Implementing Strategies to Recruit and Retain a Diverse Sample of Heart Failure Patients.

Introduction: The increased prevalence, severity, and mortality of heart disease and specifically heart failure among Hispanic and Black populations are a concern for clinicians and researchers. Additionally, patients of poor socioeconomic status also have worse outcomes for cardiovascular disease. To address disparities, it is necessary to address the persistent lack of representation in clinical research of diverse populations, including the Hispanic and Black populations and individuals who are of low socioeconomic status. Method: This study was a pilot randomized trial of a medication adherence intervention for heart failure patients conducted at a safety net hospital and affiliated pharmacy with a diverse patient population. Using an evidence-based multifactorial approach, this investigation implemented and adapted best practices to support the inclusion of Hispanic, Black, and socioeconomically diverse participants. Results: A total of 40 participants were recruited, 58% were Hispanic, 38% Black, and 5% White. A total of 40% reported the need for socioeconomic assistance. At 30 days after discharge, follow-up data were obtained for 37 of 40 (93%) of participants either by interview, electronic record, or both. Conclusion: Findings suggest that a combination of strategies used in this trial can be applied to recruit and retain ethnically and socioeconomically diverse participants.

Clinical nurse competence and its effect on patient safety culture: a systematic review.

BACKGROUND: Unsafe health practices are one of the leading causes of disability and even death. Competent nurses are crucial to ensure safe and high-quality healthcare services. The patient safety culture is concerned with internalizing safety beliefs, values, and attitudes, translating them into healthcare practices, and committing to maintaining an error-free health environment. A high level of competence ensures the achievement and compliance with the safety culture goal. This systematic review aims to identify the relationship between the level of nursing competence and the safety culture score and perception among nurses at their workplace. METHODS: Four international online databases were searched to find relevant studies published between 2018 and 2022. Peer-reviewed articles using quantitative methods, targeting nursing staff, and written in English were included. After reviewing 117 identified studies, 16 full-text studies were included. The PRISMA 2020 checklist for systematic reviews was used. RESULTS: Evaluation of the studies indicates safety culture, competency, and perception were assessed using various instruments. Safety culture was generally perceived as positive. No unique and standard tool has been developed to investigate the effect of safety competency on the perception of the safety culture in a standardized way. CONCLUSIONS: Existing research provides evidence of a positive correlation between nursing competence and patient safety score. Future research is recommended to investigate ways to measure the effect of nursing competency level on safety culture in healthcare institutions.

The relationship between job stress and patient safety culture among nurses: a systematic review.

BACKGROUND: Work stress is one of the leading causes of physical and mental problems among nurses and can affect patient safety. Nurses experiencing stress are more prone to make errors, which has consequences for the safety culture. This study aimed to describe the findings of studies that examined the relationship between job stress and patient safety culture among nurses. METHODS: A systematic review of published English-language articles from 2017 to 2021 was obtained through an electronic search of three large online databases (i.e., CINAHL through EBSCOhost, Medline through PubMed, and Embase). We used the Statement of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to guide the undertaking of this review. In addition, data extraction and quality assessment were performed for the final seven quantitative articles. RESULTS: This review showed a significant relationship between job-related stress in its different factors, patient safety culture, and patient safety. Three studies of the seven reviewed articles examined the relationship. The rest of the studies examined the relationship indirectly, discussing factors that impacted job stress and how they affected patient safety culture. However, differences in working conditions and study characteristics affected the results of these studies and the significance of this relationship. CONCLUSIONS: This review suggests that nursing managers and administrators should consider actions to minimize nursing job stress to the minimum levels and improve their work environment to provide the best possible patient care. Future studies are needed to develop interventions to reduce workplace stress and improve nurses' safety. Furthermore, nurses' managers and educators should train nurses on resilience and how to work in trauma-informed care.

Creating Effective Post-Pandemic Psychiatric Nursing Clinical Experiences Using the Roy Adaptation Model.

Introduction: The COVID-19 pandemic significantly impacted students in psychiatric clinical rotations. Clinicals were frequently limited or canceled, restricting exposure of student nurses to this experience. Many modifications led to permanent changes in the psychiatric clinical setting. Objectives: The purpose of this manuscript is to provide a cohesive approach to serving student nurses in the post-pandemic psychiatric clinical setting. Methods: A theoretical exploration of the literature framed by the Roy Adaptation Model (RAM) was conducted. Discussion: Results are presented using the four modes of the theory: Physiological, Self-Concept, Role Function, and Interdependence. Conclusions: Findings include strategies to enhance student learning while supporting students' health and wellness. Educators and practitioners should provide high-quality, safe learning environments for student nurses.

Implementing the National Incident Management System at schools of nursing in response to COVID-19.

Unprecedented financial and logistical barriers in educating nurses during COVID-19 have threatened nursing education. The purpose of this article is to provide a template to facilitate the maintenance and stability of teaching and learning in a pandemic environment for nursing school administration and faculty leaders. The National Incident Management System (NIMS), previously used in training nurses for emergency preparation and response, has been applied as a guiding framework. The framework consists of five elements: Preparedness, Communication/Information Management, Resource Management, Command and Ongoing Management/Maintenance. This paper addresses how schools of nursing may apply each of these elements to address both the needs of the institution and community. The Comprehensive Vulnerability Management paradigm is further offered as a lens for professional development. Free preparedness education is showcased from leading nursing and healthcare professional and government organizations. Finally, the Quality and Safety Education for Nurses competencies are used for integrating NIMS and social dimensions of disaster. Such tools may equip academic leaders at schools of nursing to surmount challenges posed by the pandemic, and to ensure educational readiness to respond to global health crisis through use of the NIMS framework.

Rapid Ultrasound for Shock and Hypotension: A Clinical Update for the Advanced Practice Provider: Part 1.

The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.

Rapid Ultrasound for Shock and Hypotension: A Clinical Update for the Advanced Practice Provider: Part 2.

The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.

Preventing COVID-19 Infection in Mental Health Units: Recommendations for Best Practices.

Mental health facilities should be equipped to care for patients while preventing spread of COVID-19. Peer-reviewed literature and guidelines for government and health organizations were reviewed to guide best practices. Gunderson's five therapeutic functions of a milieu are used as a conceptual framework. Patients should be screened for infection according to local or national policy prior to admission to an inpatient mental health unit. While interacting with one another in a therapeutic milieu, patients should be encouraged to practice physical distancing and hand hygiene. Clinicians may need to alter therapeutic groups to prevent COVID-19 infection. Additionally, clinicians should monitor patients for emerging symptoms and conduct rapid testing and isolation of patients suspected of COVID-19. Recommendations are made for patients unable to adhere to physical distancing or hand hygiene policies.

Academic caring pedagogy, presence, and Communitas in nursing education during the COVID-19 pandemic.

BACKGROUND: Strong faculty academic human caring presence is paramount during the exponential use of asynchronous, remote learning during the COVID-19 pandemic. PURPOSE: The purpose of this article is to provide a holistic, theoretical foundation for evidence informed-caring pedagogical practices. METHODS: Watson's (2008; 2018) Unitary Caring Science theoretical approach offers one pedagogical caring framework for advancing teaching-learning in the digital age. DISCUSSION: Examples to humanize the virtual classroom and remote or online teaching include narrative, theory-guided pedagogical approaches, such as creation of caring spaces and other modalities to transcend physical distancing and nurture Communitas (caring community) among of faculty and students. CONCLUSION: A theory-guided, holistic caring pedagogical approach supports the needs of both faculty and nursing students.

Supporting Graduate Nursing Education for Students From Disadvantaged Backgrounds.

BACKGROUND: There is a lack of diversity in the master's prepared nursing workforce. One nursing school implemented a scholarship program for students from disadvantaged backgrounds enrolled in the Family Nurse Practitioner and Adult Gerontology Primary Nurse Practitioner tracks. METHOD: Awardees were required to be full-time students from disadvantaged backgrounds with financial need. Each student was matched with a faculty member for regular mentorship. Student progress was evaluated every three months, with follow-up 1 year after graduation. RESULTS: A total of 45 students received the Scholarship for Disadvantaged Students (SDS) over 2 consecutive years. Of the 45 students, 26 (58%) identified themselves as Hispanic and 11 (24%) as black. A total of 42 (93%) of 45 SDS students completed the original plan of study and passed the national certification board. CONCLUSION: The SDS serves as a model of an effective mentorship program to assist nurse practitioner students from disadvantaged backgrounds. [J Nurs Educ. 2020;59(5):287-290.].

Charcot's foot: a clinical update for emergency nurses.

Charcot neuropathy osteoarthropathy, known as Charcot's foot, is a condition of the foot most frequently related to diabetes mellitus. It is associated with a high mortality rate, especially among patients with diabetes, therefore prompt identification and management of the condition by nurses in emergency departments is important. This article describes the pathophysiology, signs and symptoms and diagnosis of Charcot's foot, and offers guidance for initial care in emergency settings. Emergency nurses in the UK have an important role in recognising patients with this condition to ensure they receive optimal treatment and follow-up.

The Use of Ultrasonography in the Emergency Department to Screen Patients After Blunt and Penetrating Trauma: A Clinical Update for the Advanced Practice Provider.

Use of bedside ultrasonography to identify life-threatening injuries for patients with blunt and penetrating trauma is the standard of care in the emergency department. The "FAST" examination-focused assessment with sonography for trauma-ultrasound scan of the chest and abdomen allows clinicians to assess critical regions for free fluid without use of invasive procedures as quickly and as often as needed. In addition, ultrasonography has a high degree of sensitivity and specificity and is safe during pregnancy. For patients requiring evaluation of the pleura, the "eFAST" (or extended FAST) may be conducted, which may serve to locate pleural effusions, hemothorax, and pneumothorax. However, ultrasound quality is operator dependent and is recommended with other diagnostic measures to provide a complete clinical picture of trauma patients. Ongoing development of ultrasound competency among established clinicians and nurse practitioner students is vital to maintain diagnostic accuracy and ensure quality care for trauma patients in the emergency department.

Organ Donation After Circulatory Death and Before Death: Ethical Questions and Nursing Implications.

Scientific advances have enabled thousands of individuals to extend their lives through organ donation. Yet, shortfalls of available organs persist, and individuals in the United States die daily before they receive what might have been lifesaving organs. For years, the legal foundation of organ donation in the United States has been known as the Dead Donor Rule, requiring death to be defined for organ donation purposes by either a cardiac standard (termination of the heartbeat) or a neurological one (cessation of all brain function). In this context, one solution used by an increasing number of health care facilities since 2006 is donation after circulatory death, generally defined as when care is withdrawn from individuals who have known residual brain function. Despite its increased use, donation after circulatory death remains ethically controversial. In addition, some ethicists have advocated forgoing the Dead Donor Rule altogether and allowing donation before or near death in certain circumstances. However, nurses and other health professionals must carefully consider the practical and ethical implications of broadening the Dead Donor Rule-as may be already occurring-or removing it entirely. Such changes could harm both the integrity of the health care system as well as efforts to secure organ donation commitments from the public and are outweighed by the moral and pragmatic cost. Nurses should be prepared to confront the challenge posed by the ongoing scarcity of organs and advocate for ethical alternatives including research on effective care pathways and education regarding organ donation.

Transforming Health Care Through Meaningful Doctor of Nursing Practice Community Partnerships.

BACKGROUND: A critical component of doctor of nursing practice (DNP) education is practice immersion. DNP programs require 1000 hours of clinical practice experience to obtain the DNP degree. PROBLEM: Faculty struggle with providing meaningful clinical experiences congruent with the role of the DNP. APPROACH: This article describes a unique practice immersion course joining DNP students with community health care partners to provide meaningful experiences with the potential to transform health care. DNP students are assigned system-level projects designed to create organizational change. OUTCOMES: Over the course of 4 years, the practice immersion opportunities more than doubled from 30 to 66 live projects. Integrating collaborative practice immersion into the curriculum builds students' leadership skills and strengthens long-standing bonds among academia, practice, and the community. CONCLUSIONS: The creation of structured, meaningful collaborations between DNP students and community partners is an approach that has the potential to facilitate transformative, sustainable change in health care.

Evaluating a Culturally Tailored HIV Risk Reduction Intervention Among Hispanic Women Delivered in a Real-World Setting by Community Agency Personnel.

PURPOSE: To evaluate the effectiveness of Salud, Educación, Prevención, y Autocuidad/Health, Education, Prevention and Self-care (SEPA) to increase human immunodeficiency virus (HIV)/sexually transmitted infections (STI) prevention behaviors for Hispanic women delivered in a real-world setting. DESIGN: Randomized controlled trial. SETTING: Participants were recruited from the Miami Refugee Center, the Florida Department of Health, and public locations in Miami. PARTICIPANTS: Three hundred twenty Hispanic women. INTERVENTION: The SEPA is a culturally tailored intervention developed to address HIV/STI risk behaviors among Hispanic women. The SEPA intervention consisted of three 2.5 hour sessions per week conducted with small groups. The SEPA sessions consisted of group discussions, role playing, negotiation skills, partner communication, and skills building as part of the methodology. MEASURES: Acculturation, HIV/STI risk behaviors, HIV knowledge, partner communication, intimate partner violence, drug/alcohol use, condom use. ANALYSIS: Differences at baseline by group were assessed using Wilcoxon rank sum test, χ2, and a negative-binomial model. Changes in dependent variables, compared to baseline, were analyzed in separate models. Log-binomial models and negative binomial models were used for dichotomous and count/rate-type dependent variables. RESULTS: Significant outcome improvements were observed in the SEPA group at 6 and 12 months follow-up. The adjusted prevalence of any condom use was 30% and 37% higher at each follow-up. The adjusted prevalence of answering 10/12 HIV knowledge questions correctly rose by 57% and 63% at each follow-up. Intimate partner violence was significantly lower at each subsequent time point (62% and 41% of baseline). Moderate depressive symptoms were reduced to 50% and 42%, getting drunk was reduced to 20% and 30%, and condom use self-efficacy was significantly higher (84% and 96%). CONCLUSION: The SEPA intervention reduced HIV/STI risk-related behaviors when delivered in a real-world setting. The results suggest that SEPA can be implemented in various settings to reach Hispanic women, and that SEPA could reach large numbers of women in an efficient, cost-effective way.

Nursing Judgment: A Concept Analysis.

Charged with making decisions to protect and enhance patient well-being, a nurse relies on nursing judgment to render effective patient care. Nursing judgment is the culmination of education, experience, and insight that allows nurses to execute the best action possible on behalf of patients. This concept analysis uses the Walker and Avant method to demonstrate the role of nursing judgment in assessments and interventions, delegation of tasks, and prioritization of care. Nurses, other health care collaborators, and recipients of health care should be aware of the role played by nursing judgment to improve patient care and the health care system.

A Mental Health-Physical Health-Violence (MPV) Syndemic Factor in Women with Mental Disorders.

This study extended research on syndemics for women with mental disorders by including self-reported mental and physical health conditions. Syndemics explain complex relationships among co-occurring conditions, and the social circumstances that influence their overlap. Data were from the baseline assessment of a randomized trial of Healthy Home, a nursing home-visit intervention for women with children. 172 adult women who were in mental health or substance use treatment completed measures (in Spanish or English) of anxiety, depression, violence during adulthood, physical health, and cigarette use. Structural Equation Modeling was used to evaluate a single-factor syndemic, and to test the relationships of theoretical predictors of the syndemic: income, number of children, women's abuse during childhood, mental health stigma, social support, and stress. Results supported a single factor syndemic model that explained variation in mental health, physical health, and violence during adulthood. Stress, ß = .45, p < .001, and stigma, ß = .22, p = .007, were related to the syndemic factor. There was evidence that self-reported mental and physical health share covariation, which suggested that integrated services for women with mental disorders may have synergistic effects on health. Findings suggest the need to develop and test interventions that address stress and stigma as a means of reducing health disparities for women with mental disorders.

Developing Minority Nursing Students: Evaluation of an Innovative Mentorship and Leadership Program.

BACKGROUND: There is disparity in the nursing work-force of minority leaders. The aim of this article is to describe and evaluate an innovative program designed to provide mentorship and increase leadership skills of minority nursing students. METHOD: An innovative mentorship program was developed including coordination of financial aid meetings, incorporating technology, enacting an online preimmersion course, choosing and training mentors, hosting a lunch-and-lead leadership series, and using intensive review sessions and tutoring. Program evaluation data were analyzed using mixed methods. RESULTS: All 40 participants passed the NCLEX-RN and had obtained employment after the program. Of the 20 respondents, 25% already had obtained a leadership role in nursing. Qualitative data about the program revealed categories of leadership, networking, mentorship, more time, and gratitude. CONCLUSION: This program was successful in promoting retention, graduation, and development of future minority nurse leaders. [J Nurs Educ. 2018;57(9):526-534.].

Implementation of a Smoking Cessation Education Program in the Emergency Department.

Tobacco use is a major threat to public health. Current guidelines suggest that healthcare professionals in the emergency department provide routine smoking cessation screening and interventions. Evidence suggests that an educational intervention among registered nurses in the emergency department may increase education and referral for smoking cessation of patients who use tobacco products. An educational module regarding smoking cessation counseling was provided to registered nurses in the emergency department at a private hospital in South Florida. A pre- and postintervention self-reported survey evaluated changes in nurses asking about tobacco use; advising to quit; assessing readiness, assisting, and arranging follow-up for patients who smoke to quit; and encouraging pharmacological agents. All participating nurses screened for tobacco use most of the time before and after the intervention. However, the number of nurses who assessed readiness, assisted, arranged follow-up for patients and encouraged the use of pharmacological agents increased significantly in the postsurvey. Study findings agree with previous research indicating that nurses routinely screen for tobacco and advise to quit. However, implementing smoking cessation education and referral resources may better equip registered nurses in the emergency department to take an active role initiating follow-up interventions for patients who screen positive for tobacco use. Educational interventions among these nurses can increase knowledge of and utilization of existing resources to help patients quit.