Improving Heart Failure Patient Engagement with Mobile Apps Using Nurse Navigators.

ABSTRACT: Providing high-quality heart failure education through smartphone applications (apps) empowers patients to more successfully manage their disease process outside the hospital setting. The purpose of this project was to evaluate the addition of nurse navigators to increase engagement of newly-diagnosed heart failure patients with the GetWell Loop (GWL) technology program that assists patient learning and monitoring for self-care. Adding navigators increased patient engagement with the GWL over the use of the GWL without navigators.

The Global Leadership Mentoring Community: An evaluation of its impact on nursing leadership.

AIM: To evaluate a year-long mentorship program, pairing nurses from different regions across the world to support their global leadership capability, and identifying additional consequences of their participation. BACKGROUND: Investment in developing nurse leaders continues as a strategic global imperative. Building on the first cohort's recommendations, this second program illustrates continued progress. PROGRAM EVALUATION: Using the logic model of program evaluation, this non-empirical paper uses data collected from anonymized questionnaires and participants' stories to help improve the program, illustrating innovative practices to develop the confidence and competence of emerging and established nurse leaders globally. DISCUSSION: The value of mentorship was recognized, and there were gains for both mentors and mentees in the development of leadership confidence and competence. Through engagement and collaboration with the whole community, participants were encouraged to understand their own and others' cultures avoiding assumptions and stereotypes. CONCLUSION: This evaluation illustrates that in addition to helping improve future programs, mentorship has enabled the growth of individuals' skill sets and the confidence to reach out to peers across the world to understand the meaning of global health and to make a meaningful contribution to the challenges they face. IMPLICATIONS FOR NURSING PRACTICE: Nurse managers should be encouraged to develop and formalize a mentoring culture to benefit the leadership competence and well-being of their workforce. IMPLICATIONS FOR NURSING POLICY: Every nurse has a responsibility to invest in nursing leadership for themselves and others. Mentorship can assist nurse leaders to build workforce capability to lead and contribute to the policy agenda locally, nationally, and internationally. Starting early and at the individual level, global mentorship programs can develop leadership expertise to help nurses find their voice and strengthen their confidence and competence to lead and therefore build the strategic leaders of the future.

School Nurses Perceptions on Managing Asthma in Alabama Schools.

Asthma is the most common chronic condition in children under 18. In Alabama, 11% of children report a diagnosis of asthma compared to the United States with 9.5%. Childhood asthma is the leading cause of school absenteeism due to a chronic disease, and Alabama children with asthma miss approximately 10 days of school each year for uncontrolled asthma. Managing children in the school system with asthma can often be challenging for school nurses. In this cross-sectional study, perceptions of Alabama school nurses on managing asthma in the school were explored. School nurses feel prepared to manage asthma but identify lack of certain resources and supportive policies, especially access to medications as barriers to optimum care. Implications for statewide advocacy at the policy level and broadening educational activities are supported by the survey results.

Capacity building in nurse educators in a Global Leadership Mentoring Community.

Globally, nurse educators participate in the three main role activities of teaching, scholarship, and service. Matching for different global locations and career stages, 12 mentor-mentee pairs completed a one-year coordinated virtual program through Sigma Theta Tau International's Global Leadership Mentoring Community and mentees reported building their nurse educator capacities. The authors describe factors that potentially influence international mentoring such as language, time, technology, and key characteristics of mentoring relationships. Growth in educator roles occurred in the contexts of the culture of academe itself and Boyer's definitions of scholarship. Consistent with Sigma's vision statement, nurse educators have a global presence and responsibility to prepare competent nurses who can advance the health of the world's people. Readers may benefit for future planning of mentoring activities to build capacities in nurse educator roles through international interactions.

Association Development and Professional Transformation model for nurse leaders.

AIMS: This pilot study evaluated an Association Development and Professional Transformation (ADAPT) model for nursing leadership development and assessed satisfaction with the ADAPT workshop. BACKGROUND: Nurses often lack self-confidence and self-efficacy in leadership roles. There is a need for nurses to take leadership opportunities that serve to advance the nursing profession. METHODS: A quasi-experimental pre-test post-test design was used. The sampling method selected professional nursing association (PNA) members. Novice participants completed a pre-assessment and post-assessment Leadership Practice Inventory-Self (LPI-S) survey and attended the ADAPT workshop. Experienced nurse leaders participated as mentors. Both groups completed a satisfaction survey after the workshop. RESULTS: Awareness of nursing leadership behaviours increased. Total mean scores for each subscale on the LPI-S increased but this was not statistically significant. All participants reported satisfaction with the ADAPT workshop. CONCLUSIONS: This study offers evidence that the ADAPT model influences leadership behaviours. The ADAPT workshop provided a method to gain a leadership perspective and to encourage nurses to fulfil a leadership role within professional nursing associations. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations and professional nursing associations that support the leadership potential of nurses must invest in providing leadership development opportunities.

Building Bridges: The Journey of Alabama's Health Action Coalition.

AIM: The Alabama Health Action Coalition is a state coalition whose purpose is to enable access to high-quality, safe, and patient-centered health care for all Alabamians by leading change in nursing and health care. BACKGROUND: The Alabama Health Action Coalition has four focus areas: advancing nursing education, improving nursing workforce data, promoting diversity among nursing and health care professionals, and fostering a culture of health. METHOD: From 2012 to 2014, the Advancing Education Taskforce and Health Workforce Committee initiated processes to maximize resources, track changes in workforce data, and provide support for goal achievement. RESULTS: Outcomes included an increase in the number of nurses with a BSN and higher degrees from 35 percent to 50 percent, nearing national averages. CONCLUSION: Tracking of trends continues with 2016 data. This growth is particularly important in a state with a large, underserved population and high percentage of rural areas.

Nurse-Driven Catheter-Associated Urinary Tract Infection Reduction Process and Protocol: Development Through an Academic-Practice Partnership.

Translating evidence-based practices to the bedside can be facilitated by an active academic-practice partnership between nursing faculty and frontline nursing staff. A collaborative effort between the university's academic nurses and the medical center's clinical nurses explored, created, implemented, and evaluated an evidence-based nurse-driven protocol for decreasing the rate of catheter-associated urinary tract infections. The nurse-driven protocol was piloted in 4 intensive care units and included nurse-driven orders for catheter discontinuation, utilization of smaller bore urinary catheters, addition of silver-based cleansing products for urinary catheter care, and education of staff on routine catheter care and maintenance. Data were collected for more than 8 months pre- and postimplementation of the nurse-driven protocol. Postimplementation data revealed a 28% reduction in catheter-associated urinary tract infections in the intensive care units as compared with preimplementation. Secondary benefits of this academic-practice partnership included strengthening the legitimacy of classroom content as lessons learned were integrated into courses in the nursing curriculum. The result of the partnership was a stronger sense of collaboration and collegiality between hospital staff and the university faculty. Transformative leadership engaged numerous stakeholders through collaborative efforts to realize best practices. An academic-practice partnership facilitates transformative change and provides structural stability and sustainability.

Frontline Nurse Engagement and Empowerment: Characteristics and Processes for Building Leadership Capacity.

Improving health care quality is the responsibility of nurses at all levels of the organization. This article describes a study that examined frontline staff nurses' professional practice characteristics to advance leadership through the understanding of relationships among practice environment, quality improvement, and outcomes. The study design was a descriptive quantitative design at 2 time points. Findings support the use of research and quality processes to build leadership capacity required for positive resolution of interdisciplinary operational failures.

Bridge to shared governance: developing leadership of frontline nurses.

Transforming health care systems to improve quality is the responsibility of nurse executives and frontline nurses alike, yet frontline nurses are often ill-prepared to share leadership and accountability needed for transformation. The aim of this qualitative study was to describe the process used to build leadership capacity of frontline nurses engaged in resolving operational failures interrupting nursing care. The leadership development process served to bridge staff transition to shared governance. This institutional review board-approved qualitative research was designed to identify the effects of mentoring by the chief nursing officer and faculty partners on leadership development of frontline nurses working to find solutions to operational failures. Twelve nurses from 4 medical surgical units participated in a Frontline Innovations' nurse-led interdisciplinary group, which met over 18 months. Transcriptions of audiotaped meetings were analyzed for emerging process and outcome themes. The transcripts revealed a robust leadership development journey of frontline nurses engaged in process improvement. Themes that emerged from the mentoring process included engagement, collaboration, empowerment, confidence, and lifelong learning. The mentoring process provided frontline nurses the leadership foundation necessary to initiate shared governance.

Chronological progression of body dissatisfaction and drive for thinness in females 12 to 17 years of age.

The purpose of this secondary study of cross-sectional data was to examine patterns of scores on the Eating Disorders Inventory in a healthy sample of female adolescents thought to have a high potential for risk. Data were obtained as part of a consultation to identify risk of developing eating disorders. The screening and subsequent group level analysis was carried out with 44 female dancers 12 to 17 years of age enrolled in grades 7 to 12 in a Magnet school. This secondary analysis examined three components of the Eating Disorder Inventory (EDI-3): body dissatisfaction, drive for thinness, and bulimia for the purpose of comparing group findings across ages and grades. Some level of body dissatisfaction was widespread in the population, body dissatisfaction increased beginning notably at age 14 and increased sharply at age 15, with further increases until age 16. The correlation between body dissatisfaction and drive for thinness was shown to be statistically significant (r = 0.83, p < 0.001). Awareness that body dissatisfaction and drive for thinness increase at ages 15 and 16 means disordered eating may begin at this time. If body dissatisfaction and drive for thinness begins early in life and markedly increases at ages 14 and 15, eating disorder prevention must begin in childhood and continue into adolescence.

Transforming Care at the Bedside (TCAB): enhancing direct care and value-added care.

AIM: The purpose of this study was to examine the effectiveness of a Transforming Care at the Bedside initiative from a unit perspective. BACKGROUND: Improving patient outcomes and nurses' work environments are the goals of Transforming Care at the Bedside. Transforming Care at the Bedside creates programs of change originating at the point of care and directly promoting engagement of nurses to transform work processes and quality of care on medical-surgical units. METHODS: This descriptive comparative study draws on multiple data sources from two nursing units: a Transforming Care at the Bedside unit where staff tested, adopted and implemented improvement ideas, and a control unit where staff continued traditional practices. Change theory provided the framework for the study. RESULTS: Direct care and value-added care increased on Transforming Care at the Bedside unit compared with the control unit. Transforming Care at the Bedside unit decreased in incidental overtime. Nurses reported that the process challenged old ways of thinking and increased nursing innovations. Hourly rounding, bedside reporting and the use of pain boards were seen as positive innovations. CONCLUSIONS: Evidence supported the value-added dimension of the Transforming Care at the Bedside process at the unit level. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses recognized the significance of their input into processes of change. Transformational leadership and frontline projects provide a vehicle for innovation through application of human capital.

Assessing emotional well-being of children in a Honduran orphanage: feasibility of two screening tools.

The World Health Organization (WHO) has determined mental health in children to be a priority area for evidence-based interventions. Effective and efficient screening methods are needed to assess emotional well-being of children from diverse cultures. This descriptive study examined two tools for feasibility, sensitivity, cultural appropriateness, and cost/time effectiveness. Emotional well-being was conceptualized using the Roy Adaptation Model as part of the self-concept adaptive mode. Emotional indicators were measured from Human Figure Drawings. Anxiety was measured using a modification of the Revised Children's Manifest Anxiety Survey (RCMAS). The sample included 11 girls who were 7 to 12 years of age and recruited from a girls' orphanage in Honduras. Results indicated the Human Figure Drawings identified more children possibly at risk than the RCMAS. Human Figure Drawings were found to be a time/cost-effective, sensitive, and culturally appropriate means for measuring emotional well-being in the setting. This study contributes to nursing knowledge by demonstrating feasibility of the screening tools for measuring emotional well-being of children in varied cultures.

"Change can be good": unit perspectives on transforming care at the bedside.

BACKGROUND: How do nurses commit to effecting change, the kind of change that will transform both care received and the caregiver? This was the mission of Transforming Care at the Bedside, the 2003 initiative sponsored by the Robert Wood Johnson Foundation and the Institute of Healthcare Improvement. OBSERVATIONS AND OBJECTIVES: This analysis reflects processes and context of unit change through Transforming Care at the Bedside. Organizational leadership includes engagement in change. SUBJECTS AND METHODS: Descriptions of change process were solicited from stakeholder interviews and focus groups to evaluate and make recommendations for the future. RESULTS AND CONCLUSIONS: Stakeholders recognized that "Change can be good!" Reflection and strategic evaluation strengthen planning for sustainability supporting staff engagement and transformational leadership in an academic health science setting.

Promoting Adaptation in Female Inmates to Reduce Risk of Opioid Overdose Post-Release Through HOPE.

The purpose of the project was to develop a sustainable pre-release education program to reduce the risk of opioid overdose post-release in female inmates in a rural county jail in Middle Tennessee. The project was supported and guided using Roy's adaptation model. Content analysis resulted in common themes (initiation, moral failure, ineffective strategies, supportive environment, new beginnings, and adaptive domains), identified within the pre- and post-implementation surveys. The implementation of a successful reentry program for the vulnerable female incarcerated population has the potential to reduce the risk of opioid overdose death and negative health outcomes post-release.

Moral Injury in Veterans: Application of the Roy Adaptation Model to Improve Coping.

The objective of this article is to provide validation, application, and understanding of the concept of moral injury and build provider awareness to reduce veteran self-harm. Two focus groups were conducted: one to identify characteristics of moral injury and the other to refine the concepts and generate clinical approaches that address maladaptive coping strategies. The focus group sessions verified moral injury's existence, and focus group consensus centered on loss of role identity and shattering of the veteran's core integrity. The veteran's inability to self-reflect is identified as a significant contributor to the maladaptive thought process, creating internal triggers based on violations of deeply held beliefs. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A33.

Embracing changes: adaptation by adolescents with cancer.

PURPOSE: The purpose of this study was to use the Roy Adaptation Model (RAM) to examine adaptive strategies of adolescents with cancer. METHOD: This theory-based, descriptive study was conducted through a children's hematology/oncology clinic. Investigator-designed open-ended interview questions were generated based on the four adaptive modes--physiological, self-concept, role function, and interdependence. Respondents included adolescents and young adults who had experienced cancer as adolescents. FINDINGS: Adolescents and young adults reported evidences of positive adaptation. Experiences congruent with the adaptive modes included responding to uncontrolled nausea, embracing changes, wanting to feel normal, having the support and protection of family, and feeling increased psychosocial maturation. CONCLUSIONS: Respondents reported creatively managing bodily changes, keeping positive attitudes, and demonstrating psychosocial maturation. Practice implications highlight the imperative for nurses to listen to patients in the evaluation of care. In addition, establishing survivor clinics, structuring peer support, and encouraging involvement in activities such as cancer camps can facilitate adaptation. Through the crisis of cancer, the adolescent's voice can shape the direction for nursing care.

Perceptions of children with HIV/AIDS from the USA and Kenya: self-concept and emotional indicators.

Perceptions of children's self-concept and associated emotional indicators were assessed in two populations, United States and Kenya, in children living with HIV/AIDS. Assessment of the self-concept mode of the Roy Adaptation Model used both verbal and nonverbal strategies. The sample of children (N = 48), ages 7 to 12 years who were HIV-positive, was recruited from a family clinic that cares for children with chronic illness in the United States (n = 6) and an orphanage that provides for HIV-positive children in Kenya (n = 42). Self-concept was measured using a modification of Piers-Harris Self-Concept Scale. Emotional indicators were measured from Human Figure Drawings (HFD) described by Koppitz (1968). All U.S. children were found to have an average self-concept and one-third demonstrated significant emotional indicators. In Kenya, 93% of the participants had an average self-concept and half were found to have significant emotional indicators. HFD can be used with other screening tools to perform a psychosocial assessment and screening for referral. This study contributes to nursing science by introducing a model-based assessment with cross-cultural applicability.

Interprofessional Pharmacokinetics Simulation: Pharmacy and Nursing Students' Perceptions.

Interprofessional practice between pharmacists and nurses can involve pharmacokinetic dosing of medications in a hospital setting. This study describes student perceptions of an interprofessional collaboration pharmacokinetics simulation on the Interprofessional Education Collaborative (IPEC) 2016 Core Competencies. The investigators developed a simulation activity for senior undergraduate nursing and second-year pharmacy students. Nursing and pharmacy students (n = 54, 91 respectively) participated in the simulation using medium-fidelity manikins. Each case represented a pharmacokinetic dosing consult (vancomycin, tobramycin, phenytoin, theophylline, or lidocaine). Nursing students completed head-to-toe assessment and pharmacy students gathered necessary information and calculated empiric and adjusted doses. Students communicated using SBAR (Situation, Background, Assessment, and Recommendation). Students participated in debrief sessions and completed an IRB-approved online survey. Themes from survey responses revealed meaningful perceptions in all IPEC competencies as well as themes of safety, advocacy, appreciation, and areas for improvement. Students reported learning effectively from the simulation experience. Few studies relate to this type of interprofessional education experience and this study begins to explore student perceptions of interprofessional education (IPE) in a health sciences clinical context through simulation. This real-world application of nursing and pharmacy interprofessional collaboration can positively affect patient-centered outcomes and safety.