Oncology Clinical Nurse Specialists Practice in the Outpatient Setting.

PURPOSE/OBJECTIVES: With rapidly evolving oncology care, the role of the outpatient clinical nurse specialist is most valuable and essential. The purpose of this article is to describe the role of the clinical nurse specialist in the ambulatory oncology settings and highlight the clinical nurse specialists' unique influence across the spheres of impact. DESCRIPTION OF THE PROJECT/PROGRAM: This article shares several contributions of an outpatient clinical nurse specialist, which include ways this role impacts nursing practice, patient care, and standardizing organizational guidelines. A method of recording the clinical nurse specialists' encounters or indirect consults was also utilized to provide a process to log consultation received in the day-to-day practice. Work exemplars were included to further demonstrate the impact of this role in this setting. CONCLUSION: Outpatient clinical nurse specialist need is rising especially in the oncology setting where the majority of cancer care and treatment is delivered. It is important to continue to disseminate and highlight the value it brings to the organization.

Successful Clinical Nurse Specialist Recruitment: Creating a Talent Pipeline.

BACKGROUND: The future of the clinical nurse specialist (CNS) role depends on nurses enrolling in CNS programs and having access to clinical experiences. At 1 institution, challenges with CNS recruitment and variations in how students were precepted were noted. This article describes a successful CNS student program and its value in creating a talent pipeline. PROJECT: A revision to student placements was initiated to create a formalized program including enhanced academic partnerships, standardized expectations and goals, assigned clinical projects and end-of-semester presentations, appointment of a student coordinator, and structured preceptor preparation. OUTCOMES: Outcomes included 100 placements for 50 different students; the primary source of recruitment for the organization is now prior students, with 17 being hired since program inception. A 325% increase was also noted in qualified preceptors. Student productivity increased, and 11 students were accepted for national presentations. Academic sites have reported increased satisfaction. CONCLUSION: Organizations looking to increase CNS recruitment should consider the revision of their student program. A centralized CNS responsible for student experiences can ensure standardization and provide preceptor support. The CNSs have an essential role in securing their future nationally and can do so through growing new talent and aiding in preparation for practice.

Making the Transition: A Critical Care Skills Program to Support Newly Hired Nurses.

PURPOSE: This article describes the impact of a hands-on critical care skills day led by clinical nurse specialist (CNS) to enhance junior nurses' clinical skills. Program objectives included providing specialized skills training to meet the needs of high-acuity patient population and reviewing nurse-sensitive indicator-associated care bundles with the goal of increasing compliance. DESCRIPTION OF THE PROJECT: An 8-hour program of lecture and hands-on skills was developed. Curriculum included nursing-sensitive indicators, sepsis management, complex tubes and drains, airway management, and emergency response. Clinical nurse specialists mentored senior nurses to colead program planning and execution. The program has been offered 9 times. Qualitative and quantitative data were collected on attendees. OUTCOME: Quantitative data analysis showed that 89% of the assessed components were affected by the program. Medium effect was noted in defibrillator skills, retrieving items from code care, care of suicidal patient, and sepsis screening. Qualitative data based on attendee survey are also presented and analyzed. Decreases in indwelling catheter utilization on select units are discussed. CONCLUSION: The CNS has the responsibility to ensure nursing practice is reflective of hospital policy and current evidence. This program demonstrates the impact of CNSs in staff education, mentorship, and competency assessment.

Solving alarm fatigue with smartphone technology.

Alarms were developed to improve patient safety, but alarm fatigue may put patients at higher risk for harm. This article recounts one acute care institution's search for a better alarm management solution using smartphone technology to replace its beeper-based system for telemetry alarm events.

When Listening Is Better Than Reading: Performance Gains on Cardiac Auscultation Test Questions.

PURPOSE: In 2007, the United States Medical Licensing Examination embedded multimedia simulations of heart sounds into multiple-choice questions. This study investigated changes in item difficulty as determined by examinee performance over time. The data reflect outcomes obtained following initial use of multimedia items from 2007 through 2012, after which an interface change occurred. METHOD: A total of 233,157 examinees responded to 1,306 cardiology test items over the six-year period; 138 items included multimedia simulations of heart sounds, while 1,168 text-based items without multimedia served as controls. The authors compared changes in difficulty of multimedia items over time with changes in difficulty of text-based cardiology items over time. Further, they compared changes in item difficulty for both groups of items between graduates of Liaison Committee on Medical Education (LCME)-accredited and non-LCME-accredited (i.e., international) medical schools. RESULTS: Examinee performance on cardiology test items with multimedia heart sounds improved by 12.4% over the six-year period, while performance on text-based cardiology items improved by approximately 1.4%. These results were similar for graduates of LCME-accredited and non-LCME-accredited medical schools. CONCLUSIONS: Examinees' ability to interpret auscultation findings in test items that include multimedia presentations increased from 2007 to 2012.

Child Poverty: Definition and Measurement.

This article provides a discussion of what we mean when we refer to 'child poverty.' Many images come to mind when we discuss child poverty, but when we try to measure and quantify the extent of child poverty, we often use a very narrow concept. In this article a variety of poverty measures that are used in the United States are described and some of the differences between those measures are illustrated. In this article 3 measures are explored in detail: a relative measure of poverty that is used more often in an international context, the official US poverty measure, and a new supplemental poverty measure (SPM). The new measure differs from the other 2 because it takes into account noncash benefits that are provided to poor families. These include nutrition assistance such as food stamps, subsidized housing, and home energy assistance. The SPM also takes account of necessary expenses that families face, such as taxes and expenses related to work and health care. Comparing estimates for 2012, the SPM showed lower poverty rates for children than the other 2 measures. Because noncash benefits help those in extreme poverty, there were also lower percentages of children in extreme poverty with resources below half the SPM threshold. These results suggest that 2 important measures of poverty, the relative measure used in international comparisons, and the official poverty measure, are not able to gauge the effect of government programs on the alleviation of poverty, and the SPM illustrates that noncash benefits do help families meet their basic needs.

Controlling molecular transport in minimal emulsions.

Emulsions are metastable dispersions in which molecular transport is a major mechanism driving the system towards its state of minimal energy. Determining the underlying mechanisms of molecular transport between droplets is challenging due to the complexity of a typical emulsion system. Here we introduce the concept of 'minimal emulsions', which are controlled emulsions produced using microfluidic tools, simplifying an emulsion down to its minimal set of relevant parameters. We use these minimal emulsions to unravel the fundamentals of transport of small organic molecules in water-in-fluorinated-oil emulsions, a system of great interest for biotechnological applications. Our results are of practical relevance to guarantee a sustainable compartmentalization of compounds in droplet microreactors and to design new strategies for the dynamic control of droplet compositions.

Frequency of contamination of single-patient-use nebulizers over time.

Adult hospitalized patients with cystic fibrosis commonly receive nebulized medications. For single-patient-use nebulizers that are cleaned after each use, there is infrequent nebulizer contamination (0%-11%) with only low numbers of epidemiologically important pathogens (less than 100 colony-forming units), and this contamination is similar after 24, 48, and 72 hours of use.

Bronchoscopy-derived correlates of lung injury following inhalational injuries: a prospective observational study.

BACKGROUND: Acute lung injury (ALI) is a major factor determining morbidity following burns and inhalational injury. In experimental models, factors potentially contributing to ALI risk include inhalation of toxins directly causing cell damage; inflammation; and infection. However, few studies have been done in humans. METHODS: We carried out a prospective observational study of patients admitted to the NC Jaycees Burn Center who were intubated and on mechanical ventilation for burns and suspected inhalational injury. Subjects were enrolled over an 8-month period and followed till discharge or death. Serial bronchial washings from clinically-indicated bronchoscopies were collected and analyzed for markers of cell injury and inflammation. These markers were compared with clinical markers of ALI. RESULTS: Forty-three consecutive patients were studied, with a spectrum of burn and inhalation injury severity. Visible soot at initial bronchoscopy and gram negative bacteria in the lower respiratory tract were associated with ALI in univariate analyses. Subsequent multivariate analysis also controlled for % body surface area burns, infection, and inhalation severity. Elevated IL-10 and reduced IL-12p70 in bronchial washings were statistically significantly associated with ALI. CONCLUSIONS: Independently of several factors including initial inhalational injury severity, infection, and extent of surface burns, high early levels of IL-10 and low levels of IL-12p70 in the central airways are associated with ALI in patients intubated after acute burn/inhalation injury. Lower airway secretions can be collected serially in critically ill burn/inhalation injury patients and may yield important clues to specific pathophysiologic pathways.