The Implementation and Evaluation of an Innovative Clinical Immersion Experience for Undergraduate Nursing Students.

ABSTRACT: The demand for clinical placement sites for nursing students requires the development of alternative clinical settings. This study aimed to evaluate an innovative learning experience for nursing students at the World Scout Jamboree. Nineteen students and four faculty were assigned to base camp medical facilities, providing care for more than 45,000 campers. Student pre- and posttests reported significant increases in cultural awareness, communication skills, and clinical problem-solving ability; students rated interprofessional teamwork highly. Findings reveal promising direction for use of alternative clinical sites to fill the gap in clinical placements while offering unique learning experiences.

Video Monitoring for Fall Prevention and Patient Safety: Process Evaluation and Improvement.

BACKGROUND: Although video monitoring has been shown to reduce falls among at-risk hospitalized patients, there are no identified best practices for the monitoring process. PURPOSE: The purpose of this study was to evaluate the monitoring process at a large teaching hospital, with the goal of making improvements and standardizing monitoring practices. METHODS: Patients and nursing staff perceptions about the video monitoring process were elicited via survey, and perceptions of monitor technicians were obtained through structured interview. RESULTS: Video monitoring was perceived by all groups as effective in promoting patient safety. Nursing staff and monitor technicians also indicated that monitoring protects patient safety in other high-risk situations. Suggestions for improvement and standardization in the monitoring process were made by study participants. CONCLUSIONS: Suggested changes and standardization of the monitoring process have been implemented in the study facility. Insights are provided for other facilities considering video monitoring for patient safety.

Nurses' Research Capacity, Use of Evidence, and Research Productivity in Acute Care: Year 1 Findings From a Partnership Study.

OBJECTIVE: The aim of this study was to compare baseline and year 1 findings from a research-focused academic-service partnership (ASP) designed to increase research capacity, evidence-based practice (EBP) use, and research productivity. BACKGROUND: Few combined individual and organizational best practices could be found that successfully sustain EBP. An ASP model, using structural and enabling processes, was evaluated. METHODS: Using a nonexperimental pretest-posttest design, 67 acute care nurses who participated at baseline were resurveyed, and year 1 focus groups were conducted. RESULTS: Knowledge increased from baseline to year 1, and nurses who participated on a committee with an embedded scientist were more knowledgeable at year 1 than those who did not. While EBP confidence and self-reported EBP use did not improve, research productivity increased 33%. Year 1 focus groups identified facilitators and barriers. CONCLUSION: Findings support some EBP benefits related to a research-focused ASP including research productivity; however, implementation barriers and contextual factors may have limited potential outcomes.

Protecting Patient Safety: Can Video Monitoring Prevent Falls in High-Risk Patient Populations?

Despite implementation of many prevention strategies, patient falls in hospitals continue to be a significant safety problem, causing nursing staff and administrators to seek innovative means to further reduce falls among hospitalized patients. This article describes the feasibility and impact of implementing centralized video monitoring on the safety of patients identified as high risk for falls, as well as implications of video monitoring in the acute care setting.

Nurses' research capacity and use of evidence in acute care: baseline findings from a partnership study.

OBJECTIVE: The aim of this study is to report baseline findings from a research-focused academic-service partnership. BACKGROUND: Despite widespread efforts, the research-practice gap remains considerable. A research-focused academic-service partnership may offer a strategy for decreasing this gap. METHODS: With the use of a shared model and a descriptive correlational design, 75 acute care nurses were sampled from July to October 2013. RESULTS: Attitudes toward evidence-based practice (EBP) were favorable, but knowledge of common research language was low and EBP confidence was reported as moderate. Evidence-based practice confidence had the strongest relationship to EBP use and was greatest in those who held professional certification and were more educated. CONCLUSION: Findings continue to demonstrate the need for new approaches to reduce the research-practice gap.

A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation.

AIMS AND OBJECTIVES: To quantify quantitative outcomes of a practice change to a blended form of bedside nursing report. BACKGROUND: The literature identifies several benefits of bedside nursing shift report. However, published studies have not adequately quantified outcomes related to this process change, having either small or unreported sample sizes or not testing for statistical significance. DESIGN: Quasi-experimental pre- and postimplementation design. METHODS: Seven medical-surgical units in a large university hospital implemented a blend of recorded and bedside nursing report. Outcomes monitored included patient and nursing satisfaction, patient falls, nursing overtime and medication errors. RESULTS: We found statistically significant improvements postimplementation in four patient survey items specifically impacted by the change to bedside report. Nursing perceptions of report were significantly improved in the areas of patient safety and involvement in care and nurse accountability postimplementation. However, there was a decline in nurse perception that report took a reasonable amount of time after bedside report implementation; contrary to these perceptions, there was no significant increase in nurse overtime. Patient falls at shift change decreased substantially after the implementation of bedside report. An intervening variable during the study period invalidated the comparison of medication errors pre- and postintervention. There was some indication from both patients and nurses that bedside report was not always consistently implemented. CONCLUSIONS: Several positive outcomes were documented in relation to the implementation of a blended bedside shift report, with few drawbacks. Nurse attitudes about report at the final data collection were more positive than at the initial postimplementation data collection. RELEVANCE TO CLINICAL PRACTICE: If properly implemented, nursing bedside report can result in improved patient and nursing satisfaction and patient safety outcomes. However, managers should involve staff nurses in the implementation process and continue to monitor consistency in report format as well as satisfaction with the process.

Incorporating bedside report into nursing handoff: evaluation of change in practice.

Nursing shift report on the medical-surgical units of a large teaching hospital was modified from a recorded report to a blend of both recorded and bedside components. Comparisons between baseline and postimplementation data indicated increased patient satisfaction and nurse perception of accountability and patient involvement but reduced nurse perceptions of efficiency and effectiveness of report. Patient falls at shift change and medication errors were reduced, whereas nurse overtime remained unchanged.

Investigating bedside nursing report: a synthesis of the literature.

A systematic review of the literature was completed to investigate advantages and drawbacks of bedside nursing report. Qualitative evidence indicated several benefits, but quantitative evidence was not generalizable.

STUDENT EVALUATION OF THE CLINICAL EDUCATION: ENVIRONMENT: DEVELOPMENT AND TESTING OF THE SECEE VERSION 4.

Background and Purpose: Nursing education programs must ensure the quality of student clinical learning experiences. The purpose of this paper is to present psychometric data on the revised digital version of the Student Evaluation of Clinical Education Environment (SECEE) v.4 instrument. Methods: Data were extracted retrospectively from student SECEE evaluations completed between 2016 and 2019. Results: Reliability coefficients for each of the three SECEE subscales were .92 and above. Exploratory factor analysis indicated strong loadings of all selected items on the pre-identified subscales, explaining 71.8% of total score variance. The inventory scale scores were able to discriminate differences between individual clinical sites, between clinical faculty, and between student level in the program. Conclusion: Analysis supports the reliability and validity of the revised instrument and a sizable improvement in total variance accounted for by the contained subscales compared to previous SECEE versions.

The impact of a live therapeutic music intervention on patients' experience of pain, anxiety, and muscle tension.

This exploratory study demonstrated the positive impact of live music as a holistic patient intervention directed toward reducing pain, anxiety, and muscle tension levels of patients admitted to a tertiary care center for an emergent medical condition. Music can be combined with other holistic interventions to positively impact patient outcomes.

Assessing nursing student perceptions of the clinical learning environment: refinement and testing of the SECEE inventory.

The Student Evaluation of Clinical Education Environment (SECEE) instrument was developed to provide information about the quality of the student clinical learning environment to assist clinical agencies, nursing faculty, and administers in selecting clinical sites that best promote student learning. The SECEE Version 3 was used in all clinical courses at a large mid-Atlantic university from 2001 to 2005. Data from more than 2,700 inventories were analyzed to assess instrument reliability and validity. Internal consistency reliability based on coefficient alpha was .94, with subscale alphas ranging from .82 to .94. Comparisons by analysis of variance revealed significant differences in student evaluations based on both clinical sites and clinical faculty. Confirmatory factor analysis supported the predetermined three factors (subscales) and subscale item content, except for two items. The SECEE Version 3 demonstrated strong internal consistency reliability and the ability to discriminate between student evaluations of distinct clinical sites and faculty and provided practically useful information to both faculty and agency staff.

Use of Seva Stress Release Acupressure to Reduce Pain, Stress, and Fatigue in Patients Hospitalized for Cancer Treatment.

Patients undergoing treatment for cancer often experience stress, fatigue, and pain during their treatment. Medical management of these symptoms can cause additional adverse effects, but it is possible that noninvasive complementary therapies may be able to reduce these symptoms without unwanted adverse effects. The purpose of this study was to assess the feasibility and impact of the Seva Stress Release acupressure protocol on stress, fatigue, pain, and vital signs of patients hospitalized for cancer treatment. Thirty patients receiving cancer treatment and experiencing stress, fatigue, and pain were recruited for the study. After obtaining informed consent, baseline data (survey and vital signs) were obtained, followed by administration of the Seva Stress Release. After the intervention, vital signs were obtained, and patients completed 2 additional surveys. After Seva, patient stress, fatigue, pain, heart rate, and respirations were significantly decreased (P = .000). Sixty-six percent of participants experienced symptom relief for at least 1 to 4 hours. Qualitative findings also indicated that patients reported better sleep and mental clarity after the intervention. The Seva protocol could be taught to nurses and be used as an independent intervention for patients experiencing adverse effects of cancer treatment, to promote comfort and reduce stress and fatigue.

The impact of active/cooperative instruction on beginning nursing student learning strategy preference.

Rapid changes in the nursing field and high demand for practicing nurses put pressure on nursing faculty to educate increasing numbers of nursing students, often without corresponding increases in resources. Although the use of active and cooperative instruction methods in the classroom has been associated with improved student learning, these practices require increased effort on the part of both faculty and students. In addition, little is known about whether these methods influence student nurses' use of these more elaborative processing strategies in their independent study. The purpose of this quasi-experimental investigation was to identify the impact of incorporating active and cooperative classroom instructional activities on student preference for teaching methods and use of learning strategies in independent study. A convenience sample of beginning baccalaureate nursing students at a large Mid-Atlantic University was randomly assigned by the registrar to two class sections. Students in one section received primarily active/cooperative instruction, while the other received primarily traditional lecture-based instruction. Results indicated that student nurses exposed to active/cooperative instructional methods had an increased preference for these methods after a semester of instruction, while those exposed to traditional instruction had a higher preference for traditional methods. In addition, students participating in active class instruction reported increased preference for more elaborative independent study strategies, although overall preference for both groups indicated a reliance on surface study strategies of memorization and recall. Implications for use of instruction and student testing methodologies are presented.

Incorporating Health Literacy Screening Into Patients' Health Assessment.

Low health literacy (HL) has been associated with several negative health outcomes, yet routine HL screening is not commonplace. This study's purpose was to determine the feasibility of incorporating HL screening into the electronic health record (EHR) of patients admitted to a large Mid-Atlantic teaching hospital. After Registered Nurse (RN) training, the HL screening was implemented for all adult patients upon admission. After implementation, RNs were surveyed about the feasibility of HL screening, and patient EHRs were reviewed for HL status. Results indicated that RNs were receptive to HL screening. Approximately 20% of all patients screened were at risk for low HL, with HL scores decreasing as age increased. Patients with low HL had significantly higher hospital readmissions, even when controlling for age and number of health conditions. Further research is needed to determine how healthcare providers alter their patient interactions if they have knowledge that patients are at risk for having low HL.

Implementation of a Brief Abuse and Basic Needs Tool: Impact on Utilization of Social Services in Ambulatory Medical Clinics.

Domestic violence (DV) screening has become increasingly common in recent years; however, many organizations still do not practice universal screening, and there is considerable debate concerning the best screening tool for detecting DV. The current research suggests that a brief tool would be ideal and that existing brief tools are comparable to more extensive instruments. Per Joint Commission standards, the ambulatory clinics at West Virginia University Hospitals instituted the use of the Functional Health Screening (FHS), a three-item tool that screens for unexplained weight changes, DV, and basic needs deficits. This tool is administered at the beginning of every outpatient clinic visit. This study includes a retrospective chart review to investigate the detection rate of this tool for DV and basic needs deficits, the increased utilization of social services, and nursing attitudes concerning FHS.

Nurses and nutraceuticals. Knowledge and use.

Increasing use of herbal products by the American public should prompt nurses to routinely address herbal use during patient interactions. However, whether nurses possess the knowledge required to discuss risks and benefits of herbal use with patients is unknown. This study was undertaken to investigate registered nurses' knowledge about and use of five common herbal products: ginkgo, St. John's wort, ginseng, garlic, and echinacea. One hundred forty-nine (30%) of 500 randomly selected nurses responded to a mailed questionnaire addressing the frequency of use, purpose, side effects, and interactions of the above products. Most respondents had neither used nor suggested use of the products. Respondents were relatively unfamiliar with product characteristics, although somewhat more familiar with purpose than with side effects or interactions. No knowledge differences were identified according to practice area or number of years in practice, but differences were noted according to educational level and use of specific products.

Efficiently assessing patient health literacy: the BHLS instrument.

Although health literacy limitations are common among patient populations, no efficient yet comprehensive health literacy assessment tool is available to nurses for use in busy health care settings. This study presents beginning evidence for the validity and reliability of a new health literacy assessment tool, the Brief Health Literacy Screen (BHLS). One hundred patients attending four primary care clinics completed the BHLS and the Test of Functional Health Literacy in Adults (TOFHLA) short form and answered questions about the health literacy tools. Findings indicated significant correlations between BHLS and shortened version of the TOFHLA (S-TOFHLA) scores, with higher correlations between BHLS items addressing written health literacy and the S-TOFHLA. Comparative discrimination findings were significant at BHLS cut point of 18 and S-TOFHLA cut point less than 23. Patients rated the BHLS significantly less difficult to complete than the S-TOFHLA. Results of preliminary testing indicate the BHLS is a potentially efficient, effective, and patient-friendly screening tool for health literacy.

The impact of medical terminology on readability of patient education materials.

Most health-related literature is written above the reading ability of the lay audience; however, no studies to date have identified the impact of medical terms on readability of health education materials. The purpose of this study was to identify whether there was a change in calculated reading levels of patient education brochures after medical terms were removed from analysis passages. The reading levels of 5 patient education brochures were analyzed before and after removal of medical terms, using both the Fry and Simple Measure of Gobbledegook (SMOG) readability formulas. Results indicated that the reading levels for all brochures were significantly lower after removal of medical terminology, but they remained above the 5th to 6h grade level recommended by health education experts. Findings hold implications for healthcare professionals in relation to the development and evaluation of patient education materials.