Postoperative Mobilization Protocol in Lumbar Laminectomy Patients.

There are often misconceptions associated with early mobilization in postoperative spine surgery patients related to initiating mobility and staff responsibilities. Nursing staff and nursing certified technicians are responsible for ambulating patients after lumbar laminectomy surgery, resulting in improvement in clinical outcomes (Rupich et al., 2018). Lack of early mobilization in postoperative lumbar laminectomy patients may result in complications such as hospital-acquired weakness, infection, and increased length of hospital stay (Fiasconaro et al., 2020). The purpose of this quality improvement (QI) project was to increase mobilization at 24 and 48 hours in postoperative lumbar laminectomy patients as evidenced by improved electronic medical record (EMR) documentation. The Plan-Do-Check-Act (PDCA) model was used to frame the project, which took place on a neurological focused care unit in a Midwest tertiary care center. A retrospective chart audit indicated that documentation of mobility in the postoperative lumbar laminectomy patients was lacking. Staff education, using a self-paced module, was initiated related to the benefits of mobility in postoperative lumbar laminectomy patients and the importance of documentation in the EMR. The use of the John Hopkins Highest Level of Mobility scale and 6-clicks scale was discussed. A secondary chart review over 4 weeks posteducation showed results of improved documentation of early mobilized patients. This QI project demonstrated the impact of staff education on promoting mobility and appropriate documentation in the postoperative laminectomy patient. Future retrospective chart reviews will be undertaken to determine the effectiveness of a one-time education workshop on the impact of early ambulation over time.

Interactive Evidence-Based Pressure Injury Education Program for Hospice Nursing: A Quality Improvement Approach.

PURPOSE: The purpose of this quality improvement (QI) project was to develop and implement an interactive, evidence-based pressure injury (PI) education program and evaluate the impact on frontline hospice nursing staff knowledge and practice. PARTICIPANTS AND SETTING: The QI setting was a 12-bed inpatient hospice unit in a tertiary care Veterans Affairs (VA) Medical Center in Cleveland, Ohio. Nineteen licensed and unlicensed hospice nursing staff participated in this pre-/postworkshop project. APPROACH: Chart audit determined baseline PI incidence and prevalence on the inpatient hospice unit. Interviews with key leaders informed the need to develop and implement innovative PI education opportunities. A literature review determined existing standards regarding the benefits of PI education for nursing staff but did not reveal measurable targets in hospice settings. We developed a PI education intervention based on Kolcaba's Theory of Comfort framework and a Plan-Do-Study-Act (PDSA) performance improvement model. Education was delivered in 7 workshops, lasting 2 hours each. Knowledge, practice, and comfort for inpatient hospice nursing staff were evaluated at baseline and 8 weeks following the final refresher visit. Workshop satisfaction was collected once using standard program evaluation forms after final workshop delivery. OUTCOMES: We observed a significant improvement in staff PI knowledge (P = .001) and practice (P = .001) after initial workshop attendance and repeat engagement (P = .001). There was a large magnitude of effect for overall knowledge change (d = 1.04); similarly PI care planning and practice showed a large magnitude of effect and significant improvement (P = .001, d = 2.64). Staff comfort with job duties was stable with low effect size (mean 4.52, d = 0.04), and satisfaction with the workshop education was high (100% agreement with trainer effectiveness). IMPLICATIONS FOR PRACTICE: We found that frontline hospice nursing staff knowledge and practice improved after attendance at our evidence-based PI education program. Results of this QI project have stimulated ongoing discussion on how to sustain this program in our hospice setting.

Evaluating interactive technology for an evolving case study on learning and satisfaction of graduate nursing students.

Nursing education is challenged to prepare students for complex healthcare needs through the integration of teamwork and informatics. Technology has become an important teaching tool in the blended classroom to enhance group based learning experiences. Faculty evaluation of classroom technologies is imperative prior to adoption. Few studies have directly compared various technologies and their impact on student satisfaction and learning. The purpose of this study was to evaluate technology enhanced teaching methods on the learning and satisfaction of graduate students in an advanced pharmacology class using an unfolding case study. After IRB approval, students were randomly assigned to one of three groups: blogging group, wiki group or webinar group. Students completed the evolving case study using the assigned interactive technology. Student names were removed from the case studies. Faculty evaluated the case study using a rubric, while blinded to the assigned technology method used. No significant difference was found on case study grades, the range of grades on the assignment demonstrated little differences between the methods used. Students indicated an overall positive impact related to networking and collaboration on a satisfaction survey. Impact of technology methods needs to be explored in other areas of graduate nursing education.

Evaluating models of healthcare delivery using the Model of Care Evaluation Tool (MCET).

BACKGROUND AND PURPOSE: Our aim was to provide the outcome of a structured Model of Care (MoC) Evaluation Tool (MCET), developed by an FAANP Best-practices Workgroup, that can be used to guide the evaluation of existing MoCs being considered for use in clinical practice. Multiple MoCs are available, but deciding which model of health care delivery to use can be confusing. This five-component tool provides a structured assessment approach to model selection and has universal application. METHODS: A literature review using CINAHL, PubMed, Ovid, and EBSCO was conducted. CONCLUSIONS: The MCET evaluation process includes five sequential components with a feedback loop from component 5 back to component 3 for reevaluation of any refinements. The components are as follows: (1) Background, (2) Selection of an MoC, (3) Implementation, (4) Evaluation, and (5) Sustainability and Future Refinement. IMPLICATIONS FOR PRACTICE: This practical resource considers an evidence-based approach to use in determining the best model to implement based on need, stakeholder considerations, and feasibility.

Beyond Academic Evidence: Innovative Uses of Technology Within e-Portfolios in a Doctor of Nursing Practice Program.

Portfolios have been used in higher education for the past several years for assessment of student learning and growth and serve as the basis for summative and formative evaluations. While there is some information in the literature on how undergraduate and graduate medical, nursing, and allied health students might use portfolios to showcase acquired knowledge and skills, there is a dearth of information on the use of e-Portfolios with students in doctor of nursing practice programs. There are also limited findings regarding the creative use of technology (that includes infographics and other multimedia tools) to enhance learning outcomes (Stephens & Parr, 2013). This article presents engaging and meaningful ways technology can be used within e-Portfolios. Thus, e-Portfolios become more than a repository for academic evidence; they become unique stories that reflect the breadth and depth of students' learner-centered outcomes.

Baccalaureate nursing student experiences at a camp for children with diabetes: the impact of a service-learning model.

Camp nurses deliver health care in a non-traditional setting. Research indicates that camp has a positive impact on campers with diabetes mellitus, but the impact on student nurse knowledge of diabetes care and confidence in the role as a member of the health care team is unknown. This study examined the experiences of student nurses at a summer residential camp for children with diabetes using a service-learning framework. Camp positively increased knowledge of diabetes in the nursing students. Reflective journals identified themes of anxiety, fatigue, responsibility, and increased confidence in the nursing student, while developing empathy for the lifestyle of children with diabetes. Future research on camp nursing is indicated.

The impact of podcasting on the learning and satisfaction of undergraduate nursing students.

Nursing education has evolved from traditional pedagogical models to current methods using technology for knowledge acquisition. Podcasting is one example of teaching methodology used in higher education. Studies demonstrate positive student satisfaction with podcasting, but there is limited data related to knowledge acquisition. The purpose of this study was to examine the impact of podcasting on nursing student learning and satisfaction. Two classes of junior baccalaureate nursing students had scores on selected exam questions compared. The 2007 class (n=63) had select content presented in traditional lecture format where the 2008 class (n=57) had the same content presented via podcast. Both methods used the same faculty and exam questions. The 2008 class completed a satisfaction survey. Results indicated no significant difference in correct responses on exam questions. Exam scores were better with the first podcast, equal for the second, and worse with the third podcast. Students were overall satisfied with the podcasting experience and commented positively on its portability and flexibility. This study contributes to the knowledge base of podcasting effectiveness and raises the question of evaluation of new teaching methodologies. Must an increase in learning occur for new methods to be considered effective, or is positive student satisfaction adequate to encourage the adoption of new technology methods?

Pediatric nurse practitioner practice patterns and compensation in Ohio.

INTRODUCTION: The purpose of the study was to describe practice patterns and compensation patterns of Pediatric Nurse Practitioners (PNPs) in Ohio. METHOD: A survey, including open-ended and forced choice questions, was sent to all members of Ohio's chapter of NAPNAP. The resultant sample included 200 female PNPs. Over half had practiced as NPs between 5-29 years, holding at least a Master's degree. RESULTS: Fifty percent worked full-time in a variety of practice settings; 71% held prescriptive privileges. Most saw patients with a physician on-site and billed for services with the physician's name; few had "on call" responsibilities. The majority spent most of their clinical time with acute visits and providing preventative services. Only 29% had a contract with a collaborating physician and the components of the contract varied greatly. Compensation for services mimicked national rates, annual salaries from $35,000-$90,000/year and hourly rates $19-$40/hour. Salary bonuses were reported by 23%. Two-thirds of the PNPs received benefits. DISCUSSION: Practice patterns of the Ohio PNPs were found to be consistent with the practice patterns of advanced practice nurses nationally. Most PNPs remain largely uninformed about reimbursement issues. Negotiation of employment contracts with potential employers will be enhanced by demonstration of the positive impact of the NP on the number and type of patients seen, reimbursement possibilities, and quality of care. Future studies need to focus on quantifying the value of the NP.