An effective in-hospital chaplaincy-led care program for nurses: Tea for the soul a qualitative investigation.

Tea for the Soul (TFS) is an understudied care model, addressing bereavement and other emotional needs of nurses related to impactful patient care experiences. Nurses are at high risk for compassion fatigue, moral distress, and burnout. Facilitated by a Chaplain, the TFS program provides participants a venue to express their feelings and explore ways of adapting effectively with the death of a patient, and other traumatic workplace experiences. In this qualitative grounded theory study, hospital nurses (N = 7) who participated in TFS were interviewed. IRB approval was obtained. Questions were constructed within the context of the medical center research council and asked if TFS: (a) was personally beneficial, (b) helped nurses feel better about their work, and (c) affected job satisfaction. Four core themes emerged: (a) Nurses' Self-Care, (b) Professional Practice, (c) Community, and (d) Improved Patient Care Outcomes. The Roy Adaptation Model, Group Identity Mode was applied to the content analysis. Overarching themes were Compassionate Service, Ministry of Presence, Reflective Practice, and Sacred Encounters. Nurses reported that TFS facilitated a spiritual respite and a sense of enhanced community and was a source of strength and coping, thus may aid in the promotion of nurse well-being and the amelioration of moral distress, compassion fatigue, and burnout.

Building coalitions: A statewide nursing organization's role in changing nursing education regulation during the COVID-19 pandemic.

The California Association of Colleges of Nursing (CACN), representing California's baccalaureate and higher degree nursing education programs, has raised concerns for over two-years about the number, relevance, and legitimacy of nursing education regulations. Formal CACN letters to state regulators did not affect change. While California nursing education regulations require 75% direct patient contact for all clinical courses, meeting this requirement became impossible as clinical agencies closed to nursing students during the beginning of the COVID-19 pandemic. Nursing regulatory change was urgently needed to provide greater flexibility in meeting clinical course objectives using simulation and other online learning modalities. At stake was the graduation of over 14,971 RN students from public and private nursing programs. While state regulators opposed a legislative approach, CACN collaborated with stakeholders to support legislation that led to a reduction in direct patient care hours, allowing nursing students to progress and graduate. This longstanding advocacy work was accelerated by the pandemic and required leadership and knowledge about the legislative process for nurse educators to succeed. The ultimate goal for CACN is to forge a more respectful relationship and greater collaboration between educators and regulators to enhance quality, reduce costs, and redundancies in nursing education in this state.

The impact of replacing peripheral intravenous catheters when clinically indicated on infection rate, nurse satisfaction, and costs in CCU, Step-Down, and Oncology units.

BACKGROUND: A practice change of replacing peripheral intravenous (PIV) catheters when clinically indicated was implemented concurrent with a new PIV chlorhexidine securement dressing and existing IV care bundle to prevent the risk of infection. PURPOSE: The purpose of this study was to examine the impact of replacing PIV catheters when clinically indicated on infection rates, nurse satisfaction, and costs in 3 high-risk, vulnerable hospital populations (Critical Care, Step Down, and Oncology units). METHODS: A retrospective review of 473 medical records, 737 peripheral IV sites, and 2 nursing surveys were completed after the practice change. Data were gathered related to PIV 1) catheter dwell times, 2) phlebitis rates, 3) catheter-related bloodstream infection rates, 4) skin tears related to the new PIV dressing, 5) costs, and 6) a nurse satisfaction survey. RESULTS: The average PIV dwell time was 7 days with a 3% phlebitis rate. Findings showed no catheter-related bloodstream infections and 2 (0.27%) skin tears. Cost savings of $17,100.00 in PIV supplies occurred one year after the practice change. Nurse satisfaction with the new dressing was 94.2%, with a 17-month sustainment of satisfaction. CONCLUSIONS: The impact of the practice change and new dressing had positive quality outcomes on infection rate, nurse satisfaction, and costs in 3 vulnerable hospital populations.

Direct-Acting Oral Anticoagulants and Warfarin-Associated Intracerebral Hemorrhage Protocol Reduces Timing of Door to Correction Interventions.

BACKGROUND: Intracerebral hemorrhage (ICH) is a life-threatening complication of oral anticoagulant therapy that sometimes results in hematoma expansion after onset. Our facility did not have a standardized process for treating oral anticoagulant-associated ICH; this resulted in lag times from order to reversal agent administration. PURPOSE: The aim of this study was to examine the impact of a rapid anticoagulant reversal protocol, combined with warfarin and direct-acting oral anticoagulant therapy, in decreasing door to first intervention times. METHODS: This study used a retrospective quality assessment research approach in examining an oral anticoagulant reversal protocol to compare the control and intervention groups. Phytonadione was the first intervention treatment for most study participants diagnosed with warfarin-associated ICH with an international normalized ratio greater than 1.4. Factor IX was the first intervention treatment for all but one study participant with DOAC-associated ICH. RESULTS: Findings were statistically significant (P < .05) for door to first intervention treatments. Door to phytonadione in minutes decreased from 232.7 (SD, 199.4) to posttest findings of 111.4 (SD, 64.6). Door to factor IX in minutes decreased from 183.9 (SD, 230.2) to posttest findings of 116.6 (SD, 69.1). CONCLUSION: Study findings support the hypothesis that the new protocol was associated with lower door-to-treatment times for eligible patients.

Instrument Validation: Hospital Nurse Perceptions of Meaning and Joy in Work.

BACKGROUND AND PURPOSE: When workers experience meaning and joy in work (MJW), job satisfaction and retention are enhanced. No measure for MJW among nurses exists. The purpose of this work was to develop/test the MJW Questionnaire (MJWQ). METHODS: The initial MJWQ was piloted with a convenience sample of post-licensure nursing students. Factor analyses established MJWQ subscales for the MJWQ: "value /connections," "meaningful work," "caring." Subsequently, 463 employed nurses validated MJWQ psychometrics. RESULTS: The MJWQ demonstrated acceptable construct validity and internal consistency (α = .94). Scores were significantly associated with job satisfaction (r = .686). CONCLUSIONS: Initial testing supports adequate measurement of MJW for hospital nurses in varying roles. Testing in other settings, evaluation of sensitivity in determining intervention effectiveness, and inclusion in multivariate analyses of workforce engagement are suggested.

Invincibility fable: tool development to measure invincibility.

UNLABELLED: Invincibility is a phase of social-cognitive development of the adolescent and has been associated with risk behavior involvement. OBJECTIVE: To determine psychometric properties of the Adolescent Invincibility Tool (AIT). METHODS: Reliability was assessed and validity was examined using principal components analysis. RESULTS: Internal consistency was demonstrated with a Cronbach's alpha of .88; factor analysis led to the confirmation of subscales. Criterion validity was validated with similar and opposing measures of invincibility. DISCUSSION: Initial testing suggests that the AIT is a valid and reliable tool for screening invincibility. Further testing is recommended to determine relevance for other populations of youth.

Hospital staff nurse perceptions of competency to care for patients with psychiatric or behavioral health concerns.

Disruptive behaviors are common among hospitalized patients with psychiatric and substance abuse behaviors. Nurses working on nonpsychiatric units, however, may lack competencies to care for patients with such behaviors. A survey was developed and administered to 844 nurses across three hospital settings that revealed a lack of nurse confidence to intervene in situations that require de-escalation techniques and crisis communication. This study provides direction for further research and interventions in hospital settings with similar professional development needs.

Instrument validation: hospital nurse perceptions of their Behavioral Health Care Competency.

AIM: To report the development and psychometric testing of the Behavioral Health Care Competency survey, designed to measure hospital nurse perceptions of behavioral healthcare competency. BACKGROUND: Hospital nurses working in general or other non-psychiatric units may lack behavioral healthcare competency to manage disruptive behaviours associated with mental illnesses. DESIGN: Instrument development. METHOD: A nurse study team including clinical experts and nurse researchers from three community hospitals in southern California (USA) reviewed content validity of each item and the 31-item instrument and created a behavioral health care competency conceptual model based on the nursing process. Separate institutional review board permissions were obtained from each hospital. The study team collaborated in the timing of survey administration (November 2010), analysis of the results and survey validation. RESULTS: A total of 844 nurses completed the survey, representing approximately 23-41% of eligible nurses from each hospital. Using principal component analysis with varimax rotation, 23 items led to a factor structure with four components. Four subscales with adequate alpha coefficients were formed: Resource Adequacy, Patient Assessment, Practice/Intervention Competency, and Psychotropic Recommendation. CONCLUSION: The 23-item hospital nurse Behavioral Health Care Competency survey is an adequate and valid newly developed instrument. Further testing with diverse samples is needed to strengthen generalizability and address unique and specialized nursing care needs.

Helping busy educators become gero-savvy: an approach to developing faculty geriatric expertise.

Integrating geriatric competencies into an entry-level nursing curriculum is more than identifying content to be added. The knowledge and ability of faculty to teach these competencies are another important consideration as well as gaining Board of Registered Nursing faculty approval. The authors present an innovative remediation plan that addresses competency in both theory and practice to assist faculty to become gero-savvy.

The relationship of perception of invincibility, demographics, and risk behaviors in adolescents of military parents.

INTRODUCTION: The purpose of this research was to determine relationships among perceived invincibility, demographic variables, and risk behaviors in adolescents of active duty and retired military personnel. METHOD: An instrument titled the Adolescent Invincibility Tool (AIT) was constructed and administered to a group of 125 adolescents of military parents. Correlation statistics were analyzed to determine variable relationships. RESULTS: The AIT demonstrated reliability (Cronbach's alpha .88) in measuring invincibility in this sample. Participant characteristics and demographics were examined and revealed age, sex, ethnicity, and relocation frequency differences in relationship to the teen's level of perceived invincibility. Family relocation frequency and parent ranking/rating were significant variables for a military population. A significant positive relationship was identified between aggressive, delinquent behavior and invincibility; a negative correlation was demonstrated between worry and invincibility. DISCUSSION: This study provided an opportunity to learn about unique influences related to being the teen of an active duty or retired military parent(s). Study findings indicate significant differences between military teens and national surveys in regard to risk taking and mental health indicators. Risk behaviors were found to occur at a lower frequency than the nationwide average, while depression occurred more frequently in this sample of military adolescents. Variations among teens of military parents in invincibility and worry scores provide direction for further study.

The adolescent perception of invincibility and its influence on teen acceptance of health promotion strategies.

The purposes of this study were to explore the phenomenon of invincibility and to identify key factors contributing to risk behavior involvement in teens. Semistructured interviews revealed the following common themes: adolescence, a time of transition, the meaning of invincibility, learning the balance of taking chances and being safe, differences between risky and dangerous, and strategies for working with teens. Participants provided insights about intervention strategies that are most effective in working with teens. Their suggestions reinforce the critical importance of teen involvement in shaping, planning, and conducting health promotion interventions for this age-group.

Processes and outcomes of substance abuse treatment between two programs for clients insured under managed care.

The purpose of this research (N = 160) was to describe and compare substance abuse treatment in two programs under managed care: one residential (RT) and one outpatient (OP). Clients in both settings improved significantly from before to after treatment in relation to substance use and quality of life. However, intensity of treatment (hours of care/week) was much greater in RT and days of sobriety were significantly higher after treatment in RT than in OP (p = .04). Intensity was negatively related to incidents of substance use during treatment (SUdT), which predicted substance use after treatment; SUdT averaged .2 for RT, and 1.6 for OP (p = .0001). Importantly, treatment was completed by 74 patients (over 90%) from RT, with 8 dropping out, and 53 (almost 70%) of those in OP completed treatment while 25 dropped out. Intensity, as seen in the RT program, rather than duration, was more effective in substance use reduction and treatment completion.