Connie Miller

Relationships between fatigue and early postoperative recovery outcomes over time in elderly patients undergoing coronary artery bypass graft surgery

BACKGROUND Despite successful coronary artery bypass graft (CABG) surgery, some patients continue to experience fatigue after their surgery. OBJECTIVE The purpose of this secondary analysis study was to examine the relationships of fatigue and early recovery outcomes (psychosocial and physiologic functioning, and physical activity) over time (6 weeks and 3 months) among older adult subjects, age 65 years and older, after CABG surgery. Comparison groups were those subjects who had fatigue at 3 weeks after surgery and nonfatigued subjects. DESIGN A prospective, comparative design was used for this secondary analysis study. SAMPLE Subjects in this study were drawn from the control group of subjects enrolled in the larger parent study. Subjects (N = 119) were dichotomized into fatigue (n = 66) and nonfatigued (n = 53) groups on the basis of their 3-week self-reports of postoperative fatigue. RESULTS At 6 weeks after surgery, fatigued subjects had significantly (P < .05) more impaired psychosocial functioning (role-emotional [t = 1.9], social [t = 2.6], and mental [t = 1.9] functioning) on the basis of the Medical Outcome Study Short Form 36. They had significantly (P < .005) higher mean hospital anxiety (t = -3.6) and depression (t = -2.9) subscale scores, respectively. Anxiety (t = -2.3, P < .05) remained significantly (P < .05) impaired at 3 months. At 6 weeks, role physical functioning, measured by the Medical Outcome Study Short Form 36, was significantly impaired (t = 2.4, P < .01). There were no significant differences in physical activity variables as measured by an RT3 accelerometer (Stayhealthy, Inc., Monrovia, CA) and self-report diary. CONCLUSIONS Persistent fatigue can hamper early recovery after CABG surgery. Tailored interventions are needed to address fatigue management and improve patient outcomes.

Predictors of success on National Council Licensure examination for registered nurses for accelerated baccalaureate nursing graduates.

A ccelerated nursing curricula (ANC) were first offered in 1971, and the nursing shortage has fostered the development of additional programs across the country. Employers look favorably on ANC programs because they produce nurses more rapidly than traditional programs. Students are partial to them because they can reach their goal in a shorter period of time. Accelerated nursing curricula may have different prerequisites and admission criteria; however, they offer qualified, previous-degree students the opportunity to graduate with a bachelor of science in nursing in 1 year. Because of the unique characteristics of ANC students and programs, predictors for success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) may differ from those for traditional students. There are gaps in the literature concerning predictors of NCLEX-RN success in ANC students in the predictive value of pre-RN examinations, previous degree, and coursework. In an effort to evaluate a newly revised curriculum and address declining school NCLEX-RN pass rates, a retrospective study was conducted to identify variables that predicted NCLEX-RN in our graduates. Variables examined included the following: admission grade point average (GPA), previous degree (science or nonscience), senior complex care (SCC) grade, and pre-RN assessment score.

The effects of a symptom management intervention on symptom evaluation, physical functioning, and physical activity for women after coronary artery bypass surgery

The purpose of this subset analysis was to examine the effect of a symptom management (SM) intervention on postoperative symptom evaluation, physical functioning, and physical activity among the female participants (N = 40) of the larger parent study of coronary artery bypass graft patients aged 65 years and older. The intervention group (n = 23) had significantly lower fatigue scores at 6 weeks (Z = 1.96, P < .05) and higher levels of physical activity (Z = −1.71, P < .05) reflected in the expended kcal · kg−1 · d−1, as measured by the activity diary at 3 months after coronary artery bypass graft surgery. At 6 weeks and 3 months after surgery, there were significant correlations between cardiac surgery-related recovery symptoms (shortness of breath, fatigue, depression, incision pain, and sleep problems) and physical functioning (physical, vitality, and bodily pain functioning subscale scores), with correlations ranging from 0.31 to 0.46. Given that this was a subset analysis of a larger study, significant differences were not expected for all variables. Study findings support the need for a targeted (women-focused) and tailored (self-management recovery) intervention to assist females in recovering from coronary artery bypass graft surgery to improve symptom management, thereby enhancing physical functioning and physical activity outcomes.

Student Learning Outcomes After Integration of Quality and Safety Education Competencies into a Senior-Level Critical Care Course

Nursing education must respond to reports from the Institute of Medicine and others that health care education must focus more on safety and quality so graduates are empowered to positively impact patient safety. Effective teaching strategies must be developed and tested that result in positive student outcomes. The purpose of this pilot study was to test the effects of structured classroom and clinical content related to safety and quality of health care systems on a group of senior-level nursing students. A mixed-method study was conducted using repeated-measures analysis of variance quantitative data from the Student Perception of Safety and Quality Knowledge, Skills, and Attitudes Questionnaire and content analysis for the qualitative data collected from focus group discussions. Results suggest a combination of classroom and clinical learning activities have the strongest impact on student knowledge, skills, and attitudes related to safety and quality.

Longitudinal field comparison of the RT3 and an activity diary with cardiac patients

This study investigated reliability and validity of two methods of measuring patients’ physical activity following coronary artery bypass graft (CABG) surgery. Sixty-five patients wore an RT3 accelerometer and recorded activity in a diary at 3 weeks, 6 weeks, and 3 months postsurgery. Generalizability coefficients greater than .80 required approximately 2 to 4 days of data, fewer than reported elsewhere. Energy expenditure estimates correlated .77, .72, and .57 (p < .01), with mean RT3 estimates higher, especially when overall energy expenditure was low. Changes from 3 to 6 weeks correlated only moderately (r = .37–.46) across methods. The methods produce reliable but differing estimates of physical activity in this population. Although no method bias is evident in assessing change over time, correlations support the importance of using multiple methods.

Evaluation of the team performance observation tool with targeted behavioral markers in simulation-based interprofessional education

Abstract The primary aim of this study was to decrease the subjectivity of the Team Performance Observation Tool (TPOT) and determine the psychometric properties of this tool when using scenario-specific targeted behavioral markers (TBMs). We used a convenience sample of 47 physical therapy and 25 nursing students at an academic medical center who were organized in interprofessional teams of three to care for a simulated patient. The TPOT demonstrated satisfactory validity and reliability with the use of TBMs. We demonstrated significant correlations between the TPOT overall rating and two scenario-specific outcomes: (1) a negative correlation between the TPOT overall rating and the number of medical errors committed by the 24 teams (r = −0.531, p = 0.008) and (2) a positive correlation between the TPOT overall rating and a time-based functional outcome (r = 0.803, p < 0.001). We demonstrated substantial test–retest reliability (kappa = 0.707, p < 0.001), inter-rater reliability (kappa = 0.730), and good internal consistency reliability (Cronbach’s α = 0.921). The results of our study support the use of scenario-specific TBMs to enhance the reliability and validity of the TPOT for use in the evaluation of team-based simulation scenarios. Further evaluation of the TPOT with TBMs from other simulation and training contexts is warranted.

Student-Perceived Influences on Performance During Simulation.

BACKGROUND Understanding the effect of the context of simulation to learning and performance is critical to ensure not only optimal learning but to provide a valid and reliable means to evaluate performance. The purpose of this study is to identify influences on performance from the student perspective and understand the contextual barriers inherent in simulation before using simulation for high-stakes testing. METHOD This study used a qualitative descriptive design. Senior nursing students (N = 29) provided nursing care during simulation. Vocalized thoughts during simulation and reflective debriefing were digitally recorded and transcribed verbatim. Thematic analysis was conducted on transcribed data. RESULTS Student performance during simulation was influenced by anxiety, uncertainty, technological limitations, and experience with the patient condition. Students had few previous simulation-based learning experiences that may have influenced performance. CONCLUSIONS More needs to be understood regarding factors affecting simulation performance before pass-or-fail decisions are made using this technology. [J Nurs Educ. 2016;55(7):396-398.].

Predictors of success on national council licensure examination for registered nurses for accelerated baccalaureate nursing graduates.

A ccelerated nursing curricula (ANC) were first offered in 1971, and the nursing shortage has fostered the development of additional programs across the country. Employers look favorably on ANC programs because they produce nurses more rapidly than traditional programs. Students are partial to them because they can reach their goal in a shorter period of time. Accelerated nursing curricula may have different prerequisites and admission criteria; however, they offer qualified, previous-degree students the opportunity to graduate with a bachelor of science in nursing in 1 year. Because of the unique characteristics of ANC students and programs, predictors for success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) may differ from those for traditional students. There are gaps in the literature concerning predictors of NCLEX-RN success in ANC students in the predictive value of pre-RN examinations, previous degree, and coursework. In an effort to evaluate a newly revised curriculum and address declining school NCLEX-RN pass rates, a retrospective study was conducted to identify variables that predicted NCLEX-RN in our graduates. Variables examined included the following: admission grade point average (GPA), previous degree (science or nonscience), senior complex care (SCC) grade, and pre-RN assessment score.