Janice A. Neil

Disease-specific quality of life-patient acceptance: racial and gender differences in patients with implantable cardioverter defibrillators.

Background:Despite its established effectiveness, living with an implantable cardioverter defibrillator (ICD) is associated with ongoing physical and psychosocial distress. Little is known about which factors impact the patients’ adjustment to living with the device and whether there are racial or gender differences related to these factors. The purpose of this study was to investigate factors (demographic, clinical, psychosocial, and religiosity) related to patients’ ICD acceptance and to examine racial and gender differences in ICD acceptance. Methods:A total of 101 ICD patients (mean age, 65 ± 12.8 years, 34% female, 42% African American [AA]) seen in a cardiology clinic between January and August 2010 completed the Florida Patient Acceptance Survey (FPAS), Florida Shock Anxiety Scale, ENRICHD Social Support Instrument, Hospital Anxiety and Depression Scale, Hoge Religiosity Scale, and a demographic sheet during their clinic visit. Results:All multiple-item scales demonstrated good internal consistency reliability, with Cronbach &agr; values ranging from .77 to .89. Overall patient acceptance of the ICD was high, with an average FPAS acceptance score of 80.9 on the 0-to-100 point scale. The FPAS subscale scores indicated that the group was very positive about the benefits of having the device (mean, 90.3) and had few body image concerns (mean, 10.6), low device-related distress (mean, 15.6), and moderate return to function scores (mean, 63.0). White ICD participants were more accepting of their device than AA ICD patients were, scoring statistically significantly higher than AA patients on total patient acceptance and return to function and significantly lower than AA patients on device-related distress and shock anxiety. Controlling for ethnicity (&bgr; = .10, P = .15), age (&bgr; = .01, P = .90), and number of comorbidities (&bgr; = .19, P = .003) in a hierarchical multiple regression, shock anxiety (&bgr; = .31, P < .001), knowledge of the device (&bgr; = .23, P = .001), social support (&bgr; = .13, P = .08), Hospital Anxiety and Depression Scale anxiety (&bgr; = .06, P = .51) and depression (&bgr; = .25, P = .01), and importance of religion (&bgr; = .17, P = .01) explained 46.8% of the variance in FPAS scores. Conclusions:Although overall patient acceptance was high, AAs in the study had statistically significant lower mean total Florida Patient Acceptance Scale scores and Return to Function scores than whites did and higher Device-Related Distress scores. The strongest predictors of patient acceptance for the total group were shock anxiety, depressive symptoms, and device knowledge. African Americans had significantly lower device knowledge scores and higher shock anxiety scores than whites did. These findings suggest that ICD patients, especially AA ICD patients, may require education and psychosocial measures to enhance acceptance of their device. This study supports a holistic and culturally sensitive approach to focused clinical and psychological assessment and interventions for those living with this life-saving technology.

Perioperative Nursing Care of the Patient Undergoing Bariatric Revision Surgery

Obesity has become a major health concern in the United States. The number of patients seeking bariatric surgery has grown exponentially in recent years because of the proven success of weight-loss surgery, greater public acceptance, and the increasing number of insurers who will pay for these surgeries. Patients may seek bariatric revision procedures if the primary procedure does not achieve the desired results, if he or she gains back the weight lost after the primary procedure, if the comorbid conditions associated with obesity were not resolved, or if severe adverse effects and complications have occurred as a result of the primary bariatric procedure. Perioperative nurses must be knowledgeable about how to care for bariatric surgery patients with skill and compassion.

Perioperative Care of the Immunocompromised Patient

Immunity refers to the bodys capacity to resist invading organisms and toxins, thereby preventing tissue and organ damage. A patient whose immune system is impaired may be at higher risk for untoward perioperative events. Some populations most at risk for immunocompromise include infants, geriatric patients, people who have undergone organ transplantation, and people with cancer. Patients who are immunocompromised have an increased risk for hypothermia, which can affect postoperative wound healing processes and can increase the risk of wound infection. This article provides a basic overview of the immune system, a discussion of common disorders and diseases of the immune system, and a guide for perioperative nurses to use when they care for a patient who is immunocompromised.

The stigma scale: measuring body image and the skin.

&NA; People with chronic wounds or skin conditions often face not only physiological challenges, but also emotional ones as well. Measuring these emotional challenges and, more broadly, the emotional challenges of having a skin defect was the focus of this instrument development study.

Seizing the Moment: Experiences of School Nurses Caring for Students With Overweight and Obesity:

School nurses are well positioned to assess, intervene, and evaluate efforts to positively impact students who are overweight or obese. The purpose of this qualitative, descriptive study was to explore the experiences of school nurses providing care to children living with overweight and obesity. Data were collected through face-to-face, tape-recorded, in-depth, open-ended interviews with 10 school nurses from rural areas of North Carolina working with minority and low-income children in the public school setting. The text of the interviews was transcribed and analyzed into codes, categories, and themes. Three themes and eight subthemes were identified. The three themes were identified as (1) “jumping hurdles,” (2) “seize the moment,” and (3) “moral distress.” The findings of this study can be used to provide a better understanding of the experiences of school nurses caring for children with overweight and obesity that is necessary for planning successful school-based interventions.

Enhancing nursing care by understanding the bariatric patient's journey.

Patients who undergo obesity-related bariatric surgery seek a lasting solution to weight loss and a desire for a healthier lifestyle. Perioperative nurses should be prepared to provide sensitive, high-quality care to this population. Effective assessment and management of bariatric patients involves understanding the motivating factors for seeking bariatric surgery, such as to address the stigma and health problems associated with obesity. Nurses should be knowledgeable about expected outcomes of bariatric care, including long-term processes and lifestyle changes that patients must participate in to sustain weight loss. The informed perioperative nurse is essential to the successful treatment of bariatric patients in their journey to healthier living.

Lower extremity injuries sustained while farming.

Abstract Todays complex farm environment can pose many threats to the lower extremities of all people especially those with chronic diseases that affect the lower extremities. The purpose of this study was to investigate the incidence of injuries to the lower extremities among farmers and to rank the importance of these incidents in order to plan prevention programs. One hundred farmers were surveyed at a large farm show in the southeastern United States. An average of 4.86 injuries per farmer were reported. Blisters from work shoes or boots, followed by injuries from animals stepping on the feet were the most common injuries. Since those with chronic illnesses are especially prone to injury and disability, regular foot assessments, evaluation, and education about the hazards of farming are mainstays of prevention.

Farmers with diabetes: risks for lower extremity injury and disability.

ABSTRACT There are over 15 million persons with diabetes mellitus in the United States. Amputation of the feet and legs due to the complications of diabetes is one of the biggest threats to persons with diabetes and can result in permanent disability. Extrinsic factors including improper footwear, mechanical trauma, and thermal injury increase the risk of ulceration in the insensate foot. Farming is well known to be one of the most hazardous occupations. The complex farm environment poses extra threats to those with diabetes. This paper discusses some of these threats and suggestions for prevention of lower extremity ulcers.

Research in the Rehabilitation Unit Presents Challenges to Nurse Researchers

Purpose: Gathering data from patients on a rehabilitation unit poses challenges for nurse researchers. Design: A case study is presented that describes ways the researchers attempted to meet these challenges while conducting their study. Methods: The case study presents the approaches that the investigators took to undertake the study and then described the ways in which these approaches could have been improved. Findings: Their successes and failures are described. Conclusions: Suggestions are made for future investigators. Clinical Relevance: Clinical nursing research is required to develop an evidence base for practice in the rehabilitation unit. An analysis of the challenges and possible methods of overcoming these challenges is useful to both future investigators and nurses in practice to insure that studies can be carried out effectively.