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Looking forward to this project. It's a start but I do like you're suggestion about getting speakers from larger facilities. With technology, this is possible with ITV. The future is very bright with the inclusion of technology and informatics into nursing/healthcare.
Joy

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So true Fiona. I think it will be important to understand baseline knowledge of our nurses @ MLH and compare to NM knowledge and perception. Exciting I think!
deb

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Deb, great project! I think a lot of people will be very surprised to learn how prevalent diversion is among nurses. Through increasing knowledge on this topic, participants might be better prepared to identify at risk nurses.
Fiona

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Diane, this is such a great topic. While much has been written on the topic of lateral violence, it unfortunately continues in all levels of nursing. I think your idea of comparing computer based training and a traditional education program is an important one. Over the years much of our education has been moved to online learning, and it would be interesting to see which you find to be the most effective.
Fiona

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Diane, this is such a great topic. While much has been written on the topic of lateral violence, it unfortunately continues in all levels of nursing. I think your idea of comparing computer based training and a traditional education program is an important one. Over the years much of our education has been moved to online learning, and it would be interesting to see which you find to be the most effective.

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My project aims to improve wellness in the night shift nurse. The goal is to educate nurses on the potential risk of working night shift and provide strategies to decrease these risks. By administering the Epworth Sleepiness Scale both before and after the education is provided I will be able to determine if the education effectively impacted nurses’ wellness.

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hello Joy,
Yes, having internet is part of the inclusion criteria.  I have considered the  possibility of the divide among the young and the old when it comes to  technology.  However, there are a few things I have come across in my literature and my practice.  First, I used to hesitate to offer insulin pumps to the more mature adult.  However, more than once, I have  been  humbled by the success of my older patients on the insulin pump.  They can rise to the occasion.  Also, the retired person is not necessarily the one who cannot get access to the diabetes education because they may be retired and Medicare actually has decent reimbursement for the diabetes education programs.  I figured that even if I can capture a  small percentage of  the elderly, I have broken down some big barriers!
Danielle

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My plans for this project is vast and ongoing. First, I need to see if it will work here in our small community. If it does, I plan to initiate hospital by hospital here in Dubois. The nice thing here is that our home care is associated with our hospitals. Majority are under one roof per say - Penn Highlands Healthcare. So, it will make it easy - hopefully - to get up and running. For sustainability, we're thinking of using the BSN students in research to keep it up and running as part of the research curriculum and activities. Again just thoughts. We'll see how it goes over the 3 month period - fingers crossed. Joy

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Participants receive a certificate of completion so they can show their supervisor. Back in the day I used it as a pass/fail class assignment for RN to BSN students - the assignment was complete when they brought in the certificate. Feedback was always positive. But, those were small samples of course! Working on the instrument now. Hope to start beta-testing the revisions by the end of the month.

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So true (the bullying in nursing/nursing education)! Joy, to your point of culture/other professions, I was shocked when I read some of the details in the Time magazine article below. Major incivility is everywhere now - including our presidential election - and many people seem to be OK with it. Seems to me that we have reached a whole new low. Very troubling.
http://time.com/4457110/internet-trolls/
Lia

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Joy, your project focuses on such an important population. Our rural population truly needs advocates in healthcare. When speaking about disparities in care, we often get so wrapped up in our immediate geographic area, which for many of us is an area rich with academic healthcare organizations in which the consumer has an array of providers to choose from, that we forget about others that don't share the same resources. Just recently, the PA Coalition looking at nurse residency programs clearly recognized the needs of the rural community and the potential lack of resources. We need to do better partnering with these facilities to allow them to partake in some of our opportunities that we have been privileged with. Increase use of technology could help bring them our nurse residency content from guest preceptors that they could benefit from. Projects such as yours would also increase their opportunity and knowledge. Good luck - you have an awesome project.

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Billy, I love your project. This will also benefit the new nurses tremendously as the tool will validate the belief that a rapid response is warranted. If not indicated, it will slow the nurse up to critically think. Anything we can due to increase confidence and decrease possibly volatile incidents of conflict between providers is extremely value added. Not that any of us experience that. Dianne, this now spills into your topic!

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Hi Billy, I can't wait to see your results. I think this is so important, especially for all the new nurses hitting the unit. I know your looking at decreasing the number of unnecessary calls but do you think there is a missed opportunity based on nurses being afraid to call an RRT?

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Lia, I love your topic and and I daily realize the importance of accurate wound assessment, intervention and documentation. An interactive on line education module that provides real time feedback related to assessment and staging would be fabulous. In addition, organizations could tie this to their strategic initiatives as a cost saving measure based in reimbursements..

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Agreed. Once I evaluate the knowledge and awareness of staff and Nurse Managers in regards to drug diversion, my hope is that an implemented program will also help someone who needs it. Throughout the literature, most writings occur because of a serious event. Wouldn't it be great if staff nurses and leaders could early identify addictive behaviors befor it gets to drug diversion? Thanks,
deb

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After I identify the baseline knowledge I hope to plan to develop an educational program which will create and awareness as well as improve the knowledge base of our organizations nurses and leaders on drug diversion in the workplace. Cool topic agreed! For the purposes of our DNP program, I will obtain the knowledge through a survey monkey. I also want to evaluate the difference in knowledge and awareness of Nurse Managers and staff nurses. Thanks,
deb

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My PICOT question is Does a one year palliative care fellowship program increase nurses' comfort level and knowledge when caring for patients with palliative care/end of life needs? The goal of my evidence based practice project is to evaluate palliative care fellows and nurse residents (control group) palliative care knowledge and comfort level at three time points over a period of one year. These outcomes will be used to measure the effectiveness of this system program (intervention) to hopefully support the continuation of this program annually.
The need for this education is supported by the IOM (2014) , the National Consensus Project (2013) as well as the Main Line Health Strategic Initiatives. In addition there is a gap in the literature surrounding the impact of education provided within the hospital for experienced nurses.

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Joy,

I think your project is so needed in implementing a project to improve evidenced based practice, particularly in areas where nurses may not have the opportunity to attend live conferences. Is it something that you are able to implement where you work? Will you also provide webinars? Will the focus be on hospital based nurses or will it be open to home care and other community health nurses? It could also be an opportunity to nurses that work in industry and employer groups. Looking forward to seeing your site.

Marianne

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Great topic Diane!
I can personally relate to this topic because as a new grad working in a busy level 1 ER/Trauma center, I experienced first hand the lateral violence from my more experienced co-workers. This made it difficult to do my job, and it made me scared to ask questions when I didn't understand something, which ultimately is not safe for patient care. I am excited to see how your project comes together.
-Billy

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Denial is, of course, a powerful force behind substance abuse. What I see in all your posts is denial by nurses/administrators. Made me wonder - and generalizing of course - are health care professionals, including nurses better at the "denial-thing" than some other professional groups?  Substance abuse is a big problem with physicians as well.
Lia

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The topic found me actually. One week before the end of our summer semester I learned the program, which was previously validated, still exists. Funding for research on these topics is virtually non-existent so I dropped all the work I had done before and jumped. Will keep you posted. Just received IRB approval :) So excited to start testing the instrument before roll-out.
Lia

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For a number of years, I have worked with pharmacy and other managers to review patterns of potential drug diversion by staff nurses. It is truly a problem in the nursing workforce and many do not realize just how prevalent it is.  Your project will be the beginning of creating much needed change.
Diane Beatty

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Your topic is very true. Nurses eat their young. Even in nursing education, we need to be careful of lateral violence and bullying. Bullying has become a major issue in this country not only for nurses but for children, and I'm sure there are other professions that experience the same thing - like lawyers. Good luck.
Joy DuGan

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Nurses often have difficulty deciding when to call a Rapid Response and many factors go into their decision.  This is a very interesting topic.  I am looking forward to hearing about your results.  Providing nurses with an instrument to help them in their assessment of the patient will surely improve patient outcomes.
Diane Beatty

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The phenomenon of lateral violence (LV) in nursing has been identified as a problem and has been well-documented in the nursing literature for many years.  Lateral violence is also known as horizontal violence, incivility, workplace bullying, disruptive behavior, and intimidation.  Lateral violence is described as aggressive behavior directed by one peer toward another that disrespects or demeans the recipient.
In an organizational discourse analysis study, Johnson, et al. (2015) analyzed hospital policies that address lateral violence and bullying and interviewed nurse managers regarding their role and involvement in addressing lateral violence with their staff.  The nurse managers stated that they feel they have an ethical obligation to address lateral violence and bullying; however, many nurse managers also stated that they did not have clear guidelines regarding how to respond and felt that they needed support from their organization to respond effectively.
The PICOT question is:  Among nurse managers in a five hospital health system, how effective is a computer-based lateral violence educational program versus a structured educational program on improving the nurse manager’s perceived ability to effectively intervene in situations of lateral violence with their staff nurses three months after receiving education?
In the 2015 position statement by the American Nurses Association (ANA), the ANA put forth clear and specific guidelines for addressing lateral violence and bullying, with specific recommendations for registered nurses and employers (ANA, 2015).
References:
American Nurses Association. (2015). Position Statement:  Incivility, bullying, and workplace violence. Retrieved from http://www.nursingworld.org/DocumentVault/Position-Statements/Practice/Position-Statement-on-Incivility-Bullying-and-Workplace-Violence.pdf
Johnson, S. L., Boutain, D. M., Tsai, J. H., & De Castro, A. B. (2015, September). Managerial and organizational discourses of workplace bullying. The Journal of Nursing Administration, 45(9), 457-461.

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I became aware of the knowledge gap on impaired nurses and diversion after Dr. Monturo suggested watching an episode of Nurse Jackie. The hospitals here in this area do not have programs in place to educate managers or staff about impaired nurses and diversion. It's a very hot topic now, and one for concern. After you identify the knowledge gap, are you going to implement an educational program as your quality improvement plan? I think this is a great topic and one that can't be ignored or swept under the carpet anymore.
Joy DuGan

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As Marianne pointed out, from our informatics class we learned a lot about telehealth and the future. My concern for you now is the availability of older clients with computers and internet capabilities for education. Remember there still is a "digital divide" out there. Will computer access be part of your inclusion criteria?
I love informatics and moving forward with educational programs online. I'm trying to get the hospitals to put their hospital orientation materials online for students so we don't have to waste a day having hospital orientation. We can use it for clinical time. Good luck. Joy DuGan

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Well I'm glad you found your topic. I'll be interested to see the outcome. I was talking with our Wound Care Director, and she was stating about needing new algorithms for assessment purposes. This online approach may be something to interest her. Keep us posted. Joy DuGan

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Great topic, and like you said very much needed. When we were in our ethics class and were asked to watch Nurse Jackie, I became aware of the lack of knowledge I had about diversion, but also became aware of our community hospitals' lack of knowledge on the subject. So, if you find a discrepancy in knowledge, is your plan to implement a nursing diversion educational class?
Joy DuGan

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Like Billy and Deb, my DNP project is a quality improvement project to promote clinical scholarship through the dissemination of evidence based practice (EBP) findings through information systems technology to support improved patient care.The goals or objectives of this project are to: 1) provide rural area registered nurses with an avenue to easily obtain

and keep current on EBP to support and improve quality of patient care; 2) provide rural area registered nurses with a way to obtain free continuing education credits; 3) increase awareness of EBP research by assisting area

registered nurses in acquiring or improving skills to read and/or critique a research article; and 4)  promote collaboration between area registered nurses at various community health care institutions.
Extensive literature is available on nursing journal clubs and their effect on EBP knowledge. Unfortunately, there is not a great deal of literature on web based or online nursing journal clubs and EBP knowledge. So, I'm using both types of evidence to support my project.
I am currently trying to set up my website, so it will be up and running by the time I get IRB approval. Stressed, but having fun!  Joy

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Hi Billy,
I think of all the projects yours has the most immediate impact on patient lives.  I have not worked acute care in many years but can remember how quickly patient conditions can change and having that "sixth sense" to recognize when the patient is crashing is a life or death situation.  The ability of the nurse to assess the sometimes subtle changes in patient condition takes critical thinking and, more importantly, experience. A tool  would help take some of the guesswork out of the equation so nurses may recognize trouble and be more proactive in treating a patient , which is always a better scenario.
Good luck, Danielle

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Deb, I am not proud to admit that I was, at one time, not aware of the prevalence of RN drug diversion.  It sounds like I am not alone.  It was not until we began discussing it in this program that I realized how common it is.  It is a great project for your organization on so many levels. It may help deter or prevent an individual from making careless mistakes.  However, more importantly, it may get someone the help that they need before it is too late

Danielle

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Deb, sounds like a great project! There is such a need for this in our profession. It is more problematic than most people think. I have a DE license as well, and we need CEUs every 2 years that focus on drug and/or ETOH addiction but this seems to only cover patient addiction., not nursing. I think that as a profession we need to start educating ourselves about these issues among our peers as well as patients. Best of luck with your project!
-Billy

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Lia, your project is fascinating.Many new nurses have a great difficulty with understanding how to measure and document wound. Very creative idea! Very informational for staff, novice and experienced,
deb

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My DNP project is a process improvement project on RN drug diversion in the workplace. I will be sending out a anonymous survey to staff nurses and Nurse Managers(NMs)  at my organization evaluating the baseline knowledge regarding drug diversion in the workplace. I will compare data responses between NM and staff nurse.
The evidence based implications point to the need for increased nursing knowledge on the topic of RN drug diversion. Drug diversion is an unspoken threat to patient and staff safety (New, 2014). Estimates of the prevalence of drug dependency among RNs is under reported(Monroe & Kenaga, 2010). The American Nurse Association (ANA) states about 10% of RNs are dependent of addicting substances (ANA, 2010). Many new studies suggest that the incidence rate may be as high as 20-24% (Nauert, 2011). Therefore, change is needed and the first step of change is identifying baseline knowledge.
References:
American Nurse Association (2010). Code of ethics for nurses. Retrieved from www.nursingworld.org
Monroe & Kenaga, H. (2010). Ask don't tell: substance abuse and addiction among nurses. Journal of Clinical Nursing, 20, 504-509.
Nauert, R. (2011). New approach addresses substance abuse among nurses. Retrieved from http://psychcentral.com/news/2011/01/27/news-approach-addresses-substance-abuse-among-nurses/22967.html
New, K. (2014, April). Preventing, detecting and investigating drug diversion in health care facilities. Journal of Nursing Regulation, 5(1), 18-25.

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I am currently working on a quality improvement project dealing with Rapid Response Teams (RRT) and making them more effective by using the Modified Emergency Warning Score (MEWS) tool.
My goal is to set out to assess whether the current RRT policy at the project setting will need to be revised based on the findings of this project, and if the MEWS tool should or should not be implemented at the medical site.  The overall goal is to improve patient care through the appropriate use of the RRT and to decrease unnecessary RRT calls. The long term desired goal will be to improve patient care outcomes related to early identification of clinically unstable patients by using the MEWS tool if in fact this study determines that the tool is reliable in doing so.
There is ample research evidence documenting that activation of RRTs can save lives if initiated by protocol (Astroth et al., 2013). The MEWS  tool is an instrument developed to assist staff nurses in their patient assessment to identify patients at risk for clinical instability and has been shown to actually improve patient outcomes and overall care (Hammer, Jones, & Brown, 2012) .
References
Astroth, K., Woith, W., Stapleton, S., Degitz, J., & Jenkins, S. (2013). Qualitative exploration of nurses’ decisions to activate rapid response teams. Journal of Clinical Nursing, 22(19-20), 2876-2882.
Hammer, J., Jones, T., & Brown, S. (2012). Rapid response teams and failure to rescue: one community’s experience. Journal of Nursing Care Quality, 27(4), 352-358.

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Response to Danielle: Danielle, yes, I agree there is a lot of literature that shows the effectiveness of this in primary care, but it is not well published in Endocrinology. Likewise, your internet based intervention will be interesting. I think as we discussed telehealth before, this will be an approach more acceptable as time moves on. There have been numerous studies also showing the effectiveness of internet based programs. I am sure we will both be able to utilize our results in practice. 

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Response to Danielle: Danielle, yes, I agree there is a lot of literature that shows the effectiveness of this in primary care, but it is not well published in Endocrinology. Likewise, your internet based intervention will be interesting. I think as we discussed telehealth before, this will be an approach more acceptable as time moves on. There have been numerous studies also showing the effectiveness of internet based programs. I am sure we will both be able to utilize our results in practice. 

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Marianne

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My project enables licensed healthcare professionals to use an interactive on-line wound assessment and set of wound care algorithms. The goal is twofold. First, it will help them practice their wound assessment and resultant evidence-based goals of care/dressing selection decision skills. They receive feedback about their correct/incorrect decisions - which should be very helpful. Second, the (anonymously collected) data will hopefully tell us more about the wound assessment/dressing selection skills of non-wound-expert nurses and the utility of a program like this for their clinical practice. Theres is substantial evidence that checklists and algorithms themselves as well as practicing their application facilitate the implementation of EBP. The paper/pencil algorithms are evidence-based,  have been extensively validated (content and construct) and are available at guideline.gov. The on-line program has been validated with nurses who had received formal wound care education. Hence, the need for this project because non-wound care experts are the one's who could benefit the most from this exercise. Hopefully everyone in class will participate and encourage others to do so as well. Stay tuned :)
Lia

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Your study is sure to demonstrate improved clinical outcomes for patients.  There are extensive studies to support your study goals.  I have always felt that endocrinology would greatly benefit from this SMV model and have enjoyed them in my practice.  I cannot wait to see your outcomes to bring to my organization to push for more SMV support.

Danielle

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The DNP project I am working on is a pilot study in my organization in which internet-based diabetes education will be compared to classroom-based diabetes education.  The goals of the project are to demonstrate the efficacy of internet based education.  This will be measured by HgA1c, an empowerment tool, attendance, and provider referrals.
A review of the literature revealed that diabetes education is grossly under-utilized.  The diabetes education programs are poorly attended because insurance coverage is poor, providers do not see the value in the programs so they do not refer, the programs are not convenient for patients.  The web based education will, hopefully, provide an alternative way for patients to attend diabetes education. Danielle

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My pilot study is to implement the Shared Medical Visit (SMV)
model in endocrinology to improve clinical outcomes and self-efficacy for
diabetes patients. 

The goals of my project are through this clinical practice
intervention patient clinical outcomes improve as evidenced in A1c measurements,
improved patient self-efficacy and provider accessibility. Another goal is to
improve office efficiencies - through offering this practice model as an alternative
to long wait times for specialty appointments. Extensive evidence in current literature supports my project with the shared medical visit (SMV) model. The model has been implemented successfully in primary care ,
however, there are gaps in literature showing implementation and effectiveness in endocrinology. 

Marianne 

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My pilot study is to implement the Shared Medical Visit (SMV)
model in endocrinology to improve clinical outcomes and self-efficacy for
diabetes patients. 

The goals of my project are through this clinical practice
intervention patient clinical outcomes improve as evidenced in A1c measurements,
improved patient self-efficacy and provider accessibility. Another goal is to
improve office efficiencies - through offering this practice model as an alternative
to long wait times for specialty appointments. Extensive evidence in current literature supports my project with the shared medical visit (SMV) model. The model has been implemented successfully in primary care ,
however, there are gaps in literature showing implementation and effectiveness in endocrinology. 

Marianne 

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Answer the following:
1) What is the overall project statement and goals.
2) What type of evidence supported your project.