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In research settings, clinical and research requirements contribute to nursing workload, staffing decisions, and resource allocation. The aim of this article is to define patient acuity in the context of clinical research, or research intensity, and report available instruments to measure it. The design was based on Centre for Reviews and Dissemination recommendations, including defining search terms, developing inclusion and exclusion criteria, followed by abstract review by three members of the team, thorough reading of each article by two team members, and data extraction procedures, including a quality appraisal of each article. Few instruments were available to measure research intensity. Findings provide foundational work for conceptual clarity and tool development, both of which are necessary before workforce allocation based on research intensity can occur. [ABSTRACT FROM AUTHOR]

Background: Adverse event (AE) surveillance may be enhanced by the Institute for Healthcare Improvement's Global Trigger Tool (GTT). A pilot study of the GTT was conducted in one Veterans Health Administration (VA) facility to assess the rates, types, and harm of AEs detected and to examine the overlap in AE detection between the GTT and existing surveillance mechanisms. Methods: GTT guidelines were followed and medical records were reviewed for 17 weeks of acute care hospitalizations. Investigators met monthly, first to adjudicate discordant reviewer categorizations of harm and later to categorize the AEs detected using standardized definitions. GTT-detected AEs were compared with incident reports, Patient Safety Indicators, and the VA Surgical Quality Improvement Program. Results: Medical records were reviewed for 273 of 1980 eligible cases. Using the GTT, a total of 109 AEs were identified. More than 1 of 5 hospitalizations (21 %) were associated with an AE. The majority of AEs detected (60%) were minor harms; there were no deaths attributable to medical care. Ninety-six of the 109 AEs (88%) were not detected by other measures. Conclusions: The GTT identified previously undetected AEs at one VA. The GTT has the potential to track AEs and guide quality improvement efforts in conjunction with existing AE surveillance mechanisms. [ABSTRACT FROM AUTHOR]

Context. The Veterans Health Administration (VA) has improved the quality of end-of-life (EOL) care over the past several years. Several structural and process variables are associated with better outcomes. Little is known, however, about the relationship between the organization of nursing care and EOL outcomes. Objectives. To examine the association between the organization of nursing care, including the nurse work environment and nurse staffing levels, and quality of EOL care in VA acute care facilities. Methods. Secondary analysis of linked data from the Bereaved Family Survey (BFS), electronic medical record, administrative data, and the VA Nursing Outcomes Database. The sample included 4908 veterans who died in one of 116 VA acute care facilities nationally between October 2010 and September 2011. Unadjusted and adjusted generalized estimating equations were used to examine associations between nursing and BFS outcomes. Results. BFS respondents were 17% more likely to give an excellent overall rating of the quality of EOL care received by the veteran in facilities with better nurse work environments (P ≤ 0.05). The nurse work environment also was a significant predictor of providers listening to concerns and providing desired treatments. Nurse staffing was significantly associated with an excellent overall rating, alerting of the family before death, attention to personal care needs, and the provision of emotional support after the patient's death. Conclusion. Improvement of the nurse work environment and nurse staffing in VA acute care facilities may result in enhanced quality of care received by hospitalized veterans at the EOL. [ABSTRACT FROM AUTHOR]

The purpose of this post-hoc investigation was to determine the difference in response rates between respondents who received personalized prenotification prior to receiving an electronic survey and those who did not. An electronic survey was e-mailed to 236 program directors or other designated individuals from nurse practitioner (NP) programs around the United States. Seventy six percent of the NP program directors were personally contacted about the survey in advance, and 97.5% agreed to participate. The remaining 24% were sent e-mails with a link to the survey without prenotification. Response rates for those in the prenotification group who had agreed to participate versus those who did not receive prenotification were 49% and 45%, respectively. Personalized prenotification did not affect the electronic survey response rates. Electronic research methodology offers a unique opportunity to potentially survey an entire population (e.g., nursing faculty), thus further investigation regarding factors associated with electronic survey response rates and ways to improve these rates is warranted. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine current nurse practitioner (NP) curricula in the United States with regard to antibiotics and antimicrobial resistance and assess the need for a web-based module for instruction on antimicrobial resistance and appropriate prescribing of antibiotics. Data sources: A 22-item, anonymous, self-administered, web-based survey was sent to 312 NP programs; 149 (48%) responded. Survey items included questions related to NP specialties offered, program accreditation, format of pharmacology course(s), lecture hours related to antimicrobial therapy, and whether the participant would use a Web-based module to teach NP students about antimicrobial resistance, if one were available. Conclusions: Most NP programs (99.3%) required a pharmacology course, and 95% had lectures dedicated to antimicrobial therapy. Half of the programs (53.5%) devoted ≥4 lecture hours to antimicrobial therapy in the pharmacology course, and most (84.8%) reported covering antimicrobial therapy in nonpharmacology courses as well. Approximately half of the programs (45.3%) reported <4 h of lecture on antimicrobial therapy in nonpharmacology courses. Many programs (51.9%) did not offer a microbiology course; 39.2% required microbiology as a prerequisite. Most respondents (86.7%) were familiar with the Centers for Disease Control and Prevention antimicrobial resistance program, and 92.6% reported that they would use an electronic module regarding resistance. Implications for practice: NP curricula generally include <10 h of content on antimicrobial therapy. An electronic module regarding antimicrobial resistance is likely to be a useful and relevant adjunct to current curricula. [ABSTRACT FROM AUTHOR]

New competencies exist for interprofessional education, which are centered on the goal of improving quality of care and patient safety through improved interprofessional collaboration. Interprofessional education and effective interprofessional collaboration are cornerstones of the Veterans Affairs Quality Scholars fellowship program. The purpose of this project was to evaluate an innovative interprofessional education strategy in which teams of physicians and nurses were 'learning by doing' as they observed and analyzed the functioning of an interprofessional process, specifically, inpatient discharge. Fellows completed voluntary, anonymous surveys seeking their perspectives about the project. Fellows' feedback revealed several themes, with both positive and negative characteristics related to team functioning, interprofessional understanding, microsystem knowledge, pooled knowledge and assignment challenges. The strength of this strategy is exemplified by the fact that fellows not only learned from each other's separate professional observations, but also observed the emergence of a shared interprofessional perspective through working together. [ABSTRACT FROM AUTHOR]

Background: Although evidence-based practice in healthcare has been facilitated by Internet access through wireless mobile devices, research on the effectiveness of clinical decision support for clinicians at the point of care is lacking. This study examined how evidence as abstracts and the bottom-line summaries, accessed with PubMed4Hh mobile devices, affected clinicians' decision making at the point of care.Methods: Three iterative steps were taken to evaluate the usefulness of PubMed4Hh tools at the NIH Clinical Center. First, feasibility testing was conducted using data collected from a librarian. Next, usability testing was carried out by a postdoctoral research fellow shadowing clinicians during rounds for one month in the inpatient setting. Then, a pilot study was conducted from February, 2016 to January, 2017, with clinicians using a mobile version of PubMed4Hh. Invitations were sent via e-mail lists to clinicians (physicians, physician assistants and nurse practitioners) along with periodic reminders. Participants rated the usefulness of retrieved bottom-line summaries and abstracts and indicated their usefulness on a 7-point Likert scale. They also indicated location of use (office, rounds, etc.).Results: Of the 166 responses collected in the feasibility phase, more than half of questions (57%, n = 94) were answerable by both the librarian using various resources and by the postdoctoral research fellow using PubMed4Hh. Sixty-six questions were collected during usability testing. More than half of questions (60.6%) were related to information about medication or treatment, while 21% were questions regarding diagnosis, and 12% were specific to disease entities. During the pilot study, participants reviewed 34 abstracts and 40 bottom-line summaries. The abstracts' usefulness mean scores were higher (95% CI [6.12, 6.64) than the scores of the bottom-line summaries (95% CI [5.25, 6.10]). The most frequent reason given was that it confirmed current or tentative diagnostic or treatment plan. The bottom-line summaries were used more in the office (79.3%), and abstracts were used more at point of care (51.9%).Conclusions: Clinicians reported that retrieving relevant health information from biomedical literature using the PubMed4Hh was useful at the point of care and in the office. [ABSTRACT FROM AUTHOR]

The article discusses highlights of a research presentation on the use of statistical process control (SPC) methods for data analysis in quality improvement studies, held at the 2012 Advancing the Methods in Health Quality Improvement Research Conference in Arlington, Virginia. It acknowledges availability of industrial SPC methods for healthcare monitoring. Aside from evaluating clinical outcomes, SPC techniques are also deemed valuable in new medical product surveillance.

The article discusses the ImproveCareNow network that was developed to enhance quality improvement (QI) research initiatives for the benefit of pediatric patients with inflammatory bowel disease (IBD) and Crohn's Disease. How the registry can be a vital part of QI and QI research was described in a presentation at the Advancing the Methods in Health Quality Improvement Research 2012 Conference held in Arlington, Virginia. Recommendations for implementing a registry for QI are provided.

OBJECTIVE: This evaluation project focused on assessing the content validity of an adapted version of the Casey-Fink (CF) Graduate Nurse Experience Survey, which is aimed at measuring role transitions in nursing. BACKGROUND: Registered nurses in the hospice and palliative care field need training and confidence to be proficient in core skills including communication, interprofessional competence, and clinical skills required to care for the dying patient. However, a review of the literature revealed a gap in the availability of survey instruments to measure the confidence of nurses entering the field of hospice and palliative care. METHODS: Ten items from the CF survey were revised by the project team and then evaluated for relevance by a group of 7 national hospice and palliative experts. The content validity index (CVI) was used to determine item relevance. RESULTS: Item-level CVI (I-CVI) calculations ranged from 0.57 to 1.0. The 8 items scored between 0.80 and 1.0 were retained as written. One item required further revision (I-CVI, 0.71), and 1 item revision was eliminated (I-CVI, 0.57). Experts also suggested 5 additional items in the original CF-survey need modification. CONCLUSION: The adapted CF-survey tool is ready for further psychometric testing, and next steps include administration to a new sample of nurse residents to determine construct validity. [ABSTRACT FROM AUTHOR]