Removing Persistent Barriers to Systematic Searching.

This is the third article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making (EBDM). It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series on EBDM will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey. To access previous articles in this EBDM series, go to http://links.lww.com/AJN/A256.

Clinical Inquiry and Problem Identification.

This is the second article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

National evaluation of DNP students' use of the PICOT method for formulating clinical questions.

BACKGROUND: The intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence-based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence-based practice process, DNP graduates' competence in the PICOT method needs to be better understood. AIMS: This analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects. METHODS: Project questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education-accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus. RESULTS: Although the PICOT method was project author-identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty-three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0-5). LINKING EVIDENCE TO ACTION: Gaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non-evidence-based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP-prepared nurses shore up this foundational skill.

Cultivating an Evidence-Based Decision-Making Mindset.

This is the first article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

Enhancing Geriatric Competencies: Integrating the 4Ms Framework in a Baccalaureate Nursing Program.

BACKGROUND: Today's nursing students will care for tomorrow's older adult population. Integrating the Institute for Healthcare Improvement's Age-Friendly Health Systems (AFHS) 4Ms framework can improve students' knowledge and ability to care for older adults. METHODS: The 4Ms framework was pilot tested in a first-semester prelicensure course. Students were evaluated on knowledge and application of the framework through didactic, simulation, and clinical learning experiences; qualitative and quantitative data were obtained. RESULTS: Students' average score on three knowledge checks was 77.2% (range, 73.4% to 81%). Students were assessed for application of the 4Ms during clinical experiences in the Fall (76%) and Spring (92%) semesters. Qualitative data demonstrated that students' ability to apply the 4Ms in patient care increased. CONCLUSION: Integrating the 4Ms framework in the curriculum fostered nursing students' awareness of the essential components of AFHS. Learning experiences provided students the opportunity to care for older adults and gain competence in age-friendly care. [J Nurs Educ. 2023;62(10):589-592.].

National evaluation of DNP projects based on 2015 AACN white paper and 2019 DNP project roadmap.

The AACN expectation to prepare DNP graduates with EBP and QI competencies using the project was clarified with the 2015 White Paper and these expectations have not changed with the new Essentials. Evidence suggests DNP projects continue to be a mix of research and QI. Using the DNP Project Roadmap, we reviewed 214 projects from 120 schools from publicly available sources for the presence of EBP and QI project elements. Of the 27 Roadmap elements evaluated, only two had a significant (p ≤ .05) positive change after the release of the White Paper 1) a question to frame the problem/issue (pre-48.4 %, n = 45, post-64.5 %, n = 78) and 2) an evidence search (pre-26.9 %, n = 25, post-39.7 %, n = 48). Nineteen of the 27 elements had positive change; however, were still not present in >50% of the project papers. These findings can be used to engage in a national conversation on DNP curricular expectations of projects that demonstrate student competency in EBP and QI.

Promoting Safe Mobility Strategies for partnering with caregivers to maximize older adults' functional ability.

This article is the fifth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Olson,L.M., et al. Promote Safe Mobility. Am J Nurs 2022; 122(7): 46-52.

The 4Ms of an Age-Friendly Health System An evidence-based framework to ensure older adults receive the highest quality care.

This article is the first in a new series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute and originally appearing in the American Journal of Nursing, Volume 121, Issue 11, as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this new series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by the John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Guide to the 4Ms of an Age-Friendly Health System for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Emery-Tiburcio, E.E., et al. The 4Ms of an Age-Friendly Health System. Am J Nurs 2021; 121(11): 44-49.

Addressing What Matters Aligning care with the priorities of older adults and their caregivers.

This article is the second in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute and originally appearing in the American Journal of Nursing, Volume 122, issue 1, as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Carbonell, E., et al. Addressing What Matters. Am J Nurs 2022; 122(1): 54-58.

Promoting Safe Mobility.

This article is the fifth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Recognizing and Acting on Mentation Concerns.

This article is the fourth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Optimizing Older Adults' Medication Use.

This article is the third in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Addressing What Matters.

This article is the second in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

The 4Ms of an Age-Friendly Health System.

This article is the first in a new series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this new series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by the John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Guide to the 4Ms of an Age-Friendly Health System for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

CE: Acute Care for Patients with Dementia.

Among adults ages 65 and older, dementia doubles the risk of hospitalization. Roughly one in four hospitalized patients has dementia, and the prevalence of dementia in the United States is rising rapidly. Patients with dementia have significantly higher rates of hospital-acquired complications, including urinary tract infections, pressure injuries, pneumonia, and delirium, which when unrecognized and untreated can accelerate physical and cognitive decline, precipitating nursing home placement and death. The authors discuss the unique needs of patients with dementia who require acute care, highlighting evidence-based strategies for nurses to incorporate into practice.

DNP Program Faculty and Graduates' Knowledge and Use of QI and Safety Processes.

BACKGROUND: Across doctor of nursing practice (DNP) programs, wide variation exists for DNP project expectations and curricular integration of Quality and Safety Education for Nurses competencies. PURPOSE: This study examined DNP project characteristics and compared knowledge, skills, and attitudes about quality improvement (QI) processes between DNP program faculty and graduates. METHODS: This descriptive study used a national convenience sample of DNP program faculty and graduates from multiple settings (N = 147) who completed an electronic survey of a modified version of the Quality Improvement Knowledge, Skills, and Attitudes Survey. RESULTS: Most DNP projects were QI/practice improvement (85.5%) and required interprofessional collaboration (65%) and implementation of a practice change (55.8%) with evaluation (65.5%). DNP program faculty (n = 73) and graduates (n = 30) had no significant differences in QI knowledge or skills; faculty reported less confidence in their knowledge (P = .002) and skills (P = .007) than graduates. CONCLUSIONS: Faculty development efforts to improve QI knowledge and skills for DNP program faculty are needed.

Doctor of Nursing Practice Project Advisement: A Roadmap for Faculty and Student Success.

BACKGROUND: Robust enrollment in Doctor of Nursing Practice (DNP) programs has created a need for faculty teaching in other nursing programs to be project advisers. Faculty may lack the knowledge and skills needed to advise projects that are evidence-based practice (EBP) or quality improvement (QI) initiatives. A project roadmap with tools and resources was needed. METHOD: Practice-based evidence from members of the Quality and Safety Education for Nurses (QSEN) DNP Leadership Taskforce was used to inform the process for DNP project advisement. This evidence was integrated with the American Association of Colleges of Nursing Taskforce 2015 recommendations and literature on DNP project criteria to develop a roadmap. RESULTS: Twenty-two students and six faculty have piloted the DNP Project Roadmap and provided positive feedback. Eight peer-reviewed presentations and three manuscript submissions with one acceptance have resulted from using the roadmap. CONCLUSION: Data support that the project roadmap phases and associated tools and resources facilitate faculty project advisement and offer students clear project guidelines and a foundation for future practice scholarship. [J Nurs Educ. 2019;58(12):728-732.].

An innovative course to prepare advanced practice registered nurses to spearhead quality and safety initiatives for older adults.

ABSTRACT: Current trends dictate that advanced practice registered nurses (APRNs) must be competent to address quality/safety issues specific to older adults. A gap analysis and review of key competencies in an adult-gerontology APRN-Doctorate of Nursing Practice (DNP) curriculum prompted the design and evaluation of an innovative online course, Quality and Safety for the Aging Adult. Course objectives align with key competencies, including graduate-level Quality and Safety Education for Nurses (QSEN) and the DNP Essentials. The course purpose was to prepare adult-gerontology APRN-DNP students as leaders to promote quality/safety outcomes for aging adults. The six-step Knowledge-to-Action Framework guided course development and evaluation. Select graduate-level QSEN competencies were used to construct a 20-item Quality and Safety Survey (4-point Likert scale) (Cronbach's alpha, 0.916). This survey was used during week 1 (pre) and week 15 (post) of the semester to evaluate students' preparation and confidence to perform key QSEN competencies. Significant improvements (p < .000) between pre/post scores on the Quality and Safety Survey were found across five classes. Students felt more prepared and confident to apply selected QSEN competencies on course completion. Moreover, nearly 60% (primary care) and nearly 35% (acute care) adult-gerontology APRN students selected the older adult population for their DNP projects. The Quality and Safety for the Aging Adult course positively influenced five classes of adult-gerontology APRN-DNP students. Integrating QSEN competencies with gerontology and quality/safety content is an effective strategy to prepare APRNs to lead quality/safety initiatives in aging adults. This innovative online course offers a successful model for innovative DNP education of adult-gerontology APRNs.