Clinical Nurse Specialist最新文献

Purpose/objectives: The purpose of this article is to provide an overview of hospital-based credentialing and privileging processes for clinical nurse specialists (CNSs), describe barriers to success, and share lessons learned from CNSs who have successfully navigated the credentialing and privileging process.

Description of project: This article shares knowledge, experiences, and lessons learned from an initiative to achieve hospital credentialing and privileging for CNSs at 1 academic medical center.

Outcome: Policies and procedures for credentialing and privileging CNSs are now consistent with other advanced practice providers.

Purpose: The aims of this quality improvement project were to improve understanding and perceived confidence in using a tool that assesses patients at risk of violence.

Project description: The Brøset Violence Checklist is valid at assessing patients at risk of violence. Participants were given access to an e-learning module that demonstrated how to use the tool. Improvement in understanding and perceived confidence in using the tool were assessed preintervention and postintervention via an investigator-developed survey. Analysis of the data was conducted using descriptive statistics, and open-ended survey responses were analyzed using content analysis.

Outcome: Participants did not demonstrate an increase in understanding and perceived confidence after introduction of the e-learning module. Nurses reported that the Brøset Violence Checklist was easy to use, clear, reliable, and accurate and could be used to standardize assessments of at-risk patients.

Conclusion: Emergency department nursing staff were educated in use of a risk assessment tool for identifying patients at risk of violence. This supported the implementation and integration of the tool into emergency department workflow.

Introduction: Nursing homes have been disproportionally affected by the COVID-19 pandemic, particularly because of resident vulnerability, inadequate staffing, and poor quality of care.

Current state: Despite billions of dollars in funding, nursing homes often do not meet minimum federal staffing requirements and are frequently cited for infection prevention and control deficiencies. These factors significantly contributed to resident and staff deaths. For-profit nursing homes were associated with more COVID-19 infections and deaths. Nearly 70% of US nursing homes are for-profit ownership, where quality measures and staffing levels are often lower than their nonprofit counterparts. Nursing home reform is urgently needed to improve staffing and care quality in these facilities. Some states, such as Massachusetts, New Jersey, and New York, have made legislative progress in establishing standards for nursing home spending. The Biden Administration has also announced initiatives, through the Special Focus Facilities Program, to improve nursing home quality and the safety of residents and staff. Concurrently, the "National Imperative to Improve Nursing Home Quality" report from the National Academies of Science, Engineering, and Medicine made specific staffing recommendations, including an increase in direct care registered nurse coverage.

Conclusion: There is an urgent need to advocate for nursing home reform by partnering with congressional representatives or supporting nursing home legislation to improve care for this vulnerable patient population. Adult-gerontology clinical nurse specialists have an opportunity to leverage their advanced knowledge and unique skill set to lead and facilitate change to improve quality of care and patient outcomes.

Purpose/objectives: The acute care division of a tertiary medical center experienced a 167% increase in catheter-associated urinary tract infections, with 2 inpatient surgical units accounting for 67% of infections. A quality improvement project was implemented to address the infection rates on the 2 inpatient surgical units. The aim was to reduce catheter-associated urinary tract infection rates by 75% in the acute care inpatient surgical units.

Description of the project/program: A survey identified educational needs of staff, with response data informing the development of a quick response code containing resources for prevention of catheter-associated urinary tract infections. Champions rounded on patients and audited maintenance bundle adherence. Educational handouts were disseminated to increase compliance with bundle interventions. Outcome and process measures were tracked on a monthly basis.

Outcome: Infection rates decreased from 1.29 to 0.64 per 1000 indwelling urinary catheter days, catheter utilization increased 14%, and maintenance bundle compliance was 67%.

Conclusion: The project enhanced quality care through the standardization of preventive practices and education. The data reflect a positive effect on catheter-associated urinary tract infection rates from increased awareness of the nurse's role in the prevention process.

Design: This observational, descriptive study was conducted to determine the prevalence of microbial growth on toothbrushes found in hospital patient rooms.

Methods: Toothbrush sampling was conducted in 136 acute care hospitals and medical centers from November 2018 through February 2022. Inclusion criteria for the units and patient rooms sampled were as follows: general adult medical-surgical units or critical care units; rooms occupied by adults 18 years or older who were capable of (1) mobilizing to the bathroom; (2) using a standard manual, bristled toothbrush; and (3) room did not have signage indicating isolation procedures.

Results: A total of 5340 patient rooms were surveyed. Of the rooms included, 46% (2455) of patients did not have a toothbrush available or had not used a toothbrush (still in package and/or toothpaste not opened). Of the used toothbrushes collected (n = 1817): 48% (872/1817) had at least 1 organism; 14% (251/1817) of the toothbrushes were positive for 3 or more organisms.

Conclusions: These results identify the lack of availability of toothbrushes for patients and support the need for hospitals to incorporate a rigorous, consistent, and comprehensive oral care program to address the evident risk of microbe exposure in the oral cavity.

Purpose/aims: The aim of this study was to investigate the current practice of clinical nurse specialists working in US emergency care settings to (1) explicate the application of the Emergency Nurses Association core competencies and define the specialized clinical nurse specialist role in emergency care and (2) align current clinical nurse specialist practice in emergency settings with the National Association of Clinical Nurse Specialists core competencies and the identified substantive areas of clinical nurse specialist practice.

Design: This study used a quantitative exploratory descriptive approach using survey data.

Methods: A purposive convenience sample was recruited from the Emergency Nurses Association and the National Association of Clinical Nurse Specialists. Participants completed a 39-item survey based on a consensus process to develop competencies for emergency department (ED)-situated clinical nurse specialists.

Results: Respondents (n = 285) reported spending more than 50% of their work time in a primary clinical nurse specialist role. Significant differences in practice were found between geographic location, setting, educational preparation, title protection status, and type of institution.

Conclusions: Our findings suggest that that the competencies ascribed to ED-situated clinical nurse specialists are valid in both frequency and importance. However, ED-situated clinical nurse specialists are not fully credentialed or practicing to the full extent of their education and licenses, because of professional, legislative, and environmental limitations.