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Journal of Nursing



  • The Future of Nursing Education: Heading for a Major Crisis
    Rebecca E. Przywara, BSN Student Nyack College, NY & Maureen Kroning RN EdD, Associate Professor at Nyack College, NY
    Nursing as a practice and profession has experienced significant changes over the years. For instance, in the 1800s nurses were expected to be subservient to doctors. Just hear what the doctor who gave Springfield Hospital’s first nursing graduation address: "Every nurse must remember that it is the attending physician's business to make a diagnosis of disease and hence that she should never hazard an opinion herself, under any circumstances." (Dr. Hooker, Springfield Hospital Annual Report, 1894). It would be interesting to know what the nursing faculty were thinking when they heard those words. Thankfully nurses during that era did not take the doctor’s advice and remained dedicated to advance and advocate for the profession of nursing. Around the same time that Springfield Hospital’s first nursing graduating class were listening to their graduation address, Florence Nightingale along with other nurse advocates, were making incredible strides to implement nursing education. After the Crimean War, Florence Nightingale recognized and introduced the need for formal nursing education but the education was limited to basic nursing knowledge and skills. As a result of the Women’s Rights Movement in the 1900s, the idea of nursing as a profession evolved into a reality. As society’s healthcare needs changed, nursing education had to change to meet those needs. There were however, challenges each century faced when trying to ensure nursing education met society’s needs and today, the challenges faced are heading right for a major crisis.
  • Disparities in Healthcare: Night Shift Nurses
    Skip Morelock PhD, RN, NEA-BC
    Night shift nurses have been shown more likely to developing health issues than their day shift counterparts. Research over the past twenty years has led to the increasing conclusion that working night shifts for as little as eight shifts a month is associated with an increased likelihood to develop metabolic syndrome, a four-fold increase in the incidence of vascular events, and an increased chanceofdeveloping certain cancers.
  • DNP and the Transformational Leaders
    Bo Soobryan
    Transitioning advanced nursing practice to the doctoral level represents the natural evolution of the nursing profession and the right moves to ensure that nurses are prepared for the highest level of practice. Many advocates within the health care community (local and national authorities) are calling and welcoming the DNP role. National and state agencies, as a leading advocate for advanced practice nursing, understands greatly the contributions APNs (advanced practice nurse) make in the health care system as cost-effective providers. In addition, APNs have identified the need for additional education in the areas of evidence-based practice, quality improvement, and systems management, among others (Kaplan & Brown, 2009). This transition in the education of advanced practice nurses (APNs) is targeted to meet the increasingly complex needs of patients, families, and communities in a rapidly changing health care environment. DNP education also has the potential to transform the nursing profession in a variety of ways. These include: • Creating and adopting new roles in nursing practice • Increasing the influence of APNs in health care and policy development • Promoting leadership by APNs in their workplace and health care organizations • Enhancing the self-concept of advanced practice nurses • Strengthening inter-professional relationships and collaborations. (Kaplan & Brown, 2009; Swider, Levin, Cowell, Breakwell, Holland, & Wallinder, 2009) The DNP stimulates the creation and adoption of new advanced practice role. As health care becomes more complex, it will take such strong leadership criteria for nurses in all fields to continue to improve their own standards and the qualifications of others in the field (Kaplan & Brown, 2009).
  • It is Time to Recruit More Men into the Profession of Nursing
    Isaiah Monroe (Nyack College, BSN student) & Maureen Kroning RN EdD (Associate Professor of Nursing, Nyack College, NY)
    It is a benefit to have men working in the profession of nursing. We need to recruit more men into our nursing schools and to work in our healthcare institutions. Both male and female nurses bring different perspectives and benefits to the profession of nursing and to the patient’s they care for. The ability of men to negotiate and obtain higher salaries and positions in both administration and nursing specialty areas may serve as the impetus to elevate the entire nursing profession.
  • Managing behavior in children with ASD
    Karen Regan
    Unfortunately, many of these children end up in the emergency department for these behaviors due to the lack of community mental health services. These crises visits often times result in unnecessary medications being prescribed for these problematic behaviors.
  • Barriers to Patients Undergoing Methadone Maintenance Therapy
    Ashley Giordano, Lindsay Harrington, Courtney Letourneau, Laura Smith, & Sara Vermouth
    Methadone maintenance therapy is one method utilized to combat opioid addiction and is an effective treatment in the abstinence from opiates. The purpose of this article is to communicate comprehensive information to healthcare providers about methadone as a medication, and the treatment guidelines of maintenance programs in the hopes of diminishing the stigma attached to methadone maintenance therapy. Through a comprehensive literature review, information regarding mechanism of action, maintenance therapy program guidelines, different barriers to treatment, and how to overcome these barriers were collected and reviewed.
  • Why Do Nurses Eat Their Young?
    Taylor Caron, Senior Nursing Student
    This article discusses issues related to new nurses regarding bullying and how the problem can be solved.
  • When does treatment become a life sentence?
    Michelle Terwilliger, BSN, MSCN,RN
    This is an article based on patient's autonomy and dignity and the treatment process for those that have terminal illness.
  • The Far Reaching Impact of a Child
    Michelle Gosselin, RN, CEN
    Emergency care of pediatric patients leaves a deep impact to nurses career and lives. When these young lives are altered or end, how is the profession caring for the nurses left behind. This article explores the need for awareness and support during these trying times to return the nurse back to wellness.
  • The Birmingham VA Nursing Academy Partnership
    Dr. Laura Steadman, Kimberly D. Froelich, PhD, RN, NE-BC, ARNP, VHA-CM, Angie Harrison, RN, VANAP scholar, Taylor Wiggins, RN, VANAP scholar, Elijah Berry, RN, VANAP scholar
    This article describes a partnership and the importance of partnering with the Birmingham VA Medical Center and the University of Alabama at Birmingham School of Nursing as part of a pilot program in The United States to promote nursing careers in the VA hospital and to improve the quality of nursing education in the School of Nursing. Since it began, in 2009, this program, called the Veterans Affairs Nursing Academy Partnership, has consistently performed beyond expectations to increase the breadth of knowledge for a select group of baccalaureate nursing students. Further it has created a strong connection between the Birmingham VA Medical Center and the University of Alabama at Birmingham School of Nursing, a professional resource that benefits all students and faculty.
  • Rising to the Challenge of Nursing Education
    Beth Kalkman, MSN RN, RNC-OB
    As the nursing shortage and nursing faculty shortage continue, it is imperative that we look to innovative measures in order to increase the number of available baccalaureate prepared nurses. At the same time, it is crucial that we do not neglect the quality of education required to receive the Bachelor of Science in Nursing degree. This paper examines potential solutions to the ongoing nursing shortage.
  • Medication Induced Bradycardia
    Gina Noggle RN BSN
    In medicine there is never a playbook about how things are going to unfold and this is especially true when it comes to recovering from surgery and anesthesia. For example, sometimes as nurses we give medications to treat one symptom and unintentionally cause another.
  • Nursing School Angel
    Kelly Fulghum, RN
    How a patient in nursing school taught me how to deal with life and death
  • Successful Aging For Canada's LGBT Older Adults
    Tosh Reed
    A research paper I wrote for my BSN degree regarding how health care services, particularly nursing can accommodate older adult members of the LGBT community and provide safe and best practice care.
  • Improving Patient Care While Decreasing Costs: The Benefits, Barriers, and Student Perspectives on Nurse Residency Programs
    Glenn Javelona Yaira Kurtzman
    Many professions have long since realized that a vast divide exists between the classroom and real-world practice and, thus, have mandated transitional programs. Nursing lacks such an intermediate step as part of its professional training although new nurses are pressured to provide both safe and competent care to increasingly complex patients without any transitional support (Pittman, Herrera, Bass, & Thompson, 2013). To fill this gap many institutions have begun to implement their own nurse-residency programs [NRPs]. However, since not all institutions have introduced such transition-into-practice programs barriers must exist. Nationwide, NRPs are shrouded in confusion, false perceptions, and concerns that hinder their implementation. This manuscript was compiled to help shed light onto the reasons for the lack of implementation and provides evidence of the importance and overall benefits for such programs. Personal perspectives are also provided from the authors in order to gain a nursing-student perspective about these transitional programs.
  • Quiet Servant
    Deborah J. Camak ,MSN,RNC
    A poem dedicated to the service of community health nurses.
  • Reflections of Nurse Educator
    Chinazo Echezona-Johnson, Ed.D, LL.B, MSN, RNC-MNN Assistant Director of Maternal-Child Educator, Health and Hospital Corporation, Metropolitan Hospital Center
    Teaching is an art. Some people are born teachers while others acquire the skill. To be a great teacher, one has to have a sense of humor and be very flexible. Teachers will never teach to gain monetary reward. However, they will teach to achieve the best reward - satisfaction that they have an impact on the education of the leaders of the world, the training of CEOs, and the success of new breed of professionals. Teaching is a noble profession.
  • Prescriptive Authority for Nurse Practitioners
    Lacy Kusy
    The physician shortage in primary care, plus the growth of nurse practitioners and increasing need for access to health care, creates a necessity for more autonomous nurse practitioners. However, current restrictions on nurse practitioners, particularly prescription regulations for controlled substances, limit what practitioners can do for patients. These restrictions also increase wait times for patients and have the potential to increase liability claims as physicians prescribe medications for patients they have not adequately evaluated. Nurse practitioners have proven to be a safe, quality, and cost saving approach to primary care. To meet the growing needs for patients, nurse practitioners must have the ability to prescribe controlled substances in all 50 states.
  • Family Presence during a Code Blue
    Lacy Kusy
    I have been a nurse in the Cardiac Intensive Care Unit for over five years now, and have participated in many code blues. Some of these situations are appropriate for family to attend and some are not. Each situation is assessed individually to determine the appropriateness of family presence. I had been caring for a young lady, Ms. R.V., who was an 18 year old that had received a heart transplant for a congenital heart defect when she was 13 years old. She was admitted to TGH to be placed on the heart transplant list again, as her transplanted heart had been failing for months. Due to the failing heart, other organs began to also fail. R.V. had gone into heart and kidney failure and required continuous renal replacement therapy (CRRT) for continuous dialysis treatment since her blood pressure was continuously low. I had cared for R.V. for three days so far and had gotten to know her and her mother very well. R.V. and her mother were extremely close. Her mother brought her in dinner as often as she could and visited on her days off. Because her daughter had been in the hospital for so long, the patient’s mother had to return to work. She would work during the day and visit in the evening. This particular day, R.V. was stating how excited she was to see her mom that evening, and her mom was going to bring her a salad from Panera Bread. I could sense her excitement in her voice and facial expressions, although she had very little energy to spare. Around shift change, my patient began to feel “different”, and state that “something isn’t right”. I immediately took her vital signs, laid her back down in bed, and called her doctors. I also called her mother to see how close she was to the hospital. Not long after R.V. stated she felt “different”, her oxygen saturations plummeted, she turned blue, stopped breathing, and a code blue was called. With many doctors and nurses at the bedside, CPR was performed for at least 15 minutes before R.V.’s mom arrived. She was very distressed and anxious to see her daughter. One of the doctors felt that she should not be around to witness the CPR on her daughter. I, on the other hand, stated that R.V. and her mom are very close and that she should be allowed to stand in the back to be with her daughter, an 18 year old child. This particular doctor was one that strictly attends code blue situations and had no previous relationship with this patient or her mother. I calmly expressed that in this situation, the mother of R.V. should be at the bedside of her daughter if she wants to because her daughter looked as though she would not survive the code situation. R.V.’s mother was not in the way, and she stood at the head of her daughter and whispered into her ear. Once R.V.’s primary doctors arrived, they agreed that the mother should stay in the room if she wanted to be with her daughter. R.V. did not survive the code. Her mom, however, was able to be with her daughter as she passed and held her hand as she took her last breath. As heartbreaking as this scenario was, the patient’s mother thanked me for allowing her the privilege of being with her daughter as she finally got peace and can “rest now”. Although not all code blue situations are deemed appropriate for family presence, the nurse and care providers should assess each family and patient separately to determine what is best for the patient and the family.
  • "Phase 1; Exploration of paramedic protocol for field IV insertion" and "Field IVs: To Replace or Not"
    Caitlin Wright, En-Dien Liao, and Dr. Deborah Behan
    This is a two-phase study. We are willing to have either two different phases for you to publish, or combine our two studies into one manuscript for publication. HURCA Abstract Caitlin Wright, Senior II Nursing Faculty Advisor: Dr. Deborah Behan, PhD, RN-BC Phase 1; Exploration of paramedic protocol for field IV insertion Current protocol at a south central hospital in the U.S. requires nurses to change field IVs within 24-48 hours. Changing IVs in-hospital result in patient duress and nurse time loss. This article reports data from the IV Insertion Protocol Survey and the Paramedic Educator Survey. These surveys attempt to identify paramedic protocol and practice related to IV insertion and aseptic technique. Further, the surveys explore paramedic education regarding IV insertion. Surveys were hand-delivered, participants were invited to participate in the anonymous survey, and data were then analyzed using RemarkOffice. The results suggest paramedics are educated on the use of aseptic technique and that paramedics clean the IV site unless circumstances such as limited space or patient acuity prevent proper cleansing. Eighty-eight percent of participants report following a protocol, 64% almost never/never use hand sanitizer, and 83% of educators said that paramedics are not instructed to use hand sanitizer. In summary, paramedics use aseptic technique, which suggests that field IVs should not need to be replaced within 24-48 hours after a patient’s hospital admission. PURPOSE STATEMENT The purpose of this study is to determine whether or not the paramedic providers to this South Central region of the United States follow a protocol for IV insertions that is equivalent to hospital protocol. PHASE 1; EXPLORATION OF PARAMEDIC PROTOCOL FOR FIELD IV INSERTION OUTLINE Introduction • Background o Some studies indicate that IV insertions are periodically performed without maintenance of aseptic technique. • Problem and Purpose o Current protocol at a South Central hospital in the United States requires nurses to change all field IVs within 24-48 hours after a patient’s admission. o If paramedics are complying with a protocol requiring site cleansing before IV insertion, changing the IV in-hospital may not be necessary. o The purpose of this study is to determine whether or not the paramedic providers to this South Central region of the United States follow a protocol for IV insertions that is equivalent to hospital protocol. Materials and Methods • IV Insertion Protocol Survey and the Paramedic Educator Survey were created for the study. • The survey is a 10 item survey using a likert scale to determine paramedic practice and adherence to IV insertion protocol. • A pre-written script was read before each survey. • The survey was given to each paramedic, paramedic educator, and paramedic supervisor who chose to participate. Results • Eighty-eight percent said they follow a protocol for IV insertion. • Eighty-nine percent of participants reported to always use aseptic technique and the remaining 11% reported almost always. • Nine percent of participants always use hand sanitizer before inserting IVs in the field, and 64% almost never/never use hand sanitizer. • Certain circumstances in the field may not allow for aseptic technique to be used. • The Paramedic Educator Survey results showed that 100% of the educators teach cleaning of the skin before IV insertion. Discussion • The EMS providers that we surveyed do not have a protocol that is equivalent to hospital IV insertion protocols; they follow algorhythms. • The results from the Paramedic Educator Survey suggest that paramedics are taught to use aseptic technique when inserting a peripheral IV • The group felt that it was impractical to use hand sanitizer before applying gloves. • Educators did not express the desire to begin teaching about the use of hand sanitizer. • There is no form or official process of communicating whether or not the IV was placed with proper aseptic technique • Future study recommendations: hand-off report between paramedic and receiving personnel, follow IVs in-hospital to see if there is a need for replacement Conclusion • EMS providers in this South Central region of the United States have been well educated on aseptic technique and IV insertion. • Change of protocol could better manage nurse time, as well as provide substantial health benefits for the patient. ABSTRACT FIELD IVS: TO REPLACE OR NOT En-Dien Liao, B.S. in Nursing The University of Texas at Arlington, 2014 Faculty Mentor: Deborah Behan, Ph.D., RN-BC Patients admitted to the emergency room via Emergency Medical Services with a field-established peripheral intravenous catheter (IV) were observed for 96 hours while in the hospital. Currently, many nurses restart the IV upon admission because they feel an IV started by a paramedic while in the field needs to be changed within 48 hours of hospital admission. The purpose of the study was to determine if field IVs started by paramedics could be utilized after patient admission to the hospital. Each day, observations of the IV site were recorded for signs of redness, swelling, and pain or tenderness, which would indicate the IV needed to be restarted. Results suggest that IVs started in the field by a paramedic in the ambulance may last up to 96 hours before they need to be changed. PURPOSE STATEMENT The purpose of this study was to determine if the field EMS IVs can last up to 96 hours without being changed by the nurse in the acute care setting. This study is aimed at identifying the aftereffects of IVs inserted in the field and determining whether or not pre-hospital IVs need to be replaced in the acute hospital setting within 24-48 hours of patient arrival. OUTLINE Introduction Purpose • The purpose of this study was to determine if the Emergency Medical Service (EMS) peripheral intravenous catheters (IVs) can last up to 96 hours. Background/Literature Review • Lawrence and Lauro (1988)- field-started IVs are 2.88 times more likely than hospital-started IVs to develop complications within 24 hours of insertion. • Lee et al. (2009)- In the hospital setting, IV catheter replacement time can be extended from 48 up to 96 hours. • Wright (2011)- evaluation of aseptic technique used by EMS personnel. • 88% of EMS follows a protocol for IV insertion • 100% always or almost always use aseptic technique when inserting field IVs • All paramedic educators were found to teach cleaning of the skin with alcohol prior to IV insertion Method • On random days, the researcher went to the emergency room (ER) and identified patients who arrived by EMS with an EMS established IV. • After admission orders, the patient was followed to room. • Verbal consent obtained, and patients were followed for the next four days • Data were collected each day on the following criteria: Site, redness, swelling, and pain/tenderness. Result • Total participants: 62 (134 measurements across 4 days) • One participant withdrew, and another participant passed away IV Location: Within the 134 measurements, 37 of the measurements were for an IV located in the right arm (33.9%). Seventy-two of the measurements were for an IV located in the left arm (66.1%). IV Redness: Out of 134 measurements, 12 measurements had redness (9%) and 110 measurements did not have redness (82.1%). IV Pain: Out of the 134 measurements, seven measurements were reported as pain or tenderness (5.2%) and 114 reported no pain or tenderness (85.1%). IV Swelling: Out of the 134 measurements, seven had signs of swelling (5.2%) and 110 measurements did not (85.8%). Discontinued Reasons ranked from highest to lowest: 36 due to discharge (64.3%), 6 to leaking (10.7%), 5 to policy removal (8.9%), 5 to pulled-out (8.9%), 2 to infiltration (3.6%), 1 to bruising (1.8%), and 1 to poor location (1.8%). Conclusion • EMS IVs may remain longer than 24 hours and up to 96 hours before they need to be changed. • Potential benefits : • Better quality of care for patients • More time saved for nurses from restarting IVs • Decreased cost to hospitals from reduced length of stays in hospitals. • Majority of patients were left handed • Inconsistency between system policy and actual bedside practice. Further education from nurse educators may be needed on the hospital’s IV policies. • Future Research: correlation between IV needle size and IV leakiness. • Wright (2011) found 82% of paramedics to use 18 gauge needles • Leaking was found to be the 2nd highest cause for IV discontinued
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