Living well: Evidence-based self-management of chronic diseases for community-dwelling older adults.

ABSTRACT: Self-management of chronic diseases, which increase with age, is vital. This article discusses the benefits of chronic disease self-management and how nurses and other healthcare professionals can provide supportive care. It also presents an evidence-based intervention project that promoted chronic disease self-management among community-dwelling older adults.

Accuracy, potential, and limitations of probabilistic record linkage in identifying deaths by gender identity and sexual orientation in the state of Rio De Janeiro, Brazil.

BACKGROUND: Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations have dedicated themselves to this work. Despite these efforts in generating information, the scarcity of official data presents significant limitations in policy formulation and actions guided by population needs. Therefore, this manuscript aims to evaluate the accuracy, potential, and limits of probabilistic data relationships to yield information on deaths according to gender identity and sexual orientation in the State of Rio de Janeiro. METHODS: This study evaluated the accuracy of the probabilistic record linkage to obtain information on deaths according to gender and sexual orientation. Data from two information systems were used from June 15, 2015 to December 31, 2020. We constructed nine probabilistic data relationship strategies and identified the performance and cutoff points of the best strategy. RESULTS: The best data blocking strategy was established through logical blocks with the first and last names, birthdate, and mother's name in the pairing strategy. With a population base of 80,178 records, 1556 deaths were retrieved. With an area under the curve of 0.979, this strategy presented 93.26% accuracy, 98.46% sensitivity, and 90.04% specificity for the cutoff point ≥ 17.9 of the data relationship score. The adoption of the cutoff point optimized the manual review phase, identifying 2259 (90.04%) of the 2509 false pairs and identifying 1532 (98.46%) of the 1556 true pairs. CONCLUSION: With the identification of possible strategies for determining probabilistic data relationships, the retrieval of information on mortality according to sexual and gender markers has become feasible. Based on information from the daily routine of health services, the formulation of public policies that consider the LGBTQ + population more closely reflects the reality experienced by these population groups.

Simulation, Storytelling, and Pediatric End-of-Life Care: A Continuing Professional Development Approach for Nurse Residents.

Background: Providing end-of-life (EOL) care to pediatric patients and their families is challenging. Newly licensed nurses, especially those working with the hematology/oncology population, have little to no experience providing the specialized care needed for the dying child. An evidence-based continuing professional development activity provided a novel approach to improve the knowledge, attitudes, and comfort levels of nurse residents related to pediatric EOL care. Method: A high-fidelity simulation module of a pediatric oncology patient at the EOL was embedded into a 12-month nurse residency program. The module employed several teaching strategies including a storytelling approach. Results: Thirteen pediatric nurse residents participated in the program. While the evidence-based intervention increased participants' EOL care knowledge, their overall attitudes, and comfort levels remained unchanged. Discussion: EOL simulation with a storytelling approach is a highly valuable method of teaching new nurses how to care for a dying patient. Additional studies are needed to explore how to increase the comfort levels of new nurses in the delicate population of pediatric hematology/oncology.

Time Is Survival: Continuing Education on Sepsis for Neurosurgical Critical Care Nurses.

BACKGROUND: Early identification of sepsis among neurosurgical critical care patients is a significant challenge because of the many possible confounding variables that lead to altered mental status in this specific patient population. Nurses' knowledge, attitudes, confidence, and practices related to the early identification and management of sepsis are crucial to patients' survival. METHOD: This evidence-based intervention project implemented continuing education for neurosurgical critical care nurses on the early signs and symptoms of sepsis and the management of sepsis according to the Surviving Sepsis Campaign (SSC) Guidelines. RESULTS: Continuing education on sepsis increased neurosurgical critical care nurses' knowledge of the SSC 1-hour sepsis bundle, reported confidence in the management of sepsis, and likelihood of assessing for sepsis. CONCLUSION: Continuing education for neurosurgical critical care nurses on the signs and symptoms of sepsis and the SSC Guidelines is necessary and may improve patient outcomes. [J Contin Educ Nurs. 2024;55(5):224-230.].

Implementation of a self-help mobile mental health app in COVID-19 frontline health care workers: A quality improvement project.

AIM: Frontline health care workers (FHCWs) have endured a range of adverse mental health outcomes during the COVID-19 pandemic. Despite the widespread availability and ease-of-use of self-help mobile mental health apps, little is known about the feasibility of implementing such tools among COVID-19 FHCWs in real-world nursing settings. METHODS: This quality improvement project evaluated the feasibility of implementing the COVID Coach app among COVID-19 FHCWs in a skilled nursing facility. RESULTS: Participants endorsed high average ratings of the acceptability, appropriateness, feasibility, knowledge, perceived usefulness of the app. DISCUSSION: Implications for the broader dissemination of mobile self-help apps are discussed.

Theoretical-methodological essay on gender identity information validity in epidemiological surveillance of violence.

The inclusion of the "gender identity" field in the Brazilian violence surveillance system, although representing a step forward, still has limitations that may compromise epidemiological data validity. Existing response options for victims' identities do not adequately cover the diversity of this analysis category, resulting in classification biases. Additionally, the absence of options for cisgender identities reflects an approach that naturalizes these identities, while trans identities are considered deviant and subject to surveillance. To overcome these limitations, it is imperative to adopt a broader understanding of gender as a social and performative construction. This requires a reassessment of social structures and data collection instruments. In this context of discussion, this theoretical-methodological essay aims to reflect on gender identity measurement in the Reporting Diseases System interpersonal and self-inflicted violence surveillance system, taking as frameworks the theoretical conceptions about gender as a performative act and the foundations of validity in epidemiological investigations.

Where's the Marker? Perceptions of Whiteboards in the Emergency Department.

BACKGROUND: In the emergency department, bedside whiteboards are used to help improve communication, teamwork, and collaboration among health care providers. In addition, previous studies have shown that whiteboards aid the patient with the identification of their health care providers, plan of care, expected length of stay, and overall patient satisfaction. PURPOSE: This evidence-based evaluation project assessed the perceptions of emergency department health care providers on their awareness of the effectiveness of bedside whiteboards, whether there are challenges with using them, and whether they are being updated and used consistently. METHOD: A survey was utilized to evaluate emergency department health care providers (nurses, patient care technicians, and attending providers) on their perceptions of bedside whiteboards in the patient rooms using a 10-question survey. OUTCOMES: The survey was sent via email to 135 emergency department health care providers, with 64 respondents. The survey results showed that 41.3% of the respondents agreed that bedside whiteboards promote patient satisfaction, 36.5% agreed that they promote patient safety, 53.1% agreed they take minimal completion time, and 50% felt they help keep patients informed about care. However, 85.9% of participants felt bedside whiteboards are not updated consistently, and 81.2% felt they are not updated consistently among all 3 shifts. In addition, 73.4% reported that they lack access to materials to update the whiteboards and 38.1% were neutral regarding whiteboards promoting patient safety. IMPLICATIONS: Proper materials (markers and erasers) are integral to bedside whiteboard use. Continued staff education on the function of bedside whiteboards may improve proper whiteboard use.

Theoretical-methodological essay on gender identity information validity in epidemiological surveillance of violence / Ensayo teórico-metodológico sobre la validez de la información de identidad de género en el seguimiento epidemiológico de la violencia / Ensaio teórico-metodológico sobre validade da informação da identidade de gênero no monitoramento epidemiológico da violência

ABSTRACT The inclusion of the "gender identity" field in the Brazilian violence surveillance system, although representing a step forward, still has limitations that may compromise epidemiological data validity. Existing response options for victims' identities do not adequately cover the diversity of this analysis category, resulting in classification biases. Additionally, the absence of options for cisgender identities reflects an approach that naturalizes these identities, while trans identities are considered deviant and subject to surveillance. To overcome these limitations, it is imperative to adopt a broader understanding of gender as a social and performative construction. This requires a reassessment of social structures and data collection instruments. In this context of discussion, this theoretical-methodological essay aims to reflect on gender identity measurement in the Reporting Diseases System interpersonal and self-inflicted violence surveillance system, taking as frameworks the theoretical conceptions about gender as a performative act and the foundations of validity in epidemiological investigations.

RESUMEN La inclusión del campo de la "identidad de género" en el sistema brasileño de vigilancia de la violencia, aunque representa un paso adelante, todavía tiene limitaciones que pueden comprometer la validez de los datos epidemiológicos. Las opciones de respuesta existentes para las identidades de las víctimas no cubren adecuadamente la diversidad de esta categoría de análisis, lo que genera sesgos de clasificación. Además, la ausencia de opciones para las identidades cisgénero refleja un enfoque que naturaliza estas identidades, mientras que las identidades trans se consideran desviadas y sujetas a seguimiento. Para superar estas limitaciones, es imperativo adoptar una comprensión más amplia del género como una construcción social y performativa. Esto requiere una reevaluación de las estructuras sociales y de los instrumentos de recolección de datos. En este contexto de discusión, este ensayo teórico-metodológico tiene como objetivo reflexionar sobre la medición de la identidad de género en el sistema de vigilancia de la violencia interpersonal y autoinfligida del Sistema de Enfermedades de Declaración Obligatoria, tomando como referentes las concepciones teóricas sobre el género como acto performativo y los fundamentos de validez en las investigaciones epidemiológicas.

RESUMO A inclusão do campo "identidade de gênero" no sistema de vigilância de violências brasileiro, embora tenha representando um avanço, ainda apresenta limitações que podem comprometer a validade dos dados epidemiológicos. As opções de resposta existentes para as identidades das vítimas não abrangem adequadamente a diversidade dessa categoria de análise, resultando em vieses de classificação. Adicionalmente, a ausência de opções para as identidades cisgênero reflete uma abordagem que naturaliza essas identidades, enquanto as identidades trans são consideradas desviantes e passíveis de monitoramento. Para superar essas limitações, é imprescindível adotar uma compreensão mais ampla do gênero como uma construção social e performativa. Isso requer uma reavaliação das estruturas sociais e dos instrumentos de coleta de dados. Nesse contexto de discussão, este ensaio teórico-metodológico tem como objetivo refletir sobre a aferição da identidade de gênero no sistema de vigilância de violências interpessoais e autoprovocadas do Sistema de Agravos de Notificação, tomando como referenciais as concepções teóricas sobre gênero como ato performativo e os fundamentos da validade em investigações epidemiológicas.

Inclusão ou ilusão da identidade de gênero no país com o maior número de assassinatos de transgêneros: um ensaio crítico brasileiro / Inclusión o ilusión de la identidad de gênero en el país con el mayor número de asesinatos transgêneros: ensayo crítico brasileño / Inclusion or illusion of gender identity in the country with the highest transgender murders: a Brazilian critical essay

Resumo Objetivo refletir sobre as implicações e os riscos associados ao novo registro de identificação do Brasil para a população trans. Método trata-se de estudo reflexivo que explora o conceito de identidade social como um fenômeno complexo, fundamentado nos princípios da autodeterminação e da dignidade humana. São consideradas perspectivas feministas pós-humanistas e críticas, que desafiam o essencialismo biológico dos indivíduos, com foco especial na teoria de Judith Butler. Resultados o Brasil está atualmente implementando um registro nacional de identificação capaz de reconhecer a identidade de gênero das pessoas trans. Este estudo aborda as implicações do novo sistema nacional de identificação, incluindo possíveis retrocessos e avanços na luta pelos direitos das pessoas trans. Para proteger a identidade e a segurança dessas pessoas, este artigo defende a criação de um novo sistema de identificação emitido pelo governo que armazene informações pessoais em bancos de dados, exibindo apenas o nome social e o marcador de gênero no cartão. Considerações finais e implicações para a prática as altas taxas de violência contra pessoas trans no Brasil destacam a necessidade urgente do novo sistema. O reconhecimento precoce e o respeito pela identidade de gênero são fundamentais para promover o sucesso do novo sistema.

Resumen Objetivo reflexionar sobre las implicaciones y los riesgos asociados con el nuevo registro de identificación de Brasil para la población trans. Método este es un estudio reflexivo que explora el concepto de identidad social como un fenómeno complejo, fundamentado en los principios de autodeterminación y dignidad humana. Se consideran perspectivas feministas poshumanistas, que desafían el esencialismo biológico, con un enfoque particular en la teoría de Judith Butler. Resultados Brasil se encuentra implementando un registro nacional de identificación que puede reconocer la identidad de género entre personas trans. Este estudio aborda las implicaciones del nuevo sistema nacional de identificación, incluyendo posibles retrocesos y avances en la lucha por los derechos de las personas trans. Para proteger la identidad y la seguridad de estas personas, este artículo aboga por la creación de un nuevo sistema de identificación emitido por el gobierno que almacene información personal en bases de datos, mostrando solo el nombre social y el marcador de género en la tarjeta. Consideraciones finales e implicaciones para la práctica las altas tasas de violencia contra personas trans en Brasil enfatizan la necesidad urgente del nuevo sistema. El reconocimiento temprano y el respeto por la identidad de género son fundamentales para promover el éxito del nuevo sistema nacional de identificación.

Abstract Objective to reflect on the implications and risks associated with Brazil's new identification registry for the trans population. Method this is a reflective study that explores the concept of social identity as a complex phenomenon, grounded in the principles of self-determination and human dignity. To accomplish this, it draws upon feminist post-humanist and critical perspectives, challenging individuals' biological essentialism, with a particular focus on Judith Butler's theory. Results Brazil is currently implementing a national identification registry that can recognize trans individuals' gender identity. This manuscript addresses the implications of the new national identification system, including potential setbacks and advances in the struggle for trans rights. To safeguard people's identity and safety, this article advocates for a novel national government-issued identification system that stores personal information in central databases for linking purposes, displaying only the preferred name and gender marker on the identification card. Final considerations and implication for practice the high rates of anti-trans violence in Brazil emphasize the urgent need for the new system. Early recognition and respect for gender identity are integral to promoting the success of the new national identification system.

Don't Ask, Won't Tell: Suicide Screening in the Pediatric Perioperative Setting.

Suicide is the second leading cause of death for children and adolescents ages 10-19 in the United States. Globally, suicide is the fourth leading cause of death among adolescents and young adults ages 15-29. The World Health Organization identifies suicide prevention and promotion as a public health priority. In the United States, one of the key prevention strategies has been the recognition of the need for screening, particularly for children and adolescents. The American Academy of Pediatrics (AAP), National Institute of Mental Health (NIMH), and the Joint Commission recommend suicide risk screening for those ages 10 and older. Research has shown that children and adolescents won't disclose suicidal thoughts unless directly asked. Perioperative units in pediatric hospitals are uniquely positioned to integrate suicide screening as part of the nurses' pre-operative assessment of surgical patients. Utilizing pre-operative units for screening can identify at-risk patients who otherwise may not be screened. The purpose of this evidence-based practice (EBP) project was to determine if a one-time, educational intervention highlighting the importance of universal suicide screening in pediatric patients 10 years old or older would affect the beliefs and comfort level of pediatric perioperative nurses. The survey assessed perioperative nurses' beliefs and comforts around suicide screenings for patients ages 10 and older in the perioperative unit. Twenty-minute educational unit-based in-services were provided over a 2-week period to all current staff. The survey was then repeated to assess for changes in nurses' beliefs and comfort. Pre-educational intervention, 43.5% of participants did not believe it is important to ask patients about suicidal thoughts. Only 60.9% of participants agreed that all patients 10 years and older should be assessed for suicidal risk, regardless of behavioral health history. After the educational intervention, all perioperative nurse participants (n = 22) agreed it was important to ask patients about suicidal thoughts and to screen all patients 10 years and older for suicidal risk, not just behavioral health patients. Post-education, all participants (100%) agreed it was important to ask patients about suicidal thoughts and believed patients 10 years and older should be assessed for suicidal risk. Early detection through screening is crucial to combating this growing health crisis for children and adolescents. Educational in-services strengthened this group of perioperative nurses' understanding of the importance and feasibility of universal suicide screening in their unit. Responses from this EBI can potentially help guide the educational component of pediatric hospitals' initiatives to implement suicide screening.

Infection and mortality of nursing personnel in Brazil from COVID-19: A cross-sectional study.

BACKGROUND: Health care personnel (HCP) worldwide are at-risk for contracting the novel Coronavirus disease (COVID-19). Among health care personnel, nurses are at a particularly high risk due to the physical proximity and duration of time spent providing direct care. Documenting accurate rates of COVID-19 infection and deaths among nurses worldwide has been problematic, and many countries such as the USA have no systematic mechanism for collecting this information. Brazil is unique in that it prioritized the implementation of a dedicated database, the Nursing Observatory to collect accurate and timely data regarding COVID-19 and Brazilian nursing personnel. OBJECTIVES: The aim of this study was to analyze COVID-19 infections and deaths among nurses registered in the centralized and dedicated Brazilian database called the Nursing Observatory. DESIGN: A cross-sectional study using secondary data from the Brazilian Nursing Observatory was conducted. PARTICIPANTS: Data are reported for two occupational categories: professional Nurse and technical nurse by country regions. All cases or deaths of professional Nurse and technical nurse registered between the 12th and 31st epidemiological weeks of 2020 were included. METHODS: From a unique numerical identification, the appropriate records of nursing personnel affected by COVID-19 were entered by the Technical Responsible Nurse for each service, according to the condition regarding COVID-19. All suspected, confirmed or unconfirmed infections were considered "cases", and all confirmed or unconfirmed deceased as "deaths". Cases and deaths were analyzed according to the variables: 1. region of the country where the case occurred, 2. nursing category and 3. epidemiological week. Universal protocols for collecting and cleaning data were used throughout the country. Infection and mortality rates (per 100,000) were obtained from the relationship between deaths registered and the population of nursing personnel by category and region. RESULTS: Nursing personnel in the Northern, Northeast and Southeast Regions of Brazil had the highest number of COVID-19 infections and deaths overall with an ascending curve occurring mainly after Epidemiological Week 19. COVID-19 infections and deaths spread later to the Midwest and Southern regions also showing an ascending curve, although the total numbers were less. CONCLUSIONS: All occupational categories of nursing personnel showed higher than expected rates of infection and death. Inequalities and a lack of adequate healthcare resources, hospital beds and Personal Protective Equipment varied by region in Brazil. The politicization of COVID-19 and the lack of a coherent national pandemic plan is a factor to be taken into account. Tweetable abstract: This cross-sectional study shows the evolution of cases and deaths of Brazilian nursing personnel over the first months of the COVID-19 pandemic.

Segurança e educação durante a COVID-19: prevalência, fatores associados e planos de reabertura da Faculdade de Enfermagem / Safety and education during COVID-19: prevalence, associated factors and reopening plans of the School of Nursing / Seguridad y educación en COVID-19: prevalencia, factores asociados, planes de reapertura en una Facultad de Enfermería

Objetivo: analisar a prevalência e os fatores associados à triagem da COVID-19 e propor as estratégias necessárias para a reabertura das Escolas de Enfermagem universitárias para as aulas presenciais. Métodos: um estudo transversal foi projetado a partir da linha de base de uma pesquisa longitudinal baseada na Internet de uma Escola Brasileira de Enfermagem. Com o resultado ordinal (classificação operacional COVID-19), a análise de dados foi conduzida usando um modelo de regressão multinomial. Resultados: um total de 498 participantes foi incluído na análise e revelou 67,27% de casos suspeitos e 11,65% de casos confirmados de COVID-19. O uso de máscaras, o transporte público e fazer parte da linha de frente dos trabalhadores da saúde foram estatisticamente associados a um histórico positivo para a COVID-19. Conclusão: os planos de reabertura de Escolas de Enfermagem devem integrar o uso de equipamentos de proteção pessoal, o transporte público e a triagem da COVID-19 na educação

Objective: to analyze the prevalence and factors associated with COVID-19 screening and propose the necessary strategies for the reopening of university Nursing Schools to face-to-face classes. Methods: aa cross-sectional study was designed from the baseline of a longitudinal Internet-based survey of a Brazilian School of Nursing. With the ordinal outcome (COVID-19 operational classification), data analysis was conducted using a multinomial regression model Results: a total of 498 participants were included in the analysis and revealed 67.27% suspected and 11.65% confirmed cases of COVID-19. Wearing masks, public transportation, and being part of frontline healthcare workers were statistically associated with a positive history for COVID-19. Conclusion: plans to reopen Nursing Schools must integrate the use of personal protective equipment, public transportation, and COVID-19 screening into education

Objetivo: analizar la prevalencia y los factores asociados al rastreo de COVID-19 y proponer las estrategias necesarias para la reapertura de Escuelas Universitarias de Enfermería para clases presenciales. Métodos: se diseñó un estudio transversal a partir de la línea de base de una investigación longitudinal basada en Internet de una Escuela Brasileña de Enfermería. Con el resultado ordinal (clasificación operativa COVID-19), se realizó el análisis de datos mediante un modelo de regresión multinomial. Resultados: se incluyeron en el análisis un total de 498 participantes que revelaron el 67,27% de los casos sospechosos y el 11,65% de los casos confirmados de COVID-19. El uso de máscaras, el transporte público y ser parte de la primera línea de los trabajadores de la salud se asociaron estadísticamente con un historial positivo de COVID-19. Conclusión: los planes de reapertura de Escuelas de Enfermería deben integrar el uso de equipos de protección personal, transporte público y el rastreo de COVID-19 en la educación

Use of World Health Organization Guidelines to Improve Hand Washing Efficacy.

BACKGROUND: Hand washing continues to be the number one most effective way to prevent the spread of germs. This quality improvement project examines whether a hands-on soap and water hand washing tutorial increases the quality of hand washing technique. METHOD: The Glow Team developed and presented an evidence-based hands-on teaching tutorial demonstrating proper hand washing technique as recommended by the World Health Organization to 100 emergency department health care workers. The efficacy of the technique was evaluated by applying black light-sensitive lotion. Participants washed their hands before and after the education session. Participants completed a posttest to evaluate their gained knowledge of hand washing. RESULTS: Hand washing efficacy improved from 60% preeducation to 82% posteducation. Each individual step noted improvement posteducation. CONCLUSION: Of 100 participants, 98 reported this education was helpful and suggested yearly competencies, posted fliers, and repeated demonstrations to improve compliance among self and peers. [J Contin Educ Nurs. 2020;51(10):453-456.].

Don't hesitate, vaccinate! An influenza vaccine education program.

The State of Connecticut mandates that prekindergarten children be vaccinated against the influenza virus each year by December 31st. Annually, prekindergarten students in urban schools in Connecticut are not compliant with this statute due to many factors such as parents' lack of education. The purpose of an educational intervention project (EIP) is to provide urban prekindergarten parents/caregivers with education about the influenza virus, influenza vaccine, the community resources, and Connecticut mandates. An influenza vaccine educational intervention was provided to parents and caregivers of prekindergarten students in one urban elementary school in Connecticut. Parents were educated during an open house at the school and then 4 weeks later at a Meet and Greet with prekindergarten parents. Information regarding influenza virus, vaccine, and state regulations was provided along with Pre- and post-questionnaires to assess the level of knowledge. The goal of this EIP is increased knowledge of the influenza virus, the vaccine, community resources, and state regulations. The success of this educational intervention can be shared and implemented in other licensed prekindergarten programs to increase parents' knowledge and it would lead to increased rates of district-wide compliance and decreased student absences. Most importantly, implications point to the potential protection of the public from an illness stemming from the influenza virus.

Four Smart Steps: Fall Prevention for Community-Dwelling Older Adults.

Falls are associated with enormous costs in morbidity and early mortality, as well as loss of safe, independent lifestyles for community-dwelling older adults. The purpose of this quality improvement project was to implement an author-designed, easy-to-remember guide to fall prevention for community-dwelling older adults and enhance their awareness and knowledge of fall risks in the home. A Four Smart Steps Fall Prevention program (exercise, eye exams, home safety, and primary care visits) presented fall prevention education for community-dwelling older adults. The project was implemented at a senior center by registered nurses and evaluated through an anonymous questionnaire. The desired outcome was an increase in safety awareness and knowledge of fall prevention for community-dwelling older adults. Community-dwelling older adults with enhanced education on fall prevention will be more likely to be able to live independently within a safe environment.

The euphemism of good practice or advanced nursing practice / El eufemismo de las buenas prácticas o la práctica avanzada de enfermería / O eufemismo das boas práticas ou a prática avançada de enfermagem

ABSTRACT Objective: To analyze how the focus given nowadays in our country to good practices in the care process as centrality of Nursing offers support to the discussion about the expansion of nurses' performance through advanced practices. Method: This is a theoretical-reflexive article, based on critical reading of studies on the subject, focused on the need to discuss the training of nurses in the perspective of their role expansion. Results: The arguments for both subjects, based on the discussion of the theoretical reference of the two themes: good practices or practice based on evidences, and advanced practice nursing. Final considerations and implications for practice: It is proposed that, in addition to good practices, undoubtedly necessary, the appropriation of advanced nursing practice and the debate about its adoption in the country are fundamental to the new professional challenges facing nursing and the training of human resources for the Unified Health System. The arguments presented lead to the knowledge of the nursing topic of recent dissemination in Brazil, the advanced nursing practice, which can substantially change the nurses' performance in our reality.

RESUMEN Objetivo: Analizar cómo el enfoque dado actualmente en el país a las buenas prácticas en el proceso de cuidado como centralidad de la enfermería ofrece suporte a las discusiones sobre la expansión de la actuación del enfermero por medio de prácticas avanzadas. Método: Artículo teórico-reflexivo, construido con base en la lectura crítica de estudios sobre la temática, centrándose en la necesidad de discutir la formación del enfermero en la perspectiva de la expansión de su actuación. Resultados: Los argumentos para ambos asuntos son fundamentados en la discusión del referencial teórico de los dos temas: buenas prácticas o prácticas basadas en evidencia; y enfermería de práctica avanzada. Consideraciones finales e implicaciones para la práctica: Se propone que, además de buenas prácticas, sin duda necesarias, la apropiación de la enfermería de práctica avanzada y el debate sobre su adopción en el país son fundamentales para los nuevos desafíos profesionales que se colocan a la enfermería y para la formación de recursos humanos para el sistema único de salud. Los argumentos presentados conducen al conocimiento de la enfermería tema de reciente difusión en Brasil, la enfermería de práctica avanzada, que puede cambiar sustancialmente la actuación del enfermero en nuestra realidad.

RESUMO Objetivo: Analisar como o enfoque dado atualmente no país às boas práticas no processo de cuidado como centralidade da enfermagem oferece suporte às discussões sobre expansão da atuação do enfermeiro por meio de práticas avançadas. Método: Artigo teórico-reflexivo, construído com base na leitura crítica de estudos sobre a temática, voltado à necessidade de discutir a formação do enfermeiro na perspectiva de expansão da sua atuação. Resultados: Os argumentos para ambos os assuntos são fundamentados na discussão do referencial teórico dos dois temas: boas práticas ou práticas baseadas em evidência; e enfermagem prática avançada. Considerações finais e implicações para a prática: Propõe-se que, para além de boas práticas, sem dúvida necessárias, a apropriação da enfermagem prática avançada e o debate sobre sua adoção no país são fundamentais para os novos desafios profissionais que se colocam à enfermagem e para a formação de recursos humanos para o sistema único de saúde. Os argumentos apresentados levam ao conhecimento da enfermagem tema de recente veiculação no Brasil, a prática avançada de enfermagem, que pode mudar substancialmente a atuação do enfermeiro em nossa realidade.

Community-Based Stroke Recognition Education and Response: An Evidence-Based Intervention Project.

BACKGROUND: Stroke has a significant impact on mortality and disability in the United States. This led the aforementioned master's students to create a community-based educational intervention using stroke curriculum from the American Heart Association/American Stroke Association (AHA/ASA). PURPOSE: The purpose of this evidence-based intervention project was to examine the effectiveness of public stroke education utilizing the AHA/ASA's Face, Arm, Speech, Time (FAST) curriculum for stroke symptom recognition and response (Jauch, et al., 2013) at three central Connecticut senior centers. DESIGN: This evidence-based intervention project was based on the theoretical framework of Dorothea Orem's Self-Care Deficit Theory (Petiprin, 2016). Nurses can provide stroke based education to older adults in the community, ultimately empowering participants to recognize and respond to stroke symptoms. METHODS: An educational session on the AHA/ASA FAST curriculum was presented by master's students to groups of senior adults at three different senior centers, followed by a post teach-back session conducted by the students in smaller groups to assess learning. The total number of participants was 62 (n = 62). RESULTS: The majority of participants (87%) were able to accurately teach back the four components of the FAST curriculum after the educational intervention. CONCLUSIONS: FAST was simple to teach and engaging for participants. Using the FAST curriculum in senior center populations increased the participants' awareness of stroke signs and symptoms, and their willingness to activate the 911 emergency system. IMPLICATIONS FOR PRACTICE: Educational interventions in the community with older adults can produce increased awareness of stroke symptoms and willingness to respond when necessary.

Decreasing Incidence of Medical Device-Related Pressure Injuries in a Small Community Hospital: A Quality Improvement Project.

One-third of hospital-acquired pressure injuries are related to medical devices. The purpose of this quality improvement project was to create an evidence-based guideline in one acute care hospital setting for the prevention of medical device-related pressure injuries (MDRPIs) and to implement the hospital-wide use of a new nasogastric tube securement device to offload pressure to the nares. The first phase of this project comprised development of a guideline along with multiple education opportunities. The second phase of this project consisted of evaluation and subsequent conversion to a new nasogastric tube securement device. This project led to reduced MDRPI incidence rates over the past 12 months.