Nursing staffing, nursing workload, the work environment and patient outcomes

Nurse staffing (fewer RNs), increased workload, and unstable nursing unit environments were linked to negative patient outcomes including falls and medication errors on medical/surgical units in a mixed method study combining longitudinal data (5 years) and primary data collection.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Compassion fatigue in nurses

Compassion fatigue, trigger situations, and coping strategies were investigated in hospital and home care nurses. The Professional Quality of Life Scale measured compassion fatigue, compassion satisfaction, and burnout. Narrative questions elicited trigger situations and coping strategies. Compassion fatigue scores were significantly different between nurses who worked 8- or 12-hour shifts. Fifteen percent of the participants had scores indicating risk of the compassion fatigue. There were significant differences in compassion satisfaction, depending on the unit worked and time as a nurse. The most common category of trigger situations was caring for the patient. Work-related and personal coping strategies were identified.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit

This correlational study examined how mother's posttraumatic stress disorder (PTSD) symptoms are related to characteristics of the mother and her infant, as well as to mother-infant interaction and infant development, in 21 mothers of very low birthweight infants. Twenty-three percent of mothers scored in the clinical range on a measure of PTSD. How ill the infant was during the NICU hospitalization was related to mothers' PTSD symptoms. Mothers with greater PTSD symptoms were less sensitive and effective at structuring interaction with their infant. © 2011.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

The “Big 5” and beyond: Nurses, paid carers, and adults with developmental disability discuss communication needs in hospital

Adults with developmental disability and little or no speech need to communicate with nurses in hospital to (a) express physical needs, (b) discuss health, (c) convey intelligence and emotions, (d) connect socially, and (e) control the environment. All stakeholders need access to a variety of communication strategies to support communication of these needs.

Website:https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/ 

Influence of exercise mode on pregnancy outcomes: ENHANCED by mom project

In the ENHANCED by Mom study authors aim to determine the effects of different modes of exercise training (aerobic, circuit, and resistance) throughout pregnancy on childhood health by controlling individual exercise programs and assessing the effects of each on fetal and neonatal health adaptations. A better understanding on the effects of exercise training during pregnancy on fetal and neonatal health could have a profound impact on the prevention and development of chronic diseases such as obesity, hypertension, and diabetes.

ENHANCED by mom is a cross sectional comparison study utilizing 3 intervention groups in comparison to a control group.

Participants will complete three 5 min warmup + 45 min sessions weekly from 16 weeks to 36 weeks gestation of aerobic, resistance, or circuit training, in comparison to non–exercising controls.

Maternal physical measurements will occur every 4 weeks throughout the intervention period.

Fetal morphometric and heart measurements will occur at 34 weeks gestation.

Neonatal measurements will be acquired at birth and at 1 month, 6 months, and 12 months.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Preterm Birth and Associated Factors among Mothers Who gave Birth in Debremarkos Town Health Institutions, 2013 Institutional Based Cross Sectional Study

Background: The birth of a preterm infant results in significant health consequences to the infant and emotional and economic costs for families and communities. About 75% of perinatal deaths and 50% of neurological abnormalities are directly attributed to preterm. The main aim of this study was to assess the prevalence and associated factors of pre-term birth North West Ethiopia.

Methods: An institutional based cross sectional study was conducted. Systematic sampling was used to get the total sample size of 422 participants. The data was entered, cleaned and edited using EPI INFO version 2002 and exported to SPSS version 16.0 software packages for analysis. Both bivariate and multiple logistic regression were fitted and odds ratio and 95% CI were computed to identify associated factors and determine the strength of association. A p-value of <0.05 was considered as statistical significant.

Website:  http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Retroperitoneal Endometriotic Cyst Mimicking a Tumor

Ectopic endometrial tissues are rarely observed on the serosal surfaces of bowel and laparotomy incisions, in the lungs, bones and in the urinary tract. Recto-sigmoid junction is the most common site of extra-genital endometriosis,with less frequent sites being the rectovaginal septum, small intestine, cecum and appendix. Endometriotic cyst in a retroperitoneal location mimicking a retroperitoneal tumor through the mesentery of sigmoid colon is an extremely

rare presentation. Only few cases of retroperitoneal presentation of endometriotic cyst have been reported in the English literature. Retroperitoneal endometriotic cyst may mimic a retroperitoneal tumor in view of the location.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Bariatric Surgery before Pregnancy — Is This a Solution to a Big Problem?

Obesity has reached epidemic levels in the United States. According to data from the Centers for Disease Control and Prevention (CDC), in 1990 no state in the United States had a prevalence of obesity of 15% or more, but by 2010, no state had a prevalence of obesity below 20%, and a third of states had a prevalence of 30% or higher.1 This trend extends to pregnancy; almost a third of women entering pregnancy in the United States are obese.2 Moreover, the prevalence of extreme obesity is also increasing. For example, in pregnant women, the subcategories of obesity that are . . .

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Smoking cessation strategies may increase quit rates among adults of low socioeconomic status

·         Interactive technology can be used to engage low socioeconomic smokers in effective tobacco treatment outside of the traditional clinical setting.

·         Nurses should encourage all smokers to use evidence-based cessation strategies, including telephone-based counselling and pharmacotherapy.

·         More research is needed to address social and contextual factors impacting tobacco use.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Nurses experience feelings of disempowerment when caring for patients in severe pain

·         Protocols are required to enhance nurses’ lines of power when caring for patients in pain. This includes triggering a critical incidence when nurses struggle to control a patient's pain, thus mobilising senior medical staff and pain specialists to the patient's bedside.

·         Whether triggering a critical incidence in this context results in better pain care needs further evaluation.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Parents are psychologically affected by their experiences when their child is in hospital because of uncertainty about prognosis and anxiety at the time of admission

Post-traumatic stress symptoms are experienced by parents after a child's hospitalisation, even where the child's medical condition is not life-threatening.

Screening parents during admission for risk factors, such as anxiety and single parent status, may facilitate more appropriate targeting of support.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Goals of care are important for older adults with severe illness and their families, and are infrequently addressed by health professionals

Patients and families identify goals of care discussions as being essential and include preferences for care at the end-of-life, eliciting patient's values, disclosing prognosis, allowing expression of fears or concerns and questions about goals of care.

Healthcare providers often do not address guideline recommended elements of goals of care discussion, but when undertaken, patient satisfaction can improve.

Future research should examine the benefits of automatic triggers, variations of timing along the disease trajectory and interventions …

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Ateplase for ischaemic stroke: increased risk of intracranial haemorrhage is balanced by improved stroke outcomes, particularly if treated within 3–4.5 h of onset

Thrombolysis given to appropriate patients within 4.5 h of the onset of stroke symptoms increases the chance of a good outcome. The earlier it is given, the more likely it is to be effective.

Thrombolysis increases the risk of early death, but by 3–6 months mortality is equivalent in treated and untreated patients.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Heel stick test for obtaining blood samples in neonates: both swaddling and heel warming may help, but heel warming appears to provide greater pain reduction

Heel warming and swaddling are found to effectively reduce infant pain during heel stick tests for obtaining blood samples and can be used as pain interventions in routine neonatal practice.

The efficacy of swaddling and heel warming on neonatal pain can be added to the health professionals’ armoury for pain management in infants, especially in the intensive care environment.

The underpinning mechanisms of pain reduction by heel warming and swaddling may be different and need to be investigated in future studies.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Behavioural counselling improves physiological outcomes in those with cardiovascular risk factors

Clinicians need to engage community-based public health and other partners to deliver the intensity of diet and physical activity needed to have a positive impact on cardiovascular disease (CVD) risk.

More research is needed to identify the most efficient (cost and time) means of intervention delivery to achieve positive short-term and long-term impacts.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Clinically significant pain is experienced by just over a third of all hospitalised patients, affecting around a half of surgical and a quarter of medical admissions

Greater attention should be placed on assessing pain independently of vital signs, when there is evidence of pain that needs to be relieved.

Future research needs to examine the development and implementation of minimum standards for clinicians assessing and responding to pain in hospitalised patients.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

A nurse-facilitated cognitive behavioural self-management programme for heart failure is no more cost effective than usual CBT care

Using nurses to facilitate a cognitive behavioural therapy (CBT) based self-management intervention for heart failure patients is no more cost-effective than a CBT manual alone.

CBT self-management for heart failure patients may be more effectively delivered as part of collaborative care but this needs to be confirmed in future trials.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

A psychological intervention for family carers of people with dementia is clinically and cost effective at reducing carer depression and anxiety levels over 2 years of follow-up

The START (STrAtegies for RelaTives) intervention is easy to administrate, cost-effective and likely to enhance psychological well-being of family carers of people with dementia.

Training and monitoring of START therapists will be important when implemented by local mental health services.

Future research should evaluate carers’ increased positive behaviours as well as a reduction of psychological symptoms.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

The role of nursing unit culture in shaping research utilization behaviors

A hierarchical structure of authority, routinized and technology-driven work at the bedside, a workplace ethos that discouraged innovation, and an emphasis on clinical experience acted together to teach nurses both that they were to do as they were told and that they were not expected to use research. Nurses perceived that the behaviors expected of them were arbitrarily determined by physicians and managers in charge. Consequently, they were reluctant to step outside of routine and physician-ordered nursing care. This left little opportunity for research utilization.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Using saliva to measure endogenous cortisol in nursing home residents with advanced dementia

Two research teams determined the feasibility of saliva collection for cortisol measurement in nursing home residents with advanced dementia. Study aims were to:

(a) determine if sufficient saliva could be obtained for assay and

(b) examine whether cortisol values exhibited range and variability for meaningful interpretation. Useable samples were consistent across sites, suggesting that saliva collection for cortisol assay is a viable method in this setting. Cortisol values showed range and variability. More than half of the residents showed the normal adult pattern of high morning levels decreasing throughout the day. A third of the participants demonstrated an increase in the evening cortisol levels, while the remaining profiles were flat, suggesting hypothalamic-pituitary-adrenal (HPA) dysregulation in this population.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/