Initial outcomes and lessons learned from implementation of an online diversity & inclusion community.

BACKGROUND: There is an opportunity to build online communities and digitize inclusive excellence such that all students, staff, and faculty can benefit. However, literature illustrating actionable strategies for creating online communities and mitigating barriers related to engagement is limited. PURPOSE: We evaluated the feasibility, functionality, and usage of a college of nursing's (CON) online diversity and inclusion communication platform (i.e., D&I Community). METHODS: From survey and college-wide discussion, we found that CON members are interested in employing opportunities for diversity, equity, and inclusion (DEI) discussions and engaging with DEI resources, but lack of time, competing priorities, and lack of awareness of the D&I Community were barriers to participation. DISCUSSION: We are prepared to modify processes to improve engagement and promote a sense of belonging for all CON members. CONCLUSION: Implementation and sustainability of this D&I Community require continual resource investment. Scalability can be considered once processes have been fully refined.

An interdisciplinary approach to safe opioid prescribing and administration for surgical patients at an academic medical center.

AIM AND OBJECTIVES: To explore and understand the current practice, perceptions, and knowledge of general surgery trainees, advanced practice providers, and surgical nurses regarding opioid prescribing and administration. To this end, a novel opioid education and training was introduced to educate these practitioners on safe opioid practices in surgical patients. BACKGROUND: National awareness of the opioid epidemic has increased significantly in the last several years. However, there remain a disturbingly high number of opioid prescriptions written in the US indicating a need for improved provider and nurse education. This involves increasing awareness and understanding of national guidelines as well as implementing multi-modal therapy to treat pain. DESIGN: Pre-post-intervention quality improvement project. METHODS: An opioid education and training involving a morphine equivalent daily dosing calculator in the electronic medical record was provided to 26 surgical trainees, eight advanced practice providers and 97 surgical nurses in November 2019. Perceptions, current practice and knowledge were measured using a pre- and post-intervention survey (SQUIRE checklist). RESULTS: The survey results showed a positive clinical change in perception of opioid use in surgical patients following the intervention and a modest decrease in the average morphine equivalent daily dosing at discharge in general and transplant surgery patients. CONCLUSIONS: Effective pain management for surgical patients must be individualised. Safe opioid prescribing should involve an interdisciplinary approach with all members of the team undergoing assessment of their opioid knowledge and prescribing habits, easily accessible training tools and opioid calculators in the electronic medical record. RELEVANCE TO CLINICAL PRACTICE: Our initiative may provide useful information to settings that replicate use of a morphine equivalent daily dosing calculator in the electronic medical record. Utilisation of safe opioid prescribing tools in the electronic medical record and continuing education for providers and nurses can help ensure the safety of surgical patients.

Built Environment Approaches to Increase Physical Activity: A Science Advisory From the American Heart Association.

Engaging in regular physical activity is one of the most important things people can do to improve their cardiovascular health; however, population levels of physical activity remain low in the United States. Effective population-based approaches implemented in communities can help increase physical activity among all Americans. Evidence suggests that built environment interventions offer one such approach. These interventions aim to create or modify community environmental characteristics to make physical activity easier or more accessible for all people in the places where they live. In 2016, the Community Preventive Services Task Force released a recommendation for built environment approaches to increase physical activity. This recommendation is based on a systematic review of 90 studies (search period, 1980-June 2014) conducted using methods outlined by the Guide to Community Preventive Services. The Community Preventive Services Task Force found sufficient evidence of effectiveness to recommend combined built environment strategies. Specifically, these strategies combine interventions to improve pedestrian or bicycle transportation systems with interventions to improve land use and environmental design. Components of transportation systems can include street pattern design and connectivity, pedestrian infrastructure, bicycle infrastructure, and public transit infrastructure and access. Components of land use and environmental design can include mixed land use, increased residential density, proximity to community or neighborhood destinations, and parks and recreational facility access. Implementing this Community Preventive Services Task Force recommendation in communities across the United States can help promote healthy and active living, increase physical activity, and ultimately improve cardiovascular health.

Evaluation of a Bed Reaggregation Initiative at an Urban Academic Medical Center.

BACKGROUND: Hospital flow disruptions have been linked to treatment delays, longer length of stay (LOS), poor patient outcomes, and overburdened staff leading to disengagement. OBJECTIVE: This project was designed to evaluate and determine if the bed reaggregation was successful at meeting its goals. METHODS: Donabedian's framework guided the following evaluation points: 1) patient placement accuracy, 2) LOS variance, 3) emergency department (ED) boarding times, 4) hospital bypass hours, 5) operational declination rates, 6) patient satisfaction, and 7) RN engagement. Data were analyzed using pre-post percent change and χ analysis. RESULTS: Primary placement of patients, LOS variance, and operational declinations improved. Hours on bypass and ED boarding times were not reduced. RN engagement scores varied widely with significant decreases on 2 of the reaggregated units. Patient satisfaction scores varied, but overall did not decrease. CONCLUSION: Further consideration is needed for improving hospital bypass, ED boarding times, and RN engagement.

Implementing a Food is Medicine Program to Address Food Insecurity in an Academic Medical Center.

BACKGROUND: Food insecurity is a public, social, and health concern. LOCAL PROBLEM: A Food is Medicine Program was developed to address food insecurity. METHODS: A quality improvement initiative was piloted on 3 acute care units. INTERVENTIONS: Patients were screened for Social Determinant of Health (SDoH) needs and if identified as food insecure, linked to community resources and provided with a bag of food on discharge. Education was offered to nursing staff and a pre- and postsurvey was administered to assess SDoH knowledge and confidence. RESULTS: Over a 3-month period, 2354 patients were admitted; 2063 (88%) were screened for SDoH and 220 (10%) were positive for food insecurity. Patients (n = 1525, 74%) were linked to community resources. Nearly all (97%) nurses participated in education and demonstrated increased knowledge and confidence (P < .001). CONCLUSIONS: These data provide preliminary outcomes from the Food is Medicine Program.

Favorable Outcomes From an In-person and Online Feasibility Mindful Moment Pilot Study.

Long hours, inadequate staff, and increasingly complicated patients make nurses more vulnerable to increased levels of stress and burnout. Nurses skilled in exercising self-care practices are better equipped to manage complex clinical situations. The purpose of this pilot study was to evaluate the feasibility of short mindfulness sessions (Mindful Moment) practiced prior to a shift, available in person and online, on nurse burnout and perceived levels of stress. The 8-week Mindful Moment study consisted of 20-minute sessions delivered either in person or online that included yoga, self-reflection, and meditation. Nurse burnout was assessed using the Maslach Burnout Inventory at weeks 0, 4, and 8. Perceived stress was assessed using a visual analog scale before and after each Mindful Moment session. Descriptive statistics, pre/postintervention differences, and percent change calculations were used to evaluate study outcomes. Forty-seven nurses agreed to participate, with 20 nurses completing the study (43%). Participants were all female, aged 36.8 ± 9.8 years, with 12 ± 8.6 years of nursing experience. With respect to nurse burnout, there was a -31% change in emotional exhaustion (P = .079), a -31% change in depersonalization (P = .057), and a +10% change in personal accomplishment (P = .331). There were consistent reductions in nurses' perceived stress pre/post-Mindful Moment session, with percent changes ranging from -35% to 40%. Findings from this study suggest that practicing a brief Mindful Moment prior to the start of a shift is feasible and self-care interventions provide lower levels of burnout and perceived stress among this sample of nurses.

Exploring the Doctor of Nursing Practice project facilitator/mentor role.

BACKGROUND: The Doctor of Nursing Practice (DNP) facilitator/mentor is a collaborative member of the project team, yet little has been reported about this role. This qualitative study explored the experiences of DNP project facilitators. METHODS: Focus groups were conducted using a purposeful sample of project facilitators. Focus group questions were developed using Gitlin, Lyons, and Kolodner's five-stage model of collaboration. Data were transcribed and content analyzed using Kruger and Casey methods. RESULTS: Three focus groups included 21 facilitators who were affiliated with an academic health system. Six themes emerged: (a) exploring student interest, (b) establishing a collaborative fit, (c) connecting with key stakeholders, (d) overcoming barriers, (e) role clarity, and (f) interaction. CONCLUSION: DNP project facilitators have an important role not only in students' formation, but also in contributing to the academic-practice partnership. The importance of the facilitator role as the student progresses through their DNP project cannot be overstated.

Favorable Outcomes Using an eHealth Approach to Promote Physical Activity and Nutrition Among Young African American Women.

BACKGROUND: Internet and mobile devices are widely used and provide alternative approaches for promoting healthy lifestyles, yet less information is available describing outcomes of these approaches when used with young African American (AA) women at risk for developing hypertension. OBJECTIVE: In this study, we evaluated a Web-based, culturally relevant lifestyle change intervention targeting AA women (referred to as the eHealth study). METHODS: African American women, aged 18 to 45 years, with untreated prehypertension and Internet access were eligible for a 12-week study that incorporated social cognitive theory strategies. Participants were randomized to (1) lifestyle physical activity (PA) or (2) Dietary Approaches to Stop Hypertension (DASH) online education modules. RESULTS: The 14 DASH and 12 PA participant attributes were similar at baseline. The DASH participants had a significant change in total DASH score (P = .001) and large effect sizes for DASH components (vegetables, 0.84; nonfat dairy, 0.71; fruit, 0.62). The PA participants had a favorable change (+39%) in pedometer steps (P = .055). With respect to weight change, a large effect size was observed for PA (0.84) and smaller for DASH participants (0.18). Seventy-one percent of DASH and 48% of PA participants completed program activities, corresponding to a moderate difference in program engagement between groups (d = 0.58). CONCLUSION: Our eHealth platform provides an alternative approach for reaching young AA women and was successful with respect to improving PA and dietary behaviors. Furthermore, the eHealth approach has the potential as a powerful program for changing health behaviors for other at-risk populations.

The Feasibility of Using Facebook, Craigslist, and Other Online Strategies to Recruit Young African American Women for a Web-Based Healthy Lifestyle Behavior Change Intervention.

BACKGROUND: Reports describing successful recruiting of minority participants are available; however, they focus largely on traditional strategies. Internet and mobile devices are widely used, providing alternative approaches, yet less information is available describing the success of these approaches. OBJECTIVE: This article (1) evaluates the feasibility of using online advertising as a recruiting modality for a healthy lifestyle behavior change intervention targeting young African American women and (2) describes lessons learned to better inform researchers for future directions. METHODS: African American women, aged 18 to 45 years, with untreated prehypertension and Internet access were eligible for a 12-week randomized study providing physical activity or nutrition behavior change education delivered via online modules. Traditional strategies included flyers, tabletop cards, blood pressure screenings, health fairs, and clinics. Online-related strategies included posting ads on Facebook, Craigslist, and on the university Web site, intranet, and "on-hold" telephone line. Descriptive statistics were used to identify frequency of recruitment strategies. χ Analysis was used to assess differences between enrolled and nonenrolled inquiries. RESULTS: Among all 176 inquiries, the most frequented strategies were the university Web site (44%), blood pressure screenings (15%), Facebook/Craigslist (13%), and clinics (12%). Enrollment rates differed across recruitment strategies (χ P = .046). The 3 highest enrollment rates were (1) employee in-services (100%), (2) flyers/tabletop cards (31.6%), and (3) word of mouth/physician referral (25%). CONCLUSION: Online-related strategies are convenient and have great potential for reaching large numbers of people. However, the actual rate of participants successfully enrolled online was proportionally smaller when compared with traditional recruiting strategies.

Improving the Patient Experience: Call Light Intervention Bundle.

PURPOSE: Delays in call light response are a significant patient quality and safety concern. Research on call light interventions and patient outcomes has focused exclusively on adult inpatients. This project examined the impact of increasing staff awareness and workflow redesign to improve the pediatric patient experience and outcomes based on timely response. DESIGN AND METHODS: A quality improvement project was conducted on two pediatric medical surgical units' (31 and 35 beds respectively) at a large Midwest academic medical center with patients' ages from to young adults. Data on staff knowledge, patient satisfaction, and fall rates was examined pre- and post-intervention of an evidence-based call light intervention bundle which included: 1) unit-based patient experience committees, 2) purposeful rounding, 3) pod buddy assignments, and 4) staff education. RESULTS: Post-intervention both units demonstrated improvement in staff knowledge on call light interventions and exhibited sustained improvement in patient satisfaction scores for promptness to call. Likelihood to recommend the hospital and satisfaction with pain control improved for one of the two units. No impact on fall rates was noted over time for either unit. CONCLUSIONS: A call light intervention bundle can positively impact patient satisfaction with promptness to call lights in pediatric medical surgical hospitalized patients and their families. Unlike adult patients, a call light intervention bundle did not impact fall rates in children and further study in pediatric fall reduction strategies is needed.

Determinants for effective collaboration among DNP- and PhD-prepared faculty.

BACKGROUND: Uncertainty exists surrounding collaborative relations among Doctor of Nursing Practice (DNP)- and Doctor of Philosophy (PhD)-prepared faculty. PURPOSE: This qualitative study explored the attitudes and determinants for effective collaboration among doctoral-prepared nursing faculty. METHODS: Focus groups were conducted using a convenience sample of doctoral faculty who taught in either/both DNP or PhD programs. Focus group questions were derived to identify interpersonal, organizational, and systemic determinants of collaboration. Data were transcribed and content analyzed using Kruger and Casey methods. RESULTS: Four focus groups included 41 faculty members from two metro area university medical centers. Five themes emerged: (a) DNP not well understood, (b) confusion surrounding research, (c) opportunities for collaboration, (d) lack of structural support, and (e) personal characteristics and attitudes. DISCUSSION: Interpersonal relationships, organizational structures, and systemic impacts have both positive and negative influences on successful collaboration among DNP- and PhD-prepared faculty. CONCLUSION: Collaborative efforts are needed for advancing the profession.

Partnering With a Patient and Family Advisory Council to Improve Patient Care Experiences With Pain Management.

Patient-centered care is a key driver for the nation's health system, yet patient experience surveys indicate that hospitals are far from achieving favorable outcomes. Partnering with patients and families through a patient and family advisory council (PFAC) advances the practice of patient-centered care to improve outcomes and experiences. This article describes the process of implementing a PFAC and presents outcomes related to patients' perception of pain management in the acute care hospital setting.

Making Behavior Change Interventions Available to Young African American Women: Development and Feasibility of an eHealth Lifestyle Program.

BACKGROUND: Less is known about young African American (AA) women, largely because the young are hard to reach. Traditional approaches to behavior changes interventions impose several challenges, especially for AA women at risk for developing hypertension. PURPOSE: This feasibility study describes the process of transforming a face-to-face lifestyle change intervention into a Web-based platform (eHealth) accessible by iPads, iPhones, smartphones, and personal computers. METHODS: Four sequential phases were conducted using elements of formative evaluation and quantitative analysis. A convenience sample of AA women, aged 18 to 45 years, with self-reported prehypertension and regular access to the Internet were eligible to participate. RESULTS: Eleven women involved in phase 1 expressed that they (1) currently use the Internet to retrieve health-related information, (2) prefer to use the Internet rather than face-to-face contact for nonserious conditions, (3) need convenience and easily accessible health-related interventions, and (4) are amenable to the idea of an eHealth lifestyle modification program. During phase 2, learning modules derived from printed manuals were adapted and compressed for a Web audience. The modules were designed to present evidence-based content but allowed for tailoring and individualization according to the needs of the target population. During phase 3, 8 women provided formative information concerning appeal and usability of the eHealth program in relation to delivery, visual quality, interactivity, and engagement. Phase 4 involved 8 women beta testing the 12-week program, with a 63% completion rate. Most of the women agreed that the program and screens opened with ease, the functions on the screens did what they were supposed to do, and the discussion board was easy to access. Program completion was greater for physical activity compared with dietary content. CONCLUSION: This study outlines a step-by-step process for transforming face-to-face content into a Web-based platform, which, importantly, can serve as a template for promoting other health behaviors.

Reducing nasal pressure ulcers with an alternative taping device.

Mucosal tissues are vulnerable to nasal pressure ulcers (NPUs) secondary to nasogastric tubes, and can cause hospital-associated complications and increased length of stay. The findings of this study suggest a commercially available device significantly reduces NPUs and is more adherent compared to conventional adhesive taping.

Axillary temperatures in full-term newborn infants: using evidence to guide safe and effective practice.

PURPOSE: Although the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists recommend obtaining temperature in newborn infants via the axilla, controversy still exists whether to obtain rectal or axillary temperatures. Of concern is the risk of perforating the rectum or colon during rectal temperature-taking. The purpose of this study was to explore the accuracy of electronic thermometer measuring temperature in the axilla compared with the rectum in full-term newborn infants. DESIGN: This was an agreement study involving a purposive sample of newborn infants who were greater than 37 weeks' gestation. The general care nursery was located in a large, urban Midwestern academic medical center, and data collection occurred between May 2010 and August 2010. METHODS: On admission to the general care nursery, both axillary and rectal temperatures were taken using the FasTemp device by Filac Electronic. Axillary temperatures were taken first, followed immediately by rectal temperature. Descriptive statistics, Pearson correlations, and scatter plots were computed. RESULTS: In 69 newborns, the mean difference between rectal and left axilla temperatures was 0.23°C. There was a significant correlation between rectal temperature and the body temperature for the left axilla (r = 0.786; P = .01). CONCLUSIONS: These preliminary data support the use of left axillary temperature measurement in the full-term newborn infant in the first few days of life to provide a safe and accurate alternative to rectal temperatures. CLINICAL RELEVANCE: Nurses caring for newborn infants now have evidence showing that temperature-taking in the left axilla is an alternative to using rectal temperatures, possibly minimizing discomfort and potential risk of perforation.

Dietary approaches to stop hypertension patterns in older Latinos with or at risk for hypertension.

BACKGROUND: Older Latinos represent a growing segment of our population, yet little is known about whether older Latinos are following the recommended Dietary Approaches to Stop Hypertension (DASH) eating plan, which promotes certain food groups to reduce blood pressure (BP) over and above established strategies. Among Latinos, greater acculturation to the American society has been associated with suboptimal dietary choices and risk for chronic diseases. Therefore, the purpose of this study was to assess differences in DASH accordance/adherence by BP status taking into account level of acculturation. METHODS: This was a descriptive, cross-sectional study involving older Latinos wherein DASH accordance and adherence were calculated on the basis of nutrient analyses of food frequency questionnaires. A DASH score of 4.5 or higher indicated accordance, and a DASH Adherence Index greater than 0 indicated adherence. Blood pressure was measured in triplicate using Omron HEM-907XL and was categorized according to BP level and/or antihypertensive medication. The Acculturation Rating Scale for Mexican Americans-II was used to rate level of acculturation. RESULTS: Participants were 169 Latinos, primarily women (73%) and older (66 ± 9.0 years); the majority were hypertensive (66%), preferred speaking in Spanish (85%), and were more Latino oriented (63%) with respect to acculturation status. Overall, participants were moderately DASH accordant (4.2 ± 1.6) and DASH adherent (-0.8 ± 0.8). Acculturation scores (odds ratio, 1.4-1.7, P < 0.02) were predictive of hypertensive status (defined as BP ≥ 140/90 mm Hg) regardless of which dietary score was modeled. CONCLUSION: Based on these findings, greater attention should be paid to identification of traditional Latino foods and food preparation that are consistent and acceptable to this older community in effort to foster greater DASH accordance and improve BP status.

Influence of staff education on the function of hospitalized elders.

Functional loss during hospitalization can prevent older adults from returning home. This study was designed to examine the effects of an intervention on discharge destination, function, length of stay (LOS), pressure ulcers, and fall rate in older adults ≥ 75 years old. The intervention included staff education on geriatric care and infrastructural change to promote function. Data on discharge destination and the change in function measured by Katz's activities of daily living (ADL) were collected. The LOS, pressure ulcer, and fall rate were compared with previous year's data using t-tests, and Chi-square analyses. There was a 14% increase in discharges to home (n = 404), minimal ADL loss (4.60 baseline ADL vs. 4.20 discharge ADL), and a significant decrease in nosocomial pressure ulcer. There was no decrease in LOS or fall rate. This preliminary study suggests that staff education with infrastructural change to promote independence may be helpful in patients' return to home, functional status, and hospital complications.

The financial and clinical benefits of a hospital-based PhD nurse researcher.

Aligning quality outcomes with cost effectiveness is the cornerstone of the direction of health care in the United States. Implementing and supporting an evidence-based practice (EBP) environment requires resources. Because research is a foundational element of the EBP process, resources allocated for nursing research are essential. As part of operational costs, PhD nurse researchers can affirmatively impact an organization by improving quality of care and patient outcomes. Incorporation of a PhD nurse researcher can favorably alter the organization in a pay-for-performance environment.

Long-term outcomes after blunt injury to the boney thorax: an integrative literature review.

Management of blunt injury to the boney thorax centers on the hospital; yet, these injuries continue to impact patients long after hospitalization. The purpose of this literature review was to identify long-term outcomes associated with this injury. A literature search found 616 studies and, after screening, yielded 6 articles for review. Patient and injury characteristics and postinjury assessment findings were explored. The impact of this injury can be prolonged and life altering, prompting the need for further investigation. A greater understanding of injury-specific posthospitalization outcomes could elucidate the impact of these injuries on patients, families, and society.

Implementing evidence-based practice during an economic downturn.

Building a sustainable evidence-based practice (EBP) infrastructure during times of financial constraints poses challenges for nurse leaders. To be successful, plans need to be creative and adaptive, while mindful of limited resources. This commentary describes change management strategies used to implement an EBP infrastructure at a hospital after organizational restructuring occurred.