Click on Title of Presentation to View Abstract
Dexmedetomidine
Peter Kucharas, RN BSN and
Adam Krause, RN BSN
Franciscan Skemp School of
Nurse Anesthesia
Redheads and Anesthesia
Tiffany Baker, RN, BSN, SRNA
Kelly Kanary, RN, BSN, SRNA
Franciscan Healthcare School
of Nurse Anesthesia
The Role of DepressionScreening in Patients with Pre-Diabetes
Sarah A. Hayden, RN, BSN
Winona State University
The Effects of Massage for
Patients with Dementia in the Nursing Home
Brea Thomas, BS, RN, MSN
Student
Viterbo University
Background
One in eight individuals over
65 suffers from Alzheimer’s disease (AD). Forty percent of the total years with
AD are spent in the most severe stage (often in a nursing home).
Significance
In the nursing home (NH)
setting it is common for individuals with dementia to exhibit symptoms of
aggressive and non-aggressive agitation.
Purpose/objective
This project analyzed and
synthesized available research for evidence of the effective integration of
various massage techniques to impact outcomes such as agitation, aggression,
stress, sleep, relaxation, and comfort in older adults in the NH setting.
Methods
Benefits of the intervention,
possible adverse effects, and barriers of incorporating massage were
identified. Peer-reviewed research from January 2000- current was included. The
studies encompassed a wide variety of research designs including randomized
control trials.
Results
Clinically relevant findings
that were reported included: decreased agitation, increased comfort and
relaxation, decreased pain, decreased stress, satisfaction, enjoyment, feelings
of wellbeing, and improved sleep. No evidence of adverse effects was noted. Barriers
included: a lack of participation by nursing assistants, demand of an increased
workload, and that other caregiving tasks took priority.
Clinical Implications
The evidence provides clear
support for nurse practitioners to incorporate simple massage techniques into
patient treatment plans and also to educate NH personnel who care for older
adults of effective massage techniques. NPs, with a holistic view of patient
care, are uniquely suited to advocate caring, non-pharmacologic, and
cost-effective measures as adjunct treatment for patients in the NH, especially
those with dementia.
Acupressure Impact on
Chemotherapy-Induced Nausea and Vomiting
Sydney Schone BSN, PHN, OCN,
RN, MSN Studen
Project Faculty: Bonnie
Nesbitt PhD, ANP-BC
Viterbo University
Background
Nausea and vomiting are two
of the major side effects caused by the administration of chemotherapy.
Complementary and alternative medicine practices such as acupressure
administration may be beneficial in reducing the side effects of chemotherapy.
Significance
The aim of this paper was to
determine the impact of acupressure on chemotherapy-induced nausea and vomiting
in adult cancer patients, according to the research literature published
between 2000 and 2011.
Purpose/objective
The purpose of this paper was
to educate providers as well as patients on the current knowledge of the use of
acupressure in the setting of chemotherapy-induced nausea and vomiting.
Methods
. The databases searched
included CINAHL Plus, PubMed, Health Source: Nursing/Academic Edition, Academic
Search Complete, MEDLINE, PsychINFO, and the Cochrane Library.
Results
Findings revealed acupressure
points ST36 and P6 were used in conjunction with anti-emetics to reduce the
side effects of chemotherapy-induced nausea and vomiting.
Clinical Implications
While the authors of these
studies recommend further research, providers can be assured that offering P6
acupressure as an integrative therapy, along with anti-emetics, has shown
itself to be helpful for man in the context of chemotherapy-induced nausea and
vomiting.
Learning Circles to Enhance
Skill Building in Constructive Strategies for Conflict Engagement
Ana Schaper Ph.D., RN
Rebecca Inglis, M.S.N;
Shirley Newberry, Ph.D., RN
Gundersen Lutheran Health System
Background
Joint Commission states that
health care organizations must address the problem of destructive behaviors in
the workplace. The Center for American Nurses (CAN) offers the Conflict
Engagement Profile program to increase the use of constructive conflict
engagement behaviors. Following implementation of the CAN’s program for system
nurse leaders, participants recommended ongoing coaching and additional
practice sessions.
Significance
The challenge was to deliver
this multi-layered program in a manner that is efficient, cost effective and
meaningful to staff nurses.
Purpose/objective
To assess the effectiveness
of a modified Conflict Engagement Portfolio intervention with Gundersen
Lutheran staff nurses at baseline and at six months.
Methods
The CAN’s program was
modified to include: online education modules and a half-day workshop followed
by one-hour Learning Circle (LC) meetings held monthly for four months. A
convenience sample of nurse Expert Leaders (unit level staff nurse leaders)
agreed to participate. Data was collected at baseline at six months using a
demographic survey and the Conflict Dynamic Profile (CDP) instrument.
Results
A cohort of 45 (22%) Expert
Leader nurses participated with >90% attendance at Learning Circles.
Characteristics of this sample include: median age of 50 years, 58% working in
the hospital setting, 56% bachelor degree prepared and 58% active in the
system’s shared governance structure. CDP pre-test results raised awareness of
one’s own behaviors. The CDP at six-months demonstrated that the use of
constructive strategies remained the same or improved. With the exception of
“demeaning others”, destructive strategies remained the same or deceased.
Clinical Implications
High participation at monthly
Learning Circle meetings reflected staff nurses’ active interest in practice
exercises, and mutual support for engaging in conflict situations. Skill
building occurred over time. At the fourth LC, participants were able to
identify how their own behaviors contributed to conflict and the challenges in
changing behaviors.
Employee Wellness Programs as
an Intervention to Promote Weight Management
Bernadine Nogueiro, BSN, RN -
MSN Student
Viterbo University
Background
Obesity is a growing epidemic
in the US and healthcare partners are struggling to curb this problem.
Significance
One solution is to initiate
organization-based employee health programs.
Purpose/objective
The purpose of this project
is to describe the effectiveness of employee wellness programs on weight
management. An integrative review of the literature was conducted to address
the following research question: Among employees in organizations with employee
wellness programs, have interventions used for weight management been
successful?
Methods
Fifteen articles were
included in the literature review. Researchers used variables such as Body Mass
Index (BMI), waste circumference, weight in pounds, percent body fat or total
dietary fat consumption to measure responses to interventions. Interventions included
health assessments, physical activity, education sessions, group activities,
counseling sessions and guest speakers.
Results
Active involvement of
organizations in such programs have shown a decrease in employees’ weight as
well as an increase in job satisfaction, decrease in stress, decrease in costs
of healthcare visits, increase in productivity, decrease in absenteeism and
decrease in job turnover.
Clinical Implications
The findings of this project
offers guidance to organizations on how they can benefit from offering such
services in order to help their employees manage their weight.
Oral Anticoagulation Therapy
and Frequency of Testing
Kathryn J. Smrz, BSN, RN, MSN
Student
Viterbo University School of
Nursing
Background
The frequency of
international normalized ratio testing was examined in this review of
literature. Until recently, persons who require oral anticoagulation had to
travel to a physician’s office or laboratory a minimum of once per month to
have a venipuncture international normalized ratio. Through advancements,
persons requiring oral anticoagulation now have the option to perform point of
care self-testing and self-monitoring of oral anticoagulation therapy with a
home monitor. This review will focus on the relationship between the
frequencies of therapeutic international normalized ratio’s comparing patients
who test at different intervals.
Significance
A common overwhelming theme
throughout the analysis of these data is the positive correlation between
education and outcomes. Proper education in the outpatient setting can allow
the patient to be empowered. This sense of empowerment ultimately improves the
self-awareness of an individual’s health care when persons are permitted to
make independent clinical decisions.
Purpose/objective
The purpose of this review
was to examine the available literature regarding INR monitoring of patients
who receive oral anticoagulation therapy to determine if more frequent
self-testing results in increased time in therapeutic range.
Methods
A literature review sought to
determine if more frequent testing of the international normalized ratio
resulted in greater time in therapeutic range.
Results
Sixteen studies were selected
for inclusion regarding the frequency of international normalized ratio testing
in comparison with the amount of time the international normalized ratio
remained within therapeutic range. Of the 16 studies analyzed, only 5
identified that more frequent testing of the international normalized ratio
resulted in a greater percentage of time in therapeutic range.
Clinical Implications
A finding in this review
suggests the longer an international normalized ratio remains within
therapeutic range can be directly related to the amount of education recipients
of oral anticoagulation receive.
Yoga as Complementary Therapy
in Women of Child-Bearing-Age with Depression
Katie Trelstad-Andrist BSN,
RN, MSN Student
Project Faculty: Bonnie
Nesbitt Ph.D., ANP-BC
Viterbo University
Background
Depression affects between 10
and 20 percent of women, with women of child-bearing-age at even higher risk
during their lifetime. Yoga’s reputation for stress reduction and general
mental health benefits suggests its potential use as a complementary therapy
for depression.
Significance
This research has added to
the body of knowledge surrounding the beneficial effects yoga practice, and
more specifically, how it decreases the symptoms of depression in women of
child-bearing age.
Purpose/objective
The purpose of this
integrative review was to synthesize the evidence supporting yoga as a
complementary therapy for treating depression in women of child-bearing-age, in
order to educate both patients and healthcare providers. Additionally, other
reported evidence for effects on stress and health were investigated.
Methods
Eleven relevant studies were
located for analysis.
Results
Several authors identified
that practicing yoga for 30-45 minutes, three to six times per week, had
similar effects on depression as an anti-depressant. Depression remission rates
of up to 67% were found with thrice-weekly yoga sessions for just 30 minutes
per time. In those with GABA dysfunction, which occurs with mood disorders, one
60-minute yoga session demonstrated a 27% increase in GABA levels. Twice-weekly
60-minute yoga sessions for five weeks increased morning levels of cortisol,
which is associated with improved self-esteem, hardiness, and tenacity.
Numerous health benefits were reported with regular yoga practice, such as
reduced heart rate and blood pressure, increased lung capacity, stress
reduction, improved muscle relaxation and body composition, lowered
triglyceride, low-density lipoprotein (LDL) cholesterol, and fasting blood
glucose levels.
Clinical Implications
Yoga is an evidence-based,
attractive option for those suffering from depression as it is
non-pharmacological, has minimal adverse effects when practiced appropriately,
and is accepted as a form of complementary therapy internationally. Patients
and providers should view this as a recommended evidence-based integrative
therapy.
Pediatric Acute Respiratory
Infection And Associated Risks With General Anesthesia
Sara Dickenson, SRNA Lee
Webber, SRNA
Mayo Clinic Health System
Franciscan School of Anesthesia
Background
Amongst the greatest
challenges facing anesthesia providers is the prevention of airway
complications in the well pediatric population undergoing general anesthesia.
Although some complications can often easily be corrected, on a rare occasion
these complications can lead to serious morbidity. One of the most common acute
risk factors is respiratory illness.
Significance
Our goal is to provide a
simplified approach for the provider in dealing with pediatric patients with
acute respiratory illness (ARI).
Purpose/objective
Recognition of risk factors
associated with potential airway complications remains an area of controversy.
Methods
Our literature review
evaluated pediatric patients with ARI and identified the periods of time
following illness that corresponded with the greatest percentage of
complications.
Results
We found that anesthesia
performed at the time of illness or within the two week period following an ARI
is associated with a 3.5-fold increase in respiratory complications such as
bronchospasm, laryngospasm and severe coughing. Anesthesia performed within the
four weeks following an ARI increases the risk of complications up to 7 times,
and 11 times if the trachea is intubated. One study suggested that 2-4 weeks
post ARI is associated with the highest risk. A time period of greater than six
weeks from illness appears to decrease the risk to that of the healthy patient
undergoing surgery with no ARI.
Clinical Implications
A majority of pediatric
patients undergoing anesthesia do so on an elective basis. The frequency of ARI
in the population is significant as most children under the age of five years
average 6-12 ARIs each year typically lasting 5-14 days, making scheduling
elective surgeries difficult. Our review found that children with severe
symptoms such as mucopurulent secretions, productive cough, fever > 38
degrees, lethargy, or signs of pulmonary involvement are at higher risk for
anesthesia complications and should delay their procedure for a minimum of four
weeks. Children with mild symptoms such as clear secretions who are afebrile
and appear otherwise healthy could proceed with surgery knowing that there is a
slightly increased risk of airway complications. For emergent cases, the
provider should be aware of the common complications and adjust the anesthetic
plan accordingly.
Dexmedetomidine
Peter Kucharas, RN BSN and
Adam Krause, RN BSN
Franciscan Skemp School of
Nurse Anesthesia
Background
Dexmedetomidine is an
excellent alternative to other anesthetic agents due to its ability to maintain
blood pressure and spontaneous ventilation.
Significance
Health care providers are
faced with a patient population that is increasingly overweight. This increase
in the BMI of adults and children causes significant difficulty in
pre/intra/and post operative care of the surgical patient. These factors are
major contributors to anesthetic concerns intraoperatively and dexmedetomidine
allows for lessening those concerns due to the maintenance of spontaneous
ventilation.
Purpose/objective
Educating health care
professionals on the benefits of using dexmedetomidine in the obese patient.
Methods
A literature review will be
performed to compile evidence of the efficacy of dexmedetomidine.
Results
The results of this
literature review will show the superiority of utilizing dexmedetomidine in the
obese patient.
Clinical Implications
These findings will help
guide anesthetic practice in our increasingly overweight patient population by
providing anesthesia professionals with current dexmedetomidine information.
Psychosocial Impact of
Patients After Experiencing an Esophagectomy
Kaleesha E. Dittler BSN, RN,
MSN Student
Background
Esophageal cancer is a very
aggressive cancer and an esophagectomy is one of the treatments for this type
of cancer. There are negative physical, psychological, and social outcomes
after a patient experiences an esophagectomy.
Significance
This research is significant
to the advanced practice nurse because there are multiple interventions that
could be done to help improve this type of patient's QOL.
Purpose/objective
The purpose of this
literature review was to investigate the psychosocial impact of a patient who
has experienced an esophagectomy.
Methods
An extensive search with
purposeful sampling of research articles was done to find information on this
topic. Multiple data bases and hand searching was done to find relevant
articles.
Results
The reviewed literature
determined that there are 7 (anxiety, depression, QOL issues, fear, isolation,
guilt, and uncertainty/hopelessness) major psychosocial factors that a patient
experiences after an esophagectomy with QOL issues and fear being the most
prevalent. The findings indicated there is a psychosocial impact after an
esophagectomy.
Clinical Implications
The nurse caring for these
patients needs to be aware of the impact and support the patient with these
psychosocial issues. There needs to be a better definition of QOL to allow for
a better comparison of the literature. There also needs to be more research
done on his topic because the body of literature is very limited
Examining Evidence-Based
Content Related to Hospital Acquired Pressure Ulcer Prevention in paper and
Electronic Health Records
Camilla M. Jaekel, RN, PhD
Candidate
Amy Coenen, PhD, RN, FAAN
University of Wisconsin-
Milwaukee and Mayo Clinic Health System
Background
Although there have been
great advancements in the Electronic Health Record (EHR), there is a dearth of
rigorous research that examines the relationship between the use of electronic
documentation to capture nursing process components and the impact of
consistent documentation on patient outcomes (Daly, Buckwalter & Maas,
2002; Gugerty, 2006; Maas & Delaney, 2004; Solomon et al., 2000).
Significance
Demonstrating nurses’
contributions to preventing HACs, specifically pressure ulcers, is one way for
the profession to respond to increased demand for quality care from healthcare
consumers. This study contributes to nursing knowledge by describing the
concept coverage of content representing patient risk factors, nursing
diagnosis, interventions, and outcomes related to pressure ulcer prevention by
an established nursing terminology system, ICNP. The study also examined how
the concepts were represented and structured in a paper record and an EHR.
Finally, the relationship between HAPU incidence and type of patient record was
examined. A better understanding of using the patient health record to support
evidence-based practice can assist in EHR development. This study begins to
identify content, standards and structure of patient records to support the
prevention of HAPU.
Purpose/objective
The purpose of this study was
to examine evidence-based content related to HAPU prevention in both paper and
electronic health records. More specifically, the researcher aimed to describe
the concepts needed to represent evidence-based nursing practice for pressure
ulcer prevention and examine how these concepts were represented in a
standardized nursing terminology (ICNP), as well as health records for hospitalized
patients. The relationship between HAPU incidence and type of health record was
also examined.
Methods
This retrospective study used
a descriptive, non-experimental design with mixed methods combining both
qualitative and quantitative analysis to examine core concepts related to HAPU
prevention in both paper and electronic health records. The qualitative methods
included content analysis, relational-analysis, and cross-mapping. The
quantitative analysis included descriptive statistics, in the form of frequency
counts with associated percentages and a chi-square analysis test.
Results
There were 67 concepts
extracted from clinical based guidelines. Forty of the 67 concepts were cross
mapped to the International Classification of Nursing Practice (ICNP) via a
broader parent relationship while 14 of the 67 concepts could not be cross
mapped. Because of embedded rule structure in the EHR it was also determined
that consults for wound ostomy continence nurses (WOCNs) were sent on 100% of
at-risk patients in the EHR timeframe as compared to only 39% in the paper
record timeframe. The relationship between HAPU incidence and type of health
record was also examined and identified a 13% difference HAPU incidence
proportion after implementation of the electronic record (p = .107).
Clinical Implications
: Findings suggest further
research is needed to enhance the ability of ICNP to represent the more
detailed concepts for nursing interventions for HAPU prevention. The 61%
difference in the number of patients that received a WOCN consult between the
timeframes suggests certain EHR functionality has the ability to enhance
clinical decision making in HAPU prevention.
Re-defining Success:
Breastfeeding After Reduction Mammaplasty
Heather O'Connor, B.S.N., RN
Viterbo University
Background
The decision to have a breast
reduction may be based on well thought out physical, psychological, and
cosmetic reasons. However, breast reduction may impede breastfeeding
capabilities. Many women, particularly young nulliparous women, may receive
breast reductions without adequate education on the effects of breastfeeding.
Significance
Little information is
available to health care providers about breastfeeding after breast reduction
to share with their patients.
Purpose/objective
A search of the literature
was performed to analyze the effects of reduction mammaplasty on breastfeeding
as well as the perceived barriers contributing to limited breastfeeding
success, so that this information can become more widely known by healthcare
providers.
Methods
Literature review
Results
Different types of breast
reduction surgeries yield different capabilities for milk production. According
to the research, superior pedicle or lateral pedicle surgeries have shown to
have the best outcome for post-breast reduction breastfeeding. Also found was
that the definition of successful breastfeeding differs among surgeons,
healthcare providers, and breastfeeding mothers. The research shows that
breastfeeding after breast reduction is possible, however, supplementation
likely will be necessary, and education on the quality and quantity of
breastfeeding is important so the mother feels like she is contributing
adequately to the health of her baby. Successful techniques such as
supplemental feedings certain nipple types for bottles, supplemental
nutritional systems, and complete milk evacuation will help increase milk
supply and create a sense of fulfillment for breast feeding mothers who have
had breast reduction surgery.
Clinical Implications
It is imperative that health
care professionals recognize that breast reduction procedures will continue and
that encouragement and support with breastfeeding after breast reduction is
crucial to the success of the mother and infant with this goal.
Physical Activity as an
Independent Predictor of Improved Insulin Sensitivity in Overweight Children
Anneliese K. Bauer BSN, RN,
MSN-Student
Viterbo University
Background
Poor physical fitness and
increased sedentary activity among children are contributing to an escalation
in pediatric obesity.
Significance
As a result, children are
developing increasingly more comorbidities at an early age. One of these
conditions; insulin resistance, is a precursor to diabetes.
Purpose/objective
This integrative review of
literature was conducted to answer the following research question: What has
the greatest impact of reducing metabolic risk in the pediatric population,
increasing physical activity or measurable changes in body mass index or body
composition alone?
Methods
Electronic databases were
searched for peer reviewed randomized controlled trials and cross-sectional
studies measuring fasting insulin and glucose levels, maximum oxygen
consumption (VO2 max) and anthropometric measurements at baseline and post
intervention in children ages 8-18. Fourteen articles met inclusion criteria.
Results
Both an increase in physical
activity and measurable changes in body composition were shown to be
independent factors for improving insulin resistance. Improvement in physical
activity as measured by VO2 max showed the greatest effect on improving insulin
resistance and sensitivity than measurable changes in body composition alone.
Clinical Implications
Realistic and achievable
strategy to reduce metabolic risk in children. Help clinicians develop
interventions aimed at preventing children from lifelong health problems such
as diabetes.
Lifestyle Modification and
Prehypertension
Hannah Roberts, B.S.N, RN,
MSN Student
Viterbo University
Background
Approximately 1 out 3 adults
has hypertension, which greatly increases the risk of stroke, heart disease,
congestive heart failure, and kidney disease. Prehypertension is a systolic
blood pressure between 120 and 139 and a diastolic blood pressure between 80 and
89.
Significance
Patients that are
prehypertensive are at an increased risk of developing hypertension.
Purpose/objective
The purpose of this
integrative review was to identify the evidence of benefits of lifestyle
changes, especially the DASH diet, in significantly controlling and reducing
prehypertension in order to educate nurse practitioners and other providers on
the most effective lifestyle modifications to suggest.
Methods
A search of peer-reviewed
research was performed to identify sources relevant to determining the
effectiveness of lifestyle modifications in regards to actually reducing
prehypertension. Databases searched included Academic Premier, CINAHL, Cochrane
Library, Medline Plus, and PubMed using the key words prehypertension, lifestyle,
DASH, intervention, implementation, and barriers in various combinations. The
NHLBI and CDC websites also were searched. Sources were chosen, based on
relevance to the research question, being peer-reviewed, English language, and
American studies, from the past 10 years.
Results
All the recommended
interventions showed decreases in blood pressure; however, the DASH diet with
therapeutic lifestyle changes (TLC) and TLC alone, including a healthy diet,
showed the most significant improvement.
Clinical Implications
Healthcare providers need to
be creative in assisting patients overcome barriers to lifestyle modifications.
Various suggestions that were derived from the literature were that the
healthcare provider can recommend initiating a healthy diet with lowered
sodium, starting to exercise, managing weight, stopping smoking or chewing
tobacco, minimalizing alcohol consumption, and/or managing stress. Any of these
interventions can help, and can be a start to a healthier blood pressure. It is
difficult to implement all these at once; starting small can be less
overwhelming.
Redheads and Anesthesia
Tiffany Baker, RN, BSN, SRNA
Kelly Kanary, RN, BSN, SRNA
Franciscan Healthcare School
of Nurse Anesthesia
Background
Anecdotal evidence from
experienced anesthesia providers have suggested redheads react differently to
anesthetics.
Significance
Raising awareness that
redheads may react differently to an anesthetic may prove beneficial to
practicing anesthetists. This will assist anesthesia staff in providing an
optimal anesthetic to this population.
Purpose/objective
As we two presenters have red
hair, we are curious as to why redheads react differently to anesthesia.
Methods
We conducted a through
literature review utilizing medical libraries, search engines, and journals.
Results
A genetic mutation in
redheads may be significant to management and outcomes during an anesthetic.
Clinical Implications
If nurse anesthetists
consider differences redheads may experience during an anesthetic, special care
can be taken to maximize best outcomes.
Intraoperative
Anaphylaxis-Risk Factors, Recognition and Treatement
Gabe Morrison RN, BSN Rob
Bisenius RN, BSN
Franciscan School of
Anesthesia
Background
Intraoperative anaphylaxis is
a well documented complication associated with exposure to various agents in
the perioperative period, and it carries a mortality rate of 3-9%.
Significance
Though incidence is rare,
occurring in approximately 1 in 5,000 cases, the significant mortality and
emergent nature of anaphylaxis necessitate that perioperative healthcare
providers maintain familiarity with associated risk factors, diagnostic
criteria, and evidence based interventions.
Purpose/objective
A foundation of knowledge of
anaphylactic events will optimize patient outcomes by facilitating prompt
recognition and proper treatment.
Methods
A literature review is
presented, with emphasis on commonly encountered triggering agents for
anaphylaxis and widely supported interventions in the treatment of
intraoperative anaphylaxis.
Results
The findings are relevant to
safe practice in all perioperative environments.
Clinical Implications
This review should remind
clinicians of an important perioperative risk for mortality.
Peri operative assessment,
prevention and management of dental trauma during anesthesia
Lisa Golden, B.S.N., RN;
Justin Maslowski, B.S.N., B.S.I.E., RN
Mayo Clinic Health
System-Franciscan Healthcare School of Nurse Anesthesia
Background
During an anesthetic
anesthesia providers frequently manipulate oral structures and have potential
to cause damage.
Significance
The most common claim in
anesthia related litigation is dental damage. Furthermore, there are health
risks involved with dental damage.
Purpose/objective
This review aims to identify
tools to assess, prevent and manage cases of dental damage.
Methods
A review of the current
anesthesia literature will be performed.
Results
Anesthesia involves a risk of
dental damage and should be addressed.
Clinical Implications
Dental damage can cause
patient dissatisfaction as well as serious health concerns.
Learning Outcomes Associated
with Simulation Activities in Nursing Programs
Stacia K. Madsen BSN, RN MSN
Student
Viterbo University
Background
High-fidelity simulation
offers a learning environment in which students learn responses to
interventions with an advanced computerized mannequin called the Human Patient
Simulator.
Significance
Simulation engages students
in role-playing allowing for achievement of multiple outcomes in a simulated
clinical setting without harming the patient.
Purpose/objective
The purpose of this
integrative review of literature is to address the following question: “What
are associated learning outcomes among nursing students who receive high
fidelity simulation learning experiences?”
Methods
Literature published from
2005 to 2011 was reviewed and the inclusion criteria consisted of quantitative
and qualitative study, peer reviewed, limited to the English language, and BSN
and ADN programs. Nine articles met the inclusion criteria.
Results
Seven of 9 indicated learning
outcomes were affected with the use of high fidelity simulation and 2 out 9
articles reported no affect. The learning outcomes affected by use of high
fidelity simulation included increased knowledge, self-confidence, critical
thinking, organizational skills, self efficacy, communication, and clinical
judgment.
Clinical Implications
The findings of this review
offers information to guide teaching practices among nurse educators for
planning and evaluating simulation activities.
Reducing Insulin Resistance
in Children 6-18 Years of Age
Lori Degenhardt BSN, RN,
MSN-Student
Bonnie Nesbitt, Ph.D., ANP-BC
Viterbo University
Background
Obesity rates have emerged
dramatically since the 1980s, and now are at a global crisis point amongst
children and adolescents. Childhood obesity is linked to several metabolic and
endocrine imbalances, including insulin resistance.
Significance
Purpose/objective
The purpose of this
integrative review was to synthesize evidenced-based factors appropriate for
preventing insulin resistance in children 6-18 years of age.
Methods
A literature search included
database searches of CINAHL, PubMed, and Medline from the years of 2003-2011.
Results
The most frequently found
evidenced-based preventive strategies to reduce insulin resistance were dietary
factors in combination with physical activity. Focused interventions also were
effective however. Dietary factors included consuming a diet low in saturated
and low fats, consuming the recommended amount of dairy products. Consuming a
diet high in whole grains was beneficial. Incorporating aerobic activity and
participating in an active lifestyle, even without dietary modification, was
helpful in reducing insulin resistance. Also found was that sleep patterns in
this population had an effect on insulin resistance.
Clinical Implications
The literature reported
significant improvements in insulin resistance using a variety of behavioral
modifications. Even if children only met one of these behavioral modification
strategies, improvements were seen. It is the healthcare provider’s
responsibility to urge prevention and suggest specific interventions to at-risk
children. Family participation in these behavioral modifications was
recommended.
The Effect of School
Interventions on Childhood Obesity
Cheryl Gergens, BSN, RN, MSN
Student
Viterbo University
Background
The incidence of childhood
obesity is increasing at an alarming rate.
Significance
Advanced practice nurses play
a pivotal role in detecting and treating childhood obesity. Advanced practice
nurses have a responsibility to identify at-risk children and provide valuable
education.
Purpose/objective
The purpose is to determine
if school-aged children who participate in school-based programs have a reduced
incidence of obesity, specifically, lower BMIs, when compared to children who
do not attend these programs.
Methods
A literature review was
conducted of five databases were searched to yield a final sample size of 16
studies. All programs incorporated additional physical activity, nutrition
education, or both.
Results
The ability of these
school-based programs to reduce obesity is inconclusive. 9 studies reported a
significant decrease in participant BMI, while 6 studies reported no
significant change in BMI. 1 program reported a significant increase in BMI
among male participants.
Clinical Implications
Further research is needed to
determine the role of various sociocultural factors, the effect of parental involvement,
and the long-term feasibility of these programs. Advanced practice nurses have
an important role in identifying obese children and educating their families on
the associated health risks. These programs do not replace treatment for
obesity, but advanced practice nurses should encourage children to participate
in these health promotion programs. It is important for advanced practice
nurses to collaborate with school nurses, counselors, and other healthcare
providers to ensure thorough prevention, screening, and treatment for
overweight and obese children.
Insulin Administration in the
Very Young Pediatric Population
Kalie R. Freeborn, BSN, RN,
MSN-Student
Viterbo University
Background
Optimal glycemic control is
essential for the management of very young children with Type 1 diabetes to
reduce the number of diabetic complications and promote normal physiologic
development.
Significance
Advanced practice nurses may
work with pediatric individuals who have type 1 diabetes. For these advanced
practice nurses, understanding the most effective ways to control this disease
is imperative.
Purpose/objective
The purpose of this executive
summary is to examine the efficacy of insulin pump (continuous subcutaneous
insulin injection) usage compared to the use of multiple daily insulin
injections (MDIs) for glycemic control in the very young (ages birth-8 years)
pediatric population with Type 1 diabetes.
Methods
Electronic data bases were
systematically searched for peer reviewed random controlled trials or
randomized crossover studies with documented HbA1c values from the years 2000
to 2011. Fifteen articles met the inclusion and exclusion criteria. Fifteen
articles met the inclusion and exclusion criteria.
Results
Continuous subcutaneous
insulin injections were found to be as or more effective than multiple daily
injections at overall glycemic control for the very young pediatric population
with Type 1 diabetes.
Clinical Implications
Future research is needed to
investigate safety concerns and patient and caregiver satisfaction with insulin
pump therapy. However, insulin pump therapy should be considered a viable
treatment option for very young patients with Type 1 diabetes.
Psychosocial Adversity During
Childhood and Insulin Resistance Later in Life
Abby L. LeVasseur RN, BSN,
MSN Stuedent
Project Faculty: Judy K.
Anderson, Ph.D., CNE
Viterbo University
Background
Type II diabetes, a form of
insulin resistance, in children has increased by 41% since 1990. It is
predicted 30-40% of children born today will develop type II diabetes.
Significance
When insulin resistance goes
undiagnosed and untreated it can cause many life threatening complications.
Purpose/objective
The purpose of this paper is
to review the evidence that identifies psychosocial adversities in childhood as
a risk factor for increased insulin resistance later in life. What psychosocial
adversities during childhood increase the risk of insulin resistance later in
life?
Methods
A literature search was used
to identify relevant information. The databases CINAHL, PubMed, and MEDLINE
Plus were utilized.
Results
Low economic status is the
most commonly identified risk factor leading to insulin resistance later in
life. Children with parents with low levels education, children with high
levels of hostility, physical and or sexual abuse, low parental aspirations,
father hardly takes child on outings, strict upbringing and also alcohol and
drug abuse in the home are risk factors associated with insulin resistance
later in life. Stress causes a release of excess glucose and cortisol. Excess
glucose leads to glucose toxicity and causes insulin resistance. Cortisol
causes visceral adipose, a risk factor for insulin resistance.
Clinical Implications
The health care provider
needs to be aware of the patients’ psychosocial aspects of living as it
directly affects their health negatively. Research on this topic is limited and
further research needs to be done.
Improving Safety in the First
Hour Following Total Joint Replacement Surgery
Susan E. Heitman, RN, CNOR,
DNP (Candidate)
Mayo Clinic Health
System-Franciscan Healthcare
Background
Significance
Purpose/objective
The purpose of this systems
change project was to review and analyze the literature as well as evaluate patient
data related to the practice of bypassing the post anesthesia recovery room
(PACU), or Phase 1 recovery, in a Critical Access Hospital. The overarching question for this project
was: When is it safe for the total joint replacement patient receiving spinal
anesthesia with or without sedation to bypass Phase 1 recovery in a Critical
Access Hospital?
Methods
This project was grounded in
Participative Action Research, Change Theory and the nursing theory of
Relationship Based Care. A chart review
of 168 patients who had total joint replacement surgery over a 6 month period
was completed during summer 2011. Data abstracted included pre-surgical data:
age, body mass index, and ASA score as well as post-surgical data: Aldrete
score, patient vital signs including mean arterial pressure (MAO), type and
length of surgery, estimated blood loss during surgery, need for oxygen
supplementation, nausea, vomiting, itching, and pain.
Results
Of the total sample of 168
patients, 66 (39.3 %) had an Aldrete score of less than or equal to
7 in the first hour postoperatively, 32 (19%)
had a MAP ≤ to 63 in the first hour and 21 (12.5%) had an MAP ≤ to
60. Age, ASA scores and BMI were not
associated with decreased Aldrete scores or MAP. Patients with total hip
arthorplasty and bilateral total knee arthroplasty had higher incidence of
lower Aldrete scores and lower MAP than unilateral total knee arthroplasty
patients.
Clinical Implications
Because nearly 40% of the
sample had Aldrete scores of 7 or less within the first hour postoperatively,
and most PACUs have as one of the criterion for discharge an Aldrete score of 8
or higher. It is clear that patients who receive total joint replacement
arthroplasty in this setting should go to the PACU or at the very least have
1:1 nursing for the firrst postoperative hour.
Volunteer Perceptions of
Impact to Self and Community Served
Karen Arndt, RN, BSN;
Elizabeth Arnold, MPH; Lois Tucker, RN, BSN
Ana Schaper, PhD, RN; Dawn
Steffes, Research Associate
Gundersen Lutheran Health
System
Background
Gundersen Lutheran Health
System started the Global Partners program in 2008 and initiated a long-term,
sustainable partnership Pine Ridge Indian Reservation in South Dakota. Since
2009, volunteer medical teams have provided primary care and chronic disease
management services on Pine Ridge.
Significance
An assessment of a
volunteer’s experience provides insights into how nursing, medical and support
staff may be impacted professionally or personally through participation in a
volunteer trip.
Purpose/objective
The purpose of this study was
to gather volunteer feedback on the program and the impact their volunteer
experience had on their personal and professional development.
Methods
The literature identifies a
number of potential benefits to professional practice and personal development
related to volunteerism. Participants were volunteers to Pine Ridge Reservation
from October 2009 to November 2011. An anonymous evaluation survey was sent via
survey monkey. Self-selected volunteers wrote entries in a team journal
describing insights and stories of their experiences.
Results
Survey response rate was 40%
with data from 12 physicians, 26 nurses and 8 support staff. Program strengths
included:, an effective orientation, well organized travel, and good teamwork.
Most satisfying experiences centered around helping others and building new
relationships. Least satisfying aspects of the experience related to system
barriers limiting health service delivery, and the overwhelming health needs of
people living on Pine Ridge reservation. Survey data and journal entries
documented personal and professional development through the volunteer
experience.
Clinical Implications
Numerous programmatic changes
have been implemented following the feedback received from the survey, journal,
as well as debriefing meetings held by each team. Recent changes aim to
increase employee engagement, expand partnerships to create more sustainable
development, and address system barriers. Continued evaluation of the
volunteer’s experience is needed to understand how site, role, prior experience
or satisfaction specifically impact professional and personal development.
A Comparison of Two
Treatments for Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Janet L. Torkelson BSN, RN,
MSN Student
Viterbo University
Background
Chronic inflammatory
demyelinating polyradiculoneuropathy is a rare progressive disease most often
results in limited function of one or more limbs along with other neurological
symptoms. The current recommendations for treatment of this disease can be
vague, which results in a wide range of treatment options including: plasma
exchange, the administration of corticosteroids, intravenous immunoglobulin,
immunosuppressive agents, and interferons.
Significance
The quality of life for
people diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy
is greatly affected by the neurological symptoms of the disease process and
even minimal improvement is seen as a positive outcome.
Purpose/objective
Treatment is necessary to
combat these disabilities that can include paralysis and may even lead to
death, but determining the best treatment can be difficult with so many options
available. This study focused on the benefits of plasma exchange treatment on
the patients’ outcome compared with the use of intravenous immunoglobulin in
patients with chronic inflammatory demyelinating polyradiculoneuropathy.
Methods
The literary review included
a sample of 11 studies found using CINAHL, Medline, ERIC, Psych Info, and the
Cochrane Collection, which was followed with a hand search and ancestry search.
Results
The studies indicated
positive patient outcomes with the use of plasma exchange and intravenous
immunoglobulin for patients with chronic inflammatory demyelinating
polyradiculoneuropathy. However, the positive patient outcomes using plasma
exchange have been shown to be short term. Nine of the 11 studies showed that
patients benefit when using intravenous immunoglobulin, where 8 of the 11
studies showed plasma exchange has positive outcomes for patients.
Clinical Implications
Neither treatment is superior
for patients with chronic inflammatory demyelinating polyradiculoneuropathy.
Therefore, it is necessary to consider both intravenous immunoglobulin and
plasma exchange as a primary choice for treatment. The provider must initiate
discussion with the patient and consider the cost, equipment, availability of
each therapy, and individual risks and benefits when choosing either option.
Engaging in Mentorship to
Enhance Entry Level RN Retention: Does It Work?
Deborah M. Wendorf BSN, RN,
MSN Student
Viterbo University
Background
Major challenges in the
nursing workplace environment are high turnover rates and job satisfaction for
entry-level nurses.
Significance
The impact of mentorship
programs relating to entry level nurse retention rates and satisfaction was
examined to identify and report the effectiveness of mentorship programs
through a synthesis of findings found throughout the literature in this
extensive review of literature.
Purpose/objective
With the current and future
projected nursing shortages threatening adequate staffing for patient care, it
becomes essential that nursing identifies best practice strategies in assisting
entry-level nurses’ opportunities to ease the school-to-work transition.
Methods
A purposive selection of
studies was chosen. Key terms used while conducting the review of literature
included mentorship, preceptorship, interpersonal relationships, graduate
nurses, and nurse retention.
Results
This review of literature has
presented the evidence and synthesized the findings recommending a quality
mentorship program to be an effective strategy to provide for nurse retention
and workplace satisfaction among entry level nurses.
Clinical Implications
Preparing entry level nurses
for the professional role of nursing requires additional research to be
conducted on mentorship programs.
CREATING AND IMPLEMENTING A
PLAN FOR THE USE OF ESSENTIAL OILS TO SUPPORT A HEALING ENVIRONMENT: A UNIT
VIEW
Denise Nicholson RN
Gundersen Lutheran Medical
Center
Background
For centuries, essential oils
have been used to treat nausea and vomiting. Research supports this practice
and has demonstrated that essential oil use is effective as an adjunct therapy
in the management of post-operative nausea and vomiting.
Significance
As bedside nurses, focusing
more on the tasks related to patient care creates a barrier to making an
authentic caring connection with our patients. Introducing staff to the use of
essential oils with our orthopedic surgical patients, as a complimentary
therapy is one way to begin creating a healing environment.
Purpose/objective
The purpose of this pilot
project was to design and implement a process that educates staff on: the use
of essential oils, individualization of the patients' plan of care,
documentation, and creating a healing environment for our patients on all
levels (mind, body and spirit).
Methods
Dr. Val Lincoln Ph.D., RN of
the Woodwinds Health Campus was instrumental in inspiring nurses on the
orthopedic unit to engage in this intitiave. Dr. Ed Riley II serves as the
Physician champion and Jill Blackbourn RN, Nursing Systems Specialist, is the
project chair. Education for staff was provided and a pocket guide was created
as a reference for staff that included the indication of each oil and
suggestions on creating a healing environment. Oils were offered to surgical
patients of Dr. Riley II beginning January 31, 2012.
Results
Evaluation of the education
to staff revealed that they were committed to this project. They identified the
educators were knowledgeable, and the materials met their education needs. Over
85% reported they would change their practice based on what they learned.
Patient comments included: 'I love this, it smells nice, I feel better".
Clinical Implications
Quality measures are ongoing
to refine the delivery of essential oils. Reasearch to document patient
outcomes is being developed.
Leveraging Technology:
Efficaciously utilizing the electronic medical record to manage care
Kari Hamson-Kalis MSN, RN,
CNL Shannon Hulett MSN, RN, CNL
Gundersen Lutheran Medical
Center
Background
The CNLs at Gundersen
Lutheran recognized the need to utilize informatics to improve coordination and
management of patient care throughout the stay and upon discharge. Leveraging
this resource, the CNLs with support from Information Systems designed
electronic tools to provide point in time reports of patient status allowing
interdisciplinary staff to efficaciously manage the needs of patients.
Significance
Multiple demands of complex
healthcare environments Must manage/coordinate care that results in safe, high
quality, cost effective outcomes Decrease fragmentation across the continuum of
care Need to efficaciously identify, prioritize, respond to, communicate and
track the ever-changing needs of patients and families Must leverage electronic
resources such as the electronic medical record (EMR)
Purpose/objective
Understand how the electronic
medical record is utilized to efficaciously manage care throughout
hospitalization, including discharge.
Methods
Workflow processes were
determined through interdisciplinary collaboration Electronic tools were
designed Staff were educated Application of tools was hardwired into
interdisciplinary staff practices
Results
Medical Oncology Unit Direct
Expense/Discharge 8% HPPD 15.5% Delays to Skilled Nursing Facilities 26%
Continuous Observation Hours 52% Injury from Falls 66% RN Overtime 32% Patient
Satisfaction 6% General Event Reporting 94% Cardio-Pulmonary Unit Direct
Expense/Discharge 22% HPPD 1% Continuous Observation Hours 54% Injury from
Falls 22% RN Overtime 37% General Event Reporting 67% The electronic medical
record is a valuable healthcare resource that can be used to efficaciously
coordinate/manage care of multiple patients in demanding healthcare
environments. Electronic tools extend our eyes and ears and give us direction
as we collaborate with interdisciplinary staff.
Clinical Implications
Enhances the work of nurses
and interdisciplinary staff Promotes staff engagement and patient satisfaction
Results in cost savings, decreased delays, smooth transitions of care and
increased safety
CREATING AND IMPLEMENTING A
PLAN FOR THE USE OF ESSENTIAL OILS
Jill Blackbourn, RN - Nursing
Systems Specialist
Gundersen Lutheran
Background
Complementary Therapies are
one way to enhance an environment that supports healing. Based on expressed
interest from patients, staff and physicians discussions occurred regarding the
use of essential oils for patient care.
Significance
Creating a well-organized
plan for implementing a low-risk and beneficial complementary therapy and
showing tangible enhanced patient and staff experiences would be instrumental
in setting precedence for Gundersen Lutheran to adopt additional healing
modalities.
Purpose/objective
To design and implement a
pilot process that potentiates a healing environment through the use of
essential oils with a specific patient population and can be expanded as
appropriate for the organization.
Methods
In June of 2010, Gundersen
Lutheran nursing leaders met with Val Lincoln PhD, Clinical Lead - Integrative
Services, Woodwinds Health Campus. In July, 2010 and August, 2011, Dr. Lincoln
presented healing environment information to Gundersen Lutheran nurses. Work
continued October 2011 through January 2012 with interprofessional team
meetings for project planning and development. A standard operating procedure
was created. Education to staff occurred in January. January 31, 2012 was our
Go-Live date for use of essential oils in our pilot peri-operative units and
Ortho/Neuro unit with patients having surgery by Edward Riley, MD.
Results
Evaluation measures will
include: quality of essential oil administration; surgery outcomes; patient
perceptions of nausea, anxiety and pain; and patients’ and nurses’ perception
of the experience using essential oils.
Clinical Implications
Patients will experience
decreased anxiety, nausea and pain with the use of essential oils. While the
goal is not to substitute essential oils for medication, we anticipate that
patient use of essential oils will decrease the amount of medications used.
Staff will understand the benefits of potentiating an optimal healing
environment for our patients. The use of essential oils will serve as a
reminder that there are multiple ways to create a healing environment.
Outcomes of Active Learning
Strategies
Mary Shelerud, BSN, RN - MSN
Student
Viterbo University
Background
In baccalaureate degree
nursing programs, 86% of students are less than 30 years old. These groups of
students are often referred to as millennials. Millennials are thought to have
distinct characteristics, particularly related to teaching and learning and
have preferences for active learning strategies.
Significance
The findings will be used to
offer information about the association of active learning strategies and
learning outcomes to guide teaching practices of nurse educators.
Purpose/objective
The purpose of this paper was
to review literature to describe learning outcomes associated with active
learning strategies in the nursing student population.
Methods
A literature review utilizing
CINAHL, MEDLINE, and ERIC databases, for articles published between 2003 and
2011, was performed. Fourteen articles met inclusion criteria.
Results
Thirty-one outcomes were
found to be associated with several active learning strategies.
Clinical Implications
Implementing an active
learning strategy produces positive outcomes for nursing students. The
challenge for educators is to provide activities that facilitate active
learning and engage students.
Recommended Strategies and
Influencing Factors to Reduce Melanoma in High Risk Individuals
Rachel M. Kasten, BSN, RN,
CRRN, MSN Student
Viterbo University
Background
When providing care for
high-risk individuals for melanoma, it is imperative that these patients
receive adequate education on melanoma and are able to make informed decisions
in regards to their healthcare and self-preventive measures.
Significance
Determining best practices
regarding skin self-examinations and in counseling persons to prevent skin
cancer is complicated when recommendations from the U.S. Preventive Services
Task Force have stated that there is insufficient evidence to support these
practices.
Purpose/objective
The purpose of this paper was
to (a) compare effectiveness of commonly recommended strategies for high-risk
individuals in the protection against malignant melanoma and (b) assess factors
that influence high-risk individuals to seek screening and/or follow
sun-protective habits. This information will assist healthcare providers in
determining the most effective interventions for the individual at high risk of
skin cancer.
Methods
Relevant research literature
from 2002 to 2011 was reviewed and chosen based on relationship to the research
question.The primary databases used were CINAHL, Academic Search Complete, and
MEDLINE with the use of key words including skin cancer, melanoma, prevention,
high risk, sun protection behaviors, and self-assessment in various
combinations.
Results
Findings revealed that the
most positive outcomes are related to the increased effectiveness of skin
protection based upon the use of specific patient tailored interventions
implemented through educational information.
Clinical Implications
A better understanding of the
importance of skin self-examination and participation in sun-protective
behaviors for high-risk individuals will aid in offering comprehensive patient
care and appropriate counseling. The most important factors that influenced
high-risk individuals to seek screening and follow sun-protective habits were
patient specific interventions. Knowledge of this information will assist
healthcare providers in the use of the most effective interventions to focus on
the individual, especially those at high risk of developing skin cancer.
Continued research and further consensus of national guidelines would be
helpful to support skin self-examination and sun-protective behaviors.
Improving Patient Care: An
Interprofessional Approach
Susan K Stinson, MSN, RN; Ana
Schaper, PhD, RN; Becky Inglis, MSN, RN; Elizabeth Arnold, MPH;
Gundersen Lutheran Health
System
Background
The World Health Organization
(2010) states that education is a necessary step in preparing a “collaborative
practice-ready” health workforce that is better prepared to respond to local
health needs. Education must include opportunities for “students from two or
more professions learn about, from and with each other to enable effective
collaboration and improve health outcomes.”
Significance
There are few opportunities
for students to participate in interprofessional learning. For effective PFCC
delivery all members of the collaborative team must have a shared understanding
of practice principles.
Purpose/objective
This presentation describes
the development of an interprofessional education program using video
simulation and a facilitator guide that: provides knowledge and education to
assist with improved communication between patients and families and health
care professionals, and encourages continuous collaborative care from
participants
Methods
Key steps in the process
included: writing a script to depict not ideal and ideal care of a patient seen
in a regional clinic requiring transfer to a major medical center, selection of
PFCC components to be showcased, production of video simulations, development
of a facilitator guide and scheduling time for delivery of an interprofessional
learning experience. A partnership was created with the La Crosse Community
Theatre for assistance in direction and production of the video simulations.
Results
Participation in developing
and creating the education program provided opportunities for each person to
bring their own stories and histories to creating the videos. Individual
creativity added to the realistic depiction of challenges to delivering PFCC.
Stories of personal and professional growth were provided by team members, the
cast and crew working on the education program
Clinical Implications
Collaboration between
Gundersen Lutheran Health System and the community assisted in the further
understanding of interprofessional work as well as professional growth.
Civility in Nursing Education
Gina Pearse MSN, RN; Rosanne
Schulz MPH, RN
Ana Schaper PhD, RN
Gundersen Lutheran Health
system
Background
Incivility in higher
education is a growing problem in the U.S. Faculty and students’ past
experiences influence their interactions within the Nursing classroom.
Significance
The goal is to develop a
culture of civility.
Purpose/objective
In order to understand the
perceptions that contribute to incivility within Nursing education, the present
study aims to: 1) to document students’ perceptions of uncivil behaviors in
higher education prior to entering the Western Campus program; 2) to track
uncivil behaviors as perceived by students and faculty of the Western Campus
program over the next five years and 3) to generate creative strategies to
promote civility and address stress in higher education.
Methods
Nursing faculty (n=9) from
the Western Campus of the University of Wisconsin, Madison completed the
Incivility in Higher Education (IHE) scale prior to beginning the 2011-2012
school year. Students (n=24) completed the IHE scale during orientation to the
School of Nursing. Focus groups of faculty and students were held to discuss
the data.
Results
Respondents indicated that
incivility was a mild to moderate problem. Students’ behavior consistently
reported as uncivil by students included: holding distracting conversations,
cheating, being unprepared, using a computer unrelated to class and creating
tension by dominating discussion. Students’ behavior consistently reported as
uncivil by faculty included: demanding make up examinations/extensions,
cheating, using cell phones during class and not paying attention. Faculty
behaviors perceived as uncivil by both students and faculty included: making
rude gestures, being distant and cold, and refusing to answer questions. Both
cohorts reported that faculty’s failure to address disruptive behaviors as they
occur contributes to the problem.
Clinical Implications
Faculty and students need
foundational skills to address uncivil behaviors and to work together to
develop a culture of civility in nursing education. In a culture of civility,
faculty strives to empower students and students actively contribute to a civil
learning environment.
Dissemination and Implementation
of Evidence-based Methods to Measure and Improve Pain
Danielle Miller MSN, RN, CNL;
Ana Schaper PhD, RN; Dawn
Steffes, Research Associate; Jennifer Donahue; Rachel Borucki; Melissa Franz;
Libbie Nyarangi; Dylan Van Lith
Gundersen Lutheran Health
Syste
Background
Pain is a major concern for
hospitalized patients. Despite multiple quality initiatives to improve pain
management, national studies continue to demonstrate that pain is inadequately
managed. To date, no national study directly asked patients for their
perception of their pain management.
Significance
This is a national study
involving 400 hospitals, conducted by the National Database for Nurse Quality
Indicators (NDNQI), and funded by the Robert Wood Johnson Foundation. The goal
of this study is to “implement and evaluate an innovative research program to
measure and improve pain care processes and outcomes in a sample of hospitals
across the U.S.”.
Purpose/objective
The purpose of this
presentation is to compare data from patient responses at Gundersen Lutheran
(GL) hospital with responses from comparable hospitals participating in this
research.
Methods
Nursing students, trained in
research ethics and data collections, interviewed patients on one day in April
and November, 2011. Data were collected from patients on the following units:
Medical-Surgical, Rehabilitation and Postpartum.
Results
National data indicated that
patients’ mean pain score in the past 24 hours of their hospitalization was 5.7
+ .6. Overall, patients responded that 72% of their pain was relieved by pain
medications. Patients also indicated that nurses believed their reports of pain
and they received pain medication in a timely manner. Patients were less likely
to report that nurses offered them additional approaches to manage pain and
that side effects of pain medications were discussed. Ratings from GL patients
were the same or higher than those of national participants.
Clinical Implications
Research supports the
effectiveness of a growing number of nursing interventions that help manage
patients’ pain. The challenge is to deliver nursing interventions, particularly
complimentary, holistic care practices given the daily demands of the work
setting.
Have you been sitting on your
pressure ulcer data too long?
Sarah Archer, BSN, RN, OCN
Christina Waldner, BS, RN
Gundersen Lutheran Medical
Center
Background
Hospitals are aware that
pressure ulcers occur in their institutions. Often there are unknowns such as
frequency, severity or etiology. A search for answers should begin with data
collection that identifies areas for improvement related to prevention,
identification and treatment.
Significance
Pressure ulcers are a nursing
sensitive measure. Using nurses to collect data, drive changes, and deliver education
can help make and sustain changes.
Purpose/objective
To understand how development
of a standardized process related to pressure ulcer prevention, identification
and treatment improves outcomes. To identify key data elements to target areas
for improvement related to pressure ulcer.
Methods
Data were limited to the
presence of a pressure ulcer on admission, location and stage. To enhance our
data a report was created to allow identification of patients who may present
with skin breakdown. This provided an opportunity to teach staff and ensure the
patient was receiving the appropriate care. A data collection tool was then
completed for analyses. Data allowed us to learn more about the patients with
pressure ulcers. Therefor allowing for identification of areas where
improvements can be made. Surgical patients were found to be a large population
who developed pressure ulcers. This led to implementation of specific
preventative interventions on patients who met identified criteria.
Results
A Median of 62% of patients
with a Hospital Acquired Pressure Ulcer had a surgical procedure. Since the
start of our interventions in the surgical population we have seen an 18%
decrease in Hospital Acquired Pressure Ulcers.
Clinical Implications
This approach has allowed for
the overall reduction in the number of pressure ulcers that develop and will be
used on additional patient populations
The Effect of Human Patient
Simulation as a Teaching Method on Caring Efficacy in First Semester Associate
Degree Nursing Students
Laureen A. Love MSN,RN,NNP-BC
Western Technical College
Background
Literature related to caring
and nursing education focuses primarily on nurse educators as central figures
in transmitting caring to their students. Research is needed to explore means
by which students learn to care as nurses and how this process may be
encouraged in nursing curricula.
Significance
Research has been conducted
evaluating use of simulation for promotion of skills competency, critical
thinking and self efficacy. Little has been done to evaluate the role of
simulation to teach caring. The simulated human factor seems to offer an
exceptional opportunity in which to encourage the caring aspects of nursing
essential to nursing practice.
Purpose/objective
The purpose of this study was
to determine if use of human patient simulation in an introductory nursing
skills class could be effective in improving nursing students’ caring efficacy.
Methods
This study was a
quasi-experimental, repeated measures design utilizing the Coates Caring
Efficacy Scale (CES) (Coates, 1997) as pretest and posttest comparison between
control and experimental groups. Participants received instruction related to
24 nursing skills by lecture, discussion, demonstration, and coached practice.
The experimental group also interacted with the simulated patient when
practicing these nursing skills. The simulator was operated by a nursing
instructor following a scripted scenario. The CES was administered again as a
post-test to measure students’ perceptions of their caring efficacy.
Results
Results were not
statistically different between control and experimental groups. Post-test
scores for the experimental group were higher than the control. There was no
statistical difference in the experimental group between pre and
post-intervention scores; however a change in mean test scores from pre-test
5.26 to post-test 5.35 indicated a positive trend.
Clinical Implications
Assessment of students’
caring abilities has an important role to play in the development of nursing
curriculum. Findings from this study strongly suggest simulation as a method to
teach caring aspects of nursing has promise.
The Role of Depression
Screening in Patients with Pre-Diabetes
Sarah A. Hayden, RN, BSN
Winona State University
Background
Diabetes and depression are
prevalent chronic illnesses negatively impacting quality-of-life, functioning,
and life expectancy. Currently 8.3% of the United States population has a
diagnosis of diabetes and 15.7% will receive a diagnosis of depression during
their lifetime. Individuals with diabetes are 46% more likely to develop
depression and individuals with depression have a 60% increased risk of
developing diabetes. Therefore, a bidirectional relationship between diabetes
and depression has been proposed.
Significance
Identifying and treating
depression in patients with pre-diabetes may mitigate many of the factors
eventually leading to diabetes. Pender’s Health Promotion Model emphasizes the
role of healthcare providers in implementing interventions to achieve primary
prevention and Healthy People 2020 identifies both improving prevention
behaviors in patients with pre-diabetes as well as increasing depression
screening by primary care providers as current healthcare goals.
Purpose/objective
The purpose is to identify
the role of depression screening in patients with pre-diabetes.
Methods
A literature review was
conducted to determine the impact of depression on patients with pre-diabetes
and the effect of treatment on diabetes prevention.
Results
Depression is associated with
poor self-care behaviors, often leading to obesity and insulin resistance as a
result of unhealthy diet and lack of physical activity. Additionally, the
biochemical changes associated with diabetes, including increased activity of
the hypothalamic-pituitary-adrenocortical axis and sympathetic nervous system,
lead to glucose production and insulin resistance predisposing patients to
diabetes independent of lifestyle factors. Individuals with treated depression
and their non-depressed counterparts have similar levels of insulin resistance
and both are significantly lower than individuals with depression.
Clinical Implications
Depression screening is an
essential component of care in patients diagnosed with pre-diabetes. Depression
treatment positively impacts self-care behaviors as well as influences the
biochemical changes associated with depression, possibly preventing the
chemical imbalances leading to the development of diabetes. All patients
diagnosed with pre-diabetes should be screened for depression.
