Nursing Annual Report 2023 | Advancing a Healthy, Strong and Safe Practice Environment

In 2021, El Camino Health's Chief Nursing Officer established a new leadership role to bolster nursing and clinical research. Caroline Stewart, the manager of nursing research, is responsible for:

• Supporting shared governance
• Amplifying evidence-based practice (EBP)
• Contributing to clinician proficiency in research conduct as a member of the Institutional Review Board (IRB)

The manager of nursing research also disseminates new clinical knowledge, innovations, and improvements across the region, nation, and the globe, such as with Bay Area Magnet Convening^™ (BAMC), the Institute of Johns Hopkins Nursing (IJHN), and Magnet4Europe. The spirit of clinical inquiry flourishes through a variety of forums, from virtual meetings and webinars to the return of in-person conferences emerging from the pandemic.

In 2022, El Camino Health nurses shared their clinical expertise and leadership experience through a wide array of podium and poster presentations at external conferences and events.

Magnet4Europe:
Poster presentation in Cork, Ireland

• Variations on Twinning – Virtual podium presentation at Magnet4Europe Learning Collaborative (February 2022) by Cheryl Reinking, DNP, RN, NEA-BC, DipACLM, and Jackie Keane, MSN, RN, NPD-BC, with M4E partners Penn Medicine Princeton Health, New Jersey and AZ Sint-Maarten, Belgium
• You've Got Milk: A NICU Lactation Journey – Podium presentation at Gravens Conference (March 2022) by Cristina Canete, BSN, RN, RNC-NIC, IBCLC, with Dr. Rachel Land, Dr. Dharshi Sivakumar, and Dr. Malathi Balasundaram
• Implementation of an Infant Massage Program in a Community Level 3 NICU – Poster presentation at Gravens Conference (March 2022) by Georgette Aquilina, BSN, RNC-NIC, C-ELBW, with Karen Brady, Dr. Dharshi Sivakumar, Dr. Malathi Balasundaram, and Dr. Kari McCallie
• Trauma Informed Understanding of Perinatal Psychiatry – Podium presentation at MCCPOP 41st Annual Perinatal Potpourri Advances in Care Conference (March 2022) by Carolain Peregrino, PMHNP-BC, with Dr. Nirmaljit Dhami
• Utilizing M4E GAP Analysis and International Collaboration Towards Establishing a New Shared Governance Model – Poster presentation at Magnet4Europe Conference (May 2022) by Cheryl Reinking, DNP, RN, NEA-BC, DipACLM, Jackie Keane, MSN, RN, NPD-BC, and Caroline Stewart, MSHI, RN, with M4E partners Penn Medicine Princeton Health, New Jersey and AZ Sint-Maarten, Belgium
• Cardiac Rehabilitation Across Settings: Hospital, Ambulatory Settings, Cardiac Rehabilitation Centers, and Home – Podium panel presentation at 1st Annual Transforming Cardiac Rehabilitation Symposium with Stanford University Medical Center (August 2022) by Julee Arbuckle, BSN, CCRP, with panel speakers
• Riding the COVID-19 Pandemic Waves with Shared Governance for Staffing and Workforce Safety – Poster presentation at California Hospital Association Disaster Planning Conference (September 2022) by Veronica Palustra, DNP, MJ, RN, PHN, Agnes Roey, BSN, RN, and Megan Williams, MA, RN
• Command, Control, and Communicate: The 3 C's of COVID – Poster presentation at ANCC Magnet Conference (October 2022) by Cheryl Reinking, DNP, RN, NEA-BC, DipACLM, and Carla Martin, DNP(c), RN, CIC, CNL, NEA-BC, FACHE of UC Davis Health
• Starting the Transformation – Engaging Inpatient Nurses with a Lifestyle Medicine Education Program – Podium presentation at Lifestyle Medicine 2022 Conference Redesigning Health Care Better (November 2022) by Cheryl Reinking, DNP, RN, NEA-BC, DipACLM, and Alicia Potolsky, DNP, RN, NE-BC, DipACLM
• Sepsis Performance Improvement in the Emergency Department: Screening, Identification and Alert Re-design – poster presentation at IHI Forum (December 2022) by Jessica Harkey, MSN, RN, ACCNS-AG, Dr. Laura Cook, and Jumana Baluom, MSN, RN, CEN, TCRN

Balasundaram, M., Land, R., Miller, S., Profit, J., Porter, M., Arnold, C., & Sivakumar, D. (2022). Increasing early exposure to mother's own milk in premature newborns. Journal of Perinatology, 42(8), 1126-1134. https://doi.org/10.1038/s41372-022-01376-8.

Balasundaram, M., Porter, M., Miller, S., Sivakumar, D., Fleming, A., & McCallie, K. (2022). Increasing parent satisfaction with discharge planning: an improvement project using technology in a level 3 NICU. Advances in Neonatal Care, 22(2), 108-118. https://doi.org/10.1097/ANC.0000000000000841.

Schauder, B., Malcolm, T., Tan, A., Dave, D., Peterkin, A., & Taylor, K. (2022). Correlates of electroconvulsive therapy with neurocognitive functioning, subjective memory and depression. Journal of Affective Disorders Reports, 10, 100429, https://doi.org/10.1016/j.jadr.2022.100429.

The Nursing Research Council (NRC) elected its new chair, Patricia (Pattie) DeMellopine and Co-Chair, Jonathan Tong to continue the NRC's objective to empower nurses in the development and execution of quality improvement, evidence-based practice, and research. NRC members support projects that align with nursing strategic goals, with the FY2022 theme of "Respectful, Resilient, and Ready" and the FY2023 theme of "Advancing a Healthy, Strong, and Safe Practice Environment."

These themes reflect El Camino Health's mission, vision, and focus on meaningful priorities for our nurses. Research and quality improvement projects proposed to the NRC, the Nursing Research Approval Committee, and ultimately the IRB reiterate how nurses use evidence and new knowledge to elevate nursing practice.

IRB-Approved Nursing Studies Completed in 2022:

• Reducing surgical site infections with the inclusion of disposable linens as part of ongoing SSI bundle by Natalia Alvarado, DNP, MSN, RN, CNOR
• Effects of interactive automated chat services on 30-day readmission of Chronic Lung Disease patients by Afroza Khan, RPFT, and L. Michelle Canfield, MS, APRN, FNP-BC, TTS
• Correlates of Electroconvulsive Therapy with Neurocognitive Functioning, Subjective Memory and Depression; Brooke Schauder, PhD; Digant Dave, MS, RNC
• Association of patient visitation in the adult inpatient rehabilitation unit on the outcomes of patients' daily therapy participation rate and psychosocial assessment in patients with depression by Kim Tran, MSN, FNP, BSN, RN

IRB-Approved Nursing Studies Active in 2022:

• U.S. Clinician Wellbeing Study (CWS) – Multi-site principal investigators Linda Aiken, PhD, RN, & Matthew McHugh, PhD, RN, JD, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing; site principal investigators Lori Story, MSN, RN, CPAN, & Caroline Stewart, MSHI, RN (IRB Protocol ID 20-30)
• Nurses Partnering with Technology: Using Artificial Intelligence in Predicting Patient's Risk for Falling – Principal investigator Ann Aquino, MSN, RN, NEA-BC, CMSRN, DNP candidate at University of San Francisco (IRB Protocol 22-08)
• Atrial Fibrillation Management in Hispanic Adults – Principal investigator Tania Borja-Rodriguez, MSN, RN, FNP-BC, PhD candidate at University of San Diego (IRB Protocol 22-13)
• Evaluation of the SmartPICC System for PICC Placement in Adults - A Safety and Technical Feasibility Study – site principal investigator Janna Ben-Zvi, MPA, RN, VA-BC (IRB Protocol ID 21-18)
• Zero Degree head positioning In Acute IschemiC stroke (ZODIAC) – site principal investigator Xifeng (Spring) Xu, MSN, CNS, RN, ANVP-BC (IRB Protocol ID 22-03)
• Improving Exclusive Breastfeeding Rate Through Nursing Education - Julianna Youssef, MSN, BSN, RN, PHN, DNP candidate at San Jose State University (IRB Protocol ID 22-12)

Nursing Studies Proposed, Approved by IRB in 2022 for 2023:

• Assessment of Implementation Methods in Sepsis (AIMS) – site principal investigator Dr. Laura Cook & site co-Principal Investigator Jessica Harkey, MSN, RN, ACCNS-AG, (IRB Protocol ID 22-11)
• Sepsis Team in the Emergency Department – Principal investigator Catherine Kan, NP, MSN, RN, FNP-C, ENP-C, candidate at Drexel University (IRB Protocol ID 22-19)

In spring 2022, the Nursing Research Council (NRC) collaborated with the Advanced Practice Registered Nurse (APRN) Council to promote the Nursing Evidence-Based Practice (EBP) Fellowship program. Margie Kunz, MSN, CNS, RN, C-Inpatient OB, C-EFM, NPD-BC was selected for her proposed EBP project relating to postpartum preeclampsia. The EBP fellow and fellowship team adopts the Institute of Johns Hopkins Nursing (IJHN) EBP Model and is mentored by Kim Bissett, PhD, MBA, RN, Director of the Center for Evidence-Based Practice at Johns Hopkins Medicine and an internationally renowned champion of EBP.

After participating in a skills workshop, nurses were encouraged to apply their learnings. In addition to mentorship by Dr. Bissett, the fellowship team is supported by APRN Council Chairs Jessica Harkey, Melinda Porter, and former NRC Chair Caroline Stewart. EBP team members are nurses from clinical education, the emergency department, and mother-baby unit. Margie is joined by David deSimone, BSN, RN, NR-P, Yasmine Perdue, DNP, FNP, CEN, and Hennessey Ortiz, BSN, RN.

Here is a look at the team's progression over the past year:

• Phase 1 - Practice Question and Project Planning (May through August 2022): After establishing the core EBP team with support from management and leadership stakeholders, the EBP question was meticulously developed.
  For patients who present signs, symptoms, or risk factors for postpartum preeclampsia (PPPE) in the ED within 12 weeks of being pregnant or giving birth, will the use of a standardized screening tool by ED staff nurses improve recognition of postpartum preeclampsia?
• Phase 2 – Evidence (August – December 2022): The team conducted literature searches and appraised the evidence for the level and quality of each individual evidence, and synthesized findings to develop best evidence recommendations. From thousands of articles, down to hundreds, then to dozens of relevant articles, the team reviewed each evidence methodically according to the Johns Hopkins EBP model appendices.
• Phase 3 - Translation (Spring 2023): The team is actively developing a screening tool for ED triage utilizing evidence recommendations. Implementation and evaluation of outcomes will be forthcoming in late spring.