Within REACH October 2018

Volume 9│Issue 3│October 2018 Carilion Medical Center, 1906 Belleview Ave, Roanoke, VA 24014 http://chsweb.carilion.com/nursserv/NursW eb.html nursingresearch@carilionclinic.org (540)266 -6216

Writing for Internal Publication: Reflections on How to Eat an Elephant Margaret Perry, MSN, RN-BC - Sr. Nurse Educator, Education & Organizational Development It was about 10 years ago when the idea of an internal publication first occurred to me. I didn’t have a name for it, or even much of a plan. But while trying to inspire the nurses on my units to pursue CAP, the argument I got back from those who didn’t immediately walk away was “How am I supposed to get a point under Research? There’s nothing there I can do.” I remember I had a hard time refuting their claim. I focused on the CAP point for research that seemed like a logical first step into the world of nursing research: “Submits an article to an internal or external publication”. An external publication would be a long shot, especially for an inexperienced writer, so I looked for an internal one. Zero.

Zip. Nada. If I wanted these nurses to pursue CAP, I would have to create an internal publication.

The publication, then named “REACH Newsletter”, had a solid foundation. It was designed to mimic an external publication. It had a peer review board made up of many of our Clinical Nurse Specialists who would review submissions and were committed to mentor the authors to create a finished product with scholarly integrity. Many of you are familiar with the joke: “How do you eat an elephant?” Answer: “one bite at a time”. The idea was to take the ‘elephant’ of research and break it down into bite-sized pieces. While nurses might feel a research project was beyond their capability, they could interview a nurse who was involved with research, write a critique of a research article, or summarize a quality project, and maybe discover research was just a lot of bite-sized pieces. Eating the elephant could become possible.

After it was first published, despite heavy marketing (hand delivering paper copies all over the hospital), I wasn’t sure anyone saw it except the four nurses I begged to write articles. After the first couple of issues, I partnered with the Carilion Nursing Research Department to develop the internal publication. It was integrated into the Research Council and quickly began to grow. It became hospital-wide and then started accepting submissions from outlying facilities. It was re-named “Within REACH”, portraying that research IS consistent with our professional practice model (REACH) and within reach of the bedside nurse. Peer review processes were refined to resemble the processes of professional journals. Nurses wrote interesting articles, but more was added. The internal publication started covering the Week of the Nurse activities and the Nursing Research Conference. It showcased nurses doing research, getting published, and taking their work to conferences. It grew and grew. It is now published 3 times a year; with a fourth Annual Special Conference Edition covering Carilion nurses at conferences, such as the Carilion Nursing Research Conference and the ANCC National Magnet® Conference. It moved from being a paper publication to an electronic one. It surpassed my original vision for it.

Now Within REACH is entering the next phase of its growth. It has moved out from under the leadership of the Research Council. A multidisciplinary Editorial Board will now provide editorial review for Within REACH, but also for other scholarly endeavors, such as the Magnet® document, external publication critique, and award and recognition editing. Within REACH is branching out to welcome submissions from other health care professionals, as well as moving outside the inpatient world to ambulatory and outpatient arenas.

This has been an exciting journey. In many ways I have likened it to raising children. As they grow you have to step back and allow them to develop their own potential. Other people invest themselves in your children and influence their growth. Within REACH has grown and promises to continue to grow, especially given the investment of so many people- the Research Council, the Clinical Nurse Specialists, nursing administration, Kim Carter who has a vision to continue to carry this forward, but especially frontline nurses, who invest their time and energy to submit, and work with the feedback they get to make this a valuable publication with scholarly integrity and rigor. I can’t wait to see where the next ten years will take us.

~ Margaret

Carilion Clinic Roanoke Campus

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ARTICLES & DEPARTMENT INFO 1 Writing for internal publication: Reflections on how to eat an elephant.

Margaret Perry, MSN, RN

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2018 Nursing Research Conference - Registration is open.

Readmission rate reduction: An evidence based literature review.

Whitney Sprinkel, RN, CCRN; Paris Blankenship, BSN, RN

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Article Review: Traumatized: Burnout and stress in trauma nurses.

Haleigh Lambert, BSN, RN

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Human Interest Story: Carilion nurses provide care during 2018 Guatemala medical mission Anita Gooding, ADN, RN; Sara Wohlford, MPH, ADN, RN

RECOGNITION/EVENTS 10 2018 VNA 40 Under 40 Award Winners 12 A Day in the Life: Nursing Student in Progress 13 What to expect when you submit your paper for peer review 14 Nursing Recognition 16 Conference Corner 18 Citations and Recognitions 20 “See Where Our Nurses Have Presented” Map 21 2018 Nursing Research Classes

Introducing….

Carilion Nursing Research Editorial Board: Kimberly Carter, PhD, RN, NEA-BC - Editor –in-Chief Lisa Allison-Jones, PhD, MSN, RN Nancy Altice, DNP, RN, CCNS, ACNS-BC Candace Asbury, BSN, RN Desiree Beasley, MSN, RN, CCRN, CCNS Ann Beheler, ADN, RN Cat Brandon, RN Mary Brewer, MSN, MBA, RN, RD Sarah Browning, DNP, RN-BC Monica Coles, MSN, RN-BC, ACNS-BC Sarah Dooley, MPH, BSN, RN Christine Fish-Huson, MSN, RN Shanna Flowers, MA Donna Goyer, RN, BS, CPAN, CAPA Cindy W. Hodges, RNC, BSHS, FCN James Ingrassia, MSN, RN Michele Kosinski, DNP, MBA, RN Pam Lindsey, MSN, RN Margaret Perry, MSN, RN-BC Deirdre Rea, MSN, RN, PMH-BC Diana Talmadge, RN Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC Vivian Wilson, BSN, RN, CCRP

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Readmission Rate Reduction - A research based literature review Whitney Sprinkel, RN, CCRN ; Paris Blankenship, BSN, RN - CRMH 7S CCU Background Readmission rates are an increasing problem in today’s healthcare system. Medicare and insurance companies have attempted to decrease readmissions for chronic conditions by penalizing hospitals and not reimbursing them for readmissions that occur within a 30-day window from discharge. This affects us within Carilion due to the number of patients with chronic conditions that we serve. Many studies nationally and internationally have attempted to decrease frequent readmissions. This literature review will investigate the impact of readmission reduction programs on readmission rates to reduce costs and capacity issues.

Specifically, these variables were explored in this literature review:

Premature discharge Observation units Scoring systems for high-risk conditions Patient’s discharge placement proximity to the hospital Search Strategy To identify the literature related to the impact of the variables of interest on readmission rates, this search was completed with PubMed, UptoDate and Google Scholar. Twenty articles were identified, with sixteen eliminated if they focused on pediatric populations, were published more than ten years ago, or were not conducted in the United States. The four research articles included in this review specifically focused on readmission reduction programs.

Summary of the Literature Premature Discharge: Hospitals are currently facing capacity issues due to higher acuity, patients waiting too late to come in for care, lack of insurance coverage for skilled nursing and lack of skilled nursing and inpatient rehabilitation beds. Readmission is also costly. It is estimated that Medicare spends more than 15 billion dollars annually in readmission costs. 18 percent of all inpatient admissions paid by Medicare are readmitted within 30 days, accounting for $15 billion in costs annually”1. Premature discharge or discharge to an environment that is not capable of meeting the patient’s medical needs may result in readmission” 2 (p.

155).

Observation Units: Another approach identified in this literature review is the use of observation units to reduce readmissions. Zuckerman and colleagues examined the efficacy of hospital readmission reduction programs targeting chronic conditions3 (p. 1543). Over an 8-year period, more than 3,000 hospitals were analyzed for chronic conditions triggering frequent 30-day readmissions. Hospitals that implemented observation units instead of inpatient admissions demonstrated an initial decrease, followed by a slight increase. The confounding impact of the Affordable Care Act (ACA) may have influenced this outcome.

In fact, “readmission trends are consistent with hospitals’ responding to incentives to reduce admissions, including the financial penalties for readmissions under the ACA. We did not find that changes in observation-unit stays accounted for the decrease in readmissions”3 (p. 1543). There is more study needed to evaluate the efficacy of readmission reduction programs.

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Scoring systems: Scoring systems have been examined to decrease re-admission rates. Burke et al. utilized the HOSPITAL score to target medical conditions that could lead to potentially preventable readmissions, such as myocardial infarction, Chronic Obstructive Pulmonary Disease, pneumonia, and heart failure4. Review of over 9,000 patient’s charts supported the effectiveness of the HOSPITAL screening tool to identify high-risk groups for 30-day readmissions. While more psychometric work is needed, the HOSPITAL scoring system shows promise as a tool “to identify the most significant predictors of potentially preventable readmissions within 30 days of discharge” for chronic conditions4 (p. 289).

Patient’s Discharge placement: Hospitals may experience higher readmission rates if there is a population density of chronic illness. Patients may cluster closer to their physicians and medical support system. For example, transplant centers have patients who tend to reside closer to the hospital area. In a six-state study by Health Services Research, hospital discharge charts were reviewed for geographical significance for readmission. Results showed that “areas with higher percent of Medicare, Medicaid, and older {75-84} patients to have higher readmission rates”5 (p. 1147).

Implications for Practice Of the four studies reviewed, assessing for discharge readiness and the use of a tool like the HOSPITAL tool to identify patients most at risk for readmission so that more intense follow-up care can be instituted shows promise. The impact of screening patients for discharge with a valid and reliable tool to provide the best patient care during and after discharge, as well as to prevent penalties and reduced reimbursement, warrants further study. Nurses play a critical role in reducing hospital readmissions and making a positive financial impact on the organization.

References 1. Fingar, K., & Washington, R. (2015, November). Trends in Hospital Readmissions for Four High-Volume Conditions, 2009-2013. Retrieved from Healthcare Cost and Utilization Project: https://www.hcup-us.ahrq.gov/ reports/statbriefs/sb196-Readmissions-Trends-High-Volume-Conditions.jsp 2. Kuo YF, G. J. (2011). Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study. Ann Intern Med, 155(3), 152-159.

3. Zuckerman, R. B., Sheingold, S. H., Ruhter, J. M., & Epstein, A. M. (2016). Readmissions, observations and the hospital readmissions reduction program. New England Journal of Medicine, 374, 1543-1551.

4. Burke, R. E., Schnipper, J. L., Williams, M. V., Robinson, E. J., Vasilevskis, E. E., Kripalani, S. M., . . . Donze, J. D. (2017). The HOSPITAL score predicts potentially preventable 30-day readmissions in conditions targeted by the hospital readmissions reduction program. Medical Care, 55(3), 285-290.

5. Basu, J., Avila, R., & Ricciardi, R. (2016). Hospital readmission rates in U.S. States: Are readmissions higher where more patients with multiple chronic conditions cluster? Health Services Research, 51(3), 1135-1151.

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Article Review: Traumatized: Burnout and stress in trauma nurses Haleigh Lambert, BSN, RN - 9M NTICU Munnangi, S., Dupiton, L., Boutin, A., Angus, L. D. (2018). Burnout, perceived stress, and job satisfaction among trauma nurses at a level I safety-net trauma center. Journal of Trauma Nursing, 25 (1), 4-13 Burnout is defined as “exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration”1. Nurses working in the trauma setting are faced with extremely stressful situations and are at a higher risk for developing burnout2 (p. 4). This article critique is of the investigation by Munnangi, Dupiton, Boutin, and Angus (2018) of different factors affecting nurse burnout in hopes of finding ways to increase satisfaction in the work place and prevent burnout in trauma nurses. The results were significant and could be used to benefit nurses; however, there were limitations to the study including the nurse population studied and bias.

This study focused on one Level I Safety-Net Trauma Center at Nassau University Medical Center, East Meadow, NY and surveyed only nurses working in the emergency department (ED), surgical intensive care unit (SICU), and medical intensive care unit (MICU). A limitation of this study is that there are many more nurses who care for trauma patients on a daily basis that were not included - intermediate care, medical-surgical, operating room, and post-anesthesia care nurses. With this in mind, Munnangi et al. found “a significant difference was noted in the emotional exhaustion level by location of work” 2 (p. 10). The nurses surveyed from the SICU showed more emotional exhaustion than nurses working in the MICU and ED. The authors noted that the SICU cares for the most acute trauma patients. In fact, The American College of Surgeons requires that one nurse have no more than two patients in a SICU, because a higher ratio would increase the workload; therefore, causing a decrease in job satisfaction2. Although the same principle might apply in other areas of care such as an intermediate care unit, more research is needed to understand this more completely.

This study is limited by including only one safety-net trauma center. A safety-net hospital is a provider who “offers access to care regardless of a patient’s ability to pay” 3 (p. 5). Therefore, these hospitals often provide services to patients who are uninsured3. These hospitals are typically public hospitals that offer services not provided by private hospitals, such as burn care, neonatal intensive care (NICU), and trauma services 3 (p. 5). Harper, Castrucci, Bharthapudi, & Sellers noted that safety-net hospitals typically encounter greater challenges in maintaining their nursing staff due to the greater needs of the patient population and the strenuous work environment (as cited in Munnangi et al., 2018, pg. 4). A trade group for safety-net hospitals, America’s Essential Hospitals, lists Carilion Roanoke Memorial Hospital (CRMH) as a member. 5, 6 As a safety-net hospital and Level 1 Trauma Center, CRMH nurses could conduct a similar study to compare the work of Munnangi et al. to Carilion trauma nurses. It would be useful to see more safety-net trauma centers included to provide for increased generalizability.

Three tools were used for data collection: Maslach Burnout Inventory questionnaire, abridged Job Descriptive Index, and Perceived Stress Scale. The nurses completed the questionnaires on their own and returned them in envelopes at specific drop boxes throughout the hospital. Due to the nature of the study, there is concern that the targeted nurses might display a certain level of bias when filling out a survey regarding the stress levels of their respective units. For instance, if a nurse completed the questionnaires at work during/after a particularly busy day, then the nurse would probably report that he/she is more stressed; whereas the nurse may report less stress on a day when things are not as hectic. This could have affected the data that the authors collected.

The study revealed that burnout and perceived stress are problems affecting many trauma nurses. They found that employees may be happy working with one another, but can be experiencing emotional exhaustion and depersonalization. Depersonalization is defined as an “impaired and distorted perception of oneself, of others and one’s environment, and it manifests itself as an affective-symptomatic lack of empathy”4. It was also found that poor workplace relationships can lead to decreased job satisfaction. When trauma nurses feel as though they are accomplished, they have increased job satisfaction and decreased

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depersonalization (Munnangi et al., 2018).

Munnangi et al. found that work environment has a monumental impact on emotional exhaustion. The Maslach Burnout Inventory indicated emotional exhaustion levels of the nurses studied in the ED, MICU, and SICU (p= 0.0097, p. 9). After determining the results for the three different nursing departments, Pearson correlations were used to look at the “relationships among various dimensions of burnout, perceived stress score, and job satisfaction subscales” (p. 7). Pearson Correlation Coefficients showed that nurses who were more emotionally exhausted had higher levels of depersonalization (p < 0.0001) (p.10).

In summary, nurses who work in a more stressful environment are more apt to be more emotionally exhausted and therefore are at a higher risk for experiencing depersonalization2.

As noted by Munnangi and colleagues, “burnout, stress, and job satisfaction are critical understudied facets of trauma nursing”2 (p. 5). Though limited in sampling methodology and design, this study revealed important information on what impacts burnout, perceived stress, and job satisfaction in trauma nurses.

This study will be helpful in creating ways to recruit and retain nurses in the trauma field. Munnangi et al. recommended establishing activities that could enhance “a sense of personal accomplishment” (p. 11).

They also encourage support groups, employee assistance programs, and recognition programs to help increase job satisfaction.

CRMH offers an employee assistance program for staff, and the shared governance Professional Recognition Council promotes approaches for nursing staff to encourage each other and acknowledge hard work. The results of Munnangi et al.’s study could also be used to support decision making for nurse-patient ratios in different levels of care. Further studies are needed to examine the relationship between workload and nurse burnout to support staffing decisions. Future studies that include a wider trauma nurse population with better control will be a great addition to the current literature.

References 1. Merriam-Webster, Inc. (2018). Definition of Burnout. Retrieved from https://www.merriam-webster.com/ dictionary/burnout 2. Munnangi, S., Dupiton, L., Boutin, A., Angus, L. D. (2018). Burnout, perceived stress, and job satisfaction among trauma nurses at a level I safety-net trauma center. Journal of Trauma Nursing, 25, (1), 413. DOI: 10.1097/JTN.0000000000000335 3. Cunningham, P., Felland, L. (2013). Environmental scan to identify the major research questions and metrics for monitoring the effects of the affordable care act on safety net hospitals. Center for Studying Health System Change. Retrieved from https://aspe.hhs.gov/system/files/pdf/33811/ rpt_ACA_and_Safety_Net_%20EnvScan.pdf 4. Prinz, P., Hertrich, K., Hirschfelder, U., de Zwaan, M. (2012). Burnout, depression and depersonalisation – psychological factors and coping strategies in dental and medical students. GMS Z Med Ausbild, 29(1): Doc10. DOI: 10.3205/zma000780 5. Campbell, R. (2015). Safety net hospitals hit hardest by medicare fines. Center for Health Reporting.

Retrieved from http://www.centerforhealthreporting.org/article/safety-net-hospitals-hit-hardest-medicarefines 6. Our Members. America’s Essential Hospitals. Retrieved from https://essentialhospitals.org/aboutamericas-essential-hospitals/listing-of-americas-essential-hospitals-members/

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Human Interest Story: Carilion nurses provide care during 2018 Guatemala medical mission Anita Gooding, RN, CTL; Sara Wohlford, MPH, BA, ADN, RN - Pre-Surgical Testing & Emergency Department.

A 21 member team of nurses, nurse practitioner, physicians, and non-medical personnel served in the highlands of Guatemala from July 13-22, 2018. Team members from Carilion included 8 nurses (Alexandria Horn RN, Anna Romeiser RN, Annette Thomas RN, Haley Hampton RN, Selma Telavoic RN, Rebecca (Becca) Bishop RN, Sara Wohlford RN, and Anita Gooding RN) and four medical providers (Dr. Lisa Uherick, Dr. Camron Privitera and Victoria Shelly N.P).

Supported by their families and employers, the team generously gave of their time and skills to provide care to those who have limited or no resources to medical care. They were supported by a driver, six translators, and a field director from Partners in Development and former team coordinator with Boca Costa Medical Missions.

On days 1-3, the team served in the jungle village of Xojola with Boca Costa Medical Missions. The medical team treated 200 patients, and the nonmedical team provided educational programs to the children in the local library, including crafts, games, and a program for girls called WINGS1 developed by local church groups2.

On day 4, the team served the San Antonio area of Guatemala with Partners in Development by providing medical care to 75 clinic patients, and educational programs to 40 children, including crafts, games, and the WINGS program. On day 5, they provided medical care at HALO Guatemala, a school for deaf and disabled children in Mazentanango. HALO Guatemala was founded by the family of Jose Pablo Asencio, who is now the president and proprietor of the school. Their mission is to contribute to the early detection of hearing loss or disability, promoting education and awareness for the integration of the deaf in the family and society3.

Carilion Clinic supported this team through individual mission scholarships and medical supplies. The Carilion Clinic Foundation provided the Guatemala Medical Mission team with a scholarship to pay for the medication and supplies used by the team while providing medical care to those in need.

The team was sponsored by Roanoke Valley Medical Missions (RVMM). RVMM is a nonprofit that sponsors groups of medical and dental teams to provide medical and dental care to local missions, and Medical & Dental Mission teams to Guatemala and Haiti4. RVMM supports the Mayan villages in Guatemala who have no or limited access to medical and dental care. These people are challenged by financial resources for medical care, and when missing work they lose wages and are unable to feed and care for their families. RVMM also supports HALO Guatemala, a school for deaf and disabled children.

References 1. Gleaning for the World. n.d. Our WINGS program empowers women through support and education. Available online at: https://gftw.org/helpingwomen/ 2. Koerting, K. 2014, July 14. Lynchburg group helps worldâ&#x20AC;&#x2122;s women stay at work, school. The Roanoke Times.

Available online at: https://www.roanoke.com/news/lynchburg-group-helps-world-s-women-stay-at-work-school/ article_da6ee508-1d19-5036-badc-33c61dc936ff.html 3. Derechos Reservados. 2014. HALO Guatemala. Available online at http://haloguatemala.org.gt/ 4. Roanoke Valley Medical Missions. N.d. RVMM. Available online at www.rvmm.org.

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Meg Scheaffel, CNO & VP celebrates with our Virginia Nurses Association

2018 40 under 40 winners!

(l-r): Meg Scheaffel, CNO & VP, Rachel Denny, Shelly Feazell, Amanda Allen, Melissa Wray, Stephanie Defilippis, Sarah Beth Dinwiddie

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(l-r): Kristen Crouse, Brandon Jones, & Wrenn Brendel

Congratulations to our 40 under 40 Honorable Mention Winners!

We CELEBRATE all of our VNA 40 Under 40 Winners!

The VNA 40 Under 40 recognizes up and coming young nursing leaders. Nominees have significant achievements in the areas of professional practice, leadership, and positive impact on the nursing profession.

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A Day in the Life: Nursing Student in Progress Sarah Dannhardt - 2018 Nursing Research Intern - JMU Nursing Student Note: This is a letter from one of our 2018 nursing research interns who is a nursing student at James Madison University Time is really flying by at JMU... I can't believe it's already the second week of October.

Nursing school is going great! I had my first clinical at a nursing home on Monday, and it was an incredible experience. I definitely lucked out because the resident I was working with was still mobile and independent, and she just needed help with minor activities. She was such a joy to spend time with - she told me over and over again how thankful she was to have me there and that she could talk to someone all day instead of watching TV. And boy, did I get an earful! I walked away from Monday with a whole lot of the classic "Grandma" wisdom. It was nice to get to know her, but it was also really exciting to see how much I have learned in school and realize how many skills I was able to implement while helping her. It was an easy first clinical - I'm sure the patients will get more complicated from now on!

Other than clinical, I'm in 5 classes, and my favorite is Health Assessment. I really like it, because it's so neat to learn about the nursing process and how to do assessments. We get paired up with classmates and then practice on each other. So far we have covered taking the health history and then learned how to do integumentary, musculoskeletal, respiratory, and cardiovascular assessments - it's so cool and so much fun! Cardiovascular was my favorite, because I had never listened to a heart through a stethoscope before, and we also got to listen to a mannequin with different types of murmurs and heart sounds.

Today in my Clinical Applications class we started learning about IVs! We won't start them ourselves until the end of the semester, but today we practiced priming IV tubing, setting up the pumps, flushing the IV site, and changing the IV solutions. We also learned how to reconstitute medicines, which was really neat, because we have been talking about that in Pharmacology since the beginning of the semester. It's so exciting to finally be learning these kinds of skills and know that in not too long, I will actually be performing these skills with patients.

Other than classes, everything else is going great as well. One of the clubs I'm in, the JMU Nursing Student Association, is hosting an event called "Scrubs Camp". It gives pre-nursing students the opportunity to come into the actual nursing classrooms and labs and learn a lot of the basic skills (bathing, feeding, PPE, and mobility) from students already in the program. I volunteered to help, and I'm so excited - I know if this camp had existed when I was pre-nursing, I would have been all over it.

We had a career fair and were able to meet representatives from many Virginia hospitals and learn about all kinds of opportunities for internships and externships. Carilion was there too - there seemed to be a lot of interest in the Adopt-a-Student-Nurse program.

I miss seeing everyone in the office and think of you often. I've had many great stories to share with my nursing teachers and friends after this summer. :) Thanks!

Sarah Dannhardt

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What to expect when you submit your paper for peer review.

Deirdre Rea, MSN, RN, PMH-BC; Shanna Flowers, MA (members of Carilion Nursing Research Editorial Board) You have decided to try your hand at writing for publication, and you select Carilion Nursing’ peer reviewed publication Within REACH for your first publication experience.

You do your homework, examine the literature, and spend hours writing an article. You’ve poured your heart, soul, and time into it and are proud of how it turned out. You excitedly send it off to be reviewed and can’t wait to see your name in print in the next edition. And then, like a blow to the solar plexus, it comes back covered in red ink. What?? How can that be?! Waves of emotion wash over you. Shock, embarrassment, hurt, frustration, anger – you are mortified. You say, “I’m never doing this again!”

Welcome to the world of publishing.

The process of publishing an article in a peer reviewed journal can be daunting – even for people who have published numerous times. Knowing what to expect can help. Whether you are submitting to a local magazine or an international journal, it is important to understand the specific journal’s audience and the requirements for submission. Every journal has different expectations, and the article needs to be tailored specifically to them. You can find most journal’s guidelines for authors by searching the manuscript submission information at the journal’s online site.

It is a very good idea to select some colleagues or writers you may know to review your paper before you submit it. Know that the process of writing involves righting, rerighting, and rewriting. You should expect to revise your paper at least five times and likely even more than that.

There are some ethical considerations when submitting for publication. You can only submit a specific work to one journal at a time and cannot submit to a second until you have received a decision from the first journal or you have withdrawn your submission. Only then can you rework and submit the article to another journal.

Every journal’s editorial board wants their featured articles to be top quality. The point of peer review is to have a group of experienced authors combing each article for inconsistencies, gaps in clarity, ethical issues (such as plagiarism, protection of subjects, and HIPAA violations), grammatical errors, word count and general flow of the article.

Once you have submitted for peer review, you can expect the article to be carefully and thoroughly evaluated and returned with suggestions. The fact that your work is returned for edits is a good sign! It means the reviewers found merit in the article, took the time to give you feedback, and the editor is interested in hearing from you again. If you can maintain a thick skin through the process, the final result will be a polished article that provides valuable information to your professional peers.

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Commitment!

CRMH NeuroTrauma ICU Unit American Association of Critical Care Nurses Silver Beacon Redesignation This team of high performing, engaged and passionate nurses demonstrate excellence in outcomes consistent with Leadership Structures and Systems, Appropriate Staffing and Staff Engagement, Effective Communication, Knowledge, Management, Learning and Development, Evidence-Based Practice and Outcomes Measurement.

Curiosity!

Sunny Kook, MSN, RN-BC; Stephanie Defilippis, BSN, RN CRMH 7S CSICU & CRMH 10S Oncology 2018 VNA Innovations Conference Best Poster Innovation in Nursing Research

This 2017-18 Nursing Research Fellowship Team took their project â&#x20AC;&#x153;Efficacy of intermittent heparin flush versus normal saline flush in adult implanted ports in prevention of catheter occlusionâ&#x20AC;? all the way to the top with a win at the Virginia Nurses Associate Fall Conference in Short Pump, VA for Best Poster Innovation in Nursing Research.

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Courage!

Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN CRMH Trauma Services 2018 American College of Surgeons Quality & Safety Conference Best Clinical Care Abstract Jen’s abstract titled, “Decreasing trauma admission rates, implementing a call-back program”, won the Best Clinical Care Abstract competition at the 2018 ACS Quality & Safety conference in Orlando, FL in July. This project began in 2013 and Jen has presented the project at multiple conferences travelling to Florida, Oregon and locally in Virginia. She will be giving a podium presentation at this years 2018 ANCC Magnet Conference in Denver, CO

Compassion!

CMC Receives Magnet® Recognition for Fourth Time!

Curiosity!

Courage!

Commitment!

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CONFERENCE CORNER 2018 American College of Surgeons Quality & Safety Conference, Orlando ,FL Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN was selected by the American College of Surgeons to attend the 2018 ACS Quality & Safety conference as a podium presenter about her work with the Trauma Services Call Back Program. See information about the award Jen received at the conference on page 15.

Jennifer Bath

2018 (AACVPR) American Association of Cardiovascular and Pulmonary Rehabilitation 33rd Annual Meeting, Louisville, KY Renee Gerow, MSN, RN, Carilion New River Valley Medical Center Cardiac Rehab, presented her 2017 Nursing Research Fellowship project titled, Early Cardiac Rehab to Reduce Heart Failure Readmissions, at the 33rd AACVPR conference. Renee indicated the poster garnered much interest and positive comments. The AACVPR is a multidisciplinary professional association comprised of health professionals who serve in the field of cardiac and pulmonary rehabilitation.

Renee Gerow

2018 Annual Respiratory Nursing Society & Interprofessional Collaborative Congress, Roanoke, VA

Pam Flinchum, RT(R), (CT), ASN, BS, AAS and Kathleen Hayes, BSN, RN, CRRN, along with Clinical Nurse Specialist Donna Bond, attended this annual education conference at the Hotel Roanoke. Pam and Katie presented their 2017 Nursing Research Fellowship project, The Use of Unplanned Extubations, for which Donna was their mentor.

The conference is attended by nurses, therapists and others who care for patients with respiratory issues.

l-r: Kathleen Hayes, Pam Flinchum, Donna Bond

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2018 VNA Fall Conference, Glen Allen, VA Carilion Nursing was well represented at the 2018 VNA Fall Conference. Kim Carter, PhD, RN, NEA-BC and Becky Clark, PhD, RN presented Frontline Voices: How Research Fellowship Impacts Leadership Growth.

Phyllis Whitehead, PhD, APRN, Clinical Nurse Specialist was invited to speak about her team’s project titled Exploring Nurse Manager Morale Distress: Moving from collegial conversations to a collaborative research study. Sunny Kook, MSN, RN-BC and Stephanie Defilippis, BSN, RN presented their 2017 Nursing Research Fellowship Project, Efficacy of intermittent heparin flush versus normal saline flush in adult implanted ports in prevention of catheter occlusions. See page 14 for details on Sunny and Stephanie’s award!

l-r: Kim Carter, Stephanie Defilippis, Phyllis Whitehead, Sunny Kook

2018 VNA Fall Conference, Glen Allen, VA

Lee Brown, MSN, RN, Assistant Professor, Department of Nursing, Jefferson College of Health Sciences presented her poster titled, Leaders: How to Make Orientation Feedback as Fierce as Beyonce at this years VNA Fall Conference. The was a project that Lee developed during her role as an orientation coordinator for Carilion Roanoke Memorial Hospital’s Mountain

On right: Lee Brown

2018 VNA Fall Conference, Glen Allen, VA Nancy Altice, DNP, RN, CCNA, ACNS-BC, 2017 Nursing Research Fellowship mentor stepped in to present the Early Cardiac Rehab to Reduce Heart Failure Readmissions project at the 2018 VNA Fall Conference. Nancy Altice was the mentor for Nursing Research Fellow Renee Gerow, MSN, RN, who had just presented this project at the AACVPR conference earlier in September.

l-r: Nancy Altice,

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Within REACH

CITATIONS & RECOGNITIONS June 2018 - October 2018

POSTERS Carter, K., Clark, R. 2018, September 1-4.

Individualized audit and feedback to improve pneumococcal vaccination rates in ambulatory settings. International Conference on Communication in Healthcare, Porto, Portugal.

Whitehead, P., Carter, K. 2018, September 1-4. The patient preferences about serious illness instrument (PASI): An innovation in eliciting seriously ill patients’ preferences.

International Conference on Communication in Healthcare, Porto, Portugal.

Gerow, R., Altice, N. 2018, September 12-15.

Early cardiac rehab to reduce heart failure readmissions. 33rd AACVPR Annual Meeting, Louisville, KY

Gerow, R., Altice, N. 2018, September 21-22.

Early cardiac rehab to reduce heart failure readmissions. VNA Fall Conference 2018, Short Pump, VA Brown, L. 2018, September 21-22. Leaders: How to Make Orientation Feedback as Fierce as Beyonce. VNA Fall Conference 2018, Short Pump, VA Defilippis, S. , Kook, S., Whitehead, P., Porter, A., Cattigan, A. 2018, September 21-22.

Efficacy of intermittent heparin flush versus normal saline flush in adults. VNA Fall Conference 2018, Short Pump, VA *Award received for Best Poster Innovation in Research, see pg 14 for more information.

Flinchum P., Hayes, K., Bond, D. 2018, September 28-29. The use of technology to decrease unplanned extubations. 28th Annual Respiratory Nursing Society and Interprofessional Collaborative Conference, Roanoke, VA

Beels, S., Blankenship, S. 2018, October 2426. Back to Basics: Reducing CAUTIs in an

ORAL PRESENTATIONS ICU. ANCC Magnet® Conference, Denver, CO. Harvey, E., Wright, A., Freeman, D., Hamil, M., Peters, K., Meadows, G., Bollier, B., Flinchum, M. 2018, June 8. Advanced Trauma Nurse Training: Impact on trauma team attitudes and performance. Carolinas/ Virginia Chapter of Society of Critical Care Medicine, 36th Annual Scientific Symposium, Virginia Beach, VA. Garber, J., Whitehead, P, Carter, K., Epstein, E., & Seidel, L. 2018, September 21-22.

Exploring nurse manager morale distress: Moving from collegial conversations to a collaborative research study. VNA Fall Conference 2018, Short Pump, VA Carter, K., Clark, R. 2018, September 21-22.

Frontline Voices: How research fellowships l impact leadership growth. VNA Fall Conference 2018, Short Pump, VA Bath, J. 2018, October 24-26. Decreasing trauma admission rates by implementing a callback program. ANCC Magnet® Conference, Denver, CO. *Awared received for Best Clinical Care Abstract, see page 15 for more information.

RECOGNITION 9M NTICU receives AACN Silver Beacon Re-Designation.

Whitehead, P. Selected by the Schwartz Center Organization to receive the 2018 Honorable Mention National Compassionate Caregiver of the Year Award.

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PUBLICATIONS Whitehead, P. May 2018. Interventions for the reduction of prescribed opioid use in chronic non-cancer pain (Review). Research in Nursing and Health Journal, 41, 329-330. doi: doi.org/10.1002/nur.21879

GRANTS

Practical Applications of Nursing Inquiry

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Within REACH

See Where Our Nurses Have Presented!

(Since October 2014)

“The World is a book, and those who do not travel read only a page.” – Saint Augustine United Kingdom

Palm Springs

Lake Buena Vista

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Practical Applications of Nursing Inquiry

REGISTER IN CORNERSTONE FOR ONE OF OUR Nursing RESEARCH CLASSES!

Advanced Research II: Methods & Statistics (CE373L) November 14, 2018 - 1:00-4:00pm CRMH 1 South Computer Room D **********************************

Basic Nursing Research for the Frontline Nurse (CE333L) December 6, 2018 - 8:00am â&#x20AC;&#x201C;12:00pm CRMH 1 South Computer Room D *********************************

Be on the lookout for our 2019 class schedule! You will find it on the new Inside Carilion at:

https://prod.insidecarilion.org/hub/ nursing-research-evidence-basedpractice/all-activity/nursing-research -classes

Need editorial or financial support to present your work at a national nursing conference?

Contact Nursing Research & EBP for:  Assistance with writing your abstract  Poster development  Financial support through Nightingale grants. nursingresearch@carilionclinic.

Carilion Clinic Roanoke Campus