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Perceptions of ICU RNs of a Healthy Care Environment During A COVID Pandemic
No full textThe purpose of this descriptive study was to explore the perception of RNs in four ICU units in a Pacific Northwest university hospital of a healthy work environment during a COVID pandemic and with a comparison between two units.
Detailed abstract attached
The Underside of Resilience: A Critical Analysis of Resilience as a Mechanism for Burnout Management
No full textResilience is a necessary skill but not a sufficient condition to prevent burnout for professional nurses as it fails to address systemic contributors. This presentation will focus on the philosophically problematic attempt of resilience training programs to act as a primary mechanism for work-related burnout mitigation.
Detailed abstract attached
Reflecting on the Implementation of the I-PASS Handoff in an Inpatient Gastroenterology Department
No full textThe primary purpose of this project was to utilize a standardized evidence-based handoff using a modified I-PASS handoff for the gastroenterology department in an inpatient setting. The implementation of an evidence-based standardized handoff into a clinical practice is crucial to the success of patient care. According to the Joint Commission, errors in handoff communication are one of the leading factors of sentinel events (Humphrey et al., 2022). Omission of pertinent patient information during hospital handoff communication accounts for almost 30% of medical malpractice errors and lawsuits (Humphrey et al., 2022). Handoff communication can be described as the action of conveying essential information, written or verbal communication, pertinent to the continuity of care (Desmedt et al., 2021). In a study conducted by Humphrey et al., 40% of malpractice cases were a result of inefficient handoffs in patient care. More than 70% of these cases could have been prevented with a standardized handoff tool (Humphrey et al). Effective handoff communication is vital to patient safety.
In the 2018 Patient Safety Culture Survey, 51% of inpatient nurses found the use of a handoff tool to be effective (Blazin et al., 2020). The significance of implementing this project in an inpatient gastroenterology department was to improve face to face handoff communication between nurse practitioners and physicians. A previous study conducted at community-based New York Methodist Hospital in a pediatric inpatient setting focused on effectively utilizing a standardized handoff between residents and physicians (Walia et al., 2016).The inpatient gastroenterology department at a 641-bed hospital did not have a standardized evidence-based handoff between the nurse practitioners and attending physicians; nor has there ever been a standardized handoff put in place in the department. Given the lack of a standardizing handoff procedure, pertinent patient information was often missed resulting in delays/cancelations in procedures. Due to the complexity of many gastroenterology patients, a practical standardized handoff had to be flexible, accommodating, and user-friendly for daily usage (Müller et al., 2018). For these reasons, the I-PASS handoff was chosen as the evidence-based handoff of choice. Given that many of the nurse practitioners had been with this clinical group less than a year, the timing was excellent to introduce and improved handoff practice
Antenatal Mental Health Screenings: A Best Practice Implementation Project
No full textAntenatal depression, also known as prenatal or perinatal depression, is a type of clinical depression that can affect women during pregnancy. It is estimated that approximately 10-20% of pregnant women experience antenatal depression (Antenatal Maternal Health, n.d.). Antenatal depression has been linked to higher rates of postpartum depression. Additionally, antenatal depression has been associated with a reduced gestational age at the time of delivery, a lower APGAR score at 1 and 5 min, and admission to the neonatal intensive care unit. APGAR scoring is used to assess a newborn’s health immediately following birth.Providers at a women’s services clinic in the southern United States (U.S.) recently became aware that their current clinical practices did not include antenatal mental health screenings. Therefore, an evidence-based implementation project was planned to determine current adherence to EBP regarding antenatal mental health screenings.The best practice recommendations include:All health professionals providing care to pregnant women should receive training in women-centered communication, psychosocial assessment, and provision of culturally safe care. Depression and anxiety symptoms are assessed for all women at initial contact. If using the Edinburgh Postnatal Depression Scale (EPDS), further assessment is arranged for women scoring ≥ 13.
If using the Edinburgh Postnatal Depression Scale (EDPS), repeat assessment is conducted two to four weeks after the initial assessment in women scoring between 10 and 12. Psychosocial risk factors are assessed using the Antenatal Risk Questionnaire-Revised (ANRQ-R). All pregnant women are asked, when they are alone, about their exposure to family violence. Women are asked about their general health and well-being at each antenatal appointment. Women are given the opportunity to discuss any concerns they have at each antenatal appointment.The outcomes data from an initial survey and EMR review will be used to develop strategies to address gaps in best practices. Barriers to practice will be explored, and strategies will be identified to mitigate the barriers. It is impossible to know what gaps will be identified in the initial data, so specific interventions cannot be reported beforehand. Any strategies will incorporate the American College of Obstetrics and Gynecology (ACOG) standards and the best practices identified in the JBI evidence summary (Whitehorn, 2022)
Implementation of a Montessori-Based Dementia Program to Improve HealthCare Delivery in a LTC/SNF
No full textA 60-bed long-term care facility face challenges in dementia care. Staff report decreased confidence in managing behaviors (WeCare Connect, n.d.), which impacts person-centered care (Dookhy & Daly, 2021). Low engagement affects residents’ quality of life. This project aims to improve dementia care and increase resident and staff satisfaction.The Montessori-Based Dementia Care Program (MBDP) engages residents in meaningful activities by utilizing long-term memories (Montessori Method, 2020) to reduce behaviors and improve care quality (Erkes et al., 2021). This project aims to reduce incidents by 20%, increase engagement by 25%, and improve staff satisfaction by 15% by December 2025.This facility reports low staff satisfaction, with a 73% turnover rate and below-average staffing, resulting in reduced resident time (Luther Crest Nursing Facility, 2022). Increased workload limits time for person-centered care, leading to dissatisfaction (Dookhy & Daly, 2021). A new approach to managing dementia behaviors could reduce workload and improve satisfaction.Resident satisfaction is also low; 28% report worsened mobility, and 20% require more assistance, which increases fall risk and lowers quality of life. (Luther Crest Nursing Facility, 2022). Overall satisfaction is 80%, below average, especially in responsiveness and engagement (WeCare Connect, n.d.). Enhanced care and engagement are needed to improve life quality and ratings.MBDP significantly impacts engagement and job satisfaction (Booth et al., 2018). Studies by Sheppard et al. (2016) and Yan et al. (2023) show MBDP reduces disruptive behaviors and enhances life quality. A 2021-2022 MBDP pilot in this facility’s memory unit was shown to have decreased falls and turnover (WeCare Connect, n.d.).The project will utilize the Montessori Elder Care program from the Brush Development Company, incorporating the Plan-Do-Study-Act Method to provide monthly staff training and resident space redesign (How to Improve, n.d.). Key performance indicators like staff/resident surveys and incident reports will evaluate effectiveness, with refinements made utilizing the FRAME method (Madrigal et al., 2022). The $30,000 budget includes staff training, environmental changes, and data collection through third-party systems and electronic health records. To maximize cost-effectiveness, the project team will oversee data analysis, grant applications, and other roles
The Phenomena of Homeless People’s Suicidal Ideation and Mental Health
No full textIntroduction/Significance: In 2023, the number of people experiencing homelessness in the United States was 653,104. Compared to the previous year, this was a 12.1% increase. Homelessness is an important societal problem.Purpose: The purpose of this study was to examine the phenomena of mental health and suicidal ideation among people with homelessness in Tennessee, USA.Methods: Sixty people with homelessness were recruited in Eastern Tennessee, USA. This was a cross-sectional descriptive research design. Questionnaires were used to collect data. SPSS 28.0 was used to analyze the data. Descriptive data analysis was used.Results: There were 42 males (70%) and 18 females (30%). The mean age was 46.08 (SD = 12.54, range = 19-71). Fifty-one (85%) had a monthly income was US$ 999 or less. Most of the diagnoses included Depression (75%), Anxiety (65%), Substance Use (46.7%), PTSD (38.3%), and Mood Disorder (36.7%). Seventeen (28.3%) indicated that they thought seriously about killing themselves. Sixteen (26.7%) stated that they tried to kill themselves in the last year. Twenty-six (43.3%) had high-level depression and should talk to a professional, but only sixteen (26.7%) received depression treatments. Most of them drank alcohol because they felt (1) nervous or scared (61.7%), (2) Sad, depressed, or discouraged (70%), and (3) anger with themselves or someone else (73.3%). Psychological Well-being Questionnaire: (1) I have not experienced many warm and trusting relationships with others (63.3%). (2) When I look at the story of my life, I am not pleased with how things have turned out (63.3%). (3) The demands of everyday life often get me down (61.7%). (4) In many ways, I feel disappointed about my achievements in life (60%). (5) Maintaining close relationships has been difficult and frustrating for me (55%). (6) People would describe me as a giving person, willing to share my time with others (73.3%). Anxiety Questionnaire: Feelings of tension (90%), worries (88.3%), irritability (88.3%), inability to relax (85%), difficulty in falling asleep (85%), pain and aches (85%), anticipation of the worst (83.3%), fatigability (83.3%), startle response (83.3%), moved to tears easily (83.3%), and feeling of restlessness (83.3%).Conclusion: The results of this study provide evidence of the mental illnesses, alcohol use, suicidal ideation, and psychological well-being of people with homelessness for health professionals when they take care of this population
Bias-Based Bullying among Middle Eastern & North African Students: Potential Protective Factors
No full textBullying victimization among school students is associated with negative psychosocial experiences such as anxiety, depression, and sometimes suicidality.1,2 Middle Eastern and North African (MENA) students experience bias-based bullying in schools at high rates compared to other non-minority groups.1,3 Although much research focuses on this phenomenon, few studies explore the possible protective factors that buffer the effects of bias-based bullying among this specific group of students, such as religious participation and certain developmental assets. Religious participation is associated with less depression and anxiety symptoms among Asian American students.4 Developmental assets of empowerment, social competence, and positive identity enable youth with the skills and values to thrive and have meaning and purpose, which may decrease the negative impact of bullying on mental health.5 Guided by the Resilience Portfolio Model,6 this study aims to examine 1) the prevalence of bias-based bullying and mental distress indicators and 2) the moderating role of religious participation and developmental assets on the association between bias-based bullying and mental health among MENA students. This is a secondary analysis of the 2022 Minnesota Student Survey, a state-wide survey collected from public school districts.7 The study sample consists of 1,634 students in 8th, 9th and 11th grades; majority were male (52%) and in 8th grade (28%). Almost one-fourth (24%) reported religious participation at least one day in a normal school week. The Developmental assets scale ranges from 1- 4. MENA students reported a mean of 2.7 (SD = .629) for the positive identity scale, 2.9 (SD = .543) for the social competence scale, and 3.1 (SD = .522) for the empowerment scale. Bias-based bullying was reported by (56%). Almost a third (31%) of students screened positive for depression and 36% for anxiety. A positive significant correlation was found between bias-based bullying with depression (r=.313, p= \u3c .001) and anxiety (r=.314, p= \u3c .001). Preliminary multivariable findings indicate a direct effect of bullying on mental health indicators among MENA students. Further analysis of the buffering effects of the potential protective factors is planned and will enhance our understanding of these associations. Findings will be used to identify and advocate for potential intervention strategies that adults might implement in schools to limit the negative impacts of bullying
The Predictors of Mental Health and Suicidal Ideation Among People with Homelessness
No full textIntroduction/Significance: A record-high 653,104 people experienced homelessness with 39.3 percent unsheltered in 2023. This is more than a 12.1 percent increase over the 2022. Homelessness is an important societal problem. Mental illness, adverse childhood experiences, and substance use are serious issues among people with homelessness.Purpose: The purpose of this study was to examine the predictors of psychological well-being, suicidal ideation, anxiety, and depression among people with homelessness.Methods: Sixty people with homelessness were recruited in Tennessee, USA. This was a cross-sectional descriptive research design. IRB was approved. Questionnaires were used to collect data. SPSS 28.0 was used to analyze the data. Pearson Correlation and Stepwise Multiple Regression were used to examine the research questions.Results: There were 42 males (70%) and 18 females (30%). The mean age was 46.08 (SD = 12.54, range = 19-71). Most of the diagnoses included Depression (75%), Anxiety (65%), Substance Use (46.7%), PTSD (38.3%), and Mood Disorder (36.7%). The significant predictors for Psychological Well-being were Spiritual Well-being (β = 0.304, p \u3c 0.05) and Positive Personalities (β = 0.373, p \u3c 0.01). The significant predictors for Suicidal Ideation were Life Satisfaction/ self-actualization (β = -0.426, p \u3c 0.001), Emotion-Focused Engagement (β = 0.221, p \u3c 0.05), and Negative Family Interaction (β = 0.252, p \u3c 0.05). The significant predictors for Anxiety were Life Satisfaction/ self-actualization (β = -0.24, p \u3c 0.05), Negative Family Interaction (β = 0.34, p \u3c 0.01), and Positive Personalities (β = -0.28, p \u3c 0.05). The significant predictors for Depression were Negative Family Interaction (β = 0.25, p \u3c 0.05) and Positive Personalities (β = -0.40, p \u3c 0.001).Conclusion: The significant predictors for psychological well-being were spiritual well-being and personality. The significant predictors for suicidal ideation were life satisfaction/self-actualization, emotion-focused engagement, and negative family interaction. Negative family interaction was a significant predictor associated with anxiety and depression. Positive personality was a significant predictor associated with lower anxiety and depression. Life Satisfaction/ Self-actualization was a significant predictor related to lower anxiety
Fundamental Care in Times of Crisis: The Lived Experience of Chief Nursing Officers
No full textFundamental nursing care refers to the essential and practical elements of care that involve the integration of physical and psychosocial aspects of care required for every person in any care setting. The Covid-19 pandemic created unique challenges for nurses, which inhibited their ability to consistently provide fundamental nursing care. This study explored the lived experiencs of Chief Nursing Officers and delivery of fundamental nursing care during the Covid-19 pandemic. This study employed an exploratory phenomenological approach to gain an understanding of how Chief Nursing Officers (CNOs) promoted fundamental nursing care during times of crisis. Specifically, this study explored perceptions of barriers to provision of care and strategies supporting staff in providing care and monitoring clinical outcomes. Data were collected using a semi-structured hermeneutic interview process to gather information which was then explored and analyzed by the researcher. Study participants were recruited from large (defined as \u3e500 beds) tertiary care academic medical centers in the US that have Magnet designation as awarded by the American Nurses Credentialing Center. Interview transcripts were analyzed using thematic analysis. A code book, developed by the researcher, was used to determine patterns and emerging themes which demonstrated possible relationships to explain the phenomenon of interest. Emerging themes were grouped and coded to explicate relationships between research questions and study findings. Initial codes were generated at the time of transcription and subsequent codes identified with repeated reviews. Operational and conceptual definitions were developed for each theme. Finally, using the identified themes, data were transformed into a narrative that describes lived experiences of participants.This study advances the understanding of the impact of Covid-19 on the delivery of fundamental nursing care from the perspective of nursing leaders. The understanding gleaned from this study of CNOs and the context in which nurses provide fundamental care may be used to inform nursing leaders with regard to allocation of resources and optimized staffing models to support nurses in the consistent delivery of high-quality fundamental nursing care in times of crisis
Feasibility, Acceptability and Burnout in a Mentorship Program for Students and Graduate Nurses
No full textBackground: Rising patient acuity and workload have led to an exodus of nurses from the bedside and heightened stress for graduate nurses (Krofft et al., 2021; Shah et al., 2021). It is imperative that academic and clinical educators work to mitigate stress and burnout for nursing students and graduate nurses assuming nursing roles. Mentorship programs can improve confidence, reducing stress, but their impact on reducing burnout is less understood (Yukawa et al., 2020).Purpose: This project explored feasibility, acceptability and burnout in a multi-faceted mentorship program to support undergraduate/graduate nursing students and graduate nurses.Methods: In a university in the MidAtlantic United States, undergraduate/graduate nursing students, graduate nurses and experienced nurses were recruited via Sigma. Mentors and mentees were matched by mentee goals and mentor education and career experience. Mentor and mentee toolkits and a lecture series were provided help participants develop the relationship.Feasibility, acceptability and satisfaction were evaluated at 3, 6, 9, and 12-months. Mentee satisfaction with the mentor was evaluated via the Mentorship Evaluation Tool-13 (Yukawa et al., 2020). Burnout was measured at baseline, 6 and 12-months via the Maslach Burnout Inventory – Human Services Survey for Medical Personnel (National Academy of Medicine, 2021).Results: 17 mentors and 19 mentees participated. Mentors were predominantly Caucasian (88%), female (76%), ≥ 36 years old (71%), and in the nursing workforce \u3e 10 years (71%). Most mentees were Caucasian (84%) females (89%). 53% were undergraduate nursing students and 56% were 18-25 years old.Mentors and mentees were consistently satisfied with the dyad. Most mentees met monthly with their mentors (63-83%), felt meeting time was adequate (83-100%) and used videoconferencing (65%). Significant (p\u3c 0.001) reductions in burnout were seen in mentors from baseline (M=58.15, SD=24.76) to 6 (M=51.50, SD=16.96) and 12 months (M=39.83, SD=13.73). Mentee burnout significantly decreased from baseline (M=56.20, SD=14.66) to 6 (M=51.75, SD=15.71) and 12 months (M=43.83, SD=16.98).
Implications for Practice: The program was feasible, acceptable and correlated with decreased burnout. Mentors and mentees reported personal and professional benefits from program participation. The range of settings and participants suggests this program can be implemented across diverse settings and populations