Staff Education Program Research Articles

A mixed-methods evaluation of a dementia education program for hospital staff and volunteers in Melbourne, Australia

ABSTRACT People with dementia have a high likelihood of being hospitalized at some point during the disease process. Recent research has found that more can be done to improve dementia care in hospitals. One of the strategies suggested to help achieve this objective is to provide dementia education programs to hospital staff. Such programs have the potential to improve the knowledge, attitudes, and skills of staff in caring for people with dementia to optimize their in-hospital experiences and clinical outcomes. This paper reports a mixed-methods evaluation of a dementia education program delivered to staff at a hospital in Melbourne, Australia. The quantitative evaluation found significant improvements in participant’s knowledge of dementia but did not show significant improvements in “social comfort,” a measure of how comfortable respondents are around people with dementia. Qualitative interview data supported the quantitative finding regarding improvements in knowledge about dementia and demonstrated participants were largely satisfied with the content of the education program. However, qualitative data also indicated a problem with engagement with some non-clinical staff. There is a need to improve the quality of care for patients with dementia in hospitals, and this study shows that a dementia education program can be effective in improving staff knowledge about people with dementia.

Revisiting Therapeutic Communication as an Evidence-Based Intervention to Decrease Violence by Patients Against Staff on Psychiatric Wards—A Quality Improvement Project

Background Violence against healthcare workers continues to be a widespread problem and adversely impacts both healthcare providers and consumers. Objectives To evaluate the effectiveness of a staff education and training program in therapeutic communications in decreasing violence by patients against staff in an acute inpatient behavioral hospital. Further, the project measured the effect of the training on the self-efficacy and knowledge level of the 15 recruited staff in the use of therapeutic communications, and its overall impact on the participants’ reaction, learning, behavior and observed results at the hospital. Methods This study used a pretest and posttest design. Results There was a decrease (73%) in violence incidents which correlated with the staff training and education sessions compared with violence occurrence incidents during the 12 weeks preceding the implementation. There was also a significant increase in the staff’s self-efficacy, {t(−11.4), df = 114, p < 0.001}, and knowledge level {t(−10.40), df = 14, p < 0.001)} in the use of therapeutic communications, and an overall positive impact on staff’s reaction, learning, behavior and observed effects as a result of the training program. Conclusion Staff training in effective therapeutic communications had a multidimensional effect, the most important was its effect on decreasing violence. These findings underscore the need to revisit and emphasize therapeutic communications in promoting a safety culture in behavioral health settings.

Impact of COVID-19 Pandemic on Reusable Device Pre-Cleaning Training for Front-line Staff

High-level disinfection and sterilization are complex processes, requiring initial and ongoing training of frontline staff.1 A key component of appropriate disinfection and sterilization is point-of-use pre-cleaning performed by front-line staff. Our facility implemented an annual hospital-wide education and competency program for staff that perform pre-cleaning of reusable medical devices.

Implementation and improvement of a routine suicidal ideation screening process for an ambulatory, academic NCCN-designated center.

294 Background: From May – August 2021, outpatient suicidal ideation-related safety events nearly doubled from the three years prior at an academic NCCN center. This rise in events challenged staff and revealed improvement opportunities for suicide prevention, such as routine screening for suicidal ideation (SI) in the ambulatory setting. In addition, the COVID pandemic introduced an added layer of vulnerability to cancer patients, who are at an increased SI risk compared to the general population. Methods: From August 2021 - 2023, a multidisciplinary team developed and implemented a routine SI screening, intervention and escalation process that included a staff education program, a process-aligned EHR build, a metric dashboard, and a quality improvement-control plan. The vision was to identify all patients experiencing SI and support them with timely and compassionate care. A step-up metric target approach was used to set quarterly goals. The overarching goal was to screen at least 70% of eligible patients by the end of fiscal year 2024. The new process went live organization-wide on July 31, 2023. Following implementation, various improvement opportunities were identified with indicators including performance metrics, process audits, patient case reviews, and stakeholder feedback. Initial improvement efforts focused on clinics and sites that were screening &lt; 25% between FY24 Q1 and Q2. Continued collaboration between Quality Improvement and clinic leaders revealed improvement opportunities in identifying eligible patients and staff screening practices. Impactful interventions addressed patient identification and staff coaching. Results: As a new process, the overall screening rate started at 0% and increased to 48% over FY24*. Conclusions: Overall, a new SI screening process was successfully implemented, and improved with diligent PDSA work, yet metric goals were not achieved. Many factors may have contributed to underperformance. Ongoing evaluation and collaboration with stakeholders are crucial for continued improvement. Beyond these efforts exists the social and cultural stigma of suicide, which may have limited the impact of improvement endeavors. Results may demonstrate further need for open and supportive discussion with staff, patients, and the larger healthcare community. Data time range: 7/31/23-5/21/24.* FY24 + Quarter Metric Goal Screening Rate Q1 40% 35.7% Q2 50% 34.5% Q3 60% 41.2% Q4 70% 47.8%

“Everyone has a role in Rehabilitation” - Delivering staff education on rehabilitation skills in a post-acute rehabilitation unit

Abstract Background Due to a combination of disrupted services, it was observed that there was a gap in nursing and HCA knowledge of their crucial role within the rehabilitation process for the patients in an older person's post-acute rehabilitation unit. The purpose of this study was to highlight the importance of delivering nursing and healthcare assistant care (HCA) through the lens of goal specific rehabilitation. Methods A staff education programme was designed covering topics of rehabilitation including interdisciplinary team working, therapy group interventions, role of HCA in rehabilitation, personal care, toileting, continence, pressure areas, manual handling, weight bearing status, pain management, mobility aids, equipment, orthopaedic braces and physical activity recommendations in the older adult. A pre and post knowledge-based questionnaire was completed specific to each topic with maximum score 100% indicating full knowledge of the topic. Handouts and resources were created and provided at each session. Education was facilitated by an OT and PT, on a weekly basis. Participants were given the opportunity to provide feedback on the education session. An analysis of the pre/post questionnaire scores was completed using Microsoft Excel. Results Of the 26 staff (HCA and nurses) on the unit, 23 completed the education. Staff scored an average of 45% on the pre-education questionnaire and 76% on the post-education questionnaire. There was a significant increase in the post education session score (p&amp;lt;0.0001). Participants reported benefited from education session (87% strongly agreed n=20, 13% agreed n=3). Conclusion Peer to peer staff educations within the MDT improved knowledge in core aspects of rehabilitation care. To enhance patient experience and outcome the full MDT should feel part of the rehabilitation programme and be aware of the individuals' goals and their role to achieve the goal. This education initiative was beneficial in reinforcing the rehabilitation ethos of the ward and addressing gaps in ward staff’s knowledge.

Evaluation of an eating disorder screening and care pathway implementation in a general mental health private inpatient setting

BackgroundGeneral mental health inpatient units hold a valuable place in the stepped system of care, and for identification and treatment of people with eating disorders (EDs) or disordered eating behaviours (DEBs). This study aimed to pragmatically evaluate an evidence-informed screening and care pathway, alongside a staff education program, implemented to improve identification and treatment access for consumers with EDs and DEBs, with co-occurring psychiatric conditions, on a general mental health ward.MethodsA mixed methodology design was mapped to the RE-AIM implementation framework. It encompassed medical record audits across two 3-month time points pre and post implementation of the pathway, and key informant consumer and health professional interviews.ResultsProcess and implementation data were compared for three-month periods pre (2019, n = 348) and post-implementation (2021, n = 284). Post-implementation, intake SCOFF screening occurred in 94.7% of admissions. People with ED/DEBs diagnoses were 35 times more likely to have a SCOFF score ≥ 2 (OR = 35.2, p < .001) with the odds of identifying previously undiagnosed DEBs 3.3 times greater (p = .002). Post-implementation, for those with an ED/DEB, dietitian referrals (p < .001) and micronutrient supplementation (p = .013) were more likely. For those with weight and height data, both absolute (-1.1 kg ± 2.2 vs. 1.3 kg ± 2.3; p < .001) and percentage weight change were significantly higher post-implementation with similarities across BMI categories. Universally, consumers and health professionals expressed that the service had “changed care for the better” encouraging therapeutic relationships, mediated by trust, that resulted in better consumer outcomes. 50 health professionals undertook tailored ED and meal support therapy education. They noted that their knowledge and confidence improved allowing value to be seen in understanding EDs and the role for care within general mental health.ConclusionsThis study demonstrated that an articulated screening and care pathway could be feasibly implemented in general mental health. The evaluation demonstrated advances in ED detection and management with noted improvements in management access, care planning, physical monitoring and weight gain outcomes. Understanding stakeholders’ experiences of new care practices enabled the identification of enablers and barriers for implementation, and avenues to optimise care for consumers with EDs in the general mental health setting.

Use of digital technologies for staff education and training programmes on newborn resuscitation and complication management: a scoping review

BackgroundPoor-quality care is linked to higher rates of neonatal mortality in low-income and middle-income countries (LMICs). Limited educational and upskilling opportunities for healthcare professionals, particularly those who work in remote...

Improving Hotel Environmental Performance via Green Training, Green Performance Management, and Green Employee Involvement: A Systematic Study

This study investigates how Green Human Resource Management Practices (Green Training, Green Performance Management, and Green Employee Involvement) affect Hotel Environmental Performance in Dera Ismail Khan. A total of 190 hotel employees contributed to gathering the data, which was then analyzed by SPSS. The results show that the Environmental Performance of Hotels is greatly affected by Green Training, Green Performance Management, and Green Employee Involvement. The findings highlight the value of investing in education and awareness programs for staff to encourage sustainable behaviors. To further improve environmental results, it is important to incorporate green measurements and targets into performance management systems and to encourage employee participation in environmental initiatives. This research helps fill in the gaps in our knowledge of sustainable hospitality practices in low-income areas. Insights gained from this study will help hoteliers and other stakeholders to improve environmental performance and a better fit with the worldwide push for sustainability.

A SCOPING REVIEW OF SYSTEMS-LEVEL INTERVENTIONS FOR FALL PREVENTION IN LONG-TERM CARE

Abstract Older adults residing in long-term care facilities (LTCFs) are at high risk for falls. In addition to individual resident-level interventions to prevent falls and fall-related injury (FRI), system-focused interventions are also necessary to adequately address fall prevention. Relatively little attention has been given to research involving systems-focused interventions. We aimed to synthesize studies on the effects of system-focused interventions for fall and FRI prevention in LTCFs with the goal of identifying promising strategies and gaps. We searched Medline, CINAHL, and EMBASE databases from 2017 to 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline. We conducted a narrative synthesis to summarize included studies. In the initial review, 301 studies were identified and underwent title and abstract screening resulting in 98 articles were retrieved for full-text review. Fifteen studies were included in data extraction. Fall prevention interventions evaluated in LTCF settings include: (1) multicomponent fall prevention programs, (2) staff education programs, (3) training in safe handling/transfers, (4) environmental adaptations, (5) electronic health record algorithms and prompts, (6) local culture change, (7) video analysis of falls to change local interventions, and (8) facility-level physical activity programs. About half of reported studies reported significant effects of system-focused interventions to reduce fall and FRI in LTCFs. Multicomponent fall prevention programs and physical activity interventions are the most effective systems-level interventions, while electronic health record interventions were the least effective. Overall, little attention has been given in the literature to evaluation of environmental adaptations at the systems level.

Improving care for patients who experience miscarriage in emergency departments: a practice innovation.

Vaginal bleeding during pregnancy is a common patient presentation in emergency departments (EDs), and in some cases this will occur due to miscarriage. However, there are several barriers to effective and sensitive communication with patients experiencing a miscarriage. Women presenting to EDs who are experiencing a miscarriage are more likely to be psychosocially vulnerable and less satisfied with their care compared with those seeking care in the outpatient setting. There is a gap in nursing and advanced practice provider preparation regarding techniques for breaking bad news to patients in the ED setting. At one high-volume, urban ED in the US, an education programme for staff regarding best practice in breaking bad news to patients experiencing a miscarriage was developed based on an established protocol. The intention was to increase the confidence levels of nurses and other healthcare professionals in breaking bad news to these patients. After the education programme, many participants self-reported increased confidence in breaking bad news and comfort in managing patients' emotions. The results can be used to inform education for healthcare professionals who deliver bad news in the ED and other departments.

Compression therapy for NHS inpatients with leg ulcers: a literature review.

Leg ulcers are common, distressing and painful for patients, and are a significant financial burden to healthcare providers. Compression therapy is the mainstay of treatment for venous leg ulceration. Several studies have evaluated leg ulcer management and compression therapy in the community. However, little is known about the prevalence of leg ulceration and use of compression therapy in acute hospitals. The aim of this study was to explore the published literature on the use of compression therapy for inpatients with leg ulcers in UK National Health Service hospital settings. A literature search was undertaken to identify published papers reporting on inpatient leg ulcer populations and the use of compression therapy in hospitals using the following databases: CINAHL, MEDLINE Complete, Embase and PubMed. The literature review identified 364 articles, of which three met the eligibility criteria. These studies reported on the prevalence of leg ulceration, the number of Doppler assessments conducted for patients and the use of compression therapy. This review confirmed a lack of information on the prevalence of hospital inpatients with leg ulcers, and identified the need to conduct prevalence audits, establish leg ulcer services to streamline inpatient leg ulcer care and provide staff and patient education programmes.

Improving the Management of Adults With Mild Traumatic Brain Injury: An Initiative to Reduce Unnecessary Computed Tomographic Scans in the Emergency Department.

The overuse of computed tomographic (CT) scans for patients who present to the emergency department (ED) after mild traumatic brain injury (mTBI) has been well-documented. The Canadian Computed Tomography Head Rule (CCHR) is a validated tool to guide ED providers in determining the need for emergent CT of mTBI patients. The purpose of this project was to reduce radiation exposure and ED length of stay by using the CCHR to decrease unnecessary CT scans in adults with TBI. Cost of care was also estimated. The CCHR implementation strategy included an education program for ED staff. The use of the CCHR was promoted throughout the intervention period. The outcomes measured were the number of CT scans ordered, ED length of stay, and the cost of avoidable CT scans. Data were collected through medical record reviews completed by the project leader and were evaluated using the independent samples t test. A total of 600 medical records were reviewed. There was a significant difference between adherence to the CCHR before (M = 64.6%) and after provider education (M = 74.3%). The percentage of CT scans that could have been avoided significantly decreased from baseline (M = 0.63) after provider education (M = 0.46). Length of stay for mTBI patients who were managed based on the CCHR (M = 184.9) was significantly less than the length of stay for those who were not (M = 260.1). The cost of avoidable scans was decreased by 37% over the course of the project. There were no incidents of missed diagnosis found. By increasing awareness of the CCHR and promoting its use, the number of head CT scans ordered, cost of care, and ED length of stay for patients who present after mTBI were significantly improved.

Safe and sound: Strengthening cybersecurity in healthcare through robust staff educational programs.

This article emphasizes the importance of comprehensive cybersecurity education programs in the healthcare industry. The rapid development of technology in healthcare has brought numerous advantages, including electronic health records and telehealth services. However, these advancements also expose the healthcare industry to significant cybersecurity risks. The healthcare industry is an attractive target for cybercriminals due to the presence of sensitive personal and financial information. Current regulations, such as HIPAA and PIPEDA, are in place to protect patient information, but 95% of healthcare industry breaches result from human error. Healthcare organizations must prioritize robust cybersecurity measures and implement comprehensive education programs for all healthcare professionals. This article recommends tailoring educational content to different healthcare roles and incorporating ongoing learning and awareness as essential elements of cybersecurity education. Overall, it calls for a holistic approach to cybersecurity education in healthcare to protect patient information and mitigate cyberthreats.

47 The knowledge and attitudes of healthcare workers towards sexuality and sexual relationships in older persons

Abstract Background Sexuality is one of the activities of living, and a person’s sexual desire and actions can continue into old age. Even though it is a basic need for a person, organisations can often ignore this activity. Staff in the healthcare sector showed a lack of knowledge and negative attitudes towards sexuality in older persons. Older persons usually keep silent about it due to embarrassment, lack of knowledge and lack of communication. The negative attitude and lack of knowledge regarding sexuality reflects that the staff require education and other interventions to improve their knowledge and attitude towards aged sexuality. The purpose of this literature review is to identify staff knowledge and attitudes towards sexuality in older persons. Methods A literature search was conducted in the CINAHL, PubMed, Embase, Science Direct and MEDLINE databases, published from 2007. The number of articles was reduced to 10,123 when the search topic included knowledge and attitudes of staff about sexuality and sexual relationships in older persons. After screening of period, age limited, English language, title and abstract, the result was reduced to 22. Results The literature review found very insufficient studies about staff knowledge and attitudes about sexuality in older persons within the last 11 years and could not find any studies conducted in Ireland. The review appears to demonstrate that the knowledge of staff regarding sexuality and sexual relationships in older persons are inadequate. Most of the studies showed that the staff attitude towards aged sexuality remains negative. Conclusion It is evident that staff’s positive attitude will resolve one of the leading barriers to expressing sexuality. The studies show that education and training programmes for staff, supported by policies and procedures, are the important interventions that are required. The findings of this review suggest that more research and interventions are needed for health workers towards sexual relations in older persons.

342 Psychotropic medication prescriptions in a long term care setting

Abstract Background Current practice in Ireland suggests an overreliance on psychotropic medication to treat the non-cognitive symptoms of dementia. Although it is estimated that about 30% of residents in long term care in Ireland are prescribed psychotropic medication, it appears that the process of prescribing these medications including a follow up review of the prescription could be improved. Methods 16 patients in the residential unit known to be prescribed psychotropic medication were randomly selected. All data was collected between November and December 2022. Results Overall we found that documentation was poor related to the prescription of psychotropic medications. Twenty five percent of patients had no documented indication for use of psychotropic medication. In twenty five percent of cases there was no documentation of when to give psychotropic medication. Forty three percent of patients had no specific behaviour care plans in place. Sixty eight percent of prescriptions had not been discussed at psychotropic review meeting. Seventy five percent of cases had no documentation of the risk or benefits of psychotropic use. Only one of sixteen patients had documentation of a risk benefit discussion with patient and family. Psychotropic review meetings infrequently. However this audit did demonstrate that in this long term care unit psychotropic medications were administered infrequently with only 31% of patients receiving as required psychotropic medication within the previous six weeks. Conclusion While as required psychotropic medication was infrequently administered in this long term care unit, the documentation around the prescription of these medications was poor and needs to improve. Implantation of an education programme for staff will be required prior to re-audit.

Human factors in cybersecurity: Designing an effective cybersecurity education program for healthcare staff.

Leaders who promote cybersecurity education focused on the human factors of cyberattack build a resilient workforce that complements technical protections, reducing organizational risk. Cybersecurity is a priority for information technology teams, relying primarily on technology to protect systems. As technical protections mature, the vulnerability shifts to human factors. Education must focus on the risk presented by humans rather than machines. A human factors-centred education program trains human reaction to threats considering the unique healthcare environment. Leaders may look to industries, like aviation, experiencing similar technical advancement, for education practices based on human factors. This article outlines a cybersecurity education program developed for healthcare, applying strategies adopted from commercial aviation. Four core pillars of training are defined: (1) dynamic education delivery options, (2) social engineering focused simulations, (3) high-risk positions and role-based training, and (4) stakeholder and leadership engagement. The first phase of implementation is analyzed, and lessons learned defined.

Workshop (Clinical/Best Practice Implementation) ID 2001167

Background Hamilton’s Spinal Cord Injury (SCI) Regional Rehabilitation Program in collaboration with SCI Consortium is implementing tissue integrity monitoring for pressure injury (PI) prevention. An increased prevalence of PI was found in 2021 - 2022 compared to 2020 on Hamilton’s SCI Rehabilitation Unit. To address this finding, the clinical team introduced a staff and patient education program focused on PI prevention. Upon completion of this workshop, the attendees will be aware of the CQI methodology used to implement the best practices related to tissue integrity and appreciate the education pathway for both staff and patients. Methods Using a Continuous Quality Improvement model, a systematic approach was used to enhance the education model for staff and patients on skin assessment and appropriate interventions. A process map was created outlining steps for each discipline involved in skin assessment, intervention, and patient education. Education plan included Skin &amp; Wound Management workshop, individual and group patient education, daily skin check calendar for patient/staff use. The workshop will be delivered in a lecture format, ending with discussion time. Results Preliminary data post partial implementation of the education program showed a decrease of 12% in the prevalence of PIs in the patients discharged from the program between July 2022 and March 2023 compared to January 2021 – June 2022. Conclusion Preliminary results are encouraging in demonstrating that implementation of a comprehensive education plan for staff and patients using a structured framework is effective in reducing the prevalence of pressure injuries in the inpatient SCI rehab unit.

Decreasing inconsistent alarms notifications: a pragmatic clinical trial in a post-anesthesia care unit

BackgroundAlarms alert healthcare professionals of deviations from normal/physiologic status. However, alarm fatigue may occur when their high pitch and diversity overwhelm clinicians, possibly leading to alarms being disabled, paused, and/or ignored. We aimed to determine whether a staff educational program on customizing alarm settings of bedside monitors may decrease inconsistent alarms in the Post-Anesthesia Care Unit (PACU). MethodsThis is a prospective, analytic, quantitative, pragmatic, open-label, single-arm study. The outcome was evaluated on PACU admission before (P1) and after (P2) the implementation of the educational program. The heart rate, blood pressure, and oxygen saturation alarms were selected for clinical consistency. ResultsA total of 260 patients were included and 344 clinical alarms collected, with 270 (78.4%) before (P1), and 74 (21.6%) after (P2) the intervention. Among the 270 alarms in P1, 45.2% were inconsistent (i.e., false alarms), compared to 9.4% of the 74 in P2. Patients with consistent alarms occurred in 30% in the P1 and 27% in the P2 (p = 0.08). Patients with inconsistent alarms occurred in 25.4% in the P1 and in 3.8% in the P2. Ignored consistent alarms were reduced from 21.5% to 2.6% (p = 0.004) in the P2 group. The educational program was a protective factor for the inconsistent clinical alarm (OR = 0.11 [95% CI 0.04–0.3]; p < 0.001) after adjustments for age, gender, and ASA physical status. ConclusionCustomizing alarm settings on PACU admission proved to be a protective factor against inconsistent alarm notifications of multiparametric monitors.

An Overview of Blood Transfusion Services in Palestine

Blood transfusion is a vital component of the health-care system, especially considering the ongoing violent Palestinian-Israeli conflict that increases the need to maintain sufficient availability of safe blood for medical emergencies. We assessed the elements of blood transfusion services (BTS) against the guidelines of the World Health Organization guidelines to identify the achievements and gaps of the Palestinian BTS. Before the provision of the Palestinian Authority in 1994, BTS was provided by one blood bank and lacked any legislative or regulatory framework. Currently, BTS is overseen by the Palestinian Ministry of Health (MoH). There are 32 functional blood banks in the West Bank. Fourteen functional blood banks are overseen by MoH including the Central Blood Bank, which takes the role of a reference blood bank and 13 hospital-based blood banks. BTS in Palestine still lacks some of the major components required for a good national effective and safe BTS such as legislative and regulatory frameworks that are integrated within the national health system, defined standards and national guidelines on the clinical use of blood components, a national comprehensive quality assurance program for BTS, and a hemovigilance system to capture data on adverse events. In addition, there are no national blood donor programs or educational programs for staff in place.

Psychometric Testing of the Caregiver Attitudes on Substance Use in Pregnancy Instrument

ObjectiveTo modify an existing instrument used to measure the attitudes of perinatal nursing caregivers about pregnant women with substance use disorder (SUD) and to psychometrically test the new instrument: Caregiver Attitudes on Substance Use in Pregnancy (CASUD-OB). DesignInstrument modification and psychometric testing of results from a modified instrument. SettingMulti-hospital health care system in the midwestern United States. ParticipantsA total of 147 perinatal nursing caregivers (perinatal nurses: n = 131; unlicensed assistive personnel: n = 16) who worked on obstetric and neonatal nursing units. MethodsWe modified the existing instrument, and 12 experts in perinatal nursing (1 who also had expertise in SUD in the perinatal period) evaluated the items for content validity. We administered the CASUD-OB via online survey between November 2019 and December 2019. We used item reduction, calculated item–total correlations, and conducted exploratory factor analysis to modify the instrument and assessed its internal consistency. ResultsAfter psychometric testing, we reduced the number of items from 26 to 16. Through item reduction and exploratory factor analysis, we identified three subscales (Caregiver Bias, Caregiver Self-Awareness, and Caregiver Perception of Parental Fitness). The Cronbach’s alpha for the overall instrument was .92. ConclusionThis study provides preliminary evidence to suggest that the CASUD-OB may be a valid and reliable instrument for measuring nurses’ attitudes toward pregnant women with SUD. Through additional testing, this instrument has the potential to become a valuable resource to evaluate quality improvement initiatives, staff education programs, and other interventions designed to transform the attitudes of nursing caregivers toward pregnant women with SUD.