Susan Salmond

Healthcare Transformation and Changing Roles for Nursing

Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Cost and quality concerns along with changing social and disease-type demographics created the greatest urgency for the need for change. Caring for and paying for medical treatments for patients suffering from chronic health conditions are a significant concern. The Affordable Care Act includes programs now led by the Centers for Medicare & Medicaid Services aiming to improve quality and control cost. Greater coordination of care—across providers and across settings—will improve quality care, improve outcomes, and reduce spending, especially attributed to unnecessary hospitalization, unnecessary emergency department utilization, repeated diagnostic testing, repeated medical histories, multiple prescriptions, and adverse drug interactions. As a nation, we have taken incremental steps toward achieving better quality and lower costs for decades. Nurses are positioned to contribute to and lead the transformative changes that are occurring in healthcare by being a fully contributing member of the interprofessional team as we shift from episodic, provider-based, fee-for-service care to team-based, patient-centered care across the continuum that provides seamless, affordable, and quality care. These shifts require a new or an enhanced set of knowledge, skills, and attitudes around wellness and population care with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement.

Using Systematic Reviews to Guide Decision Making About Family-Witnessed Resuscitation

Family-witnessed resuscitation (FWR) allows family members to be present while emergency cardiac life support measures are applied. This article describes the use of systematic reviews to inform best clinical policy on FWR. The authors searched Medline and CINAHL for relevant systematic reviews and retrieved four. The reviews were then tested for rigor and validity using the open source Critical Appraisal Skills Programme from the Institute of Health Science, University of Oxford. The reviews were assessed to be of acceptable quality and therefore good sources of evidence to guide practice and policy development. Two reviews examined FWR of adult patients, one examined FWR of children and adults, and one examined FWR of children. Together, the four reviews covered 83 studies that describe the perspectives of more than 15,000 health care providers; 2,000 family members; and 2,000 patients. The systematic reviews provide clear evidence that both patients and family members want the option to be present during FWR. In contrast, there is significant variability among health care providers, with those in favor ranging from 7% to 96%. This wide range is related to (worldwide) geography and to provider status (e.g., Registered Nurse and Medical Doctor). Generally, patients, family, and providers agreed on the benefits of FWR. Barriers to FWR include perceptions of possible performance anxiety and family interruption of care. The authors conclude that institutional settings need to develop a rational policy on FWR, have family support personnel present during FWR, and develop training programs for students and staff on family presence.

The journey to independent nurse practitioner practice

Purpose The aim is to achieve a comprehensive understanding of the journey of states that achieved independent nurse practitioner (NP) practice from 2007 to 2011. Data sources Qualitative, retrospective, descriptive study with interviews of NP state leaders in those states as well as literature review. Conclusions There are key strategies that should be utilized by states when attempting to pass independent NP practice legislation. Strategies that have been tried and tested by states that have successfully passed legislation are collated and presented. Implications for practice Data from key national movements and legislation with release of the 2010 Institute of Medicine Report The Future of Nursing and the passage of the Patient Protection and Affordable Care Act add weight and supportive context to the independent NP legislative process, and were used in addition to and as groundwork for arguments and evidence of a national trend toward increasing access to primary care services and decreasing barriers to practice. Kingdons model illustrates these research findings and suggests the open window for policy change is now.Purpose:The aim is to achieve a comprehensive understanding of the journey of states that achieved independent nurse practitioner (NP) practice from 2007 to 2011. Data sources:Qualitative, retrospective, descriptive study with interviews of NP state leaders in those states as well as literature review. Conclusions:There are key strategies that should be utilized by states when attempting to pass independent NP practice legislation. Strategies that have been tried and tested by states that have successfully passed legislation are collated and presented. Implications for practice:Data from key national movements and legislation with release of the 2010 Institute of Medicine Report The Future of Nursing and the passage of the Patient Protection and Affordable Care Act add weight and supportive context to the independent NP legislative process, and were used in addition to and as groundwork for arguments and evidence of a national trend toward increasing access to primary care services and decreasing barriers to practice. Kingdons model illustrates these research findings and suggests the open window for policy change is now.

Moving evidence to practice: reflections on a multisite academic-practice partnership.

ABSTRACTThis paper describes the challenges encountered by an academic team when working with clinical teams to translated knowledge for the purposes of quality improvement in multiple sites. The sites were four differing health care settings in a Northeastern US state: two acute care hospital sites (one rural, one urban), one visiting nurse service and one psychiatric specialty hospital were purposively chosen for the action research study. In conducting this study at these diverse sites the importance of developing relationships and trust, understanding the context and dealing with real world complexities were evident. We conclude with observations and recommendations on important elements for effective knowledge translation work.

Case Study: Integrating Cultural Competence and Health Equity in Nursing Education

Academic programs preparing nurses for the future must ensure that nurses are prepared to be culturally competent. Achieving this goal requires a multifaceted curricular, student, faculty, and infrastructure approach. This case study summarizes the strategies taken by one school to move from an implicit understanding of the importance of cultural competence to explicit changes that were made to achieve this outcome

Care Bundles: Increasing Consistency of Care.

Care bundling is a strategy for reliably delivering quality, evidence-based care for patients undergoing treatments known to be accompanied by potential risks. This article reviews the purpose, types, and components of care bundles, as well as the process for development and implementation.

Experiences of HIV-infected adults and healthcare providers with healthcare delivery practices influencing engagement in primary healthcare settings: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this qualitative systematic review is to examine the experience and impact of health care delivery on health care engagement for adults infected with the human immunodeficiency virus receiving primary care. This review will identify and synthesize the best available evidence on health care structures, processes and practices that promote patient engagement in primary health care.The review question to be addressed is: What are the experiences of people living with human immunodeficiency virus (PLWH) and their health care providers with health care delivery processes and practices that impact engagement in primary health care settings (clinics, physician offices, and other community-based health care settings)? Specifically this review will compile evidence to illuminate health care system structures, provider practices, care delivery and programmatic processes that impact engagement in primary health care, as perceived by PLWH and their providers.

Experiences of stigma among family members of persons living with schizophrenia: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The aim of this qualitative systematic review is to explicate the experiences of stigma among family members of persons living with schizophrenia in any setting where they receive care. More specifically, the review will: (i) describe the experiences of stigma among family members of persons living with schizophrenia, (ii) describe the factors that influence the experiences of stigma, and (iii) describe the strategies and approaches used to cope with the stigma.

Families’ Experiences of Having an Adult Family Member in a Critical Care Area: A Systematic Review of Quantitative Evidence

The intention of this review is to examine what it is like to have a family member in a critical care area, and to use this information to generate recommendations for best practices, as an anticipated outcome. As such, this review intends to synthesize available knowledge about family needs so that conclusions can be drawn that: firstly, are directly relevant to practice; and secondly, provide an understanding of how family members report these experiences; and thirdly, determine the extent to which family needs are met and unmet. More specifically, the review seeks to:

PODCAST TRANSCRIPTS: CNCN Podcast Transcript: The aims and strategies for the Cochrane Nursing Care Network Node Nursing Care Clinical Trials Database

The main aim of this node is to identify primary studies of nursing care by searching databases and hand-searching relevant journals and conference proceedings especially those published in languages other than English. This is a very important endeavour to support systematic reviewers in their search and discovery of trials related to nursing care. In other words, we hope to develop a one-stop shop for any reviewer who wants to comprehensively find all the literature in all languages from any country related to the effect of an intervention. For example, if I was interested in the effect of open vs. closed visiting hours in a critical or intensive care nursing unit, I would expect many countries have conducted trials like this to assess the effect of these approaches to visiting. If our Node is successful, I would be able to find studies in both indexed English language and non-indexed non-English languages in Cochrane’s central database of trials. Our task of uncovering all clinical trials of nursing will be a daunting task if only a few individuals become involved. It will be a very reasonable task if we can recruit a global army of volunteers willing to search and find randomized and clinical controlled trials in their native languages and journals. We hope to develop a network of networks in order to scale this task into a manageable size. We are looking for people willing to volunteer in small and larger ways. We need regional directors willing to recruit and coordinate a group of searchers, we need searchers who would be willing to monitor a journal or two to identify randomized controlled trials and clinical trials related to nursing care. In addition to journals, we need searchers who will monitor conference proceedings to uncover trials that exist as abstracts. Then the citation and the English abstracts will be uploaded to the central database. Now, this is a very important endeavour that will widen the catch of all trials related to nursing care. In addition, we will increase the availability and regard for trials of nursing care that might currently go unnoticed by Cochrane reviewers. Currently, only 35 nursing journals are hand-searched by other Cochrane entities. We are absolutely certain there are more journals that publish trials relevant to nursing care. We welcome anyone who is willing to hand-search to participate, we are particularly interested in those of you who speak other languages besides English. To volunteer, visit the Cochrane nursing care website for an online form to participate.