Advancing the Quality and Safety of Radiology and Imaging Nursing Practice Through Scholarly Writing

Radiology and imaging nurses have specific knowledge and expertise that can enhance the quality and safety of patient care. In order for care enhancement to occur, nurses must disseminate their knowledge and expertise. One approach to dissemination is through scholarly writing. This article presents a comprehensive approach to developing as a scholarly writer. The results of a hermeneutic phenomenological study that uncovered the experience of developing as a scholarly writer from the perspective of first semester PhD nursing students served as the basis for the recommended strategies. The strategies include learn about scholarly writing, create a writing scaffold, put the pieces together, and celebrate accomplishments that can be used by individuals and groups interested in advancing the specialty of radiology and imaging nursing through scholarly writing.     

Telehealth Triage and Oncology Nursing Practice

ObjectiveTo provide an overview of telehealth and explore the roles that the registered nurse can play in the context of a telehealth setting.Data SourcesReview of articles via PubMed and CIANHL from 2009 to present and relevant telehealth websites.ConclusionThe advancement of technology, the need to improve access to health care, and the changing expectations of consumers to have access to information has helped to expand telehealth as an innovative care delivery model and has created new opportunities for telehealth nursing care. The use of telehealth in the oncology setting continues to evolve and provide nurses the opportunity for new and potentially expanded roles.Implications for Nursing PracticeRegistered oncology nurses need to understand the various methods used to deliver care via a telehealth environment and how establish and work in this new environment to assure that they are practicing safely and within the full scope of their license.     

Advancing Nursing Practice with a Unit-based Clinical Expert

Objective: To explore patterns in the practice of nursing and patient outcomes.
Design: Qualitative field research.
Population, Sample, Setting: Populations were critical care nurses and critically ill adult patients in the 10-bed medical critical care unit of a 900-bed teaching hospital. A convenience-purposive sample of 27 nurses and 31 patients was studied in 1985.
Methods: Six months of participant observation, unstructured interviews, and the constant comparison method of grounded theory.
Findings: Markedly different patterns were found in expert and nonexpert practice. The substantive theory of conversion helped explain how the majority of nonexpert nurses advanced their practice. The metaphor of catalyzed conversion captures how a unit-based expert nurse serves as a catalyst to advance the practice of nonexperts. Presence, defined as the way of being within a given clinical context, differentiated nurses.
Conclusions: (a) Expert and nonexpert practices are substantively different, (b) Expert and nonexpert practice results in different patient outcomes, (c) Conversion helps explain changes in nonexpert practice.
Clinical Implications: A unit-based expert nurse can increase patient-focused care.     

Collaborative Practice Through Nursing Case Management

A 528-bed community teaching hospital redesigned its patient care delivery system, implementing a collaborative practice model on the 30-bed inpatient rehabilitation unit in April 1990. This model is a patient-centered delivery model that encourages the healthcare team to facilitate the achievement of patient outcomes within effective time frames and with an appropriate use of resources. The collaborative practice model includes a nurse case manager's role for the staff nurse, which had as its framework the concept of nursing case management. Tested project management techniques were used to ensure a successful implementation process. Various strategies, such as using project teams and providing educational programs, were used to respond to the issues of role conflict and overlap, especially between social workers and nurse case managers. The implementation of this model provided a number of benefits, including improved interdisciplinary relationships and decreased length of stay.     

Addressing Sexual Violence Through Preventive Nursing Practice

Approximately 1 in 20 women will experience sexual violence at some point in her life. The negative health consequences to women can be serious and lifelong, prompting the Centers for Disease Control and Prevention and the World Health Organization to declare sexual violence a public health problem. Nurses, in their provision of care to individuals and communities, can contribute to improved outcomes related to the problem of sexual violence through the application of preventive care practices.     

Optimizing Clinical Monitoring Tools to Enhance Patient Review by Pharmacists

Background  The Clinical Monitoring List (CML) is a real-time scoring system and intervention tool used by Mayo Clinic pharmacists caring for hospitalized patients. Objective  The study aimed to describe the iterative development and implementation of pharmacist clinical monitoring tools within the electronic health record at a multicampus health system enterprise. Methods  Between October 2018 and January 2019, pharmacists across the enterprise were surveyed to determine opportunities and gaps in CML functionality. Responses were received from 39% ( n  = 162) of actively staffing inpatient pharmacists. Survey responses identified three main gaps in CML functionality: (1) the desire for automated checklists of tasks, (2) additional rule logic closely aligning with clinical practice guidelines, and (3) the ability to dismiss and defer rules. The failure mode and effect analysis were used to assess risk areas within the CML. To address identified gaps, two A/B testing pilots were undertaken. The first pilot analyzed the effect of updated CML rule logic on pharmacist satisfaction in the domains of automated checklists and guideline alignment. The second pilot assessed the utility of a Clinical Monitoring Navigator (CMN) functioning in conjunction with the CML to display rules with selections to dismiss or defer rules until a user-specified date. The CMN is a workspace to guide clinical end user workflows; permitting the review and actions to be completed within one screen using EHR functionality. Results  A total of 27 pharmacists across a broad range of practice specialties were selected for two separate two-week pilot tests. Upon pilot completion, participants were surveyed to assess the effect of updates on performance gaps. Conclusion  Findings from the enterprise-wide survey and A/B pilot tests were used to inform final build decisions and planned enterprise-wide updated CML and CMN launch. This project serves as an example of the utility of end-user feedback and pilot testing to inform project decisions, optimize usability, and streamline build activities.     

Multidimensional Pain Assessment Tools for Ambulatory and Inpatient Nursing Practice

BackgroundOne of the critical components in pain management is the assessment of pain. Multidimensional measurement tools capture multiple aspects of a patient's pain experience but can be cumbersome to administer in busy clinical settings.AimWe conducted a systematic review to identify brief multidimensional pain assessment tools that nurses can use in both ambulatory and acute care settings.MethodsWe searched PUBMED/MEDLINE, PsychInfo, and CINAHL databases from January 1977 through December 2019. Eligible English-language articles were systematically screened and data were extracted independently by two raters. Main outcomes included the number and types of domains captured by each instrument (e.g., sensory, impact on function, temporal components) and tool characteristics (e.g., administration time, validity) that may affect instrument uptake in practice.ResultsOur search identified eight multidimensional assessment tools, all of which measured sensory or affective qualities of pain and its impact on functioning. Most tools measured impact of pain on affective functioning, mood, or enjoyment of life. One tool used ecological momentary assessment via a web-based app to assess pain symptoms. Time to administer the varying tools ranged from less than 2 minutes to 10 minutes, and evidence of validity was reported for seven of the eight tools.ConclusionsOur review identified eight multidimensional pain measurement tools that nurses can use in ambulatory or acute care settings to capture patients’ experience of pain. The most important element in selecting a multidimensional pain measure, though, is that one tool is selected that best fits the practice and is used consistently over time.     

Graduate Nursing Students' Awareness of Digital Resources for Patient Education

Digital health literacy is increasingly important in health care delivery. The purpose of this study was to assess graduate nursing students’ awareness of the role of digital resources in patient education. A required learning activity regarding the analysis of health care websites was performed by graduate nursing students. Pre- and postactivity surveys were completed. After analyzing health care websites through a digital health literacy learning activity, students reported increased awareness of digital health resources and an increased awareness of the low readability level of many sites. Curricular initiatives can increase knowledge and skills related to digital health literacy.