The Effect of L-Carnitine on Critical Illnesses Such as Traumatic Brain Injury (TBI), Acute Kidney Injury (AKI), and Hyperammonemia (HA).

L-carnitine (LC) through diet is highly beneficial for critical patients. Studies have found that acetyl-L-carnitine (ALC) can reduce cerebral edema and neurological complications in TBI patients. It significantly improves their neurobehavioral and neurocognitive functions. ALC has also been shown to have a neuroprotective effect in cases of global and focal cerebral ischemia. Moreover, it is an effective agent in reducing nephrotoxicity by suppressing downstream mitochondrial fragmentation. LC can reduce the severity of renal ischemia-reperfusion injury, renal cast formation, tubular necrosis, iron accumulation in the tubular epithelium, CK activity, urea levels, Cr levels, and MDA levels and restore the function of enzymes such as SOD, catalase, and GPx. LC can also be administered to patients with hyperammonemia (HA), as it can suppress ammonia levels. It is important to note, however, that LC levels are dysregulated in various conditions such as aging, cirrhosis, cardiomyopathy, malnutrition, sepsis, endocrine disorders, diabetes, trauma, starvation, obesity, and medication interactions. There is limited research on the effects of LC supplementation in critical illnesses such as TBI, AKI, and HA. This scarcity of studies highlights the need for further research in this area.

Conceptualizing Student Experiences of Psychological Safety in Simulation: A Grounded Theory Study.

BACKGROUND: Simulation-based learning activities have become more prevalent in prelicensure nursing curricula. When following the Simulation Standards of Best Practice, optimal learning conditions can be achieved, including the creation of a psychologically safe learning environment. Yet, the process of how students come to feel psychologically safe during a simulation experience remains unknown. METHOD: A grounded theory approach was used to conceptualize the basic social process by which nursing students feel psychologically safe during a simulation learning experience. RESULTS: Six categories emerged from the data: (1) being nervous; (2) having a good instructor; (3) learning; (4) coming together; (5) being in debriefing; and (6) leaving on a positive note. The core category of putting myself out there emerged as the basic social process. CONCLUSION: The social process of psychological safety in simulation develops within nursing students as the result of interplay among several dimensions of the learning experience. [J Nurs Educ. 2024;63(7):427-433.].

The impact of hypertonic saline on damage control laparotomy after penetrating abdominal trauma.

PURPOSE: The inability to achieve primary fascial closure (PFC) after emergency laparotomy increases the rates of adverse outcomes including fistula formation, incisional hernia, and intraabdominal infection. Hypertonic saline (HTS) infusion improves early PFC rates and decreases time to PFC in patients undergoing damage control laparotomy (DCL) after injury. We hypothesized that in patients undergoing DCL after penetrating abdominal injury, HTS infusion would decrease the time to fascial closure as well as the volume of crystalloid required for resuscitation without inducing clinically relevant acute kidney injury (AKI) or electrolyte derangements. METHODS: We retrospectively analyzed all penetrating abdominal injury patients undergoing DCL within the University of Pennsylvania Health System (January 2015-December 2018). We compared patients who received 3% HTS at 30 mL/h (HTS) to those receiving isotonic fluid (ISO) for resuscitation while the abdominal fascia remained open. Primary outcomes were the rate of early PFC (PFC within 72 h) and time to PFC; secondary outcomes included acute kidney injury, sodium derangement, ventilator-free days, hospital length of stay (LOS), and ICU LOS. Intergroup comparisons occurred by ANOVA and Tukey's comparison, and student's t, and Fischer's exact tests, as appropriate. A Shapiro-Wilk test was performed to determine normality of distribution. RESULTS: Fifty-seven patients underwent DCL after penetrating abdominal injury (ISO n = 41, HTS n = 16). There were no significant intergroup differences in baseline characteristics or injury severity score. Mean time to fascial closure was significantly shorter in HTS (36.37 h ± 14.21 vs 59.05 h ± 50.75, p = 0.02), and the PFC rate was significantly higher in HTS (100% vs 73%, p = 0.01). Mean 24-h fluid and 48-h fluid totals were significantly less in HTS versus ISO (24 h: 5.2L ± 1.7 vs 8.6L ± 2.2, p = 0.01; 48 h: 1.3L ± 1.1 vs 2.6L ± 2.2, p = 0.008). During the first 72 h, peak sodium (Na) concentration (146.2 mEq/L ± 2.94 vs 142.8 mEq/L ± 3.67, p = 0.0017) as well as change in Na from ICU admission (5.1 mEq/L vs 2.3, p = 0.016) were significantly higher in HTS compared to ISO. Patients in the HTS group received significantly more blood in the trauma bay compared to ISO. There were no intergroup differences in intraoperative blood transfusion volume, AKI incidence, change in chloride concentration (△Cl) from ICU admit, Na to Cl gradient (Na:Cl), initial serum creatinine (Cr), peak post-operative Cr, change in creatinine concentration (△Cr) from ICU admission, creatinine clearance (CrCl), initial serum potassium (K), peak ICU K, change in K from ICU admission, initial pH, highest or lowest post-operative pH, mean hospital LOS, ICU LOS, and ventilator-free days. CONCLUSIONS: HTS infusion in patients undergoing DCL after penetrating abdominal injury decreases the time to fascial closure and led to 100% early PFC. HTS infusion also decreased resuscitative fluid volume without causing significant AKI or electrolyte derangement. HTS appears to offer a safe and effective fluid management approach in patients who sustain penetrating abdominal injury and DCL to support early PFC without inducing measurable harm. LEVEL OF EVIDENCE: Level III.

Traumatic pneumothorax: updates in diagnosis and management in the emergency department.

Pneumothorax, or air in the pleural space, is common in trauma, and has been found in up to 50% of severe polytrauma patients with chest injury. Findings associated with pneumothorax include dyspnea, chest pain, tachypnea, and absent breath sounds on lung auscultation. Although pneumothorax is traditionally diagnosed on plain film and confirmed with CT, the advent of portable ultrasonography has provided a way to rapidly diagnose pneumothorax, with a higher sensitivity than plain film. Patients with traumatic pneumothorax are typically treated with needle decompression or tube thoracostomy. However, recent literature has found that many patients can be managed conservatively via observation, or with a smaller thoracostomy such as a percutaneous pigtail catheter rather than a larger chest tube.

Development and testing of the Hogan Inventory of Bereavement short form for children and adolescents.

To reduce response burden for bereaved children and adolescents, we provide data on the development and psychometric testing of a short form of the Hogan Sibling Inventory of Bereavement (HSIB). The resulting measure of grief symptoms and personal growth was renamed the Hogan Inventory of Bereavement - Short Form (Children and Adolescents; HIB-SF-CA). Psychometric properties were evaluated in a sample of 86 bereaved siblings. Instrument development and validation research design methods were used. Evidence of strong reliability and convergent validity indicates that the 21-item HIB-SF-CA is comparable to the original 46-item HSIB in measuring grief and personal growth in this population.

A Rasch Rating Scale Analysis of the Presence of Nursing Scale-RN.

The phenomenon of nursing presence encompasses the emotional connection between nurse and patient, and technical skills performed by the nurse. The Presence of Nursing Scale-RN version (PONS-RN) was developed to measure nurses' perceptions of their ability to be present to their patients. This study summarizes the process of re-evaluation of the psychometric properties of the PONS-RN instrument. A sample of 76 registered nurses providing direct patient care responded to the 31-item questionnaire. The Rasch rating scale model was used for assessing construct validity of PONS-RN data. A principal component analysis (PCA) of residuals supported appropriateness of the subscales defined by a 2-dimensional structure. The results of item and person fit analysis, rating scale functioning analysis and reliability analysis have demonstrated that the thirty-one item Presence of Nursing Scale-RN instrument yielded measures with high validity and reliability as two sub-scales.

The bereavement process of tissue donors' family members: responses of grief, posttraumatic stress, personal growth, and ongoing attachment.

CONTEXT: Donated tissues can save lives of critically burned patients and those needing a heart valve replacement. Tissues enhance the lives of a million recipients annually through transplants of corneas, bones, tendons, and vein grafts. Unfortunately, the need for some tissues exceeds their availability. OBJECTIVE: The goal of the quantitative component of this mixed methods study was to identify the grief, posttraumatic stress, personal growth, and ongoing attachment response of tissue donors' family members during a 2-year period. DESIGN: Simultaneous mixed methods design. PARTICIPANTS: The sample for this study consisted of 52 tissue donors' family members, mostly widows (83%). DATA COLLECTION AND ANALYSIS: Data were collected for 2 years to test changes in grief, posttraumatic stress, panic behavior, personal growth, and ongoing attachment. The bereaved participants experienced significantly fewer grief reactions, less posttraumatic stress, and greater personal growth. There was no significant difference in the ongoing attachment to their deceased loved ones. CONCLUSION: The results of this study may reinforce the positive meaning that tissue donors' family members can find in tissue donation. Findings also demonstrate that the bereavement process corroborates contemporary bereavement and attachment theories. Health professionals are encouraged to seek donations with less worry that tissue donors' family members will experience adverse outcomes during bereavement.

The mentor-mentee relationship: an intricate dance.

Leadership in the mentoring of novice researchers is the focus of this column. Interviews with two senior nurse research scientists is presented in which they respond to questions about the nature of mentoring, advantages and disadvantages of the process for both the mentor and the mentee, and the necessary factors for a good mentoring relationship. Both scientists discuss their on-going work in mentoring and finally a synopsis of their thoughts is presented.

Making meaning in the legacy of tissue donation for donor families.

CONTEXT-Individuals needing lifesaving (heart valves, skin grafts for repair of critical burn injuries) and life-enhancing (corneas, bone and tendon grafts, skin, and veins) tissue donations outnumber the tissues available for transplant. OBJECTIVE-To describe the grief family members experienced 6 months after donation and to learn how family decision makers gained meaning from the decision to donate a loved one's tissues. This is phase 1 of a longitudinal study in which family decision makers will be surveyed again at 13 and 25 months after donation. DESIGN-Qualitative descriptive.Participants-One hundred seven family decision makers whose family member died a traumatic sudden death and who authorized donating tissues for transplant. DATA COLLECTION AND ANALYSIS-Data were written responses to the questions, "If you could ask or tell your dead family member something, what would it be?" and "What meaning does donating tissue to others have for you?" Data were analyzed by using content analysis procedures. RESULTS-Concepts derived from the first question represent the context of family members grieving the sudden death of a loved one. Concepts were (1) feeling empty, (2) missing and loving, (3) being grateful, and (4) having regrets. The concepts derived from the second question were (1) fulfilling their family member's wish, (2) doing the right thing, (3) believing something good came from the death, (4) helping others, and (5) living on. Reasons for donating were based, in part, on honoring the legacy of their loved ones who had given of themselves to others in life and now continued to give to others after death. CONCLUSION-The results of this study provide a basis for health professionals and donation staffs to better understand the context within which families grieve and give meaning to tissue donation.

Cross-cultural validity of the Individualised Care Scale - a Rasch model analysis.

AIMS AND OBJECTIVES: The aim of this study was to investigate, using Rasch model analysis, the measurement invariance of the item ratings of the Individualised Care Scale. BACKGROUND: Evidence of reliability is needed in cross-cultural comparative studies. To be used in different cultures and languages, the items must function the same way. DESIGN: A methodological and comparative design. METHODS: Secondary analysis of data, gathered in 2005-2006 from a cross-cultural survey using the Individualised Care Scale from Finnish, Greek, Swedish and English predischarge hospitalised orthopaedic and trauma patients (n = 1093), was used. The Rasch model, which produces calibrations (item locations and rank) and item fit statistics, was computed using the Winstep program. RESULTS: The rank of average Individualised Care Scale item calibrations (-2·26-1·52) followed a generally similar trend (Infit ≤ 1·3), but slight differences in the item rank by country were found and some item misfit was identified within the same items. There was some variation in the order and location of some Individualised Care Scale items for individual countries, but the overall pattern of item calibration was generally corresponding. CONCLUSIONS: The Rasch model provided information about the appropriateness, sensitivity and item function in different cultures providing more in-depth information about the psychometric properties of the Individualised Care Scale instrument. Comparison of the four versions of the Individualised Care Scale - patient revealed general correspondence in the item calibration patterns although slight differences in the rank order of the items were found. Some items showed also a slight misfit. Based on these results, the phrasing and targeting of some items should be considered. RELEVANCE TO CLINICAL PRACTICE: The Individualised Care Scale - Patient version can be used in cross-cultural studies for the measurement of patients' perceptions of individualised care. Information obtained with the use of the Individualised Care Scale in clinical nursing practice is important, and valid measures are needed in evaluating patients' assessment of individualised care, one indicator of care quality.

Development and psychometric testing of the Spiritual Care Inventory instrument.

AIM: This article is a report of the development and psychometric testing of the Spiritual Care Inventory. BACKGROUND: Research supporting the positive association between spirituality and health has lead to interest in providing spiritual care in healthcare settings. Few instruments exist that measure the provision of spiritual care. METHOD: In February/March 2007, a convenience sample of 298 adult and paediatric acute care, ambulatory, home health, hospice staff and rehab nurses at two hospitals (n = 248) and graduate students at a school of nursing (n = 50) completed a 48-item initial version of the Spiritual Care Inventory. In study 2 from July through August 2007, 78 staff nurses at one hospital (n = 30) and a different cohort of graduate students at a school of nursing (n = 48) completed the 18-item second version of the Spiritual Care Inventory. RESULTS: Exploratory factor analysis in study 1 supported a 3-factor solution (spiritual care interventions, meaning making and faith rituals) with internal consistency measures for the subscales above 0·80. In study 2, internal consistency remained high. CONCLUSION: Factor structures identify that spiritual care is a process of intervention, meaning making and faith rituals.

Impact of patient characteristics on orthopaedic and trauma patients' perceptions of individualised nursing care.

RATIONALE AND OBJECTIVES: Relatively few studies have investigated the relationship between patient characteristics and individualised care, in relation to the improvement of care efficiency, efficacy and quality. Individualised care is a key concept in health strategy and policy in Western countries. The aim of this exploratory study was to identify orthopaedic and trauma patients' characteristics relating to their perceptions of individualised nursing care in Western hospital settings. METHODS: A cross-sectional questionnaire survey was conducted among orthopaedic and trauma patients (n=1126) from acute care in hospitals from five countries: Finland, Greece, Sweden, the UK and the USA, in 2005-06. The data were analysed using descriptive statistics, one-way analysis of variance and a multivariate analysis of variance (manova) of the main effects. RESULTS: The separate examination of each background factor showed statistically significant differences between patients' perceptions of individualised care. In the multivariate analysis the statistically significant main effects, associated with patients' perceptions, were age, gender, education and type of admission. These explained 13% of the variance in the support of patient individuality in care and 19% in perceived individuality in care received. CONCLUSIONS: These results can be used in individualising care to different patient groups and in prioritising and focusing quality programs to improve care. Detailed questions about specific aspects of patients' experiences are likely to be more useful in monitoring hospital performance from the patients' perspective.

Making sure: registered nurses watching over their patients.

BACKGROUND: Surveillance has been identified as an important patient quality and safety intervention, but the process used by registered nurses as they perform this function with their hospitalized patients on a single work shift has not been conceptualized or studied. OBJECTIVE: The purpose of this study was to generate a substantive theory of the process used by hospital registered nurses as they watch over their assigned patients during a work shift. METHODS: Classical grounded theory was used to generate the substantive theory. Fifteen registered nurses from a variety of hospital patient care settings were interviewed to determine the process they used to watch over their assigned patients during a work shift and the conditions that facilitated or hindered their abilities to watch over their patients. RESULTS: Making Sure emerged as the basic social process used by registered nurses as they watch over their assigned patients during a single work shift. Making Sure was conceptualized as a process involving six categories: (a) knowing what's going on and (b) being close set conditions for (c) watching in which the nurse is (d) not taking anything for granted. As necessary, (e) taking action occurs to achieve the outcome of this process, (f) protecting patients from harm and negative events to the extent possible. As more information about the patient is obtained through the process, this information is incorporated into the knowing what's going on category. CONCLUSIONS: The results of this study provide the theoretical basis for the process used by registered nurses as they watch over their patients on a work shift and provide insight into one of the key nursing care processes that may impact patient outcomes. Measures should be developed to operationalize the concepts of the theory and to conduct quantitative testing of the theory.

Adapting the Individualized Care Scale for cross-cultural comparison.

RATIONALE: Cross-cultural comparative studies using reliable and valid instruments can increase awareness of the differences and similarities between health worker's ability to respond to patients' individual needs within different health systems. This will enable a better understanding of cultural perspectives in individualized nursing care. AIM: To describe the translation and adaptation process of the Individualized Care Scale (ICS) and examine its reliability and validity in a cross-cultural study. DESIGN: A cross-sectional comparative study. SETTINGS: Twenty-seven orthopaedic and trauma in-patient units at 14 hospitals in 5 countries. PARTICIPANTS: A total of 1126 patients were included in the study: Finland (n = 425), Greece (n = 315), Sweden (n = 218), UK (n = 135) and USA (n = 33). METHODS: A systematic forward- and back-translation procedure using bilingual techniques, a committee approach, pretest techniques and pilot testing were used with a convenience sample to produce a valid ICS for each participating group. Psychometric evaluation of the adapted ICS was based on means, SD, missing data analysis, Cronbach's alpha coefficients and average inter-item correlations. Construct validity was examined using sub-scale correlations to total scales and principal components analysis. RESULTS: The use of the range of options and the sub-scale mean scores ranging from 2.72 to 4.30 demonstrated the sensitivity of the scale. Cronbach's alpha coefficients (0.77-0.97) and average inter-item correlations (0.37-0.77) were acceptable. The sub-scale correlations to total scales were high (0.83-0.97). The underlying theoretical construct of the ICS was demonstrated by the explained variances ranging from 58% to 79%. CONCLUSIONS: The ICS shows promise as a tool for evaluating individualized care in European cultures. The international expansion of an existing instrument developed for one country facilitates comparative studies across countries. There is a need to further test the construct validity and appropriateness of the ICS in different settings in European and nonwestern cultures.

European orthopaedic and trauma patients' perceptions of nursing care: a comparative study.

AIM: To compare English, Finnish, Greek and Swedish orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. BACKGROUND: Patient perceptions are important when evaluating nursing care delivery. Evaluations usually take place sub-nationally though European citizens may be treated throughout the European Union. International comparative studies are possible because of the universal nature and philosophical roots of quality in nursing care. They are needed to assist in improving care outcomes. DESIGN: A cross-sectional, comparative study design was used. METHOD: The Schmidt Perception of Nursing Care Survey was used to obtain data from orthopaedic and trauma patients in acute hospitals in four countries: Finland (n = 425, response rate 85%), Greece (n = 315, 86%), Sweden (n = 218, 73%) and UK (n = 135, 85%). Data were first analysed using descriptive statistics, then between-country comparisons were computed inferentially using a one-way analysis of variance and a univariate analysis of covariance. RESULTS: Between-country differences were found in patients' perceptions of the nursing care received. Over the whole Schmidt Perception of Nursing Care Survey the Swedish and Finnish patients gave their care the highest assessments and the Greek patients the lowest. The same trend was seen in each of the four sub-scales: Seeing The Individual Patient, Explaining, Responding and Watching. Responding was given the highest assessments in each participating country and Seeing the Individual Patient the lowest except in Greece. CONCLUSIONS: Further research is needed to consider whether the between-country differences found are caused by differences between cultures, nursing practices, roles of healthcare personnel or patients in the different countries. The Schmidt Perception of Nursing Care Survey is suitable for the assessment of European orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. RELEVANCE TO CLINICAL PRACTICE: The results are useful in evaluating and developing nursing care in hospitals from different European countries.

Measuring individualized nursing care: assessment of reliability and validity of three scales.

AIM: This paper is a report of a study to assess the reliability and convergent validity of three measures of nursing care individualization. BACKGROUND: Individualized care is a key element of nursing care quality, yet little is known about the extent to which it is implemented, its effects, and the factors that help or hinder nurses in giving individualized care. Therefore reliable and valid instruments are needed to measure individualized nursing care. METHOD: A cross-sectional correlational survey design was used. The purposive sample consisted of 861 patients from six hospitals in Finland (response rate 82%). Data were collected in 2004. The Individualized Care Scale was administered simultaneously with translated versions of the Schmidt's Perceptions of Nursing Care Survey and the Oncology Patients' Perceptions of the Quality of Nursing Care Scale. Internal consistency reliability and convergent validity were assessed for each scale. FINDINGS: Evidence for convergent validity was identified between the Individualized Care Scale (part A/B), the Individualization subscale (r = 0.64 with Part A, r = 0.66 with part B) and the Seeing the Individual Patient subscale (r = 0.68 with part A, r = 0.71 with part B). Cronbach alpha coefficient was 0.97 for the Individualized Care Scale, 0.82 for Seeing the Individual Patient and 0.87 for the Individualization subscale. CONCLUSION: Data provided preliminary evidence for the convergent validity of the individualized care scales, as well as acceptable internal consistency reliability for each scale. These scales represent useful measures for assessing patients' perceptions of the individualization of nursing care received.

Telecare for women with postpartum depression.

Data were collected to pilot test the feasibility and effects of telecare as an intervention for depression in a small group of mothers with postpartum depression. Treatment involved a 10-week telecare therapy consisting of three related aspects: cognitive-behavioral therapy, relaxation techniques, and problem-solving strategies. Beck Depression Inventory II scores were significantly lower after telecare treatment. Women identified psycho-education as the greatest help to them.

Lowering stress while teaching research: a creative arts intervention in the classroom.

Undergraduate students often request "hands-on" research experience but seldom have the time and opportunity during a one-semester introductory course to participate in such a project. The purposes of this educational approach, implemented during a beginning research class for baccalaureate nursing students, were to provide an opportunity for students to participate in an experimental research study, and test the effect of a creative arts intervention on students' stress, anxiety, and emotions. Students designed, participated in, and analyzed the results of the project. The intervention significantly reduced stress and anxiety and increased positive emotions in this student population, while providing a creative research experience. For future use, the intervention may be helpful with a variety of vulnerable groups.