Susan Alexander

Implementation of customized health information technology in diabetes self management programs.

Purpose: The project was a nurse-led implementation of a software application, designed to combine clinical and demographic records for a diabetes education program, which would result in secure, long-term record storage. Background/Rationale: Clinical information systems may be prohibitively expensive for small practices and require extensive training for implementation. A review of the literature suggests that the use of simple, practice-based registries offer an economical method of monitoring the outcomes of diabetic patients. Project Description: The database was designed using a common software application, Microsoft Access. The theory used to guide implementation and staff training was Rogers Diffusion of Innovations theory (1995). Outcomes: Outcomes after a 3-month period included incorporation of 100% of new clinical and demographic patient records into the database and positive changes in staff attitudes regarding software applications used in diabetes self-management training. These objectives were met while keeping project costs under budgeted amounts. Conclusions: As a function of the clinical nurse specialist (CNS) researcher role, there is a need for CNSs to identify innovative and economical methods of data collection. The success of this nurse-led project reinforces suggestions in the literature for less costly methods of data maintenance in small practice settings. Ongoing utilization and enhancement have resulted in the creation of a robust database that could aid in the research of multiple clinical issues. Implications: Clinical nurse specialists can use existing evidence to guide and improve both their own practice and outcomes for patients and organizations. Further research regarding specific factors that predict efficient transition of informatics applications, how these factors vary according to practice settings, and the role of the CNS in implementation of such applications is needed.

The Effect of Transplant Education on Nurses Attitudes Toward Organ Donation and Advocacy for Transplantation: Instrument Development

Nurses are the largest group of health-care professionals, yet they are not uniformly educated regarding transplantation and organ donation. The future of transplantation hinges on education of this group. Before meaningful studies can be conducted, an instrument to measure attitudes and commitment to organ transplantation is needed. The purpose of this study was to examine content and construct validity as well as establish internal reliability of an investigator-developed online instrument to measure nurses’ attitudes and commitment to organ transplantation by registered nurses. The online instrument was administered to registered nurses enrolled in transplantation electives at the University of Alabama in Huntsville and Vanderbilt University. Exploratory factor analysis revealed 4 components with eigenvalues over 1.0. The components were as follows: (1) desire to work in transplantation, (2) confidence in transplantation advocacy, (3) organ donation advocacy, and (4) procurement. Internal consistency of the revised instrument was established (α = .94). The Transplant-Registered Nurse (TXP-RN) instrument is a new instrument with excellent reliability and validity that can be used to measure attitudes and knowledge of American nurses about organ donation and transplantation. This important step is necessary before educational interventions can be accurately assessed.

Challenges in the Prevention of Falls and Fall-Related Injuries in Older Adults

Falls in older adults are a significant global and national health problem. Estimates suggest that 1 in every 3 adults older than 65 years will experience a fall annually. Older adults may experience serious sequelae from fall events, such as hip fractures and brain injuries. Even falls that do not result in injury may create anxiety and fear in older adults, leading to reduced physical activity and avoidance of social situations. Falls result from a complex interplay of predisposing factors that can be found in both inpatient and community-based settings. Using strategies to reduce both risk of falls and injuries related to those falls is an emerging area of opportunity for advanced practice nurses (APNs) across many settings.

The Nurse as Author: Is Publishing for You?

Why don’t more nurses write? It would seem that plenty of material exists on the topic of nurses and nursing care. A recent survey of Amazon using the search term ‘‘nurses’’ yielded 48 531 results ranging from novels to textbooks and including items such as socks with electrocardiogram tracings. At the top of the search list was a book described as ‘‘investigative journalism,’’ offering intimate details of hazing, sex, painkiller addiction, and bullying in the everyday lives of hospital nurses. While this book was not written by a nurse, there were several books present in the search that were authored by nurses, including textbooks, fiction, nonfiction, and others. For nurses who are employed as faculty members in academic settings, there is often an expectation of publication that accompanies the position, yet the practice of writing is certainly not limited to nurse researchers and faculty. Writing and publishing can be a viable career choice for nurses, and there are strategies that may assist nurses in overcoming the hurdle of experiencing their first publication. For Marijke Vroomen Durning, a nurse-author/editor based in Montreal, Quebec, Canada, writing was an early interest, so much so that ‘‘Iif I was given a choice I would choose essay exams instead of multiple-choice items every time’’ (oral communication, M.V. Durning, January 21, 2016). Durning managed to successfully combine her years of expertise in nursing with a lifelong passion for writing into a successful career in the publishing industry. Beginning as a registered nurse in the 1980s, in her first work experience on the postpartum floor, and retiring from the palliative care field, she has literally cared for patients from birth to death and attributes her success in publishing to the rich experiences gained from her career as a nurse. Throughout her nursing career, Durningwas a freelance writer from time to time. Eventually, as her expertise began to establish her reputation in the publishing field, she was offered a position managing a team of writers, as editor for The Doctor’s Guide to the Internet, an online news website for physicians. Durning went on to author chapters in several books, one of which was translated into Spanish, and to publish articles in lay health magazines and magazines for the nursing profession, such as Nursing2013. At present, she works with a roster of clients for whom she provides weband print-basedwriting services, social outreach and content, and manages email correspondences on healthcare sites. Durning credits her experiences with patients as key to informing her interest and assisting her in developing a niche in the writing industry. She believes that her success as awriter was due to her nursing background. Despite her deep interest in writing and publishing, achieving initial successes in the writing industry was not easy. Writing can be lonely work, a feeling that has been voiced by other nurse authors. According to Tina Shalof, author ofANurse’s Story, ‘‘You sit alone. You’re writing, writing, writing. You don’t even know if you’re going to get published’’. Yet there are stories that nurses can tell, and contributions that nurses can make, apart from the usual methods of patient care, that foster persistence in nurse writers. ‘‘There is such a need for people who know about health towrite about itVif they feel they canwrite, and they like it, take writing classes and see what it is they like to do. Do they like to write for patients? Would they prefer to write on a higher level for their peers or other healthcare professionals? Find amentor, someonewhosewriting you admire and reach out to them,’’ states Durning. Her desire to write for patients led to her interest in self-publishing a book for patients, Just the Right Dose: Your Smart Guide to Prescription Drugs and How to Take Them Safely, which was reviewed by Rob Campbell, RPh. Durning states that her book was born of the frustration in performing endless medication reconciliations with patients and from bearing witness to the multiple errors Author Affiliation: College ofNursing, Universityof Alabama, Huntsville. The author reports no conflicts of interest. Correspondence: SusanAlexander,DNP,ANP-BC,ADM-BC,301Sparkman Dr, Huntsville, AL 35899 (susan.alexander@uah.edu). DOI: 10.1097/NUR.0000000000000206

Nurses in Business: The Time Is Now.

More and more nurses are beginning businesses for many reasons: wound care, family therapy, in-home respite services, and acute/chronic patient management. Owning a business can be a fulfilling and flexible way to build a career, or it can be a professional nightmare. According to the US Department of Labor Statistics, half of all small businesses will fail within 5 years, and only a third survive 10 years or more. For nurses who want to start their own businesses, taking the time to plan a strategy of business design, implementation, and ownership can contribute to long-term success. Use your head. The first key investment is the timeneeded to create a solid business plan,which should begin asmuch as a year before the doors of a new company are ready to open. Think carefully about realistic short-, mid-, and longterm goals. The bottom line for any business is revenue generation, and this entails more complexity in the world of healthcare. For example, howmanypatientswill need to be seendaily to create the cash flowneeded to sustain daily operations, while building capital for other projects? Lending agencies will likely want to review this business plan as they work with potential borrowers to design the best financial strategies for new companies. In the beginning, an attorney, preferablywith a specialty in business law, will be needed to assist with creating the articles of incorporation for the company and obtaining tax identification numbers and to offer expertise on the intricacies of state and local business permits and licensing. To prepare the physical site of the business, the negotiation of building leases or purchases, repair and/or renovations contracts that may be necessary, and follow-up inspections to ensure that local building codes are met is needed. For many health-related businesses, having a location near the local hospital maximizes visibility for those patients whomay be unattached to providers and in need of care. An attractive building,with easy-to-access entrances, bright lighting, and lots of parking,may be especially appealing to patient populations such as older adults or familieswith small children. Manage the bottom line. The cycle of revenue generation is vitally important to a business; in healthcare, this begins with providers’ ability to produce cash flow. To bill third-party reimbursers, healthcare providersmust be credentialed with each insurer. The process of credentialing can be lengthy, taking 3 to 6 months or more with some reimbursers. Once the physical and mailing addresses of the business are established, the process of credentialing can begin. Retaining a billing agency that can comprehensively manage the credentialing process simultaneously for multiple insurers is a strategy that has been suggested by practice owners as a method to both initiate and maintain cash flow from day 1 of operations (C. Landrum, personal communication, October 8, 2015). Creating financial policies for the business, with review by legal counsel, is also needed before the business opens so that key steps in the revenue cycle can be established before clients are seen. These policies also need to be supported by the practicemanagement systems. Building payment fee schedules into billing systems can eliminate errors as patient volume grows. In the 21st century, efficient management of a healthcare practice necessitates the use of electronic health records (EHRs) for management of patient visits, scheduling, and billing. Many (EHR) systems contain all 3 of these functionalities. It is important that you take the time to investigate these systems and how you will integrate them into your daily work flow. Consider goals for productivity, ease of system use, adherence to clinical guidelines, and how the system will Author Affiliations: College of Nursing, University of Alabama, Huntsville. The author reports no conflicts of interest. Correspondence: SusanAlexander, DNP,ANP-BC, ADM-BC, 301 Sparkman Dr, Huntsville, AL 35899 (susan.alexander@uah.edu). DOI: 10.1097/NUR.0000000000000185

Polishing Your Presence Online: Wise Use of Social Media to Enhance Your Reputation.

How do colleagues or prospective employers learn more about you and your history as a nurse? Chances are, they seek your presence in the virtual world by looking at your Web site or profile in the evergrowing forms of social media. Many nurses do not realize the enduring importance of online content and its power to influence decision making by potential patients, hiring agencies, and colleagues. When managed correctly, the use of virtual resources can be a valuable way to paint a picture of expertise and professionalism. However, inappropriate postings can be a source of continuing dismay for the professional nurse. Comments or photos posted impulsively may prove to be of lasting damage to a nurse’s reputation. Protecting your online image and clinical reputation patients is of growing importance in the world of social media channels.

Powering transplant professional collaborations with Web and mobile apps.

s & W Because communication is at the heart of the dissemination of scientific knowledge, online collaborative environments can provide easy mechanisms to suggest, share, critique, and pull together ideas, data, and experiences. Mobile applications further the information retrieval and publishing functions of these collaborative environments, making them more immediately accessible. In 2009, Stroud et al performed a surveywith 124 nurse practitioners on whether personal digital assistants with various medical reference programs helped them during clinical practice. The result was overwhelmingly affirmative. Garrett andKlein put emphasis on the need for development of new applications to meet the demands of many of the new graduates in nursing, who are becoming more technologically advanced. Our initial Web searches found that there are numerous Web sites aimed at healthcare providers that implement a certain task. For example, the United Network of Organ Sharing uses portal technology to manage a centralized potential transplant patient listing. However, in our searches, we did not find aWeb site for the transplant community that provides collaboration, aggregation, and rapid dissemination of research findings as well as a mobile application. A preliminary survey conducted among advanced practice nurses working in transplant centers across the nation suggested that there was a need to fill this gap. The need for evaluating the efficacy of such technologies in the clinical setting, previously identified in the literature, is partially addressed by the results of our research on attitudes, adoption, and patterns of use of the Web collaborative environments and mobile applications. Recently, Phillippi andWyatt have highlighted the importance of having the latest evidence-based information in the hands of nurses. They suggested that most nurses are already using smartphones. In addition, they envision an easy integration of mobile applications into nursing curricula. Mobile applications are a rapidly developing segment of the global mobile market, and healthcare providers involved in organ transplantation can benefit from having