Integration of Advance Care Planning Into Clinical Practice: A Quality Improvement Project for Leaders.

OBJECTIVE: This quality improvement initiative sought to develop a proactive integrated system approach to advance care planning (ACP) through leadership and colleague engagement. BACKGROUND: Nurse leaders have the capacity to influence the professional competencies of care teams in ACP. Nurse leaders were educated on the importance of ACP, national quality metrics, resources for staff education, and ways to integrate ACP into workflows based on a population management model. METHODS: The project design is a prospective, mixed method design. RESULTS: Nurse leader participants demonstrated a significant increase in knowledge of the importance of ACP and evidence-based models to increase staff engagement and competency. CONCLUSIONS: Study supports nurse leader interventions, promoted engagement of proactive ACP to honor patient choice, and aligns with the mission and vision of one of the largest national Catholic healthcare organizations of being a trusted partner for life.

A Multimodality Approach to Learning: Educating Nursing Students in Palliative Care.

Palliative care education at the undergraduate and graduate level is necessary to improve the competency and confidence of nurses and ultimately improve the care of patients with a chronic illness. Unfortunately, the curriculum in nursing education programs lacks palliative care content, resulting in a lack of preparation and confidence among nursing students. The purpose of this study is to examine the effect of educating nursing students utilizing an interactive, multimodality palliative care class that focuses on palliative and end-of-life care. The Palliative Care Quiz for Nurses and Frommelt Attitude Toward Care of the Dying survey were used to assess nursing students before and after a newly developed palliative care class. A Wilcoxon matched-pairs signed rank test was used to determine a difference in pre and post scores. Results revealed a significant improvement in knowledge, attitude, and comfort with palliative and end-of-life care.

Childhood adversity: a review of measurement instruments.

Measurement instruments are needed to stimulate research on the long-term outcomes of childhood adversity. Therefore, the purpose of this review was to locate, describe, and assess instruments to measure retrospective perceptions of childhood adversity. An electronic search of instruments was conducted using a combination of keywords that included child maltreatment, child trauma, and childhood stressful events. Nine instruments were located and described according to format, definition of childhood adversity as measured by the instrument, characteristics of the sample used in development and testing, reliability and validity evidence, and feasibility for use. Six out of the nine instruments were suitable for investigators who require a comprehensive measure of childhood adversity. Corroboration with independent sources and use of randomized samples are needed to improve upon reports of validity.

Suicide Screening for Prisoners: An Ethical Critique of Research Rejection.

A retrospective review of medical records was proposed to examine mental health staff compliance with documentation of a suicide assessment tool according to institutional policy on suicide screening within a U.S. correctional facility. A shift in focus was necessary when the proposed study was rejected by the institutional review board. Reasons for the rejection included low perceived benefit versus greater risk to the correctional facility and the need for prisoner informed consent, albeit the design was a retrospective medical record review. Because of this rejection, ethical issues in the prevention of suicide in prisons were examined with implications for the forensic nurse leading quality improvement initiatives.

Transforming graduate nursing education in the context of complex adaptive systems: implications for master's and DNP curricula.

The purpose of this article is to describe the evolution and implementation of a graduate nursing program's curricular framework. A number of factors contributed to the realization that the curricular framework needed revision. These factors included the rapid changes occurring in the U.S. health care system, the publication of the 2011 edition of the Essentials of Master's Education in Nursing, and the publication of the Institute of Medicine's report entitled The Future of Nursing: Leading Change, Advancing Health (2010). A careful analysis of key guiding documents resulted in the development of three central, interrelated concepts to guide this revision, namely, relationship-based care, creative inquiry, and leadership.

The impact of a nurse practitioner rapid response team on systemic inflammatory response syndrome outcomes.

BACKGROUND: Early recognition of systemic inflammatory response syndrome (SIRS) can significantly alter outcomes such as mortality, unplanned intensive care unit admissions, and cost. PURPOSE: Through utilization of a nurse practitioner rapid response team (NP-RRT) and a revised database query, earlier identification of SIRS patients and consistent implementation of early goal-directed therapy (EGDT) on the medical-surgical units would positively impact SIRS outcomes. METHOD: A database query that indicated when patients had 2 or more of the SIRS criteria and anion gap acidosis was initiated. The NP-RRT reviewed the triggered patients, and if blood cultures, lactic acid levels, volume resuscitation, or antibiotics were not in place, they were either ordered or recommended to the physicians. RESULTS: All 4 components of EGDT were more frequently discussed with physicians at a statistically significant level. Individual components of EGDT had high levels of implementation. Unplanned intensive care unit admissions were reduced by 3.25% after intervention with a cost savings of approximately $250 000. After initiation of the database query, patients seen by the NP-RRT were more acutely ill, with a statistically higher mean anion gap acidosis, and as a result, mortality was essentially unchanged. DISCUSSION: Improved detection of SIRS and successful implementation of EGDT led to a bridging of the evidence-to-practice gap. Future recommendations on earlier detection of lactic acidosis were rendered as a consequence of this study. The NP-RRT will continue to use the database query to identify SIRS patients in a timely manner and expedite EGDT.

Promoting mental health concepts in a doctor of nursing practice curriculum: an integrated and global approach.

Mental health disorders represent a significant burden across all nations with the vast majority of people being undiagnosed and/or undertreated. There is an urgent need to address these mental health disparities and to implement strategies that will improve appropriate diagnosis and treatment at both the local and international level. Two solutions will be discussed in this paper. First, an integrated care model which has the potential to decrease fragmentation of care and barriers to appropriate treatment. Second, the training and education of nurses in basic mental health competencies. This paper argues that nurses are well positioned to help meet the growing need for mental health care in a variety of health care settings. This paper will describe an educational workshop that was part of a plan to incorporate mental health concepts across a Doctor of Nursing Practice curriculum. It is believed that the underlying concepts of this educational model are transferrable to other countries and can serve as a template for improving the ability to identify, treat, and manage mental health care.

The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit.

PURPOSE: The purpose of this study was to examine the impact of the mindfulness-based stress reduction (MBSR) program on managing work stress and improving patient outcomes. DESIGN AND METHODS: A one-group pre-/post-test design was used to measure the impact of the MBSR program. The Mental Health Professionals Stress Scale, the Sense of Self Scale, the Toronto Mindfulness Scale, and the Maslach Burnout Inventory were used. FINDINGS: The MBSR class assisted staff in decreasing their stress levels and improve their self-care, which resulted in improved patient care. PRACTICE IMPLICATIONS: Increases in patient satisfaction and decreases in patient safety events were found.