The relationship between self-efficacy and sustainable Lean management systems within the healthcare arena.

PURPOSE: The purpose of this paper is to improve the understanding of the social contexts of sustainable Lean culture in healthcare by examining self-efficacy (SE) as a fundamental construct related to the value of perceived readiness, prior education of Lean and the importance of leadership's system-level support. DESIGN/METHODOLOGY/APPROACH: A descriptive correlational study was conducted to identify the relationships between SE and Lean readiness factors, SE and prior Lean training, SE and clinical vs administrative roles and SE and perceived system-level support in a large health system. FINDINGS: There was a statistically significant difference in self-reported readiness to use Lean tools between individuals who had received Lean training during their academic education and those who had not; however, their level of education did not impact SE. Lastly, and perhaps most important, the learner who embodies SE also has system-level support. RESEARCH LIMITATIONS/IMPLICATIONS: Future directions of this research, in addition to assessing team readiness as other studies suggest, would be to evaluate individual team member readiness by gauging SE and addressing deficits prior to the deployment of process improvement (PI) projects to promote success and sustainability. PRACTICAL IMPLICATIONS: This contributes to the ongoing scholarship of Lean management systems, providing clinical and non-clinical leaders with a contextual understanding of their supportive role in the SE of teams. ORIGINALITY/VALUE: This study demonstrates the value of understanding SE of individual team members and how it can contribute to overall improved team outcomes, directly impacting the sustainability of Lean change culture and its promotion of improved patient safety, cost efficiencies and access to care.

Pressure injury screening in the emergency department: A concept analysis.

AIM: This concept analysis analyzes pressure injury screening in the emergency department setting using Walker and Avant's approach. BACKGROUND: Pressure injury treatment cost in the United States totals over 11 billion dollars annually. Although a pressure injury could develop in the few hours a patient is in the emergency department, there is little guidance on how an emergency department should screen, prevent, and treat patients. DATA SOURCE: Five sources resulted from database searches of CINAHL full-text, Health Business FullTEXT, and MEDLINE with Full Text. Key search terms used to narrow the search consist of the following terminology: "pressure injury" OR "pressure ulcer" AND "screening" AND "risk factors" AND "emergency room" OR "emergency department. REVIEW METHODS: Walker and Avant's method of concept analysis was used to clarify the concept of pressure injury screening in the emergency department. RESULTS: The concept analysis identified two attributes of pressure injury screening in the emergency department: patient length of stay and the cost of pressure injury treatment. Antecedents identified are patient risk factors: age, mobility status, sensory perception, comorbidities, and pre-existing pressure injuries. Positive consequences identified are increased patient comfort, increased staff satisfaction, decreased hospital-acquired pressure injuries, and increased adherence to established treatment protocols. CONCLUSIONS: This concept analysis may help to guide evidence-based practice for pressure injury screening in the emergency setting. Perhaps screening in the emergency department, if adopted globally, is the missing element needed to finally see a reduction in pressure injury rates.

An Examination of Factors Associated With Student Resiliency.

BACKGROUND: Student resiliency, success, and retention are top priorities for nursing programs. PURPOSE: The purpose of the cross-sectional descriptive study was to identify factors associated with the resiliency level and physical and mental health of nursing students. METHODS: A cross-sectional descriptive study design was used with a convenience sample of 199 nursing students from organizations that comprise the Community Patient Safety Coalition Nursing Research Consortium. Resiliency was measured with the Connor Davidson Resiliency Scale. Physical and mental health was measured with the Patient Reported Outcomes Measurement Information System Global Health Short Form. RESULTS: Most of the nursing students in the sample were female (92%), White (94%), and in BSN programs (74.4%). Students had low resiliency (P < .0001) and low physical and mental health (P < .0001) compared with the general population. CONCLUSIONS: Student resilience was positively correlated to self-perception of physical and mental health.

Peripheral Vascular Disease.

Peripheral vascular disease (PVD) is a leading health concern in the United States, with an estimated prevalence of 8.5 million. The incidence of PVD is growing due to increasing rates of obesity and diabetes, as well as an aging population. Peripheral vascular disease is categorized as either venous, arterial, or mixed. A differential assessment is essential to identify the type of PVD and to plan management strategies to prevent further vascular dysfunction. This article describes assessment of patients with PVD, risk factors, treatments, and patient education.

The Effect of a Perioperative Clinical Immersion on Senior Nursing Students' Perception of Readiness to Practice: A Quality Improvement Project.

Health care organizations have tasked nursing education leaders with increasing enrollment and graduating nursing students ready to practice. The purpose of this quality improvement project was to evaluate the effect of a perioperative clinical immersion on the perceptions of readiness for practice held by senior students working toward a bachelor of science in nursing. Seven senior nursing students participated in the perioperative clinical immersion at one midwestern university. At the end of the immersion, the students participated in an interview that was designed to capture their perceptions of the program. We performed data analysis and identified recurring key words that were evaluated further as attributes of critical thinking, skill competency, and role socialization. The data analysis revealed the students' perceptions of growth and readiness for practice. We found that a perioperative clinical immersion provides senior nursing students with an opportunity for professional growth and possible employment in the perioperative area.

An academic-VA partnership: Student interprofessional teams integrated with VA PACT teams.

Veterans are challenged with multiple unique healthcare issues related to their military service environment. Likewise, health care providers must understand the special concerns associated with military conflict and recognize how the veteran's care can be optimized by interprofessional care delivery. Little is taught didactically or clinically that supports nursing students in addressing the unique issues of the veteran or the student's need to work collaboratively with allied health team members to enhance the veteran's care. Because of limited exposure to the veteran's special conditions, nursing students who may seek a career with the veteran population often face challenges in rendering appropriate care. The VA offers an invaluable opportunity for health profession students to collaborate with VA interprofessional Patient Aligned Care Teams (PACT) ultimately optimizing veteran health outcomes. This academic partnership, that implements an interprofessional model, will prepare students to better embrace the veteran population. This article describes the immersion of health profession students in interprofessional collaborative practice (IPCP) using PACT team principles which ultimately promotes the students' ability to link theory content to patient care delivery.

Understanding Transitions to Promote Student Success: A Concept Analysis.

AIM: The purpose of this analysis is to provide an extensive exploration of the concept of transitions, specifically within the context of nursing students. BACKGROUND: Transitions are a universal part of life. The concept of transitions is rooted in disciplines such as anthropology, sociology, psychology, and business. Transitions are also a central theme in nursing. While various definitions of the concept exist, most agree that transitions involve a process, which over time results in transformation of self. DESIGN: Walker and Avant's eight-step method of concept analysis served as the framework for exploration of the concept. REVIEW METHODS: The databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Education Resources Information Center, ProQuest, and Academic Search Premiere were searched using the search terms transition, transitions, transformation, nursing students, anxiety, and clinical education. Quantitative and qualitative studies, published concept analysis, and transition theory articles were included. CONCLUSIONS: During a transition, people experience stress and anxiety. This applies to nursing students as well, who often report much stress and anxiety upon entering the initial clinical experience. However, consequences of a successful transition include increased knowledge, attainment of new skills, and identify reformation. By understanding the concept, nurse educators can develop effective teaching strategies to facilitate successful transitions, which will improve the educational experience, support student retention, and promote graduation of competent practitioners. Hart Swenty.

Interprofessional education: Lessons learned from conducting an electronic health record assignment.

Ineffective collaboration and communication contribute to fragmented patient care and potentially increase adverse events, clinical errors, and poor patient outcomes. Improving collaboration and communication is essential; however, interprofessional education (IPE) supporting this cause is not a common practice. Most often healthcare profession students are educated in profession-centered silos limiting opportunities to develop effective communication and collaboration practices. Students from nursing, health informatics, and radiologic technology collaboratively populated an academic electronic health record (AEHR) using fictitious case study data. The assignment was designed to address the Quality and Safety Education for Nurses and IPE Collaborative competencies. The objective was to evaluate students' informatics competency, teamwork behaviors, and communication skills while exploring the different roles and responsibilities for collaborative practice after participating in an interprofessional case study assignment. Students gained experience using the AEHR for data entry, analysis, and application increasing their informatics competency. The assignment required students to communicate and actively collaborate as an interprofessional team to achieve the assignment objectives. Clinical errors often occur during care transitions, so simulating this process in the assignment was essential. Nursing and radiologic technology students had to analyze patient data and develop a hand-off communication template supporting patient safety and optimizing outcomes. The assignment required students to work as an interprofessional team and demonstrate how communication and collaboration is an essential component to quality and safe patient care.

A Balanced Scorecard With Strategy Map: Measuring the Value of a Nursing Sabbatical.

Seasoned nurses frequently resign from their positions due to burnout. An innovative idea that could support nurse retention is nurse sabbaticals. Balanced scorecards with strategy maps can display financial benefit, positive customer experience, and operational and human capital development required to initiate and sustain a professional nurse sabbatical. A balanced scorecard with strategy map is an effective tool that demonstrates connection between the organizational mission and the outcomes of a nurse sabbatical program.

An education intervention in an incarcerated population to reduce the occurrence of infectious skin diseases.

A study conducted at a Midwest county confinement center focused on detainees' intention to wash their hands to prevent the spread of infectious skin diseases. Results of a qualitative interview and learning style inventory were used in conjunction with the theory of planned behavior to develop a Standard Precautions DVD to address hand washing, use of personal protective equipment while cleaning body fluids, and handling of laundry. A postintervention survey revealed significant knowledge-based learning among inmates. A regression model predicting behavioral intention (hand washing) with three predictor variables (attitude toward action, subjective norm, and perceived behavioral control) was developed. The highest correlation was found to be between inmates' subjective norms and their intent to wash their hands, which indicates that inmates' behavior after watching the DVD is most influenced by how others view them, with family members having the greatest influence on subjective norms.

Nursing sabbatical in the acute care hospital setting: a cost-benefit analysis.

Practice-based acute care nurses experience a high incidence of burnout and dissatisfaction impacting retention and innovation and ultimately burdening the financial infrastructure of a hospital. Business, industry, and academia have successfully implemented professional sabbaticals to retain and revitalize valuable employees; however, the use is infrequent among acute care hospitals. This article expands upon the synthesis of evidence supporting nursing sabbaticals and suggests this option as a fiscally sound approach for nurses practicing in the acute care hospital setting. A cost-benefit analysis and human capital management strategies supporting nursing sabbaticals are identified.

Nursing sabbatical in the acute care setting: what is the evidence?

PURPOSE: To review and examine the literature supporting a professional sabbatical, a potentially viable and innovative change strategy that could renew, revitalize, and retain nursing staff practicing in the acute care setting. METHOD: A literature search was completed using multiple search engines to procure articles that could answer the question: What is the evidence related to professional sabbaticals in nursing? FINDINGS: The search yielded 19 articles: one historical document, eight scholarly business articles, and 10 nursing publications. The literature review revealed most sources described sabbaticals using anecdotal data and 14 of the 19 articles were labeled as expert opinion or consensus. CONCLUSION: Borrowing from the successes in academia and other non-nursing professions, a human capital investment opportunity exists to design and test nursing sabbaticals. The authors identified a nursing sabbatical as a viable option, which can enhance nursing retention and revitalization.

Showcasing differences between quality improvement, evidence-based practice, and research.

The literature confirms that much confusion exists regarding the terms quality improvement (QI), evidence-based practice (EBP), and research. A multifaceted approach was used to provide clarity regarding these three equally important concepts. First, the authors present a synthesis of the literature that discusses differences between QI, EBP, and research. Second, the authors introduce a newly created comparative table that synthesizes current literature and showcases differences between QI, EBP, and research. Finally, the authors highlight uses of the comparative table within multiple settings.