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\"For millions of people worldwide, nurses are the difference between life and death, self-sufficiency and dependency, hope and despair. But a lack of understanding of what nurses really do -- one perpetuated by popular media's portrayal of nurses as simplistic archetypes -- has devalued the profession and contributed to a global shortage that constitutes a public health crisis. Today, the thin ranks of the nursing workforce contribute to countless preventable deaths. This fully updated and expanded edition of Saving Lives highlights the essential roles nurses play in contemporary health care and how this role is marginalized by contemporary culture. Through engaging prose and examples drawn from television, advertising, and news coverage, the authors detail the media's role in reinforcing stereotypes that fuel the nursing shortage and devalue a highly educated sector of the contemporary workforce. Perhaps most important, the authors provide a wealth of ideas to help reinvigorate the nursing field and correct this imbalance. As American health care undergoes its greatest overhaul in decades, the practical role of nurses -- that as autonomous, highly skilled practitioners -- has never been more important. Accordingly, Saving Lives addresses both the sources of, and prescription for, misperceptions surrounding contemporary nursing\"--Provided by publisher.

Background . Most frontline nurses lack sufficient readiness for effective disaster response. Therefore, designing a disaster management training program (DMTP) to promote nurses’ readiness for disaster response is imperative. Aim . This study aimed to evaluate the effectiveness of a structured DMTP on nurses’ readiness for response to disasters. Methods . A randomized controlled trial was conducted. One hundred eligible nurses, recruited using convenience sampling from a medical centre in northern Taiwan, were randomly assigned to either the experimental (EG, n  = 50) or control (CG, n  = 50) group. Both groups received regular continuous nursing education. The EG received an extra two‐day (16 h) structured DMTP delivered by transdisciplinary collaborations through multiple teaching strategies (lectures, simulations, problem‐solving lessons, demonstrations, tabletop exercises, discussions, group presentations, and reflections). Readiness for disaster response, consisting of four subscales (emergency response, clinical management, self‐protection, and personal preparation), was assessed at baseline and 12 weeks after the intervention. Generalized estimating equations were used as the primary method of data analyses to evaluate the intervention effects. Results . Ninety‐four nurses (94%) completed the study, and 100 nurses were included in the intention‐to‐treat analysis. While participants in the EG had increased readiness for disaster response after training and at the 12‐week follow‐up, those in the CG exhibited no differences between baseline and 12‐week follow‐up. When the group × time interaction was examined, the EG had a greater increase in readiness for disaster response and its four domains, including emergency response, clinical management, self‐protection, and personal preparedness after 12 weeks, than the CG. Conclusion . A two‐day structured DMTP utilizing multiple teaching strategies through transdisciplinary collaborations is recommended to enhance hospital nurses’ readiness for disaster response. Implications for Nursing Management . Nursing leaders should consider incorporating such a structured DMTP into ongoing nursing training as a critical component of professional development programs, thereby strengthening nurses’ disaster readiness in hospital settings.

Objective. This study aimed to evaluate the impact of the shared governance model application on the level of perceived professional governance among clinical nurses in a tertiary hospital in Riyadh. Background. Professional governance continues traditional governance, shared governance, and self-governance. Shared governance (SG) is the engagement of clinical nurses in decision-making at different levels. This empowers nurses, increases job satisfaction, improves clinical outcomes, and enhances patient satisfaction. Methods. This randomised control trial in which researchers distributed the Index of Professional Nursing Governance (IPNG) to a random sample of 440 nurses working in a 1200-bed tertiary hospital in Riyadh and divided into experimental and control groups. The intervention included designing and implementing a nursing shared governance model at the hospital level; professional governance was measured before and eight months after implementation. The IPNG was used to measure nurses’ perceived level of professional governance before and after the intervention. The sample was divided into experimental and control groups. Results. By comparing experimental and control groups, there was no statistically significant difference between them regarding professional governance subscales and the total IPNG scores before the intervention. At the same time, there was a considerable difference between them after the intervention. Moreover, the scores of the six professional governance subscales and the overall IPNG scores significantly increased after the intervention in the experimental group. They showed no significant difference in the control group. Conclusion. Designing and implementing specific shared governance structures and processes effectively enhanced nurses’ perceived level of shared governance at the hospital, as evidenced by significantly higher postintervention IPNG scores. Elements of the shared governance model that proved effective included engaging nurses in decision-making at various organizational levels and empowering their involvement.

Although there are studies showing that mobile phone solutions can improve health service delivery outcomes in the developed world, there is little empirical evidence that demonstrates the impact of mHealth interventions on key maternal health outcomes in low income settings. A non-randomized controlled study was conducted in the Amhara region, Ethiopia in 10 health facilities (5 intervention, 5 control) together serving around 250,000 people. Health workers in the intervention group received an android phone (3 phones per facility) loaded with an application that sends reminders for scheduled visits during antenatal care (ANC), delivery and postnatal care (PNC), and educational messages on dangers signs and common complaints during pregnancy. The intervention was developed at Addis Ababa University in Ethiopia. Primary outcomes were the percentage of women who had at least 4 ANC visits, institutional delivery and PNC visits at the health center after 12 months of implementation of the intervention. Overall 933 and 1037 women were included in the cross-sectional surveys at baseline and at follow-up respectively. In addition, the medical records of 1224 women who had at least one antenatal care visit were followed in the longitudinal study. Women who had their ANC visit in the intervention health centers were significantly more likely to deliver their baby in the same health center compared to the control group (43.1% versus 28.4%; Adjusted Odds Ratio (AOR): 1.98 (95%CI 1.53-2.55)). A significantly higher percentage of women who had ANC in the intervention group had PNC in the same health center compared to the control health centers (41.2% versus 21.1%: AOR: 2.77 (95%CI 2.12-3.61)). Our findings demonstrated that a locally customized mHealth application during ANC can significantly improve delivery and postnatal care service utilization possibly through positively influencing the behavior of health workers and their clients.

To evaluate the impact of Artificial Intelligence Assisted Prevention and Management for Delirium (AI-AntiDelirium) on improving adherence to delirium guidelines among nurses in the intensive care unit (ICU). Between November 2022 and June 2023, A cluster randomized controlled trial was undertaken. A total of 38 nurses were enrolled in the interventional arm, whereas 42 nurses were recruited for the control arm in six ICUs across two hospitals in Beijing, comparing nurses’ adherence and cognitive load in units that use AI-AntiDelirium or the control group. The AI-AntiDelirium tailored delirium preventive or treated interventions to address patients’ specific risk factors. The adherence rate of delirium interventions was the primary endpoint. The other endpoints were adherence to risk factors assessment, ICU delirium assessment, and nurses’ cognitive load. The repeated measures analysis of variance was utilized to explore the influence of time, group, and time × group interaction on the repeated measurement variable (e.g., adherence, cognitive load). A cumulative total of 1040 nurse days were analyzed for this study. The adherence to delirium intervention of nurses in AI-AntiDelirium groups was higher than control units (75 % vs. 58 %, P < 0.01). When compared to control groups, AI-AntiDelirium was found to be significantly effective in both decreasing extraneous cognitive load (P < 0.01) and improving germane cognitive load (P < 0.01). This study supports the effectiveness of AI-AntiDelirium in enhancing nurses’ adherence to evidence-based, individualized delirium intervention and also reducing extraneous cognitive load. A nurse-led systemshould be applied by nursing administrators to improve compliance with nursing interventions among ICU nurses.

Medical abortion is under-used in developing countries. We assessed whether early first-trimester medical abortion provided by midlevel providers (government-trained, certified nurses and auxiliary nurse midwives) was as safe and effective as that provided by doctors in Nepal. This multicentre randomised controlled equivalence trial was done in five rural district hospitals in Nepal. Women were eligible for medical abortion if their pregnancy was of less than 9 weeks (63 days) and if they resided less than 90 min journey away from the study clinic. Women were ineligible if they had any contraindication to medical abortion. We used a computer-generated randomisation scheme stratified by study centre with a block size of six. Women were randomly assigned to a doctor or a midlevel provider for oral administration of 200 mg mifepristone followed by 800 μg misoprostol vaginally 2 days later, and followed up 10–14 days later. The primary endpoint was complete abortion without manual vacuum aspiration within 30 days of treatment. The study was not masked. Abortions were recorded as complete, incomplete, or failed (continuing pregnancy). Analyses for primary and secondary endpoints were by intention to treat, supplemented by per-protocol analysis of the primary endpoint. This trial is registered with ClinicalTrials.gov, NCT01186302. Of 1295 women screened, 535 were randomly assigned to a doctor and 542 to a midlevel provider. 514 and 518, respectively, were included in the analyses of the primary endpoint. Abortions were judged complete in 504 (97·3%) women assigned to midlevel providers and in 494 (96·1%) assigned to physicians. The risk difference for complete abortion was 1·24% (95% CI −0·53 to 3·02), which falls within the predefined equivalence range (−5% to 5%). Five cases (1%) were recorded as failed abortion in the doctor cohort and none in the midlevel provider cohort; the remaining cases were recorded as incomplete abortions. No serious complications were noted. The provision of medical abortion up to 9 weeks' gestation by midlevel providers and doctors was similar in safety and effectiveness. Where permitted by law, appropriately trained midlevel health-care providers can provide safe, low-technology medical abortion services for women independently from doctors. UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization.

Venous thromboembolism (VTE) is a common cause of preventable harm in hospitalized patients. While numerous successful interventions have been implemented to improve prescription of VTE prophylaxis, a substantial proportion of doses of prescribed preventive medications are not administered to hospitalized patients. The purpose of this trial was to evaluate the effectiveness of nurse education on medication administration practice. This was a double-blinded, cluster randomized trial in 21 medical or surgical floors of 933 nurses at The Johns Hopkins Hospital, an academic medical center, from April 1, 2014 -March 31, 2015. Nurses were cluster-randomized by hospital floor to receive either a linear static education (Static) module with voiceover or an interactive learner-centric dynamic scenario-based education (Dynamic) module. The primary and secondary outcomes were non-administration of prescribed VTE prophylaxis medication and nurse-reported satisfaction with education modules, respectively. Overall, non-administration improved significantly following education (12.4% vs. 11.1%, conditional OR: 0.87, 95% CI: 0.80-0.95, p = 0.002) achieving our primary objective. The reduction in non-administration was greater for those randomized to the Dynamic arm (10.8% vs. 9.2%, conditional OR: 0.83, 95% CI: 0.72-0.95) versus the Static arm (14.5% vs. 13.5%, conditional OR: 0.92, 95% CI: 0.81-1.03), although the difference between arms was not statistically significant (p = 0.26). Satisfaction scores were significantly higher (p<0.05) for all survey items for nurses in the Dynamic arm. Education for nurses significantly improves medication administration practice. Dynamic learner-centered education is more effective at engaging nurses. These findings suggest that education should be tailored to the learner. ClinicalTrials.gov NCT02301793.

Background Implementing the treatment arm of a clinical trial often requires changes to healthcare practices. Barriers to such changes may undermine the delivery of the treatment making it more likely that the trial will demonstrate no treatment effect. The ‘Major outcomes with personalized dialysate temperature’ (MyTEMP) is a cluster-randomised trial to be conducted in 84 haemodialysis centres across Ontario, Canada to investigate whether there is a difference in major outcomes with an individualized dialysis temperature (IDT) of 0.5 °C below a patient’s body temperature measured at the beginning of each haemodialysis session, compared to a standard dialysis temperature of 36.5 °C. To inform how to deploy the IDT across many haemodialysis centres, we assessed haemodialysis physicians’ and nurses’ perceived barriers and enablers to IDT use. Methods We developed two topic guides using the Theoretical Domains Framework (TDF) to assess perceived barriers and enablers to IDT ordering and IDT setting (physician and nurse behaviours, respectively). We recruited a purposive sample of haemodialysis physicians and nurses from across Ontario and conducted in-person or telephone interviews. We used directed content analysis to double-code transcribed utterances into TDF domains, and inductive thematic analysis to develop themes. Results We interviewed nine physicians and nine nurses from 11 Ontario haemodialysis centres. We identified seven themes of potential barriers and facilitators to implementing IDTs: (1) awareness of clinical guidelines and how IDT fits with local policies (knowledge; goals), (2) benefits and motivation to use IDT (beliefs about consequences; optimism; reinforcement; intention; goals), (3) alignment of IDTs with usual practice and roles (social/professional role and identity; nature of the behaviour; beliefs about capabilities), (4) thermometer availability/accuracy and dialysis machine characteristics (environmental context and resources), (5) impact on workload (beliefs about consequences; beliefs about capabilities), (6) patient comfort (behavioural regulation; beliefs about consequences; emotion), and (7) forgetting to prescribe or set IDT (memory, attention, decision making processes; emotion). Conclusions There are anticipatable barriers to changing healthcare professionals’ behaviours to effectively deliver an intervention within a randomised clinical trial. A behaviour change framework can help to systematically identify such barriers to inform better delivery and evaluation of the treatment, therefore potentially increasing the fidelity of the intervention to increase the internal validity of the trial. These findings will be used to optimise the delivery of IDT in the MyTEMP trial and demonstrate how this approach can be used to plan intervention delivery in other clinical trials. Trial registration ClinicalTrials.gov NCT02628366 . Registered November 16 2015.

ABSTRACT Objectives: to evaluate the effectiveness of a clinical simulation scenario in enhancing nurses’ knowledge of postpartum hemorrhage management. Methods: a randomized clinical trial was conducted in the obstetric center of a tertiary-level maternity hospital. Nurses involved in maternal care were divided into two groups. The control group received a didactic lecture (standard institutional training), while the intervention group, in addition to attending the lecture, participated in a clinical simulation for postpartum hemorrhage management. Data were analyzed using R software, version 4.2.0. Results: the sample consisted of 37 nurses, most of whom were female, with an average age of 40 years. The average pre-test score was 65%. After the clinical simulation-based intervention, the average post-test score increased to 90%. Conclusions: clinical simulation was effective in enhancing nurses’ knowledge of postpartum hemorrhage management. RESUMEN Objetivos: evaluar la eficacia de un escenario de simulación clínica para la adquisición de conocimientos de los enfermeros en el manejo de la hemorragia posparto. Métodos: ensayo clínico aleatorizado llevado a cabo en el centro obstétrico de una maternidad de nivel terciario. Los enfermeros que participan en la atención materna fueron divididos en dos grupos. El grupo de control recibió una clase expositiva dialogada (entrenamiento estándar de la institución), mientras que el grupo de intervención, además de recibir la clase, participó en la simulación clínica para el manejo de la hemorragia posparto. Los datos fueron analizados utilizando el software R 4.2.0. Resultados: la muestra estuvo compuesta por 37 enfermeros, la mayoría de sexo femenino, con una edad promedio de 40 años. El promedio de aciertos en el pretest fue del 65%. Tras la intervención basada en simulación clínica, el promedio de aciertos en el postest aumentó al 90%. Conclusiones: la utilización de la simulación clínica fue eficaz para la adquisición de conocimientos por parte de los enfermeros en el manejo de la hemorragia posparto. RESUMO Objetivos: avaliar a eficácia de um cenário de simulação clínica para a aquisição de conhecimentos de enfermeiros no manejo da hemorragia pós-parto. Métodos: ensaio clínico randomizado conduzido no centro obstétrico de uma maternidade de nível terciário. Enfermeiros atuantes na assistência materna foram divididos em dois grupos. O grupo controle recebeu uma aula expositiva dialogada (treinamento padrão da instituição), enquanto o grupo de intervenção, além de receber a aula, participou da simulação clínica para o manejo da hemorragia pós-parto. Os dados foram analisados usando o software R 4.2.0. Resultados: a amostra foi constituída por 37 enfermeiros, a maioria do sexo feminino, com média de idade de 40 anos. A média de acertos no pré-teste foi de 65%. Após a intervenção baseada em simulação clínica, a média de acertos no pós-teste aumentou para 90%. Conclusões: a utilização da simulação clínica foi eficaz para a aquisição de conhecimento pelos enfermeiros no manejo da hemorragia pós-parto.

Background Nursing informatics (NI) along with growth and development of health information technology (HIT) is becoming a fundamental part of all domains of nursing practice especially in critical care settings. Nurses are expected to equip with NI competency for providing patient-centered evidence-based care. Therefore, it is important and necessary to improve nurses’ NI competency through educational programs for effective using of HIT. This study aimed to evaluate the impact of a training program on NI competency of critical care nurses. Methods This interventional study was conducted in 2019. Stratified sampling technique was used to select 60 nurses working in critical care units of three hospitals affiliated with a large University of Medical Sciences in the southeast of Iran. These nurses were assigned randomly and equally to the control and intervention groups. NI competency was trained to the intervention group in a three-day workshop. Data were collected using demographic questionnaire and the adapted Nursing Informatics Competency Assessment Tool (NICAT) before and 1 month after the intervention. Rahman in the US (2015) developed and validated the original NICAT to assess self-reported NI competency of nurses with 30 items and three dimensions (Computer literacy, Informatics literacy Information management skills). The NICAT is scored on a five-point Likert scale and the overall score ranges from 30 to150. Two medical informatics specialists and eight nursing faculty members approved the validity of the adapted version of NICAT and its reliability was confirmed by Cronbach’s alpha (95%). Results All 60 participants completed the educational program and returned the completed questionnaire . Majority of participants in the intervention and control groups were female (83.30%), married nurses (70.90, 73.30%) aged 30–40 years (51.6, 35.5%). In the pretest stage, both intervention and control groups were competent in terms of the NI competency and its dimensions, and no significant difference was observed between them ( p  = 0.65). However, in the posttest, the NI competency and its dimensions in the intervention group significantly increased with a large effect size compared with the control group ( p  = 0.001). This difference showed that the intervention group was proficient in the posttest stage. The highest mean difference in the intervention group was associated with the informatics literacy dimension and the lowest mean difference was associated with the informatics management skills dimension. Conclusions The improved scores of NI competency and its dimensions after using the training program implied the effectiveness of this method in enhancing the NI competency of nurses working in the critical care units. The application of the training program in diverse domains of nursing practice shows its high efficiency. The project is fundamental for improving nurses’ NI competency through continuous educational programs in Iran, other cultures and contexts.