COVID-19 related messaging, beliefs, information sources, and mitigation behaviors in Virginia: a cross-sectional survey in the summer of 2020.

Background: Conflicting messages and misleading information related to the coronavirus (COVID-19) pandemic (SARS-CoV-2) have hindered mitigation efforts. It is important that trust in evidence-based public health information be maintained to effectively continue pandemic mitigation strategies. Officials, researchers, and the public can benefit from exploring how people receive information they believe and trust, and how their beliefs influence their behaviors. Methods: To gain insight and inform effective evidence-based public health messaging, we distributed an anonymous online cross-sectional survey from May to July, 2020 to Virginia residents, 18 years of age or older. Participants were surveyed about their perceptions of COVID-19, risk mitigation behaviors, messages and events they felt influenced their beliefs and behaviors, and where they obtained information that they trust. The survey also collected socio-demographic information, including gender, age, race, ethnicity, level of education, income, employment status, occupation, changes in employment due to the pandemic, political affiliation, sexual orientation, and zip code. Analyses included specific focus on the most effective behavioral measures: wearing a face mask and distancing in public. Results: Among 3,488 respondents, systematic differences were observed in information sources that people trust, events that impacted beliefs and behaviors, and how behaviors changed by socio-demographics, political identity, and geography within Virginia. Characteristics significantly associated (p < 0.025) with not wearing a mask in public included identifying as non-Hispanic white, male, Republican political identity, younger age, lower income, not trusting national science and health organizations, believing one or more non-evidence-based messages, and residing in Southwest Virginia in logistic regression. Similar, lesser in magnitude correlations, were observed for distancing in public. Conclusions: This study describes how information sources considered trustworthy vary across different populations and identities, and how these differentially correspond to beliefs and behaviors. This study can assist decision makers and the public to improve and effectively target public health messaging related to the ongoing COVID-19 pandemic and future public health challenges in Virginia and similar jurisdictions.

Trio Rounding: Perceptions of Acute Inpatient Rehabilitation Nurses and Physicians.

PURPOSE: The purpose of this study was to explore the process, benefits, and challenges of patient-centered Trio rounding in acute inpatient rehabilitation from the perspectives of nurses and physicians. DESIGN: A descriptive qualitative design was used in this study. METHODS: Focus group interviews (FGIs) involving 27 nurses and physicians were thematically analyzed using Dedoose. A descriptive survey of rounding practices was conducted. FINDINGS: Five primary themes were identified: (1) interprofessional team collaboration; (2) patient safety and quality of care; (3) communication, education, and patient/family partnering; (4) synchronicity of workflow; and (5) participants' recommendation to develop rehabilitation Trio rounding standard process. Themes were consistent with Picker's patient-centered care principles. Findings from a survey on current rounding practice done prior to the FGI reinforced participants' discussion on challenges in conducting patient-centered Trio rounding. CONCLUSIONS: Trio rounding in acute inpatient rehabilitation is a complex process challenged by asynchronous workflow and patients' therapy schedules. Nurses and physicians reported benefits outweighed challenges for Trio rounding in acute rehabilitation. CLINICAL RELEVANCE: The study provided valuable recommendations to develop acute inpatient rehabilitation Trio rounding standard process.

Identifying Holistic Nursing Research Priorities for 2023-2026.

The primary goal of holistic nursing research is to develop and expand the knowledge base of holism and healing for nursing praxis. This article provides an overview of the process used to identify the research priorities for holistic nursing research over the next 3 to 5 years. A mixed method design using Appreciative Inquiry and surveys revealed five research priorities and the holistic philosophical foundation for these priorities. Additionally, new challenges in the environment, person, health, and nursing will undoubtedly emerge, requiring nurses to discern the research needs beyond 2026. This work seeks to inspire holistic nurses to consider research related to the American Holistic Nurses Association's five key research priorities.

A Nurse-Led Implementation Science Specialist Program.

ABSTRACT: A well-known challenge in health care is integrating evidence into practice. Implementation science (IS) is a growing field that promotes the sustainable application of evidence-based practice (EBP) to clinical care. Health care organizations have an opportunity to support sustainable change by creating robust IS infrastructures that engage nurses in the clinical environment. Integrating IS into a nursing shared governance model is an ideal vehicle to empower direct care nurses to sustain EBP. Importantly, an IS infrastructure may also promote nurse retention and increase interdisciplinary collaboration. This article, the first in a series on applying IS, describes how a multisite health care organization developed a systemwide nurse-led IS Specialist program within a shared governance model.

Receptive Music Therapy for Patients Receiving Mechanical Ventilation in the Intensive Care Unit.

BACKGROUND: Live music therapy provided by a board-certified music therapist reduces anxiety, decreases pain, and improves the physiological response of patients in the intensive care unit (ICU). OBJECTIVES: To examine the effect of live music therapy on the physiological parameters and pain and agitation levels of adult ICU patients receiving mechanical ventilation. METHODS: A total of 118 patients were randomly assigned to live music therapy or standard care. The music therapy group received 30 minutes of live music therapy tailored to each patient's needs. The Richmond Agitation-Sedation Scale and the Critical Care Pain Observation Tool were completed by critical care nurses immediately before and after each session, and the patients' heart rates, respiratory rates, and oxygenation levels were measured. RESULTS: Patients who received live music therapy had significantly different scores on the Richmond Agitation-Sedation Scale (P < .001) and the Critical Care Pain Observation Tool (odds ratio, 6.02; P = .002) compared with the standard care group. Significant differences between groups were also reported in heart rate (P < .001). No significant differences were found in oxygen values. CONCLUSIONS: Live music therapy significantly reduced agitation and heart rate in adult patients receiving mechanical ventilation in the ICU. These findings provide further evidence for the benefits of music therapy in the ICU, including in intubated patients.

Virtual Focus Groups as an Answer to Research During a Pandemic: Implications for Nursing Professional Development.

Focus groups are a standard method of qualitative data collection and an excellent method for data collection in nursing professional development. Advances in technology, virtual health care, and the COVID-19 pandemic increase the opportunities to use virtual focus groups for rich data collection. In this perspective article, the authors promote virtual focus groups as an answer to challenging data collection, while exploring ways that privacy and confidentiality can be maintained in an online environment.

Development of the Perception of Opioid Use Survey Instrument.

BACKGROUND AND PURPOSE: A new instrument was designed specifically to evaluate nurses' knowledge, attitude, and practice toward patients who use opioids. This study team developed and tested the psychometric properties of the Perception of Opioid Use Survey (POUS) instrument. METHODS: The instrument was tested among 306 nurses at a 183 bed acute care community hospital, with psychometric evaluation for validity, reliability, and exploratory factor analysis. RESULTS: Internal consistency results were Cronbach's alpha = .550 for the overall scale and each subscale: Self-Efficacy = .796, Attitudes = .744, Community Impact = .806, and Causative Factors = .763. CONCLUSIONS: Psychometric testing results support that the POUS is valid, reliable, and significantly correlated with theoretically selected variables.

Selection of Screening Tool for Sleep-Disordered Breathing or Obstructive Sleep Apnea in Pediatric Patients in the Perianesthesia Setting.

PURPOSE: This study was undertaken to select an appropriate tool to predict risk of obstructive sleep apnea (OSA) among pediatric patients in the preoperative setting. DESIGN/METHODS: A retrospective chart review and a survey of nursing staff to compare two tools that were determined to be valid in assessing risk of OSA and postanesthesia complications in pediatric patients aged 6 months to 18 years was conducted. About 300 pediatric patients presenting for elective surgery were screened for OSA using STBUR (Snoring, Trouble Breathing during sleep, struggling to Breathe during Sleep, and waking UnRefreshed) and ST(1)OP-BANG (Snoring, Tonsillar hypertrophy, sleep Obstruction, BMI, Age, Neuromuscular disorders, and Genetic/congenital deformities) concurrently. Six preoperative nurses were then surveyed to compare ease of use and time to complete the screening tools. FINDINGS: The STBUR tool was found to predict complications in 37.5% patients versus 22.7% patients with the pediatric ST(1)OP-BANG. Nursing staff found that although both tools were quick and easy to use, the STBUR tool was easier for parents to answer. CONCLUSIONS: Use of a screening tool to help predict risk of OSA and postanesthetic complications also helps to dictate anesthesia technique, nursing staffing requirements, and plans of care for postoperative management of pediatric patients.

The Effect of Healing Touch on Critical Care Patients' Vital Signs: A Pilot Study.

To determine the impact of Healing Touch on vital signs, adult intensive care unit patients were recruited from multiple hospital sites. Both pain and agitation improved and there was a significant change in hemodynamics that reflected a calming effect. Healing Touch may be considered a respected addition to symptom management.

Use of Evidence-based Practice Models and Research Findings in Magnet-Designated Hospitals Across the United States: National Survey Results.

BACKGROUND: All nurses have responsibilities to enculturate evidence-based practice (EBP) and translate and implement research findings into nursing care, practices, and procedures. AIMS: To report EBP-related findings from the national Hospital-Based Nursing Research Characteristics, Care Delivery Outcomes, and Economic Impact Survey questionnaire. METHODS: In this cross-sectional survey research study of 181 nursing research leaders, 127 responded to these questions: "Has your hospital adopted or does it use a model of evidence-based practice?" "If yes, what is the name of the model and how is it used?" "Does your hospital implement (translate) findings from nursing research into clinical practice?" "Describe how your hospital implements these findings and whose responsibility it is." "What factors do you believe facilitate the implementation of findings from nursing research into clinical practice at your hospital?" Qualitative content analyses were used. RESULTS: Over 90% of nursing research leaders specified that their hospital used an EBP model and implements findings into practice. The most frequently reported models were the Iowa Model of Evidence-Based Practice, Johns Hopkins Nursing Evidence-Based Practice Model, and Advancing Research and Clinical Practice Through Close Collaboration Model. EBP models were used most frequently for education and training, nurse residency programs, and EBP and research fellowships. Findings were implemented through policy and procedure committee processes, shared governance structures, and EBP processes. Those responsible for implementing findings were project leads, nursing professional practice councils, and clinical nurse specialists and advanced practice nurses. Implementation facilitators were nursing leadership, dissemination of findings, and engaged and educated nurses. LINKING EVIDENCE TO ACTION: These new findings report >90% EBP model use and implementation. All nurses, especially our leaders, have responsibilities to evaluate EBP and how nursing research findings are implemented (translated) into practice. Ideally, engaged and educated nurses who enculturate, support, and sustain EBP will facilitate advancing nursing practice to improve patient and work environment-related outcomes.

Effects of Aromatherapy on Pain and Anxiety Scores in Adult Patients Admitted to a Community Hospital on the Medical Unit or Telemetry Unit: A Pilot Study.

The purpose of the study was to determine the impact of aromatherapy intervention on pain and anxiety. The hypothesis was that the use of aromatherapy will improve pain and anxiety scores when assessed within 30 to 60 minutes of administration. The study design was a prospective comparison of aromatherapy using a pre-/postdesign study. A convenience sample of patients was recruited from both a medical unit and a telemetry unit with patients aged 18+ years from a 182-bed acute care Magnet community hospital. Pain and anxiety levels were assessed prior to administration of a medication, within 60 minutes of receiving pain medication, and within 60 minutes of receiving aromatherapy. Ninety-six percent of the participants would use aromatherapy if offered again, would use it in the future, and would recommend its use to family and friends. Both pain and anxiety improved after the aromatherapy with a P value of <.0001. This pilot study demonstrated that aromatherapy is safe and effective at reducing pain and anxiety and should be considered as a valuable adjunct to symptom management.

Impact of an Active Music Therapy Intervention on Intensive Care Patients.

BACKGROUND: Nonpharmacological interventions appear to benefit many patients and do not have the side effects commonly associated with medications. Music-based experiences may benefit critical care patients. OBJECTIVE: To examine the effect of an active music therapy intervention on physiological parameters and self-reported pain and anxiety levels of patients in the intensive care unit. METHODS: A study was conducted using a pretest-posttest, within-subject, single-group design. The study population consisted of a convenience sample of 52 patients. Study participants received a 30-minute music therapy session consisting of either a relaxation intervention or a "song choice" intervention. The music therapist recorded the patients' vital signs before and after the intervention, and patients completed self-assessments of their pain and anxiety levels before and after the intervention. RESULTS: After the intervention, significant decreases (all P < .001) were found in respiratory rate (mean difference, 3.7 [95% CI, 2.6-4.7] breaths per minute), heart rate (5.9 [4.0-7.8] beats per minute), and self-reported pain (1.2 [0.8-1.6] points) and anxiety levels (2.7 [2.2-3.3] points). No significant change in oxygen saturation level was observed. Outcomes differed between the 2 intervention groups: patients receiving the relaxation intervention often fell asleep. CONCLUSIONS: The results of this study support active music therapy as a nonpharmacological intervention in intensive care units. This study may lay the groundwork for future research on music therapy in critical care units using larger, more diverse samples.

Survivability of Existing Peripheral Intravenous Access Following Blood Sampling in a Pediatric Population.

PURPOSE: Although pediatric patients report venipuncture as their most feared experience during hospitalization, blood sampling from peripheral intravenous accesses (PIVs) is not standard of care. Blood sampling from PIVs has long been considered by healthcare personnel to harm the access. In an effort to minimize painful procedures, pediatric nursing staff conducted a prospective, observational study to determine if blood sampling using existing PIVs resulted in the loss of the access. The ability to obtain the sample from the PIV was measured along with patient and PIV characteristics. DESIGN AND METHODS: Specimen collection using 100 existing PIVs was attempted on pediatric inpatients. Each PIV was observed for functionality, infiltration, occlusion, and dislodgement following collection and again in 4h. Frequencies of PIV loss and successful blood sampling were calculated. Patient age, PIV gauge, access site, and PIV age were evaluated for associations with successful sampling using chi-square tests, Fisher's exact tests, and logistic regression. RESULTS: PIV survivability was reported at 99%. The ability to obtain a complete specimen was reported at 76% and found to be significantly related to PIV age and site. Size of PIV and patient's age were not significantly related to successful sampling. CONCLUSIONS: Encouraging rates of PIV survivability and collectability suggest blood sampling from PIVs to be a valuable technique to minimize painful and distressful procedures. PRACTICE IMPLICATIONS: Nursing practice was changed in this pediatric department. Patients and families are saved the pain and distress of venipuncture. Nurses reported saving time and personal distress by avoiding the venipuncture procedure.

Exploration of Portal Activation by Patients in a Healthcare System.

A study of patient portal utilization was conducted at a not-for-profit healthcare system in Northern Virginia. The healthcare system serves more than 2 million people each year. The encounters with the portal included 461 700 different patients occurring between July 2014 and June 2015. Univariate analysis and multivariable logistic regression indicated associations between patient portal activation and predictive factors. Multiple findings emerged: patient portal activation was greater for English-speaking patients; differences in portal activation were observed by patient age; and patients who had an identified primary care provider were more likely to use the portal. The implications were that patients who have limited English skills and have economic challenges may be less engaged. This review demonstrates the importance of understanding the population using a patient portal and provides insight for future development on how to engage patients to interact with their providers through the portals.

Evidence-Based Practice: Video-Discharge Instructions in the Pediatric Emergency Department.

PROBLEM: While a high quality discharge from a Pediatric Emergency Department helps caregivers feel informed and prepared to care for their sick child at home, poor adherence to discharge instructions leads to unnecessary return visits, negative health outcomes, and decreased patient satisfaction. Nurses at the Inova Loudoun Pediatric ED utilized the Johns Hopkins Model of Evidence Based Practice to answer the following question: Among caregivers who have children discharged from the ED, does the addition of video discharge instructions (VDI) to standard written/verbal discharge instructions (SDI) result in improved knowledge about the child's diagnosis, treatment, illness duration, and when to seek further medical care? METHODS: A multidisciplinary team reviewed available evidence and created VDI for three common pediatric diagnoses: gastroenteritis, bronchiolitis, and fever. Knowledge assessments were collected before and after delivery of discharge instructions to caregivers for both the SDI and VDI groups. RESULTS: Analysis found that the VDI group achieved significantly higher scores on the post test survey (P < .001) than the SDI group, particularly regarding treatment and when to seek further medical care. After integrating the best evidence with clinical expertise and an effective VDI intervention, the team incorporated VDI into the discharge process. IMPLICATIONS FOR PRACTICE: VDI offer nurses an efficient, standardized method of providing enhanced discharge instructions in the ED. Future projects will examine whether VDI are effective for additional diagnoses and among caregivers for whom English is not the primary language.

Findings From a Pilot Study: Bringing Evidence-Based Practice to the Bedside.

BACKGROUND: To translate research supporting inpatient care outcomes and provide evidence-based care, registered nurses (RNs) need continuing education and mentoring support to adopt evidence-based practice (EBP). AIMS: The aim of this study was to assess a demonstration project intended to pilot and evaluate a structured EBP education with mentoring innovation for nurses in a multihospital system. METHODS: Nurses from five units in five hospitals were included in an education with mentoring innovation to implement the Johns Hopkins Nursing Evidence-Based Practice Model and the Advancing Research and Clinical practice through close Collaboration (ARCC) Model. To determine outcomes, the EBP beliefs scale (EBPB) and implementation scale (EBPI) were administered before and after the education with mentoring innovation. Eighty-three RNs completed both preintervention surveys. A total of 57 RNs completed the postintervention surveys. In addition, qualitative data were obtained from focus groups involving 24 participants. FINDINGS: Statistical analysis indicated positive movement toward EBP in project participants. Qualitative analysis revealed perceived successes and challenges involved with implementing an evidence-based program, provided logistical lessons learned, and indicated that nurses at all levels of practice require mentoring and coaching to foster EBP sustainment. LINKING EVIDENCE TO ACTION: The engagement of nurses in this project supported professional development and clinical application of evidence at the point of care. The pilot project's outcome informed a decision by health system administrators to fund more nurse driven EBP projects in the five hospitals. This innovative program provides a replicable structure for deployment and appraisal of EBP nursing model implementation.

Examination of the Use of Healing Touch by Registered Nurses in the Acute Care Setting.

Acute care nursing is currently undergoing unprecedented change, with health systems becoming more open to nonpharmacological approaches to patient care. Healing Touch (HT) may be a valuable intervention for acute care patients. Research has shown that HT helps both the patient and the caregiver; however, no study to date has examined the impact that the education of nurses in and their use of HT have on daily care delivery in the acute care setting. The purpose of the current qualitative study was to examine the use of HT by registered nurses in the acute care setting during their delivery of patient care, as well as the impact of education in and use of HT on the nurses themselves. Five themes were identified: (1) use of HT techniques, processes, and sequence; (2) outcomes related to HT; (3) integration of HT into acute care nursing practice; (4) perceptions of HT, from skepticism to openness; and (5) transformation through HT. Education in HT and delivery of this modality by nurses in the acute care setting provide nurses with a transformative tool to improve patient outcomes.

Reducing nurses' stress: A randomized controlled trial of a web-based stress management program for nurses.

BACKGROUND: Nursing is a notoriously high-stress occupation - emotionally taxing and physically draining, with a high incidence of burnout. In addition to the damaging effects of stress on nurses' health and well being, stress is also a major contributor to attrition and widespread shortages in the nursing profession. Although there exist promising in-person interventions for addressing the problem of stress among nurses, the experience of our group across multiple projects in hospitals has indicated that the schedules and workloads of nurses can pose problems for implementing in-person interventions, and that web-based interventions might be ideally suited to addressing the high levels of stress among nurses. PURPOSE: The purpose of this study was to evaluate the effectiveness of the web-based BREATHE: Stress Management for Nurses program. METHODS: The randomized controlled trial was conducted with 104 nurses in five hospitals in Virginia and one hospital in New York. The primary outcome measure was perceived nursing-related stress. Secondary measures included symptoms of distress, coping, work limitations, job satisfaction, use of substances to relieve stress, alcohol consumption, and understanding depression and anxiety. RESULTS: Program group participants experienced significantly greater reductions than the control group on the full Nursing Stress Scale, and six of the seven subscales. No other significant results were found. Moderator analysis found that nurses with greater experience benefitted more. CONCLUSION: Using a web-based program holds tremendous promise for providing nurses with the tools they need to address nursing related stress.

The effects of healing touch on pain, nausea, and anxiety following bariatric surgery: a pilot study.

CONTEXT: Given the growth in the number of bariatric surgeries, it is important for healthcare practitioners to maximize symptom management for these patients, including the option of complementary therapies such as Healing Touch. OBJECTIVE: A quasi-experimental study was conducted to determine the feasibility of a Healing Touch intervention for reducing pain, nausea, and anxiety in patients undergoing laparoscopic bariatric surgery. DESIGN: Following surgery, a nurse administered the Healing Touch intervention once daily. Study participants reported levels of pain, nausea, and anxiety immediately before and after the Healing Touch intervention using separate numeric rating scales. RESULTS: Significant decreases in pain, nausea, and anxiety were observed immediately following the intervention on post-operative days one and two, and in pain and anxiety on post-operative day three compared with pre-intervention levels. These findings indicate that the Healing Touch intervention is feasible and acceptable to patients undergoing bariatric surgery, and significantly improved pain, nausea, and anxiety in these patients.

Promoting caring-healing relationships: bringing healing touch to the bedside in a multihospital health system.

New legislative mandates, evaluation metrics, and patient demand have led acute care organizations to expand their patient-centered care model to include the use of complementary therapies. One multihospital health system is offering Healing Touch training to nurses who will provide Healing Touch to self, colleagues, and patients, promoting a caring-healing consciousness.