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Background: The concept of inclusion within diversity, equity, and inclusion has broad meanings and implications and has not been explored in nursing through a World Café. Purpose: To describe the process and experiences of 9 nurse scientists who hosted a World Café focused on inclusion, to share participants' insights, and to offer considerations to advance inclusion in nursing. Approach: We hosted and encouraged active participation in a World Café that focused on 7 inclusion topics in nursing during the 2024 Midwestern Nursing Research Society Annual Research Conference. During the 90-min World Café, 40 participants ("members") engaged in iterative rounds of small group dialogue, moving from table to table every 10 min and randomly changing groups. Table hosts welcomed new members, provided background information, and asked probing questions about topics related to inclusion. Members shared insights verbally and through creative expression using colored markers/pencils or craft supplies and creating images on paper tablecloths. Table hosts used notes, photographs of words and images from the paper tablecloths, and collective post-Café reflections to synthesize insights regarding inclusion. Discoveries: Across all topics, members stated that inclusion requires connecting as human beings, creating welcoming spaces, being open to others, and actively listening. Table hosts described the World Café process as engaging, invoking, and inspiring. Hosts found the World Café process itself to be inclusive, inviting diverse perspectives, and gleaning insights about inclusion in nursing. Considerations generated from this World Café offer tangible behaviors to promote inclusion across various nursing topics, roles, and settings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the associations between demographic, professional and other personal nurse characteristics, social support factors and comfort in conducting research with nurses' level of active participation in clinical research. Design: A prospective, cross‐sectional, correlational design was used. Methods: Clinical nurses working in a multihospital healthcare system were recruited by email to complete an anonymous survey that used multiple valid and reliable scales to assess demographic and professional work characteristics, curiosity, grit, locus of control, perceived social support (for research activities), comfort in conducting research, and level of being research‐active. Univariate and multivariable analyses were completed. Results: Of 310 participants, 274 (88.4%) were female and mean (SD) age was 42.9 (13.1) years. After condensing 11 levels of research activity to four categories, 179 (57.7%) were not research‐active, and 91 (29.4%), 26 (8.3%) and 14 (4.5%) were engaged at low, moderate, and high levels, respectively. Of 78 factors, 69 (88.5%) were associated with being research‐active in univariate analyses. In multivariable analysis that adjusted for age, personal experience as a patient, years as a nurse and hours in direct patient care, professionalism characteristics, higher curiosity, internal locus of control, grit perseverance, support of a nurse scientist and nurse friends, and comfort in conducting research remained associated with higher levels of being research‐active (all p < 0.01). Conclusion: Research‐active nurses were more likely to be engaged professionally in hospital‐based activities beyond their work roles and displayed higher levels of positive psychological characteristics and mentorship that supported research capacity. Clinical Relevance: Research‐active nurses were more likely to have internal factors and external resources that promoted higher levels of being research‐active. A strong professional governance model may enhance clinical nurses research activities. [ABSTRACT FROM AUTHOR]

Aims: To identify the personal and professional impact of the COVID‐19 pandemic on clinical nurses with regard to personal and workplace safety, personal and professional relationships and perceptions of their team, organization and community, and to understand lessons learned to inform future responses to pandemics or global emergencies. Design: Qualitative, descriptive free‐text surveys, informed by appreciative inquiry. Methods: Nurses working in adult COVID‐ and non‐COVID cohort medical‐surgical and intensive care units, outpatient cancer and general surgery centres were invited to participate. Data were collected between April and October 2021 and analysed using summative content analysis. Results: In total, 77 participants completed free‐text surveys. Five themes were identified: (1) Constraints on nursing: barriers in communication and diminished patient safety and quality of care; (2) Navigating uncertainty: the emotional toll of the pandemic; (3) Team solidarity, renewed appreciation and reaffirming purpose in nursing work; (4) Enhanced trust versus feeling expendable; and (5) Increased isolation and polarization within communities. Nurses described a perceived negative impact on a number of their relationships, including with patients, employer and community. They described a huge emotional toll that included feelings of isolation and polarization. While some nurses described feeling supported by their team and employer, others described feeling expendable. Conclusion: Nurses' responses provided insights into negative emotional experiences during the pandemic due to heightened uncertainty and fear, and also the importance of support received from peers, colleagues and their employer. Nurses experienced feelings of isolation and polarization within their communities. The varied responses reflect the importance of societal solidarity when faced with global emergencies, and the need for nurses to feel valued by their patients and employer. Impact: Effective responses to public health emergencies require individuals and communities to work together to achieve collective goals. Efforts to retain nurses are critical during global emergencies. Patient or Public Contribution: No patient and public involvement. [ABSTRACT FROM AUTHOR]

Much attention has focused on interventions to improve the management of chronic obstructive pulmonary disease (COPD), yet patients continue to report many unmet needs. This article explores potential benefits of combining telemedicine and shared medical appointments to meet the needs of these patients. [ABSTRACT FROM AUTHOR]

Background: There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard "narrow" definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims: To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design: A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants: Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations: IRB approval was obtained. Results: 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by "other" distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions: Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. [ABSTRACT FROM AUTHOR]

Natriuretic peptides, brain (B‐type) natriuretic peptide (BNP) and N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP) are globally and most often used for the diagnosis of heart failure (HF). In addition, they can have an important complementary role in the risk stratification of its prognosis. Since the development of angiotensin receptor–neprilysin inhibitors (ARNIs), the use of natriuretic peptides as therapeutic agents has grown in importance. The present document is the result of the Trilateral Cooperation Project among the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America and the Japanese Heart Failure Society. It represents an expert consensus that aims to provide a comprehensive, up‐to‐date perspective on natriuretic peptides in the diagnosis and management of HF, with a focus on the following main issues: (1) history and basic research: discovery, production and cardiovascular protection; (2) diagnostic and prognostic biomarkers: acute HF, chronic HF, inclusion/endpoint in clinical trials, and natriuretic peptide‐guided therapy; (3) therapeutic use: nesiritide (BNP), carperitide (ANP) and ARNIs; and (4) gaps in knowledge and future directions. [ABSTRACT FROM AUTHOR]

This study examined the association between perceived pre-COVID exercise volume and severity of the virus based on symptom burden and hospitalization for adults who tested positive for COVID-19. The results have implications for educating adults about best-practice exercise volume during periods of peak COVID-19 diagnoses. [ABSTRACT FROM AUTHOR]

Using a randomized controlled, non-blinded, two-group design, differences in fall risk assessment, post-discharge sustainable fall risk changes, fall events and re-hospitalization were examined in 77 older adults who received a simulation (n = 36) or written (n = 41) education intervention. Between-group differences and changes in pre- versus post-fall risk assessment scores were examined using Pearson's chi-square, Wilcoxon rank sum or Fisher's exact tests (categorical variables) and two-sample t -tests (continuous variables). There were no statistically significant differences between groups in demographic characteristics. Patients who received simulation education had higher fall risk post-assessment scores than the written education group, p =.022. Change in fall risk assessment scores (post-vs.-pre; 95% confidence intervals) were higher in the simulation group compared to the written education group, 1.43 (0.37, 2.50), p =.009. At each post-discharge assessment, fall events were numerically fewer but not significantly different among simulation and education group participants. There were no statistically significant between-group differences in re-hospitalization. [ABSTRACT FROM AUTHOR]

Aims: To identify and understand ethical challenges arising during COVID‐19 in intensive care and nurses' perceptions of how they made "good" decisions and provided "good" care when faced with ethical challenges and use of moral resilience. Background: Little is known about the ethical challenges that nurses faced during the COVID‐19 pandemic and ways they responded. Design: Qualitative, descriptive free‐text surveys and semi‐structured interviews, underpinned by appreciative inquiry. Methods: Nurses working in intensive care in one academic quaternary care centre and three community hospitals in Midwest United States were invited to participate. In total, 49 participants completed free‐text surveys, and seven participants completed interviews. Data were analysed using content analysis. Results: Five themes captured ethical challenges: implementation of the visitation policy; patients dying alone; surrogate decision‐making; diminished safety and quality of care; and imbalance and injustice between professionals. Four themes captured nurses' responses: personal strength and values, problem‐solving, teamwork and peer support and resources. Conclusions: Ethical challenges were not novel but were amplified due to repeated occurrence and duration. Some nurses' demonstrated capacities for moral resilience, but none described drawing on all four capacities. Implications for Nursing Management: Nurse managers would benefit from greater ethics training to support their nursing teams. [ABSTRACT FROM AUTHOR]

Aims: We assessed for an association between improvements in left ventricular ejection fraction (LVEF) and future outcomes, including health status, in routine clinical practice. Methods and results: CHAMP‐HF was a registry of outpatients with heart failure (HF) and LVEF ≤40%. Enrolled participants completed the Kansas City Cardiomyopathy Questionnaire‐12 (KCCQ‐12) at regular intervals and were followed as part of routine care. We assessed for associations between improvements in LVEF (≥10%) over time and concurrent changes in KCCQ‐12, as well as the subsequent risk of poor outcomes. We included 2092 participants in the study. They had the following characteristics: median age 67 years (25th–75th percentile 58–75), 29% female, median duration of HF 2.7 years (0.6–6.8), and median baseline LVEF 30% (23–35). Of the study participants, 689 (33%) had a ≥10% absolute improvement in LVEF. Participants with an LVEF improvement also had an improvement in KCCQ‐12 overall summary score compared with participants without an LVEF improvement (+7.6 vs. +3.5, adjusted effect estimate +4.01 [95% confidence interval CI 2.3–5.7]). Similarly, subsequent all‐cause death or HF hospitalization occurred in 12% in the LVEF improvement group versus 25% in the group without an LVEF improvement (adjusted hazard ratio 0.50, 95% confidence interval 0.41–0.61). Conclusion: In a large cohort of outpatients with chronic HF, improvements in LVEF were associated with improved health status and a reduced risk for future clinical events. These data underscore the importance of improvement in LVEF as a treatment target for medical interventions for patients with chronic HF. [ABSTRACT FROM AUTHOR]

Aims: The aims of the study were to compare characteristics, resources, benefits and outcomes of academic‐clinical collaborations of nursing researcher leaders from academic, clinical and joint‐employer sites. Background: Few research‐based publications addressed academic‐clinical research collaborations. New knowledge could increase nursing and multidisciplinary research productivity, including implementation science. Design: An anonymous survey using a 40‐item questionnaire. Methods: Information letters with a link to the questionnaire were emailed to United States nursing research leaders. Data were grouped by institution type: academic, clinical or joint‐employer. Analyses included Kruskal–Wallis tests for ordered responses, Pearson's chi‐square test or Fisher's exact test for categorical responses and Cohen's Kappa agreement statistic for expected and actual time devoted to research. STROBE guidelines were followed. Results: Of 120 respondents from academic (n = 60; 50.0%), clinical (n = 53; 41.2%) and joint‐employer (n = 7; 5.8%) sites, 78.3%, 92.3% and 100%, respectively, were from metropolitan areas. Mean (SD) priority for active collaborations was higher at joint‐employer sites; p =.002. Clinical sites were more likely to have directors of evidence‐based practice (p =.031) and informatics (p =.008) and librarians (p =.029). Sites with collaborations were more likely to have access to research subjects (p =.008) and post‐award research account management (p =.045). By collaboration status, there were no differences in the number of ethics board‐approved studies. Collaborating site benefits were perceived to be executive leadership support (p =.003), greater research engagement by clinical nurses (p =.048), more co‐authored publications (p =.048) and more abstracts accepted at national meetings (p =.044). Despite more resources and perceived benefits, outcomes did not differ by collaboration status. Conclusions: Sites with and without academic‐clinical research collaborations differed; however, outcomes were similar. Future efforts should focus on nurse scientist collaboration to address important clinical questions aimed at improving clinical outcomes. Relevance to Clinical Practice: Despite some successful outcomes, potential benefits of academic‐clinical research collaborations have not been fully actualised. [ABSTRACT FROM AUTHOR]

Aims: We aimed to develop a risk prediction tool that incorporated both clinical events and worsening health status for patients with heart failure (HF) with reduced ejection fraction (HFrEF). Identifying patients with HFrEF at increased risk of a poor outcome may enable proactive interventions that improve outcomes. Methods and results: We used data from a longitudinal HF registry, CHAMP‐HF, to develop a risk prediction tool for poor outcomes over the next 6 months. A poor outcome was defined as death, an HF hospitalization, or a ≥20‐point decrease (or decrease below 25) in 12‐item Kansas City Cardiomyopathy Questionnaire (KCCQ‐12) overall summary score. Among 4546 patients in CHAMP‐HF, 1066 (23%) experienced a poor outcome within 6 months (1.3% death, 11% HF hospitalization, and 11% change in KCCQ‐12). The model demonstrated moderate discrimination (c‐index = 0.65) and excellent calibration with observed data. The following variables were associated with a poor outcome: age, race, education, New York Heart Association class, baseline KCCQ‐12, atrial fibrillation, coronary disease, diabetes, chronic kidney disease, smoking, prior HF hospitalization, and systolic blood pressure. We also created a simplified model with a 0–10 score using six variables (New York Heart Association class, KCCQ‐12, coronary disease, chronic kidney disease, prior HF hospitalization, and systolic blood pressure) with similar discrimination (c‐index = 0.63). Patients scoring 0–3 were considered low risk (event rate <20%), 4–6 were considered intermediate risk (event rate 20–40%), and 7–10 were considered high risk (event rate >40%). Conclusions: The PROMPT‐HF risk model can identify outpatients with HFrEF at increased risk of poor outcomes, including clinical events and health status deterioration. With further validation, this model may help inform therapeutic decision making. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a growing health problem associated with high morbidity and mortality. Use of evidence-based therapies improves clinical outcomes in patients with HF with reduced ejection fraction (HFrEF). However, in real-world research studies, adults with HFrEF were often medically undermanaged, including failure to use the right medications and failure to up titrate core HF therapies to doses similar to those used in randomized controlled trials. Although guidelines provide best-practice statements about care management, nurse practitioners and physician assistants (NPs and PAs) and clinical nurses often have questions about how to implement guideline-directed therapies in patient care management. With emerging new medications for managing HFrEF, and the possibility of new medications for patients with HF with preserved ejection fraction, complexity of care management will continue to increase. The aims of this review are to provide a summary of the 2017 updates to the national chronic HF management guidelines and use a case-based approach to discuss treatment change considerations associated with optimal guideline-based clinical care. [ABSTRACT FROM AUTHOR]

Aims: Improving the health status (symptoms, function, and quality of life) of patients with heart failure with reduced ejection fraction (HFrEF) is a primary treatment goal. Angiotensin receptor neprilysin inhibitors (ARNI) improve short‐term health status in clinical practice, but the sustainability of these improvements is unknown. Methods and results: In CHAMP‐HF, a multicentre observational study of outpatients with HFrEF, patients initiated on ARNI were propensity score matched 1:2 to patients not using ARNI with Cox regression modelling time to ARNI initiation, adjusted for sociodemographic and clinical variables, medical history, medications, and baseline Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Repeated measures models for the overall KCCQ score and each domain compared the health status trajectories of patients initiated on ARNI vs. not. Among 3930 participants, 746 (19.0%) began ARNI, of whom 576 were matched to 1152 non‐ARNI patients. Prior to matching, participants initiated on ARNI were younger, non‐Hispanic, had lower EFs, more commonly had a history of ventricular arrhythmia, were less likely to be taking an ACEI/ARB, and more likely to be treated with beta‐blockers and mineralocorticoid receptor antagonists. There were no differences after matching. In the matched cohort, participants initiated on ARNI experienced improved health status by 3 months that persisted through 12 months [KCCQ Overall Summary Score (OSS) = 73.4 vs. 70.8; P < 0.001], with the largest benefit observed in the KCCQ Quality of Life domain (68.7 vs. 64.7; P < 0.001). Similar health status benefits were noted through 18 months (KCCQ‐OSS = 73.9 vs. 71.3; P < 0.001). A responder analysis showed that 12 patients would need to be initiated on ARNI for one to experience at least a large improvement (≥10 points) in health status benefit at 12 months. Conclusions: In outpatient practice, ARNI therapy was associated with improved health status by 3 months and continued to 18 months after initiating therapy. [ABSTRACT FROM AUTHOR]

Importance: Adoption of guideline-directed medical therapy for patients with heart failure is variable. Interventions to improve guideline-directed medical therapy have failed to consistently achieve target metrics, and limited data exist to inform efforts to improve heart failure quality of care.Objective: To evaluate the effect of a hospital and postdischarge quality improvement intervention compared with usual care on heart failure outcomes and care.Design, Setting, and Participants: This cluster randomized clinical trial was conducted at 161 US hospitals and included 5647 patients (2675 intervention vs 2972 usual care) followed up after a hospital discharge for acute heart failure with reduced ejection fraction (HFrEF). The trial was performed from 2017 to 2020, and the date of final follow-up was August 31, 2020.Interventions: Hospitals (n = 82) randomized to a hospital and postdischarge quality improvement intervention received regular education of clinicians by a trained group of heart failure and quality improvement experts and audit and feedback on heart failure process measures (eg, use of guideline-directed medical therapy for HFrEF) and outcomes. Hospitals (n = 79) randomized to usual care received access to a generalized heart failure education website.Main Outcomes and Measures: The coprimary outcomes were a composite of first heart failure rehospitalization or all-cause mortality and change in an opportunity-based composite score for heart failure quality (percentage of recommendations followed).Results: Among 5647 patients (mean age, 63 years; 33% women; 38% Black; 87% chronic heart failure; 49% recent heart failure hospitalization), vital status was known for 5636 (99.8%). Heart failure rehospitalization or all-cause mortality occurred in 38.6% in the intervention group vs 39.2% in usual care (adjusted hazard ratio, 0.92 [95% CI, 0.81 to 1.05). The baseline quality-of-care score was 42.1% vs 45.5%, respectively, and the change from baseline to follow-up was 2.3% vs -1.0% (difference, 3.3% [95% CI, -0.8% to 7.3%]), with no significant difference between the 2 groups in the odds of achieving a higher composite quality score at last follow-up (adjusted odds ratio, 1.06 [95% CI, 0.93 to 1.21]).Conclusions and Relevance: Among patients with HFrEF in hospitals randomized to a hospital and postdischarge quality improvement intervention vs usual care, there was no significant difference in time to first heart failure rehospitalization or death, or in change in a composite heart failure quality-of-care score.Trial Registration: ClinicalTrials.gov Identifier: NCT03035474. [ABSTRACT FROM AUTHOR]

Background: Although African Americans represent the largest racial minority group, their nursing program success rates are lower. Understanding circumstances that lead to nursing school success may facilitate changes in educational practices that increase graduation among African American students. Method: A qualitative, phenomenological research study of 11 African Americans was used to understand their experiences as nursing students. Data were collected through an interview process, and Colaizzi's analysis methods and synthesis of themes were used. Results: Four themes were identified: Resolve to Succeed, Ineffective Education Models, A Need for Support of the College Experience, and Finding African American Mentors. Conclusion: Enhanced student connections via racial minority mentors and revised teaching pedagogies, including integration of classroom and clinical learning and use of case studies and simulation, may foster retention in nursing education and promote graduation. Increasing the number of practicing African American nurses may improve the care experience for African Americans. Enhanced student connections via racial minority mentors and revised teaching pedagogies, including integration of classroom and clinical learning and use of case studies and simulation, may foster retention in nursing education and promote graduation. Increasing the number of practicing African American nurses may improve the care experience for African Americans. [[J Nurs Educ. 2021;60(3):150–154.] [ABSTRACT FROM AUTHOR]

Aims: The aim of our study was to investigate heterogeneity of health status treatment response of sacubitril/valsartan in patients with heart failure with reduced ejection fraction (HFrEF). Methods and results: We leveraged data from CHAMP‐HF, an observational registry of 140 US clinics and 5026 outpatients with chronic HFrEF, where health status was serially assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ)‐12 Overall Summary Scale (range from 0 to 100; ≥20‐point improvement is a very large improvement). In 334 patients newly initiated on sacubitril/valsartan, we used hierarchical multivariable logistic regression (13 patient‐level characteristics as well as baseline KCCQ‐12 score) to calculate the odds ratio (OR) of any characteristic being associated with a very large health status improvement. A total of 104/334 (31.1%) of patients achieved the primary endpoint, where only worse baseline health status [KCCQ‐12 score of 0–60 points had an OR = 0.86/5‐point higher score (CI 0.79, 0.93)], and those with a KCCQ‐12 score of 60–80 points had an OR = 0.61/5‐point higher score (0.45–0.82), which was associated with a very large benefit. No other patient characteristic was associated with a very large health status improvement (P > 0.05). Conclusions: We found that, after initiation of sacubitril/valsartan, only worse baseline health status was associated with very large health status improvement. Accordingly, a trial of therapy—particularly in those with worse symptoms, function, and quality of life—and assessing treatment response are likely to be the best prospective strategy. [ABSTRACT FROM AUTHOR]

Background: In pediatric patients, intravenous placement success may be related to predetermined vascular access difficulty. The study purpose was to examine validity and reliability of the 6-item Pediatric Intravenous Difficulty Score. Methods: We determined if a tool that assesses pediatric intravenous difficulty was associated with clinical outcomes of peripheral attempts (criterion validity), hypotheses regarding patients' age, race, and medical diagnosis (construct validity), and reliability of difficulty levels. Results: In 596 episodes of peripheral intravenous attempts, first-attempt success, overall success, and number of staff attempting access were associated with level of intravenous access difficulty by tool score. The tool met hypothesized construct validity criteria, and in multivariable modeling, the tool was reliable based on difficulty levels of 2 user groups. Conclusions: The 6-item Pediatric Intravenous Difficulty Score has criterion and construct validity and is reliable over time among clinicians with different levels of expertise in peripheral vascular access. [ABSTRACT FROM AUTHOR]

Objective: In this study, clinical nurses' documentation of incontinence-associated dermatitis (IAD) were compared with wound expert documentation before and after implementing a valid, reliable severity index (SI) instrument. Methods: A prospective, non-equivalent, two group comparative design within three hospital medical units. Pre- and post-implementation skin condition documentation were compared by clinician type, and post-implementation IADSI scores were assessed for agreement using standard and weighted Kappa. Results: Of 89 patients (pre-, n=48 and post-, n=38), mean (standard deviation) age was 72.4±13.7 years and 57.3% had IAD. Mean IADSI score was 13.2 (standard deviation: 10.5; range: 0–52), reflecting pink intact skin. Post-implementation, skin documentation between clinicians was more likely to match, from 35.4 to 84.2%, p<0.001. Post-implementation, after controlling for age, gender and race, the odds ration (OR) of matched documentation between clinicians was 5.80 ([95% confidence interval: 1.8, 18.6], p=0.003) compared with pre-implementation. In the post-implementation period, standard Kappas for agreement in clinical nurse-wound expert documentation in the lower back/buttocks/upper thigh areas ranged from 0.82 to 1.0, reflecting very good agreement. Weighted kappas ranged from 0.76 to 1.0, also reflecting good to very good agreement. Conclusion: Implementation of an IADSI assessment instrument improved accuracy of IAD documentation. [ABSTRACT FROM AUTHOR]

Heart failure is a burdensome cardiovascular condition associated with high rates of morbidity and mortality. The 3-month period after hospitalization is a vulnerable phase in which patients are at high risk for mortality and rehospitalization. To reduce risk during this period, patients with heart failure and reduced ejection fraction should receive guideline-directed pharmacological therapies--the right drugs at the right doses--before hospital discharge. Optimal pharmacotherapies for these patients include agents that suppress the renin-angiotensin-aldosterone system, suppress the sympathetic nervous system, enhance vasodilation, slow heart rate when needed, and reduce excess volume. Because optimal prescription and adherence are both necessary to ensure the best clinical outcomes, nurses need to participate in interventions that optimize prescription and drug use over time. Collaboration with pharmacists and advanced practice acute care nurses may help ensure that medication selection and dosing are consistent with national guidelines. Use of a predischarge order set and electronic medical records checklist can enhance collaborative care. [ABSTRACT FROM AUTHOR]