Implementing diversity, equity, and inclusion modules into a nursing trends and issues course: A quality improvement project

ObjectivesProvision of quality safety-netting advice is key to any discharge. Failure in doing so can result in ambiguity for parents of children and delays in seeking urgent treatment. Social determinants...

Future directions for research and education

Cultural Competencies for Graduate Nursing Education

Hallmarks of the professional nursing practice environment.

The Clinical Nurse Leader: A Comparative Study of the American Association of Colleges of Nursing Vision to Role Implementation

During a recent session of the theory course for the Ph.D. program in at the University of Michigan, the students and I were discussing an editorial by Dr. Ann Whall (2005) . In the editorial, Whall was commenting on a comparison of practice-focused and research-focused doctoral in reported in a document of the American Association of Colleges of Nursing (AACN). In the current version of this document, the AACN (2006) states that ... practice-focused understandably place greater emphasis on practice, and less emphasis on theory, meta-theory, research methodology, and statistics than is apparent in research-focused programs (p. 3). Whall was warning of the dangers to our practice that could spring from inattention to the philosophical (arguably metatheoretical) basis of our field. The students were stunned to learn that the national organization for higher education in in the United States would de-emphasize in any doctoral program, whether practice- or research-focused, what they saw as both an essential basis for intelligent and informed practice and critical information for any effort at knowledge development for our field. One went so far as to reason that the lack of such knowledge and appreciation for it among registered nurses in general was a source of the power imbalance between and other health professions in interdisciplinary contexts and to argue that such content actually be introduced and emphasized in baccalaureate (Hear, hear!). I was heartened by the students' passion and commitment to our disciplinary ideals, focus, and tools, and my hope for a better future for our profession and discipline rose significantly. Nonetheless, the discussion prompted me to take another look at what the AACN Essentials of Doctoral Education for Advanced Nursing Practice document espoused as to the nature of within such programs. In laying out Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice, the document relies on a distinction between Boyer's (1990) of discovery and of integration, deemed by the AACN as relevant to a research-focused doctorate, and his of application, seen as a frame for the practice-focused doctorate. While this is a tidy way to distinguish the scholarly focus within these two degree options, it is not an argument that supports a de-emphasis of our theoretical, metatheoretical, methodological, or statistical foundations in a practice doctorate. If the of application for our practice is not grounded in the same philosophical traditions as the of discovery and integration, what then is at its base? And, if its base is truly different than that of the of discovery and integration, could the scholars of application rationally draw upon the theories and findings of their counterparts in the vein of discovery to apply them? Further, in light of the complexities of the of application, rapidly coming to be known as translational science, a strong connection to our foundations would seem critical for emerging a scholarship of practice in nursing (p.11), as the Essentials document terms it, in order that such is grounded in the historical perspective, ontology, and epistemology of our field. Anyone doubting that metatheoretical issues abound in translational science is just not reading! (see Rycroft-Malone, 2007 and related articles in Nursing Research , 56(4S).) Clearly, scholars seeking to advance translational science are grappling with these matters in a very real and considered way. Would we want and expect those best educated in the of practice in to be any less prepared to handle these questions? Looking further at the Essentials document, practice is broadly defined and appropriately so. Great latitude is given to pursue any in the full range of specializations and to select across the span of roles from direct patient care to policy making. …

Improving Glycemic Control in Patients With COVID-19 : A Quality Improvement Project

The American Association of Colleges of Nursing (AACN) Essentials (2021) and the National Organization of Nurse Practitioner Faculties (NONPF) Role Competencies (2022) outline professional nursing competencies, resulting in a shift toward Nurse Practitioner (NP) competency-based education. To evaluate the reliability and validity of the Nurse Practitioner Student Competency Assessment (NPSCA), a revised instrument measuring person-centered competencies established by AACN and NONPF. Fifty-three students from four NP programs in their first clinical experience participated in the study. Each student performed one simulation, which was video-recorded. Two faculty members reviewed and scored each student's video recording using the NPSCA and the Virginia Commonwealth University (VCU) Scale, an instrument similar to those used by NP programs. The faculty ratings were collected using an online survey program. The final version of the NPSCA has 17 items. Eight faculty members rated the items on a scale from 1 (not very relevant) to 4 (very relevant), with 100% agreement that the items were relevant or very relevant, indicating sufficient content validity. Internal consistency: α = 0.884-0.895. Correlations between the NPSCA and the VCU scale were r = 0.288, p = .036 and r = 0.589, p < .001, respectively. The evidence supports the reliability and validity of the NPSCA. Its internal consistency is excellent, and the content validity and criterion-related validity were sufficiently supported. With a shortage of reliable and valid tools to assess NP graduates, the NPSCA may play a role in evaluating and ensuring the readiness of NP graduates for practice.

Examining the barriers to BSN prelicensure education among ADN students: A quantitative follow-up

Early onset sepsis (EOS) is an important cause of neonatal morbidity and mortality. Timely administration of antibiotics is crucial in management. We initiated a quality improvement project to improve timely administration of antibiotics. Primary drivers of change identified by the team were improving delivery of antibiotics from pharmacy and improving time to admit in the electronic medical record (EMR) in order to improve overall timeliness of antibiotics administration. Timings of antibiotics administration was tracked by using a control chart. Timings of antibiotics and outcomes of pre-intervention (December 2016) were compared with post intervention of PDSA cycles (January 2017-November 2018). There was statistically significant improvement in time to admission in electronic medical records over the time periods of pre-intervention, PDSA I and PDSA II (p-value < 0.05) (Table1). Also, time to delivery of antibiotics from pharmacy was significantly reduced between PDSA cycles from 21 minutes to 9 minutes with improvement in overall workflow. An average time to infusion of antibiotics decreased from 70 minutes to 48 minutes. There was also overall improvement in number of neonates receiving antibiotics under 1 hour of decision making from 37% to 77%. In our study we were able to successfully implement our "antibiotics under one hour" goal. The ability to achieve this objective can be met across multi-institutions rendering care to newborns if the approach is multidisciplinary. Deleting obstructions in the process that involve admission, registration and entry into the EMR effectively reduced time.

Introduction: Increasingly children are dying in the Pediatric Intensive Care Unit (PICU) as a result of withdrawal of life sustaining technology (WOLST). High quality end of life (EOL) care after WOLST may benefit from standardization. In addition, staff may feel better equipped to care for a child after WOLST if the team participates in a deliberate multidisciplinary huddle prior to WOLST. A needs assessment on EOL practices revealed lack of clear communication and documentation on the EOL care plan as the biggest barrier to quality EOL care. In an effort to optimize EOL care for children after WOLST, we developed a clinical pathway that relies on two WOLST huddles to prepare our teams for EOL care. Methods: A multidisciplinary group from the PICU and the palliative care team met regularly to develop and review EOL interventions and outcomes. As a quality improvement project, we aimed to perform at least one multidisciplinary huddle in > 80% of deaths after WOLST in the PICU during 2024, as evidenced by documentation in the medical record, A secondary aim was to improve staff satisfaction and preparedness when caring for a child receiving WOLST. Results: Baseline data was analyzed. In 2023, there were a total of 28 deaths in the PICU; 14/28 were as a result of WOLST. Of the 14 deaths after WOLST, there was no documentation of any communication regarding the EOL care plan. Our team underwent three PDSA cycles, with interventions including dissemination and education on the WOLST huddle and clinical pathway, identifying the charge nurse to initiate a huddle, and the development of a dot phrase.. Post intervention, data was re-analyzed. In 2024 there were 21 total PICU deaths; 12/21 of those deaths were a result of WOLST. 10/12 (83%) of deaths as a result of WOLST had at least one documented WOLST huddle. After the second PDSA cycle in February 2024, 10/10 (100%) of all deaths as a result of WOLST had at least one WOLST huddle documented in EPIC. Conclusions: When a WOLST huddle was performed in our PICU, staff reported feeling more prepared, improved communication amongst the team, and improved quality of EOL care. Quantitative data from surveys of PICU staff to assess perceived effect of EOL interventions including the WOLST huddle are pending. Next steps include implementing WOLST huddles hospital wide.

AimsWhen the coronavirus disease 2019 pandemic hit the UK, clinicians within Pennine Care NHS Foundation Trust (a five-borough mental health trust) were faced with the challenge of rapidly switching to a novel way of assessing patients remotely.The idea for a QI project on trainees’ experience with remote consultations was conceived in April 2020. We present our February 2021 results here.We aimed to improve trainee confidence in conducting remote psychiatric assessments by at least 40%, to ensure effective and safe patient care during their 6 months placement.MethodOur discovery process included surveying trainees in April 2020 to explore experiences with remote psychiatric consultations, a literature search of current UK guidance and a local audit. The audit reviewed documentation of consent to remote consultations, with reference to standards as per NHS England remote consultation guidance. Key change ideas included publication of an article, ‘Remote consultations – top tips for clinical practitioners’, video-simulated remote consultations and a session on remote consultations in the trainee induction.In the first ‘plan-do-study-act’ (PDSA) cycle, we presented key findings from the article in a video presentation, which was sent trust-wide. We measured confidence in conducting remote assessments pre- and post-presentation via a feedback survey. Unfortunately, response rates were low and in the second PDSA cycle we targeted a smaller cohort of trainees at the August 2020 induction, although encountered similar difficulties. In the third PDSA cycle, we collected real-time data using an interactive app at the February 2021 trainee induction, and measured pre- and post- confidence following a presentation and a video-simulated remote consultation.Result2/34 respondents had accessed previous remote psychiatric consultation training and12/35 had some telepsychiatry experience. Pre-induction trainee confidence results revealed: extremely uncomfortable (16%), not confident (31%), neutral (47%), confident (6%) and very confident (0%) and post-induction confidence was 0%, 22%, 52%, 26% and 0%, respectively.ConclusionOur project started during the first peak of the pandemic, which may be a reason for initial limited response rates. Our results suggest that the remote psychiatric consultation trainee induction session has shown some improvement in trainee confidence; the ‘confident’ cohort improved from 6% to 26%.Our next steps include collecting similar real-time data, mid-rotation and uploading video-simulated remote consultations to the Trust Intranet. We plan to complete the local audit cycle. We also plan to incorporate patient experience (from an ongoing systematic review) to inform a potential triage process post-pandemic, choosing between face-to-face versus remote consultations.

Aims In 2016 NICE published standards hat inpatients in an acute setting should have a reconciled list of their medicines within 24 hours of admission. Baseline data collected from our paediatric ward shows that medicines reconciliation by doctors is only completed 50% of the time. Evidence shows that medicines-related patient safety incidents are more likely when medicines reconciliation happens more than 24 hours after a person is admitted to an acute setting. The aim of this quality improvement project was therefore to ensure that 100 Methods The paediatric pharmacy team reviewed all paediatric inpatient drug charts from Monday to Friday for 12 weeks. The number of regular medications and the number of medicines reconciled was recorded each day. The effectiveness of various interventions were reviewed using PDSA cycles. Results On average, 40 patients were reviewed each week. The mean reconciliation rate was 79% and the worst rate was 0%. 100% reconciliation was achieved on 34 occasions and was achieved continuously for the last three weeks of data collection. Conclusion Multiple interventions occurred during this quality improvement project: teaching sessions for doctors, posters to raise awareness and questionnaires for parents/children to complete about their regular medications. The main factor for success in this project has been involving all members of the paediatric department including children and their parents. Additionally both A and E and the paediatric ward have both been involved ensuring consistency across the whole paediatric team.

Medical admission units are continuously under pressure to move patients off the unit to outlying medical wards and allow for new admissions. In a typical district general hospital, doctors working in these medical wards reported that, on average, three patients each week arrived from the medical admission unit before any handover was received, and a further two patients arrived without any handover at all. A quality improvement project was therefore conducted using a 'Plan, Do, Study, Act' cycle model for improvement to address this issue. P - Plan: as there was no framework to support doctors with handover, a series of standard handover procedures were designed. D - Do: the procedures were disseminated to all staff, and championed by key stakeholders, including the clinical director and matron of the medical admission unit. S - STUDY: Measurements were repeated 3 months later and showed no change in the primary end points. A - ACT: The post take ward round sheet was redesigned, creating a checkbox for a medical admission unit doctor to document that handover had occurred. Nursing staff were prohibited from moving the patient off the ward until this had been completed. This later evolved into a separate handover sheet. Six months later, a repeat study revealed that only one patient each week was arriving before or without a verbal handover. Using a 'Plan, Do, Study, Act' business improvement tool helped to improve patient care.

Background It is well established that perioperative anaemia is associated with poor outcomes, including prolonged recovery period and increased post-operative mortality. This is especially true for orthogeriatric patients, with iron deficiency being a major cause of anaemia within this patient cohort. Objectives To improve 1) the diagnostic testing for iron-deficiency anaemia (IDA) with full iron studies and 2) the usage of intravenous iron to treat iron deficiency in perioperative orthogeriatric patients in a tertiary hospital. Methodology Baseline inpatient data for geriatric hip and femur fractures from October to December 2023 were audited against the perioperative anaemia guideline by Centre for Perioperative Care, analysing the proportion of full iron studies tested and intravenous iron usage. Two ‘clusters’ of interventions were introduced; cluster 1: introduction of a local guideline and increasing ward availability of parenteral iron; cluster 2: introduction of a dedicated ‘Silver Trauma’ team and wider communication of the local guideline, including two sessions of departmental teaching. PDSA cycles were conducted following each intervention cluster. Results Initial audit showed 25.8% of patients with anaemia were tested for full iron studies, which improved to 57.9% and 78.9% after each intervention cluster. 62.5% of patients with IDA in the initial audit were given intravenous iron, which improved to 73.3% and 79.2% after each cluster. Conclusion There are significant improvements in both objectives following the interventions, which will have an impact in improving patient outcomes. Further strategies are currently being discussed to increase sustainability of the new pathway. All efforts have been undertaken to ensure compliance with established ethical standards for this work.