The association between the practice environment and selected nurse educator outcomes in public nursing education institutions: A cross-sectional study

AimThe purpose of this study is to describe the association between the practice environment and nurse educator outcomes (burnout, engagement, incivility, job satisfaction and intention to leave) in public nursing education institutions in the Gauteng province of South Africa.BackgroundThe practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse workforce; however, the association between the practice environment and nurse educator outcomes has been relatively unexplored.DesignCross-sectional design.MethodsThe Gauteng province was purposively selected, as it has the highest number of public nursing education institutions in South Africa. All-inclusive sampling was applied to public nursing educations institutions in Gauteng province (N = 6) and then to Heads of Department (N = 30; n = 17) and nurse educators (senior lecturers [N = 162; n = 45] and lecturers [N = 257; n = 80]). Data were collected during March to November 2018. The data were collected using the Practice Environment Scale of the Nursing Work Index; Maslach Burnout Inventory - Educators Survey; Utrecht Work Engagement Scale (UWES); Incivility in Nursing Education-Revised (INE-R); job satisfaction and Propensity to Leave Scale.ResultsThe results show that nurse educators are an aging population, with limited numbers having master’s and doctoral qualifications. The most job dissatisfaction is regarding wages (M=2.0; SD 1.07); appreciation, recognition and rewards for good work (M=2.1; SD 1.01); and opportunities for advancement (M=2.2; SD 1.01). The nurse educators do not experience their public nursing education institutions as having a positive practice environment. Nurse educators experienced high levels of work engagement, moderate levels of burnout and low levels of incivility, that were highly correlated with the subscale of foundations of quality outcomes. They experienced moderate levels of job satisfaction but did not intend to leave their places of employment, which was highly correlated with the subscale of manager’s ability, leadership and support.ConclusionsA positive practice environment improves nurse educator outcomes. The subscale of foundations of quality outcomes and manager’s ability, leadership and support had the most impact on nurse educator outcomes, thus quality teaching practices should be cultivated and recognised; and managers must have the necessary skill and knowledge to lead effectively, while also including nurse educators in decisions that impact them and involving them in the affairs of the nursing education institution. There is a shortage of qualified nurse educators globally and in South Africa and urgent attention must be given to factors that influence the recruitment and retention of nurse educators.Twitter abstractThe practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse educator workforce, especially regarding foundations of quality outcomes and manager’s ability, leadership and support.     

Effectiveness and safety of droperidol in a United States emergency department

BackgroundDroperidol is a dopamine receptor antagonist that functions as an analgesic, sedative, and antiemetic. In 2001, the U.S. Food and Drug Administration required a black box warning in response to case reports of QT prolongation and potential fatal arrhythmias. The aim of this study was to evaluate the effectiveness and safety of droperidol in patients presenting to a United States Emergency Department (ED).MethodsObservational cohort study of all droperidol administrations from 1/1/2012 through 4/19/2018 at an academic ED. The primary endpoint was mortality within 24 h of droperidol administration. Secondary endpoint included use of rescue analgesics.ResultsA total of 6,881 visits by 5,784 patients received droperidol of whom 6,353 visits authorized use of their records for research, including 5.4% administrations in children and 8.2% in older adults (≥65). Droperidol was used as an analgesic for pain (N = 1,387, 21.8%) and headache (N = 3,622, 57.0%), as a sedative (N = 550, 8.7%), and as an antiemetic (N = 794, 12.5%). No deaths secondary to droperidol administration were recorded within 24 h. Need for rescue analgesia occurred in 5.2% of patients with headache (N = 188) and 7.4% of patients with pain (N = 102); 1.1% of patients with headache received rescue opioids (N = 38) after droperidol, as did 5.4% of patients with pain other than headache (N = 75). No patients had fatal arrhythmias. Akathisia occurred in 2.9%.ConclusionNo fatalities were seen among this large cohort of patients who received droperidol in the ED. Our findings suggest droperidol's effectiveness and safety when used as an analgesic, antiemetic and/or sedative.     

Perceived barriers to early goal-directed mobility in the intensive care unit: Results of a quality improvement evaluation

BackgroundA multicentre randomised trial demonstrated improved outcomes for intensive care unit (ICU) patients using early, goal-directed mobility implemented by nurses.ObjectivesThe aim of the study was to evaluate barriers to nursing mobility, using a validated survey, during an ongoing quality improvement (QI) project (2019) in a medical ICU and determine changes from the pre-QI (2017) baseline.MethodsNurses, nurse practitioners, physician assistants, and clinical technicians completed the 26-item Patient Mobilization Attitudes and Beliefs Survey for the ICU (PMABS-ICU). An overall score and three subscale scores (knowledge, attitudes, behaviour), each ranging from 0 to 100, were calculated; higher scores indicated greater barriers.ResultsSeventy-five (93% response rate) nurses, eight (100%) nurse practitioners and physician assistants, and 11 (100%) clinical technicians completed the PMABS-ICU. For all respondents (N = 94), the mean (standard deviation) overall PMABS-ICU score was 32 (8) and the knowledge, attitudes and behaviour subscale scores were 22 (11), 33 (11), and 34 (8), respectively. Among all respondents completing the survey in both 2017 and 2019 (N = 46), there was improvement in the mean (95% confidence interval) overall score [?3.1 (?5.8, ?0.5); p = .022] and in the knowledge [?5.1 (?8.9, ?1.3); p = .010] and attitudes [?3.9 (?7.3, ?0.6); p = .023] subscale scores. Among all respondents (N = 48) taking the PMABS-ICU for the first time in 2019 compared with those taking the survey before the QI project in 2017 (N = 99), there was improvement in the mean (95% confidence interval) overall score [?3.8 (?6.5, ?1.1); p = .007] and in the knowledge [?6.9 (?11.0, –2.7); p = .001] and attitude [?4.3 (?8.1, –0.5); p = .027] subscale scores.ConclusionsUsing a validated survey administered to ICU nurses and other staff, before and during a structured QI project, there was a decrease in perceived barriers to mobility. Reduced barriers among those taking the survey for the first time during the QI project compared with those taking the survey before the QI project suggests a positive culture change supporting early, goal-directed mobility implemented by nurses.     

Comparative Efficacy and Safety of Fostemsavir in Heavily Treatment-Experienced People With HIV-1

PurposeHeavily treatment-experienced (HTE) people with multidrug-resistant HIV-1 have limited treatment options. Treatment with the first-in-class attachment inhibitor fostemsavir in addition to optimized background therapy (OBT) resulted in sustained virologic and immunologic responses in HTE participants throughout 96 weeks in the BRIGHTE trial. In the absence of long-term direct comparative evidence between fostemsavir-based and other antiretroviral regimens, this analysis indirectly compares efficacy and safety across relevant available trials, adjusting for demographic and baseline characteristics.MethodsA systematic literature review was conducted to identify trials with designs and populations comparable to BRIGHTE. Using matching-adjusted indirect comparison analyses, individual participant data from BRIGHTE were reweighted to create balanced populations across trials, and efficacy and safety outcomes were compared.FindingsThree comparator trials were identified, 2 of which reflected an optimized therapy without fostemsavir (OBT alone): TMB-301 (ibalizumab and OBT), BENCHMRK-1/-2 (OBT alone), and VIKING-3 (OBT alone). Compared with ibalizumab and OBT (N = 40), fostemsavir and OBT (unadjusted, N = 347; adjusted, N = 236) were associated with numerically higher nonsignificant odds of virologic suppression (odds ratio [OR] = 1.44; 95% CI, 0.74–2.80; P = 0.284) and a similar increase in CD4⁺ cell count of approximately 65 cells/mm³ from baseline through week 24 (mean difference = 7.05 cells/mm³; 95% CI, ?60.88 to 74.98 cells/mm³; P = 0.834). Compared with OBT from BENCHMRK-1/-2 (N = 237), fostemsavir and OBT (adjusted, N = 126) were associated with significantly higher odds of virologic suppression (OR = 3.26; 95% CI, 2.08–5.11; P < 0.001) and increased CD4⁺ cell count (135.78 cells/mm³; 95% CI, 91.93–179.63 cells/mm³; P < 0.001) at week 96. Compared with OBT from VIKING-3 (N = 183), fostemsavir and OBT (adjusted, N = 78) were associated with numerically higher odds of virologic suppression (OR = 1.34; 95% CI, 0.78–2.30; P = 0.297) and a modest CD4⁺ cell count increase (26.86 cells/mm³; 95% CI, ?10.79 to 64.52; P = 0.162) through week 48; however, differences were not significant. All-cause discontinuations and safety comparisons varied across studies.ImplicationsAlthough matching-adjusted indirect comparison analyses have limitations, these results support the use of fostemsavir and OBT as an important treatment option in HTE people with multidrug-resistant HIV-1.     

A comparison in independent nurse prescribing and patient group directions by nurse practitioners in the emergency department: A cross sectional review

AimTo explore nurse prescribing in an emergency department using patient group directions versus independent nurse prescribing.BackgroundPatient group directions allow restricted access to medication in unselected patients using pre-set criteria. Independent nurse prescribing is a flexible method of medication provision. Limited data exists on the application of either method in clinical practice.MethodsExploration of patient group directions and independent nurse prescribing application in an emergency department using 617 nurse practitioners’ clinical notes; 235 and 382 respectively. Patient attendances from 01/07/2009 to 30/06/2010 were randomly sampled. Prescribing frequency; range of medications and diagnoses; independent episode completion and prescribing safety was explored.ResultsStatistical difference exists in prescribing frequency between the independent nurse prescribers (51.6%, n = 197) and patient group directions (32.3%, n = 76). Appropriate medication given by 99.7% (n = 381) of independent nurse prescribers, with 1 contraindicated drug provided. The limitations of patient group directions was highlighted in 11.8% (n = 9) of cases, however all drugs given were appropriate for the diagnosis. No statistical difference in independent episode completion.ConclusionsNurses provide appropriate medication in an emergency department. Patients being managed by nurse prescribers were more likely to receive medication. Further investigation is required to justify this.     

Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce

BackgroundMultiple professional organizations and institutes recommend the Bachelor of Science in Nursing (BSN) degree as a minimum standard for registered nurse practice. Achieving this standard may be particularly challenging in rural areas, which tend to be more economically disadvantaged and have fewer opportunities for higher educational attainment compared to urban areas.PurposeOur primary objective was to provide updated information on rural-urban differences in educational attainment. We also examined rural-urban differences in employment type, salary, and demographics among registered nurses in different practice settings.MethodsData were obtained from the 2011–2015 American Community Survey (ACS) Public Use Microdata Sample (PUMS). The sample included registered nurses (RN) between the ages of 18–64 years (n = 34,104) from all 50 states. Chi-square tests, t-tests, and multivariable logistic regression were used to examine the relationship between rurality and BSN preparedness and salary across practice settings.ResultsUrban nurses were more likely to have a BSN degree than rural nurses (57.9% versus 46.1%, respectively; p < 0.0001), and BSN preparedness varied by state. In adjusted analysis, factors in addition to residence associated with BSN preparation included age, race, and region of the country. Differences in wages were experienced by nurses across practice settings with urban nurses generally earning significantly higher salaries across practice settings (p < 0.0001).ConclusionsStrategies to advance nursing workforce education are needed in rural areas and may contribute to improved care quality and health outcomes.     

Impact of a nurse-led family support intervention on family members' satisfaction with intensive care and psychological wellbeing: A mixed-methods evaluation

BackgroundFamilies of critically ill persons face uncertainty and experience distress during and after their close other's stay in an intensive care unit (ICU). Proactive nurse engagement and support is recommended to meet families' needs in the ICU, but little is known about its impact on quality of family care. We introduced a family support intervention that consisted of an interprofessional family support pathway and a new role of an advanced practice family nurse.ObjectivesThe aim of the study was to examine the effect of an advanced practice nurse–led family support intervention on family members' satisfaction, wellbeing, and psychological distress.MethodsWe conducted a quasi-experimental before-and-after study with embedded qualitative interviews in a Swiss University Hospital from March 2018 to July 2019 using a questionnaire (Family Satisfaction in the ICU-24 Survey, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised-6) and qualitative interviews (n = 19) after patient discharge.ResultsFamilies in the intervention group (n = 75) showed a trend for increased overall satisfaction (difference of 5.544, 95% confidence interval [CI]: −0.11 to 11.20), a statistically significant increase in satisfaction with decision-making (7.258, 95% CI: 0.89 to 13.63), and a nonsignificant increase in satisfaction with care (4.178, 95% CI: −1.53 to 9.89). Psychological distress was higher in the intervention group, with depression reaching statistical significance (difference of 1.706, 95% CI: 0.16 to 3.25), which may be explained by longer ICU stays and higher proportion of deaths in the intervention group. Families receiving the intervention reported to be feeling cared for, well informed, and better able to cope. Data integration suggests that early onset, fit to need, and quality of intervention were the most important intervention characteristics impacting family wellbeing.ConclusionsOur study found that family members experience a nurse-led support intervention as beneficial for their wellbeing. It increased their satisfaction, but was unable to demonstrate a favourable impact on psychological distress.     

Burnout and the Sexual Assault Nurse Examiner: Who Is Experiencing Burnout and Why?

IntroductionA sexual assault nurse examiner role exemplifies the high-stress and highly emotional patient interactions that are often associated with burnout. The purpose of this study was to examine the frequency of burnout among sexual assault nurse examiners in North Carolina.MethodsThis cross-sectional study was an anonymous survey of practicing sexual assault nurse examiners within North Carolina using the Maslach Burnout Inventory and additional demographics. Results were analyzed with odds ratios, confidence intervals, Fisher exact, chi-square, and Kruskal Wallis tests as appropriate.ResultsAmong 95 respondents, burnout was more frequent in sexual assault nurse examiners who stopped both emergency and nurse examiner work (55.6%, odds ratio 4.41, 95% confidence interval 1.07-18.06) and in dual function nurses (both emergency and nurse examiner work, 35.7%, odds ratio 2.71, 95% confidence interval 1.04-7.06). Sexual assault nurse examiners who had a high percentage of pediatric cases (above the median of 40%) were more likely to meet burnout thresholds for emotional exhaustion scores > 26 (48.78% vs 25.93%, χ² = 5.30, P = .02) and more likely to meet burnout thresholds for depersonalization scores > 9 (48.78% vs 24.07%, χ² = 6.28, P = .01).DiscussionHigher frequency of burnout threshold criteria was found in those people who worked concurrently as a sexual assault nurse examiner and an emergency nurse and in those who had retired from both specialties. We also found that sexual assault nurse examiners with a higher case mix of pediatric cases had higher emotional exhaustion scores and higher depersonalization scores.     

Population health as a ‘platform’ for nurse education: A qualitative study of nursing leaders

BackgroundChallenges to the sustainability of global healthcare systems are prompting a shift towards more population-focused models of care. Nurse educators need to develop courses that prepare students for population health practice. However, the educational approaches that can support this shift are poorly understood. Publication of new standards for nurse education by the United Kingdom's (UK) Nursing and Midwifery Council that place greater emphasis on population health presented an opportunity to seek nursing leaders' views on population health in nurse education.ObjectivesTo assess the views of nursing leaders within a Scottish context on the connection between nurse education and population health for all students, evaluate what student nurses need to know to support population health practice, and draw insights from the UK for pre-registration programmes internationally.DesignQualitative interview study.ParticipantsTwenty-four nursing leaders from academic (n = 15), practice (n = 4) and regulatory (n = 5) sectors.MethodsSemi-structured interviews were conducted face-to-face (n = 21), by telephone (n = 2) or Skype (n = 1). Interviews were transcribed and analysed, using interview questions as structural themes, followed by thematic and content analyses.ResultsNursing leaders encouraged rebalancing nurse education towards population health, suggesting that population health concepts should sit at the core of spiral curricula to enable students to (re)view learning through a population health lens. Seven outcomes were identified to equip student nurses for practice in any setting. These formed the mnemonic FULCRUM: Find and interpret evidence; Understand the psychology of behavior and change; Link epidemiology to population health; Consider others and themselves in context; Recognise social determinants of health; Understand the impact of policy and politics on health; Motivate to encourage behaviour change.ConclusionsFULCRUM can guide nurse educators globally to support preparation of graduate nurses for the significant shifts in healthcare delivery and service organisation towards improving population outcomes.     

Characteristics,work environments,and rates of burnout and job dissatisfaction among registered nurses in primary care

BackgroundAlthough more people than ever are seeking primary care, the ratio of primary care providers to the population continues to rapidly decline. As such, registered nurses (RNs) are taking on increasingly central roles in primary care delivery. Yet little is known about their characteristics, their work environments, and the extent to which they experience poor job outcomes such as nurse burnout.PurposeThe purpose of this study was to examine the characteristics of the primary care RN workforce and analyze the association of the nurse work environment with job outcomes in primary care.MethodsCross-sectional analysis of survey data representing N = 463 RNs who worked in 398 primary care practices, including primary care offices, community clinics, retail/urgent care clinics, and nurse-managed clinics. Survey questions included measures of the nurse work environment and levels of burnout, job dissatisfaction, and intent to leave.DiscussionApproximately one-third of primary care RNs were burnt out and dissatisfied with their jobs, with the highest risk of these outcomes among RNs in community clinics. Community clinic RNs were also significantly more likely to be Black or Hispanic/Latino, hold a Bachelor of Science in Nursing, and speak English as a second language (all p < .01). Across all settings, better nurse work environments were significantly associated with lower levels of burnout and job dissatisfaction (both p < .01).ConclusionPrimary care practices must be equipped to support their RN workforce. Adequate nursing resources are especially needed in community clinics, as patients receiving primary care in these settings frequently face structural inequities.     

Lateral epicondylitis: Are we missing out on radial nerve involvement? A cross-sectional study

IntroductionLateral epicondylitis (LE) is a common ailment causing pain and functional limitations. There is an inadequate understanding of its etiopathogenesis. Involvement of the radial nerve (RN) as the primary causative factor for this condition remains debatable. The aim of the present study was to assess the RN thickness in patients with LE and compare it with the unaffected side.MethodsThe study included seventy eligible patients (M:F, 22:48) in the age group of 30–60 years with a clinical diagnosis of LE. The cross-sectional area of RN was measured at the spiral groove (SG) and around the antecubital fossa (AF) using ultrasound and compared with the unaffected side. Numeric Pain Rating Scale (NPRS) and the QuickDASH scale were used to assess pain and functional impairment.ResultsThickness of RN at the AF (p = 0.026) and the SG (p = 0.0117) on the affected were statistically significant compared to the unaffected side in the cohort comprising of all the 70 patients. Out of 70 patients, increased thickness was seen in 23 at the SG and 19 at the AF. QuickDASH was statistically significant in patients who had thickened nerves compared to the unaffected side at the SG (p = 0.04) but not at the AF (p = 0.16). NPRS was not statistically significant at either the AF (p = 0.34) or the SG (p = 0.71) in patients with thickened nerves.ConclusionTennis elbow needs to be no longer acknowledged only as tendinopathy. It also requires consideration of the involvement of the RN.     

Pilot study of Qigong/Tai Chi Easy acute effects of meditative movement,breath focus and “flow” on blood pressure,mood and oxytocin in older adults

BackgroundOlder adults are increasingly lonely and at risk for hypertension. Endogenous oxytocin levels are associated with lowering blood pressure (BP), suggesting value in increasing oxytocin. Regular practice of Tai Chi improves BP and mood; we explored a single session of Tai Chi Easy (TCE) with older adults and feasibility of measuring oxytocin as a key biomarker.MethodIn a single-arm pre-post design pilot study, 21 older adults (age 55–80) with mild-moderate hypertension practiced a single session (50-min) TCE. BP, psychosocial measures, and saliva samples were collected pre/post to examine feasibility of acute measures of oxytocin and explore effect sizes of outcomes. Participants (N = 21; 19 % Latinx, 76.2 % female, mean age 66.76).ResultsBP systolic: 138.43–134.86; diastolic 78.48–78.00 (p > .05; Cohen’s d −0.23; −0.08 respectively). Total Mood Disturbance (TMD) and Connection (CN) improved [TMD mean pre 41.891 (SD=19.60) to post 35.00 (SD=10.21), p = .01; Cohen’s d − 0.67); CN mean 7.85 (SD=2.01) to post 9.05 (SD=1.00), p = .01; Cohen’s d 0.70]. Baseline oxytocin was positively correlated with baseline loneliness (N = 14, r = .599); pre/post oxytocin changes were negatively correlated with baseline loneliness (N = 14, r = −.585). BP decrease was associated with characteristics of the intervention: “flow” (coef=.=0.58N = 17) and meditative/breath focus (coef=−1.78; N = 17).Discussion/ConclusionMedium to large effect sizes indicating change in mood and connection were found for this single session intervention. Knowing that Tai Chi improves BP when practiced over time, this TCE intervention shows promise for planning a fully powered, randomized controlled study of BP, mood and perceptions of connection in hypertensive older adults. Feasibility of assessing acute salivary oxytocin is less promising. Increase in oxytocin levels occurred for those less lonely, but declined for lonelier participants. With different responses based on baseline loneliness scores, no mean change in oxytocin levels was found. Seemingly unstable levels (possibly related to interaction with study staff) suggests the need for further testing in more controlled study designs. Finally, BP associations with meditative/breath focus and flow could be further explored in future study designs addressing mediation.     

Promoting respectful maternal and newborn care using the Dignity game: A quasi-experimental study

AimThis study assessed a) the impact of playing the Dignity board game on participants’ understanding of respectful maternal and newborn care and b) participants’ perceptions of how the game influenced their subsequent practice in Malawi and Zambia.BackgroundNurse-midwives’ poor understanding of respectful maternal and newborn care can lead to substandard practice; thus, effective education is pivotal. Used in several disciplines, game-based learning can facilitate skills acquisition and retention of knowledge.Designa quasi-experimental study, using mixed-methods of data collection.MethodsData were collected between January and November 2020. Nurse-midwives (N = 122) and students (N = 115) were recruited from public hospitals and nursing schools.Completion of paper-based questionnaires, before and after game-playing, assessed knowledge of respectful care principles and perceptions around behaviours and practice. Face-to-face interviews (n = 18) explored perceived impact of engaging with the game in clinical practice. Paired and unpaired t-test were used to compare scores. Qualitative data were analysed and reported thematically.ResultsThe study was completed by 215 (90.7 %) participants. Post-test scores improved significantly for both groups combined; from 25.91 (SD 3.73) pre-test to 28.07 (SD 3.46) post-test (paired t = 8.67, 95 % confidence interval 1.67–2.65), indicating an increased knowledge of respectful care principles. Nurse-midwives performed better than students, both before and after. In Malawi, the COVID pandemic prevented a third of nurse-midwives’ from completing post-game questionnaires. Qualitative findings indicate the game functioned as a refresher course and helped nurse-midwives to translate principles of respectful care into practice. It was also useful for self-reflection.ConclusionsThe Dignity board game has the potential to enhance understanding and practice of respectful maternal and newborn care principles in low-resource settings. Integration into nursing and midwifery curricula and in-service training for students and healthcare workers should be considered.     

The use of family nurse practitioners and pediatric nurse practitioners as providers of neonatal intensive care: Safe practice or risky business?

Neonatal nurse practitioners (NNPs) have shown their worth as caregivers in the neonatal intensive care unit. Changes in the health care system, including increasingly complex technology, census growth, decreasing support for residency programs, and reductions in the amount of intensive care training for pediatric residents, have placed a burden on neonatal intensive care units. These changes have resulted in a greater demand for NNPs. There are currently 35 graduate programs for NNPs in the United States, which leaves many geographical areas educationally underserved. Thus, there are too few NNPs to address critical staffing problems. To fill this need, it has become common for family nurse practitioners (FNPs) and pediatric nurse practitioners (PNPs) to function in the NNP role. There are no references in the current literature to support or oppose this practice. Although FNPs and PNPs are advanced practice nurses, the belief that they are adequate substitutes for NNPs in the acute care neonatal setting is fraught with misconception. This article discusses the ethical and legal implications posed by issues surrounding role definition, educational preparation, specialty certification and credentialing, and scope of practice of FNPs and PNPs in the neonatal intensive care unit. Copyright © 2001 by W.B. Saunders Company