Archive for the ‘Nursing research’ Category

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AJN in February: Latino RNs in the U.S., Nurse Bullying, Hypoglycemia in Older Adults, More

January 29, 2016

AJN0216.Cover.Online

On this month’s cover, nurse Sarah Carruth comforts a young patient at Children’s National Medical Center in Washington, DC. This photo is the second-place winner of AJN’s 2015 Faces of Caring: Nurses at Work photo contest, in which readers worldwide submitted candid photos of nurses on the job.

When the child’s parents had to leave the room and he became unsettled, Carruth held him and comforted him with a stuffed toy. She says the photo captures the important type of quiet moment that often gets lost in the bustle: “It can be so busy that you forget about the times when you get to show that you care.”

Having worked as a pediatric nurse for 15 years, Carruth knows that meeting the emotional needs of children is a crucial aspect of caring for them. “It’s not just about giving medicine and assessing vital signs,” she says. “They need the time to be loved.”

Some articles of note in the February issue:

Original Research: Latino Nurses in the United States: An Overview of Three Decades (1980–2010).” Latinos are underrepresented in the nursing workforce. The authors of this article find that while the overall number of Latinos has grown dramatically in the U.S. over the 30-year study period, the number of Latino nurses has not. As the Latino population in the U.S. continues to increase, nursing education programs and institutions will need to do more to ensure that Latinos are adequately represented in the nursing workforce. To help achieve this, the authors make recommendations for increasing access to and improving nursing education for Latinos.

CE Feature: Hypoglycemia: A Serious Complication for the Older Adult with Diabetes.” Hypoglycemic events occur at an increased rate among older adults with diabetes. While hypoglycemia can often be easily treated, the physiologic, sensory, and cognitive changes of aging can inhibit the body’s warning symptoms of low blood glucose and impair the ability to recognize such symptoms when they occur. This article examines the risk factors, symptoms, and treatment of hypoglycemia in older adults with diabetes, and emphasizes the role of nurses in educating older patients in preventing hypoglycemic events and recognizing their warning signs.  Read the rest of this entry ?

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One Nursing Wish for the New Year

January 4, 2016

By Shawn Kennedy, AJN editor-in-chief

ShawnKennedyIf there’s one universal complaint by nurses, it’s that there aren’t enough of them on a shift to provide the care their patients need. We have a lot of data linking nurse staffing to patient outcomes and revealing the deleterious effects of missed care because of insufficient staffing. Yet, according to many hospital nurses I’ve spoken with, they still find themselves stretched to the breaking point by high patient acuity, rapid patient turnover, and increasing documentation requirements.

These nurses see no end in sight to this situation as hospitals argue that they have insufficient reimbursements and revenues to increase staffing. Ironically, as hospitals invest in pricey, cutting-edge new technologies that haven’t been shown to improve patient outcomes, the evidence about nurse staffing continues to be ignored.

In November, the ANA released a white paper, “Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes.” The paper summarizes and updates the research on staffing and outcomes, linking staffing to Medicare initiatives to reduce costs, adverse events, and readmissions. The report notes:

“Existing nurse staffing systems are often antiquated and inflexible. Greater benefit can be derived from staffing models that consider the number of nurses and/or the nurse-to-patient ratios and can be adjusted to account for unit and shift level factors. Factors that influence nurse staffing needs include: patient complexity, acuity, or stability; number of admissions, discharges, and transfers; professional nursing and other staff skill level and expertise; physical space and layout of the nursing unit; and availability of or proximity to technological support or other resources.”

The report offers some specific evidence-based examples and rationales for a variety of staffing models. It’s a good review and resource for nurses who are looking to support staffing increases.

However, for me, one model—incorporating internal “float” pools—is disheartening to see. While certainly more cost-effective than outside staffing agencies, and advantageous in that the nurses are already familiar with the hospital policies and systems, this model still hearkens back to the premise that nurses are interchangeable warm bodies.

Yes, there can be some matching of skill sets—but the bottom line is that the nurse is not familiar with the patients he/she will be assigned to care for that shift. CNOs want to keep staffing lean for budget reasons, and that’s understandable. But too lean means frequent use of floaters, which may mean patients see different nurses each shift. How does that leave time for developing a nurse–patient relationship or support patient-centered care?

Read the rest of this entry ?

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Attention to Patients’ Mobility: Low-Tech But Essential

December 7, 2015

A critical care nurse led a multidisciplinary team to explore the effects of a dedicated ‘mobility team’ on functional and other outcomes in ICU patients.

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

julie kertesz/ via flickr creative common

julie kertesz/ via flickr creative common

It’s long been known that immobility leads to deconditioning. Various studies indicate that muscle strength drops by 3% to 11% with each day of bed rest. As most of us have witnessed firsthand in both patients and family members, it can take months to regain pre–bed rest levels of functioning. For some people, the strength and mobility needed for independence never return.

In this month’s issue, a community hospital critical care nurse led a multidisciplinary team to explore the effects of a dedicated “mobility team” on functional and other outcomes in ICU patients. In “Implementation of an Early Mobility Program in an ICU,” Danielle Fraser and colleagues share what they learned.

The mobility team consisted of a physical therapist, a critical care RN, and an ICU rehab aide. Respiratory therapists worked closely with the team. Patients assigned to the early mobility intervention could progress through four successive levels of movement, from passive range-of-motion exercises to full ambulation.

Compared with ICU patients who received routine care, the patients in the intervention group were more functionally independent at discharge. In addition, this early mobility group also had fewer falls, ventilator-associated events, pressure ulcers, and CAUTIs. They experienced fewer episodes of delirium and lower levels of sedation, and their hospitals costs were lower. And there was a 30% reduction in ICU readmissions! Read the rest of this entry ?

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Message to Authors: Think. Check. Submit.

October 5, 2015

By Maureen Shawn Kennedy, AJN editor-in-chief

Think. Check. Submit.

The above three words sum up the message of a new campaign to increase awareness among researchers and authors about predatory publishers—entities that take advantage of authors by unscrupulous practices that often leave the authors tied up in a contract and owing a large fee to publish in a journal that has little or no standing. (See my related editorial on predatory publishing in the April issue of AJN.)

Promising rapid publication, predatory journals lack peer review and fact-checking, often tout fake metrics, and may adopt names that are deceptively similar to those of established journals. Jeffrey Beall, a librarian at the University of Colorado, has been tracking predatory publishers since 2009 and maintains a list of them on his Web site, Scholarly Open Access.

The Think. Check. Submit. campaign describes itself as an “industry-wide initiative that provides a checklist of quality indicators that can help researchers identify if a journal is a trustworthy.” It’s a new campaign “produced with the support of a coalition from across scholarly communications in response to discussions about deceptive publishing.” In brief, it asks authors to:

THINK about where they should publish their work. Are the journals they are considering reputable?

CHECK the list of questions designed to help determine if a journal is respectable and sound.

SUBMIT . . . only if most of the criteria on the checklist are met. Read the rest of this entry ?

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On Nursing Identity: What We Can Learn from African Nurses’ Oral Histories

August 17, 2015

 By Sylvia Foley, AJN senior editor

Port of Mauritius by Iqbal Osman, via Flickr

Port of Mauritius by Iqbal Osman, via Flickr

“I have chosen this profession and nobody can take it away from me.”—Sophie Makwangwala, study participant

In the summer of 2009, at the International Council of Nurses (ICN) Quadren­nial Congress in Durban, South Africa, a small group met to discuss collaborating on joint history projects. At that meeting, several African leaders of pro­fessional nursing associations reported that their expertise had long gone unrecognized. Seeking to have the stories of African nursing history told, they pro­posed interviews with other retired nurse leaders. Barbara Mann Wall, an American nurse researcher who was in the room that day, found herself intrigued.

The study. In keeping with Braun’s tenet that “indigenous research should be led, de­signed, controlled, and reported by indigenous peo­ple,” Wall first trained three of the African nurse leaders in the oral history method, aided by a grant from the University of Pennsylvania School of Nursing. Then the team embarked on the study reported on in this month’s original research CE, “ ‘I Am A Nurse’: Oral Histories of African Nurses.” Here’s an overview: Read the rest of this entry ?

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Editing a Journal: Not Bedside Nursing, But Still an Urgency to Get Things Right

August 14, 2015

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

‘Nurses practice based on what’s in the literature; we need editors who will draw lines and stand firm against publishing biased and inaccurate papers.’

Niklas Bildhauer/ Wikimedia Commons

Niklas Bildhauer/ Wikimedia Commons

I recently returned from a meeting in Las Vegas, the land of lights and bells and six-story marquees—and heat (it hit 109 when I was there, but “a dry heat”). The long flight home gave me time to reflect on the meeting I’d attended (of editors of nursing journals) and on what I do.

When I began my nursing career, I always thought I would stay in the acute care setting. I found the fast pace of the ER challenging and never boring. When I moved into a clinical specialist position and then an administrative one, I could still get involved in challenging situations, from dealing with problems that occurred on clinical units or with staff to navigating the politics of hospital committees and community liaisons.

But time passes and paths twist and turn, and here I am the editor of AJN—and it’s the most challenging and professionally fulfilling job I’ve had.

The International Academy of Nursing Editors (INANE for short) meets annually. It’s a loose networking group, mainly held together through a Web site, blog, and listserv. There are no officers or bylaws, no dues. Each year someone volunteers to host the annual meeting and whoever would like to help joins in. Anyone can propose a project, and those who want to work on it volunteer. We pass the hat to raise funds to support the Web site and incidental expenses and to help new editors attend the INANE meeting.

But don’t accuse this laid-back group of being inactive or frivolous—serious issues are tackled on an ongoing basis. True, they are not as exciting as the situations one might encounter in the clinical arena, but they have an effect on what many nurses do and think and implement in practice.

In Las Vegas, sessions focused on some important topics, including

  • the retraction of articles, i.e., when a publisher basically admits that an article is flawed and should not have been published.
  • the ethics of authorship and what to do when authors don’t want to disclose who actually wrote the paper, thus leaving room for conflicts of interest, bias, and skewed results and conclusions.
  • when and how much to fact-check authors’ references.
  • how to ensure students are getting the correct information about scholarly writing and publishing.
  • how to help new authors get their articles published.

Read the rest of this entry ?

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AJN in August: Oral Histories of African Nurses, Opioid Abuse, Misplaced Enteral Tubes, More

August 3, 2015

AJN0815.Cover.OnlineOn this month’s cover, a community nurse practices health education with residents of a small fishing village in rural Uganda. Former AJN clinical managing editor Karen Roush took the photo in a small community center made of dried mud bricks, wood, and straw.

According to Roush, nurses wrote the lessons out on poster-sized sheets of white paper and tacked them to the mud wall as they addressed topics like personal hygiene, sanitation, food safety, communication, and prevention of infectious diseases. The reality of nursing in Africa is explored this month in “‘I Am a Nurse’: Oral Histories of African Nurses,” original research that shares African nurse leaders’ stories so we may better understand nursing from their perspective.

Some other articles of note in the August issue:

CE feature: A major source of diverted opioid prescription medications is from friends and family members with legitimate prescriptions.  “Nurses’ Role in Preventing Prescription Opioid Diversion” describes three potential interventions in which nurses play a critical role to help prevent opioid diversion.

From our Safety Monitor column: More than 1.2 million enteral feeding tubes are placed annually in the United States. While the practice is usually safe, serious complications can occur. “Misplacements of Enteral Feeding Tubes Increase After Hospitals Switch Brands,” a report from the Pennsylvania Patient Safety Authority, reviews cases of misplaced tubes and offers guidance for how nurses can prevent such errors in their own practice.

Clinical feature: It is no surprise that physical activity comes with numerous physical and mental benefits, nor that a majority of Americans do not get enough exercise. “The Evolution of Physical Activity Promotion” updates nurses on physical activity guidelines and provides tips for encouraging patients to improve their physical activity. This feature also highlights the importance of decreasing one’s amount of sedentary and sitting time, even in physically active people. Read the rest of this entry ?

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