Stress and Coping in Emergency Nurses Following Trauma Patient Care: A Qualitative Grounded Theory Approach.

BACKGROUND: Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions. OBJECTIVE: This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care. METHODS: Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs. RESULTS: A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support. CONCLUSIONS: Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses.

Addressing a Key Leadership Challenge: Workplace Violence.

Workplace violence is a growing concern among health care workers, especially staff working in emergency departments. Emergency department leaders have oversight accountability that includes mitigation of workplace violence risks and staff education related to workplace violence prevention. Challenges associated with workplace violence events include disruption of safe patient care, decreased staff job satisfaction, and increased turnover. Improving safety for staff, patients, and visitors requires a culture focused on safety. A summary of current regulations, standards, and resources available to date is provided, including a list of mitigation strategies that can be easily translated into practice by emergency nurse leaders.

The Path Toward Fellow Designation in the Academy of Emergency Nursing: Understanding and Navigating the Process to Ensure Your Success.

The Academy of Emergency Nursing was established to honor emergency nurses who have made enduring and substantial contributions that have had significant impact and continue to advance the emergency nursing specialty. Nurses who have been recognized as having made enduring and substantial contributions to emergency nursing achieve fellow status in the Academy of Emergency Nursing and are conferred the credential, Fellow of the Academy of Emergency Nursing. Academy of Emergency Nursing Board Members want to dismantle any structural barriers, clarify any misunderstandings or mysteries, and support diverse candidates by providing clear and equitable resources about the path toward fellow designation and the application process. Therefore, the purpose of this article is to support interested persons in their path toward Academy of Emergency Nursing fellow designation and give explicit details of each section of the application to develop a shared understanding among potential applicants, sponsors, and Fellows of the Academy of Emergency Nursing.

DNP Practice Improvement Initiative: Staff Nurse Competency Evaluation.

This article describes a practice improvement initiative (PII) demonstrating the impact of doctorate of nursing practice (DNP) skills beyond direct patient care. The Donna Wright Competency Assessment Model, AACN DNP Essentials, and National Organization of Nurse Practitioner Faculties nurse practitioner competencies framed the PII. The DNP graduates planned, implemented, and evaluated an assessment of 1,055 staff nurses on shift hand-off, physical assessment, and hand hygiene. Results indicated that 95% of the staff nurses scored 100% on competency assessment. The PII model was adopted for future competency evaluation.

An Academic-Practice Partnership Model to Grow and Sustain Advanced Practice Nursing.

OBJECTIVE: The aims of this article were to describe the implementation of an academic-practice partnership for healthcare system workforce development and provide preliminary outcomes of the associated pilot study. BACKGROUND: The demand for cross-continuum healthcare delivery models necessitates creation of workforce development structures for advanced practice nursing. METHODS: An academic-practice partnership specified enrollment of 5 cohorts of BSN staff nurses in a 3-year DNP program. Qualitative methods were used to explore pilot data at midpoint of cohort 1 student progression to determine learning outcomes and DNP projects with potential for impact on organization goals. RESULTS: Partnership implementation experiences indicate that contractual agreements and an established evaluation plan are keys to academic-practice partnership success. Pilot study findings suggest that curriculum core courses provide a foundation for designing DNP projects congruent with acute and primary care health system goals. Implementing an academic-practice partnership is a strategy for workforce development to increase retention of advanced practice nurses. CONCLUSION: Academic-practice partnerships can serve as a catalyst for a paradigm shift for changing models of care, thus enhancing workforce development succession planning for sustainable growth in healthcare systems.

Vorapaxar in atherosclerotic disease management.

OBJECTIVE: To review the pharmacology, efficacy, and safety of vorapaxar, a protease activator receptor-1 (PAR-1) antagonist, in the management of atherosclerotic diseases. DATA SOURCES: Peer-reviewed clinical trials and review articles were identified from MEDLINE and Current Content database (both 1966 to December 31, 2014) using the search terms vorapaxar and protease activator receptor antagonist. STUDY SELECTION AND DATA EXTRACTION: A total of 30 clinical studies were identified (16 clinical trials, including subanalyses, 14 related to pharmacology, pharmacokinetics, and pharmacodynamics and drug interactions). DATA SYNTHESIS: Two phase III clinical trials with vorapaxar have been published. In patients with non-ST segment elevation myocardial infarction (MI), vorapaxar failed to significantly reduce the primary efficacy end point (composite of cardiovascular death, MI, stroke, recurrent ischemia with hospitalization, and urgent coronary revascularization). Conversely, in a study of secondary prevention for patients with cardiovascular disease, the composite end point of cardiovascular death, MI, or stroke was significantly reduced. In both trials, the safety end points of major/minor bleeding were increased compared with placebo. In the secondary prevention trial, an increased incidence of intracranial hemorrhage led to the exclusion of patients with a prior history of stroke. CONCLUSION: Vorapaxar is approved for use with aspirin and/or clopidogrel in the secondary prevention of cardiovascular events in stable patients with peripheral arterial disease or a history of MI. However, the addition of vorapaxar to other antiplatelets can significantly increase the risk of bleeding. It is, therefore, essential to balance the need for further reduction of risk of thrombotic event with patient's individual bleeding risk.

The leadership role of nurse educators in mental health nursing.

Leadership behaviors and actions influence others to act, and leadership in clinical practice is an important mediator influencing patient outcomes and staff satisfaction. Indeed, positive clinical leadership has been positioned as a crucial element for transformation of health care services and has led to the development of the Practice Doctorate Movement in the United States. Nurse educators in health care have a vital leadership role as clinical experts, role models, mentors, change agents, and supporters of quality projects. By enacting these leadership attributes, nurse educators ensure a skilled and confident workforce that is focused on optimizing opportunities for students and graduates to integrate theory and practice in the workplace as well as developing more holistic models of care for the consumer. Nurse educators need to be active in supporting staff and students in health care environments and be visible leaders who can drive policy and practice changes and engage in professional forums, research, and scholarship. Although nurse educators have always been a feature of the nursing workplace, there is a paucity of literature on the role of nurse educators as clinical leaders. This discursive article describes the role and attributes of nurse educators with a focus on their role as leaders in mental health nursing. We argue that embracing the leadership role is fundamental to nurse educators and to influencing consumer-focused care in mental health. We also make recommendations for developing the leadership role of nurse educators and provide considerations for further research such as examining the impact of clinical leaders on client, staff, and organizational outcomes.

Health Behavior Decision-making in African-American Adults Diagnosed with Schizophrenia.

Little is known about the factors that influence health behavior decision-making among people with schizophrenia. The purpose of this qualitative study was to describe the processes used by 10 African-American adults with schizophrenia when making health behavior decisions and identification of perceived barriers and facilitators to health. Three phases of health behavior decision-making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. Findings may guide clinicians' efforts to improve the health status of patients, as well as influence future research in understanding health behavior decision-making among vulnerable populations.

Treating Heart Failure with Preserved Ejection Fraction: A Challenge for Clinicians.

Despite a decline in many forms of cardiovascular disease, heart failure (HF) continues to increase. Heart failure with preserved ejection fraction (HFpEF) is common, especially among persons with multiple comorbidities. HFpEF presents many challenges for clinicians due to the incomplete understanding of the underlying mechanisms and lack of consensus on the most effective strategies for treatment. Angiotensin and beta receptor-blocking drugs, which form the cornerstone for the treatment of systolic HF, have failed to show similar benefits in patients with impaired diastolic function. This article provides an overview of drug therapy for HFpEF, including newer agents now under investigation.

Association of Uninterrupted Oral Anticoagulation During Cardiac Device Implantation with Pocket Hematoma.

PURPOSE: Implantation of permanent pacemakers (PPMs) or implantable cardiac defibrillators (ICDs) may be complicated by the development of pocket hematomas. Current practice guidelines provide little guidance to clinicians about the preferred strategy for chronic oral anticoagulation (OAC). The purpose of this study was to examine the frequency and clinical significance of pocket hematoma among patients receiving uninterrupted OAC during cardiac device implantation. METHODS: This was a retrospective cohort study of adult patients undergoing cardiac device implantation between January 1, 2011, and December 31, 2012, at an academic teaching hospital. Medical records were reviewed for demographics, comorbidities, and medications. The primary outcome was development of pocket hematomas within 30 days of device implantation. Clinical significance was based on the need for additional intervention. Data were assessed using descriptive statistics, logistic regression, and chi-square tests. RESULTS: The final cohort included 380 patients. The median age was 68.4 years, and 56.6% were male. Cardiovascular comorbidities were common. Among 80 patients receiving uninterrupted OAC, 71.3% were taking warfarin, 11.2% rivaroxaban, and 17.5% dabigatran. The incidence of pocket hematomas for the entire cohort was 9.7%, of which 1.3% were clinically significant. Pocket hematoma occurred in 21.4% of patients continued on OAC versus 7.7% of those not anticoagulated (P = .001). Pocket hematoma was more common among those receiving ICDs than PPMs (18.5% vs 5.7%, respectively; P < .001). CONCLUSIONS: Continuing chronic OAC increased pocket hematoma formation but most were clinically insignificant. Pocket hematoma occurred irrespective of the oral anticoagulant drug used, but additional study is needed to determine comparative risks among the drugs.

Challenges of implementing a medication management evidence-based practice in a community mental health setting: results of a qualitative study.

The Medication Management Approaches in Psychiatry (MedMAP) is a medication management evidence-based practice (EBP) to guide the use of psychotropic medications in the treatment of schizophrenia. This qualitative study examined facilitators and barriers to implementing MedMAP in community mental health treatment settings. Audio-taped qualitative interviews were conducted with practitioners and administrators involved in a MedMAP implementation project conducted in six community mental health centers. Data analysis was conducted using thematic analysis of transcribed interviews. Findings indicate that facilitators to MedMAP implementation included practitioner recognition of the value of MedMAP, consumer involvement, collaboration, continuity of care, and fidelity assessments. Barriers to MedMAP implementation included problematic technology, work flow issues, lack of flexibility in prescribers' ability to implement MedMAP guidelines, regulatory and financial barriers, and consumer insurance status. Recommendations for improving future implementation efforts of MedMAP emphasize technological readiness, development of innovative models of care delivery, an emphasis on treatment guided by outcomes, and active leadership to promote EBPs within organizations and academic settings.

Diabetes and cardiovascular risk: are dipeptidyl peptidase-4 inhibitors beneficial?

Cardiovascular (CV) disease is a major cause of morbidity and mortality in patients with diabetes. Whereas the link between glycemic control and reducing microvascular disease is firmly established, the evidence for macrovascular risk reduction remains unclear. Despite a host of available drugs for lowering serum glucose, none to date have been shown to substantially reduce CV risk and some have been associated with adverse effects. Recent trials have examined the CV effects of the dipeptidyl peptidase 4 (DPP-4) inhibitors or "gliptins."

Aspirin for primary cardiovascular prevention: when is it worth the risks?

Low-dose aspirin is widely used by individuals to prevent first myocardial infarction and stroke. Although many health care professionals and patients believe that aspirin is safe and effective, the evidence is far from conclusive. As a result, current practice guidelines are inconsistent and leave practitioners with many unanswered questions. Because aspirin is available without prescription, pharmacists may often be the only health care professional positioned to advise and educate the patient.

Krill oil for cardiovascular risk prevention: is it for real?

Omega-3 fatty acids play an important role in cardiovascular health. Although it is suggested that individuals obtain these nutrients through diet, many prefer to rely on supplements. Fish oil supplements are widely used, yet large capsule sizes and tolerability make them less than ideal. Recently, krill oil has emerged as a potential alternative for omega-3 supplementation. This article will discuss what is known about krill oil and its potential use in cardiovascular risk prevention.

Curbing the major and growing threats from invasive alien species is urgent and achievable.

Although invasive alien species have long been recognized as a major threat to nature and people, until now there has been no comprehensive global review of the status, trends, drivers, impacts, management and governance challenges of biological invasions. The Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) Thematic Assessment Report on Invasive Alien Species and Their Control (hereafter 'IPBES invasive alien species assessment') drew on more than 13,000 scientific publications and reports in 15 languages as well as Indigenous and local knowledge on all taxa, ecosystems and regions across the globe. Therefore, it provides unequivocal evidence of the major and growing threat of invasive alien species alongside ambitious but realistic approaches to manage biological invasions. The extent of the threat and impacts has been recognized by the 143 member states of IPBES who approved the summary for policymakers of this assessment. Here, the authors of the IPBES assessment outline the main findings of the IPBES invasive alien species assessment and highlight the urgency to act now.