AJN in July: Opioids and Chronic Pain, Moral Distress, Prediabetes, More

CE Feature: Appropriate Use of Opioids in Managing Chronic Pain.”

Unintentional death related to prescription opioids has been identified as a public health crisis, owing in part to such factors as insufficient professional training and medication overprescription, misuse, and diversion. The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal.

CE Feature: “Moral Distress: A Catalyst in Building Moral Resilience.”

Moral distress is a pervasive problem in nursing: an inability to act in alignment with one’s moral values is detrimental not only to the nurse’s well-being but also to patient care and clinical practice as a whole. Moral distress has typically been characterized in terms of powerlessness and victimization. This article offers an alternate view: ethically complex situations and experiences of moral distress can become opportunities for growth, empowerment, and increased moral resilience.
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Intimate Partner Violence: ‘Troubling Knowledge and Practice Gaps’ among Rural Providers

By Sylvia Foley, AJN senior editor

Table 8. Perceived self-efficacy on a 1-to-5 scale (mean score above 2.5 indicates greater sense of self-efficacy). Table 8. Perceived self-efficacy on a 1-to-5 scale (higher score indicates greater self-efficacy).

Intimate partner violence (IPV) remains a widespread health and social problem in the United States, affecting an estimated one in three women during her lifetime.

Health care providers can make a critical difference in the lives of these women, yet a lack of IPV-related knowledge, negative attitudes and beliefs, and low rates of screening are common. And women in rural areas face particular challenges.

To learn more about rural providers with regard to IPV, nurse researchers Karen Roush and Ann Kurth conducted a study. They report their findings in this month’s CE–Original Research feature, “Intimate Partner Violence: The Knowledge, Attitudes, Beliefs, and Behaviors of Rural Health Care Providers.” Here’s an overview:

Methods: Health care providers working in a large rural health network were asked to complete electronic surveys that examined their IPV-related knowledge, attitudes, beliefs, and behaviors. Descriptive and correlational statistical analyses of the data were conducted.
Results: A total of 93 providers returned completed surveys. In general, the respondents demonstrated good overall knowledge, judicious attitudes, and beliefs congruent with the available evidence. Of concern were their knowledge and practice gaps regarding the prevalence of IPV, the higher risk of injury faced by women who leave their abusers, the ability of women to make appropriate choices about their situations, and what actions to take when someone discloses abuse.
Conclusion: The results were encouraging with regard to the IPV-related knowledge, attitudes, beliefs, and behaviors of rural health care providers. But they also indicated important knowledge and practice gaps. Preparing providers to deliver compassionate, effective care to women who experience IPV is essential for the health and well-being of women and their families.

Implications. Pointing to confusion stemming from variation in state laws regarding mandated reporting of IPV, the authors call for the creation of a uniform national law. They recommend that health care organizations develop formal IPV policies with clear goals and procedures; and they urge organizations to provide IPV-related education for all staff.
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Napping on the Night Shift: What a Pilot Study Revealed

By Sylvia Foley, AJN senior editor

Table 1. Guidelines for Hospital Nurses on Implementing Naps on the Night Shift (click to enlarge)Nurses who work the night shift often struggle with high levels of sleepiness. But while onsite napping is effectively used to counter worker fatigue in other safety-sensitive industries, the practice has yet to win wide acceptance in nursing.

Curious about why this is so, nurse researchers Jeanne Geiger-Brown and colleagues recently conducted a pilot study. They report their findings in this month’s CE–Original Research feature, “Napping on the Night Shift: A Two-Hospital Implementation Project” (for some night shift napping ground rules, see, at right, Table 1: Guidelines for Hospital Nurses on Implementing Naps on the Night Shift—click table to enlarge).

Here’s an overview:

Purpose: To assess the barriers to successful implementation of night-shift naps and to describe the nap experiences of night-shift nurses who took naps.

Methods: In this two-hospital pilot implementation project, napping on the night shift was offered to six nursing units. Unit nurse managers’ approval was sought, and further explanation was given to a unit’s staff nurses. A nap experience form, which included the Karolinska Sleepiness Scale, was used to assess pre-nap sleepiness level, nap duration and perceived sleep experience, post-nap sleep inertia, and the perceived helpfulness of the nap. Nurse managers and staff nurses were also interviewed at the end of the three-month study period.

Results: Successful implementation occurred on only one of the six units, with partial success seen on […]

AJN in May: Night-Shift Naps, Intrathecal Cancer Pain Relief, Teaching Nurses to Write, More

On this month’s cover is A Maid Asleep (1656–57) by the Dutch master Johannes Vermeer. We chose this painting to call attention to the issue of sleepiness in nurses who work the night shift, which is explored in this month’s Original Research article.

On-the-job sleepiness among nurses can increase the risk of patient care errors, job-related injuries, and long-term health problems.

For night-shift nurses, one potential solution is being allowed to take brief naps during a shift, which the American Nurses Association recommends as an evidence-based countermeasure to fatigue. But nurses may face barriers to doing so, including a lack of formal breaks on the unit and concerns about impeding the quality of nursing care. To learn about a project that explored those barriers and attempted to implement night-shift naps, read “Napping on the Night Shift: A Two-Hospital Implementation Project.”

Some other articles of note in the May issue:

CE Feature: Intrathecal Pumps for Managing Cancer Pain.” Among patients with cancer, moderate to severe pain is prevalent and can be refractory even with the use of systemic opioids, which may cause adverse effects that are difficult to manage at the doses required to control pain. When delivered intrathecally, however, opioids and adjuvant analgesics may provide greater pain relief at dramatically lower doses and with fewer adverse effects. This article provides an overview of intrathecal pump therapy, including its benefits and potential risks and complications; the medications that can be delivered intrathecally; and the nursing care required by patients who use an intrathecal pump.

Special Feature: Mentoring Clinical Nurses to Write for Publication: Strategies for Success.” Clinical nurses often find writing a challenge, but it’s important to disseminate clinical practice initiatives that result in notable patient outcomes. Nurses have a responsibility to share what they do to improve patient care. This article describes the initiation of a workshop series designed to teach clinical nurses about the writing process and mentor them through the stages of submitting a manuscript for publication. […]

April 29th, 2016|Nursing, nursing perspective, nursing research|0 Comments

‘Do You Consider Yourself Healthy?’ Study Sheds Light on RNs’ Lifestyle Practices

By Sylvia Foley, AJN senior editor

Over the past decade, the lifestyle practices of nurses and their connection to quality of care and patient outcomes have been gaining attention. Indeed, according to the patient-centered, relationship-based care model, one of the main conditions for optimal care is that providers engage in healthy self-care behaviors. Yet there is some evidence suggesting that RNs don’t consistently do so, especially when it comes to exercise and stress reduction—even when they believe they should.

Nurse researchers Karen Thacker and colleagues recently conducted a study to learn more. They report their findings in this month’s CE–Original Research feature, “An Investigation into the Health-Promoting Lifestyle Practices of RNs.” Here’s a brief summary:

Purpose: To gather baseline data on the health-promoting lifestyle practices of RNs working in six major health care and educational institutions in southeastern Pennsylvania.
Methods: The 52-item Health-Promoting Lifestyle Profile II instrument was used to explore participants’ self-reported health-promoting behaviors and measure six dimensions: health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management.
Results: Findings revealed that physical activity and stress management scores were low for the entire group of RNs. There were statistically significant differences between nurses 50 years of age and older and those 30 to 39 years of age for the subscales of health responsibility, nutrition, and stress management, suggesting that older nurses are more concerned about their health. Sixty-seven percent of participants reported having too many competing priorities and had significantly lower subscale scores for spiritual growth, interpersonal relations, and stress management, as well as significantly lower total scores.
Conclusion: The findings provided baseline data that will be useful in planning health-promoting lifestyle interventions for participants specific to their institutions, and that may help guide future research and educational initiatives. […]