Case Report: Priapism Following an Anterior Lumbar Interbody Fusion.

Priapism is a disorder where the penis without sexual stimulation maintains a prolonged rigid erection lasting 4 or more hours. There are two classifications of priapism, ischemic (low flow) or nonischemic high flow, and each have specific etiologies, diagnostic criteria, and management. This presented case study involved a 58-year-old male who experienced an ischemic priapism more than 24 hours after an anterior lumbar interbody fusion (ALIF). A flaccid penis was achieved after the patient received two 400 µg of phenylephrine HCL into the corpora cavernosum. Review of the literature suggests anesthetic medications given during the surgical procedure may have caused the priapism. Lessons that can be learned from this case study highlight that even though the nurse may not expect to see a priapism after an ALIF, the nurse must always be diligent and not become complacent with unexpected findings or assessments that may cause irreparable harm to the patient.

A Philosophical Analysis of Spiritual Coping.

Utilizing Whall and associates' philosophical analysis method, the concept of spiritual coping was critically evaluated to determine the relevance of this concept to nursing science. Studies were included in the literature review if participants were 55 years and older, as this cohort has reported using more spiritual coping strategies than younger cohorts. Twenty-four articles were reviewed and revealed 3 recurrent themes: enhanced physical, psychological, and social well-being, resilience, and self-transcendence. Support for the relevance of spiritual coping to nursing science was found, as these themes were easily placed within the context of 3 postmodern philosophical approaches and multiple extant nursing theories.

Use of Continuing Education to Increase Nurses' Knowledge of Chronic Wound Care Management.

BACKGROUND: Providing effective management of chronic wounds can be a major challenge for nurses practicing in health care systems. As the older adult population continues to increase, the prevalence of chronic health-related diseases that can lead to chronic wounds has also increased. Nurses have reported a lack of preparation in the management of chronic wounds. METHOD: The purpose of this pretest-posttest research designed study was to determine whether nurses' knowledge regarding current chronic wound care management would differ after attending an educational workshop that emphasized evidence-based clinical practices in chronic wound management. RESULTS: Thirty-one nurses consented to participate. A statistically significant increase in nurses' knowledge was found from pretest (M = 13.48, SD = 2.49) to posttest (M = 16.03, SD = 2.21; t[30] = -4.50, p < .05). The majority of nurses reported referring patients to wound care specialists and believed they were inadequately prepared to care for patients with chronic wounds. CONCLUSION: These findings support the need for continuing education regarding changes in chronic wound care management. J Contin Educ Nurs. 2018;49(10):454-459.

The Efficacy of Regional Anesthesia Techniques to Control Postoperative Pain After Total Knee Arthroplasty.

BACKGROUND: Choosing the most effective type of anesthesia for controlling postoperative pain is paramount for improving patient outcomes and patient satisfaction. Most often, the type of anesthesia selected is dependent on the duration and type of surgical procedure and anesthesiologist/surgeon preference. Using a combination of regional anesthesia techniques, however, remains the cornerstone of multimodal analgesia for postoperative pain management after total knee arthroplasty. PURPOSE: The purpose of this study was to determine what regional anesthesia techniques and/or combinations of regional anesthesia techniques provided the best postoperative pain control in patients who had undergone a total knee arthroplasty. METHODS: Retrospective chart review. RESULTS: Patients who received a single-shot regional anesthetic reported significantly more postoperative opiate consumption and requested pain medication significantly sooner than patients who received multimodal techniques of regional analgesia. CONCLUSION: This study found support for the use of multimodal analgesia techniques for optimum postoperative pain management after total knee arthroplasty.

Assessing Nurses' Knowledge of Spiritual Care Practices Before and After an Educational Workshop.

BACKGROUND: Although current research findings reflect that spiritual care is integral to the discipline of nursing, implementation of spiritual care still remains a neglected area of practice. METHOD: The purpose of this pretest-posttest study was to determine whether a spiritual care educational workshop would increase nurses' knowledge, self-awareness, and abilities regarding spiritual care practices. The Spirituality and Spiritual Care Rating Scale (SSCRS) was used to measure the nurses' knowledge, attitudes, and beliefs about spirituality and spiritual care practices. RESULTS: Forty-nine nurses working at a satellite hospital within the midwestern United States attended the educational workshop. A statistically significant increase in nurses' knowledge, self-awareness, and abilities regarding spiritual care practices was observed after the educational workshop. The majority of nurses reported that their nursing education inadequately prepared them to provide spiritual care to their patients, and they were unable to meet the spiritual needs of their patients. CONCLUSION: Findings support the need for continued education regarding spiritual care practices among working nurses. J Contin Educ Nurs. 2017;48(3):115-122.

Applying Integrative Learning Strategies and Complexity Theory to Design Simulations for Care of Complex Patients.

Nurse educators use a variety of clinical simulation strategies to promote cognitive, psychomotor, and affective learning. Statistically significant increases in self-confidence levels were found among senior-level nursing students in the assessment and management of medical and psychiatric symptoms after participating in strategically designed, complex, student-led clinical simulations. Having students role play simulation scenarios that are developed from real-life clinical experiences is a cost-effective interactive strategy that enhances their communication and technical skills.

Exploring the Relationship Between Resilience and Ostomy Adjustment in Adults With a Permanent Ostomy.

PURPOSE: The aims of this study were to describe the relationship between resilience and ostomy adjustment in adults with permanent stomas and to determine if participants who report higher levels of resilience also report higher levels of adjustment to a permanent ostomy. DESIGN: Descriptive, correlational research design utilizing the Roy Adaptation Model as the theoretical framework was used. SUBJECTS AND SETTING: Persons with permanent stomas were recruited from ostomy support groups on the East Coast of the United States. The study sample included 48 respondents. Their mean age was 66 ± 12.7 years (mean ± SD); the majority (60.4%) were women, had an ileostomy (62.5%), and had a history of inflammatory bowel disease (62.5%). METHODS: Respondents completed a questionnaire that queried demographic and pertinent clinical data, along with 2 previously validated instruments, the Resilience Scale and Ostomy Adjustment Inventory-23. The relationships between levels of resilience, levels of adjustment to an ostomy, and demographic characteristics were examined. RESULTS: Participants with higher levels of ostomy adjustment had higher levels of resilience than respondents who reported lower levels of ostomy adjustment (r = 0.65, P ≤ .01). CONCLUSIONS: Findings from this study suggest that higher levels of resilience facilitate adjustment to a permanent ostomy.

The prevalence of uncontrolled pain in long-term care: a pilot study examining outcomes of pain management processes.

Pain in long-term care (LTC) is common among older residents despite the vast options available for optimal pain management. Inadequate pain management affects individual health care outcomes. Researcher evidence has shown that nurse practitioners (NPs) improve the quality of care in LTC but are challenged by multiple barriers that inhibit optimal pain control. The purpose of the current pilot study was to explore both the pain management processes used by nurses in LTC and the documented patient outcomes that come from these processes. In addition, factors were identified that may impact the NP role in providing adequate pain control in LTC. This descriptive study used a retrospective, case-controlled research design that incorporated reviewing 55 LTC resident medical records. Results show how the process of pain management in LTC can be improved by expanding the professional role of the NP.

Self-transcendence and medication adherence in older adults with hypertension.

PURPOSE: The purpose of this study was to examine the relationship between self-transcendence and medication adherence among older adults prescribed antihypertensive medication. DESIGN: Descriptive, correlational research design. METHOD: Forty-six older adults who were prescribed antihypertensive medications from an independent living facility participated in this study. Participants were given a survey that included a demographic questionnaire, the Morisky Medication Adherence Scale, and Reed's Self-Transcendence Scale. FINDINGS: No significant relationship was found between medication adherence and self-transcendence (r = -.20, p = .18). Ninety percent of the participants however, admitted to cutting back or stopping their medication without notifying their providers. CONCLUSION: Continued investigation is needed to identify reasons why older adults fail to adhere to taking prescribed hypertension medications in order to improve health outcomes in this population.

Development of an amygdalocentric neurocircuitry-reactive aggression theoretical model of emergence delirium in posttraumatic stress disorder: an integrative literature review.

The purposes of this integrative literature review were to (1) present a synopsis of current literature describing posttraumatic stress disorder (PTSD), the amygdalocentric neurocircuitry, emergence delirium, reactive aggression, and the interaction of general anesthetics and the amygdalocentric neurocircuitry; (2) synthesize this evidence; and (3) develop a new theoretical model that can be tested in future research studies. Over the past decade, a dramatic rise in PTSD among veterans has been reported because of recent combat deployments. Modern anesthetics alter the function of the amygdalocentric neurocircuitry to produce amnesia and sedation. The etiology of emergence delirium is poorly understood, and the condition is uncommon outside the pediatric population. Emergence delirium among patients with PTSD, however, has been reported by military nurse anesthetists. To date, there have been no scientific studies conducted to identify the cause of emergence delirium in combat veterans with PTSD. This new theoretical model may explain why noxious stimuli at the time of emergence may stimulate the thalamus, leading to activation of an uninhibited amygdalocentric neurocircuitry. Because of the loss of top-down inhibition, the hyperactive amygdala then stimulates the hypothalamus, which is responsible for creating an increase in excitatory activity in the unconscious patient, resulting in emergence delirium.

Knowledge and attitudes of pain management among nursing faculty.

A descriptive correlational design was used in this study to examine nursing faculty knowledge and attitudes in pain management. Relationships between age, education level, pain management preparation, length of time practicing as a nurse, length of time teaching nursing, time teaching pain management in the classroom, taught pain guidelines in the classroom, and additional continuing education about pain management were explored. Ninety-six nursing faculty participated from 16 schools of nursing in one Midwestern U.S. region. Findings identified that most of the nursing faculty recalled being taught about pain management in their basic education, but less than one-half felt adequately prepared. Most respondents said that they taught pain management, yet fewer than one-half identified that they used specific pain management guidelines. Faculty demonstrated adequate knowledge of pain assessment, spiritual/cultural issues, and pathophysiology. Areas of weakness were found in medications, interventions, and addiction. Faculty that reported teaching pain management in the classroom and reported more continuing education missed fewer items. Older nursing faculty reported more years of practice, more years of teaching, and more continuing education in pain management than younger faculty. Younger nursing faculty remembered being taught pain management in nursing school and felt more adequately prepared than older nursing faculty. Faculty that reported practicing for longer periods of time felt less prepared in pain management than faculty who practiced for shorter periods of time. More continuing education in pain management may be needed for older nurses to meet the recommendations of the Institute of Medicines' report on relieving pain in the U.S.

Using multisensory technology to create a therapeutic environment for people with dementia in an adult day center: a pilot study.

This quantitative pilot study examined the feasibility of using a multisensory environment (MSE) as a nonpharmacological intervention for people with behavioral and psychological symptoms of dementia (BPSD) within an adult day care center. Outcome measures were participant agitation, participant reaction to MSE, and caregiver satisfaction with MSE as a management strategy for older adults with BPSD. A within-subjects, repeated measures research design was used to obtain results from a total of 8 older adults with BPSD and 4 formal caregivers. Results indicated that the majority of participants enjoyed the MSE and improvements in some BPSD were observed after using the MSE. Reports from formal caregivers indicated that they believed the MSE was a useful nonpharmacological therapy for reducing anxiety and agitation among the day care participants who exhibited BPSD. Caregivers also suggested that this intervention should be incorporated into the design of the building and that a dedicated staff be assigned to facilitate the intervention for older adults each day.

Comparative analysis of two musical genres within a multisensory environmental intervention.

PURPOSE: The purpose of this study was to determine if there were any differences in the behavioral responses of persons with dementia while listening to nonreligious and religious music within a multisensory environment. RESEARCH DESIGN: A within-subjects, repeated measures design was used. METHOD: Participants were exposed to both musical genres during multiple sessions over a 4-week period. Neuropsychiatric symptoms were recorded before and after the musical intervention. Behavioral responses to the music were recorded while listening to the music. FINDINGS: No significant difference was found between the numbers of neuropsychiatric behaviors observed before and after the participants listened to the nonreligious and religious music. A significant difference was found between the musical interventions as a whole and the number of agitated behaviors before and after intervention. No significant difference was found in the observed behavioral responses with the nonreligious and religious music. CONCLUSIONS: Music can be a useful intervention to reduce neuropsychiatric symptoms in persons with dementia.

The continued lived experience of the unexpected death of a child.

The purpose of this qualitative study was to further examine the lived experiences of families that faced the sudden loss of a child. Six mothers that had previously participated approximately 9 years ago in the study entitled "The Lived Experience of the Unexpected Death of a Child" were interviewed. All of the mothers were Caucasian and had achieved a high school or greater level of education. Taped interviews and field notes were transcribed for data display. Together, two raters completed data reduction and coding for theme identification and categorization. Six themes were revealed that described helpful coping behaviors used by the mothers: positive beliefs, faith beliefs, everlasting love, pleasant remembrances, social engagement, and staying connected. Two themes, avoidance and rumination, described the behaviors that did not help the mothers cope with their loss. Finally, answers to the questions regarding acceptance and healing time were also revealed.

Self-care and quality of life among patients with heart failure.

PURPOSE: The purpose of this cross-sectional, descriptive study was to determine if there were specific self-care deficits among patients with heart failure at the time of discharge in an acute care setting, which may be related to a decreased quality of life. DATA SOURCES: Patients admitted with acute, chronic congestive heart failure were recruited to complete both the Self-care of Heart Failure Index and the Minnesota Living with Heart Failure questionnaires. Data analyses were conducted to determine if there were any significant relationships between self-care abilities and quality of life. CONCLUSIONS: Results from this study were promising as "self-care confidence" and perceived better health were found to be significantly related to improved quality of life. Heart failure is a chronic disease that requires patients to develop confidence in their self-care abilities to maintain and improve quality of life. IMPLICATIONS FOR PRACTICE: Findings from this research study suggest that nurse practitioners need to first identify patients with heart failure who lack the self-care confidence required to manage their condition at home, and then focus on specific educational interventions to build confidence in self-care prior to discharge.

Building an organizational culture of caring: caring perceptions enhanced with education.

BACKGROUND: This pilot study was undertaken to determine whether an educational intervention called Reigniting the Spirit of Caring (RSC) from Creative Healthcare Management would enhance perceptions of caring behaviors among nurses. A pretest/posttest within-subjects research design was used to evaluate the educational intervention. METHODS: Investigators used the licensed RSC program as the educational intervention. This study included 36 registered nurses employed in one Midwestern hospital. RESULTS: Statistical differences were found in the pretest and posttest measurement of nurses' perceptions of caring behaviors. CONCLUSION: The RSC program can be used as an effective educational intervention to increase nurses' perceptions of caring, and the Caring Assessment for the Caregiver tool can be used as an effective tool to measure nurses' perceptions of caring behaviors.

Knowledge, attitudes, and perceptions of advanced practice nurses regarding urinary incontinence in older adult women.

This study examined the level of knowledge and the attitudes and perceptions of advanced practice nurses (APNs) regarding urinary incontinence (UI) in older adult women. UI is a common health issue for older adult women, and APNs are in a unique position as health care providers to prevent, diagnose, treat, and manage the condition successfully. Little is known about how well APNs were educated regarding UI, especially in older adult women. Purposive sampling was utilized to conduct a cross-sectional, descriptive, and correlational design study. Fifty-four APNs completed a questionnaire developed by the author based on the aging literature, advanced practice nursing competencies, and UI guidelines. Findings suggest that APNs generally have positive attitudes, perceptions, and knowledge of UI in women. However, participants had difficulty in applying this knowledge to the clinical setting: assessing, diagnosing, treating, and managing UI. More emphasis is needed in graduate nursing curriculums and in precepted clinical experiences regarding UI in women.

Daily activity patterns of an adult experiencing lower back pain undergoing electro-acupuncture: a case study.

In the United States, adults experiencing lower back pain (LBP) have reported using alternative health care to manage symptoms. Chiropractic techniques, relaxation, and massage have been cited as the most commonly used alternative therapies. Electro-acupuncture (EA), along with conventional health care, has been found to be a useful complementary and alternative medicine (CAM) modality in alleviating the disability associated with LBP. The purpose of this single-subject case study was to evaluate the daily activity pattern effects of EA and CAM modality usage on pain intensity levels and functional status of an adult experiencing LBP. Activity patterns and pain intensity ratings were recorded for two consecutive weeks through the use of a daily pain diary in natural environments. Results from the data analyses revealed daily LBP intensity ratings ranging from slight to moderate pain. On average, the participant reported using approximately ten CAM modalities per day. The participant reported decreases in pain intensity levels, increases in energy levels, and feeling better after EA and acupuncture treatments, maintaining an exercise and weight loss regimen, taking megavitamins, drinking teas, praying, singing, and using humor, distraction, and relaxation techniques. Use of herbs and too much exercise were the least effective. Findings suggest that for this patient, EA and certain CAM modalities were effective interventions that promoted well-being and self-healing. In addition, the daily pain diary was found to provide rich research and assessment data.

Development and psychometric testing of a new geriatric spiritual well-being scale.

Aims and objectives. Assess the psychometric properties of a new geriatric spiritual well-being scale (GSWS), specifically designed for older adults. Background. Religiosity and spiritual wellness must be measured as two distinct concepts to prevent confounding them as synonymous among atheist and agnostic population. Design. A test-retest survey design was used to estimate the psychometric properties. Methods. A convenience sample of 138 community-dwelling older adults was drawn from the inner city of Detroit. Data were collected using telephone survey interviews. Data analyses included descriptive statistics, structural equation modelling, reliability analyses, and point-biserial correlations. Results. The factorial validity of the proposed model was not supported by the data. Fit indices were χ(2) = 185.98, d.f. = 98, P < 0.00, goodness-of-fit index of 0.85, comparative fit index of 0.87 and root mean error of approximation of 0.08, indicating a mediocre fit. Reliability statistics for the subscales ranged from being poor (0.36) to good (0.84) with an acceptable overall scale alpha of 0.76. Participants' performance stability and criterion-related validity were also supported. Conclusions. The GSWS is an age-specific assessment tool that was developed specifically to address a population's cultural diversity. Future research endeavors will be to test the psychometric properties of this scale in culturally diverse older adult populations for further instrument development. Relevance to clinical practice. Nurses need to recognize that agnostics/atheists have spiritual needs that do not include religious beliefs or practices. Thus, assessing patients' religious beliefs and practices prior to assessing spiritual well-being is essential to prevent bias.

Predictors of self-reported health among older African-American central city adults.

Relationships between holistic factors and self-reports of health were examined. Ninety-two African-American older adults were sampled. Comorbid health conditions, higher pain intensity ratings, and more depressive symptoms were significantly related to lower self-rated health scores while age, marital status, education, and spiritual factors were not significantly related.