Implications For Nursing Practice Research Articles

Abdominal aortic aneurysm screening

An abdominal aortic aneurysm (AAA) rarely produces warning symptoms, and can be fatal if left untreated. Shelagh Murray gives an update on recent developments in screening and discusses the implications for practice nurses

Type 2 diabetes: the importance of managing weight

Weight management and weight maintenance cannot be overestimated in individuals with type 2 diabetes. Paul Pipe-Thomas and Catherine Storey consider the management implications for practice nurses

Comparison of professional values of Taiwanese and United States nursing students

Globalization is a part of modern life. Sharing a common set of professional nursing values is critical in this global environment. The purpose of this research was to examine the professional values of nursing students from two distinct cultural perspectives. Nurse educators in Taiwan partnered with nurse educators in the United States to compare professional values of their respective graduating nursing students. The American Nurses Association Code of Ethics served as the philosophical framework for this examination. The convenience sample comprised 94 Taiwanese students and 168 US students. Both groups reported high scores on an overall measure of values. They did differ substantially on the relative importance of individual items related to advocacy, competence, education, self-evaluation, professional advancement, and professional associations. Global implications for the collaborative practice of nurses from different cultures working together can be improved by first recognizing and then attending to these differences in value priorities.

QOF: new headlines, new rewards

With recent revisions to the Quality and Outcomes Framework (QOF), Gillian Champion looks at the changes and considers the implications for practice nurses' workload

Experiences, understandings and support needs of family carers of older patients with delirium: a descriptive mixed methods study in a hospital delirium unit

Delirium is common in older patients. Little is known of support needs of families of older hospital patients with delirium. To inform nursing practice, we sought to describe families' experiences, understanding of delirium and delirium care, and support needs. Descriptive mixed methods. Review of questionnaire items used with families of people with terminal delirium informed development of a new questionnaire to evaluate the support needs in our study population. In a tertiary hospital delirium unit, we recruited 17 family carers of older patients with (non-terminal) delirium to respond to this questionnaire. Twelve participants (11 female) also took part in interviews addressing the study's aims. Descriptive statistics were calculated and thematic analysis was undertaken. From the survey, key family issues included distress about the patient's condition, worries about future care, and a need for more information about how the patient might feel and how families could support the patient. Themes from interviews included The admission experience, Worries and concerns, Feeling supported, and The discharge experience. Limited understanding of delirium underpinned all themes. Families experienced shock and sadness at the change in the patient; they were reassured by the specialist care but needed more information about delirium, its effects and outcomes, and how they could help with care. Meeting long-term postdischarge needs was a key concern. In this study, families with a hospitalised older relative who had delirium described a distressing experience and needs for informational support. Further research is needed outside of delirium-specific units and in samples including a greater proportion of male relatives. Nurses should work within the interdisciplinary team to ensure a planned, sensitive and timely approach to informing the patient's family about delirium and its implications for their relative, recognising the family carer's role and likely distress.

Magnesium Sulfate During Anticipated Preterm Birth for Infant Neuroprotection

Advances in medical care of preterm infants, including the widespread use of surfactant and antenatal steroids, and improvements in ventilation management, have increased the survival rates of some of the most vulnerable infants. Yet, the risk of neurologic impairment and long‐term medical complications remains a concern. Recently, the use of magnesium sulfate during anticipated preterm birth has been identified as a potential treatment to reduce adverse neurologic outcomes among preterm infants. This article discusses the use of magnesium sulfate for anticipated preterm birth to reduce neurologic impairment in preterm infants, including current clinical practice guidelines and implications for nurses.

Call for Action: Caring for the United States' Aging Cancer Survivors

The United States is undergoing significant societal shifts that will have profound implications for the professional practice of oncology nurses, including the aging of the nation's baby boomers and an anticipated increase in cancer survivors. Understanding of the confluence of those factors and their impact on survivors' physical and psychological outcomes remains limited. Nurses may be aware of advances in general survivorship care but may not have the specific knowledge and skills to meet the distinctive needs of older adult cancer survivors. The authors call for a paradigm change in nursing practice, which will increase awareness across professional specialties that survivorship care for older adults is a professional obligation of all nurses.

Care and Companionship in an Isolating Environment

The purpose of this study was to examine the values, beliefs, and perceptions of end-of-life (EOL) care held by inmates caring for peers approaching the end of their lives. The study is part of a broader participatory action research project to infuse enhanced EOL care into state prisons. Face-to-face interviews using a semistructured discussion guide were conducted with 17 male prisoners who were providing care for peers with advanced chronic illness and approaching end of life. Qualitative data were analyzed using content and thematic analyses. Key themes were getting involved, living the role, and transforming self through caring for others. As well, contextual features at the organizational, peer, and personal levels were identified, which either facilitated or impeded inmate caregiving. Provision of enhanced EOL care by inmate peers shows promise for improving prison community relations and morale, reducing suffering, and demonstrating care and compassion within the harsh prison environment. This study provides clear evidence that providing compassionate care for dying peers may result in transformative experiences for inmate caregivers. Implications for correctional nursing practice include providing training for inmate caregivers, including them in team meetings, and implementing grief support programs. Also, upholding nursing's code of ethics and watching for predatory behavior are critical.

Living With Migraine Headache

This qualitative study explored the lived experience of women who had migraine headache. The guiding framework was phenomenological inquiry and story theory. The transcripts of audiotaped stories gathered from 8 women living with migraine headache were analyzed. Seven interrelated themes comprised the findings of the study. Implications for holistic nursing practice emphasizing assessment of lived time, lived body, lived space, and lived relations in the context of the findings of the study are discussed.

Bone micro‐environment in prostate cancer: impact, treatment and implications for nursing practice

Prostate cancer is a substantial worldwide health care challenge. The disease is associated with detrimental effects on bone remodelling, mediated by the RANK/RANK ligand (RANKL) system. Androgen deprivation therapy (ADT) causes an imbalance in regular bone turnover, resulting in bone loss [cancer‐treatment‐induced bone loss (CTIBL)]. As prostate cancer progresses, bone metastases may develop, leading to a vicious cycle of increased bone turnover and tumour growth. In both cases, patients have reduced quality of life and an increased risk of fracture. However, data show that subcutaneous denosumab, a human monoclonal antibody that targets RANKL, is superior to the intravenous bisphosphonate zoledronic acid in delaying the onset of skeletal‐related events (SREs) and has a favourable safety profile in terms of nephrotoxicity and acute‐phase reactions.Urology nurse practitioners, as members of multidisciplinary teams, have an important role to play in assessing and helping to manage patients with bone‐related disease in prostate cancer. In this review, an overview of prostate‐cancer‐related bone disease is provided. Currently available pharmacological interventions for the different stages of the disease are discussed, and implications for urological nursing practice are suggested.

“Aye, Aye Captain!” Implementing an Induction Initiative to Improve Safety and Outcomes

Childbearing Poster Presentation starting the intravenous line, and monitoring the fetal heart tones. The outcome of this project shows that the surgical site infection rate after cesarean dropped from 2.6% to 1.5% during the quarter in which the project was implemented. Because of the reduced infection rate, costs are reduced for patient readmissions to the hospital and repeat visits to a physician’s office for surgical site care. Implications for Nursing Practice Implications for nursing practice involve a onestep preoperational warming process that takes place during the preoperative period with a forced air warmer for scheduled cesareans. This practice takes place during the time the nurse is doing other tasks to prepare the patient for surgery. On admission to the PACU, fewer nursing interventions are required to treat hypothermia after the surgery.

A Postpartum Pertussis Vaccination Program: A Celebration of the Baystate Experience

Childbearing Poster Presentation starting the intravenous line, and monitoring the fetal heart tones. The outcome of this project shows that the surgical site infection rate after cesarean dropped from 2.6% to 1.5% during the quarter in which the project was implemented. Because of the reduced infection rate, costs are reduced for patient readmissions to the hospital and repeat visits to a physician’s office for surgical site care. Implications for Nursing Practice Implications for nursing practice involve a onestep preoperational warming process that takes place during the preoperative period with a forced air warmer for scheduled cesareans. This practice takes place during the time the nurse is doing other tasks to prepare the patient for surgery. On admission to the PACU, fewer nursing interventions are required to treat hypothermia after the surgery.

Accident Occurrence and Functional Health Patterns: A Pilot Study of Relationships in a Graduate Population

This pilot study sought to examine the relationship between functional health patterns and accident proneness. A quantitative-descriptive design was employed assessing accident proneness by collecting data on the occurrence of accidents among a sample of university graduates, and examining this in relation to biographical data and information collated using the Functional Health Pattern Assessment Screening Tool (FHPAST). Data were analyzed using descriptive and inferential statistics. One FHPAST factor predicted more frequent sports accidents. Age was also shown to be a significant predictor but in a counterintuitive way, with greater age predicting less accident proneness. The FHPAST may have a role to play in accident prediction. Functional health pattern assessment may be useful for predicting accidents.

Achieving safe staffing for older people in hospital

Hospitals provide care for older people who are the frailest, most acutely ill and have the most complex needs, yet older people's wards in many hospitals are poorly staffed. The Royal College of Nursing (2012) has published summary guidance and recommendations on safe staffing for older people's wards. The guidance and recommendations were developed as part of a project that explored staffing and factors underpinning good quality nursing care for older people in hospital. The full report of the project will be published later this year. This article presents further data from the project exploring the relationship between staffing levels and care delivery, as well as staff views on the adequacy of staffing and approaches to workforce planning at ward level. It also explores the practical implications for nurses working on older people's wards.

Cues for Nursing Diagnosis of Ineffective Self‐management of Fluid and Dietary Restrictions in Dialysis Therapy in Japan

We aimed to identify the cues of expert nurses and validate the cue information on the defining characteristics for a nursing diagnosis of ineffective self-management of fluid and dietary restrictions in dialysis therapy in Japan. We used qualitative interviews and two-round Delphi studies. The expert nurses regarded four signs of unmaintained fluid and dietary restrictions as major defining characteristics and nine other cues as minor defining characteristics. Expert nurses in dialysis therapy regard symptoms of health behavior as major cues for nursing diagnosis of ineffective self-management of fluid and dietary restrictions in dialysis therapy. Verification of the clinical validity and development of a specific, clinically useful database on nursing diagnoses are required.

Socio-demographics and health profile: Influence on self-care

Variability in the performance of self-care behaviours have been reported in the cardiovascular surgical population. Theoretical evidence suggest that demographic characteristics and health profile influence patients’ engagement in self-care behaviours. However, the influence of these variables on performance of self-care has not been examined. The purpose of this quantitative, non-experimental study was to determine how much variance in performance of self-care behaviours is accounted for by demographic characteristics, as well as the health profile of patients who underwent heart surgery. Data from a sample of 248 study participants, recruited from two cardiovascular surgical units, were collected. Descriptive statistics were used to characterize the sample on demographics and health profile, while multiple regression analysis was conducted to determine the relationship between variables. Findings suggest these factors have a minimal influence on self-care behaviour performance. Alternative factors influencing self-care behaviour performance were identified along with implications for future nursing practice.

RN Knowledge of Vascular Access Devices Management

PurposeTo explore the level of RNs knowledge of managing vascular access devices (VADs)- peripherally inserted central catheters (PICCs) and midline catheters, and to determine if nurse characteristics are associated with knowledge level. BackgroundEducation of nursing staff about VAD management can improve quality of care and assure standards of practice are maintained. Review of LiteratureMinimal research is available on nurses' knowledge of managing VAD catheters. MethodsNurses working on a colo-rectal unit who frequently manage VADs in a large tertiary-care medical center voluntarily completed one anonymous, validated, 10-item survey of VAD management themes. Analysis included descriptive and correlational statistics. ResultsOf 36 nurses, (97% female, 53% full time), mean VAD knowledge score was 8.1±1.4 (81% mean sum score). Perceived general level of comfort in flushing PICCs (r=.35, P=0.04), using Alteplase with PICCs (r=.36, P=0.03) and changing dressings (r=.38; P=0.03) were associated with higher knowledge scores. Of 10 items, 4 resulted in scores below 80%: how fast a Midline can be used after insertion, first step in managing a PICC upon admission, steps in dealing with a withdrawal occlusion, and steps post interventional radiology PICC insertion; however, nurse characteristics were not associated with scores above or below 80%. ConclusionsNurses working in the colo-rectal unit that frequently treat patients with VADs were generally knowledgeable about their management. Perceived nurse comfort in flushing a PICC, using Alteplase, and changing dressings were associated with higher knowledge. Implications for PracticeNurses' impressions of comfort with VAD management should be regularly assessed by nurse managers to assure optimal knowledge.

Sexually Transmitted Disease in a Female Young Adult

This case study demonstrates the sexual health challenges experienced by a woman newly married and recently migrated to the United States. Data were obtained through the author's clinical experiences in primary healthcare nursing and published sources. The nursing diagnoses, nursing interventions, and patient outcomes for this woman were identified using the classifications of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. This case study demonstrates the appropriate nursing diagnoses, interventions, and outcomes that are relevant for an individual with a sexually transmitted infection. It provides a framework for nurse practitioners in primary health care when caring for individuals with sexually transmitted infections. Based on the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification, and the Nursing Outcomes Classification provided the needed structure to improve the care of a woman with issues involving sexual health.

The ethical component of professional competence in nursing: An analysis

The purpose of this article is to initiate a philosophical discussion about the ethical component of professional competence in nursing from the perspective of Brazilian nurses. Specifically, this article discusses professional competence in nursing practice in the Brazilian health context, based on two different conceptual frameworks. The first framework is derived from the idealistic and traditional approach while the second views professional competence through the lens of historical and dialectical materialism theory. The philosophical analyses show that the idealistic view of professional competence differs greatly from practice. Combining nursing professional competence with philosophical perspectives becomes a challenge when ideals are opposed by the reality and implications of everyday nursing practice.

Determinants of Altered Life Perspectives Among Older-Adult Long-term Cancer Survivors

In the recent literature on cancer survivorship, positive changes are emphasized in the aftermath of trauma. However, there is insufficient research on older-adult survivors and more complex transformations. Consistent with nursing researchers' views about the duality of cancer survivor experiences, this research examined both positive and negative posttraumatic transformations (PTTs) among long-term survivors. Demographic, stress, and appraisal-related predictors of transformations were considered. Using cross-sectional survey design, interviews were conducted with 288 survivors of breast, colorectal, and prostate cancer. The sample, obtained from a hospital tumor registry, was 58% female, 33% African American, and 67% white (mean age, 72.5 [SD, 7.6] years). Demographic characteristics, cumulative stress exposure, appraisals of stress, and self-reported PTTs were measured. Most respondents reported diverse transformations attributed to their illness experience. Demographic characteristics and stress appraisals were more strongly associated with PTT outcomes than was cumulative stress exposure. Appraisals of the cancer experience as stressful, as generating worry, and as stigmatizing were significantly associated with diverse PTT outcomes. Many long-term older cancer survivors report PTT reflecting altered perspectives on life. Posttraumatic transformations are related to the view that cancer is a continuing worrisome and stigmatizing experience. Nurses have a unique opportunity to discuss with patients the potentially life-changing nature of the cancer experience in a manner that allows for understanding and acceptance of complex changes, incorporating benefit finding along with acknowledgement of loss and suffering. This type of discussion can enhance cancer survivors' mental health.