Search

Background: In 2014, the Hawaii Department of Education (DOE), the only statewide school system in the United States, predominately enrolled children (keiki) from underserved communities and lacked school nurses or a school health program. Chronic absenteeism due to health concerns was identified as a barrier to academic success. Methods: The DOE and a public university created Hawaii Keiki--Healthy and Ready to Learn (HK), a program to provide school-based services for 170 Title 1 schools in urban and rural settings and build momentum for statewide collective action. HK has maintained support from public and private entities to address student health. Results: This paper describes 5 years of program development, implementation, and continuing challenges. Most recently in 2020-2021, HK pivoted in the face of school campus closings due to COVID-19 with strategic plans, including telehealth, to move forward in this changed school environment. Conclusions: The HK program has increased awareness of students' needs and is addressing the imperative to build health services within public schools. The multipronged approach of building awareness of need, providing direct services, educating future care providers, and supporting sound policy development, has an impact that goes beyond any one individual area.

The article focuses on the Hawai‘i Interprofessional Education Workgroup (HIPE) and its efforts to facilitate interprofessional collaboration among health professional students from various University of Hawai‘i (UH) schools, particularly the Daniel K. Inouye College of Pharmacy (DKICP). It mentions the outcomes of distance education initiatives, including telehealth simulations and telepresence robot-assisted exercises.

The Coronavirus Disease 2019 (COVID-19) pandemic has caused unprecedented disruption in health care systems and may continue to do so. Nurses, the largest contingent of the nation's health care workforce, have borne the brunt of those disruptions, which have caused increased workload and resultant occupational stress. This study identified differences in nurses' occupational stress by practice specialty, time spent caring for patients with COVID-19, and nurses' demographic characteristics. A descriptive crosssectional online survey of RNs and APRNs (N=328) was conducted at a Level 1 Trauma Center on the island of O'ahu, Hawai'i in September and October of 2021. Participants completed the 57-item Expanded Nursing Stress Scale (ENSS). Nurses reported an average overall stress score of 2.11 out of 4. The ENSS subscales of workload, patients and their families, inadequate preparation, and uncertainty concerning treatment all had higher mean scores than the total scale. Nurses working in perioperative/procedural areas and obstetrics reported lower overall occupational stress scores than nurses in other specialties. Nurses who spent > 50% of their time caring for patients with COVID-19 reported higher overall occupational stress scores than nurses who spent = 50% of their time caring for patients with COVID-19 (F = 8.21, P < .001). Nurses over the age of 50 reported less stress than their younger counterparts (F = 5.75, P = .004). Understanding how occupational stress impacts acute care nurses can aid employers in allocating resources to address the problem, and thus improve workforce retention. [ABSTRACT FROM AUTHOR]

To better understand facilitators and barriers to implementation of quality improvement (QI) efforts, this study examined 2 evidence-based interventions, video laryngoscopy (VL)-assisted coaching, and apneic oxygenation (AO). One focus group with frontline clinicians was held at each of the 10 participating pediatric intensive care units. Qualitative analysis identified common and unique themes. Intervention fidelity was monitored with a priori defined success as >50% VL-assisted coaching or >80% AO use for 3 consecutive months. Eighty percent of intensive care units with VL-assisted coaching and 20% with AO met this criteria during the study period. Common facilitator themes were adequate device accessibility, having a QI culture, and strong leadership. Common barrier themes included poor device accessibility and perception of delay in care. A consistently identified theme in the successful sites was strong QI leadership, while unsuccessful sites consistently identified insufficient education. These facilitators and barriers should be proactively addressed during dissemination of these interventions. [ABSTRACT FROM AUTHOR]

In the article, the author discusses how health employers in Hawai'i envision the roles of population health nursing in the health care sector, particularly in addressing societal inequalities. Topics include how people with limited access to health care services and poor economic and living conditions suffered higher rates of COVID-19 infection, hospitalization and death, and nurses' role as promoters of interconnections between health and social care in communities.

The coronavirus disease (COVID-19) pandemic has placed extraordinary strain on health care systems. This has led to increased stress among health care workers, and nurses in particular, which has had a negative impact on their physical and psychosocial wellbeing. This is likely to negatively impact the nursing workforce at the state and national levels as the pandemic continues. The purpose of this study was to assess whether nurses licensed in Hawai'i have considered leaving the workforce. A cross-sectional online survey was conducted among Hawai'i nurses at all levels of licensure, with 421 responding. Of these nurses, 97 (23.0%) reported considering leaving the workforce, with safety (39.2%) and family/caregiver strain (32.0%) being the most common reasons. Reconsidering whether they should stay employed in their current roles (Odds ratio [OR] 2.05; 95% CI 1.56 - 2.69) and fear to continue providing direct patient care (OR 1.97; 95% CI 1.54 - 2.54) were associated with increased odds of having considered leaving the workforce. Based on these results, the State of Hawai'i and local health care organizations need to adjust their nursing workforce estimates and address how to alleviate nurses' stressors and safety concerns to mitigate a potential workforce shortage. Research is needed to develop interventions to support and empower nurses in their current roles but also address future emergency preparedness. [ABSTRACT FROM AUTHOR]

The article presents the discussion on health care educators being charged with implementing interprofessional education (IPE). Topics include competency in IPE is a requirement for nearly all health professional students endorsed by Health Professional Accreditors Collaborative (HPAC) and supported by accrediting bodies; and delivering patient-centered care and improving population health in an affordable and efficient manner.

The article presents the discussion on health professionals, workers, and students called to action helping in slowing the spread of a disease about the minimal knowledge. Topics include extensive clinical experience and expertise in global health, public health, emergency response, and disaster management; and statewide organization representing hospitals, hospice, long-term care, and other healthcare organizations requiring health care students.

BACKGROUND: In 2014, the Hawaii Department of Education (DOE), the only statewide school system in the United States, predominately enrolled children (keiki) from underserved communities and lacked school nurses or a school health program. Chronic absenteeism due to health concerns was identified as a barrier to academic success. METHODS: The DOE and a public university created Hawaii Keiki: Healthy and Ready to Learn (HK), a program to provide school‐based services for 170 Title 1 schools in urban and rural settings and build momentum for statewide collective action. HK has maintained support from public and private entities to address student health. RESULTS: This paper describes 5 years of program development, implementation, and continuing challenges. Most recently in 2020‐2021, HK pivoted in the face of school campus closings due to COVID‐19 with strategic plans, including telehealth, to move forward in this changed school environment. CONCLUSIONS: The HK program has increased awareness of students' needs and is addressing the imperative to build health services within public schools. The multipronged approach of building awareness of need, providing direct services, educating future care providers, and supporting sound policy development, has an impact that goes beyond any one individual area. [ABSTRACT FROM AUTHOR]

Achieving a decade long successful academic-practice partnership between a university-based school of nursing and a large private healthcare organization during a time of healthcare payment transformation is a significant accomplishment. Goals of the partnership are to provide evidence that 1. research collaboration and mentoring are instrumental in improving patient care by shaping nursing infrastructure and capacity and 2. consultation and mentoring activities will effectively engage faculty and staff nurses in an academic-practice research partnership. Nursing faculty and practicing clinicians collaborate on organizational priorities to improve patient care outcomes. Of the 28 approved studies, 17 are completed, five are in progress, and six were not completed. Dissemination products directly related to this partnership include: three publications, 23 podium presentations, and eight poster presentations delivered at local, national, and/or international conferences. Findings from seven of the 17 completed projects have been translated to improve practice. Several partnership participants have continued their academic progression and continue to conduct studies. This innovative partnership is a successful endeavor that bridges education and practice in our community, while developing research capacity in both institutions. This article adds to the emerging literature on models of academic-practice partnership to develop nursing research. • Long-standing academic-practice partnerships are achievable. • Innovation and perseverance are necessary for partnership survival. • Research collaboration and mentoring can shape nursing infrastructure and capacity. • Long-term commitment of all participants to the partnership is the key to success. [ABSTRACT FROM AUTHOR]

Collaborative efforts of the Hawai’i State Center for Nursing (HSCN) and participating local hospitals, supported by local medical libraries, provide training in evidence-based practice (EBP). A critical part of the program was integrating the concepts of The Iowa Model of EBP developed by Dr. Marita G. Titler. The Iowa Model includes critique and synthesis of the best literature, identifying stakeholders and identifying triggers in the process of moving evidence into practice (1). The resulting training program led to the development and implementation of numerous nurse-driven projects and 14 peer-reviewed publications that have demonstrated a positive impact on clinical operations within Hawai’i state health organizations including Hawai’i Pacific Health (HPH). This article focuses on collaboration between the HPH EBP program, the HPH Library and the practical application and impact of that concept in a clinical setting. [ABSTRACT FROM AUTHOR]

Problem Patient fall prevention begins with accurate risk assessment. However, sustained improvements in prevention and quality of care include use of validated fall risk assessment tools (FRATs). The goal of FRATs is to identify patients at highest risk. Adult FRATs are often borrowed from to create tools for pediatric patients. Though factors associated with pediatric falls in the hospital setting are similar to those in adults, such as mobility, medication use, and cognitive impairment, adult FRATs and the factors associated with them do not adequately assess risk in children. Eligibility Criteria Articles were limited to English language, ages 0–21 years, and publish date 2006–2015. Sample The search yielded 22 articles. Ten were excluded as the population was primarily adult or lacked discussion of a FRAT. Critical appraisal and findings were synthesized using the Johns Hopkins Nursing evidence appraisal system. Results Twelve articles relevant to fall prevention in the pediatric hospital setting that discussed fall risk assessment and use of a FRAT were reviewed. Comparison between and accuracy of FRATs is challenged when different classifications, definitions, risk stratification, and inclusion criteria are used. Conclusions Though there are several pediatric FRATs published in the literature, none have been found to be reliable and valid across institutions and diverse populations. Implications This integrative review highlights the importance of choosing a FRAT based on an institution's identified risk factors and validating the tool for one's own patient population as well as using the tool in conjunction with nursing clinical judgment to guide interventions. [ABSTRACT FROM AUTHOR]

High-risk low-volume therapies are those therapies that are practiced infrequently and yet carry an increased risk to patients because of their complexity. Staff nurses are required to competently manage these therapies to treat patients' unique needs and optimize outcomes; however, maintaining competence is challenging. This article describes implementation of Just-in-Time Training, which requires validation of minimum competency of bedside nurses managing high-risk lowvolume therapies through direct observation of a return-demonstration competency checklist. [ABSTRACT FROM AUTHOR]

Purpose This integrative review aims to increase our understanding of current pain management care practices for children undergoing tonsillectomy. Conclusions Synthesis of the literature resulted in four main opportunities for care providers to manage pain: preoperative education and preparation, intraoperative surgical interventions, and postoperative pharmacologic and nonpharmacologic interventions in the post anesthesia care unit and home settings. Practice Implications Nurses have many opportunities to understand pain management practices and intervene to minimize pain experienced in pediatric outpatients undergoing tonsillectomy. [ABSTRACT FROM AUTHOR]

Background: Each year in the United States, an estimated 40,000 children are born with congenital cytomegalovirus (CMV) infection, causing an estimated 400 deaths and leaving approximately 8000 children with permanent disabilities such as hearing or vision loss, or mental retardation. More children are affected by serious CMV-related disabilities than by several better-known childhood maladies, including Down syndrome, fetal alcohol syndrome, and spina bifida. Discussion: Congenital CMV is a prime target for prevention not only because of its substantial disease burden but also because the biology and epidemiology of CMV suggest that there are ways to reduce viral transmission. Because exposure to the saliva or urine of young children is a major cause of CMV infection among pregnant women, it is likely that good personal hygiene, especially hand-washing, can reduce the risk of CMV acquisition. Experts agree that such measures are likely to be efficacious (i.e., they will work if consistently followed) and the American College of Obstetricians and Gynecologists recommends that physicians counsel pregnant women about preventing CMV acquisition through careful attention to hygiene. However, because of concerns about effectiveness (i.e., Will women consistently follow hygienic practices as the result of interventions?), the medical and public health communities appear reluctant to embrace primary CMV prevention via improved hygienic practices, and educational interventions are rare. Current data on the effectiveness of such measures in preventing CMV infection are promising, but limited. There is strong evidence, however, that educational interventions can prevent other infectious diseases with similar transmission modes, suggesting that effective interventions can also be found for CMV. Until a CMV vaccine becomes available, effective educational interventions are needed to inform women about congenital CMV prevention. Summary: Perhaps no single cause of birth defects and developmental disabilities in the United States currently provides greater opportunity for improved outcomes in more children than congenital CMV. Given the present state of knowledge, women deserve to be informed about how they can reduce their risk of CMV infection during pregnancy, and trials are needed to identify effective educational interventions. [ABSTRACT FROM AUTHOR]