Physiological Effects of Handling in Moderate to Late Preterm Infants Receiving Neonatal Intensive Care.

BACKGROUND: Of all preterm births, approximately 82% are moderate to late preterm. Moderate to late preterm infants are often treated like full-term infants despite their physiological and metabolic immaturity, increasing their risk for mortality and morbidity. PURPOSE: To describe the relationship between routine caregiving methods and physiological markers of stress and hypoxemia in infants born between 32 and 36 6/7 weeks' gestation. METHODS: This descriptive study used a prospective observational design to examine the relationship between routine caregiving patterns (single procedure vs clustered care) and physiological markers of stress and hypoxemia such as regional oxygen saturation, quantified as renal and cerebral regional oxygen saturation (StO 2 ), systemic oxygen saturation (Sp o2 ), and heart rate (HR) in moderate to late preterm infants. Renal and cerebral StO 2 was measured using near-infrared spectroscopy during a 6-hour study period. Sp o2 and HR were measured using pulse oximetry. RESULTS: A total of 231 procedures were captured in 37 participants. We found greater alterations in cerebral StO 2 , renal StO 2 , Sp o2 , and HR when routine procedures were performed consecutively in clusters than when procedures were performed singly or separately. IMPLICATIONS FOR PRACTICE AND RESEARCH: Our results suggest that the oxygen saturation and HR of moderate to late preterm infants were significantly altered when exposed to routine procedures that were performed consecutively, in clusters, compared with when exposed to procedures that were performed singly or separately. Adequately powered randomized controlled trials are needed to determine the type of caregiving patterns that will optimize the health outcomes of this vulnerable population.

Sanctification of work and hospital nurse employment outcomes: An observational study.

AIM: To explore nurse ascriptions of sacredness to work and measure its association with the employment outcomes of job satisfaction, burnout, organisational commitment, employee engagement and turnover intention. BACKGROUND: High portions of hospital nurses experience burnout. Many factors contributing to burnout also contribute to job dissatisfaction and other negative employment outcomes. Personal factors, such as religiosity, help nurses to cope with work. METHODS: Questionnaires measuring study variables were distributed to all nursing personnel at a faith-based hospital in Los Angeles; 463 responded. Regression analyses allowed measurement of how sacredness ascribed to work (measured by Sanctification of Work Scale) and religiosity (measured by Duke Religiosity Index) were associated with the various employment outcomes. RESULTS: Sanctification of work consistently was found to be associated with less burnout and intention to leave, and more job satisfaction, employee engagement and organisational commitment. CONCLUSION: The sacredness with which a nurse views work explains, in part, positive employment outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Nurturing a sense of sacredness for work in nurses may provide them with an internal buffer against negative employment outcomes. Suggestions for creating rituals and educating nurses are offered.

A Nurse-Led Evidence-Based Practice Protocol to Reduce Postoperative Nausea and Vomiting in the Bariatric Surgery Patient.

PURPOSE: To create and implement a standard care bundle to reduce postoperative nausea and vomiting (PONV) in the bariatric surgery patient. DESIGN: Evidence-based quality improvement project. METHODS: A pre- and postintervention chart review identified high-risk indicators for PONV in patients with longer lengths of stay (LOS), which led to the development of targeted care bundle components. FINDINGS: A clinically significant difference was observed in predicted PONV for Apfel scores 3 and 4 in patients receiving the full bundle compared with those receiving a partial bundle. Decreased LOS after implementation of the antiemetic care bundle was found. Health care provider compliance with bundle administration was low (57%). CONCLUSIONS: Clinically significant PONV scores were low after implementation of the antiemetic bundle for high-risk patients. The nurse-led creation and implementation of an antiemetic care bundle may have contributed to decreased LOS, reduced PONV, and reduced provider variability in care management.

Operational Failures Detected by Frontline Acute Care Nurses.

Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.

Use of the Iowa Model of Research in Practice as a Curriculum Framework for Doctor of Nursing Practice (DNP) Project Completion.

Doctoral education requires academic motivation and persistence on the part of nursing students; commitment to the process is essential and should be linked to programmatic structure. Programmatic issues in doctor of nursing practice (DNP) programs may be barriers to completion of the final project and lead to attrition. A large, private health care university developed an infrastructure for the DNP curriculum and final project utilizing the Iowa Model of Research in Practice. The purpose was to ensure competency fulfillment, retention and timely completion, and implementation of evidence-based practice and translation science utilizing a leadership approach. The program has experienced a high completion rate to date.

PhD-Prepared Nurses' Areas of Inquiry.

BACKGROUND: Nursing science is heavily dependent on nurse scientists with adequate funding. Nurse scientists should be aware of organizations' research agendas and, to the extent possible, align research with stated research priorities. Current information on the demographics of nurse scientists, their projects, and the alignment to known priorities is illusive. PURPOSE: To describe areas of inquiry pursued by PhD-prepared nurses and congruence with the research agendas of nursing organizations. METHODS: A descriptive, exploratory approach was undertaken with PhD-prepared nurse scientists to gather data about their PhD program, dissertation topic, current work status, productivity, and future recommendations. RESULTS: Key findings were that dissertation topics were broad and aligned with research priorities. Elements influencing research productivity are described. CONCLUSIONS: Understanding current nursing science stewardship and intentionally strategizing for the future of research, academia, and clinical practice will enhance our ability to tailor PhD programs accordingly.

Preserving the Bedside Nurse: Grip Strength and Orthopedic Problems Among Nurses and Nursing Students.

BACKGROUND: Bedside nurses and nursing students are at increased risk of musculoskeletal injury due to the physicality and complexity of their work. The purpose of this study was to explore the relationship between grip strength and orthopedic injuries or pain among nurses and nursing students. METHODS: A cross-sectional study of nursing staff and nursing students at a health sciences university was conducted. The survey consisted of work-related demographics, exercise habits, and validated scales. The Nordic Musculoskeletal Questionnaire was used to collect information on musculoskeletal problems. Anthropomorphic measures included height, weight, body mass index (BMI), and grip strength. Logistic regression was performed. FINDINGS: Participants with grip strength at or above the national average had significantly lower odds of self-reported orthopedic problems, B = 0.86, OR = 2.35, p =.01, indicating participants with grip strength at or above national average were 135% less likely to report orthopedic problems compared to participants with grip strength below the national average. CONCLUSION/APPLICATION TO PRACTICE: Healthcare workers in direct patient care who have lower grip strength may be at increased risk for injuries. Nursing staff and students with below average grip strength were more likely to experience orthopedic problems. Increased muscle mass and grip strength are known to effectively reduce the risk of upper extremity injuries. Nurse leaders may benefit from promoting grip strengthening activities among employees to prevent workplace injuries. Further research is needed to understand the biophysiological mechanisms, confirm the findings of this study and evaluate effective interventions.

Facilitating Shared Decision Making About Prostate Cancer Screening Among African American Men.

PURPOSE/OBJECTIVES: To describe the development and implementation of a prostate cancer screening intervention and risk assessment decision tool.
. DESIGN: Community health promotion with pre- and post-education knowledge questionnaires.
. SETTING: Two predominantly African American churches in different suburban communities in Southern California.
. SAMPLE: A convenience sample of 50 African American men aged from 30-75 years. 
. METHODS: A Prostate Cancer Screening Decision Aid was developed and used in conjunction with an educational intervention for African American men in two suburban communities in Southern California. The educational intervention was implemented in local African American churches. The intervention included a PowerPoint® presentation with a four-minute video. Men completed pre- and post-education knowledge questionnaires and a risk assessment decision tool.
. MAIN RESEARCH VARIABLES: Prostate cancer knowledge, awareness of prostate cancer personal risks and benefits of prostate cancer screening, information needed for initiating discussions with provider, and intention to participate in shared decision making with healthcare providers.
. FINDINGS: An 8% increase in knowledge was calculated when comparing pre- and post- education responses. Awareness of personal risks, having the information needed to initiate a discussion with a healthcare provider, intention to participate in shared decision making within six months, prostate cancer knowledge, and having had participated in screening increased.
. CONCLUSIONS: The intervention was successful in increasing knowledge and awareness of personal risks and providing tools to facilitate shared decision making with healthcare providers.
. IMPLICATIONS FOR NURSING: Nurses can play a meaningful role in collaborating with community lay leaders to develop and implement effective health promotion interventions for African Americans.

The youth alternative solutions program: evaluating a hospital-based intervention for adolescent substance use.

Issues of alcohol and drug use are more pronounced during adolescence than at any other period of the lifespan and represent a significant public health concern in the United States. As a result, there is currently a need for research on developmentally appropriate interventions for adolescent substance use (SU). Nurses and other mental health professionals working with adolescents need effective evidenced-based programs to refer clients having issues with SU. The current pilot study evaluated the effectiveness of the Youth Alternative Solutions Program, a hospital-based intervention program at a Level I trauma center in Southern California that partners with community stakeholders to accomplish its goals. A sample of 27 adolescents was recruited from August 2010 until October 2011. Twenty-seven total participants completed both pretest and posttest questionnaires; 14 of these participants also completed follow-up data collection. Results indicated a significant increase in negative alcohol outcome expectancies between the three study time points. More comprehensive studies of the Youth Alternative Solutions Program should be conducted in the future to determine the utility of hospital-based SU interventions and to provide evidence of the program's long-term effects.

Continuity of care and quality care outcomes for people experiencing chronic conditions: A literature review.

Continuity of patient care is frequently linked to quality care outcomes. The purpose of this paper is to examine the clinical trial literature in order to determine the extent to which informational, management, and relational continuity of care are associated with quality care indicators. A MEDLINE search of the literature via PubMed was conducted for clinical trials that were carried out from 1 January 1996-1 June 2005. Analyses of 32 unduplicated citations revealed a focus on one or more aspects of continuity and its association with quality care outcomes. Management continuity interventions were identified most often, followed by informational and relational continuity interventions. The outcomes were primarily patient-focused with a wide range of functional status, quality of life, and patient satisfaction indicators. This analysis provides implications for research that could contribute to an understanding of the types of continuity of patient care and their relationships to quality care.