High fidelity tracheostomy simulation quality improvement project

PurposeTo increase NICU RNs confidence and performance ability with obstruction and decannulation of a mature and fresh tracheostomy through an effective high-fidelity simulation and education project.DesignPre and post intervention confidence surveys were given and compared, initial and final simulations performance ability scores were obtained and compared, and a simulation effectiveness survey was given following the intervention.SampleNeonatal Intensive Care Unit staff nurses at The University of Chicago Comer Children's Hospital.Main outcome variablesIncreased RN confidence and performance and an effective simulation training.ResultsRN C-Scale confidence mean scores increased from 16.15 to 22.23 with a z-test of −8.95 and a p value of <0.05 showing statistical significance. RN simulation performance scores on the Creighton Competency Evaluation Instrument increased from 8.47 to 17.47 with a z score of −24.03 and a p value of <0.5. Simulation design survey score mean of 97.9 out of 100.     

Promoting independence: the nurse as coach

The government's modernization agenda strives to place the patient at the centre of healthcare services. Coaching techniques can be used to develop the skills of both patients and nurses. This article discusses the use of a coaching model to help patients make informed choices and take ownership of their health, while receiving healthcare support.     

Best practices for improving intervention fidelity that every nurse should know

Column Editor: Lauren Clark Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.     

Onboarding orientation for novice nurse faculty: A quality improvement pilot project

BackgroundNovice nurse faculty have a challenging time transitioning into academia, resulting in reduced satisfaction and retention. After conducting a thorough literature review, it was determined that formalized mentoring combined with professional development workshops could improve the transition into academia, thus improving the satisfaction and retention of novice nurse faculty.MethodsIn fall 2020, an onboarding orientation program for novice nurse faculty was implemented. The objectives included matching mentoring dyads based on similar interests and goals, developing mentoring guidelines, implementing the Department of Nursing (DON) Orientation Checklist, and providing five monthly professional development workshops with topics ranging from creating learning objectives to the promotion and tenure requirements. Five novice nurse faculty participated in the study, and each was matched with a mentor with similar goals.ResultsAfter 6 months of project implementation, overall faculty satisfaction dropped slightly from 4.1 to 4.0. A dependent t-test (p = 0.83) and Wilcoxon signed ranks test (p = 0.461) both indicated no significant difference in satisfaction post project implementation. Although, the results indicate the novice nurse faculty and mentors agreed that the program was effective and should continue. The novice nurse faculty reported that the DON Orientation Checklist, mentoring relationships, and professional development workshops contributed to their successful transition into academia. Retention was 100% 2 years after project implementation. One significant factor noted after program evaluation was conducted is that there should be regular meetings with mentors to support them in their role.ConclusionsThe onboarding orientation program for novice nurse faculty was an effective strategy to ease the transition into academia and maintain satisfaction within the role.     

Promoting nurse interventionist fidelity to motivational interviewing in a diabetes self-care intervention

We describe interventionist training procedures for a pilot intervention study that tested the effects of a nurse-delivered Motivational Interviewing (MI) intervention on diabetes self-care among adults diagnosed with type 2 diabetes mellitus. It reports on findings from MI fidelity assessments. Training consisted of didactic workshops plus practicum. Fidelity of MI was assessed using the MI Treatment Integrity (MITI) Scale. Fidelity assessments were conducted on 18 (25%) audiotaped MI sessions, which were randomly selected from a total of 72 sessions with 26 participants. Scores of the MITI were in the proficient and competent range. Results suggest that training strategies were sufficient to promote satisfactory interventionist fidelity to MI.     

Measuring treatment fidelity in a rehabilitation intervention study

Attaining and demonstrating treatment fidelity is critical in the development and testing of evidence-based interventions. Treatment fidelity refers to the extent to which an intervention was implemented in clinical testing as it was conceptualized and is clearly differentiable from control or standard-of-care interventions. In clinical research, treatment fidelity is typically attained through intensive training and supervision techniques and demonstrated by measuring therapist adherence and competence to the protocol using external raters. However, in occupational and physical therapy outcomes research, treatment fidelity methods have not been used, which, in our view, is a serious gap that impedes novel treatment development and testing in these rehabilitation fields. In this article, we describe the development of methods to train and supervise therapists to attain adequate treatment fidelity in a treatment development project involving a novel occupational and physical therapy-based intervention. We also present a data-driven model for demonstrating therapist adherence and competence in the new treatment and its differentiation from standard of care. In doing so, we provide an approach that rehabilitation researchers can use to address treatment fidelity in occupational and physical therapy-based interventions. We recommend that all treatment researchers in rehabilitation disciplines use these or similar methods as a vital step in the development and testing of evidence-based rehabilitation interventions.     

Assessing treatment fidelity in pilot studies assist in designing clinical trials: an illustration from a nurse practitioner community-based intervention for pain

Treatment fidelity refers to the degree to which treatment is administered as intended, and it is key to interpreting and translating research into practice. As an illustration, we report the benefits of examining treatment fidelity in a pilot study of nurse practitioner-delivered Coping Skills Training for chronic pain. Analysis revealed both strengths and weaknesses of protocol design and treatment delivery. This pilot work formed the basis for subsequently modifying the design of a large-scale clinical trial. Monitoring treatment fidelity throughout the pilot and trial phases of research can dramatically improve the research enterprise and facilitate successful dissemination.     

Outcomes of same day discharge after percutaneous coronary intervention: A quality improvement project

BackgroundLiterature about how same day discharge following percutaneous coronary intervention influences patient and organisational outcomes, especially length of stay and outpatient cardiac rehabilitation attendance, is limited.AimThe study aimed to evaluate patient and organisational outcomes after implementing same day discharge in one Australian tertiary hospital.MethodsAn uncontrolled before and after study design was adopted. Data on patient and organisational outcomes from patients who underwent percutaneous coronary intervention 6 months in the pre-implementation (n = 66) and 6 months in the post-implementation periods (n = 82) were compared. In the post-implementation period, subgroups of same day discharge patients (n = 19) and overnight stay patients (n = 63) were compared for the same outcome data.ResultsWhen comparing overnight stay, same day discharge contributed to reduced length of stay (21 hours) and cost-savings ($2,546) per patient, which were statistically significant. However, the low implementation rate (23.2%) meant that the length of stay and healthcare costs were similar in the pre- and post-implementation groups. Although non-statistically significant, same day discharge patients had a higher rate of outpatient cardiac rehabilitation attendance than overnight stay patients. Post-procedure complications or readmissions were similar between the groups.Discussion and conclusionWhile same day discharge resulted in reduced length of stay and healthcare costs, more patients must be discharged the same day before a meaningful impact on healthcare delivery will be realised. Encouragingly, a higher proportion of same day discharge patients attended outpatient cardiac rehabilitation than overnight stay patients. More research is warranted to investigate further how same day discharge impacts on outpatient cardiac rehabilitation attendance.     

Initial implementation and evaluation of a Hepatitis C treatment clinical decision support system (CDSS): A nurse practitioner-driven quality improvement initiative

Background

Clinician compliance with clinical guidelines in the treatment of patients with Hepatitis C (HCV) has been reported to be as low as 18.5%. Treatment is complex and patient compliance is often inconsistent thus, active clinician surveillance and support is essential to successful outcomes. A clinical decision support system (CDSS) embedded within an electronic health record can provide reminders, summarize key data, and facilitate coordination of care. To date, the literature is bereft of information describing the implementation and evaluation of a CDSS to support HCV treatment.

Objective

The purpose of this case report is to describe the design, implementation, and initial evaluation of an HCV-specific CDSS while piloting data collection metrics and methods to be used in a larger study across multiple practices.

Methods

The case report describes the design and implementation processes with preliminary reporting on impact of the CDSS on quality indicator completion by comparing the pre-CDSS group to the post-CDSS group.

Results

The CDSS was successfully designed and implemented using an iterative, collaborative process. Pilot testing of the clinical outcomes of the CDSS revealed high rates of quality indicator completion in both the pre- and post-CDSS; although the post-CDSS group received a higher frequency of reminders (4.25 per patient) than the pre-CDSS group (.25 per patient).

Conclusions

This case report documents the processes used to successfully design and implement an HCV CDSS. While the small sample size precludes generalizability of findings, results did positively demonstrate the feasibility of comparing quality indicator completion rates pre-CDSS and post-CDSS. It is recommended that future studies include a larger sample size across multiple providers with expanded outcomes measures related to patient outcomes, staff satisfaction with the CDSS, and time studies to evaluate efficiency and cost effectiveness of the CDSS.     

精神病院年轻护士素质提高行动的实践及成效

目的：探讨江苏省“年轻护士索质提高行动”在精神病院的实践效果,以改进培训工作,提高培训效果。方法：根据省厅的活动方案结合我院实际情况制定了哉院的“年轻护士素质提高行动”的实施方案,录用自制调查表,对实施前后68名年轻护士的临床工作能力进行自评调查,对实施前后的理论及操作成绩进行统计学分析。结果：68名年轻护士培训前后临床工作能力自评量表得分比较有统计学意义（P〈0．05）;理论、操作考试成绩比较有统计学意义（P〈0．05）;自评专业核心能力得分比较有统计学意义（P〈0．05）。结论：江苏省“年轻护士素质提高行动”可有效提高护士的理论、操作及沟通水平,使其尽快适应临床护理工作的需要。     

Better together: Faculty development for quality improvement in the nurse educator role

The purpose of this article is to describe the lessons learned about the challenges and benefits of using online modules to enhance the skills of novice and experienced nurse educators. Some faculty chose a self-paced experience, and some chose a group experience with discussion to complete the modules. The discussions turned out to be a very important component of the program, and future initiatives will build on this serendipitous outcome.     

提高临床实习护生带教质量的研究进展

临床实习是护生从课堂走向社会的第一步,也是培养良好职业道德、敬业精神和职业认同感的关键时期。如何提高临床教学质量,引导护生走好第一步,为今后从事临床护理工作打下坚实的基础,是护理管理者及临床带教老师应关心的问题。近年来,国内学者对此进行了深入研究,现综述如下。     

Prevention and reduction of involuntary treatment at home: A feasibility study of the PRITAH intervention

Sometimes care is provided to a cognitively impaired person against the person's will, referred to as involuntary treatment. We developed the PRITAH intervention, aimed at prevention and reduction of involuntary treatment at home. PRITAH consists of a policy discouraging involuntary treatment, workshops, coaching by a specialized nurse and alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy.