Helen Schultz

Time delay to surgery for appendicitis: no difference between surgical assessment unit and emergency department

Background In Denmark, emergency departments (EDs) are replacing acute surgical and medical units. The aim of this study was to compare the trajectory of patients undergoing surgery on the suspicion of appendicitis in a surgical assessment unit (SAU) and EDs with an observation unit, respectively. The primary outcome measure was the time from hospital arrival-to-decision for surgery. Materials and methods A comparative retrospective study with a cross-sectional design and a before-and-after design was carried out during January 2011 to December 2012 at a SAU and an ED at a university hospital (U-SAU and U-ED) and at an ED at a regional hospital (R-ED). Data included time of arrival, decision for surgery, surgery and discharge, and number of blood tests. Results In total, 250 patients were included. Time to decision for surgery was 4.50, 4.95, and 4.63 h (P=0.58) in the U-SAU, R-ED, and U-ED, respectively. Time from decision for surgery to start of surgery was 4.60, 3.29, and 4.12 h in the U-SAU, R-ED, and U-ED, respectively. The difference was significant between the U-SAU and R-ED (P=0.05) and between R-ED and U-ED (P=0.03). Time from surgery to discharge from the hospital was 17.88, 19.28, and 15.13 h in the U-SAU, R-ED, and U-ED, respectively. The difference was significant between the EDs (P=0.02). Significantly more blood tests were performed in the EDs than in the U-SAU. Conclusion The introduction of EDs with observation units did not influence time to decision for surgery, but more blood tests were performed.

Discharge from an emergency department observation unit and a surgical assessment unit: experiences of patients with acute abdominal pain

AIMS AND OBJECTIVES To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit. BACKGROUND The increase in emergency department observation units has increased short-term admissions and changed the patient journey from admission and discharge from specialised wards staffed by specialist nurses to admission and discharge from units staffed by emergency nurses. DESIGN A comparative qualitative interview study. METHODS The study included 20 patients: 10 from an emergency department observation unit and 10 from a surgical assessment unit, and took a phenomenological-hermeneutic approach. Patients were interviewed at discharge and three months later. RESULTS More patients from the emergency department observation unit experienced readiness for discharge and had plans for follow-up, compared with patients from the surgical assessment unit. In the surgical assessment unit, more patients were readmitted, had unanswered questions after three months and experienced a follow-up visit at the general practitioner as insufficient. More patients from the surgical assessment unit reported receiving useful self-care advice, compared with those from the emergency department observation unit. CONCLUSION The experience of emergency department observation unit patients on discharge and follow-up was that the health professionals were more supportive, compared with surgical assessment unit patients, who felt discharge occurred too early, but with more preparation for independent home self-care. These results are an important factor in the patient experience of discharge from hospital and may reflect differences in specialisation of the nurses. RELEVANCE TO CLINICAL PRACTICE Units discharging patients with acute abdominal pain could be inspired by scheduled fast-track surgery programmes with structured information about admission, treatment and follow-up and easy access to relevant health professionals after discharge.

Patient-controlled oral analgesia for acute abdominal pain: A before-and-after intervention study on pain intensity and use of analgesics

AIM To compare the use of patient-controlled oral analgesia with nurse-controlled analgesia for patients admitted to hospital with acute abdominal pain. The primary outcome measure was pain intensity. The secondary outcome measures were the use of analgesics and antiemetics. BACKGROUND Inadequate pain management of patients with acute abdominal pain can occur during hospital admission. Unrelieved acute pain can result in chronic pain, stroke, bleeding and myocardial ischemia. METHODS A before-and-after intervention study was conducted in an emergency department and a surgical department with three subunits. Data were collected from medical charts and analyzed using chi-squared and Kruskal-Wallis tests. RESULTS A total of 170 patients were included. The median pain intensity score, using the numeric ranking scale, was 2.5 and 2 on Day 2 (p = 0.10), 2 and 2 on Day 3 (p = 0,40), 2.5 and 0 on Day 4 (p = 0.10), 2 and 0 on Day 5 (p = 0.045) in the control and intervention group, respectively. The percentage of patients receiving analgesics was 93 and 86 on Day 2 (p = 0.20), 91 and 75 on Day 3 (p = 0.02), 89 and 67 on Day 4 (p = 0.009) and 80 and 63 on Day 5 (p = 0.39). The use of antiemetics was similar in the two groups. CONCLUSION Patient-controlled oral analgesia significantly reduced the numerical ranking pain scale score on Day 5 and the consumption of analgesics on Days 3 and 4 after hospital admission. Patient-controlled oral analgesia is feasible as pain management for patients, but only with minor impact on experienced pain intensity and use of analgesics.

Psychometric evaluation of the Danish version of a modified Revised American Pain Society Patient Outcome Questionnaire (APS_POQ-R-D) for patients hospitalized with acute abdominal pain

Abstract Background and aims This paper forms part of a study evaluating the effect of patient-controlled oral analgesia for patients admitted to hospital with acute abdominal pain. Pain is a subjective experience, and a multifaceted evaluation tool concerning patient-reported outcome measures is needed to monitor, evaluate, and guide health care professionals in the quality of pain management. The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) is a validated multifaceted evaluation tool for measuring patient-reported pain experiences to evaluate different pain management interventions. The aim of this study was to evaluate the psychometric properties of a modified Danish version of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-D) used during and after hospitalization for patients with acute abdominal pain. Methods The APS-POQ-R was translated into Danish and two slightly different questionnaires were formed. Questionnaire one had 39 items and the six subscales pain severity (pain), perception of care (satisfaction), pain interference with function (activity) and emotions (emotion), side effects of treatment (safety), and patient-related barriers to pain management. The questionnaire focused on time during hospital stay and was to be completed at discharge. Questionnaire two included 25 items and the five subscales pain, satisfaction, activity, emotion, and safety and focused on time at home and was to be completed daily 1 week after discharge. The questionnaires were tested on 156 patients with acute abdominal pain. Internal consistency reliability and construct validity was examined. Results In both questionnaires, the results of correlations and tests for internal consistency reliability showed a Cronbach’s alpha of >0.7 for the pain, activity, and emotion subscales, but the value was ≥0.69 for the satisfaction subscale. In questionnaire one, Cronbach’s alpha was ≤0.64 for the safety subscale, but this was 0.73 when the item “itching” was deleted. In questionnaire two, Cronbach’s alpha was ≤0.51 for the safety subscale. For the patient-barrier subscale in questionnaire one, Cronbach’s alpha was ≤0.62 for any combination of the items in the subscale. The results of the construct validity and factor analysis showed a five-factor structure in questionnaire one and a three-factor structure in questionnaire two. In questionnaire one, items from the pain, activity, emotion, and safety subscales, except for the items “least pain” and “itching,” loaded on factor one. In questionnaire two, all items from the pain, activity, and emotion subscales loaded on factor one. Conclusions The modified APS-POQ-R-D demonstrated adequate psychometric properties for the five subscales pain severity (pain), perception of care (satisfaction), pain interference with function (activity) and emotions (emotion), side effects of treatment (safety), but not for the patient-barrier subscale for patients hospitalized with acute abdominal pain. Consequently, the APS-POQ-R-D may be used without the patient-barrier subscale. Implications The clinical implications of this study may help clinicians with investigating how acute patients manage pain during and after hospital admission.

The journey of patients with acute abdominal pain in the ED, EDOU and surgical assessment unit

Context: Emergency department nurses are challenged by the potential dangers associated with increasing volumes of psychiatric patients. These high-risk patients can threaten the safety of employees delivering care and contribute to escalating violence in the health care workplace. Recognizing a concern that one fourth of all Americans have underlying mental health conditions compounds the challenge to providing safe care. Mental health patients may seek care for acute physical illness, trauma, or chronic conditions that exacerbate their psychological instabilities (Bennett, 2001; Sorkin, Pham, & Ngo, 2009). When emergency care teams deliver medical care to mental health patients, superior training, planning, and skills can improve employee safety and patient outcomes. Method: Literature review, retrospective data analysis from local patient populations, and experiential knowledge from reviewing patient care scenarios led to development of a plan for improving patient and employee safety related to psychiatric care in one rural emergency department. Results: The case review shared a nurse’s experience caring for a medical patient with underlying psychiatric illness. By learning from this experience, leaders developed a strategy to improve employee safety, share education, mandate training, instill confidence, and promote competence in an interdisciplinary environment. Observing safe staffing ratios, recognizing escalation, reducing length of stay, and starting early therapeutic intervention for behavioral health problems improves patient outcomes and reduces the risk of patient outbursts. Conclusions: Mental health populations represent a vulnerable segment within the United States’ health care system. The trend of increasing volumes in this sub-group can be expected to increase as state facilities close and patients are discharged back into communities for long-term management. Aging populations facing isolation, depression, or declining cognitive stability have increased the incidence of patients with combined mental challenges and physical illness. Increasing awareness, maintaining vigilance for safety, and minimizing danger are important to the success of delivering medical care to these mental health patients. Caroline Vierheller, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002I diagnosed with cancer experience more than physical impacts. There are also emotional, psychosocial, spiritual, and practical consequences. Distress emerges as patients cope with the changes they face throughout their cancer journey. Although all patients experience distress, between 35-45% have clinically significant levels such as anxiety, depression, and adjustment difficulties. Early identification of distress and providing interventions to reduce this symptom is a standard of quality cancer care and a requirement of health services accreditation. Nurses have a critically important role to indentify distressed individuals, engage in relevant assessment, and provide interventions to manage distress. A programmatic approach to screening for distress (6th vital sign) has been implemented in several cancer facilities across Canada. The program includes protocols for screening, algorithms for assessment, and guidelines for evidenced based interventions. Implementation of the programs has included relevant education of nurses, close attention to uptake and utilization of practice guidelines, a context of continuous quality improvement, and the use of rapid cycle evaluations. Cancer nurses are expected to respond to the standardized distress scores by opening conversations with items that are of concern to patients. Evaluation has shown increased patient satisfaction with care. Patient concerns provide the focus for opening conversations with individuals and the basis for planning person-centered approaches to care. Patient concerns are identified beyond those related to tumor and side effects. Nurses are in an excellent position to respond to scores on a standardized distress screening tool as part of patient assessment. The assessments provide a foundation for individualized or tailored interventions. Margaret I. Fitch, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002B cancer is the most common cancer among women in Thailand. Despite the proliferation of reports in Western countries regarding the effectiveness of cancer support group and the benefit of changing health behaviors after cancer diagnosis in improving health and quality of life (QOL) of people with cancer, no cancer support group studies with an emphasis of health promotion and wellness have been conducted in Thai women with breast cancer. This study aimed to examine the effects of 5-weekly health promotion cancer support groups intervention, with three monthly telephone support on health promoting behaviors and QOL in Thai women with recently diagnosed breast cancer. The final sample consisted of 59 breast cancer women receiving treatment; 29 women were assigned to experimental group and 30 women to control group. Data were collected at three times: baseline prior to the intervention (T1), within two weeks of completion of 5-weekly group sessions (T2), and six months (T3). Research instruments were functional assessment of cancer therapy-breast scale and health promotion lifestyle profile II for assessing QOL and health promoting behaviors respectively. Using repeated measures ANOVA, the results revealed that women in experimental group, compared with those in control group, demonstrated significant improvement of health promoting behaviors and QOL both in short-term (Week 5-7) and long-term effect (6 months). These findings suggest that the health promotion cancer support group may be an efficacious psychosocial intervention for changing health behaviors and improvement of QOL in Thai women with breast cancer during and following treatment.T healthcare industry demands nurses function as leaders of interprofessional teams. The scope of practice of nursing has broadened and will continue to expand to include working within complex health systems and managing large groups of diverse people. Leaders in healthcare are needed to carry the multiple health initiatives mandated by changes in federal healthcare and private insurance carriers. Nurses are key stakeholders and players in leading change in healthcare. The Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health (2011,) issued a call to action for nurses to lead change in healthcare. In order to be a leader, self-confidence and knowledge of successful leadership qualities are needed. Nurses face many possibilities in leading effective change to promote optimal outcomes. It is important that nurses step up to this transformation call. There are 3.1 million nurses who have the potential to develop leading change. This session will define leadership and discuss how to engage others, encourage individual best performance, and acknowledge accomplishments toward the identified goals. Pam O’Neal, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002Small volumes of medication are routinely drawn from sterile vials and administered to patients as either a single drug dose or a combination of drug doses from multiple vials. However, the error associated with the accuracy of syringes and needles in combination with variability in practitioner technique can result in administration of doses that are outside of an acceptable limit of error. Measurement of some medications, especially potent drugs and drugs with narrow therapeutic margins (e.g., chemotherapeutic agents, radiopharmaceuticals, or pediatric dosing) requires high precision and accuracy for patient safety. The general rule of thumb in the measurement of liquids to measure at least 20% of the total volume of the instrument used in order to minimize error. However, no substantiated guidelines seem to exist for either the minimum or maximum volume for accurate measurement in a syringe. Clinically, unsubstantiated recommendations for measurement of small volumes in syringes varies including ranges of ±20%, similar to the guidelines for volumetric glassware, up to a minimum volume of 50% of the syringe capacity. These values differ significantly from the manufacturer specifications for syringes, which state a volumetric accuracy for syringes of ±5%. Current research from our laboratory validates the use of the so-called “20% Rule”. In addition, the dead space of a syringe tip and needle can be a source of error if not properly accounted for in dosage calculations, especially where a change of needle or mixing of multiple small volumes into a single syringe is concerned. This presentation will review calculations and avoidance some of the common pitfalls associated with syringe use, especially in measuring small volume and potent medications. Participants will gain a better understanding of syringe use, which will promote improved dosing accuracy and ultimately patient safety.The Centers for Disease Control (CDC) reports that in 2010, there were 129.8 million emergency department (ED) visits in the U.S.; only 25.1% of those patients were seen by a physician/mid-level provider within 15 minutes of arrival and the average a length of stay was 2-4 hours. We have re-imagined the way emergency care is delivered. The new process implements a two tiered triage approach; a first line Pivot team screens walk-in patients, designating a patient as sick or not sick. The Pivot process is brief, no vital signs or medical history is obtained and the patient is not formally registered until they are in an ED room. From Pivot, ‘sick’ patients are directly roomed and ‘not sick’ patients are sent to an intake room. When in intake, the patient is seen by a physician who conducts a medical screening exam, initiates orders based upon the patient’s presentation, and the patient is then roomed directly from the intake point. Changes to both nurse and ED tech staffing were implemented to create a team based approach to care for 6 to 9 patients. From the front end at intake to the back end at discharge ED patient flow has dramatically changed. In a matter of 3 weeks, we have seen a 12% increase in our ED census, while at the same time decreasing arrival to physician time by 55%, decreasing the number of patients who left without being seen to 0 and decreasing our average length of stay by 39%. Biography Robin Scott has 10 years of emergency nursing experience, 7 years of experience as an Emergency Department Nurse Educator and 1 year of experience as the Emergency Department Clinical Nurse Specialist. Robin.Scott@uchealth.orgPurpose: Sham feeding with chewing gum has been shown to promote bowel motility. This study is to determine whether sham feeding with chewing gum improves abdominal discomfort, nausea, vomiting, and drug compliance for the patients taking polyethylene glycol (PEG) solutions before colonoscopy. Methods: The study was conducted from August 15 to October 15, 2012. The participants were 131 patients who underwent colonoscopy at a hospital in Korea. The eligible patients were randomly allocated into two groups: a control group (n=65) and a gum-chewing group (n=66). The patients in the control group had PEG solutions according to the general protocol. The patients in the experimental group had PEG solutions while chewing one stick of sugarless gum during the resting phase. The categorical variables were analyzed using the Chi-square or t-test. Results: The experimental group chewing gum reported significantly lower abdominal discomfort (p=.005), nausea, and vomiting (p=.002) than the control group. Also, the drug compliance for the experimental group to PEG solutions was better than the control group (p=.006). Conclusion: Chewing gum was effective for abdominal discomfort, nausea, and vomiting for the patients in the preparation undergoing colonoscopy. Therefore, chewing gum is recommended as an effective, safe, inexpensive, and practical nursing intervention.I patients are at the highest risk of acquiring nosocomial infections, especially ventilator associated pneumonia. This acquired infection is almost always preceded by colonization with Gram-negative bacteria in the respiratory tract. In mechanically ventilated ICU patients, it is assumed that the multiple use closed suction system (CSS) reduces exposure risk to patient secretions and subsequently a reduces risk of bacterial contamination of patients, health care workers, and inanimate environment. Therefore, use of CSS is often preferred instead of the single use, open suction system (OSS). We performed a prospective multicenter crossover trial to determine whether CSS, as compared to OSS, reduced the incidence of cross-transmission of Gram-negative bacteria in ICUs. In total 1,110 patients were included (585 with CSS and 525 with OSS), of which 37% acquired colonization with Gramnegative bacteria, both after closed and open suctioning. One fifth of the acquisitions occurred through crosstransmission, again without significant difference between both systems. We could not demonstrate a difference in overall crosstransmission, nor in overall acquisition of respiratory tract colonization, between CSS and OSS. However, the risk of colonization increased with duration of mechanical ventilation, while use of systemic antibiotics decreased the risk. The assumption on CSS could not be confirmed, and both suction systems can be considered equally safe in mechanically ventilated ICU patients. Choice of system can be based on personal preference and costs. Irene P. Jongerden, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002O disease is pandemic in regions across the world. In Canada and the United States, dental caries is the number one pediatric chronic health disease. Oral health is an essential component of total health and can be a reliable and expedient indicator of general health. Dental disease can influence a child’s ability to speak, eat, and socialize and has been linked with heart disease, diabetes, asthma, pneumonia, and stroke. Despite this evidence, oral health care has not been emphasized in pediatric nursing. Recent studies have shown that, traditionally, the focus of pediatric oral health care has been on hygiene and dental caries, and this misconception by nurses has perhaps been one of the greatest barriers to oral health care in children and adolescents. The purpose of this presentation is to explore the factors influencing pediatric oral health and to describe the collaboration of the Colleges of Nursing and Dentistry within the Caring for Kids Where They Live program, which has been implemented in three Mid-Western Canadian schools. Integrating oral health care into the pediatric clinical nursing practicum has been highly successful as evidenced by identification and intervention of multiple urgent oral health problems and other important health issues. Details of the pediatric oral health assessment guide, follow-up, and referral processes will be discussed. Nurses are encouraged to support an approach to pediatric nursing practice that includes oral health care as an essential component of overall health and wellness. Shelley Spurr, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002Context: In an effort to improve the quality of patient care while maintaining patient safety, health care professionals are increasingly turning to up-to-date evidence to ensure better patient outcomes. In order to make informed decisions, health care practitioners, including nurses, must be skilled at introducing, developing and evaluating evidence-based practice. This article presents evidence related to the use of cardiac computed tomography angiography (CCTA) as adjuvant to the care of patients who present to the emergency department (ED) with acute chest pain. Using the Iowa model as a guide, the aim of this literature review was to provide an overview of the effectiveness of this technology and its implications for nursing care of acute chest pain in the ED. Method: PubMed database articles published in the English language from June 2008 to July 2013. Studies with an evidence rating scale (ERS) for evidence based nursing of IV or above were selected for review. Data was systematically extracted from each article included for review. A summary of key findings are reported. Results: This review found that CCTA has an excellent negative predictive value and a strong sensitivity and specificity for diagnosing coronary artery disease and ruling out acute coronary syndrome in patients with low-to-intermediate risk of coronary artery disease. Using this CCTA, patients can be safely discharged to home, often from the ED, in less time and at a lower cost than the current standard of care. In addition, recent technological improvements in scanning equipment, coupled with improved scanning protocols, has significantly reduce the radiation exposure associated with these scans, which is the most significant limiting factor. Conclusions: CCTA is an efficient tool for the evaluation of low-to-intermediate risk patients presenting to the emergency department with the primary complaint of acute chest pain. Joan Catherine Widmer, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002W the need for transacting caring is widely advocated, research-based strategies for its implementation in nursing education are not well articulated. Justifying nursing programs in higher education might not be as convincing as it should be in some countries. A study based on a qualitative approach recently conducted in Singapore to gain insights into the transaction of caring could not be timelier for infusing some useful considerations to the current debates in nursing education. The focus of the study was on students’ perspectives but participants included nurse lecturers, clinical instructors in the hospitals and patients in their care. Non-participant observations of student interactions with others and semi-structured interviews of students were conducted to elicit relevant information for content analysis of the emerging themes. Results demonstrated that caring was viewed as two distinct aspects of instrumental and expressive caring in varying combinations for quality patient care by students. Both were transacted in classroom settings and were considered by students as essential for building confidence in clinical practice. Students felt that the opportunities for learning caring were bountiful in clinical placements. However, students benefited more from nurse lecturers who in their opinions were good at explaining the clinical observations. The myths of clinical placements as being the best for transacting caring were dismissed. Successful caring transaction undoubtedly demanded clinical opportunities, but more critically, it needed consciously engineered teaching strategies at every level of students’ daily nursing educational experience; in a controlled and safe learning environment within the higher educational context. Jennifer C. F. Loke, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002To assess the performance of graduates based on selected nursing duties after completing a post registration Baccalaureate nursing programme of the University of the West Indies, St Augustine, Trinidad and Tobago. All 273 graduates of the programme were asked to provide their self-assessment of their performance using a Likert-like scale. Additionally, 110 supervisors rated their satisfaction with graduates’ performance using a self-administered Likert-like questionnaire. Response rates were 67.4% and 60.1% for graduates and supervisors respectively. Results show that 73.4% of the graduates are aged 21-40years, while, 82.2% of the supervisors are 41 years or over. The mean scores from the supervisors were highest in Leadership (4.09) and lowest in “managing challenging situations” (3.22) while Graduates scored 4.41 and 3.87 for “Teaching junior nurses” and “Leadership” respectively. Results have shown high and positive agreement in the scores of the performance of the graduates but significantly discrepant scores on some of the nursing duties (p<0.05).Introduction: The trauma charge nurse role at a Level 1 Pediatric Hospital benefits the emergency department, the trauma patients, the trauma service, the hospital itself and the community. Methods: The trauma charge nurses (TCN) are emergency department (ED) nurses who have passed off a trauma module which is made up of individual learning units, simulated skills pass-off stations and hands-on bedside nursing care of trauma patients. The TCNs are staffed 24/7 in the ED to insure that there is an RN with a high level of clinical expertise available to take care of patients at all times. In addition to being a clinical resource to the ED, the TCN is the bedside nurse for all high acuity trauma patients and coordinates the mobilization and response of the hospital trauma team to care for all trauma patients in the ED. The TCN also acts as a liaison for the ED with the hospital trauma team for communicating changes in procedures, process improvement, etc. In addition to their duties in the hospital, the TCNs provide pediatric trauma education to EMS agencies and community safety fairs throughout the state. Results: The trauma charge nurse role in the emergency department has helped to improve the care of the trauma patients in this Level 1 Trauma Center since the roles inception 12 years ago. Although the TCN role was initially set up to give the trauma team a consistent core group of nurses in the ED caring for the trauma patients, the TCN role has benefitted the ED, the hospital and the community. Conclusion: The TCN role has strengthened the trauma program and the ED at this Level 1 Trauma Center. Rhonda Carter, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002Aim: The aim of this research was to examine the therapeutic impact of the provision of a lifelike baby doll as a therapeutic tool, on the behaviour of a person living with dementia. Specifically, the research assessed the potential benefits, if any, of the use of doll therapy in reducing behaviours of concern such as anxiety and agitation that may be associated with observed past attachment needs of a person with dementia. Method: A single, female participant, with moderately advanced Alzheimer’s disease was the subject of this research to examine the therapeutic impact of the use of a doll on behaviours of concern, attachment needs and social interaction. The study used both qualitative and quantitative research designs and methodologies in data collection and analysis. Results: Results demonstrate that doll therapy was a positive intervention for the person living with dementia who was the participant in this research. The findings indicate significant reduction in behaviours of concern related to the need for attachment and a considerable decline in levels of anxiety and agitation. There was extensive ongoing improvement in social interaction, selfworth and communication. Conclusion: Crucially, this study advances an understanding of a) the use of a doll as a therapeutic tool on the behaviour of a person living with dementia; b) the long term attachment needs of the participant to reduce or prevent behaviours reflective of other needs; c) the effect therapeutic interventions on the well-being of the participant. It also extends an understanding of the use of complementary therapy to inform professional practice; to promote opportunities for the exchange of knowledge; and to stimulate research and promote best practice. This study will also contribute to the general body of knowledge about the use of complementary therapy to meet past attachments needs and to improve the continuity of an uplifting life experience for people living with dementia. Further, the benefits of this research will encourage a change in attitude to one of the many alternative therapeutic ways of meeting the specific requirements of a person living with dementia. The outcome also provides further evidence of an improved quality of life, growth and fulfilment in the maintenance of self to assist other people with similar needs. As professionals, we need to build upon this evidence to promote therapeutic interventions that demonstrate another valuable way forward in the provision of person-centred dementia care. This single case study may also provide the impetus for aged care providers to develop an increased sensitivity to contribute to, and promote, therapeutic interventions that encourage positive ageing and wellbeing of people living with dementia. Leah Bisiani, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002P problems account for at least 5.4% of all emergency department (ED) visits, and the rate of psychiatric-related visits has increased 15% since 1992. The World Health Organization ranks major depression as one of the most prevalent and disabling diseases in the world, and the lifetime prevalence of major depressive disorders in the United States is 16.2%. Depressed patients also have associated anxiety disorders (almost 60%), substance use disorders (24%), and impulse control disorder (30%). There are over 33,000 suicides in the US yearly and the number is climbing with war veterans. These patients present to ED’s with a myriad of complaints and it is up to the clinician to identify the risk. The specific diagnosis for patients presenting to the ED with psychiatric complaints and the common clinical presentations are a mandatory knowledgebase for emergency care providers and nurses. The safety of providers when encountering these often volatile patients is pertinent and how to maintain that safety will be discussed. And in context to management of the patient to offset their exacerbation medication regime will be determined. Most importantly the world wide epidemic of psychiatric illness and its ramifications if not managed will be elaborated upon with hope for a healthier future. Elda G. Ramirez, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002Background: As of fiscal year 2013-2014 hospitals are being reimbursed based hospital’s VBP scores. The VBP score is based 70% on clinical processes and outcomes of care and 30% on patient reports of care on the HCAHPS Survey. Purpose: The purpose of the study was to determine if there are differences in the occurrence of 30-day mortality and readmission rates (for MIs, CHF, and pneumonia) between hospitals based: teaching status, Magnet status, hospital ownership, geographical location, and bed size. Methodology: This study was a secondary data analysis of data collected by the Centers of Medicare and Medicare Services. Measures /Outcomes: Outcome measures included 30-day mortality and readmission rates (for MIs, CHF, and pneumonia). Conclusion: The hospital characteristics investigated demonstrated varied results depending on the outcome measures investigated. Many of which may have a significant impact on Medicare reimbursement with the VBP program roll out. This study provides a good baseline of data to build upon with future longitudinal designed studies.S of oral and pulmonary secretions is a common procedure performed daily across patient care areas and settings. The purpose of pulmonary suctioning is to remove secretions in the oral cavity, tracheal, and bronchial areas to improve gas exchange. The focus of this presentation is on quality pulmonary secretion recovery and removal to optimize patient comfort, satisfaction, and oxygenation. Quality in suctioning is a concept that can be transitioned to the bedside and adopted in practice by considering the patient (characteristics and clinical conditions), the process (suctioning practice standards, evidenced based practice guidelines, and equipment function), and performance indicators such as health outcomes (morbidity, secretion recovery, patient satisfaction, and improved airway oxygenation). Adopting Donabedian’s Quality Framework related to structure, process, and outcomes can guide the improvement of quality in suctioning and secretion recovery. Various questions posed in the clinical setting will be addressed. How quality of suctioning is assessed and measured? What are associated patient outcomes of a quality suctioning event? How do you determine effective suctioning pressure? What is infection control and quality control of suctioning equipment? Pam O’Neal, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002T many guest workers who migrated during the 1960s and 1970s from Mediterranean to central European countries entered the age of retirement. The formerly vital, strong and healthy often are in the need of care, suffer from chronic illness or struggle with the burden of age. In severe cases, younger family members are not able to cope with problems like dementia and bed riddenness in the care of their elderlies. This situation in general challenges programs and offers of elderly care: How to include migrants’ special needs in elderly care and how to implement a culturally conscious care? It can be observed that elder migrants may have a certain reservation against nursing homes, often because of language barriers and divergent culturally shaped expectations expressed by meal preferences, a pronounced sense of shame, or religion. In my talk, I will thus focus on what kind of health care offers migrants typically accept. Furthermore, and more importantly, I will present distinct model examples of culturally specific and sensitive offers in elderly care in Germany and Switzerland for Turkish and Italian migrants, which can be regarded as development during the paradigm of the so-called ‘intercultural opening of the elderly care’. Typical elements of language and cultural competency will be discussed. Finally, the given examples demonstrate how elderly care in central European countries prepares to encounter the demand of individual care’ in a diverse society. Nevin Altintop, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002B play a key role in basic and translational research, by contributing to advance the development of new therapies and drugs. Biobank processes involve a number of professionals including pathologists, geneticists, bioinformaticians, and lawyers. Biobanks also involve a number of “non health-related professionals”, such as patients, patient families, patients’ organizations. These two categories are different and often distant by speaking different languages and having different mentalities. Based on their education and experience, nurses may play a key role in bringing together biobank professionals and specimen donors. Usually, biobanking issues relate to consent handling and return of results to patients or patient families. Nurses can contribute to resolve controversial issues both in adult and pediatric biobanks by taking part in consent processes and result communications. By moving from clinical or research practice to biobank processes, nurses can provide adequate information to patients and patient representative about the use of specimens for therapeutic or research purposes. Nurses can also serve as liaison between biobankers and patients when relevant health results emerge from research based on biobanks. By promoting a new role and competence of nurses in biobanking field can be a good way to deal with recurrent and onerous issues. Elena Salvaterra, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002T prevalence of hypertension and pre-hypertension in the pediatric population is increasing. The development of primary hypertension earlier in life increases the chances of cardiovascular morbidity and mortality later in life. Studies have already shown that 34 to 38% of children and adolescents with mild untreated hypertension already show signs of left ventricular hypertrophy. Evidence shows that childhood and adolescent hypertension and pre-hypertension are under recognized due to a number of factors including lack of provider knowledge regarding the National High Blood Pressure Educational Program (NHBPEP) guidelines for diagnosing, evaluation, and treatment of high blood pressure in children and adolescents. Another issue is the complexity of diagnosing HTN in this population that requires utilizing 1,904 variables based on gender, age, and height percentile delineated from the CDC development charts. To more easily detect hypertension in children and adolescents, a Smartphone application, Pedia BP, was designed and developed. The existing tables from The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents (NHBPEP, 2005), which contain hundreds of normal and abnormal blood pressure values based on gender, age, and height percentile, were analyzed and streamlined into a much simplified, single user interface Smartphone application. Pedia BP makes it easy to identify abnormal blood pressure values in an accurate and timely manner in any setting where internet access is available. The time saving Pedia BP application, allows the practitioner to quickly follow best practice protocols regarding management of identified issues. Hope Bussenius, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002Acute stroke is the leading cause of morbidity and the 4 th leading cause of death in the country. Prevention is key, however stroke does occur, the treatment modalities are aimed at mitigating secondary brain injury. Tissue plasminogen (t-Pa) has been an effective treatment in acute stroke, but is limited in terms of which patients can receive it due to the strict time window. Newer strategies are aimed at treating stroke based on tissue perfusion and not a set time frame utilizing neuroimaging. Additionally, t-Pa is of limited use when the patient presents with a large vessel stroke. Interventional stroke treatment is the gold standard in reanalyzing vessels in appropriate patients. Nurses need to be aware of the available treatment modalities that are available for stroke patients and understand the implications for patient care afterwards. In this lecture, the various types of strokes that occur, which patients are appropriate for treatment, uses of neuroimaging and what modalities are available both now and what is in development will be discussed. Current guidelines will be reviewed as well as evidenced based practice. Biography Catherine Harris, Ph.D., MBA, CRNP is an Assistant Professor at Jefferson School of Nursing and an advanced nurse practitioner in neurosurgery with expertise in neurological critical care and the management of acute stroke patients. She works at Jefferson Hospital for Neuroscience in Philadelphia, a leader in comprehensive stroke care and cerebrovascular diseases. She completed her Ph.D. in 2011 from the University of Pennsylvania with a focus on cerebrovascular injury and Master’s in Nursing in 2005. She is board certified in Adult and Acute Care and has spoken extensively both nationally and internationally on topics of ischemic and hemorrhagic stroke. catherine.harris@jefferson.eduD is the sixth leading cause of death in the United States. There are over 15 million caregivers supporting loved ones with dementia. More than 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of care giving as high or very high and one-third report symptoms of depression. Given these numbers, an approach that is helpful and effective for both the person with dementia and the care giver is important. Approaching this vulnerable population, both the family and the person with dementia, with compassion and holistic care is essential. Searching for an approach to care for that will be effective for both the caregiver and the person with dementia can seem overwhelming. However, in Burford England a wraparound model of care has been in place for over twenty years. Results with this method demonstrate decreased anxiety for both the caregiver and the person with dementia. This approach also shows that the care giver will provide care that is respectful and maintain dignity throughout the dementia disease for both the person and the family. Based on the foundational principles of person centered care, this session will provide participants a framework and relational strategies that have positive impact when caring for dementia clients and their family. An emerging behavioral approach will be described with expected measurable results that can be achieved for the person with dementia and the care team. This will be a practical “hands on” approach to care, allowing participants to have an experiential learning session. Margo Karsten, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.0021. To compare the impact of the two training strategies (5 contacts) on the status of maternity care preparedness among primigravida women in the study population 2. To ascertain the feasibility of operating a maternity care room in Gyne/Obst OPD of a tertiary care hospital of north India. Research Design: A two group randomized controlled trial design was used. Research Setting: Out Patient Department, Antenatal Clinic, Labour Room, Postnatal Wards.Target population and Study Unit: Primigravida mothers Visit 1: Topics covered in Training Package I (13-20 weeks of gestation) Minor disorders during pregnancy, Warning signals during pregnancy, Self care during pregnancy. training package (TP1) Group B received manual as well as counseling & Group A received only manual for self reading. Visit 2: Topics covered in Training Package 2 (30-32 weeks of gestation) Anatomy & Physiology of labor, what to do during labor, warning signals during labor, Self – care during pregnancy and labor. Visit 3: Topics of Training Package 2 were repeated. Visit 4: Topics covered in Training package 3 (on the first day after delivery) 1. Anatomy & Physiology of breast, self care of mothers during puerperium, care of the baby Warning signals for mothers and babies. Visit 5: Follow-up (6 weeks after delivery): Schedule for collection of data pertaining to outcome variablesUnderstanding issues with teaching and learning for Culturally and Linguistically Diverse (CALD) learners will increase the capacity of nurse academics in supporting CALD learners to become socialised into the culture of the university and succeed in their studies.Literature indicates nurse academics need to engage in cultural inclusive teaching practices to meet the needs of CALD learners and move away from using a mono-cultural approach. More importantly, nurse educators need to be mindful that they do not stereotype learners based on their cultural background but instead reflect and askquestions such as: Is my classroom atmosphere open and positive for all students? How can I encourage collaborative as opposed to competitive learning between my students? How can I ensure my students feel comfortable learning in a culturally diverse environment? How do I help students from disadvantaged and diverse cultural backgrounds so they do not feel inadequate compared to their peers? By reflecting on these questions, nurse academics can createa supportive learning environment and use teaching approaches that resonate with intercultural pedagogy, especially those that promote interdependence and collective sharing of knowledge. In this paper, the author shares cultural inclusive teaching practices,such as, engaging students in collective dialogue, optimizing on CALD students’ lived experience in role paly, and promoting peer teaching, that they had used successfully to influence, motivate and inspire students to learn.S disturbance is a common complaint during pregnancy, particularly in the third trimester. Aim of the study was to investigate sleep patterns and sleeping disorders among low risk and high risk pregnant Saudi women. A descriptive crosssectional design was utilized for this study. The study was conducted at King Khaled National Guard Hospital, King AbdulAziz Medical City, Jeddah. Simple random stratified sample of 300 pregnant women were recruited for the study, the study included pregnant women who were in the first, second and third trimesters of pregnancy, both low risk and high risk pregnant women. Data was collected with the use of self-administrated questionnaire and Modified Epworth Sleepiness Scale to collect data related to sleep patterns and disorders among pregnant women. Results of the study indicated that more than half of the studied sample was low risk (61.3%) where 38.7% were high risk. The most common problems among the high risk pregnant women were gestational diabetes, anemia, hypertension, respiratory problems and urinary tract infection. It was found that the overall dimensions of chance dozing mean score ranged from 0.00 to 2.5 with a mean of 0.94±0.53, women who were in the first quarter of pregnancy have highest mean score of week-day sleeping time (8.62±3.80) as compared with women who were in the fourth quarter of pregnancy (5.96±4.48). As for symptoms of sleep apnea results indicated that 55% never have awaken choking while 42.67% sometimes have awaken chocking, (61.33% ). Result indicated that there was a statistically significant difference between common sleeping problems and gestational age of pregnant women (X2=39.59; p≤0.05). Moreover, the highest mean percentage of common sleeping problems was recorded for leg cramps style (34.33%). Abeer Eswi et al., J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002Introduction: Venipunture can be classified as a minor invasive procedure but for children it is accompanied by pain, fear and anxiety. Health care professionals in the clinical setting have a responsibility to reduce pain and anxiety as much as possible while maintaining patient safety. Hence this study was carried out with objective to assess the effectiveness of animated cartoons as a distraction strategy to reduce perception of pain and fear among children of 3-6 years age undergoing venipuncture. Method and Material: The study was conducted for a period of 8 weeks. The study sample was 50 children of 3-6 years age who were undergoing venipuncture, through purposive sampling method. During the first venipuncture, children were assessed at pre, during and post venipuncture for perception of pain and fear with routine care only and during the second venipuncture with routine care and animated cartoon. FLACC, behaviour pain scale and Ottawa Georgia mood scale were used in the study. Result: The animated cartoon was found significantly effective in reducing the perception of pain and fear among children undergoing venipuncture. The results revealed that there is significantly (p<0.001) less pain related behavioural responses as well as decreased perception of fear with animated cartoons as intervention at pre, during and post venipuncture. It is an effective, easy, economical, and non-pharmacological intervention which needs limited training and can be used in clinical setting. Sandhya Ghai, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002I who are diagnosed with cancer experience more than a physical impact. There are emotional, psychosocial, spiritual, and practical consequences as well. While some individuals manage to cope successfully with the many changes, others experience on-going difficulty and emotional distress. If unchecked, this emotional distress can escalate and eventually interfere with problem-solving, adherence to treatment, and overall adjustment. The wide range of variation in coping behaviors and adaptation stages make selecting the correct intervention challenging. Clearly, astute assessment is required as the basis for developing a tailored approach to interventions. If the supportive care needs of those living with cancer are to be met appropriately, intentional approaches are needed in busy clinical settings to identify, assess, and manage the distress. Without concrete efforts, the supportive care needs may easily be overlooked and the predominant focus of the health care team will remain on tumor assessment and treatment. Person-centered or whole person care will not be the focus of the team’s interactions. This presentation will outline the supportive care needs of cancer patients and summarize the evidence concerning the level of unmet need in cancer populations. Programmatic approaches to identify patient concerns and distress related to their supportive care needs, assess at a deeper level when necessary, and intervene based on relevant evidence will be discussed. Cancer centre need to be thinking about adopting programmatic approaches for this area of care as health service accreditation standards cite attention to supportive care needs of patients as a requirement within quality patient care. Margaret I. Fitch, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002Background: Research indicates aggression prevention requires a systematic process for identifying high risk individuals on arrival to the ED. This paper will discuss how aggression risk screening was developed and present preliminary findings. Method: Audit: A 12 month retrospective audit of security responses (N=1959) to manage aggression were analyzed. The sensitivity and specificity for the implementation phase identified if triage nurses can identify patient who will require an emergency response during ED treatment. Observations: Purposive samples of 10 triage nurses were observed to record how risk screening could be used. Public perceptions: Semi structured interviews with a convenience sample of ED service users (N=19) used thematic analysis to summaries participants’ perspectives on aggression screening. Results: A high risk group of patients presented more than once in 12 months was identified. Although this group represents only 12% (105/857) of patients, they accounted for 577/1796 (32%) of emergencies. Observing triage practice revealed that nurses’ use observed and reported information rather than direct questioning. Interviews revealed a strong expectation that nurses identify and manage risk of aggression at triage in order to protect the public. Over half the patients who required a security response were identified at triage. Conclusion: This study developed an aggression risk screen that is integrated with current ED triage nurse practice. This process allows for prevention to commence once patients at risk of aggression/violence are identified. Cathy Daniel et al., J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.002Background Communication issues amongst healthcare professionals and the patients are a major problem in the clinical area often resulting in medical errors that lead to death or permanent disability for many patients. Most of these errors are preventable. Although there is significant evidence to support the use of mobile technologies in the clinical area, nurses have been slow in adopting these technologies. The main reasons are hospital policy and tradition however with the advent of the smartphone nurses are now using this device to support clinical communications and workflow. Objectives This paper reports on the preliminary findings (focus group discussion) of a research project investigating the use of iPhone’s by nurses in a gynaecological unit at the Royal Women’s Hospital, a major teaching hospital in Melbourne Australia. The study will ascertain whether the iPhones improved nurses’ communication and decision making processes which indirectly have the potential to impact positively on the quality and safety of care provided to patients. Methods The research design employed both quantitative and qualitative methods: a cross sectional survey and focus group discussions to determine the impact and the use of the iPhones by twenty nurses in the gynaecology unit. To date the 12 month trial period has commenced, and the first focus group discussions have been completed. Results The positive findings from this qualitative data showed that the iPhones enhanced communication in the workplace, especially amongst the nurses, followed by physicians. Another advantage was the accessibility and portability of the device when providing point of care to the patients, resulting in more efficient and effective care. All the nurses also believed that this technology would evolve and be embraced by all nurses in the future. The negatives were the small screen when undertaking bedside education for the patient and the invasive nature of the device. Another issue was the perception of being viewed as unprofessional when using the device in real time with the patients and their family. Conclusions In conclusion the use of smartphones will be adopted by all nurses in the future and nursing managers and educators will need to ensure that policy is developed so that this occurs. This will require a cultural change from nursing administrators and educators as there is still a perception that nurses will use these devices in appropriately, that is checking their email and Facebook. Keywords: iPhones, acute care, communication, decision making, nursing []

Following patients with acute abdominal pain in emergency departments

Background The Danish health care system is reorganizing care and treatment of acute patients in the hospitals by replacing the emergency departments and departments that receive acute patients with emergency departments with observation units. The objective is to study the professional efforts and experiences of patients with acute abdominal pain in an acute visitation unit for abdominal surgery (AVUAS) versus an emergency department with an observation unit (ED).