Archive for the ‘nursing research’ Category

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The Power of Imagination: Helping Kids with Sickle Cell Disease to Cope with Pain

April 2, 2014

By Sylvia Foley, AJN senior editor

Many people with sickle cell disease suffer from both acute and chronic pain, which can be severe. Although the exact mechanism isn’t known, the pain is believed to result when sickled erythrocytes occlude the vascular beds, causing tissue ischemia. Such pain, which often begins in early childhood, arises unpredictably. Although some pain crises may require ED visits, hos­pitalization, opioid treatment, or a combination of these, most are managed at home. Yet little is known about at-home pain management in people with sickle cell disease, especially children.

Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training

Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training

Cognitive behavioral therapy (CBT) has shown promise in helping patients with other chronic illnesses to cope with pain. Cassandra Elaine Dobson and Mary Woods Byrne decided to test guided imagery, a form of CBT, among children enrolled at one sickle cell treatment clinic in New York City. They report on their findings in this month’s original research CE, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease.” The abstract below offers a quick overview; if you click the image above, you’ll see an enlarged view of one table showing key results.

Objectives: The purposes of this study were to test the effects of guided imagery training on school-age children who had been diagnosed with sickle cell disease, and to describe changes in pain perception, analgesic use, self-efficacy, and imaging ability from the month before to the month after training.
Methods: A quasi-experimental interrupted time-series design was used with a purposive sample of 20 children ages six to 11 years enrolled from one sickle cell disease clinic, where they had been treated for at least one year. Children completed pain diaries daily for two months, and investigators measured baseline and end-of-treatment imaging ability and self-efficacy.
Results: After training in the use of guided imagery, participants reported significant increases in self-efficacy and reductions in pain intensity, and use of analgesics decreased as well.
Conclusions: Guided imagery is an effective technique for managing and limiting sickle cell disease–related pain in a pediatric population.

The technique was easily taught in training sessions lasting 15 to 45 minutes, with no child needing more than one session. The authors concluded that “the use of guided imagery in this population assumes that a child’s imagination has the potential to affect health, and our findings support that assumption.” Because this was a small study, they urged further large-scale clinical trials.

To learn more, read the article, which is free online. As always—and especially if you have experience caring for children with sickle cell disease—we welcome your comments.

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AJN’s April Issue: Sickle Cell Anemia, Telehealth, Systematic Reviews, FOAMed, More

March 28, 2014

AJN0414.Cover.OnlineAJN‘s April issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Coping with pain in sickle cell anemia. Our April cover features a painting of red flowers in a vase. But on closer inspection, you might notice that the flowers are actually red blood cells, painted by a young girl who suffers from sickle cell anemia. Afflicting about 90,000 to 100,000 people in the United States, sickle cell disease often causes acute and chronic pain syndromes described as being on par with cancer-related pain. Cognitive behavioral therapies, such as the use of guided imagery, have shown promise in changing pain perception and coping patterns in people with chronic illnesses. April’s original research CE article, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease,” suggests that this technique can be effective for managing pain in school-age children with the disease.

Implementing advances in telehealth. New technologies such as remote monitoring and videoconferencing often emerge before a facility is ready to efficiently integrate them. Sometimes referred to as disruptive innovations, these technologies, while convenient and easy to use, may not be readily accepted. “Telehealth: A Case Study in Disruptive Innovation” discusses the many applications of telehealth, a means of delivering care that is likely to be a part of every nurse’s skill set. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

New installment on systematic reviews. Last month, we debuted our new series from the Joanna Briggs Institute on the systematic review. This second installment, “Developing the Review Question and Inclusion Criteria,” provides an overview of the first steps taken when conducting such a review, starting with forming the perfect review question.

#FOAMed. The April iNurse column, “Have You FOAMed?” delves into the new and still evolving social media concept called FOAM, or Free Open Access Meducation. FOAM is an umbrella concept that refers to online media that students and professionals can use to educate themselves and to share and discuss new knowledge and ideas. It spans many social media platforms and is a fast, free way to keep up with the latest in medical knowledge. Read the rest of this entry ?

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Sexual Assault Survivors, SANEs, and the Nonreport Option

March 14, 2014

Figure 1. Process in the nonreport optionBy Sylvia Foley, AJN senior editor

Until recently, survivors of sexual assault had to make quick decisions about whether to report the assault to law enforcement. Those who chose not to report it weren’t entitled to a free medical forensic examination, and many felt further traumatized by this situation.

The Violence Against Women and Department of Justice Reauthorization Act of 2005 changed this. It added a “nonreport” option, which mandates that survivors be given medical forensic examinations even if they choose not to cooperate with law enforcement or the criminal justice system; states must pay for these medical examinations, regardless. In order to receive certain federal funds, states had to comply by 2009. States have responded in various ways. (Click the image above for an enlarged view of the steps followed in Texas.) But there has been little investigation into the impact of the new provision.

An important question. How has the nonreport option affected survivors, sexual assault nurse examiners (SANEs), and victim advocates? To learn more, Laurie Cook Heffron and colleagues conducted a study in Texas. They report on their findings in this month’s original research CE, “Giving Sexual Assault Survivors Time to Decide: An Exploration of the Use and Effects of the Nonreport Option.” The following abstract offers a quick overview. Read the rest of this entry ?

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Need Help Writing Systematic Reviews?

March 10, 2014

By Shawn Kennedy, AJN editor-in-chief

CaptureAs I explain in this month’s editorial, we’ve seen an increase in submissions, especially literature reviews, many from students in doctoral programs and from clinicians in organizations pursuing Magnet status. Many purport to be systematic reviews but lack many of the defining features, such as detail about search strategies or real synthesis of the results. This lack of knowledge around writing scholarly works reflects poorly on us as a profession.

We are very pleased to be collaborating with the Joanna Briggs Institute, the Australia-based group (they are at the University of Adelaide) with an expertise in appraising and synthesizing research and facilitating its dissemination and use. We launch a new series, Systematic Reviews, Step By Step, in the March issue. As our Evidence-Based Practice, Step-By-Step series does for applying evidence-based practice, this series presents a clear, progressive plan for writing a systematic review in several monthly installments. Read the rest of this entry ?

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AJN’s March Issue: New Series on Systematic Reviews, HIV Update, C. Diff on the Rise, Sexual Assault, More

February 28, 2014

AJN0314.Cover.OnlineAJN’s March issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Advances in HIV testing and treatment. The photo on our cover, showing members of  Sexy With A Goal (SWAG), a program provided for lesbian, gay, bisexual, and transgender individuals affected by HIV and AIDS by the AIDS Service Center of New York City’s Lower East Side Peer Outreach Center, reflects the changing face of the AIDs epidemic. Thirty years ago, a diagnosis of HIV was tantamount to a death sentence. But the young men on our cover prove that this is no longer the case. With advances in treatment and patient advocacy, education, and support, HIV is now a chronic, manageable disease. A CE feature, “Nursing in the Fourth Decade of the HIV Epidemic,” discusses HIV epidemiology and policy in the United States, the HIV care cascade, advances in HIV testing and treatment, and how nurses can continue to have a positive impact on the HIV epidemic.

If you’re reading AJN on your iPad, you can watch a video describing one author’s early experience with an HIV-infected patient by tapping on the podcast icon on the first page. The video is also available on our Web site. A

New option for victims of sexual assault. Until recently, survivors of sexual assault were not entitled to a free medical forensic examination unless they reported the assault to law enforcement. The authors of “Giving Sexual Assault Survivors Time to Decide: An Exploration of the Use and Effects of the Nonreport Option,” March’s original research CE, studied the implementation of the new nonreport option, exploring its impact on survivors, the criminal justice system, and sexual assault nurse examiners. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

New series on systematic reviews. Since the advent of evidence-based practice in health care, nurses and other clinicians have been expected to rely on research evidence to inform their decisions. But how does one uncover all the evidence relevant to a question? “Systematic Reviews, Step by Step: The Systematic Review: An Overview,” the first article in a new series from the Joanna Briggs Institute, provides a synopsis of the systematic review as a scientific exercise, and introduces nurses to the steps involved in conducting one. Read the rest of this entry ?

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Staffing and Long Shifts – Some Recent Coverage

February 24, 2014

By Shawn Kennedy, AJN editor-in-chief

by patchy patch, via flickr

by patchy patch, via flickr

The March issue will soon be published and be featured on the home page of our Web site, so before the February issue is relegated to the archive section, I want to highlight two articles. Knowing that some readers of this blog may not be regular readers of AJN (I know, hard to believe), I wanted to bring them to your attention.

I don’t usually blog about my own editorials, but the February editorial (“It All Comes Back to Staffing”) has apparently resonated with many readers. I’ve received several letters and a request to reprint it from a state nursing association. (The editorial includes a portion of a poignant letter I received from a reader in response to an editorial I’d written for the December 2013 issue, “Straight Talk About Nursing,” in which I discussed missed care—that is, the nursing care that we don’t get to but is often at the heart of individualizing care.)

The February editorial ties in with a special report, “Can a Nurse Be Worked to Death?”, by Roxanne Nelson, which addresses the recent death of a nurse who was killed in a car accident while driving home after a 12-hour shift. It’s a compelling report and I urge all nurses to read this piece and to think about what it says about long shifts. Read the rest of this entry ?

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A Physician Finally Gets Nursing

February 14, 2014

RelmanArticleCaptureBy Shawn Kennedy, editor-in-chief

Earlier this month, the New York Review of Books published an article by a patient who described his hospital stay following a life-threatening accident. This was no ordinary patient—the author, Arnold Relman, is a noted physician, emeritus professor of medicine at Harvard, a former editor of the New England Journal of Medicine, and along with his wife Marcia Angell, well known as a critic of the “medical–industrial complex.” His account is very detailed and gives a good example of how it can look when the system works (and when one has access to it).

His understanding of his condition and treatment, his knowledge of the system, and also his relative prominence as an individual, all undoubtedly helped him avoid some pitfalls and make a remarkable full recovery. However, as a number of others have pointed out recently, one comment in his account was surprising.

In reflecting on his hospitalization and recovery, he wrote, “I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.” After all his years in medicine, he only realized the value of nursing as a 90-year-old trauma patient.

This week, Lawrence Altman, another physician and author, wrote an excellent post for Well, the New York Times health care blog, examining why that might have happened. Altman, attributing a good part of physicians’ attitudes toward nurses (and other health care professionals) to how they have been educated, says that clinical medical education focuses on and values the interpretation of technology—the numbers as indicators of a patient’s progress, as in vital signs, monitor strips, ventilator settings, lab results, medication dosages. But personalized care is left to nurses, Altman argues, and physicians just don’t give it much attention.

Altman recognizes that nurses are sentinels, vigilant watchers who first note potential life-threatening problems, and he urges us to work toward a greater focus on interprofessional teamwork and education. I hope all who work in health care read his article, especially medical and hospital administrators.

While it’s always gratifying to hear that influential people support nursing’s value, the fact that Relman’s insight occurred so late in his life also makes me angry. How can a leading physician, an advocate for a better medical system, an educator of the next generation of physicians, go through most of his career and not realize nursing’s worth? One would hope that working alongside nurses during years of practice would have changed any misperceptions he might have had as a new physician. Read the rest of this entry ?

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AJN’s February Issue: New Nurses, Children’s Posttonsillectomy Pain, Medication Errors, More

January 31, 2014

AJN0214.Cover.Online

AJN’s February issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

With high hospital turnover rates, keeping newly licensed RNs (NLRNs) continues to be a priority for hospitals. This month’s original research article, “Changing Trends in Newly Licensed RNs,” found that new nurses considered themselves to have fewer job opportunities and to be less likely to work in hospitals and more likely to have a second job than new nurses who were surveyed six years earlier. Earn 2.5 CE credits by reading this article and taking the test that follows.

Tonsillectomy is effective at treating a variety of pediatric disorders, such as sleep apnea and frequent throat infection. But it often results in prolonged, moderate-to-severe pain. “Posttonsillectomy Pain in Children” reviews the causes of posttonsillectomy pain, the efficacy of various treatment interventions, and the recommendations for patient and family teaching regarding pain management. Earn 2.3 CE credits by reading this article and taking the test that follows. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

According to an Institute of Medicine report, at least 1.5 million preventable medication-related adverse events occur in the U.S every year. This month’s Cultivating Quality article, “The Sterile Cockpit: An Effective Approach to Reducing Medication Errors” (abstract only without a subscription or article purchase), describes how nurses on one hospital unit used a commercial aviation industry innovation in an attempt to reduce medication errors. Read the rest of this entry ?

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Workplace Discrimination: A Survey among Newly Arrived Foreign-Educated Nurses

January 27, 2014

By Sylvia Foley, AJN senior editor

Table 2. Outcome Metrics by Recruitment Model

Table 2. Outcome Metrics by Recruitment Model

This country has often relied on foreign-educated nurses (FENs) to ease nursing shortages—and  with more shortages predicted for as early as next year, it’s likely we’ll do so again. A positive workplace environment is a known predictor of staff retention; yet little is known about how FENs experience their jobs. To learn more, Patricia Pittman and colleagues surveyed more than 500 FENs. This month’s original research CE, “Perceptions of Employment-Based Discrimination Among Newly Arrived FENs,” reports on their findings. This abstract offers a brief overview.

Objective: To determine whether foreign-educated nurses (FENs) perceived they were treated equitably in the U.S. workplace during the last period of high international recruitment from 2003 to 2007.
Background: With experts predicting that isolated nursing shortages could return as soon as 2015, it is important to examine the lessons learned during the last period of high international recruitment in order to anticipate and address problems that may be endemic to such periods. In this baseline study, we asked FENs who were recruited to work in the United States between 2003 and 2007 about their hourly wages; clinical and cultural orientation to the United States; wages, benefits, and shift or unit assignments; and job satisfaction.
Methods. In 2008, we administered a survey to FENs who were issued VisaScreen certificates by the Commission on Graduates of Foreign Nursing Schools International between 2003 and 2007. We measured four outcomes of interest (hourly wages, job satisfaction, adequacy of orientation, and perceived discrimination) and conducted descriptive and regression analyses to determine if country of education and recruitment model were correlated with the outcomes.
Results: We found that 51% of respondents reported receiving insufficient orientation and 40% reported at least one discriminatory practice with regard to wages, benefits, or shift or unit assignments. Read the rest of this entry ?

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Chronic, Common, Hidden: Helping Patients With Urinary or Fecal Incontinence

January 13, 2014
Article illustration by Gingermoth. All rights reserved.

Article illustration by Gingermoth. All rights reserved.

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

Urinary and fecal incontinence are not the kinds of health topics widely discussed—people may compare notes about knee or hip replacements or their cholesterol levels, but you’ll find few people talking about leaking urine or feces. Even at medical and nursing conferences—unless one happens to be at a conference specifically dealing with those issues—you might be hard-pressed to find the topic on a program agenda.

But these are common problems—a 1995 report in the CDC’s MMWR estimated that 15%–30% of adults over age 60 suffer from urinary incontinence. (And that was 10 years ago. No doubt that number is higher by now, given the higher numbers of people who are over 60.) Fecal incontinence occurs in about one in 12 adults—in a 2009 report, that was 18 million people.

It’s the kind of problem that can drastically change the quality of life for those who have it, due to their fear of having an “accident” in public. Think about it: no extended excursions unless there are facilities all along the way (this can rule out many outdoor activities like golf, trips to the beach, or hiking); timed meals and beverages to reduce the chance of leaking, or even foregoing them altogether. It isolates people unnecessarily, and may contribute to further decline.

Our CE article this month, “Self-Management of Urinary and Fecal Incontinence,” examines self-management concepts and provides strategies to enable nurses to to help people self-manage their incontinence. Here’s the article overview:

Widely used by patients to control symptoms of chronic conditions such as diabetes, asthma, and arthritis, self-management can also help patients with urinary or fecal incontinence. The authors discuss the principles of self-management, the behaviors and skills self-managing patients need to acquire, and the nurse’s role in reinforcing their use. They then describe strategies that can be incorporated within the framework of self-management to control urinary, fecal, or dual incontinence. Read the rest of this entry ?

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