Using the Eat Sleep Console Model to Promote Optimal Care and Outcomes for Infants With Neonatal Abstinence Syndrome: A Nurse-Driven, Multidisciplinary Initiative.

BACKGROUND: A nurse led a team of providers in a quality improvement (QI) project to positively impact inpatient care and outcomes for infants with neonatal abstinence syndrome (NAS). The Eat Sleep Console (ESC) model was implemented to promote rooming-in and family-centered care as part of a nonpharmacological treatment approach. PURPOSE: To compare the ESC model with the traditional Finnegan treatment approach to describe differences in infants' pharmacotherapy use (morphine), length of stay (LOS), weight loss, consumption of mother's own milk by any feeding method within 24 hours of discharge, Neonatal Intensive Care Unit (NICU) use, and Pediatric Unit utilization. METHODS: The QI project was conducted at a single hospital site with more than 1700 deliveries per year in the Midwestern United States. A comparative effectiveness study design was used to evaluate the ESC model. RESULTS: The ESC model impacted care and outcomes for infants with NAS, contributing to a significant reduction in morphine treatment, decrease in LOS among morphine-treated infants, increase in weight loss in infants who did not require morphine treatment, less NICU use, and greater Pediatric Unit utilization. A nonsignificant increase was found in the number of infants who consumed their mother's own milk by any feeding method in the 24-hour period prior to discharge. IMPLICATIONS FOR PRACTICE AND RESEARCH: Results may be helpful for hospitals striving to optimize care for infants exposed to opioids, using assessments of eating, sleeping, and consoling to guide individualized treatment decisions and to reduce morphine use.

Evidence-Based, Ethical Decision-Making: Using Simulation to Teach the Application of Evidence and Ethics in Practice.

BACKGROUND: Evidence-based practice and ethics should not be taught as isolated concepts. Instead, it is imperative to prepare students with the knowledge needed to practice ethical, evidence-based decision-making in health care. PURPOSE: The purpose of this project was to describe how a mock hospital ethics committee meeting impacted students' learning about the use of evidence to support ethical decision-making in health care. METHOD: A mock hospital ethics committee was convened for 121 students from schools of nursing, social work, law, and medicine. RESULTS: Thematic content analysis showed a positive impact on nursing students' learning of ethics, group dynamics, discipline-specific responsibilities, and EBP. LINKING EVIDENCE TO ACTION: This interprofessional education experience showed students how evidence and ethics can be used to guide and support practice priorities, responsibilities, and decisions on resource utilization and treatment to enable optimal outcomes for patients and organizations.

A National Study Across Levels of Nursing Education: Can Nurses and Nursing Students Accurately Estimate Their Knowledge of Evidence-Based Practice?

AIM: This national study sought to: a) describe the evidence-based practice (EBP) knowledge levels of nursing students enrolled in baccalaureate through doctorate of nursing practice programs; b) examine relationships between objective and subjective EBP knowledge measures; c) describe correlations between educational and demographic factors and EBP knowledge; and d) further evaluate validity and reliability evidence for the Evidence-Based Practice Knowledge Assessment in Nursing. BACKGROUND: Rigorous evaluation of students' EBP knowledge across nursing program levels is vital to enhancing education and patient care. METHOD: A cross-sectional, correlational design using large-scale survey procedures was used in this study. RESULTS: Mean Evidence-Based Practice Knowledge Assessment in Nursing scores (N = 674 respondents from five universities in the United States) increased with greater levels of nursing education degree attainment. A weak, positive correlation was found between objective and subjective EBP knowledge measures (r = .13, p = .001). CONCLUSION: More research is needed to identify effective approaches to EBP education in nursing programs.

Loss of Magnet® Designation and Changes in RN Work Engagement: A Report on How 1 Hospital's Culture Changed Over Time.

OBJECTIVE: The aim of this study was to examine the loss of Magnet® designation and how RNs' work engagement changed at 1 community hospital. BACKGROUND: The importance of RN work engagement to promote quality and safety is widely recognized in healthcare. Ongoing consistent research is critical to determine what organizational structures are needed to support RN work engagement. METHODS: This was a comparative, descriptive, correlational study of RN cohorts at 2 time points: time 1 (T1), in 2011 during Magnet designation (n = 119), and time 2 (T2), in 2016, approximately 2 years after the loss of Magnet designation (n = 140). RESULTS: The cohort of RNs at T2 reported significantly lower work engagement in the time period after the loss of Magnet designation when compared with the RN cohort at T1 during Magnet designation (P ≤ .0002). CONCLUSION: These results provide insights for clinical leaders striving to support a culture of RN work engagement and quality care.

Supporting and Empowering Direct-Care Nurses to Promote EBP: An Example of Evidence-Based Policy Development, Education, and Practice Change.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Validity and Reliability Evidence for a New Measure: The Evidence-Based Practice Knowledge Assessment in Nursing.

BACKGROUND: Studies of evidence-based practice (EBP) among nurses often focus on attitudes and beliefs about EBP and self-reported EBP knowledge. Because knowledge self-assessments can be highly inaccurate, the authors developed and tested a new objective measure of EBP knowledge--the Evidence-Based Practice Knowledge Assessment in Nursing (EKAN). METHOD: Seven subject matter experts reviewed candidate items, resulting in a scale content validity index of 0.94. Rasch modeling was used to evaluate item-person performance on the proposed unidimensional trait of EBP knowledge. The candidate item pool was then tested among 200 undergraduate nursing students. RESULTS: Strong evidence of unidimensionality was confirmed by narrow item infit statistics centering on 1.0. The item separation index was 7.05, and the person separation index was 1.66. Item reliability was 0.98, and person reliability was 0.66. CONCLUSION: The 20-item EKAN showed strong psychometric properties for an instrument developed under the Rasch model and is available for use in research and educational contexts.

Work engagement in Magnet(®)-designated hospitals: Exploring social and institutional demographics of RNs to optimize improvement efforts.

OBJECTIVE: This study analyzed and evaluated relationships between work engagement (WE) and social/institutional demographic variables of RNs in Magnet(®)-designated hospitals. BACKGROUND: Organizational structures of Magnet-designated hospitals are recognized to promote engagement of RNs. Because little is known about relationships between WE and the social/institutional demographics of nurses, this study focused on age (generation), gender, education, shift, hours worked per week, percentage of time in direct patient care, and nursing unit. METHODS: A convenience sample of hospital RNs (n = 220) completed 2 surveys to measure WE and demographic variables in this descriptive correlational study. RESULTS: Shift was significantly related to RN engagement; however, age, gender, education, hours worked per week, percentage of time in direct patient care, and nursing unit were not. CONCLUSIONS: This study provides empirical evidence about the relationships between WE and social/institutional characteristics of RNs. The findings are relevant to patients, nurses, nurse leaders, and organizations.