• Building the Evidence - Use of the Electronic Health Record in the Measurement of Nurse Practitioner Performance

      Wilson, Janice (2009)
      Background: Health care providers are required to demonstrate evidence of ongoing competence or performance. This is especially crucial for nurse practitioners working in critical care arenas, like the Neonatal Intensive Care Unit (NICU). Neonatal nurse practitioners (NNP) working in these settings must competently perform multiple high risk procedures, like the percutaneous insertion of central catheters (PICC), yet performance for these providers and outcomes for these procedures are often not visible. In addition few frameworks exist that adequately measure them. Purpose: The main purpose of the project was to determine if an evidence based electronic PICC line note could be utilized as a tool to evaluate NNP PICC line performance or outcomes in a Neonatal Intensive Care Nursery Setting. The objectives of the project were as follows: 1.) Determine what tools if any, are utilized by Baltimore-Washington area NICU’s to evaluate NNP PICC line insertion performance or competence 2.) Evaluate the perception of eight commonly used performance measurement tools. 3.) Build and implement an evidence based electronic PICC line note embedded within the electronic health record, for NNP providers to use in the NICU at Mercy Medical Center. 4.) Using data analysis software, analyze the PICC line note elements to determine the usability of the note as a tool to measure NNP PICC line performance. 5.) Evaluate the note implementation process and NNP satisfaction with the updated PICC line note format. Methods: Baltimore Washington area NICU’s were surveyed to determine what tools they use to measure NNP PICC line performance, and what their perceptions were of those tools as measures of NNP PICC line performance outcomes. Using GE Centricity Perinatal Software, an evidence based electronic NNP PICC line procedure note was developed and implemented. A post implementation survey was conducted using the Clinical Information Systems Evaluation Scale. SPSS was used to analyze both survey results as well as the outcomes of the PICC line note. Results: Out of 14 NICU’s surveyed, 78.6% (N=11) do not measure NNP PICC line outcomes or performance. Of the 21.4 % (N=3) that do measure NP PICC line performance, two used the electronic health record to do so, but felt that it was less than adequate to measure NNP PICC line performance (M = 1.7, SD = 0.6). Eighty one percent of note fields were completed in the insertion section of the note, 85% of fields were completed for the adjustment part of the note and 88% of the removal note fields were completed. The implementation was viewed as moderately to highly successful with a CISIES total score of 3.2. Conclusions: NNP PICC line performance is not routinely measured in local Baltimore Washington area NICU’s. The successful implementation of a clinical information system, in this case an evidence based electronic NNP PICC line procedure note, demonstrates the potential power of the electronic health record to serve as a tool in the evaluation of NNP performance, outcomes and competence.
    • Implementation of Mindfulness with Emergency Nurse Practitioners to Decrease Burnout

      Brown, Jennifer C.; Rawlett, Kristen (2020-05)
      Problem & Purpose: The emergency department is challenging due to its fast-paced and highly stressful environment. Nurse Practitioners (NPs) are at risk for increased stress and decreased well-being leading to burnout. This quality improvement project aim was to teach nurse practitioners the skill of mindfulness, specifically guided sitting meditation. With effective intervention, it is expected that the skill of mindfulness can directly impact stress and well-being with the goal of decreasing burnout amongst the group. The Maslach Burnout Inventory (MBI) tool was used to identify burnout. Methods: This quality improvement project involves nurse practitioners that work in an urban emergency department in the Mid-Atlantic region. NPs were invited to four mindfulness sessions over a 12 week period focused on guided sitting meditation. The MBI pretest was administered to the NPs at the start of the mindfulness session and then they had access to a self-guided sitting meditation via electronic file after each session. The NPs were encouraged to practice the guided sitting meditation for 10 minutes a day for at least 5 days a week independently and report weekly the frequency of use. Results: Brief mindfulness, specifically guided sitting meditation can impact burnout, Twenty-one NPs participated in four mindfulness sessions completing the MBI both pre and post sessions. Means scores for Emotional Exhaustion (EE) showed a positive trend going from 25.1 to 22.9 (p=0.27) Depersonalization (DP) also showing a positive trend declining from 9.9 to 9.3 (p= 0.70) However, neither was statistically significant.
    • Nursing Informatics Certification and Competencies: A Report on the Current State and Recommendations for the Future

      Halimi, Miriam (2009)
      Background: Nurses have worked in informatics roles for nearly 40 years, but the phrase "nursing informatics" was not seen in the literature until 1984. Since then, nursing informatics has established itself as a professional specialty. The American Nurses Credentialing Center (ANCC) is the official certifying organization for nurses. The ANCC has offered basic certification in nursing informatics since 1994, but it does not offer advanced certification in this specialty. As a result of revised certification that took place July 2008, the informatics competency level of the current exam is unclear. However, descriptions of informatics competencies for different levels of nursing practice developed since 2000 may link the competences tested in the exam more closely to the informatics nurse specialist than to the generalist level of the experienced nurse. The American Medical Informatics Association (AMIA), with a grant from the Robert Wood Johnson Foundation, has initiated work to develop a certification process in Clinical Informatics, intended to be offered to physicians. Recognition of clinical informatics as a medical specialty is unprecedented. As with other medical boards, it would be possible to offer certification to doctorally prepared non-physicians who are working in the field. Objectives ofthis study: • To clarify the level of the current nursing informatics certification offered by ANCC • To advise the ANCC regarding the need, if any is discovered, for other or different levels of certification • To investigate the similarities and differences in the content and criteria for certification in nursing informatics as offered by ANCC and in clinical informatics as AMIA proposes • To formulate a recommendation as to whether Clinical Informatics certification offered by AMIA should be available as an advanced level of certification for Nurse Informaticians. Methodology: This study used a two-round Delphi methodology to elicit opinions from experts about certification in nursing informatics. IRE approval was obtained. The first round of the study consisted of 8 open-ended questions about nursing informatics certification based on the core content ANCC Nursing Informatics Certification exam and AMIA's core content for clinical informatics certification. The second-round survey, based on the information obtained from the first survey, contained nine statements that respondents were asked to rate on a 7 point Likert scale ranging from strongly disagree to strongly agree. Both surveys were administered electronically via Survey Monkey. Responses were anonymous. Conclusions: This study found consensus among experts on the similarities and differences between the competencies and core content of nursing informatics and clinical informatics. Experts agreed that there is much overlap between the competencies required for nursing informatics certification and those proposed for clinical informatics certification, but that each field retains some distinctive features. Recommendations are formulated for ANCC and AMIA on how to proceed with their respective certifications.
    • Simulation to Improve Confidence and Competence of the Neonatal Nurse Practitioner

      Williams, Julie E.; McComiskey, Carmel A. (2019-05)
      Background: Neonatal nurse practitioners must maintain competence in low-volume, high-risk procedures to provide timely, high-quality, and safe care. In institutions with multiple providers e.g. fellows, residents, and neonatal nurse practitioners, the number of procedures available per provider may be very low. Simulation education provides an opportunity to practice procedures without compromising the care of patients or competition. Local Problem: The project institution is an academic center with a high level of procedural competition due to the presence of physicians, physician trainees, and nurse practitioners. The purpose of this quality improvement project was to implement and evaluate the impact of a needle thoracentesis simulation on the confidence and competence of neonatal nurse practitioners. Interventions: A simulation was implemented for 15 full-time neonatal nurse practitioners in the Neonatal Intensive Care Unit. A pre-simulation survey to assess each neonatal nurse practitioner’s perception of procedural confidence and competence was conducted. Subsequently, each neonatal nurse practitioner received PowerPoint slides with an embedded video on the correct performance of a needle thoracentesis. Following the pre-survey and PowerPoint slides, each neonatal nurse practitioner participated in the needle thoracentesis simulation. Utilizing a procedural checklist adapted from the National Association of Neonatal Nurse Practitioner Competency and Orientation Toolkit for Neonatal Nurse Practitioners, the nurse practitioners needle chest thoracentesis skills were assessed. After completing the simulation, the nurse practitioners received an identical post-simulation survey to re-evaluate their perception of their procedural confidence and competence. Results: Neonatal nurse practitioners reported an increase in confidence in their 1) ability to determine when a needle thoracentesis was necessary versus allowing spontaneous resolution (p<0.01); 2) and in their ability to perform an emergency needle thoracentesis competently without or with minimal procedural guidance (p=0.04). They also reported an increase in confidence in their ability to troubleshoot unexpected problems that might occur during the procedure (p<0.01) and an increase in confidence in their ability to incorporate patient safety measures in the event of an emergency thoracentesis (p=0.03). Conclusions: This quality improvement project provided support for the use of simulation to increase the confidence and competence of the neonatal nurse practitioner in performing a chest needle thoracentesis and to assist neonatal nurse practitioners in maintaining competency in low volume high risk procedures.
    • Use and assessment of a Palliative Care Nurse Practitioner on a Pancreatic Cancer Web Site

      Grant, Marian (2010)
      Patients with pancreatic cancer and their families struggle with physical and emotional issues. They could benefit from palliative care services, but may not have access to them. The Internet has become an important source of health information and a link between patients, families and health care providers. The purpose of this capstone project was to 1) determine if patients and their families would use a Web page where they could access a palliative care nurse practitioner (PCNP); 2) to identify the palliative care needs of the patients and families who accessed the PCNP; and 3) to determine the helpfulness of the Web page. Participants were recruited to the PCNP Web page from the Johns Hopkins Pancreatic Cancer Research Center’s (JHPCRC) Web site. A mixed method design was used to determine 1) the volume of participation with the PCNP Web page, 2) patient and family member needs, and 3) the usefulness of the Web page. Participants could post their questions to the public comments section of the PCNP Web or send the PCNP a private email. There also was a link to an online survey to gather demographic and evaluative information. The PCNP Web page was visited 650 times by 395 unique individuals over an 8-week period. Participants spent an average of 4 minutes and 4 seconds on the PCNP Web page. Half, 49%, came from a link posted on the discussion board of the JHPCRC Web site. Forty-eight participants posted a total of 55 questions or sent individual emails to the PCNP. The majority were from female family members of patients with pancreatic cancer. The majority of questions (66%) fell into one of the eight domains of palliative care. Of these, most of the questions, 42%, asked about physical aspects of pancreatic cancer with the next largest domain, 11%, being psychological concerns about the illness and the risks of developing it. The other third of questions had to do with non-palliative aspects of pancreatic cancer and its treatment. Twenty participants (5% of total visitors) completed the online survey. Most survey respondents were female, family members, middle-aged, white, and college-educated. Although statistical significance was not achieved, most survey respondents found the PCNP website helpful. It was considered easy to use and participants found information and support there and recommended that the PCNP page should be an on-going resource. Access to a PCNP is an important resource for patients with pancreatic cancer and their family members. The Internet can be used to offer information, support and advice to patients and families dealing with a life-threatening illness.