Technology Use and Frailty for Community Dwelling Older Adults: A Scoping Review

Background: Frailty is a common geriatric syndrome defined as a state of increased vulnerability to acute stressors related to a decline in reserve. There is abundant literature on frailty interventions, however, the literature on technology as an intervention for frailty is scarce. Objectives: The purpose of this scoping review is to identify and summarize existing evidence on technology use as an intervention for frail older adults and to identify research gaps in the evidence base in order to inform future research. Methodology: This review utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a rigorous scoping review method to search the literature. A comprehensive search of computerized databases was conducted in July 2018 in the following databases published from 2013 to 2018: CINAHL, PubMed, and Academic Search Complete. Results: The database searches yielded a total of 183 articles. Forty-four duplicates were removed. There were 114 results excluded based on title and abstract ineligibility. Thirty-two relevant articles were retrieved for fulltext examination. Eighteen of the articles were excluded based on the inclusion or exclusion criteria. References of 14 included articles were hand-searched for relevant works to ensure completeness of the search. Four pertinent additional articles were identified. The final analysis included 18 articles. Discussion: Current research on technology use for frail older adults focuses on assessment and diagnosis. Methodological weaknesses limit generalizability and the validity of its findings. Few studies utilize frailty as an outcome measure, limiting available research directly related to frailty. Conclusion: More research is needed on the potential for technological tools as interventions for frailty in older adults living at home, specifically, to prevent pre-frailty and frailty. Keywords: frailty, frail elderly, aged, independent living, technology

Quality and Safety Competencies in Undergraduate Nursing Education: Where are we now?

BACKGROUND: Medical errors are the third leading cause of death in the United States. To address this problem, a concerted effort by nurse educators to integrate Quality and Safety Education for Nurses (QSEN) competencies into nursing curricula is relevant. There is a need for innovative educational strategies, faculty development, and implementation approaches to support successful QSEN competency implementation. PURPOSE: The purpose of this research was to evaluate a faculty development course that included QSEN competency education, resources, and support. METHODS: A pretest posttest design was used and 19 nursing faculty from a northeast U.S. public college participated in the program. Participants completed the National QSEN Faculty Survey before and after a 6-part QSEN competency-based training course. Descriptive statistics and the chi-square statistical test were used to compare means of pretest and post-test responses. RESULTS: Results indicated a significant increase of incorporating the QSEN competencies in nursing courses following the faculty development program. The most helpful QSEN resource was found to be the QSEN website followed by the Institute for Healthcare Improvement (IHI) in pre and post-test results. Case studies, lectures, and group projects were the most frequently used teaching strategies, and the classroom was found to be the setting where most faculty integrated QSEN competencies into their courses. IMPLICATIONS: Faculty development programs are an effective method of providing support for the integration of QSEN competencies into the undergraduate nursing curricula. Evaluation of faculty development programs is essential so that effective programs can be shared and sustained. Keywords: QSEN, competencies, faculty development, quality, safety

Health Policy Immersion Experience of Doctoral Nursing Students: A Phenomenological Study

Background: In today’s political environment, there is a significant need for healthcare professionals to be aware of health policy and its impact on practice and the population. Nursing, a respected and trusted profession, has a responsibility to increase its awareness and advocacy efforts to ensure practice and execution of responsible and ethical health policy. Objectives: The purpose of this study was to describe the lived experience of doctoral nursing students' (PhD and DNP) engagement in a week-long immersion trip to Washington, D.C. as a requirement of their mandatory health policy course. This immersion trip encompassed participation in numerous activities that focused on health policy, nursing's role in research, and its presence in the political arena. In addition to describing doctoral nursing students' lived experience, the researchers sought to discover how this experience impacts doctorally-prepared nurses’ political awareness and future interest in health policy. Methods: Data were gathered using Google Forms to obtain doctoral nursing students’ experiences after participating in a week-long Washington, D.C. immersion as part of their mandatory doctoral coursework at a Mid-Atlantic college in the United States. The survey was emailed to 43 PhD and DNP students, of which 30 met the inclusion criteria. Demographic data analysis, in addition to thematic analysis of survey responses with the aid of NVivo, were performed. Results: Four themes emerged from the analysis to describe the experience and impact that the week-long Washington, D.C. immersion had on doctoral nursing students: Knowledge and Understanding of the Political Process, Recognition of the Role Professional Nursing Organizations Play in the Political Arena, Empowerment Through Increased Awareness, and Nursing’s Role as an Advocate for the People Conclusion: Through increased knowledge and awareness of health policy, doctorally-prepared nurses may be more inclined to seek and engage in the political arena and actively participate in advocacy efforts to improve health policy and the healthcare system. Keywords: advocacy, doctoral nursing students, health policy, healthcare system, political process

Common Pitfalls in Conducting Quantitative Nursing Research: A Commentary and Suggestions to Facilitate Publication of Studies

Background: This article is a commentary on some of the common pitfalls that many researchers (including nurse researchers) experience when developing and implementing studies which impede their ability to publish their work. Purpose: The goal is to provide a summary and recommendations to assist novice nurse researchers with respect to some aspects of methodology and statistical analyses that are often overlooked and limit the validity of studies’ findings and the reliability of the results. Discussion: Specific research design attributes, data management and analyses procedures are identified that can be used to improve a study’s integrity and appeal to academic journals for publication. Conclusion: This article attempts to assist nurse researchers of all levels and in a variety of capacities to improve the quality of research and the ability to publish their studies. Keywords: Quantitative, Research, Methodology, Publication

Nursing and Antimicrobial Stewardship: An Unacknowledged and Underutilized Focal Point

Background: Nurses have the ability to play an important role in patient safety related to antibiotic use and overuse but are often not involved in antimicrobial stewardship programs (ASP). Therefore, nurses need to be educated and trained in antimicrobial stewardship (AS) so that they can more competently contribute to safe patient care. Lewin’s change theory may be utilized as a framework for understanding the integration of nurses into these efforts. Objective of the Study: This integrative review is intended to explore the role of nurses in AS and discuss the importance of nurses needing to be educated, trained, and competent in this so that they can become more actively involved in such programs. Methodology: Articles were gathered from the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Google Scholar from June 2015 to December 2019. A five-year time frame was implemented to ensure that the most current information was included. Seventeen peer reviewed, written in English, original research studies that met the inclusion criteria (from the original 107 studies) and conducted in Australia, Canada, Scotland, South Africa, and the United States were included in this review. Results: The identified 17 recent studies focused on nursing and AS. Six major themes emerged, including nurses’ competency requirements and training related to AS, antimicrobial knowledge and educational gaps, perceived role of the nurse, nurses’ attitudes toward antimicrobial use, nurse and provider perspectives on ASPs, and nurses’ valuable contributions to AS. Discussion: This integrative review found that including nurses in AS would benefit ASPs and that finding ways for facilities to organize and implement such efforts is vital. This ties into the first stage of Lewin’s change theory of “unfreezing” and recognizing that the current (or old) way of practicing is in need of change. The literature reviewed provides evidence that nurses have the capacity to be an integral part of any ASPs and that they can help combat antimicrobial resistance in myriad ways when provided the necessary training and education. All studies reviewed found positive aspects to having nurse representation. However, there are gaps in antimicrobial based knowledge on the part of the nurses. Limitations: The limitations of this integrative review include the fact that the publications used were limited to a five-year timeframe and came specifically from nursing journals or have at least one nurse author contributor. Also, the current review included five international studies where the nurses’ scope and standards of practice may be different from those in the United States. A search of the grey literature reports related to AS was not conducted and could have provided additional valuable information as well. Conclusion and Recommendations: Nursing participation is needed in all ASPs. Empowering and educating nurses to feel confident and competent in this role will help to mitigate the overuse and misuse of antimicrobials. The ASPs most likely vary from institution to institution and future research should provide a framework for how to best disseminate information to nurses. Keywords: Antimicrobial Stewardship, Antibiotic Training, Nurses

Evidence-based Nursing Practice in New York State: A Delphi Study

Background. Today’s landscape of population health, economics, and educational delivery methods have influenced the progress and implementation of nursing practice built on the best evidence. International literature has documented barriers to implementing and sustaining evidence-based practice (EBP). Purpose. The purposes of this study were to (a) identify barriers to implementing evidence into clinical practice in New York State (NYS), (b) prioritize resources needed to address these barriers, and (c) determine how the Cathryne A. Welch Center for Nursing (CNR) of the Foundation of NYS Nurses might provide support to address the identified barriers. Methodology. Using a modified Delphi technique, a sample of nurse leaders completed two online survey rounds. The first Round provided qualitative feedback, which was categorized via content analysis, with a second Round that asked respondents to rank the categories from Round I. Results. Organizational culture, productivity demands, and time were ranked as the top three barriers to implementing EBP in NYS. Time, leader support, and guidance/mentoring were identified as top resources needed to employ EBP. Respondents reported the CNR could facilitate EBP through financial support, communication, and mentoring. Data stratification revealed differences between rural and urban respondents, academic and clinical respondents, and geographical regions of the State, and differences in resources and support needed. Conclusion. Findings confirm barriers for NYS nurses mirror those described in the literature. Resources and support needed, however, may be demographically specific. Awareness of these differences will enable the CNR to best support NYS nurses’ implementation of EBP across the State. MeSH Keywords: Nursing, Delphi Technique, Evidence-Based Practice, Barriers to EBP, Resources for EBP

An Integrative Review of Causes, Manifestations and Evaluation of Cognitive Fatigue among Persons with Multiple Sclerosis

Background: Fatigue is the most distinguishing symptom for patients with Multiple Sclerosis (MS) and for some of these patients it can be quite disabling. Studies exploring MS-related fatigue have differentiated this into various dimensions: motor, cognitive, physical, psychosocial, performance, and subjective. It is the cognitive dimension that can have serious consequences such as loss of vocation, independence, and possibly, more relapses or worsening of the disease. Objective: The aims of this integrative review were to explore the advances in understanding cognitive fatigue in MS, as well as its causes and manifestations, and to identify the objective methodologies that best measure cognitive fatigue in MS. Methodology: An integrative review of the scientific literature was performed using methods and criteria following the PRISMA-P2015 guidelines for data extraction. The studies were critically appraised using the Rapid Critical Appraisal and the qualitative study method of Constant Comparison. Results: Twenty-three studies (2010-2019) were identified from the United States and other countries. The majority of articles were published within the last three years. Evaluation of outcomes from these studies was conducted through self-reporting. Cognitive fatigue may result in more relapses among those with relapsing and remitting MS and from those with secondary progressive MS. Cognitive fatigue and physical fatigue should be considered distinct domains. Conclusion and Recommendations: An increasing number of studies focused on cognitive fatigue, however, there is no standard definition or conceptual framework available to understand this phenomenon. Various methodologies were identified to evaluate cognitive fatigue. Additionally, there should be a valid, reliable, and readily available instrument for use in the clinical setting. Keywords: Multiple Sclerosis, Cognitive Fatigue, Fatigue, Integrative Review