Have our backs-medical-surgical nurses' safety culture experiences: An inductive qualitative descriptive study.

AIM: This study aims to describe medical-surgical registered nurses' experiences with safety culture. DESIGN: Qualitative, Inductive descriptive. METHODS: Registered nurses were recruited from a Midwestern community hospital in the United States using purposive sampling. The participants were interviewed using semi-structured interview questions from February 6, 2020-April 9, 2020. Safety huddles were observed and key documents were collected. The interviews were transcribed and analyzed using inductive qualitative content analysis. The COREQ checklist was followed. RESULTS: A total of 16 registered nurses were interviewed. Six themes emerged: Time to know my patient to keep them safe, using my gut and nursing interventions, getting extra eyes on the patient, not always having what is needed to provide safe care, organization prioritizes patient safety, and learning: have our backs. No Patient or Public Contribution.

Development of a decision support tool to prevent community acquired pressure injuries for use in the spinal cord injury clinic using the delphi technique.

STUDY DESIGN: Delphi Technique. OBJECTIVES: Describe the development of a decision support tool to prevent community-acquired pressure injuries (CAPrIs) in individuals with spinal cord injury (SCI) for use in SCI clinics, called the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT). SETTING: Veteran Health Administration Hospital, Chicago, Illinois, USA. METHODS: Concept mapping of current pressure injury (PrI) guidelines and qualitative research describing risks, actions, and resources needed to prevent CAPrIs associated with SCI were used to develop 40 veteran checklist items (Items) along with 37 associated provider actions (Actions) for the tool. The Delphi technique was used to refine Items and Actions with a panel of interprofessional SCI providers (n = 15), veterans with SCI (n = 4), and caregivers (n = 3) to determine consensus on a 4-point Likert scale (strongly agree-strongly disagree) for each Item and Action. A 75% agreement was set for responses rated as strongly agree or agree. RESULTS: Panelists were 60% female, 62% White, 33% veterans with SCI or caregivers, 33% wound care certified with a mean age of 59 years. Two survey rounds were required for consensus for 41 Item and 38 Action CAPP-FIT. Response rate was 95% for both rounds. Delphi round 1 showed all but two Actions affirming agreement above 75%. Substantive comments from panelists required revision to 5 Items and 9 Actions and one additional Item/Actions related to coping, meeting threshold percent agreement in Round 2. CONCLUSIONS: The CAPP-FIT could become a useful tool for Veterans living with SCI, caregivers, and SCI providers.

The role of awards in promoting educational leadership in nursing: A qualitative descriptive study in gerontological nursing.

Background: As the population ages, the need for high quality nursing education in the unique health and illness needs of older people is required at undergraduate and postgraduate levels. Gerontological nursing and gerontological nursing education are critically important in this new age of human longevity and chronic disease. To facilitate high quality and engaging educational practices in gerontology, the National Hartford Center for Gerontological Nursing Excellence offered a professional recognition award program, entitled the Distinguished Educator in Gerontological Nursing Award (the Award). Objectives: Describe participants' perceptions of an awards program in gerontological nursing education. Design: Qualitative descriptive research. Settings: National Hartford Center for Gerontological Nursing Excellence, a professional body that aims to enhance and sustain the capacity and competency of nurses to provide quality care to older adults, opened the Award to international applications in 2018. Participants: Nine awardees, residing in North America and Asia. Methods: Semi-structured individual interviews followed by inductive, thematic analysis. Results: The Award was valued for its prestige and recognition; the process of applying was affirming; and achievement of the Award strengthened awardee confidence to lead and advocate for gerontological nursing education. A model for understanding the Award, focused on value, application and confidence is proposed. Conclusions: The use of award programs for gerontological education expertise may improve nurse educators' confidence and performance within educational settings. How the Award impacts student learning remains unknown. Further research into the benefits and limitations of award programs for nurse educators specializing in gerontological nursing and other fields, their managers, and students is required to fully understand the role of educational award programs in nursing.

Triangulation of veteran and provider models of preventing community-acquired pressure injuries in spinal cord injury to reveal convergence and divergence of perspectives.

CONTEXT/OBJECTIVE: Community-acquired pressure injuries (CAPrI) are a common and costly complication of spinal cord injury (SCI). The majority of PrIs occur in the community, but there is little guidance in CAPrI prevention. This study describes how provider and veteran perspectives of CAPrI prevention converge and diverge. DESIGN: The Farmer triangulation method was used to compare two models from previous qualitative research describing provider and veteran perspectives of CAPrI prevention based on the framework of CAPrI risks, resources, and preventive activities. The previous qualitative research revealed the provider model of CAPrI prevention using semi-structured interviews with interprofessional SCI providers at the Veteran Health Administration (VA) (n = 30). A qualitative descriptive design using photovoice (n = 30) with or without guided tours (n = 15) revealed the Veteran model of CAPrI prevention. SETTING: The previous qualitative research was conducted at three geographically different VA spinal cord injury/disorder centers in the United States (north, south, west). PARTICIPANTS: 30 interprofessional SCI providers; 30 Veterans living with SCI at three VA SCI Centers in the United States. INTERVENTIONS: n/a. OUTCOME MEASURES: Provider-Veteran perspectives of CAPrI prevention that demonstrated agreement, partial agreement, divergence, and silence. RESULTS: Providers and veterans agreed on what is basic care, and the importance of family, caregiver and health provider/system supports, but they viewed motivation, veteran role, informal supports, and adequacy of supports differently. CONCLUSION: Understanding how SCI providers and veterans living with SCI view prevention in the community informs how to promote preventive care in the context of veterans' lives.

Medical-surgical nurse leaders' experiences with safety culture: An inductive qualitative descriptive study.

AIM: The aim of this study is to describe safety culture as experienced by medical-surgical nurse leaders. BACKGROUND: Safety culture remains a barrier in safer patient care. Nurse leaders play an important role in creating and supporting a safety culture. METHODS: We used an inductive qualitative descriptive study using semistructured interviews, document review and observations in a Midwestern community hospital in the United States. RESULTS: Results of the study are as follows: making sure nurses are keeping patients safe, making sure nurses have nursing interventions in place, expecting nurses to stop unsafe acts or escalate when they feel uncomfortable, making sure nurses have what they need to provide safe care, organization prioritizes patient safety and making sure nurses are learning and growing emerged as themes describing safety culture. CONCLUSIONS: Nurse leaders made sure patients were safe by making sure everyone was doing their best to provide safe care. Insufficient time, too many priorities, insufficient resources, poor physician behaviours and lack of respect for their role emerged as barriers to leading a safety culture. IMPLICATIONS FOR NURSING MANAGEMENT: Organizations must remove barriers for nurse leaders to develop and lead a safety culture. Nurse leaders must learn to advocate successfully for safe nursing care and professional work environments.

Provider perspectives of community-acquired pressure injury prevention in veterans with spinal cord injury.

CONTEXT/OBJECTIVE: Community-acquired pressure injuries (CAPrI) are a common and costly complication of spinal cord injury (SCI). Most studies and interventions focus on the prevention of pressure injuries acquired in the hospital. The goal of this study is to better understand SCI provider perspectives of the risks, actions and resources needed to prevent CAPrIs. DESIGN: Qualitative descriptive, semi-structured interviews of SCI providers analyzed using a deductive-inductive approach. SETTING: Three geographically different veteran health administration spinal cord injury/disorder centers. PARTICIPANTS: 30 interprofessional SCI providers. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Provider perspective of risks, actions and resources for CAPrI prevention in veterans with SCI. RESULTS: 30 interviews revealed a model of provider perspectives of CAPrI prevention including veteran risk characteristics, veteran preventive activities and provider, family, community caregiving resources. CONCLUSION: Understanding provider perspectives of Veteran CAPrI preventive risks, actions and resources guides more appropriate interventions to prevent CAPrIs in individuals living with SCI.

Veteran model of preventing community-acquired pressure injuries associated with spinal cord injury: A qualitative descriptive study.

CONTEXT/OBJECTIVE: Pressure injuries (PrIs) are the second leading cause of hospitalization in people with spinal cord injury (SCI). The majority of PrIs occur in the community, but there is little known about prevention of community acquired PrI (CAPrI). The purpose of this study was to better understand risks, resources, and actions associated with CAPrI prevention from the perspective of veterans living with SCI in the community. METHODS: A qualitative descriptive design using photovoice (n = 30) with or without guided tours (n = 15) was conducted with Veterans living with SCI at 3 sites across the United States to determine environmental/lifestyle risks at home, prevention activities, resources used, and challenges in CAPrI prevention. Interviews were audio-recorded, transcribed and analyzed using thematic analysis, followed by inductive thematic synthesis. RESULTS: Qualitative analyses revealed a model describing veteran's perspective of preventing CAPrIs associated with SCI. The model included 3 themes and 9 subthemes: Factors that Lead to Risk for Pressure Injury (Challenges and Barriers), Factors that Affect Chosen Actions (Veteran Motivators, Veteran Values, Veteran Satisfaction with Provider Relationships, and Veteran Supports), and Preventive Activities within Context of Life (Physical Care, Coping, Advocacy). CONCLUSION: Incorporating the veteran model of prevention within the context of life into clinical care could support provider-veteran collaboration to identify and integrate successful strategies that prevent CAPrIs while also improving veteran quality of life.

Developing a decision support tool to prevent community-acquired pressure injuries in spinal cord injury in ambulatory care: A nurse-led protocol for mix methods research.

BACKGROUND: There is a lack of formal guidelines and decision support tools to prevent community-acquired pressure injuries (CAPrIs) in Veterans with spinal cord injury (SCI). PURPOSE: In this article we present our research protocol that describes our plans to create and test a decision support tool to prevent CAPrIs in SCI. METHODS: In Aim 1, we identified mental-models of CAPrI prevention from the perspectives of Veterans (using photovoice, guided tours), and Veterans Health Administration SCI providers (using interviews), and triangulation to compare the two mental-models. This led to a decision support tool developed and validated using Delphi approaches in Aim 2 and will be followed by tool automation and system redesign for pilot implementation in Aim 3. FINDINGS: The nurse-led research protocol provides a map to systematically explore, address and translate research into evidence-based practice. DISCUSSION: Refinement of the protocol will guide future research and implementation.

Internet Programming to Reduce Loneliness and Social Isolation in Aging.

Loneliness and social isolation in older adults carry mortality risks similar to cigarette smoking. The study aim was to use a Culturally Informed Healthy Aging (CIHA) assessment process in Housing and Urban Development (HUD) communities of older adults (N = 262). Through the CIHA assessment process, older adults identified pertinent health problems and the study team developed a health intervention, an Internet Information Station (IIS). The IIS pilot study included computer lesson participation (n = 261), written feedback (n = 42), and the revised University of California, Los Angeles (R-UCLA) Loneliness Scale (n = 11). Increased confidence with technology and connectedness were reported, and a significant difference in "There is no one I can turn to" was observed (IIS compared to non-IIS). The IIS remains an active site for interaction 1-year post intervention. These pilot results supplement the research on older adult engagement in problem identification, intervention design, and outcomes measurement. TARGET: Older adults living in HUD communities. INTERVENTION DESCRIPTION: Through CIHA assessment, health problems were identified, and the IIS was developed and implemented. MECHANISMS OF ACTION: Lessons were developed (e.g., computer basics, connecting with technology, open forum) and evaluated. Pre and post lesson, the R-UCLA Loneliness Scale measured social isolation and loneliness. OUTCOMES: Older adults were engaged in problem identification, program development, and implementation. Feelings of connectedness improved; however, program evaluation with the R-UCLA scale was difficult to obtain. [Research in Gerontological Nursing, 13(5), 233-242.].

A culturally informed lower-extremity complication prevention program for people living with diabetes in south India.

BACKGROUND: Diabetes and its complications are increasing in frequency worldwide. Lower-extremity complications carry a high risk for morbidity and mortality, yet are largely preventable through education and self-monitoring. In India, rural areas lack access to education, care, and treatment. Despite existing evidence-based programs to reduce diabetes-related lower-extremity complications in areas with limited resources, uptake and sustainability may be hampered by the lack of translation to the local cultural context. AIMS: To address this gap, this study used the Culturally Informed Healthy Aging nursing process to develop a lower extremity complication prevention program in a rural village. The paper describes the results of a community health needs assessment conducted annually from 2009 to 2014, and subsequent pilot test of an intervention incorporating these results. METHODS: The Culturally Informed Healthy Aging process is a naturalistic, inductive method used to identify and address health needs. Components include community partnership, community assessment, program planning, selection of health priorities, workgroup formation and translation of evidence, and program outcome evaluation. The programming is assessed using process evaluation, which allows for continuous monitoring and program modification. RESULTS: Community assessment revealed a number of values, beliefs, and practices related to foot care and assessment in rural south India. These were incorporated into culturally informed programming and evidence-based protocols were adapted for use in the local context. Programming resulted in increased community capacity for lower extremity complication prevention, accessible population screening, and culturally informed foot care education. DISCUSSION: Strengths, limitations and implications for care in rural India and other areas are discussed.

Development of core competencies and a recognition program for gerontological nursing educators.

Despite efforts to implement learner competencies in gerontological nursing, a significant knowledge-attitude disassociation remains, with few students interested in pursuing careers in the care of older adults. One reason may be the lack of well-qualified faculty who can design engaging learning experiences with older adults and serve as positive role models for aging care. In response, the National Hartford Center of Gerontological Nursing Excellence commissioned the development of core competencies and a recognition program for educators in gerontological nursing. The goal of these competencies is to promote quality instruction in the care of older adults by describing a set of preferred skills characterizing faculty teaching gerontological content to nursing and interprofessional learners. These educator-focused competencies can guide individual career development for new and current educators who specialize in teaching about the care of older adults. They provide direction for selecting well-prepared individuals for gerontological nursing teaching positions and evaluating educator role performance. This paper describes the development of seven core competencies for nurse educators who teach in academic and professional development programs, as well as criteria for their recognition. An iterative development process was used to define the core competencies, along with descriptions and exemplars of each domain.

Why nursing needs community-centred care.

Patient- and family-centred care improve patient satisfaction, healthcare outcomes and healthcare delivery. But how would the addition of another layer, community-centred care, affect this model?

How Do We Promote Health?: From the Words of African American Older Adults With Dementia and Their Family Members.

As population diversity increases, understanding what health promotion means to ethnically diverse older adults and their family members aids in the design of health programming. This understanding is particularly relevant for the African American population who experience a high prevalence of Alzheimer's disease and related dementias (ADRD). The purpose of the current study was to describe family members' definition of health, health promotion activities (HPAs), barriers to HPAs, and the perceived effectiveness of HPAs for African American older adults with ADRD. A qualitative descriptive design was used to collect data from African American family caregivers (n = 26) and care recipients (n = 18). Transcripts, journals, and field notes were reviewed using inductive content analysis. Common health promotion activities included taking care of self, positive attitude on life, social engagement, spiritual and religious activity, stimulation and active movement, and financial stability. This research informs person-centered care strategies for African American families caring for older adults with ADRD. [Res Gerontol Nurs. 2016; 9(6):278-287.].

Community Models of Care: A Scoping Review.

Nurse preparation and role in community models of care for older adults is not well documented. The purpose of the current structured scoping literature review was to identify nurse-led or nurse-involved community models of care for older adults, articulate the nurse's role and preparation in the model, and identify Triple Aim policy implications. Literature from 2008 through 2014 yielded 34 models identified in 51 articles. Twenty-one of 34 models were evaluated and none clearly articulated the full impact of a nurse role. Policy implications include: (a) consensus on degree preparation for nurses working in communities with older adults; (b) clearly defined nurse-sensitive measurements that capture the role of nursing in ambulatory and community care; (c) nonrestrictive scopes of practice for gerontological nurses and adult-gerontological nurse practitioners to extend their role beyond clinic settings; and (d) extending beyond value-based payment, which currently is largely physician awarded, and including additional Medicare and Medicaid policy to support nurses, community-level practice, and reimbursement. [Journal of Gerontological Nursing, 42(12), 12-20.].

Aging in Community: Developing a More Holistic Approach to Enhance Older Adults' Well-Being.

Public health advances have contributed to increased longevity; however, individuals are more likely to live longer with multiple chronic conditions. The existing health care system primarily focuses on treating disease rather than addressing well-being as a holistic construct that includes physical, social, and environmental components. The current commentary emphasizes the importance of supporting healthy active aging and aging in community. The barriers to aging in community and the state of the intervention science in response to this problem are discussed, and recommendations for future research are provided. Active aging is more than managing illness or care transitions-it promotes engagement, participation, dignity, self-fulfillment, self-determination, and support for older adults. To support aging in community and healthy active aging, a paradigm shift is needed in how the well-being of older adults is thought about and supported.

Doing it my way.

PURPOSE: Historically, hotels and single-room occupancy residences have provided room, board, and social support services to elders, in particular the poor and the disenfranchised. This article presents the results of a case study drawn from a larger ethnographic community study that set forth to describe how and why elders from one rural community chose to live in a motel in that same rural community. The focus of this study is a description of 7 middle-income and affluent rural elders living in a motel setting as a housing option that enabled them to remain independent in their community. DESIGN AND METHODS: Using a community study ethnographic design and the strategies of formal and informal interviews, participant observation, and inductive comparative case study analysis, this study provides a description of why these elders decided to live in the motel and how this facilitated their living in the community. RESULTS AND IMPLICATIONS: Reasons that these elders decided to live at the motel included "saving my energy for living," "safety," "connections and privacy," and "the freedom to come and go." This study informs elder care policy, emphasizing the importance of naturally occurring networks to develop community capacity for healthy aging in one rural setting.