Pamela Willson

Valid Items for Screening Dysphagia Risk in Patients With Stroke A Systematic Review

Background and Purpose— Screening for dysphagia is essential to the implementation of preventive therapies for patients with stroke. A systematic review was undertaken to determine the evidence-based validity of dysphagia screening items using instrumental evaluation as the reference standard. Methods— Four databases from 1985 through March 2011 were searched using the terms cerebrovascular disease, stroke deglutition disorders, and dysphagia. Eligibility criteria were: homogeneous stroke population, comparison to instrumental examination, clinical examination without equipment, outcome measures of dysphagia or aspiration, and validity of screening items reported or able to be calculated. Articles meeting inclusion criteria were evaluated for methodological rigor. Sensitivity, specificity, and predictive capabilities were calculated for each item. Results— Total source documents numbered 832; 86 were reviewed in full and 16 met inclusion criteria. Study quality was variable. Testing swallowing, generally with water, was the most commonly administered item across studies. Both swallowing and nonswallowing items were identified as predictive of aspiration. Neither swallowing protocols nor validity were consistent across studies. Conclusions— Numerous behaviors were found to be associated with aspiration. The best combination of nonswallowing and swallowing items as well as the best swallowing protocol remains unclear. Findings of this review will assist in development of valid clinical screening instruments.

Predicting NCLEX-RN Success: the Seventh Validity Study HESI Exit exam.

The findings of six previously conducted studies indicated that the HESI (E2) was highly accurate in predicting NCLEX-RN success. The purpose of this study—the seventh study to investigate the validity of the E2—was to examine the accuracy of three parallel versions of the E2in predicting licensure success and to describe program practices regarding E2 benchmark scores, remediation programs, and retesting policies. The findings of this study again indicated that the E2 was highly accurate in predicting NCLEX-RN success. Additionally, all three versions of the E2 were found to have a predictive accuracy above 90%. The most common E2 benchmark score designated by faculty at the participating schools was 850, and most schools required students to retest with different versions of the E2 until the faculty-designated E2 benchmark score was achieved. Remediation seemed to be effective in raising students’ E2 scores, and it was recommended that future research investigate the effectiveness of specific remediation strategies.

KNOWLEDGE MANAGEMENT: ORGANIZING NURSING CARE KNOWLEDGE

Almost everything we do in nursing is based on our knowledge. In 1984, Benner (From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984) described nursing knowledge as the culmination of practical experience and evidence from research, which over time becomes the “know-how” of clinical experience. This “know-how” knowledge asset is dynamic and initially develops in the novice critical care nurse, expands within competent and proficient nurses, and is actualized in the expert intensive care nurse. Collectively, practical “know-how” and investigational (evidence-based) knowledge culminate into the “knowledge of caring” that defines the profession of nursing. The purpose of this article is to examine the concept of knowledge management as a framework for identifying, organizing, analyzing, and translating nursing knowledge into daily practice. Knowledge management is described in a model case and implemented in a nursing research project.

Determining predictors of delayed recovery and the need for transitional cardiac rehabilitation after cardiac surgery

Purpose: To examine the relationship between demographic and clinical characteristics of cardiac surgery patients with postoperative length of stay (PLOS) greater than 7 days and determine the demographic, social, and clinical predictors of the need for transitional cardiac rehabilitation (TCR) after cardiac surgery. Data sources: A retrospective review of characteristics, clinical indices, caregiver availability, and patient status (whether living alone) was completed for 304 patients undergoing cardiac surgery over 24 consecutive months. Univariate analyses and multivariable logistic regression models were used to evaluate risk factor characteristics for PLOS greater than 7 days and to predict discharge disposition to TCR or home. Conclusions: Older patients, those with preoperative comorbidities, and those without a caregiver at home experience delays in functional recovery and discharge and are more likely to need TCR services. Implications for practice: Our findings support the addition of functional recovery and social support risk items to the preoperative cardiac surgery risk assessment.

Prototype to practice: Developing and testing a clinical decision support system for secondary stroke prevention in a veterans healthcare facility.

A clinical decision support system that guides nurse practitioners and other healthcare providers in secondary stroke prevention was developed by a multidisciplinary team with funding received from the Veterans Health Administration Office of Nursing Services. This article presents alpha-testing results obtained while using an integrated model for clinical decision support system development that emphasizes end-user perspectives throughout the development process. Before-after and descriptive methods were utilized to evaluate functionality and usability of the prototype among a sample of multidisciplinary clinicians. The predominant functionality feature of the tool is automated prompting and documentation of secondary stroke prevention guidelines in the electronic medical record. Documentation of guidelines was compared among multidisciplinary providers (N = 15) using test case scenarios and two documentation systems, standard versus the prototype. Usability was evaluated with an investigator-developed questionnaire and one open-ended question. The prototype prompted a significant increase (P < .05) in provider documentation for six of 11 guidelines as compared with baseline documentation while using the standard system. Of a possible 56 points, usability was scored high (mean, 48.9 [SD, 6.8]). These results support that guideline prompting has been successfully engineered to produce a usable and useful clinical decision support system for secondary stroke prevention.

Feasibility of Using Cranial Electrotherapy Stimulation for Pain in Persons with Parkinson's Disease

Objectives. To assess the feasibility of treating musculoskeletal pain in the lower back and/or lower extremities in persons with Parkinsons disease (PD) with cranial electrotherapy stimulation (CES). Design. Randomized, controlled, double-blind trial. Setting. Veterans Affairs Medical Center, Community. Participants. Nineteen persons with PD and pain in the lower back and/or lower extremities. Thirteen provided daily pain rating data. Intervention. Of the thirteen participants who provided daily pain data, 6 were randomly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks. They recorded their pain ratings on a 0-to-10 scale immediately before and after each session. Main Outcome Measure. Average daily change in pain intensity. Results. Persons receiving active CES had, on average, a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES (Wilcoxon Z = −2.20, P = .028). Conclusion. Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain. A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES. Guidelines for future studies are provided.

Academic Policies and Practices to Deter Cheating in Nursing Education

AIM The aim of this systematic literature review was to assess the evidence available to facilitate nursing faculty in policy development and implementation of strategies to deter cheating. BACKGROUND No previous comprehensive summary of successful faculty practices was found in the literature on which to base academic practice. METHODS A search of six databases was undertaken using the combination of terms: nursing and policy, nursing and student misconduct, nursing and cheating, and nursing and integrity. More than 28,000 publications were reviewed for English language, US higher education system, and health care programs. Excluded articles described bioethical and research misconduct, admission policy, or workforce issues. RESULTS Forty‐three articles met criteria; a matrix table lists specific faculty action plans and deterrent strategies by category of misconduct for each publication. CONCLUSION Clearly defined behaviors, processes, and consequences should be delineated by school policies to guide implementation of specific cheating deterrent strategies.

A pilot test of videoconferencing to improve access to a stroke risk-reduction programme for Veterans

We conducted a pilot study to determine the feasibility of using videoconferencing for a programme of self-management to prevent stroke (V-STOP). A total of 37 Veterans with a history of stroke, or with multiple risk factors for stroke, were enrolled in the study from two rural sites. The V-STOP intervention consisted of 6 weekly sessions of self-management classes and clinic visits delivered via videoconferencing, with one or two individual telephone counselling sessions. Participants’ mean satisfaction scores were 4.7 out of 5, indicating very high approval of the programme. Attendance was 87%, almost twice as high as at an equivalent in-person programme. Access was improved as participants saved, on average, 160 km by travelling to a community centre instead of the main Veterans Administration facility. Stroke risk knowledge and self-management behaviours such as communication with healthcare providers significantly improved from baseline. Overall, videoconferencing is feasible for delivering self-management classes and clinic visits and the V-STOP programme shows promise as a method for delivery of self-management education and preventive care services to reduce stroke risk.

Faculty Experiences Developing and Implementing Policies for Exit Exam Testing.

Nursing schools use standardized exit examinations to determine student readiness for the NCLEX-RN. Yet little is known about how nursing programs develop policies for using the examinations, set benchmarks scores, and implement remediation strategies with their students. In a phenomenological study, faculty identified a testing policy process that fell into the major themes of triggers for change, policy modification, and reactions to change.