Transitioning Florida NPs to opioid prescribing.

Prior to statutory changes in prescriptive authority for controlled substances, this study examined the knowledge gaps and prescribing limitations of Florida advanced registered nurse practitioners regarding opioids. Study results revealed statistically significant knowledge gaps in the areas of federal and state guidelines; opioid classes and proper doses; risk assessment skills; monitoring of treatment; and confidence in dealing with challenges of opioid prescribing.

Predictors of depression in outpatients with heart failure: An observational study.

BACKGROUND: Depression is a common comorbidity of heart failure. Little is known about the influence of heart failure symptomatology and coping resources, such as social support and social problem-solving, on depression. OBJECTIVE: To examine whether individual and clinical characteristics, heart failure symptomatology, and the subcomponents of social support and social problem-solving increase the likelihood of depression in outpatients with heart failure. METHODS: A secondary data analysis of a cross sectional study with 201 outpatients with heart failure was conducted. The following self-report questionnaires were used to collect data: the Heart Failure Symptom Survey, the Interpersonal Support Evaluation List-12, the Graven and Grant Social Network Survey, the Social Problem-Solving Inventory Revised-Short, and the Center for Epidemiological Studies - Depression scale. Descriptive statistics examined patient characteristics. Logistic regression explored predictors of depression from among individual and clinical characteristics, heart failure symptomatology, and subcomponents of social support (i.e., belonging, tangible, and appraisal support) and social problem-solving (i.e., positive and negative problem orientation; rational, impulsiveness/carelessness, and avoidance problem-solving styles). RESULTS: The sample was primarily Caucasian (86.1%) male (62.6%) with an average age of 72.57 years. Individuals who were unmarried, experienced a higher symptom burden, and those who perceived less belonging support were more likely to be depressed. The subcomponents of social problem-solving did not influence depression. CONCLUSIONS: Belonging support was the most beneficial type of social support related to depression. Components of social problem-solving were not related to depression. Assessment of marital status, heart failure symptomatology, and perceived belonging support is needed to identify potential stressors and available social support in order to promote psychological adaptation.

Identifying Health Consumers' eHealth Literacy to Decrease Disparities in Accessing eHealth Information.

The increasing amount of health information available on the Internet highlights the importance of eHealth literacy skills for health consumers. Low eHealth literacy results in disparities in health consumers' ability to access and use eHealth information. The purpose of this study was to assess the perceived eHealth literacy of a general health consumer population so that healthcare professionals can effectively address skills gaps in health consumers' ability to access and use high-quality online health information. Participants were recruited from three public library branches in a Northeast Florida community. The eHealth Literacy Scale was used. The majority of participants (n = 108) reported they knew how and where to find health information and how to use it to make health decisions; knowledge of what health resources were available and confidence in the ability to distinguish high- from low-quality information were considerably less. The findings suggest the need for eHealth education and support to health consumers from healthcare professionals, in particular, how to access and evaluate the quality of health information.

Symptomatology and Coping Resources Predict Self-Care Behaviors in Middle to Older Age Patients with Heart Failure.

Background. Symptoms of heart failure (HF) and coping resources, such as social support and social problem-solving, may influence self-care behaviors. Research regarding the influence of HF symptomatology characteristics and components of social support and social problem-solving on self-care is limited. Objective. To identify predictors of HF self-care behaviors using characteristics of HF symptomatology, components of social support and social problem-solving, and demographic and clinical factors. Methods. Using a cross-sectional, correlational predictive design, a convenience sample (N = 201) of outpatients with HF answered self-report surveys. Multiple linear regression with stepwise variable selection was conducted. Results. Six predictors of HF self-care were identified: race, symptom frequency, symptom-related interference with enjoyment of life, New York Heart Association Class HF, rational problem-solving style, and social network (ß = 34.265, R (2) = 0.19, P = 0.001). Conclusions. Assessing the influence of race on self-care behaviors in middle to older age patients with HF is important. Clinical assessment that focuses on symptom frequency, symptom-related interference with enjoyment of life, and HF Class might also impact self-care behaviors in this population. Rational problem-solving skills used and evaluation of the size of and satisfaction with one's social network may be appropriate when assessing self-care.

Mitigating procedural pain during venipuncture in a pediatric population: A randomized factorial study.

BACKGROUND: Evidence suggests that a significant number of children receive less than optimal management of procedure-related pain. OBJECTIVES: To determine if there was a difference in the perceived pain associated with a venipuncture procedure in a group of pediatric patients based on the preparatory intervention used during the procedure and, to determine if age, sex, or ethnic group were associated with the effectiveness of the preparatory interventions used. DESIGN: A quasi-experimental, 3×4 factorial design was used. SETTING: Participants were recruited from a non-profit, regional hospital in the southeast United States. PARTICIPANTS: Participants were recruited from children between the ages of 18 months and 17 years who were admitted to the facility. Criteria for inclusion was the first needle stick during admission with a parent or guardian present, English as the primary language. Potential participants were excluded if they had previous experience with any of the preparatory interventions, were sedated, unconscious, hemodynamically unstable, developmentally delayed for their age, or had a known chronic condition. Of the 285 participants consented to participate, 173 children completed the process including 35 (20.2%) toddlers, 34(19.7%) preschool and 65 (37.6%) school age children, and 39 (22.5%) adolescents. There were 77 (44.5%) females and 96 (55.5%) males; and 101 (58.4%) non-Hispanic white children and 72 (41.6%) minority children. METHODS: Children were randomized to one of three treatment interventions. There was a purposeful effort to include representative numbers of each age group, ethnic group, and sex and in each treatment group. Measures of pain before and after the procedure included an observational measure completed by the parent/guardian and a self-report measure completed by the two older age groups. FINDINGS: There were no statistically significant differences among treatment groups based on the observational measures of pain or the self-report measures of pain. There was a statistically significant interaction between ethnic group and treatment group (p=0.006) based on the observational measure of pain which was also found between ethnic group and treatment group (p=.04) based on self-report scores in school age children and adolescents. CONCLUSION: Findings support the use of both mechanical vibration and topical anesthetic as effective in children regardless of age group or sex. Further, the interaction between ethnic group and treatment contributes to a growing body of knowledge that suggests ethnic group is an important factor in the pain response and requires further study in an effort to better customize approaches to pain management in children.

Disruptive behavior within the workplace.

INTRODUCTION: The aim of this study was to determine the incidence of disruptive behavior among nurses in the healthcare workplace, the details that are associated with its occurrence, and the organizational procedures utilized when disruptive incidents occur. BACKGROUND: Healthcare workers have a higher risk of experiencing disruptive behavior among staff in the workplace compared to other industries, and nurses are more susceptible than other healthcare workers. METHOD: A quantitative, descriptive, survey design asked nurses if they had experienced disruptive behavior within the past 12 months and how this was handled by their organization. Disruptive behavior included any type of verbal abuse, electronic or e-mail abuse, or physical abuse within the work environment. RESULTS: There were 2,821 participants that validated the occurrence of verbal, electronic, and physical disruptive behavior, and the majority rated their overall work environment to be at high risk of experiencing disruptive behavior at least once every 6 months. DISCUSSION: Twenty-four statistically significant relationships were found with strongest associations (<0.001) between: age and electronic abuse; position and verbal abuse; position and physical abuse; years of experience and electronic abuse; susceptibility of the organization to workplace violence and position as well as education; missing work due to disruptive behavior and position; and feeling comfortable reporting the abuse and position as well as education. CONCLUSION: It is evident that disruptive behavior exists verbally, electronically, and physically, and that the overall work environment is felt to be at high risk of experiencing repeated disruptive behavior.