Accelerated baccalaureate nursing students use of emotional intelligence in nursing as "caring for a human being": a mixed methods grounded theory study.

Accelerated nursing students are ideal informants regarding abstract nursing concepts. How emotional intelligence (EI) is used in nursing remains a relatively elusive process that has yet to be empirically modeled. The purpose of this study was to generate a theoretical model that explains how EI is used in nursing by accelerated baccalaureate nursing students. Using a mixed methods grounded theory study design, theoretical sampling of EI scores directed sampling for individual interviews and focus groups. Caring for a human being emerged as the basic social process at the heart of which all other processes--Getting it; Being caring; The essence of professional nurse caring; Doing something to make someone feel better; and Dealing with difficulty--are interconnected. In addition to a theoretical explanation of the use of EI in nursing, this study corroborates findings from other qualitative studies in nursing and contributes a rich description of accelerated baccalaureate nursing students and an example of a mixed methods study design to the small but growing literature in these areas.

A collaborative exercise between graduate and undergraduate nursing students using a computer-assisted simulator in a mock cardiac arrest.

Faculty at the University at Buffalo designed and implemented a mock cardiac arrest that involved joint participation by both undergraduate and graduate students. Various instruments were developed to evaluate the effectiveness of this teaching modality, including scales that measured pre- and postsimulation knowledge and confidence. Students were also asked to evaluate the strengths and weaknesses of the experience especially regarding teamwork during an emergency situation. Management of the arrest by the graduate students was evaluated using a scale that included competency criteria related to assessment, diagnosis, treatment, and resource management. Undergraduate students' performance was also evaluated. Using paired t-test statistics, postsimulation knowledge scores were significantly higher than presimulation scores (p = .000), while postsimulation confidence scores were not statistically significant (p = .177). Students at both levels reported high satisfaction with the experience and with the opportunity to participate in a simulated cardiac arrest as a member of the health team. The use of a computer-assisted human patient simulator involving different levels of nursing students appears to be an effective teaching method; more investigation into specific outcomes is needed.

An Outpatient Heart Failure Clinic Reduces 30-Day Readmission and Mortality Rates for Discharged Patients: Process and Preliminary Outcomes.

BACKGROUND: The first outpatient heart failure clinic (HFC) in Western New York was developed within a large private cardiology practice with the objective of reducing 30-day all-cause rehospitalization and inpatient mortality. PURPOSE: The aim of this study was to analyze the process and patient outcomes of this independent outpatient HFC. The specific aims were to (a) describe the outpatient care strategies employed and (b) determine whether the HFC reduced 30-day all-cause rehospitalizations and inpatient mortality by comparing HFC data with census data. METHODS: This study used a retrospective chart analysis of 415 adults who had been enrolled in the target HFC after hospitalization for HF. Data were summarized using frequency comparisons and descriptive statistics. One-sample chi-square tests were conducted to test the observed values in the study sample against census data. RESULTS: Patients in the HFC were less likely to experience a readmission to hospital within 30 days of discharge (69% reduction within the study period, p < .001). Patients were seen acutely after discharge, had multiple medication adjustments, and received ongoing telephonic follow-up. The HFC had statistically lower inpatient mortality rates (1.2% vs. 11.6% national average, p < .001), likely a result of the HFC care regimen and referrals for palliative care (17%). CONCLUSIONS: The results of this analysis highlight the importance of developing an outpatient HFC in collaboration with hospitals that is aimed at reducing 30-day all-cause readmissions and inpatient mortality, with referral to palliative care when indicated.

Nurse practitioner and physician assistant students' knowledge, attitudes, and perspectives of chiropractic.

OBJECTIVE: The purpose of this study was to assess nurse practitioner (NP) and physician assistant (PA) students' views of chiropractic. As the role of these providers progresses in primary care settings, providers' views and knowledge of chiropractic will impact interprofessional collaboration and patient outcomes. Understanding how NP and PA students perceive chiropractic may be beneficial in building integrative health care systems. METHODS: This descriptive quantitative pilot study utilized a 56-item survey to examine attitudes, knowledge, and perspectives of NP and PA students in their 2nd year of graduate studies. Frequencies and binomial and multinomial logistic regression models were used to examine responses to survey totals. RESULTS: Ninety-two (97%) students completed the survey. There were conflicting results as to whether participants viewed chiropractic as mainstream or alternative. The majority of participants indicated lack of awareness regarding current scientific evidence for chiropractic and indicated a positive interest in learning more about the profession. Students who reported prior experience with chiropractic had higher attitude-positive responses compared to those without experience. Participants were found to have substantial knowledge deficits in relation to chiropractic treatments and scope of practice. CONCLUSION: The results of this study emphasize the need for increased integrative initiatives and chiropractic exposure in NP and PA education to enhance future interprofessional collaboration in health care.

Implementation of Medical Orders for Life-Sustaining Treatment.

BACKGROUND: When an outpatient in a northeastern cancer institute requested a Medical Orders for Life-Sustaining Treatment (MOLST) form, the state's approved resuscitation form in all settings, none were available. A project was undertaken to institute MOLST forms into policy and routine practice. Research supports early discussions of end-of-life care in patients with cancer and the use of MOLST as an effective tool. OBJECTIVES: The purpose of this article is to discuss the initiation and facilitation of MOLST implementation into practice and policy at a cancer institute. METHODS: Introducing, overcoming resistance to, piloting, and adopting MOLST in an oncology setting is reported and explained based on the three stages of Lewin's Theory of Planned Change. FINDINGS: A small pilot of MOLST with palliative care providers demonstrated the feasibility and suitability of using MOLST in the oncology setting. MOLST was adopted into policy and routine practice at the cancer institute.

Patients' knowledge of pain agreements.

UNLABELLED: This study was conducted to determine patients' knowledge of pain agreements. METHODS: Descriptive quantitative survey design. A 28-item questionnaire regarding patients' knowledge of pain agreements was distributed to pain management office patients. RESULTS: Participants (N = 76) scored 30%-100% (mean 80%) on knowledge of 10 pain agreement items. CONCLUSIONS: Patients demonstrated moderate knowledge of terms.

A challenge in academia: meeting the healthcare needs of the growing number of older adults.

PURPOSE: The purposes of this study were to survey nurse practitioners (NPs) to determine their comfort level with knowledge about caring for individuals aged 65 years and older and to obtain their input on enhancing geriatric content in the educational preparation of advanced practice nurses who provide care to older adults but are not specialists in gerontology. DATA SOURCES: The sample consisted of 500 randomly selected NPs who were certified to practice in New York State. The Geriatric Curriculum Survey designed by the researchers was based on the 47 "Older Adult Care" competencies developed by the American Association of Colleges of Nursing. The survey was mailed to the subjects along with a stamped self-addressed envelope to facilitate its return. Two hundred and twenty-two surveys (44%) were returned. CONCLUSIONS: A majority of the respondents were comfortable with their assessment skill knowledge of individuals aged 65 years and older in all areas except those related to cultural/ethnic items. Over half of the respondents were only "somewhat comfortable" with knowledge of management of Alzheimer's disease, delirium, dementia, neurological problems, polypharmacy, and sleep issues. Finally, respondents were asked to rate their knowledge comfort level on topics relevant to physical and psychosocial issues of individuals aged 65 years and older. The majority of respondents only felt "somewhat comfortable" with their knowledge on all but one of the nine items in this category. Health promotion and disease prevention was the only item that over 50% of the respondents felt "very knowledgeable" about. Ninety-five percent indicated they would be better prepared to care for individuals aged 65 years and older if a didactic course in geriatrics was required in their program of study. Seventy percent indicated they would consider taking an online course in geriatrics. IMPLICATIONS FOR PRACTICE: Based on the results of this study, an online, four-credit geriatric-focused course "Issues in Geriatric Management" was developed. The course is required in the acute care and adult NP programs. Eventually, this course will be offered as continuing education credit for practicing NPs. The offering of a course focused on geriatrics will help to better prepare NPs to care for the growing number of elderly in this country.

Daily versus thrice-weekly interferon alfa-2b plus ribavirin for the treatment of chronic hepatitis C in HIV-infected persons: a multicenter randomized controlled trial.

Among HIV-infected persons, chronic hepatitis C virus (HCV) infection causes substantial morbidity and mortality. However, few studies have evaluated the safety and efficacy of interferon alfa (IFN) and ribavirin (RBV) therapy in co-infected persons. Accordingly, a randomized, controlled, open-label, multicenter trial was conducted to establish the safety, tolerability, and efficacy of IFN alfa-2b 3 mIU daily plus RBV 800 mg/d compared with IFN alfa-2b 3 mIU thrice weekly (TIW) plus RBV 800 mg/d in HCV treatment-naive, HIV-infected subjects with compensated liver disease and stable HIV disease. The primary endpoint was sustained virologic response (SVR), defined as an undetectable HCV RNA level 24 weeks after discontinuation of HCV therapy. At study entry, subjects in both groups were similar with respect to age, gender, HCV genotype, and HIV disease status. Of 180 randomized subjects, 162 received at least 1 dose of study medication, constituting the modified intention-to-treat population. After 12 weeks of therapy, 122 (75%) had serum HCV RNA levels assessed; of these subjects, early virologic response (undetectable HCV RNA or >2 log10 decrease from baseline) was observed in 33 (42%) and 13 (16%) of subjects taking daily and TIW IFN, respectively (P < 0.001). SVR was observed in 15 (19.0%) and 7 (8.4%) of subjects taking daily and TIW IFN, respectively (P = 0.05). Adverse events were similar in both groups. However, while no deaths or opportunistic infections were observed, nearly 30% of subjects stopped treatment due to adverse events and 7 subjects experienced a serious adverse event. In conclusion, SVR was achieved in 19% of HIV/HCV coinfected subjects treated with daily IFN plus RBV, but the effectiveness of therapy was substantially diminished by relatively high rates of treatment-related toxicity.