Effect of Electronic Rounding Board on Falls and Self-harm Among Psychiatric Inpatients: Quality Improvement Project.

More than 1 million falls are reported in US hospitals each year. Psychiatric inpatients are at high risk for self-harm behaviors with reported suicide rate of 6.5 per 1000 patients. Patient observation is the primary risk management intervention in preventing adverse patient safety incidents. This project aimed to examine the effectiveness of handheld electronic rounding board (ObservSMART) implementation on falls and self-harm incidents among psychiatric inpatients. A retrospective review of adverse patient safety incidents was conducted to compare the 6-month preimplementation period versus the 6-month postimplementation period with staff training and implementation in July 2019. The monthly fall rates per 1000 patient-days were 3.53 versus 3.80 during the pre- and postimplementation periods, respectively. About one-third of the falls resulted in mild or moderate injuries for both periods. The incidence of self-harm was 3 versus 7 during the pre- and postimplementation periods, with incidence of 1 versus 6, respectively, among adult patients, who are more likely to hide self-harm. Although there were no changes in falls, the implementation of ObservSMART markedly increased the detection of patient self-harm, including self-injury and suicide attempts. It also ensures staff accountability and provides an easy-to-use tool to perform timely, proximity-based patient observations.

Leveraging a funding collaborative to develop more PhD prepared nurse scientists and leaders.

BACKGROUND: Over its almost 50 year history, The Robert Wood Johnson Foundation (RWJF) has provided about $500M to nursing initiatives focused on education, practice, policy and leadership development. While RWJF was most often the sole funder of many of these initiatives, it has also joined with others to create a larger and more sustained impact on particularly challenging nursing, health, and health care issues. PURPOSE: The purpose of this article was to describe the challenges and opportunities of a unique funding collaborative developed to engage new partners, increase the visibility of doctoral nursing education and increase funding of the RWJF Future of Nursing Scholars program to develop more PhD prepared nurses and nurse faculty. METHODS: Interviews were conducted with several members of the FNS Funders Collaborative as well as the scholars they supported. The perspectives of three funders, a regional philanthropy (IBC Foundation) and two health systems (Cedars Sinai and Sharp HealthCare) are presented here. Together they supported 13 nurses to complete their PhD through the RWJF Future of Nursing Scholars program. FINDINGS: RWJF contributed $20 M and 13 other funders contributed an additional $3Mto the initiative. The additional funds supported 42 nurses to earn their PhD degree through the program. Six of the 13 funders are health systems, four are regional or health related philanthropies, and others include United Health Care, Johnson & Johnson, and the Care Institute. DISCUSSION: There were many lessons learned for RWJF and the other funders. Given the size of RWJF, some other philanthropies were concerned about how contributions would be represented, others wanted their funding to go directly to care improvement. Some health systems were not prepared for their nurses to decrease work time while pursuing further education. The nurse faculty and nurse PhD shortages have persisted now for over a decade. Although FNS made a significant contribution by developing over 200 new nurse PhDs (faculty and leaders), more funding collaborations that engage new and different partners must be developed so that nursing education does not have to focus on the same problems in the next decade.

Development and Psychometric Testing of a Leadership Competency Assessment.

OBJECTIVE: This article discusses the development and psychometric testing of the Nursing Leadership Competency Assessment (LCA). BACKGROUND: Several leadership assessments are available for purchase, which are aligned with professional organizations. A competency-based leadership assessment is needed to identify the developmental needs of nurse leaders. Competent and confident nurse managers are critical to ensure positive relationships between nurse managers and clinical nurses. METHODS: A multimethod approach was used to develop and test psychometric properties of the LCA. Items were drawn from 8 sources identifying nurse leader competencies. RESULTS: The 76-item assessment had a Cronbach's α of 0.99. Confirmatory factor analysis supported 6 hypothesized factors (domains): leading self, people, organizations, change, innovation, and globally. Subscale reliabilities ranged from α = 0.87 to α = 0.98. CONCLUSIONS: The LCA has demonstrated utility in assessing nurse leader competencies and guiding the development of educational opportunities in targeted content areas for specific leadership roles.

A 1-Year Accredited Nurse Residency Program's Effect on Intent to Leave.

OBJECTIVE: This article describes the evaluation of a system-wide program to enhance new graduate nurse resident (NGNR) experience, enculturation, and commitment to the organization. BACKGROUND: Structured nurse residency programs support NGNR transition to the work environment and increase retention and organizational commitment. METHODS: The study used a descriptive, comparative design measuring NGNR perceptions of affective commitment, job satisfaction, job stress, and other variables over 3 times from baseline to 24 months. RESULTS: Findings demonstrated a reduction in affective commitment and an increase in nursing stress from baseline to 12 and 24 months of employment. The highest mean in intent to leave occurred at 12 months, highlighting the vulnerability of the NGNR at that time. CONCLUSIONS: Nurse leaders must consider resources supporting NGNRs beyond the traditional 12 months to ensure retention and organizational commitment, thereby decreasing intent to leave.

Does Gender Matter in Septic Patient Outcomes?

PURPOSE: The purpose of this study was to examine potential gender disparities in relation to factors associated with sepsis management among a cohort of patients admitted through an emergency department with a discharge diagnosis of severe sepsis or septic shock. Sepsis is one of the leading causes of death globally, with significant associated costs. Predictors of survival for those with sepsis-related diagnoses are complex. DESIGN AND METHODS: The study had a retrospective, descriptive cross-sectional design. The sample (N = 482) included patients 18 years of age or older who presented to the emergency department of a nonprofit, Magnet-recognized, acute care hospital located in southern California. Subjects included those who subsequently met the criteria for a discharge diagnosis of severe sepsis or septic shock as defined by the Surviving Sepsis Campaign. Patient characteristics, clinical variables, care management processes, and outcomes were extracted from the electronic health record. A multivariate model was analyzed. FINDINGS: The sample included 234 women (48.5%) and 248 men (51.5%). Logistic regression with eight independent variables (discharge diagnosis, age, comorbidities, length of hospital stay, source of infection, first serum lactate level measured, recommended fluids administered, and gender) reliably predicted odds for patient survival, Ï°2 (12) = 118.38, p < .001, and correctly classified 77.3% of cases. All eight independent variables significantly contributed to the model. Men had a higher likelihood of hospital survival than women (odds ratio 1.68; 95% confidence interval 1.01-2.79; p = .045). CONCLUSIONS: The Surviving Sepsis Campaign has provided a clear pathway for care of patients with sepsis-related diagnoses. Therapeutic strategies should be developed to address differences in outcome by gender. The adoption of more aggressive applications of evidence-based interventions for these patients may result in better patient outcomes. CLINICAL RELEVANCE: Providers should understand the importance of adhering to sepsis protocols, minimizing treatment disparities, and recognizing gender differences.

Six-Month Follow-up of a Regional Evidence-based Practice Fellowship Program.

OBJECTIVE: This study examined a 6-month follow-up of a regional evidence-based practice (EBP) fellowship program and the predictors of EBP adoption at hospital units. BACKGROUND: The immediate beneficial effects of a regional EBP program are known, but the medium-term effects are not certain. METHODS: A matched pretest/posttest study was conducted using a mailed questionnaire 6 months after the completion of a 9-month regional EBP fellowship program among 3 annual cohorts of participants. RESULTS: Statistically significant improvements in the mean scores of EBP beliefs, EBP implementation, and group cohesion were found (P < .05). Of the 47 participants who completed their EBP projects, more than three-quarters reported EBP adoption at their own hospital units, and EBP beliefs were a positive predictor of EBP adoption (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P = .017). CONCLUSIONS: The outcome improvements continued 6 months after the fellowship program, and strong EBP beliefs predicted EBP adoption in the participants' units.

Design and Testing of a Postanesthesia Care Unit Readiness for Discharge Assessment Tool.

PURPOSE: This article describes the development and psychometric testing of a new Postanesthesia Care Unit (PACU) Readiness for Discharge Assessment Tool (RDAT) that can be used in assessing patients' readiness for discharge from a phase 1 PACU. DESIGN: This study used an instrument development methodology described by Waltz and Strickland that included item development and testing for content and convergent validity and interrater reliability. METHODS: Items were developed from a review the literature, best practice exemplars, and input from an expert panel. Ten items were identified for patient assessment using a dichotomous response set (yes/no). Two nurses independently assessed the patients using the RDAT and Respiration, Energy, Alertness, Circulation, and Temperature, and comparing independent assessments using the RDAT. FINDING: The content validity index was determined to be a = .80, and interrater reliability index was a = 1.0. CONCLUSIONS: The RDAT is a useful, safe tool to assess patients' readiness for discharge from the PACU.

Benefits of a Regional Evidence-Based Practice Fellowship Program: A Test of the ARCC Model.

BACKGROUND: The Advancing Research and Clinical practice through close Collaboration (ARCC) model postulates that improvement in nurses' evidence-based practice (EBP) beliefs results in improved EBP implementation, which in turn improves nurse-related outcomes, such as nurses' job satisfaction and group cohesion. However, there is a dearth of interventional studies that evaluate the relationships among these variables. AIMS: This study evaluated whether a regional EBP fellowship program improved participants' EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness, and examined the relationships among these improvements, using structural equation modeling. METHODS: A pretest-posttest design was used among three annual cohorts of a regional, 9-month EBP fellowship program, from 2012 to 2014, in San Diego, California. Matched pretest and posttest questionnaires, including EBP Beliefs, EBP Implementation, Job Satisfaction, Group Cohesion, and Group Attractiveness scales, were analyzed (N = 120). RESULTS: Paired t-tests showed statistically significant improvements in EBP beliefs, EBP implementation, job satisfaction, and group cohesion (p < .05). Structural equation modeling showed that improvement in EBP implementation had no direct effect on improvements in job satisfaction, group cohesion, or group attractiveness. However, improvement in EBP beliefs had direct effects on improvements in job satisfaction (ß = .24; p = .002) and group attractiveness (ß = .22; p = .010). LINKING EVIDENCE TO ACTION: A regional, collaborative EBP fellowship program was effective in improving EBP beliefs, EBP implementation, job satisfaction, and group cohesion. Improvement in EBP beliefs appears to have had direct effects on improvements in job satisfaction and group attractiveness. Regional fellowship programs that educate and support EBP champions and their mentors may enhance EBP adoption in nursing practice across multiple health care institutions.

Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants.

BACKGROUND: A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. AIMS: This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. METHODS: A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. RESULTS: There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (ß = 0.33; p <.001) and job satisfaction (ß = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. LINKING EVIDENCE TO ACTION: In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.

Standardizing Nurse Transition to Practice: An Infrastructure to Support Nursing Excellence.

Nurse residency programs (NRPs) require effective structures and processes to ensure achievement of desired outcomes, including program accreditation, newly licensed nurse retention, and a healthy nursing workforce for the future. A healthcare system created strategic positions of director of nursing workforce transitions and nursing workforce professional development specialists to standardize an NRP across six hospitals and to achieve Practice Transition Accreditation Program accreditation. The positions provide a strong infrastructure to optimize nurse transition to practice.

Staff nurse perceptions of the Magnet journey.

OBJECTIVE: The objective of this study was to compile a rich description of the phenomenon Magnet journey by registered nurses in clinical settings who provide direct patient care in community healthcare systems recently receiving Magnet designation. BACKGROUND: Evidence supports that Magnet designation leads to improved nursing, patient, and organizational outcomes. Descriptions abound regarding the organizational and cultural transformation during the time leading up to the Magnet designation, commonly referred to as the Magnet journey. There are no published reports regarding the impact of this transformational process on staff nurses. METHODS: Focus groups were conducted at recently designated Magnet hospitals; data were transcribed, reviewed, coded, and themed. The 58 subjects represented various work areas, specialties, and practice sites. RESULTS: Key themes emerged consistent with components of the Magnet model: relationships with leaders, professional accountability, staff voice, Magnet continuum, professional relationships, professional development, and resources/supports. Overall, staff nurses emphasized the positive impact of the transformation that occurred during the journey and the resultant Magnet designation on stakeholders. CONCLUSIONS: Results from this study offer guidance for Magnet project directors, chief nursing officers, managers, advanced practice nurses, and staff nurses involved in or considering the Magnet journey. "Magnet slippage" emerged as a new concept.

Implementation and Evaluation of a Healthcare System's Approach to Surge Staffing and Training.

In response to the coronavirus pandemic, a multihospital healthcare system expanded its nursing resources to accommodate the anticipated and actual surge of patients infected with COVID-19. Nursing professional development practitioners rapidly implemented and evaluated a novel, structured orientation and training program to provide additional surge staffing. Transitioning to a team-based model using the new role of nurse extender ensured the continued deployment of safe, person-centered care. Evaluation strategies enabled iterative improvements to the program.

Oncology Nurse Navigator Effect on Emergency Department Visits and Hospital Admissions of Adults With Cancer Post-Outpatient Chemotherapy.

OBJECTIVES: To examine the effect of oncology nurse navigators (ONNs) on the number of emergency department (ED) visits and hospital admissions (HAs) of adults with cancer post-outpatient chemotherapy. SAMPLE & SETTING: 1,370 patients with cancer between January 1, 2018, and December 31, 2019, in a comprehensive community cancer center in southern California. METHODS & VARIABLES: A descriptive cross-sectional study was conducted using retrospective electronic health records. Primary analysis included bivariate and multiple linear regression to identify correlates of ED visits and HAs in terms of ONN involvement. RESULTS: About 35% of patients had an ED visit or HA. Anemia, dehydration, and pain were common diagnoses. No significant differences were found in ED visits and HAs by ONN group. Medicare and chemotherapy administration location contributed to the likelihood of ED visits; nausea, pain, and pneumonia contributed to the likelihood of HAs. IMPLICATIONS FOR NURSING: ED visits and HAs are not appropriate clinical outcomes to measure ONNs' efficacy. Further research is needed to understand the long-term fiscal and operational outcomes of ONNs.

Psychometric Testing of a Nurse Residency Program Stakeholder Evaluation Survey.

This article describes the development and psychometric testing of a 43-item nurse residency program stakeholder evaluation. The valid and reliable survey provides nursing professional development practitioners with insight into opportunities to improve nurse residency program design and educational content. Survey results may also substantiate human and capital resources required for effective programs.

Evidence-based architectural and space design supports Magnet® empirical outcomes.

This department expands nursing leaders' knowledge and competencies in health facility design. The editor of this department, Dr Jaynelle Stichler, asked guest authors, Drs Ecoff and Brown, to describe the process of using the conceptual models of a nursing evidence-based practice model and the Magnet Recognition Program® as a structured process to lead decision making in the planning and design processes and to achieve desired outcomes in hospital design.

Multi-institutional study of barriers to research utilisation and evidence-based practice among hospital nurses.

AIMS: The study aims were to explore the relationships between perceived barriers to research use and the implementation of evidence-based practice among hospital nurses and to investigate the barriers as predictors of implementation of evidence-based practice. BACKGROUND: Evidence-based practice is critical in improving healthcare quality. Although barriers to research use have been extensively studied, little is known about the relationships between the barriers and the implementation of evidence-based practice in nursing. DESIGN: Cross-sectional study. METHOD: Data were collected between December 2006-January 2007 for this cross-sectional study using computerised Evidence-Based Practice Questionnaire and BARRIERS surveys. A convenience sample (n=1301) of nurses from four hospitals in southern California, USA, participated. Hierarchical multiple regression analyses were performed for each of the three dependent variables: practice, attitude and knowledge/skills associated with evidence-based practice. BARRIERS subscales were used as predictor variables. RESULTS: The perceived barriers to research use predicted only 2·7, 2·4 and 4·5% of practice, attitude and knowledge/skills associated with evidence-based practice. Conclusions. It was unexpected that the barriers to research use predicted such small fractions of practice, attitude and knowledge/skills associated with evidence-based practice. The barriers appear to have minimal influence over the implementation of evidence-based practice for most hospital nurses. RELEVANCE TO CLINICAL PRACTICE: In implementing evidence-based practice, the focus on barriers to research use among general nursing staff may be misplaced. Further studies are needed to identify the predictors of evidence-based practice and to identify the subset of nurses who are most amenable to adopting evidence-based practice.

Joint optimization: Merging a new culture with a new physical environment.

Nearly $200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and capabilities in healthcare design. This bimonthly department prepares nurse leaders to use the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the authors discuss the concept of joint optimization of merging organizational culture with a new hospital facility.

Moving into a new hospital: strategies for success.

The work of moving into a new hospital does not end with construction. Planning a move must include preparing staff and physicians for the changes in their usual routines in care delivery. This bimonthly department expands nurse leaders' knowledge and competencies in health facility design and enables them to lead in transition planning for operations in a new setting. As editor of the Health Facility Design department, I asked the guest authors to describe their use of conceptual frameworks and change acceleration processes to ensure a successful transition to a new hospital tower.

Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center.

AIM: This paper is a report of a study to describe nurses' practices, knowledge, and attitudes related to evidence-based nursing, and the relation of perceived barriers to and facilitators of evidence-based practice. BACKGROUND: Evidence-based practice has been recognized by the healthcare community as the gold standard for the provision of safe and compassionate healthcare. Barriers and facilitators for the adoption of evidence-based practice in nursing have been identified by researchers. Healthcare organizations have been challenged to foster an environment conducive to providing care based on evidence and not steeped in ritualized practice. METHODS: A descriptive, cross-sectional research study was conducted in 2006-2007 with a convenience sample of 458 nurses at an academic medical center in California (response rate 44.68%). Two reliable and valid questionnaires were electronically formatted and administered using a secured website. Relationships between responses to the two instruments were examined and results compared with previously published data. RESULTS: Organizational barriers (lack of time and lack of nursing autonomy) were the top perceived barriers. Facilitators were learning opportunities, culture building, and availability and simplicity of resources. Statistically significant correlations were found between barriers and practice, knowledge and attitudes related to evidence-based practice. CONCLUSION: Similar barriers to the adoption of evidence-based practice have been identified internationally. Educators must work with managers to address organizational barriers and proactively support evidence-based practice.