Complementary and alternative medicine carts in the inpatient rehabilitation unit: Access and nurses' use.

PURPOSE: To determine if increased accessibility to complementary and alternative medicine (CAM) increases the usage of CAM interventions. METHODS: A prospective pre-post study with a "run-in" design in a hospital with two inpatient rehabilitation floors was used. Data were analyzed with SAS v9.4. RESULTS: CAM use before implementation was 2.8 (1.0); after implementation, 3.1 (0.56). CONCLUSION: Greater access to CAM materials did not significantly increase their use (P = .233). Aromatherapy was used more after increased availability, but heat and cold application decreased. Nurses valued CAM even though independent practice was not fully supported.

Association of Recent Use of Non-Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase.

Importance: Current guidelines recommend against use of intravenous alteplase in patients with acute ischemic stroke who are taking non-vitamin K antagonist oral anticoagulants (NOACs). Objective: To evaluate the safety and functional outcomes of intravenous alteplase among patients who were taking NOACs prior to stroke and compare outcomes with patients who were not taking long-term anticoagulants. Design, Setting, and Participants: A retrospective cohort study of 163 038 patients with acute ischemic stroke either taking NOACs or not taking anticoagulants prior to stroke and treated with intravenous alteplase within 4.5 hours of symptom onset at 1752 US hospitals participating in the Get With The Guidelines-Stroke program between April 2015 and March 2020, with complementary data from the Addressing Real-world Anticoagulant Management Issues in Stroke registry. Exposures: Prestroke treatment with NOACs within 7 days prior to alteplase treatment. Main Outcomes and Measures: The primary outcome was symptomatic intracranial hemorrhage occurring within 36 hours after intravenous alteplase administration. There were 4 secondary safety outcomes, including inpatient mortality, and 7 secondary functional outcomes assessed at hospital discharge, including the proportion of patients discharged home. Results: Of 163 038 patients treated with intravenous alteplase (median age, 70 [IQR, 59 to 81] years; 49.1% women), 2207 (1.4%) were taking NOACs and 160 831 (98.6%) were not taking anticoagulants prior to their stroke. Patients taking NOACs were older (median age, 75 [IQR, 64 to 82] years vs 70 [IQR, 58 to 81] years for those not taking anticoagulants), had a higher prevalence of cardiovascular comorbidities, and experienced more severe strokes (median National Institutes of Health Stroke Scale score, 10 [IQR, 5 to 17] vs 7 [IQR, 4 to 14]) (all standardized differences >10). The unadjusted rate of symptomatic intracranial hemorrhage was 3.7% (95% CI, 2.9% to 4.5%) for patients taking NOACs vs 3.2% (95% CI, 3.1% to 3.3%) for patients not taking anticoagulants. After adjusting for baseline clinical factors, the risk of symptomatic intracranial hemorrhage was not significantly different between groups (adjusted odds ratio [OR], 0.88 [95% CI, 0.70 to 1.10]; adjusted risk difference [RD], -0.51% [95% CI, -1.36% to 0.34%]). There were no significant differences in the secondary safety outcomes, including inpatient mortality (6.3% for patients taking NOACs vs 4.9% for patients not taking anticoagulants; adjusted OR, 0.84 [95% CI, 0.69 to 1.01]; adjusted RD, -1.20% [95% CI, -2.39% to -0%]). Of the secondary functional outcomes, 4 of 7 showed significant differences in favor of the NOAC group after adjustment, including the proportion of patients discharged home (45.9% vs 53.6% for patients not taking anticoagulants; adjusted OR, 1.17 [95% CI, 1.06 to 1.29]; adjusted RD, 3.84% [95% CI, 1.46% to 6.22%]). Conclusions and Relevance: Among patients with acute ischemic stroke treated with intravenous alteplase, use of NOACs within the preceding 7 days, compared with no use of anticoagulants, was not associated with a significantly increased risk of intracranial hemorrhage.

Music as a Therapy to Alleviate Anxiety During Inpatient Rehabilitation for Stroke.

PURPOSE: The aim of the study was to determine if listening to music may reduce anxiety experienced by stroke patients during acute rehabilitation. DESIGN: A prospective, nonblinded, randomized study in an inpatient rehabilitation setting. METHODS: Fifty participants were randomized into two groups: (1) 1 hour of music (intervention) or (2) no music (control). All participants completed pretest anxiety and depression screening and 44 completed the posttest anxiety screening. Differences between groups were determined using chi-square and t tests. FINDINGS: After listening to music for 1 hour, participants who completed the posttest (n = 44) reported significantly less anxiety (p < .0001) compared to before the intervention. The control group showed no difference in their pre- and posttest anxiety scores (p = .84). No differences were determined among age, gender, or diagnostic groups. CONCLUSIONS: These findings demonstrate that music intervention may help lessen anxiety in rehabilitation patients poststroke. CLINICAL RELEVANCE: Offering musical intervention to stroke patients in rehabilitation may lessen symptoms of anxiety.

Development of an Instrument to Examine Nursing Attitudes Toward Fertility Preservation in Oncology.

PURPOSE/OBJECTIVES: To develop an instrument to measure staff nurse perceptions of the barriers to and benefits of addressing fertility preservation (FP) with patients newly diagnosed with cancer. 
. DESIGN: A prospective, nonrandomized instrument development approach. 
. SETTING: Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center in Dallas. 
. SAMPLE: 224 RNs who care for patients with cancer. 
. METHODS: The instrument was developed with content experts and field-tested with oncology staff nurses. Responses to a web-based survey were used in exploratory factor analysis. After refining the instrument, the authors conducted a confirmatory factor analysis with 230 web-based survey responses. 
. MAIN RESEARCH VARIABLES: Self-perceived barriers to providing FP options to patients newly diagnosed with cancer.
. FINDINGS: The results supported a 15-item instrument with five domains. CONCLUSIONS: This instrument can be used to explore oncology nurses' attitudes toward FP in newly diagnosed people with cancer in their reproductive years. 
. IMPLICATIONS FOR NURSING: A more comprehensive understanding of attitudes and barriers related to FP will guide the building of optimal systems that support effective FP options, resources, and programs for individuals with cancer.

Feasibility and Efficacy of Nurse-Driven Acute Stroke Care.

BACKGROUND: Acute stroke care requires rapid assessment and intervention. Replacing traditional sequential algorithms in stroke care with parallel processing using telestroke consultation could be useful in the management of acute stroke patients. The purpose of this study was to assess the feasibility of a nurse-driven acute stroke protocol using a parallel processing model. METHODS: This is a prospective, nonrandomized, feasibility study of a quality improvement initiative. Stroke team members had a 1-month training phase, and then the protocol was implemented for 6 months and data were collected on a "run-sheet." The primary outcome of this study was to determine if a nurse-driven acute stroke protocol is feasible and assists in decreasing door to needle (intravenous tissue plasminogen activator [IV-tPA]) times. RESULTS: Of the 153 stroke patients seen during the protocol implementation phase, 57 were designated as "level 1" (symptom onset <4.5 hours) strokes requiring acute stroke management. Among these strokes, 78% were nurse-driven, and 75% of the telestroke encounters were also nurse-driven. The average door to computerized tomography time was significantly reduced in nurse-driven codes (38.9 minutes versus 24.4 minutes; P < .04). CONCLUSIONS: The use of a nurse-driven protocol is feasible and effective. When used in conjunction with a telestroke specialist, it may be of value in improving patient outcomes by decreasing the time for door to decision for IV-tPA.

Music as Medicine: The Therapeutic Potential of Music for Acute Stroke Patients.

Nurses caring for patients with acute stroke are likely to administer both music and medication with therapeutic intent. The administration of medication is based on accumulated scientific evidence and tailored to the needs of each patient. However, the therapeutic use of music is generally based on good intentions and anecdotal evidence. This review summarizes and examines the current literature regarding the effectiveness of music in the treatment of critically ill patients and the use of music in neurologically injured patients. The rationale for hypothesis-driven research to explore therapeutic music intervention in acute stroke is compelling.

Therapeutic Use of Music and Television in Neurocritical Care: A Practice Survey.

INTRODUCTION: Although health care providers often play music via radio, or play television, to calm and soothe patients, limited research is available to guide practice. METHOD: This study used a 17-item practice survey that was distributed electronically to neurocritical care society members in July 2014. Responses were collated and analyzed using SAS (Version 9.3). RESULTS: There were 118 completed responses, including from 71 attending physicians, 9 resident or fellow physicians, 30 nurses, and 8 affiliate professional members. The majority of respondents sometimes or always play music (65%) and agree that music is therapeutic (70%). However, there was no clear practice pattern regarding when or why music or TV should be used as an intervention in the neurocritical care unit. CONCLUSION: The use of music and TV is a common intervention in the neurocritical care unit but lacks a strong scientific foundation and is associated with a high practice variance.