Implementation Strategies to Improve Knowledge and Adherence to Spinal Cord Injury Guidelines.

Purpose: The purpose of this study was to evaluate a bundle of implementation strategies (local opinion leaders, printed educational materials, and educational outreach) to increase neurocritical care nurses' knowledge of and adherence to spinal cord injury guidelines.

Design: A preprogram, postprogram, and follow-up design was used to evaluate outcomes.

Methods: Adherence was measured via self-reported anticipatory adherence; knowledge was measured by an author-developed assessment.

Program evaluation of neuroscience competency programs to implement evidence-based practices.

Rationale: Program evaluation is essential to help determine the success of an evidence-based practice program and assist with translating these processes across settings.

Aims: The purpose of this study was to evaluate the usefulness of 2 competency programs that sought to improve neurocritical care nurses' knowledge of and adherence to evidence-based stroke and spinal cord injury guidelines. These programs consisted of 3 specific implementation strategies, including local opinion leaders, printed educational materials, and educational outreach.

Nurses' experiences with errors in nursing.

Background: Health care organizations seek to maximize the reporting of medical errors to improve patient safety.

Purpose: This study explored licensed nurses' decision-making with regard to reporting medical errors.

Methods: Grounded theory methods guided the study.

"Mr Smith's been our problem child today…": anticipatory management communication (AMC) in VA end-of-shift medicine and nursing handoffs.

Background: Tools and procedures designed to improve end-of-shift handoffs through standardisation of processes and reliance on technology may miss contextually sensitive information about anticipated events that emerges during face-to-face handoff interactions. Such information, what we refer to as anticipatory management communication (AMC), is necessary to ensure timely and safe patient care, but has been little studied and understood.

Objective: To investigate AMC and the role it plays in nursing and medicine handoffs.

"Anybody on this list that you're more worried about?" Qualitative analysis exploring the functions of questions during end of shift handoffs.

Background: Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood.

Advancing the science of research in nursing education: contributions of the critical decision method.

Advancing the science of nursing education will require the discipline to conduct research that investigates complex phenomena, such as students' clinical thinking and decision-making skills, using multiple methods. The research methods developed in other disciplines can provide nursing education researchers with new ways to investigate clinical teaching and learning in nursing. The critical decision method (CDM), derived from psychology and human factors engineering, is a technique by which researchers elicit experts' thinking and the cognitive work informing decision making in the context of practice.

Nurse manager cognitive decision-making amidst stress and work complexity.

Aim:   The present study provides insight into nurse manager cognitive decision-making amidst stress and work complexity.

Background:   Little is known about nurse manager decision-making amidst stress and work complexity. Because nurse manager decisions have the potential to impact patient care quality and safety, understanding their decision-making processes is useful for designing supportive interventions.

Understanding nurse manager stress and work complexity: factors that make a difference.

Objective: This study provided insight into nurse manager stress and coping experiences.

Background: Overwork and stress have been implicated in today's nursing shortage. Although nurse managers play a pivotal role in creating work environments that retain staff nurses, little is known about nurse manager work.

Impact of continuous vigilance monitoring on nursing workflow.

Background: Increasing nursing time in patient care is beneficial in improving patient outcomes, but this is proving increasingly difficult with the nursing shortage, budgetary constraints, and higher patient acuity.

Objective: Nursing workflow was evaluated after the implementation of a continuous vigilance monitoring system to determine if the system enhanced patient-centric nursing care.

Methods: Work sampling observations were conducted at 3 hospitals for 6 categories of nursing activities (direct and indirect nursing, documentation, administrative, housekeeping, and miscellaneous) at baseline and at 3 and 9 months.

Exploring the persistence of paper with the electronic health record.

Objective: Healthcare organizations are increasingly implementing electronic health records (EHRs) and other related health information technology (IT). Even in institutions which have long adopted these computerized systems, employees continue to rely on paper to complete their work. The objective of this study was to explore and understand human-technology integration factors that may be causing employees to rely on paper alternatives to the EHR.

Sleepless in America: nurse managers cope with stress and complexity.

Although nurse managers play a pivotal role in creating work environments for staff nurses, performance expectations for nurse managers practicing in acute care hospitals may be unrealistic. The authors discuss nurse manager interview data showing that these expectations are increasing nurse manager perceptions of stress, making coping more difficult, and potentially harming nurse manager and work environment well-being.

Themes surrounding novice nurse near-miss and adverse-event situations.

Objective: The study purpose was to identify human performance factors that characterized novice nurse near-miss/adverse-event situations in acute-care settings.

Background: Increased focus on recruitment and retention of newly graduated registered nurses (RNs) in light of patient safety improvement goals will challenge healthcare educators and administrators. What we are beginning to learn about human performance issues during real work situations from patient safety research provides information related to human performance in complex environments that may guide education and system supports for novice RNs.

Understanding the complexity of registered nurse work in acute care settings.

Nursing shortages and patient safety mandates require nursing managers and administrators to consider new ways of understanding the complexity of healthcare provider work in actual situations. The authors report findings from a study guided by an innovative research approach to explore factors affecting registered nurse performance during real work on acute care medical-surgical units. Our findings suggest beginning targets for interventions to improve patient safety, as well as recruitment and retention, through support for registered nurse work.

The "New Look" approach to patient safety: a guide for clinical nurse specialist leadership.

This article describes a complex system model based on human performance factors that is borrowed from other industries but can be used by clinical nurse specialists for making progress in patient safety. Traditional approaches to investigation and follow-up of errors in healthcare organizations have not resulted in improvement in patient safety. The New Look approach described in this article emphasizes the complexity in which healthcare workers make decisions about patient c are every day and how increased learning about the resiliency of healthcare workers in the face of multiple system gaps and discontinuities will lead to long-lasting improvements in safety.

Understanding hope and factors that enhance hope in women with breast cancer.

Purpose/objectives: To examine the extent to which antecedent variables and appraisals differentiate levels of hope in women during treatment for breast cancer.

Design: Descriptive, correlational.

Setting: Two large midwestern urban areas.