Pharmacologic Pain Management Trends among Adults Hospitalized with Cellulitis: An Evidence-Based Practice Project.

BACKGROUND: Nurses commonly administer opioids, following "as needed" order sets, to patients hospitalized for acute pain conditions like cellulitis. Practice guidelines recommend limiting opioid administration for acute pain management. At two hospitals in the Pacific Northwest, an opioid stewardship committee was formed to align with best practice. AIMS: The main objective was to describe changes to inpatient rates of opioid and non-opioid administration following implementation of evidence-based opioid stewardship efforts. DESIGN: Observational, retrospective, evidence-based practice project. SETTINGS: One 200-bed and one 680-bed hospital in Washington State. PARTICIPANTS/SUBJECTS: Data were included from patients aged 18 years or older hospitalized for cellulitis. METHODS: Demographic and pain-related data were extracted from the electronic health record (n = 4,523 encounters) guided by the symptom management framework. The proportion of patients receiving opioid or non-opioid medications before and after implementation of evidence-based practice opioid stewardship interventions was calculated descriptively. A logistic regression tested factors related to administration of an opioid medication. RESULTS: The proportion of patients receiving an opioid decreased following opioid stewardship efforts while those receiving non-opioid analgesics remained stable. Factors significantly influencing inpatient opioid administration were: average inpatient pain score, pre-hospital opioid prescription, length of stay, and year of hospitalization. CONCLUSIONS: Analgesic administration treating painful, acute cellulitis at two hospitals in the Pacific Northwest included opioid and non-opioid medications. The proportion of patients receiving opioids decreased following best practice opioid stewardship actions. Opportunities may exist for nurses to collaborate with providers to improve inpatient analgesic administration practices.

The Cost of Nurse-Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting.

INTRODUCTION: Obstetrical care often involves multiple expensive, and often elective, interventions that may increase costs to patients, payers, and the health care system with little effect on patient outcomes. The objectives of this study were to examine the following hospital related outcomes: 1) use of labor and birth interventions, 2) inpatient duration of stay, and 3) total direct health care costs for patients attended by a certified nurse-midwife (CNM) compared with those attended by an obstetrician-gynecologist (OB-GYN), within an environment of safe and high-quality care. MATERIAL AND METHODS: Electronic health records for 1,441 medically low-risk women who gave birth at a hospital located in the U.S. Pacific Northwest between January and September 2013 were sampled. Multilevel regression and generalized linear models were used for analysis. RESULTS: Reduced use of selected labor and birth interventions (cesarean delivery, vacuum-assisted delivery, epidural anesthesia, labor induction, and cervical ripening), reduced maternal duration of stay, and reduced overall costs associated with CNM-led care relative to OB-GYN-led care were observed for medically low-risk women in a hospital setting. Maternal and neonatal outcomes were comparable across groups. CONCLUSIONS: This study supports consideration of increased use of CNMs as providers for the care of women at low risk for complications to decrease costs for the health care system. The use of CNMs to the fullest extent within state-regulated scopes of practice could result in more efficient use of hospital resources.

A Course-Based Approach to the Doctor of Nursing Practice Project: Supporting Student Growth From Concept to Completion.

We describe a course-based approach to the doctor of nursing practice project in which students work in groups of 8 to 12 with a faculty member to complete individual final projects that require a minimum of 360 practicum hours in 3-semester-long courses. Project teams include agency or community-based mentors. Project findings are disseminated through written and oral reports. This approach preserves faculty resources and provides students with mentoring, opportunities for reflection, and time for project development.

Implementing AACN's recommendations for environmental sustainability in colleges of nursing: from concept to impact.

In 2011, the American Association of Colleges of Nursing (AACN) released a guidance report titled Toward an Environmentally Sustainable Academic Enterprise: An AACN Guide for Nursing Education. The report was developed in response to a vivid slide presentation at an AACN meeting depicting the deleterious public and environmental health effects of global industrialization. Following the presentation, AACN members capitalized on the opportunity to provide national leadership to U.S. colleges of nursing in regard to environmental sustainability and stewardship. This article summarizes key features of the AACN plan and outlines one college's multifaceted implementation plan. The goal of the implementation plan was to translate the AACN recommendations from concept into college-specific actions. Specific steps taken by the college included the following: (a) increasing student and faculty awareness, (b) greening business operations, (c) increased participation in media events, (d) leveraging the impact of national sustainability initiatives, and (e) enhancing curricula at the undergraduate and graduate levels. Through this work, the college achieved not only a higher standard of sustainability within its own walls but also a richer appreciation of the importance of educating nurses as future stewards in an environmentally sustainable health care system.

Motivational interviewing for older adults in primary care: a systematic review.

Chronic disease is now the leading cause of death and disability in United States. Many chronic illnesses experienced by older adults can be prevented or managed through behavior change, making patient counseling an essential component of disease prevention and management. Motivational Interviewing (MI), a type of conversational method, has been effective in eliciting health behavior changes in people in a variety of settings and may also be a useful tool to help older adults change. This review of the literature analyzes current research and describes potential biases of MI interventions that have been conducted in primary care settings with older adults. MI shows promise as a technique to elicit health behavior change among older adults. However, further study with this population is needed to evaluate efficacy of MI interventions in primary care settings.

Facilitated family presence at resuscitation: effectiveness of a nursing student toolkit.

BACKGROUND: Facilitated family presence at resuscitation is endorsed by multiple nursing and specialty practice organizations. Implementation of this practice is not universal so there is a need to increase familiarity and competence with facilitated family presence at resuscitation during this significant life event. One strategy to promote this practice is to use a nursing student toolkit for pre-licensure and graduate nursing students. The toolkit includes short video simulations of facilitated family presence at resuscitation, a PowerPoint presentation of evidence-based practice, and questions to facilitate guided discussion. METHODS: This study tested the effectiveness of this toolkit in increasing nursing students' knowledge, perceptions, and confidence in facilitated family presence at resuscitation. Nursing students from five universities in the United States completed the Family Presence Risk-Benefit Scale, Family Presence Self-Confidence Scale, and a knowledge test before and after the intervention. RESULTS: Implementing the facilitated family presence at resuscitation toolkit significantly increased nursing students' knowledge, perceptions, and confidence related to facilitated family presence at resuscitation (p<.001). The effect size was large for knowledge (d=.90) and perceptions (d=1.04) and moderate for confidence (d=.51). CONCLUSIONS: The facilitated family presence at resuscitation toolkit used in this study had a positive impact on students' knowledge, perception of benefits and risks, and self-confidence in facilitated family presence at resuscitation. The toolkit provides students a structured opportunity to consider the presence of family members at resuscitation prior to encountering this situation in clinical practice.

Assessing the continuing education needs and preferences of rural nurses.

BACKGROUND: Difficulty recruiting and retaining well-qualified nursing staff can frustrate rural hospitals. Collaborative relationships between university nursing programs and rural hospitals may lead to the development of continuing education (CE) programs to enhance clinical competence, patient safety, job satisfaction, and nursing work force retention. METHODS: As part of an effort to develop a collaborative relationship between a university nursing program and two rural hospitals, a pilot study was conducted with 27 nurses working at two hospitals to determine needs and preferences for CE topics and delivery. RESULTS: The pilot study provided important information, furthering the development of a collaborative relationship between the university and rural hospitals and offering insight into barriers preventing rural nurses' participation in CE activities. Using results from the survey, the university and hospital are working together to plan online CE offerings about topics of interest to these rural nurses. CONCLUSION: Discussion of this process and the results of the pilot study will be useful for those who are contemplating offering CE programs to nurses in rural regions or are interested in exploring opportunities for the development of collaborative relationships that could result in improved job satisfaction, patient safety, and work force retention.

Advanced practice nursing education: challenges and strategies.

Nursing education programs may face significant difficulty as they struggle to prepare sufficient numbers of advanced practice registered nurses to fulfill the vision of helping to design an improved US healthcare system as described in the Institute of Medicine's "Future of nursing" report. This paper describes specific challenges and provides strategies to improve advanced practice nursing clinical education in order to ensure that a sufficient number of APRNs are available to work in educational, practice, and research settings. Best practices are identified through a review of classic and current nursing literature. Strategies include intensive interprofessional collaborations and radical curriculum revisions such as increased use of simulation and domestic and international service work. Nurse educators must work with all stakeholders to create effective and lasting change.

Improving nurse practitioner assessment of woman veterans.

PURPOSE: To provide nurse practitioners (NPs) with brief screening tools that can be used to identify postmilitary healthcare concerns common among women veterans. DATA SOURCES: Existing screening tools for posttraumatic stress disorder, traumatic brain injury, and military sexual trauma. CONCLUSIONS: Women represent more than 10% of military veterans who have served in combat settings during the current wars in Afghanistan and Iraq. As a result of their military service, women veterans may present in community healthcare settings with one or more of a variety of functional health problems, posttraumatic stress disorder, depression, anxiety, or other evidence of significant physical or psychiatric stress. Their families may be temporarily or permanently unstable as a result of the disruption caused by their military service, deployment, or health status. IMPLICATIONS FOR PRACTICE: NPs who are aware of the unique healthcare needs of women veterans returning from combat will be better prepared to assess and intervene when these patients present with symptoms or health consequences of military service. Simple, straightforward assessments can determine the extent to which women veteran patients require intervention during wartime and/or referral.