Implications For Nursing Practice Research Articles

Effectiveness of bedrails in preventing falls among hospitalized older adults: a systematic review.

Falls are a major problem today affecting adults of any age, but the elderly are a population that is more susceptible to falls. Falls are the leading cause of injury or death among older adults. Hospitalized older people are particularly vulnerable to falls. Falls cause direct injuries (minor injuries, severe wounds of the soft tissues and bone fractures) to patients and increased length of stay. The prevention of falls is commonly considered an indicator of the quality of care. Therefore, health institutions and professionals treat the identification and implementation of strategies to prevent or minimize their effects as a high priority. Fall prevention interventions involving physical restraints are still common and considered a primary preventative measure, despite controversy in their use. One of the most frequently used restraint interventions is bedrails. The question of the effectiveness of bedrails in preventing falls cuts across all societies and cultures and has with significant implications for the clinical practice of nurses. The objective of this review was to identify the effectiveness of the use of bedrails in preventing falls among hospitalized older adults when compared with no use of bedrails or any type of physical restraints. The current review considered studies that included hospitalized adults (female and male), 65 years and over with any clinical condition in a non-intensive care unit (ICU). The current review considered studies that evaluated the use of bedrails as a restraint to prevent falls among older adults in non-ICUs compared to no use of bedrails or any type of physical restraints, for example, bedrails versus no bedrails, and bedrails versus no wrist or ankle ties. The current review considered any randomized controlled trials (RCTs). In the absence of RCTs, other research designs such as non-RCTs, before and after studies, cohort studies, case-control studies, descriptive studies, case series/reports and expert-opinion were considered. The current review considered studies that included primary outcomes (number of patients who fell or the number of falls per patient) and secondary outcomes (number of head trauma, bone fractures or soft tissue injuries). The search strategy aimed to find both published and unpublished articles. A three-step search strategy was utilized in 13 databases. Articles published in Portuguese, English and Spanish beginning from 1980 were considered for inclusion. Assessment of methodological quality was not conducted as no articles were identified that met the inclusion criteria. Data extraction and synthesis was not performed, because no articles were included in this systematic review. The search identified a total of 875 potentially relevant articles. Sixteen articles were identified through the reference lists of all identified articles. One hundred and thirteen full-text papers were assessed by two independent reviewers to determine eligibility. However, 11 articles were not found (despite all the efforts), and 102 articles did not meet the inclusion criteria. There is no scientific evidence comparing the use of bedrails in preventing falls among hospitalized older adults to no use of bedrails or any type of physical restraints.

Home infusion teaching practices at federally funded hemophilia treatment centers in the United States of America

Unlabelled Box BackgroundHome management of hemophilia is standard of care in many countries. This study examined current nursing practices in teaching home infusion (HI) at hemophilia treatment centers (HTC) in the USA. ObjectivesThe aims were to identify and compare tools and resources used, areas of unmet needs, and to discuss implications for nurses in practice. MethodsAn anonymous electronic survey was distributed to 574 HTC nurses; 156 responses were analyzed. ResultsThe data demonstrated that nurses, more specifically nurse coordinators, were most responsible for teaching HI. However, many nurses lack the knowledge and confidence to do so: 23.0% responded feeling somewhat or not very confident with teaching. Of those 36.4% were staff nurses, 11.9% nurse coordinators, and 41.7% advanced practice registered nurses. The majority of nurses have worked more than 5 years as a nurse, with a mean length of time of 23.7 years (SD=11.12, range 3‐47) and a mean of 12.9 years (SD=10.29, range 1‐42) in a HTC. Thirty‐eight and a half percent of nurses have worked less than 5 years in a HTC. Most nurses appeared to follow the Infusion Nurses Society standards when performing venipunctures. Many centers reported using a formal tool or curriculum to teach HI. Nonetheless, these curricula are not uniform and their use is inconsistent between centers and regions. ConclusionThere are currently no national guidelines or standards to assist nurses in this task. The data confirmed the need to develop guidelines and a standardized curriculum to teach HI.

The Identity Threat of Weight Stigma in Adolescents

Obesity remains a serious public health issue in adolescents, who may be subjected to weight stigma leading to increased stress and poor health outcomes. Stigma can be detrimental to adolescents during self-identity formation. The purpose of this study was to examine weight stigma in adolescents in light of the Identity Threat Model of Stigma. A cross-sectional correlational design was used to examine the relationships among the variables of weight stigma, psychosocial stress, coping styles, disordered eating, and physical inactivity. Regression modeling and path analysis were used to analyze the data. Over 90% of the sample had scores indicating weight stigma or antifat bias. Avoidant coping style and psychosocial stress predicted disordered eating. The strongest path in the model was from avoidant coping to disordered eating. The Identity Threat Model of Stigma partially explained adolescents' weight stigma. Nursing practice implications are discussed.

Conscience, conscientious objection, and nursing: A concept analysis.

Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses' ethical care provision. Conscientious objection is one such strategy for addressing nurses' personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. To analyze the concepts of conscience and conscientious objection in the context of nurses. Concept analysis using the method by Walker and Avant. Data were retrieved from Philosopher's Index, PubMed, and CINAHL with no date restrictions. This analysis was carried out per established, scientific guidelines. Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.

A study exploring the protean responses of nurses transitioning to primary healthcare.

Background Healthcare systems are faced with changing community health profiles and ageing populations. Together with economic considerations, these factors have influenced the increase in provision of care in primary rather than other healthcare settings. Many nurses are electing to move from acute care to meet demands for a skilled primary healthcare workforce. However, little is reported about these nurses' experiences of transition. Aim To describe how role theory provides a theoretical framework to inform the design of a mixed-methods study exploring the transition of acute care nurses to roles in primary health care. Discussion The paper explores the relevance of role theory and its components as a validated framework for informing the design of the quantitative and qualitative components of the study. The methodology consisted of a national survey of recently transitioned nurses, with questions that explored experiences of nurses in relation to role exit, role entry, role enactment, role ambiguity, role stress, role strain and rites of passage. The qualitative component of the study incorporated semi-structured interviews with selected participants to further explore aspects of the transition. Conclusion There are few published reports on the value of theoretical frameworks in the design of nursing research. This paper describes one example of the value of selecting an appropriate theoretical framework for a national study of experiences of transition. Implications for practice Nurses transitioning between clinical settings experience a range of personal and professional challenges. Role theory provides a valuable framework which is applicable to qualitative and quantitative research into these experiences.

The Impact of Survivorship Care Planning on Patients, General Practitioners, and Hospital-Based Staff.

In 2005, the Institute of Medicine recommended that all cancer patients receive a survivorship care plan (SCP). Despite widespread support, few centers have routinely implemented them. Understanding of their impact is limited. The aims of this study were to examine the impact of SCP delivery on patients and healthcare professionals at an Australian comprehensive cancer center and determine enablers and barriers to implementation. Six groups were surveyed: (1) patients who had received SCPs; (2) nurse coordinators using SCPs, (3) general practitioners (primary care, GPs) of patients who had received SCPs, (4) clinical service chairs, (5) heads of allied health, and (6) nurse coordinators not using SCPs (nonengaged nurse coordinators). Groups 1 to 3 completed written questionnaires. Groups 4 to 6 participated in semistructured interviews. Fifty patients, 7 nurse coordinators, 18 GPs, 7 clinical service chairs, 4 heads of allied health, and 8 nonengaged nurse coordinators participated. Eighty-seven percent of patients considered the SCP to be very or somewhat useful; 50% felt it helped them understand their cancer experience. All engaged nurse coordinators reported SCPs to be very or somewhat useful, and 86% believed SCPs improved communication with GPs. General practitioners felt SCPs were very or somewhat useful (67%) and wished to receive SCPs for future patients (83%). Organizational and clinical leadership, multidisciplinary engagement, resourcing, and timing of SCP delivery were considered critical enablers. Patients and healthcare professionals support the use of SCPs; however, they are resource intensive and require significant organizational support. Nurses are instrumental to SCP implementation. Attention to enablers and barriers is important for successful implementation.

CE: Veteran Women: Mental Health-Related Consequences of Military Service.

: The last two decades have seen increasing numbers of women entering all branches of the U.S. armed forces. Now that women in the military are no longer prohibited from holding direct combat positions, they are often exposed to traumatic events that place them at higher risk for mental health conditions. Nurses working within the Veterans Affairs (VA) system and those working in non-VA settings are likely to encounter female veterans. It's essential for all nurses to be knowledgeable about the mental health issues commonly seen in this population, and to understand the importance of screening, not only for mental health issues but also for physical conditions that may be related to service.Numerous studies have focused on the mental health effects of deployment among military men, but very few have been conducted among military women. To learn more, the literature was searched for relevant articles published between January 2005 and December 2015. The research supports the contention that both active-duty and veteran women are at increased risk for postdeployment mental health problems, including posttraumatic stress disorder, military sexual trauma, and suicide. This article discusses the relevant research; identifies gaps in the literature; and addresses the nursing practice implications, including screening.

A path analysis of stress and premenstrual symptoms in Korean international and Korean domestic students.

To identify the relationships between perceived stress, acculturative stress and premenstrual symptoms, among other associated factors (e.g. depressive symptoms, coping self-efficacy, perceived social support) of premenstrual symptoms suggested in the literature by testing the conceptual framework of the 'Stress and Premenstrual Experience Model: Women in Cultural Transition'. Level of perceived stress has been cited as a major influencing factor for women's premenstrual symptoms; however, how these two elements are related, including possible mediators and moderators, remains unclear. A longitudinal causal-comparative web-based study design. Data collection occurred between November, 2014 - February, 2015. The convenience sampling method was used to recruit 98 Korean international students and 89 Korean domestic students. Weekly surveys were conducted for 10weeks to capture women's levels of perceived stress, acculturative stress and premenstrual symptoms from two menstrual cycles. The survey data collected during the premenstrual phase was analysed using path analyses. The hypothesized pathways based on the conceptual model were partially supported in the study. Depressive symptoms were a partial mediator between perceived stress and premenstrual symptoms and between acculturative stress and symptoms in Korean international students. The perceived social support was a moderator between perceived stress and premenstrual symptoms in Korean domestic students. This study proposes a revised conceptual model that will contribute to the understanding of stress and premenstrual symptom severity in women in the acculturation process and concludes with suggestions and implications for future nursing practice and research.

Nurses Teaching Prison Officers: A Workshop to Reduce the Stigmatization of Prison Inmates With Mental Illness.

This report describes and evaluates the effectiveness of a nurse-led workshop designed to improve correctional officers' stigmatizing attitude toward inmates with mental illness. Eighty-three prison officers attended a 6-day workshop targeting the cognitive, psychoeducational, and behavioral components of publicly expressed stigma, and combining theoretical learning, observational experience on psychiatric wards, frontal lectures, case reviews, discussions, peer supervision, and simulations. The workshop's impact was measured systematically using a structured self-administered questionnaire examining cognitive, affective, and behavioral components of stigmatization. The workshop significantly increased perceived knowledge and decreased stigmatizing attitudes. The evaluation presented here demonstrates a less-known aspect of the possible contribution of expert psychiatric nurses to mental health education in a wider context.

Blinatumomab: A New Treatment for Adults With Relapsed Acute Lymphocytic Leukemia.

Patients with acute lymphocytic leukemia (ALL) often experience relapse of their disease following standard treatment. Blinatumomab (Blincyto®) is a newly approved option for inducing remission in individuals with relapsed or refractory Philadelphia chromosome-negative B-cell ALL. This article provides an overview of blinatumomab, its benefits demonstrated in clinical trials, adverse effects, administration details, and the role of the oncology nurse in caring for and educating patients who receive blinatumomab. This article summarizes the results of two phase II studies on blinatumomab and provides practice implications for nurses caring for patients receiving this therapy. Attentive symptom monitoring and management are crucial. Individuals who achieve remission from blinatumomab can then be considered for stem cell transplantation and a chance for cure.

A Clinical Translation of the Article Titled "Evidence for the Implementation of the Early Start Denver Model for Young Children With Autism Spectrum Disorder".

The purpose of this article is to offer a clinical translation of a literature review titled "Evidence for the Implementation of the Early Start Denver Model for Young Children With Autism Spectrum Disorder" by Ryberg (2015). The literature review was conducted to determine the strength of the research evidence regarding the effectiveness of the Early Start Denver Model in improving cognitive, language, and behavioral functioning of children with autism spectrum disorder. In an effort to narrow the gap between evidence and practice, this clinical translation will discuss the components of the literature review in terms of its rationale for and objectives, methods, results, and implications for evidence-based nursing practice.

Exploring the compatibility of mental health nursing, recovery-focused practice and the welfare state.

Mental health nurses are expected to adhere to a range of professional values. The values of social integration that mental health nurses practise are somewhat at odds with the values of the British welfare state. Alternative systems of welfare support are demonstrated in other countries. Mental health nurses must consider models of practice, such as that described by Clifton et al. (2013b), to manage the disconnection between what is expected and what can be achieved. This discussion paper considers the implications for mental health nursing practice when working alongside individuals in receipt of state benefits. There is arguably a profound impact on an individual's recovery from mental ill health when that individual is also dependent on financial support from the government. Access to welfare benefits can have a significant impact on the recovery journey of that individual. This discussion paper will consider the practice implications for mental health nurses whose professional values include maxims such as 'challenging inequality' and 'respecting diversity', and will seek to examine the implications for practice when such values are divergent from those demonstrated in government policy. The paper will make comparisons with international welfare systems to demonstrate the way in which alternative configurations of state welfare can promote a system of social justice that is in greater equilibrium with the professional values of mental health nurses. Finally, the discussion will focus on the options for mental health nurses to either subscribe to government policy or to find compromise solutions that enable attention to remain focused and active on a strong value base of social justice and recovery-focused practice.

History, Policy and Nursing Practice Implications of the Plan B® Emergency Contraceptive

Numerous policy changes have expanded access to emergency contraception, such as Plan B®, in recent years. Plan B® is a progesterone‐based medication that prevents pregnancy from occurring up to 120 hours after unprotected intercourse by preventing ovulation and tubal transport. Increased access to Plan B® allows women to make independent decisions regarding reproductive health. Nurses play an important role in providing education as well as comprehensive, compassionate and holistic care.

Measles: A tale of birth cohorts and herd immunity

Sarah Lang reviews the effect of measles infection and the impact of measles vaccination since its introduction in the UK in 1988. She discusses the implications for practice nurses and requirements for practice

The impact and implications of undocumented immigration on individual and collective health in the United States

A nation of immigrants, the United States currently has more foreign-born residents than any other country; approximately 28% of these foreign-born residents are undocumented immigrants—individuals who either entered or are currently residing in the country without valid immigration or residency documents. The complex and constantly changing social, political, and economic context of undocumented migration has profound effects on individuals, families, and communities. The lack of demographic and epidemiologic data on undocumented immigrants is a major public health challenge. In this article, we identify multiple dimensions of vulnerability among undocumented persons; examine how undocumentedness impacts health and health care access and utilization; and consider the professional, practice, and policy issues and implications for nurses.

The time for practice nursing is now

Professor Lisa Bayliss-Pratt is co-chair of the Shape of Caring Review. Practice Nursing asked her about its implications for practice nurses

Ocular involvement in systemic lupus erythematosus: implications for ophthalmic nursing practice

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect any part of the body and lead to the development of sight-threatening eye complications. The ophthalmic nurse's role is important in the early identification and management of patients who present with ocular manifestations. After diagnosis, patient education and family involvement are both essential on an ongoing basis, and ophthalmic nurses play a vital role in this. This empowerment will help patients to selfcare and be in control of the disease. The care of patients who have developed eye complications can be very challenging, and patient care must be individualised as the symptoms and complications vary from patient to patient. This article discusses the epidemiology, pathogenesis, and ophthalmic complications of SLE, and the ophthalmic nurse's role in managing this condition.

Concept Analysis: Alzheimer's Caregiver Stress.

The aim of this article was to analyze the concept of caregiver stress in the context of caring for a person with Alzheimer's disease and related dementias. Currently, there are more than 15 million unpaid caregivers for persons suffering from Alzheimer's disease and related dementias. This unpaid care can be stressful for caregivers due to the chronic nature of the disease process, as well as other factors. The paper incorporates the modified method of Wilson's concept analysis procedure to analyze the concept of caregiver stress. A review of the literature was undertaken using the Cumulative Index to Nursing and Allied Health Literature, Google Scholar, and PubMed. A theoretical definition of caregiver stress is provided, and the defining attributes, related concepts, antecedents, and consequences of caregiver stress are proposed, and case studies are presented. The analysis demonstrates that caregiver stress is the unequal exchange of assistance among people who stand in close relationship to one another, which results in emotional and physical stress on the caregiver. Implications for future nursing research and practice conclude the paper.

Using Findings From the Human Rights Authority Reports to Inform Psychiatric Nursing Practice.

In Illinois, the Human Rights Authority (HRA) exists to conduct investigations of complaints of violations of the rights of persons with disabilities. The purpose of this study is to describe the findings from the HRA investigations and to determine significant implications for psychiatric nursing practice. A descriptive cross-sectional design was used, and the sample was composed of reports from the Illinois Guardianship & Advocacy Commission HRA (N = 129) for 2008. Allegations of restriction/notification of rights were significantly more likely to be substantiated than other allegation types. State hospitals were less likely to have allegations against them, whereas medical hospitals were less likely to have inadequate treatment allegations and more likely to have restriction/notification of rights allegations. The HRA findings will inform psychiatric nursing practice by expanding the nurses' knowledge of patient rights issues.

The approach to the elderly in the family health strategy and the implications for nursing practice

Objetivo: identificar as ações de cuidado do enfermeiro da APS em relação ao idoso. Método: pesquisa de campo, descritiva de abordagem qualitativa. Os sujeitos foram sete enfermeiros da APS. Os dados empíricos foram coletados mediante entrevistas semiestruturada e analisados na perspectiva da Análise Temática. A pesquisa foi aprovada pelo Comitê de Ética da universidade, CAEE 09233312.8.0000.5353. Resultados: a abordagem acontece por intermédio da participação dos idosos nos programas do Ministério da Saúde ou através da consulta de enfermagem, nenhum desses contemplando as particularidades existentes na velhice. A visita domiciliária não foi citada como instrumento de abordagem a esses sujeitos. Conclusões: as ações deveriam contemplar a longevidade e qualidade de vida de quem envelhece e sua família e, para isso, implica em uma otimização dos serviços de saúde e a reestruturação de programas de saúde. Descritores: Papel do profissional de enfermagem, Idoso, Atenção primária à saúde, Programa saúde da família.