Twitter, Millennials, and Nursing Education Research.

AIM: This article reports the use of Twitter as an intervention delivery method in a multisite experimental nursing research study. BACKGROUND: A form of social networking, Twitter is considered a useful means of communication, particularly with millennials. This method was chosen based on current literature exploring the characteristics of millennial students. METHOD: Ahern's Model of Adolescent Resilience served as the theoretical framework. Participants were 70 junior-level baccalaureate nursing students, ages 19-23, at two state-supported universities. RESULTS: Twitter was found to be a convenient, cost-effective, and enjoyable means of intervention delivery for the researcher. Participants in the experimental and control groups expressed positive feelings about the use of Twitter. CONCLUSION: The findings contribute to future efforts to use social media in nursing research and education to increase faculty-student engagement, promote critical reflection, provide social support, reinforce course content, and increase the sense of community.

Increasing nursing treatment for pediatric procedural pain.

Procedural pain management is an underused practice in children. Despite the availability of efficacious treatments, many nurses do not provide adequate analgesia for painful interventions. Complementary therapies and nonpharmacologic interventions are additionally essential to managing pain. Owing to the increasing awareness of inadequate nursing utilization of pharmacologic measures for procedural pain, this paper focuses only on analgesic treatments. The aim of this review was to examine how varying degrees of quality improvement affect nursing utilization of treatments for routine pediatric procedural pain. A comprehensive search of databases including Cinahl, Medline/Pubmed, Web of Science, Google Scholar, Psycinfo, and Cochrane Library was performed. Sixty-two peer-reviewed research articles were examined. Ten articles focusing on quality improvement in pediatric pain management published in English from 2001 to 2011 were included. Three themes emerged: 1) increasing nursing knowledge; 2) nursing empowerment; and 3) protocol implementation. Research critique was completed with the use of guidelines and recommendations from Creswell (2009) and Garrard (2011). The literature reveals that nurses still think that pediatric pain management is essential. Quality improvement increases nursing utilization of procedural pain treatments. Although increasing nursing knowledge improves pediatric pain management, it appears that nursing empowerment and protocol implementation increase nursing compliance more than just education alone. Nurses providing pain management can enhance their individual practice with quality improvement measures that may increase nursing adherence to institutional and nationally recommended pediatric procedural pain management guidelines.

Two suspected cases of immunoglobulin-mediated interference causing falsely low vancomycin concentrations with the Beckman PETINIA method.

OBJECTIVE: To describe 2 recent cases of suspected immunoglobulin-mediated interference with the Beckman Coulter particle-enhanced turbidimetric inhibition immunoassay (PETINIA) used to measure vancomycin serum or plasma concentrations and to review the existing literature. CASE SUMMARY: A 64-year-old woman with a history of multiple immune-related comorbidities received vancomycin for treatment of a prosthetic joint infection growing coagulase-negative Staphylococcus spp. A 33-year-old man with a history of Felty syndrome received vancomycin for the treatment of methicillin-resistant Staphylococcus aureus pneumonia. Both patients had multiple vancomycin trough concentrations determined using the Beckman Coulter PETINIA method and had measured concentrations reported as less than 4 mg/L despite appropriate vancomycin dosing for their size, age, and organ function. The patients' serum was then tested by alternative methods, which reported vancomycin concentrations consistent with those expected with the patients' dosing regimens. DISCUSSION: Immunoglobulins are well known for interfering with chemistry assays. It is suspected that high levels of immunoglobulins in these 2 patients interfered with the accurate measurement of serum vancomycin concentrations. An objective causality assessment supported the interactions as being definite and probable, respectively. Two other cases of suspected immunoglobulin interference with vancomycin measurement have been reported in the literature when vancomycin concentrations were initially measured using the Beckman Coulter PETINIA method. In vitro studies support the hypothesis that immunoglobulin interference with vancomycin measurement by this method occurs and is a graded phenomenon. CONCLUSIONS: These cases suggest a high likelihood of immunoglobulin-mediated interference with the Beckman Coulter PETINIA method, which results in the reporting of falsely low vancomycin serum concentrations. When vancomycin concentrations do not correlate with what would be expected clinically, clinicians should have a high index of suspicion for potential assay interference.

Childhood sibling and peer relationships of perpetrators of child sexual abuse.

Maltreatment by parents inhibits a child's ability to form relationships with other children. Given that many sex offenders experienced parental abuse, investigation of their relationships with siblings and peers could provide new directions for early childhood interventions. Interview transcripts of 23 community-dwelling perpetrators of sexual abuse against children were examined in this secondary data analysis. Ages of participants ranged from 20s to 70s, and education ranged from GED to PhD. Phenomenological analysis revealed that neither sibling nor peer relationships adequately promoted participants' capacity for developing and maintaining healthy relationships in adulthood. Until societal preventive actions and early clinical interventions are more successful, the crime of child sexual abuse will continue to be far too common.

Empathic anger in junior nursing students.

The ideal clinical experience fosters development of psychomotor, cognitive, and affective skills while affording initial socialization into the profession. It is expected that during these experiences, nursing students will encounter illustrative exemplars of caring and professional values. The primary stressors during initial clinical experiences arise from issues related to performance and socialization. Nursing students view a good relationship with the RNs at the clinical site as the most crucial influence on their professional growth and development. Even more distressing to students than being treated poorly themselves is watching patients receive uncaring treatment. Students' sadness and anger provoked by perceived uncaring treatment blends to form empathic distress. A content analysis of an assigned narrative from junior nursing students explores empathic anger experienced by the students during their initial clinical rotations.

Social context of rural Women with HIV/AIDS.

The South has more AIDS cases than any other region of the US, with most new diagnoses among African American women (56%). In a previous study, a peer counseling intervention for rural women with HIV/AIDS was developed and tested. The purpose of this analysis was to describe, from the peer counselors' perspective, the predominant concerns of the women, contextualized by living in isolated, impoverished circumstances in the rural Deep South. Following home visits, peer counselors recorded a description of the encounter. A multidisciplinary qualitative research group extracted, coded, and thematized the chief concerns and context of the women's lives. Findings provide a vivid portrait of HIV-infected women experiencing deeply troubling psychological and physiological symptoms of HIV/AIDS against the contextual ground of poverty and isolation. Themes include: (1) struggle/effort; (2) stigma/hiding; (3) loss/depression; and (4) independence/ dependence. These women lived in extremely difficult life circumstances that reflected not only a devastating chronic illness, but a life of poverty and abuse. Appropriate care for HIV-infected women living in the rural Deep South will need to address the whole context of their lives.

Cranial electrotherapy stimulation for the treatment of depression.

More prevalent in women than men, clinical depression affects approximately 15 million American adults in a given year. Psychopharmaceutical therapy accompanied by psychotherapy and wellness interventions (e.g., nutrition, exercise, counseling) is effective in 80% of diagnosed cases. A lesser known adjunctive therapy is that of cranial electrotherapy stimulation (CES). The major hypothesis for the use of CES in depression is that it may reset the brain to pre-stress homeostasis levels. It is conjectured that the pulsed electrical currents emitted by cranial electrical stimulators affect changes in the limbic system, the reticular activating system, and/or the hypothalamus that result in neurotransmitter secretion and downstream hormone production. While evidence is good for applied research, basic research about the mechanisms of action for CES remains in its infancy. A review of the literature provides an overview of current research findings and implications for clinical mental health practice.

Clinical Pharmacist Services on Admission to a Large Correctional Center.

The clinical role of pharmacists in a correctional facility has not been fully described. We report the proportion of patients assessed by a pharmacist within 48 hours of admission to a large correctional facility. Of those assessed, the frequency and type of pharmacist interventions were described. A retrospective chart review was conducted for patients admitted to the Edmonton Remand Center (ERC) from September to November 2017. From 1,500 patients, 518 (34.5%) were assessed by a pharmacist, and 511 (98.6%) of those received one or more pharmacist interventions. Interventions were most commonly health care provider interactions (89.0%) and drug therapy interventions (76.1%). ERC pharmacists assessed a sizable proportion of admitted patients, with most receiving at least one pharmacist intervention.

Clinical Pharmacists in Correctional Facilities: A Literature Review and Future Directions.

The role of pharmacists has undergone a significant transformation. Expanding clinical roles in the community and hospital settings have led to opportunity for correctional facility pharmacists to expand their practice. This literature review identifies past and present roles of correctional pharmacists, along with areas for growth. Peer-reviewed and gray literature is described, outlining current and expanding pharmacist roles from 1997 to 2017. The literature reveals that health care provided in correctional facilities is shifting from a basic level of care to a greater role in inmate health and identifies the challenges and barriers that pharmacists meet. There is strong evidence to support the expanding role of pharmacists as primary care providers in the corrections setting through activities such as direct patient care, health care clinics, and medication management.

Deferred empathy: a construct with implications for the mental health of older adults.

Deferred empathy occurs when an experience provokes a memory that after reflection allows people to say, "Now I understand." Heretofore, the concept was explored only in quantitative research; therefore, the purpose of this phenomenological study was to elicit a more detailed description of the construct of deferred empathy. For most of the participants (n = 20) triggering events involved personal challenges such as loss, loss of control, or interpersonal conflict that reminded them of, and changed, their perception of earlier relationships. Development of empathy involved reflection on past and present events, making choices, changing expectations, and learning acceptance. The process resulted in appreciative understanding of others as well as personal benefits. Findings have implications for mental health promotion in older adults in which life review promotes gerotranscendence.

Independent prescribing by hospital pharmacists: Patterns and practices in a Canadian province.

PURPOSE: Results of a survey to determine the frequency of prescribing by Canadian hospital pharmacists with independent prescribing authority are reported. METHODS: A Web-based questionnaire was used to collect data on the prescribing activities of a designated group of hospital-affiliated pharmacists in the province of Alberta who had been granted "additional prescribing authorization" (APA) through a peer-review process and were providing clinical pharmacy services in inpatient and/or outpatient settings at the time of the survey (January-March 2014). Descriptive statistics and logistic regression analysis were used to determine the median weekly frequency of prescribing, factors associated with increased use of APA, and perceived prescribing barriers and enablers. RESULTS: The survey response rate was about 50% (77 of 153 eligible pharmacists). The median self-reported number of prescriptions and medication orders written during an average week was 4.2 (interquartile range, 2.0-10.0) per 10 patients. Antibiotics and anticoagulants were the most commonly prescribed medications. Interdisciplinary care team dynamics was rated as a leading enabler of prescribing but also a leading barrier to the exercise of APA. The greatest motivators to apply for APA were the potential for increased efficiency and the potential for enhanced patient care. CONCLUSION: The survey results indicated that, in an average week, hospital pharmacists with APA prescribed for almost half of the patients they cared for as part of the interdisciplinary team. Prescribing most frequently occurred after team discussion and most often involved adjusting dosages based on organ function and clinical assessment.

Treatment beliefs, illness perceptions, and non-adherence to antiretroviral therapy in an ethnically diverse patient population.

BACKGROUND: Ethnic diversity is increasingly encountered in the HIV-infected population in North America, and it is unknown if beliefs surrounding illness and treatment vary among different ethnic groups. OBJECTIVE: Our objectives were to determine whether self-reported adherence, illness perceptions and treatment beliefs regarding HIV differ based on ethnicity. SETTING: This study was conducted during outpatient HIV clinic visits between March 1, 2010 and April 30, 2010 at two hospital-based clinics in Edmonton, AB, Canada. METHODS: A cross-sectional sample of 65 patients on antiretroviral therapy (34 Caucasian, 23 Aboriginal, and 8 from other ethnic groups) attending hospital-based clinics completed a self-administered survey; medical records were reviewed for demographic and treatment information. MAIN OUTCOME MEASURE: An ANOVA with covariates was performed to measure variation of beliefs and adherence between ethnic groups. RESULTS: Mean self-reported adherence in the past week and past month was high (96 %) and the majority of patients (78.5 %) had a viral load <40 copies/mL. Patients had high perceived necessity scores and a low degree of perceived concern with antiretroviral therapy. In our study, treatment beliefs, illness perceptions, and self-reported adherence did not vary between ethnicities (p > 0.05). CONCLUSION: Treatment beliefs, illness perceptions, and adherence appear to be largely similar in English-speaking patients with diverse ethnic backgrounds who have been on treatment for at least 3 months. Strong supports may overcome any cultural differences in treatment beliefs that were expected at the outset.

Prevalence and treatment patterns of lower extremity peripheral arterial disease among patients at risk in ambulatory health settings.

BACKGROUND: Lower extremity peripheral arterial disease (PAD) is underdiagnosed and undertreated in Canada, although data are limited. We sought to measure PAD prevalence and treatment patterns in ambulatory settings. METHODS: Five trained undergraduate pharmacy students screened subjects > 50 years of age in 10 community pharmacies and 4 physician offices in northern and central Alberta. We assessed cardiovascular risk factors, cardiovascular disease (CVD), and use of evidence-based therapies; administered the Edinburgh Claudication Questionnaire; and measured the ankle-brachial index (ABI). Patients with definite claudication but ABI > 0.90, or patients with ABI > 1.30 were referred to the study vascular medicine physician for further assessment. PAD was defined as an ABI ≤ 0.90 at the initial community screening or an exercise ABI of ≤ 0.90 and 20% lower than the resting ABI, or toe-brachial index of ≤ 0.70. RESULTS: We recruited 361 patients (65.1 ± 9.5 years old, 55% female, 85% white) between July 1 and November 30, 2008. Sixteen subjects had PAD (prevalence 4.4%; 95% confidence interval [CI], 2.3-6.5), and all were previously unaware that they had PAD. Nine patients (2.5%) had PAD only, 7 (1.9%) had both PAD and CVD, 87 (24%) had CVD only, and 259 (72%) had neither PAD nor CVD. Use of antiplatelet agents (44%), angiotensin blockade (56%), or statins (44%) was low in patients with newly diagnosed PAD and without other CVD. CONCLUSIONS: About 1 in 20 ambulatory persons > 50 years of age screened had PAD. All cases of PAD that we found were previously undiagnosed, and there was a large treatment gap for those without concomitant CVD.

The relationship between leadership styles and empathy among student nurses.

Much of the nursing literature on leadership describes the qualities of existing nursing leaders, while emphasizing the need for leadership development in student nurses for both managerial and clinical practice. However, there is a lack of research literature on the characteristics of current students. Conducted by the University of Tennessee College of Nursing Empathy Research Group, this pilot study explores the relationship between leadership styles and empathy (cognitive and affective) levels. This correlational descriptive study involved self-report using 3 instruments. Hogan Empathy Scale (HES) and Emotional Empathy Tendency Scale (EETS) measured cognitive and affective empathy levels. The Multifactoral Leadership Questionnaire (MLQ-5x) was used to determine leadership style. Data analysis yielded evidence of a weak positive correlation between the predominant transformational leadership style and empathy levels in both junior and senior students. This correlation has implications for both nurse educators and future employers.

Nurses' narratives of unforgettable patient care events.

PURPOSE: To explore the experience of registered nurses (RNs) caring for patients in contemporary hospitals. DESIGN: The descriptive phenomenological study was based in the philosophical perspectives of Husserl and Merleau-Ponty. METHODS: A purposive sample of 46 RNs employed in acute care hospitals in the southeastern United States (US) were recruited by network sampling. Data from unstructured interviews were analyzed in an interpretive group and themes were identified. FINDINGS: Four themes were identified: (a) extraordinary caregiving events, (b) incomprehensibility, (c) questioning whether anything else could have been done, and (d) "alone or together," indicating the isolation nurses often experience while giving care as well as profound moments of connection, especially with patients. CONCLUSIONS: Caregiving experiences resulted in an accumulating residue of moral distress which in turn became ground for future experiences in the everyday work life of RNs. Sometimes years later, participants were still trying to justify and understand the outcomes and perhaps to absolve themselves from blame. Participants were confronted with the limits of science and skill and plunged into the realm of existential questions for which they had no ready answers.

A discipline-specific determination of high quality nursing care.

AIM: The purpose of this study is to establish a framework for defining quality of care based in nursing's unique body of knowledge through identification of nursing actions associated with high quality care. RATIONALE: Nurses are legally liable and morally responsible for the quality of the care they provide to patients. Yet the meaning of 'high quality nursing care' remains ambiguous mainly because models used to define it are borrowed from other disciplines. DESIGN: Two frameworks, quality and nursing knowledge, guided the selection and review of this literature review. The third framework of learning domains, an educational theory, assisted in organizing the data gathered from the literature. FINDINGS: Attributes of high quality nursing care as perceived by both patients and nurses are described. Despite a professed philosophy of holism and humanism, nursing relies heavily on the industrially derived structure-process-outcome model with current emphasis on outcomes. CONCLUSIONS: Patient outcomes are the product of the service nurses deliver and are appropriate as defining criteria only when care is being evaluated from the patient's perspective. Defining quality from the nursing profession's frame of reference focuses on evaluating the services provided; that is, nursing actions and behaviours, linked to the use of nursing knowledge. High quality nursing equates with competence in the cognitive, affective, and psychomotor domains.