The purpose of this mixed-methods pilot study was to explore the feasibility of using Second Life to conduct research and to describe nurses' experiences in using Second Life to facilitate nursing journal clubs.A QUAN→qual sequential design using survey and qualitative methods was used to guide scientific inquiry. Survey data were analyzed using descriptive statistics, and t, Mann-Whitney U, and χ tests were used to test for presurvey and postsurvey group differences. Journal club screencast recordings were thematically analyzed.This study was conducted in an Internet-accessible, 3-dimensional multiuser virtual environment.A convenience sample of registered nurses from 7 facilities consented to participate. Completed data from 29 presurveys and 20 postsurveys were included in data analyses.Overall, nurses reported a benefit in using Second Life to facilitate journal clubs. The Mann-Whitney U test identified (P < .05) improvement in 7 of 8 critical appraisal competencies after journal club activities: determining design, determining population, interpreting statistics, linking findings/conclusions, identifying limitations, identifying implications, and interpreting qualitative findings. Qualitative analyses of screencastings validated reports of improved critical appraisal competencies and identified 3 inworld themes: presence, learning strategies, and learning outcomes.Registered nurse study participants reported a benefit of using Second Life for nursing journal clubs. Participants perceived and demonstrated improvement in critical appraisal competencies.Further research is warranted on outcomes associated with nurses' appraisal of evidence for application to practice using a multiuser virtual environment.

A systematic review of the literature was conducted to identify the level of evidence and to describe the evidence on the transition from pediatric to adult healthcare services among youth with diabetes.The transition from pediatric to adult healthcare services is an expectation of youth with diabetes; however, little is known to guide policy and procedures on such transitions. DESCRIPTION OF PROJECT: The literature was first searched and screened according to predetermined criterion and then evaluated for level of evidence.There were 16 mixed qualitative and/or quantitative studies, 23 quantitative studies, and 2 expert opinion articles reviewed. Most of the evidence was from uncontrolled studies. Youth report challenges in making the transition in services. Delay in seeking adult services and poor clinic attendance are issues for these youth. However, it is unclear if these problems are a result of the transition in services. Several promising transition programs have been evaluated and, overall, are found acceptable and useful by youth. In general, evidence suggests that these programs improve glycemic control.More research is needed in this challenging area to guide policies and procedures.Expert opinion is a guide for policy and procedures at this point in time.

The purpose of this study was to examine the association of obstructive sleep apnea (OSA) with difficult intubation in patients undergoing general anesthesia requiring tracheal intubation.Using a retrospective, case-control study design, 90 adults with difficult tracheal intubation were compared with 81 gender-matched controls, between 2007 and 2010. Analyses included descriptive and inferential statistics, and multivariate regression was used to estimate predictors of difficult intubation while adjusting for patient demographics.In the univariate analysis, OSA was not associated with difficult intubation. After patient factors were controlled for in the multivariate logistic regression, patients without OSA were more likely to have difficult intubation (odds ratio, 0.36; 95% confidence interval, 0.13-0.99; P = .048). Other predictors of difficult intubation were lower body mass index and higher Mallampati score.In adult subjects, OSA history was not a predictor of difficult intubation. Other patient or anesthesiologist factors should be assessed for their association with difficult intubation.

Hospital quality and financial sustainability rely on reducing healthcare-associated events/infections, length of stay, and readmissions. This project focused on designing an integrated role for the clinical nurse specialist (CNS) and the infection prevention professional (IPP) to proactively manage the delivery of evidence-based practice to high-risk surgical patients.The healthcare industry is in the midst of a paradigm shift driven by changing health policy focusing on quality indicators, patient satisfaction, and lowering costs. Coupled with these indicators is the expectation and responsibility to provide evidence-based practice at all levels of the healthcare continuum. This paradigm shift places healthcare facilities in a very competitive atmosphere as they rally for the revenue of a fixed payer mix.A literature search using CINHAL, PubMed, and the CNS national listserve databases was completed to identify if there was any previously written information available on an integrated role of the CNS/IPP. An online business plan template was used to communicate the significance, implications, and return on organizational investment to practice with establishing this role. Chronic health conditions such as diabetes, hypertension, congestive heart failure, and colonization with multidrug-resistant organisms can place patients at an increased risk for developing a surgical site infection or complications. The CNS/IPP will proactively manage these risk factors, including the patient and family in a preventive care model to manage the acute inpatient high-risk surgical patient. Care management will include coordinated, collaborative, and consultative follow-up by the CNS/IPP in the acute care, long-term care facilities, and home settings.The infection prevention skill set brings a level of clinical expertise that makes a unique CNS. The IPP is immersed in using epidemiological principles that examine the impact of comorbidities and the added risk that can contribute to developing a surgical site infection. This CNS/IPP incorporates the CNS Spheres of Influence Model and the Association of Professionals in Infection Prevention Competency Model. This combination advanced practice nurse uses a nurse-managed model of care focused on patient/family education, prevention, and self-care management. Therefore, this specific and specialized practice will bring value to the organization by improving financial outcomes through reducing infections, readmission rates, and length of stay.By providing this level of focused care, patient satisfaction will improve and system financial stability will be supported by decreasing hospital readmissions, length of stay, and other hospital-acquired conditions that the surgical candidate is prone to developing.The critical juncture in healthcare is providing opportunities for innovation by examining the CNS role and considering the feasibility of pairing it with the infection preventionist skills. This pairing provides an unprecedented opportunity to improve patient outcomes across the continuum of care. This provider has the ability to influence the Centers for Medicare and Medicaid Services quality indicators in a positive way by using implementation science to partner with system/organization stakeholders that focuses on prevention rather than reactive care processes.The dynamic trends in healthcare continue to drive "intrepreneurial," innovative, and creative ways of thinking; provide clinical practice that has the ability to perform nimbly; and maintain a proactive vision to provide quality care to a diverse patient population. This CNS/IPP role meets the dynamic proactive planning that will shift with patient, system, and nursing needs to deliver cost-effective managed care to improve the health of our patients.