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Purpose: The rise in rural hospital closures has sparked concern about the potential loss of essential health care services for rural communities. It is crucial to incorporate the perspectives of community residents, which have been largely missing from the literature, when devising strategies to improve health care for this population. The purpose of this study was to describe community residents' perceptions of access to care following a rural hospital closure in an economically distressed Appalachian county of Tennessee. Methods: This study used a qualitative descriptive approach to illustrate how community residents perceive accessing care post hospital closure. We conducted semi‐structured interviews with 24 community residents via telephone in May through August of 2020. Interviews were analyzed using conventional content analysis. Findings: Five themes were identified based on Penchansky and Thomas' framework of health care: accessibility, availability, affordability, accommodation, and acceptability. Accessibility was identified as the most common concern among participants. Specifically, participants perceived longer travel times to receive care, reduced availability of emergency and specialty care, increased costs associated with ambulance services, and extended wait times to see providers. Conclusions: Our findings provide a critical perspective to inform local leaders and policymakers on the impacts of a hospital closure in a rural community. As rural hospitals continue to close, it is crucial to develop multi‐level, community‐driven solutions to ensure access to care for rural communities. [ABSTRACT FROM AUTHOR]

Background: Nurse staffing committees offer a means for improving nurse staffing and nursing work environments in hospital settings by giving direct care nurses opportunities to contribute to staffing decisionmaking. These committees may be mandated by state law, as is the case currently in nine U.S. states, yet little is known about the experiences of staff nurses who have served on them. Purpose and design: This qualitative descriptive study was conducted to explore the experiences of direct care nurses who have served on nurse staffing committees, and to better understand how such committees operate. Methods: Participants were recruited by sharing information about the study through online nursing organization platforms, hospital nurse leadership, state chapters of national nursing organizations, social media, and nonconfidential nursing email lists. A total of 14 nurses from five U.S. states that have had nurse staffing committee legislation in place for at least three years were interviewed between April and October 2022. Results: Four themes were identified from the data--a "well-valued" committee versus one with "locked away" potential: committee value; "who benefits": staffing committee beneficiaries; "not just the numbers": defining adequate staffing; and "constantly pushing": committee members' persistence. Conclusions: The results of this study highlight the importance of actualizing staff nurse autonomy within nurse staffing committees--and invite further exploration into how staff nurses' perspectives can be better valued by nursing and nonnursing hospital leadership. Nurse staffing committees generally recommend staffing-related policies and practices that address the needs of patients and nurses, and work to find areas of compromise between nursing and hospital entities. But to be effective, the state laws that govern nurse staffing committees should be enforceable and evaluable, while committee practices should contribute to positive patient, nurse, and organizational outcomes; otherwise, they're just another form of paying lip service to change. [ABSTRACT FROM AUTHOR]

Introduction. Hospital and emergency department closures are emblematic of America's changing healthcare delivery system, which often places rural vulnerable communities at further risk for poor health outcomes. Employing the Vulnerable Populations Conceptual Model (VPCM), we aimed to synthesize the existing research addressing care quality in these facilities and the impacts of their closures on affected communities and health status. Materials and Methods. We conducted a modified integrative literature review (outlined by Whittemore and Knafl), comparing and contrasting articles via an organizational matrix. We identified articles through three databases and ancestral searches. We included English-written, peer-reviewed articles published from 2010 forward. We excluded international and nonresearch articles that focused on the closure of specific departments (other than emergency departments). Our final sample included 26 primary research studies (24 quantitative and two qualitative). We scored the articles according to their scientific rigor and data relevance, then deductively coded them according to the VPCM constructs. Results. We identified two overarching themes from the literature: (1) association of rural hospital care and patient health outcomes and (2) access to hospital care-effects of closures and openings on rural vulnerable populations. Subthemes reflected access to care and other resources, relative risks associated with time-sensitive health events, and health outcomes. Discussion and Conclusion. We found that rural hospitals provide access to essential health services and emergency care in these vulnerable, underserved communities. Their loss may increase adverse outcomes in affected communities and the overall health system. However, our review was limited by the retrospective, nonexperimental nature of most included articles, and more data quantifying these effects and the impact of confounding factors are needed. Multidisciplinary stakeholders must jointly address declining access to hospital and emergency care by sustainably addressing social determinants of health, quality assurance, innovative healthcare delivery systems, and rural hospital funding. [ABSTRACT FROM AUTHOR]

As the College of Nursing at the University of Tennessee, Knoxville prepared to move their graduate programs online, a nursing faculty grass-roots movement led to the implementation of a faculty development program. This instructional design portfolio describes the design, development, implementation, and evaluation of this program, with the goal of identifying best practices in the design of programs for learning to teach online. These include understanding the importance of just-in-time learning, developing the ability to meet diverse needs, defining workshop expectations and workload requirements, increased integration of technology and pedagogy training, and the importance of modeling. (Contains 3 tables and 1 figure.)

As the health care and well-being of sexual and gender minority (SGM; i.e., lesbian, gay, bisexual, and/or transgender or gender non-binary) people in the United States receive federal and local-level attention, SGM older adults and caregivers continue to be left out of important health policy and care conversations. The current article describes policy issues and affirmative strategies related to inclusive care practices among SGM older adults and caregivers. In addition to the broader policies considered related to health and well-being, we include a discussion of local-level policy strategies to mitigate discrimination and promote inclusive care for SGM older adults and caregivers. [Journal of Gerontological Nursing, 48(12), 6–15.] [ABSTRACT FROM AUTHOR]

Background: Hospitalized patient and nursing outcomes improve when nurses are involved in decision-making practices through shared governance structures. Yet there has been little research investigating how staff nurses are involved in hospital staffing policymaking and how they perceive this process. Purpose: The study's primary aims were to increase understanding of staff nurses' perceptions of factors that hinder or support nurse involvement in hospital nurse staffing policymaking and to learn more about how nurses are, or would like to be, so involved. We also collected nurses' work environment and demographic information to further inform our understanding. Methods: This study used a qualitative descriptive approach. Using QuestionPro software, we solicited open-ended responses to semistructured questions to explore the topics of interest. The online form was distributed via social media. Results were analyzed using conventional content analysis. Multiple-choice questions related to demographics and nurse work environments were also included, and these results were analyzed using descriptive statistics. Results: Thirty-two staff nurses completed the online form between April 5 and May 24, 2021. Identified themes include "We aren't asked": structural barriers to staff nurse involvement; "No one cares": workplace culture barriers to staff nurse involvement; and "'They' versus 'we'": lack of power sharing for staffing decision-making. Participants described feeling powerless with regard to, and having little to no involvement in, hospital staffing policymaking. Yet they also expressed their desire to be engaged in this process and offered suggestions for how nurse involvement in such policymaking could be improved. Conclusion: Our findings provide crucial insight into how organizations can address existing structural barriers to nurse involvement, offer more equitable opportunities for nurse involvement, foster more inclusive workplace cultures, and recognize the value of nurse input and autonomy regarding staffing decisions. This qualitative study examined staff nurses' perceptions of factors that hinder or support nurse involvement in hospital nurse staffing policymaking—and how nurses are, or would like to be, so involved. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trauma nurses may experience secondary traumatic stress, compassion fatigue, and burnout as their clinical roles expose them to patients with traumatic injuries. Because traumatic events described as being most stressful for nurses involve sudden death or children and adolescents, multicasualty, school-associated shooting events are likely to be particularly stressful for nurses who care for the affected patients. OBJECTIVE: This research examined the psychosocial effects of caring for patients in an inpatient trauma unit following a multicasualty, school-associated shooting event. METHODS: This research was guided by a qualitative case series approach, a theory of secondary traumatic stress, and the compassion fatigue resilience model. Registered nurses who provided care in the trauma unit of a Level I trauma center to patients who were injured during a multicasualty, school-associated shooting event in the Southeastern United States were invited to participate. RESULTS: The three themes identified by this research were (a) innocence of the patients, (b) trajectories of increased emotions, and (c) processing emotional stressors. Nurses reported the benefits of peer support and provided recommendations to increase the efficacy of formal debriefing sessions. CONCLUSIONS: Nurses value self-care routines and peer support as coping mechanisms to foster well-being following exposure to traumatic events. Hospitals should encourage active participation in timely critical incident stress debriefings and promote the use of employee assistance services to support nursing staff after these events. [ABSTRACT FROM AUTHOR]

Background: In response to the COVID‐19 pandemic, Tennessee's Governor issued executive orders temporarily suspending certain practice restrictions on advanced practice registered nurses (APRN), which expired after 2 months as the pandemic worsened. Purpose: This purpose of this qualitative study was to analyze APRN interview data to evaluate how prepandemic APRN practice barriers, executive orders, and the pandemic affected APRN practice in Tennessee. Methods: Fifteen Tennessee APRNs who completed the National APRN Practice and Pandemic study also completed follow‐up interviews via a HIPAA‐compliant Zoom platform. Given the unprecedented circumstances associated with the COVID‐19 pandemic, we conducted a qualitative descriptive study seeking descriptions and unique perspectives of Tennessee APRNs. Consistent with qualitative study design, we conducted an atheoretical study that featured interviews, purposeful sampling with maximum variation sampling, and content analysis. Results: The major themes were practice changes, impact of executive orders, and ongoing care barriers. The data revealed that patients, APRNs, and other health care providers were strained in new and profound ways during the pandemic. An underlying theme was Tennessee APRNs' frustration with continued regulatory and other practice barriers despite their state's health and health care disparities and under resourced health care system. Conclusion: These findings indicate the need to improve care access and health outcomes, advocate for full practice authority for APRNs, support telehealth expansion, address transportation deficiencies, and respond to the pandemic‐precipitated mental health crisis. [ABSTRACT FROM AUTHOR]

Interviews with 15 Tennessee Advanced Practice Registered Nurses early in the COVID-19 pandemic revealed a major theme of mental health challenges unrelated to the primary study purpose. Without direct prompts, 13 out of 15 interviewees mentioned mental health issues among patients and 14 of the 15 interviewees discussed provider mental health problems. A secondary analysis of interview transcripts revealed three themes associated with mental health challenges: general barriers to mental health care, patient-specific concerns, and provider issues. Responding to the new and worsening mental health and substance use disorders revealed by informants and cited in the literature is an urgent priority. [ABSTRACT FROM AUTHOR]

Advanced practice registered nurses (APRNs) significantly contribute to health promotion, disease prevention, and disease management. Yet, barriers to APRN practice exist, including regulatory, state, and institutional barriers, that hinder their ability to practice to the full extent of their education, licensure, and certification. Nurse leaders can play an important role in helping reduce unnecessary institutional barriers to APRN practice. [ABSTRACT FROM AUTHOR]

Unsafe nurse staffing conditions in hospitals have been shown to increase the risk of adverse patient events, including mortality. Consequently, United States and international professional nursing organizations often advocate for safer staffing conditions. There are a variety of factors to consider when staffing nurses for patient safety, such as the number of patients per nurse, nurse preparation, patient acuity, and nurse autonomy. The complex issue of staffing nurses often is compounded by cost issues and can become politicized. When nurse organizations' recommendations for safe staffing measures are disregarded by hospital administrations, nurse lobbyists and interest groups often pursue legislative action to protect patients and nurses from unsafe staffing conditions. This article presents a narrative review of safe nurse staffing factors and an analysis of nurse staffing legislation. Using a patient‐centric lens, three state‐level nurse staffing policies (mandated nurse‐to‐patient ratios, public reporting of staffing plans, and nurse staffing committees) were evaluated by empirical evidence, cost to hospitals and state governments, political feasibility, and potential to affect patient populations. Although nurse staffing policy analysis can be conducted in several ways, it is crucial that nurses consider empirical evidence related to staffing policies as well as evaluations of implemented policies and political influences. [ABSTRACT FROM AUTHOR]

"Deaths of despair", deaths due to drugs, alcohol, and suicide, occur at higher rates in rural communities. The incidence of such deaths highlights underlying access and treatment disparities which result in poorer outcomes. Telehealth is a viable option for addressing rural mental healthcare needs as it enables more effective care management, provides expanded access to services, and fosters integrating primary and mental healthcare services. Implementing telemental health will involve overcoming coverage and reimbursement, licensure, broadband access and adequacy, and privacy and security barriers and advancing select policy changes. Telehealth diffusion will require changes in professional training and care delivery models. [ABSTRACT FROM AUTHOR]

In the current healthcare environment, the healthcare industry has become increasingly focused on population health concerns. While advanced practice registered nurses (APRNs) are well prepared to contribute to population health by delivering holistic healthcare to individuals, families, groups, communities, and populations, they are not engaged in initiatives to improve population health commensurate with their numbers, education, training, experience, and role as primary care providers and essential healthcare team leaders and members. This article discusses the rationale for integrating population health into APRN curricula, one program's approach to doing so, and preliminary lessons learned from this effort. The three main lessons learned include population health content should be integrated across the curriculum for all APRN cohorts, supplementary population health content should be considered, and opportunities for integrating didactic population health content should be included across the FNP curriculum. [ABSTRACT FROM AUTHOR]

Lessons learned from a faculty development program that preceded the move of a traditional PhD program in nursing to a blended learning model using online and face-to-face strategies are discussed. The majority of lessons and strategies presented are universal to any faculty development program. The lessons are organized into seven topics: Situational Leadership, Adult Learners, Just in Time Teaching, Thinking About Learning and Teaching, Lifelong Learning, Transparency and Collaboration, and Community. Our far-reaching lessons are related to the contextual nature of leadership, how to effectively design and time learning experiences for adults, the importance of open and supportive communities working for a common purpose, and how each person’s perspective shapes his or her learning experience and how the lessons learned are applied. [ABSTRACT FROM AUTHOR]

Background: Understanding the personal and professional motivations that shape learning needs is fundamental to high-quality continuing nursing education (CNE). This statewide survey assessed nurses' CNE needs, learning priorities, perceived benefits and barriers, and motivation for voluntary CNE participation. Methods: An online needs assessment accessed through state professional organizations' websites and various health care facilities was available to all registered nurses in the state. The needs assessment included demographic and professional characteristics and items related to CNE preferences and barriers. Results: Among 672 nurses, motivating factors for CNE participation varied and priority learning needs included leadership and management, evidence-based practice, and advanced practice issues. CNE program costs, travel, and time away from work were key barriers to participation. Conclusion: CNE participation is influenced by personal, professional, and organizational factors. In the absence of state mandates, policy changes are needed to promote CNE and overcome persistent barriers to participation. [ABSTRACT FROM AUTHOR]

The shortage of nursing faculty and the need for MSN-prepared faculty to have access to doctoral education and remain in their teaching roles has resulted in a growing number of nurse education programs moving online. A better understanding of how best to support faculty during this transition is needed. This case study describes the experiences of faculty at one institution as they participated in a grassroots effort to learn about online teaching. Six themes related to the faculty development experience were identified: 1) plugging in; 2) peer sharing, modeling and community building; 3) multidimensional learning; 4) role-shifting and meta-learning; 5) paradigm shifting; and 6) sustaining momentum. Findings are connected to recommendations related to how best to prepare faculty to ensure that quality nursing education continues. [ABSTRACT FROM AUTHOR]

The sudden, expanded need for telehealth during the COVID-19 pandemic added to the challenges advanced practice RNs face in the United States. The purposes of this article are to summarize advanced practice RNs' responses about the use of telehealth before and during the pandemic and to analyze free-text comments about how the use of telehealth changed during the pandemic. A 20-item survey was distributed using convenience sampling to advanced practice RNs from June 1 to September 23, 2020. Analyses of descriptive and open text responses related to telehealth were conducted. Most of the respondents did not use telehealth prior to the pandemic (n = 5441 [73%]), but during the pandemic, half used telehealth at least daily (n = 3682 [49%]). The most common barriers related to telehealth were about the difficulty some populations had in accessing the necessary technology. The most common favorable comments cited by respondents were related to some patients' improved access to care. Telehealth use is unlikely to return to prepandemic levels. As a result, considerations of telehealth-related recommendations provided for advanced practice RN education, policy, and practice are encouraged for the purpose of increasing healthcare access., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)