A Literature Review of Nursing Extern Program Outcomes.

This literature review gathers in one place recent published literature on extern programs. Fourteen extern articles published between 2009 and 2019 were identified, and program information was extracted. Student benefits were increased in confidence, clinical skills, and learning the nursing environment.

Using focus groups to identify characteristics of an ideal work environment for Advanced Practice Clinicians.

Advanced Practice Clinicians (APCs) in collaborative practice represent a diverse and valuable group of health care professionals, including nurse practitioners, physician assistants, nurse anesthetists, and nurse midwives. Because these healthcare professionals have been identified as part of the solution to physician shortages, it is critical for health networks to examine and address issues affecting collaborative relationships. We invited our network APCs to participate in focus group sessions to determine both attributes and barriers to an ideal work environment.

Prioritizing partners across the continuum.

With the advent of accountable care organizations, bundled payments, value-based purchasing, and penalties for preventable hospital readmission, tight connections and collaboration across the care continuum will become critical to achieve successful patient outcomes and to reduce the cost of care delivery. Lehigh Valley Health Network (LVHN), the largest provider of health services in eastern Pennsylvania, set out on a journey to build collaborative relationships with skilled nursing facilities (SNFs) in their eastern Pennsylvania community. LVHN desired SNF partners with mutual interests in improving quality of care and lowering costs of delivery where possible.

Delivering specialized palliative care in the community: a new role for nurse practitioners.

The rising population of older Americans with advanced illness challenges current care delivery models. We use the metaphor of advanced illness as a difficult journey and propose a specific role, that of the "OACIS NP [nurse practitioner]," who helps provide a place of refuge during this journey. "OACIS" is an acronym for Optimizing Advanced Complex Illness Support, a program to provide home-based palliative medical care.

Getting published in an academic-community hospital: the success of writing groups.

Expressed barriers to writing for publication include lack of time, competing demands, anxiety about writing and a lack of knowledge about the submission process. These limitations can be magnified for practitioners in non-university environments in which there are fewer incentives or expectations regarding academic publication productivity. However, as members of professional disciplines, practitioners have both the responsibility and, oftentimes, the insights to make valuable contributions to the professional literature.

Hourly rounding: challenges with implementation of an evidence-based process.

Introduction of an evidence-based practice change, such as hourly rounding, can be difficult in the hospital setting. This study used ethnographic methods to examine problems with the implementation of hourly rounding on 2 similar inpatient units at our hospital. Results indicate that careful planning, communication, implementation, and evaluation are required for successful implementation of a nursing practice change.

The "dance" continues ... evaluating differences in call bell use between patients in private rooms and patients in double rooms using ethnography.

Staff response to patient call bells is a communication issue that influences patient assessment of care quality and satisfaction. An ethnographic, grounded theory approach was used to examine nurses and nursing support staff perspectives about call bell use on single- versus double-patient-room units. We used the dance metaphor to describe differences in staff behaviors related to answering call bells on the 2 units in the study.

Understanding the role of the promotora in a Latino diabetes education program.

We explore the role of the promotora de salud (health promoter) who provided diabetes self-management education to Puerto Rican diabetics in her community. The education program was developed as a hospital and community-based organization partnership. Information from both Spanish-language focus groups with 35 class participants and an in-depth interview with the promotora indicated patients appreciated having the classes taught in Spanish by a Latina promotora from their community.

Using rapid assessment to evaluate noise on an in-patient unit.

Rapid assessment was used to evaluate a noise problem on a busy, high-traffic, high-acuity medical/surgical telemetry unit over a 4-week period. Six sources of environmental noise were identified including conversational noise, noise from doors, noise from housekeeping activities, noise from the pneumatic message tube station, hallway noise, and miscellaneous noise. Our study also demonstrates the value of rapid-assessment methodology for the evaluation of clinical problems such as noise.

Becoming a leader in patient satisfaction: changing the culture of care in an academic community hospital.

In the context of the current health care payer system, quality of care standards, financial incentives and consumer choice are not well aligned, yet competition for increased admissions has become a matter of survival. Satisfaction and loyalty are two constructs that are the most meaningful measures in the context of sustaining and increasing admissions. Lehigh Valley Hospital and Health Network (LVHHN) launched an ambitious patient satisfaction improvement initiative in 2001.

Integrating palliative medicine and critical care in a community hospital.

Our objective was to describe the rationale and implementation of educational, environmental, clinical, and communication interventions designed to maximize indicators of improved palliative care in a community hospital intensive care unit. Surveys were used to develop educational content and methods for all levels of clinical staff and medical education. All clinical staff expressed confidence in clinical palliative processes but not in communication and psycho-spiritual issues shared with patient/families.

Dance of the call bells: using ethnography to evaluate patient satisfaction with quality of care.

Ethnographic methods can provide insights into patients' perceptions of quality of care. We used ethnographic methods to examine problems related to answering patient call lights on one inpatient unit in the hospital. Communication through call bells consisted of 3 interrelated components.

Research on the frontlines of healthcare: a cooperative learning approach.

Background: Evidence-based practice is a common goal in hospitals, but learning about research so that the practice can be done is often challenging for clinicians.

Objectives: The aims of this study were to (a) develop a process that supports organizational and staff development while conducting research and (b) conduct a research study in the emergency department (ED) to examine patient population, satisfaction, and waiting room issues.

Methods: A multidisciplinary team of clinicians and scientists was assembled to learn and do research while evaluating the ED waiting room of a Level I trauma center.

Cognitive versus technical debriefing after simulation training.

Background: Recent literature describes "cognitive dispositions to respond" (CDRs) that may lead physicians to err in their clinical reasoning.

Objectives: To assess learner perception of high-fidelity mannequin-based simulation and debriefing to improve understanding of CDRs.

Methods: Emergency medicine (EM) residents were exposed to two simulations designed to bring out the CDR concept known as "vertical line failure.

Evaluation and recommendations from a study of a critical-care waiting room.

The intensive care unit (ICU) waiting room is a dynamic place that influences the satisfaction of families of critically ill patients. Waiting-room comfort and amenities are important, because families often spend a great deal of nonvisiting time there. A quality improvement evaluation of the ICU waiting room at Lehigh Valley Hospital, Allentown, PA, was conducted.

The effects of mindfulness-based stress reduction on nurse stress and burnout: a qualitative and quantitative study, part III.

Part III of the study on mindfulness-based stress reduction (MBSR) describes qualitative data and discusses the implications of the findings. Study analysis revealed that nurses found MBSR helpful. Greater relaxation and self-care and improvement in work and family relationships were among reported benefits.

Using simulation to instruct emergency medicine residents in cognitive forcing strategies.

Purpose: Recent literature defines certain cognitive errors that emergency physicians will likely encounter. The authors have utilized simulation and debriefing to teach the concepts of metacognition and error avoidance.

Method: The authors conducted a qualitative study of an educational intervention at Lehigh Valley Hospital during academic year 2002-03.