American Journal of Nursing最新文献

ACCORDING TO THIS STUDY.

Background: Since the COVID-19 pandemic, the turnover rate among U.S. nurses has remained elevated, and now stands at 16.4%, costing the average hospital organization more than $3 million annually. The U.S. military faces similar challenges in its nursing workforce, with rising resignations and increasing job demands resulting in a shortage of more than 1,300 active-duty nurses. Without sufficient military nurses, service members, their families, and our national defense may be negatively impacted. We therefore felt it was important to examine how military nurses' experiences influence retention.

Purpose: This interpretive, descriptive, qualitative study aimed to explore the unique experiences of active-duty U.S. Army nurses to determine the concepts that influence retention in the military.

Methods: Twenty-four active-duty Army nurses with varying levels of nursing experience were recruited via social media. Semistructured interviews were conducted via Zoom. A six-phase cyclic process of reflexive thematic analysis was used to generate the findings.

Results: The concepts that influence the retention of active-duty Army nurses are multifactorial. The main themes identified were (1) "It's the people," consisting of leaders, mentors, the Army nurse community, and military care recipients, and (2) "I'm not only a nurse," capturing the dual professional roles of nurses, who are also military officers, while also considering their nonprofessional roles as individuals and family members.

Conclusions: Our findings suggest that positive interpersonal relationships and the ability to balance multiple professional and nonprofessional roles contribute to retention among active-duty Army nurses. Future retention efforts should include fostering relationship-based leadership styles, enhancing mentorship opportunities, uniting the military nursing community, and instituting a clinical career track so nurses can remain focused on their patient population and the nursing profession.

Abstract: Health professionals and health care organizations globally are beginning to recognize that climate change significantly threatens patient health and the sustainability of health care systems. To address these issues, health care professionals can use three approaches-mitigation, adaptation, and advocacy-to promote climate action, decarbonize the health care system, transform health care practice, and develop policies that protect the public. In this article, we discuss advocacy, focusing on the ways nurses can use their professional and personal voices to address climate change.

Background: Children with autism spectrum disorder (ASD) may experience heightened fear and distress when accessing health care services, which can result in noncompliance with procedures. Management of needle pain and fear is particularly important for children with ASD given their higher utilization of health care services, neurodiversity, and limited coping skills.

Purpose: The purpose of this quality improvement project was to implement and evaluate evidence-based interventions to improve procedural care processes and challenging behaviors in children with ASD undergoing venipuncture.

Methods: The Iowa Model was used to guide evidence-based practice (EBP) improvement in the care of children with ASD undergoing venipuncture at a pediatric procedure and imaging suite of a children's hospital at an academic medical center. Based on evidence from the literature, patient and family preferences, and clinician input, a practice change that included individualized care, patient and family preparation, clinician preparation, and system design was implemented.

Results: Sixteen clinicians, including RNs, medical assistants, and nursing assistants, demonstrated increased knowledge and comfort in caring for children with ASD, improved availability of resources, improved utilization of procedure support cues and workflows, and improved outcomes. Similarly, 20 parents of children with ASD demonstrated improved preparedness, staff comfort, appointment flow, supportive environment, and awareness of individual needs and communication. Process measures were used to identify opportunities for improvement, select implementation strategies, and design the practice change.

Conclusions: Improvement in individualized care, patient and family preparation, clinician preparation, and system design can optimize care of children with ASD undergoing venipuncture procedures. An EBP process model and multiple targeted implementation strategies may facilitate the adoption of interventions to support these children.

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Implications for practice and research: