Background: Insomnia negatively impacts quality of life and is associated with increased morbidity and mortality. Although national guidelines recommend cognitive behavioral therapy for insomnia (CBT-I), providers serving those 65 years of age and over may not have the expertise or resources to provide this treatment option. Objective: This study aimed to implement a brief online group CBT-I to adults 65 years of age and over, consisting of 4-week, 1-hour CBT-I classes at a virtual practice. Methods: The Insomnia Severity Index questionnaire was used to assess insomnia. A sleep diary was used to record an individual’s quality and quantity of sleep to understand sleep patterns. A satisfaction survey was used to collect feedback on providers’ experiences and perceptions during this quality improvement project. Results: The 17 patients evaluated had a mean CBT-I score of 22.53 (standard deviation [ SD ] = 2.57) preintervention and 14.88 ( SD = 3.01) postintervention ( t [16] = 10.51, p < .001). The mean difference of 7.65 (95% confidence interval [6.11, 9.18]) indicated a substantial reduction in insomnia symptoms. The effect size was large, with a Cohen’s d of 2.48, indicating a strong impact of the intervention on reducing insomnia symptoms. Conclusions: A brief cognitive behavioral intervention for patients with insomnia in a practice serving those 65 years of age and over is feasible. Additional studies are needed to determine whether this type of intervention can be used to improve patient care or patient outcomes at other practices serving older adults. Implementation of nurse-supported cognitive behavioral therapy for insomnia (CBT-I) in primary care practices serving older adults may reduce insomnia severity and improve health-related quality of life through individualized education, behavioral guidance, and ongoing support.
Background: Malnutrition, particularly vitamin A deficiency, affects approximately 49% of children aged 6–59 months in sub-Saharan Africa, increasing the risks of morbidity, mortality, poor growth, and preventable blindness. Tanzania has followed the World Health Organization’s (WHO) guidelines for biannual vitamin A supplementation (VAS) since 2004, but rural access remains limited. A preliminary assessment at a rural Tanzanian day care showed only 29% VAS coverage, indicating a substantial gap in coverage. Objective: To improve nutritional health among children aged 6–59 months through a comprehensive VAS program at a local day care in Tanzania. Methods: An interdisciplinary team coordinated structural and workflow changes, secured the supplement through established partnerships, and administered it to all 21 eligible children per WHO protocols. Results: All 21 eligible children enrolled in the day care received their initial dose of VAS at implementation. VAS was sustained at 100% among 29 children, including the 21 original children and 8 newly enrolled. Conclusions: A structured, community-based supplementation program in rural Tanzania successfully addressed critical gaps in vitamin A access for children aged 6–59 months. Implications for Nursing: This quality improvement project demonstrates the feasibility of global health collaboration through strategic planning, stakeholder engagement, and context sensitivity to improve child health outcomes.
Background: Ovarian cancer is the deadliest gynecological malignancy, often diagnosed at advanced stages due to vague symptoms and lack of standardized screening. Rural populations face limited access to specialty care, delayed referrals, and reduced availability of diagnostic resources. Objective: The purpose of this quality assurance project was to propose the implementation of a workflow informed by a clinical decision support system (CDSS) to support earlier identification, risk stratification, and referral for patients at increased risk for ovarian cancer. Methods: A retrospective chart review was conducted of 13 female patients aged 18–80 years diagnosed with ovarian cancer at a rural gynecology clinic between January 2022 and December 2023. Findings were analyzed using Avedis Donabedian’s structure–process–outcome framework to identify gaps in care delivery. Results: Of the participants, 69.2% were aged 50 years or older. Obesity was present in close to 70%, and approximately 23% were positive for BRCA1/2 pathogenic variants. Additionally, 69.2% presented with symptoms, and 69.2% were diagnosed with advanced-stage disease (Stage III-IV), highlighting missed opportunities for early detection. Conclusions: The findings highlight the need for standardized diagnostic workflows to improve the timeliness of ovarian cancer identification and referral. Implications for Nursing: Based on retrospective chart review findings, a proposed CDSS workflow was developed to guide early identification and referral in a rural gynecology clinic.
Background: Professional ethical principles are fundamental to nursing practice, and ethics education is therefore embedded as a continuous component throughout nursing education. Objective: This study aims to present a bibliometric and scientific mapping analysis of nursing ethics education research. Methods: Web of Science and Scopus databases were searched for the keywords “ethic* education,” “nurs*,” and similar terms, and 514 documents published between 1964 and 2024 were analyzed. Bibliometric indicators were analyzed using the Bibliometrix package in the R programming language. Results: The analyzed publications were authored by 1,459 researchers and disseminated across 238 journals. The United States emerged as the most productive country, contributing 104 publications. An overall annual growth rate of 5.03% was observed, indicating a steady increase in scholarly interest in nursing ethics education. Conclusions: Research on ethics education in nursing demonstrates sustained academic attention alongside evolving thematic and methodological trends. Emerging technologies present new opportunities to diversify pedagogical approaches and strengthen the integration of ethics into nursing curricula. Implications for Nursing: Ethics education plays an important role in the formation of nurses’ professional identity and in strengthening the patient-centered clinical decision-making process. Therefore, ethical values must be integrated into curricula and professional development programs at all levels.
Background: Allergy testing is typically performed as a skin prick test. This test can cause pain and anxiety in children. Objective: The goal of this project was to improve the patient experience during allergy testing. Methods: This quality improvement project employed a pretest–posttest design to assess pediatric anxiety levels before and after exposure to virtual reality (VR). Results: There was a significant decrease in anxiety scores pre- to post-VR implementation. Anxiety scores of patients who wore VR were significantly less than when VR was not used ( M = 2.29 vs. 5.43). Anxiety scores demonstrated a greater decrease with VR in the 4–9 years old age group ( M = 5 vs. 1.33) compared with the 2–3 years old age group ( M = 5.75 vs. 3). Patients wore the VR headset from 1 to 10 minutes, with a mean time of 4.07 minutes. The 4–9 years old age group stayed engaged longer in the VR headset (7 minutes) versus the 2–3 years old age group (1.88 minutes). Satisfaction scores were high among caregivers and patients. Staff reported feeling between neutral and highly satisfied. Conclusions: This project suggested the use of VR during allergy testing reduced anxiety. Implications for Nursing: VR may be a useful nonpharmacological intervention for nurses to use during allergy testing to improve the patient and family experience.
