Guiding the Management of Acute Promyelocytic Leukemia: A Quality Improvement Project.

BACKGROUND: Despite successful treatment regimens and remission rates of greater than 90%, early death is a concern for patients with acute promyelocytic leukemia (APL). The challenges surrounding proper care for APL are centered on the low volume of patients, which limits healthcare professionals' knowledge of disease management. OBJECTIVES: The purpose of this project was to develop resources and present an educational module specific to managing patients newly diagnosed with APL. An intervention to evaluate bedside nurses' knowledge of APL was implemented. METHODS: Thirty-four RNs were recruited for participation. A clinical practice guideline, an algorithm, and a fact sheet were developed to provide resources for providers. An educational module was presented to the RNs to increase their knowledge of APL. Pre- and postintervention surveys were created to assess knowledge and confidence before and after the intervention. FINDINGS: Thirty-four RNs completed the module, and 27 participated in the pre- and postintervention surveys. Mean knowledge test scores increased significantly from 7.19 preintervention to 14.04 postintervention (p < 0.001).

The Beacon Collaborative: A Journey to Excellence.

TOPIC: The development of the Critical Care Beacon Collaborative to achieve meaningful recognition. CLINICAL RELEVANCE: Recognizing nurses for contributions to their work environment and care delivery is important for their professional and personal fulfillment, job satisfaction, and retention; such recognition can occur at the individual, unit, or organizational level. The American Nurses Credentialing Center's Magnet Recognition Program acknowledges nursing excellence at the organizational level. It would, however, be difficult for an organization to achieve Magnet designation without nursing excellence at the unit level. To recognize excellence at the unit level, the American Association of Critical-Care Nurses developed the Beacon Award in 2003. OBJECTIVE: To describe one academic medical center's journey toward winning Beacon Awards across 8 units within the adult critical care service. CONTENT COVERED: The Critical Care Beacon Collaborative resulted in a Beacon Award for each unit and important staff outcomes. This article describes the organization, the process before the Critical Care Beacon Collaborative convened and the desired state, and the methods used to achieve our goal. It also discusses unit- and service-level stakeholder involvement. The successes, lessons learned, sustainability, and growth of the Critical Care Beacon Collaborative are shared to assist readers who aspire to pursue a Beacon Award.

Nursing Faculty Experiences During the COVID-19 Pandemic Response.

AIM: The specific aim of the study was to describe nursing faculty experiences during the COVID-19 pandemic. BACKGROUND: Academic nursing experiences were disrupted due to the COVID-19 pandemic. There is concern that the resulting stress threatens nursing faculty emotional well-being. METHOD: A descriptive, quantitative study was conducted, exploring faculty academic and clinical roles during the COVID-19 pandemic, including perception of institutional support provided; faculty burnout, satisfaction, and well-being; and student support needs and well-being. RESULTS: Analyses were performed on 117 quantitative and 49 qualitative responses. Participants perceived support from academic institutions and increased need to provide emotional support to students. Most reported negative effects on well-being but did not report high levels of burnout. CONCLUSION: Nursing faculty are essential to the profession. Stress responses from the COVID-19 pandemic may not be fully realized. Nursing faculty require proactive and sustained institutional and personal support to provide exceptional ongoing education, build resilience, and support students.

A Comparison of Teaching Methods for a Baccalaureate Nursing Health Assessment Course.

New teaching methods are designed and implemented to ensure student success and application of knowledge. One of these designs is the flipped classroom. Nursing programs are also integrating technology, including simulation, into nursing education in order to enhance student engagement. Although several research studies support flipped classroom methodology, no studies have compared traditional and flipped classroom teaching methods, as well as the use of a technology-enhanced classroom, in a baccalaureate nursing health assessment course. The purpose of this study was to compare learning outcomes and student satisfaction in an undergraduate health assessment course across three teaching methods: traditional lecture, flipped classroom, and a technology-enhanced interactive flipped classroom. All three methods incorporated virtual patient simulation. Using a quasi-experimental design, formative and summative assignment grades were compared. Student course evaluations were compared to assess satisfaction with each teaching method. Significant differences in mean grades were found in 12 of the 23 assignments. The technology-enhanced interactive flipped classroom section outperformed the traditional and flipped classroom sections on most of these assessments. Only one difference was noted in student satisfaction. The results showed that a technology-enhanced interactive flipped classroom design supported student learning. A longitudinal analysis of student performance is recommended.

Management of Intracranial Pressure Part II: Nonpharmacologic Interventions.

Pharmacologic and nonpharmacologic interventions are available to treat patients who experience serious elevations in intracranial pressure (ICP). In some cases, patients may experience ICP that is refractory to treatment. Significant negative effects on cerebral blood flow, tissue oxygenation, and cerebral metabolism occur as a result of intracranial hypertension, leading to secondary brain injury. In part 2 of this series, nonpharmacologic interventions for ICP and ICP refractory to treatment are discussed. Interventions include neurologic monitoring (bedside assessment and multimodal monitoring), ventilatory support, fluid and electrolyte maintenance, targeted temperature management, and surgical intervention. Technology is always evolving, and the focus of multimodal monitoring here includes devices to monitor ICP, brain tissue oxygen tension, and cerebral blood flow and cerebral microdialysis monitors. Nursing care of these patients includes perspicacious assessment and integration of data, monitoring ventilatory and hemodynamic functioning, and appropriate patient positioning. Nurses must collaborate with the interprofessional care team to ensure favorable patient outcomes while utilizing an evidence-based guideline for the management of ICP.

Management of Intracranial Pressure: Part I: Pharmacologic Interventions.

Dangerous, sustained elevation in intracranial pressure (ICP) is a risk for any patient following severe brain injury. Intracranial pressure elevations that do not respond to initial management are considered refractory to treatment, or rICP. Patients are at significant risk of secondary brain injury and permanent loss of function resulting from rICP. Both nonpharmacologic and pharmacologic interventions are utilized to intervene when a patient experiences either elevation in ICP or rICP. In part 1 of this 2-part series, pharmacologic interventions are discussed. Opioids, sedatives, osmotic diuretics, hypertonic saline solutions, and barbiturates are drug classes that may be used in an attempt to normalize ICP and prevent secondary injury. Nursing care of these patients includes collaboration with an interprofessional team and is directed toward patient and family comfort. The utilization of an evidence-based guideline for the management of rICP is strongly encouraged to improve patient outcomes.

Compassion satisfaction: A concept analysis in nursing.

BACKGROUND: Nurses experience an intrinsic sense of fulfillment derived from their work in caring for other people. There is a need to further investigate the concept of compassion satisfaction as it is experienced in the profession of nursing. AIM: The aim of this analysis is to provide clarity to the concept of compassion satisfaction in nursing. DESIGN/DATA SOURCE: A search of social work and nursing literature was completed. The search terms "compassion satisfaction," "nursing," "social workers," "teachers," and "educators" were entered in various combinations to the CINAHL, Journals@Ovid, ProQuest Nursing & Allied Health Source, ProQuest Psychology Journals, PsychINFO, ERIC, and Education Full Text databases. REVIEW METHODS: A comprehensive review of the literature was completed to identify features of compassion satisfaction. Utilizing the Walker and Avant method, assumptions, antecedents, characteristics, and consequences of compassion satisfaction were identified. RESULTS: A conceptual model of compassion satisfaction was developed encompassing 7 antecedents, 11 characteristics, and 8 consequences. Further, a theoretical definition of compassion satisfaction in nursing was derived. CONCLUSION: There is a need to focus on the positive effects of caring. This concept analysis provides the initial step to strengthening the science related to compassion satisfaction in nursing and other helping professions.

Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit.

Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial. During this time, unit champions were integral to successful trial execution. Outcome measurement included patient and unit outcomes, nursing satisfaction, and a pre- and postimplementation patient comparison. Following implementation, unit length of stay decreased by 4.16% and there was a 17.81% decrease in average time on the ventilator following the initiation of weaning. Patient reports of nurse sensitivity and responsiveness to pain increased from 93.7 to 94.9. Nurses reported satisfaction with the practice change and improvements in care. In comparing pre- and postimplementation patient data, there was a significant decrease in mean analgesic treatment duration and an increase in the use of antipsychotics for delirium management. Following the trial period, this guideline was permanently adopted across the adult critical care service. The development of a nurse-driven analgosedation guideline was noted to be both feasible and successful.

Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses.

BACKGROUND: Although critical care nurses gain satisfaction from providing compassionate care to patients and patients' families, the nurses are also at risk for fatigue. The balance between satisfaction and fatigue is considered professional quality of life. OBJECTIVES: To establish the prevalence of compassion satisfaction and compassion fatigue in adult, pediatric, and neonatal critical care nurses and to describe potential contributing demographic, unit, and organizational characteristics. METHODS: In a cross-sectional design, nurses were surveyed by using a demographic questionnaire and the Professional Quality of Life Scale to measure levels of compassion fatigue and compassion satisfaction. RESULTS: Nurses (n = 221) reported significant differences in compassion satisfaction and compassion fatigue on the basis of sex, age, educational level, unit, acuity, change in nursing management, and major systems change. CONCLUSIONS: Understanding the elements of professional quality of life can have a positive effect on work environment. The relationship between professional quality of life and the standards for a healthy work environment requires further investigation. Once this relationship is fully understood, interventions to improve this balance can be developed and tested.