Effect of Loratadine for Pegfilgrastim-Induced Bone Pain.

AIMS: Breast cancer patients on chemotherapy who receive pegfilgrastim to prevent neutropenia may experience severe bone pain as a side effect. Traditional treatment recommendations include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioids, and/or antihistamine use. However, little research was found comparing these interventions. The study aim was to address the gaps in literature and to explore the use of and perceived effectiveness of loratadine versus acetaminophen or NSAIDs in women with breast cancer treated with pegfilgrastim. This study also sought to understand how patients became aware of loratadine or other treatments for management of bone pain. DESIGN/METHODS: This cross-sectional study used survey methods to collect data from 66 adult female breast cancer patients receiving chemotherapy with pegfilgrastim. RESULTS: The incidence of bone pain was 45% (n = 30) in our sample, but more than half (n = 45; 69%) of the women took either acetaminophen, NSAIDs, or loratadine alone or in combination to prevent bone pain. All medication were rated as effective by patients, with acetaminophen slightly more effective than loratadine, and loratadine more effective than NSAIDs. CONCLUSIONS: Acetaminophen, NSAIDs, and loratadine are easily available and inexpensive. However, unlike acetaminophen and NSAIDs, loratadine is dosed once a day and well tolerated with minimal adverse effects. CLINICAL IMPLICATIONS: Randomized controlled trials are needed to adequately assess the effectiveness of all three medication options. Because little is known about optimal use of any of these medications for pegfilgrastim-induced bone pain, it is also important to identify the optimal time to initiate treatment and ideal treatment duration.

The effect of active distraction compared to midazolam in preschool children in the perioperative setting: A randomized controlled trial.

PURPOSE: The primary purpose of this study was to compare the effect of active distraction to midazolam as a non-pharmacological method of reducing preoperative anxiety in preschool children. A secondary purpose was to compare emergence delirium, sedation/agitation, and length of stay between groups. DESIGN AND METHODS: Preschool children (N = 99) scheduled for elective surgery participated in this 2-group randomized controlled trial: the active distraction (tablet) group (n = 52) had unlimited playtime with a tablet and the midazolam group (n = 47) were medicated approximately 10 min before mask induced anesthesia. Data were collected using the modified Yale Preoperative Anxiety Scale, Pediatric Anesthesia Emergence Delirium scale, and Richmond Agitation Sedation Score. Length of stay (LOS) was measured in minutes from PACU admission to discharge. Wilcoxon rank sum, Pearson's chi square, and Fischer's exact tests were used in analysis. RESULTS: Preschool children (3-5 years old), predominantly male (61%) and White (85%) presented for ear, nose, throat, ophthalmology, urology, and general surgery at a pediatric surgical center within a large Midwestern hospital. There was no significant difference in anxiety, emergence delirium, or sedation/agitation scores between midazolam and tablet groups. Children assigned to the tablet group had shorter LOS (p = 0.021). CONCLUSION: Active distraction with a tablet as an anxiolytic was as effective as midazolam for pre-school aged children with no side effects and reduced length of stay. PRACTICE IMPLICATIONS: Preoperatively, non-pharmacological methods such as active distraction with a tablet should be considered for preschool children as an alternative to medication.

Academic Faculty Shadowing Their Graduate Nurses: A Case Study.

AIM: The purpose of this study was to describe insights gained by academic nursing faculty after shadowing one of their new graduate nurses. BACKGROUND: Shadowing experiences have been successfully used to orient students and new nurses to the role and reality of clinical practice. However, no studies were found on the experience of faculty shadowing a new graduate. This study addressed that gap. METHOD: A case series design and methodology used both qualitative and quantitative data collection procedures. Qualitative data were derived from faculty during a debriefing session; quantitative data were obtained from a short survey completed by new graduates and faculty. RESULTS: Faculty identified challenges faced by new graduates and opportunities to modify their nursing programs by addressing patient care delivery, time management, communication, and role ambiguity in more detail. CONCLUSION: A shadowing experience for academic faculty leaders can help bridge the academic-practice gap and promote collaborative efforts to improve preparation for practice.

From the Patient's Perspective: Orthopedic Virtual Rounds.

Interdisciplinary rounding on hospital inpatients is an integral part of providing high-quality, safe patient care. As orthopedic groups have grown and geographic coverage increased, surgeons are challenged to make in-person rounds on their patients every day given time constraints and physical distances. Virtual technology is being used in multiple healthcare settings to provide patients with the opportunity to connect with health care professionals when in-person options are not available. The purpose of this study was to explore the patient experience of virtual inpatient rounding. Using digital communication technology, virtual rounds were conducted by having the surgeon connect via their mobile device or laptop to the nursing unit's communication tablet. Twenty-seven patient interviews were digitally recorded and qualitatively analyzed. Results demonstrated that virtual rounds provided a positive patient experience for many. Most patients felt that virtual rounds were a good alternative when in-person rounds are not possible. Dissatisfaction was related to feeling "rushed" by the surgeon. This feedback can be used to better prepare patients and providers for virtual rounds and to enhance virtual technologies.

A descriptive study of factors that facilitate nurses' participation in shared governance and attendance at unit meetings.

AIM: To identify factors that facilitate participation in shared governance and attendance at unit meetings. BACKGROUND: Shared governance and unit meetings are crucial for education and communication. Current literature explores barriers to participation and attendance; however, removal of barriers may be insufficient to bring about behaviour change in nurses. METHOD: Secondary analysis of data from 511 clinical nurses, who worked at one of nine facilities within one large health care system in the Midwest United States, was used to address our aim. RESULTS: Shared governance participants and unit meeting attendees were most satisfied with nursing as a career and more likely to be optimistic that nurses could change things, than non-participants and non-attendees, and this difference was statistically significant (p < .05). The organizational variable most associated with participation and attendance dealt with paid time-off to attend meetings. Personal reasons for participation and attendance were the opportunity to express opinions and to hear opinions of others. CONCLUSION: Organizations should encourage nurses to express their opinions and ensure that nurses are paid for the time spent participating in meetings. IMPLICATIONS FOR NURSING MANAGEMENT: While some variables cannot be controlled by organizations, nursing leadership can provide opportunities for nurses to become more active and participate in decision-making.

Complementary and alternative therapies (CAT) in academic programs and nursing practice: Is more education is needed?

BACKGROUND AND PURPOSE: Use of CAT has increased in the past decade. However, it is unclear if this has impacted nursing practice. The purpose of this study was to explore CAT use and beliefs of academic and clinical nurses. MATERIALS AND METHODS: A cross-sectional design using an electronic survey was sent to 1000 clinical and academic nurses in the US. RESULTS: Academic and clinical nurses were more alike than different, and of the contextual factors that impacted CAT use, lack of knowledge was most cited. Faculty were most likely to teach that which they were knowledgeable about and nurses were most likely to use what was taught in school. CONCLUSIONS: There is a need for a standardized CAT curriculum for schools of nursing in the US to facilitate knowledge and use of CAT, but to also train nurse scientists who can develop the clinical research needed to support practice decisions.