Trauma Patient-Centered Discharge Plan Form: A Pilot Study.

BACKGROUND: Comprehensive and multidisciplinary discharge planning can improve trauma patient throughput, decrease length of hospitalization, increase family and patient support, and expedite hospital discharge. OBJECTIVE: This study aimed to assess the feasibility and acceptability of implementing a patient-centered discharge plan form for adult trauma patients. METHODS: A single-center pilot study was conducted with adult trauma patients on a neurosurgical medical-surgical floor at a Level II trauma center in the Western United States from January to February 2023. The study had three phases: observation, pilot intervention, and follow-up. The key pilot intervention was the development of a standardized patient-centered discharge plan form, pilot tested by a trauma advanced practice provider and an inpatient discharge nurse. The primary outcome was the frequency of discharge orders being written before noon on the day of discharge. Qualitative and quantitative outcomes are reported. RESULTS: The discharge form was used for eight patients during the pilot intervention phase; an advanced practice provider and an inpatient discharge nurse each completed the forms for four patients. Five of eight observed patients had discharge orders before noon; the incidence of orders before noon was slightly higher when the form was completed by the discharge nurse (three of four patients) than by the advanced practice provider (two of four patients). CONCLUSIONS: The pilot study found that the patient-centered discharge plan form was feasible and acceptable to help improve the discharge process for trauma patients. Additional work to further refine the form's content and administration is warranted.

Bioenergy for Stress Relief in University Students: A Randomized Controlled Trial.

This study addressed the efficacy of a 20-minute Chakra Connection to treat self-assessed stress in a group of university students. A randomized, control design was used to identify group mean differences for intervention and control groups. A convenience sample of university students was randomly assigned to an intervention (Healing Touch Chakra Connection) or control (Healing Touch Video) group. Self-assessed stress, blood pressure, cortisol, and IL6 were collected before and after the healing touch intervention or control video. The bio-field intervention led to significant decreases in self-reported levels of stress, and stress related biological markers (blood pressure, cortisol, and IL6). Decreases in blood pressure were (statistically) greater for the treatment than for the control but not for the other markers (cortisol and IL6). The higher the level of stress before the intervention, as measured by one of the stress measures, the greater the decrease in stress regardless of treatment group. This study lends support to Principle 5 of the Complex Systems Science and supports bio-field interventions for the treatment of anxiety in university students.

Bio-Energy during Finals: Stress Reduction for a University Community.

To re-examine the effectiveness of a bio-energy intervention on self-reported stress for a convenience sample of university students during dead week, a quasi-experimental, single-group pretest-posttest design was used. Thirty-three students participated, serving as their own controls. After participants had consented, a 15-min Healing Touch intervention followed enrollment. Self-reported stress was significantly reduced after the bio-energy (Healing Touch) intervention. Bio-energy therapy has shown to be beneficial in reducing stress for students during dead week, the week before final examinations. Further research is needed.

Integrative oncology: managing cancer pain with complementary and alternative therapies.

For the projected 1,638,910 patients with a diagnosis of cancer this year, the great majority of them (75-90 %) will experience cancer-related pain. A growing number of these patients will turn to complementary and alternative therapies to assist with the management of their pain and other cancer-related symptoms. The World Health Organization's suggested approach to pain management begins with the use of time honored opioids, but recommends the use of adjuvant therapies early in the management process. Complementary and alternative therapies are being used by more patients each year to assist with the management of their pain. Practitioners and researchers must be aware of the evidence that exists to support or refute the use of these therapies. In this manuscript we review evidence from the recent past on complementary and alternative therapies for pain with emphasis on more common modalities including acupuncture, bio-energy, massage, and music.

Ritual: the final expression of care.

Hospice nurses know that all their patients will die. There are several potential benefits of including rituals and healing practices into the hospice care setting for staff. Evidence suggests that not only does it provide an outlet for hospice workers to express their grief and reflect on their work in an accepting environment; providing closure for their patient's passing but it has also been shown to decrease the risk of burnout and compassion fatigue. This article discusses the important aspects of grief rituals and provides an illustrative example of one such ritual.

When there is nothing left to do, there is everything left to do.

Circle of Life Hospice in Reno, Nevada is not only a special place for patients and their families to find peace through a sense of meaning and purpose at the end of their life but is also an important place for staff to take care of each other as they take care of those who are dying. The Circle of Life Hospice provides a unique opportunity to examine carefully the power of providing an outlet for hospice staff to process their grief and offer support for one another so that they can continue to give the "everything that there is to do to" to their patients.

A Pilot Study.

AIM: To examine the effectiveness of a bio-energy intervention on self-reported stress for a convenience sample of University students, faculty, and staff during finals week. We hypothesized that participants would report a decrease in stress after a 20 minute bio-energy intervention. STUDY DESIGN: A quasi-experimental, single-group, pretest-posttest design was used. METHOD: Thirty-nine faculty, staff, and students participated. Participants served as their own controls. A specific technique was provided by each bio-energy practitioner for 20 minutes after participants had completed a visual analogue scale identifying level of stress and listing two positive and negative behaviors they were currently using in response to stress. RESULTS: A one-sample t test indicates that bio-energy therapy significantly reduces stress, t(35) = 7.74, p < .0001. A multiple regression analysis further indicates that the decrease in stress levels is significantly greater for higher initial stress levels, t(31) = 4.748, p < .0001); decreases in stress are significantly greater for faculty and staff compared to students, t(31) = -2.223, p = .034; and decreases in stress levels are marginally significantly higher for older participants, t(31) =1.946, p = .061. CONCLUSION: Bio-energy therapy may have benefit in reducing stress for faculty, staff, and students during final examination week. Further research is needed.

Prescriptive patterns of nurse practitioners and physicians.

PURPOSE: To compare the prescriptive patterns of nurse practitioners (NPs) and physicians in a primary care setting for the treatment of sinusitis, bronchitis, musculoskeletal injury, and back pain. DATA SOURCES: One hundred charts were reviewed for each condition for a total of 400 charts (200 of the charts were for NP providers, and 200 were for physician providers). CONCLUSIONS: While the mean scores of the differences in prescriptive patterns were found to be statistically significant in only one instance, the overall findings indicate slight differences in the administration of medications for patients. Additionally, NPs prescribed more over-the-counter medications and provided more nonpharmacotherapeutic interventions for their patients than the physicians. IMPLICATIONS FOR PRACTICE: The results, although statistically significant in only one category, indicate that NPs may be more cautious in their prescriptive interventions and provide more teaching for patients.

Bioenergy and Breast Cancer: A Report on Tumor Growth and Metastasis.

As many as 80% of the 296,000 women and 2,240 men diagnosed with breast cancer in the United States will seek out complementary and alternative medicine (CAM) treatments. One such therapy is Healing Touch (HT), recognized by the National Center for Complementary and Integrative Health (NCCIH) as a treatment modality. Using a multiple experimental groups design, fifty-six six- to eight-week-old Balb/c mice were injected with 4T1 breast cancer tumor cells and randomly divided into intervention and positive control groups. Five days after tumor cell injection, mice in the intervention groups received HT either daily or every other day for 10 minutes by one HT practitioner. At 15 days after tumor cell injection, tumor size was measured, and metastasis was evaluated by a medical pathologist after necropsy. Tumor size did not differ significantly among the groups (F(3,52) = 0.75, p value = 0.53). The presence of metastasis did not differ across groups (chi-square(3) = 3.902, p = 0.272) or when compared within an organ (liver: chi-square(3) = 2.507, p = 0.474; lungs: chi-square(3) = 3.804, p = 0.283; spleen: chi-square(3) = 0.595, p = 0.898). However, these results did indicate a moderate, though insignificant, positive impact of HT and highlight the need for continued research into dose, length of treatment, and measurable outcomes (tumor size, metastasis) to provide evidence to suggest application for nursing care.

Decreased Cortisol and Pain in Breast Cancer: Biofield Therapy Potential.

Breast cancer is one of the leading causes of cancer death among women of all races. Pain is a common symptom associated with cancer; 75-90% of cancer patients experience pain during their illness and up to 50% of that pain is undertreated. Unrelieved pain leads to increased levels of the stress hormone cortisol. The purpose of this study was to examine the impact of bioenergy on fecal cortisol levels for mice injected with murine mammary carcinoma 4T1 in two separate pilot studies. Using a multiple experimental group design, six to eight week old female BALB/c mice were injected with tumor and randomly assigned, in groups of 10, to daily treatment, every other day treatment, and no treatment groups. Five days after tumor cell injection, bioenergy interventions were begun for a period of ten consecutive days. Fecal samples were collected for each study and ELISA analysis was conducted at the end of both studies. For both studies, cortisol levels were decreased in the every other day treatment groups but remained high in the no treatment groups. Future studies utilizing bioenergy therapies on cortisol levels in a murine breast cancer model can begin to describe pain outcomes and therapeutic dose.

Oncology pain and complementary therapy.

Half of all patients with cancer experience some level of pain, so pain management is an important topic for oncology nurses. Pharmacologic measures traditionally are the primary intervention for bone, visceral, neuropathic, and procedural pain; however, many patients are turning to an integrative approach of Western and complementary therapies for pain and symptom management. The authors explored the current evidence concerning the effectiveness of complementary therapies in relation to cancer pain and symptom control.

Job satisfaction as self-care within a restrictive regulatory environment: Nevada's study.

PURPOSE: Of western states, Nevada has experienced the greatest population growth and healthcare provider shortage, yet regulations remain restrictive and there are scarce published research data for nurse practitioner (NP) characteristics and none for job satisfaction. We viewed job satisfaction as reflective of professional self-care based on Herzberg's job satisfaction theory and Orem's self-care nursing theory. DATA SOURCES: Surveys were mailed to 512 advanced practice nurses; only NPs were asked to respond. CONCLUSIONS: The eligible NP sample was 315, or 61.5% of the total advanced nursing population. The sample was racially diverse, with a high male population. Job satisfaction was just over midway between "minimally satisfied" to "satisfied," with the highest satisfaction in "challenge/autonomy" and the lowest in "professional growth." Income was positively correlated with satisfaction for northern NPs earning less income and working fewer hours; bonuses were positively correlated for all. Those interested in higher education (e.g., doctorate) were younger, less experienced, part-time, professional members, and urban (south). IMPLICATIONS FOR PRACTICE: Findings provide insight for maximizing professional self-care, particularly in areas of professional growth. Job satisfaction data assist leaders in maximizing the role for improving patient access to care, particularly in states with restrictive regulations.

Veteran preferences for end-of-life care.

Understanding one's disease and prognosis is a difficult thing for anyone to be faced with. Thinking about end-of-life issues can be incredibly stressful, and this is true for individuals who have knowledge of the options and services that are available to them. Not having knowledge about these issues can make facing decisions confusing, to the point of impossible. In addition, not having awareness of options when facing a terminal illness could mean missing out on receiving a lot of healthcare needs that others who have been provided with education and planning around these issues are afforded with. It is necessary that this very important aspect of care, education about palliative care, hospice, comfort care and advanced directives begin in primary care clinics, before individuals find themselves in acute care with so many unknowns.

A Survey of Hospices Use of Complementary Therapy.

As people live longer with chronic illnesses, the need for hospice services will increase. Complementary therapies have been shown to increase ease, relieve pain, and improve quality of life; all relevant for people with chronic illness at the end of their lives. The first aim of this study was to identify complementary therapy services available to, and provided for, clients receiving hospice care in Nevada and Montana. The second aim was to identify differences in those therapies for urban and rural hospice clients. Using a descriptive survey design, data were collected from surveys sent to all hospice administrators in Nevada and Montana (N=54). A 50% (n=27) response rate was obtained. Most (70.4%, n=19) of the participating hospices offered complementary therapy; slightly more than half (52.9%, n=9) provided the services for less than 25% of their clients. No significant differences were found between rural and urban hospices.

Physician perceptions of nurse practitioners: a replication study.

PURPOSE: To replicate and update findings from an earlier study on the perceived incentives of physicians to work with nurse practitioners (NPs). DATA SOURCES: Four hundred and three questionnaires were mailed to NPs who distributed them to their collaborating physicians. CONCLUSION: Physicians ranked "accessibility to health care" and the "quality of care" as equally important and more important than "physician satisfaction" and "economic incentives." The findings were consistent with findings from the earlier study; however, the original study demonstrated a much clearer distinction among the four groups of incentives. IMPLICATIONS FOR PRACTICE: These findings imply that collaboration between physicians and NPs is maturing as NPs move into more arenas in health care.

An innovative model for conducting a participatory community health assessment.

Understanding a community's perceived health care needs is essential to the promotion of community health. The purpose of this article is to review various methodologies used to assess community health care needs, and then provide a case example of a transcultural exploration of perceived health care needs of the residents of Utila, Honduras. This study presents a template for using unique assessment tools to empower communities to identify their health care needs. Implications for future transcultural community nursing studies are discussed.