Clinical Nurse Specialist最新文献

Purpose: The purpose of this article is to describe the experiences of an entry-level clinical nurse specialist (CNS) leveraging practice from a structured orientation and mentorship program developed by advanced practice supervisors.

Description of program: An entry-level CNS may experience feelings of ambiguity, role confusion, social isolation, and inadequacy when transitioning into a CNS role. The author applied key components of a transition-to-practice program from a review of literature that includes a standardized competency-based orientation with mentorship, leadership support, and professional development opportunities.

Outcome: An annual portfolio outlined the completion of entry-level CNS outcomes in the 3 spheres of impact: patient care, nursing practice, and health system innovation.

Conclusion: A structured CNS onboarding and mentoring program is crucial to support entry-level CNS on transition to practice. Entry-level CNSs are in a position to take action advocating for role clarity, establishing a working relationship with mentors and peers, and maintaining clinical competence through a structured orientation program with mentorship.

Purpose/objectives: Medical cannabis is often prohibited for inpatient use. This disallows patients from using a substance they find beneficial, when other treatments have failed, for symptom relief including pain, nausea, insomnia, and mood. We found no other facilities with medical cannabis policies. Our team amended the medical cannabis policy to align with California state laws to facilitate inpatient use. Project aims were to (1) align the policy with state guidelines, (2) update workflow including eligibility algorithm with lockbox, and (3) improve patients' pain relief.

Description: A clinical nurse specialist spearheaded a cannabis interdisciplinary integration committee. A medical cannabis policy existed but did not meet recent legislative changes, prohibiting inpatient cannabis utilization. The committee revamped existing policy and created an eligibility algorithm, a medical administration record order, and a drug cross-referencing guide.

Outcome: Fifty patients were able to utilize cannabis during their inpatient stay over a 1-year period after medical cannabis policy implementation. Pain relief was the primary reason for cannabis usage, with 60% of surveyed patients reporting reducing opioids since starting cannabis.

Conclusion: Implementation of the revamped medical cannabis procedure to facilitate inpatient use was successful in implementation and patient outcomes. This can serve as a guiding framework for other institutions.

Purpose: Central line-associated bloodstream infection (CLABSI) rates have been consistently high at an academic comprehensive cancer hospital. CLABSI prevention bundles can mitigate central line infections, and many components focus on nursing practice. Identification of barriers to maintaining adherence to these elements is not always assessed or addressed. The purpose of this project was to increase adherence to CLABSI prevention nursing practices and to implement a sustainable program to elevate nurses' skills and documentation of CLABSI prevention bundle components.

Description: Pre-implementation/post-implementation chart reviews, post-implementation visual audits, and a survey for nurses post project were completed over a 9-week period. This project identified and addressed barriers to CLABSI prevention bundle compliance. Audits assessed nursing practice elements of the CLABSI prevention bundle. Evidence-based Kamishibai cards (K-cards) were used as a visual audit tool to display compliance of CLABSI bundle elements.

Outcomes: Compliant documentation of daily chlorhexidine gluconate (CHG) bathing increased to 75%. Inconsistent communication practices and knowledge gaps were frequent barriers to compliance. Seventy-five percent of nurses reported the K-card display changed their own CLABSI prevention practices.

Conclusion: This project increased knowledge, adherence to CLABSI prevention practices, and awareness of components most often missed.

Purpose/aims: To understand, based on the literature, how to implement the role of a clinical nurse specialist (CNS) in the hospital setting.

Design: A scoping review was conducted following the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute.

Method: The search was conducted during March and April 2023 and was updated in November 2023. Electronic searches were conducted in the following major databases: PubMed, CINAHL, Web of Science, Scopus, PsycINFO, and Cochrane Library. Additionally, a "snowballing" strategy was used. A critical reading was conducted using the Joanna Briggs Institute methodological quality criteria. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for the Scoping Review guidelines were used.

Results: Eleven relevant studies were included in this review. The primary results are presented in 4 sections related to the framework, process, components, and evaluation of the implementation of the CNS role. The findings of the reviewed studies suggest that the implementation process of the CNS is cyclical, variable, context-dependent, and multifactorial and can be assessed using the indicators of structure, process, and outcome.

Conclusions: This scoping review provides relevant information to support the design of implementation and evaluation strategies for the role of the CNS in the hospital context. Based on the findings of the reviewed studies, a comprehensive strategy is suggested for implementing the role of the CNS in a hospital setting.

Purpose: This article describes a protocol used to implement a continuous glucose monitoring program for patients treated with intravenous insulin.

Description: Although continuous glucose monitoring is not indicated for use in hospitalized patients, the COVID-19 pandemic created an immediate need to effectively address the increasing number of people hospitalized with hyperglycemia. The article highlights the implementation process and key glycemic outcomes, discusses the impact of continuous glucose monitoring use on staff time and healthcare resource utilization, and provides information about program expansion.

Outcome: Most patients achieved established glycemic targets. Our program improved staff safety by reducing their exposure to infection. Use of continuous glucose monitoring decreased staff time by almost 2 hours per person per day compared with point-of-care testing and resulted in an average cost savings of $278.00 per patient.

Conclusion: Continuous glucose monitoring is safe and effective in managing glycemia among patients treated with intravenous insulin.

Purpose: Patient management, care, and education are influenced by the core competencies of hematology nurses. Nurse specialists enhance patient safety and nursing care quality. However, no study has constructed an index of core competence assessment for hematology nurses.

Design: In this study, a literature review, theoretical analysis, and group discussion were performed to construct the core competency evaluation index system for hematology nurses.

Methods: Twenty-six experts from 7 provinces and cities across China were selected by purposive sampling for 2 rounds of Delphi expert consultation, and the indicators were selected based on the mean importance score >3.5 and coefficient of variation <0.25. A precedence chart determined the indicator weights at all levels.

Results: The evaluation index included 6 primary, 18 secondary, and 70 tertiary indicators. The positive coefficients of the questionnaire on the 2 rounds were 100% and 92.86%. The Kendall's harmony coefficients for indicators at all levels were 0.176 to 0.461 and 0.197 to 0.220. Experts' familiarity, judgment, and authority coefficients were 0.892, 0.871, and 0.882, respectively.

Conclusions: The evaluation index system may provide references for the training, curriculum setting, assessment, and qualification certification of hematology nurses.

Introduction: The role of the wound care nurse is identified as a key element in the management of patients with venous leg ulcers (VLUs). However, the literature offers fragmented knowledge of the outcomes associated with their practice.

Aims: To identify, summarize, and map all available evidence based on the wound care nurses practice for the treatment of VLUs.

Methods: A scoping review was conducted in May 2024 on PubMed, CINAHL, Scopus, and Cochrane Library databases. Observational or experimental studies related to patients affected by VLUs and cared for by wound care nurse specialists were included.

Results: Of the 1562 articles reviewed, 9 studies met the inclusion criteria. The most frequently measured outcomes were clinical responses and included healing rate and ulcer recurrence. Less frequent outcomes were patient-reported and resource utilization measures.

Conclusion: This review indicates a general predominance of outcomes related to objective clinical responses. Future studies should broaden the types of outcomes by also including patient-reported parameters (eg, pain, quality of life, stress) in order to gain greater evidence on the impact of wound care nurse specialists in the care of patients affected by VLUs.