A Practical Guide to Implementing an Evidenced-Based Hands-On Naloxone Training.

Synthetic opioids contribute to the majority of opioid overdose-related deaths in the United States. Expansion of naloxone training to community laypersons is one strategy to mitigate opioid overdose-related deaths. A hands-on naloxone training demonstrated efficacy in improving opioid knowledge and overdose response in baccalaureate nursing students, Greek-affiliated students, and rural clinicians and staff post-training. The purpose of this practical guide is to provide detailed steps to implement an evidence-based hands-on naloxone training for laypersons in community settings. The hands-on naloxone training consisted of five components: evaluator training, a validated pre-post opioid knowledge questionnaire, an opioid lecture, a performance evaluation, and a satisfaction survey. Post-training, trainees demonstrated increased knowledge related to opioids and overdose response, and they felt comfortable administering naloxone to someone experiencing an opioid overdose. Researchers, educators, and community health nurses can adapt this evidence-based practical guide to train peers and acquaintances who are likely to witness an opioid overdose. Virtual training and multi-lingual protocols should be considered to successfully train diverse groups of community laypersons. An active hands-on naloxone training can improve confidence for community health nurses and other health care professionals, and it may reduce delays in response time and naloxone administration. Nurses can use this hands-on training to educate students, families, community members, and stakeholders how to respond to an opioid overdose event.

Antihypertensive Teach-Back to Reduce Delays, Cancellations, and Interventions in a Freestanding Gastroenterology Clinic.

The purpose of this study was improving patient compliance with the 2014 American College of Cardiologists/American Heart Association Joint Task Force Clinical Practice Guidelines recommendation regarding continuation of antihypertensive medications throughout the perioperative period. A patient education initiative, using the teach-back method of instruction, was implemented and evaluated. Effectiveness of instruction was measured by tracking hypertension requiring pharmacological intervention, procedure delay, and procedure cancellation. Pre- and postintervention data were collected from electronic health records using a retrospective cohort design. A χ 2 analysis compared pre- and postintervention groups. The p value was calculated using the χ 2 analysis, (χ 2 [1, N = 1,044] = 7.71, p = .00548). No incidence of case delay or cancellation was experienced in either test group. Incidence of patients requiring preprocedural pharmacological intervention decreased by 70.5%. Statistically significant decreases in pharmacological treatment of hypertension supported permanent inclusion of the antihypertensive patient teaching method at the project gastroenterology clinic.

An exploratory study of a hands-on naloxone training for rural clinicians and staff.

INTRODUCTION: Since the COVID-19 pandemic, an increase in fentanyl-combined drugs has led to a surge in opioid overdose deaths in the United States. Higher opioid overdose mortality rates are problematic in rural communities, and there are few prevention, treatment, and recovery resources for individuals experiencing opioid use disorder. METHOD: This exploratory project aimed to investigate a hands-on naloxone training for rural clinicians and staff. Rural clinicians and staff at two behavioral health centers were recruited to participate in a 30-min lecture and 30-min hands-on intranasal naloxone training using a low-fidelity mannequin. A pre-post opioid knowledge questionnaire, rubric based on the Substance Abuse and Mental Health Services Administration toolkit, and investigator-generated survey were used to evaluate opioid knowledge and response, demonstration of intranasal naloxone administration, and participants' perceptions of the training. Enrollment characteristics were summarized using descriptive statistics and paired t-tests were used to assess mean differences. RESULTS: Of the nine participants in the project, seven (87.5%) were female and six (75.0%) were Black. Four participants assumed a therapist role, attained a MS or MA degree, and had 5 or more years of experience working in healthcare. The total mean rubric score for all participants was 96.0 (SD = 8.8). No significant pre-post mean differences among opioid knowledge, overdose risk, and overdose response categories were found, all p > 0.05. However, post-intervention mean scores were slightly higher in all categories except overdose risk. Most participants (77.8%) responded that they felt comfortable handling an opioid situation and teaching the training to community members. Open-ended responses indicated that participants liked the demonstrations, examples used, hands-on nature of the training, and the presentation materials. CONCLUSION: A hands-on naloxone training is beneficial for training rural clinicians and staff to respond to opioid overdose. This training may be a promising solution to reduce response time between recognition of opioid symptoms and administration of the life-saving medication, naloxone. Future studies should examine the efficacy of this training in larger samples with the inclusion of rural interdisciplinary teams, trusted community leaders, and family and friends of those impacted by opioid use disorder. CLINICAL RELEVANCE: This innovative hands-on naloxone training is designed for rural clinicians and residents who are most likely to witness individuals experiencing opioid toxicity. The primary goal is to reduce response time between recognition of signs and symptoms and administration of the life-saving medication, Naloxone.

Down Syndrome: A Review of Key Perioperative Implications.

Down syndrome (DS) is the most common chromosomal abnormality in humans that is compatible with life. This syndrome occurs when there is an extra copy of the 21st chromosome. Down syndrome is associated with numerous comorbidities that can pose challenges for the perioperative nurse caring for a patient with DS undergoing surgery. These challenges can affect the patient assessment, communication with the patient, and patient safety (eg, preventing complications). As the life expectancy of people with DS has increased, so too have the chances that perioperative nurses will care for a patient with this disorder. This article reviews the pathophysiology of DS, discusses common comorbidities that may directly affect perioperative care, and reviews an exemplar case study that demonstrates how personnel with knowledge of DS can positively influence surgical team decision making for these patients in the perioperative setting.

Reducing Hypothermia After Cardiac Ablation Using the ASPAN Normothermia Guidelines.

PURPOSE: The purpose of this quality improvement project was to determine if the integration of the ASPAN 2010 Normothermia Guidelines would reduce postprocedural hypothermia and recovery time in patients undergoing cardiac ablation under general anesthesia. DESIGN: A retrospective cohort design over a continuous 12-week period was used. METHODS: Fifty-five patients were divided into 2 groups. The preintervention group (n = 26) consisted of patients who received care over a 6-week period before the implementation of the ASPAN 2010 Normothermia Guidelines. The postintervention group (n = 29) included patients who received care for 6 weeks with guidelines in place. An electronic health record review of cardiac ablation patients was conducted to compare the difference in PACU discharge times, the occurrence of hypothermia, and how well body temperature was maintained between the groups. FINDINGS: Hypothermia was detected in 3.85% of the preintervention group, while there was none in the postintervention group. Compared with the preintervention group (M = 53.6 minutes, SD = 18), patients meeting inclusion criteria in the postintervention group (M = 44.73 minutes, SD = 9.78) spent less time recovering from anesthesia in PACU; t(42) = 2.03, P = .048. Body temperatures in the preintervention group (M = -0.068°C, SD = 0.456) fell throughout the perioperative period while the postintervention group's temperature (M = 0.154°C, SD = 0.275) was higher following cardiac ablation; t (41) = -2.13, P= .04. CONCLUSIONS: The ASPAN 2010 Normothermia Guidelines reduced recovery time and mitigated changes in patient temperatures throughout the periprocedure period in patients undergoing cardiac ablation under general anesthesia.

Opioids: Understanding How Acute Actions Impact Chronic Consequences.

In the last decade, critical-care nurses have seen a surge in acute opioid overdose admissions to intensive care units; there have also been significant increases in intensive care unit admissions due to opioid-related illness such as dependence, tolerance, and hyperalgesia. Despite these issues, opioids continue to be the criterion standard of pain management, and the search for opioid alternatives has not produced a clear replacement. A contributor to this problem has been the prevailing opinion that once bound to a receptor, all opioids engaged in the same types of intracellular signaling, which resulted in the same types of responses, only differing in the magnitude of those responses. Contemporary research with G-protein-coupled receptor models (eg, opioids) has demonstrated that this oversimplification is incorrect or incomplete. Understanding the complexity of opioid pharmacodynamics and pharmacokinetics helps us to grasp the intricacies of opioid-related adverse effects. Although there are many potential adverse effects related to opioids, this review focuses on the major adverse effects commonly seen in critical care, namely, respiratory depression, tolerance, hyperalgesia, and central sensitization. In addition, a case study has been incorporated to aid in understanding of strategies nurses can incorporate into their practices: that help mitigate the development of these effects.

An Opioid Education Program for Baccalaureate Nursing Students.

BACKGROUND: Unintentional drug overdose is the leading cause of accidental death in the United States. Previous research identified training health caregivers in the rescue medication naloxone as a strategy to prevent death from opioid overdose. Existing research on naloxone training with nursing students is limited. This educational research project investigated whether training on opioids, opioid toxicity, and overdose response could impact student knowledge, skills, and confidence responding to overdoses. METHOD: Data were collected from baccalaureate nursing students using three sources: the Brief Opioid Overdose Knowledge questionnaire, a rubric based on the Substance Abuse and Mental Health Services Administration opioid overdose prevention toolkit, and a researcher-developed evaluation. RESULTS: Planned repeated-measures analyses of variance conducted on data from 284 baccalaureate students indicated high uptake of knowledge and skills for opioid toxicity and naloxone administration. Results were maintained with slight enhancement at 1 week, and training was highly rated. Cohort analysis suggests efficacy across semesters. CONCLUSION: Education improved student opioid knowledge, skills, and confidence and was relevant across undergraduate nursing curricula.

Thrombocytopenia: Effect in Ischemic and Hemorrhagic Stroke.

BACKGROUND: There are 2 classification of strokes: ischemic, if caused by an arterial occlusion from a clot or obstruction by atherosclerosis, and hemorrhagic, if caused by the rupture of a vessel and subsequent bleeding. Each type of stroke is influenced by platelet counts and platelet function. The intention of this article is to discuss the role of the platelet in the pathophysiology of acute stroke processes. This serves as a prelude to discussing these processes as disrupted with thrombocytopenia (low platelet counts). Platelets initiate clot formation and obstruct blood flow through the creation of a platelet plug. They also extend the penumbra in ischemic and hemorrhagic strokes. Thrombocytopenia can be a causal factor in an ischemic stroke, a risk factor for hemorrhagic stroke, and a risk factor for hemorrhagic stroke conversion. METHODS: The aims of this study were to review 1 case study that illustrates the pivotal role of the platelet in strokes and to review the aspect that was impacted by autoimmune thrombocytopenia. DISCUSSION: Thrombocytopenia is a hematologic disorder not often included in stroke care discussions. Thrombocytopenia sets up strokes to occur and, paradoxically, may also set the patient up for bleeding complications in the brain or groin. CONCLUSION: Acknowledging the impact of both platelet and thrombocytopenia on stroke causation, stroke interventions, and outcomes is a pivotal aspect of comprehensive stroke care. Platelet function processes are impactful in each point of the continuum of stroke care, prevention, intervention, and discharge.

Herbal Medications Used to Treat Fever.

Fever is a natural body defense and a common symptom of disease. Herbs have been used for thousands of years to treat fever. Many herbs have anti-inflammatory properties. Some are useful in reducing the release of cytokines and mediators of inflammation, whereas others work as natural aspirins to inhibit cyclooxygenase. In addition, herbs have known antipathogenic properties and can be effective in the treatment of infection from numerous microorganisms. Last, in traditional Chinese medicine, herbs are used to restore imbalances between the nonpathogenic and the pathogenic clearing interior heat and treating heat patterns in a variety of ways.

Tolvaptan for Autosomal Dominant Polycystic Kidney Disease: Pharmacokinetics and Implications for Practice.

Autosomal dominant polycystic kidney disease (ADPKD) is incurable and occurs once in every 1,000 births. Confirmation of AKPKD is made through imaging and a positive family history. Symptoms typically appear in mid-life and include kidney, side, and/or back pain related to the rupture of kidney cysts, renal stones, infection, pressure of cysts against other organs, and stretching of the renal capsule. In addition to end stage renal disease, cerebral aneurysm may also be a threat to individuals with this diagnosis. Recent clinical trials have shown that tolvaptan, a vasopressin-2 receptor antagonist, produced a moderate to significant reduction in total kidney volume and improved function, leading to its recent approval by the U.S. Federal Drug Administration for treatment of patients with ADPKD. This article provides a comprehensive look at the pathophysiology of ADPKD, pharmacokinetics and pharmacodynamics of tolvaptan, and tolvaptan's clinical implications, effects, and contraindications. In addition, we present a case study discussing tolvaptan's clinical usefulness and address patient concerns in an adult presenting with rapidly progressing ADPKD.

Bone Cement Implantation Syndrome: Key Concepts for Perioperative Nurses.

Bone cement implantation syndrome (BCIS) is a potentially fatal complication of orthopedic surgeries that use cement. The symptoms of BCIS occur primarily during femoral fracture repairs, but this complication has been reported in a wide variety of cemented procedures. Clinical presentation of this syndrome begins as a cascade with hypoxia and hypotension; if it is not reversed, it ends with right-sided heart failure and cardiac arrest. This syndrome usually occurs at cementation, prosthesis insertion, joint reduction, or tourniquet deflation, and should be treated with aggressive resuscitation and supportive care. This article provides a comprehensive explanation of bone cement, the identification and management of BCIS, and the roles of the perioperative team in the event of cardiopulmonary collapse. It includes a case study that can be used as an educational tool for simulation, mock drills, or staff meetings; it also may be used as a framework for creating policies.

Understanding Bone Cement Implantation Syndrome.

Bone cement implantation syndrome (BCIS) is a rare and potentially fatal perioperative complication of cemented bone surgery. Clinically, it can be as benign as transient desaturation or mild hypotension. In its more severe presentation, BCIS can cause serious cardiac dysrhythmias and cardiac arrest, and in cemented hemiarthroplasty for femoral neck fracture, BCIS may carry up to a 16-fold increase in 30-day postoperative mortality. The etiology and pathophysiology of BCIS are not fully established; however, results of studies and clinical reports are consistent, citing right ventricular failure secondary to increased pulmonary artery pressure as the cause of systemic hypotension and sudden cardiac arrest. The purpose of this article was to review the literature for a comprehensive understanding of bone cement and BCIS. This article reviews the history of bone cement and its associated hazards, etiology/ pathophysiology and clinical presentation of BCIS, preoperative assessment and planning for cemented procedures, anesthetic management of BCIS, and the surgeon's role in reducing the risk of BCIS.

Clinical Judgment Scripts as a Strategy to Foster Clinical Judgments.

BACKGROUND: Clinical judgment encompasses how nurses use their knowledge of the patient to generate, assess, and prioritize patient care alternatives. Previous research has identified debriefing as critical to developing clinical judgment. Best practice for debriefing has yet to be identified. The purpose of this research was to investigate whether a standard debriefing script, based on Tanner's clinical judgment model, could foster clinical judgment. METHOD: Participants were senior nursing students in their final semester of study. Data were gathered and analyzed from three sources: independent raters observing students in simulation, participating students, and the students' clinical instructors. RESULTS: Students identified the script as an effective debriefing tool, and significant improvements were observed in clinical judgment scores from all data sources. CONCLUSION: The standardized debriefing script helped students focus on the learning process, resulting in student improvement in all areas of clinical judgment: noticing, interpreting, responding, and reflecting. [J Nurs Educ. 2016;55(12):691-695.].