients received standard discharge instructions (text only). The next 30 patients received discharge instructions using the new program and a handheld mirror to assist with visualization of the incision. A follow-up telephone questionnaire was completed on day 7 after surgery to assess patients' ability to inspect their incision for infection and determine comprehension with discharge instructions. OUTCOME: Patients receiving the revised program had improvement in comprehension of instructions, felt that instructions were clearly stated, and were confident in their ability to identify normal healing versus a surgical site infection (SSI) and about notifying physicians. Compared with the text-only group, the text, picture, and mirror group using the teaching program (text, pictures, and mirror) felt more confident on self-assessment to identify SSI. CONCLUSION: The revised teaching program (text and pictures) and use of a handheld mirror improved patient confidence in self-assessing an incision and increased ease in detecting an SSI. IMPLICATIONS: Clinical nurse specialists can influence patient outcomes. Discharge instructions that include text and pictures plus a mirror should be part of a comprehensive packet for patients asked to assess an incision.

Addressing barriers to achieving nursing certification: development of a certification achievement program on a medical-surgical unit.

Nursing certification is recognized as advanced competency and knowledge beyond basic preparation, thus empowering nurses to contribute to improved outcomes by demonstrating expertise in their specialties. It has been recognized that nurses do not seek certification because of identified barriers. Through a structured Certification Achievement Program that reduced barriers, a cohort of nurses was able to achieve certification in medical-surgical nursing.

Utilizing bedside shift report to improve the effectiveness of shift handoff.

Handoff of patient information during shift report between nurses is a time of risk and liability. A quality improvement project was conducted on a 23-bed inpatient unit to measure the value of a bedside change-of-shift report in improving the effectiveness of shift report. Indicators including end-of-shift overtime, call light usage, nurse perceptions, and patient satisfaction were impacted by the change in process.

From onsite to online: lessons learned from faculty pioneers.

As the demand for online courses grows, academic settings that do not offer this option risk losing potential students to universities that adopt more innovative approaches to education. Understanding strategies that will prepare faculty to meet the challenges associated with this transformation is essential to developing a quality online program. Most basic to this transition is the philosophic acceptance of online learning as an educational method equivalent to traditional didactic lecture. Because the knowledge and skills associated with navigating Web-based tools and resources are perceived as a barrier by many faculty, focused efforts must be undertaken to assess faculty learning needs and to provide formal and informal education related to recommended teaching strategies and available technology. Collaboration with course design experts and participation in faculty work groups will facilitate acceptance and promote a sense of involvement. Administrative support is also imperative to produce satisfactory student outcomes that meet the needs for accreditation agencies, certification, or higher education standards.

Energy capacity model for nurses: the impact of relaxation and restoration.

OBJECTIVE: This study assessed the effect of stress management techniques and a restoration room on energy renewal of nurses. BACKGROUND: Nursing stress is linked to increased turnover, decreased well-being, and decreased decision-making capabilities. Energy renewal may be an effective method of addressing stress-induced exhaustion and its negative effects. METHODS: Stress reduction techniques and a restoration room were provided on a pilot unit. Results were measured with the Nursing Stress Scale (NSS), payroll data, and room usage diaries. RESULTS: There was an overall reduction in NSS scores. The room was used less often than anticipated. The sample size was inadequate to measure reduction in unplanned time off. Anecdotally, nurses felt positive about the room and continue to use it. Results were limited by sample size and a positive baseline work environment but promising enough to explore further. CONCLUSIONS: Results suggest that further study is warranted with a larger sample in Magnet® and non-Magnet settings.

Using high-fidelity simulation as a teaching strategy with Baby Boomers returning to the RN workforce.

As a result of a changing economy, many Baby Boomer nurses are returning to the workforce. Common teaching strategies used in schools of nursing, such as high-fidelity simulation, are unfamiliar to this group of learners. Educators must learn not only the characteristics of Baby Boomer returning nurses but also how to adapt simulation to their learning styles.

A curriculum designed to decrease barriers related to scholarly writing by staff nurses.

Demonstrating professional development outcomes, such as scholarly publication, is critical as nurse leaders guide organizations seeking recognition as centers of excellence. However, personal and situational barriers often prevent staff nurses from achieving scholarly publication. This project tested a workshop and mentoring approach to decrease publication barriers with staff nurses in 2 community hospitals. Self-efficacy principles guided the curriculum that resulted in a statistically significant improvement in staff nurse perception of successful scholarly publication endeavors.

The effects of barriers on Health Related Quality of Life (HRQL) and compliance in adult asthmatics who are followed in an urban community health care facility.

This cross sectional descriptive study sought to identify perceived barriers to follow-up care for adult asthmatics who are followed in two community health care facilities. A second purpose of the study was to determine the effect of any barriers to Health Related Quality of Life (HRQL) and compliance in the sample. Thirty-four adults completed a demographic and health status survey, the MiniAQLQ and the EWash Access to Health Care Survey. "Long waiting time in provider's office," "someone had to miss work," "cost of care too much, "and "long wait for an appointment" were the most prevalent perceived barriers in the sample. "Lack of transportation" was significantly associated with study participants who receive health care at one site or who stated the emergency room as their usual place of care. "Someone had to miss work" was significantly correlated with the following variables: employment, a higher annual household income, 1-2 daily medications for asthma, no overnight hospitalizations for asthma and no psychological co-morbidities. A higher reported HQOL was significantly correlated with study participants whose medical care needs were met and found access to local health care services. The only perceived barrier that was significantly correlated with compliance was study participants who "sometimes" had to reschedule an appointment with a health care provider due to "lack of transportation." The present study suggests that strategies designed to decrease the perceived barriers might improve compliance with the treatment regime, thus decreasing costs, absenteeism, and lack of continuity.

The effects of human patient simulators on basic knowledge in critical care nursing with undergraduate senior baccalaureate nursing students.

BACKGROUND: The nursing literature to date has offered many descriptive accounts utilizing human simulation in undergraduate and graduate nursing curricula. However, the nursing literature remains sparse in the area of studies that evaluate the effectiveness of simulation on knowledge attainment in critical care using standardized assessment tools. The primary aim of this paper is to report on a study that investigates whether participation in instruction involving human patient simulators, in conjunction with a traditional clinical experience, improves professional competence in senior-level undergraduate nursing students related to basic knowledge of critical care nursing. METHODS: This study (n=29) used a pre- and posttest repeated-measure design. Senior baccalaureate nursing students enrolled in an advanced medical-surgical nursing course participated. Students were assigned to groups and completed 7 weeks of traditional clinical experience (45 hours total) and 7 weeks of high-fidelity human simulation (45 hours total). Students completed the Basic Knowledge Assessment Tool-6 (BKAT-6) prior to traditional clinical and on the last day of human simulation experience. RESULTS: Results showed a significant improvement on the BKAT-6 overall and a significant improvement in 6 subscales of the BKAT-6. CONCLUSION: Instruction involving high-fidelity human simulation is a viable teaching strategy to improve basic knowledge acquisition as one essential attribute needed for professional competence.

Returning nurses to the workforce: developing a fast track back program.

TOPIC: Fast Track Back: Re-entry into Nursing Practice program. PURPOSE AND SOURCES OF INFORMATION: Describes the development, implementation, and evaluation of a state-of-the-art re-entry program facilitating the return of licensed nonpracticing RNs to the workforce through a quality education program that retools them for the workforce in the areas of pharmacology, skill development using the latest technology, practice standards, and nursing issues. The program consists of didactic content taught via classroom, Internet, skills laboratory, and high fidelity human simulated technology and a clinical component. CONCLUSIONS: The program is a mechanism that enables re-entry nurses to improve skills and competencies necessary to practice in today's healthcare environment.

A collaborative approach to expand clinical experiences and cultural awareness among undergraduate nursing students.

Nurse educators are constantly seeking opportunities to expose undergraduate students to different cultures. This requirement is essential to prepare tomorrow's nursing professionals to practice culturally component care in diverse health care environments. This article describes a unique collaborative experience between the University of Pittsburgh School of Nursing and the Miami Children's Hospital that offers senior baccalaureate students the opportunity to complete one term of clinical experience in a culturally diverse health care facility.

The evolution of hospice in America: nursing's role in the movement.

In the current society, many individuals fear death and the feelings of suffering and loneliness that often accompany death. Two visionaries in the United States, Florence Wald and Dr. Elisabeth Kubler-Ross, recognized these fears and planned the nation's first hospice movement in the 1970s. The hospice philosophy continues to prosper in the new millennium. In this article, the founding American hospice's philosophy, types of facilities, standards, health team composition, patient demographics, organizations, reimbursement, and research are compared and contrasted with those of the current hospice movement. Existing issues with the modern movement are also discussed.

Update on transplant pharmacology: sirolimus.

Rapamune (Sirolimus), the latest immunosuppressant agent for solid organ transplants, is prescribed for induction therapy, refractory rejection, steroid withdrawal, and combination therapy. As the use of this agent increases among various transplant populations, it is essential for critical care nurses to be cognizant of the indications, pharmacodynamics, current research findings, side effects, and implications. This knowledge will ultimately improve patient education and outcomes in this ever-growing field of nursing.