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.

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.

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.

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.

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.

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.

School-Based Interprofessional Asthma Self-Management Education Program for Middle School Students: A Feasibility Trial.

BACKGROUND: Asthma is the most common chronic disease among school-aged children under 18 years of age and is a major cause of morbidity, loss of school days, and increased hospitalizations. Asthma disproportionately affects low-income, minority youth in Alabama. The benefits of improving asthma control and self-management have significance for improving health, preventing disease, and reducing health disparities by addressing social, behavioral, environmental, economic, and medical determinants of health. OBJECTIVES: This collaborative community partnership between the Mobile County Public School System, University of South Alabama (USA), and USA Children's and Women's Hospital involved nursing students, respiratory therapy students, and medical residents from three colleges and the hospital. The research question was whether a school-based asthma self-management education program presented by an interprofessional team was feasible for teens with asthma in a medically underserved area (MUA). METHODS: Middle school students with a diagnosis of asthma participated in this institutional review board-approved study. Asthma assessments, one-on-one coaching, and group education were done over five sessions, using Power Breathing for teens curriculum. Instruments were the Childhood Asthma Control Test (ACT), the Asthma Responsibility Questionnaire (ARQ), the Self-Efficacy Scale, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), peak flow monitoring, and spirometry. RESULTS: Eighteen students with moderate to severe persistent asthma completed the program with reduced asthma symptoms and increased asthma control, medication knowledge/skills, self-efficacy, and asthma responsibility. CONCLUSIONS: Adolescents with asthma need education in medication management, spacer use, peak flow, trigger avoidance, and coaching to take on the responsibility of asthma care. This multidimensional, interprofessional approach can strengthen asthma self-management in a middle school medically underserved community population.

Distressing situations in the intensive care unit: a descriptive study of nurses' responses.

Moral distress is a significant stressor for nurses in critical care. Feeling that they are doing the "right thing" is important to nurses, and situations of moral distress can make them question their work. The purpose of this study was to describe critical care nurses' levels of moral distress, the effects of that distress on their personal and professional lives, and nurses' coping strategies. The study consisted of open-ended questions to elicit qualitatively the nurses' feelings about moral distress and a quantitative measure of the degree of distress caused by certain types of situations. The questionnaires were then analyzed to assess the nurses' opinions regarding moral distress, how their self-perceived job performance is affected, and what coping methods they use to deal with moral distress. The most frequently encountered moral distress situations involved critically ill patients whose families wished to continue aggressive treatment when it probably would not benefit the patient in the end.

Maturing responsibility in young teens participating in an asthma camp: adaptive mechanisms and outcomes.

PURPOSE: The purpose of this study was to describe adolescent adaptation in the four adaptive modes of the Roy Adaptation Model in campers attending a Young Teen Asthma Camp and relate that adaptation to the acquisition of asthma responsibility. DESIGN AND METHODS: The camp experience included asthma education and an opportunity to grow socially. A quasi-experimental design investigated ratings of self-efficacy and responsibility from before to after camp. RESULTS: Improvements in self-efficacy supported adaptation in self-concept and role function. Adolescents demonstrated maturing responsibility in asthma management in interdependence mode. PRACTICE IMPLICATIONS: Asthma camps are effective for delivering asthma education, enhancing maturation, and assisting with normalizing life experiences. Nurses can be instrumental in facilitating adolescents' participation.

Medication adherence after heart transplantation: adolescents and their issues.

CONTEXT: Medication nonadherence among adolescent heart transplant recipients can have overwhelming negative consequences including rejection and mortality. Because of issues specific to adolescents such as peer pressure, risk taking, independence, self-image, and self-esteem, they are a population susceptible to nonadherence. Adherence may be associated with a supportive environment, fewer physical and cosmetic side effects, and a sufficient knowledge of therapies. Adherence also may be related to regimens with fewer medications, predominantly fewer immunosuppressive drugs. OBJECTIVE: To examine the differences in motivation between adolescents who are more adherent and those who are less adherent to their medication regimen following transplant surgery. DESIGN: A descriptive design and mixed methodology, including a modified written survey, the Frazier Noncompliance Inventory; a self-report measure of overall medication adherence; and an interview designed by the investigator. Interview questions were reviewed for content validity by nurse clinicians and researchers. SETTING: A heart transplant follow-up clinic in the southeastern United States. RESULTS: Findings for 2 participants revealed striking contrasts in adolescent issues and factors affecting adherence. These findings are presented in a case comparison. Data show that a supportive environment and knowledge of medications were significant in increasing self-responsibility and adherence in adolescent transplant recipients. Also, experiencing rejection early in treatment because of less adherence led to increased adherence for fear of further rejections or death.

The Newborn Behavioral Observations system as a nursing intervention to enhance engagement in first-time mothers: feasibility and desirability.

Engagement is the social process of maternal transition that enables growth and transformation and is linked to attachment and bonding. The feasibility and desirability of the Newborn Behavioral Observations (NBO) system as a nursing intervention to enhance engagement in first-time mothers were examined. The NBO is an exploration of the newborn conducted with parents to increase their understanding of their infant's behavioral cues as well as how to respond. Perceptions of the NBO were obtained from mothers who participated in NBO sessions in the postpartum period and from unit nurses who had been given information on the NBO. Mothers (n= 10) rated the NBO high for increasing their knowledge of what their infants can do (m=3.7/4.0, SD=0.48), and how to interact with them (m=3.8/4.0, SD=0.63). Two of the activities of engagement, experiencing the infant and active participation in care, emerged as themes from the mothers' qualitative responses. Nurses (n=20) believed the NBO would be an effective intervention. Participants believed the NBO to be an effective nursing intervention for enhancing maternal engagement in the early postpartum period.

Identification of special care needs: the comparison of the cardiothoracic intensive care unit patient and nurse.

The purposes of this study were to assess (a) the critically ill patient's and critical care nurse's identification and perception of special care needs and (b) the relationship between the patient's and nurse's perception of the identified special care needs. A qualitative approach, using linked data and open-ended surveys, was used to identify common themes and patterns in data. Data collection took place over a 2-month period at a metropolitan research hospital in the Southeast. Common themes and patterns of identified special care needs were recognized across data and with linked data between the patient and nurse. Findings indicate that both nurses and patients feel that the special care needs of the patient are being met. Common needs currently identified by the patient include miscommunication, anxiety, pain, and relaxation. Common needs currently identified by the nurses include pain management, nausea, and comfort.

Knowledge, resilience, and effectiveness of education in a young teen asthma camp.

A young teen asthma camp was developed as a 3-day residential experience in a traditional camp setting offering activities such as swimming, canoeing, horseback riding, ropes, course crafts, and games. The overall purpose, goals and plans for the camp experience were developed by a team of nurse educators, nurse practitioners, clinicians (nurses and physicians) with experience in asthma management, and camp directors. Feasibility and outcomes were measured for the camp using materials in the Power Breathing Program for teens developed by the Asthma and Allergy Foundation of America (AAFA) and questionnaires developed by the Consortium of Children's Asthma Camps.

Post-Revolution Egypt: The Roy Adaptation Model in Community.

The 2011 Arab Spring swept across the Middle East creating profound instability in Egypt, a country already challenged with poverty and internal pressures. To respond to this crisis, Catholic Relief Services led a community-based program called "Egypt Works" that included community improvement projects and psychosocial support. Following implementation, program outcomes were analyzed using the middle-range theory of adaptation to situational life events, based on the Roy adaptation model. The comprehensive, community-based approach facilitated adaptation, serving as a model for applying theory in post-crisis environments.

Critical care nurses' attitudes and knowledge related to organ donation.

The need for organ transplant has nearly quadrupled in the past decade, but the number of organ donors has remained relatively constant. Critical care nurses are the vital link in the organ donation process because they can be responsible for referring potential donor cases to an organ procurement organization. This study found that the majority of nurses had overwhelmingly positive attitudes toward organ donation, but they failed to act on their beliefs. Applications for practice include the need to increase critical care nurses' knowledge about designated requesters, the organ donation process, and procedures that assure ethical standards are met.