Clinical Outcomes of an Intensity Program for Children With Movement Challenges.

PURPOSE: Physical therapists at an outpatient pediatric facility developed and implemented an Intensity Program for children with movement challenges. The program was initiated on the basis of best evidence, parent advocacy, and clinician expertise. The purpose of this investigation is to analyze outcome data gathered from the program since 2012 to determine the effect of the program along with any specific child characteristics that were more likely to lead to positive outcomes. METHODS: A variety of outcome data were analyzed to compare preprogram performance with postprogram performance. RESULTS: Program participants made statistically significant and clinically important improvement in most outcome measures. Parents were highly satisfied with the program, including 98% of respondents who indicated that they would like to repeat their participation in the program. CONCLUSIONS: The results of this investigation suggest that many children with movement challenges are likely to benefit from participation in an Intensity Program.

Reducing Patient Length of Stay After Surgical Correction for Neuromuscular Scoliosis.

BACKGROUND: Surgical correction remains the most effective treatment of patients with severe neuromuscular scoliosis (NMS). However, postoperative inpatient clinical care after spinal surgery for NMS patients is highly complex and variable, depending on the provider and/or institution. Our project used a quality improvement methodology to implement a standardized clinical care pathway for NMS patients during their primary spinal surgery, with the global aim of decreasing postoperative hospitalized length of stay (LOS). METHODS: A multidisciplinary team developed a postoperative pathway for nonambulatory patients with NMS after their primary, nonstaged corrective spinal surgery. The outcome measure was mean LOS, and the process measure was percentage compliance with the newly implemented NMS pathway. The team used statistical process control charts and measures were evaluated over 3 phases to assess the impact of the interventions over time: pretesting, testing, and sustain. RESULTS: The mean LOS decreased from 8.0 to 5.3 days; a statistically significant change based on statistical process control chart rules. Percentage compliance with the NMS pathway improved during the testing and sustain phases, compared with the pretesting phase. LOS variability decreased from pretesting to the combined testing and sustain phases. CONCLUSIONS: Using quality improvement methodology, we successfully standardized major components of clinical care for patients with NMS after spinal corrective surgery. Through enhanced care consistency, the mean postoperative LOS decreased by nearly 3 days and decreased LOS variability. Robust multidisciplinary involvement with key stakeholders ensured sustainability of these improvements.

Exploring Occupational Health Professionals Understanding and Needs in Regard to Total Worker Health (TWH).

BACKGROUND: Occupational health professionals (OHPs) are in a unique position to impact the health and well-being of employees at work and outside of work. One way of achieving this holistic health goal is to integrate the concept of Total Worker Health® (TWH) into the organization's culture. It is critical for OHPs to develop the ability to incorporate TWH into their practices, yet there are gaps in our understanding of OHP's attitudes toward change and toward TWH, their level of TWH knowledge, and the number of OHPs who have adopted TWH. METHODS: An electronic survey was administered to a national sample of 4,777. This cross-sectional study used Qualtrics to record survey responses measuring knowledge of TWH, attitude toward change, resistance to change, transformational leadership ability, perception of organizational readiness, and leadership commitment. FINDINGS: The total sample size was 253 (5.3%). Most respondents were bachelors prepared nurses (75.1%) with greater than 10 years' experience (71.5%) and employed in manufacturing (42.6%). Approximately 74% (n = 125) of respondents knew about TWH, but did not have a program in place or were unsure of the existence of one. A high percentage (74.0%) were open to implementing TWH, had favorable attitudes toward change (M = 3.9 on a 5-point Likert-type scale), but needed education on how to move forward (56.0%). CONCLUSIONS/APPLICATION TO PRACTICE: Findings suggest that most OHPs know about TWH, but generally have not adopted the TWH concept at their worksites. However, they are open to implementing TWH programs and have favorable attitudes toward change.

Reducing Commercial Truck Driver BMI Through Motivational Interviewing and Self-Efficacy.

Obesity is recognized as a national and global health epidemic. Commercial truck drivers (CTDs) have a higher obesity rate and lower life expectancy compared with the general population. CTDs work sedentary jobs with long hours that pose barriers to healthy eating and regular exercise. An evidenced-based practice (EBP) change project that used motivational interviewing (MI) and education regarding diet and exercise over a 4-week period was found to have a positive impact on CTDs behavior. Results revealed an increase in aggregated self-efficacy for weight loss (14.8%, exceeding the benchmark of 11%). For aggregated body mass index (BMI), CTDs lost a mean of 0.65 kg/m2, over a 4-week period which was statistically significant at p = .0001. The results suggest a short-term MI intervention can be effective when implemented as a clinical standard for CTDs.

Boot Camp for Occupational Health Nurses: Understanding Social Media.

Social media is a buzzword frequently referred to in marketing materials, general media, and personal conversations. Although many refer to the term social media, some individuals do not understand its meaning or how it affects their daily lives at work and home. Since the expansion of the Internet to web 2.0, multiple platforms of communication occur virtually through various social media. Understanding and learning how to use these platforms are essential to stay connected with friends, family, and colleagues; advance connections to professional organizations; and extend educational opportunities. This article presents basic information for occupational health nurses to improve their understanding of social media and how to communicate virtually using different platforms safely and securely.

Follow Me, Like Me, Tweet Me! Implementing Social Media Into Occupational Health.

Occupational health nurses can advance their professional practices through virtual platforms (e.g., social media and mobile applications). Virtual platforms allow occupational health nurses to disseminate occupational safety and health information efficiently to employees, families, and other stakeholders. Occupational health nurses exchange information with employees, enhancing communication and disseminating appropriate and accurate safety and health information to workers and their families. This article assists occupational health nurses in understanding how to use social media and other mobile applications to enhance their practices.

Promoting health and safety virtually: key recommendations for occupational health nurses.

Nurses' use of the Internet and social media has surfaced as a critical concern requiring further exploration and consideration by all health care organizations and nursing associations. In an attempt to support this need, the American Nurses Association (2011) published six principles of social networking that offered guidance and direction for nurses. In addition, the National Council of State Boards of Nursing (2011) published a nurse's guide to using social media. Surfing the Internet and using social media for professional and personal needs is extremely common among nurses. What is concerning is when nurses do not separate their professional and personal presence in the virtual world. This article presents an Institutional Review Board-approved pilot survey that explored nurses' use of social media personally and professionally and offers recommendations specifically directed to the occupational health nurse.

Obstructive sleep apnea among commercial motor vehicle drivers: using evidence-based practice to identify risk factors.

Commercial motor vehicle driving is a hazardous occupation, having the third highest fatality rate among common U.S. jobs. Among the estimated 14 million U.S. commercial motor vehicle drivers, the prevalence of obstructive sleep apnea is reported to be 17% to 28%. Despite the identified increased prevalence of obstructive sleep apnea among commercial motor vehicle drivers, federal law does not require that they be screened for obstructive sleep apnea. This article presents an evidence-based practice change project; the authors developed, implemented, and evaluated a screening program to identify commercial motor vehicle drivers' risk for obstructive sleep apnea during commercial driver medical examinations. The results of this practice change indicated screening for obstructive sleep apnea during the commercial driver medical examination led to improved identification of obstructive sleep apnea risk among commercial motor vehicle drivers and should be a clinical standard in occupational health clinics.

Mentoring and coaching: a model guiding professional nurses to executive success.

Although many nurses aspire to executive positions, they lack the knowledge, support, and guidance to handle the challenges. To succeed at the executive level, ongoing deliberate skill development coupled with support is crucial across a nurse's career trajectory. This article introduces a model emphasizing the importance of mentoring and/or coaching for the aspiring executive nurse leader.

Shaping the future of nursing education today using distant education and technology.

In 1860, Florence Nightingale, published "Notes on Nursing" that provided the foundation for many curricula. Today, nursing education is available through many diverse settings and methodologies. One of the most evolving methods is through distant education (DE). Evidence demonstrates that the demand for DE is increasing across the United States for students enrolling in DE classes to meet their personal life style. In addition, the data reveal that more colleges and universities are offering additional courses through DE. Today, the Net Generation excels in the technological world with skills that are easily adaptable to any form of technological device or approach. Students desire teaching learning methods that appeal to their cyber senses. Nursing faculty need to think outside of the box regarding what type of learning environment students prefer. Key concepts presented center on faculty leadership, communication, organizational, collaborating and problem solving skills needed within a DE program.

Nurses using futuristic technology in today's healthcare setting.

Human computer interaction (HCI) equates nurses using voice assisted technology within a clinical setting to document patient care real time, retrieve patient information from care plans, and complete routine tasks. This is a reality currently utilized by clinicians today in acute and long term care settings. Voice assisted documentation provides hands & eyes free accurate documentation while enabling effective communication and task management. The speech technology increases the accuracy of documentation, while interfacing directly into the electronic health record (EHR). Using technology consisting of a light weight headset and small fist size wireless computer, verbal responses to easy to follow cues are converted into a database systems allowing staff to obtain individualized care status reports on demand. To further assist staff in their daily process, this innovative technology allows staff to send and receive pages as needed. This paper will discuss how leading edge and award winning technology is being integrated within the United States. Collaborative efforts between clinicians and analyst will be discussed reflecting the interactive design and build functionality. Features such as the system's voice responses and directed cues will be shared and how easily data can be documented, viewed and retrieved. Outcome data will be presented on how the technology impacted organization's quality outcomes, financial reimbursement, and employee's level of satisfaction.

Clinical decision support. How CDS tools impact patient care outcomes.

Clinical decision support tools are important components of the electronic health record and can directly improve patient care outcomes and the performance of healthcare organizations. These tools can be used within order sets, electronic alerts, reference materials that are readily available, reports related to patient data, as well as clinical guidelines that were developed by regulatory agencies The development and use of CDS tools at the point of care offers clinicians the ability to analyze and work with patient data in real-time while making critical decisions. In the future, CDS tools will be important when changes in financial reimbursement related to patient care outcomes become the primary focus for many insurance-related organizations. This financial shift will have a tremendous impact on healthcare organizations bottom line. This article presents outcome data resulting from the implementation of several electronic CDS tools within a community hospital where all physicians enter orders electronically and clinical staff use electronic documentation.

Can nurses impact patient outcomes using a patient-centered care model?

OBJECTIVE: The aim of this study was to determine if nurses, using patient-centered care (PCC), affect patient satisfaction, perceptions of nursing care, and quality outcomes. BACKGROUND: The Institute of Medicine proposed PCC as 1 of 6 national quality aims, whereas the Centers for Medicare and Medicaid Services highlighted integration of PCC as 1 of 12 actions for quality improvement. METHODS: A total of 116 patients were randomized into an intervention (PCC) or control group. Patients who were to receive PCC were called before admission and cared for by nurses who trained to administer/practice PCC. Control patients received usual care. Both groups completed questionnaires and received postdischarge calls. Length of stay, falls, infections, and adverse events were measured to assess quality of care. RESULTS: No significant differences were found between groups for length of stay, infection, falls, postoperative complications, quality of care, satisfaction level, or perceptions of nursing care. CONCLUSIONS: Patient-centered care did not affect patient's level of satisfaction or quality of care. However, findings yielded clinically relevant results regarding patient/staff responses.

Effect of patient-centered care on patient satisfaction and quality of care.

A clinical randomized study (posttest design) was conducted to examine whether patient-centered care (PCC) impacts patient satisfaction, perception of nursing care, and quality of care. Differences were seen in 2 of 3 subscales within the Baker and Taylor Measurement Scale. The PCC group rated satisfaction (P = .04) and quality of services (P = .03) higher than controls. PCC may impact patients' perception of the level of satisfaction and quality of care received.

Patient first: a patient sensitivity tool for an electronic health record implementation.

Throughout the country, use of electronic health records continues to increase. For successful implementation of an electronic health record system in an acute care setting, it is vital to educate and address the patient's perceptions about the use of technology when caring for the patient. This article describes the development of an educational sensitivity tool designed to enhance clinicians' simultaneous interactions with patients and computers in a midsize community hospital. The Patient First tool brings attention to the thoughts and perceptions a patient may have in various situations, promoting alternative solutions for staff to properly address the patient's concerns. A committee was developed to address concerns regarding the impact a computer at the bedside would have on patient and clinician interactions. One primary educational tool developed was the Patient First sensitivity presentation that cautioned and guided clinicians to be aware of patient perceptions.