Search

In this month's Magnet Perspectives column, guest author Kathleen Martinez, MSN, RN, CPN, joins Rebecca Graystone, MS, MBA, RN, NE-BC, for an in-depth look at the explosive growth of ambulatory care nursing over the past decade. The authors take a deep dive into multiple factors contributing to this rapid evolution, the role of the Magnet Recognition Program in accelerating and supporting ambulatory care and the nurses who provide it, and the prospects for continued growth in the decade ahead.

Objective The aims of this study were to identify and discuss reflections of ambulatory care nursing and the integral role of the clinical nurse specialist (CNS) in defining nursing practice in the ambulatory care setting. Description of project Three CNSs and a CNS student, all assigned to the ambulatory care setting, discussed their experiences supporting nursing practice in the ambulatory care setting. Major reflections were identified, organized, and then expounded from personal experiences and published studies to highlight the impacts of the CNS in ambulatory care nursing. Outcomes Four major reflections were identified: ambulatory nursing is complex, ambulatory care nursing is in its infancy, ambulatory care nursing adds value, and opportunities exist for measuring the impact of ambulatory care nursing. Progress is being made in determining the role of the nurse in the ambulatory care setting, but more work is required. The CNS is prepared to define nursing practice in the ambulatory care setting and develop nursing-specific resources that support nurses in practicing to the full extent of their licensure. Conclusion The ambulatory care setting is expected to support the majority of the healthcare needs of the future. Ambulatory care nurses are well suited to meaningfully contribute to patient care. Evidence-based nursing practice in this setting is vital to ensure safe, quality patient care.

Aims Fever is an important sign in children with sickle cell disease (SCD), often being the only indicator of serious and potentially life-threatening secondary bacterial infection. Treatment of febrile children with SCD in our Paediatric Emergency Department (PED) can be variable, including escalation of care of those who are unwell and pragmatic management of those who are well. We therefore audited the management of fever with SCD presenting to PED and developed guidance to aid management, particularly looking at whether ambulatory nursing teams can be utilised to manage ‘low-risk’ patients. Methods We analysed the management of SCD children presenting to PED with fever over a one year period. Using these results, we developed guidance for febrile children with SCD, based on risk stratification. Results 28 children with SCD presented between July 2018 – July 2019, of whom 22 were admitted and 6 discharged from PED. Diagnoses among these patients are displayed in table 1. Antibiotic treatment was consistent in the management of fever due to acute chest syndrome, but was otherwise variable. One third of children discharged (2/6) received oral antibiotic treatment to complete at home. None of the discharged children were referred to the ambulatory nursing team for review. Subsequently we developed guidance to standardise clinical assessment, direct antibiotic choice, give clear risk-stratification criteria and advice on management of low-risk fevers of SCD children in the community. Conclusions Fever may indicate serious bacterial infection in children with SCD, requiring prompt and specific antibiotic treatment. Implementation of a guideline will help tailor treatment to the most likely cause of fever and risk-stratify these children accordingly. Utilisation of ambulatory nursing teams should be encouraged to promote admission avoidance and ensure low-risk children can be managed safely at home.

Background We compared the cost-effectiveness of 10 weeks of outreach rehabilitation (intervention) versus usual care (control) for ambulatory nursing home residents after hip fracture. Methods Enrollment occurred February 2011 through June 2015 in a Canadian metropolitan region. Seventy-seven participants were allocated in a 2:1 ratio to receive a 10-week rehabilitation program (intervention) or usual care (control) (46 intervention; 31 control). Using a payer perspective, we performed main and sensitivity analyses. Health outcome was measured by quality-adjusted life years (QALYs), using the EQ5D, completed at study entry, 3-, 6-, and 12-months. We obtained patient-specific data for outpatient visits, physician claims, and inpatient readmissions; the trial provided rehabilitation utilization/cost data. We estimated incremental cost and incremental effectiveness. Results Groups were similar at study entry; the mean age was 87.9 ± 6.6 years, 54 (71%) were female and 58 (75%) had severe cognitive impairment. EQ5D QALYs scores were nonsignificantly higher for intervention participants. Inpatient readmissions were two times higher among controls, with a cost difference of −$3,350/patient for intervention participants, offsetting the cost/intervention participant of $2,300 for the outreach rehabilitation. The adjusted incremental QALYs/patient difference was 0.024 favoring the intervention, with an incremental cost/patient of −$621 for intervention participants; these values were not statistically significant. A sensitivity analysis reinforced these findings, suggesting that the intervention was likely dominant. Conclusion A 10-week outreach rehabilitation intervention for nursing home residents who sustain a hip fracture may be cost-saving, through reduced postfracture hospital readmissions. These results support further work to evaluate postfracture rehabilitation for nursing home residents.

The Magnet Model for Nursing Excellence® provides a conceptual framework to guide orthopedic nursing practice. Patient assessment is the cornerstone of patient care delivery and nursing practice communication is a key factor for effective care coordination. Nurses coach and support patients and families through multiple care transitions. Knowledge and self-care competency is achieved through patient and family education.

Aim The integration of families into healthcare services is being emphasized increasingly in healthcare polices. The aim of this study was to investigate how professionals during home visits support both patients and caregivers in accepting and accommodating to illness. Design An explorative qualitative design. Methods Participant observations from home visits (N = 20) of pulmonary ambulatory nurses to COPD patients in Norway, followed by interviews with these nurses. Results Our findings demonstrate the delicate nature of nurses’ work during home visits to COPD patients and their caregivers. They support both patients and caregivers in reconciling themselves with the negative consequences of illness, as well as giving legitimation to and potential room for, sustainable arrangements within the scope of the relationship. The nurses address significant issues, having transformative potential concerning attitudes and practices related to the management of illness and adjusting to a complex illness trajectory.

For a new ambulatory care nursing course in an undergraduate baccalaureate program, a standardized patient simulation was created to support the clinical component of the course. The goals were for students to enhance their critical thinking skills, apply the nursing process to an ambulatory setting, apply learned skills to the non-acute care setting, and increase their confidence. The simulation format included three stations: skills refresher, telehealth, and clinic. Volunteers from faculty, clinical preceptors, and nursing management acted as clients for the mock clinical settings. Feedback was positive and supported this simulation as an educational option.

Atrial fibrillation (AF) is the most common dysrhythmia encountered in the United States. Symptoms may be similar to those of other cardiac conditions, which can delay the timely detection, diagnosis, and management of AF. This article provides an overview of AF and modalities used in remote monitoring.

The role of ambulatory nursing is diverse, and the impact on patient outcomes is difficult to measure. The concept of care coordination is an important focus for the ambulatory nurse. We describe the efforts to implement the Cardiac Care Coordination Measurement Tool to document and quantify care coordination activities in a pediatric cardiac ambulatory setting.

Background There has been a proliferation of online training programs for nursing home direct care staff related to dementia care, yet little is known about the effectiveness of the training. Some evidence exists that online training is effective in addressing problem behaviors of nursing home residents with dementia by enhancing self-efficacy, improving attitudes, and increasing knowledge of nursing home staff. Study aim The current study aim was to evaluate the implementation of an online training program consisting of ten, one-hour modules which applies the CARES® concepts and learning framework to activities of daily living (ADL) care for persons with dementia. Methods Responses from Likert-type items, and open-ended questions were analyzed in a sample of 48 certified nursing assistants (CNAs) from 10 nursing homes in six states (ME, MT, ND, WI, MN, MO) that were part of a National Institute of Aging funded intervention study (Grant #AG026210). Results The mixed-method study findings indicated that CNAs gained a better understanding, more knowledge, and more confidence in caring for persons with dementia. Recommendations were made regarding training length and technical issues, and some questioned the practicality of providing person-centered care when resident assignment was very high. CNAs expressed satisfaction with the online training, found it easy to use, and many said they would recommend the training. CARES® ADL Dementia Care online training appears to be a viable way of helping CNAs address the personal care needs of long-term care residents. Future CARES® ADL Dementia Care program research should include more racially diverse CNAs.

To investigate the knowledge of and attitudes towards palliative care for advanced dementia and their associations with demographics among nursing staff, including nurses and nursing assistants, in long-term care settings.Nursing facilities are places where persons with dementia die; therefore, providing quality end-of-life care to residents with advanced dementia is crucial. To date, little attention has been paid to palliative care practice for patients with advanced dementia.A descriptive, cross-sectional, survey design was used.In total, a sample of 300 nurses (n = 125) and nursing assistants (n = 175) working in long-term care settings in Taiwan participated in this study. Two instruments were administered: demographic characteristics and responses to the Questionnaire of Palliative Care for Advanced Dementia. Descriptive statistics and multiple regression were used for data analysis.Overall, the nurses and nursing assistants had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Additionally, nursing staff who were nurses with greater work experience and those who had received palliative care and hospice training had greater knowledge of palliative care. In addition, nursing staff who had received dementia care training and who had worked in nursing homes had higher levels of positive attitudes towards palliative care.This study indicates the need to provide nurses and nursing assistants with more information about palliative care practice for people with advanced dementia. Particularly, providing education to those who are nursing assistants, who have less working experience, who have not received palliative and dementia care training, and who have not worked in nursing homes can improve overall nursing staff knowledge of and attitudes towards palliative care.Continuing education in principles of palliative care for advanced dementia is necessary for currently practicing nursing staff and should be developed according to their educational background and needs.

Purpose To describe the quality of care for children in emergency departments (ED) as perceived by the nursing staff, and to compare the quality of care for children in a pediatric ED and in a general ED and to identify care quality factors that predict nursing staff's satisfaction with pediatric care in an ED. Design and Methods A cross-sectional survey study was performed using the 41-item Children Revised Humane Caring Scale (CRHCS) to collect data (n = 147) from acute hospitals' pediatric EDs and general EDs in November 2015. The data were analyzed using descriptive statistics and multiple linear regression. Results Nurses evaluated the quality of professional practice to be high. Children were treated in a respectful and friendly fashion, and received help when needed. The nurses perceived a lack of human resources in the studied EDs. Nurses in pediatric EDs gave more positive evaluations of the quality of care for children than nurses in general EDs. Positive assessments of professional practice, interdisciplinary collaboration and human resources by nursing staff predicted higher satisfaction with the quality of ED care for children. Conclusions The quality of children's care seemed to be higher in the pediatric ED than in the general ED. Key predictors of quality in children's care are professional practices of nursing staff, interdisciplinary collaboration and adequate human resources. Practice Implications In EDs, children should be treated by nursing staff and facilities designated for them. Pediatric nursing and teamwork skills should be maintained in the training of nurses.

BACKGROUND Many healthcare stakeholders view nurse practitioners (NPs) as an important workforce resource to help fill the anticipated shortage of 20,400 ambulatory care physicians that is expected by 2020. Multiple quantitative studies revealed the attributes of NPs' practice autonomy and roles. However, there is no qualitative meta-synthesis that describes the experiences of NPs' practice autonomy and roles. AIM To describe and understand the experiences of NPs regarding their practice autonomy and roles in various ambulatory settings through the exploration of existing qualitative studies: meta-synthesis. DESIGN A qualitative meta-synthesis was conducted to gain insight into ambulatory NPs' practice autonomy and roles through content analysis and reciprocal translation. METHODS Articles published between 2000 and 2017 were retrieved by searching 7 databases using the following key words: U.S. qualitative studies, advance practice nurses, NP role in ambulatory care, NP autonomy, and outpatient care. RESULTS Autonomy, NPs' roles and responsibilities, practice relationships, and organizational work environment pressures are the four main themes that emerged from the content analysis of the nine selected qualitative studies. CONCLUSION Within and between states, NPs' experiences with autonomy and NPs' roles are multifaceted depending on state regulations, practice relationships, and organizational work environments.

This study aims to identify satisfaction levels of adult chronic patients regarding the care they received at the hospital. The descriptive and cross-sectional study was conducted at Cukurova University Faculty of Medicine Balcali Hospital between 01.08.2016-31.10.2016. The sample consisted of 910 patients. The data was collected with “Personal Information Form” and "Patient Assessment of Chronic Illness Care (PACIC)." The data were analyzed via IBM 20.0 program. Ethical committee approval, permission from the institution and verbal consent from the patients were obtained for the study. The average age of the participants was 50.88±16.55. The average hospitalization duration was 9.22±11.55 days. It was indicated that 38% of the respondents have cardiovascular diseases, 94.6% use a kind of medication,91.7% have their medications on time, 85.5% take recommended dosages, 45.5% know the name and the number of the medication they take. The average score for chronic patient care evaluation scale was 3.11±0.74. When the subscales of the scale are analyzed, it was found that the average score for patient participation subscale is 3.75±0.93, decision-making support subscale is 3.46±3.33, target-setting subscale is 2.95±0.78, problem-solving subscale is 3.28±0.97 and monitoring/coordination subscale is 2.51±1.03. Significant correlations were found between the respondents’ education level and health education with their evaluations of chronic care. It was indicated that the patients’ satisfaction with the nursing care is medium, the highest average scores are in decision-making subscale while the average score for monitoring/coordination subscale is the lowest. In order to raise the satisfaction levels of chronic patients regarding nursing care, chronic patient care should be prioritized in organized education and on-the-job training for nurses. By emphasizing the importance of monitoring and coordinating the patients, better management of chronic diseases can be achieved. Article DOI: https://dx.doi.org/10.20319/lijhls.2017.32.3850 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

PURPOSE To identify the NANDA-I–NOC–NIC (NNN) linkages for inpatients of the obstetrics nursing unit using electronic nursing records. METHODS In this retrospective, descriptive survey, the electronic nursing records for 220 adult patients aged ≥18 years who were discharged after obstetrics nursing unit were analyzed. FINDINGS The 7 most frequent nursing diagnoses were found to be associated with 9 nursing outcomes and 26 nursing interventions. CONCLUSIONS Herein, the list of nursing diagnoses was observed to comprise the safety/protection domain, the list of nursing outcomes the physiological health domain, and the list of nursing interventions the physiological: complex domain. IMPLICATIONS FOR NURSING PRACTICE This result can contribute to improving the nursing quality and will help continuing education and documentation system refinement.

Background People living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study. Methods We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention. Results Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness. Conclusions Leadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

A mixed quantitative/qualitative study using two questionnaires was undertaken, to explore nurses’ attitudes to and their perceptions of the concepts of spirituality and spiritual care and to determine whether they believed they could meet patients’ needs in this field. Following ethical approval, the questionnaires were distributed to 68 nurses on the Haematology, Oncology and Elderly Care wards. Analyses included descriptive statistics and Cronbach’s alpha, and content analysis of open text. A response rate of 52.9% was obtained. Nurses indicated a broad understanding of spirituality, not only one related to religious beliefs and practices. The majority (89.9%) believed that patients should receive spiritual support as part of their holistic care, and 55.6% reported that they could o er this. Content analysis identified key themes relating to spiritual care and to spirituality. A need for further training in spiritual care was recorded by 58.3% of respondents. Further studies concentrating on nurses treating patients with a poor prognosis would be helpful.

Background: Provision of health care service at home is one of the advanced forms of care for patients being discharged from hospitalization. Little is known about the experience of nurses providing home care services through a nursing home-care model especially in Indonesian context. Objective: This study aims to explore the experience in order to increase understanding on the form of home care provision, and consequently the nurses may understand the form of home care globally. Methods: This study employed a phenomenological design and performed interview in the process of data collection. Data were analysed by using content analysis. Results: The main contexts of home care nurse experiences were generated. There were definition and role of home care nurses, the involvement of family members in the provision of care, the facilitating and hindering factors contributed to home care provision as well as manual on providing home care nursing. Conclusion: The implication from this study is that nursing care should be given to the patients continuously and consequently the need for family involvement is important. Additionally, in providing the home care, a proper manual is needed by home care nurses as the guidance to give best quality of care to patients.

This study explores the association between patients’ use of ambulatory care resources and features of patient-centered primary care (PCPC), specifically clinic-level National Committee for Quality Assurance (NCQA) recognition of PCPC, continuity of care, and care team communication. Data for this study were compiled from the electronic health records of a large multispecialty group practice in California, covering the period between 2009 and 2010 for 37,042 nonelderly patients under capitated managed care plans. Regression analysis of these data was performed using a generalized linear model, comparing measures of patient-level annual resource use (in total relative value units [tRVUs]) against measures of both clinic- and patient-level PCPC, and patient-level risk (eg, age, comorbidities). Patients linked to NCQA Recognition Level III versus Level II clinics used 4.8% (P < 0.001) fewer ambulatory care tRVUs. Patients with a 1 standard deviation increase in primary care continuity used 3.9% (P < 0.001) fewer ambulatory care tRVUs. Patients who switched primary care physicians used 17.4% (P < 0.001) more ambulatory care tRVUs. These results indicate that PCPC is associated with reductions in resource use related to both clinic- and patient-level features. The patient-level associations document within-clinic heterogeneity in PCPC. Based on these findings, practices can be encouraged to perform consistent with high NCQA recognition, promote primary care continuity, and be mindful of differences at an individual patient level.

Background Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. Objectives To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. Methods The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Results Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Conclusions Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians.

To quantify the contribution of acute versus postacute care factors to survival and functional outcomes after hip fracture.Retrospective cohort study using Medicare data; subjects included previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009.We used logistic regression to measure the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility; we quantified the contribution of hospital versus nursing home factors to outcomes by the ω statistic.Among 45,996 hospitalized patients, 1814 (3.9%) died during hospitalization. A total of 42,781 (93%) were discharged alive to a nursing home. Of these, 12,126 (28%) died within 180 days and 20,479 (48%) died or were newly unable to walk within 180 days. Hospital characteristics were not consistently associated with outcomes. Multiple nursing home characteristics predicted 30- and 180-day outcomes, including bed count, chain membership, and performance on selected quality measures. Nursing home factors explained 3 times more variation in the odds of 30-day mortality than did hospital factors [ω, hospital vs. nursing home: 0.32; 95% confidence interval (CI), 0.11, 0.96], 7 times more variation in the odds of 180-day mortality (ω: 0.15; 95% CI, 0.04, 0.61), and 8 times more variation in the odds of 180-day death or new dependence in locomotion (ω: 0.12; 95% CI, 0.05, 0.31).Nursing home factors explain a larger proportion of the variation in clinical outcomes following hip fracture than do hospital factors.

In the last two decades, quality of life and health-related quality of life have become commonly used outcome measures in the large number of studies evaluating healthcare and home care nursing. The objective of this systematic search and review was to evaluate studies that include self-rated generic quality of life instrument used among elderly patients receiving home care nursing. Searches were conducted in Medline, Embase, PsycINFO and Cinahl for articles published between January 2005 and June 2016, with 17 studies in eight countries meeting the inclusion criteria and assessed for quality. Overall, the review shows great variations in the included studies regarding characteristics of the participants and place of origin, the generic quality of life instruments applied and their dimensions. In this review, we raise the question of whether the generic questionnaires used to measure quality of life do in fact measure what is essential for quality of life in elderly users of home care nursing. The psychological and physical dimensions of quality of life were assessed in almost all included studies, while older-specific dimensions like autonomy, control and sensation were less frequently assessed. There is reason to believe that generic quality of life instruments frequently do not capture the dimensions that are most important for elderly people with health problems in need of home care nursing.

Background:Postgraduate year 2 ambulatory care pharmacy residents (PGY2 residents) may be able to improve healthcare quality by providing clinical pharmacy services provided to self-insured employer health plan patients. The objectives of this study are to describe this care delivery in a family medicine clinic, and to identify patients most likely to benefit from the service.Methods:From October 1, 2014 till June 30, 2015, comprehensive medication review was completed by PGY2 residents for patients insured by CU Anthem at the University of Colorado Westminster Family Medicine. For patients with medication-related problems (MRPs), a note was sent to the provider before the patient visit. Patient characteristics were compared in those who received a clinical pharmacy note with those who did not.Results:Sixty-eight MRPs were identified in 39 notes; 40 (58.8%) recommendations were implemented. The following Clinical Pharmacy Priority (CP2) score criteria were identified more frequently in patients with MRPs: age ≥65 years, diagnosis of diabetes, hypertension, chronic obstructive pulmonary disease, cardiovascular disease, blood pressure ≥140/90, hemoglobin A1c>7.9%, and ≥6 items on the medication list.Conclusion:PGY2 residents identified and resolved numerous clinically relevant MRPs. Patient-specific criteria can be utilized to target self-insured employer health plan patients who are likely to have clinically relevant MRPs.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions. 2. Describe the significance of interprofessional collaboration in the delivery of quality health care. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The purpose of the current project was to (a) examine the type of information accompanying patients on transfer from acute care to skilled nursing facilities (SNFs), (b) discuss how these findings meet existing standards, and (c) make recommendations to improve transfer of essential information. The study was a retrospective convenience sample chart audit in one SNF. All patients admitted from an acute care hospital to the SNF were examined. The audit checklist was developed based on recommendations by local and national standards. One hundred fifty-five charts were reviewed. Transferring of physician contact information was missing in 65% of charts. The following information was also missing from charts: medication lists (1%), steroid tapering instructions (42%), antiarrhythmic instructions (38%), duration/indication of anticoagulant medications (25%), and antibiotic medications (22%). Findings support the need for improved transitional care models and better communication of information between care settings. Recommendations include designating accountability and chart audits comparing timeliness, completeness, and accuracy. [Journal of Gerontological Nursing, 43(3), 19-28.].

There is agreement across all provinces that there is transformation needed in the area of home and community care. Yet, where is the collective voice of nurse leaders in this transformation? The guest editor calls on nurses to respond to this unique opportunity to shape the transformation of our health system, and improve care for patients and their caregivers.

Calls for transformational change of our healthcare system are increasingly clear, persuasive and insistent. They resonate at all levels, with those who fund, deliver, provide and receive care, and they are rooted in a deep understanding that the system, as currently rigidly structured, most often lacks the necessary flexibility to comprehensively meet the needs of patients across the continuum of care. The St. Joseph's Health System (SJHS) Integrated Comprehensive Care (ICC) Program, which bundles care and funding across the hospital to home continuum, has reduced fragmentation of care, and it has delivered improved outcomes for patients, providers and the system. This case study explores the essential contribution of nursing leadership to this successful transformation of healthcare service delivery.

According to the American Academy of Ambulatory Care Nursing (AAACN), Ambulatory care nursing is a unique realm of specialized nursing practice. RNs in the ambulatory setting are leaders in their practice settings and are uniquely qualified to influence organizational standards related to patient safety and care delivery in the outpatient setting.5 RNs in the inpatient setting are highly regarded as critical thinkers often implementing and providing care utilizing the steps of the nursing process which promote excellent quality care. As more and more patients transition from inpatient to outpatient settings, there is a greater demand for professional nursing services in the outpatient settings. RNs can utilize the same steps of the nursing process, which include assessment, nursing diagnosis, planning, implementing, and evaluation in caring for individuals in the outpatient setting. Tools used to provide care are order sets, protocols, and care plans. Primary Care offices can utilize registered nurses in day to day patient care delivery, education, self-management support, chronic disease care management and care coordination of services, and oversight and collaboration of panels of individuals. Providing these services will make a positive impact on patient outcomes and will prevent chronic diseases. In Canada, payment models have recently been implemented in primary care to address the increasing burden that patients with chronic diseases place on the Canadian healthcare system.4

Aims: This claims data-based study compares the intensity of diabetes care in community dwellers and nursing home residents with dementia. Methods: Delivery of diabetes-related medical examinations (DRMEs) was compared via logistic regression in 1,604 community dwellers and 1,010 nursing home residents with dementia. The intra-individual effect of nursing home transfer was evaluated within mixed models. Results: Delivery of DRMEs decreases with increasing care dependency, with more community-living individuals receiving DRMEs. Moreover, DRME provision decreases after nursing home transfer. Conclusion: Dementia patients receive fewer DRMEs than recommended, especially in cases of higher care dependency and particularly in nursing homes. This suggests lacking awareness regarding the specific challenges of combined diabetes and dementia care.

Objective The main purpose of this study was to investigate factors affecting dental care utilization among nursing home residents in Jordan. Methods A total of 221 subjects with a mean age of 62.4 years (121 males and 100 females) taken from among nursing home residents across Jordan were recruited and composed a convenience sample for this study. The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Tinetti Assessment Battery for gait and balance (TAB), Disability of Arm, Shoulder, and Hand test (DASH) were administered and oral health status was assessed for all subjects and examined as expected correlates of dental care utilization among nursing home residents. Results The response rate was about 88%. One-third of residents suffered from total edentulism and most of the remaining dentate residents exhibited periodontal disease (90%). Of the dentate sample, 90% of residents had bleeding upon probing, 85% were diagnosed with tooth mobility, 88% had presence of dental calculus, and 30% were diagnosed with root caries. Of the denture wearers, 59.1 % reported having soreness with their dentures and 32% of denture wearers reported having poor quality dentures. MMSE score, suffering from tooth sensitivity and having diabetes mellitus were identified to be indicators for utilization of dental care services among the study population. Conclusion Regular oral care, assessments, and rehabilitation services are considered to be limited for nursing home residents in Jordan. Based upon these findings, future interventions should address oral health among nursing home residents in Jordan.