Supporting Parkinson's disease medication safety for nurses in the acute care setting through an educational intervention study.

INTRODUCTION: Patient medication safety in the acute care setting is a foundational action provided by nurses and healthcare providers for safe patient care. Hospitalization of patients with Parkinson's disease (PD) can be dangerous due to the unique and variable medication regimen required. Patients with PD often have their medication administered inappropriately in the acute care setting (e.g., holding a PD medication in preparation for surgery, not administering the medication on the patient's home schedule, and delaying administration). The research question posed in this study was the following: does a PD medication educational intervention in the clinical setting enhance knowledge, comfort, and competence of practicing nurses in the care of patients with PD regarding their medication safety? DESIGN: A mixed methods study design was used for this 5-month, two-part study with a sample of practicing RNs at three different hospitals. Part one of the study assessed nurses' initial knowledge of PD and PD medication safety and included an educational intervention. Part two of the study occurred 3 months later and evaluated if knowledge from the educational intervention was retained. METHODS: The study was conducted in two parts and included a pre-test, educational intervention, post-test, and follow-up test 3 months later. The educational intervention consisted of a 15-minute video of two PD advanced practice nurses being interviewed regarding the general care of a patient with PD. The pre-test, post-test, and follow-up test were identical and consisted of six questions regarding knowledge, comfort, and self-perceived competency. Participants were additionally asked three open-ended questions at follow-up to gain insight on the effectiveness of the educational intervention. RESULTS: A total sample of 252 RNs participated in this study. Statistically significant improvements in knowledge, comfort, and self-perceived competency were observed in the post-test scores compared to pre-test scores. These statistically significant improvements were retained after 3 months, despite a 42.9% decrease in the number of responders (n = 252 vs. n = 144). Additionally, compared to the post-test, there were no statistically significant declines in knowledge, comfort, or competency in the follow-up test. Qualitative findings indicated that the training regarding PD medications was retained and found to be valuable, even if it was seldom applied in practice. CONCLUSION: A review of the literature and this study both support the need for increased education for practicing nurses as it relates to PD and PD medication safety. Healthcare systems, organizations, and associations that support continuing education for nurses create a stronger workforce. Education has been found to keep nurses up to date on the latest advances in care and treatment while also providing exposure to other areas of nursing beyond their clinical settings. CLINICAL RELEVANCE: Promoting better patient outcomes through safe medication administration is a hallmark of nursing care excellence. This study found that supporting the use of an educational intervention of PD medication safety for nurses improved RN levels of knowledge, comfort, and competency up to 3 months later. As the population of those with PD increases, healthcare systems, and nurses must now, more than ever, be poised to care for these individuals. This is a critical point in PD patient care since persons with PD are hospitalized 1.5 times more than their peers without PD.

Innovative Pedagogical Approaches to Teaching Advanced Forensic Nursing.

Forensic nursing is a specialty in nursing with unique knowledge and skills, founded on a theoretic framework identifying three pillars of knowledge--legal principles, forensic science, and forensic nursing with concepts, context, and content unique to the specialty. To care for patients with trauma backgrounds, who are or have intersected with the legal system, forensic nursing education and subsequent certification today requires educational technology. Transforming learning takes demonstrative activities, changing them into interactive dynamic opportunities that teach metacognitive activities to provide complex trauma-informed care in the aftermath of violence, to forensic nurses.

School Shooters: Patterns of Adverse Childhood Experiences, Bullying, and Social Media.

INTRODUCTION: Since 2013 there have been at least 421 recorded incidents of gunfire on school grounds METHOD: This study used a critical review of national and local media news reports of 25 American male school shooter cases from 2013 to 2019. RESULTS: Approximately 88% of school shooters had at least one social media account, and 76% posted disturbing content of guns and threatening messages. Over 72% of shooters had at least one reported adverse childhood experience, and 60% reported being bullied in-person or online DISCUSSION: Professionals who work with adolescents are front-line providers who routinely assess student safety. Social media use is often underassessed, demonstrating a knowledge gap that may reveal insights into the perspective and well-being of adolescents. Inclusion of questions on social media, adverse childhood experiences, and experiences of bullying by pediatric nurses and others may be proactive measures that can help identify, protect, and intervene with at-risk students.

Using the word "Healthy" in an emergency food pantry: An unexpected response.

The word "healthy" holds significant value when discussing health and nutrition; however, the word was identified as having a negative and confusing connotation at an Emergency Food Pantry (EFP). The sample of 11 women, ages 40-70 years, who are patrons at an EFP in Southeastern Pennsylvania shared that "healthy" is a misunderstood term, frequently perceived as expensive and tasteless. Identification of the word "healthy" as a barrier was unexpected for the interprofessional team of health educators. Understanding the perspectives of individuals who utilize EFPs can benefit anyone working in public health and community settings since "healthy" and "healthy eating" are common words. When planning nutrition and health education classes, barriers must be recognized in order to promote health by using words that resonate with EFP patrons and their community. It is crucial for nurses and providers to communicate with patients using the most effective and impactful terminology.

Access to clean water and urinary tract infections in Haitian women.

OBJECTIVES: Access to clean water is a global concern. For women living in developing countries, the lack of clean water increases their risk of bacterial infections, such as a urinary tract infection (UTI). The purpose of this study was to examine if the location of water source has a relationship with the rate of UTIs in women who lived in the Léogâne area of Haiti. DESIGN: Descriptive, correlational, retrospective chart review used de-identified data from medical intake flow sheets. SAMPLE: A total of 311 medical intake flowsheets with 32.4% of the sample were treated for a UTI. The majority of women were between the ages of 20 and 44 years. RESULTS: The youngest group, ages 10-14 years, were more likely (83.3%) to be diagnosed with a UTI (X2  = 7.956, df = 3, p < .05) when compared to the other age groups. The location of water source also had a relationship with UTI, with women who reported using pump water more likely to be treated for a UTI than those who reported using short-well water (X2  = 4.318, df = 1, p < .05). CONCLUSIONS: Although the study only involved Haitian women, the concepts of access to clean water, reducing bacterial infections such as a UTI, and health promotion are useful for any provider practicing in or going to a developing country.

Perceptions of pediatric nurse practitioners and how a pulmonary function printout influenced practice.

The rate of asthma in the pediatric population has risen over the last two decades and is now considered to be the most common serious chronic disease in children and adolescents as well as a serious public health concern. In one suburban, Pennsylvania nurse-managed clinic, a group of pediatric nurse practitioners (PNPs), noted an increase in the number of children with asthma and purchased a pulmonary function machine (Spirometer). The purpose of this paper is to discuss how the integration of a pulmonary function measurement printout influenced a small group of PNPs visit satisfaction, their delivery of nursing care, and the response of the families. As the incidence of asthma increases in the pediatric population, nurse practitioners and other healthcare professionals can take a leading role in patient teaching and provision of care by augmenting their practice with new technology combined with continued education for the client and family.

Urban seventh grade students: a report of health risk behaviors and exposure to violence.

The health of adolescents and the adults they will become can be linked to the health-related behaviors they adopt as children. To replicate a pilot study with a more culturally diverse population a descriptive, correlational study was undertaken with 379 seventh grade students. Key findings from this study include (a) students exposed or involved in violence (e.g., fighting and carrying a weapon) were more likely to report smoking cigarettes, (b) nearly a quarter (24%) of students have smoked cigarettes at some time, and (c) almost half of the students (48%) reported having at least one alcoholic drink. Middle school can be critical time in the life of an adolescent who may be faced with opportunities to experiment with and participate in health risk behaviors. School nurses, practitioners, and other health care professionals are in an ideal position to assess the type of and level of participation by an adolescent in a health risk behavior.

Cigarette Smoking and Alcohol Use among Adolescents and Young Adults with Asthma.

Asthma is one of the most common, serious chronic diseases in pediatric and young adult populations. Health-risk behaviors, including cigarette smoking and alcohol use, may exacerbate chronic diseases and complicate their management. The aim of this study was to longitudinally analyze rates of cigarette smoking and alcohol use in adolescents and young adults who have asthma and those who do not have asthma. A secondary analysis of data from the National Longitudinal Study of Adolescent Health was undertaken. Individuals with asthma were found to exhibit increasing rates of cigarette smoking and alcohol use as they aged. When an adolescent with a chronic health issue begins health-risk-taking behaviors, behavior change interventions must be planned. Pediatric nurses, practitioners, and clinicians are uniquely positioned to assess for health-risk behaviors in youth with asthma and to intervene with plans of care that are tailored for the needs of this vulnerable population.

Risky internet behaviors: a case study of online and offline stalking.

Today's youth are more technologically savvy than any other generation possessing the ability to go online anytime. This increase in use of and access to technology has also provided adolescents with increasing opportunities to experience online relationships, which can place them in a vulnerable position and risk for harassment, bullying, stalking, exploitation, sexual solicitation, and victimization. A case study of a 15-year-old, 10th-grade girl who demonstrated characteristics of risky Internet and health risk behaviors and experienced online and offline stalking is presented along with tips for Internet Safety for school nurses, parents, and teachers are offered. In the diverse and complex health care settings of the 21st century, professionals are increasingly encountering risk situations defined by the technology being used by both victim and offender. Adolescents who form online relationships should be informed about the risks and rewards, just as the adults who interact with them should be.

Grandmother caregiver reactions to caring for high-risk grandchildren: I could write a book.

During the past decade there has been an increase in the prevalence of grandmothers raising their grandchildren because of parental drug use and child neglect and maltreatment in the United States. A study was designed and conducted to examine the relationship between caregiver burden and caregiver physical health for grandmothers raising their high-risk grandchildren. The sample consisted of 104 grandmothers. The findings indicated that caregiver physical health correlated strongly with level of burden and financial status. Further analysis suggests physical health variables had an observable impact on caregiver burden. Because this study indicates, from descriptive and correlational statistics, that the well-being of the grandmother and grandchild are both linked to the grandmother's physical health, there are numerous nursing interventions that may support a positive outcome for both. The provision of emotional and psychosocial support, coupled with health education and periodic health evaluations, are known to improve a grandmother's perception of her own health. Nurses can use the measures of caregiver burden to develop care plans targeting the health issues most likely to improve a grandmother's functional ability to remain the primary caregiver for a high-risk grandchild.

Grandmother caregivers and caregiver burden.

PURPOSE: To describe the experience of grandmothers who are parenting their grandchildren, and determine the amount of caregiver burden felt by the grandmothers. STUDY DESIGN AND METHODS: This descriptive correlational study had a sample of 104 grandmothers, reporting on 249 custodial grandchildren. Grandmothers completed the Caregiver Reactions Assessment to determine perceived physical health, family support, financial status, and caregiver burden. RESULTS: Overall, grandmothers perceived the health of their grandchildren as excellent. Of the grandchildren who had been born prematurely (30%), the primary health problems were hyperactivity and asthma. Parental drug use was reported as the reason for child placement with the grandmother in 80% of the cases. The range of time grandchildren had been living with the grandmother was 6 months to 15 years. Low ratings of grandchild physical health correlated with low ratings of grandmother physical health, which correlated strongly with low levels of self-esteem, a strong perception of poor family support, and poor financial status, all of which represent measures of caregiver burden. CLINICAL IMPLICATIONS: This study demonstrated that the well being of the grandmother and grandchild are both linked to good physical health. Thus, indicators of poor health for both grandchild and grandmother must be identified early. Grandmothers in this study were surprised at how much had changed in every aspect of child health since they had raised their own children. Nurses working with grandmothers who have custody of grandchildren should understand the dynamics of the relationship, the possibility of caregiver burden, provide anticipatory guidance about the changes in child care and child healthcare in the 21st century, and help link grandmothers who have little support to community programs.

Health risk behavior assessment: nutrition, weight, and tobacco use in one urban seventh-grade class.

Health attitudes and behaviors develop in childhood and progress through adolescence into adulthood. To better understand the health risk behaviors being undertaken by a seventh-grade urban population, a study was conducted to identify what health risk behaviors a group of adolescents were participating in. The purpose of this study was to describe (1) the types of health risk behaviors being undertaken, (2) the frequency of their taking health risk behaviors, and (3) the age of initiation of the health risk behavior. The findings from this study indicate that this sample of 54, urban seventh graders suffers from multidimensional health needs. These students participated in a variety of health risk behaviors, as measured by the Youth Risk Behaviors Surveillance System Questionnaire. These students have begun to smoke regularly, which correlated with the use of alcohol. They rate their health as being good or excellent but rarely met the daily requirements for intake of fruits and vegetables. And, although they rate their weight as being acceptable, most are trying to lose weight. Additionally, differences between the boys and girls were noted in weight perception, with girls more likely than boys to use smoking as the primary method of weight control. Nursing is in an ideal position to provide effective primary care interventions and community health outreach to this adolescent population.

The relationship between health risk behaviors and fear in one urban seventh grade class.

A descriptive, correlational study was undertaken with 54 urban, 7th graders (age, 11-13 y) from one class. By using the Youth Risk Behaviors Surveillance System Questionnaire (YRBSS), information was collected about health risk behaviors as well as unintentional and intentional injury. Findings indicate that these adolescent students have significant fears related to their environment; they are fearful of being hurt. These students also reported increased incidence of health risk behaviors including alcohol use, carrying weapons, and staying up late at night. The findings suggest a need to understand how adolescents channel fear of harm to self into other unhealthy behaviors. Nurses are often in an ideal position to assess the health and behaviors of adolescents and to offer education, health promotion, and support to this at-risk population.

Urban seventh graders and smoking: a health risk behavior assessment.

Health risk behaviors undertaken in adolescence, such as smoking, can have a lasting impact on both short-term and long-term health developments. To better describe the health risk behaviors of an adolescent urban population, a study was conducted at two parochial middle schools in the southwest section of Philadelphia. The study purpose was to describe (1) the types of health risk behaviors being undertaken by a seventh grade student population, (2) the frequency of health risk behaviors, and (3) the age of initiation of the health risk behavior, e.g., age when they first began smoking. A descriptive, correlational study was undertaken with 106 urban seventh graders (ages of 11-13 years) from two seventh grade classes. Using the Youth Risk Behaviors Surveillance System Questionnaire, information was collected about health risk behaviors. Correlational statistics indicated significant correlations between students who smoke and alcohol use, dieting, and not feeling safe in their neighborhood. Interestingly, girls were more likely to use smoking as their primary method of weight control and dieting. Because the long-term impact of smoking is known to be negative, nurses should provide support to this at-risk population and also should be prepared to educate adolescents who come under their care.