Publications by authors named "Kiersten Lebar"

5 Publications

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A Quality Improvement Project to Increase Frequency of Skin-to-Skin Contact for Extreme Low-Birth-Weight Infants in the Neonatal Intensive Care Unit.

J Perinat Neonatal Nurs 2021 Jul-Sep 01;35(3):247-257

Duke University, Durham, North Carolina, and Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee (Dr Nation); Division of Neonatology, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee (Dr Sanlorenzo); Women's and Children's Service Line, Philadelphia, Pennsylvania (Dr Lebar); and Duke University School of Nursing, Durham, North Carolina (Dr Brandon).

Benefits of skin-to-skin contact (SSC) are documented but often delayed in the extremely preterm population due to medical complexity and staff misconceptions about safety. This quality improvement initiative was designed to increase SSC utilization among infants born before 29 weeks' gestation regardless of respiratory support by addressing nursing barriers inhibiting SSC. A pre-/postsurvey evaluated comfort level performing and perceived barriers to SSC utilization. Implementation consisted of an updated unit-specific SSC protocol and tailored education specific to identified barriers. Evaluation included SSC rates and maternal human milk usage in the first 30 days of life. In total, 81 patients (22-28 weeks, 370-1410 g) were included. SSC rates ranged from 3.3% to 17.7% at baseline and increased to 33.2% to 39.1% postintervention. Maternal human milk utilization increased above target (≥75%) postintervention for days 7 and 14, but declined towards baseline on days 21 and 30. A statistically significant increase was observed in nursing comfort level when performing SSC for intubated infants as well as infants with a peripherally inserted central catheter or umbilical venous catheter. SSC rates increased with infants younger than 29 weeks requiring intubation and central line management, possibly as a result of greater nursing comfort surrounding with SSC.
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http://dx.doi.org/10.1097/JPN.0000000000000556DOI Listing
July 2021

The Role of Advanced Practice Providers and Telemedicine in Reinventing Care: The Transition of a CAR T-Cell Transplantation Program to the Outpatient Setting.

J Adv Pract Oncol 2020 Sep-Oct;11(7):757-763. Epub 2020 Sep 1.

Vanderbilt Ingram Cancer Center, Nashville, Tennessee.

As the health-care industry continues to be pushed to find new, innovative ways to deliver quality care with an emphasis on enhancing quality of life, the use of advanced practice providers and telemedicine technology are two promising developments at the forefront of this new era. Advanced practice providers have been shown to provide highly effective, quality patient care. They often deliver this care at a decreased cost to the patient and healthcare system. Telemedicine technology allows providers to access patients through new, patient-centered avenues, thus enhancing their healthcare experience. Advanced practice providers are well equipped to apply telemedicine technology to expand access to care and innovate new care delivery models. This article describes the design and implementation of a novel telemedicine care model within a malignant hematologic team.
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http://dx.doi.org/10.6004/jadpro.2020.11.7.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646631PMC
September 2020

Development and testing of an advanced practice clinical advancement program within an academic medical center.

J Am Assoc Nurse Pract 2020 Jul 7;33(9):719-727. Epub 2020 Jul 7.

Vanderbilt University Medical Center, Nashville, Tennessee.

Background: Faculty advanced practice registered nurses (APRNs) and physician assistants (PAs) employed by Vanderbilt University Medical Center (VUMC) have historically participated in rank promotion tracks for recognition of professional accomplishments in education, practice, and research. However, there has not been a clinical advancement program for nonfaculty practitioners. Satisfaction, engagement, and health surveys indicated VUMC APRNs and PAs were seeking opportunities for professional growth and development. Many health care organizations have incorporated clinical advancement programs as key recruitment and retention strategies. With a growing number of nonfaculty APRNs and PAs, VUMC began to explore the development, implementation, and evaluation of a clinical advancement program.

Purpose: A VUMC Clinical Advancement Task Force was created to explore, develop, implement, and evaluate an advanced practice clinical advancement pilot.

Methods: Two teams were selected to participate in a 6-month pilot. Presurveys and postsurveys were conducted, and postpilot focus groups were held with participating practitioners. A 9-square tool was developed as a rubric for evaluating the practitioner's progress. Applications, leader assessments, and recommendations were housed in a secure database for a selected advancement committee to evaluate.

Results: Of 23 participants, 47% indicated satisfaction with professional development opportunities, when compared with 84% postpilot. Postpilot focus groups further improved the tool and the process for the program.

Implications For Practice: Opportunities for advancement/professional development positively influence APRN and PA perceptions of job satisfaction. This program could be tested with other APRN and PA teams for impact on job satisfaction, engagement, and retention.
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http://dx.doi.org/10.1097/JXX.0000000000000456DOI Listing
July 2020

Care Models Preventing Readmission.

Authors:
Kiersten LeBar

Semin Oncol Nurs 2020 Jun 19;36(3):151021. Epub 2020 May 19.

Vice President, Advanced Practice Providers Jefferson Health, Philadelphia, PA. Electronic address:

Objectives: This article aims to identify the steps necessary to evaluate the clinical need for innovative coverage models within the oncology setting to help prevent hospital readmissions.

Data Sources: Multiple published studies suggest alternative methods for patient care delivery that are safe and cost effective.

Conclusion: Improving care transitions for the oncology patient is necessary to be able to provide low-cost, high-quality, and patient-centered care. Many of the review studies in this article suggest that emergency room visits and subsequent readmission could be decreased with the use of innovative care models.

Implications For Nursing Practice: Nurses are critical to the care of medically fragile patients. Nurse-led activities such as telephone triage, post discharge phone calls, or telehealth visits can reduce patient emergency department utilization and readmissions through early recognition of symptoms and oncologic emergencies by prompting timely referrals/consultations and quick interventions.
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http://dx.doi.org/10.1016/j.soncn.2020.151021DOI Listing
June 2020

Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study.

J Am Assoc Nurse Pract 2019 Nov 5;33(1):38-48. Epub 2019 Nov 5.

Vanderbilt University Medical Center, Nashville, Tennessee.

Background: Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs).

Purpose: This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being.

Methods: A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout.

Results: The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout.

Implications For Practice: The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.
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http://dx.doi.org/10.1097/JXX.0000000000000324DOI Listing
November 2019
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