Interruptions During Medication Administration: A Descriptive Study.

Interruptions decrease the efficiency of the medication administration process. In this study, interruptions were found in 63% of the medication passes on four medical-surgical units in a community hospital. However, interruptions do not always lead to negative outcomes.

Latino Adolescent Perspectives Toward Sexually Transmitted Infection Educational Programs.

PURPOSE: The study aims to identify knowledge about sexually transmitted infections (STIs) among Latino adolescents, to explore programmatic components that are essential for an effective educational program, and to explore gender differences regarding STI knowledge and essential components. METHODS: A naturalistic inquiry approach was used. FINDINGS: Knowledge of specific STIs was minimal. Themes including humor, fear, empowered decision-making, peer educators, self-protection, knowledge and information on STIs, and consistency of the sexual health education were identified as essential components for STI educational programs. CONCLUSION: The findings of this study enhance the understanding of STIs, sexual behaviors, and essential components of an effective STI educational program as perceived by Latino adolescents. IMPLICATIONS FOR NURSING PRACTICE: It is essential for nurses to provide accurate information about STIs and safe sex to help decrease the transmission of STIs.

Pain management after total knee arthroplasty: a case­control study of continuous nerve block therapy.

BACKGROUND: Continuous femoral nerve block infusions (CFNBIs) have been found to both decrease patient postoperative pain and improve postoperative joint mobilization, both of which impact patient satisfaction, outcome, and length of stay. When we began the use of CFNBIs, we needed to create a policy, process, standing order form, and staff education plan as well as a means to maximize therapy efficacy and believed that a research study would best meet those needs. PURPOSE: To evaluate the patient response to the institution of CFNBI therapy, identify process improvement areas, and suggest areas for future study. METHODS: Through retrospective chart review, using a case­control research design with 27 pairs of patients matched by body mass index, American Society of Anesthesiologists patient physical status classification, and age, we examined whether patients receiving CFNBI therapy after total knee arthroplasty would report less postoperative pain, require less narcotics, and achieve mobilization goals earlier than patients receiving traditional narcotic analgesia only. RESULTS: The CFNBI case group reported significantly less pain over the fi rst three postoperative days ( p = .05), but findings revealed no significant differences between case and control groups in total narcotic use or achievement of mobility goals. On the basis of this study, we increased the CFNBI drug concentration and expect that this will allow us to meet all 3 patient goals. CONCLUSION: This study has added to previous research that supports CFNBI as a proven therapy to decrease postoperative pain in patients undergoing total knee arthroplasty. The structure of a research project facilitates the implementation, evaluation, and improvement of such new therapies. Evaluating patient data allows identification of process improvement areas­in our case, the change in drug concentration­as well as the need for staff education aimed at facilitating their active participation in CFNBI therapy.

Factors related to sexual practices and successful sexually transmitted infection/HIV intervention programs for Latino adolescents.

OBJECTIVE: The purpose of this integrative literature review was to explore factors that are related to sexual practices among Latino adolescents and identify which of those factors are common across successful sexually transmitted infection (STI)/HIV intervention programs for Latino adolescents. DESIGN: An integrative literature review was conducted. Search terms included Latino, Hispanic, education, intervention/prevention programs, sex, sexuality, reproductive health, health risk behaviors, multiple sex partners, contraception, STI/HIV/AIDS, sexually transmitted diseases, delay in initiation of sexual intercourse, consistent use of birth control, avoidance of STI/HIV infections, unintended pregnancy, cultural factors, and gender roles. RESULTS: Findings revealed from the review of 17 articles addressing factors related to sexual practices among Latino adolescents included familialism, religion, gender roles, level of knowledge/information, and privacy/confidentiality. Five successful STI/HIV intervention programs, that incorporated those factors to effectively reduce risky sexual behaviors were identified. STI/HIV knowledge and gender roles were recognized as common factors integrated into and across successful intervention programs for this population. CONCLUSION: Only STI/HIV knowledge and gender roles were found as common factors across the five successful STI/HIV intervention programs and should be incorporated into future intervention programs that are culturally and gender specific. Therefore, health care providers need to understand culturally related gender roles and their impact on sexual practices to provide culturally sensitive and appropriate sex education about STIs and HIV for Latino adolescents to increase the program potential for reducing STI/HIV.

Eating behaviors among early adolescent African American girls and their mothers.

African American (AA) girls aged 10-12 living in urban communities designated as food deserts have a significantly greater prevalence of overweight and obesity than girls that age in the general population. The purpose of our study was (a) to examine the agreement in nutritional intake between AA girls aged 10-12 and their mothers and (b) to determine if the girls' weight categories were associated with their or their mothers demographic characteristics, eating behaviors, nutritional intake, and health problem. A cross-sectional descriptive study was conducted in predominantly low-income AA communities in Chicago. Forty-three dyads of early adolescent AA girls and their mothers responded to food frequency and eating habits questionnaires. There was a strong and significant correlation between mother's and daughter's kilocalories consumed (r = .61). Our study suggests that interventions aimed at improving eating behaviors in early adolescent AA girls should include their mothers.

Stressors related to depression among elderly Korean immigrants.

While depression in the elderly is well documented, little is known about depression in specific groups of immigrant elderly. In this study, 160 elderly Korean immigrants completed measures of depression, stressful life events, acculturative stress, family relationships, social support, and demographic variables. Findings revealed that income, acculturative stress, and living place were significant predictors of depression. As income declined, depression increased; living with one's adult children was associated with less depression; depression increased in concert with acculturative stress. These findings suggest that maintaining family relationships may be a key factor in preventing and/or lessening depression in elderly Korean immigrants.

Family Relationships and Depression among Elderly Korean Immigrants.

The purposes of the study were to describe family relationships within the context of living arrangements (living with adult children or without adult children) and support network, and to further determine associations of these factors to depression in elderly Korean immigrants. Over 70% (N = 160) of Korean elders were found to live apart from their adult children. However, Korean elders who were living independently reported higher levels of depression in spite of their expressed desire to live independently and to be less dependent upon their adult children. These findings suggest that family support and close relationships with their adult children play a central role in adjusting to a new life and in preventing and/or lessening depression in elderly Korean immigrants.

Promoting cardiovascular health: special considerations for the elderly.

Although clinicians and researchers understand the need to promote cardiovascular health in people of all ages, with population aging there are particular insights/issues that should be considered when counseling and caring for elderly patients. The focus here is to present current statistics relative to aging in the United States, discuss risk factors and lifestyle with a particular focus on those 65 years and older, and further discuss the need to continuously monitor activities of daily living and instrumental activities of daily living in elderly persons to ensure that whatever is done to promote cardiovascular health does not interfere with functional independence.

Bridges to the Doctorate: mentored transition to successful completion of doctoral study for underrepresented minorities in nursing science.

Nursing has a shortage of doctorally-prepared underrepresented minority (URM) scientists/faculty. We describe a five-year University of Illinois at Chicago (UIC) Bridges program for URM master's students' transition to doctoral study and factors in retention/graduation from the PhD program. Four master' students from two partner schools were recruited/appointed per year and assigned UIC faculty advisors. They completed 10 UIC credits during master's study and were mentored by Bridges faculty. Administrative and financial support was provided during transition and doctoral study. Partner schools' faculty formed research dyads with UIC faculty. Seventeen Bridges students were appointed to the Bridges program: 12 were admitted to the UIC PhD program since 2004 and one graduated in 2007. Eight Bridges faculty research dyads published 5 articles and submitted 1 NIH R03 application. Mentored transition from master's through doctoral program completion and administrative/financial support for students were key factors in program success. Faculty research dyads enhanced the research climate in partner schools.

Evidence-based practice: a falls prevention program that continues to work.

The successful implementation of an evidence-based falls prevention protocol in an acute care facility is described. The number of falls per 1000 patient days decreased by 50% without rebound over a 5-year period.

Self-rated competency and education/programming needs for Care of the Older Adult with Cardiovascular Disease: a survey of the members of the Council of Cardiovascular Nursing.

An online survey, Care of the Older Adult with Cardiovascular Disease (COA-CVD), was used to describe self-rated competency in the care of the aging adult with cardiovascular disease and subsequently determine the future education and programming needs of the Council of Cardiovascular Nursing. Respondents indicated that developing relationships, patient teaching, and assessment were areas where they felt most competent. The areas of highest priority for future programming included assessment of the older adult, diagnosis of health status, deriving a plan of care, implementing a treatment plan, patient teaching, and ensuring quality care. Most stated that content relative to the care of the older adult should be available at the annual meeting, Scientific Sessions of the American Heart Association, followed by self-study modules (65%), local and regional conferences (64%), and stand-alone national conferences (53%). The conclusions are that the Council of Cardiovascular Nursing and its membership need to address the importance of care of aging adults with cardiovascular disease and stroke in future programming. Although the Scientific Sessions of the American Heart Association is an appropriate venue, efforts can be directed toward developing self-study modules and local and regional conferences. As always, there is a need to work collaboratively with the other councils of the American Heart Association and other nursing organizations who view the care of the older adult as a high priority.

Analysis of measures of functional and cognitive ability for aging adults with cardiac and vascular disease.

Baseline and follow-up assessments of functional and cognitive status are essential for aging patients who survive acute cardiac and vascular disease, as they are faced with new medications and implementing changes in lifestyle. Because declining functional and/or cognitive status will interfere with treatment regimens and taking prescribed medications, it is imperative that healthcare providers develop an understanding of approaches to functional and cognitive assessment that can be used with aging patients, selecting those most appropriate for the venue in which they practice and for their particular patient population.

Quality of life in women following coronary artery bypass graft surgery.

The purpose of this study was to determine the effect of coronary artery bypass graft (CABG) surgery on the quality of life of women. Wilson and Cleary's conceptual model of health-related quality of life, which examines five major outcomes (biological variables, symptom status, functional status, general health perceptions, perceived quality of life), was used. Participants included 61 women who provided information by self-report questionnaires before and three months after surgery. The major findings of the study are that women had significantly improved quality of life (p = .004) due to increased satisfaction with health and functioning (p < .001) at three months following CABG surgery. They experienced less angina (p < .001) and shortness of breath (p = .014), although fatigue was unrelieved for the majority of women. Psychological well being improved after surgery for most women (p < .001), with lower anxiety levels (p < .001), greater levels of well being (p = .021), feelings of health (p < .001) and vitality (p = .023). Women reported less use of emotive coping (p = .043), indicating less emotional distress. Nevertheless, 25% of the sample continued to experience severe psychological distress three months after surgery, indicating the need for continued follow-up.

Relationship between soft tissue body composition and bone mass in perimenopausal women.

OBJECTIVES: Perimenopause, the transition into menopause, marks the beginning of accelerated bone loss, contributing to the development of osteoporosis, a major public health problem. This perimenopausal transition has also been associated with a decrease in body lean mass, an increase in fat mass, and an increase in body weight. How these changes in fat mass and lean mass may influence bone mineral density (BMD) is currently unknown. The purpose of this study is to determine the independent effect and relative contribution of lean mass and fat mass to BMD in perimenopausal women. MATERIAL AND METHODS: The sample consisted of 43 sedentary perimenopausal women (age: mean = 49.6; S.D. = 3.2) with an intact uterus and ovaries, participating in a study of exercise and perimenopausal symptoms. Total body BMD, regional BMD, and soft tissue body composition were measured by dual-energy X-ray absorptiometry. Other measures including age, height, weight, and serum FSH and E2 were also obtained. RESULTS: Findings revealed that 14% of these perimenopausal women had low bone mass (osteopenia) in the lumbar spine and/or the femoral neck. Overall body fat mass and lean mass had positive relationships with BMD of lumber spine and the femur. However, using multiple regression analyses, only lean mass and ethnicity remained significant predictors for BMD of the femoral neck (r2 = 45%) with lean mass explaining more variance than ethnicity. Lean mass was the sole predictor of total proximal femur BMD explaining 38% of the variance. Fat mass was not a significant predictor of BMD at any skeleton site. CONCLUSIONS: These findings suggest that body lean mass, not fat mass, is a significant contributor to femoral BMD in perimenopausal women.

Frequency and outcomes of transient myocardial ischemia in critically ill adults admitted for noncardiac conditions.

BACKGROUND: Critically ill adults admitted for noncardiac conditions are at risk for acute myocardial ischemia. OBJECTIVES: To detect myocardial ischemia and injury in patients admitted for noncardiac conditions and to examine the relationship of myocardial ischemia, injury, and acuity to cardiac events. METHODS: Transient myocardial ischemia, acuity, elevations in serum troponin I, and in-hospital cardiac events were examined in 76 consecutive patients. Transient myocardial ischemia, determined by using continuous electrocardiography, was defined as a 1-mm (0.1-mV) change in ST level from baseline to event in 1 or more leads lasting 1 or more minutes. Acuity was determined by scores on Acute Physiology and Chronic Health Evaluation II. RESULTS: A total of 37 ischemic events were detected in 8 patients (10.5%); 32 (86%) were ST-segment depressions, and 35 (96%) were silent. Twelve patients (15.8%) had elevated levels of troponin I. Transient myocardial ischemia, elevated troponin I levels, and advanced age were significant predictors of cardiac complications (R2 = 0.387, F = 15.2, P < .001). Acuity correlated only modestly with increased length of stay in the intensive care unit (r = 0.26, P = .02) and elevated troponin I levels (r = 0.25, P = .03). Patients with transient myocardial ischemia had significantly higher rates of elevations in troponin I (P < .001) and cardiac events (P < .001) than did patients without. CONCLUSIONS: Transient myocardial ischemia and advanced age are predictors of cardiac events and may indicate patients at risk for cardiac events.

The coronary artery bypass experience: gender differences.

OBJECTIVE: The primary purpose of this study was to examine differences between women and men on physical, social and psychological domains of health quality of life before, 1 month after, and 3 months after coronary artery bypass surgery. DESIGN: A prospective, longitudinal design was used. SETTING: The study was conducted at a Midwestern, 500-bed community hospital with an ongoing cardiothoracic surgical program. PARTICIPANTS: Forty pairs of women and men matched on age within 5 years and body surface area within 0.1m 2. INSTRUMENTS: The physical, social and psychological domains of health quality of life were assessed using the following instruments: Ferrans and Powers Quality of Life Index, Specific Activity Scale, Symptom Scale, Profile of Mood States, Overall Health Rating Index, and Personal Resource Questionnaire. RESULTS: Both women and men improved on physical and psychological measures following coronary artery bypass surgery. Compared with men, women reported more shortness of breath and depression and lower ratings of activity, vigor, and overall health. Measures of social support yielded little information. CONCLUSIONS: Despite matching for age and body surface area, women did not have as favorable an outcome after surgery as men. Continued research needs to further examine the interaction of physical outcomes and depression in women after coronary artery bypass surgery.