Sue & Bill Gross School of Nursing

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The Veterans Health Administration (VHA) Office of Nursing Services (ONS) was an early adopter of Clinical Nurse Leader (CNL) practice, generating some of the earliest pilot data of CNL practice effectiveness. In 2011 the VHA ONS CNL Implementation & Evaluation Service (CNL I&E) piloted a curriculum to facilitate CNL transition to effective practice at local VHA settings. In 2015, the CNL I&E and local VHA setting stakeholders collaborated to refine the program, based on lessons learned at the national and local level. The workgroup reviewed the literature to identify theoretical frameworks for CNL practice and practice development. The workgroup selected Benner et al.'s Novice-to-Expert model as the defining framework for CNL practice development, and Bender et al.'s CNL Practice Model as the defining framework for CNL practice integration. The selected frameworks were cross-walked against existing curriculum elements to identify and clarify additional practice development needs. The work generated key insights into: core stages of transition to effective practice; CNL progress and expectations for each stage; and organizational support structures necessary for CNL success at each stage. The refined CNL development model is a robust tool that can be applied to support consistent and effective integration of CNL practice into care delivery.

AIMS:To determine the power of a conceptual clinical nurse leader practice model to explain the care model's enactment and trajectory in real world settings. BACKGROUND:How nursing, organised into specific models of care, functions as an organisational strategy for quality is not well specified. Clinical nurse leader integrated care delivery is one emerging model with growing adoption. A recently validated clinical nurse leader practice model conceptualizes the care model's characteristics and hypothesizes their mechanisms of action. METHODS:Pattern matching case study design and mixed methods were used to determine how the care model's constructs were operationalized in one regional United States health system that integrated clinical nurse leaders into their care delivery system in 2010. RESULTS:The findings confirmed the empirical presence of all clinical nurse leader practice model constructs and provided a rich description of how the health system operationalized the constructs in practice. The findings support the hypothesized model pathway from Clinical Nurse Leader structuring to Clinical Nurse Leader practice and outcomes. CONCLUSION:The findings indicate analytic generalizability of the clinical nurse leader practice model. IMPLICATIONS FOR NURSING MANAGEMENT:Nursing practice organised to focus on microsystem care processes can catalyse multidisciplinary engagement with, and consistent enactment of, quality practices. The model has great potential for transferability across diverse health systems.

Background: Type 2 diabetes is a growing problem across the world. Diabetes leads to increased levels of hemoglobin A1c (A1C), and if left untreated, can lead to further chronic disease. This review examines the effectiveness of group-based diabetes self-management education (DSME) on lowering A1C levels and increasing diabetes knowledge.

Methods: Databases used for this review include PubMed, CINAHL, Google Scholar, and Web of Science. The three studies chosen for this review include two randomized controlled trials (RCT's) and one quasi-experimental study, which were peer-reviewed and published in the past 5 years.

Results: All studies demonstrated a slight decrease in A1C levels; however, one study found a significant decrease between pre-and-post intervention (p<0.0001). The two RCT's also reported a significant increase in diabetes knowledge.

Discussion: The strengths found across all studies were the study design used, fidelity of the intervention, and validity of the methods used to measure the primary outcome. All three studies took a different DSME approach; however, their end-goal was the same as they measured similar outcomes.

Conclusion: DSME is a feasible approach in improving diabetes education and attempting to reduce A1C levels. Further research is needed to develop a standardized curriculum that maximizes the benefits of DSME.

Sleep deprivation is a common problem in the intensive care unit because it can increase rates of delirium, impede proper recovery, lead to longer hospital stays, and increase health care costs. This study aims to review three randomized controlled trials that observe the effect of noise reduction methods in improving sleep quality among intensive care patients. One study compared rates of delirium among those use earplugs and those who do not. Two other studies found that interventions such as earplugs, eye masks, and melatonin have proven to improve sleep quality. While interventions such as earplugs may be uncomfortable for some patients, it is reasonable it to at least offer these products to those who may want it. This can in turn improve patient satisfaction rates, decrease hospital length of stays and reduce healthcare costs. Moreover, these interventions are safe, cost effective, and easy to implement.

Faculty advisor: Jill P Berg, Ph.D., Professor Emeritus (jpberg@uci.edu) - Program in Nursing Science

Interpretation of pain in infants - especially in the NICU - is difficult to assess due to their inabilities to communicate verbally or demonstrate their pain. Most often, healthcare providers rely on indicators such as facial activity, changes in muscle tone, and duration of sleep/wake states to assess the presence of pain. With the high incidence of painful procedures occurring in the NICU, it is essential to find effective methods to decrease the associated discomfort and assist infants in gaining short and long term benefits. While there are a variety of methods to treat and manage pain levels in the NICU, the focus of this paper will be on one: the administration of oral sucrose.

Faculty advisor: Yuqing Guo, Ph.D. (gyuqing@uci.edu) - Program in Nursing Science