Justice, Equity, Diversity, Inclusion, and Belonging (JEDI-B) in Transition to Practice Programs.

Justice, equity, diversity, inclusion, and belonging (JEDI-B) are essential for creating safe and productive professional environments. Clear definitions of JEDI-B terms are essential for collective understanding and organizational buy-in. Institutional and transition to practice program efforts should focus on the development of inclusive cultures, diverse curriculum, and data-driven evaluation of JEDI-B policies, processes, and practices. Engagement in bias recognition and the unlearning of those biases is also vital. Despite current legislative challenges, the integration of JEDI-B principles remains a vital component in enhancing health care experiences for patients and fostering inclusive workplaces. [J Contin Educ Nurs. 2024;55(6):273-275.].

How Implementing a Digital Competency Management System Reduced Nurse Training Cost and Improved NPD Practitioner Satisfaction in a Pediatric Hospital.

BACKGROUND: Traditional competency evaluations and manual tracking created a problem within one organization. Subjective competency assessments and inconsistent recordkeeping resulted in increased organizational costs. These factors increased the workload of nursing professional development (NPD) practitioners, leading to job dissatisfaction and turnover. METHOD: The project lead evaluated how implementing a digital competency management system (CMS) affected nurse training costs and assessed NPD practitioners' satisfaction after the digital CMS conversion. RESULTS: A cost analysis compared training costs before and after implementation of a digital CMS. A pre- and postsurvey compared NPD practitioners' satisfaction before and after digital implementation. A digital CMS provided a centralized repository and educational platform, which saved $500,000 in training costs and increased NPD practitioners' job satisfaction by decreasing workload and creating meaningful mechanisms to accurately assess staff knowledge and skills. CONCLUSION: The NPD practitioners showed tangible outcome measures and return on investment by combining adult learning and technology. [J Contin Educ Nurs. 2024;55(5):239-245.].

Application of telemedicine in the COVID-19 epidemic: An analysis of Gansu Province in China.

This paper analyzes the application of various telemedicine services in Gansu Province, China during the COVID-19 epidemic, and summarizes the experiences with these services. In addition, the satisfaction levels of patients and doctors with the application of telemedicine in COVID-19 were investigated, the deficiencies of telemedicine in Gansu were determined, and recommendations for modification were proposed. Coronavirus Disease 2019 (COVID-19) has broken out in China, and Gansu Province in Northwest of China has not been spared. To date, there are 91 local COVID-19 cases and 42 imported cases. 109 hospitals were selected as designated hospitals during the COVID-19 outbreak, and most of them were secondary hospitals. However, it was unsatisfactory that the ability of medical services is relatively low in most of secondary hospitals and primary hospitals. Therefore, we helped the secondary hospitals cope with COVID-19 by means of remote consultation, long-distance education, telemedicine question and answer (Q&A). Our practical experience shows that telemedicine can be widely used during the COVID-19 epidemic, especially in developing countries and areas with lagging medical standards.

Burden of an educational program on end of life management in a Internal Medicine ward: a real life report.

BACKGROUND AND AIM: Appropriate end of life (EOL) management in Internal Medicine wards is challanging. The aim of this study was to analyze the burden of an educational program on EOL management in a Internal Medicine ward. Materials and methods: We retrospectively analysed characteristics and management of patients consecutively died in an italian Internal Medicine ward along one year. We compared demographic, co-morbidity, pharmacological treatment in the last 48-hours of life and procedures during hospital stay in patients died six months before and after an educational program on palliative cares and EOL management addressed to a team of physicians and nurses. RESULTS: Study population was composed by 354 patients (190 females), with mean age ± DS 83.5 ± 10.6 years, one half admitted after the educational program. Eighty-four percent of deaths was exepected in the last 48 hours before exitus. Demographic characteristics and causes of hospitalization were not different before and after educational program. After the educational program the sharing of palliative care program with patient, relatives and/or caregivers (97.7% vs 85.8%, p=0.0001) and written order to withdrawal vital parameters relevation (39.5% vs 22%, p=0.0005) significantly increased, while difference in pharmacological classes prescribed in the last 48 hours of life was not find. Blood (54.8% vs 67.2%, p=0.0219) and arterial gas analysis (28.8% vs 39.5%, p=0.0435) samples in the last 48 hours of life were significantly reduced. Radiological and/or endoscopic examinations, red cells or platelets transfusion were reduced and palliative therapy was increased, despite difference between the two periods was not statistically significant. CONCLUSION: Educational program in Internal Medicine wards aimed to improve skills could contribute to make EOL management more appropriate and patient-oriented and it should be strongly encour-aged.

Systems Thinking for Managing COVID-19 in Health Care Systems: Seven Key Messages.

This article provides the most current guidelines for nurse educators and nurses to use systems thinking to manage COVID-19 in health systems. A working definition of systems thinking is offered, with a review of basic knowledge and care in the context of the system awareness model (SAM). Seven key messages assist nurse educators and nurses in the management of COVID-19 patients culminating in leadership of complex health care systems using systems thinking. [J Contin Educ Nurs. 2020;51(9):402-411.].

Access to Care: Using eHealth to Limit Location-Based Barriers for Patients With Cancer.

BACKGROUND: Rural and urban communities may encounter barriers to care, which can lead to delays in timely screening, diagnosis, and treatment. eHealth interventions, such as televisits and remote patient monitoring, are being used increasingly to improve patient access to quality clinical cancer care and to support patient-provider communication. OBJECTIVES: This article describes how eHealth can bridge gaps in patient access to cancer care and provides insight into successful eHealth program implementation. METHODS: Articles that evaluate access to care and eHealth program implementation were summarized. Two case studies illustrate eHealth as a strategy to improve care delivery and access. FINDINGS: Integrating eHealth into clinical practice can help to transform care delivery and improve patient access to quality cancer care by limiting barriers.

Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis.

BACKGROUND: In the last decade, there is an increasing focus on detecting and compiling lists of low-value nursing procedures. However, less is known about effective de-implementation strategies for these procedures. Therefore, the aim of this systematic review was to summarize the evidence of effective strategies to de-implement low-value nursing procedures. METHODS: PubMed, Embase, Emcare, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched till January 2020. Additionally, reference lists and citations of the included studies were searched. Studies were included that described de-implementation of low-value nursing procedures, i.e., procedures, test, or drug orders by nurses or nurse practitioners. PRISMA guideline was followed, and the 'Cochrane Effective Practice and Organisation of Care' (EPOC) taxonomy was used to categorize de-implementation strategies. A meta-analysis was performed for the volume of low-value nursing procedures in controlled studies, and Mantel-Haenszel risk ratios (95% CI) were calculated using a random effects model. RESULTS: Twenty-seven studies were included in this review. Studies used a (cluster) randomized design (n = 10), controlled before-after design (n = 5), and an uncontrolled before-after design (n = 12). Low-value nursing procedures performed by nurses and/or nurse specialists that were found in this study were restraint use (n = 20), inappropriate antibiotic prescribing (n = 3), indwelling or unnecessary urinary catheters use (n = 2), ordering unnecessary liver function tests (n = 1), and unnecessary antipsychotic prescribing (n = 1). Fourteen studies showed a significant reduction in low-value nursing procedures. Thirteen of these 14 studies included an educational component within their de-implementation strategy. Twelve controlled studies were included in the meta-analysis. Subgroup analyses for study design showed no statistically significant subgroup effect for the volume of low-value nursing procedures (p = 0.20). CONCLUSIONS: The majority of the studies with a positive significant effect used a de-implementation strategy with an educational component. Unfortunately, no conclusions can be drawn about which strategy is most effective for reducing low-value nursing care due to a high level of heterogeneity and a lack of studies. We recommend that future studies better report the effects of de-implementation strategies and perform a process evaluation to determine to which extent the strategy has been used. TRIAL REGISTRATION: The review is registered in Prospero (CRD42018105100).

Critical Thinking Skills of RNs: Exploring Demographic Determinants.

BACKGROUND: Previous studies of nurses' critical thinking skills that included demographic characteristics as determinants have been inconclusive. This study explored demographic determinants of critical thinking skills among nurses from public hospitals in Peninsular Malaysia. METHOD: This cross-sectional study included 549 nurses recruited via multistage cluster sampling. Nurses completed the demographic questionnaire and Health Sciences Reasoning Test (HSRT). RESULTS: The majority of respondents failed to demonstrate critical thinking skills with a mean overall HSRT score of 13.8 (SD = 3.4). Educational qualifications (p = .003) and clinical specialties (p = .022) were significantly related to nurses' critical thinking skills. Years of clinical experience, age, and job ranking were not significant CONCLUSION: The findings indicate a need to address the present curriculum in nursing education and to reinforce critical thinking skills in the nursing workforce. Future research on how nurses in Malaysia acquire critical thinking skills is needed. [J Contin Educ Nurs. 2020;51(3):109-117.].

Adapting a Nurse-Managed Mobile Simulation Program to Meet Rural Health Nursing Continuing Education Needs.

BACKGROUND: Rural nurses often practice in settings with limited access to continuing education resources. A hospital alliance in southeastern North Carolina developed a unique nurse-led mobile simulation program as a shared regional asset, for the purpose of meeting continuing education needs of rural nurses. METHOD: The alliance used a hub-and-spoke model to deliver education to staff in rural, critical access hospitals in order to reduce costs associated with education travel, the resulting staffing shortages, and delays in critical training. Continuing education credit was awarded to nurses participating in the learning activity. RESULTS: Fully mobile simulation can be an effective delivery mode for continuing and just-in-time education for nurses practicing in rural settings. Establishing the program as a regional shared resource can make this a financially viable option for rural hospitals. CONCLUSION: Lessons learned during the mobile simulation program's evolution and the resulting financial sustainability are discussed. [J Contin Educ Nurs. 2020;51(2):82-86.].

Survivorship Fellowship: Evaluation and Evolution of a Program for Advanced Practice Providers.

A comprehensive cancer center in the midwestern United States implemented a stakeholder-engaged quality improvement process to extend its existing one-year advanced practice provider (APP) fellowship program consisting of general oncology education and clinical experience to include an additional survivorship clinical rotation. APP fellowship alumni and program stakeholders reported noticeable benefits and greater importance attributed to program participation, validating inclusion of a survivorship clinic rotation as part of the fellowship program.

Public health nurses' perinatal mental health training needs: A cross sectional survey.

AIM: To examine public health nurses' education, training, and professional support needs in perinatal mental health. BACKGROUND: Public health nurses have a key role in supporting maternal mental health including screening, support, referral, and decreasing stigmatization. DESIGN: A cross-sectional survey. METHODS: Data were collected from a convenience sample of Irish public health nurses (N = 105) from December 2016-February 2018. The anonymous postal survey consisted of the Perinatal Mental Health Questionnaire, Mental Illness: Clinician's Attitudes scale and Perinatal Mental Health Learning Needs questionnaire. RESULTS: Public health nurses reported good levels of knowledge (77.2%) and confidence (83.8%) in recognising women experiencing stress, anxiety and depression. They indicated less confidence in caring (50.5%) for women. The average score for the Mental Illness: Clinician's Attitudes scale was 35.9 (SD 5.9), suggesting positive attitudes towards women with significant mental illness. CONCLUSION: Public health nurses require educational opportunities to explore expressions of psychological distress across cultures and their own personal attitudes to mental health, systems of clinical supervision, and support pathways. IMPACT: Generating new knowledge on the importance of incorporating an attitude component in perinatal mental health education for public health nurses.

Health Care Leadership in the New Economy.

Most health care organizations are designed using industrial model performance standards based on conformity and conventionality. In the new economy, marked with exponential change, convergent competition, and empowered consumers, leaders are faced with building a model that can accommodate personalized medicine, managing patient-centered expectations, and value-creating hubs to remain viable. [J Contin Educ Nurs. 2019;50(5):196-198.].

Nursing Professional Development and Continuing Education in 2019: Organization, Assessment, and Evaluation.

The Administrative Angles column focuses on the practical aspects of continuing education and professional development administration. At the start of 2019, this column reflects on the organization, assessment, and evaluation needed to ensure successful professional development and continuing education programs. [J Contin Educ Nurs. 2019;50(1):6-8.].

Challenges in Implementing an E-Learning Education Program for Syringe Pump Use.

To prevent the incidence of risks imputable to human error during the process of preparing the infusion pump, clarity in teaching and learning are required. Because traditional classroom training is difficult and time-consuming, the aim of the present study was to challenge the implementation of an e-learning education program for syringe pump use. The impact of the e-learning program was evaluated with 100 nurses between March and June 2016. The e-learning program significantly increased general baseline knowledge in syringe pump use; however, aspects of the program confused participants. The feedback from 98 % of nurses on the e-learning program was that it was effective in helping them with this skill. However, only 54 % opted for the e-learning program versus traditional training. The present study showed nurses preferred a blended learning format. Based on our hospital incident and error reports, this study shows local training requires a specific approach strategy for syringe pump education.

Exploring health economics course competencies' value for nurse administrators.

BACKGROUND: A survey of nursing administrators in the United States was conducted to solicit opinions about health economics (HE) course competencies for baccalaureate nursing programs. PURPOSE: To provide rationale for intensifying educational efforts to increase nurses' awareness about the value of HE skills in their everyday work. METHODS: Participants were asked to rate six HE competencies using a Likert scale. Paired-samples t tests, bivariate correlations, and standard multiple linear regressions were used to analyze survey results. DISCUSSION: A strong direct relationship exists between the amount of prior knowledge nursing administrators have about HE and the perceived level of usefulness of HE skills. CONCLUSION: Nurses' contributions to creating value in healthcare must be encouraged. Increasing the share and accessibility of the HE content in continuing education offerings could be one way to expand HE knowledge among practicing nurses and promote cost-effective delivery of healthcare in the United States.

Care of veterans in a non-veteran health administration hospital: What is the status of nursing practice after continuing education?

AIMS AND OBJECTIVES: To identify how civilian nurses are caring for military veterans following mandatory continuing education on veterans' mental health needs and to describe challenges nurses are facing in provision of that care. BACKGROUND: Veterans and military personnel experience mental health conditions at a high rate and are increasingly receiving care in civilian healthcare facilities. Nonmilitary providers may not be prepared to address this population's challenging needs. Military culture may influence the presentation of mental health conditions; thus, critical assessment points by nonmilitary medical personnel may be missed. Education is touted internationally as a means to address deficits, but research is lacking to support that statement. METHODS: Adhering to research reporting guidelines, 115 of a proposed 322 civilian nurses in a tertiary hospital volunteered to complete a one-time online survey that contained quantitative and demographic questions. Forty of 115 nurses went on to complete the qualitative query. Descriptive statistics summarised quantitative results, and constant comparative analysis was applied to qualitative responses for theme identification. RESULTS: The study was stopped early due to reports of violence from veterans upon nurses. Results showed continuing education did not change documentation of military status. Following mandatory continuing education, civilian nurses continued to describe uncertainty in how to adapt care, on how to interact with veterans and in how to deal with violence. CONCLUSION: The status of care to veterans remains insufficient, but nurses are asking critical questions on how to update practice. Additional support and research in the clinical setting is needed to promote a safe caring environment. RELEVANCE TO CLINICAL PRACTICE: Continuing education alone may not advance care of the veteran. A multipronged approach to include mandatory documentation of military status and coaching of providers by those experienced with the military way of life may be used to augment staff preparedness.

The Family Meal Challenge: A Faith-Based Intervention to Empower Families.

African Americans have increased rates of overweight and obesity and are least likely to participate in family meals compared with other racial groups. A Family Meal Challenge (FMC) was developed with the objective of empowering individuals to eat healthy meals together as a family. The FMC was presented through four classes in three churches, two faith-based ministries, and two community service programs in health disparity zip codes. Surveys (N = 257) indicated a positive response. Engaging participants and teaching the benefits of eating healthy family meals in a faith-based environment are feasible and may increase the frequency of family meals. Information is provided to create and implement an FMC in any faith setting.

Strategies for Integrating Global Awareness and Engagement Into Clinical Practice.

Nurse educators are faced with the challenge of educating learners about global health for clinical practice, particularly as cultural diversity increases in their own communities. This third article in the four-part Teaching Tips series focuses on active teaching-learning strategies for global health awareness and engagement in clinical practice using interprofessional education global health competencies and evidence-based interactive teaching strategies. Tips and topic ideas are offered for integrating global awareness and engagement in both the academic and practice settings to prepare today's nurses for systems-based culturally competent care in clinical practice. J Contin Nurs Educ. 2018;49(5):203-205.

Creating LGBTQ-Inclusive Care and Work Environments.

In considering the full depth of inclusion in care and work environments (and developing inclusive engagement skills for lesbian, gay, bisexual, transgender, queer or questioning [LGBTQ] patients and their families), professional development leaders must bring these discussions and shared learnings into the open. Understanding the LGBTQ population's unique needs is essential to providing personalized health care, and inclusive work environments help to foster more inclusive care for this population. J Contin Educ Nurs. 2018;49(4):151-153.