Acute Care Nurses Research Articles

Acute illness and positive life changes: Can critical health problem lead to personal transformation?

Experiencing acute illness usually associated with psychological distress. However, some survivors also experience positive psychological development in the post disorders period. Aim: The present study aimed to investigate the extent of perceived post traumatic growth among acutely ill patients. Research design: Quantitative descriptive research design was utilized to carry out this study in acute care units at King Abdulaziz University Hospital. Sampling: A purposive sampling technique was used to select 100 adult patients who admitted with acute illness and were conscious and have history of recurrent acute episode. Data collection tools: two tools were used to conduct the study; the first tool “Growth related factors assessment sheet” was developed to assess factors affecting personal growth. The second tool “Arabic post traumatic growth inventory short form scale” was adopted and translated into Arabic to evaluate the extent of post traumatic growth. Results: The results show higher levels of post traumatic growth during acute illness episodes; the mean score was (43.34±4.56). In-addition, there was a significant association (p<0.05) between growth related factors (e.g. diagnosis, psychological assistance, living style, management received) and perceived post traumatic growth. Conclusion: highly extent of post traumatic growth can developed during acute illness and affected with personal features, psychosocial support, and type of management received. Recommendation: Guiding the acute care nurses to start stress management interventions early during acute episode and focused on identifying positive outcomes and meaning in patient’s experiences.

Innovative Applications of ELNEC Curriculum: Eighteen Years Equipping Nurses to Deliver Palliative Care in Diverse Care Settings (FR413)

•Define primary palliative care and name three reasons why primary palliative care is important for all patients and families.•Describe the ELNEC program and model for dissemination of primary palliative care education and give three examples of how ELNEC curriculum has been adapted in diverse care delivery settings to provide clinicians with primary palliative care education The End-of-Life Nursing Education Consortium (ELNEC) was established in 2000 as a national education initiative to expand the capacity of nurses in diverse care settings to integrate palliative care into practice. ELNEC uses a train-the-trainer model and adaptable curriculum materials. ELNEC has expanded to offer multiple specialty courses; and in 2017, the ANA and HPNA recommended that all nurses have ELNEC training as the basis of primary palliative nursing practice. We use case examples to demonstrate how ELNEC curriculum has been successfully adapted for diverse learners. ELNEC curriculum has been implemented to educate acute care nurses, graduate students in a palliative care certificate program, and care managers and social workers within a health plan:1.A metropolitan medical center administered a needs assessment survey to all inpatient nursing staff. Based on the survey results, multiple 30-minute unit-based educational sessions using portions of ELNEC modules are being piloted to increase nurses’ knowledge of palliative care.2.Clinical staff at a community hospital wanted to better support families after they had received bad news. ELNEC Core curriculum was used to provide a 3-hour training on communication.3.Learning strategies from the ELNEC modules are being threaded throughout graduate level interdisciplinary palliative care courses housed within the School of Nursing at a university.4.An ELNEC Course was offered to more than 250 care managers and social workers for a health plan to increase awareness of the comprehensive needs of members with serious illness and encourage early referral to palliative and community resources. Across care settings, nurses, care managers, and social workers are ideally positioned to identify and address unmet palliative care needs in the populations they serve. These examples demonstrate how ELENC curriculum can be adapted to disseminate primary palliative care knowledge, enabling clinicians to improve quality of life for their patients living with serious illness.

Integration of Simulation to Prepare Adult-Gerontology Acute Care Nurse Practitioners

BackgroundThe nation’s demographics and health care needs are changing, concurrent with the demand to double the number of doctorally prepared nurses by 2020. This combination has intensified challenges associated with finding quality clinical placements and appropriate preceptors for nurse practitioner (NP) students. Purposefully integrated simulations offer alternate experiences and expose students to deliberately crafted and consistent learning opportunities. MethodsScaffolded simulations were integrated within an Adult-Gerontology Acute Care Nurse Practitioner Program over the course of six semesters. ResultsAnalysis is currently underway, but preliminary data show that simulation experiences helped to develop assessment, critical thinking, and decision-making skills. The students also felt better prepared to communicate with other health care providers in this new role. ConclusionAlthough resource intensive, simulation provides an unparalleled opportunity for NP students to independently perform, without direct supervision, as an NP. Presenting an example of simulation integration can aid other educators seeking to develop a similar program.

Interdisciplinary partnerships for rural older adults’ transitions of care

Purpose Integrated transitions of care for rural older persons are key issues in policy and practice. Interdisciplinary partnerships are suggested as ways to improve rural-care transitions by blending complementary skills of disciplines to increase care’s holistic nature. Yet, only multidisciplinary efforts are frequently used in practice and often lack synergy and collaboration. The purpose of this paper is to present a case of a partnership model using nursing, gerontology and public health integration to support rural-residing elders as a part of building an Adult-Gerontology Acute Care Nurse Practitioner program. Design/methodology/approach This paper uses the Centre for Ageing Research and Development in Ireland/O’Sullivan framework to examine the creation of an interdisciplinary team. Two examples of interdisciplinary work are discussed. They are the creation of an interdisciplinary public health course and its team-based on-campus live simulations with a panel and site visit. Findings With team-building successes and challenges, outcomes show the need for knowledge exchange among practitioners to enhance population-centered and person-centered care to improve health care services to older persons in rural areas. Practical implications There is a need to educate providers about the importance of developing interdisciplinary partnerships. Educational programming illustrates ways to move team building through the interdisciplinary continuum. Dependent upon the needs of the community, other similarly integrated partnership models can be developed. Originality/value Transitions of care work for older people tends to be multi- or cross-disciplinary. A model for interdisciplinary training of gerontological practitioners in rural and frontier settings broadens the scope of care and improves the health of the rural older persons served.

Nurses' Safety Motivation: Examining Predictors of Nurses' Willingness to Report Medication Errors.

Medication errors are common in health care settings. Safety motivation, such as willingness to report error, is needed to contain medication errors. Limited evidence exists about measures to enforce nurses' safety motivation. The purpose of this study was to test a proposed model explaining the mechanism by which organizational and social factors influence nurses' safety motivation. Survey for this cross-sectional study was mailed to a random sample of 500 acute care nurses. Data collection started in January 2014 and lasted 6 months. Path analysis results showed a good fitting final model with 15% of explained variance on nurses' safety motivation. Safety climate dimensions of error feedback (β = .38, p ⩽ .00) and nonpunitive response to errors (β = .22, p = .01) significantly predicted the outcome. There is a need for both organizational and social factors to motivate nurses to report errors. Leadership practices emphasizing safety as a priority is needed to enhance nurses' safety motivation.

Self-confidence and attitude of acute care nurses to the presence of family members during resuscitation.

the present study aimed to assess the relationship between attitude to the presence of family members during cardiopulmonary resuscitation and confidence of acute care nurses in performing cardiopulmonary resuscitation in the presence of family. this descriptive-analytical study was conducted on nurses working in acute care units (intensive care unit, coronary care unit, and emergency department) in Iran in 2017. A total of 150 nurses entered the study by convenience sampling. Data were collected on nurses' attitude towards the presence of family scale and nurses' self-confidence in presence of family scale. of the 150 participants, 48 (32%) were men and 102 (68%) were women. Total mean score of attitude was 67±10.4 (obtained scores by nurses ranged from 32 to 100). Total mean score of self-confidence was 53.86 ±11.7 (obtained scores by nurses ranged from 23 to 81). Pearson correlation test showed a significant negative relationship between nurses' attitude toward presence of family members during cardiopulmonary resuscitation and their self-confidence (rr=-0.45, p=0.001). the present study showed that nurses with a higher self-confidence have a more positive attitude toward presence of family members during cardiopulmonary resuscitation. Given the importance of the subject, it should be considered by nursing managers and planners.

Adult Gerontology Acute Care Nurse Practitioner Student and Prelicensure Registered Nurse Student Perceptions of Intradisciplinary, High-Fidelity Rapid Response Team Simulations

BackgroundAdult gerontology acute care nurse practitioner (AGACNP) students and prelicensure registered nurse (RN) students rarely have the opportunity to actively participate in the management of acutely decompensating patients during inpatient clinical rotations. However, upon completion of their academic programs, these two groups will frequently interact in the hospital setting when managing acutely ill patients. This combined lack of hands-on experience and failure to practice team interactions may contribute to impaired intradisciplinary collaboration, delayed utilization of the organizational rapid response team (RRT), and adverse patient outcomes. MethodsAGACNP and RN students were presented with high-fidelity simulation experiences in which they worked collaboratively to stabilize and manage acutely ill patients after RRT activation. Following debriefing after the simulation experience, AGACNP and RN students were provided with an optional pen and paper survey that measured their perceptions of the experience on a five-point Likert scale. ResultsThe survey data support that the RRT simulation experience provided AGACNP students with the opportunity to lead and collaborate with intradisciplinary team members in stressful situations and reinforced their views that detailed communication and a cohesive team is critical in the management of acutely ill patients. The experience assisted RN students in identifying criteria for RRT activation, practicing communication skills with intradisciplinary health care team members, working collaboratively as part of an intradisciplinary team, and recognizing areas for improvement in communication. ConclusionsAGACNP and RN students perceive intradisciplinary, high-fidelity simulation to be a valuable form of preparation in the management of acutely ill patients requiring RRT activation.

Differing pathways to resiliency: A grounded theory study of enactment of resilience among acute care nurses.

It is well-recognized that nurses are exposed to high levels of stress, thus resilience has been postulated as a key trait in enabling nurses to cope successfully and remain in the profession. In this qualitative study, we used Glaser's approach to grounded theory. Nine nurses who scored low and nine nurses who scored high on the Connor-Davidson Resilience Scale were recruited for one-on-one semistructured interviews of the factors contributing to their work-related stress and how they overcome these stressors. Three categories emerged from the data: outlook on work, self-efficacy, and coping responses. These categories led to the emergence of the theory "differing pathways to resiliency". Despite the stresses experienced at work, some nurses were highly resilient, while others were not. Highly-resilient nurses tend to adopt active coping mechanisms, whereas nurses who have low resilience tend to undertake passive measures to let nature runs its course. The emerging theory provided an understanding of the different pathways to resiliency and how nurse leaders can potentially develop and grow the level of resiliency among nurses.

In-Hospital Initiation of Guideline-Directed Heart Failure Pharmacotherapy to Improve Long-Term Patient Adherence and Outcomes.

Heart failure is a burdensome cardiovascular condition associated with high rates of morbidity and mortality. The 3-month period after hospitalization is a vulnerable phase in which patients are at high risk for mortality and rehospitalization. To reduce risk during this period, patients with heart failure and reduced ejection fraction should receive guideline-directed pharmacological therapies-the right drugs at the right doses-before hospital discharge. Optimal pharmacotherapies for these patients include agents that suppress the renin-angiotensin-aldosterone system, suppress the sympathetic nervous system, enhance vasodilation, slow heart rate when needed, and reduce excess volume. Because optimal prescription and adherence are both necessary to ensure the best clinical outcomes, nurses need to participate in interventions that optimize prescription and drug use over time. Collaboration with pharmacists and advanced practice acute care nurses may help ensure that medication selection and dosing are consistent with national guidelines. Use of a predischarge order set and electronic medical records checklist can enhance collaborative care.

Understanding the influence of resilience on psychological outcomes — Comparing results from acute care nurses in Canada and Singapore

BackgroundBuilding resilience among nurses is one of the ways to support and retain nurses in the profession. Prior literature which evaluated influence of resilience on psychological outcomes, were conducted in relatively homogeneous populations. It is of interest to evaluate whether relationships between resilience and psychological outcomes remain consistent across nations and among different nursing populations. AimTo evaluate a theoretical model of the impact of resilience on burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS) by comparing results between nurses in Canada and Singapore. MethodA self-reported questionnaire consisting of questions on demographics, resilience (Connor-Davidson Resilience Scale), and psychological adjustment (Professional Quality of Life) was administered via an online survey. One thousand three hundred and thirty-eight nurses working in two Academic Medical Centres in Singapore responded to the online survey. Similar data was also collected from 329 nurses in Canada. Hypotheses were tested using structural equation modeling. ResultsResilience exerts a significant negative direct impact on STS, and a significant negative direct impact on BO. Additionally, resilience has a positive direct impact on compassion satisfaction. STS exerts a positive direct impact on BO while CS has a negative direct impact on BO. ConclusionCurrent study affirmed significant associations between resilience and professional quality of life. Knowledge on resilience is key in informing design and implementation of resilience-building strategies that include professional development, and strengthening of interpersonal skills. A resilience-based approach will help reduce nurses' BO and STS while caring for their patients, and in turn reduce turnover.

The Teach Back Project: A System-wide Evidence Based Practice Implementation

PurposeTeach-back is an evidence-based strategy identified as a cornerstone intervention for improving communication during healthcare encounters. Evidence supports the use of teach back with patients and families to improve understanding of discharge instructions and supporting self-management. There is significant evidence that staff do not routinely use teach-back while communicating with patients and families. Design and MethodsThis evidence-based practice project examined the impact of a brief educational intervention for a multidisciplinary staff on knowledge of health literacy and the use of teach-back during patient-education. Clinical staff working at a 290 bed Magnet® designated Midwest pediatric healthcare organization attended a 45–60 min, standardized, instructor led interactive teaching session about the impact of low health literacy, the use of open ended questions and how to use teach-back with patients and families. Pre and post education surveys, and a one-year sustainability survey were administered. ResultsOver 300 multidisciplinary team members (including acute care, emergency room, and surgical nurses, dieticians, respiratory care practitioners and occupational and physical therapists) participated in the education and surveys. Both nurses and non-nurses demonstrated increased knowledge of the teach-back process and reported high rates of clarifying information and correcting misunderstandings when using teach back with patients and families. Qualitative data revealed clarifications are often about medications and skill-based treatments. Conclusions and Practice ImplicationsTeach-back is a valuable strategy that can improve the safety and quality of health care and supports the National Action Plan to Improve Health Literacy.

Simulation as an educational tool in acute nursing care: A controlled intervention study.

Simulations have become a common educational tool among nursing students; however, the impact of clinical simulations as tested using an experimental design is not yet well established. In a controlled intervention study, nursing students received either traditional classroom lessons (C) or traditional classroom lessons combined with simulation-based lessons at the hospital (I). The primary outcome variable was the basic knowledge of acute nursing measured by a multiple-choice questionnaire. Secondary outcome variables were grade point average, the students' perception of the learning process, and self-efficacy. Seventy-four students participated in the study; C:n = 36 and I:n = 38. Regarding basic knowledge, there was no significant difference between the groups (I:11.8 ± 0.4, C:12.1 ± 0.4, p = 0.54). The I-group had a more positive perception of the learning process (Δ:6.0 ± 1.1,p < 0.002) and rated their self-efficacy higher (Δ:8.5 ± 2.3,p < 0.002). The students reported higher levels of self-efficacy, when combining the traditional lessons and simulation-based lessons. When combining the two approaches, their fundamental knowledge is not improved.

An investigation into compassion fatigue and self-compassion in acute medical care hospital nurses: a mixed methods study

BackgroundIn the acute medical care hospital setting, nursing the sick and dying is both physically and emotionally demanding, making acute medical care hospital nurses more vulnerable to Compassion Fatigue (CF) or Secondary Traumatic Stress (STS). If not addressed in its earliest stages, CF can adversely change the caregiver’s ability to provide compassionate care. It has been shown that Self-Compassion (SC) can be beneficial for the caregiver, with corresponding benefits for the individual needing care. However, the relationship of this attribute to CF in the acute medical care hospital nursing setting has not been intensively studied. This study explores the environmental and psychosocial factors affecting the prevalence and levels of CF in acute medical care hospital nursing staff and whether SC can be used as a coping strategy that enables nurses to mitigate the prevalence and levels of CF.MethodsUsing a mixed-methods study design, acute medical care hospital nurses were surveyed using a demographic/work-related questionnaire, the Secondary Traumatic Stress Scale (used to measure CF), the Self-Compassion Scale, questions requiring a narrative written response and semi-structured informal interviews. One-way ANOVA was conducted to explore the impact of work-related and demographic characteristics on levels of SC and CF. Pearson correlation co-efficient (r value) was used to explore the relationship between CF and SC and lastly, multiple regression was used to discover whether a predictive relationship existed between SC and CF. The interviews were recorded, transcribed verbatim and subjected to thematic analysis.ResultsThe results of this study have exposed the prevalence of CF in acute medical care nurses and it’s damaging effects. And has also confirmed that SC can have a moderating effect on CF and an ability to be predictive of CF. Factors that influence the distress and vulnerability to CF were also identified, as well as the personal approaches used, whether successful or not, to enhance levels of SC and the ‘barrier’s to achieving it.ConclusionThis unique study could lead to care environments encouraging the self-compassion and well-being of their acute medical care nursing staff and become places where threat cultures, weak leadership, an emphasis on task rather than process and a feeling of being undervalued, do not monopolise.

Evaluating the Effect That Diabetes Education Has on Acute-Care Nurses' Knowledge Level

Although there are published inpatient diabetes guidelines, successful implementation is often met with resistance and fear of complications in treated patients. This is often due to a lack of knowledge among healthcare providers and nurses (RNs), which increases the risk of complications, dysglycemia, length of stay and readmissions. Diabetes affects every hospitalization and healthcare organizations need to provide all RNs with the education to reduce the effects of uncontrolled or undiagnosed diabetes. This project developed a 25-question, multiple choice test to evaluate acute-care RNs knowledge on inpatient diabetes management and was evaluated to determine the validity and reliability of the test. Validity was verified by a certified nurse leader with advanced diabetes management to ensure the questions were within a registered nurses scope of practice and an endocrinologist verified comprehensive inclusion of published inpatient diabetes guidelines across the continuum. The questionnaire was completed by 13 RNs and included a focus on pathophysiology of type 1 and type 2 diabetes, non-insulin agents, insulin, acute complications, nutrition, and sick day management. A paired t-test statistical analysis was conducted to determine the reliability of the questionnaire post-administration of diabetes education to the same group of RNs. The comparison showed an improvement in the overall diabetes knowledge level with a mean score of 79.7%, SD= 3.796, compared to pre-test mean score of 67.38%, SD= 14.86 and t= -3.524, p=0.004. Additional variables evaluated through a two way ANOVA (F[2, 10], f=.931, p=.426) showed no significant effect were the years of experience or level of nursing degree on the overall scores. In order to further strengthen the reliability of the questionnaire, the project should be repeated throughout the organization including all inpatient nursing departments. Additional variables that should be evaluated for effect include nursing unit and type of experience. Disclosure J. Kuchta: Other Relationship; Self; Medtronic MiniMed, Inc..

Knowledge of, and participation in, advance care planning: A cross-sectional study of acute and critical care nurses’ perceptions

BackgroundNurses have a core role in facilitating discussions and enacting decisions about end-of-life issues for patients in hospitals. Nurses’ own knowledge and attitudes may influence whether they engage in meaningful end-of-life conversations with patients. AimsTo determine in a sample of nurses working in acute and critical care hospital wards:1) their knowledge of advance care planning, including the authority of substitute decision-makers and legal validity of advance directives;2) their own participation in advance care planning decision-making practices; and3) associations between nurses’ socio-demographic characteristics; clinical expertise; and knowledge and behaviour in relation to advance care planning practices. DesignQuestionnaire-based, cross-sectional study. Setting and participantsThe study was conducted with 181 registered and enrolled nurses employed in acute and critical care wards of three metropolitan hospitals in Australia. ResultsNurses were least knowledgeable about items relating to the authority of medical (56%) and financial (42%) substitute decision-makers. Few nurses had prepared advance directives (10%) or appointed medical (23%) or financial (27%) decision-makers, when compared to discussing end-of-life wishes (53%) or organ donation (75%). Overall, 15% of nurses had not engaged in any advance care planning practices. Nurses who had cared for 11–30 dying patients in the last six months were more likely to have an increased knowledge score. Older nurses were more likely to participate in a greater number of advance care planning practices and an increase in shifts worked per week led to a significant decrease in nurses’ participation. ConclusionNurses have a key role in providing advice and engaging dying patients and their families in advance care planning practices. Nurses’ own knowledge and rates of participation are low. Further education and support is needed to ensure that nurses have an accurate knowledge of advance care planning practices, including how, when and with whom wishes should be discussed and can be enacted.

Replace “Have to” With “Want to”

Replace “Have to” With “Want to”

The impact of a multimodal education strategy (the DeTER program) on nurses' recognition and response to deteriorating patients.

Nurses are ideally positioned to recognise and respond to patient deterioration. However, premonitory signs of patient deterioration are often overlooked, not managed, or not communicated in a timely fashion. Education programs aimed at improving nurses' technical and non-technical skills have been developed, however, the outcomes of these educational strategies remain unclear. A quasi-experimental time series design was used in this study to evaluate the impact of a multi-modal education program (DeTER) on acute care nurses' technical and non-technical skill development and recognition and response to patient deterioration. Participants were asked to complete a survey on four occasions: one month prior to commencement of the DeTER program, immediately prior and post workshop attendance and two-three months' post workshop completion. Pre-intervention, data were collected on participants' demographic profile and their responses to the Clinical Emergency Recognition and Response Survey designed by (Buckley and Gordon, 2011). Post intervention these data were collected again and, in addition, respondents were asked to report on their recent experiences of deteriorating patients and report on their confidence in managing these incidents. Sixty staff consented to participate in the study and all completed the surveys at time 2 and 3. In total 32 staff (45%) responded at all time points. Participants included registered nurses (n = 51; 85%), and enrolled nurses (n = 9; 15%), on average they had worked for 10.4 years (sd = 11.1). Participants rated patient advocacy and assertiveness skills as the most useful aspects of the workshop. Recognition and response to deteriorating patients by ward nurses is a multifaceted process influenced by many factors. Our study supports the importance of multimodal educational strategies in sustaining changes to ward nurses' technical and non-technical skills over time.

Barriers to Clinical Practice Guideline Implementation for Septic Patients in the Emergency Department

Contribution to Emergency Nursing Practice •The current literature on implementation of clinical practice guidelines for sepsis indicates that more research is needed to understand the unique facilitators and barriers in the emergency department. •This article contributes to a heightened awareness that clinical practice guidelines for sepsis are associated with improved patient outcomes; compliance with interventions in guidelines is variable; multiple internal and external barriers exist; and facilitators, such as education, improve patient outcomes and increase compliance. •Key implications for emergency nursing practice found in this article are that knowledge of barriers and facilitators for use of clinical practice guidelines can assist emergency nurses and advance practice nurses to develop solutions to barriers in their workplaces through use of a toolkit such as from the Registered Nurses’ Association of Ontario. Contribution to Emergency Nursing Practice •The current literature on implementation of clinical practice guidelines for sepsis indicates that more research is needed to understand the unique facilitators and barriers in the emergency department. •This article contributes to a heightened awareness that clinical practice guidelines for sepsis are associated with improved patient outcomes; compliance with interventions in guidelines is variable; multiple internal and external barriers exist; and facilitators, such as education, improve patient outcomes and increase compliance. •Key implications for emergency nursing practice found in this article are that knowledge of barriers and facilitators for use of clinical practice guidelines can assist emergency nurses and advance practice nurses to develop solutions to barriers in their workplaces through use of a toolkit such as from the Registered Nurses’ Association of Ontario. Contribution to Emergency Nursing Practice •The current literature on implementation of clinical practice guidelines for sepsis indicates that more research is needed to understand the unique facilitators and barriers in the emergency department. •This article contributes to a heightened awareness that clinical practice guidelines for sepsis are associated with improved patient outcomes; compliance with interventions in guidelines is variable; multiple internal and external barriers exist; and facilitators, such as education, improve patient outcomes and increase compliance. •Key implications for emergency nursing practice found in this article are that knowledge of barriers and facilitators for use of clinical practice guidelines can assist emergency nurses and advance practice nurses to develop solutions to barriers in their workplaces through use of a toolkit such as from the Registered Nurses’ Association of Ontario. Elizabeth N. Reich is Graduate Programs Student, Faculty of Nursing, at University of Calgary, Calgary, Alberta, Canada. Karen L. Then is Professor, Faculty of Nursing, University of Calgary; and is Acute Care Nurse Practitioner, Alberta Health Services in Cardiac Sciences, Calgary, Alberta, Canada. James A. Rankin is Professor, Faculty of Nursing, University of Calgary; and is Acute Care Nurse Practitioner, Alberta Health Services in Rheumatology, Calgary, Alberta, Canada.

Evaluating the Impact of EBP Education: Development of a Modified Fresno Test for Acute Care Nursing.

Proficiency in evidence-based practice (EBP) is essential for relevant research findings to be integrated into clinical care when congruent with patient preferences. Few valid and reliable tools are available to evaluate the effectiveness of educational programs in advancing EBP attitudes, knowledge, skills, or behaviors, and ongoing competency. The Fresno test is one objective method to evaluate EBP knowledge and skills; however, the original and modified versions were validated with family physicians, physical therapists, and speech and language therapists. To adapt the Modified Fresno-Acute Care Nursing test and develop a psychometrically sound tool for use in academic and practice settings. In Phase 1, modified Fresno (Tilson, 2010) items were adapted for acute care nursing. In Phase 2, content validity was established with an expert panel. Content validity indices (I-CVI) ranged from .75 to 1.0. Scale CVI was .95%. A cross-sectional convenience sample of acute care nurses (n = 90) in novice, master, and expert cohorts completed the Modified Fresno-Acute Care Nursing test administered electronically via SurveyMonkey. Total scores were significantly different between training levels (p<.0001). Novice nurses scored significantly lower than master or expert nurses, but differences were not found between the latter cohorts. Total score reliability was acceptable: (interrater [ICC (2, 1)]) = .88. Cronbach's alpha was 0.70. Psychometric properties of most modified items were satisfactory; however, six require further revision and testing to meet acceptable standards. The Modified Fresno-Acute Care Nursing test is a 14-item test for objectively assessing EBP knowledge and skills of acute care nurses. While preliminary psychometric properties for this new EBP knowledge measure for acute care nursing are promising, further validation of some of the items and scoring rubric is needed.

Acute care nurses' perceptions of electronic health record use: A mixed method study.

AimThe overall aim of this study is to examine nurses’ perceptions of electronic health record use in an acute care hospital setting.DesignThis study uses a sequential mixed methods design in two phases.MethodsPhase one consists of a survey of Registered Nurses to understand nurses’ perceptions of electronic health record use. Phase two is comprised of focus groups of a subsample from phase one. Data collection occurred from November 2015 ‐ August 2016 and was done in Toronto, Canada.ResultsIn phase one, navigation was found to be a predictor of nurses’ perceptions of electronic health record use. In phase two, participants discussed the following five topics: (1) navigation; (2) functionality; (3) organizational standards; (4) documentation workload and (5) issues of system performance and response time. This study has implications for organizations implementing electronic health records, nursing leaders and electronic health record vendors.