Digital Commons Network^™

Nurse Well-Being And Patient Specific Outcomes: A Scoping Review, Stacy L. Pryor, Hope Brunner, Janet Chan, Ardis Hanson, Rayna Letourneau, Usha Menon

Creating Healthy Work Environments (CHWE)

Background: In late 2019, the COVID-19 virus spread across the world causing a global pandemic that affected populations, health care workers, and the health care industry. The health and well-being of the nursing workforce received attention due to nurse attrition and the critical projected national nurse shortage. However, the concept of nurse well-being is inconsistently defined in the literature perhaps due to its fluidity. Additionally, patient adverse outcomes continue to occur in the hospital setting and are costly to patients, families, nurses, and healthcare organizations. There is limited information on the association between nurse well-being and the occurrence of adverse …

Pressure Injury Prevention And Education, Maria T. Gonzales, Tammy Tyree, Kari Johnson, Crystelle Johnson

Creating Healthy Work Environments (CHWE)

Background: Increased age is a significant risk factor for hospital-acquired pressure injuries (HAPI) due to increased morbidities, decreased mobility, reduced nutrition, sensory impairments, reduced circulation, incontinence, and decreased immunity.

Purpose: Determine if focused education related to the Braden Scale (BS), pressure injuries (PI), and pressure injury prevention (PIP) will increase bedside staff knowledge of PI prevention and decrease HAPI incidence over three months.

Method: Pre/post-test design - Pre-intervention questionnaire, Educational Intervention, and Post-intervention questionnaire

Setting: 28-bed Orthopedic-Spinal Surgical Unit

Sample: Up to 38 nurses (RNs), four nursing supervisors, one director, and 14 patient care technicians (PCTs). Inclusion criteria: All full-time/part-time …

Examining The Perceptions Of Sleep Quality In The Intensive Care Unit, Elizabeth Newport, Jodie C. Gary

Creating Healthy Work Environments (CHWE)

Study Purpose/Problem Statement: This is a BSN honors student project with the oversight of a research mentor. The purpose of the study is to understand perceived sleep quality and interventions currently used to promote sleep as well as elicit barriers and identify potential solutions for promoting sleep in the critically ill from the perspective of critical care nurses and/or critical care nurse leaders.

Significance of Study: In times of illness, sleep is vital, and deprivation and disturbances weaken the immune system, which exacerbates illness and prolongs healing (Longley et al., 2018). For critically ill patients, sleep is essential for positive …

Fostering Healthy Work Environments With Nurse Manager Transition To Practice Program, Anastasia Y. Rose, Janelle Schira, Marja Ross

Creating Healthy Work Environments (CHWE)

Background: Healthy work environments need effective nursing leadership (Mabona et al., 2022). Many new nurse managers lack the skills and knowledge needed for leadership roles (Espinoza et al., 2009). Turnover of new nurse managers is high, which can have a negative impact on nurse retention and quality of care (Warden, 2021). Per a national survey, over 50% of nurse leaders intend to leave their positions within next 5 years (Warden, 2021). A new manager orientation and mentorship programs could impact their practice, retention, and quality indicators, improve job satisfaction, organizational culture, and patient outcomes, and foster a healthy work environment …

Community Or Commodity? Nurse Perceptions Of Support From Healthcare Institutions And The Community, Jacqueline Christianson, Madaline Mccarthy, Bonnie Sommers-Olson, Jill Guttormson, Norah Louise Johnson

Creating Healthy Work Environments (CHWE)

Purpose: High stress, moral distress, and burnout are common in nursing workplaces and are associated with poorer patient and nurse outcomes. Research showed that excessive work-related stress was a growing problem for the nursing workforce prior to the Covid-19 pandemic (Bakhamis et al., 2019). However, working conditions became considerably more stressful because pandemic-related workplace changes made previous methods of caring, connecting empathetically with patients, and behaving altruistically difficult to impossible for nurses to achieve (Foli et al., 2021; McAndrew et al., 2023). Community connectedness and mutual social support may be buffers against the harmful effects of chronic occupational stress and …

Creating A Healthy Workplace Culture With A “Steps To Wellness” Initiative, Jennifer M. Clifton, Michael Caserta, Cheryl Armstrong, Katarina Friberg-Felsted, Jennifer Macali, Sara Simonsen

Creating Healthy Work Environments (CHWE)

Purpose: The aim of this project was to promote the health and wellness of nursing academia faculty and staff by implementing a physical movement initiative.

Background: Promoting the health and wellness of faculty and staff working in nursing academia is an important and timely initiative (Amaya et al., 2019; Mabona et al., 2022). Researchers have noted that an individual's lifestyle behaviors directly affect their work productivity, physical activity, and stress levels (Labrague et al., 2022; Reif et al., 2020; Stanulewicz et al., 2020). Amaya et al. (2019) suggested that institutions of higher education could improve work-life balance by “creating campus …

Keeping It Zen: In-Hospital Decompression Space For Employee Resiliency, Karen Richendollar, Caren E. Herring

Creating Healthy Work Environments (CHWE)

Research has shown that 33% (Ibrahim, 2022) of nurse's experience depression and posttraumatic stress within their job and that rate continues to grow each year. A member of the team survey sent out to all staff at an acute care hospital in Virginia Beach, Virginia, showed that staff members could not decompress emotionally and physically after their shifts. Staff members expressly indicated they could not leave work at work and continued thinking about work when they were at home. Literature has shown that implementing a decompression space to allow staff members to decompress away from clinical areas promotes staff resiliency, …

Applying The Lean Process To Achieve The Quadruple Aim In Community Care Imaging Consults, Cynthia L. Austin

Creating Healthy Work Environments (CHWE)

Introduction: Care coordination has been challenging in scheduling high-risk patients needing diagnostic imaging procedures. Missing crucial patient information can lower the value of patient-reported outcomes because it influences decision-making in care plans, results in duplication of services, and delays the delivery of care or treatments (Ayilara et al., 2019). Incomplete data delays diagnostic procedures, diagnosis, and medical treatments (Fernholm et al., 2019). Numerous studies have revealed that prolonged waiting times are frequently the leading cause of patients' discontent with outpatient scheduling, and equitable waiting periods are necessary based on clinical competency (Ala & Chen,2022). Medical imaging methods frequently cause increased …

The Impact Of A Coaching Program On Student Retention In An Associate Degree Nursing Program, Angela J. Dryden

Creating Healthy Work Environments (CHWE)

Student success in college is judged by retention and graduation rates (Millea et al., 2018). Nursing student retention and attrition are identified as ongoing areas of international concern. Academic failure is known to impact students, their families, the institutions, and the greater communities in relation to the overall nursing shortage (Brown et al., 2020). Nursing students that do not progress affect the present nursing shortage since the failure leaves an opening that is then not filled (Cross & Rogers, 2022). For those institutions that may have a direct relationship with a health system, students who do not progress have an …

Can Offering Mental Health Promotion Mhealth Apps To Hospital Nurses Improve Mental Health And Well-Being?, Cynthia A. Moore, Stephanie Kelly

Creating Healthy Work Environments (CHWE)

Background: Post-pandemic surveys show hospital nurses continue to struggle with anxiety, depression, burnout, and stress, and to a greater degree than before the pandemic¹. In 2022, approximately half of nurses surveyed reported an interest in leaving their current job or leaving nursing altogether². Few studies focus on the use of mental health mobile apps (mHealth) in the hospital nurse population. Exploring interventions to mitigate negative responses to nurse-specific demands and stressors can inform how to help improve the mental health of the nursing workforce³. Improving nurses’ mental health may have a positive effect on …

Implementing Mandatory Minimum Nurse-To-Patient-Ratios In British Columbia, Canada, Mycal Barrowclough, Tarya Morel

Creating Healthy Work Environments (CHWE)

Researchers and nursing advocates have been advocating for safe staffing for many years; unions and health employers have implemented many different approaches with little success. The nursing shortage was already reaching a critical level when the COVID-19 pandemic dramatically highlighted and worsened the impacts of understaffing, leaving nurses consistently working short in an overstretched system. Shift after shift, nurses find themselves risking their licenses and their own mental and physical health as they do their best to meet their patients’ care needs.

In light of the rapidly worsening nursing shortage, it became clear that a different approach was needed. We …

Use Of Integrative Self-Care To Promote Resilience And Mental Health In Nursing Students, Stacey C. Nseir, Betty Parisek, Stephanie Kelly

Creating Healthy Work Environments (CHWE)

Background: Students enrolled in nursing programs have clinical, academic, and personal challenges which can lead to depression, anxiety, and burnout (Vargas-Benitez et al., 2023). Challenges are likewise present in nurses who practice in a variety of settings and nurses have higher levels of depression, anxiety, and burnout compared to the general population (Guttormson et al., 2022). Studies have shown that the practice of self-care decreases depressive and anxiety symptomatology (Pilkington et al., 2020) and burnout (Horn, 2020) and increases resilience (Blackburn et al., 2020).

Methods: This study is a three-year prospective repeated measures cohort trial for pre-licensure nursing students entering …

The Evaluation Of Therapeutic Communication In Competency Based Nursing Education, Tracy J. Perron, Chelsea Lebo, Mary Louise Thomas, Romy Zemer

Creating Healthy Work Environments (CHWE)

Therapeutic communication is an essential part of nursing care. Therapeutic communication (TC) is the process of using verbal and nonverbal communication to connect with patients.TC is holistic, patient-centered and involves aspects of the physiological, psychological, environmental and spiritual care of the patient. Poor communication in the healthcare setting can lead to poor patient outcomes such as, decreased adherence to treatment, patient's dissatisfaction, inefficient use of resources and even death. Studies have shown that nurses lack communication skills due to a variety reasons from inadequate training, the lack of understanding of the importance of patient-centered communication, and the increased generational use …

What Is Your Preference? Creating A Healing Culture Through Employee Feedback, Julia W. Millspaugh, Mildred Ortu Kowalski, Sunnie A. Mortimer, Catherine C. Errico

Creating Healthy Work Environments (CHWE)

Stress levels are high for healthcare employees. The negative impact of employee burnout is well-documented within healthcare (Shanafelt et al., 2020; U.S. Department of Health and Human Services Office of the U.S. Surgeon General, 2022). A healthy work environment that optimizes the health and wellbeing of nurses is paramount to providing quality care to patients (Mabona et al., 2022). There is an immediate need for brief, feasible, and rapidly scalable interventions while at work to promote wellbeing for our healthcare workers (Putrino et al., 2020). There is no singular tool or one-size-fits-all approach that holds the answer to wellbeing. Wellbeing …

Responding To Workplace Violence, Penny A. Sauer

Creating Healthy Work Environments (CHWE)

Workplace violence against healthcare workers has increased in the past five years (pre-pandemic) (Brigo et al., 2022; Odes et al., 2023; Sari et al., 2023), with no indication that the violence will return to pre-pandemic levels. In the United States, two nurses are assaulted in the acute care setting every hour (ANA, 2022), but this number is likely much more significant as 40%- 80% of WPVs go unreported.

WPV has been a persistent problem in healthcare for decades. The World Health Organization, Joint Commission, Occupational Safety and Health Administration (OSHA), and many professional practice organizations have statements and recommendations about …

The Escape Room Challenge: Integrating Diversity, Equity, Inclusion Initiatives To Promote A Healthy Work Environment, Teresa D. Welch

Creating Healthy Work Environments (CHWE)

Academic nurse leaders nationally face the constant challenge of incorporating diversity, equity, inclusion, and accessibility (DEIA) initiatives and promoting healthy work environments (HWE) standards with limited resources. This presentation describes a professional development offering for academic nurse leaders via an “escape room” approach.

An escape room is a themed challenge event where players collaborate to find clues, complete tasks, and solve various puzzles. The aim is to achieve a specific, time-bound goal, usually to escape from somewhere. Escape rooms help participants develop the knowledge, experience, and skills to overcome complex challenges (Parker & Welch, 2021; Adams et al, 2018; Brown …

Claiming A Seat At The Table: An Ethnography On A Unionizing Urban United States Hospital, Jacqueline Christianson, Cathleen Fox, Carmen Camelio, Norah Johnson, Kristin Haglund

Creating Healthy Work Environments (CHWE)

Purpose: Advocacy for the inherent value, dignity, and well-being of patients is a fundamental nursing duty (American Nurses Association, 2015). However, not all nurses are empowered to act as patient advocates. Nurses who work in cost-constrained environments undertake greater patient loads, experience greater burnout, and have poorer access to opportunities to improve patient care (Harvey et al., 2018; Tubbs-Cooley et al., 2019). Union formation and participation is an intervention that nurses worldwide may employ to advocate for patient care needs and equitable working conditions (Dube et al., 2016; Johnson & Billingsley, 2014). The purpose of this study is to describe …

Reset (Resilience, Empathy And Support For Employees And Teams): Pilot Program To Mitigate Nurse Burnout, Karen E. Vizyak, Andrea K. Moore

Creating Healthy Work Environments (CHWE)

The COVID-19 pandemic significantly shaped alarming healthcare trends, including plummeting nurse engagement and retention along with skyrocketing reports of burnout. In response, a community hospital in Colorado launched the RESET (acronym for Resilience, Empathy and Support for Employees and Teams) pilot program to create customized individual, team and organization-wide interventions to foster optimal well-being of all staff. A multidisciplinary RESET team collected data from various departments, and the Professional Quality of Life (ProQOL) survey administered to nurses on the two medical-surgical units revealed the highest frequency of nurses (59% in one unit and 41% on the other) were experiencing moderate …

Enhancing Professional Well-Being Through Implementation Of A Wellness Initiative In Nursing Academia, Angela G. Opsahl, Jennifer L. Embree, Amy Hagedorn Wonder

Creating Healthy Work Environments (CHWE)

Recent studies convey a lack of work-life balance in nurse faculty (Boamah, 2022; Moyer, 2022). Work-life imbalance has been shown to increase anxiety, depression, and burnout, negatively impacting productivity as lines blur between work and home environment responsibilities (Farber et al., 2023). Clinicians who perceive workplace support for well-being tend to have better mental and physical health outcomes (Melnyk et al., 2021a; Melnyk, et al., 2021b). To diminish the issues of job-related stressors, academic institutions should provide support to bolster faculty and staff well-being.

Therefore, nursing faculty and staff were invited to participate in a wellness initiative on self-care practices …

The Impact Of Collaborative Well-Being Sessions On Senior Nursing Students, Uzo Nwankpa

Creating Healthy Work Environments (CHWE)

Introduction: This quality improvement project assessed the impact of facilitating a wellness session on the confidence and interest of senior nursing students as part of their transition to practice experiences. We explored the role of collaborative wellness activities led by students and their effects on overall wellbeing.

About 60% of U.S. college students show signs of mental health disorders (Lipson et al., 2022). The mental health challenges are rising, making it crucial to address their overall wellbeing. There's a significant correlation between clinical trainees' burnout, depression, and increased risk of suicidal thoughts (Menon et al., 2020). The three core barriers …

We See You! Increased Focus On Implementing Virtual Monitoring, Valerie E. Menter, Brittney L. Williamson

Creating Healthy Work Environments (CHWE)

A quality improvement project was implemented, focused on increasing utilization of the virtual monitoring unit (VMU) to reduce patient falls. For a three-month period, there were 208 patient falls. Fifty-nine and a half percent of these patients met virtual monitoring criteria but did not have it implemented. Review of the electronic health record (EHR) flowsheet discovered challenges for the nurse to effectively identify patients who met criteria, leading to underutilization of this safety resource. Analysis found nurses were implementing VMU based on subjective reasoning instead of objective criteria, leading to inadequate observation of patients and increased falls.

Outcomes: After receiving …

The Impact Of Using Wearable Technology On Caregiver Perceptions Of Health And Well-Being, Jacob W. Poyer, Marilyn Stapleton, Bridget Nettleton, Victoria Mccartney, David Theobald

Creating Healthy Work Environments (CHWE)

This presentation conforms with the conference theme of creating healthy work environments for nurses. Specifically, this presentation will focus on enhancing the professional well-being of caregivers. Davin Healthcare, Inc., a nurse-founded, employee-owned company, offers staffing and managed service provider solutions for healthcare systems. In keeping with a commitment made by Davin Healthcare, Inc. to care for the future of healthcare and its caregivers, and through its commitment to the AACN Standards for Establishing and Sustaining Healthy Work Environments, a goal was adopted to support the health and well-being of its employees.

The short-term and long-term strategies aim to provide the …

Addressing Staff Nurses’ Work-Related Stress With Peer-Led Interventions, Stacy Horowitz

Creating Healthy Work Environments (CHWE)

Background: The nursing staff in the behavioral health division identified high levels of work-related stress (WRS) in a hospital-wide learning needs assessment (NLNA) and furthermore suggested that the reduction of WRS was the number one priority that needed to be addressed. It is widely known that WRS has implications for nursing staffs' productivity, retention, safety and over-all wellbeing. Provision 5 of the Code of Ethics for Nurses notes that “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety...” and Provision 6 requires that “The nurse, through individual and collective …

Counting Twitches, Cutting Costs: The Financial Impact Of Quantitative Monitoring, Logan E. Young, David Sanford

Group: Samford University Moffett & Sanders School of Nursing

Healthcare systems today face the dual challenge of escalating costs and shrinking budgets, forcing administrators to scrutinize every investment in technology and medication. Even as innovations continue to advance patient safety, financial sustainability demands that hospitals allocate resources strategically to achieve the greatest impact. In the case examined, a 67-year-old man with extensive comorbidities including paraplegia, coronary artery disease, and obstructive sleep apnea, underwent sacral flap reconstruction requiring deep neuromuscular blockade. Quantitative electromyography monitoring (qNMM) with a TetraGraph device was applied concurrently with a traditional qualitative peripheral nerve stimulator (PNS). Discrepancies were observed between devices throughout the case, with the …

Education Accountability Regarding Oral Contraceptives And Sugammadex, Hallianne Hobson Herndon, Terri M. Cahoon

Group: Samford University Moffett & Sanders School of Nursing

Sugammadex is commonly used to antagonize neuromuscular blockade and has a clinically significant interaction with hormonal contraceptives by binding to plasma progesterone, reducing contraceptive efficacy and mimicking a missed dose. This case involved a healthy 21-year-old woman undergoing elective anterior cruciate ligament and medial collateral ligament repair whose only home medication was an oral contraceptive. She received midazolam prior to anesthesia assessment, limiting her ability to retain education, and counseling occurred at a suboptimal time without a support person present. Postoperative education was verbally relayed without standardized documentation or accountability. This project examined whether implementation of a standardized protocol regarding …

Intraoperative Anxiolytic Management During Cesarean Delivery, Mary Katherine Dowdy, Maria Ledbetter

Group: Samford University Moffett & Sanders School of Nursing

Perioperative anxiety is common among parturients undergoing cesarean section with neuraxial anesthesia. This issue has led to alterations in hemodynamics, length of stay, opioid consumption, and postoperative pain scores. It has been demonstrated that the anxiolytic, sedative, and analgesic effects of intravenous (IV) dexmedetomidine, as opposed to midazolam, can benefit parturients who are anxious during cesarean deliveries.

A 22-year-old, gravida 2 para 1, presented for an elective repeat cesarean section. Her past medical history included gestational hypertension, GERD, and anxiety. The patient also reported that her previous cesarean section, which was performed under subarachnoid block (SAB), was uncomplicated. During SAB …

Navigating The Nasal Route: A Case Study In Preventing Epistaxis, Eleanor R. Hodge, Terri Cahoon

Group: Samford University Moffett & Sanders School of Nursing

Nasotracheal intubation (NTI) is a widely used technique in maxillofacial surgery that allows optimal surgical field access while maintaining secure airway control. Epistaxis is one of the most reported complications, resulting from mucosal trauma in the nasal passage. Although the bleeding is typically self-limiting, it can complicate laryngoscopy, obscure visualization, and could lead to an airway emergency. To mitigate this risk, various strategies and device modifications have been developed. Advancements such as video laryngoscopy, fiberoptic visualization, administration of topical vasoconstrictors, and refinements in nasal endotracheal tube (ETT) design and insertion technique have been investigated to minimize epistaxis and enhance patient …

Neuromonitoring Efficacy Based On Intraoperative Anesthetic Technique, Megan N. Duncan, David Sanford

Group: Samford University Moffett & Sanders School of Nursing

Severe neurological complications can occur in approximately 1% of spine surgery patients, often resulting from spinal cord or nerve injury due to compression, traction, or ischemia. Intraoperative neurophysiological monitoring (IONM) is utilized during spine surgeries to rapidly detect potential neural compromise and prevent permanent neurological damage. Optimal anesthetic management during IONM presents a challenge, as anesthetic agents can significantly influence the reliability and quality of neuromonitoring signals. Total intravenous anesthesia (TIVA) is generally preferred to minimize interference with evoked potentials.

This case described an episode of delayed emergence following an anterior cervical discectomy and fusion with IONM performed under a …

Continuous Blood Pressure Monitoring: Clearsight System Vs Invasive, Samantha H. Gladstein, Amy Snow

Group: Samford University Moffett & Sanders School of Nursing

Continuous blood pressure monitoring is essential for intraoperative hemodynamic management, particularly in patients with cardiovascular comorbidities or procedures associated with significant hemodynamic shifts. Invasive arterial catheterization remains the standard for continuous monitoring but carries risks including infection, thrombosis, and hematoma. The ClearSight system (Edwards Lifesciences) is a noninvasive finger-cuff device that provides continuous beat-to-beat blood pressure monitoring using a volume clamp method. This case involved a 67-year-old female with multiple cardiovascular and metabolic comorbidities undergoing revision shoulder arthroscopy in the beach chair position who refused preoperative arterial line placement. Multiple post-induction attempts were required to obtain invasive access, resulting in …

The Relevance Of Climate Change And Sustainability In Nursing Education: A Cross-Sectional Study Of Students’ Perspectives, Jennie Aronsson, Marie Elf, Paul Warwick, Riccardo Lomartire, Anna Anåker

Individual Articles

Background: As climate change continues to challenge global health, nursing education must evolve to prepare future nurses for the impacts on care delivery and promote sustainable practices within the healthcare system which is itself a contributor to the climate crisis through emissions and waste. In this study we aimed to i) explore undergraduate nursing students’ attitudes towards and awareness of climate change and sustainability issues and its inclusion in nursing education at a Swedish university, and ii) explore differences in awareness and attitudes across student groups in different semesters.

Methods: In this cross-sectional descriptive research study, nursing students from six …