Nursing Student Experiences Regarding Safe Use of Electronic Health Records: A Pilot Study of the Safety and Assurance Factors for EHR Resilience Guides.

Previous research has linked improper electronic health record configuration and use with adverse patient events. In response to this problem, the US Office of the National Coordinator for Health Information Technology developed the Safety and Assurance Factors for EHR Resilience guides to evaluate electronic health records for optimal use and safety features. During the course of their education, nursing students are exposed to a variety of clinical practice settings and electronic health records. This descriptive study evaluated 108 undergraduate and 51 graduate nursing students' ratings of electronic health record features and safe practices, as well as what they learned from utilizing the computerized provider order entry and clinician communication Safety and Assurance Factors for EHR Resilience guide checklists. More than 80% of the undergraduate and 70% of the graduate students reported that they experienced user problems with electronic health records in the past. More than 50% of the students felt that electronic health records contribute to adverse patient outcomes. Students reported that many of the features assessed were not fully implemented in their electronic health record. These findings highlight areas where electronic health records can be improved to optimize patient safety. The majority of students reported that utilizing the Safety and Assurance Factors for EHR Resilience guides increased their understanding of electronic health record features.

Immunization Status of NICU Graduates at a Tertiary Care Children's Hospital.

BACKGROUND: Approximately 500,000 infants are born prematurely each year in the United States. Immunization of infants in a neonatal intensive care unit (NICU) set a precedence for future immunizations. PURPOSES: The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were aged 60 days or older at time of discharge. METHODS: This descriptive pilot study utilized retrospective paper medical record review in one tertiary children's hospital. The relationships between immunization status and study variables were examined using t tests and logistic regression. RESULTS: Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were fully immunized in accordance with American Academy of Pediatrics (AAP) recommendations. Significant predictors were age at discharge for immunization and steroid use for nonimmunization. IMPLICATIONS FOR PRACTICE: Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status. Nurses need to implement hospital policies ensuring immunizations of NICU graduates. IMPLICATIONS FOR RESEARCH: Future studies should focus on samples from diverse hospitals and levels of NICUs. Qualitative studies exploring and describing parent and provider knowledge of current AAP guidelines will strengthen our understanding of potential barriers to immunization.

Leadership style and patient safety: implications for nurse managers.

OBJECTIVE: The purpose of this study was to explore the relationship between nurse manager (NM) leadership style and safety climate. BACKGROUND: Nursing leaders are needed who will change the environment and increase patient safety. Hospital NMs are positioned to impact day-to-day operations. Therefore, it is essential to inform nurse executives regarding the impact of leadership style on patient safety. METHODS: A descriptive correlational study was conducted in 41 nursing departments across 9 hospitals. The hospital unit safety climate survey and multifactorial leadership questionnaire were completed by 466 staff nurses. Bivariate and regression analyses were conducted to determine how well leadership style predicted safety climate. RESULTS: Transformational leadership style was demonstrated as a positive contributor to safety climate, whereas laissez-faire leadership style was shown to negatively contribute to unit socialization and a culture of blame. CONCLUSIONS: Nursing leaders must concentrate on developing transformational leadership skills while also diminishing negative leadership styles.

Impact of universal disinfectant cap implementation on central line-associated bloodstream infections.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) result in increased length of stay, cost, and patient morbidity and mortality. One CLABSI prevention method is disinfection of intravenous access points. The literature suggests that placing disinfectant caps over needleless connectors decreases CLABSI risk. METHODS: A quasi-experimental intervention study was conducted in a >430-bed trauma I center. In addition to an existing standard central line bundle, a new intervention consisting of a luer-lock disinfectant cap with 70% alcohol was implemented in all intravenous (IV) needleless connectors on patients with peripheral and central lines. Compliance to the disinfectant cap was monitored weekly. A generalized linear model using a Poisson distribution was fit to determine if there were significant relationships between CLABSIs and disinfectant cap use. Impacts on costs were also examined. RESULTS: The rate of CLABSI decreased following implementation of the disinfectant cap. The incidence rate ratios (.577, P = .004) for implementing the disinfectant caps was statistically significant, indicating that the rate of patient infections decreased by >40%. Increased compliance rates were associated with lower infection rates. Disinfectant cap use was associated with an estimated savings of almost $300,000 per year in the hospital studied. CONCLUSIONS: Use of a disinfectant cap on IV needleless connectors in addition to an existing standard central line bundle was associated with decreased CLABSI and costs.

Managerial span of control: a pilot study comparing departmental complexity and number of direct reports.

Nurse managers play pivotal roles in hospitals. However, restructuring has resulted in nurse managers having wider span of control and reduced visibility. The purpose of this pilot study was to compare two methods of measuring span of control: departmental complexity and number of direct reports. Forty-one nurse managers across nine hospitals completed The Ottawa Hospital Clinical Manager Span of Control Tool (TOH-SOC) and a demographic survey. A moderate positive relationship between number of direct reports and departmental complexity score was identified (r=.49, p=<.01). Intensive care departments were more likely to be classified differently, using departmental complexity compared to number of direct reports (54%). TOH-SOC is a reliable instrument (Cronbach's alpha = .838). Using departmental complexity rather than direct reports may more accurately reflect the full scope of nurse managers' responsibility.

Developing an effective quantitative research proposal.

In 2010, the Infusion Nurses Society began work to identify research priorities for infusion nursing. Nurses need to understand the research process and become proficient in collaboration to promote research in their specialty. One of the most important components of conducting research is the written research proposal. A poorly written proposal may result in denial of funding, rejected publications, and prolonged discussion and revision at the institutional or ethics review board. This article provides an overview of the elements needed in a research proposal, identifies institutional review board requirements, and highlights important criteria for recruitment and consent of subjects.

Hospital nursing research program: partnership of service and academia.

Hospitals in a nonprofit mountain west corporation conducted a gap analysis to determine readiness for Magnet Recognition. Major gaps included nursing research and availability of consultation and resources for research. Based on the findings, the development of a dynamic research program promoting nursing research and evidence-based practice within hospitals was undertaken. A nursing research council was reestablished with representatives from service and academia. A literature review and analysis of corporate/academia resources were completed. The plan called for a nursing research coordinator position and development of a research budget. Academia continues to be represented on the hospital institutional review board. A semiannual research symposium including poster presentations by nursing staff and nursing students was implemented. The plan calls for development of a research fellowship program and unit-based evidence-based specialists. With administrative support and resources and partnering with nursing academia, nonteaching hospitals can develop successful dynamic nursing research and evidence-based practice programs.