Mobile Health Application and Hypertension Management in Rural, Middle-Aged Adults: A Quality Improvement Project.

Over 29% of the adult population in the United States are diagnosed with hypertension, and rates are significantly higher in those adults who live in rural areas. Hypertension is recognized as the most prevalent comorbidity and modifiable risk factor leading to premature death. The purpose of this quality improvement project was to determine if using a mobile phone-based health application called Medisafe could enhance medication adherence and improve blood pressure control in rural-dwelling adults. A small group (N = 14) of middle-aged (45-64 years old) patients with hypertension were recruited to download the free Medisafe phone-based health application. Patients utilized the Medisafe application between their initial visit and a 4- to 6-week follow-up. At the follow-up visit, 64% (n = 9) of participants improved their level of hypertension control by blood pressure classification and improved their scores on the medication adherence questionnaire. The findings from this quality improvement project suggest the Medisafe application is useful to enhance medication adherence and blood pressure control. Future research and quality improvement initiatives are necessary to determine the broader efficacy of phone-based health applications in the rural adult population.

Implementation of an Evidence-Based Clinical Guideline for Depression Screening of the Adolescent.

The evidence supports use of a depression screening tool to increase screening completion in the adolescent population. Clinical guidelines include use of the PHQ-9 in the adolescent population (ages 12-18). PHQ-9 screenings are currently lacking in this primary care setting. The aim of this Quality Improvement Project was to improve depression screening in a primary care practice setting located in a rural Appalachian health system. An educational offering with pretest and posttest surveys and a perceived competency scale are utilized. Focus is added to the process and guideline used to complete depression screening. As a result of the QI Project, posttest assessment of knowledge relating to educational offering increased, and use of the screening tool increased by 12.9%. The findings support the importance of education on primary care provider practice and depression screening of adolescents.

De-escalation Training as Part of a Workplace Violence Prevention Program.

Workplace violence, including verbal and physical abuse, is escalating nationwide. As healthcare workers try to enforce COVID-19 prevention policies and practices, this phenomenon is exacerbated. De-escalation training is a method to prepare nurses through increased situational awareness, leading to early recognition and improved coping and confidence in dealing with aggression. Outcomes are presented, suggesting education of nurses may have a positive influence on the number of security calls and incident reports.

Use of an Electronic Reporting Tool and Clinical Surveillance Process in the Neonatal Intensive Care Unit to Decrease Risk for Central Venous Catheter Complications Associated With Tip Migration.

This quality improvement project formalized central venous catheter tip surveillance augmented by the use of electronic patient reporting tool. The project setting was a large level IV academic neonatal intensive care unit with a representative convenience sample of patients with central venous catheters and quality improvement reports of complications from tip migration. Providers received education before implementation of a central venous catheter tip surveillance program using a revised electronic reporting tool was initiated. Provider evaluations of the electronic reporting tool included compliance with the guidelines and use of the tool in multidisciplinary patient rounds, and were entered into a database for analysis. Nine evaluations of the electronic reporting tool were completed, with an average of 97% compliance with guidelines. Seven evaluations during multidisciplinary patient rounds using the reporting tool data demonstrated use by both resident physicians and advanced practice nurses. Central venous catheter patient data were reviewed after process implementation. Overall, infant central venous catheter complications related to tip migration decreased following implementation. Therefore, the use of an electronic reporting tool improved compliance with evidence-based clinical practice guidelines and resulted in a decrease in the risk for central venous line complications related to tip migration in this setting.

Implementation of a Smoking Cessation e-Learning Education Program for Oncology Clinic Healthcare Providers: Evaluation With Implications for Evidence-Based Practice.

BACKGROUND: Continued smoking after a cancer diagnosis increases the risk for treatment complications, primary cancer recurrence, and secondary malignancy development, while also reducing treatment efficacy, survival, and overall health. The lack of formal evidence-based smoking cessation education programs for oncology healthcare providers is a barrier to smoking cessation practices. PURPOSE: To evaluate the use of an evidence-based, smoking cessation e-learning education program for oncology healthcare providers. METHODS: A single group, pre- and post-test, nonexperimental design was used in this evidence-based quality improvement project. To assess the provider's knowledge in smoking cessation, a baseline assessment, a post-test, and an online survey were completed by the providers. A telephone survey was conducted to assess the patients' perception of cessation services received. RESULTS: The healthcare providers' (N = 58) test scores on smoking cessation knowledge increased significantly (p < .0001) after completing the e-learning education program. A majority of the providers reported that the education program increased their confidence (86%) in successfully helping the patient to quit smoking and agreed to make smoking cessation a priority (89%) in their practice. A majority of the patients (85%) were satisfied or extremely satisfied with the smoking cessation services received. Many patients (71%) self-reported having tried to quit smoking. CONCLUSION: An evidence-based e-learning education program is effective in increasing oncology healthcare providers' knowledge and confidence in tobacco dependence treatment practices. The program also has a positive impact on oncology patients' perception of cessation services received. LINKING EVIDENCE TO ACTION: A self-paced e-learning program is a feasible and effective way to educate healthcare providers in smoking cessation treatment. Incorporating evidence-based tobacco dependence treatment into their daily oncology practice is warranted.

An Electronic Medical Record Training Conversion for Onboarding Inpatient Nurses.

In recent times, policies stemming from the American Recovery and Reinvestment Act of 2009 have served as a stimulus for healthcare organizations to adopt an electronic medical record. As a result, nurses are now more knowledgeable of and experienced with an electronic medical record. In August 2016, our facility converted from instructor-led training to electronic learning for inpatient nurse electronic medical record training, hoping to capitalize on previous experience with the clinical information system. However, a complete program evaluation of this transition had yet to be conducted. The purpose of this study was to evaluate electronic learning usability and the return on investment of an electronic medical record training conversion. Evaluations of electronic medical record electronic learning training were collected from 75 newly hired, inpatient nurses from November and December 2017, and compared to our instructor-led program. Results showed that users found it effective and were satisfied with this training method. The electronic learning had superior efficiency, reducing training time by ~50% compared to instructor-led training, while proving to yield effectiveness and satisfaction. The return on investment was $18 540, with a gain of 593.25 hours in nursing time during the study period of two months. These results support the organizational decision to convert to electronic learning, further supporting the conversion for other clinical roles.

A Congregation Transition of Care Program Using Faith Community Nurses and Volunteer Faith-Based Nurses.

Transition of Care Models can reduce the 30-day hospital readmission rate up to 67% by offering coordination and continuity of care. The purpose of this project was to evaluate a Congregation Transition of Care (CTOC) program in faith-based communities with the use of a faith community nurse and volunteer faith-based registered nurses. Descriptive statistics were used to describe findings, revealing a CTOC program can be effective in reducing 30-day readmissions in the faith community.

Associations Among Nurse Fatigue, Individual Nurse Factors, and Aspects of the Nursing Practice Environment.

OBJECTIVE: This study examined the relationships among nurse fatigue, individual nurse factors, and the practice environment in the inpatient setting. BACKGROUND: Nurse fatigue affects the quality of care provision on inpatient units. Scant literature exists regarding how aspects of the practice environment relate to nurse fatigue. METHODS: A cross-sectional, correlational design was used in this survey study of 175 neonatal intensive care unit nurses from multiple hospitals. Data were collected using the Checklist Individual Strength questionnaire and the Practice Environment Scale of the Nursing Work Index. Hierarchical regression analysis was performed to examine the relationships. RESULTS: Higher fatigue was significantly associated with more hours worked, fewer hours of sleep, a physical or mental contributor to fatigue, and a recent distressing patient event. Lower fatigue was significantly associated with better nurse manager ability, leadership, and support. CONCLUSIONS: Nurse fatigue may be diminished with organizational and individual strategies. Developing tactics for nurse managers to better support staff members after a recent distressing patient event is indicated.

Using Quick Response Codes in the Classroom: Quality Outcomes.

With smart device technology emerging, educators are challenged with redesigning teaching strategies using technology to allow students to participate dynamically and provide immediate answers. To facilitate integration of technology and to actively engage students, quick response codes were included in a medical surgical lecture. Quick response codes are two-dimensional square patterns that enable the coding or storage of more than 7000 characters that can be accessed via a quick response code scanning application. The aim of this quasi-experimental study was to explore quick response code use in a lecture and measure students' satisfaction (met expectations, increased interest, helped understand, and provided practice and prompt feedback) and engagement (liked most, liked least, wanted changed, and kept involved), assessed using an investigator-developed instrument. Although there was no statistically significant correlation of quick response use to examination scores, satisfaction scores were high, and there was a small yet positive association between how students perceived their learning with quick response codes and overall examination scores. Furthermore, on open-ended survey questions, students responded that they were satisfied with the use of quick response codes, appreciated the immediate feedback, and planned to use them in the clinical setting. Quick response codes offer a way to integrate technology into the classroom to provide students with instant positive feedback.

Improvement in Nurses' Knowledge of Subcutaneous Catheter Use for Pain Management.

BACKGROUND: Nurses often have insufficient knowledge of subcutaneous catheter use for pain management. This quality improvement project evaluated implementation of an evidence-based subcutaneous catheter nursing policy with education to improve pain management for hospitalized patients. METHOD: A convenience sample of nurses (N = 515) completed a posttest after online training on effective subcutaneous pain management. Patient pain ratings were assessed to evaluate whether they changed after nurses' training. RESULTS: Posttest scores showed the online learning module effectively contributed to nurses' knowledge of subcutaneous catheter pain management. A statistically significant reduction occurred in patient pain ratings (p < .001) postintervention. The number of patients experiencing moderate or severe pain decreased by 58%, for a significant reduction in pain. CONCLUSION: An online learning module was successful in educating nurses on pain medication administration through an indwelling subcutaneous catheter. [J Contin Educ Nurs. 2024;55(1):13-20.].

Oral care education in the prevention of ventilator-associated pneumonia: quality patient outcomes in the intensive care unit.

BACKGROUND: Ventilator-associated pneumonia (VAP) is associated with high morbidity and mortality rates in mechanically ventilated patients in the United States. Routine oral care has been shown to have a direct effect on reducing VAP rates. METHODS: Intensive care unit registered nurses attended educational sessions about oral care and also used online education modules. Nursing care involving 180 intubated patients was observed, and changes were noted in practices related to oral care. RESULTS: After the education intervention, the frequency of oral care increased significantly (p = .001) to tooth brushing every 4 hours and swabbing every 12 hours with 0.12% chlorhexidine solution. The evidence-based practice education intervention decreased VAP rates by 62.5%. CONCLUSION: Significant reductions in VAP rates may be achieved through improved education and implementation of oral care protocols with 0.12% chlorhexidine solution.

A Medicaid Statewide Hypertension Quality Improvement Project: Initial Results.

Background Hypertension control is critical to reducing cardiovascular disease, challenging to achieve, and exacerbated by socioeconomic inequities. Few states have established statewide quality improvement (QI) infrastructures to improve blood pressure (BP) control across economically disadvantaged populations. In this study, we aimed to improve BP control by 15% for all Medicaid recipients and by 20% for non-Hispanic Black participants. Methodology This QI study used repeated cross-sections of electronic health record data and, for Medicaid enrollees, linked Medicaid claims data for 17,672 adults with hypertension seen at one of eight high-volume Medicaid primary care practices in Ohio from 2017 to 2019. Evidence-based strategies included (1) accurate BP measurement; (2) timely follow-up; (3) outreach; (4) a standardized treatment algorithm; and (5) effective communication. Payers focused on a 90-day supply (vs. 30-day) of BP medications, home BP monitor access, and outreach. Implementation efforts included an in-person kick-off followed by monthly QI coaching and monthly webinars. Weighted generalized estimating equations were used to estimate the baseline, one-year, and two-year implementation change in the proportion of visits with BP control (<140/90 mm Hg) stratified by race/ethnicity. Results For all practices, the percentage of participants with controlled BP increased from 52% in 2017 to 60% in 2019. Among non-Hispanic Whites, the odds of achieving BP control in year one and year two were 1.24 times (95% confidence interval: 1.14, 1.34) and 1.50 times (1.38, 1.63) higher relative to baseline, respectively. Among non-Hispanic Blacks, the odds for years one and two were 1.18 times (1.10, 1.27) and 1.34 times (1.24, 1.45) higher relative to baseline, respectively. Conclusions A hypertension QI project as part of establishing a statewide QI infrastructure improved BP control in practices with a high volume of disadvantaged patients. Future efforts should investigate ways to reduce inequities in BP control and further explore factors associated with greater BP improvements and sustainability.

Coaching quality improvement in primary care to improve hypertension control.

BACKGROUND: Effective management of hypertension (HTN) is a priority in primary care, necessary to decrease the costs, morbidity, and mortality associated with cardiovascular disease. Strategies to support quality improvement (QI) efforts in primary care are needed to make significant improvements in population health, especially for patients who experience socioeconomic inequalities. LOCAL PROBLEM: To address the high rate (>50%) of uncontrolled HTN in the state of Ohio, a statewide QI project was implemented in high-volume Medicaid practices, aimed at improving blood pressure control and addressing racial disparities. The initiative expanded to include coaching QI to support efforts in primary care practices. METHODS: The Model for Improvement guided development of Plan-Do-Study-Act (PDSA) cycles facilitated by QI coaching and APRN collaboration to implement key components of HTN guidelines: accurate blood pressure measurement, effective treatment, and timely follow-up. INTERVENTIONS: Interventions were implemented after PDSA cycles over 18 months in two practice sites to address HTN control. Linking multiple PDSA test cycles and review of data bimonthly allowed for reflection on the impact of interventions for non-Hispanic Black patients and the overall patient population. RESULTS: The percentage of patients with controlled HTN, repeat blood pressure measurement, and timely follow-up improved in an urban primary care practice associated with an academic medical center and in a rural federally qualified health center. CONCLUSIONS: Primary care practices can benefit from the external support of coaching when implementing QI processes to make meaningful change. APRNs are key collaborators for expanding QI efforts in primary care.

Provider-directed education to reduce unnecessary neuroimaging in uncomplicated headache disorders.

BACKGROUND: More than 1.9 million annual outpatient visits to neurologists in the United States are associated with headache diagnoses. For uncomplicated headache disorders, the evidence-based practice (EBP) guidelines recommend against neuroimaging unless specific neurological signs and symptoms are present; however, neuroimaging rates have only modestly decreased since the guidelines were developed. LOCAL PROBLEM: We evaluated unnecessary neuroimaging rates in patients with uncomplicated headache at the Emory Department of General Neurology. The rate of unnecessary neuroimaging suggested a provider knowledge gap in the use of neuroimaging in patients with uncomplicated headaches. METHODS: A provider-directed educational session was delivered, and outcomes were evaluated 8 weeks after implementation. The postintervention rates of unnecessary neuroimaging were compared with preintervention rates. INTERVENTIONS: A 15-minute educational session on the EBP guidelines for neuroimaging use in uncomplicated headache was presented to all general neurology providers (n = 9). The providers were given an electronic version of the presentation and a pocket-sized EBP algorithm for neuroimaging in this population. RESULTS: Data collected from the project site's neuroimaging dashboard showed a significantly lower proportion of unnecessary neuroimaging orders in the 8-week posteducational interval (4.2%) compared with the 8-week preeducation interval (7.2%) (t = 2.78, p = .014), a 41.6% reduction. CONCLUSIONS: We found that a provider-directed educational session reviewing the EBP guidelines for neuroimaging in patients with uncomplicated headache disorders was successful in lowering rates of neuroimaging. Implementing similar projects in other departments could further reduce unnecessary neuroimaging use across the organization.

Effects of Knowledge and Value on Quality of Supportive Peer Feedback.

BACKGROUND: Motivational barriers and lack of knowledge about peer review inhibit creation of supportive peer feedback between nursing students. PURPOSE: The purpose of this study was to examine the effects of knowledge of peer-review practices and value for the process of creating supportive peer feedback on the quality of feedback nursing students create for their peers. METHOD: Data from 155 graduate nursing students were analyzed in this quasi-experimental, repeated-measures design, using analysis of covariance and conditional process analysis. RESULTS: Students who had high levels of knowledge and a strong sense of value for providing feedback to peers produced higher-quality supportive peer feedback. CONCLUSION: Even when a student has sufficient knowledge and skills to produce supportive peer feedback, their ability may not transfer to real peer-review contexts if they do not also have a strong sense of value for providing high-quality feedback to peers.

Personal digital assistants (PDAs): review and evaluation.

With the rapid turnover of health care information and the ongoing need for content revision, traditional textbooks may no longer serve as reliable, current resources for nursing students. Nurse educators, challenged to select relevant resources, are looking to handheld technology, or personal digital assistants (PDAs), for teaching and learning. The National League for Nursing Task Group on Instructional Technology has undertaken a review of articles in an attempt to summarize current literature regarding the use of PDAs in nursing. This article reports on the task group's findings. The task group identified a variety of articles and summarized relevant information for nursing education. Findings from the literature indicate that PDA use in the classroom and clinical setting has become more prevalent. However, only a small number of articles provide evidence about the effectiveness of PDAs in nursing. Most provide descriptive information and are also of value.

Registered nurse empowerment and intent to leave current position and/or profession.

AIM: This study explored the relationship between Registered Nurses' (RN) empowerment and intent to leave their current position and/or profession. BACKGROUND: While there is documentation of the relationship between job satisfaction and retention, little is known about the relationship between empowerment and intent to leave either the current position and/or profession. METHODS: A web-based survey was conducted in which 1355 respondents completed measures of personal demographics, empowerment, intent to leave their current position and the profession. RESULTS: Relationships were found between empowerment and intent to leave the current position (F = 80.08, P < 0.001) and intent to leave the profession (F = 75.99, P < 0.001). IMPLICATIONS FOR NURSING MANAGEMENT: The results of this study contribute to the limited body of knowledge in this area. It is suggested that nursing leaders utilize empowerment and intent to leave the position and/or profession as new concepts to measure future retention within the nursing workforce. CONCLUSION: Retention strategies need to focus on strategies for nurse empowerment.

Exploring student response systems in nursing education.

Using software products in the classroom can be an effective component in an overall technology integration plan. Choosing the right software for the subject area and classroom, however, can be a formidable task if undertaken without preplanning. In this article, we describe the developing process experienced professionally and personally with the student response system. The Internet and other new digital technologies have changed the way we respond to information. These changes are making an impact on students' learning styles and preferences. How to address this issue might be found in an endeavor that places the student at the center of the learning process and facilitates a more active experience: the interactive student response system. Imagine classrooms where teachers electronically introduce assignments using receivers and students beam information from pocket-sized remote controls. Imagine students working on group projects exchanging information without pen or paper.

The relationship of educational preparation, autonomy, and critical thinking to nursing job satisfaction.

BACKGROUND: This descriptive correlational study explored factors influencing job satisfaction in nursing. Relationships between educational preparation, autonomy, and critical thinking and job satisfaction were examined. METHOD: A convenience sample of 140 registered nurses was drawn from medical-surgical, management, and home health nursing specialties. The nurses were asked to complete the Watson-Glaser Critical Thinking Appraisal and Minnesota Satisfaction Questionnaire. Relationships between variables were analyzed to determine which explained the most variance in job satisfaction. RESULTS: Results indicated significant positive correlations between total job satisfaction and perceived autonomy, critical thinking, educational preparation, and job satisfiers. Significant negative correlations between job dissatisfiers and total job satisfaction were also found. CONCLUSIONS: Understanding nursing job satisfaction through critical thinking, educational level, and autonomy is the key to staff retention. Further research focusing on increasing these satisfiers is needed.

Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections in a Long-Term Acute Care Hospital.

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are the second most common health care-associated infection. CAUTIs represent a serious threat to chronic critically ill patients in long-term acute care hospitals (LTACHs). Evidence-based guidelines have been shown to reduce the risk of infection in acute care settings but are not well documented in LTACHs. METHOD: An evidence-based urinary catheter protocol was developed and implemented across three units in a large LTACH. RNs were oriented to the new protocol through online educational modules. During the evaluation period, 120 patients were admitted with a urinary catheter who qualified for chart review for CAUTI incidence. Overall catheter-days and CAUTI rates were compared, and changes in practice were noted. RESULTS: After the education intervention, overall urinary catheter-days decreased by 10.1%, and CAUTI incidence decreased by 74% (4.82 CAUTI per 1,000 patient-days to 1.24). The absolute risk reduction was 3.58 infections per 1,000 catheter-days. The findings were statistically significant (z = 1.00, p < .03). CONCLUSION: Significant reductions were noted in total catheter-days, and CAUTI rates improved after implementation of an education program and an evidence-based urinary catheter protocol in an LTACH. J Contin Educ Nurs. 2018;49(8):372-377.