Digital Commons Network^™

Experiencing Moral Uncertainty In Practice, Mary Ellen Wurzbach

General Submissions: Nursing as Profession

This study examined the experience of moral uncertainty in practice and its effect on the nurses who experience it. Humility is coming to an understanding of the complexity of ethical understanding. This means acknowledging that moral beliefs may exist that are equally fundamental and yet contradictory within a given situation. It also means recognizing and acknowledging moral uncertainty. Instead of pursuing a search for moral certainty, living with the ambiguities of the ethical life is not only suggested, but recommended. Although even statements of fact may be tentative, one can have sufficient knowledge to take moral action, subject to revision …

Moral Regret - The Experience Of Breaches Of A Nursing Ideal, Mary Ellen Wurzbach

General Submissions: Nursing as Profession

Recently, Johnstone and Hutchinson (2015) called for abandoning the construct of "moral distress". For various reasons, they believe that too much attention is paid to it in the nursing literature, that the studies are not sound and that calling for action to relieve moral distress may be a moral imposition in the lives of our patients, families and colleagues.

Treatment Trials - The Need For An End-Of-Life Policy, Mary Ellen Wurzbach

General Submissions: Nursing as Profession

Currently, there is an epidemic of elders in nursing homes with swallowing difficulties, Alzheimer's, and other maladies, which cause diminished decision-making capacity and initiate the discussion of whether to insert a gastrostomy tube. Furthermore, there is an overriding belief among health care practitioners that once inserted the tube will remain until the death of the resident.

The need for policy provisions related to treatment trials of gastrostomy tubes at the end-of-life is discussed. The arguments supporting and opposing treatment trials as applied to the individual and to the community are articulated and the benefits of such a policy discussed from …

Breaking The Cycle Of Bullying In Nursing: Emerging Themes, Debra J. Nogueras Conner, Deborah S. Adelman

General Submissions: Nursing as Profession

Bullying, horizontal, or lateral violence, and incivility are all terms that are used to describe aggressive behaviors seen in nursing practice between nurses. How and why these behaviors arise has been studied in recent years, but a focus on changing bullying and victim behaviors in prelicensure nursing students has been absent from the literature. The purpose of this pilot study was to examine the attitudes and reactions towards bullying behaviors observed in clinical rotations for BSN students and professional practice for MSN students. The study was conducted utilizing the Bullying in Nursing Education Questionnaire (Cooper et al., 2009) to study …

Nurse Job Satisfaction Research: A Literature Review, 2006-2011, John W. Nelson, Mary Ann Hozak, Alice Albu, Linda Thiel

General Submissions: Nursing as Profession

This literature review aims to evaluate the state of nurse job satisfaction research by identifying the instruments and scientific rigor used to measure the latent construct of nurse job satisfaction around the globe, during the years 2006-2011.

Incorporating Ecosystem Information Into The Federal Fisheries Management Process, Adelle Molina

Sustainability Seminar Series

The goal of fisheries management is to maintain sustainable fisheries and preserve their value. Fisheries management councils set fishing rules and regulations based on scientific advice in the form of a stock assessment. Stock assessments collect and analyze data, produce reports on the condition or status of an exploited stock, and estimate sustainable yield. Stock assessment scientists use analytical approaches and quantitative methods to develop stock assessment models that describe the population dynamics of a stock. Traditionally, stock assessments have not accounted for either ecological interactions, such as predation, or the environment. In this presentation, I will briefly describe the …

Unconventional Nursing: Exploring Non-Traditional Nursing Roles, Monica Jaramillo

General Submissions: Non-Traditional Settings and Methods

Besides the well-known traditional nursing career paths, such as the clinical and academic settings, there is a wide variety of non-traditional nursing roles worth exploring. This concise advocacy manuscript seeks to open dialogue and collaborations that inspire the creation of innovative pathways conducive to recruiting more individuals to this caring and empathetic profession within health care.

Energy Through Motion: An Evidence-Based Exercise, Katie Heuther, Linda Abbott, Laura Cullen, Liz Cullen, Ami Gaarde

General Submissions: Non-Traditional Settings and Methods

Cancer related fatigue (CRF) is a result of cancer and cancer treatment. CRF can be debilitating for patients during and after treatment. Evidence supports activity as effective for reducing cancer related fatigue. An innovative Energy Through Motion© program was develop to provide an evidence-based intervention to help patients experiencing CRF. This evidence-based practice change was effective and improved patient symptoms.

Clinical Practice In A Digital Health Environment, Registered Nurses' Association Of Ontario

General Submissions: Clinical Settings Materials

The purpose of this BPG is to foster nurses' ability to maintain, advance, and strengthen professional practice in the context of a digital health environment. Broadly, this guideline includes information related to: - The skills and competencies required by clinical nurses to ensure safe, quality, person-centred and compassionate clinical care through therapeutic relationships in a digital health environment - The skills and competencies required by nurses to engage in the design, development and evaluation of digital health environments - The skills and competencies required by nurse leaders and other leaders in all domains of clinical care, administration, education, research, and …

Intra-Professional Collaborative Practice Among Nurses, Registered Nurses' Association Of Ontario

General Submissions: Clinical Settings Materials

The purpose of this best practice guideline (BPG) is to strengthen collaborative practice among nurses, because effective collaborative practice is essential for working in health-care organizations.

In this guideline, there is a focus on collaborative practice amongst three types of nursing professionals:

• registered nurse (RN),
• registered practical nurse (RPN)
• nurse practitioner (NP)

The guideline explores what fosters healthy work environments for these groups of nurses (being aware that collaboration must align with the needs of the patient or client).

For more information including supplementary documentation and available translations, visit https://rnao.ca/bpg/guidelines/intra-professional-collaborative-practice-among-nurses

The Role Of The National Certification As A Mark Of Professionalism In Critical Care, Monica Jaramillo

General Submissions: Clinical Settings Materials

Professional certifications in health care represent a mark of professionalism, accountability, knowledge, and expertise. Lifelong learning is vital to ensure positive outcomes. This concept is especially true in critical care areas where the demands of caring for critically ill patients require advanced training. This manuscript is a call to action for acute care and all allied health professionals to engage in similar achievements to promote high-quality services and expand the body of knowledge of health care globally.

Developing And Sustaining Safe, Effective Staffing And Workload Practices (2nd Ed.), Registered Nurses' Association Of Ontario

General Submissions: Clinical Settings Materials

The purpose of this best practice guideline (BPG) is to inform staffing and workload recommendations that can be implemented to benefit patients, nurses and other health-care providers, and organizations, as well as research, education, health-care policy, and systems. The goal of this guideline is to assist nurses, nursing leaders, and senior management groups across practice domains and settings to create healthy work environments through safe, effective staffing and workload practices.

For more information including supplementary documents and available translations, visit https://rnao.ca/bpg/guidelines/developing-and-sustaining-effective-staffing-and-workload-practices

Utilizing An Individualized Music Playlist And A Receptive Music Approach To Reduce Agitation In Hospitalized Patients With Dementia As Evidenced By The Agitated Behavior Scale (Abs), Michelle W. Moreno Lee, Mary Harris

General Submissions: Clinical Settings Materials

The number of patients with Dementia (PwD) admitted to acute care hospitals is increasing worldwide. Prolonged hospital stays are associated with a deterioration in cognitive, functional, and physiological status (Mathews, Arnold, & Epperson, 2014). Dementia is a disease that causes cognitive deterioration leading to a decrease in the stress threshold, and a decreased ability to comprehend verbal language (Wall & Duffy, 2010).

Reducing Food Insecurity In Pediatric Patients And Families, Alexandra Yusah Cramer

General Submissions: Clinical Settings Materials

This pilot was designed to evaluate the feasibility of implementing food insecurity interventions on our pediatric general surgery and orthopedic inpatient unit.

Forest Bathing As A Self-Care Modality For Nurses, Nancyruth Leibold

General Submissions: Clinical Settings Materials

The self-care practice of forest bathing for nurses is the focus of this article. Self-care is the use of actions to promote one's well-being and is an essential aspect of being a nurse. The Japanese form of shinrin yoku is not a perfect translation to English as forest bathing. Forest bathing means walking or being in the woods. Included in this article is the self-care practice of forest bathing, evidence, and safety tips. Forest bathing is a healthy self-care activity. Health benefits based on evidence include an increase in killer T lymphocyte cells, lower cortisol levels, reduced blood pressure, lower …

The Jacki Jacket After Mastectomy With Reconstruction: A Randomized Pilot Study, Donna L. Berry, Traci Blonquist, Barbara Halpenny, Fangxin Hong, Samantha Morrison-Ma, Michele Mccullough, Katherine Carelli, Laura Dominici, Tari King

General Submissions: Clinical Settings Materials

Breast cancer patients undergoing mastectomy with reconstruction (TM+R) often experience post-operative discomfort from surgical drains. Despite a variety of garment options for use in the post-operative period, high quality data assessing the impact of specific garments on post-operative pain are lacking. We report results of a prospective randomized trial assessing the impact of the Jacki Jacket (JJ), a long-sleeve jacket with inner drain receptacle pockets, on post-discharge pain and quality of life (QOL) after TM+R.

Elnec Final Hours Of Life Supplemental Materials, End-Of-Life Nursing Education Consortium, Betty Rolling Ferrell

General Submissions: Clinical Settings Materials

Nurses new to caring for patients who are actively dying during the COVID-19 pandemic may need educational support to be aware of the signs and symptoms during final hours of life. Physical, psychological, social and spiritual symptoms and interventions are presented in this handout.

Ideal Nursing Workflows To Support The Development Of Information Technology Solutions, Jane Englebright

General Submissions: Clinical Settings Materials

An understanding of workflows is fundamental to designing information technology solutions to advance patient care, as these solutions must integrate into the workflow. As a precursor to developing a clinical documentation system, our large healthcare system undertook the task of defining important workflows. We began in 2007 with the formation of a Clinical Workflow Action Team to oversee the defining of workflows and the clinical processes and data flows that would support safe, effective and efficient patient care. The action team and various sub-teams invited clinicians from across the enterprise to discuss ideal workflows.

A Study To Analysis Barrier To Compliance Of Self Care Practice Among Patient With Diabetes In Selected Area Of Mumbai, Anisha Tony, Yojana Jadhav, Samrudhi Shinde, Rekha Kumbhar, Ankita Bhoir, Nirmal Chinvanle

General Submissions: Clinical Settings Materials

The objective of this study is to analyze self care practices among patients with Diabetes, identify its barriers to compliance and justify any association between barriers to compliance with their demographic components.

Preoperative Instructions, Health Literacy, And Medication Adherence, Lynette Khanna, Titilope Fajuyigbe

General Submissions: Clinical Settings Materials

The purpose of this pilot research study was to determine nurses' beliefs and practices in assessing health literacy and medication adherence in the ambulatory surgical setting.

Decreasing Primary Care Providers' Stigma Of Mental Illness, Nicole Hoogasian

General Submissions: Clinical Settings Materials

A recent study has indicated that primary care providers hold comparable and possibly more negative attitudes towards persons with mental illness than the general public (Mittal et al., 2016b). Because of their regular interactions with patients with mental illness, providers stigmatizing attitudes has been implicated as a primary factor behind healthcare disparities for this population (Flanagan et al., 2016; Lebowitz & Ahn, 2016). Effective interventions at decreasing mental health stigma needs to be researched, evaluated, and implemented in primary care settings (Beaulieu et al., 2017). An analysis of the literature was done to answer the question,"What interventions are effective in …

Ventilator Associated Pneumonia (Vap): Bundle Prevention Strategies In The Pediatric Intensive Care Unit, Raulin D. Feria

General Submissions: Clinical Settings Materials

Evidence-based protocols in the prevention of ventilator-associated pneumonia (VAP) in the intensive care setting have been well established in the adult population. Research studies using adult samples in intensive care have addressed the use of bundles, yet only a few have focused on children admitted to the pediatric intensive care unit (PICU). With issues concerning health care cost metrics and VAP being one of the hospital-acquired infections (HAI), preventative strategies must be equally placed for high-risk children and infants who are intubated and mechanically ventilated.

This paper aims to explore evidence on the use of VAP bundle in the PICU. …

The Role Of Fast Tracks On Length Of Stay In Emergency Departments, Brandon Watson, Konrad Borkowski, Jonathan Conca-Petit

General Submissions: Clinical Settings Materials

Overcrowding in emergency departments (EDs) is a national crisis affecting hospitals. It has led to an association with poor patient outcomes and is a threat to public safety. Fast tracks (FTs) in the ED are one strategy that has been implemented to alleviate overcrowding while still ensuring quality of care. To evaluate if FTs are effective, length of stay (LOS) was investigated relative to the implementation of FTs across a variety of hospitals. Nurses are an integral part of the triage, assessment, and care that are central to the system of FTs. This review provides an in-depth look at the …

Efficacy Of Aloe Vera Gel Topical Application On Radiation Induced Mucositis In Head And Neck Malignancy: A Double-Blind, Randomised Clinical Trial In Mumbai, India, Rita Lakhani, A. Y. Kshirsagar, Rupal Chedha

General Submissions: Clinical Settings Materials

One word that is even more daunting than the death itself and eats up a person from the inside is cancer. Head and neck malignancy (HNM) is a heterogeneous disease characterized by complex clinical and pathologic presentations. The treatment of HNM has undergone a gradual evolution over the past 3 decades, with an increased emphasis placed on organ preservation and multimodality management, including the use of radiotherapy (RT) and chemotherapy. RT approach, however, is associated with increasing rates of muco-toxicity that have been well documented in the context of numerous clinical trials in light of the radiation oncology literature and …

Barriers And Facilitators For Successful Integration Of Nurse Practitioners Into Interdisciplinary Care Teams, Laura Stankovic

General Submissions: Clinical Settings Materials

The purpose of this review is to explore the barriers and interventions for successful NP integration to healthcare teams. Research aims are to study the evidence related to autonomy, empowerment, and physician oversight on NP practice; role ambiguity and incivility in healthcare teams; and interventions at the educational and professional levels to promote successful integration.

An Exercise In The Provision Of Care For An Adult Patient Under Investigation (Pui) For Ebola: A Patient Care Drill, Justin Mast, Julie Poore, Evelyn Stephenson, Alisha Harter, Debra Fawcett, Claire Roembke, Vicki Harden, Mary Kay Foster, Shawn Gibbs, Amy Voris, Melissa Mcmasters

General Submissions: Clinical Settings Materials

In October of 2014 Indianapolis found itself, like many communities, preparing for the unknown realities of providing care to a Patient under Investigation (PUI) for Ebola Virus Disease (EVD). A group of clinical experts from local facilities gathered to discuss clinical management, guidelines, challenges, and opportunities. Trainings and exercises with local EMS agencies had already begun within the community. But more in depth hospital exercises had not yet been conducted. The clinicians recommended developing an exercise specific to patient care areas where a PUI would be taken care of.

70% Ethanol For Decontamination Of Central Venous Lines Exposed To Calcineurin Inhibitors, Jessica Ann Copacia, Kimberly Taylor, Melissa Laudick, Rolla Abu-Arja, Jeffery J. Auletta, Hemalatha G. Rangarajan, Amy Pyle-Eilola, Joseph Stanek, Vinta B. Pai, Rajinder Bajwa

General Submissions: Clinical Settings Materials

Tacrolimus, commonly used for GvHD prophylaxis is usually administered via a dedicated CVL and trough levels drawn from the unexposed lumen. Being an oil-based medication, it may be adsorbed to the inside lumen of the CVL and result in falsely high levels drawn from an inadvertently exposed lumen. There is no treatment for decontamination of such CVLs and natural decay occurs over months before the CVL can be used to draw reliable trough levels.

Assessment Of Risk For Osteoporosis, Raymol Abraham, Rita Lakhani

General Submissions: Clinical Settings Materials

Osteoporosis is a major global public health problem associated with significant morbidity, mortality, and socioeconomic burden. Osteoporosis is a silent disease, reflected only in a low bone density, till a fracture occurs. Much in the manner that asymptomatic conditions such as hypertension and dyslipidaemia predispose to stroke and myocardial infarction, respectively, a low bone density predisposes to osteoporotic fractures.

Process Improvement: Increasing Skin-To-Skin Contact During A Cesarean Birth, Dina Khentigan

General Submissions: Clinical Settings Materials

There are many documented benefits to breastfeeding not only for infants, but for mothers as well. The hospital where I'm employed, which had over 6,600 births last year, wanted to improve maternal/infant skin-to-skin contact rates because this has been shown to increase exclusive breastfeeding rates at discharge. In order to improve both rates, a work group of multidisciplinary healthcare workers was formed. Initially the work group met monthly and then weekly, to review audits, develop and implement education, and then to evaluate if the interventions were successful. Involving front-line personnel, such as healthcare providers, primary nurses, perioperative nurses, Certified Registered …

Breathing Techniques Associated With Improved Health Outcomes, Kathleen Benjamin Rickard, Dorothy J. Dunn, Virginia M. Brouch

General Submissions: Clinical Settings Materials

The purpose of this study was to determine if there is evidence to support teaching purposeful breathing techniques to patients for the improvement of health outcomes.