Care of veterans in a non-veteran health administration hospital: What is the status of nursing practice after continuing education?

AIMS AND OBJECTIVES: To identify how civilian nurses are caring for military veterans following mandatory continuing education on veterans' mental health needs and to describe challenges nurses are facing in provision of that care. BACKGROUND: Veterans and military personnel experience mental health conditions at a high rate and are increasingly receiving care in civilian healthcare facilities. Nonmilitary providers may not be prepared to address this population's challenging needs. Military culture may influence the presentation of mental health conditions; thus, critical assessment points by nonmilitary medical personnel may be missed. Education is touted internationally as a means to address deficits, but research is lacking to support that statement. METHODS: Adhering to research reporting guidelines, 115 of a proposed 322 civilian nurses in a tertiary hospital volunteered to complete a one-time online survey that contained quantitative and demographic questions. Forty of 115 nurses went on to complete the qualitative query. Descriptive statistics summarised quantitative results, and constant comparative analysis was applied to qualitative responses for theme identification. RESULTS: The study was stopped early due to reports of violence from veterans upon nurses. Results showed continuing education did not change documentation of military status. Following mandatory continuing education, civilian nurses continued to describe uncertainty in how to adapt care, on how to interact with veterans and in how to deal with violence. CONCLUSION: The status of care to veterans remains insufficient, but nurses are asking critical questions on how to update practice. Additional support and research in the clinical setting is needed to promote a safe caring environment. RELEVANCE TO CLINICAL PRACTICE: Continuing education alone may not advance care of the veteran. A multipronged approach to include mandatory documentation of military status and coaching of providers by those experienced with the military way of life may be used to augment staff preparedness.

Measuring Harm in Hospitalized Children via a Trigger Tool.

BACKGROUND: The 1999 report To Err Is Human published by the Institute of Medicine estimated that between 44,000 and 98,000 deaths occur each year in US hospitals due to medical errors. However, processes to detect medically induced harm remain inaccurate and inconsistent. Hospitalized pediatric patients are at high risk for adverse events, with published rates ranging between 1% and 11% of all hospitalizations. OBJECTIVE: The study aimed to use the Global Assessment of Pediatric Patient Safety (GAPPS) tool to detect adverse events in a pediatric inpatient setting of an academic medical center children's hospital and compare to internal incident reporting methods. METHODS: Nurse reviewers used the GAPPS tool during a retrospective chart review of 100 patients discharged from the children's hospital. Among the total 100 cases, 20 adverse events were discovered with the tool. Adverse events were validated by physician reviewers, and the severity of harm and preventability were assigned. The number of adverse events was then compared to internal incident reporting for the same time frame. RESULTS: The detection rate is 4.87% within 411 patient-days. In contrast, the hospital had only 1.22% incident reports. CONCLUSIONS: The GAPPS tool can detect four times more adverse events than the hospital incident reporting system. The results are likely to be replicated for other children's hospitals to increase identification of adverse events and harm to patients.

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.

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.

Nurses' Perception of Caring for Patients With Substance Use Disorder.

ABSTRACT: The objective of this research was to explore the perceptions of nurses regarding patients with substance use disorder (SUD), healthcare provided, and desired resources to care for this population properly. This study used a cross-sectional, descriptive design. Data were collected via an anonymous 12-item survey and three open-ended questions. Data were analyzed using descriptive statistics and conventional content analysis. Nurses with less than 1 year of experience reported more significant challenges when caring for patients with SUD. These challenges included difficulties in managing pain, implementing alternative pain management techniques, and knowing who to contact when problems occur. The study revealed many needs of nurses to provide compassionate care for patients with SUD. Findings indicate a need for education for nurses, especially novice nurses, who care for patients with SUD.

Implementing Best Practices for Decreasing Nurse Hesitancy to Call the Rapid Response Team: An Evidence-Based Quality Improvement Initiative.

BACKGROUND: Nurses, regardless of experience, sometimes wait for the Modified Early Warning Score to indicate physiological decline before initiating the hospital's Rapid Response Team (RRT). The goal of this quality improvement initiative was to reduce nurse hesitancy to call the RRT, as indicated by the monthly number of proactive calls before the Modified Early Warning Score increased and triggered an automated page. METHOD: Education, planned handoff communication, debriefing, and good catch emails were the educational strategies used in the implementation of the quality improvement initiatives, encouraging RRT calls sooner. Increasing RRT knowledge and communication is an evidence-based practice strategy to reduce nurse reluctance to call the RRT. RESULTS: After implementation, monthly proactive RRT calls increased (χ2 [1, n = 1,964] = 14.6085, p = .000159). Bedside interventions, unscheduled transfers, and Acute Physiologic and Chronic Health Evaluation scores did not differ. CONCLUSION: Education, structured handoff communication, and acknowledging good catches reduced nurses' reluctance to call the RRT proactively. [J Contin Educ Nurs. 2023;54(6):281-288.].

Creating an Optimal IP Learning Environment: NCICLE Pathways to Excellence.

Clinical learning environments are a shared space for various professions working together to provide the best care for patients. The National Collaborative for Improving the Clinical Learning Environment (NCICLE) published the NCICLE Pathways to Excellence: Expectations for an Optimal Interprofessional Clinical Learning Environment to Achieve Safe and High-Quality Patient Care as a tool that can be used to assess and develop ways to optimize learning and patient care. This framework provides guidance for health care professionals to collaborate with executives to transform the clinical learning environment and patient outcomes. [J Contin Educ Nurs. 2022;53(4):150-152.].

Best of the 2021 ANCC PTAP Symposium: Create, Cultivate, Celebrate.

The American Nurses Credentialing Center (ANCC) Practice Transition Accreditation Program (PTAP) sponsors an annual symposium for participants to share in best practices across the globe. Due to COVID-19, the 2021 symposium was held virtually. With close to 700 participants, the ANCC PTAP team was challenged to provide an engaging virtual conference. This column speaks to the success of the symposium based on creating, cultivating, and celebrating best practices. [J Contin Educ Nurs. 2021;52(8):352-354.].

Moving Forward Together: What Hope, Efficacy, Optimism, and Resilience Tell Us About Generation Z.

Generation Z is entering the workforce, requiring nursing professional development (NPD) practitioners to consider their unique characteristics when planning ongoing professional learning. They are also entering the profession at a time when concerns for well-being and resilience are at an all-time high. This article compares psychological capital scores between generational cohorts and provides strategies for the NPD practitioner with the development and education of Generation Z nurses. [J Contin Educ Nurs. 2021;52(4):160-162.].

Veteran-to-Veteran Program.

More Veterans are receiving health care outside of the Veterans Health Administration. Over concern for the Veteran's safety and the provider's competency, three progressive steps have been taken within the state of West Virginia. J Contin Educ Nurs. 2018;49(11):493-495.