Susan M. Hasenau

Factors that affect functional status in patients with cancer-related pain

Abstract Cancer‐related pain in outpatient adult populations remains high and has a direct effect on functional status. Factors that affect functional status have been explored separately, but the inter‐relatedness of those factors has not been examined. Using a cross‐sectional design, the purpose of this study was to examine the relationships between pain level, beliefs about pain, symptom distress, perceived control over pain, and functional status in 304 ambulatory cancer patients who experienced cancer‐related pain within the past 2 weeks. Participants completed standardized questionnaires during regularly scheduled clinic visits. Patient’s pain level was positively related to increased distress and decreased perceived control over pain and functional status. Structural equation modeling indicated that symptom distress mediated the relation between pain level and functional status. Perceived control over pain had a direct effect on symptom distress and mediated the effect of beliefs about pain and pain level on symptom distress. Patients’ perceived control over pain may be an important component in pain management. The direct and mediating effects of perceived control and symptom distress suggest areas of further research. Interventions to increase knowledge and decrease barriers to pain control have the potential for increasing perceived control over pain.

Identifying the barriers to use of standardized nursing language in the electronic health record by the ambulatory care nurse practitioner

Purpose: This study identified the perceived user barriers to documentation of nursing practice utilizing standardized nursing language (SNL) in the electronic health record (EHR) by ambulatory care nurse practitioners (NPs). Data Sources: A researcher‐developed survey was sent to a randomized sample of ambulatory care NPs in the United States who belonged to the American Academy of Nurse Practitioners (n= 1997). Conclusions: Surveyed ambulatory care NPs placed a higher value on documenting medical care versus nursing care. Only 17% of respondents currently use SNL and 30% believe that SNL is not important or appropriate to document NP practice. Barriers to using SNL in EHRs included lack of reimbursement for nursing documentation, lack of time to document, and lack of availability of SNL in electronic records. Implications for Practice: Respondents identified NP practice as a blend of medical as well as nursing care but NPs have not embraced the current SNLs as a vehicle to document the nursing component of their care, particularly in EHRs. Until these barriers are addressed and discreet data in the form of SNL are available and utilized in the EHR, the impact of the NPs care will be unidentifiable for outcomes reporting.

Improving the Culture of Safety on a High‐Acuity Inpatient Child/Adolescent Psychiatric Unit by Mindfulness‐Based Stress Reduction Training of Staff

PROBLEM The purpose of this study was to reduce perceived levels of interprofessional staff stress and to improve patient and staff safety by implementing a brief mindfulness-based stress reduction (MBSR) training program on a high-acuity psychiatric inpatient unit. METHODS A one-group repeated measure design was utilized to measure the impact of the (MBSR) training program on staff stress and safety immediately post-training and at 2 months. Two instruments were utilized in the study: the Toronto Mindfulness Scale and the Perceived Stress Scale. FINDINGS The MBSR program reduced staff stress across the 2-month post-training period and increased staff mindfulness immediately following the brief training period of 8 days, and across the 2-month post-training period. A trend toward positive impact on patient and staff safety was also seen in a decreased number of staff call-ins, decreased need for 1:1 staffing episodes, and decreased restraint use 2 months following the training period. CONCLUSIONS A brief MBSR training program offered to an interprofessional staff of a high-acuity inpatient adolescent psychiatric unit was effective in decreasing their stress, increasing their mindfulness, and improving staff and patient safety.

An Interprofessional Process to Improve Early Identification and Treatment for Sepsis

&NA; The course of sepsis is rapid. Patient outcomes improve when sepsis is diagnosed and treated quickly. The clinical goals of the evidence‐based bundled strategies from the International consortium Surviving Sepsis Campaign (SSC) include optimizing timeliness in the delivery of care and creating a continuum for sepsis management that runs from the emergency department (ED) to the acute and critical care settings. Successful implementation of processes that integrate sepsis bundles can improve patient mortality and hospital costs. Improving interprofessional education and collaboration are necessary to facilitate the effective use of bundled strategies. An intervention that included interprofessional education resulted in a statistically significant difference between the three phases studied. There was a statistically significant improvement between the phases for lactate completion X2 = 16.908 (p < .01) after education. Frequency of blood cultures being obtained before antibiotic administration was nearing statistical significance (p < .054). There was an improvement in time to antibiotic administration between phase 2 (182.09 mean average minutes, SD = 234.06) and phase 3 (91.62 mean average minutes, SD = 167.99).

Applying STAAR Interventions in Incremental Bundles: Improving Post‐CABG Surgical Patient Care

BACKGROUND Rehospitalization within 30 days of discharge after coronary artery bypass surgery (CABG) is a contributing factor to higher-than-acceptable overall hospital readmission rates throughout the United States. CABG rehospitalizations are of such concern that they are specifically targeted for action in 2015 under the Patient Protection and Affordable Care Act (2010). The phenomenon of increasing readmission rates has prompted the Institute for Healthcare Improvement to devise the Triple Aim initiative and the STate Action on Avoidable Rehospitalizations (STAAR) initiative to reduce 30-day readmission rates nationally. AIMS This study explored the impact of implementing STAAR interventions delivered as part of a quality improvement project in incremental bundles on 30-day readmission rates and the experience of care in CABG patients. Specifically, the use of the teach-back patient education method and the scheduling of follow-up cardiology appointments prior to discharge using existing staff were examined. METHODS A quantitative comparative study was conducted with 189 post-CABG patients at a tertiary care facility in the United States over a 2-year period, comparing outcomes between the group of patients prior to implementation of the STAAR interventions and those who later received them. Outcome variables included 30-day readmission rate and patient perception of experience of care. RESULTS The overall 30-day readmission rate for CABG patients in the postintervention group was decreased to 12.0%, compared to 25.8% in the preintervention group. Of the demographic and health characteristics explored, only chronic lung disease was significantly related to 30-day readmission rates, and only in the postintervention group. LINKING EVIDENCE TO ACTION Thirty-day readmission rates among CABG patients can be reduced and the experience of care can be enhanced through the use of targeted interventions utilizing existing staff and resources. The deliberate incremental implementation of bundled initiatives is an effective strategy in reducing 30-day readmissions in post-CABG patients.

Developing a Culturally Competent Workforce through Collaborative Partnerships

Inthis article, the authors describe a federally funded project to implement a partnership model involving the Transcultural Nursing Society (TCNS) and two universities that have undergraduate and graduate programs in nursing. The overall goal of the project is to use transcultural nursing as a framework for developing the cognitive, affective, and psychomotor cultural competencies of nursing faculty, practicing .nurses, and nursing students. The purpose of this article is fourfold: (a) to describe the background and environmental context of the TCNS-university partnership; (b) to provide an overview ofthe project objectives, key partners, and organizational structure of the partnership; (c) to discuss the current and future project activities; and (d) to critically examine the benefits of partnering for both the TCNS and the two universities involved in this project.

Challenges to Recruitment of Urban African American Patients with Cancer Pain.

There are many assumptions about recruitment of African Americans to cancer studies. The population is often characterized as older, low income, with limited education, scarce resources, and distrust of the health care system. Support systems for African Americans are reported to be centered on family and church communities. Observations made during recruitment and enrollments for a longitudinal intervention study with urban African Americans with cancer pain are presented. Majority of the subjects being recruited in this study are well educated, knowledgeable about research and very open to healthcare providers and researchers. Our population is younger than anticipated and struggling with an absence of family, faith, or community supports. They are more connected in terms of phone ownership, but often difficult to contact due to interruptions in phone service, housing insecurity and time demands related to medical care for their cancer. We conclude that familiarity with cultural patterns of a population of interest is necessary, but local and individual assessment is critical to successful recruitment to research.

An Examination of Nurse Caring and Hospital Acquired Pressure Ulcers

The Nyberg Caring Assessment Scale (NCA) and the National Database of Nursing Quality Indicators (NDNQI) were used to measure nurse caring and hospital acquired pressure ulcers. This is an exploratory, descriptive, single-site study conducted in a large academic, trauma center, twice Magnet® designated in the southeast United States. Caring theory, the mechanics of pressure ulcer development, and wound prevalence between medical-surgical and critical care units was explored. No statistically significant differences in caring scores were identified between nurse groups, although pressure ulcer prevalence differed. Existing high standards of care and the tool itself are noted as factors influencing the results.