Enculturating, embedding and investing in fundamental care in an academic health science centre.

AIM: This manuscript aims to provide a discursive description of how one academic health care centre is enculturating, embedding and investing in the fundamental care framework and lessons learned that can serve as a blueprint for other organizations. BACKGROUND: A call to action to focus on fundamental care is not new as the initial Fundamentals of Care (FoC) Framework has been evolving over the last decade through efforts lead by the International Learning Collaborative (ILC). Now more than ever, there is a pressing need for leaders to influence a humane, compassionate evidence-informed approach to the COVID-19 pandemic and beyond by embedding an FoC framework and focusing on fundamental care as part of their academic mandate and daily care practices. DESIGN: This discursive paper delineates an evolving and ongoing enculturation, embeddedness and investment in advancing fundamental care as part of a larger academic practice strategy and quality improvement plan that is evidence-informed and collaborative in nature. METHOD: The action framework (value, talk, do, own and research fundamental care) developed by ILC guides efforts to how the FoC framework was embedded into one academic health science centre's strategic directions, academic practice strategy, professional practice model, quality plan and research and innovation platform. CONCLUSION: An overview of how we leveraged the FoC and ILC Leadership frameworks in our efforts to enculturate, embed and invest in advancing fundamental care and lessons learned that may inform other healthcare organizations in their efforts. IMPACT ON NURSING SCIENCE, PRACTICE OR DISCIPLINARY KNOWLEDGE: Underpinning all of our efforts is the integral value we place on fundamental care to guide how we practice, educate and learn, discover and innovate and lead at x. We shared how we value, talk, do, own and research fundamental care by having it embedded into our strategic directions, academic practice strategy, professional practice model, quality aims and research and innovation platform. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Focusing on fundamentals of care in an ICU setting during a pandemic.

AIMS: This manuscript aims to describe one acute care hospital's ICU journey during the COVID-19 pandemic and how fundamental care was central to the implementation of team-based models of care. BACKGROUND: Over the course of the COVID-19 pandemic, team-based and alternative models of care are being employed to manage and address global shortages and surge capacity. Employing these alternate models of care required attention to ensure fundamental care needs of patients were being met. DESIGN/METHOD: The following paper describes an ICU's journey of focusing on the delivery of the fundamentals of care through the implementation of team-based models of care to address the surge in patient care demands experienced in response to our global pandemic. CONCLUSIONS: The implementation of an evidence-informed approach to optimizing models of care and staffing in the ICU amid the evolving COVID-19 waves in one acute-care hospital is provided. This local approach focused on meeting patients' fundamental care needs throughout the necessary introduction of team-based care models and staffing changes and drew from evolving evidence, the ILC Fundamentals of Care Framework, and regulatory guidance.

"It Takes a Virtual Village" Achieving Magnet Redesignation Amidst the COVID-19 Pandemic: Canada's Magnet Hospital Journey.

This article outlines how a Canadian hospital achieved the American Nursing Credentialing Center Magnet Recognition Program redesignation after participating in a virtual site visit (VSV) appraisal process amidst the COVID-19 pandemic. Within our current COVID-19 landscape, being a resilient Magnet-designated organization is paramount. In this context, the American Nurses Credentialing Center (ANCC) has developed a VSV model that (1) extends the use of audio/video (A/V) conferencing technology to showcase nursing excellence; (2) maintains the integrity of the appraisal process; and (3) ensures the safety and well-being of staff, patients and their care partners, and the appraisers. Key narrative insights are highlighted around planning and on-site execution of a successful VSV. The redesignation is a culmination of several stakeholders' efforts who shared their sense of pride, inspiration, and accomplishment during the VSV. The redesignation status notification exemplifies resiliency and was welcomed amidst uncertainty with the evolving COVID-19 pandemic. The planning and on-site implementation plan may serve as a blueprint for others who will be engaged in a VSV as part of their designation or redesignation journey. Insights are shared around preparing for the VSV, hosting the VSV, and achieving the ANCC Magnet Recognition Program redesignation.

Sustained quality improvement in outcomes of preterm neonates with a gestational age less than 29 weeks: results from the Evidence-based Practice for Improving Quality Phase 3 1.

Quality improvement initiatives in neonatology have yielded positive results; however, few programs have demonstrated sustainability. We evaluated an ongoing, national quality improvement initiative (Evidence-based Practice for Improving Quality Phase 3 (EPIQ-3)) on outcomes of preterm neonates with a gestational age (GA) of 220-286 weeks (i.e., from 22 weeks and 0 days of gestation to 28 weeks and 6 days of gestation). Data from 7459 neonates admitted to 25 Canadian centers between 2013 and 2017 were studied. Trends in mortality and major morbidities were evaluated. The number of neonates with a GA of 220-236 weeks increased from 90 in 2013 to 139 in 2017 without a significant change in any other GA categories. In the entire cohort, the odds of composite outcome of mortality or any major morbidity (adjusted odds ratio (AOR) 0.72, 95% confidence interval (CI) 0.61-0.84) and of necrotizing enterocolitis (AOR 0.66, 95% CI 0.49-0.89) were lower in 2017 than in 2013. When calculated per year, the odds of composite outcome (AOR 0.93, 95% CI 0.89-0.97) and odds of necrotizing enterocolitis (AOR 0.89, 95% CI 0.82-0.96) decreased significantly. Among the subgroup of neonates with a GA of 260-286 weeks, the odds of composite outcome (AOR 0.63, 95% CI 0.51-0.79), necrotizing enterocolitis (AOR 0.44, 95% CI 0.26-0.73), and nosocomial infection (AOR 0.64, 95% CI 0.49-0.84) were reduced. The collaborative, multidisciplinary, nationwide EPIQ-3 program improved outcomes of preterm neonates, and the improvement was sustainable over 5 years.

An Academic Health Sciences Centre's Strategy to Enhance Nurse Resilience and Psychological Safety.

The rapid cadence of change and the fear of acquiring and spreading COVID-19 - coupled with moral distress exacerbated by fulfilling one's duty to care under extremely challenging conditions - continue to impact nurses' coping ability, resilience and psychological safety globally (McDougall et al. 2020). This paper provides an overview of how an academic health sciences centre (AHSC) has responded to the evolving waves of the COVID-19 pandemic. Specifically, we share our context and the strategies we used to build and enhance nurse resilience and psychological safety at the organizational, clinical team and individual levels. This is followed by a description of our nurses' achievements amid the pandemic.

Impact of a "Brain Protection Bundle" in Reducing Severe Intraventricular Hemorrhage in Preterm Infants <30 Weeks GA: A Retrospective Single Centre Study.

BACKGROUND: despite advances in perinatal care, periventricular/intraventricular hemorrhage (IVH) continues to remain high in neonatal intensive care units (NICUs) worldwide. Studies have demonstrated the benefits of implementing interventions during the antenatal period, stabilization after birth (golden hour management) and postnatally in the first 72 h to reduce the incidence of IVH. OBJECTIVE: to compare the incidence of severe intraventricular hemorrhage (IVH ≥ Grade III) before and after implementation of a "brain protection bundle" in preterm infants <30 weeks GA. STUDY DESIGN: a pre- and post-implementation retrospective cohort study to compare the incidence of severe IVH following execution of a "brain protection bundle for the first 72 h from 2015 to 2018. Demographics, management practices at birth and in the NICU, cranial ultrasound results and short-term morbidities were compared. RESULTS: a total of 189 and 215 infants were included in the pre- and post-implementation phase, respectively. No difference in the incidence of severe IVH (6.9% vs. 9.8%, p = 0.37) was observed on the first cranial scan performed after 72 h of age. CONCLUSION: the implementation of a "brain protection bundle" was not effective in reducing the incidence of severe IVH within the first 72 h of life in our centre.

Simulation-Based Learning During COVID-19: A Teaching Strategy for Protected Code Blues.

In light of the COVID-19 pandemic and uncertainties around risk of transmission, urgent hospital resuscitation (also known as "Code Blue") efforts are needed, pivoting to protect health care workers. This article provides teaching tips for "Protected Code Blues." [J Contin Educ Nurs. 2020;51(9):399-401.].

Co-Designing a Collaborative Academic Professional Practice Model for an Integrated Health System: Sinai Health's Journey.

In the current environment of increasingly complex healthcare needs, evidence-informed practice, stronger partnerships and collaborative foundations with nursing professions, health professions and physicians (referred to as collaborative academic practice) are required to deliver integrated, value-based services across the care continuum. This paper outlines the co-design of a collaborative academic practice model in a recently integrated health system. An overview of key concepts from the literature around professional practice models is provided that lays the foundation for the integrated healthcare system's inaugural collaborative academic practice model.

Developing a Nursing Scorecard Using the National Database of Nursing Quality Indicators®: A Canadian Hospital's Experience.

Nursing-sensitive indicators are often reported on scorecards that enable nurse leaders to evaluate their progress in achieving their strategic goals and operational and quality targets. Providing unit-level reporting of nursing-sensitive indicators is one of the requirements of the American Nursing Credentialing Center's Magnet Recognition Program®. This descriptive article outlines one healthcare organization's experience in refining their nursing scorecard using the indicators as part of their Magnet Recognition Program® re-designation efforts.