The development, implementation and evaluation of an educational program for staff nurses to identify and manage risk factors for ischemic stroke in patients with a history of migraine

The literature findings demonstrate that patients with migraines have a significantly high incidence of ischemic stroke (Kurth, 2010). Migraine is a common neurological disease that is defined very poorly and is estimated to affect between 1 % and 10% of men and 3 % and 20% of women within the United States (Buring & Hennekens 1995). Decreasing migraine frequency and management of modifiable stroke and cardiovascular risk factors\u27-, such as hypertension, high cholesterol and smoking can help decrease risk of stroke occurrences (Tietjen, 2005). Therefore, to decrease stroke occurrence, it is imperative that staff nurses are educated on the importance of managing modifiable risk factors in patients with a history of migraine

A Foucauldian analysis on the professionalisation effort of nursing in Singapore

Aim: A discussion using Foucault’s genealogical analysis to explain the professionalisation effort of nursing in Singapore. Background: Nursing in Singapore is strongly influenced by Western civilisation, however, the discipline may not have adopted similar responses to the world’s nursing professionalisation agenda as led by the West. An explanation on the ways nursing is spoken of and practiced in Singapore provides insights to the effects on nursing development in the country. Design: The discussion uses Foucault’s genealogy of power to draw on the practices of clinical nursing and nursing education in Singapore in an attempt to uncover the unorthodox professionalisation effort. Data Sources: The discussion is an outcome of a critical reflective observation made by the authors between 1993 and 2014. It is supported by related literature, critical debates amongst Singapore healthcare professionals, nurse lecturers and the Singapore locals. Implications for Nursing: Time and effort vested in overcoming medico-political dominance, should be used in the pursuit of high quality nursing clinical knowledge and acumen. Specialised nursing knowledge and autonomous practice should adopt an explicit focus in its mission to achieve the common good which is in favour of the public interest. Conclusions: While the hierarchical nursing structure was the foundation for professionalising nursing, nursing subservience was the gateway for advancing nursing in Singapore. Without generalising the positive effects of the power-relations in Singapore, nursing practice which reflected the ‘subservience in females’ and demonstrated respect for authority within a hierarchical system had evidently led to good quality nursing practices which serve as a strong foundation for nursing to secure professional recognition

Using a Quality Workbook Committee to Improve Nurse-Sensitive Patient Indicator Scores

Health care providers gather and track quality patient indicator scores to monitor patients\u27 safety and outcomes and decrease the number of adverse events. Nursing leaders implemented a Quality Workbook Committee (QWC) within a hospital setting to improve patient outcomes and the facility\u27s reported scores for nurse-sensitive patient indicators. The practice-focused question for this quality improvement evaluation project examined whether the implementation of the QWC improved nurse-sensitive patient indicator scores. Watson\u27s theory of human caring was used to evaluate the gap in practice, and Rosswurm and Larabee\u27s model for evidence-based practice change provided guidance for planning the project. Sources of evidence were 2017 end-of-year organization report cards. The 4 specific areas chosen for evaluation were: patient falls, hospital-acquired pressure ulcers, pain reassessment scores, and medication scanning rates. Results from an analysis of variance showed improvements in 3 of the 4-nurse-sensitive patient indicator scores. Hospital-acquired pressure ulcers decreased by 13 pressure ulcers, pain reassessment rates increased by 18.42%, and medication scanning scores increased by 4.03%. However, patient falls increased by 15, suggesting the need for further evaluation measures. Project findings may help nursing leaders to improve nurse-sensitive patient indicator scores and promote social change by reducing hospital adverse events, length of hospitalization stays, and wasted healthcare resources

Caring attributes and preparedness to care: effects of a pre-enrolled nursing certificate programme in Singapore

Background: Caring is a highly complex and abstract concept, and nurturing a caring attribute among individuals for a nursing career is believed to be best introduced at the start of student journey in preparatory courses specifically designed for nursing. However, because of the need to professionalise nursing, pre-enrolled nursing programmes have been discontinued and replaced by generic healthcare programmes in many parts of the world. Aim: This study aims to evaluate the impact of pre-enrolled certificate nursing education on students’ caring attributes and their preparedness to care. Methodology: A mixed methods approach using unstructured questions and the Caring Behaviour Inventory was employed to determine student caring attributes and their preparedness to care. The participants were final year pre-enrolled nursing students in Singapore. Findings: Students demonstrated attributes of caring based on an average CBI score of 4.55 (SD 0.32). Expressions of professional nurse caring were explicit in students’ entire learning journey and these took various forms of approach embedded in both curricular and extracurricular activites. The study also found that nurturing caring attributes was associated with a high expectation of student social behaviour and closely linked to the increasingly good reputation of nursing as a profession in that region. Conclusions: This study indicates the high potential value of pre-enrolled nursing education for developing the caring attributes of individuals. A nursing-oriented programme title and its high status associated with nursing were critical elements for nurturing the caring attributes. The implications for developments in nurse education and research are discussed

Critical discourse analysis : an alternative but vital route to understanding how nurses' caring behaviour is translated in text-based interprofessional online learning in higher education

Paper presented at ProPEL international conference 2014, 24-27 June, Stirling, Scotland. ABSTRACT Aim: to demonstrate Fairclough’s critical discourse analysis as an alternative but vital route to the understanding of translation of nursing caring behaviour in asynchronous text-based interprofessional online learning within higher education. Background: Positive asynchronous text-based online learning experience indicating nursing caring behaviours were reported in only a small number of studies about homogeneous nursing groups. In addition, these positive findings seemed to be eroded by nurses’ dominance in interprofessional learning situations. The dominance which might be a result of professional boundaries is a critical barrier to interprofessional education, where little is yet understood about the phenomenon. Design: A study which employed Fairclough’s critical discourse analysis was used to seek understanding of the translation of nursing caring behaviour in text-based interprofessional online learning within higher education. Data Source: The main findings based on Fairclough’s critical discourse analysis of a text-based discussion is used to demonstrate the usefulness of the methodology. The asynchronous online discussions for analysis was produced by 9 students who were undertaking an interprofessional online learning module at master’s level in a University in North England Findings: By using Fairclough’s critical discourse analysis, understanding of the semiotic categories corresponding to genres, discourses and styles is gained. However, it is through appreciating on how these 3 categories relate to social practices and social events has helped in making explicit the dialectical relations between semiosis and its other elements. In doing so, how nurses’ caring behaviours in interprofessional learning were translated in an asynchronous text-based learning environment can be explained. Conclusions: Fairclough’s critical discourse analysis was useful in explaining how nursing caring attributes could result in the interprofessional learning space being used as an alternate platform for nurses and allied healthcare professionals to co-construct the power-relations. It is critical to appreciate that the analysis was based on the researcher’s emic position. Owing to the fact that tacit knowledge of the research in the power-relations which entangled in the social order and practices in healthcare is required in the analysis, the strength of an emic position could become a limitation. This is particularly perceived amongst researchers who hold a strong view for an etic perspective in discourse analytic work. In this regard, research exploring issues of interprofessional education should consider triangulating the critical discourse methodology with other qualitative theoretical frameworks

Nursing care behaviour in interprofessional learning explained by critical discourse analysis

Aim: to demonstrate Fairclough’s critical discourse analysis as a way to understand nurse caring behaviour in asynchronous text-based interprofessional online learning within higher education. Background: asynchronous text-based learning experience of homogeneous nursing groups indicated nurse caring behaviour in a small number of studies. However, positive findings were not found in studies about interprofessional learning undertaken by nurses. Instead, nurses’ dominance which might be a result of professional boundaries was frequently reported as a barrier to interprofessional education, yet little is understood about the phenomenon. Design: a study which employed Fairclough’s critical discourse analysis was used to understand the translation of nurse caring behaviour in text-based online interprofessional learning within higher education. Data Source: the asynchronous online discussions produced by thirteen students undertaking an online interprofessional learning module at master’s level in a University in the North of England were the discourse data for analysis. Findings: By using Fairclough’s critical discourse analysis, understanding of the semiotic categories corresponding to genres, discourses and styles yielded information on nurses’ discourse in online learning. Through appreciating the subliminal way in which these three categories relate to social practices and social events, the dialectical relations between semiosis of the online text and its other elements were made explicit. In doing so, the way nurse caring behaviour in interprofessional learning were translated in an asynchronous text-based learning environment was explained. Conclusions: Fairclough’s critical discourse analysis was useful in explaining how nurse caring attributes when displayed online could result in the interprofessional learning space being used as a platform for nurses and allied healthcare professionals to co-construct power-relations. The analysis required researchers’ tacit knowledge, based on an emic (insider) position in healthcare practice and education, which is closely linked to the power-relations that is entangled in the social order and practices in healthcare. This explains why researchers outside of critical discourse analytic work would hold a strong view for an etic (outsider) perspective in discourse analysis. In this regard, one should consider triangulating critical discourse methodology with other qualitative theoretical frameworks

Innovative Programs Serving Diverse Populations: The Community College Caregiver Training Initiative

Turnover among homecare workers is alarmingly high, due to difficult working conditions, low pay, few benefits and little opportunity for career advancement. The significance of our Community College Caregiver Training Initiative is reinforced by the recommendation by the Institute of Medicine in its 2008 report, Retooling for an Aging America, for improved education and training and support for professional caregivers

Purposeful Rounding for Fall Reduction

Objective. The quality improvement project aimed to study the effects of purposeful rounding on falls in a long-term care unit. The focus was on CNAs who provided care for 6 residents each, with a current census of 36 residents in the long-term care setting. Problem. Many of the residents are at risk for falls due to immobility, medication, and environmental hazards (Centers for Disease Control and Prevention, 2022). Context. Research has found that the key reasons residents call for staff include needing to use the bathroom, to address pain, to address positioning, and to address IV pumps and alarms (Studer Group, 2023). Intervention. Purposeful rounding includes preemptively addressing the patient’s needs before they were urgent. This technique reduced falls by 50% in the clinical setting (Studer Group, 2023). Measures.Using evidence-based research on implementing changes and the quality improvement PDSA tool, the staff in a long-term care setting in Marin staff were trained on how to round purposefully exhibiting 8 key behaviors and addressing the 5 Ps. Results. Preliminary results were encouraging. The most meaningful outcome was the feedback from the staff. Conclusion. Purposeful rounding when used in collaboration with the motion sensor detector reduces fall incidents in a long-term care setting. Keywords: purposeful rounding, intentional rounding, fall reduction, quality improvement interventio

Development and evaluation of flipped learning classes using film clips within a nursing informatics course

Aim: To develop flipped learning classes by using film clips for undergraduate nursing students in an online nursing informatics course, based on the Analysis, Design, Development, Implementation, and Evaluation model, and to evaluate the effectiveness and students’ responses to this method of teaching.Methods: Sixty-four second-year nursing students participated in the course. The nursing students’ knowledge was assessed at the beginning and end of each of the five classes. Moreover, their intention to recommend the classes to other students and additional comments were elicited by using semistructured questionnaires.Results: Knowledge about each core concept of nursing informatics reflected significant improvement. Regarding the intention to recommend the class to others, 62 (96.8%) students answered “strongly recommend” or “recommend.”Conclusion: Integrating flipped learning classes by using film clips in an online nursing informatics course improved the nursing students’ knowledge and is a format that is desired by students

A Quality Improvement Project to Increase Eye Care Screenings and Recommendations for Patients With Type II Diabetes Mellitus

Type 2 diabetes affects more than 90 million people and is a major cause of reduced vision and blindness in the United States (Lu et al., 2016). Without proper preventative measures, T2D damages the microvascular within the retina causing diabetic retinopathy (Lima, Cavalieri, Lima, Nazorio, & Lim, 2016). Despite the success of early detection and the availability of diabetic retinopathy screenings, many people diagnosed with T2D do not complete the recommended routine eye exam (Lu et al., 2016). Healthy People 2020’s (HP2020) (2016) target goal for annual dilated eye exams for patients with T2D is 58%. At baseline, only 2% of patients received eye care screenings & referrals within the host Internal Medicine clinic. The purpose of this quality improvement project was to increase the number of eye care screenings performed and referrals completed in non-WellMed patients over the age of 18 diagnosed with T2D. The primary objective was to increase eye care screenings and ophthalmology referrals and educate patients and staff regarding diabetic retinopathy. The intervention included staff training, a patient education handout, and the development of a provider protocol checklist. Between June 12 and August 4, 2017, 76 patients met the inclusion criteria. Following the intervention, 40 patients (53%) received a complete eye care assessment, 29 patients (38%) were recommended to an ophthalmologist, and 33 patients (43%) received patient education handouts. Results suggest that a combination of staff training, patient education, and assistance with the assessment and referral process can influence provider’s adherence to recommended care