Impacting the Patient's Experience in a Children's Hospital Using a Communication Bundle Strategy.

BACKGROUND: The aim of this quality improvement project was to determine whether a communication bundle would impact parents' ratings of nurse-child communication in relation to (a) how often the nurse listened carefully to the child and (b) how often the nurse explained things in a way easy for the child to understand. LOCAL PROBLEM: The Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores on the unit lagged behind the hospital's 75th percentile external benchmark established by the National Research Corporation. METHODS: A convenience sample of the unit's staff participated in the project. INTERVENTIONS: The outcome measure was a comparison of Child HCAHPS scores and percentile ranks for the questions pre- and postimplementation of the communication bundle. RESULTS: Following implementation of the communication bundle, the unit's patient satisfaction scores for both questions exceeded the 75th-percentile benchmark. CONCLUSIONS: This project enhanced nurse communication at the bedside and the parent's perception of nurse-child communication.

Transitioning Nurse Handoff to the Bedside: Engaging Staff and Patients.

The emergency department is a complex environment in which reliable communication is vital for safe patient care. Communication during nurse shift report can be risky without an effective report process in practice. Reliability improves with the use of a standardized, patient-centered nurse handoff process. Quality improvement methods were used to promote reliable information exchange during nurse shift handoff through the implementation of a standardized, patient-centric bedside report process. Forty-six hospital-based emergency nurses participated in the project. Outcomes were measured through observation of bedside report process, nurse, and patient surveys. Of 13 handoffs observed, 92% occurred at the bedside and 54% of patients actively participated in the report process. The offgoing nurses adopted most elements of the handoff process, while the oncoming nurses were less successful. Nurses believed that the new process influenced their ability to respond to patient needs and patients were more satisfied with nurses. A structured, patient-centered bedside handoff process can reduce safety risk and promote satisfaction with care through reliable information exchange. This implementation template for bedside handoff engages staff and patients while translating best practice.

Implementing an Alcohol Withdrawal Protocol: A Quality Improvement Project.

This quality improvement project evaluates the effectiveness of implementing an evidence-based alcohol withdrawal protocol in an acute care setting. Patient outcomes, length of stay, and nurses' knowledge and satisfaction with care are compared pre- and postimplementation. Implementation resulted in significant reduction of restraint use, transfers to critical care, 1:1 observation, and length of stay, whereas no reduction was seen in rapid response calls. Nurses' knowledge post-alcohol withdrawal protocol education increased and satisfaction with patient care improved.

Mitigating the Impact of Nurse Manager Large Spans of Control.

Nurse managers are instrumental in achievement of organizational and unit performance goals. Greater spans of control for managers are associated with decreased satisfaction and performance. An interprofessional team measured one organization's nurse manager span of control, providing administrative assistant support and transformational leadership development to nurse managers with the largest spans of control. Nurse manager satisfaction and transformational leadership competency significantly improved following the implementation of large span of control mitigation strategies.

Frontline Nurse Engagement and Empowerment: Characteristics and Processes for Building Leadership Capacity.

Improving health care quality is the responsibility of nurses at all levels of the organization. This article describes a study that examined frontline staff nurses' professional practice characteristics to advance leadership through the understanding of relationships among practice environment, quality improvement, and outcomes. The study design was a descriptive quantitative design at 2 time points. Findings support the use of research and quality processes to build leadership capacity required for positive resolution of interdisciplinary operational failures.

Bridge to shared governance: developing leadership of frontline nurses.

Transforming health care systems to improve quality is the responsibility of nurse executives and frontline nurses alike, yet frontline nurses are often ill-prepared to share leadership and accountability needed for transformation. The aim of this qualitative study was to describe the process used to build leadership capacity of frontline nurses engaged in resolving operational failures interrupting nursing care. The leadership development process served to bridge staff transition to shared governance. This institutional review board-approved qualitative research was designed to identify the effects of mentoring by the chief nursing officer and faculty partners on leadership development of frontline nurses working to find solutions to operational failures. Twelve nurses from 4 medical surgical units participated in a Frontline Innovations' nurse-led interdisciplinary group, which met over 18 months. Transcriptions of audiotaped meetings were analyzed for emerging process and outcome themes. The transcripts revealed a robust leadership development journey of frontline nurses engaged in process improvement. Themes that emerged from the mentoring process included engagement, collaboration, empowerment, confidence, and lifelong learning. The mentoring process provided frontline nurses the leadership foundation necessary to initiate shared governance.

Effectiveness of simulation-based orientation of baccalaureate nursing students preparing for their first clinical experience.

This study evaluated the effectiveness of a 2-day, simulation-based orientation for baccalaureate nursing students preparing to begin their first clinical experience. Students were recruited for participation in the study from a clinical foundation course. Actors (standardized patients) provided students with the chance to engage with simulated real patients in realistic clinical situations prior to entering the clinical setting. Students' perceived stress, knowledge acquisition, anxiety, self-confidence, and satisfaction with the orientation process were assessed. Findings indicated a statistically significant increase in knowledge of and confidence in skills needed when first entering the clinical setting and a decrease in anxiety following the orientation activity. Students had a positive attitude about interaction with real patients, faculty, and other students during the experience. Improved self-confidence and satisfaction were reported as a result of participation in simulation-based orientation.

Transforming Care at the Bedside (TCAB): enhancing direct care and value-added care.

AIM: The purpose of this study was to examine the effectiveness of a Transforming Care at the Bedside initiative from a unit perspective. BACKGROUND: Improving patient outcomes and nurses' work environments are the goals of Transforming Care at the Bedside. Transforming Care at the Bedside creates programs of change originating at the point of care and directly promoting engagement of nurses to transform work processes and quality of care on medical-surgical units. METHODS: This descriptive comparative study draws on multiple data sources from two nursing units: a Transforming Care at the Bedside unit where staff tested, adopted and implemented improvement ideas, and a control unit where staff continued traditional practices. Change theory provided the framework for the study. RESULTS: Direct care and value-added care increased on Transforming Care at the Bedside unit compared with the control unit. Transforming Care at the Bedside unit decreased in incidental overtime. Nurses reported that the process challenged old ways of thinking and increased nursing innovations. Hourly rounding, bedside reporting and the use of pain boards were seen as positive innovations. CONCLUSIONS: Evidence supported the value-added dimension of the Transforming Care at the Bedside process at the unit level. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses recognized the significance of their input into processes of change. Transformational leadership and frontline projects provide a vehicle for innovation through application of human capital.

"Change can be good": unit perspectives on transforming care at the bedside.

BACKGROUND: How do nurses commit to effecting change, the kind of change that will transform both care received and the caregiver? This was the mission of Transforming Care at the Bedside, the 2003 initiative sponsored by the Robert Wood Johnson Foundation and the Institute of Healthcare Improvement. OBSERVATIONS AND OBJECTIVES: This analysis reflects processes and context of unit change through Transforming Care at the Bedside. Organizational leadership includes engagement in change. SUBJECTS AND METHODS: Descriptions of change process were solicited from stakeholder interviews and focus groups to evaluate and make recommendations for the future. RESULTS AND CONCLUSIONS: Stakeholders recognized that "Change can be good!" Reflection and strategic evaluation strengthen planning for sustainability supporting staff engagement and transformational leadership in an academic health science setting.

Concept mapping a baccalaureate nursing program: a method for success.

The understanding of curricular design and development is paramount for faculty. For novice faculty, learning teaching methods commonly takes precedence over understanding curriculum development. Professional accrediting bodies of nursing programs require curriculum course content to be pertinent and flow logically. Baccalaureate nursing programs can choose to be accredited by the Commission on Collegiate Nursing Education. The purpose of this article is to describe an educational innovation that one College of Nursing implemented to orient new faculty to the curriculum and prepare for an accreditation renewal. Assigned faculty developed and implemented a concept mapping process aimed to evaluate and revise course content based on national standards and guidelines. Undergraduate faculty understanding and ownership of the curriculum was evident throughout the process. The concept mapping process proved to be an innovative approach to enhance the curriculum and equip faculty with an understanding of the relationship between concepts and course content.

GROWTH: A Strategy for Nursing Student Retention.

BACKGROUND: Faculty focused on student success may look for opportunities to facilitate nursing student retention. Students commonly struggle with study skills, time management, and critical thinking in the nursing curriculum. This article presents the GROWTH (Growth, Readiness, Opportunity, Work, Time management, and Habits) form, an open-ended question form aimed at the identification of affective, environment, and psychosocial variables known to impede nursing student success. METHOD: Faculty used the GROWTH form when meeting with students in the beginning of the prelicensure program. RESULTS: Using the GROWTH form facilitates structured, focused faculty-student meetings and individualized action plans for students who are not achieving their desired level of academic performance. The GROWTH form also encourages students to take ownership of their own learning. CONCLUSION: Using the GROWTH form facilitates faculty-student meetings and encourages student self-reflection. Future research should investigate whether use of the GROWTH form has further implications for program progression and retention. [J Nurs Educ. 2019;58(3):173-177.].

Fall Prevention for Older Adults Receiving Home Healthcare.

Falls pose a significant risk for community-dwelling older adults. Fall-related injuries increase healthcare costs related to hospitalization, diagnostic procedures, and/or surgeries. This article describes a quality improvement project to reduce falls in older adults receiving home healthcare services. The fall prevention program incorporated best practices for fall reduction, including fall risk assessment, medication review/management, home hazard and safety assessment, staff and patient fall prevention education, and an individualized home-based exercise program. The program was implemented and evaluated during a 6-month time frame. Fewer falls occurred post implementation of the falls prevention program with no major injuries.

Improving transition of care for veterans after total joint replacement.

BACKGROUND: Patients transitioning from hospital to home are at risk for readmission to the hospital. Readmissions are costly and occur too often. Standardized discharge education processes have shown to decrease readmissions. PURPOSE: The purpose of this quality improvement project was to utilize evidence-based practice changes to decrease 30-day all-cause readmissions after total joint replacement. METHODS: Review of literature revealed that improved discharge education can decrease unnecessary readmissions after discharge. A quality improvement project was developed including standardized total joint replacement discharge education, teach-back education methodology, and improved postdischarge telephone follow-up. The quality improvement project was initiated and outcomes were evaluated. OUTCOMES: Improving coordination of the discharge process, enhanced education for patients/caregivers, and postdischarge follow-up decreased total joint replacement readmissions.

Evidence-based nursing education: effective use of instructional design and simulated learning environments to enhance knowledge transfer in undergraduate nursing students.

Much confidence has been placed in the nursing profession's potential to positively impact the U.S. health care system. However, concerns about patient safety and quality beckon health care providers to reassess traditional practices. Professional nursing programs aim to prepare novice nurses with strong clinical skills to effectively and safely care for patients. Faculty shortages and fewer clinical sites for students present challenges to faculty. Limited exposure in the clinical practice setting hinders the development of intuition. In addition, new graduates often enter practice with an unclear understanding of their role at the bedside. Educators are challenged to find innovative teaching strategies to effectively prepare new graduates for entering the workforce. Simulation has been shown to be a valuable teaching-learning strategy. Using an instructional design model that is student centered as the basis for simulation activities in an undergraduate curriculum is one method to effectively provide much needed clinical experience in a safe learning environment. This article details the application of the ADDIE (analysis, design, development, implementation, evaluation) model of instructional design to the use of simulation in nursing education in an effort to facilitate improved clinical performance in new graduate nurses.