Enhancing Organizational Review and Promoting Sustainability of DNP Student Projects: Implications for Nurse Leaders.

This project aimed to evaluate the DNP projects at an academic medical center, assess the sustainability of DNP final projects, and explore potential opportunities to enhance the organizational review processes. The organization's graduate student review committee reviewed DNP projects implemented at the organization over the last 8 years. The sustainability of projects was less than anticipated. Recommendations are provided to enhance the DNP project approval process and improve strategies for sustainability.

Academic-clinical nursing partnership use an evidence-based practice model.

AIMS AND OBJECTIVES: The purpose of this study was to compare the experience of a new clinical model with traditional clinical teaching and examine the effects of evidence-based practice strategies among staff and student nurses. BACKGROUND: This provides an innovative approach to nursing student clinical learning that emphasised the academic-clinical partnership with the use of a new model called the Evidence-based Clinical Academic Partnership (ECAP) model. The model incorporates three main components (a) unit transformation into an innovative hybrid version of a dedicated education unit (hDEU); (b) Evidence-in-Action (EIA) rounding; and (c) the cognitive apprenticeship theoretical framework. DESIGN: This pilot study used a mixed-method, quasi-experimental design. METHODS: The quantitative portion included a pre-test, post-test non-randomised quasi-experimental design using self-reported survey data. The qualitative methodology used was a hermeneutic phenomenological approach to data interpretation of three focus groups with staff nurses and unit leaders. SQUIRE 2.0 guidelines were followed (Ogrinc et al., 2016). CONCLUSIONS: The themes that emerged emphasised relationships and the partnership with this innovative approach to clinical teaching. The staff nurses emphasised the need for a collaborative approach and having the presence of the academic faculty member as a way to support the teaching and learning aspects with students. RELEVANCE TO CLINICAL PRACTICE: This study did provide significant contributions to the development of an innovative clinical model and highlighted the importance of the academic-clinical partnership with the education of undergraduate nursing students. The study results provided insight to the ways the hDEU framework may be strengthened, such as increased communication and partnership in the implementation of the ECAP model. Implementing curricular change to include innovative clinical models within a nursing programme is vital in this time of healthcare transformation.

Psychometric Properties of the Short Versions of the EBP Beliefs Scale, the EBP Implementation Scale, and the EBP Organizational Culture and Readiness Scale.

BACKGROUND: Evidence-based practice (EBP) is a problem-solving approach to clinical decision making that leads to a higher quality and safety of health care. Three valid and reliable scales that measure EBP attributes, including the EBP Beliefs Scale, the EBP Implementation Scale, and the Organizational Culture and Readiness Scale for System-Wide Integration of EBP, are widely used but require approximately 5 min each to complete. Shorter valid and reliable versions of these scales could offer the benefit of less time for completion, thereby decreasing participant burden. AIM: The aim of this study was to determine the psychometric properties of the three shortened EBP scales, adapted from the longer versions. METHODS: This study used a descriptive survey design with 498 nurses who completed the three original EBP scales along with a shortened version of each scale. Exploratory factor analysis was conducted with principal components extracted to examine the factor structure of each EBP measure for the three shortened EBP scales. Item intercorrelations and the Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) were used to confirm the validity of using factor analysis. Reliability of each scale using Cronbach's α was examined. Convergent validity of the three shortened EBP scales was assessed by correlating each shortened scale with its longer scale. RESULTS: Factor analysis supported the construct validity of each of the three shortened scales, as all item intercorrelations were greater than 0.40, and KMO values were 0.62 to 0.74. The shortened scales Cronbach alphas were 0.81 for the EBP Beliefs Scale, 0.89 for the EBP Implementation Scale, and 0.87 for the EBP Culture and Readiness Scale. The three shortened EBP scales had acceptable convergent validity (r = 0.42-.072) for the correlations between the shortened and longer scales. LINKING EVIDENCE TO ACTION: The three shortened EBP scales, which are valid and reliable, can be used as an alternative to the longer three scales to decrease participant burden when conducting program evaluations, research, or organizational assessments.

Top-of-License Nursing Practice, Part 2: Differentiating BSN and ADN Perceptions of Top-of-License Activities.

OBJECTIVE: The aim of this study was to describe differences in associate degree (ADN) and baccalaureate degree-prepared (BSN) nurses' perceptions of top-of-license (TOL) practice. BACKGROUND: To date, no empirical work has examined whether ADN and BSN nurses approach TOL practice nursing activities differently. METHODS: We conducted a qualitative pilot study with focus groups to explore the perceptions of a group of ADN- and BSN-prepared nurses concerning nursing activities and their relation to TOL practice. RESULTS: Subthemes emerged differentiating how ADN and BSN nurses perceived their responsibilities related to critical thinking, communication, and patient education. For professional nursing care, 5 subthemes further emerged: (a) approaches to assessment, (b) chart review, (c) psychosocial patient care, (d) documentation, and (e) handoff. CONCLUSIONS: The differences identified in approaches to TOL practice activities by educational preparation have implications for staffing patterns that can optimize the contribution of ADN- and BSN-prepared nurses. Further research is indicated.

Top-of-License Nursing Practice: Describing Common Nursing Activities and Nurses' Experiences That Hinder Top-of-License Practice, Part 1.

OBJECTIVE: The aims of this study were to describe nurses' perceptions of nursing activities and analyze for consistency with top-of-license (TOL) practice. BACKGROUND: The Advisory Board Company expert panel proposed 8 TOL core nursing responsibilities representing practice at its potential. Thus far, no empirical work has examined nursing practices relative to TOL, from staff nurses' points of view. METHODS: This qualitative study used focus groups to explore perceptions of typical nursing activities. We analyzed activities for themes that described nurses' work during typical shifts. RESULTS: Nurses' full scope of work included TOL-consistent categories, as well as categories that did not exemplify TOL practice, such as nonnursing care. A proposed model was developed, which depicts nurses' total scope of work, inclusive of all activity categories. In addition, hindrances to TOL practice were also identified. CONCLUSIONS: Findings from this study can inform leadership imperatives and the development of innovative, sustainable nursing practice models that support nursing practice at TOL.

Nurses' Time Allocation and Multitasking of Nursing Activities: A Time Motion Study.

Nurses have been required to provide more patient-centered, efficient, and cost effective care. In order to do so, they need to work at the top of their license. We conducted a time motion study to document nursing activities on communication, hands-on tasks, and locations (where activities occurred), and compared differences between different time blocks (7am-11am, 11am-3pm, and 3pm-7pm). We found that nurses spent most of their time communicating with patients and in patient rooms. Nurses also spent most of their time charting and reviewing information in EHR, mostly at the nursing station. Nurses' work was not distributed equally across a 12-hour shift. We found that greater frequency and duration in hands-on tasks occurred between 7am-11am. In addition, nurses spent approximately 10% of their time on delegable and non-nursing activities, which could be used more effectively for patient care. The study results provide evidence to assist nursing leaders to develop strategies for transforming nursing practice through re-examination of nursing work and activities, and to promote nurses working at top of license for high quality care and best outcomes. Our research also presents a novel and quantifiable method to capture data on multidimensional levels of nursing activities.

Effects of the Nurse Athlete Program on the Healthy Lifestyle Behaviors, Physical Health, and Mental Well-being of New Graduate Nurses.

Recognizing that transition from nursing student to point-of-care nurse can be a stressful time period in one's career. A pilot study at a large Midwestern medical center tested the preliminary effects of a health-oriented workshop, the Nurse Athlete, on new graduate nurses' healthy lifestyle beliefs, healthy lifestyle behaviors, depressive and anxiety symptoms, as well as health outcomes. The Nurse Athlete workshop, provided in partnership with Johnson & Johnson's Human Performance Institute (HPI), used materials from HPI's Corporate Athlete program. The 2-day workshop focuses on energy management through a comprehensive examination of goals and values in relation to one's spiritual, mental, emotional, and physical development and provides practical strategies to improve self-care. Eighty-eight new graduate nurses hired at the university's medical center were offered the opportunity to participate in the Nurse Athlete program and associated study. Sixty-nine percent of these new graduate nurses (n = 61) consented and participated in the program. There was a statistically significant decrease in the participants' weight and body mass index from baseline to the 6-month follow-up assessment, which resulted in small to medium positive effects for the Nurse Athlete program. There was also a significant decrease in body fat percentage across time, resulting in a large positive intervention effect. Statistically significant reductions in depressive symptoms were measured between baseline and 6 months.

Searching for management approaches to reduce HAI transmission (SMART): a study protocol.

BACKGROUND: Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)-including culture and management strategies-to proactively support clinical teams. METHODS: Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an implementation program for toolkit use, and disseminate that Toolkit nationwide. DISCUSSION: Providing hospitals with the tools they need to successfully measure management structures that support clinical care provides a powerful approach that can be leveraged to reduce the incidence of HAIs experienced by patients. This study is critical to providing the information necessary to successfully "make health care safer" by providing guidance on how contextual factors within a healthcare setting can improve patient safety across hospitals.

Exploring Nurses' Perception of Dynamic Patient Events.

OBJECTIVE: The study aim was to describe nurses' perceptions of dynamic patient events (DPEs) impact on workflow and patient care. BACKGROUND: The process of determining optimal nurse staffing has challenged nurse leaders for decades. METHODS: This study took place on 3 inpatient units in 3 hospitals at a large academic medical center. A qualitative design that included focus groups composed of RNs with a minimum of 1-year experience was used. RESULTS: The most commonly identified DPEs were patient travel, code blues, rapid emergency response events, and requirement for an unplanned 1-on-1 sitter. The impact of DPEs influences the nurse's perception on job satisfaction, workflow, patient's safety/satisfaction, and delayed/missed care. CONCLUSION: It is incumbent upon nursing leaders to understand DPEs and anticipate how these events impact nursing workload, staffing, and care delivery.

Understanding and Visualizing Multitasking and Task Switching Activities: A Time Motion Study to Capture Nursing Workflow.

A fundamental understanding of multitasking within nursing workflow is important in today's dynamic and complex healthcare environment. We conducted a time motion study to understand nursing workflow, specifically multitasking and task switching activities. We used TimeCaT, a comprehensive electronic time capture tool, to capture observational data. We established inter-observer reliability prior to data collection. We completed 56 hours of observation of 10 registered nurses. We found, on average, nurses had 124 communications and 208 hands-on tasks per 4-hour block of time. They multitasked (having communication and hands-on tasks simultaneously) 131 times, representing 39.48% of all times; the total multitasking duration ranges from 14.6 minutes to 109 minutes, 44.98 minutes (18.63%) on average. We also reviewed workflow visualization to uncover the multitasking events. Our study design and methods provide a practical and reliable approach to conducting and analyzing time motion studies from both quantitative and qualitative perspectives.

Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor.

INTRODUCTION: The timing of when a woman is admitted to the hospital for labor care following spontaneous contraction onset may be among the most important decisions that labor attendants make because it can influence care patterns and birth outcomes. The aims of this study were to estimate the percentage of low-risk, nulliparous women at term who are admitted to labor units prior to active labor and to evaluate the effects of the timing of admission (ie, preactive vs active labor) on labor interventions and mode of birth. METHODS: Data from low-risk, nulliparous women with spontaneous labor onset at term gestation were merged from 2 prospective studies conducted at 3 large Midwestern hospitals. Baseline characteristics, labor interventions, and outcomes were compared between groups using Fisher's exact and Mann-Whitney U tests, as appropriate. Likelihoods for oxytocin augmentation, amniotomy, and cesarean birth were assessed by logistic regression. RESULTS: Of the sample of 216 low-risk nulliparous women, 114 (52.8%) were admitted in preactive labor and 102 (47.2%) were admitted in active labor. Women who were admitted in preactive labor were more likely to undergo oxytocin augmentation (84.2% and 45.1%, respectively; odds ratio [OR], 6.5; 95% confidence interval [CI], 3.43-12.27) but not amniotomy (55.3% and 61.8%, respectively; OR, 0.8; 95% CI, 0.44-1.32) when compared to women admitted in active labor. The likelihood of cesarean birth was higher for women admitted before active labor onset (15.8% and 6.9%, respectively; OR, 2.6; 95% CI, 1.02-6.37). DISCUSSION: Many low-risk nulliparous women with regular, spontaneous uterine contractions are admitted to labor units before active labor onset, which increases their likelihood of receiving oxytocin and giving birth via cesarean. An evidence-based, standardized approach for labor admission decision making is recommended to decrease inadvertent admissions of women in preactive labor. When active labor cannot be diagnosed with relative certainty, observation before admission to the birthing unit is warranted.

Nasal continuous positive airway pressure: a multisite study of suctioning practices within NICUs.

PURPOSE: The purpose of this multisite study was to describe suctioning techniques of registered nurses (RNs) and respiratory therapists (RTs) caring for neonates requiring nasal continuous positive airway pressure (CPAP). The care practices investigated included suctioning frequency, assessment parameters, and techniques used to suction. SUBJECTS: A convenience sample of neonatal intensive care unit (NICU) RNs and practicing RTs at 8 Midwestern hospitals in the United States caring for neonates on nasal CPAP in a level II or III NICU were included. Eighty-five percent of respondents were RNs of which almost 89% (88.6%) were staff RNs, 63% were bachelor prepared, and 33% of the RNs had greater than 20 years of neonatal nursing experience. DESIGN: A cross-sectional descriptive comparative design was used for this study. METHODS: An investigator-developed Web-based survey pertaining to current practice concerns was developed by the research team. The 31-item survey tool consisted of 4 sections. The first section addressed the frequency of suctioning. The second section addressed assessment parameters used to determine the need for suctioning. The third section addressed the technique used to suction, including gloving techniques, hyperoxygenation, and the use of catheters in nares and mouth and suctioning devices. Demographic data, including staff position, level of education, years of nursing, and NICU experience and certification, were collected in the fourth section. Descriptive statistics were used to characterize demographics and each item of the survey. Chi-square statistics (Pearson chi-square and Fisher Exact text) were used to compare RNs' and RTs' nasal CPAP suctioning practices. PRINCIPAL RESULTS: The results of this study indicated that decision making related to the need to suction was variable. In addition, the frequency of suctioning and nasopharyngeal and oropharyngeal suctioning techniques were highly variable for neonates requiring nasal CPAP. CONCLUSIONS: Despite the treatment of respiratory distress with nasal CPAP, there are no best practice guidelines for providing nasopharyngeal and oropharyngeal suctioning for maintenance of a patent airway. Future randomized controlled clinical trials are needed to develop best practices for nasal CPAP suctioning.

Stress and coping responses to proficiency testing in school-age children.

Nurses encounter school-age children experiencing multiple stressors and stress symptoms. Performance on proficiency tests is viewed as stressor. The purpose of this repeated measures study was to assess 53 fourth grade children's appraisal of proficiency tests, concurrent stressors, stress symptoms, and coping strategies. During October, February, March, and April, children completed a ranking of their stress associated with proficiency testing and also reported their stressors, stress symptoms, and coping strategies. Results indicated that children appraised proficiency tests as most stressful at the beginning of the school year but less stressful at the time of the test. Stressors and stress symptoms increased from baseline to 1 month before testing then declined. The number of coping strategies used by the children decreased throughout the year. Nurses can work with parents and teachers to identify children with test anxiety and target these children for interventions to improve their coping strategies.