Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia affecting more than six million people in the United States. The economic burden is estimated to be >$6 billion annually with catastrophic events dramatically increasing expenditure. When patients experience symptoms, they commonly present to an acute care facility; this can be costly and anxiety provoking. LOCAL PROBLEM: Same-day access issues prohibit patients from communicating directly with their cardiology provider, forcing them to use resources and increasing psychological burden. METHODS: A convenience sample, made up of 43 patients, was given a KardiaMobile device. Eligible patients had ≥2 AF-related emergency department (ED) or urgent care (UC) visits over 12 months, needed rate control with medication titration, or were monitored for AF reoccurrence after reestablishing sinus rhythm. INTERVENTIONS: Patients emailed recordings daily and when experiencing symptoms. The recordings were reviewed by a nurse practitioner (NP); abnormal readings were followed by a phone call, telehealth, or in-person visit. RESULTS: An independently designed survey was conducted online; almost all respondents (97%) found value in the project and the device. Virtually all respondents (97%) felt that the program improved access. A majority (86%) reported decreased anxiety. Had the respondents not been in the program, 34% indicated that they would have presented to an ED and 25% would have presented to an UC, realizing a cost savings of $81,950 in reduced ED visits alone. CONCLUSION: A personal electrocardiogram, with NP oversight, to manage AF is cost-effective and reduces unnecessary resource utilization. It is patient centered, improves access, and empowers patients to manage their symptoms.

Intentional learning: a student-centered pedagogy.

Objective The objective was to test the assumption that characteristics of intentional learning are not fixed and if an interview assignment enhanced intentional learning. Methods In order to meet the needs of practice, nursing educators have trialed student-centered pedagogies, often with resistance from students. Intentional learning appears to mirror the characteristics, such as autonomy, responsibility of one's own learning, self-regulation, and motivation, needed by students to be successful in student-centered pedagogies. Intentional learning had not been studied in nursing. A quasi-experimental pre/post-test design was used to test intentional learning in nursing students (N=92). Results While the interview assignment did not enhance intentional learning scores, intentional learning scores did significantly increase over the semester (p=0.039). Conclusion Intentional learning scores did increase, showing that students move along the intentional learning continuum depending on their learning experiences. Future research should include testing teaching strategies that foster intentional learning.

Perceived Evidence-Based Practice Competency Acquisition in Graduate Nursing Students: Impact of Intentional Course Design.

BACKGROUND: Acquisition of evidence-based practice (EBP) competencies in graduate-level nursing programs bridges the research-practice gap in professional practice. This study evaluated the impact of the Star Model of Knowledge Transformation as a framework for course design on graduate-level nursing students' perceived EBP competencies. METHOD: Data were collected from 2012 to 2017 (N = 544). Repeated-measures ANOVA was used to analyze pre- and postassessment data over time. Data were collected for each of the five stages or Star Points of EBP competencies. RESULTS: Significant postcourse improvement in perceived EBP competencies was demonstrated (p ≤ .000) for all Star Points and years. The greatest pre- and postassessment percentage change occurred in the Translation Star Point scores and the least percentage change occurred in Discovery. CONCLUSION: These data support the use of intentional course design based on a recognized EBP model to improve perceived EBP competencies in Master of Science in Nursing students. [J Contin Educ Nurs. 2019;50(2):79-86.].

Comparing NET and ERI standardized exam scores between baccalaureate graduates who pass or fail the NCLEX-RN.

In the United States, nursing programs are commonly evaluated by their graduates success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The purpose of this paper is to describe a change in NCLEX-RN success rates following the addition of standardized exams throughout our program's curriculum, and to compare these exam scores between graduates who pass NCLEX-RN and those who do not. Our results indicate an 8.5% change (p < 0.000) in the NCLEX-RN pass rate from our previous 5-year mean pass rate, and significant differences in standardized test scores for those who pass the NCLEX-RN compared to those who do not (p < 0.03). We conclude that our selected standardized exam scores are able to significantly identify graduates who are more likely to pass NCLEX-RN than not.

Physiological and psychological symptoms of grief in widows.

In this cross-sectional descriptive survey of 173 widows, we describe their grief symptoms using an open-ended questionnaire and the Revised Grief Experience Inventory. Self-reported physical symptoms included pain, gastro-intestinal problems, medical/surgical conditions, sleep disturbances, and neurological/circulatory issues. Psychological symptoms were reported as depression, anxiety, and loneliness. The mean total grief score was 71.4 +/- 30.2 (possible range 22-132). Physical symptoms were significantly correlated with the total mean grief score, and subscales of physical distress, depression, existential tension, and guilt. When the subjects were grouped by years since loss, (range 1-5 years), there was no significant decrease found in overall grief scores, suggesting symptoms of grief experienced by widows may continue up to at least 5 years.