Other Nursing Commons^™

Family Behaviors As Unchanging Obstacles In End-Of-Life Care: 16-Year Comparative Data, Renea L. Beckstrand, Jasmine B. Jenkins, Karlen E. Luthy, Janelle L. B. Macintosh

Faculty Publications

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined.

Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time.

Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999.

Results Of the 2000 questionnaires …

Measuring Learning And Engagement During Debriefing: A New Instrument, Shelly Jensen Reed

Faculty Publications

Background: Debriefing is considered to be where the bulk of learning takes place. Examination of debriefing is needed to help determine if facilitation methods effectively contribute to the learning process. More instruments are needed to evaluate all key debriefing elements, and no tools exist that evaluate participant engagement in the learning process.

Method: Kolb’s experiential learning theory was used to inform tool development. The focus of the new instrument is behaviors that indicate engagement with the learning process as the learner moves through Kolb’s learning cycle. A qualitative study of debriefing facilitators was performed, and a behaviorally anchored instrument was …

Hereditary Cancer Syndrome Recognition And Testing: Beyond Brca, Deborah O. Himes, Hanford B. Shuman

Faculty Publications

Hereditary cancer syndromes, resulting from mutations of tumor suppressor genes, can significantly increase the risk for breast cancer. Although hereditary breast and ovarian cancer syndrome caused by BRCA1/2mutations is well-known, less well-known hereditary cancer syndromes also exist. This article focuses on 3 other syndromes, including Li-Fraumeni, Cowden, and Peutz-Jeghers. This article will help prepare nurse practitioners to recognize key clinical features of these syndromes and understand testing criteria. Additionally, this article discusses barriers to diagnosing hereditary cancer syndromes and the role of primary care nurse practitioners in ordering genetic tests and making genetic referrals for optimal patient care.

Patient With Questions About Cancer Risk, Deborah O. Himes, Jennie Vagher

Faculty Publications

Primary care nurse practitioners routinely care for patients with personal or family histories of cancer. Approximately 5% to 10% of all cancers are related to hereditary cancer syndromes (HCSs), which cause an increased risk for developing more cancers and cancers at earlier ages than the general population. Nurse practitioners in primary care must become comfortable with identifying patients at risk for HCSs. Ordering genetic tests can be a challenge because the number of genetic tests available is growing at a rapid pace. This case highlights a woman who survived breast cancer at age 25 and basal cell carcinoma at age …

Academic Electronic Health Record Implementation: Tips For Success, Patricia K. Ravert, Kristen Whipple, Stacie Hunsaker

Faculty Publications

Many nursing programs use simulation experiences to augment or replace clinical experiences. Use of an electronic health record (EHR) in the educational setting extends the realism. A task force reviewed EHR programs, selected an EHR, and created an implementation plan with successful rollout over 2 years.

Disruptive Innovation: Impact For Practice, Policy, And Academia, Heather V. Nelson-Brantley, K. David Bailey, Joyce Batcheller, Laura Caramanica, Bret Lyman, Francine Snow

Faculty Publications

The 2019 Association for Leadership Science in Nursing International Conference, Disruptive Innovation, was held in Los Angeles, California, with attendees from 30 US States, Canada, Brazil, and China. Presenters discussed the need for nurse leaders to advocate for health equity, lead evidence-based innovation, how robots and other technology are generating disruptive innovations in healthcare, and building strong academic-practice partnerships to address nursing workforce challenges. This article will report on these important insights.

The Effect Of Dyad Rounding On Collaboration And Patient Experience, Amy Christensen, Korby Miller, Jason Neff, Rusty A. Moore, Sharee Hirschi, Katreena Collette Merrill

Faculty Publications

Communication among the healthcare team is essential to providing high-quality patient care. In the hospital, nurses care for multiple patients during their shift. Physicians or advanced practice clinicians (APCs) visit hospitalized patients daily to update orders, complete assessments, and contribute to care plans. One method to ensure that healthcare providers communicate effectively is interdisciplinary, or dyad, rounding in the hospital. This consists of purposeful rounding on each patient by the nurse and the physician or APC together to review the patient's status and update the care plan. When healthcare providers and nurses round together, it improves communication, patients are more …

Cryolipolysis: A Guide For Primary Care Practitioners, Miryam Harper, Jane H. Lassetter

Faculty Publications

A desire for the ideal body image has influenced the development of a nonsurgical body-shaping procedure known as cryolipolysis. The purpose of this clinical feature is to inform nurse practitioners about the risks and benefits of cryolipolysis so they can educate their patients. Cryolipolysis is a safe, effective method of reducing small areas of unwanted fat. Adverse effects are minimal and include pain, redness, bruising, and swelling. Results are seen within 12 weeks, but long-term effects are unknown. There are contraindications, and it is relatively expensive; however, it may be a safer option than invasive surgery.

Antimicrobial Stewardship: Staff Nurse Knowledge And Attitudes, Katreena Collette Merrill, Sandra Forsyth Hanson, Sharon Sumner, Todd Vento, John Veillette, Brandono Webb

Faculty Publications

Background: Registered nurses are uniquely qualified to augment antimicrobial stewardship (AS) processes. However, the role of nursing in AS needs further development. More information is needed regarding gaps in registered nurse knowledge, attitudes toward AS, and how infection preventionists can help.

Methods: An online descriptive survey was deployed to a convenience sample of approximately 2,000 nurses at the bedside. The survey included 15 questions addressing: (1) overall knowledge of AS; (2) antimicrobial delivery; (3) knowledge and attitudes regarding antimicrobial use; (4) antimicrobial resistance; and (5) antimicrobial resources and education.

Results: Three hundred sixteen staff nurses from 3 hospitals (15.8%) responded …

Educating Patients About Opioid Disposal: A Key Role For Perianesthesia Nurses, Katreena C. Merrill, Valynn Christina Haslam, Karlen E. (Beth) Luthy, Craig Nuttall

Faculty Publications

Purpose: To examine opioid prescription practices, patient use of opioids after laparoscopic cholecystectomy, and patient knowledge about disposal of unused medication.

Design: Mixed methods design with a chart review and structured phone interview.

Methods: Thirty-four patients were interviewed by phone and asked how many opioids were prescribed, how many excess pills they had 6 to 10 days postoperatively, and if they knew how to dispose of them.

Findings: Average number of excess pills ranged from 0 to 42 (mean = 14; SD = 11.7). Nearly half of patients (47%) perceived the prescribed quantity as “too many.” Seventy-one percent of patients …

Exercises For Older Adults With Knee And Hip Pain, Neil E. Peterson, Kay D. Osterloh, M. Nichole Graff

Faculty Publications

Half of all older adults report knee and/or hip pain. Obesity and sedentary lifestyle contribute to the incidence and prevalence of painful knee and hip conditions. Weight loss should be a priority in overweight or obese patients. Improving joint function over time requires a balance of rest and usage. Practitioners should assess joint disorders and recommend exercises for reducing knee and hip pain with patients when appropriate. Instruction should include a combination of 1) stretching and flexibility, 2) strength training, and 3) endurance conditioning exercises. Even small improvements in exercise can make meaningful improvements in pain, movement, endurance, and quality …

Forensic Nursing: Overview Of A Growing Profession, Julie L. Valentine

Faculty Publications

IN THE CURRENT ERA of the #MeToo movement and prominent sexual assault disclosures, these types of crimes are finally receiving the attention they deserve. Our society is acknowledging what research has been telling us for years about the high incidence of sexual violence in the United States. According to a recent Centers for Disease Control and Prevention (CDC) report, more than 36% of women have experienced contact sexual violence in their lifetime and 19% have experienced attempted or completed rape. Men also report high rates of sexual violence; more than 17% have experienced some form of contact sexual violence in …

Napnap Position Statement On Immunizations, Lacey Eden, Cheryl Cairns, Karlen E. (Beth) Luthy, Mary Koslap-Petraco

Faculty Publications

The National Association of Pediatric Nurse Practitioners (NAPNAP) supports the timely and complete immunization of all infants, children, adolescents, and adults in an attempt to maximize the health and wellbeing of all people. Routine childhood immunizations prevent as many as 3 million deaths per year. In addition, 1.5 million deaths per year could be avoided if global vaccination efforts continue to improve (World Health Organization, 2017).

Nicu Nurses' Suggestions For Improving End-Of-Life Care Obstacles, Renea L. Beckstrand, Rebecca F. Isaacson, Janelle L. B. Macintosh, Karlen E. Luthy, Lacey Eden

Faculty Publications

Background: Neonatal deaths (infants less than 28 days old) account for two thirds (66.7%) of all infant deaths with most occurring in an ICU setting. NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles.

Objective: The objective of this study was to obtain NICU nurses’ suggestions for improving obstacles in EOL care in NICUs.

Methods: Suggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions.

Results: A total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication between …

Emergency Nurses’ Department Design Recommendations For Improved End-Of-Life Care, Renea L. Beckstrand, Elise M. Corbett, Janelle L. B. Macintosh, Karlen E. (Beth) Luthy, Ryan J. Rasmussen

Faculty Publications

Introduction: Although death is common in emergency departments, there is limited research regarding ED design as an obstacle to end-of-life care. This study identifies emergency nurses’ recommendations regarding ways designs have negative or positive impact on care for dying patients and their families.

Methods: A 25-item questionnaire was sent to a national random sample of 500 emergency nurses. Inclusion criteria were nurses who could read English, worked in emergency departments, and had cared for at least 1 patient at the end of life (EOL). Responses were individually reviewed and coded.

Results: Major obstacles included (1) issues related to limited space, …

Effectiveness Of Integrative Restoration (Irest) Yoga Nidra On Mindfulness, Sleep, And Pain In Health Care Workers, Eva Livingston, Katreena Collette Merrill

Faculty Publications

This article examines the effectiveness of Integrative Restoration (iRest) Yoga Nidra meditation on mindfulness, sleep, and pain in health care workers. As health care workers provide emotional support to patients, it is not uncommon for workers to experience both physical and mental exhaustion. One holistic approach to support employees is mindfulness training. iRest Yoga Nidra is a complementary and integrative health therapy that increases mindfulness. A pre-/postinterveniton descriptive survey design was used. Before and after experiencing iRest meditation, participants completed a 51-item questionnaire consisting of demographics plus 3 validated instruments: the Five-Facet Mindfulness Questionnaire (FFMQ), the Epworth Sleepiness Scale (ESS), …

Effective International Medical Disaster Relief: A Qualitative Descriptive Study, Nicolette Broby, Jane H. Lassetter, Mary Williams, Blaine A. Winters

Faculty Publications

Purpose: The aim of this study was to assist organizations seeking to develop or improve their medical disaster relief effort by identifying fundamental elements and processes that permeate high-quality, international, medical disaster relief organizations and the teams they deploy.

Methods: A qualitative descriptive design was used. Data were gathered from interviews with key personnel at five international medical response organizations, as well as during field observations conducted at multiple sites in Jordan and Greece, including three refugee camps. Data were then reviewed by the research team and coded to identify patterns, categories, and themes.

Results: The results from this qualitative, …

Critical Care Nurses’ Qualitative Reports Of Experiences With Family Behaviors As Obstacles In End-Of-Life Care, Renea L. Beckstrand, Caitlin Mallory, Janelle L. B. Macintosh, Karlen E. Luthy

Faculty Publications

Background: Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care.

Objectives: We wanted to gather firsthand experiences of CCNs regarding working with families of dying patients. We then wanted to determine the predominant obstacle themes noted when CCNs …

Organizational Learning In A College Of Nursing: A Learning History, Bret Lyman, Lisa A. Cowan, Hannah C. Hoyt

Faculty Publications

Background: College of nursing leaders can foster organizational learning as a means of achieving their desired organizational outcomes. Organizational learning has not previously been studied in colleges of nursing, leaving college administrators and faculty little guidance as they strive to improve outcomes in their own colleges.

Objectives: The purpose of this study was to discover new insights related to organizational learning in a college of nursing.

Design: The learning history method was used to document and describe organizational learning in a college of nursing.

Setting: This study was conducted with a college of nursing situated in a private, religious-based university …

Antibiotic Stewardship: The Role Of Clinical Nurses And Nurse Educators, Sharon Sumner, Sandra Forsyth, Katreena Collette Merrill, Caroline Taylor, Todd Vento, John Veillette, Brandon Webb

Faculty Publications

Within 10 years of the breakthrough development of Penicillin, antibiotic resistance was reported. According to the Centers for Disease Control (CDC) and Prevention (CDC, 2017), each year 2 million cases of antibiotic resistant bacteria occur resulting in approximately 23,000 deaths in the United States. The World Health Organization (WHO) also reports that approximately 25,000 people die from antibiotic resistant organisms annually in the European Union (WHO, 2014). To combat these alarming trends, antibiotic stewardship (AS) programs have been strongly recommended by the WHO, the National Institute for Health and Care Excellence (NICE) Centers for Disease Control and Prevention (CDC), the …

A Whooping Cough Education Module For Wic Clients In Utah, Karlen E. Luthy, Alicia Anderson, Janelle L. B. Macintosh, Renea L. Beckstrand, Lacey M. Eden, Ryan Amy, Christopher I. Macintosh

Faculty Publications

Background: Clients in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are required to complete education modules quarterly to maintain eligibility. The purposes of this project were to: (1) create a whooping cough vaccination education module for WIC clients; (2) evaluate baseline perceptions of WIC clients on the whooping cough vaccine and disease; and (3) evaluate whooping cough knowledge following completion of the module. Problem: A decline in vaccination rates among infants and children using WIC services was reported by a local WIC program director who requested whooping cough vaccination education materials. This quality improvement project included …

Should Nurse Practitioners Be Required To Record Immunizations In Immunization Information Systems?, Donald Gardenier, Lacey Eden, Karlen E. (Beth) Luthy

Faculty Publications

The United States Centers for Disease Control and Prevention (CDC)’s Vaccines for Children (VFC) Program, which provides the majority of childhood immunizations, has been in existence for over 20 years. The CDC also created the Immunization Information Systems (IIS) program in which states were allocated funding to create statewide immunization databases. The goal was to maintain a reliable immunization tracking system to keep children on schedule and avoid unnecessary immunizations. In most states, however, only health care providers who are enrolled in the VFC Program are required to enter data into the IIS. Should all providers be required to enter …

Critical Care Nurses’ Suggestions To Improve End-Of-Life Care Obstacles: Minimal Change Over 17 Years, Renea L. Beckstrand, Kacie Hart Hadley, Karlen E. Luthy, Janelle L. B. Macintosh

Faculty Publications

Background: Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients.

Objectives: The purposes of this study were to collect CCNs’ current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998.

Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions …

Best Practice For Prevention Of Vaccination Common Problems With Antipyretic/Analgesic Medications, Lacey M. Eden, Meridith G. Lind, Karlen E. Luthy, Janelle L. B. Macintosh

Faculty Publications

Nurse practitioners are on the front lines providing parental education regarding vaccines. Some reasons for vaccine hesitancy include the potential common mild problems of vaccine administration, such as pain and/or elevated temperature. According to research, prophylactic administration of an antipyretic/analgesic medication, such as acetaminophen, reduces common mild problems related to vaccines when administered before or at the time of vaccination. Additionally, the evidence that prophylactic administration of antipyretic/analgesic medication decreases antibody response to vaccinations is insufficient at this time. However, this research has led to some confusion on best practice guidelines. This review of the literature resulted in recommendations that …

Identifying United States And Territory Education Requirements For Childhood Vaccination Exemptions, Lacey M. Eden, Emily G. Dunn, Karlen E. Luthy, Katelyn Wells, Janelle L. B. Macintosh, Renea Beckstrand

Faculty Publications

Background: : Children are required by law to receive vaccinations to enter school. States and territories offer exemptions for parents who refuse to vaccinate their children. Types of exemptions vary by state or territory, as does the exemption filing process. The purpose of this research was to identify the various education-related processes implemented by states and territories which allow parents to exempt children from vaccinations.

Methods: A questionnaire was distributed to immunization program managers in the 50 United States, District of Columbia, the United States Indian Health Service, and eight United States territories. Managers reported vaccination requirements for their jurisdiction …

Role Of The Endocannabinoid System And Medical Cannabis, Sabrina Jarvis, Sean Rassmussen, Blaine A. Winters

Faculty Publications

Our bodies produce complex substrates called endocannabinoids, which attach to the endocannabinoid system (ECS) receptors and impact many physiologic processes. Current research on the ECS and cannabis-based medications is accelerating in the presence of continued conflict between federal and state laws. In this article we present a summary of the latest information on the ECS, its receptors, and current research on the cannabis-based medicines and their potential to treat various disease pathologies and medical conditions. Our study includes the latest information on the continued legal ramifications nurse practitioners face in treating patients with these medications.

The Peanut Allergic Patient: Diagnosis, Treatment, And Prevention, Daniel W. Hill, Jane H. Lassetter, Craig Nuttall

Faculty Publications

The prevalence of peanut allergies (PAs) continues to rise through recent decades, despite the best attempts to reverse that trend. PAs are unpredictable and can be life-threatening. Therefore, it is imperative that nurse practitioners (NPs) are fully aware of the most recent guidelines and evidence regarding diagnosis, treatment, and prevention of PAs. This article presents information on the current research in the diagnosis and treatment of PAs as well as the latest guidelines established to prevent PA development. NPs should understand this information, allowing them to provide the best care possible for their patients.

Rural Emergency Nurses’ Suggestions For Improving End-Of-Life Care, Renea L. Beckstrand, Kelly E. Smith, Karlen E. (Bethy) Luthy, Janelle L. B. Macintosh

Faculty Publications

Introduction: Many patient visits to emergency departments result in the patient dying or being pronounced dead on arrival. The numbers of deaths in emergency departments are likely to increase as a significant portion of the U.S. population ages. Consequently, emergency nurses face many obstacles to providing quality end-of-life (EOL) care when death occurs. The purpose of this study was to identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments.

Methods: A 57-item questionnaire was sent to 53 rural hospitals in 4 states in the Intermountain West, plus Alaska. One item asked nurses to identify …

Global Immunizations: Health Promotion And Disease Prevention Worldwide, Janelle L. B. Macintosh, Lacey M. Eden, Karlen E. Luthy, Aimee E. Schouten

Faculty Publications

Background: Immunizations are one of the most important health interventions of the 20th century, yet people in many areas of the world do not receive adequate immunizations. Approximately 3 million people worldwide die every year from vaccine-preventable diseases; about half of these deaths are young children and infants. Global travel is more common; diseases that were once localized now can be found in communities around the world.

Problems: Multiple barriers to immunizations have been identified. Healthcare access, cost, and perceptions of safety and trust in healthcare are factors that have depressed global immunization rates.

Interventions: Several global organizations have focused …

Using Patient-Centered Care After A Prenatal Diagnosis Of Trisomy 18 Or Trisomy 13: A Review, Shelly Haug, Mitchell Goldstein, Denise Cummins, Elba Fayard, Allen Merritt

Faculty Publications

IMPORTANCE Patient-centered care (PCC) has been advocated by the Institute of Medicine to improve health care in the United States. Four concepts of PCC align with clinical ethics principles and are associated with enhanced patient/parent satisfaction. These concepts are dignity and respect, information sharing, participation, and collaboration. The objective of this article is to use the PCC approach as a framework for an extensive literature review evaluating the current status of counseling regarding prenatal diagnosis of trisomy 18 (T18) or trisomy 13 (T13) and to advocate PCC in the care of these infants.

OBSERVATIONS Extensive availability of prenatal screening and …