Diana Lyn Baptiste

Cultural Humility: A Concept Analysis

Diversity is being increasingly recognized as an area of emphasis in health care. The term cultural humility is used frequently but society’s understanding of the term is unclear. The aim of this article was to provide a concept analysis and a current definition for the term cultural humility. Cultural humility was used in a variety of contexts from individuals having ethnic and racial differences, to differences in sexual preference, social status, interprofessional roles, to health care provider/patient relationships. The attributes were openness, self-awareness, egoless, supportive interactions, and self-reflection and critique. The antecedents were diversity and power imbalance. The consequences were mutual empowerment, partnerships, respect, optimal care, and lifelong learning. Cultural humility was described as a lifelong process. With a firm understanding of the term, individuals and communities will be better equipped to understand and accomplish an inclusive environment with mutual benefit and optimal care.

A Mixed-Methods, International, Multisite Study to Develop and Validate a Measure of Nurse-to-Physician Communication in Simulation

AIM This study examined the reliability and validity of the ISBAR Interprofessional Communication Rubric (IICR). BACKGROUND Improving education regarding communication in health care is a global priority. Communication is difficult to measure and no evaluation rubrics were located that uniquely focused on nurse‐to‐physician communication in simulation. METHOD This study used a mixed‐methods design and included five sites. RESULTS The IICR was determined reliable among nurse educator raters (rs = 0.79). The scale was found valid as assessed by nurse and physician experts (content validity index = 0.92). When describing their experience of using the tool, nurse educator raters described three categories: overall acceptability of the tool, ease of use, and perceptions of the importance of communication skills for patient safety. CONCLUSION Teaching and evaluating communication in simulation with a standardized rubric is a research area in need of further exploration and refinement.

Nutritional Interventions in Heart Failure: A Systematic Review of the Literature

BACKGROUND Heart failure (HF) is a major health care burden and there is a growing need to develop strategies to maintain health and sustain quality of life in persons with HF. The purpose of this review is to critically appraise the components of nutrition interventions and to establish an evidence base for future advances in HF nutrition research and practice. METHODS AND RESULTS Cinahl, Pubmed, and Embase were searched to identify articles published from 2005 to 2015. A total of 17 randomized controlled trials were included in this review. Results were divided into 2 categories of nutrition-related interventions: (1) educational and (2) prescriptive. Educational interventions improved patient outcomes such as adherence to dietary restriction in urine sodium levels and self-reported diet recall. Educational and prescriptive interventions resulted in decreased readmission rates and patient deterioration. Adherence measurement was subjective in many studies. Evidence showed that a normal-sodium diet and 1-liter fluid restriction along with high diuretic dosing enhanced B-type natriuretic peptide, aldosterone, tumor necrosis factor α, and interleukin-6 markers. CONCLUSIONS Educational nutrition interventions positively affect patient clinical outcomes. Although clinical practice guidelines support a low-sodium diet and fluid restriction, research findings have revealed that a low-sodium diet may be harmful. Future research should examine the role of macronutrients, food quality, and energy balance in HF nutrition.

Establishing a dedicated difficult vascular access team in the emergency department: A needs assessment

Peripheral vascular access is one of the most common procedures performed in emergency departments across the United States. Successful venipuncture is critical in providing timely diagnosis and treatments for patients. The aim of this article is to describe a needs assessment performed in a level-one academic emergency department to establish the need for a dedicated team for patients with difficult vascular access. Results from this assessment suggest that difficult vascular access represents tangible threats to patient safety and increased use of resources.

Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action

Abstract Nurses have always been involved in the diagnostic process, but there remains a pervasive view across physicians, nurses, and allied health professionals that medical diagnosis is solely a physician responsibility. There is an urgent need to adjust this view and for nurses to take part in leading efforts addressing diagnostic errors. The purpose of this article is to define a framework for nursing engagement in the diagnostic process that can serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error. We offer a conceptual model to formalize and expand nurses’ engagement in the diagnostic process through education, maximize effectiveness of interprofessional teamwork and communication through culture change, and leverage the nursing mission to empower patients to become active members of the diagnostic team. We describe the primary barriers, including culture, education, operations, and regulations, to nurses participating as full, equal members of the diagnostic team, and illustrate our approach to addressing these barriers. Nurses already play a major role in diagnosis and increasingly take ownership of this role, removing barriers will strengthen nurses’ ability to be equal, integral diagnostic team members. This model should serve as a foundation for increasing the role of the nurse in the diagnostic process, and calling nurses to take action in leading efforts to reduce diagnostic error.

Outcomes of an Innovative Evidence-Based Practice Project: Building a Difficult-Access Team in the Emergency Department

Problem: Difficult venous access is a common problem in health care—especially in the emergency setting—that relies on quick diagnostics to differentiate patient acuities and administer critical medications. The creation of a dedicated team to address difficult venous access (DVA) is a possible solution to the problems of delayed venous access, yet no studies have been published on implementing such a team in the emergency department. Methods: This was a quasi‐experimental study in an urban emergency department. Researchers performed chart audits of staff‐identified patients with DVA to gather baseline data. A DVA team was subsequently implemented 16 hours a day, 7 days a week. Data were recorded on patients referred to the team and included time, number of IV attempts, and patient characteristics. Results: Baseline data were collected on 53 patients, and postintervention data included 135 patients. The implementation of a DVA team decreased the mean lab order‐to‐lab completion time by 115 minutes (P < 0.0001). Decreases in the number of attempts were not statistically significant. Patients requiring increased numbers of IV attempts also had many common characteristics including history of multiple attempts, poor skin quality, and IV drug use. Discussion: The use of a dedicated team for DVA reduces the lag time from physician orders to actionable diagnostics or administration of medication. A dedicated DVA technician is a concrete solution to threats of patient safety, as well as ED crowding, and has the potential to affect both patient‐ and department‐level care.

Hypertension among adults living in Haiti: An integrative review

AIMS AND OBJECTIVES To determine what is known about hypertension among adults living in Haiti. BACKGROUND Hypertension is the leading cause of morbidity, the identified cause of heart failure in 45% of patients and is associated with more than 70% of cardiovascular disease-related hospital admissions in Haiti. DESIGN An integrative review of the literature. METHODS Searching four databases from 2007 to 2018, Whittemore and Knafls method was used to review the literature. Three nurse researchers independently reviewed and appraised each publication applying the Johns Hopkins Evidence-based Practice Appraisal tool. RESULTS Eight publications were identified and appraised for level and quality of evidence. The synthesis of the literature yielded common themes of (i) high prevalence of hypertension among adults living in rural areas, (ii) public health challenges, (iii) lack of knowledge and awareness of hypertension and (iv) barriers to effective treatment. CONCLUSION Hypertension is a highly prevalent disease in Haiti that is understudied and warrants attention. To better serve this vulnerable population, culturally tailored prevention strategies and disease management programmes are recommended. RELEVANCE TO CLINICAL PRACTICE There is a lack of quality evidence to guide nurses in the management of hypertension for this vulnerable population. Identification of barriers to effective treatment among this underserved population will assist nurses and other healthcare professionals in identifying best possible practices for patient care in clinical settings across Haiti.

An observational study of patient handover communications among nurses on an oncology critical care unit

Background: Breakdown in communication is a common cause of errors in hospitals. Aim/Objectives: To evaluate the feasibility and utilization of evidence-based recommendations for nurse-to-nurse shift handover on an oncology critical care unit. Design: Observational study. Methods: Nurses were provided education that integrated evidence-based recommendations for handover of care. Nursing shift report was observed for one month in 2015 and for one month in 2016. Results were evaluated for inclusion of 24 evidence-based essential elements for handover communication. Results: Total completeness of handover increased with 86.64% (N = 38) in 2015 and 88.68% (N = 35) in 2016. Interruptions during handover were positively correlated with length of handover (r = 0.587, n = 18, p = .010), thus confirming the need for structured, more effective handover methods. Conclusions: Providing education, mentoring, and real-time feedback to motivated staff may lead to improvements in handover communication methods, yielding positive patient outcomes.

Evaluation of an Intervention to Improve Clinical Nurse Educators’ Knowledge, Perceived Skills, and Confidence Related to Diversity

This article describes the evaluation of a diversity-related video and its impact on clinical nurse educators. Our evaluation suggests that educators’ knowledge, perceived skills, and confidence in creating a diversity-friendly learning environment were positively affected. Their awareness of their own biases did not improve significantly, thus suggesting the need for continued emphasis on self-assessment. The video was considered relevant and was supported by most educators, suggesting that similar videos may be an acceptable strategy for engaging them in diversity-related issues.

Increasing the Number of Certified Registered Nurses in an Emergency Department: A Cohort Program Implementation.

Nationally, hospital emergency departments are met with challenges because of increasing patient demands, overcrowding, and the need to protect patient safety. It is imperative that frontline emergency department nurses are prepared to meet the complex needs of diverse patient populations by having appropriate continuing education, training, and institutional resources. Professional certification is associated with improved patient safety, higher organizational performance scores, professional growth, and credibility among nurses. The purpose of this article is to describe the process and outcome of a nursing professional development-practitioner-led intervention to promote professional certification among nurses in an urban adult emergency department while reducing overall cost of institutional support for certification preparation.