Emotional and Psychological Effects of the COVID-19 Pandemic on Nursing Students.

ABSTRACT: The COVID-19 pandemic impacted the mental health and educational experiences of nursing students in undergraduate and graduate programs. A larger mixed-methods study aimed to understand how COVID-19 impacted personal lives and learning experiences of students across all programs levels. This article reports on qualitative data obtained from focus groups organized by student program level. Six themes emerged, including fear and uncertainty, trust in God, educational and career concerns, concerns about family, mental health issues, and isolation/lack of human touch. Key areas covered are the emotional and psychological effects of COVID-19 and its factors and the role of faith during COVID-19 among nursing students.

Facilitation of Forgiveness: Impact on Health and Well-being.

Although the practice of forgiveness is encouraged, the healing properties of this virtue by health care professionals are often overlooked. Forgiveness is the voluntary, conscious decision to abandon negative feelings toward another who has caused hurt and replacing those feelings with unconditional love and compassion. It is not about forgetting the hurt or ignoring the pain; it is an actual transformation of the heart. The Enright Forgiveness Process Model and the Pyramid Model of Forgiveness are 2 models that facilitate the forgiveness process. By utilizing either of these pathways, the forgiver ultimately experiences peace of mind and a "release from emotional prison" that leads to holistic healing. As a result, the forgiver experiences lower levels of depression, anxiety, and aggression, which improves quality of life. In addition, physiological benefits such as decreased stress levels, lower blood pressure, and a lower heart rate have also been reported. Throughout the course of their careers, nurses encounter patients and families in acute or end-of-life care situations who want to forgive or be forgiven. As holistic health care providers, nurses should be able to facilitate and close this gap in patient care. This article attempts to raise awareness to the importance of forgiveness in health and well-being among nurses and other health care professionals.

Impact of COVID-19 on Nursing Students: Factors Associated with PTSD Risk.

ABSTRACT: The COVID-19 pandemic rapidly transformed nursing education, creating multiple stressors for students. The researchers in this study examined how undergraduate and graduate nursing students at a faith-based university perceived the impact of COVID-19. A multiple linear regression model explored the effect of 17 variables on the Impact of Events Scale-Revised (IES-R) scores. Anxiety level, quality of sleep, and perceived health demonstrated a statistically significant influence on IES-R scores; 27% of students had IES-R scores above 33, indicating high risk for posttraumatic stress disorder. Strategies to help address student stress and anxiety are discussed.

The Efficacy of a Forgiveness Bibliotherapy: A Randomized Controlled Trial with Nursing Students.

Purpose of study: The need for forgiveness education for nursing self-care and forgiveness facilitation has risen. Therefore, the present pilot study tested the efficacy of an 8-week forgiveness bibliotherapy with a small number of undergraduate nursing students. Design of study: Matched pairs of nursing students were randomly assigned to either the experimental group or no-contact control group. The experimental group, using 8 keys to forgiveness by R. Enright (2015) as the treatment manual, read one chapter a week for 8 weeks and provided weekly reflections. Forgiveness and forgiveness-related outcome measures were administered at pretest, posttest, and one-month follow-up. Findings: At the posttest, the experimental group had significantly greater improvement in forgiveness compared to the control group with a large effect size, which was maintained at one month follow-up. There was no other significant difference between the two groups. Within-group comparisons of the experimental group showed improvement in forgiveness, anxiety, depression, and fatigue from pre to post testing periods and forgiveness, anger, anxiety, depression, and fatigue from pre to follow-up testing periods. Conclusion: Use of bibliotherapy may be a cost-effective way to promote the virtue of forgiveness for students in nursing programs.

Reducing the Negative Impact of Social Distancing Through Intentional Connectedness.

ABSTRACT: Social distancing during the COVID-19 pandemic resulted in both positive and negative effects. Nursing education was significantly impacted by the necessity of remote learning and absence of clinical experiences. The purpose of this article is to discuss how intentionality in social connectedness can combat the negative impact of social distancing in nursing education. Lessons learned and strategies employed by nursing educators during the intentional application of social connectedness are presented.

Caring for a Child with Cancer: Experiences of Jordanian Mothers.

The diagnosis of childhood cancer is one of the most serious and unexpected experiences a mother can endure. A descriptive phenomenological approach was used to explore the experiences of mothers of children diagnosed with cancer in Jordan. Themes that emerged include (1) Emotional response on knowing the diagnosis (feelings of shock, lack of preparedness, denial, and feelings of "paralysis"), (2) Fear of the dreaded disease (fear of suffering and fear of death), and (3) The challenges of the treatment journey (inadequate financial resources, role transition, and feeling socially isolated). This study describes the experiences of Jordanian mothers who care for their children diagnosed with cancer so that health care providers can develop strategies to provide adequate psychological support to these mothers.

Nurses' knowledge and practices of physical restraints in intensive care units: An observational study.

Aim: To investigate the knowledge and practice of physical restraints (PR) among Jordanian intensive care unit (ICU) nurses. Design: A descriptive, observational design was used. Methods: A convenience sampling was used to recruit participants. We examined the knowledge of PR in 301 nurses (knowledge check) and the real-time practice of PR in 81 nurses (direct observation) in ICU. A knowledge questionnaire was used to collect data on knowledge about PR use, and data on their practice of PR were observed and documented using an observation checklist. Results: The mean scores of nurses' knowledge and practices were 61.5 (SD = 12.1) and 57.4 (SD = 9.7), respectively. More than half of nurses had poor knowledge of PR use and incorrect practice of implementing PR (51.5% and 60.5%, respectively). Results indicated a positive correlation between nurses' knowledge and their use of PR.

Effect of the Helping Babies Breathe Training Program: An Experimental Study on Jordanian Midwives' Knowledge and Skills.

The Helping Babies Breathe (HBB) training program trains providers in effective resuscitation of infants in developing countries. This study evaluated the effectiveness of the HBB training program on midwives' knowledge and skills in Northern Jordan. Using a nonequivalent control group design, 50 midwives (control, n = 25; experimental, n = 25) from 3 public hospitals in Northern Jordan were recruited and their knowledge and skills were evaluated before and after the training. The program has 3 aspects: 2 hours of teaching, 1 hour of testing, and 25 minutes of skills assessment per participant. The skills were tested individually for each participant, and they were reevaluated at 8 months after. The control and experimental groups significantly differed in posttest scores on knowledge, Objective Structured Clinical Examination A and B skills, and bag-mask application after adjusting for covariates. The HBB training program significantly enhanced knowledge of midwives in the experimental group (P < .05) and demonstrated skills. The HBB training program was helpful in improving midwives' knowledge and practices on immediate care of a newborn baby. Therefore, training midwives using the HBB training program can improve their knowledge and skills and thereby improve infant outcomes in Jordan.

Parenting a Child With Autism Spectrum Disorder: Perspective of Jordanian Mothers.

INTRODUCTION: Parenting a child diagnosed with autism spectrum disorder (ASD) is challenging for mothers because of concerns related to behavior, difficulties in accessing specialized care, and lack of community acceptance, yet their stories in Jordanian context are still unknown. Common challenges in Jordan include financial burdens, lack of public awareness, and lack of specialized knowledge even among health care providers, which may lead to delays in obtaining the diagnosis and interventions for ASD. METHOD: A phenomenological descriptive approach was used to explore and understand the mothers' everyday lived experiences of raising a child with ASD. Semistructured interviews were conducted with 14 mothers to identify their challenges so that nurses can identify gaps in services, empower families, and facilitate optimum care to these Jordanian families. FINDINGS: The main themes that emerged were (1) mothers' journeys with the diagnosis, in which mothers recognized the abnormalities of their children, reported delays in getting the diagnosis and initiation of treatment, and described a wide range of reactions to the diagnosis from grief and guilt to a blessing from God; (2) the burden of care, by which mothers reported physical and emotional exhaustion, financial burdens, and concerns about the quality of available services; and (3) the consequences and the hurdle of having a child with ASD, which affected the family relationships and social life. DISCUSSION: Jordanian mothers caring for children with ASD face several challenges, including physical, psychological, financial, and social challenges, in addition to limited specialized services. Identifying their unique challenges and needs are essential to support them, provide appropriate services and resources, and develop policies and guidelines for culturally competent quality services.

Horizontal Integration of Concepts: An Innovative Teaching Strategy.

BACKGROUND: Horizontal integration of a prelicensure nursing curriculum is an innovative discipline-specific teaching-learning strategy for facilitating interactive learning and achievement of quality student learning outcomes. PURPOSE: The purpose of this article is to describe the impact of the horizontal integration of an nursing curriculum on students' attendance, collaboration for interactive learning, course grades, and satisfaction with the course learning outcomes. METHODS: An intervention of horizontal integration of 2 courses, one on nursing research and evidence-based practice and the other on mental health nursing, in an undergraduate nursing curriculum was used. RESULTS: Class attendance and student collaboration improved by 60% to 65%, and final examination scores improved by 14% to 16% for students in the intervention group. CONCLUSION: Horizontal integration of a nursing curriculum is a strategy that can improve class attendance, student collaboration, course grades, and student satisfaction with the course learning outcomes.

Surrogacy: Pathway to Parenthood.

Assistive reproductive technology has progressed significantly over the past few decades. In spite of the advances, people may still resort to a surrogate for bearing and birthing a baby. Surrogacy, though an altruistic act, has been commercialized in the past few years, leading to emergence of several ethico-legal concerns. Nurses care for the surrogates, the infants, and the intended parents through their journey with sensitivity, advocacy, compassion, and confidentiality. This article intends to explore the implications of surrogacy to individuals, families, nations, and health care.

Nursing Care of Infants With a Ventriculoperitoneal Shunt.

BACKGROUND: Infants with congenital or posthemorrhagic hydrocephalus may require a ventriculoperitoneal (VP) shunt to divert the flow of cerebrospinal fluid, thus preventing increase in intracranial pressure. Knowledge on various aspects of caring for a child with a VP shunt will enable new and experienced nurses to better care for these infants and equip parents for ongoing care at home. PURPOSE: To review the nurses' role in care of infants with hydrocephalus, care after VP shunt placement, prevention of complications, and parental preparation for home care. METHODS/SEARCH STRATEGY: A literature review involving electronic databases, such as CINAHL and MEDLINE, Cochrane Database Systematic Reviews, and resources from the Web sites of the National Hydrocephalus Foundation and Hydrocephalus Association, was performed to gather evidence for current practice information. FINDINGS AND IMPLICATIONS FOR PRACTICE AND RESEARCH: Vigilant care can help with early identification of potential complications. The younger the infant at VP shunt placement, the higher the occurrence of complications. All neonatal intensive care unit nurses must be equipped with knowledge and skills to care for infants with hydrocephalus and those who undergo VP shunt placement. Monitoring for early signs of increased intracranial pressure can facilitate timely diagnosis and prompt surgical intervention. Equipping families will be helpful in early identification and timely management of shunt failure. Research on infants with VP shunt placement is essential to develop appropriate guidelines and explore experiences of families to identify caregiver burden and improve parental preparation.

Expanded Newborn Screening: Challenges to NICU Nurses.

BACKGROUND: Newborn screening programs provide testing for all newborns born in this country for conditions that can potentially cause death or disability. Currently each state is responsible for its programs and the number of disorders screened varies from state to state. The current universal recommended metabolic screening panel may include 32 to 58 disorders. Expansion of the programs has impacted the role of nurses in the neonatal intensive care units (NICUs). Nurses are responsible for facilitating the screening process, educating the family, and assisting with follow-up. In addition, they are the first-line defense for emotional, spiritual, and social support. PURPOSE: To review of the expansion of this program over time and discuss challenges the NICU nurse encounters. METHODS/SEARCH STRATEGY: Research literatures along with the national recommendation by governmental and professional agencies were reviewed to obtain evidence on current practice recommendations. FINDINGS/RESULTS/IMPLICATIONS FOR PRACTICE AND RESEARCH: NICU nurses face several challenges with the expansion of newborn screening programs. This includes gaining knowledge to answer questions posed by empowered parents and educate them appropriately; ensuring quality of the process that minimizes errors and optimal communication; and, addressing ethical concerns about the storage and subsequent use of specimens. New and ongoing research can measure and ensure provision of quality services provided through the NICUs globally.

Ideal Site for Skin Temperature Probe Placement on Infants in the NICU: A Review of Literature.

BACKGROUND: Maintaining normothermia and prevention of hypothermia are critical determinants of morbidity and mortality in infants. Noninvasive monitoring of skin temperature using skin temperature probes (STPs) has been a practice in neonatal intensive care units (NICUs) for decades. Incubators and radiant warmers use feedback mechanisms from the STP readings to determine the heat output to maintain normothermia. Placing the STP on an ideal site on the infant's body is essential for optimum servo control of the temperature. More importantly, where is the ideal site for the STP placement? Clinical practice guidelines (CPGs) vary on information regarding the site and proper placement of the STPs. The literature is analyzed to identify evidence for the ideal STP placement on infants in NICUs. PURPOSE: To review the literature for evidence for ideal placement for skin temperature probe placement on an infant. SEARCH STRATEGY: OVID/MEDLINE, CINAHL, Cochrane databases, and CPGs were searched to identify research, literature reviews, and guidelines for ideal sites for STP placement. Twenty documents were reviewed. RESULTS: Guidelines vary in suggested sites for STP placement. The majority of the studies compared temperature measurement between abdomen and axilla. Although a Cochrane review found abdominal skin as an ideal site, other studies did not find any difference between axially and abdominal skin temperature measurements. IMPLICATIONS FOR PRACTICE AND RESEARCH: Placing the STP on an ideal site is essential for accurate and safe monitoring of skin temperature in infants. NICU nurses are uniquely positioned to undertake research to identify the ideal site for STP placement to guide safe practice and impact optimal neonatal outcome.

Oral Feeding Outcome in Infants with a Tracheostomy.

PURPOSE: Currently, there is a lack of evidence-based guidelines on the proper protocol for feeding infants with a tracheostomy in the neonatal intensive care unit (NICU). The purpose of this study was to provide preliminary insight into the outcomes of these infants in one mid-Atlantic pediatric hospital. DESIGN AND METHODS: Retrospective and descriptive. The study team reviewed 114 patient records, 42 of which met the inclusion criteria. Data were organized based on: 1) general demographics and history; b) feeding-related variables at multiple points; c) speech-related variables, including assessments and swallowing studies; d) respiratory variables at multiple points; and, e) discharge data. Other variables included birth-related information, ventilation settings and feeding modifications. RESULTS: Infants were placed into three groups at discharge based on feeding outcomes. Forty-three percent were discharged on full oral feeds, 38% on combined oral and gavage, and 19% of infants were discharged on full gavage feeds. Informal analysis showed that all three categories of infants gained weight during hospitalization, different PEEP pressures and different lengths of hospitalization were observed among the groups, and infant characteristics (e.g., APGAR, gestational ages) were similar across groups. CONCLUSIONS: Overall results provide insight into factors that may be predictive of feeding status at discharge for infants with a tracheostomy in an NICU. PRACTICAL IMPLICATIONS: Results of this study can provide important insight into the feeding outcomes of infants in a NICU with a tracheostomy and can hopefully lead to additional research to help determine the most efficacious procedures for feeding this patient population.

Transition from NICU to Home: Are the Parents Ready to Manage Any Emergency? An Evidence-Based Project.

Transitioning the care of a previously critically ill infant to home poses many challenges for the parents. Prior to the infant's discharge, the parents undergo rigorous training to continue the care of their infants at home. Even after training, parents may feel overwhelmed by the thought of managing an emergency at home. This evidence-based practice project aims to provide parents with additional hands-on practice of cardiopulmonary resuscitation (CPR) prior to their infant's discharge. Based on this project, a program of teaching CPR regularly is established currently in the NICU at Nemours Alfred I. duPont Hospital for Children.

Prolonged Mechanical Ventilation: Challenges to Nurses and Outcome in Extremely Preterm Babies.

Worldwide, about 15 million infants are born prematurely each year. Technological advances, including invasive mechanical ventilation, play a major role in the survival of extremely preterm babies. Those who survive may have prolonged morbid conditions that result in long-term sequelae. Nurses face several challenges during the hospitalization of these infants. Vigilant care, monitoring, and careful handling of the infants can prevent infections and long-term complications. Newer, less invasive technologies are promising for improved outcomes in extremely preterm infants.

Tracheotomy after laryngotracheoplasty: risk factors over 10 years. [Corrected].

BACKGROUND: Subglottic stenosis (SGS) is the most common congenital and/or acquired laryngotracheal anomaly requiring tracheotomy in infants. We sought to determine factors associated with a greater likelihood of tracheotomy in symptomatic infants with SGS who underwent laryngotracheoplasty (LTP). METHODS: Retrospective case series with chart review of patients undergoing single-stage LTP for SGS over a 10-year period (2001-2010) in a tertiary-care pediatric hospital. RESULTS: Twenty-two children (15 boys, 7 girls), with a mean gestational age of 32.5weeks, underwent LTP with and without interpositional grafting, at a median age of 89days. Ten patients (43%) required postoperative tracheotomy. Of patients weighing <2.5kg, 7 of 8 eventually required tracheotomy, while none weighing >5kg needed tracheotomy (p=0.003). The average length of stay for patients with a tracheotomy was 125days, while those without tracheotomy required only 58days (p=0.011). The grade of SGS (p=0.809), gender (p=0.968), age at surgery (p=0.178), and gestational age (p=0.117) were not significantly associated with the need for tracheotomy. Weight at surgery was significantly correlated with the likelihood of needing tracheotomy (p=0.003). CONCLUSIONS: Patients who weighed less than 2.5kg at the time of LTP procedures were more likely to require a postoperative tracheotomy. Children who required tracheotomy had longer lengths of hospital stay.

Double ABCX model of stress and adaptation in the context of families that care for children with a tracheostomy at home: application of a theory.

Theories provide a roadmap for scientific inquiry, help organize knowledge, and establish the foundation for knowledge development. The Double ABCX Model of Family Stress and Adaptation is a middle-range theory developed in social science and widely used by researchers of various disciplines. This model encompasses the major variables of interest in this study, including stress, coping, duration of tracheostomy, and quality-of-life, and forms an excellent framework for this specific research study. The purpose of this article was to discuss relationships between various individual and environmental factors that can impact health and well-being in families. In addition, this article illustrates how the application of the model helps nurses and healthcare providers understand the significance of the family context on positive well-being and promote optimal caring practices to achieve a balance in the midst of illness and suffering.