Nurses Association Research Articles

Impact of Implementation of the Maternal-Fetal Triage Index on Patients Presenting With Severe Hypertension

ABSTRACT The timely triage of pregnant patients presenting for emergent care is an important factor for decreasing maternal morbidity and mortality. The Maternal-Fetal Triage Index (MFTI) is an assessment tool developed by the Association of Women's Health, Obstetric and Neonatal Nurses in 2014 and endorsed by the American College of Obstetricians and Gynecologists (ACOG) in 2016 for triaging obstetrical patients presenting for emergent care. The Joint Commission has identified response time to severe hypertension, or preeclampsia, as one of its elements of performance. The aim of this study was to examine the management of women with severe hypertension before and after the implementation of MFTI. This was a prospective, observational study at a county-supported, urban academic hospital, serving medically indigent women. Included were women at ≥24 weeks of gestation, who presented in the hospital's obstetric triage unit with severe preeclampsia diagnosed by severe hypertension. Severe hypertension was defined as blood pressure (BP) ≥160/110 mm Hg. Excluded were those who were not admitted for delivery at the time of presentation. Patients with BP ≥160/110 mm Hg were given magnesium sulfate (MgSO4) prophylaxis and treated with intravenous hydralazine, labetalol, or immediate-release nifedipine. Patients admitted before the implementation of MFTI (between January 1, 2019, and December 31, 2019) represented epoch 1 of the cohort. Those admitted after MFTI implementation (between March 1, 2021, and September 30, 2021) made up epoch 2. Nursing staff used the criteria outlined in the MFTI to prioritize patient acuity. A 1 score is the highest priority, and a 5 score is the lowest priority. The primary outcome was the time interval to evaluate and manage women with severe hypertension before and after MFTI implementation, as measured by arrival time to provider assessment, arrival time to MgSO4 prophylaxis, and arrival time to the administration of antihypertensive medications. There were 370 patients in epoch 1, before MFTI implementation, and 254 patients in epoch 2, after implementation. The time from arrival to provider assessment improved significantly from epoch 1 to epoch 2 (median time: 44 minutes [interquartile range, 0–65 minutes] vs 17 minutes [IQR, 0–39 minutes], respectively; P < 0.001). The time from arrival to MgSO4 prophylaxis also improved (160 minutes [IQR, 109–256 minutes] vs 126 minutes [IQR, 85–258 minutes], respectively; P = 0.001). There was a decrease in the time from arrival to administration of antihypertensive medications between the 2 time frames (101 minutes [IQR, 61–177 minutes] in epoch 1 vs 66 minutes [IQR, 35–203 minutes] in epoch 2; P < 0.001). In a separate analysis, race and ethnicity did not factor into the performance of MFTI. Overall, there was an improvement in the evaluation and management of pregnant women with severe hypertension after the implementation of MFTI, regardless of race and ethnicity. Timely identification and management of this high-risk population may improve maternal morbidity and mortality.

Position Statement on Cancer Nursing Leadership.

Position Statement on Cancer Nursing Leadership.

Propuesta de modelo para la enfermera de práctica avanzada

The proposal presented is the result, on one hand, of the outcomes of the Project “IPACAT22: Consensus on the key aspects of the model for advanced practice in Catalonia”, prepared with the participation of 24 nurses representing multidisciplinary or nursing scientific associations of Catalonia. On the other hand, it is also the result of the exciting, relevant, and sometimes difficult discussion among the team members with different professional careers and point of views which enhance the common objective. It is appropriate to present the outcomes of this discussion, based on rigour and results of the research projects for the improvement and progress of advanced practice nurses. This discussion also represents a major role in the professional setting, to conduct an effective leadership in organizations and the health system. We are convinced that this document can be a starting point to set up the model for the advanced practice nurse in our setting.

Addressing Secondary Traumatic Stress Among Nurses: A Brief Unit-Based Group Program

The nursing profession requires constant adaptation to change, along with resilience and unwavering provision of excellent patient care. Secondary traumatic stress (STS) challenges this adaptive process and provision of patient care, leaving nurses with impairment in several well-being domains critical to resilience, including emotional, physical, spiritual, and professional well-being. STS is described as experiencing a patient’s trauma, resulting in a form of posttraumatic stress disorder with hyperarousal, avoidance, sleep disturbance, intrusive thoughts, mood disturbance, and impaired performance. Currently there is a nationwide paradigm shift among national and state nursing associations about how to address stress in nursing and support the well-being of nursing professionals. However, many nurses often do not recognize the signs of stress in themselves or colleagues, and they tend not to utilize strategies for prevention or intervention. Also, it is difficult for busy nursing professionals providing direct patient care to leave their units to engage in stress management programs offered by their institutions. This article addresses this gap and presents a short-term, four-session unit-based group model that integrates cognitive behavioral strategies and mindfulness practice for stress reduction, which has been implemented at a large, busy, urban academic medical center in the Northeast. The short-term unit-based group model aims to assist nursing professionals with recognition, prevention, and mitigation of stress. Such an intervention supports the emotional well-being of nursing professionals, which in turn contributes to a resilient and engaged workforce, a high-functioning team, and improved patient care.

Current Practice and Practice Competencies of Clinical Nurse Specialists Working in US Emergency Care Settings: A Survey Study.

The aim of this study was to investigate the current practice of clinical nurse specialists working in US emergency care settings to (1) explicate the application of the Emergency Nurses Association core competencies and define the specialized clinical nurse specialist role in emergency care and (2) align current clinical nurse specialist practice in emergency settings with the National Association of Clinical Nurse Specialists core competencies and the identified substantive areas of clinical nurse specialist practice. This study used a quantitative exploratory descriptive approach using survey data. A purposive convenience sample was recruited from the Emergency Nurses Association and the National Association of Clinical Nurse Specialists. Participants completed a 39-item survey based on a consensus process to develop competencies for emergency department (ED)-situated clinical nurse specialists. Respondents (n = 285) reported spending more than 50% of their work time in a primary clinical nurse specialist role. Significant differences in practice were found between geographic location, setting, educational preparation, title protection status, and type of institution. Our findings suggest that that the competencies ascribed to ED-situated clinical nurse specialists are valid in both frequency and importance. However, ED-situated clinical nurse specialists are not fully credentialed or practicing to the full extent of their education and licenses, because of professional, legislative, and environmental limitations.

Preventive Cardiovascular Nurses Association News and Resources.

Preventive Cardiovascular Nurses Association News and Resources.

The Canadian Landscape of Genetics and Genomics in Nursing: A Policy Document Analysis.

Genetics and genomics (GG) are transforming approaches to healthcare in Canada and around the globe. Canadian nurses must be prepared to integrate GG in their practice, but modest research in this area suggests that Canadian nurses have limited GG competency. Countries that have integrated GG across nursing provided guidance to nurses about the practice implications of GG through regional nursing policy documents. These documents propelled action to integrate GG across nursing. Little is known about the GG content in the nursing policy document infrastructure in Canada. This study aimed to examine the guidance for GG-informed nursing practice as provided by Canadian nursing organizations in official professional documents. Qualitative document analysis was used. A hybrid inductive/deductive analysis approach was used to analyze findings within the diffusion of innovation theory framework. There is an overall lack of depth and breadth of Canadian nursing documents that include content related to GG. Of the (n = 37) documents analyzed, four themes were generated including (a) GG guidance in nursing education; (b) regulators' requirements for foundational GG knowledge, (c) Canadian Nurses Association (CNA) as an early catalyst to GG integration; and (d) early adopters in speciality practice. There are opportunities to enhance the guidance available to Canadian nurses for the application of GG, through documents of nursing professional associations, nursing education accreditation organizations, and regulatory bodies. Findings suggest oncology and perinatal nurses are the early adopters which is an important consideration in future strategies to implement GG into Canadian nursing.

The 2023-2026 Hospice and Palliative Nurses Association Research Agenda.

The Hospice and Palliative Nursing Association established the triannual research agenda to ( a ) provide focus for researchers to conduct meaningful scientific and quality improvement initiatives and inform evidence-based practice, ( b ) guide organizational funding, and ( c ) illustrate to other stakeholders the importance of nursing research foci. HPNA Research Agendas are developed to give direction for future research to continue advancing expert care in serious illness and ensure equitable delivery of hospice and palliative care.

In House Training 3S (SDKI. SLKI, SIKI) to Improve Nurses' Knowledge of 3S-Based Nursing Care

Nurses are obliged to carry out nursing practice in accordance with established standards. The standards set by PPNI (Indonesian Nation Nurses Association) as standards in carrying out nursing care are SDKI (Indonesian Nursing Diagnosis Standards), SLKI (Indonesian Nursing Output Standards), and SIKI (Indonesian Nursing Intervention Standards). In-House Training is one of the efforts to increase nurses' knowledge and skills in conducting 3S-based nursing documentation in accordance with the standards set by PPNI. This training aims to increase nurses' knowledge about 3S-based nursing care. This study is a quantitative study with a pre - posttest design approach without control sample consisting of 131 nurses in a private hospital taken via total sampling. The instrument used was a knowledge questionnaire that had been tested for validity using judgment validity with the result > 0,3 that the all items were valid. Data normality test with Kolmogorov Smirnov with a significance value of 0.000 (abnormal data distribution). Data analysis using Wilcoxon test (sig 0.000). The mean value of the pretest was 43.84 and the mean value of the post test was 89.12. the lowest pretest value was 16 and the highest was 84, while the lowest posttest value (64), the highest posttest (100). A total of 130 nurses (99.23%) experienced an increase in post test scores. There was an increase in nurses' knowledge about 3S-based nursing care before and after training.

Crowding in the Emergency Department: Challenges and Best Practices for the Care of Children.

Emergency department (ED) crowding has been and continues to be a national concern. ED crowding is defined as a situation in which the identified need for emergency services outstrips available resources in the ED. Crowding is associated with higher morbidity and mortality, delayed pain control, delayed time to administration of antibiotics, increased medical errors, and less-than-optimal health care. ED crowding impedes a hospital's ability to achieve national quality and patient safety goals, diminishes the effectiveness of the health care safety net, and limits the capacity of hospitals to respond to a disaster and/or sudden surge in disease. Both children and adults seeking care in emergency settings are placed at risk. Crowding negatively influences the experience for patients, families, and providers, and can impact employee turnover and well-being. No single factor is implicated in creating the issue of crowding, but elements that influence crowding can be divided into those that affect input (prehospital and outpatient care), throughput (ED), and output (hospital and outpatient care). The degree of ED crowding is difficult to quantify but has been linked to markers such as hours on ambulance diversion, hours of inpatient boarding in the emergency setting, increasing wait times, and patients who leave without being seen. A number of organizations, including the American College of Emergency Physicians, the Emergency Nurses Association, and the National Quality Forum, have convened to better define emergency metrics and definitions that help provide data for benchmarks for patient throughput performance. The Joint Commission has acknowledged that patient safety is tied to patient throughput and has developed guidance for hospitals to ensure that hospital leadership engages in the process of safe egress of the patient out of the ED and, most recently, to address efficient disposition of patients with mental health emergencies. It is important that the American Academy of Pediatrics acknowledges the potential impact on access to optimal emergency care for children in the face of ED crowding and helps guide health policy decision-makers toward effective solutions that promote the medical home and timely access to emergency care.

Chair squat performance as a potential predictor of nurses’ physical capabilities in ergonomic patient transfers

Muscle activation and movements performed during occupational work can lead to musculoskeletal disorders, one of the nursing profession's most significant health hazards. However, physical activity like exercise training tailored to the exposure and physical ability offers health prevention and rehabilitation. Professional nursing associations have advised squat training to promote occupational health because it strengthens lower limb and back muscles. Given that squatting is a fundamental part of many daily activities and various actions in caregiving processes, we hypothesized that chair squat performance is a potential predictor of nurses’ physical capabilities to perform occupational tasks. We conducted kinetic and electromyographic assessments of 289 chair squat repetitions and compared them to ergonomic patient transfer tasks. In this task, nurses transferred a supine patient to a lateral position in a care bed using similar movement characteristics of the squat task. This cross-sectional pilot study provides initial insights into nurses’ kinetic and muscle activation patterns of health-enhancing and compensational strategies. Highly asymmetric movements corresponded to distinct extremes in lower limb and spine muscle activity data—e.g., increased activity of the rectus femoris indicates increased hip flexion, including postural sway and, therefore, high torsional forces affecting the sacroiliac joints. The potential of the chair squat performance as a predictor of nurses’ physical capabilities in ergonomic patient transfers was quantified by a 2 × 2 contingency table resulting in an accuracy rate of 73%.

The effect of COVID-19 on fear, anxiety, and sleep in nursing students.

This research was conducted to determine the effect of COVID-19 on fear, anxiety, and sleep in nursing students. The sample of the study consisted of 1222 students in the 2019-2020 academic year who were members of the student nurses association. The data were collected online via Google Form between June and August 2020 using the student information form containing socio-demographic characteristics, the Generalized Anxiety Disorder 7-Item (GAD-7) Scale, the fear of COVID-19 scale, and the Bergen Insomnia Scale. In our study, the mean score of the fear of COVID-19 scale of nursing students was 18.23 ± 6.31, and it was determined that 51.8% had sleep problems and 70.9% had anxiety (39.9% mild, 20.8% moderate, and 10.2% severe). In simple linear regression analysis, the fear of COVID-19 was found to be statistically significant and positively correlated with anxiety (β: 0.383, p = 0.001), and the fear of COVID-19 (β: 0.120, p = 0.001) and anxiety (β: 0.346, p = 0.001) was found to be statistically significant and positively correlated with sleep. In our study, there is a relationship between nursing students' fear of COVID-19 and anxiety and sleep quality. Accordingly, it is recommended to train students in effective methods for coping with the fear of COVID-19, and to take initiatives to reduce related anxiety and sleep problems.

ANAC Policy Agenda 2022-2025.

Carole Treston, RN, MPH, ACRN, FAAN, is the Executive Director of the Association of Nurses in AIDS Care, Washington, District of Columbia, USA. *Corresponding author: Carole Treston, e-mail: [email protected]

Nurses' Knowledge, Communication Needs, and Future Directions in Neonatal Research: Results of an International Survey.

Preterm birth is a significant contributor to neonatal morbidity and mortality. Despite legislative efforts to increase pediatric drug development, neonatal clinical trials continue to be infrequent. The International Neonatal Consortium (INC) includes nurses as key stakeholders in their mission to accelerate safe and effective therapies for neonates. INC developed a survey for nurses, physicians, and parents to explore communication practices and stakeholders' perceptions and knowledge regarding clinical trials in neonatal intensive care units (NICUs). A stepwise consensus approach was used to solicit responses to an online survey. The convenience sample was drawn from INC organizations representing the stakeholder groups. Representatives from the National Association of Neonatal Nurses and the Council of International Neonatal Nurses, Inc, participated in all stages of the survey development process, results analysis, and publication of results. Participants included 188 nurses or nurse practitioners, mainly from the United States, Canada, the European Union, and Japan; 68% indicated some level of research involvement. Nurses expressed a lack of effective education to prepare them for participation in research. Results indicated a lack of a central information source for staff and systematic approaches to inform families of studies. The majority of nurses indicated they were not asked to provide input into clinical trials. Nurses were uncertain about research consent and result disclosure processes. This study indicates the need to educate nurses in research, improve NICU research communication through standardized, systematic pathways, and leverage nurse involvement to enhance research communication.

Association of nurses' mental well-being and professional quality of life (ProQOL) to their resiliency during the COVID-19 pandemic crisis

This study was conducted in determining the factors that affect nurses’ resiliency while working in public hospitals during the COVID-19 pandemic. A cross-sectional design was used and self-administered surveys were completed by 420 nurses. Nurses working in public hospitals have had high levels of resilience and mental well-being during the outbreak of the COVID-19 pandemic, with their ProQOL found to be average. Higher levels of mental well-being and ProQOL contributed to developing better resiliency. The study poses the significance of taking preemptive measures on the parts of both the government and the healthcare institutions themselves to assist nursing professionals in enduring disasters such as the pandemic.

Pregnant nurses' experiences of working shifts: a qualitative systematic review protocol.

The proposed systematic review will synthesize the experiences of nurses working in any shifts during pregnancy. Nurses are among the most burdened health care workers and are at risk of diseases of the circulatory system due to prolonged standing. For pregnant nurses, this could reduce blood circulation and blood flow to the uterus and placenta. Contributing factors include long working hours and frequent heavy lifting, which may induce uterine contractions and premature birth; irregular shifts, which exacerbate fatigue; and high levels of psychosocial stress. There is no qualitative evidence as to what nurses are experiencing while working shifts when pregnant. This review will evaluate and integrate the current available findings related to the experience of shift-working nurses who are pregnant. This review will include qualitative studies focusing on the experience of shift work among pregnant nurses. No language or date limits will be applied. All types of pregnancy among nurses will be included. The databases to be searched will include CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycINFO (EBSCOhost), and Igaku Chuo Zasshi (the Japan Medical Abstracts Society). Sources of gray literature will include MedNar and DANS, as well as the websites of the American Nurses Association and the Japanese Nursing Association. Study selection, critical appraisal, data extraction, and data synthesis will be performed independently by 2 reviewers. The synthesized findings will be graded according to the ConQual approach for establishing confidence in findings. PROSPERO CRD42022309674.

Using the Neonatal Intensive Care Unit Wisely: A National Survey of Clinicians Regarding Practices for Lower-Acuity Care.

The objective of this study was to document the practices and preferences of neonatal care stakeholders regarding location and duration of care for newborns with low illness acuity. We developed a survey instrument that comprised 14 questions across 2 global scenarios and 7 specific clinical conditions. The latter included apnea of prematurity, gestational age for neonatal intensive care unit admission, jaundice, neonatal opioid withdrawal, thermoregulation, and sepsis evaluation. Respondents reported their current practice and preferences for an alternative approach. We administered the survey to individuals in the membership email distribution lists of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine, the National Association of Neonatal Nurses, and the Vermont Oxford Network. Of 2284 respondents, 53% believed that infants were, in general, admitted to a higher level of care than was required, and only 13% reported that the level of care was too low. Length of stay was perceived to be generally too long by 46% of respondents and too short by 21%. Across 10 specific clinical questions, there was substantial variability in current practice and up to 35% of respondents reported discordance between current and preferred practice. These respondents preferred a lower level of care in 8 of 10 scenarios. A multidisciplinary sample of US clinicians reported significant variation in the level and duration of care for infants with low illness acuity. Among individuals reporting discordance between current and preferred practice, a majority believed that current management could be accomplished in a lower level of care location.

Celebrating the 70th Anniversary of The Journal of Nursing

The Journal of Nursing (JN) was first published in Taiwan seventy years ago in 1953 under its former name, Nursing Quarterly. The first issue of JN under its current name was published in 1961. JN mainly publishes academic papers. Despite the vicissitudes of history, the Taiwan Nurses Association (TWNA) remained true to its mission of serving its members, and resumed publication of JN after relocating to Taiwan from China after 1949. JN articles published over the past seven decades have focused on promoting professional competence, advocating clinical practice, advancing nursing education, introducing new concepts of administrative reform, and disseminating research findings and clinical case reports with goals of promoting nurses' understanding of nursing professional theory, cultivating critical thinking and creativity, helping nurses acquire and accumulate knowledge and skills in scientific language, and solving problems encountered in clinical care and education. In addition, in response to advances in medical care and the COVID-19 pandemic, the content of JN published in 2020 highlighted the current pandemic situation in special articles, research, and case reports to provide readers with knowledge about related care and research results. Through the publication of journal papers, we are promoting more interactions and inspiring more sparks of insight. JN is valued by readers around the world because the contributions and support of its many authors have allowed the journal to grow and thrive. At the same time, I would also like to thank the editor of each topic for their enthusiasm and enthusiastic welcoming of manuscript contributions and all Review Committee members for their careful review of manuscripts and tireless modification and review of articles, so as to provide readers with reliable reference resources. Therefore, the quality of the content published in JN has been recognized globally, and has been successively indexed in the globally recognized databases, including MEDLINE/PubMed (indexed from 2004), CINAHL (Cumulative Index to Nursing & Allied Health Literature; indexed from 1996), EBSCO Publishing (indexed from 2002), Scopus (indexed from 2004), ProQuest (indexed from 2012), and Airiti Library (indexed from 2004). Moreover, JN has been a RIHSS-accredited tier three journal since 2019. In addition, JN has won awards for five consecutive years since 2017. The excellent content quality of JN has made it an important source of knowledge dissemination and influence in domestic academic circles. Since becoming Editor-in-Chief of JN, I have read many contributors' articles and feel regularly grateful to the authors for their submissions, whether their articles are accepted for publication or not. With the efforts of previous Editors-in-Chief and Editorial Committee members, JN has continuously adjusted its mode of operations to meet social changes and has gradually established a comprehensive process for submission, review and publication. In recognition of JN's 70th anniversary in publication, we look forward to continued, sustainable development of the journal and of service for our global readership. We look forward for JN to do even more in the coming decade and beyond!

Improving practicing nurses' knowledge of the cognitive impairment, continence, and mobility needs of older people.

To test if two e-learning modules - one on cognitive impairment, and one on continence and mobility - in older people would improve the knowledge of nurse members from the Canadian Gerontological Nurses Association and College of Licensed Practical Nurses of Alberta. A pre-post-test design was used to test 88 nurses' knowledge of cognitive impairment and 105 nurses' knowledge of continence and mobility and their perceptions of how the modules contributed to their learning. There was a statistically significant increase in practicing nurses' knowledge about cognitive impairment (0.68 increase), continence (2.30 increase), and its relationship to mobility. Nurses' self-report on the feedback survey demonstrated increases in knowledge, confidence, and perceptions about older people. These results suggest the modules have strong potential to enhance practicing nurses' knowledge about cognitive impairment, continence, and mobility.

Enhancing nurses' involvement in policy making: A qualitative study of nurse leaders.

Nurses can play a valuable role in not only the implementation but development of general and health policies. However, evidence indicates limited involvement of nurses in politics and general health policy making owing to individual, interpersonal, and systematic barriers. Strategies are required to increase nurses' participation and engagement in policymaking. However, no studies explored the perspective of nurse leaders in policy making roles and how to improve nurses' involvement in policy making. To explore strategies to enhance nurses' involvement in policy making from the perspective of nurse leaders. A qualitative descriptive study was conducted. Semistructured interviews were conducted with a purposive sample of 11 nurse leaders with at least one year of experience in policy making. Data were analyzed using a thematic analysis approach. The COREQ guidelines were followed for reporting. Five themes were generated: strategically revisit and implement educational approaches, becoming transformative leaders, improving social image of nurses, developing triadic partnerships, and empowering nurses through reflective and supportive mechanisms. Nurses' involvement in policymaking can be enhanced by implementing grassroots-level educational strategies, managerial-level empowerment efforts, and social mechanisms focused on improving the social image of nursing. Self and professional role empowerment through education, increasing awareness, and improving the social image of nursing can boost nurses' involvement in policymaking. Nurse leaders, national and global nursing associations, and nursing regulatory bodies should collaborate with associations of nursing colleges to design nurse policymaking competencies framework and contextually tailored strategies to enhance nurses' engagement in policymaking.