<p> This paper evaluates nursing students&rsquo; perceptions and barriers as related to medical error reporting. This study was conducted as a mixed method based on the PS-ASK survey tool designed by Schnall et al (2008). Medical errors are a large problem in healthcare institutions. Understanding the underlying causes of why these events occur is needed in order to prevent repeat occurrences of the same error. However, in order to fully understand the underlying cause of the error, first and foremost, it must be reported. Evaluating nursing students&rsquo; perceptions and barriers to utilization of an error reporting system and addressing these issues is a crucial step towards decreasing medical error and improving patient safety. This study found that nursing students have an overall positive attitude toward error reporting. This survey validated the need for instituting a <i>just culture</i> within nursing education, in order to help encourage error reporting, rather than discourage it. Practice changes should be made in nursing education to provide transparency and role modeling with error reporting in order to encourage student accountability for reporting errors.</p>

<p> As ardent import is recognized for collaborative decision making (DM) generating effectual patient care, minimal investigation has been allotted to consider what health professionals inherently bring to decision forums. The purpose of this pilot study is to examine the capacity to enhance decision making collaboration of nurse leaders in a community hospital through Myers-Briggs Type Indicator (MBTI) application. Personality influence is vital for self-awareness and colleague appreciation. True collaboration transcends cooperation to embrace mutual respect and goals for ethical decisions (Barrett, Piatek, Korber, &amp; Padula, 2009). By four educational modules, designed to explicate type influence upon recognized leadership constructs, aligned with a defined DM process, nurse leaders of a Shared Governance Council were assessed to discern collaborative DM. A convenience sample of eight nurses completed the study. The targeted sample size enabled deep investigation of skill development and teamwork through MBTI application, explored by descriptive content analysis. The assessment tool, developed from a collaborative training survey, appraised seven constructs of nurse leadership and three definers of decision evaluation, incorporating MBTI influences. Outcomes, measured by self-reported pre/post survey methodology, revealed an overall 87.5% improvement in collaboration, 62.5% improvement in team trust, decision expediency and pragmatism. A 50% improvement was reported in colleague understanding and communication skills. There remains much to be discovered about personality impacts upon nurse leadership for augmenting collaboration. Bringing empowered nurses to decision making tables is critical for accomplished investment, improved teamwork, and professional accountability for decisions, from bedside to boardroom. It is the focus of this study.</p>

The purpose of this study was to describe the differences between three groups of African American Women (AAW) from three generations, Baby Boomers (BB), Generation X (Gen X), and Generation Y (Gen Y) and the role of faith beliefs in determining the health perceptions of AAW. This descriptive quantitative design described addressed the following specific aims: (a) describe the demographic characteristics, faith beliefs, health beliefs, and depression features of three generational groups; (b) compare faith beliefs, health beliefs, and depression among three generational groups; and (c) describe relationships among generational age, faith beliefs, health beliefs (susceptibility, severity, barriers, benefits, cues to action, self-efficacy), and depression. Data were gathered using a demographic questionnaire, the Santa Clara Strength of Religious Faith questionnaire, the Generation Identification questionnaire, Champions Health Belief Model, modified to include the variables faith beliefs and depression and the Patient Reported Outcome Measurement Information System for Depression questionnaire. The final sample consisted of 159 participants. Sixty-seven were Baby Boomers (BB), 73 were from Generations X (Gen X) and 19 were from Generation Y (Gen Y). The results showed at least 90% of BB, Gen X and Gen Y indicated a high level of faith beliefs by scoring on the high end of the SCSORF questionnaire. Results from Chi square, ANOVA and linear regression analyses did not support moderating effects of generational age upon the relationship between faith beliefs and health beliefs about depression. Further, these analyses did not support a direct relationship between faith beliefs and health beliefs such that faith beliefs are predictors of health beliefs about depression.

<p> Delirium in adults aged 65 and older is a common occurrence in the acute care setting and is often unrecognized by bedside nurses. Delirium can trigger a negative cascade of events resulting in an increase in morbidity and mortality, functional decline, longer length of stay, and high rates of post hospital institutionalization and has a significant socioeconomic impact. The purpose of this quality improvement project was to establish a solid foundation using scholarly literature to support the development of a delirium prevention, recognition, and treatment program in the medical-surgical acute care setting applying the program logic framework. The goal was accomplished by developing a structured program to enhance nurse education (phase 1) using a pretest/posttest design. Phase 2 will be implemented at a later date. The null hypothesis for the project was there is no difference between the pretest group knowledge of delirium scores and the posttest group scores following education. The results of the 36-paired pretests/posttests indicated a significant difference (p &lt; 0.05) following the educational PowerPoint on delirium. Providing education and opportunities for bedside nurses to apply this new knowledge is an effective strategy to increase the identification of delirium, which can lead to improved patient outcomes, reduced socioeconomic burden associated with delirium, and increased positive social change. The economic impact of delirium is considerable with the average cost per day of delirium patients reaching nearly 3 times the cost of patients not having delirium. The elderly population is projected to continue to rise, which will have a profound impact on hospitals and health care as a whole.</p>

<p> The purpose of this Doctor of Nursing Practice (DNP) Project was to establish preliminary evidence for validity of the Kissick Framework for DNP education and practice of Family Nurse Practitioners (FNPs). The history of the education of nurse practitioners (NPs) was explored to determine which frameworks should be considered in planning future curricula. The current need for more primary care practitioners due to the Affordable Care Act and the response in nursing to increase the number of primary care providers is discussed.</p><p> The role of the NP has expanded and in 2004 the American Association of Colleges of Nursing (AACN) endorsed the DNP as the terminal practice degree to replace the Masters&rsquo; of Science in Nursing (MSN) requirement for NPs. Frameworks for education and practice of doctorally prepared FNPs were examined and compared to the Kissick Framework.</p><p> The Kissick Framework integrates the Essentials of Doctoral Education for Advanced Nursing Practice recommended by the AACN, the National Organization of Nurse Practitioner Faculties (NONPF) Core Competencies, and Ida J. Orlando&rsquo;s Theory of the Nurse-Patient Relationship. Preliminary evidence supports consideration of the Kissick Framework for the education of doctorally prepared FNPs and as a guide for practice.</p>

<p> Nonadherence to antihypertensive medications is a widespread problem among dialysis patients. Nonadherence to antihypertensive medications can result in the dialysis patients&rsquo; morbidity and mortality. A pilot study was used to determine whether a medication reminder mobile application would improve dialysis participants&rsquo; adherence to their prescribed antihypertensive medications from a Midwest outpatient dialysis clinic. Dialysis participants prescribed one or more antihypertensive medications were invited to participate in the pilot study using Dosecast&reg;, a mobile medication reminder application. The dialysis participants completed four self-reported questionnaires: Demographic Questionnaire, Brief Medication Questionnaire (BMQ-1), Modified Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), and Morisky Medication Adherence Questionnaire (MMAS-8). The questionnaires were analyzed with descriptive statistics and an independent t-test. The results from the 20 dialysis participants showed that the participants&rsquo; improved their adherence with the antihypertensive medications. This showed that Dosecast&reg; is a beneficial tool to increase dialysis participants&rsquo; adherence to antihypertensive medications. </p>

<p> The nurse turnover rate continues to rise; currently 17.2%. The challenges of the acute care environment are multifaceted and contribute to nurse turnover. Stressful working conditions may contribute to negative relationships among colleagues; subsequently quality of care can suffer, as well as, job satisfaction and nurse intent to stay. A cross-sectional, correlational study, guided by the Coworker Exchange Theory (Sherony &amp; Green, 2002), used data obtained through a printed survey from a sample of 427 registered nurses. </p><p> The purpose of this dissertation was to investigate the influence of perceived <i>same-status nurse-to-nurse</i> coworker exchange relationships, quality of care provided, overall nurse job satisfaction, and organizational commitment on intent to stay and job search behavior of nurses in the acute care nurse work environment. Study variables were made operational using six instruments. </p><p> Results from path analysis showed that <i>same-status nurse-to-nurse </i> coworker exchange relationships explained 43% of variance in nurse perceived quality of care provided, 21% of variance in overall nurse job satisfaction, and 8% of variance in nurse intent to stay. Overall nurse job satisfaction accounted for 25% of the effect of <i>same-status nurse-to-nurse</i> coworker exchange relationships on nurse perceived quality of care provided and 68% of <i>same-status nurse-to-nurse</i> coworker exchange relationships on nurse intent to stay. Nurse perceived quality of care provided accounted for 71% of <i>same-status nurse-to-nurse</i> coworker exchange relationships on nurse intent to stay. </p><p> Findings provide beginning evidence that coworker exchange relationships influence the nurse work environment and nurse turnover. Strategies to address <i> same-status nurse-to-nurse</i> coworker exchange relationships warrant being identified. Organizational leaders may wish to consider allocating resources to build, develop, and maintain improved coworker exchange relationships within the nurse work environment to aid in discouraging nurse job search behavior. </p>

<p> Healthcare organizations are responding to changes in reimbursements by redesigning and re-evaluating existing programs to improve patient outcomes. .One such intervention at the project setting was the re-evaluation of the treatment of patients with low risk for chest pain and implementing a cardiology nurse practitioner (NP) service focusing on the reduction of length of stay (LOS) with the goal of improving patient outcomes. The purpose of this doctor of nursing practice project was to evaluate the effectiveness of a nurse practitioner-led service on the reduction of LOS of patients with low risk for chest pain. An established evidenced-based guideline developed by the American Heart Association for the treatment of patients with low risk for chest pain was adopted by the NP service. The project was guided by both the Donabedian model of quality care and the Aday and Anderson theory of access to medical care. The project design proposal is a comparative study using retrospective data obtained from the medical records of LOS pre- and post-implementation of the project. Implications for social change include improvement in patient care on a national level, not only for patients with low risk for chest pain, but also for patients with other chronic diseases. Streamlining care will improve the financial standing of hospitals as well as provide care that is equal and equitable regardless of race or financial status. The findings of this project have strengthened the role of the APN globally as a social advocate for change, actively participating in designing and implementing programs to improve patients&rsquo; outcomes.</p>

<p> Depression is a challenge for the rurally based primary care nurse practitioner. Within all primary care settings, women seek assistance for depression more often than men. In addition, the rural woman faces challenges in her management related to lack of specialty providers, lack of insurance and lack of health resources. Evidence-based guidelines recommend a stepped approach to care which includes pharmaceuticals such as selective serotonin reuptake inhibitors (SSRIs) and cognitive behavior therapy (CBT). One approach to meet the needs of the rural woman is guided self-help CBT (GSH-CBT). The aim of the review was to discover different methods of CBT and the feasibility of methods within the rural health setting. Formats reviewed include telephone supported CBT, internet based CBT, and written material CBT. Each method was utilized in conjunction with traditional care by primary care providers; however, only one study demonstrates the nurse practitioner as the guide of CBT within the primary care setting. The evidence indicates that GSH-CBT does improve depression symptoms; however, most of the studies were performed in homogeneous groups within the National Health Service of the United Kingdom. More pilot studies need to be carried out within rural communities of different population groups, to include African-American, Hispanic, Asians, and Native American. The goal of this paper is to discuss a case study of a rural woman, utilizing <i> Understanding Depression</i>, which improved depression in a primary care setting. The case study also revealed various challenges which include primary care management of depression in a rural setting and lack of personal self-reflective perspective.</p>

<p> The purpose of the current study was to explore nurses&rsquo; lived experiences floating in an acute health care facility within a large southern city of the United States. Husserl&rsquo;s transcendental approach assisted in capturing the essence of floating as a lived phenomenon occurring in the nurses&rsquo; natural work environment. Karasek job demand-control was the theoretical framework. The study data analysis was conducted using the NVivo 10 software and Giorgi&rsquo;s six steps, reflecting Husserl&rsquo;s descriptive transcendental phenomenology. The study purposive sample included eleven full-time staff male and female registered nurses who routinely float to other units. Participants described their feelings on floating during digitally recorded interviews based on three open-ended interview questions aligned with the research questions to address the research purpose. Six themes emerging from the data analysis were (1) workflow process, (2) patients care assignment, (3) work environment, (4) psychological components, (5) sociological factors, and (6) physiological needs. Nurses expressed concerns about their ability to deliver quality, safe patients care in areas different from their area of expertise. In this study, nurses recognized that they have to float for diverse reasons, a finding different from previous studies. A conclusive evidence from this study was that nurses are reluctant to float but will do so comfortably if there were some measures in place to ease the process. The recommendations included ideas for changes in floating based on the data analyzed from participants&rsquo; responses. </p>