Bonnie P. Dumas

Moving Toward Greater Diversity A Review of Interventions to Increase Diversity in Nursing Education

Purpose: To report the results of a comprehensive review of interventions used by nursing programs to increase the success of underrepresented minority nursing students graduating from prelicensure programs. Design/Method: This review used the five stages of review methodology described but Whittemore and Knafl to extract data, summarize, and synthesize findings of 11 studies included in this review. Intervention strategies were organized using concepts of Jeffreys’s Nursing Undergraduate Retention and Success model. Findings: Interventions were designed to improve recruitment, retention, and academic performance through a variety of innovative activities. Conclusions: This review highlighted the necessity for future researchers to report in-depth and detailed information about the implementation of interventions. Comprehensive information about the program, faculty, setting, interventions, and challenges faced during implementation were often missing from these reports, making replication difficult.

Outcomes of a quality improvement project implementing stroke discharge advocacy to reduce 30-day readmission rates.

The purpose of this quality improvement project was to determine whether use of aspects of a transitional care model by nurse navigators would affect 30-day readmission rates in hospitalized ischemic stroke patients discharged home with self-care. Thirty-day readmission rates and emergency department (ED) visits were compared before, during, and after the implementation of the revised discharge process. Comparative analysis demonstrated reductions in readmissions and in ED visits. Thirty-day readmission rates to our hospital decreased from 9.39% to 3.24% when comparing pre- with postintervention data. Thirty-day ED visit rates to all state hospitals decreased from 16.36% to 12.08% when comparing pre- with postintervention data.

Implementation of Recovery Programming on an Inpatient Acute Psychiatric Unit and Its Impact on Readmission.

BackgroundRecovery-oriented models of care are evidence based and have been shown to improve patient satisfaction and outcomes as well as decrease the percentage of readmissions to inpatient psychiatric units. MethodsThis quality improvement project was implemented on a 16-bed inpatient adult mental health unit in a Veterans Affairs Medical Center. Percentages of readmissions were compared throughout the course of implementation of the recovery model. Readmissions during the months of July–September were tabulated over 3 subsequent years and compared readmission percentages before recovery implementation, during the early stage of recovery implementation, and finally, during ongoing recovery implementation. ResultsA decrease in readmission percentages was seen with implementation of recovery-oriented care when comparing the same 3-month period over 3 years. ConclusionAfter implementation of recovery-oriented care measures, there was a decrease in percentage of readmissions to the unit. In addition, this decrease was sustained and was shown to improve over time as recovery-oriented programming was further developed on the unit. These data suggest that Veterans Affairs Medical Centers should consider adding tools and procedures to successfully implement recovery programming on inpatient units and efforts should include direct involvement of patients in their own recovery journey, revision of policies and procedures to reflect the importance of recovery, thorough training of frontline staff regarding recovery principles, and transfer of recovery information directly from inpatient units to outpatient providers.

Integrating a Question Prompt List on an Inpatient Oncology Unit to Increase Prognostic Awareness.

BACKGROUND Many patients with incurable cancer do not accurately understand their prognosis, which can lead to aggressive and, often, futile treatment. Improved prognostic awareness can help patients to appropriately de-escalate aggressive treatment sooner in an illness trajectory. OBJECTIVES The purpose of this article is to introduce a patient-initiated discussion aid (question prompt list) on an oncology unit to increase prognostic awareness by promoting patient-provider dialogue, which could lead to limitation of life-sustaining treatments at the end of life and increased do-not-resuscitate (DNR) orders and hospice referrals. METHODS Medical records of consecutively admitted patients with a solid malignancy who were urgently admitted to the inpatient setting were reviewed for three months to determine the percentage of DNR orders and referrals to hospice care. After inclusion of the communication aid in admission packets, records of consecutively admitted patients to the inpatient setting were reviewed for three months to reassess the percentage of DNR orders and referrals to hospice care. FINDINGS An increase was seen in the percentage of patients with active DNR orders and in hospice referrals after a discussion aid was included in admission packets.

Depression Screening in Chronic Disease Management: A Worksite Health Promotion Initiative.

This pilot project aimed to improve depression symptoms and quality-of-life measures for individuals in a worksite disease management program. Two hundred forty-three individuals were invited to participate, out of which 69 enrolled. The participants had a history of diabetes, hypertension, or hyperlipidemia, and demonstrated depression using the Patient Health Questionnaire–9 (PHQ-9). The project consisted of counseling sessions provided every 2 to 4 weeks by a family nurse practitioner. PHQ-9 scores and those of an instrument that measures quality of life, the Veteran’s Rand–12 (VR-12), were compared pre-intervention and post-intervention to evaluate the effectiveness of the project. PHQ-9 and VR-12 Mental Health Component (MHC) scores improved significantly after 3 months of nurse practitioner-led individual counseling sessions. This project demonstrated that depression screening and therapeutic management, facilitated by a nurse practitioner, can improve depression and perceived quality of life in individuals with hypertension, hyperlipidemia, or type 2 diabetes.

Preventing ventilator-associated events: complying with evidence-based practice.

The leading cause of death due to health care–associated infections is ventilator-associated pneumonia (VAP). The lack of clarity in the definition of VAP has made it difficult to execute and evaluate the effectiveness of prevention strategies. Beginning in 2013, hospitals were expected to implement a new surveillance definition algorithm to identify ventilator-associated events (VAEs). The Institute for Healthcare Improvement recommended the use of the Ventilator Care Bundle as part of an initiative to decrease the incidence of VAP. This article outlines the results of a quality improvement project that was conducted to address this recommendation, improve current staff knowledge, identify gaps in practice, and determine the rate of compliance with prevention strategies. The major findings of this project also exposed limitations of the electronic medical record system, and suggested enhancements, which would promote the VAP Bundle initiatives, facilitate documentation, and permit straightforward data collection.

Improving Follow‐Up for Failed Newborn Hearing Screening in Emirati Infants

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

An analytic system for the analysis of covariance a mini-computer application

In order to enable the researcher and clinician to obtain analyses of their data with the speed, efficiency and relatively low cost that the minicomputer provides, an Analysis of Covariance computer package has been written and implemented for the WANG 2200 in conjunction with WANG Laboratories, Inc., of Tewksbury, Massachusetts. This package requires only 8K of memory, a restriction achieved in the design of the system by the judicious use of overlays, and scrutiny of the analysis structure to permit maximum subroutine reuse. The programs are written in basic.