An Innovative Use of the Logic Model for a Qualitative Analysis Framework.

BACKGROUND: Qualitative analysis can be a daunting and time-consuming task for those who are attempting to code qualitative data for the first time. METHOD: This article presents select secondary data analysis from a previously published study to demonstrate the applicability and usefulness of implementing a logic model approach to provide a framework for qualitative analysis. RESULTS: The use of the logic model provided systematic organization during the analysis process, efficiency for analytical tasks, and enhanced trustworthiness by documenting each analysis step. The model allowed for easier visualization of data that facilitated a richer and more focused analysis. CONCLUSION: With qualitative data that are focused on processes or outcomes, implementing a logic model framework to categorize and organize data can be useful and efficient, particularly for a novice analyst whether analyzing qualitative text for quality improvement, evidence-based practice, program evaluation, or formal research. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

Factors Influencing Medication Administration Outcomes Among New Graduate Nurses Using Bar Code-Assisted Medication Administration.

Paramount to patient safety is the ability for nurses to make clinical decisions free from human error. Yet, the dynamic clinical environment in which nurses work is characterized by uncertainty, urgency, and high consequence, necessitating that nurses make quick and critical decisions. The aim of this study was to examine the influence of human and environmental factors on the decision to administer among new graduate nurses in response to alert generation during bar code-assisted medication administration. The design for this study was a descriptive, longitudinal, observational cohort design using EHR audit log and administrative data. The study was set at a large, urban medical center in the United States and included 132 new graduate nurses who worked on adult, inpatient units. Research variables included human and environmental factors. Data analysis included descriptive and inferential analyses. This study found that participants continued with administration of a medication in 90.75% of alert encounters. When considering the response to an alert, residency cohort, alert category, and previous exposure variables were associated with the decision to proceed with administration. It is important to continue to study factors that influence nurses' decision-making, particularly during the process of medication administration, to improve patient safety and outcomes.

Leadership Behaviors of Frontline Nurse Managers: A Mixed-Methods Research Study Identifying Essential Areas for Social Support.

OBJECTIVE: This study examined how frontline nurse managers (FLNMs) perceive and experience formal and informal social support and how personal factors and social support relate to their transformational leadership (TL) behaviors. BACKGROUND: Ineffective leadership by FLNMs is associated with costly outcomes. Evidence suggests that leadership development is a function of personal and social factors; however, a better understanding of this process is needed. METHODS: A convergent mixed-methods design was used. The quantitative strand included a cross-sectional survey in a sample of FLNMs. The qualitative strand used a semistructured interview and a descriptive qualitative approach with a subset of this sample. RESULTS: Formal and informal social support is positively related to the TL behaviors of FLNMs as evidenced by the convergent data. The influence of family members in the work-related decisions of FLNMs has been underreported in the literature and is an area for consideration in supporting retention and desired leadership behaviors. CONCLUSION: The findings of this study imply a need for organizations to establish systems that endorse the growth of FLNMS, create opportunities for career advancement, and integrate members of the FLNMs' personal support systems into recognition initiatives.

Describing Medication Administration and Alert Patterns Experienced by New Graduate Nurses During the First Year of Practice.

The aim of this study was to describe medication administration and alert patterns among a cohort of new graduate nurses over the first year of practice. Medical errors related to clinical decision-making, including medication administration errors, may occur more frequently among new graduate nurses. To better understand nursing workflow and documentation workload in today's clinical environment, it is important to understand patterns of medication administration and alert generation during barcode-assisted medication administration. Study objectives were addressed through a descriptive, longitudinal, observational cohort design using secondary data analysis. Set in a large, urban medical center in the United States, the study sample included 132 new graduate nurses who worked on adult, inpatient units and administered medication using barcode-assisted medication administration. Data were collected through electronic health record and administration sources. New graduate nurses in the sample experienced a total of 587 879 alert and medication administration encounters, administering 772 unique medications to 17 388 unique patients. Nurses experienced an average medication workload of 28.09 medications per shift, 3.98% of which were associated with alerts, over their first year of practice. In addition to high volume of medication administration, new graduate nurses administer many different types of medications and are exposed to numerous alerts while using barcode-assisted medication administration.

Modifiable factors contributing to belongingness of undergraduate nursing students in the clinical learning environment: An exploratory study.

BACKGROUND: Belongingness has been tied to positive personal and educational outcomes in undergraduate nursing students in the clinical learning environment, but there is limited literature on specific factors that promote these important feelings of acceptance and value alignment. OBJECTIVES: This study aimed to assess demographic characteristics, program/clinical structure factors, and modifiable clinical setting factors that may impact feelings of belongingness in U.S. undergraduate nursing students in the clinical learning environment. DESIGN: A cross-sectional survey design was used to assess the relationship between demographics, program/clinical structure factors, and modifiable clinical setting factors and levels of belongingness using the U.S. version of the Belongingness Scale - Clinical Placement Experience. SETTING: A national study was conducted via the National Student Nurses Association database from December 2022 to January 2023. PARTICIPANTS: 759 volunteer undergraduate nursing students in the U.S. who had completed at least one clinical course. METHODS: An online survey was disseminated to assess demographic factors, program/clinical structure factors, students' perceptions on the frequency of occurrence and perceived value of modifiable clinical setting factors (including clinical format, clinical site, relationship and interpersonal, and miscellaneous factors), and to measure levels of belongingness experienced. RESULTS: Bivariate analyses revealed one statistically significant program/clinical structure factor (p <.001) and 10 statistically significant modifiable clinical setting factors (p <.001) that contribute to belongingness. The findings also support the use of the U.S. version of the BES-CPE as a reliable and valid instrument. CONCLUSIONS: Results demonstrate the importance of fostering belongingness in undergraduate nursing students in the clinical learning environment and, for the first time, extrapolate qualitative findings from the literature into the identification of factors that contribute to these critical feelings of inclusion. There are immediate implications for nursing educators and a rich foundation for future intervention research is proposed.

CE: Current and Emerging Applications of Fecal Microbiota Transplantation.

ABSTRACT: Fecal microbiota transplantation (FMT) is a life-changing treatment for people with recurrent Clostridioides difficile infection (rCDI). Frequently acquired in the hospital, CDI can cause serious gastrointestinal symptoms, including persistent watery diarrhea, abdominal pain, and severe dehydration. Antibiotics, the primary treatment, can unfortunately disrupt the gut microbiome and lead to antimicrobial resistance. FMT involves introducing stool from a healthy donor into the affected recipient to strengthen their compromised microbiome. Individuals receiving this treatment have reported remarkable improvement in clinical outcomes and quality of life. In addition to a discussion of rCDI within the context of the gastrointestinal microbiome, this article provides an overview of the FMT procedure, discusses nursing management of individuals undergoing FMT, and highlights emerging applications beyond rCDI. A case scenario is also provided to illustrate a typical trajectory for a patient undergoing FMT.

Longitudinal Assessment to Evaluate Continued Certification and Lifelong Learning in Healthcare Professionals: A Scoping Review.

The balance of lifelong learning with assessment for continued certification is a challenge faced by healthcare professions. The value of single-point-in-time assessments has been questioned, and a shift to longitudinal assessments (LA) has been undertaken to assess lifelong learning over-time. This scoping review was conducted to inform healthcare certifying organizations who are considering LA as an assessment tool of competence and lifelong learning in healthcare professionals. A search of 6 databases and grey literature yielded 957 articles. After screening and removal of duplicates, 14 articles were included. Most articles were background studies informing the underpinnings of LA in the form of progress testing, pilot studies, and process of implementation. Progress testing is used in educational settings. Pilot studies reported satisfaction with LA's ease of use, online format, and provision of lifelong learning. Implementation processes reveal that key aspects of success include stakeholder participation, phased rollout, and a publicly available content outline. Initial outcomes data affirm that LA addresses knowledge gaps, and results in improved performance on maintenance of certification exams. Future research is needed to substantiate validity evidence of LA and its correlation with high-stakes exam performance when assessing lifelong learning and continued competence of healthcare professionals over time.

Rating Dyspnea and Pain: "No" is Not Always "Zero".

Nurses routinely assess pain in hospitalized patients; similar assessment of dyspnea is increasing. Most nurses start with a yes-no question when assessing pain or dyspnea; many record "no" as a zero rating, skipping the rating scale. We tested the hypothesis that recording "no" answers as "zero" fails to detect the symptoms that would have been detected with a rating scale. Nurses asked 60 patients yes-no questions about the presence of dyspnea and pain, then asked patients to rate the symptoms using a 0-10 scale. All "yes" answers were followed by a concordant rating (i.e., greater than zero). More than 25% of "no" answers were followed by a discordant rating (> zero). Documenting "no" as "zero" missed information potentially useful in care planning; patients who rate dyspnea above zero are at greater risk of adverse outcomes. This information can also provide opportunity to start a discussion with patients who may benefit from symptom management.

Unleash your inner author: Getting published in a professional nursing journal.

ABSTRACT: This article guides nurses through the journal publication process, specifically how to choose a topic, send a query email, establish authorship, avoid predatory journals, and successfully advance on the publication path.

Belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment: A scoping review.

AIM: The aim of this scoping review was to map the literature investigating belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment. BACKGROUND: The concept of belongingness, which encompasses feelings of acceptance, connection and value alignment, has been tied to positive outcomes in undergraduate/pre-licensure nursing students including increased learning, participation, confidence and professional socialization. It is critical for educators and clinical staff to foster a sense of belongingness for nursing students to promote positive and effective clinical learning experiences. DESIGN: The scoping review strategy established by the Joanna Briggs Institute was followed. The databases searched were CINAHL Complete (EBSCO), Education Source, Medline Complete (EBSCO), APA PsycINFO (EBSCO) and Epistemonikos. METHODS: Following a search of the five databases, studies were screened by title and abstract by two independent reviewers for inclusion. Data including population, concept, context, methods and key findings relevant to the review question were extracted and synthesized using an instrument developed by the reviewers. RESULTS: A total of 47 articles with varying methodologies were critically appraised. Three overarching focus areas emerged: outcomes resulting from feelings of belongingness versus alienation, factors that contribute to a sense of belongingness in the clinical learning environment and interventions to promote a sense of belongingness while students are immersed in the clinical learning environment. CONCLUSIONS: Belongingness in the clinical learning environment is an important concept that lends itself to positive learning experiences and increased satisfaction of undergraduate/pre-licensure nursing students. Environmental, relational and experiential factors can be maximized and specific interventions employed to promote belongingness. This review identifies a lack of evidence on measured interventional effectiveness at the student, school and clinical unit level. Future research to address these gaps is recommended. TWEETABLE ABSTRACT: Scoping review suggests environmental, relational and experiential factors promote positive outcomes in belongingness of nursing students.

Development of Nurse-Sensitive, Emergency Department-Specific Quality Indicators Using a Modified Delphi Technique.

BACKGROUND: There is no identified set of nursing-sensitive, emergency department (ED)-specific quality indicators. PURPOSE: The purpose of this study was to address the gap in quality indicators specific to the emergency care environment and identify a list of nursing-sensitive, ED-specific quality indicators across ED populations and phases of the ED visit for further development and testing. METHODS: A modified Delphi technique was used to reach initial consensus. RESULTS: Four thematic groups were identified, and quality indicators within each were rank ordered. Of the 4 groups, 21 quality indicators were identified: triage (6) was ranked highest, followed by special populations (4), transitions of care (4), and medical/surgical (7). CONCLUSIONS: Many of the recommended metrics were questionable because they are nonspecific to the ED setting or subject to influences in the emergency care environment. Some identified priorities for quality indicator development were unsupported; we recommend that alternate methodologies be used to identify critical areas of quality measurement.