Archive for the ‘Nursing research’ Category

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Are Nurses Ready for Retirement? Apparently Not

January 5, 2015

By Shawn Kennedy, AJN editor-in-chief

Photo by Judy Schmidt/CDC

Photo by Judy Schmidt/CDC

If you ask many nurses in their sixties if they’re ready to retire, they may heartily say, “Yes, can’t wait.” But if the question is whether they are financially ready to retire, the answer may be quite different.

In their article in this month’s issue of AJN, “Preparing for Retirement in Uncertain Times” (free until the end of January), authors Shanna Keele and Patricia Alpert note that surveys reveal nurses to be unsure of how to begin preparing for retirement. A 2011 survey reported that “71% felt they were not saving enough for retirement”; another survey revealed that “59% of nurses do not know how to begin the retirement planning process” and most do not feel knowledgeable about investing and other related financial processes.

Keele and Alpert, who’ve conducted research around nurses’ readiness to retire, “explore the obstacles that nurses, especially female nurses, confront in planning and preparing for retirement. We outline steps nurses can take to begin the process; discuss various types of retirement accounts; and refer readers to helpful, free online resources.” There’s also a box that lists crucial steps to take if you’re getting a late start on retirement planning. Read the rest of this entry ?

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Nurses Reconsider Accepted Wisdom About Transfusion Catheter Size

December 17, 2014

By Betsy Todd, MPH, RN, CIC, AJN clinical editor.

Photo copyright Thinkstock.

Photo copyright Thinkstock.

Most of us have had the unhappy experience of replacing a patient’s perfectly good IV with a 19- or 20-gauge catheter in preparation for transfusion. The Question of Practice column in our December issue, “Changing Blood Transfusion Policy and Practice,” explores the rationale behind the long-time practice of using only large-bore catheters for blood transfusions.

After one patient’s particularly harrowing series of sticks to place a “large enough” catheter, a small team of oncology nurses asked themselves, “What evidence supports the use of a 20-gauge-or-larger catheter for blood transfusions?”

Most of these nurses had little experience with formal literature searches. Under the guidance of their clinical nurse specialist, they formulated a “PICOT” question (Population, Intervention, Comparison intervention, Outcome, and Time):

In adults receiving blood transfusions (P), what is the effect of using a smaller-than-20-gauge catheter (I) versus using a 20-gauge-or-larger catheter (C) on hemolysis or potassium level or both (O) within 24 hours of transfusion (T)? (Many of us were taught that a larger-bore catheter is necessary in order to prevent hemolysis during transfusion. Potassium is released when red blood cells rupture.)

The nurses set out to explore the literature and the guidelines of authoritative sources such as the Infusion Nurses Society. But they weren’t left to work on this question in their “spare time.” Their clinical nurse manager scheduled time off for the team’s work, set up meeting space, and even arranged for financial support for a poster presentation of their results. Read the rest of this entry ?

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‘Suppose a Client Went Out of His Room’: Study Explores RNs’ Use of Surveillance Technology in Residential Facilities

December 15, 2014

By Sylvia Foley, AJN senior editor

“If people are for instance walking around in the units, well, then they could do all sorts of things . . . ”—study participant

Table 2. Surveillance Devices and Their Use in the Selected Care Facilities

Table 2. Surveillance Devices and Their Use in the Selected Care Facilities

Surveillance technology in residential care facilities for people with dementia or intellectual disabilities has been touted both as a solution to understaffing and as a means to increasing clients’ autonomy. But it’s unclear whether surveillance technology delivers on its promises—and there are fears that its use could attenuate the care relationship. To explore how nurses and support staff actually use this technology, Alexander Niemeijer and colleagues decided to conduct a field study. They report on their findings in this month’s CE–Original Research feature, “The Use of Surveillance Technology in Residential Facilities for People with Dementia or Intellectual Disabilities.” Here’s a brief summary.

Methods: An ethnographic field study was carried out in two residential care facilities: a nursing home for people with dementia and a facility for people with intellectual disabilities. Data were collected through field observations and informal conversations as well as through formal interviews.
Results: Five overarching themes on the use of surveillance technology emerged from the data: continuing to do rounds, alarm fatigue, keeping clients in close proximity, locking the doors, and forgetting to take certain devices off. Despite the presence of surveillance technology, participants still continued their rounds. Alarm fatigue sometimes led participants to turn devices off. Though the technology allowed wandering clients to be tracked more easily, participants often preferred keeping clients nearby, and preferably behind locked doors at night. At times participants forgot to remove less visible devices (such as electronic bracelets) when the original reason for use expired.
Conclusions: A more nuanced view of the benefits and drawbacks of surveillance technology is called for. Study participants tended to incorporate surveillance technology into existing care routines and to do so with some reluctance and reservation. Client safety and physical proximity seemed to be dominant values, suggesting that the fear that surveillance technology will attenuate the care relationship is unfounded. A clear and well-formulated vision for the use of surveillance technology seems imperative to successful implementation.

Read the rest of this entry ?

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How Do RNs View Palliative Care for Hospitalized Older Adults? What a Study Reveals

November 17, 2014

By Sylvia Foley, AJN senior editor

“I think [palliative care is] also for that portion of the population that falls in the crack, in terms of, they’re not quite ready for the hospice thing but they’re not really ready for new aggressive chemo or anything else. … They’re in that vague no man’s land of where they fit in terms of services.”—study participant

Timely referral to palliative care could potentially benefit many seriously ill, hospitalized older adults. Such care not only offers relief from disease symptoms, but also helps patients and families to reach personal goals, reconcile conflicts, and extract meaning from their varied experiences. Yet those who might benefit are less likely to receive such care if their providers are unclear about the concept and how it differs from hospice care.

Table 5. Five Main Thematic Categories with Associated Subcategories

Table 5. Five Main Thematic Categories with Associated Subcategories

To learn more about how staff nurses understand and manage palliative care, nurse researcher Maureen O’Shea decided to conduct an exploratory study. She reports on the findings in this month’s CE–Original Research feature, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults.”

Here’s a quick overview. Read the rest of this entry ?

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Choosing Wisely: American Academy of Nursing Highlights Unnecessary Nursing Practices

October 24, 2014

The American Academy of Nursing (AAN) recently announced that it has joined the ABIM Choosing Wisely campaign with a list that focuses specifically on nursing interventions or practices that are not supported by evidence. The list is called Five Things Nurses and Patients Should Question. Here it is in short form—full explanations of the rationale for each item are available at the above link.

  1. Don’t automatically initiate continuous electronic fetal heart rate Screen Shot 2014-10-24 at 11.10.10 AMmonitoring during labor for women without risk factors; consider intermittent auscultation first.
  2. Don’t let older adults lay in bed or only get up to a chair during their hospital stay.
  3. Don’t use physical restraints with an older hospitalized patient.
  4. Don’t wake the patient for routine care unless the patient’s condition or care specifically requires it.
  5. Don’t place or maintain a urinary catheter in a patient unless there is a specific indication to do so.

The Choosing Wisely initiative encourages health care provider organizations to create their own lists of tests and procedures that may be overused, unsafe, or duplicated elsewhere. Using these lists, providers can initiate conversation with their patients to help them choose the most necessary and evidence-based care for their individual situations. The lists are not meant to be proscriptive, and also address situations where the procedures may be appropriate. Read the rest of this entry ?

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Planning Postdischarge Care with Cognitively Impaired Adults

October 15, 2014
McCauley

A patient performs the CLOX 1, a clock-drawing task used to assess patients for cognitive impairment. Photo by Ed Eckstein.

By Shawn Kennedy, AJN editor-in-chief

The transition from hospital to home can be fraught with pitfalls, especially if the patient in question is an older adult with multiple conditions and a not-so-prepared caregiver. The transitional care model, in which NPs coordinate care and provide follow-up care after discharge, has been shown to be successful in reducing hospital readmissions in this group of patients.

With Medicare levying penalties on hospitals with higher-than-average readmissions rates, the stakes aren’t just high for patients and their families. Might similar models of care also work with cognitively impaired adults?

In “Studying Nursing Interventions in Acutely Ill, Cognitively Impaired Older Adults,” a feature article in AJN‘s October issue (free until the end of October), Kathleen McCauley and colleagues from the University of Pennsylvania seek to answer this question, among others.

In the article, McCauley and colleagues describe the methodology and protocols used in their study, summarize their findings, and discuss some of the challenges in conducting research in the clinical setting. Among their findings is the important lesson that research involving cognitively impaired older adults must actively engage clinicians, patients, and family caregivers, as well as the need for hospitals to make cognitive screening of older adults who are hospitalized for an acute condition “a standard of care.” Read the rest of this entry ?

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AJN in October: Getting Inpatients Walking, Calciphylaxis, Nurses and Hurricane Sandy, More

September 30, 2014

AJN1014.Cover.OnlineAJN’s October issue is now available on our Web site. Here’s a selection of what not to miss.

Calciphylaxis is most often seen in patients with end-stage renal disease. “Calciphylaxis: An Unusual Case with an Unusual Outcome” describes the rare case of a patient diagnosed with calciphylaxis with normal renal function, and how the nursing staff helped develop and implement an intensive treatment plan that led to the patient’s full recovery. This CE feature offers 2.5 CE credits to those who take the test that follows the article. To further explore the topic, listen to a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

The adverse effects of bed rest. Prolonged periods of immobility can have adverse effects for patients, such as functional decline and increased risk of falls. “A Mobility Program for an Inpatient Acute Care Medical Unit” describes how an evidence-based quality improvement project devised for and put to use on a general medical unit helped mitigate the adverse effects of bed rest. This CE feature offers 2 CE credits to those who take the test that follows the article. Read the rest of this entry ?

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