Teamwork in Acute Care: Perceptions of Essential but Unheard Assistive Personnel and the Counterpoint of Perceptions of Registered Nurses.

Teams of unlicensed personnel and registered nurses have provided hospital-based nursing care for decades. Although ineffective teamwork has been associated with poor patient outcomes, little is known of the perspectives of nursing assistive personnel (NAP). The purpose of this study was to gain insights into the perceptions of NAP and professional registered nurses (RNs) on teamwork in acute care. In a qualitative descriptive approach in a metropolitan hospital in the southeastern United States, 33 NAP participated in audio-recorded focus group sessions, and 18 RNs provided responses to open-ended electronic survey questions. Findings were examined in relation to previously identified coordinating mechanisms of teamwork: shared mental models, closed-loop communication, and mutual trust. None of the mechanisms was strongly represented in these data. In contrast to RNs' mental models, NAP perceptions of teamwork included the centrality of holistic caring to the NAP role, functional teams as NAP-only teams, NAPs and RNs working in parallel spheres rather than together, and team coordination in silos. Closed-loop communication was less common than one-way requests. Mutual trust was desired, but RNs' delegation of tasks conveyed to NAP a lack of value and respect for the NAP role, while RNs perceived a professional obligation to delegate care to ensure quality of care amid changing patient priorities. Further empirical research into NAP practice is needed to enhance understanding of teamwork issues and direct effective interventions to improve work environments and ultimately patient outcomes. © 2016 Wiley Periodicals, Inc.

Isothermal dialysis to control intradialytic hypotension and patient comfort: a pilot study.

Isothermal hemodialysis to improve intradialytic tolerance in hypotension-prone patients has been effective in outpatient settings. The purpose of this pilot study was to examine thermal control in an acute care setting and describe comfort issues associated with thermal control Although complaints of cold or shivering occurred more frequently with the isothermal hemodialysis group, cold discomfort was managed by nursing interventions and was not a cause of significant discomfort. No statistically significant difference was observed in blood pressure or patient's comfort level between standard and isothermal dialysis. However, isothermal hemodialysis may be an appropriate hemodialysis option for control of intradialytic hypotension in the acute care setting. Further research is recommended.

The development of the next generation of nurse leaders.

This article explains the development of a value-added leadership focus to a graduate nursing program. With the changes to and complexity within the health care system, advanced practice nurses need academic preparation in advanced care management of populations and leadership competencies. Strategic environmental scanning suggested that some revisions could better prepare future nurse leaders. Through literature review and focus groups, faculty's analysis provided evidence for development of a different kind of advanced practice nurse. This process led to a graduate program that prepares nurse leaders who are competent in the clinical settings and leadership roles of today's health care organizations. The 40-semester hour program allows flexibility for minimum career disruption and a choice of tracks to accommodate individuals' educational needs. Grounded in practicum experiences and guided by health care theory, policy, and research, graduates possess the knowledge and competencies to assume the advanced leadership roles required in future health care systems.

Utilizing evidence-based design in a community hospital ICU.

This project documents a strategic planning process utilized during an academic clinical experience to establish evidence-based design features in new construction of an intensive care unit at a community hospital, while optimizing safe and cost-effective quality care, based upon evidence-based research.

Research Prescription for Undergraduate Students: Research Mentoring in a Small Liberal Arts University.

Creating and executing unique research projects for completion in four semesters is a challenge especially in a small liberal arts university in a rural Health Professions Shortage Area (HPSA) with a newly established BSN program. HPSAs are designations that indicate health care provider shortages in primary care, dental health or mental health. Undergraduate research is an emerging focus across campus with limited faculty funding. Most of our nursing faculty are in the process of developing their programs of research which required faculty of the research course to become mentors for both faculty and students. This article describes one strategy utilized in establishing an undergraduate research focus within a BSN nursing program. Working in small groups with a faculty mentor, students planned and conducted their entire research study, presenting their findings to the university community in the period of four semesters of the nursing program. Research course faculty served as mentors for less experienced faculty, involving the entire nursing program in research. Research projects were conducted in institutional and community settings to improve population health in our HPSA.

The use of human patient simulators: best practices with novice nursing students.

Only recently have nursing educators begun to consider the enormous implications of using high-fidelity human patient simulation in general nursing education. As a first step in exploring the potential of this new technology with novice nursing students, faculty conducted a quantitative and qualitative analysis of students' reactions to a simulation. In addition, from the analysis and the review of literature, the faculty identified specific best practices for using this educational methodology with novice nursing students.

Pilot Feasibility Study of an Educational Intervention in Women With Gestational Diabetes.

OBJECTIVES: To pilot test the feasibility of an educational intervention, Start Understanding Gestational Diabetes and Risk of Developing Type 2 Diabetes (SUGAR), in women with gestational diabetes mellitus (GDM). DESIGN: A pretest-posttest, two-group study design. SETTING: Three obstetrics and gynecology offices in the southeastern United States. PARTICIPANTS: Twenty-three women with a first-time diagnosis of GDM. METHODS: Women diagnosed with GDM were recruited and placed in a control group or educational intervention group. Women completed six self-report, standardized questionnaires at baseline (third trimester) and posttest (6-8 weeks postpartum). Women in the intervention group (n = 18) received the SUGAR educational intervention after the baseline data collection with a booster session at 2 to 4 weeks postpartum. Women in the control group (n = 5) received an attention control treatment. RESULTS: Study participants had obesity, and most had a family history of type 2 diabetes mellitus. The attrition rate was low (n = 2; 8%). The educational intervention significantly increased diabetes mellitus knowledge for women in the SUGAR group. In addition, 39% of participants received the recommended postpartum glucose screening. CONCLUSION: Although the effect of the SUGAR intervention with a small sample was not expected to produce statistically significant changes, we add our pilot study to the limited research of diabetes mellitus preventative care for women with GDM and provide preliminary findings to develop meaningful education and support for women diagnosed with GDM. Future researchers need to focus on prevention programs that center on self-efficacy, postpartum glucose screening, and adoption of healthy lifestyle behaviors.

The effect of unit-based simulation on nurses' identification of deteriorating patients.

Patients are admitted to healthcare organizations with multiple, complex conditions that can lead to acute deterioration events. It is imperative that nurses are adequately trained to recognize and respond appropriately to these events to ensure positive patient outcomes. The purpose of this pilot research study was to examine the effects of a unit-based, high-fidelity simulation initiative on cardiovascular step-down unit registered nurses' identification and management of deteriorating patients.