Effect of individualized learning plans on nurse learning outcomes and risk mitigation.

INTRODUCTION: A "Primary Learner Assessment" (PLA) was created to provide an individualized learning plan, offering education as part of a 4-step computer-based process. The PLA is intended to improve learner's knowledge, skills, and patient safety perceptions, regarding interpretation of electronic fetal monitoring (EFM) data and administration of appropriate interventions in a timely fashion to mitigate fetal and maternal risks. Research was conducted to determine if learner knowledge, skills, and patient safety perceptions improved after completion of a 4-step computer-based, individualized adaptive-learning process. METHODS: Participants were registered nurses (RNs) responsible for administering and interpreting EFM, from three U.S. hospitals with labor and delivery units. This mixed method pilot study was determined to be exempt by the institutional review board; all participants provided consent. The process included four steps. In step one, RNs completed the baseline PLA. Based on incorrect quantitative and EFM interpretation responses, computer-based EFM education courses were recommended (step two). After completion of recommended courses weeks or greater of practice (step three), the RNs completed a follow-up PLA (step four). RESULTS: Of the 55 RN participants, most (85.5%) were clinical nurses, had a bachelor degree in nursing or higher (80.0%), and 11.2 average years of labor and delivery experience. There was a statistically significant improvement (P < .0001) in overall average percentage of correct PLA scores from baseline (76.7, SD = 9.1) to follow-up (82.5, SD = 6.9). Practice-related perceptions showed increased ranking of familiarity with the National Institute of Child Health and Human Development (NICHD) 2008 EFM terminology and guidelines from baseline of 49.0% to follow-up of 87.4% and of impact to which the participants integrated EFM administration and interpretation of NICHD EFM terminology and guidelines into practice from 52.8% at baseline to 94.5% at follow-up. In addition, RNs perceived improvement in their oxygen therapy competence and accuracy in interpreting EFM data with implementation of appropriate interventions. CONCLUSION: These pilot study findings support a 4-step, computer-based individualized adaptive-learning process as RNs responsible for EFM to potentially mitigate fetal and maternal risk had improved knowledge and skills. Research is warranted in larger samples.

Evaluating a psychosocial intervention for men with prostate cancer and their partners: Outcomes and lessons learned from a randomized controlled trial.

AIM: This study evaluated the process and outcome of a psychosocial intervention for men with prostate cancer and their partners. As more men survive prostate cancer, they and their partners need help and support to help them cope with the physical and psychosocial effects of the disease and treatment. There is a lack of psychosocial interventions for men with prostate cancer and their partners. METHODS: A randomized controlled trial was conducted with 34 participants to measure the effects of the intervention on selected psychosocial outcomes, post-intervention and at one month' follow-up. The nine-week program (CONNECT) consisted of three group and two telephone sessions. It focused on symptom management, sexual dysfunction, uncertainty management, positive thinking and couple communication. The outcomes, measured by validated tools were: self-efficacy, quality of life, symptom distress, communication, uncertainty and illness benefits. RESULTS: The men in the intervention group did better on two outcomes (communication and support) than controls. Partners in the intervention group did better than controls on most outcomes. Less participants than expected participated in the trial. The reasons for non-participation included partners not wishing to participate, men not interested in group work, and not understanding the core purpose of the intervention. The cost of training facilitators and for delivering the intervention appeared to be low. CONCLUSION: The knowledge generated from this study will be beneficial for all those grappling with the challenges of developing, implementing and evaluating complex psychosocial interventions. This study has also highlighted the difficulties in recruiting men and their partners in clinical trials.

District nursing workforce planning: a review of the methods.

District nursing services in Northern Ireland face increasing demands and challenges which may be responded to by effective and efficient workforce planning and development. The aim of this paper is to critically analyse district nursing workforce planning and development methods, in an attempt to find a suitable method for Northern Ireland. A systematic analysis of the literature reveals four methods: professional judgement; population-based health needs; caseload analysis and dependency-acuity. Each method has strengths and weaknesses. Professional judgement offers a 'belt and braces' approach but lacks sensitivity to fluctuating patient numbers. Population-based health needs methods develop staffing algorithms that reflect deprivation and geographical spread, but are poorly understood by district nurses. Caseload analysis promotes equitable workloads but poorly performing district nursing localities may continue if benchmarking processes only consider local data. Dependency-acuity methods provide a means of equalizing and prioritizing workload but are prone to district nurses overstating factors in patient dependency or understating carers' capability. In summary a mixed method approach is advocated to evaluate and adjust the size and mix of district nursing teams using empirically determined patient dependency and activity-based variables based on the population's health needs.

The effects of rhinitis, asthma, and acute respiratory distress syndrome as acute or chronic pulmonary conditions during pregnancy.

Pulmonary complications from both obstetrical and non-obstetrical causes contribute to a mortality rate as high as 80% in the pregnant population. The effect of numerous mechanical and biochemical physiologic alterations during pregnancy can influence the maternal and fetal outcomes in a woman with a pulmonary complication. Progesterone, the primary hormone of pregnancy, is a respiratory stimulant that enhances carbon dioxide release and alters the maternal pH in favor of releasing oxygen to the fetus. During systemic compromise, which may be experienced as an acute asthmatic attack or respiratory distress syndrome, desaturation and carbon dioxide retention ensue. Under these conditions, the fetus is at risk for perinatal hypoxemia. Although prompt recognition and treatment are important to minimize maternal, fetal, and neonatal morbidity and mortality, evidence-based literature regarding critical care techniques that promote optimal obstetrical outcomes is limited. Therefore, a collaborative approach to the care of these women is warranted. In addition to critical care, emergency medicine, and obstetrical nurses, the medical team may include an obstetrician, a perinatologist, a neonatologist, a pulmonologist, an intensivist, and an immunologist.

A systematic approach to the physiologic adaptations of pregnancy.

When a woman learns that she is pregnant, her emotions are like a roller coaster. To her, she is pregnant. She begins to plan all the things that could be and is in constant motion to await the 9 months until the arrival of her bundle of joy. However, to those of us in the perinatal nursing field, it means so much more. The pregnant woman's body goes through some profound anatomical, physiologic, and biochemical changes to adapt to and support the entire pregnancy, which ultimately support the growing fetus. Although these physiologic changes are normal, often they can be misinterpreted as disease. These changes may also unmask or worsen a preexisting condition or disease, ultimately because the pregnant woman's body cannot adequately adapt to the changes of pregnancy. It is essential to know and understand the physiology-the inner workings-of both the mother and the fetus. This includes the basic adaptations related to pregnancy, placental physiology and action, uterine activity physiology, and fetal heart rate regulation, although this article will focus on maternal and uterine physiology only.

Perianesthesia care following obstetric emergencies at risk for multisystem organ dysfunction.

Perianesthesia care provided to obstetric patients is on the rise due to current obstetric practice habits, changes in the maternal population, and the increased desire for scheduled childbirth. Both scheduled and emergent cesarean deliveries create risk, yet the use of general anesthesia increases maternal morbidity and mortality significantly. Obstetric emergencies make up the majority of emergent cesarean deliveries. Detrimental events during pregnancy and childbirth may be categorized into hemorrhagic, septic, or anaphylactic shock. Excessive loss of circulating volume with subsequent loss in oxygenation creates an environment for multisystem organ dysfunction syndrome (MODS). Both MODS and pregnancy are hyperdynamic and hypermetabolic states. Close monitoring is needed to differentiate pregnancy for the progression of organ dysfunction. Caring for pregnant women with the intent that pregnancy is a normal, physiologic state can lead to complacency and the risk of misdiagnosis. The purpose of this article is to review current obstetric emergencies that place the obstetric population at risk for MODS and offer management options to perianesthesia providers.

Intrapartum emergencies.

Intrapartum emergencies are challenging to all perinatal nurses because of the increased risk of adverse outcomes for the mother and fetus. Perinatal emergencies, such as seizures, amniotic fluid embolus, hemorrhage, and uterine rupture, create physiological challenges and trigger intrinsic survival techniques. The pregnant uterus becomes a vital source of blood volume during hypovolemic events because it is not considered a vital organ. The pregnancy itself may become burdensome, and birth may occur as an intrinsic maternal compensatory mechanism. The resultant fetal hypoxemia may also stress the fetus into initiating labor. During extensive oxygen desaturation and decompensation, the focus should be on maternal stabilization, which will subsequently enhance fetal stabilization. Clinical assessments, critical thinking, decision making, and resource allocation must be quick and appropriate to increase the likelihood of a positive outcome for the mother, fetus, and neonate.

Multiple organ dysfunction syndrome (MODS) in the obstetric population.

Multiple organ dysfunction syndrome (MODS) has the potential to negatively affect obstetric outcomes of critically ill maternity patients. This pathophysiologic condition may often be indistinguishable from that which occurs during normal pregnancy. The normal adaptations of pregnancy, in their exaggerated form, may cause functional change to become dysfunctional in the maternal patient. Although pregnancy is considered a state of health, MODS is a grave condition with terminal outcomes. Regional perfusion deficits in oxygen and global defects of volume are two potential pathologic sequelae. Many general medical and obstetric causes may be identified. An exaggerated systemic inflammatory response syndrome (SIRS) precedes this patterned process of death. This article will apply current theories, assessment, and treatment practices of MODS to the obstetrical populace.