Angela Jukkala

Developing a standardized tool to improve nurse communication during shift report.

Standardization of communication has been suggested as an effective approach to improve communication during patient handoffs such as shift report. Using the clinical microsystem framework, unit leaders and nursing staff developed and pilot tested the medical intensive care unit communication tool. Findings from the pilot study indicated that perceived communication among nurses in general and communication specific to shift report improved significantly following implementation of the tool.

Self-assessed knowledge of treatment and fertility preservation in young women with breast cancer

Young women with breast cancer do not identify themselves as knowledgeable about the effect of cancer treatment on fertility or fertility preservation treatments and resources. These women need access to high-quality health information to support their participation in medical decision making about fertility preservation.

Provider Readiness for Neonatal Resuscitation in Rural Hospitals

OBJECTIVE To describe nurse and physician readiness for neonatal resuscitation in rural hospitals. DESIGN Descriptive, correlational, and comparative. SETTING Twenty-six rural hospitals in two Midwestern states. PARTICIPANTS Rural providers of care to newborns (165 nurses and 59 physicians). INSTRUMENTS Neonatal Resuscitation Index (knowledge about neonatal resuscitation) and Neonatal Resuscitation Experience Index (comfort and recent skill performance). RESULTS The average Neonatal Resuscitation Index (knowledge) score of 69% was low. Many skills needed for full resuscitation had not been performed by rural providers during the previous year. Nurses reported lower levels of comfort with skills needed for full resuscitation (t=-4.68; p<.01). Correlation between frequency of skill performance and comfort was higher for nurses than physicians (r=.50 vs. .34). Nurses who were current Neonatal Resuscitation Program providers had significantly higher average levels of comfort (3.67 vs. 3.11; p<.01), knowledge (72.18 vs. 60.71; p<.01), and recent experience (0.94 vs. 0.51; p<.01) with resuscitation skills than nurses who were not current Neonatal Resuscitation Program providers. CONCLUSIONS Maintaining high levels of readiness for neonatal resuscitation in rural hospitals is challenging. Nurses and physicians should make special effort to obtain continuing neonatal resuscitation education to ensure optimal outcomes when newborn emergencies arise in rural hospitals. Teamwork training for neonatal resuscitation readiness is an important topic for future rural health research.

Attention and memory deficits in breast cancer survivors: implications for nursing practice and research.

Abstract Breast cancer survivors (BCSs) commonly report deficits in attention and memory, cognitive functions crucial for daily optimal functioning. Perceived deficits are reported before, during, and after adjuvant therapy and affect quality of life throughout survivorship. Deficits of attention and memory are particularly disruptive for BCSs working or attending school who report that subtle impairment diminishes their confidence and their performance at all levels of occupation. Chemotherapy and endocrine therapy contribute to attention and memory deficits, but research findings have not fully established the extent or timing of that influence. Fortunately, potential interventions for attention and memory deficits in BCSs are promising. These include cognitive remediation therapies aimed at training for specific areas of deficit, cognitive behavioral therapies aimed at developing compensatory strategies for areas of deficit, complementary therapies, and pharmacologic therapies.

Rural hospital preparedness for neonatal resuscitation.

CONTEXT Neonatal resuscitation is a critical component of perinatal services in all settings. PURPOSE To systematically describe preparedness of rural hospitals for neonatal resuscitation, and to determine whether delivery volume and level of perinatal care were associated with overall preparedness or its indicators. METHODS We developed the 15-point Hospital Neonatal Resuscitation Survey to examine institutional preparedness for neonatal resuscitation in 4 areas: policy and procedure, resuscitation team membership, continuing education, and connections with a wider system of perinatal care. All 58 rural hospitals with perinatal services in 2 upper Midwestern states (North Dakota and Minnesota) were asked to provide information describing preparedness for neonatal resuscitation. Nursing administrators responded to the survey. FINDINGS A total of 26 hospitals took part. Annual delivery volume ranged from 4 to 958. Preparedness scores ranged from 4 to 12. Hospitals with more than 125 deliveries each year reported significantly higher levels of preparedness than lower volume hospitals (9.50 vs 5.83, P < .001). Overall preparedness was not associated with level of perinatal care. Most rural hospitals did not identify a formal collaborative relationship with a regional level III perinatal center. CONCLUSIONS Substantial variation in hospital preparedness for neonatal resuscitation was identified. Preparedness was associated with delivery volume. Lack of collaborative agreements between rural hospitals and level III perinatal centers was pervasive. Additional research into the measurement of hospital preparedness for neonatal resuscitation as a component of quality rural perinatal care is needed to optimize outcomes for rural-born neonates.

Creating Innovative Clinical Nurse Leader Practicum Experiences Through Academic and Practice Partnerships

Introduction. The new Clinical Nurse Leader (CNL) nursing role was developed to meet the complex health care needs of patients, families, and health care systems. Case Presentation. This article describes the process used by nurse leaders at the University of Alabama at Birmingham School of Nursing and Hospital to develop Model C CNL practicum courses, recruit and prepare clinical preceptors, prepare clinical microsystems for CNL students, and develop additional practice partnerships throughout the region. Management and Outcome. Critical to the success of the CNL role is a dynamic partnership between academic and practice leaders. The partnership allows faculty to develop curricula that are relevant and responsive to the rapidly changing health care system. Clinical leaders become more aware of trends and issues in nursing education. Discussion. Continued growth and success of the CNL role is largely dependent on the ability of faculty and practice partners to collaborate on innovative educational programs and models of care delivery.

Breast Cancer Survivors and Fertility Preservation: Ethical and Religious Considerations

OBJECTIVES To review religious and ethical considerations for health care professionals when discussing fertility preservation with young survivors. DATA SOURCES Published research reports and articles, published guidelines, and web sites. CONCLUSION Although advances in assisted reproductive technology have increased fertility preservation options, not all treatments are acceptable or available for all young survivors. IMPLICATIONS FOR NURSING PRACTICE The ongoing provision of information from health care professionals allows young survivors to make high-quality decisions about fertility across the survivorship continuum. Knowledge of the influence that religious beliefs and economics have on decisions help nurses to better understand and support patients during this difficult time.

Professional development needs of nurse managers.

BACKGROUND Nurse managers have a key role in creating positive work environments where safe, high-quality care is consistently provided. This requires a broad range of skills to be successful within todays complex health care environment; however, managers are frequently selected based on their clinical expertise and are offered little formal preparation for this leadership role. METHOD We conducted three focus groups with 20 nurse managers to understand their professional development needs. Transcripts were analyzed using conventional content analysis. RESULTS Three themes emerged: Managing Versus Leading, Gaining a Voice, and Garnering Support. Managers focused on daily tasks, such as matching staffing to patient needs. However, the data suggested gaps in foundational management skills, such as understanding organizational behavior, use of data to make decisions, and refined problem-solving skills. CONCLUSION Professional development activities focusing on higher level leadership competencies could assist managers to be more successful in this challenging, but critical, role.

Readability and usefulness of the clinical microsystem assessment tool.

Using an instrument such as the Clinical Microsystem Assessment Tool (CMAT) to examine microsystem performance can provide valuable guidance for the development of quality and safety initiatives within the microsystem. However, instruments developed for this purpose must take into account diverse literacy levels. Perceptions of health care professionals of the usefulness and readability of the CMAT were examined. Readability was determined with the Flesch Reading Ease scale, in which the CMAT was rated as “very difficult” to read, and a Simple Measure of Gobbledygook analysis revealed that 14.71 years of education would be needed to understand the content. Although the majority of the participating health care professionals identified the tool as useful, the high level of reading ability required to understand the content may create limitations for use, given the educational diversity of the health care workforce.

Development of the knowledge of fertility and fertility preservation scale

Correspondence: Angela M Jukkala School of Nursing, University of Alabama at Birmingham, 312 School of Nursing Building, 1701 University Boulevard, Birmingham, AL 35294, USA Tel +1 205 996 6136 Email jukkalaa@uab.edu Objective: Infertility is a severe and often underestimated consequence of successful treatment for breast cancer. Ensuring young breast cancer survivors receive patient-centered health information on the impact of treatment on fertility and fertility preservation options in a timely manner is a critical component of high quality nursing care. The objective of this manuscript is to report the process used to develop and examine the reliability and validity of an instrument to measure a breast cancer survivor’s self-assessed knowledge of fertility and fertility preservation. Design: A scale development and descriptive study. Setting: Online and global. Participants: Ninety-two young breast cancer survivors (ages 25–45 years). Methods: Participants completed the Knowledge of Fertility and Fertility Preservation (KF) Scale as part of their participation in a larger study, the Fertility Cancer Project (FCP). Results: An exploratory factor analysis revealed five domains: normal reproductive function; general information about fertility; cancer treatment factors affecting fertility; infertility information; and alternative parenting options. A confirmatory factor analysis confirmed the validity of the construct with a demonstrated good fit between the factor structure of the new scale and the observed data. Many participants self-assessed their overall knowledge of fertility and fertility preservation as “a little” and the majority rated their knowledge of infertility information as “a little”. Conclusion: The KF Scale can be used to provide useful information to support health care professionals in the development of patient-centered education that is responsive to the unique needs of each young breast cancer survivor. The initial testing of the KF Scale indicates that it is reliable and easy to use; however, additional testing with larger and more diverse groups of breast cancer survivors is needed to further determine reliability and validity. The KF Scale could also be examined as a possible measure of self-assessed knowledge of fertility and fertility preservation across diverse groups of young cancer survivors, such as survivors of Hodgkin’s disease or childhood leukemia.