Introduction: the Interdisciplinary Nursing Quality Research Initiative

Qualitative study of willingness and demand for participation in decision-making regarding anticoagulation therapy in patient undergoing heart valve replacement

Background

Promoting patient participation in decision-making aims to maintain the partnership between doctors and patients, reflect the patients’ goals, values, and preferences, and achieve patient-centered care. Realizing patient-centered care, shared collaboration between doctors and patients, and the decision-making process that considers the patients’ priorities and goals are the keys to high-quality health care. Therefore, it is indispensable to analyze the patients’ willingness to participate in the decision-making process and related participation needs regarding anticoagulation treatment for patients undergoing valve replacement.

Purpose

To analyze the patients’ willingness to participate in the decision-making process and the participation needs of patients undergoing mechanical cardiac valve replacement in the process of anticoagulation therapy to provide a basis for promoting patients' participation in decision-making.

Methods

Using phenomenological research methods, data were collected through semistructured interviews. Patients were interviewed after mechanical valve replacement from June to August 2021 in a Grade A hospital in Nanjing. Data were analyzed according to the Colaizzi phenomenology method.

Results

Three major themes were identified from the data: strong willingness to participate but low actual participation, supportive needs, and family members’ participation.

Conclusions

This study guided interventions to encourage patients who underwent heart valve replacement to participate in the decision-making process. From the patient's perspective, obtaining support in the decision-making process and caregiver enthusiasm is important. This study prompted thoughts about the use of auxiliary tools and provided a reliable basis for constructing decision-making auxiliary programs to guide clinical practice.

Current status and future directions of U.S. genomic nursing health care policy

BACKGROUND

As genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing's holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care.

PURPOSE

To examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation.

METHODS

We conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health.

FINDINGS

Genomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed.

DISCUSSION

Nine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas.

CONCLUSIONS

To advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.

Collaboration: Does It Require Pragmatic Thought?

The authors of this column consider the subject of collaboration in terms of healthcare practice, research, and education. To that end, the concept of pragmatism is discussed as a precursor to collaboration followed by consideration of specific instances of collaboration in practice, research, and education. Additionally, the consequences of collaboration are discussed.

Variation in Cesarean Birth Rates by Labor and Delivery Nurses

OBJECTIVE

To examine variation in the cesarean birth rates of women cared for by labor and delivery nurses.

DESIGN

Retrospective cohort study.

SETTING

One high-volume labor and delivery unit at an academic medical center in a major metropolitan area.

PARTICIPANTS

Labor and delivery nurses who cared for nulliparous women who gave birth to term, singleton fetuses in vertex presentation.

METHODS

Data were extracted from electronic hospital birth records from January 1, 2013 through June 30, 2015. Cesarean rates for individual nurses were calculated based on the number of women they attended who gave birth by cesarean. Nurses were grouped into quartiles by their cesarean rates, and the effect of these rates on the likelihood of cesarean birth was estimated by a logit regression model adjusting for patient-level characteristics and clustering of births within nurses.

RESULTS

Seventy-two nurses attended 3,031 births. The mean nurse cesarean rate was 26% (95% confidence interval [23.9, 28.1]) and ranged from 8.3% to 48%. The adjusted odds of cesarean for births attended by nurses in the highest quartile was nearly 3 times (odds ratio = 2.73, 95% confidence interval [2.3, 3.3]) greater than for births attended by nurses in the lowest quartile.

CONCLUSION

The labor and delivery nurse assigned to a woman may influence the likelihood of cesarean birth. Nurse-level cesarean birth data could be used to design practice improvement initiatives to improve nurse performance. More precise measurement of the relative influence of nurses on mode of birth is needed.

To Give and To Get: How Nurse Faculty Scholars Contribute and Benefit From Participating in Interdisciplinary Research Teams

BACKGROUND

Meeting the demands for career advancement in the faculty tenure track of a university becomes a challenge for new researchers when active nursing research is limited or nonexistent. Nurse faculty transitioning from clinical practice settings may face greater difficulty climbing the ladder of promotion because of the limited opportunity for nursing research. A way to create a research thread that will allow an opportunity to ease into the new role and build an effective research team is to participate in an interdisciplinary research (IDR) team.

PURPOSE

This article is written to encourage academic nurse faculty who may find themselves in a nursing research "desert" to collaborate with other disciplines and consider joining an IDR team to get started in career advancement.

DESCRIPTION

Three "Gs"-get, give, and generate-have been created to illustrate the benefits and contribution of IDR. Practical ways to help get started and make the best use of the IDR team are suggested.

CONCLUSION

The participation in an IDR team offers new nurse faculty a way to jump-start a scholarly career. Collaboration with like-minded colleagues from various disciplines offers an opportunity to expand knowledge, gain professional growth, and contribute to scientific development.

Measuring nurses' impact on health care quality: progress, challenges, and future directions

BACKGROUND

Quality measurement is central in efforts to improve health care delivery and financing. The Interdisciplinary Nursing Quality Research Initiative supported interdisciplinary research teams to address gaps in measuring the contributions of nursing to quality care.

OBJECTIVE

To summarize the research of 4 interdisciplinary teams funded by The Interdisciplinary Nursing Quality Research Initiative and reflect on challenges and future directions to improving quality measurement.

METHODS

Each team summarized their work including the targeted gap in measurement, the methods used, key results, and next steps. The authors discussed key challenges and recommended future directions.

RESULTS

These exemplar projects addressed cross-cutting issues related to quality; developed measures of patient experience; tested new ways to model the important relationships between structure, process, and outcome; measured care across the continuum; focused on positive aspects of care; examined the relationship of nursing care with outcomes; and measured both nursing and interdisciplinary care.

DISCUSSION

Challenges include: measuring care delivery from multiple perspectives; determining the dose of care delivered; and measuring the entire care process. Meaningful measures that are simple, feasible, affordable, and integrated into the care delivery system and electronic health record are needed. Advances in health information systems create opportunities to advance quality measurement in innovative ways.

CONCLUSIONS

These findings and products add to the robust set of measures needed to measure nurses' contributions to the care of hospitalized patients. The implementation of these projects has been rich with lessons about the ongoing challenges related to quality measurement.

Facilitators and challenges to conducting interdisciplinary research

BACKGROUND

Complex, interconnected issues challenge the United States health care system and the patients and families it serves. System fragmentation, limited resources, rigid disciplinary boundaries, institutional culture, ineffective communication, and uncertainty surrounding health policy legislation are contributing to suboptimal care delivery and patient outcomes.

METHODS

These problems are too complex to be solved by a single discipline. Interdisciplinary research affords the opportunity to examine and solve some of these problems from a more integrative perspective using innovative and rigorous methodological designs.

RESULTS

In this paper, we explore lessons learned from exemplars funded by the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative.

DISCUSSION

The discussion is framed using an adaptation of the Interdisciplinary Research Model to evaluate improvements in individual health outcomes, health systems, and health policy. Barriers and facilitators to designing, conducting, and translating interdisciplinary research are discussed. Implications for health system and policy changes, including the need to provide funding mechanisms to implement interdisciplinary processes in both research and clinical practice, are provided.