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Investing in Nurse Well-Being
No full textBackground: COVID-19 exacerbated the already high rates of moral distress, trauma, and burnout among healthcare professionals. To address these challenges, the Nursing and Allied Health Resilience and Well-Being Program partnered with an external organization to offer overnight nurse renewal retreats. These retreats aim to empower nurses to rediscover their passion, purpose, and connection to their profession by providing a safe, nurturing environment for processing difficult experiences.Methods: This mixed-methods pilot study was conducted in two hospitals within a 12-hospital system in Washington state. Participants engaged in journaling, trauma-informed care, mindfulness, yoga, self-compassion, and healing circles to promote self-awareness, cognitive reframing, and healing. Qualitative data focused on satisfaction were collected to evaluate the program\u27s effectiveness.Results: The intervention cost 1,277,656.03, 12 months post-intervention.Qualitative data collected from participants revealed positive outcomes. Nurses reported feeling truly cared about for the first time in my life and this was the first workshop that I felt safe and open to express my inner most feelings about work. These comments highlight the program\u27s ability to create a supportive and safe environment for processing difficult emotions and experiences.Despite initial challenges in filling the retreats, demand has exponentially increased, with 240 nurses requesting to attend for the available 48 spots. This surge in interest highlights the critical need for such programs to support the well-being of healthcare professionals.Limitations: Retreats over two years included a relatively small sample size and relied on self-reported data. Ongoing research is exploring the long-term impact of the intervention.Conclusion: Overnight Nurse Renewal Retreats provide a valuable investment in the well-being of healthcare professionals. By offering a safe space for processing difficult experiences, these retreats empower individuals to reconnect to their purpose and heal from occupational stress and trauma. The results demonstrate significant benefits in terms of retention, job satisfaction, and cost savings
Improving Confidence in Newly Hired Medicine ICU Registered Nurses
No full textIntensive care topics were taught by clinical nurse experts in structured lectures covering several critical care topics including pulmonary catheters, external pacing, massive transfusion, prone therapy, cardiopulmonary arrest, Minnesota/Blakemore tubes, continuous renal replacement therapy and rapid sequence intubation at a large academic university medical center in the southeastern United States.Among a small sample of newly hired intensive care nurses (P) who attended ICU lectures (I) how much did they improve (C) their scores for confidence in caring for patients with specific conditions (O)?Through the analysis of the empirical data collected in a simple matched-response pretest and posttest survey it was recognized that conventional inferential statistics (e.g., t-tests) used to analyze the data collected in a non-randomized one group pretest posttest design in a healthcare setting generally provide biased and misleading results. For this reason, Knapp (2012, p.467) argued “Why is the one-group pretest posttest design still used? In the context of research in nursing, Spurlock (2018, p. 69) recommended: “the single-group pre- and post-test design in nursing education research: it’s time to move on”. (The sample size used in the present study was only N = 10 and therefore inferential statistics were underpowered.Dendrograms were used depicting the results of the hierarchical cluster analysis to classify the ten nurses by their confidence in caring for patients with specific conditions before and after the intervention (i.e., ICU lectures).The conclusion is that a p-value, or statistical significance, does not measure the size of an effect or the importance of a result.” (Wasserstein et al., 2016, p.129). The nursing science community is implored to abandon the language of statistical significance in favor of meaningful statistics
Empowering Nurses as Change Agents for Climate Action: A Global Advocacy Action Plan
No full textBackground: The World Health Organization has identified climate change as the single biggest threat to human health1. Healthcare systems will inevitably struggle to meet the increasing demand of a sicker population as climate hazards increase in frequency and intensity (e.g. extreme heat, air pollution, extreme weather events)2. The healthcare sector itself, however, is a significant source of greenhouse gas emissions, exacerbating the burden of disease on the patients and communities it serves3. Radical transformation of the healthcare sector and its workforce is urgently needed to create climate-resilient health systems that align with the United Nations’ Sustainable Development Goals (SDGs)4. As the largest proportion of the global health workforce5, nurses have a professional and ethical responsibility to address the health impacts of climate change6.Problem: Despite its profound impact on human health, climate change is often not integrated into undergraduate nursing curricula or continuing education7,8,9. As a result, many nurses are unaware of the connection between climate change, health, and nursing practice7,8,9,10.Plan: This action plan, anchored in SDG 13 (Climate Action), aims to empower nurses and nursing students to become advocates and change agents for climate action. It focuses on connecting them with accessible online resources and training on the intersection of climate change and health. Strategies for integrating these concepts into nursing curricula and continuing education are also presented. Central to this effort is collaboration with key stakeholders (e.g. nursing faculty, clinical nurse educators, nurses associations, interdisciplinary partners). Continuous monitoring and evaluation will determine the effectiveness of educational strategies and identify further knowledge gaps.Conclusion: The ultimate goal of this action plan is to create a climate-smart nursing workforce that advances the SDGs. Empowered with the requisite knowledge and skills, nurses will be poised to influence policy, improve health outcomes, and lead the healthcare sector into a sustainable future
Critical Nursing Interventions for Post-Extubation ICU Patients
No full textIntroduction: The 24-to-72-hour period post-extubation is a critical phase for intensive care patients, and can result in many complications. Nurses must be expertly trained in the interventions available to reduce the risks associated with the procedure.
Objectives: This systematic review aims to critically evaluate the existing literature about nursing interventions associated with patients after extubation, providing evidence to guide the nursing practice to reduce extubation failure, reintubation rates, and hospital stays.
Methodology: This systematic review includes studies from CINAHL, PubMed Central, Medline, and Health Source Nursing Academic Edition, focusing on international peer-reviewed full-text research articles.
Setting: The study has a sample size of 11,756, and it faces limitations with articles published before 2018 and the diversity of intensive care patients. Inclusion criteria involve adult intensive care patients aged ≥18 years who experienced extubation, and exclusion criteria included patients under this age and categorized as surgical patients.
Main outcome measures: It analyzes the efficacy in reduce post-extubation complications related to desaturation, secretion management, stridor/laryngeal edema and pneumonia.
Findings: When compared with standard care, studies have shown that high-flow nasal cannula and noninvasive ventilation has shown the potential to reduce extubation failure and reintubation rates. Mechanical insufflation-exsufflation effectively promotes airflow in ventilated patients to stimulate a cough, facilitating sputum expectoration. Effective oral hygiene plays a crucial role in preventing Ventilator-Associated Pneumonia, and steroids are efficient in prevent laryngeal edema/stridor.
Conclusion: Implementing these nursing interventions can significantly benefit adult intense care patients recently extubated, increasing their safety, reducing reintubation rates, and optimizing recovery.
Implications: When critical patients stays are prolonged, it can strain nursing resources and lead to higher nurse-patient ratios, compromising patient care. It requires nurses to become active participants in monitoring the extubation outcomes and implement strategies for further improvement of a national guideline and protocol for post-extubation care
Reducing the Strain on Emergency Medical Services: A Rural Community Nursing Intervention
No full textIntroduction: Community nursing serves as an alternative healthcare model aimed to enhance access to care for patients who are Medicare beneficiaries in rural areas and have a chronic medical condition. Timely access to healthcare is essential to prevent frequent emergency department (ED) visits and hospitalization.
Background: Over 80% of Medicare beneficiaries manage at least one chronic illness while 68% manage two or more. Populations in rural areas face significant barriers to healthcare access including provider shortages and geographic isolation. The community nursing intervention reduces ED visits and hospital admissions for Medicare patients with chronic disease in rural settings.
Methods: A literature review was performed utilizing research from various qualitative and quantitative studies between 2017 and 2023. This review and analysis aligned with the 2021 AACN Essentials, focusing on public health and primary care initiatives. Common themes identified: alternative care model, reduction in healthcare utilization, the role of a community nurse, and barriers to community nursing.
Results: Results of this literature review suggest community nursing contributes to healthcare utilization reduction, improved chronic disease management, and augmented patient education. The Length of stay, Acuity, Comorbidities, and Emergency department visits (LACE) is a suggested tool to help identify high risk patients who may benefit from community nursing interventions. Other alternative care models, such as community paramedicine, demonstrate the feasibility and efficacy of in-home, nurse led healthcare management strategies.
Conclusion: Studies reviewed indicate implementation challenges that require the need for standardized training programs for community nurses, continuity of care through a patient referral process, and policy support for sustainable longevity of community nursing and its funding. Future recommendations include pilot programs to evaluate effectiveness, stakeholder collaboration, and policy advocacy for rural and Medicare healthcare services. Community nursing presents as a viable solution to address healthcare disparities by improving health equity and reducing the burden on emergency services in rural Medicare populations
Nurses\u27 Perceptions on Cyber Risk Disclosure to CIED Patients: Right to Know, Safety, and Well-Being
No full textSubject Population: Nurses will be invited to participate in an online questionnaire to understand their perceptions of 1) whether cyber risk language should be included in informed consents, 2) what perceived barriers exist when communicating cyber risks to patients (people, process and/or policy); 3) how can nursing facilitate solutions in supporting patient advocacy, improving nursing practice standards, and influencing policy change.
Research Design: This cross-sectional convergent parallel mixed-methods research design incorporates a hermeneutical approach for the qualitative assessment. The objective is to understand how nurses view the relationship between advocating for patients’ right to know, ethical adherence in patient care, promoting patient-centered care practice, and communicating the increased cyber risks to a target patient population.
Instrument: The research instrument is an online mixed-methods questionnaire.
Procedure: Nurses will be invited to participate in an online mixed-methods questionnaire and results will be published. An international nursing symposium will be organized and invite nurse academics, nurse leaders and experts from various fields to review these findings. In a collaborative process, proposed suggestions for cyber risk language in the informed consent, patient cyber safety education, enhancements to support services, and nursing cybersecurity practice standards will be co-created and presented in a group position paper
Exploring the Graduate Research Assistant Experience: Perspectives of Nursing PhD Students
No full textThis research project studied nursing PhD students at East Carolina University’s College of Nursing. These students have the opportunity to serve as graduate research assistants (GRAs) throughout their enrollment in the program. GRAs work with faculty on various research projects, including transcription services, recruitment, and data analysis. Given that less than 1% of nurses hold a PhD in nursing and that many who enroll do not graduate, evaluating the perspectives of current and former GRAs can provide valuable insights into our research question: How does serving as a GRA impact PhD nursing students’ academic progress and career trajectories? Answering this question can inform the effectiveness of this strategy in engaging students through unique teaching and learning experiences.Additionally, this research bridges the gap between our understanding of similar programs in non-nursing PhD education and the experiences of nursing PhD students, a group underrepresented in studies of terminal degree education. Data-backed insights from this study contribute to strategies for creating an engaging academic environment, enhancing student and program excellence, and improving health outcomes as these students enter the workforce.Data collection began with a demographics questionnaire distributed via REDCap to current and former GRAs. The survey also identified individuals interested in participating in a focus group. Eight surveys were completed, and six respondents expressed interest in the focus group. After scheduling, three participants attended a virtual session via Teams, which included automatic transcription and video recording. Thematic analysis of the focus group identified six key themes. Academic impacts included opportunities to apply lecture material, fund their education, and receive faculty support. Career impacts included relationship-building, personalizing their practice as nursing scientists, and making informed career decisions post-graduation.By identifying these themes, programs can use GRA perspectives to create opportunities that are both attractive and beneficial to prospective students. Further development of such initiatives could increase retention rates in nursing PhD programs and provide students with a meaningful experience, potentially encouraging them to engage with similar GRA programs as future nurse scientists
An Integrative Review of Telehealth for Rural Veterans
No full textIntroduction: Telehealth may be a sustainable healthcare delivery option for rural veterans as it allows for increased access to services and can lead to improved healthcare outcomes; however, the use of telehealth in this population is understudied.1 Accordingly, the purpose of this integrative review was to analyze the barriers, outcomes, and effectiveness of telehealth for rural veterans. Levesque’s Patient-Centered Access to Health Care Framework guided this review as it considers supply-side and demand-side dimensions that influence how individuals access healthcare.2
Methods: A comprehensive literature search was performed in the PubMed and Scopus databases. The framework outlined in Whittemore and Knafl (2005) guided this review process.3 Findings were synthesized and input into a data matrix. The John Hopkins Hierarchy of Evidence Guide was then used to determine the level of evidence of included articles.
Results: The initial search yielded 419 articles, five of which were retained for data extraction and synthesis. Articles employed a mix of qualitative and quantitative methodologies. A majority of participants were White and male. Thematic analysis revealed rural veterans’ experiences with telehealth through the dimensions of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Physician participation, convenience in service use, reduced travel burden, cost-effectiveness, and remote health surveillance were found to influence the use of telehealth services in the rural veteran population. However, preference for in-person resources and difficulties with care coordination were determined to be barriers.
Discussion: Telehealth is an affordable, appropriate, and easy-to-use approach to improve healthcare access for rural veterans. Future studies should consider including a larger sample of non-White, female veterans as their needs or perspectives may differ from their White, male counterparts. Additionally, healthcare workers should advocate for policies that increase telehealth access for this vulnerable group, as it proves to be a promising way for rural veterans to access healthcare
Personal Healthcare Networks: Integrative Review of Patient-Centered Social Network Analysis Studies
No full textBackground: Social network analysis is an interdisciplinary social science methodology used to investigate relationships between individuals, communities, and systems. In health research, it has often been used to research interpersonal dynamics on healthcare teams. However, it is infrequently applied to the patient perspective of those teams. One kind of social network analysis, the “personal” network, collects data based on one’s own perception of their connections and relationships. This methodology may be useful to gain the patient’s perspective on accessing healthcare services.
Purpose: To describe and evaluate empirical research using social network approaches to capture the patient perspective about healthcare teams’ structure and function.
Methods: Guided by Whittemore & Knafl’s integrative review methodology, we searched four databases (PubMed, CINAHL, Embase, and Web of Science) using terms for three concepts: “patient care team,” “social network analysis,” and “patient perspective.” Included studies applied theories or methods of social network analysis and collected data directly from patients about their healthcare teams (i.e., not informal social networks). Studies primarily collecting data from healthcare workers were excluded. The Mixed Methods Appraisal Tool was used for quality appraisal.
Results: The search yielded 3,785 unique records and 19 met criteria for inclusion. Included studies used quantitative (n = 5), qualitative (n = 9), and mixed methods designs (n = 5); were mostly outside of the United States; and spanned many health research areas (e.g., chronic illness management, primary care). Key themes were: A focus on description, opportunities for growth in mixed methods, inconsistent conceptualization of networks, the central role of the general practitioner, and dynamics of power and trust. While methods and topics of interest varied widely, the most rigorous research was completed via qualitative methods. Little work attempted analytically complex hypothesis testing. However, patient-provider dynamic findings point to the value of these approaches for gaining nuanced patient experiences.
Conclusions: This review identifies several opportunities for growth in the social network analysis literature but establishes the approach’s potential as a highly patient-centered methodology. Further, findings contribute to a more unified “personal healthcare network” concept and encourage developing these methodologies in new settings and populations
Understand Caregiving Appraisal in Chronic Illness and Disability Caregiving Over Extended Period
No full textCaregiving appraisal is the subjective evaluation and interpretation of the holistic caregiving experience. We aim to investigate the underlying factors related to caregivers\u27 perceptions and evaluations of their caregiving role and experience in chronic illness caregiving contexts. This study utilized a qualitative descriptive design. In-depth interviews were conducted with 20 caregivers to explore their experiences in providing care to adults with chronic illnesses or disabilities. Data were analyzed using conventional content analysis. We uncovered five interconnected themes: caregiving gain and loss tradeoff, caregiving competency, caregiving motivation, caregiving dyadic relationship, and caregiving meaning appraisal. Caregiving loss and gain tradeoff appraisal is the cognitive evaluation process through which caregivers assess the negative and positive outcomes associated with their caregiving role, weighing personal growth and benefits against the burdens and sacrifices required. Caregiving competency appraisal is the caregiver’s subjective evaluation of their ability to perform caregiving tasks effectively and confidently, shaped by professional and personal experience, external support and resources, physical and emotional challenges. Caregiving motivation appraisal reveals the interplay of voluntary and obligatory motivations, shaped by cultural and social expectations, familial commitment, personal fulfillment, love and affection, and practical demands. Caregiving dyadic relationship appraisal illustrates the subjective evaluation of the quality, dynamics, and changes in their relationship with the care recipient, shaped by mutual interactions, emotional connections, and the caregiving context. Caregiving meaning appraisal emphasizes the personal significance caregivers attach to their role. It encompasses their perceptions, beliefs, and emotional responses regarding what caregiving represents to them. Our finding highlighted the multifaceted nature of caregiving, shaped by personal values, practical circumstances, and relational dynamics. Insights from this study informed multiple caregiving-related scale development. Future research should explore caregiving appraisal across diverse populations, considering cultural and contextual factors, with longitudinal designs to track its evolution. Our findings also demonstrated the need to develop of tailored interventions that address practical, relational, and emotional dimensions of caregiving