Implementation of an Assault Prevention Quality Improvement Initiative in an Urban Emergency Department.

BACKGROUND: Emergency department (ED) health care workers experience high rates of workplace violence (WPV). LOCAL PROBLEM: Patient-to-staff physical assaults at an urban, academic adult ED ranged between 1 and 5 per month, with a rate of 0.265 per 1000 patient visits. METHODS: A quality improvement initiative, guided by the Social Ecological Model framework that contextualized WPV in the ED setting, informed the development of a Risk for Violence Screening Tool (RVST) to screen adult patients presenting to the ED. INTERVENTIONS: Plan-Do-Study-Act cycles were utilized to implement a violence prevention bundle that incorporated the RVST, an alert system, and focused assault reduction strategies. RESULTS: Patient-to-staff physical assaults decreased to a rate of 0.146 per 1000 patient visits. CONCLUSIONS: Risk for violence screening, an alert system, and assault prevention strategies provide opportunities for nurse leaders to promote ED workplace safety.

Exploring ecosystem-based management in the North Atlantic.

The United States, the EU and Canada established a trilateral working group on the ecosystem approach to ocean health and stressors under the Atlantic Ocean Research Alliance. Recognizing the Atlantic Ocean as a shared resource and responsibility, the working group sought to advance understanding of the Atlantic Ocean and its dynamic systems to improve ocean health, enhance ocean stewardship and promote the sustainable use and management of its resources. This included consideration of multiple ocean-use sectors such as fishing, shipping, tourism and offshore energy. The working group met for 4 years and worked through eight steps that covered the development of common language as a basis for collaboration, challenges of stakeholder engagement, review of the governance mandates, exploring the links between sectors and ecosystems effects, identifying gaps in knowledge and uptake of science, identification of tools for ecosystem-based management, customary best practice for tool development and communication of key research priorities. The key findings were that ecosystem-based management enables new benefits and opportunities, and that we need to make the business case. Further findings were that adequate mandates and effective tools exist for ecosystem-based management, and that ecosystem-based management urgently requires integration of human dimensions, so we must diversify the conversation. In addition, it was found that stakeholders do not see their stake in ecosystem-based management, so greater engagement with stakeholders and targeting of ocean literacy is required and a sustainable future requires a sustained investment in ecosystem-based management, so long-term commitment is key.

Improving Nurse Management of the Second Stage of Labor.

OBJECTIVE: To develop, implement, and evaluate an educational program to improve nurses' management of the second stage of labor. DESIGN: Evidence-based practice project guided by the Iowa Model-Revised. SETTING: Acute care teaching hospital in central California averaging 2,100 births/year with 12 labor, delivery, and recovery rooms and a Level III nursery. PARTICIPANTS: Eighteen registered nurses participated in the educational intervention. INTERVENTION: An instructional course addressed contemporary labor management guidelines and delayed and open/closed glottis pushing. Assessment/documentation of maternal-fetal status, progress/fetal descent, and nurse/provider communication were discussed. Participants engaged in an interactive experience regarding maternal positions. MEASUREMENTS: Data collected from the electronic health record included the number of position changes, nurse/provider communication interactions, and minutes from 10 cm to birth and minutes in delayed pushing. RESULTS: Second-stage labor outcomes for nulliparous patients at term with a singleton in vertex presentation improved with more position changes and percentage of spontaneous vaginal births. Patients of nurses who participated in the educational intervention (n = 18) had a vaginal birth rate of 87.5% and a surgical birth rate of 6.2%. Patients of nurses who did not participate in the educational intervention (n = 31) had a vaginal birth rate of 81.8% and a surgical birth rate of 9.1%. CONCLUSION: Based on the positive response to the intervention and improved clinical outcomes, regularly scheduled interactive nursing education focused on strategies to improve the second stage of labor may be beneficial.

Concurrent enrollment pathway: A model for ADN-BSN programs.

INTRODUCTION: The purpose of this article is to share the collaborative planning and execution of these two public universities and one community college in developing an innovative program to increase BSN-prepared nurses. The aim of the collaboration is to offer a high quality, affordable, and time-saving pre-licensure, concurrent enrollment program (CEP) which allows community college ADN students direct access to BSN study, while maintaining excellent program outcomes, and increasing diverse baccalaureate-prepared nurses in practice. METHODS: Key stakeholders in two public educational systems met to discuss the development of a regional collaboration between two state universities and one local community college. The group designed university-specific, concurrent curricular roadmaps for each university. Students admitted in ADN program chose if they want to attend a concurrent enrollment or a traditional plan of study. RESULTS: In Fall 2019, the CEP program was launched admitting 40 ADN students concurrently enrolled in one university. Subsequently, another cohort started in Spring 2020 with 39 students dually enrolled at the other state university. All students in both cohorts resided in the region. Over 75 % of the total CEP enrollees came from diverse backgrounds, 49 % Hispanics, 16 %, Asians, and 8 % African Americans and 4 % native Hawaiians. Forty-four percent were first generation college students. The average age was 25 with a range of 21-39. Twenty percent of the students were male which is above the national average of 12 %. After four semesters, students completed their ADN degree, passed the licensure exam, and transitioned to earn their BSN degree in the university for another two semesters. CONCLUSION: The literature reveals that BSN-prepared nurses contribute to safe patient care. The current number of cost-effective and accessible nursing programs are not sufficient to reach the IOM 80/20 goal, which contributes to the ongoing shortage of BSN-prepared nurses in the nation, including California. Creativity and open collaboration of nurse leaders, faculty, and staff across different levels of education was instrumental in the success of the students and the program.

Changes in nurse practitioners' knowledge and behaviors following brief training on the healthy eating and activity together (HEAT) guidelines.

INTRODUCTION: Primary care providers, particularly pediatric nurse practitioners, are an integral force involved in tackling the obesity epidemic among youth. The majority of nurse practitioners, however, report low proficiency regarding their ability to adequately prevent and treat pediatric overweight. In response, the National Association of Pediatric Nurse Practitioners (NAPNAP) developed the evidence-based Healthy Eating and Activity Together (HEAT) Clinical Practice Guideline (CPG) to improve provider behavior and efficacy. METHOD: Thirty-five nurse practitioners attending the NAPNAP Annual Conference participated in an intensive 4-hour HEAT CPG training session. Pre-training and post-training data were collected on provider knowledge, practice behaviors, and barriers in relation to the prevention of overweight among youth. RESULTS: Post-training results revealed significant improvements in (a) practitioner knowledge (assessment of patient growth, family history, psychosocial functioning, nutrition, and physical activity); (b) practitioners' intent to improve behavior (i.e., increased intent to use behavior modification and counseling aimed at patient and family behavior change); and (c) practitioners' report of increased confidence in ability to address barriers. DISCUSSION: Study findings demonstrate preliminary support for the HEAT CPG as an effective tool aimed at helping providers to improve their ability to maintain patients' healthy weight. Future research is needed to verify the effects of HEAT CPG on long-term improvements in care.

A survey of NAPNAP members' clinical and professional research priorities.

INTRODUCTION: The purpose of this methodological article is to describe the development, implementation, and analysis of the survey used to determine NAPNAP members' ranking of research priorities, to describe the top priorities ranked by participants, and to determine if priorities differed by area of practice (primary, acute, or specialty care) or participant age. METHOD: A cross-sectional descriptive design with an online survey was used. Completed by 324 NAPNAP members, the survey consisted of a demographic section and 90 statements in two domains: Clinical Priorities and Professional Role Priorities. RESULTS: Survey respondents strongly supported the top priorities with an average overall mean score of 4.0 or above on a 5-point Likert scale. Only three of the top 10 clinical and professional priorities differed by area of practice. No clinical priorities and only three professional priorities differed by age. DISCUSSION: The survey results were used to develop the NAPNAP Research Agenda. Both the survey results and the agenda can provide guidance for the NAPNAP Board, committees and interests groups as they develop initiatives and programs.