Creating a Just Culture in the Perioperative Setting.

There has been an increased perioperative focus on avoiding adverse events and providing safe patient care since To Err Is Human: Building a Safer Health System published in 2000. Adverse events continue to occur in perioperative areas and are likely underreported. The interdisciplinary nature and high cost of perioperative care may discourage personnel from speaking up for fear of retribution and punishment when reporting. Organization leaders can implement a just culture that focuses on improving patient care processes and safety rather than placing blame after an adverse event. A tenet of just culture is achieving balanced accountability between systems and individuals. Strategies for just culture implementation include leader support, policies and procedures for reporting, accessibility of reporting systems, provision of information for staff members, identification of support champions, and creation of a good catch program. Leaders also should measure and track progress associated with the just culture in their facility.

A National Survey of Collaboration Between Nurse Faculty Members and Staff Nurses in the Clinical Learning Environment.

AIM: The purpose of this study was to measure collaboration in the clinical learning environment. BACKGROUND: Clinical learning, which is essential for nursing education, allows students to integrate what they have learned in the classroom in a complex social context with an interactive network of forces. Stakeholders are nursing students, nursing faculty, and staff nurses who must collaborate in providing an effective learning environment for students. METHOD: Quantitative data were collected via the Collaboration in the Clinical Learning Environment tool, an author-developed 24-item Likert scale designed to measure the amount of collaboration between staff nurses and nursing faculty members in the clinical learning environment. RESULTS: Three groups (n = 882) were surveyed: staff nurses, nurse faculty, and nurses who worked concurrently in academia and practice. CONCLUSION: This study adds to the literature on collaboration between nursing faculty members and staff nurses. It also highlights areas for improvement for both parties.

Factors influencing the implementation of falls prevention practice in primary care.

BACKGROUND: Patient falls in the primary care setting are a complex problem and are detrimental to the independence and quality of life of older adults. OBJECTIVES: The purpose of this integrative review is to identify what factors influence the implementation of fall prevention practice in the primary care setting. This review explores qualitative and quantitative research published between 2004 and 2018 on barriers to fall prevention management in primary care. DATA SOURCES: The authors conducted a systematic search of the evidence and identified 18 articles which met the inclusion criteria. CONCLUSIONS: Five themes were identified that described barriers in fall risk management in the primary care setting. These included provider beliefs and practice, lack of provider knowledge, time constraints, patient engagement, and financial issues. IMPLICATIONS FOR PRACTICE: The lack of screening and assessment regarding fall risk identification demonstrates a gap in the management of older adults in primary care. Using the evidence- and theory-based Stopping Elderly Accidents, Deaths, and Injuries toolkit and algorithm is an effective method to assist practitioners with fall assessment and preventative measures.

Preventing Hypothermia during Cesarean Birth: An Integrative Review.

PURPOSE: The purpose of this integrative review was to assess common warming measures used for prevention of hypothermia during the perioperative period for women having cesarean birth and to determine their efficacy. METHODS: A literature search was conducted via electronic databases EBSCO, PUBMED, Academic Search Premier, Google Scholar, and CINAHL using keyword search terms hypothermia, cesarean, and warming. Inclusion criteria were articles written in English and published between 2006 and 2018. RESULTS: Seventeen articles were included in the review, covering three common warming measures; intravenous (IV) fluid warming, forced-air warming, and combined IV fluid and forced-air warming. Several other warming modalities were noted including warming mattresses and various combinations of interventions. CLINICAL IMPLICATIONS: Maternal hypothermia risk is increased during the perioperative period for women having cesarean birth without use of warming measures. Warming modalities that are beneficial in preventing maternal hypothermia in women having cesarean birth are IV fluid warming, upper body force-air warming, ambient OR temperature, and warming mattresses. National standards and guidelines from the American Society of PeriAnesthesia Nurses, the Association of Perioperative Registered Nurses, and the Association of Women's Health, Obstetric, and Neonatal Nurses are consistent with current evidence and should be in place and followed in every maternity unit caring for women having cesarean birth.

Development and Testing of the Collaboration in the Clinical Learning Environment Tool.

BACKGROUND AND PURPOSE: This study was done to develop and psychometrically test the Collaboration in the Clinical Learning Environment (CCLE) tool. The researcher acknowledged 2 distinct populations that required input into this particular tool development: staff nurses and nursing faculty members. Both have influence into student learning. METHODS: Research followed the 8-step methodology for tool development as defined by DeVellis. RESULTS: Reliability testing was done on the 24-item CCLE, which confirmed a Cronbach's alpha of .96. Exploratory factor analysis with principal component factor analysis was done to examine the structure of the instrument. Validity was supported through the content expert review, along with concurrent validity. CONCLUSIONS: Although collaboration has been emphasized for many years in the clinical learning environment, the construct has never been successfully operationalized. Implications for nursing education, practice, and theory are discussed.

Nursing Students' Qualitative Experiences in the Medical-Surgical Clinical Learning Environment: A Cross-Cultural Integrative Review.

BACKGROUND: The nature of the clinical learning environment has a huge impact on student learning. For instance, research has supported the idea that a positive learning environment increases student learning. Therefore, the ability to gain information from the student perspective about the learning environment is essential to nursing education. METHOD: This article reviews qualitative research on nursing students' experiences of the clinical learning environment. The significance of the issue, the purpose of the integrative review, the methods used in the literature search, and the results of the review are presented. RESULTS: Seventeen studies from 12 countries are identified for review, and six common themes are discussed. An exhaustive literature review revealed that among the 17 articles evaluated, six themes were common. CONCLUSION: The findings indicate the need to continue quality improvement to advance clinical education.

Evaluation of instruments developed to measure the clinical learning environment: an integrative review.

The nature of the clinical learning environment has a huge impact on student learning. This article reviews current methods available for evaluating the clinical learning environment. Five instruments were identified that measure the clinical learning environment. All of these instruments focus solely on the student perspective of the clinical learning environment. Although gaining student input is important, there are other perspectives that offer valuable insights on the nature of the clinical learning environment. The findings from this integrative review indicate the need for future development and testing of an instrument to evaluate the clinical learning environment from the staff nurse and nurse faculty perspective.

Preprocedure warming maintains normothermia throughout the perioperative period: a quality improvement project.

Research supports the practice of preprocedure warming as a method to prevent the development of unplanned perioperative hypothermia. ASPAN defines hypothermia as a core temperature lower than 36°C. The purpose of this quality improvement project was to explore the idea that preprocedure warming maintains perioperative normothermia. Information was obtained through retrospective chart reviews (n = 148). Temperatures were compared for patients who received standard preprocedure care versus patients who were warmed with a warming gown for one hour preprocedure. Before the institution of warming, about 50% of the patients received in the PACU were hypothermic. After the warming was instituted, only 12% of patients were received in a hypothermic state in the PACU. Concepts discussed in this paper include preprocedure warming, postprocedure hypothermia, and complications associated with hypothermia.