Disaster Preparedness in Home Care: Moving Beyond Checklists.

Disasters have become increasingly common, with hurricanes off the southern, eastern, and western coasts, fires in the northwest, earthquakes, mass shootings, and continuing cases of COVID-19 looming over healthcare systems. Home care agencies have a history of meeting patients' needs during disasters and are strategically positioned to support communities during public emergencies and disasters. However, the "who" and the "how" of engaging the disaster cycle of mitigation, preparedness, response, and recovery is not always understood by clinicians and leadership. A gap in the literature cries out for better preparedness strategies for home care leadership and staff that go beyond the broad guidance of regulatory and accreditation organizations. This article aims to examine current literature and offer direction to home care leaders and staff as they seek to understand the "who" and the "how" in preparing for disasters in an increasingly unstable world.

RN-to-BS Nursing Education Research: A Scoping Review.

AIM: The purpose of this scoping review was to examine the extent, range, and nature of RN-to-BS nursing education research. BACKGROUND: The state of nursing education science specific to RN-to-BS education is not available. METHOD: Scoping review methodology was used to identify categories and types of published research related to RN-to-BS nursing education. RESULTS: Eight categories were identified across the 41 articles that met the inclusion criteria: teaching strategies (n = 11), curriculum (n = 9), enrollment/retention (n = 8), benefits of a bachelor's degree (n = 4), student characteristics (n = 3), professional values (n = 2), role transition (n = 2), and faculty/student expectations (n = 2). CONCLUSION: Opportunities exist for researchers to study RN-BS students and faculty to better support evidence-based teaching practices and faculty development needs relevant for the increasingly hybrid and online student populations.

Purpose, Planning, and Individualization of Master of Science in Nursing Capstone Experiences: An Integrative Review.

BACKGROUND: Graduate-level education programs use capstone experiences for students to demonstrate achieving essential learning and programmatic outcomes. However, a lack of standardization of these experiences and outcome measurements could result in varying competencies among students with the same degree. Employers seeking specific skills may find this problematic, and graduates may feel unprepared for new roles, which could hinder transition. METHOD: A systematic search of nine databases was conducted to identify: (1) the essential characteristics of master in nursing capstones and (2) the assessments programs use to demonstrate achievement of program outcomes. RESULTS: Synthesis and analysis of six sources of evidence revealed uniform agreement in purpose, planning, and individualization of experiences, yet ways of assessing student achievement of program outcomes were less clear and varied widely. CONCLUSION: Capstone experiences should be relevant to graduate-level education and include mapping to program outcomes to ensure students' competency and readiness to transition into their new role. [J Nurs Educ. 2023;62(9):502-508.].

Safety Considerations for Home Care Providers.

Home care is one of the fastest growing industries in the United States, projected to continue increasing as the population ages. However, there are unique safety concerns associated with home care compared to the more controlled hospital or clinic settings, such as driving distractions, potentially dangerous neighborhoods, and in-home risks categorized as environmental, biological, chemical, and emotional. Each home is essentially a new worksite with its own set of safety hazards, increasing the need for home care providers to be aware of safety risks in these ever-changing environments. Ensuring worker safety is essential to the recruitment and retention of home care workers. This article discusses safety risks unique to home care and offers solutions that increase the safety of home care providers. Education around workplace violence, implementation of evidence-based practices, and establishing and adhering to safety policies are paramount.

Walking into a COVID Petri Dish: Home Care Providers' Experiences during a Pandemic.

As we approach the third anniversary of the COVID-19 pandemic, the long-term effects on the health and well-being of those caring for patients in their homes, where less control of the environment can be maintained, remain a concern. The purposes of this study were to describe home care providers' experiences caring for patients during the pandemic, barriers and facilitators to the provision of care, and lessons learned for practice during future healthcare crises. A qualitative descriptive study using semistructured interviews was conducted with 13 home care providers. Four themes emerged from the data: Riding an emotional roller coaster, Putting a fire out with a garden hose, Walking into a COVID petri dish, and I'm just trying to do my job. Support for frontline staff should be initiated early in a healthcare crisis or pandemic. Communication needs to be clear, consistent, and made available at regular intervals. Home care leaders need to be visible and transparent to reduce emotional uncertainties that can negatively influence staff and patient outcomes. Education and planning around emergency preparedness are essential in future crises to mitigate the negative consequences on staff and patients.

Making Time and Being Present: Spiritual Care Revisited.

The COVID-19 pandemic has placed significant strain on home healthcare clinicians, shifting the focus of care to essential physical care needs. Spiritual care needs have always been present, but the pandemic has heightened recognition of the importance of spiritual care in home care. The goals of spiritual care include promoting physical healing, improving quality of life, and enhancing patient and family wellbeing. The use of a standardized spiritual assessment tool can increase provider awareness and patient expression of spiritual care needs. Spiritual care activities consist of obtaining a spiritual history, compassionate presence, mindful listening, interprofessional collaboration, and the provision of space for spiritual practices. This article provides a conceptual overview and strategies for application of spiritual care competencies.

Above and Beyond the Call of Duty: Rural Home Care and Hospice Nurses' Experiences Caring for Veterans.

Approximately 4.7 million Veterans live in rural areas and face challenges receiving support and care for complex service-connected healthcare needs. The purpose of this qualitative descriptive study was to explore nurses' experiences caring for Veterans in rural home care/hospice settings. Semistructured interviews (N = 14) were conducted between August 2020 and March 2021. Content and thematic analysis resulted in three central themes: Mission readiness: Ensuring safe home environments, Partnering with Veterans: Knowing when to lead and when to follow, and It's my duty: Caring with purpose and honor. Study findings highlight the need for cultural competence in both rural and Veteran cultures. Implications for practice reinforce currently emerging national priorities, including personal safety considerations and need for further professional development associated with screening for firearms and gun safety. Other implications for home care/hospice agencies, as well as nursing education, are discussed.

Veteran Competencies in Nursing Textbooks: Implications for Educators.

AIM: The aim of this study was to examine the adequacy of military/veteran-related content in nursing textbooks used in prelicensure programs. BACKGROUND: With increased numbers of veterans receiving care in civilian settings, nurses may lack essential knowledge, skills, and attitudes outlined in competencies required to provide culturally sensitive veteran-centered care. One explanation for this may be inadequate preparation during prelicensure nursing education. METHOD: A quantitative, descriptive study guided the analysis and rating of 32 key words in 24 textbooks across eight content areas. RESULTS: Key words were included in most textbooks but frequently not connected to military service or veterans. The key word with the highest mean rating was posttraumatic stress disorder; the highest rated content area was psychiatric/mental health. CONCLUSION: With limited textbook resources, nurse faculty must engage in deliberate efforts to include veteran content in nursing curricula. As competency-based education trends evolve, these findings are relevant and should be considered in curricular design and revision.

Analysis of Content Gaps in Prelicensure Nursing Textbooks to Meet Veteran Care Competencies.

BACKGROUND: Despite the Joining Forces initiative and recently published veteran care competencies, nursing students and graduates are often unprepared to care for veterans who have unique service-connected illnesses and injuries. PURPOSE: The purpose was to evaluate identified content gaps in prelicensure nursing textbooks with the veteran care competencies knowledge, skills, and attitude (KSA) domains. METHODS: A secondary qualitative analysis was conducted of veteran content in prelicensure nursing textbooks. RESULTS: The skills and attitude domains of veteran care competencies were poorly addressed in nursing textbooks. Overall, the knowledge domain was adequately covered; however, most had limited connection with veterans and veteran care. Competency-focused recommendations for expanding and enhancing veteran content, KSAs, and teaching strategies are offered. CONCLUSIONS: Prelicensure textbooks met the knowledge domain for each veteran competency. Overcoming content gaps needed to achieve requisite skills and attitudes requires interaction with veterans through clinical immersion experiences in various care settings.

Predictors of student veterans progression and graduation in Veteran to Bachelor of Science in Nursing (VBSN) Programs: A multisite study.

BACKGROUND: Capitalizing on the veteran's extensive service experience, values, and norms, Health Resources Services Administration (HRSA) proposed Nurse Education, Practice, Quality and Retention - Veterans' Bachelor of Science (VBSN) Program grants (2016-2019). PURPOSE: The purpose was to identify predictors of student veterans' (SV) progression and graduation rates in VBSN programs. METHODS: A descriptive correlational retrospective design was used. Two hundred and eighty-two (282) SV records were examined. RESULTS: One hundred and forty (140) SVs graduated (49.6%) and 107 (37.9%) were still enrolled. Only program delivery mode (hybrid) was significantly associated with completion and confirmed by logistic regression modeling. An increased representation of SVs' gender, race/ethnicity was present; however, gender, age, race, ethnicity, and veteran status did not significantly predict progression nor graduation. CONCLUSIONS: Hybrid program delivery became the single predictor influencing VBSN progression and graduation. As non-traditional students in higher education with a history of social isolation and help-seeking stigma, this delivery mode may have assisted SV retention and persistence. With a registered nurse shortage and workforce calls for increased gender, race, and ethnic diversity, the findings suggest nursing education programs designed for veterans are a viable solution.

US military spouses' experiences transitioning abroad: A narrative analysis.

Moving to a new country and culture has emotional, social, financial, health, and cultural consequences. Military spouses face a wide range of stressors when relocating or sojourning, placing them at risk for a variety of health challenges. The aim of this study was to describe the transition experiences of military spouses who sojourn abroad as part of a service member's assignment. Using qualitative narrative inquiry, semi-structured interviews of 13 US military spouses living in Italy were conducted. Narrative thematic and structural analysis was used to analyze the data. Six themes represent the transition experience: adding stress to an already stressful situation, managing a new set of worries and fears surrounded by the unknown, reestablishing an everyday life from chaos, battling social, personal, and physical isolation, reinventing myself to move beyond simply functioning to control, and pondering about life, returning, and repatriation. Internationally, the nursing profession has a responsibility to understand the transition experience of military spouses to overseas assignments so appropriate strategies aimed at strengthening resiliency, building cultural flexibility, and maintaining health and well-being can be provided, while minimizing negative consequences. Additionally, nurses and health care providers can play a role by continually developing culturally congruent and sensitive practice.

Learning transfer and transition of certified nursing assistants' to baccalaureate nursing programs.

BACKGROUND: Certified nursing assistants (CNAs) provide vital care to patients in a variety of care settings, yet little is known about their transition and transfer of learning to baccalaureate nursing education. Faculty play a key role in helping them successfully progress through their educational journey. PROCEDURE: Using a qualitative descriptive design, semi-structured interviews of eight CNAs enrolled in U.S. schools in the south-central region of Pennsylvania were conducted. Data were analyzed using content and thematic analysis. RESULTS: The influence of prior health care experience afforded participants confidence in their transition to BSN education, as well as accelerated learning. Three themes emerged from participant data related to transfer of learning: jumping in and demonstrating confidence from the beginning, learning from a foundation to transform my thinking from tasks to process, and merging new learning into practice. Results support that even if CNAs face varying challenges entering nursing education, most possess some clinical reasoning and critical thinking skills, as well as experience working with patients and within teams. CONCLUSIONS: All of which can influence the learning experience. Findings can help faculty identify CNAs' strengths, which may facilitate learning transfer, foster leadership potential, and engage them in peer teaching and mentoring; ultimately positively influencing the transition to practice.

Chronic venous insufficiency: A review for nurses.

Chronic venous insufficiency (CVI) is a potentially debilitating disorder associated with serious complications such as lower extremity venous ulcers. This article reviews the incidence and pathophysiology of CVI, nursing assessment, diagnosis and interventions, and patient education needed to manage the disease and prevent complications.

Urostomy Care: A Guide for Home Care Clinicians.

This article focuses on the care and management of patients living with a urostomy. Improved surgical techniques and shortened hospital stays result in more patients receiving home care in the immediate postoperative period after surgical creation of a urostomy. It is important that home care clinicians have the knowledge and skills to manage the care of patients with a urostomy from hospital discharge to self-care. This article reviews the anatomy and physiology of the urinary tract, the formation of a stoma, and indications for the creation of a urostomy. Stent management, peristomal skin care, stomal complications as well as pouching options and accessories are discussed. Knowledge of care of patients with a urostomy can reduce the risk of complications and hospital readmissions, and assist patients to adjust to life with a urostomy.

Committing to my mission: Faculty experiences with student veterans in baccalaureate nursing education.

Veterans transition to baccalaureate nursing education with significant experiences from their military service. Faculty play a role in facilitating this transition, in and out of the classroom. Approaches to enhance nursing education programs to better meet student veterans' needs have been proposed. However, less is known about the experiences of faculty teaching student veterans. A qualitative descriptive design was used to examine nursing faculty experiences teaching veterans, and in facilitating veterans' transfer of learning and knowledge from their military experience to baccalaureate nursing education. Semi-structured interviews with twelve faculty from the United States were conducted and data analyzed using content and thematic analysis. Three major themes included: committing to my mission, facilitating a shared understanding between military service and nursing, and appreciating a new duty. Results support faculty purposefully engaging in activities to increase their cultural sensitivity, while continuously developing humility and competence, to be successful teaching student veterans. Nursing faculty are positioned to leverage education as a means to improve the social status of veterans, ultimately improving their health and well-being, as well as academic success. It is recommended schools of nursing encourage and support faculty in attending professional development activities aimed at improving individual cultural sensitivity.

Understanding learning transfer of veterans in baccalaureate nursing programs: Their experience as student nurses.

With the continued growth of the numbers of veterans in nursing programs, faculty need to be aware of how to best facilitate their learning and build on their diverse experiences and expertise. Understanding how veterans transfer learning from the military context to an academic context is crucial for nursing education. The findings of this qualitative descriptive study support that veterans transfer learning from their military experience to their nursing education. Eleven veterans comprised the sample. The themes were: Embracing and living core professional values, Learning from a team-based framework to achieve a common goal, Learning how and when to communicate with faculty and healthcare members, and Incorporating learned behaviors into everyday professional practice. One recommendation for faculty included gaining basic knowledge of military culture and how that influences veterans once they transition to civilian life. The study findings can help faculty to build on previously acquired knowledge and enrich the learning experience for students and faculty. Ultimately, this may help to recruit and retain veterans in nursing programs; thus, impacting the global workforce.

Discovering a New Purpose: Veterans' Transition to Nursing Education.

With the downsizing of military forces and the support of GI Bill benefits, a growing number of veterans are returning to college. Using a qualitative descriptive approach, the researchers sought to understand the transition experiences of 11 veterans enrolled in baccalaureate nursing programs. Data suggest the transition process is challenging, marked by significant change in structure and culture from one context to the next. Veterans return to school to learn and seek meaning and purpose in the pursuit of a nursing degree. Faculty understanding of military culture is a first step in guiding the student veteran to success in nursing education.

Ileostomy Care: A Guide for Home Care Clinicians.

This article focuses on the care and management of patients living with an ileostomy. Due to shortened hospital stays, patient teaching related to self-care of ostomies has shifted from the hospital to the home setting. It is important for home care clinicians to be knowledgeable about all aspects of ostomy care. Patients with ileostomies are particularly prone to peristomal skin problems, as well as fluid and electrolyte and nutritional imbalances. This article reviews the anatomy and physiology of the gastrointestinal tract, indications for the creation of an ileostomy, and prevention and treatment of early and late complications. Practical advice on ileostomy care and patient teaching is provided.