Pilot Implementation of the Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool.

CONTEXT: Specialist palliative care services must balance provision of needs-based care within resource restraints. The Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool is a novel, evidence-based, 7-item prioritization tool, with recommended response times for any given score. OBJECTIVES: To investigate the acceptability and appropriateness of the RUN-PC Triage Tool implemented into clinical practice. METHODS: A single-arm, multisite, prospective implementation pilot conducted at 12 community/inpatient palliative care services, using Quality Improvement methodology with Plan-Do-Study-Act cycles. Data collected for each triage episode included demographics, scoring, user feedback and clinical outcomes. Group differences were tested by chi-squared, Wilcoxon Rank Sum or Kruskal Wallis tests. RESULTS: A total of 5418 triage episodes were captured, 1509 with outcome data. Referrals to inpatient services were of higher acuity than those to community (median score 24 vs. 14). Whilst high numerical scores were unusual, a significant proportion of cases were clinically urgent. Admissions occurred within recommended response times in over 80% of triage episodes; 5.8% of referred patients died before being admitted. Users reported the tool was easy to complete (99.3% of applications), rarely requiring additional time (0.07%), and appropriate in its triage determination (96.0% of applications). CONCLUSION: The RUN-PC Triage Tool is feasible to implement, with high clinician acceptability and virtually no additional time required. The recommended response times are feasible and highlight target areas for improvement. Implementation of the tool enables palliative care services to better characterize their referral population and, in turn, improve transparency around access to care.

Promoting civility in nursing practice using systems thinking: Evidence-based teaching strategies for nurse educators.

There is a critical need for nurse educators to promote civility in nursing practice using systems thinking to promote quality and safety and improve patient outcomes by preventing undue patient harm. In this article, evidence is synthesized in order that readers can recognize, respond and manage workplace incivility. Systems thinking is introduced as a best practice solution for advancing a civil workplace culture. The author-created Systems Awareness Model, adapted for civility awareness, guides nurse educators with evidence-based strategies for teaching nurses the essential skills to promoting a civility culture within health systems. The strategies can be used by nurse educators in practice to interface workplace application. Proposed examples of evaluation methods are aligned with the teaching strategies. The purpose of this article is to provide nurse educators in practice with evidence-based teaching strategies and evaluation methods to address incivility in health care using a systems thinking perspective.

Systems Thinking for Managing COVID-19 in Health Care Systems: Seven Key Messages.

This article provides the most current guidelines for nurse educators and nurses to use systems thinking to manage COVID-19 in health systems. A working definition of systems thinking is offered, with a review of basic knowledge and care in the context of the system awareness model (SAM). Seven key messages assist nurse educators and nurses in the management of COVID-19 patients culminating in leadership of complex health care systems using systems thinking. [J Contin Educ Nurs. 2020;51(9):402-411.].

Using Systems Thinking to Implement the QSEN Informatics Competency.

There is an urgent need to improve the use and usability of the electronic health record (EHR) in health care to prevent undue patient harm. Professional development educators can use systems thinking and the QSEN competency, Informatics, to educate nurses about such things as nurse-sensitive indicators in preventing medical errors. This article presents teaching tips in using systems thinking to champion communication technologies that support error prevention (betterment). [J Contin Educ Nurs. 2019;50(9):392-397.].

Academic-Practice Partnerships: A Win-Win.

Partnerships between academia and practice can lead to improved patient care and health system innovations. Nurse educators in both academia and practice are positioned to facilitate opportunities for students and practicing nurses to be involved in evidence-based practice (EBP) care initiatives involving academic-health care partners in clinical and/or community-based systems. Best practices in collaborative partnerships have demonstrated the significance of their far-reaching impact on patients, students, direct care nurses, and health systems. Translation of EBP knowledge to practice transforms patient outcomes and empowers nurses to address the complexity of health care systems. This article describes the process and outcomes of an academic-practice partnership facilitated by nurse educators in both academic and practice settings. The impact of the adoption of EBP projects on clinical practice, students, and practicing nurses is described. National and international implications for academic- practice partnerships are discussed. [J Contin Educ Nurs. 2019;50(6):282-288.].

Systems Thinking for Transitions of Care: Reliability Testing for a Standardized Rubric.

PURPOSE: The purpose of this study was to develop a standardized rubric for systems thinking across transitions of care for clinical nurse specialists. DESIGN: The design was a mixed-methods study using the Systems Awareness Model as a framework for bridging theory to practice. METHODS: Content validity was determined using a content validity index. Reliability was established using statistical analysis with Cronbach's α and intraclass correlation coefficient. Usability of the rubric was established using content analysis from focus group discussions about their experiences in using the rubric. RESULTS: Content validity was established with a content validity ratio of 1.0. Statistical analysis showed a high interrater reliability (α = 0.99), and sections of the rubric showed a strong degree of reliability with α's ranging from 0.88 to 1.00. Content analysis revealed several overall themes for usability of the rubric: clarity, objectivity, and detail. The area for improvement included adding more detail in the scholarly writing section. CONCLUSION: The research team recommends using the rubric to reflect application of systems thinking across transitions of care.

Systems Perspective for Incivility in Academia: An Integrative Review.

AIM: The purpose of this integrative review was to identify evidence of systems thinking on civility in academic settings. BACKGROUND: Incivility is present in academic systems, including nursing education. What is learned in academia translates to the workplace. Systems-based solutions may promote quality and safety in health care. METHOD: Whittemore and Knafl's integrative approach guided this study. RESULTS: Forty-nine articles were reviewed. Themes emerged describing incivility in nursing as embedded within layers of a performance-driven, oppressive hostile bureaucracy, trickling down, instilling fear, and reinforcing uncivil behavior among and between members. Other themes defined faculty-to-faculty and faculty-to-student incivilities, reasons for it, reactions to it, and suggestions for improved civility. CONCLUSION: The systems awareness model is offered as a means of promoting civility in nursing education. A lack of evidence to support how incivility in academia transfers to quality and safety in practice settings is identified as a gap for future study.

Strategies for Integrating Global Awareness and Engagement Into Clinical Practice.

Nurse educators are faced with the challenge of educating learners about global health for clinical practice, particularly as cultural diversity increases in their own communities. This third article in the four-part Teaching Tips series focuses on active teaching-learning strategies for global health awareness and engagement in clinical practice using interprofessional education global health competencies and evidence-based interactive teaching strategies. Tips and topic ideas are offered for integrating global awareness and engagement in both the academic and practice settings to prepare today's nurses for systems-based culturally competent care in clinical practice. J Contin Nurs Educ. 2018;49(5):203-205.

Global Health Engagement: At Home and Abroad.

Nurses and nurse educators need to be prepared to accelerate progress toward the United Nations' Sustainable Development Goals to improve local and global health in the face of continued poverty, hunger, and disease. This four-part Teaching Tips series will focus on developing nurse educators to prepare nurses for global engagement on the following topics: introduction to global health, systems thinking for global health, strategies for integrating global awareness and engagement into clinical practice, and leading and participating in service trips. The authors offer tips for increasing global awareness and using frameworks, strategies, and resources for both students and nurses to use in their own settings and practice. J Contin Educ Nurs. 2018;49(3):109-110.

Using Systems Thinking to Advance Global Health Engagement in Education and Practice.

The integration of global health into nursing practice within complex systems requires a strategic approach. The System-Level Awareness Model (SAM) can be used to guide the process of enhancing systems thinking for global health. The purpose of this article is to explain the SAM and how to use it for integrating systems thinking into nursing education in academic, professional development, and continuing education settings to promote global health across the nursing continuum. Tips are provided on how to teach systems thinking for global health in nursing education and practice, consistent with continuing education national learning competencies for health care professionals. J Contin Educ Nurs. 2018;49(4):154-156.

Systems thinking and incivility in nursing practice: An integrative review.

BACKGROUND AND PURPOSE: There is a critical need for nurses and interprofessional healthcare providers to implement systems thinking (ST) across international borders, addressing incivility and its perilous effects on patient quality and safety. An estimated one million patients die in hospitals worldwide due to avoidable patient-related errors. Establishing safe and civil workplaces using ST is paramount to promoting clear, level-headed thinking from which patient-centered nursing actions can impact health systems. The purpose of the paper is to answer the research question, What ST evidence fosters the effect of workplace civility in practice settings? METHODS: Whittemore and Knafl's integrative review method guided this study. The quality of articles was determined using Chu et al.'s Mixed Methods Assessment Tool. RESULTS: Thirty-eight studies were reviewed. Themes emerged describing antecedents and consequences of incivility as embedded within complex systems, suggesting improvements for civility and systems/ST in nursing practice. IMPLICATIONS FOR PRACTICE: This integrative review provides information about worldwide incivility in nursing practice from a systems perspective. Several models are offered as a means of promoting civility in nursing practice to improve patient quality and safety. Further study is needed regarding incivility and resultant effects on patient quality and safety.

QSEN Institute RN-BSN Task Force: White Paper on Recommendation for Systems-Based Practice Competency.

The Quality and Safety Education for Nurses (QSEN) Institute RN-BSN Task Force presents a white paper on Recommendation for a Systems-based Practice Competency. The task force proposes a seventh QSEN competency, systems-based practice, to improve patient quality and safety. Recommendations to integrate systems-based practice into both education and practice settings, consistent with job descriptions and promotion criteria, involve a comprehensive continuing education program for nurses upon interview, orientation, residency programming, performance evaluation, and license renewal.

A Concept Analysis of Systems Thinking.

PURPOSE: This concept analysis, written by the National Quality and Safety Education for Nurses (QSEN) RN-BSN Task Force, defines systems thinking in relation to healthcare delivery. METHODS: A review of the literature was conducted using five databases with the keywords "systems thinking" as well as "nursing education," "nursing curriculum," "online," "capstone," "practicum," "RN-BSN/RN to BSN," "healthcare organizations," "hospitals," and "clinical agencies." Only articles that focused on systems thinking in health care were used. The authors identified defining attributes, antecedents, consequences, and empirical referents of systems thinking. FINDINGS: Systems thinking was defined as a process applied to individuals, teams, and organizations to impact cause and effect where solutions to complex problems are accomplished through collaborative effort according to personal ability with respect to improving components and the greater whole. Four primary attributes characterized systems thinking: dynamic system, holistic perspective, pattern identification, and transformation. CONCLUSION: Using the platform provided in this concept analysis, interprofessional practice has the ability to embrace planned efforts to improve critically needed quality and safety initiatives across patients' lifespans and all healthcare settings.

Integrating Systems Thinking Into Nursing Education.

A critical need exists for nursing leadership in current complex health care settings. Systems thinking can be incorporated into nursing education at all levels by using evidence-based principles in education. Teaching tips are provided using a systems awareness model to guide nurse educators in the assessment and integration of systems thinking and engaging learners in interprofessional education and practice. J Contin Educ Nurs. 2016;47(9):395-397.

Fostering Future Leadership in Quality and Safety in Health Care through Systems Thinking.

There is a critical need for leadership in quality and safety to reform today's disparate spectrum of health services to serve patients in complex health care environments. Nurse graduates of degree completion programs (registered nurse-bachelor of science in nursing [RN-BSN]) are poised for leadership due to their recent education and nursing practice experience. The authors propose that integration of systems thinking into RN-BSN curricula is essential for developing these much needed leadership skills. The purpose of this article is to introduce progressive teaching strategies to help nurse educators achieve the student competencies described in the second essential of the BSN Essentials document (American Association of Colleges of Nursing, 2009), linking them with the competencies in Quality and Safety Education for Nurses (QSEN; L. Cronenwett et al., 2007) using an author-created model for curricular design, the Systems-level Awareness Model. The Systems Thinking Tool (M. A. Dolansky & S. M. Moore, 2013) can be used to evaluate systems thinking in the RN-BSN curriculum.

Improving the adoption of evidence-based practice through RN-to-BSN education.

BACKGROUND: Although enrollment in RN-to-BSN degree completion programs has grown profoundly, a dearth of literature exists regarding the impact of RN-to-BSN education and the adoption of evidence-based practice (EBP). This study examined the elements of RN-to-BSN education that improve the awareness and adoption for EBP. METHOD: A mixed methods meta-synthesis was conducted using qualitative, textual-narrative, and descriptive research studies. Data from six articles were analyzed, using standardized critical appraisal instruments. RESULTS: Two findings were identified. First, EBP skills for RN-to-BSN students are influenced by exposure to educational partnerships, contextual teaching and learning, and practice experiences. Second, barriers to adoption exist for RN-to-BSN students, which limit advances in nursing practice. CONCLUSION: A variety of contextual teaching and learning strategies can provide empowerment for RN-to-BSN students to adopt EBP in their practice. Forming partnerships in creating EBP experiences may set the stage for RN-to-BSN leadership opportunities in today's health care system.

Investigating nicotinic acetylcholine receptor expression in neonicotinoid resistant Myzus persicae FRC.

The peach-potato aphid Myzus persicae is a pest of many commercial crops due to its polyphagous nature of feeding and has a well-documented history of acquiring resistance to insecticides. In 2009 a strain (M. persicae FRC) emerged in southern France with a point mutation (R81T) at the nicotinic acetylcholine receptor (nAChR), the target site for neonicotinoids such as imidacloprid. This point mutation was associated with the loss of the high affinity imidacloprid binding site (pM Kd), with the single remaining binding site (low nM Kd) highly overexpressed compared to laboratory controls (Bass et al., 2011 [1]). Here we report that after 2years of continuous selection in the glass house environment with neonicotinoids, the total level of IMD-sensitive nAChRs (low nM Kd) in M. persicae FRC is now comparable to laboratory controls (pM and low nM Kd). Interestingly, despite this large reduction in IMD-sensitive nAChRs, this was not associated with any significant alteration in NNIC-lethality. Additionally, sustained absence of neonicotinoid-selection did not alter nAChR protein levels. We suggest that alterations in nAChR protein expression level described in the original characterisation of the field-isolated M. persicae FRC is unlikely to have been a direct consequence of the R81T mutation. Rather, we speculate that nAChR expression in aphids is likely influenced by as yet unknown conditions in the natural field environment that are absent in the laboratory setting.

Voices of innovation: building a model for curriculum transformation.

Innovation in nursing education curriculum is critically needed to meet the demands of nursing leadership and practice while facing the complexities of today's health care environment. International nursing organizations, the Institute of Medicine, and; our health care practice partners have called for curriculum reform to ensure the quality and safety of patient care. While innovation is occurring in schools of nursing, little is being researched or disseminated. The purposes of this qualitative study were to (a) describe what innovative curricula were being implemented, (b) identify challenges faced by the faculty, and (c) explore how the curricula were evaluated. Interviews were conducted with 15 exemplar schools from a variety of nursing programs throughout the United States. Exemplar innovative curricula were identified, and a model for approaching innovation was developed based on the findings related to conceptualizing, designing, delivering, evaluating, and supporting the curriculum. The results suggest implications for nursing education, research, and practice.

Creating tomorrow's leaders and innovators through an RN-to-bachelor of science in nursing consortium curricular model.

The critical need to increase the number of baccalaureate-prepared RNs to improve the safety and quality of patient care in today's complex health care system is a pressing issue in health care. One part of the solution lies in the attainment of higher education of RNs prepared at the associate and diploma levels who make up the majority of the nursing workforce in the United States today. The Indiana University Schools of Nursing located throughout the state of Indiana collaborated to create a statewide RN-to-bachelor of science in nursing curriculum that is flexible, innovative, and meaningful. The plan focuses on the strengths and unique learning needs of returning RN students. Specifically, this curriculum offers year-round online courses in 7-week terms, which allows students to enter and exit the program within 1 year, and a curriculum with more choices and fewer constraints than is typical for baccalaureate nursing degrees. This learner-centered plan fully incorporates the American Association of Colleges of Nursing Essentials for Baccalaureate Education (2009) throughout the curriculum. It is conveniently delivered online, takes into account and gives credit for students' previous learning and work experience, and allows the students to pursue nursing specialty knowledge for college credit. Working together as a consortium to achieve these goals across an entire state with 8 regional campuses required focused attention on the concerns and strengths of all the stakeholders and successful implementation of effective communication strategies.

Preparing nurse educators to use simulation technology: a consortium model for practice and education.

BACKGROUND: As nurses seek to advance their education through online courses, considering best practices in feedback is especially important. Rich and rapid feedback has long been considered a best teaching practice, but how to provide this feedback in an online course environment is not always clear. This study was conducted to identify how experienced faculty provide feedback to online students. METHODS: This descriptive exploratory study surveyed faculty about their approach to feedback with broad exploratory questions and a validation survey. The sample included faculty in four different states who benchmark online educational best practices. RESULTS: Content analysis was used to evaluate data, with 15 themes emerging. These themes were organized into three categories: using best available tools; having a system; and creating a feedback-rich environment. CONCLUSION: The findings support and extend the guidelines for best practices in online education, including a focus on multisource feedback opportunities during course design.