5^th World Nursing and Nursing Care Congress

Heather Hetrick is a Senior Professional Staff Nurse II at UPMC Hamot. She has been a nurse for 10 years and has her MSN. Heather holds a certification in Medical Surgical Nursing and has experience working in a variety of acute care settings at UPMC Hamot and recently was named a DAISY award recipient . She also graduated from the Nurse Leader Residency Program in 2018.

Statement of the Problem: There is an urgent need for proper succession planning for nursing leaders. Over the next 5 years there will be more than 67,000 leadership vacancies as a result of more than 75% of current nurse leaders leaving the workforce. Purpose statement: Develop a formal residency program for nurses who possess leadership aspirations. Allowing for immersion of the bedside nurse alongside nursing executives to participate in organizational leadership activities and experiences. Growing the bedside nurse through social capital. Background: The program takes place in a 433 bed tertiary care hospital in the United States. In 2008 the organization experienced high turnover and lengthy nurse leader vacancies (up to one year) that served as a call to action for nursing executives. An idea for bringing bedside nurses with leadership aspirations off of their units to the boardroom evolved. Through this process, the bedside nurse would be afforded the opportunity to leave their assigned unit to fully integrate with the nursing executive process, allowing them participation, observation, and imitation of various leadership styles. The application guidelines and process for panel interviews with nursing executives were established. Precursors for bedside registered nurses to be considered for residency selection include; two years clinical experience, a BSN, and a good work record. In addition, active membership within the organization’s five shared governance councils was integral to narrowing candidate selection. Methodology: A three month full time intensive program relocating the bedside nurse to the executive wing allowing for full immersion. The Nurse Leader Resident (NLR) will develop successful behaviors through shadowing of key leaders. The immersive experience is what makes this program successful. Social capital is created allowing for sharing, trust, relationships, personal bonds and connections to be established. Throughout the three month program the NLR completes assigned readings, attends meetings, journals their experiences, participates in weekly debriefings, actively contributes in discussions and serves as a project manager to assigned by the CNO. Findings: Since program inception in 2008, 45 bedside nurses have completed the NLR program, with 84% hired into a leadership role within the organization. The program has become a powerful tool for succession planning and retention within the organization. There are now numerous applicants for the residency and multiple candidates for any leadership vacancies. Those choosing not to elect into a leadership role remain at the organization as influential informal leaders supporting the shared governance structure. Conclusion: The programs structure, strategy, goals, and outcomes allow the participant to replicate this program within their own health care organization.

Megan Heslink is a Senior Professional Staff Nurse at UPMC Hamot. She has been a nurse for 19 years and held various roles in acute and post-acute settings. Megan is certified as a hospice and palliative nurse and has her BSN. She is also a recent graduate of the Nurse Leader Residency Program in 2018.

Statement of the Problem: There is an urgent need for proper succession planning for nursing leaders. Over the next 5 years there will be more than 67,000 leadership vacancies as a result of more than 75% of current nurse leaders leaving the workforce. Purpose statement: Develop a formal residency program for nurses who possess leadership aspirations. Allowing for immersion of the bedside nurse alongside nursing executives to participate in organizational leadership activities and experiences. Growing the bedside nurse through social capital. Background: The program takes place in a 433-bed tertiary care hospital in the United States. In 2008 the organization experienced high turnover and lengthy nurse leader vacancies (up to one year) that served as a call to action for nursing executives. An idea for bringing bedside nurses with leadership aspirations off of their units to the boardroom evolved. Through this process, the bedside nurse would be afforded the opportunity to leave their assigned unit to fully integrate with the nursing executive process, allowing them participation, observation, and imitation of various leadership styles. The application guidelines and process for panel interviews with nursing executives were established. Precursors for bedside registered nurses to be considered for residency selection include; two years clinical experience, a BSN, and a good work record. In addition, active membership within the organization’s five shared governance councils was integral to narrowing candidate selection. Methodology: A three-month full-time intensive program relocating the bedside nurse to the executive wing allowing for full immersion. The Nurse Leader Resident (NLR) will develop successful behaviors through shadowing of key leaders. The immersive experience is what makes this program successful. Social capital is created allowing for sharing, trust, relationships, personal bonds and connections to be established. Throughout the three-month program the NLR completes assigned readings, attends meetings, journals their experiences, participates in weekly debriefings, actively contributes in discussions and serves as a project manager to assigned by the CNO. Findings: Since program inception in 2008, 45 bedside nurses have completed the NLR program, with 84% hired into a leadership role within the organization. The program has become a powerful tool for succession planning and retention within the organization. There are now numerous applicants for the residency and multiple candidates for any leadership vacancies. Those choosing not to elect into a leadership role remain at the organization as influential informal leaders supporting the shared governance structure. Conclusion: The programs structure, strategy, goals, and outcomes allow the participant to replicate this program within their own health care organization.

Head nurse Hsiao-Wen Tasi has her expertise in adult nursing and passion in improving the surgical care quality. She has clinical experience in emergency department, intensive care unit and surgical ward. She has 16 years of experience in nursing care, patient safety, teaching and administration in Kaohsiung Municipal Hsiao-Kang Hospital.

Statement of the Problem: Surgical site infections (SSI) are significantly associated with longer inpatient length of stay, higher medical expense and poor life quality. It is estimated that 40~60% of SSI is preventable. Unplanned hypothermia could predispose to SSI and might occur in 50% of patients undergoing anesthesia in the operation room. World Health Organization (WHO) have suggested that maintaining peri-operative normothermia above 36℃ is effective in reducing SSI. The purpose of this study is to describe the experience of team work from surgical ward, operation room and anesthesia department to improve body temperature management for inpatients undergoing surgery. Methodology & Theoretical Orientation: An inter-departmental improvement program was initiated to use warming equipment, establish hypothermia guideline and hand-over system. The guideline kept perioperative body temperatures with various warming equipment according to body temperature. Findings: Peri-operative body temperature monitoring and complete hand-over reached 100%. Unplanned hypothermia decreased from 38.2% (335/884) to 29.2% (121/418) during transfer from ward to operation room and decreased from 27% to 1.5% during transfer from operation room to the post-anesthesia care unit. Conclusion & Significance: An inter-departmental body temperature management protocol reduced perioperative hypothermia. A team work between surgery ward, operation room and anesthesia department provided continuous body temperature monitoring and suitable warming guideline thus ensured the perioperative care quality.

I am currently a DNP student specializing in Clinical Systems Administration and graduating in May 2019 from Creighton University. I received my BSN at Creighton University in 2014 and I have worked as a nurse in both the cardio thoracic progressive care units at Sarasota Memorial Hospital and at the University of Kansas Hospital. I have also worked on a medical surgical unit at Sarasota Memorial Hospital where I served as unit practice council chair, research council chair, and received Nurse of Excellence on my unit in 2017.

Purpose: Numerous studies have shown that effective communication in the health care realm is vital to improving patient satisfaction scores, a healthier work environment, and patient safety and quality outcomes. The purpose of this project is to provide a program for staff on using civility when effectively communicating patient needs in the health care environment; then, evaluate their knowledge, patient satisfaction scores, and the work environment. A baseline survey, using the AACN’s Healthy Work Environment Assessment tool, the Nursing Incivility Scale, HCHAPs scores, and a Class Evaluation Tool, which is evaluated using numbers 1-5 and, will be utilized to assess the current use of civility in communication, the workplace environment, and patient satisfaction scores Background: Using civility in conversation and within the health care realm has been a relatively new topic in health care over the course of these past few years. Incivility and miscommunication have been linked to a decrease in patient satisfaction, higher nurse turnover rates, and an unhealthy work environment. Methods: HCAHPS scores are pulled for the months of July, August, and September on an acute care unit in the hospital. An acute care unit with registered nurses, techs, and ancillary staff were asked to attend a 1.5 hour workshop related to civility and communication in health care. Following, participants utilized real life scenarios and role playing to apply civility in their conversations. A pre-and post-test using the AACN’s Healthy Work Environment Assessment Tool, Nursing Incivility Scale, and Class Evaluation tool was utilized for measuring the educational outcomes of the workshop. The unit’s HCHAPS scores were then pulled for evaluation both 1 month and 2 months after the workshop. In addition, the AACN’s Healthy Work Environment assessment tool, the Class Evaluation Tool, and the Nursing Incivility Scale was given as an assessment of the working environment pre-and immediately post-workshop, 1-month post work shop, and 2 months post workshop to determine sustainability. Post communication workshop interviews were conducted amongst the staff for further evaluation of the course and staff experiences.

Yuki Kamada; Master of Science, Nursing, student, Saga University Graduate School of Medical Science, JPN. She has experienced nursing for Mentally disabled and dementia in the community and hospital and has expertise in Mental Health Care. She challenges to improve the quality of Community Mental Health Outreach Service.

Objective: This was a basic research aiming to develop a self-evaluation scale of outreach activity implementation by multidisciplinary teams for persons with mental health concerns and examine the scale’s reliability and validity. Method: Based on the interview with professionals having experience of concept analysis of outreach activities for persons with mental health concerns and operational experiences of outreach support for them, we devised a draft of a scale with 25 items. As the first step to verifying its reliability and validity, we conducted a questionnaire survey with the professionals having the experiences of operational outreach activities with persons with mental health concerns. For this study, we obtained approval from the ethical committee of the university to which the representative of this study belongs (Approval No. 29-86). Result: The subjects were 4 males and 11 females, with an average age of 43.3±0.724 years and outreach experience of 7.3±6.47 years. Through principal component analysis, 5 factors were extracted. The cumulative contribution ratio was 84.34%, and the coefficient of the whole Cronbach’s alpha was 0.963 (p≺0.05). Discussion: The 25 items of the draft scale were found to have one-dimensional property as an item group for a self-evaluated scale of outreach implementation with persons with mental health concerns, along with internal consistency among the items of the whole scale items. We will carry out a nationwide survey to examine its reliability and validity further.

Dr. Norman B. Juruena is currently working as Nurse II at Southern Philippines Medical Center as well as Assistant Professor I (Part-time) at Davao Medical School Foundation, Inc. He received his PhD in Nursing Practice in 2017. He completed his Master of Arts in Nursing major in Medical-Surgical Nursing in 2015. He is currently undertaking his second professional doctorate degree, Doctor of Healthcare Management. He also works as one of the Editorial Board Members and Peer Reviewers in Nursing and Palliative Care International Journal at Ology Press in Budapest, Hungary. He has authored two research studies, one for Master’s thesis and the other is Doctorate dissertation. His works reflect his research interests in healthcare management and clinical nursing. He is serving as a member of Philippine Nurses Association and National League of Philippine Government Nurses.

Studies on leadership nowadays are tend to focus more on leaders’ influence to their followers. But little did we know that followers have also influenced their leaders. Mutual perceived support relationship between leaders and followers is essential as it would affect the performance outcomes of the latter. However, on the head nurses’ perspective, there has no study conducted on how they manage to support their staff nurses amidst of work demands which may possibly hinder their job to succeed. The purpose of the study was to examine the impact of perceived support relationship of head nurses on the performance outcomes of staff nurses in two selected government hospitals. The study utilized a descriptive-analytical research design. Nineteen head nurses and 137 staff nurses were agreed to participate in this study using the universal sampling technique. Creditor ideology of the head nurses has a significant effect on the staff nurses’ performance outcomes. Head nurses’ perceived support relationship, dispositional variables, and work stressors through staff nurses’ perceived supportive supervision are all predictors of staff nurses’ performance outcomes. Improving the organizational support and supportive supervision of head nurses notably increase the staff nurses’ performance outcomes; reducing the head nurses’ perceived negative reciprocity norm and role-conflict increase the staff nurses’ performance outcomes; reducing the head nurses’ perceived reciprocation wariness and need for emotional support decrease the staff nurses’ performance outcomes; reducing the head nurses’ perceived follower support, exchange ideology, and creditor ideology significantly decrease the staff nurses’ performance outcomes; and, the more the head nurses become narcissistic, have more workload, and large span of control greatly decrease the staff nurses’ performance outcomes.

Maduka kenward is a registered nurse trained at school of nursing and midwifery Christ the King College Onitsha Anambra State Nigeria, Iyienu in anambra state. The first male midwife from the history of the institution. Currently he is working as a Midwife in Orbit Healthcare Hospital.

Background: This study was carried out to determine the knowledge of Genetics and Teratogen for Obstetrics and Gynecological advancement among student midwives of School of Basic Midwifery Nkpor, Anambra state Teratology is the study of abnormal development congenital malformations or birth defects while Genetics denotes genes and heredity. Objectives: The study aimed to know the knowledge of Genetics and Teratogen for Obstetrics and Gynecological advancement among student Midwives in School of Basic Midwifery Nkpor. Methodology: A descriptive Cross-Sectional Design Data collection was Semi Structured Interview Administered Questionnaire Multistage Random Sampling Technique was used with 100 Sample size of Student Midwives Statistics package for social science (SPSS) version 22.0 was used for analysis in percentages central tendency chi-square test and represented in tables and graphs. Result : The Result showed that Most of the respondents were single females with mean age of (24.50± 3.119) Majority of the respondents were in first year The study showed that a minimal percentage of the respondents had Knowledge of Genetics and Teratogens but does not know its application in practice while majority got their information from school Most of the respondents felt it is important for midwives to Incorporate Genetic Health Risks Assessment into their Clinical Practice as their major challenge There is significant relationship of (p <0.001) while the Likelihood Ratio is 4 and Linear-by-Linear Association is 1 which is ,so alternative hypothesis was accepted and degree of freedom is 4 Conclusion/Recommendation: The study revealed that respondents have minimal knowledge of Genetics and Teratogens Study also recommends there should be adequate education on Genetics and Teratogens among Student Midwives in order to be confident in patient’s management at all sector during practice.

Ching-Hua Lu is a Post-doctoral research fellow. He is currently doing his PhD in Department of Business Administration at Tunghai University Taiwan

With an increased proportion of elderly with dementia living in community-based daycare center in Taiwan, this study therefore investigated at the types and the effectiveness of the healing environment (HE) by reviewing studies that applied non-medication elements into HE design and measurement. In recent years, healing environment (HE) was created to help the healing or recovery process. HE can be described as an environment consisting of physical and non-physical. This review investigates on an evidence-based HE design for dementia patients (DP) and formal dementia caregivers (DC) outcomes. A total of 494 papers were first selected as potentially relevant; 71 articles were fitted all the inclusion criteria and selected for review. The evidence level was classified in four which from low to high were: (i)Emerging: Anecdotal program, without careful or formal evaluation; (ii)Promising: With Structured design or formal evaluation and results are published in public; (iii)effective: research was published in a peer-reviewed journal; (iv) Evidence-Based: A review study of the HE design for dementia patient approach was found in a peer-reviewed publication More than half of these papers were below Evidence-Based level. HE design also has significant effect on different stage of dementia patients living in community-based daycare center. Some suggestions for designing a healing environment for dementia patients were provided to be conclusion of this study.

Denisha Cuffee, RN BSN, DNP FNP is a Registered nurse. Currently she is doing her master’s degree in University of Maryland Baltimore, School of Nursing, Baltimore.

Statement of Problem: Linkage-to-care templates (LTCTs) within human immunodeficiency virus (HIV) patient electronic medical records (EMRs) are not all being routinely completed at discharge or closed out within the allotted timeframe. The HIV clinic’s current practice is to efficiently discharge patients and effectively link the patient to a primary care provider after discharge. Incomplete EMR LTCTs compromise follow-up care and result ultimately in poor patient outcomes. The purpose of this Doctor of Nursing Practice (DNP) project is to increase the number of completed LTCTs via use of a point-of-care reminder pop- up placed in Outlook calendar of case managers treating HIV patients aged 18 and older in a HIV health clinic. Linkage-to-care (LTC) is a key determinant in improving outcomes for HIV patients. Studies have demonstrated that any form of a reminder method can aid staff in adhering to the standard of practice. In particular, linkage to a primary care provider reliably improved HIV patient outcome. Studies also show that thorough LTC provided by an HIV clinic may have profound positive influence on whether patients follow through with appointments with providers and stay linked to care. Methods: A pre-intervention questionnaire was administered to the clinic staff to assess current barriers to linking patients to care. Staff education and training was conducted on setting Outlook calendar reminders for efficiently discharging (linking to care) patients. EMR audits will be conducted to track completed discharges. Significance: The results of this project can help staff efficiently link patients living with HIV to primary care, which in return improve patients’ overall outcome. Linking patients to care effectively has the opportunity to decrease HIV related complications, comorbidities, and mortality.

Lanaya Davis, RN BSN, DNP FNP is a registered nurse. Currently she is doing her master’s degree in University of Maryland, School of Nursing, USA.

Statement of problem: Hospital acquired pneumonia (HAP) is the second most common hospital acquired infection and is responsible for 20-33% of mortality rates from infection. Patients with HAP also have higher 30-day hospital readmission rates compared to patients without a hospital acquired infection. Nationwide, HAP accounts for 32.5-35.4 million discharges annually. According to the Centres for Disease Control, 5-7% of hospitalizations due to pneumonia end in death. The oral cavity is a high reservoir for infection, and Evidence-Based practice suggests oral hygiene interventions to prevent HAP. HAP is more common in at risk individuals, and there are four routes of transmission: (1) through aspiration of oral contents (food, oropharyngeal secretions, or gastrointestinal contents), (2) from infectious sites, (3), from inhalation of aerosols that are infected, and (4) from extra-pulmonary sites. Aspiration of infectious organisms remains the number one way to acquire HAP, so reducing oral bacteria is critical in HAP prevention. Methods: This project took place over a 14-week time span. Education sessions was provided to staff to ensure appropriate use of oral care equipment. A five question pre and post education test was administered to measure retention of information. Staff documented each time oral care was performed, and they also documented all of the supplies that were used. Conclusion and significance: The results of this project can help establish a standardized protocol to prevent HAP in elderly patients being treated in a hospital setting. Effective implementation of this protocol could potentially decrease the number of cases of HAP in a hospital setting which in turn decreases the overall costs spent to treat this diagnosis.