The Mountain Model for Evidence-Based Practice Quality Improvement Initiatives.

ABSTRACT: This article introduces the Mountain Model, the first conceptual model for evidence-based practice quality improvement (EBPQI) initiatives. The Mountain Model merges modern evidence-based practice (EBP) and quality improvement (QI) paradigm principles into a unified conceptual framework with the goal of disseminating and sustaining EBPQI projects across health care and related settings. The model was developed within the nursing discipline, but is designed for transdisciplinary implementation through interprofessional teams.

Clinical reasoning skill of nurses working in teaching medical centers in dealing with practical scenarios of King's model concepts.

BACKGROUND: The present study was conducted to determine clinical reasoning of nurses working in teaching medical centers in dealing with practical scenarios of King's concepts. METHODS: The study population in this cross-sectional descriptive-analytical study comprised 133 nurses. Data were collected using scenarios based on the King's model. Data were analyzed in SPSS-16. FINDINGS: Mean age of the participating nurses was 27.71 ± 8.1 years.The clinical reasoning score was less than average in most participating nurses, and had a significant relationship with education(P < 0.05), service ward(P < 0.001)and organizational position(P < 0.05). In the multivariate analysis of factors relating to clinical reasoning, higher education level (B = 9.5, P = 0.018) and organizational position (B = 4.3, P = 0.017) were predictors of clinical reasoning score. DISCUSSION: Existing nursing models such as King's, which is closely related to clinical reasoning, can be used more in educational and clinical systems, and as a clinical guide for promoting the clinical reasoning of nurses and students.

Truth for the Moment and Importance to Nursing.

In the article that follows the authors present information focused on nursing care delivery involving Neuman systems theory and improving the stress and stability. The authors then follow up with a clinical scenario which utilizes the Neuman system model as a means to prevent and ameliorate aggression and violence. The structure and evidence guided by Betty Neuman's systems model centers on managing and reducing stresses and working towards reconstitution. The thoughts contained in this article highlight some considerations regarding the importance of truth and truth for the moment for the nursing discipline.

A Paradigm Shift for the Nursing Education Model: A Scoping Review.

BACKGROUND: The Nursing Education Model (NEM) introduced a framework for education reform. This study examined the applications of NEM in education to determine whether modifications to NEM were warranted. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews process for scoping reviews was used. Online databases and searches identified peer-reviewed articles published from 2010-to June 2023, and 71 articles were identified that met the inclusion and exclusion criteria. RESULTS: Six themes were derived from the findings: (1) learner-centered curricula; (2) instructional methods; (3) inclusive classrooms; (4) pedagogical creativity; (5) bridge theory-clinical divide; and (6) multiple units of analysis. CONCLUSION: The findings support the application of the NEM to promote a paradigm shift in instructional content, methods, and evaluation of outcomes. Based on use of the model identified in the literature, future modifications to NEM may be indicated, based on continued evidence. [J Nurs Educ. 2024;63(3):141-147.].

Integrating Hospital-Based Harm Reduction Care-Harnessing the Nursing Model.

Hospitals are risk environments for people who use drugs, and most hospitals are unprepared to deliver substance use disorder (SUD) care, including harm reduction (HR) interventions. HR philosophy clashes with traditional hospital hierarchy and norms, and staff may resist HR interventions due to stigma, fear of enabling substance use, legal and safety concerns. Nurses are central to hospital culture and care and could promote and deliver HR care. Our US hospital has an inter-professional addiction consult service (ACS) that includes medical providers, social workers, and peers. We developed and launched a hospital-based registered nurse-(RN) led HR intervention, including distributing safe-use supplies (eg, syringes). We describe model development and early experience, using an Exploration, Preparation, Implementation, and Sustainment framework. ACS experiences and community HR interventions informed our exploration phase. In the preparation phase we secured funding from Medicaid payers for a 2-year pilot, including full-time RN salary and HR supplies. We elicited buy-in from hospital executive leaders, partly by partnering with nurse champions who described unmet patient care and staff education needs. We consulted hospital lawyers and developed an institution-wide media campaign targeting staff, including in-person booths distributing naloxone and materials promoting international overdose awareness day (eg, "#EndOverdose" buttons). We collaborated with local and national experts to develop the intervention, which includes RN bedside HR education and staff trainings. The Implementation was from September 2022 to March 2023. We trained 459 staff (over 15 trainings) and conducted 209 patient encounters. Generally, patients and staff embraced the HR RN role, including previously controversial safe-use supply distribution. Sustainment efforts include engaging stakeholders in continuous improvement and evaluation efforts. A nurse-led hospital-based HR intervention can expand patient services, support staff, and bridge HR and medical models.

The use of theory or model in studies on postpartum care: A narrative review.

PURPOSE: It is aimed to raise awareness about the science of nursing for women's health and the use of nursing theories and models in research by reviewing the studies using theories or models in postpartum care. DATA SOURCES: The data of the study were obtained by searching YÖK National Thesis Center, EBSCOhost, PubMed, Web of Science, Cochrane, and ScienceDirect databases. Reviewed studies were analyzed in terms of the type of research, sample characteristics, purpose, the field of use of theory and model in the research, and research results. CONCLUSIONS: As a result of the review, it was noted that in the studies, Orem's Self-Care Deficit Nursing Theory/Model (n = 9), Roy's Adaptation Theory (n = 7), and Kolcaba's Theory of Comfort (n = 7) were the most used theories, theories and models were not used in a systematic structure at every stage of the research, and positive outcomes were obtained with the theory and model-based nursing interventions. IMPLICATIONS FOR NURSING PRACTICE: The application of theory and model in postpartum care can be chosen by nurses as it improves patient outcomes. Furthermore, the use of theories and models in research to develop nursing knowledge will benefit nursing science while increasing professional autonomy.

Nursing care after hand replantation based on Roy's adaptation model: A case report.

BACKGROUND: Hand injuries are very complex and worrying in terms of hindering activities of daily living, functionality and self-care skills. Hand injuries are caused by traumatic events, resulting in a partial or complete loss. The focus of acute treatment is surgical replantation. AIM: In this study, nursing care and nursing experiences of a patient who was replanted as a result of hand trauma were discussed in the light of the Roy Adaptation Model. CASE: The male patient admitted to the emergency room due to traumatic amputation was a 49-year-old farmer. He lost his hand to an agricultural tool while working the land and was taken to the hospital within 4 h. He was taken up for emergency surgery for replantation. He has a history of diabetes mellitus. Nursing follow-up and interventions were applied by evaluating the data according to four adaptation modes (physiological needs, self-concept, role function and interdependence) within the scope of the Roy Adaptation Model. CONCLUSION: and Suggestions: Patients experience difficulties (loss of function, financial problems, loss of role, psychological traumas) due to disability after injury. Therefore, nurses should know the underlying physiological risks, complications, and interventions to recognize and respond to situations that cause the loss of the reattached limb. Nursing models can identify patients' needs and problems, prevent complications, provide quality care, and manage the process. This study discussed the postoperative nursing care of a patient based on Roy's Adaptation Model.

More Thoughts About Environment.

The purpose of this essay is to present more thoughts about the environment. This essay is about the internal environment whereas a previous essay published in 2022 was about the external environment. This essay includes an overall understanding of internal environment as well as descriptions or definitions of internal environment given in selected nursing conceptual models. A possible interpretation of internal environment from a Native American perspective is mentioned. A call is issued for understanding of internal environment by persons from diverse cultures.

Exploring the adaptive leisure activities of classified nursing model in elderly colon cancer patients: a perspective on interactive care.

OBJECTIVE: The aims of the study were first to explore the adaptive leisure activities of classified nursing model from the perspective of nurse-patient interactive care, and to explore its impact on the physical and mental health of patients with colon cancer. METHODS: From September 2017 to March 2022 as the observation time node, 82 patients with colon cancer who met the established inclusion and exclusion criteria were regarded as the research objects through the random number table as the grouping tool. The two groups of patients were named as the research group and the control group, with 41 patients in each group. The control group implemented routine nursing measures, and the research group implemented classified nursing mode and adaptive leisure activity mode. The two groups of patients received 4 weeks of nursing intervention. With the help of self-rating anxiety scale, self-rating depression scale, self-care ability evaluation scale and health status survey brief form, the two groups of patients were compared before intervention and at the end of the 4th week after intervention. RESULTS: After the intervention, the anxiety score (t = 6.656, p < 0.001) and depression score (t = 4.851, p < 0.001) of the research group were lower than those of the control group, and the difference was statistically significant. After the intervention, the self-concept (t = 4.845, p < 0.001), self-responsibility (t = 6.071, p < 0.001), self-care skills (t = 3.341, p < 0.001), health knowledge (t = 3.698, p < 0.001) and total score (t = 9.246, p < 0.001) of the research group were higher than those of the control group, and the difference was statistically significant. After the intervention, physical functioning (t = 8.141, p < 0.001), bodily pain (t = 6.083, p < 0.001), general health (t = 9.424, p < 0.001), role-physical (t = 8.057, p < 0.001), role-emotional (t = 13.252, p < 0.001), mental health (t = 12.565, p < 0.001), social functioning (t = 10.813, p < 0.001) and vitality score (t = 12.890, p < 0.001) of the research group were higher than those of the control group, with significant differences. CONCLUSION: Interactive care through adaptive leisure nursing improves mental well-being, self-management, and psychosocial functioning in elderly colon cancer patients, promoting overall health.

Efeito da Tele-enfermagem no Processo Adaptativo de Pessoas Com Estomia Intestinal: Ensaio Clínico / Effect of Telenursing on the Adaptive Process of People With Intestinal Stoma: Clinical Trial / Efecto de la Teleenfermería en el Proceso Adaptativo de Personas Con Estomía Intestinal: Ensayo Clínico

Objetivo:Analisar o efeito da tele-enfermagem no processo adaptativo de pessoas com estomia intestinal. Método: Ensaio clínico randomizado, unicego. Aplicou-se a escala de verificação do nível de adaptação da pessoa com estomia, e formaram-se dois grupos. O grupo controle recebeu atendimento convencional com profissionais do centro de referência, e o grupo intervenção obteve o acompanhamento convencional associado à intervenção complementar via telefone (três chamadas telefônicas realizadas no 20º, 40º e 60º dia após contato inicial). Ao final da intervenção, os participantes foram avaliados novamente pela escala. O recrutamento ocorreu desde o primeiro contato e contou com uma amostra de 16 participantes no grupo intervenção e 17 no grupo controle. Resultados: Notou-se semelhança nos níveis de adaptação no baseline entre os dois grupos, entretanto dados do pós-intervenção demonstraram diferença significante dos grupos no decorrer do estudo e menores valores das médias do grupo controle comparados às medidas do grupo intervenção, indicando maior nível de adaptação no grupo intervenção. Conclusão: O estudo verificou o efeito da tele-enfermagem no processo adaptativo da pessoa com estomia e sugere benefícios no acompanhamento complementar via tele-enfermagem no nível de adaptação de pessoas com estomia de tempo ≤ 12 meses de cirurgia.

Objective: To analyze the effect of telenursing on the adaptive process of people with intestinal ostomy. Method: Randomized, single-blind clinical trial. The verification scale of the level of adaptation of the person with ostomy was applied, and two groups were formed. The control group received conventional care with professionals from the reference center, and the intervention group received conventional follow-up associated with the complementary intervention via telephone (three phone calls on the 20th, 40th and 60th day after initial contact). At the end of the intervention, the participants were evaluated again through the scale. Recruitment occurred from the first contact and had a sample of 16 participants in the intervention group and 17 in the control group. Results: There was a similarity in the levels of adaptation at baseline between the two groups. However, post-intervention data showed a significant difference between the groups during the study and lower values of the means of the control group compared to the measures of the intervention group, demonstrating a higher level of adaptation in the intervention group. Conclusion: The study verified the effect of telenursing on the adaptive process of the person with a stoma and suggests benefits in complementary monitoring via telenursing at the level of adaptation of people with a stoma after ≤ 12 months of surgery.

Objetivo:Analizar el efecto de la teleenfermería en el proceso adaptativo de personas con ostomía intestinal. Método: Ensayo clínico aleatorizado, simple ciego. Se aplicó la Escala de Verificación del Nivel de Adaptación de la Persona con Ostomía y se formaron dos grupos, el grupo control recibió atención convencional con profesionales del centro de referencia y el grupo intervención recibió seguimiento convencional asociado a la intervención complementaria vía telefónica (3 llamadas telefónicas los días 20, 40 y 60 después del contacto inicial). Al final de la intervención, los participantes fueron evaluados nuevamente mediante la escala. El reclutamiento se produjo desde el primer contacto y contó con una muestra de 16 participantes en el grupo de intervención y 17 en el grupo control. Resultados: Hubo similitud en los niveles de adaptación al inicio del estudio entre los dos grupos, sin embargo, los datos posteriores a la intervención mostraron una diferencia significativa entre los grupos durante el estudio y verificaron valores más bajos de las medias del grupo control en comparación con el medidas del grupo de intervención, demostrando un mayor nivel de adaptación en el grupo de intervención. Conclusión: El estudio verificó el efecto de la teleenfermería en el proceso adaptativo de la persona con estoma y sugiere beneficios en el seguimiento complementario a través de la teleenfermería a nivel de adaptación de la persona con estoma después de ≤ 12 meses de la cirugía

Concept analysis: Community-based postnatal care.

BACKGROUND:  Community-based postnatal care is a valuable resource in the provision of maternal and neonatal care, specifically outside the hospital environment. However, its application in maternal and neonatal care is not clearly documented in relation to the rendering of services by primary caregivers. OBJECTIVES:  This study clarifies the concept of 'community-based postnatal care' by using the concept analysis method. METHOD:  To analyse the concept, relevant literatures were reviewed and analysed using the Walker and Avant method, namely, selecting a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case, identifying borderline, related and contrary cases, identifying antecedents and consequences and identifying the empirical referents. Characteristics that repeatedly appeared throughout the literature were noted and categorised. RESULTS:  It was established from the concept analysis that 'community-based postnatal care' was complex and experienced ethnically. The analysis included that primary caregiver participation was based on home-levelled-skilled care, community participation and mobilisation, linkages of health services and community stakeholders. The attributes were influenced by antecedents and consequences. CONCLUSION:  The empirical referents of community based can be integrated within the midwifery guidelines to measure the concept. When concepts are understood, self-care on early detection, early management and referral during early postnatal care will be enhanced.Contribution: The results of this study will foster independence, confidence and a respectful relationship between primary caregivers and the health care facility staff. The results are expected to guide future research and enhance community-based postnatal care in midwifery practice.

Recommendations From a Systematic Review of Leadership Development to Support a New Nursing Practice Model.

OBJECTIVE: To develop a new nursing practice model for use within the US military, researchers aimed to create evidence-based recommendations for nursing leadership development based on current literature. BACKGROUND: The role of nursing leadership has many implications, including better nurse and patient outcomes. Therefore, an actionable compilation of recommendations informing how to develop effective nurse leaders could be helpful for current and aspiring nurse leaders. METHODS: Researchers conducted a systematic literature review of 5 databases searching for relevant articles published from 2001 to 2020. RESULTS: Seventy-eight articles were synthesized to develop a list of 5 broad yet actionable recommendations for leadership development. CONCLUSIONS: Leadership development is essential for current and future nurse leaders. The recommendations identified from this review can assist in developing leaders. Leaders can use these recommendations to guide leadership training initiatives, engage in self-development, or begin succession planning.

Fast-track and person-centred care in geriatric traumatology in a German-speaking Swiss hospital - A practice development project.

INTRODUCTION: Elderly persons have an increased risk for negative health-related outcomes, including higher mortality rates. A centre for geriatric traumatology was established in a German-speaking Swiss hospital to provide more specialised, person-centred care and to lower negative health outcomes. Adaptations and changes in the patient pathway were made by implementing fast-track and person-centred care to better address individual needs. METHODS: The current patient pathway was analysed by an interprofessional and interdisciplinary geriatric traumatology expert team. The practice development methodology and the Person-Centred Practice Framework (PCP-Framework) were used throughout this engagement process. In consensus within the expert team, the sample was defined as elderly persons aged 65 years or older with suspected hip joint closed fractures. The focus was on three elements of "practice environment" from the PCP-Framework. These were: (1) supportive organisational systems; (2) the physical environment; (3) appropriate skill mix. RESULTS: Several adaptations and changes were made addressing the three elements of "practice environment". These were for example: (1) use of specific assessments, shared decision-making; (2) proper and effective use of aids; (3) integration of Advanced Practice Nurses. The adaptations in the patient pathway were integrated into the standard operating procedures. CONCLUSIONS: Through active engagement with the practice development methodology and the focus on person-centredness, the process of care for elderly persons was adapted. Thus, by addressing individual needs, fast-track and person-centred care in geriatric traumatology is provided. Further research is needed to evaluate and to verify implications in clinical practice.

More Thoughts About Health Policies: Focus on Conceptual Models.

The purpose of this essay is to demonstrate how existing conceptual models of nursing designed for clinical research, education, practice, and administration also can be used to guide health policy development, analysis, evaluation, and research by nurses. The concept of each of various nursing conceptual models that might be represented by health policies is identified.

Focus group in the development of concepts for a Nursing model: experience report.

OBJECTIVE: To communicate the experience of developing concepts for the construction of a care model through focus groups. METHODS: An experience report on the development of concepts through remote focus groups with members of a research group from a public university in southern Brazil. RESULTS: Focus groups were developed in which homogeneity and heterogeneity criteria were observed among participants. In addition to the concepts of the nursing metaparadigm, the concepts of care and family-centered care were developed, relevant to the nursing care model in question. FINAL CONSIDERATIONS: Despite the challenges of conducting remote focus groups, they were suitable for the collective construction of concepts for a nursing care model, allowing the interaction of participants from different locations.

KEDUSIA-RSM: un modelo de enfermería basado en Android para la prevención de la demencia y una mejor función cognitiva en adultos mayores / KEDUSIA-RSM: An Android-Based Nursing Model for Dementia Prevention and Better Cognitive Function in Older Adults

Introducción: Los ancianos con demencia pueden ser una carga para sus familias. El conocimiento de los factores de riesgo de la demencia puede reducir los efectos negativos de la propia demencia. El uso de aplicaciones basadas en Android puede ayudar a las familias a prevenir la senilidad y cuidar a los ancianos. Propósito: Este estudio tiene como objetivo formular un modelo efectivo de enfermería familiar a través de la aplicación Android Dementia Care Family – Raden Siti Maryam (KEDUSIA-RSM), para mejorar la función cognitiva y monitorear los factores de riesgo de demencia en los ancianos. Métodos: Este estudio utilizó un diseño de investigación operativa en dos fases: 1) desarrollo del modelo, integración de los antecedentes del estudio, revisión de la literatura y consulta de expertos, y 2) prueba del modelo piloto que compara los grupos de prueba previa y posterior con el grupo de control. La técnica de muestreo utilizada fue el muestreo por conglomerados compuesto con los resultados de 156 muestras, es decir, 79 familias en el grupo de intervención y 77 familias en el grupo de control. Resultados: La primera etapa produjo dos componentes principales del modelo de enfermería KEDUSIA-RSM, a saber, guías y aplicaciones basadas en Android; hubo una diferencia media significativa en la función cognitiva y el manejo de los factores de riesgo de demencia entre los grupos antes y cuatro meses después del modelo de intervención (valor de p < 0,05). Conclusión: KEDUSIA-RSM ha demostrado ser eficaz para mejorar la función cognitiva y controlar los factores de riesgo de demencia en los ancianos. Es muy recomendable replicar el modelo, realizar capacitación continua para enfermeras en salud pública y desarrollar otros estudios en aplicaciones basadas en iOS o en la web con modelos similares. (AU)

Introduction: Elderly people with dementia can become a burden to their family. Knowledge of the risk factors for dementia may lower the negative effects of dementia itself. Using Android-based applications can be helpful to families in preventing dementia and caring for the elderly. Objective: This study aimed to formulate an effective family nursing model through an Android-based application, Keluarga Peduli Demensia – Raden Siti Maryam (KEDUSIA-RSM), to enhance cognitive function and to monitor the risk factors of dementia in the elderly. Methods: This study employed an operational research design in two stages: 1) model development, integrating the study background, literature review, and expert consultation, and 2) model trials comparing pre- and post-test groups to control group. The sampling technique used was composite clustering sampling with the results of 156 samples: 79 families in the intervention group and 77 families in the control group. Results: The first stage resulted in the creation of two of the main components of the KEDUSIA-RSM nursing model: the guidebook and its android-based application; There were significant mean differences in cognitive function and dementia risk factor management between those groups before and four months after intervention model (p value < 0.05). Conclusion: KEDUSIA-RSM is proven to be effective in raising cognitive function and managing risk factors for dementia in the elderly. It is highly recommended to replicate the model, to conduct sustainable training for nurses within the community health field and to develop another study on an iOS-based or web-based app with a similar model. (AU)