Background Self-management of complex medication regimens for chronic illness is challenging for many older adults. Objectives The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. Design Randomized controlled trial with three arms and longitudinal outcome measurement. Setting Older adults having difficulty self-managing medications (N = 414) were recruited at discharge from three Medicare-certified home health care agencies in a Midwestern urban area. Methods All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (Geriatric Depression Scale, Mini-Mental Status Examination, Physical Performance Test, and the SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline, 3, 6, 9, and 12 months. Results After covariate and baseline health status adjustment, time by group interactions for the MD.2 and medplanner groups on health status outcomes were not significant; time by group interactions were significant for medplanner and control group comparisons. Discussion Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.

Much has been written about the need for health care professionals to consistently promote policies and best practices that create safe, high-quality care environments. At times, nurses deviate from established policies and procedures to create work-arounds or changes in work patterns to accomplish patient care goals. The purpose of this study was to identify common work-arounds and describe what influenced the nurse to engage in the work-around as observed by fourth-year baccalaureate students in clinical settings. A descriptive qualitative approach was used to describe the findings from a Quality and Safety Education for Nurses-based assignment. Ninety-six individual student assignments were included in this analysis; the themes of infection prevention and control and medication management emerged. The theme of workload emerged as the reason why students believed nurses engaged in work-arounds. Further studies are needed to determine how work-arounds influence short- and long-term patient outcomes.

Background: Currently, graduating nurses face pandemic-related uncertainty including gaps in risk perception, unexpected Covid-19 moral dilemmas, and distress surrounding personal health risk. Research question/aim/objectives/Method: The purpose of this basic qualitative descriptive study is to describe the willingness of graduating nurses to provide care during the Covid-19 pandemic. Participants and research context: One week prior to graduation, students were required to submit a written assignment describing willingness to practice in light of the ongoing pandemic. Ethical considerations: This study was approved by an Institutional Review Board. Findings/results: Eighty-four ( n = 84) assignments were used for analysis. Of these, 82% (n = 69) of the graduating nurses describe a willingness to voluntarily care for Covid-19 patients. After summarizing narrative responses, two themes emerged including self-assessment of personal and familial risk and conflicting obligations. Discussion: The assessment of risk to self and family are key in determining whether graduating nurses will care for Covid-19 patients. Conflicting obligations may contribute to stress and uncertainty potentially leading to early burnout. Conclusion: Findings from this study can inform academicians of the need to adequality prepare graduating nurses for Covid-19-associated risks and ethical decision making. Organizations should alter residencies and orientation to support the needs of new nurses.

The purpose of this study was to describe how students identify and interpret multiple embedded clinical cues in a case study, and then reflect these using SBAR (Situation, Background, Assessment, and Recommendation). Using Tanner's model of clinical judgment, a descriptive design was used to examine SBAR assignments completed by second-semester nursing students (n = 80). The majority of students (n = 62, 77.5%) in the study were unable to successfully follow all of the clinical judgment phases of the model: noticing, interpreting, responding, and reflecting. Although SBAR is an important tool for communicating clinical information, gaps exist between noticing and interpreting clinical cues, and forming an appropriate course of action.

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Conferences and low-fidelity simulation are effective methods for improving nurses' knowledge of end-of-life care in India. Improved education surrounding end of life may positively affect attitudes.

Background: Generation Z nursing students born after 1995 have been described as true digital natives with a short attention span and tendencies toward boredom. The purpose of this pilot study is to compare readiness for practice and anxiety and self-confidence during decision making between Generation Z students who completed a 4-week immersive clinical and those in a 14-week immersive clinical. Method: A convenience sample ( n = 46) of Generation Z graduating baccalaureate nursing students was surveyed. Results: Independent samples t tests were conducted, with no statistical differences between groups on any measures. Conclusion: Findings suggest that extended periods of time in an immersive clinical do not influence readiness to practice or anxiety and self-confidence during decision making in the next generation of students. [ J Nurs Educ. 2019;58(10):604–606.]

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