Nursing Strategic Imperatives: Engaging Nurses in Strategy Development and Execution to Drive Value.

Strategic plans provide a roadmap for value creation by outlining key priorities that, when executed successfully, enhance quality and efficiency. Nurses are uniquely positioned to inform strategic planning because of their understanding of clinical operations and consumer needs. This article describes a multiphase process for engaging nurses, at all levels, in developing, implementing, and revising a nursing strategic plan over a 5-year period.

Moving beyond the measure: Understanding patients' experiences of communication with nurses.

Under Medicare's Value-Based Purchasing Program, scores derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey are used in the determination of incentive payments and financial penalties for healthcare organizations. Organizations, therefore, invest in approaches to improve the likelihood of positive patient responses. Evidence suggests that nurse communication as measured by HCAHPS influences overall patient satisfaction, yet little is known regarding what patients believe constitutes effective communication with nurses. In this qualitative descriptive study, we conducted phone interviews with 49 recently hospitalized patients to better understand patients' perceptions of their communication with nurses. Our findings indicate that patients perceived their communication with nurses to unfold via nurses' behaviors. Namely, nurses' engagement with patients, anticipation of patients' needs, responsiveness to patients' concerns, and teaching practices positively influence patient satisfaction with communication with nurses. These behaviors resonated most strongly with patients during particularly memorable moments of uncertainty and vulnerability over the course of a hospital stay. These findings suggest that focusing on the development of nurses' behaviors, ensuring processes are in place to support positive behaviors and creating organizational environments that position nurses to consistently apply these behaviors, can improve patients' perceptions of their communication with nurses. These findings also provide a foundation for further research focused on developing and testing specific behavioral interventions and their effect on communication perception.

Professional networks and support for nursing home directors of nursing.

In this study, we examined the influence of professional network characteristics, available professional support, and perceived support quality on intent to stay among for-profit nursing home (NH) directors of nursing (DON). We hypothesized that the receipt of high quality professional support would be associated with DON intent to stay. DONs have a critical mandate to provide leadership that influences their facilities' work climate and care quality. Yet, they often struggle to manage overwhelming responsibilities and are left feeling alienated, frustrated, and intent on leaving their jobs. Professional support, accessed via professional networks, may help DONs combat frustration and mitigate turnover that threatens NH care quality. Using a descriptive survey design, we electronically surveyed all DONs employed by a single for-profit NH corporation to collect data pertaining to their professional networks, receipt of professional support, perceptions regarding support quality, and intentions to stay in their positions. One-hundred-ninety-five DONs (65%) responded, with 133 (44%) completing every survey component. We employed social network analysis methods to construct datasets linking descriptors of DON respondents with attribute information about 1,164 network members. Statistical analyses (ANOVAs, point biserial correlations, and binomial logistic regression) yielded several findings supporting our hypothesis: (i) DONs' professional networks closely resembled the teams in which they worked daily; (ii) DONs relied on this core network of individuals to provide task support primarily; (iii) DON-nursing home administrator relationships were most important; and (iv) perceptions of support quality and support from nursing home administrators were the strongest predictors of DON intent to stay.

Silicone Foam Dressing for Prevention of Sacral Deep Tissue Injuries Among Cardiac Surgery Patients.

OBJECTIVE: To evaluate the effect of silicone foam dressings, placed preoperatively, on the incidence of postoperative sacral deep-tissue pressure injuries. DESIGN, SETTING, AND PATIENTS: An uncontrolled before-and-after quality improvement method was used. Within a single, urban academic medical center, consecutively admitted adult cardiac surgery patients were included in the pre- and postintervention groups; only those receiving elective procedures were included. INTERVENTION: Nurses applied a sacral silicone foam dressing preoperatively. This dressing was maintained on the patient's sacrum intraoperatively and postoperatively for up to 5 days in the intensive care and step-down units. MAIN RESULTS: This project demonstrated a clinically significant decrease (P < .02) in the incidence of postoperative sacral deep-tissue pressure injuries from 2.3% (preintervention, n = 300) to 0% (postintervention, n = 224). These results were sustained for 24 months after the trial was completed. CONCLUSIONS: The use of silicone foam dressings may be an effective prophylactic intervention to reduce the incidence of perioperative deep-tissue pressure injuries among cardiac surgery patients, a high-risk population.

Development of a Comprehensive Geriatric Assessment Led by Geriatric Nurse Consultants: A Feasibility Study.

Hospitalized older adults are at high risk for complications, leading to negative outcomes such as longer lengths of stay, hospital readmissions, and functional and cognitive decline. Comprehensive Geriatric Assessment (CGA) models are effective in mitigating these syndromes but are not widespread. Nurses with expertise in gerontology who can provide consultation and care coordination can improve care processes and clinical outcomes. This pilot study capitalized on the role of the geriatric nurse consultant (GNC) to develop, implement, and test the feasibility, acceptability, and utility of a GNC-led CGA. Through repeated applications with hospitalized patients, this study demonstrated that GNCs could complete a CGA and identify clinically actionable findings. This study also uncovered clinical geriatric concerns that would not have otherwise been identified via traditional nursing assessments. The results highlight contribution of a GNC-led CGA as a mechanism to support care process improvements to address common geriatric concerns in the acute care setting. [Journal of Gerontological Nursing, 44(12), 25-34.].

Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue.

RESEARCH PURPOSE: Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population. STUDY DESIGN: This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006-2007. METHODS: Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls. FINDINGS: Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p < .001) and 17% lower odds of failure to rescue (p < .01). CONCLUSIONS: Hospitals with lower levels of nurse autonomy place their surgical patients at an increased risk for mortality and FTR. CLINICAL RELEVANCE: Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes.

Risk Factors Associated With Pressure Ulcer Formation in Critically Ill Cardiac Surgery Patients: A Systematic Review.

BACKGROUND: Cardiac surgery patients are among those most at risk for developing pressure ulcers (PUs), with a reported incidence as high as 29.5%. Although numerous studies documenting PU risk factors and prevention strategies exist, the availability of literature examining risk factors specific to the cardiac surgery population is limited. AIM: A systematic review was completed that aimed to identify the risk factors associated with PU development in critically ill, adult, cardiac surgery patients. METHODS: The MEDLINE, CINAHL, and Cochrane databases were searched. Studies that focused on PU risk factors in critical care, surgical intensive care, or cardiac surgery populations and used PU occurrences as an outcome variable were included in the review. FINDINGS: Twelve high-quality studies were retrieved and included in the review; they revealed 30 potential PU risk factors. Current evidence is limited in 2 important ways. First, the impact of intraoperative factors, such as cardiopulmonary bypass time or body temperature, appears to be underexplored. Second, a substantive discussion of the risk factors associated specifically with deep tissue injuries, a unique PU category, is absent. CONCLUSION: The relatively high PU incidence among cardiac surgery patients suggests that typical PU prevention methods are insufficient for this population. Targeted prevention measures must be developed and implemented. Completion of this task required identification of risk factors unique to this population. Specific risk factors likely to increase risk among cardiac surgery patients include prolonged exposure to pressure during long surgical procedures, vascular disease, and/or vasopressor use postoperatively. Additional research concerning risk factors specific to this population is urgently needed.

Hartford Gerontological Nursing Leaders: From Funding Initiative to National Organization.

In 2000, the John A. Hartford Foundation established the Building Academic Geriatric Nursing Capacity Program initiative, acknowledging nursing's key role in the care of the growing population of older adults. This program has supported 249 nurse scientists with pre- and postdoctoral awards. As a result of the program's success, several Building Academic Geriatric Nursing Capacity Program awardees formed an alumni organization to continue to advance the quality care of older adults. This group of Building Academic Geriatric Nursing Capacity Program awardees joined others receiving support from the John A. Hartford Foundation nursing initiatives to grow a formal organization, the Hartford Gerontological Nursing Leaders (HGNL). The purpose of this article is to present the development, accomplishments, and challenges of the HGNL, informing other professional nursing organizations that are experiencing similar accomplishments and challenges. This article also demonstrates the power of a funding initiative to grow an organization dedicated to impact gerontological health and health care through research, practice, education, and policy.