BACKGROUND: During the COVID-19 pandemic, providing care for critically ill patients has been challenging due to the limited number of skilled nurses, rapid transmission of the virus, and increased patient acuity in relation to the virus. These factors have led to the implementation of team nursing as a model of nursing care out of necessity for resource allocation. Nurses can use prior evidence to inform the model of nursing care and reimagine patient care responsibilities during a crisis.
OBJECTIVE: To review the evidence for team nursing as a model of patient care and delegation and determine how it affects patient, nurse, and organizational outcomes.
METHODS: We conducted an integrative review of team nursing and delegation using Whittemore and Knafl\'s (2005) methodology.
RESULTS: We identified 22 team nursing articles, 21 delegation articles, and two papers about U.S. nursing laws and scopes of practice for delegation. Overall, team nursing had varied effects on patient, nursing, and organizational outcomes compared with other nursing care models. Education regarding delegation is critical for team nursing, and evidence indicates that it improves nurses\' delegation knowledge, decision-making, and competency.
UNASSIGNED: Team nursing had both positive and negative outcomes for patients, nurses, and the organization. Delegation education improved team nursing care.

The purpose of this prospective evaluation is to document in-hospital management and discharge trends of patients presented for acute heart failure.
A prospective evaluation of the patients presented for heart failure exacerbation at eight sites over 1 month using the method of the New South Wales Heart Failure Snapshot.
Trained personnel situated at each of the study sites recruited eligible patients to the study and collected data on their sociodemographic characteristics, clinical presentation, self-care, frailty, and depression.
Eight sites, out of the 27 contacted, agreed to participate in this study. A total of 137 admissions were reported in the 1-month time window. Mean age was 72 (SD = 13) years and the majority were female (52%). More than half (n = 60%) had heart failure reduced ejection fraction with a mean ejection fraction of 41%. The mean Charlson Comorbidity Index score was four with hypertension (80%) and diabetes (56%) being the most frequent. The majority were frail (86%), self-care mean scores were low; self-care maintenance (29), self-care management (48) and self-care confidence (42). The mean depression score was 14 indicating major depression. In reference to international guidelines recommendations, hospital administered medications and discharge medications were suboptimal. Some items of the discharge education recommended by the international guidelines were provided to 84% of the patients but none of the patients received the complete items of the discharge education.
The snapshot revealed that patients admitted for acute heart failure were frail with high levels of illiteracy and low self-care scores. Despite these findings, these patients were not provided with complete discharge education in reference to the international guidelines. Additionally, when provided, discharge education was inconsistent across the study sites. This study highlights the need for enlisting complete education as part of the discharge process, in addition to abidance to the guidelines in prescribing medication. The study draws major implications for nursing practice, research and policy.
Literacy among patients with heart failure is low and should be addressed in educational intervention to improve outcomes. Discharge education is under practiced across the country and should be implemented in accordance with the international guidelines.

BACKGROUND: Tele-coaching has been used by nurses as one of the accessible and sustainable interventions for individuals with type 2 diabetes mellitus. However, evidence has been lacking to demonstrate its effectiveness in mitigating the related cardiovascular risk factors.
OBJECTIVE: To systematically evaluate the effectiveness of nurse-led tele-coaching on the modifiable cardiovascular risk factors (glycated hemoglobin, blood pressure, & lipid levels) among individuals with type 2 diabetes mellitus.
METHODS: A systematic search of eight databases (Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, PsycINFO, Web of Science, & ProQuest Dissertations and Theses) was conducted for randomized controlled trials of nurse-led tele-coaching for individuals with type 2 diabetes mellitus published in English up to October 30, 2018. A meta-analysis was conducted for the primary outcomes of the studies.
RESULTS: Twelve randomized controlled trials were selected that included 3,030 participants. Results from the meta-analysis revealed statistically significant reductions for not only glycated hemoglobin (pooled mean difference = -1.23, 95% CI: -1.63 to -0.8, I2  = 0%, p < .00) but also systolic blood pressure (SBP; pooled mean difference = -2.22, 95% CI: -3.95 to -0.49, I2  = 0%, p < .01); such findings are supportive of the use of nurse-led tele-coaching on the primary outcome.
UNASSIGNED: Results from the meta-analyses have shown that nurse-led tele-coaching is an effective and accessible intervention that could improve the glycemic control and SBP among individuals with type 2 diabetes mellitus.

BACKGROUND: Evidence-based guidelines assist clinicians in practice, but how the guidelines are implemented is less established.
OBJECTIVE: To describe the nurses\' implementation of activities recommended in evidence-based guidelines for falls prevention and care of older people with cognitive impairment.
METHODS: Structured observation with a categorical checklist was used. Nursing personnel were recruited from one subacute and two acute wards in two hospitals in one tertiary-level health service in south-eastern Queensland, Australia. The data collection instrument identified 31 activities drawn directly from the evidence-based guidelines, which were categorized into six domains of nursing practice: clinical care, comfort, elimination, mobility, nutrition and hydration, and social engagement. Four-hour observation periods, timed to occur across the morning and evening shifts, were conducted over 2 months.
RESULTS: Nineteen registered nurses, six enrolled nurses, and 16 assistants in nursing (N = 41) were observed for 155 hr of observation. There was variability in adherence with specific activities, ranging from 21% to 100% adherence. Three categories with the highest adherence were nutrition and hydration, mobilization safety, and social engagement. The clinical care, comfort, and elimination categories had lower adherence, with lowest adherence in activities of education provision about falls risk, pain assessment, using a clock or calendar to reorient to time and place, and bowel care.
UNASSIGNED: Nursing care is delivered within an interdisciplinary team. Therefore, responsibility for the everyday fundamental care activities known to prevent falls in older people with cognitive impairment requires localized negotiation. A practical guide for preventing in-hospital falls in older people with cognitive impairment addressing the interdisciplinary context of practice is required. Interdisciplinary teams should develop strategies to enhance the implementation of pain assessment and prevention of constipation in the context of regularly implemented hydration, nutrition, and mobilization care strategies.

BACKGROUND: Heart failure (HF) is considered a condition in which a portion of hospital admissions are preventable if timely and appropriate outpatient care management occurs. Facility readmission rates for HF are reportable and subject to penalty. Both military and civilian healthcare systems have fiscal responsibility and are accountable for successful disease management. Therefore, best practices and evidence-based strategies to reduce readmissions are in critical demand. However, translating best evidence into practice can be challenging due to the complexities of the healthcare system.
OBJECTIVE: This crosswalk paper provides strategies and considerations for nurses planning HF readmission reduction initiatives.
METHODS: Insight regarding implementation strategies, challenges, successes, and lessons learned is shared through a framework-guided description of two separate but similar HF readmission reduction projects conducted in military and civilian healthcare facilities.
RESULTS: Lessons learned suggest defined and attainable outcomes, multidisciplinary inclusivity, redundancy in roles, greater collaboration, and engagement with stakeholders are most beneficial when initiated before dedicating resources and continuously throughout practice change implementation, maintenance, and sustainment.
CONCLUSIONS: The authors advocate for interdisciplinary evidence-based practice consortiums to share lessons learned that may promote success potential and optimize return on invested time and efforts in the same or similar initiatives-in this instance, reducing 30-day readmissions for HF patients.

To present an emerging innovative care model that supports participation and thriving by older adults in residential care, by introduction to new technology and mobilizing volunteer services.
Qualitative, exploratory study, introducing tablet computers to 15 older adults in two municipalities.
The intervention encompassed weekly workshops over the course of 1 year with volunteer adolescents as personal tutors. Observations of workshops, interviews with nurses, and repeated semistructured interviews with older adult participants eliciting their perspective on use, experiences, perceived usefulness, and overall evaluation of the intervention.
A model of four components is suggested to support participation and thriving by older adults in residential care: (a) simplified tools: iPad-technology relatively easy to use; (b) person-centered process: one-to-one tutoring following each individual\'s own pace; (c) young volunteers to teach technology, establishing an intergenerational arena; and (d) being mindful of driving forces that encourage use and learning. We found that all kinds of use and all levels of mastery generated a sense of pride that supported thriving and enjoyment.
These findings support the use of new technology and use of volunteer services for sustaining thriving in older adults. The person-centered approach stimulates use of the tablet, and participants showed enjoyment, more social participation, and reported subjective experiences of thriving.
Innovative models of care that prevent (or postpone) functional decline and support thriving in older adults are highly sought after in health care. A model that systematically involves volunteer services comes with potentials to alleviate nurses\' workload, and then the intervention is seen as a manageable and low-cost initiative in residential care.

Transitional care is an emerging model of health care designed to decrease preventable adverse events and associated utilization of health care through temporary follow-up after hospital discharge. This study describes the approaches and outcomes of two distinct transitional care programs serving different populations: one is provided by master\'s-prepared clinical nurse specialists (CNS) with a chronic disease self-management focus, another by physicians specializing in palliative care (PPCs). Existing research has shown that transitional care programs with intensive follow-up reduce hospitalizations, emergency department (ED) visits, and costs. Few studies, however, have included side-by-side descriptions of the efficacy of transitional care programs varying by healthcare providers or program focus.
This is a retrospective cohort study comparing the number of ED visits and hospitalizations in the 120 days before and after the intervention for patients enrolled in each transitional care program. Each program included post-hospitalization home visits, but included differences in program focus (chronic disease vs. palliative), assessment and interventions, and population (rural vs. urban). Data from participants in the CNS program (September 2014 to December 2014) were analyzed (n = 98). The average age of participants was 69 years and 65% were female. Data were collected from patients from the PPC program from September 2014 to April 2015 (n = 71). Thirty participants died within 120 days after the intervention and were excluded; the remaining 41 were included in the analysis. Participants had an average age of 81 years and 63% were female.
For the CNS program, a secondary analysis of existing data was performed. For the PPC program, a review of patient charts was done to collect data on encounters. A Wilcoxon matched-pairs signed-rank test was performed to test for significance.
Patients in the CNS intervention had significantly fewer ED visits (p < .005) and hospitalizations (p < .005) in the 4 months after the intervention than in the 4 months before the intervention. Patients in the PPC program had a nonsignificant reduction in ED visits (p = .327) and a significant reduction in hospitalizations postintervention (p = .03).
Both transitional programs have value in decreasing rehospitalizations. The CNS intervention also significantly reduced ED visits for their target population. Further study with randomized controlled trials is needed to allow for a better understanding of the healthcare workforce best fitted to enhance transitional care outcomes. Future study to examine the cost savings of each of the interventions is also needed.
Transitional care programs have the potential to prevent unnecessary utilization of health care at the critical periods of transition that leave patients vulnerable to adverse events and poor outcomes.

OBJECTIVE: The present research study was conducted with the objective of determining the effect of uterine and nipple stimulation on induction with oxytocin and the birth process.
METHODS: A randomized controlled experiment was conducted at the maternity ward of a state hospital located in the province of Sivas in Turkey. Three hundred ninety pregnant women who were giving birth via vaginal delivery were randomly assigned to three groups (nipple stimulation, uterine stimulation, control). After the birth, the groups were assessed in terms of the birth duration and synthetic induction with oxytocin. Statistical analyses were performed through the use of SPSS 14.0 software and included analysis of variance, Tukey\'s test, Dunnett\'s test, Tamhane\'s T2 test, and chi-square test.
RESULTS: The study established statistically significant differences (p < .05) among the groups in terms of the average durations of the first, second and third phases of the action of birth, the status concerning delivery by C-section and the application of labor induction. The phases of birth were shorter for the nipple stimulation group (first phase: 3.8 hours, second phase: 16 minutes, third phase: 5 minutes) and the uterine stimulation group (first phase: 4.0 hours, second phase: 21 minutes, third phase: 6 minutes) when compared to the control group (first phase: 6.8 hours, second phase: 27 minutes, third phase: 6 minutes). In the control group, 89.2% of the pregnant women were subject to labor induction and 8.5% to cesarean section. No women in the nipple stimulation group or uterine stimulation group had a cesarean section.
CONCLUSIONS: Nipple and uterine stimulation reduce the frequency of elective labor induction, the rate of relevant complications, and support normal vaginal birth by providing endogenous labor induction. Therefore, these interventions should be considered for pregnant women in labor.

BACKGROUND: Although the literature has noted the positive effects of facilitation in implementation research, little is known about what facilitators do or how they increase adoption of a program. The purpose of this study was to understand internal facilitation activities in implementing a national safe patient handling program from the perspective of facility coordinators who implemented the program.
METHODS: Using a qualitative descriptive design, data were collected in five focus groups at two international Safe Patient Handling and Mobility Conferences. Participants were 38 facility coordinators implementing a safe patient handling program in the Department of Veterans Affairs medical centers throughout the United States. Data were analyzed using direct content analysis to gather descriptions of internal facilitation.
RESULTS: The internal facilitation process involved engaging multiple disciplines and levels of leadership for implementation. Fifty-four facilitation activities were identified, including five activities not currently listed in an existing taxonomy. Key characteristics and skills of facilitators included persistence, credibility and clinical experience, and leadership and project management experience. Themes were mapped onto an existing framework and taxonomy of facilitation activities.
CONCLUSIONS: Internal facilitation is both an implementation intervention and a process involving a wide range of activities. The findings provide an understanding of what internal facilitators are doing to support practice changes and the characteristics and skills of internal facilitators that are likely to result in long-term organizational change. Five recommendations for action address organizations, senior leaders, and internal facilitators.