Champion Nursing Research Articles

An Interview With Susan Reinhard.

This column addresses how AARP, a consumer organization, is leading a Center for Health Equity through Nursing. The Center is working to support nursing to mitigate the nursing workforce crisis. Susan C. Reinhard is a senior vice president at AARP, directing its Public Policy Institute (PPI), the focal point for public policy research and analysis at the state, federal, and international levels. She leads PPI's family caregiving initiatives and serves as the chief strategist for the Center to Champion Nursing in America, a national resource center created to ensure that America has the highly skilled nurses it needs to provide care in the future. As a previous deputy commissioner of the New Jersey Department of Health and Senior Services, Reinhard led the development of policies and nationally recognized programs for family caregiving, consumer choice, and community-based care options. She is a fellow of the American Academy of Nursing, the Gerontological Society of America, and Salzburg Global. She holds a master's degree in nursing and a PhD in sociology.

Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them?

Background and objectiveThe prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital.Materials and methodsA prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting.ResultsThe surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7).ConclusionDUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.

Denise Chaffer vows to champion nurses’ pay, safe staffing, and retention and recruitment

Denise Chaffer vows to champion nurses’ pay, safe staffing, and retention and recruitment

2020: International year of the nurse and midwife

2020 will be a great year to champion nursing and midwifery, as it is both the bicentenary of Florence Nightingale's birth and The Year of the Nurse and the Midwife, Ian Peate explains

Rapid Response Team-Quality Champion Registered Nurse: Observations and Perceptions.

Operationalization of the rapid response team (RRT) and its quality champion (QC) nurses at a community hospital is unique and provides benefits not entirely captured by analysis of mortality data. The purpose was to determine the perceived benefits of the RRT at the facility and behaviors and activities observed during actual RRT responses. Also examined was the timeliness of the RRT calls. This was a mixed-method study including qualitative (interviews, focus groups, and surveys) and quantitative (retrospective chart reviews) data collection. Themes included teaching/education, foster development of critical thinking skills, expertise/resource, communication/facilitation/go-between, safety net/security, validation, and advocate/foster collaboration. RRT calls were made quickly after clinical deterioration. Benefits of the RRT-QC registered nurse were extensive. Observations showed support, education, and teamwork in an effort to improve outcomes and support clinicians.

The Robert Wood Johnson Foundation and AARP Story:: How Our Partnership Advanced the Future of Nursing

The Robert Wood Johnson Foundation’s (RWJF’s) and AARP’s partnership to create the Center to Champion Nursing in America (CCNA) was crucial to advancing the Future of Nursing: Leading Change, Advancing Health report recommendations. By housing CCNA at a major consumer organization (AARP), RWJF brought prominent attention to issues that are critical to consumers and the nursing profession. This article describes the partnership and the essential involvement of nursing organizations and their outside partners to strengthen nursing education, enable all nurses to practice to the full extent of their education and training, promote nursing leadership, and expand workforce diversity.

Winning strategies for full access to care.

The Center to Champion Nursing in America and the Future of Nursing: Campaign for Action envision everyone in America can live a healthier life, supported by nurses as essential partners in providing care and promoting health equity and well-being. This column describes the history of partnerships created in support of these efforts and strategies learned through grassroots efforts. The discussion offers an example of how one person's experiences and education led her to positions in support of actions designed to promote healthier life by all and practical strategies everyone can use in support of the goal of promoting care, health equity, and well-being for all Americans.

National Education Progression in Nursing (NEPIN): Developing Leadership Capacity for Organizations.

In 2011, the Robert Wood Johnson Foundation and the Center to Champion Nursing in America set a course to address the recommendations of the Institute of Medicine's Future of Nursing report. In response, the Academic Progression in Nursing (APIN) provided national leadership for advancing nursing academic progression. A new entity, the National Progression in Nursing Education Collaborative, has formed to continue the important work started by APIN.

Interrater Reliability of the Braden and Braden Q by Skin Champion Nurses

The interrater reliability of the Braden Q skin risk assessment scale has never been reported. The purpose of the study was to assess the interrater reliability among pediatric Skin Champion (SC) nurses with the use of the Braden and Braden Q scales. The pilot study included 16 paired SC nurses. Each pair of nurses attempted to assess 8 patients using the Braden and Braden Q scales. However, patient care requirements at the time of the study assessments limited the number slightly. The actual number of assessments with the Braden scale was n = 52 and the Braden Q was n = 63. The Intra-class Correlation Coefficient (ICC) for the Braden scale was 0.894, 95% confidence interval (CI) (0.823, 0.938), which is excellent agreement. The ICC for the Braden Q was 0.726, 95% CI (0.585, 0.824), which is fair to good agreement. Among the six subcategories on the Braden scale, mobility and activity had higher agreement scores among the SC nurses. Among the seven subcategories on the Braden Q scale, mobility and sensory perception had higher agreement scores. Nutrition and friction/shear subcategories on both scales had the lowest agreement scores. Subcategories with the lowest agreement usually have the greatest measurement error. Possible sources of error include unclear definitions of scoring criteria, different clinical data pulled from different locations in the chart. Error can be reduced by clarifying the subcategory definitions and standardizing the data used for the assessment and the location of each data point in the EMR. A high interrater agreement is the goal because it provides confidence that the scale is used reliably to identify high risk patients who require additional care to prevent harmful events.

C5 Improving Documentation of Components of Pain Re-Assessment in the Electronic Medical Record

The purpose of this project was to determine if matching components of the EMR to nursing workflow would increase compliance with required documentation. Pain champion nurses throughout the healthcare system conducted documentation audits of the components of pain re-assessment, including pain intensity score, respiratory rate, respiratory characteristics and the Pasero Opioid Induced Sedation Scale (POSS). Results revealed significant non-compliance with documentation requirements. Nurses reported that documentation of pain re-assessment was confusing and difficult because of the need to navigate to numerous locations in the EMR. A team of nurses, including pain specialists and clinical informaticists, collaborated to re-design the EMR by using reminders and carry forward logic, simplifying documentation and matching it to nursing workflow. Preliminary recommended changes were reviewed by bedside nursing associates for input. Shortly after implementation of the EMR changes, nurses received mandatory education on utilization of the new EMR design. Post-implementation audits revealed substantial improvement in compliance with documentation of respiratory characteristics and the POSS. Results of 53 chart audits prior to the implementation of the EMR changes showed that RNs were documenting the POSS only 37% of the time. Respiratory characteristics were charted 68% of the time and pain intensity was charted 71% of the time. After implementation 85 charts were audited which revealed that the POSS was charted 63% of the time and respiratory characteristics 70% of the time. Of note is that both the POSS and respiratory characteristics were made required fields when the EMR was updated. In contrast, documentation of pain intensity was not a required field which may explain why charting of the pain intensity dropped to 57% post implementation. Design of the EMR in collaboration with pain specialists and informaticists can improve compliance with pain re-assessment documentation. The use of required fields seems to be particularly important in driving compliance.

Growing Diverse Nurse Leaders: The Current Progress of the Future of Nursing Campaign for Action

On December 1, 2010, The AARP Foundation and the Robert Wood Johnson Foundation launched the Future of Nursing: Campaign for Action. This national campaign was created to implement the Institute of Medicine’s (IOM) recommendations in its historic Future of Nursing: Leading Change, Advancing Health report (2011). 1 Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. National Academies Press, Washington, DC2011 Google Scholar For the first 2 years, the campaign—managed by the Center to Champion Nursing in America (CCNA), a joint initiative of the AARP Foundation, AARP, and the Robert Wood Johnson Foundation—organized itself in a 2-pronged approach. First, the CCNA built field operations by developing action coalitions (ACs) in each state and in the District of Columbia. Second, “pillars” and their strategies were prioritized, based on the IOM’s 8 sets of recommendations that pertained to: •Transforming Nursing Education •Promoting Nursing Leadership •Improving Access to Care •Fostering Interprofessional Collaboration •Collecting Workforce Data •Increasing Diversity in Nursing.

The Competency/Outcomes Model: Advancing Academic Progression.

This article describes the Competency Model (CM) as a promising curriculum framework to foster academic progression from the associate to the baccalaureate degree in nursing. The CM was identified by the Center to Champion Nursing in America as one of four seamless nursing academic progression models to streamline nursing academic progression. It is built on a foundation of authentic collaboration between education and practice partners to develop and maintain explicit, current, practice-relevant nursing education outcomes. Salient features and exemplars were collected from a convenience sample of education practice partnerships across the country that have implemented the CM. Characteristics, trends, and variations in the CM from different state, regional, and local approaches are described and contrasted. A comparison of varied approaches in CM design and implementation demonstrates its versatility to support seamless academic progression and fortify education and practice collaboration.

Addressing the Global Zika Epidemic Locally: An Interprofessional Model of Universal Screening at One Center.

Escalating evidence for the fetal impact of Zika virus infection required a change in care by all prenatal providers. This article describes an effective model of rapid implementation of universal prenatal screening at one hospital and its network of community health centers for a large and diverse immigrant population exploring the challenges, experiences, and lessons learned. Implementation of national recommendations required a workflow change, challenging a system with a heterogeneity of settings and providers. Using a physician clinical champion and advanced practice nurses in the roles of logistical coordinator and liaison to the network, Zika screening was embedded into prenatal intake visits at both the hospital and community health centers. Challenges addressed include varied medical record systems, acceptance by patients, providers, and community health center leadership, as well as culturally appropriate outreach to diverse ethnic and linguistic communities. In 6 months, the prenatal screening rates increased from 20% to 88%, which resulted in the identification of more than 300 pregnant patients at risk of exposure to Zika virus. This model offers key lessons for emergency preparedness in heterogeneous, safety net hospital settings.

Implementation of a Modified Bedside Handoff for a Postpartum Unit.

The most frequent cause of sentinel events is poor communication during the nurse-to-nurse handoff process. Standardized methods of handoff do not fit in every patient care setting. The aims of this quality improvement project were to successfully implement a modified bedside handoff model, with some report outside and some inside the patient's room, in a postpartum unit. A structured educational module and champion nurses were used. The new model was evaluated based on the change in compliance, patient satisfaction, and nursing satisfaction. Two months after implementation, there was an increase in nursing compliance in completing all aspects of the model as well as an increase in both patient and staff satisfactions of the process. Replicating this project may help other specialty units adhere to safety recommendations for handoff report.

Nurses leading change to advance health

BackgroundThe article includes a review of selected past and current leadership initiatives as well as a summary of three leadership meetings convened by The Center to Champion Nursing in America, a partnership of the Robert Wood Johnson Foundation (RWJF), AARP and the AARP Foundation. PurposeThese “Leadership in Action” meetings were designed to address the Campaign for Action’s (CFA) goal to increase the number of nurse leaders in health- and health care-related boardrooms at the local, state and national levels. MethodsRWJF supported key nursing organizations in initial discussions around integrating state and national efforts to get more nurses onto boards leading to a active vibrant coalition making significant progress. ConclusionThis article concludes with a call to action encouraging all nurses to consider board service as an essential component of improving health and health care and to do their part to help build a Culture of Health in the United States.

RN to BSN at the Community College: A Promising Practice for Nursing Education Transformation

Provision of a postlicensure Bachelor of Science in Nursing (BSN) by the community college was identified as a promising model of academic progression by a learning collaborative of nursing educators, practice partners, and other stakeholders formed by the Center to Champion Nursing in America (CCNA). Successes and challenges of implementing a Registered Nurse to Bachelor of Science in Nursing (RN - BSN) program at the community college (CC) are shared. The model has the potential to increase access to affordable streamlined academic progression through building on existing infrastructure. As programs mature, additional data should be evaluated regarding their impact.

Gaining independent prescriptive practice: one state's experience in adoption of the APRN Consensus Model.

Nurses are increasingly encouraged to be active participants in health policy. This article provides an exemplar of how nurse practitioners (NPs) in one state, North Dakota, used strategic policy actions to obtain independent prescriptive privileges. Consistent and clear communication among NPs and with key stakeholders, including legislators, contributed to a positive policy outcome. North Dakota nurse leaders in this initiative have shared their experiences with a variety of audiences including other state boards of nursing and NP organizations in states such as New York, South Dakota, and Louisiana. In addition, a webinar sponsored by the Center to Champion Nursing in America at AARP featured several of the North Dakota NP leaders, who shared their reflections of this experience and the strategies they used. Regulatory environments and public policies will continue to significantly influence the future of all nurses. This case study of one state can be useful to NPs and other nurses seeking meaningful policy change through laws or regulations with regard to scope of practice or other health policy issues.

Promoting Midwife‐Provided Gynecologic Care: With Women for a Lifetime

Promoting Midwife‐Provided Gynecologic Care: With Women for a Lifetime

NPs of the Future Require Changes in the Present

PhD, NP T he groundbreaking Institute of Medicine report “The Future of Nursing: Leading Change, Advancing Health” was released in October 2010. This consensus report mandates a transformation of nursing at the levels of practice, education, and leadership in order to more fully realize the potential of nurses to help reshape health care. Various implementation actions to realize these objectives have been offered through the Robert Wood Johnson Foundation’s Future of Nursing Campaign and the AARP Center to Champion Nursing. The IOM report stresses, “...nurses must be allowed to practice in accordance with their professional training, and the education they receive must better prepare them to deliver patient-centered, equitable, safe, high-quality health care services; engage with physicians and other health care professionals to deliver efficient and effective care; and assume leadership roles in the redesign of the health care system.”...It “will require changes in nursing scopes of practice, advances in the education of nurses across all levels, improvements in the practice of nursing across the continuum of care, transformation in the utilization of nurses across settings, and leadership at all levels so nurses can be deployed effectively and appropriately as partners in the health care team.” Throughout 2011 numerous nursing programs, organizations, and agencies have initiated strategies to implement these mandates for change. Having a clear vision of the nurse of the future is essential before changes in scope of practice and education can be made. These changes will have a great impact on nurse practitioners (NPs) if they continue to believe that the most important component of their role is being a nurse. Thus, NPs must be involved in these decisions about basic changes in nursing. As well as being well-qualified clinicians, NPs must be the leaders of the future. Many things in the IOM report will require the cooperation of other professions, organizations, or agencies. Helping strengthen the scholarship in nursing journals does not. This movement should arise within nursing. As an editor, I would request that one essential change be in the quality of articles submitted to nursing journals. A review of articles in health care journals is an eye-opening experience. My evaluation is that some of what is printed in many journals does not merit publication. At the same time, there seems a dearth of high-quality nursing research in particular, and the best articles are often seen in medical journals or journals of other disciplines, which may have the greatest credibility and perhaps the broadest dissemination of ideas. While it is a laudatory accomplishment that nurses are doing research and getting it published in these venues, this approach leaves nursing journals bereft of some of the articles that would enrich them and increase the scholarship and credibility of nursing journals. Do nurses really value and respect nursing publications? When nurses fail to quote nurse authors or articles in nursing journals in their own writing, I believe it is a reflection of deepseated beliefs that have to change for nursing leadership to develop.

The Institute of Medicine Report on the Future of Nursing: A Legacy for Nursing Leadership

Although nurses have long championed for patients and sought to provide high-quality, patient- and family-centered care, our healthcare system too often fails to provide optimum services. The Robert Wood Johnson Foundation (RWJF), the largest US-based health and healthcare philanthropy, and the AARP Center to Champion Nursing in America, part of the largest US consumer organization, have joined forces to help remake our healthcare system. The two organizations have embarked on a Campaign for Action that builds on the blueprint in the Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” 1 Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. The National Academies Press, Washington, DC2010http://www.nap.edu/catalog/12956.html Google Scholar for transforming the nursing profession to enhance the quality and value of healthcare. RWJF has long invested in nursing programs, and AARP has advocated social change on behalf of older people for more than 50 years. With the backing of RWJF and AARP, nurse leaders have a unique opportunity to truly transform our profession and improve patient care. Although nurses have long championed for patients and sought to provide high-quality, patient- and family-centered care, our healthcare system too often fails to provide optimum services. The Robert Wood Johnson Foundation (RWJF), the largest US-based health and healthcare philanthropy, and the AARP Center to Champion Nursing in America, part of the largest US consumer organization, have joined forces to help remake our healthcare system. The two organizations have embarked on a Campaign for Action that builds on the blueprint in the Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” 1 Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. The National Academies Press, Washington, DC2010http://www.nap.edu/catalog/12956.html Google Scholar for transforming the nursing profession to enhance the quality and value of healthcare. RWJF has long invested in nursing programs, and AARP has advocated social change on behalf of older people for more than 50 years. With the backing of RWJF and AARP, nurse leaders have a unique opportunity to truly transform our profession and improve patient care.