OBJECTIVE:This article reconciles the NACNS practice domains framework to the Integrative Model of innovation diffusion to demonstrate how Clinical Nurse Specialists exercise their unique practice competencies to overcome technological, social, and learning environment barriers to knowledge translation using digital chest systems as a clinical exemplar. DESCRIPTION:A narrative synthesis of evidence from surgical and emerging nonsurgical literature was conducted. The National Association of Clinical Nurse Specialists (NACNS) competencies were compared with the Integrative Model domains-technology, social structure, and learning conditions. Key factors examined included evidence of clinical benefit, nurse and physician preferences, health system cost implications, and knowledge translation gaps. OUTCOME:We used the NACNS competency and integrated model of knowledge translation frameworks to examine digital drainage systems, which demonstrate clear clinical and operational advantages. We identified that digital chest drainage adoption in trauma is limited by entrenched orientations toward analog systems, weak social contagion, educational barriers, and inadequate marketing. Social factors, particularly peer influence and the need for local evidence, outweigh technological complexity in limiting diffusion. CONCLUSIONS:Technology-focused approaches alone are insufficient for widespread implementation of digital chest drainage in trauma care. Effective implementation strategies should prioritize clinician engagement, social learning, and systems-level value. Addressing siloed innovation through targeted knowledge translation strategies can bring high-performing technologies such as digital chest drainage into broader trauma care practice.
AIMS:To explore how operating room nurses (ORNs) make clinical decisions during surgical wound closure, a delegated act for which they are legally authorized but often constrained in practice. MATERIALS AND METHODS:A qualitative exploratory-descriptive study was conducted with 14 ORNs working in public and private surgical facilities in northern France. Individual semistructured interviews were carried out between February 2025 and March 2025. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke's reflexive thematic analysis. COREQ guidelines informed reporting. RESULTS:Six themes were identified. ORNs primarily developed wound closure skills through experiential learning rather than formal training. Their autonomy was conditional, shaped by institutional protocols, surgeon expectations, and hierarchical dynamics. Trust and familiarity within surgical teams determined whether nurses could take initiative or adapt closure techniques. Institutional factors-such as operating room turnover and prioritization of surgical residents-limited opportunities for nurse-led closure. Many ORNs reported low recognition of their role, leading to professional invisibility. Despite these constraints, some ORNs demonstrated patient-centered reasoning, adapting closure methods to individual characteristics when possible. CONCLUSION:ORN decision-making during wound closure reflects a persistent tension between legal authorization and limited enacted autonomy. Enhancing nurse-led closure practices requires clearer protocols, improved interprofessional recognition, and educational strategies that integrate both technical and judgment-based competencies.
PURPOSE/OBJECTIVES:Generative artificial intelligence (GenAI), as a new technology and innovation in practice, is here. The purpose of this paper is to introduce general principles for using GenAI to enhance the workflow of the clinical nurse specialist. DESCRIPTION:This technology is rapidly advancing and influencing practice, education, communication, and workflow for nurses and clinical nurse specialists. Understanding how to optimize GenAI, including developing strong prompts to improve outputs, is shared. OUTCOME:A hypothetical example of a clinical error is used to demonstrate ways in which GenAI can be used to search the literature, create a Situation, Background, Assessment, and Recommendation (SBAR) document and a competency tool is presented. CONCLUSIONS:GenAI is a useful tool supporting the workflow of clinical nurse specialists in all practice settings. Understanding the nuances of using AI inclusive of the importance of human, expert oversight by the clinical nurse specialist, can build stronger nursing and healthcare systems resources and optimize patient outcomes.
PURPOSE/OBJECTIVES:Hospital procedure departments such as cardiac catheterization, electrophysiology, radiology, and periprocedural units have traditionally lacked dedicated clinical nurse specialist (CNS) support despite their complexity. This article describes the role of the clinical nurse specialist in procedural, nonsurgical settings and highlights their unique influence across the spheres of impact. DESCRIPTION OF THE PROJECT/PROGRAM:This manuscript outlines key contributions of a CNS assigned to hospital procedure departments in advancing nursing practice, supporting patient care, and standardizing organizational guidelines in procedural departments. A Project Tracking Tool was used to document CNS consultations and ongoing initiatives, and exemplars illustrate the CNS practice impact across the enterprise. OUTCOME:CNS practice in hospital procedure departments supported patient care, nursing practice, and system performance by standardizing workflows, strengthening staff competency, and supporting evidence‑based and regulatory compliance. The Project Tracking Tool demonstrated increased efficiency, reduced variation, and enhanced safety and quality outcomes, highlighting the clinical and economic value of the role. CONCLUSIONS:CNS practice is essential in hospital procedure departments-nonsurgical settings where much of contemporary cardiology and radiologic care is delivered. Continued dissemination is needed to clarify role contributions, promote consistent standards, and strengthen outcome reporting in these settings.
Purpose/Objectives: This project evaluated preoperative bathing workflows using evidence-based methods, comparing them to suggested practices. This data was used to determine whether implementing evidence-based preoperative bathing protocols could lower costs and surgical site infection (SSI) rates after 12 months. Description of the Project/Program: An interdisciplinary team was established to develop and implement process improvement protocols for preoperative bathing. This team employed Lean Six Sigma methods to identify the problem, define project objectives, analyze the root cause, implement new processes, monitor the plan, and eliminate defects. An audit tool, developed based on evidence from the Association for the Advancement of Medical Instrumentation, was then used to determine the risk of SSI. Outcome: Based on the data collected, a preoperative bathing skin aseptic care bundle was developed, resulting in a SSI rate decline from 2.16% to 1.26%, patient adherence increase from 16% to 91%, and cost savings of 73% per patient, with an estimated $200,000 savings per year. Conclusion: This project demonstrated the effective use of preoperative skin antiseptics in reducing bacteria near the surgical incision site. Through the implementation of an evidence-based PBB bundle, the risk of postoperative SSI can be significantly decreased.
Aims:Missed nursing care is a significant factor that affects the effectiveness of the patient care process and patient satisfaction. This study aimed to determine whether missed nursing care predicts patient satisfaction by examining their relationship from the perspective of surgical patients. Methods:The sample of the descriptive study consisted of 130 patients who underwent surgery. The data were collected face-to-face using a patient identification form, MISSCARE Survey-Patient and Newcastle Satisfaction with Nursing Care Scale. Descriptive statistics, Pearson correlation, multiple linear regression, Mann-Whitney U and independent-samples t tests were performed. Correlation strengths were interpreted according to Cohen's criteria. Results:The participants demonstrated a mean missed nursing care score of 1.84 +/- 0.56 and a mean satisfaction score of 81.1 +/- 15.4. A strong negative correlation was found between the perception of missed nursing care and patient satisfaction (r = -0.619, P < 0.001). The regression analysis showed that 37.8% of the variance in patient satisfaction was explained by the perception of missed nursing care. The communication subscale (beta = -0.634, P < 0.001) was significant, strong negative predictor of patient satisfaction. Conclusion:The findings revealed that increased missed nursing care is associated with decreased patient satisfaction. Missed nursing care, and particularly communication-related omissions, were significant predictors of satisfaction, highlighting the need for interventions to reduce care omissions in surgical settings.
