Evidence-Based Practice: Implementing Trauma-Informed Care of Children and Adolescents in the Inpatient Psychiatric Setting.

INTRODUCTION: At our inpatient psychiatric hospital, which cares for children and adolescents, internal data of use of seclusions and holds as crisis interventions for immediate behavioral health issues demonstrated that we were using these too often. AIMS: Benchmarking indicated that we were at the 75% in use of these measures, and it became an organizational goal to reduce the use of these strategies in order to reduce the risk of retraumatization to an already traumatized child. METHODS: We used the Iowa Model for Evidence Based Practice-Revised to initiate an evidence-based practice project introducing and hardwiring Trauma Informed Care to the staff and institution. This involved implementing six core strategies specifically designed to reduce the use of crisis interventions. RESULTS: Data obtained at 6 months revealed a 40% reduction in the use of holds and seclusions, and at 12 months, this change was sustained and even improved, reducing the use of these approaches by another 9%. Furthermore, the culture in the institution was changed, and Trauma Informed Care became the norm. CONCLUSIONS: Evidence-based practice is a viable approach to change the culture and improve patient outcomes in inpatient psychiatric care of children and adolescents. Further investigation is warranted to determine the specific patient and staff experiences of being cared for, and caring within, the context of trauma-informed care.

Scholarly Requirements and Support for Nursing Faculty Development and Career Advancement: A Nationwide Delphi Study.

AIM: The aim of the study was to better understand the scholarship requirements and support for nursing faculty as they work to advance their scholarship and careers. BACKGROUND: Nursing faculty are often required to participate in teaching, service, and scholarship. New faculty often struggle with the scholarship component. METHOD: A nationwide Delphi study was conducted, surveying deans and/or associate deans for research at master's and doctoral degree-granting institutions. RESULTS: Scholarly requirements provided for faculty to enable development of scholarship were well defined: having a dedicated leader; funding support; a culture of scholarship; publications, presentations, and grant writing expectations; formal programs; mentors; and support. CONCLUSION: This study provided a beginning understanding of important aspects of faculty support for scholarship and career development. More information is needed to determine if the support structures and activities described reach faculty and enhance career development.

What do novice faculty need to transition successfully to the nurse faculty role? An integrative review.

OBJECTIVES: The objective was to describe and illustrate what is known about the needs of novice nursing faculty as they transition into the faculty role. The worldwide nursing shortage is partly due to the lack of faculty, and one reason for that lack is the reported difficulty of transitioning into the faculty role. METHODS: An integrative review of the literature was conducted. RESULTS: Results demonstrated that new faculty are either intentionally supported in their new environment, with successful development of their skills and career, or they are unintentionally unsupported, which leaves them languishing and reduces intent to stay. CONCLUSIONS: Despite gaps in the literature and a low level of strength of evidence, the review offers implications for managing and maintaining relationships with novice faculty to facilitate their ultimate success. Institutions should aim to have in place identified elements that ensure novice faculty are intentionally supported rather than unintentionally unsupported.

Methodology Update: Delphi Studies.

BACKGROUND: The Delphi method is a research approach that is beneficial when wanting to solve real-world problems, and expert opinions are needed. OBJECTIVES: The purpose of this study was to describe the Delphi method as a qualitative research approach and provide a case study example of a study using the Delphi method to demonstrate the advantages and challenges of this methodological approach. METHODS: A literature search was conducted to understand the Delphi method and examine its use in nursing. RESULTS: The literature search revealed what the Delphi method was and how it could be used. To better help explain the method, a case study from the literature is presented. DISCUSSION: Using the Delphi method in nursing research is becoming easier. With emerging technology, communication with geographically diverse experts may be easily and affordably achieved. With updated software, results can be interpreted almost immediately, and additional rounds of the Delphi occur in a timely manner, increasing participation and decreasing attrition rates. The Delphi method is a viable option for nurse researchers looking for expert opinion.

"I do the best I can:" Personal care preferences of patients of size.

AIM: Obesity is a common co-morbidity of hospitalized patients, and nurses sometimes have great difficulty meeting the skin care needs of patients of size. The purpose of this qualitative study was to identify successful self-care strategies patients of size used to care for themselves at home, in order to replicate these successes in the hospital. BACKGROUND: When patients who are obese are hospitalized they are vulnerable to complications, including skin integrity problems. These can be made worse for the patient if s/he cannot engage in their usual self-care hygiene practices. By uncovering self-developed solutions to hygienic care at home, nurses could incorporate these into their individualized plan of care. METHODS: This qualitative descriptive study used an appreciative inquiry approach, to discover what works well, in order to replicate these actions. A skilled qualitative nurse researcher used a semi-structured interview process to uncover the personal care preferences of patients whose admission body mass index (BMI) was >50. A step-wise approach was used for data reduction, and triangulation of researchers added to the study's trustworthiness. RESULTS: Fourteen patients of size were interviewed. Nine categories emerged from the data, all of which fit under the overarching theme: "I do the best I can." Multiple ideas for quality care, delivered while preserving patient dignity, were identified. Implications for nursing practice are included. CONCLUSION: Patients of size have developed creative and useful approaches to managing skin health that could be used in the hospital when patients are unable to manage their self-care alone.

Influencing Commitment to BSN Completion: A Pilot Project Using Motivational Interviewing.

The 2010 Institute of Medicine's Future of Nursing report posed recommendations to increase numbers of nurses with baccalaureate degrees or greater to 80%. This project engaged associate degree nurses in motivational interviewing focusing on finding and removing barriers to baccalaureate matriculation and completion. Results indicated a statistically significant influence on attitudes and return-to-school decision making and identified a qualitative theme: "I know more now… I could be a better nurse."

"To See With My Own Eyes": Experiences of Family Visits During Phase 1 Recovery.

PURPOSE: Long separations are a characteristic of the day of surgery, keeping patients and their family members waiting and apart. At a time of high vulnerability, these separations can cause anxiety and worry. The purpose of this study was to identify the outcomes and experiences of patients and family members who engaged in a 5- to 10-minute supervised family visit during phase I postanesthesia recovery. DESIGN: This was a descriptive, single-group, mixed-methods study. METHODS: Quantitative data, gathered on the day of surgery, was obtained from patients (vital signs, state anxiety scores) and their designated family members (state anxiety scores); satisfaction with the visit was also measured. An optional second, qualitative phase included a semi-structured interview examining the remembered experiences of patients and family members. FINDING: A statistically significant drop in state anxiety was discovered after the visit, and satisfaction with the visit was exceedingly high. Qualitatively, patients and family members described their overwhelming relief to be able "to see with my own eyes" how well each was doing. CONCLUSIONS: This study supports that family visits in the postanesthesia care unit are safe and profoundly important as an independent nursing intervention. Recommendations include implementation of family visits during postanesthesia care unit recovery for all patients and family members who desire them.

Social Media in Nursing Education: A Systematic Review.

BACKGROUND: Although social media is emerging as an educational tool in health care professions, little is known about which social media platforms support nursing education in different situations. METHOD: This systematic review examined and ranked the level of evidence that supports social media use in nursing education. RESULTS: A total of 19 studies published between 2017 and 2022 were evaluated and described in an evidence table. Results revealed social media is used in a variety of settings and in different ways, including providing enhanced learning for hands-on skills, supporting course activities such as journal clubs, and creating a sense of community and belongingness. CONCLUSION: Social media in health care education can address asynchronous learning management system issues; create community belongingness; and support student collaboration; however, such uses also may allow a loss of privacy. [J Nurs Educ. 2024;63(1):6-9.].

Fracture Resistance and Failure Mode of Polyethylene Fiber-reinforced Resin-based Restorations in Structurally Compromised Premolars: an in Vitro Study.

OBJECTIVE: To evaluate the effect of polyethylene fiber-reinforcement on the fracture resistance and fracture mode of extensive resin-based composite (RBC) restorations in structurally compromised maxillary premolars. METHODS AND MATERIALS: Maxillary premolars (54) with specific dimensions and extracted for orthodontic reasons were used. Following mesio-occluso-distal (MOD) cavity preparation and endodontic access, teeth were randomly assigned to one of three restorative protocols (n=18): RBC applied incrementally (I) or reinforced with woven polyethylene fibers (Ribbond) placed horizontally (H) or U-shaped (U). Restored teeth were stored for 45 days in distilled water at 37°C and then loaded monotonically until fracture. Half of the specimens in each group received axial loading (A) and the other half was loaded paraxially (PA). Fracture load data was assessed using two-way analysis of variance and Tukey's post hoc test for multiple comparisons (α=0.05). The fracture initiation and propagation path were analyzed using stereomicroscopy and scanning-electron microscopy. RESULTS: No significant differences were observed for the fracture strength among loading configurations, except for groups IA (825 N) and HA (553 N). Fracture initiated and propagated mainly at and through the RBC restoration in the I group, whereas a shift to the interface was observed in both polyethylene fiber-reinforced groups. Blocking and bridging of cracks were identified around the fibers, especially in specimens of group U. CONCLUSIONS: Incorporation of woven polyethylene fibers to reinforce extensive MOD resin-based composite restorations on endodontically treated premolars reduced the occurrence of cohesive fractures in the restorative material but was unable to increase the fracture resistance of the affected teeth.

No more "fumbling alone": effect of a nurse-led academic advising service in a Magnet(®) hospital.

BACKGROUND: A nurse-led, hospital-based academic advising service (AAS) was developed at a large Magnet(®) hospital. The AAS aided nurses and aspiring nurses as they considered advancing education. This research project was developed to evaluate the AAS. METHODS: This qualitative study used a web-based survey to gather information from those who had accessed the service; there were 80 participants. Satisfaction was determined quantitatively, and qualitative data analysis was completed with naturalistic inquiry approaches and standards of rigor. RESULTS: A total of 347 codes were isolated from the data and collapsed into nine categories. One comment, "I did not have to fumble through this alone," suggested the idea of coaching within a context of football as the overarching metaphor. Quantitative results indicated that advises were satisfied, with 61 of 80 respondents taking specific action after the session. CONCLUSION: Nurses and aspiring nurses found academic advising at work helpful, and the AAS facilitated a return to formal education for some of the participants.

"Finding My Place in Academia": Understanding the Experiences of Novice Faculty.

BACKGROUND: The current nursing faculty shortage rapidly has expanded the need to hire faculty. New faculty are clinical experts in their own practice; however, many lack formal knowledge about the academic setting, making the transition from practice to academia difficult. METHOD: A qualitative descriptive study was developed to identify how new faculty transition into their academic positions. The sample consisted of 12 clinical nursing faculty participants. RESULTS: A total of 12 themes emerged: awful day as faculty, career plans, compensation, finding my place in academia, great day at clinical, "I wanted to be successful," preparation for the faculty role, struggling, student experiences, support, lack of support, and surprise. Finding ways to recruit and retain qualified faculty is imperative. CONCLUSION: Inadequate support for transitioning to the faculty role may contribute to faculty turnover; developing a strong mentoring program may help retain qualified faculty. [J Nurs Educ. 2023;62(8):433-442.].

How to Write Powerful Letters of Recommendation.

Nurses at all levels may be asked to write a letter of recommendation to support colleagues' and students' career and academic advancement. This article outlines key steps and considerations in the letter-writing process.

8-year multicenter retrospective study on partial laminate veneers.

Purpose This retrospective study aimed to evaluate the survival and success rates of ceramic partial laminate veneers. Scanning electron microscopy was used to evaluate fractures and marginal defects.Methods In total, 31 patients received 79 partial laminate veneers on the maxillary anterior teeth. After adhesive luting, restorations were evaluated by calibrated clinicians for up to eight years using modified United States Public Health Service (USPHS) criteria. In addition, epoxy resin replicas were fabricated from silicone impressions and analyzed using scanning electron microscopy. Survival analyses were performed using the Kaplan-Meier and log-rank tests (α = 0.05). Success was analyzed in percentages by comparing the baseline and last follow-up.Results The cumulative survival rates were 100% after 1 year; 95.9% (SE 2.8%) after 5 years; and 61.4% (SE 25.3%) after 8 years. No significant differences (P > 0.05) were observed between functional and non-functional restorations. Changes in the USPHS criteria evaluation were only observed for adaptation: 12.5% (SE 4.7%), marginal discoloration: 4.2% (SE 3.0%), color match: 4.2% (SE 3.0%), and fractures: 16.7% (SE 5.3%). Scanning electron microscopy evaluations revealed undetected initial cracks and deficiencies in the restorations.Conclusions Partial laminate veneers displayed good survival rates during the long-term follow-up. The main problems observed were related to the quality of the margins, color mismatch, and restoration integrity. However, in most cases, restoration replacement was not required.

Weathering the storm: nurses' satisfaction with a mobile admission nurse service.

AIM: To evaluate nurses' satisfaction with, and perceptions of, a practice innovation introducing a Mobile Admission Nurse service. BACKGROUND: Staff nurses identified that the admission process, while crucial to initiating safe and appropriate acute care, can be disruptive and interfere with care in progress. A pilot project implementing the role of a Mobile Admission Nurse was introduced to address this need. METHOD: A self-developed web-based survey was administered to a convenience sample of 104 RNs who had used the services during the pilot project. RESULTS: Staff nurses (n = 78) reported a chaotic, demanding work environment within which the admission process disrupts the flow of care. The Mobile Admission Nurse helped them in 'weathering the storm', which was the overarching theme that emerged during data analysis. CONCLUSIONS: Having an admission nurse complete the admission process steadied workflow processes for nurses. Improved patient safety and increased staff and family satisfaction were also reported. The strongly positive feedback led to expansion of the service. IMPLICATIONS FOR NURSING MANAGEMENT: Proactively redesigning work processes, using a structured theoretical model such as the (Plan-Do-Study-Act) PDSA approach, may improve outcomes in a chaotic practice environment.

Evaluating the impact of a nurse residency program for newly graduated registered nurses.

Nurse residency programs are designed to support graduate nurses as they assume the professional role. Evaluation of these programs has been inconsistent. The purpose of this descriptive research study was to evaluate a year-long nurse residency program using a nonexperimental, repeated measures design with qualitative questions. Results showed statistically significant differences in new nurse confidence, skills, and abilities at 12 months. Nursing turnover was one third of the national average. The metatheme that emerged from the data was "I see that I am not the only one."

Older adults 'Have so Much to Teach Us': A qualitative study of BSN student perceptions when anticipating clinical in the nursing home.

BACKGROUND: As the population of older adults is estimated to double by 2050, the growing demand for nurses to provide care to older adults will grow. Internationally, attitudes among nursing students towards caring for older adults range from negative to slightly positive. OBJECTIVE: The purpose of this qualitative descriptive study was to examine undergraduate nursing students' thoughts, feelings and perspectives towards older adults residing in nursing homes prior to their clinical experience. METHODS/RESULTS: Students enrolled in a clinical component of a course within a baccalaureate nursing programme were prompted to write a one-page reflection on their thoughts and feelings toward caring for older adults in a nursing home. Artefacts from 72 undergraduate students' were examined, and data saturation was obtained at 20 cases. Utilizing a one-time inquiry approach, we identified eight categories that emerged from the data: Range of emotions when anticipating clinical, building rewarding relationships with older adults, preparing for my nursing career, student pre-existing attitudes, providing the best care possible, relationships with grandparents, experience(s) in nursing homes and older adults 'have so much to teach us'. Two themes encompassed all the others: '[Older adults] have so much to teach us' and 'providing the best care possible'. A strong majority of students expressed enthusiasm for their upcoming clinical in a nursing home. CONCLUSION: Students' attitudes were significantly more positive than those in prior studies. The results offer essential insight for nursing faculty who teach and design clinical experiences for undergraduate nursing students in nursing home facilities. Faculty should take account of their students' prior experiences, thoughts, and feelings to prepare them appropriately to care for older adults in their future nursing careers. IMPLICATIONS FOR PRACTICE: Increasing staffing and retention of staff in nursing homes facilities remains a priority for stakeholders in long-term care of older adults. Nursing educators must continuously assess students' knowledge and attitudes assists to identify knowledge gaps and misconceptions, which must be addressed to teach student nurses how to provide high-quality, effective and culturally sensitive care to older adults. As students become more competent in caring for older adults, their desire to pursue a nursing career in gerontology care may increase. Early experiences of student nurses with older adults will prepare nursing students for their future career. Understanding students' thoughts and feelings will assist faculty in tailoring clinical orientation, designing clinical experiences and post-conference debriefings that address students' concerns. This research contributes to the knowledge of perceptions of nursing students and will assist to design educational experiences. Nursing educators who understand nursing students' attitudes toward caring for older persons can facilitate therapeutic interactions between nursing students and older adults. Designing experiences with these research results in mind may facilitate the development of positive attitudes towards caring for older adults.

Reflecting on research: sharpening nurses' focus through engaged learning.

BACKGROUND: The Bedside Scientist Institute is a basic research course provided for nurses using an engaged, interactive learning environment. This qualitative study evaluated the course outcomes. METHODS: A large Magnet®-designated teaching hospital provided the setting for both the education and the study. Coding categories and themes were identified from 16 interviews; a focus group confirmed the study findings. RESULTS: Culture change was facilitated by enlarging the perceptual field, reflecting on research evidence and the practice-research interface, and focusing on a new vision for evidence-based practice. Half of the nurses who participated returned to formal education. CONCLUSION: Participating in the Bedside Scientist Institute was transformative. The course opened participants' minds to question traditional practice, developing champions for research.

State of the Science: A Concept Analysis of Surgical Smoke.

Surgical smoke has not been clearly defined in the literature and often is identified using surrogate terms (eg, plume). In January 2020, a literature search was performed and a principle-based concept analysis involving four general principles (epistemological, pragmatic, linguistic, and logical) was used to define surgical smoke and identify implications for perioperative personnel, patients, researchers, and policymakers. Surgical smoke is a visible plume of aerosolized combustion byproducts produced by heat-generating surgical instruments. It consists of water vapor and gaseous substances; can carry toxic chemicals, bacteria, viruses, and tumors; can obscure the surgical field; and can be inhaled. Surgical smoke has a distinctive noxious odor and can cause physical symptoms such as watery eyes and throat irritation. Perioperative leaders should promote protection from occupational harm by educating their staff members on the use of smoke evacuators to mitigate the effects of surgical smoke on perioperative patients and personnel.

Safe clinical practice in pre-licensure nursing students: A concept analysis.

The aim of this paper is to provide a concept analysis for safe clinical practice for pre-licensure nursing students. Safe clinical practice is crucial to creating a safe environment. Defining the concept of safe clinical practice is important. Walker and Avant's concept analysis approach was used. Cumulative index to Nursing and Allied Health, Business Source Elite, Education Resources Information Center, and PsycINFO were searched for literature on safe clinical practice. The key words "student," "safety," "performance," and "unsafe student" were used. From a review of the literature, defining attributes, antecedents, and consequences of safe clinical practice were established and a definition of the concept emerged. The defining attributes identified are knowledge, skills, individual accountability, and professionalism. Students demonstrating appropriate knowledge levels and good technique with skills contribute to safe clinical practice. Taking accountability for one's actions and being professional also are important attributes to maintaining a safe clinical environment and ensuring safe clinical practice. Safe clinical practice in a patient-student situation occurs when pre-licensure nursing students who have been adequately prepared and practicing within a safe environment demonstrate knowledge of the clinical situation and its risks; communicate with faculty and staff members professionally; and develop appropriate relationships.

Sliding contact wear and subsurface damage of CAD/CAM materials against zirconia.

OBJECTIVE: Most previous work conducted on the wear behavior of dental materials has focused on wear rates and surface damage. There is, however, scarce information regarding the subsurface damage arising from sliding contact fatigue. The aim of this study was to elucidate the wear mechanisms and the subsurface damage generated during sliding contact fatigue in 5 contemporary CAD/CAM materials against a zirconia indenter. METHODS: Forty discs (Ø12mm, 1.55mm thick) were cut out of IPS e.max CAD (e.CAD), Suprinity PC (SUP), Enamic (ENA), Vitablocs Mark II (VMII) and Lava Ultimate (LU) blocks and mirror polished. After cementation onto a dentin-like composite, off-axis mouth-motion cycling was conducted with a spherical zirconia indenter (r=3.18mm) in water (200N load, 2Hz frequency) for 5 different cycling periods (102, 103, 104, 105, 106 cycles, n=8). Analysis of the wear scars was conducted using light-microscopy, scanning-electron-microscopy and optical profilometry. Subsurface damage was assessed using sagittal and transverse sections of the samples. RESULTS: Fatigue wear mechanisms predominated in glassy materials (e.CAD, SUP, VMII), accompanied by extensive subsurface damage, whereas abrasive wear mechanisms were responsible for the large wear craters in the resin composite (LU) with an absolute absence of subsurface fracture. A combination of both mechanisms was observed in the polymer-infiltrated reinforced-glass (ENA), displaying large wear craters and severe subsurface damage. SIGNIFICANCE: Well-controlled laboratory simulation can identify wear and subsurface damage susceptibility of various classes of restorative materials. Both wear and subsurface fracture are determining factors for the long-term success of restorations.