Insights to Identifying and Managing Pain in Persons With Dementia in Long-Term Care: A Mixed Methods Study Comparing the Abbey Pain Scale and Pain Assessment in Advanced Dementia Scale.

Pain is usually identified by specific behaviors driven by the need for relief; however, persons with dementia present a unique challenge for nurses in assessing and managing pain. The aim of this mixed methods study was to explore the relationship between two observational pain scales, expressed need-driven behaviors, and likelihood of medication administration for persons with dementia. The qualitative strand examined nurses' perceptions regarding facilitators and barriers to pain scale use. Quantitative data analysis indicated the Abbey Pain Scale was significantly correlated with behaviors (r[26] = 0.41, p < 0.05) and approached significance with medication administration (r[26] = 0.35, p = 0.067). Qualitative analysis identified three core themes: (a) Challenges in Assessing Persons With Dementia for Pain; (b) Facilitators and Barriers to Pain Management; and (c) Difficulty Caring for Persons With Dementia. Clinical implications suggest the need for a systematic, consistent method of observing pain-related behaviors in persons with dementia. [Journal of Gerontological Nursing, 47(2), 21-30.].

Effects of wheelchair Tai Chi ball exercise on physical and mental health and functional abilities among elderly with physical disability.

The purpose of this study was to examine the effect of a 12-week Wheelchair Tai Chi Ball (WTCB) intervention, a combination of mind-body exercise with strength training, on physical and mental health and functional abilities among elderly with disability. Twenty-six elderly persons participated in the study, nine WTCB group participants and ten control group participants completed the study. The WTCB group practised WTCB12 twice/week for one hour each time. The control group did their daily routine without WTCB intervention. The outcomes measures were: Pain Self-Efficacy Questionnaire (PSEQ), SF-36v2 for physical and mental health, heart rate, blood pressure, range of motion and muscle strength of the dominant arm at the shoulder, elbow and wrist joints. The Mixed Model ANOVA was employed to examine the differences between and within the two groups using pre-test and post-test scores. The results demonstrated the WTCB group had significant improvements on PSEQ, general physical health and had positive effects on maintaining muscle strength at the shoulder, elbow and wrist joints as compared to the control group. The WTCB12 exercise had positive effects on self-efficacy for pain management, general physical health, and maintain upper extremity muscle strength and is a feasible exercise for elderly with disability.

The nature and meaning of insulin pump use in emerging adults with type 1 diabetes.

Objective. The purpose of this study is to investigate the meaning of living with an insulin pump for the management of type 1 diabetes during the period of emerging adulthood. Through a phenomenological narrative, this study contributes to the reflective understanding of the everyday life experiences of this population. Methods. A hermeneutic phenomenological design was used for this study of nine emerging adults (aged 19-24 years). Data were generated through face-to-face interviews and analyzed using the phenomenological approach of Max van Manen. Results. Four themes represent the essence of the day-to-day experiences of these emerging adults: seeking control, becoming responsible, staying connected, and accepting me. Conclusions. An in-depth understanding of the meaning of daily experiences with insulin pump technology has the potential to promote a developmentally appropriate approach to this age-group. The human understanding gained through this study is essential to the development of evidence-based practice guidelines and resources for this vulnerable population.

Perspectives of Asians living in Texas on pain management in the last days of life.

AIM: The recognition that someone's ethnic identity does not necessarily predict their health-care beliefs and preferences, and lack of scientific evidence on this topic provide the fundamental justification for this study. The aim of this descriptive qualitative study was to determine the attitudes about and preferences for pain management in the last days of life for persons born in Japan, China and Vietnam living in Texas. METHOD: Personal interviews were conducted to elicit people's perspectives on pain management, such as open or indirect acknowledgement of pain and endurance of pain for clarity of consciousness. RESULTS: Thematic analysis revealed three overarching themes for the Japanese group and five themes each for the Chinese and Vietnamese groups. Avoidance of stereotyping based on cultural background was a major finding of this study. CONCLUSION: Promoting quality of life in the last days of life is a priority for health professionals, and effective, individualised management of pain is of the utmost importance.

The effectiveness of microcurrent neurofeedback on depression, anxiety, post-traumatic stress disorder, and quality of life.

BACKGROUND: The world faces a mental health crisis with elevated rates of depression, anxiety, and post-traumatic stress, leaving a profound impact on daily quality of life (QOL). Current treatments show varying degrees of efficacy and carry burdensome challenges. Evidence exists for use of an innovative neurotechnology to reduce symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), but the science is lacking for use in the general population. PURPOSES: The purpose of this pilot study was to explore the effects of microcurrent neurofeedback on depression, anxiety, PTSD symptoms, and QOL in adults. METHODOLOGY: This was a one-group, exploratory pilot study that tested outcomes of depression, anxiety, PTSD risk, suicide risk, and QOL in 20 adults using convenience sampling. IASIS microcurrent neurofeedback (I-MCN) was the intervention that was delivered twice a week for 10 weeks; data collection was baseline, 5 weeks, and 10 weeks. RESULTS: Depression, anxiety, PTSD risk, and QOL improved significantly by the 10th and 20th session; suicidal risk showed nonsignificant reduction. Use of a more feasible interventional procedure established a foundation for use in clinical settings for the population. CONCLUSIONS: Using a more simpler procedure than what was used in a previous study reflected positive outcomes earlier and sustained over 10 weeks. This safe and effective technology carries rare but easily overcome adverse effects and could be an alternative to existing treatments or treatment-resistant conditions. IMPLICATIONS: Advanced practice nurses can apply the evidence to reduce symptoms of depression, anxiety, and PTSD. Randomized controlled trials and testing on diverse populations are needed.

Pain management knowledge and attitudes of baccalaureate nursing students and faculty.

Pain affects approximately 76 million adults in the US. Though pain management has been targeted as a top priority, it continues to be inadequately addressed. Nursing faculty are in a unique position to significantly address the problem through facilitating the acquisition and utilization of knowledge by student nurses. The purpose of this study was to determine the knowledge of and attitudes toward pain in baccalaureate nursing students and faculty to establish a foundation for a systematic and comprehensive integration of pain content in the curricula. The descriptive design included a sample of 162 junior and senior students enrolled in a baccalaureate nursing program in Texas and 16 nursing faculty. The Knowledge and Attitudes Survey Regarding Pain (KASRP) was used to measure knowledge and attitudes toward pain. A direct correlation was found between the level of education and the percentage correct score. Differences found in knowledge and attitudes among the three levels of students and faculty were significant (df = 3.173; F = 14.07, p < .001). Senior students nearing graduation scored only 68% (SD = 6.8) with faculty scoring only slightly better with a mean of 71% (SD = 13). Significant differences also were found in assessment of pain through case scenarios of a patient who was smiling and talking as compared to a patient who was lying quietly and grimacing (X2 = 37.13, p < .05 (df = 24). Reevaluation of the way pain assessment and treatment are taught is indicated. Further studies are needed to assess changes in knowledge and attitudes toward pain as curricular revisions are made.

Attitudes regarding life-sustaining measures in people born in Japan, China, and Vietnam and living in Texas.

Cultural beliefs about and preferences for care at the end of life are diverse and unique in many respects. This descriptive qualitative study presents findings about the attitudes and preferences of people born in Japan, China, and Vietnam and living in the southern part of the USA regarding life-sustaining measures. In-depth personal and focus group interviews were conducted with 46 participants and thematic analysis completed. The findings reflected some similarities and differences among the three groups concerning initiation and discontinuance of artificial nutrition and mechanical ventilation. They also demonstrated the requirement for sensitivity to individual needs when honouring the wishes of patients and surrogate decision makers. Interventional studies should follow that test educational strategies to improve practice outcomes for health-care providers who care for these populations at this vulnerable time of life.

Therapy Dog Effects on Nursing Student Stress: A Mixed Methods Study.

BACKGROUND: Nursing students experience stress levels that may interfere with success in rigorous nursing programs. While evidence indicates therapy dogs can decrease stress, no intervention standards exist, and outcomes are usually measured with questionnaires. PURPOSE: The purpose of this research was to enhance empirical evidence supporting a campus therapy dog by explaining the therapy dog's effect on nursing student stress. METHODS: The research used an embedded mixed-methods design. Introductory-level students interacted with a therapy dog on designated days. They measured stress using a smartphone application and Cohen's Perceived Stress Scale. Focus group discussion and program graduate surveys provided qualitative data explaining quantitative results. RESULTS: Results supported use of a campus therapy dog to decrease nursing student stress. CONCLUSIONS: The therapy dog's regular presence on campus may have improved student outcomes by decreasing stress and improving focus.

Job Embeddedness: The Differences Between Registered Nurses and Healthcare Assistants.

Retention of registered nurses (RNs) and health care assistants continue to be a challenge in acute care settings. This descriptive, comparative study examined differences of job embeddedness (JE) scores between RNs and health care assistants (HCAs) in acute care facilities. Generational differences for JE scores were also compared. A convenience sample of RNs and HCAs from medical and surgical units at two Texas hospitals completed the surveys. RNs valued community sacrifices significantly higher than HCAs. Total JE scores between baby boomers and millennials were significantly different, while organizational links scores among all three generations showed statistical significantly differences. Organizational fit, organizational sacrifice, and level of education added statistical significance to the prediction of job satisfaction.

Experiences of African American Mothers Following the Death of Their Infants.

OBJECTIVE: To explore the lived experiences of African American mothers after the death of their infants. DESIGN: Qualitative, interpretive phenomenologic study. SETTING: Northeast Louisiana. PARTICIPANTS: Seven self-identified African American women whose infants died during the first year of life; the women's ages ranged from 18 to 38 years at the time of the infant's death. METHODS: Heidegger's interpretive phenomenologic approach guided the data collection and analysis. The women were interviewed using in-depth questioning to determine the meaning of the infant loss experience and their subsequent efforts to cope. RESULTS: Six themes represented the experiences of loss for the mothers: Shattered Dreams, Questioning God, Dissociation, Paralyzing Fear, Left in the Dark, and Uniqueness of Grieving. Three themes affected the women's efforts to cope after their loss: Authentic Presence, Spiritual Empowerment, and Disconnectedness. CONCLUSION: African American women who experienced infant death described intense feelings of loss, guilt, and isolation. These negative emotions can potentially affect their physical and psychological health. These findings may help health care providers develop culturally sensitive understanding of African American mothers' experiences of loss and equip providers to provide holistic assessment, appropriate support, and treatment for these vulnerable women.

Exploring the Relationships Among Moral Distress, Moral Courage, and Moral Resilience in Undergraduate Nursing Students.

BACKGROUND: Nurses and students face a demanding and fluid health care system that can present overwhelming challenges. Moral distress is a challenge encountered by students who experience complex situations. Certain virtues such as moral courage and moral resilience are necessary to navigate around this phenomenon. METHOD: Using a descriptive correlational study design, a convenience sample of nursing students distributed among three sites were surveyed using three tools: The Moral Distress Thermometer (MDT), the Connor-Davidson Moral Resilience Scale (CD-RISC), and the Moral Courage Scale for Physicians (MCSP). RESULTS: Students reported mild levels of moral distress (M = 2.73, SD = 1.9). Moral resilience was significantly correlated with moral courage, age, and students having a previous degree. CONCLUSION: Interventions to cultivate moral resilience in nursing curricula are necessary. Valid instruments to measure moral resilience and moral distress in nursing students should be investigated further. [J Nurs Educ. 2020;59(7):392-395.].

Simulation to Enhance Empathy of Nursing Students Toward Patients With Alcohol Use Disorder: A Mixed-Methods Study.

BACKGROUND: Empathy can be challenging when caring for individuals with alcohol use disorders (AUDs). PURPOSE: This study examined the effectiveness of simulation for enhancing the empathy of nursing students toward patients with AUD. METHODS: A mixed-methods study used a pretest-posttest intervention measurement of empathy with the Comprehensive State Empathy Scale (CSES) and focus groups. Quantitative data were analyzed with t tests, whereas thematic analysis evaluated the qualitative data. RESULTS: No significant differences were found between pre- and post-CSES scores. The subscales of empathic concern and shared affect were significant: empathic concern, t55 = - 2.16, P = .04, and shared affect, t55 = -2.16, P = .02. Empathic imagination reached significance for students with personal experience with someone with an AUD, t54 = -2.39, P = .02. CONCLUSIONS: Additional research is warranted regarding the effect of simulation on empathic concern, shared affect, and empathic imagination toward individuals with AUD.

Nurses Consuming Energy Drinks Report Poorer Sleep and Higher Stress.

The energy drink consumption habits of nurses working in clinical settings is unknown. Utilizing a descriptive-comparison design, researchers examined the caffeine and energy drink habits of clinical nurses and relationships or differences that existed with their sleep quantity, sleep quality, and perceived stress levels. Data were analyzed using descriptive and inferential statistics. Significant relationships existed between energy drink consumption and sleep quality, sleep quantity, and perceived stress levels. Nurses who consumed energy drinks had poorer sleep quality and fewer sleep hours compared with caffeine-only consumers and noncaffeine consumers. Nurses who consumed energy drinks also had increased levels of perceived stress than noncaffeine consumers. Educating nurses regarding energy drink ingredients and relationships that exist between energy drink consumption, sleep, and perceived stress could be beneficial. Future studies are needed to examine motivational factors related to energy drink consumption as well as any health or safety implications that might be associated.

Social Support to Reduce Uncertainty in Childhood Cancer in South Texas: A Case Study.

PURPOSE: To determine if supportive measures are found to be most helpful and feasible for families of children with cancer by obtaining in-depth perspectives of uncertainty and adaptation. HYPOTHESES: Traditional methods of psychosocial support do not meet the needs of parents and families dealing with cancer. Participants prefer more informal meetings and gatherings that are more social in nature. METHOD: A descriptive single embedded case study was used to study uncertainty and social support for families with children treated at a pediatric hematology/oncology department in south Texas. The sample included members of the health care team in a pediatric cancer/bone marrow transplant unit and parents of children diagnosed with cancer. Data were gathered through audio-recorded interviews. DATA ANALYSIS: Data were transcribed and analyzed through thematic content and pattern matching using computer software. RESULTS: Four themes were identified: meaning of uncertainty in parents and members of the health care team, facilitators of parental adaptation, education and psychosocial support, and patient/family obstacles hindering successful adaptation. These demonstrated aspects of care interventions, clarifying what uncertainty means and how it affects the ability of parents to adapt to life with pediatric cancer, perceptions regarding the helpfulness of education and support interventions or lack thereof, and what internal and external obstacles hinder the family's adaptation. IMPLICATIONS FOR PRACTICE: Improving patient education through individualization and delivery time frame as well as providing opportunities for informal sharing and community building are key to reducing uncertainty and improving family adaptation to life with childhood cancer.

A Pilot Randomized Controlled Trial Examining the Effects of Tai Chi and Electronic Tablet Use on Older Adults' Cognition and Health.

PURPOSE: To evaluate the feasibility of Tai Chi (TC) and electronic tablet (ET) interventions on older adults' cognition and health and to explore participants' perceptions of intervention activities. DESIGN: An emergent embedded experimental mixed methods design was used in which the qualitative strand helped explain intervention results. METHOD: Older adults who participate in TC classes will have improved cognition and health compared with older adults who participate in ET classes. Twenty-six participants from two assisted living residences were recruited and randomized to receive nine TC or ET classes. The Modified Mini Mental State Exam was used to measure cognition and the SF-12v2 assessed perceived health before and after the intervention. Participants were invited to share perceptions of the two interventions. Institutional review board approval was obtained and participants provided signed consent for both quantitative and qualitative strands. FINDINGS: There was no significant difference within or between groups on cognition and health scores. CONCLUSIONS: TC and ET use are activities that can be delivered in the community and have the potential to promote compensatory scaffolding as described by the revised scaffolding theory of aging and cognition. Future research should involve larger samples and teaching methods that promote learning postures.

Navigating the evidence-based practice maze.

AIM: This article's purpose is to provide nurses with key points to consider in facilitating informed decision making while navigating the evidence-based practice (EBP) maze. BACKGROUND: EBP in nursing evolved from the medical model and continues developing within the holistic nursing paradigm. Inconsistent terminology, multiple applications, and lack of a unifying theory create challenges for nurses. KEY ISSUES: Recognition that multiple knowledge sources to support clinical decision making have merit for facilitating 'best' patient outcomes; EBP must be an internalized value of professional nursing. CONCLUSIONS: Multiple ways of knowing, or evidence, for informed clinical decision making must be considered based on situational context. No hierarchy fits all situations. Nurses must provide support and resources to facilitate nurse empowerment; nurses are accountable for using EBP to enhance patient outcomes. Implications for nursing management Effective EBP implementation relies on nurses being cognizant of what current nursing EBP trends are based on and where they are going. Nurses have a key role in facilitating consensus regarding evidence to be used in EBP, and ensuring availability of resources for empowering nurses to be accountable for outcome-oriented patient care through utilizing EBP.

Effect of an educational intervention on attitudes toward and implementation of evidence-based practice.

PURPOSE: Transitioning to an evidence-based practice (EBP) environment is a new and often overwhelming challenge for many organisations. The most effective strategies to implement EBP have yet to be determined. In this study an accelerated development EBP program, which was administered to nurses from five hospitals was evaluated. At each hospital, nurses were selected as an "EBP champion" whose role would be to help facilitate the transition within that organisation. AIMS: The purpose of this study was to evaluate the effectiveness of an accelerated educational program on the attitudes toward and implementation of EBP among nurses employed in acute-care facilities. METHODS: Forty-nine nurses from five acute-care facilities participated in an 8-week program to develop into EBP champions. Participants attended a 2-hour class each week conducted by four faculty members of a local university. Pre- and post-test mean scores of the EBP barriers (EBPB) and EBP implementation (EBPI) scales were compared using paired t tests to determine the effect of the accelerated development program. RESULTS: Respondents reported higher scores on both the beliefs and implementation scales at the end of the program. Paired t tests indicated a significant difference in means for both the EBPB (p < .01) and EBPI (p < .01). CONCLUSIONS: Nurses who attend an accelerated educational program have the potential to significantly improve beliefs and attitudes about EBP. Administrative support and collaboration between academia and service are essential for successful intervention.

Knowledge, attitudes and practices of nursing personnel regarding advance directives.

The aim of the study was to describe the knowledge, attitudes and practices of nursing personnel working in acute care settings regarding advance directives (ADs). The study was descriptive using a 40-item, newly developed tool (Update on Advance Directives questionnaire) distributed to 108 nursing personnel (mostly registered nurses) who were willing to complete the questionnaire. The findings were that nursing personnel reflected a lack of knowledge concerning federal and state laws and general information about ADs. Nursing personnel had very low rates of AD completion but most felt ADs were valuable for the patient. We concluded that nurses need more resources, e.g. knowledge, administrative and physician support, and communication tools to facilitate advance planning for end-of-life care for patients. The role of the health care provider, be it the nurse, physician or other, needs to be clarified regarding the most practical setting for AD formulation.

Factors influencing completion of advanced directives in hospitalized patients.

AIM: A cross-sectional, descriptive study to describe characteristics and other factors that influenced the decision by hospitalized patients in the East Texas area to formulate an advanced directive (AD). FINDINGS: Spouses, family members and sense of spirituality were the strongest influential factors for completion of an AD. Most learned about ADs from family, friends, personal attorneys, and others, while less than a quarter of the sample learned about ADs from health care providers. Not wanting to be a burden on their family was the major reason cited for completing an AD. CONCLUSIONS: Health care provider roles are vague in terms of responsibility for AD discussion and education. Further exploration of the attitudes, knowledge and practices concerning ADs of nurses and primary health care providers is recommended to provide focal points for future research in order to facilitate peace of mind for patients and families at end-of-life.