Jo-Ann V. Sawatzky

Stress in critical care nurses : Actual and perceived

OBJECTIVE To describe the stressful work experiences and the perception of stress in female critical care nurses, and to explore possible relationships between these variables. DESIGN A descriptive, correlational study. SETTING Two Canadian, university-affiliated, tertiary care hospitals. SUBJECTS A convenience sample of 96 female nurses, with at least 1 year of critical care experience, currently working in adult intensive care units. INSTRUMENTS Subjects were administered a demographic instrument, the Critical Care Nursing Stress Scale, and the Perceived Stress Scale. RESULTS Ranking the stressful work situations revealed that patient care-related stressors ranked the highest overall. Although lack of control appeared to be a common element among those situations ranked as the most stressful, there was considerable diversity in the stressor rankings between the individual units. There were significant correlations between perceived life stress and the perceived severity of work stressors (r = 0.296, p < 0.005), as well as between actual (frequency) and perceived (intensity) stressful work events (r = 0.50, p < 0.001). CONCLUSIONS This study provides valuable insight into the actual and perceived stressful experiences of critical care nurses, thus contributing to the ongoing effort to reduce burnout in this population. The findings also establish a foundation for further nursing stress research in the context of the Adaptation Nursing Model.

Teaching Excellence in Nursing Education: A Caring Framework

Nursing education plays a central role in the ability to practice effectively. It follows that an optimally educated nursing workforce begets optimal patient care. A framework for excellence in nursing education could guide the development of novice educators, establish the basis for evaluating teaching excellence, and provide the impetus for research in this area. However, a review of the social sciences and nursing literature as well as a search for existing models for teaching excellence revealed an apparent dearth of evidence specific to excellence in nursing education. Therefore, we developed the Caring Framework for Excellence in Nursing Education. This framework evolved from a review of the generic constructs that exemplify teaching excellence: excellence in teaching practice, teaching scholarship, and teaching leadership. Nursing is grounded in the ethic of caring. Hence, caring establishes the foundation for this uniquely nursing framework. Because a teaching philosophy is intimately intertwined with ones nursing philosophy and the ethic of caring, it is also fundamental to the caring framework. Ideally, this framework will contribute to excellence in nursing education and as a consequence excellence in nursing practice and optimal patient care.

Improving cardiovascular health with motivational interviewing: A nurse practitioner perspective

Purpose: The purpose of this article is to provide nurse practitioners (NPs) with an evidence‐based counseling strategy for motivating patients to adopt healthier cardiovascular lifestyles and reduce their cardiovascular disease (CVD) risk. A comprehensive overview of motivational interviewing (MI), framed within the context of the transtheoretical model of change (TTM), demonstrates how primary care NPs can utilize this counseling approach to optimize cardiovascular outcomes in their patients. Data sources: Published original research and review articles in scholarly journals on the following topics: MI; advice giving; counseling techniques; TTM; CVD; quality NP care. Conclusions: Although the major risk factors for CVD are largely preventable, CVD rates are increasing to epidemic proportions. Traditional advice giving to decrease CVD risk is minimally effective. MI combined with TTM is an effective counseling technique, which motivates patients who are resistant and ambivalent to change. MI is an appropriate, evidence‐based strategy to promote cardiovascular health. Implications for practice: NPs working in primary care can integrate MI with TTM into ongoing patient encounters to facilitate positive behavior changes in their patients over time. Thus, NPs can play a key role in decreasing the growing burden of CVD in North America.

Prehabilitation program for elective coronary artery bypass graft surgery patients: a pilot randomized controlled study:

Objective: To determine the feasibility of a cardiac prehabilitation (Prehab) program for patients waiting for elective coronary artery bypass graft (CABG). Design: A two-group parallel randomized controlled trial. Setting: Medical fitness facility. Subjects: Seventeen preoperative elective CABG surgery patients were randomized to standard care (n = 9) or Prehab (n = 8). Intervention: Standard care: three-hour preassessment appointment. Prehab: exercise and education classes for 60 minutes/day, twice weekly for at least four weeks. Main measures: Data were collected at baseline, one week preoperatively, and three months postoperatively. The primary outcome measure was walking distance using a 6-minute walk test. Secondary outcome variables included 5-meter gait speed, and cardiac rehabilitation attendance three months postoperatively. Results: Fifteen patients (standard care, n = 7; Prehab, n = 8) completed the study. No Prehab patients developed cardiac symptoms during study participation. Walking distance remained unchanged in the standard care group; whereas, the Prehab group increased their walking distance to mean ± SD 474 ±101 and 487 ±106 m at the preoperative and three month postoperative assessments (p < 0.05). Gait speed was unchanged in the standard care group, but improved in the Prehab group by 27% and 33% preoperatively and three months postoperatively, respectively (p < 0.05). Enrollment in cardiac rehabilitation three months postoperatively was higher for Prehab participants (100%) than standard care participants (43%; p < 0.05). Conclusion: These data provide evidence for the feasibility of a Prehab intervention to improve the health status of patients waiting for elective CABG surgery. A larger trial of 92 patients will be utilized to demonstrate the safety and efficacy of Prehab.

Transitioning Into the Nurse Practitioner Role Through Mentorship

Transitioning into the nurse practitioner (NP) role is stressful. The stress arises from both internal or personal and external or organizational and professional sources. The novice NP may have a sense of inadequacy and lack of confidence in the ability to provide optimal patient care. The organizational expectations to be clinically competent and able to meet the demands of a complex health care system can be overwhelming. Most NP programs excel in their ability to provide the didactic information and clinical exposure necessary for the beginning-level practitioner; however, additional guidance and support are essential for the novice NP to evolve into an expert clinical practitioner. To this end, mentorship is an effective transition strategy for novice NPs. An awareness of the many stressors facing the novice NP, the benefits of mentorship, and how an effective mentoring relationship can ease the transition establishes sound rationale for mentoring as a strategy for optimal transitioning into the NP role.

The Coronary Artery Bypass Graft Surgery Trajectory: Gender Differences Revisited

Over the past several decades there has been substantial research interest in gender differences within the coronary artery bypass graft (CABG) surgery trajectory. However, the debate persists regarding the reasons why women may have less favorable outcomes. As part of a larger study, we explored gender differences in the physiological and psychosocial dimensions of pre-operative status, and post-operative morbidity and quality of life outcomes in CABG surgery patients. A purposive sample of patients on the waiting list for CABG surgery (N = 195; 157 males; 38 females) was followed for 6 months post-surgery. The results reflected consistent evidence of a male advantage across the CABG surgery trajectory. Though gender differences in age were non-significant, females had significantly more post-operative respiratory complications (p = 0.005), a longer hospital stay (p = 0.003), more symptoms at 2 weeks post-discharge, and a lower quality of life at 6 weeks and 6 months post-discharge. Our findings provide important insights for improving CABG surgery outcomes for both men and women. In particular, implementing creative strategies to improve physical functioning pre-operatively, may improve post-operative quality of life outcomes in this population.

Chronic Neuropathic Pain in Women After Breast Cancer Treatment

Chronic neuropathic pain affects between 20% and 50% of women after their breast cancer treatment. The Human Response to Illness (HRTI) model provides a comprehensive theoretic framework to guide the assessment and management of this pain in women with breast cancer. Knowledge of the physiologil, pathophysiologic, behavioral, and experiential perspectives, as well as personal and environmental factors, will assist nurses and other health care professionals to develop better assessment tools and improve interventions and treatment modalities. This will provide guidance for nursing practice, education, and research and ultimately improve the quality of life, optimize outcomes, and reduce the incidence of chronic neuropathic pain in the breast cancer population.

Coronary artery bypass graft surgery: exploring a broader perspective of risks and outcomes.

Although the literature is replete with evidence related to physiological predictors and short-term outcomes of coronary artery bypass graft (CABG) surgery, there is still a paucity of data that encompass a broader perspective of risk and outcomes. The primary objective of this prospective cohort study was to explore the physiological and psychosocial dimensions of preoperative status that may be predictive of the short- and longer term outcomes of CABG surgery. Patients (N = 136) scheduled for elective/urgent CABG surgery were followed from the time of placement on the waiting list until 6 months after the surgery. Significant predictors of intensive care unit length of stay (LOS) included the following: age, urgency of operation, and perioperative complications. Hospital LOS was best predicted by baseline unemployment, longer bypass time, and perioperative complications. Baseline unemployment and less optimism regarding surgery outcomes were predictive of postdischarge home care utilization. Lower baseline physical functioning predicted postdischarge emergency room visits. Sex and baseline mental status predicted quality of life/health satisfaction scores at 6 weeks and 6 months after discharge. The ability to predict patient outcomes has implications for program planning, patient education, and policy development. The findings of this study provide rationale for clinicians, educators, and administrators to consider a broader scope of physiological and psychosocial parameters to predict outcomes of CABG surgery. Although the sample size was relatively small, the broader perspective on risk and outcomes provides insight for strategies to optimize overall outcomes for the CABG surgery population. These findings also establish the cornerstone for ongoing CABG surgery outcomes evaluation and research.

Identifying the key predictors for retention in critical care nurses

AIMS The aim of this study was to explore the key predictors of retention in nurses working in critical care areas. BACKGROUND The shortage of critical care nurses is reaching crisis proportions in Canada and throughout the industrialized world. Identifying the key influencing (i.e. person and organizational) factors and intermediary factors (i.e. job satisfaction, engagement, professional quality of life and caring) that affect intent to leave is central to developing optimal retention strategies for critical care nurses. DESIGN As part of a larger mixed-methods study, we used a quantitative, cross-sectional research design. A novel framework: the Conceptual Framework for Predicting Nurse Retention was used to guide this study. METHODS On-line survey data were collected from on a convenience sample of 188 registered nurses working in critical care areas of hospitals in the province of Manitoba, CANADA in 2011. RESULTS Twenty-four per cent of the respondents reported that they would probably/definitely leave critical care in the next year. Based on bivariate and regression analyses, the key influencing factors that were significantly related to the intermediary factors and intent to leave critical care and nursing included: professional practice, management, physician/nurse collaboration, nurse competence, control/responsibility and autonomy. Of the intermediary factors, all but compassion satisfaction were related to intent to leave both critical care and nursing. CONCLUSION This study highlights the importance of exploring multiple organizational and intermediary factors to determine strategies to retain critical care nurses. The findings also support the Conceptual Framework for Predicting Nurse Retention as a theoretical basis for further research.Aims The aim of this study was to explore the key predictors of retention in nurses working in critical care areas. Background The shortage of critical care nurses is reaching crisis proportions in Canada and throughout the industrialized world. Identifying the key influencing (i.e. person and organizational) factors and intermediary factors (i.e. job satisfaction, engagement, professional quality of life and caring) that affect intent to leave is central to developing optimal retention strategies for critical care nurses. Design As part of a larger mixed-methods study, we used a quantitative, cross-sectional research design. A novel framework: the Conceptual Framework for Predicting Nurse Retention was used to guide this study. Methods On-line survey data were collected from on a convenience sample of 188 registered nurses working in critical care areas of hospitals in the province of Manitoba, CANADA in 2011. Results Twenty-four per cent of the respondents reported that they would probably/definitely leave critical care in the next year. Based on bivariate and regression analyses, the key influencing factors that were significantly related to the intermediary factors and intent to leave critical care and nursing included: professional practice, management, physician/nurse collaboration, nurse competence, control/responsibility and autonomy. Of the intermediary factors, all but compassion satisfaction were related to intent to leave both critical care and nursing. Conclusion This study highlights the importance of exploring multiple organizational and intermediary factors to determine strategies to retain critical care nurses. The findings also support the Conceptual Framework for Predicting Nurse Retention as a theoretical basis for further research.

Dyspnea in the thoracic trauma patient: a human response to illness.

Dyspnea is one of the most common presenting symptoms in thoracic trauma patients; therefore, trauma nurses require extensive knowledge of this symptom. The Human Response to Illness model provides an organizing framework to establish a comprehensive understanding of the human response of dyspnea following thoracic trauma. The model is used to describe the physiological, pathophysiological, behavioral, and experiential perspectives of dyspnea in thoracic trauma, while considering personal and environmental factors. This comprehensive overview will provide the trauma nurse with appropriate evidence-based rationale for interventions in the management of acute dyspnea in the thoracic trauma population.