Regional Transformation: An Integrated System's Approach to Magnet Designation Utilizing High-Reliability Organization Implementation Strategies.

BACKGROUND: Synergistic opportunity exists between Magnet-aspiring environments and High Reliability Organization (HRO) cultures to elevate safety, quality, new knowledge, continuous improvement, hierarchical flattening, and frontline empowerment. LOCAL PROBLEM: Variation existed across a region's 15 hospitals regarding Magnet-readiness, leadership engagement, journey strategies, and resource capacity. METHODS: Quality improvement (QI) methodology and a hybrid-hub-spoke-model (HHSM) were used to support region-wide Magnet designation, improve patient outcomes, and advance nursing research. INTERVENTIONS: HRO strategies were used region-wide to strengthen implementation and enculturation of Magnet excellence infrastructure. RESULTS: Nine facilities achieved Magnet recognition. Magnet sites demonstrated significantly lower falls with injury (P = .012), lower health care-associated infections and hospital-acquired pressure injuries than non-Magnet sites. Nursing research studies increased 223%. CONCLUSIONS: Utilizing a HHSM and HRO strategies represent effective methods for supporting region-wide Magnet designation and continuous QI.

Quantitative, Qualitative, Mixed Methods, and Triangulation Research Simplified.

For the novice nurse researcher, identifying a clinical researchable problem may be simple, but discerning an appropriate research approach may be daunting. What are the differences among quantitative, qualitative, mixed methods, and triangulation research? Which method is applicable for the study one wants to conduct? This article discusses the two main research traditions (quantitative and qualitative) and the differences and similarities in methods for front-line nurses. It simplifies and clarifies how the reader might enhance the rigor of the research study by using mixed methods or triangulation. The four types of research are described, and examples are provided to support readers to plan projects, use the most appropriate method, and effectively communicate findings. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

Evidence-Based Practice Implementation: Dependent on Capacity and Capabilities.

OBJECTIVE: This study was conducted to determine the benefits, facilitators, and barriers of implementing evidence-based practice (EBP) into organizational culture. BACKGROUND: Implementing EBP leads to higher quality of patient outcome care, improved patient outcomes, and decreased healthcare costs. Nurse leader (NL) influence is essential for successful EBP implementation. METHODS: Data were collected using a descriptive qualitative approach with focus group interviews using 2 open-ended questions. Participants included NL attendees at the 2022 Association of California Nurse Leaders Annual Program/Conference. Data were analyzed and themes were identified using Sandelowski's method. RESULTS: Two overarching themes emerged: capacity (the amount something can produce) and capabilities (the power or ability to do something). CONCLUSIONS: Healthcare organizations need to invest in building NLs' capacity to implement EBP and allocate resources to strengthen the organization's capabilities in supporting EBP.

A Nursing Research Residency Experience.

ABSTRACT: Nursing research is essential to improving patient care, yet barriers may hinder bedside nurses from participating in research and evidence-based practice (EBP) activities. This article describes a nursing research residency program that aimed to inspire direct care nurses to participate in research and EBP projects. The program described may be a potential solution to bridge the gap between clinical work and research.

Advocating for the Vulnerable: The Clinical Nurse Specialist and Nursing Home Reform.

INTRODUCTION: Nursing homes have been disproportionally affected by the COVID-19 pandemic, particularly because of resident vulnerability, inadequate staffing, and poor quality of care. CURRENT STATE: Despite billions of dollars in funding, nursing homes often do not meet minimum federal staffing requirements and are frequently cited for infection prevention and control deficiencies. These factors significantly contributed to resident and staff deaths. For-profit nursing homes were associated with more COVID-19 infections and deaths. Nearly 70% of US nursing homes are for-profit ownership, where quality measures and staffing levels are often lower than their nonprofit counterparts. Nursing home reform is urgently needed to improve staffing and care quality in these facilities. Some states, such as Massachusetts, New Jersey, and New York, have made legislative progress in establishing standards for nursing home spending. The Biden Administration has also announced initiatives, through the Special Focus Facilities Program, to improve nursing home quality and the safety of residents and staff. Concurrently, the "National Imperative to Improve Nursing Home Quality" report from the National Academies of Science, Engineering, and Medicine made specific staffing recommendations, including an increase in direct care registered nurse coverage. CONCLUSION: There is an urgent need to advocate for nursing home reform by partnering with congressional representatives or supporting nursing home legislation to improve care for this vulnerable patient population. Adult-gerontology clinical nurse specialists have an opportunity to leverage their advanced knowledge and unique skill set to lead and facilitate change to improve quality of care and patient outcomes.

Research, Evidence-Based Practice, and Quality Improvement Simplified.

Is the research process different than evidence-based practice and quality improvement, or is it the same? Scattered evidence and misperceptions regarding research, evidence-based practice, and quality improvement make the answer unclear among nurses. This article clarifies and simplifies the three processes for frontline clinical nurses and nurse leaders. The three processes are described and discussed to give the reader standards for differentiating one from the other. The similarities and differences are highlighted, and examples are provided for contextualization of the methods. [J Contin Educ Nurs. 2023;54(1):40-48.].

Equipping Nurses to Lead Evidence-Based Practice: An Opportunity for Professional Nursing Associations.

OBJECTIVE: The aim of this study was to describe the evidence-based practice (EBP) attributes among California nurse leaders who are members of a professional nursing organization. BACKGROUND: Nurse leaders are pivotal for successful EBP implementation. The Association of California Nurse Leaders' (ACNL) mission to equip nurses to lead self, others, and systems propelled them to conduct a study of members' EBP beliefs, knowledge, competencies, and implementation. METHODS: Evidence-based practice attributes of California nurse leaders were measured using valid and reliable scales via an anonymous, electronic survey. RESULTS: Although ahead in the subjective EBP scales, California nurse leaders' perceptions of organizational EBP culture were comparable with those of a similar national sample. Scores still indicated opportunities for improvement. CONCLUSIONS: Nurse leaders must be prepared to lead EBP in their organizations. Professional organizations such as ACNL have an opportunity to help leaders by conducting research and assessing and meeting their members' learning needs.

Readmission Predictors in Patients With Type II Diabetes.

BACKGROUND: In patients with type II diabetes, hospital readmissions occur frequently and contribute significantly to morbidity. Limited research has predicted the factors that contribute to preventable readmission. PURPOSE: This study identified the predictors of 30-day hospital readmission in patients with type II diabetes. METHODS: This single-site 400 patients study examined effects of comorbidities, race, endocrinology consultation, diabetes self-management education, and diabetes medications on 30-day hospital readmissions. RESULTS: Patients with more comorbidities, who were Hispanics, and those who received an endocrinology consultation were more likely to be readmitted. Patients who received diabetes self-management education or were prescribed both oral and insulin medications were less likely to be readmitted. CONCLUSION: Findings identified the factors related to 30-day readmission in patients with diabetes, emphasizing the need for diabetes self-management education. Understanding why patients are readmitted within 30 days of initial admission will empower nurses to create targeted plans to improve nursing care quality and prevent readmission.

A Virtual World: New Graduate Education in the Era of COVID-19.

In this article, the authors share strategies of adult learning principles for successful transition to virtual learning for new graduate clinical nurses. Knowles' theory was used to redesign a simulation-based education approach to fulfill the diverse learning needs during the COVID-19 pandemic. The delivery of efficient, effective, and meaningful education was achieved by leveraging technology. This evidence-based strategy was delivered via a cost-effective virtual platform that offered improved accessibility and convenience of education without compromising the quality of the educational outcomes, participant engagement, or learner satisfaction. This virtual platform incorporating a variety of active learning strategies exhibited effective practices, engaging the new graduate clinical nurses and enhancing their acquiring, retaining, and applying knowledge in providing high-quality and safe patient care. It demonstrated the promise that virtual education holds for future programs to enhance professional development and build the nursing workforce. Nurse educators can be instrumental in advancing this virtual agenda. [J Contin Educ Nurs. 2022;53(7):307-311.].

Validity and Usefulness of an Electronic Health Care Record-Generated Mobility Ambulation Tool: The Human Body Was Designed to Move.

BACKGROUND: Mobility is a vital function of human life. Nurses have an essential role in preventing hospitalized patient complications through movement and ambulation. PURPOSE: This study examined the integration, accuracy, and precision of a paper-based mobility/ambulation tool into an electronic health record (EHR) to assess inpatient mobility/ambulation status. METHODS: This multisite mixed-methods study was a time-series correlational evaluation of a mobility/ambulation tool into the EHR. RESULTS: Sustainability data revealed strong correlations between nurse responses and EHR levels (r = 0.602; scores r = 0.624). Cronbach's α values were 0.737 and 0.761. Nurses' anecdotes supported the findings. CONCLUSION: Findings revealed that the EHR-Mobility Ambulation Tool is a valid, reliable, and stable tool. EHR-generated scores can assist in reducing charting burden, care planning, and inform the interdisciplinary health team at all patient care stages. Tool adoption could potentially assist nurses plan interventions suitable to maintain or increase hospitalized patients' mobility status and contribute to discharge planning.

Compassion Fatigue and Compassion Satisfaction Among Multisite Multisystem Nurses.

Compassion fatigue is a phenomenon that might affect nurses of all specialties. Compassion fatigue occurrence could be profound and costly. The immediate impact could be disruption of the unit culture. This study investigated the prevalence and individual-level factors associated with compassion fatigue among nurses. An upsurge in patients' complexity today may leave nurses stressed with increasing practice demands and vulnerable to compassion fatigue. If ignored, compassion fatigue may compromise nurses' health and care outcomes. A sample of 1174 nurses from 2 large Southern California health care organizations completed an online survey measuring compassion fatigue, burnout, and compassion satisfaction. Overall, participants scored moderate to average (23-41) on compassion satisfaction, burnout, and compassion satisfaction. Experienced and working nights nurses experienced higher compassion satisfaction levels. Higher compassion fatigue means were associated with new graduates = 29.5, BSN nurses = 27.2, ICU nurses = 27.4, and working 12-hour shift nurses = 26.9, suggesting higher compassion fatigue vulnerability. Nurse leaders and managers can apply this baseline evidence to create tailored programs for specific nursing specialties and inexperienced nurses to tackle compassion fatigue and reduce related unit disorder. Seasoned nurses' perspective can be of value in enhancing those efforts.

An Integrative Review of Nurse-to-Nurse Incivility, Hostility, and Workplace Violence: A GPS for Nurse Leaders.

Bullying, lateral violence, and incivility are real phenomena in the nursing workplace and remain widespread across all care settings. The American Nurses Association recommends zero tolerance for any form of violence from any source and adopting evidence-based strategies to mitigate incivility and bullying. This integrative review examined the evidence regarding nurse-to-nurse incivility, bullying, and workplace violence for 4 nurse populations-student, new graduate, experienced, and academic faculty. Ganong and Cooper's review methodology structured the evidence synthesis. Twenty-one articles pertained to the clinical inquiry. The evidence consistently described the incidents, instigators, and targets of incivility/bullying, which contributes to 84 negative academic, organizational, work unit, and personal outcomes. A safe and just organizational culture demands a comprehensive systems-level approach to create civil environments. The evidence-based structures, processes, and recommendations serve as a Global Positioning System for practice and academic leaders to use in creating a healthy work environment where nurses are encouraged and empowered. The critical choices by nurse leaders will determine not only the future of 21st century professional nursing practice but how the public views the nursing profession for many years to come.

Hospital-Acquired Pressure Injury: Risk-Adjusted Comparisons in an Integrated Healthcare Delivery System.

BACKGROUND: Although healthcare organizations have decreased hospital-acquired pressure injury (HAPI) rates, HAPIs are not eliminated, driving further examination in both nursing and health services research. OBJECTIVE: The objective was to describe HAPI incidence, risk factors, and risk-adjusted hospital variation within a California integrated healthcare system. METHODS: Inpatient episodes were included in this retrospective cohort if patients were hospitalized between January 1, 2013, and June 30, 2015. The primary outcome was development of a HAPI over time. Predictors included cited HAPI risk factors in addition to incorporation of a longitudinal comorbidity burden (Comorbidity Point Score, Version 2 [COPS2]), a severity-of-illness score (Laboratory-Based Acute Physiology Score, Version 2 [LAPS2]), and the Braden Scale for Predicting Pressure Ulcer Risk. RESULTS: Analyses included HAPI inpatient episodes (n = 1661) and non-HAPI episodes (n = 726,605). HAPI incidence was 0.57 per 1,000 patient days (95% CI [0.019, 3.805]) and 0.2% of episodes. A multivariate Cox proportional hazards model showed significant (p < .001) hazard ratios (HRs) for the change from the 25th to the 75th percentile for age (HR = 1.36, 95% CI [1.25, 1.45]), higher COPS2 scores (HR = 1.10, 95% CI [1.04, 1.16]), and higher LAPS2 scores (HR = 1.38, 95% CI [1.28, 1.50]). Female gender, an emergency room admission for a medical reason, and higher Braden scores showed significant protective HRs (HR < 1.00, p < .001). After risk adjustment, significant variation remained among the 35 hospitals. DISCUSSION: Results prompt the consideration of age, severity of illness (LAPS2), comorbidity indexes (COPS2), and the Braden score as important predictors for HAPI risk. HAPI rates may be low; however, because of significant individual site variation, HAPIs remain an area to explore through both research and quality improvement initiatives.

Barriers to breast cancer screening participation among Jordanian and Palestinian American women.

PURPOSE: Increasing breast cancer screening (BCS) among diverse women from minority groups is a goal of health care providers and national organizations as a way to help in the early detection and treatment of breast cancer. The purpose of this article is to investigate barriers to BCS encountered by Jordanian and Palestinian women living in the United States (US). METHODS: Descriptive content analysis of interviews of 107 Jordanian and Palestinian immigrant women provided data on BCS barriers that were thematically analyzed. RESULTS: Data revealed 4 barriers that affect Jordanian and Palestinian immigrant women's participation in BCS: (1) culture-specific barriers such as embarrassment, family relationships, fatalism, and traditional healers consultation; (2) immigration-related barriers (citizenship issues and language); (3) general barriers (including nonparticipation in health screening, stigmatization of cancer, fear, and ignorance about BCS); and (4) irrelevant barriers. CONCLUSIONS: Clinicians should be cognizant of the culture, beliefs and practices of Arab Middle Eastern immigrant women and the influence of these factors on their decision to participate in routine BCS. To increase participation in BCS and knowledge of breast cancer, appropriate language and culturally sensitive educational materials should be created and made available to Arab Middle Eastern immigrant women.

Jordanian and Palestinian immigrant women's knowledge, affect, cultural attitudes, health habits, and participation in breast cancer screening.

Our purpose in this report is to describe relationships among knowledge, affect, attitudes, including cultural beliefs, about breast cancer screening (BCS), and health habits to BCS participation in a convenience sample of 130 immigrant women with Jordanian or Palestinian background living in the Washington DC area. Using our analysis of questionnaires we show correlations among knowledge, affect, utility, general health habits, and participation in BCS consistent with previous research in non-Arab samples. Measures of the relationship of cultural factors to BCS participation need refinement. Future research related to BCS among Jordanian and Palestinian women can build on the results of this study.