Nancy Short

A rubric for improving the quality of online courses.

All of the graduate students in the School of Nursing take some of their Master of Science courses online. A group of six School of Nursing faculty members and a graduate student received funding to determine best practices in online courses. The group developed an evaluation rubric to measure quality in the graduate online curriculum. They then applied the rubric to the core courses which are primarily offered online and are required for all graduate nursing students. The project had a positive impact on faculty by offering a tool useful for online course evaluation and development. Additionally it brought to attention the needs of faculty member development in online education.

Regulation of LPN Scope of Practice in Long-Term Care

With changing staffing structures and persistent quality concerns in nursing homes, registered nurses are challenged to ensure that appropriate care is delivered. We describe differences in the nurse practice acts (NPAs) and related administrative code for all 50 states and the District of Columbia for licensed practical nurse (LPN) delegation and supervision. Next, we explore relationships between these differences and quality measures from the Centers for Medicare & Medicaid Services for United States nursing homes, using 2007 data. Findings indicate that how boards of nursing (BONs) regulate LPN scope of practice is directly related to care quality. States with NPAs stating that LPN practice does not include delegation and supervision have better care quality outcomes. Further, the greater the extent to which BONs are either silent or permissive in these critical areas of LPN practice, the poorer the state performance on care quality.

Strategic Deployment of Technology in Hospitals: Evidence for Reengineering

What are the strategic operations choices that shape the hospital’s capabilities and at the same time define its constraints? In this article, we identify competitive capabilities hospital executives believe are required for competing successfully and discuss the strategic role of technology in hospital operations. First, a meta-process model for understanding the hospital delivery system as an organized linkage of generic processes is presented. The importance of technology as a hospital-wide process enabler in the model is illuminated. Then we explore how 65 hospital executives perceive strategic technology choices now and in the future. From the data, we identify a core set of critical success factors with respect to strategic technology use in hospitals. Wide gaps between the competitive priorities needed to achieve success and current capabilities are found. These gaps are highlighted by investigating the differences in capabilities and investments in both clinical and management technologies.

Promoting Patient Safety: Results of a TeamSTEPPS® Initiative.

Teamwork is an essential component of communication in a safety-oriented culture. The Joint Commission has identified poor communication as one of the leading causes of patient sentinel events. The aim of this quality improvement project was to design, implement, and evaluate a customized TeamSTEPPS® training program. After implementation, staff perception of teamwork and communication improved. The data support that TeamSTEPPS is a practical, effective, and low-cost patient safety endeavor.

Influencing health policy: strategies for nursing education to partner with nursing practice.

Cost, access, and quality have dominated health policy for more than 30 years. During that time, the number of health policy analysts and health services researchers has grown exponentially; however, health care policy remains a mysterious topic for most registered nurses. The foundations for a professional understanding of health care policy and policymaking should be well laid in formal education and synthesized with practice and work environments. Without time to promote synthesis of policy concepts related to the practice environment, nurses have no basis for further exploration and may remain naive to the influences of policy throughout their career. Practicing nurses, as eyewitnesses to the shortcomings of the U.S. health care system, are best suited to inform policymakers of needs, unintended consequences, and success stories. This article summarizes strategies to promote a partnership between the academy and nursing practice.

Physician assistants and nurse practitioners: a missing component in state workforce assessments

Due to current or predicted health workforce shortages, policy makers worldwide are addressing issues of task allocation, skill mix, and role substitution. This article presents an example of this process in the United States (US). Health workforce analysts recommend that US physician workforce planning account for the impact of physician assistants (PAs) and nurse practitioners (NPs). We examined 40 state workforce assessments in order to identify best practices for including PAs/NPs. Most assessments (about 60%) did not include PAs/NPs in provider counts, workforce projections or recommendations. Only 35% enumerated PAs/NPs. Best practices included use of an accurate data source, such as state licensing data, and combined workforce planning for PAs, NPs, and physicians. Our findings suggest that interprofessional medical workforce planning is not the norm among the states in the US. The best practices that we identify may be instructive to states as they develop methods for assessing workforce adequacy. Our discussion of potential barriers to interprofessional workforce planning may be useful to policy makers worldwide as they confront issues related to professional boundaries and interprofessional workforce planning.

A Plan for Academic Biobank Solvency—Leveraging Resources and Applying Business Processes to Improve Sustainability

Researcher‐initiated biobanks based at academic institutions contribute valuable biomarker and translational research advances to medicine. With many legacy banks once supported by federal funding, reductions in fiscal support threaten the future of existing and new biobanks. When the Brain Bank at Duke Universitys Bryan Alzheimers Disease Center (ADRC) faced a funding crisis, a collaborative, multidisciplinary team embarked on a 2‐year biobank sustainability project utilizing a comprehensive business strategy, dedicated project management, and a systems approach involving many Duke University entities. By synthesizing and applying existing knowledge, Duke Translational Medicine Institute created and launched a business model that can be adjusted and applied to legacy and start‐up academic biobanks. This model provides a path to identify new funding mechanisms, while also emphasizing improved communication, business development, and a focus on collaborating with industry to improve access to biospecimens. Benchmarks for short‐term Brain Bank stabilization have been successfully attained, and the evaluation of long‐term sustainability metrics is ongoing.

An evidence-based quality improvement perspective for a chronic obstructive pulmonary disease case-finding program

Chronic obstructive pulmonary disease (COPD) is a persistent progressive respiratory disease that is increasing in prevalence and cost in the United States health care system. Delays in recognition, diagnosis, and treatment are associated with poorer clinical outcomes. These delays are seen more often in populations experiencing economic hardship, lack of access to care, and lack of insurance, such as those seen in an indigent care clinic. The COPD case-finding program was planned as an evidence-based quality improvement project with a prospective, descriptive design generating a convenience sample of patients meeting modified screening criteria (i.e. patients 40 years of age with a smoking history and no pulmonary disease history) in a community-based indigent care clinic which was not screening for COPD. Practice change recommendations were guided by the Diffusion of Innovations Model. Descriptive statistics were used to describe the sample (i.e. age, ethnicity, race, gender, income, and selected comorbidities). Sensitivity, specificity, positive predictive value, negative predictive value, prevalence, and receiver operator characteristics curve COPD Questionnaire were calculated for this sample.

A Systems Approach to Improving Care for All Bereaved Families.

Bereavement services for families are an established part of hospice and palliative care. However, patients also die in the acute care and long-term care environments. Often, hospice is not involved, creating a potential gap in care. This article recounts a journey to improve care for all families of deceased patients, despite the presence or absence of hospice. A palliative care clinical nurse specialist led a quality improvement team, which used a systems thinking approach to develop and implement a downloadable bereavement booklet for families. Expected and unexpected outcomes are discussed for this replicable project.

Clinical Decision Support for Nurses A Fall Risk and Prevention Example

Clinical decision support tools in electronic health records have demonstrated improvement with process measures and clinician performance, predominantly for providers. Clinical decision support tools could improve patient fall risk identification and prevention plans, a common concern for nursing. This quality-improvement project used clinical decision support to improve the rate of nurse compliance with documented fall risk assessments and, for patients at high risk, fall prevention plans of care in 16 adult inpatient units. Preintervention and postintervention data were compared using quarterly audits, retrospective chart review, safety reports, and falls and falls-with-injury rates. Documentation of fall risk assessments on the 16 units improved significantly according to quarterly audit data (P = .05), whereas documentation of the plans of care did not. Retrospective chart review on two units indicated improvement for admission fall risk assessment (P = .05) and a decrease in the documentation of the shift plan of care (P = .01); one unit had a statistically significant decrease in documentation of plans of care on admission (P = .00). Examination of safety reports for patients who fell showed all patients before and after clinical decision support had fall risk assessments documented. Falls and falls with injury did not change significantly before and after clinical decision support intervention.