From crisis management to multi-level interinstitutional partnerships: Development of the southeastern conference deans nursing coalition.

The Southeastern Conference (SEC) Nursing Dean's Coalition is a purposeful alliance organized to collaboratively address several challenges that arose during the COVID-19 pandemic. Over the last three years, this strategic team of academic leaders has evolved from a crisis response team to a multidimensional support team, leveraging both individual and collective strengths, to provide several benefits to the dean members, as well as other SEC nursing faculty members, students, and institutions. Participation has grown from the original 12 deans to engage a broader team of associate deans and nurse leaders in faculty development, research, service, and diversity, equity, and inclusion. This article describes the origin, evolution, and outcomes of this coalition to date, as well as visions for the future.

Embracing diversity: measuring the impact of an international immersion learning experience on nursing students' cultural beliefs and values.

OBJECTIVES: An international Nursing Leadership Collaborative covened in Japan to hold a patient safety and quality workshop for nursing students from six countries. The purpose was to measure students' self reported beliefs reflecting sensitivity and openness to cultural diversity before and after the international experience. METHODS: A pre-post-test design was used and the Beliefs, Events, and Values Inventory was administered to international undergraduate and graduate nursing students. RESULTS: The group aggregate data analysis indicate that prior to the start of the workshop, the group presented itself as quite introspective and after the workshop the group reported being more sophisticated in making causal explanations about why the world works in the way it does. CONCLUSIONS: Nursing students experienced an expanded awareness of their beliefs and values that reflect a greater degree of intercultural sensitivity for acceptance of inclusivity and diversity after the experience.

Student outcomes of an international learning collaborative to develop patient safety and quality competencies in nursing.

BACKGROUND: Patient harm is a global crisis fueling negative outcomes for patients around the world. Working together in an international learning collaborative fostered learning with, from and about each other to develop evidence-based strategies for developing quality and safety competencies in nursing. AIMS: To report student outcomes from an international learning collaborative focused on patient safety using the Quality and Safety Education for Nurses competency framework. METHODS: A global consortium of nursing faculty created an international learning collaborative and designed educational strategies for an online pre-workshop and a 10-day in-person experience for 21 undergraduate and graduate nursing students from six countries. A retrospective pre-test post-test survey measured participants' confidence levels of patient safety competence using the health professional education in patient safety survey and content analysis of daily reflective writings. RESULTS: Statistical analysis revealed student confidence levels improved across all eight areas of safe practice comparing-pre and post-education (significance, alpha of P < 0.05). Two overarching themes, reactions to shared learning experiences and shared areas of learning and development, reflected Quality and Safety Education for Nurses competencies and a new cultural understanding. CONCLUSIONS: The international learning collaborative demonstrated that cross-border learning opportunities can foster global development of quality and safety outcome goals.

Ethical Reasoning Debriefing in Disaster Simulations.

BACKGROUND: With disasters occurring often, nurses must understand and ethically implement disaster management and patient care coordination. Yet these topics are often not discussed in nursing education curricula. Simulations are a potential solution to this ethical educational deficit, allowing students to act as professional nurses in a realistic scenario with minimal threat of harm to themselves or others. AIM: This study investigates the effect of a high fidelity, multiple-casualty disaster simulation followed by a structured faculty-led debriefing session on perceived ethical reasoning confidence on senior Bachelor of Science in Nursing (BSN) students. Additionally, the effect of the intervention on students' perceived importance of ethical reasoning and perceptions of such skills was explored. METHODS: Students were provided with preparatory materials on the START (Simple Triage and Rapid Treatment) System and The Madison Collaborative's Ethical Reasoning in Action Eight Key Questions (8KQ) frameworks one week before the simulation exercise. In total, 90 students worked in pairs during the 15-minute disaster simulation. Participants' ethical reasoning attitudes were measured before and after the exercise, employing the Survey of Ethical Reasoning (SER) to indicate the importance of each of the 8KQ in students' ethical reasoning process using a five-point Likert scale. The SER was administered electronically using Qualtrics and statistical analysis was completed using SPSS. The 8KQ was also used in the debriefing led by faculty. RESULTS: Comparative assessment of pre and post-results demonstrate significant growth in students' ethical reasoning confidence scores (t(89) = -6.609, p < 0.001). CONCLUSIONS: Simulations are shown to be effective educational approaches in developing ethical reasoning confidence and promoting the development of students' ethical preparedness.

Implementing Posthospital Interprofessional Care Team Visits to Improve Care Transitions and Decrease Hospital Readmission Rates.

PURPOSE/OBJECTIVES: Today's health care climate is composed of patients who experience complex conditions with multiple comorbidities, requiring higher utilization of acute care services. It is imperative for acute care and primary care landscapes to bridge silos and form collaborative relationships to ensure safe and effective transitions of care from hospital to home. An interprofessional, posthospital follow-up clinic (Discharge Clinic) is one approach that can be used to improve transitions of care and decrease preventable hospital readmissions. The purpose of the Discharge Clinic is to improve transitions of care and decrease 30-day hospital readmission rates. The clinic's objective is to utilize an interprofessional care team to improve transitions of care posthospital, for complex care patients. PRIMARY PRACTICE SETTING: The posthospital Discharge Clinic is an innovative, interprofessional clinic located in a large western state that was initiated to improve transitions of care for its patients discharged from an acute care setting. The interprofessional care team consists of a certified family nurse practitioner, a clinical pharmacist, a nurse case manager, and a social worker. FINDINGS/CONCLUSIONS: In 2013, Medicare and private coverage data reveal 30-day readmission rates of 17.3% and 8.6%, respectively (). From February 2016 to September 2016, Discharge Clinic project participants achieved a 30-day readmission rate of 2.7%. The Discharge Clinic enrolled 75 patients in the project (n = 75). The 30-day readmission rate achieved by the Discharge Clinic represents a significant decrease compared with national benchmark data. Two patients enrolled in the project were readmitted within 30 days of hospital discharge. For fiscal year 2015, the medical group's estimated cost of readmissions was $7,156,800 and 30-day all-cause readmission rate was 12.3%. This equated to the Discharge Clinic's estimated impact in reducing readmissions at 9.63% and an estimated savings of $689,199.84. The Discharge Clinic estimated its operating costs at $354,000, which gave a total estimated net savings of $335,199.84. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The current health care landscape is composed of an aging population, rising in complexity. New approaches are needed to bridge gaps between acute care and primary care settings. The Discharge Clinic serves as an innovative model that health systems throughout the country can replicate to improve transitions of care for complex patients. The interprofessional care team model can be implemented to advance and bridge the management of acute and ambulatory care patient populations.

Leading during loss: Death of a beloved faculty member.

In any job setting, the sudden or expected death of a coworker can cause profound grief and loss. Moreover, in academic settings there are unique challenges that warrant further discussion. Given the aging of the nursing professoriate, the shortage of nursing faculty, and the medical advances prolonging our life expectancy, we can forecast a greater frequency of loss of faculty while employed. The impact of a faculty member death on colleagues, staff, and students can cause great distress and therefore requires careful attention and consideration for all. As Deans and Directors at Schools of Nursing, how do we navigate grief and mourning, supporting others while experiencing some of the same feelings ourselves? This requires a careful balance, as our actions can create an impact on the culture and health of our colleges and schools of nursing and those who work and attend classes therein.

Be the Change: An Interprofessional Team-Based Health Advocacy Summit.

In a complex health care environment, nursing and health care professional graduates should be able to understand and collaboratively advocate for health policy benefitting patients, families, and communities. This study explored the effectiveness of interprofessional team-based learning to improve political astuteness in undergraduate health profession students. This engaging method may prove to enhance health care professionals' likelihood of understanding, involvement, and influencing health policy in the future.

The aging Hispanic in America: challenges for nurses in a stressed health care environment.

The aging of America and the explosion of Hispanic immigrants into the United States are causing a tremendous burden to the health care system. The challenges already apparent in an overburdened health care system are examined, and useful strategies for health care providers are offered. The significant challenges facing the Hispanic population are presented, and the need for cultural sensitivity and its importance in providing culturally competent, patient-relevant care are highlighted.

An intervention to change the approach to colorectal cancer screening in primary care.

PURPOSE: The purpose of this project was to increase colorectal cancer screening (CRC) rates in the state of Nevada. Research has shown that there are several interventions for providers to use to increase CRC screening rates in practice. The Nevada Colon Cancer Partnership (NCCP) has created a toolkit to assist providers to implement these interventions in practice. DATA SOURCES: Research has repeatedly shown that CRC screening has a great impact on the morbidity and mortality of CRC. Studies have shown that a fecal occult blood test can detect 60-85% of CRCs and a colonoscopy with polyp removal can reduce mortality by 60-90%. Multiple studies have shown that a provider's recommendation is the most consistently influential factor in cancer screening. Furthermore, offering patients a choice and encouraging active participation in health care decision making has proven to increase CRC screening rates. CONCLUSIONS: The NCCP has collaborated with the American Cancer Society to create a web based toolkit for use by providers to change practice and screen all eligible patients for CRC. The toolkit is designed to encourage providers to decrease the morbidity and mortality of CRC and other cancers. The toolkit is useful to facilitate efforts of office-based clinicians to reduce disparities by applying screening guidelines on a universal basis to the age-appropriate population. A team approach to screening is encouraged to promote an opportunistic or global approach to assure all eligible patients are reached. IMPLICATIONS FOR PRACTICE: As healthcare reform continues to evolve, Nurse Practitioners (NPs) will assume much of the primary care needs of our country. A preventive care model is an important aspect of the future of healthcare. NPs are in a perfect position to change the health of patients in a global way. The strategies and tools presented in this toolkit are designed to improve preventive care and assist the NP in assuring that every eligible patient receives the screening tests they need.

A process of decision making by caregivers of family members with heart failure.

Heart failure (HF) is a major cardiovascular problem and the number of people living with HF continues to climb. Throughout the illness continuum, patients and their family caregivers are involved in decision making. As the illness worsens and patients can no longer make decisions, decision making becomes the responsibility of their caregivers who may have little preparation for the role. The purpose of this grounded theory study was to examine how caregivers of family members with HF make decisions. A nonlinear decision-making process consisting of several actions was identified, which included actualizing; seeking input, information, or support; reflecting; choosing; evaluating; and validating the decision.

"I see my mother's face": student nurse experiences caring for cancer patients.

PURPOSE: With the numbers of cancer diagnoses increasing annually and the aging of the global citizenry, it is certain that more nurses with expert competencies in cancer care will be needed. Nursing students must have a broad understanding of cancer content in order to provide safe, effective care in the clinical setting as they learn to recognize their own experiences in caring for cancer patients. Experienced nursing educators are aware that student nurses bring into any clinical learning situation their unique knowledge, values, fear, uncertainty and bias. The purpose of this study was to examine the experiences of nursing students caring for cancer patients. METHOD: This descriptive qualitative study included participants who were Junior or Senior Baccalaureate nursing students and had provided care for at least one patient with cancer during clinical experiences. Focus group interviews were transcribed verbatim for analysis and coding using accepted qualitative techniques. RESULTS: Data analysis revealed student experiences to be varied in the type of cancer patient experiences. Four prevalent sub-themes emerged regarding student experiences: caring for patients and families, interactions between students and healthcare providers, student experiences with dying patients, and students' prior experiences with cancer. Further discussion with students revealed a student perspective for strengthening cancer in the curriculum. CONCLUSION: Preparing students to be comfortable with cancer patients across the cancer illness trajectory will provide students with the necessary skills to gain confidence in their cancer patient care.

The process of family waiting during surgery.

In 2006, there were 46 million surgical procedures performed in the United States, all of which would have typically included waiting by the family and/or friends. A grounded-theory approach was used to examine the experiences of waiting family members during surgery of a loved one. A convenience sample of 32 family members of patients undergoing surgery were interviewed in two surgical waiting rooms. Constant comparison of the data was performed until saturation of categories was achieved. The resulting middle-range theory, maintaining balance during the wait, described the family member's struggle for balance during the surgical wait. Four domains were identified: focusing on the patient, passing the time, interplay of thoughts and feelings, and giving and/or receiving support. Study findings showed that understanding this struggle for balance during a surgery is imperative for nurses who often interact with family members and need to address their needs.

The WebQuest: constructing creative learning.

An exciting expansion of online educational opportunities is occurring in nursing. The use of a WebQuest as an inquiry-based learning activity can offer considerable opportunity for nurses to learn how to analyze and synthesize critical information. A WebQuest, as a constructivist, inquiry-oriented strategy, requires learners to use higher levels of thinking as a means to analyze and apply complex information, providing an exciting online teaching and learning strategy. A WebQuest is an inquiry-oriented lesson format in which most or all of the information learners work with comes from the web. This article provides an overview of the WebQuest as a teaching strategy and provides examples of its use.

Revisiting geriatric failure to thrive: a complex and compelling clinical condition.

Geriatric failure to thrive (GFTT) poses a complex clinical issue in gerontological nursing practice. GFTT is not a normal part of aging, nor is it an outcome of chronic illness. Rather, GFTT describes a lack of vitality and diminished capacity for life and outlines a process of functional decline that is often difficult to explain. The purpose of this article is to review GFTT, examine the literature on GFTT, and suggest strategies for the identification, assessment, and creative management of this complex condition that affects millions of older adults.

Patterns of decision making by wives of patients with life-threatening cardiac disease.

Implementation of the Patient Self-Determination Act (PSDA) in the United States has transferred decision making from the responsibility of health care professionals to the responsibility of family members. Dilemmas occurring as a result of this responsibility may cause stress and conflict among family members. The purpose of this study is to describe the patterns of decision making by family members of patients with life-threatening cardiac disease. Purposive sampling is used to select 10 wives of patients with life-threatening cardiovascular disease. Data are gathered through unstructured interviews and are analyzed using grounded theory and theory triangulation. Analysis of the data reveal three patterns of decision making: advocacy, acquiescence, and abdication.

Polymedicine and aging. Enhancing older adult care through advanced practitioners. GNPs and elder care pharmacists can help provide optimal pharmaceutical care.

Approximately one third of all drugs prescribed in the United States are considered unnecessary. Polymedicine, polypharmacy, medication nonadherence, and adverse drug reactions are among the top five causes of acute care hospitalizations in persons older than age 65. These conditions significantly increase health care costs and will continue to do so at an alarming rate as America's population ages. Although medications are an important factor in improving and maintaining the quality of life for older adults, polymedicine places them at risk of an acute care admission for medication-related problems and other complications. This article reviews polymedicine and common medication errors, explores the depth of the problem in aging clients, and advocates for the use of gerontological nurse practitioners as advanced practice nurses and specialty-trained elder care pharmacists as active members of the interdisciplinary health care team.

The health status of rural caregivers.

The purposes of this study were to examine the relationships among stress, caregiver burden, and the health status of rural caregivers and assess whether caregiver burden and stress predict the physical health status of caregivers in the rural setting. A descriptive-correlational design was used to explore the caregiver health status of 63 informal caregivers in rural Alabama and Mississippi. The relationships among stress, burden, and health status in rural caregivers were significantly related (p .000) and significant variance in health status (p .000) was accounted for by the model variables of stress and caregiver burden. Rural caregivers experienced difficulty with transportation to the hospital and their physicians, and complained of experiencing uncomfortable physical symptoms.