What Patients Think: A Study Examining Perceptions of Teamwork, Self-Management, and Quality of Life of Patients Diagnosed With Diabetic Foot Ulceration.

Identifying strategies to support patients diagnosed with diabetic foot ulceration (DFU) is essential to affect not only wound outcomes but also mortality and quality of life. This article reports on a cross-sectional, descriptive, correlational study of patients receiving treatment for DFU at a specialty clinic. Most participants were <60 years of age and had been diagnosed with diabetes for >5 years. Results indicated that patients with higher self-management scores reported improved general health, physical functioning, and quality of life. These findings, in a younger patient population with normal work and family obligations, suggest that interventions supporting self-management behaviors can improve physical, emotional, and general health and, ultimately, quality of life. The involvement of an interprofessional care team enhances these self-management behaviors.

Patient and family perceptions of interprofessional collaborative teamwork: An integrative review.

AIMS: To understand the patient and family perceptions of teamwork by synthesising existing evidence using the Interprofessional Education Collaborative Core Competencies for Interprofessional Collaborative Practice as a guiding framework. BACKGROUND: Advances in healthcare have resulted in more people living longer with health conditions, and patients and families have become the primary caregivers. The role of the interprofessional collaborative team supports a paradigm shift to a care model with the patient and family at the centre of healthcare decisions. However, patient and family views of interprofessional collaborative team care have rarely been studied. METHODS: The authors applied Whittmore and Knafl's methodology to conduct an integrative review of the literature. Databases searched included Cumulative Index to Nursing and Allied Health Literature, PubMed and PsycINFO along with reference searches. The studies included were those related to patient and family perceptions of teamwork published from 2000 to 2020. The IPEC Core Competencies for Interprofessional Collaborative Practice served as the guiding framework for analysis. A PRISMA flow chart documented the search, inclusion and exclusion criteria for the review. RESULTS: Seventeen articles met the inclusion criteria. The findings identified differing perspectives by patients of the impact of the interprofessional collaborative team in their care which suggests that interventions to increase knowledge about interprofessional collaborative team care from the patient and family perspective may be beneficial. CONCLUSIONS: There is limited research on understanding IPC teams from the patient and family viewpoint. This review reveals incongruencies in patient and provider perspectives of IPC teams and suggests the need for additional research about patient and family perspectives of teamwork. To fully implement the IPC team vision, perceptions of teamwork must be fully understood.

SARS-CoV-2 in infant urine and fecal samples after in utero COVID-19 exposure.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a pandemic that has and will continue to affect many pregnant women. Knowledge regarding the risk of vertical transmission is limited. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcriptase-polymerase chain reaction (RT-PCR) of nasopharyngeal swabs typically have been used to confirm the diagnosis among infants, but whether the virus can be detected in other biological specimens, and therefore potentially transmitted in other ways, is unknown. Positive SARS-CoV-2 RT-PCR has been reported from feces and urine from adult patients. We hypothesize that the presence of SARS-CoV-2 in infant urine and fecal samples after prenatal COVID-19 exposure is low. METHODS: We examined the presence of SARS-CoV-2 RNA using RT-PCR in urine and fecal samples among 42 infants born to SARS-CoV-2-infected mothers during different stages of pregnancy. RESULTS: A urine sample was collected from 39 of 42 infants and fecal samples from all 42 infants shortly after birth. Although the majority of the women had the symptomatic disease (85.6%), we were unable to detect the presence of SARS-CoV-2 virus from any infant urine or fecal samples. CONCLUSIONS: SARS-CoV-2 was not detected in infant urine or feces after maternal infection during pregnancy, providing further evidence for low rates of perinatal transmission. IMPACT: SARS-CoV-2 was not detected in the urine or feces of infants of mothers with COVID-19 during various time points in pregnancy. This study provides further evidence for low rates of perinatal transmission of SARS-CoV-2. Results help to provide guidance on perinatal care practices for infants exposed to COVID-19 in utero.

Children of Parents With Opioid Use Disorder.

Substance use disorders (SUDs) have been a priority public health concern for decades, with most recent conversations focusing on the opioid use disorder (OUD) epidemic. Children of parents with OUD have been impacted through poverty, violence, neglect, and emotional and physical abuse. Although treatment programs may address the family and parental role, few focus on the children. Without building resiliency in a child's mental and physical health, the far-reaching impact of the opioid epidemic will continue. The goal of the current literature review was to critique available intervention programs that focus on children of parents with SUD/OUD and provide recommendations for best practice. A literature search found six child-focused intervention programs dated in the 1990s and early 2000s and generalized to parents with SUDs. No intervention was found specific to children of parents with OUD. Nurses and other health professionals can use these findings to determine which evidence-based intervention is most appropriate for the needs of this specific population. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 28-34.].

The Effect of the Magnet Recognition Signal on Hospital Financial Performance.

EXECUTIVE SUMMARY: The objective of this study was to investigate the effect of the Magnet Recognition (MR) signal on hospital financial performance. MR is a quality designation granted by the American Nurses Credentialing Center (ANCC). Growing evidence shows that MR hospitals are associated with various interrelated positive outcomes that have been theorized to affect hospital financial performance.In this study, which covered the period from 2000 to 2010, we applied a pre-post research design using a longitudinal, unbalanced panel of MR hospitals and hospitals that had never received MR designation located in urban areas in the United States. We obtained data for this analysis from Medicare's Hospital Cost Report Information System, the American Hospital Association Annual Survey Database, the Health Resources & Services Administration's Area Resource File, and the ANCC website. Propensity score matching was used to construct the final study sample. We then applied a difference-in-difference model with hospital fixed effects to the matched hospital sample to test the effect of the MR signal, while controlling for both hospital and market characteristics.According to signaling theory, signals aim to reduce the imbalance of information between two parties, such as patients and providers. The MR signal was found to have a significant positive effect on hospital financial performance. These findings support claims in the literature that the nonfinancial benefits resulting from MR lead to improved financial performance. In the current healthcare environment in which reimbursement is increasingly tied to delivery of quality care, healthcare executives may be encouraged to pursue MR to help hospitals maintain their financial viability while improving quality of care.

Decreasing Opioid Utilization in Rehabilitation Patients Using a Clinical Nurse Specialist Pain Consultant Program.

OBJECTIVE: To investigate whether access to a clinical nurse specialist (CNS) with expertise in pain management will result in more rapid decline in opioid use across the rehabilitation hospitalization. DESIGN: Retrospective chart review of patients discharged during 6 months prior to and 6 months after introduction of the CNS role. SETTING: Not-for-profit 98-bed community inpatient rehabilitation hospital. PARTICIPANTS: Two population-based samples of adult, inpatient rehabilitation patients (N=72) with daily opioid use ≥30mg morphine equivalent dose (MED) per day on admission and length of stay ≥24 days. INTERVENTIONS: Implementation of a CNS pain consult program. MAIN OUTCOME MEASURES: Change in average daily opioid use (milligrams of MED per day), measured at admission, week 1, week 2, and week 3. RESULTS: Linear mixed modeling was used to estimate individual and group average opioid trajectories, including individual patient intercepts (opioid use at admission) and slopes (change in opioid use over time). There was a significant interaction between group and time (b=5.75, t=2.52, P<.01), indicating faster change in opioid use for the CNS group (quadratic slope, -5.91) compared with the no CNS group (quadratic slope, -.16). Quadratic change in the CNS group reflected an initial increase in opioid use from admission to week 1, followed by a steady decline. Conversely, there was virtually no change in the no CNS group. Random effects revealed considerable variability in opioid trajectories across patients. CONCLUSIONS: Addition of a CNS pain consultant program to an inpatient rehabilitation hospital supported a distinct pattern of opioid tapering that promoted more rapid titration of daily opioid use across the rehabilitation hospitalization.

A pilot study to evaluate mindfulness as a strategy to improve inpatient nurse and patient experiences.

The purpose of the Mindful Nursing Pilot Study was to explore the impact of mindfulness training for nursing staff on levels of mindfulness, compassion satisfaction, burnout, and stress. In addition, the study attempted to determine the impact on patient satisfaction scores. The pilot was designed as a quasi-experimental research study; staff on one nursing unit participated in the 10-week mindfulness training program while another, similar nursing unit served as the control group. The intervention group showed improvement in levels of mindfulness, burnout, and stress as well as patient satisfaction while the control group remained largely the same. This pilot provides encouraging results that suggest that replication and further study of mindfulness in the workplace would be beneficial.

A matched-cohort study of pediatric head injuries: collecting data to inform an evidence-based triage assessment.

UNLABELLED: Triage nurses are the "first stop" for patients who present to the emergency department for care. The assessment of pediatric head injuries is especially challenging because signs and symptoms of head trauma in children do not correlate well with the risk of closed head injury (CHI). METHODS: A retrospective matched cohort study was conducted to compare 2 groups of patients who presented to a pediatric emergency department for evaluation of a head injury: a CHI-positive cohort and a CHI-negative cohort as identified by computed tomography scan. The purpose of the chart review was to collect specific information from both cohorts which could be used to inform a nurse-driven pediatric head injury assessment tool. RESULTS: The younger the child, the more likely they were to be asymptomatic. Scalp hematomas in infants <3 months were associated with CHI even if the infants were otherwise asymptomatic. Injuries to the temporal-parietal region were associated with CHI at every age. Frequency of caregiver report of loss of consciousness (LOC) was almost identical in both cohorts. Children in every age category sustained CHIs as the result of minor falls based on standard age-related fall criteria. DISCUSSION: The infants and children at highest risk for CHI are often the most difficult to assess. The results of this study reinforce the need for a nurse-driven, evidence-based risk scoring system that could be used to aid with early identification of infants and children who are at high risk for CHI.

Maternal, Infant, and Breast Milk Antibody Response Following COVID-19 Infection in Early Versus Late Gestation.

BACKGROUND: Coronavirus disease 2019 [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] infection at varying time points during the pregnancy can influence antibody levels after delivery. We aimed to examine SARS-CoV-2 IgG, IgM and IgA receptor binding domain of the spike protein and nucleocapsid protein (N-protein) reactive antibody concentrations in maternal blood, infant blood and breastmilk at birth and 6 weeks after SARS-CoV-2 infection in early versus late gestation. METHODS: Mothers with SARS-CoV-2 infection during pregnancy were enrolled between July 2020 and May 2021. Maternal blood, infant blood and breast milk samples were collected at delivery and 6 weeks postpartum. Samples were analyzed for SARS-CoV-2 spike and N-protein reactive IgG, IgM and IgA antibodies. Antibody concentrations were compared at the 2 time points and based on trimester of infection ("early" 1st/2nd vs. "late" 3rd). RESULTS: Dyads from 20 early and 11 late trimester infections were analyzed. For the entire cohort, there were no significant differences in antibody levels at delivery versus 6 weeks with the exception of breast milk levels which declined over time. Early gestation infections were associated with higher levels of breastmilk IgA to spike protein ( P = 0.04). Infant IgG levels to spike protein were higher at 6 weeks after late infections ( P = 0.04). There were strong correlations between maternal and infant IgG levels at delivery ( P < 0.01), and between breastmilk and infant IgG levels. CONCLUSIONS: SARS-CoV-2 infection in early versus late gestation leads to a persistent antibody response in maternal blood, infant blood and breast milk over the first 6 weeks after delivery.

Benefits of quiet time for neuro-intensive care patients.

The primary mission of any intensive care unit (ICU) is to provide critically ill patients with high-quality care and an atmosphere in which to recuperate. However, all too often, the intensive environment, which is often busy, chaotic, and noisy, may contribute to just the opposite. Patients overstimulated with noise, lights, and other distractions often suffer from sleep deprivation. Research in medicine and nursing has shown that sleep deprivation can have detrimental effects on an ailing patient. Therefore, a quiet time program was developed in the neuro-ICU to reduce noise and light levels, with the ultimate goal to allow sleep. Quiet time, a period of reduced controllable noise and light, took place twice daily coinciding with circadian rhythms. The study included 50 neuro-ICU patients, 35 observed during day hours and 15 observed during night hours. Noise and light levels were measured at multiple locations before, during, and after quiet time hours. Patients' sleep behavior was recorded every half hour, beginning 1/2 hour before quiet time until 30 minutes after. Analysis of data, adjusted for multiple testing and repeated measures on patients, demonstrated significantly lower noise and light levels during day shift quiet time. In addition, patients were significantly more likely to be observed sleeping during day shift quiet time hours.

Quality Olympics: Experiential Interprofessional Learning to Improve Quality and Safety.

BACKGROUND: Effective communication and teamwork is essential to improve the safety, quality, and cost-effectiveness of patient care. Quality Olympics, a competitive, educational intervention, was designed to offer nursing and medical students the opportunity to apply new knowledge on safety quality and cost in an interprofessional environment. METHOD: Nursing (N = 220) and medical students (N = 163) participated in Quality Olympics. Student perceptions of teamwork were analyzed using the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R). RESULTS: In years one and two, significance was found for nursing students on all survey items. Medical student responses reached significance on four items in year two. CONCLUSION: The contrast in findings between these professions suggests that students would benefit from early, additional opportunities to link patient safety and outcomes to interprofessional collaboration. In doing so, educators may ensure that future providers have the attitudes, knowledge, and skills to impact individualized care and transform health care systems.[J Nurs Educ. 2020;59(10):589-593.].

Implementation of the Fetal Monitor Safety Nurse Role: Lessons Learned.

BACKGROUND: The fetal monitor safety nurse role was created as a supplemental support for nurses assessing fetal heart rate tracings in response to an adverse event. An experienced labor and delivery nurse without a patient care assignment was designated to continuously assess all active fetal monitoring tracings, via an electronic display away from the main nurses' station, as an adjunct to the care and assessment of the nurse with primary responsibility for the patient. PURPOSE: The purpose of this project was to evaluate the views of nurses who served as fetal monitor safety nurses about various aspects of the role. METHODS: Nurses who served as fetal monitor safety nurses were invited to attend a small group session where they completed a survey about the role and then received information on the importance of fetal monitoring safety. Two weeks later, they were asked to take the survey again to evaluate potential changes in viewpoints. RESULTS: Thirty nurses attended small group sessions and completed the survey. Of those, 22 nurses completed the post survey 2 weeks later. There was minimal change in nurses' views of the fetal monitor safety nurse role after attending the small group sessions. Nurses expressed comfort in notifying peers about concerns related to the fetal heart rate tracing and perceived overall safety benefits; however, they felt that safe staffing measures were not in place to support the role. Concerns were expressed about a nurse being in a nondirect patient care position during times of high census and acuity. CLINICAL IMPLICATIONS: The fetal monitoring safety nurse may be an innovative potential solution to minimize risk of adverse events during labor that are related to accurate assessment of electronic fetal monitoring data and timely and appropriate interventions. More data are needed on improvements in fetal outcomes and adverse events potentially related to the fetal monitor safety nurse role. Budgetary support and adequate nurse staffing are required to make the role operationally feasible and safe. Valuing and seeking nurses' input as bedside experts about perinatal safety initiatives should be a part of implementing new practices.

Cost-effective care a phone call away: a nurse-managed telephonic program for patients with chronic heart failure.

Health care providers and health care systems are challenged to find cost-effective ways to address the costs associated with heart failure. A multidisciplinary team of nurses, physicians, pharmacists, and dieticians was assembled at New Hanover Regional Medical Center (Wilmington, NC) to develop strategies to decrease the readmission rate without compromising patient care. The team developed a disease management program that included comprehensive inpatient education, as well as an outpatient telephonic program to reinforce education after discharge. Goals were to reduce readmissions of patients with heart failure, to decrease the cost per case of each patient with chronic heart failure, and to reduce the length of stay for patients who were readmitted. The CHF Telephonic Program was extremely successful in meeting patient-focused and organizational goals related to readmissions, length of stay, and cost of care.

Reducing Mortality and Avoiding Preventable ICU Utilization: Analysis of a Successful Rapid Response Program Using APR DRGs.

Even though rapid response teams (RRTs) have been widely adopted, reports about their efficacy in reducing mortality have been conflicting, both in terms of outcomes, and standardization of measures. Our data demonstrate that it is possible to detect significant changes within the patient population while overall mortality rates appear not to change. Our focus will be on three indicators: unplanned transfers to the ICU as an RRT outcomes measure, changes in ICU patient utilization, and mortality. Between 2005 and 2008, RRT intervention had an impact on patient outcomes by reducing the rate of unplanned transfers to our ICU following an RRT event by 35.9%. With less severe patients able to remain on the medical wards, 12.5% of ICU beds were able to be utilized by more severe patients, and the Hospital-Standardized Mortality Ratio decreased 31.2%. The All Patient Refined Diagnostic-Related Groups (APR DRGs) risk of mortality (ROM) was used to stratify and group patients by severity, and revealed reductions in mortality among specific risk groups as well as shifts in the proportion of patient risk groups within the ICU population which were not readily apparent.

From synthesis to script: transforming qualitative research findings for use in practice.

Although qualitative research synthesis has secured a place in the evidence-based practice movement, little effort has as yet been directed toward translating the results into material form for practice. The authors transformed a qualitative research synthesis of findings pertaining to stigma in HIV-positive women into a script and DVD. The process of transformation entailed bringing together the norms and imperatives of scientific research, clinical practice, and artistic presentation.

Spiritual care practices of nurse practitioners in federally designated nonmetropolitan areas of North Carolina.

PURPOSE: The purpose of this study was to explore if and then how nurse practitioners (NPs) living in federally designated nonmetropolitan areas of North Carolina integrated spiritual care into their practices. Participants identified the frequency in which they utilize spiritual care practices, specific spiritual interventions, and their definitions of spiritual care. DATA SOURCES: A sample of 101 NPs was chosen through systematic sampling from 507 eligible NPs. Each participant was mailed a demographic data sheet and the Nurse Practitioner Spiritual Care Perspective Survey (NPSCPS). The NPSCPS was modified from the Oncology Nurse Spiritual Care Perspective Scale developed by Taylor and colleagues. Of the 101 mailings, 65 were returned and included in the analysis. CONCLUSIONS: Although most of the NPs in this study felt that spiritual care was an important part of nursing practice, 73% did not routinely provide spiritual care to their patients. Barriers and limitations to the provision of spiritual care must be explored. IMPLICATIONS FOR PRACTICE: As providers of holistic care, NPs should be proficient and comfortable in providing spiritual care to their patients. Educational programs should provide NPs and NP students with knowledge and skills to provide spiritual care.

Reducing mortality and avoiding preventable ICU utilization: analysis of a successful rapid response program using APR DRGs.

Even though rapid response teams (RRTs) have been widely adopted, reports about their efficacy in reducing mortality have been conflicting, both in terms of outcomes, and standardization of measures. Our data demonstrate that it is possible to detect significant changes within the patient population while overall mortality rates appear not to change. Our focus will be on three indicators: unplanned transfers to the ICU as an RRT outcomes measure, changes in ICU patient utilization, and mortality. Between 2005 and 2008, RRT intervention had an impact on patient outcomes by reducing the rate of unplanned transfers to our ICU following an RRT event by 35.9%. With less severe patients able to remain on the medical wards, 12.5% of ICU beds were able to be utilized by more severe patients, and the Hospital-Standardized Mortality Ratio decreased 31.2%. The All Patient Refined Diagnostic-Related Groups (APR DRGs) risk of mortality (ROM) was used to stratify and group patients by severity, and revealed reductions in mortality among specific risk groups as well as shifts in the proportion of patient risk groups within the ICU population which were not readily apparent.