Applying Complexity Science as a DNP Quantum Leader.

As Doctor of Nursing Practice (DNP) students and graduates begin to apply new knowledge in real-life situations, they are transforming their organizations. The impact of DNP projects is noted by measurable outcomes in diverse settings. This article presents 4 unique clinical/organizational examples of DNP projects. The authors have identified an application of complexity science and leadership theory in their practice changes. In addition, they share their thoughts and feelings as emerging leaders.

Implementation of the Stopping Elderly Accidents, Deaths, and Injuries Initiative in Primary Care: An Outcome Evaluation.

BACKGROUND AND OBJECTIVES: Older adult falls pose a growing burden on the U.S. health care system. The Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative was developed as a multifactorial approach to fall prevention that includes screening for fall risk, assessing for modifiable risk factors, and prescribing evidence-based interventions to reduce fall risk. The purpose of this study was to determine the impact of a STEADI initiative on medically treated falls within a large health care system in Upstate New York. RESEARCH DESIGN AND METHODS: This cohort study classified older adults who were screened for fall risk into 3 groups: (a) At-risk and no Fall Plan of Care (FPOC), (b) At-risk with a FPOC, and (c) Not-at-risk. Poisson regression examined the group's effect on medically treated falls when controlling for other variables. The sample consisted of 12,346 adults age 65 or older who had a primary care visit at one of 14 outpatient clinics between September 11, 2012, and October 30, 2015. A medically treated fall was defined as a fall-related treat-and-release emergency department visit or hospitalization. RESULTS: Older adults at risk for fall with a FPOC were 0.6 times less likely to have a fall-related hospitalization than those without a FPOC (p = .041), and their postintervention odds were similar to those who were not at risk. DISCUSSION AND IMPLICATIONS: This study demonstrated that implementation of STEADI fall risk screening and prevention strategies among older adults in the primary care setting can reduce fall-related hospitalizations and may lower associated health care expenditures.

The CNO US Healthcare Immersion Program, Part 1: A Transformational Leadership Model.

As a result of recent global health events, US health care leaders are strengthening international relationships to share best practices, health research, and support of workforce capacity. The Institute for Healthcare Improvement, the National Academies of Sciences, Engineering, and Medicine, the American Nurses Credentialing Center, and the Joint Commission International have all committed to expanding their vision and mission to improve health and health care globally. To support excellence in international health care delivery, the authors embarked on a Chief Nursing Officer (CNO) US Healthcare Immersion Program. The purpose of the program is to introduce the US nursing leadership competences to China CNO colleagues in preparation for their future role with health care reform.

The CNO US Healthcare Immersion Program, Part 2: Expanding the Footprint of Professional Nursing.

As global leaders, US nurses will have an increasingly recognized role and responsibility in shaping health care in all countries. They should be at the forefront of changing and improving health systems to achieve universal health. Currently, a major health care reform is underway that requires a shift in the professional nursing footprint of China's nurse leaders. These leaders must garner knowledge capital to reinforce ethics, regulations, and standards; use current best practices; implement a comprehensive performance evaluation process; and capture the spirit of caring within their health care environments. Therefore, China is seeking US immersion opportunities for their emerging nurse leaders. Although US Immersion Programs exist, there is scant literature related to international precepting and how transformational learning occurs within this experience. This article introduces a transformational learning experience between US International Nurse Preceptors and a Chief Nursing Officer from Yinchuan, China.

Healthcare Antibiotic Resistance Prevalence - DC (HARP-DC): A Regional Prevalence Assessment of Carbapenem-Resistant Enterobacteriaceae (CRE) in Healthcare Facilities in Washington, District of Columbia.

OBJECTIVE Carbapenem-resistant Enterobacteriaceae (CRE) are a significant clinical and public health concern. Understanding the distribution of CRE colonization and developing a coordinated approach are key components of control efforts. The prevalence of CRE in the District of Columbia is unknown. We sought to determine the CRE colonization prevalence within healthcare facilities (HCFs) in the District of Columbia using a collaborative, regional approach. DESIGN Point-prevalence study. SETTING This study included 16 HCFs in the District of Columbia: all 8 acute-care hospitals (ACHs), 5 of 19 skilled nursing facilities, 2 (both) long-term acute-care facilities, and 1 (the sole) inpatient rehabilitation facility. PATIENTS Inpatients on all units excluding psychiatry and obstetrics-gynecology. METHODS CRE identification was performed on perianal swab samples using real-time polymerase chain reaction, culture, and antimicrobial susceptibility testing (AST). Prevalence was calculated by facility and unit type as the number of patients with a positive result divided by the total number tested. Prevalence ratios were compared using the Poisson distribution. RESULTS Of 1,022 completed tests, 53 samples tested positive for CRE, yielding a prevalence of 5.2% (95% CI, 3.9%-6.8%). Of 726 tests from ACHs, 36 (5.0%; 95% CI, 3.5%-6.9%) were positive. Of 244 tests from long-term-care facilities, 17 (7.0%; 95% CI, 4.1%-11.2%) were positive. The relative prevalence ratios by facility type were 0.9 (95% CI, 0.5-1.5) and 1.5 (95% CI, 0.9-2.6), respectively. No CRE were identified from the inpatient rehabilitation facility. CONCLUSION A baseline CRE prevalence was established, revealing endemicity across healthcare settings in the District of Columbia. Our study establishes a framework for interfacility collaboration to reduce CRE transmission and infection. Infect Control Hosp Epidemiol 2017;38:921-929.

Working with grocers to reduce dietary sodium: lessons learned from the Broome County Sodium Reduction in Communities pilot project.

The purpose of this article is to describe implementation of and lessons learned from the Broome County Sodium Reduction in Communities grocery store initiative. This pilot project was conducted in collaboration with a regional supermarket chain and endeavored to develop population-based strategies for reducing sodium intake. Key interventions included marketing strategies, taste test demonstrations, and a public media campaign. Project staff worked closely with corporate registered dietitian nutritionists, a nutrition specialist, and an advertising agency in its development and implementation. A social marketing approach was used to educate consumers about the hidden sources of dietary sodium, to raise awareness of the adverse health effects of excess sodium intake, to encourage consumers to read food labels, and to urge them to purchase food items lower in sodium. The lessons learned from this experience may be of assistance to other communities that seek to implement similar sodium-reduction strategies in the grocery store environment.