Showing papers in "American Journal of Nursing in 2016"
TL;DR: The benefits and challenges of using a "flipped" classroom to promote active engagement among learners and more meaningful interaction between learners and educators are described.
Abstract: This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. This article describes the benefits and challenges of using a "flipped" classroom to promote active engagement among learners and more meaningful interaction between learners and educators.
297 citations
TL;DR: The concept and prevalence of moral distress is outlined, its impact and precipitating factors are described, and promising practices and interventions are discussed.
Abstract: Moral distress is a pervasive problem in the nursing profession. An inability to act in alignment with one's moral values is detrimental not only to the nurse's well-being but also to patient care and clinical practice as a whole. Moral distress has typically been seen as characterized by powerlessness and victimization; we offer an alternate view. Ethically complex situations and experiences of moral distress can become opportunities for growth, empowerment, and increased moral resilience. This article outlines the concept and prevalence of moral distress, describes its impact and precipitating factors, and discusses promising practices and interventions.
111 citations
TL;DR: Alpha-2 agonists, such as dexmedetomidine and clonidine, sedate patients but staff can still interact with them, ease pain but do not depress breathing, and enable patients to be easier to wake and more able to communicate their discomfort and pain.
Abstract: RELEVANCE FOR NURSING Patients who require mechanical ventilation typically need some form of sedation. However, some commonly used sedatives, such as propofol, midazolam, and lorazepam, also lower blood pressure, depress breathing, and delay awakening after a long-term infusion. They may also prolong breathing support time and hospital length of stay. Alpha-2 agonists, such as dexmedetomidine and clonidine, sedate patients but staff can still interact with them, ease pain but do not depress breathing, and enable patients to be easier to wake and more able to communicate their discomfort and pain. Therefore, these drugs may be a good alternative to the more traditional sedatives for use in longterm sedation.
84 citations
TL;DR: It is suggested that when barriers to napping are overcome, napping on the night shift is feasible and can reduce nurses’ workplace sleepiness and drowsy driving on the way home.
Abstract: Background: Nurses who work the night shift often experience high levels of sleepiness. Napping has been adopted as an effective countermeasure to sleepiness and fatigue in other safety-sensitive industries, but has not had widespread acceptance in nursing.Purpose: To assess the barriers to successf
51 citations
[...]
41 citations
[...]
TL;DR: This is the story of a woman who was diagnosed with breast cancer at a young age and had to undergo surgery to remove her ovary.
Abstract: Time and experience have a way of complicating every cancer story.
33 citations
TL;DR: The authors describe the complications that developed in an elderly patient whose skin tear was improperly dressed and discuss best practices for preventing, assessing, documenting, and managing skin tears.
Abstract: Although skin tears are common, particularly among older adults and neonates, they are often inadequately documented and poorly managed, resulting in complications, extended hospital stays, and negative patient outcomes. In this article, the first in a series on wound care in collaboration with the World Council of Enterostomal Therapists (www.wcetn.org), the authors describe the complications that developed in an elderly patient whose skin tear was improperly dressed and discuss best practices for preventing, assessing, documenting, and managing skin tears.
30 citations
TL;DR: This literature review reveals the challenges of providing EOL care to prisoners and may inspire nurses to consider steps they can take individually or within nursing organizations to improve this care and address the unique challenges faced by dying inmates.
Abstract: To conduct a systematic review of the published research literature on end-of-life (EOL) care in prisons in order to determine the current state of the science and suggest implications for nursing practice and areas for future research.Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search of the literature using the following databases: CINAHL, Criminal Justice Abstracts, the National Criminal Justice Reference Service, PsycINFO, PubMed, and Sociological Abstracts. All databases were searched from the time of their inception through June 2014. All English-language articles that reported on original quantitative and qualitative research involving EOL or palliative care delivered to prisoners were included. We abstracted data, using the matrix method, and independently reviewed and graded the evidence on its level of strength and quality in accordance with the Johns Hopkins Nursing Evidence-Based Practice rating scales.Nineteen articles, all published between 2002 and 2014, met the inclusion criteria. Of these, 53% were published between 2009 and 2014, and 58% reported findings from qualitative research. One article reported on research conducted in the United Kingdom; the remaining 18 reported on research conducted in the United States. Capacity (that is, the number of prisoners requiring EOL care and the ability of the prison to accommodate them) and the site of EOL care delivery varied across studies, as did the criteria for admission to EOL or hospice services. Care was provided by prison health care staff, which variously included numerous professional disciplines, corrections officers, and inmate caregivers. The inmate caregivers, in particular, provided a wide array of services and were viewed positively by both EOL patients and health care staff. There are insufficient data to characterize the patients' and inmate caregivers' perceptions of the EOL care staff and the quality of care they provided. The screening criteria applied to inmate caregivers and the training they received varied widely among care programs. Inmates providing EOL care viewed caregiving as a transformational experience. Likewise, prison administrators and health care staff viewed inmate participation positively.This literature review reveals the challenges of providing EOL care to prisoners and may inspire nurses to consider steps they can take individually or within nursing organizations to improve this care and address the unique challenges faced by dying inmates. By being aware of these issues and advocating for best practices, nurses can help inmates at the end of life to have a dignified death.
29 citations
TL;DR: In this article, the authors describe the existing treatment guidelines, discuss pharmacologic and nonpharmacologic approaches (including CAM-based modalities), and outline nursing approaches aimed at enhancing patient self-management.
Abstract: Fibromyalgia syndrome (FMS), one of the most common rheumatic disorders, is estimated to affect up to 15 million people in the United States, 80% to 90% of whom are women. The syndrome is characterized by the presence of chronic widespread pain and various concurrent symptoms, which may include fatigue, cognitive disturbances (memory problems, difficulty concentrating, confusion), distressed mood (anxiety, depression), nonrestorative sleep, and muscular stiffness. Symptom management appears to be best addressed using a multimodal approach, with treatment strategies tailored to the individual. While medication may provide adequate symptom relief for some patients, experts generally recommend integrating both pharmacologic and nonpharmacologic approaches. Some patients may benefit from the adjunctive use of complementary and alternative medicine (CAM) modalities. Because symptom remission is rare and medication adverse effects can complicate symptom management, well-informed nursing care practices and patient education are essential. This article describes the existing treatment guidelines, discusses pharmacologic and nonpharmacologic approaches (including CAM-based modalities), and outlines nursing approaches aimed at enhancing patient self-management.
24 citations
TL;DR: In this paper, the authors used the 52-item Health-Promoting Lifestyle Profile II instrument to explore participants' self-reported health-promoting behaviors and measure the dimensions of health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management.
Abstract: Purpose The purpose of this study was to gather baseline data on the health-promoting lifestyle practices of RNs working in six major health care and educational institutions in a southeast Pennsylvania community. Methods A descriptive correlational study design was used. The 52-item Health-Promoting Lifestyle Profile II instrument was used to explore participants' self-reported health-promoting behaviors and measure the dimensions of health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management. Results Findings revealed that physical activity and stress management scores were low for the entire group of RNs. There were statistically significant differences between nurses 50 years of age and older and those 30 to 39 years of age for the subscales of health responsibility, nutrition, and stress management, suggesting that older nurses are more concerned about their health. There were also statistically significant differences between nurses 50 years of age and older and those 29 years of age and younger for the subscale of health responsibility. Sixty-seven percent of participants reported having too many competing priorities and had significantly lower subscale scores for spiritual growth, interpersonal relations, and stress management, as well as significantly lower total scores. Conclusion This study's findings provided baseline data that will be useful in planning health-promoting lifestyle interventions for participants specific to their institutions, and may help guide future research and educational initiatives related to numerous issues common to the RN workforce. The failure of many nurses to take adequate care of themselves needs to be better understood and addressed, by both individual nurses and their employers.
21 citations
TL;DR: The authors touch on the history of massage in nursing care and discuss its emotional and physiologic benefits for both patient and nurse, as well as describing specific massage techniques and discussing precautions to consider before using massage with certain patients.
Abstract: Since ancient times, massage therapy has been used to promote healing by people of all backgrounds and cultures Massage therapy was once taught as a core nursing skill, but it gradually lost ground in the United States during the second half of the 20th century with the increased use of technology and documentation in nursing In recent years, however, there has been a resurgence in the use of massage therapy Research has provided insight into the mechanisms by which massage supports the healing process, and this has sparked support for including massage therapy in routine hospital care In this article, the authors touch on the history of massage in nursing care and discuss its emotional and physiologic benefits for both patient and nurse They describe specific massage techniques and discuss precautions to consider before using massage with certain patients
TL;DR: The authors discuss the underlying causes of late and long-term sequelae of breast cancer treatment and describe effective assessment and management strategies, focusing specifically on the most common and potentially debilitating upper body effects of Breast cancer surgery and external radiation therapy.
Abstract: More than 12% of women will be diagnosed with breast cancer at some point in their lives, and 78% of them can be expected to survive for at least 15 years More than 28 million breast cancer survivors currently reside in the United States After breast cancer treatment, as many as 90% of survivors report physical problems that can reduce functional ability, produce or exacerbate emotional problems, negatively affect body image, and diminish quality of life Many survivors will seek care for late and long-term effects of treatment, which will not necessarily be recognized as such by health care providers and appropriately treated In this article, the authors discuss the underlying causes of late and long-term sequelae of breast cancer treatment and describe effective assessment and management strategies They focus specifically on the most common and potentially debilitating upper body effects of breast cancer surgery and external radiation therapy: lymphedema, axillary web syndrome, postmastectomy pain syndrome, rotator cuff syndrome, adhesive capsulitis, arthralgias, cervical radiculopathy, and brachial plexopathy
Journal Article•
TL;DR: This paper conducted a systematic review of the published research literature on end-of-life care in prisons in order to determine the current state of the science and suggest implications for nursing practice and areas for future research.
Abstract: Objective
To conduct a systematic review of the published research literature on end-of-life (EOL) care in prisons in order to determine the current state of the science and suggest implications for nursing practice and areas for future research.
Methods
Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search of the literature using the following databases: CINAHL, Criminal Justice Abstracts, the National Criminal Justice Reference Service, PsycINFO, PubMed, and Sociological Abstracts. All databases were searched from the time of their inception through June 2014. All English-language articles that reported on original quantitative and qualitative research involving EOL or palliative care delivered to prisoners were included. We abstracted data, using the matrix method, and independently reviewed and graded the evidence on its level of strength and quality in accordance with the Johns Hopkins Nursing Evidence-Based Practice rating scales.
Results
Nineteen articles, all published between 2002 and 2014, met the inclusion criteria. Of these, 53% were published between 2009 and 2014, and 58% reported findings from qualitative research. One article reported on research conducted in the United Kingdom; the remaining 18 reported on research conducted in the United States. Capacity (that is, the number of prisoners requiring EOL care and the ability of the prison to accommodate them) and the site of EOL care delivery varied across studies, as did the criteria for admission to EOL or hospice services. Care was provided by prison health care staff, which variously included numerous professional disciplines, corrections officers, and inmate caregivers. The inmate caregivers, in particular, provided a wide array of services and were viewed positively by both EOL patients and health care staff. There are insufficient data to characterize the patients’ and inmate caregivers’ perceptions of the EOL care staff and the quality of care they provided. The screening criteria applied to inmate caregivers and the training they received varied widely among care programs. Inmates providing EOL care viewed caregiving as a transformational experience. Likewise, prison administrators and health care staff viewed inmate participation positively.
Conclusions
This literature review reveals the challenges of providing EOL care to prisoners and may inspire nurses to consider steps they can take individually or within nursing organizations to improve this care and address the unique challenges faced by dying inmates. By being aware of these issues and advocating for best practices, nurses can help inmates at the end of life to have a dignified death.
TL;DR: The majority of falls occurred when patients were unassisted by nurses, most often during toileting, and an accountability care program that required nurses to use reflective practice to evaluate each fall resulted in decreases in the unit's rates of falls and falls with injury.
Abstract: Despite standard fall precautions, including nonskid socks, signs, alarms, and patient instructions, our 48-bed cardiac intermediate care unit (CICU) had a 41% increase in the rate of falls (from 2.2 to 3.1 per 1,000 patient days) and a 65% increase in the rate of falls with injury (from 0.75 to 1.24 per 1,000 patient days) between fiscal years (FY) 2012 and 2013. An evaluation of the falls data conducted by a cohort of four clinical nurses found that the majority of falls occurred when patients were unassisted by nurses, most often during toileting. Supported by the leadership team, the clinical nurses developed an accountability care program that required nurses to use reflective practice to evaluate each fall, including sending an e-mail to all staff members with both the nurse's and the patient's perspective on the fall, as well as the nurse's reflection on what could have been done to prevent the fall. Other program components were a postfall huddle and guidelines for assisting and remaining with fall risk patients for the duration of their toileting. Placing the accountability for falls with the nurse resulted in decreases in the unit's rates of falls and falls with injury of 55% (from 3.1 to 1.39 per 1,000 patient days) and 72% (from 1.24 to 0.35 per 1,000 patient days), respectively, between FY2013 and FY2014. Prompt call bell response (less than 60 seconds) also contributed to the goal of fall prevention.
TL;DR: The authors focus specifically on the inhalation, both direct and by diffusion, as well as the topical application of essential oils, providing guidance for their use in acute care, self-care, community nursing, and long-term care that will enable readers to incorporate this modality into nursing practice.
Abstract: With the growing popularity of integrative medicine, essential oils have found their way back into health care. Essential oils provide a simple way to alleviate certain physical symptoms, promote emotional well-being, and provide comfort. This article, the last in a five-part series on holistic nursing, discusses the administration and common uses of essential oils; their reported benefits, potential risks, and contraindications; and the current state of associated research. The authors focus specifically on the inhalation, both direct and by diffusion, as well as the topical application of essential oils, providing guidance for their use in acute care, self-care, community nursing, and long-term care that will enable readers to incorporate this modality into nursing practice.
TL;DR: A series of policy briefs on topics of interest to nurses is presented in this paper, where the authors focus on the following topics of particular relevance to nurses' work: NER.
Abstract: A series of policy briefs on topics of interest to nurses.
TL;DR: The American Academy of Nursing has identified nurses they call edge runners-"practical innovators who have led the way in bringing new thinking and new methods to a wide range of health care challenges."
Abstract: As part of its Raise the Voice campaign to showcase nurses who are key players in transforming health care, the American Academy of Nursing has identified nurses they call edge runners-"practical innovators who have led the way in bringing new thinking and new methods to a wide range of health care challenges." This is the seventh in AJN's series of profiles of these nursing innovators. Read and be proud of what nurses can accomplish.
TL;DR: In this article, the authors explored and compared the perceptions of nurse leaders, RRT members, and RRT users regarding the benefits of RRTs, and found that nurse leaders' perceptions tended to focus on macro-level benefits.
Abstract: The perceived benefits of rapid response teams (RRTs) influence whether RRTs are used and sustained. Perceived benefits are particularly important to sustaining RRTs when limited RRT data are shared with organizational members. Nurse leaders' perceptions of the benefits of RRTs likely influence their support, which is crucial for sustained RRT use. The perceptions of RRT members and end users similarly will affect use. But little is known regarding the perceptions of nurse leaders, RRT members, and RRT users in this regard.This study sought to explore and compare the perceptions of nurse leaders, RRT members, and RRT users regarding the benefits of RRTs.A qualitative, multiple-case study design was used. Semistructured interviews were conducted with nurse leaders, RRT members, and RRT users at four community hospitals, as part of a larger mixed-methods study examining RRT sustainability. Purposive and snowball sampling were used. Recruitment strategies included e-mail and listserv announcements, on-site presentations, direct personal contact, and a study flyer.All participants reported perceiving various ways that RRTs benefit the organization, staff members, and patients. Variations in the benefits perceived were observed between the three participant groups. Nurse leaders' perceptions tended to focus on macro-level benefits. RRT members emphasized the teaching and learning opportunities that RRTs offer. RRT users focused on the psychological support that RRTs can provide.Both similarities and differences were found between nurse leaders, RRT members, and RRT users regarding their perceptions of RRT benefits. Differences may be indicative of organizations' information-sharing processes; of variation in the priorities of nurse leaders, RRT members, and RRT users; and of the challenges nurses face daily in their work environments. Future research should investigate whether the perceived benefits of RRTs are borne out in actuality, as well as the relationships between the perceived benefits of RRTs and organizational and RRT characteristics.
TL;DR: When engaging in telemedicine, it is important for a nurse to understand legal and regulatory requirements.
Abstract: When engaging in telemedicine, it is important for a nurse to understand legal and regulatory requirements.
TL;DR: The manufacturer of Zecuity, a transdermal formulation of sumatriptan, which is used to treat migraine headache, has temporarily suspended sales, marketing, and distribution while it works with the FDA to investigate the reports of burns and scarring associated with the patch.
Abstract: The manufacturer of Zecuity, a transdermal formulation of sumatriptan, which is used to treat migraine headache, has temporarily suspended sales, marketing, and distribution while it works with the FDA to investigate the reports of burns and scarring associated with the patch.Clinicians should immed
TL;DR: How nurses at a Magnet-designated academic medical center developed and implemented a bullying task force to address the problem is described.
Abstract: Bullying in the workplace can create a dysfunctional environment that is associated with serious physical and psychological harm to the person being bullied. Nurses' experience with bullying has gained considerable attention in recent years, and warrants further discussion. Nurse leaders need to develop and implement effective bullying prevention initiatives that will foster the functioning of a professional and productive staff in a healthy work environment. The aim of this article is to review workplace bullying as experienced by nurses, and describe how nurses at a Magnet-designated academic medical center developed and implemented a bullying task force to address the problem.
TL;DR: The issues faced by U.S. health care organizations—and the policies to address them—are examined, with a focus on mental health and substance abuse.
Abstract: Examining the issues faced by U.S. health care organizations—and the policies to address them.
TL;DR: In-hospital and community-oriented evidence-based teaching on safe sleep practices and environments was associated with no sleep-related infant deaths after discharge from this hospital's neonatal intensive care unit in calendar year 2015.
Abstract: Objective: The purpose of this project was to design, implement, and evaluate a safe sleep program for expectant mothers and the families of infants discharged from our hospital's neonatal intensive care unit (NICU). It was prompted by the sleep-related deaths of two infants in the community, both o
TL;DR: Consolidated approaches are needed from employers, victims, and the political system to address gender-based violence in the workplace.
Abstract: Consolidated approaches are needed from employers, victims, and the political system. Language: en
Journal Article•
TL;DR: In this article, a retrospective study was conducted to determine which patient factors are associated with injurious falls in hospitalized adults and found that having a primary discharge diagnosis of "symptoms, signs, and ill-defined conditions" was a significant predictor of injurious fall.
Abstract: &NA; Background: Despite years of research and increasingly evidence-based practice, falls continue to be the most commonly reported adverse events experienced by hospitalized adults. Yet a majority of the relevant research has focused on predicting and preventing falls in general; there has been little focus on injurious falls. Purpose: The purpose of this retrospective study was to determine which patient factors are associated with injurious falls in hospitalized adults. Methods: The study site's adverse event reporting database was used to identify 1,369 patients who fell between January 1, 2006, and October 31, 2013. Of these, 381 (27.8%) subjects suffered injurious falls. Variables of interest included age, sex, fall history, use of diuretics, use of central nervous system medications, cognitive impairment, primary discharge diagnoses, abnormal laboratory values, impaired mobility, and body mass index. Findings: Bivariate analysis revealed a statistically significant association between injurious falls and having a primary discharge diagnosis of “symptoms, signs, and ill-defined conditions.” Having this discharge diagnosis was a significant predictor of injurious falls. Conclusions: Findings from this study may help hospital clinicians to better identify which patients are most at risk for injurious falls and to create better fall-related injury prevention interventions.
TL;DR: Cases of anencephaly in Washington State have continued to increase, with the current rate estimated at 9.5 per 10,000 live births, and the findings of Washington's ongoing investigation are explored.
Abstract: In the spring of 2012, a nurse in Washington State detected a cluster of babies born with anencephaly-a fatal condition in which infants are born without parts of the brain or skull. The resulting investigation initially confirmed a rate of anencephaly between January 2010 and January 2013 of 8.4 per 10,000 live births-more than four times the national average. As of November 2015, cases of anencephaly in Washington State have continued to increase, with the current rate estimated at 9.5 per 10,000 live births. While no distinct cause has yet been determined, neural tube defects-including anencephaly-are known to have multiple causes, including folic acid deficit, genetic variants in the folate pathway, and exposure to a variety of environmental and occupational toxins. This article describes many of these risk factors and explores the findings of Washington's ongoing investigation.
TL;DR: Mentoring strategies clinical instructors and preceptors can use to help ease novice nurses' transition to practice are described.
Abstract: This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. This article describes mentoring strategies clinical instructors and preceptors can use to help ease novice nurses' transition to practice.
TL;DR: The data show that Latinos lag far behind all other racial and ethnic groups in representation among RNs, and nursing education programs and institutions need to improve their efforts to increase the number of Latino nurses relative to the Latino population.
Abstract: Objective: This study aims to provide demographic data on the 5.4% of U.S. RNs who are Latino in order to assist nursing educators in planning more effective engagement with the growing U.S. Latino population.
Methods: Detailed data from the U.S. Census for the years 1980 to 2010 were used to identify the total U.S. population and the total number of RNs in four standard U.S. Census racial and ethnic groups: non-Latino white (NLW), Latino, African American, and Asian/Pacific Islander.
Results: The number of RNs in each racial or ethnic group per 100,000 persons of that same group is reported for all four groups. Spanish-language ability and nativity were derived only for the NLW and Latino groups. Data are reported for the United States as a whole and for the five states with the largest Latino populations: California, Florida, Illinois, New York, and Texas. Of the four racial and ethnic groups, Latinos had the fewest number of RNs per 100,000 population in the period from 1980 to 2010. Compared with NLW RNs, Latino RNs were more likely to speak Spanish and to have been born abroad. State-by-state variations from the national patterns are provided.
Conclusions: While major nursing organizations have expressed a desire to increase the diversity of the nursing workforce, the data show that Latinos lag far behind all other racial and ethnic groups in representation among RNs. Nursing education programs and institutions need to improve their efforts to increase the number of Latino nurses relative to the Latino population.
TL;DR: Providing learners the experiences without the risks.
Abstract: Providing learners the experiences without the risks.