Enhancement of Preoperative Mental Health Assessment Through Clinical Nurse Specialist Project Leadership.

PURPOSE/OBJECTIVES: The aim of the project was to discern whether a collaborative, consultative-rich, clinical nurse specialist-led project could increase completion rates of a patient health questionnaire for depression and a generalized anxiety disorder questionnaire with appropriate referrals in adult patients in the ambulatory and hospital settings of a robust cardiovascular surgery practice before cardiovascular surgery. DESCRIPTION OF PROJECT: The Define, Measure, Analyze, Improve, Control implementation methodology guided this quality improvement project. The workflow was analyzed in collaboration with stakeholders, and barriers to and facilitators of questionnaire completion were identified. Interpreter services partnerships were enhanced and used for patients with a preferred language other than English. Weekly data analysis assessed ongoing questionnaire completion rates. OUTCOME: Documented completion rates of questionnaires improved across ambulatory and hospital settings by 15%. Patients with a preferred language other than English had an 80-percentage-point increase in documented questionnaire completion. CONCLUSION: Clinical nurse specialists are poised to lead projects because of their use of the collaborative and consultative core competencies. A formal electronic health record report was established for monitoring outcomes. Embedding questionnaire administration within the standard workflow of ambulatory and hospital staff makes administering questionnaires preoperatively a sustainable practice in both settings.

Oncology-Hematology Nurses' Perspectives on the Compassion Fatigue Resiliency Program: A Qualitative Study.

Background Oncology-hematology nurses are at increased risk for compassion fatigue. It remains unclear whether the Compassion Fatigue Resiliency program is effective, and qualitative evidence from participant feedback is limited. This was a follow-up study to a quantitative study of the Compassion Fatigue Resiliency program. The aims of this study were to evaluate how the content of the program affects nurses' compassion fatigue and coping abilities and to obtain their views. Method This qualitative study was performed with 24 oncology-hematology nurses at two hospitals. Three focus groups were conducted using a semi-structured questionnaire. The data were analyzed using conventional content analysis. Results Four themes emerged: awareness; coping; not for others, for me; and training design. Nurses stated they had only just learned what compassion fatigue and its impact were and had gained more awareness. Conclusion The content of the Compassion Fatigue Resiliency program helped nurses learn effective coping skills; however, the program's design is important to its effectiveness. [J Contin Educ Nurs. 2022;53(7):329-336.].

Experiences of oncology nurses regarding self-compassion and compassionate care: A qualitative study.

AIM: The aim of this study was to explore the experiences of oncology nurses about self-compassion and compassionate care. BACKGROUND: The concept of self-care is emphasized in detail in the literature, and not much is known about the concept of self-compassion among nurses. Beyond the definitions of self-compassion and compassion in the literature, there is a need to explore and express the meaning of self-compassion and compassion in the context of oncology nursing. METHODS: This is a descriptive qualitative study. Semistructured interviews were conducted with 19 oncology nurses working in the oncology service of a university hospital. Interviews were analyzed using thematic analysis through an inductive approach. Consolidated criteria for reporting qualitative studies (COREQ) were used to ensure the comprehensive reporting of this qualitative study protocol. RESULTS: Two themes emerged: (1) compassion through the eyes of oncology nurses and barriers to compassionate care fall under the theme of wounded healers, and (2) self-compassion through the eyes of oncology nurses, barriers to self-compassion, and self-care as a dimension of self-compassion fall under the theme of caring for our suffering: self-compassion. CONCLUSIONS: Although nurses think that self-compassion is important, they do not show self-compassion. There are personal and organizational barriers to compassionate care and self-compassion for oncology nurses. IMPLICATIONS FOR NURSING POLICY: These findings show that oncology nurses need personal and organizational resources for their self-compassion. The existence of programs to develop self-compassion can offset the effects of being in a caregiving position. Oncology nurses must request these services from organization, managers and even policymakers. The existence of policies that also consider the mental health of nurses can pave the way for compassionate care.

Fatiga por compasión y factores relacionados en enfermeras de cuidados intensivos: un estudio multicéntrico / Compassion fatigue and related factors in intensive care nurses: a multicentre study

Objetivo: Determinar los niveles de fatiga por compasión y sus factores relacionados en profesionales de enfermería de tres Unidades de Cuidado Intensivo de la ciudad de Bucaramanga. Material y métodos: Estudio correlacional de corte transversal realizado entre febrero del 2018 y febrero del 2020. Se utilizó un muestreo a conveniencia. Se aplicó el cuestionario de Calidad de vida para profesionales ProQOL (Professional Quality of Life Scale). Resultados: En general se encontró según las pautas de la escala niveles inferiores al promedio de satisfacción por compasión 45.71% (n=32), niveles medios de Burnout: 56.34% (n=40) y niveles medios de trauma por compasión: 49.30% (n=35). No se encontraron diferencias significativas en relación a factores sociodemográficos. Conclusiones: Se encontraron bajos niveles de satisfacción por compasión lo que incrementa el riesgo de fatiga por compasión. No se hallaron diferencias significativas en relación a los años de experiencia laboral, la edad, el género, los años de experiencia o el estado civil (AU)

Objective: To determine the levels of compassion fatigue and its Related factors in nursing professionals from three Units Intensive Care. Material and methods: Cross-sectional correlational study carried out between February 2018 and February 2020. A sampling at convenience. The Quality of life questionnaire for professionals ProQOL (Professional Quality of Life Scale) was applied. Results: In general, it was found according to the scale guidelines lower than average levels of compassion satisfaction 45.71% (n = 32), mean levels of Burnout: 56.34% (n = 40) and mean levels of compassion trauma: 49.30% (n = 35). Significant differences were not found in relation to sociodemographic factors. Conclusions: Low levels of satisfaction were found for compassion, which increases the risk of compassion fatigue. No significant differences were found in relation to the years of work experience, age, gender, years of experience, or civil status (AU)

Caring for Patients with Aneurysmal Subarachnoid Hemorrhage: Nursing Perspectives from the United Kingdom.

The risk of rebleeding is greatest between 2 and 12 hours and is associated with increased risk of mortality and long-term dependent survival. Aneurysms should be secured within 48 hours of diagnosis. However, delays occur because of diagnosis and transfer of patients. Ninety-six hours is the current time it can take until treatment. The challenges for this service continue to be access to and sharing of diagnostic imaging, repatriation back to district general hospitals to continue treatment (eg, for rehabilitation), access to neurorehabilitation, and access to psychological and neurocognitive support.

Factors associated with registration for organ donation among clinical nurses.

PURPOSE: Healthcare professionals play an important role in the organ donation process. The aim of this study was to examine the organ donation registration rate and related factors among clinical nurses. MATERIAL AND METHODS: In this cross-sectional, correlational study, we used mailed questionnaires to collect data from four geographical areas and three hospital levels in Taiwan from June 6 to August 31, 2018. Two thousand and thirty-three clinical nurses participated in this study. RESULTS: Participants' mean age was 34.47 years, and 95.7% were women. Of them, 78.3% were willing to donate their organs and 20.6% had registered for organ donation after death. The results of logistic regression showed that in the personal domain, higher age (odds ratio (OR) = 1.03, p < 0.001), better knowledge of organ donation (OR = 1.09, p < 0.001), and a positive attitude toward organ donation (OR = 2.91, p < 0.001) were positively associated with organ donation registration, while cultural myths (OR = 0.69, p < 0.001) were negatively correlated. In the policy domain, the convenience of the registration procedure (OR = 1.45, p < 0.001) was positively associated with registration. A gap between willingness to donate and actual registration was observed. CONCLUSIONS: Personal factors played an important role in organ donation registration. Therefore, efforts to improve knowledge and inculcate positive cultural beliefs about organ donation among clinical nurses are recommended. There is also a need to cooperate with government policies to provide appropriate in-service training and policy incentives and establish an efficient registration process.

Clinical Nurse Specialist Collaboration With a Community-Based Palliative Care Program: An Evidence-Based Practice Project.

PURPOSE/OBJECTIVES: The purpose of the project was to evaluate the impact of a clinical nurse specialist (CNS) collaborating with an established Midwestern community-based palliative care program on the following quality outcomes: care coordination, 30-day readmissions, and emergency department (ED) utilization. DESCRIPTION OF PROJECT: Palliative care services are evolving from the inpatient setting to community-based models to meet the needs of patients in their homes. As community-based programs develop, healthcare systems are examining the various models of care. The evidence-based practice project evaluated a collaborative practice model between a CNS and a community-based palliative care team. Quantitative analysis included 30-day readmissions and ED utilization in a preimplementation and postimplementation design. Qualitative data were obtained from a focus group of the community-based palliative care team to discuss the role of the CNS on the team. OUTCOMES: The addition of a CNS did not significantly impact 30-day readmissions or ED visits. An unexpected outcome was that the CNS intervention was associated with an increase in social work visits. Results of the focus groups suggested that the CNS improved care coordination, nursing support, education, and medical management. CONCLUSION: Both quantitative and qualitative analyses suggest that the CNS enhanced coordination of care and quality outcomes. Examining the CNS contribution over a longer period will further clarify the CNS's impact to the team.

Vitals.

Oncology nurses responded to these questions about their experiences during the COVID-19 pandemic: What have you learned about yourself, or what insights or competencies have you applied to your practice?

Assessment of Turkish oncology nurses' knowledge regarding COVID-19 during the current outbreak in Turkey.

PURPOSE: To assess Turkish oncology nurses' knowledge regarding novel coronavirus (COVID-19) during the current outbreak in Turkey. METHODS: This descriptive study was carried out with the 185 oncology nurses between April and May 2020 in Turkey. Research data were collected through online survey using "Nurse Information Form" and "Nurse Information Scale for COVID-19." Multilinear regression analysis was used in determining the factors affecting oncology nurses' information regarding COVID-19. RESULTS: According to the data delivered from 185 oncology nurses, 57.7% of the participants had an undergraduate degree, 74.1% were working in adult oncology units, and 52.4% of them were working as clinical nurses, 48.1% of the nurses received education for COVID-19 (51.9% did not receive) and 70.3% followed and read the COVID-19 Guidelines published by the Ministry of Health (29.7% did not follow guidelines). Using multiple regression analysis, a model based on the relationship between the variables was created. In the model, the descriptive characteristics of the oncology nurses and their experiences of COVID-19 were found to explain 29.1% of their knowledge level for COVID-19. Nurses' education level, the presence of a relative diagnosed with COVID-19, and following the COVID-19 guidelines were found to statistically significantly affect the knowledge levels of COVID-19. CONCLUSION: These findings suggest that hospital management and the Ministry of Health should provide more information for the oncology nurses to better control of cancer patients from the infectious disease.

Understanding Clinicians' Perceived Barriers and Facilitators to Optimal Use of Acute Oxygen Therapy in Adults.

Background: Supplemental oxygen is commonly administered to patients in acute care. It may cause harm when used inappropriately. Guidelines recommend prescription of acute oxygen, yet adherence is poor. We aimed to identify barriers and facilitators to practicing in accordance with the evidence-based Thoracic Society of Australia and New Zealand (TSANZ) oxygen guideline, and to determine the beliefs and attitudes relating to acute oxygen therapy. Methods: A national cross-sectional survey was conducted. The survey consisted of 3 sections: (1) introduction and participant characteristics; (2) opinion/beliefs, knowledge and actions about oxygen therapy and other drugs; and (3) barriers and facilitators to use of the TSANZ guideline. Convenience sampling was employed. A paper-based survey was distributed at the TSANZ Annual Scientific Meeting. An online survey was emailed to the TSANZ membership and to John Hunter Hospital's clinical staff. Results: Responses were received from 133 clinicians: 52.6% nurses, 30.1% doctors, and 17.3% other clinicians. Over a third (37.7%) were unaware/unsure of the oxygen guideline's existence. Most (79.8%) believe that oxygen is a drug and should be treated as one. Most (92.4%) stated they only administered it based on clinical need. For four hypothetical cases, there was only one where the majority of participants identified the optimal oxygen saturation. A number of barriers and facilitators were identified when asked about practicing in accordance with the TSANZ guideline. Lack of oxygen equipment, getting doctors to prescribe oxygen and oxygen being treated differently to other drugs were seen as barriers. The guideline itself and multiple clinician characteristics were considered facilitators. Conclusion: There is discordance between clinicians' beliefs and actions regarding the administration of oxygen therapy and knowledge gaps about optimal oxygen therapy in acute care. Identified barriers and facilitators should be considered when developing evidence-based guidelines to improve dissemination and knowledge exchange.

Coaching Strategies Used to Support Interprofessional Teams in 3 Primary Care Centers.

PURPOSE/AIMS: Clinical nurse specialists and other advanced practice registered nurses use healthcare team coaching to foster interprofessional practice and enhance healthcare quality. Although coaching has been shown to support positive changes in healthcare, little is known about how coaching strategies are used in practice. The purpose of this study was to describe the strategies used by an experienced healthcare team coach tasked with advancing interprofessional care and teamwork in primary care clinics. METHODS: This qualitative description study was part of a larger project that included an objective to increase interprofessional practice in 3 primary care clinics in the midwestern United States. Data drawn from 35 audio-recorded and transcribed coaching telephone calls were analyzed using content analysis. RESULTS: Twelve coaching strategies were identified and divided into the following groups: (a) enhancing team development, (b) affirming the work of the team, (c) facilitating progress, (d) providing resources, and (e) connecting work to theoretical frameworks. CONCLUSIONS: The coaching strategies described in this study can inform the work of clinical nurse specialists and other advanced practice registered nurses charged with advancing interprofessional collaborative practice. Future research is recommended to examine the efficacy of strategies and develop a comprehensive model of healthcare team coaching.

Integration and Standardization of Clinical Nurse Specialists in a Multihospital System: Exemplars in Practice.

PURPOSES/OBJECTIVES: In 2013, our multihospital system began the process to integrate and standardize clinical nurse specialist (CNS) practice. The goal was to standardize work and to increase collaboration as part of one system. DESCRIPTION OF THE PROJECT/PROGRAM: An overall job description was established to provide a framework inclusive of the broad areas of practice. Clinical nurse specialists were positioned to support medical-surgical, critical care, or women and children's services offered at community-based hospitals. Main campus and community-based CNSs led significant system integration efforts such as the standardization of nursing policies and procedures across the health system. System CNSs were created to address the needs of specialties common to all hospitals. As an example, a system CNS collaborated with the main campus and community-based CNSs to improve the delirium screening process. OUTCOME: Clinical nurse specialists across the system have been integrated into a single team and report to 1 central director. Efforts to leverage expertise included the creation of a CNS-led practice council, increased communication via regular departmental meetings, and the sharing of resources using electronic platforms. There is now a CNS at hospitals that previously did not have one. The group values the structure and opportunities it provides as evidenced by favorable engagement surveys. CONCLUSION: Our integration efforts improved collaboration and could be modified to benefit other care settings.

Structured Mentorship and the Nursing Clinical Ladder.

When nursing turnover is greater than the national average, professional development of nursing staff increases job satisfaction and employment retention. One approach that can address the professional development is mentoring. PURPOSE: The evidence-based practice (EBP) project's aim was to determine whether a short-term structured mentorship program led by a clinical nurse specialist increased work engagement among staff nurses within 8 to 10 weeks. DESCRIPTION: The EBP project was implemented on 2 adult acute care inpatient units. Using Wagner's caring mentorship model, a mentorship program using the organization's clinical ladder criteria was established where nurses were able to participate and complete selected professional development activities based on personal interests and perceived strengths. The clinical nurse specialist provided guidance and advice based each participant's identified activity. OUTCOME: Since the completion of the initial pilot, the organization has expanded the mentorship program to include mentorship of nursing leaders as well as staff on the clinical units. With this expansion, the organization has trained an additional 167 mentors and has a consistent 27% overall advancement of nurses on the clinical ladder. In addition, advanced practice registered nurses have implemented mentorship as part of their onboarding practice for advanced practice nursing. CONCLUSION: The EBP project demonstrated that a mentorship program using an established clinical ladder can increase elements of work engagement and satisfaction with the mentor and program among hospital nursing staff. Sustaining and expanding the program can facilitate with increased nursing job satisfaction and employee retention.

The Emotional Burden of the Correctional Health Care Advanced Practice Nurse.

This state-of-the-science review highlights the unique experiences of the correctional health care advanced practice nurse and the risks involved with repeated exposure to violent behavior, verbal assaults, and other rigors of working within a correctional facility. This article also investigates the outcomes of these risks such as compassion fatigue, vicarious trauma, and burnout. As each of these terms is dissected, insight into the correctional health care advanced practice nurse's daily experience emerges. Very little literature exists on the topic of correctional nursing and the pitfalls of this field; however, all literature that examines these phenomena indicate that innate qualities such as resilience, along with efforts of education and awareness, will empower any advanced practice nurse to endure and overcome the high-risk field of correctional nursing.

How Does an Oncology Nurse Increase Moral Resilience During a Pandemic?

As an oncology advanced practice nurse, I find myself asking, "How can I continue to provide the same level of competent, quality care while meeting the unique, holistic needs of this population leveraged with self-care during the COVID-19 pandemic?" In talking with colleagues, we find ourselves torn between providing fluid oncology care that is compassionate and comprehensive while managing our uncertainties with our family since the beginning of this pandemic. I practice in a state that is known nationally to have the worst rates of cancer-associated deaths and comorbidities, which predisposes patients to poor outcomes with COVID-19 (Centers for Disease Control and Prevention, 2020). Providers grasp that patients are at higher risk, yet patients with active cancer must be seen in person regularly and providers are tasked with how to protect them.