Nursing Commons^™

Should I Stay Or Should I Go? Nursing And Midwifery Academics Intention To Stay In Or Leave Academia: A Scoping Review, Marion Tower, Rachel Muir, Peta Anne Zimmerman, Amanda G. Carter, Robyn Maude, Kathy Hollaway, Lynore Geia, Debbie Massey, Elizabeth Elder

Research outputs 2022 to 2026

Background: There is a chronic lack of appropriately qualified nurses and midwives being attracted into and remaining in the academic workforce. Reasons for this are not well understood but have been linked to stressful work environments related to balancing multiple roles in sometimes unsupportive environments, resulting in overload and demoralisation. Aim: To illuminate factors associated with nursing and midwifery academics' intention to remain in academia and factors associated with intention to leave. Design: A scoping review was undertaken to provide a comprehensive and broad analysis of the related literature. This was guided by Arksey and O'Malley. A search strategy was …

Socio-Economic Disparities In Prenatal Prognosis And Intervention Accessibility, Simona Raluca Iacoban, Madalina Piron Dumitrascu, Camil Laurentiu Bohiltea, Ioan Dumitru Suciu, Silviu Cristian Voinea, Nicolae Suciu

Journal of Mind and Medical Sciences

Objectives. This study aimed to assess the impact of socio-economic factors on prenatal care accessibility and outcomes and to evaluate the effectiveness of specialized integrative prenatal care in mitigating these disparities. Materials and Methods. A prospective cohort study was conducted between 2020 and 2023 in Bucharest, Romania, involving 100 pregnant women. Participants were equally divided into two groups that received standard and specialized prenatal care. Data were collected through structured interviews, medical record reviews, and standardized questionnaires at multiple time points during pregnancy and postpartum. Results. Women receiving integrative care had longer gestation periods (37.8 vs. 37.6 weeks), higher average …

Minding The Details: The Importance Of Assessment Accuracy And Consistency In Managing Nursing-Sensitive Indicator Interventions, Elizabeth Card, Noah Zanville

HCA Healthcare Journal of Medicine

Evidence-based practice holds the potential to streamline health care, reduce costs, and improve patient outcomes. A good share of the data collected to create the evidence comes from electronic health records and other digital sources. Nurse-sensitive indicators, such as patient falls, pressure injuries, and hospital-acquired infections, are examples of data used to reflect the quality of nursing care. Other data may come from routine assessments nurses perform. It is crucial that nurses use valid and reliable instruments to create this data and that the use of the instruments is consistent across nurses in units, different shifts, and even different facilities. …

Measures Of Success: Making The Case For Advanced Practice-Sensitive Quality Indicators, Ruth Kleinpell, April Kapu, Cynthia Borum

HCA Healthcare Journal of Medicine

Advanced practice registered nurses (APRNs) are key health care providers in a variety of settings. Often APRNs are grouped in a collective category, along with physician assistants, and referred to collectively as advanced practice providers. As APRNs assume an increasing role in patient care management in hospital, outpatient, and community settings, such as clinics and rural practices, measuring the impact of their care on patient outcomes and quality of care becomes a necessary component of performance evaluation. APRN-sensitive outcome indicators are an important way to identify the impact of the role. While a number of studies have been conducted that …

Development Of A Facility-Level Second Victim Syndrome Peer-Mentor Program: Program Design And Future Directions, Jacqueline Trammell, Noah Zanville, Caryn Alper

HCA Healthcare Journal of Medicine

Background

Despite efforts to prevent errors, studies show that iatrogenic, or health care-related, errors continue to occur. Understandably, these errors, which can range in severity from near-misses to serious harm, can be devastating for the health care professionals involved, creating a potential second set of victims, in addition to the patient(s) that were harmed directly. Studies show that individuals struggling with second-victim syndrome (SVS) can be at increased risk for depression, burnout, and poor work performance. However, programs designed to develop peer mentors to support individuals struggling with SVS are poorly described.

Methods

Following a review of the literature, our …

Nursing And Supply Chain As Critical Partners In Enterprise-Level Efforts To Prevent Hemodialysis Associated Central Line-Associated Blood Stream Infections: A Case Study, Dana L. Blayney, Julia Moody, James Pittman, Noah Zanville, Missy Pennington, Sarah A. Fraker, E. Jackie Blanchard

HCA Healthcare Journal of Medicine

Background

Preventing central line-associated bloodstream infections (CLABSIs) remains a critical national focus for health care facilities. This notion is particularly true for patients undergoing hemodialysis (HD), where the associated mortality rates for HD-CLABSI range from 12% to 25%. Studies show that the use of central venous catheter (CVC) end caps coated with antiseptic agents, such as chlorhexidine gluconate (CHG) on HD-CVCs, can reduce the incidence of CLABSIs. However, issues ranging from difficulty finding and maintaining an adequate (and fully standardized) supply of CHG-impregnated HD end caps and ensuring consistent practice by clinicians can prevent the use of this valuable tool. …

Effectively Addressing Hospital-Acquired Pressure Injuries With A Multidisciplinary Approach, Nicki Roderman, Shandlie Wilcox, Andrew Beal

HCA Healthcare Journal of Medicine

Background

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national …

Improving Maintenance Of Central Line Dressing To Reduce Risk Of Central Line-Associated Bloodstream Infections In An Acute-Care Setting, Kristi Gaskill, Kerry Wilder, Emily Sneed, Astrid J. Pujals, Kim Newman

HCA Healthcare Journal of Medicine

Background

Central line-associated bloodstream infections (CLABSI) increase morbidity, mortality, and healthcare costs. Central venous access device (CVAD) dressing integrity is critical to prevent CLABSI. From the First Quarter to the Third Quarter of 2023, CLABSI rates related to disruption in CVAD dressing integrity increased significantly at our facility. Despite the delivery of education, competency validation, and checklist implementation, CLABSI rates remained high, making this our top strategic priority.

The purpose of this quality improvement initiative was to determine if gum mastic adhesive and hemostatic powder would improve dressing integrity and decrease CLABSI rates related to disruption of central line dressings. …

Central Line-Associated Bloodstream Infection Reduction In Hemodialysis Patients Across 9 Hospitals And 3 States, Nicki Roderman, Kasadi Moore, Shandlie Wilcox, Jennifer Jellerson, Zoey Bridges

HCA Healthcare Journal of Medicine

Background

This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis.

Methods

To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) …

A Randomized Controlled Trial Of 2% Chlorhexidine Gluconate Skin Preparation Cloths For The Prevention Of Surgical Site Infections In Adults Undergoing Spine Surgeries: Residual Reduction In Skin Bacterial Load For 4 Days, Elizabeth Card, Yaping Shi, Wuraola Adesinasi, Matt Shotwell, Nancy Wells, Elizabeth Hall, Joseph Cheng, Edward Sherwood

HCA Healthcare Journal of Medicine

Background

Surgical site infections (SSI) result in increased morbidity and mortality, prolonged recovery, longer hospital length of stay for medication or possible additional surgeries, and escalated health care costs. The purpose of this randomized controlled trial was to compare SSI rates and overall skin flora burden between those using chlorhexidine (CHG) cloths versus soap and water preoperatively in the adult spine surgery population.

Methods

Subjects were randomized preoperatively to use 2% CHG cloths versus soap and water the night before and morning of surgery prior to the operation. A skin culture was obtained at enrollment prior to any cleansing, again …

Assessing The Effectiveness Of A Non-Punitive Fall Prevention Program, Nicki Roderman, Shandlie Wilcox, Cynthia Lang

HCA Healthcare Journal of Medicine

Background

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods

Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive …

Inpatient Falls: Epidemiology, Risk Assessment, And Prevention Measures. A Narrative Review, Taylor Locklear, Jeannie Kontos, Callaham A. Brock, Alexander B. Holland, Rachel Hemsath, Anna Deal, Shannon Leonard, Carsten Steinmetz, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Patient falls are a common inpatient dilemma and comprise the largest category of preventable adverse events in hospitalized patients. These events place a clinical burden on the patient, such as increased morbidity and reduced quality of life, in addition to an economic burden on the hospital system. Fall prevention strategies have the opportunity to decrease inpatient health care costs and length of stay. Several risk factors have been identified that contribute to inpatient falls and several strategies have been identified to minimize this risk. These risk factors are typically characterized as intrinsic and extrinsic factors. Intrinsic factors include characteristics such …

Nursing Informatics: The Vital Nursing Link Between Technology And Patient Care, Sherri L. Hess, Caryn Alper

HCA Healthcare Journal of Medicine

Advances in technology offer additional health care tools to improve the health of patients and efficiencies for our clinicians in innovative ways. These technologies cover a huge variety of therapeutics, ranging from wearable devices, such as insulin pumps, to robotic-assisted surgeries. Nursing informatics is firmly embedded in the use of technology to improve nursing care and science. One of the most recent developments in nursing is the exploration of virtual nursing. This paper will present the past, current, and future projections for this unique blend of nursing art and science with cutting-edge technology.

Revitalizing Emergency Rooms Nationally: Strategies And Insights, Jeffin Dejanovich, Noah Zanville

HCA Healthcare Journal of Medicine

Throughout the United States, the post-COVID-19 pandemic period has been marked by profound disruption to health care operations, coordination, and care capacity. These disruptions have been especially serious in the emergency room (ER) setting. While intensely challenging, the post-pandemic period has also presented opportunities for health care systems to approach classic challenges facing the ER with fresh eyes. In this editorial, the authors discuss key strategies being used to help revitalize ERs nationally and reflect on future challenges and directions.

Infection Prevention: The Small But Mighty Teams In Health Care, E. Jackie Blanchard

HCA Healthcare Journal of Medicine

Infection prevention is a team within health care facilities and systems whose members are vital to reducing and mitigating patient harm secondary to infectious disease. Infection preventionists are subject matter experts who reside in the quality department and are responsible for multiple areas beyond infectious disease spread. They assist nursing teams, employee health programs, and epidemiologists in decreasing the spread of illness. They are widely under-recognized, though they have a significant impact on the overall stability of the health care system and the communities they serve.

A Historical View Of Nursing Research At Hca Healthcare, Jane D. Englebright

HCA Healthcare Journal of Medicine

HCA Healthcare has been a pioneer in evidence-based practice (EBP) in nursing for over 20 years. Nursing leaders overcame 2 major challenges, generating useful data to inform practice and disseminating EBP across their vast network. These challenges were overcome by using data outside the electronic health record (EHR) while advancing the standardization of data within the EHR. Standardizing data had a significant impact on nurse-led research, leading to improvements in patient outcomes and changes in practice including medication dispensing, patient fall reporting, and scheduling guidelines. This retrospective shares some of these important innovations in nursing practice.

The Future Of Nurse-Led Research: The Road Ahead, Sammie Mosier

HCA Healthcare Journal of Medicine

Nursing as a profession is full of innovation. From nurse-led research and new technology to emerging models of care, nurses continue to blaze trails and take steps to improve patient care. As one of the largest employers of nurses in the United States, HCA Healthcare has an obligation to produce research and evidence-based practices to pave the way for the future of nursing practice and potentially change how care is delivered. In this editorial, HCA Healthcare’s chief nurse officer describes her vision for the future of nurse-led research and examines how education, partnerships, and technology facilitate the road ahead for …

Inspiring And Supporting Nurses’ Scholarly Works Through A Special Issue Highlighting Nursing-Sensitive Indicators, Sammie Mosier, Elizabeth Card, Caryn Alper

HCA Healthcare Journal of Medicine

Nursing represents the largest discipline in health care, with just over 5 million nurses in the United States, and the discipline is under increasing pressure to make evidence-based decisions in the delivery of patient care. This special issue of the HCA Healthcare Journal of Medicine can inspire and support nurses’ scholarly work with an eye to dissemination in peer-reviewed medical journals. This issue highlights nursing’s contributions to improving patient outcomes through nurse-sensitive indicators, with the hope of elevating the quality of tomorrow’s health care.

How Do Scholars Conceptualize And Conduct Health And Digital Health Literacy Research? A Survey Of Federally Funded Scholars, Mayank Sakhuja, Brooks Yelton, Simon Kavarana, Lauren Schaurer, Jancham Rachel Rumthao, Samuel Noblet, Michelle Angelique Arent Rd, Mph, Cscs, Cissn, Mark M. Macauda Phd, Mph, Lorie Donelle Phd, Rn, Fcan, Daniela B. Friedman Ph.D.

Publications

Background: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research.

Objective: This study examined scholars’ conceptualization and scope of work focused on HL and DHL.

Methods: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from …

Comparing Student And Np Faculty Simulation Satisfaction And Confidence Following Debriefing, Rhonda D'Agostino

Doctor of Nursing Practice Scholarly Project

The utilization of simulation technology can increase critical thinking, as well as advance practice skills, satisfaction and confidence in learning. The purpose of this research was to evaluate the impact of in-person student debriefing on students and NP faculty confidence and satisfaction in student learning utilizing standardized patient simulation. The study was open to the 50 enrolled students and 10 faculty participating in the summative SP simulation for advanced health assessment at Pace University’s Pleasantville campus. Students were randomly selected to undergo in-person debriefing by faculty. After simulation, students and faculty participated in a survey. Of the 33 students, 15 …

Staff Education To Nurses Of Five Departments Performing Point-Of-Use Treatment, Natalia G. Nunez

Walden Dissertations and Doctoral Studies

Staff Education to Nurses of Five Departments Performing Point-of-Use Treatment by Natalia G. Nunez MPH, Walden University, 2019 BS, Florida International University, 2011 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2024 Point-of-use treatment (POU) treatment is the first step of sterilization, and it is critical for staff performing this process to undergo proper education and training as noted by the Centers for Disease Control and Prevention (CDC). Performing proper POU treatment reduces the risk of infections in patients and extends the life of the instruments and devices. A …

Moving Teamwork Into Teaming: Evaluating A Team-Based Model Of Nursing Care, Katie Lynn Maloney

Walden Dissertations and Doctoral Studies

Nursing practice faces staffing shortages, complex patient care, and a need to develop creative ways to fill staffing holes within the acute care clinical setting (Beckett et al., 2021). A hospital in New Hampshire, United States implemented a team-based nursing care model on a geriatric psychiatric unit in January 2023. The model has been in place for 18 months. The focus of this Doctor of Nursing Practice (DNP) quality improvement (QI) evaluation project was to determine if implementing the team-based nursing model of care improved patient outcomes such as falls, restraint use, and hospital-acquired pressure injuries and reduced the number …

The Experience Of Young Adult Caregivers Of Patients With Left Ventricular Assist Devices (Lvads), Amy Emmarco

Seton Hall University Dissertations and Theses (ETDs)

Advanced heart failure is a serious diagnosis that is associated with limited options at the end stage of the disease. Left Ventricular Assist Devices (LVADs) are mechanical circulatory support systems that can be used for patients with end stage heart failure. These devices are complex and require specialized training to manage. Visiting home care services are unable to provide support and the management responsibility falls solely on the patient and their designated caregiver. Young adults serve in this caregiving role and very little is known about their specific journey. The aim of the study was to understand the experience of …

Strategies To Reduce Meditation Errors Hospitals, Elizabeth Davies

Walden Dissertations and Doctoral Studies

Each year, nearly 100,000 patients in the United States die as a result of medication errors. Medication errors are a concern to hospital leaders, resulting in increased expenses, extended hospital stays, and patient harm. Grounded in the Lean Six Sigma quality model, the purpose of this qualitative single case study was to explore the strategies three hospital managers in one hospital system in the eastern United States used to reduce medication errors. Data were collected through semistructered interviews, archival hospital documents, and analyzed using Yin's 5-step approach. The findings revealed key themes, including prioritizing staff training, building a safety culture, …

Executive Summary: Clinical Practice Guideline Obstetrics Diabetes Management, Carole N. Louis

Walden Dissertations and Doctoral Studies

Summary A clinical practice guideline (CPG) was developed because the perinatal department lacked standardized management of pregestational and gestational diabetes. The practice issue is relevant since managing maternal glucose ranges during pregnancy mitigates adverse maternal and neonatal outcomes. The practice-focused question asks, “What are the best practices to manage diabetes in the intrapartum and postpartum settings?” The project was designed to develop an evidence-based protocol to provide standardized management for nurses and providers. Most studies in the literature search were quantitative sources with either A or B overall quality ratings. Based on the evidence, the intrapartum target maternal glucose range …

Implementing Online Educational Modules To Introduce Specialty Disability Care To Students In Undergraduate Nursing Programs, Keegan Brunner, Molly Helton

James Madison Undergraduate Research Journal (JMURJ)

In 2016, 1 in 4 adults reported living with a disability in the United States; however, few nursing schools include education about how to best care for these individuals in their curricula. Studies have found that when nurses and other healthcare workers have better attitudes toward patients with disabilities, it leads to better health outcomes. The literature suggests that education and exposure are the most effective ways to increase positive attitudes toward disabled communities. This study offered Equity Access modules titled “Disability and Healthcare” and “Accessibility” developed by Duquesne University to pre-professional health students planning on pursuing Nursing degrees at …

Staff Education To Use The Mental Health Risk Assessment Tool, Nkeiruka Okwuoma Okonkwo

Walden Dissertations and Doctoral Studies

Suicide/self-harm continues to be one of the most common sentinel events that could result in significant harm or death especially among mental health patients (Mills et al., 2020). Environmental hazards seem to be the primary contributing factor in patient suicide and self-harm cases. Thus, patient suicide remains a safety concern, especially in mental health facilities. It is important that nurses have the knowledge to prevent, identify, assess, and respond appropriately whenever they encounter patients at risk for suicide/self-harm. This Doctor of Nursing Practice (DNP) staff education project focused on educating staff on how to use the Mental Health Environmental Risk …

The Application Of Therapeutic Communication Between Staff And Patients, Aloysius Mokom Tamufor

Walden Dissertations and Doctoral Studies

The practice problem identified was the limited use of therapeutic communication among staff at the project site facility, which was attributed to low knowledge. The purpose of the project was to improve nurses’ knowledge of and intent to use therapeutic communication when interacting with patients with mental health disorders. The question that guided the project was: Does staff education about therapeutic communication improve nurses’ knowledge of and intent to use it when interacting with patients? A sample of 20 healthcare staff, which included advanced practice registered nurses and registered nurses who practiced in a mental health facility completed the education …

Universal Suicide Screening In Outpatient Primary Care And Specialty Care, Tamaria Featherlin

Walden Dissertations and Doctoral Studies

Native Americans are disproportionately affected by suicide, with mortality rates that are 2.5 higher than White and non-Hispanic Americans. Nursing staff in an Indian Health Service (IHS) outpatient and specialty care clinic inconsistently assess for suicide risk before outpatient and specialty clinic appointments due to sporadic use of screening tools and lack of confidence to ask patients suicide risk screening questions. The purpose of this staff education project was to determine if interactive education of outpatient nursing providers regarding universal screening for suicide risk using the Ask Suicide Screening Questions (ASQ) for patients who are 8 to 11. Patient Safety …

Social Determinants Of Health Curriculum For The Pediatric Clerkship, Caroline Roth, Amy Prudhomme, Kayla Griese, Robbie Beyl, Jessica Patrick-Esteve

School of Medicine Faculty Publications

Introduction: Education on social determinants of health (SDH) aligns with national standards for medical education. However, there are minimal existing resources targeted to medical students specific to the care of the pediatric population. We designed a case-based curriculum on SDH for third-year medical students on their pediatric clerkship to address this deficit. Methods: Third-year medical students on their pediatric clerkship received a case-based flipped classroom educational series on SDH in four 10-minute segments. Students completed voluntary and anonymous surveys delivered via an electronic survey tool before and after completion of the curriculum. Surveys were a self-assessment of knowledge and skills …