An Evaluation of an Advanced Practice Provider Led Weight Intervention in Liver Disease (WILD) Pathway.

Within the scope of their practice, advanced practice providers provide similar patient care as physicians, but in some cases have outperformed physicians in terms of health outcomes, satisfaction, and cost-effectiveness. At an academic medical center, hepatology trained advanced practice providers, who were also certified in obesity management, led an interprofessional team to develop the Weight Intervention in Liver Disease pathway. In September 2018, patients who were seen in the hepatology practice and met criteria for enrollment were referred to the Weight Intervention in Liver Disease program for comprehensive care of obesity and related metabolic disorders. A program evaluation was conducted in 2021 to identify whether the effectiveness of the advanced practice provider-led structure and process, and the Weight Intervention in Liver Disease pathway, supported weight loss goals as well as improvement in alanine aminotransferase levels, patient satisfaction, and provider satisfaction. Results found that the structure of the pathway and the implementation are resulting in positive outcomes of 100% patient satisfaction, 80% provider satisfaction, and a total average sustained weight loss of 5.05% ( SD = 7.98, p < .01). A weight loss pathway led by trained advanced practice providers proves successful in long-term weight loss goals.

A Quality Improvement Project to Increase Utilization of an Urgent Care Clinic for Cancer.

BACKGROUND: Nationally, patients with cancer experience high numbers of emergency department (ED) visits. Many ED visits may be prevented using cancer-specific urgent care services. OBJECTIVES: The purpose of this quality improvement initiative was to first assess the reasons that adult patients with cancer used the ED instead of an urgent care clinic for cancer (UCC-C). Second, an education program was developed and implemented to improve UCC-C use. METHODS: Using semistructured interviews pre- and postintervention (education program about ED/UCC-C use), this project described knowledge of adult patients with cancer about using the ED instead of the UCC-C. The project also evaluated the efficacy of the education intervention. FINDINGS: Pre- to postimplementation change showed an increase in patient UCC-C knowledge, patients who said they would present to the UCC-C, and patients who presented to the UCC-C for treatment. In addition, there was a decrease in adult patients with cancer who presented to the ED and were subsequently hospitalized.

Leveraging Professional Governance During the COVID-19 Pandemic.

Dynamic nursing leadership and engagement of nursing at all levels are critical to effective care delivery. During the COVID-19 crisis, many organizations suspended non-COVID-related meetings, including professional governance councils where practice decisions are made. This article highlights how shared or professional governance was leveraged during this global pandemic at a large academic medical center and community hospital effectively sustaining autonomous nursing practice while responding to a rapidly changing environment and impacting quality patient care.

Integrating the Social Determinants of Health into Nursing Practice: Nurses' Perspectives.

PURPOSE: The purpose of this study was to assess nurses' knowledge, perceived self-efficacy, and intended behaviors relative to integrating the social determinants of health (SDoH) into clinical practice. DESIGN AND METHODS: A cross-sectional study was completed with 768 nurses working in three hospitals within a large regional healthcare system located in the Midwest. Data were collected using an adapted 71-item SDoH Survey, which measured nurses' confidence in and frequency of discussing the SDoH with patients, general knowledge of the SDoH, familiarity with patients' social and economic conditions, and awareness of their institution's health equity strategic plan to achieve health equity. The institution's health equity strategic plan reflects the organization's commitment to improving the health of individuals and neighborhoods by addressing the SDoH known to influence health status and life expectancy. Finally, participants were asked to describe barriers to incorporating the SDoH into practice along with completing five demographic items. Descriptive statistics were used to describe the findings. FINDINGS: Of the 768 respondents, 63% had a baccalaureate degree in nursing and 33.1% reported more than 20 years in nursing. Fifty percent of respondents reported feeling more knowledgeable or confident in their ability to discuss access to care issues with patients compared to the other SDoH. Identified barriers to discussing the SDoH included insufficient time to address identified needs and unfamiliarity with internal and external resources. Respondents stressed the need for interdisciplinary education and collaboration along with more information on the role of social workers. CONCLUSIONS: Nurses are more confident in discussing certain determinants of health and could benefit from more skill development in discussing SDoH issues and stronger collaborative partnerships to address identified needs. CLINICAL RELEVANCE: Findings from the study have implications for supporting the educational and resource needs of front-line nurses employed in hospitals and health systems seeking to address broader societal issues influencing the health status and outcomes of patients and communities.

Critical social theory approach to disclosure of genomic incidental findings.

Technology has expanded genomic research and the complexity of extracted gene-related information. Health-related genomic incidental findings pose new dilemmas for nurse researchers regarding the ethical application of disclosure to participants. Consequently, informed consent specific to incidental findings is recommended. Critical Social Theory is used as a guide in recognition of the changing meaning of informed consent and to serve as a framework to inform nursing of the ethical application of disclosure consent in genomic nursing research practices.

Visioning as a hiring strategy for quality outcomes.

Mutual trust and shared nurse leadership behaviors between the chief nurse executive and nursing staff are linked to improved clinical outcomes through an initial visioning process. The authors outline a hospital's strategy to improve nurse-driven outcomes by using visioning in the hiring process. Visioning, implemented in the hiring process, is a unique application of this tool for creating a desired future.