The DNP Graduate and the Potential to Advance Nursing: An Interview With Thought Leader Michael Bleich, PhD, RN, FAAN, by Carol Bradley, MSN, RN, FAONL.

This column is an interview of Michael Bleich PhD, RN, FAAN and focuses on the current state of DNP education. As a thought leader in nursing education, Michael shares his views on the state of DNP nursing education and the opportunity it provides to transform health care through nursing.

A mixed-methods exploration of nurse loneliness and burnout during COVID-19.

AIM: This study investigated the phenomenon of nurse loneliness as a potential contributor to burnout. BACKGROUND: Nurse wellbeing is critical for safe and efficient healthcare delivery. However, evidence indicates nurses' wellbeing is at risk. The levels of burnout, the most commonly measured symptom of suboptimal wellbeing, are rising and may relate to a largely unexplored phenomenon: loneliness. METHODS: A mixed-methods approach was used to investigate burnout and loneliness in direct-care nurses in four diverse hospitals in the midwestern and southeastern United States. Burnout and loneliness were measured, prevalence was estimated, and correlation was examined. Interpretive descriptive inquiry and analysis was used to develop a richer understanding of nurse loneliness in the context of burnout. While this study did not explicitly explore the impact of the global pandemic, data was collected in late 2021 and early 2022, during the Delta variant wave. RESULTS: In the study population (n = 117), rates of burnout are high and positively correlate with loneliness. Qualitative interviews (n = 11) revealed that nurses feel unseen, emotionally detached from their work, and dehumanized. However, social connection with peers is protective and nurses still report a strong sense of devotion to the profession and solidarity with peers. CONCLUSIONS: This study offers insight into nurse loneliness, highlighting the importance of social connectedness to improve nurse wellbeing.

A Quality Improvement Approach to Violence Reduction: Standardizing the Risk Identification Process.

BACKGROUND: The impact of aggressive and violent behaviors directed toward staff in psychiatric facilities has layers of implications tied to recruitment and retention, cost, quality and safety. LOCAL PROBLEM: Increased patient aggressive behaviors contributed to staff dissatisfaction and high turnover rates, triggering an analysis of current aggression management approaches. METHODS: The Plan-Do-Study-Act quality improvement method was used for this project. INTERVENTIONS: The Dynamic Appraisal of Situational Aggression (DASA) risk assessment tool was implemented. RESULTS: Daily aggression risk identification increased by 69%, and aggressive incidents toward staff and patients decreased by 64% and 28%, respectively, when the tool was completed more consistently. Surveys revealed acceptance of the tool by nurses. CONCLUSIONS: Quality improvement statistical tools supported evidence-based strategies. A risk for aggression assessment laid the foundations for implementing strategies for reducing aggression and violence.

Stakeholder Perspectives on Implementation of Smart Speakers for Aging in Place in Low-Income Senior Housing: A Qualitative Study.

In the current study, a smart speakers-based system (Amazon® Echo Dot device, a safety pendant, and facility tailored functionalities) for supporting aging in place was implemented in one low-income senior housing property. We aimed to explore perceived benefits, concerns, and expectations about this system among three stakeholder groups (older adults, housing staff, and technology developers) to identify facilitators of and barriers to system implementation. A qualitative analysis of individual interviews using inductive coding methods was performed to identify emerging themes. All stakeholder groups perceived smart speakers as valuable for convenience in daily living and safety. Older adults and system developers identified user difficulty with setting up functions they wanted to use, suggesting the need for user-centered technology support. There were differences in priorities for smart speaker use among three stakeholder groups. This work contributes to the identification of factors affecting smart speaker adoption and use among low-income older adults who often have limited technology experience and support. [Journal of Gerontological Nursing, 48(10), 33-39.].

Unprecedented Leadership: How Nurses Responded to the COVID-19 Pandemic.

An inquiry was posed to nurse leaders in December 2020 by the American Organization for Nursing Leadership (AONL) as the first wave of the COVID-19 pandemic peaked. More than 100 responses were received and organized into themes based on problems, solutions, and unique innovations that were employed. These themes included a return to team-based care, redeployed providers, work design, space accommodation, technology applications, provider support, and the advancement of community-based partnerships. Four exemplars highlight these themes.

The Elements of Engagement Framework to Improve Organizational Uptake of Evidence-Based Practice.

Considerable time, money, and training efforts in organizations have been spent advancing evidence-based practice (EBP). Adding science to clinical decision making is profound, yet organizational strategies to ensure mainstream use of EBP as a return on the training investment is sparse. The Elements of Engagement Framework addresses organizational dynamics: emotion, engagement, energy, expectations, and execution to normalize implementation of EBP within the organizational culture. [J Contin Educ Nurs. 2021;52(8):355-358.].

A Development Challenge: Embracing Technology in Leadership Development.

Leaders must train in technology use and build a portfolio of competencies that mark a rapidly emerging future. Three categories of technology with examples of how to approach increasing technology literacy in each are presented. Five emerging or rapidly advancing technology trends provide a framework for leader development. [J Contin Educ Nurs. 2021; 52(6):260-262.].

A Framework for Developing Holistic Leaders.

Advocating for holistic leaders' development, holistic leadership is defined and contrasted with other developmental approaches. A model that frames four dimensions of development is presented. These dimensions include self-awareness and values identification, relational capacity, problem solving and action orientation, and other orientation. [J Contin Educ Nurs. 2021;52(5):211-213.].

Naturalistic Lessons in Post-Inauguration Leadership.

Leadership development opportunities can be derived from naturalistic learning experiences. Six lessons from the recent presidential campaign are presented through a leadership lens rather than a political lens. Topics include networking, polarity management, communication, managing agreement, ambition, and transition management. [J Contin Educ Nurs. 2021;52(3):112-114.].

Attitudes and Perceptions Toward Voice-Operated Smart Speakers Among Low-Income Senior Housing Residents: Comparison of Pre- and Post-Installation Surveys.

Smart speakers have the potential to support independent living and wellness among low-income senior housing (LISH) residents. The aim of this study was to examine and compare LISH residents' attitudes and perceptions toward smart speakers at two time points: before and after technology use (N = 47). A descriptive survey was administered to ask questions about hedonic motivation, perceived ease of use, self-efficacy, perceived usefulness of some potential or existing smart speaker features, cost, and privacy. Participants were initially favorable toward using a smart speaker and its digital agent (e.g., Alexa) as a daily assistant and wellness tool. They especially liked the smart speaker's potential functionality of detecting harmful events and notifying someone to receive immediate help. The comparison of pre- and post-use responses revealed non-significant declines in most items, with the exception of willingness to use Alexa as a reminder system (p < .01), asking Alexa for help (p < .01), and asking for help in using Alexa (p < .01). This finding may reflect confusion or frustration with the device among participants. We conclude with recommendations for the design of smart speakers specifically tailored to the needs of LISH residents.

The Discussion Board in Online Learning: Leadership Development Opportunities.

The COVID-19 pandemic has created unprecedented opportunities for training and development to move to online formats. The discussion board is an essential online tool to advance leadership development. Both learner and educator tips are provided for discussion board optimization, including considerations for rubric development for learner evaluation. [J Contin Educ Nurs. 2020;51(12):541-543.].

Leadership in Serving the Public's Health.

Building on a premise that core public health principles advance leadership capabilities across sectors, the case for linking leadership to public health is made. With public health references, leadership topics are presented that address eight domains. [J Contin Educ Nurs. 2020;51(8):352-354.].

Public Policy in a Pandemic: A Call for Leadership Action.

Crisis breeds innovation and creativity. The COVID-19 pandemic shows where policy-related gaps exist. Three policy exemplars linked to COVID-related changes faced by professional development educators and leaders are presented: broadband Internet availability for training and development, information technology infrastructure, and scope of practice expansion. [J Contin Educ Nurs. 2020;51(6):250-252.].

Exploring Executive Presence: Leadership Traits or Skills?

Executive presence frequently is discussed from a developmental and training perspective. This column explores the meaning of the concept, training, and development approaches to foster awareness of and expectations linked to its meaning, and the challenges of measuring leader-learner outcomes. Four domains for measuring improvement include ego state, focus, impact, and legend. [J Contin Educ Nurs. 2020;51(4):152-154.].

QSEN Transcends Cultures: Teaching Quality and Safety Education in China.

There has been increasing focus on improving the quality and safety of health care globally. Understanding that the health of one nation impacts others worldwide drives initiatives for collaboration to improve the health of all. In this, the Year of the Nurse and Midwife as designated by the World Health Organization, The Quality and Safety Education for Nurses (QSEN) Competencies provide structure that transcends culture for framing the nursing role to contribute to improving patient safety and the quality of care delivery internationally. This article describes initiatives to share resources and strategies to support quality and safety education and practice with nurses across countries. [J Contin Educ Nurs. 2020;51(3):106-108.].

QSEN Transcends Cultures: Leadership Lessons Learned From a Global Experience.

Quality and Safety Education for Nurses (QSEN) has global appeal, acknowledging the important role of nursing in care delivery. This article complements the Teaching Tips column, shifting from content covered to the leadership lessons that presenters must consider when preparing for and presenting to a global audience. Four critical lessons are addressed: humility and acceptance, time for translation, job role assumptions, and conceptual clarification. [J Contin Educ Nurs. 2010;51(1):9-11.].

Evidence-Based Leadership Practice and the Role of the Librarian.

Evidence-based clinical practice is now the norm. When evidence exists to enhance practice, organizational leaders work to instill the best practices that benefit patient outcomes. Leaders are also responsible for organizational outcomes and best practices in human and material resource management, improving the culture, and ensuring and retaining a workforce with sufficient talent, skills, and abilities. The authors address the role of the librarian in securing evidence-based leadership practice. [J Contin Educ Nurs. 2019;50(12):537-539.].

Implementation Science as a Leadership and Doctor of Nursing Practice Competency.

Leaders must distinguish between diffusion as a change strategy, education as a stimulus for change, and implementation strategies associated with implementation science. This article provides an operational definition for implementation science, the distinguishing characteristics in leading transformational change, and the degrees of implementation. [J Contin Educ Nurs. 2019;50(11):491-492.].

The Langston Center for Innovation in Quality and Safety: A Moderating Variable in Humanizing Disruptive Innovation.

Disruptive innovations may serve both good and ill causes. This means that disruption can stimulate positive outcomes or tip people and organizations into chaos. The Langston Center for Innovation in Quality and Safety plays a moderating role by ensuring that innovations consider the upstream and downstream consequences potentiated by change initiatives characterized by a rapid implementation cycle. Drawing on change management and implementation science approaches, human factor variables are intentionally considered to generate acceptance of substantive disruptions.