Who is Billy Reuben? Health literacy and patient education.

The issue of health literacy is focused on whether health consumers understand and are able to apply the information provided to them. In the neonatal setting, limited parent and caregiver health literacy can result in increased stress and poor compliance with instructions. Health literacy and patient education go hand in hand. This article includes an overview of health literacy and how it applies to the neonatal setting. Information is provided to assist with assessing for health literacy. Hints and resources are also provided for improving patient and family education.

Challenges in Clinical Nurse Specialist Education and Practice.

Clinical nurse specialists (CNSs) are well-positioned to participate in the transformation of healthcare as outlined by the Institute of Medicine and called upon by the Patient Protection and Affordable Care Act of 2010. CNSs exercise their expertise through population-based care across three spheres of influence (patient/family, nurses/other professionals, systems). However, challenges during the educational process as well as implementation in practice can be barriers to optimization of the role, denying the public full benefit from the potential of CNSs. This article highlights some of the issues and provides solutions for mitigating these difficulties.

Implementing SBAR across a large multihospital health system.

BACKGROUND: Communication problems among health care personnel during critical clinical situations can jeopardize patient safety. SBAR, a structured-communication technique, has been adapted from aviation and the military as a strategy for clear communication based on a statement of the situation, background, assessment, and recommendations related to a critical issue. Nurses' use of SBAR and physician perception of communication quality after SBAR implementation was assessed at a 13-hospital health care system. METHODS: Baylor Health Care System initiated a campaign to implement SBAR and train staff in SBAR techniques across its hospitals. Nurse surveys and physician audits were conducted. FINDINGS: Of 156 nurses interviewed, 152 (97.4%) had been educated about SBAR, and 91 (58.3%) used SBAR for critical communication. Of 84 nurses whose proficiency with SBAR was assessed, 72.6% demonstrated good or high proficiency. Of the 155 physicians who responded to the physician survey, 121 (78.1%) said that the last report they received was adequate to make clinical decisions. Of the 27 who indicated that the last report was not adequate to make clinical decisions, 25 (92.6%) had not received the report in SBAR format. CONCLUSIONS: SBAR was generally well understood. Challenges included inconsistent uptake across facilities, lack of physician education about SBAR, and a tendency to view SBAR as a document rather than a verbal technique. Future research will address the need for refresher education with nurses after initial SBAR education, the need for formal physician education about SBAR use, and the possibility of conducting annual competency validation of the utilization of SBAR. Research should also examine the effect of SBAR on quality of care and patient outcomes in controlled trials.

Regulation and accreditation of pre-licensure education of registered nurses: a scoping review protocol.

OBJECTIVE: The objective of the scoping review is to examine and map the literature that reports outcomes of the regulation and accreditation of pre-licensure education of registered nurses (RNs). INTRODUCTION: Pre-licensure nursing education is the basic education that a person must complete before becoming an RN. Regulation and accreditation of nursing education vary by country and may vary within a country. The intended purpose of regulation and accreditation is to protect the public and ensure the quality of education programs; however, there is a gap in published evidence on the outcomes of such regulation and accreditation. INCLUSION CRITERIA: Published and unpublished studies worldwide of any pre-licensure RN students or any pre-licensure graduates of RN programs will be considered. Concepts of interest for the proposed review are reported outcomes related to regulatory activities or accreditation requirements affecting any pre-licensure education programs preparing students to become RNs. The context is pre-licensure regulation or accreditation of RN education in any country or setting. This review will consider quantitative research designs, qualitative research designs, economic evidence evaluations, and textual evidence/gray literature. METHODS: Databases to be searched include CINAHL Complete, Cochrane Central Register of Controlled Trials, Directory of Open Access Journals, Education Source, Health Policy Reference Center, MEDLINE Complete, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, and Ovid Nursing. Articles published in English will be included. No date limits will be set. Selected studies will be reviewed and data extracted by two independent reviewers. Extracted data will be placed in a table and synthesized in narrative format.

Accelerating the Development of Higher-Level Clinical Thinking in Novice Nurses.

Enhancing clinical expertise of novice nurses is a challenge for nursing professional development practitioners. Time and availability of expert preceptors are limited. This article describes a process evaluation project using a specific method of cognitive skills training to expose inexperienced nurses to expert thinking and help them develop more advanced cognitive skills. Development of scenarios, decision points, and expert rationale is described along with project outcomes and lessons learned. Nursing professional development practitioners and inexperienced nurses may benefit from using this method.

Continuous ST-segment monitoring: raising the bar.

ST-segment monitoring is recommended by clinical experts to assist in the early detection of transient myocardial ischemia; however, a gap exists between the recommendations and clinical practice. This article provides a review of research to support the use of ST-segment monitoring in a variety of clinical situations. Patient selection for monitoring, techniques, and strategies to facilitate successful implementation of ST monitoring are included. Nurses are encouraged to advocate for patients by raising the bar of electrocardiogram monitoring practice to aid in optimizing patient outcomes.

Can Children Reduce Delayed Hospital Arrival for Ischemic Stroke?: A Systematic Review of School-Based Stroke Education.

BACKGROUND: Delayed hospital arrival after onset of ischemic stroke reduces the number of patients eligible for tissue plasminogen activator, which must be given soon after stroke onset. There are conflicting results about the impact of mass media stroke education on timing of hospital arrival and tissue plasminogen activator administration rates. School-based programs are a new way to communicate stroke information. METHODS: A search of MEDLINE, CINAHL, PsycINFO, and ERIC databases from 1995 to 2014 identified school-based stroke education interventions. Twelve studies involving 3,312 children and 612 parents met criteria for review. RESULTS: School-based stroke education interventions were effective to improve knowledge of stroke symptoms among children in kindergarten through junior high. Improvement for stroke risk factors was less robust. Interventions were effective regardless of format, length, or who delivered the information. Despite low parental response rates in some studies, there was evidence that children transmitted stroke information to parents. CONCLUSIONS: School-based stroke education programs appear effective to improve knowledge of stroke symptoms. Research is needed to determine if children who participate are able to recognize stroke and respond appropriately by calling 911 in the real world. More study is needed about transfer of stroke knowledge from child to parent. Strategies to improve parent participation are needed.

Application of a Comprehensive Unit-based Safety Program in critical care: the royal exchange.

This article discusses the history of the Comprehensive Unit-based Safety Program (CUSP) and how it is used to foster a culture of safety. CUSP involves interdisciplinary teamwork and empowers nurses at all levels to pioneer changes and develop leadership skills. A case study is presented to show how CUSP was used effectively in critical care to create a standardized handover of patients from the operating room to the intensive care unit.

Review of evidence about family presence during resuscitation.

Family presence during resuscitation (FPDR) has not been implemented consistently as standard practice across health care settings despite the availability of supporting research and recommendations from professional organizations. Health care providers, patients, families, and the public have divergent attitudes about FPDR. Inconsistencies in if, when, and how FPDR is offered can lead to inequities in care. This article presents relevant research on attitudes about FPDR and interventions to help change practice. The authors also share their experience with a project to implement FPDR in a medical intensive care unit.

Pulmonary issues in acute and critical care: pulmonary embolism and ventilator-induced lung injury.

Many patients admitted to acute care hospitals are at risk for VTE. Nurses play a pivotal role in prevention of VTE events by assessing risk and implementing prophylactic interventions, promptly recognizing and reacting to signs and symptoms of DVT and PE, and collaborating with other team members to ensure rapid treatment ensues. When patients require mechanical ventilation, nurses need to remain alert for complications indicative of VILI, effectively communicate assessment findings to other team members and confidently implement nursing and ordered medical interventions to promote the best possible patient outcomes.

Falls and patient mobility in critical care: keeping patients and staff safe.

Creating safe passage for patients is a priority in hospitals across the United States, a priority in which critical care and advanced practice nurses play a crucial role. Three unique but related areas within this safety framework are fall prevention, the emerging practice of early mobility in intensive care, and safe patient handling. This article explores these 3 topics in tandem to determine whether sufficient evidence exists to guide fall prevention strategies, to explore patient safety associated with early mobility in intensive care units, and, because mobilizing patients is physically demanding for health care workers, to describe safe patient-handling techniques aimed at injury prevention for critical care nurses and others. A review of what is currently known about falls, effects of mobility, and safe patient handling provides a foundation for practice considerations and reveals research opportunities.

ST-segment monitoring: putting standards into practice.

ST-segment monitoring is one key reason that continuous electrocardiographic monitoring is performed in hospitals, and can help with early detection of myocardial ischemia for at-risk patients. Although ST-segment monitoring research, guidelines, and expert consensus statements have been published, ST-segment monitoring has not been implemented in all appropriate clinical areas. The purpose of this article is to present relevant research, review the latest practice standards, and discuss issues important to nurses wishing to implement ST-segment monitoring.