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Journal of Nursing

  • 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
  • Clinical Considerations for Patients with Active Clostridium difficile Infection
    Donna Boyer,RN,WCC James McShane,BA,RN
    This article addresses the probable significant environmental Clostridium difficile (c. difficile) spore contamination that occurs when patients with active C. difficile infection are utilizing low air loss mattress therapy. We site published works that have proven environmental contamination exists in the absence of low air loss therapy. We assert that by virtue of the mechanism of action of low air loss surfaces, significantly increased environmental soiling is inevitable. Therefore, the risk of spreading infection is significantly increased. We are calling for additional research to determine the extent of increased contamination that occurs when low air low therapy is used on patients with active C difficile infection.
    Principal Author: Cik Norfidah Binti Mohamad Contributing Author(s) 1. Zaleha Binti Mohd Hashim 2. Umi Kalsom Binti Ibrahim 3. Nordiana Binti Borhan Designation PA Head, Department of Nursing CA1. Registered Nurse CA2. Registered Nurse CA3. Registered Nurse Principal Author Tel. No: +6019 2413108 Principal Author-email address: [email protected]
    Abstract Background: Obesity and overweight are more frequent in workers working in shift and psychological distress increased among working women in Malaysia. A supportive manager and a flexible working time are linked with a decrease of the conflicts between family and work. Objectives: The purpose of the research was to investigate the patterns of eating habit and its relationship factors, with focus on psychological factor among nurses. Methods: A study of 100 nurses was conducted in medical-surgical wards of a public hospital. Data was collected using a cross sectional study using a convenience sampling (non probability). A self-administered questionnaire on eating habits was used, and analyzed using SPSS (version 21). Results: A majority of (89%) participants was from a female group while a number of male participants are only (11%). Majority (86%) responded they ate because of feeling happy followed by eating because of feeling lonely (80%) and most of them did not perceived that they have a healthy eating habits (53%). Conclusions: The findings indicated that employers need to identify physical workload that is acceptable to avoid risks of unhealthy eating habits and monitor the availability of healthy food in the worksite. Keywords: Eating habits,Psychological Factors, working in shifts.
  • History of Ebola and Nursing
    Chinazo Echezona-Johnson, Ed.D, LL.B, RNC-MNN Assistant Director of Nursing/Women and Children Nursing Education Metropolitan Hospital Center
    Many healthcare providers and the public are paying very special attention to the outbreak of the Ebola Virus in West Africa and the subsequent infection of the two critical care nurses at Texas. Many healthcare professionals expressed their confusion about the virus and the seeming stigmatization of nurses. Currently with the outbreak in Texas, nurses and other healthcare providers were encountered the same dilemmas as Central Africa nurses years ago.
  • The Cost of Caring
    Julie Givens RN, BSN Cynthia Bain MSN, RN, CNE
    Nurses care for individuals when they are most vulnerable and often serve as emotional outlets. It is this deep caring that can lead to nurses becoming burnt out or developing vicarious traumatization, secondary traumatic stress, or compassion fatigue. Awareness of these phenomena and methods of prevention needs to be increased throughout the profession. This includes teaching nursing students as they begin having interactions with patients in the clinical setting.
    Tags: cost, caring
  • Love in the ICU
    Brynn Knibbe, RN, BSN, CCRN
    the love I have witnessed between people during my time as an ICU nurse
    Tags: ICU, love
  • Cultural Diversity
    Elizabeth Shiferaw
    Cultural Diversity plays a very important role and will continue to play an even greater role as we move into a more diversified world. We live in an era of constant change and transformation, which in return paves the way for cultural transparency. The U.S. population consists of members from different racial and ethnic groups and depending on their geographical location, they can either be more or less concentrated.
  • Diabetes Insipidus
    Karen Resseguie-Vickstrom, BSN, BBA, MBA (current DNP student)
    ABSTRACT: Diabetes Insipidus (DI) is a deficiency response to the antidiuretic hormone (ADH) also known as vasopressin. There are two types of vasopressin (V) receptors known as V1 and V2 in which the V1 receptors located in the vascular smooth muscles cause vasoconstriction whereas V2 receptors located on the tubular cells of the cortical collecting duct control the reabsorption of water via the kidneys. DI effects the renal mechanisms of the water reabsorption which is particularly imperative for maintaining body fluid osmolality. Edification that medication management is available in conjunction with readily accessible liquids at all times to replenish the enormous losses that occur through urination in addition to enforcement that this disease can easily turn to life threatening if not managed properly. PURPOSE STATEMENT: The principle of this article is to aide nurses and advanced specialty nurses in providing educational awareness to parents whom have a child with Diabetes Insipidus as it correlates with an insufficient response to the antidiuretic hormone (ADH).
  • Abnormal Gait in Toddlers
    Author: Karen Resseguie-Vickstrom BSN, BBA, MBA (current DNP student)
    Disorders of the skeletal system can develop as a result of abnormal growth and development due to hereditary or congenital abnormalities (Grossman, 2013). Three possible diagnosis that could result in a three year old child that is having a noted abnormal gait is Torsional Deformities, Developmental Dysplasia of the Hip and Legg-Calveʹ-Perthes disease.
  • One Day, One Shift, One Year
    Maria Hatter, RN, BSN, CCRN
    Nurse's experience of delivering a baby in the restroom of an ED.
  • Not Just Another Day
    Kimberly Heister
    Brief story about helping someone say goodbye and knowing their loved one was cared for.
  • A Difficult Patient
    Catherine Stevens
    managing a difficult patient in the PACU setting. In my nursing career, there are many different types of challenges. Job challenges, schedule challenges and patient related challenges. No matter what type of nursing I have encountered there are always difficult patients that test my nursing skills. Whether the demands are related to technical skill, assessment or cultural understanding, I enjoy that critical thinking that is required to rise to the occasion. As a seasoned nurse I feel that technical challenges have become easier to handle, while the social or cultural challenges have my increased interest. I continue to obtain as much education as I can to assist my nursing challenges.
  • True Suffering In An ICU
    Carlton R. Smith, Professional Therapeutic Counselor, Author, The Ignorant Grandfather, 2014.
    Essay concerning the view of various interactors in an ICU. Told from the perspective of a Professional therapeutic counselor who has counseled doctors, nurses, family, allied health and patients. Considers the suffering of all involved in the daily interactions of the ICU milieu.
  • Self Examination of Body : An Effective Measure for Early Detection and Treatment Properly of Cancers among Girls/Women in Rural Area and Slum Area of India
    Harasankar Adhikari
    Cancer is the one of the scariest and second largest non-communicable disease. It contributes a sizable in the total numbers of deaths. The World cancer Report, 2003 indicates that cancer rates are set to increase at an alarming rate globally and it would be increased by 50% new cases for the year 2020. In case of India the number is expected to rise seven million by 2015. Ignorance among the public, delayed diagnosis and lack of adequate medical facilities has given it the dubious distribution of being a ‘killer disease’. Only early diagnosis and properly treatment strategies can be prevented the one third of common cancers. It is the prime matter of concern that the female population at their reproductive age and beyond is badly infected by the disease. The incidence of breast cancer, cervix and ovarian cancer are raising steadily. There are several factors like life style and diets specially among urban women associated with this increasing rate of victimization. But among females of rural and urban slums it speaks another scenario because these female populations has a little scope of self examination of their body which is an effective strategy rather than education, awareness and screening test.
  • No, Ms. Ray, I'm Not Thankful to Have a Job
    Pat Miller, RN
    Response to HR telling nurses they are lucky they have a job after cutting pay and benefits.
  • Educational Requirements for Baccalaureate Nursing Faculty: How do the States Differ?
    Kelli Fuller DNP, RN, ANP-BC Renee Davis DNP, RN, CPNP Bobbi Shatto PhD, RN, CNL
    Nursing shortages have plagued the United States for the past several decades. By 2020, the deficit of Registered Nurses (RN) is projected to exceed 1.2 million (AACN, 2012). One important factor is the shortage of qualified nursing faculty. Every year many qualified applicants are denied admission to nursing programs due to nursing faculty shortages (AACN, 2012). Nursing programs can only accommodate as many students as they have faculty to teach. State Boards of Nursing (SBN) throughout the country are collaborating with colleges and universities to fill nursing faculty vacancies utilizing a variety of creative strategies. An educational research team, at a private university in the Midwestern section of the country, examined each state’s SBN rules and regulations related to pre-licensure faculty requirements for baccalaureate nurse educators. The researchers found that there were vast differences in the educational requirements allowed by individual State Boards of Nursing for Baccalaureate nurse educators.
  • Teach Your Children CPR
    Maureen Kroning RN EdD
    CPR is a skill most anyone including our own children can learn. It is a skill that needs to be taught in all schools. We should not underestimate our youth being able to save someone's life by performing CPR.
  • Eating Disorder among Elderly Causing Heart Attack in Post Retirement Life
    Harasankar Adhikari
    In the era of globalization growing elderly faces multifaceted problems range from absence of ensured and sufficient income to support themselves and their dependents, to ill-health, absence of social security, loss of social role and recognition, and non-availability of opportunities for creative use of free time in all societies of India in their post retirement. In developed countries population ageing substantially shifted in social programmes.
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