Facilitators and barriers to adopting or expanding medications for opioid use disorder provision in rural Colorado jails: a qualitative analysis.

BACKGROUND: Opioid use disorder (OUD) is common among individuals who are incarcerated. However, OUD treatment services are sparse in smaller county jails found in many rural areas, which limits a healthy and supportive jail environment. This study assesses the facilitators of and barriers to medications for opioid use disorder (MOUD) adoption or expansion in rural Colorado jails. A qualitative descriptive design was implemented during the summer of 2022 using semi-structured interviews with jail staff, sheriffs, and contracted personnel. Interview questions focused on facilitators of existing MOUD services and barriers to adopting or expanding services. To identify the facilitators and barriers, data were coded using thematic analysis. RESULTS: Seven jails were included in the study. Representatives from each jail participated in the seven interviews, which often included multiple participants per interview. Three of the jails had established routine practices for MOUD administration. Two jails occasionally administered MOUD or had plans in place to be able to administer, while the remaining two did not offer any MOUD. While administrative support, collaborative partnerships, and jail nurses facilitated MOUD use, barriers were more prevalent, including physical space limitations, distance to services, lack of providers in the area, staffing and training issues, funding/budget issues, and perceived risk of diversion. CONCLUSION: Making MOUD available to people who are incarcerated is an important and timely step in enhancing the jail environment, especially in rural areas that often lack access to MOUD. As states look to require MOUD availability for people who are incarcerated, facilitators to MOUD adoption/expansion can be leveraged while strategies are needed to overcome barriers.

Role of Stigma for Health Care Professionals With Nonmedical Substance Use.

BACKGROUND: Stigma toward those with non-medical substance use may present as anticipated, perceived, enacted, or internalized stigma. OBJECTIVE: The purpose of the study was to describe the role of stigma on health care professionals with non-medical substance use, from the perspective of treatment providers. Soliciting information about stigma from treatment providers is a unique perspective lacking in current literature. METHODS: A qualitative descriptive design was used with semi-structured interviews of treatment providers (N = 16) in Colorado. Inductive content analysis was used to identify concepts and themes across interviews. RESULTS: Findings showed that stigma is a major concern and a barrier for health care professionals seeking substance use treatment. Nurses and physicians demonstrate shame and guilt (internalized stigma) around their substance use. These professionals also experience fear around their reputation (perceived stigma) and challenges around re-entry to the workforce after treatment (anticipated stigma). CONCLUSIONS: The awareness of existing stigma as well as internalized stigma impacts how health care professionals approach treatment, recovery, and returning to work.

CPD providers can positively impact practice by better understanding how APNs are educated, licenced, and certified.

Advanced practice nurses (APNs) care for various patient populations in a wide variety of settings. The four types of APNs in the USA (certified nurse practitioner, clinical nurse specialist, certified nurse-midwife, and certified registered nurse anaesthetist) have differences and commonalities related to education, licensure, and certification. Care provided by APNs has been demonstrated to be of high quality, and APNs are active and engaged participants in continuing professional development (CPD) as CPD is required to maintain licensure and board certification. APNs also frequently function as clinical and academic faculty.

Nasal Tube Securement: Randomized Controlled Trial in Pediatric Hospitalized Patients.

PURPOSE: The aim of this study was to compare accidental dislodgement rates of nasal gastric tubes secured with standard methods or a nasal tube securement device in pediatric patients. DESIGN: A randomized controlled trial was conducted. METHODS: Participants ( n = 43) were randomized into standard securement or nasal tube securement device using block randomization to control for age and diagnosis. Surveys were collected from staff and caregivers on device ease of use and satisfaction. RESULTS: There were a similar number of tube dislodgements for patients in the nasal tube securement device group ( n = 6) and the standard practice group ( n = 7). The median hospital length of stay was higher for the standard practice group (13 days vs. 9 days). CONCLUSION: Use of the nasal tube securement device did not significantly decrease the rate of tube dislodgements compared with standard practice. CLINICAL RELEVANCE TO REHABILITATION NURSING: The study provides information for pediatric rehabilitation nurses in choosing securement options for nasal gastric tubes.

Perceived impact of COVID-19 on prevention, treatment, harm reduction, and recovery services for opioid use disorder: National survey of local health departments.

Background: US local health departments (LHDs) have faced the COVID-19 pandemic and the opioid epidemic simultaneously. This article investigates the perceived impact of COVID-19 on the continuation of locally available services for addressing opioid use disorder (OUD). Methods: A national survey of US LHDs was conducted from November to December 2020. The survey asked key personnel in LHDs about the availability of OUD services in their jurisdiction, and how COVID-19 impacted such availability (i.e., whether terminated or continued at a reduced, the same, or an increased level after the arrival of COVID-19). Proportions for each impact category were estimated for prevention, treatment, harm reduction, and recovery services. Logistic regression tested for rural-urban and regional differences in perceived service impact. Results: An 11.4% (214 out of 1873) response rate was attained. Of the returned surveys, 187 were used in the analysis. Reported terminations were generally low, especially for treatment services. School-based prevention initiatives had the highest termination rate (17.2%, 95% CI = 11.4-25.1%). Prevention services had the highest proportions for continuing at a reduced level, except for recovery mutual help programs (53.9%, 95% CI = 45.2-62.4%). LHDs reported continuing services at an increased level at a higher frequency than terminating. Notably, 72.2% (95% CI = 62.7-80.0%) continued telehealth/telemedicine options for OUD at an increased level, and 23.8% (95% CI = 17.8-31.1%) and 10.0% (95% CI = 5.7-16.7%) reported doing the same for naloxone distribution and medications for opioid use disorder (MOUD), respectively. More harm reduction services were continued at the same versus at a reduced level. Service continuation differed little between rural-urban LHDs or by region. Conclusions: The impacts of COVID-19 on OUD service availability in LHD jurisdictions may depend on the specific area of opioid response while the long-term consequences of these changes remain unknown.

Board Certification: A Role for the Nurse Educator.

Nurse educators are essential to the success of other nurses by supporting the attainment of professional competencies, knowledge, and continual development. In addition, board-certified nurse educators are also role models in lifelong learning. They are in an optimal position to promote and support others in pursuit of board certification. [J Contin Educ Nurs. 2021;52(11):497-499.].

The Importance of Board Certification.

The investment to support and obtain board certification demonstrates a nurse leader's commitment to their staff, the organization, and the communities they serve. It is important for nurse leaders to appreciate how organizational support of board certification can positively impact patient care and to be advocates for funding to support board certification for their staff. This month's Magnet® Perspectives column discusses the empirical evidence, as well as the professional value of certification.

Comparison of electromagnetic guided imagery to standard confirmatory methods for ascertaining nasogastric tube placement in children.

PURPOSE: Evaluate the accuracy of an electromagnetic device (EMD) guided nasogastric tube (NGT) placement compared with standard confirmation methods. A secondary aim was to determine if EMD guided NGT placement would avert potential pulmonary misplacements of the tube. DESIGN AND METHODS: Pediatric Intensive Care Unit (PICU) patients were enrolled if they had an NGT order during the study period of April 2014 through December 2016. Patients were included if they were one through 18 years of age. An EMD trained nurse inserted the NGT using EMD guidance. An insertion questionnaire, confirming if the nurse determined the NGT to be gastric per EMD, was completed immediately after NGT placement and before confirmation via either pH testing or radiographic imaging. RESULTS: Forty-five patients were enrolled in the study. Nurses reported, based on EMD, that 86.7% (n = 39) of placements were gastric. Overall agreement between EMD guided tube placement and pH testing was 58% (n = 26). The marginal distribution was significantly different between the two methods (p = .0029). When compared to radiographic confirmation, sensitivity of the pH method was 32% (95% confidence interval [CI]: 17%-51%) compared with 85% (95% CI 69%-95%) for the EMD method. CONCLUSIONS: EMD guidance was superior to pH testing when compared with radiographic confirmation of nasogastric tube placement in children. PRACTICE IMPLICATIONS: EMD guided NGT placement is a potentially viable method for confirming nasogastric tube placement in children when done by appropriately trained clinicians. More research on EMD guided NGT placement in children is needed before any practice recommendation can be made.

Opioid Seeking Behaviors and Diversion in Hospitalized Pediatric Patients: A Case Series.

All nurses have a responsibility for monitoring their patients for signs of substance misuse or substance use disorder. Adolescents and young adults are at risk for substance use. Prescription medications may be used by adolescents for non-medical reasons such as to feel high, to assist with sleep, to avoid negative feelings or thoughts or to avoid withdrawal symptoms after chronic use. Some adolescents with legally prescribed medications have been asked to divert those medications by giving them to someone else. Drug diversion by employees is often reported in healthcare settings, but diversion of medications done by patients is far less commonly reported. This paper is a report of two patients with complex medical issues and chronic pain who diverted opioid medications while hospitalized. Hiring clinical staff, such as nurses, working in Drug Diversion Prevention positions will provide knowledge and expertise to facilitate investigations and to help reduce risks for diversion in healthcare settings. In addition, nurses with concerns about patient diversion should discuss these concerns with the care team. Organizational leaders need to support their teams by providing education and resources so staff feel comfortable addressing these challenging situations.

A Systematic Process for Selection of a Crisis Prevention/De-Escalation Training Program in the Hospital Setting.

INTRODUCTION: The current de-escalation program utilized in this organization was not adequately meeting the needs of all the pediatric populations served. AIMS: Identify a de-escalation program, which is evidenced-based and able to be effective across all sizes and ages of patients served at this organization. METHOD: The work described in this article displays the thorough systematic process used to select a new behavioral health crisis prevention/de-escalation training program within a large children's hospital. RESULTS: Fourteen de-escalation programs were initially identified, nine of them were further analyzed based on curriculum, cost, training requirements, emphasis on verbal de-escalation, ability to address needs of those with Autism Spectrum Disorders, and overall fit for this organization. One final program was selected for implementation after a robust selection process. CONCLUSIONS: The team used a comprehensive approach during program selection to attempt to decrease or limit potential resistance to change from affected employees.

Pediatric Fall Risk Assessment Tool Comparison and Validation Study.

PURPOSE: Compare two pediatric fall risk assessment tools (I'M SAFE and Humpty Dumpty) used at the same organization to determine if one is better able to predict which patients fall. DESIGN AND METHODS: Retrospective data was obtained from patients admitted in 2014. Each patient who experienced a fall during hospitalization was matched with two non-fallers based on age and diagnosis. Logistic regression was performed to identify which tool more accurately determines fall risk and reliability testing was completed for the I'M SAFE tool. RESULTS: Over 22,000 patient files were extracted for this study. One hundred seventy-seven falls were identified, seventy-one of them were intrinsic. Of those patients who fell, the majority were assessed to be at high risk for falls. There were too few falls during the study period using the Humpty Dumpty tool to assess and make formal conclusions. The results for the I'M SAFE tool were opposite of what was expected and showed an increased risk for falls for patients who scored low risk using this tool. CONCLUSIONS: At completion of this study the data reflected that the I'M SAFE tool was not adequately predicting patients at greatest risk for intrinsic falls for this particular population. PRACTICE IMPLICATIONS: Further research on these tools is needed in other populations or across multiple sites. Additional work to adapt the tools may be necessary to better predict fall risk without over identifying high risk patients.

Utilization of a biomedical device (VeinViewer® ) to assist with peripheral intravenous catheter (PIV) insertion for pediatric nurses.

PURPOSE: Vascular access in pediatric patients can be challenging even with the currently available technological resources. This nurse-driven research study explored time, cost, and resources for intravenous access to determine if a biomedical device, VeinViewer® Vision, would facilitate improvements in pediatric access. In addition, this study looked at nurse perceptions of skills and confidence around intravenous insertion and if the use of the VeinViewer® impacted these perceptions. Literature examining pediatric intravenous access success rates compared with nurse perceived skills and confidence is lacking. DESIGN: Nonblinded randomized control trial of pediatric nurses working in an acute care hospital setting. METHODS: A preliminary needs assessment solicited feedback from nurses regarding their practice, perceived skills, and confidence with placing peripheral intravenous catheters (PIVs). Due to the results of the preliminary needs assessment, a research study was designed and 40 nurses were recruited to participate. The nurses were randomized into either a VeinViewer® or standard practice group. Nurse participants placed intravenous catheters on hospitalized pediatric patients using established procedures while tracking data for the study. RESULTS: Needs assessment showed a majority of nurses felt a biomedical device would be helpful in building their intravenous insertion skills and their confidence. The study results did not demonstrate any clinically significant differences between VeinViewer® use and standard practice for intravenous catheter insertion in pediatric patients for success of placement, number of attempts, or overall cost. In addition, no difference was noted between nurses in either group on perceived skills or confidence with insertion of PIVs. PRACTICE IMPLICATIONS: The ongoing need for resources focused on building nurse skills and confidence for PIV insertion was highlighted and organizations should continue to direct efforts toward developing skills and competency for staff that are responsible for pediatric vascular access. This study illustrates the importance of data-driven decision-making for expensive hospital-funded equipment purchases. This nursing led research study highlights how perceptions do not always align with outcomes. The lessons gleaned from this study may aid in decision-making around pediatric intravenous access practice.

Exploring provider and parental perceptions to influenza vaccination in the inpatient setting.

BACKGROUND: Hospitalization provides an ideal opportunity for immunization, but few studies have explored provider and parental attitudes toward pediatric inpatient vaccination against influenza. OBJECTIVES: The objectives were to determine provider and caregiver attitudes and explore potential barriers to inpatient influenza vaccination. METHODS: We developed and distributed two surveys to parents/caregivers as well as providers of general pediatric inpatients at Children's Hospital Colorado between October 2014 and March 2015 assessing attitudes toward influenza and inpatient influenza vaccination. We analyzed the Likert scale responses using univariate analyses and multiple logistic regression to assess associations between responses and vaccination status. RESULTS: The overall response rate was 95% and 58% for parents and providers, respectively. Parents of hospitalized children who agreed that flu vaccines are safe (adjusted OR 2.50 [95%CI 1.76-3.58]), and that the influenza vaccine is needed every year had higher odds of having a vaccinated child (adjusted OR 3.30 [95%CI 2.30-4.81]). Most providers (91%) agree that influenza vaccination is an important priority among inpatients, but believe that parental misconceptions and their reluctance for inpatient vaccination are the most important barriers to influenza vaccination. Providers forgetting to ask about vaccination status and order the vaccine are the next most commonly identified barriers. In contrast, most parents surveyed had favorable attitudes toward inpatient influenza vaccination and disagreed that their child was too sick to receive the vaccine during hospitalization.

When Nursing Assertion Stops: A Qualitative Study to Examine the Cultural Barriers Involved in Escalation of Care in a Pediatric Hospital.

Pediatric codes outside the ICU are associated with increased morbidity and mortality. This qualitative research highlights results from confidential interviews with 10 pediatric nurses with experience of caring for children who required rapid response, code response, or transfer to intensive care. Detailed examination of nurses' experiences revealed local factors that facilitate and inhibit timely transfer of critical patients. Nurses identified themes including the impact of nurse assertiveness, providers' lack of understanding of nursing, team communication, and other hospital cultural barriers.