Beliefs and Decision-Making of First-Time Mothers Planning to Use a Breast Pump.

Beliefs and decision-making processes associated with breast pump use in first-time mothers providing human milk to healthy, term newborns soon after birth are explored in this qualitative, descriptive study. Eight women participated in an individual semistructured interview in a community hospital in the southeastern United States. Guided by the theory of planned behavior, conventional content analysis about prenatal and early postpartum beliefs of planning and utilizing breast pumps yielded themes of Resource Gathering, Intention Refining, and Behavior Navigating. An understanding of these beliefs gives insight into ways health professionals can increase collaboration with expectant and new mothers about the selection and safe use of breast pumps, resource availability at various stages, and infant-feeding goals.

Is Perception Reality? Using Person-in-Context Simulation to Promote Empathic Understanding of Dementia Among Nurse Practitioner Students.

ABSTRACT: This one-group nonexperimental pretest/posttest repeated-measures design plus interpretative phenomenological analysis explored nurse practitioner students' perceptions of dementia using virtual simulation. Perceptions of dementia and its associated challenges differed after the simulation. A critical theme that emerged was "developing empathic understanding"; the two subthemes were "mirroring dementia behaviors" and "provoking emotions." Virtual dementia simulation is an inexpensive, low-fidelity strategy to challenge assumptions and preconceived belief systems about dementia. Person-in-context experiential learning is valuable in nurse practitioner education for facilitating empathic understanding. Further research is needed to explore the correlation between empathic understanding and altruistic helping behaviors in professional practice.

Digital Storytelling: A Qualitative Study Exploring the Benefits, Challenges, and Solutions.

Many years ago, the National League for Nursing voiced the need to improve nursing education through innovative pedagogies supported by research. Digital stories are one of the newest pedagogical tools using storytelling in the digital world. This descriptive qualitative study reports the benefits, challenges, and solutions of digital story use in nursing education. Twelve nurse educators from Europe and the United States who had published or demonstrated use of digital stories in the classroom were recruited and interviewed. Data analysis revealed themes about the benefits and challenges associated with digital story use. The benefits identified were a greater depth of discussion, making points, engaging students, and promoting reflection and empathy. Development of critical thinking and the use of information technology skills were also identified. Challenges associated with digital stories included finding an appropriate digital story, legal issues involved, and the ability to assess student learning. Time in class to show digital stories and recognition of intended points by students were also uncovered. Solutions to some of these issues are also presented. This study revealed that the new pedagogy of digital stories engages students in the learning process.

Family Influences on Patients' Decisions to Undergo Bariatric Surgery.

Bariatric surgery is the treatment of choice for many obese patients. Although bariatric surgery has recognized benefits, some patients wait several years before deciding to proceed and many patients rely on family member advice and support during the decision-making process. Using a secondary qualitative analysis of transcribed interviews, we examined family member influences on the patient's decision to undergo bariatric surgery. We identified four main themes: role modeling, quality of life with children, family and marital factors, and acquaintances' success with bariatric surgery. Participants indicated that being active with children and demonstrating healthier lifestyles was important, and that adult family members' perceptions of the surgery affect the decision. Because family member influences are evident in the decision-making process, perioperative nurses should be aware of the family's influence and include family members and significant others in the patient's decision-making process for bariatric surgery.

Majority of female bariatric patients retain an obese identity 18-30 months after surgery.

PURPOSE: When bariatric surgery is performed, a successful outcome is usually described as % total weight lost (EWL) or a change in BMI. These definitions fail to address the importance of post-operative psychosocial adjustment. Previous research has alluded to a 'mind-body lag' where the patient's experienced body feels larger than their physically smaller post-operative body, perhaps as a result of amygdalae conditioning. The purpose of this study is to further investigate this psychological issue and assess its relationship to health locus of control, alexithymia, health quality of life and weight regain in bariatric surgery patients. METHODS: Forty female bariatric surgery patients between 18 and 30 months post-op completed demographic data, survey instruments and anthropometric testing. Their evolving self-view, health locus of control, tendency toward alexithymic thought, and health quality of life were measured to identify significant relationships. Hermans' Dialogical Self Theory was used to understand the conflicted self-view of the participants. RESULTS: The majority of participants retained an obese view of self despite weight loss. Those who retained an 'I-obese' viewpoint were significantly more likely to see external situations and powerful others as controlling their weight, have difficulty identifying their feelings and score significantly lower in vitality, social functioning and mental health. CONCLUSION: Despite losing weight, the majority of participants retained an obese view of self that was significantly associated with a lessened health quality of life. Use of the Evolving Self-View (ESV) exploratory tool may allow early identification of post-operative patients with a prolonged 'I-obese' self-view and provide an opportunity for intervention. LEVEL OF EVIDENCE: Level III, cross-sectional case-control study.

A Concept Analysis of Disturbed Body Image in Bariatric Surgery Patients.

PURPOSE: This article describes the concept of disturbed body image in bariatric surgery patients. METHOD: Walker and Avant's (2011) method of concept analysis is used in this study. FINDINGS: After bariatric surgery, the patient's body may change more rapidly than their allocentric ("inside, lived") view of themselves, leading to physical and psychosocial sequelae. CONCLUSION: If not prepared physically and psychologically for body image challenges after bariatric surgery, patients may experience disturbed body image in the postoperative phase. IMPLICATIONS FOR NURSING PRACTICE: Understanding the concept of disturbed body image in postoperative bariatric surgery patients may allow health providers to provide preoperative teaching and preparation, as well as postoperative interventions to create congruence between the patient's internal and external selves.

'Shopping for a new body': descriptions of bariatric post-operative adjustment.

PURPOSE: Co-morbid conditions resulting from obesity cause 3.4 million deaths per year. Bariatric surgery has become a solution for obesity. Post-operative psychosocial changes can be problematic and must not be neglected. Up to 74% of people with overweight or obesity have body image distortion or dissatisfaction, which may persist even after surgery and weight loss. The questions addressed by this research were: (a) what are the categories of open-ended responses from bariatric surgery patients about their experiences of post-operative adjustment? (b) Do the categories of response support previous quantitative findings of a retained obese identity after surgery? METHODS: Herman's Dialogical Self Theory provides the basis for understanding the post-operative transition from "I-obese" to "I-ex-obese". Fifty-five bariatric surgery patients (18-30 months post-op) were asked to tell the investigator about their adjustment after surgery. Their open-ended responses were written down and analyzed using content analysis. RESULTS: Individual responses were analyzed and divided into four dominant categories: (a) shopping for a new body; (b) relationship transitions; (c) focus on the new body; and (d) cheating on the fat person inside. CONCLUSION: This study presents an opportunity to gain perspective on the physical and psychosocial adjustment after bariatric surgery. The information can be used to guide pre-op and post-op education and counseling efforts for patients. Physical healing should be paired with healthy psychological adjustment to ensure a positive outcome. LEVEL OF EVIDENCE: Level V, descriptive analysis of previous Level III research.

Coping with Intradialytic Events and Stress Associated with Hemodialysis.

Intradialytic events (IDEs), such as cramping, loss of consciousness, bleeding, and allergic reactions, are major stressors for persons on hemodialysis (HD). This study examined the association between coping strategies and stress associated with HD in persons who have experienced an IDE. Using a cross-sectional correlation design, a convenience sample of patients (N=73) completed a Hemodialysis Demographic Form, Ways of Coping Questionnaire, and a Hemodialysis Stress Visual Analog Scale. Most participants were African American (95%), male (52%), with a mean age of 57 (SD=11.98) years, and an average of 41 (SD=31.55) months on HD. Coping strategies explained 34% of the variance in stress associated with HD (F [11, 61] = 2.89; p=0.004); positive reappraisal and planful problem solving were negatively correlated with stress. Emotion-focused coping strategies were used most during an IDE.

Evolving self view and body image concerns in female postoperative bariatric surgery patients.

AIMS AND OBJECTIVES: To explore the experience of postoperative bariatric surgery patients as they adjust to diminished weight and differentiate that adjustment from the more general concept of body image. BACKGROUND: Bariatric surgery is an effective way to reduce weight and comorbidities associated with obesity. Complete success requires that patients must adjust psychologically as they lose weight. If this does not occur, bariatric patients may experience a "mind-body lag," in which the patient's internal body image lags behind the external changes. Hermans' Dialogical Self Theory of "I-positions" is a foundation with which to understand this problem. DESIGN: Descriptive correlational study of postoperative bariatric patients explored the concept of "I-obese" and "I-ex-obese" in an effort to quantify previous qualitative findings and develop a survey questionnaire. METHODS: Bariatric patients (N = 55) between 18-30 months postoperative completed one-hour interviews. Cluster analysis and chi-squared analysis compared mean scores and explored the prevalence of "I-positions" and body image concerns in the participants. RESULTS: Cluster analysis of the survey data identified participants as falling into either "I-obese," "I-ex-obese" or "mixed I-obese" categories. There were significantly higher body image concerns in the "I-obese" participants than those identified as "I-ex-obese." The majority of female participants reported high body image concerns. There was no significant association with weight loss percentage. CONCLUSION: This research establishes a connection in this study sample of women who experience body image concerns and prolonged "I-obese" identification 18-30 months after their bariatric surgery. RELEVANCE TO CLINICAL PRACTICE: To date, the primary measure of bariatric surgery success has focused almost exclusively on the amount of weight loss. Implementing psychological as well as physiological care, however, may be the key to full recovery and long-term success. Practitioners can use this new information to plan effective pre- and postoperative psychological preparation and support.

Seizing the Moment: Experiences of School Nurses Caring for Students With Overweight and Obesity.

School nurses are well positioned to assess, intervene, and evaluate efforts to positively impact students who are overweight or obese. The purpose of this qualitative, descriptive study was to explore the experiences of school nurses providing care to children living with overweight and obesity. Data were collected through face-to-face, tape-recorded, in-depth, open-ended interviews with 10 school nurses from rural areas of North Carolina working with minority and low-income children in the public school setting. The text of the interviews was transcribed and analyzed into codes, categories, and themes. Three themes and eight subthemes were identified. The three themes were identified as (1) "jumping hurdles," (2) "seize the moment," and (3) "moral distress." The findings of this study can be used to provide a better understanding of the experiences of school nurses caring for children with overweight and obesity that is necessary for planning successful school-based interventions.

Research in the Rehabilitation Unit Presents Challenges to Nurse Researchers.

PURPOSE: Gathering data from patients on a rehabilitation unit poses challenges for nurse researchers. DESIGN: A case study is presented that describes ways the researchers attempted to meet these challenges while conducting their study. METHODS: The case study presents the approaches that the investigators took to undertake the study and then described the ways in which these approaches could have been improved. FINDINGS: Their successes and failures are described. CONCLUSIONS: Suggestions are made for future investigators. CLINICAL RELEVANCE: Clinical nursing research is required to develop an evidence base for practice in the rehabilitation unit. An analysis of the challenges and possible methods of overcoming these challenges is useful to both future investigators and nurses in practice to insure that studies can be carried out effectively.

Tipping point: factors influencing a patient's decision to proceed with bariatric surgery.

BACKGROUND: Despite the fact that bariatric surgery is the most effective intervention for morbid obesity, only a fraction of obese patients, even after undergoing evaluation for surgery, decide to undergo the surgery. Opting out by patients is fairly common yet little is known about factors that lead a patient to decide to undergo surgery. OBJECTIVE: The purpose of this qualitative study was to identify factors that "tipped the scales" in the patient's experience leading to a decision to move ahead with surgery. SETTING: The study was carried out in the bariatric surgical clinic of a southeastern regional medical center. METHODS: This qualitative descriptive study utilized semistructured interviews with patients (n = 24) at the time of their "decision visit" to determine the factors related to their positive decision to move forward. A modification of Colaizzi's procedural steps of analysis was used to extract, organize, and analyze data for central themes. RESULTS: Two main factors leading participants to decide to move ahead with bariatric surgery were their own worsening health issues and low energy levels that limited their activities. Participants also noted additional factors that impacted their "tipping point" such as financial considerations and family influences. CONCLUSIONS: The decision to move ahead with bariatric surgery is influenced by many factors to which this research provides additional insight. Further research is warranted to fully understand this phenomenon and develop appropriate outreach and educational approaches.

Enhancing nursing care by understanding the bariatric patient's journey.

Patients who undergo obesity-related bariatric surgery seek a lasting solution to weight loss and a desire for a healthier lifestyle. Perioperative nurses should be prepared to provide sensitive, high-quality care to this population. Effective assessment and management of bariatric patients involves understanding the motivating factors for seeking bariatric surgery, such as to address the stigma and health problems associated with obesity. Nurses should be knowledgeable about expected outcomes of bariatric care, including long-term processes and lifestyle changes that patients must participate in to sustain weight loss. The informed perioperative nurse is essential to the successful treatment of bariatric patients in their journey to healthier living.

Perioperative nursing care of the patient undergoing bariatric revision surgery.

Obesity has become a major health concern in the United States. The number of patients seeking bariatric surgery has grown exponentially in recent years because of the proven success of weight-loss surgery, greater public acceptance, and the increasing number of insurers who will pay for these surgeries. Patients may seek bariatric revision procedures if the primary procedure does not achieve the desired results, if he or she gains back the weight lost after the primary procedure, if the comorbid conditions associated with obesity were not resolved, or if severe adverse effects and complications have occurred as a result of the primary bariatric procedure. Perioperative nurses must be knowledgeable about how to care for bariatric surgery patients with skill and compassion.

Disease-specific quality of life-patient acceptance: racial and gender differences in patients with implantable cardioverter defibrillators.

BACKGROUND: Despite its established effectiveness, living with an implantable cardioverter defibrillator (ICD) is associated with ongoing physical and psychosocial distress. Little is known about which factors impact the patients' adjustment to living with the device and whether there are racial or gender differences related to these factors. The purpose of this study was to investigate factors (demographic, clinical, psychosocial, and religiosity) related to patients' ICD acceptance and to examine racial and gender differences in ICD acceptance. METHODS: A total of 101 ICD patients (mean age, 65 ± 12.8 years, 34% female, 42% African American [AA]) seen in a cardiology clinic between January and August 2010 completed the Florida Patient Acceptance Survey (FPAS), Florida shock anxiety scale, ENRICHD social support instrument, hospital anxiety and depression scale, Hoge Religiosity Scale, and a demographic sheet during their clinic visit. RESULTS: All multiple-item scales demonstrated good internal consistency reliability, with Cronbach α values ranging from .77 to .89. Overall patient acceptance of the ICD was high, with an average FPAS acceptance score of 80.9 on the 0-to-100 point scale. The FPAS subscale scores indicated that the group was very positive about the benefits of having the device (mean, 90.3) and had few body image concerns (mean, 10.6), low device-related distress (mean, 15.6), and moderate return to function scores (mean, 63.0). White ICD participants were more accepting of their device than AA ICD patients were, scoring statistically significantly higher than AA patients on total patient acceptance and return to function and significantly lower than AA patients on device-related distress and shock anxiety. Controlling for ethnicity (ß = .10, P = .15), age (ß = .01, P = .90), and number of comorbidities (ß = .19, P = .003) in a hierarchical multiple regression, shock anxiety (ß = .31, P < .001), knowledge of the device (ß = .23, P = .001), social support (ß = .13, P = .08), Hospital Anxiety and Depression Scale anxiety (ß = .06, P = .51) and depression (ß = .25, P = .01), and importance of religion (ß = .17, P = .01) explained 46.8% of the variance in FPAS scores. CONCLUSIONS: Although overall patient acceptance was high, AAs in the study had statistically significant lower mean total Florida Patient Acceptance Scale scores and Return to Function scores than whites did and higher Device-Related Distress scores. The strongest predictors of patient acceptance for the total group were shock anxiety, depressive symptoms, and device knowledge. African Americans had significantly lower device knowledge scores and higher shock anxiety scores than whites did. These findings suggest that ICD patients, especially AA ICD patients, may require education and psychosocial measures to enhance acceptance of their device. This study supports a holistic and culturally sensitive approach to focused clinical and psychological assessment and interventions for those living with this life-saving technology.

Improving wound care simulation with the addition of odor: a descriptive, quasi-experimental study.

Improving problem-solving skills and expertise in complex clinical care provision requires engaging students in the learning process--a challenging goal when clinical practicums and supervisors are limited. High-fidelity simulation has created many new opportunities for educating healthcare professionals. Because addressing malodorous wounds is a common problem that may be difficult to "teach," a descriptive, quasi-experimental simulation study was conducted. Following completion of a wound care simulation and Laerdal's Simulation Experience Evaluation Tool by 137 undergraduate nursing students, 50 control subjects were randomly selected and 49 volunteer students (experimental group) participated in a wound care simulation after one of three cheeses with a strong odor was added to simulate a malodorous wound. Compared to the control group, study group responses were significantly better (P <0.001) for eight of the 12 survey variables tested and indicated the addition of odor was beneficial in enhancing the perceived realism and value of the simulation. Students responded that the addition of odor in the simulation laboratory improved realism and they felt better prepared to handle malodorous wounds in a clinical setting. An unanticipated outcome was the enhanced feeling of involvement associated with paired care teams as opposed to working in larger groups. The results of this study indicate that wound care education outcomes improve when nursing students are able to practice using a multi-sensorial wound care simulation model.

Perioperative care of the patient with tuberculosis.

Approximately 1.7 billion people are thought to be infected with Mycobacterium tuberculosis. The estimated mortality rate is 3 million people per year. Multidrug resistant-tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) are serious problems that threaten global TB control. Patients who are inadequately treated remain chronic carriers and can spread the disease to family members and their communities. Treatment recommendations for TB include directly observed treatment and monitoring the patient's response to medications. Perioperative nurses must protect the patient and other health care workers when a patient with TB undergoes a surgical procedure.

Perioperative care of the immunocompromised patient.

Immunity refers to the body's capacity to resist invading organisms and toxins, thereby preventing tissue and organ damage. A patient whose immune system is impaired may be at higher risk for untoward perioperative events. Some populations most at risk for immunocompromise include infants, geriatric patients, people who have undergone organ transplantation, and people with cancer. Patients who are immunocompromised have an increased risk for hypothermia, which can affect postoperative wound healing processes and can increase the risk of wound infection. This article provides a basic overview of the immune system, a discussion of common disorders and diseases of the immune system, and a guide for perioperative nurses to use when they care for a patient who is immunocompromised.

Environmental surveillance in the operating room.

Environmental cleaning in surgical settings minimizes patients' and health care workers' exposure to potentially infectious microorganisms. This article describes the implementation of an instrument designed to help nurses monitor OR environments, identify problem areas, and correct cleaning deficiencies before patient care is affected adversely. During a six-month pilot test in which the instrument was used daily to compare contamination events in rooms and on room surfaces, contamination events in the ORs decreased. These measurable outcomes helped health care workers develop strategies for proper cleaning and influenced multidisciplinary decision making about terminal cleaning issues.

Prevention of foot ulcers in patients with diabetes and end stage renal disease.

This quasi-experimental pilot study used a convenience sample of 23 adult men and women with either Type 1 or Type 2 diabetes who received hemodialysis three times a week. The experimental group received a four-part intervention that included individual and group foot care education, foot assessment, and special shoes. Pre- and posttesting of foot care knowledge was done using the Siriraj questionnaire. Out of a possible score of 20, those in the experimental group had a mean score of 15.3 versus 14.33 in the control group on the posttest. The nephrology nurse has the opportunity to play a role in early detection and intervention in clients with ESRD.