Nurse managers have a pivotal role in fostering unit climates supportive of implementing evidence-based practices (EBPs) in care delivery. EBP leadership behaviors and competencies of nurse managers ...and their impact on practice climates are widely overlooked in implementation science. The purpose of this study was to examine the contributions of nurse manager EBP leadership behaviors and nurse manager EBP competencies in explaining unit climates for EBP implementation in adult medical-surgical units.
A multi-site, multi-unit cross-sectional research design was used to recruit the sample of 24 nurse managers and 553 randomly selected staff nurses from 24 adult medical-surgical units from 7 acute care hospitals in the Northeast and Midwestern USA. Staff nurse perceptions of nurse manager EBP leadership behaviors and unit climates for EBP implementation were measured using the Implementation Leadership Scale and Implementation Climate Scale, respectively. EBP competencies of nurse managers were measured using the Nurse Manager EBP Competency Scale. Participants were emailed a link to an electronic questionnaire and asked to respond within 1 month. The contributions of nurse manager EBP leadership behaviors and competencies in explaining unit climates for EBP implementation were estimated using mixed-effects models controlling for nurse education and years of experience on current unit and accounting for the variability across hospitals and units. Significance level was set at α < .05.
Two hundred sixty-four staff nurses and 22 nurse managers were included in the final sample, representing 22 units in 7 hospitals. Nurse manager EBP leadership behaviors (p < .001) and EBP competency (p = .008) explained 52.4% of marginal variance in unit climate for EBP implementation. Leadership behaviors uniquely explained 45.2% variance. The variance accounted for by the random intercepts for hospitals and units (p < .001) and years of nursing experience in current unit (p < .05) were significant but level of nursing education was not.
Nurse managers are significantly related to unit climates for EBP implementation primarily through their leadership behaviors. Future implementation studies should consider the leadership of nurse managers in creating climates supportive of EBP implementation.
Children dependent on long-term mechanical ventilation after discharge from an acute care center are at high risk for readmissions, morbidity, and mortality directly related to the care they receive ...in the home environment. Parents are inadequately prepared to provide the level of care needed in the home setting before their child's discharge home. The primary goal of the Parental Airway Assessment with Simulation program was to assess parent learning and confidence in managing these children in the home setting after discharge. The Simulation Model for Improved Learner and Health Outcomes framed this assessment program's development, implementation, and evaluation which focused on artificial airway management. The evaluation of parent discharge education was quantified at multiple intervals with parent(s) acting as their own controls. This program implemented a multistep simulation-based assessment intervention over a 6-8 weeks which included a home visit after discharge. After program completion, parents showed a 22% increase in self-reported confidence in caring for their technology-dependent child after discharge using an administered pre-post family assessment survey. At the end of the program, parents showed significant improvement in clinical skills with a demonstrated increase across all four tracheostomy skill assessments.
Objectives:
Rural residents comprise approximately 15% of the United States population. They face challenges in accessing and using a health care system that is not structured to meet their unique ...needs. It is important to understand rural residents’ perceptions of health and experiences interacting with the health care system to identify gaps in care.
Methods:
Our team conducted focus groups with members of the Michigan Farm Bureau during their 2019 Annual Meeting. Topics explored included resources to manage health, barriers to virtual health care services, and desired changes to localized healthcare delivery. Surveys were used to capture demographic and internet access information.
Conclusion:
Analysis included data from 2 focus groups (n = 14). Participants represented a wide age range and a variety of Michigan counties. The majority were full-time farm owners with most—93% (n = 13)—reporting they had access to the internet in their homes and 86% (n = 12) reporting that their cellphones had internet capabilities. Participants identified challenges and opportunities in 4 categories: formal health care; health and well-being supports; health insurance experiences; and virtual health care.
Conclusion:
The findings from this study provide a useful framework for developing interventions to address the specific needs of rural farming residents. Despite the expressed challenges in access and use of health care services and resources, participants remained hopeful that innovative approaches, such as virtual health platforms, can address existing gaps in care. The study findings should inform the design and evaluation of interventions to address rural health disparities.
Background:
This study was conducted to determine how closely nurses’ perceptions of their clinical judgment abilities matched their demonstrated clinical judgment skills during a simulation.
...Methods:
Seventy-four registered nurses participated in a simulation using a video format. After the simulation, the nurses self-assessed their performance using the Lasater Clinical Judgment Rubric. This rubric was then used to rate the nurses’ actual performance in the simulation activity.
Results:
The study results showed a significant discrepancy between nurses’ perceptions of their own clinical judgment abilities and their demonstrated clinical judgment skills. Age and length of nursing experience enhanced the difference between the findings of self-assessment and actual performance.
Conclusion:
Younger nurses and those with 1 year or less of nursing experience were significantly more likely to have self-assessed their abilities at a much higher level compared with their actual skills.
2013;44(9):399–405.
J Contin Educ Nurs
2013;44(9):399–405.
Abstract only
266
Background: Chemotherapy is a high-volume, high-risk clinical intervention that requires interprofessional clinical teams. With increased demand for chemotherapy, a record number of ...newly-approved drugs, and health system cuts to professional development, we sought to develop and deliver an evidence-based educational program for nurses and pharmacists on safe handling of hazardous drugs, management of oncology emergencies, extravasations, oral oncolytic therapy, and promoting clinical practice change. Methods: After mail and web-based recruitment activities, selected participants completed pre-workshop online modules. Live workshops included a blend of faculty-led interactive sessions and four simulations to reinforce content. Post-simulation debriefing sessions clarified concepts and identified participant action plans for clinical practice change. Attendees have access to lecture videos, handouts, resources, and a discussion board. Applying Kirkpatrick’s framework, we assessed participant confidence to meet program objectives before and after the workshop, a 27-item knowledge assessment before and after the workshop, and satisfaction with specific learning activities on a 5-point Likert scale. Results: To date, faculty have led two workshops. 266 nurses and 72 pharmacists applied and we accepted 77 (29%) and 30 (42%), respectively. Participants' change scores in confidence to meet program objectives increased from pre- to post-workshop (range 0.51-1.00). Knowledge scores increased between pre- and post- workshop (16.3 vs. 18.76, p < .01). Overall satisfaction was high across all content areas (range 4.76 - 4.98). Nearly all participants (n = 104, 97.2%) reported they were extremely satisfied with the program. Conclusions: An interprofessional education program with online modules, in-person interactive sessions, and simulation activities is a promising strategy to deliver chemotherapy safety content to practicing oncology nurses and pharmacists. Future efforts include recruiting a more diverse pool of participants, and expanding the program to include advanced practice providers.
Drug therapy for cancer is a high-risk, high-volume clinical intervention that requires interprofessional teams. Given the complexity of anticancer drug therapy and safety concerns, an ...interdisciplinary team developed a novel training program for oncology registered nurses and pharmacists to improve cancer drug safety.
Participants completed preworkshop learning assessments and received access to web-based modules on six topics: hazardous drug handling, drug extravasation, hypersensitivity reaction management, sepsis recognition, immune checkpoint inhibitor toxicities, and oral oncolytic adherence. In a 7-hour workshop, participants applied module content in interactive exercises and high-fidelity simulations. Preworkshop and postworkshop questionnaires assessed changes in knowledge and confidence in each topic. Program satisfaction and changes to clinical practice or policies were assessed 3 months after the workshop.
Two hundred ninety-two nurses and 82 pharmacists applied to participate, and 103 (35%) and 44 (54%) have participated, respectively. Long-term follow-up data were available on 133 (90%) participants. Change scores in confidence to meet program objectives increased between pre- and postworkshop (range of increase 0.6-0.8,
< .01). Knowledge scores increased significantly between pre- and postworkshop (average improvement of 3.2 points,
< .01). Overall program satisfaction was high (mean 5.0, standard deviation 0.2 on a five-point scale). Seventy-seven (60%) reported that they had made at least one clinical practice or institutional policy change at 3 months.
An interprofessional education program with online modules, in-person interactive sessions, and simulation activities is a promising strategy to deliver cancer drug safety content to practicing oncology clinicians.
Fifteen simulation specialists met at Columbia University School of Nursing on October 12, 2018, for an interprofessional summit on innovations in simulation. Three successive panels focused on the ...future of simulation-based education, latest trends in simulation research, and linking simulation to improved patient safety outcomes. Discussions following each panel presentation generated many forward-thinking recommendations. In addition to summarizing those recommendations, this article reviews the evolution of simulation and explores steps that can take it to the next level for students, educators, researchers, and practicing clinicians, with the goal of improving patient outcomes.
•Simulation experts provide recommendations for advancing simulation in health care.•Three focus areas: simulation-based education, research, and improved patient safety.•Careful scenario planning and facilitator training needed for simulation success.•Research should connect the impact of simulation on improved patient outcomes.
•Screen-based simulation (SBS) activities incorporated into the Continued Professional Certification (CPC) Program could target and improve the management of high-acuity, low-frequency events like ...intraoperative emergencies.•Simulation modalities like SBS offer greater distribution, accessibility, and scalability than in-person simulation and should be explored for potential inclusion in the CPC Program.•Quality improvement projects and research on SBS are needed to guide future use of SBS for recertifying CRNAs and the CPC Program.
Certified registered nurse anesthetists (CRNAs) recertify through the Continued Professional Certification (CPC) Program. Screen-based simulation (SBS) is broadly accessible and should be considered as a recertification option.
Using the modified Delphi method, eight CRNAs with simulation expertise evaluated the usability and utility of a SBS.
Eighty percent of modified System Usability Scale items reached consensus and established content validity (ICC=0.674) while 87.5% of utility survey items reached consensus with ICC=0.805, indicating good reliability.
Technological aptitude may impact usability yet SBS may be a viable adjunct to the CPC Program. Future SBS exploration for recertification is warranted.
Several patient safety organizations have acknowledged that interruptions may be a contributing factor in medical error. Studies examining individual cognitive reactions to interruptions are lacking, ...which hinders the development of effective interventions to reduce interruptions.
A mixed-methods study was conducted including observations (n = 15), participation in high-fidelity simulations (n = 30), and debriefing interviews with participants after completion of the simulation exercise.
Experienced nurses more frequently violated policy in terms of allowing interrupting events to continue during time-out procedures (p < .003). Results from debriefing interviews indicated that participants used two cognitive strategies to manage distractions and interruptions.
This study showed that there were frequent distractions and interruptions during critical tasks in the operating room. It also supports the use of high-fidelity simulation as a tool to examine circulating nurses' decision-making in management of distractions.
•We found a high frequency of distractions/interruptions during the induction period.•Simulation scenario can be used as a tool to explore cognitive process.•The majority of participants were prioritizing and were concerned about patient safety.
To show clinical benefit in the main outcome measures by the use of a standardized protocol for identification, characterization, and treatment of alcohol withdrawal syndrome (AWS) in postoperative ...patients with head and neck cancer.
Prospective cohort study with a retrospective cohort control.
Tertiary care university.
A total of 26 consecutive postoperative patients with AWS were selected from among 652 patients with head and neck cancer to be enrolled in the protocol from March 2003 through March 2005. Controls consisted of 14 of 981 consecutive patients with AWS from March 2000 through December 2002.
Application of a standardized care protocol.
Sensitivity and specificity of preoperative screening for AWS risk, predictability of outcomes, length of stay, transfers to the intensive care unit (ICU), AWS symptoms, postoperative morbidity and mortality, doses of pharmacotherapy required, and charges.
Protocol patients demonstrated significantly fewer AWS-related ICU transfers and less delirium and violence than preprotocol patients. Mortality, wound complications, hospital charges, and doses of benzodiazepines, clonidine, and haloperidol were not significantly different between these 2 groups. Preoperative medical history correlated poorly with AWS outcomes. Screening was 87.5% sensitive and 99.7% specific. Late enrollees to the protocol (false-negative screening results) showed many significantly worse outcomes than immediate enrollees.
Use of the standardized AWS symptom-triggered protocol decreased delirium, violence, and AWS-related ICU transfers without significantly increasing hospital charges.
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