Mobile Computing Devices in the Perioperative Environment: A Survey Exploring Uses and Experiences Among Certified Registered Nurse Anesthetists.

The use of mobile computing devices (MCDs) such as smartphones, tablet computers, and laptops among Certified Registered Nurse Anesthetists (CRNAs) in the clinical area may provide benefits as well as pose risks. Limited research is available on the use of MCDs in the practice of nurse anesthesia. The purpose of this study was to answer the following questions: (1) What are the clinical and nonclinical uses of mobile computing devices among Michigan CRNAs? and (2) What are the experiences of Michigan CRNAs with regard to the impact of using these devices on patient care? A descriptive survey design was used to answer the research questions. Findings from the study reveal that CRNAs believe there are many important benefits as well as major risks associated with using MCDs while providing direct patient care. In addition, some respondents either personally experienced or witnessed incidents of distraction, performance declines, or serious anesthesia events as the result of MCD use during patient care. This study elucidates the need for the development and adoption of policies that promote safe, appropriate, patient-centered use of MCDs for the specialty of nurse anesthesia.

Musculoskeletal Injury Prevention for New Nurses.

Nurses continue to sustain musculoskeletal injuries even with increased emphasis on safe patient handling and mobility (SPHM) and organizational cultures of safety to protect health care workers. Analysis of data from 2011-2014 registered nurse graduates explored hospital safety culture, SPHM education/training, and incidence of new-nurse musculoskeletal injury. Results indicated hospitals provided some type of SPHM education and training, but 46% of study participants were not informed or aware of national SPHM standards or guidelines. Merely 13.9% of participants stated a written "no manual lifting policy" had been implemented; only 32.9% indicated staffing was adequate for SPHM tasks; and only 39.4% stated the hospital had all of the equipment needed to perform SPHM safely. Thirty-nine percent of participants had already sustained a musculoskeletal injury with an additional 35% sustaining but not reporting an injury. More actions are needed to ensure a decrease in musculoskeletal injuries for new nurses.

Factors Influencing Registered Nurses' Decision to Activate an Adult Rapid Response Team in a Community Hospital.

BACKGROUND: One factor impacting patient outcomes in the acutely deteriorating patient is a delay by nursing staff to activate a rapid response team (RRT); however, a gap in knowledge exists concerning factors influencing activation of an RRT by nursing staff working in adult areas outside the medical-surgical and telemetry setting. OBJECTIVES: The purpose of this study was to examine beliefs and behaviors that influence registered nurses' decision to activate an adult rapid response team in a community hospital that includes 3 specialties: medical-surgical and telemetry, peripartum, and psychiatric areas. METHODS: One hundred sixty-three nurses were surveyed using a 17-item Likert-style instrument to assess registered nurses' beliefs and attitudes on and barriers to utilizing an RRT. RESULTS: The survey was analyzed yielding 3 factors: RRT barriers, RRT positive/intent to activate, and patient management beliefs. Barriers cited by other research to activate RRT including criticism by the team and perception that the RRT increases workload or reduces skills were not found to be influential considerations. A significant difference was found among the 3 specialty groups related to RRT positive/intent to activate (F2,159 = 6.09, P = .003) and patient management beliefs (F2,159 = 5.87, P = .003). A strong negative correlation was found between years of experience as an RN and RRT barriers (ρ161 = -0.250). DISCUSSION: Organizations should examine RRT activation delays particularly in the area of calls to covering physicians prior to RRT activations. Differences between specialty groups highlight the need for education across specialties on the recognition of the acutely deteriorating patient. The findings indicate that the inexperienced nurse requires support from experienced colleagues and temporary adjustments to workload during situations of acute deterioration of a patient.

Patient Satisfaction With Electronic Health Record Use by Primary Care Nurse Practitioners.

The purpose of this research study was to determine if satisfaction and communication between the patient and the nurse practitioner are affected by allowing patients to view their electronic health records during the history portion of the primary care office visit compared with patients who do not view their records. A cross-sectional, experimental design was utilized for this study. The intervention group was shown several components of the electronic health record during the history portion of the nurse practitioner assessment. This group's scores on a patient satisfaction survey were compared with those of the control group, who were not shown the electronic health record. The study findings suggest that the introduction of the electronic health record does not affect patients' satisfaction related to the office visit by the nurse practitioner.

Student Immersion in Perioperative Nursing.

The aging workforce and the lack of perioperative clinical practice and theoretical content in nursing education programs are factors contributing to the perioperative nursing shortage. This article discusses the implementation of a creatively designed perioperative program, which includes a didactic course and a 210-hour clinical course, developed by the faculty members of a Michigan school of nursing in collaboration with administrators at area hospitals. The didactic content covers materials presented during the first three months of orientation for newly employed perioperative nurses. Interested baccalaureate nursing students in their senior year are selected to participate in the program after being interviewed by hospital personnel and university faculty members. To date, the program has 18 student graduates in two semesters; all have been offered positions in the perioperative setting, and 14 have accepted positions. The active learning strategies used in the course are described with examples.

Effect of body mass index and albumin on mortality rates for adult African-American hemodialysis patients.

PURPOSE: The purpose of this retrospective descriptive study was to investigate if body mass index (BMI) and serum albumin (SA) impacted mortality rates in adult African-American patients on hemodialysis (HD). DATA SOURCES: Records of 204 patients on HD (N = 204) from a clinic in the metropolitan Detroit area were examined for the period January 1, 2007-December 31, 2012 to determine the relationship of BMI and SA on mortality rates in this population. Logistics regression was utilized to analyze the association of several risk factors (BMI and SA) on survival (mortality rates). CONCLUSION: Research findings from this study demonstrated that both undernourishment (being underweight; BMI < 23 kg/m(2) ) and hypoalbuminemia (<3.2g/dL) were strong predictors of death in patients on HD. However, obesity provided a survival advantage for adult African-American patients on HD (p = .030). Patients with higher SA levels also survived longer (p < .001). IMPLICATIONS FOR PRACTICE: Advanced practice nurses (APNs) working with adult African-American patients on HD could work on developing targeted nutritional interventions to maintain higher SAs and BMIs while awaiting the results of further research in this area.

The efficacy of preemptive analgesia for postoperative pain control: a systematic review of the literature.

The purpose of preemptive analgesia is to reduce postoperative pain, contributing to a more comfortable recovery period and reducing the need for narcotic pain control. The efficacy of preemptive analgesia remains controversial. This systematic review of the literature evaluated the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, and gabapentin as preemptive oral analgesics for surgical patients. Included articles were limited to studies of adult patients that compared the difference in postoperative pain between control and treatment groups. Of 40 studies reviewed, 14 met the inclusion criteria, including two on NSAIDs, four on COX-2 inhibitors, and eight on gabapentin. Research was predominantly conducted outside the United States. Gabapentin and COX-2 inhibitors were found to be the most effective preemptive analgesics for postoperative pain control. As part of a collaborative team, perioperative nurses and certified RN anesthetists are responsible for ongoing pain assessment and management for preemptive analgesic interventions.

Do higher dispositions for empathy predispose males toward careers in nursing? A descriptive correlational design.

PURPOSE: The purpose of this research was to understand male nursing students' empathy traits compared with other university students using the systematizing quotient and empathizing quotient questionnaires. CONCLUSION: Female students have higher empathizing traits than male students. However, when male nursing students were compared with the general population of other male students, they revealed higher empathy traits 3.0 (p < .01) than other males. PRACTICE IMPLICATION: Empathy plays a significant role in attracting men to a nursing career. Male nurses are not only caring individuals but also have high problem-solving skills in complex environments, demonstrating their strong systemizing characteristics to organize, plan, and implement care.

Reducing hospital ICU noise: a behavior-based approach.

Noise in Intensive Care Units (ICUs) is gaining increasing attention as a significant source of stress and fatigue for nursing staff. Extensive research indicates that hospital noise also has negative impact on patients. The objective of this study was to analyze noise variations as experienced by both nursing staff and patients, to gain a better understanding of noise levels and frequencies observed in ICU settings over extended (week-long) durations, and to implement a low cost behavior modification program to reduce noise. The results of our study indicate that behavioral modification alone is not adequate to control excessive noise. There is a need for further research involving the supportive involvement by clinicians, ICU staff, along with effective medical device alarm management, and continuous process improvement methods.

Perceptions of weight loss experience between African-Americans and Caucasians: a pilot study.

BACKGROUND: Obesity is a growing epidemic in the USA, which leads to comorbidities associated with diseases such as hypertension, diabetes, sleep apnea, cardiovascular disease, osteoarthritis, cancer, gallbladder disease, and dyslipidemia. The purpose of this study is to identify perceptions of weight loss experience between African-American (AA) and Caucasian patients undergoing bariatric surgery. METHODS: A convenience sample of 31 patients participated in this study from May to June 2013. The sample size consisted of 16 AA and 15 Caucasians from two fully accredited and licensed bariatric clinics in metropolitan Detroit. RESULTS: The sample (N = 31) consists of eligible AA and Caucasian presurgical bariatric patients on their first preoperative appointment. Snacking and sexual satisfaction showed a significant difference (p < 0.05), lower amongst Caucasians than amongst the AA. The results revealed that salary within the AA population was significantly lower than that of the Caucasians, especially in the $26.000 to $36,000 category as well as in the over $40,000 category. CONCLUSIONS: The discrepancy widened as the variables of snacks, sexual satisfaction, and salary revealed a significant difference for Caucasians than AA. It is prudent that health-care providers become part of the obesity management solution by examining these variables when planning weight loss interventions.

Empathy as a determining factor for nursing career selection.

The ability to empathize with others is a highly desirable characteristic for the delivery of quality care by nurses. Little research is available that explores the empathy characteristics of students who are attracted to nursing. The purpose of this study is to explore whether empathizing and systemizing characteristics are important factors underlying students' self-selection into and continuing success in nursing programs and whether the importance of these characteristics tends to differ for men and women who choose nursing as a career. A descriptive correlative design was used for this study of 1,872 undergraduates enrolled in a variety of majors, including nursing, at a large midwestern U.S. research university. Findings supported that nursing students had significantly higher empathy characteristics than students in other disciplines.

A closer look at academic probation and attrition: what courses are predictive of nursing student success?

The purpose of this retrospective study was to identify undergraduate courses that serve as predictors of success for nursing students completing a BSN program. The sample included records of 327 students placed on probation or dismissed from a Midwest school of nursing between 2002 and 2010. Though previous research has shown that science courses can be used as predictors of nursing student success, our results suggest that non-science courses can serve in this capacity as well. In particular, an across-the-life-span fundamental psychology course was found to be an important predictor in determining whether or not probationary students eventually completed the program. These results suggest that nursing programs need to evaluate their programs not only reviewing students success in nursing courses but also in prerequisites beyond just science courses such as chemistry and biology.

Cardiovascular disease risk in children and adolescents.

Atherosclerosis is a global health issue beginning in childhood. Children's early development of cardiovascular disease (CVD) risk factors may include exposure to key biological components responsible for vascular inflammation in young adults. A retrospective medical record review based on the 2008 American Academy of Pediatrics childhood lipid screening recommendations examined current and initial CVD risk factors for 227 at-risk school-aged children during wellness exams to better determine the age when children are most likely to convert from being risk-free to at risk for CVD. An original risk trend algorithm analyzed risk clustering and risk trend progression. Risk onset was young (M=2.88 years), with family risk most prevalent and risk clustering and accumulation noted, perhaps precluding primordial prevention.

Accelerated second-degree nursing students: predictors of graduation and NCLEX-RN first-time pass rates.

It is important to understand and identify factors that affect students' academic performance before entry into a nursing program and as they progress through the program. The authors discuss a study, and its outcomes, that assessed accelerated second-degree nursing students' prenursing and core nursing grades that served to predict their success at completing the nursing program and passing NCLEX-RN on first attempt. Strategies were identified to help at-risk students to be successful in the program and with first-time passage of NCLEX-RN.

Relative dose intensity--improving treatment and outcomes in early-stage breast cancer: a retrospective study.

PURPOSE/OBJECTIVES: To determine the amount of chemotherapy delivered compared to amount of chemotherapy scheduled by calculating relative dose intensity (RDI) and to identify factors associated with nonadherence of scheduled treatment regimens for patients with early-stage breast cancer (ESBC). DESIGN: Retrospective, descriptive, correlational study. SETTING: Two community hospital cancer centers in northern Michigan. SAMPLE: 77 patients with ESBC receiving adjuvant chemotherapy. METHODS: The RDI Calculator™ was used for data collection. A worksheet was developed for each patient and included characteristics, treatment information, and RDI calculations. SAS®, version 19.2, was used for multivariate analyses based on logistical regression analyzing relationships among dependent and independent variables. MAIN RESEARCH VARIABLES: Dependent variables were RDI prescribed and RDI received. Independent variables included chemotherapy regimen, clinical characteristics, planned dose, and schedule. FINDINGS: The average RDI was 86.6%. The average RDI was 86.7% for patients younger than age 65, and 85.5% for those 65 and older. The most common reasons for dose reduction or dose delay were treatment toxicity, chronic disease risk factors, age, unplanned versus planned treatment dose, institution (different standards of care), patient preference, and weight. CONCLUSIONS: Meeting treatment goals of RDI for patients with ESBC has been shown to increase the disease-free survival rate and positively affects overall survival. IMPLICATIONS FOR NURSING: Nurses have the unique opportunity to case manage patients with ESBC throughout the spectrum of care. One of the key areas of focus is education of the patient and her family members from the time of diagnosis throughout treatment and rehabilitation.

Work-related emotional stressors and coping strategies that affect the well-being of nurses working in hemodialysis units.

The purpose of this pilot study was to identify and describe work-related emotional stressors that impact the well-being of nurses working in hemodialysis units and to identify their coping techniques. The literature shows that constant exposure to stressors induces emotional conflict and ambiguity, which results in the use of coping techniques to balance well-being. Nineteen participants from six hemodialysis centers completed the Ways of Coping Questionnaire, a 66-item survey based on a four-point scale. Mean and standard deviations were conducted on eight coping techniques. Findings revealed that participants most frequently used ways of coping were planful problem solving (M = 17266), followed by self-controlling (M = 15.29), positive appraisal (M = 14.93), and seeking social support (M = 14.49) when dealing with work-related stressors.

The use of high-fidelity simulation in the admissions process: one nurse anesthesia program's experience.

Nurse anesthesia programs across the country are frequently in search of better selection criteria and more efficient evaluation systems. The goal is to select qualified applicants who will successfully complete the program and represent the profession of nurse anesthesia. The primary method of assessing the quality of candidates' noncognitive attributes at the Oakland University Beaumont Program of Nurse Anesthesia (Royal Oak, Michigan) was by face-to-face interviews. The admissions committee believed that high-fidelity simulation may be a valuable tool to improve the overall admission process. For the 2008 application interview process, high-fidelity simulation was used as a method of simultaneously evaluating candidates' cognitive and noncognitive attributes, in addition to the traditional face-to-face interview. On completion of the admission interview process, a retrospective research design was used to identify a possible correlation between high-fidelity simulation performance scores and other candidate characteristics. The findings of this pilot study revealed a positive correlation between simulation and face-to-face interview scores, suggesting that candidates who exhibited desirable noncognitive attributes in the face-to-face interview also performed well in the simulation environment. The use of high-fidelity simulation as an interview tool may provide an innovative adjunct for admission committees in assessment of candidates.

Perceptions, orientation, and transition into nursing practice of accelerated second-degree nursing program graduates.

This study discusses factors that influence newly graduated accelerated second-degree nursing students to remain at the bedside. It also identifies areas for improvement within the program curriculum to better prepare these unique nursing graduates for the transition into nursing practice. Twenty-nine graduate second-degree nursing students were surveyed 3 months after graduation from an accelerated second-degree nursing program. Key findings indicated that preceptorship within nursing courses and orientation programs was the most significant factor in preparing the graduates for the transition from student nurse to registered nurse. Also important to the successful transition into practice was the acceptance and support of the nursing staff on the clinical unit. The participants overwhelmingly cited preceptorships, at both the student nurse and recent graduate levels, as critical to preparing them for the transition from student nurse to registered nurse.

Understanding overweight adolescents' beliefs using the theory of planned behaviour.

This qualitative inquiry examined adolescents' experiences surrounding their beliefs towards being overweight. The purpose of this qualitative study was to understand behavioural, normative and control beliefs of overweight adolescents regarding losing weight, exercising and eating healthy. Purposive sampling was used to obtain 10 overweight adolescents between the ages of 13 and 19. The theory of planned behaviour was used as a theoretical framework for this study. An interview guide based on the Theory of Planned was used to conduct individual semistructured interviews. Content analysis showed that overweight adolescents exhibited positive attitudes in dealing with their weight status and valued their family's support and guidance in helping control their weight. Although friends were important to facilitate regular exercise, families, particularly mothers, were crucial in addressing healthy eating habits. Understanding the subtleties and complexities of living with childhood overweight might assist health professionals in creating more effective and developmentally sensitive interventions.