Nursing Challenges and Strategies During the COVID-19 Pandemic.

The COVID-19 pandemic has required healthcare organizations to creatively address patient care needs. The pandemic-induced disruption resulted in multiple examples of disruptive innovation. Several innovative strategies and learnings identified during the COVID-19 pandemic have resulted in approaches to nursing education and staffing, which will serve to optimize the future healthcare environment. The solutions identified by the nursing workforce during the COVID-19 pandemic can readily be replicated in similar or dissimilar healthcare environments.

Efficacy of the Well-Being Index to identify distress and stratify well-being in nurse practitioners and physician assistants.

BACKGROUND AND PURPOSE: To evaluate the ability of the Well-Being Index (WBI) to stratify distress and well-being (high quality of life [QOL]) in nurse practitioners and physician assistants (NPs and PAs) and identify those whose degree of distress place them at an increased risk for medical error or turnover. METHODS: A national sample of NPs and PAs completed a survey that included the WBI and instruments to measure QOL, fatigue, burnout, recent suicidal ideation, medical error, and intent to leave the current job. CONCLUSIONS: Overall, 1,576 of 4,106 (38.4%) NPs and PAs completed the survey. Those NPs and PAs with low mental QOL, extreme fatigue, recent suicidal ideation, or burnout had less favorable WBI scores (all p < .0001). Using a prevalence of low overall QOL among APPs of 14.4% as the pretest probability, the WBI score can reduce the posttest probability of low QOL to 2% or increase it to 64.7%. As the WBI score worsened, the posttest probability of high overall QOL decreased from 73% to 8.2%. Also, WBI score stratified the NPs and PAs likelihood of reporting recent medical errors and intent to leave his or her current job. IMPLICATIONS FOR PRACTICE: The WBI is a useful screening tool to stratify distress and well-being in APPs across a variety of domains and identify those NPs and PAs whose degree of distress may increase the risk of medical error or turnover.

Efficacy of the Well-Being Index to Identify Distress and Well-Being in U.S. Nurses.

BACKGROUND: Studies suggest there is a high prevalence of burnout and depression among U.S. nurses. OBJECTIVES: The aim of the study was to gauge the capability of the Well-Being Index (WBI) to stratify nurse distress (e.g., low quality of life [QOL], extreme fatigue, burnout, recent suicidal ideation) and well-being (high QOL) and detect those whose level of distress may negatively affect retention or work performance. METHODS: In 2016, we conducted a cross-sectional survey of 3,147 U.S. nurses. The survey included the WBI and standard instruments to assess overall QOL, fatigue, burnout, recent suicidal ideation, patient care errors, and intent to leave current job. We used Fisher exact test and Wilcoxon/two-sample t-test procedures with a 5% Type I error rate and a two-sided alternative. RESULTS: Of the 812 (26%) nurses who completed the survey, 637 were eligible for the present analysis. Nurses with low mental QOL, extreme fatigue, recent suicidal ideation, or burnout had a higher total score (all ps < .001), resulting in less favorable WBI scores. With a 17% pretest probability of low overall QOL, the WBI score can decrease the posttest probability of low QOL to 2% or increase it to 72%. The likelihood of high overall QOL decreased in a stepwise fashion from 3.38 to 0.04, as the WBI score increased. WBI score also stratified nurses' likelihood of reporting a recent patient care error and/or intent to leave current job. DISCUSSION: The WBI is a useful screening tool to stratify both distress and well-being across a variety of domains in nurses and identify those nurses whose severity of distress may negatively affect patient care and retention.

Effect of a multidisciplinary fall risk assessment on falls among neurology inpatients.

OBJECTIVE: To evaluate whether the addition of a physician assessment of patient fall risk at admission would reduce inpatient falls on a tertiary hospital neurology inpatient unit. PATIENTS AND METHODS: A physician fall risk assessment was added to the existing risk assessment process (clinical nurse evaluation and Hendrich II Fall Risk Model score with specific fall prevention measures for patients at risk). An order to select either "Patient is" or "Patient is not at high risk of falls by physician assessment" was added to the physician electronic admission order set. Nurses and physicians were instructed to reach consensus when assessments differed. Full implementation occurred in second-quarter 2008. Preimplementation (January 1, 2006, to March 31, 2008) and postimplementation (April 1, 2008, to December 31, 2009) rates of falls were compared on the neurology inpatient unit and on 6 other medical units that did not receive intervention. RESULTS: The rate of falls during the 7 quarters after full implementation was significantly lower than that during the 9 preceding quarters (4.12 vs 5.69 falls per 1000 patient-days; P=.04), whereas the rate of falls on other medical units did not significantly change (2.99 vs 3.33 falls per 1000 patient-days; P=.24, Poisson test). The consensus risk assessment at admission correctly identified patients at risk for falls (14/325 at-risk patients fell vs 0/147 low-risk patients; P=.01, χ2 test), but the Hendrich II Fall Risk Model score, nurse, and physician assessments individually did not. CONCLUSION: A multidisciplinary approach to fall risk assessment is feasible, correctly identifies patients at risk, and was associated with a reduction in inpatient falls.

Local shear stress transduction.

This is a comprehensive review of local direct measurement shear stress transducers. Transducers are first classified by their movement, measuring mode, and mechanism. These categories are then subclassified into active or passive movement, static or dynamic measuring mode, and rotational or translational mechanisms. Over 80 transducers are reviewed and tabulated. Finally, sources of transducer error are analyzed. Primary sources of error are transducer and housing misalignment, material ingress around the active face, active face roughness, and the effects of temperature gradients when making measurements on surfaces where temperature gradients develop.

The consultation role of a nurse educator.

Consultation is one component of the nurse educator's role. This role is rapidly expanding as health care changes. Nurse educators are being called on to provide support for the educational process in areas outside their clinical specialty. This article describes the educational consultation process in a large medical center where nurse educators have expanded their roles to ambulatory care areas. Key principles guiding the educational consultation process are delineated as well as possible uses. A five-stage process is described to aid the nurse educator in implementing the educational consultation process. In addition, some of the barriers that may be encountered during a consultation are identified.