Postoperative management of patients with obstructive sleep apnea: implications for the medical-surgical nurse.

Obstructive sleep apnea (OSA) affects up to 7% of Americans, and those undergoing surgery are at risk for complications. Medical-surgical nurses should be knowledgeable regarding this common disorder and understand how to screen effectively and monitor patients with OSA.

Making better decisions during triage.

Interactions between nurses and patients during triage are crucial if the urgency of patient need is to be assessed accurately. This article reports on the results of a study of emergency nurses' perspectives and experience of triage in the United States. Findings indicate that triage encounters are multifaceted and that emergency nurses require experience as well as knowledge to make good decisions. Two themes emerged from the study's findings: the need for nurses to connect with patients and the ability of nurses to 'read between the lines'. Nurses who connect with patients can take more detailed histories, while those who can read between the lines can identify the salient points and subtle signs from patients. Nurses with these skills can make better triage decisions.

Adolescents and headaches: maintaining control.

Migraine headaches, much like a chronic illness, are reported to negatively affect adolescents physically, mentally, and socially, further disturbing this already turbulent time of development. Prior migraine research is limited in adolescents, and no qualitative studies have examined the lived experience of adolescents with migraines. This interpretive phenomenological study explored the experience of living with migraines in six adolescents ranging in age from 12 to 17 years. After coding data and grouping into clusters, three themes emerged: 1) maintaining control by either pressing on and enduring the burden, or by disengaging and isolating self; 2) mind overload; and 3) unsettling manifestations. Adolescents approach migraine episodes by either continuing with their life as "normal," or by removing themselves physically and/or emotionally. By understanding the potentially unique physical and psychological disruptions that adolescents with migraines experience, nurses can offer education, provide nonpharmacologic interventions, and conduct further research that will improve health outcomes.

Qualitative data collection with children.

Qualitative researchers have clear methods to guide them in data collection with adult participants, but little is known about effective interview techniques with children. The findings from this methodological study on qualitative interviews with children indicate that children are able to articulate their experiences in interviews.

Long-bone fracture pain management in the emergency department.

INTRODUCTION: The purposes of this study were to investigate the adequacy of pain management for patients with long-bone fractures seen in the emergency department and to determine whether racial disparities exist. METHODS: The design was an exploratory, correlational design using patient data abstract ed from electronic medical records of 2 major urban medical centers located in the Southeastern United States. Data collected included demographics, time of initial pain assessment by the registered nurse, time of pain medication administration, severity of pain, fracture location by radiograph, type of pain medication, and route-dosage of pain medication administered. The primary outcome variable, which was the pain management index, was calculated and used as a measure of adequate pain management. RESULTS: The majority of the sample (N = 218) was female (61%) and white (63%), with 28% black and about 10% of the sample consisting of other minorities. Seventy-nine (36%) of the 218 patients received no medication while in the emergency department despite a mean pain score of 6.9 (SD = 2.5) on a 0 to 10 scale representing moderate to severe pain. Patients who received pain medication (n = 126) waited for the medication 1.76 hours (±1.47). Among the patients who received an analgesic (n = 126), younger patients, black patients, and those with higher pain severity were more likely to receive inadequate pain management than were white patients. DISCUSSION: According to the pain management index, the majority of the patients in this study received inadequate pain management while in the emergency department. Future interventions may need to focus on giving ED nurses information about inadequate pain management and disparities in pain management in the ED setting and exploring possible reasons for disparities in order to ultimately improve patient care.

Perceptions of cardiac risk factors and risk-reduction behavior in women with known coronary heart disease.

BACKGROUND: Risk factor reduction has been linked to personal perceptions of risk, yet few data exist about women's personal perceptions of coronary heart disease (CHD) risk, especially women who have experienced a cardiac event or intervention. OBJECTIVE: The purpose of this study was to explore perceptions of risk for CHD and to examine perceptions of risk-reducing behaviors in women with known CHD. METHODS: Because women's attitudes are conceptualized to be embedded in their everyday practices, an interpretative qualitative approach was chosen to reveal this phenomenon. The purposive sample consisted of 7 women with CHD. Interviews were conducted and transcribed verbatim. Data collection continued until saturation occurred. Efforts were made to increase trustworthiness through participant review of transcripts, peer debriefing, and using field notes. RESULTS: Three major themes emerged from the data: "out of sight, out of mind," "why doesn't he talk to me like that?" and "it's scary." The women indicated their CHD was currently not a major problem because they were asymptomatic or did not "feel sick," which led to decreased focus on their CHD, including risk factor reduction. They expressed the desire to return to normal, rather than focus on the chronicity of CHD. Participants felt that physicians treated them differently because they were women and that their concerns were taken less seriously. They perceived that the patient-physician relationship lacked open dialogue. Fear was experienced by all women, and many feared the unknown, especially not knowing when something was wrong with their heart. CONCLUSIONS: Data indicated that, during stable periods in the CHD trajectory, women may not understand the chronicity of their disease and may not recognize the importance of reducing their risk for future cardiac events. Helping women understand CHD chronicity even when they may not feel sick may assist them in engaging in risk-reducing behaviors.

Why are nurses leaving? Findings from an initial qualitative study on nursing attrition.

The nursing shortage remains problematic, yet research with nurses no longer in clinical practice is scarce. The purpose of this study was to understand the factors influencing the decision of registered nurses (RNs) to leave clinical nursing. A phenomenological research design was chosen to reveal the complex phenomena influencing the RNs' decisions to leave clinical nursing practice. Interviews were conducted with RNs who were no longer practicing clinically.

Nurses' Perceptions of Quality of Life for Adolescents with Congenital Heart Disease.

The purpose of this study was to understand nurses' perceptions and experiences regarding Quality of Life (QOL) of adolescents with complex congenital heart disease (CHD). Interpretive, hermeneutic, phenomenology was used to explore the perceptions and experiences of nurses who care for adolescents with complex CHD. The participants included 6 female registered nurses with experience taking care of adolescents with complex CHD. Data were collected using semi-structured interviews. Data analysis revealed 4 themes: QOL depends on how the psychological and social issues are interwoven with the physical; finding that balance between overprotection and too much freedom; setting goals to envision a future; and not being defined by a CHD. These results indicate that understanding nurses' perspectives and experiences may contribute to effective guidance for adolescents with complex CHD transitioning into adulthood.

Nursing structure, processes, and patient outcomes in army medical centers.

The purpose of this study was to describe patient outcomes in Army Medical Centers, identify differences in outcomes between mixed medical-surgical bed and specialty intensive care units (ICUs), and explore predictive models for outcomes attributable to nursing structure and processes. Data were collected from 138 patients and 103 nurses in four medical-surgical and four ICUs in two Army Medical Centers. Significant differences for unit type were found for length of stay and patient satisfaction with nursing care. Outcome predictive models were modest (adjusted R2 = .16 to .24) and significant for length of stay, satisfaction with nursing care, satisfaction with pain management, and health status following discharge. Exploring differences and commonalities between military and civilian hospitals will ultimately provide insight into ways of improving patient outcomes and bettering the work environment of nurses.

A qualitative descriptive study of the lived experiences of school-aged children with epilepsy.

INTRODUCTION: The purpose of this study was to gain a better understanding of children's personal experiences with epilepsy to guide health care providers in providing care to these children. METHOD: This qualitative study examined the experiences of eight children, ages 9 to 12 years, who have epilepsy. The audiotaped interviews were guided by eight open-ended questions designed by the researchers. The taped interviews were later transcribed and discussed by the researchers. Patterns identified from the interviews were (a) my seizure medications; (b) seizures are not fun; (c) what my friends think about seizures; (d) what I do for fun; and (e) ways I live with my seizures. Several themes were identified from each of the patterns. RESULTS: These findings suggest that children with epilepsy dislike having seizures and taking seizure medication; friends provide significant relationships and support; children with epilepsy participate in sports; and children with epilepsy are cognizant of auras and ways to prevent seizures. DISCUSSION: Through these school-aged children's experiences and perceptions, pediatric nurse practitioners and other health care providers can establish developmentally appropriate, comprehensive methods to help these children cope with epilepsy and seizures.

The early recognition of patient problems among medical-surgical nurses.

Because nurses' early recognition of patient problems is a key aspect in producing positive patient outcomes in acute care settings, the skill of early recognition, the language to describe it, and institutional support of the nurse to use it in a consistent way are critical to quality care. An important aspect of clinical judgment, the early recognition of patient problems is described from the perspective of medical-surgical nurses.

Exploring the day-to-day life of mothers dealing with preschool children who have behavioral disorders.

INTRODUCTION: The purpose of this study was to explore the day-to-day life of mothers dealing with preschool children who have behavioral disorders and to explore the mothers' experiences with their children's health care. METHOD: A qualitative design was used to explore mothers' experiences in their day-to-day lives. A purposive sample of eight mothers was interviewed in their homes. A recorded face-to-face format was used that included open-ended, semi-structured questions. RESULTS: Two major themes emerged from the day-to-day experiences of these mothers: "abandoning my other child" and "parenting in unsupportive environments". DISCUSSION: The theme of "parenting in unsupportive environments" reflects the frustrations the mothers felt in their day-to-day lives while trying to find help for their children. The theme of "abandoning my other child" refers to the siblings of the children with behavioral disorders being overlooked by the mothers because so much of the mothers' attention and time was given to the child with the behavioral disorder.

The experiences of school-age children with a tracheostomy.

PURPOSE: The purpose of this study was to explore the school-age child's perspective about living with a tracheostomy. DESIGN AND METHODS: A qualitative design using phenomenological methods was used to describe and interpret the lived experiences of school-age children with a tracheostomy. RESULTS: The perceptions of five children were explored, and three themes emerged: "I'm the only one," "friends are helpful," and "just tell them." CONCLUSIONS: Data indicated that encouraging friendships with other children enhances the well-being of the child with a tracheostomy. In addition, data suggested that when schoolmates understand the experiences of children with tracheostomies, they are supportive of the child. Nurse practitioners are in a unique position to assist the child with a tracheostomy in the development of peer networks.

Living with chronic obstructive pulmonary disease: insiders' perspectives.

AIM: This paper reports a study of the experiences of older adults with severe chronic obstructive pulmonary disease, with the aim of gaining an understanding of how the disease had affected their lives. BACKGROUND: Chronic obstructive pulmonary disease is a major personal and public health burden and is the fifth cause of mortality worldwide. The brief encounters that healthcare professionals have with patients in hospitals, physicians' offices and other outpatient settings are insufficient to be able to truly understand the challenges that people face in the attempt to integrate a chronic illness into their lives. Previous qualitative studies on chronic obstructive pulmonary disease have tended to focus on specific problems associated with the disease, such as fatigue and social isolation. METHOD: A hermeneutic phenomenological study was carried out with 10 older adults who participated in a local hospital's case management or pulmonary rehabilitation programme. Data were collected by interviews in 2003. FINDINGS: Three major themes were identified: Knowing What Works, Hanging On...Barely, and Losing Control-Gaining Control. The changes associated with chronic obstructive pulmonary disease were described as increasingly challenging and even threatening to participants' current lifestyles. The impact of dyspnoea was great and invaded almost every aspect of their lives. Participants identified the most effective methods to resolve shortness of breath. CONCLUSION: People with severe chronic obstructive pulmonary disease have had extensive experience of managing their disease and are familiar with techniques that have helped them integrate the illness and symptoms into their lives. Nurses can synthesize patient knowledge with nursing knowledge to assist patients with severe chronic obstructive pulmonary disease to achieve their maximum quality of life.

Nurse moral distress and ethical work environment.

This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, whereas being African American was related to higher levels of moral distress intensity. The ethical work environment predicted moral distress intensity. These results reveal a difference between moral distress intensity and frequency and the importance of the environment to moral distress intensity.

Moral distress or moral comfort.

Moral distress in healthcare results from a professional's inability to provide compassionate care to patients because of individual, organizational, or societal barriers. Research suggests that moral distress is a growing concern among nurses, and may be a major reason why nurses leave one job for another or abandon the profession of nursing. Some professionals, however, have identified strategies that help them work through their moral distress toward an experience of moral comfort. These strategies may be individual, organizational, or societal. The focus of this paper is to identify examples of strategies professionals have used to alleviate distressful feelings and enhance moral comfort.

Characteristics of nurses and hospital work environments that foster satisfaction and clinical expertise.

OBJECTIVE: The purpose of this aspect of a larger study was to describe characteristics of nurses and their work environment at two military hospitals. BACKGROUND: Few studies have explored characteristics among nurses who practice in military hospitals. There is reason to believe that differences exist between nurses who work in military and civilian hospitals, some of which are required educational level, leadership experience, officer status, and career development opportunities. METHODS: A descriptive design was used to address how military and civilian nurses who work in military hospitals describe their autonomy, control over practice, nurse-physician collaboration, and clinical expertise and what relationships exist among these variables. RESULTS: Scores on autonomy, control over practice, and nurse-physician relationships all were above midpoint for all respondents as a group, indicating positive work environments in both of the military hospitals studied. Scores from the clinical expertise instrument were well above midpoint, indicating a desirable level of clinical expertise. These findings all reflect favorably on the military hospital work environment. CONCLUSIONS/IMPLICATIONS: This information will help to make a case for instituting or preserving those nursing processes that are effective and for identifying and working to change nursing processes that are not effective. Nurses will benefit by having a more collaborative work environment.