Immersion Project: RN-BSN Students Improving the Health and Well-Being of Migrant Workers and Their Families in Immokalee, Florida.

In Immokalee, Florida, farmworkers returning for the fall harvest season and students returning to school for in-person classes combined to create fertile ground for a new outbreak of COVID-19 (ciw-online, 2020). In response to this situation, the goal of this service-learning experience was to provide health screenings and health education to migrant workers and their families in Immokalee, a rural medically underserved community. In the first immersion, RN-BSN students provided educational programs in three churches, at Boys & Girls Club and Pace Center for Girls, reaching 984 migrant workers and their families. In the second immersion, students served 820 migrant workers and their families. Interviews were conducted on 50 students and transcribed. Twenty-five (25) were then selected for content analysis with some key statements presented as results. The students improved their ability to provide culturally competent care to migrant workers.

Standardizing the Bedside Report to Promote Nurse Accountability and Work Effectiveness.

BACKGROUND: This study evaluated bedside reporting from the nurse's perspective regarding accountability, empowerment, work effectiveness, satisfaction, and communication. The aim was to examine the effects of an educational learning activity on bedside handoff reporting related to accountability and work effectiveness. The communication was used at change of shift between frontline nurses, with future interprofessional implementation. METHOD: A demographic questionnaire, the Specht and Ramler Accountability Index-Individual Referent and the Conditions for Workplace Effectiveness Questionnaire-II were administered pre-posteducational (learning activity) intervention. Of 184 RNs, 104 completed the pretest, with only 73 of those completing the posttest. RESULTS: Statistically significant differences were seen with empowerment, work effectiveness, communication, and nurse job satisfaction posttest; no statistically significant difference was found with accountability. The sample was ethnically diverse, with the majority being Latino pretest (n = 63, 55.8%) and posttest (n = 44, 60.3%). CONCLUSION: For medical-surgical units, incorporating bedside reporting can increase nurse satisfaction, accountability, and positive outcomes. J Contin Educ Nurs. 2018;49(10):460-466.

Knowledge and Competency of Nursing Faculty Regarding Evidence-Based Practice.

The Institute of Medicine recommended that 90% of clinical decisions should be evidenced based by 2020. Both the IOM and the American Association of Critical-Care Nurses identified evidenced-based practice (EBP) as a core competency for practice. EBP can reduce costs, improve patient outcomes, and ensure optimal nursing interventions. Because nursing faculty may have deficits in knowledge, attitudes, and competencies to teach EBP, few nursing students conduct EBP reviews. The purpose of this project was to develop EBP educational resources to increase nursing faculty knowledge and competency of EBP in a southeastern college with both a multicultural faculty and student body. A pre- and postsurvey design using Stevens' ACE Star Model of Knowledge Transformation and Evidence Based Practice Readiness Inventory (ACE-ERI) determined the effectiveness of the educational intervention. Results indicated that faculty's self-confidence about their competency in EBP increased significantly from presurvey to postsurvey, t(17) = -2.04, p = .028, but there was no significant change from pretest to posttest, t(17) = -0.576, p =.572, for the EBP knowledge component of ACE-ERI. The results of the study suggest that educational programs for RN-to-BSN faculty are vital in increasing participant's readiness for EBP. J Contin Educ Nurs. 2016;47(9):409-419.

Outcomes of an Immersion Proiect in the Dominican Republic Bateyes.

Faculty and nursing students from a southeastern college participated in a service-learning immersion in an intra-professional collaboration to treat migrant workers living in the bateyes (the name given to those communities that reside inside sugar plantations in the Dominican Republic that are comprised mainly of Haitians and Dominicans of Haitian descent) in the targeted Dominican Republic agricultural plantations. The mission team included physicians, nurse practitioners, registered nurses and nursing students These team members provided health assessment, screenings, and preventive health education to men, women, and children, and their families. The students were provided an in-depth orientation and briefed about what to expect during their visit to a foreign culture. Students were informed about local nursing care practices, beliefs of health-care practices, and the possibility of unexpected occurrences in the bateyes. The cultural and health issues of the Haitian migrant workers living in the bateyes were discussed prior to the trip, and upon arrival in the Dominican Republic. The immersion field experience had two primary aims, which included: 1. Exposing students to a field experience in another country that created avenues for developing a global perspective; and 2. Exposing students to methods of collecting and analyzing retrospective data to glean an understanding of the healthcare needs of individuals living in the Dominican Republic. The charts of 735 patients from the 1437 patients (51%) treated were analyzed with 49% not accounted for. Of those patients, 59% were females and 41% were males. The lower number of males in this retrospective study was probably due to restrictions of working with sugar cane; the males had difficulties leaving their work to be seen by the health-care professionals. The largest age group was the 12-21 age group (24%), with the next age groups 22-32 (18%), 6-11 (16%) and 33-43 (11%), 44-54(9%),0-5 (9%), 55-65 (7%), 66-76 (4%), and 77-87(2%). Many patients had multiple diagnoses in multiple diagnostic categories with the most frequent diagnosis, Gastrointestinal (24%), followed by Neurology (16%), Respiratory (14%), Genitourinary (11%), Musculoskeletal (10%), Dermatology (8%), Eyes, Ears, Nose & Throat (8%), Cardiology (7%), and Hematology (2%).

Inpatient falls in freestanding children's hospitals.

Patient falls are considered a significant safety risk, but little evidence regarding the significance of falls in children is available. A multisite, observational study of fall events occurring in pediatric inpatients (younger than 18 years of age) from Child Health Corporation of America member hospitals was conducted to determine the prevalence and significance of falls. Fall prevalence was 0.84 per 1,000 patient days with 48% classified as preventable. Injuries occurred in 32%, but only two falls resulted in an increased length of stay; none resulted in permanent disability or death. Only 47% of the children who fell were identified to be at risk for fall. Alert mechanisms were used in 60% and preventive measures in 23%. These findings suggest that while inpatient pediatric fall rates are lower than those of adults, greater diligence in identification and risk reduction may further reduce the prevalence of falls and the proportion of fall-related injuries.

ANF scholars (1955-2012): stepping stones to a nursing research career.

The American Nurses Foundation (ANF) grant program has been successful in funding nurse researchers' initial research studies for nearly 60 years. (ANF, 2013). From 1955-2012, over 1,000 ANF scholars have been identified through this historical nursing research study. Over the years, obtaining an ANF grant has become increasingly competitive for scholars. The environment supportive of research is evident from the schools that are the top recipients of grants. The ANF has a proud legacy of scholars who have and continue to make contributions to the advancement of nursing science. The paths forged by the ANF scholars illustrate the significant role that small grant programs play in the evolvement of nursing research and the expansion of nursing science.

Unaccompanied hospitalized children: nurses' search for understanding.

PURPOSE: To explore the experiences and feelings of pediatric nurses who care for hospitalized children that are unaccompanied by their parents. DESIGN AND METHODS: This phenomenological study consisted of interviews with 12 pediatric nurses. Verbatim transcriptions were reviewed with participants and analyzed. FINDINGS: Pediatric nurses viewed the circumstances of unaccompanied hospitalized children through the perspective of their own life-worlds. They used both cognitive and emotional constructs to describe the phenomenon. Nurses' perceptions were affected by day-to-day contingencies of their life worlds which come through the four dimensions of space, mind/body, time, and relationships. These perceptions affected their assessment of parents' situated contexts. Nurses' assessments could lead to negative judgments of parents because they worried about ill effects on the unaccompanied children. Meanwhile,nurses often perceived that parents demonstrated trust when they relegated their child's care to them. CONCLUSIONS: Pediatric nurses dealt with increased emotional work while remaining compassionate with their patients. Nurses indicated that they needed to understand their own life-worlds and that parents' day-to-day contingencies may affect parents' ability to remain with their hospitalized children. Participants were aware of judgmental attitudes which could interfere with the development of therapeutic relationships with parents, and therefore, with hospitalized children.

Perceived value of national certification for pediatric nurses.

PURPOSE: This study evaluated whether pediatric nurses who were certified valued national certifications to a greater degree than those who were not certified. METHODS: The Gaberson, Schroeter, Killen, and Valentine (2003) Perceived Value of Certification Tool (PVCT) was used to measure nurses' perceptions of certification. The PVCT includes 18 certification-related value statements, using a five-point Likert scale response ranging from strongly agree to strongly disagree. A principal factor analysis was performed to identify clusters of related variables. RESULTS: Certified pediatric nurses valued national certifications to a greater degree than those who were not certified. More favorable views of certification were moderately associated with favorable views of the effects of certification on salary. The PVCT was found to have one factor, not two, as previously reported in the literature. Lower perceived relationships were reported between certification and salary, clinical competence, and consumer confidence compared with feelings of professionalism and personal satisfaction. CONCLUSION: Efforts to improve the relationship between certification and its perceived value at one institution were addressed. More attention may be needed to strengthen relationships, perceived or otherwise, between certification and competency skills, public awareness, and compensation of nurses for holding national certification.

Support programs for new graduates in pediatric nursing.

This study examined intent to stay and the relationship between work satisfaction and burnout in a sample of new registered nurse graduates hired at a freestanding children's hospital. The following research questions were addressed: (1) Two years after initial employment, what is the percentage of new graduates who intend to stay on the job? (2) Is there a relationship between work satisfaction and burnout? (3) What is the turnover rate after the implementation of a support group program for new registered nurses? Of a target group of 75 new graduate nurses, 33 (44%) completed a modified version of Aiken's Revised Nursing Work Index and the Maslach Burnout Inventory. A majority of the registered nurses intended to stay on the job, with 87.9% reporting that they were satisfied with their current position and 97.0% reporting that they were satisfied with being a nurse. The correlation between job satisfaction and burnout was as follows: r = -0.684, F(1,30) = -21.71; p < .001. Of the participants, 39% reported an increase in the amount of time they spent with patients over the year, 27% reported an increase in the amount of time they spent documenting patient care, and 24% reported that the "quality of care" they were providing was better than 1 year ago. Before the implementation of a support group program for new graduates in 2006, the turnover rate was 7.6%; in 2009, the turnover rate was 5.7%.

Hispanic parents' perspective on early PACU visitation.

Many reports indicate that family member presence in the PACU may decrease anxiety levels in both patients and family members. PACUs, nevertheless, often restrict family visitation because of the close proximity to ORs, complexity, and the fast-paced recovery environment. The purpose of this study was to determine the effect of parental presence on the anxiety levels of children ages 9 to 18, observed behavior of children ages 6 to 8, and reported parental anxiety in the pre- and postoperative periods. The quasi-experimental design used a sample of 72 parent-patient dyads, predominately Hispanic, who completed either the pediatric (9-12) or teenager/adult Speilberger State Anxiety forms. Forty (40) parents were placed in the PACU with their children, and 32 remained in the Waiting Room. PACU nurses coded observations of parents and observations of patients aged 6 to 8 years. FLACC or numeric pain scales scores were also collected. Results showed no difference in parental anxiety between those who were placed in the PACU or Waiting Room. Patients aged 13 to 18 with parents in-PACU had significantly lowered anxiety scores than patients with parents in-Waiting Room (t = 2.51, P = .02). Anxiety scores for younger children (9-12 years old) were not lowered postoperatively regardless of parent placement. Regardless of age, patients with parents in-PACU showed statistically significantly greater pain pre-operatively compared with patients with in-Waiting Room parents (t = 3.15, P = .002), but this difference disappeared postoperatively.

Racial differences in women's prodromal and acute symptoms of myocardial infarction.

BACKGROUND: Minority women, especially black and Hispanic women, have higher rates of coronary heart disease and resulting disability and death than do white women. A lack of knowledge of minority women's symptoms of coronary heart disease may contribute to these disparities. OBJECTIVE: To compare black, Hispanic, and white women's prodromal and acute symptoms of myocardial infarction. METHODS: In total, 545 black, 539 white, and 186 Hispanic women without cognitive impairment at 15 sites were retrospectively surveyed by telephone after myocardial infarction. With general linear models and controls for cardiovascular risk factors, symptom severity and frequency were compared among racial groups. Logistic regression models were used to examine individual prodromal or acute symptoms by race, with adjustments for cardiovascular risk factors. RESULTS: Among the women, 96% reported prodromal symptoms. Unusual fatigue (73%) and sleep disturbance (50%) were the most frequent. Eighteen symptoms differed significantly by race (P<.01); blacks reported higher frequencies of 10 symptoms than did Hispanics or whites. Thirty-six percent reported prodromal chest discomfort; Hispanics reported more pain/discomfort symptoms than did black or white women. Minority women reported more acute symptoms (P < .01). The most frequent symptom, regardless of race, was shortness of breath (63%); 22 symptoms differed by race (P <.01). In total, 28% of Hispanic, 38% of black, and 42% of white women reported no chest pain/discomfort. CONCLUSIONS: Prodromal and acute symptoms of myocardial infarction differed significantly according to race. Racial descriptions of women's prodromal and acute symptoms should assist providers in interpreting women's symptoms.

Magnetism and the nursing workforce.

The focus of this chapter is to highlight practice exemplars and research findings related to the five components of the new Magnet Model. A brief overview of the historical development and professional evolution of the American Nurses Credentialing Center (ANCC) Magnet Recognition Program is presented followed by a brief overview of the original fourteen forces of magnetism. Content related to empirical practice-based research framed under the components of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation, and improvement; and empirical outcomes is presented and discussed. The authors provide key findings from scholarly publications and describe how the findings contribute to the creation of work environments based on the tenets of magnetism. The chapter concludes with a brief over of the ANCC Pathway to Excellence Program.

Imogene M. King's scholars reflect on her wisdom and influence on nursing science.

Reflections on the impact of the work of great leaders are vital for both scientists and practitioners to gain important perspectives on the progress of the evolution of the discipline. Recognizing the influence of a particular theorist's impact is particularly important at the time of death, which is the time where the development of a particular theory moves from the originator to the followers. This column serves as a tribute to Imogene M. King, and is dedicated to her wisdom in promoting the conceptual system she developed.

The Humpty Dumpty Falls Scale: a case-control study.

PURPOSE: The purpose of this descriptive study was to assess whether the Humpty Dumpty Falls Scale (HDFS) identifies hospitalized pediatric patients at high risk for falls. DESIGN AND METHODS: The study was a matched case-control design. A chart review of 153 pediatric cases who fell and 153 controls who did not fall were pair-matched by age, gender, and diagnosis. RESULTS: High-risk patients fell almost twice as often as low-risk patients (odds ratio 1.87, confidence interval = 1.01, 3.53, p = .03). PRACTICE IMPLICATIONS: A Falls Prevention Pediatric Program with the HDFS tool addresses the Joint Commission Patient Safety Goals, but further research is needed to examine HDFS sensitivity-specificity.

Enhancing nurse-physician collaboration using pediatric simulation.

PURPOSE: The purpose of this study was to determine the level of nurse-physician collaboration during simulation training. METHODS: A human patient simulator (HPS) of three mock codes with life-threatening scenarios in children, an understudied population, was used. A set of standardized measures and observational techniques were used to determine levels of nurse-physician collaboration and interaction on multiple dimensions found to improve patient outcomes. RESULTS: High levels of group cohesion (GC) and collaboration and satisfaction with patient care decisions (CSPCD) were identified among both physicians and nurses. The male respondents, regardless of discipline, had significantly higher GC scores (p = .029) and significantly higher CSPCD scores (p = .005) than the female respondents. Although the nurses and physicians self-reported good collaboration following the scenarios, analysis of the videotapes revealed that collaboration improved over time. CONCLUSION: The results of this study hold promise for this critical area of science that seeks to improve the outcomes of patients who experience life-threatening events.