Social determinants of health and preventable emergency department patient encounters among adults with hypertension.

Limited access to resources promoting optimal health outcomes can lead to increased emergency department utilization for conditions often manageable by primary care resulting in rising healthcare costs, overcrowding in emergency departments, and poor patient outcomes. Social determinants of health often affect an individual's ability to achieve optimal health. To examine the association between social determinants of health and hypertension-related patient encounters among adults, we analyzed data from a 340-bed community hospital in the southeast region of the United States. Gender, race, and geographic location were strongly associated with hypertension-related encounters. Hypertension-related encounters in the emergency department were highest in women, African Americans, and young adults. Insurance status and geographic location were also strongly associated. Public health nursing is positioned to prevent disease and increase access to care, considering hypertension-related encounters in the emergency department account for a significant number of overall visits.

Teaching Empathic Communication at the End of Life: A Virtual Simulation for Nursing Students.

ABSTRACT: There is a gap in the literature regarding prelicensure nursing students' knowledge/communication regarding death and dying. A virtual telecommunication pilot simulation-based experience (SBE) was designed to address the gap in learner experiences communicating with the family of a dying loved one. Learners had to provide the family member, a role portrayed by a simulated patient, an update on the patient's rapidly declining condition. The course leaders noticed the value in learners having personalized conversations and empathetic emotion with family members. This virtual SBE will replace an older face-to-face end-of-life SBE going forward.

Replacing community clinical hours with an antepartum simulation-based experience.

BACKGROUND: Community and population health is an essential part of pre-licensure nursing education. Securing community clinical sites for large cohorts of nursing students is challenging. Individual community sites in nursing specialty areas, such as women's health, limit the number of students, making it difficult to provide a consistent clinical experience for all students. The literature shows simulation is an effective alternative to traditional clinical hours. PURPOSE: This article describes a pilot simulation-based antepartum experience in the community setting. This simulation-based experience replaced the clinical hours for a previous traditional clinical experience in the community setting, for which students were only able to observe and not interact. The objectives were to allow students to be engaged in communication, patient education, and anticipatory guidance with a live patient. METHOD: Faculty at a large southeastern university created an antepartum simulation-based clinical experience focused on important elements of obstetrics and maternal health assessment utilizing standardized patients. RESULTS: Student responses from the post-simulation survey showed 96 % strongly agreed they were more confident in communicating with clients. CONCLUSION: Faculty concluded this simulation-based experience is an effective alternative to traditional community clinical experiences in the antepartum setting.

Examining the Impact of Structured, Reflective Prebriefing on Student Performance During Simulation.

ABSTRACT: Little is known about the impact of prebriefing on students' experiences of learning with simulation. This mixed-methods study evaluated the impact of prebriefing activities on nursing students' satisfaction, confidence, and performance of nursing skills during a simulation. Findings revealed students who experienced a structured, more robust prebriefing had improved performance during the simulation and reported higher levels of confidence and satisfaction in learning compared to a group that experienced a standard prebriefing. Findings are significant to the profession, they support the incorporation of structured, reflective prebriefing activities in simulation-based experiences.

Promoting older adult fall prevention education and awareness in a community setting: A nurse-led intervention.

BACKGROUND AND OBJECTIVES: Falls are costly and one of the most expensive medical conditions to treat. The implementation of fall prevention toolkits (FPTs), such as fall risk screenings and fall prevention education (FPE), have become progressively important in reducing fall incidences. Nurses have a greater role and responsibility to care for the aging population. The purpose of this project was to implement a FPT to adults age 65 and older that attended mobile IPE community clinics. RESEARCH DESIGN AND METHODS: This project used quantitative pretest-posttests and an open-ended participant feedback survey. The Missouri Alliance for Home Care 10-question survey and components of the CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) FPE were used to assess and educate participants on fall risks and fall prevention. An initial baseline fall assessment and fall education score was obtained at the mobile IPE clinics. Follow-up assessments occurred one month after the initial assessment and compared to the initial fall assessment and fall education scores with an additional open-ended participant survey. RESULTS: In both fall risk assessment tools, lower scores indicated a lower fall risk; both fall risk assessment tool mean scores decreased over the one-month period. DISCUSSION AND IMPLICATIONS: Future FPE implementation projects should consider providing needed resources the participants may need so there is no delay in increasing fall prevention and safety measures. The follow-up time period should also be increased to fortify FPE and keep participants engaged in fall prevention safety.

Student-Novice Nurse Preparation: Addressing Barriers in Discharge Teaching.

AIM: The aim of this article was to assess how and to what degree nursing students are prepared for patient discharge teaching (DT). BACKGROUND: The process of discharging patients has become more complex. Despite the expectation that nursing students will be competent in providing effective DT upon graduation, the preparation of new graduates is a problem for hospitals. METHOD: A review of the literature was conducted. REVIEW: The review showed that novice nurses enter the workforce unprepared to provide adequate DT due to limited communication and limited time during their education, which led to low confidence and limited knowledge. CONCLUSION: Methods to overcome current barriers in DT, including simulation practices, the teach-back method, dedicated education units, collaborative efforts, discharge checklists, and health literacy identification, are presented as recommendations for nursing education.

Nurse-Initiated Mobilization Practices in 2 Community Intensive Care Units: A Pilot Study.

BACKGROUND: Critical-care nurses play a vital role in promoting safe early mobilization in intensive care unit (ICU) settings to reduce the risks associated with immobility in ICUs, including the risk of delirium, ICU-acquired weakness, and functional decline. OBJECTIVE: The purposes of this study were to describe nurse-led mobilization practices in 2 community hospital ICUs and to report differences and similarities between the 2 settings. METHODS: This was a cross-sectional exploratory study of 18 nurses (ICU A: n = 12, ICU B: n = 6) and 124 patients (ICU A: n = 50, ICU B: n = 74). Patient-specific therapeutic intervention needs and nurse-initiated mobilization practices were tracked over a 1-month period. RESULTS: Differences in patient characteristics and nurse-led mobilization activities were observed between ICUs. After controlling for patient characteristics, we found statistically significant differences in nurse-led mobilization activities between the 2 units, suggesting that factors other than patient characteristics may explain differences in nurse-led mobilization practices.