Key stakeholders' perspectives: A gap analysis of hospital-acquired pressure injuries.

INTRODUCTION: Hospital-acquired pressure injuries (HAPIs) are a global high-stakes patient safety issue. Key stakeholder perspectives regarding their role and experiences with pressure injuries is critical as part of the solution to minimizing HAPI occurrence and attain sustainability. DESIGN: A qualitative, descriptive approach provided multiple perspectives of key stakeholders to support the complexity of HAPI care. The qualitative data are a part of a mixed method convergent research study examining pressure injury prevention and management practices. METHODS: Nursing system theory, mixed method convergent design, and participatory action research methodologies were chosen to address both the gap analysis development and results, achieve collaborative comprehensiveness, and enable key stakeholder involvement throughout this HAPI prevention and management initiative. Participants were recruited and enrolled from a large Level I trauma hospital and the key stakeholders. Demographic information were collected prior to the individual interview. Focused interviews were conducted virtually using zoom technology. Qualitative data were analyzed using NVivo software and thematic analysis was confirmed across the co-investigators for congruence and applicability to the research questions. RESULTS: Qualitative interviews with 26 key stakeholders provided data to support and integrate a link with gap analysis results on the complex health issue of HAPIs. Specific barrier and recommendation themes identified interventions that could be prioritized. The 52 barrier and 52 recommendation themes/sub-theme(s) respectively were organized by Donabedian (structure, process, and outcome) with structure elements the majority. The top three structure barrier themes involved equipment and standards for use, staff prevention education, and specialized health professionals. The top three structure recommendation themes involved specialized health professionals, equipment and standards for use, and an educational plan for those at risk or with HAPIs. CONCLUSION: The article provides findings from the qualitative portion of a mixed method study related to HAPIs. The qualitative findings associated with the gap analysis quantitative results, achieved the goal of the participatory action research key stakeholders' input into HAPI care and can be replicated internationally. CLINICAL RELEVANCE: The benefit of key stakeholder's involvement in solving a clinical problem is sustainability. A quantitative approach and integrating qualitative stakeholders' perspectives provide an in-depth solution that will advance nursing capacity toward health care delivery and HAPI nursing science and policy development on a global level.

Academic-Practice Partnership to Prevent and Manage Pressure Injuries: An Evidence-Based Quality Improvement Initiative.

PURPOSE: This evidence-based quality improvement (EBQI) initiative examined the effect of an academic-practice (A-P) partnership on improvement in quality measures in an acute care setting, specifically hospital-acquired pressure injury (HAPI) prevention and management. DESIGN: A pre-/postdescriptive design was conducted using the practice-informed active learning program to guide the project. PARTICIPANTS AND SETTING: The EBQI initiative was conducted at a Southern Gulf-Coast university college of nursing and clinical nursing practice leaders at its affiliated 406-bed academic health center/level I trauma center, regional burn center, and comprehensive stroke center. Both institutions are located in the Southeastern United States (Mobile, Alabama). METHODS: The A-P council used a participatory action research approach and developed a practice-informed active learning program incorporating Melnyk's evidence-based practice (EBP) steps, the Donabedian Model and the Patient-Centered Outcomes Research Institute (PCORI) Stakeholder Engagement in Question Development and Prioritization (SEED). METHOD: Hospital-acquired pressure injuries were selected as the quality outcome to address. To identify HAPI prevention/management evidenced-based practices, the A-P council conducted an integrative literature review and developed a concept map and the Pressure Injury Prevention Gap Analysis Instrument. The gap analysis identified significant gaps between EBP and current pressure injury prevention practices, with priority ranking of gaps for action by key stakeholders. OUTCOME: Following the practice-informed active learning program objectives, the A-P council identified 79 HAPI best EBPs organized by Donabedian domains of structure, process, and outcome and prioritized 3 gaps for action. Actions to address the HAPI gaps included: restructuring the hospital HAPI program, incorporating appropriate leadership to guide the HAPI program, modifying the HAPI reporting process, hiring specialized experts (WOC nurses) with emphasis on pressure injury prevention, establishing a standardized HAPI prevalence survey, improving electronic documentation, increasing transparency of HAPI reporting, improving HAPI accountability at the unit level, and exploring technology to enhance skin assessment. While HAPIs increased by 6.3% from 2019 (n = 104) to 2021 (n = 111), HAPI severity (Stages 3 and 4) decreased by 9.9% from 2019 (n = 14, or 13.46%) to 2021 (n = 4, or 3.6%). IMPLICATIONS FOR PRACTICE: Our experience with this quality improvement initiative indicates that an A-P partnership can provide a model to address complex clinical problems, quality indicators, and quality improvement while advancing a culture of inquiry and scholarship and building nursing capacity.

Pressure Injury Prevention and Management: A Gap Analysis Using Key Stakeholder Engagement.

PURPOSE: The purpose of this study was to examine pressure injury prevention and management (PIPM) practices in an academic acute care setting. Specific aims were to (1) develop and examine key stakeholder engagement regarding PIPM practices, (2) develop a valid/reliable gap analysis instrument, and (3) conduct a gap analysis of current PIPM practices. DESIGN: Mixed-methods convergent design and participatory action research. SUBJECTS AND SETTING: A nurse-led council (Council) of key stakeholders from a large academic university healthcare setting was developed. The gap analysis was conducted in a southern gulf coast level I trauma academic acute care hospital in the Southeastern United States. METHODS: A multidisciplinary key stakeholder Council with 27 members was developed to accomplish study aims using the participatory action research approach to train, promote, and foster key stakeholder engagement in all aspects of the research process. The Pressure Injury Prevention Gap Analysis Instrument (PIPGAI) was developed and psychometrically tested. A gap analysis of PIPM practices across a level I trauma academic acute care hospital was conducted using the PIPGAI. RESULTS: The PIPGAI was developed using 2019 Pressure Ulcer/Injury Clinical Practice Guideline recommendations, an integrative literature review/appraisal, a concept map, and Council input. The overall PIPGAI content validity index of 0.95 demonstrated excellent content validity. The individual item content validity index scores ranged from 0.62 to1.0. Low-scoring items (0.62-0.75) were deleted or revised. Interrater reliability was demonstrated by percentage of agreement (62%-79%). Using a modified Delphi approach, items of disagreement were summarized and discussed until 100% consensus was achieved. A gap analysis of PIPM practices was conducted resulting in a cumulative score of 267/553 (48%), indicating gaps in PIPM practices. Fifty (73%) items had content present; 37 of 58 (64%) items had minimal detail, and 36 of 58 (62%) items were difficult or required notable effort to accomplish. Fifty items (63%) had a total score of 4 or less and were identified as a gap (range: 0-7). CONCLUSIONS: The main outcome of this study was an innovative and evidence-based gap analysis process. The study provides (1) a model for key stakeholder engagement, (2) a valid/reliable gap analysis instrument, and (3) a method to evaluate PIPM practices.

Characteristics of Negative and Positive Mental Health Among Nursing Students in the United States.

BACKGROUND: Researchers have documented significant psychological problems among nursing students, but findings have been inconclusive as to whether nursing students are "at-risk" for mental health problems compared with their non-nursing peers. AIMS: This study examined whether nursing students have unique mental health characteristics compared with students from other professions. METHOD: Undergraduates (N = 18,312; nursing n = 1,399) were selected from the 2016-2017 National Healthy Minds Study. Participants completed the Patient Health Questionnaire-9 (depression), the Generalized Anxiety Disorder-7 (anxiety), and the Flourishing Scale (positive psychology). RESULTS: Nursing students were equally likely to screen positive for depression and anxiety compared with their non-nursing peers. However, when controlling for gender, age, and year in school, multigroup structural equation modeling analyses revealed that female (but not male) nursing students reported significantly higher levels of specific anxiety symptoms and certain psychological strengths than female students from other professions. Nursing students are equally likely to screen positive for depression or anxiety as their non-nursing peers; however, anxiety disorders may reflect symptom profiles unique to nursing students. CONCLUSIONS: Findings suggest a need for tailored screening and interventions to reduce mental health problems and harness psychological strengths unique to nursing students.

Applying Self-Determination Theory to Adolescent Sexual-Risk Behavior and Knowledge: A Structural Equation Model [Formula: see text].

BACKGROUND: National health priorities identify adolescent sexual-risk behavior outcomes as research and intervention targets for mental health. OBJECTIVE: Reduce sexual-risk behavioral outcomes by applying self-determination theory to focus on decision-making autonomy. This study examined late adolescents' recollections of parental autonomy support/sexual-risk communication experiences and autonomy motivation as predictors of sexual-risk behaviors/knowledge. METHOD: A convenience sample ( N = 249) of 19- and 20-year-old university students completed self-report questionnaires. Structural equation modeling with latent variables examined direct/indirect effects in the hypothesized model. RESULTS: Parents contributed uniquely through sexual-risk communication and/or autonomy support to late adolescents' autonomous motivation. The final model evidenced acceptable fit and explained 12% of the variation in adolescent sexual-risk behavior, 7% in adolescent autonomous motivation, and 2% in adolescent sexual-risk knowledge. CONCLUSIONS: Psychiatric mental health nurses should conduct further research and design interventions promoting parent autonomy support and adolescent autonomous motivation to reduce sexual risk-behavior and increase sexual-risk knowledge.

Frontline Nurse Engagement and Empowerment: Characteristics and Processes for Building Leadership Capacity.

Improving health care quality is the responsibility of nurses at all levels of the organization. This article describes a study that examined frontline staff nurses' professional practice characteristics to advance leadership through the understanding of relationships among practice environment, quality improvement, and outcomes. The study design was a descriptive quantitative design at 2 time points. Findings support the use of research and quality processes to build leadership capacity required for positive resolution of interdisciplinary operational failures.

Bridge to shared governance: developing leadership of frontline nurses.

Transforming health care systems to improve quality is the responsibility of nurse executives and frontline nurses alike, yet frontline nurses are often ill-prepared to share leadership and accountability needed for transformation. The aim of this qualitative study was to describe the process used to build leadership capacity of frontline nurses engaged in resolving operational failures interrupting nursing care. The leadership development process served to bridge staff transition to shared governance. This institutional review board-approved qualitative research was designed to identify the effects of mentoring by the chief nursing officer and faculty partners on leadership development of frontline nurses working to find solutions to operational failures. Twelve nurses from 4 medical surgical units participated in a Frontline Innovations' nurse-led interdisciplinary group, which met over 18 months. Transcriptions of audiotaped meetings were analyzed for emerging process and outcome themes. The transcripts revealed a robust leadership development journey of frontline nurses engaged in process improvement. Themes that emerged from the mentoring process included engagement, collaboration, empowerment, confidence, and lifelong learning. The mentoring process provided frontline nurses the leadership foundation necessary to initiate shared governance.

Traditional/restrictive vs patient-centered intensive care unit visitation: perceptions of patients' family members, physicians, and nurses.

BACKGROUND: Patient-centered intensive care units (ICUs) are advocated by professional organizations for critical care nursing and medicine. The patient-centered ICU paradigm recognizes the patient-family unit as inseparable and supports visitation designed to meet the needs of patients and patients' families. OBJECTIVES: To understand perceptions about patient-centered ICUs among patients' family members, physicians, and nurses from 5 ICUs that had restrictive visitation and to guide development of a patient-centered, open visitation paradigm. METHODS: Patients' family members, nurses, and physicians from 5 ICUs with a traditional/restrictive visitation policy at a southeastern academic, tertiary care hospital were invited to participate in focus group meetings to understand perceptions about patient-centered care. All qualitative work was taped, transcribed, reviewed, and corrected after each session. Corrected transcripts and observer notes were integrated and coded. RESULTS: Patients' families identified facilitators of patient-centeredness as nurses' and physicians' communication, concern, compassion, closeness, and flexibility. However, competing roles of control over the patient's health care served as barriers to a patient-centered paradigm. CONCLUSIONS: Patient-centered care is an expectation among patients, patients' families, and health quality advocates. These exploratory methods increased understanding of the powerful perceptions of family members, physicians, and nurses involved with patient care and provided direction to plan interventions to implement patient-centered, family-supportive ICU services.

Parents' experiences supporting self-management of middle adolescents with type 1 diabetes mellitus.

The purpose of this article is to describe the experiences of parents regarding the fostering of self-management of diabetes mellitus with their middle adolescents with type 1 diabetes mellitus (T1DM). A purposive sample of parents of 16- to 18-year-old adolescents with T1DM from 23 families who attended the endocrinology clinic of a children's hospital were interviewed about their experience with their adolescent's diabetes management and how they supported or inhibited their adolescent's diabetes self-management. Qualitative description was used to analyze the transcripts of audio-recorded interviews. Parents often described having negative experiences involving struggle, frustration, and worry about adolescent self-management. Parents supported their adolescent's self-management primarily by reminding, recognizing positive aspects of the adolescent's diabetes management, and granting more freedom. Conversely, parents inhibited their adolescents' diabetes management by scolding and judging, checking and nagging, and becoming emotional. Clinicians can help parents share their experiences, cope with their emotions, and practice effective strategies to motivate adolescent diabetes self-management in the transition to later adolescence.

GLB adolescent's "coming out".

TOPIC: A greater number of gay males, lesbians, and bisexual females or males (GLB) are "coming out" during adolescence. Discussion includes nursing implications. PURPOSE: The purpose of this paper is to review the process of GLB disclosure, highlight the trend toward earlier outing, and discuss its implications for nursing practice. SOURCES: Sources include scholarly published literature, professional organization documents, and GLB advocacy publications. CONCLUSIONS: Nurses need to update their knowledge of coming-out issues, as well as nondisclosing sexual behavior, to assess youth and family needs and direct care appropriately.