Using Critical Incident Assessments to Understand Nursing Students' Perceptions That Impact Learning.

ABSTRACT: Nurse faculty have a responsibility to examine nursing incidents that have a negative effect on students and identify methods for improvement. The purpose of this study was to explore nursing students' perceptions of weekly incidents that impact learning in order to alert faculty to problems early in the program of study. A qualitative descriptive design was used to identify common themes of first-semester BSN students' perceptions using Brookfield's Critical Incident Questionnaire. Four themes were identified. Critical reflection, analysis, and active learning are vital components in nursing education.

The Impact of Preoperative Education on Patients Undergoing Elective Total Hip and Knee Arthroplasty: The Relationship Between Patient Education and Psychosocial Factors.

BACKGROUND: Preoperative education has been found to be responsible for patients having a realistic expectation of surgery as well as high level of satisfaction with their recovery. The Joint Academy offers preoperative educational classes for all patients undergoing elective knee and hip replacements. PURPOSE: The purpose of this descriptive study was to determine whether the education provided by The Joint Academy has an impact on anxiety, expectation, and preparedness in patients who undergo elective total knee or hip arthroplasty. METHODS: All patients who had total joint or hip arthroplasty over a 2-month period were invited to participate in this descriptive correlational study. RESULTS: Of the 49 study participants, 28 attended The Joint Academy. Those who attended The Joint Academy were more likely to hold surgical expectations that better correlated with actual experience (p = .425). There was no statistically significant difference between the groups for nervousness (p = .171) or feeling prepared for the surgery (p = .425). CONCLUSION: Offering education before knee or hip arthroplasty provides patients with an understanding of the expectations related to surgery.

Understanding Interconnectedness From the Military Nurse Perspective.

BACKGROUND: Nurses who serve in the military have a unique perspective on nursing and health care delivery that nurtures wholeness and inspires peace and healing on a global scale. PURPOSE: The purpose of this study was to explore health promotion and healing from the military nurse perspective. DESIGN: Video-recorded interviews were conducted with 10 military nurses who represented various branches and times of service. Participants were asked to share their experiences as military nurses and discuss the challenges and rewards. FINDINGS: Thematic analysis of the recorded interviews revealed two major themes: interconnectedness and human potential. CONCLUSION: This study showed that military nurses have unique experiences that influenced their way of promoting health and healing. Interconnectedness with family (personal and military) had many positive and negative factors. Interconnectedness with the health care team was more prominent for the nurses during military service than in the civilian arena. Global interconnectedness included working with teams from around the world, helping children of detainees see that Americans were not evil, and caring for international communities. Military service strengthened the three human qualities of mind, body, and spirit, which resulted in increasing each military nurse's human potential by enabling them to serve as instruments of healing on a global scale.

Quality Improvement in Clinical Nutrition: Screening and Mealtime Protection for the Hospitalized Patient.

PURPOSE: The purpose of the quality improvement project was to (1) enhance awareness, accuracy, and use of the validated nutrition screening tool by the nurse and (2) improve compliance to the nutrition care plan that included increasing patient meal intake percentage. DESCRIPTION OF THE PROJECT: Nurses were provided with an in-depth educational program focused on the implementation of the nutrition screening tool on patient admission to the clinical site. Second, a unit-level patient protected mealtime program was implemented in an effort to decrease unnecessary mealtime interruptions and promote nurses and nursing assistants to assist with meals during mealtime to improve patient meal intake percentage and, finally, to encourage collaboration between the clinical nurse specialist, unit level nurses, and registered dietitians to improve patient nutritional care. OUTCOME: The results indicate that the quality improvement strategies were successful in promoting the patient protected mealtime program and use of the nutrition screening tool. CONCLUSIONS: The clinical nurse specialist plays a valuable role in program development, implementation, and evaluation to achieve quality healthcare through interdisciplinary collaboration. Adhering to nutrition guidelines for the hospitalized adult patient improves nutrition care plan guidance and meal intake.

The Impact of a Cultural Immersion Study Abroad Experience in Traditional Chinese Medicine.

Study abroad programs have increased dramatically. Most programs are short-term and include a cultural immersion as well as classroom and/or service learning. In this article, the authors discuss a study abroad program to China that included cultural immersion and classroom learning specific to traditional Chinese medicine. Participants kept journals with specific writing assignments and reflections about their experiences during the trip. At the conclusion of the trip, a qualitative survey was administered to the participants. Outcomes included the benefits of cultural immersion and a greater appreciation of cultural diversity, complementary and alternative medicine and holistic health care. Participants were able to describe transformational experiences of living in and learning from the Chinese culture and peoples. They intended to incorporate their experiences and enhanced understanding of traditional Chinese medicine and complementary and alternative therapies to provide culturally competent holistic health care in their nursing practice.

Delirium: Why Are Nurses Confused?

Nurses have a key role in detection of delirium, yet this condition remains under recognized and poorly managed. The aim of this study was to explore nurses' knowledge of delirium-related information as well as their perception of their level of knowledge.

Arch support use for improving balance and reducing pain in older adults.

PURPOSE: The purpose of this study was to examine the effects of arch supports on balance, functional mobility, and pain in the back and lower extremity joints among older adults. DESIGN: A single-factor within-subjects design was used. METHOD: A convenience sample of older adults formed a single group for fitting with arch supports. Balance, functional mobility, and self-reported pain in the back and lower extremities were measured without the arch supports, immediately after the insertion of the supports in the subjects' shoes, and after 6 weeks of arch support use. FINDINGS: Sixty-seven older adults completed the study. The measures used indicated statistically significant improvements in scores for the Berg Balance Scale [Berg, K., Williams-Dauphinee, S., & Williams, J. I., (1995). The Balance Scale: Reliability assessment for elderly residents and patients with an acute stroke. Scandinavian Journal of Rehabilitation Medicine, 27, 27-31] and functional mobility [Timed Up and Go test; Podsiadlo, D., & Richardson, S. (1991). The Timed "Up and Go": A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142-148] as well as reduced back, foot, knee, and hip pain (p < .05). There was no statistically significant change in ankle pain (p > .05). IMPLICATIONS: Knowledge of interventions that enhance health and well-being is essential for nurses. Arch supports may provide improved balance and functional mobility while reducing back and lower extremity joint pains. Further research is needed to support evidence-based practice.

Caring for the orthopaedic patient who is obese.

Obesity is a major health problem in the United States, and it is occurring at an increasing rate. When an orthopaedic patient is obese, the care plan and interventions must be adjusted for the specific patient needs. This article explores the multidimensional challenges and suggests strategies to provide safe care for the patient who is obese.

Effects of T'ai Chi exercise on fibromyalgia symptoms and health-related quality of life.

BACKGROUND: Fibromyalgia (FM), one of the most common musculoskeletal disorders, is associated with high levels of impaired health and inadequate or limited symptom relief. The cause of this complex syndrome is unknown, and there is no known cure. Numerous research results indicate that a combination of physical exercise and mind-body therapy is effective in symptom management. T'ai Chi, an ancient Chinese exercise, combines physical exercise with mindbody therapy. PURPOSE: To investigate the effects of T'ai Chi exercise on FM symptoms and health-related quality of life. DESIGN: Pilot study, one group pre-to-post posttest design. METHODS: Participants with FM (n = 39) formed a single group for 6 weeks of 1-hour, twice weekly T'ai Chi exercise classes. FM symptoms and health-related quality of life were measured before and after exercise. FINDINGS: Twenty-one participants completed at least 10 of the 12 exercise sessions. Although the dropout rate was higher than expected, measurements on both the Fibromyalgia Impact Questionnaire (FIQ) (Buckhardt, Clark, & Bennett, 1991) and the Short Form-36 (SE-36) (Ware & Sherbourne, 1992) revealed statistically significant improvement in symptom management and health-related quality of life. IMPLICATIONS FOR NURSING RESEARCH: Knowledge of interventions to enhance health for the patient with musculoskeletal problems is a National Association of Orthopaedic Nurses priority. Tai Chi is potentially beneficial to patients with FM. Further research is needed to support evidence-based practice.

Effects of Tai Chi exercise on balance, functional mobility, and fear of falling among older women.

The purpose of this study was to determine the effects of Tai Chi exercise among older women. Multiple regression analysis revealed statistically significant improvements in scores for balance (p <.001), functional mobility (p <.05), and fear of falling (p <.001) and associated demographic factors. Three months of twice weekly, 30-minute Tai Chi classes was associated with statistically significant improvements in balance and functional mobility and a reduction in the fear of falling in this sample of older women living in retirement communities. T'ai Chi exercises may be an age-appropriate and acceptable form of exercise for older women.

National practice patterns for the care of the patient with total joint replacement.

PURPOSE: The purpose of this study was to determine national practice patterns for common nursing procedures related to the care of total hip and total knee patients. DESIGN: This was a comparative descriptive study utilizing a survey developed by the NAON Total Joint Special Interest Group. SAMPLE: Two hundred eight-seven valid surveys were completed by NAON members. FINDINGS: An average of 226 total knee replacements (TKR) and 183 total hip replacements (THR) were performed annually per facility. Data about perioperative practices, postoperative activity practices, use of equipment, anticoagulation practices, and discharge practices (including length of stay) were collected. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of national practice patterns and incorporation of the information into clinical practice can reduce the patient's risk of unsafe or ineffective care while promoting positive patient outcomes. Nurses can use these data to adjust clinical pathways and practice standards to improve patient outcomes.