Lene Symes

ICU nurses' experiences in providing terminal care

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

TESTING THERAPEUTIC LIFE REVIEW OFFERED BY HOME CARE WORKERS TO DECREASE DEPRESSION AMONG HOME-DWELLING OLDER WOMEN

The purpose of the study was to test a psychosocial intervention, therapeutic life review, offered by home care workers to decrease depression among home-dwelling older women. A quasi-experimental, one-group time-series design measured the effect of a once-a-week, 40-minute therapeutic life review intervention, delivered for six weeks by home care workers, on the depression scores of women 65 years and older, compared to their scores during the ten weeks prior to the intervention. Over time, depression scores improved with a significant decrease in depression immediately following the six-week intervention. Based on these findings, we concluded that home care workers can deliver a community-based psychosocial intervention that decreases depression in their home-dwelling clients.

Tubing Misconnections Normalization of Deviance

BACKGROUND Accidental connection of an enteral system to an intravenous (IV) system frequently results in the death of the patient. Misconnections are commonly attributed to the presence of universal connectors found in the majority of patient care tubing systems. Universal connectors allow for tubing misconnections between physiologically incompatible systems. METHODS The purpose of this review of case studies of tubing misconnections and of current expert recommendations for safe tubing connections was to answer the following questions: In tubing connections that have the potential for misconnections between enteral and IV tubing, what are the threats to safety? What are patient outcomes following misconnections between enteral and IV tubing? What are the current recommendations for preventing misconnections between enteral and IV tubing? Following an extensive literature search and guided by 2 models of threats and errors, the authors analyzed case studies and expert opinions to identify technical, organizational, and human errors; patient-related threats; patient outcomes; and recommendations. RESULTS A total of 116 case studies were found in 34 publications. Each involved misconnections of tubes carrying feedings, intended for enteral routes, to IV lines. Overwhelmingly, the recommendations were for redesign to eliminate universal connectors and prevent misconnections. Other recommendations were made, but the analysis indicates they would not prevent all misconnections. CONCLUSIONS This review of the published case studies and current expert recommendations supports a redesign of connectors to ensure incompatibility between enteral and IV systems. Despite the cumulative evidence, little progress has been made to safeguard patients from tubing misconnections.

Psychometric Testing of the MDASI-HF: A Symptom Assessment Instrument for Patients With Cancer and Concurrent Heart Failure

BACKGROUND The debilitating symptoms of cancer and heart failure (HF) can adversely affect the patients quality of life. This study evaluated the psychometric properties of the MD Anderson Symptom Inventory--Heart Failure (MDASI-HF), a 27-item self-report assessment instrument for patients with cancer and concurrent HF. METHODS AND RESULTS Psychometric testing used data from 156 patients (age 63.3 +/- 13.2 years, 56% male) with a diagnosis of cancer and HF receiving care in a major cancer center. Reliability of the MDASI-HF for the 13 symptoms (alpha = 0.89), 8 HF-specific items (alpha = 0.83), and interference items (alpha = 0.92) was high. Criterion-related validity with the Eastern Cooperative Oncology Group performance scale (r = 0.63) and the New York Heart Association classification (r = 0.65) were statistically significant, P = .01. Construct validity supported two constructs for the additional HF specific items: covert HF factor and overt HF factor. CONCLUSION The MDASI-HF is a valid and reliable instrument for symptom assessment in patients with cancer and HF. This instrument can be used to identify symptom occurrence and enhance the providers understanding of the prevalence and severity of symptoms from the patients perspective.

Resident strategies for making a life in a nursing home: a qualitative study

AIM To identify strategies that older adults use to adapt to live in long-term care. BACKGROUND The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Moving into a long-term care setting has been documented internationally as an overwhelming life change for many older adults. It has been observed that residents adjust differently over time, but the basis for these differences needs further exploration. DESIGN A qualitative design using grounded theory method was employed. METHODS A total of in-depth interviews were conducted in October 2008-February 2009 with a sample of 21 participants. Participants ranged in age from 65-93 years, 81% women and 19% men; mainly Caucasian with one African American and one Hispanic. Length of stay ranged from 3 days to over 9 years living in long-term care so that all stages of adjustment were included in the study. Ground theory method was used to analyse the data. FINDINGS The results of this study yielded 21 facilitative strategies. The core category identified was personal resiliency, which served as the underpinning for the strategies used by the participants. Strategies were identified in making the decision to move into long-term care and in day-to-day living. CONCLUSION Understanding the strategies that facilitate residents to make a successful transition to long-term care life will assist nurses to intervene in ways that are supportive. The strategies identified in this study may be used to develop interventions for residents that are having difficulty living in long-term care. Further exploration of how resiliency has an impact on strategies used by residents is clinically relevant, but further research is needed.

An Evaluation of the Nursing Success Program: Reading Comprehension, Graduation Rates, and Diversity

The Nursing Success Program was developed to enhance retention of baccalaureate nursing students. Reading comprehension scores are used to identify students who are at risk for failure and direct them into the retention program that addresses their skill deficits. To evaluate the program, the authors assessed reading comprehension, graduation rates, and ethnic diversity.

An innovative, multidisciplinary strategy to improve retention of nursing students from disadvantaged backgrounds.

Nursing students from disadvantaged backgrounds must overcome many barriers in order to succeed. This article will focus on how a multidisciplinary team helped 76 percent of these high-risk students persist in their nursing programs by addressing some of these barriers. Three baccalaureate nursing schools in the Texas Medical Center embarked on a three-year retention program designed to enhance the success of students identified by federal criteria as being at risk. Multidisciplinary teams led various activities, including a study skills component, which included preparing for lectures, taking notes, critical thinking, and test-taking strategies. Also addressed were written and oral communication skills, medical terminology, critical thinking, career coaching, and socialization activities. Collaboration among faculty and students at the three schools was key to the success of the program.

Developing and retaining expert learners: the Student Success Program.

The goal of the Student Success Program is to retain bright and capable nursing students by supporting them to become expert learners through enhancing their study, test taking, time and stress management, written and oral communication, and critical thinking skills. Students for whom English is a second language also receive instruction in accent reduction. Retention rates increased following implementation of the program. Recommendations for those considering implementing a retention program are addressed.

Arriving at readiness to recover emotionally after sexual assault

The purpose of this grounded theory study was to discover behaviors and processes that lead survivors of sexual assault to seek help with emotional recovery. The substantive theory Arriving at Readiness was developed from interviews with 11 women survivors of sexual assault. Eleven categories, each containing several strategies, form the theory. The core variable is arriving at readiness. The findings clarify why survivors often delay obtaining help with emotional recovery. The theory can be used as a tool to make it more likely survivors will be identified and receive help that is responsive to their needs.

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

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