Safety Competency: Exploring the Impact of Environmental and Personal Factors on the Nurse's Ability to Deliver Safe Care.

BACKGROUND: Patient safety is a priority in health care systems. Nurses' safety competence along with environmental and personal factors plays a role in patient safety. PURPOSE: The purpose of this study was to explore the relationships among safety competency, structural empowerment, systems thinking, level of education, and certification. METHODS: A cross-sectional exploratory design was used to collect data from nurses (n = 163) practicing in a large Midwestern hospital system. RESULTS: There were significant positive correlations between safety competency and ( a ) structural empowerment, ( b ) systems thinking, and ( c ) certification. Systems thinking explained 12.9% of the variance in the knowledge component of safety competency and 6.8% of the variance in the skill component of safety competency. Certification explained 2.4% of the variance in the skill component of safety competency. CONCLUSIONS: Understanding factors that affect safety competency supports the development of effective interventions that may improve safety.

The Nurse Empowerment Program for Nurses in Direct Care Positions.

OBJECTIVE: An educational program including online generic and nursing-specific content was evaluated for self-assessed leadership skill outcomes. BACKGROUND: Leadership development for nurses in direct care positions has not received the same support as for nurses in formal leadership positions. Pandemic and workforce changes make it critical that leadership skills be built at all levels of nursing. METHODS: Early-career nurses (≤10 years of experience) were recruited to participate in an online leadership development program offering 9 LinkedIn Learning courses, 3 leadership courses from Sigma, an e-book, and a discussion board. RESULTS: Most participants who responded to both immediate postsurvey and 3-month follow-up survey (98.6% of n = 69) reported having applied new or improved abilities in their nursing practice to at least a small degree, and the majority reported having done so to a moderate or great degree. CONCLUSION: This online leadership development program was valued and was associated with improved self-assessed leadership.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

Nurses and Midwives as Global Partners to Achieve the Sustainable Development Goals in the Anthropocene.

PURPOSE: To highlight ongoing and emergent roles of nurses and midwives in advancing the United Nations 17 Sustainable Development Goals by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the professions worldwide. DESIGN: Discussion paper. METHODS: Literature review. FINDINGS: Realizing the Sustainable Development Goals will require all nurses and midwives to leverage their roles and responsibility as advocates, leaders, clinicians, scholars, and full partners with multidisciplinary actors and sectors across health systems. CONCLUSIONS: Making measurable progress toward the Sustainable Development Goals is critical to human survival, as well as the survival of the planet. Nurses and midwives play an integral part of this agenda at local and global levels. CLINICAL RELEVANCE: Nurses and midwives can integrate the targets of the Sustainable Development Goals into their everyday clinical work in various contexts and settings. With increased attention to social justice, environmental health, and partnership building, they can achieve exemplary clinical outcomes directly while contributing to the United Nations 2030 Agenda on a global scale and raising the profile of their professions.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Advancement of global health: Recommendations from the Global Advisory Panel on the Future of Nursing & Midwifery (GAPFON®).

AIMS: To discuss nurses' contributions to global health through their participation in GAPFON®. DESIGN: Discussion paper that reviews literature related to global health, global nursing and midwifery based on the contributions of the GAPFON® report. DATA SOURCES: A literature search of electronic databases was conducted for published articles during 2014-2018 in English focusing on the main themes of the GAPFON® report. Manual searches of relevant journals and internet sites were also undertaken. RESULTS: Recommendations and strategies were discussed that could have an impact on the advancement of the nursing profession's contribution to global health based on the GAPFON® report outcomes. IMPLICATIONS FOR NURSING: GAPFON® provides a framework to synergize and converge our activities to address professional issues around the globe, through implementation of the suggested strategies identified in the GAPFON® report. GAPFON® has engaged with nursing and midwifery leaders around the globe to determine both the most pressing health issues and professional issues in regions and the report is a synthesis of all the data, reflecting regional and global challenges. This article explores ways of how the report can be used as a basis for engagement with decision makers in global health. CONCLUSION: Advances in the professional areas embedded in the GAPFON® Model are expected to lead to capacity building, evidence-based practice and ultimately improved quality of global health care. The strategies for implementation identified by regional stakeholders can have an impact on the global health agenda by focusing on nurses and midwives as the drivers of this change.

Facilitating the Academic Success of International PhD Students.

AIM: This article discusses the challenges of international PhD nursing students and recommends strategies to support them. BACKGROUND: Approximately 10 percent of the students enrolled in research-focused nursing doctoral programs in the United States are non-US residents, challenging schools of nursing to examine ways to support these students. METHOD: We searched five electronic databases using international student* AND doctoral OR graduate as search terms; we integrated the authors' experiences. RESULTS: Faculty and peer support can promote a smooth transition into the United States. Participating on research teams or school committees promotes academic socialization. Dissertation work has multiple unique challenges, including international relevance of topics, translation, funding, and location of the research. CONCLUSION: Faculty advisers and universities can facilitate student adjustment. Once international students become familiar with the academic requirements and culture, they have the capacity to contribute rich, diverse perspectives that greatly enhance the quality of PhD education.

Empowerment of front-line leaders in an online learning, certificate programme.

AIM: To evaluate the effectiveness of an online learning, certificate programme for front-line nurse leaders' sense of empowerment. BACKGROUND: Front-line leaders play a crucial role in health care. Current training is often inadequate. The Institute of Medicine report on The Future of Nursing: Leading Change, Advancing Health (2010) recommends nurses at all levels receive training for their role. METHODS: A pre- to post-study design was used; instruments included Conditions for Work Effectiveness Questionnaire, Psychological Empowerment Scale, intent to stay, and self-reported knowledge and effectiveness of intervention questions. This study evaluated the effects of online learning for 29 acute care front-line leaders in the USA and Australia. RESULTS: Structural empowerment significantly improved, pre-assessment (M = 18.50, SD = 1.6940) to post-assessment (M = 19.47, SD = 1.6940). There was no significant difference in intent to stay or overall psychological empowerment. Participants agreed (24/29, 83%) the intervention contributed to their 'sense of empowerment in their role' and 'ability to create an empowering work environment'. CONCLUSION: Online learning was effective and could be integrated into orientation and/or continuing education plans to develop empowering work environments. IMPLICATIONS FOR NURSING MANAGEMENT: Online learning may be a means of educating and empowering front-line leaders for their role.

Psychiatric disease in surgically treated colorectal cancer patients.

BACKGROUND: Underlying psychiatric conditions may affect outcomes of surgical treatment for colorectal cancer (CRC) because of complex clinical presentation and treatment considerations. We hypothesized that patients with psychiatric illness (PSYCH) would have evidence of advanced disease at presentation, as manifested by higher rates of colorectal surgery performed in the presence of obstruction, perforation, and/or peritonitis (OPP-surgery). MATERIALS AND METHODS: Using data from the 2007-2011 National Inpatient Sample, we identified patients with a diagnosis of CRC undergoing colorectal surgery. In addition to somatic comorbid conditions flagged in the National Inpatient Sample, we used the Clinical Classification Software to identify patients with PSYCH, including schizophrenia, delirium/dementia, developmental disorders, alcohol/substance abuse, and other psychiatric conditions. Our study outcome was OPP-surgery. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to analyze the independent association between each of the PSYCH conditions and OPP-surgery, after adjusting for patient demographics and somatic comorbidities. RESULTS: Our study population included 591,561 patients with CRC and undergoing colorectal cancer surgery, of whom 60.6% were aged 65 years or older, 49.4% were women, and 6.3% had five or more comorbid conditions. Then, 17.9% presented with PSYCH. The percent of patients undergoing OPP-surgery was 13.9% in the study population but was significantly higher for patients with schizophrenia (19.3%), delirium and dementia (18.5%), developmental disorders (19.7%), and alcohol/substance abuse (19.5%). In multivariable analysis, schizophrenia, delirium/dementia, and alcohol/substance abuse were each independently associated with increased rates of OPP-surgery. CONCLUSIONS: Patients with PSYCH may have obstacles in receiving optimal care for CRC. Those with PSYCH diagnoses had significantly higher rates of OPP-surgery. Additional evaluation is required to further characterize the clinical implications of advanced disease presentation for patients with PSYCH diagnoses and colorectal cancer.

Using Text Reminder to Improve Childhood Immunization Adherence in the Philippines.

A comparative descriptive study was conducted to determine the effectiveness of text messages with pictures compared with plain text messages or verbal reminders in improving measles, mumps, and rubella immunization compliance in the rural areas of the Philippines. We found that text messaging with or without pictures is a feasible and useful tool in measles, mumps, rubella immunization compliance for childhood immunization. Texting with pictures (n = 23), however, was no more effective than plain text messaging (n = 19) or verbal reminder (n = 17) in improving measles, mumps, and rubella immunization compliance. Compared with parents who received verbal reminders alone, either type of text reminders was linked to parents bringing their child for measles, mumps, and rubella immunization on a timelier basis, as defined by the difference between the scheduled visit and the actual visit, although this was not statistically significant. Mobile technology that uses text reminders for immunization can potentially improve the communication process between parent, the public health nurse, and healthcare provider. Future studies can explore the application of plain text messages or text messages with pictures to improve compliance more broadly for maternal and child healthcare especially in rural areas of developing countries and may be a helpful tool for health promotion for this population.

Promoting Simulation Globally: Networking with Nursing Colleagues Across Five Continents.

Simulation education is gaining momentum internationally and may provide the opportunity to enhance clinical education while disseminating evidence-based practice standards for clinical simulation and learning. There is a need to develop a cohesive leadership group that fosters support, networking, and sharing of simulation resources globally. The Frances Payne Bolton School of Nursing at Case Western Reserve University has had the unique opportunity to establish academic exchange programs with schools of nursing across five continents. Although the joint and mutual simulation activities have been extensive, each international collaboration has also provided insight into the innovations developed by global partners.

NATIONAL INCIDENCE OF MEDICAL TRANSFER: PATIENT CHARACTERISTICS AND REGIONAL VARIATION.

The aim of this descriptive study was to establish and describe the national incidence, cost, and outcomes of patients that undergo medical transfer. Using discharge data from the Nationwide Inpatient Sample 2011, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, the dataset was analyzed using weighted frequency distribution. Approximately 1.6 million patients are transferred yearly. Transferred patients experience a mean length of stay of 9.3 days (std dv 13.5) versus 4.3 days for patients not transferred (std dv 6.0), and cost more than twice as much (mean $19,234) versus those not transferred (mean $9,469). Additionally, patients who undergo inter-facility transfer cost an additional $15.8 billion annually. Interhospital patient transfers require closer scrutiny regarding appropriateness and future policy implications.

The Future of Home Health Care: A Strategic Framework for Optimizing Value.

The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on "The Future of Home Health Care," the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework.

Barriers and Facilitators to Provision of Influenza and Pneumococcal Vaccines in Home Health Care Agencies.

The recommendations for influenza and pneumococcal vaccines are widely known yet the rates of both immunizations for home health care patients are 70 percent or less. The purpose of this study was to identify the facilitators and barriers to immunizations ultimately to improve vaccination rates among home health care patients. Using a multi-case study approach with five agencies and one group of administrators, facilitators included providing patients with a vaccine "card" and using the agency electronic medical record (EMR) for decision support/reminders. We determined that there were patient barriers (misperceptions about vaccines in general, difficulty in recalling vaccine status) and provider barriers (misperceptions about vaccines among health care workers, home health care agencies not receiving accurate information from other providers or difficulty in determining vaccine status).

Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters.

PURPOSE: An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS: Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research. RESULTS: Key contextual factors involve complementary perspectives across multiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flexible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care providers, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, philanthropic organizations, and the business community. CONCLUSION: Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multimethod approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life.

Home health care with telemonitoring improves health status for older adults with heart failure.

Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalization or emergency visit between those who received telemonitoring versus usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore, for older adults with heart failure, telemonitoring may be an important adjunct to home health care services to improve health status.

Developing a community care team: lessons learned from the community connections program, a health care home-community care team partnership.

This article describes the development of the Community Connections Program (CCP), a community care team, within a health care home (HCH), as a short-term, intensive, team-based service planning and coordination program for older adults with multiple chronic health conditions. Three proven approaches were combined to support patient's self-management, nurse care coordination, the Wraparound process, and use of community services. Particzpants'responses to the CCP demonstrated the success of the community care team in connecting patients and nurse care coordinators (NCCs) with community service providers, thus supplying primary care providers with important information regarding the development of a community care team to support patient-centered care within a HCH.

Turnover intention among hospital-based registered nurses in the Eastern Caribbean.

PURPOSE: Vacancy rates for nurses in the English-speaking Caribbean are estimated at 30% with turnover typically associated with migration. The purpose of this study was to describe the characteristics of hospital-based registered nurses (RNs) in the sub-region, their practice environment and turnover intention in two and five years, respectively, and to determine the relationships among practice environment characteristics and turnover intention. DESIGN: A descriptive correlational design was used with self-reported questionnaires from a convenience sample of 301 RNs working in hospitals in four English speaking Eastern Caribbean countries. Single-item visual analog scales (VAS) were used to measure turnover intention in 2 years and 5 years. The Practice Environment Scale of the Nursing Work Index (PES-NWI) measured the characteristics in the practice environment. FINDINGS: The mean age of the nurses was 32.5 (SD = 6.75) years. Most nurses (58.8%) were single and 91.4% had relatives living abroad. Nurses scored three PES-NWI subscales < 2.5, indicating a less positive practice environment: resource adequacy, nurse participation in hospital affairs, and nurse managers' ability, leadership, and support. The subscale for collegial nurse-physician relations received the best rating (mean = 2.61, SD = .62). For 2-year intention to leave, the mean rating on the 100-mm VAS was 63.2, while that for the 5-year intention to leave was 65.6. No significant correlations were found among four of the five PES-NWI subscales and turnover intention in 2 and 5 years. CONCLUSIONS: The practice environment, while generally unfavorable, is not associated with the nurses' intention to leave their jobs. These findings support the current policy position that calls for managing turnover among nurses. Nursing and health system administrators should assess, plan, and implement workforce policies to slow the outflow of nurses. CLINICAL RELEVANCE: Initiatives to improve the work environment and the delivery of high-quality care are important to RNs in the Eastern Caribbean. Managing the negative impact of continuous outflow of nurses through turnover requires long-term coordinated policy and human resource development and management initiatives to sustain the supply of RNs in the subregion.

Using low-fidelity simulation with sophomore nursing students in a baccalaureate nursing program.

Opportunities to achieve competency in the psychomotor and cognitive outcomes required of the nursing profession are limited due to shortages of clinical sites and situations. One solution is to use simulation to replicate some of the essential aspects of a clinical situation so it may be readily understood and managed when it occurs in reality. A program developed for sophomore students integrated the pharmacology, health assessment, and pathophysiology theory courses using low-fidelity simulation and computer-assisted instruction. The objectives of the program were based on Quality and Safety Education for Nurses competencies. The simulation strategies were evaluated using the Educational Practice Scale for Simulation, the Student Satisfaction and Self-Confidence in Learning questionnaire, and the Simulation Design Scale. The initial findings are encouraging for promoting active and diverse methods of learning, high and positive expectations for students, self-confidence, and collaborative team-building opportunities.