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Diabetes mellitus is one of the leading causes of death in the United States, contributing to rising health care costs and increased morbidity and mortality rates. Researchers demonstrated that aggressive heath measures involving ongoing diabetes self-management education are paramount in minimizing associated complications of diabetes. The management and prevention of diabetes is not standardized and providers within a health clinic in Illinois reported challenges in providing self-management education during scheduled patient appointments due to limited resources and time. The purpose of this DNP project was to develop a clinical practice guideline to be used by all providers within the health care clinic for the management of Type 2 diabetes. The goal of the developed guideline was to optimize the time providers spend with patients diagnosed with diabetes and improve the consistency and quality of education and care. The health promotion model provided a guide for the development of the practice guideline. The method and design of this DNP project involved extensive research, literature review, evidence grading, and development of an evidence-based practice guideline for Type 2 diabetes management. A selected team of 3 diabetes experts appraised the developed guideline using the AGREE II instrument, and guideline usability was evaluated by 3 nurse practitioners within the medical clinic using a 10-item questionnaire. Results of the appraisal confirmed the high quality, feasibility, and usability of the developed guideline for diabetes self-management education and support. Improving the delivery of care can bring about positive social change by improving health outcomes in individuals with Type 2 diabetes and reducing morbidity and mortality rates.

In a Department of Veterans Affairs hospital on the East Coast of the United States, behavioral outbursts result in 2 out of 10 veterans dismissed from a posttraumatic stress disorder (PTSD) unit prior to completing the 6-week program. The purpose of this evidence-based quality improvement project was to create a clinical practice guideline (CPG) based on social cognitive theory (SCT) to provide new strategies for managing veterans with PTSD and to improve the confidence of the nurses in managing outbursts. The Star Model guided the project development with the Delphi method to achieve participant consensus, the AGREE II to assess the CPG quality, and the Generalized Self-Efficacy (GSE) scale to measure the change in participant knowledge and confidence. The literature was searched, compiled, assessed, and shared with 10 participants, registered nurses on the PTSD unit. Through the Delphi process, the participants achieved consensus (8/10) for the CPG, with two neutral participants. The GSE was administered pre- and post-test and analyzed using a paired t test to measure the mean differences of the GSE scores. The data was normally distributed to different scores to gauge the impact of the CPG development process on improving nursing knowledge and confidence was normally distributed [t(9) = -4.188, p < 0.05, &, t(9) = -2.714, p =0.003]. The data indicated a significant increase in participant knowledge about role of SCT, and confidence toward implementing the CPG into clinical practice. This project contributes to positive social change as nurses identified a clinical practice problem, transferred evidence about strategies from the literature into their clinical practice through a CPG, and implemented the CPG with the knowledge and confidence to impact patient care.

Ineffective pain management in the post anesthesia care unit (PACU) increases patients' risk of adverse effects including decreased mobility, infection, chronic pain, depression, cardiopulmonary complications, increased length of stay, insomnia, fatigue, and overall decrease in quality of life. The PACU in a community hospital did not provide an evidence-based pain management guideline for nurses treating postoperative patients, resulting in nurses' concerns about providing pain management. The purpose of this project was to translate evidence on pain management into an evidence-based guideline for improved nursing practice in a PACU. Evidence was obtained from a detailed literature search using multiple databases and professional organizations' guidelines. Nursing practice guidelines were developed and evaluated by 3 expert panelists using the Agree II guidelines. The panelists selected included; Two anesthesiologists, one who is trained in pain management and is also a pharmacist. The third expert is a practicing nurse practitioner in an acute setting who is also a surgical first assist and the associate director of robotics. The panel endorsed the guidelines for advancement through the hospital's review committees. Implementation of the evidence-based pain management guideline in the PACU might provide nurses with tools to guide their interventions and improve patient outcomes. Social changes resulting from the use of evidence-based pain management guidelines include decreased time to opiate administration, decreased adverse effects, improved assessment of pain, and an increase in the number of patients who receive proper pain management.

In occupational therapy (OT), there is a push to encourage the entry-level doctorate (eOTD) over the master's of OT (MOT), without having identified which degree develops therapists who can best meet the needs of clients, while providing the fewest negative consequences for stakeholders. This collective case study assessed whether there are differences between OTs with MOT and with eOTD. Each supervisor's experiences with the two degree groups represented a separate case, then all were collectively considered. The central research question was whether OT supervisors, who have observational knowledge of clinical performance, perceived differences between MOTs and eOTDs in factors that impact the stakeholders of OT services, as identified using Freeman's stakeholder theory. Ten supervisors who geographically represented the five eOTD programs and diverse areas of OT practice were selected for initial interviews, with four others added to achieve saturation. Fourteen semi-structured interviews were conducted to begin to identify perceived similarities and differences between OTs with the different degrees. These data were inductively coded and then analyzed using a thematic analysis procedure. The results of this small, exploratory study indicate that eOTDs do not have higher skills and abilities; desire higher compensation, but do not receive it; sometimes bring attitudes of superiority; are not more respected because of their degree; and are negatively affected by higher debt load. Positive social change implications stemming from this study suggest that stakeholder theory can be used to guide policy discussions in professional healthcare associations and that policy makers in the profession of OT should exercise caution in adopting the eOTD as the required entry-level degree until further evidence on the efficacy of the eOTD degree is clear.

Managing heart failure patients in the outpatient setting can pose a challenge for nurses and health care staff due to the need to educate patients on self-care skills and management of disease. Several factors, including health literacy and numeracy, need to be considered when developing an education program for heart failure patients to promote self-care management. The purpose of this project was to provide nursing staff with a clinical practice guideline (CPG) that incorporated health and numeracy literacy assessment into an individualized education program. The Johns Hopkins nursing evidence-based practice (EBP) model, the situation-specific theory of heart failure (HF) self-care, and Wagner's chronic care model guided the development and implementation of this project. The practice-focused question for this project asked whether evidence informs a CPG intended to assess health literacy and numeracy assessment and promote an enhanced individualized education intervention in an outpatient HF population. A literature review using 20 articles from 2006-2018 was completed. Five articles were selected to review levels of evidence, and three articles were chosen to support the development of the CPG. The CPG was reviewed, refined, and validated by an expert panel of HF nurses and physicians. The CPG might support a positive social change in the practice setting by improving the tools for nurses to assess health literacy in the HF patient population and provide individualized education to influence self-care interventions.

Assessment of left ventricular (LV) function is one of the most common requests made to cardiac imaging services. This demand stems from a large body of evidence that shows abnormal LV systolic and, more recently, diastolic function has important prognostic and treatment related implications for patients with a wide range of cardiovascular diseases. The vast majority of information supporting the use of conventional measures of LV function, such as ejection fraction, originates from population studies and large clinical trials. However, the application of these measurements to individual patients is far less defined, especially when used for serial evaluation. Central to these concerns is the relative paucity of data surrounding the test-retest reliability of conventional measures in clinical settings. Newer measures of LV function have been developed over recent years, with several techniques becoming widely used in clinical practice (i.e. tissue Doppler imaging) and others remaining largely research tools (i.e. 3D echocardiography, tissue strain/strain rate). Possible benefits of new technologies include improved identification and early detection of myocardial disease, improved reliability for monitoring progression of disease, and the development of novel methods to assess response to therapy. Despite this potential, the application and clinical utility of these techniques above and beyond more conventional measures remains in many cases to be adequately characterized. This thesis addresses several of these issues: from variability of novel and conventional measures of LV function in clinical practice, to new applications of novel functional measures in clinical settings.

<p>Handledning av sjuksköterskestudenter är ett komplext arbete som kräver tid och. Handledare upplever brist på stöttning från kollegor och avdelningschef. Det är önskvärt om kollegor är villiga att ta över en del av patientomvårdnande så att handledare får mer tid för handledning av studenter under verksamhetsförlagd utbildning [Vfu]. Syftet med denna litteraturstudie var att belysa studenthandledning under Vfu där studenters och handledares uppfattningar belyses. Litteraturstudien består av 20 artiklar vilka analyserats utifrån studiens syfte och delats in i två teman utifrån handledares och studenters uppfattningar. Resultatet visar att det är tidsbrist som gör att handledare inte känner sig tillräckliga i student- och handledarrelationen. Studenter upplever att den viktigaste faktorn för en bra Vfu är att bli bemötta på ett respektfullt och trevligt sätt av både handledare och kollegor och att studenter blir en del av arbetsteamet och arbetet som utförs på avdelningen. Resultatet visar vidare att det är viktigt att studenter är medvetna om sitt egenansvar för att utvecklas och uppnå sina mål. Detta kräver att studenter vågar ta ett eget ansvar samtidigt som de vet sina begränsningar och när det är tid att stiga åt sidan. Slutsatsen är att handledare behöver få mer tid för planering, samt mer utbildning i studenthandledning. För att åstadkomma detta krävs det att kollegor och avdelningschefer är villiga att ta över en del av arbetsbördan samt vara medvetna om hur tidskrävande handledning är. Implikationen av denna litteraturstudie är att utbildningskvaliten kan höjas om utbildningen i handledning av sjuksköterskestudenter förbättras, samt sponsrar mer forskning kring samarbetet mellan handledare och lärosäten.</p> / <p>Precepting nursing students is a complex assignment which is time consuming and requires planning. Preceptors experience lack of support from co-workers and their manager. Ideally the preceptor’s regular work assignments should be reprioritized enabling the preceptor to allocate more time for student supervision. The purpose of this literature review is to highlight student preceptorship during clinical placement and explore the students’ and preceptor’s opinions of each others roles during the clinical placement period. The review is build upon 20 articles that have been analyzed with the help of different themes comprising of supervisor and student relationship. The study concludes that lack of the adequate time is the main reason why preceptors experience their student supervision insufficient. The students express that most important factor for a valuable clinical placement is that they are met with respect and an inviting tone from both the preceptor and the co-workers. It was also found important that the students must be aware of their personal responsibility, understand their limitations and understands when to step back and let someone with more experience take over. The conclusion is that preceptors need more allocated time to supervise the students during, as well as training in student supervision. To make the preceptors workload balanced, their co-workers and manager must help them decrease their regular work assignments. The co-workers and manager also needs to understand how time consuming precepting students during clinical placement can be. The implication of this review is that the quality of the nursing training can get better if we improve training in precepting of nursing students, and sponsors more research around collaboration between the preceptors and the university.</p>

Handledning av sjuksköterskestudenter är ett komplext arbete som kräver tid och. Handledare upplever brist på stöttning från kollegor och avdelningschef. Det är önskvärt om kollegor är villiga att ta över en del av patientomvårdnande så att handledare får mer tid för handledning av studenter under verksamhetsförlagd utbildning [Vfu]. Syftet med denna litteraturstudie var att belysa studenthandledning under Vfu där studenters och handledares uppfattningar belyses. Litteraturstudien består av 20 artiklar vilka analyserats utifrån studiens syfte och delats in i två teman utifrån handledares och studenters uppfattningar. Resultatet visar att det är tidsbrist som gör att handledare inte känner sig tillräckliga i student- och handledarrelationen. Studenter upplever att den viktigaste faktorn för en bra Vfu är att bli bemötta på ett respektfullt och trevligt sätt av både handledare och kollegor och att studenter blir en del av arbetsteamet och arbetet som utförs på avdelningen. Resultatet visar vidare att det är viktigt att studenter är medvetna om sitt egenansvar för att utvecklas och uppnå sina mål. Detta kräver att studenter vågar ta ett eget ansvar samtidigt som de vet sina begränsningar och när det är tid att stiga åt sidan. Slutsatsen är att handledare behöver få mer tid för planering, samt mer utbildning i studenthandledning. För att åstadkomma detta krävs det att kollegor och avdelningschefer är villiga att ta över en del av arbetsbördan samt vara medvetna om hur tidskrävande handledning är. Implikationen av denna litteraturstudie är att utbildningskvaliten kan höjas om utbildningen i handledning av sjuksköterskestudenter förbättras, samt sponsrar mer forskning kring samarbetet mellan handledare och lärosäten. / Precepting nursing students is a complex assignment which is time consuming and requires planning. Preceptors experience lack of support from co-workers and their manager. Ideally the preceptor’s regular work assignments should be reprioritized enabling the preceptor to allocate more time for student supervision. The purpose of this literature review is to highlight student preceptorship during clinical placement and explore the students’ and preceptor’s opinions of each others roles during the clinical placement period. The review is build upon 20 articles that have been analyzed with the help of different themes comprising of supervisor and student relationship. The study concludes that lack of the adequate time is the main reason why preceptors experience their student supervision insufficient. The students express that most important factor for a valuable clinical placement is that they are met with respect and an inviting tone from both the preceptor and the co-workers. It was also found important that the students must be aware of their personal responsibility, understand their limitations and understands when to step back and let someone with more experience take over. The conclusion is that preceptors need more allocated time to supervise the students during, as well as training in student supervision. To make the preceptors workload balanced, their co-workers and manager must help them decrease their regular work assignments. The co-workers and manager also needs to understand how time consuming precepting students during clinical placement can be. The implication of this review is that the quality of the nursing training can get better if we improve training in precepting of nursing students, and sponsors more research around collaboration between the preceptors and the university.

Bakgrund: Sjuksköterskestudenter kan känna sig sårbara i början av sin verksamhetsförlagda utbildning (VFU) och kan påverkas både positivt och negativt av bemötandet från både handledare och övrig personalgrupp. Syfte: Att undersöka sjuksköterskestudenters upplevelser av bemötande från handledare och övrig personalgrupp och hur detta påverkar förmågan att utföra omvårdnad, samt studenternas upplevelse av studentrollen. Metod: Kvalitativ forskningsdesign med fem semistrukturerade intervjuer. Resultat: Resultatet delades in i tre huvudkategorier: Bemötande från handledare; Bemötande från övrig personalgrupp och Studentroll. Ett bra bemötande karaktäriserades av vänlighet, involvering i arbetet och förmedlande av trygghet. Ett dåligt bemötande kunde bestå av försummelse, att känna sig i vägen och dålig struktur. Studenterna hade haft skiftande roller under VFU och samtliga hade positiva aspekter. Studenterna upplevde att de hade utvecklats i sin förmåga att utföra omvårdnad. Slutsats: Studien påvisar att det är viktigt för studenter hur de blir bemötta på sin VFU, och vilken roll de får på arbetsplatsen. Den visar även att det är betydelsefullt att samtliga ur personalgruppen visar studenten ett bra bemötande. En undersköterskeroll kan vara utvecklande för sjuksköterskestudenter i termin två. Det förekommer dock negativa aspekter i bemötande från handledare och personalgrupp, vilket tyder på att studentens roll på VFU bör förtydligas. / Background: Nursing students may feel vulnerable in the beginning of a clinical practice placement. The relationship and interaction with their preceptors and other staff members can have a positive as well as a negative effect on the nursing student. Aim: To investigate nursing students’ experiences of the relationship and interaction with their preceptors and other staff members and the influence these factors have on their ability to perform nursing care, and also how the students experienced the student role. Method: Qualitative design with five semi-structured interviews. Result: The result was divided into three main categories: Relationship and interaction from preceptors; Relationship and interaction from other staff members and Student role. A good relationship and interaction was characterised by kindness, involvement in tasks and a sensation of safety. A bad relationship and interaction would consist of neglect, the sensation of being in the way and a bad structure. The students had a variety of roles that emerged during their clinical practice which all had positive aspects on their ability to perform nursing care. Conclusion: The study presented how important the relationship and interaction with the preceptors and other staff members are for nursing students during their clinical practice placement. As important is the role the student acquires. The study presents the importance of a good relationship with all staff members. A health care assistant role can be of value for nursing students during their first clinical practice placement. Certain negative aspects emerged indicating that clarifying information about the student role during clinical practice placement is needed.