The nurse COVID and historical epidemics literature repository: Development, description, and summary.

BACKGROUND: During COVID-19, a Kaggle challenge was issued to data scientists to leverage text mining to provide high-level summaries of full-text articles in the COVID-19 Open Research Dataset (CORD-19) data set, a data set containing articles around COVID-19 and other epidemics. A question was asked: "What if nursing had something similar?" PURPOSE: Describe the development and function of the Nursing COVID and Historical Epidemic Literature and describe high-level summaries of abstracts within the repository. METHOD: Nurse-specific literature was abstracted from two data sets: CORD-19 and LitCOVID. LitCOVID is a data set containing the most up-to-date literature around COVID-19. Multiple text mining algorithms were utilized to provide summaries of the articles. DISCUSSION: As of July 2020, the repository contains 760 articles. Summaries indicate the importance of psychological support for nurses and of high-impact rapid education. CONCLUSION: To our knowledge, this repository is the only repository specific for nursing that utilizes text mining to provide summaries.

Moving from practice to praxis: A qualitative descriptive study revealing the value of Project7 Mindfulness Pledge©.

AIM: To examine the experiences of nurses and nursing assistants who participated in a mindfulness project. BACKGROUND: Increased demands and fewer resources have become the norm in most health care settings. As a result, health care professionals face exceptional stress in their work environments and are vulnerable to burnout and compassion fatigue. Even more distressing, many new nurses are leaving their jobs within the first two years. METHODS: Qualitative interviews were conducted with nine participants to discover their experience with the project. RESULTS: The major theme, a process of moving from practice to praxis, is brought forth through in-depth descriptive analysis of nine individual interviews. The process occurred through three themes: fostering self-awareness and compassion; fostering other-awareness and compassion; and compelling transformation in the unit culture. CONCLUSIONS: This study develops an evidence base for incorporating and building mindfulness into health care environments at a time when there is a tremendous need for highly functioning practitioners. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders are encouraged to examine how they can support their staff in moving from practice to praxis as a part of improving professional well-being, retention, quality and safety in health care.

Clinicians' Perspectives on Providing Emergency-Only Hemodialysis to Undocumented Immigrants: A Qualitative Study.

Background: In the United States, nearly half of undocumented immigrants with end-stage kidney disease receive hemodialysis only when they are evaluated in an emergency department and are found to have life-threatening renal failure ("emergency-only hemodialysis" [EOHD]). These patients experience psychosocial distress and much higher mortality than patients receiving regularly scheduled hemodialysis, but little is known about how providing EOHD affects the clinicians involved. Objective: To understand clinicians' experiences providing EOHD. Design: Qualitative study using semistructured interviews. Setting: A safety-net hospital in Denver, Colorado, and a safety-net system in Houston, Texas. Participants: Fifty interdisciplinary clinicians experienced in providing EOHD. Measurements: Interviews were analyzed using thematic analysis. Outcomes included themes and subthemes. Results: Four themes and 13 subthemes (in parentheses) were identified: 1) drivers of professional burnout (emotional exhaustion from witnessing needless suffering and high mortality, jeopardizing patient trust, detaching from patients, perceived lack of control over EOHD criteria, and physical exhaustion from overextending to bridge care), 2) moral distress from propagating injustice (altered care based on nonmedical factors, focus on volume at the expense of quality, and need to game the system), 3) confusing and perverse financial incentives (wasting resources, confusing financial incentives, and concerns about sustainability), and 4) inspiration toward advocacy (deriving inspiration from patients and strengthened altruism). Limitation: Whether the findings apply to other settings is unknown, and social desirability response bias might have reduced reporting of negative perceptions and experiences. Conclusion: Clinicians in safety-net settings who provide EOHD to undocumented patients describe experiencing moral distress and being driven toward professional burnout. The burden of EOHD on clinicians should inform discussions of systemic approaches to support provision of adequate care based on medical need. Primary Funding Source: Robert Wood Johnson Foundation and Doris Duke Charitable Foundation.

Using Time-Referenced Data to Assess Medication Administration Performance and Quality.

OBJECTIVE: This study tests the feasibility of using a large (big) clinical data set to test the ability to extract time-referenced data related to medication administration to identify late doses and as-needed (PRN) administration patterns by RNs in an inpatient setting. METHODS: The study is a secondary analysis of a set of data using bar-code medication administration time stamps (n = 3043812) for 50883 patients admitted to a single, urban, 525-bed hospital in 11 inpatient units by 714 nurses between April 1, 2013, and March 31, 2015. RESULTS: The large majority of scheduled medications (43.3%) were administered between 9 to 10 AM and 9 to 10 PM accounting for the most amount of delayed doses. On average, patients received 8.9 medications per day, and nurses administered 19.7 medications per shift. The average full-time nurse administered 3414 medications per year. CONCLUSIONS: The findings support use of time-referenced data to identify clinical processes and performance in administering scheduled and PRN medications.

Description of Nurse Scientists in a Large Health Care System.

Replicating a research study that described the work of nurse scientists in children's hospitals, the purpose of the study was to describe the role, activities, and outcomes of nurse scientists employed in a national health care organization. The characteristics of nurses filling the nurse scientist role in clinical settings and outcomes associated with the role have not been extensively described. The setting of this study is ideal since the organization includes facilities of various sizes located in rural, urban, and suburban areas in 18 states. Names and contact information of nurse scientists were obtained from nurse executives at each of the 110 affiliated organizations. Nurse scientists completed an anonymous survey. The primary role of the nurse scientists is to facilitate the work of others. Recommendations to strengthen the research infrastructure are provided.

Intradermal lidocaine or bacteriostatic normal saline to decrease pain before intravenous catheter insertion: a meta-analysis.

PURPOSE: Anesthetics used to decrease pain during peripheral intravenous catheter insertion have been studied with equivocal results. This meta-analysis determined if lidocaine or bacteriostatic normal saline (BaNS) is more effective in reducing pain associated with peripheral intravenous catheter cannulation in adults. METHODS: PubMed, EMBASE, CINAHL, ProQuest Dissertation and Theses, and Web of Science databases were queried. Thirteen randomized controlled trials were analyzed. RESULTS: Mean sample was 119.9 (±82.0); combined N was 1,559. Mean effect size was z = 0.46 (confidence interval = 0.24-0.68) indicating lidocaine was more effective than BaNS in providing pain relief (P < .001). CONCLUSION: Cost-benefit issues and lidocaine drug shortages must be considered when making definitive practice recommendations.

Lessons learned from the implementation of a bedside handoff model.

At the University of Colorado Hospital, nurse-to-nurse shift reports traditionally occurred in a conference room setting and consisted of nurse-to-nurse verbal communication. Evidence supports moving this information exchange to the patient bedside. This model of report improves clinical effectiveness, patient safety, nurse efficiency, and staff satisfaction. Bedside reporting empowers patients and families to ask questions and contribute to their plan of care and increases patient satisfaction. This article describes the process of implementing and evaluating a model of nurse-to-nurse bedside handoff report.

The Effect of RN Circulator-Scrub Person Dyad Consistency on Total OR Time and Turnover Time.

Operating room efficiency is an important consideration for perioperative nurse leaders because it can affect their facilities' revenue and provider and patient satisfaction. Using consistent perioperative teams, including the same RN circulator and scrub person, for consecutive procedures may improve OR efficiency. This retrospective cross-sectional cohort study assessed the effects of a consistent team in the form of RN circulator-scrub person dyads on the total OR and turnover times for 310 surgical procedures using electronic OR records data from the National Surgical Quality Improvement Program that was collected in 2008. Controlling for relevant variables (eg, procedure type consistency, number of staff members present, procedure complexity), the association between RN circulator-scrub person dyads and total OR time and turnover time was not significant.

Prepping for Prevention: An Intervention to Optimize Skin Antisepsis and Peri-Operative Antibiotic Prophylaxis.

Background: The U.S. Centers for Disease Control and Prevention recommend bathing prior to surgery, surgical skin antisepsis, peri-operative antibiotic administration, normothermia throughout the procedure, serum glucose concentration <200 mg/dL throughout the procedure, and hyperoxygenation in the immediate post-operative period to prevent surgical site infection (SSI). We developed interventions to standardize skin antisepsis and peri-operative antibiotic administration at our institution. Methods: This is a cross-sectional evaluation of surgical skin antisepsis and antibiotic administration before and after a series of interventions designed to standardize the processes. Results: One hundred twenty-four surgical skin antisepsis opportunities were observed; significant improvement was seen in hand hygiene prior to performing skin antisepsis (compliance changing from 1% to 48%; p < 0.001), sleeves being worn during skin antisepsis (1% versus 67%; p < 0.001), use of the correct cleansing time (47% versus 85%; p < 0.001), allowance for adequate drying time (67% versus 87%; p = 0.02), and use of a cleansing motion from the incision to the periphery (78% versus 95%; p = 0.004). Pre-operative antibiotic order placement, correct antibiotic selection, and optimal antibiotic dose were evaluated in 466 surgical procedures. Significant improvement was seen in both peri-operative order placement (59% versus 70%; p = 0.02) and correct antibiotic selection (52% versus 95%; p < 0.001). Conclusion: An intervention to standardize skin antisepsis and to encourage early ordering of peri-operative antibiotics was successful.

The experience of nursing students in an online doctoral program in nursing: a phenomenological study.

The increased sophistication of technology has led to greater use of distance learning, providing graduate nursing students with increased access to such programs, while more easily maintaining employment. Little information is available regarding the experience for those students enrolled on these programs. This information would be of value to both those who are considering online courses, and to those who are charged with developing and teaching these courses. A phenomenological approach was used in order to examine the experience of five students enrolled in an online doctoral program in nursing in the United States. Verbatim transcripts were analyzed for themes from which three main ones emerged as the essence of the experience: considering the fit, liking the fit, and making it fit. Recommendations are provided for future research pertaining to distance education, particularly in the form of graduate outcomes.

Determining high touch areas in the operating room with levels of contamination.

BACKGROUND: The Centers for Disease Control and Prevention put forth the recommendation to clean areas considered high touch more frequently than minimal touch surfaces. The operating room was not included in these recommendations. The purpose of this study was to determine the most frequently touched surfaces in the operating room and their level of contamination. METHODS: Phase 1 was a descriptive study to identify high touch areas in the operating room. In phase 2, high touch areas determined in phase 1 were cultured to determine if high touch areas observed were also highly contaminated and if they were more contaminated than a low touch surface. RESULTS: The 5 primary high touch surfaces in order were the anesthesia computer mouse, OR bed, nurse computer mouse, OR door, and anesthesia medical cart. Using the OR light as a control, this study demonstrated that a low touch area was less contaminated than the high touch areas with the exception of the OR bed. CONCLUSIONS: Based on information and data collected in this study, it is recommended that an enhanced cleaning protocol be established based on the most frequently touched surfaces in the operating room.

Crew Resource Management for Obstetric and Neonatal Teams to Improve Communication During Cesarean Births.

OBJECTIVE: To assess the effectiveness of crew resource management training and interventions on the quality and quantity of communication during cesarean births in a tertiary academic hospital's labor and birthing services. DESIGN: A prospective pre-post crew resource management training intervention. SETTING: Tertiary academic hospital in the Western United States. PARTICIPANTS: All members of obstetric and neonatal teams that participated in cesarean births. METHODS: Over a 5-month time period, all obstetric and neonatal staff were required to participate in team training in crew resource management critical language, communication, and team structure. Trained observers collected baseline data (n = 52) for 3 months on the quantity and quality of communications that occurred during cesarean births. Postintervention data (n = 50) were gathered for 3 months after team training. Analysis approach included use of Fisher's exact test, independent-samples t test, and multilevel generalized linear regression models with Poisson distribution. RESULTS: There was a statistically significant increase in quantity and quality of communication from pre- to postintervention assessment for obstetric and neonatal staff. Although the increase in quality was similarly great between both types of teams, increase in quantity was more substantial in obstetric staff. CONCLUSION: Principles of team communication training shown to be effective in increasing communication among team members in a variety of clinical areas were also effective in improving communication in the labor and birth setting during cesarean births.

Coaching to improve the quality of communication during briefings and debriefings.

Communication breakdowns have been identified as a root cause of many medical errors. Sentinel events occurring in surgery comprise a significant number of these events. Despite the addition of briefings and debriefings in the OR and the introduction of crew resource management principles, communication problems continue to occur in the surgical setting. The purpose of this research was to evaluate coaching as an intervention to improve the quality of OR briefings and debriefings. A retired orthopedic surgeon conducted coaching that included all members of the perioperative team. The quality of both briefings and debriefings significantly improved after the coaching intervention. Analysis of the results of this study suggests that coaching should be considered as an intervention to improve communication during surgical procedures, especially during briefings and debriefings.

AORN and University of Michigan School of nursing research alliance.

Research related to perioperative care requires advanced training and is well suited to take place at a research-intensive university. A recent research alliance established between AORN and the University of Michigan School of Nursing, Ann Arbor, uses the strengths of both a robust perioperative professional organization and a research-intensive university to make progress toward improving patient safety and transforming the perioperative work environment. Research activities undertaken by this alliance include investigating nurse staffing characteristics and patient outcomes, as well as evaluating the congruence and definitions of data elements contained in AORN's SYNTEGRITY™ Standardized Perioperative Framework. Disseminating the findings of the alliance is expected to facilitate the communication and application of new knowledge to nursing practice and help advance the perioperative nursing profession.