Use of an Electronic Referral Application to Address Post-Injury Needs of Victims of Firearm Injury in a Hospital-Based Violence Intervention Program.

BACKGROUND: Wraparound referrals are a cornerstone of hospital-based violence intervention programs, which have proven to be an effective public health approach for mitigating violence and recidivism. We hypothesized that replacing a manual referral process with an electronic referral application would increase the number of generated referrals and improve compliance with follow-up visits. STUDY DESIGN: The population for this single center quantitative study was a convenience sample of firearm-injured patients. Data from 74 patients were collected using the electronic health record, the electronic referral application, and the trauma registry before and after the intervention. RESULTS: Post-implementation of the electronic referral application showed an increased number of generated referrals, increased emergency department and inpatient utilization of trauma recovery center services, and an increase in second follow-up visit compliance. CONCLUSION: This study demonstrated an increase in the number of referrals and greater likelihood of completion of post-injury follow-up visits after implementing the electronic referral system.

Informatics Experience Can Help Predict Doctor of Nursing Practice Student Mastery of Informatics Competencies.

With information technology increasingly guiding nursing practice, Doctor of Nursing Practice students must be prepared to use informatics to optimize patient outcomes despite their varied experience and education. Understanding how students' baseline experience affects their mastery of informatics competencies could help faculty design Doctor of Nursing Practice course content. Therefore, the aim of this retrospective descriptive study was to evaluate whether Doctor of Nursing Practice students' baseline informatics experience affected their mastery of four competencies: meaningful use, datasets, e-health, and clinical support systems. Participants were Doctor of Nursing Practice students (n = 55) enrolled in an online informatics course. Participant experience was compared to competency mastery using χ tests. Logistic regression was performed to assess the effect of experience and highest degree obtained on competency mastery. Analysis revealed that participants with meaningful use experience were significantly more likely to master the meaningful use competency than were those without it. Relevant experience did not predict mastery of dataset competencies. Participants with e-health experience were significantly more likely to master the e-health competency (applying e-health resources to vulnerable patients' learning needs). While not significant, a greater percentage of students with clinical support systems experience mastered the clinical support systems competency. Informatics courses might need to be designed to address students' needs based on their experience.

Academic Partnerships: Preparing Nurse Practitioners for Underserved Populations.

Medically underserved populations suffer disproportionately from disease and poor health, and nursing schools are challenged to prepare nurse practitioner students to effectively care for underserved patients. This article describes one university's endeavor to create and evaluate academic partnerships with HIV/hepatitis C virus primary care clinics in underserved settings. Designated preceptorships and specific preparation of students tailored for this population via online modules were strategies created to increase students' readiness to practice as primary care providers and increase clinical placements for nurse practitioner students. Outcomes include student readiness to practice and student satisfaction with clinics and preceptors.

Can follow-up phone calls improve patients self-monitoring of blood glucose?

AIMS AND OBJECTIVES: To evaluate the effectiveness of follow-up phone calls in improving frequency of glucose monitoring over a three month period in two groups of patients with type 2 diabetes with the goal to lower haemoglobin A1C. BACKGROUND: Telephone intervention has been successfully used in improving adherence to diabetes self-management and other chronic disease conditions. DESIGN: A quality improvement study. METHODS: Forty one Type 2 diabetic patients with HA1C ≥7·5% were included in the study. The patients were assigned to two groups. The first group of patients received standard diabetic care (Group 1) and the second group of patients (Group 2) received standard diabetic care plus follow-up phone calls within two weeks after a monthly clinic visit over a three month period. A haemoglobin A1C if indicated was done at the initial study visit. RESULTS: There were no statistically significant differences in the baseline haemoglobin A1C between the two groups or the three month haemoglobin A1C of the two groups. There were no statistically significant differences in mean haemoglobin A1C change between Group 1 and Group 2. The analysis revealed that there were no statistically significant differences between groups in the number of patients who kept logs of their blood glucose readings throughout the study. CONCLUSION: The intervention using telephone follow-up calls did not show a statistically significant improvement in overall HA1C, but there was a clinically significant change in HA1C in the group of patients that received follow-up phone calls. RELEVANCE TO CLINICAL PRACTICE: The clinical significance of the change in A1C in the follow-up phone call group (Group 2) supports that frequent contact by telephone may likely improve adherence to diabetes self-management.

An Intervention to Improve Cultural Competence in Graduate Nursing Education.

Noting the small number of studies on the influence of an entire curriculum on graduate nursing students' cultural competence, the researchers examined the effect of a curricular intervention using a pretest-posttest design. The study, conducted from 2012 to 2014, focused solely on the Doctor of Nursing Practice program at a midwestern university. Results from a pre- and postintervention faculty curriculum survey indicated that the percentage of courses including a cultural competence objective increased from 65 percent to 81 percent. Results from the pre- and postintervention administration of the Transcultural Self-Efficacy Tool showed a statistically significant improvement in students' overall score and three subscale scores.

Moving toward health and fitness: a collaborative academic and community mental health services partnership.

For individuals with serious mental illness, physical fitness is a health imperative. This article describes the progression of an ongoing interprofessional partnership formed between a university's school of health professions and a community mental health services agency to find ways to improve the physical health status of individuals served by the agency. Clinical and research initiatives involving nursing and physical therapy faculty and students have contributed to the establishment of a growing physical fitness and health promotion program championed by agency administrators, staff, and service users. The groundwork has been laid for future collaborative efforts. More needs to be done to turn the tide on the chronic disease tsunami that prematurely takes the lives of people struggling with mental disorders.

Academic integrity in online examinations in a graduate nurse practitioner program: Student perceptions and lessons for nurse educators.

BACKGROUND: While nursing is repeatedly voted the most trusted profession, academic dishonesty is nearly as prevalent in nursing as it is in other disciplines and has been increasing for 30 years. The relationship between academic dishonesty in nursing programs and unethical behavior in clinical settings underscores the importance of exploring student perceptions of academic dishonesty. METHOD: This descriptive study used a survey methodology to examine graduate nursing students' perceptions of academic dishonesty (willingness to report cheating, exam cheating deterrents, and importance of academic integrity). RESULTS: The results showed that students would report cheating, felt current processes were overall sufficient to deter cheating, value academic integrity, and take their studies seriously. Significant findings included this was more representative of students earlier in their programs vs. those nearer to graduation who felt the current program processes may not be as effective. CONCLUSION: It is vital that graduate nursing faculty hold students accountable and enact processes that deter cheating. Furthermore, based on the survey results, the researchers incorporated one new best practice from the literature: a syllabus statement for online courses.

Improving Palliative Care Conversations Through Targeted Education and Mentorship.

Health care provider communication proficiency is critical in the initiation and revisitation of these discussions throughout the trajectory of chronic illness. The delivery of palliative care (PC) throughout the continuum of illness has traditionally been underutilized. Nurses have the ability to significantly improve PC utilization through the use of advance care planning strategies to confidently initiate conversations with patients and families at multiple points throughout the continuum of illness. Nurses are uniquely positioned to contribute to the improvement of care provided to terminally and chronically ill patients because of the relationship developed and the knowledge of patient-specific disease progression that unfolds during the time spent with patients. In this study, nurses improved communication efficacy by learning to utilize advance care planning-specific interview strategies inclusive of scripting and cued language when initiating PC conversations. The preintervention/postintervention confidence levels of nurses in initiating early PC conversations significantly increased to improve the delivery of PC to patients.

Are we moving toward an expanded role for part-time faculty?

The 30-year trend of increased use of part-time faculty in higher education warrants the following questions: Are part-time faculty roles changing in light of the increased presence of part-time faculty in the academia? In addition, what is their contribution to the educational institution's mission of research, teaching, and service? Boyer's model of scholarship was used in this research to answer these questions. The author discusses the research findings and their implications.

Examining Admission Factors Predicting Success in a Doctor of Nursing Practice Program.

BACKGROUND: Graduate nursing programs are challenged to select students who are likely to succeed and who add to nursing workforce diversity. METHOD: For this retrospective study, researchers examined 5 years of admission and retention data from a 4-year Bachelor-to-Doctor of Nursing Practice (DNP) program (n=144) at a large public midwestern university. Using a multinomial logistic regression analysis, four factors were examined to determine which predicted student success, delayed success, or failure: last 60-credit grade point average (GPA), admission essay score, average recommendation letter score, and demographic data (i.e., race, age, gender). RESULTS: GPA, age, and race were found to be significant predictors of student outcomes in this program. Writing and recommendation scores and gender did not predict student outcomes. CONCLUSION: DNP admission committees should consider the weight given to the GPA in their admission formulas and be prepared to work with retention committees to support older and minority students. [J Nurs Educ. 2018;57(1):49-52.].

Implementation of an Educational Intervention to Reduce Inappropriate Antibiotic Use in Upper Respiratory Infections.

Background: Inappropriate use of antibiotics for viral upper respiratory infections (URI) directly contributes to antibiotic resistance. Educational interventions reduce antibiotic prescriptions written for viral (URI) symptoms and antibiotic resistance. Objective: This study aims to ascertain whether provider education will reduce antibiotic prescriptions. The study also aims to change provider prescribing practices through education on antibiotic resistance. Methods: Simple random sampling was used to review charts of patients pre- and postintervention in a single provider primary care practice for patients aged 18-64 years with URI diagnosis and/or symptoms. Results: Preintervention, 85% received an antibiotic for URI symptoms compared to 79% in the postintervention group (p = .514). Chi-square analysis comparing the 2 groups indicated there was no statistical significance between the proportion of antibiotics prescribed within these timeframes (p = .58). Conclusion: Morbidity and mortality will continue to increase without aggressive antibiotic stewardship. Although the results did not reach statistical significance, there was still a 6% reduction in the amount of antibiotics prescribed by the single provider. The decrease, albeit small, has the potential for clinical significance, and further studies should be pursued.

Healthcare provider compliance with the 2013 ACC/AHA Adult Cholesterol Guideline recommendation for high-intensity dose statins for patients with coronary artery disease.

BACKGROUND: Atherosclerotic cardiovascular disease is the foremost cause of death for U.S. adults. The 2013 ACC/AHA Adult Cholesterol Guidelines recommend high-intensity dose statins for individuals with coronary artery disease (CAD). OBJECTIVE: To determine healthcare provider compliance with the Cholesterol Guideline recommendation specific to high-intensity dose statins for patients with CAD. METHODS: A retrospective chart review was conducted to determine compliance rate. A questionnaire was developed to evaluate healthcare provider beliefs, attitudes, and self-confidence toward this recommendation. RESULTS: Of the 473 patients with CAD, 67% were prescribed a high-intensity dose statin. Patients with non-ST segment myocardial infarction and ST segment myocardial infarction were more likely to be prescribed a high-intensity dose statin versus a moderate or low-intensity dose. Healthcare providers strongly agreed with this guideline recommendation. CONCLUSION: There exists a dichotomy between intention to prescribe and actual prescribing behaviors of high-intensity dose statin for patients with CAD.

A model plan for the uninsured: delivering quality and affordability in a limited benefit managed care safety net program in Flint, Michigan.

This paper presents the background and multiyear outcome data for a limited benefit safety-net care program in Michigan. It is a possible solution for policymakers and hospital/clinic administrators to consider when evaluating plans to provide primary care for the 30 million uninsured Americans who will be affected by the Affordable Care Act.

Developing a selection method for graduate nursing students.

PURPOSE: The student selection process is an important faculty responsibility that impacts student success in individual courses, retention, and ultimately graduation rates. The purpose of this article is to review the existing research on graduate student selection and describe one university's newly developed selection process. DATA SOURCES: Existing literature and research and one university's selection data. CONCLUSIONS: There is limited existing research on graduate student selection to assist faculty in selecting students. One university's process is described in detail for possible replication by others to improve the process. IMPLICATIONS FOR PRACTICE: The process highlighted in this article may be useful to other faculty as a model for improvement of student selection processes.

Nurse practitioner management of chronic musculoskeletal pain: a chart review.

This study explored NPs' management of chronic musculoskeletal pain via a record review of 50 uninsured patients. The findings include a summary of the utilization of services and treatments along with demographic data. Recommendations for education, practice, and further research are discussed.