Delirium Screening in Critically Ill Children: Secondary Analysis of the Multicenter PICU Up! Pilot Trial Dataset, 2019-2020.

OBJECTIVES: To determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices. DESIGN: A secondary analysis of 2019-2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168). SETTING: Six PICUs in the United States. PATIENTS: One thousand sixty-four patients who were admitted to a PICU for 3 or more days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 1064 patients, 74% (95% CI, 71-76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1-3 days (aOR 3.36 [95% CI, 2.62-4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32-2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04-1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08-2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63-0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63-0.90]) or ketamine (aOR 0.48 [95% CI, 0.29-0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates. CONCLUSIONS: In the 2019-2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.

Nurse engagement in antibiotic time-outs: The collaborative process of leveraging design to disseminate research findings.

INTRODUCTION: Research findings and knowledge translation are typically disseminated via presentations at professional meetings and publication in peer-review journals. However, other opportunities to translate research evidence into practice exist, including the use of visual cues. AIM: The aim of this paper is to describe the collaborative process of translating key research findings into a clear and compelling visual communication tool. DESIGN: As part of a multimodal research dissemination strategy, the researchers partnered with the University Health Communication Design Program faculty to develop a visual communication strategy to promote the use of antibiotic time-outs by nurses in a health system. An environmental poster was identified as an appropriate mode of communication for its potential to convey a message quickly, impactfully, and economically. METHODS: Five-step systematic approach, including feedback from end-users. RESULTS: To augment our research dissemination strategy, an action-oriented visual communication tool in the form of a 36x48 inch poster was created within four weeks and placed in the work environment. Unit nursing leaders and staff decided on poster locations for maximum nurse engagement with the message. CONCLUSION: Creating visual communication to display scientific information is an important skill, but most nurse researchers never receive any formal training that encourages participation in collaborative development of visual communication tools. Our collaboration, was iterative, reflective, and provided a unique opportunity for shared learning. Partnering with health communication designers to expand research reach and impact is invaluable and should be considered as part of a dissemination strategy. CLINICAL RELEVANCE: Clinical nurses' benefit from 'seeing' the science narrowed to a simple message in order to spark dialogue or remind them what they need to 'do'.

Voices from frontline nurses on care quality and patient safety during COVID-19: An application of the Donabedian model.

BACKGROUND: The COVID-19 pandemic has adversely impacted quality of care and patient safety. This study aimed to describe registered nurses' (RNs) perceptions on the impact of the COVID-19 pandemic on their ability to adhere to patient safety protocols using Donabedian's Health Care Quality model. METHODS: In October 2020, a survey was conducted among all actively licensed RNs in New Jersey who provided direct patient care during the first peak of COVID-19. RESULTS: Of 3,027 participants, 68% reported that the number of patients assigned impacted their ability to adhere to protocols. RNs identified a variety of organizational structures impacting adherence, including inadequate staffing, staff qualifications, and inadequate resources. Impacted processes included the inability to adhere to patient safety protocols and conduct comprehensive assessments and surveillance, the need for additional time spent on personal protective equipment and isolation policies, and difficulty maintaining isolation integrity; the need to prioritize and cluster care; and guidelines limiting personnel who could enter the room. Nurses attributed both adverse patient and staff outcomes to inadequate staffing and high patient acuity. CONCLUSIONS: These findings highlight the need for health care organizations to support frontline nursing staff in adhering to patient safety and infection prevention and control protocols during times of crises. Infection preventionists have substantial contact with bedside nurses and should leverage their collegial relationships to promote patient safety.

Factors influencing antibiotic prescribing by nurse practitioners: A quantitative pilot study using the theory of planned behavior.

BACKGROUND: The overuse of antibiotics contributes to the development of antibiotic resistance (AR) and exposes patients to potential antibiotic-related harm. Nurse practitioners (NPs) are well positioned to optimize antibiotic use; however, little is known about the factors influencing NP prescribing behaviors. PURPOSE: Describe the knowledge, attitude, subjective norms, and perceived behavioral control in prescribing antibiotics among NPs practicing at a large university-affiliated health care system in the northeast United States. METHODOLOGY: This was a cross-sectional online anonymous survey using the Theory of Planned Behavior. Descriptive statistics were used to describe the sample. Nonparametric tests were used to examine differences in the dependent variables by demographic characteristics. RESULTS: One hundred seventy-four of 618 NPs (28%) completed the survey. Almost all considered AR a problem in the United States, but only half considered it a problem in their health care setting. More than half indicated they prescribed antibiotics less than 25% of the time in daily practice. Most were confident in making antibiotic prescribing decisions. There was a positive relationship between years of experience as NPs and their confidence in making antibiotic prescribing decisions ( p < .003) and an inverse relationship between years of experience as NPs and asking for advice from physicians or pharmacists when prescribing antibiotics ( p < .002). CONCLUSION/IMPLICATIONS: With increasing numbers of NPs managing infectious diseases and prescribing antibiotics, these findings will inform interventions to support appropriate prescribing behaviors.

Aligning the Post Master's DNP with the 2021 AACN Essentials.

BACKGROUND: The Essentials: Core Competencies for Professional Nursing Education was published in 2021 to establish competency-based education on two levels; entry and advanced. Advanced level competencies are intended for doctorally prepared professionals. PURPOSE: The purpose of this initiative was to align a Post Master's Doctor of Nursing Practice (DNP) Program with the new 2021 American Association of Colleges of Nursing (AACN) Competency-Based Essentials. METHODS: Three DNP faculty met weekly, outlined a timeframe and approached the revision as a quality improvement plan to revise the curriculum based on our comprehensive review of the domains and concepts of the revised (2021) AACN Essentials. DNP Course Leads were interviewed to evaluate the course objectives, student learning objectives, assignments, and course content. RESULTS: Six new program outcomes (POs) were written. For each (PO), measurable student learning outcomes (SLOs) were articulated for each course. Several courses were combined or retired, and several new courses were added including an elective. The DNP project was reframed based on a 'systems' approach to implement quality improvement (QI) within the health care system in consideration of the concepts of diversity, equity, and inclusion (DEI) and the impact on patient outcomes. CONCLUSIONS: In keeping with the Mission, Vision and Values of the College and with the collaboration and support from the Dean, the graduate Chair, and faculty of the College, the post-master's DNP program was approved with an anticipated start date in Summer, 2023.

Advancing Antibiotic Stewardship Nursing Practice Through Standardized Education: A Pilot Study.

Background Antibiotic resistance is a leading global public health threat. Nurses are well positioned to optimize antibiotic use via targeted antibiotic stewardship (AS) nursing practices. However, standardized AS education for nurses is lacking. The objective of this study was to evaluate the effect of an online AS for nurses continuing education program on nurses' antibiotic resistance, antibiotic, and AS knowledge and their intent to integrate AS into their clinical practice. Method A quasi-experiential pretest-posttest design was used with a convenience sample of nurses at a U.S. academic medical center. Focus groups were conducted with those completing the program. Results Forty-seven of 100 eligible nurses completed the program and the pre- and posttest surveys. Participation resulted in statistically significant increases (p < .05) in antibiotic resistance, antibiotic, and AS knowledge, confidence, and perceptions related to the role of nursing in AS. Focus group participants had multiple recommendations for ways to integrate AS in daily nursing practice. Conclusion Completing a comprehensive AS nursing continuing education program could prove instrumental to motivating nurses to adopt AS nursing practices. [J Contin Educ Nurs. 2022;53(9):417-423.].

Effect of a virtual simulated participant experience on antibiotic stewardship knowledge among pre-licensure baccalaureate nursing students: A pilot study.

BACKGROUND: Antibiotic resistant infections are a growing global public health threat poised to render antibiotics ineffective in treating even the most common infectious diseases. It is essential that future nurses have the knowledge and skills to keep patients safe from antibiotic harm in all health care settings, however, studies indicate that there is limited education provided in nursing schools regarding antibiotic use, antibiotic resistance, and antibiotic stewardship nursing practices. OBJECTIVE: Evaluate the effect of a virtual, scenario-based simulation experience using simulated participants on pre-licensure baccalaureate nursing students' antibiotic, antibiotic resistance, and antibiotic stewardship nursing practice knowledge. METHODS: A quasi-experiential repeated measure pre-posttest design was used with a convenience sample of 165 pre-licensure baccalaureate nursing students enrolled in a health promotion course at a private university in the northeast region of the United States. The NLN Jeffries Simulation Theory guided the virtual simulation experience and used simulated participants methodology. RESULTS: All students participated in the simulation experience. Statistically significant increases were noted (p < 0.005) in antibiotic, antibiotic use, and antibiotic resistance knowledge between the pre and post surveys. The most significant changes were in knowledge of antibiotic stewardship nursing practices. CONCLUSION: Integration of virtual, scenario-based simulations provided students an active learning opportunity to practice antibiotic stewardship assessment and practice skills through real life-like situational experiences with simulated participants, resulting in improved antibiotic, antibiotic resistance, and antibiotic stewardship knowledge.

Racial and ethnic differences in vaccine hesitancy Among registered nurses in New Jersey: A cross-sectional survey.

Nurses play an important role in the vaccine readiness process and high vaccination rates among nurses are essential to ensuring successful vaccination programs. This study sought to examine whether the intention to get vaccinated varied by race and/or ethnicity among a large sample of registered nurses in New Jersey.

A novel framework to guide antibiotic stewardship nursing practice.

BACKGROUND: There is a pervasive view among some nurses and health care disciplines that antibiotic stewardship (AS) is solely a physician or pharmacist responsibility. There is an urgent need to alter this view so that nurses can seize every opportunity to prevent patient harm from antibiotics and optimize antibiotic use. One challenge to achieving full nurse engagement as equal members of the AS team is lack of an organizing framework to illustrate relationships of phenomena and concepts inherent to adoption of AS nursing practices. METHODS: We sought to create a framework derived from the peer-reviewed literature, systematic and scoping reviews, and professional standards, consensus statements and white papers. The emerging framework went through multiple iterations as it was vetted with nurse clinicians, scholars and educators, physicians, pharmacists, infection preventionists and AS subject matter experts. RESULTS: Our evidence-based Antibiotic Stewardship Nursing Practice SCAN-P Framework provides the much-needed context and clarity to help guide local-level nurses to participate in and lead AS nursing practice. CONCLUSIONS: Nurses worldwide are ideally situated to provide holistic person-centered care, advocate for judicious use of antibiotics to minimize antibiotic resistance, and be AS educators of their patients, communities and the general public. The Antibiotic Stewardship Nursing Practice SCAN-P Framework provides a tool to do so.

Utilizing high-fidelity simulation to improve newly licensed pediatric intensive care unit nurses' experiences with end-of-life care.

PURPOSE: New pediatric intensive care unit (PICU) nurses face distinct challenges in transitioning from the protected world of academia to postlicensure clinical practice; one of their greatest challenges is how to support children and their caregivers at the end-of-life (EOL). The purpose of this quality improvement project was to create, implement, and assess the efficacy of a high-fidelity EOL simulation, utilizing the "Debriefing with Good Judgment" debriefing model. DESIGN AND METHODS: Participants were nurses with 4 years or less of PICU experience from a 404-bed quaternary care, free-standing children's hospital in the northeastern United States. Data were collected with the Simulation Effectiveness Tool-Modified (SET-M) and the PICU EOL Simulation Evaluation Survey. RESULTS: Twenty-four nurses participated; the majority (54%) were 25-29 years of age. The SET-M results indicate that the EOL simulation was beneficial to their learning and increased nurse confidence in delivering EOL care. Responding to the EOL Simulation Survey, participants rated high levels of confidence with tasks such as utilizing unit and hospital-based supports, self-care, ability to listen and support families, and medicating their patients at the EOL. PRACTICE IMPLICATIONS: This high-fidelity EOL simulation is a robust teaching tool that serves to support the unmet needs of the PICU nurses who care for dying children. Nurse participants had a unique opportunity to practice procedural and communication skills without risk for patient or family harm. Findings from this project can serve to guide curriculum changes at the undergraduate level as well as provide direction for new nurse orientation classes.

Evaluation of infection concept and content integration in a baccalaureate nursing program curriculum.

Nursing students must graduate from their programs equipped with evidenced-based knowledge and skills to prevent, detect, control, and stop the spread of infectious agents regardless of setting. This program evaluation sought to determine curricular integration of the concept of infection and infection prevention and control practices.

eSIMPLER: A Dynamic, Electronic Health Record-Integrated Checklist for Clinical Decision Support During PICU Daily Rounds.

OBJECTIVES: Design, implement, and evaluate a rounding checklist with deeply embedded, dynamic electronic health record integration. DESIGN: Before-after quality-improvement study. SETTING: Quaternary PICU in an academic, free-standing children's hospital. PATIENTS: All patients in the PICU during daily morning rounds. INTERVENTIONS: Implementation of an updated dynamic checklist (eSIMPLER) providing clinical decision support prompts with display of relevant data automatically pulled from the electronic health record. MEASUREMENTS AND MAIN RESULTS: The prior daily rounding checklist, eSIMPLE, was implemented for 49,709 patient-days (7,779 patients) between October 30, 2011, and October 7, 2018. eSIMPLER was implemented for 5,306 patient-days (971 patients) over 6 months. Checklist completion rates were similar (eSIMPLE: 95% [95% CI, 88-98%] vs eSIMPLER: 98% [95% CI, 92-100%] of patient-days; p = 0.40). eSIMPLER required less time per patient (28 ± 1 vs 47 ± 24 s; p < 0.001). Users reported improved satisfaction with eSIMPLER (p = 0.009). Several checklist-driven process measures-discordance between electronic health record orders for stress ulcer prophylaxis and user-recorded indication for stress ulcer prophylaxis, rate of venous thromboembolism prophylaxis prescribing, and recognition of reduced renal function-improved during the eSIMPLER phase. CONCLUSIONS: eSIMPLER, a dynamic, electronic health record-informed checklist, required less time to complete and improved certain care processes compared with a prior, static checklist with limited electronic health record data. By focusing on the "Five Rights" of clinical decision support, we created a well-accepted clinical decision support tool that was integrated efficiently into daily rounds. Generalizability of eSIMPLER's effectiveness and its impact on patient outcomes need to be examined.

COVID-19 vaccination readiness among nurse faculty and student nurses.

BACKGROUND: Unprecedented efforts are underway to develop COVID-19 vaccines, widely seen as critical to controlling the pandemic. Academic nursing leaders must be proactive in assuring widespread faculty and student vaccination uptake. PURPOSE: The purpose of this study was to describe nursing faculty and student nurse factors associated with COVID-19 vaccine readiness. METHODS: Cross-sectional online survey of nursing faculty and student nurses at a university affiliated with an academic medical center was conducted. FINDINGS: Most full-time faculty (60%) intended to receive the vaccine; but only 45% of adjunct faculty and students reported intending to get vaccinated. The major reasons for not getting vaccinated were vaccine safety and side effects. Collectively, participants reported a low level of knowledge related to vaccine development. DISCUSSION: As the most trusted profession, nurses will play a decisive role in counseling patients about COVID-19 risks and benefits. Findings suggest that academic nursing leaders need to consider faculty and student vaccine concerns and provide vaccine development education.

Infection preventionists role in antimicrobial stewardship: Survey of APIC members.

The primary job responsibility of infection preventionists (IPs) is to lead organizational initiatives that prevent and control health care-associated infections. Increasingly, IPs are participating in activities that support antimicrobial stewardship programs (ASPs). We conducted a survey of Association of Professionals in Infection Control and Epidemiology members practicing in acute care facilities to determine the degree of their involvement in ASP activities.

Infection Concept Integration and Teaching Strategies in US Baccalaureate Nursing Programs in an Era of Concept-Based Curriculum.

BACKGROUND: Health care-associated infections remain a major patient safety problem. Antibiotic resistance and the resurgence of infectious diseases pose an escalating threat to public health. It is essential for nursing students to develop an understanding of the infection concept and the ability to apply their knowledge and skills in all settings. PURPOSE: The purpose was to describe the integration of the infection concept and associated teaching strategies in US baccalaureate nursing programs. METHODS: A comprehensive literature review was conducted using multiple online databases. RESULTS: There is some evidence of infection concept integration within single courses but limited evidence of integration across courses. We were unable to ascertain the degree of infection concept integration throughout a curriculum. Faculty used a blend of creative, innovative strategies to foster active teaching and learning. CONCLUSION: The concept of infection and the related teaching strategies used to help students organize infection-related knowledge, skills, and attitudes to form logical connections needs greater attention.

Clinical Nurse Preparation and Partnership in Antibiotic Stewardship Programs: National Survey Findings Are a Call to Action for Nurse Leaders.

OBJECTIVE: Describe clinical nurse involvement in antibiotic stewardship programs (ASPs). BACKGROUND: The extent to which clinical nurses are supported and integrated into ASPs is unknown. METHODS: Electronic survey of infection preventionists (IPs) working in acute care hospitals. RESULTS: A total of 207 IPs nationwide reported on clinical nurses' involvement in their hospital's ASP. Among respondents, 42% reported the presence of a designated nurse executive that championed nurses' involvement in ASPs; 33% reported that the hospital provides antibiotic stewardship education and training to clinical nurses, and only 14% believed that clinical nurses have adequate stewardship knowledge to participate in ASP activities. CONCLUSIONS: Study findings indicate the need for nurse leaders to improve the preparation and integration of clinical nurses in ASPs. While clinical nurses routinely perform activities that contribute to optimal antibiotic use, the knowledge and competency of clinical nurses in these activities and their formal integration in ASPs are minimal.