Safety Competency: Exploring the Impact of Environmental and Personal Factors on the Nurse's Ability to Deliver Safe Care.

BACKGROUND: Patient safety is a priority in health care systems. Nurses' safety competence along with environmental and personal factors plays a role in patient safety. PURPOSE: The purpose of this study was to explore the relationships among safety competency, structural empowerment, systems thinking, level of education, and certification. METHODS: A cross-sectional exploratory design was used to collect data from nurses (n = 163) practicing in a large Midwestern hospital system. RESULTS: There were significant positive correlations between safety competency and ( a ) structural empowerment, ( b ) systems thinking, and ( c ) certification. Systems thinking explained 12.9% of the variance in the knowledge component of safety competency and 6.8% of the variance in the skill component of safety competency. Certification explained 2.4% of the variance in the skill component of safety competency. CONCLUSIONS: Understanding factors that affect safety competency supports the development of effective interventions that may improve safety.

The Nurse Empowerment Program for Nurses in Direct Care Positions.

OBJECTIVE: An educational program including online generic and nursing-specific content was evaluated for self-assessed leadership skill outcomes. BACKGROUND: Leadership development for nurses in direct care positions has not received the same support as for nurses in formal leadership positions. Pandemic and workforce changes make it critical that leadership skills be built at all levels of nursing. METHODS: Early-career nurses (≤10 years of experience) were recruited to participate in an online leadership development program offering 9 LinkedIn Learning courses, 3 leadership courses from Sigma, an e-book, and a discussion board. RESULTS: Most participants who responded to both immediate postsurvey and 3-month follow-up survey (98.6% of n = 69) reported having applied new or improved abilities in their nursing practice to at least a small degree, and the majority reported having done so to a moderate or great degree. CONCLUSION: This online leadership development program was valued and was associated with improved self-assessed leadership.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

Nurses and Midwives as Global Partners to Achieve the Sustainable Development Goals in the Anthropocene.

PURPOSE: To highlight ongoing and emergent roles of nurses and midwives in advancing the United Nations 17 Sustainable Development Goals by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the professions worldwide. DESIGN: Discussion paper. METHODS: Literature review. FINDINGS: Realizing the Sustainable Development Goals will require all nurses and midwives to leverage their roles and responsibility as advocates, leaders, clinicians, scholars, and full partners with multidisciplinary actors and sectors across health systems. CONCLUSIONS: Making measurable progress toward the Sustainable Development Goals is critical to human survival, as well as the survival of the planet. Nurses and midwives play an integral part of this agenda at local and global levels. CLINICAL RELEVANCE: Nurses and midwives can integrate the targets of the Sustainable Development Goals into their everyday clinical work in various contexts and settings. With increased attention to social justice, environmental health, and partnership building, they can achieve exemplary clinical outcomes directly while contributing to the United Nations 2030 Agenda on a global scale and raising the profile of their professions.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Facilitating the Academic Success of International PhD Students.

AIM: This article discusses the challenges of international PhD nursing students and recommends strategies to support them. BACKGROUND: Approximately 10 percent of the students enrolled in research-focused nursing doctoral programs in the United States are non-US residents, challenging schools of nursing to examine ways to support these students. METHOD: We searched five electronic databases using international student* AND doctoral OR graduate as search terms; we integrated the authors' experiences. RESULTS: Faculty and peer support can promote a smooth transition into the United States. Participating on research teams or school committees promotes academic socialization. Dissertation work has multiple unique challenges, including international relevance of topics, translation, funding, and location of the research. CONCLUSION: Faculty advisers and universities can facilitate student adjustment. Once international students become familiar with the academic requirements and culture, they have the capacity to contribute rich, diverse perspectives that greatly enhance the quality of PhD education.

Empowerment of front-line leaders in an online learning, certificate programme.

AIM: To evaluate the effectiveness of an online learning, certificate programme for front-line nurse leaders' sense of empowerment. BACKGROUND: Front-line leaders play a crucial role in health care. Current training is often inadequate. The Institute of Medicine report on The Future of Nursing: Leading Change, Advancing Health (2010) recommends nurses at all levels receive training for their role. METHODS: A pre- to post-study design was used; instruments included Conditions for Work Effectiveness Questionnaire, Psychological Empowerment Scale, intent to stay, and self-reported knowledge and effectiveness of intervention questions. This study evaluated the effects of online learning for 29 acute care front-line leaders in the USA and Australia. RESULTS: Structural empowerment significantly improved, pre-assessment (M = 18.50, SD = 1.6940) to post-assessment (M = 19.47, SD = 1.6940). There was no significant difference in intent to stay or overall psychological empowerment. Participants agreed (24/29, 83%) the intervention contributed to their 'sense of empowerment in their role' and 'ability to create an empowering work environment'. CONCLUSION: Online learning was effective and could be integrated into orientation and/or continuing education plans to develop empowering work environments. IMPLICATIONS FOR NURSING MANAGEMENT: Online learning may be a means of educating and empowering front-line leaders for their role.

Psychiatric disease in surgically treated colorectal cancer patients.

BACKGROUND: Underlying psychiatric conditions may affect outcomes of surgical treatment for colorectal cancer (CRC) because of complex clinical presentation and treatment considerations. We hypothesized that patients with psychiatric illness (PSYCH) would have evidence of advanced disease at presentation, as manifested by higher rates of colorectal surgery performed in the presence of obstruction, perforation, and/or peritonitis (OPP-surgery). MATERIALS AND METHODS: Using data from the 2007-2011 National Inpatient Sample, we identified patients with a diagnosis of CRC undergoing colorectal surgery. In addition to somatic comorbid conditions flagged in the National Inpatient Sample, we used the Clinical Classification Software to identify patients with PSYCH, including schizophrenia, delirium/dementia, developmental disorders, alcohol/substance abuse, and other psychiatric conditions. Our study outcome was OPP-surgery. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to analyze the independent association between each of the PSYCH conditions and OPP-surgery, after adjusting for patient demographics and somatic comorbidities. RESULTS: Our study population included 591,561 patients with CRC and undergoing colorectal cancer surgery, of whom 60.6% were aged 65 years or older, 49.4% were women, and 6.3% had five or more comorbid conditions. Then, 17.9% presented with PSYCH. The percent of patients undergoing OPP-surgery was 13.9% in the study population but was significantly higher for patients with schizophrenia (19.3%), delirium and dementia (18.5%), developmental disorders (19.7%), and alcohol/substance abuse (19.5%). In multivariable analysis, schizophrenia, delirium/dementia, and alcohol/substance abuse were each independently associated with increased rates of OPP-surgery. CONCLUSIONS: Patients with PSYCH may have obstacles in receiving optimal care for CRC. Those with PSYCH diagnoses had significantly higher rates of OPP-surgery. Additional evaluation is required to further characterize the clinical implications of advanced disease presentation for patients with PSYCH diagnoses and colorectal cancer.

Using Text Reminder to Improve Childhood Immunization Adherence in the Philippines.

A comparative descriptive study was conducted to determine the effectiveness of text messages with pictures compared with plain text messages or verbal reminders in improving measles, mumps, and rubella immunization compliance in the rural areas of the Philippines. We found that text messaging with or without pictures is a feasible and useful tool in measles, mumps, rubella immunization compliance for childhood immunization. Texting with pictures (n = 23), however, was no more effective than plain text messaging (n = 19) or verbal reminder (n = 17) in improving measles, mumps, and rubella immunization compliance. Compared with parents who received verbal reminders alone, either type of text reminders was linked to parents bringing their child for measles, mumps, and rubella immunization on a timelier basis, as defined by the difference between the scheduled visit and the actual visit, although this was not statistically significant. Mobile technology that uses text reminders for immunization can potentially improve the communication process between parent, the public health nurse, and healthcare provider. Future studies can explore the application of plain text messages or text messages with pictures to improve compliance more broadly for maternal and child healthcare especially in rural areas of developing countries and may be a helpful tool for health promotion for this population.

Promoting Simulation Globally: Networking with Nursing Colleagues Across Five Continents.

Simulation education is gaining momentum internationally and may provide the opportunity to enhance clinical education while disseminating evidence-based practice standards for clinical simulation and learning. There is a need to develop a cohesive leadership group that fosters support, networking, and sharing of simulation resources globally. The Frances Payne Bolton School of Nursing at Case Western Reserve University has had the unique opportunity to establish academic exchange programs with schools of nursing across five continents. Although the joint and mutual simulation activities have been extensive, each international collaboration has also provided insight into the innovations developed by global partners.

NATIONAL INCIDENCE OF MEDICAL TRANSFER: PATIENT CHARACTERISTICS AND REGIONAL VARIATION.

The aim of this descriptive study was to establish and describe the national incidence, cost, and outcomes of patients that undergo medical transfer. Using discharge data from the Nationwide Inpatient Sample 2011, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, the dataset was analyzed using weighted frequency distribution. Approximately 1.6 million patients are transferred yearly. Transferred patients experience a mean length of stay of 9.3 days (std dv 13.5) versus 4.3 days for patients not transferred (std dv 6.0), and cost more than twice as much (mean $19,234) versus those not transferred (mean $9,469). Additionally, patients who undergo inter-facility transfer cost an additional $15.8 billion annually. Interhospital patient transfers require closer scrutiny regarding appropriateness and future policy implications.

Barriers and Facilitators to Provision of Influenza and Pneumococcal Vaccines in Home Health Care Agencies.

The recommendations for influenza and pneumococcal vaccines are widely known yet the rates of both immunizations for home health care patients are 70 percent or less. The purpose of this study was to identify the facilitators and barriers to immunizations ultimately to improve vaccination rates among home health care patients. Using a multi-case study approach with five agencies and one group of administrators, facilitators included providing patients with a vaccine "card" and using the agency electronic medical record (EMR) for decision support/reminders. We determined that there were patient barriers (misperceptions about vaccines in general, difficulty in recalling vaccine status) and provider barriers (misperceptions about vaccines among health care workers, home health care agencies not receiving accurate information from other providers or difficulty in determining vaccine status).

Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters.

PURPOSE: An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS: Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research. RESULTS: Key contextual factors involve complementary perspectives across multiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flexible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care providers, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, philanthropic organizations, and the business community. CONCLUSION: Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multimethod approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life.

Using low-fidelity simulation with sophomore nursing students in a baccalaureate nursing program.

Opportunities to achieve competency in the psychomotor and cognitive outcomes required of the nursing profession are limited due to shortages of clinical sites and situations. One solution is to use simulation to replicate some of the essential aspects of a clinical situation so it may be readily understood and managed when it occurs in reality. A program developed for sophomore students integrated the pharmacology, health assessment, and pathophysiology theory courses using low-fidelity simulation and computer-assisted instruction. The objectives of the program were based on Quality and Safety Education for Nurses competencies. The simulation strategies were evaluated using the Educational Practice Scale for Simulation, the Student Satisfaction and Self-Confidence in Learning questionnaire, and the Simulation Design Scale. The initial findings are encouraging for promoting active and diverse methods of learning, high and positive expectations for students, self-confidence, and collaborative team-building opportunities.

Urinary catheter policies in home healthcare agencies and hospital transfers due to urinary tract infection.

BACKGROUND: Urinary tract infections (UTIs) are a frequent cause of hospital transfer for home healthcare (HHC) patients, particularly among patients with urinary catheters. METHODS: We conducted a cross-sectional, nationally representative HHC agency-level survey (2018-2019) and combined it with patient-level data from the Outcome and Assessment Information Set (OASIS) and Medicare inpatient data (2016-2018) to evaluate the association between HHC agencies' urinary catheter policies and hospital transfers due to UTI. Our sample included 28,205 patients with urinary catheters who received HHC from 473 Medicare-certified agencies between 2016-2018. Our survey assessed whether agencies had written policies in place for (1) replacement of indwelling catheters at fixed intervals, and (2) emptying the drainage bag. We used adjusted logistic regression to estimate the association of these policies with probability of hospital transfer due to UTI during a 60-day HHC episode. RESULTS: Probability of hospital transfer due to UTI during a HHC episode ranged from 5.62% among agencies with neither urinary catheter policy to 4.43% among agencies with both policies. Relative to agencies with neither policy, having both policies was associated with 21% lower probability of hospital transfer due to UTI (P < .05). CONCLUSION: Our findings suggest implementation of policies in HHC to promote best practices for care of patients with urinary catheters may be an effective strategy to prevent hospital transfers due to UTI.

Influenza vaccination of home health care staff and the impact on patient hospitalizations.

BACKGROUND: Influenza is associated with significant morbidity and mortality for adults aged 65 years and older. Influenza vaccination of health care workers is recommended. There is limited evidence regarding influenza vaccinations among health care workers in the home health care (HHC) setting and their impact on HHC patient outcomes. METHODS: A national survey of HHC agencies was conducted in 2018-2019 and linked with patient data from the Centers for Medicare and Medicaid Services. Adjusted logistic regression models were used to estimate the association between hospital transfers due to respiratory infection during a 60 day HHC episode and staff vaccination policies. RESULTS: Only 26.2% of HHC agencies had staff vaccination requirements and 71.2% agencies had staff vaccination rates higher than 75%. Agency policies for staff influenza vaccination were associated with reduced hospital transfers due to respiratory infection among HHC patients. DISCUSSION: Influenza vaccination rates among HHC staff were low during the 2017-2018 influenza season. Policymakers may consider vaccination mandates to improve health care worker vaccination rates and protect patient safety. CONCLUSIONS: This study sheds light on the potential impact of COVID-19 vaccination among HHC workers on patient outcomes. COVID-19 vaccination mandates could prove to be a vital tool in the fight against COVID-19 variants and infection outbreaks.

Home Health Care Nursing Visit Intensity and Heart Failure Patient Outcomes.

This study is a secondary analysis of data for 107 home health care heart failure patients. The authors investigate the impact of patient characteristics and nursing visit intensity on change in activities of daily living (ADL) status and instrumental activities of daily living (IADL) status and improvement/stabilization of dyspnea. Prior hospital stay (ß = .38, p = .001) and nursing visit intensity (ß = -.39, p = .001) predict improvement in ADL status. The model for change in IADL status is not significant. Patients with more than two comorbidities (OR = 6.5, p = .04) and patients who received higher nursing visit intensity (OR = 7.0, p = .04) are more likely to have improved/stabilized dyspnea at home care discharge.

Communicating Expectations: Developing a Rubric for Peer Reviewers.

The peer-review process is a form of self-regulation by qualified members of the profession to evaluate works done by one or more individuals. However, without a clear structure, the peer-review process can be problematic. Rubrics have been shown to increase peer reviewer satisfaction and author compliance, but only when they convey clear and specific descriptions for task-specific criteria. Sigma developed a peer-review rubric to provide consistency in judging scientific abstracts. An asynchronous provider-directed, provider-paced educational activity can be used to successfully educate peer reviewers on the benefit and use of a peer-review rubric. [J Contin Educ Nurs. 2021;52(2):64-66.].

The state of infection prevention and control at home health agencies in the United States prior to COVID-19: A cross-sectional study.

BACKGROUND: Home health care is a rapidly growing healthcare sector worldwide. Home health professionals face unique challenges related to preventing and controlling infections, which are likely to amplify during an infectious disease outbreak (e.g. SARS-CoV-2). Little is known about the current state of infection prevention and control-related policies and outbreak preparedness at U.S. home health agencies. OBJECTIVES: In this study, we conducted a national survey to assess infection prevention and control-related policies, infrastructure, and procedures prior to the SARS-CoV-2 pandemic. DESIGN: Cross-sectional study. SETTING/PARTICIPANTS: Using a stratified random sample of 1506 U.S. home health agencies, we conducted a 61-item survey (paper and online) from November 9, 2018 to December 31, 2019. METHODS: Survey data were linked to publicly-available data on the quality of patient care, patient satisfaction, and other agency characteristics. Probability weights were developed to account for sample design and nonresponse; Pearson's χ2, Fisher's exact, t-tests or linear regression were used to compare the universe of agencies/respondents and urban/rural agencies. RESULTS: 35.6% of agencies responded (n = 536). Most home health personnel in charge of infection prevention and control have other responsibilities; one-third have no formal infection prevention and control training. Rural agencies are more likely to not have anyone in charge of infection prevention and control compared to those in urban areas. About 22% of agencies implement recommended guidelines when administering antibiotics. Less than a third (26.4%) report that their staff vaccination rates were higher than 95% during the last flu season. Only 48.1% of agencies accept patients requiring ventilation, and of those, 40.9% located in rural areas do not have specific infection prevention and control policies for ventilated patients, compared to 20.8% in urban areas (p < 0.001). Only 39.7% of agencies provide N95 respirators to their clinical staff; rural agencies are significantly more likely to provide those supplies than urban agencies (50.7% vs. 37.7%, p = 0.004). Lastly, agencies report their greatest challenges with infection prevention and control are collecting/reporting infection data and adherence to/monitoring of nursing bag technique. CONCLUSIONS: Prior to the SARS-CoV-2 pandemic, we found that infection prevention and control was suboptimal among U.S. home health care agencies. Consequently, most agencies have limited capacity to respond to infectious disease outbreaks. Staff and personal protective equipment shortages remain major concerns, and agencies will need to quickly adjust their existing infection prevention and control policies and potentially create new ones. In the long-term, agencies also need to improve influenza vaccination coverage among their staff. Tweetable abstract: Infection prevention and control infrastructure, policies and procedures and outbreak preparedness at U.S. home health agencies was found to be suboptimal in nationally-representative survey conducted just prior to the COVID-19 pandemic.