A Comparison of the 1918 and 2019 Pandemics in the United States.

ABSTRACT: There are eerie similarities between the 1918 Spanish influenza and 2019 COVID-19 pandemics that are somewhat surprising and disheartening, given that the time interval between the 2 pandemics is more than 100 years. This article covers the national response, etiology and pathophysiology, disease course and treatments, nursing shortages, healthcare responses, sequelae following infections, and economic and social impacts of both pandemics. Understanding the development and course of both pandemics will inform clinical nurse specialists about the changes that need to be made to be better prepared to recognize the changes that need to be made to prepare for the next pandemic.

Is now our time? History to provider status for allied health professions and the path for pharmacists.

The designation of health care providers is limited to physicians, physician assistants, nurse practitioners, certified nurse midwives, nurse anesthetists, clinical psychologists, dietitians, and social workers. Pharmacists are not federally recognized health care providers and, therefore, are not eligible for cognitive service reimbursements. This commentary explains the intentions of adding pharmacists as Medicare Part B providers, evaluates current state pharmacist provider status, and calls pharmacists, technicians, and other key stakeholders to advocate on behalf of the profession of pharmacy. If federal provider status is granted to pharmacists, patients will gain better access to care, health spending will decline, and physician lead care teams will have an expert in medications readily available for consultation or other medication-related needs. Reimbursement would provide more resources to administer these needed services to more patients in areas with limited access to health care resources.

An Exploration of New Graduate Nurses' Transition to Specialty Practice.

New graduates' adjustment to high-acuity specialty areas was evaluated using qualitative methods in a hospital system that uses the Versant New Graduate Residency Program. Subjects were interviewed at baseline in person, answered interview questions at 6 months via computer, and were interviewed at 12 months in person. Twelve themes emerged from the interviews, reflecting intrinsic and extrinsic factors affecting new graduate nurse adjustment. Study results were used to evaluate the program and improve the program implementation.

Examining bacteria on skin and jewelry since the implementation of hand sanitizer in hospitals.

Nurses currently disinfect their hands with antibacterial soap and hand sanitizer. This comparative, descriptive study evaluated skin bacteria at baseline and 30 days after jewelry removal in intensive care unit nurses. Identified bacteria species were: (1) Bacillus, (2) Micrococcus, (3) coagulase negative Staphylococcus, (4) Diphtheroid, ( 5) Streptococcus, and (6) nonenteric gram-negative rods. The majority of the bacteria was found on skin at baseline. Bacterial counts significantly decreased at 30 days.

Are genetics/genomics competencies essential for all clinical nurses?

In 2006, the American Nurses Association created a set of essential genetics and genomics (G/G) competencies for all RNs, regardless of academic preparation, practice setting, or specialty. However, more than half of the RNs practicing today received no prelicensure education on these G/G competencies. This study describes the current use of G/G nursing competencies in acute care hospitals and how nurses perceive them.

Improving the Patient Experience and Decreasing Patient Anxiety With Nursing Bedside Report.

PURPOSE: The study's purpose was to explore the patient experience in an intervention group participating in nursing bedside report and the control group not participating. DESIGN: This descriptive, observational study had 3 objectives: (1) to measure baseline anxiety on admission to the hospital using the Beck Anxiety Inventory, (2) to describe patient self-reported anxiety and patient experiences during hospitalization, and (3) to evaluate the opinions by the intervention group about participating in nursing bedside report. METHODS: This mixed-methods study included quantitative and qualitative data. Three data collection tools were used: a demographic data tool, the Beck Anxiety Inventory, and daily journal entries. Quantitative data were analyzed using SPSS, and qualitative data using content analysis. RESULTS: There were no differences in baseline anxiety scores between patient groups. Anxiety levels decreased during hospitalization. About 73% of patients completed their journals. Themes that emerged were patients' perceptions of care, patient engagement, communication, and teamwork. CONCLUSIONS: Journal responses showed communication played a significant role in patients' perceptions of their patient experience. Because patients exhibited different baseline anxiety levels, assessing anxiety level on admission may help nurses develop plans of care that improve the patient experience. Further study is needed about the patient experience.

A Nurse-Directed Model for Nitrous Oxide Use During Labor.

BACKGROUND: Nitrous oxide has a long history of use and has been well documented in the literature as a safe, effective, and inexpensive option for pain management in labor in other countries, but it is underused in the United States. LOCAL PROBLEM: Pain relief options for laboring women in rural community hospitals with a small perinatal service are limited due to lack of availability of in-house anesthesia coverage. METHOD: This quality improvement project involved development and implementation of a nurse-driven, self-administered, demand-flow nitrous oxide program as an option for pain relief for laboring women in a rural community hospital. INTERVENTION: Women's Services registered nurses developed the project using an interdisciplinary team approach based on an extensive literature review and consultation with experts across the country. The hospital is part of a large healthcare system; approval was sought and obtained by the system as part of the project. Cost analysis and patient satisfaction data were evaluated. Outcomes were monitored. RESULTS: Approximately one half of the patients who have given birth at the hospital since initiation of the project have used nitrous oxide during labor. The majority of women who participated in a survey after birth found it helpful during mild-to-moderate labor pain. No adverse effects have noted in either the mother or the baby following nitrous oxide use. CLINICAL IMPLICATIONS: Initiation and management of nitrous oxide by registered nurses is a safe and cost-effective option for labor pain. It may be especially beneficial in hospitals that do not have 24/7 in-house anesthesia coverage.

Integrating Retired Registered Nurses Into a New Graduate Orientation Program.

PURPOSE: The project goal of was to decrease new graduate nurse (NGN) attrition during the first year of employment by improving communication skills and providing additional mentoring for NGNs employed in a community hospital located in a rural area. DESCRIPTION OF PROJECT: All NGNs participate in the Versant Residency Program. Even with this standardized residency program, exit interviews of NGNs who resigned during their first year of employment revealed 2 major issues: communication problems with patients and staff and perceived lack of support/mentoring from unit staff. A clinical nurse specialist-led nursing team developed an innovative program integrating retired nurses, Volunteer Nurse Ambassadors (VNAs), into the Versant Residency Program to address both of those issues. OUTCOME: All NGNs mentored by a retired nurse remain employed in the hospital (100% retention). Before the VNA program, the retention rate was 37.5%. Both the NGNs and VNAs saw value in their mentor-mentee relationship. There have been no critical incidences or failure to rescue events involving NGNs mentored by a VNA. CONCLUSION: Use of VNAs to support NGNs as they adjust to the staff nurse role can prevent attrition during their first year of nursing practice by providing additional support to the NGN.

Empowering nurses with evidence-based practice environments: surveying Magnet®, Pathway to Excellence®, and non-magnet facilities in one healthcare system.

BACKGROUND: Nurses have an essential role in implementing evidence-based practices (EBP) that contribute to high-quality outcomes. It remains unknown how healthcare facilities can increase nurse engagement in EBP. PURPOSE: To determine whether individual or organizational qualities could be identified that were related to registered nurses' (RNs') readiness for EBP as measured by their reported EBP barriers, ability, desire, and frequency of behaviors. METHODS: A descriptive cross-sectional survey was used in which a convenience sample of 2,441 nurses within one United States healthcare system completed a modified version of the Information Literacy for Evidence-Based Nursing questionnaire. Descriptive statistics, t tests, one-way ANOVA, and regression modeling were used to analyze the data. RESULTS: RNs employed by facilities designated by the American Nurses Credentialing Center (ANCC) as Magnet® or Pathway to Excellence® reported significantly fewer barriers to EBP than those RNs employed by non designated facilities. RNs in Magnet organizations had higher desire for EBP than Pathway to Excellence or non designated facilities. RNs educated at the baccalaureate level or higher reported significantly fewer barriers to EBP than nurses with less education; they also had higher EBP ability, desire, and frequency of behaviors. A predictive model found higher EBP readiness scores among RNs who participated in research, had specialty certifications, and engaged in a clinical career development program. LINKING EVIDENCE TO ACTION: Education, research, and certification standards promoted by the Magnet program may provide a nursing workforce that is better prepared for EBP. Organizations should continue structural supports that increase professional development and research opportunities so nurses are empowered to practice at their full capacity.

Discovering Sexual Health Conversations between Adolescents and Youth Development Professionals.

Youth development professionals (YDPs), working at community-based organizations are in a unique position to interact with the adolescents as they are neither parents/guardians nor teachers. The objectives of this study were to explore qualitatively what sexual health issues adolescents discuss with YDPs and to describe those issues using the framework of the Sexuality Information and Education Council of the United States (SIECUS) comprehensive sexuality education guidelines. YDPs reported conversations with adolescents that included topics related to the SIECUS key concepts of human development, relationships, personal skills, sexual behavior, and sexual health.

Redefining "charge nurse" within the front line.

Don't overlook the importance of charge nurses. Learn how one organization redefined the role and strengthened these leaders, increasing patient and staff satisfaction.

The impact of health education transmitted via social media or text messaging on adolescent and young adult risky sexual behavior: a systematic review of the literature.

Despite the increased use of social media and text messaging among adolescents, it is unclear how effective education transmitted via these mechanisms is for reducing sexual risk behavior. Accordingly, we conducted a systematic review of the literature to examine the effectiveness of social media and text messaging interventions designed to increase sexually transmitted disease (STD) knowledge, increase screening/testing, decrease risky sexual behaviors, and reduce the incidence of STDs among young adults aged 15 through 24 years. Eleven studies met our inclusion criteria. Most of the included studies used a control group to explore intervention effects and included both young men and women. Sample sizes ranged from 32 to 7606 participants, and follow-up periods ranged between 4 weeks and 12 months. These studies provide preliminary evidence indicating that social media and text messaging can increase knowledge regarding the prevention of STDs. These interventions may also affect behavior, such as screening/testing for STDs, sexual risk behaviors, and STD acquisition, but the evidence for effect is weak. Many of these studies had several limitations that future research should address, including a reliance on self-reported data, small sample sizes, poor retention, low generalizability, and low analytic rigor. Additional research is needed to determine the most effective and engaging approaches for young men and women.

Developing a rural transitional care community case management program using clinical nurse specialists.

PURPOSE: This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. BACKGROUND: As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. RATIONALE: Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. DESCRIPTION: After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. OUTCOMES: The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. CONCLUSION: Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. IMPLICATIONS: The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.

Six to success: improving primary care management of pediatric overweight and obesity.

INTRODUCTION: Despite the existence of established guidelines addressing pediatric obesity, many primary care providers fail to successfully implement recommendations. This study measured the impact of Six to Success, a weight management program based on the Chronic Care Model, on primary care provider adherence to pediatric weight management guidelines. METHOD: We used comprehensive pre- and postimplementation chart audits (N = 396) to conduct a quality improvement study at a hospital-based pediatric outpatient clinic. Charts of patients with a body mass index percentile at or above the 85th percentile (preimplementation, n = 90; postimplementation, n = 97) were audited for 23 identification, assessment, and prevention measures recommended in the care of the pediatric overweight/obese patient. RESULTS: Statistically significant improvements to clinical guideline adherence were found in the following areas: correct diagnosis, physical examination, lifestyle assessment, use of motivational interviewing, and prevention strategies. DISCUSSION: These findings suggest that Six to Success can be an effective method of improving primary care provider adherence to established pediatric weight management guidelines.

Smoking cessation in primary care: implementation of a proactive telephone intervention.

PURPOSE: To perform a smoking cessation intervention by a nurse practitioner in a primary care setting and assess its effectiveness. DATA SOURCES: The intervention developed was an operationalization of the five As from the U.S. Department of Health and Human Services' updated Clinical Practice Guideline: Treating Tobacco Use and Dependence. Data were generated from a two-group controlled intervention that compared adult smokers who either received or did not receive an intensive proactive telephone intervention focused on cessation. CONCLUSIONS: The intervention group showed movement across the stages of change, lower nicotine dependence, and increased confidence to quit. Also, 19% quit smoking and were abstinent at the end of study; none in the control group achieved abstinence. Quit rates were similar to those of other studies. The statistically necessary sample size was not attained, highlighting recruitment difficulties in smoking cessation studies. For a pilot study, the sample size was acceptable. IMPLICATIONS FOR PRACTICE: Measuring stage of change and nicotine dependence can assist clinicians in implementing cessation strategies. Although effective, a provider may find the intervention too intensive to employ with more than one patient at a time. This intervention should be evaluated with smokers ready to make a quit attempt.

Elder case management by registered nurses.

PURPOSE/OBJECTIVES: Before integrating advanced practice registered nurse (APRN) case management, we compared managed Medicare clients' hospital admissions for 12 months prior to and 12 months after registered nurse (RN) or social worker case management. PRIMARY PRACTICE SETTING(S): Our clients are cared for by a multispecialty physician group and five local hospitals. FINDINGS/CONCLUSIONS: The 12-month admissions dropped from 351 to 101. There was a 75.5% reduction for Level 1 clients, a 72% reduction for Level 2 clients, and a 25% reduction for Level 3 clients. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: (1) RNs, APRNs, and social workers are educated to holistically manage care for elders with chronic disease who require physiological, psychosocial, spiritual, and environmental interventions, not just disease treatment. (2) The complex interaction between aging and chronic disease in elders necessitates RN, social worker, and/or APRN case management. (3) Although RNs, social workers, and APRNs can work independently, dyads may be more effective.

A comparison of coagulation study results between heparinized peripherally inserted central catheters and venipunctures.

PURPOSE/OBJECTIVE: The purpose of this study was to test an evidence-based procedure of drawing blood samples for coagulation testing from heparinized peripherally inserted central catheter (PICC) by comparing results with blood drawn from venipuncture (VP). DESIGN: A prospective, quasi-experimental design using purposive sampling was used. SETTING: The setting was a 230-bed community hospital located in the Southwest. The hospital is part of a 15-hospital system. SAMPLE: : The sample was composed of 30 hospitalized patients with heparinized PICCs. METHODS: Informed consent was obtained. Using aseptic technique, samples of blood were drawn via VP and from the PICC using the evidence-based procedure. Data were analyzed using Pearson product moment correlations and Bland-Altman analysis. FINDINGS: For 5 coagulation tests studied, correlations between PICC values and VP values ranged from 0.990 to 0.998, indicating almost perfect correlations. In Bland-Altman analyses, mean biases and SDs were small to moderate for prothrombin time, 0.13 seconds (-0.55 to 0.81 seconds) (P = 0.0484); international normalized ratio, 0.010 (-0.050 to 0.070) (P = 0.085); partial thromboplastin time, 2.16 seconds (-5.10 to 9.43 seconds) (P = 0.0033); and fibrinogen, -18.2 mg (-70.4 to 34.1 mg) (P = 0.0033) and 0.52 (-0.73 to 1.77) seconds (P = 0.0003). Correlations of absolute difference versus average ranged from 0.18 to 0.49. Only the paired international normalized ratio samples had P values suggesting nonagreement. CONCLUSIONS: Drawing blood samples from heparinized PICCs for coagulation tests using the evidence-based procedure developed for this study resulted in accurate coagulation test results in 4 of the 5 tests: prothrombin time, partial thromboplastin time, and fibrinogen in seconds and in milligrams.