Impact of aromatherapy on anxiety among ICU nurses: A randomized, blinded, placebo-controlled trial.

PURPOSE: The purpose of this study was to examine the effect of aromatherapy with an essential oil blend containing lavender, bergamot, ylang-ylang, and sweet orange, compared with placebo, on perceptions of anxiety in ICU RNs. METHODS: Nurses recruited from six adult ICUs and a neonatal ICU participated in this blinded, randomized, placebo-controlled study, which took place over a 30-day intervention period. RESULTS: Although there were no statistically significant changes in anxiety pre- to postintervention or between the intervention and placebo groups, there were also no adverse events or untoward effects. CONCLUSION: The results of this study may support aromatherapy as an evidence-based strategy to reduce anxiety in ICU nurses. Additional research is needed.

Irritable bowel syndrome: Clinical practice update.

ABSTRACT: Irritable bowel syndrome (IBS) is a common and burdensome disorder characterized by chronic recurrent abdominal pain and altered bowel habits. IBS remains misunderstood, leading to delayed diagnosis, impaired quality of life, and substantial healthcare costs. Advancing clinicians' understanding of this complex biopsychosocial process, using a positive diagnostic strategy rather than a diagnosis of exclusion, and incorporating a multimodal treatment approach expedite time to diagnosis, facilitate symptom relief, and reduce financial expenditure.

When and How to Utilize Pudendal Nerve Blocks for Treatment of Pudendal Neuralgia.

Chronic pelvic pain is a common cause of pain in reproductive age women with debilitating consequences for affected women's health and quality of life. Treatment providers must be well versed in all treatment options for these patients, understanding the overlap in the management and treatment of chronic pelvic pain caused by pudendal neuralgia, myofascial pelvic pain, and vulvodynia. Pudendal blocks are a simple and quick procedure that can be performed in the office and often helps improve all the above conditions when used along with other treatment options. We review the anatomy and methodology on when and how to perform pudendal blocks in the office to better inform the general gynecologist on how to implement offering this treatment in the outpatient clinical setting.

The nurse wellbeing self-assessment supports the model of leadership influence for health professional wellbeing.

BACKGROUND: Despite emerging evidence of effective strategies for reducing burnout among health professionals, health professional burnout continues increasing. PURPOSE: A systematic Model of Leadership Influence for Health Professional Wellbeing is presented suggesting steps to measurably improve wellbeing by managing or mitigating stressors that generate burnout. METHOD: This paper examines (a) the psychometric properties of the Nurse Wellbeing Self-Assessment's (NWSAT)© four 10-item scales and (b) whether and how the Model of Leadership Influence can apply NWSAT results to reduce burnout. Using nurse survey data (N = 1,394) from one large eastern US healthcare system, the four NWSAT scales are psychometrically evaluated. FINDINGS: Predictive tests demonstrate the fit of the Model of Leadership Influence by documenting associations between NWSAT and burnout. All four NWSAT scales are strongly and inversely associated with burnout. DISCUSSION: Leaders can use NWSAT to systematically implement and evaluate a variety of strategies to improve staff wellbeing in one or more domains of NWSAT to manage or mitigate specific stressors that may otherwise contribute toward burnout.

Application of the model of leadership influence for health professional wellbeing during COVID-19.

BACKGROUND: Nurse burnout is a top patient safety concern. Workplace stress and burnout results in high turnover rates, costs, and lessened productivity and quality care. Although the relationship of burnout to patient outcomes and communication has been proposed, there is little available in terms of a theoretical framework to guide leaders in developing a comprehensive and effective approach to promoting wellbeing and reducing burnout. PURPOSE: This paper demonstrates a theoretical application of the Model of Leadership Influence for Health Professional Wellbeing to support staff wellbeing by developing targeted approaches that address the four dimensions of whole person wellbeing. METHOD: Published literature from the COVID-19 pandemic is used for context to demonstrate the use of the model. FINDINGS: The model can be used to facilitate exploration and navigation of the complex issues surrounding burnout and wellbeing. DISCUSSION: Leaders may find the model can be a useful tool to promote staff wellbeing.

The Nurse Manager's Experience of Moral Distress.

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood. We conducted a qualitative descriptive study with 19 nurse managers from 5 healthcare institutions in Virginia. Interview data were analyzed using a directed content analysis, as the structural components of the moral distress phenomenon are already known. Participants suffered moral distress when they were unable to achieve or maintain effective unit function and felt caught in the middle between their units' and employees' needs and organizational directives. System-level causes of moral distress are common among nurse managers. Future research should involve measurement of moral distress among nurse managers and exploration of effective interventions.

Brief Mindfulness Practice Course for Healthcare Providers.

OBJECTIVE: The aim of this study was to examine the short-term and sustained effect on well-being, burnout, and mindful awareness of an abbreviated mindfulness practice course designed for nurses and other healthcare professionals. BACKGROUND: Most mindfulness programs are impractical for frontline healthcare providers because of the intensive, off-site initial training and prolonged practice commitment. A psychiatric nurse educator developed a brief training program tailored for healthcare providers. METHODS: Two institutional review board-approved studies examined the abbreviated mindfulness practice course for healthcare providers: the first, a single-group pretest-posttest design with 25 nursing employees in an academic medical center, and the second, a randomized controlled trial with 83 healthcare professionals. RESULTS: Significant improvement in mindful awareness and at least 1 indicator of burnout were demonstrated. Improvements in quality of life were noted with nurses. CONCLUSIONS: Findings support the short-term and sustained impact of this brief mindfulness curriculum on mindful awareness, quality of life, and aspects of burnout for healthcare professionals.

A Longitudinal Study of the Impact of Schwartz Center Rounds on Moral Distress.

Moral distress occurs when moral integrity is compromised and can affect any healthcare professional. This study examined the impact of Schwartz Center Rounds (SCRs) on moral distress using a longitudinal, quasi-experimental design to examine SCR attendees from 2015 to 2019. Data were collected via a 2-part survey composed of demographics and Moral Distress Thermometer (MDT) readings before rounds and immediately after rounds. Most participants experienced either no change in moral distress (50.6%) or a decrease in moral distress (33.7%) after attending one of the SCRs. Participants who worked with adult populations had higher moral distress after participation for most topics. An increase in moral distress was associated with a longer time in the current position. Fifty percent of the physicians had a decrease in their moral distress immediately after the rounds. Schwartz Center Rounds is a promising approach to foster high-functioning teams while promoting wellness and mitigating moral distress among employees.

Pediatric and Neonatal Tracheostomy Caregiver Education with Phased Simulation to Increase Competency and Enhance Coping.

PURPOSE: Infants and children with medically complex needs depend on their caregivers for activities of daily life and specialized care of various devices they need to survive. Caregiver education is a primary goal in discharge planning to ensure safe, competent home care for these medically fragile children. Standard of care is bedside teaching. The Family Tracheostomy Program complements traditional training with a phased process of simulation. The purpose of this QA/QI project was to increase caregiver competency and decrease anxiety level for pediatric tracheostomy care through simulation training. METHOD: For two years, the pediatric and neonatal intensive care units trained twenty caregivers of new tracheostomy patients with the supplementation of simulation to standard bedside training. Using a five-point rating scale, caregivers completed pre- and post- tests for separate skills and scenario training sessions. RESULTS: Skills scores were hypothesized to increase after simulation training. In a small sample (n = 20), scores increased from pre-test (µ = 11.45, SD = 4.88) to post-test (µ = 22.6, SD = 2.01). This change was significant (t(19) = 10.78, p < 0.001). Scenario scores were hypothesized to increase after simulation training. In another small sample (n = 15), scores increased from pre-test (µ = 23.40, SD = 7.11) to post-test (µ = 28.73, SD = 2.31). This change was significant (t(14) = 3.78, p < 0.001). CONCLUSION: Simulation as a complement to bedside caregiver education increased caregiver competency and decreased anxiety levels for these samples. PRACTICE IMPLICATIONS: Organizations caring for neonatal and pediatric tracheostomy patients might consider providing additional support with a phased method of simulation as part of caregiver education.

A practical approach to selecting a colorectal cancer screening test.

ABSTRACT: Colorectal cancer is the second leading cause of cancer-related deaths in the United States, but timely, effective, and adherent screening can reduce the number of cases. Screening tests continue to evolve, creating opportunities and challenges. Medical societies offer varying guidelines about optimal screening tests and when to begin screening. This article reviews available and emerging colorectal cancer screening tests and discusses how to educate patients, advise them in selecting an appropriate test, and promote increased participation in colorectal cancer screening.

Being a Research Mentor: A Qualitative Study.

OBJECTIVES: This qualitative study was designed to describe the experiences of mentors for a nursing research fellowship at a southeastern US academic medical center. BACKGROUND: Mentoring is an important aspect of nursing and is a key strategy to develop nurse leaders and faculty. Research mentors have been identified as essential for novice researchers to be able to complete clinical studies. However, there has been limited research on the experience of nursing research mentors, despite the emphasis on the critical nature of this role. METHODS: Eight mentors for 23 studies over 8 years of a nursing research fellowship participated in a study outlining their experiences as research mentors. RESULTS: Common themes emerged from mentors' identification of key components in the research mentoring process and elements necessary for effective support of frontline nurse researchers. CONCLUSIONS: Recommendations for developing effective, confident research mentors are drawn from the analyses.

Hazardous substances as the dominant non-methane volatile organic compounds with potential emissions from liquid storage tanks during well fracturing: A modeling approach.

Chemical additives used in hydraulic fracturing fluids (HFFs) are made up of various organic compounds that are potential human carcinogens. To estimate the emissions from these organic constituents in on-site liquid storage tanks, studies were performed using the AP-42 model on data collected from 72,023 wells put into production using hydraulic fracturing between 2008 and 2014 in the United States. Results show that a total of 8.11 × 105 kg volatile organic compounds (VOCs) were potentially emitted from liquid storage tanks during fracturing operations, which was relatively low compared to other sources/activities in well fracturing. The median well emission roughly increased from 0.110 to 0.786 kg per well in 2008 and 2014, respectively, and was primarily due to the increase in the volume of chemical additives for fracturing one well. Of NMVOC emissions, 95.1% was contributed by 60 compounds listed on the priority list of hazardous substances defined by the Agency for Toxic Substances & Disease Registry (ATSDR), while 16.7% was caused by 15 carcinogenic compounds. Specially, methanol, formaldehyde, 2-propanol, and ethanol accounted for 55.5%, 16.6%, 11.7%, and 8.31% of NMVOC emissions. Our study highlights methanol, formaldehyde, 2-propanol, and ethanol as the targeted compounds for reducing organic emissions and occupational inhalation exposures related to storage tank operations.

Surface Water Microbial Community Response to the Biocide 2,2-Dibromo-3-Nitrilopropionamide, Used in Unconventional Oil and Gas Extraction.

Production of unconventional oil and gas continues to rise, but the effects of high-density hydraulic fracturing (HF) activity near aquatic ecosystems are not fully understood. A commonly used biocide in HF, 2,2-dibromo-3-nitrilopropionamide (DBNPA), was studied in microcosms of HF-impacted (HF+) versus HF-unimpacted (HF-) surface water streams to (i) compare the microbial community response, (ii) investigate DBNPA degradation products based on past HF exposure, and (iii) compare the microbial community response differences and similarities between the HF biocides DBNPA and glutaraldehyde. The microbial community responded to DBNPA differently in HF-impacted versus HF-unimpacted microcosms in terms of the number of 16S rRNA gene copies quantified, alpha and beta diversity, and differential abundance analyses of microbial community composition through time. The differences in microbial community changes affected degradation dynamics. HF-impacted microbial communities were more sensitive to DBNPA, causing the biocide and by-products of the degradation to persist for longer than in HF-unimpacted microcosms. A total of 17 DBNPA by-products were detected, many of them not widely known as DBNPA by-products. Many of the brominated by-products detected that are believed to be uncharacterized may pose environmental and health impacts. Similar taxa were able to tolerate glutaraldehyde and DBNPA; however, DBNPA was not as effective for microbial control, as indicated by a smaller overall decrease of 16S rRNA gene copies/ml after exposure to the biocide, and a more diverse set of taxa was able to tolerate it. These findings suggest that past HF activity in streams can affect the microbial community response to environmental perturbation such as that caused by the biocide DBNPA.IMPORTANCE Unconventional oil and gas activity can affect pH, total organic carbon, and microbial communities in surface water, altering their ability to respond to new environmental and/or anthropogenic perturbations. These findings demonstrate that 2,2-dibromo-3-nitrilopropionamide (DBNPA), a common hydraulic fracturing (HF) biocide, affects microbial communities differently as a consequence of past HF exposure, persisting longer in HF-impacted (HF+) waters. These findings also demonstrate that DBNPA has low efficacy in environmental microbial communities regardless of HF impact. These findings are of interest, as understanding microbial responses is key for formulating remediation strategies in unconventional oil and gas (UOG)-impacted environments. Moreover, some DBNPA degradation by-products are even more toxic and recalcitrant than DBNPA itself, and this work identifies novel brominated degradation by-products formed.

Evaluating the Burnout-Thriving Index in a Multidisciplinary Cohort at a Large Academic Medical Center.

OBJECTIVES: There has been significant discussion about the quality of burnout research, especially with regard to abbreviated measurements of burnout and/or well-being. The purpose of this study was to compare a single-item, investigator-developed question measuring perceived well-being with validated multi-item measures of burnout and well-being. METHODS: Between 2016 and 2017, healthcare professionals and medical students at a large academic hospital system were sent an online survey measuring the risk of burnout (Maslach Burnout Inventory), well-being (Physician or Nurse Well-Being Self-Assessment Tool), and perception of personal well-being (Burnout-Thriving Index [BTI], an investigator-developed, single-item measure). Analyses included linear and multiple regression and Pearson correlations. RESULTS: The study sample included 1365 medical students, frontline nurses, resident physicians, supervising physicians or fellows, and advanced care practitioners. There were significant differences in all Maslach Burnout Inventory and Physician or Nurse Well-Being Self-Assessment Tool subscale scores based on BTI score (all P < 0.001). Adjusted R2 ranged from 0.066 (religiospiritual wellness) to 0.343 (emotional exhaustion). BTI had a stronger relation with personal accomplishment in medical students compared with nurses (P = 0.049) and a stronger relation with psychoemotional wellness in physicians and physicians-in-training compared with nurses (P < 0.05). A low BTI score demonstrated >80% sensitivity for high emotional exhaustion, depersonalization, and low personal accomplishment. CONCLUSIONS: The BTI may be used to screen for individuals who could benefit from completing a full burnout assessment and may be used to collect a quick "big picture" impression of burnout and well-being at a healthcare institution. Further research is needed to compare BTI score with known consequences of burnout and to explore differences in the relation between BTI score and psychoemotional wellness in different professional groups.

Interpersonal Gun Violence Research in the Social Work Literature.

Interpersonal gun violence remains a major public health issue in the United States and beyond. This article explores the research on interpersonal gun violence published in peer-reviewed social work journals since the mid-1990s. Findings from this review indicate that the existing scholarship offers some important insights into this topic, particularly related to risk factors for and the effects of exposure to gun violence. These findings, however, also point to some shortcomings in the literature, including problems with the measurement and analytic treatment of exposure to gun violence and a lack of research with direct victims and perpetrators of gun violence. Implications for future research are discussed.

Successful grant applications: Follow the 4 F's.

All nurses have the potential to influence the healthcare industry and the nursing profession through research, but preparing a grant application can be intimidating. This article addresses the process of writing and developing successful grant proposals.

Understanding Electrochemically Activated Persulfate and Its Application to Ciprofloxacin Abatement.

This study offers insight into the roles anodic and cathodic processes play in electrochemically activated persulfate (EAP) and screens EAP as a viable technique for ciprofloxacin degradation in wastewater. Sulfate radical formation at a boron-doped diamond (BDD) anode and persulfate activation at a graphite cathode were experimentally elucidated using different electrolytes and electrochemical setups. Rapid ciprofloxacin transformation occurred via pseudo-first-order mechanisms with respect to ciprofloxacin in persulfate electrolyte, reaching 84% removal in 120 min using EAP. Transformation pathways were compared to those in nitrate and sulfate electrolytes. Ciprofloxacin removal rates in the electrochemical system were 88% and 33% faster in persulfate than nitrate and sulfate electrolytes, respectively. Total organic carbon removal rates were 93% and 48% faster in persulfate than nitrate and sulfate, respectively. Use of sulfate electrolyte resulted in removal rates 6-7 times faster than those in nitrate solution. Accelerated removal in sulfate was attributed to anodic sulfate radical formation, while enhanced removal in persulfate was associated with cathodic persulfate activation and nonradical persulfate activation at the BDD anode. Quenching experiments indicated both sulfate radicals and hydroxyl radicals contributed to degradation. Comparisons between platinum and graphite cathodes showed similar cathodic persulfate activation and ciprofloxacin degradation.

Integrating High-Reliability Principles to Transform Access and Throughput by Creating a Centralized Operations Center.

High-reliability organizations (HROs) demonstrate unique and consistent characteristics, including operational sensitivity and control, situational awareness, hyperacute use of technology and data, and actionable process transformation. System complexity and reliance on information-based processes challenge healthcare organizations to replicate HRO processes. This article describes a healthcare organization's 3-year journey to achieve key HRO features to deliver high-quality, patient-centric care via an operations center powered by the principles of high-reliability data and software to impact patient throughput and flow.

Audit and Feedback: A Quality Improvement Study to Increase Pneumococcal Vaccination Rates.

The purpose of this quality improvement study was to explore the impact of audit and feedback on the pneumococcal immunization rate for at-risk adults in ambulatory settings. Study findings support the hypothesis that timely, individualized audit and feedback can have a positive impact on immunization rate; generalized feedback that did not provide actionable information did not have the same impact. The difference between the interventions was significant, χ (1, N = 1993) = 124.7, P <.001.