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Stucky CH, Stucky MG, Dindinger RA. Every drop counts: Providing lactation support to breastfeeding surgical patients. Nursing 2024; 54:46-48. [PMID: 38386452 DOI: 10.1097/01.nurse.0001006296.26556.f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT Over half of surgeries in the US are conducted in physician-owned ambulatory surgery centers (ASCs). While ASCs provide cost-effective and quality healthcare comparable to inpatient hospitals, they often lack robust support services, including lactation support. This article presents key information on breastfeeding benefits, early weaning risks, and strategies for nurses in ASCs to educate and support patients who are breastfeeding.
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Affiliation(s)
- Christopher H Stucky
- At Landstuhl Regional Medical Center, Christopher Stucky is the Chief of Research and a Nurse Scientist, Michelle Stucky is a Women's Health Nurse Practitioner and Lactation Consultant, and Rebeccah Dindinger is a Perinatal Clinical Nurse Specialist
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Stucky CH, Michael Hartmann J, Yauger YJ, Romito KJ, Bradley DF, Baza G, Lorenz ME, House SL, Dindinger RA, Wymer JA, Miller MJ, Knight AR. Surgical Safety Does Not Happen By Accident: Learning From Perioperative Near Miss Case Studies. J Perianesth Nurs 2024; 39:10-15. [PMID: 37855761 DOI: 10.1016/j.jopan.2023.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/30/2023] [Indexed: 10/20/2023]
Abstract
Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany.
| | - J Michael Hartmann
- Adult Gerontology-Clinical Nurse Specialist Program, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Young J Yauger
- TriService Nursing Research Program (TSNRP), Bethesda, MD
| | - Kenneth J Romito
- Adult Gerontology-Clinical Nurse Specialist Program, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - David F Bradley
- Adult Gerontology-Clinical Nurse Specialist Program, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Gaston Baza
- Adult Gerontology-Clinical Nurse Specialist Program, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Megan E Lorenz
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Sherita L House
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC
| | - Rebeccah A Dindinger
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Joshua A Wymer
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, CA
| | - Melissa J Miller
- Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Liberty, NC
| | - Albert R Knight
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
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Miller MJ, Johansen ML, de Cordova PB, Swiger PA, Stucky CH. Impact of the primary care nurse manager on nurse intent to leave and staff perception of patient safety. Nurs Manag (Harrow) 2024; 55:32-42. [PMID: 38170887 DOI: 10.1097/nmg.0000000000000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Melissa J Miller
- Melissa J. Miller is a nurse scientist and Chief, Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center in Honolulu, Hawaii. Mary L. Johansen is a clinical professor at Rutgers, The State University of New Jersey in Newark, N.J., and a member of the Nursing Management Editorial Advisory Board. Pamela B. de Cordova is an associate professor at Rutgers, The State University of New Jersey in Newark, N.J. Pauline A. Swiger is a nurse scientist and CNO for the Defense Health Agency in Falls Church, Va. Christopher H. Stucky is a nurse scientist and Chief, Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center in Landstuhl, Germany
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Stucky CH, Knight AR, Dindinger RA, Maio S, House S, Wymer JA, Barker AJ. Periop 101: Improving Perioperative Nursing Knowledge and Competence in Labor and Delivery Nurses Through an Evidence-Based Education and Training Program. Mil Med 2023; 189:24-30. [PMID: 37956334 DOI: 10.1093/milmed/usad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/22/2023] [Accepted: 07/11/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION To reach the highest levels of health care quality, all nurses providing intraoperative care to surgical patients should have a firm grasp of the complex knowledge, skills, and guidelines undergirding the perioperative nursing profession. In military treatment facilities, either perioperative registered nurses or labor and delivery (L&D) nurses provide skilled intraoperative nursing care for cesarean deliveries. However, L&D and perioperative nurses occupy vastly different roles in the continuum of care and may possess widely differing levels of surgical training and experience. MATERIALS AND METHODS The purpose of this project was to improve surgical care quality by standardizing and strengthening L&D nurse perioperative training, knowledge, and competence. Our population, intervention, comparative, and outcome question was, "For labor and delivery nurses of a regional military medical center (P), does implementing an evidence-based training program (I), as compared to current institutional nursing practices (C), increase nursing knowledge and perioperative nursing competence (O)?" We implemented Periop 101: A Core Curriculum-Cesarean Section training for 17 L&D nurses, measured knowledge using product-provided testing, and assessed competence using the Perceived Perioperative Competence Scale-Revised. RESULTS We found that perioperative nursing knowledge and competence significantly improved and were less varied among the nurses after completing the training program. Nurses demonstrated the greatest knowledge area improvements in scrubbing, gowning, and gloving; wound healing; and sterilization and disinfection, for which median scores improved by more than 100%. Nurses reported significantly greater perceived competence across all six domains of the Perioperative Competence Scale-Revised, with the largest improvements realized in foundational skills and knowledge, leadership, and proficiency. CONCLUSIONS We recommend that health care leaders develop policies to standardize perioperative education, training, and utilization for nurses providing intraoperative care to reduce clinician role ambiguity, decrease inefficiencies, and enhance care.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, DE 66849, Germany
| | - Albert R Knight
- Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, DE 66849, Germany
| | - Rebeccah A Dindinger
- Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, DE 66849, Germany
| | - Shannon Maio
- Competency and Credentialing Institute, Englewood, CO 80112, US
| | - Sherita House
- University of North Carolina at Greensboro, School of Nursing, Greensboro, NC 27402, US
| | - Joshua A Wymer
- Department of Nursing, Naval Medical Center San Diego, San Diego, CA 92134, US
| | - Amber J Barker
- Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, DE 66849, Germany
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Stucky CH, Kabo FW, De Jong MJ, House SL, Wymer JA. Surgical Team Structure: How Familiarity and Team Size Influence Communication Effectiveness in Military Surgical Teams. Mil Med 2023; 188:232-239. [PMID: 37948213 DOI: 10.1093/milmed/usad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Preventable patient harm has persisted in health care despite recent advances to reduce errors. There is increasing recognition that non-technical skills, including communication and relationships, greatly impact interprofessional team performance and health care quality. Team familiarity and size are critical structural components that potentially influence information flow, communication, and efficiency. METHODS In this exploratory, prospective, cross-sectional study, we investigated the key structural components of surgical teams and identified how surgical team structure shapes communication effectiveness. Using total population sampling, we recruited surgical clinicians who provide direct patient care at a 138-bed military medical center. We used statistical modeling to characterize the relationship between communication effectiveness and five predictors: team familiarity, team size, surgical complexity, and the presence of surgical residents and student anesthesia professionals. RESULTS We surveyed 137 surgical teams composed of 149 multidisciplinary clinicians for an 82% response rate. The mean communication effectiveness score was 4.61 (SD = 0.30), the average team size was 4.53 (SD = 0.69) persons, and the average surgical complexity was 10.85 relative value units (SD = 6.86). The surgical teams exhibited high variability in familiarity, with teams co-performing 26% (SD = 0.16) of each other's surgeries. We found for every unit increase in team familiarity, communication effectiveness increased by 0.36 (P ≤ .05), whereas adding one additional member to the surgical team decreased communication effectiveness by 0.1 (P ≤ .05). Surgical complexity and the influence of residents and students were not associated with communication effectiveness. CONCLUSIONS For military surgical teams, greater familiarity and smaller team sizes were associated with small improvements in communication effectiveness. Military leaders can likely enhance team communication by engaging in a thoughtful and concerted program to foster cohesion by building familiarity and optimizing team size to meet task and cognitive demands. We suggest leaders develop bundled approaches to improve communication by integrating team familiarity and team size optimization into current evidence-based initiatives to enhance performance.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz 66849, Germany
| | - Felichism W Kabo
- Institute for Social Research (ISR), University of Michigan, Ann Arbor, MI 48106-1248, USA
| | - Marla J De Jong
- University of Utah College of Nursing, University of Utah, Salt Lake City, UT 84112-5880, USA
| | - Sherita L House
- Indiana University School of Nursing, Indiana University, Indianapolis, IN 46202, USA
| | - Joshua A Wymer
- Department of Nursing, Naval Medical Center San Diego, San Diego, CA 92134, USA
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Kabo FW, Stucky CH, De Jong MJ. Associations of Surgical Team Communication With the Layout of Physical Space: A Network Analysis of the Operating Room in a Military Medical Center. HERD 2023; 16:134-145. [PMID: 36866407 DOI: 10.1177/19375867231159130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
AIM To examine how the spatial topology of the operating room (OR) within the medical center impacts surgical team communication. BACKGROUND Understanding the complex association between surgical team communication and the OR's spatial network location is critical to patient safety. Effective surgical communication is associated with fewer adverse events and medical errors. METHODS We employed a cross-sectional, quantitative, case study, and network-centric study design. We studied the population of 204 clinicians in a large military medical center (36 perioperative nurses, 34 surgical technicians, 62 anesthesia providers, and 72 surgeons), focusing on surgical teams with cases completed within duty hours. Data were collected from December 2020 to June 2021 using an electronic survey. Spatial network analysis was done using electronic floor plans. Statistical analysis was done with descriptive statistics and linear regressions. The outcomes were general and task-specific communication, and team-level variables were aggregated from scores for all team members. Spatial effects were assessed with network centrality (degree, Laplacian, and betweenness). RESULTS The individual-level survey response rate was 77% (157 of 204). Data were collected on 137 surgical teams. On a 5-point scale, general and task-specific communication ranged from 3.4 to 5.0 and 3.5 to 5.0, respectively (for both, median = 4.7). Team size ranged from 4 to 6 individuals (median = 4). Surgical suites with higher network centralities were associated with significantly lower communication scores. CONCLUSIONS The OR's spatial network location has important impacts on surgical team communication. Our findings have design and workflow implications for ORs and even surgical care in combat zones.
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Affiliation(s)
- Felichism W Kabo
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Marla J De Jong
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Cramer E, Stucky CH, Stobinski JX, Wymer JA, Boyle DK. Differences in Perioperative Nurse Job Satisfaction by Specialty Certification Status. J Perianesth Nurs 2023; 38:246-252. [PMID: 36402723 DOI: 10.1016/j.jopan.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe differences in perioperative RN job satisfaction by specialty certification status. DESIGN A retrospective, exploratory, cross-sectional design. METHODS We conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales. The sample consisted of 776 perioperative units in 206 hospitals with 13,061 study participants. We used multilevel mixed modeling to examine differences in job satisfaction for nurses holding CAPA (Certified Ambulatory Perianesthesia Nurse), CPAN (Certified Post Anesthesia Nurse), CNOR (certification for perioperative registered nurses), CRNFA (Certified RN First Assistant), other specialty certification, and not specialty certified. FINDINGS Twelve percent of RN participants held a perioperative nursing certification (CAPA, CPAN, CNOR, CRNFA), 15% held other nursing specialty certifications, and 73% were not certified. Regardless of certification status, nurses were the most satisfied with nurse-nurse interactions and task. They were the least satisfied with nursing administration, decision-making, and pay. CNOR certified nurses reported the lowest levels of job satisfaction in the study. CAPA and CPAN certified nurses reported higher job satisfaction than their noncertified colleagues on multiple job satisfaction scales (ie, CAPA 10 of 12; CPAN 5 of 12). CNOR certified nurses did not report meaningful differences in job satisfaction from non-certified nurses. CONCLUSIONS As job satisfaction impacts retention, productivity, and patient care quality, our findings have important implications for hospital leaders, nurses, and health care consumers. Based on our findings, we identified nursing professional development as a potential gap in job satisfaction that leaders can target for improvement. Our findings suggest that higher specialty nursing certification rates in perianesthesia nurses may potentially improve job satisfaction and retention of nurses.
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Affiliation(s)
- Emily Cramer
- Biostatistics and Epidemiology Core, Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO
| | - Christopher H Stucky
- Perioperative Consultant to the Army Surgeon General, Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Germany
| | | | - Joshua A Wymer
- San Diego Market, Defense Health Agency, Naval Medical Center San Diego, San Diego, CA
| | - Diane K Boyle
- Fay W. Whitney School of Nursing, University of Wyoming, Laramie, WY.
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Kostas-Polston EA, Terehoff CB, Nash LN, Brown AM, Delabastide ZA, Andersen EW, Brown WJ, Stucky CH, Norcross KR, Smith HN, Randall NR. Patterns in Urogenital Health in Active Duty Servicewomen: A Prospective Cross-Sectional Survey Evaluating Impacts of Water, Sanitation, and Hygiene Resources Across Three Military Environments. Mil Med 2023; 188:usad042. [PMID: 36852858 DOI: 10.1093/milmed/usad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/04/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION Female warfighters are at risk for sex-specific and frequently unrecognized urogenital health challenges that may impede their ability to serve. The constraints on water, sanitation, and hygiene (WASH) resources by austere environments, whether at home or abroad, require women to practice unhealthy hygiene behaviors that jeopardize their urogenital health. In this manuscript, we examine the use of WASH resources by U.S. Army active duty servicewomen (ADSW) across three settings-home duty, field training, and deployment-to determine how the changing availability of WASH resources alters hygiene and sanitation practices in austere environments. Additionally, we report findings from a previously developed theoretical framework for determining the impacts of austere environments on ADSW's hygiene knowledge, behaviors, and outcomes. MATERIALS AND METHODS This study used a prospective, cross-sectional survey design with population sampling and generalized ordered logit regression models. We recruited ADSW assigned to a large military installation in the southeastern United States after conducting a structured field hygiene training for female readiness. RESULTS We surveyed a highly diverse sample of 751 ADSW and found that the use of WASH resources significantly differs between field training and deployment. Clean running water significantly differed among all settings, with nearly 70% reporting clean running water to be rarely or never available during field training. Bathing facility types significantly differed in each setting, with Cadillac bathrooms more often used during deployment than during field training and wipe baths more often used during field training than during deployment. We found that women were significantly less likely to wash their private areas more than 2 days a week during field training, compared to deployment. Women reported changing their underwear ≤2 times per week in field training environments as compared to during deployment. Soap and water were reported as the most common ways of washing in both home duty stations and during deployment, followed by wipes at home duty stations and in deployed settings. Participants reported wipes as their primary bathing method during field training, followed by soap and water. Participants used intentional dehydration or delayed urination more frequently in field training than during deployment. Women reported significant differences in holding their urine between field training and deployment, with principal reasons reported as "dirty facilities" and "distance to the nearest restroom." Significantly, they reported safety concerns when bathing, using the bathroom, or toileting facilities across the three settings. CONCLUSIONS This is the first study to characterize sex-specific challenges by a large sample of operational ADSW and to explore the use of WASH resources in home duty, field training, and deployment settings. The results show that field training is more austere than deployed settings, indicating that austerity, not deployment, increases the urogenital infection risk for ADSW. With women more integrated into the military strategy than at any time in U.S. history, military leaders can use our results to develop interventions that ameliorate the unique challenges that influence the military readiness and overall health of female warfighters.
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Affiliation(s)
- Elizabeth A Kostas-Polston
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Christina B Terehoff
- Executive Medicine Clinic, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Lauren N Nash
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Angelyn M Brown
- Department of Public Health, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | | | | | - William J Brown
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
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Kostas-Polston EA, Terehoff CB, Nash LN, Brown AM, Delabastide ZA, Andersen EW, Brown WJ, Stucky CH, Norcross KR, Smith HN, Randall NR. Impacts of Austerity on Urogenital Infection Rates in Active Duty Servicewomen. Mil Med 2023:usad043. [PMID: 36840451 DOI: 10.1093/milmed/usad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/04/2023] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Female warfighters are at increased risk of urogenital infections (UGIs) when serving in austere environments with varying levels of access to water, sanitation, and hygiene resources. Urogenital infections among servicewomen were among the top five reported medical encounters and one of the top seven reasons for medical evacuation from deployed locations between 2008 and 2013. In this study, we examine the use of water and sanitation resources across three environments (home duty station, field training, and deployment) and analyze associations between water, sanitation, and hygiene resource access and UGIs during training or deployment. The analyses are based on answers from 751 diverse active duty servicewomen (ADSW) at a large military installation in the southeastern USA. MATERIALS AND METHODS Data for this population-based, prospective, cross-sectional survey design were collected during the administration of the Military Women's Readiness Urogenital Health Questionnaire. This research study was guided by two specific research questions derived from self-reported data in sections 2 and 3 of the questionnaire. RESULTS The sample consisted of an extremely diverse pool of U.S. Army ADSW attached to highly operational units with robust field training and deployment tempos. Over one-half of the participants reported being diagnosed with one or more UGIs before military service. Of that participant group, more than 76.0% experienced one or more infections since joining the military. We found that the majority of UGIs occurred while U.S. Army ADSW were at their home duty stations rather than during field training or deployment. Of the three types of UGIs, bacterial vaginosis is more often associated with water and sanitation constraints. None of the water factors were significantly associated with UGIs during deployment. Intentional dehydration was not associated with UGIs in either field training or deployment, but intentionally delaying urination was associated with a significant increase in the odds of developing urinary tract infection during deployment. We identified trends in hygiene practices that may put ADSW at a higher risk for UGIs. CONCLUSIONS Austere conditions, which may exist in any service environment, pose risks to the urogenital health and wellness of a female warfighter. Access to clean water and sanitation resources in military settings is essential for optimal health and operational readiness. It is necessary to identify and investigate critical research and policy gaps in need of investment and support for successful, evidence-based integration of female warfighters into military combat roles and to optimize their performance.
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Affiliation(s)
- Elizabeth A Kostas-Polston
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Christina B Terehoff
- Executive Medicine Clinic, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Lauren N Nash
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Angelyn M Brown
- Department of Public Health, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | | | | | - William J Brown
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
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Abstract
Trust is foundational for all interpersonal communication and activities in an increasingly networked and interdependent world. Trust is also essential to the effective delivery of health care and for building collegial environments rich in innovation and readily adaptable to change. As the world's most trusted profession and vested peer collaborators across interprofessional health care teams, nurses are uniquely qualified to shepherd change and foster an innovation mindset across organizations and systems. Innovation requires creative teams that are appropriately resourced and supported, and team-based innovation requires time, space, and safety for groups to realize their full potential and maximize contributions. Appropriate staffing, resourcing, internal engagement, and external partnerships are essential to successfully conceive, launch, sustain, and deliver change initiatives that successfully challenge the status quo. Diverse teams are vital to enhancing the performance, effectiveness, and delivery of change and innovation. Effective change management and innovation practices require courage and imagination, skills that nurses have long possessed. Nurses are uniquely equipped to champion human-centered design through all phases of innovation while bringing knowledge of patients and communities to bear in ways that deliver innovation, are respectful of challenges, and mindful of opportunities to strengthen individuals and communities.
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Affiliation(s)
- Joshua A Wymer
- San Diego Market, Defense Health Agency, San Diego, California, and Naval Medical Center San Diego, San Diego, California (Mr Wymer); and Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl, Germany (Dr Stucky)
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Stucky CH, Wolf JM. Fire in the Operating Room: Surgical Case Report From a Forced-Air Warming Device Equipment Fire. J Perianesth Nurs 2022; 37:766-769. [PMID: 35811224 DOI: 10.1016/j.jopan.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 10/17/2022]
Abstract
Surgical fires are critical life-threatening events that can result in patient morbidity and mortality. This case report describes an equipment fire originating from a forced-air warming device occurring during a shoulder arthroscopy operation and discusses how the surgical team responded to mitigate risks to the patient and staff. Rapid response by the anesthesia professional and the surgical team helped prevent the fire from negatively impacting patient and staff safety. The patient was discharged from the hospital without any complications. We recommend that surgical teams engage in a coordinated and continual cycle of fire prevention, including enhanced education and interprofessional team training.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl, Germany.
| | - Joshua M Wolf
- Certified Registered Nurse Anesthetist (CRNA), Department of Anesthesia, Landstuhl Regional Medical Center, Landstuhl, Germany
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12
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Stucky CH, Brown WJ, Knight AR, Hover AJ, De Jong MJ. Operation Allies Refuge and Operation Allies Welcome: Military Perioperative and Perianesthesia Nursing Support to the Afghan Evacuation Mission. J Perianesth Nurs 2022; 37:298-307. [PMID: 35339386 DOI: 10.1016/j.jopan.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/01/2021] [Accepted: 12/26/2021] [Indexed: 10/18/2022]
Abstract
Nursing has a long and celebrated history of providing life-saving care during crises and periods of great need. Following the government collapse in Afghanistan and the withdrawal of US troops, a severe humanitarian and human rights crisis emerged. The US military participated in one of the largest and most complex humanitarian missions in history to aid Afghan relief efforts. US and coalition forces evacuated more than 130,000 people in the chaotic Allied airlift from the Kabul Airport. The overarching missions, Operation Allies Refuge and Operation Allies Welcome, provided humanitarian support to at-risk Afghan nationals who contributed to the Global War on Terrorism efforts, as well as US citizens living in Afghanistan. Landstuhl Regional Medical Center (LRMC), an overseas military treatment facility located in Germany, supported the healthcare needs of Afghan evacuees and injured US service members during the humanitarian crisis. LRMC clinicians provided emergent, urgent, and specialty care while advocating for evacuee health, wellness, and living conditions. Perioperative and perianesthesia nurses were essential to the humanitarian response, as many evacuees and injured US service members arrived in Germany requiring immediate surgical interventions. In this article, we describe the vital contributions of military perioperative and perianesthesia nurses to the Operation Allies Refuge and Operation Allies Welcome missions, and share our experiences providing humanitarian relief. Military and civilian healthcare planners can learn from our humanitarian relief contributions, experiences, and lessons to strategically prepare their health systems to respond to future crises.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center. Rheinland-Pfalz, Germany.
| | - William J Brown
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center. Rheinland-Pfalz, Germany
| | - Albert R Knight
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center. Rheinland-Pfalz, Germany
| | - Andrew J Hover
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center. Rheinland-Pfalz, Germany
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Stucky CH, De Jong MJ, Kabo FW. The Paradox of Network Inequality: Differential Impacts of Status and Influence on Surgical Team Communication. Med J (Ft Sam Houst Tex) 2022:56-63. [PMID: 34940969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Introduction: Healthcare is a dynamic and complex system predisposed to adverse events caused by human and technical errors. The ability of multidisciplinary clinicians to effectively communicate clinical information influences healthcare quality. Authority gradients, culture, and organizational hierarchy frequently constrict communication and contribute to surgical adverse events. Hierarchy is especially pronounced in military medicine, where military status, rank, and professional roles potentially create barriers to communication. METHODS We used an exploratory, prospective, cross-sectional design to determine how the social structure of military surgical teams influences group (network) communication effectiveness. Using a social network questionnaire, we surveyed members of surgical teams concerning their close-working relationships with other team members and perceptions of their communication effectiveness. We addressed the following research question: In surgical teams, how do the status (indegree) and influence (outdegree) of its individual members impact communication within the team? RESULTS We surveyed 50 surgical teams comprised of 45 clinicians and found that for close-working relationship networks communication effectiveness improved with lower concentrations of status and higher concentrations of influence. Network indegree (i.e., status) (β=-0.893, p=.019) had a larger impact than outdegree (i.e., influence) (β=0.617, p=.015), indicating status had a larger effect on communication effectiveness than influence. Put simply, our results show communication improves when there is more equality of status in the surgical team. Paradoxically, communication improves when there are higher concentrations of network influence among surgical team members. CONCLUSIONS Inequality in surgical team networks has paradoxical effects on communication effectiveness. The impact of network structure on organizational behavior is of high interest to the military and provides essential insights into clinicians' ability to communicate in a highly complex and task-based environment. Communication will likely improve in surgical teams through methods to foster equality of team member status and promote surgical leadership. Military medical policies could both amplify the positive effects and mitigate the negative effects of network inequality.
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Affiliation(s)
- Christopher H Stucky
- Nurse Scientist, Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Bragg, NC
| | - Marla J De Jong
- Dean, University of Utah College of Nursing, Salt Lake City, UT
| | - Felichism W Kabo
- Assistant Research Scientist, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI
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Akpan EU, Murray WO, Vergara MA, Murray SJ, Stucky CH, De Jong MJ, Villacorta E. Nursing Leadership During COVID-19: Leading an Inpatient Response at a Regional Military Medical Center. Mil Med 2021; 186:50-55. [PMID: 34469527 PMCID: PMC8499850 DOI: 10.1093/milmed/usab179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/29/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022] Open
Abstract
The coronavirus disease 2019 pandemic stressed healthcare systems worldwide and exposed major flaws in military and civilian healthcare systems. Landstuhl Regional Medical Center (LRMC) serves as the only military medical center for over 205,000 U.S. service members, beneficiaries, and coalition partners stationed throughout Europe, Africa, and the Middle East. The pandemic response required LRMC leaders to reconfigure services to meet pandemic concerns while providing lifesaving care to injured service members from combatant commands. The quickly evolving pandemic challenged leaders to ensure healthcare delivery amid constant change and imperfect information. While LRMC senior leaders developed a strategic pandemic response plan, a multidisciplinary team of nurses, doctors, and technicians collaborated to create an inpatient team to support the dual mission of coronavirus disease 2019 response and casualty care for the warfighter. In this manuscript, we discuss how a multidisciplinary clinical working group at a regional medical center prepared and responded to the pandemic, strategically planned patient care, and ensured support to combatant commands for ongoing forward military operations. Additionally, we share our experiences and lessons learned to inform other military facilities across the medical community and global healthcare systems.
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Affiliation(s)
- Ekerette U Akpan
- Department of Nursing, Landstuhl Regional Medical Center, APO, AE 09180, USA
| | - William O Murray
- Department of Nursing, Landstuhl Regional Medical Center, APO, AE 09180, USA
| | - Mario A Vergara
- Department of Nursing, Landstuhl Regional Medical Center, APO, AE 09180, USA
| | - Sarah J Murray
- Virtual Health, Regional Health Command, Europe, APO, AE 09180, USA
| | - Christopher H Stucky
- Department of Nursing, Womack Army Medical Center, Fort Bragg, NC 28310-7301, USA
| | - Marla J De Jong
- University of Utah College of Nursing, Salt Lake City, UT 84112-5880, USA
| | - Elba Villacorta
- Public Health Command Pacific Region, Ft. Shafter, HI 96859, USA
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Abstract
The dynamic nature of perioperative care often brings unfamiliar clinicians together yet requires them to collectively provide complex health care in a challenging environment. In this review, we comprehensively evaluated evidence regarding surgical team familiarity and its relationship to surgical team performance. Using a comprehensive and iterative search strategy, we searched PubMed, Web of Science, PsycInfo, and EMBASE for surgical team familiarity manuscripts. We identified 598 manuscripts, 16 of which met our inclusion criteria. We found that surgical team familiarity is associated with improved performance for many metrics, including shorter total operative time, team member safety, decreased surgical errors and disruptions, reduced miscommunication, and fewer patient readmissions. Although additional research would be helpful, surgical managers should consider team familiarity and consistency in team membership when assigning staff members to surgical teams to optimize surgical care, decrease inefficiencies, and promote safe patient outcomes.
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Wymer JA, Stucky CH, De Jong MJ. Nursing Leadership and COVID-19: Defining the Shadows and Leading Ahead of the Data. ACTA ACUST UNITED AC 2021; 19:483-488. [PMID: 34149326 PMCID: PMC8196329 DOI: 10.1016/j.mnl.2021.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic overwhelmed health care systems and exposed major gaps in preparedness and response plans. The crisis challenged nurse leaders to develop and implement novel care delivery plans while preventing disease transmission to patients and staff. COVID-19 required nurse leaders to make decisions in an environment of conflicting data and directives. The authors share essential nurse leader competencies vital to the development and support of thriving nurse leaders. As crises persist and future challenges arise, nurse leaders can leverage these essential competencies to successfully drive engagement, lead ahead of consensus, and define the shadows of limited, incomplete, and conflicting data.
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Affiliation(s)
- Joshua A Wymer
- Chief Nursing Informatics Officer, Naval Medical Center San Diego. Contact: Tel: (619) 532-7619, Address: Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA 92134
| | - Christopher H Stucky
- Deputy Chief of Research; Nurse Scientist, Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center. Contact: Tel: (910) 907-8888, Address: Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310-7301
| | - Marla J De Jong
- Dean, Louis H. Peery Presidential Endowed Chair; Professor. Contact: Tel: (801) 585-1087, Address: University of Utah College of Nursing, Annette Poulson Cumming Building, 10 South 2000 East, Salt Lake City, UT 84112-5880
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Affiliation(s)
- Christopher H Stucky
- Christopher H. Stucky is a nurse scientist and deputy chief of research at the Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, in Fort Bragg, N.C
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Migliore L, Braun L, Stucky CH, Gardner C, Huffman S, Jumpp S, Bell E. Considerations for Acute and Emergent Deployed Mental Health Patient Management and Theater Transports: A Scoping Review. Mil Med 2020; 186:e932-e942. [PMID: 33382426 PMCID: PMC8399236 DOI: 10.1093/milmed/usaa568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022] Open
Abstract
Background Although combat stress and psychiatric casualties of war have consistently contributed to the need for deployed patient transport to higher echelons of care, little is known regarding specific evidence-based strategies for providing psychological support and optimal transport interventions for warriors. Study Objective The purpose of this scoping review is to map existing literature related to considerations for deployed mental health patient transport. The review’s primary aims are to identify the existing scientific research evidence, determine research and training gaps, and recommend critical areas for future military research. Methods We used Arksey and O’Malley’s six-stage scoping review methodological framework (identify the research question, identify relevant studies, select studies, chart data, report results, and consultation). Using a systematic search strategy, we evaluated peer-reviewed literature from five databases (PubMed, CINAHL, PsycINFO, Web of Science, and Embase) and gray literature from the Defense Technical Information Center. All publications were independently screened for eligibility by two researchers during three review rounds (title, abstract, and full text). Results We identified 1,384 publications, 61 of which met our inclusion criteria. Most publications and technical reports were level IV evidence and below, primarily retrospective cohort studies and epidemiologic surveillance reports. Few rigorously designed studies were identified. Eight research themes and a variety of research and critical training gaps were derived from the reviewed literature. Themes included (1) characterizing mental health patients aeromedically evacuated from theater; (2) in-flight sedation medications; (3) need for aeromedical evacuation (AE) in-theater education, training, and guidelines for staff; (4) epidemiological surveillance of AE from theater; (5) mental health management in deployed settings; (6) suicide-related event management; (7) transport issues for mental health patients; and (8) psychological stressors of AE. Research is needed to establish clinical practice guidelines for mental health condition management in theater and throughout the continuum of en route care.
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Affiliation(s)
- Laurie Migliore
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | - Lisa Braun
- Nursing Research, Naval Medical Center, Portsmouth, VA 23708, USA
| | - Christopher H Stucky
- Center for Nursing Science & Clinical Inquiry, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Cubby Gardner
- Air Force Medical Readiness Agency, Falls Church, VA 22041, USA
| | - Sarah Huffman
- Airman Readiness Optimization Division, 711th Human Performance Wing, Dayton, OH 45433, USA
| | - Savannah Jumpp
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | - Emily Bell
- TriService Nursing Research Program, Uniformed Services University, Bethesda, MD 20814, USA
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Stucky CH, De Jong MJ, Rodriguez JA. A Five-Step Evidence-Based Practice Primer for Perioperative RNs. AORN J 2020; 112:506-515. [PMID: 33113177 DOI: 10.1002/aorn.13220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 11/06/2022]
Abstract
Perioperative nurses work in a complex health care setting and are well-positioned to mitigate unexpected events and promote optimal patient outcomes. Thus, perioperative nurses must adapt to rapid advances in technology, treatments, and scientific discoveries to maintain clinical competence and provide care that reflects current evidence. Evidence-based practice (EBP) is a standard of professional nursing performance and an expectation of professional nursing practice. Because EBP is foundational to health care quality and safety, perioperative nurses must understand the concepts of EBP and have the capacity to apply evidence to their clinical practice. However, some perioperative nurses struggle with EBP concepts and find it difficult to access, appraise, and apply evidence. In this article, we describe the five-step EBP process and provide valuable insights into EBP for perioperative RNs.
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Stucky CH, Brown WJ, Stucky MG. COVID 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority. Nurs Forum 2020; 56:222-227. [PMID: 33047352 PMCID: PMC7675696 DOI: 10.1111/nuf.12515] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/17/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic ushered in a new era for advanced practice registered nurses, as emergency regulatory and policy changes expanded the nurse practitioner (NP) scope of practice. The legislative changes enabled NPs to bolster the national pandemic response by working to the full extent of their education and training. The changes are only temporary, and many have contemplated the permanent impact of COVID-19 when healthcare transitions to a postpandemic normal. NPs now have a unique opportunity to educate others about the merit of their role and advocate for permanent legislative changes. In this creative controversy manuscript, we build a case that national NP full practice authority increases access to care and is vital for a sustainable and resilient healthcare system that can react to future pandemic crises.
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Affiliation(s)
- Christopher H Stucky
- Department of Nursing, Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - William J Brown
- Department of Nursing, Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Michelle G Stucky
- Cumberland County Public Health Department, Women's Health Nurse Practitioner, Fayetteville, North Carolina, USA
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Abstract
To serve as leaders in the broader health care system, nurses must have the capacity to write confidently and communicate innovations in clinical practices and outcomes to multiple stakeholders. This article describes the importance of publishing for nurses and guides professional development educators to develop supportive organizational cultures that foster writing for publication. [J Contin Educ Nurs. 2020;51(10):447-449.].
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Stucky CH, De Jong MJ, Wymer JA. Certified Surgical Services Manager (CSSM): The New Gold Standard for Perioperative Nurse Leaders. J Perianesth Nurs 2020; 35:557-563. [PMID: 32732003 DOI: 10.1016/j.jopan.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Abstract
Specialty certification promotes improved surgical outcomes, enhances health care quality, and is an important external benchmark of overall clinician competence. Given the growing technological, financial, and administrative demands of the modern health care system, the roles of perianesthesia and perioperative nurse managers are increasingly complex. The Certified Surgical Services Manager (CSSM) certification establishes a standard of excellence for perioperative managers, demonstrating that they possess the capacity to adapt and lead in the continually evolving roles of perioperative leadership and surgical services management. In this article, we comprehensively review CSSM certification and offer insights into the importance of lifelong learning and continuous professional development. The topics discussed include the advantages of holding the CSSM credential, the importance of specialty certification, and a general examination overview. In addition, we emphasize the value of the CSSM credential and adopting it as the national standard for surgical service managers.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Bragg, NC.
| | | | - Joshua A Wymer
- Nursing Administration, Naval Medical Center San Diego, San Diego, CA
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Abstract
Nursing specialty certification is an objective measure that assures the public that nurses demonstrate the highest level of professional knowledge in their field. Many nurses do not seek specialty certification, as evidenced by low certification rates. In this creative controversy article, we build a case that progressing toward nursing specialty certification as a national standard will increase overall nursing professionalism while better preparing nurses to meet the needs of their specialty patient populations and the changing health care system.
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Affiliation(s)
- Christopher H Stucky
- Nurse Scientist, Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Bragg, North Carolina
| | - Joshua A Wymer
- Chief Nursing Informatics Officer, Naval Medical Center San Diego, San Diego, California
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Stucky MG, Jolles D, Stucky CH. Right care: Improving timeliness and promoting preventive health in a lower socioeconomic reproductive health clinic. Nurs Forum 2020; 55:407-415. [PMID: 32185798 DOI: 10.1111/nuf.12445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Missed prevention opportunities are a financial burden to the US health care system and result in excess consumption of resources, reduced quality of life, increased morbidity, and premature death. LOCAL PROBLEM High staff turnover and inefficient practices at a local health department caused long patient wait times and missed opportunities for preventive health care. The project aim was to improve timeliness through Right Care in a lower socioeconomic reproductive health clinic while decreasing patient cycle time by 10% in 90 days. METHODS We used four plan-do-study-act cycles incorporating tests of change that focused on team and patient engagement and two process changes. The interventions included a care coordination huddle, an infant feeding decision aid to better understand patient values, a sexual health screening tool to identify prevention opportunities, and a redesigned patient-centered discharge process to improve efficiency. RESULTS Over 90 days, the receipt of Right Care increased while patient cycle time decreased by 2.6%. The team improved function with a mean huddle effectiveness score increase from 2 to 4.4 (1-5 Likert scale). Intent to breastfeed increased by 49% (35%-52%), and identification of preventive care needs increased by 320% (15%-63%). Preventive care follow-up remained unchanged at 26% with the new discharge process, identifying weaknesses in the health department referral systems. CONCLUSIONS Standardized tools and processes improved primary prevention opportunities at a local health department while reducing patient cycle time. The tools improved documentation of intent to exclusively breastfeed, increased preventive care identification, and streamlined the discharge process; while demonstrating a systems-level gap for long-term follow-up.
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Affiliation(s)
- Michelle G Stucky
- Doctorate of Nursing Practice Program, Frontier Nursing University, Hyden, Kentucky
| | - Diana Jolles
- Doctorate of Nursing Practice Program, Frontier Nursing University, Hyden, Kentucky
| | - Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Bragg, North Carolina
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Stucky CH, De Jong MJ, Lowe AW, Mathews B. COVID-19: Initial Perioperative and Perianesthesia Nursing Response in a Military Medical Center. J Perianesth Nurs 2020; 35:353-356. [PMID: 32561253 PMCID: PMC7242965 DOI: 10.1016/j.jopan.2020.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 01/20/2023]
Abstract
Nurses have historically led efforts to improve the health of populations while simultaneously and unselfishly providing care during pivotal moments of national need. The COVID-19 pandemic has placed an unprecedented strain on the US health care system, including severe shortages of hospital beds, supplies, equipment, pharmaceuticals, and healthy frontline clinicians. Perioperative and perianesthesia leaders and clinicians have unique opportunities to provide patient care during the COVID-19 crisis. In this manuscript, we describe the initial changing roles and contributions of perioperative and perianesthesia registered nurses during the COVID-19 pandemic and share recent experiences from a military medical center. Perioperative and perianesthesia nurses are vital to the overall nursing viability of the health care system, as they possess the requisite knowledge and skills to provide expert clinical care in many hospital settings and meet the demands of a global pandemic.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Bragg, NC.
| | - Marla J De Jong
- Division of Acute and Chronic Care, University of Utah College of Nursing, Salt Lake City, UT
| | - Adam W Lowe
- Perioperative Nursing Services, Womack Army Medical Center, Fort Bragg, NC
| | - Bruce Mathews
- Perioperative Nursing Services, Womack Army Medical Center, Fort Bragg, NC
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Abstract
AbstractIntroductionMedical error is the third leading cause of death in the United States, contributing to suboptimal care, serious patient injury, and mortality among beneficiaries in the Military Health System. Recent media reports have scrutinized the safety and quality of military healthcare, including surgical complications, infection rates, clinician competence, and a reluctance of leaders to investigate operational processes. Military leaders have aggressively committed to a continuous cycle of process improvement and a culture of safety with the goal to transform the Military Health System into a high-reliability organization. The cornerstone of patient safety is effective clinician communication. Military surgical teams are particularly susceptible to communication error because of potential barriers created by military rank, clinical specialty, and military culture. With an operations tempo requiring the military to continually deploy small, agile surgical teams, effective interpersonal communication among these team members is vital to providing life-saving care on the battlefield.MethodsThe purpose of our exploratory, prospective, cross-sectional study was to examine the association between social distance and interpersonal communication in a military surgical setting. Using social network analysis to map the relationships and structure of interpersonal relations, we developed six networks (interaction frequency, close working relationship, socialization, advice-seeking, advice-giving, and speaking-up/voice) and two models that represented communication effectiveness ratings for each participant. We used the geodesic or network distance as a predictor of team member network position and assessed the relationship of distance to pairwise communication effectiveness with permutation-based quadratic assignment procedures. We hypothesized that the shorter the network geodesic distance between two individuals, the smaller the difference between their communication effectiveness.ResultsWe administered a network survey to 50 surgical teams comprised of 45 multidisciplinary clinicians with 522 dyadic relationships. There were significant and positive correlations between differences in communication effectiveness and geodesic distances across all five networks for both general (r = 0.819–0.894, P < 0.001 for all correlations) and task-specific (r = 0.729–0.834, P < 0.001 for all correlations) communication. This suggests that a closer network ties between individuals is associated with smaller differences in communication effectiveness. In the quadratic assignment procedures regression model, geodesic distance predicted task-specific communication (β = 0.056–0.163, P < 0.001 for all networks). Interaction frequency, socialization, and advice-giving had the largest effect on task-specific communication difference. We did not uncover authority gradients that affect speaking-up patterns among surgical clinicians.ConclusionsThe findings have important implications for safety and quality. Stronger connections in the interaction frequency, close working relationship, socialization, and advice networks were associated with smaller differences in communication effectiveness. The ability of team members to communicate clinical information effectively is essential to building a culture of safety and is vital to progress towards high-reliability. The military faces distinct communication challenges because of policies to rotate personnel, the presence of a clear rank structure, and antifraternization regulations. Despite these challenges, overall communication effectiveness in military teams will likely improve by maintaining team consistency, fostering team cohesion, and allowing for frequent interaction both inside and outside of the work environment.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310-7301
| | - Marla J De Jong
- University of Utah College of Nursing, Annette Poulson Cumming Building, 10 South 2000 East, Salt Lake City, UT 84112-5880
| | - Felichism W Kabo
- Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Room 3348 ISR, Ann Arbor, MI 48106-1248
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