Moving the Needle on Patient Cancellations Through Mobile Integration: A Hospital-Based Quality Improvement Project.

The Annie application (Annie app) prompts patients to track and guide their adherence to colonoscopy bowel prep protocol referred to as nothing by mouth (NPO) instructions. The app is a series of timed educational text messages geared toward colonoscopy preparation. This quality improvement project aimed to establish whether implementing a short message service (SMS) application (Annie app) would decrease the same-day cancellation rate among individuals receiving a nonemergent colonoscopy in a large Houston hospital clinic. Most same-day cancellations are related to failure to follow NPO instructions provided by the clinic nursing staff. All patients received the standard 14-day call, as well as the 3-day nurse reminder calls. The Annie app SMS was in addition to the standard nurse reminder calls. There were significant associations between using the Annie app and cancellations. Cancellation rates decreased by 21% when patients elected to receive the Annie app messages versus receiving voice-mail-only messages. African American individuals benefitted the most from the Annie app decreasing from 28.4% to 17.9%.

Interpersonal Violence: What Undergraduate Nursing Students Know.

A program evaluation of undergraduate nursing curricula content was completed and survey developed to assess undergraduate nursing students' knowledge about interpersonal violence. Students electively answered a 43-question survey regarding interpersonal violence as a public health problem. The sample included 104 traditional and accelerated undergraduate nursing students. Increasing scores during undergraduate program enrollment suggests that students receive some content on violence from the undergraduate curriculum. This study provides data about curricular deficits and proposes content revisions to prepare nursing students to address violence in patient populations.

Self-Efficacy: Changing the Tide of Evidence-Based Practice.

AIMS: The specific aim for this study was to describe differences in evidence-based practice (EBP) and self-efficacy in frontline RNs. This project utilized a national study with a convenience selection of acute care agencies to examine the relationship between organizational and unit culture, EBP, and self-efficacy in frontline nurses. METHODS: This national study used descriptive correlational methodology to describe differences in EBP and self-efficacy among RNs. The sample included 245 frontline RNs employed in acute care settings. To measure the study variables, the Nursing Evidence-Based Practice Survey (Titler, Hill, Matthews, & Reed, 1999)  and the Evidence-Based Nursing Practice Self-Efficacy Scale were used (Tucker, Olson, & Frusti, 2009). Each instrument was delivered via the Qualtrics online platform. RESULTS: The correlation of bivariate interval level variables was analyzed using Pearson's r. The correlation between EBP and self-efficacy was strongly correlated: r(170) = .537, p = .01. Sections within the Nursing Evidence-Based Practice Survey were calculated and found to be significant (unit culture r = .241, p = .01; organizational culture r = .570, p = .01; knowledge, skills, attitude r = .538, p = .01). LINKING EVIDENCE TO ACTION: Several implications exist for education, staff development, and nursing management. Nursing school programs incorporate EBP into the curriculum so that nurses have a foundation for EBP. However, staff development professionals in clinical settings must continue to build on the nurses' knowledge and skill, thus increasing self-confidence for EBP. Nursing management can provide the resources for staffing models and policies to reinforce the value of EBP and positive patient outcomes. This combination provides frontline staff with EBP participation and increased self-efficacy in its usage.

Comfort or Care: Why Do We Have to Choose? Implementing a Geriatric Trauma Palliative Care Program.

The geriatric (≥65 years of age) population is one of the fastest growing age groups in the United States. As this number increases, so does the number of geriatric trauma patients. Because this group has higher mortality rates and requires more resources, a Geriatric Trauma Palliative Care Program was created at a Level 1 Trauma Center in Dallas, TX, to provide concurrent lifesaving therapies and primary palliative care to older adults. The trauma program implemented the American College of Surgeons (ACS) Trauma Quality Improvement Program Palliative Care Best Practices Guidelines () to better care for acute traumatic injuries as well as the specific spiritual, emotional, and psychiatric needs of the geriatric trauma palliative care patient and family. Using the guidelines, the team performed a gap analysis, carried out program development, created a palliative care pathway to guide our evidence-based practice implementation, and performed retrospective chart reviews for 3-month pre- and postimplementation analysis. Using Person's χ test and Fisher's exact test, our initial evaluation of the program showed statistically significant (p < .001) improvements in the measures related to the implementation of primary palliative care, pain and symptom management, and end-of-life care. The guidelines gave the team a consistent framework for implementing the basic competencies required to deliver primary palliative care, pain and symptom management, and end-of-life care to trauma patients.

The Dark Side of Dissemination: Traditional and Open Access Versus Predatory Journals.

AIM: The purpose of the article is to alert faculty about predatory online journals, review characteristics of three broad categories of journals, and provide suggestions for faculty evaluation of journals before submission of scholarship for publication. BACKGROUND: The availability of online journals in recent years has rapidly increased the number of journals available for publication of faculty scholarship. However, not all online journals meet the same standards as traditional journals. METHOD: The article is not a report for a research study. RESULTS: Currently, there are three broad categories of journals for faculty scholarship publication: traditional, open access scholarly, and predatory open access journals. CONCLUSION: Faculty authors need to carefully evaluate the journal characteristics and publisher business practices before submitting a manuscript for publication to prevent inadvertent submission to a predatory open access journal.

End-of-life planning in a rural elderly cohort.

Relationships between end-of-life (EOL) planning and demographic and health related variables for individuals living in three rural West Texas counties were examined using a prospective cohort study design. Project FRONTIER, a longitudinal community-based participatory research project, served as the database for this study. Abstracted data from 692 older adults focused on demographic variables, medical conditions, and EOL planning. EOL planning activities included completing a will (39%), a durable power of attorney (32%), advanced directives (14%), talking with family about EOL wishes (31%), and designating a decision maker (55%). The mean EOL Planning Index was 1.6 (SD = 2.58) with higher numbers indicating greater level of planning. Regression findings supported significantly higher levels of EOL planning influenced by age, education, non-Hispanic ethnicity, chronic disease, depression, and communication with family about nursing home placement. Aging rural adults and their healthcare providers would benefit from learning more about EOL planning.

From nursing home to acute care: signs, symptoms, and strategies used to prevent transfer.

Older adults are vulnerable to experiencing physiologic changes that may permanently decrease functional abilities when transferring from the nursing home (NH) to the acute care setting. Making the right decision about who and when to transfer from the nursing home (NH) to acute care is critical for optimizing quality care. The specific aims of this study were to identify the common signs and symptoms exhibited by NH residents at the time of transfer to acute care and to identify strategies used to prevent transfer of NH residents. Using survey methodology, this descriptive study found change in level of consciousness, chest pressure/tightness, shortness of breath, decreased oxygenation, and muscle or bone pain were the highest ranked signs/symptoms requiring action. Actions to prevent transfer focused on stabilizing resident conditions and included hydration, oxygen, antibiotics, medications, symptom management, and providing additional physical assistance. When transfer was warranted, actions concentrated on the practical tasks of getting the residents transferred.

Simulation evaluation using a modified Lasater Clinical Judgment Rubric.

AIM: The purpose of this study was to describe the process of evaluating senior nursing students in the simulation laboratory using a modified Lasater Clinical Judgment Rubric (LCJR). BACKGROUND: The LCJR is a clinical evaluation tool used to measure outcomes in simulated learning settings. The LCJR was revised to provide numeric grading and clarity regarding expectations of clinical competency. METHOD: The study was conducted over two years with students enrolled in their final bachelor of science in nursing semester (Phase I, n = 86; Phase 2, n = 102) using high-fidelity simulation. RESULTS: The modified rubric measured student performance more holistically than a procedural checklist and provided objective criteria for evaluation. CONCLUSION: A well-constructed rubric provides a mechanism to evaluate student performance in simulation by focusing on clinical reasoning essential for patient safety and allowing numeric evaluation of performance.

Taking Stock: Disruption in the Life of a Professional Organization.

The purpose of this paper is to describe the journey of the National Hartford Center for Gerontological Nursing Excellence, a 501(c)(3) organization, during the COVID-19 pandemic. Using the RISE (resilience, intention, sustain, and endurance) model, the organization's response is detailed. The COVID-19 pandemic pushed us to think about the way we operate and proactively develop and implement strategies for the organization. For example, changing to a virtual format for our leadership conference was a very successful change that has influenced our planning for future conferences. We are emerging as a stronger organization due to our initial and sustained responses to this crisis.

Academic Tenure: Perceptual Variations Among Tenured, Tenure-seeking and Non-tenure Faculty.

BACKGROUND: Tenure is a hallmark of higher education, but its value and relevance is questioned. PURPOSE: This study examined faculty perceptions of the value of tenured and non-tenured nursing faculty appointments. METHODS: A descriptive correlational design using an anonymous survey was sent to members of the American Association of College of Nursing. Participants (N = 542) from 44 states completed the survey. RESULTS: Significant differences in workload were found in teaching, administrative responsibilities, scholarship, and academic service. Compared to non-tenured faculty, tenured faculty had higher scores on Career Opportunities (p < 0.001), lower Life Balance scores (p = 0.001) and higher Academic Support scores (p = 0.014). Non-tenured faculty were less likely to agree than tenured faculty that tenure improves quality of education (χ2 = 86.48, p < 0.001) or is relevant to the modern university (χ2 = 75.20, p < 0.001). Narrative responses revealed six themes about tenure. Faculty on both tracks questioned the value of tenure. CONCLUSIONS: Faculties in schools of nursing nationwide need to re-evaluate the purpose of tenure and the tenure criteria in light of each institution's unique mission and expectations to determine how they are meeting the needs of both academic institution and nursing faculty. Although the idea of tenure is institutional, implementation is initiated at the school level. Our study revealed naivete about tenure among nursing faculty at the school level.

Creating Shared Meaning: Communication Between Nurses and Physicians in Nursing Homes.

The current study sought to obtain pilot data from a Situation, Background, Assessment, Recommendation (SBAR) communication intervention focused on the shared meaning construct of the sensemaking model and explore shared meaning in communication between nursing home (NH) nurses and physicians. The study design was an exploratory sequential mixed method with a pre/post quasi-experiment. Grounded theory was used to collect and analyze nurse and physician interviews and medical records. The Pathway to Shared Meaning model illustrating distinct processes supported use of the sensemaking model for understanding nurse-physician communication. Quantitative changes in communication were not significant. Shared meaning and training in SBAR for communication can be used to strengthen the design and use of structured communication in NHs. TARGETS: Nurses and physicians providing direct care in NHs. INTERVENTION DESCRIPTION: Stories describing nurse-physician sharing of resident information using SBAR. MECHANISM OF ACTION: Mutual understanding of one another's perspective enhances communication. OUTCOME: Communication openness and satisfaction. [Res Gerontol Nurs. 2019; 12(3):121-132.].

Time requirements for implementation of the course facilitator role.

The purpose of this descriptive study was to identify the time requirements to implement the lead position (course facilitator) for nursing courses at a health sciences center school of nursing located in the southwestern United States. Faculty participants completed instruments dividing tasks into pre-course, within-course, and post-course responsibilities. The results of this study revealed that more than 1 hour per week was spent in pre-course and post-course activities and 3.79 hours per week were spent in within-course activities. Recommendations include examining tasks requiring large amounts of time for management alternatives; developing workload expectations that accurately reflect pre-course, within-course and post-course time requirements; and using course facilitators as mentors when preparing novice faculty for the course facilitator role. Although the results of this study are not generalizable, the findings represent formal assessment of a critical component of the faculty role and suggest the need for further investigation into the demands placed on nursing faculty.

Due diligence in the open-access explosion era: choosing a reputable journal for publication.

Faculty are required to publish. Naïve and "in-a-hurry-to-publish" authors seek to publish in journals where manuscripts are rapidly accepted. Others may innocently submit to one of an increasing number of questionable/predatory journals, where predatory is defined as practices of publishing journals for exploitation of author-pays, open-access publication model by charging authors publication fees for publisher profit without provision of expected services (expert peer review, editing, archiving, and indexing published manuscripts) and promising almost instant publication. Authors may intentionally submit manuscripts to predatory journals for rapid publication without concern for journal quality. A brief summary of the open access "movement," suggestions for selecting reputable open access journals, and suggestion for avoiding predatory publishers/journals are described. The purpose is to alert junior and seasoned faculty about predatory publishers included among available open access journal listings. Brief review of open access publication, predatory/questionable journal characteristics, suggestions for selecting reputable open access journals and avoiding predatory publishers/journals are described. Time is required for intentionally performing due diligence in open access journal selection, based on publisher/journal quality, prior to manuscript submission or authors must be able to successfully withdraw manuscripts when submission to a questionable or predatory journal is discovered.

Making It All Work: Qualitative Descriptions of Hispanic Adults Managing Type 2 Diabetes With Limited Resources.

The greater prevalence of type 2 diabetes is a critical issue among the U.S. Hispanic population. This study examined the struggles of Hispanic adults managing type 2 diabetes with limited resources. Ten Hispanic adults (enrolled in a larger study to determine the effects of diabetes self-management intervention), 25 to 80 years of age and living in a rural West Texas county in the United States, were selected. Three categories of challenges emerged: (a) diabetes self-care behaviors and challenges, (b) challenges with limited resources, and (c) challenges with support mechanisms. "Making it all work" was the overarching theme that tied all the categories together. This study offers lessons for health care providers and policymakers on how to maximize the availability of resources for Hispanic individuals with type 2 diabetes living within the constraints of limited resources.

A comparison of cognitive and functional care differences in four long-term care settings.

Matching residential setting with cognitive and physical abilities is crucial for the provision of a supportive long-term care (LTC) environment. This study compares the cognitive and functional care differences of LTC residents on skilled nursing units designed for dementia care, chronic care, or ambulatory care, and an assisted living setting using the Minimum Data Set (MDS) Texas Index of Level for Effort (TILE) clinical categories (heavy care, rehabilitation/restorative, clinically unstable, clinically stable), MDS Activities of Daily Living (ADL), and Mini-Mental State Examination (MMSE). The goal of the comparison was to find a parsimonious approach for determining resident placement in LTC using the MDS and MMSE. Using a descriptive comparative design, the study took place at a not-for-profit, urban, continuing care retirement center (CCRC) with a 120-bed skilled nursing facility and a 34-unit assisted living facility. Sixty residents, 15 from each of the 3 skilled nursing units and assisted living unit, consented to participate. To understand the differences in the MDS and MMSE scores between units, a Level of Care Algorithm was constructed to analyze resident placement. Results revealed that MDS and MMSE scores placed greater than 75% of elders who had extremely poor cognitive or physical function but did not discriminate well for residents with moderate cognitive and/or physical impairment. For these residents, interaction between institutional philosophy (aging in place versus moving to a new location); resource availability; and elder, family, and staff values and preferences may have influenced placement.

The latex allergic psychiatric patient.

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.

Differentiating between pre-arrest and failure-to-rescue.

The similarities and differences between pre-arrest and failure-to-rescue are examined. Case studies are used to discuss the importance of early recognition and intervention in pre-arrest. In light of the poor survival-to-discharge rate for in-hospital resuscitation, it is important for the medical-surgical nurse to anticipate the unexpected, recognize the problem, and intervene before it is too late.

The meaning in life for patients recently hospitalized with congestive heart failure.

PURPOSE: Quality of life (QOL) is based on individual values and is identified by what each person believes it to be. To provide patient centered care, practitioners must have an understanding of what each individual identifies as important in their lives. The purpose of this study was to identify what provides meaning to the lives of patients recently hospitalized with congestive heart failure (CHF). DATA SOURCE: Participants for this pilot study were a convenience sample of 32 patients hospitalized as a result of complications of CHF. Study methodology was a cross-sectional, interview style survey, utilizing the Schedule for Meaning in Life Evaluation (SMiLE). CONCLUSION: No statistical significance was found between SMiLE scores and demographic data, including number of admissions or length of time since diagnosis. These findings suggest meaning in life (MIL), and subsequently QOL, may not be related to having a diagnosis of CHF. IMPLICATIONS FOR PRACTICE: Identifying patients' relationship with their families, through the use of the SMiLE, has the ability to guide advanced planning decision making. Knowing, and preparing for, various family dynamics before the final stages of CHF may decrease episodes of care provided in opposition to patients' wishes, whether or not their wishes were previously stated or documented.