Marian Wilson

Compassion fatigue and satisfaction: A cross‐sectional survey among US healthcare workers

Professional quality of life among healthcare providers can impact the quality and safety of patient care. The purpose of this research was to investigate compassion satisfaction and compassion fatigue levels as measured by the Professional Quality of Life Scale self-report instrument in a community hospital in the United States. A cross-sectional survey study examined differences among 139 RNs, physicians, and nursing assistants. Relationships among individual and organizational variables were explored. Caregivers for critical patients scored significantly lower on the Professional Quality of Life subscale of burnout when compared with those working in a noncritical care unit. Linear regression results indicate that high sleep levels and employment in critical care areas are associated with less burnout. Identification of predictors can be used to design interventions that address modifiable risks.

Empowering Nurses With Evidence‐Based Practice Environments: Surveying Magnet®, Pathway to Excellence®, and Non‐Magnet Facilities in One Healthcare System

Background Nurses have an essential role in implementing evidence-based practices (EBP) that contribute to high-quality outcomes. It remains unknown how healthcare facilities can increase nurse engagement in EBP. Purpose To determine whether individual or organizational qualities could be identified that were related to registered nurses’ (RNs’) readiness for EBP as measured by their reported EBP barriers, ability, desire, and frequency of behaviors. Methods A descriptive cross-sectional survey was used in which a convenience sample of 2,441 nurses within one United States healthcare system completed a modified version of the Information Literacy for Evidence-Based Nursing questionnaire. Descriptive statistics, t tests, one-way ANOVA, and regression modeling were used to analyze the data. Results RNs employed by facilities designated by the American Nurses Credentialing Center (ANCC) as Magnet® or Pathway to Excellence® reported significantly fewer barriers to EBP than those RNs employed by non designated facilities. RNs in Magnet organizations had higher desire for EBP than Pathway to Excellence or non designated facilities. RNs educated at the baccalaureate level or higher reported significantly fewer barriers to EBP than nurses with less education; they also had higher EBP ability, desire, and frequency of behaviors. A predictive model found higher EBP readiness scores among RNs who participated in research, had specialty certifications, and engaged in a clinical career development program. Linking Evidence to Action Education, research, and certification standards promoted by the Magnet program may provide a nursing workforce that is better prepared for EBP. Organizations should continue structural supports that increase professional development and research opportunities so nurses are empowered to practice at their full capacity.

Integrating the Concept of Pain Interference into Pain Management

Undertreatment of pain is a significant problem. Nursing pain assessments have been identified as an area for improvement. This concept analysis sought to examine the use of pain interference as a measurement to assist pain management practices. Existing literature including the term pain interference was reviewed for the years 2000-2010. Pain interference is a common outcome measurement in clinical research. It is not well differentiated from other pain concepts in routine nursing pain assessments, nor consistently defined in research articles. Pain interference has been linked to quality of pain management and recommended as a standard of pain measurement. It aligns with current and emerging theories in pain and symptom control. Further exploration is needed to determine whether integrating this concept into nursing practice will result in improved patient pain experiences.

Securing Pediatric Peripheral IV Catheters—Application of an Evidence-Based Practice Model

Peripheral intravenous catheter (PIV) insertion is a traumatic experience for children and should not be repeated more frequently than necessary. Proper securement of pediatric i.v.s can preserve catheter life; however, little evidence is available to describe optimal methods. Pediatric nurses at a 246-bed, community-owned district hospital observed they were frequently attempting to rescue or restart PIVs prematurely. In the context of exemplary professional practice, an exploratory evidence-based practice project was designed to increase knowledge about the best practices in maintaining and preserving pediatric PIVs. Data collection and analysis determined that practices were inconsistent and more research is needed to determine the optimal securement practices.

Empowering Patients with Persistent Pain Using an Internet-based Self-Management Program

New strategies are needed to improve access to cognitive and behavioral therapies for patients with persistent pain. The purpose of this randomized, controlled trial was to determine the effectiveness of the Chronic Pain Management Program, an 8-week online intervention targeting cognitive, emotional, behavioral, and social pain determinants. Program efficacy and engagement was evaluated for 92 individuals with a diagnosis of chronic noncancer pain who had a current opioid prescription. Participants were recruited from primary care practices and Internet sites, then randomly assigned to receive access to the intervention either immediately (treatment group) or after an 8-week delay (wait-list comparison). Biweekly self-report measurements were collected using online surveys on pain, depressive symptoms, pain self-management behaviors, and health care utilization during the 8-week trial. Additional measurements of opioid misuse behaviors, pain self-efficacy, and medicine regimens were completed at baseline and week 8. Engagement was evaluated by examining completion of program learning modules. The results from analysis of variance showed that at week 8, the treatment group had significantly greater improvements on pain self-efficacy and opioid misuse measures than the wait-list comparison group. Engagement level was positively associated with improvements in pain intensity, pain interference, and pain self-efficacy. In conclusion, patients on opioids were able to engage and demonstrate positive outcomes using an Internet-based self-management program. Future efforts toward heightening engagement could further maximize impacts.

Depression and Pain Interference Among Patients With Chronic Pain After ED Encounters

INTRODUCTION Patients with chronic pain who frequent emergency departments present a challenge to health care providers. Mental health, substance abuse, and pain issues are difficult to distinguish in fast-paced clinical settings, and significant symptoms may remain unaddressed. This pilot study sought to determine whether electronically delivered screening tools measuring pain and mood could identify areas to target for improving emergency care. METHODS A prospective, descriptive pilot study used repeated measures of validated instruments to investigate the status of patients after their ED encounter. Persons with chronic pain not related to cancer and documented opioid use were recruited by nursing personnel after an ED encounter. Consenting participants (n = 52) were invited to perform an online survey that included self-reported measurements of pain intensity, pain interference, depression, subjective health, and health distress. The survey was repeated after 8 weeks. RESULTS The baseline survey was completed by 42.3% of 52 patients who provided consent (n = 22, 68.2% female). The mean pain severity score was 5.96 (SD 1.57) and the mean pain interference score was 7.52 (SD 1.81) using 0 to 10 scales of the Brief Pain Inventory. Personal Health Questionnaire Depression Scale ratings indicated that a major depressive disorder should be considered for 54% of the participants. DISCUSSION Online surveys delivered to patients with chronic pain detected unmet needs for depression and persisting high levels of pain interference after ED encounters. Adding mood-specific screening tools to pain assessments may be necessary in clinical settings to identify depression and refer for appropriate treatment.

Secondary Traumatic Stress and Burnout Among Muslim Nurses Caring for Chronically Ill Children in a Turkish Hospital

Purpose: This study investigated secondary traumatic stress and its relationship to burnout among nurses working at a Turkish hospital. Design: A mixed-methods design included a cross-sectional survey administering the Professional Quality of Life instrument and Maslach Burnout Inventory to 106 nurses. Interviews with a subgroup of eight participants explored nurses’ experiences and coping strategies related to caring for chronically ill pediatric patients. Results: High risk levels of secondary traumatic stress existed among 40.6% participants, and those over the age of 40 years were at greater risk. Two main interview themes emerged that identified (a) consequences and (b) coping strategies while caring for chronically ill children. Nurses experience emotional burdens and may purposefully distance themselves from chronically ill children. Social support from nurse colleagues and spiritual beliefs assist coping. Implications: Workplaces should acknowledge stressors inherent in chronic pediatric nursing care. Environments that welcome spiritual practices and actively encourage social support could address job hazards.

Feasibility study to implement nurse-delivered massage for pain management

Pain is a significant problem in acute health care settings and has consistently been found to be poorly managed. Furthermore, hospitalized patients are becoming more complex, and health care dollars, more scarce. Nurses at the bedside have a unique opportunity to affect these issues. Although pharmacological tools are used extensively to address pain in acute care settings, there is a gap in understanding how nondrug approaches can be included to manage pain and its accompanying distress. This article details the findings of a feasibility study initiated in a 250-bed, community-owned hospital in the northwestern United States. The purpose was to determine whether massage could be delivered by registered nurses in an acute care setting. Nurses were invited to participate in a class to learn massage techniques and were asked to incorporate their skills during normal work hours and within their usual work assignment. Data were collected on patients’ reported pain and distress levels before and after 22 massage encounters. Nurses were asked to give feedback on the encounters and report on barriers and observed benefits. Patients reported favorable responses to the massages with reduced levels of pain and distress. In addition, the nurses providing the massages described personal benefit from performing the massage.

Influences on Patient Satisfaction Among Patients Who Use Emergency Departments Frequently for Pain-Related Complaints

Introduction: The primary purpose of this study was to assess relationships between opioid prescribing practices, patient and ED attributes, and patient satisfaction ratings of nursing and physician care among patients with high utilization of the emergency department for pain relief. Methods: A retrospective cohort study was conducted to examine 305 individual patient satisfaction surveys from users with high ED utilization for pain complaints. Responses were compared with an age‐matched control group (n = 305) of nonfrequent ED users. Patient satisfaction survey responses and electronic medical records were used to model relationships between patient satisfaction and predictor variables. Results: ED frequent users with pain complaints were 75% less likely to return a satisfaction survey compared with other patients (odds ratio = 0.2488; P < .0001). Patient satisfaction with physician behavior was largely accounted for by ED cleanliness, pain control, wait time for the physician, satisfaction with nursing, and feelings that ED staff cared about the patient personally. On the other hand, patient satisfaction with nursing care was largely accounted for by perceptions that nursing care was compassionate, feelings that the patient mattered personally, perceptions of safety precautions, and wait times. Receipt of prescriptions for scheduled drugs did not significantly influence patient satisfaction with physician or nursing behaviors. Discussion: Emergency nurses can influence patient satisfaction scores by promoting clean, caring environments and prioritizing patient flow and pain management. ED providers can withhold opioids when appropriate without fear of a significant impact on patient satisfaction.

Engaging Adults With Chronic Disease in Online Depressive Symptom Self-Management:

The main purpose of this study was to evaluate participant engagement and effects of an Internet-based, self-directed program for depressive symptoms piloted among adults with a chronic disease. Eligible participants (N = 47) were randomly assigned to either the “Think Clearly About Depression” online depression self-management program or the control group. The Patient Health Questionnaire–8 and Chronic Disease Self-Efficacy Scales were administered at baseline and at Weeks 4 and 8 after initiating the intervention. Number Needed to Treat analysis indicated that one in every three treatment group participants found clinically significant reductions in depressive symptoms by Week 8. Paired-sample t tests showed that depressive symptoms and self-efficacy in management of depressive symptoms improved over time for those in the treatment group and not for those in the control group. Participants’ engagement and satisfaction with the online program were favorable.