Biomechanical evaluation of nursing tasks in a hospital setting.

A field study was conducted to investigate spinal kinematics and loading in the nursing profession using objective and subjective measurements of selected nursing tasks observed in a hospital setting. Spinal loading was estimated using trunk motion dynamics measured by the lumbar motion monitor (LMM) and lower back compressive and shear forces were estimated using the three-dimensional (3D) Static Strength Prediction Program. Subjective measures included the rate of perceived physical effort and the perceived risk of low back pain. A multiple logistic regression model, reported in the literature for predicting low back injury based on defined risk groups, was tested. The study results concluded that the major risk factors for low back injury in nurses were the weight of patients handled, trunk moment, and trunk axial rotation. The activities that required long time exposure to awkward postures were perceived by nurses as a high physical effort. This study also concluded that self-reported perceived exertion could be used as a tool to identify nursing activities with a high risk of low-back injury.

Developing and using preparatory information for women undergoing radiation therapy for cervical or uterine cancer.

PURPOSE/OBJECTIVES: To describe symptoms associated with radiation therapy necessary to develop preparatory concrete, objective information for women with cervical or uterine cancer. DESIGN: Prospective, descriptive. SETTING: University-affiliated radiation oncology department in the mid-south. SAMPLE: 49 of 52 women undergoing external beam radiation and low-dose rate brachytherapy for cervical or uterine cancer. Stage of disease ranged from I-IIIA. Mean age of subjects was 54 years; mean years of education was 11. METHODS: Investigator-developed symptom checklist based on prior research. MAIN RESEARCH VARIABLES: Symptom reports. FINDINGS: At least 40% of the women reported difficulty sleeping, fatigue, diarrhea, anorexia, nausea, urinary frequency, dysuria, vaginal discharge, and perineal irritation. Incidence and timing of symptoms varied by operative status and brachytherapy timing. CONCLUSIONS: Findings confirm and clarify the symptoms women associate with radiation treatment for cervical or uterine cancer. IMPLICATIONS FOR NURSING PRACTICE: Assessing research findings for relevance to the care of patients in specific settings is necessary. These findings are appropriate for developing preparatory information for women undergoing external beam radiation and low-dose rate brachytherapy.

Comparison of the effectiveness of two pressure-relieving surfaces: low-air-loss versus static fluid.

Limited research has been done to determine the effectiveness of the multitude of pressure reduction devices currently available for patient care. The purpose of this investigation was to examine the relative effectiveness of a dynamic low-air-loss (LAL) mattress and a static fluid mattress in reducing the risk of pressure ulcer development. The investigation consisted of two components: a comparative laboratory study and a retrospective clinical study. In the laboratory study, tissue interface pressures were measured on the two surfaces at three interface sites in a sample of six healthy adult volunteers. In the clinical study, a retrospective chart review was conducted to compare the actual incidence of pressure ulcer formation in a sample of 73 postoperative transplant patients who were placed on either the static fluid or LAL product. The instruments used were the Xsensor Pressure Mapping System (laboratory) and chart review tool (clinical). The main outcome measures included tissue interface pressures and incidence of pressure ulcer formation. The results were as follows: the laboratory study revealed significantly lower sacral pressures (t = -5.30, P = .003) on the low-air-loss mattress than on the static fluid mattress. Pressures did not differ significantly at the heel or trochanter sites. In the clinical study, the overall incidence of skin breakdown was 8.2%, with 5 occurrences (13.8%) in the LAL group and 1 occurrence (2.7%) in the static fluid group. However, this difference was not significant (Fisher's exact test = 0.107, P = .09). When considered jointly, the results of the two studies suggest that the static fluid and LAL products may be comparable in efficacy. Although the relatively small sample sizes used in the investigation limit generalizability, the results provide some initial direction for further clinical research in this area.

Achieving femoral artery hemostasis after cardiac catheterization: a comparison of methods.

BACKGROUND: Cardiac catheterization is a common procedure that involves the introduction of a small sheath (5F-8F) into the femoral artery for insertion of other diagnostic catheters. After cardiac catheterization, local compression of the femoral artery is required to prevent bleeding and to achieve hemostasis. Traditional methods of achieving hemostasis require significant time and close supervision by medical personnel and can contribute to patients' discomfort. VasoSeal is a recently developed device that delivers absorbable collagen into the supra-arterial space to promote hemostasis. OBJECTIVES: To compare outcomes between patients receiving a collagen plug and patients in whom a traditional method of achieving hemostasis was used after diagnostic cardiac catheterization. METHODS: An outcomes tracking tool was used to analyze the medical records of 95 patients in whom a traditional method was used (traditional group) and 81 patients in whom VasoSeal was used (device group) to achieve hemostasis. Complications at the femoral access site, patients' satisfaction, and times to hemostasis, ambulation, and discharge were compared. RESULTS: Hematomas of 6-cm diameter occurred in 5.3% of the traditional group; no complications occurred in the device group. The device group also achieved hemostasis faster and had earlier ambulation (P < .001). Patients in the device group were discharged a mean of 5 hours sooner than patients in the traditional group (P < .05). No significant differences were found in patients' satisfaction. CONCLUSIONS: VasoSeal is a safe and effective method of achieving hemostasis after cardiac catheterization that can hasten time to hemostasis, ambulation, and discharge.

Recognition of staff nurse job performance and achievements: staff and manager perceptions.

Recognition for job performance is central to staff nurse morale. However, little research has been done to identify recognition methods most valued by nurses themselves. The authors report results of a multisite survey conducted to compare staff and manager perceptions of meaningful recognition behaviors. They provide data for developing management interventions that may help to improve morale and increase retention. Given the financial constraints of the current environment, the nonmonetary recognition practices identified are of particular significance.

Social support and adjustment in women following coronary artery bypass surgery.

Social support expected, discrepancies in support (differences between support expected and received), and self-esteem were used to predict emotional (tension and depression) and functional outcomes (recreation, housework, and social life) in a sample of women who had coronary artery bypass surgery (N = 86). Women were interviewed before hospital discharge (T1) and 1 (T2) and 3 (T3) months later. Higher self-esteem was associated with lower depression and tension (T3) and less disruption in social interaction (T2 and T3) and recreation (T3). Results suggest that social support may influence outcomes through enhancement of self-esteem. Directions for further study are given.

Nurses' attitudes towards cost-effectiveness and quality of care.

OBJECTIVE: To describe nurses' attitudes toward cost-effectiveness in nursing practice and its perceived effects on quality of care, and to examine the influence of role, education, and experience on these attitudes. DESIGN: A comparative, descriptive design was used. SETTING: Two community hospitals in the midwest. SUBJECTS: Registered nurses and licensed practical nurses. MEASUREMENTS AND MAIN RESULTS: Blaney Hobson Nursing Attitude Scale was used to measure nurses' attitudes toward cost-effectiveness. Demographic information was obtained by asking open-ended questions. Scores ranged from 30 to 96, with a mean score of 65.57 (SD = 13.58). CONCLUSIONS: Nurses with greater than 10 years experience had more positive attitudes than nurses with 10 years or less experience. Nurses in administration/management positions had more positive attitudes than did staff nurses. No significant correlation was found between education level and attitudes toward cost-effectiveness. The major concern of participants was that quality of care would suffer due to cost containment efforts. The majority of participants agreed that education in cost containment and budgetary issues should begin in basic nursing school and should be included in employer orientation programs.

Psychosocial and functional outcomes in women after coronary artery bypass surgery.

In this longitudinal study of women after CABS, the women were coping admirably with good psychosocial and functional outcomes up to 3 months postoperatively. It is suggested that women be instructed how to find and use their support systems and be told that most women do well and return to normal activities of daily living after CABS.

Removal of femoral sheaths by registered nurses: issues and outcomes.

The results of this evaluation indicate that specially trained critical care nurses can remove femoral sheaths with an acceptable margin of safety. As a result, these nurses can provide quality, cost-effective care to angioplasty patients. However, before this procedure is included as part of the RN's responsibility, written protocols are needed to identify appropriate patients, proper removal technique, and specific actions to take if complications occur. In addition, plans must be developed for initial education and ongoing competency evaluation to ensure that each nurse involved maintains an adequate knowledge base and skill level.

Identifying nursing research priorities in an acute care hospital.

The purpose of this study was to identify nursing research priorities for an acute care hospital. Using the Delphi technique, data were obtained from a panel of 52 nurses who held administrative, staff, or support positions. After three rounds of data collection, a prioritized listing of potential research topics was obtained. The study results have helped motivate and guide research efforts, stimulate formation of research interest groups, and attract local researchers to the facility.

Psychosocial adjustment to coronary artery disease: current knowledge and future directions.

Adjusting to the diagnosis of coronary artery disease can be a challenge to the coping abilities of patients and their families. To effectively support these clients' coping efforts, cardiovascular nurses must be knowledgeable about factors that affect the adjustment process. This article reviews recent findings regarding physiologic, psychologic, and sociodemographic influences on adjustment and presents a model that integrates these findings. Possible directions for further research are suggested.

Importance of nurse caring behaviors as perceived by patients after myocardial infarction.

Our purpose was to identify nursing behaviors perceived as indicators of caring by patients who have had a myocardial infarction. A sample of 22 hospitalized patients were interviewed, with use of an open-ended question and the Caring Behaviors Assessment, to determine what things nurses said or did that conveyed caring to the patients during their stay in the coronary care unit (CCU). An analysis of the relative importance of each identified behavior revealed that nursing actions that focused on the physical care and monitoring of patients were seen as most indicative of caring. Teaching activities were also perceived as significant whereas extra, individualized aspects of care were viewed as less important in the critical care setting. No significant differences in perceptions were found on the basis of sex, age, education level, number of CCU admissions, or length of CCU stay. Critical care nurses should be aware that assessment activities and demonstration of professional competence are viewed by patients as significant expressions of caring.