Factors Affecting Perioperative Nurse Adherence to Ergonomic Safety Measures.

AORN has identified safety risks unique to the perioperative setting and has developed ergonomic safety measures to help prevent musculoskeletal injuries and disorders. Little is known about adherence to these safety measures or the perceived barriers and facilitators to adherence. This study used a cross-sectional survey to determine the prevalence of pain and occurrence of musculoskeletal injuries and disorders. We asked perioperative staff members about their perceived barriers and facilitators to adherence with safety measures. A total of 155 perioperative nurses in one health system completed the online survey (55% response rate). Most (93%) had experienced at least one musculoskeletal injury or disorder or related pain. Years worked as a perioperative nurse and having neck pain were associated with safety measure adherence. The most reported barrier to safety measure adherence was inadequate staffing. Study findings highlight the need for increased attention to the physical workload demands in the perioperative setting.

Identifying barriers and facilitators to seeking care for symptoms of bacterial sepsis: A qualitative study.

AIM: Research suggests that early access to quality care is essential to improving bacteraemia outcomes and reducing the risk of developing sepsis because it allows for early intervention. Currently, there are limited data regarding the facilitators and barriers that alter the trajectory of arrival at the hospital when patients in the United States experience symptoms of bacteraemia and sepsis. This study sought to explore and describe the facilitators and barriers to seeking care for suspected bacteraemia and sepsis symptoms. DESIGN: A qualitative descriptive study. METHODS: Ten men and women were recruited using convenience sampling. The study used audio-recorded semi-structured interviews and the collection of socio-demographic data as the data collection techniques. Thematic analysis was used, including inductive and deductive approaches, to analyse the data. RESULTS: During data analysis, the codes related to barriers and facilitators were collapsed into three themes-symptom recognition, psychosocial support and healthcare planning and coordination. PATIENT CONTRIBUTION: The patients' participation in the study has contributed to our understanding of patients' perspectives and experiences in the pre-hospital phase and provides important insights into what barriers and facilitators are encountered. Study findings highlight the need to develop interventions to improve patient decision time, patient-provider interactions and knowledge of bacteraemia and sepsis through patient and provider education.

At Risk Safety Behaviors of the Perioperative Nursing Team: A Direct Observational Study.

BACKGROUND: The operating room setting has unique workforce hazards and extremely high ergonomic demands due to patient lifting/positioning requirements, long periods of standing, and the heavy equipment and supplies that are needed for surgical procedures. Despite worker safety policies, injuries among registered nurses are increasing. Most of the research on the ergonomic safety of nurses is conducted utilizing survey methodology, which may not provide accurate data. It is imperative to understand the at-risk safety behaviors that perioperative nurses face if we are to design interventions to prevent injury. METHODS: Two perioperative nurses were directly observed during 60 different operating room surgical procedures (n = 120 different nurses). Data were collected utilizing the job safety behavioral observation process (JBSO), which is designed specifically for the operating room environment. RESULTS: There were 82 total at-risk behaviors observed amongst the 120 perioperative nurses. More specifically, 13 (11%) of the surgical procedures had at least one perioperative nurse observed in a position of at-risk behavior, and a total of 15 (12.5%) individual perioperative nurses performed at least one at-risk behavior. CONCLUSION: More attention must be placed on the safety of the perioperative nurse if we are to retain a healthy, productive workforce to provide the highest quality patient care.

Exploration of pre-hospital patient delays in seeking care for symptoms of bacteremia and sepsis: A qualitative study.

AIM: We explored patient pre-hospital delays in seeking care for symptoms of bacteremia and sepsis. DESIGN: A qualitative descriptive study. METHODS: In January 2021, we recruited a convenience sample of four men and six women who were former patients diagnosed with bacteremia. We conducted semi-structured interviews by telephone. The tape-recorded interviews were transcribed, coded and analysed using the Common-Sense Model of Self-Regulation. Data analysis continued until May 2021. RESULTS: The three main themes included: gathering threads of information, weaving together the threads of information and impact and outcome of the illness. The main finding revealed was that an inability to recognize symptoms of bacteremia resulted in delayed help-seeking. Participants had difficulty recognizing their symptoms as being related to bacteremia when they lacked experience with infection or could not differentiate them from symptoms of other chronic co-morbid conditions. Recognizing symptoms and searching for their meaning was an early step in developing an action plan for seeking care. Patient-reported physical and psychological outcomes of the infection on their quality of life (QOL) varied widely, from none to major impact.

Nurses' Knowledge Regarding Nursing Surveillance of the Septic Patient.

PURPOSE: Sepsis remains a life-threatening condition and leading cause of death in the United States despite vast efforts to understand and treat it. Successful sepsis treatment requires the timely implementation of the sepsis bundle to avoid multiple organ system failure; a key component of sepsis care is nursing surveillance. The purpose of this study was to explore nurses' knowledge of nursing surveillance related to the patient with sepsis and to describe barriers to the implementation of nursing surveillance for sepsis and the sepsis bundle. DESIGN: A qualitative descriptive design study used focus groups to elicit responses to open-ended questions. METHODS: Focus group interviews with 28 registered nurses were conducted. All focus group participants had a minimum of 6 months' experience caring for patients with sepsis. RESULTS: Five themes emerged from the study: (1) knowledge deficit of the sepsis bundle and nursing surveillance, (2) uncertain and overwhelmed, (3) lack of resources, (4) in the dark, and (5) lack of partnership/respect. The notion of fearing the patient with sepsis and knowledge deficits of nursing surveillance and sepsis bundle were unique findings. CONCLUSIONS: Findings highlight the need for increased attention on the importance of nurse surveillance of the patient with sepsis.

The opioid epidemic and the impact on opioid prescribing in hospice and palliative care: a qualitative study.

BACKGROUND: In the US, rising rates of opioid abuse has led to regulatory policies designed to curb opioid prescribing. While these policies generally exclude hospice and palliative care from prescribing restrictions, it is not known if these policies have had unintended consequences that affect opioid prescribing within hospice and palliative care. METHODS: A qualitative, descriptive design, guided by the Theory of Planned Behaviour, was utilised to conduct a study to answer the following two research questions: 1) How has the opioid epidemic and related policies affected opioid prescribing practises among hospice and palliative care clinicians? and 2) How do hospice and palliative care clinicians perceive patients' end-of-life care has been impacted by the opioid epidemic and related policies? FINDINGS: Ten clinicians, comprising physicians and nurse practitioners working in hospice and palliative care settings, were directly interviewed one-on-one. Data analysis revealed that the opioid epidemic and related policies have had an impact on the patient, clinician, nursing and hospice and palliative care speciality. CONCLUSIONS: As the broader medical community shifts away from opioid prescribing, care must be taken to ensure that hospice and palliative care patients still receive access to needed medications. Education is needed to assure that the relief of human suffering at end of life is prioritised.

First-Time Mothers' Invisible Presence Using Social Networking Sites.

PURPOSE: To describe first-time mothers' experiences with online social networking sites in the early postpartum period, explore how mothers use them to gain support, and to evaluate how their use can aid or hinder maternal role transition. STUDY DESIGN: Qualitative descriptive study. METHODS: This qualitative descriptive study, using convenience and snowball sampling, first-time mothers in the early postpartum period were recruited through social media. Semistructured interviews were conducted virtually where mothers were asked to describe their experiences with online social networking. Thematic analysis methods were used to develop themes from participant interviews. RESULTS: Twelve first-time mothers ranging from 4 to 12 weeks postpartum participated in the study. Thematic analysis revealed four themes: 1) Habits of first-time mom using social networking sites, 2) New purpose online, 3) Taking it to the moms, and 4) Impact on motherhood. CLINICAL IMPLICATIONS: Maternal child nurses have opportunities to further customize support for first-time mothers online. Awareness of habits, trends, implications of early mothering during COVID-19, and the role social networking sites can play in supporting mothers in the early postpartum period offers new ways for nurses to support and empower the motherhood collective.

The Experiences of African American Male Caregivers.

Aging of the population has led to an increasing number of caregivers. While research has been conducted on caregiver experiences, less is known about the experiences of African American males in the U.S. This qualitative descriptive study describes the experiences of 13 African American men who acted as caregivers to adult chronically ill or debilitated loved ones, the majority of whom provided care during the COVID-19 pandemic. The revised Sociocultural Stress and Coping Model (R-SSCM) guided this study. Individual interviews were conducted via the Zoom application. Content analysis revealed four themes: (1) "My time to take the reins", (2) "It's a male thang", (3) "Caring amid a pandemic", and (4) "Effects of the caregiver's journey". This study's findings in relation to the literature provide overdue attention to the African American male caregiving experience, especially in relation to the COVID-19 pandemic. The implications of our findings include the need for more culturally congruent support services for African American male caregivers, as well as increased efforts to encourage trust in the healthcare system-especially in relation to vaccination for the SARS-CoV-2 virus.

Can Nurses Self-Assess Fatigue?: Implications for Nurse Leaders.

OBJECTIVE: The aims of this study were to describe nurses' self-perceptions of fatigue and to examine nurses' acceptance of specific fatigue countermeasures. BACKGROUND: The work of nurses places them at a high risk of fatigue. Evidence suggests 75% to 80% of nurses in the United States experience high levels of fatigue. METHODS: This descriptive, cross-sectional correlational study surveyed 279 nurses. RESULTS: Results suggest that almost half of nurses (46%) are not able to accurately self-assess fatigue. Nurses expressed acceptance of several workplace fatigue reduction strategies. CONCLUSIONS: It may be unrealistic to expect nurses to self-assess fatigue levels and make decisions about their ability to safely provide patient care. Reliable methods for assessing fatigue in the workplace are needed. Several strategies exist that may be used to alleviate fatigue, and many were acceptable to nurses. Nurse leaders are well positioned to implement changes that impact the occurrence of nurse fatigue and thereby the quality of patient care.

Opioid epidemic and prescribing in hospice and palliative care: a review of the literature.

BACKGROUND: Rising rates of opioid abuse worldwide have led to the implementation of policies to curb opioid prescribing. It is unknown what impact these policies have on prescribing within the setting of hospice and palliative care. OBJECTIVES: To determine the current state of the science of opioid prescribing in hospice and palliative care in relation to the opioid epidemic and associated policies. METHODS: A systematic integrative literature review was conducted using the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest Central and SCOPUS. RESULTS: Most of the existing literature examines physician perspectives related to opioid prescribing in primary care settings. Ample evidence exists that policies can and do affect rates of opioid prescribing in specialties outside of hospice and palliative care. There is limited evidence to suggest how these policies affect opioid prescribing in hospice and palliative care. However, the available evidence suggests that opioids are necessary in hospice and palliative care in order to manage pain. CONCLUSION: Further research is necessary to examine the possible negative impact of the opioid epidemic on opioid prescribing in hospice and palliative care.

Ergonomic Challenges in the Perioperative Setting.

Working in health care can be physically stressful. The perioperative setting, which is largely concealed from other health care workers and the general public, places unique physical demands on its workers. Perioperative personnel are responsible for a variety of physical tasks, including moving and positioning patients, holding extremities, and moving equipment and supplies. As the nursing workforce ages, the physical demands of the perioperative environment may affect the development of musculoskeletal disorders in older nurses. The purpose of this article is to review published research and describe the ergonomic challenges of working in the OR. There currently is a paucity of literature on the effects of ergonomic risk factors on perioperative nurses in the United States. This article also provides some recommendations for perioperative staff members and leaders that may assist them with creating and maintaining a healthy and safe work environment.

The Pursuit of Nurse Practitioner Practice Legislation: A Case Study.

Across the United States, nursing practice acts (NPAs) have been revised to include provisions that promote full practice authority (FPA) for nurse practitioners (NPs). Such revisions provide a mechanism to better utilize the full scope of NP services to address growing demands for access to health care. Modernized NPAs that facilitate FPA for NPs are imperative, especially now with the unprecedented health care crisis that the world now faces: Coronavirus Disease 2019. This is the first known study to use an embedded single-case study design, guided by the Kingdon policy stream model, to provide a detailed account of how stakeholders for NP FPA determine the appropriate time to pursue legislative changes to NP scope of practice regulations. Qualitative data analysis revealed four themes which comprised the components considered by stakeholders during their decision-making processes related to NP FPA: participants, problem, policy development, and politics. Themes were further collapsed within concepts from the Kingdon model to form the case description. Study findings can be used to increase the competency among NP FPA stakeholders in determining the timing of legislative pursuits for regulatory change.

Associations of Lifestyle Intervention Effect with Blood Pressure and Physical Activity among Community-Dwelling Older Americans with Hypertension in Southern California.

A healthy lifestyle and regular physical activity are highly recommended for older adults. However, there has been limited research into testing lifestyle intervention effects on physical activity in older adults with hypertension. The purpose of this study was to assess the association of lifestyle intervention effects with physical activity and blood pressure in older adults with hypertension, accounting for social support and perceived stress as control variables. This study performed a secondary analysis of a two-arm randomized controlled trial. A total of 196 participants were randomly assigned to a six-month lifestyle intervention group or a control group. Hierarchical multiple regression analyses demonstrated that lifestyle intervention effects were not significantly associated with improvements in physical activity and blood pressure, but the final regression models were statistically significant (all p < 0.001). The result revealed that only physical activity frequency at baseline was significantly related to improvement in physical activity. Systolic blood pressure (SBP) at baseline and monthly income were significantly associated with change in SBP, while age and diastolic blood pressure (DBP) at baseline were significantly related to change in DBP. The findings provide empirical evidence for developing and optimizing lifestyle interventions for future research and clinical practice in this population.

Systemic assessment of depressive symptoms among registered nurses: A new situation-specific theory.

BACKGROUND: A mentally-healthy nursing workforce is vital to providing quality healthcare. While there has been research conducted internationally on depressive symptoms in nurses, most studies have lacked a theoretical framework. PURPOSE: The purpose of this article is to describe the development of a situation-specific theory, the Systemic Assessment of Depressive Symptoms among Registered Nurses (SAD-RN). METHODS: The SAD-RN was developed through theory synthesis using the Roy's Adaptation Model (RAM) as a framework. Sixty-four research articles were selected to abstract relevant concepts based on a priori RAM concepts. FINDINGS: Using depressive symptoms as the anchor concept, related emergent concepts of SAD-RN include context, stressors, protective factors, negative health outcomes, and low patient care quality. DISCUSSION: SAD-RN is an evidence-based comprehensive model that offers researchers a guiding theory to be used in their future research on depressive symptoms among RNs.

Effect of a Lifestyle-Based Intervention on Health-Related Quality of Life in Older Adults with Hypertension.

The purpose of this study was to examine the effect of a six-month lifestyle-based intervention on health-related quality of life (HRQOL) in older adults with hypertension. A secondary analysis of a randomized controlled trial was conducted to test the differences between the intervention and control groups on HRQOL (N=196). The results indicated that there were no statistically significant differences between the intervention and control groups on change in HRQOL, but the final regression models were statistically significant. SF-36 mental component summary (MCS) score at baseline, stress at baseline, and change in stress were significant predictors for predicting change in the SF-36 MCS. SF-36 physical component summary (PCS) at baseline and change in stress were significant predictors for predicting change in the SF-36 PCS. The findings suggest that the development of an effective intervention in improving HRQOL should be considered within individual, interpersonal, societal, and cultural factors for future research and clinical practice.

Does a Doctor of Nursing Practice Degree Provide Preparation for Assuming a Magnet Program Director Role?

One of the blueprints used by health care organizations for attaining and sustaining nursing excellence is the American Nurses' Credentialing Center's (ANCC) Magnet designation. The ANCC requires organizations to identify a Magnet program director (MPD), who serves as the contact and communication point through the process of application, designation, and maintenance of the credential. The MPD role is complex, has a wide variety of necessary skills and competencies, and can be challenging and overwhelming to undertake. Literature reveals no guidelines nor recommendations regarding educational preparation for assuming the role. Chief nursing officers (CNOs) support "program director" as a potential employment option for doctor of nursing practice (DNP) graduates. Given the complexity of the MPD, would DNP education provide elements that would help new MPDs prepare for the position? The purpose of this project was to determine if MPDs recommend concepts within DNP program Essentials as preparation for their roles. A mixed methods design was used, with qualitative data obtained from a focus group and quantitative, nonexperimental data obtained through a cross-sectional survey. Data were collected from current MPDs. The concepts of DNP Essentials presented in the survey were all recommended as preparation for the MPD role, making DNP education a relevant option.

Fibromyalgia, Fibro Fog, and Exercise.

Fibro fog causes serious problems for those with fibromyalgia syndrome. The mechanisms that cause it have not been well identified. Since prescription medication and other conventional medical interventions have proven less than satisfactory, and while waiting for more investigational information, research suggests that exercise might be helpful.

Assuring Quality Health Care in the Emergency Department.

The provision of quality healthcare is an international mandate. The provision of quality healthcare for mental health patients poses unique challenges. Nowhere is this challenge greater than in the emergency department. The purpose of this manuscript is to describe evidence-based initiatives for improving the quality of care of mental health patients in the emergency department. Specifically, the use of telepsychiatry and reducing provider biases will be presented.

Differences in health, productivity and quality of care in younger and older nurses.

AIM: To determine if younger and older hospital employed nurses have differences in their self-reported health, health related productivity and quality of care. BACKGROUND: An understanding of age cohort differences may assist nurse managers in understanding the health related productivity and potential quality of care concerns of their staff. METHOD: A cross-sectional survey design was utilised. There were 1171 usable surveys returned (47% response rate). Nurses over the age of 50 made up 26% of the respondents. RESULT: Older nurses had a higher body mass index (BMI), higher mental well-being, higher pain scores, a 12% higher prevalence of having health problems, and reported a higher health related productivity loss than younger nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers must determine if their older nurses are being given more difficult, complex patients because of their experience. Perhaps older nurses, especially those with health problems, need assignments that require their assessment and critical thinking skills rather than their strength and physical abilities.