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In the United States and the United Kingdom, the roles of nurses in antimicrobial stewardship (AS) have been described in guidelines. However, in Japan, no previous studies have clarified nurses' recognition of the role of AS. Moreover, how the AS roles were implemented among nurses in Japan has not been fully clarified. The objectives of this study were to determine the perceptions of infection control nurses (ICNs) in Japan regarding the AS role of nurses and the extent of nurses' practice.A questionnaire survey of ICNs was conducted.Four hundred responses (response rate, 30.8%) were analyzed. Some of the items that have already gained consensus as the AS role of nurses were not recognized as the AS role of nurses by ICNs or had low implementation rates in Japan. Meanwhile, both recognition and implementation rates were high for the 5 types of care proposed.The reason the ICNs agreed that these 5 types of care are AS roles for nurses is that they know that such care can prevent infection and thereby obviate the need for antimicrobial administration. However, whether nurses themselves understand that these are roles for nurses in AS is unclear. To promote AS in Japan, communicating the fact that nurses already contribute to AS, strengthening nurse education, and improving staffing are desirable.

The aim of this manuscript is to embolden nurses to engage in policy that promotes diversity, equity, inclusion, and belonging to advance health equity.It uses the Future of Nursing Report 2020-2030 to acknowledge the impact of structural racism and the need for a more equitable, just, and fair society.It also recognizes that nurses must harness their power and political will, to change and strengthen policies, so all nurses can practice to the full extent of their education and license.A case study of the response to COVID-19 in one underserved community is included to illustrate policy in action.

This study aimed to evaluate the feasibility and acceptability of a nurse-led eHealth transition care program for adolescents with spina bifida.This study used a single-arm, pretest-posttest intervention study. Adolescents with spina bifida, aged 12-15 years, and their parents participated in the program. A 6-week program was delivered through an online platform in real-time by nurses. We evaluated feasibility and acceptability using criteria such as the completion rate, program satisfaction, changes in transition readiness, social support, career preparation behavior, sexual knowledge, and sexual worries at three time points from July to September 2021.Thirteen adolescents completed all sessions and surveys (13/14, 92.9%). All adolescents expressed high satisfaction with both the content and delivery methods of the program. Significant benefits in transition readiness, career preparation behavior, and sexual knowledge were identified over the study period. However, the evaluation of social support and sexual worries did not demonstrate any significant improvements. Additionally, through family counseling, adolescents benefited from experiences such as reflecting on their current transition readiness, setting and achieving individualized goals and plans using a self-checklist with their parents and nursing professionals.This nurse-led eHealth intervention was feasible and acceptable for adolescents with spina bifida. Furthermore, our results highlight the practicability and the potential for strategic dissemination of using this eHealth program in transitional care during the COVID-19 pandemic.The eHealth transition care program contributes to broadening existing nursing interventions not only in medical areas but also in daily life areas.

This study aimed to investigate the clinical effectiveness of nurse-led cognitive/behavioral therapy (CBT) in Japanese routine outpatient care. We retrospectively collected data from 100 cases with mental disorders who had received nurse-led CBT. Results demonstrated that CBT provided by nurses led to significant improvements in quality of life and other clinical outcomes during the intervention period (all p < 0.001). Among participants who received optional follow-up, these improvements were well-maintained. This real-world evidence of nurse-led CBT bridges the research-practice gap, and will encourage frontline nurses and motivate institutional/organizational leaders, academic/professional societies, and policymakers to employ empirically-supported psychotherapeutic techniques in routine nursing care.

Charge nurses (CNs) are shift leaders who manage resources and facilitate patient care, yet CNs in EDs receive minimal training, with implications for patient safety and emergency nursing practice. The purpose of the study was to describe the experiences of emergency nurses related to training, preparation, and function of the CN role.An explanatory sequential mixed methods design using survey data (n = 2579) and focus group data (n = 49) from both CN and staff nurse perspectives.Participants reported minimal training for the CN role, with divergent understandings of role, required education and experience, the need for situational awareness, and the acceptability of the CN taking on other duties.The ED CN is critical to the safety of both nursing environment and patient care. Nurses in this pivotal role do not receive adequate leadership orientation or formal training in the key areas of nurse patient assignment, communication, and situational awareness. Formal training in nurse-patient assignment, communication, and situational awareness are critical to appropriate patient care and maintenance of interprofessional trust necessary for successful execution of the CN role. ED nurse managers should advocate for this training.

To evaluate the effectiveness of a nurse-led couples intervention on the marital quality of couples coping with gynecological cancer.Couples coping with gynecological cancer were randomly allocated to the intervention (n = 51) and the control (n = 53) group. The intervention group received the nurse-led couples intervention developed based on the Preliminary Live with Love Conceptual Framework plus routine nursing care. The control group received only routine nursing care. Marital quality, including marital satisfaction, marital communication, and sexual life, were measured using Olson Marital Quality Questionnaire at 3 timepoints (baseline, 2- and 3-months following baseline). Generalized estimating equation was used to examine the effectiveness of the intervention in improving marital quality.Patients and husbands in the intervention group had significantly improved marital satisfaction scores (WaldχThe nurse-led couples intervention based on the Preliminary Live with Love Conceptual Framework improved marital satisfaction and marital communication, but not sexual life, of couples coping with gynecological cancer. The provision of professional sexual health psychology training for nurses may be crucial if nurse-led models are to truly support the sexual health of couples coping with gynecological cancer.Registered with www.chictr.org.cn (ChiCTR2000034232).

Insertion of a peripheral intravenous catheter into the external jugular vein is regularly performed in emergency departments to treat patients with difficult intravenous access. Although emergency nurses are experienced in inserting peripheral intravenous catheters, there is an inconsistent practice and a lack of education and training regarding the insertion of catheters in the external jugular vein. This manuscript provides a practical guide for emergency nurses to care for patients who require an external jugular peripheral intravenous catheter. Key information found in this manuscript includes indications for external jugular intravenous access, the nurse's role in performing external jugular peripheral intravenous catheters, and clinical considerations when caring for patients with an external jugular peripheral intravenous catheter.

Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. Data on the diagnostic yield of ILRs, on nurse-led syncope clinics, and on nurse-led ILR implants are limited.We evaluated the safety and efficacy of our nurse-led syncope clinic and nurse-led ILR implants.A retrospective study of all consecutive patients undergoing nurse-led ILR implantations was performed between April 2016 and April 2018. Patients were referred from both nurse-led and physician-led clinics. Data were collected on baseline demographic characteristics, referral source, symptom-rhythm correlation, ILR findings, and subsequent changes to management. All ILRs were enrolled into remote monitoring with automatic arrhythmia detection, and all immediate (≤24 hours) ILR implant complications were recorded. Comparisons were made between nurse-led and physician-led clinics and subsequent outcomes.A total of 432 patients with an ILR were identified: 164 (38%) from nurse-led and 268 (62%) from physician-led clinics; 200 (46%) were women (mean age 66.5 ± 18.2 years; mean follow-up duration 28.9 ± 9.5 months). Primary ILR indications were syncope (n = 251 [58%]), presyncope (n = 33 [7%]), palpitation (n = 39 [9%]), cryptogenic stroke (n = 78 [18%]), and other reasons (n = 31 [7%]). No immediate ILR implant complications occurred. Overall, 156 patients (36%) had a change in management as a direct result of ILR findings, with no overall differences between nurse-led and physician-led clinics (35% vs 36%; P = .7). More patients had newly diagnosed atrial fibrillation in physician-led clinics (15% vs 7%; P = .01), and more patients had pacemaker implants for bradycardia in nurse-led clinics (23% vs 13%; P.01).Nurse-led ILR implantation was safe and effective. Nurse-led syncope clinics achieved good symptom-rhythm correlation with resultant significant changes to management in comparison to physician-led clinics. Larger prospective studies are needed to evaluate their longer-term impact.

Background Studies have shown that providers deliver inadequate pain management, which is important since ineffective pain management can lead to patient safety concerns and negative health outcomes. There is a gap in the literature understanding the specific details of nurses’ struggles treating patients who need help with pain management. Methods This qualitative descriptive study assessed nurses’ challenges with pain management to provide a comprehensive, low-inference summary of the data. Participants were interviewed about their biggest challenges. Findings Three main themes emerged from the data: prescribing patterns, education on zero pain, and system problems. Major challenges identified in this study were understanding nurses’ perceptions of pain management care delivery and the need for quality pain management education. Discussion The health community needs to raise awareness and provide more comprehensive education regarding the nurse’ role in pain management.

Evidence-based practice (EBP) within healthcare leads to improved patient outcomes, high-quality care, job satisfaction, reduced turnover, professional autonomy, and validates nursing practice. Although a plethora of research focuses on implementing EBP, there has been little attention on assessing organizational readiness for integration. The primary aims of this study were to explore nursing beliefs and attitudes about EBP and explore the culture and readiness among pediatric nurses for system-wide integration of EBP.This study was a quantitative, cross-sectional survey-based study conducted at a large pediatric health system.Overall pediatric nurses had a mean score of 61.78 ± 9.32 on the EBPB (n = 396). Results of the EBPB Scale and OCRSIEP showed no statistical difference between nursing roles EBPB scores; however, nursing leaders had higher scores than any other nursing role. The OCRSIEP had a mean score of 84.98 ± 19.53 (n = 388).Findings suggest that pediatric nurses believe that EBP results in the best clinical care for patients and can improve clinical care, but they lack the skills and time necessary to engage in the process. This study found that increasing awareness of EBP resources and developing EBP competencies may assist pediatric nurse leaders with EBP integration into daily practice.Increasing visibility and competencies of EBP may positively impact organizational readiness by increasing confidence needed to remove identified barriers and engrain EBP in the organization's culture.

Background There is a growing number of pediatric procedures requiring sedation outside the operating room. Among these are auditory brainstem response (ABR) tests, the gold standard for objective hearing evaluation in infants and toddlers. Recently, a nurse-led pediatric sedation service based on a structured protocol has been developed for ABR testing. Objectives To retrospectively analyze the safety and efficacy of the pediatric nurse-led sedation protocol (PNLSP) in a tertiary medical center using Chloral Hydrate (CH) in children undergoing ABR testing. Methods Data from medical charts of children who underwent sedation for ABR testing between January 2014 and December 2017, were retrieved. Analysis of sedation success/failure rates, sleep induction time (SIT), sleep duration time (SDT), and adverse events (AE), was performed. Findings 1348 children with a mean age of 13.4 months (range 3–42 months), classified by the American Society of Anesthesiologists Physical Status Classification System (ASA score) 1–3, were included in the analysis. All children received a fixed dose of 75 mg / kg CH orally or rectally. Sedation success rate was 98.7% and enabled completion of ABR testing. Failure to sedate was evident in 17 children (1.3%), all classified as ASA score 1–2. Median SIT and SDT were 25 and 100 min, respectively. Mild AE occurred in 9 children (0.67%), none of which required further intervention. Conclusions Findings support the use of a structured PNLSP using CH as safe and efficient. The suggested protocol is an effective alternative for general anesthesia (GA) for ABR testing in healthy young children.

Patient fall-risk awareness, self-efficacy, and engagement in fall-prevention activities are important aspects of fall-prevention. The current pilot study examined the effect of a nurse-led multimodal intervention on hospitalized adults' levels of fall risk awareness, self-efficacy, and engagement in fall prevention. Sixty hospitalized older adults in an acute care setting in Florida participated in the study. There were significant differences [pre-test (M = 19.02, SD=1.152) and post-test (M = 21.71, SD=0.527); t (17.355) = 58, p≤.001] on level of fall risk awareness in fall prevention. There were no significant findings for fall self-efficacy and engagement. Study findings suggested that the higher the fall self-efficacy, the higher the engagement. Future research is needed to examine self-efficacy and engagement for fall prevention in larger diverse cohorts of hospitalized older adults.

Background Internationally, nurses are gaining recognition for their contributions to public health and global health initiatives, however, their contributions to surveillance and the detection of new and emerging infectious disease, which is an important element of global health security, remain largely unknown. Purpose The purpose of this study was to investigate the perceptions of nurse experts related to the current and optimal roles of nurses in surveillance of new and emerging infectious diseases. Additionally, this study aimed to identify the skills needed by nurses in all practice settings for optimal performance of surveillance and to identify barriers to achieving optimal performance of surveillance. Methods A three-round Delphi study was conducted. Nurse experts participated in Round 1 interviews followed by ranking current and optimal role, skill, and barrier statements in Rounds 2 and 3. Findings Findings revealed four current roles and 13 optimal roles for nurses in surveillance, 13 skills needed to perform surveillance activities, and seven barriers to optimal performance of surveillance activities by nurses. Disucssion Results of this study are intended to inform nursing practice and education in the U.S., and to provide guidance on the role of nurses in surveillance of new and emerging infectious disease as part of the Global Health Security Agenda.

Background Individuals who self-harm may present to emergency departments (EDs) for medical care. As first responders, emergency nurses can have a significant impact on the health outcomes of people who self-harm. This research explored emergency nurses' experiences of working with patients who self-harm. Methods Data were collected using semi-structured interviews and analysed using Elo and Kyngas' inductive content analysis. Researcher checks ensured consensus of identified categories. Adherence to the research method and inclusion of participant citations added to the trustworthiness of findings. Results Eighteen emergency nurses from across Australia participated in the research. The category "Nurses' level of preparedness to work with people who self-harm" emerged during data analysis with four sub-categories: (1) Nurses' level of comfort to work with people who self-harm; (2) Nursing role; (3) Barriers and facilitators to providing quality care; and (4) Education and training. Conclusions The ED is a challenging environment to provide care to people who present with self-harm. Nurses' level of comfort and attitudes towards caring for people who self-harm improved with knowledge, support and experience. Education and training in the area were important.

Objective To describe the experience of nurses who support parents during perinatal death, particularly how perinatal death influences the nurse, how the nurse feels when caring for a suffering parent, and how the perinatal death contributes to the nurse’s understanding of self. Design Descriptive qualitative. Setting Four regions of Quebec, Canada. Participants Twenty-five nurses from different perinatal clinical and community backgrounds who worked with parents who experienced perinatal death. Methods We conducted individual, semistructured interviews during which the participants were given the opportunity to describe what they felt and experienced when they supported parents who experienced perinatal death. Results Analysis of the data showed three main themes related to the nurse’s experience of perinatal death: Unrealistic Self-Expectations, Self-Denial, and Negative Self-Awareness. Conclusion Our results suggest that during perinatal death, nurses want to feel useful and to relieve the suffering of parents. A clear understanding of this experience can help nurses to better understand their own experiences.

Objective The present study aimed to verify the feasibility and preliminary effects of nurse-led square dancing designed to improve older adults’ cognitive function and depressive symptoms who with MCI. Methods A quasi-experimental pilot study design was adopted for the present study. Screening for cognitive function was conducted among older adults (≥ 60 years old) living in two communities in Beijing who complained of memory loss. A total of 107 older patients with MCI and depressive symptoms were diagnosed after obtaining informed consent. Thirty-five patients selected from each community were included in the study as control and intervention groups, respectively. The two groups of patients received health education while the intervention group participated in a square dance intervention program led by nurses three times per week for 60 min per session over a period of three months. The Montreal Cognitive Assessment-Peking version (MoCA-P) and Geriatric Depression Scale (GDS-30) were used to assess the cognitive function and depressive symptoms of patients in the two groups at three time intervals; before intervention, at the end of the three-month intervention period, and over a three-month follow-up period after the end of intervention. Results Feasibility of the intervention was established with a high completion rate of 90%. Data collection for 63 out of 70 patients enrolled for the study was completed after six months. MoCA-P and GDS-30 scores of the intervention group were significantly different after the intervention when compared with the control group. A significant improvement in cognition was observed in the intervention group, and depressive symptoms decreased after intervention and follow-up when compared with the control group. During the intervention and follow-up phases, the MoCA-P score of the intervention group increased gradually with time. Furthermore, the MoCA-P and GDS-30 scores of the control group remained unchanged. Conclusion This study has revealed that square dance intervention exerts a positive impact on cognitive function and depressive symptoms among older patients suffering from MCI and depressive symptoms. The results of this study support the feasibility and preliminary effects of square dancing on relieving cognitive decline and depressive symptoms. Square dancing is a recommended type of intervention that can be applied to the local Chinese population because of its simplicity, convenience, and suitability for the older adults.

Background Community-based nurse-led interventions have the potential to impact admission rates in Heart Failure (HF) patients. No reviews have focused on identifying the best combination or duration of interventions to reduced hospital admissions. Objective To assess the impact of nurse-led community-based interventions on hospital admission rates in HF patients. Methods This study was conducted following Whittmore and Knafl's Methodology. CINAHL, PubMed, Embase and Web of Science and hand searching were used to identify articles. Selected studies were analyzed using the Matrix Method. Results Telemonitoring, home visits, phone calls, care coordination, and telemedicine were identified as interventions in 10 studies. Telemonitoring with phone calls or care coordination was not impactful. Studies with significant results included those with multiple interventions, APN-led, or conducted over one year. Conclusions The combination of intervention type and length are important factors when designing interventions for HF management. More research is needed on intervention length.

Background The COVID-19 pandemic has highlighted the need for nurse leaders who “embrace the interconnection” between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. Yet, despite a clear need for improved population health, educational programs designed to produce Advanced Public Health Nurses, with skills to address complex system changes, have become increasingly scarce. Purpose We put forward the perspective that the nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health. Discussion We argue that opportunities should be expanded for nurses to attain education for these roles through increased investments in the Doctor of Nursing Practice model to prepare nurses for advanced public health specialty practice.

Background Education is the most essential component for effective asthma control and is endorsed by guidelines worldwide. However, multiple caregivers are often jointly involved in child care, and educating them is often a challenging task. This study determines the effectiveness of a web-based asthma education program in enhancing knowledge, attitude and practice of caregivers and reducing unscheduled hospital visits of children for asthma. Methods A two-arm, randomized controlled trial was carried out between November 2018 and December 2019. Child-parent dyads were recruited when the children (4–11 years of age) were admitted due to asthma exacerbations. A nurse-led web-based home asthma education program was developed and implemented before discharge. Outcomes included parents' knowledge, attitude and practice regarding asthma and frequency of unscheduled visits and readmissions in children. Results 112 child-parent dyads were enrolled. The parents' knowledge, attitude and practice and the number of unscheduled visits of the children were found to be significantly different between two groups at different time points (Ps 0.8). Conclusion This intervention was shown to be an effective strategy to educate caregivers who are jointly involved in their child's asthma control after discharge from hospital. Trial registration The Chinese Clinical Trial Registry, World Health Organization (ChiCTR1800019706).

Background To shape priorities for health and health care outcomes, it is essential for nurse leaders to be influential. The application and impact of influence are readily recognized, but not its characteristics. Purpose The purpose of this project was to conduct a concept analysis of influence relative to nurse leaders. Methods The Walker and Avant method of concept analysis was utilized. Findings Attributes of influence include advocacy, communications skills, competency, confidence, credibility, and engagement. Antecedents of influence are authority, collaboration, integrity, and mentorship. Consequences of influence are action, change, commitment, compliance, decision-making, motivation, and resistance. Discussion By drawing upon a systematic understanding of the concept of influence, nurse leaders are urged to develop and leverage the attributes of influence to drive and achieve collective good for the future of health and health care in society.

Background Healthy work environment is essential to patients’ safety, staff recruitment, retention, and organization's financial viability. It is imperative to examine, understand and mitigate any and all factors that may contribute to unhealthy work environment. Purpose This study aimed to describe how African-born Black nurses felt their race affected their experience of the work environment and whether these experiences contributed to perceptions of unhealthy work environments. Method Thematic analysis was performed on data obtained from unstructured interviews of 17 African born Black nurses in this qualitative descriptive study. Findings Seven themes emerged from the study: disregard for personhood, poor communication, democratic disqualification, lack of recognition, missing authentic leadership, attrition, and finding control. Discussion The finding suggests African born Black nurses’ experiences are uniquely and qualitatively different from that of their American born counterparts. Creating healthy work environment require authentic nurse leaders who can influence and support others in its achievement.

Objectives The objective of the study was to compare nurse-led sedation protocols with physician-led usual care in intensive care units (ICUs) in treating mechanically ventilated adult patients. Review method used This is a systematic review and meta-analysis. Data sources PubMed, Cochrane Library, EMBASE, CINAHL, China National Knowledge Infrastructure, and China Wanfang databases were interrogated for articles published before May 2020. Review method As per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, eight randomised controlled trials (RCTs) and six preintervention and postintervention studies published in English and Chinese met the inclusion criteria for the meta-analysis. Two reviewers independently extracted data into a tabular format using predefined data fields. Disagreements were resolved by consensus. The quality of the included RCTs and preintervention and postintervention studies was assessed using the Cochrane Quality Assessment Tool and Risk Of Bias In Non-randomised Studies of Interventions assessment tool. Results Eight RCTs were of intermediate methodological quality, and six preintervention and postintervention studies exhibited a low to moderate risk of bias. Compared with usual care, nurse-led sedation protocols resulted in significantly decreased durations of mechanical ventilation (days) (standardised mean difference = −1.765; 95% confidence interval [CI] = −2.461, −1.068); P Conclusions Although pre–post intervention study design cannot establish causality, the present findings raise the considerable possibility that a sedation protocol can be safely implemented by nurses to reduce mortality in ICUs and sedation-related adverse events in patients on mechanical ventilation compared with physician-led usual care.

Our professional responsibility as nurses is to enact social justice by changing oppressive structures. However, this may be difficult with competing perspectives in healthcare environments. Deconstructing our identity is foundational if we are to understand how to develop professional relationships with peers to move forward as a collective to enact social justice. A paradigm shift, from one world view to multiplicity, will help us develop insight into our own identities and professional relationships to sustain morally habitable workplaces.

Background A literature review was conducted to assess nurse-led nonpharmacologic pain management interventions intended for total knee/hip replacement patients. Design This was a systematic review and meta-analysis. Data Sources The PubMed, Embase, CINAHL, and Cochrane Library databases were searched to identify relevant studies. Review Methods The systematic review was conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and all Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guidelines. Two reviewers independently selected the studies and appraised their quality. Thereafter, the effects of all described nurse-led nonpharmacologic pain management interventions were estimated regarding pain, anxiety, and satisfaction through a meta-analysis. Results In total, 219 relevant studies were found through a search. Finally, 23 studies were selected for review, with 17 included in the meta-analysis. Nurse-led nonpharmacologic pain management was effective for pain relief (effect size, −0.22; 95% confidence interval [CI], −0.42 to −0.02), and educational interventions were especially effective (effect size, −0.36; 95% CI, −0.69 to −0.03). Although interventions reduced anxiety and improved satisfaction, these results were not statistically significant based on the analysis. Conclusion Our findings support that nurse-led nonpharmacologic pain management interventions could help reduce pain in patients with total knee/hip replacement by supplementing pharmacologic pain management. Implications for Nursing Nurse-led nonpharmacologic pain interventions should be considered to reduce patient pain with total knee/hip replacement.

Background Nurse-driven discharge pathways following pediatric appendectomies have proven effective in children’s hospitals; studies in general hospital settings are lacking. Additionally, despite the central role of nursing in such pathways, nursing perspectives aren’t investigated in the literature. Methods Data from all pediatric acute uncomplicated appendicitis patients who underwent laparoscopic appendectomy in the 12 months following institution of a nurse-driven discharge pathway (intervention, n = 67) were compared to those treated in the preceding year (control, n = 64). Surveys on the pathway were distributed to pediatric ward nurses. Results Postoperative length of stay (POLOS) decreased by 37% in the intervention group, about 6 h, (0.44 days ± 0.22 vs 0.7 days ± 0.27, p-value 0.0001), without a significant increase in related readmissions. Same day discharges increased from 10.9% to 46.3%, (P-value 0.0001). Nurse surveys revealed a high approval of the pathway (7–10/10) and yielded valuable feedback. Conclusion A nurse-driven discharge pathway decreased POLOS without increasing readmission following pediatric laparoscopic appendectomy in a general hospital setting. Valuable insight into nursing perspectives on this pathway was acquired.

Transcutaneous pacing is commonly performed in emergency departments to treat patients with cardiac dysrhythmias. Although emergency nurses are required to complete a standardized course that reviews components of transcutaneous pacing, such as Advanced Cardiac Life Support, performing transcutaneous pacing on patients may be done infrequently in some facilities and can lead to anxiety and fear for bedside emergency nurses, especially novice emergency nurses and nurses who infrequently care for patients requiring external pacing. This manuscript provides a practical guide for emergency nurses to care for patients who require transcutaneous pacing. Key information found in this manuscript includes indications for transcutaneous pacing, the nurse's role when performing transcutaneous pacing, and transcutaneous pacing troubleshooting information.

Aim To describe the state of the professionalisation of midwifery in Belgium, and to formulate recommendations for advancing the midwifery profession. Methods A descriptive overview of maternity care in Belgium and the professionalisation of midwifery through an analysis of relevant policy and academic texts, underpinned by Greenwood’s sociological criteria for a profession: (1) own body of knowledge, (2) recognised authority, (3) broader community sanctions, (4) own code of ethics and (5) professional culture sustained by formal professional associations. From these insights, recommendations for advancing the midwifery profession in Belgium are formulated. Findings Current strengths of the professionalisation of midwifery in Belgium included unified midwifery education programmes, progress in midwifery research and overarching national documents for guiding midwifery education, practice and regulation. In contrast however challenges, such as the limited recognition of midwives’ roles by its clientele, limitations of midwives’ competencies and autonomy, lacking development of advanced roles in maternity care practice and a lack of unity of the organisation and its members, were also identified. Based on these, recommendations are made to strengthen Belgian midwifery. Conclusions Recommendations for advancing the midwifery profession in Belgium includes in particular increasing public awareness of midwives’ roles and competencies, implementing the full scope of midwifery practice and monitoring and advancing this practice. Thus, professional autonomy over both midwifery practice and working conditions should be enhanced. United midwifery organisations, together with women’s groups, other maternity care professionals and policy-makers as equal partners are key to bring about changes in the Belgian maternity care landscape.

Women in the period of emerging adulthood (18–25 years of age) have the greatest rates of unintended pregnancy and sexually transmitted infections. Despite this disproportionate risk, women’s sexual and reproductive health needs during emerging adulthood are poorly understood. As a result, few age-specific policies or person-centered practice guidelines are available to reduce sexual risk. In this commentary we explore the unique characteristics of emerging adulthood that contribute to greater sexual and reproductive health risks for women. Current evidence on sexual and reproductive health outcomes of women during emerging adulthood and limited practice guidelines are discussed. Recommendations for health care providers, especially nurses, for guiding personalized care for women in emerging adulthood are discussed.

Problem No South Australian study has previously investigated the role of midwives in the promotion and provision of antenatal influenza immunisation. Background Influenza acquired in pregnancy can have serious sequalae for both mother and foetus. Recent studies have demonstrated that influenza vaccine in pregnancy is both safe and effective. Despite this, evidence suggests that vaccine uptake in pregnancy is suboptimal in both Australia and worldwide. Aim The aim of this study was to investigate the role of midwives in the promotion and provision of antenatal influenza vaccine and, to provide a statistical and thematic description of the barriers and enablers midwives encounter. Methods This mixed method study incorporated a cross sectional on-line survey and in-depth interviews conducted with midwives, employed in urban and regional South Australia. Findings Quantitative data were available for 137 midwives and 10 midwives participated in the interviews. Recruitment for the interview phase was through the last question on the survey. Whilst all midwives indicated that education and vaccine promotion were part of their role, immunisation knowledge varied between Registered Nurse/Midwives (RM/RN) 80% and Registered Midwives (RM) 48.90% (p = 0.001). Quantitative data showed that only 43% of midwives felt sufficiently educated to provide the vaccine. Midwives who had received formal immunisation training were more likely to recommend the vaccine 93.7% (p = 0.001). Qualitative data confirmed these results and identified the lack of immunisation education as a barrier to practise. Conclusion Midwives identified an immunisation knowledge deficit. Midwives who had received immunisation education were more likely to actively promote and provide the vaccine to pregnant women. These findings indicate the need for more immunisation education of midwives in both tertiary and practice settings.

The “nurse-led” oral and maxillofacial (OMFS) head and neck (H&N) clinic has been introduced and developed over the last decade, and we are now close to a point that this endeavour can potentially be implemented nationwide. This paper is a systematic review of the proposed OMFS H&N nurse-led clinic model. Literature on the topic is limited: only eight eligible papers were identified and reviewed. These were appraised focusing on four domains: requirement/necessity, true cost, patient safety and outcomes, and education and training. Most of the advantages/proposed benefits of these clinics have previously been discussed. This current review has revealed that the available published evidence on the concept of OMFS H&N nurse-led clinics demonstrates that they might not be necessary. The alleged cost savings have not been described in detail and might not be as significant as expected, more intense collaboration is required to establish watertight quality assurance processes concerning patient safety, and the clinics might have an impact on the education and training of OMFS trainees. The nurse-led clinic concept is interesting and exciting, but more discussion and planning is needed prior to it being launched nationwide.

Background Student nurses are expected to implement a caring practice in order to become professional nurses. Caring has remained the art and science of nursing, which student nurses learn from professional nurses during clinical practice. The South African Nursing Council mandates professional nurses to teach and supervise student nurses to master the art of caring during clinical practice. Caring is taught through role-modelling of daily nursing activities. Research purpose This study was performed to gain an understanding of South African student nurses' experiences of professional nurses' role-modelling of caring. Methods Phenomenological, qualitative research. Purposive sampling of fourth-year student nurses. Data collection: focus groups, observations and field notes. The data were analysed using Giorgi's modified Husserlian five-step method. Ethical principles were respected. Results Three themes were identified. Theme 1: inconsistency in the clinical environment; Theme 2: effective and ineffective role-modelling of caring and Theme 3: carelessness cascading. Conclusions The study facilitated an understanding of student nurses' experiences of professional nurses' role-modelling of caring. Recommendations to facilitate professional nurses' role-modelling of caring in a public hospital were formulated: Mentorship training, recognition system for professional nurses, clinical support for student nurses, open channels of communication, random nurse leader rounds, employee wellness program, workshops and positive learning environment promotion.

Objective The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for nursing homes, where staff have faced rapidly evolving circumstances to care for a vulnerable resident population. Our objective was to document the experiences of these front-line health care professionals during the pandemic. Design Electronic survey of long-term care staff. This report summarizes qualitative data from open-ended questions for the subset of respondents working in nursing homes. Setting and Participants A total of 152 nursing home staff from 32 states, including direct-care staff and administrators. Methods From May 11 through June 4, 2020, we used social media and professional networks to disseminate an electronic survey with closed- and open-ended questions to a convenience sample of long-term care staff. Four investigators identified themes from qualitative responses for staff working in nursing homes. Results Respondents described ongoing constraints on testing and continued reliance on crisis standards for extended use and reuse of personal protective equipment. Administrators discussed the burden of tracking and implementing sometimes confusing or contradictory guidance from numerous agencies. Direct-care staff expressed fears of infecting themselves and their families, and expressed sincere empathy and concern for their residents. They described experiencing burnout due to increased workloads, staffing shortages, and the emotional burden of caring for residents facing significant isolation, illness, and death. Respondents cited the presence or lack of organizational communication and teamwork as important factors influencing their ability to work under challenging circumstances. They also described the demoralizing impact of negative media coverage of nursing homes, contrasting this with the heroic public recognition given to hospital staff. Conclusions and Implications Nursing home staff described working under complex and stressful circumstances during the COVID-19 pandemic. These challenges have added significant burden to an already strained and vulnerable workforce and are likely to contribute to increased burnout, turnover, and staff shortages in the long term.

Background Clinical leadership is fundamental to patient safety. The Emergency Department (ED) nurse-in-charge is a key leadership role; however, few studies have explored the management of clinical deterioration from the ED nurse-in-charge perspective. The aim of this study was to explore ED nurses-in-charge’ perceptions of their role in responding to episodes of escalation of care for clinical deterioration of ED patients. Methods A prospective exploratory descriptive design was used to address the study aims. The study was conducted in an urban ED in Melbourne, Australia. Senior emergency nurses who fulfilled the role of being in charge of the ED were invited to participate. In-depth semi-structured interviews were conducted between December 2015 and March 2016. Interview transcripts were analysed using thematic analysis. Results Two major themes, each with two subthemes were identified. The first major theme of Clinical Risk Management comprised sub-themes of Clinical Skills and Confidence. The second major theme of Resource Management comprised sub-themes of Human Resource Management and Logistical Resource Management. Conclusions Strong collaboration, logistical and clinical risk management roles were perceived as fundamental to the nurse-in-charge's capacity to respond to escalations of care for clinical deterioration within in a complex team environment such as the ED.

Presence and therapeutic listening are complementary therapies that are incorporated into daily nursing practice. This article presents the nurse's role in facilitating complementary therapies of presence and therapeutic listening, barriers encountered, and the behaviors and techniques to be used. Also discussed is the impact that using presence and therapeutic listening has on patient outcomes. These interventions have the potential to significantly alter patients' perceptions of care and improve patient outcomes. Presence and therapeutic listening are vital to developing a therapeutic nurse-patient relationship. This relationship is what drives positive patient outcomes and increases overall satisfaction and quality of care.

Violence against women is a major public health issue and women with mental illness (WMI) are at a double disadvantage. While nurses play a key role in identifying and responding to abused women, research is limited on this issue from India. This qualitative study was aimed to explore nurses' knowledge, confidence, and learning needs in the identification and responding to disclosure of abuse in women with mental illness. The focus group discussions were conducted among nurses (N = 21) working in psychiatry units at a tertiary care center. An interview guide with semi-structured questions was used to collect the data. Five dominant themes and fifteen sub-themes have emerged from qualitative analysis. The dominant themes include; Awareness of abuse among women with mental illness (AWMI), Experiences of recognizing and responding to abuse, Barriers for routine screening for abuse, Educational preparedness, and learning needs, and Prevention of abuse in women with mental illness. The identified barriers include personal related (personal discomfort, lack of knowledge, etc.), job related (Time consuming, not a nurse's job, lack of time, etc.) and organizational (lack of policies and administrative support, etc.). Most of the participants expressed that they lack confidence in the routine screening of women for abuse due to inadequate training. Therefore, it is critical to include a topic on domestic violence in the nursing curriculum and provide ongoing learning opportunities to the nurses through CNE programs, workshops, and conferences.

Background Patients requiring vascular surgery have turned in older subjects with several comorbidities with frailty problems and increased vulnerability. Treating this kind of patients has become an important challenge both for vascular surgeons and for dedicated nurses, as these patients are more susceptible to postoperative complications and during discharge. The aim of this review is to analyze the role of vascular nurse in vascular surgery activities. Methods For this study, Medline, ScienceDirect, and Scopus databases were searched. The following keywords were used: nursing and vascular surgery, nursing and vascular disease, nursing and vascular procedure, and care and vascular patient. Results From the search strategy, the following areas were identified as relevant and analyzed in detail: vascular disease related to vascular surgery, the definition of vascular nursing, the role of vascular nursing in implementing clinical pathways in vascular surgery procedures, nursing postoperative care in vascular surgery, frailty assessment in vascular patient, nursing in phlebology and wound care, and the management of vascular access. Conclusions Vascular nursing is a discipline that is able to provide comprehensive and optimal care, better postoperative outcomes, and coordinated, standardized, and cost-effective clinical pathways for patients managed in the area of vascular surgery.

Critical care nurses frequently provide end-of-life and bereavement care. This type of care is rewarding, but can put nurses at risk for moral distress, compassion fatigue, and burnout. By incorporating self-care into their routine, critical care nurses minimize this risk and maintain their own health and well-being. This article provides suggestions for promoting physical, emotional, and spiritual self-care for nurses caring for dying intensive care unit patients and their families. A case scenario illustrates the importance of this concept. Practical examples of self-care are highlighted along with discussion on how leadership can support self-care and maintain a healthy work environment.

Background Delirium is an acute disorder of attention and cognition with the highest rates among adults receiving intensive care. An acute episode of delirium is associated with morbidity and mortality, as well as a significant psychological sequela. Importantly, an increasing body of evidence supports the benefit of nonpharmacological, nurse-led interventions to reduce the incidence and duration of delirium among adults cared for in the intensive care unit (ICU). Objectives This study will evaluate the impact of a nursing-led delirium prevention protocol that is aimed at reducing the incidence and duration of delirium among adults admitted to the ICU. The delirium prevention nursing protocol specifically targets risk factors for delirium. Study plan A stepped-wedge cluster randomised controlled trial approach will be used to assess the effectiveness of the nurse-led intervention, in four adult ICUs across the South Western Sydney Local Health District (SWS-LHD), over a 12-month period. The primary outcomes of interest are (i) the incidence of delirium before and after the implementation of the nurse-led intervention and (ii) the number of delirium-free days during an ICU stay, before and after the implementation of the nurse-led intervention. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): (ACTRN12618000411246p)

Unplanned readmission rates in necrotizing pancreatitis (NP) are among the highest of any medical disease (72%). Recent work has identified several potentially preventable causes of unplanned readmission in NP. We hypothesized that intensive outpatient communication would identify developing problems and decrease unplanned hospital readmission.A review of NP patients treated at a single institution between 2016 and 2019 compared patients 2 y before (NP-pre, 2016-2018) and 1 y after (NP-post, 2018-2019) the establishment of a dedicated pancreatitis nurse coordinator. Unplanned hospital readmission and emergency room visits were compared between groups.A total of 178 NP patients were treated-112 patients in the NP-pre group and 66 patients in the NP-post group. No differences between groups were observed in age, sex, comorbidities, pancreatitis etiology, NP severity, or mortality. A mean of 5.4 ± 0.2 outpatient communications per patient with the pancreatitis nurse coordinator was documented in the NP-post group. Unplanned readmission rates decreased significantly from 64% (NP-pre) to 45% (NP-post; P = 0.02). The frequency of readmission decreased from 1.6 readmissions per patient (NP-pre) to 0.8 readmissions per patient (NP-post; P = 0.001). Readmissions because of symptomatic necrosis, failure to thrive, nonnecrosis infection, and drain dysfunction decreased (P 0.05). Overall disease duration was similar (NP-pre, 4.6 ± 0.3 mo; NP-post, 5.0 ± 0.3 mo; P = 0.4); however, the mean number of unplanned inpatient days decreased from 15.4 ± 2.2 d (NP-pre) to 7.8 ± 1.6 d (NP-post; P = 0.02).Improved outpatient communication identifies treatable problems and significantly decreases unplanned readmission in NP patients.

Today, nurse leadership positions are more and more common. However, there have been many exemplary Nurse Leaders in the past whose contributions and sacrifices enabled nursing to transform to the leadership position it is today but have not been documented. It is important to recover and record this history so that future generations of nurses can learn from past examples in a way they cannot learn with current nursing education alone. This article examines the development of the professional nurse through the lens of the service of Brigadier General Sue Ellen Turner. The oral history method guided the exploration of memories and experiences. The recurring characteristics of discernment, reflection, and ability to break barriers/build relationships contributed most to the general's success in restructuring organizational systems to optimize leadership opportunities for nurses. The conclusion discusses the lasting impact and future implications of Turner's work on the profession of nursing.

Nurses have historically led efforts to improve the health of populations while simultaneously and unselfishly providing care during pivotal moments of national need. The COVID-19 pandemic has placed an unprecedented strain on the US health care system, including severe shortages of hospital beds, supplies, equipment, pharmaceuticals, and healthy frontline clinicians. Perioperative and perianesthesia leaders and clinicians have unique opportunities to provide patient care during the COVID-19 crisis. In this manuscript, we describe the initial changing roles and contributions of perioperative and perianesthesia registered nurses during the COVID-19 pandemic and share recent experiences from a military medical center. Perioperative and perianesthesia nurses are vital to the overall nursing viability of the health care system, as they possess the requisite knowledge and skills to provide expert clinical care in many hospital settings and meet the demands of a global pandemic.

Purpose The purpose of this project was to describe differences in the numbers of children with a diagnosis of asthma identified through two methods, determine barriers to receiving asthma interventions in elementary school settings, and make recommendations for action and advocacy for school nurses to increase the number of children with access to asthma medications at school. Design and methods The authors conducted a review of the asthma diagnosis process from the initial identification of a diagnosis to the delivery of interventions with 349 enrolled students in one large, urban public school in Tennessee. Results Sixty children were identified using the school's existing parent identification process and 91 children who participated in a concurrent asthma education program self-identified or were referred by a teacher, staff, or administrator. Only seven students identified through the combined methods had access to asthma medication (albuterol) at school. Conclusion Missing asthma action plans, medication forms and inhalers emerged as major barriers to intervention even when a child's diagnosis is documented. Practice implications The Asthma School Readiness Process (ASRP) was developed, which describes recommendations for nurses in school and community settings to promote safety and access to asthma medication in schools.

Nursing research involves much planning and attention to details, yet novice and seasoned nurse researchers often overlook the day-to-day operations required to conduct research studies. Project management is a set of iterative steps that can facilitate the process of conducting nursing research. In this paper we aim to provide an overview of project management and identify ways in which its specific principles and strategies may be applied to facilitate nursing research. Here we give an overview of our current longitudinal study using a Solomon four-group design and illustrate how we applied strategies and tools from the project management literature. In addition, we offer descriptions and illustrations of several other project management tools that could have been used in specific phases of this research project. We encourage nurse educators and researchers to familiarize themselves with the principles of project management and consider using them in future studies.

Undergraduate nursing students have difficulty comprehending the relevance of research to their future as nurses. Working as an undergraduate research assistant may provide opportunities to develop an appreciation of research. The purpose of this study was to explore former undergraduate research assistants' perceptions of their experience and its effects on their practice as professional nurses. This study used a qualitative descriptive design. Seven former undergraduate research assistants were interviewed. Interview transcripts were analyzed for themes using content analysis. Data analysis yielded three main themes: immersion in the research process, empowered to practice evidence-based nursing, and future nurse scientists and educators. Immersion in the research process increased participants' understanding of research and its importance to nursing practice. This experience facilitated acquisition of skills they used in their current clinical settings to practice evidence-based nursing. Close relationships with a faculty mentor and exposure to a community of nurse scientists at a regional research conference inspired some to consider a future as nurse scientists and educators. An undergraduate research assistant program may be an effective approach to preparing baccalaureate nursing students for clinical practice and for graduate education. Positive experiences with conducting research are essential to nurturing the next generation of nurse scientists and educators.

Purpose The objective of this study was to identify the characteristics and tasks vital for individuals to successfully navigate a proactive rapid response role at a quaternary children's hospital. Design and methods A qualitative thematic analysis of open-ended interviews was utilized to define the essential characteristics and functions of a WATCh (Watch, Assess, Triage for Children) nurse. The sample included both WATCh nurses and other healthcare providers that work with WATCh nurses. Results Effective WATCh nurses are excellent communicators with advanced skills who are experienced, confident, and visible. They work as an extension of the nurse and as a care facilitator for high-risk children, advocate, and educator. Conclusions A more proactive approach is essential for successful pediatric rapid response teams in hospital settings to prevent patient decompensation and code blue events. This study has identified that a successful program requires defined tasks and essential role characteristics. Practice implications Implications for integration into practice include a defined selection process and training program for the WATCh nurse role to provide standardization and consistency. Experience was identified as an essential characteristic for the role but an exact amount was not defined. Strong communication skills are also necessary and while training can help supplement the characteristic, a certain level of personality and confidence should be identified in potential candidates. Training will need to include not only practice skills, but also personal skills to be an effective role in the institution.

Background The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded on October 1, 2018, to enhance cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic arteriopathy has been selected as the very first topic to be investigated by the federation. Methods MeFAVS members were asked to reply to a questionnaire on the management of diabetic ischemic foot. Results were collected and analyzed statistically. The questionnaire consisted of 15 multiple choice answers regarding diabetic foot (DF) diagnosis and treatment. The questionnaire was submitted to 21 centers on April 20, 2019. Results Response rate was 62%. The survey revealed that vascular surgeons, diabetologists, and wound care nurses made-up the core of the diabetic teams present in 76.9%, 69.3%, and 92.3% of the centers, respectively. Diabetic teams were most often led by vascular surgeons (53.8%) and diabetologists (42.2%), but only in 7.9% of cases by nurses. Duplex ultrasonography and computed tomographic angiography were the most commonly available tools used to assess diabetic peripheral arterial disease (PAD). Surgical wound care was undertaken by vascular surgeons in the majority of cases, and only in 46.2% of the cases to orthopedic or plastic surgeons, while nonsurgical wound care was handled by specialized nurses (76.6%) and diabetologists (53.8%). First-line revascularization was preferred over conservative treatment (61.5% vs 53.8%) and endovascular strategy (45.3%) over open (33.7%) or hybrid (21.0%) surgery. Vascular surgeons and interventional radiologists were found to be the most common performers of endovascular revascularization (92.3% and 53.8%, respectively). Amputations had an overall rate of 16.6% (range 4–30%) and a mean reintervention rate of 22.5%, and were usually performed by vascular surgeons for both minor and major interventions (84.6%) followed by orthopedic surgeons (15.4% minor and 30.8% major). The availability of a DF clinic (84.6%) and endovascular (53.8%) and open surgery (46.2%) capabilities were considered fundamental to reduce amputation rates. Conclusions Especially since the introduction and spreading of new endovascular techniques for the treatment of DF, it is a common consensus amongst vascular surgeons that a standardized approach to the discipline is necessary in order to improve outcomes such as amputation-free survival and mortality and it is with this perspective and purpose that transnational cooperation amongst vascular professionals and residents in training are aiming for greater proficiency in endovascular and open surgery.