Self-Efficacy: Nurses’ Perceptions of Caring for Patients Living with Diabetes

Diabetes is an epidemic that affects over 415 million people worldwide. In the United States, the number of people diagnosed with diabetes is projected to triple to over 60 million by 2060. With this surge, the number of hospitalizations across the country has significantly increased. Direct care nurses play a vital role in the management of patients living with diabetes. The purpose of this research study was to explore and describe medical-surgical nurses’ perceptions of self-efficacy related to caring for patients living with diabetes. This study\u27s guiding research question was: What are nurses’ perceptions on the influences that impact self-efficacy in caring for patients living with diabetes on a medical-surgical unit? Bandura’s Self-Efficacy Theory provided the conceptual framework of this study and guided the development of the interview questions and the analysis of the data. A qualitative descriptive design using a constant comparative analysis method, as described by Strauss and Corbin (1990), was utilized. A purposive, convenience sampling plan was used to recruit eight medical-surgical nurses from two acute care hospitals in the Southeastern United States. Four major themes were revealed in this study: (a) educational preparation, (b) biases towards patients, (c) current clinical environment, and (d) patients’ behaviors affect nurses’ emotions. Additionally, six subthemes were identified. This study\u27s results may inform targeted interventions that promote improved self-efficacy among medical-surgical nurses resulting in optimal patient outcomes for people living with diabetes

Innovative Strategies to Support Mental Wellbeing

The Coronavirus disease 2019 (COVID-19) pandemic has adversely affected many people’s mental wellbeing. COVID-19 has led healthcare organizations to reconceptualize and reform healthcare through an innovative lens that will foster resilience. Finding strategies to support mental wellbeing, especially for frontline clinicians, is crucial to ensure a comprehensive recovery. This manuscript describes innovative strategies implemented within one healthcare organization in the Southeastern United States to nurture mental wellbeing for the community and frontline healthcare clinicians

COVID-19: Innovative Strategies to Support Mental Wellbeing for Frontline Nurses

Background The Coronavirus disease 2019 (COVID-19)pandemic has adversely affectedmany people’s mental wellbeing.Healthcare organizations have beenfaced with incredible challenges dueto COVID-19. Finding strategies tosupport mental wellbeing, especiallyfor frontline nurses is crucial to ensurea comprehensive recovery. Shortly after the pandemic started, one nurse realized frontline healthcare clinicians needed a quiet space to unwind and rejuvenate. With space limited at the hospital, this proved to be a challenging goal. Project Goals The purpose of this initiative was to create a space intended to offer a stress-free tranquil environment that promoted mental wellbeing for frontline nurses during the pandemic at an acute care community hospital. Methods of Implementation Two conference rooms &one officewere utilized to create the Relaxation Spaces Relaxation Spaces offered a stress-freeenvironment by providing forms of self-care such as aroma & music therapy With the lights dimmed, the RelaxationSpaces were stocked with infusedwater & mints Each room was set up to accommodateone person at a time, allowing a spaceto safely remove their mask Cleaning guidelines when entering &exiting the Relaxation Spaces followedCDC recommendations Outcomes The response from frontline nurses has been overwhelmingly positive, with many calling it a much needed tranquil space. The Relaxation Spaces allowed many nurses to have a quiet moment to reenergize. Discussion The Relaxation Spaces are one example of how hospitals can quickly and proficiently create a quiet space for frontline nurses that builds resilience and promotes mental wellbeing. The gratitude from the frontline clinicians further affirms the need to foster ways to support wellbeing for all, especially our frontline healthcare heroes

Reduction in Length of Stay by Early Oral Feeding

Problem/Purpose: Length of stay (LOS) has an average of 5.4 days in the inpatient setting and 0.1 days in the ambulatory setting. Many factors can effect a patient’s post-op LOS such as age, gender, and anesthesia type utilized. However, other factors such as early nutrition warrants further research. The research aim was to determine the association between early oral feeding and LOS among postoperative adults hospitalized within medical-surgical units at a Magnet hospital in the Southeastern United States. The overall purpose of the research study was to explore the difference in length of stay (LOS) between patients who received early oral feeding compared to patients who did not receive early oral feeding thus generating new knowledge that will promote enhancement of recovery by reducing LOS. Methods: The study employed a quasi-experimental ex-post facto study design, using retrospective data. The instrument utilized was the Charlson Co-Morbidity Index (CCI). The CCI measures mortality risk and liability for disease. A single database was created using set variables. A CCI index score was calculated for each patient record based on ICD 10 codes for all primary and secondary diagnoses. Statistical analyses were completed using descriptive and inferential statistics. Similarities and differences in patient characteristics and in the LOS between those who were fed early and those who were not were explored. Association between LOS and other variables were examined. Results: A total of 407 patients were included in the study. Multiple linear regression was used to model LOS as a function of age, gender, CCI, procedure type and feeding status. A unit increase in age was associated with a 0.014 days increase in LOS ( p = .041). Each unit increase in the CCI score was also associated with 0.497 days longer LOS ( p \u3c .001). Open procedures resulted in 1.3 days longer LOS compared with laparoscopic procedures ( p \u3c .001). The results showed no significant association between early feeding and LOS. However, it was noted that patients with early feeding had a lower LOS ( Median = 2.00, IQR = 1.00 – 3.00) compared with those fed later ( Median = 3.00, IQR = 2.00 – 3.50). Conclusion/Implications for Practice: Although early feeding was not statistically significant, a decrease in LOS was noted. The implications surrounding LOS are profound for healthcare organizations and patients. Nurses can enhance the recovery period for post-op patients and decrease LOS by promoting early oral feeding

The Efficacy of a Diabetes Self-Management Education Program at a Rural Critical Access Hospital

Background/Purpose: Diabetes is a condition in which the body is not able to produce or respond to insulin resulting in decreased energy to perform activities of daily living. The main goal of an educational program is to improve outcomes and quality of life. Mariners Hospital has had a Diabetes Self-Management Educational (DSME) program since 2008. However, the program has never been evaluated for its effectiveness. The purpose of this study was to test the efficacy of Mariners Hospital’s Diabetes Educational pro-gram in improving coping skills and quality of life for people living with diabetes. Methods: We conducted a quasi-experimental design utilizing the Living with Diabetes (LWD) survey, which was implemented pre and post the 10-week educational program. The validated survey consisted of 15 questions with responses based on a five-point Likert scale, designed to assess the understanding of the participants’ knowledge and coping ability. All patients in the education program were invited to participate. To maintain anonymity and the sanctity of the study, no identifiable information was collected from the participants. A total of 32 participants were enrolled at the inception of the program and 50% completed the study. Results: There was an increase in the patients’ LWD rating post-program (M = 66.38, SD = 5.8) compared to pre-program as shown by t -tests. (M = 51.94, SD = 9.75), t (46) = 5.44, p \u3c .001, Cohen’s d = 1.80. The 95% CI for the mean difference in rating was 9.09 to 19.78. The results demonstrated that participants were able to increase their understand-ing and coping skills of diabetes self-management after the structured outpatient educa-tional program. Conclusion/Implications for Practice: People living with diabetes need the tools and resources to care for themselves. The implication for practice may demonstrate a decrease in emergency room visits and hospital admissions. The educational program showed a significant improvement in the quality of life for people living with diabetes, which will result in positive outcomes for the individual, their families and the community

Hospital Survey on Culture of Transitions in Patient Care at a Community Hospital

Background/Purpose: The efficiency and effectiveness of patient progression through an episode of hospital care remains a concern after almost three decades of focus. Complex adaptive systems theory suggests that a hospital’s culture is a preeminent factor in the success and sustainability of large scale change and one that is often not well understood by change agents. The purpose of this study was to develop a better understanding of attitudes, beliefs, values, and practices related to transitions in patient care and to determine if any demographic variables were predictors of these key components of culture. Methods: We conducted a quantitative correlational, cross-sectional study utilizing a convenience sample. The instrument used in the study was the Hospital Survey on Culture of Transitions in Patient Care developed by M. McClelland DNP, RN, CPHQ. The instrument included a series of 23 statements using a Likert scale. All employees were invited to participate. Volunteers, students, and contracted workers were excluded from the study. Results: Sixty-one respondents answered the survey questions with a broad variability in demographics, including role, department, tenure at the hospital and years of experience. Questions were aggregated into seven domains suggested by the instrument developer with descriptive statistics to examine frequencies. Spearman correlations between demographic variables and question responses showed no significance. However, moderate to strong correlations were found in questions within each domain as expected. Additionally, correlations in many questions between do-mains were significant, most notably between the “My Unit Culture” and “Other Units Culture” do-mains. Conclusion/Recommendations: To be effective and sustainable, large scale change in hospitals relies on all affected members of the organization to implement and sustain the change to achieve the desired outcome. The study found that the attitudes, beliefs, values, and practices related to transitions in patient care are not influenced by individual roles, departments, tenure, or years of experience. Instead, this finding indicates that they are influenced by a particular organizational culture and not a culture defined by their demographics. In addition, the descriptive and correlational findings provide a baseline to better understand this hospital’s culture related to transitions in patient care for incorporation into change strategy designs

Hospital Survey on Culture of Transitions in Patient Care at a Community Hospital

Background: Delays in patient transitions of care are complex and, therefore, a reductionist model of improvement is not likely to produce sustainable results. Exploration of the culture-performance link in the organization has the potential to guide improvement methods aimed at complex, non-linear processes. Methods: An exploratory, descriptive correlational study was conducted employing the administration of the Hospital Culture of Transitions in Patient Care survey to a cross sectional convenience sample. Results: Sixty-three participants responded to the survey. In assigning a grade to transitions in the organization, 35% of participants selected a grade of “A” with 33.3% “B”, 23.3% “C”, and 8.3% “D”. In the descriptive analysis, the most favorable responses related to the Hospital Leadership and the Unit Leadership domains. The least favorable responses revealed a perception of staff delaying transfers in both the “My Unit Culture” (49.1%) and the “Other Units’ Culture” (29.8%) domains. The correlational analysis of the domains of the survey found the Hospital Leadership domain correlating significantly (p \u3c .001) with five of the other six domains. Discussion: The 65% of participants selecting grades of “B”, “C”, and “D” for organizational performance in transitions of patient care is indicative of improvement needed. The insights developed from the responses to the survey suggest it as a very relevant diagnostic tool for hospital leadership seeking to improve performance. The significant correlations of the hospital leadership domain with other domains are powerful indicators of the leveraging potential of leadership at the study site