Journal of Doctoral Nursing Practice最新文献

Background: Understanding pain perceptions in older adults is important for pain management. An interprofessional team conducted a feasibility project to examine whether a pain diary designed for older adults in a transitional care unit offered a more holistic description of the pain experience.

Objectives: The project was designed to: (a) Develop a pain diary, (b) Examine patient usability, (c) Determine feasibility of the diary in workflow, and (d) Examine outcomes of diary entries and satisfaction surveys.

Methods: Three rapid change cycles assisted in developing and implementing the diary.

Results: Five patients followed for 32 days during implementation wrote simple narratives and rated their pain (M = 2-5.3) on 11-point pain rating scales. Themes from narrative responses were medicated relief and alternative methods, finding a balance between motion and activity, emotional burden of pain, and the importance of feeling supported by the health-care team. Patients and staff completed satisfaction questionnaires indicating enhanced communication.

Conclusions: The diary was feasible for patients and staff to use and has potential as an effective interprofessional tool for pain management.

Implications for nursing: The pain diary provides the interprofessional team an opportunity to understand the patient experience and provide holistic care.

Background: Students enter doctor of nursing practice (DNP) programs with varying interests and professional experiences. Little is known about how this impacts learning.

Objective: To explore if differences existed in students' perceptions of task values related to learning the skill sets of a DNP-prepared nurse.

Methods: Students were sent a link to a 17-item electronic survey consisting of demographic questions and nine statements based on competencies as outlined in The Essentials of Doctoral Education for Advanced Nursing Practice (American Association of Colleges of Nursing [AACN], 2006). Students ranked the statements in order of perceived value of performing after program completion.

Results: Mean rankings of task values demonstrated the advanced practice registered nurse (APRN) group (n = 32) identified the most valuable skill as "suggest an evidence-based change in professional practice based on the findings of published research articles and professional practice experience." The non-APRN group (n = 10) reported "work collaboratively with other non-nursing healthcare professionals to improve patient and population health outcomes."

Conclusions: Students' perceptions of the value of learning the skill sets vary amongst APRNs and non-APRNs, and are shaped by past professional experiences and future role demands.

Implications for nursing: Findings provide faculty with knowledge that can be used to tailor teaching and engagement strategies.

Background: Skin cancer is the most common cancer in the United States. Skin cancer is a broad term that includes squamous cell carcinoma, basal cell carcinoma, and melanoma. Melanoma is the most concerning of the three types of skin cancer and is the focus of this project. The projected number of individuals impacted by a new diagnosis of melanoma in 2020 is a staggering 100,350 coupled with an estimated 6,850 patients dying from melanoma each year. In Wisconsin, it is estimated there will be 2,190 new cases of melanoma, and 150 deaths in 2020. Expanding patient's knowledge about the risk and benefits of skin cancer screenings, techniques, and characteristics will enhance understanding of the significance of skin cancer.

Objectives: The purpose of this study was to assess current skin cancer knowledge and raise awareness by providing education regarding skin cancer risks and statistics among manufacturing employees in Wisconsin.

Methods: A quality improvement procedure took place as employees of a Midwestern global manufacturer were educated about self-skin screens, skin cancer risks, and the importance of sun protective behaviors. Pre- and post-education surveys were distributed and obtained.

Results: A total of 16 individuals participated in the study, and the results were clinically significant. Providing education about skin cancer risks and sun protection behaviors improved employee's knowledge base by 50%.

Conclusions: Although individuals identified skin cancer as an area of high concern, few reported knowing how to prevent skin cancer and the risks for skin cancer before being provided the related education. Therefore, it is evident, even with this small group that simple skin cancer counseling offers great benefit in helping increase knowledge among those educated about skin cancer risk factors and sun protective behaviors.

Background: Screening patients for obstructive sleep apnea (OSA) risk factors is an effective method for helping reduce adverse outcomes in conscious sedation. Patients receiving conscious sedation for endoscopy were not being screened for OSA at a rural hospital.

Objective: The purpose of this quality improvement project was to implement a nurse education program to improve OSA screening of endoscopy patients, using an evidence-based screening tool, and to increase nurse OSA knowledge and patient education.

Methods: This study was conducted in the outpatient perioperative section of a small rural hospital in northern Michigan. Data were obtained from pre/post chart review and nurse knowledge assessment. Twenty-eight nurses participated in an educational session that included OSA education and instructions on using the STOP-Bang questionnaire for OSA screening.

Results: Nurse OSA knowledge increased from 75% preeducation program to 89% posteducation program. Use of the STOP-Bang Questionnaire for patients presenting for outpatient endoscopy procedures requiring conscious sedation and patient OSA education increased from 43.5% to 81.2% pre- to posteducation program.

Conclusions: This study's educational session was successful in promoting use of the STOP-Bang questionnaire among perioperative nurses and increasing education for patients screened positive for OSA.

Implications for nursing: Training nurses to use a brief OSA screening tool effectively improved the OSA screening of patients presenting for outpatient conscious sedation involving endoscopy.

Background: Childhood vaccines prevent more than 10 million illnesses and 33,000 deaths in the United States each year. Noncompliance rates for children 2 and under are higher in underserved and resource poor communities.

Objective: The aim of this project was to develop and implement a five-step, direct-call reminder system to increase vaccination rates among children ages 2 and under presenting to a federally qualified health center (FQHC).

Methods: This project examined whether direct phone contact with parents can increase office visits to discuss vaccine status over a 6-week period following implementation of a five-step, direct-call reminder system.

Results: 47 parents/guardians were contacted from a list of 455 patients. Thirty-six percent of parents contacted scheduled and kept appointments.

Conclusions: This study found that the vaccines rates of a FQHC practice initiative are directly affected by methods of contact and knowledge of the vaccine schedule. Reaching out and discussing vaccine schedules with parents can increase vaccination rates. Yet, many of them have limited methods of contact.

Implications for nursing: A five-step, direct-call reminder system has a positive impact on vaccination compliance. Vaccination compliance is complicated, and approaches should be multifaceted.

Background: Transformational leadership is one of the most utilized models of leadership across the disciplines. It can positively impact the leader-follower relationship, performance of the leader, and productivity of the organization.

Objective: The purpose of the project was to assess the impact of an educational session on the recognition and execution of transformational leadership characteristics for nurse leaders and nurse educators.

Methods: An interactive transformational leadership education session aimed to affect the recognition and execution of nurse leaders' and nurse educators' transformational leadership characteristics.

Results: A Wilcoxon Signed Rank Test yielded a statistically significant increase in idealized influence (behavior), and an increase in intellectual stimulation and inspirational motivation.

Conclusions: This project creates the infrastructure for future ongoing initiatives focusing on the beneficial impact of transformational leadership development for nurse leaders and educators.

Implications for nursing: A supportive environment for transformational leadership development may take the institution to the next level regarding engagement, productivity, and performance, all of which are vital to organizational success.

Background: The majority of patients admitted to intensive care units (ICU) require central venous catheters (CVC) for medication delivery, monitoring and blood draws. Repeated access of CVCs for collection of blood can cause central line associated bloodstream infection (CLABSI). If the number of times CVCs accessed for routine blood draws can be limited, the incidence of CLABSI in ICUs could be decreased.

Objective: The focus of this quality improvement (QI) project was to decrease the CLABSI rate through limiting the use of and standardizing the process for routine blood draws through CVCs.

Methods: All nursing staff were educated on the process change. Pre and post education CLABSI rates were compared to measure the outcome.

Results: The number of times CVCs accessed for routine blood work and CLABSI rate decreased after the intervention.

Conclusion: The data collected supported that decreasing the use of CVCs for routine blood draws can decrease the number of times CVCs are accessed per shift and decrease the CLABSI rate.

Implications for nursing: Nurses are at the front line in preventing, reducing, and sustaining zero CLABSI rate through implementing evidence based practices.

Background: When measuring new practice approaches for improving patient safety in the clinical setting, researchers need instruments with evidence of reliability and validity.

Objective: The purpose of this analysis was to examine the reliability and validity of an instrument to assess knowledge and attitudes toward communication using situation-background-assessment-recommendation (SBAR; KA-SBAR).

Methods: This psychometric analysis was conducted with data from an interprofessional simulation-based learning experience with doctor of nursing practice students (n = 19) and physical therapy students (n = 52). Internal consistency reliability and construct validity tests including factor analysis for the KA-SBAR were conducted.

Results: The KA-SBAR instrument had adequate internal consistency reliability and evidence of construct validity, including identification of two factors that explained 70% of the instrument's variance. However, there may be a ceiling effect of scores, making it difficult to show change.

Conclusions: The KA-SBAR instrument may be useful in assessing clinicians' perceptions of SBAR communication in education and practice settings.

Implications for nursing: When selecting data collection measures, nurses need to carefully consider the purpose of the measure and evidence of the instrument's reliability and validity. Educators need to consider the clinical expertise of the students in designing challenging simulations to advance learning.

Background: Exclusive breastfeeding for 6 months is recommended by all health professional organizations. However, women cite lack of support from health professionals as a barrier to breastfeeding. Foundational nursing education does not prepare students (future nurses) to support breastfeeding women. Therefore, an evidence-based breastfeeding curriculum "toolkit" supporting health policy was developed and implemented.

Objective: The study was performed to determine the effectiveness of the toolkit education compared with standard education in an associate degree nursing program.

Methods: A pretest-posttest survey design with intervention and comparison groups was used. Students (N = 102) completed pre- and posttests. A 15-item survey derived from Marzalik's (2004) instrument was used to measure nursing student knowledge about breastfeeding.

Results: The mean number of pretest questions correct were statistically the same for the control and intervention groups. Both groups showed growth in their posttest scores, however the intervention group scored significantly higher on the posttest (intervention mean = 12.34, control mean = 10.73, t value (100 df) = -4.12, p < .0001).

Conclusion: The toolkit provides a curriculum that demonstrated enhanced student learning about breastfeeding.

Implications for nursing: Use of a reliable intervention like this breastfeeding toolkit is essential in the development of nurses who can provide effective breastfeeding support.

Background: Cigarette-smoking disparities continue to exist among minority groups of adults, particularly American Indians, who had the highest prevalence of cigarette smoking at 24% in 2017.

Objective: Implement a nurse practitioner-led smoking cessation pilot program at an urban American Indian health center.

Methods: The cessation program is based on the "Treating Tobacco Use and Dependence" clinical practice guideline with incorporation of motivational interviewing, and is guided by the Transtheoretical Model of Health Behavior Changes. The program consisted of ten sessions: one in-person visit and nine telephone sessions over the course of eight weeks. Evaluation of project objectives was achieved through the collection of qualitative and quantitative data via weekly phone counseling sessions and a final follow-up phone call.

Results: Among program participants (n = 5), three achieved complete cessation, one decreased their smoking behavior, and one experienced no change in smoking behavior.

Conclusions: Although the program is effective among participants who completed the program, attrition was a significant issue requiring potential future changes to the program design.