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Background: To prepare nursing students to deliver high-quality care, educators need strategies to foster person-centered care (PCC). Purpose: This pilot study evaluated an intervention with interactive case studies on undergraduate nursing students' PCC competency. Methods: We conducted a pilot study with sophomore undergraduate nursing students (n = 39) from a Midwestern US university. We developed a 90-minute class seminar with interactive case studies highlighting how patient preferences, values, and circumstances could influence fall risk. We assessed PCC using the Patient-Centered Care Competency Scale. Results: Although there was no statistically significant change in overall PCC competency before and after the intervention, we noted a small to medium effect size on PCC competency per Cohen's d standards (d = 0.35). Content analysis of students' open-ended responses reflected PCC and clustered into 5 themes. Conclusions: Findings suggest that educators may use interactive case studies to foster nursing student PCC competency. [ABSTRACT FROM AUTHOR]

Background: Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim: To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic. Research design: Qualitative analysis using a directed content methodology. Participants and research context: The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations: Participant privacy and data confidentiality were addressed. Findings: Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion: This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions: Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. [ABSTRACT FROM AUTHOR]

The U.S. Centers for Disease Control established the central line maintenance care bundle in 2011, yet nurses' adherence to all seven components remains challenging. The specific aim of this study was to explore and understand intensive care nurses' perceptions and beliefs regarding central line maintenance, bundle care elements, and associated adherence. This qualitative study used a phenomenological approach. Three main themes emerged as follows: (1) thoughts about the ability to adhere to the central line bundle created feelings about central line maintenance care, (2) feelings about the nurses' ability to adhere to the central line bundle influenced behaviors, and (3) behaviors for central line bundle adherence reinforced thoughts. Each theme had several subthemes. Organizations must assess and mitigate the unique cognitive and behavioral factors that affect nurses' adherence to the central line-associated bloodstream infection (CLABSI) maintenance bundle. In addition, nursing adherence requires knowledge of CLABSI rates and direct care nurse involvement in identifying solutions. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this qualitative study was to synthesize frontline U.S. nursing perspectives about the current state of U.S. public health emergency preparedness and response. The study findings may inform public health policy change and improve future national pandemic planning and responses. Design: We conducted a secondary thematic qualitative analysis using grounded theory methodology. Methods: Data collection occurred through semi‐structured, in‐depth focus groups between July and December 2020, from 43 frontline nurses working in hospitals in four states (Ohio, California, Pennsylvania, and New York). Data were analyzed deductively, aligned with Khan et al.'s Public Health Emergency Preparedness Framework and inductively for emergent themes. Results: Three themes emerged: (1) Validation of the presence of health disparities and inequities across populations; (2) Perceived lack of consistency and coordination of messaging about pandemic policies and plans across all levels; and (3) challenges securing and allocating nursing workforce resources to areas of need. Conclusion: From a frontline nursing perspective, this study demonstrates the critical need to address health inequities and inequalities across populations, a consistent national vehicle for communication, and national plan for securing and allocating nursing workforce resources. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to explore nurses' experiences and perceptions at selected United States (U.S.) healthcare sites during the COVID‐19 pandemic. Background: The COVID‐19 pandemic brought rapid changes to the healthcare community. While a few studies have examined the early pandemic experiences of nurses in China and Europe, nurses' experiences across the United States have remained relatively underexplored. Design: A qualitative study design was used. Methods: Using a constructivist grounded theory methodology and methods, we conducted eight focus groups across four hospital sites in the eastern, midwestern and western United States. Registered nurses with a minimum of six months' experience working in all clinical specialties were eligible. Forty‐three nurses participated. Data were analysed iteratively using the constant comparative method. The COREQ guidelines supported the work and reporting of this study. Results: The nurses experiencing a pandemic (NEXPIC) grounded theory emerged positing associations between four interrelated themes: Challenges, Feelings, Coping and Ethics. Nurses reported Challenges associated with changes in the work environment, community and themselves. They expressed more negative than positive feelings. Nurses coped using self‐care techniques, and teamwork within the healthcare organisation. Moral dilemmas, moral uncertainty, moral distress, moral injury and moral outrage were ethical issues associated with nurses' Challenges during the pandemic. Moral courage was associated with positive Coping. Conclusions: Awareness of frontline nurses' complex and interrelated needs may help healthcare organisations protect their human resources. This new theory provides preliminary theoretical support for future research and interventions to address the needs of frontline nurses. Relevance to clinical practice: Nurses face added distress as frontline at‐risk caregivers. Interventions to promote nurses' ability to cope with personal and professional challenges from the pandemic and address ethical issues are needed to protect the nursing workforce. This study offers a new substantive theory that may be used to underpin future interventions. [ABSTRACT FROM AUTHOR]

There is inadequate research about nurses' confidence in implementation strategies that foster the application and sustainability of evidence-based practice (EBP). Guided by Bandura's self-efficacy theory, we propose that self-efficacy (confidence) in EBP implementation strategies can accelerate the uptake of evidence into practice to improve health care quality. The purpose of this study was to develop and test the psychometric properties of the Implementation Self-efficacy for EBP (ISE4EBP) scale as a measure for evaluating self-efficacy in using EBP implementation strategies. In a sample of 65 registered nurses, the 29-item ISE4EBP scale demonstrated adequate content validity (via content validity index), internal consistency reliability (Cronbach's alpha = 0.987), and construct validity indicated by associations with organizational readiness for EBP. Clinicians may use the ISE4EBP scale to identify areas for building implementation confidence to accelerate the uptake of evidence to improve quality care. [ABSTRACT FROM AUTHOR]

Objective: This study explored the relationships between nurse-sensitive structures, processes (work engagement [WE], frequency of fall risk discussion during report, and frequency of purposeful rounds), and patient falls., Background: Strong WE is associated with better nurse-assessed quality of care, but previous research is limited by self-reported outcome measures., Methods: We used a descriptive, cross-sectional, survey design with 41 nursing units from 7 hospitals. Nurses completed a survey including the Utrecht Work Engagement Scale. National Database of Nursing Quality Indicators reports provided falls data., Results: WE was not related to patient falls, even after controlling for RN staffing and skill mix. The nursing units that had more nurses performing frequent purposeful rounds experienced greater falls with injury. Highly engaged nurses participated more in purposeful rounding and discussion of fall risk during bedside report than less engaged nurses., Conclusions: Further research is needed to understand the impact of WE on patient outcomes.