Improving Safety and Quality With an Emergency Department Overcrowding Plan.

INTRODUCTION: Emergency department overcrowding is a concern that predates the recent coronavirus disease pandemic. Overcrowding in the emergency department continues to worsen internationally. There are multiple combined strategies that help to maintain quality and safety by reducing patient wait times, left-without-being-seen rates, and the length of time a patient stays in the emergency department. The objective of the project was to use an interdisciplinary team to strengthen and revise the emergency department overcrowding plan to reduce the patient wait times, length of stay, and the left-without-being-seen rates. METHODS: The quality improvement team used interprofessional collaboration to focus on 3 areas of the emergency response plan. The team automated an instrument to measure overcrowding in the emergency department, developed a tiered response plan to overcrowding, and implemented a standardized multidisciplinary paging protocol. RESULTS: The emergency department overcrowding plan resulted in a 2.7% decrease in the left-without-being-seen rates, a 42-minute (14.5%) decrease in median emergency department length of stay, and a 3.56-hour (33.3%) decrease in daily overcrowding. DISCUSSION: Emergency department overcrowding is influenced by a multitude of factors. The development and implementation of an efficient and effective overcrowding plan have significant value for patient quality and safety as well as health system planning. An effective response to emergency department overcrowding is a pre-established plan that incrementally uses system-wide resources to support emergency department functions as the census and patient acuity fluctuate.

Trauma-Informed Pedagogy to Foster Resilience in Graduate Nursing Education.

ABSTRACT: The experiences of graduate nursing students during the COVID-19 pandemic necessitate a trauma-informed approach to education. Three hundred graduate nursing students responded to a discussion assignment in a doctoral-level health care policy course. Thematic analysis identified common themes of fear, anxiety, frustration, and exhaustion ( n = 93). Conflict and strain were identified in relation to all major roles (provider, student, and family member), ultimately creating physical and mental barriers to fulfilling each of the roles. Curricular standards must maintain rigor while incorporating flexibility into design standards to assist students when faced with trauma or crisis.

Simulation-Based Training Program to Improve Cardiopulmonary Resuscitation and Teamwork Skills for the Urgent Care Clinic Staff.

INTRODUCTION: Lack of high-quality cardiopulmonary resuscitation (CPR) and effective team communication during cardiovascular emergencies could lead to poor patient outcomes and adverse events. Studies have shown that CPR psychomotor skills declined 3 months and plateaued up to 6 months after the completion of CPR training. The Urgent Care Clinic (UCC) interprofessional staff did not receive consistent training on CPR and teamwork skills beyond what was received from the biannual American Red Cross (ARC) Basic Life Support (BLS) training and semiannual Resuscitative Care Function mock cardiac arrest. Most participants took their last CPR training for more than 6 months (n = 12, 67%), between 3 and 6 months (n = 2, 11%), and within the last 3 months before the pre-intervention period (n = 4, 22%). The purpose of the project was to form an interprofessional team to lead the development and implementation of a theory- and evidence-based simulation-based training program to improve CPR and teamwork skills while enhancing patient safety and emergency medical readiness in the hospital and UCC. MATERIALS AND METHODS: The quality improvement project utilized an interprofessional in situ simulation-based training to improve participants' CPR and teamwork skills. The UCC physicians, nurses, and medical technicians completed a CPR and teamwork simulation-based training with a high-fidelity mannequin, pre-simulation preparation, briefing, and debriefing. The project collected pre-intervention and post-intervention data for CPR competence and teamwork perceptions. A paired t-test was used to assess differences in participant CPR skills and Team Strategies to Enhance Performance and Patient Safety Teamwork Perceptions Questionnaire responses before and after the simulation-based training intervention. The 59th Medical Wing and the University of South Alabama Institutional Review Boards approved the quality improvement project. RESULTS: A total of 18 participants completed the ARC BLS and Team Strategies to Enhance Performance and Patient Safety simulation-based training. Most participants were medical technicians (n = 8, 44%), followed by physicians (n = 5, 28%) and (n = 5, 28%) nurses. There was a statistical significance in participants' ARC BLS scores, with a pre-simulation mean score of 45.42 and a post-simulation mean score of 89.21 (P = .000, 95% CI = 36.89-50.68). For Team Strategies to Enhance Performance and Patient Safety teamwork perceptions, there was a statistically significant increase in the participants' teamwork perception levels, with a pre-simulation mean score of 4.61 and a post-simulation mean score of 4.86 (P = .000, 95% CI = 0.20-0.31). CONCLUSIONS: Our results demonstrated that the participants' ARC BLS scores and UCC's team perceptions have increased after in situ simulation-based training. We did not assess the ideal time for re-training. We recommend a 3- to 6-month post-training assessment to determine the optimal time for a CPR and teamwork refresher training. A high-fidelity simulation-based program with trained facilitators that assess the healthcare providers' CPR and teamwork skills could enhance the delivery of high-quality CPR and execution of effective teamwork skills in their workplace.

Evidence-Based Facebook Recruitment of Study Participants.

Traditional methods for research study recruitment such as snail mail lists and posting flyers may fail to reach the tech-savvy participants needed for today's healthcare studies. Word of mouth can be effective for recruiting a few participants but can rarely accomplish the numbers needed for a representative sample. Social media can be a viable avenue to reach increased numbers of sample participants; however, a good understanding of the risks and benefits of using social media is needed before embarking on active recruitment. A recent study developed an evidence-based participant recruitment plan for the use of Facebook. Potential participant misrepresentation was addressed with clear inclusion criteria, no incentives, and open-ended questions. The Facebook ads to recruit study participation targeted licensed nurses who worked in the prior 2-year period living in the United States based on information in Facebook user profiles. A total of 536 participants responded to all questions on the survey at a cost of $1.78 per completed survey. Daily activity and cost for ads were closely monitored and adjusted to maintain cost control. Facebook can be an effective tool for study participant recruitment across all age ranges for completion of online surveys.

Increasing Outpatient Clinic Healthcare Provider Engagement Through Nursing Leader Communication.

Maintaining engaged nurses and other health care providers were challenging at a multi-specialty outpatient clinic where engagement scores were trending downward. This quality improvement (QI) was developed to improve engagement by implementing structured, evidence-based practice (EBP) interventions to increase nursing leader communication, visibility, and feedback. The Utrecht Work Engagement Scale (UWES-17) compared pre-and post-intervention effectiveness from week one to week eight. The interventions increased the pre-UWES-17 scores by 7.4%. The findings confirmed the effectiveness of the interventions for improving overall healthcare provider engagement.

Implementing a Mentorship Program for New Nurses During a Pandemic.

This article describes the implementation of an evidence-based mentoring program for new registered nurses (RNs) hired into medical-surgical units in a small community-based hospital during the unfolding of the SARS-Cov2 (COVID-19) pandemic. The hospital's nursing leadership supported the program implementation during the COVID-19 pandemic to provide a broader support system to new RNs to improve nurse retention. During a response to the pandemic, the medical-surgical units faced numerous process changes in a short time, which further reinforced the urgency of an additional support system for the newly hired RNs.

Understanding Nurse Perception of Leader Empathy.

Patient perception of caregiver empathy has been studied internationally for decades. Although leadership empathy has been described as having a critical influence on staff retention, this subject is less evident in the literature. This article described a study undertaken to gain a baseline understanding of nurses' perceptions of leader empathy from those they identify as their managers. A baseline for nurses' perception of leader empathy has been established that may be used to benchmark future interventions to assess and improve nurses' perception of their leaders' empathy in the work setting.

Why Seek a Doctorate-Prepared Nurse to Join Your Team?

Increasing numbers of doctoral-prepared nurses are joining interprofessional health care teams. Interestingly, the evolving doctoral programs for nurse leaders can be confusing to other health care professionals. Advanced education for nursing leaders is driven by a growing need for cost-effective implementation of evidence-based practices. Professional nursing organizations and nursing education programs have redefined education to respond to the call for knowledgeable experts to lead evidence-based quality improvements. As interprofessional health care management teams face the daunting task of selecting team members, an understanding of the differences in nursing doctoral programs is needed. A doctor of nursing practice degree-prepared nurse can strengthen the health care team by providing a skill set that includes not only the ability to translate evidence into best practice, but also the ability to communicate effectively with all members of the interprofessional team.

An integrative review of interventions for adolescent weight loss.

The number of overweight adolescents aged 12-19 has tripled during the past 2 decades. Although health risks associated with obesity in adolescence and adulthood are well documented in the literature, little is known about the efficacy of interventions to reduce health risks of this group. The purpose of this study was to conduct a systematic review to describe the scope, domain, and effectiveness of weight loss interventions with overweight adolescents. English-language journal articles published in nursing, psychology, nutrition, medicine, and exercise physiology literature between 1980 and 2003 were retrieved. Seventeen studies using comparison or control groups and interventions directed at reductions in adolescent body mass index or body weight were identified. Descriptive findings of those studies are reported here. Five specific limitations of these studies emerged from the analysis of the interventions: the study findings have not been validated by replication, the samples failed to include adequate representation of Latino and African American male participants, family participation in studies has been inconsistent and infrequent, there is a need for attention to study dropout rates (with attrition reported as high as 45%), and there is a need for conceptual frameworks to guide the studies.