Secure Messaging: Demonstration and Enrollment Patient Portal Program: Patient Portal Use in Vulnerable Populations.

Vulnerable populations face challenges gaining access to quality healthcare, which places them at a high risk for poor health outcomes. Using patient portals and secure messaging can improve patient activation, access to care, patient follow-up adherence, and health outcomes. Developing and testing quality improvement strategies to help reduce disparities is vital to ensure patient portals benefit all, especially vulnerable populations. This quality improvement initiative aimed to increase enrollment in a patient portal, use secure messages, and adhere to follow-up appointments. Before the project, no patients were enrolled in the portal at this practice site. Over 8 weeks, 61% of invited patients were enrolled in the patient portal. Eighty-five percent were Medicaid recipients, and the others were underinsured. Eight patients utilized the portal for secure messaging. The follow-up appointment attendance rate was better in the enrolled patients than in those who did not enroll. The majority of survey respondents reported satisfaction in using the patient portal. Patient portal utilization and adoption in vulnerable groups can improve when a one-on-one, hands-on demonstration and technical assistance are provided.

Optimizing Quality Improvement Methods in Practice: A Case Study Approach.

BACKGROUND: Quality improvement (QI) initiatives help ensure patients are receiving high-quality care. Iterative Plan-Do-Study-Act (PDSA) cycles are used to test change. Data are evaluated over time, and tests of change can be modified or discarded as needed. PROBLEM: Health care QI teams lack the flexibility to conduct PDSA cycles, often conducting pre/post quasi-experimental research studies instead. APPROACH: This article reviews a case study of a "personal improvement" initiative as an example of QI methods and data evaluation for an individual trying to lose weight. The purpose of this article is to provide guidance on best practices for conducting QI initiatives; common pitfalls that clinicians may face when leading their own QI initiatives are identified and recommendations to overcome these challenges are discussed. CONCLUSIONS: Concepts from this case study, along with supplemental resources provided, can help clinicians optimize QI methodologies in the health care setting.

Evidence-Based Practice Quality Improvement Critical Appraisal Tool.

BACKGROUND: Optimal quality improvement in health care is based on research and other types of evidence. Critical appraisal of evidence is a fundamental component of evidence-based practice (EBP) and is also needed to evaluate the quality of quality improvement (QI) projects. PROBLEM: Currently available EBP or QI critical appraisal tools can be challenging for students learning the critical appraisal process and for practicing clinicians who desire access to a standardized EBPQI approach to inform health care decision-making. The currently available tools are incomplete, too brief, or too complicated for ease of use in education and practice. APPROACH: This article introduces the first combined EBP and QI (EBPQI) critical appraisal tool, which is aligned with the new EBPQI mountain model. CONCLUSION: This newly developed appraisal tool may be used in appraising evidence for an EBPQI initiative and to appraise the quality of disseminated EBPQI.

Tailoring African American Faith Community-Based Diabetes Self-Management Education.

ABSTRACT: African Americans (AA) experience a disparate effect of type II diabetes (T2D). For this nurse-led pilot study, a pre-validated 6-week diabetes self-management education (DSME) program was implemented in a faith community setting and tailored to the participants' faith and culture by using short scriptural lessons, prayers, and individual sharing. Participants demonstrated improvements in fasting blood glucose (p = .042), diabetes knowledge (p = .002), and psychosocial self-efficacy (p = .001). Although generalizability of findings is limited, the structure and methods used in tailoring this DSME program could be transferable to other faith-based settings.

Nurse editors' roles and practices.

PURPOSE: While nurse editors carry great responsibility for the scientific literature in the nursing profession, little has been published about this unique role. The purpose of this study was to examine contemporary nurse editors' roles and practices. DESIGN: In early 2019, a sample of 129 nurse editors participated in a cross-sectional study using survey methods. METHODS: The online survey was based on an instrument used in a prior study and included 43 primarily multiple-choice questions. Findings were analyzed using descriptive statistics. FINDINGS: Beyond the expected roles of journal management, editorial decision making, leadership for the profession, and specific journal focus, some aspects of the nurse editor role have remained unchanged. The role continues to be learned mostly on the job and nurse editors still find satisfaction in helping other nurses publish and disseminate their work. Nurse editors are older and better educated. They also are receiving more manuscripts submitted to their journals and perceive this role as hard work but worth it. This is also the first study to report on the role of other levels of editors. CONCLUSION: This study provides a description of the current roles and practices of nurse editors. Nurse editors can bring more attention to the role and encourage more nurses to consider this role as an attainable and a satisfying one. CLINICAL RELEVANCE: Being a nurse editor is a leadership role and one that many nurses may not consider as a career goal. Nurse editors can increase the visibility of this role and engage, encourage, and support nurses who are interested in this role.

Dissemination of doctor of nursing practice project findings: Benefits and challenges associated with publishing in healthcare journals.

BACKGROUND: Doctor of Nursing Practice (DNP) programs require a project to improve outcomes in a health care setting. However, dissemination methods vary. PURPOSE: This evaluation examined benefits and challenges associated with submitting project manuscripts to a peer-reviewed health care journal in a DNP program with this requirement. METHODS: Benefits and challenges were assessed with surveys completed by 85 DNP program alumni and 28 DNP mentors and by interviewing 5 faculty who teach in the DNP program and 5 editors of nursing journals. FINDINGS: Benefits of completing a manuscript included sharing knowledge to improve health care outcomes and enhancing nursing scholarship. Among alumni, 81% reported manuscript development was beneficial and 69% published their work. Most students, most faculty, and all editors endorsed the requirement with alternatives for projects lacking rigor or innovation. Challenges included need for faculty involvement and editorial/statistical resources. DISCUSSION: Despite challenges, there are benefits of publishing rigorous and innovative DNP work.

School Nurses Perceptions on Managing Asthma in Alabama Schools.

Asthma is the most common chronic condition in children under 18. In Alabama, 11% of children report a diagnosis of asthma compared to the United States with 9.5%. Childhood asthma is the leading cause of school absenteeism due to a chronic disease, and Alabama children with asthma miss approximately 10 days of school each year for uncontrolled asthma. Managing children in the school system with asthma can often be challenging for school nurses. In this cross-sectional study, perceptions of Alabama school nurses on managing asthma in the school were explored. School nurses feel prepared to manage asthma but identify lack of certain resources and supportive policies, especially access to medications as barriers to optimum care. Implications for statewide advocacy at the policy level and broadening educational activities are supported by the survey results.

The Effects of Shared Decision-Making on Patient Participation in Discharge Meetings in a Behavioral Health Unit.

BACKGROUND: Research suggests that persons diagnosed with behavioral health illnesses can benefit from shared decision-making. On an inpatient behavioral health unit, low Press Ganey scores related to satisfaction with involvement in care triggered a root cause analysis that identified patients did not feel engaged by nursing during their time together; and discharge meetings with the health care team were not required. AIMS: The purpose of this quality improvement project was to improve patient perception of involvement in their care as evidenced by increased Press Ganey scores and increased number of patients involved in discharge meetings. METHODS: Nurses used an evidence-based model for nurse-patient communication: the Seeking information, Engaging in conversation, Exploring options, and Deciding on treatment (SEED) and use of a Control Preferences Scale (CPS) to increase communication about treatment and discharge decisions. RESULTS: A total of 120 patients engaged in the intervention. Patient presence at discharge meetings increased from 39% to 82% (p < .001), and Press Ganey scores evidenced minimal change. CONCLUSIONS: Use of the SEED model and CPS by nurses was effective in increasing patients' involvement in their treatment. Although findings were limited due to COVID-19, the study suggests that improving patient involvement from admission through discharge throughout hospitalization can improve patient experience scores.

Integrating Maternal Depression Screening Into an Early Intervention Program: An Implementation Evaluation.

BACKGROUND: In all 50 states, early intervention (EI) services to improve long-term child cognitive and academic outcomes are provided to infants and toddlers with suspected or diagnosed developmental delays. When mothers of EI-enrolled children experience depressive symptoms, uptake of EI services can be compromised. AIMS: The purpose of the article is to present a depressive symptom screening intervention for mothers consisting of toolkit development for EI staff and families, symptom screening for mothers and follow-up protocol. To formally evaluate the implementation of the intervention, our research team followed the consolidated framework for implementation research (CFIR). METHODS: Participants were 12 EI service coordinators across two offices. Focus groups and individual interviews were used to develop the toolkit and education module. Through the five CFIR domains, we evaluated the implemented intervention in order to allow other teams to learn from our experiences. RESULTS: Our team successfully partnered with SCs to develop the intended deliverables. Still, the SCs found it challenging to conduct the screenings and reported mixed success. CONCLUSIONS: Preparation of EI SCs to integrate mental health screenings into their existing skillsets requires a high level of support from the research team, resulting in a rich understanding of the barriers-and potential rewards-for staff and families.

Parenting Interventions and Secondary Outcomes Related to Maternal Mental Health: A Systematic Review.

PURPOSE: Perinatal mood and anxiety disorders can have far reaching negative impact on both maternal mental health and child growth and development. Multimodal group parenting programs have been shown to improve maternal mental health symptoms however, they are often costly to provide and not accessible to many mothers, especially those mothers suffering from mental health symptoms. Therefore, the authors sought to answer the following question by undertaking a systematic review of the literature: are parenting interventions aimed at improving maternal-child interaction also a way to address mental health symptoms (i.e. depression, anxiety, stress) in mothers? METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. An online platform that supports the systematic review process and quality assessment according to Cochrane guidelines, Covidence, was used in conjunction with an adapted extraction tool to identify relevant studies and extract data for analysis. RESULTS: 11 articles were included in the qualitative synthesis. There was great heterogeneity between study interventions and measurement of outcomes for maternal mental health symptoms which precluded meta-analysis. CONCLUSION: Studies reviewed did not demonstrate consistent evidence to recommend that parenting interventions leads to improvement in maternal mental health symptoms for depression, anxiety or stress. However, there was evidence that participating in parenting programs does not worsen these symptoms and some encouraging evidence that alternative delivery methods, beyond face to face, could, with more research, lead to more financially feasible and sustainable models of delivery of these types of interventions in the future.

Publishing in Predatory Journals: Guidelines for Nursing Faculty in Promotion and Tenure Policies.

PURPOSE: The purpose of this study was to assess the extent to which academic promotion and tenure (APT) criteria and guidelines in schools of nursing recognize predatory publishing. This assessment included an analysis of APT documents looking specifically for guidance about predatory publications by faculty in schools of nursing. DESIGN: This study used a cross-sectional, descriptive design and was conducted in 2020. METHODS: A mixed methods approach was used to collect data from two sources. Data were extracted from APT documents for 92 research-intensive universities found online and specifically focused on documents for universities and for schools of nursing in the United States. Interviews were conducted with a subsample of academic administrators (n = 10) from selected schools. FINDINGS: The majority (57%; n = 50) of APT documents reviewed addressed quality of the journals in which faculty publish. However, very nonspecific terms, such as "high quality" or "peer reviewed" were used. None of the documents reviewed (n = 88) included any reference to predatory journals. Deans who were interviewed validated the analysis of the APT documents. While most deans reported faculty were aware of predatory journals and the risks of publishing in them, formal guidelines for consequences for publishing in predatory journals were not developed or available. CONCLUSION: This study examined how schools of nursing in research-intensive universities address the issue of predatory journals. APT criteria do not provide guidance to faculty and promotion and tenure committees about issues related to predatory publications as low-quality publication outlets. Recommendations for APT committees, mentors, and faculty are provided. CLINICAL RELEVANCE: Clinicians rely on researchers, many of whom are faculty, to publish rigorous studies that produce evidence they can translate into practice. One measure of the quality of a study's findings is where the paper is published and reflects the level of peer review it has been through. Faculty who publish in predatory journals may not have had their work reviewed by experts; evidence produced may or may not be adequate for translation to guide nursing practice.

Improving the Accuracy of Newborn Weight Classification.

PURPOSE: The purpose of this project was to improve the accuracy of newborn weight classification using a regional newborn growth reference (Olsen), an evidence-based method, to determine SGA, AGA and LGA in term infants compared to the current growth reference (Lubchenco). DESIGN: Quality improvement methods using Lewin's Change Theory guided the process. SETTING/LOCAL PROBLEM: At an academic medical center term infants were evaluated for weight-for-gestational age using the Lubchenco growth reference as well as other growth references based on provider preference. PATIENTS: All term newborns (N = 314) admitted to the newborn nursery during one month following a 3-months implementation of the practice change. INTERVENTION/MEASUREMENTS: Newborn nursery nursing staff and provider staff were provided education and training on using and interpreting the new growth reference. RESULTS: Use of the Olsen regional growth reference identified more infants as small and fewer infants as large for gestational age. Post hoc analysis with a more global growth reference (Fenton) also identified more infants as small and fewer infants as large for gestational age. There was no statistically significant difference between the Olsen or Fenton growth references. CONCLUSION: Use of either of these two updated growth references more accurately classifies infant weight for gestational age compared to the Lubchenco growth reference, potentially decreasing newborn health risks such as hypoglycemia.

Improving Evaluation and Treatment of Hyperbilirubinemia in Late Preterm Infants.

Late preterm (LPT) infants are at an increased risk for hyperbilirubinemia. Accurate identification and early treatment are needed for optimal health outcomes. In a newborn nursery at an academic medical center, bilirubin levels were drawn at 24 hours of life, per protocol. These infants were rarely treated at this time. Rather, predischarge bilirubin levels (at about 48 hours of life) would indicate treatment, often leading to increased length of hospital stay. The practice change evaluation was conducted using retrospective medical record review. Practice change to test serum bilirubin levels at 36 hours of life rather than 24 hours of life. Compliance with the practice change was achieved (P < .05). More LPT infants were identified and treated for hyperbilirubinemia without an increase in length of stay. Readmissions for hyperbilirubinemia and blood draw rates also declined. Although more LPT infants were identified and treated for hyperbilirubinemia, there is room for improvement, and increased adherence to the policy might yield an even greater impact on quality and safety of care surrounding bilirubin management.

Systematically Building a Model to Support and Unify Advanced Practice Providers.

Nursing leaders at the University of South Alabama (USA) Health collaborated to explore the need for a structured practice model for advanced practice providers (APP). The goal of this collaboration was to create an organizational structure where APPs could thrive clinically and professionally.

The role of Doctor of Nursing Practice-prepared nurses in practice settings.

BACKGROUND: The role of the Doctor of Nursing Practice-prepared nurse (DNP) outside of academic settings has not been clearly articulated or widely explored, and therefore the value DNP-prepared nurses bring to their practice settings is largely unknown. This study: (1) surveyed existing DNP programs to identify the nonacademic settings in which their DNP graduates were employed and (2) conducted semistructured interviews with employers to identify the role and value of the DNP-prepared nurse in nonacademic settings. METHOD: Data were collected from January 2016 to August 2016 in two parts: (1) an online survey of the DNP programs and (2) qualitative semistructured telephone interviews with employers. First, we conducted an online survey of program directors (or their equivalent) from 288 DNP programs across the United States to capture descriptive information about current DNP programs (e.g., location, modality, profit status), the types of nonacademic institutions that hire their graduates, percentage of graduates employed by each setting, and the contact information for these employers. Employers were identified either by DNP program directors through the online survey or by a convenience sampling method. Using semistructured telephone interviews, we asked questions to employers in different care settings about the role of the DNP in these settings and how the DNP compares to other nurse leaders and advanced practice nurses (APRN). Employers were asked to describe the role of the DNP-prepared nurse working in direct patient care roles such as APRNs or as leaders, administrators, and managers. FINDINGS: Descriptive thematic analyses were derived from the interviews, to identify the roles DNP-prepared nurses filled and how they compared to other nurse leaders and advanced practice nurses in these settings. A total of 130 DNP program directors responded to the online survey. Twenty-three employers participated in semistructured telephone interviews. The thematic analysis resulted in four main themes regarding the role of the DNP-prepared nurse in non-academic settings: "DNP-Prepared Nurse Positions and Roles," "Perceived Impact of the DNP-Prepared Nurse on Staff, Patient, and Organizational Outcomes," "Comparison of the DNP-Prepared Nurse to Other Nurses With Advanced Training," and "Challenges Experienced by Nurses With DNP Degrees. DISCUSSION: The role of the DNP-prepared nurse in nonacademic settings is unclear. These DNP-prepared nurses typically function as APRNs in clinical care or as health care system leaders. While there is a low number of DNPs in clinical practice settings, the number is expected to grow as more graduate and enter practice. Thus, knowledge of the roles, value, and outcomes of the DNP-prepared nurse can guide practice setting leaders on how to best use DNP-prepared nurses in their setting.

Self-Publishing: A Novel Incentive to Write in Graduate Nursing Education.

Professional communication and the dissemination of expertise are expected of nurses prepared at the doctoral level. However, little emphasis is placed on opportunities for professional writing in most clinically focused doctoral programs for nurse practitioners. This innovative extracurricular writing project provided a professional writing experience for novice writers, helping them gain the confidence needed to achieve dissemination beyond the educational setting in the form of a self-published e-book. This project could be used for many other types of writing in nursing.

Mothers' Perspectives on Managing the Developmental Delay of a Child With Considerations for Contextual Influences and Maternal Functioning.

Developmental delay in very young children is trending upward. Maternal depressive symptoms are known to negatively impact child development and may also impact family management of the child's condition. Research on family management guided this second phase of a sequential mixed methods study. The purpose of this study was to explore mothers' perceptions of family management of their children's developmental delays. Mothers of very young children who received early intervention services were interviewed. A team-based content analysis approach revealed key findings: (a) views of the child that were not holistic, (b) condition management ability was informed by what the mother thought her child needed, (c) views of condition impact were related to adapting to possible child outcomes and experiences of isolation, and (d) parental/caregiver mutuality was impaired by conflict. Understanding perceptions of family management and influence of depressive symptoms in this context is essential to extend assessment and intervention.

Recognizing Maternal Depressive Symptoms: An Opportunity to Improve Outcomes in Early Intervention Programs.

Objective A higher rate of depressive symptoms is found among mothers of children with disabilities compared to other parents. However, there is a lack of study of mothers with children <3 years of age participating in Early Intervention (EI) programs. This study aims to more fully describe the extent of mood disorders in these mothers including estimated prevalence, severity and factors associated with maternal mental health, using gold standard clinical diagnostic and symptom measures, and test models associating depressive symptoms with contextual factors and child behavior. Methods A cross-sectional study was conducted with 106 women who had at least one child enrolled in EI. Mothers were interviewed and completed reliable, valid measures to evaluate mental health, health status, family conflict, parent-child interaction, self-efficacy, social support, child behavioral problems, hardship, endangerment, and child disability. Descriptive statistics and multivariate analyses were performed. Results We found 8 % of participants met all criteria for a Major Depressive Episode (MDE) with 44 % of the sample reporting a past episode and 43 % endorsing recurrent episodes. Using the CES-D to assess depressive symptom severity approximately 34 % of mothers screened in a clinically significant range. Using linear regression to predict severity of current depressive symptoms demonstrated that current depression severity was primarily predicted by poorer maternal health status, lower self-efficacy and past MDE (p < 0.05). Conclusions for practice A brief assessment of maternal mood, health and self-efficacy are important factors to assess when evaluating how to support mothers of children in EI.