Leadership Strategies to Increase Psychological Safety of Nurses: A Longitudinal Study.

BACKGROUND AND OBJECTIVES: A work environment where employees feel comfortable taking chances without fear and with sufficient protection from retaliation is psychologically safe. The objective of this study was to investigate the effects of leader training for nurse managers on psychological safety of clinical registered nurses. METHODS: The study was designed a longitudinal outcomes approach to assess nurse leader intervention (classes on leadership methods and psychological safety) with pre- and post-intervention measurement of nurse psychological safety at each time point. RESULTS: The intervention and nurse leader rounding were shown to increase individual psychological safety climate scores of clinical nurses. CONCLUSION: Psychological safety is an important component to consider in a nursing leadership role. Leadership interventions that focus on the tenets of psychological safety and include methods of being present, such as nurse leader rounding, can foster a sense of a psychologically safe environment for clinical registered nurses.

Highlighting the Benefits of the Clinical Education Resource Nurse for New Graduate Nurses.

Nurse residency programs provide a valuable transition to practice environment for graduate nurses. The Clinical Education Resource Nurse (CERN) role offers continued clinical assistance to graduate nurses who have completed orientation with a preceptor during the 1st year of practice including education and continued clinical oversight when needed. This column defines the role of CERN and provides a description of the clinical application and support provided.

Comparison of Task-Layered Clinical Orientation to Traditional Orientation in a RN Residency Program.

OBJECTIVE: The purpose of this study was to compare outcomes of using a task-layered clinical orientation when compared with the original patient-layering approach. BACKGROUND: Use of task-layering to orient new graduate nurses to the clinical world of nursing has been theorized to provide a decrease in cognitive load and allow for more streamlined clinical orientation. METHODS: The method of this study was a nonrandomized, comparative design to measure the outcomes of length of orientation, new graduate perceptions about level of confidence/comfort with professional nurse responsibilities/skills, stress, satisfaction, and perceptions about orientation. RESULTS: Analysis revealed no statistical significance between the 2 groups. However, the task-layered clinical orientation group completed orientation earlier than the traditional patient-layered group. CONCLUSIONS: The task-layered approach to clinical orientation provided as good of outcomes as traditional orientation strategy and may result in cost savings due to decrease in total clinical orientation days.

Original Research: Patient-to-Nurse Violence During One-to-One Assignments: A Silent Epidemic.

BACKGROUND: Nurses and nursing assistants given one-to-one ("sitter") assignments are placed with one patient for long periods of time. Some of these patients require a sitter for reasons that include dementia, traumatic brain injury, psychiatric disturbances such as delirium, and risk of self-harm. Some may become verbally abusive, physically violent, or both, putting the assigned staff member in danger. PURPOSE: The study purpose was to investigate workplace violence from the perspective of nurses and certified nursing assistants working one-to-one assignments who had experienced violent encounters with patients or visitors. METHODS: This qualitative cross-sectional study used a phenomenological approach. Participants were nurses and nursing assistants at one hospital in the western United States. Data were collected in five focus groups, which were conducted online; a semistructured interview guide allowed researchers to elicit participants' responses and foster discussion. Thematic analysis was used to identify themes in the data. RESULTS: A total of 13 nurses and nursing assistants participated. Four themes emerged: silent epidemic, culture of unsafety, emotional occupational hazard, and policy and response. CONCLUSIONS: This study adds to the work of researchers who are asking difficult questions about workplace violence. It's our hope that the participants' comments and insights, as well as their recommendations, can move the needle in improving prevention and follow-up practices related to patient-initiated workplace violence.

Task-Layered Clinical Orientation for New Graduate Registered Nurses.

New nurse residency programs focus on the professional transition from student nurse to clinical nurse. In some facilities, the way in which new graduate nurses are oriented to the fast-paced clinical setting is based on tradition rather than theory, research, or available evidence. This article offers a theory-based approach to clinical practice orientation of new graduate nurses termed task-layered clinical orientation and offers an innovative approach for consideration.

Use of toilet alarms in inpatient settings.

PURPOSE: To investigate the use of toilet alarms among patients at an increased risk for falls in inpatient settings while allowing for privacy and maintaining safety. METHODS: Pre- and postsurvey data were collected among patients in the intervention and control groups, as well as among the healthcare staff, to determine perceptions of privacy and safety. RESULTS: Each participant group was compared according to the participants' responses to the pre- and postsurveys. On average, the intervention group perceived increased levels of privacy and safety compared with the control group. Staff also indicated increased privacy and safety. CONCLUSION: Additional research is necessary, but patient satisfaction, privacy, and dignity may be augmented by using toilet alarms in hospital settings.

Rapid Response to Ready RNs for the COVID-19 Pandemic.

Rapid response is a common term in hospital settings, reflecting immediate clinical response to a critical challenge. In preparation for the oncoming pandemic of novel coronavirus 2019, nurse leaders within a large health system in the Mountain West region implemented a rapid response to prepare nondirect care registered nurses for deployment to the bedside. This article highlights the prompt action, organization, and implementation of this process, as well as the lessons learned for future events.

Student Perception of the Flipped Classroom in Nursing Education.

As nurse educators consider new pedagogy for teaching nursing, the students' views and perceptions must be considered. Many studies and commentaries have been written to date on the flipped classroom in nursing education, but few have used research methods to tease out student views of this teaching approach. The purpose of this study was to investigate student perceptions of the flipped classroom using a phenomenological approach. Students who had experienced traditional lecture instruction and the flipped classroom in the same semester were asked about their perceptions and comparisons of the two instructional methods. Qualitative analysis of fifteen individual interviews and two focus groups revealed seven themes, each encompassing a rich data set to inform nurse educators about student perceptions of the flipped classroom. This research informs educators on the effects of launching innovative teaching and learning strategies while considering the audience within the classroom.

Laboratory diagnosis of overt type 2 diabetes in the first trimester of pregnancy.

OBJECTIVE: The objective of this study was to compare the use of hemoglobin A1C to oral glucose tolerance testing to diagnose overt type 2 diabetes in the first trimester of pregnancy. The study used a nonexperimental descriptive design to compare the use of the hemoglobin A1C test results to oral glucose tolerance test results. METHODS: The study used a sample of 45 women at high risk for type 2 diabetes in the first trimester of pregnancy. Participants were consented to draw a hemoglobin A1C with their ordered oral glucose tolerance testing for comparison of the two tests' ability to diagnose overt type 2 diabetes. RESULTS: Hemoglobin A1C tests were highly positively correlated with oral glucose tolerance testing for diagnosis of type 2 diabetes in women in the first trimester of pregnancy. CONCLUSION: The research provides beginning evidence that the hemoglobin A1C should be considered as a first-tier diagnostic test for overt type 2 diabetes in the first trimester of pregnancy.

Nursing education: Flipping the classroom.

This article will introduce the innovative educational concept of the "flipped classroom." How to implement the flipped learning model will be addressed within the framework of The Intentional Instruction Environment Model.

Inpatient ambulation: use of an ambulation platform apparatus.

Ambulation has proven to be an important part of recovery for medical-surgical patients. This study provides original research on the use of a platform apparatus for ambulation of patients on a medical-surgical unit. Outcomes included number of ambulation attempts, distance of ambulation, length of hospital stay, number of staff necessary to ambulate, and discharge destination. Compared with a control group, patients who had access to the ambulation platform apparatus had a shorter length of stay with fewer nurses and other staff needed to ambulate. Staff rated ambulation with the apparatus as easier than without and noted that patients were more willing to ambulate on their own with the ambulation platform apparatus.

Interactive learning research: application of cognitive load theory to nursing education.

The purpose of this research was to investigate the effectiveness of interactive self-paced computerized case study compared to traditional hand-written paper case study on the outcomes of student knowledge, attitude, and retention of the content delivered. Cognitive load theory (CLT) provided the theoretical framework for the study. A quasi-experimental pre-test post-test design with random group assignment was used to measure by self-report survey student cognitive load and interactivity level of the intervention. Student scores on quizzes in semester 1 and post-test follow-up quizzes in semester 3 were assessed for the intervention's effects on knowledge retention. While no significant statistical differences were found between groups, the students in the interactive case study group rated their case study as more fun and interactive. These students also scored consistently higher on the post-test quiz items in their third semester, showing the viability of using CLT to improve student retention of nursing curricula information.

Prenatal birth planning for families of the imperiled newborn.

Guidelines have not been established to address the needs of parents with imperiled newborns due to the infrequency of this obstetric situation. In this article we offer an approach to prenatal care planning for imperiled newborns and their families. Use of an interdisciplinary team and family involvement are the foci of the care planning process, which result in a perinatal birth plan that reflects parental values and ethical guidelines.

Nurse practitioner attitudes and treatment practices for childhood overweight: how do rural and urban practitioners differ?

PURPOSE: Pediatric overweight and obesity has become an epidemic problem of our nation. Nurse practitioners (NPs) are exposed to overweight pediatric patients on a regular basis. The purpose of this study was to investigate NP attitudes toward pediatric overweight and obesity and explore their current diagnosis and treatment practices. Differences between rural and urban NPs were also investigated. DATA SOURCES: Survey data were gathered from 1088 family and pediatric NPs from the American Academy of Nurse Practitioners member list randomly. Only family and pediatric NPs were included in the sample. CONCLUSIONS: NPs in the sample believed that pediatric overweight and obesity are problems in need of treatment, but also reported not assessing and diagnosing the condition per current guidelines. Initiation of treatment was reported at very low rates. Rural NPs reported having fewer referral resources than urban NPs. IMPLICATIONS FOR PRACTICE: NPs are in an ideal position to properly assess, diagnose, and treat pediatric overweight and obesity. The findings suggest that more education on these topics is necessary for NPs. Rural NPs reported fewer referral services, and may need to have more knowledge about how to provide obesity treatment services in their own practice settings due to this disparity.

Cascade® Autologous System Platelet-Rich Fibrin Matrix in the Treatment of Chronic Leg Ulcers.

PROBLEM: Lower extremity ulcers (venous, diabetic) are often unresponsive to standard treatment. Various systemic and local cellular, vascular, and anatomical factors can result in nonhealing wounds that are refractory to normal healing processes and standard care. SOLUTION: Several published wound care guidelines strongly suggest that if an ulcer does not respond to standard good wound care within 4 weeks, then advanced wound therapies should be considered. These advanced therapies include wound bed preparation agents (negative wound pressure therapy, hyperbaric oxygen), recombinant growth factors, or bioengineered cell therapies. NEW TECHNOLOGY: The Cascade® system produces platelet-rich fibrin matrix (PRFM), a novel autologous sterile biologic, produced at the bedside from a small volume (18 mL) of the patient's own blood by using Vacutainer® separation technology optimized for fibrin and platelet isolation. Prepared as an easy to apply, suturable membrane, without the use of exogenous thrombin, PRFM consists of a dense cross-linked fibrin lattice containing intact, viable platelets with their full complement of platelet-derived growth factors. INDICATIONS FOR USE: From the FDA 510(k) clearance: The Cascade system "is designed to be used for the safe and rapid preparation of autologous platelet-rich plasma from a small sample of blood at the patient point of care." PRFM has been used to successfully treat severe venous leg ulcer (VLU), neuropathic diabetic foot ulcer (DFU), mixed arterial and Charcot-deformity associated foot ulcers. CAUTIONS: When treating venous or DFUs, the Cascade system should be used together with standard wound care practice (therapeutic compression for VLU and weight off-loading, debridement, and infection control for DFU) in patients with an adequate blood supply to the lower limb.

Physical activity behaviors of rural preschoolers.

PURPOSE: The purpose of this qualitative study was to investigate the physical activity and active play of rural preschoolers. METHOD: A micro-ethnography approach using observation, photography, individual interviews, and focus groups led to five major themes describing preschool activity and play in the rural area. FINDINGS: The five major themes describing preschool activity and play in the rural area were Self-Reliance, Learning Through Play, One Big Rural Family, Rural Surroundings, and Money Matters. CONCLUSIONS: Rural areas may not be as conducive to every day physical activity for children as traditionally believed. Nurses can apply these results when intervening to increase physical activity levels of preschool children.

Student evaluations: advice for novice faculty.

Student evaluations can be a valuable method to transform teaching strategies and course design in nursing education. Negative student comments are difficult to view as constructive criticism and have the potential to lead to negative changes, rather than positive, productive changes for improved instruction and course design. This article provides a glimpse of recent empirical evidence regarding student evaluations of instructors as well as providing novice faculty with suggestions for promoting positive change in teaching strategies.

Autologous platelet-rich fibrin matrix as cell therapy in the healing of chronic lower-extremity ulcers.

A novel autologous platelet-rich fibrin matrix membrane (PRFM) was assessed for the ability to facilitate healing in patients with chronic lower-extremity ulcers. Preliminary data are presented from a prospective trial (n=21). Twelve patients were identified with 17 venous leg ulcers (VLU) and nine bearing 13 nonvenous lower-extremity ulcers. Before enrollment, the patients were evaluated for vascular status and received appropriate surgical intervention to optimize arterial and venous circulatory status. None of the ulcers had responded to a variety of standard treatments from 4 months to 53 years. Initial ulcer size ranged from 0.7 to 65 cm(2) (mean, 11.2 cm(2)). Each PRFM-treated patient received up to three applications of either a 35 or 50 mm fenestrated membrane, depending on initial ulcer size. The primary endpoints were percent and rate of complete closure as measured by digital photography, computerized planimetery, and clinical examination. Patients were followed weekly for 12 weeks with a follow-up visit at 16 weeks. At each 4-week interval, the extent of healing was assessed, and those patients with >50% reduction in wound area were allowed to continue to complete closure. Patients with <50% closure received repeated applications. Complete closure was achieved in 66.7% of the VLU patients (64.7% of treated ulcers) in 7.1 weeks (median, 6 weeks) with an average of two applications per patient. Forty-four percent complete closure was seen with non-VLU patients (31% of treated ulcers). From the results of this small-scale pilot study, PRFM shows significant potential for closing of chronic leg ulcers.

Perceptions of nursing student clinical placement experiences.

There is an unprecedented shortage of registered nurses (RNs) in the United States of America. Efforts to educate more RNs have been limited by a shortage of both clinical placements and preceptors for nursing students. The purpose of this study was to examine nursing education issues associated with student clinical placement as experienced by hospital personnel who coordinate the placements with various schools of nursing. A qualitative study involving 15 state-wide participants directly associated with clinical placement of nursing students was conducted. Emergent themes from the data included lack of consistent terminology and definition of student and preceptor roles, preference of clinical scholars, process of site placements, rewards for supervision of students, dis-satisfiers to the supervision of students and suggested strategies for change. Recommendations which developed from the research are summarized and discussed.