A Nurse-Driven Plan to Diminish First-Case Operating Room Delays.

OBJECTIVE: The purpose of this study was to examine the use of a nurse-driven plan to describe factors associated with delays in the 1st case on time start within the operating room. METHODS: A posttest-only quasi-experiment was conducted to examine the effect of designating specific time periods for steps in the preoperative process on 1st case operating delays. Rationale for delays was also examined. Using an audit form, data on target time, time met, delay in minutes, and reasons for delay were collected by an observer. RESULTS: Thirty-one percent (n = 31) of patient/participants (N = 99) were late to the operating room. Controllable factors, such as caregivers being late, and uncontrollable factors, such as patients' needing to use the restroom just prior to surgery, were identified. CONCLUSIONS: Results of this study support the identification and examination of steps in the preoperative process to prevent delays by adjusting activities as needed. Identifying controllable and uncontrollable factors can help in preparing to prevent delays.

Relationships Among Mode of Birth, Onset of Labor, and Bishop Score.

OBJECTIVE: To investigate mode of birth in relation to onset of labor and Bishop score. DESIGN: Retrospective observational cohort design. SETTING: A 434-bed Magnet redesignated community hospital. PARTICIPANTS: Nulliparous women, 18 years of age or older, who gave birth at 37 to 41 weeks gestation to live, singleton fetuses in the vertex presentation (N = 701). METHODS: We conducted a retrospective chart review and used chi-square analysis to measure the associations among mode of birth, onset of labor, and Bishop score. We used logistic regression to test the probability of cesarean birth for women undergoing elective induction of labor. RESULTS: Most participants (n = 531, 75.7%) gave birth vaginally. Significant findings included the following relationships: spontaneous onset of labor and vaginal birth (χ2 = 22.2, Ø = 0.18, p < .001) and Bishop score of greater than or equal to 8 and vaginal birth (χ2 = 4.9, Ø = .14, p = .028). Induction of labor was a significant predictor in cesarean birth when controlling for age and body mass index (OR = 2.1, 95% confidence interval [1.5, 3.1], p < .001). CONCLUSION: Reducing elective induction of labor in women with low-risk pregnancies may help lower the risk of cesarean birth. Clinically, Bishop score and mode of birth have a weak association, particularly when induction includes cervical ripening.

The Effect of an Educational Intervention on Nurses' Knowledge, Beliefs, and Actions to be Taken, Regarding Suicide.

OBJECTIVE: The aim of this study was to examine the effect of an educational intervention on nurses' knowledge defined as understanding, beliefs, and actions to be taken, regarding nurse suicide. BACKGROUND: Between 2007 and 2018, nurses were 18% more likely to die by suicide than the general public. As a result, an assessment of nurses' knowledge regarding suicide has become an important issue for nursing administration. METHODS: A quasi-experiment (N = 225) was conducted. Variables of interest were assessed pre and post an educational intervention on 3 domains related to suicide. RESULTS: Significant and meaningful differences were found regarding 2 domains of interest in nurses' understanding related to nurse suicide, and actions to be taken, pre and post intervention. A significant change occurred regarding beliefs; however, the difference was small and therefore not meaningful. CONCLUSIONS: Finding demonstrate that educational interventions focused on issues related to suicide can enhance nurses' knowledge of the challenges implicit when one considers taking one's own life.

Nurse Preceptor Burnout: Contributing Factors.

OBJECTIVE: The aim of this study was to assess nurse preceptor burnout and examine related factors. BACKGROUND: Nurse preceptors are essential to the provision of optimal hospital-based care. Preceptors guide and support nurses' transition from professional training to practice as well as movement within practice roles. METHODS: As a component of the DevelopYou database, nurse preceptors (N = 210) were surveyed electronically using the BHLex Preceptor Role Questionnaire. Data retrieved from this data set were analyzed. RESULTS: Twenty-eight percent (n = 60) of participants experienced burnout. Most (n = 203, 96.7%) enjoyed their role. Reasons for becoming a preceptor included a love for teaching, a desire to help others, and feelings of responsibility to the profession and the institution. Strategies to enable perceived value of the role focused on activities involving person-to-person interactions. CONCLUSIONS: On the basis of the results of this analysis, it is apparent that nurse preceptors want to feel valued and supported by administration and have opportunities to interact regularly with colleagues.

The Effect of a Required 48-Hour Window to Schedule Genetic Counseling on Time From Diagnosis of Breast Cancer to Surgery.

BACKGROUND: The length of time from diagnosis of breast cancer to surgery has steadily increased. Consultations and tests, in addition to a lack of available counseling programs, contribute to delays. Evidence suggests that delays between diagnosis and surgery may adversely affect patients. OBJECTIVES: This article examines the effect of time from diagnosis of breast cancer to surgery by requiring nurse navigators to contact the genetic counseling office within 48 hours of the diagnosis to schedule an appointment for the patient as soon as possible. METHODS: Using a quasiexperimental design, data of time from diagnosis to surgery among patients with breast cancer were collected retrospectively preintervention (N = 30) and prospectively postintervention (N = 30). FINDINGS: Time from diagnosis to surgery decreased significantly from pre- (mean = 50.3 days, SD = 22 days) to postintervention (mean = 39 days, SD = 16 days) (t = 2.25, p = 0.03).

Agency in the Anthropocene: education for planetary health.

Collective action is essential to address planetary health as current and future environmental challenges are socioecological and require coordinated, informed, and sustained action from all societal sectors. Education that engages intergenerational communities is a crucial means of building collective action as it provides opportunities to develop an informed citizenry capable of making the necessary decisions to work towards planetary health. Schools are valuable sites of community learning and action, and will benefit from a new orientation towards and commitment to educator training, curriculum development, and youth agency. This orientation is supported by the Organisation for Economic Co-operation and Development's Programme for International Student Assessment's (PISA) 2025 Science Framework, which measures the competence (skills and knowledge) of 15-year-old students. This Personal View describes a new concept, Agency in the Anthropocene, a contributing element of the 2025 Science Framework that defines the way science education could develop agency and hope in this era of socioecological challenges that are impacting planetary health.

Developing the Baptist Health Injury Risk Assessment Phase 1: Exploring Risk Factors.

OBJECTIVES: The aim of this study was to explore risk factors for developing hospital-acquired pressure injuries (HAPIs) among critically ill adult inpatients. BACKGROUND: Hospital-acquired pressure injuries remain a priority quality focus for Magnet ® organizations. Recent studies cite medical devices as a primary cause, yet published risk assessments lack inclusion of those threats. METHODS: Nurses at a 434-bed, 4-time Magnet ® -designated hospital led a retrospective study acros 9 American Nurses Credentialing Center-designated facilities. Using a chart review tool, data were collected within 48 hours of a confirmed HAPI. RESULTS: Of 207 HAPIs reported, 54% (n = 113) involved deep tissue pressure injuries and 50.2% (n = 104) involved 19 medical devices. Individuals with a HAPI also used 1 or more of 7 distinct types of mobility-limiting medical equipment. CONCLUSIONS: Study findings support the development of a critical care risk assessment with inclusion of a medical device and mobility-limiting medical equipment as risk factors. A secondary study is underway for specificity and sensitivity testing of this assessment.

Breakthrough Cancer Pain: What Outpatient Oncology Nurses Need to Know.

Breakthrough cancer pain (BCP) is a devastating symptom that can occur in individuals with cancer throughout the disease trajectory, particularly in those with advanced cancer. Oncology nurses have a critical role in treating.

Educating Nurses During a Pandemic to Manage Mechanically Ventilated Patients.

Providing care for critically ill patients diagnosed with COVID-19 presented a number of challenges. Initially, few treatment strategies were available; however, evidence of pulmonary complications led to patients' need for ventilators. This article describes the rapid development and implementation of a mechanical ventilation cross-training program for acute care nurses.

Chief Nursing Officers: Their COVID-19 Experience.

OBJECTIVE: The purpose of this study was to describe the experience of chief nursing officers (CNOs), including leadership strategies that they developed as they encountered the administrative challenges posed by COVID-19. BACKGROUND: The COVID-19 pandemic required CNOs to make difficult decisions and to support nursing staff as they cared for critically ill and dying patients, and therefore, they experienced intense stress during a pandemic of a highly infectious disease. Understanding the challenges that CNOs faced in this crisis will help hospitals and CNOs to better prepare for the future. METHODS: Using a descriptive qualitative approach, we conducted interviews with 9 CNOs from hospitals across the United States. The goal of the interviews was to develop an understanding of the difficulties that these CNOs encountered during the COVID-19 pandemic and their emotional response to the challenging situations. RESULTS: Themes of frustration, heartbreak, and feeling overwhelmed, exhausted, and helpless were revealed. In addition, pride in being a nurse was expressed. CONCLUSION: Themes revealed in this study suggested intentional leadership strategies that would be useful in future healthcare crises.

The Effect of Hospital-Based Childbirth Classes on Birth Outcomes.

The purpose of this study was to examine the effect of a hospital-based childbirth preparation class on birth outcomes in nulliparous women (N = 222). Outcomes of expectant mothers who attended the class were compared to a matched control cohort who did not attend preparation classes. Findings revealed women in the intervention group were more likely to give birth vaginally. While trends in a positive direction occurred, no significant difference was found in the frequency of elective induction, preterm birth, or length of stay. Data were also analyzed pre COVID-19 pandemic and 14 weeks after. A shorter time between hospital arrival and birth was significant for the intervention group. In addition, a significant change in elective induction (increase) occurred in the control group.

COVID-19: The Lived Experience of Critical Care Nurses.

OBJECTIVE: The goal of this qualitative phenomenological study was to explore in-depth, critical care nurses' (CCNs) lived experience while caring for coronavirus disease 2019 (COVID-19) patients during the pandemic. BACKGROUND: CCNs play an important role during pandemics characterized by highly contagious, life-threatening disease. Understanding the experience of CCNs during a pandemic is particularly important because of the high rate of burnout within this group, as well as a shortage of these caregivers across the globe. METHODS: Using Heidegger's interpretive phenomenological approach, interviews were conducted with 10 CCNs caring for COVID-19 patients. The goal of the interviews was to access a deep layer of understanding regarding participants' lived experience. RESULTS: Themes of role frustration, emotional and physical exhaustion, and the importance of presence were revealed. CONCLUSION: Themes revealed suggest a number of actions hospital administrators could take to support CCNs as they experience the challenges of a pandemic.

Women's Perceptions of Hospital-Based Breastfeeding Care and the Association With Exclusive Breastfeeding.

OBJECTIVE: To examine the differences in women's perceptions of hospital-based breastfeeding care and the association of these perceptions with exclusive breastfeeding. DESIGN: Observational, mixed-methods study. SETTING/LOCAL PROBLEM: A 932-bed, Baby-Friendly Hospital Initiative-designated, university hospital with approximately 2,000 births per year, where 50% of women who wanted to breastfeed were supplementing with formula before hospital discharge. PARTICIPANTS: Thirty-four women who gave birth to a term, singleton newborn and had a desire to breastfeed exclusively. MEASUREMENTS: Women's perceptions were assessed using a modified version of the Questionnaire for the Breastfeeding Mother. RESULTS: Women's perceptions of breastfeeding care were positively associated with exclusive breastfeeding (p = .049). In addition, the influence of how a woman's own mother fed her as an infant was shown, because women who themselves were breastfed as infants were more likely to exclusively breastfeed their own newborns. Content analysis showed that women appreciated the care received in the hospital from lactation consultants and access to a hospital-administered breastfeeding clinic after discharge. CONCLUSION: Creating a hospital environment supportive of breastfeeding could yield positive breastfeeding outcomes for women and newborns.

Conducting a Virtual Research Symposium: Path to Success.

Strategies used to change an annual statewide research symposium from a face-to-face experience to a virtual event at a 434-bed Magnet® redesignated community hospital are described. The program met with success and increased access for attendees. For the 1st time, credited to the virtual format, representatives from all 9 hospitals in the system were able to attend. Feedback following the symposium suggested that participants who live at a distance from the hospital appreciated being able to attend the meeting without traveling, technical issues were promptly resolved, and presenters received positive evaluations.

A dedicated nurse for skin-to-skin care after cesarean birth.

An evaluation of clinical outcomes and cost.

Mission impossible or mission accomplished: Do zoo organizational missions influence conservation practices?

Conservation is an important organizational focus for zoos and aquariums. Organizational identity theory predicts a relationship between what is central to organizations, such as their mission statements, and their strategic activities. Based on this theory, we tested how organizational missions relate to their conservation strategies and practices. Tax forms and websites provided data from 173 zoos and 38 aquariums in the Association of Zoos and Aquariums in North America. We analyzed conservation mission strength, organizational characteristics, and project features with dependent variables representing the depth of organizational conservation commitments: amount of grants zoos funded, number of partner organizations, and number of projects per zoo. On tax forms, the average amount of total conservation grants donated to partner organizations per zoo was over $650,000, while the average number of partners reported on the tax forms was two. The content analysis of websites revealed an average of 14 conservation partners and 10 projects per zoo. Negative binomial regression models were significant. The financial analysis revealed that only the number of zoo personnel, as a surrogate for organization size, significantly predicted the amount of zoos' conservation grants. Website analyses found increasing budgets, organizational involvement, and geographic reach of the projects predicted increasing numbers of conservation projects and partnerships. However, our findings did not support the hypothesized relationship-strength of organizational mission did not predict strategy and activities. Zoos could do more to strategically activate their organizational identities and conservation missions to achieve their conservation goals.