Fast-tracking the postanesthesia patient: the pros and cons.

Fast-tracking patients in the perianesthesia setting is a health care practice initiative that is rapidly increasing in popularity in hospitals and freestanding surgery centers throughout the United States and the world. ASPAN recognizes the efficacy of fast-tracking ambulatory surgery patients through the postanesthesia phase of care and currently recognizes 2 important models of fast-tracking: rapid PACU progression and bypassing Phase I PACU. This article reviews the pros and cons of these fast-tracking initiatives. Finally, ethical issues will be critically evaluated to ensure safe, quality, cost-effective care is maintained when fast-tracking this patient population.     

A Competency-Based Orientation (CBO) Protocol Enhances Competency Among Newly Hired Perianesthesia Nurses

PurposeThe purpose of this quality improvement project was to develop a competency-based orientation (CBO) protocol based on the American Society of PeriAnesthesia Nurses Nursing Standards and CBO for perianesthesia nurses.DesignFeasibility study with pre–post survey design.MethodsA CBO protocol that included nursing care workflows for 11 common surgical cases was developed and used in orienting newly hired perianesthesia nurses. Newly hired nurses completed a pre–post self-assessment on their level of competency in caring for surgical patients.FindingsUsing Wilcoxon signed rank test, improved competency was found in all service areas except for pediatric care.ConclusionsNursing competency in the perianesthesia area is critical in fulfilling one's role as a nurse. A robust CBO protocol for the perianesthesia nurse is important when integrating an employee into the organization and preparing the nurse for success.     

The role of academic-practice partnerships from perspectives of nursing students: A cross -sectional study

BackgroundCollaborations between nursing schools and teaching hospitals are important for achieving the goals of clinical nursing education. While previous work showed that nursing students benefit from academic-practice partnerships, it is unclear how these collaborations help nursing students.ObjectiveTo identify the role of academic-practice partnerships from the perspective of nursing students. Two hypothetical models based on system theory were proposed that utilized input-transformation-output processes. The input, transformation, and outputs were the “academic-practice partnership”, “interaction between nurses and nursing students”, and “professional self-concept and organizational socialization of nursing students”, respectively.DesignThis study used a cross-sectional research design.SettingThis study was conducted at a nursing school in Korea.ParticipantsThe participants included 243 fourth-year nursing students who were about to graduate.MethodsA questionnaire was used to collect data in August 2019. Path analysis was used to explore the models to determine the roles of academic-practice partnerships.ResultsTwo hypothetical models indicated the role of academic-practice partnership. The academic-practice partnership positively affected the interaction between nurses and nursing students, which directly and indirectly benefitted professional self-concept and organizational socialization of nursing students.ConclusionThe higher perceived academic-practice partnership by nursing students, the better their interactions with nurses, professional self-concept, and organizational socialization. Therefore, nursing students should be aware of the academic-practice partnerships and nursing educators should effectively show these partnerships or collaborations to nursing students. Moreover, nursing educators should also encourage nursing students to interact with their preceptors in their practicums and, as nurses are important educators in academic-practice partnerships, they should be qualified as preceptors to teach nursing students.     

The critical elements of effective academic-practice partnerships: a framework derived from the Department of Veterans Affairs Nursing Academy

Background

The nursing profession is exploring how academic-practice partnerships should be structured to maximize the potential benefits for each partner. As part of an evaluation of the U.S. Department of Veterans Affairs Nursing Academy (VANA) program, we sought to identify indicators of successful partnerships during the crucial first year.

Methods

We conducted a qualitative analysis of 142 individual interviews and 23 focus groups with stakeholders from 15 partnerships across the nation. Interview respondents typically included the nursing school Dean, the VA chief nurse, both VANA Program Directors (VA-based and nursing school-based), and select VANA faculty members. The focus groups included a total of 222 VANA students and the nursing unit managers and staff from units where VANA students were placed. An ethnographic approach was utilized to identify emergent themes from these data that underscored indicators of and influences on Launch Year achievement.

Results

We emphasize five key themes: the criticality of inter-organizational collaboration; challenges arising from blending different cultures; challenges associated with recruiting nurses to take on faculty roles; the importance of structuring the partnership to promote evidence-based practice and simulation-based learning in the clinical setting; and recognizing that stable relationships must be based on long-term commitments rather than short-term changes in the demand for nursing care.

Conclusions

Developing an academic-clinical partnership requires identifying how organizations with different leadership and management structures, different responsibilities, goals and priorities, different cultures, and different financial models and accountability systems can bridge these differences to develop joint programs integrating activities across the organizations. The experience of the VANA sites in implementing academic-clinical partnerships provides a broad set of experiences from which to learn about how such partnerships can be effectively implemented, the barriers and challenges that will be encountered, and strategies and factors to overcome challenges and build an effective, sustainable partnership. This framework provides actionable guidelines for structuring and implementing effective academic-practice partnerships that support undergraduate nursing education.

     

The power of partnership to shape the future of nursing: the evolution of the clinical nurse leader

Aim(s)  This article describes the evolution of the clinical nurse leader role and demonstrates the vital nature of partnerships between academia and practice in the design and implementation of this new role.
Background  The health care system as it exists in the United States may put patients at risk in terms of safety and quality of care. Nursing leadership from across the US recognized a need for nursing practice and academia to work in partnership to develop workable and effective solutions. The vision was of a nurse generalist who would be prepared to address the complexities that make the current systems dysfunctional.
Evaluation  Review, share experiences and discuss the benefits of engaging stakeholders with broad and diverse viewpoints.
Key issues  Engaging a group of stakeholders with diverse backgrounds, varied world views and experiences for the purpose of developing common mutually beneficial goals, creates synergy and greater commitment to the goals, which results in success.
Conclusion(s)  The power of partnership in the development and implementation of the CNL is evident. Old ways of trying to 'go it alone' are no longer viable in a complex health care environment.
Implications for nursing management  With continued collaboration, practice and academia can continue to confront challenges and develop effective solutions.     

Academic-practice partnerships in evidence-based nursing education: Protocol of a theory-guided scoping review

AimThis theory-guided scoping review aims to provide an overview of existing literature about academic-practice partnerships in evidence-based nursing education.BackgroundAcademic-practice partnership is an approach to improve evidence-based nursing education, to promote evidence-based nursing practice which could reduce the nursing care discrepancy, improve the nursing care quality and patient safety, reduce healthcare costs and promote nursing professional development. However, the related research is limited and there is a lack of systematic review of related literature.DesignA scoping review guided by the theories of the Practice-Academic Partnership Logic Model and the JBI Model of Evidence-Based Healthcare.MethodsThe researchers will use JBI guidelines for scoping reviews and related theories to guide this theory-guided scoping review. The researchers will systematically search Cochrane Library, PubMed, Web of Science, CINAHL, EMBASE, SCOPUS and Educational Resource Information Centre (ERIC) using major search concepts including academic-practice partnership, evidence-based nursing practice and education. Two reviewers will be responsible for independent literature screening and data extraction. Discrepancies would be solved by a third reviewer.Expected resultsThis scoping review will identify related research gaps to provide implications for researchers and identify specific information to provide implications for developing interventions of academic-practice partnerships in evidence-based nursing education.Registration numberThis scoping review had been registered on Open Science Framework (https://osf.io/83rfj).     

The state of ambulatory surgery and perianesthesia nursing

The continued success of the ambulatory surgery environment of care has been achieved through patient, physician, and nursing staff satisfaction. The growth in this industry has been greatly influenced by advances in technology, as well as the development and administration of newer anesthetic agents. The implications delineated in this article provide an overview of what is in store for the specialty of perianesthesia nursing. Issues of competency, professional excellence, patient expectations, continuous quality improvement, research, and ethics have become part of the daily lexicon. Never before has the professional nurse been counted on for so much, and future expectations of the nurse continue to grow. To survive, the nurse needs to expand the boundaries of nursing practice as they have been defined. Nurses are the backbone of the delivery of patient care, nurses are on the front line guiding the patient through every care decision, and nurses are positioned to influence the continued evolution of ambulatory surgery and perianesthesia nursing care.     

Perianesthesia care of cardiac surgery patients: a CPAN review.

Postoperative nursing management of cardiac surgery patients is considered part of perianesthesia nursing core curriculum by ASPAN. In many hospitals, however, these patients bypass the PACU and are admitted directly to the ICU. For that reason, perianesthesia nurses who do not have cardiothoracic surgical ICU experience need information related to the immediate postoperative routine and nursing care regimen of cardiac surgery patients. Bleeding, cardiac tamponade, low cardiac output syndrome, and dysrhythmias are postoperative complications that are discussed. A brief overview of postoperative nursing management and several "nursing pearls of wisdom" are also presented.     

Best organizational practices that foster scholarly nursing practice in Magnet® hospitals

BackgroundFor nurses to become leaders in the transformation of the future health care delivery system, they need organizational support to develop a scholarly nursing practice across a full career trajectory.PurposeThe purpose of this qualitative study was to describe best organizational practices that support the development and growth of a scholarly nursing practice throughout a nurse's full career progression.MethodThirty-two senior nurse leaders from American Nurses Credentialing Corporation Magnet® hospitals were interviewed. Questions focused on strategies used in the workplace to support nurses' growth and development of a scholarly nursing practice. Content analysis was used to analyze data.ResultsThe following themes emerged: The Organization Creates and Sustains a Core Culture Supportive of Scholarly Nursing Practice; Expectations for Professional Development; Resources that Support Scholarly Nursing Practice; and Power of the Senior Nurse Leader. Nursing culture in the institutions led by our participants had a significant and influential impact on the overall organizational culture.ConclusionsA nursing culture that embraces a scholarly nursing practice environment is one that is tightly integrated with an overall institutional culture that supports nursing. Senior nurse leaders were the driving force behind the development of a culture that supports scholarly nursing practice.     

Differences in nursing practice environment among US acute care unit types: A descriptive study

BackgroundThe hospital nursing practice environment has been found to be crucial for better nurse and patient outcomes. Yet little is known about the professional nursing practice environment at the unit level where nurses provide 24-hour bedside care to patients.ObjectivesTo examine differences in nursing practice environments among 11 unit types (critical care, step-down, medical, surgical, combined medical–surgical, obstetric, neonatal, pediatric, psychiatric, perioperative, and emergency) and by Magnet status overall, as well as four specific aspects of the practice environment.DesignCross-sectional study.Settings5322 nursing units in 519 US acute care hospitals.MethodsThe nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index. The Practice Environment Scale of the Nursing Work Index mean composite and four subscale scores were computed at the unit level. Two statistical approaches (one-way analysis of covariance and multivariate analysis of covariance analysis) were employed with a Tukey-Kramer post hoc test.ResultsIn general, the nursing practice environment was favorable in all unit types. There were significant differences in the nursing practice environment among the 11 unit types and by Magnet status. Pediatric units had the most favorable practice environment and medical–surgical units had the least favorable. A consistent finding across all unit types except neonatal units was that the staffing and resource adequacy subscale scored the lowest compared with all other Practice Environment Scale of the Nursing Work Index subscales (nursing foundations for quality of care, nurse manager ability, leadership, and support, and nurse–physician relations). Unit nursing practice environments were more favorable in Magnet than non-Magnet hospitals.ConclusionsFindings indicate that there are significant variations in unit nursing practice environments among 11 unit types and by hospital Magnet status. Both hospital-level and unit-specific strategies should be considered to achieve an excellent nursing practice environment in all hospital units.     

Examination of Factors Affecting Therapeutic Attitude and Empowerment of Perianesthesia Nurses Who Care for Patients With Opioid Use Disorder

PurposePatients with opioid use disorder (OUD) and associated complexities are presenting to hospitals in increasing numbers. Preparation of perianesthesia nurses caring for this patient population has lagged, with noted deficits in continuing education, resources, and role support. Previous research found education without considering therapeutic attitude (TA), empowerment and factors that influence nursing practice does not translate into feelings of competence in nursing care. The purpose of this study was to identify correlates and predictors that affect TA and empowerment among perianesthesia nurses caring for patients with OUD.DesignA cross-sectional, correlation design was used to identify correlates and predictors of TA and empowerment in a national sample of perianesthesia nurses (N = 215)MethodsA national survey collected data from perianesthesia nurses. The Perianesthesia Nurse Empowerment and Therapeutic Attitude Model was the guiding framework. Pearson product-moment correlation and hierarchical multiple regression analyses were used to examine relationships between personal factors, the professional practice environment and societal factors of perianesthesia nurses.FindingsThe standardized regression coefficients indicated the professional practice environment (β = -0.28), drug user stigma (β = 0.27), access to a pain specialist (β = 0.25), and exposure to drug users (β = 0.25) were the strongest predictors of TA. Access to a pain specialist (β = -0.15) and the professional practice environment (β = 0.72) were the strongest predictors of empowerment.ConclusionsThe professional practice environment directly influenced the degree of empowerment and TA reported by perianesthesia nurses. Exposure to persons with OUD and personal stigmatization of persons who misuse drugs decreased TA but had no association with empowerment. Access to a pain specialist was moderately predictive of empowerment and negatively associated with TA suggesting a lack of role legitimacy and the need for further research into perianesthesia nurses’ perceptions of their role when caring for this population.     

Protection procedures and preventions against the spread of coronavirus disease 2019 in healthcare settings for nursing personnel: Lessons from Taiwan

BackgroundSince coronavirus disease 2019 was first discovered, at the time of writing this article, the number of people infected globally has exceeded 1 million. Its high transmission rate has resulted in nosocomial infections in healthcare facilities all over the world. Nursing personnel account for nearly 50% of the global health workforce and are the primary provider of direct care in hospitals and long-term care facilities. Nurses stand on the front line against the spread of this pandemic, and proper protection procedures are vital.ObjectivesThe present study aims to share the procedures and measures used by Taiwan nursing personnel to help reduce global transmission.Review methodsCompared with other regions, where large-scale epidemics have overwhelmed the health systems, Taiwan has maintained the number of confirmed cases within a manageable scope. A review of various national and international policies and guidelines was carried out to present proper procedures and preventions for nursing personnel in healthcare settings.ResultsThis study shows how Taiwan's health system rapidly identified suspected cases as well as the prevention policies and strategies, key protection points for nursing personnel in implementing high-risk nursing tasks, and lessons from a nursing perspective.ConclusionsVarious world media have affirmed the rapid response and effective epidemic prevention strategies of Taiwan's health system. Educating nurses on procedures for infection control, reporting cases, and implementing protective measures to prevent nosocomial infections are critical to prevent further outbreaks.     

Creating Synergy between Academia and Practice: The Arizona State University and Mayo Clinic Arizona Model

BackgroundThe academic-practice partnership began in 2005 with a collaborative Pre-licensure Bachelor of Science in Nursing (BSN) program. Since that time the partnership has broadened to include faculty development, evidence-based practice, interprofessional education, and research initiatives.PurposeThe purpose is to share the outcomes of this academic-practice partnership and to provide a model for other institutions.MethodsThis successful partnership is grounded in the American Association of Colleges of Nursing and the American Organization of Nurse Executives' eight guiding principles for academic-practice partnerships. The cornerstones to the partnership are communication, collaboration, and mutual respect.ResultsThe initial outcomes of this collaboration increased enrollment, thereby increasing the number of BSN prepared registered nurses; created opportunities for clinical nurses to teach; increased the number of nursing faculty; and capitalized on the strengths of each partner.ConclusionThe most exciting aspect of this partnership is the shared commitment to decrease the gap between nursing education and practice; thus, improving the quality of nursing education, advancing the practice of nursing and healthcare delivery, and enhancing the health of our community. Consistent with the AACN-AONE recommendations, this academic-practice partnership prepares nurses of the future to be evidence-based practitioners and creates opportunities for nurses to achieve educational and career advancements.     

Critical action research applied in clinical placement development in aged care facilities

XIAO LD, KELTON M and PATERSON J. Nursing Inquiry 2012; 19 : 322–333
Critical action research applied in clinical placement development in aged care facilities The aim of this study was to develop quality clinical placements in residential aged care facilities for undergraduate nursing students undertaking their nursing practicum topics. The proportion of people aged over 65 years is expected to increase steadily from 13% in 2006 to 26% of the total population in Australia in 2051. However, when demand is increasing for a nursing workforce competent in the care of older people, studies have shown that nursing students generally lack interest in working with older people. The lack of exposure of nursing students to quality clinical placements is one of the key factors contributing to this situation. Critical action research built on a partnership between an Australian university and five aged care organisations was utilised. A theoretical framework informed by Habermas’ communicative action theory was utilised to guide the action research. Multiple research activities were used to support collaborative critical reflection and inform actions throughout the action research. Clinical placements in eight residential aged care facilities were developed to support 179 nursing students across three year‐levels to complete their practicum topics. Findings were presented in three categories described as structures developed to govern clinical placement, learning and teaching in residential aged care facilities.     

Development of a Remote Monitoring Application to Improve Care and Support Patients in the First 30 Days Following Colorectal Cancer Surgery

ObjectiveTo design and develop a digital monitoring application to support and improve the care of patients in the first 30 post-operative days following colorectal cancer surgery.Data SourcesPatient interviews, health professional focus groups, patient co-creation activities, and health professional prioritization discussions.ConclusionThe structured and iterative co-design activities adopted in this study with key stakeholders, including patients and health professionals, lead to the development of a prototype application (app) to support patients at home during the first 30 days following surgery for colorectal cancer. A similar approach could be implemented to develop comparable apps for patients with other cancer diagnoses requiring different surgical procedures. Further research should focus on the continued development and testing of this app in relation to patient care and outcomes as well as the app's affect on nursing and other health services.Implications for Nursing PracticeClinical implementation of remote monitoring following discharge home after surgery for colorectal cancer gives patients the opportunity to report issues of concern to relevant health professionals. This could facilitate the early identification of concerning signs and symptoms, ensuring appropriate and timely interventions to minimize readmission rates. Patients’ experiences during the recovery period could also be improved through the provision of reliable and relevant online information. More specifically, health professionals could easily identify those patients requiring additional support to manage their recovery, for example, those with more severe symptoms or problems, facilitating the direction of appropriate health services to those most in need of their expertise.     

Abstracting pain management documentation from the electronic medical record: comparison of three hospitals

BackgroundPain management science results are derived from research conducted using medical record.ApproachThis article describes methodological issues arising from abstracting pain management documentation (PMD) from the electronic medical record in three hospitals. After approval, PMD data were collected from the patient's history and physical, discharge summary, operative care notes, computerized nursing flow sheets, progress notes, and medication records.ResultsEach acute care facility required a different approach to abstract data. Inconsistent documentation in pain management assessments, interventions, and reassessments were identified across hospitals.DiscussionInconsistencies pose measurement threats and hinder benchmarking efforts. Work to standardize PMD across propriety computer systems is warranted.