Examination of the Relationship Between Clinical Hours and NCLEX Success.

BACKGROUND: Clinical education provides important learning opportunities for students. Finding clinical sites and faculty can be a challenge. Exploring the relationship between the number of clinical practice hours and NCLEX-RN success may be helpful for curriculum development and revision. PURPOSE: The purpose of this study was to provide descriptive information about clinical education in RN programs and determine if a relationship existed between the number of clinical hours and NCLEX-RN pass rate. METHOD: A descriptive research design using a survey was sent to over 1000 accredited nursing programs in the United States. RESULTS: One hundred and fourteen surveys were completed. When comparing 2021 NCLEX-RN pass rates with clinical hours, there was a statistically significant difference at the 500 clinical hour interval. CONCLUSION: Nursing programs can ensure fiduciary responsibility while supporting clinical judgment development and licensure success by reviewing their curriculum and reconsidering the number of clinical hours in their programs.

Evaluating the Efficiency of Survey Collection Methods to Trauma Patients.

BACKGROUND: Traumatic injury survivors often experience negative health consequences, impacting recovery. No studies have assessed the feasibility of evaluating the resiliency of hospitalized trauma patients using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). PURPOSE: The purpose of this study was to determine the most efficient method to collect survey responses on the CD-RISC-10. METHODS: This cross-sectional study used a convenience sample of admitted patients with traumatic injury. Patients were randomized to complete the CD-RISC-10 using pen and paper, tablet, or workstation on wheels. RESULTS: Of the 161 patient surveys, the tablet-based survey took the shortest time to complete (2 minutes, 21 seconds), and the paper survey resulted in the lowest percentage of missed questions (0.5%). Trauma patients reported high levels of resiliency. CONCLUSION: The CD-RISC-10 can be easily administered to trauma patients. Clinicians should balance efficiency and patient preferences when deciding on a survey collection method.

Exploring Nurses' Perceptions of Specialty Certification.

BACKGROUND: The strategic nursing plan for a large Midwestern health care system includes achievement of the American Nurses Credentialing Center's Magnet® recognition for all their hospitals. This study explored the barriers to and perceived value of certification among nurses employed by the same health care system across eight facilities in a metropolitan region. One of these facilities holds Magnet® recognition. METHOD: Subjects were recruited by direct email to collect demographic data and complete a barrier to certification survey and the Perceived Value of Certification Tool-12. RESULTS: There were statistically significant differences in the perception that lack of institutional support is a barrier to certification both in aggregate and when comparing the Magnet® hospital with the others. CONCLUSION: As an initial exploration into barriers and perceived value, this study provides data for this health care system to plan strategies to promote certification. This study also serves as an exemplar for other organizations considering evaluation of certification barriers and value among their nursing staff. [J Contin Educ Nurs. 2023;54(12):567-573.].

Does the addition of post-operative gabapentin reduce the use of narcotics after orthopedic surgery?

OBJECTIVES: To evaluate the efficacy of post-operative gabapentin administration as an analgesic agent and its effect on narcotic use after orthopedic surgery in an outpatient sports medicine practice by comparing patients prior to and after initiating the routine use of gabapentin as part of a standardized post-operative pain medication regimen. We hypothesized that adding gabapentin to a multimodal post-operative pain regimen would decrease the number of requested pain medication refills and have no detrimental effect on Visual Analogue Scale and Single Assessment Numerical Evaluation scores at these early post-operative visits. METHODS: All outpatient surgical patients, <90 years of age, undergoing outpatient orthopedic surgery by the study's senior author were included between 08/05/2021 and 02/22/2022. Patients were allowed 1 narcotic refill post-operatively and only in the first 3 weeks. The primary outcome was difference in percentage of patients who requested a narcotic refill within 3 weeks post-op. Two- and 6-week Visual Analogue Scale and Single Assessment Numerical Evaluation scores, and baseline health and demographic data. T-tests were run on continuous variables, Chi-Square or Fisher's Exact Test were run on dichotomous variables, and Mann-Whitney U test was run on all other categorical variables. Statistical significance was set at P < .05 for all tests. RESULTS: There was a significant difference in narcotic refills at 3 weeks: 23 pre-gabapentin patients and 9 post-gabapentin patients (22.8% vs 9.0%, respectively: P = .006). There were no differences between 2- and 6-week Visual Analogue Scale and 2-week Single Assessment Numerical Evaluation scores. There was a significant difference in 6-week SANE between groups: mean difference = 6.4 (P = .027) though less than the established MCID. CONCLUSION: Addition of gabapentin to a post-operative multimodal pain regimen reduced the use of narcotics after orthopedic sports medicine surgeries while also providing equivalent pain control.

Characteristics of Adult Patients for Violence-Related Injuries Presenting to a Level 1 Trauma Center in Midwest United States.

BACKGROUND: Hospital violence intervention programs (HVIPs) have recently been initiated in trauma centers across the United States. However, violence-related injuries have unique factors and issues that should be addressed in the health care provided in emergency departments. PURPOSE: This study aimed to characterize the patient population presenting at a level 1 ACS verified trauma center, with a chief complaint of violent trauma, and identify characteristics of patients most at risk for violence-related trauma. METHODS: The cross-sectional retrospective study examined patients' electronic health records, at least 18 years, with a diagnosis of blunt or penetrating injury treated by the emergency and trauma team at level 1 ACS verified trauma center in the Midwest. RESULTS: Assault injuries accounted for most of the mechanisms that required treatment at the hospital and disposed to home. Nearly 80% of the population had no documentation of the relationship of the assailant. The average age of the patients was 33 years and black males. Eleven patients were treated in the emergency department twice for a trauma-related injury during the six-month data collection. CONCLUSION: Injuries from violence require comprehensive care from various healthcare disciplines, similar to managing acute and chronic illnesses. The American College of Surgeons (ACS) guidelines support the development of an HVIP to identify risk factors and treatment plans for any patient exposed to violence. This research demonstrates that HVIPs should provide standardized screening and follow-up care while in the emergency department or immediately following the hospital to reduce the cyclical events.

The other side of conflict: Examining the challenges of female orthopaedic surgeons in the workplace.

BACKGROUND: As more women begin to enter the traditionally male-dominated field of orthopaedics, it is critical to examine their experiences in navigating gender-based conflicts in the workplace. METHODS: An anonymous survey was distributed via a web link to approximately 1,100 members of Ruth Jackson Orthopaedic Society (RJOS) and 1,600 members of Women in Orthopaedics (WIO) Facebook group, with an estimated response rate of 50% and 50% respectively and protocols to mitigate duplicate response. Questions included demographics and presented several workplace scenarios. RESULTS: Of the 373 respondents, 72% described experiencing some type of workplace conflict self-attributed to being female. Additionally, 8% reported either being forced out or leaving their previous job due to workplace conflict, leading to depression, anxiety, and burnout. 17% of respondents would not choose the same career again if given the opportunity. CONCLUSIONS: Workplace conflict diminishes a surgeon's career satisfaction and may ultimately contribute to burnout. Understanding the relationship between gender bias and orthopaedic surgery is essential in moving towards change, and addressing these issues will create a more positive working environment for female surgeons.

Burn trauma from a space heater requiring paraspinal muscle flap back reconstruction with skin grafting: A case report.

Full-thickness burns damage all layers of skin and may also damage underlying tissue including bones, muscles, and tendons. Full-thickness burns almost always require immediate medical and surgical management. Some may require extensive bone, muscular, and other reconstructive surgery depending on the depth of involvement of surrounding tissues. Bone exposure in burn patients can lead to unique complications including osteomyelitis. We present the case of an elderly patient with a history of dementia who presented with full-thickness burns to the back with exposed spinal elements who later developed osteomyelitis requiring lumbar spine reconstruction with bilateral paraspinous muscle flap for back reconstruction, adjacent tissue transfer, and split thickness skin grafting. This case represents the severity of full-thickness burns with underlying bone exposure and the importance of aggressive wound care and multidisciplinary team approach.

Septic Emboli Resulting From Severe Trauma: A Primer on Care.

INTRODUCTION: Trauma nursing requires specialized knowledge and skills. This article describes the case of a patient who was involved in a motor vehicle accident and presented to the emergency department with hypovolemic shock secondary to a splenic laceration. In the hospital, the patient experienced prolonged hypotension. CLINICAL FINDINGS: The patient sustained a variety of insults to the cardiovascular, respiratory, endocrine, and musculoskeletal systems. Microbiological data and laboratory test results did not reveal the defining characteristics of sepsis or systemic inflammatory response syndrome typical of trauma patients, making it challenging to identify the source of the sepsis. DIAGNOSIS: The patient was diagnosed with nontraumatic cerebral septic emboli, a condition that is less common in trauma patients and more common in cases of endocarditis, septic thrombophlebitis, and central venous catheter infections. The condition has a 50% mortality rate if not detected promptly and appropriate treatment administered. OUTCOMES: The patient survived the 4-week hospitalization owing to timely management of his conditions by the health care team and their persistence in identifying the cause of his atypical sepsis. CONCLUSION: To provide adequate care to trauma patients, critical care nurses require specialized knowledge of this unique population. Trauma critical care nursing should involve hands-off communication, thoughtful review of laboratory test and imaging results, and engagement in interdisciplinary care rounds.

Transpedicular Screw Placement Accuracy Using the O-Arm Versus Freehand Technique at a Single Institution.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: The objective of this study was to assess the effectiveness of the O-arm as an intraoperative imaging tool by comparing accuracy of pedicle screw placement to freehand technique. METHODS: The study comprised a total of 1161 screws placed within the cervical (n = 187) thoracic (n = 657), or lumbar (n = 317) spinal level. A pedicle breach was determined by any measurable displacement of the screw outside of the pedicle cortex in any plane on postoperative images. Each pedicle screw was subsequently classified by its placement relative to the targeted pedicle. Statistical analysis was then performed to determine the frequency and type of pedicle screw mispositioning that occurred using the O-arm versus freehand technique. RESULTS: A total of 155 cases (O-arm 84, freehand 71) involved the placement of 454 pedicle screws in the O-arm group and 707 pedicle screws in the freehand group. A pedicle breach occurred in 89 (12.6%) screws in the freehand group and 55 (12.1%) in the O-arm group (P = .811). Spinal level operated upon did not influence pedicle screw accuracy between groups (P > .05). Three screws required revision surgery between the 2 groups (O-arm 1, freehand 2, P > .05). The most frequent breach type was a lateral pedicle breach (O-arm 22/454, 4.8%; freehand 54/707, 7.6%), without a significant difference between groups (P > .05). CONCLUSIONS: The use of the O-arm coupled with navigation does not assure improved transpedicular screw placement accuracy when compared with the freehand technique.

Preparedness to Write Items for Nursing Education Examinations: A National Survey of Nurse Educators.

BACKGROUND: Nursing programs in the United States primarily use multiple-choice questions to prepare students for the NCLEX. BACKGROUND: Nursing programs in the United States primarily use multiple-choice questions to prepare students for the NCLEX. Currently, the optional next-generation NCLEX is testing the validity and reliability of situational case studies. PURPOSE: The purpose of this study was to investigate the preparedness and confidence of nurse educators in writing NCLEX-style questions. METHODS: A descriptive survey design with snowball sampling was used to collect the data and was sent to 1550 deans/directors/coordinators of publicly available email addresses of accredited schools of nursing. RESULTS: A total of 300 participants completed the survey from 44 states. When asked about confidence in writing NCLEX-style items, those who received formal education or training reported being somewhat confident (51%), whereas those who did not reported ambivalent or not confident (49%). CONCLUSION: Surveyed nurse educators lack confidence in writing questions and feel unprepared for the new question types instituted by the NCSBN in 2023. Nurse educators need continued education to develop and review NCLEX-style items and examinations.

Performance on advanced pharmacy practice experiences after implementation of mock acute care patient simulations.

INTRODUCTION: We sought to compare student performance on acute care advanced pharmacy practice experiences (APPEs) pre- and post-incorporation of mock acute care patient simulations into the curriculum. METHODS: A series of mock acute care APPE simulations (MACAS) were developed and incorporated into Touro University California College of Pharmacy curriculum for first- and second-year pharmacy students. Results for student performance on Acute Care I and Acute Care II APPEs were collected for students who received none, one year, or two years of the MACAS. Student admission characteristics and didactic academic performance (grade point average [GPA]) were also gathered. Student characteristics and APPE performance were compared across cohorts of students who received none, one year, and two years of MACAS. Multivariate models were created to measure the impact of the MACAS while controlling for student characteristics. RESULTS: The final cohort included 394 students. In unadjusted analyses, students with one or two years of MACAS received significantly higher preceptor acute care APPE evaluations for communication, professionalism, and patient scores vs. students who received no MACAS. In multivariate models controlling for age, gender, and undergraduate GPA, one year of MACAS increased student acute care APPE communication, professionalism, and patient care scores, relative to no MACAS. Similar increases in acute care APPE scores were seen for students who received two years of MACAS. CONCLUSIONS: MACAs significantly improved acute care APPE scores relative to students with no MACAS. This improvement in acute care APPEs occurred after students received a single year of MACAS.

A Prospective Assessment of Opioid Utilization Post-Operatively in Orthopaedic Sports Medicine Surgeries.

BACKGROUND: The healthcare system is plagued finding the balance between opioid use and abuse. Orthopaedic surgeons are expected to curtail the number of opioids prescribed in order to lower opioid abuse. We sought to prospectively evaluate opioid consumption following a wide range of sports orthopaedic surgical procedures to determine utilization patterns. METHODS: All patients receiving procedures within a one-year period were consented and then called daily for one week followed by weekly for up to two months or until the patients no longer were taking their opioid medication. We studied the number of opioids patient's took postoperatively and also collected information in regards to the patient and the surgical procedure. RESULTS: Included were 223 patients with a mean age of 32.9 years (range, 11 to 82). Surgeons prescribed a mean total of 59.5 pills, and patients reported consuming a mean total of 20.9 pills, resulting in a utilization rate of 40%. 94.4% of patients received no education on how to properly dispose of unused opioids. The mean SANE score was 53.9. The mean Pain Catastrophizing Scale score was 15.1. The mean Opioid Risk Tool was 3.3. The procedures were broken down into: 47.5% ligamentous knee repair, 18.4% shoulder arthroscopy/other shoulder, 7.6% meniscus, 7.6% shoulder arthroplasty, 5.4% distal biceps, 4.0% lower leg (ankle/foot/tibia) and 4.0% shoulder ORIF. CONCLUSION: Over-prescribing opioids after sports orthopaedic surgeries is widespread. In this study, we found that patients are being prescribed 2.48 times greater opioid medications than needed following sports orthopaedic surgical procedures. We recommend surgeons take care when prescribing postoperative pain control and consider customizing their opioid prescriptions on the basis of prior opioid usage, anatomic location and procedure type. We also recommend educating the patients on proper disposal of excess opioids and consider involving pain management for patients likely to require prolonged opioid usage.

Effect of Patient Resilience and the Single Assessment Numeric Evaluation (SANE) Score on Return to Sport Following Anterior Cruciate Ligament Reconstruction Surgery.

BACKGROUND: This study aims to determine the effect of resilience, as measured by the Brief Resilience Scale (BRS), and perceived self-efficacy of knee function, as measured by the Single Assessment Numeric Evaluation (SANE) score on return to sport outcomes following ACL Reconstruction (ACLR) surgery. METHODS: Seventy-one patients undergoing ACLR surgery were followed up for a minimum of one year. At six-months post-op, ACLR patients completed the BRS and the SANE score. Patients were stratified into low, normal, and high resilience groups, and outcome scores were calculated. RESULTS: The median return to sports participation, in months post-operatively, for the low, normal, and high resiliency groups were 7.1, 7.3, and 7.2 months, respectively (P=0.78). A multiple logistic regression analysis revealed that the SANE score was a significant predictor of return to sport at nine months when adjusted for age, sex, and BRS score (P=0.01). Patients that returned to sport by nine months demonstrated a mean SANE score of 92.7, compared to a mean of 85.7 (P=0.08). In patients who had returned to sport, neither the BRS resilience group nor the SANE score were significant predictors of the returned level of competition status (P=0.06; P=0.18). CONCLUSION: The SANE score may serve as a significant predictor of return to sport when adjusted for age, sex, and BRS score. Resilience, as measured by the BRS, was not significantly associated with return to sport, but may have utility in specific patient populations.

Operative vs. Nonoperative Treatment of Isolated Humeral Shaft Fractures: A Prospective Cohort Study.

The purpose was to compare plate and screw fixation (open reduction internal fixation [ORIF]) and functional bracing (FB) of isolated humeral shaft fractures with treatment and patient-based outcomes. We performed a prospective trial of ORIF v. FB at 12 centers. Surgeons counseled patients on treatment options and a patient centered decision was made. We enrolled 179 patients, of which 6-month data was analyzed for 102 (39 female; 63 male). Forty-five were treated with ORIF and 57 with FB. We found no difference in the disability of the arm, shoulder and hand (DASH) score, visual analogue score (VAS) or elbow range of motion (ROM) at 6 months. However, 11% of the FB group developed nonunion. Complications in the ORIF group included a 2% infection and nonunion rate and 13% iatrogenic radial nerve dysfunction (RND). ORIF can be expected to result in higher union rates with the inherent risks of infection and RND. Finally, at 6 months, both groups demonstrated higher DASH scores than population norms, indicating a lack of full recovery. (Journal of Surgical Orthopaedic Advances 30(2):067-072, 2021).

Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures?

Our purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making. There were 80 patients that healed with adequate data. The receiver operating characteristic (ROC) had best fit with a sagittal radiographic angle of 10° (AUC: 0.731) and coronal angle of 15° (AUC: 0.580) at 1-year follow-up. We found increased or worse disabilities of the arm, shoulder and hand (DASH) scores with > 10° sagittal alignment or > 15° of coronal alignment. Poor DASH scores were observed at angles lower than previously accepted for nonoperative treatment. These findings are useful in decision making and patient guidance. (Journal of Surgical Orthopaedic Advances 30(2):073-077, 2021).

An Applicant's Residency Program Region May Influence Where They Complete Fellowship.

The primary goal of this study was to determine if an applicant's geographic region of residency was associated with where they matched for fellowship. San Francisco Match (SF Match) provided results regarding applicant data and match results from 2014-2018 for orthopaedic subspecialties except hand and shoulder and elbow. Residency programs were divided into five regions: (Northeast [NE], Southeast [SE], Midwest [MW], Southwest [SW] and West [W]). The MW region had the fewest number of fellowship positions per applicant (0.62), the W region had the most (1.7). Applicants from each region were significantly (p < 0.0001) more likely to complete fellowship in the same region where they completed residency, and there were significant (p < 0.05) differences between regions for specific subspecialties. There are imbalances in terms of the number of applicants and specific fellowship spots available in each region. This imbalance seems important considering the strong associations found between the region in which an applicant completes residency and fellowship. Level of Evidence: Level 3. (Journal of Surgical Orthopaedic Advances 30(1):030-035, 2021).

Changes in attitudes toward diabetes in nursing students at diabetes camp.

AIM: The research purpose was to determine whether exposure to residential diabetes camps affects attitudes toward diabetes care and management in nursing students. BACKGROUND: Summer camp for children with type 1 diabetes mellitus (T1D) provides a unique and engaging clinical environment for nursing students to learn about evolving diabetes care and to help children develop diabetes management skills. METHODS: This prospective, pretest/posttest study assessed student nurses' attitudes about diabetes, who attended one of four residential summer camps in the United States, using the Diabetes Attitude Survey 3 (DAS3). The survey was administered before and after clinical experience designed to fulfill experiential curricula requirements from various nursing programs. RESULTS: After attending diabetes camp, nursing students (N = 73) had a positive change in their attitudes regarding the need for special training and the psychosocial impact of diabetes. DISCUSSION: The diabetes camp clinical experience impacted nursing students' attitudes. Diabetes camps are a unique clinical setting that uses learned clinical knowledge and judgment to promote health and prevent disease and disability, supporting the integration of primary care and public health nursing.

Leadership development of nursing professionals: Education and influences of self-efficacy.

BACKGROUND: According to Bandura's theory, understanding the relationship of traits and leader self-efficacy in the various roles of nursing can aid in leader development and the growth of the profession. PURPOSE: The purpose of this study was to explore the perceptions of leader self-efficacy of academic nursing professionals to determine if traits and participation in certain activities was predictive of leader self-efficacy. METHOD: A validated survey tool, the Leader Efficacy Questionnaire (LEQ) was administered to nursing professionals using snowball sampling from publicly available email addresses. FINDINGS: Statistical significance was found between the academic degrees and the 4 scores of the LEQ. Overall, the participants reported moderate to high leader self-efficacy with an LEQ overall score (LSME) of 70 or greater. DISCUSSION: The dynamic challenges of health care require an understanding of nursing professionals' leader self-efficacy in light of their academic preparation and activities to grow the profession.

Gunshot Wounds to the Hip: Doomed to Failure?

The purpose is to evaluate hip fractures due to gunshot wounds (GSW) to the hip, which are treated surgically, and the complications. Patients who sustained a low velocity GSW with fracture to the femoral head/neck and intertrochanteric/peritrochantric region at three Level 1 Trauma Centers were eligible. There were 69 patients (63 males-91%), with an average age of 29 (18-60). Nine patients had orthopaedic surgical site infections. There were 6 nonunions, 4 patients with hardware failure, 2 cases of avascular necrosis (AVN), 3 patients with post traumatic arthritis (PTA) and 20 patients with heterotopic ossification (HO). There was no significant difference found regarding fracture site or type of fixation with regards to complications. This represents the largest study of surgically treated GSW to the hip. Of patients studied, 61% sustained additional GSW. These injuries are not benign; the main complications being infection and heterotopic ossification. (Journal of Surgical Orthopaedic Advances 29(3):135-140, 2020).

High Energy Midfoot Fracture-Dislocations: Does Staged Treatment with External Fixation Help?

This study analyzes the outcomes of patients treated for high energy midfoot injuries with temporary stabilization (TS) prior to definitive operative fixation compared to a control group (C) treated initially with splint only. Three Level 1 trauma centers reduced and temporized high energy Lisfranc injuries. A matched control group was compared with the intervention group. Clinical parameters, complications and need for additional surgery were evaluated. There were 15 patients in group C and 29 patients with temporary stabilization (TS). Both the TS and C groups demonstrated no significant difference in the number of additional operations, infection rate, incidence of deep vein thrombosis (DVT), nonunion and need for orthotics postoperatively (p > 0.05). Staged treatment of high energy Lisfranc injuries in the TS group led to a delay in definitive fixation or arthrodesis while having a similar minimal complication rate relative to the controls. This is a Level III, Retrospective Case Control Study. (Journal of Surgical Orthopaedic Advances 29(3):154-158, 2020).