Don't interrupt me! development of a handoff education bundle to simulate the real world.

OBJECTIVES: Ineffective nurse-to-nurse handoff communication is associated with information omissions, diagnostic errors, treatment errors, and delays. New nurses report a lack of confidence and ability in handoff communication, which may stem from inadequate training in prelicensure nursing programs. Our objective was to introduce prelicensure nursing students to a standardized, theory-based method for handoff, including behavioral strategies employed by nurses during interrupted handoff. METHODS: A handoff education bundle (HEB) was developed. Kern's six-step curriculum model was utilized to design, implement, and evaluate the handoff curriculum. RESULTS: Student feedback highlighted the importance of integrating multiple, varying distractors during learning cycles and recognition of the impact of distractors on handoff. CONCLUSIONS: Implementing a HEB at the prelicensure nursing level could promote competency in handoff communication for new graduate nurses. IMPLICATIONS FOR INTERNATIONAL AUDIENCE: Handoff is an international patient safety priority, as inadequate communication has been linked to adverse patient events.

Nurse-to-nurse handoff with distractors and interruptions: An integrative review.

AIM: An integrative review of the literature was conducted to explore perceptions of distractors and interruptions during nurse-to-nurse handoff. BACKGROUND: Handoff distractors and interruptions are recognized as barriers to effective nurse handoff and may lead to preventable and costly medical errors. However, little is known about the perception of these barriers to nurses and strategies to mitigate distractors and interruptions during nurse-to-nurse handoff. METHODS: Using the framework of Whittemore and Knafl, four electronic databases were searched for articles written in English and published in the last five years. Inclusion criteria included: qualitative, quantitative, mixed-methods or quality improvement papers focused on distractors/interruptions during nurse handoff. A multi-author independent review of articles was completed with a rigorous process of data extraction and quality assessment. RESULTS: A total of 17 articles were reviewed with findings categorized into the following themes: perceptions of handoff, characteristics of handoff, or logistics of handoff. Nurses reported that interruptions and distractions were a limitation in handoff quality and handoff efficiency, occurring during inter-shift and unit-to-unit handoff. The two most common types of interruptions and distractions were people (patient, family) and environmental factors (equipment alarms). An organized and standardized approach to handoff was recommended, but few specific examples were reported. CONCLUSION: Despite recent research related to interruptions and distractions in nurse handoff, few evidence-based strategies have been identified that effectively mitigate these patient safety problems. More evidence is needed to determine best practice methods for handoff training for nurses and nursing students.

Nursing Handoff Education Using Experiential and Virtual Innovations.

BACKGROUND: Seventy percent of serious medical errors are the result of ineffective communication, including handoff errors. PROBLEM: Nursing students have cited a need for more experience on how to give handoff; yet, handoff education remains variable. APPROACH: Two innovative curricular approaches were implemented on the basis of Bloom's taxonomy to teach handoff education: experiential and virtual. The outcomes of the 2 curricular innovations were evaluated for handoff completion, handoff accuracy, and handoff quality, based on context. OUTCOMES: During the experiential approach, students demonstrated average handoff completion rates of 84%. During the virtual approach, students' handoff completion rates rose from 25% to 63% and accuracy handoff rates rose from 13% to 31%. CONCLUSIONS: Evaluations support that varying educational methods successfully teach nursing students how to give handoffs. Complementary innovations grant educators flexibility to tailor innovations to curriculum and course context, as supported by Bloom's taxonomy.

Telehealth Competencies for Nursing Education and Practice: The Four P's of Telehealth.

BACKGROUND: Telehealth is a rapidly growing health care delivery modality with advanced practice nurses as key providers. This growth has occurred without critical consideration of provider training. Training requires the development of competencies situated within a framework. PROBLEM: Standardized telehealth competencies for advanced practice nursing are missing. The purpose of this article is to describe the development of telehealth competencies for education and practice. APPROACH: Using the Four P's of Telehealth framework (planning, preparing, providing, and performance evaluation), a modified Delphi technique was used to identify, develop, and evaluate telehealth competencies. OUTCOMES: Competencies were arranged around telehealth domains, expected activities, and outcomes. Effective use of the competencies to guide curriculum development, practice, and future research related to telehealth was identified. CONCLUSIONS: Providing education with competencies aligned to the Four P's Telehealth framework will provide learners with tools to assume leadership roles in all phases of telehealth implementation, delivery, and refinement.

Telehealth educational interventions in nurse practitioner education: An integrative literature review.

BACKGROUND: Telehealth is a solution to combat multiple health care problems such as lack of access, provider shortages, increasing health care expenditures, and a growing number of people living with chronic conditions. Nurse practitioner students are not adequately educated in telehealth and may be unprepared to use it in their future careers. OBJECTIVE: To evaluate the efficacy of telehealth educational interventions synthesizing current literature. DATA SOURCES: Using PubMed and Cumulative Index to Nursing and Allied Health Literature databases, a search was conducted in October 2019 for peer-reviewed articles in English using search terms "telemedicine," telehealth," "ehealth," "mhealth," and "mobile health," along with "graduate nursing education" and "nursing education." CONCLUSIONS: A total of 15 articles were included for review. Minimal nurse practitioner student education should include didactic content and student projects because of the ease of implementation. When telehealth didactic education is combined with experiential learning such as simulation and clinical experience, the benefit is greater. IMPLICATIONS FOR PRACTICE: The identified methods for increasing telehealth education should be implemented to prepare nurse practitioner students because telehealth continues to grow and become a vital part of American health care. Telehealth educational resources should be increased, as telehealth is only as useful as providers are prepared to use it.

Using Simulation to Evaluate Nurse Competencies.

A multimodal nursing pedagogy utilizing simulation was incorporated into annual nurse competencies at a 465-bed academic medical center to translate into practice the required surveillance of a potentially septic patient and the necessary clinical decision-making. Pretest/posttest was used to determine knowledge retention from simulation. Nurses' sepsis knowledge following simulation was improved. Simulation can provide long-term knowledge retention of sepsis for application into clinical practice and be a viable option for competency assessment for professional nurses.

Comparison of a Nurse-Nurse Handoff Mnemonic With Real-World Handoffs.

BACKGROUND: Communication failures, including clinical handoff or clinical handover errors, contribute to 80% of all serious preventable adverse events each year. The N-PAS, N = Nurse, P = Patient Summary, A = Action Plan, and S = Synthesis, is a flexible standardized clinical handoff tool for nurses. PURPOSE: The purpose of this study was to determine the proportion of N-PAS core components present in real-world patient handoffs. METHODS: A mixed-methods design was used to analyze secondary data. Patient handoffs (n = 138) were transcribed into statements and then independently coded by 2 research assistants. RESULTS: Of all handoff statements, 63.2% were coded as Patient Summary and 13.6% were coded as Action Plan, whereas Synthesis was not coded in any handoffs. Three new Patient Summary elements and 1 new Action Plan element were identified. CONCLUSION: Patient Summary and Action Plan are critical data reported during clinical handoff. A handoff synthesis is a critical step to include in handoff training.

Multiregion Quantification of Extracellular Signal-regulated Kinase Activity in Renal Cell Carcinoma.

To personalize treatment for renal cell carcinoma (RCC), it would be ideal to confirm the activity of druggable protein pathways within individual tumors. We have developed a high-resolution nanoimmunoassay (NIA) to measure protein activity with high precision in scant specimens (eg, fine needle aspirates [FNAs]). Here, we used NIA to determine whether protein activation varied in different regions of RCC tumors. Since most RCC therapies target angiogenesis by inhibiting the vascular endothelial growth factor (VEGF) receptor, we quantified phosphorylation of extracellular signal-regulated kinase (ERK), a downstream effector of the VEGF signaling pathway. In 90 ex vivo FNA biopsies sampled from multiple regions of 38 primary clear cell RCC tumors, ERK phosphorylation differed among patients. In contrast, within individual patients, we found limited intratumoral heterogeneity of ERK phosphorylation. Our results suggest that measuring ERK in a single FNA may be representative of ERK activity in different regions of the same tumor. As diagnostic and therapeutic protein biomarkers are being sought, NIA measurements of protein signaling may increase the clinical utility of renal mass biopsy and allow for the application of precision oncology for patients with localized and advanced RCC. PATIENT SUMMARY: In this report, we applied a new approach to measure the activity of extracellular signal-regulated kinase (ERK), a key cancer signaling protein, in different areas within kidney cancers. We found that ERK activity varied between patients, but that different regions within individual kidney tumors showed similar ERK activity. This suggests that a single biopsy of renal cell carcinoma may be sufficient to measure protein signaling activity to aid in precision oncology approaches.

A Delphi study to identify the core components of nurse to nurse handoff.

AIM: The aim of this study was to identify the core components of nurse-nurse handoffs. BACKGROUND: Patient handoffs involve a process of passing information, responsibility and control from one caregiver to the next during care transitions. Around the globe, ineffective handoffs have serious consequences resulting in wrong treatments, delays in diagnosis, longer stays, medication errors, patient falls and patient deaths. To date, the core components of nurse-nurse handoff have not been identified. This lack of identification is a significant gap in moving towards a standardized approach for nurse-nurse handoff. DESIGN: Mixed methods design using the Delphi technique. METHODS: From May 2016 - October 2016, using a series of iterative steps, a panel of handoff experts gave feedback on the nurse-nurse handoff core components and the content in each component to be passed from one nurse to the next during a typical unit-based shift handoff. Consensus was defined as 80% agreement or higher. RESULTS/FINDINGS: After three rounds of participant review, 17 handoff experts with backgrounds in clinical nursing practice, academia and handoff research came to consensus on the core components of handoff: patient summary, action plan and nurse-nurse synthesis. CONCLUSION: This is the first study to identify the core components of nurse-nurse handoff. Subsequent testing of the core components will involve evaluating the handoff approach in a simulated and then actual patient care environment. Our long-term goal is to improve patient safety outcomes by validating an evidence-based handoff framework and handoff curriculum for pre-licensure nursing programmes that strengthen the quality of their handoff communication as they enter clinical practice.

Integrative Review of Interprofessional Simulation in Nursing Practice.

AIM: The aim of this integrative review was to examine what is known about interprofessional (IP) simulation involving practicing nurses. BACKGROUND: The use of simulation within health care education and practice has rapidly expanded; however, there is a gap in what is known about the benefits of nurses engaging in IP simulation. METHOD: Five reviewers conducted a systematic literature search on studies of IP simulation among practicing nurses, published between January 1, 2010, and July 1, 2016. An initial sample of 1,400 articles was found and was further narrowed to 18 studies. RESULTS: There is a role for IP simulation in enhancing nurses' roles and understanding of the roles of other practitioners. However, the diversity of studies and lack of rigor prevents the formation of conclusive evidence to support IP simulation in enhancing patient care quality and safety. CONCLUSION: Structured simulation research designs using published guidelines for best practice implementation are needed. J Contin Educ Nurs. 2018;49(2):91-96.

Pooling of bronchoalveolar lavage in children with cystic fibrosis does not adversely affect the microbiological yield or sensitivity in detecting pulmonary inflammation.

BACKGROUND: Bronchoalveolar lavage (BAL) is a potentially useful outcome measure for clinical trials in children with CF but its use is limited by variations in approach internationally. We sought to determine if pooling adversely affected the diagnostic properties of BAL. METHODS: Children undergoing bronchoscopy for clinical reasons were included. A multi-step study protocol ensured BAL was collected and analysed both separately and as a pooled fluid. RESULTS: Eighty-five children (53 CF, 32 control) were recruited. There was a high level of concordance between pooled and non-pooled samples in terms of organism identification (76%). There was good agreement (Bland Altman) between the two methods in terms of detection of inflammation independent of centre, microbiological concordance or disease status. Bi-directional variability in IL-8 levels between pooled and non-pooled samples was seen. Free neutrophil elastase (NE) was detected in 4 cases in pooled lavage when absent in non-pooled lavage. Levels of interleukin-8 (IL-8) were similar between the two groups with pooled samples showing a greater spread of values. CONCLUSIONS: Pooling of BAL in children does not negatively impact on either the detection of pulmonary infection or inflammation or the observed relationship between infection and inflammation. Intra-patient variability in BAL IL-8 levels suggests regional differences in inflammation.

Effectiveness of online simulation training: Measuring faculty knowledge, perceptions, and intention to adopt.

BACKGROUND: Best practice standards of simulation recommend standardized simulation training for nursing faculty. Online training may offer an effective and more widely available alternative to in-person training. OBJECTIVES: Using the Theory of Planned Behavior, this study evaluated the effectiveness of an online simulation training program, examining faculty's foundational knowledge of simulation as well as perceptions and intention to adopt. DESIGN: One-group pretest-posttest design. SETTING: A large school of nursing with a main campus and five regional campuses in the Midwestern United States. PARTICIPANTS: Convenience sample of 52 faculty participants. METHODS: Knowledge of foundational simulation principles was measured by pre/post-training module quizzes. Perceptions and the intention to adopt simulation were measured using the Faculty Attitudes and Intent to Use Related to the Human Patient Simulator questionnaire. RESULTS: There was a significant improvement in faculty knowledge after training and observable improvements in attitudes. Attitudes significantly influenced the intention to adopt simulation (B=2.54, p<0.001). CONCLUSIONS: Online simulation training provides an effective alternative for training large numbers of nursing faculty who seek to implement best practice of standards within their institutions.

Measure of Clinical Decision-Making Abilities of Nurse Practitioner Students.

BACKGROUND: This study reports the validity and reliability of using unfolding case studies to measure the clinical decision-making abilities of nurse practitioner students. METHOD: Two unfolding case studies were developed to assess students' ability to collect, interpret, and evaluate data. Content validity was assessed through percent agreement from three expert clinicians. Reliability was measured using Cronbach's alpha, test-retest, and interrater reliability. RESULTS: Fifty-two participants, primarily from family, acute care, and adult nurse practitioner programs, completed both unfolding cases. Content validation was nearly 100% for most items; other items were revised or deleted. A significant correlation was found between total mean scores at initial testing and at 1 month after both cases. High inter-rater reliability of the scored tool was noted, as measured with intraclass correlation coefficient. CONCLUSION: The use of case studies is a learner-centric method to measure the development and transition of clinical decision making.

Real-time nanoscale proteomic analysis of the novel multi-kinase pathway inhibitor rigosertib to measure the response to treatment of cancer.

INTRODUCTION: Rigosertib (ON01910.Na), is a targeted therapeutic that inhibits multiple kinases, including PI3K and PIk-1. Rigosertib has been found to induce the proliferative arrest and apoptosis of myeloblasts but not of other normal hematopoietic cells. Rigosertib has significant clinical activity as a therapy for patients with high-risk myelodysplastic syndrome who are otherwise refractory to DNA methyltransferase inhibitors. Moreover, rigosertib has potential clinical activity in a multitude of solid tumors. AREAS COVERED: The objective of this review is to evaluate the mechanism of activity, efficacy and dosing of rigosertib. Furthermore, the challenge in the clinical development of rigosertib, to identify the specific patients that are most likely to benefit from this therapeutic agent, is discussed. A PubMed search was performed using the following key words: rigosertib and ON01910.Na. EXPERT OPINION: We describe the application of a novel nanoscale proteomic assay, the nanoimmunoassay, a tractable approach for measuring the activity and predicting the efficacy of rigosertib, in real-time, using limited human clinical specimens. Our strategy suggests a possible paradigm where proteomic analysis during the pre-clinical and clinical development of a therapy can be used to uncover biomarkers for the analysis and prediction of efficacy in human patients.

A comprehensive look at the early detection of ovarian cancer.

Ovarian cancer is the leading cause of gynecologic cancer deaths and the fifth leading cause of cancer deaths among American women. Advances in surgery and treatment modalities have slightly improved five-year survival rates, but the prognosis for most women continues to be poor. Rectovaginal examination, ultrasound, and the CA-125 blood test are three modalities currently used to screen for ovarian cancer, although no universal ovarian cancer screening guidelines are recommended for the general population. Developments in the early detection of ovarian cancer are emerging and include blood tests that could lead to identifying asymptomatic, early-stage ovarian cancer. Nurses should be knowledgeable about these developments in ovarian cancer as they educate women about ovarian cancer risk, prevention, and early detection.

Temporal patterns of diagnostic results in serial samples from cattle with advanced paratuberculosis infections.

As part of investigating diagnostic strategies for Mycobacterium avium subsp. paratuberculosis (Map), serial results from polymerase chain reaction (PCR) on extraintestinal tissues (blood, milk, and liver) were compared with those from more conventional detection methods including serum enzyme-linked immunosorbent assay (ELISA), fecal culture, and fecal PCR. Three cows previously identified as being subclinically infected with Map were selected for the study. Blood, milk, and feces were collected daily and liver biopsies were obtained weekly for a 30-day period. Unexpectedly, a substantial daily variation in serum ELISA sample to positive (S/P) ratios was observed in all 3 cows. In contrast, fecal culture results were consistently positive. However, whereas fecal culture colony counts were consistently high for 2 cows throughout the study, colony counts from the third cow varied from day to day. Diagnostic sensitivity of PCR for fecal, blood, milk, and liver samples in these advanced subclinically infected cows was 87%, 40%, 96%, and 93%, respectively.