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Papers by Ramona Whichello

Journal of cultural diversity, Jul 1, 2013

Abstract: The increasingly diverse population of the United States poses many challenges to the p... more Abstract: The increasingly diverse population of the United States poses many challenges to the provision of health care services. Academic health care centers, community health clinics, and private providers all struggle to make services accessible and acceptable to people of many cultures, and who speak many languages. A level of cultural competence is required and organizations are having a difficult time incorporating knowledge, attitude and value changes. Studies continue to document differences in the quality of care that racial and ethnic groups are receiving. Nursing leaders are in a critical position to influence environments to optimize cultural and linguistic services. This document discusses the effectiveness of a cultural competence focus in a new master program in nurse administration. Hopefully, other educational programs will utilize lessons learned for nurse administrators.Key Words: Cultural Competence, Nurse Administrators and Leaders, Master of Science ProgramThe Department of Health and Human Services (DHHS) Office of Minority Health (2001) published fourteen standards for Culturally and Linguistically Appropriate Services (CLAS) that strive to achieve goals of ensuring access to care, quality care (patient centered and safe), and reducing disparities in health and treatment. These standards assist in clarifying Title IV of the Civil Rights Act of 1968, and require agencies that receive federal funds to provide language assistant services to people with limited use of tne English language. These services must be provided without charge and within a reasonable timeframe at all times the agency is open at all points of contact. Some agencies nave dealt with these mandates by fully embracing opportunities to enhance quality of care that is provided to diverse populations. Others have taken more limited measures attempting to meet the standards.Studies that have evaluated initiatives by agencies enhancing the delivery of cultural and linguistic services have recommended educational interventions for staff and providers (Medrano et al., 2005; Hunt, 2007; and Raso, 2006). In response, many educational efforts have been implemented in academic and practice settings. Bull & Miller (2008) described a PhD program designed to prepare teacher-scholars in leadership to reduce health disparities. Mun oz et al., (2009) discussed an interdisciplinary professional course to enhance provider cultural competence. Other authors who have discussed professional and staff development in an educational curricular in cultural competence include Braithwaite & Majumdar, 2006; Ndiwane et al., 2004.Measuring the effectiveness of cultural competence training has been extremely difficult, in part because of a lack of a clear definition of cultural competence and inadequate tools for measurement. Most models of cultural competence have included cognitive, affective and behavioral components. Some existing tools only measure the participant's self-perception of competence, and have been shown to be fraught with potential errors in establishing reliability, validity and social desirability bias. Other studies on the effectiveness of educational interventions designed to improve cultural competence relied on self-report measures, such as cognitive, which only captures one aspect of the concept and independent verification of responses that are costly and labor intensive.Barriers to the provision of cultural competent care have been cited that have little to do with content knowledge and more to do with the provider's personal choices and values. Changing the habitual beliefs and behaviors of adults is difficult when the changes require them to "first confront and overcome self-deception and bias" (Swanson, 2004, p. 207). Being culturally competent requires the complex mental ana attitudinal skills of adaptation to change, respect for difference, being sensitive with empathy, willingness to accept challenges, and a strong commitment to equality and social justice. …

Journal of Holistic Nursing, Aug 30, 2018

To evaluate the effectiveness of implementing yoga into the treatment of patients with chronic lo... more To evaluate the effectiveness of implementing yoga into the treatment of patients with chronic low back pain. Design: Quantitative analysis with opportunity for qualitative feedback. Method: Effectiveness of this complementary treatment was assessed using a pretest/posttest design of patients who volunteered to participate in yoga classes as part of their back pain management. Measurements included low back pain rating, perception of back pain interference with daily activities, and self-efficacy in dealing with chronic low back pain. Findings: Although no statistically significant findings were found due to the small sample size, most participants demonstrated improved individual scores on all measurement surveys including qualitative comments. Conclusion: Based on the findings of this pilot study, further studies on implementing yoga into the treatment of chronic low back pain are encouraged.

Nursing Management, Feb 1, 2010

At Mission Hospitals in Asheville, NC, Brenda B. Harton is director of clinical support and devel... more At Mission Hospitals in Asheville, NC, Brenda B. Harton is director of clinical support and development, Ramona C. Whichello is chief nursing officer and vice president of operations, and Lou Ellen Hammond is vice president of operations.

Journal of Nursing Education, Nov 1, 2019

Background: Despite increased awareness of the importance of cultural competence in the reduction... more Background: Despite increased awareness of the importance of cultural competence in the reduction of health care disparities, the nursing profession does not reflect the patient demographics of the United States. The purpose of this article is to report the results of a comprehensive review of the experiences of nontraditional nursing students in undergraduate nursing programs and the interventions used by nursing programs to increase their success. Method: Data from 13 studies were extracted, summarized, and synthesized. This review was organized using concepts from Jeffreys' nursing undergraduate retention and success model. Results: Nontraditional nursing students faced unique challenges when pursuing undergraduate nursing education. Conclusion: This review highlighted the need for continued efforts to support nontraditional students that pursue nursing education. Future research is necessary to identify and prioritize interventions that enhance nontraditional students' experiences and improve student outcomes. [ J Nurs Educ . 2019;58(11):641–646.]

Journal of Nursing Management, Nov 16, 2012

The aim of this review is to synthesize the current body of knowledge concerning transitional car... more The aim of this review is to synthesize the current body of knowledge concerning transitional care for patients 65 years of age and older moving from the acute care setting to home. Transitional care is a timely topic as hospital days of care decrease whereas patient needs grow more complex as a result of aging populations. This review considers evidence-based research as well as reports, case studies and literature reviews related to transitional care. International articles are included. The authors explore transitional care through the lens of wicked problems; problems that appear seemingly intractable and are characterized by inter-related dilemmas, contradictory agendas, and multi-layered societal, economic and political influences. Outcome measures of success, barriers to achieving successful transitional care and effectiveness of interventions are investigated. While the literature offers specific strategies that positively affect transitional care, there are few strategies that do not negatively affect an alternate agenda. Conscientious leaders should consider transitional care in the context of its wicked nature in order to achieve optimal patient care. Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers.

Nursing Management, Dec 1, 2016

Journal for Healthcare Quality, Mar 1, 2013

The aim of this review is to evaluate the application of value-added processes in healthcare, wit... more The aim of this review is to evaluate the application of value-added processes in healthcare, with an emphasis on their effects on bedside nursing. Literature relevant to Lean methodology and inpatient care was reviewed, excluding all research related to other service lines (i.e., surgical services, emergency services, laboratory, radiology, etc.). Increased value is also an important tenet of transforming care at the bedside (TCAB), an initiative launched by the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF). Therefore, articles concerning TCAB were also included in this review. A systematic study of the literature revealed varied applications of Lean principles in practice, ranging from the implementation of a single tool, to full organizational restructuring. All articles reviewed reported positive results, although the majority lacked strong supporting evidence for claims of improvement. Even though there is some indication that the application of Lean principles to nursing processes is successful in improving specific outcomes, the authors cannot conclude that the implementation of Lean methodology or TCAB greatly influences direct patient care, or increases time spent at the bedside.

Nursing education perspectives, Jul 1, 2018

AIM This review of studies conducted since the 2011 publication of the Institute of Medicine (IOM... more AIM This review of studies conducted since the 2011 publication of the Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” evaluates the current state of evidence showing an association between an increased ratio of BSN-prepared nursing staff and improved patient outcomes. BACKGROUND The IOM established a nationwide goal to increase the number of BSN nurses to 80 percent by 2020 to meet the challenges seen in today’s health care environment. METHOD The literature search included a five-year (2011-2016) span following the initial release of the IOM report. RESULTS Mortality, failure to rescue, and readmission rates all decrease as the proportion of BSN nurses is increased in a nursing staffing ratio. CONCLUSION It is the recommendation of this project that nurse leaders and organizations support the findings of this literature review and the IOM BSN recommendation.

Journal of Christian nursing, 2018

ABSTRACT: A literature review was conducted to evaluate existing knowledge of incivility in the n... more ABSTRACT: A literature review was conducted to evaluate existing knowledge of incivility in the nursing workplace through the lens of nursing ethics and spirituality. Study articles presented a consistent theme of improved organizational commitment and job satisfaction when spirituality was injected into the workplace. It seems plausible to suggest a positive correlation between spirituality and more civil environments in nursing workplaces.

Journal of Nursing Education, 2019

Background: Despite increased awareness of the importance of cultural competence in the reduction... more Background: Despite increased awareness of the importance of cultural competence in the reduction of health care disparities, the nursing profession does not reflect the patient demographics of the United States. The purpose of this article is to report the results of a comprehensive review of the experiences of nontraditional nursing students in undergraduate nursing programs and the interventions used by nursing programs to increase their success. Method: Data from 13 studies were extracted, summarized, and synthesized. This review was organized using concepts from Jeffreys' nursing undergraduate retention and success model. Results: Nontraditional nursing students faced unique challenges when pursuing undergraduate nursing education. Conclusion: This review highlighted the need for continued efforts to support nontraditional students that pursue nursing education. Future research is necessary to identify and prioritize interventions that enhance nontraditional students' e...

Journal of Radiology Nursing, 2018

Ambulatory education holds its own unique challenges to patient education. The purpose of this li... more Ambulatory education holds its own unique challenges to patient education. The purpose of this literature review was to examine the effectiveness of audiovisual teaching methodologies used for patient education in the interventional radiology (IR) adult ambulatory population. This literature review included evidencebased literature, peer-reviewed articles, and clinical practice guidelines. The results of the literature review revealed positive outcomes in the use of visual aids during the education process. Individual studies showed improved information retention and increased patient satisfaction when audiovisual aids were used. Further study is needed to broaden the scope of research in the use of audiovisual aids during education in the IR ambulatory setting and best practices on educational tool development.

Journal of Holistic Nursing, 2018

Purpose: To evaluate the effectiveness of implementing yoga into the treatment of patients with c... more Purpose: To evaluate the effectiveness of implementing yoga into the treatment of patients with chronic low back pain. Design: Quantitative analysis with opportunity for qualitative feedback. Method: Effectiveness of this complementary treatment was assessed using a pretest/posttest design of patients who volunteered to participate in yoga classes as part of their back pain management. Measurements included low back pain rating, perception of back pain interference with daily activities, and self-efficacy in dealing with chronic low back pain. Findings: Although no statistically significant findings were found due to the small sample size, most participants demonstrated improved individual scores on all measurement surveys including qualitative comments. Conclusion: Based on the findings of this pilot study, further studies on implementing yoga into the treatment of chronic low back pain are encouraged.

Nursing Education Perspectives, 2018

AIM This review of studies conducted since the 2011 publication of the Institute of Medicine (IOM... more AIM This review of studies conducted since the 2011 publication of the Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” evaluates the current state of evidence showing an association between an increased ratio of BSN-prepared nursing staff and improved patient outcomes. BACKGROUND The IOM established a nationwide goal to increase the number of BSN nurses to 80 percent by 2020 to meet the challenges seen in today’s health care environment. METHOD The literature search included a five-year (2011-2016) span following the initial release of the IOM report. RESULTS Mortality, failure to rescue, and readmission rates all decrease as the proportion of BSN nurses is increased in a nursing staffing ratio. CONCLUSION It is the recommendation of this project that nurse leaders and organizations support the findings of this literature review and the IOM BSN recommendation.

Journal of Christian Nursing, 2018

ABSTRACT: A literature review was conducted to evaluate existing knowledge of incivility in the n... more ABSTRACT: A literature review was conducted to evaluate existing knowledge of incivility in the nursing workplace through the lens of nursing ethics and spirituality. Study articles presented a consistent theme of improved organizational commitment and job satisfaction when spirituality was injected into the workplace. It seems plausible to suggest a positive correlation between spirituality and more civil environments in nursing workplaces.

Journal of Cultural Diversity, Jul 1, 2013

Abstract: The increasingly diverse population of the United States poses many challenges to the p... more Abstract: The increasingly diverse population of the United States poses many challenges to the provision of health care services. Academic health care centers, community health clinics, and private providers all struggle to make services accessible and acceptable to people of many cultures, and who speak many languages. A level of cultural competence is required and organizations are having a difficult time incorporating knowledge, attitude and value changes. Studies continue to document differences in the quality of care that racial and ethnic groups are receiving. Nursing leaders are in a critical position to influence environments to optimize cultural and linguistic services. This document discusses the effectiveness of a cultural competence focus in a new master program in nurse administration. Hopefully, other educational programs will utilize lessons learned for nurse administrators.Key Words: Cultural Competence, Nurse Administrators and Leaders, Master of Science ProgramThe Department of Health and Human Services (DHHS) Office of Minority Health (2001) published fourteen standards for Culturally and Linguistically Appropriate Services (CLAS) that strive to achieve goals of ensuring access to care, quality care (patient centered and safe), and reducing disparities in health and treatment. These standards assist in clarifying Title IV of the Civil Rights Act of 1968, and require agencies that receive federal funds to provide language assistant services to people with limited use of tne English language. These services must be provided without charge and within a reasonable timeframe at all times the agency is open at all points of contact. Some agencies nave dealt with these mandates by fully embracing opportunities to enhance quality of care that is provided to diverse populations. Others have taken more limited measures attempting to meet the standards.Studies that have evaluated initiatives by agencies enhancing the delivery of cultural and linguistic services have recommended educational interventions for staff and providers (Medrano et al., 2005; Hunt, 2007; and Raso, 2006). In response, many educational efforts have been implemented in academic and practice settings. Bull & Miller (2008) described a PhD program designed to prepare teacher-scholars in leadership to reduce health disparities. Mun oz et al., (2009) discussed an interdisciplinary professional course to enhance provider cultural competence. Other authors who have discussed professional and staff development in an educational curricular in cultural competence include Braithwaite & Majumdar, 2006; Ndiwane et al., 2004.Measuring the effectiveness of cultural competence training has been extremely difficult, in part because of a lack of a clear definition of cultural competence and inadequate tools for measurement. Most models of cultural competence have included cognitive, affective and behavioral components. Some existing tools only measure the participant's self-perception of competence, and have been shown to be fraught with potential errors in establishing reliability, validity and social desirability bias. Other studies on the effectiveness of educational interventions designed to improve cultural competence relied on self-report measures, such as cognitive, which only captures one aspect of the concept and independent verification of responses that are costly and labor intensive.Barriers to the provision of cultural competent care have been cited that have little to do with content knowledge and more to do with the provider's personal choices and values. Changing the habitual beliefs and behaviors of adults is difficult when the changes require them to "first confront and overcome self-deception and bias" (Swanson, 2004, p. 207). Being culturally competent requires the complex mental ana attitudinal skills of adaptation to change, respect for difference, being sensitive with empathy, willingness to accept challenges, and a strong commitment to equality and social justice. …

Nursing Management (Springhouse), 2010

At Mission Hospitals in Asheville, NC, Brenda B. Harton is director of clinical support and devel... more At Mission Hospitals in Asheville, NC, Brenda B. Harton is director of clinical support and development, Ramona C. Whichello is chief nursing officer and vice president of operations, and Lou Ellen Hammond is vice president of operations.

Journal of Nursing Management, 2012

The aim of this review is to synthesize the current body of knowledge concerning transitional car... more The aim of this review is to synthesize the current body of knowledge concerning transitional care for patients 65 years of age and older moving from the acute care setting to home. Transitional care is a timely topic as hospital days of care decrease whereas patient needs grow more complex as a result of aging populations. This review considers evidence-based research as well as reports, case studies and literature reviews related to transitional care. International articles are included. The authors explore transitional care through the lens of wicked problems; problems that appear seemingly intractable and are characterized by inter-related dilemmas, contradictory agendas, and multi-layered societal, economic and political influences. Outcome measures of success, barriers to achieving successful transitional care and effectiveness of interventions are investigated. While the literature offers specific strategies that positively affect transitional care, there are few strategies that do not negatively affect an alternate agenda. Conscientious leaders should consider transitional care in the context of its wicked nature in order to achieve optimal patient care. Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers.

Journal for Healthcare Quality, 2013

The aim of this review is to evaluate the application of value-added processes in healthcare, wit... more The aim of this review is to evaluate the application of value-added processes in healthcare, with an emphasis on their effects on bedside nursing. Literature relevant to Lean methodology and inpatient care was reviewed, excluding all research related to other service lines (i.e., surgical services, emergency services, laboratory, radiology, etc.). Increased value is also an important tenet of transforming care at the bedside (TCAB), an initiative launched by the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF). Therefore, articles concerning TCAB were also included in this review. A systematic study of the literature revealed varied applications of Lean principles in practice, ranging from the implementation of a single tool, to full organizational restructuring. All articles reviewed reported positive results, although the majority lacked strong supporting evidence for claims of improvement. Even though there is some indication that the application of Lean principles to nursing processes is successful in improving specific outcomes, the authors cannot conclude that the implementation of Lean methodology or TCAB greatly influences direct patient care, or increases time spent at the bedside.

Journal of cultural diversity, Jul 1, 2013

Abstract: The increasingly diverse population of the United States poses many challenges to the p... more Abstract: The increasingly diverse population of the United States poses many challenges to the provision of health care services. Academic health care centers, community health clinics, and private providers all struggle to make services accessible and acceptable to people of many cultures, and who speak many languages. A level of cultural competence is required and organizations are having a difficult time incorporating knowledge, attitude and value changes. Studies continue to document differences in the quality of care that racial and ethnic groups are receiving. Nursing leaders are in a critical position to influence environments to optimize cultural and linguistic services. This document discusses the effectiveness of a cultural competence focus in a new master program in nurse administration. Hopefully, other educational programs will utilize lessons learned for nurse administrators.Key Words: Cultural Competence, Nurse Administrators and Leaders, Master of Science ProgramThe Department of Health and Human Services (DHHS) Office of Minority Health (2001) published fourteen standards for Culturally and Linguistically Appropriate Services (CLAS) that strive to achieve goals of ensuring access to care, quality care (patient centered and safe), and reducing disparities in health and treatment. These standards assist in clarifying Title IV of the Civil Rights Act of 1968, and require agencies that receive federal funds to provide language assistant services to people with limited use of tne English language. These services must be provided without charge and within a reasonable timeframe at all times the agency is open at all points of contact. Some agencies nave dealt with these mandates by fully embracing opportunities to enhance quality of care that is provided to diverse populations. Others have taken more limited measures attempting to meet the standards.Studies that have evaluated initiatives by agencies enhancing the delivery of cultural and linguistic services have recommended educational interventions for staff and providers (Medrano et al., 2005; Hunt, 2007; and Raso, 2006). In response, many educational efforts have been implemented in academic and practice settings. Bull & Miller (2008) described a PhD program designed to prepare teacher-scholars in leadership to reduce health disparities. Mun oz et al., (2009) discussed an interdisciplinary professional course to enhance provider cultural competence. Other authors who have discussed professional and staff development in an educational curricular in cultural competence include Braithwaite & Majumdar, 2006; Ndiwane et al., 2004.Measuring the effectiveness of cultural competence training has been extremely difficult, in part because of a lack of a clear definition of cultural competence and inadequate tools for measurement. Most models of cultural competence have included cognitive, affective and behavioral components. Some existing tools only measure the participant's self-perception of competence, and have been shown to be fraught with potential errors in establishing reliability, validity and social desirability bias. Other studies on the effectiveness of educational interventions designed to improve cultural competence relied on self-report measures, such as cognitive, which only captures one aspect of the concept and independent verification of responses that are costly and labor intensive.Barriers to the provision of cultural competent care have been cited that have little to do with content knowledge and more to do with the provider's personal choices and values. Changing the habitual beliefs and behaviors of adults is difficult when the changes require them to "first confront and overcome self-deception and bias" (Swanson, 2004, p. 207). Being culturally competent requires the complex mental ana attitudinal skills of adaptation to change, respect for difference, being sensitive with empathy, willingness to accept challenges, and a strong commitment to equality and social justice. …

Journal of Holistic Nursing, Aug 30, 2018

To evaluate the effectiveness of implementing yoga into the treatment of patients with chronic lo... more To evaluate the effectiveness of implementing yoga into the treatment of patients with chronic low back pain. Design: Quantitative analysis with opportunity for qualitative feedback. Method: Effectiveness of this complementary treatment was assessed using a pretest/posttest design of patients who volunteered to participate in yoga classes as part of their back pain management. Measurements included low back pain rating, perception of back pain interference with daily activities, and self-efficacy in dealing with chronic low back pain. Findings: Although no statistically significant findings were found due to the small sample size, most participants demonstrated improved individual scores on all measurement surveys including qualitative comments. Conclusion: Based on the findings of this pilot study, further studies on implementing yoga into the treatment of chronic low back pain are encouraged.

Nursing Management, Feb 1, 2010

At Mission Hospitals in Asheville, NC, Brenda B. Harton is director of clinical support and devel... more At Mission Hospitals in Asheville, NC, Brenda B. Harton is director of clinical support and development, Ramona C. Whichello is chief nursing officer and vice president of operations, and Lou Ellen Hammond is vice president of operations.

Journal of Nursing Education, Nov 1, 2019

Background: Despite increased awareness of the importance of cultural competence in the reduction... more Background: Despite increased awareness of the importance of cultural competence in the reduction of health care disparities, the nursing profession does not reflect the patient demographics of the United States. The purpose of this article is to report the results of a comprehensive review of the experiences of nontraditional nursing students in undergraduate nursing programs and the interventions used by nursing programs to increase their success. Method: Data from 13 studies were extracted, summarized, and synthesized. This review was organized using concepts from Jeffreys' nursing undergraduate retention and success model. Results: Nontraditional nursing students faced unique challenges when pursuing undergraduate nursing education. Conclusion: This review highlighted the need for continued efforts to support nontraditional students that pursue nursing education. Future research is necessary to identify and prioritize interventions that enhance nontraditional students' experiences and improve student outcomes. [ J Nurs Educ . 2019;58(11):641–646.]

Journal of Nursing Management, Nov 16, 2012

The aim of this review is to synthesize the current body of knowledge concerning transitional car... more The aim of this review is to synthesize the current body of knowledge concerning transitional care for patients 65 years of age and older moving from the acute care setting to home. Transitional care is a timely topic as hospital days of care decrease whereas patient needs grow more complex as a result of aging populations. This review considers evidence-based research as well as reports, case studies and literature reviews related to transitional care. International articles are included. The authors explore transitional care through the lens of wicked problems; problems that appear seemingly intractable and are characterized by inter-related dilemmas, contradictory agendas, and multi-layered societal, economic and political influences. Outcome measures of success, barriers to achieving successful transitional care and effectiveness of interventions are investigated. While the literature offers specific strategies that positively affect transitional care, there are few strategies that do not negatively affect an alternate agenda. Conscientious leaders should consider transitional care in the context of its wicked nature in order to achieve optimal patient care. Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers.

Nursing Management, Dec 1, 2016

Journal for Healthcare Quality, Mar 1, 2013

The aim of this review is to evaluate the application of value-added processes in healthcare, wit... more The aim of this review is to evaluate the application of value-added processes in healthcare, with an emphasis on their effects on bedside nursing. Literature relevant to Lean methodology and inpatient care was reviewed, excluding all research related to other service lines (i.e., surgical services, emergency services, laboratory, radiology, etc.). Increased value is also an important tenet of transforming care at the bedside (TCAB), an initiative launched by the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF). Therefore, articles concerning TCAB were also included in this review. A systematic study of the literature revealed varied applications of Lean principles in practice, ranging from the implementation of a single tool, to full organizational restructuring. All articles reviewed reported positive results, although the majority lacked strong supporting evidence for claims of improvement. Even though there is some indication that the application of Lean principles to nursing processes is successful in improving specific outcomes, the authors cannot conclude that the implementation of Lean methodology or TCAB greatly influences direct patient care, or increases time spent at the bedside.

Nursing education perspectives, Jul 1, 2018

AIM This review of studies conducted since the 2011 publication of the Institute of Medicine (IOM... more AIM This review of studies conducted since the 2011 publication of the Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” evaluates the current state of evidence showing an association between an increased ratio of BSN-prepared nursing staff and improved patient outcomes. BACKGROUND The IOM established a nationwide goal to increase the number of BSN nurses to 80 percent by 2020 to meet the challenges seen in today’s health care environment. METHOD The literature search included a five-year (2011-2016) span following the initial release of the IOM report. RESULTS Mortality, failure to rescue, and readmission rates all decrease as the proportion of BSN nurses is increased in a nursing staffing ratio. CONCLUSION It is the recommendation of this project that nurse leaders and organizations support the findings of this literature review and the IOM BSN recommendation.

Journal of Christian nursing, 2018

ABSTRACT: A literature review was conducted to evaluate existing knowledge of incivility in the n... more ABSTRACT: A literature review was conducted to evaluate existing knowledge of incivility in the nursing workplace through the lens of nursing ethics and spirituality. Study articles presented a consistent theme of improved organizational commitment and job satisfaction when spirituality was injected into the workplace. It seems plausible to suggest a positive correlation between spirituality and more civil environments in nursing workplaces.

Journal of Nursing Education, 2019

Background: Despite increased awareness of the importance of cultural competence in the reduction... more Background: Despite increased awareness of the importance of cultural competence in the reduction of health care disparities, the nursing profession does not reflect the patient demographics of the United States. The purpose of this article is to report the results of a comprehensive review of the experiences of nontraditional nursing students in undergraduate nursing programs and the interventions used by nursing programs to increase their success. Method: Data from 13 studies were extracted, summarized, and synthesized. This review was organized using concepts from Jeffreys' nursing undergraduate retention and success model. Results: Nontraditional nursing students faced unique challenges when pursuing undergraduate nursing education. Conclusion: This review highlighted the need for continued efforts to support nontraditional students that pursue nursing education. Future research is necessary to identify and prioritize interventions that enhance nontraditional students' e...

Journal of Radiology Nursing, 2018

Ambulatory education holds its own unique challenges to patient education. The purpose of this li... more Ambulatory education holds its own unique challenges to patient education. The purpose of this literature review was to examine the effectiveness of audiovisual teaching methodologies used for patient education in the interventional radiology (IR) adult ambulatory population. This literature review included evidencebased literature, peer-reviewed articles, and clinical practice guidelines. The results of the literature review revealed positive outcomes in the use of visual aids during the education process. Individual studies showed improved information retention and increased patient satisfaction when audiovisual aids were used. Further study is needed to broaden the scope of research in the use of audiovisual aids during education in the IR ambulatory setting and best practices on educational tool development.

Journal of Holistic Nursing, 2018

Purpose: To evaluate the effectiveness of implementing yoga into the treatment of patients with c... more Purpose: To evaluate the effectiveness of implementing yoga into the treatment of patients with chronic low back pain. Design: Quantitative analysis with opportunity for qualitative feedback. Method: Effectiveness of this complementary treatment was assessed using a pretest/posttest design of patients who volunteered to participate in yoga classes as part of their back pain management. Measurements included low back pain rating, perception of back pain interference with daily activities, and self-efficacy in dealing with chronic low back pain. Findings: Although no statistically significant findings were found due to the small sample size, most participants demonstrated improved individual scores on all measurement surveys including qualitative comments. Conclusion: Based on the findings of this pilot study, further studies on implementing yoga into the treatment of chronic low back pain are encouraged.

Nursing Education Perspectives, 2018

AIM This review of studies conducted since the 2011 publication of the Institute of Medicine (IOM... more AIM This review of studies conducted since the 2011 publication of the Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” evaluates the current state of evidence showing an association between an increased ratio of BSN-prepared nursing staff and improved patient outcomes. BACKGROUND The IOM established a nationwide goal to increase the number of BSN nurses to 80 percent by 2020 to meet the challenges seen in today’s health care environment. METHOD The literature search included a five-year (2011-2016) span following the initial release of the IOM report. RESULTS Mortality, failure to rescue, and readmission rates all decrease as the proportion of BSN nurses is increased in a nursing staffing ratio. CONCLUSION It is the recommendation of this project that nurse leaders and organizations support the findings of this literature review and the IOM BSN recommendation.

Journal of Christian Nursing, 2018

ABSTRACT: A literature review was conducted to evaluate existing knowledge of incivility in the n... more ABSTRACT: A literature review was conducted to evaluate existing knowledge of incivility in the nursing workplace through the lens of nursing ethics and spirituality. Study articles presented a consistent theme of improved organizational commitment and job satisfaction when spirituality was injected into the workplace. It seems plausible to suggest a positive correlation between spirituality and more civil environments in nursing workplaces.

Journal of Cultural Diversity, Jul 1, 2013

Abstract: The increasingly diverse population of the United States poses many challenges to the p... more Abstract: The increasingly diverse population of the United States poses many challenges to the provision of health care services. Academic health care centers, community health clinics, and private providers all struggle to make services accessible and acceptable to people of many cultures, and who speak many languages. A level of cultural competence is required and organizations are having a difficult time incorporating knowledge, attitude and value changes. Studies continue to document differences in the quality of care that racial and ethnic groups are receiving. Nursing leaders are in a critical position to influence environments to optimize cultural and linguistic services. This document discusses the effectiveness of a cultural competence focus in a new master program in nurse administration. Hopefully, other educational programs will utilize lessons learned for nurse administrators.Key Words: Cultural Competence, Nurse Administrators and Leaders, Master of Science ProgramThe Department of Health and Human Services (DHHS) Office of Minority Health (2001) published fourteen standards for Culturally and Linguistically Appropriate Services (CLAS) that strive to achieve goals of ensuring access to care, quality care (patient centered and safe), and reducing disparities in health and treatment. These standards assist in clarifying Title IV of the Civil Rights Act of 1968, and require agencies that receive federal funds to provide language assistant services to people with limited use of tne English language. These services must be provided without charge and within a reasonable timeframe at all times the agency is open at all points of contact. Some agencies nave dealt with these mandates by fully embracing opportunities to enhance quality of care that is provided to diverse populations. Others have taken more limited measures attempting to meet the standards.Studies that have evaluated initiatives by agencies enhancing the delivery of cultural and linguistic services have recommended educational interventions for staff and providers (Medrano et al., 2005; Hunt, 2007; and Raso, 2006). In response, many educational efforts have been implemented in academic and practice settings. Bull & Miller (2008) described a PhD program designed to prepare teacher-scholars in leadership to reduce health disparities. Mun oz et al., (2009) discussed an interdisciplinary professional course to enhance provider cultural competence. Other authors who have discussed professional and staff development in an educational curricular in cultural competence include Braithwaite & Majumdar, 2006; Ndiwane et al., 2004.Measuring the effectiveness of cultural competence training has been extremely difficult, in part because of a lack of a clear definition of cultural competence and inadequate tools for measurement. Most models of cultural competence have included cognitive, affective and behavioral components. Some existing tools only measure the participant's self-perception of competence, and have been shown to be fraught with potential errors in establishing reliability, validity and social desirability bias. Other studies on the effectiveness of educational interventions designed to improve cultural competence relied on self-report measures, such as cognitive, which only captures one aspect of the concept and independent verification of responses that are costly and labor intensive.Barriers to the provision of cultural competent care have been cited that have little to do with content knowledge and more to do with the provider's personal choices and values. Changing the habitual beliefs and behaviors of adults is difficult when the changes require them to "first confront and overcome self-deception and bias" (Swanson, 2004, p. 207). Being culturally competent requires the complex mental ana attitudinal skills of adaptation to change, respect for difference, being sensitive with empathy, willingness to accept challenges, and a strong commitment to equality and social justice. …

Nursing Management (Springhouse), 2010

At Mission Hospitals in Asheville, NC, Brenda B. Harton is director of clinical support and devel... more At Mission Hospitals in Asheville, NC, Brenda B. Harton is director of clinical support and development, Ramona C. Whichello is chief nursing officer and vice president of operations, and Lou Ellen Hammond is vice president of operations.

Journal of Nursing Management, 2012

The aim of this review is to synthesize the current body of knowledge concerning transitional car... more The aim of this review is to synthesize the current body of knowledge concerning transitional care for patients 65 years of age and older moving from the acute care setting to home. Transitional care is a timely topic as hospital days of care decrease whereas patient needs grow more complex as a result of aging populations. This review considers evidence-based research as well as reports, case studies and literature reviews related to transitional care. International articles are included. The authors explore transitional care through the lens of wicked problems; problems that appear seemingly intractable and are characterized by inter-related dilemmas, contradictory agendas, and multi-layered societal, economic and political influences. Outcome measures of success, barriers to achieving successful transitional care and effectiveness of interventions are investigated. While the literature offers specific strategies that positively affect transitional care, there are few strategies that do not negatively affect an alternate agenda. Conscientious leaders should consider transitional care in the context of its wicked nature in order to achieve optimal patient care. Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers.

Journal for Healthcare Quality, 2013

The aim of this review is to evaluate the application of value-added processes in healthcare, wit... more The aim of this review is to evaluate the application of value-added processes in healthcare, with an emphasis on their effects on bedside nursing. Literature relevant to Lean methodology and inpatient care was reviewed, excluding all research related to other service lines (i.e., surgical services, emergency services, laboratory, radiology, etc.). Increased value is also an important tenet of transforming care at the bedside (TCAB), an initiative launched by the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF). Therefore, articles concerning TCAB were also included in this review. A systematic study of the literature revealed varied applications of Lean principles in practice, ranging from the implementation of a single tool, to full organizational restructuring. All articles reviewed reported positive results, although the majority lacked strong supporting evidence for claims of improvement. Even though there is some indication that the application of Lean principles to nursing processes is successful in improving specific outcomes, the authors cannot conclude that the implementation of Lean methodology or TCAB greatly influences direct patient care, or increases time spent at the bedside.