Concept Analysis of Systems Thinking in the Context of Interprofessional Practice and Improved Patient Outcomes.

AIM: The purpose of this study was to explore the definition and application of systems thinking (ST) in interprofessional practice and improved patient outcomes. BACKGROUND: Nurse educators need a universal definition of ST to implement in curricula to foster quality and safety while enhancing outcomes for nursing students. METHOD: The QSEN RN-BSN Task Force used the hybrid model of concept analysis to identify the process of fostering ST in clinical and didactic learning experiences and how ST changed over time from the perspective of educators. RESULTS: The definition of ST in the context of interprofessional practice and outcomes was "a dynamic, analytical process that looks at complex patterns, relationships, and connections within elements and structures, resulting in the ability to recognize the whole picture." CONCLUSION: The concept of ST in the context of interprofessional practice and improved patient outcomes may be integrated within nursing curricula.

Using VoiceThread to Build a Community of Inquiry in Blended RN-to-BSN Education.

ABSTRACT: VoiceThread, a cloud-based social media tool, was used to create a sense of community in an undergraduate blended nursing leadership course. The purpose of this quasi-experimental study was to explore the use of VoiceThread to build a community of inquiry. The Community of Inquiry and IDEA surveys were completed by 163 students enrolled in an undergraduate nursing leadership course within an RN-BS curriculum. Results indicated using VoiceThread increased student-perceived teacher excellence, supported social presence and teacher presence, and promoted a community of inquiry.

Promoting civility in nursing practice using systems thinking: Evidence-based teaching strategies for nurse educators.

There is a critical need for nurse educators to promote civility in nursing practice using systems thinking to promote quality and safety and improve patient outcomes by preventing undue patient harm. In this article, evidence is synthesized in order that readers can recognize, respond and manage workplace incivility. Systems thinking is introduced as a best practice solution for advancing a civil workplace culture. The author-created Systems Awareness Model, adapted for civility awareness, guides nurse educators with evidence-based strategies for teaching nurses the essential skills to promoting a civility culture within health systems. The strategies can be used by nurse educators in practice to interface workplace application. Proposed examples of evaluation methods are aligned with the teaching strategies. The purpose of this article is to provide nurse educators in practice with evidence-based teaching strategies and evaluation methods to address incivility in health care using a systems thinking perspective.

Developing System-Level Awareness Through Virtual Clinical Learning.

Lack of clinical sites and disparate experiences contribute to the challenge for RN-to-BS nursing programs to provide sufficient leadership and quality improvement opportunities. A virtual clinical learning experience using WordPress was developed as a faculty-graduate student think tank project and implemented in an RN-BS hybrid nursing leadership course. The unfolding case study created an interactive experience to portray use of systems thinking and transformational leadership. Mann-Whitney U analysis identified no significant difference in learning outcomes. The low-cost, easy-to-develop technology counteracted limited clinical sites, allowing for learning on the go with equivalent learning outcomes.

Exploring the Lived Experiences of Staff Nurses Transitioning to the Nurse Manager Role.

OBJECTIVE: The objective of this study was to discover the experience of nurse managers (NMs) who had transitioned from a staff nurse position BACKGROUND: Nurses who become NMs may receive little or no training or support during the transition process. This study sought to gain the perspective of NMs who transitioned into the role. METHODS: A phenomenology method was used to interview 10 NMs regarding their experience of transitioning into the NM role. Meleis Role Transition theory provided the theoretical framework. RESULTS: Five themes were identified that related to the research questions: expectations, essential knowledge and skills, graduate education prepared, sought support and mentoring from colleagues, and role mastery not possible. Participants experienced role insufficiency due to lack of support and resources. CONCLUSIONS: Further research is needed to understand nurses' experience after completing an NM developmental program, contributing to role mastery.

Using Systems Thinking to Implement the QSEN Informatics Competency.

There is an urgent need to improve the use and usability of the electronic health record (EHR) in health care to prevent undue patient harm. Professional development educators can use systems thinking and the QSEN competency, Informatics, to educate nurses about such things as nurse-sensitive indicators in preventing medical errors. This article presents teaching tips in using systems thinking to champion communication technologies that support error prevention (betterment). [J Contin Educ Nurs. 2019;50(9):392-397.].

Systems Thinking for Transitions of Care: Reliability Testing for a Standardized Rubric.

PURPOSE: The purpose of this study was to develop a standardized rubric for systems thinking across transitions of care for clinical nurse specialists. DESIGN: The design was a mixed-methods study using the Systems Awareness Model as a framework for bridging theory to practice. METHODS: Content validity was determined using a content validity index. Reliability was established using statistical analysis with Cronbach's α and intraclass correlation coefficient. Usability of the rubric was established using content analysis from focus group discussions about their experiences in using the rubric. RESULTS: Content validity was established with a content validity ratio of 1.0. Statistical analysis showed a high interrater reliability (α = 0.99), and sections of the rubric showed a strong degree of reliability with α's ranging from 0.88 to 1.00. Content analysis revealed several overall themes for usability of the rubric: clarity, objectivity, and detail. The area for improvement included adding more detail in the scholarly writing section. CONCLUSION: The research team recommends using the rubric to reflect application of systems thinking across transitions of care.

A Concept Analysis of Systems Thinking.

PURPOSE: This concept analysis, written by the National Quality and Safety Education for Nurses (QSEN) RN-BSN Task Force, defines systems thinking in relation to healthcare delivery. METHODS: A review of the literature was conducted using five databases with the keywords "systems thinking" as well as "nursing education," "nursing curriculum," "online," "capstone," "practicum," "RN-BSN/RN to BSN," "healthcare organizations," "hospitals," and "clinical agencies." Only articles that focused on systems thinking in health care were used. The authors identified defining attributes, antecedents, consequences, and empirical referents of systems thinking. FINDINGS: Systems thinking was defined as a process applied to individuals, teams, and organizations to impact cause and effect where solutions to complex problems are accomplished through collaborative effort according to personal ability with respect to improving components and the greater whole. Four primary attributes characterized systems thinking: dynamic system, holistic perspective, pattern identification, and transformation. CONCLUSION: Using the platform provided in this concept analysis, interprofessional practice has the ability to embrace planned efforts to improve critically needed quality and safety initiatives across patients' lifespans and all healthcare settings.

Intersection of Quality and Excellence: Characteristics of Redesignated National League for Nursing Centers of Excellence.

The purpose of this research was to identify characteristics of redesignated National League for Nursing Centers of Excellence in Nursing Education that represent the intersection between quality and excellence. A qualitative content analysis of six final applications submitted for redesignation disclosed essential resources that supported students, faculty, and staff and identified six characteristics: connections through relationships, communities of learning and service, support for students and faculty, connections through technology, use of innovation, and a systems focus. The systematic focus on excellence in teaching and learning identified in this research represents best practices from exemplary schools worthy of emulation by other nursing education programs.

Vaccinia virus modulation of natural killer cell function by direct infection.

Natural Killer (NK) cells have been implicated in the response to poxviruses, but the interaction between NK and infected cells is not well characterized. We show that downregulation of class I major histocompatibility complex (MHC-I) molecules in human cells by vaccinia virus (VV) sensitizes the cells to lysis by NK cells. We provide evidence suggesting that NK cells are infected as a consequence of co-culture with infected target cells. We also show that infection of NK cells leads to a marked depression of cytotoxicity. Moreover, the effect on NK cytotoxicity occurs within hours of infection and is prevented by UV inactivation of the virus but is only partially prevented by blocking late gene expression. VV infection also renders the NK cells more sensitive to inhibitory signals. Together our observations suggest that VV infection of NK cells can modulate their signaling in a manner that prevents them from acting on infected target cells.