Changes in knowledge, attitudes and beliefs in BSN students after SBIRT education and practice in home health.

BACKGROUND: Substance Use Disorders (SUD) have detrimental effects on US population's health, healthcare system, and economy. Nursing knowledge gaps in SUD justifies need for nursing education in screening for SUD. PURPOSES: Purposes include examining differences in: METHOD: This single-group, pretest-posttest study of 488 BSN students who completed education for integrating SBIRT into home assessments. Instruments included a demographics' survey, SBIRT Knowledge instrument, and Substance Abuse and Attitude Survey (SAAS). Descriptive statistics using analysis of variance (ANOVA) models and paired-sample t-tests were employed to analyze data. RESULTS: Successful identification of knowledge and attitudes significantly improved after BSN education and revealed specific areas for future research. No significant differences in knowledge, and attitudes and beliefs based on gender, race, and ethnicity were found. CONCLUSION: Understanding educational interventions' influence on knowledge and attitudes and beliefs of BSN students toward clients may have a significant effect on quality of care. Positive findings support students SBIRT education. Integrating SBIRT education and practice provides knowledge and attitudinal enhancements for SUD care and supports population and public health initiatives.

Reexamining Nurse Manager Span of Control With a 21st-Century Lens.

The primary aim of this literature review was to examine the quantity, quality, and consistency of evidence regarding the span of control (SOC) specific to nurse managers. A secondary aim was to meaningfully translate the evidence and offer guidance to 21st-century nurse leaders. The review results were categorized using Donabedian's (2003) Structure-Process-Outcomes model. The Structure-Process-Outcomes approach was used to review the literature and consider SOC recommendations for today's health care environment. Structures outlined the conditions for current SOC, which included material resources, human resources, and organizational characteristics. Processes were defined as activities or actions stemming from identified structures that led to outcomes. Examples included management/administrative activities, as well as frontline staff participation in these tasks. Outcomes were performance measures of human resources, financial, and quality metrics. The review revealed that an SOC model built on a simplistic full-time employment ratio is outdated. Yet, nurse managers remain in their role in the face of these simplistic models despite feelings of inadequacy, exhaustion, and failure because they passionately care about patients and staff. New attitudes and integration of advanced technologies, pioneering tools including SOC assessment tools, and ongoing competency developments will result in different needs of SOC as health care moves deeper into the modern era. This evidence is offered to inform and drive conversations focused on providing optimal nurse manager SOC for maximum effectiveness within unique and ever-evolving care environments.

Case management redesign in an urban facility.

PURPOSE OF THE STUDY: To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges. PRIMARY PRACTICE SETTING: Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities. METHODOLOGY AND SAMPLE: Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff. RESULTS: Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.