Next Generation NCLEX: Why Simulation Matters.

BACKGROUND: The Next Generation NCLEX (NGN) is designed to specifically measure nursing clinical judgment. Schools of nursing are looking for ways to better integrate nursing clinical judgment into their curriculum. One effective strategy to promote nursing clinical judgment is simulation. METHOD: This article explains how to conduct simulations that follow the National Council of State Boards of Nursing Clinical Judgment Measurement Model (NCJMM). Focusing on layer three of the NCJMM, specific examples are provided that link each step of layer three to nursing clinical judgment using simulation. RESULTS: Beginning with Recognizing Cues, the simulation focuses on each step of layer three ending with Evaluating Outcomes. The simulation concludes with a debriefing session to solidify relationships between the variables. CONCLUSION: Simulation has the potential to improve nursing clinical judgment as well as pass rate on the NGN. [J Nurs Educ. 2023;62(5):285-289.].

A qualitative exploration of nurse-physician collaboration in intensive care units.

BACKGROUND: Effective nurse-physician collaboration is associated with superior patient outcomes and improved job satisfaction for both nurses and physicians. OBJECTIVES: This qualitative study explored factors that contribute to nurse-physician collaboration in critical care. Using a qualitative descriptive design, in-depth interviews were conducted with intensive care unit physicians and nurses. Four physicians and six nurses were interviewed between November 2018 and February 2019. Using an iterative process, data analysis occurred after each interview and Lincoln & Guba's Trustworthiness criteria was used to establish validity. FINDINGS: The importance of effective collaboration was emphasized by all nurses and physicians who participated in this study. All participants emphasized the importance of communication and linked effective collaboration to better patient outcomes. Nurses valued respect while physicians stressed the importance of relationships. Both nurses and physicians identified multidisciplinary rounds as the best mechanism for collaboration. Collaboration was also linked to both nurse and physician job satisfaction. CONCLUSION: Effective nurse-physician collaboration is essential to a healthy work environment and optimal patient outcomes. Collaboration improves with the implementation of multidisciplinary rounds. This is the first study to examine this relationship using a qualitative approach. Regardless of health system, both nurses and physicians value effective collaboration. Efforts should be made to invest in activities to improve this relationship. IMPACT: Intenisve care units with effective collaboration are associated with superior patient outcomes. This study used an intimate approach to examine nurses' and physicians' perceptions on collaboration which provided candid and provoking opinions.

Hospital-Acquired Infections: Current Trends and Prevention.

Health care-associated infections (HAIs) are the primary cause of preventable death and disability among hospitalized patients. According to the Centers for Disease Control and Prevention (CDC), complications or infections secondary to either device implantation or surgery are referred to as HAIs. Specifically, the CDC monitors surgical site infections, central-line-associated bloodstream infection, catheter-associated urinary tract infections, and ventilator-associated pneumonias. This article explores HAIs specific to pathophysiology, epidemiology, and prevention, and how nurses can work together with other health care providers to decrease the incidence of these preventable complications.

Nursing job satisfaction, certification and healthcare-associated infections in critical care.

OBJECTIVE: The purpose of this study was to examine the relationship between nursing job satisfaction and healthcare-associated infections (HAIs) in adult critical care. METHODS: Multilevel modelling was used to examine the relationship between nursing job satisfaction and two HAIs, ventilator-associated pneumonia (VAP) and central-line associated bloodstream infections (CLABSI). RESULTS: Units with nurses that reported satisfaction with organisational policies were associated with a 6.08 decrease in VAP (p=0.013) and units with nurses reporting favourable perception of task requirements were associated with a 7.02 decrease in VAP (.014). Positive perception of organisational policies was associated with lower rates of CLABSI (p=0.002). Unexpected findings include a positive relationship between perception of pay and autonomy and CLABSI as well as perception of interactions and VAP. Units with a higher proportion of Critical Care Registered Nurse (CCRN) certified nurses were associated with lower rates of both CLABSI (p<0.001) and VAP (p=0.037). CONCLUSION: This study provides preliminary evidence to support the relationship between nursing job satisfaction and HAIs in critical care, although some relationships were counterintuitive. A secondary finding included significant relationships between CCRN certified nurses and HAIs.

Nurse-physician collaboration and hospital-acquired infections in critical care.

BACKGROUND: Nurse-physician collaboration may be related to outcomes in health care-associated infections. OBJECTIVE To examine the relationship between nurse-physician collaboration and health care-associated infections in critically ill adults. METHODS: A secondary analysis was done of 5 years of nurses' perception data from 671 surveys from 4 intensive care units. Ventilator-associated pneumonia and central catheter-associated bloodstream infections were examined. Multilevel modeling was used to examine relationships between nurse-physician collaboration and the 2 infections. RESULTS: Nurse-physician collaboration was significantly related to both infections. For every 0.5 unit increase in collaboration, the rate of the bloodstream infections decreased by 2.98 (P= .005) and that of pneumonia by 1.13 (P= .005). Intensive care units with a higher proportion of certified nurses were associated with a 0.43 lower incidence of bloodstream infections (P= .02) and a 0.17 lower rate of the pneumonia (P= .01). With nursing hours per patient day as a covariate, units with more nursing hours per patient day were associated with a 0.42 decrease in the rate of bloodstream infections (P= .05). CONCLUSION: Nurse-physician collaboration was significantly related to health care-associated infections.

Critical analysis of 2 nurse perception instruments: the Index of Work Satisfaction and the Practice Environment Scale of the Nursing Work Index.

OBJECTIVES: This study provides a critical comparison and analysis of the Index of Work Satisfaction (IWS) and the Practice Environment Scale of the Nursing Work Index (PES-NWI). BACKGROUND: Nurses' perception of work environment is of critical importance and is linked to patient safety. Two widely accepted instruments, the IWS and the PES-NWI, are used in the process of Magnet designation. METHODS: This study used existing data that measured nurses' perception of work environment using the IWS and PES-NWI. RESULTS: Nurses reported a positive perception of work environment as measured by both the IWS and PES-NWI. Perception of work environment as measured by the IWS was significantly lower compared with the PES-NWI (P < .001). CONCLUSIONS: Although there was conceptual overlap between the subscales of the IWS and PES-NWI, the differences in the constructs that each tool measured culminated with significant differences in overall scores.

The relationship between nurses' perception of work environment and patient satisfaction in adult critical care.

BACKGROUND: Patient satisfaction in critical care is rarely measured yet has a major impact on hospital reimbursement. The critical care setting is characterized by high patient acuity and a fast-paced work environment. Nurses' perception of work environment in relation to various patient outcomes including patient satisfaction has not been explored exclusively in critical care. OBJECTIVES: (a) Examine patient's perception of nursing care associated with their hospitalization in the intensive care unit. (b) Describe nurses' perception of work environment within a defined sample of adult critical care units, using the Practice Environment Scale of the Nursing Work Index (PES-NWI). (c) Explore the relationships between nurses' perception of work environment and patient satisfaction in adult critical care. METHODS: This study used existing data to address the study aims. Unit-level comparisons were examined using analysis of variance. The final aim was examined using multilevel modeling for longitudinal data. RESULTS: Patients were very satisfied with their hospitalization (4.48 out of 5.0). Significant differences were noted among all unit level comparisons (p < .001). Nurses also reported moderate satisfaction with work environment as measured by the PES-NWI, with perception of the role of their nurse manager receiving the highest scores. Perception of nurse manager leadership and ability was significantly related to patient satisfaction (p= .018). Favorable perception of the nurse manager was associated with a .424 point increase in patient satisfaction. CONCLUSIONS: This study offers preliminary support for the relationship between nurses' perception of work environment and patient satisfaction in critical care. It also highlights the pivotal role of the nurse manager in both nurse and patient satisfaction. CLINICAL RELEVANCE: This study examines two important aspects that are both relevant and important to clinical nursing. The first aspect is the healthy work environment. Multiple studies have linked the nursing work environment to patient outcomes and this is an area that deserves further attention. The second aspect, patient satisfaction, is now associated with hospital reimbursement. The relationship between the nursing work environment and patient satisfaction highlights an important link to improving patient care.

Quantitative pupillometry: normative data in healthy pediatric volunteers.

OBJECT: The authors describe the prospective use of a new hand-held point-and-shoot pupillometer (NeurOptics) to assess pupil function quantitatively. METHODS: Repetitive measurements were made in 90 pediatric participants ranging in age from 1 to 18 years, providing a total of 100 measurements under ambient light conditions. The participants consisted of 45 patients without known intracranial or ophthalmological pathological conditions as well as 45 volunteers in the outpatient setting. Quantitative pupil measurements were reliably replicated in the study participants. The mean resting pupil aperture was 4.11 mm and the minimal diameter after stimulation was 2.65 mm, resulting in a 36% change in pupil size. The mean constriction velocity was 2.34 mm/second, with a mean dilation velocity of 2.2 mm/second. CONCLUSION: Pupil symmetry was impressive in the entire cohort.