Role of Stigma for Health Care Professionals With Nonmedical Substance Use.

BACKGROUND: Stigma toward those with non-medical substance use may present as anticipated, perceived, enacted, or internalized stigma. OBJECTIVE: The purpose of the study was to describe the role of stigma on health care professionals with non-medical substance use, from the perspective of treatment providers. Soliciting information about stigma from treatment providers is a unique perspective lacking in current literature. METHODS: A qualitative descriptive design was used with semi-structured interviews of treatment providers (N = 16) in Colorado. Inductive content analysis was used to identify concepts and themes across interviews. RESULTS: Findings showed that stigma is a major concern and a barrier for health care professionals seeking substance use treatment. Nurses and physicians demonstrate shame and guilt (internalized stigma) around their substance use. These professionals also experience fear around their reputation (perceived stigma) and challenges around re-entry to the workforce after treatment (anticipated stigma). CONCLUSIONS: The awareness of existing stigma as well as internalized stigma impacts how health care professionals approach treatment, recovery, and returning to work.

Nasal Tube Securement: Randomized Controlled Trial in Pediatric Hospitalized Patients.

PURPOSE: The aim of this study was to compare accidental dislodgement rates of nasal gastric tubes secured with standard methods or a nasal tube securement device in pediatric patients. DESIGN: A randomized controlled trial was conducted. METHODS: Participants ( n = 43) were randomized into standard securement or nasal tube securement device using block randomization to control for age and diagnosis. Surveys were collected from staff and caregivers on device ease of use and satisfaction. RESULTS: There were a similar number of tube dislodgements for patients in the nasal tube securement device group ( n = 6) and the standard practice group ( n = 7). The median hospital length of stay was higher for the standard practice group (13 days vs. 9 days). CONCLUSION: Use of the nasal tube securement device did not significantly decrease the rate of tube dislodgements compared with standard practice. CLINICAL RELEVANCE TO REHABILITATION NURSING: The study provides information for pediatric rehabilitation nurses in choosing securement options for nasal gastric tubes.

Board Certification: A Role for the Nurse Educator.

Nurse educators are essential to the success of other nurses by supporting the attainment of professional competencies, knowledge, and continual development. In addition, board-certified nurse educators are also role models in lifelong learning. They are in an optimal position to promote and support others in pursuit of board certification. [J Contin Educ Nurs. 2021;52(11):497-499.].

Comparison of electromagnetic guided imagery to standard confirmatory methods for ascertaining nasogastric tube placement in children.

PURPOSE: Evaluate the accuracy of an electromagnetic device (EMD) guided nasogastric tube (NGT) placement compared with standard confirmation methods. A secondary aim was to determine if EMD guided NGT placement would avert potential pulmonary misplacements of the tube. DESIGN AND METHODS: Pediatric Intensive Care Unit (PICU) patients were enrolled if they had an NGT order during the study period of April 2014 through December 2016. Patients were included if they were one through 18 years of age. An EMD trained nurse inserted the NGT using EMD guidance. An insertion questionnaire, confirming if the nurse determined the NGT to be gastric per EMD, was completed immediately after NGT placement and before confirmation via either pH testing or radiographic imaging. RESULTS: Forty-five patients were enrolled in the study. Nurses reported, based on EMD, that 86.7% (n = 39) of placements were gastric. Overall agreement between EMD guided tube placement and pH testing was 58% (n = 26). The marginal distribution was significantly different between the two methods (p = .0029). When compared to radiographic confirmation, sensitivity of the pH method was 32% (95% confidence interval [CI]: 17%-51%) compared with 85% (95% CI 69%-95%) for the EMD method. CONCLUSIONS: EMD guidance was superior to pH testing when compared with radiographic confirmation of nasogastric tube placement in children. PRACTICE IMPLICATIONS: EMD guided NGT placement is a potentially viable method for confirming nasogastric tube placement in children when done by appropriately trained clinicians. More research on EMD guided NGT placement in children is needed before any practice recommendation can be made.

Opioid Seeking Behaviors and Diversion in Hospitalized Pediatric Patients: A Case Series.

All nurses have a responsibility for monitoring their patients for signs of substance misuse or substance use disorder. Adolescents and young adults are at risk for substance use. Prescription medications may be used by adolescents for non-medical reasons such as to feel high, to assist with sleep, to avoid negative feelings or thoughts or to avoid withdrawal symptoms after chronic use. Some adolescents with legally prescribed medications have been asked to divert those medications by giving them to someone else. Drug diversion by employees is often reported in healthcare settings, but diversion of medications done by patients is far less commonly reported. This paper is a report of two patients with complex medical issues and chronic pain who diverted opioid medications while hospitalized. Hiring clinical staff, such as nurses, working in Drug Diversion Prevention positions will provide knowledge and expertise to facilitate investigations and to help reduce risks for diversion in healthcare settings. In addition, nurses with concerns about patient diversion should discuss these concerns with the care team. Organizational leaders need to support their teams by providing education and resources so staff feel comfortable addressing these challenging situations.

Pediatric Fall Risk Assessment Tool Comparison and Validation Study.

PURPOSE: Compare two pediatric fall risk assessment tools (I'M SAFE and Humpty Dumpty) used at the same organization to determine if one is better able to predict which patients fall. DESIGN AND METHODS: Retrospective data was obtained from patients admitted in 2014. Each patient who experienced a fall during hospitalization was matched with two non-fallers based on age and diagnosis. Logistic regression was performed to identify which tool more accurately determines fall risk and reliability testing was completed for the I'M SAFE tool. RESULTS: Over 22,000 patient files were extracted for this study. One hundred seventy-seven falls were identified, seventy-one of them were intrinsic. Of those patients who fell, the majority were assessed to be at high risk for falls. There were too few falls during the study period using the Humpty Dumpty tool to assess and make formal conclusions. The results for the I'M SAFE tool were opposite of what was expected and showed an increased risk for falls for patients who scored low risk using this tool. CONCLUSIONS: At completion of this study the data reflected that the I'M SAFE tool was not adequately predicting patients at greatest risk for intrinsic falls for this particular population. PRACTICE IMPLICATIONS: Further research on these tools is needed in other populations or across multiple sites. Additional work to adapt the tools may be necessary to better predict fall risk without over identifying high risk patients.

Utilization of a biomedical device (VeinViewer® ) to assist with peripheral intravenous catheter (PIV) insertion for pediatric nurses.

PURPOSE: Vascular access in pediatric patients can be challenging even with the currently available technological resources. This nurse-driven research study explored time, cost, and resources for intravenous access to determine if a biomedical device, VeinViewer® Vision, would facilitate improvements in pediatric access. In addition, this study looked at nurse perceptions of skills and confidence around intravenous insertion and if the use of the VeinViewer® impacted these perceptions. Literature examining pediatric intravenous access success rates compared with nurse perceived skills and confidence is lacking. DESIGN: Nonblinded randomized control trial of pediatric nurses working in an acute care hospital setting. METHODS: A preliminary needs assessment solicited feedback from nurses regarding their practice, perceived skills, and confidence with placing peripheral intravenous catheters (PIVs). Due to the results of the preliminary needs assessment, a research study was designed and 40 nurses were recruited to participate. The nurses were randomized into either a VeinViewer® or standard practice group. Nurse participants placed intravenous catheters on hospitalized pediatric patients using established procedures while tracking data for the study. RESULTS: Needs assessment showed a majority of nurses felt a biomedical device would be helpful in building their intravenous insertion skills and their confidence. The study results did not demonstrate any clinically significant differences between VeinViewer® use and standard practice for intravenous catheter insertion in pediatric patients for success of placement, number of attempts, or overall cost. In addition, no difference was noted between nurses in either group on perceived skills or confidence with insertion of PIVs. PRACTICE IMPLICATIONS: The ongoing need for resources focused on building nurse skills and confidence for PIV insertion was highlighted and organizations should continue to direct efforts toward developing skills and competency for staff that are responsible for pediatric vascular access. This study illustrates the importance of data-driven decision-making for expensive hospital-funded equipment purchases. This nursing led research study highlights how perceptions do not always align with outcomes. The lessons gleaned from this study may aid in decision-making around pediatric intravenous access practice.