Rural Nurse Managers' Perspectives into Better Communication Practices.

The aim of this qualitative study was to describe the communication perceptions of nurse managers in rural areas. Prior research in tertiary settings was the impetus for studying viewpoints in other settings. Grounded theory methods were used to collect and analyze interview data with nine managers from regional, critical access hospitals, and home health settings in central Pennsylvania. Nurse Managers associated successful communication with job satisfaction, work efficiency, and employee retention. Circumstances influencing communication involved discussion tones, techniques, resources, and environmental factors. Recommended techniques included regular conversations, diverse messaging, and conferencing huddles to improve information dissemination and workflow in rural settings.

A compliance assessment of midpoint formative assessments completed by APPE preceptors.

INTRODUCTION: Experiential pharmacy preceptors should provide formative and summative feedback during a learning experience. Preceptors are required to provide colleges and schools of pharmacy with assessments or evaluations of students' performance. Students and experiential programs value on-time completion of midpoint evaluations by preceptors. The objective of this study was to determine the number of on-time electronically documented formative midpoint evaluations completed by preceptors during advanced pharmacy practice experiences (APPEs). METHODS: Compliance rates of on-time electronically documented formative midpoint evaluations were reviewed by the Office of Experiential Education of a five-member consortium during the two-year study period prior to the adoption of Standards 2016. Pearson chi-square test and generalized linear models were used to determine if statistically significant differences were present. RESULTS: Average midpoint compliance rates for the two-year research period were 40.7% and 41% respectively. No statistical significance was noted comparing compliance rates for year one versus year two. However, statistical significance was present when comparing compliance rates between schools during year two. Feedback from students and preceptors pointed to the need for brief formal midpoint evaluations that require minimal time to complete, user friendly experiential management software, and methods for documenting verbal feedback through student self-reflection. CONCLUSIONS: Additional education and training to both affiliate and faculty preceptors on the importance of written formative feedback at midpoint is critical to remaining in compliance with Standards 2016.

Communication and the healthy work environment: nurse managers' perceptions.

OBJECTIVE: A qualitative design was used to decipher the viewpoints of nurse managers about communication trends associated with their leadership roles and unit subcultures. BACKGROUND: Disruptive behaviors such as poor communication and inadequate teamwork have been associated with patient harm and deficient workplace cultures. However, few studies have focused on nurse managers' perceptions of communication and a healthy workplace. METHODS: A descriptive qualitative study was conducted using 12 in-depth interviews of 6 nurse managers to better understand communication patterns of managers. Analysis identified 5 themes and 13 subthemes. RESULTS: Workplace processes were identified that either promoted or hindered managers' abilities to set a positive tone and to stay connected to their staff, ensuring effective communication while meeting multiple unit and institutional challenges. CONCLUSIONS: Findings can be used to strengthen communication practices, obviate communication disconnects, and ensure a healthy workplace.

Role of phosphodiesterase type 5 inhibitors for lower urinary tract symptoms.

OBJECTIVE: To determine the efficacy of phosphodiesterase inhibitors for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). DATA SOURCES: MEDLINE and PubMed were searched from January 1, 2000, to October 31, 2012, using the MeSH terms phosphodiesterase inhibitor, lower urinary tract symptoms, benign prostatic hyperplasia, sildenafil, vardenafil, and tadalafil. Additional articles were obtained from references identified in the original search. STUDY SELECTION AND DATA EXTRACTION: English-language randomized controlled trials and review articles were evaluated. DATA SYNTHESIS: Men with BPH commonly experience lower urinary tract symptoms (LUTS) such as urgency, frequency, nocturia, and dribbling. α-Adrenergic antagonists have been the mainstay of medical treatment of LUTS but are associated with adverse effects such as orthostatic hypotension, dizziness, and sexual dysfunction. The 5-α reductase inhibitors are associated with sexual dysfunction, and treatment effects may be delayed for 6-12 months. Phosphodiesterase type 5 (PDE-5) inhibitors are effective for the treatment of erectile dysfunction (ED), and large-scale epidemiologic studies suggest a strong link between LUTS and ED. The available PDE-5 inhibitors (sildenafil, tadalafil, and vardenafil) have shown efficacy in the treatment of LUTS in several randomized controlled trials in men with and without concomitant ED. CONCLUSIONS: PDE-5 inhibitors consistently reduce LUTS associated with BPH. These medications may offer advantages over conventional therapies such as rapid onset of action, fewer adverse effects, and enhanced sexual function. Quality of life improvements have also been realized in men with BPH who receive PDE-5 inhibitors.

Evidence-based clicker use: Audience Response Systems for rehabilitation nurses.

PURPOSE: An Audience Response System (ARS) commonly used in schools and universities was studied for its benefit in rehabilitation. Audience response systems or "clickers" are technological tools for promoting interactive learning. Clickers were studied for their applicability to clinical settings as well. METHOD: Current literature shows evidence-based research and best practices for clicker use within schools. This study expanded ARS into the rehabilitation milieu and then analyzed learner opinions and outcomes. Qualitative data was obtained from both professional and patient groups. RESULTS: Clickers were used while presenting research findings at conferences, when conducting staff seminars, and during client support groups and subsequent educational sessions. Response graphs and decision trees illustrate the flexibility of ARS for helping educators match presentation content to audience feedback. DISCUSSION: Clickers narrowed the gap between those with expertise and those with minimal experience, since immediate clarification was given according to clicker results. ARS helped to engage listeners, which is consistent with clicker research conducted in academic environments. CONCLUSION: With clickers, the knowledge and viewpoints of participants can be instantly graphed and displayed, and pertinent information can be provided in real-time. Examples from rehabilitation scenarios depict benefits of Audience Response Systems beyond academia.

Impact of advanced pharmacy practice experience placement changes in colleges and schools of pharmacy.

OBJECTIVE: To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload. METHODS: Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes). RESULTS: APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes. CONCLUSION: APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.

Urological disorders in men: urinary incontinence and benign prostatic hyperplasia.

Urinary incontinence (UI) and benign prostatic hyperplasia (BPH) are 2 common urogenital problems in men. UI is associated with involuntary leakage of urine and lower urinary tract symptoms (LUTS) of urgency, frequency, and nocturia. Types of UI include functional, urge, stress, and overflow. Treatment for UI is based on the type of incontinence, patient-specific factors, and treatment preferences of both patients and health care providers. Options for the management of UI include environmental modifications, disposable incontinence products, pelvic floor exercises, pharmacotherapy, surgically implanted devices, and intermittent catheterization. BPH may be also associated with LUTS. Patient symptoms, assessed with a measurement tool such as the American Urological Association Symptom Index (AUASI), serve as the basis for determining treatment. Management approaches for BPH include pharmacotherapy, surgery, and minimally invasive procedures. Anticholinergic drugs as well as α-receptor antagonists and 5-α reductase inhibitors, either alone or in combination, are effective and useful for LUTS unresponsive to traditional pharmacotherapy. Transurethral resection of the prostate (TURP) can eliminate symptoms of BPH but is associated with relatively more complications than other available surgical and minimally invasive procedures.

Web-based portfolios for pharmaceutical care plans during advanced pharmacy practice experiences.

OBJECTIVE: To implement and assess a Web-based patient care portfolio system for development of pharmaceutical care plans by students completing advanced pharmacy practice experiences (APPEs) throughout a statewide preceptor network. DESIGN: Using a Web database, students in APPEs documented 6 patient cases within 5 disease state categories. Through discussion of the disease states and inclusion of patient information such as problems, desired outcomes, and interventions, a complete pharmaceutical care plan was developed for each patient. ASSESSMENT: Student interventions were compared by geographical regions to assess continuity of patient care activities by students. Additionally, students completed an evaluation of the portfolio course to provide feedback on the portfolio process. Students documented an average of 1.8 therapeutic interventions per patient case and documented interventions in all geographical regions. The majority of students indicated that the portfolio process improved their ability to develop a pharmaceutical care plan. CONCLUSION: The Web-based patient care portfolio process assisted with documentation of compliance with Accreditation Council of Pharmacy Education (ACPE) standards and College of Pharmacy Competency Statements. Students indicated the portfolio process was beneficial in developing skills needed for creating pharmaceutical care plans.

Barriers to expanding advanced pharmacy practice experience site availability in an experiential education consortium.

OBJECTIVES: To compare 2006-2007 and projected 2010-2011 advanced pharmacy practice experience (APPE) availability and needs for 4 colleges and schools of pharmacy in Georgia and Alabama and to examine barriers and offer potential solutions to increase APPE site and preceptor availability. METHODS: Data on APPE needs and availability were gathered prospectively and evaluated relative to current and projected enrollment and planned programmatic changes. RESULTS: Combined 2006-2007 non-community APPE needs and availabilities were 3,590 and 4,427, respectively, with a surplus availability of 837. Combined projected 2010-2011 non-community APPEs were estimated at 4,309. Assuming 2006-2007 non-community availability remained unchanged, the surplus availability declined to 118. CONCLUSIONS: The need for quality experiential education represents a significant barrier and rate-limiting step to the matriculation of the increased numbers of pharmacists. Barriers to expanding APPE availability include: introductory pharmacy practice experience (IPPE) and APPE expansion, growth of new and existing pharmacy programs, financial instability of acute care facilities, and lack of preceptor development resources. Regional experiential education consortiums can provide a constructive approach to improve access to quality sites and preceptors through standardizing processes and leveraging resources.