Mary Jo Vetter

Abstract

ABSTRACT: Nurse practitioners (NPs) are educated to provide high-quality patient- and family-centered care to underserved, culturally diverse, medically complex populations. Nurse practitioner faculty plan curricular activities that challenge NP students to critically assess individuals and populations with the goal of preparing NP students to be "practice-ready" upon graduation. Nurse practitioner clinical training occurs in practice settings with NP preceptors, with specific areas of clinical expertise. However, there is a lack of NP clinical preceptors educationally prepared to clinically teach and evaluate NP students. This article presents the design, implementation, evaluation, and outcomes from a 3-year grant funded by the United States Human Resources and Administration Services that featured a web-based Primary Care Nurse Practitioner Preceptor Development Program. Ninety percent of NPs who precepted NP students completed all web-based learning modules. Preceptors with educational preparation via online modules to guide NP student learning in clinical settings are a critical resource for faculty to prepare NP students to be practice-ready upon graduation. This web-based learning platform for online NP preceptor education may be a successful approach for expanding and improving the NP preceptor pool nationwide.

Abstract

Background: Evidence-based quality improvement (EBQI) is an established methodology for identifying nursing practice changes that improve health care quality and safety. However, EBQI itself does not provide a framework for navigating the barriers to practice change. Local Problem: An EBQI program in an orthopedic specialty hospital fostered many successful quality improvement projects. However, program participants frequently encountered barriers to project implementation. Methods: Lean Six Sigma (LSS) principles, tools, and strategies were incorporated into the EBQI program to help participants overcome organizational barriers to successful implementation. Interventions: LSS interventions included stakeholder alignment, process analysis, change management, project management, structured check-ins, mentoring, and organizational recognition. Results: The addition of LSS principles gave EBQI project leaders new tools for gaining executive support, securing resources, and overcoming organizational inertia to facilitate effective practice change. Conclusions: Lean Six Sigma can increase the effectiveness of an EBQI program.

Abstract

simulation for advanced practice nurses

Abstract

simulation of an initial telemedicine visit

Abstract

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Abstract

Background: Clinical decision support systems (CDSSs) at the point of care are evidence-based interventions that have demonstrated incremental positive impact on quality of healthcare delivery over the past two decades. Existing best practices inform strategies to promote adoption and achievement of targeted outcomes. The purpose of this improvement project was to conduct a pilot implementation to understand the contextual factors and readiness for dissemination of a newly acquired electronic CDSS by evaluating its influence on diagnostic accuracy in nurse practitioners (NPs) functioning in a community health setting. Aims: The specific aims of this project were to measure and compare diagnostic accuracy in a pilot group before and after CDSS use, educate clinicians about the system and pilot its use, and then leverage the experience to design the practice-wide CDSS dissemination strategy. Methods: The project engaged a subset of NPs from a home-based primary care practice and other organizational stakeholders who provided tangible support and necessary resources for successful adoption of this innovation in practice. A structured conceptual model of Evidence-Based Practice Improvement enhanced with elements of the Promoting Action on Research Implementation in Health Sciences framework was used to guide the development, implementation and evaluation of this practice improvement initiative. A group of seven NP representatives of the practice participated in the project. Data collection was composed of small tests of change (plan-do-study-act) cycles at the local practice level, measuring achievement of improvement of the chosen outcome of correctness of medical diagnosis evidenced by appropriate substantiating clinical documentation. Linking evidence to action: In this home visiting primary care practice setting, use of a CDSS by NPs achieved eventual improvement in diagnostic accuracy and clinical documentation, as demonstrated on chart audit, though the improvement was not sustained over time. The pilot findings ultimately informed decision making about CDSS dissemination strategies and future uses of the system. When appropriately deployed, a CDSS offers the potential to improve professional practice, support differential diagnosis and evidence-based treatment, and provide detailed information about the disease state to facilitate robust clinical documentation.