Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool

Elder abuse (EA) is common and has devastating health impacts, yet most cases go undetected limiting opportunities to intervene. Older Veterans receiving care in the Veterans Health Administration (VHA) represent a high-risk population for EA. VHA emergency department (ED) visits provide a unique opportunity to identify EA, as assessment for acute injury or illness may be the only time isolated older Veterans leave their home, but most VHA EDs do not have standardized EA assessment protocols. To address this, we assembled an interdisciplinary team of VHA social workers, physicians, nurses, intermediate care technicians (ICTs; former military medics and corpsmen who often conduct screenings in VHA EDs) and both VHA and non-VHA EA subject matter experts to adapt the Elder Mistreatment Screening and Response Tool (EM-SART) to pilot in the Louis Stokes Cleveland VA Medical Center geriatric ED (GED) program. The cornerstone of their approach is an interdisciplinary GED consultation led by ICTs and nurses who screen high-risk older Veterans for geriatric syndromes and unmet needs. The adapted EM-SART was integrated into the electronic health record and GED workflow in December 2020. By July 2022, a total of 251 Veterans were screened with nine (3.6%) positive on the prescreen and five (2%) positive on the comprehensive screen. Based on the first-year pilot experience, the interdisciplinary team was expanded and convened regularly to further adapt the EM-SART for wider use in VHA, including embedding flexibility for both licensed and nonlicensed clinicians to complete the screening tool and tailoring response options to be specific to VHA policy and resources. The national momentum for VHA EDs to improve care for older Veterans and secure GED accreditation offers unique opportunities to embed this evidence-based approach to EA assessment in the largest integrated health system in the United States.     

Nurse staffing and patient outcomes in Veterans Affairs hospitals

OBJECTIVE: To assess characteristics and perceptions of nurses working in the Veterans Health Administration (VHA), comparing types of nursing personnel, to benchmark to prior studies across healthcare systems. BACKGROUND: Prior studies have shown relationships between positive registered nurse (RN) perceptions of the practice environment and patient outcomes. To date, no study has reported the comparison of RN perceptions of the practice environment in hospital nursing with those of non-RN nursing personnel. This study is the first to offer a more comprehensive look at perceptions of practice environment from the full range of the nursing work force and may shed light on issues such as the relationship of skill mix to nurse and patient outcomes. METHODS: Cross-sectional observational study with a mailed survey administered to all nursing personnel in 125 VA Medical Centers between February and June 2003. RESULTS: Compared with other types of nursing personnel in the VHA, RNs are generally less positive about their practice environments. However, compared with RNs in other countries and particularly with other RNs in the United States (Pennsylvania), VHA RNs are generally more positive about their practice environment and express more job satisfaction. CONCLUSIONS: The nursing work force of the VHA has some unique characteristics. The practice environment for nurses in the VHA is relatively positive, and may indicate that the VHA, as a system, provides an environment that is more like magnet hospitals. This is significant for a public sector hospital system.     

建立心理健康护理虚拟学组的实践

建立心理健康护理虚拟学组,明确学组职责,建立标准化的评估、干预体系,开展专业培训及心理健康知识宣传教育,对护理人员、住院患者及家属实施心理护理。通过学组的建设,提高了学组成员的心理护理技能,优化了护士的职业心态,提升了护理服务水平,促进了心理健康护理的规范化发展。     

Certificate programs in continuing professional education

BACKGROUND: Career-long learning is a concept at the heart of professional disciplines such as nursing. Nursing shortages, especially in some areas of practice, have stimulated the need for in-depth education and training in specific knowledge content areas. One approach to career-long learning is certificate programs. METHOD: Factors, trends, and strategies to consider in creating certificate programs are reviewed, and guidelines for developing certificate programs are presented. FINDINGS: Certificate programs are increasingly in demand by both employers and nurses. Certificate programs provide individuals with a chance to refresh their study skills and raise their abilities and levels of confidence for mastering new learning. Certificate programs also serve as a recruitment and retention strategy for hospitals and agencies. CONCLUSION: Certificate programs are a viable continuing professional education activity and offer opportunities for nurses to develop specific skill sets and in-depth knowledge in specialized areas of nursing practice.     

对我国护理学硕士研究生需掌握核心知识的调查与分析

目的初步调查护理学硕士研究生应具备的核心知识,以便根据核心知识组织该专业的基础课程体系。方法采用访谈法对8名护理教育专家、临床管理专家进行个人访谈,对25名学习者分别进行焦点小组访谈。结果受访者认为,护理学硕士研究生的核心知识应涵盖临床护理实践、教育、管理、研究方法及促进专业发展5个领域,护理学硕士教育应避免与其他医学专业研究生课程知识重复。结论护理学硕士研究生的核心知识体系应基于高级护理实践、教育、管理、研究和促进专业发展5个关键学习领域来构建,尽快建立具有专业特色的护理学硕士课程体系。     

Internet-based education for enrolled nurses: could it be e-ffective?

There has been an extraordinary growth of technology-mediated learning in the higher education system over the last 10 years (IHEP 2000, p.1), predominantly in the area of distance education. These technological advances provide exciting opportunities for the delivery of education to those who have not previously been able to access on-campus learning, usually because of barriers of distance and cost. While there are a growing number of studies supporting the implementation of distance education programs in nursing education, the use of Internet-based learning as a sole means of education delivery is relatively new. This paper investigates the current literature available regarding the use of Internet-based education delivery for registered and enrolled nurses in undergraduate and postgraduate programs, and reviews contemporary education trends in Victoria, Australia, for enrolled nurses (ENs). The challenge in nursing education currently is to design curricula that will address the health care needs of the future. This is not easy with the rapidly changing environment health care professionals, especially nurses, face in their daily work. To prepare graduates who can function successfully as professional nurses in this new century, nurse educators must examine the dominant trends in health care and education, and analyse whether the processes used to prepare students for practice will result in the desired outcome (Jorgensen et al 1998, p.109). The current growth and impact of web-based and online learning courses has been proposed by some as a major revolution for education, and has been firmly embraced by many tertiary institutions as the way of the future (Sims 1998, p. 21).     

A new model in teaching undergraduate research: A collaborative approach and learning cooperatives

Forming new, innovative collaborative approaches and cooperative learning methods between universities and hospitals maximize learning for undergraduate nursing students in a research course and provide professional development for nurses on the unit. The purpose of this Collaborative Approach and Learning Cooperatives (CALC) Model is to foster working relations between faculty and hospital administrators, maximize small group learning of undergraduate nursing students, and promote onsite knowledge of evidence based care for unit nurses. A quality improvement study using the CALC Model was implemented in an undergraduate nursing research course at a southern university. Hospital administrators provided a list of clinical concerns based on national performance outcome measures. Undergraduate junior nursing student teams chose a clinical question, gathered evidence from the literature, synthesized results, demonstrated practice application, and developed practice recommendations. The student teams developed posters, which were evaluated by hospital administrators. The administrators selected several posters to display on hospital units for continuing education opportunity.This CALC Model is a systematic, calculated approach and an economically feasible plan to maximize personnel and financial resources to optimize collaboration and cooperative learning. Universities and hospital administrators, nurses, and students benefit from working together and learning from each other.     

Making a difference: the value of preceptorship programs in nursing education

The benefits of clinical nursing experience in nursing education cannot be overemphasized. Literature has shown that proficient clinical nursing education enhances nursing practice through the development of professional growth with opportunities for the application of theoretical knowledge. Clinical preceptorship has been shown to be an effective method in the development of professional nurses through clinical education. The role of a clinical nursing preceptor is complex and not necessarily applicable to all nurses. Understanding the clinical environment, comprehending individual learning styles, and dealing effectively with conflict are skills that an effective preceptor needs to acquire before participating in the role. This article describes the origin of the preceptor role in clinical nursing education and discusses how the role can be enhanced through a proficient and well-planned preceptorship education program.     

Doctoral-prepared nurses in the Veterans Health Administration: A cross-sectional survey

BackgroundDoctoral-prepared nurses with diverse skillsets are required to meet nursing care needs in a complex and changing healthcare environment. A better understanding of the roles of doctoral-prepared nurses in Veterans Health Administration (VHA) workforce will help leverage their expertise to meet the needs of Veterans.PurposeAssess the current roles of doctoral-prepared nurses within the VHA.MethodA cross-sectional survey was used to collect information on doctoral-prepared nurses within the VHA in 2016. Multiple strategies were used to identify doctoral-prepared nurses to recruit for an online survey. Survey invitations were sent electronically to unique individuals identified (N = 2403).ResultsResponses were received from 1015 nurses (42.2% response rate), with 929 nurses with a doctoral degree identified. DNP/DNAP degrees were most common (55%), followed by a PhD or DNS (33%). Significant differences were noted between nurses in different doctoral education categories across four main roles: research, clinical, educational, and administration.ConclusionsThis survey generated the first comprehensive list of VHA doctoral-prepared nurses. Findings are being used by the VHA Office of Nursing Services to align degree types, duties of different positions, functional statements, and position expectations. Results support the continued need for collaboration between nurses with PhDs and DNPs to achieve research and clinical goals.     

The development of nurse practitioners via flexible learning: toward an innovative Masters degree curriculum in Thailand

The changing health system in Thailand has provided Thai people with more equitable opportunities in accessing health care services. As a result of medical practitioner shortages and a strong desire for nurses to expand their scope of practice, the Thailand Nursing and Midwifery Council (TNC) plans to increase the number of nurse practitioners at master degree level to staff primary care units (PCUs) and Health Centres around the country. Nursing master degree curricula in Thailand are currently offered using the traditional on-campus face-to-face mode of delivery and have low numbers of student enrolments. Furthermore, research indicates that many graduate nurses in Thailand are seeking entry to master degree curricula, but accessibility, convenience and availability of curricula locally are limiting enrolments. Nursing education globally is a dynamic and iterative process. Educational curricula are based on the principles of adult learning, continuing professional education and life-long learning, which advocate flexible and learner-oriented education. Flexible learning, which has the ability to closely match the professional and academic needs of the learner, has the potential to lead nursing education toward meeting the TNC policy and health system reform in Thailand. It is essential that nursing education in Thailand be revolutionised, embracing flexible delivery modes by traditional higher education providers. This paper presents a new model of health care service delivery and the mechanism used to integrate the principles of flexible learning into a new master degree curriculum for nurse practitioners (NPs) in Thailand.     

Seven years on: distance learning courses for first level registered nurses and midwives

There is a recognized need to increase the accessibility and flexibility of post-registration course provision for first level registered nurses and midwives. Distance learning courses were developed and implemented at the University of Dundee in response to this need. The courses provide a range of learning opportunities from single module certificate courses to Bachelor, Honours and Masters level studies. The courses are well received by nurses and midwives and experience, over the last 7 years, has highlighted important aspects for distance learning education for both professional groups. Different educational strategies such as Work-based Learning and Problem-based Learning are incorporated into distance learning course design to facilitate the integration of theory and practice and develop cognitive and meta-cognitive skills. The relationship between course assessment and clinical environment is also a key feature of course design, with assessment methods built around work-based learning opportunities in clinical practice. Experience has shown that students require support throughout the learning process. This is achieved through text-based study guides and a range of other support strategies. It is concluded that distance learning can be individualized to meet the professional and personal needs of students and provide quality, flexible learning opportunities for nurses and midwives, facilitating practice development and benefiting patient care.     

Promoting personal safety in community health: four educational strategies

Nurse educators must confront the issue of nursing students' personal safety in community health practice, provide the necessary knowledge and skills, and document their actions. Learning opportunities are required to assist students to recognize and evaluate risks, and prevent their consequences. Thematic analysis of interviews with 56 public health nurses in Alberta, Canada uncovered knowledge, skill, and attitudinal components of risk assessment. Categories under the theme framing personal risk in work environments and the sub-themes framing for action and framing for no action provided a conceptual framework for planning educational strategies. Based on how these nurses framed their personal risk, 4 educational strategies are presented: a checklist, small group learning activities, a template for Web-based courseware, and a problem-based learning scenario.     

When nursing education becomes political: Norm-critical perspectives in a campus-based clinical learning environment

Nursing education is in the process of incorporating critical thinking, social justice, and health inequality perspectives into educational structures, aspiring to help nursing students develop into professional nurses prepared to provide equal care. Norm criticism is a pedagogical philosophy that promotes social justice. This qualitative case study aimed to gain an understanding of and elaborate on an educational development initiative in which norm criticism was incorporated into the composition of a new campus-based clinical learning environment for nursing education. By analyzing documents and interviews with the help of reflexive thematic analysis three themes were generated: “Intention to educate beyond nursing education,” “Educating in alliance with society,” and “The educative ambiguity of the Clinical Learning Centre.” The case study indicates that the incorporation of norm criticism into a campus-based clinical learning environment may encourage nursing students to evolve social skills for nursing practice that support health equality within healthcare. By collaborating with society, nursing education can considerably improve its educational frameworks in alignment with societal demands. However, the inclusion of norm criticism in a setting such as a campus-based clinical learning environment entails a clash with established institutionalized norms and being perceived as too proximate to politics.     

Survey of continuing professional education within nursing homes

This article reports a survey of qualified nurses employed in nursing homes in a large city in the north of England. The aim of the study was to describe nurses' experiences and perceptions of continuing professional education (CPE), and their views on the development of their knowledge and skills through formal and informal education. Findings revealed that nurses in nursing homes perceived the value of educational programmes but had limited opportunities to attend formal education programmes. They faced a number of barriers and challenges in accessing formal education. Various informal ways of learning were used, including reading professional journals, watching videotapes and television programmes and accessing the Internet. However, respondents appeared not to use fully opportunities for sharing knowledge with colleagues. Although this study is based on a small sample, the findings support those of other studies in this field. Collectively, these studies suggest an urgent need to develop a range of approaches to CPE within care homes, both formal and informal, if the standards outlined within recent policy initiatives are to be achieved.     

社区签约护士叙事护理体验的质性研究

目的 了解社区签约护士在运用叙事护理方法为患者实施健康管理过程中,自身护理体验、个人成长收获及职业发展需求,为社区进一步推广叙事护理及人才培养提供依据。 方法 采用现象学研究方法,对北京市2所开展签约服务工作,且由护士对患者实施叙事护理的社区卫生服务中心（站）的13名护士进行半结构式访谈。采用Colaizzi 7步分析法进行资料分析。 结果 开展叙事护理后,社区签约护士在工作体验和感受方面提炼出工作成就感增强、职业价值感凸显、叙事护理模式认同感提升、护患关系亲密感增加4个主题;在个人成长收获方面提炼出学会尊重、懂得理解、关爱彼此、自我赋能4个主题;在未来职业发展需求方面提炼出希望人员配置更合理、渴望更多的专业培训机会、期望更大的护理交流平台3个主题。 结论 通过叙事护理在签约患者中的实施,社区护士职业认同感及自我价值感明显提升。相关机构应给予护士更多学习、培训、交流的机会,以提升护士专业能力,为社区护理事业的发展提供保障。     

Future trends in school health nursing

School health nursing is one of the "frontline" professional community nursing services. School nurses need both theoretical professional knowledge and practical skills. The tasks of school nurses are becoming increasingly important due to the changing social environment, changes in disease patterns, decreasing birth rates, and the increasing demands of today's customers. But the field of school health nursing enjoys a certain independence. In line with society's demands, the essential trend in school health nursing is specialization. Planned and well-arranged pre-service education is required to develop programs for school nurse specialists, and, more importantly, we need to return to the advancement system. Nurses working at schools need plenty of clinical, practical experience, ideally having completed in-service education at N3 level in a medical institution, so that they can bring their professional competence into play, and satisfy the demands of their work. In this way, the nurses work in medical institutions will still have opportunities to contribute their skills when they are elderly. This is a constructive and positive development for the nursing profession.     

Integration of research and nursing experiential learning: a case study

Teaching research to undergraduates has it own challenges and involving undergraduates in research practical experience is just one of those challenges. As nursing students are in the process of becoming professional nurses, knowledge and skills in research are specific outcomes of the curriculum. One of the outcomes of the B Tech Nursing Science programme offered by the Tshwane University of Technology states that for the baccalaureate nursing programme include analysis, interpretation and utilisation of a range of research findings in scientific nursing and midwifery care as well as the development of a research protocol in a given context. In an effort to ensure that students would experience research as an essential part of their daily activities, an integrated approach is suggested whereby the nursing experiential learning opportunities are also research experiential learning opportunities. Using the integration strategy, research theory come 'alive' for the students. The integration approach is uncomplicated and transferable to any other discipline. The case study presented is the second year nursing students using school nursing experiential learning as a research project. The second year nursing students have a community focus during their second year and one of the experiential learning opportunities is school health nursing in a primary school in Tshwane. The results of the school health survey are presented. The students developed a health education intervention based on the research results.     

学习障碍护理研究进展及启示

英国学习障碍护理距今已有一百多年的历史,在其发展过程中经历了许多困难和革新,同时也积累了丰富的经验。该文主要对英国学习障碍护理的发展概况、护士角色职责和工作内容、人才培养和管理制度、面临的挑战及其应对进行介绍,并提出中国学习障碍护理发展的建议,旨在为护理服务模式的创新及护理服务体系的完善提供新视角,为护士引领健康服务提供借鉴。     

Inpatient mortality of hip fracture patients in the Veterans Health Administration.

Hip fractures among elderly people frequently result in permanent disabilities, nursing home placement, and death. The bulk of hip fracture research focuses on elderly women. Within the Veterans Health Administration (VHA), the majority of patients are men. There are no published national reports on hip fractures with large male samples, or on related inpatient mortality among veterans. This retrospective study of 13,546 veterans with hip fracture discharges from 1998-2002 found unadjusted mortality rates are higher in the VHA, compared with the general population. VHA patients tend to be older men in poor health who stay in the hospital longer Increased knowledge about the risks and outcomes associated with hip fractures in men could lead to improved primary and secondary injury-prevention programs. Rehabilitation nurses in acute care can be catalysts in proactively incorporating protective devices, screening for osteoporosis, and initiating lifestyle changes in their plans of care to optimize outcomes for hip fracture patients.