Perceptions and experiences of perioperative nurses and nurse anaesthetists in robotic-assisted surgery.

AIMS AND OBJECTIVES: To explore the perceptions and experiences of perioperative nurses and Certified Registered Nurse Anaesthetists (CRNAs) in robotic-assisted laparoscopic surgery (RALS). The objective was to identify the factors that affect nursing care of patients who undergo robotic-assisted laparoscopic surgery (RALS). BACKGROUND: The rapid introduction of technological innovations into the healthcare system has created new challenges for perioperative nurses. RALS affects the physical and interpersonal context of the surgical team's work and subsequent patient outcomes. Despite significant changes to the workflow for perioperative nurses and CRNAs, there is little research focusing on the nurses' experience and their challenges with RALS. DESIGN: A qualitative descriptive study. METHOD: Semi-structured interview questions guided data collection. A total of seventeen participants including six preoperative and postoperative nurses, seven intraoperative nurses, and four CRNAs in the United States were interviewed. The interviews were conducted between 26 April-24 June 2018. Data were analysed using thematic analysis, and the COREQ checklist was used to report data collection, analysis and the results. RESULTS: Three major themes and two categories within each theme were identified: (a) surgical innovation: nurse perception and workflow; (b) interprofessional practice: teamwork and standards; and (c) outcome: patient outcomes and system outcomes. CONCLUSIONS: The findings indicate that RALS has the potential to improve patient outcomes when performed in a timely fashion by skilled surgeons, and efficient, well-trained surgical teams. For patients to experience full benefits of RALS, patient characteristics, the underlying reason for surgery, and cost must be considered. RELEVANCE TO CLINICAL PRACTICE: The results of this study highlight the necessity of promoting factors that improve the surgical team training and practice for RALS and will ultimately impact patient outcomes.

Impact of Cold Therapy on Paclitaxel-Induced Peripheral Neuropathy and Quality of Life in Patients With Breast Cancer.

BACKGROUND: Taxane drugs frequently produce peripheral neuropathy (PN). Cold therapy to hands and feet during chemotherapy has been effective in reducing PN. OBJECTIVES: The purpose was to compare the frequency and severity of PN and quality of life in patients with breast cancer receiving cold therapy to their hands and feet versus standard of care during 12 weekly paclitaxel infusions with a follow-up at 16 weeks. METHODS: Forty-eight female participants were consecutively recruited and randomized to treatment versus control groups. This randomized control trial used the Common Terminology Criteria for Adverse Events and the Functional Assessment of Cancer Therapy-Taxane questionnaires to collect data weekly for 12 weeks and at 16 weeks. FINDINGS: A repeated-measures ordinal logistic model and binomial logistic model showed that patients on standard therapy were three times more likely to develop PN, with a progression toward severe PN, when compared to patients who were on cold therapy. There was no effect of treatment on quality of life.

Nursing Student Differences in Transcultural Self-Efficacy by Culture Curriculum: A Longitudinal Study.

INTRODUCTION: Longitudinal studies regarding educational strategies to help nursing students gain transcultural self-efficacy skills are limited. This study aimed to compare the long-term effects of an entry-level nursing culture course (ELNCC) on transcultural self-efficacy (TSE) in beginning nursing students with a graduating class who did not have the ELNCC. METHOD: Using a longitudinal, quasi-experimental time-series design, data were collected using Jeffreys's Transcultural Self-Efficacy Tool (TSET) from the experimental group (n = 106) pre- and post-ELNCC, end of second semester, and program exit. A control group of 62 senior nursing students who did not take the ELNCC were administered the TSET once, at graduation. RESULTS: All posttest scores were significantly higher than pretest scores in overall TSE, cognitive, practical, and affective dimensions. At graduation, the experimental group's scores were significantly higher than those of the control group in all dimensions except the affective. DISCUSSION: This study supports the early introduction of a separate culture course with field components to teach TSE to nursing students.

Family presence during resuscitation and invasive procedures: the nurse experience.

The purpose of this study was to understand the experiences of nurses who participate with families during resuscitation and invasive procedures in the hospital. Seventeen nurses in a large metropolitan area in the northeastern United States were interviewed about their thoughts and feelings about participating with families during these procedures. Conversations were audiotaped and transcribed verbatim for analysis. Transcripts were analyzed using van Manen's technique of isolating thematic statements. Four main themes were identified from the data: forging a connection, engaging the family, transition to acceptance, and a cautious approach.The experience of participating in family presence during resuscitation or invasive procedures can be a positive experience for the nurse by forging a connection with family.The experience for the nurse might include a transition to acceptance and a committed change in practice.

EBP partners: doctoral students and practicing clinicians bridging the theory-practice gap.

The theory-practice gap is one component of the barriers to implementing evidence-based practice. Texas Woman's University College of Nursing and Presbyterian Hospital of Denton joined forces to bridge this gap, allowing doctoral students to provide educational offerings to practicing nurses. Through a Graduate Assistance in Areas of National Need grant, doctoral students completed supervised teaching practicums at the hospital, assisting the hospital to implement evidence-based practice with the ultimate goal of applying for Magnet status. The hospital benefited from the addition of research expertise and mentoring for the staff members. The students benefited from the opportunities to teach and to share knowledge with these clinical experts. This program has been successful in meeting the needs of both parties. Recommendations are given for other institutions interested in establishing similar relationships.

A pilot study to test the feasibility and effectiveness of an intervention to help teen mothers and their mothers clarify relational boundaries.

Teen mothers and their mothers experience conflict due to poor relational boundaries. This conflict can result in maternal stress, which can affect the quality of mother-infant interactions. The purpose of this pilot study was to test the feasibility and effectiveness of an intervention to improve relational boundaries between teen mothers and their mothers. Seven first-time teen mothers living with their mothers or mother figures completed the cognitive-behavioral intervention. Participants evaluated each session and the accompanying homework. Relational boundaries were observed before and after the intervention. Results revealed many feasibility issues including scheduling, language, and sample recruitment. Findings are discussed, and recommendations for further research are offered.

Comparison of Two Methods of Teaching Culture to Bachelor of Science in Nursing Students.

BACKGROUND: The nursing literature examining effective methods to teach transcultural self-efficacy demonstrates inconsistent findings. This study evaluated the effectiveness of a nursing stand-alone culture course with concurrent field experiences compared with the standard integrated culture content in the curriculum in increasing transcultural self-efficacy in nursing students. METHOD: This quasi-experimental, static-group comparison used the Transcultural Self-Efficacy Tool to measure outcomes. The treatment group consisted of first-semester nursing students (n = 53) enrolled in a pilot 2-credit culture course. The control group consisted of graduating senior nursing students (n = 19) who had culture integrated throughout the curriculum. RESULTS: The posttest of the first-semester students in the treatment group scored higher than either their pretest or the graduating senior students (control group). CONCLUSION: The stand-alone culture course had a greater positive effect than the integrated culture content on students' transcultural self-efficacy. [J Nurs Educ. 2018;57(10):609-613.].

Cerebral automatism, the brain, and the soul in Bram Stoker's Dracula.

Neither literary critics nor historians of science have acknowledged the extent to which Bram Stoker's Dracula (1897) is indebted to late-Victorian neurologists, particularly David Ferrier, John Burdon-Sanderson, Thomas Huxley, and William Carpenter. Stoker came from a family of distinguished Irish physicians and obtained an M.A. in mathematics from Trinity College, Dublin. His personal library contained volumes on physiology, and his composition notes for Dracula include typewritten pages on somnambulism, trance states, and cranial injuries. Stoker used his knowledge of neurology extensively in Dracula. The automatic behaviors practiced by Dracula and his vampiric minions, such as somnambulism and hypnotic trance states, reflect theories about reflex action postulated by Ferrier and other physiologists. These scientists traced such automatic behaviors to the brain stem and suggested that human behavior was "determined" through the reflex action of the body and brain-a position that threatened to undermine entrenched beliefs in free will and the immortal soul. I suggest that Stoker's vampire protagonist dramatizes the pervasive late-nineteenth-century fear that human beings are soulless machines motivated solely by physiological factors.

Parenting needs, goals, & strategies of adolescent mothers.

PURPOSE: To identify and organize the perceived needs, goals, and strategies of teen mothers. STUDY DESIGN AND METHODS: Qualitative, using a microethnographic design. Data collection strategies included focus groups and interviews in a naturalistic setting. The sample consisted of five unmarried 18-year-old mothers enrolled in an urban high school in a southern state. Data were analyzed using a clustering technique and a modified multistage method of content analysis. RESULTS: Teen mothers identified their needs as support and knowledge. Goals were happiness, independence, and career, and strategies were a support group, life skills education, formal education, and a job. A model was developed incorporating these themes. CLINICAL IMPLICATIONS: Nurses can use the findings of this study to develop support groups for adolescent mothers that offer peer support and education about teen and child needs, are flexible and multidisciplinary, are supportive and accepting, have a comfortable physical environment, and include the adolescents' children and occasionally grandparents.

Relationships among personal space boundaries, peer acceptance, and peer reputation in adolescents.

PROBLEM: Peer relationships are important to the health of adolescents who are at a developmental period of moving from parental influence to potentially dangerous peer influence. Interpersonal communication processes are logical antecedents of peer relationships. However, research in this area with adolescent populations is limited. METHODS: Exploratory descriptive study using observational technique to collect nonverbal and verbal communication data on adolescents (N = 28). Observer ratings of personal boundaries and peer acceptance were correlated with anonymous peer ratings of sociability/leadership, aggressiveness/disruptiveness, and sensitivity/isolation, with comparisons made between males and females. FINDINGS: Boundaries are related to peer acceptance and peer reputation and are interpreted differently in males and females. CONCLUSIONS: This study provides beginning evidence of the usefulness of Personal Space Boundary Theory in understanding adolescent behavior.

Measuring maternal sensitivity in teen mothers: reliability and feasibility of two instruments.

This study's purpose was to compare the reliability and feasibility of two instruments measuring maternal sensitivity in adolescent mothers-the Maternal Sensitivity Q-Sort (MBQS) and the Ainsworth Maternal Sensitivity Scale (AMSS). After 2, 4, and 6 hours of home observations, 2 raters completed the MBQS and the AMSS on 10 adolescent mothers. The intraclass correlations for interrater reliability of the MBQS and AMSS were .80 and .81, respectively. There was no significant difference in raters' scores among times 1, 2, or 3 for either instrument, implying that perhaps only 2 hours of observation is required. Training times for the MBQS and AMSS were 15 hours and 13 hours, respectively. Completion time for the MBQS averaged 59 minutes compared to 5 minutes for the AMSS. At a pay rate of $12/hour for one rater, completion of 30 visits costs $354 for the MBQS compared to $30 for the AMSS. There was magnitude bias in both instruments such that the lower the sensitivity score, the greater was the difference in ratings. Results suggest that while both tools are equally reliable, the AMSS is the most cost-effective and time-efficient. Agreement among raters leads only to reliability, not validity. Testing needs to be done on a larger sample of adolescents to further evaluate reliability as well as the relative validity of the measures.

Bram Stoker's brother, the brain surgeon.

This essay examines the life and work of Sir William Thornley Stoker, 1st Baronet (1845-1912), the eldest brother of Bram Stoker (1847-1912), the author of Dracula (1897). Sir William or "Thornley," as he was commonly known, was one of Ireland's leading physicians. He performed some of the first brain surgeries in Ireland using Sir David Ferrier's maps of the cerebral cortex. From 1879 into the twentieth century, Thornley served as inspector for Ireland under the 1876 Cruelty to Animals Act. In this role, Thornley was responsible for granting licenses to researchers who performed experiments on live animals. Due to his reservations about animal experimentation, Thornley eventually became an advocate for the antivivisection cause, testifying at the second Royal Commission on Vivisection (1906-1912). Thornley also influenced Irish literature, albeit indirectly. Bram Stoker's composition notes for Dracula show that he consulted his older brother about the medical scenes in his novel. Thornley's knowledge of cerebral localization and his animal rights advocacy both surface in Dracula.

Lord Byron's physician: John William Polidori on somnambulism.

John William Polidori (1795-1821) was the Edinburgh-trained physician hired by Lord Byron to accompany him to Switzerland, where he participated in the story-telling event proposed by Byron that led, with Polidori's help, to Mary Shelley's Frankenstein. Although those interested in English literature might also remember Polidori as the author of The Vampyre, one of the first extended works of fiction about vampires, his earlier interest in somnambulism and trance states is only beginning to be appreciated. Even more than students of Romantic literature, historians of science and medicine seem little aware of what Polidori had written about oneirodynia, a synonym for somnambulism, and how his thoughts from 1815 about such activities reflected the changing medical zeitgeist at this time. This chapter examines Polidori's medical thesis in a neuroscience context and compares what he wrote to the writings of several other physicians who were fascinated by nocturnal wanderings, their causes, their manifestations, and their possible treatments.

The lived experience of ovarian cancer: a phenomenological approach.

PURPOSE: To describe the lived experience of women diagnosed with ovarian cancer using individual interviews. DATA SOURCES: Eleven women who had been diagnosed with ovarian cancer within the past five years were interviewed with open-ended guiding questions. The narrative responses were analyzed for constitutive patterns and relational themes according to Diekelmann and Allen's hermeneutic phenomenological process. CONCLUSIONS: This phenomenological study gave voice to the women's experience with ovarian cancer. The following six constitutive patterns and associated themes emerged: (a) The Revelation, (b) Jeopardy, (c) On the Lookout, (d) Becoming Normal, and (e) Living Every Moment. IMPLICATIONS FOR PRACTICE: An understanding of the common experiences and shared meanings of women with ovarian cancer may contribute to earlier diagnosis and improved quality of life. The women identified symptoms that should generate concern when reported to providers, potentially leading to diagnostic testing. The experiences may also serve to inform the development of interventions aimed at meeting the needs of women diagnosed with ovarian cancer.

Predictors of student outcomes on perceived knowledge and competence of genetic family history risk assessment.

The publication of the human genome project has launched a number of discoveries set to change the landscape of healthcare. Unfortunately, nursing faculty across the United States report they are unprepared to teach students who will be practicing in the genomic era. The purpose of this study, utilizing Rogers' (2003) Diffusion of Innovation theory as a framework, was to determine the degree to which nursing school characteristics predict graduating undergraduate nursing students' perceived knowledge and competence of genetic family history risk assessment. School characteristics included school size, proximity to a large city, faculty's perceived barriers to diffusion of genomics into nursing practice, faculty innovativeness, faculty who have attended a genetics program for nursing faculty, and the integration of genomics into the curriculum. Faculty and students from 103 nursing schools across the United States participated in the study by completing online surveys. Hierarchical multiple regression was employed to determine how well the independent variables predicted student perceived knowledge and student perceived competence. No combination of the independent variables in this study predicted student knowledge or competence to the degree expected. This could be attributed to a lack of diffusion of genomics content across nursing curricula, based on Rogers' (2003) theory. Other findings included faculty continue to believe they are not competent to teach genomics, and the curriculum is too dense to include more content. However, contrary to prior research, faculty did believe genomics was valuable. The findings of this study give direction for further research into student outcomes and curriculum evaluation after 2011, when a consensus panel working to diffuse genomics into nursing curriculum and practice will have implemented their strategic plan for this diffusion.

Case study of an intervention to enhance maternal sensitivity in adolescent mothers.

The purpose of this case study was to examine the efficacy of a teen parenting home intervention on maternal sensitivity in one teen mother/infant dyad by exploring the changes from pre- to postintervention in parenting stress, depression, and social support, all of which influence maternal sensitivity. Levels in all four variables of interest changed postintervention as predicted. Assessment and intervention related to maternal sensitivity should be incorporated into care of adolescent mothers in all settings.