Common and Best Nail Practices Among Nail Care Providers: A Descriptive Study.

PURPOSE: The purpose of this project was to identify common and best practices for safe nail care among nail care providers. DESIGN: Descriptive study using online survey. SUBJECTS AND SETTING: The study was conducted by 2 credentialed foot and wound care nurses within a large Midwest healthcare system. Participants were nurses and physicians who provide nail care to patients and individuals in the hospital and community setting such as private homes and nursing homes and hospice agencies. METHODS: Email invitations with a link to the survey were sent to eligible individuals and organizations in which wound care specialists were employed. Information about the survey was posted on the Certified Foot Care Specialty homepage, and on the Wound, Ostomy and Continence Nursing (WOCN) Members-only Forum and Facebook page. RESULTS: An estimated 1000 surveys were sent of which 246 surveys were returned. Fifty-three percent (121/229) of respondents were certified through the WOCN Certification Board and 41% (93/229) were certified through the American Foot Care Nurse Association. Most respondents reported using some form of self-protection when filing (225/246, 91.5%), trimming (215/246; 87.4%), or using a rotary tool (204/246, 82.9%) on patients' nails. However, approximately one-fourth of respondents reported offering some type of protection for patients when filing (63/246, 25.6%), trimming (41/246, 16.7%), or using a rotary tool (64/246, 26.0%). Most of the nurses surveyed provided nail care in outpatient and foot care clinics, acute care settings, private homes, and nursing homes/hospice. CONCLUSIONS: When providing nail care, the patient/client protections should closely mirror the personal protective equipment used by the nurse. Future research is needed to contribute to a national consensus guideline for best practices and protections at all levels of nail care in the acute care and community settings.

Development and Implementation of an Emergent Documentation Aggression Rating Tool: Quality Improvement.

INTRODUCTION: Workplace violence is prevalent in the emergency department, putting patients and staff at risk for harm. An ED-specific standardized tool is needed to promote a consistent assessment process to strengthen documentation of escalating patient behaviors, give justification for de-escalating interventions, and reduce restraints. The purpose of this project was to design, implement, and evaluate feasibility of an ED-specific tool to help nurses proactively identify and intervene with patients' escalating behaviors, capture better documentation of aggressive/violent patient events, and reduce restraint usage. METHODS: A quality improvement design was used. The Emergent Documentation Aggression Rating Tool was constructed by combining evidence-based behavioral cues for potential aggression/violence with observed behaviors and successfully implemented interventions in patients. Nurses were trained on how to use the tool to rate patients' behaviors and take necessary action. Chart data were collected from August 2018 to December 2019 at a Midwestern suburban hospital emergency department. Chart audits and just-in-time education were conducted after implementation. Survey data were collected to evaluate nurses' perception of the tool's usefulness. RESULTS: Use of the novel Emergent Documentation Aggression Rating Tool increased over time (67.36% in Quarter 3 2018 to 97.55% in Quarter 4 2019). After Emergent Documentation Aggression Rating Tool implementation, visual inspection of the time series indicated a decrease in percent restraints, and there was an overall increase in documented escalations de-escalations over time. The patients that escalated most frequently had diagnoses of alcohol use, suicidal ideations, pain-related complaints, or mental health issues. CONCLUSION: The Emergent Documentation Aggression Rating Tool was feasible for emergency nurses to proactively identify and intervene with patients at risk for aggression/violence.

A descriptive study of adverse childhood experiences and depression, anxiety, and stress among undergraduate nursing students.

BACKGROUND/SIGNIFICANCE: The 10-point Adverse Childhood Experiences (ACEs) score measures childhood exposure to traumatic events. An ACEs score of 4 or higher has been associated with long-term physical and mental health problems, and increased mortality. It is unclear if the rates of undergraduate nursing students experiencing ACEs is different from the general population, and what impact ACEs has on nursing students' depression, anxiety and stress. PURPOSE: The purpose of this study was to assess the rate of ACEs in nursing students and to examine the relationship between ACEs and perceived depression, anxiety, and stress among undergraduate nursing students. METHODS: This is a descriptive correlational study to determine Adverse Childhood Experiences (ACEs) scores and Modified Depression Anxiety and Stress Scale (DASS-21) scores for undergraduate pre-licensure students at a private mid-western college. Students' ACEs scores were correlated with DASS-21 scores and demographic data. RESULTS: 409 students volunteered to participate in the study. Seventeen percent of students had high ACEs scores (≥4). Those students with high ACEs scores also scored statically significantly higher on the DASS-21 items relating to depression, anxiety, and stress. CONCLUSION/IMPLICATIONS: Results from this study demonstrated that many nursing students have experienced ACEs and nursing students with ACEs scores of 4 or higher had higher rates of depression, anxiety, and stress. These findings should drive faculty in nursing programs to acknowledge the prevalence of ACEs among their nursing students and recognize that impact on the mental health of students.

Empathy Huddles: Cultivating a Culture of Empathy.

Managing complex neurological patients challenges new nurses with minimal experience, which can interfere with their ability to relate empathetically to their patients. This article is the story of how 1 neuroscience unit's experience with Empathy Huddles improved the staff's ability to respond to their patients and families with empathy. The hospital collects quarterly patient satisfaction data using the Hospital Consumer Assessment of Healthcare Provider and Systems. In the third and fourth quarters of 2015, the unit's patient satisfaction scores had declined significantly and remained low, in particular, the score for "how often did nurses listen carefully to you." In February 2016, Empathy Huddles were implemented on the unit. Hospital Consumer Assessment of Healthcare Provider and Systems scores for this question were compared pre and post intervention. The top box response score was 46% preintervention (fourth quarter of 2015). After 2 quarters of Empathy Huddles, the top box score rose to 75% in the third quarter and 82% in the fourth quarter of 2016. The unit has maintained the top box score above 78%. In the fourth quarter of 2017, they achieved a top box score of 91%. Scores greater than 82% were sustained through the third quarter of 2018. Connecting was the overarching theme that emerged from interviews regarding Empathy Huddles. Interviewees described how Empathy Huddles helped them to connect empathetically with their patients, families, and each other. The huddles reminded staff to consider the day from the patients' point of view and be mindful of their experiences.

CNAs' experiences in the nursing home: "It's in my soul".

Issues affecting CNAs' ability to do the job can affect resident care quality. The purpose of this study was to explore the meaning of CNAs' experiences in the nursing home. A naturalistic design using qualitative methods guided data collection and analysis. Data were analyzed using qualitative content analysis. Four themes emerged: Transitioning Between Two Worlds, Responding to the Call, Living the Job, and Transcending the Job. The challenge is to create strategies that identify CNAs'passion for the job, support their ability to balance daily tasks with relationships, and value their knowledge and contributions to the care team.

Bayesian data analysis: estimating the efficacy of T'ai Chi as a case study.

BACKGROUND: Bayesian inference provides a formal framework for updating knowledge by combining prior knowledge with current data. Over the past 10 years, the Bayesian paradigm has become a popular analytic tool in health research. Although the nursing literature contains examples of Bayes' theorem applications to clinical decision making, it lacks an adequate introduction to Bayesian data analysis. METHODS: Bayesian data analysis is introduced through a fully Bayesian model for determining the efficacy of tai chi as an illustrative example. The mechanics of using Bayesian models to combine prior knowledge, or data from previous studies, with observed data from a current study are discussed. RESULTS: The primary outcome in the illustrative example was physical function. Three prior probability distributions (priors) were generated for physical function using data from a similar study found in the literature. Each prior was combined with the likelihood from observed data in the current study to obtain a posterior probability distribution. In each case, the posterior distribution showed that the probability that the control group is better than the tai chi treatment group was low. DISCUSSION: Bayesian analysis is a valid technique that allows the researcher to manage varying amounts of data appropriately. As advancements in computer software continue, Bayesian techniques will become more accessible. Researchers must educate themselves on applications for Bayesian inference, as well as its methods and implications for future research.

Metaphors in qualitative research: shedding light or casting shadows?

The use of metaphors in qualitative research provides an opportunity to examine phenomena from a unique and creative perspective. Metaphors can be used to provide structure to the data; to understand a familiar process in a new light; to identify situation-specific interventions; and to evoke emotion. Misuse of metaphors may detract from the intended research message. Mixing metaphors, failing to follow through with metaphors, and using metaphors that do not fit the data can misrepresent the data. The choice to use metaphors should not become a self-serving attempt at creativity that supersedes subject and substance. At their best, metaphors illuminate the meanings of experiences; at their worst, metaphors distort or obscure the essences of them.