Marilyn Sawyer Sommers

Preventing Assaults by Nursing Home Residents: Nursing Assistants’ Knowledge and Confidence–A Pilot Study

OBJECTIVEnTo describe the frequency and context of assaults against nursing assistants (NAs) from residents and to describe NAs beliefs about their violence prevention knowledge and self-efficacy to prevent assaults from residents.nnnDESIGNnSurvey.nnnSETTINGnSix nursing homes.nnnPARTICIPANTSnA total of 138 nursing assistants.nnnMEASUREMENTSnNAs completed two investigator-developed surveys, the Demographic and Employment Questionnaire and the Knowledge and Self-Efficacy Survey. The Demographic and Employment Questionnaire included questions about race, gender, age, and education, current and previous employment, number of residents usually assigned, frequency of assaults, and training on workplace violence. On the Knowledge and Self-Efficacy Survey, the participants used a five-point Likert scale to rate their knowledge and confidence in recognizing and preventing assaults from residents.nnnRESULTSnAssaults against nursing assistants from residents in nursing homes were common; 59% stated they were assaulted at least once a week and 16% stated they were assaulted daily. Fifty-one percent stated that they had been injured in their lifetime from an assault from a resident, and 38% of those injured received medical attention for an injury. On the Likert items, nursing assistants reported that they believed they had the most knowledge (mean = 3.76) and confidence (mean 3.81) in their ability to recognize when a resident is agitated or becoming aggressive. In comparison, NAs rated lower their knowledge (mean = 3.45) and confidence in their ability (3.50) to keep residents from becoming agitated or aggressive (mean 3.50). NAs rated lowest their knowledge (3.42) and confidence (mean = 3.47) in their ability to decrease residents agitation and aggressiveness once they become agitated or aggressive.nnnCONCLUSIONSnThese findings provide useful information that supports the need for violence prevention education and for developing violence prevention programs in nursing homes.

Current Screening Instruments Related to Alcohol Consumption in Pregnancy and a Proposed Alternative Method

Because alcohol is a known teratogenic substance that negatively affects the fetus, screening for alcohol use is included in maternal child texts for nurses. They present no standard screening approach, however. In the general literature, a multitude of screening instruments exist for the purpose of detecting maternal alcohol dependence but few allow the nurse to detect fetal alcohol exposure in the absence of maternal alcohol dependence. After a comparative analysis of existing screening instruments, we concluded that the Timeline Followback method has the most utility as a screening instrument to detect fetal exposure to alcohol. The purpose of this article is to present a critical review of current screening instruments related to alcohol consumption in pregnant women and to propose the use of the Timeline Followback method as the preferred approach.

Brief intervention as an advanced practice strategy for seriously injured victims of multiple trauma

Trauma is the leading cause of death during the first 4 decades of life. Approximately 40-50% of seriously injured patients who require hospitalization have an alcohol-related injury. The traumatic injury offers nurses in advanced practice roles a unique opportunity to discuss the relation between the patients traumatic injuries and their alcohol use. One strategy that has shown promise in recent research is the Brief Intervention, a simple and quick clinical tool used to motivate patients to consider the consequences of their alcohol-related behavior. The Brief Intervention technique uses a screening instrument, the Alcohol Use Disorders Test, to determine whether the patient is a sensible, heavy, or dependent drinker. A counseling session, focusing on reducing alcohol use in the nondependent drinker, follows while the patient is still acutely injured. Through the use of Brief Intervention, the nurse has an opportunity to motivate trauma patients to change their patterns of drinking and limit their risk for repeated injuries. If nurses can prevent future injuries, the potential savings in lives lost and dollars spent are huge.

Focused Life Stories of Women with Cardiac Pacemakers

Biotechnical devices such as cardiac pacemakers are implanted into people to manage a range of disorders, yet comparatively little is known about the emotional impact of this experience. Women may have a unique response to implanted devices due to cultural messages about the masculinity of technology. In this qualitative study using Hall’s focused life stories design, 11 women from teenagers to elders with permanent cardiac pacemakers were asked to describe their experiences using semistructured interviews. The themes that emerged are relinquishing care, owning the device, experiencing fears and/or resistance, imaging the body, normalizing, positioning as caretaker, finding resilience, and sensing omnipotence. Understanding what it means for women to live with an implanted biotechnical device may facilitate planning interventions to support their psychological and physiological health. Effective pacemaker function may depend, in part, on recipients’ successful emotional attachment to the device.

The cellular basis of septic shock.

Severe sepsis and septic shock are among the most complex and challenging conditions treated by critical care practitioners. Although the pathophysiology of severe sepsis and septic shock is not fully understood, bacteria and immune responses are known to trigger the release of cytokines. These cytokines initiate a cascade of events that lead to illness behaviors such as fever, anorexia, and sleepiness, as well as a host of physiologic events such as activation of the coagulation cascade, vasodilation, hypotension, and increased vessel permeability. As research advances the understanding of severe sepsis and septic shock, practitioners must become aware of the cellular basis of events so that treatments can be implemented knowledgeably and evaluated.

Missed Injuries: A Case of Trauma Hide and Seek

The incidence of missed injuries in the trauma population has been reported as low as 2% and as high as 50%. Missed injuries can lead to serious complications and even death. A variety of factors lead to missed injuries: instability of the patients condition, alterations in the patients level of consciousness, health care provider inexperience, radiologic errors, technical errors, and admission to an inappropriate physician service. The most common type of missed injuries are musculoskeletal injuries, although missed injury occurs with head, chest, abdominal, spinal, and neurovascular trauma. Strategies such as repeat physical examinations, implementation of protocols for trauma management, and organization of a forum for discussion of errors are methods to decrease missed injuries.

Sensitive topics and adolescents: making research about risk behaviors happen.

This article discusses conducting research with adolescents as a positive experience, both from a clinical and scholarly perspective. However, topics involving risk-taking behaviors may be especially difficult for adolescents to discuss openly. To implement research protocols with the adolescent population, particularly when dealing with risk-taking behaviors, investigators need to be aware of developmental challenges that warrant specific methodological choices. In a pilot study that involved adolescents who had been hospitalized for traumatic injury, the researchers gained valuable experience in conducting a study on substance use. Experiences with the study provide direction for future research about investigating sensitive topics with adolescents.

Laboratory measures of alcohol (ethanol) consumption: strategies to assess drinking patterns with biochemical measures.

Alcohol (ethanol) use is a global, health-related problem that spans a continuum ranging from low-risk, at-risk, and problem drinking to alcohol dependence and chronic abuse. Clinicians and researchers alike have the need to quantify drinking patterns to determine the risk for adverse, health-related events such as injury, liver damage, and cancer. Biochemical measures of ethanol consumption are affected by temporal patterns of drinking as well as individual characteristics such as gender and age. The choice of a laboratory analysis to determine ethanol consumption is complex; no single laboratory test will predict drinking accurately across all drinking patterns, across the life span, and across gender. In conjunction with interviews and physical assessment, however, biochemical laboratory tests are sensitive tools used to measure both recent and long-term patterns of alcohol consumption.

Designer genes and critical care nursing: the future is now.

Discoveries about the human genetic code and innovations to manipulate genes are rapidly advancing. Laboratory strategies used for recombinant deoxyribonucleic acid techniques have revolutionized medication production and have led to experimental protocols for gene therapy. The implications for critical care nursing practice are profound. To keep pace with new discoveries, critical care nurses now need to consider the impact of advances in genetic engineering on their practice. Nurses assisting with gene therapy protocols will need to not only update their knowledge of genetics but also learn the fundamentals of recombinant technology. Administration of genetically engineered medications almost certainly will lead to new clusters of side effects and new routes for delivery. A multitude of ethical considerations such as biosafety and patient selection raises a realm of clinical practice implications. To provide the care that critically ill patients require, practitioners will need to update their knowledge constantly about the rapidly changing discipline of genetics and how advances in genetics relate to nursing and medical practice.

Molecular genetics: from bench to bedside.

Diligent work performed at the laboratory bench during the 20th century has resulted in advances in the health care industry and benefits for the patients it serves. Time-saving laboratory techniques such as DNA isolation and polymerase chain reaction (PCR) have helped molecular biologists and geneticists learn more about genes and their function. Information resulting from genetic research is currently used by medical researchers to develop genetic testing, genetic engineering, and gene therapy procedures that will benefit patients with genetic needs. This article provides basic information regarding several of these procedures, including DNA isolation, PCR, gel electrophoresis, and restriction enzyme techniques. In addition, the article explores the experiences of a clinical nurse, who by learning genetic laboratory techniques, developed an appreciation of the nursing implications related to genetic laboratory procedures.