Browsing by Sigma Chapters "Pi at-Large"
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- ItemActive Learning: A Concept Analysis(2018-03-14) Smith, Nicole Elena; Pi at-Large
Active learning has become a popular term in nursing education. However, there is no unified definition of the term within the discipline. Using the concept analysis technique delineated by Walker and Avant (2011), the author provides an operational definition of the term active learning for use in nursing education.
- ItemActivities of daily living in residents of nursing home and assisted living facilities: A multilevel analysis(2016-03-21) Liu, Wen; Unick, Jay; Resnick, Barbara; Galik, Elizabeth; Pi at-Large
Session presented on Saturday, November 7, 2015 and Sunday, November 8, 2015:
Background: The ability to perform activities of daily living (ADLs) is the most basic function for older adults living in long-term care (LTC). Various personal and institutional factors can be associated with functional performance in ADLs among LTC residents.
Purpose: The purposes of this study were to examine the trajectory of functional performance in ADLs over time, the variance in functional performance that is attributable to individual and institutional variations, as well as the impact of individual and institutional characteristics on functional performance among residents living in LTC settings.
Methods: This study was a secondary analysis of longitudinal data of 788 residents from 8 Nursing Home (NH) and 16 Assisted Living (AL) facilities from four cluster-randomized controlled trials. The independent variables included time nested within resident (level 1), resident characteristics including demographics, balance, cognition and length of stay in the long-term care setting (level 2), and facility characteristics including type of intervention and facility (level 3). The dependent variable was resident functional performance of ADLs (level 2) measured by Barthel Index. Covariates were determined based on prior research and bivariate analysis of the data. Multilevel modeling approach was used to distinguish resident and facility level variations on functional performance. Both Random Intercept (RI) and Random Coefficient models were examined, and model fit was compared using likelihood ratio difference. Inter-class correlation was reported to demonstrate the percentage of variance attributable to the resident and facility level variations, as well as the variance explained by covariates.
Results: The 3-level RI model with covariates was a better fit to the data. Functional performance of ADLs declined over time, decreased as residents' balance and cognition deteriorated and among those who lived longer in the long-term care facility. Functional performance of ADLs was higher among male, white and AL residents with higher education compared to their counterparts, while such difference decreased between male and female and increased between AL and NH residents over time. More than 78% of variance in function was accounted for by the resident (28%) and facility level (50.5%) variation, while the individual and institutional covariates captured around 20% of the variance, mostly from the facility level.
Discussion: This study provided preliminary information to support the effects of individual and institutional characteristics on functional performance among long-term care residents. Attentions that are paid to improve balance, alleviate progression of cognitive decline, and reduce the length of stay in NH settings may hold promise for maintaining or improving functional performance in ADLs.
- ItemAdult patients’ experience using patient portal: The impact of perceived usability on portal use behaviorSon, Hyojin; University of Maryland, Baltimore, Baltimore, Maryland, USA; Pi at-Large
Background: Patient portals (PPs) are a robust tool that can engage patients into their care. PPs can be especially helpful for older adults who have complex healthcare conditions. Usability of PPs is a major influencing factor for PP use. PP usability is more important for older adults who tend to be less familiar with technologies and may need additional support for using PPs. Currently, there has been a lack of studies that examined PP usability perceived by patients after PP implementation in healthcare settings.
Objectives: The primary aim of the study was to test a modified PP Acceptance Model that explains factors affecting patients’ PP use. The secondary aim was to compare the difference in PP usability, PP self-efficacy, and PP use between older adults recruited from community settings and older adults recruited from hospital settings.
Methods: To test the primary aim, an anonymous cross-sectional online survey was conducted with adult patients in an integrated healthcare system. Data from 743 patients who used PPs in the past 12 months were subject to structural equation modeling (SEM). For the secondary aim, a secondary data analysis was performed using descriptive statistics and content analysis (272 community-residing older adults). From this sample, those who used PPs (n=126) were compared with hospital/clinic-based older adults (n=174) by conducting regression analyses.
Results: Among 743, about two-thirds were White and female (mean age, 53.1; range, 18-92). Mean PP usability was 36.6 (range, 6-42). The SEM revealed that the final model fit the data: CFI=.983, RMSEA=.059. PP self-efficacy and privacy/security concerns had a direct impact on PP use. PP use was indirectly influenced by PP usefulness, PP ease of use, eHealth literacy, education, and age. The secondary data analysis indicated that older adults recognized PP benefits and were willing to use PPs. However, their PP use was limited due to several challenges. The relationship between PP usability and PP use was stronger in the community sample.
Conclusion: Findings suggest a strong potential for using PPs to engage patients in healthcare and strategies to improve patients’ PP use. Further studies need to include more diverse populations in various settings.
- ItemApplying Predictive Analytics at the Bedside to Reduce Mortality and Facilitate Transitions of CareSullivan, Christine A.; Marlett, Janice E.; Pi at-LargeRecognizing early changes in a patient's condition is essential to saving lives. This large urban facility successfully reduced mortality, increased situational awareness, and supported appropriate transitions of care. Utilizing a validated predictive analytics tool, nurses and providers identify patient decline earlier and intervene to reduce cardiac arrest outside the ICU.
- ItemThe Baltimore Buprenorphine Initiative: A comparison of treatment modalities for addressing heroin addiction in an urban-based community(2013-10-22) Murphy, Lyn Stankiewicz; Oros, Marla T.; Pi at-Large
Session presented on: Friday, July 26, 2013:
Purpose: Adequate drug treatment for substance users continues to be a challenge for most United States (US) cities. In order to address heroin addiction in Baltimore, the Baltimore Buprenorphine Initiative (BBI) was implemented as a joint project to promote individualized, patient-centered buprenorphine therapy in conjunction with behavioral treatment to accelerate recovery from opioid addiction.
Methods: The BBI sample consisted of 1,039 subjects treated with buprenorphine and counseling between January 1, 2008 and June 1, 2009. Demographic and outcome variables were evaluated against two comparison groups of 8,692 patients receiving methadone treatment and 6,664 patients receiving intensive outpatient or standard outpatient (IOP-OP) treatment. Analytical methods were utilized to assess each of the three treatment groups in order to measure the simultaneous impact of a set of variables on an individual's LOS.
Results: The BBI sample consisted of 1,039 subjects treated between January 1, 2008 and June 1, 2009. Using analysis of variance, statistically significant differences among the groups were identified in three areas: age, lapse of time until admission to treatment, and length of stay in treatment. Controlling for age, gender, education, race, income, and employment, the following independent variables were used to predict LOS: lapse of time to admission, ASI scores, number of addictions, frequency of addictions, and group membership (BBI, methadone, or IOP). Demographic characteristics accounted for 15.8 % of the variance (R2 = 0.158) with the overall model explaining 42.6% of the variance surrounding the dependent variable LOS (R2=0.426). The model was statistically significant (F=223.51, df 18, 5413, p<0.001).
Conclusion: The findings of this study have practical implications for the design and implementation of heroin addiction programs. The research indicates that focusing on these specific predictive variables early in the program design phase could increase recovery success rates as measured by length of stay.
- ItemBarriers to the implementation of mobility and upright positioning during the first stage of labor(2017-10-18) Bates, Keisha Nicole Shirlyn; University of Maryland, Baltimore, Baltimore, Maryland, USA; Pi at-Large
This review investigated barriers to the implementation of mobility and upright positioning during the first stage of labor. Barriers presented in recent literature centered around two themes: 1) medicalization of birth and 2) lack of education and professional consensus on the benefits of mobility during labor.
- ItemThe biopsychosocial model of metabolic syndrome among U.S. adultsSaylor, Jennifer L.; Friedmann, Erika; Beta Xi; Pi at-LargeBackground: The Metabolic Syndrome (MetS) is a cluster of medical disorders (obesity, hypertension, dyslipidemia, and insulin/resistance/glucose intolerance) that characteristically occur together in individuals. The prevalence of MetS continues to increase in the U.S. and increases the risk of type 2 diabetes, cardiovascular disease (CVD), and mortality. Little research uses a theoretical model to identify direct or indirect contributions to MetS and predictors to MetS. Identifying the factors that influence MetS in a national sample is necessary to understand targets for intervention to prevent the MetS and its sequelae. Purpose: This study tested a hypothesized conceptual model of the biopsychosocial factors associated with MetS in adults using a representative sample. Methods: A secondary data analysis was conducted using the National Health and Nutrition Examination Survey (NHANES) 2007-2008 data from non-pregnant participants who were 20-80 years old and completed the questionnaire and medical examination with fasting laboratory data. The sample of 2,583 adults represented 212 million non-institutionalized civilian Americans living in the U.S. Path analysis was conducted to test the biopsychosocial model of MetS. Complex samples logistic regression models (CSLR) were utilized to examine the direct and indirect contributions of biomedical (age), biosocial (gender, race, education, income, and marital status), and psychosocial factors (depressive symptoms, diet, physical activity, smoking status, and sleep) to MetS. Results: Of the study population, 29% met the criteria for MetS and 95% had at least one component of MetS. The hypothesized model fit the nationally representative data. The parsimonious model with age, gender, race, education, income, depressive symptoms, physical activity, smoking, and the interaction between age and physical activity explained 25.2% of the variance in the presence of MetS. Mediating effects among the biosocial and psychosocial factors help explain their relationship with MetS. Conclusion: The study supported the hypothesized model and the contributions of biopsychosocial factors to MetS. The study indicated that certain demographic groups were vulnerable to MetS. More studies are needed to examine factors associated with MetS than were from the hypothesized model. Prospective studies are needed to improve psychosocial status and to prevent/reverse MetS.
- ItemBullying and its prevention among a national sample of Israeli ICU nurses(2014-11-17) DeKeyser Ganz, Freda; Pi at-Large
Session presented on Friday, July 25, 2014:
Purpose: The purpose of this study was to describe the prevalence of bullying as well as what measures were taken to prevent it, as perceived by a national sample of Israeli ICU nurses. Background: 'Bullying refers to repeated, offensive, abusive, intimidating, or insulting behaviors; abuse of power; or unfair sanctions that make recipients feel humiliated, vulnerable, or threatened, thus creating stress and undermining their self-confidence (Embree, & White, 2010; Hutchinson, Wilkes, Jackson & Vickers, 2010; Murray, 2009; Rowell, 2005; Yildrim & Yildrim, 2007).' This phenomenon has been shown to be widespread within nursing in many different countries around the world (For example, Johnson & Rhea, 2009; RCN, 2002; Vessey, DeMarco, Gaffney & Budin, 2009; Yildrim & Yildrim, 2007). Bullying has been shown to have both physical and psychological consequences for the victim (Murray, 2009; Rowell, 2005; Katrini) and to affect patient care (Woelfle & McCaffrey, 2007), leading to decreased job satisfaction and increased burnout (Laschinger, Grau, Finegan & Wilk, 2010). 'There has been some literature that has described how to prevent bullying (Katrini, Atabay, Gunay & Cangarli, 2010).' These measures include increased awareness about the potential presence of bullying and the development of institutional protocols that call for the documentation of bulling with disciplinary action against it (Katrini, et al., 2010; Lewis, 2006; MacIntosh, 2006). At present there are no reports that describe the prevalence of bullying among nurses in Israel nor are there reports of what actions are taken to prevent its occurrence.' Furthermore, no study was found that investigated bullying only among critical care nurses, despite the fact that these units have been shown to have a high prevalence of bullying.'
Methods: This was a cross sectional, correlational, descriptive survey.
Sample: The sample was a convenience sample of 155 ICU nurses. Members of the Evidence Based Practice Subgroup of the Israeli Society of Cardiology and Critical Care Nursing recruited ICU nurses from five medical centers. As the primary purpose of the study was to describe the prevalence of bullying and its perceived prevention, it was determined that data collectors would try and recruit a maximum amount of respondents without concern for statistical power. Data collection: Data were collected after institutional and ethical approval at each institution. Head nurses were contacted and asked to approve participation of members of their units. A pilot test of the initial 25 respondents was conducted. Questionnaires were found to be clear and so the results of the pilot were included in the final results. Questionnaires were administered according to the preference of the local administration, either in staff meetings or participants were approached individually on their respective units. All responses were placed in an envelope at a central location and were anonymous.
Instruments: Three questionnaires were used: 'a. Demographic and work characteristics questionnaire, including personal demographic and work-related data. 'b. Negative Acts Questionnaire-Revised: a 22 item, Likert-style questionnaire developed by Einarsen, and colleagues in 1994 and revised in 2009 (Einarsen, Hoel & Notelaers, 2009) to measure the level of exposure to bullying in the workplace. It was found to have acceptable levels of reliability and validity. 'c. Bullying Prevention Questionnaire: developed by the investigators to determine measures currently available to prevent bullying.' This questionnaire contains 42 items on a 4 point Likert scale and lists measures conducted by institutions, units and individuals. The questionnaire is based on a review of the bullying literature and underwent content review.
Data Analysis: Descriptive statistics were conducted on all of the questionnaires. Bivariate analyses were conducted to determine if there are any demographic or work characteristic variables associated with bullying or perceived prevention. Those characteristics found to be significantly associated were used as predictor variables in a logistic regression model with bullying as the criterion variable.
Results: The sample consisted of 155 ICU nurses.'The majority of the sample was female (n=102, 69%), married (n=112, 77%) and Jewish (n = 96, 67%).'Most worked as staff nurses (n=111, 76%), had a baccalaureate nursing education (n=87, 60%) with post-basic ICU certification (n=122, 83%) with a mean age of 41.3 (SD= 9.9) and 11.5 years experience as an ICU nurse (SD=9.0).'Almost one third of the respondents (n= 43, 29%) reported being the victim of some bullying, although no one reported being bullied on a daily basis.'The mean total score on the NAQ-R was 33.3 (SD=11.6) with a mean item score of 1.6 (SD= 1.4) out of 5.'The mean Bullying Prevention total score was 96.8 (SD=14.4, range: 48-140, out of a possible 168) with an item mean score of 2.4 (out of 4) (SD= 0.3); Results for the subscale scores were: institutional prevention: item mean= 2.7 (SD= 0.5); unit prevention: item mean = 2.2 (SD=0.4) and individual prevention: item mean 2.4 (SD=0.3). A significant difference in the level of bullying was found between hospitals (F (4,155) = 2.7, p=.039). The mean scores on the Prevention Scale was found to differ between type of unit (F (5,143) = 3.4, p=.006) and hospital (F (4,155) = 2.9, p.026). However post-hoc Bonferroni analyses did not find significant differences between specific hospitals or units.'The Prevention Scale was found to significantly correlate with that of the NAQ-R (r= .58, p < .001). No other variables were found to be associated with either the bullying or prevention scores, therefore regression models were not created.
Conclusion: An alarming percentage of nurses were found to have been victims of bullying in their workplace.'The prevalence of bullying fell between levels presented in the literature (RCN, 2002; Johnson and Rhea, 2009; Yildrim & Yildrim, 2007).'This result is despite current policies of zero tolerance for bullying. On the other hand, those who reported being bullied, were not bullied on a daily basis and levels were low to moderate for specific bullying actions. The level of prevention was weak to moderate with little difference between measures taken by the individual, unit or institution. Prevention and perceived level of bullying significantly differed between hospitals and types of units while no other demographic or work characteristic was found to be associated. These results imply that bullying and its prevention happen for the most part at a unit and hospital level. Others have found some individual characteristics related to bullying but this finding was not seen in this study.
Implications: The results of this study suggest that on a policy and administrative basis, more measures must be taken and adhered to, related to prevention of bullying. Nurses must be educated to accept only a zero tolerance to bullying and to report bullying when confronted with it. More research should be conducted to determine what other factors are associated with bullying, and based on these results, to design interventional studies to prevent it.
- ItemChildhood obesity: Approaches to policy change to improve population health in Baltimore County Public SchoolsRaynor, Caroline; Western Governors University, Parkville, Maryland, USA; Pi at-Large
Childhood Obesity predisposes children to chronic diseases that reduce the quality of life, increase the cost of healthcare, and increase health disparities. This poster presentation illustrates two approaches to health policy advocacy to reduce childhood obesity and improve the population health in Baltimore County Public Schools (BCPS).
- ItemA comparison of intensive care versus oncology nurses' knowledge, attitudes and behaviors of palliative care(2016-07-13) DeKeyser Ganz, Freda; Andrews, Caryn; Pi at-Large
Session presented on Thursday, July 21 2016 and Friday, July 22 2016:
Purpose: Approximately 30-40% of the deaths in the US occur in the Intensive Care Unit (ICU) or after ICU discharge1. Most of these deaths did not occur suddenly but were the final result of a process of physiological decompensation towards end-of-life 2. Palliative care is a treatment approach whose goal is to improve quality of life and relieve the suffering of patients and their families, often at end-of-life. 3. Its adoption has been met with resistance in the ICU, often due to the underlying culture (save life at any cost) and a sense of failure when moving from curative treatments to palliative care 4. Oncology nurses are not necessarily more adept at providing palliative care services to patients with cancer. Recently the emphasis on including palliative care services within general oncology services has been suggested as part of National Cancer Center Network (NCCN) guidelines for supportive care 5,6. In these guidelines it has been suggested that palliative care be a part of all cancer treatment, on a trajectory from cure to end-of-life. Therefore the purpose of this study was to compare the knowledge, attitudes and behaviors of intensive care with oncology nurses related to palliative care.
Methods:
Design: Web based survey Sample: The sample was a convenience sample of 126 members of the Israel Association for Cardiology and Intensive Care Nurses and of the Israel Oncology Nursing Society.
Data collection: Data were collected after institutional and ethical approval. An on-line survey using MySurveyLab was sent to all of the members of the two nursing associations. Responses were returned to the authors without any identifying information. Instruments: The survey included a questionnaire based on that of Montagnini, Smith & Balistrieri 7, based on self- efficacy theory that measures nurses' self- perceptions of their knowledge, attitudes and behaviors related to palliative care. Knowledge is defined as the confidence that a respondent possess the information necessary to perform end-of-life palliative care practices such as symptom control or spiritual support 7. Attitude is defined as a personal evaluation of end-of-life palliative care practices such as feeling comfortable discussing advance care directives with patients and families 7. Behaviors are defined as the confidence to perform of end-of-life palliative care practices such as initiating advance care planning with patients and families7. Cronbach's alpha reliability for the questionnaire in the current study was .90. A demographic and work characteristics questionnaire was also included in the survey.
Analysis: Descriptive statistics (including frequencies, means and standard deviations, medians) were calculated for the entire questionnaire as well as for its sub-sections (knowledge, attitudes and behaviors). Differences between oncology and intensive care nurses were determined using Independent t tests.
Results: The sample consisted of 126 nurses, 79 oncology and 47 intensive care nurses. The majority of the sample was female (n= 115, 91%), married (n=99, 79%), and Jewish (n=111, 88%). Almost half worked as staff nurses (n=58, 46%) with post-basic certification (n=102, 81%) with a mean age of 48.6 years (SD=10.6) and 10.0 (SD=10.3) or 15.0 (SD=8.9) years of experience as an oncology or intensive care nurse, respectively. Mean total scores for the knowledge section of the questionnaire were 45.1 (SD=7.9) and 41.7 (SD=10.6) (out of a possible 60) for the oncology and intensive care nurses, respectively. Mean attitude scores for the oncology nurses was 19.6 (SD=4.3) and 19.1 (SD=5.0) for intensive care nurses (out of a possible 25). Mean behavior scores were 26.8 (SD=13.0) and 27.2 (SD=9.7) for oncology and intensive care nurses, respectively (out of a possible 55). No significant differences were found between oncology and intensive care nurses on any of the sections of the questionnaire.
Conclusion: The oncology and intensive care nurses in this sample showed moderate levels of self-perceived knowledge and attitudes towards palliative care however the level of their self-reported behaviors was low. While oncology nurses tended to score slightly higher than those from critical care, these differences were not found to be significant. Results from the original study of self-perceived knowledge, attitudes and behaviors of American ICU nurses, found higher scores on all of the subscales 7. Others 8 from China found that nurses from intensive care units scored higher compared to oncology nurses on a measure of knowledge and attitudes on comfort care. Nurses (including intensive care and oncology nurses) from southeast Iran also scored low on knowledge about palliative care 9. Therefore, culture seems to play a role in the self-perceived knowledge, attitudes and behaviors related to palliative care. Efforts should be made to educate all nurses, including those in oncology, about palliative care. Further research should be conducted related to how to better introduce and implement palliative care.
- ItemCritical care performance in a simulated military aircraft cabin environmentMcNeill, Margaret; Morton, Patricia Gonce; Pi at-Large
Since the start of Operation Enduring Freedom in 2001, over 42,063 patients have been transported by the United States Air Force aeromedical evacuation system. Critical Care Air Transport Teams (CCATTs) provide care for 5-10% of the injured and ill warriors that are transported on military cargo aircraft to definitive treatment facilities. The purposes of this study were to determine the effect of two stressors of flight, altitude-induced hypoxia and aircraft noise, and to examine the contributions of fatigue and clinical experience on cognitive and physiological performance of CCATT providers. This repeated measures 2 x 2 x 4 factorial study included a sample of 60 military nurses. The participants completed a simulated patient care scenario under aircraft cabin noise and altitude conditions. Cognitive performance was measured with Critical Care Scores, Critical Care Errors and Omissions, and Critical Care Reaction Times during the scenario. Physiological performance was measured four times during the scenario via vital signs and oxygen saturation. Differences in cognitive and physiological performance were analyzed using RM ANOVA. A multiple regression model was developed to determine the independent contribution of fatigue and clinical experience to cognitive and physiological performance as a function of altitude and noise. Critical Care Scores (p = .020) and Errors and Omissions (p = .047) were negatively impacted by aircraft cabin noise. Noise resulted in increase in respiratory rate (p = .019). Critical Care Scores (p < .001) and Errors and Omissions (p = .002) worsened with altitude. Heart rate (p < .001) and respiratory rate (p < .001) increased with altitude, and oxygen saturation (p < .001) decreased. A regression analysis of Critical Care Reaction Time to First Defibrillation with altitude, noise, fatigue, current critical care experience, and experience accounted for 20% of the variance in reaction time (p = .028). The care of critically ill patients is significantly affected by aircraft cabin noise and altitude. Noise and altitude largely act independently of each other. Safety and quality of care may be positively impacted with training and equipment better designed to assist in monitoring and assessment during aeromedical transport.
- ItemThe DAISY nurse-leader in compassionate bedside care: A collaborative model for membership in SigmaSweeney, Cynthia D.; Wiseman, Rebecca; Jacobs, Barbara; The DAISY Foundation, Anacortes, Washington, USA; Pi at-Large
Sigma recognizes community leaders who epitomizes the characteristics of Love, Honor and Courage. A collaboration between Pi Chapter and one healthcare organization became a model to recognize DAISY Award recipients as leaders at the bedside, create academic and clinical relationships as well as grow chapter membership.
- ItemDeployment-related needs of children of army reserve soldiers(2017-07-20) Wilmoth, Margaret C.; Rossiter, Alicia Gill; Boyd, A. Suzanne; Pi at-Large
Purpose: The spouse of a deployed Army Reservist said that her 5 year old was the only child in his kindergarten class whose daddy was in the military. He would sit in a corner and cry during school yet refuse to talk to his daddy on Skype. Concerned for her child’s health she reached out to the community for support and encountered many barriers. Not only did she have difficulty finding a child therapist to help her son, finding one with experience caring for the unique physical and psychological healthcare needs of military children was nonexistent. The school, while willing to help, lacked the knowledge and expertise to fully comprehend the impact of parental military service on children. Furthermore, the family did not live near an active duty military post, however even if they did, her spouse’s reservist status would significantly limit services available to her child.
This is just one story from thousands of stories on the effect of a parent’s deployment on Army Reserve children (ARC). Military children sacrifice when a parent volunteers to serve in the Armed Forces of the United States and face many of the same stressors as their Army Reserve (AR) parent—essentially military children serve too. Little is known about the impact of deployment on children of Army Reserve Soldiers. This project identifies gaps in the literature regarding deployment concerns of AR children and provides the first ever description of this population.
Methods: Systematic review of the literature on the physical and mental health needs of children of deployed Reserve Component (RC) Soldiers. Descriptive analysis of AR Child and Youth Services (CYS) Programmatic Needs Surveys utilized a convenience sample of parents attending a pre-deployment Yellow Ribbon Program.
Results: The systematic review of the literature is ongoing, but of the 10 studies reviewed to date, RC children comprised approximately 10% of the total sample and none had a sample limited to AR children. A convenience sample of 6,000 parents of children of AR Soldiers who completed the CYS Programmatic Needs Survey, with a majority of children in the age range of (4-16), noted that the greatest need of their child are school support services that include school transition, individual education plans, 504 accommodations, decline in grades due to deployment, and behavior concerns related to deployment. In addition, finding affordable and quality childcare within their local communities can be very challenging. This challenge is compounded if the child requires specialized childcare due to medical or behavior health requirements.
Conclusion: While military children as a whole are an understudied group, even less research is available regarding Army Reserve children specifically. Their needs differ from those of their active duty peers because of their geographic distribution, often making them the only military child in their school, church and other community organizations. Knowledge regarding these unique needs is critical to meeting the educational needs as well as the physical and psychological healthcare needs of this underserved population.
Army Reserve Component children face challenges that differ in many ways from their Active Component counterparts, such as reduced access to military-sensitive psychological support services, military-sensitive school support and peer group support for both parent and child/adolescent. Given the paucity of data on this population, no definitive conclusions can be drawn about the impact of deployment on their psychosocial development. More funding to support research in this population is essential.
- ItemDeveloping a culturally sensitive seminar assessing attitudes toward advance care planning in Chinese Americans(2013-12-19) Hinderer, Katherine A.; Lee, Mei Ching; Pi at-Large
Session presented on: Tuesday, November 19, 2013:
Purpose: Develop a culturally sensitive advance care planning (ACP) seminar for a community of Chinese Americans (CA). The aim of the study was to examine the relationship of a culturally sensitive ACP seminar and attitudes toward advance directives (AD) in CA. Background: Advance directives are documents that guide end-of-life (EOL) decisions when decision-making capacity is lost. Research about ADs is limited in minority populations. Chinese Americans represent the third largest immigrant group in the United States. Interventions to increase awareness and knowledge of ACP in CA are important in promoting quality EOL care.
Methods: A cross-sectional pre-test post-test design was used. Institutional review board approval was obtained. A convenience sample of community-dwelling CA was recruited. Using Five Wishes, an AD available in Chinese, a bilingual seminar with hands-on activities was conducted. The Advance Directive Attitude Survey (ADAS) was completed pre-and post-seminar. Descriptive analyses and t-tests were conducted using SPSS.
Results: Of the 72 participants, 44 (61.1%) were female, 45 (62.5%) were college educated, and 23 (31.9%) had a chronic disease. Participant age ranged from 32 to 87 (M= 60.91+12.31). Only one had been on life support and had made EOL decisions. Post-seminar ADAS scores were significantly higher (M= 52.05, SE=5.99) than pre-seminar (M=50.17, SE=4.28), t(62)= -3.159, p <.05, r= .37.
Conclusion: Positive attitudes toward ACP increase the likelihood of AD completion. We found community dwelling CA had a less positive attitude towards AD compared to the US inpatient population. The findings of this study have global implications that a culturally sensitive seminar improved the attitudes of ADs in minority ethnic groups. Chinese Americans in this study were open and eager to learn about ACP. Nurses can create culturally-sensitive educational programs to meet the needs of individuals within their communities and to promote the completion of AD and ACP.
- ItemDevelopment and evaluation of an adolescent and young adult healthcare transition program(2016-03-29) Phillips, Leslie A.; Children's National Hospital, Washington, DC, USA; Pi at-Large
Session presented on Saturday, April 9, 2016, and Friday, April 8, 2016:
The purpose of the practice improvement project is to develop an adolescent, young adult healthcare transition (AYAHT) program, develop training modules on the AYAHT program for clinic staff and conduct and evaluates the initial education on the AYAHT program for the clinic staff. The AYAHT program promotes transition for the AYA (14-21) with special healthcare needs followed in the outpatient pediatric rehabilitation department of a national pediatric health system. The significance and anticipated outcomes of this project are that AYA and their caregivers are provided a program to be implemented that fosters transition in a safe, effective, patient- centered efficient, timely and equitable manner.
- ItemEducational program for obstetric nurses: How to effectively screen for intimate partner violenceMasano, Nicole; Mercer University, Atlanta, Georgia, USA; Pi at-Large
Intimate partner violence (IPV) can have serious negative outcomes on a pregnancy. It is a topic on which nurses receive little training In order to improve screening, an educational program was developed and implemented to educate nurses on the proper methods for intimate partner violence screening in the obstetric setting.
- ItemEffectiveness of analgesics administered for lower extremity fracture pain during hospitalizationGriffioen, Mari A.; O'Toole, Robert; Ziegler, Melissa L.; Dorsey, Susan G.; Renn, Cynthia; University of Delaware, Newark, Delaware, USA; Pi at-Large
Participants will identify analgesics that resulted in the largest percent change in pain score in a cohort of patients with lower extremity fracture pain during hospitalization, treated in the emergency room and on the in-patient unit.
- Item[Excerpt and supplemental materials for] Johns Hopkins evidence-based practice for nurses and healthcare professionals (4th ed.)(Sigma Theta Tau International, 2021) Dang, Deborah; Dearholt, Sandra L.; Bissett, Kim; Whalen, Madeleine; Ascenzi, Judith; The Johns Hopkins Health System, Baltimore, Maryland, USA; Pi at-Large
This item record pertains to an excerpt from Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, which is provided free of charge by the publisher.
About this book: Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals has proven to be one of the most foundational books on EBP in nursing and healthcare. Building on the strength of previous versions, the fourth edition is fully revised to include updated content based on more than a decade of the model’s use, refinement in real-life settings, and feedback from nurses and other healthcare professionals around the world.
To purchase the entire book from the publisher click here.
To order additional books, buy in bulk, or order for corporate use, contact Sigma Marketplace at 888.654.4968 (US and Canada) or +1.317.634.8171 (outside US and Canada).
To request a review copy for course adoption, email solutions@sigmamarketplace.org or call 888.654.4968 (US and Canada) or +1.317.634.8171 (outside US and Canada).
To request author information, or for speaker or other media requests, contact Sigma Marketing at 888.634.7575 (US and Canada) or +1.317.634.8171 (outside US and Canada).
- Item[Excerpt and supplemental materials for] Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.)(Sigma Theta Tau International, 2018) Dang, Deborah; Dearholt, Sandra L.; The Johns Hopkins Hospital, Baltimore, Maryland, USA; Pi at-Large
This item record pertains to materials from Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition, which are provided free of charge by the publisher.
About this book: Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines has proven to be one of the most foundational books on EBP in nursing. This fully revised third edition builds on the strength of the first two editions with updated content based on more than a decade of the model's use and refinement in real-life settings. Authors Deborah Dang and Sandra L. Dearholt also incorporated feedback from nurses around the world.
To purchase the entire book from the publisher, click here.
To order additional books, buy in bulk, or order for corporate use, contact Sigma Marketplace at 888.654.4968 (US and Canada) or +1.317.634.8171 (outside US and Canada).
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- ItemExperiences of family members of dying patients receiving palliative sedation(2016-07-13) DeKeyser Ganz, Freda; Tursunov, Olga; Pi at-Large
Session presented on Sunday, July 24, 2016:
Purpose: The suffering of a dying patient sometimes includes 'refractory symptoms'. These symptoms are defined as severe symptoms, both physical and psychological, that cannot be treated for long periods, or their treatment leads to uncontrollable side effects 1, 2. Palliative care is meant to improve the quality of life of all patients and their families, including dying patients, and to relieve their suffering 3. The recommended treatment for a dying patient suffering from 'refractory symptoms' is palliative sedation 4. Family members remain with the patient in his last days, are involved and are influenced by medical treatment 5 and should understand the aim of medical care 3, 5. The suffering of the dying patient may cause distress to these family members 3, 5, 6. According to the principles of Family Centered Care, treatment for the dying patient and family members should take into consideration the physical and psycho-social state 3, 7 and provide emotional and physical support, medical advice and education both for the patient and relatives 3,6,7,8. It has been reported that the dying patient's family are often distressed and feel fear, helplessness, and exhaustion before the initiation of the sedation treatment 1, 5. These experiences can be the trigger to start palliative sedation in order to improve the patient's quality of life and to relieve the stress on family members who were watching the suffering of their loved one 9. On the other hand, it is postulated that family members may feel guilt and anxiety over making the decision to initiate palliative sedation, often thought to hasten death 6, 8. There have been few studies that have investigated the experiences of family members of terminal patients receiving palliative sedation and none were found that investigated these experiences over time. The purpose of this study was to describe the experience of family members of patients receiving palliative sedation at the initiation of treatment and after the patient has died and to compare these experiences over time.
Methods:
Design: Descriptive, comparative longitudinal study.
Sample: A convenience sample of 34 family members of dying patients receiving palliative sedation therapy on an Oncology ward in Israel were included in this study.
Data collection: After receiving approval from the Institutional Ethics Review Board, family members were requested to complete the study questionnaire and to agree to complete the same questionnaire again by telephone one to four months after the death of their loved one. Thirty eight family members were asked to participate in the study and 34 (89.5%) agreed. Of the 34 who agreed to fill out the first questionnaire (T1), 8 refused to answer the second data collection (T2) after the death of the patient (76.5% of the sample). Instruments: The study questionnaire was based on that of Morita et al. 10. The purpose of the original questionnaire was to describe the experiences of family members of patients receiving palliative sedation in Japan. The questionnaire consisted of four sections: a. demographic and background data of the family member study participant, b. demographic and background data related to the patient receiving the palliative sedation c. the participant's experience concerning the palliative sedation, d. experiences related to regret and satisfaction with the use of palliative sedation. Content validity of the questionnaire was checked by two experts in palliative care. Small changes were made to increase the questionnaire's sensitivity. Reliability was checked using Cronbach's Alpha with results for T1 =.87 and for T2 =.84. The test retest reliability for the fourth part of the questionnaire between T1 and T2 was found to be r=.70
Analysis: Descriptive statistics were used to describe the sample and results of the questionnaire. Differences between T1 and T2 were determined using the McNemar test for a dichotomous variable, the Marginal Homogeneity test for a nominal variable, the Wilcoxon Signed Ranks test for an ordinal variable and the Paired Samples T-test for continuous variables. Results: The average age of family member participants was 50.9 years (range 19-77; SD=15.4). Most participants were children or spouses of the patient. The average patient age was 62.27 years (range 21-89; SD=15.54), and almost all were Oncology patients excluding one with Leukemia. Most of patients were suffering from agitation, pain and dyspnea. Most relatives felt that their loved ones were in distress or great distress before starting palliative sedation (T1:91%; n=31, T2: 92%; n=24). The vast majority of participants were either satisfied or very satisfied with the medical care and with the use of sedation medication. At T1 the vast majority reported that the beginning of the sedation was properly timed (77%; n=26,) but at T2 this fell to 62% (n=16). Explanations about palliative sedation usually included the purpose of the sedation (T1: 88%, n=30; T2: 92%, n=24). However, occasionally this explanation did not adequately address the impact of the treatment on the patient's ability to communicate (T1: 29%, n=10; 23%, n=6), the patient's prognosis (T1: 38%, n=13; T2: 15%, n=4), nor its physical effect on the patient (T1: 38%, n=13, T2: 15%, n=4). In more than two thirds of the cases, the family perceived that the patient did not receive an explanation of the treatment (T1: 67.6% n=23; T2: 65.4% n=17). Most family members were not informed of this treatment option before the patient's status deteriorated and received an explanation of palliative sedation only on the same day that the decision to initiate treatment was made (T1: n=25, 73.5%; T2: n=19, 73.1%). Almost all of the participants (T1:100%; T2: 88%) felt that palliative sedation was an ethical way to decrease suffering and the vast majority felt that it was very important that the patient did not suffer any longer (T1: 88% n=30, T2: 92% n=24). Almost one third thought that the treatment shortened the patient's life (T1: 32% n=11; T2: 27% n=7) and a smaller proportion feared that it killed the patient (T1: 15% n=5; T2: 19% n=5). No significant differences were found between T1 and T2.
Conclusion: The primary purpose of palliative sedation is to relieve the suffering of the dying patient. This was achieved according to the participants of this study. Family members were involved in making the decision to initiate palliative sedation but were often burdened by the consequences of their choice. Communication was not as effective as it could have been. Family members reported that patients often did not receive an adequate explanation, particularly regarding the consequences of sedation. Further evidence of poor communication was not being prepared for the sudden change in the patient's condition and decreased ability to communicate. This is partially explained by the large percentage of participants who first discussed the use of palliative sedation on the same day it was initiated and that many had not heard of the use of palliative sedation at all before that time. It would seem that the explanation process might need more time. One of the more important ethical questions related to palliative sedation is whether the treatment may shorten the patient's life. Some participants agreed but fewer felt that the patient died because of sedation. However, most felt that there were no other means to relieve such suffering and most family members reported that they did not have legal or ethical concerns about the use of sedation. Over time suspicions associated with the legal aspects of the therapy remained stable. Therefore, it would seem that the majority of participants in this study were not conflicted on an ethical level about their decision to administer palliative sedation.
Summary: Most of the families were satisfied with the use of palliative sedation, the relief of suffering, and the support given by staff during the initiation of treatment and 1-4 months later. The results highlight the importance of communication between caregivers and family members, and the importance of providing timely and repeated explanations of palliative sedation. In addition, treatment should be started early enough to avoid unnecessary suffering of the patient and his family. Despite some fear of shortening the patient's life by use of sedation, all participants agreed that this is an ethical way to ease the suffering of the dying patient. More research, including qualitative and interventional studies, is needed to investigate this subject.