Microlearning: A Concept Analysis.

With an overall rise in technology adoption, the information-seeking behaviors of today have become instant and single-focused, and demand convenience for learning and the acquisition of knowledge. Digital technologies expand the reach of learning and allow for the development of innovative and creative methods of teaching. The use of microlearning has been gaining popularity in academic and professional development settings and corporate training. Currently, there is no standardized definition of microlearning. Using Walker and Avant's method of concept analysis, a comprehensive overview of microlearning is provided through identifying the concept and describing its uses, attributes, exemplary cases, antecedents, consequences, and empirical referents. Seven attributes associated with microlearning are single focus, bite-sized, asynchronistic, accessibility, flexibility, interactivity, and multimodal delivery. A proposed definition is a self-directed, on-demand, teaching strategy where small single-focused interactive content is presented to learners asynchronously, using technologies that accommodate multimodal delivery, and access where and when convenient for the learner. This analysis will assist informatics and nursing educators in understanding how microlearning, as a strategy, fits into the electronic learning landscape, is supported by digital technologies, and adds portability to leverage in an on-demand asynchronous way providing targeted learning for use in all areas of clinical practice.

Strategies for developing faculty confidence and competencies to mentor quality improvement DNP projects.

DNP faculty who mentor students in quality improvement (QI) DNP projects often lack essential knowledge of QI principles. The purpose of this article is to guide DNP programs in developing confident and competent faculty mentors for QI DNP projects, facilitating DNP student success. At a multi-campus practice- and research-intensive university, strategies employed to teach College of Nursing faculty essential knowledge of QI principles comprise structural and process components. Structural supports standardize faculty workload, promote potential for collaborative scholarship, and provide instructional and resource support for faculty mentors. Organizational processes facilitate identification of practice sites and meaningful projects. A College of Nursing and university Institutional Review Board collaboration established policy to guide human subjects protection regarding DNP project activity, streamlining and standardizing the process. Library support mechanisms, access to ongoing faculty QI training and resources, and faculty feedback processes to improve QI faculty development are ongoing and sustained. Peer coaching provides continued support for faculty development. Initial process outcomes indicate that implemented strategies are well-received by faculty. The transition to competency-based education provides opportunities to create tools to measure multiple student quality and safety competencies highlighted in Domain 5 of The Essentials: Core Competencies for Professional Nursing Education and inform future directions for faculty development essential to support student success.

Identifying barriers and facilitators for nurse practitioners' opioid management of chronic pain.

BACKGROUND: Drug overdose deaths greatly increased during the COVID-19 pandemic, with 100,306 cases occurring in the United States over 12 months from 2020 to 2021, an increase of 28.5% from the year before. Three quarters of these deaths involved opioids, and this epidemic has seriously complicated chronic pain management. The role of nurse practitioners (NPs) in opioid prescription has expanded since Affordable Care Act passage in 2010, but their prescription of opioids for chronic pain management is not well understood. OBJECTIVES: This integrative review aimed to identify barriers, facilitators, and other factors influencing NPs' management of chronic pain with opioids. DATA SOURCES: Five databases were searched for the highest level of evidence in articles published from 2011 to 2021. Search results were refined to focus on NPs' chronic pain management via opioid prescription. CONCLUSIONS: Nine studies were selected for the review. Six identified themes were indicative of barriers, facilitators, and other factors affecting NPs' opioid management: nurse practitioner education, patient subjectivity and patient education, systemic change and alternative treatment access, interprofessional collaboration, nurse practitioner prescriptive authority, and practice environment. States and schools of nursing should modify policy and curricula to better support NPs' opioid management and reduce associated prescription barriers. IMPLICATIONS FOR PRACTICE: NPs' opioid management can best be improved by providing them with current guideline-based education regarding opioid prescription, emphasizing patient education, supplying NPs with systemic support, encouraging interprofessional collaboration, and solving the prescriptive authority issues. Enhancing NPs' opioid prescription and chronic pain management knowledge would help to mitigate the opioid epidemic.

Health Care Quality and Safety in a Correctional System: Creating Goals and Performance Measures for Improvement.

This article summarizes a collaboration between the Illinois Department of Corrections and an academic partner, University of Illinois at Chicago College of Nursing (UIC Nursing), to deliver a quality improvement (QI) and patient safety plan to the state. Included is a description of the need for meaningful data-driven QI as a method to deliver health care to the incarcerated population. An overview of the assessment, gap analysis, and collaboration between partners to develop a mission, vision, and performance dashboard with a beginning set of measures is presented. The dashboard with performance measures was developed to highlight the priorities of the organization and to focus improvement work to meet those goals. Next step recommendations for UIC Nursing to consult on implementation priorities and training are described.

Addressing Sex Disparities in Lung Cancer Screening Eligibility: USPSTF vs PLCOm2012 Criteria.

BACKGROUND: Lung cancer is the leading cause of cancer death in women in the United States. Prospective randomized lung screening trials suggest a greater lung cancer mortality benefit from screening women compared with men. RESEARCH QUESTION: Do the United States Preventative Services Task Force (USPSTF) lung screening guidelines that are based solely on age and smoking history contribute to sex disparities in eligibility, and if so, does the use of the PLCOm2012 risk prediction model that is based on 11 predictors of lung cancer reduce sex disparities? STUDY DESIGN AND METHODS: This retrospective analysis of 883 lung cancer cases in the Chicago Race Eligibility for Screening Cohort (CREST) determined the sensitivity of USPSTF vs PLCOm2012 eligibility criteria, stratified according to sex. For comparisons vs the USPSTF 2013 and the recently published USPSTF 2021 (released March 9, 2021) eligibility criteria, the PLCOm2012 model was used with risk thresholds of ≥ 1.7%/6 years (6y) and ≥ 1.0%/6y, respectively. RESULTS: The sensitivities for screening by the USPSTF 2013 were 46.7% for women and 64.6% for men (P = .003) and by the USPSTF 2021 were 56.8% and 71.8%, respectively (P = .02). In contrast, the PLCOm2012 ≥ 1.7%/6y sensitivities were 64.6% and 70.4%, and the PLCOm2012 ≥ 1.0%/6y sensitivities were 77.4% and 82.4%. The PLCOm2012 differences in sensitivity using ≥ 1.7%/6y and ≥ 1.0%/6y thresholds between women and men were nonsignificant (both, P = .07). Compared with men, women were more likely to be ineligible according to the USPSTF 2021 criteria because their smoking exposures were < 20 pack-years (22.8% vs 14.8%; ORWomen vs Men, 1.70; 95% CI, 1.19-2.44; P = .002), and 27% of these ineligible women were eligible according to the PLCOm2012 ≥ 1.0%/6y criteria. INTERPRETATION: Although the USPSTF 2021 eligibility criteria are more sensitive than the USPSTF 2013 guidelines, sex disparities in eligibility remain. Adding the PLCOm2012 risk prediction model to the USPSTF guidelines would improve sensitivity and attenuate sex disparities.

Brief Report: Risk Prediction Model Versus United States Preventive Services Task Force 2020 Draft Lung Cancer Screening Eligibility Criteria-Reducing Race Disparities.

INTRODUCTION: Eligibility criteria for lung cancer screening based solely on age and smoking history are less sensitive than validated risk prediction models. The U.S. Preventive Services Task Force (USPSTF) has proposed new guidelines to improve the sensitivity for selecting high-risk individuals and to decrease race disparity. In this retrospective study, termed the Chicago Race Eligibility for Screening Cohort, we compare the sensitivity of the proposed USPSTF2020 criteria versus the PLCOm2012 risk prediction model for selecting a racially diverse lung cancer population with a smoking history for lung cancer screening. METHODS: This Chicago Race Eligibility for Screening Cohort study applies the PLCOm2012 model with a risk threshold of 1.0%/6 years and the USPSTF2020 criteria (age 50-80 y, pack-years ≥ 20 y, quit-years ≤ 15 y) to 883 individuals with a smoking history diagnosed with having lung cancer. RESULTS: The PLCOm2012 was more sensitive than the USPSTF2020 overall (79.1% versus 68.6%, p < 0.0001) in White (81.5% versus 75.4%, p = 0.029) and in African American (82.8% versus 70.6% p < 0.0001) individuals. Of the total cohort, 254 (28.8%) would not have qualified owing to less than 20 pack-years, quit-time of more than 15 years, and age less than 50 years. Of these 254 cases, 40% would have qualified by the PLCOm2012 model. For the 20 pack-year criterion, of the 497 African American individuals, 19.3% did not meet this criterion, and of these, an additional 31.3% would have qualified by the PLCOm2012 model (p = 0.002). CONCLUSIONS: Although more sensitive than USPSTF2013, the proposed USPSTF2020 draft guidelines still have a race disparity in eligibility for screening. This study provides "real world" evidence that use of the PLCOm2012 risk prediction model eliminates this race disparity.

Interprofessional Student Quality Improvement Project in a Federally Qualified Health Center.

BACKGROUND: Quality improvement (QI) and interprofessional competencies are needed to adequately prepare the health care workforce. A nurse-led, federally qualified health center provided university students from multiple health care programs a volunteer opportunity to collaborate on a QI project influenced by social determinants of health. METHOD: Working in dyads, students surveyed patients to understand what they want to learn while waiting to see their provider. Analysis prioritized healthy lifestyles and nutrition topics. Students identified, provided, and evaluated culturally appropriate educational materials, including language and literacy in their preferred modality. A healthy lifestyles/nutrition video, recipes in English and Spanish, and a pamphlet were delivered. RESULTS: Patients deemed some materials helpful, and patients and staff provided feedback for the next project phase. Students achieved basic interprofessional and QI competencies and described project satisfaction. CONCLUSION: The hands-on approach allowed students to develop beginning interprofessional and QI competencies for their future professional practice. [J Nurs Educ. 2020;59(10):585-588.].

Risk Prediction Model Versus United States Preventive Services Task Force Lung Cancer Screening Eligibility Criteria: Reducing Race Disparities.

INTRODUCTION: Disparities exist in lung cancer outcomes between African American and white people. The current United States Preventive Services Task Force (USPSTF) lung cancer screening eligibility criteria, which is based solely on age and smoking history, may exacerbate racial disparities. We evaluated whether the PLCOm2012 risk prediction model more effectively selects African American ever-smokers for screening. METHODS: Lung cancer cases diagnosed between 2010 and 2019 at an urban medical center serving a racially and ethnically diverse population were retrospectively reviewed for lung cancer screening eligibility based on the USPSTF criteria versus the PLCOm2012 model. RESULTS: This cohort of 883 ever-smokers comprised the following racial and ethnic makeup: 258 white (29.2%), 497 African American (56.3%), 69 Hispanic (7.8%), 24 Asian (2.7%), and 35 other (4.0%). Compared with the USPSTF criteria, the PLCOm2012 model increased the sensitivity for the African American cohort at lung cancer risk thresholds of 1.51%, 1.70%, and 2.00% per 6 years (p < 0.0001). For example, at the 1.70% risk threshold, the PLCOm2012 model identified 71.3% African American cases, whereas the USPSTF criteria only identified 50.3% (p < 0.0001). In contrast, in case of whites there was no difference (66.0% versus 62.4%, respectively [p = 0.203]). Of the African American ever-smokers who were PLCO1.7%-positive and USPSTF-negative, the criteria missed from the USPSTF were those with pack-years less than 30 (67.7%), quit time of greater than 15 years (22.5%), and age less than 55 years (13.0%). CONCLUSIONS: The PLCOm2012 model was found to be preferable over the USPSTF criteria at identifying African American ever-smokers for lung cancer screening. The broader use of this model in racially diverse populations may help overcome disparities in lung cancer screening and outcomes.

Facilitating faculty knowledge of DNP quality improvement projects: Key elements to promote strong practice partnerships.

Enrollment in Doctor of Nursing Practice (DNP) programs is growing rapidly. This poses a challenge to faculty because there is a gap in knowledge about evidence-based practice and quality improvement DNP projects. Challenged by the growing unavailability of preceptors and mentors in the practice setting, solutions are needed to help students meet the essentials of the degree and competencies for practice. Faculty knowledge of key DNP quality improvement project elements, measuring, monitoring, and sustaining improvement outcomes, may help students design projects to provide value to practice partners. A literature review was conducted to identify gaps in faculty knowledge of potential practice partners' value-added elements of DNP quality improvement projects (measuring, monitoring, and sustainability) to make recommendations for faculty development to improve DNP project mentoring. There is evidence in the literature that faculty feel ill-prepared to mentor DNP projects. Quality improvement content is available for faculty development in the nursing and other health sciences literature. Optimizing faculty knowledge regarding evidence-based practice, quality improvement processes, and mentoring of sustainable DNP projects that improve health care provides value to practice partners and may advance long-term partnerships. Adding structures to support faculty knowledge in these areas contributes to solutions to the challenges of rapidly expanding DNP programs.

Accelerating Improvement of a Doctor of Nursing Practice Project Proposal Course Using Quality Improvement Methods.

BACKGROUND: Transition from traditional research-based to Doctor of Nursing Practice (DNP) projects led students and faculty in our program to express confusion and anxiety about proposal requirements and project planning. This demanded an improvement approach to engage students and faculty. METHOD: Plan-Do-Study-Act cycles were used to accelerate improvement in the first DNP project course. Strategies targeted both students and faculty mentors and included tools and resources to assist with course and project navigation. Voice of the customer feedback and lessons learned were used to plan for improvement in the next cycle. RESULTS: After four PDSA cycles, student evaluation of course quality was favorable and scholarly writing and feasibility improved. Student comments about course anxiety and confusion decreased and faculty mentors' confidence improved. CONCLUSION: A quality improvement strategy is a successful approach for continued course improvements and can role model quality improvement approaches expected in DNP project work. [J Nurs Educ. 2019;58(5):306-311.].

Addressing Safe Opioid Monitoring Practices Using an Interprofessional Approach.

OBJECTIVE: The aims of the project are to increase knowledge related to opioids and improve adherence to evidence-based interventions for sedation monitoring and assessment in adult inpatients receiving opioids for pain through delivery of an interprofessional online program. BACKGROUND: Preventable opioid-induced respiratory depression is a patient safety risk in hospitals. Sedation and respiratory assessment and monitoring guidelines and tools are available to improve practice. METHODS: An interprofessional team identified organization-specific drivers of opioid-induced sedation and respiratory depression using process improvement methodology, developed interventions, and evaluated clinician opioid knowledge and documentation practice. RESULTS: Opioid knowledge survey responses improved after the interventions. Audits showing improved appropriate documentation by RNs of the correct sedation scale were performed over 2 separate 3-month periods. CONCLUSIONS: Clinicians demonstrated increased knowledge about newly adopted sedation and monitoring practices targeted to prevent opioid-induced respiratory depression.

Reducing Medication Administration Errors in Acute and Critical Care: Multifaceted Pilot Program Targeting RN Awareness and Behaviors.

OBJECTIVE: The aim of this medication safety pilot program was to increase RN sensitivity to potential error risk, improve behaviors, and reduce observed medication administration errors (MAEs). BACKGROUND: MAEs are common and preventable and may lead to adverse drug events, costing the patient and organization. MAEs are low visibility, rarely intercepted, and underreported. METHODS: An interprofessional team used process improvement methodology to develop a human factors-based medication safety pilot program to address identified issues. An observational time-series design study monitored the effect of the program. RESULTS: After the program, error interception practices during administration increased, and some nurses reported using a mindfulness strategy to gain situational awareness before administration. Process behaviors were performed more consistently, and the risk of MAE decreased. Familiarity and complexity were identified as additional variables affecting MAE outcome. CONCLUSIONS: Strategies to support safe medication administration may reduce error and be of interest to nurse leaders.