<p> Despite an initiative to provide preconception care (PCC) and reproductive life planning (RLP) for all women of childbearing age, many women, especially those with low incomes, are not receiving it. As a result, there continues to be a high rate of infant morbidity and mortality in this population. Furthermore, low income adolescent females have not been adequately studied regarding this phenomenon. The purpose of this phenomenological study was to explore low income adolescent females&rsquo; knowledge, attitudes, and beliefs about PCC and RLP in order to serve them more effectively. Five low income adolescent females, aged 18 to 21, were recruited through criterion sampling and they each engaged in 2 individual in-depth interviews. The health belief model, social cognitive theory, and adolescent affective and cognitive theory were the conceptual frameworks used to develop the interview guide, conduct the interviews, analyze the data, and formulate the recommendations for future studies. Moustakas&rsquo;s phenomenological interview process was used as a guiding framework to prepare and conduct the interviews. Qualitative data were analyzed using Moustakas&rsquo;s modified version of the Stevick-Colaizzi-Keen method of analysis. Findings were that participants (a) had no experiences with PCC or RLP, (b) lacked knowledge about preparing for pregnancy, (c) had negative interactions with medical personnel, and (d) wanted more information about PCC and RLP. Further research is recommended to examine current PCC/RLP practices, conduct additional PCC studies of adolescents, and develop culturally- and age-appropriate PCC programs. Findings from these studies could improve both the lives of the adolescents and the health of their offspring. </p>

<p> Nurse residency programs (NRPs) have been identified as a means to promote transitioning of new nurses into the professional nursing role. Questions have arisen related to which elements within those programs are most meaningful to the development of new nurses. As the nursing shortage drives the need for quick transition and development of nurses to meet workforce needs, nursing must identify what is meaningful to nurses in their transition to practice. The purpose of this multi-site study was to explicate meaning from the experiences of newly licensed registered nurses (NLRNs) who have just completed NRPs. The research question was &ldquo;What factors have meaning for NLRNs who have experienced transition to practice in nurse residency programs in acute care settings?&rdquo;</p><p> Semi-structured interviews were used to collect data from six NLRNs from three different NRPs after completion of their programs. Using interpretative phenomenological analysis, themes and variations within those themes were derived from the descriptive narratives provided from participant interviews. Overarching themes identified were <i>Relationships, Reflection, Active Learning, Resources</i> and <i>Organizational Systems</i>. Findings have implications for practice and education as the nursing profession strives to find ways to transform nurses in an effective and efficient manner. </p>

<p> Heart failure affects over 600,000 persons annually across the U.S. The chronic nature of heart failure requires treatment and adequate patient education to prevent exacerbations and frequent readmissions. Health care dollars are expected to increase to $70 billion by the year 2020 to treat heart failure and chronic conditions. A quality improvement project was done within the 300-bed acute care hospital in west Texas. The heart failure patients continue to have frequent readmissions to the critical care unit that coincides with the national average at 21%. The Transformational Learning Theory was used to assess adult learning readiness for knowledge and health behavior change. The purpose of the project involved using the Teach back method as the education process with the <i>Living Well with Heart Failure</i> (2015) booklet as the teaching tool on (n=30) heart failure participants. The Quality of Life (QOL) measurement was analyzed using the Minnesota Living with Heart Failure Questionnaire survey. The project was a pre/posttest design which used SPSS analysis of the test scores. A paired sampled <i> t</i>-test was completed to determine if any significant differences existed between the tests. The results of the pre-scores (M=59.2, SD=17.2) and post scores (M=62.1, SD=17.9) determined the scores were not statistically significant, although the post test scores were higher with the determination of QOL. The readmission rate remained equivalent to 20%. Tools are necessary for measuring QOL in heart failure patients to assess learning or depression. </p>

<p> The purpose of this scholarly project was to examine the use of a high-fidelity simulation workshop to improve accuracy with pediatric dosage calculations among practicing pediatric nurses. The NLN Jeffries Simulation Theory provided a framework for this descriptive quantitative project. A convenience sample of 15 pediatric nurses completed a 10-question pediatric dosage calculation pre-test, a high-fidelity simulation workshop, a 10-question pediatric dosage calculation post-test, and a post-simulation evaluation survey. In addition, a one-month follow-up 10-question pediatric dosage calculation post-test and a one-month follow-up post- high-fidelity simulation workshop survey were administered via Survey Monkey^&copy;, in which 12 pediatric nurse participants completed. Pre-tests and post-tests were analyzed for central tendency and a t-test analysis was performed for statistical significance. Results revealed statistical significance between pre-test and post-test as well as statistical significance between post-test and one-month follow-up post-test. The Likert scale post-simulation survey and one month post-simulation survey were analyzed for central tendency. The results from the post simulation survey and one-month follow-up survey revealed the participants agreed to strongly agreed the high-fidelity simulation workshop impacted their proficiency and accuracy in calculating pediatric dosages. The findings from this project provides insights into the use of high-fidelity simulation as a continuing education tool for the practicing pediatric nurse in relation to pediatric medication efficacy.</p>

<p> Heart failure (HF) is a serious, life limiting chronic illness and is the most common cause of &lt;30-day hospital readmission, which is costly both in its profound negative impact on patient mortality and quality of life, and in economics. Limited access to care in rural communities increases the prevalence of hospitalizations for heart disease in rural areas. </p><p> The aims of this project using data mined from Arizona Health Sciences Center Clinical Research Data Warehouse, are to define clinical events (fever, pain, changes in respiratory status, change in level of consciousness, changes in output, bleeding, and suicide ideation) for patients with heart failure, and determine what assessment values are for chronically ill patients and compare to &ldquo;normal&rdquo; assessment values for non-chronically ill patients. A literature review was completed to determine how to define clinical events for chronically ill patients with HF, and how decision making is used at home to manage chronic illness. Assessment value data was mined from the clinical research data warehouse and compared to &ldquo;normal&rdquo; assessment values, with identification of associations between clinical events and action taken in the hospital. </p><p> The project results support that there are differences in &ldquo;normal&rdquo; assessment values for fever, pain, and change in respiratory status between chronically ill patients with HF, and non-chronically ill patients; there was insufficient data to define bleeding, change in output, or suicide ideation. Impacts to care include earlier recognition of worsening HF symptoms that could result in an earlier call or visit to primary care provider forestalling the need for emergent care and hospital readmission. Application of the mined clinical may inform development of evidenced-based algorithm to guide decision-making at home, and it may also provide the foundation for the development of a tool for patient use to prevent &lt;30-day hospital readmission.</p>

<p> Health information literacy influences patient health outcomes, yet almost 90% of adults struggle to understand health information. This study explored the impact of an education course in health literacy on healthcare professionals&rsquo; methods of providing information to patients in order to increase effective communication and improve patient outcomes. This study drew from an integrated theoretical framework that suggests development and validation of tools to measure health literacy. Access to and understanding of reliable, high-quality health care information equalizes many other variables that impact health outcomes, including age, economic class, and cultural background. This study analyzed survey data collected from 2 doctors, 2 nurse practitioners, and 1 staff nurse selected based on their expertise and experience working with patients. They completed a learner- centered course, in which learners interact and instructors provide feedback. Based on survey responses, the participants strongly supported implementing the proposed education module. Four of the 5 experts agreed that a course in health literacy will help health care workers recognize and address patients with low health literacy. Limited health literacy is associated with poor health outcomes and higher health care costs. This type of literacy requires a complex group of reading, listening, analytical, and decision- making skills, and the ability to apply these skills to health situations. The results of this study may guide educators to effectively communicate with patients, increase health literacy, and improve patient outcomes.</p>

<p> This study investigated the use of deliberate practice theory as a technique to improve hand hygiene performance (HHP) of first-semester associate degree nursing program students. Proper HHP at specific intervals during patient care prevents the spread of healthcare-associated infections. HHP consistently falls below industry expectations and this gap exists worldwide. Modifying established HHP behaviors of professionals in the health care setting is resource intensive, yet novice health care professionals such as nursing students are uniquely positioned to acquire optimal hand hygiene habits as they enter professional practice. The research question for this study was as follows: Is there a performance difference between a group of nursing students using a routine practice approach and a group using deliberate practice theory as a technique for the task of hand hygiene in the nursing skills laboratory setting? The research design was a multiple-measures pretest/posttest nonrandomized quasi-experimental design using a convenience sample. The target population was prelicensure first-semester associate degree nursing students in the United States and a sample of 47 nursing students was obtained from an intact cohort of first-semester associate degree nursing students. The method of data analysis was an independent-samples <i> t</i> test to determine if a statistically significant performance difference existed between the control and experimental groups. The experimental group using deliberate practice theory as a technique for HHP had higher performance scores (<i>M</i> = 97.10, <i>SD</i> = 9.60) than the control group using a routine approach (<i>M</i> = 91.67, <i>SD</i> = 14.74); however, it was not statistically significant, with <i>t</i>(39.73) = &ndash;1.503, <i>p</i> = .141. An additional analysis was conducted to determine hand hygiene compliance rates. The control group dropped 4.16% for hand hygiene compliance from the pretest to the posttest whereas the experimental group dropped only 0.72%. The most impressive findings from this alternative examination of the findings is that the control group had two (8.33%) of its participants with one hand hygiene omission during the pretest and the experimental group had one (4.35%). For the posttest, the control group had six (25%) of its participants with one hand hygiene omission and the experimental group had two (8.69%). The number of individuals in the experimental group with hand hygiene omissions doubled from the pretest to the posttest whereas the number of individuals with hand hygiene omissions tripled for the control group. This additional analysis indicates that deliberate practice theory as a technique to improve HHP may have important clinical implications.</p><p>

<p> Challenges regarding patient safety, limited clinical instruction time, and competitive clinical placements are factors that continue to contribute to the growing interest in the use of simulation in nursing education programs across the nation (Kaddoura, 2010). While there is an abundance of literature supporting the use of high-fidelity simulation in baccalaureate and associate degree registered nurse programs, there is limited literature addressing the effects of its use in practical nursing programs. The overarching question for this study is: <i>What is the relationship between high-fidelity simulation and perceived efficacy as it relates to practical nursing education? </i> Building upon this premise, the relationship between the following subscales comprising high-fidelity simulation were examined: knowledge, clinical judgment, and technical skills. Practical nursing students&rsquo; perceptions of benefits and challenges related to participation in high-fidelity simulation were studied along with their perceptions of self and collective efficacy. These culminated with the faculty focus groups feedback regarding practical nursing students&rsquo; progression from novice toward advanced beginner.</p><p>

<p> A projected deficit in the perioperative workforce of 32,000 perioperative nurses retiring by 2024, creates an inability to meet the nursing needs of the United States population. The need for experienced perioperative nurses has been increasing while the availability of nurses with perioperative education has been decreasing. The purpose of this phenomenological study was to explore the lived experience of post-licensure nurses who participated in a perioperative clinical rotation within their baccalaureate nursing program and did that experiential experience affect the recruitment and employment for perioperative nursing to halt the impending shortage. The integrations of Kolb&rsquo;s experiential learning theory and Bandura&rsquo;s theory of self-efficacy model was the framework that supported the study. Thirteen interviews were conducted using van Manen&rsquo;s (1990) method for researching the lived experience. The two themes emerging from the data were value and attitude. Subthemes under value are gaining knowledge and skill set and a different type of nursing. Subthemes under attitude are (a) communication with the medical team and advocacy for families and patients. The experiential perioperative clinical rotation affected the study participants&rsquo; interest for working in the operating room (OR). Most had a highlighted interest in the specialty, and those participants&rsquo; not choosing the OR as their choice of employment expressed that the experience positively affected the type of nurse they are today. Experiential learning can build the fundamental knowledge necessary to understand the novice perioperative nurse&rsquo;s role as a career choice.</p><p>

<p> Effective communication ensures patient safety and quality care. Shift report is multi-faceted, and if not conducted in a consistent manner, can be a source of errors. Implementing bedside report places focus on the patient&rsquo;s values and needs and meets Quality and Safety Education for Nurses (QSEN) competencies, including patient-centered care. Bedside reporting with an established template improves patient safety, as well as nurse and patient satisfaction. The investigator expected that by implementing nurse and patient education while establishing a bedside reporting template, there would be an increase in nurse and patient satisfaction, improved bedside reporting frequency, and a decrease in patient safety alerts. </p><p> This advanced scholarly project was conducted at a Midwest hospital including approximately 160 nurses in various departments. A nonrandomized control pretest and posttest assessed nurse satisfaction with bedside report frequency. The requirements of the reporting template were established by the Council for Nursing Excellence (CFNE). Education on the template included nurse training and patient brochures before implementation. Additional assessments examined patient satisfaction scores and safety alerts. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores provided details on patient satisfaction, while Iris alerts offered information on patient safety as it related to communication or a lack thereof. </p><p> HCAHPS scores revealed inconsistencies throughout the various units while Iris alerts provided minor quantities of data. Nurse survey results demonstrated a decrease in nurse satisfaction with the new template, as well as a reduction in the verification of report; however, there were improvements in satisfaction for all other areas examined including the frequency of report while including the patient, sufficiency of report, the ease of including the patient in report, as well as the belief that information is not lost during the reporting process.</p><p>