Analyzing a Multifactorial Fall Prevention Program Using ARIMA Models.

BACKGROUND: Preventing inpatient falls is challenging for hospitals to improve and often leads to patient injury. PURPOSE: To describe multifactorial patient-tailored interventions and to evaluate whether they were associated with a sustained decline in total and injury falls. METHODS: A multifactorial fall prevention program was instituted over the course of several years. An interrupted time series design was used to assess the effect of each intervention on total and injury fall rates. ARIMA models were built to assess the step and ramp change. RESULTS: Total fall rates decreased from 4.3 to 3.6 falls per 1000 patient days (16.28% decrease), and injury fall rates decreased from 1.02 to 0.8 falls per 1000 patient days (21.57% decrease). All the interventions contributed to fall reduction, with specific interventions contributing more than others. CONCLUSIONS: Using multiple interventions that are sustained long enough to demonstrate success reduced the total fall rate and injury fall rate.

Protecting Pediatric Healthcare Personnel With Personal Protective Equipment-Specific Roles.

During the height of the COVID-19 pandemic, organizations had to prioritize protecting healthcare personnel (HCP) through effective communication and providing necessary personal protective equipment (PPE). Inadequate and inconsistent supply of PPE has been noted as a cause of anxiety and concern for HCPs. A pediatric hospital in the Western United States responded by developing a system of processes to protect their staff. This column describes the creation of specific COVID-19 roles to support the communication and the resourcing of PPE.

Assessing the Impact of Weighted Blankets on Anxiety Among Patients With Anorexia Nervosa and Avoidant- Restrictive Food Intake Disorder: A Randomized Controlled Trial.

IMPORTANCE: Interventions to reduce anxiety are needed for patients with anorexia nervosa (AN) and avoidant- restrictive food intake disorder (ARFID). Weighted blankets are one such intervention. OBJECTIVE: To evaluate the impact of weighted blankets on anxiety for patients with AN and ARFID. DESIGN: Randomized controlled trial conducted between November 2018 and March 2019. Patients were randomized into the control group or the intervention group. SETTING: Inpatient setting; medical stabilization unit. PARTICIPANTS: Patients (N = 23) diagnosed with AN or ARFID and experiencing moderate anxiety. The majority were female (91%), with a mean age of 26 yr (SD = 9.3), and the mean length of hospitalization was 22 days (SD = 17.3). INTERVENTIONS: Control group participants received usual care, which included occupational therapy services. Intervention group participants received a weighted blanket along with usual care. OUTCOMES AND MEASURES: Mixed-effects regression models were conducted. Primary outcomes included improvement in Beck Anxiety Inventory (BAI) scores by discharge. RESULTS: Intervention group patients had a greater, non-statistically significant decrease in BAI score over time (B = 1.16, p = .83) than control group patients. CONCLUSIONS AND RELEVANCE: Weighted blankets may be an effective tool for reducing anxiety among patients with AN or ARFID. What This Article Adds: The use of a weighted blanket, in conjunction with occupational therapy interventions, is potentially a beneficial non-pharmacological option for patients with anorexia nervosa (AN) and avoidant-restrictive food intake disorder (ARFID). The current study adds an additional modality to the multidisciplinary treatment approach for eating disorders.

The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction, teamwork, and workplace environments.

BACKGROUND: Burnout rates among nurses have detrimental impact on job satisfaction, teamwork, and patient care. This costs millions of dollars in the healthcare system and challenges nurse leaders to address in order to keep up with the healthcare demands. Furthermore, burnout is especially relevant in our current healthcare climate, as frontline nurses have increased workload and multiple psychosocial stressors during the coronavirus disease (COVID-19) pandemic (Sultana, Sharma, Hossain, Bhattacharya, & Purohit, 2019). Literature also suggests that mindful self-care practices need to be reinforced in order to impact burnout long term (Chamorro-Premuzic & Lusk, 2017). Project7 Mindfulness Pledge© is an accessible and voluntary mindfulness tool that nurses can utilize in their individual practice to reduce burnout and does not require significant time commitment. OBJECTIVE: To evaluate the effectiveness of intentional self-care practices on nurse burnout and workplace environment by measuring job satisfaction and teamwork among nurses. METHODS: Comparisons between inpatient units on data from the National Database of Nursing Quality Indicators (NDNQI) with the Practice Environment Scale (PES), specifically on job enjoyment and teamwork, were done utilizing ANOVA. RESULTS: Results show that nurses in an inpatient unit that implemented Project7 has significantly higher job satisfaction as compared to units that did not implement Project7. CONCLUSIONS: This suggests that this tool provides an effective and accessible mindfulness framework managers and directors can utilize to improve job satisfaction, teamwork, and thereby reduce burnout to create healthier work environments.

The nurse COVID and historical epidemics literature repository: Development, description, and summary.

BACKGROUND: During COVID-19, a Kaggle challenge was issued to data scientists to leverage text mining to provide high-level summaries of full-text articles in the COVID-19 Open Research Dataset (CORD-19) data set, a data set containing articles around COVID-19 and other epidemics. A question was asked: "What if nursing had something similar?" PURPOSE: Describe the development and function of the Nursing COVID and Historical Epidemic Literature and describe high-level summaries of abstracts within the repository. METHOD: Nurse-specific literature was abstracted from two data sets: CORD-19 and LitCOVID. LitCOVID is a data set containing the most up-to-date literature around COVID-19. Multiple text mining algorithms were utilized to provide summaries of the articles. DISCUSSION: As of July 2020, the repository contains 760 articles. Summaries indicate the importance of psychological support for nurses and of high-impact rapid education. CONCLUSION: To our knowledge, this repository is the only repository specific for nursing that utilizes text mining to provide summaries.

Assessing the Effect of Unit Champion-Initiated Audits on Fall Rates: Improving Awareness.

BACKGROUND: Inpatient falls remain challenging with repercussions that can include patient injury and increased hospital expense. Fall rates were consistently above the national benchmark. An initiative to reduce fall rates was use of Fall Champion Audits (FCAs). PURPOSE: The aim of this study was to assess the effect of FCAs on patient fall rates. METHODS: FCAs were piloted on a medical-oncology unit. An interrupted time series design was used to assess the effect of FCAs on fall rates. INTERVENTION: FCA is an audit conducted by the unit fall champion that assesses fall risk, interventions, and barriers among staff and patients. RESULTS: Analysis suggested a significant decrease in fall rates from pre- (3.75) to postimplementation (1.62). FCAs worked in conjunction with a division-wide fall program in reducing fall rate. CONCLUSIONS: FCAs, in conjunction with a fall program, are a feasible intervention in reducing fall rates.

Moving from practice to praxis: A qualitative descriptive study revealing the value of Project7 Mindfulness Pledge©.

AIM: To examine the experiences of nurses and nursing assistants who participated in a mindfulness project. BACKGROUND: Increased demands and fewer resources have become the norm in most health care settings. As a result, health care professionals face exceptional stress in their work environments and are vulnerable to burnout and compassion fatigue. Even more distressing, many new nurses are leaving their jobs within the first two years. METHODS: Qualitative interviews were conducted with nine participants to discover their experience with the project. RESULTS: The major theme, a process of moving from practice to praxis, is brought forth through in-depth descriptive analysis of nine individual interviews. The process occurred through three themes: fostering self-awareness and compassion; fostering other-awareness and compassion; and compelling transformation in the unit culture. CONCLUSIONS: This study develops an evidence base for incorporating and building mindfulness into health care environments at a time when there is a tremendous need for highly functioning practitioners. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders are encouraged to examine how they can support their staff in moving from practice to praxis as a part of improving professional well-being, retention, quality and safety in health care.

Exploring Inpatient Medication Patterns: A Big Data and Multilevel Approach.

PURPOSE: Exploratory study to examine inpatient medication administration patterns. METHODS: Data from multiple sources were utilized for this study. The outcome was time difference between medication schedule and administration. A 3-level hierarchical linear regression approach, both unadjusted and adjusted, was considered for this study where medication administration events are nested within patients nested within nurses or units. Intraclass correlation coefficients (ICCs) were calculated and compared. RESULTS: On average, medications were delayed by 12 (SD, 48.8) minutes. From the full model, patient ICCs decreased when "unit" replaced "nurse" as the 3rd level (0.541 vs 0.444). Patients who spoke Spanish had a significant 2.3- to 4.2-minute delay in medication administration. Certified nurses significantly give medications earlier compared with noncertified nurses by 1.6 minutes. DISCUSSION: Optimal medication administration is a multifactorial concern with nurses playing a role. Nursing leaders should also consider patient demographics and unit conditions, such as culture, for medication administration optimization.

Impact of the Pandemic on Newly Licensed Nurses' Role Transition Experiences.

This study examined differences in newly licensed nurses' role transition experiences while enrolled in a nurse residency program before and during the pandemic. The Casey-Fink Graduate Nurse Experience Survey measured baseline, 6-month, and 12-month program outcomes. The prepandemic cohort had higher subscale scores at baseline. Both cohort groups showed significant increases in role confidence, patient safety, communication/leadership, and job satisfaction. Despite the pandemic, nurse residency program completion rates remained stable. Implications for nursing professional development practitioners are presented.

Exploring the Relationship Between Psychological Capital and Turnover Among New Nurses.

The COVID-19 pandemic drastically changed the health care work environment and exacerbated workplace demands and stress. New graduate nurses (NGNs) transitioning into their first registered nurse role were not exempt. Little is known about the emotional well-being of NGNs during the COVID-19 pandemic. In this article, we share NGN psychological capital (PsyCap) trends from 2019 to 2022 and explore the relationship between NGN PsyCap and turnover. Organizational, leadership, and individual implications for practice are discussed. Findings from this study can help health care leaders tailor emotional development and coping strategies for this important segment of the nursing workforce.

Understanding the Relationships Between Health Care Providers' Moral Distress and Patients' Quality of Death.

Introduction: Moral distress is a commonly recognized phenomenon among health care providers; however, the experience of moral distress by staff caring for patients who die during an acute care hospital stay has not been previously examined. It also remains unclear how the quality of a death may impact moral distress among these providers. Objectives: We sought to understand levels of moral distress experienced by intern physicians and nurses who provided care during a patient's final 48 hours of life, and how the perceived quality of death impacted moral distress. Materials and Methods: We utilized a mixed-method prospective cohort design, surveying nurses and interns following inpatient hospital deaths at an academic safety-net hospital in the United States. Participants completed surveys and answered open-ended questions to evaluate moral distress and the quality of the patient's death. Results: A total of 126 surveys were sent to nurses and interns caring for 35 patients who died, with 46 surveys completed. Overall moderate-to-high levels of moral distress were identified among participants, and we found that higher levels of moral distress correlated with lower perceived quality of death. We identified five themes in our qualitative analysis highlighting the challenges nurses and interns face in end-of-life care, including the following: poor communication, unexpected deaths, patient suffering, resource limitations, and failure to prioritize a patient's wishes or best interests. Conclusions: Nurses and interns experience moderate-to-high levels of moral distress when caring for dying patients. Lower quality of end-of-life care is associated with higher levels of moral distress.

Facilitating Health Information Exchange to Improve Health Outcomes for School-Aged Children: School Nurse Electronic Health Record Access.

BACKGROUND AND OBJECTIVES: School-aged children with chronic conditions require care coordination for health needs at school. Access to the student's accurate, real-time medical information is essential for school nurses to maximize their care of students. We aim to analyze school nurse access to medical records in a hospital-based electronic health record (EHR) and the effect on patient outcomes. We hypothesized that EHR access would decrease emergency department (ED) visits and inpatient hospitalizations. METHODS: This retrospective secondary data analysis was conducted using EHR data 6 months pre- and post-school nurse access to students' hospital-based EHR. The main outcome measures were the ED visits and inpatient hospitalizations. RESULTS: For the sample of 336 students in the study, there was a 34% decrease in ED visits from 190 visits before access to 126 ED visits after access (p <0.01). Inpatient hospitalizations decreased by 44% from 176 before access to 99 after access (p <0.001). The incident rate of ED visits decreased (IRR: 0.66; 95% CI: 0.53-0.83; p = 0.00035), and hospitalizations decreased (IRR: 0.56; 95% CI: 0.44-0.72; p <0.0001) from pre to post access. These findings suggest school nurse access to medical records is a positive factor in improving school-aged patient outcomes. CONCLUSION: School nurse access to medical records through the hospital-based EHR may be a factor to improve patient outcomes by utilizing health information technology for more efficient and effective communication and care coordination for school-aged children with chronic medical conditions.

Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.

BACKGROUND: Few studies have examined differences in functional, cognitive, and psychological factors between patients utilizing only nurse practitioners (NPs) and those utilizing only primary care medical doctors (PCMDs) for primary care. PURPOSE: Patients utilizing NP-only or PCMD-only models for primary care will be characterized and compared in terms of functional, cognitive, and psychological factors. METHODOLOGY: Cohorts were obtained from the Medicare Current Beneficiary Survey linked to Medicare claims data. Weighted analysis was conducted to compare the patients within the two care models in terms of functional, cognitive, and psychological factors. RESULTS: From 2007 to 2013, there was a 170% increase in patients utilizing only NPs for primary care. In terms of health status, patients utilizing only NPs in their primary care were not statistically different from patients utilizing only PCMDs. CONCLUSION: There is a perception that NPs, as compared with PCMDs, tend to provide care to healthier patients. Our results are contrary to this perception. In terms of health status, NP-only patients are similar to PCMD-only patients. IMPLICATIONS FOR PRACTICE: Results of this study may inform research comparing NP-only care and PCMD-only care using Medicare and the utilization of NPs in primary care.

States with the least restrictive regulations experienced the largest increase in patients seen by nurse practitioners.

The use of nurse practitioners (NPs) is one way to address the shortage of physician primary care providers. NP training programs and the number of practicing NPs have increased in the past two decades. However, regulations limiting their scope of practice vary greatly by state. We assessed the impact of state regulations on the increase in care provided by NPs in the United States, using a 5 percent national sample of Medicare beneficiaries. We found that between 1998 and 2010 the number of Medicare patients receiving care from NPs increased fifteenfold. By 2010 states with the least restrictive regulations of NP practice had a 2.5-fold greater likelihood of patients' receiving their primary care from NPs than did the most restrictive states. Relaxing state restrictions on NP practice should increase the use of NPs as primary care providers, which in turn would reduce the current national shortage of primary care providers.