The Mountain Model for Evidence-Based Practice Quality Improvement Initiatives.

This article introduces the Mountain Model, the first conceptual model for evidence-based practice quality improvement (EBPQI) initiatives. The Mountain Model merges modern evidence-based practice (EBP) and quality improvement (QI) paradigm principles into a unified conceptual framework with the goal of disseminating and sustaining EBPQI projects across health care and related settings. The model was developed within the nursing discipline, but is designed for transdisciplinary implementation through interprofessional teams.

A Mixed-Methods Exploration of Competencies and Professional Development Needs Among Chief Certified Registered Nurse Anesthetists.

This project sought to explore the experiences, self-perceived preparation, professional development needs, and preferred learning methods of certified registered nurse anesthetists (CRNAs) in a management role. A sample of 10 current chief CRNAs responded to a demographics survey and participated in one-on-one interviews using a 14-question, semi-structured interview framework modified from a previous study. Interview responses were deidentified and qualitatively analyzed for common themes by two content experts and one qualitative analysis expert.

CE: Beyond PICO-A New Question Simplifies the Search for Evidence.

The framework for the PICO (population, intervention, comparison intervention, outcome) question was developed for use in the field of medicine to help determine the best treatment or intervention for a patient. However, use of the PICO question often fails to make sense when the problem or issue of interest is unrelated to determining the best treatment; in such cases, PICO is a less-than-optimal framework to use in searching for evidence. Nurses undertaking an evidence-based practice quality improvement (EBPQI) initiative must begin with a full understanding of the problem by exploring both external evidence (research) and internal evidence from the local setting to support the initiative.

The Role of Doctor of Nursing Practice-Prepared Nurses to Improve Quality of Patient Care.

Translating evidence-based practices (EBPs) and quality improvement (QI) initiatives to the bedside is a significant need among hospitals and outpatient settings to improve the provision of quality nursing care. However, health-care systems continue to struggle with implementing and sustaining EBPs. To improve the application of EBPs and QI initiatives, hospitals should consider using Doctor of Nursing Practice (DNP)-prepared nurses in Quality Improvement roles, as DNP graduates have acquired unique expertise in these topics.

Empowered Approaches to Critical/Challenging Encounters: Promoting PEACE in a School of Nursing.

The Promoting Empowered Approaches for Critical/Challenging Encounters (PEACE) program, developed at Duke University School of Nursing, is designed to navigate communication when there has been an exchange between community members, either with actions, words, or behaviors, that does not align with the school's core values. The goal of this program is to provide resources that promote conflict resolution through conversation, as well as managing conflict at the organizational level.

Original Research: The Impact of COVID-19 on Pain Care Among Older Adults.

Purpose: In this qualitative descriptive study, we sought to understand the professional experiences and perceptions of pain management nurses who cared for older adults in the United States during the height of the COVID-19 pandemic.

Methods: Data were collected between July 2020 and July 2021 through individual, semistructured interviews with a nonprobability sample of 18 pain management nurses. An inductive content analysis approach, in which categories were derived from a coding process based on a close reading of data extracts from the interview transcripts, was used to reveal the major theme related to the study aim.

Delirium prevention and management in hospitalized older adults.

Delirium is a common neurocognitive disorder among hospitalized older adults, and it can have devastating effects. The purpose of this article is to inform NPs in the hospital setting to recognize, prevent, and manage delirium in older adults. The roles of nonpharmacologic and pharmacologic interventions are described.

Missing the Care in Health Care.

This article describes the case of a chronically ill patient whose care was grossly mismanaged as a result of the policies and practices of a dysfunctional health system. This case illustrates the importance of truly listening to patients and communicating effectively with colleagues within the health care system. It also discusses appropriate steps for the practice of patient-centered care, including a reevaluation of late arrival policies at hospitals and clinics.

Three myeloproliferative neoplasms: An overview.

A group of rare hematologic cancers, myeloproliferative neoplasms (MPNs) evolve when bone marrow dysfunction causes overproduction of one or more blood cell types. This article explores the diagnosis, treatment, and nursing care of patients diagnosed with one of three classic MPNs: essential thrombocythemia, polycythemia vera, and primary myelofibrosis.

Implementing Cardiac Surgical Unit-Advanced Life Support Through Simulation-Based Learning: A Quality Improvement Project.

Background: The European Association for Cardio Thoracic Surgery and the Society of Thoracic Surgeons endorse Cardiac Surgical Unit-Advanced Life Support, a protocol designed specifically for cardiothoracic surgical patients who suffer postoperative cardiac arrests. To enhance patient outcomes and to reduce death rates, cardiothoracic intensive care unit nurses must be able to perform the protocol with confidence, proficiency, and without delays. To this end, simulation-based learning (SBL) is a pedagogical method ideal for optimized learning.

Evaluating a Quality Improvement Initiative to Increase Anesthesia Providers' Use of and Understanding of Quantitative Neuromuscular Monitors.

Improved understanding of the monitoring and dosing practices of anesthesia providers regarding neuromuscular blockade is necessary. The use of subjective methods such as peripheral nerve stimulation and clinical assessment tests can increase the risk of residual neuromuscular blockade and adverse postoperative outcomes. Quantitative monitoring of neuromuscular blockade is an alternative tool to peripheral nerve stimulation to guide neuromuscular blockade; however, it is rarely used by providers.

Leaders, managers, and followers: Working in harmony.

All nurses have the potential and responsibility to effect positive change in nursing practice and healthcare. This article details the characteristics of leaders and effective followers and clarifies that one does not need to be in a management position to function as a leader.

Creation of a Low-Cost Simulated Trachea for Deliberate Practice of Cricothyrotomy and Retrograde Wire Use.

Simulation is an accepted teaching tool that focuses on active learning and is used to solidify cognitive, motor, critical thinking, and communication skills. This method of experiential learning was introduced and integrated into the distance-based degree completion program for practicing anesthetists at the University for Development Studies (UDS), Tamale, Ghana. Because of scarce resources, a simulated trachea was created for teaching students how to perform a needle cricothyrotomy and use a retrograde wire to secure an airway.

Implementation of a Sustainable Ventilator-Associated Pneumonia Prevention Protocol in a Pediatric Intensive Care Unit in Managua, Nicaragua.

Background: Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (ICUs). Ventilator-associated pneumonia protocols decrease the incidence of VAP; however, many components of these protocols are not feasible in all settings. This study was done in a large pediatric hospital in Nicaragua.

Pre-participation physical evaluations for athletes.

The pre-participation physical evaluation helps keep athletes safe. This article discusses the essential components of the PPE history and physical. Findings that should prompt further evaluation of the athlete, including those consistent with risk for sudden cardiac death, are discussed.