Clayton W. Keene BSN,RN; MSN student
Alayna Erlandson BSN, RN.
Patricia E. Zander Ph.D., RN
Embracing Electronic Textbooks in Nursing Theory Courses
Dawn CM Summerfield; MSN; RN Judy K Anderson; PhD; RN; CNE
Western technical College; Viterbo University
Research
Background:
Textbook selection is one component of faculty responsibility in curriculum. Textbooks are often used over the span of the program and into the early years of a nurse’s practice.
Significance:
The “E-book” or electronic book format is being promoted by textbook companies and vendors of electronic reading devices; however little is know about the nursing student perception of textbooks in electronic format for major nursing theory courses.
Purpose/objective:
Purpose: To determine the perception of nursing students regarding the use of electronic textbooks for nursing theory classes (e.g. Adult Health, Maternal-Child Health)
Methods/project:
This descriptive, exploratory study surveyed nursing students regarding perceptions of the use of electronic textbooks. A self-reporting, rating and rank / order questionnaire was utilized. Questionnaires were distributed to 588 students from 14 schools of nursing in five Midwestern states.
Results:
On a scale of one to five, (1 = strongly dislike; 5 = strongly like) the mean student perception of electronic textbooks was 2.77. There was no significant difference found between ADN and BSN students (p = 0.19). There was a significant difference found between student age groups. Students aged 18-24 were less eager to adopt electronic textbooks then their older counterparts (p= 0.04). Students responded somewhat more favorably to electronic technology for reference materials and textbooks (mean rating 3.25; r = 0.72; p = 0.1). The perceived benefit was frequently lower cost.
Clinical Implications:
Students were not found eager to embrace electronic textbooks for their core nursing theory textbooks. Perceived disadvantages include screen readability, the ability to highlight, and technical issues. Additionally financial investment and training on devices were cited disadvantages. Schools considering adopting electronic textbooks are recommended to consider cost of implementation to student and institution, offering a choice of formats, and providing technical support in training and problem-solving.
Glycemic Control: Self-Management and Self-Efficacy
Michele M. Merten, RN, BSN
Viterbo University
Research
Background:
Globally, diabetes continues to rise at alarming rates with an estimated 285 million people worldwide afflicted. Type 2 diabetes makes up the majority of these numbers with diet and sedentary lifestyles as major contributing factors in this disease.
Significance:
Beyond the 24 million people in the United States already diagnosed with diabetes, an estimated 57 million Americans have pre-diabetes. With a continued rise in diabetes, there will be a sequelae of increases in cardiac disease, blindness, renal failure, and lower extremity amputations associated with uncontrolled high blood glucose levels.
Purpose/objective:
To further investigate in adults with type 2 diabetes whether strategies to enhance an individuals’ self-efficacy are more effective in improving glycemic control over a 3 to 24-month period compared to adults with type 2 diabetes receiving usual care. 1. Do self-management and patient empowerment strategies influence self-efficacy? 2. Do strategies to enhance self-efficacy have a subsequent positive influence on glycemic control?
Methods/project:
Review of the literature between 2005-2010 including all countries was performed using CINAHL, Ovid MEDLINE, and EMBASE. Key words: self-efficacy, diabetes, diabetes mellitus type 2, self-care, self-management, glycemic control, and hemoglobin A1c.
Results:
The research overwhelmingly supports self-management strategies to enhance one’s self-efficacy with a subsequent positive influence on glycemic control. Improvement in self-efficacy was demonstrated in all eleven studies with seven having improvement at level of statistical significance. Ten of eleven studies showed an improvement in both self-efficacy and glycemic control with half reporting improvement at level of statistical significance.
Clinical Implications:
As the incidence of diabetes continues to rise, it will be imperative for nurse practitioners to understand and utilize technological, institutional, and community based self-management programs. Diabetes affects individuals worldwide; therefore, nurse practitioners should draw upon motivational and change theories not only to empower individuals but to guide the individual with lifestyle changes and self-management specific to their needs.
Review of Barriers and Strategies to Enhance Living Organ Transplantation in Minorities
Linda Yang, BSN, RN
Research
Background:
Living organ transplantation can decrease the mortality and morbidity associated with end-stage chronic diseases; however, minorities are least inclined to explore the option of living organ transplants.
Significance:
With the growing prevalence of end-stage chronic diseases among African Americans, Asians, and Hispanics, there is a great need for living organ donation within these minority groups.
Purpose/objective:
The purpose of this integrative review is to examine the existing research literature to discern the current barriers to living organ transplantation in African Americans, Asians, and Hispanics and to identify strategies to overcome these barriers.
Methods/project:
An extensive search was completed on four databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVIDs Medline, EMBASE, and PubMed Central. A purposive sample of 20 articles based on a review of abstracts for relevant content forms the basis of this integrative review.
Results:
Identified barriers included lack of knowledge, personal and cultural beliefs, fear, mistrust of healthcare providers, low socioeconomic status, and referral patterns. Suggested strategies to overcome barriers to organ donation in minority groups consisted of varying efforts to increase awareness and family discussion.
Clinical Implications:
Further research is needed to examine the understanding of end-stage chronic diseases and the perceptions of living organ donation as a treatment option among African Americans, Asians, and Hispanics.
Yoking the Physical Practice of Yoga with Alleviating Symptoms of Depression
Rebecca A. Zatorowski, BSN, RN
Viterbo University
Evidence-based practice
Background:
Yoga, a form of complementary and alternative therapy (CAT), may prove to be an attractive adjunct treatment in the alleviation of depressive symptoms.
Significance:
Nurse Practitioner's have a primary responsibility to their patients to be well versed not only in medical treatments for depression, but also in complementary and alternative therapies (CAT) such as yoga. Given the likelihood the patient is already using or considering CAT in conjunction with their medical treatment.
Purpose/objective:
The aim of this executive summary is to explore the evidence in regards to the effectiveness of yoga in the alleviation of symptoms of depression.
Methods/project:
Twelve individual studies and four systematic reviews were included in the review of the literature. Keywords: yoga, depression, mood
Results:
The initial indications of yoga interventions on depressive symptoms are potentially beneficial. Variation in types of yoga, aspects of yoga practice, low number of study participants, and differing levels of depression studied suggest that the findings be interpreted with caution.
Clinical Implications:
Nevertheless, further research of yoga as a therapeutic adjunct therapy in the alleviation of symptoms of depression is warranted.
A Comparison of Key Aspects of Motivational Interviewing for Lifestyle Change in Primary Care
Catherine Compton, FNP student, RN, BSN
Viterbo University
Evidence-based practice
Background:
Lifestyle choices are a significant influence on health and quality of life for individuals, therefore, impacting society as well.
Significance:
Motivational interviewing (MI) method is well suited to nurse practitioners, who spend a significant amount of time at each visit on communication and interpersonal activities to promote healthy lifestyle choices.
Purpose/objective:
Therefore, the purpose of the integrative literature review was to determine if the use of motivational interviewing (MI) in the primary care setting improves lifestyle choices. The type of client for whom MI is effective; type and length of MI training; and method of MI utilized were examined. Additionally, practice issues surrounding MI, and gaps in MI research were explicated.
Methods/project:
Relevant research conducted since 2005 was gleaned from PsychINFO, CINAHL, Pub Med, Medline, and PsychARTICLES, with primary and ancestry searches performed.
Results:
MI was effective for different populations, and 13 out of 15 articles reached statistical significance for outcomes. Statistical significance was reported after eight hours of MI education for counselors. In person contact or face-to-face contact with follow-up telephone MI produced statistically significant results compared to telephone alone. Practice issues mentioned were training costs and provider’s ability to direct the office visit discussion. The research revealed there was a lack of minority participation.
Clinical Implications:
This knowledge will serve to inform primary care providers, the nursing profession, and ancillary staff how to best incorporate the evidence available regarding key aspects of MI into everyday practice, thereby promoting healthy lifestyle changes.
Efficacy of Non-Pharmacological Interventions in Reducing Pain in Patients with Fibromyalgia
Sherri Bohlinger, B.A.,B.S.N.,RN
Viterbo University MSN Student
Evidence-based practice
Background:
Fibromyalgia is a chronic pain condition that is not well understood. Individuals suffering from fibromyalgia often utilize treatment modalities outside of the conventional realm. Are they helpful in relieving pain? Patients and healthcare providers, alike, may not understand alternative treatments, yet wish to pursue them.
Significance:
To better understand various non-pharmacological treatment modalities available in treating pain in patients with fibromyalgia and the efficacy in pain reduction of those treatment modalities.
Purpose/objective:
Will non-pharmacological interventions be effective in reducing pain in patients who suffer from fibromyalgia?
Methods/project:
integrative lit. review
Results:
Significant research has been conducted showing consistent findings that acupuncture has reduced pain in patients suffering from fibromyalgia. Multiple other modalities show positive results in decreasing pain as well; however, further studies need to be conducted to strengthen these results.
Clinical Implications:
Patients will seek out non-pharmacological treatment modalities for pain reduction. NPs need to stay abreast of the most recent research to understand those treatments to tactfully educate and counsel their patients on such alternatives. Treating the patient with care and compassion will build rapport and respect and enhance the professional relationship.
The Value & Retention of the Older, Experienced Nurse in the Workforce
Linda Sargent, B.S.N., RN
Viterbo University
Research
Background:
Nationally, the debated issue of healthcare with the impending shortage of nurses to provide care for an increasing number of aged patients has become a threat that needs immediate attention. At the same time that there has been a continual decline in the number of nurses in the under 25 years and the 25-29 year old groups, there continues to be an increasing rise in the percentage of RNs in the age groups of 40-55+ age group. An improtant strategy to ease the impending shortage is to retain the experienced senior nurses and those nurses approaching retirement who still want to continue to work.
Significance:
With baby boomers currently filling the ranks of nurses, the next generation of nurses just does not have enough people to take the places of the baby boomers who may be retiring.
Purpose/objective:
The objective of this literature was to examine how valuable are the older, expert nurses to the nursing profession; and what strategies are needed to increase the retention of the older, expert nurse in the workforce.
Methods/project:
To examine this objective, a literature review of the studies that had a focus on the value of older, experienced nurses; and implementation of strategies to increase retention and/or recruitment of older nurses was completed.
Results:
The findings of this study indicate that the retirement of the largest population of nurses will push the RN workforce well below the projected need by 2020 and provide an indicator of progress or lack of progress in addressing older nurse recruitment and retention.
Clinical Implications:
With the need to retain older nurses in the workforce for as long as possible to avert the threat to health care with this impending nurse shortage, the American Nurses Association and state hospital associations are now calling for measures to retain nurses past the age of retirement.
General Anesthesia Effects on the Eye
Robyn Davis, RN, BSN, SRNA & Nicole Martiny, RN, BSN, SRNA
Franciscan Skemp School of Nurse Anesthesia
Research
Background:
The patient relies on the anesthesia provider to provide a safe anesthetic. Protection of the patient's well-being is imperative from head to toe.
Significance:
Patient advocate
Purpose/objective:
Corneal abrasion is the most common ocular injury occurring in the perioperative period. The anesthesia provider, with vigilant care, can use strategies for prevention preoperatively and perioperatively.
Methods/project:
Literature review
Results:
Although there are multiple potential injuries, corneal abrasion is the most common ocular complication occurring during the perioperative period. Preventative measures and attentive care can aid in the reduction of corneal abrasions in susceptible patients.
Clinical Implications:
Awareness of the signs and symptoms of corneal abrasions, seeking appropriate consultations, and providing early treatment may reduce ocular morbidity.
Sugammedex: A Steroidal Non-depolarizing Muscle Relaxant Reversal Agent
Slade Bahls RN, BSN Cole Dolan RN, BSN
FSH School of Anesthesia
Research
Background:
To research the effectiveness of sugammedex in the reversal on non-depolarizing muscle relaxants.
Significance:
Current reversal of neuromuscular block requires the use of acetylcholinesterase inhibitors and muscarinic antagonists. Which lack the ability to reverse profound muscle blockade and have undesirable side effects.
Purpose/objective:
To review current studies on the effectiveness and side effects of sugammadex on reversing muscle blockade.
Methods/project:
Lit. Review
Results:
Sugammadex can provide immediate reversal of profound neuromuscular blockade. Studies suggest sugammadex may be used safely among various patient populations.
Clinical Implications:
The use of sugammadex can reduce the need to use acetylcholinesterase inhibitors and muscarinic antagonists to reverse muscle blockade. In addition the use of suggamedex along with rocuronium may provide an alternative to succinylcholine for rapid sequence intubation.
Hope Fostering Strategies for Terminally Ill Patients
Andrea Branson, BSN, RN, MSN Student
Viterbo University
Research
Background:
Hope is an obscure nursing concept and an essential coping strategy. Its interpretation differs between individuals and changes throughout an individual’s life. The concept of hope is especially complex when applied to terminally ill individuals.
Significance:
The meaning of hope contrasts greatly between those who are terminally ill and healthy individuals. It is vital that healthcare providers nurture hope effectively; however, they often find it challenging to enhance hope in individuals diagnosed with a terminal illness.
Purpose/objective:
The purpose of this literature review was to identify hope fostering strategies that healthcare providers can utilize to enhance end of life care for terminally ill individuals.
Methods/project:
A literature search was performed using CINAHL, PubMed, and bibliography searches. Thirteen articles published between 1990 and 2009 were selected that identified specific hope fostering strategies that health care providers can implement in practice.
Results:
The strategies found were organized into fifteen categories: encourage meaningful relationships with loved ones, facilitate development and redirection of realistic goals, facilitate expression of spiritual beliefs, adequate management of uncomfortable symptoms, affirmation of worth, conduct life reviews and reminisce, lightheartedness and humor, be present, balance honesty with optimism and hope, form a patient centered partnership, personal attributes, encourage participation in leisure activities, allow patient to maintain independence, communicate own sense of hope for patient, and help find joy in the present and day-to-day activities.
Clinical Implications:
Healthcare providers cannot effectively implement any the hope fostering strategies without first establishing a mutual trust and respect with patients and their families. In order to establish trust the provider must treat the patients with dignity, encourage the patients to actively participate with the development of their plan of care, speak to the patients about their condition at a level that they can understand, and create an environment that allows open and honest communication.
Improving Patient Safety During Carboplatin Therapy
Dena L. Navoichick RN/BSN
Viterbo University Graduate Student in Nursing
Research
Background:
Carboplatin is a platinum-derived chemotherapy used for a variety of malignancies. Low toxicity rate and ease of administration make carboplatin a preferred agent for treating cancer. Carboplatin hypersensitivity is an oncologic emergency, which can be life threatening.
Significance:
To assist the professionals who are responsible for administering carboplatin to cancer patients in being prepared to both predict patients at risk and manage therapy following this oncologic emergency.
Purpose/objective:
The purpose of this integrative literature review was to synthesize the evidence on the most effective ways to predict which patients are at greater risk for carboplatin hypersensitivity reactions. Methods for continuation of platinum therapy following a carboplatin hypersensitivity reaction also were explored.
Methods/project:
Relevant databases were searched for medium to high-quality evidence on the topic of prediction and management of carboplatin hypersensitivity reactions. Desensitization and substitution of therapy were evaluated for safety and effectiveness as a means to continue platinum therapy after a carboplatin hypersensitivity reaction.
Results:
Findings indicated having received more than six cycles of carboplatin is an established method of predicting those at increased risk. Carboplatin skin testing, history of allergies, and administration of carboplatin following progression or recurrence are important factors to consider, but were less strongly supported as predicting patients at risk. Desensitization and substitution of therapy are both viable methods of continuing platinum therapy in those who have experienced a carboplatin hypersensitivity.A tool to assist providers in identifying patients who may be at increased risk for nurses was developed using the evidence from this review.
Clinical Implications:
Carboplatin hypersensitivity is a risk for any patient receiving this common chemotherapy. Predicting those at risk prior to a hypersensitivity reaction and responding after a reaction are critical elements in their management.
Xenon, a Noble Anesthetic
Matt Roth, RN, BSN Matt Keyes, RN, BSN
Franciscan Skemp School of Nurse Anesthesia
Research
Background:
Currently used anesthetic gasses do not possess all the characteristics of an Ideal Anesthetic Agent. In addition, they are flurinated carbons, which are known to contribute to ozone depletion and global warming. The search for an Ideal Anesthetic Agent that is also environmentally safe leads to considerations of Xenon.
Significance:
Nurses are at the forefront of providing quaility, wholistic care in an efficient, cost effective and timely mannor. In the 21st century, this includes environmental considerations.
Purpose/objective:
To explore the benefits and identify the barriers to using Xenon as an anesthetic agent.
Methods/project:
Combination
Results:
Xenon is an effective anesthetic agent; further study is needed to overcome the challenges of delivery and cost on a widespread scale.
Clinical Implications:
New technologies will aid in continuing to provide quality care while addressing the pressures placed on the health care deliverly system.
Associations between Smoking and Breastfeeding: A Review of Literature
Julie Osten, BSN, RN MSN student
Viterbo University
Research
Background:
A review of the literature from 1998 to 2010 was done to determine the correlations between smoking and breastfeeding.
Significance:
The significance of this review resulted in the understanding of the need for maternal child health care providers to consistently advocate for proactive healthy choices; namely, to quit smoking and breastfeed, as both have an impact on the health of the mother and her child.
Purpose/objective:
The purpose of this review is to establish the associations between maternal smoking and breastfeeding, with the intent to advocate for smoking cessation and the promotion of breastfeeding.
Methods/project:
Literature review
Results:
Several themes emerged: quitting smoking and human lactation are complex activities requiring positive self-efficacy and establishment of significant support systems, quitting smoking and remaining smoke-free is dependent upon many demographic variables which also impact the outcome of breastfeeding duration, and health professionals must be consistent in the implementation of evidence-based interventions.
Clinical Implications:
It has been shown that the woman’s intention to breastfeed can impact the decision to quit smoking, and that women refrain from smoking because of nicotine transfer in breast milk, thus, this recognition confirms a strong association between breastfeeding and smoking. Breastfeeding has shown to have a reciprocal benefit towards smoking cessation.
Academic and Community Partnership to Reduce Chronic Disease through Health Improvement and Capacity Building in Four Western Wisconsin Counties
Donna Ferry BSN, RN, Judith Talbott MHA, MS, RN, Sheryl Jacobson, MS, RN
Viterbo School of Nursing
Evidence-based practice
Background:
One-half of all adults have more than one chronic disease, and this prevalence accounts for seven of every 10 deaths each year. Seventy-five percent of health care costs are related to chronic illness.
Significance:
The project was an academic and community partnership funded by the Healthier Wisconsin Program at the Medical College of Wisconsin. Partners included Viterbo University School of Nursing, Department of Family and Community Medicine at the Medical College of Wisconsin, four local health departments and one free medical clinic. A review of the literature provided information and about best practice for conducting community needs assessment and building community coalitions.
Purpose/objective:
This evidence based project sought to impact morbidity and mortality through increased disease prevention and health promotion activities in the population of uninsured and medically underserved citizens in communities in four Western Wisconsin counties.
Methods/project:
Student and public health nurses conducted needs assessments, analyzed data, and developed community coalitions to identify local health needs in each of the four counties.
Results:
Chronic Disease Community Coalitions analyzed the community needs assessment data and identified priority health needs and health improvement interventions to inform capacity building. Health improvement interventions were implemented and informed capacity building in each of the four mostly rural counties.
Clinical Implications:
Paradoxical Reactions to Benzodiazepines in Pediatric Patients
Michelle Becker, RN, BSN; Natasha Baker, RN, BSN
Franciscan Skemp School of Nurse Anesthesia
Research
Background:
Healthcare practitioners rely on the predictability of pharmacologic agents to deliver safe and effective care to patients. Occasionally, medications can react adversely in a body system to create paradoxical effects, and thereby becoming counterintuitive to its purpose. These paradoxical effects sometimes prove to be tendencies when introduced into certain physiologic states, as is the case of benzodiazepines. Research continues to show trends in adverse effects of benzodiazepines in both the very young and very old. This information influences the use of these medications by practitioners and appreciating it helps to ensure the safety of our patients.
Significance:
Purpose/objective:
Methods/project:
Results:
Clinical Implications:
Clinical Nurse Leader: Role Development and Implementation Journey
Shannon Hulett, BSN, RN, CNL Fellow
Gundersen Lutheran Medical Center
Evidence-based practice
Background:
The need for advanced nursing education, clinical expertise, and leadership training at the bedside has been recognized in the context of the current complex healthcare environment. The clinical nurse leader (CNL) is a master’s prepared nurse generalist who manages and promotes group processes to achieve lateral integration of care, with a patient and family focus at the microsystem (point of care) level. The CNL’s primary foci include nursing leadership at the bedside, managing patient outcomes and managing the care environment.
Significance:
The CNL is the newest advanced degree in nursing in almost forty years. Little is known about the details of role development and implementation within an individual organization.
Purpose/objective:
-Gain an understanding of key components in CNL role development and implementation on an inpatient unit -- Phase 1 – Planning -- Phase 2 - Implementation on initial unit -- Phase 3 - Expansion to other units -- Phase 4 – Evaluation -Identify staff, unit and organizational needs during CNL role development and implementation
Methods/project:
-Field Project -Microsystems Process Improvement Methodology -CNL Task Force Guiding Principles
Results:
-Key components in CNL role development and implementation on an inpatient unit were completed -Staff, unit and organizational needs during CNL role development & implementation were recognized -CNL responsibilities continue to evolve -Outcomes of the identified metrics will be determined
Clinical Implications:
-Utilize phase 1 and 2 lessons learned to refine implementation of phase 3 -Continue to identify and collect evaluation data for phase 4 -Network with academic CNL programs to improve curriculums -Network with other macrosystems to share innovative strategies of CNL implementation
Creating Contextual Learning Experiences via Virtual Simulation
Ramona Yehle RN, MS, Doctoral Learner
PhD student of Capella University, Employed at Western Technical College
Research
Background:
Military virtual simulations in aviation, medical and nursing science have been conducted since the 1970s (Caro, 1977). Medical education has conducted simulations, using mannequins, since the early 1960s (Alinier, Hunt, Gordon, & Harwood, 2006, p. 360). Mannequin simulators are classified on a scale from low-fidelity to high-fidelity. Fidelity is the “degree of accuracy depicted by the simulation, compared to the real experience” (Medley & Horne, 2005, p. 32). Unfortunately, human patient simulators are quite costly; a 3D virtual environment offers an alternative solution for nursing education.
Significance:
Classroom patient care simulations are commonly offered and now virtual simulations can offer a similar experience. Educational delivery methods are changing, and educators need to keep abreast of the transformation in the teaching and learning paradigms as well as with the technological changes. Educational virtual patient care simulations offer the most powerful realistic learning situations ever imagined (Aldrich, 2004). In fact, Second Life® (SL), a 3D virtual world, supports interactive experiences found in real life (Boellstorff, 2008). According to Skiba (2007b), SL, offers several attractive features such as promoting interaction within learning situations via audio, text or avatar movement, building environmental content, and learning within an immersive social networking web program. It is unknown if 3D respiratory patient nursing care simulations are beneficial for learning.
Purpose/objective:
The purpose of this research study was to determine the measurable difference in knowledge attainment among Midwestern undergraduate nursing students who participated in a Second Life® virtual respiratory patient nursing care simulation.
Methods/project:
Methodology: Literature Review In 2008, the NLN recommended that “health care professionals develop knowledge and skills in computer literacy, information literacy, and the use of information technologies” (Jeffries, et al., 2009, p. 1). Today, it is common practice for nursing students to learn critical thinking skills through designed interactive simulation practice scenarios. Online 3D virtual programs offer an exciting learning opportunity for instructional designers and educators, as well as students. This research study is framed from the social constructivist perspective as described by prominent theorists “of this [last] century” (Perkins, 1991, p. 20), Dewey, Piaget, Bruner, and Vygotsky (Driscoll, 2005, p. 386). Constructivists believe that learners “construct meanings for concepts” (Schweitzer & Stephenson, 2008, p. 585), students are not passively attaining knowledge from the instructor’s lecture. Grounded within constructivism are two principles: “knowledge is not passively received but actively built up … [and] the function of cognition is adaptive and serves the organization of the experiential world” (von Glasersfeld, 1989, p. 114). Andragogy incorporates the process of adult learning. Technical and community college adult students are frequently employed females who are returning to school to improve their futures (Brey, 1988; Porter, 1997). Educational simulations premised on the social constructivist paradigm entwine easily with adult learning needs. As “online technologies are gradually decreasing the barriers of traditional distance education comprised of interactive or communication problems” (Huang, 2002, p. 34), futurists believe that 3D virtual worlds can provide the first step to full authenticity in distance/online education. At the moment, there is a strong need to develop safe nursing “practice in the clinical environment” (Jeffries, et al., 2009; Larew, et al., 2006, p. 21). Students frequently ask for further contact with patient nursing care clinical simulations because the practice addresses “their underlying fear, lack of confidence, and lack of exposure to clinical situations” (Seropian, et al., 2004, p. 168) and definitely improves performance. Unfortunatley, due to the high cost of high fidelity mannequins, faculty attendance requirement, and minimal available laboratory space, simulation practice is limited (Laschinger et al., 2008). Research Design The Midwest technical college system has a shared nursing curriculum. Nursing courses are designed with the same program outcomes, course competencies, and learning outcomes. A second semester medical-surgical course in the two-year Nursing-Associate Degree program served as the resource for the research participants. A quasi-experimental research design framed the study. The independent variable was defined as the patient simulated respiratory 3D virtual scenario, whereas the dependent variable was comprised of the one-group, pre-test and post-test. The pre-test and post-test contained the same questions and multiple-choice options. Items on the pre-test and post-test assessed the level of the participant’s respiratory nursing care knowledge before and after the 3D virtual simulation experience.
Results:
H0 = There will be no measurable difference in knowledge attainment between the pre-test and post-test respiratory test results of nursing students who participate in the Second Life® virtual respiratory patient-care simulation. A t-test was performed to determine the statistical differences of the mean between the paired dependent sample, pre-test and post-test. The null hypothesis was accepted. No significant difference p> .05.
Clinical Implications:
Second Life® offers an immersive, stimulating, collaborative environment for nursing students. Rich opportunities abound for instructors as well as learners (Warburton, 2009). To avoid incurring financial stress from purchasing high-fidelity simulated mannequins 3D virtual worlds offer lower cost patient-care simulations. Perhaps as technical challenges are overcome pedagogy of 3D virtual worlds will improve. Access to expanded network connections and greater bandwidth is a prerequisite for valid learning experiences. Growth in virtual worlds will change the potential for learning; complex situated learning will be transformed.
Feasibility and Barriers of Early Mobility with Critically Ill Patients
Joshua Fenske BSN, RN, CCRN
Research
Background:
Critically ill patients often receive bed rest as their standard of care in the intensive care unit (ICU). Bed rest leads to muscle weakness, cognitive deterioration, dyspnea, depression and a decreased quality of life. Early mobility in this environment may improve patient outcomes.
Significance:
The use of bed rest has been the culture in the ICU for the treatment of the critically ill. Early mobility has positive patient outcomes that will change the way nurses will care for these patients.
Purpose/objective:
The purpose of the literature review is to explore recent literature to determine if early mobility is feasible with critically ill patients and what barriers may prevent it from occurring.
Methods/project:
A data base search of CINAHL, Medline, and PubMed using the key words of early mobility, intensive care unit, physical therapy, intubated, and mechanically ventilated provided data for the review.
Results:
Data indicated early mobility is feasible to be performed with critically ill patients. Barriers are present and deal with patient related factors and staff resistance.
Clinical Implications:
Incorporating early mobility in the ICU environment will be a difficult task to complete. Getting all staff to understand the need for change will be key in implementing early mobility into practice. Change is difficult in any setting and developing a plan of action can help assist to put change into practice. Early mobility is a practice the will have a positive effect on the patients outcome after a critical illness. More research is needed to develop a protocol to implement early mobility into practice.
Use of System and Task Force Initiatives in Complex Adaptive Systems to Increase Pain Documentation on the Cardiopulmonary Unit
Karen Hayter MS, RN
Gundersen Lutheran
Evidence-based practice
Background:
External agency audited facility and found inadequate documentation of pain assessment and reassessment.
Significance:
Pain assessment/reassessment is necessary to ensure proper pain mangement and patient satisfaction
Purpose/objective:
System and unit based initiatives were developed to increase nurses knowledge and documentation of pain.
Methods/project:
Quality nurse completed weekly audits on pain assessment/reassessment related to documentation, systems education occured, and unit based chart audits completed. Literature reviews support: audit and feedback as having a positive effect on outcomes; peer chart review enhances the practice of documentation by nurses; and health care systems are Complex Adaptive Systems in which change will not occur with education alone.
Results:
Overall outcomes of systems and unit based initiatives increased pain docuementation 166% over a nine month time period.
Clinical Implications:
System and unit based initiatives work together to create change. Layered interventions are needed for consistent improvement. Dramatic results can be obtained in a 9 month time period utilizing these techniques.
Parents: Gatekeepers to Childhood Obesity Prevention
Emily Dresher, RN MSN Student
Viterbo University
Research
Background:
•Influences on childhood obesity are multifaceted. •Early experiences in the family environment influence future choices related to diet and physical activity. • Parents are key decision-makers when it comes to nutrition, physical activity, and health needs of their children. • It is important to empower parents to improve healthy lifestyles. • Interventions for childhood obesity that begin in the family environment can shape healthy choices for future decision making.
Significance:
Childhood obesity is becoming a “silent” pandemic. These alarming rates pose a risk to the longevity of our youth. Parents are the first line of defense in obesity prevention and play an integral role in influencing behaviors. A collaborative effort by the family and healthcare community is warranted. Interventions that assist and support families may be a promising strategy for childhood obesity. Healthcare providers are in a vital position to introduce early interventions that decrease the risk of childhood obesity.
Purpose/objective:
To explore how parents influence healthy behaviors to prevent childhood obesity in children ages 5-18 years of age.
Methods/project:
Review of literature
Results:
Family involvement supports the best outcomes for obesity prevention. Emerging themes identified barriers to healthy behaviors that parents encountered. Barriers included: problem identification, lack of knowledge, behavior change, motivation, and goal setting.
Clinical Implications:
Education is the hallmark for childhood obesity prevention for the child and family. Assisting families to identify obesity is essential. Healthcare providers should discuss, role model, and advocate for healthy behaviors.
Potential Food-Drug Interactions in Long-Term Care
Judy K. Anderson, Ph.D, RN, CNE
Jodie Rox, BSN, RN-BC
Viterbo University
Research
Background:
Standardized medication times are utilized in many institutions for drug administration. This facilitates efficient use of nursing time and can enhance patient safety. However, these times often occur at mealtimes posing a potential risk for food-drug interactions.
Significance:
Older adults are at high risk for food-drug interactions as this population: (a) consumes 1/3 of all prescription drugs, (b) have complex drug regimes, and (c) encounter physiologic changes that can alter drug absorption and metabolism. Research in this area is limited and dated.
Purpose/objective:
The purpose of this study was to answer the questions: What is the frequency of potential food-drug interactions when using standardized medication administration times? and What medication groups are most frequently administered at times when food-drug interactions may occur?
Methods/project:
Database analysis conducted of medications scheduled at mealtimes from 4 long-term care facilities in the Upper Midwest. Frequency data were compiled of potential food-drug interactions and the type of interaction possible.
Results:
Forty-nine percent of medications scheduled at mealtimes had the potential for food-drug interaction. Cardiovascular, followed by neurological, agents were the most frequently scheduled medication group with a potential for drug-food interaction. Potential interactions with specific food elements and a potential decrease in absorption were the most frequently observed interaction types. The researchers acknowledge the actual administration times were unknown and interactions are only potential.
Clinical Implications:
The practice of standardized medication times corresponding with mealtimes presents the possibility of multiple adverse reactions as a result of increased bioavailability of medications, or a sub-therapeutic response resulting from decreased drug bioavailability. Either have a potential economic impact on healthcare costs. Findings of this study suggest a need for enhanced awareness of the potential for food drug-interactions, along with a need to identify creative and individualized scheduling that maintains safety in drug administration while preserving nursing care quality and time.
Facilitators and Barriers of Electronic Health Records
Ruth A Rexroat RN, BSN, MSN Student-Viterbo University
Viterbo University
Research
Background:
Electronic health records will soon be implemented in all health care settings in the United States.
Significance:
It is important for nurses to have a clear understanding of the facilitators and barriers of EHRs in order to evaluate the impact EHRs will have on nursing documentation, patient safety, and nursing practice.
Purpose/objective:
The purpose of this integrative review of literature has been to explore how the utilization of EHRs influences nursing documentation, patient safety,and nurses' perceptions of EHRs impact nursing practice.
Methods/project:
Eighteen published reports were included in this review of literature.
Results:
Positive and negative implications were noted with the implementation of EHRs.
Clinical Implications:
With EHRs in the early stages of implementation in the United States, research is needed to yield a more comprehensive perspective of the benefit to nursing practice and patient outcomes
Administering Immunizations to Preschool Children: Best Practices to Reduce Pain
Nicholle Frahm-Ward, RN, MSN
Viterbo University
Evidence-based practice
Background:
Vaccinations are a vital component of childhood preventive care, protecting thousands of children from life threatening illness. Unfortunately, they are also the most frequent painful procedure done in a pediatric clinic (Wallace et al., 2010). By age two the Centers for Disease Control and Prevention (CDC) recommends that children be vaccinated against fourteen preventable diseases. Currently, if combination vaccines are not used, this means that before age two a child could receive twenty or more intramuscular (IM) or subcutaneous (SQ) injections.
Significance:
“The pain linked with immunizations is a source of anxiety and distress for the children receiving the immunizations, their parents, and the providers who must administer them” (Schechter et al., p. 1184). This anxiety of needles can cause routine care to be delayed or avoided due to the anxiety that immunizations cause (Cassidy et al., 2001). It is imperative that those who are administering vaccines along with the caregivers of these children have a clear understanding of the best methods to decrease the child’s perception of pain while receiving routine vaccinations.
Purpose/objective:
The purpose of this project was to translate the results of the three recent systemic/integrative reviews into an understandable evidenced-based teaching sheet for caregivers and nurses concerning best practices to reduce pain perceptions when a pre-school aged child receives an intramuscular or subcutaneous immunization.
Methods/project:
An initial search was performed to locate literature related to the most effective psychological and physical interventions to decrease pain perception in preschoolers during routine immunizations. The Cochrane Database, Medline, Centers for Disease Control (CDC) and the American Academy of Pediatrics Journal (AAP) web sites were searched.. Key words such as immunization and pain, injection and pain, children and immunization, children and injection, pediatric immunization and pain, preschool and injection and pain, vapocoolant and injection, childhood and immunization and pain, distress and injection, and Shot Blocker were used in the literature search. Peer-reviewed articles only were incorporated. Current relevant literature (within the past 5 years) was utilized. Studies that included only infants, adults, or older children were not selected. All studies located were quantitative. No current qualitative studies were found to be relevant to the topic under consideration. In the course of searching for articles, two current systematic reviews were found, along with one “evidence-based review.” Since systematic reviews serve as a form of the highest level of evidence (Polit & Beck, 2008) and since the findings of these reviews are often not disseminated widely, a decision was made to focus upon developing an evidenced-based guideline derived from the findings of these reviews.
Results:
There are specific interventions that can be used to reduce perceived pain in children receiving injections. Evidence-based interventions that are specific to pre-school children are provided below. The interventions include: • cognitive and behavioral distraction (Uman, Chambers, McGrath, & Kisely, 2006) • combined cognitive and behavioral interventions (Uman et al., 2006) • developmentally appropriate preparation for all children greater than age two (Schechter et al. 2007) • a calm and matter of fact parental demeanor without excessive reassurance (Schechter et al. 2007) • use of local anesthetic in overly anxious children (Schechter et al. 2007) • children sitting in an upright position (Taddio et al. 2009) • stroking the skin near the injection site prior to and during injection (Taddio et al. 2009) • the order of vaccine injections when 2 injections are administered successively (most painful injection last) (Taddio et al. 2009) • rapid injection without aspiration for intramuscular injection (Taddio et al. 2009)
Clinical Implications:
It is clear that evidenced- based interventions exist and could be more widely utilized.
Who is the Nurse? Role Identification in Fast Paced Health Care
Sandra Schlichenmeyer BSN
Ana Schaper PhD, RN
Gundersen Lutheran Health System
Evidence-based practice
Background:
A systematic review of the evidence demonstrated that in the fast paced environment of health care, ease of nurse identification enhances patient safety by speeding up communication, comforting patients and families with a known presence, and decreasing confusion. Since 1974, staff nurses at Gundersen Lutheran (GL) have worn uniforms of their own choosing. In 2007, the recommendation for a standardized uniform was introduced, followed by strong opposition from nurses citing loss of individuality and abandoned. In the summer of 2009, the Nursing Marketing and Communication Committee received the directive to develop a policy to support patient safety through visual identification of the Registered Nurse. Because of the past controversy related to standardized uniforms, the Committee requested and received Nursing Council status to have the authority to act upon and enforce recommendations reflecting the voice of 1200 nurses in a difficult decision making process.
Significance:
Shared governance model utilized to make decisions for nurses by nurses.
Purpose/objective:
Registered Nurses providing direct care to patients in the hospital and clinic setting at Gundersen Lutheran will be distinguishable from other staff and disciplines to make them easily identifiable “as nurses” by colleagues, patients, families and others.
Methods/project:
The Rosswurm-Larabee Model of evidence-based practice (EBP) guided the development of the project and work of defined task forces: Identity/Attire and Economics, Project Scope, Policy Oversight, Communication, and EBP. Principles of patient safety, and patient- and family-centered care grounded all decision making by the Council.
Results:
Nurses’ voices were solicited by council member recruitment, presentation at nurse staff meetings, use of a feedback board, a website covering frequently asked questions, and a system-wide opinion poll. The Council decided that nurses would wear a uniform of a white scrub top and navy blue scrub pants.
Clinical Implications:
Lessions learned include the following. The timeline was too fast for some nurses and too slow for others. Additional communication and interactions with other Nursing Councils would have enhanced transparency of the process and provided another option for nurses to share their voices. Use of an opinion poll as a strategy to enhance nurses' voices was perceived as the decision making process. This perception lead to nurse dissatisfaction when the decision was made by the Council, as defined in the system's shared governance model. The process, however, effectively set the stage for a transition to standardized uniforms for LPNs, CNAs, MAs and Technicians using appropriate decision making strategies for uniform color by each group.
Wisconsin Nursing Working
Rebecca Inglis, MSN RN, La Crosse District Nurses Association, Gundersen Lutheran; Mary Jahangir, MSN RN, La Crosse District Nurses Association, Viterbo University
Sue Schuler MSN RN
Former President of the Wisconsin Center for Nursing
Research
Background:
High quality health care demands a sufficient supply of nurses. A shortage of nurses currently exists nationally. Nurse Workforce planning and effective policy making both require improved data collection. The Health Resources and Services Administration (HRSA) is responsible for the development of the nursing workforce in the United States. HRSA collects data nationally for workforce planning that includes small state samples but the data is not generally available for several years after collection. Population projections for Wisconsin reveal an 1.5 million increase by 2035, a 24% increase in people 65 and over and a 133% increase in elders 85 and older. Effective nurse workforce data collection is required in order to begin planning for the future of Wisconsin health care.
Significance:
see above
Purpose/objective:
The purpose of this study was to describe the current workforce supply of nurses in the state of Wisconsin.
Methods/project:
Descriptive non-experimental survey. All registered nurses were required to complete the survey as part of the licensing process.
Results:
30% of WI nursing work force is 55 years or older. 11.6% of WI nursing work force is <30 years old. 36% of the WI nursing force plan to leave direct patient care in the next nine years. Nursing academia is the oldest cohort of nurses where 42.8% is age 55 or older. Hospital nurses make up the largest cohort by work area (49.9%) and they work the longest hours. 59.3% report working > 40 hours per week. 7.7% of direct care providers report working > 49 Hours per week. There is a lack of diversity in gender, race, and ethnicity in the WI nursing workforce.
Clinical Implications:
New nurses are not entering the profession at a rate the current nurses will be leaving. Direct patient care providers plan to leave their positions at very high rate over the next 9 years. Academia has the lowest percentage of working RNs yet has the highest percentage average age (55 or older). Nursing educators are needed to prepare new nurses for the profession. Almost half will retire within 9 years. Current number of nurse educators does not support access to nursing schools: Waiting list to get into nursing schools. Limited access to clinical experiences. Historically clinical experience was in the hospital setting. Consider the ambulatory setting as a clinical site. Hospital nurses make up the largest cohort by work area (49.9%) and they work the longest hours. 59.3% report working > 40 hours per week. 7.7% of direct care providers report working > 49 Hours per week. There is a lack of diversity in gender, race, and ethnicity in the WI nursing workforce.
Improving Documentation and Nursing Satisfaction in Electronic Medical Record
Rosemarie Hoff, MS, RN
Rozina Bhimani, PhD, DNP, RN, CNP; Camilla Jaekel, PhD(c),
Franciscan Skemp Healthcare
Evidence-based practice
Background:
Over the past 20 years the emergence of electronic medical records (EMR)has changed nursing documentation. Identified gaps in the clinical knowledge include; identification of missing elements in nursing documentation from the organizational standards of practice documents and to determine nursing satisfaction with EMR documentation.
Significance:
There is modest evidence that education/competency training can improve the quality of nursing documentation and nursing satisfaction in the EMR; therefore, a lower level of evidence would be acceptable to recommend education as an option to improve nursing documentation and nursing satisfaction in the EMR.
Purpose/objective:
The purpose of this project is to (a) identify missing elements of nursing documentation from the organizational patient care standards documents and (b) determine nursing satisfaction with documentation in Electronic Medical Record (EMR) within a postpartum nursing unit.
Methods/project:
Goal I: Pre- and post-intervention chart audit reviews were conducted utilizing the Measurement Instrument: Quality of Diagnosis, Interventions and Outcomes (Q-DIO) to identify gaps between the nursing documentation in EMR and the organization’s standard of practice set for safe patient care. Goal II: A web-based survey was administered immediately pre-intervention, immediately post-intervention, and three-eight weeks post intervention to measure whether an education session in EMR improved accuracy of documentation and nursing satisfaction in EMR.
Results:
Goal I: No significant difference (p<0.05) with the organizational patient care standards and nursing documentation in the EMR were noted. Goal II: Results indicate that education intervention was statistically significant (p < 0.05) in increasing registered nurses’ ability to navigate, locate information and forms in EMR, as well as the location of the identified diagnosis related to the Patient Care Standard in EMR. However, overall nursing satisfaction did not change.
Clinical Implications:
Nurses experienced significant improvements in ability to navigate, locate information and forms in EMR, as well as the location of the identified diagnosis related to the Patient Care Standard in EMR following education intervention.
Family Presence during Traumatic Events, Resuscitation, and Invasive Procedures:
Clayton W. Keene BSN,RN; MSN student
Viterbo University
Research
Background:
This integrative review explained why adapting policies to allow family presence during traumatic events, cardiopulmonary resuscitation (CPR), and invasive procedures could be beneficial to patients and family.
Significance:
The literature review explicated eight common fears; fear of litigation, fear of family interference, fear of confidentiality issues, fear of inappropriately aggressive efforts, fear of psychological effects for family, fear of increased staff stress, fear of family misunderstanding, and fear of overcrowding, which are expressed by health care providers and contribute to limiting family presence at the bedside in these situations.
Purpose/objective:
According to the research evidence analyzed, the benefits of family presence outweighed the potential risks. Minimal evidence has been offered to support any of the common fears and most fears remain anecdotal such that any evidence is produced.
Methods/project:
evidence-based project
Results:
Providing a family facilitator may prevent and or eliminate most common fears associated with family presence and provide one way to allow for increased family presence in the emergency setting during traumatic events and invasive procedures, as well as CPR.
Clinical Implications:
There is no evidence to refute that a change in policies is indicated.
Using a Levonorgestrel Intrauterine System: Benefits and Barriers in Perimenopausal Women
Alayna Erlandson BSN, RN.
Viterbo University
Research
Background:
The IUS provides effective contraception with the added benefit of decreasing menorrhagia. Women of all ages,especially perimenopausal women, can greatly benefit from the effects of the IUS.
Significance:
Despite its proven effectiveness, less than 2% of women in America choose to use an IUS.
Purpose/objective:
This integrative review examines the literature for clear evidence of the benefits and explicates potential issues in using the Levonorgestrel Intrauterine System (IUS) for perimenopausal women with menorrhagia. The findings will be used to inform primary care providers in order to provide evidence which may influence their recommendation for this method of treating menorrhagia in perimenopausal women.
Methods/project:
An article search was conducted including: CINAHL (EBSCOhost), Medline, Cochrane Library, and PubMed. Terms searched included: Levonorgestrel, IUD, IUS, intrauterine system, menorrhagia, menopause, perimenopause, progesterone IUD, and Mirena.
Results:
The IUS is more successful in decreasing bleeding than oral contraceptives, no treatment, placebo, and systemic therapy including Medroxy-progesterone acetate. The IUS is as efficient at decreasing heavy menstrual bleeding as both hysterectomy and intrauterine ablation.
Clinical Implications:
The IUS is extremely effective and there is significant evidence to place the IUS as a first line therapy for contraception and decreasing menorrhagia. More research is needed to explicate potential barriers to using the IUS, and why women or providers choose to or not to use it for treatment of menorrhagia or contraception, especially in the perimenopausal population.
Educational Strategies to Promote Professional Nursing in Long-Term Care: An Integrative Review
Jodie Fox BSN, RN-BC
Viterbo University
Research
Background:
Abstract The acuity level of older people receiving care in nursing homes is on the rise. There is a lack of highly skilled, professionally educated nurses currently practicing in nursing homes. This integrative review investigates various educational strategies that facilitate positive attitudes toward working with older people in the nursing home environment. The search of the literature includes studies that focus on baccalaureate nursing programs, attitudes nursing students and educators have toward the care of older people, and nursing knowledge related to older people. Nine articles met criteria for this review. Facilitators and barriers were explored. Each of the nine studies selected contain facilitators that may increase positive attitudes of baccalaureate prepared nurses toward older people. The barrier most frequently identified is lack of gerontological knowledge by both faculty and baccalaureate nursing students. This review suggests increasing knowledge in nursing faculty as the initial step necessary to ensure the aging population receives high quality nursing care in the future. This review corroborates current research suggesting that early introduction of students to people who are aging successfully may dispel bias toward older people. The lack of current nursing role models in long-term care reinforces the negative stereotype that nursing homes are bad places to live and work. Additionally, nursing leadership in long-term care will lead to more baccalaureate prepared nurses working with older adults in the future.
Significance:
Increasing interest in caring for older people will lead to higher educated nurse leaders in long term care
Purpose/objective:
explore student and faculty interest in gerontology
Methods/project:
Literature Review
Results:
Increasing faculty knowledge and interest in nursing care of older people is the first step
Clinical Implications:
Increasing interest in caring for older people will lead to higher educated nurse leaders in long term care
Headaches And Their Relationship To Temporomandibular Joint Disorder
Roxanne Grosskopf, BSN, RN
Viterbo University
Research
Background:
The purpose of this paper is to improve communication between health care disciplines to include a complete work-up for temporomandibular joint disorders (TMJD) in patients experiencing chronic daily headache. The temporomandibular joints and their associated musculature are innervated by the trigeminal nerve. Headaches are also mediated through the trigeminal system; thus pain associated with TMJD may be perceived as headache. Patients experiencing headache often see a variety of health care providers without being assessed for TMJD as a probable cause. Various databases were searched, using the key words; chronic headache, migraine, cephalgia, temporomandibular jaw disorder (TMJD, TMD, TMJ) located in titles and abstracts. Evidence was found to support the notion that headaches resulting from TMJD were going undiagnosed as such. However, when correctly diagnosed and treated all subjects discussed in the reviewed literature reported relief from their headaches. This review proposes a multidisciplinary approach to headache management in primary care. Incorporating definitive questions related to jaw function in the health assessment for headaches will lead to correct diagnosis with referrals to the appropriate discipline for management of the headache pain
Significance:
As nurse practitioners we are in the unique position to assess all patients presenting with headache for TMJD, and are in a position to ensure a multidisciplinary approach is taken
Purpose/objective:
Patients suffering daily headaches are not being assessed for TMJD as a possible cause.
Methods/project:
Literature Review
Results:
Patients treated for TMJD found relief of headaches with other unknown etiology.
Clinical Implications:
Assessing each patient presenting with headache for TMJD will assure accurate diagnosis and appropriate referrals when needed.
Breastfeeding and its Affect on Developing Type-2 Diabetes in Early Adulthood
Kirsten Connaughty, BSN, RN
Patricia E. Zander Ph.D., RN
Viterbo University
Research
Background:
Type-2 Diabetes is quickly becoming the fastest growing preventable disease in adolescents and young adults. Prevention at the earliest possible stage in life may be the key to controlling this growing epidemic.
Significance:
Identifying risk factors associated with type-2 diabetes which are affected by breastfeeding is the first step in determining the earliest possible age for preventing type-2 diabetes.
Purpose/objective:
This literature review examines the affects of being breastfed during infancy on the development of type-2 diabetes.
Methods/project:
Fourteen articles were chosen using CINAHL, Epscohost, and Medline databases. Articles chosen included retrospective studies and meta-analyses of breastfeeding practices in conjunction with one or more risk factors associated with type-2 diabetes: (a) weight or BMI, (b) blood glucose or serum insulin levels, (c) metabolic syndrome and (d) duration of breastfeeding.
Results:
Findings support being breastfed during infancy influences weight both in early life and adulthood, lowers pre-prandial glucose levels in infants, and decreases the occurrence of metabolic syndrome in those under the age of 15. Duration of breastfeeding also has a positive relationship in reducing the risk of developing type-2 diabetes later in life.
Clinical Implications:
Sufficient evidence supports breastfeeding as an influence on the development of type-2 diabetes; however further research must be conducted to evaluate the strength of confounding factors such as family history, exercise habits, and nutritional practices.
Factors Influencing Compliance with Glycemic Control in Youths with Type 1 Diabetes Mellitus
Wendy Cheruiyot RN MSN student
Judy Anderson PhD
Viterbo University
Evidence-based practice
Background:
The purpose of this review is to explore the current research to determine factors or influences that affect compliance with recommendation for maintaining optimal glycemic control in youths diagnosed with type 1 diabetes mellitus.
Significance:
This facilites a nurse practitioner’s ability to optimize treatment options and educational information
Purpose/objective:
The purpose of this review is to explore the current research to determine factors or influences that affect compliance with recommendation for maintaining optimal glycemic control in youths diagnosed with type 1 diabetes mellitus.
Methods/project:
Sixteen articles exploring the positive or negative effect of these factors affecting compliance for maintaining glycemic control were reviewed. A decade of research revealed 14 factors that may positively or negatively affect compliance in youth with type 1 diabetes.
Results:
Adherence to diabetes care, parent’s knowledge, insulin pump use, and improved quality of parent and youth relationship positively affected compliance to glycemic control. Factors negatively affecting compliance include: parent- youth conflict, critical parenting, single parent home, perceived youth burden, peer- oriented youth, Hispanic or African American ethnicity, and disruptive meal-time behaviors.
Clinical Implications:
Each factor fell into the community, family, or youth circle of influencing factors of compliance with glycemic control in youths. This assists nurse practitioners in choosing the appropriate education and treatment options for youths influenced by a certain factor. Findings may also help nurse practitioners to identify factors more readily, understand the positive or negative influence the factor has on the youth’s compliance, and treat youths with type 1 diabetes more effectively.
Conflict Engagment: Promoting Safe and Effective Communication
Shirley Newberry PhD, RN
Rebecca Inglis MS, RN, Ana Schaper PhD, RN
Gundersen Lutheran Health System
Research
Background:
Conflict is inevitable in every workplace and may take on many forms. From verbal disagreements between coworkers to the more subtle forms of conflict such as gossip or “eating our young”, everyone will experience conflict throughout their working careers.
Significance:
In healthcare, poorly addressed conflict can be particularly dangerous because the stakes for patient safety and the well being of the people who care for them are incredibly high. Understanding the link between poorly addressed conflict and the effect of patient safety, “The Joint Commission” in January 2009 updated their leadership standards to specifically address conflict within healthcare settings. The updated leadership standards require, in part, that organization leaders implement a process for conflict management and that those implementing such processes be skilled in conflict management (Scott, 2009 - per Center for American Nurses website: http://www.can.affiniscape.com/displaycommon.cfm?an=1&subarticlenbr=235)
Purpose/objective:
The purpose of this study is to evaluate the multi-level training program (Conflict Engagement Profile) in conflict engagement for: a) formal and informal nurse leaders, and b) staff nurses.
Methods/project:
Program evaluation research methodology utilized. There are two cohorts of nurses participating in this research: 1) staff nurses participate at Level One and 2) formal and informal leaders participate at Level One and Level Two. Quantitative data collected included a work information questionnaire, a conflict engagement knowledge questionnaire, a self-report conflict engagement skills questionnaire, the Conflict Dynamic Profile (CDP), and the Nurse Workplace Scale (NWS). Permission was received for use of the CDP and NWS from their respective developers.
Results:
Survey return rate for the work information questionniare and the Nurse Workplace Survey was 55%. Overall, 36% of nurses indicated conflict as common or very common. Nurse working in a hospital setting reported more conflict compared with nurses working in ambulatory care. Conflict was equally prevalent in nurse-nurse interactions and physican-nurse interactions.
Clinical Implications:
Data suggested the following: need for a consistent working definition of conflict, need to address belief that all conflict is bad and need to addrss the perception that conflict should not occur in the work setting. In developing a proactive initiative, research suggests starting with manager training, but there is little evidence on how to move forward with staff nurses skill bulding. Limited opportunities exist for conflict engagment structured learning and ongoing skill building.
Safety of Using a Laryngeal Mask Airway in Pediatric Patients Undergoing Adenotonsillectomy
Mary Dudley CRNA, MS
Ana Schaper PhD, RN; Jenna Hanson BSN; Chelsea McMorrow BSN
Gundersen Lutheran Health System
Research
Background:
Adenotonsillectomy (T&A) is one of the most common surgical procedures performed in children in the U.S. Since 1983, laryngeal mask airway (LMA)anesthesia has been utilized for T&A as an alternative to endotracheal intubation (ETT). The LMA has proven to be a safe and effective technique for airway management. However, little research on LMA has been conducted on populations with in the U.S.
Significance:
Advantages to the LMA include: increased ease and speed of placement by less experienced personnel, improved hemodynamic stability during induction and emergence, lower incidence of coughing and sore throat, improved oxygen saturation, and reduced anesthetic requirements for airway tolerance.
Purpose/objective:
To describe the safety for using the LMA in a community sample of children and adolescents.
Methods/project:
A retrospective chart review was conducted for 100 pediatric patients who underwent a T&A at Gundersen Lutheran during a three-year time period.
Results:
Hypertrophy was the most common implication for surgery. Sleep disordered breathing was the second most common implication for surgery at 84%. Only 1% of the patients in our study were converted from a LMA to ETT and only 5% of patients required a hospital admission. Reasons for hospital admission included: dehydration, post-operative rebleeding, and significant sleep apnea.
Clinical Implications:
The LMA is a valid method to use with similar event rates to the ETT.
Multidisciplinary Rounding
Ruth Berns, RN ACNS-BC
Desirae Bailey RN BSN; Marie Hill MD; Nathalie Weibel, RN BSN
Franciscan Skemp, La Crosse
Evidence-based practice
Background:
Multidisciplinary team engagement with patient care delivery is known to have a positive effect on patient outcomes. A process to achieve the engagement of multidisciplines is multidisciplinary rounding (MDR). A barrier to conducting MDR is the time commitment and establishing a specified time that all the necessary team members can participate. This project was designed to measure the effects of MDR. Providing disciplines with the measurable outcomes provides support for time spent in this activity.
Significance:
MDR team members consist of the disciplines that are vital to planning and evaluating the patient plan of care. Disciplines include and are not limited to Physician, Nursing, Rehabilitation Therapies, Pharmacists, Nutritionists, Case managers, Behavioral Health Services. Research does validate that multidisciplinary team engagement does improve patient outcomes, facilitates implementation of best practices, and decreases deaths in the ICU (Spuhler, 2009, Kim, 2010). When the entire team is knowledgeable of the plan of care, they can more effectively work together to implement the plan. This also promotes consistency in communicating the plan to the patient/family. Communications with patient/family also engages the patient/family in management of their disease/illness.
Purpose/objective:
The purpose of the project is to validate that the time spent in MDR has a positive impact on patient care delivery
Methods/project:
The project involved the comparison of two homogenous groups of patients on a medical floor. The patients were placed into two groups according to their ages and diagnosis. One group of patients had multidisciplinary rounding and the other did not have rounding. Retroactive data collection was used. The following parameters were compared: Length of stay Costs of hospitalization Number of hospital errors (events) 30 Day readmission Rates The data does reflect that there is a comparable decrease in length of stay and costs of hospital charges with MDR.
Results:
In comparing the rounding group to the non rounding group the following is concluded: Average hospital costs of rounding group is lower. Average length of stay for the rounding group is 4.1 hours shorter. Number of events from each group is the same. The readmission rate of the rounding group is higher.
Clinical Implications:
Some of the data reflects that rounding does make a difference in patient outcomes. The patients who were readmitted should be analyzed to determine the reasons for readmission. Because the rounding group of patients were managed by the Hospitalists, it would be interesting to see if the reason for readmission is influenced by not having the primary physician involved in the hospital care.
