Evaluation of lay health workers on quality of care in the inpatient setting.

AIMS: To evaluate the impact of a lay health worker support role in the inpatient setting. BACKGROUND: Healthcare systems are facing critical nursing and nurse assistant staffing shortages. These disciplines can be challenging to recruit and retain, leading healthcare leaders to identify innovative staffing models. Whereas lay health workers have been used in the community and low-income setting, there is scant evidence of their use in the inpatient setting. We implemented a lay health worker role, called Patient Attendant Service Aides (PASAs), on two medical/surgical units at a community hospital. METHODS: A pre/post-implementation design was used for this study. An online survey was provided to nurses, nursing assistants, and PASAs on the two medical/surgical units to assess their satisfaction and perceptions of the role. Nursing quality metrics, patient satisfaction, and nursing and nursing assistant turnover were evaluated before and after implementing the role. RESULTS: The online survey showed that nurses and nursing assistants felt that PASAs helped offload their workload, allowing them to focus on nursing-related tasks. PASAs felt supported by the team and believed they were making a meaningful contribution to the unit. There were slight improvements in patient satisfaction, although not significant. There was a significant improvement in nursing turnover on Unit A, from 71.1% to 21.6% (p = 0.009). CONCLUSIONS: This is one of the first studies to evaluate the use of lay health workers in the inpatient setting; we found this role to be a feasible way to offload tasks from clinical staff. This role may serve as a pathway for workforce development, as several PASAs are now enrolled in nursing assistant training. Nurse managers may consider using lay health workers in the inpatient setting as they face severe clinical staff shortages.

A scoping review on the nurse scientist role within healthcare systems.

BACKGROUND: The role of the nurse scientist in the clinical setting is not well defined, which contributes to variability in role implementation, scope, administration, funding, and affiliation across healthcare sites. AIMS: The aim of this scoping review was to identify attributes of the clinical nurse scientist role and its operationalization in the clinical setting through available evidence. METHODS: A comprehensive, computerized search of the literature in PubMed, Medline, and CINAHL was conducted in early May 2020 by a medical research librarian and repeated in July 2021 and April 2022. The 5-step framework described by Arskey and O'Malley guided the review methodology. Two reviewers conducted an independent screen of all articles, followed by a full-text review of eligible articles by two independent reviewers each using a standardized data extraction template. Themes were then organized and synthesized using descriptive content analysis from the included articles. RESULTS: A final sample of 55 full-text articles were included in the review. Overall, the findings suggest that the nurse scientist role in a clinical setting can be challenging to implement in complex healthcare environments. Successful models include the nurse scientist in a leadership role, alignment of research with institutional priorities, and strong support from senior leadership. LINKING EVIDENCE TO ACTION: Findings suggest that standardized guidelines are lacking to govern the implementation of the nurse scientist role in the clinical setting. To succeed, the nurse scientist role must be valued and supported by organizational leaders. Further, access to resources to build infrastructure must be provided. The magnitude and scope of individual organizational support can be tailored based on the resources of the institution; however, the foundation of having institutional leadership support is critical to role success of the clinical nurse researcher.

Using an Electromagnetic Guidance System for Placement of Small-Bowel Feeding Tubes to Reduce Feeding Start Times.

BACKGROUND: Cardiothoracic surgery patients have an increased risk for aspiration and may require enteral access for nutrition. LOCAL PROBLEM: In a cardiothoracic intensive care unit, feeding start times were delayed because of scheduling conflicts with support services. An electromagnetic device (Cortrak 2 Enteral Access System, Avanos Medical) was introduced to allow advanced practice providers (nurse practitioners and physician assistants) to independently establish postpyloric access and reduce dependence on ancillary services. METHODS: A quality improvement study was performed. Pre- and postimplementation data included order time, service arrival, tube placement time, tube positioning, and feeding start times for 207 placements. Pre- and postimplementation surveys were conducted to evaluate advanced practice provider satisfaction with enteral tube placement practices. RESULTS: Feeding start time for initial placement decreased by 35.5% (15.6 hours to 10 hours); for subsequent placement, by 55.2% (15.5 hours to 7.0 hours). Assistance by support services decreased by 80.4% (before implementation, 100 of 100 placements [100%]; after implementation, 21 of 107 placements [19.6%]; P < .001; ϕ = 0.815). Overall, advanced practice provider satisfaction increased. Most participants said that using the electromagnetic device was faster, nutrition was delivered sooner, and implementation was a valuable practice change. CONCLUSIONS: Using an electromagnetic device decreased feeding start times, reduced the need for support services, and increased advanced practice provider satisfaction with small-bowel feeding tube placement practices.

Program Evaluation of an Early Nurse Intervention Team.

BACKGROUND: Many hospitals have implemented early rapid response teams to improve detection of patients at risk for decline. However, formal evaluation of these programs is rare. OBJECTIVE: To evaluate the Early Nurse Intervention Team program at a large community hospital in the southeastern United States. METHODS: A retrospective evaluation was performed of unplanned intensive care unit transfers, hospital length of stay, length of stay index, ventilator days, and mortality in 2 patient groups: those with and those without an Early Nurse Intervention Team nurse present. RESULTS: There was a marked decline in unplanned intensive care unit transfers as the Early Nurse Intervention Team nurse staffing increased. There were no significant interaction or main effects for length of stay, length of stay index, ventilator days, or mortality between the 2 groups. CONCLUSIONS: This study showed a positive impact of implementation of an Early Nurse Intervention Team program, with significant savings given the cost of unplanned intensive care unit transfers.

The impact of nurse staffing on falls performance within a health care system: A descriptive study.

AIM: The purpose of this study was to examine the impact of nurse staffing on inpatient falls performance across a multi-hospital system. BACKGROUND: Evidence to support which staffing variables influence fall performance so that health care organizations can better allocate resources is lacking. METHOD: A descriptive study design was used to analyse the impact of nurse staffing and falls performance, with units dichotomized as either high or low performing based on national benchmarking data. The impact was evaluated using 10 nurse staffing variables. RESULTS: A total of nine units were included (five high and four low performing). Higher performing units showed less use of sitters and travellers, had fewer overtime hours worked by nurses, and employed more expert-level clinical nurses and combined nursing assistant/health unit coordinator positions, than lower performing units. CONCLUSION: Findings provide evidence of how staffing variables affect a unit's falls performance. While significant relationships were found, further evaluation is needed to explore the relationship of staffing variables and quality outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers may consider trying to reduce use of sitters and travellers, and utilize innovative staffing models, such as using combined nursing assistant/health unit coordinator positions, to help improve their falls performance.

The effect of a nurse manager's authentic leadership intervention on nurses' well-being: A single unit QI project.

INTRODUCTION: Nurse well-being is at the forefront of nursing leadership's focus, particularly with the impact of the ongoing COVID-19 pandemic. Nurse managers, as authentic leaders, should understand their role in supporting the spectrum of nurse well-being. At the negative end of well-being, leaders must address staff burnout as it increases nurse turnover, shortage of nurses, and poor patient outcomes. PURPOSE: The specific aim for this quality improvement (QI) project was to implement a program that could guide a nurse manager of a single inpatient unit on how to improve well-being in their nursing staff as measured by: (a) improved well-being scores to a composite score of 3.5 or greater as indicated by follow-up Culture Pulse surveys distributed in 2021; and (b) reduced absenteeism among nursing staff by 18%. RESULTS: Five surveys identical to the organization's work culture survey, that measures well-being, were sent to staff each month starting in January 2021 and ending in May 2021. The average composite score from all five surveys was 2.8, indicating an overall improvement. Absenteeism was reduced during implementation by 39%. DISCUSSION: This QI project guides nurse managers in the evidence-based interventions that can promote well-being in their staff.

Student nurse perceptions of an innovative role to support clinical practices during a pandemic: A qualitative study.

INTRODUCTION: During the COVID-19 pandemic, healthcare systems needed to quickly identify personnel to provide symptom screening and PPE observations. Through an established academic-practice partnership, pre-licensure nursing students were able to fill this new Patient Services Aid role. The purpose of this paper is to evaluate the students' experiences in this mutually beneficial innovative role. METHODS: Electronic surveys and qualitative focus groups were used to evaluate the students' experiences. RESULTS: A total of 34 students were employed at the health system as PSAs. Focus groups (n = 16) analysis showed that, while the role was not a substitute for academic clinical experiences, they did improve the students' confidence in the clinical setting and helped teach necessary non-technical skills. Students appreciated the ability to network with multiple disciplines while working as PSAs. CONCLUSIONS: This role was developed to assist with immediate COVID-19 needs; however, this model of using pre-licensure students in non-clinical roles can improve students' non-technical skills and confidence in the clinical setting. The success of the activity was due to the strong relationships between the School of Nursing and health system. Other schools of nursing could benefit from developing collaborative partnerships with local healthcare systems.

Chlorhexidine Gluconate Bathing Reduces the Incidence of Bloodstream Infections in Adults Undergoing Inpatient Hematopoietic Cell Transplantation.

Bloodstream infections (BSIs) occur in 20% to 45% of inpatient autologous and allogeneic hematopoietic cell transplant (HCT) patients. Daily bathing with the antiseptic chlorhexidine gluconate (CHG) has been shown to reduce the incidence of BSIs in critically ill patients, although very few studies include HCT patients or have evaluated the impact of compliance on effectiveness. We conducted a prospective cohort study with historical controls to assess the impact of CHG bathing on the rate of BSIs and gut microbiota composition among adults undergoing inpatient HCT at the Duke University Medical Center. We present 1 year of data without CHG bathing (2016) and 2 years of data when CHG was used on the HCT unit (2017 and 2018). Because not all patients adhered to CHG, patients were grouped into four categories by rate of daily CHG usage: high (>75%), medium (50% to 75%), low (1% to 49%), and none (0%). Among 192 patients, univariate trend analysis demonstrated that increased CHG usage was associated with decreased incidence of clinically significant BSI, defined as any BSI requiring treatment by the medical team (high, 8% BSI; medium, 15.2%; low, 15.6%; no CHG, 30.3%; P = .003), laboratory-confirmed BSI (LCBI; P = .03), central line-associated BSI (P = .04), and mucosal barrier injury LCBI (MBI-LCBI; P = .002). Multivariate analysis confirmed a significant effect of CHG bathing on clinically significant BSI (P = .023) and MBI-LCBI (P = .007), without consistently impacting gut microbial diversity. Benefits of CHG bathing were most pronounced with >75% daily usage, and there were no adverse effects attributable to CHG. Adherence to daily CHG bathing significantly decreases the rate of bloodstream infection following HCT.

Cancer-related cognitive impairment in patients with non-central nervous system malignancies: an overview for oncology providers from the MASCC Neurological Complications Study Group.

Cancer-related cognitive impairment (CRCI) is commonly experienced by individuals with non-central nervous system cancers throughout the disease and treatment trajectory. CRCI can have a substantial impact on the functional ability and quality of life of patients and their families. To mitigate the impact, oncology providers must know how to identify, assess, and educate patients and caregivers. The objective of this review is to provide oncology clinicians with an overview of CRCI in the context of adults with non-central nervous system cancers, with a particular focus on current approaches in its identification, assessment, and management.

The Nightingale Legacy.

The World Health Organization (WHO, 2020) has designated 2020 as the International Year of the Nurse and the Midwife to mark the 200th anniversary of Florence Nightingale's birth. This celebration honors her work and impact on the nursing profession-one of engagement and advocacy for public health. Nightingale's Notes on Nursing (1860) illustrated her observations of social determinants for health wellness and illness. She championed efforts for community access to clean water and public sanitization and emphasized the importance of nutrition and hygiene on healing and wellness. Her calls for action still resonate with enduring worldwide healthcare shortcomings, which contribute significantly to morbidity and mortality.

Surface Contamination With Antineoplastic Drugs on Two Inpatient Oncology Units.

OBJECTIVES: To measure surface contamination with antineoplastic drugs on inpatient oncology units and to characterize nursing staff personal protective equipment (PPE) use and factors that predict this use. SAMPLE & SETTING: A descriptive pilot study of two inpatient oncology units at Duke University Hospital in Durham, North Carolina, administering etoposide and cyclophosphamide. METHODS & VARIABLES: Surfaces in four patient rooms and select shared areas were swabbed with methanol, acetonitrile, and water. Samples were analyzed by liquid chromatography tandem mass spectrometry. Nursing staff (N = 27) answered questions about their demographics, PPE use, and factors that influence PPE use via online survey. RESULTS: Contamination with cyclophosphamide and etoposide was detectable and quantifiable in 61% and 31% of surfaces tested, respectively. Nursing staff reported suboptimal use of PPE when administering, disposing, and handling excreta of patients. Workplace safety climate was predictive of PPE use. IMPLICATIONS FOR NURSING: The potential for contamination with antineoplastic drugs in inpatient oncology units presents exposure risks for healthcare workers, patients, family members, and visitors. Future research and interventions to limit exposure and increase routine surface sampling should focus on those areas of greatest contamination, including toilet seats, a prominent finding from the current study.

Assessing for and managing chronic insomnia in primary care settings.

Chronic insomnia is the most common sleep disorder. Improper or delayed diagnosis can lead to serious health problems. Early accurate assessment is essential to guide and provide safe treatment. This article reviews assessment and management of insomnia in the primary care setting.

Depression in Arab Adolescents: A Qualitative Study.

Depression rates among Arab adolescents are expected to rapidly increase necessitating research-based data to aid in planning effective strategies to implement primary prevention and treatment interventions. The current study aimed to capture Jordanian adolescents' experience of depression, identify perceived contributing factors, and assess their attitudes toward depression interventions. An exploratory, qualitative design was used to collect data from 92 participants (age range = 14 to 17) through 12 focus groups. Two main analytical themes and related subthemes were identified. The first theme focused on participants' perceived mental health status, Being a Depressed Adolescent, with two related subthemes: Symptom Profiles and Feelings of Uncertainty and Perceived Roots of Depression. The second theme focused on the experience of Living With Depression and encapsulated two subthemes: Seeking Supportive Resources and Escaping From Labeling. The study revealed gender differences in the recognition of depression symptoms, willingness to seek care, the ability to communicate symptoms, expectations of care, and views on the best sources of help. For girls and boys, the fear of being labeled as mentally ill contributes to poor engagement in, adherence to, and use of mental health services. A comprehensive approach that considers Arab adolescents' beliefs, attitudes, and experiences in conjunction with the family and social context is needed to address the burden of adolescent depression in Arab nations. [Journal of Psychosocial Nursing and Mental Health Services, 57(10), 34-43.].

Patients with diabetes observing Ramadan: The experience of Muslims in the United States.

BACKGROUND AND PURPOSE: Little is known about the experience of Muslims with diabetes while fasting during Ramadan in the United States. Providing quality care for Muslim patients requires being aware of Islamic beliefs and practices, particularly in regard to healthcare ramifications. Therefore, the aims of this study were to (a) explore the beliefs which influence the experience and practices of diabetes management among Muslims in the United States during Ramadan, and (b) explore perspectives of Muslims with diabetes on their experience with healthcare providers providing support during their fasting experience. METHODS: Using an exploratory design, semi-structured interviews were conducted for qualitative analyses. A purposive sample of 14 Muslim patients with diabetes was recruited from mosques located across North Carolina. RESULTS: Analyses revealed six subthemes on their "feelings" that were inherent to their experiences of managing diabetes while fasting during Ramadan. These were organized into two main themes: (1) having diabetes and fasting during Ramadan and (2) fasting challenges. Having diabetes and fasting during Ramadan focused on the experience of fasting and comprised four "feelings": (1) feeling spiritually connected, (2) feeling socially connected, (3) feeling physically healthy, and (4) feeling religiously obligated. The second theme focused on fasting challenges and included (1) feeling sick and dehydrated, and (2) feeling vulnerable and poorly understood by healthcare providers. CONCLUSION: This is the first known study to explore the experience of Muslims with diabetes while fasting during Ramadan in the United States. Our findings offer important insights into how Muslims manage their diabetes while fasting and the missed opportunities for relevant conversations when partnering with healthcare providers during Ramadan. The importance of cultural competency across healthcare systems in the United States cannot be overemphasized. Healthcare providers need to hold conversations embracing shared decision-making to resolve healthcare dilemmas resulting from cultural differences, expand cultural knowledge, and adapt services to meet culturally-unique needs of their patients.

Impact of Cognitive Impairment in Patients with Gliomas.

OBJECTIVES: To address the estimated rates of incidence, potential underlying etiologies, and cognitive domains affected from diagnosis and treatment. To describe potential cognitive function interventions. DATA SOURCES: PubMed. CONCLUSION: Adults with gliomas report that the most distressing, persistent, and greatest negative impact on their lives relates to the cognitive impairment they experience. However, there are several potential interventions that may prevent cognitive decline during treatment or maintain cognitive function long term. IMPLICATIONS FOR NURSING PRACTICE: Awareness of cognitive sequela that adults with gliomas face can lead to early identification, full neurocognitive profiling, and implementation of evidence-based interventions for those experiencing cognitive impairments following cancer treatment.

Head and Neck Cancer Survivors: Specific Needs and Their Implications for Survivorship Care Planning.

BACKGROUND: Head and neck cancer (HNC) survivors experience significant sequelae of treatment, including long-term physical side effects and ongoing cancer surveillance. OBJECTIVES: The aim of this study is to understand patients' survivorship knowledge gaps and supportive care needs. METHODS: Through an anonymous cross-sectional survey, the authors evaluated 41 HNC survivors' knowledge regarding post-treatment issues. FINDINGS: Patients had undergone a variety of treatment modalities.

Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care.

Long-term care for head and neck cancer (HNC) survivors is complex and requires coordination among multiple providers. Clinical practice guidelines highlight the role of primary care providers (PCPs) in screening for secondary cancer/recurrence, assessment of late/long-term side effects, and referrals for appropriate specialty management of toxicity. However, these responsibilities may be difficult to meet within the scope of primary care practice. We conducted this study to explore preferences, comfort, and knowledge of PCPs in the care of HNC survivors. We piloted a 40-item web-based survey developed with oncologist and PCP input targeted for family medicine and internal medicine providers. Responses were collected within a single university health system over 2 months. PCPs (n = 28; RR = 11.3%) were interested in learning about health promotion after cancer treatment (89%) and generally agree that their current practice patterns address healthy lifestyle behaviors (82%). However, only 32% of PCPs felt confident they could manage late/long-term side effects of chemotherapy, radiation, or surgery. Only 29% felt confident they could provide appropriate cancer screening. Looking at shared care responsibilities with oncology providers, PCPs perceived being responsible for 30% of care in the first year after treatment and 81% of care after 5 years. Seventy-one percent of PCPs agreed that oncologists provided them necessary information, yet 32% of PCPs found it difficult to coordinate with cancer providers. While these PCPs perceive increased care responsibility for long-term survivors, most are uncomfortable screening for recurrence and managing late/long-term side effects. Education and mutual coordination between PCPs and oncology providers may improve survivor care.