Online Journal of Issues in Nursing最新文献

{"title":"Informatics: Empowering ePatients to Drive Health Care Reform","authors":"R. Nelson","doi":"10.3912/OJIN.Vol21No03InfoCol01","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No03InfoCol01","url":null,"abstract":"Citation: Nelson, R., (September 13, 2016) \"Informatics: Empowering ePatients to Drive Health Care Reform\" OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3.DOI: 10.3912/OJIN.Vol21No03Inf°Col01Historically, the American healthcare delivery system has rewarded providers for the number of patients seen and procedures performed. For example, seeing twice as many patients in a day resulted in more income for providers; and admitting more patients to a hospital enabled the hospital to collect more money. Today, the American healthcare delivery system is transitioning from a volume-based approach to a value-based approach. As this transition progresses, providers will be increasingly rewarded for the quality of care provided as measured by patient outcomes; ePatients are now one of the major force driving this transition. In this my first column (Part I of three columns on empowering ePatients), I will describe who ePatients are, introduce the reader to real ePatients and eCaregivers, and discuss how ePatients are being empowered to drive this transition.Part I: Introduction to the ePatientIn 1955, Virginia Henderson first published her well-recognized definition of nursing. Early on Henderson defined nursing as \"assisting the individual (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. It is likewise the unique contribution of nursing to help the individual to be independent of such assistance as soon as possible\" (Harmer & Henderson, 1960, p. 4). Implied in this definition, as well as many other definitions of nursing, is the idea that an educated professional nurse would be responsible for providing the care that a patient could not do for him or herself. To meet this responsibility, nurses have developed a systematic process called the nursing process.Today, the role and responsibility of the nurse is changing. Healthcare is moving from a world where the educated, informed nurse offers services to patients who cannot meet their own healthcare needs to a world where the equipped, enabled, empowered, and engaged patient is becoming a peer, working together with nurses and other healthcare providers in identifying their healthcare needs. The final decision about how these needs might best be met is being placed in the hands of the patient. In truth, patients were always supposed to be in charge of meeting their needs; this is one of the reasons there are so many permission forms in healthcare. In this first column (Part I) in this three-part series on empowering ePatients, I will explain who/what e-Patients are, introduce the reader to real ePatients and eCaregivers, and explore the concept of empowered ePatients and eCaregivers.What is an ePatient?In today's lexicon there is a long list of eWords, for example, eHealth, eMail, eShopping, and eLearning. The small e in front of the term is use","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"21 3 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2016-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview and Summary: Elimination of Barriers to RN Scope of Practice: Opportunities and Challenges","authors":"K. Baker, T. Williams","doi":"10.3912/OJIN.Vol21No03ManOS","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No03ManOS","url":null,"abstract":"Citation: Baker, K., Williams, T.E., (September 30, 2016) \"Overview and Summary: Elimination of Barriers to RN Scope of Practice: Opportunities and Challenges \" OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3, Overview and Summary.DOI: 10.3912/OJIN.Vol21No03ManOSIf you could envision a preferred future for registered nurses (RNs), what would that look like? Would you want an RN's voice heard, honored, and considered essential at every healthcare decision-making table? Would you want every RN energized to begin work each day; to experience a continuous journey of professional growth and improvement; to be acknowledged and recognized appropriately for their optimal contribution? Have you pondered how this preferred future could be realized?When the Institute of Medicine's original report on the future of nursing was released (IOM, 2011), it outlined a future full of opportunity and with the challenge for all nurses to practice to the full extent of their education and scope. Over the last several decades, much has occurred to elevate the practice and value of the RN. Patient needs have become more complex and quality and patient safety are now the front and center of reimbursement and regulatory landscapes. Nurses have adapted to these changes by expanding their skill sets and knowledge of science, securing their places as linchpins to provision of improved health outcomes in the era of healthcare reform (IOM, 2011).Still, there is much to be done. Experts agree that the ability of RNs to practice to the fullest extent of their education and scope has not yet been achieved in most healthcare settings (IOM, 2015). In response to this problem, the American Nurses Association (ANA) established a Professional Issues Panel-the Barriers to RN Scope of Practice Panel (Panel)-to explore factors that both promote and inhibit nurses ability to practice to the top of their licensure. The Panel was established as a think tank to create an environment for RNs to consider and identify some barriers to RNs' ability to practice to the full extent of their education, experience, and scope of practice.Five of the six introductory articles in this OJIN topic are based on the work of the ANA panel and written by members of the panel steering committee. These articles include evidence-based recommendations to address some of the barriers identified by the panel that prevent RN practice to the full extent of education and scope. The first four articles are organized in this OJIN topic based on key roles of RNs that emerged from the panel work and demonstrate RN value to the healthcare delivery system: RN as professional, RN as advocate, RN as innovator, and RN as collaborative leader. The fifth article provides an executive summary of the panel work. The sixth article discusses a research study that considered several variables important to full scope of practice, such as nurse educational level and organizational factors.The first article, \"Registered Nurs","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"21 3 1","pages":"1 p preceding 1"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Nursing Avatars: Nurse Roles and Evolving Concepts of Care","authors":"Miriam R. B. Abbott, P. Shaw","doi":"10.3912/OJIN.Vol21No03PPT39,05","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No03PPT39,05","url":null,"abstract":"Advances in computer software have provided interactive tools that perform many of the duties once in the domain of the nursing profession. Sometimes referred to as 'virtual nursing avatars,' the duties delegated to this technology include facilitating check-ins for patients and coaching patients as they make lifestyle changes. Researchers continue to develop computer applications for virtual nurse avatars. As computers and smartphones take on tasks once in the domain of humans, the roles of nurses will evolve. The arc of this evolution will be determined by the limits of technology, evolving concepts of care, and changing population needs. In this article, the authors share examples of nursing avatar applications, discuss concerns about virtual nurse avatars, reinforce nursing as a caring profession, present avatars as caring agents, and consider the future of nursing avatars. They conclude that, although virtual nurse avatars can perform some nursing tasks in an acceptable manner, they are limited in their ability to make complex judgments and engage in collaboration.","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"21 3 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2016-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Distress and Workplace Bullying Among Registered Nurses","authors":"P. Berry, G. Gillespie, B. Fisher, Denise k. Gormley, J. Haynes","doi":"10.3912/OJIN.Vol21No03PPT41","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No03PPT41","url":null,"abstract":"Workplace bullying (WPB) behaviors are pervasive in some healthcare organizations leading to difficult work environments for registered nurses. We conducted an exploratory quantitative dominant (QUANT/qual) mixed method design study to determine the differences in respondents in three Midwestern states on psychological distress symptoms using WPB exposure levels and select nurse characteristics. This article discusses background information and WPB consequences. We report on the study purpose, methods, and Phase I qualitative results, including significant differences with perceived stress, anxiety, and posttraumatic symptoms reported by persons with frequent to daily WPB behavior exposure. The discussion section considers significant differences found between respondents related to age and posttraumatic stress symptoms. Narrative analysis on strategies used after bullying also illuminates the discussion. Finally, we examine implications for nurse leaders and empowerment of their direct reports to resolve minor interpersonal conflicts and move swiftly to resolve escalating bullying.","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"21 3 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2016-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome Measurement in Nursing: Imperatives, Ideals, History, and Challenges","authors":"T. Jones","doi":"10.3912/OJIN.Vol21No02Man01","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No02Man01","url":null,"abstract":"Nurses have a social responsibility to evaluate the effect of nursing practice on patient outcomes in the areas of health promotion; injury and illness prevention; and alleviation of suffering. Quality assessment initiatives are hindered by the paucity of available data related to nursing processes and patient outcomes across these three domains of practice. Direct care nurses are integral to self-regulation for the discipline as they are the best source of information about nursing practice and patient outcomes. Evidence supports the assumption that nurses do contribute to prevention of adverse events but there is insufficient evidence to explain how nurses contribute to these and/or other patient outcomes. The purposes of this article are to examine the imperatives, ideal conditions, history, and challenges related to effective outcome measurement in nursing. The article concludes with recommendations for action to move quality assessment forward, such as substantial investment to support adequate documentation of nursing practice and patient outcomes.","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"21 2 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Review: Integrating Lewin’s Theory with Lean’s System Approach for Change","authors":"E. Wojciechowski, Tabitha Pearsall, P. Murphy, E. French","doi":"10.3912/OJIN.Vol21No02Man04","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No02Man04","url":null,"abstract":"The complexity of healthcare calls for interprofessional collaboration to improve and sustain the best outcomes for safe and high quality patient care. Historically, rehabilitation nursing has been an area that relies heavily on interprofessional relationships. Professionals from various disciplines often subscribe to different change management theories for continuous quality improvement. Through a case review, authors describe how a large, Midwestern, rehabilitation hospital used the crosswalk methodology to facilitate interprofessional collaboration and develop an intervention model for implementing and sustaining bedside shift reporting. The authors provide project background and offer a brief overview of the two common frameworks used in this project, Lewin’s Three-Step Model for Change and the Lean Systems Approach. The description of the bedside shift report project methods demonstrates that multiple disciplines are able to utilize a common framework for leading and sustaining change to support outcomes of high quality and safe care, and capitalize on the opportunities of multiple views and discipline-specific approaches. The conclusion discusses outcomes, future initiatives, and implications for nursing practice.","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"21 2 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information and Communication Technology: Design, Delivery, and Outcomes from a Nursing Informatics Boot Camp","authors":"Manal Kleib, Nicole Simpson, B. Rhodes","doi":"10.3912/OJIN.Vol21No02Man05","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No02Man05","url":null,"abstract":"Information and communication technology (ICT) is integral in today’s healthcare as a critical piece of support to both track and improve patient and organizational outcomes. Facilitating nurses’ informatics competency development through continuing education is paramount to enhance their readiness to practice safely and accurately in technologically enabled work environments. In this article, we briefly describe progress in nursing informatics (NI) and share a project exemplar that describes our experience in the design, implementation, and evaluation of a NI educational event, a one-day boot camp format that was used to provide foundational knowledge in NI targeted primarily at frontline nurses in Alberta, Canada. We also discuss the project outcomes, including lessons learned and future implications. Overall, the boot camp was successful to raise nurses’ awareness about the importance of informatics in nursing practice.","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"21 2 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview and Summary: Organizational Outcomes for Providers and Patients","authors":"M. Rosenkoetter","doi":"10.3912/OJIN.Vol21No02ManOS","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No02ManOS","url":null,"abstract":"Citation: Rosenkoetter, M., (May 31, 2016) \"Overview and Summary: Organizational Outcomes for Providers and Patients\" OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 2, Overview and Summary.DOI: 10.3912/OJIN.Vol21No02ManOSThe Commonwealth Fund (2014) reported that while the United States (US) has the most expensive healthcare system among 11 industrialized countries, it ranked last on \"measures of health system quality, efficiency, access to care, equity, and healthy lives\" (para.1). While we have a substantial investment in healthcare, there continues to be a deficient in attainable outcomes. The Patient Protection and Affordable Care Act (ACA) (Kaiser Family Foundation, 2013), was signed into law on March 23, 2010 by President Obama as a comprehensive health reform law. It was intended to \"expand healthcare coverage, control healthcare costs, and improve healthcare delivery system[s]\" (p. 1). Controversy continues regarding whether the outcomes of this law have actually achieved the goals and the original purpose. In this election year, the law has become fodder for considerable debate, with some Republicans pushing for its repeal. The outcome of the Presidential and Congressional elections may well determine the law's future.At the same time, total healthcare costs in the US are expected to be $4.8 trillion in 2021. Healthcare spending was nearly $2.6 trillion in 2010 and half of this was to pay the cost of medical services by hospitals and physicians (Aetna, 2016). Many Americans continue to lack health insurance, experience rising healthcare costs, and have difficulty paying for healthcare needs (Consumer Reports. 2014). With healthcare costs rising, accountability and measuring the actual outcomes of care provided has greater emphasis. The ACA includes a provision to \"allow providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings...[and] ...must agree to be accountable for the overall care of their Medicare beneficiaries.\" (Kaiser Family Foundation, 2013, section 11). This implies that sufficient data must be compiled to document outcomes.Two other current concerns are the number of preventable adverse events that occur in hospitals and premature deaths associated with preventable harm. James (2013) estimated this number between 210,000 and 400,000 per year, depending on the completeness of medical records and the search technology. Given the ramifications and potential repercussions of these events, it is plausible to assume that some are not reported and hence, accurate outcomes are unknown. Greater involvement in their healthcare decisions by patients and families is indicated, with greater attention to outcomes that they perceive have caused \"harm\" as well as how nursing care at the individual and team level can impact those outcomes.Over the past decade, technology has increasingly changed both healthcare delivery and outcome measurement. Electronic me","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"21 1","pages":"1 p preceding 1"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multigenerational Challenges: Team-Building for Positive Clinical Workforce Outcomes","authors":"Jill Moore, Marcee C. Everly, Renee N. Bauer","doi":"10.3912/OJIN.Vol21No02Man03","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No02Man03","url":null,"abstract":"Patient acuity in hospital settings continues to increase, and there is greater emphasis on patient outcomes. The current nursing workforce is comprised of four distinct generational cohorts that include veterans, baby boomers, millennials, and generation Xers. Each group has unique characteristics that add complexity to the workforce and this can add challenges to providing optimal patient care. Team building is one strategy to increase mutual understanding, communication, and respect, and thus potentially improve patient outcomes. In this article, we first briefly define generational cohorts by characteristics, and discuss differing expectations for work/life balance and potential negative outcomes. Our discussion offers team building strategies for positive outcomes, a case scenario, and concludes with resources for team building and organizational opportunities.","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"21 2 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue","authors":"Nancy Rudner Lugo","doi":"10.3912/OJIN.Vol21No02PPT54","DOIUrl":"https://doi.org/10.3912/OJIN.Vol21No02PPT54","url":null,"abstract":"In the United States, Advanced Practice Registered Nurse (APRN) regulations are determined at the state level, through legislation and rule making. The lack of an evidence base to APRN regulation has resulted in a patchwork of varied regulations and requirements for nurse practitioners. The author begins this article by reviewing the history of the Equal Rights Amendment (ERA) in the United States and describing her study that assessed APRN fullpractice authority in states that ratified the ERA versus states that opposed it. She presents the study findings, limitations of the comparison, and discussion of the findings and implications. In conclusion, the findings demonstrated that progress toward full APRN practice will require building strategies for political support and framing the need to update APRN regulations in a manner that aligns with each state’s social and political values.","PeriodicalId":35614,"journal":{"name":"Online Journal of Issues in Nursing","volume":"43 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2016-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70294317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}