BACKGROUND: There are currently unprecedented threats to the nursing workforce, including burnout and stress, which contribute to low job satisfaction, inadequate staffing, and decreasing retention rates. Virtual nursing...BACKGROUND: There are currently unprecedented threats to the nursing workforce, including burnout and stress, which contribute to low job satisfaction, inadequate staffing, and decreasing retention rates. Virtual nursing is a possible solution to address many of these issues. Although this is a well-established staffing model in the ICU, it is newer to other hospital-based settings, and there are no current best practices for implementing virtual nursing in the non-ICU setting. PURPOSE: The purpose of this integrative review was to address the following question: What are best practices for implementing virtual nursing in the inpatient, non-ICU setting? METHODS: An evidence-based practice team at The Johns Hopkins Health System in Baltimore, Maryland, performed a systematic review of the available research and nonresearch literature, guided by the Johns Hopkins Evidence-Based Practice model. Reviewers searched PubMed, CINAHL, Embase, and Cochrane using search terms related to "virtual nursing" and "inpatient." All evidence underwent an independent screening and appraisal process to generate a synthesis of existing information and create best-evidence recommendations. RESULTS: The initial search yielded 327 unique records, six of which were included in the final review (one quasi-experimental study and five quality improvement projects). The evidence was limited but provided some guidance on the scope and skills of the virtual nurse, such as concrete clinical skills and soft skills (such as communication and interpersonal skills); the needs of the bedside nurse and patients, such as education and communication norms; and operational concerns for leadership and other health care providers, such as creating standardized workflows and establishing metrics for success. CONCLUSIONS: Despite the growing prevalence of virtual nursing, there is limited information on its use in the non-ICU hospital setting. Although there is some evidence to inform the skills and scope of the virtual nurse, the impact of virtual nursing on the bedside nurse, patient priorities, leadership implications, and considerations for all staff, more information is needed. Rigorous implementation science research should be conducted in parallel with the development of virtual nursing programs to contribute to the state of the evidence and provide much-needed guidance on this quickly developing technology.
BACKGROUND: Continuous video monitoring programs have been found to reduce inpatient falls and 1:1 sitter use in the short-term acute care hospital setting. But the impact and potential benefits of such programs in the l...BACKGROUND: Continuous video monitoring programs have been found to reduce inpatient falls and 1:1 sitter use in the short-term acute care hospital setting. But the impact and potential benefits of such programs in the long-term acute care hospital (LTACH) setting are still unknown. PURPOSE: The goal of this study was to track the implementation of a continuous video monitoring program in an LTACH setting and evaluate its impact on inpatient falls and 1:1 sitter use, as well as on associated costs. METHODS: A prospective observational cohort study design was used. Prospective data were collected from patients who were admitted to an LTACH in the northeastern United States and subsequently enrolled in a continuous video monitoring program during the 20-month period of February 1, 2021, through September 30, 2022. Primary outcome measures, including inpatient falls and 1:1 sitter hours, were then compared to 20 months of historical data, from June 1, 2019, through January 31, 2021, which were collected through chart review. RESULTS: Following development and implementation of the continuous video monitoring program, the mean rate of inpatient falls decreased significantly, from 17.2 falls per month in the historical reference period to 12.9 falls per month during the study period (P = 0.02). Similarly, the mean number of 1:1 sitter hours decreased from 1,428 hours per month during the reference period to 140 hours per month during the study period (P < 0.001); when converted to full-time equivalents (FTEs), this translated to a decrease from 8.2 1:1 sitter FTEs during the reference period to 0.8 1:1 sitter FTEs in the study period. Cost analysis indicated that the reduced labor costs and fall rate during the study period led to estimated total cost savings of over $3.2 million. CONCLUSIONS: Both patients and the hospital benefited from the implementation of the continuous video monitoring program. Continuous video monitoring was found to be a cost-effective way to reduce inpatient falls, decrease 1:1 sitter use, and improve patient safety in the LTACH setting.
A meaning-focused approach to palliative nursing helps patients and their family caregivers make sense of and cope with serious illness. It also helps nurses find meaning and purpose in their work. This orientation to ca...A meaning-focused approach to palliative nursing helps patients and their family caregivers make sense of and cope with serious illness. It also helps nurses find meaning and purpose in their work. This orientation to care promotes a sense of connection, creates a framework for difficult conversations, and optimizes clinical care delivery. This article reviews the theoretical foundations of meaning making, describes formal and informal strategies for delivering meaning-focused nursing care, and suggests opportunities for practice improvement. Making meaning in serious illness care can promote diverse benefits for patients, family caregivers, and nurses.
BACKGROUND: Frailty is a prevalent geriatric syndrome that markedly diminishes the functional capacity and overall quality of life of older adults. Anemia, a common comorbidity in geriatric populations, has been associat...BACKGROUND: Frailty is a prevalent geriatric syndrome that markedly diminishes the functional capacity and overall quality of life of older adults. Anemia, a common comorbidity in geriatric populations, has been associated with adverse health outcomes. Both frailty and anemia are highly prevalent among geriatric inpatients. PURPOSE: This study aims to explore the relationship between frailty and anemia among older hospitalized patients, thereby contributing to the development of evidence-based strategies for identifying and managing the care of these vulnerable patients. METHODS: We conducted a retrospective cohort study involving patients 65 years of age and older admitted to our hospital's geriatric department between October 2022 and August 2024. Demographic and clinical data were collected for these patients, who were stratified by frailty status. We compared these data and investigated factors associated with frailty within this cohort. RESULTS: The study cohort comprised 160 geriatric inpatients, with 109 (68.1%) classified as frail. Anemia was identified in 65 (40.6%) of the inpatients. The incidence of anemia was significantly higher among frail than among nonfrail geriatric inpatients (P = 0.003). Anemia was also significantly correlated with frailty incidence (P < 0.001) and with total scores on the Tilburg Frailty Indicator (TFI) (P < 0.001), as well as with TFI scores pertaining to the physical (P < 0.001) and psychological (P = 0.01) dimensions of frailty. Logistic regression identified age (P = 0.001), anemia (P = 0.047), and lack of regular exercise (P = 0.001) as significant risk factors for frailty in this population. CONCLUSIONS: Our study revealed a correlation between anemia and frailty among geriatric inpatients, highlighting the critical need to incorporate vigilant monitoring and management of anemia into the nursing care regimen for these patients.
BACKGROUND: Fostering a culture of inquiry within an academic health system can be both challenging and rewarding. Having a strategic approach can help navigate these complexities. PURPOSE: The aim of this program evalua...BACKGROUND: Fostering a culture of inquiry within an academic health system can be both challenging and rewarding. Having a strategic approach can help navigate these complexities. PURPOSE: The aim of this program evaluation is to describe the steps taken to develop, implement, and sustain a nursing science fellowship (NSF) in an academic health system. METHODS: Grounded by a nursing strategic map, the NSF was established under the leadership of a steering committee. Key components of the NSF, including eligibility guidelines, curriculum development, outcome measurements, and faculty and mentor selection, were created over a three-month period. The first cohort of fellows began the 13-month program in January 2023. Fellows attended monthly lectures and were provided with individualized mentorship to advance either an evidence-based practice (EBP) or research project. Prior to beginning the curriculum, fellows were given a research/EBP textbook. A survey to determine their confidence in nursing science skills both before and after the program was administered to all fellows. RESULTS: Of the 11 inaugural fellows, eight completed the program. Four fellows conducted research studies, and four completed EBP projects. The results were disseminated through national presentations, posters, and peer-reviewed publications. Evaluations demonstrated significant improvements in the fellows' confidence in all measured nursing science skills and topics, with notable increases in navigating institutional review board submissions (148.54%), utilizing theoretical frameworks (86.92%), and critically appraising evidence (68.07%). A second cohort began the NSF program in September 2024, and a third will begin in 2026. CONCLUSION: The NSF helped to sustain a culture of inquiry within the academic health system. This program highlights the critical role of strategic planning and stakeholder engagement in advancing a culture of inquiry. The NSF fosters professional curiosity and aligns with the tenets of the American Nurses Credentialing Center Magnet model by advancing nursing science. As health care evolves, programs like the NSF are essential for cultivating sustainable nursing research and EBP practices that drive professional growth and innovation and can lead to enhanced patient care.