Roadmap for integrating the AACN essentials with perioperative nursing.

Faculty members teaching in pre-licensure nursing programs are entrusted with revising nursing education to meet the American Association of Colleges of Nursing's The Essentials: Core Competencies for Professional Nursing Education. Colleges of nursing faculty experience difficulty establishing enough clinical sites as healthcare facilities continue to overcome staffing challenges since the start of the COVID-19 pandemic. Perioperative nursing is an underutilized area despite the potential for students to attain valuable nursing competencies and experiences in perioperative areas. An opportunity exists for faculty, regardless of having perioperative nursing experience or not, to use perioperative environments for clinical experiences in didactic and simulation courses. Our aim is to provide a roadmap for nursing faculty to include perioperative nursing in the pre-licensure nursing curriculum. Perioperative education exemplars aligned with the American Association of Colleges of Nursing's The Essentials: Core Competencies for Professional Nursing Education domains are included for adoption in any college of nursing.

Characteristics of substance-addicted mothers that predict graduation from the family treatment court.

INTRODUCTION: In the United States, substance addiction is a major contributing factor to incarceration of mothers and separation of children from their families. Five hundred Family Treatment Courts (FTC) operate across the country to combat the growing problem of women addicted to drugs. The FTC model provides mothers with substance addiction treatment, intensive judicial monitoring, repeated drug testing, counseling, incentives or sanctions, and case management with the goal of reaching long-term sobriety and reunification with their children. DESIGN: This retrospective study examined the relationship between sociodemographic characteristics and substance use characteristics, in predicting participants' graduations from the FTC program. METHODS: Data were gathered from 317 participants from five Family Treatment Courts in the southeastern United States and analyzed using logistic regression. RESULTS: Participants who completed the FTC program were more likely to be older, completed Cognitive Behavioral Training, completed high school, and Caucasian. CONCLUSION: Age and completion of Cognitive Behavioral Therapy were the greatest predictors of graduating from the Family Treatment Court. These results convey the need for development of interventions tailored to each participant's age to maximize the success of the FTC participants. In addition, Cognitive Behavioral Therapy should be integrated into all FTC programs. CLINICAL RELEVANCE: The findings from this study will offer research scholars a foundation for designing future studies, aid researchers in creating interventions to increase success in substance addiction treatment programs, and contribute to the framework for theory development. In addition, understanding characteristics that may influence graduation from the Family Treatment Court will provide valuable information on developing interventions to support participants' success.

Perceived stress and salivary biomarkers in educators: comparison among three stress reduction activities.

Background: The teaching profession is a potentially stressful occupation with up to 30% of all novice teachers leaving the profession and annual teacher turnover is higher when compared with turnover of all other occupations. This study investigated the effects of a one-time stress reduction activity (meditation, yoga, or aerobic exercise) in university and K-12 educators who were part of one-day seminar on Stress Reduction. Methods: Participants (N = 26) self-selected their stress reduction activity, completed a demographic questionnaire, educator stress self-assessment tool, and visual analogue scales indicating current stress levels. Salivary cortisol and amylase levels were measured before, immediately after, and 30 minutes after completion of the stress reduction activity. Results: Three (time) by three (activity) mixed factorial ANOVAs were computed for salivary analytes. The ANOVA for cortisol revealed a significant interaction (F (4, 66) = 3.60, p = .01). Comparisons showed significant differences with the aerobic exercise group having significantly higher cortisol levels at the 30-minute post-activity level when compared to the meditation (p < .05, Cohen's d = .74) and yoga groups (p < .05, Cohen's d = .52). Conclusion: Overall, the one-time activity of meditation and yoga showed lowered salivary cortisol levels at 30-minutes post-activity when compared to aerobic exercise activity. Additional research to examine the effects of stress reduction on educators in the work setting is needed.

Comparative Study of Lamina Cribrosa Thickness Between Primary Angle-Closure and Primary Open-Angle Glaucoma.

PURPOSE: To compare lamina cribrosa thickness (LCT) of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) using the enhanced depth-imaging mode of the Heidelberg Spectralis spectral-domain optical coherence tomography (EDI-OCT). PATIENTS AND METHODS: A comparative cross-sectional study was conducted. We enrolled 34 patients with PACG, 38 with POAG, and 62 controls, testing only one eye of each participant. Lamina cribrosa thickness was determined at the center of the optic nerve head using EDI-OCT. Nine points of LCT were measured, and LCT averages were analyzed. RESULTS: Mean age, number of glaucoma medications, current intraocular pressure (IOP), cup to disc ratio, and visual field indices, were not significantly different between PACG and POAG eyes. The maximum IOP (SD) was higher in PACG than in POAG, at 32.5 (10.46) vs 25.05 (6.42) mmHg (p = 0.001), and LCTs were significantly different among the PACG, POAG and control groups. Mean (SD) LCTs were 226.99 (31.08), 257.17 (19.46), and 290.75 (28.02) µm, respectively (p < 0.001). Lamina cribrosa thickness was correlated with mean deviation of the visual field (p = 0.001; correlation coefficient, rs = 0.347), while it was inversely correlated with maximum IOP (p < 0.001; correlation coefficient, rs = -0.592). Linear regression analysis revealed that LCT was inversely related to age (p = 0.008), female (p = 0.018), and maximum IOP (p = 0.002). LCT was marginally related to visual field MD (p = 0.053). CONCLUSION: Glaucomatous eyes had thinner LCT than controls, and maximum IOP was inversely correlated to the LCT. PACG eyes had higher maximum IOP and thinner LCT than POAG ones. In living eye, EDI-OCT emphasizes the pressure-dependent mechanism of glaucoma on lamina cribrosa deformation and the higher IOP-loaded stress which leads to a greater lamina cribrosa strain.

The Relationship of Postoperative Delirium and Unplanned Perioperative Hypothermia in Surgical Patients.

PURPOSE: The purpose of this study was to investigate associations between postoperative delirium (POD) and unplanned perioperative hypothermia (UPH) among adults undergoing noncardiac surgery. DESIGN: A retrospective, exploratory design was used. METHODS: A retrospective, exploratory study was conducted using electronic medical record data abstracted from a purposive convenience sample of adult patients undergoing noncardiac surgery from January 2014 to June 2017. FINDINGS: The analyzed data set included 22,548 surgeries, of which 9% experienced POD. Logistic regression indicated that American Society of Anesthesiologists (ASA) class was the strongest predictor of POD (χ2 = 1,207.11, df = 4, inclusive of all ASA class terms). A significant relationship between UPH and POD (χ2 = 54.94, df = 4, inclusive of all UPH terms) and a complex relationship among UPH, patient age, ASA class, and POD were also found. CONCLUSIONS: Results support a relationship between UPH and POD. Notably, there is also a complex relationship in the noncardiac surgery population among UPH, age, ASA class, and POD. Preliminary understanding of this relationship is based on the pathophysiological response to surgical stress. Further research is indicated.

Global shape processing deficits are amplified by temporal masking in migraine.

PURPOSE: Individuals with migraine show subtle defects in a range of visual tasks compared to nonmigraineurs. Increased neuronal noise can account for some of these deficits. To examine the generality of increased noise in migraine, masking effects were compared in migraineurs and headache-free controls using a shape discrimination task, thought to involve processing in extrastriate cortical areas. METHODS: Nine migraineurs with aura, nine migraineurs without aura, and nine headache-free controls participated. observers had to detect deviations in circular shapes with or without a larger contour mask. The nonoverlapping mask was presented at five temporal intervals (stimulus onset asynchronies, SOA): 0 (simultaneous), 66, 100, 133, and 250 ms. RESULTS: Migraineurs with aura performed worse in all tests than migraineurs without aura and controls. Both migraine groups performed poorer than controls at discriminating shapes without masks. Typical masking functions were obtained from all groups, but they were steeper for migraineurs than controls with thresholds raised most dramatically (2.1 and 4.4 times for migraineurs without and with aura relative to controls, respectively) at SOAs where masks had their most detrimental effect (66-100 ms). Modeling the effect of masking showed that raised internal noise alone is insufficient to explain these deficits. Rather, an abnormal nonlinear transducer function (e.g., as part of gain-control) together with increased multiplicative noise is required to capture the data. CONCLUSIONS: The findings are consistent with an extrastriate deficit in migraine that cannot be explained completely by defective inhibition.

Intraoperatively acquired pressure ulcers and perioperative normothermia: a look at relationships.

The risk of developing an intraoperatively acquired pressure ulcer (IAPU), which is recognized as a significant complication of deep tissue injury occurrence, is associated with duration of surgery and patient positioning. There is a strong association between hypothermia, tissue viability, and surgical site infections; however, the relationship between hypothermia and pressure ulcers has not been fully explored. We examined the incidence of pressure ulcers in surgical patients and determined that there is a relationship between maintaining perioperative normothermia and a reduction in IAPU development. We used a retrospective, explanatory, nonexperimental design, and we fit a binary logistic model to the data. This study shows that patients at higher risk for developing an IAPU include those who are critically ill, have a low Braden Scale skin assessment score, are thin, and are male with at least a 1° F (1.8° C) drop in temperature. These are important risks for perioperative nurses to take into account during care of surgical patients. More perioperative research is needed to identify ways to reduce risk, provide close assessment of high-risk patients, and implement the identified risk-reduction strategies.

Long-range inhibitory mechanisms in the visual system are impaired in migraine sufferers.

BACKGROUND: After viewing dynamic noise surrounding a homogeneous grey patch (artificial scotoma), observers perceive a prolonged twinkling-noise after-image within the unstimulated area. It has been suggested that noise-stimulated neurons induce a long-range inhibition in neurons within the artificial scotoma, which generates a rebound signal perceived as twinkling noise following noise termination. We used this paradigm to test whether migraineurs have enhanced excitability or weakened inhibition. METHODS: Twinkling-noise duration was measured in 13 headache-free volunteers, 13 migraineurs with aura and 13 migraineurs without aura. RESULTS: The durations of the after-image were significantly shorter for both migraine groups compared to controls. DISCUSSION: Enhanced excitation of noise-activated neurons in migraineurs would produce stronger rebound activity and longer after-image durations, while weakened inhibitory mechanisms would diminish the rebound activity and shorten the after-image durations compared to control subjects. The results suggest that cortical inhibitory mechanisms might be impaired in migraineurs with and without aura.

Visual noise selectively degrades vision in migraine.

Purpose. Migraine is a disabling condition with underlying neuronal mechanisms that remain elusive. Migraineurs experience hyperresponsivity to visual stimuli and frequently experience visual disturbances. In the present study, the equivalent input noise approach was used to reveal abnormalities of visual processing and to isolate factors responsible for any such deficits. This approach partitions visual sensitivity into components that represent the efficiency of using the available stimulus information, the background internal noise due to irregular neuronal fluctuations, and the neuronal noise induced by the external stimulation. Methods. Ten migraine with aura, ten migraine without aura, and ten age-matched headache-free subjects participated. Performance in detecting luminance targets embedded in visual noise, resembling grainy photographs, was measured at various noise levels. Results. Contrast thresholds of the three subject groups were similar in the absence of noise, but both migraine groups performed worse in the presence of high noise levels, with performance of migraineurs with aura significantly poorer (P < 0.05) than that of control subjects. Data were fitted with a perceptual template model that showed that the model parameter determining the internal (neuronal) noise triggered by the external (stimulus) noise was significantly higher (P < 0.001) in both migraine groups than in the non-migraineur group. Migraineurs without aura also showed a significant (P < 0.05) though weak reduction of sampling efficiency (0.12 +/- 0.02) compared with control subjects (0.17 +/- 0.02). Conclusions. The results revealed substantial external noise-exclusion deficits in migraine with aura and a minor impairment of noise exclusion in migraine without aura. Migraineurs appeared prone to abnormally high variability of neuronal activity. This result provides a promising explanation of observed visual deficits in migraine.

Effects of comfort warming on preoperative patients.

THERMAL COMFORT IS ONE DIMENSION of overall patient comfort, and it usually is addressed by covering the patient with warmed cotton blankets. WARMING HELPS A PATIENT maintain normothermia and appears to decrease patient anxiety. AN STUDY WAS CONDUCTED in a preoperative setting to compare the effects of preoperative warming with warmed cotton blankets versus patient-controlled warming gowns on patients' perceptions of thermal comfort and anxiety. BOTH WARMING INTERVENTIONS had a positive effect on patients' thermal comfort and sense of well-being. Patients who used the patient-controlled warming gown also experienced a significant reduction in preoperative anxiety.

How to use medical devices safely.

Perioperative nurses play an important role in the prevention of medical device problems. Be proactive and prevent the harm device problems can cause. Nurses can have a profound effect on eliminating this type of patient harm in the perioperative setting, and through reporting, they can prevent reoccurrence and harm to other patients.