Reframing care while enduring the traumatic nature of witnessing disrupted family-patient-nurses' relationships during COVID-19.

AIM: To describe the lived experiences of nurses caring for patients and families in the context of COVID-19 in Brazil and United States. DESIGN: A phenomenological philosophical approach following the van Manen analysis method. METHODS: Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID-19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi-structured interviews that were audio-recorded and transcribed for analysis. A cross-cultural examination occurred among researchers from each country. RESULTS: The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient-family-nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons. CONCLUSION: The nurses' lived experience of caring for patients and families during the COVID-19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient-family and nurse-own family relationships, vulnerable bodies, threatened space and dynamic and volatile time. IMPACT: Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.

Living in COVID's Disbeliefs, Media, and Fear: Nurses in Brazil and the United States Share Their Experiences.

During the COVID-19 pandemic, nurses were placed in an unprecedented context in which they engaged with community members, family members, and friends while positioned between dire hospital situations and community disbelief about the seriousness of the pandemic, often along political lines. A secondary analysis of a qualitative study exploring experiences of 39 nurses in the United States and Brazil in engaging with the community and political discourse during the pandemic provided insights into the impact of these interactions on nurses, and implications for how nurses may emerge from this pandemic time stronger and more supported by those in administrative positions.

Social Isolation Among Individuals With Cancer.

The COVID-19 pandemic has intensified the social isolation of individuals with cancer. Studies about how to address social isolation among patients with cancer are limited, yet data from other high-risk populations can inform.

Implementing the Serious Illness Care Program in Primary Care.

Inadequate communication about serious illness care preferences affects patients, families, health care providers, and health care systems. Many patient and system barriers prevent comprehensive serious illness communication. The purpose of this evidence-based practice project was to provide a structure within a primary care clinic to facilitate conversations with seriously ill individuals about their care preferences that (a) was adaptable to clinic workflow, (b) improved providers' perception of the care conversation experience, (c) improved documentation of care preferences, and (d) provided a comfortable and helpful experience. The Johns Hopkins Nursing Evidence-Based Practice model and Serious Illness Care Program were used to address provider and system barriers to conversations about care preferences. Program interventions included training providers and staff; identifying patients at risk for high symptom burden and mortality; integrating system interventions; and evaluating outcomes. Providers completed training, after which a 5-week pilot practice change was conducted. Provider perceptions of conversations after implementation were positive. During the pilot, 3 serious illness care conversations were initiated with additional patients prepared for future conversations using an information sheet and introduction to the conversation.

Propofol Disposal in the Anesthesia Setting: Overcoming Barriers.

Propofol accounts for 41% of reported substance abuse cases among anesthesia providers. No guidelines outline appropriate propofol disposal in the healthcare setting. The lack of controlled disposal presents concerns for environmental harm, economic waste, and diversion. An evidence-based practice project was conducted in a large, Midwestern teaching institution to address propofol disposal. Data collected regarding propofol waste and from a survey indicated that Certified Registered Nurse Anesthetists (CRNAs) have limited access to sinks in the operating rooms for disposal, have environmental concerns regarding pouring propofol into the sink, and find propofol vials difficult to open. Interventions tailored to address these barriers included implementing a specially designed bottle opener and activated carbon pouch in each operating room to be used for propofol disposal. A χ² analysis showed that changing CRNA practice from sink disposal to carbon pouch disposal significantly decreased the percentage of unemptied propofol vials remaining in unsecured bins from 25.8% before the intervention to 3.4% after the intervention (P < .0001). Decreasing access for diversion is critical for anesthesia practices, and removing barriers to disposal can help reduce access. This evidence-based practice project demonstrated how tailoring interventions to address identified barriers produced an effective practice change for propofol disposal.

Cognitive behavioral therapy, self-efficacy, and depression in persons with chronic pain.

Chronic pain is a complex and often disabling condition compounded by depression and poor self-efficacy. The purpose of this evidence-based project was to explore the relationship of cognitive behavioral therapy (CBT)-focused groups with self-efficacy and depression in persons with chronic pain at an intensive interdisciplinary 3-week pain rehabilitation center (PRC). The project sample consisted of 138 persons admitted to a PRC and scoring ≥27 on the Center for Epidemiological Study Depression Scale (CES-D) and then completing the Pain Self-Efficacy Questionnaire (PSEQ). After completing the PRC program, including CBT-focused groups, discharge CES-D and PSEQ scores were analyzed. A comparison group of CES-D scores from 134 persons admitted to the PRC from a 9-month time period preceding the addition of the CBT-focused groups was also examined. There was a significant increase in self-efficacy after participation in the intensive pain rehabilitation program including CBT-focused groups. Patient groups both before and after introduction of CBT-focused groups showed the same rate of improvement on the depression scores, suggesting that persons who participated in CBT-focused groups improved equally compared with persons who did not participate in these groups. Ninety-three percent of the participants expressed satisfaction with the CBT groups. This evidence-based practice is well supported in the literature and can be implemented with knowledgeable staff and engaged stakeholders.

Group interpersonal and social rhythm therapy for bipolar depression.

PURPOSE: To evaluate the feasibility of 2-week interpersonal and social rhythm therapy group (IPSRT-G) for bipolar depression. DESIGN AND METHODS: Participants with bipolar depression received two individual sessions, six IPSRT-G sessions, and a 12-week telephone call. The Inventory of Depressive Symptomatology-Clinician Rated (IDS-C), Young Mania Rating Scale (YMRS), Sheehan Disability Scale (SDS), and Clinical Global Impressions-Bipolar Version (CGI-BP) were used. FINDINGS: IDS-C and SDS scores improved significantly at 12 weeks. YMRS and CGI-BP scores improved but did not reach statistical significance. PRACTICE IMPLICATIONS: The promising antidepressive response supports further study of IPSRT-G for bipolar depression.

The value of oncology nursing certification.

The attainment of oncology nursing certification indicates that a nurse has the knowledge and expertise to competently care for patients with an actual or potential diagnosis of cancer. Research regarding the value nurses associate with certification is lacking; therefore, the Oncology Nursing Certification Corporation participated in a national study led by the American Board of Nursing Specialties Research Committee to explore the value of certification in a sample of certified and noncertified nurses and nurse managers. A total of 940 oncology nurses participated and completed a demographic survey and the Perceived Value of Certification Tool. Most were Caucasian women, with a mean age of 54 years; 36% were staff nurses, 19% were nurse managers, and 10% were advanced practice nurses. A high value of certification was reported. Barriers to certification included cost issues and lack of institutional reward and support. Benefits included institutional reimbursement and listing certification credentials on name badges or business cards. Both certified and noncertified nurses value certification. Increasing institutional recognition and financial support could improve nurse certification rates and ultimately may result in improved patient care.

Predictors of adjustment and growth in women with recurrent ovarian cancer.

PURPOSE/OBJECTIVES: To analyze predictors of adjustment and growth in women who had experienced recurrent ovarian cancer using components of the Resiliency Model of Family Stress, Adjustment, and Adaptation as a conceptual framework. DESIGN: Cross-sectional. SETTING: Participants were recruited from national cancer advocacy groups. SAMPLE: 60 married or partnered women with recurrent ovarian cancer. METHODS: Participants completed an online or paper survey. MAIN RESEARCH VARIABLES: Independent variables included demographic and illness variables and meaning of illness. Outcome variables were psychological adjustment and post-traumatic growth. FINDINGS: A model of five predictor variables (younger age, fewer years in the relationship, poorer performance status, greater symptom distress, and more negative meaning) accounted for 64% of the variance in adjustment but did not predict post-traumatic growth. CONCLUSIONS: This study supports the use of a model of adjustment that includes demographic, illness, and appraisal variables for women with recurrent ovarian cancer. Symptom distress and poorer performance status were the most significant predictors of adjustment. Younger age and fewer years in the relationship also predicted poorer adjustment. IMPLICATIONS FOR NURSING: Nurses have the knowledge and skills to influence the predictors of adjustment to recurrent ovarian cancer, particularly symptom distress and poor performance status. Nurses who recognize the predictors of poorer adjustment can anticipate problems and intervene to improve adjustment for women.

Husbands' perspective of living with wives' ovarian cancer.

OBJECTIVES: The purpose of this qualitative study was to describe the experience of ovarian cancer from the husband's perspective. METHODS: Participants were recruited through a large Midwestern hospital and a state ovarian cancer advocacy organization. A one-time telephone interview was conducted with each participant. The interviews were tape-recorded, transcribed and analyzed for themes. RESULTS: Eleven husbands were interviewed. Themes included the emotional devastation of the initial diagnosis, the ovarian cancer being a whole new focus/priority, changes to the marital relationship, his response influenced by her response, others sharing the burden of providing support and relying on other family members. CONCLUSION: Ovarian cancer presents unique challenges for husbands. Both positive and negative effects can result and can linger well past the diagnosis and treatment period. Social support, particularly from family members, may be especially helpful to husbands of women with ovarian cancer. Husbands experience multiple emotional, psychological, social effects from their experience with ovarian cancer. Addressing these effects in practice and future research is imperative. Research based on multidimensional frameworks or family theory using standardized instruments may further elucidate consequences of ovarian cancer on spouses and could evaluate predictors or positive and negative effects.

An experiential interdisciplinary quality improvement education initiative.

Seven learners, including 2 preventive medicine fellows, 2 family medicine residents, 1 internal medicine resident, and 2 master's-level nursing students participated in an experiential 4-week quality improvement rotation at a major academic medical center. Together they worked on a quality improvement project that resulted in enhanced medication reconciliation in a preventive medicine clinic. Learner knowledge measured on the QI Knowledge Application Tool increased from an average of 2.33 before the start of the rotation to 3.43 (P = .043) by the end of the rotation. At the conclusion, all learners said they were confident or very confident that they could make a change to improve health care in a local setting. Although this pilot supports the feasibility and potential benefits of interdisciplinary quality improvement education, further research is necessary to explore strategies to implement the same on a larger scale, and to examine the impact on patient outcomes.

Stories of breast cancer through art.

PURPOSE/OBJECTIVES: To describe the use of an art exhibit, created in response to breast cancer survivor stories, and additional supplementary activities to increase cancer awareness and provide support to those with cancer. DATA SOURCES: Published articles and books, personal experiences. DATA SYNTHESIS: Art has been used to educate and promote the expression of emotions. Using an art exhibit as the central feature, a planning committee composed of staff members and volunteers developed a repertoire of activities to improve cancer awareness and provide support to cancer survivors. Visitor and staff reactions to the event were profound. CONCLUSIONS: Art can capture the most intimate and personal aspects of the cancer experience. This event was a novel and effective way to increase awareness about the cancer experience. The event brought together patients, family members, friends, staff members, and the community and facilitated new partnerships to help people with cancer. IMPLICATIONS FOR NURSING: Nurses are well equipped to direct the therapeutic use of art and support the potential reactions of viewers. Nurses can promote the benefit of art exhibits for cancer education, support, and awareness and use their knowledge and skills in planning and implementing supplementary activities.

Twin quilts--stories to be told.

A perusal of the literature reveals the many ways quilt design and personal communication is interwoven. We selected quilt making to provide those affected by breast cancer-as a patient, friend or relative-the opportunity to communicate their experience through quilt making. With the participation of community quilters, a concept and quilt design was developed to incorporate the work of patients and others in making a quilt. The project pattern and materials were presented. Contributors were invited to write about what inspired them to participate. For the 80 blocks that were constructed as twin quilts, 36 individuals wrote something about their block. Analysis of the vignettes identified major categories. The most common theme was honoring a specific person's life and their breast cancer journey. Displayed together with their accompanying vignettes, the quilts have become a focal point for interaction among patients and their families.

Operationalizing advanced practice registered nurse legislation: perspectives from a clinical nurse specialist task force.

Many state boards of nursing are currently examining advanced nursing practice and determining a process to recognize and regulate it appropriately. In 1999, Minnesota state law was altered to define and provide title protection for advanced practice registered nurses. After passage of the new law, the Minnesota Board of Nursing convened 4 task forces, representing each of 4 advanced practice nursing groups, to develop recommendations regarding issues of certification, criteria for determining acceptable certifying organizations, procedures in the event of examination failure, and a process for communicating this information to the nursing community. This article provides an overview of the legislation and describes the process used to obtain and operationalize the new law. The process undertaken in the clinical nurse specialist task force is also described, including the key issues that emerged and lessons that were learned.