A Qualitative Exploration of Chief Nursing Officer Perspectives on Maintaining Magnet® Designation.

OBJECTIVE: The purpose of this study was to determine chief nursing officer (CNO) perspectives on how to sustain the infrastructure required for successful American Nurses Credentialing Center (ANCC) Magnet® redesignation. BACKGROUND: American Nurses Credentialing Center Magnet designation is a prestigious achievement reflective of years of dedication, innovation, mentoring, and leadership support. As challenging as the initial attainment of Magnet status can be, sustaining the success and becoming redesignated is considered even more difficult by many CNOs. However, there have been no published reports indicating how to be successful in Magnet redesignation. METHOD: A grounded theory qualitative approach was used, and data were collected through telephone interviews with CNOs who had successfully attained at least 1 redesignation. RESULTS: Fourteen CNOs participated; data were organized into 6 themes and 15 subthemes describing the critical elements for Magnet redesignation. CONCLUSION: Relationships among the 6 themes and subthemes are theorized in the form of a wheel with 6 spokes. When "set in motion," the wheel gathers momentum and all of the model elements become coalesced into the organizational ethos.

Nutrition Environment Gaps and Distribution Challenges in Rural Food Pantries During the COVID-19 Pandemic: A Mixed-Methods Study.

BACKGROUND: Food insecurity disproportionately affects low-income, racially marginalized, and rural communities. The COVID-19 pandemic led to higher demand for emergency food distribution, potentially impacting food pantry operations and services. Limited research exists assessing consumer nutrition environments of pantries in rural regions. OBJECTIVES: To assess the consumer nutrition environment of rural food pantries and report challenges and adaptations encountered during the pandemic. DESIGN: A mixed-methods, cross-sectional survey. PARTICIPANTS/SETTING: Nineteen food pantry representatives from California's San Joaquin Valley were surveyed between August 2020 and June 2021. Representatives were eligible if their pantry served the general population and was open at least once a week. Nine were church-based pantries, and 10 were from other settings. MAIN OUTCOME MEASURES: The Nutrition Environment Food Pantry Assessment Tool (NEFPAT) measured the nutrition food environment and scored pantries as bronze (0-15), silver (16-31), or gold (32-47) categories. Eleven items were developed to explore pandemic-related challenges. STATISTICAL ANALYSES PERFORMED: Independent χ2 tests assessed the relationship between the organization type and NEFPAT scores and food supply sources. Fisher's exact test explored associations between food pantry type, NEFPAT category, and challenges. Nonparametric tests were run on non-normally distributed data. Inductive content analysis was used to examine open-ended pandemic-related questions. RESULTS: The nutrition environment of most pantries was suboptimal, because no pantry scored in the "gold" category based on total NEFPAT scores (median, 18 of 47). No statistically significant differences were found in the NEFPAT scores by organization type. Most pantries did not provide healthy food nudges or culturally diverse foods. Key COVID-19 challenges encountered consisted of supply- and demand-side issues, including reduced personnel, capacity, and resources, and increased client quantity and demand for food. CONCLUSIONS: Assessing the nutrition environment of rural food pantries revealed gaps and strategies for improvement, including the use of healthy nudges and increasing the availability of culturally diverse foods.

Structural and Social Determinants of Inequitable Environmental Exposures in the United States.

American Indian (AI)/Alaskan Natives, African Americans, and Latino Americans have disproportionally high exposure to harmful environmental conditions as a consequence of unjust laws and policies, systemic racism, residential segregation, and discrimination. In this review, we draw connections between historical policies and social movements in the United States' history that have been rooted in racism and classism, leading to social isolation and marginalization of AIs, African Americans, and Latino Americans. We then discuss the structural factors that stem from the aforementioned inequities and that contribute to the inequitable distribution of environmental hazards.

Practice Integration as an Effective Educational Strategy.

Bundles are composed of individually established practices supported by research that, when combined, structure patient care. Implementing bundles improves patient outcomes. The ABCDEF initiative is an example of a bundled approach that improves outcomes of critically ill patients that are related to the likelihood of hospital death within 7 days, delirium and coma days, physical restraint use, intensive care unit readmission, and discharge disposition, with outcomes being proportional to the number of appropriate components performed. The purpose of this quality improvement project was to implement practice integration as an educational strategy to increase nursing knowledge of complex topics and, specifically, components of the ABCDEF bundle. Nurses' knowledge of all the BDE components of the ABCDEF bundle increased after implementing practice integration. Findings from this project support the use of resources to implement practice integration as an educational strategy for comprehensive concepts, specifically the BDE components of the ABCDEF bundle.

Establishing the Clinical Nurse Specialist Identity by Transforming Structures, Processes, and Outcomes.

PURPOSE: The purpose of this project was to delineate the clinical nurse specialist (CNS) from other nursing roles within this academic medical center with the goal of (1) aligning role responsibilities with core competencies, (2) categorizing role-specific activities using a productivity spreadsheet, and (3) disseminating role-sensitive outcomes. DESCRIPTION OF PROJECT: The Donabedian model was used to evaluate the recently added CNS position and ensure the position aligned with professionally established role responsibilities and practice expectations. Using CNS competencies and standards of practice, the job description was restructured. A process for tracking productivity was developed, and outcomes reporting method was selected. OUTCOME: Changes to the job description resulted in 88% of the job description being reflective of CNS competencies and standards of practice. With this new process, collective role-specific work increased from 36% to 95%. Outcomes were identified from 4 frequently performed role-specific activities. CONCLUSION: The CNS role was successfully established and differentiated from other nursing roles by redesigning the job description, documenting role-specific activities, and capturing role-sensitive outcomes. Success was captured and disseminated using a year-end report, resulting in a positive response from hospital leadership and a recognized need for current and additional CNSs.

How Can I Implement Accurate Delirium Screening and Prevention Practices?

As a clinical nurse specialist (CNS), I am tasked with improving patient outcomes through collaborative research, evidence-based practice, and process improvement efforts that affect the quality and safety of patient care. However, I have learned over time that it is not enough to simply incorporate the latest evidence into organizational policies and procedures; it has to be followed in practice. 
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Correlación clínico patológica de los ganglios cervicales enpacientes con cáncer de cabeza y cuello / Clinical pathological correlation between lymph node inpatients with head and neck cancer

Objetivo: Correlacionar la clasificación clínica ganglionar con el estudio de anatomía patológica de las disecciones cervicales realizadas a los pacientes con cáncer de cabeza y cuello en la Cátedra Servicio de Otorrinolaringología del Hospital Universitario de Caracas desde el 2011 al 2016.Método: Estudio descriptivo y cuantitativo que evaluó 27pacientes, a quienes se les practicó disección cervical tipo radical clásica, radical modificada y selectiva. Resultados: edad promedio 56 años, el 77,8% sexo masculino. El tipo histológico más frecuente fue carcinoma escamoso 81,5%. El tipo de disección más practicada fue la selectiva 53,3%, seguida dela radical clásica 26,7% y de la radical modificada 20,0%. Se constató 36% de recidiva local o cervical. Dieciséis pacientes con ganglios clínicamente positivos, 13 fueron confirmados histológicamente. Todos aquellos clínicamente sin ganglios, fueron confirmados histológicamente como negativos. La sensibilidad de la clasificación clínica para ganglios positivos fue 81,3% y la especificidad 100%. Las siete recidivas cervicales presentaban ganglios positivos. No hubo recidivas en los 11pacientes ganglios negativos. El 22,7% y 71,6% de pacientes con estado ganglionar positivo y negativo sobrevivieron a los 5 años, respectivamente; fue una diferencia estadística significativa (p=0,024). Conclusión: La relación entre la clasificación patológica y la clínica, así como la presencia de ganglios positivos en las recidivas cervicales son estadísticamente significativas y se relacionan con la disminución en la sobrevida. La palpación de cuello continúa siendo una herramienta útil en la toma de decisiones terapéuticas, que demostró una sensibilidad y especificidad superior al promedio(AU)

Objective: To correlate the clinical lymph node classification with the pathological result of neck dissections performed in patients with head and neck cancer at the Otorhinolaryngology Department of the Hospital Universitario de Caracas from January 1, 2011 to December 31, 2016. Method: Descriptive, quantitative and retrospective study, which evaluated 27 patients, who under went classical radical, modified radical and selective neck dissection. Results: averageage 56 years, 77.8% male. the most frequent histological type was squamous carcinoma 81.5%. The most used type of dissectio was selective 53.3%, followed by the classical radical 26.7% and the modified radical 20.0%, of these 36% presented local or cervical recurrence. Of the 16 patients with positive lymph nodes, 13 had patology confirmation, and all the negative nodes also had negative patology confirmation; regarding cervical recurrence, of the 7 cases where it was present, all positive nodes, and in the 11 patients negative nodes, all negative cervical recurrence. Conclusion: thee relationship between the pathological and clinical classification, as well as the presence of positive lymph nodes in cervical recurrences are statisticall ysignificant and are related to the decrease in survival. Neck palpation continues to be a useful tool in therapeutic decision making, which has shown higher than average sensitivity andspecificity(AU)

Contrast-enhanced ultrasound detection and treatment guidance in a renal transplant patient with renal cell carcinoma.

Contrast-enhanced ultrasonography (CEUS) is an imaging modality that shows promise in the detection and characterization of renal masses, as well as treatment through CEUS-guided percutaneous radiofrequency ablation. These techniques may be especially valuable in challenging patients who cannot tolerate traditional contrast agents, such as those with diminished renal function, and those who cannot tolerate more invasive surgical treatment. The following case report details an incidence of renal cell carcinoma in a renal transplant patient whose tumor was diagnosed with CEU and successfully treated with CEUS-guided percutaneous RFA.