Impact of Evidence-Based Charge Nurse Education on Charge Nurse Skills and Nurse-Specific Metrics.

OBJECTIVE: This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics. BACKGROUND: Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience. METHODS: University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program. RESULTS: The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction. CONCLUSIONS: Interventions targeting frontline leaders positively impact CN performance.

Cultural and Generational Considerations in RN Retention.

OBJECTIVE: The aim of this study was to identify evolving cultural and generational factors influencing nurse retention. BACKGROUND: Multigenerational/culturally diverse workforces challenge the nurse leader's understanding of nurse satisfaction. METHODS: A survey was designed to identify the RN's career intentions, desired leadership traits, and practice environment appraisal. RESULTS: While generally satisfied with their current position, generational differences in the average number of years nurses intend to stay at their current employer exist with Millennials anticipating staying 3.03 years; Generation X, 5.83 years; and Boomers, 8.25 years. Perceived inability to meet patient needs, which varied by generation, was significantly related to nurse satisfaction (P < .01). Factors identified by the nurses that may improve retention, regardless of generation, were pay, staffing, and nursing leadership support. Preferred leader traits varied by generation and ethnicity. Hispanic nurses value hardworking, honest leaders, whereas non-Hispanic nurses value dependability. CONCLUSION: Nurse leaders must individualize efforts to retain an ethnically diverse and multigenerational nursing workforce.

Building a Practice-Focused Academic-Practice Partnership.

A practice-focused academic-practice partnership merging the strengths and resources of 2 faith-based community organizations built evidence-based practice, nursing research, and innovative nursing programs. The unique partnership emphasizing quality care and patient outcomes resulted in hospital-acquired infection reduction, interventional research reducing readmissions, clinical redesign, increased percentage of bachelor's degree-prepared nurses, and dissemination through publication and presentation. Key elements to partnership success were shared mission and vision, program oversight, strong contract, and annual plans with specific measurable outcomes.

Human Trafficking Victim Identification, Assessment, and Intervention Strategies in South Texas Emergency Departments.

INTRODUCTION: Human-trafficking victims seek assistance for health issues in emergency departments. This point of contact provides an opportunity for screening and identification of the victim's situation, enabling intervention. METHODS: This descriptive research study was designed to identify whether a standard protocol is currently used to identify, assess, and intervene for human-trafficking victims in 47 south Texas counties. ED leaders were surveyed using a sequential set of strategies including online, e-mail, and/or phone surveys to identify the methods used in emergency departments screening for adult and child human-trafficking victims. RESULTS: Researchers surveyed 99 emergency departments in south Texas, which includes 21 counties bordering Mexico. Twenty-seven ED leaders responded (27.3%). Despite being located in an area with high rates of human trafficking, these leaders stated that few trafficking victims were identified in 2017. Eleven (40.7%) of the responding emergency departments specifically screened adults for human trafficking, and 10 (37.0%) specifically screened children for human trafficking. A variety of methods were used by each of these emergency departments to identify human-trafficking victims. DISCUSSION: The failure to recognize human-trafficking victims prevents assessment of the victim's status and further delays referral to appropriate resources. Barriers to screening for human trafficking included lack of awareness of the human-trafficking experience, need for clinical education related to evidence-based protocols, and need for validated screening instruments and standardization of processes that promote action and provide victim assistance.

Impact of Population Differences: Post-Kidney Transplant Readmissions.

Early hospital readmissions after kidney transplantation are common and considered an indicator of healthcare quality. The purpose of this study was to identify and describe the risk factors for and causes of 30-day readmission post-kidney transplant for adults in a predominantly Hispanic Southern Texas population in comparison to the United States kidney transplant population and published research. A single-center, descriptive, retrospective study of adult kidney transplant recipients readmitted to a hospital in southern Texas was conducted. Results indicated that this population had lower education levels, a greater percentage of Spanish-speaking patients, and a high number of patients with either or both diabetes mellitus and hypertension, necessitating the development of additional methods of increasing understanding and adherence to restrictions, requirements, and medication regimes.

The DNP project: Quandaries for nursing scholars.

BACKGROUND: In the evolving Doctor of Nursing Practice (DNP) movement, there continues to be a lack of agreement about the final scholarly project. PURPOSE: This study identifies and describes the faculty practices and challenges related to the DNP project across the United States. METHODS: In a descriptive research study, 90 DNP program directors responded to an online survey describing the environment of the DNP program with emphasis on the final scholarly project. DISCUSSION: According to the respondents, 87% of faculty are somewhat or very dissatisfied with the DNP project. Elements that may contribute to the dissatisfaction are the reported lack of faculty knowledge of evidence-based practice and quality improvement, lack of consensus on the DNP project, lack of faculty resources for DNP projects, challenges with clinical sites for the DNP project, and students' scholarly writing skills. CONCLUSION: It is imperative to have academic/practice faculty oriented to DNP concepts; achieve consensus on the project title, type, depth, and outcomes; and have an ongoing dialog regarding DNP project design, execution, and challenges. Project implementation models need to be appropriate for the escalating DNP enrollment. Program support related to institutional review board relationships, student writing and statistical skills, and program-practice site partnerships are needed.

Relationship of Nurse-Led Education Interventions to Liver Transplant Early Readmission.

INTRODUCTION: Early hospital readmission following liver transplantation is associated with lower survival and worse long-term graft function. Language, cultural practices, and health literacy influence patient understanding of posttransplant care education. Complex medication regimes, changes in metabolism and nutrition absorption, and infection/rejection further complicate the prevention of readmission. PURPOSE: The purpose of this study was to compare the 30-day readmissions of single-organ liver transplant recipients for 1-year prior and 1-year following the implementation of nurse-led education. The study examined the demographics, clinical characteristics, and 30-day readmissions of 35 liver transplant recipients who participated in the newly designed nurse-led education and 51 liver transplant recipients who experienced the prior post-liver transplant education. DESIGN: A single-center, correlational study with a convenience sample was conducted at a Hispanic-serving South Texas hospital. The new education intervention maintained the standard education and added twice-daily mutual patient-focused goal setting between the nurse and the recipient that aligned with readiness for discharge activities/goals, structured education using abbreviated handouts written at a second-grade level available in both English and Spanish, and the use of repetition through multimodal methods. RESULTS: The odds for 30-day readmissions the year prior to the nurse-led patient education intervention were 2.088 times greater than the year following the implementation. Thirty-day readmissions were reduced by 16.3% from the 2017 cohort to the 2018 cohort. DISCUSSION: Understanding unique risk factors facilitates structured patient education which can be individualized to the patient and caregiver including collaborative nurse-patient goals.

Improving Vaccination Rates in Adults With Type 2 Diabetes in a Family Practice Setting Through the Use of Evidence-Based Interventions.

BACKGROUND: Adults with diabetes are at increased susceptibility to infectious disease because of hyperglycemia, poor glucose control, and decreased immunity. Diabetes is the seventh leading cause of death in Texas and the United States. OBJECTIVE: The purpose of this evidence-based quality improvement project was to implement processes to facilitate providers' adherence to immunization guidelines for adults with type 2 diabetes mellitus. METHOD: A protocol was created for a family practice clinic using the Four Pillars Transformation Program. Interventions included immunization standing orders, vaccine needs screening, patient education, electronic medical record alerts, an appointed immunization champion, and quality improvement meetings. RESULTS: Ten weeks post project implementation, the increased screening and education resulted in 64% of the eligible patients being vaccinated with pneumococcal polysaccharide vaccine 23, 86% pneumococcal conjugate vaccine, 89% tetanus, and 54% herpes zoster. CONCLUSIONS: The results indicate that formal printed education on diabetes and vaccines increased vaccine uptake in eligible patients by 76%. IMPLICATIONS FOR NURSING: The Four Pillars Transformation Program allows each practice the ability to modify and select interventions best suited to the practice needs, making it a feasible tool for any clinic.

Mock Institutional Review Board: Promoting Analytical and Reasoning Skills in Research Ethics.

Although it is critical that nurses possess ethical reasoning skills for research, there is limited information on effective strategies to develop these skills in graduate health care students. A research study analyzing educational interventions including the effect of online human subjects training followed by a mock institutional review board simulation demonstrated that knowledge acquisition is not enough to acquire the ethical reasoning skills needed to implement health care research. Situational context is also needed to envision the application of ethical principles.

Developing Policies and Protocols in the Age of Evidence-Based Practice.

Prior to evidence-based practice, policies and procedures were reviewed annually or even triennially to ensure that they reflected current practice and demonstrated adherence to regulatory standards. With the publication of the Institute of Medicine report, a shift to operationalization of best evidence practices, formal statements, and frameworks for care has gained increased importance. Processes for policy and protocol development and revision are now based on the inclusion of best evidence, clinician expertise, and patient values or preference. Policies and protocols are now updated when new evidence justifies a revision and are designed to share the most recent evidence and facilitate staff adherence to new practices. This article describes the essential practices for policy and protocol development, including leadership support, team commitment, identification of current resources, recognition of current practices, development of the policy and protocol to logically flow with nursing practices, effective dissemination methods, and evaluation and sustainability practices. J Contin Nurs Educ. 2017;48(2):87-92.

A Unique Approach to Dissemination of Evidence-Based Protocols: A Successful CAUTI Reduction Pilot.

A unique approach to disseminate an evidence-based protocol for urinary catheter management was led by a staff-driven catheter-associated urinary tract infection (CAUTI) reduction team in one hospital. The nurseeducators, faculty from a local university, and the facility's clinical nurse leader mentored the team. As an approachto reduce CAUTIs in the transplant care and intensive care units, the team developed an interdisciplinary CAUTIEducation Fair, which provided a safe, nonthreateningenvironment to unlearn prior behaviors and showcompetency in new evidence-based ones.