Unlicensed Personnel Research Articles

Cuidándome: A trauma-informed and cultural adaptation of a chronic disease self-management program for Latina immigrant survivors with a history of adverse childhood experiences and depression or anxiety symptoms.

To develop a cultural and trauma-informed mental health self-management program for immigrant Latina survivors of adverse childhood experiences with depression or anxiety symptoms. Guided by Barrera's five-stage process for cultural adaptation, we collaborated with multiple stakeholders including clinical psychologists, community health workers, and Latina immigrant women with a history of adverse childhood experiences and depression or anxiety to transform a chronic disease self-management program to be trauma informed, culturally appropriate, and focus on self-management of depression and anxiety symptoms. Adaptations included translating program materials to Spanish, education on how early life adversity and trauma may impact mental health, virtual delivery, more frequent and shorter sessions, and addition of graphics and written prompts in workbook materials. For the facilitator's manual, culturally relevant vignettes and guidance were added to guide participants through activities and adapt sessions based on participant needs. Barrera's five-stage process was useful for adapting a program to be both trauma and culturally informed for an underserved population disproportionately affected by trauma and limited access to mental health services. The adaptation demonstrated acceptability with Latina immigrant women and the promise of utilizing unlicensed personnel and technology for increasing the reach of mental health support. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical Issues—March 2022

Nursing scope of practice Key words: state nurse practice act (NPA), state board of nursing, decision-making framework, standards, guidance. Practice of unlicensed perioperative personnel Key words: job description, task delegation, unlicensed personnel, allied health care provider, scope of practice. Definition of a cavity for counting procedures Key words: anatomical hollow space, counting, cavity, retained surgical item (RSI), retained foreign object (RFO). Identifying retained suture needles on radiographic images Key words: suture needle size, suture needle length, radiographic imaging, counting procedures, count discrepancy.

The effect of data aggregation on estimations of nurse staffing and patient outcomes.

To examine how estimates of the association between nurse staffing and patient length of stay (LOS) change with data aggregation over varying time periods and settings, and statistical controls for unobserved heterogeneity. Longitudinal secondary data from October 2002 to September 2006 for 215 intensive care units and 438 general acute care units at 143 facilities in the Veterans Affairs (VA) health care system. This retrospective observational study used unit-level panel data to analyze the association between nurse staffing and LOS. This association was measured over both a month-long and a year-long period, with and without fixed effects. We used VA administrative data to obtain patient data on the severity of illness and LOS, as well as labor hours and wages for each unit by month. Overall, shorter LOS was associated with higher nurse staffing hours and lower proportions of hours provided by licensed professional nurses (LPNs), unlicensed personnel, and contract staff. Estimates of the association between nurse staffing and LOS changed in magnitude when aggregating data over years instead of months, in different settings, and when controlling for unobserved heterogeneity. Estimating the association between nurse staffing and LOS is contingent on the time period of analysis and specific methodology. In future studies, researchers should be aware of these differences when exploring nurse staffing and patient outcomes.

A mobile app for unlicensed support personnel who care for older adults with dementia

A mobile app for unlicensed support personnel who care for older adults with dementia

School Personnel’s Knowledge, Attitudes, and Management Practices about Diabetes Care in Shelby County, TN, and Surrounding Counties in Arkansas and Mississippi

Background: Approximately 130,000 people under age 18 years have diabetes. It is estimated that type 1 diabetes is growing at 3% per year in children and adolescents. With more children with diabetes there has been a shift in care from trained professionals to unlicensed personnel. Children and adolescents with uncontrolled diabetes are at an increased risk of developing serious health problems and reduced life expectancy. Therefore, fragmented care within the school setting only exacerbates the risk of poor health outcomes of children and adolescents with diabetes.

Pioneering Orientation Using Multiple Teaching Methods and Low-Fidelity Simulation for Unlicensed Care Providers.

Patient care assistants (PCAs) are unlicensed personnel that perform direct patient care. Providing quality orientation is critical in supporting the transition of a PCA from new staff member to competent employee. PCAs have limited to no experience with simulation in prehire training. An 8-hour orientation day, using interactive teaching strategies and simulation, was successfully implemented at a large academic healthcare institution. This article explores the various teaching methods and outcomes of the class.

Unlicensed Personnel’s Experience of Digital Signing for Medication Administration in Municipal Healthcare

Aim: To describe unlicensed personnel’s experience of digital signing lists via a smartphone application for the distribution of medication in municipal healthcare in Western Sweden. Design: A qualitative and quantitative design was used. Methods: The study included 48 unlicensed personnel, 28 of whom answered an open-ended questionnaire, while an additional 20 volunteered for individual interviews. The material was analysed by qualitative content analysis. Results: The results indicate that digital signing lists via a smartphone application are feasible, and efficient and facilitate the work. However, some aspects negatively affected the sense of security, meetings with patients and quality of care, such as an insufficient internet signal in some rural areas, difficulty remembering the password, as well as the change of focus from patient to smartphone. To improve quality of care and the meeting with the patient, it is crucial that the technology works and that unlicensed personnel develop technical skills.

Experiences of home care assistants providing social care to older people: A context in transition.

The aim was to describe home care assistants' (HCA) experiences of providing social care in older people's own homes. With the increase in average life expectancy and related growth of the elder population, addressing geriatric care needs has become an increasingly vital issue. However, the frontline workforce faces major challenges in meeting these needs, including a lack of trained professionals entering the field. A qualitative inductive design was used. A descriptive, qualitative study using focus group interviews and content analysis. The findings revealed that HCAs are active in an area facing challenges due to an older home-dwelling generation. Transfer of tasks should be reviewed considering changes to the workforce's skill mix brought on by task shifting. Certain prerequisites are needed to enable unlicensed assistive personnel to perform a good job; they also need to receive affirmation that they are a crucial workforce carrying out multifaceted tasks. To improve and maintain the pull factors of social care work, it is crucial to clarify how older people's requirements influence the daily care relation. The findings highlight HCAs' blurred responsibility when providing nursing and care to older people with multiple chronic conditions and functional disabilities. Increasing expectations are placed upon HCAs to cope with practical situations that are theoretically outside the bounds of social care. The findings contribute knowledge to further development of collaboration between social and health care providers as well as the important affirmation of this unlicensed personnel group in transition. A long-term plan is therefore needed to provide HCAs with the skills and tools they need to deliver care and support to older people with a variety of needs.

Should There be Laws Mandating Nurse Practitioner/Patient Ratios?

Should There be Laws Mandating Nurse Practitioner/Patient Ratios?

Differences in Knowledge Base at First Registered Nurse Employment Following Introduction of a Focused, High-Fidelity Simulation in a Baccalaureate Program

New graduate registered nurses (NGRNs), armed with a degree and having passed the licensure exam, regularly have difficulty in transitioning to registered nurse practice. This phenomenon has been a part of the professional community for decades. Central to the problem of knowledge gaps at hire is the debate on what competencies are required of the new graduate and what challenges the new graduate faces. In a qualitative study of NGRNs, commonalities of their experiences were elicited. Problematic communication with physicians, concern over their ability to supervise unlicensed personnel, and the impact of horizontal violence from experienced nurses were all part of the transition process. 1 Competence in the clinical setting has been found to be positively correlated with empowerment; empowerment includes such factors as courage, autonomy and innovativeness. 2 Organizational factors have a direct impact on empowerment. Academic preparation is key to communication skills and the ability to prioritize.

Alternative payment models lead to strategic care coordination workforce investments

BackgroundCare coordination is generally viewed as a key to success for health systems seeking to adapt to a range of new value-based payment policies. PurposeThis study explores care coordination staffing in four health systems participating in new payment models, including Medicaid payment reform and Accountable Care Organizations. MethodsComparative case study design is used to describe models of care coordination. Analysis of 43 semi-structured interviews with leadership, clinicians, and care coordination staff at four health systems engaged in value-based contracts. DiscussionEach of the sites engaged in significant task shifting of low-complexity care coordination activities to licensed practical nurses, medical assistants, and other unlicensed personnel freeing up registered nurses and social workers for more complex patients. Few have care coordination experience, requiring a significant investment in on-the-job training. ConclusionPayment reform is leading to a greater investment in the care coordination workforce. However, demonstrating the return on investment remains a challenge.

Application of an Evidence-Informed Health Policy Model for the Decision to Delegate Insulin Administration

In 2014, the South Dakota Board of Nursing decided to allow registered nurses to delegate diabetes care for school children to trained unlicensed personnel. The policy changes were based on a pilot study, a review of the literature, expert opinion from diabetes clinical nurse specialists, and input from stakeholders. This article retrospectively applies Loversidge's model for evidence-informed health policy to the board of nursing's process for making policy decisions and is intended to serve as an example of using a model that promotes evidence-based nursing regulation.

Assessing nursing staff's competences in mobility support in nursing-home care: development and psychometric testing of the Kinaesthetics Competence (KC) observation instrument.

BackgroundBetween 75 and 89% of residents living in long-term care facilities have limited mobility. Nurses as well as other licensed and unlicensed personnel directly involved in resident care are in a key position to promote and maintain the mobility of care-dependent persons. This requires a certain level of competence. Kinaesthetics is a training concept used to increase nursing staff’s interaction and movement support skills for assisting care-dependent persons in their daily activities. This study aims to develop and test an observation instrument for assessing nursing staff’s competences in kinaesthetics.MethodsThe Kinaesthetics Competence (KC) observation instrument was developed between January and June 2015 based on a literature review, a concept analysis and expert meetings (18). The pilot instrument was evaluated with two expert panels (n = 5, n = 4) regarding content validity, usability and inter-rater agreement. Content validity was assessed by determining the content validity index (CVI). The final instrument was tested in a cross-sectional study in three nursing homes in the German-speaking part of Switzerland between July 2015 and February 2016. In this study nursing staff (n = 48) was filmed during mobilization situations. Based on this video data two observers independently assessed nursing staff’s competences in kinaesthetics with the KC observation instrument. Inter-rater reliability and inter-rater agreement was evaluated using the intra-class correlation coefficient (ICC) and percentage of agreement. Construct validity was assessed by a discriminating power analysis. Internal consistency was evaluated using Cronbach’s alpha coefficient and item analysis.ResultsThe final version of the KC observation instrument comprised of four domains (interaction, movement support of the person, nurses’ movement, environment) and 12 items. The final instrument showed an excellent content validity index of 1.0. Video sequences from 40 persons were analysed. Inter-rater reliability for the whole scale was good (ICC 0.73) and the percentage of inter-rater agreement was 53.6% on average. Cronbach’s alpha coefficient for the whole instrument was 0.97 and item-total correlations ranged from 0.76 to 0.90. The construct validity of the instrument was supported by a significant discrimination of the instrument between nursing staff with no or basic and with advanced kinaesthetics training for the total score and 3 of 4 subscales.ConclusionsThe KC observation instrument showed good preliminary psychometric properties and can be used to assess nursing staff’s competences in mobility care based on the principles of kinaesthetics.

Infection Prevention and Antimicrobial Stewardship Knowledge for Selected Infections Among Nursing Home Personnel.

OBJECTIVE To assess knowledge about infection prevention among nursing home personnel and identify gaps potentially addressable through a quality improvement collaborative. DESIGN Baseline knowledge assessment of catheter-associated urinary tract infection, asymptomatic bacteriuria, antimicrobial stewardship, and general infection prevention practices for healthcare-associated infections. SETTING Nursing homes across 14 states participating in the national "Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infection." PARTICIPANTS Licensed (RNs, LPNs, APRNs, MDs) and unlicensed (clinical nursing assistants) healthcare personnel. METHODS Each facility aimed to obtain responses from at least 10 employees (5 licensed and 5 unlicensed). We assessed the percentage of correct responses. RESULTS A total of 184 (78%) of 236 participating facilities provided 1 response or more. Of the 1,626 respondents, 822 (50.6%) were licensed; 117 facilities (63.6%) were for-profit. While 99.1% of licensed personnel recognized the definition of asymptomatic bacteriuria, only 36.1% knew that pyuria could not distinguish a urinary tract infection from asymptomatic bacteriuria. Among unlicensed personnel, 99.6% knew to notify a nurse if a resident developed fever or confusion, but only 27.7% knew that cloudy, smelly urine should not routinely be cultured. Although 100% of respondents reported receiving training in hand hygiene, less than 30% knew how long to rub hands (28.5% licensed, 25.2% unlicensed) or the most effective agent to use (11.7% licensed, 10.6% unlicensed). CONCLUSIONS This national assessment demonstrates an important need to enhance infection prevention knowledge among healthcare personnel working in nursing homes to improve resident safety and quality of care. Infect. Control Hosp. Epidemiol. 2016;1-6.

Registered nurses' experience of delegating the administration of medicine to unlicensed personnel in residential care homes.

The aim was to describe registered nurses' experience in the context of delegating the administration of medication to unlicensed personnel in residential care homes. The residents in residential care homes have a need for extensive care and nursing, and large amounts of medicines are common practice. Registered nurses' workload and difficulties in fulfilling their duties, such as administration of medicines, have led to frequent delegation of this task between the registered nurses and unlicensed assisting personnel. It is, of course, a great responsibility to ensure that the care of the older people remains safe while maintaining quality in the prevailing situation. A qualitative inductive descriptive study. Data were collected using audio-recorded semistructured interviews with a purposive sample of 18 registered nurses and interpreted using manifest content analysis. The study was approved by the ethical research committee. Registered nurses found the organisation unsupportive with regard to nursing interventions. The delegation context was experienced as a grey zone; the rules and regulations were not in line with the unspoken expectation to delegate the administration of medicine to unlicensed personnel, in order to be able to manage their daily work. The slimmed organisation of residential care homes relies upon registered nurses' use of delegation of medicine administration to unlicensed assistant personnel. It becomes an inevitable assignment entailing a challenging responsibility for patient safety and the quality of care. The results of this study may contribute to a better understanding of the complexity of caring for older people in residential care homes and to improving the work environment of all healthcare personnel.

Teamwork in Acute Care: Perceptions of Essential but Unheard Assistive Personnel and the Counterpoint of Perceptions of Registered Nurses.

Teams of unlicensed personnel and registered nurses have provided hospital-based nursing care for decades. Although ineffective teamwork has been associated with poor patient outcomes, little is known of the perspectives of nursing assistive personnel (NAP). The purpose of this study was to gain insights into the perceptions of NAP and professional registered nurses (RNs) on teamwork in acute care. In a qualitative descriptive approach in a metropolitan hospital in the southeastern United States, 33 NAP participated in audio-recorded focus group sessions, and 18 RNs provided responses to open-ended electronic survey questions. Findings were examined in relation to previously identified coordinating mechanisms of teamwork: shared mental models, closed-loop communication, and mutual trust. None of the mechanisms was strongly represented in these data. In contrast to RNs' mental models, NAP perceptions of teamwork included the centrality of holistic caring to the NAP role, functional teams as NAP-only teams, NAPs and RNs working in parallel spheres rather than together, and team coordination in silos. Closed-loop communication was less common than one-way requests. Mutual trust was desired, but RNs' delegation of tasks conveyed to NAP a lack of value and respect for the NAP role, while RNs perceived a professional obligation to delegate care to ensure quality of care amid changing patient priorities. Further empirical research into NAP practice is needed to enhance understanding of teamwork issues and direct effective interventions to improve work environments and ultimately patient outcomes. © 2016 Wiley Periodicals, Inc.

Analysis of Kentucky's Law Protecting the Rights of Schoolchildren With Type 1 Diabetes Mellitus: Application of Kingdon's Policy Stream Model.

Type 1 diabetes mellitus is a chronic, life-threatening disorder that affects children of all ages. Based on data from 2008 to 2009, the Centers for Disease Control and Prevention estimates that in the United States, 191,986 youth younger than age 20 require treatment for diabetes, the majority of whom have Type 1 diabetes mellitus. These children require assistance with counting carbohydrates, testing blood glucose, and administering subcutaneous insulin. Establishing appropriate diabetes care models in schools is necessary for children's immediate safety, long-term well-being, and optimal academic performance. Kentucky House Bill 98 was passed by the state legislature in 2014 to allow unlicensed school personnel to assist children with diabetes care. The purpose of this article is to apply Kingdon's policy streams model to an analysis of a state policy allowing unlicensed school personnel to assist children with diabetes care. The article covers potential policy alternatives and concludes with a discussion of implications for nursing practice.

Developing a Job Description for Assistant Nurses at Assuit University Hospitals

AbstractBack ground: Health Care Assistants (HCA) emerged primarily to support the professional nurse and to undertake non-nursing duties under the supervision of qualified nurses. Recently unlicensed personnel have been used as substitutes for professional nurses. Aim of the study: To develop a job description for assistant nurses. Setting: The study was carried out at Assuit University Hospitals. Subjects and methods: The subjects included all head nurses working in the designated settings (n = 72) and 10% of the total assistant nurses (n = 40). Data collection tools: The data for the present study was collected using three different tools: a questionnaire sheet, an observation sheet (job analysis) and focus group discussion. Results: The present study revealed that there is no training program and orientation made for assistant nurses and there is no job description for them. There was congruency between the head nurses' opinions, job analysis and focus group discussion as regards indirect care, and environmental activities performed by assistant nurses. Recommendations: The researchers recommended a conduct training program for assistant nurses about infection control principles, communication skills, and nursing profession .Constant direct supervision by authoritative persons for assistant nurses should be established in the hospitals.

Abstract W P291: Crime Scene Investigation: Using Simulation to Assess and Demonstrate Annual Competencies

Background: It is a requirement to have licensed and unlicensed care-givers demonstrate clinical competency on an annual basis to ensure the safety of patients. It is often accomplished by the use of didactic education and skill demonstration without observing a patient safety assessment. Purpose: The purpose of using an alternative method to assess and confirm annual competencies was to create a situation that would more accurately reflect the skills required by the licensed and unlicensed personnel in the Neurologic Intensive Care Unit. Methods: Staff completed computer based learning modules that were determined by the critical care department. After the didactic was completed, personnel reserved a time for competency check-off in a patient room with a simulated patient situation. The providers were given a “report” utilizing common patient diagnoses and procedures in the ICU. A mannequin was surrounded by typical ICU monitoring devices and equipment with a focus on high-risk situations. The nurses and PCT’s were then allotted time to assess the patient and environment, identifying the errors and risks discovered in the simulated patient scenario. Correct identification of the known dangers and errors and being able to state the necessary corrections resulted in confirmed competency for the year. Results/Lessons Learned: All care-givers in the Neuro ICU verbalized satisfaction using this method of competency assessment. Staff felt as if it was an accurate demonstration of the skills required to care for critically ill patients presented in a manner that was enjoyable. The benefits to the Clinical Nurses Specialist included identification of common errors or dangers that were over-looked, which formed the teaching plan for unit-based education for the coming year. Conclusions: Simulation based skills check-off is an effective and efficient method to ascertain annual competency. Care givers were satisfied with the opportunity to demonstrate their skills in an environment that mimicked their daily practice. While accomplishing the requirement the CNS was also able to assess the learning needs of staff members.

Virtual Nursing Care for School Children with Diabetes

Access to safe health care when a nurse is not present is a public protection issue facing many boards of nursing. This is especially true in schools where a nurse is not present to provide care for children with diabetes. This study examined the safety and effectiveness of a model of care that linked trained unlicensed school personnel to registered nurses (RNs) via telehealth technology to delegate and supervise diabetes care tasks, including insulin administration. The study took place from December 2010 to May 2013, and 5,568 doses of insulin were administered safely by unlicensed personnel. Surveys taken before and after implementation measured the perceptions of parents and school personnel regarding the safety and efficacy of the model of care. Statistical results showed large degrees of effectiveness. This study provides preliminary evidence supporting regulatory changes for the delegation of insulin administration and other diabetes care tasks by RNs. Access to safe health care when a nurse is not present is a public protection issue facing many boards of nursing. This is especially true in schools where a nurse is not present to provide care for children with diabetes. This study examined the safety and effectiveness of a model of care that linked trained unlicensed school personnel to registered nurses (RNs) via telehealth technology to delegate and supervise diabetes care tasks, including insulin administration. The study took place from December 2010 to May 2013, and 5,568 doses of insulin were administered safely by unlicensed personnel. Surveys taken before and after implementation measured the perceptions of parents and school personnel regarding the safety and efficacy of the model of care. Statistical results showed large degrees of effectiveness. This study provides preliminary evidence supporting regulatory changes for the delegation of insulin administration and other diabetes care tasks by RNs. A video demonstration of a virtual RN consultation is available on the South Dakota Board of Nursing’s website http://www.nursing.sd.gov. This article was funded through grants from the National Council of State Boards of Nursing’s Center for Research Excellence and the South Dakota Department of Health.