Anne Young

ICU nurses' experiences in providing terminal care

At least 1 in 5 Americans die while using intensive care service—a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providing care at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzis steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses.

Transition of Chronically Ill Youth to Adult Health Care: Experience of Youth With Hemoglobinopathy

INTRODUCTIONnThe purpose of this study was to describe the transition experience, expectations, and concerns of chronically ill youth with hemoglobinopathy (CIYH) (e.g., sickle cell disease) who have transitioned to adult health care.nnnMETHODnA descriptive phenomenological study was used to explore the transition experience of CIYH through interviews. A purposive sample of 14 CIYH aged 19 to 25 years were recruited from a large southwestern medical center. The Colaizzi method was used to analyze the CIYHs meaning of the transition experience.nnnRESULTSnThemes identified were: Reactions to adult care transition (I dont want to go), concerns about transition experience (Whats going to happen to me?), pushed into transitioning to adult care (Facing the music), and transitioned to adult care (Accepting that I had to leave).nnnDISCUSSIONnThe findings revealed CIYHs adjustment process, which may facilitate the design of effective interventions to provide uninterrupted medical care as the CIYH transitions to adult health care.

Predicting NCLEX-RN Success: the Seventh Validity Study HESI Exit exam.

The findings of six previously conducted studies indicated that the HESI (E2) was highly accurate in predicting NCLEX-RN success. The purpose of this study—the seventh study to investigate the validity of the E2—was to examine the accuracy of three parallel versions of the E2in predicting licensure success and to describe program practices regarding E2 benchmark scores, remediation programs, and retesting policies. The findings of this study again indicated that the E2 was highly accurate in predicting NCLEX-RN success. Additionally, all three versions of the E2 were found to have a predictive accuracy above 90%. The most common E2 benchmark score designated by faculty at the participating schools was 850, and most schools required students to retest with different versions of the E2 until the faculty-designated E2 benchmark score was achieved. Remediation seemed to be effective in raising students’ E2 scores, and it was recommended that future research investigate the effectiveness of specific remediation strategies.

The meaning of adolescents' eating experiences during bone marrow transplant recovery.

Bone marrow transplant (BMT) is a common treatment option for adolescents with various diseases; however, the aggressive therapy often causes significant side effects that can lead to poor eating. There is little documentation of eating experiences and necessary support needed after the initial BMT hospitalization. This phenomenological study, guided by Martin Heidegger’s philosophical influences, revealed the meaning of adolescents’ eating experiences, eating strategies, and the impact of eating on the adolescents’ quality of life during the first 100 days post-BMT. Individual interviews were conducted at 50 and 100 days post-BMT. Data analysis used the hermeneutic circle and revealed 5 themes. Adolescents discussed the slow return of eating, barriers that affected their eating, personal eating strategies, significance of eating, and feelings regarding eating. Eating issues do not end when a BMT patient is discharged from the hospital, and caregivers need to have a better understanding of the ongoing issues affecting adolescents throughout the BMT recovery phase.

Afghanistan and Iraq War Veterans’ Health Care Needs and Their Underuse of Health Care Resources: Implications for Psychiatric-Mental Health Nurses

U.S. Veterans who have served in the Afghanistan and Iraq wars have combat-related medical and mental health issues, notably posttraumatic stress disorder and traumatic brain injury, but underuse health care resources. To better understand their health care needs, resource use, and facilitators and barriers to seeking health care, a literature review was conducted. The results suggest high prevalence of mental and medical health issues and disproportionate use of quantitative research design that lacked approaches to understanding the psychosocial, cultural, and contextual factors that affect help-seeking by Veterans. Strategies to increase the likelihood that Veterans will seek needed health care, gaps in the literature, and the need for further research are discussed.

Faculty Experiences Developing and Implementing Policies for Exit Exam Testing.

Nursing schools use standardized exit examinations to determine student readiness for the NCLEX-RN. Yet little is known about how nursing programs develop policies for using the examinations, set benchmarks scores, and implement remediation strategies with their students. In a phenomenological study, faculty identified a testing policy process that fell into the major themes of triggers for change, policy modification, and reactions to change.

The Influence of Race and Gender on Nursing Care Decisions: A Pain Management Intervention

Background: Understanding whether a patients race or gender and/or the nurses race or gender influence how nurses form care decisions can contribute to exploration of methods that can positively affect disparate treatment. Aims: This research examined how the variables of race and gender of both the nurse and the patient influence nurses decision making about pain management. Design: A randomized four‐group post‐test–only experimental design was used to examine the variables and variable interactions. Settings: An investigator‐developed case vignette tool hosted online was used to obtain data about nursing pain management decisions. The vignette intervention was developed to simulate four exact patient scenarios that differed only by patient race and gender. Participants/Subjects: A quota sample of 400 nurses was recruited using a self‐selected face‐to‐face recruitment technique. Methods: A four‐way between‐groups analysis of variance assessed whether the gender of the nurse, race of the nurse, gender of the patient, or race of the patient made any differences in the dose intensity of pain medications selected by the nurse sample. Results: No significant interactions were noted between any combinations of the four independent variables. A significant main effect was noted in medication intensity for nurse gender (F [1,384] = 9.75, p = .002). Conclusions: Data trends suggested that gender stereotypes about how patients managed pain played a role in dose intensity decisions because female patients on average were given higher doses of pain medication than male patients were by all the nurses in the study. Further research is needed in this complex area of study.

Understanding the meaning of seeking healthcare for Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) male veterans: An interpretive phenomenological study

More than 2.3 million United Sates service men and women have served in the Afghanistan (Operation Enduring Freedom, OEF) and Iraq (Operation Iraqi Freedom, OIF) conflicts (GAO-14-676, Veterans Affairs, 2014), with many veterans having served multiple deployments. OEF/OIF veterans have sustained physical and psychological injuries with lasting health and psychosocial implications. The result is a high prevalence of mental health issues, notably posttraumatic stress disorder (PTSD), generalized anxiety disorders, depression, and suicidal behaviors (Dursa, Reinhard, Barth, & Schneiderman, 2014; Hoge et al., 2004; Milliken, Auchterlonie, & Hoge, 2007; Seal, Bertenthal, Miner, Sen, & Marmar, 2007). Among these veterans, PTSD is reported at rates of 13% to 37%, with rates of PTSD increasing as deployments and combat exposure increase (Eisen et al., 2012; Hoge, Auchterlonie, & Milliken, 2006; Jakupcak et al., 2010). PTSD has a high co-occurrence rate with other mental health disorders (Shen, Arkes, & Williams, 2012; Stecker, Fortney, Owen, McGoven, & Williams, 2010) including substance use disorders, high rates of tobacco use (Kirby et al., 2008), and alcohol use (Seal et al., 2011). These veterans also have medical health issues related to physical injuries including traumatic brain injury (TBI), limb injuries, and limb loss. Concussions may result in chronic pain, memory loss, headaches, sleep dysfunction, and hearing loss (Morissette et al., 2011; Stecker et al., 2010). The Veterans Healthcare Administration (VHA) is an equal access system with initiatives aimed at enhancing access to care for all veterans including OEF/OIF Veterans. During the enhanced eligibility period, OEF/OIF veterans that were involved in a theater of combat are qualified to receive free healthcare services for five years from the date of separation from the military, for service-related healthcare needs. To take advantage of this benefit, veterans must enroll in VHA and meet one of the eight eligibility Priority Groups. Group one has the highest priority. To qualify for group one, veterans must have service related disabilities of 50% or greater or be unemployable as a result of their service (VA, 2016). Despite efforts to improve veterans healthcare access and health services use, current evidence suggest that many OEF/OIF veterans with heightened medical and psychological healthcare needs either do not seek, delay, or underuse healthcare services, or do not sustain engagement in treatment modalities and follow-up care (Hoge et al., 2004; Seal et al., 2010; Stecker, Fortney, Hamilton, & Ajzen, 2007; Vogt, 2011). The reasons for OEF/OIF veterans patterns of seeking and using available healthcare resources are not fully understood (Nworah, Symes, Young, & Langford, 2014). Understanding what seeking healthcare means to OEF/OIF male veterans may help with formulation of policies, interventions, and future studies to facilitate veterans to seek and use healthcare resources. This study was designed to answer the question: What is the meaning of seeking healthcare for United States male veterans who served in the Iraq and Afghanistan conflicts?

The lived experience of nurse practitioners practicing within the Transformational Advanced Professional Practice Model: A phenomenological study

PURPOSEnThe purpose of this study was to describe the lived experiences of nurse practitioners (NPs) practicing within the Transformational Advanced Professional Practice (TAPP) Model, a professional practice model (PPM).nnnDATA SOURCESnA descriptive phenomenological analysis using semistructured interviews of 11 NPs across multiple inpatient and outpatient clinical areas at Texas Childrens Hospital. Member checking and theming data occurred using Colaizzis Method concurrently with Mind Mapping technique.nnnCONCLUSIONSnMain themes included: (a) transforming professional practice, (b) cultivating the inner self, and (c) mentoring professional transitions.nnnIMPLICATIONS FOR PRACTICEnThe findings of this study provide qualitative evidence that the TAPP Model influences role transition and professional development. Transforming NP practice within organizations and within the nursing profession itself will take mindfulness with an intentional approach to design PPMs specifically for NPs.