Identifying barriers and facilitators to seeking care for symptoms of bacterial sepsis: A qualitative study.

AIM: Research suggests that early access to quality care is essential to improving bacteraemia outcomes and reducing the risk of developing sepsis because it allows for early intervention. Currently, there are limited data regarding the facilitators and barriers that alter the trajectory of arrival at the hospital when patients in the United States experience symptoms of bacteraemia and sepsis. This study sought to explore and describe the facilitators and barriers to seeking care for suspected bacteraemia and sepsis symptoms. DESIGN: A qualitative descriptive study. METHODS: Ten men and women were recruited using convenience sampling. The study used audio-recorded semi-structured interviews and the collection of socio-demographic data as the data collection techniques. Thematic analysis was used, including inductive and deductive approaches, to analyse the data. RESULTS: During data analysis, the codes related to barriers and facilitators were collapsed into three themes-symptom recognition, psychosocial support and healthcare planning and coordination. PATIENT CONTRIBUTION: The patients' participation in the study has contributed to our understanding of patients' perspectives and experiences in the pre-hospital phase and provides important insights into what barriers and facilitators are encountered. Study findings highlight the need to develop interventions to improve patient decision time, patient-provider interactions and knowledge of bacteraemia and sepsis through patient and provider education.

Clinical Evaluation of Competence in Nursing Education: What Do We Know?

AIM: The purpose of this article was to examine the research literature to identify objective, replicable measurement of clinical competence in undergraduate nursing education. BACKGROUND: Although a standardized licensure examination is used to determine minimal competence to practice, no consensus on the definition or components of competence exists in the research literature. METHOD: A comprehensive search was conducted to locate studies that evaluated nursing students' general competence in the clinical setting. Twelve reports published from 2010 to 2021 were examined. RESULTS: Measures to evaluate competence were varied and contained multiple concepts including attributes of knowledge, attitudes and behaviors, ethics and values, personal attributes, and cognitive or psychomotor skills. Most studies used researcher-created instruments. CONCLUSION: Although essential to nursing education, competence in the clinical setting is not commonly defined or evaluated. The lack of standardized instruments has contributed to the use of varied methods and measures for evaluating competence in nursing education and research.

Exploration of pre-hospital patient delays in seeking care for symptoms of bacteremia and sepsis: A qualitative study.

AIM: We explored patient pre-hospital delays in seeking care for symptoms of bacteremia and sepsis. DESIGN: A qualitative descriptive study. METHODS: In January 2021, we recruited a convenience sample of four men and six women who were former patients diagnosed with bacteremia. We conducted semi-structured interviews by telephone. The tape-recorded interviews were transcribed, coded and analysed using the Common-Sense Model of Self-Regulation. Data analysis continued until May 2021. RESULTS: The three main themes included: gathering threads of information, weaving together the threads of information and impact and outcome of the illness. The main finding revealed was that an inability to recognize symptoms of bacteremia resulted in delayed help-seeking. Participants had difficulty recognizing their symptoms as being related to bacteremia when they lacked experience with infection or could not differentiate them from symptoms of other chronic co-morbid conditions. Recognizing symptoms and searching for their meaning was an early step in developing an action plan for seeking care. Patient-reported physical and psychological outcomes of the infection on their quality of life (QOL) varied widely, from none to major impact.

A secondary analysis to inform a clinical decision rule for predicting skull fracture and intracranial injury in children under age 2.

The purpose of this study was to identify factors associated with the risk of closed head injury (CHI) in children under age 2 years with suspected minor head injuries based on age-appropriate, or near age-appropriate, mental status on an exam. The study was a secondary data analysis of a public-use dataset from the largest prospective, multicenter pediatric head injury study found in the current literature. An existing, validated clinical decision rule was examined using a sample of 3,329 children under age 2 to determine whether it, or the individual variables within it, could be utilized alone, or in conjunction with other variables to accurately predict the risk of underlying CHI in this sample. Results indicated that the keys to an accurate triage assessment for children under age 2 with suspected minor head injuries include the ability to identify the specific skull region injured, the ability to assess for the presence and size of any scalp hematoma, the ability to identify signs of altered mental status in this age group, and having access to accurate information regarding the child's age and the details of the injury mechanism. The findings from this study add to the body of knowledge regarding what factors are associated with CHI in children under age 2 with suspected minor head injuries and could be used to inform age-specific recommendations for children under age 2 in triage, educational resources, and national trauma criteria.

The State of the Science on Clinical Evaluation in Nursing Education.

AIM: The purpose was to synthesize the published evidence to present the state of the science in clinical evaluation research in nursing education. BACKGROUND: Clinical evaluation is key to ensuring nursing students' clinical competence, application of knowledge, and critical thinking, all of which are important to patient safety and quality nursing care. METHOD: Cooper's research synthesis method was used. RESULTS: A comprehensive literature search resulted in 250 documents, of which 88 met study criteria. Topics were exhaustive but not mutually exclusive and included competence, instrumentation, congruence, teaching methods, objective structured clinical evaluation, faculty/preceptor issues with clinical evaluation, essential clinical behaviors, topic-based evaluation, decision-making about clinical grade, and clinical reasoning. CONCLUSION: Nursing education science is in its infancy in many areas. Two areas most in need of future research are the need to accurately define and efficiently measure competence in the clinical area and the need for reliable and valid instrumentation.

The role of maternal elaborative structure and control in children's memory and suggestibility for a past event.

In this investigation, preschool-aged children experienced a staged event about which their mothers received misinformation suggesting that their children witnessed an activity that did not occur. Later, mothers were asked to talk about this event with their children. Consistent with previous research, mothers' provision of structure (defined as elaborative questions and statements) and degree of control (defined in terms of functional control of conversational turns) emerged as separate dimensions of maternal memory sharing style. When later interviewed by an unfamiliar examiner about the event, children whose mothers demonstrated both high structure and high control provided the highest levels of false reports of the activity suggested to mothers and generously embellished their accounts of this activity with nonoccurring details. In contrast, children with mothers who provided low structure, regardless of their degree of control, made few false reports and used sparse narrative detail. The implications of these findings for children's memory and suggestibility are discussed.

Assessment of Nursing Student Confidence Using the Clinical Skills Self-Efficacy Scale.

Student self-efficacy related to clinical skills is important to successful performance in the clinical setting. This pilot study was designed to evaluate the confidence levels of junior and senior nursing students in performing selected nursing skills, using the Clinical Skills Self-Efficacy Scale. A descriptive cross-sectional design was used in which participants completed an online survey. Findings indicate that senior students demonstrated higher self-efficacy than juniors; their experiences and confidence related to performing specific clinical skills varied across groups. Strategies to improve students' clinical skills learning specific to the laboratory and clinical settings are addressed.

Sex and Intimacy after Stroke.

PROBLEM: The sequelae of a stroke can negatively affect sex and intimacy for survivors and their partners. PURPOSE: This clinical article offers practical evidence-based recommendations for nurses to use in advising couples who may be experiencing sexual problems due to decreased desire, erectile dysfunction, vaginal dryness, paraparesis, pain, spasticity, fatigue, aphasia, concrete thinking, emotional lability, shame, embarrassment, fear, depression, or neurogenic bladder. KEY FINDINGS AND CLINICAL RELEVANCE: Recent research and clinical articles show that intimacy and sexual concerns are often ignored by the rehabilitation team, yet research shows that couples want information to assist them to maintain their sexual relationships. Using the PLISSIT model to address sexual concerns, nurses can facilitate discussions to aid couples toward improved sexual function and quality of life.

Teaching pathophysiology: strategies to enliven the traditional lecture.

The depth and breadth of pathophysiology content, foundational for nursing practice, is well suited for traditional lecture delivery. Use of creative strategies can deepen students' understanding while respecting students' diverse talents and ways of learning. The authors discuss strategies they used, including case studies, questions asked during lecture using immediate feedback technology, creative visual demonstrations, group pathophysiologic theory projects, short videos, and games, to enhance students' understanding and retention of content.

The effects of correction insulin and basal insulin on inpatient glycemic control.

Hospitalized patients with type 2 diabetes may benefit from tighter glycemic control to prevent hyperglycemia and its complications. The glycemic control of two groups of inpatients with diabetes receiving subcutaneous insulin via a basal-bolus approach or sliding scale was compared.

NNN language and evidence-based practice guidelines for acute cardiac care: retaining the essence of nursing.

Multidisciplinary management of the acute cardiac patient, for decades, has been driven by best practices, treatment algorithms, and research-based protocols. As nurses continue to develop and implement evidence-based care, they must ensure that the essence of nursing is not lost in the process. In this article, strategies for the development of evidence-based practice guidelines for acute cardiac patients using standardized nursing language are provided.

Promoting family integrity to inspire hope in rehabilitation patients: strategies to provide evidence-based care.

The disability of one family member who requires inpatient rehabilitation care can negatively affect all family members and ultimately disrupt family integrity. The purpose of this article is to demonstrate how promoting family integrity also promotes hope when families are confronted with a newly disabled teen or adult. Current research findings indicate that rehabilitation nurses are in a key position to promote hope and family integrity by facilitating open communication between family members, fostering a tone of togetherness within and among families, and helping families resolve feelings of guilt and move toward forgiveness. These strategies are based on activities from the Nursing Interventions Classification (NIC) intervention "Family Integrity Promotion". This article presents a review of research to support these NIC activities and offers practical suggestions so rehabilitation nurses can incorporate these strategies into their daily practice with patients and their family members.

Impact of intravenous insulin protocols on hypoglycemia, patient safety, and nursing workload.

The practice of tight glycemic control using an intravenous insulin infusion has been adopted in many clinical settings, and although beneficial patient outcomes have been clearly documented, the therapy poses potential risks to patient safety related to hypoglycemia and increases nursing workload. This article examines these issues through a review of current research on tight glycemic protocols. Strategies for nurse leaders are provided to improve patient safety and support bedside nurses in the administration of insulin infusion protocols.

Loss and depression after traumatic injury: the importance of case management in the recovery process.

UNLABELLED: PURPOSES OF STUDY: This study aims to (1) explore the types of resource loss commonly experienced by trauma patients as a result of their injuries, (2) examine the relationship between loss of resources and depressive symptoms after traumatic injury, (3) identify the types of coping behaviors used during trauma recovery, and (4) identify other factors influencing depression after injury. PRIMARY PRACTICE SETTING(S): Primary settings comprise the case managers working with trauma patients in hospital, rehabilitation, outpatient, and home environments. METHODOLOGY AND SAMPLE: This study used a cross-sectional design. A sample of 50 trauma patients who had sustained an unintentional injury in the prior 1-4 months completed a single interview during which participants completed measures of general health, loss of resources, coping, and depressive symptoms. Types of resource losses were also explored through open-ended questions. RESULTS: Symptoms of depression were prevalent in the sample. Participants experienced multiple and varied loss of resources, especially in financial and personal realms. Loss of resources and depression scores were significantly related. Participants reported using a variety of coping strategies, most commonly accepting the reality of their circumstances and limitations. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The case manager can serve an important role in the recognition of depression in trauma patients and the implementation of appropriate interventions, including referral to mental health professional for further evaluation. Strategies to aid in the prevention of depression after injury include early identification of individuals who are more vulnerable to resource loss, assessment of current resource stores, and facilitating and coordinating access to essential resources to aid in trauma recovery.

Promoting cultural awareness and knowledge among faculty and doctoral students.

This article describes the activities conducted by the Race and Gender Committee of one school of nursing in North Carolina to promote cultural awareness and knowledge among faculty and doctoral students. Wells's Institutional Cultural Development Model provided a theoretical framework for a systematic approach to the development of activities designed to identify cultural issues as they relate to teaching and research. Strategies used included a variety of seminars and workshops and the participation of consultants and experts. The workshops and other programs led to improved interdepartmental dialogue among faculty and doctoral students, facilitated faculty and students' understanding of cultural diversity, provided the groundwork for promotion of attitudinal and behavioral changes, and increased cultural awareness and knowledge. Recommendations are included for developing similar programs.

An exemplar of the use of NNN language in developing evidence-based practice guidelines.

PURPOSE: To explore the use of standardized language, NNN, in the development of evidence-based practice (EBP). DATA SOURCES: Published research and texts on family interventions, nursing diagnoses (NANDA-I), nursing interventions (NIC), and nursing outcomes (NOC). DATA ANALYSIS: Research literature was summarized and synthesized to determine levels of evidence for the NIC intervention Family Integrity Promotion. CONCLUSIONS: The authors advocate that a "standards of practice" category of levels of evidence be adopted for interventions not amenable to randomized controlled trials or for which a body of research has not been developed. Priorities for nursing family intervention research are identified. IMPLICATIONS FOR NURSING PRACTICE: The use of NANDA-I nursing diagnoses, NIC interventions, and NOC outcomes (NNN language) as research frameworks will facilitate the development of EBP guidelines and the use of appropriate outcome measures.

Promotion of family integrity in the acute care setting: a review of the literature.

The acute illness of 1 family member can then negatively affect all family members and lead to the disruption of family functioning and integrity. During the patient's hospitalization, nurses are in a key position to support family members, maintain family integrity, and ready them for assuming the role of caretaker during the patient's recovery and management of health at home. This article reviews current research findings that provide empirical support for activities that promote family integrity. Strategies for nurses to support family members during the hospitalization of an adult family member and suggestions for future research are provided.

An exploration of recurrent injury prevention in patients with trauma.

INTRODUCTION/PURPOSE: Individuals who have sustained an injury are also at an increased risk for recurrent injury. The purposes of this study were to explore perceptions of recurrent injury risk and prevention, factors associated with the initiation of behavioral and environmental injury prevention strategies, and barriers to injury prevention. The Health Belief Model provided the theoretical framework for this study. METHODS: In this descriptive cross-sectional study, subjects completed a semi-structured interview. Questions were designed to explore subjects' perceptions and behaviors regarding strategies to prevent recurrent injury and any injury prevention information they may have received since their injury event. SAMPLE: Thirty adults who had sustained a nonviolent unintentional injury, mean age 43, mean time since injury 4 months. RESULTS: The majority of subjects reported high levels of perceived susceptibility to injury, and a large degree of perceived control in injury prevention. Factors associated with initiation of environmental strategies included injury to a lower extremity, lower physical function scores, use of an assistive device, and higher perceived injury severity. Few barriers to injury prevention were identified. DISCUSSION/CLINICAL IMPLICATIONS: Previously injured individuals made a variety of environmental and behavioral changes to prevent recurrent injury. However, subjects' perceived susceptibility for recurrent injury and lack of injury prevention information support the need for nursing interventions designed to decrease the risk of recurrent injury.

A modified technique for anterior multilevel cervical fusion.

Anterior cervical fusion with interbody bone graft and anterior plating is commonly performed. Unfortunately, the plate has been reported to shield the graft from loading, thus reducing fusion rates. Interbody fusion cages have been effective in the lumbar spine and have gained acceptance in the cervical spine. Twenty-five patients underwent anterior cervical fusion with this modified technique. All patients received anterior diskectomy and corpectomy, placement of an interbody fusion cage packed with corpectomy bone, and application of an anterior cervical plate. Fusion was defined by radiographic evidence of trabecular bone bridging through the cage. No external bracing was used except soft collars as needed. Pre- and postoperative pain scales were completed and statistically analyzed using paired t tests. There were no cases of pseudoarthrosis or major neurological, vascular, or wound complications. There was one case of mild dysphagia that remained unresolved. Mean operative time was comparable to standard instrumented multilevel cervical fusion surgeries. Visual analogue pain scales were significantly improved following surgery. The advantages of using interbody cages with anterior plating include immediate stability and support, elimination of donor site pain from iliac crest bone autograft, and a decrease in pseudoarthrosis by halving the number of fusion surfaces.