Margaret L. McClure

Careers in nursing

Registered Nurses (RN) work to promote health, prevent disease and help patients cope with illness. They are advocates and health educators for patients, families and communities. When providing direct patient care, they observe, assess and record symptoms, reactions and progress in patients; assist physicians during surgeries, treatments and examinations; administer medications; and assist in convalescence and rehabilitation. RNs also develop and manage nursing care plans, instruct patients and their families in proper care and help individuals and groups take steps to improve or maintain their health.

Nursing education at the crossroads: Empowering nurses and patients

Background: The Institute of Medicine in 2011 reported over 100 million American adults are affected by chronic pain which is more than the combination of those affected with heart disease, cancer, and diabetes. The report also estimated the United States spends up to

Introduction to the proceedings

635 billion each year in medical treatment and lost productivity due to chronic pain. The 2007 National Health Interview Survey reported 38% of American adults use some form of integrative or complementary and alternative medicine (CAM). The National Center for Complementary and Alternative Medicine estimates CAM use accounts for

New York University Medical Center's Cooperative Care Unit: Patient Education and Family Participation During Hospitalization - The First Ten Years

33.9 billion total health care expenditures spent out of pocket. Conditions associated with pain are the number one reason adults reported as the reason for using CAM therapies. Research on guided imagery has produced mixed results in its use in pain management. Purpose: The purpose of the project was the creation of an integrative medicine program initially using guided imagery with patients referred to the advanced practice nurse (APN) led pain management service at a tertiary care hospital located in the Texas Medical Center in Houston, TX. Materials and Methods: After receiving Institutional Review Board approval, patients were recruited from the APN-led pain management service. Upon receiving consent, an MP3 player with a guided imagery recording was given to the patient with instructions to use the recording twice daily. Pain and anxiety scores along with analgesic and anti-anxiolytic use were recorded pre-intervention and 24 and 48 hours after enrollment. Results: At the time of abstract submission, thirty-six patients were recruited; 20 enrolled with 18 completing all data collection. • Pain scores declined by 4% at 24 hours and 48 hour pain score declined 3% from pre-intervention score. • 27% decline in anxiety scores at 24 hours and 49% decline at 48 hours in anxiety scores were seen when compared to preintervention. • Analgesia use declined 7% at 24 hours and 19% at 48 hours. • Positive feedback was received from the participants. Conclusions: • Statistical significance was seen with anxiety scores at 24 hours (p=0.006) and 48 hours (p=0.0002) but not with the other measures due to small sample size. • Clinical significance was seen with declines at 48 hours in anxiety scores (49%), analgesia use (19%), and pain scores (3%). • Guided imagery appears to be a viable CAM approach to reduce pain, anxiety, and analgesic use Linda Cole, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.004Background: As of 2013-2014, hospitals are reimbursed based on hospital’s VBP scores. The VBP score is based 70% on clinical processes and outcomes and 30% on patient reports of care. Purpose: The purpose of this study was to determine if magnet (N=160), magnet-in-progress (N=99), and non-magnet hospitals (N=1742) have significant differences in the occurrence of 30-day mortality and readmission rates (for MIs, CHF, and pneumonia); and the percent of patients that assign hospitals the highest ranked rating on questions related to patient satisfaction with care. Methodology: This study utilized a secondary data analysis methodology. Measures /Outcomes: Outcome measures included 30-day mortality and readmission rates (for MIs, CHF, and pneumonia); and patient satisfaction rates on the HCAHPS Survey. Conclusion: Analysis revealed that 30 day mortality rates for MIs were found to be significantly lower (p<0.001) in magnet hospitals (14.87) than in non-Magnet hospitals (15.43). Magnet and Magnet-in-progress hospitals were found to have significantly (p<0.007) higher scores than non-magnet hospitals on six of the seven subjective outcome variables investigated regarding patient reported satisfaction with care. The implication of these results for nursing practice, policy, and future research are discussed. Sarah A. Smith, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.004A can be a victim of a workplace assault, but risks are much greater in certain occupations such as nursing. The investigation of violence toward health care workers especially nurses, as an occupational hazard is relatively new and underreported. This study describes the incidence, short and long term effects, and legal implications of violence against nurses by patients and adds to the existing data regarding violence against nurses. Information also was obtained regarding measures used to prevent violence. Nurses in this investigation were asked to complete an assault survey & assessment tool (developed by the Sharp Team and Dr. Marilyn Lanza). This study expanded the research conducted by the sharp team of the department of labor and industries in washington state and Dr. Marilyn Lewis Lanza in the department of nursing service for research at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts. The sample included 108 randomly selected nurses living in Ohio, Kentucky, and Indiana who were members of the International Association of forensic Nurses (IAFN). Of the total number of nurses completing the assault questionnaire, 88 nurses (81%) reported patient violence. The majority of these nurses experienced some type of physical violence including cuts, lacerations, bruises, soreness, nausea, vomiting, panic, fear and a host of other symptoms. Data were analyzed by measure of central tendency and variability and measures of association were made by Chi square and Pearson correlations. This information was supplemented by anecdotal comments, descriptions, or comments by the respondents to the survey. Yvonne D. McKoy, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.004O adults comprise the fastest growing demographic in Canada, and represent a large number of patient visits to the emergency department (ED). The complexity of these patients frequently results in the consumption of more ED resources, high rates of return ED visits, and more frequent admissions to hospital. However, despite the frequency of visits the unique needs of older adults may be difficult to realize within the fast-paced ED environment. Additionally, current system demands result in increased pressure to rapidly triage, assess and treat older patients. These factors, together with the existing knowledge gap regarding geriatric specific interventions, has led to an ED environment that is frequently unreceptive and poorly adapted to meet the needs of older adults. Ultimately this impacts the patient experience and ED use, and may contribute to decline and loss of independence. The Geriatric Emergency Management (GEM) program was developed to optimize the treatment, safety and independence of identified high-risk seniors who are discharged home from the ED. GEM is an evidence-based, collaborative initiative between the ED and the Regional Geriatric Program of Eastern Ontario, and includes more than 20 community partners in the planning of care strategies and supports. This presentation will provide an overview of the innovative clinical, education, research & program strategies utilized to build capacity within the ED to achieve successful outcomes with this population. The success of this program has led to regional program expansion in order to promote an improved approach to the management of older adults in the ED. Laura Wilding et al., J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.004C disease and cancer are the major causes of death worldwide. Cardiovascular deaths after surgery in patients over age 45 occur in 1% or more, amounting to more than 1 million worldwide annually. Risk factors for these events include known cardiovascular and/or cerebrovascular disease, diabetes, hypertension, and smoking. At certain levels of risk, the procedural benefit to lifestyle or survival may be inadequate and procedural modifications or avoidance may be appropriate. The single most useful test to determine perioperative risk is probably the immediate postoperative troponin. Investigation to prevent and treat perioperative myocardial infarction and stroke is in progress. Michael Jacka, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.004Objective: Few studies have examined predictors of quality of life (QOL) of breast cancer survivors over time. Methods: Breast cancer survivors (n=116) were asked to complete measures of QOL, mood, spirituality, and social support every 6 months from 2-4 years post diagnosis. Results: Overall QOL at 4 years was predicted by previous physical and functional well-being, the breast cancer-specific items, and vigor and current levels of social support (Adj R2=.72, F=30.53, p=.000). Physical QOL was predicted by previous levels of physical and functional well-being and current levels of functional and social/family well-being (Adj R2=.84, F=44.30, p=.000). Functional well-being was predicted by prior levels of physical, functional, and social/family well-being and current levels of physical well-being and vigor (Adj R2=.72, F=3-.53, p=.000). Emotional well-being was predicted by previous levels of emotional well-being and current physical well-being, the breast cancer-specific items, and anxiety (Adj R2=.60, F=26.30, p=.000). Social/ family well-being was predicted by previous levels of social/family well-being, social support, and confusion (Adj R2=.71, F=34.18, p=.000). The breast cancer-specific items were predicted by age, previous levels of the breast cancer-specific items, confusion and current levels of emotional and functional well-being and spirituality (Adj R2=.58, F=17.57, p=.000). Conclusions: Overall and specific dimensions of QOL at 4 years were predicted by different combinations of QOL, mood, and spirituality. Interventions should be tailored to which dimensions of QOL are affected and other types of QOL as well as social support, mood, and spirituality as coping mechanisms that influence the specific dimension of QOL affected. Ellen G. Levine, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.004Overview of where we are today and how we arrived at our current state A. Development of Community Colleges B. Recommendations of past studies conducted during the 20th century C. Changes in practice and career opportunities The IOM study entitled The Future of Nursing: Leading Change, Advancing Health A. Findings of the study and how they affect nursing education B. Actions underway at present The demand for more nurses prepared to exert leadership in all aspects of health care A. Changes in delivery systems B. Innovations for today and the future C. Resultant increased power for nurses in all settings. Margaret L. McClure, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.004R nurses who work in rural hospitals not only need critical thinking skills but also need to call on a variety of information at a moment’s notice with little medical and ancillary support. Further, the knowledge they need to call on is frequently associated with speciality or critical care practice areas. Indeed, novice rural registered nurses need to acquire a specialized knowledge base, skill set, and relational expertise in order to be successful in rural hospital nursing practice. Unfortunately, novice nurses as well as those who supervise them, suggest that novices feel unprepared for the rigors of rural hospital nursing and so may lack this complex reasoning ability. Recreating a synthetic natural environment in the simulation lab, unstructured observation and semi-structured qualitative interviews to generate data, 5 novice registered nurses (i.e. less than 5 years post-graduation), 3 registered nurses with 5-10 years of work experience in rural hospitals, and 7 registered nurses with over 10 years of work experience in rural hospitals were invited to participate in this pilot study. The aim of the study was to explore how rural registered nurses think through clinical problems. This purpose of this presentation is threefold: to present the lessons learned when using a simulated environment for conducting research; to discuss the findings of this study; and last, to provide recommendations to undergraduate nursing programs and employers that support and enhance Registered Nurses clinical reasoning ability. Lance Grigg, J Nurs Care 2013, 2:3 http://dx.doi.org/10.4172/2167-1168.S1.004