A Quality Improvement Project to Reduce Antibiotic Utilization and Ancillary Laboratory Tests in the Appraisal of Early-Onset Sepsis in the NICU.

BACKGROUND: Diagnosis and treatment of early-onset sepsis (EOS) of the newborn remains a controversial issue among providers due to the non-infectious symptomology which exists in the newborn period. METHODS: Pre/post interventional quality improvement project in a level III NICU to reduce antibiotic utilization and ancillary laboratory tests with the introduction of an evidence-based guideline for the evaluation of EOS in the NICU. RESULTS: Primary outcome measures include mean number of empiric antibiotic treatment days and utilization rate (AUR), number of laboratory tests ordered, and incidence of unwarranted antibiotic therapy beyond the 48-h rule out period. Mean empiric antibiotic treatment days decreased from 2.94 to 1.58 days and overall antibiotic use decreased from 73.7% to 57.1%. Likewise, the mean AUR decreased from 212.5 to 147.6 days of therapy per 1000 patient days. There was an 86% decline in the number of ancillary tests and unwarranted antibiotic use beyond 48- h was reduced by 74%. DISCUSSION: Guidelines for EOS of the newborn should include a thorough baseline evaluation of the drivers of antibiotic use to create an evidence-based foundation. Reducing unnecessary antibiotic use and EOS evaluations in a safe and effective manner have the potential to lower consumer and healthcare expenditures while improving the long-term health of the newborn in the NICU. CONCLUSIONS: These findings emphasize the importance of implementing an evidence-based protocol for antibiotic stewardship in the NICU. With further research there is the potential to improve the healthcare of newborns while reducing expenditures in a safe, effective evaluation of EOS in the newborn population.

School Nurses' Perceived Barriers and Perceptual Influences When Implementing AED Programs.

School nurses' experienced barriers and benefits with perceptions of self-efficacy are important factors to consider for program implementation in the school setting. Little research has been done in the area of automated external defibrillator (AED) program implementation by the school nurse for the treatment of sudden cardiac arrest. The purpose of this study was to identify benefits of and barriers to AED program implementation in public schools and measure school nurses' self-efficacy related to their role as a change agent in program implementation. Results revealed that school nurses are functioning with a high level of self-efficacy in their ability to influence major health-care decisions in the school setting, and despite barriers, AED program implementation is considered beneficial and a necessary component of emergency care.

Journey to simulation program accreditation.

Accreditation of simulation programs is relatively new, and entails a rigorous process of planning, development and evaluation of all aspects of the simulation experience for students and/or health care professionals. The purpose of this paper is to describe the experience of a Nursing Simulation Program in achieving designation as a fully accredited program. The process of developing a formal simulation program, strategic plan, policies and procedures, and an evaluation plan are included, as well as the benefits to achieving accreditation.

Nursing Faculty Attitudes and Practices Related to Online Teaching.

Online education as a teaching methodology is relatively new in higher education in comparison to traditional face-to-face instruction. There is often concern that the quality of online classes is inferior and that academic rigor is compromised when faculty are not engaged with students in a classroom. The purpose of this pilot study was to assess nursing faculty attitudes and practices regarding online teaching. Findings indicated that overall, faculty feel that achievement of student learning outcomes in online and hybrid settings is comparable to face-to-face and report excitement with most aspects of teaching online.

School nurse intention to pursue higher education.

In 2011, the Institute of Medicine recommended that 80% of the nurses possess a minimum of a bachelor of science in nursing by 2020 and double the number of doctorally prepared nurses. This has prompted a significant number of registered nurses to advance their educational level. School nurses in Louisiana are not required to have a bachelor's degree. In many states, the bachelor's degree is required for all school nurses, and many school nurses are prepared at the masters' and doctoral levels. The purpose of this study was to examine the intention of Louisiana school nurses to pursue higher education in nursing. A survey was distributed to all members of the Louisiana School Nurses Organization, and results indicated that 65% of the participants were motivated to return to school. Incentives and barriers to pursuing higher education were identified, and strategies for overcoming these barriers were proposed.

Student and faculty perceptions of effectiveness of online teaching modalities.

BACKGROUND: When the COVID-19 pandemic forced colleges and universities to rapidly transition from face-to-face teaching to online teaching/learning environments, different instructional methods were employed to deliver course content and help students remain engaged in learning. With the transition back to the on-campus environment, select online teaching modalities may be effective in the face-to-face environment as well. While online and distance learning have been extensively studied, little research is available to guide faculty in using technologies designed for distance learning in the face-to face environment. PURPOSE: The purpose of this study was to determine pre-licensure baccalaureate nursing student and nursing faculty perceptions of the effectiveness of various online teaching modalities. METHOD: A mixed-methods study using a convenience sample of students and faculty at two universities was conducted. Students and faculty completed a researcher-developed survey to rate a variety of online teaching methods and technologies from a scale of one (not effective at all) through six (extremely effective). Participants also provided comments within the survey and in focus groups of randomly selected students and faculty. Surveyed items included modes of asynchronous and synchronous instruction, instructional technology, and instructional activities. RESULTS: There were significant differences as well as similarities in student and faculty perceptions of effectiveness. Students demonstrated a clear preference for pre-recorded lectures, while faculty perceived synchronous lectures and assigned readings to be equally as effective as pre-recorded lectures. Synchronous activities such as case studies and student presentations were rated as more effective by faculty than by students. Both groups perceived instructional games, especially quiz games, as very or extremely effective. CONCLUSIONS: Students were more engaged with instructional activities that they perceived as effective for learning. The results of this study will assist faculty in developing effective online and in-person instruction which will optimize the teaching/learning experience.

Implementing handoff communication.

Healthcare systems are seeking assistance from other well-known industries for a solution to issues related to handoff communication, the system for relaying patient information from one caregiver to another. Although the handoff should provide accurate information about a patient's care, treatment, services, and condition, inconsistencies in communication among practitioners exist. This lack of consistent messages prompted staff development nurses in a community hospital to introduce the SBAR process (situation, background, assessment, and recommendation) as the standard for handoff communication to reduce errors and improve patient safety.

School nurse resilience: experiences after multiple natural disasters.

This qualitative descriptive study explored the experiences of school nurses in coastal Louisiana, who were affected by Hurricanes Gustav and Ike in 2008 and who had also been in the path of destruction caused by Hurricanes Katrina and Rita in 2005. The purpose of the study was to describe the experiences of school nurses affected by repeated natural disasters in relation to their professional practice. The researchers conducted interviews with five school nurses, using the constant comparative method of data analysis to analyze transcripts for recurrent themes. Findings revealed a common process of developing resilience among participants. As a result of their experiences, participants described the ability to recover and adapt in the face of adversity. Various factors affected this resilience, including preparedness, support from others, both personally and professionally, and commitment to the communities in which they live.

Camp nursing: rewards and challenges.

Every summer, millions of children attend summer camp, bringing with them flashlights, sleeping bags, bug spray, and a wide array of acute and chronic medical conditions. Registered nurses provide care to these children in an environment that is fun-filled, rewarding, and challenging. Familiarity with camp settings, as well as with expectations of the nurse at camp, are important because the demands are quite different from traditional nursing practice. Due to the challenges that are inherent in the camp nursing role, nurses considering this area of practice must be knowledgeable about the various camp settings, camp nurse responsibilities, practice issues for camp nursing, implications for education and research, and resources for the nurse contemplating a camp nursing position.

School nursing: not just band-aids any more!

ISSUES AND PURPOSE: School nursing has changed dramatically over the past 25 years. The complex social and physical needs of children require an expanded role with advanced knowledge and skills. The school nurse functions as health promoter, health educator, collaborator, and researcher. Issues related to advanced practice and policy development also affect school nursing practice. CONCLUSIONS/PRACTICE IMPLICATIONS: The current emphasis on educational accountability and improvement of standardized test scores has mandated close examination of resource allocation. There is a need to appreciate an expanded role for the school nurse, as the provision of healthcare services in the school will afford children an increased capacity to learn, thus improving school performance.

Effective partnership: how school nurses and physical education teachers can combat childhood obesity.

School systems face many challenges in attempting to address the childhood overweight and obesity epidemic. Given the accumulated nature of the required physical activity and the likelihood that only one meal will be delivered while on school grounds, the potential for impactful change in obese or overweight children through school policy is limited. From this vantage point, it is easy to see that physical education programs alone cannot ensure that children participate in 60 minutes of daily physical activity. The necessary multifaceted approach requires opportunities for physical activity to be obtained throughout the school day. The school nurse and physical education teachers are the school personnel most likely to be involved in efforts to curtail the childhood overweight and obesity epidemic at the school level. These individuals are in critical roles of assisting both parents and children when it comes to understanding the devastating effects of being overweight and obese and in helping children identify positive health behaviors that may help reverse this condition. The purpose of this article is to describe the ways in which the school nurse and physical education teacher can work collaboratively to better address the childhood overweight and obesity epidemic.

Sudden cardiac arrest in schools: the role of the school nurse in AED program implementation.

A school nurse has many obstacles to overcome when providing emergency care for an age group ranging from four to adulthood. The 21st century school nurse faces the challenges of providing care to medically fragile children at multiple sites, with high student-nurse ratios. The implementation of an Automated External Defibrillation (AED) program can assist the school nurse and staff in providing necessary life-saving services for Sudden Cardiac Arrest (SCA) victims of all ages. The purpose of this article is to describe AED program implementation in a school setting, including the need, essential elements, benefits, and potential concerns related to this vital component of the American Heart Association five-link chain of survival.

Influencing school health policy: the role of state school nurse consultants.

BACKGROUND: The role of the State School Nurse Consultant has been well defined by the National Association of School Nurses. State School Nurse Consultants serve as a resource to school nurses on issues related to their practice, as well as a liaison between top-level educators and school nurses. The purpose of this article is to describe the role of the State School Nurse Consultant, and to present results of a survey of Louisiana school nurses related to their practice needs. METHODS: A survey was administered via Survey Monkey to determine the perceived needs of Louisiana school nurses related to their professional practice. Eighty-eight members of the Louisiana School Nurse Organization participated in the online survey. RESULTS: Louisiana is 1 of 6 states that do not have a State School Nurse Consultant. Respondents to the survey indicated an overwhelming need to have a school nurse representative at the state level. Twenty-two of the respondents specifically stated that they would like to have a State School Nurse Consultant within the Department of Education. CONCLUSIONS: Budgetary constraints have resulted in a lack of funding for a State School Nurse Consultant in Louisiana. Partnerships with federally qualified health centers (FQHC) and billing of Medicaid for school nursing services are 2 examples of revenue sources for school nurses that Louisiana is investigating. Revenue from these sources may serve to supplement state funds so that this important resource for Louisiana school nurses can be put into place.

Community-associated methicillin-resistant Staphylococcus aureus (MRSA): an overview for nurses.

Upon completion of this activity, the learner will be able to:1. Differentiate between the two types of Methicillin-resistant Staphylococcus aureus (MRSA)--HA-MRSA and CA-MRSA. 2. Describe evidence-based management of MRSA infections. 3. Describe the epidemiology and clinical manifestations of MRSA infections.

Preparing pediatric nurses: the role of simulation-based learning.

Simulation-based learning is increasingly being integrated into pediatric nursing education for students as well as novice nurses in practice. Various levels of technology in simulation provide for a range of cognitive, psychomotor, and affective skills acquisition within the controlled setting provided by this teaching strategy. This article provides an overview of simulation, the emergence of simulation in nursing education with an emphasis on pediatric nursing, a description of one baccalaureate program's experience in developing a state-of-the-art maternal child-simulation skills laboratory, and the role of simulation-based learning in continuing education.

The impact of hurricanes Katrina and Rita on Louisiana school nurses.

In the fall of 2005, the coast of Louisiana was devastated by two hurricanes, Katrina and Rita. Not only did these natural disasters have detrimental effects for those directly in their path, the storms had an impact on the lives of everyone in Louisiana. The professional practice of many Louisiana school nurses was affected by several factors, including a sudden influx of students with no medical records. A qualitative descriptive study was conducted to gain an understanding of school nurses' feelings and experiences related to the hurricanes and their aftermath. Forty-one school nurses participated in the study, and findings revealed significant effects on their personal and professional lives. Themes within each area were identified: uncertainty, hopelessness and helplessness, thankfulness, practice challenges, and practice rewards. Implications for school nursing practice include the need for support during natural disasters and the importance of school nurse involvement in disaster preparedness.

Empowerment in school nursing practice: a grounded theory approach.

Professional empowerment is vital to nurses' productivity and job satisfaction. A grounded theory study was conducted to describe the basic social process experienced by school nurses in relation to professional empowerment. Interviews with 10 school nurses led to the development of a situation-specific theory of school nurse empowerment, Making a Difference: The Role of the School Nurse in the Health of Children in Schools. This theory was derived from four theoretical constructs: (a) enlisting support, (b) getting through the day, (c) maintaining control over practice, and (d) adjusting to challenges. Interviews revealed that knowing at the end of each school day that they made a difference in the health of children resulted in feelings of empowerment. Participants cited various areas in which their sense of empowerment was limited, including salaries and workload. Despite these issues, they believed they had a positive impact on the health of children, leading to job satisfaction and feelings of value.