Initial outcomes and lessons learned from implementation of an online diversity & inclusion community.

BACKGROUND: There is an opportunity to build online communities and digitize inclusive excellence such that all students, staff, and faculty can benefit. However, literature illustrating actionable strategies for creating online communities and mitigating barriers related to engagement is limited. PURPOSE: We evaluated the feasibility, functionality, and usage of a college of nursing's (CON) online diversity and inclusion communication platform (i.e., D&I Community). METHODS: From survey and college-wide discussion, we found that CON members are interested in employing opportunities for diversity, equity, and inclusion (DEI) discussions and engaging with DEI resources, but lack of time, competing priorities, and lack of awareness of the D&I Community were barriers to participation. DISCUSSION: We are prepared to modify processes to improve engagement and promote a sense of belonging for all CON members. CONCLUSION: Implementation and sustainability of this D&I Community require continual resource investment. Scalability can be considered once processes have been fully refined.

Feasibility and Impact of Physical Activity on Compassion Fatigue and Burnout Among Ambulatory Care Oncology Nurses.

BACKGROUND: Compassion fatigue (CF) and burnout are well described phenomena among oncology nurses. Physical activity (PA) has been shown to reduce CF and burnout. OBJECTIVES: The purpose of this pilot study was to determine the feasibility of promoting PA and assessing its impact on CF and burnout among RNs across three ambulatory care cancer clinics. METHODS: A convenience sample of nurses with varying roles were invited to participate. Feasibility was assessed by participant accrual and retention rates. CF and burnout were assessed at weeks 0, 6, and 12. The Yale Physical Activity Survey was used to obtain self-reported PA, and daily steps were tracked using participants' personal devices. FINDINGS: Stress scores decreased. Burnout scores demonstrated levels of low emotional exhaustion, moderate depersonalization, and moderate to high personal achievement. Leisurely walking increased significantly, and average daily step counts increased by 37% for weekdays, 10% for weekend days, and 29% for the total week.

Using a Generous Leadership Model to Promote Evidence-Based Practice.

This article is part of a series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to https://links.lww.com/AJN/A133). This follow-up series features exemplar success stories, in which authors describe how initiatives using an implementation framework or evidence-based strategy resulted in a successful practice or program change. Column coordinators Sharon J. Tucker and Lynn Gallagher-Ford alternate in providing commentary at the end.

Favorable Outcomes: Moving Nursing Orientation to a Hybrid Program During the COVID-19 Pandemic.

This article describes how a traditional in-person general nursing orientation was converted to a hybrid program, incorporating online and modified in-person components during the COVID-19 pandemic. From April to September 2020, our hybrid program successfully onboarded 125 new nurses while maintaining all COVID-19 safety precautions. As the global pandemic persists, nursing professional development teams will continue to require innovative ways to onboard nurses while meeting all orientation requirements, such as our hybrid program.

An interdisciplinary approach to safe opioid prescribing and administration for surgical patients at an academic medical center.

AIM AND OBJECTIVES: To explore and understand the current practice, perceptions, and knowledge of general surgery trainees, advanced practice providers, and surgical nurses regarding opioid prescribing and administration. To this end, a novel opioid education and training was introduced to educate these practitioners on safe opioid practices in surgical patients. BACKGROUND: National awareness of the opioid epidemic has increased significantly in the last several years. However, there remain a disturbingly high number of opioid prescriptions written in the US indicating a need for improved provider and nurse education. This involves increasing awareness and understanding of national guidelines as well as implementing multi-modal therapy to treat pain. DESIGN: Pre-post-intervention quality improvement project. METHODS: An opioid education and training involving a morphine equivalent daily dosing calculator in the electronic medical record was provided to 26 surgical trainees, eight advanced practice providers and 97 surgical nurses in November 2019. Perceptions, current practice and knowledge were measured using a pre- and post-intervention survey (SQUIRE checklist). RESULTS: The survey results showed a positive clinical change in perception of opioid use in surgical patients following the intervention and a modest decrease in the average morphine equivalent daily dosing at discharge in general and transplant surgery patients. CONCLUSIONS: Effective pain management for surgical patients must be individualised. Safe opioid prescribing should involve an interdisciplinary approach with all members of the team undergoing assessment of their opioid knowledge and prescribing habits, easily accessible training tools and opioid calculators in the electronic medical record. RELEVANCE TO CLINICAL PRACTICE: Our initiative may provide useful information to settings that replicate use of a morphine equivalent daily dosing calculator in the electronic medical record. Utilisation of safe opioid prescribing tools in the electronic medical record and continuing education for providers and nurses can help ensure the safety of surgical patients.

Favorable Outcomes After Implementing a Nurse-Driven Sedation Protocol.

BACKGROUND: In patients receiving mechanical ventilation, prolonged exposure to sedative and analgesic medications contributes to negative clinical outcomes. OBJECTIVE: To reduce exposure to sedative and analgesic medications among patients receiving mechanical ventilation by implementing a nurse-driven sedation protocol. METHODS: This quality improvement project followed a plan-do-study-act cycle. Nurses were educated on the protocol, and 30 patient medical records were reviewed both before and after protocol implementation. Data were extracted on intensive care unit length of stay, duration of mechanical ventilation, duration of continuous sedation, presence of delirium, pain, level of sedation, and performance and documentation of spontaneous awakening trials. Data were analyzed using descriptive statistics, the χ2 test, and calculated percent change. RESULTS: Forty-four nurses completed protocol education. The mean (SD) duration of mechanical ventilation decreased by 26% (from 5 [3.7] days to 3.7 [3.2] days), and the mean (SD) intensive care unit length of stay decreased by 27% (from 6.3 [4.3] days to 4.6 [3.7] days). The mean (SD) duration of continuous sedation decreased by 35% (from 6419 [7241] minutes to 4178 [4507] minutes). Spontaneous awakening trials documented increased by 35% (from 57% to 77%), and spontaneous awakening trials performed increased by 92% (from 40% to 77%), a statistically significant change (P = .004). CONCLUSION: These preliminary data suggest that implementation of a nurse-driven sedation protocol resulted in favorable outcomes by decreasing duration of mechanical ventilation, intensive care unit length of stay, and duration of continuous sedation and increasing the number of spontaneous awakening trials performed.

Nursing student experiences in turmoil: A year of the pandemic and social strife during final clinical rotations.

BACKGROUND: The duration and magnitude of the coronavirus (COVID-19) posed unique challenges for nursing students, whose education was altered because of the pandemic. PURPOSE: To explore the perceptions and experiences of nursing students whose clinical rotations were abruptly interrupted by COVID-19's initial surge in the United States. METHODS: This qualitative study was conducted at a midwestern, academic medical center to elicit senior nursing students' experiences. An online survey was administered with eight open-ended questions asking about: initial impressions of the pandemic; experiences of being a senior nursing student; sources of stress and coping mechanisms; preparing to work as a registered nurse; and views on the nursing profession. RESULTS: Among the 26 students who completed the survey, the majority were female (92%), aged 28 ∓ 4.1 years. A total of 18 subcategories emerged with four main themes identified as: a) breakdown of normal systems, b) feeling alone and the inability to escape, c) protective factors/adaptability, and d) role identify and formation. CONCLUSIONS: Findings indicate students implemented a variety of strategies while adapting to the abrupt interruption of in-person clinical rotations, mandated restrictions, and social unrest. The cascading themes illustrate the enormity of sudden changes and their significant impact on daily life.

Favorable Outcomes From an In-person and Online Feasibility Mindful Moment Pilot Study.

Long hours, inadequate staff, and increasingly complicated patients make nurses more vulnerable to increased levels of stress and burnout. Nurses skilled in exercising self-care practices are better equipped to manage complex clinical situations. The purpose of this pilot study was to evaluate the feasibility of short mindfulness sessions (Mindful Moment) practiced prior to a shift, available in person and online, on nurse burnout and perceived levels of stress. The 8-week Mindful Moment study consisted of 20-minute sessions delivered either in person or online that included yoga, self-reflection, and meditation. Nurse burnout was assessed using the Maslach Burnout Inventory at weeks 0, 4, and 8. Perceived stress was assessed using a visual analog scale before and after each Mindful Moment session. Descriptive statistics, pre/postintervention differences, and percent change calculations were used to evaluate study outcomes. Forty-seven nurses agreed to participate, with 20 nurses completing the study (43%). Participants were all female, aged 36.8 ± 9.8 years, with 12 ± 8.6 years of nursing experience. With respect to nurse burnout, there was a -31% change in emotional exhaustion (P = .079), a -31% change in depersonalization (P = .057), and a +10% change in personal accomplishment (P = .331). There were consistent reductions in nurses' perceived stress pre/post-Mindful Moment session, with percent changes ranging from -35% to 40%. Findings from this study suggest that practicing a brief Mindful Moment prior to the start of a shift is feasible and self-care interventions provide lower levels of burnout and perceived stress among this sample of nurses.

Implementing a faculty mentoring process to improve academic-clinical partnerships for nurse led evidence based practice and research projects.

A unique nursing faculty mentoring process within a large academic medical center, and led by the College of Nursing (CON), Center for Clinical Research and Scholarship, provides faculty with the resources needed to collaborate with clinical nursing staff and multidisciplinary project teams who want to engage in clinical evidence based practice, quality improvement, and research projects. Guidelines for mentoring clinical staff allow CON faculty mentors work with clinical staff to enhance their own professional growth and leadership activities and improve clinical outcomes, as well as to increase faculty scholarship activities.

The development of an online diversity and inclusion community: Promoting a culture of inclusion within a college of nursing.

Societal demographics are rapidly changing and driving the need to develop a culturally aware and sensitive nursing workforce. Nursing faculty are essential to transform academic and healthcare settings into culturally responsive environments. Yet, there isn't a "one size fits all" plan for faculty to foster diversity and inclusion (D&I) within academic nursing. For instance, cultural humility best practices in academia are limited as D&I interventions historically focus on cultural competency. Cultivating cultural humility exceeds developing cultural competency. Cultural humility incorporates elements of self-reflection/critique (acknowledging assumptions and beliefs), learning from others (listening and being open), and partnership-building (gaining appreciation and respect), all of which encompasses a life-long process. The purpose of this paper is to outline the development of an online D&I communication platform for a college of nursing. We present lessons learned and helpful recommendations for others promoting culturally responsive educational environments. This work is important as limited literature exists outlining the development of online communication platforms where faculty, students, and staff can foster cultural humility. Adopting cultural humility into the fabric of the college of nursing can lead to open communication, a greater understanding of one another, and an opportunity to improve relationships with diverse individuals and patient populations.

Exercise Intervention: A Pilot Study to Assess the Feasibility and Impact on Cancer-Related Fatigue and Quality of Life Among Patients With High-Grade Glioma.

BACKGROUND: Cancer-related fatigue (CRF) is a challenging symptom, often compromising quality of life (QOL) and hindering physical activity among patients with cancer. OBJECTIVES: This 18-month pilot study assessed the feasibility to recruit and retain participants with high-grade glioma into a 10-week exercise intervention and evaluated the effects on CRF and QOL. METHODS: Participants were enrolled into the usual care, education, or exercise group based on time of enrollment and radiation treatment location. Feasibility was determined by accrual and retention rates. Fatigue and QOL were assessed at weeks 0, 3, and 10. Descriptive statistics and percentage change were used for pre-/post-test differences. FINDINGS: Exercise participants experienced less fatigue and improved QOL as compared to the usual care and education groups, suggesting that exercise favorably affects clinical outcomes and is feasible among patients with high-grade glioma.

Implementing a Heart Failure Transition Program to Reduce 30-Day Readmissions.

BACKGROUND: Thirty-day readmissions for heart failure (HF) patients are often considered avoidable and linked to inadequate treatment and poor coordination of services and discharge plans. PROBLEM: Lack of coordinated transitional care services and high 30-day readmissions prompted the interdisciplinary team to develop an HF Transition Program (HFTP). METHODS: This quality improvement initiative used monthly trend data before and after HFTP implementation. INTERVENTIONS: The American Heart Association Guidelines for HF Transitions served as a framework for developing the HFTP. RESULTS: Over an 11-month period, 466 patients were enrolled into the HFTP, resulting in 18.2% (n = 82/450) 30-day cumulative readmission rate that is lower than the 21.9% national average. Sixteen patients did not code for HF after discharge. Heart Failure Transition Program calls to patients and families within the first week home were consistently high at 92.3% (430/466). CONCLUSIONS: These data show that care coordination and transitional care are important strategies to decrease 30-day HF readmissions.

Evaluation of a Bed Reaggregation Initiative at an Urban Academic Medical Center.

BACKGROUND: Hospital flow disruptions have been linked to treatment delays, longer length of stay (LOS), poor patient outcomes, and overburdened staff leading to disengagement. OBJECTIVE: This project was designed to evaluate and determine if the bed reaggregation was successful at meeting its goals. METHODS: Donabedian's framework guided the following evaluation points: 1) patient placement accuracy, 2) LOS variance, 3) emergency department (ED) boarding times, 4) hospital bypass hours, 5) operational declination rates, 6) patient satisfaction, and 7) RN engagement. Data were analyzed using pre-post percent change and χ analysis. RESULTS: Primary placement of patients, LOS variance, and operational declinations improved. Hours on bypass and ED boarding times were not reduced. RN engagement scores varied widely with significant decreases on 2 of the reaggregated units. Patient satisfaction scores varied, but overall did not decrease. CONCLUSION: Further consideration is needed for improving hospital bypass, ED boarding times, and RN engagement.

Implementing a Food is Medicine Program to Address Food Insecurity in an Academic Medical Center.

BACKGROUND: Food insecurity is a public, social, and health concern. LOCAL PROBLEM: A Food is Medicine Program was developed to address food insecurity. METHODS: A quality improvement initiative was piloted on 3 acute care units. INTERVENTIONS: Patients were screened for Social Determinant of Health (SDoH) needs and if identified as food insecure, linked to community resources and provided with a bag of food on discharge. Education was offered to nursing staff and a pre- and postsurvey was administered to assess SDoH knowledge and confidence. RESULTS: Over a 3-month period, 2354 patients were admitted; 2063 (88%) were screened for SDoH and 220 (10%) were positive for food insecurity. Patients (n = 1525, 74%) were linked to community resources. Nearly all (97%) nurses participated in education and demonstrated increased knowledge and confidence (P < .001). CONCLUSIONS: These data provide preliminary outcomes from the Food is Medicine Program.

Built Environment Approaches to Increase Physical Activity: A Science Advisory From the American Heart Association.

Engaging in regular physical activity is one of the most important things people can do to improve their cardiovascular health; however, population levels of physical activity remain low in the United States. Effective population-based approaches implemented in communities can help increase physical activity among all Americans. Evidence suggests that built environment interventions offer one such approach. These interventions aim to create or modify community environmental characteristics to make physical activity easier or more accessible for all people in the places where they live. In 2016, the Community Preventive Services Task Force released a recommendation for built environment approaches to increase physical activity. This recommendation is based on a systematic review of 90 studies (search period, 1980-June 2014) conducted using methods outlined by the Guide to Community Preventive Services. The Community Preventive Services Task Force found sufficient evidence of effectiveness to recommend combined built environment strategies. Specifically, these strategies combine interventions to improve pedestrian or bicycle transportation systems with interventions to improve land use and environmental design. Components of transportation systems can include street pattern design and connectivity, pedestrian infrastructure, bicycle infrastructure, and public transit infrastructure and access. Components of land use and environmental design can include mixed land use, increased residential density, proximity to community or neighborhood destinations, and parks and recreational facility access. Implementing this Community Preventive Services Task Force recommendation in communities across the United States can help promote healthy and active living, increase physical activity, and ultimately improve cardiovascular health.

The use of national collaborative to promote advanced practice registered nurse-led high-value care initiatives.

BACKGROUND: High-value healthcare focuses on improving healthcare to produce cost effective care, however limited information on the role of advanced practice registered nurses (APRNs) exists. PURPOSE: This descriptive report describes APRN-led initiatives implemented as part of a national collaborative promoting the Choosing Wisely® campaign and high-value care measures. METHOD: An APRN national collaborative focuses on developing and implementing high-value care initiatives. Monthly calls, podcasts, and a file sharing platform are used to facilitate the work of the national collaborative. FINDINGS: A total of 16 APRN teams from 14 states are participating and have implemented a number of initiatives to reduce unnecessary testing and treatments, promote appropriate antibiotic use, and promote optimal clinical practices such as mobility for hospitalized elderly patients, among others. DISCUSSION: A national collaborative has proven to be a successful way to engage APRN teams to focus on targeting high-value care and promoting evidence-based practices in clinical care.

Mediterranean Diet: Outcomes from an Education Session Among Patients With Cancer and Nursing Staff.

BACKGROUND: Strong evidence supports the benefits of the Mediterranean diet, but little is reported among patients and nurses regarding knowledge about the diet and its health benefits. OBJECTIVES: A pre-/post-test practice initiative was implemented to identify level of knowledge about the Mediterranean diet in patients with cancer and nursing staff and to provide education about the diet's health benefits. METHODS: A 17-item survey was developed to assess knowledge and willingness to try or recommend the Mediterranean diet, current practices, and general nutrition knowledge. A 10-minute education session was provided to patients and nursing staff. Descriptive statistics were used. FINDINGS: The majority of patients reported eating from one to four servings of fruits and vegetables daily. For patients and nursing staff, post-education session scores demonstrated increased knowledge, willingness to try the diet, and perceived effectiveness of the diet.

Integration of an Advance Care Planning Model in Home Health: Favorable Outcomes in End-of-Life Discussions, POLST Rates, and 60-day Hospital Readmissions.

Only 2.3% of patients at a Midwest home healthcare (HH) agency had documented advance directives (ADs), compared with 28% nationally. Of concern, this HH agency lacked standardized procedures for advance care planning (ACP) leading to inadequate staff knowledge regarding end-of-life, avoidable hospital readmissions, and delayed transitions into hospice care. Lack of ADs is directly correlated to higher hospital readmission rates and lower hospice length of stay. The purpose of this initiative was to develop evidence-based procedures using the Respecting Choices ACP model to: 1) educate staff, 2) increase ACP conversations offered and completed among high-risk patients, 3) increase Practitioner Orders for Life-Sustaining Treatment (POLST) rates, 4) reduce 60-day hospital readmissions, and 5) support hospice care admissions. Staff received discipline-specific education on ACP/ADs. The Knowledge-Attitudinal-Experiential Survey on Advance Directives (KAESAD), assessed staff ACP/AD knowledge, confidence, and experiences. Standardized electronic medical record tools were created to track ACP conversations, POLST rates, 60-day hospital readmissions, and hospice admissions. Paired t-test and chi-square analyses compared changes pre- and post implementation. The KAESAD survey was analyzed for 75 staff (100%) and demonstrates improvement in knowledge, confidence, and experiences. Data also demonstrate increases in: ACP offered 6% to 80% (p < .001); ACP conversations completed 4% to 31% (p < .001); POLST rates 26% to 43.6% (p = .059); decreased 60-day hospital readmissions 40% to 20% (p = .025); whereas hospice care admissions was not impacted ranging from 10% to 5.5% (p = .381). Respecting Choices serves as an effective ACP framework to improve ACP conversations, POLST rates, and hospital readmissions.

Massage Chair Sessions: Favorable Effects on Ambulatory Cancer Center Nurses' Perceived Level of Stress, Blood Pressure, and Heart Rate.

BACKGROUND: High stress levels over time can contribute to compassion fatigue and burnout and negatively affect individual health and well-being. OBJECTIVES: A pre-/post-test initiative was implemented to determine the effects of massage chair sessions on ambulatory cancer center nurses (RNs and advanced practice providers) based on their perceived stress, blood pressure (BP), and heart rate (HR). METHODS: A mechanical massage chair was available for 20-minute sessions in a secure room, and nurses self-recorded perceived stress using a visual analog scale, as well as BP and HR using a wrist cuff device. Descriptive statistics and paired t tests were used to assess nurse characteristics and differences before and after massage chair sessions. FINDINGS: Nurses participated in 200 massage chair sessions during a six-month period. Significant reductions were noted in perceived stress, systolic and diastolic BP, and HR. These data indicate that providing a relaxing room with chair massage has favorable effects on nurses' perceived stress, BP, and HR.

Exploring the Doctor of Nursing Practice project facilitator/mentor role.

BACKGROUND: The Doctor of Nursing Practice (DNP) facilitator/mentor is a collaborative member of the project team, yet little has been reported about this role. This qualitative study explored the experiences of DNP project facilitators. METHODS: Focus groups were conducted using a purposeful sample of project facilitators. Focus group questions were developed using Gitlin, Lyons, and Kolodner's five-stage model of collaboration. Data were transcribed and content analyzed using Kruger and Casey methods. RESULTS: Three focus groups included 21 facilitators who were affiliated with an academic health system. Six themes emerged: (a) exploring student interest, (b) establishing a collaborative fit, (c) connecting with key stakeholders, (d) overcoming barriers, (e) role clarity, and (f) interaction. CONCLUSION: DNP project facilitators have an important role not only in students' formation, but also in contributing to the academic-practice partnership. The importance of the facilitator role as the student progresses through their DNP project cannot be overstated.