Effects of Tactile Desensitization on Postoperative Pain After Amputation Surgery.

PURPOSE: Pain in the acute setting after amputation is complex with multiple types of pain experienced, including somatic and neuropathic. No studies have measured multiple pain control modalities while using self-management techniques for acute amputation pain. Desensitization could provide a means of pain control for somatic and neuropathic pain. The purpose of this study was to test the efficacious use and effects of tactile desensitization in managing acute postoperative pain after lower limb amputation. DESIGN: This was a pre-experimental repeated measure study. METHODS: Pain description, intensity, anxiety, depression, and medication usage were measured during repeated time periods. Pain intensity was measured before and after each intervention along with efficacy. FINDINGS: Of the times the intervention was self-administered (n = 50) there was a statistically significant reduction in the pain level (P < .001) with large effect sizes for all paired comparisons. Participants found the intervention efficacious and feasible to use. CONCLUSIONS: The findings support a reduction in pain intensity scores using pain medication coupled with tactile desensitization.

Disease-specific quality of life-patient acceptance: racial and gender differences in patients with implantable cardioverter defibrillators.

BACKGROUND: Despite its established effectiveness, living with an implantable cardioverter defibrillator (ICD) is associated with ongoing physical and psychosocial distress. Little is known about which factors impact the patients' adjustment to living with the device and whether there are racial or gender differences related to these factors. The purpose of this study was to investigate factors (demographic, clinical, psychosocial, and religiosity) related to patients' ICD acceptance and to examine racial and gender differences in ICD acceptance. METHODS: A total of 101 ICD patients (mean age, 65 ± 12.8 years, 34% female, 42% African American [AA]) seen in a cardiology clinic between January and August 2010 completed the Florida Patient Acceptance Survey (FPAS), Florida shock anxiety scale, ENRICHD social support instrument, hospital anxiety and depression scale, Hoge Religiosity Scale, and a demographic sheet during their clinic visit. RESULTS: All multiple-item scales demonstrated good internal consistency reliability, with Cronbach α values ranging from .77 to .89. Overall patient acceptance of the ICD was high, with an average FPAS acceptance score of 80.9 on the 0-to-100 point scale. The FPAS subscale scores indicated that the group was very positive about the benefits of having the device (mean, 90.3) and had few body image concerns (mean, 10.6), low device-related distress (mean, 15.6), and moderate return to function scores (mean, 63.0). White ICD participants were more accepting of their device than AA ICD patients were, scoring statistically significantly higher than AA patients on total patient acceptance and return to function and significantly lower than AA patients on device-related distress and shock anxiety. Controlling for ethnicity (ß = .10, P = .15), age (ß = .01, P = .90), and number of comorbidities (ß = .19, P = .003) in a hierarchical multiple regression, shock anxiety (ß = .31, P < .001), knowledge of the device (ß = .23, P = .001), social support (ß = .13, P = .08), Hospital Anxiety and Depression Scale anxiety (ß = .06, P = .51) and depression (ß = .25, P = .01), and importance of religion (ß = .17, P = .01) explained 46.8% of the variance in FPAS scores. CONCLUSIONS: Although overall patient acceptance was high, AAs in the study had statistically significant lower mean total Florida Patient Acceptance Scale scores and Return to Function scores than whites did and higher Device-Related Distress scores. The strongest predictors of patient acceptance for the total group were shock anxiety, depressive symptoms, and device knowledge. African Americans had significantly lower device knowledge scores and higher shock anxiety scores than whites did. These findings suggest that ICD patients, especially AA ICD patients, may require education and psychosocial measures to enhance acceptance of their device. This study supports a holistic and culturally sensitive approach to focused clinical and psychological assessment and interventions for those living with this life-saving technology.

A School-Based Health Center-University Nursing Partnership: How We Filled in the GAPS.

Young adolescents, age 10-15 years, have increasing psychosocial and biomedical health care needs, yet are some of the lowest users of conventional health services. In eastern North Carolina, school-based health centers (SBHCs) provide primary health care to thousands of school-age children in the most rural, medically underserved areas. SBHCs receive reimbursement from local, state, and private funding sources and their viability depends on the demonstration of outcomes. Using the Guidelines for Adolescent Preventive Services (GAPS) assessment tool, an SBHC-university nursing partnership evaluated the use of preventive health services by fifth and sixth grade students (n = 690). Findings suggest that the vast majority of early adolescents needed a referral for a physical exam, nutrition, mental health, or health education services. This article describes key components for a successful SBHC-university nursing partnership that can evaluate and improve existing school health programs.

The front line of patient safety: staff nurses and rapid response team calls.

BACKGROUND: In response to growing concerns about patient safety, many hospitals are implementing rapid response teams (RRTs). Although the staff nurse plays a critical role in recognizing the need for the RRT and initiating the call, little is known about actions of staff nurses in relation to the RRT. OBJECTIVE: The purpose of this study was to examine relationships between nurse educational preparation, years of experience, degree of engagement, and the RRT call status (independent vs dependent). Nurse engagement was measured by the Manifestations of Early Recognition Scale. METHODS: A descriptive correlational design was used. The sample comprised 75 staff nurses at an academic medical center who cared for patients for whom the RRT was called. Educational level and nursing experience were independent predictors of call status, after controlling for effects of other independent variables. RESULTS: Independent callers were almost 5 times more likely to have a BSN degree, and almost 4 times more likely to have more than 3 years of experience, than did RNs who called because someone asked them to call. High levels of engagement were also significantly associated with call status, but after controlling for educational level and nursing experience, the relationship was not significant. CONCLUSIONS: This study has implications for clinicians and managers in health care facilities that rely on RRTs.

School Nursing: Becoming Credible and Visible.

A group of school nurses attending the innovation relay event at the NASN 2017 Annual Conference were asked to tackle the problem expressed by many school nurses: How can we increase the visibility and credibility of school nurses? The innovation relay allowed school nurses to look at the problem differently so that they could identify innovative solutions. This article shares more detail on each of the team's solutions and illustrates how school nurses can look at problems in a new light.

Nicaraguan and US nursing collaborative evaluation study: Identifying similarities and differences between US and Nicaraguan curricula and teaching modalities using the community engagement model.

BACKGROUND: Curricula evaluation is an essential phase of curriculum development. Study describes the implementation of a formative evaluation used by faculty members between Universidad Nacional Autonóma de Nicaragua (UNAN-Leon) Escuela de Enfermeriá, Nicaragua and East Carolina University College of Nursing (ECU CON) in North Carolina, US. OBJECTIVES: Program evaluation study to conduct an assessment, comparison of a medical-surgical adult curriculum and teaching modalities. Also, explore the Community Engagement (CE) Model to build a Central American-US faculty partnership. DESIGN: Methodological evaluation study utilizing a newly developed International Nursing Education Curriculum Evaluation Tool related to adult medical and surgical nursing standards. Also, the CE Model was tested as a facilitation tool in building partnerships between nurse educators. DATA: Nicaragua and US nursing faculty teams constructed the curriculum evaluation by utilizing the International Nursing Education Curriculum Evaluation Tool (INECET) by reviewing 57 elements covering 6 Domains related to adult medical and surgical nursing standards. METHODS: Developed, explored the utilization of the INECET based on a standard of practice framework. The Community Engagement Model, a fivephase cycle, Inform, Consult, Involve, Collaborate, and Empower was utilized to facilitate the collaborative process. RESULTS: Similarities between the US and Nicaraguan curricula and teaching modalities were reflective based on the 57 elements covering 6 Domain assessment tool. Case studies, lecture, and clinical hospital rotations were utilized as teaching modalities. Both schools lacked sufficient time for clinical practicum time. The differences, included UNAN-Leon had a lack of simulation skill lab, equipment, and space, whereas ECU CON had sufficient resources. The ECU school lacked applied case studies from a rural health medical-surgical adult nursing perspective and less time in rural health clinics. The UNAN-Leon nursing standards generalized based on the Ministry of Health (MINSA) and the US program was specific based on the American Nurses Association and various sub-specialties of nursing practice requirements. The CE Model was a useful framework to facilitate a collaborative partnership. CONCLUSION: Collaborative evaluation study using the International Nursing Education Curriculum Evaluation Tool can be an effective method to evaluate medical and surgical curricula similarities and differences within international nursing schools. The Community Engagement Model fostered a faculty partnership.

Leading through collaboration: a regional academic/service partnership that works.

This article describes a regional education/service partnership that has thrived for > 20 years. The collaboration takes place between a tertiary medical center and a university-based school of nursing located in a rural underserved area. Several critical issues have been creatively addressed by the partners including: the shortage of new nurses and nurse educators; the shortage of advanced practice nurses; the need to foster competence in new employees, particularly new graduates; and the advancement of clinical nursing research. Throughout history, academic/service partnerships have been discussed and developed. Cronenwett suggests that while the models have changed and evolved, there is a long-term history of collaborative partnerships in nursing.(1) Some of the most successful partnerships described in the literature have occurred when hospitals and schools of nursing share their governance structure.(2) However, in today's world, collaboration is based on a pressing need to address complex issues even when schools of nursing and clinical agencies have different governing structures. O'Neil suggests that the building blocks of an effective partnership include a coherent institutional strategy, potential partners that bring value and assets to the partnership, mutually beneficial goals, and accountability to each other.(3) Time and timing, tact, talent, and trust are other essentials of a productive partnership.(4) This article describes a collaborative model in which a university-based school of nursing has collaborated with a tertiary care hospital. The institutions have separate governing structures and each has its own personnel policies, job descriptions, and benefits. The collaboration takes place in a rural area of the state characterized by poverty and high morbidity and mortality. There is one hospital and one baccalaureate program in the region. There are also several associate degree programs in nursing (ADN) and these programs have been involved in many of the collaborative initiatives. Several critical issues have been addressed by the partners including: the shortage of new nurses and nurse educators, the shortage of advanced practice nurses, the need to foster competence in new employees (particularly new graduates), and the advancement of clinical nursing research.