A Distance Accessible Education Model: Teaching Skills to Nurse Practitioners.

INTRODUCTION: Health care providers in rural areas are often unable to attend continuing education trainings due to limited staffing coverage. The coronavirus pandemic has created a unique situation, requiring many health care providers to obtain continuing education through virtual offerings. METHODS: This study used a descriptive design with a team-developed presurvey for demographics, 2 posttraining instruments, and a team-developed competency validation checklist. RESULTS: The study sample included nurse practitioner (NP) students and practicing NPs. All participants met competency in the skills validation. DISCUSSION: The results indicate that continuing education and competency validation of procedures is feasible in a virtual format.

Medical Surgical Nurse Self-perceived Competency in Posttraumatic Stress Disorder/Substance Use Disorder Veteran Care in a Non-Veterans Health Administration Setting.

OBJECTIVE: This study evaluated the self-perceived readiness of medical-surgical nurses in a non-Veterans Health Administration (VHA) facility to care for veterans with posttraumatic stress disorder (PTSD) and substance use disorder (SUD). BACKGROUND: Nurses caring for veterans with PTSD and SUD at facilities other than the VHA should be equipped with the knowledge, skills, and attitudes to provide care for this population. METHODS: Nurses evaluated their self-perceived knowledge, skills, attitudes, experiences, and perspectives related to caring for veterans. RESULTS: Nurses overwhelmingly indicated that they had no knowledge of the "Have you served?" campaign, and fewer than half inquired about military status when assessing patients CONCLUSION: Nurses caring for veterans in non-VHA facilities do not consistently identify veterans or assess for service-related conditions, including PTSD and SUD. Nurses report low skill levels related to identifying, addressing, and referring patients with service-related conditions.

Virtual Postoperative Visits for New Ostomates.

Postoperative education, discharge instructions, and follow-up appointments provide a foundation for new ostomates after discharge, but a gap in care remains. New ostomates utilize resources twice as much as other colorectal patients. Virtual visits allow visual inspection of the patient while providing verbal support. The purposes of this project were to determine the feasibility of Virtual Postoperative Visits, to define specific issues patients want addressed, and to assess patient satisfaction with a virtual format. In this pilot project, 10 patients attended two outpatient virtual visits following hospital discharge. The virtual visits were conducted using video conferencing software. Descriptive statistics were used to analyze data from a survey assessing patient satisfaction; content analysis described video interactions. All patients successfully completed two virtual visits from their homes. Ninety percent felt these visits helped with ostomy management and agreed they should be part of a discharge plan. All patients felt comfortable with a virtual format. Common themes discussed included pouching and skin irritation. We found that virtual visits are feasible, and patients are satisfied with this format to address goals of care. Future work will focus on large-scale implementation of virtual visits for new ostomates.

The Impact of Patient and Family Advisors on Critical Care Nurses' Empathy.

OBJECTIVE: The objective of this study was to determine if patient and family advisors' (PFAs) collaboration in an educational program could increase the empathy levels of intensive care unit (ICU) nurses. BACKGROUND: Data suggest that nurse empathy is on the decline. Ensuring that nurses consistently empathize with patients and families helps create positive patient experiences. METHODS: Thirty nurses participated in a PFA-designed educational intervention using simulation-based role playing. The Toronto Empathy Questionnaire (TEQ) was used to measure empathy before and after the intervention. RESULTS: The TEQ empathy scores increased significantly after nurses completed the PFA-designed educational program. Younger nurses (<30 years) improved on average 3.03 ± 3.6 points compared with older nurses (>30 years), who improved, on average, only 0.43 ± 2.06 points (t24.4 = 2.46, P = .021). For the changes in TEQ scores from preintervention to postintervention, age was significantly associated with improvements in TEQ scores. CONCLUSIONS: Patient and family advisors can positively impact empathy among ICU nurses.

Evidence-Based Guidelines for Interface Design for Data Entry in Electronic Health Records.

Electronic health records use a variety of data entry methods that are often customized to clinician needs. Data entry interfaces must be appropriately designed to maximize benefits and minimize unintended consequences. There was relatively little evidence in the literature to guide the selection of specific data entry methods according to the type of data documented. This literature review summarizes existing data entry design recommendations to guide data entry interface design. Structured data entry uses predefined charting elements to limit acceptable data entry to standard coded data and improve completeness and data reuse at the expense of correctness. Unstructured data entry methods use natural language and improve correctness, at the expense of completeness and data reusability. Semistructured data entry uses a combination of these data entry methods to complement the strengths and minimize the weaknesses of each method. Documentation quality is influenced by the method of data entry. It is important to choose data entry methods based on the type of data to be documented. This literature review summarizes data entry design guidelines to inform clinical practice and future research.

Development of a simulated smart pump interface.

Medical device user interfaces are increasingly complex, resulting in a need for evaluation in clinicallyaccurate settings. Simulation of these interfaces can allow for evaluation, training, and use for research without the risk of harming patients and with a significant cost reduction over using the actual medical devices. This pilot project was phase 1 of a study to define and evaluate a methodology for development of simulated medical device interface technology to be used for education, device development, and research. Digital video and audio recordings of interface interactions were analyzed to develop a model of a smart intravenous medication infusion pump user interface. This model was used to program a high-fidelity simulated smart intravenous medication infusion pump user interface on an inexpensive netbook platform.

Transcultural mapping and usability testing of the clinical care classification system for an Iranian neonatal ICU population.

The aim of this research study was to map nursing diagnoses and interventions documented and observed in a neonatal ICU to the Clinical Care Classification system and to validate the translation of these mapped diagnoses and interventions into Persian. This descriptive research used directed content analysis to map diagnoses and interventions to the Clinical Care Classification. Documentation reports of nursing care were extracted from a paper-based documentation system for infants hospitalized in April, May, and June 2011. Observations of care were conducted and compared with documentation to itemize any interventions not included in the documented record. Documented reports of nurses' care and recorded observations were analyzed through directed content analysis, and obtained expressions were mapped to the diagnoses and intervention coding system of the Clinical Care Classification and translated into Persian. Validation of the subsequent code translation was obtained from nursing experts using the Delphi method in two rounds. Findings showed the most frequent nursing diagnoses were related to respiratory condition of infants such as mechanical ventilation dependency (21.1%), and the most frequent nursing interventions were related to completing physician orders such as blood sampling and medication administration (23.9%). Only 47.8% of Clinical Care Classification diagnoses and interventions codes were reflected in the data set. The relatively low rate of nursing care documented in therecords could be due to both the lack of a nursingcare delivery framework, such as the nursing process, and the lack of any framework or standardization in the documentation system in this setting. Using a framework for care delivery and a coding system for documentation of care such as the ClinicalCare Classification would allow for the more complete documentation of nursing care and subsequently the ability to track and analyze this care.

A nurse developed toolkit for long-term care ombudsmen.

Federal regulations provide all nursing home resident access to third party advocates, known as ombudsmen. The ombudsmen are provided unrestricted access to this vulnerable population for complaint investigation and protection of their federally mandated resident's rights. States autonomously administer their ombudsman programs, allowing latitude in hiring and training practices. The majority of state programs rely on a combination of paid and volunteer staff, with most staff lacking formal healthcare training. In an attempt to educate long-term care ombudsmen on common geriatric clinical diagnoses, a clinical toolkit was developed and ombudsmen employed by Alabama Department of Senior Services agreed to pilot test the toolkit. Results of the pilot test did not show ombudsmen with less experience would find the toolkit more useful. Results revealed that all ombudsmen regardless of length of tenure found the toolkit useful.

An observational study of the accuracy and completeness of an anesthesia information management system: recommendations for documentation system changes.

Anesthesia information management systems must often be tailored to fit the environment in which they are implemented. Extensive customization necessitates that systems be analyzed for both accuracy and completeness of documentation design to ensure that the final record is a true representation of practice. The purpose of this study was to determine the accuracy of a recently installed system in the capture of key perianesthesia data. This study used an observational design and was conducted using a convenience sample of nurse anesthetists. Observational data of the nurse anesthetists'delivery of anesthesia care were collected using a touch-screen tablet computer utilizing an Access database customized observational data collection tool. A questionnaire was also administered to these nurse anesthetists to assess perceived accuracy, completeness, and satisfaction with the electronic documentation system. The major sources of data not documented in the system were anesthesiologist presence (20%) and placement of intravenous lines (20%). The major sources of inaccuracies in documentation were gas flow rates (45%), medication administration times (30%), and documentation of neuromuscular function testing (20%)-all of the sources of inaccuracies were related to the use of charting templates that were not altered to reflect the actual interventions performed.

Total added sugar consumption is not significantly associated with risk for prediabetes among U.S. adults: National Health and Nutrition Examination Survey, 2013-2018.

Prediabetes affects 38% of U.S. adults and is primarily linked to added sugars consumed from sugar-sweetened beverages. It is unclear if total dietary intake of added sugar also increases the risk for prediabetes. This study examined if total (g/day) and percent intakes of <10%, 10-15%, or >15% added sugar increase the odds for prediabetes in U.S. adults. A cross-sectional, secondary analysis using 2013-2018 NHANES data was conducted. This study included data from U.S. adults ≥ 20 years with normoglycemia (N = 2,154) and prediabetes (N = 3,152) with 1-2 days of dietary recall information. Prediabetes was defined as a hemoglobin A1c of 5.7%-6.4% or a fasting plasma glucose of 100-125 mg/dL. Survey-weighted logistic regression was used to estimate odds ratios of prediabetes based on usual intakes of added sugar (total and percent intakes) using the National Cancer Institute Method. Differences in prediabetes risk and total and percent intakes of added sugar were compared by race/ethnicity. The sample's total energy intake from added sugar was 13.9%. Total (unadjusted: OR: 1.01, 95% CI: .99-1.00, p = .26; adjusted: OR: 1.00, 95% CI: .99-1.00, p = .91) and percent intakes of added sugar (unadjusted [<10%: (ref); 10-15%: OR: .93, 95% CI: .77-1.12, p = .44; >15%: OR: 1.03, 95% CI: .82-1.28, p = .82] and adjusted [<10%: (ref); 10-15%: OR: .82, 95% CI: .65-1.04, p = .09; >15%: OR: .96, 95% CI: .74-1.24, p = .73]) were not significantly associated with an increased odds of prediabetes. Prediabetes risk did not differ by race/ethnicity for total (unadjusted model [p = .65]; adjusted model [p = .51]) or percent (unadjusted model [p = .21]; adjusted model [p = .11]) added sugar intakes. In adults ≥20 years with normoglycemia and prediabetes, total added sugar consumption did not significantly increase one's risk for prediabetes and risk estimates did not differ by race/ethnicity. Experimental studies should expand upon this work to confirm these findings.

Intensive Care Unit Nurses' Lived Experiences of Psychological Stress and Trauma Caring for COVID-19 Patients.

BACKGROUND: Intensive care unit (ICU) nurses are enduring unprecedented burden caring for COVID-19 patients. Few studies have reported types of work-related events that lead to occupational stress and post-traumatic stress disorder (PTSD). METHODS: ICU nurses were recruited at an academic health science center to explore their experiences of caring for COVID-19 patients. Participants were interviewed for 1 hour using open-ended questions. Symptoms of PTSD were assessed using the PTSD Checklist, job satisfaction with a Likert-type scale, and intention to leave their job with a "yes or no" question. Semi-structured interviews were transcribed and analyzed using NVivo software; quantitative data were analyzed using frequencies and means with R 4.0.5. FINDINGS: The ICU nurse sample comprised nine females and one male, all Caucasian, with a mean age of 26.6 years. Analysis of interview transcripts revealed six recurring themes: Change in Practice, Emotion, Patient's Family, Isolation, Job Satisfaction, and Public Reaction. Quantitative findings revealed 7 of 10 met diagnostic criteria for PTSD. Most participants (7/10) were "somewhat satisfied" with their job. Five of 10 considered leaving their job in the last 6 months. CONCLUSION/IMPLICATIONS FOR PRACTICE: Understanding the impact stressful pandemic-related patient care has on ICU nurses provides evidence that new policies are needed. Furthermore, qualitative findings provide insight into the best design and deployment of interventions to reduce stress and prevent development of PTSD. More research is needed to understand long-term effects of PTSD and to evaluate strategies to prevent PTSD during stressful emergency surges in intensive care.

Integrating a simulated electronic medical record system and barcode medication administration into a pre-licensure nursing program.

BACKGROUND: Many healthcare facilities implement technology to reduce medication errors. Nursing schools are exploring implementing similar technology to promote best practice. PURPOSE: Our institution developed a quality improvement project to evaluate the integration of similar technology into pre-licensure curriculum. METHOD: Our quality improvement project examined using a simulated electronic medical record (EMR) and a barcode medication administration (BCMA) system in pre-licensure nursing curriculum. In our initial project, 96 second-semester BSN students participated in a skill check off using the system. RESULTS: Student perception was positive, 96% of respondents stated the system increased realism, and 94% indicated improved clinical preparedness. CONCLUSION: Implementing this system was a positive experience which enriched our pre-licensure curriculum.

Costing nursing care: using the clinical care classification system to value nursing intervention in an acute-care setting.

The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96). Future studies across a variety of nursing specialties and units are needed to validate the relative value unit for Clinical Care Classification System action types developed for use with the Clinical Care Classification System nursing interventions as a method to cost nursing care.

Smart pump technology: what we have learned.

Intravenous infusion may present the greatest preventable medication administration error risk to hospitalized patients. Smart pumps can provide clinical decision support at the bedside for nurses who are administering intravenously administered medications with the potential to significantly reduce medication errors and subsequent patient harm. However, implementations of smart pumps have yielded mixed results and mixed perceptions of their ability to actually decrease error. To realize the potential of smart pumps, there must exist a clear understanding of how these devices are being integrated into healthcare organizations, specifically nursing practice. The purpose of this article was to describe current smart pump evaluation studies and to suggest areas of future evaluation focus.

Smart pump technology: what we have learned.

Intravenous infusion may present the greatest preventable medication administration error risk to hospitalized patients. Smart pumps can provide clinical decision support at the bedside for nurses who are administering intravenously administered medications with the potential to significantly reduce medication errors and subsequent patient harm. However, implementations of smart pumps have yielded mixed results and mixed perceptions of their ability to actually decrease error. To realize the potential of smart pumps, there must exist a clear understanding of how these devices are being integrated into healthcare organizations, specifically nursing practice. The purpose of this article was to describe current smart pump evaluation studies and to suggest areas of future evaluation focus.

Best practices for preventing hospital-acquired pressure injuries in surgical patients.

Hospital-acquired pressure ulcers (HAPUs) and deep tissue injuries (DTIs), while considered to be preventable in most cases continue to affect many patients in acute care facilities. Surgical patients have an especially high risk of developing HAPUs for several reasons, including immobility during the intraoperative and immediate postoperative periods. HAPUs are responsible for significant patient harm in the form of pain, increased susceptibility to infection, and delayed recovery. Perioperative nurses must take a proactive and comprehensive approach to protecting their patients from pressure injuries, including HAPUS and DTIs.

Impact of Data Entry Interface Design on Cognitive Workload, Documentation Correctness, and Documentation Efficiency.

Clinical documentation serves as the legal record of patient care and used to guide clinical decision making. Inadequately designed data entry user-interfaces may result in unintended consequences that negatively impact patient safety and outcomes because inaccurate information is used to guide clinical decision making. This study utilized an electronic simulated documentation interface (i.e., artificial electronic health record) combined with eye-tracking hardware to analyze documentation correctness, documentation efficiency, and cognitive workload of anesthesia providers (N = 20) generating documentation using different computer-assisted data entry types (drop-down box, radio button, check-box, and free text with autocomplete suggestions). Our study methodology incorporating eye-tracking with electronic health record user interfaces to assess documentation correctness, efficiency, and cognitive workload can be translated to other health care provider types.

Post-Traumatic Stress Disorder in Intensive Care Unit Nurses: A Concept Analysis.

BACKGROUND: Intensive care unit (ICU) nurses are at an increased risk of post-traumatic stress disorder (PTSD) due to their stressful work environment. Using the Walker and Avant conceptual analysis method, we sought to review the literature to better understand PTSD as it pertained to ICU nurses and its impact on their lives, patient care, and health care organizations. METHODS: For the review, we searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO. The keyword searches included the terms "post-traumatic stress disorder" AND "psychological stress" AND "intensive care unit nurses." Abstract and full text reviews were conducted. Ten articles met our inclusion criteria of being published in the past 10 years (2010-2020), peer reviewed, written in English, and referred specifically to PTSD and psychological stress in ICU nurses. FINDINGS: Antecedents for PTSD in ICU nurses are their stressful work environment, where exposure to traumatic events is experienced, and a lack of support from their manager, coworkers, and organization. Defining attributes for ICU nurses with PTSD included reexperiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Consequences identified included burnout, job dissatisfaction, and the intention to leave their job. The conceptual definition of PTSD in ICU nurses was illustrated by the attributes, antecedents, consequences, model case, empirical referents, and by the negative impact on the nurse, patients, and the health care organization. CONCLUSION/APPLICATION TO PRACTICE: Hospital administrators, nurse managers, and occupational health nurses should ensure that policies and interventions are in place to recognize and reduce the risk of PTSD among ICU nurses.

Medication counseling: analysis of electronic documentation using the clinical care classification system.

Medication counseling is a central aspect of medication safety. Counseling refers to the process of informing, advising and administering medication to help patients manage their medication regimen. This pilot study examined 379 descriptions of medication counseling carried out in surgical care and documented in an electronic patient record system by using the Clinical Care Classification System. The objective was to identify counseling methods and to evaluate the need for additional counseling descriptor codes in the record. Eleven counseling methods were identified and the data were classified according to counseling methods with and without documentation of the nature of the interaction with patients. There were no descriptions of the nature of counseling conducted in 127 of the documented entries. These results can be used when developing the documentation of medication care in electronic patient records.

Strengthening universal health: development of a nursing and midwifery education quality improvement toolkit.

OBJECTIVE: to present the development of a toolkit for education quality improvement in universal health and primary health care, targeting schools of nursing and midwifery in Latin American and Caribbean countries. METHODS: an expert work group conducted a systematic literature review, selected key content and completed toolkit drafting, using an iterative consensus approach. International partners reviewed the toolkit. Cognitive debriefing data were analyzed, revisions and new tools were integrated, and the final version was approved. RESULTS: twenty-two articles were identified and mapped as resources. The Model for Improvement, a data-driven approach to performance analysis, was selected for its widespread use and simplicity in carrying out the following steps: 1) organize a team, 2) assess improvement need regarding universal health and primary health care education, 3) set an aim/goal and identify priorities using a matrix, 4) establish metrics, 5) identify change, 6) carry out a series of Plan-Do-Study-Act learning cycles, and 7) sustain change. CONCLUSIONS: the Education Quality Improvement Toolkit, developed through stakeholder consensus, provides a systematic, and potentially culturally adaptable approach to improve student, faculty, and program areas associated with universal health coverage and access.