COMMUNICATION AND WORKFLOW ON A TYPICAL DAY IN NH VERSUS A DAY WITH A CHANGE IN RESIDENT CONDITION

A major reason technologic innovations for nursing home (NH) communication have not worked is because testing of technology fails to consider workflow of the environment. The aim of this observational study was to examine communication and workflow surrounding assessment of NH residents on a dementia care unit with suspected UTI to establish baseline data prior to introduction of technology to enhance NH staff communication. The flow of communication between CNAs, LVNs, and PCPs was recorded using a structured observation on an online survey platform. For a 3-month period, 3 days a week, an observation period from 7am to 11am was chosen to reflect one peak staff interaction time. Field notes describing the environment and what was being talked about during communication events were analyzed using content analysis. A total of 185 communication events were recorded by 3 trained observers, yielding 22 assessments for change in condition (pain, UTI, falls). The LVN was the center of 44% of communication. After the LVN assessed the resident, 43% of the time no further action was taken by the LVN; 17% of the time the PCP was texted about a change in condition. Types of change in condition was limited. Workflow surrounding LVN collection of information on days related to change in condition reflected focused communication among staff occurring away from resident rooms and nurses’ station. The NH is a stable environment for provision of nursing care, thus suggesting communication technology can be accepted by staff and added into the care routine.

Technology Guided Assessment for Urinary Tract Infection: Creating a Common Interprofessional Language

The Shared Meaning Model (SMM) is a grounded theory, derived in a previous study. This model demonstrates pathways for communication between nurse and primary care providers (PCPs) in the nursing home (NH), In this study we used the SMM for feasibility testing of a clinical decision support app (CDS app) using a descriptive, structured observational design. This study also provided a forum for initial testing of the SMM. The CDS app algorithm provided a common language to assess a resident with the goal of sharing this information with a PCP. The CDS app guided licensed vocational nurses (LVNs) (N=10) in assessing a standardized nursing home resident in a simulation setting experiencing symptoms of a potential urinary tract infection (UTI). Interviews with LVNs provided details of CDS app usability and concerns about using the CDS app with NH residents. Videos recorded LVNs interacting with the resident while using the CDS app on an iPad®. Time-stamps logged duration of the assessment. Bookmarked segments were used for discussion in LVN interviews. Videos were coded for eye contact, conversation, and touch between LVN and resident and documented personalized interactions. Findings indicated areas (lab values, drug names) for changes to language in the algorithm. In less than 12 minutes the CDS app enabled LVNs to collect information based on language used by PCPs to make decisions about the presence of a UTI. Relationships between initial constructs in the SMM were supported. This CDS app holds promise for building a common language to enhance interprofessional communication.

Interpersonal Violence: What Undergraduate Nursing Students Know

A program evaluation of undergraduate nursing curricula content was completed and survey developed to assess undergraduate nursing students' knowledge about interpersonal violence. Students electively answered a 43-question survey regarding interpersonal violence as a public health problem. The sample included 104 traditional and accelerated undergraduate nursing students. Increasing scores during undergraduate program enrollment suggests that students receive some content on violence from the undergraduate curriculum. This study provides data about curricular deficits and proposes content revisions to prepare nursing students to address violence in patient populations.

Academic Tenure: Perceptual Variations Among Tenured, Tenure-seeking and Non-tenure Faculty

BACKGROUND

Tenure is a hallmark of higher education, but its value and relevance is questioned.

PURPOSE

This study examined faculty perceptions of the value of tenured and non-tenured nursing faculty appointments.

METHODS

A descriptive correlational design using an anonymous survey was sent to members of the American Association of College of Nursing. Participants (N = 542) from 44 states completed the survey.

RESULTS

Significant differences in workload were found in teaching, administrative responsibilities, scholarship, and academic service. Compared to non-tenured faculty, tenured faculty had higher scores on Career Opportunities (p < 0.001), lower Life Balance scores (p = 0.001) and higher Academic Support scores (p = 0.014). Non-tenured faculty were less likely to agree than tenured faculty that tenure improves quality of education (χ2 = 86.48, p < 0.001) or is relevant to the modern university (χ2 = 75.20, p < 0.001). Narrative responses revealed six themes about tenure. Faculty on both tracks questioned the value of tenure.

CONCLUSIONS

Faculties in schools of nursing nationwide need to re-evaluate the purpose of tenure and the tenure criteria in light of each institution's unique mission and expectations to determine how they are meeting the needs of both academic institution and nursing faculty. Although the idea of tenure is institutional, implementation is initiated at the school level. Our study revealed naivete about tenure among nursing faculty at the school level.

Assessment of a Potential UTI–Using Videos to Analyze a Simulated Nursing Home Experience

In the past, urinary tract infections (UTIs) have been attributed to poor hygiene, the natural course of aging, an unfortunate corollary of nursing home (NH) residence, and a condition routinely treated empirically with antibiotics. Recent UTI management consensus statements foretell a very different future and support the need to consider all UTIs in the NH as complex infections. Improving assessment capabilities of the NH nurse workforce is essential for improving quality of care. This study aimed to determine how, using simulation, licensed vocational nurses (LVNs) integrated a mobile decision-support app (MDS-app) into assessment of a NH resident with a potential UTI. The MDS-app directed the LVN to examine or question the resident (mannequin) to identify signs and symptoms developed as part of a simulated clinical scenario. MDS-app items were based on UTI practice guidelines. A descriptive, participant observation design (video-taped) was used with ten practicing LVNs. An observation checklist was used to examine audiovisual recordings and included frequency of verbal interaction (17.9+/-7.2), and eye contact (10.6+/-4.1). Participants (47%) were “glued to” the MDS-app without making resident eye contact or touching residents during the assessment. 60% of participants deviated from the app to ascertain urine odor and color; irrelevant symptoms for UTI diagnosis. Assessments required 11.20 (+/-4.67) minutes to complete. The MDS-app provided LVNs with needed focus on data driven by guidelines and not individual LVN preferences. Training LVNs should focus on integration of communication, assessment skills, and MDS-app use for evidence-based data collection as a basis for UTI treatment decisions.

Self-Efficacy: Changing the Tide of Evidence-Based Practice

AIMS

The specific aim for this study was to describe differences in evidence-based practice (EBP) and self-efficacy in frontline RNs. This project utilized a national study with a convenience selection of acute care agencies to examine the relationship between organizational and unit culture, EBP, and self-efficacy in frontline nurses.

METHODS

This national study used descriptive correlational methodology to describe differences in EBP and self-efficacy among RNs. The sample included 245 frontline RNs employed in acute care settings. To measure the study variables, the Nursing Evidence-Based Practice Survey (Titler, Hill, Matthews, & Reed, 1999)  and the Evidence-Based Nursing Practice Self-Efficacy Scale were used (Tucker, Olson, & Frusti, 2009). Each instrument was delivered via the Qualtrics online platform.

RESULTS

The correlation of bivariate interval level variables was analyzed using Pearson's r. The correlation between EBP and self-efficacy was strongly correlated: r(170) = .537, p = .01. Sections within the Nursing Evidence-Based Practice Survey were calculated and found to be significant (unit culture r = .241, p = .01; organizational culture r = .570, p = .01; knowledge, skills, attitude r = .538, p = .01).

LINKING EVIDENCE TO ACTION

Several implications exist for education, staff development, and nursing management. Nursing school programs incorporate EBP into the curriculum so that nurses have a foundation for EBP. However, staff development professionals in clinical settings must continue to build on the nurses' knowledge and skill, thus increasing self-confidence for EBP. Nursing management can provide the resources for staffing models and policies to reinforce the value of EBP and positive patient outcomes. This combination provides frontline staff with EBP participation and increased self-efficacy in its usage.

Due diligence in the open-access explosion era: choosing a reputable journal for publication

Faculty are required to publish. Naïve and "in-a-hurry-to-publish" authors seek to publish in journals where manuscripts are rapidly accepted. Others may innocently submit to one of an increasing number of questionable/predatory journals, where predatory is defined as practices of publishing journals for exploitation of author-pays, open-access publication model by charging authors publication fees for publisher profit without provision of expected services (expert peer review, editing, archiving, and indexing published manuscripts) and promising almost instant publication. Authors may intentionally submit manuscripts to predatory journals for rapid publication without concern for journal quality. A brief summary of the open access "movement," suggestions for selecting reputable open access journals, and suggestion for avoiding predatory publishers/journals are described. The purpose is to alert junior and seasoned faculty about predatory publishers included among available open access journal listings. Brief review of open access publication, predatory/questionable journal characteristics, suggestions for selecting reputable open access journals and avoiding predatory publishers/journals are described. Time is required for intentionally performing due diligence in open access journal selection, based on publisher/journal quality, prior to manuscript submission or authors must be able to successfully withdraw manuscripts when submission to a questionable or predatory journal is discovered.

Perceptions of Job Satisfaction and the Regulatory Environment Among Nurse Aides and Charge Nurses in Long-Term Care

OBJECTIVE

To explore perceptions about job satisfaction and the regulatory environment among certified nurse aides (CNAs) and licensed vocational nurses (LVNs) in selected nursing homes in West Texas.

BACKGROUND

As long-term care nurse leaders struggle with maintaining an adequate, well-trained workforce, clarifying factors that affect job satisfaction and turnover is essential. Studies have identified several factors that contribute to job dissatisfaction and turnover, but the extent to which the regulatory environment contributes is unknown.

METHODS

The study used a qualitative research design with one-on-one semistructured interviews conducted with 38 participants employed as CNAs or LVNs in 1 of 5 nursing homes located in West Texas.

RESULTS

Participants acknowledged that regulations pervade their daily work and accept regulatory oversight as necessary for providing good care. However, participants expressed concern that the presence of the surveyors in the facility often created a tense, almost adversarial atmosphere. Other reasons for job dissatisfaction included excessive paperwork, ineffective communication, frequent deaths, combative and uncooperative residents, and inadequate staffing.

CONCLUSIONS

Strategies are suggested to improve the survey process, address care-related stressors, promote positive communication techniques, reduce paperwork inefficiencies, and reduce staff shortages.

The Latex Allergic Psychiatric Patient

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.