The Impact of Moral Injury on Self-reported Work Performance in Hospital Nurses Following the Global Pandemic Surge.

OBJECTIVE: The aim of this study was to determine relationships between moral injury (MI) and self-reported nurse work performance (NWP) among hospital nurses after the COVID-19 pandemic surges. BACKGROUND: Previously studied in the military, nurse MI became evident due to the pandemic. No previous studies have examined the impact of MI on NWP. Few studies have attended to how MI in nurses can be addressed by nursing leadership. METHODS: A convenience sample of 191 nurses from 7 hospitals in Southern California participated in a multisite correlational survey-design study. RESULTS: Significant levels of MI occurred in 57% (n = 114) of participants. Increased levels of MI were a significant predictor of decreased levels of self-reported NWP. Younger and less experienced nurses reported greater levels of MI. CONCLUSIONS: This study relates MI in nurses to NWP. There is a need for further research to assist nursing administrators in ameliorating MI in nurses and in preparing for the impact of MI on the nursing workforce in future emergent situations.

Interprofessional Education to Address Substance Use among Adults with Persistent Pain: A Pre-Post Program Evaluation.

BACKGROUND: Substance use disorders (SUDs) are highly prevalent among adults with persistent pain. Yet, standard competencies for integrating pain and SUD content are lacking across health science student curricula. Additionally, pharmacotherapies to treat SUDs are underutilized. AIM: To address these gaps, a team of health science faculty created an interprofessional simulation activity using a standardized patient and evaluated learner outcomes related to assessment and treatment of comorbid persistent pain and substance use. METHODS: A total of 304 health science students representing nursing, medicine, pharmacy, and social work programs attended virtual learning sessions. Interprofessional student teams developed a team-based care plan for an adult with musculoskeletal pain who takes prescribed opioids while using alcohol. Pre- and post-activity surveys assessing knowledge and confidence were matched for 198 students. Descriptive statistics summarized survey data with inferential analysis of paired data. RESULTS: The largest significant improvements between pre- and post-activity knowledge were observed in items specific to pharmacotherapy options for alcohol and opioid use disorders. Similar gains were noted in students' confidence regarding pharmacotherapies. No significant differences were noted on pre-post-activity knowledge scores between the three main profession groups (medicine, nursing, and pharmacy). CONCLUSIONS: Students attending this interprofessional simulation demonstrated improved knowledge and confidence, particularly in pharmacotherapies for alcohol and opioid use disorders. Replication of such programs can be used to provide consistent content across health science disciplines to heighten awareness and receptivity to medications available to treat SUDs in people treated for persistent pain. The curriculum is freely available from the corresponding author.

A videoconferencing verification method for enrollment of breastfeeding dyads to an online prospective mixed methods study during the COVID-19 pandemic.

AIMS: To apply videoconferencing as a new verification method prior to enrollment for an online survey-based study. DESIGN: A prospective-observational, mixed methods, three group, repeated measures study involved recruiting a population-based sample of breastfeeding mothers and infants (N = 81). Twenty-seven mothers were recruited for each group: mothers returning to work outside of the home, mothers returning to work from home and mothers staying home with their infants full-time. METHODS: Data were collected at four time points, infant age 4, 12, 20 and 24 weeks, via online survey. Participating mothers received a $10 gift card for completing each survey. Social media, word of mouth and brochures promoted United States-based recruitment nationwide. A publicly available direct link to the survey was initially provided to interested mothers. After the suspicion of online fraud, videoconferencing was instituted for self-referrals and phone calls for professional referrals. RESULTS: The survey was invaded by response fraud 3 weeks after the initial survey deployment. Out of 109 respondents who visited the survey site during that timeframe, only eight mothers (10%) were eligible (22 June 2022 to 14 July 2022). After recruitment modification, 313 individuals emailed the study team with 65 self-referred mothers (80%) enrolled in the study via videoconferencing while eight mothers (10%) had a professional referral and enrolled via phone call (23 August 2022 to 30 March 2023). CONCLUSION: Providing a direct survey link, even with CAPTCHA-protection, evoked fraudulent responses. Videoconferencing is an emerging verification method that can be readily applied to the enrollment of breastfeeding dyads for an online study. IMPACT: The emergence of fraudulent respondents and internet bots threatens data quality. This study addressed the strategy of videoconferencing as a new verification method for recruitment and enrollment of breastfeeding dyads. This knowledge can be applied by researchers to secure sample validity and data integrity.

Hyperbaric Oxygen Therapy for Pain, Opioid Withdrawal, and Related Symptoms: A Pilot Randomized Controlled Trial.

BACKGROUND: Pain, drug cravings, and opioid withdrawal symptoms can interfere with substance use disorder or opioid tapering treatment goals. AIM: This pilot study investigated the feasibility of a protocol designed to test opioid withdrawal symptom relief relative to a sham condition after two consecutive days of hyperbaric oxygen therapy (HBOT) for adults prescribed daily methadone for opioid use disorder. METHOD: Using a double-blind protocol, eight adults were randomized to receive either a full 90-minute HBOT dose in a pressurized chamber with 100% oxygen at 2.0 atmospheres absolute (ATA) or a sham condition receiving 21% oxygen (equivalent to room air within the chamber) at a minimal pressure of ≤1.3 ATA. Measures included study retention, treatment satisfaction, and pre- and post-intervention effects for opioid withdrawal symptoms, drug cravings, pain intensity and interference, sleep quality, and mood. RESULTS: Study retention and treatment satisfaction was high. All measurements improved more, on average, for participants receiving full-dose HBOT treatment than among participants receiving sham treatments except for clinically observed withdrawal symptoms. The largest positive effects were observed in measurements of pain intensity and drug craving. CONCLUSIONS: These pilot results provide evidence to support a fully powered study of HBOT as a potential treatment adjunct for adults receiving methadone for opioid use disorder. Trends towards symptom improvements were detected from pre- to post-HBOT in the full treatment arm versus sham condition. More research into novel non-pharmacologic options to relieve distressing symptoms related to pain and opioid use disorder is essential to improve clinical outcomes.

Cross-Sectional Analysis of Burnout, Secondary Traumatic Stress, and Compassion Satisfaction Among Emergency Nurses in Southern California Working Through the COVID-19 Pandemic.

OBJECTIVE: The purpose of this study was to assess burnout, secondary traumatic stress, and compassion satisfaction scores in emergency nurses after working through the COVID-19 pandemic using the Professional Quality of Life Scale version 5 and compare those scores with similar studies conducted before the pandemic. METHODS: A cross-sectional analysis of a descriptive survey including the Professional Quality of Life Scale version 5 questionnaire was sent to nurses working in the emergency department before 2021 from urban, adult, and pediatric receiving hospitals in Southern California. Results were analyzed to provide insight into the effect of the COVID-19 pandemic on the levels of burnout, secondary traumatic stress, and compassion satisfaction compared with prepandemic studies found in the literature using the same Professional Quality of Life Scale version 5 instrument. RESULTS: Mean subcategory scores were in the moderate range for burnout (25.6), secondary traumatic stress (24.5), and compassion satisfaction (38.7). Burnout scores for midshift nurses were found to be significantly higher than day shift nurses (mean difference 5, P = .02) as were secondary traumatic stress scores (mean difference 4.6, P = .007). In addition, compassion satisfaction subcategory scores in nurses with 1 child living at home were significantly higher than those with 2 (mean difference 6.7, P = .02). DISCUSSION: The unnormalized mean findings were similar to prepandemic studies conducted using the same Professional Quality of Life Scale version 5 instrument indicating nurses are at risk of compassion fatigue. In addition, the scores from midshift nurses reflect increased burnout and secondary traumatic stress whereas nurses with 2 children had lower compassion satisfaction. This implies the need for leadership to proactively seek interventions to support nurses on each shift.

Shared Decision-Making for Patients Using Cannabis for Pain Symptom Management in the United States.

OBJECTIVES: Gaps in research evidence and inconsistent policies regarding use of cannabis for pain and associated symptoms result in confusion for healthcare providers and patients. The objective of this review was to synthesize information on cannabis use for pain with legal and policy implications to create a shared decision-making model that can be used to guide patient care interactions. APPROACH: Current cannabis policies, state laws, research, and patient care practices related to medical and recreational cannabis in the United States were reviewed, along with best practices in shared decision-making. Reviewed literature was then synthesized to create a model that can be used by registered nurses and others to address cannabis use, where legal, for pain and related symptoms. RESULT AND CONCLUSIONS: Cannabis is a legal option for many patients with pain. To minimize harms and optimize benefits, nurses can play a key role when authorized by law in assisting with decision-making surrounding cannabis use.

Mepolizumab.

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433. The May 2016 monograph topics are sugammadex, lesinurad, selexipag, sebelipase alfa, and alectinib. The Safey MUE is on sugammadex.

Uridine Triacetate.

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433. The June 2016 monograph topics are elbasvir/grazoprevir, ixekizumab, brivaracetam, reslizumab, and sofosbuvir/velpatasvir. The Safety MUE is on reslizumab.

Medication Therapy Management for Patients Receiving Oral Chemotherapy Agents at a Community Oncology Center: A Pilot Study.

Purpose: To determine the impact of a pharmacist-driven medication therapy management (MTM) program for patients receiving oral chemotherapy agents. Methods: We assessed the impact of MTM consultations with a pharmacist for patients who were receiving a new prescription for an oral chemotherapy agent. Data were assessed for outcomes including (1) number of medication errors identified in electronic medical records (EMRs), (2) number of interventions performed by the pharmacist, (3) time spent on the MTM process, and (4) patient satisfaction. Data were compared between patients who received their oral chemotherapy agents from the onsite specialty pharmacy or from a mail-order pharmacy. The data were also examined for correlations, and logistic regression was utilized to determine the largest variant cofactor to create an equation for estimating the number of errors in a patient's EMR. Results: Fifteen patients received an MTM consultation, and the pharmacists identified an average of 6 medication EMR errors per patient. There was an average of 3 pharmacist-led interventions per patient. Multiple significant correlations were noted between the variables: (1) total number of prescriptions a patient was taking, (2) total number of medication errors identified, (3) time spent on the MTM process, and (4) total number of interventions performed by the pharmacist. Patient satisfaction was favorable for the program. Conclusion: The implementation of a pharmacist-driven MTM program for patients receiving a prescription for an oral chemotherapy agent had a significant impact on patient care by improving medication reconciliation, identifying drug-related problems, and strengthening pharmacist-patient interactions in the oncology clinic.

Biological correlates and predictors of insulin resistance among early adolescents.

Abnormal glucose metabolism is associated with obesity, insulin resistance (IR), and Type 2 diabetes mellitus. The purposes of this study were to describe anthropometric and laboratory markers of adolescents, examine correlates of IR, and test ability of anthropometric and laboratory markers to predict risk of exhibiting IR. A total of 150 early adolescents participated. Participants with obesity had increased IR, high-sensitivity C-reactive protein, triglycerides, and blood pressure. Waist circumference and triglycerides were predictive of IR. Multiple risk factors compound and lead to long-term health consequences among youth. Nurses can evaluate these factors to identify IR.

Direct oral anticoagulants and warfarin safety in rural patients with obesity.

BACKGROUND: Direct oral anticoagulants (DOACs) are often used in patients with atrial fibrillation or flutter instead of warfarin and although supporting evidence is limited, available studies suggest this may be an acceptable route of care. Our study assessed the question: are DOACs as effective and safe as warfarin in patients with atrial fibrillation and class III obesity specifically in a rural population? METHODS: A retrospective analysis was conducted by examining the first 6-12 months of therapy with a DOAC (apixaban or rivaroxaban) or warfarin in patients with weight >120kg or class III obesity. Events of interest, thrombosis and bleeding, were documented for analysis. The risk and odds of events of interest for both groups were calculated and compared. RESULTS: Characteristics of both arms were similar (DOAC n=42; warfarin n=43). A lack of thrombosis events limited efficacy analysis. A total of 22 bleeds occurred with 8 in patients prescribed a DOAC (7 minor; 1 major) and 14 in those prescribed warfarin (12 minor; 2 major). Weight in kg (p<0.001), BMI (p=0.013) and HAS-BLED score (p=0.035) were predictive of a first bleeding event in patients prescribed warfarin. The odds ratio for any type of bleed on DOAC vs warfarin was 0.55 (0.180-1.681; 95% CI). CONCLUSIONS: In patients with atrial fibrillation and class III obesity, regarding safety, DOACs appear to be non-inferior to warfarin during the first six to 12 months of therapy in our rural population - consistent with other analyses; however, the lack of thrombosis events limited the efficacy analysis.

Using Aromatherapy to Improve Nighttime Comfort in Hospitalized Patients With Cancer: A Pilot Study.

BACKGROUND: Sleep disturbances have been shown to have negative health effects leading to inferior well-being, increased fatigue, and impaired performance. For hospitalized patients receiving oncology care, improving nighttime comfort may positively affect well-being and health outcomes, leading to decreased length of stay. Aromatherapy can improve sleep quantity and quality. OBJECTIVES: This pilot study aimed to determine whether aromatherapy improves nighttime comfort, in particular well-being and sleep quality, for hospitalized patients with cancer. METHODS: This quasi-experimental pilot study with a single-arm pre-/post-test design evaluated the effects of nighttime aromatherapy for hospitalized patients with cancer. Measures were the World Health Organization-Five Well-Being Index and Pittsburgh Sleep Quality Index. FINDINGS: A total of 34 hospitalized patients with cancer participated. After aromatherapy, mean well-being scores improved significantly. Mean sleep quality scores also improved but did not reach significance. Of participants who submitted open-ended responses, 20 of 22 described a positive experience with aromatherapy, including better sleep, relaxation, soothing effects, and nausea relief.

Serum uric acid: relationships with biomarkers in adolescents and changes over 1 year.

OBJECTIVES: To (1) elucidate the range of serum uric acid (UA) levels in adolescent sample; (2) examine the relationships of serum UA and 1-year change with gender, anthropometric and cardiometabolic factors. MATERIALS AND METHODS: Measurements (anthropometrics, fasting venipuncture and blood pressure) were performed at the beginning of the seventh and eighth grades. Descriptive data, differences according to weight, correlations and changes over time were examined. FINDINGS: In 77 adolescents, BMI and serum UA had relationships with several cardiometabolic measures. Males had higher serum UA at follow-up compared to baseline; female change was minimal. Time-by-gender interaction was significant, as were the main effects of gender and BMI classification. Males had lower HDL-C at follow-up than at baseline; females had higher HDL-C at follow-up. CONCLUSIONS: Serum UA has importance in cardiometabolic examination of youth risk factors. It should be examined in youth with elevated BMI and/or hypertension. Early adolescence is the period when gender-related metabolic changes occur.