COVID-19 Surge: Extraordinary Response to Unprecedented Times

Background Beginning in March of 2019, during intermittent COVID-19 pandemic surges, large influxes of patients overwhelmed the COVID-19 patient care areas. These areas were challenged with having adequate staff to perform all the tasks necessary to provide safe and comprehensive care. Staff were overwhelmed and stressed. Project Goals/Objective The purpose of the development of a labor pool was to emergently and systematically provide support staff to hospital COVID-19 patient care and other areas during times of patient surge. Methods of Implementation • Innovative concept of a Labor Pool emerged to optimize staffing during COVID-19 crisis with collaborative efforts of both nursing teams and Human Resources. • Non-direct patient care staff from across organization were asked to volunteer to provide extra support in COVID-19 areas. • Labor Pool included staff from various departments. • To assist direct care nurses: Non-clinical nurses re-trained to take vital signs and make phone calls to update families that could not come to visit. Nursing students teamed up with clinical partners. Dietary increased delivery to accommodate high demand of food requests. Environmental department deployed key personnel to areas in most need. Office personnel helped take temperatures at employee entrances. • These opportunities allowed many staff members to feel part of nursing team. Outcomes Through the implementation of the Labor Pool, non-direct care staff were deployed to COVID-19 patient care areas. The clinical staff in these areas felt supported and relieved. The Labor Pool proved to be an innovative initiative that benefited the clinical staff, patients and healthcare organization. Discussion The unprecedented COVID-19 pandemic patient surges brought about out-of-the-box thinking on how to help support the clinical staff. The extraordinary collaboration will remind us thru history that teamwork between departments in the hospital setting is vital for the survival of the nursing team

E-Dates: Enhancing Competency of Novice/Advanced Beginner RNs

Abstract Category: Practice Innovation / Performance Improvement (PI) Purpose: The purpose of the implemented initiative was to improve communication, critical thinking and decision making of novice/advanced beginner nurses on the medical/surgical areas. Methods: The bedside Clinical Nurse Educator’s (CNE’s) identified Novice/Advance Beginner Nurses in their departments. Meetings were planned on a 1:1 basis with the CNE’s and the identified nurses on the respective units. They called the sessions “Educational Dates,” or” E-Dates”. A tool for documentation during the E-dates was developed. During these E-dates the CNE shadowed the identified nurses for intervals of two to three hours in two separate occasions. During these E-dates the CNE would assessed on the areas of hand off report, patient assessment, documentation, medication administration and communication; looking for opportunities of improvement. Upon the E-date completion the CNE’s compared and discussed observations with the observed nurses and used reflection to promote learning and understanding of identified areas for improvement Findings: Improving the competency of nurses reflects on a delivery of safer patient care. As nurses develop and advance in their roles it is important to address their skills in all levels of practice. Enhancing nurses’ communication skills and assisting with their critical thinking will not only elevate nurses’ competency but also improve nursing practice. Discussion: With the current nursing shortage it is found experienced nurses are limited in number, healthcare systems use new graduates to help fill the gap (Blevins & Millen, 2016). Recently an increased in novice/advanced beginner nurses have being identified in the medical/surgical areas. However our institution is committed to the successful transition of these novice advance/beginner nurses. Leadership is aware that a successful transition influences patient safety and outcomes, financial cost and nurses’ longevity in the profession. The transition from advanced beginner to competent-proficient nurse includes experience within the clinical environment. Nurses at this level have showed mastered technical skills and the ability to provide patient care with competence and confidence. The interprofessional relations with physicians and nurses it’s greatly valued in our organization. Novice/advanced beginners nurses must feel comfortable and confident when communicating with physician, reporting findings, and documenting. Recent physician satisfaction survey scores showed that the physician’s perception of nurse’s competency decreased. Therefore, an initiative aimed to improve communication, critical thinking and decision making of novice nurses was started. Consequently with the expectation of improvement on the physicians’ perception of nurses’ competency. Implications for Practice: Improving the competency of nurses reflects on a delivery of safer patient care. As nurses develop and advance in their roles it is important to address their skills in all levels of practice. Enhancing nurses’ communication skills and assisting with their critical thinking will not only elevate nurses’ competency but also improve nursing practice

Escape Room: A Competency Validation Approach

Purpose: The purpose of the implemented initiative is to enhance annual competencies of clinical staff in the medical/surgical areas through innovative validation methods. Methods: Clinical Nurse Educator’s (CNE’s) identified a need for change with annual competencies for clinical staff. The educators brainstormed new concepts for creating competencies. In collaboration with the Unit Based Practice Council (UBPC), a learning needs assessment was conducted in each of four medical-surgical units. As a result, unit-based competencies were identified. By using a teamwork approach, the concept of an escape room activity was adapted and tailored to meet the needs of competency validation. A set up of different competency skill stations were designed separately for both Registered Nurses (RNs) and Clinical Partners (CPs). Groups of 6 to 8 staff participated and completed the activity within a one and a half hour time frame. A pretest and post test were conducted to measure knowledge before and after completion of the activity and an evaluation form was completed by all staff. Findings: A total number of 120 RNs and 45 CPs were able to complete the activity in a total of 29 and 10 sessions respectively. All sessions were provided in a period of 4 months. By the end of each session, RNs completed twelve and CPs completed five competencies. There was a significant improvement from pre to post test. The pretest average scores measuring knowledge for the RNs were only 50% and posttest increased to 91%. Additionally, the CPs pretest average scores were 42% and posttest increased to 92%. Staff evaluations determined a 100% satisfaction rate with the activity in which the main statements denoted innovation as the reason for such contentment. Discussion: Clinical Nurse Educators still face challenges with incorporating learning that is joyful, meaningful, and still effective for the staff. In trying to develop innovative ways of measuring competency of clinical staff in the medical-surgical areas, the nurse educators explored ways to include non-traditional strategies for engaging the team through active learning. The nurse educators searched for modalities to demonstrate competency, improve nurse satisfaction, bridge the generational gaps of the staff, while saving cost associated with annual education. The escape room competency validation approach proved to be a successful method. It was a strategy through which staff demonstrated skill proficiency and teamwork in an entertaining setting. By the end of the activity staff felt glad that they were not only able to show competency in their role, but also reinforce current knowledge. All staff expressed motivation and desire to complete the activity again in the future. Implications for Practice: Staff competency is essential to provide adequate care to patients. Validating staff’s ability to perform skills within their role has traditionally been designed based on staff’s lack of proficiency in performing a designated skill. Although these skills are evaluated on a set frequency basis, completing this process has brought dissatisfaction. Clinical nurse educators need to find new learning strategies to engage active learning all while increasing the level of competency. The escape room proved to be one strategy that did increase competency and overall satisfaction and may positively reflect an improvement of clinical outcomes

Escape Room: A Competency Validation Approach

Goal The purpose of the evidence-based practice initiative is to enhance annual competencies of clinical staff in the medical/surgical areas through innovative validation methods. Methods • Clinical Nurse Educators (CNEs) identified need for change with clinical staff annual competencies. • CNEs brainstormed new concepts for creating competencies. • In collaboration with the Unit Based Practice Councils (UBPC), a learning needs assessment was conducted in each of the four units. • Unit-based competencies were identified. • The concept of an escape room activity was adapted and tailored to meet the needs of competency validation (Figure 1). • A set up of different competency skill stations were designed separately for both Registered Nurses (RNs) and Clinical Partners (CPs). • Groups of 6 to 8 staff participated and completed the activity within a one and a half hour time frame. • A pre-test and post-test were conducted to measure knowledge before and after completion of the activity and an evaluation was completed by all staff. • A scale evaluation was used from very dissatisfied to very satisfied and for the 180 submitted evaluations 100% answered very satisfied. Outcomes • A total number of 120 RNs and 45 CPs completed the activity. • Total of 29 RN and 10 CP sessions were conducted over a period of 4 months. • RNs completed twelve and CPs completed five competencies. • The pre-test average scores measuring knowledge for the RNs were only 50% and post-test increased to 91%. The CPs pretest average scores were 42%and posttest increased to 92% (Figure 2). • Staff evaluations determined a 100% satisfaction rate. Discussion • The innovative method for measuring competency of RNs and CPs in the medical-surgical areas was initiated by the exploration of non-traditional strategies for engaging the team through active learning. • The nurse educators searched for modalities to demonstrate competency, improve nurse satisfaction, bridge the generational gaps of the staff, while saving cost associated with annual education. • The escape room competency validation approach proved to be a successful method where staff demonstrated skill proficiency and teamwork in an entertaining setting. • Staff felt glad to show competency in their role and reinforce current knowledge. Implications for Practice • Staff competency is essential to provide adequate care to patients. • Validation of staff’s ability to perform skills within their role has traditionally been designed based on staff’s lack of proficiency in performing a designated skill. • Clinical nurse educators need to find new learning strategies to engage clinical staff in active learning while increasing their level of competence. • Overall, increased competency and satisfaction may positively reflect an improvement of clinical outcomes

E-Dates: Enhancing Competency of Novice/Advanced Beginner RNs

Discussion: With the current nursing shortage it is found that experienced nurses are limited in number, and healthcare systems use new graduates to help fill the gap (Blevins & Millen, 2016). In 2015, an increase in novice/advanced beginner nurses was identified in the medical/surgical areas. The 2015 physician satisfaction survey scores showed that the physicians’ perception of nurses’ competency decreased. An initiative for improvement aimed to improve communication, critical thinking and decision making of novice nurses was implemented. Purpose: The purpose of the implemented initiative was to improve physician and peer satisfaction of working with clinically competent nurses by improving communication, critical thinking and decision making of novice advanced/beginner nurses in the acute med-ical surgical area. Methods: Clinical Nurse Educator’s (CNE’s) identified Novice/Advance Beginner Nurses in their departments. Meetings were planned on a 1:1 basis with the CNE’s and the identi-fied nurses on the respective units. They called the sessions Educational Dates, or “E-Dates”. A tool for documentation during the E-dates was developed. During these E-dates the CNE shadowed the identified nurses for intervals of two to three hours in two separate occa-sions. During these E-dates the CNE would assessed on the areas of hand off report, patient assessment, documentation, medication administration and communication. As opportuni-ties for improving critical thinking were identified the CNE addressed findings with the nurses and encouraged nurses to reflect on the experience. Findings: The implementation of the E-Dates by the CNE in the acute med-surg areas im-proved the communication, critical thinking and decision making of the novice advanced/beginner nurses. The result was an increase in physician and peer satisfaction improving the interprofessional relationships valued by our organization

Failure of psychiatric referrals from the pediatric emergency department

<p>Abstract</p> <p>Background</p> <p>Recognition of mental illness in the pediatric emergency department (PED) followed by brief, problem oriented interventions may improve health-care seeking behavior and quality of life. The objective of this study was to compare the frequency of mental health follow up after an enhanced referral compared to a simple referral in children presenting to the PED with unrecognized mental health problems.</p> <p>Methods</p> <p>A prospective randomized control trial comparing an enhanced referral vs. simple referral in 56 families of children who were screened for mental health symptoms was performed in a large tertiary care PED. Children presenting to the PED with stable medical problems were approached every fourth evening for enrollment. After consent/assent was obtained, children were screened for a mental health problem using both child and parent reports of the DISC Predictive Scales. Those meeting cutoffs for a mental health problem by either parent or child report were randomized to 1) simple referral (phone number for mental health evaluation by study psychiatrist) or 2) enhanced referral (short informational interview, appointment made for child, reminder 2 days before and day of interview for an evaluation by study psychiatrist). Data analysis included descriptive statistics and Chi-Square test to calculate the proportion of children with mental health problems who completed mental health follow-up with and without the enhanced referral.</p> <p>Results</p> <p>A total of 69 families were enrolled. Overall 56 (81%) children screened positive for a mental health problem as reported by either the child (self report) or mother (maternal report of child mental health problem). Of these, 33 children were randomized into the enhanced referral arm and 23 into the simple referral arm. Overall, only 6 families with children screening positive for a mental health problem completed the psychiatric follow up evaluation, 2 in the enhanced referral arm and 4 in the simple referral arm (p = .13).</p> <p>Conclusion</p> <p>Children screened in the ED for unrecognized mental health problems are very unlikely to follow-up for a mental health evaluation with or without an enhanced referral. Understanding the role of ED based mental health screening and the timing of an intervention is key in developing ED based mental health interventions.</p

Determinantes sociales que influyen en la anemia en niños de 6 a 36 meses de edad que acuden al Centro de Salud de Urcos, Cusco 2019

La investigación: “DETERMINANTES SOCIALES QUE INFLUYEN EN LA ANEMIA EN NIÑOS DE 6 A 36 MESES DE EDAD QUE ACUDEN AL CENTRO DE SALUD DE URCOS, CUSCO 2019”. Cuyo objetivo es establecer como los determinantes sociales en las dimensiones sociodemográficas, entorno, atención de salud y hábitos alimentarios influyen en la anemia en niños de 6 a 36 meses de edad, diseño cuantitativo, descriptivo, correlacional y transversal. La muestra fue 92 niños con anemia. Las técnicas utilizadas fueron la entrevista y observación cuyos instrumentos fueron un cuestionario y una guía de observación. RESULTADOS: El 45,7% son niños de 13 a 24 meses; 62% son de sexo femenino; 97,8% fueron nacidos a término y tuvieron embarazos de producto único; 62% presentaron anemia leve y 38% moderada. Las características de los determinantes sociales que influyen en la anemia en niños de 6 a 36 meses de edad se tiene las siguientes Dimensiones: Sociodemográficas de la madre; 54,3% tuvieron grado de instrucción secundaria; 70,7% eran casadas; 41,3% tenían 2 hijos; 60,9% fueron amas de casa; 53,3% procedían de la zona urbana; 47,8% tardaban hasta 30 minutos en llegar al Centro de Salud y 58,7% percibían un ingreso económico menos a S/500. Dimensión hábitos alimentarios: Los niños con anemia consumían una vez por semana lo siguiente; 73,9% vísceras; 62% carnes rojas; 75% carnes blancas; 51,1% frutas cítricas y 66,3% indicaron que el número que de veces que consumían sus alimentos los niños de 13 a 36 meses fueron desayuno almuerzo y cena. Concluyendo que los determinantes sociales en las dimensiones sociodemográficas y hábitos alimentarios influyen en la anemia en niños de 6 a 36 meses de edad que acuden al Centro de Salud de Urcos, Cusco 2019.The Investigation: “DETERMINING SOCIAL THAT THEY INFLUENCE THE ANEMIA IN children OF 6 To 36 ELDERLY MONTHS THAT THEY ATTEND to URCOS's HEALTH CARE FACILITY, CUSCO 2019 ”. It is to establish whose objective like the determining social in dimensions sociodemográficas, surroundings, attention of health and alimentary habits influence the anemia in children of 6 to 36 elderly months, quantitative, descriptive design, correlacional and side road. The sign was 92 children with anemia. The utilized techniques were the interview and observation whose instruments were a questionnaire and a guide of observation. RESULTS: The 45,7% they are children of 13 to 24 months; 62% belong to female sex; 97,8% were born to term and had pregnancies of only product; 62% presented light anemia and 38% moderated. The social characteristics of the determining that influence the anemia in children of 6 to 36 elderly months one has the following Dimensions: Sociodemográficas of the mother; 54,3% had grade of secondary instruction; 70,7% were married; 41,3 % had 2 children; 60,9% were home mistresses; 53,3% came from the urban zone; 47,8% delayed to 30 minutes in getting to the Health Care Facility and 58,7% perceived a costreducing entrance less to S/500. Dimension alimentary habits: The children with anemia consumed once per week the following; 73,9% viscera; 62% red meats; 75% tender meat; 51,1% the citrus fruits and 66,3% indicated than the number than of times that the children of 13 consumed their foodstuff to 36 months they were brunch and dine. Coming to an end than the determining social sociodemográficas and alimentary habits influence the anemia in children of 6 to 36 elderly months that they attend to Urcos's Health Care Facility in dimensions, Cusco 2019.Tesi

Análisis de las técnicas de traducción del doblaje al español del videojuego Kingdom Hearts II

Objetivo: Identificar las técnicas de traducción más empleadas en el doblaje al español del videojuego “Kingdom Hearts II”. Metodología: Investigación descriptiva, aplicada y transversal. El corpus estuvo constituido por un total de 35 muestras seleccionadas de los capítulos 1, 2 y 3. Resultados: Se evidenció el empleo de las siguientes técnicas de traducción: adaptación, modulación, equivalente acuñado, creación discursiva, elisión, particularización, descripción y transposición. Conclusiones: Se concluyó que las técnicas más empleadas fueron la adaptación, modulación y la creación discursiva. –La técnica más empleada fue la adaptación – La segunda técnica más empleada fue la modulación. –La tercera técnica más empleada fue la creación discursiva. Recomendaciones: - Es importante que el traductor de videojuegos trabaje junto con el equipo de desarrollo - El traductor debe utilizar un “español estándar” para evitar el rechazo de algunos jugadores hispanos. – El traductor debe poseer un gran conocimiento tanto de la cultura receptora como de su propia cultura. –La traducción de videojuegos requiere mayor investigación, ya que la industria de este entretenimiento va en crecimiento.Tesi