Nursing Administration Quarterly最新文献

The global population is aging, and there is a concomitant increase in surgery for the elderly. In geriatric patients, where postoperative pain assessment is difficult, technological tools that perform automatic pain assessment are needed to alleviate the workload of nurses and to accurately assess patients' pain. This study offers a more reliable and rapid assessment tool for assessing the pain of elderly patients undergoing surgery. The study aimed to develop a machine learning-based pain assessment application for postoperative geriatric patients. A methodological study was conducted with 68 patients in the general surgery clinic of a hospital between October 2022 and June 2024. Data were collected using a Sociodemographic Data Collection Form, the Numeric Rating Scale, and the Wong-Baker FACES Pain Scale. Then, machine learning was used. Data are summarized using descriptive statistics and presented using narrations, tables, and graphs. The study reveals that nurses assigned lower scores to patients' pain levels. In the categorical classification, a high level of agreement was observed between the patient and the machine learning for each measurement. A machine learning-based pain assessment application is an efficacious method for assessing pain following geriatric surgery. It facilitates nursing care and supports the advancement of geriatric nursing.

A rapidly emerging topic in nursing and health care literature is virtual nursing. New hospital care delivery models are being developed largely in response to the shortage of registered nurses willing to work in the inpatient setting and proposed as the way to ensure safety in staffing in that context. One national health care system successfully presented a case for the implementation of an innovative model that would team a bedside nurse, a dedicated care partner and leverage technology to deliver adult acute care on inpatient units. The model was developed, prototyped and tested, with outcomes providing the impetus for a system decision to scale and sustain the model across all acute care hospitals. An innovative implementation team, guided by a focused change methodology and grounded in the core values of the organization, was established to implement the model across an initial 2500 beds. Principles of Human Caring Science and Relational Coordination were both cornerstones of the model and enablers of the change process. This paper will address details of the model, change tactics, implementation, learnings through scaling across an enterprise, and the implications for research.

In today's fast-paced health care environment, nurse managers face increasing complexity in their roles due to shifting care models, regulatory demands, and rising patient acuity. Technology is reshaping how nurse managers lead, requiring advanced digital competencies to navigate tools such as artificial intelligence, automation, predictive analytics, electronic health record interoperability, and virtual care. To lead digital transformation successfully, nurse managers must develop strategic leadership, informatics, and digital and data literacy skills. Empowering them with the right tools, training, and support is essential for ensuring high-quality, efficient, and future-ready care delivery. The leadership of nurse managers in the adoption of technology within the health care sector is significantly affected by their digital competencies. Many leaders recognize the importance of digital competencies for successful transformation, fostering confidence in the process. Key nurse manager competencies that empower this transformation include strategic leadership, health informatics, cybersecurity, data privacy, data literacy, and analytics. These insights highlight the necessity of providing nurse managers with the essential tools and knowledge to succeed in leading digital transformation.

Registered Nurse (RN)-led visits are increasingly utilized in ambulatory care. However, little information is available about implementation and sustainability for RN-led visits. Patients experienced difficulties accessing care in an ambulatory neurosurgery specialty care clinic. This article presents the implementation process and sustained success of RN-led visits over more than a 25-year time span in this neurosurgery specialty ambulatory care clinic. The number of operating room (OR) cases by a single neurosurgeon was increased by an average of 95 cases per year over a 5-year implementation time frame, growing from an average of 211 cases per year (2000-2004) to 306 (2005-2009), and sustained at this average with 309 cases in the 2020-2024 period. The sustained increased OR caseload over a 20-year time-period suggests RN-led visits can be an effective strategy to promote the entire ambulatory care team working at the top of their scope of practice. Further research is needed on economic impacts of RN-led visits, patient access wait times, and team satisfaction.

Nursing practice changes advance rapidly and can be difficult for health care professionals to navigate. As best practices, technology, regulatory requirements, and performance benchmarks continue to progress, nurses must adjust while continuing to provide excellent patient care. One key strategy for guiding these changes is through the use of shared decision-making. This article will provide nurse leaders with strategies to successfully guide their teams through practice changes using shared decision-making.

Patient safety remains an elusive goal for health care systems despite 2 decades of reports, strategies, tools, and revamped health professions education. These actions alone have lowered many targeted areas of preventable harm, particularly hospital-acquired conditions, yet evidence indicates better outcomes depend on "total system" approaches that embed patient safety in the core of care delivery. The first national patient safety plan, Safer Together: A National Action Plan to Advance Patient Safety from the Institute for Health Care Improvement, presents 4 recommendations to achieve total system safety. For decades, the Quality and Safety Education for Nurses (QSEN) competencies and the American Nurses Credentialing Center Magnet Recognition Program guided nursing care to ensure safe and high-quality care to pursue nursing excellence. By intertwining with Safer Together, the 3 re-envision a nursing practice model ensuring safe quality patient care. This paper describes integrating the 4 pillars defined by Safer Together into a nursing model with the Magnet Framework fueled by a nursing workforce grounded in the QSEN competencies. Nurses are in frontline positions for leading a total systems safety approach but need guidance for integrating these recommendations into effective professional practice models that define values, structures, and processes for delivering safe quality care.

The COVID pandemic was undeniably one of the most challenging times for health care with more than 100 000 nurses leaving the profession due to burnout and pandemic-related stress. Unfortunately, the nursing shortage is predicted to worsen, with the number of new nurses entering the workforce not measuring up to the rate of decline. To decrease some of the burden and burnout of the bedside nurses, an alternative nursing resource was implemented. Virtual nursing is an emerging strategy utilized to support safe and effective staffing in acute care amid the continued nursing workforce challenges. Virtual nursing is a team approach that leverages advanced technology such as smart screens (tablets with speakers installed on a cart), previously used for Telehealth, to support specific aspects of care. The Virtual Nurse functions from a remote location in real time, working in tandem with the bedside care team. A 3-month virtual nurse pilot at a community hospital improved communication with nurses, discharge information, and communication about medication, according to a Press Ganey survey. Anecdotally, patients reported feeling more valued and heard by the care team.