Measuring the PULSE of Nursing: Development of a Dashboard to Evaluate and Monitor Nursing Care Models.

BACKGROUND: Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings. PROBLEM: A mechanism to continuously monitor the impact of this staffing change was not available. APPROACH: Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics. OUTCOMES: The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators. CONCLUSION: The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.

Mapping the Expert Mind: Integration Method for Revising the ACES Medical Simulation Curriculum.

PURPOSE: This article shares our experience developing an integrated curriculum for the ACES (Acute Critical Event Simulation) program. The purpose of the ACES program is to ensure that health care providers develop proficiency in the early management of critically ill patients. The program includes multiple different types of educational interventions (mostly simulation-based) and targets both specialty and family physicians practicing in tertiary and community hospitals. METHODS: To facilitate integration between different educational interventions, we developed a knowledge repository consisting of cognitive sequence maps that make explicit the flow of cognitive activities carried out by experts facing different situations - the sequence maps then serving as the foundation upon which multimodal simulation scenarios would be built. To encourage participation of experts, we produced this repository as a peer-reviewed ebook. Five national organizations collaborated with the Royal College of Physicians and Surgeons of Canada to identify and recruit expert authors and reviewers. Foundational chapters, centered on goals/interventions, were first developed to comprehensively address most tasks conducted in the early management of a critically ill patient. Tasks from the foundational chapters were then used to complete the curriculum with situations. The curriculum development consisted of two-phases each followed by a peer-review process. In the first phase, focus groups using web-conferencing were conducted to map clinical practice approaches and in the second, authors completed the body of the chapter (e.g., introduction, definition, concepts, etc.) then provided a more detailed description of each task linked to supporting evidence. RESULTS: Sixty-seven authors and thirty-five peer reviewers from various backgrounds (physicians, pharmacists, nurses, respiratory therapists) were recruited. On average, there were 32 tasks and 15 situations per chapter. The average number of focus group meetings needed to develop a map (one map per chapter) was 6.7 (SD ± 3.6). We found that the method greatly facilitated integration between different chapters especially for situations which are not limited to a single goal or intervention. For example, almost half of the tasks of the Hypercapnic Ventilatory Failure chapter map were borrowed from other maps with some modifications, which significantly reduced the authors' workload and enhanced content integration. This chapter was also linked to 6 other chapters. CONCLUSIONS: To facilitate curriculum integration, we have developed a knowledge repository consisting of cognitive maps which organize time-sensitive tasks in the proper sequence; the repository serving as the foundation upon which other educational interventions are then built. While this methodology is demanding, authors welcomed the challenge given the scholarly value of their work, thus creating an interprofessional network of educators across Canada.

Teaching nurses teamwork: Integrative review of competency-based team training in nursing education.

Widespread demands for high reliability healthcare teamwork have given rise to many educational initiatives aimed at building team competence. Most effort has focused on interprofessional team training however; Registered Nursing teams comprise the largest human resource delivering direct patient care in hospitals. Nurses also influence many other health team outcomes, yet little is known about the team training curricula they receive, and furthermore what specific factors help translate teamwork competency to nursing practice. The aim of this review is to critically analyse empirical published work reporting on teamwork education interventions in nursing, and identify key educational considerations enabling teamwork competency in this group. CINAHL, Web of Science, Academic Search Complete, and ERIC databases were searched and detailed inclusion-exclusion criteria applied. Studies (n = 19) were selected and evaluated using established qualitative-quantitative appraisal tools and a systematic constant comparative approach. Nursing teamwork knowledge is rooted in High Reliability Teams theory and Crew or Crisis Resource Management sources. Constructivist pedagogy is used to teach, practice, and refine teamwork competency. Nursing teamwork assessment is complex; involving integrated yet individualized determinations of knowledge, skills, and attitudes. Future initiatives need consider frontline leadership, supportive followership and skilled communication emphasis. Collective stakeholder support is required to translate teamwork competency into nursing practice.

Optimizing Oxygenation in the Mechanically Ventilated Patient: Nursing Practice Implications.

Critical care nurses constitute front-line care provision for patients in the intensive care unit (ICU). Hypoxemic respiratory compromise/failure is a primary reason that patients require ICU admission and mechanical ventilation. Critical care nurses must possess advanced knowledge, skill, and judgment when caring for these patients to ensure that interventions aimed at optimizing oxygenation are both effective and safe. This article discusses fundamental aspects of respiratory physiology and clinical indices used to describe oxygenation status. Key nursing interventions including patient assessment, positioning, pharmacology, and managing hemodynamic parameters are discussed, emphasizing their effects toward mitigating ventilation-perfusion mismatch and optimizing oxygenation.