Ambulatory Care Nurse-Sensitive Indicators: A Scoping Review of the Literature 2006-2021.

BACKGROUND/PURPOSE: Meeting recommendations that nurses should partner in leading health care change is hampered by the lack of ambulatory care nurse-sensitive indicators (ACNSIs). This scoping review was conducted to identify evidence regarding ACNSI identification, development, implementation, and benchmarking. METHODS: Following the PRISMA-ScR reporting guide, we performed PubMed/MEDLINE, CINAHL, and Cochrane Library searches for the period January 2006 to March 2021. RESULTS: Twelve of the 1984 articles from 6 countries met inclusion criteria. All focused on identifying, developing/pilot testing indicators, and included structure, process, and outcome indicators. Seven articles were level II and all were at least grade B quality. Leverage points involved leadership support, automated data extraction infrastructure, and validating links between nurses' roles/actions and patient outcomes. CONCLUSIONS: While high-quality work is ongoing to identify clinically meaningful and feasible ACNSIs, knowledge in this field remains underdeveloped. Prioritizing this work is imperative to address gaps and facilitate national strategic health care goals.

Improving 9.5 Million Lives: Pilot Testing Ambulatory Care Nurse-Sensitive Quality Indicators.

OBJECTIVE: The aim of this study was to evaluate scientific acceptability, feasibility, utility, and value of ambulatory care nurse-sensitive quality indicators (ACNSIs) in military outpatient clinics. BACKGROUND: Optimizing healthcare quality and cost requires scientifically sound metrics. However, ACNSI development and measurement have lagged behind inpatient nurse-sensitive indicators. Validated and reliable ACNSIs are urgently needed to maximize nurses' efforts to improve healthcare quality. METHODS: Two staffing and 4 patient-centered ACNSIs were pilot tested in 5 military clinics over a 6-month period using a mixed-methods design. RESULTS: Reliability and validity were generally acceptable. Most ACNSIs demonstrated feasibility, utility, and value for performance measurement. Challenges to using ACNSIs include absence of standardized administrative and clinical processes, infrastructure, and leadership and technological support. CONCLUSIONS: These ACNSIs show promise as valid performance metrics. Provider- and nurse-level metrics may synergistically improve practice, enhancing the team approach so critical to ambulatory care.

Ambulatory Care Nurse-Sensitive Indicators Series: Capturing the Role of Nursing in Ambulatory Care--The Case for Meaningful Nurse-Sensitive Measurement.

The nation has been on a quest to advance quality in providing health care services and improving patient outcomes. The challenge has been to identify and define metrics that will demonstrate improvement. Acute care settings have a fairly well-established system of quality measurement, but ambulatory care systems are in less-developed stages. Imperative to accurate quality measurement in ambulatory care is to identify and define metrics that reflect the value of registered nurses to improved patient care and outcomes as well as to the organization. The American Academy of Ambulatory Care Nursing (AAACN) established a task force to determine appropriate measures of nursing quality. The task force spent 2 years investigating measures and produced an Industry Report that addresses measures of nursing quality. This article is the first in a series of articles that will reveal and discuss the contents of the Industry Report.

Nursing-Sensitive Indicators in Ambulatory Care.

Ambulatory nursing care can be difficult to comprehend in all its complexity. In August 2013, the American Academy of Ambulatory Care Nursing commissioned a task force to identify nursing-sensitive indicators specific to ambulatory care settings. Given the great variation in settings, staff mix, patient populations, role dimensions, skill sets, documentation systems, and resources, determining metrics that apply across the entire continuum of care is a daunting task. However, it is incumbent upon nurse leaders to define the metrics that will promote the value of the registered nurse in ambulatory practice and care coordination. Once initial measures are identified, piloted, and validated, the infrastructure can be created for ongoing benchmarking and collaboration. The long-term goal is to leverage professional nursing practice, based in the ambulatory care setting, to improve quality, safety, and cost in health care.

Experience with voluntary severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of asymptomatic staff at the National Institutes of Health for one year.

Voluntary asymptomatic severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing was provided by the NIH Clinical Center over 1 year. Among 105,927 tests, 0.2% were positive. Among eligible staff, 79% participated with variable frequency and 61% of positive individuals had symptoms at the time of testing. Saliva specimen collection was chosen as an option less frequently than midturbinate collection.

Clinician integrity and limits to patient autonomy.

A 28-year-old man with chronic granulomatous disease developed worsening respiratory status in the setting of chronic bacterial and fungal infections. The attending physician recommended transfer to the intensive care unit (ICU), but the patient declined. The patient understood that the nurses in the ICU have expertise in caring for patients with poor respiratory function. He also understood that he faced an increased risk of dying if he remained on the medical ward. At the same time, the patient was familiar with the nurses on the medical ward and felt comfortable there. Unsure of whether it was appropriate for clinicians to agree to provide less than optimal care for a critically ill patient, the clinicians on the medical ward requested a bioethics consultation. This article reviews the ethical issues that arise when patients ask clinicians to provide less than optimal care. Although it is well established that clinicians ought to respect patient autonomy, that obligation conflicted, in the present case, with the clinicians' sense of professional integrity. Future research on this vital but underexplored topic is needed to determine the extent to which clinicians' professional integrity places limits on the types of patient requests to which they should agree.

Unveiling the silent threat among us: leveraging health information technology in the search for asymptomatic COVID 19 healthcare workers.

Assuring the safety of both patients and healthcare workers (HCWs) in hospitals has been the primary focus of every healthcare organization during the COVID 19 pandemic. This article discusses the NIH Clinical Center's interdisciplinary approach to deploying an organizational Asymptomatic Staff Testing System.

Educating Health Care Providers in Treatment of Patients With Ebola Virus Disease.

Nurses manage patients with common infectious diseases by following institutional guidelines based on expert advice, evidence in the literature, and a wealth of experience. Today nurses are challenged to provide care to patients with multidrug-resistant organisms and virulent infectious diseases such as Ebola virus disease. Management of some patients with virulent infectious diseases occurs in the context of minimal experience with the pathogen, course of infection, diagnostics, nursing care, and treatment. Limited evidence exists in the US or international literature about direct nursing care of patients with virulent infectious diseases in the community, clinic, or hospital. Workplaces may have insufficient supplies, equipment, and knowledge of the management of patients with these diseases. At the National Institutes of Health Clinical Center in Bethesda, Maryland, nursing education strategies for enhanced experiential learning are used to prepare staff to care for patients with virulent infectious diseases, especially Ebola virus disease.

Defining clinical research nursing practice: results of a role delineation study.

Clinical research nursing is a specialty nursing practice focused on the care of research subjects and implementation of clinical research. A five-dimensional model (Clinical Practice [CP], Study Management, Care Coordination and Continuity, Contributing to the Science [CS], Human Subjects Protection) has been validated nationally to represent the domain of clinical research nursing practice. The purpose of this study was to describe the frequency and importance of activities within each dimension as performed by nurses in clinical research and to describe differences between roles. One thousand and four nurses from the NIH Intramural Campus in Bethesda, Maryland, were invited to participate in an anonymous web-based survey. Participants (N = 412) were predominantly female (90%) with ≥11 years research experience (70%). Two hundred eighty-eight respondents (70%) identified themselves as clinical research nurses (CRNs) and 74 (18%) as research nurse coordinators (RNCs). CP activities were reported most frequent and important whereas CS activities were least frequent and important. CRN and RNC activity frequency differed across all dimensions (p < 0.001) with CRNs reporting significantly higher levels of CP activities and significantly lower levels in other dimensions. Delineating specialty activities and practice across roles enhances the understanding of nurses' role in clinical research and provides groundwork for role-based training.

Validating the clinical research nursing domain of practice.

PURPOSE/OBJECTIVES: To develop and validate a taxonomy for the domain of clinical research nursing. DESIGN: Survey. SETTING: Clinical research settings in the United States. SAMPLE: A purposefully selected expert panel of 22 nurses who were actively practicing or supervising in a clinical research environment. METHODS: A study team consisting of nurses with experience in clinical research synthesized peer-reviewed articles, academic curricula, professional guidelines, position descriptions, and expert opinion. Using the Delphi technique, three rounds of surveys were conducted to validate the taxonomy. The three sequential questionnaires were completed over five months. MAIN RESEARCH VARIABLES: Activities performed by nurses in a clinical research setting. FINDINGS: A taxonomy for clinical research nursing was validated with five dimensions and 52 activities: Clinical Practice (4 activities), Study Management (23 activities), Care Coordination and Continuity (10 activities), Human Subjects Protection (6 activities), and Contributing to the Science (9 activities). CONCLUSIONS: This study validated activities for direct care providers and nurses with the primary focus of research coordination. The findings identify a variety of activities that are unique to nurses in a clinical research setting. IMPLICATIONS FOR NURSING: Nurses play an integral role in the clinical research enterprise. Validating a taxonomy for the specialty of clinical research nursing allows for roles to be compared across settings, competency requirements to be defined, and nursing organizations to be guided in the development of specialty certification.