Journal of Doctoral Nursing Practice最新文献

Background: Obesity rates have continued to increase throughout the United States. Traditional healthcare settings have been unsuccessful at slowing down the epidemic. Finding innovative ways to improve obesity is critical.

Objective: This article discusses a worksite weight loss program that utilized a group visit format to help participants lose weight, decrease waist circumferences, increase physical activity levels, and empower patients for change.

Methods: A total of 18 participants completed the 6-week comprehensive weight loss program, which provided education and support on nutrition, physical activity, meal-planning, stress reduction, and goal setting.

Results: Participants in the worksite weight loss program showed improvements in several measured variables, including 100% of the participants achieving weight loss. In addition, 89% of the participants had a decrease in waist circumference, 53% improved their activity level, and 61% improved their level of readiness to change.

Implications for nursing: Non-traditional settings, like worksites, as well as group-visit formats, can be successful in improving obesity rates in communities.

Objective: First responders play a crucial role in caring for patients with sepsis, as they are often first on the scene in emergency medical situations. Many first responders lack the advanced knowledge and skill set needed to identify patients with sepsis or those at risk for sepsis.

Methods: This mixed-methods study examined if the implementation of a sepsis education program would impact and reduce the knowledge gap in first responders' ability to identify patients at risk for sepsis. Two hundred and thirteen first responders participated in an online sepsis education program, during which their knowledge was evaluated using a pretest and posttest.

Results: The difference in the mean of the preeducation test scores and the posteducation test scores' mean was significantly different. The mean of the pretest scores was lower than the mean of the posttest scores, thus suggesting that the education of first responders is effective in increasing their knowledge of sepsis. After completing the program, participants felt better prepared to encounter instances of sepsis.

Conclusion: standardizing communication between first responders and the emergency room through a "Sepsis Alert" can improve treatment times and allow for more timely intervention.

Background: Research shows providing cancer patients with adequate information has many benefits, but how do nurse practitioners know whether the initial consultation meets the information needs of their patients? Furthermore, how can the initial consultation be improved?

Objective: A low-cost continuous quality improvement process centered on decreasing distress and increasing information satisfaction was piloted to determine its effectiveness and feasibility.

Methods: Immediately before and after an initial consultation with a breast cancer surgeon, 59 women completed a questionnaire to measure distress and specific problems they were having. They then completed a questionnaire to measure information satisfaction. Pre-post changes in the distress score and number of problems were analyzed, as was information satisfaction. Feasibility was qualitatively examined.

Results: For the study sample, pre-post median distress scores decreased significantly (from 5 to 3, Chi-square = 5.73, p < .017). Information dissatisfaction scales were identified. The process was deemed feasible.

Conclusions: This effective and feasible process may help the nurse practitioner continuously improve the initial consultation process.

Implications for nursing: (a) the initial breast cancer consultation is important, (b) a novel process for improving the initial breast cancer consultation is proposed, and (c) this feasible, low-cost process should be embedded into normal practice operations.

Background: As the need for healthcare professionals continues to grow, different learning environments have been assessed to optimize knowledge while keeping the student engaged. Escape rooms, live action, team-based exercises, supplemented with TeamSTEPPS tools can assist in overall team performance, while keeping the participant engaged in a new learning environment.

Objective: The goal of this quality improvement project was to enhance teamwork and collaboration through the integration of TeamSTEPPS concepts and escape room active learning. This concept was explored through the integration of TeamSTEPPS tools and strategies in an escape room setting. The purpose was to improve team dynamics and cohesiveness in a new dynamic way with a small cohort of nurse leaders in a large urban academic medical center, while exploring the engagement and depth of learning experience for the participant.

Methods: Twelve nurse leaders completed two different escape rooms while observers completed the TeamSTEPPS observation tool assessing team dynamics and performance and participants assessed their perceptions before and after intervention. These nurses also were observed at staff meetings and completed a perceptions tool on teamwork pre- and postintervention. A postescape room survey was completed by participants to assess learning and interest in this interactive learning exercise.

Results: There was a significant statistical difference after TeamSTEPPS and escape room intervention (Mean 17.3 and p = 0.004 SD 5.9) when compared to before intervention as well as has a more positive sense of teamwork was noted. In addition, 75% of the nurses strongly agreed that the escape room was engaging and fun with 25% agreeing. Ninety-one percent agreed or strongly agreed that the escape room was an effective team-building exercise with 100% agreeing or strongly agreeing to recommend the escape room experience to others.

Conclusions: This cohort validated the integration of TeamSTEPPS tools and strategies in an escape room setting as an enjoyable and engaging way to learn while providing an effective team-building activity. This small cohort demonstrates that new methods of learning such as an escape room should be explored further for engaging participants and improving communication and teamwork skills.

Implications for nursing: Integrating TeamSTEPPS into an escape room offers this institution a way to continue this project while providing valuable team-building skills to its participants. While this was just a small sample in one intercity hospital, new methods for learning should be reviewed for successful teamwork in nursing and in healthcare as a whole, as there was some data to suggest that utilizing an escape room could have a positive impact on team cohesiveness as well as leadership skills for the individual.

Background: Adolescent electronic cigarette use has been steadily increasing since first being introduced commercially in 2007.

Objective: The aim of this pilot study was to determine if adolescents who watched an educational video during a wellness visit would increase their perception of risk related to electronic cigarette use.

Method: Seventy-nine adolescents participated and were randomly assigned to the intervention (n = 40) or control (n = 39) group. Results included risk perception, perceived benefit, and provider discussion about electronic cigarettes.

Results: There was no statistical difference between intervention and control groups for electronic cigarette risk or perceived electronic cigarette benefit. Adolescents who watched the video intervention compared to those who did not watch a video intervention were significantly more likely to report having discussed electronic cigarettes with their provider (p < .001).

Conclusions: Watching a video intervention on electronic cigarettes increased the likelihood of a reported discussion between provider/patient about electronic cigarettes but did not increase risk perception or decrease perceived benefit of electronic cigarettes.

Implications for nursing: Utilizing video education is one tool that could potentially be used to augment provider education during wellness visits.

Background: Transitioning patients from the hospital to home after a total hip or knee arthroplasty is challenging. Severe pain, comorbidities and complex medication regimes have the potential to delay readiness for discharge, increase length of stay (LOS), and cause readmissions.

Objective: The goal of this practice improvement project was to improve patient readiness for discharge after total joint arthroplasty to reduce LOS, prevent emergency department (ED) visits, and prevent hospital readmissions.

Methods: This quality improvement project was guided by the Iowa Model and implemented a prepost program implementation evaluation design. Nurses incorporated the Registered Nurse Assessment of Readiness for Hospital Discharge Scale (RN-RHDS) to guide and evaluate discharge education efforts.

Results: The focused education cohort demonstrated significantly decreased LOS and decreased readmissions compared to the cohort receiving standard education efforts. ED visits were not significantly different amongst cohorts.

Conclusion: This practice improvement project demonstrates successful translation of research into practice.

Implications for nursing: The use of focused education and the RN-RHDS tool is recommended for nursing to improve patient readiness for discharge and patient outcomes.

Background: Learning depends not only upon how teachers have designed and structured their subjects and courses but also upon how their students perceive and understand this design and structure. Understanding student's level of perception with their clinical education forms a basis of determining the quality of nursing education.

Objective: Assess nursing students' perception of their learning experience with community health nursing practical modules.

Methods: Cross-sectional descriptive study, the convenience sample included 149 students studying a community health nursing practical course at the Faculty of Nursing affiliated to Modern University for Technology and Information. Three tools were used; (a) interviewing questionnaire regarding demographic characteristics. (b) Undergraduate modules experience questionnaire and (c) Student evaluation of clinical education environment inventory.

Results: Students' total perception mean scores regarding the practical modules experience questionnaire was (79.82%), and different community clinical learning environment, family health centers (82.01%), schools (76. 83%), and geriatric homes (79. 29%) with statistical significance differences p ≤ .042. Furthermore, significant relationship was found between students' academic achievement and total perception of the Undergraduate Modules Experience Questionnaire (UMEQ) and its subscales, Good Teaching, Intellectual Motivation (p ≤ .01), Clear goals and standards and Generic Skills (p ≤ .04), Appropriate Assessment and Overall Satisfaction (p ≤ .05).

Conclusion: Nursing students revealed a higher positive perception of community health nursing practical modules experiences. However, there was few areas are required for improving quality of the practical modules.

Implications for nursing education: Increasing period of students' clinical training exposure, teaching the skills of effective time management as well as increasing number of the academic staff in the community health nursing department are recommended strategies for improving quality of community health nursing practical modules.

Background: Suicide is a risk in hospitalized patients within and outside of behavioral health units. Williams et al. (2018). Incidence and method of suicide in hospitals in the United States. Williams et al. (2018), suicides occur annually in hospitals, 14%-26% of occurrences outside of a behavioral health unit.

Objectives: The purpose of this project was to improve compliance with universal patient suicide ideation screening and targeted actions for patients screening positive admitted to nonbehavioral health units.

Methods: Electronic medical record (EMR) changes to support screening and targeted patient safety measure documentation were implemented. Nursing education was provided to support these changes. Pre- and postassessments were used to measure knowledge gained from the education. A compliance report was generated from the EMR to measure compliance with universal screening and patient safety measures.

Results: In a 4-month period, screening compliance improved by 20.6%, bedside safety companion use was 100%, suicide precautions, documentation 82.5%, and a behavioral health social work note documented 76% of the time.

Conclusions: Universal screening improvement is feasible and has the potential to improve patient safety. Implementation should be considered across health care organizations.

Implications for nursing: Providing nursing education and easier EMR workflows for nursing documentation of suicide screening and prevention strategies improves patient safety.

Background: Severe acute respiratory infection Coronavirus 2 (SARS-CoV-2) infection has spread all over the world since December 2019. Treatment of the syndrome represents an important challenge for all physicians. Spread prevention relies on a correct diagnosis which is performed with nasopharyngeal swabs.

Objective: To describe the proper execution of the swab with a few simple steps.

Methods: Figures and video recording.

Results: A few simple steps are presented within this paper in order to perform easily nasopharyngeal swab for SARS-Cov-2 diagnosis and for other possible infectious diseases of the airways tract.

Conclusions and implication for nursing: Nasopharyngeal swab may be performed in an easier way than usually thought. This method may also be used for any other microorganism detection. By following simple steps, a correct diagnosis can easily be obtained.

Background: Perceived health-related quality of life (HRQOL) is fundamental to well-being and is a meaningful way to measure physical and mental health.

Local problem: No standard method exists for measuring perceived HRQOL during the COVID-19 pandemic in participants as they attempt to improve their self-determined wellness goals. An implementation plan that considers the social distancing limitations imposed can be used to predict an individual's likelihood of long-term success.

Methods: During the four, 2-week plan-do-study-act (PDSA) cycles, the Social Cognitive Theory model informed the implementation of the four core interventions. To guide iterative changes, the data was analyzed through Excel and run charts.

Interventions: The four core interventions were the shared decision-making tool (SDMT), health mobile app tool (HMAT), wellness tracker tool (WTT), and the team engagement plan.

Results: Among 28 participants, perceived quality of life increased by 70%, engagement in shared decision-making increased to 82%, app use and confidence increased to 85%, and goal attainment reached 81%.

Conclusions: The SDMT, health app, and wellness tracker created a methodical plan of accountability for increasing participant wellness. The contextual barrier of the COVID-19 pandemic added a negative wellness burden which was mitigated by creating a patient-centered culture of wellness.