Innovations in Academic/Clinical Partnerships During COVID-19 to Prepare a Ready Nursing Workforce.

Management of the COVID-19 pandemic required healthcare leaders and frontline workers to rapidly innovate and adjust to a new reality that has forever transformed nursing education and practice. Throughout the pandemic, key stakeholders in Alabama lobbied for transformations in clinical training practice that ultimately improved students' exposure to clinical environments and alleviated the pressure on practicing nurses and other healthcare workers during pandemic hospitalization surges. The present article highlights the key partners and regulatory innovations that led to these successes in Alabama.

Early detection of obstructive sleep apnea in patients with atrial fibrillation.

BACKGROUND: Obstructive sleep apnea (OSA) is an independent and modifiable risk factor for atrial fibrillation (AF) and correlates with a three-fold higher risk of incident AF. Although OSA is prevalent in patients with AF, it remains underdiagnosed. Guidelines for OSA screening are ambiguous. LOCAL PROBLEM: A small community hospital in the southeast United States lacked standardized OSA screening and consistent sleep clinic referral for hospitalized patients with AF. METHODS: Over 3 months, an OSA bundle (including screening, education, and referral) was implemented for hospitalized patients with AF. A retrospective electronic health record (EHR) review established a baseline comparison group. Descriptive analyses between the intervention and comparison groups evaluated the effectiveness of the OSA bundle. INTERVENTIONS: Eligible patients received OSA screening with the STOP-Bang questionnaire. A STOP-Bang score of 3 or higher triggered patient education about the arrhythmogenic relationship of OSA and AF. At discharge, patients received an ambulatory sleep clinic referral. After 3 months, an EHR review assessed the rate of sleep clinic follow-up, sleep testing, OSA diagnosis, and initiation of positive airway pressure. RESULTS: Of the 68 patients in the comparison group and 33 patients in the intervention group, the rate of OSA screening increased from 4.4% to 100%. Sleep clinic referral increased from 66.7% to 93.5%. Sleep clinic follow-up increased from 0% to 10%. CONCLUSION: Screening for OSA and sleep clinic referral improved with the OSA bundle; however, sleep clinic follow-up remained low. Further quantitative and qualitative investigation is needed to better understand barriers to sleep clinic follow-up.

Telehealth Mental Health Clinical Experience for Prelicensure Nursing Students During COVID-19.

BACKGROUND: The use of an innovative approach for mental health interviews met unprecedented needs during the coronavirus disease 2019 pandemic for patients and staff at a community health clinic and provided nursing students with a telehealth activity that met patient care education requirements while practicing essential skills. METHOD: The nursing students and instructors worked collaboratively with the clinical team to call patients using an algorithm that incorporates screeners for depression, anxiety, and chronic disease distress. RESULTS: Reports during daily debriefings and feedback obtained from evaluations were summarized by faculty and used to improve the activity. These reports indicated the experience was beneficial to students and clinic staff. CONCLUSION: Providers were able to follow up on vulnerable patients more quickly, students were able to practice essential nursing skills during a time when safety concerns limited direct patient interaction, and patients continued to feel connected to health care providers during a global pandemic. [J Nurs Educ. 2022;61(4):205-207.].

Evaluating interventions to delay the progression of prediabetes to type-2 diabetes mellitus in an uninsured Hispanic population.

BACKGROUND: Diabetes is a chronic progressive disease affecting 34 million Americans. The Centers for Disease Control and Prevention estimates that 12.5% of people aged 20 years or older diagnosed with diabetes are Hispanic. The American Diabetes Association further estimates that 84.1 million Americans aged 20 years and older have prediabetes based on fasting blood sugar and hemoglobin A1c (HbA1c) levels alone. LOCAL PROBLEM: In Georgia, the overall rate of diagnosed diabetes is 9.7%, undiagnosed is 6.5%, and prediabetes is 1.1%. The prevalence of diabetes for the Hispanic population in Georgia is 9% and is 10% among Clayton County residents. The purpose of this quality improvement project (QIP) was to evaluate interventions implemented to delay the progressions of prediabetes to type-2 diabetes in an uninsured Hispanic population. METHODS: Retrospective chart review was conducted comparing pre- and postmeasurements for HbA1c and body mass index (BMI) in Hispanic patients identified as having prediabetes. INTERVENTIONS: Patients with HbA1c of 5.7-6.1% were provided with a diabetes tool kit, whereas patients with an HbA1c of 6.2-6.4% were given the diabetes tool kit plus metformin. RESULTS: A decrease in mean HbA1c was noted in both groups of patients. However, a paired sample t-test indicated nonsignificant decrease in HbA1c for the diabetes tool kit group (p = .51) but significant decrease for the diabetes tool group kit plus metformin group (p < .01). CONCLUSIONS: Although this QIP did not reveal statistically significant changes in HbA1c and BMI for both groups, the results were clinically significant among this Hispanic population.

Low-cost thoracentesis simulation for nurse practitioner students.

The fast-paced hospital setting is not routinely a conducive environment for practicing procedural skills. Simulation learning can provide an opportunity for learners to achieve accuracy, confidence, and competence when performing the thoracentesis procedure. The cost associated with many commercial-brand manikins and the additional supplies needed to teach thoracentesis is expensive. However, thoracentesis is a skill many nurse practitioners (NPs) need to learn. The use of a whole, unstuffed turkey purchased at a supermarket to simulate a thoracentesis is a way in which NP students can safely practice this skill. Nurse practitioner students perform assessment skills on another student, whereas students perform the thoracentesis procedure on this turkey carcass. Nurse educators can teach NP students to safely, accurately, and efficiently perform a thoracentesis procedure using a low-cost simulator. Nurse educators can teach NP students how to perform a thoracentesis using a turkey carcass at a relatively low cost with a high yield.

Kaizen: Interactive Gaming for Diabetes Patient Education.

Objective: An estimated 100 million Americans have diabetes, undiagnosed diabetes, a high risk of being diagnosed with diabetes, or prediabetes. Many complications can arise if diabetes is poorly managed. Hence, the need for adequate knowledge, skills, and ability to care for oneself, known as diabetes self-care management, is needed to reduce complication rates. We used an interactive platform that incorporates principles of gamification to enhance user engagement to enhance diabetes knowledge. The purpose of this descriptive pilot study was to discover what adult patients with diabetes thought about this novel educational approach to diabetes education. Materials and Methods: We collected focus group data from participants at a diabetes clinic after they played an interactive diabetes trivia game, on our software platform (Kaizen Education). Transcripts were coded and common themes were identified. Results: We conducted 9 focus groups that included 33 adult (age >18) participants who had diabetes. An overarching theme of play/gaming as a form of learning was apparent, and after analyzing the coding several themes emerged, including preferences and desired environments (clinic and home) for learning, desired players (including family, significant others), and a good balance of question difficulty. Conclusions: Participants were overwhelmingly positive about gamified education and felt empowered to lead discussions with their health care providers about diabetes self-care education, in a sense "flipping" the traditional clinic patient education paradigm. These results suggested that a flipped clinic approach could be beneficial, empowering, and engaging for patients.

Competency-based education in transitioning nurse practitioner students from education into practice.

Competency-based education (CBE) provides a framework for nursing programs including those educating nurse practitioners (NPs). The basic assumption of CBE is that the student will demonstrate acquisition of the identified essential knowledge, skills, and attitudes expected for the designated educational process before leaving the learning environment. The work done to date in developing competencies and progression indicators provides the critical basis to move toward a common language and clear expectations for the continuum of linear progression of proficiency. Entrustable professional activities (EPAs) are built on competencies and stated as measurable activities that providers can be expected to do, at varying levels of competence or trust or supervision, and allow the faculty member, preceptor, or supervisor to make decisions as to what teaching methods and level of supervision are needed. Numerous methods are used to measure competency in clinical skill knowledge, performance, and practice readiness including clinical preceptor feedback, objective structured clinical examination, and simulation, just to name a few. NP programs continue to struggle with the education practice gap between theory and the actual provision of care. The discussion about novel and reliable methods for measurement of competencies must address the strategic importance of a consensus about when, where, and how students can obtain the appropriate amount and type of experience and supervision required in the transition to independent practice. There is also a significant need for processes and standardized guidelines that can contribute to EPA development.

Improving Population Health Among Uninsured Patients with Diabetes.

Diabetes is a leading cause of morbidity and mortality; prevalence of diabetes is especially high in the southeastern United States among minority populations and those from lower socioeconomic sectors without access to health care services. The purpose of this project was to evaluate the clinical and financial outcomes of a nurse-led, interprofessional collaborative practice model that provides care coordination and transitional care for uninsured patients with diabetes. Data for this study were collected and evaluated from medical records of patients seen at the Providing Access to Health Care (PATH) Clinic between August 1, 2015, through May 30, 2017. Clinical outcomes were evaluated by comparing hemoglobin A1c (HbA1c) values before and after referral to the PATH Clinic. Cost savings to the academic medical center were evaluated by comparing costs associated with inpatient or emergency department encounters before and after referral to the PATH Clinic. A significant decrease in HbA1c (P < .0005) was noted for patients attending the PATH Clinic. In addition, financial analyses revealed a 55% decrease in pre to post PATH Clinic patients' direct costs. Similarly, a 42% decrease in the pre to post PATH Clinic patients' direct cost per encounter was noted. Average length of stay also was reduced when these patients were readmitted to the academic medical center. Results from this study support the effectiveness of the PATH Clinic model in caring for uninsured patients with clinically complex medical and social needs, often with behavioral health problems, who incur high health care spending and are often readmitted.

Changes in the treatment of inpatient hyperglycemia: what every nurse practitioner should know about the 2012 standards of care.

PURPOSE: To provide nurse practitioners (NPs) with a review of the 2012 Standards of Care for the management of hospitalized patients who are hyperglycemic. DATA SOURCES: The 2012 American Diabetes Association's (ADA) Standards of Care for the treatment of inpatient hyperglycemia and selected evidence-based articles. CONCLUSIONS: Because hyperglycemia occurs at alarming rates in the inpatient setting when hyperglycemia is not controlled, there is a great impact on acute and even chronic conditions. These complications will lead to increased healthcare costs. IMPLICATIONS FOR PRACTICE: It is essential that NPs who care for hospitalized, hyperglycemic patients are aware of the 2012 ADA Standards of Care.

Neuroplasticity and successful cognitive aging: a brief overview for nursing.

The brain remains dynamic even in older age and can benefit from mental exercises. Thus, it is important to understand the concepts of positive and negative neuroplasticity and how these mechanisms either support or detract from cognitive reserve. This article provides a brief review of these key concepts using four exemplary studies that clearly show the effects that these neurological mechanisms exert on cognitive reserve and cognitive functioning. From this review, a working knowledge of how neuroplasticity and cognitive reserve are expressed in patients will be provided along with how this information can be incorporated into nursing practice and research.