Integrating Palliative Care Screening in the Intensive Care Unit: A Quality Improvement Project.

BACKGROUND: Patients admitted to the intensive care unit have complex medical problems and increased rates of mortality and recurrent hospitalization for the following 10 years compared with patients without a history of critical illness. Delayed access to palliative care can result in untreated symptoms, lack of understanding of care preferences, and preventable admissions. Despite studies supporting palliative care screening, there is no standardized method to assess palliative care needs of patients admitted to critical care units. LOCAL PROBLEM: A community hospital critical care team identified a need for an improved palliative care process for patients admitted to the intensive care unit. METHODS: The aim of this quality improvement project was to improve patient access to timely palliative care consultation while increasing the reach of the palliative care team. Guided by the Institute for Healthcare Improvement model of plan-do-study-act cycles, the team created a palliative care screening tool with clinical indicators for nurses to use upon patient admission. Patients with numeric scores indicating positive screening tool results could be automatically referred for palliative care consultation. RESULTS: Of 267 patients, 59 (22%) had positive screening tool results, compared with 31 (11.6%) identified with the traditional consultative method. Descriptive analysis revealed that patients identified for referral without use of the screening tool were hospitalized a mean of 6 days until consultation was requested. CONCLUSION: The screening process can maximize the benefit of palliative care services with early patient identification, improved consultation efficiency, decreased critical care resource use, and reduced readmission rates.

Impact of Nurse-Led Interprofessional Rounding on Patient Experience.

Interprofessional collaborative practice (IPCP) was recommended to improve siloed and fragmented patient care. The Institute of Medicine recommended nurses lead this change through innovative models of patient-centered care and IPCP participation. One strategy to improve patient experience is rounding. This project presents a nurse-led interprofessional bedside rounding model to improve communication and collaboration between providers and with patients on a complex inpatient unit. Outcomes were analyzed using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores to examine patient experience. Postimplementation results demonstrate an increase in HCAHPS patient experience scores for this patient population above hospital and national average.

CNO Rounding Using an Electronic Tracking Tool: Closing the Loop.

Nurse executives must develop creative solutions to improve staff perceptions of the work environment and decrease turnover, as well as stay connected with their staff. This article summarizes an innovative closed feedback loop using an electronic record incorporated into chief nursing officer rounding and the impact on NDNQI survey results.

Recognizing, Confronting, and Eliminating Workplace Bullying.

Workplace bullying (WPB) behaviors negatively affect nurse productivity, satisfaction, and retention, and hinder safe patient care. The purpose of this article is to define WPB, differentiate between incivility and WPB, and recommend actions to prevent WPB behaviors. Informed occupational and environmental health nurses and nurse leaders must recognize, confront, and eliminate WPB in their facilities and organizations. Recognizing, confronting, and eliminating WPB behaviors in health care is a crucial first step toward sustained improvements in patient care quality and the health and safety of health care employees.

Changing the rhythm of dysrhythmia education through blended learning.

A large urban academic medical center installed a telemetry system that increased patient monitoring hospital-wide, which required staff to learn basic electrocardiogram dysrhythmia interpretation. This article outlines the course development, implementation, and evaluation of this electrocardiogram dysrhythmia education.

Considerations when developing online continuing education programs in nursing.

The integration of educational technology into nursing continuing education in the form of online learning involves a shift in thinking from traditional views of nursing education. With advances in technology and increased comfort with the Internet, more professional development staff are offering online continuing education courses. Considerations for professional development staff include transition of roles for the educator and the learner, structure of course offerings, and whether to use synchronous or asynchronous formatting.

Transition of care for adolescent patients with chronic illness: education for nurses.

Because of the longevity of children diagnosed with chronic illness, many adult institutions are now seeing an influx of adolescents with chronic illnesses. An urgent need exists to educate adult care nurses on adolescent development, childhood chronic illness, and techniques to guide young adult patients through illness and hospitalization.This article describes the development of an educational program for nurses who care for these chronically ill young adult patients who are transitioning to adult care.

Assessing nurses' continuing education preferences in rural community and urban academic settings.

Continuing education programs that increase nursing knowledge and collaboration are needed across urban and rural settings. A survey was distributed to determine interest in nursing grand rounds and preferred educational modalities at two unaffiliated hospitals. Results revealed that nurses from the urban and rural hospitals were interested in nursing grand rounds as a recorded online offering, thus providing valuable information used to develop a nursing grand rounds program.

Motivating online learners using attention, relevance, confidence, satisfaction Motivational Theory and distributed scaffolding.

Learning online requires self-regulation, intrinsic motivation, and independence. Building an online classroom environment that fosters the development of these behaviors for students is key to their success. Use of ARCS (attention, relevance, confidence, satisfaction) Motivational Theory and distributed scaffolding can assist faculty in developing intentional support to help the online student achieve learning outcomes. The authors discuss development of teaching strategies in online, distance learning courses that will enhance student motivation and learning outcomes.

Predictors of turnover intention in nurse faculty.

Turnover of nurse faculty is an increasingly important issue in nursing as the available number of qualified faculty continues to decrease. Understanding the factors that contribute to turnover is important to academic administrators to retain and recruit qualified nursing faculty. The purpose of this study was to examine predictors of turnover intention in nurse faculty working in departments and schools of nursing in Carnegie Doctoral/Research Universities-Extensive, public and private, not-for-profit institutions. The multidimensional model of organizational commitment was used to frame this study. The predictor variables explored were organizational climate, organizational commitment, work role balance, role ambiguity, and role conflict. The work roles examined were research, teaching, and service. Logistical regression was performed to examine the predictors of turnover intention. Organizational climate intimacy and disengagement, affective and continuance organizational commitment, and role ambiguity were shown to predict turnover intention in nurse faculty.

Are we on the same page? Staff nurse and manager perceptions of work environment, quality of care and anticipated nurse turnover.

AIMS: The purpose was to examine differences in perceptions of work environment and quality of care between nurse managers and staff nurses, and the relationship between nurses' perceptions of the work environment and intention to leave. BACKGROUND: It is important for managers to understand how staff nurses perceive the work environment as these perceptions may affect nurses' intention to leave the organization. Few studies have examined the perceptions of nurses compared with nurse manager/directors regarding the organizational influences on intention to leave. METHODS: This study was a cross-sectional, non-experimental design. A total of 336 nurses and managers participated from two Midwestern hospitals. Participants completed the Perceived Nurse Work Environment Scale (PNWE), Anticipated Turnover Scale (ATS), and a researcher developed perception of quality scale. Data were analysed for descriptive statistics, Analysis of Variance, and Pearson's correlation. RESULTS: Significant differences were found between nurses and managers on perceptions of work environment. Managers rated work environment higher than staff on all subscales. Work environment was related to anticipated turnover. CONCLUSIONS: Managers and staff nurses are 'not on the same page' in perceptions of work environment. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to understand the organizational influences that may affect nurses' intention to leave. Strategies to improve the work environment are necessary to meet the needs of the staff nurse.

Influence of work role and perceptions of climate on faculty organizational commitment.

The purpose of this study was to examine how organizational commitment is influenced by organizational climate and nurse faculty work role in departments/colleges of nursing. The research was based on Meyer and Allen's Multidimensional Model of Organizational Commitment. The sample was comprised of full-time tenure track, doctorally prepared nurse faculty. Descriptive analyses were used to summarize institutional and nursing program data. ANOVA and t-tests were performed to determine differences between faculty information and study variables. A significant difference was found between teaching work role, and role ambiguity, role conflict and organizational climate. Pearson correlation analyses examined relationships between nurse faculty work role balance, role ambiguity, role conflict, and affective, continuance, and normative organizational commitment. A moderately strong negative relationship was present between role ambiguity and role conflict, and affective and continuance organizational commitment. Significant relationships were observed between subscales of organizational climate and role ambiguity and role conflict. The study's findings offer interesting insights into the dynamic relationships between organizational commitment and climate, work role balance, role ambiguity, and role conflict.

Perceptions of stress, burnout, and support systems in pediatric bone marrow transplantation nursing.

Bone marrow transplantation (BMT) is used to treat various conditions, ranging from immune disorders to many types of cancer. The critical complexity of patients and the environment in which BMT nurses work can lead to stress, burnout, and, ultimately, poor retention. This study aimed to investigate nurses' perceptions of work-related stress and burnout as well as current support systems for nurses. The study included 30 BMT staff nurses from a large pediatric medical center in the midwestern United States. Critical illness or acuity of patients was reported as the most stressful factor; long work hours was the least stressful factor. Most nurses perceived moderate to high levels of emotional exhaustion, and 33% reported moderate levels of depersonalization. Fifty percent perceived high levels of personal accomplishment, despite the critical illness or acuity of their patients, demanding patient families, rotating shifts, short staffing, and caring for dying patients. Most nurses felt that support systems were in place and that staff was accessible, but most respondents were undecided about the helpfulness of the support systems. Results suggest that support systems may significantly affect work satisfaction and feelings of accomplishment for BMT nurses.

Pathways to Nursing: an innovative program to encourage high school students to enter nursing.

Pathways to Nursing was implemented as a partnership between Northern Kentucky University School of Nursing and Health Professions, a local high school in the Northern Kentucky region, a local hospital system, and a large regional medical practice. The goal of this project was to increase interest in nursing as a career among local high school students in order to impact the nursing shortage and improve the health of Northern Kentuckians. Pathways to Nursing activities allowed high school students to explore post-secondary nursing education by participating in nursing career day activities at the university and summer nursing camp which included an overnight stay at the university and nurse shadowing days at the local hospital. High school students were exposed to various clinical experiences, diverse nursing roles, nursing skills laboratory activities and human simulation activities. Students also met with nursing faculty, academic advisors, and university admissions counselors. One hundred and twenty-four high school students participated in Nurse Career Days over the two-year period of the program, and 45 students participated in Summer Nurse Camp over two summers. Ninety-four percent of the high school students who participated in Nurse Career Day stated they would "probably choose" or "definitely choose" the university to attend nursing school; 93.6% stated they "might want to be a nurse" or "definitely would want to be a nurse", and 93.7% rated the information covered as very relevant. Sixty-two percent of the students reported that they "definitely want to be a nurse" after attendance at Summer Nurse Camp. The goal of the Pathways to Nursing program was to provide Northern Kentucky high school students the opportunity to explore nursing through active learning experiences that augment career and academic interests. Collaborative relationships were developed between the University, the School of Nursing and Health Professions (SNHP), a local hospital system and a regional medical practice to encourage Northern Kentucky high school students to pursue a career in nursing. The following objectives were used to complete this project. 1. Build collaborative relationships among all partners to plan, implement and evaluate all phases of the Pathways to Nursing program. 2. Complete Pathways to Nursing activities throughout the year that allow high school students to explore post secondary nursing education and diverse clinical experiences. 3. Implement cooperative learning experiences for "Pathways to Nursing" high school students through educational and mentoring activities conducted by university undergraduate and graduate nursing students.

Factors affecting job satisfaction in nurse faculty: a meta-analysis.

Evidence in the literature suggests job satisfaction can make a difference in keeping qualified workers on the job, but little research has been conducted focusing specifically on nursing faculty. Several studies have examined nurse faculty satisfaction in relationship to one or two influencing factors. These factors include professional autonomy, leader role expectations, organizational climate, perceived role conflict and role ambiguity, leadership behaviors, and organizational characteristics. This meta-analysis attempts to synthesize the various studies conducted on job satisfaction in nursing faculty and analyze which influencing factors have the greatest effect. The procedure used for this meta-analysis consisted of reviewing studies to identify factors influencing job satisfaction, research questions, sample size reported, instruments used for measurement of job satisfaction and influencing factors, and results of statistical analysis.