Development of a Moral Resilience Collaborative Program During a Pandemic.

Elevated psychological stress can lead to moral distress affecting health care workers and organizations affecting patient care, job satisfaction, and retention. A Moral Resilience Collaborative program was implemented through an academic partnership between a school of nursing and a rehabilitation facility to provide the health care workers in the facility the skills necessary for self-management of moral distress and move them toward moral resilience. Moral distress and resiliency were measured pre-implementation using the Measure of Moral Distress for Healthcare Professionals (MMD-HP) and Short Resiliency Survey (SRS), respectively. Unfortunately, postsurvey quantitative data collection failed due to COVID-19 surges though qualitative data obtained during debriefing sessions demonstrated effectiveness of the project. Based on debriefing comments and the preimplementation MMD-HP mean score and SRS decompression score, the staff in this facility experienced similar types of moral distress as those working in acute care or critical care settings. Even when resiliency programs are needed the most and readily available, patient care demands, a busy work environment, and external factors can hinder staff participation in such endeavors.

Teaching Professional Peer Review With the Use of Simulation.

BACKGROUND: Quality improvement practices such as peer review and just culture are important components of patient safety initiatives, and health professions students should be introduced to these practices during their education. PURPOSE: The purpose of this study was to evaluate a peer-review simulation learning experience using just culture principles in a graduate-level, online nursing education program. METHODS: The students rated their learning experience with high, positive scores in all 7 domains on the Simulation Learning Experience Inventory. Responses to the open-ended question indicated that the students thought the experience provided opportunities for deep learning, increased confidence, and enhanced critical thinking skills. CONCLUSION: A peer-review simulation program using just culture principles provided a meaningful learning experience for graduate-level students in an online nursing education program.

Adults Without Advocates and the Unrepresented: A Narrative Review of Terminology and Settings.

Socially isolated adults, including those with and without the ability to make medical decisions, are encountered in clinical practice and are at risk for adverse health outcomes. Consensus is lacking on appropriate terminology to describe subpopulations of these patients. In addition, little is known about the settings in which they present. These gaps prevent clinicians and policymakers from identifying and understanding these populations and deploying appropriate resources to meet their complex needs. We conducted a narrative review of literature on socially isolated adults aged 50 and older to assess and integrate the available evidence regarding the terminology used to describe unrepresented patients and adults without advocates to inform consensus on terminology. We also identified the settings in which unrepresented patients and adults without advocates are described in the literature, including both within and outside health care settings. Our results indicate that there is heterogeneity and inconsistency in the terminology used to describe socially isolated adults, as well as heterogeneity in the settings in which they are identified in the literature. Our findings suggest that future work should include achieving consensus on terminology and integrating proactive interdisciplinary interventions across health systems and communities to prevent adults without advocates from becoming unrepresented.

Nurse Faculty Provide Essential Support to Graduate Nursing Students During COVID-19 Pandemic.

Nurses in formal and informal leadership roles have been stretched to fulfill duties in their own role and be pulled into staffing. These emerging leaders have little energy to pursue an advanced academic degree when they are already considering leaving the profession. In a health care industry filled with ambiguity and volatility, continued efforts to support, retain, and recruit nurses in graduate leadership programs are essential. This article describes how graduate nursing faculty provided support to graduate students in unprecedented times.

Shared governance council to engage advanced practice registered nurses in a hospital setting.

BACKGROUND: Health care organizations use advanced practice registered nurses (APRNs) to expand patient access and support high-quality care. However, turnover, often exacerbated by inadequate engagement, has steep financial and experiential costs. LOCAL PROBLEM: The project site, a large urban academic institution with quaternary care capabilities, employs more than 300 APRNs to provide patient care. Due to variations in hiring entity, leadership structure, and organizational visibility, efforts to maintain APRN engagement were complex. In addition, inconsistencies in standardization of clinical, credentialing, and privileging procedures created organizational risk. METHODS: Quality improvement principles informed the implementation of a shared governance council for APRNs that included nurse practitioners and certified registered nurse anesthetists. Data were collected pre and postintervention using validated engagement questions. INTERVENTION: Implementation of a shared governance council to support the organizational engagement of APRNs through decisional involvement in professional practice issues. RESULTS: Analysis included the percentage of change in aggregate scores and the Wilcoxon rank-sum test to obtain p values of the 2 independent samples. There was an 8.9% increase in aggregate postintervention scores and statistical improvement in measures of quality improvement involvement. CONCLUSION: Participation in the shared governance council increased APRN engagement through enhanced opportunities to communicate professional and clinical practice issues, decisional involvement, and collaboration. Statistically significant improvements in quality improvement involvement values potentially affirm the council's role in facilitating work environment improvements. Potential long-term gains include improved job satisfaction, retention, and organizational cost savings.

Every Story Is Different: Experiences With Body Changes Related to Cancer.

One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.

The Impact of Guided Imagery on Pain and Anxiety in Hospitalized Adults.

BACKGROUND: The use and impact of guided imagery in the acute care setting is limited. AIMS: The purpose of this quality improvement project was to evaluate the feasibility of a guided imagery intervention to change pain scores, anxiety scores, and opioid analgesia usage among hospitalized adults in an acute care setting. DESIGN: Quality improvement project using three measurements (baseline, 24 hours, and 48 hours). SETTINGS: Acute care hospital. PARTICIPANTS/SUBJECTS: Adult inpatients referred to an APRN-led pain management service. METHODS: The intervention was the use of a 30-minute guided imagery recording delivered via MP3 player which patients used twice daily. RESULTS: Limited changes were seen in pain scores, with no statistically significant results (p = .449). Statistically significant reductions were found in both anxiety scores (p < .001) and opioid analgesia usage (p = .043). CONCLUSIONS: Findings from this quality improvement project support the impact of guided imagery on anxiety and opioid analgesia use. Changes in pain scores were not demonstrated in this project. Additional research with a rigorous design is needed to determine cause and effect conclusions. CLINICAL IMPLICATIONS: The use of guided imagery as an adjunctive intervention for pain control may engage and empower the patient in self-care activities, which may have an impact on how care is perceived. Guided imagery is a low-cost, easily implemented approach that can be incorporated into patient care to reduce anxiety and, potentially, opioid analgesia use.

A Systematic Process for Evaluating Teaching Methods in Nursing Education.

BACKGROUND: An evidence-based process for the evaluation of teaching methods in nursing education, including classroom assignments, is not well described in the literature. PROBLEM: Nurse educators are familiar with evidence-based teaching but may be less knowledgeable about evidence-based methodologies to evaluate the effectiveness of teaching methods. Global measures of students' success, such as passing a licensing or certification examination, are often used as benchmarks for nursing education programs. APPROACH: The authors suggest an evidence-based, 8-step evaluation process for evaluating the effectiveness of teaching methods. This process is demonstrated using simulation learning experiences in 2 courses in an advanced practice nursing education program. OUTCOMES: The 8-step evaluation process was found to be effective for evaluating teaching methods within a graduate-level nursing education program. CONCLUSIONS: The proposed evaluation process is applicable for evaluating teaching methods at all levels of nursing education. This systematic evaluation of teaching methods may ensure that students are engaged in learning activities leading to the attainment of assignment and course objectives.

Psychosocial Issues and Lifestyle Changes for the Renal Patient.

This article provides an overview of the psychosocial issues faced by those with renal disease. The article discusses the physiologic connection between anxiety, depression, and pain-symptoms commonly seen in renal disease and other chronic illnesses. The application of integrative medicine or nonallopathic medicine and its role in the management of anxiety, depression, and pain are presented. Also presented is evidence surrounding several frequently used nonallopathic modalities appropriate for incorporation into a comprehensive management regimen for renal patients to reduce symptom burden. The article concludes with a discussion on the role of palliative care in treatment decisions for renal patients.

A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit.

IMPORTANCE: Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit. OBJECTIVE: To examine whether CoQ10 could slow disease progression in early PD. DESIGN, SETTING, AND PARTICIPANTS: A phase III randomized, placebo-controlled, double-blind clinical trial at 67 North American sites consisting of participants 30 years of age or older who received a diagnosis of PD within 5 years and who had the following inclusion criteria: the presence of a rest tremor, bradykinesia, and rigidity; a modified Hoehn and Yahr stage of 2.5 or less; and no anticipated need for dopaminergic therapy within 3 months. Exclusion criteria included the use of any PD medication within 60 days, the use of any symptomatic PD medication for more than 90 days, atypical or drug-induced parkinsonism, a Unified Parkinson's Disease Rating Scale (UPDRS) rest tremor score of 3 or greater for any limb, a Mini-Mental State Examination score of 25 or less, a history of stroke, the use of certain supplements, and substantial recent exposure to CoQ10. Of 696 participants screened, 78 were found to be ineligible, and 18 declined participation. INTERVENTIONS: The remaining 600 participants were randomly assigned to receive placebo, 1200 mg/d of CoQ10, or 2400 mg/d of CoQ10; all participants received 1200 IU/d of vitamin E. MAIN OUTCOMES AND MEASURES: Participants were observed for 16 months or until a disability requiring dopaminergic treatment. The prospectively defined primary outcome measure was the change in total UPDRS score (Parts I-III) from baseline to final visit. The study was powered to detect a 3-point difference between an active treatment and placebo. RESULTS: The baseline characteristics of the participants were well balanced, the mean age was 62.5 years, 66% of participants were male, and the mean baseline total UPDRS score was 22.7. A total of 267 participants required treatment (94 received placebo, 87 received 1200 mg/d of CoQ10, and 86 received 2400 mg/d of CoQ10), and 65 participants (29 who received placebo, 19 who received 1200 mg/d of CoQ10, and 17 who received 2400 mg/d of CoQ10) withdrew prematurely. Treatments were well tolerated with no safety concerns. The study was terminated after a prespecified futility criterion was reached. At study termination, both active treatment groups showed slight adverse trends relative to placebo. Adjusted mean changes (worsening) in total UPDRS scores from baseline to final visit were 6.9 points (placebo), 7.5 points (1200 mg/d of CoQ10; P = .49 relative to placebo), and 8.0 points (2400 mg/d of CoQ10; P = .21 relative to placebo). CONCLUSIONS AND RELEVANCE: Coenzyme Q10 was safe and well tolerated in this population, but showed no evidence of clinical benefit. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00740714.

Music as an adjuvant therapy in control of pain and symptoms in hospitalized adults: a systematic review.

The objective of this review is to evaluate the evidence regarding the use of music as an adjuvant therapy for pain control in hospitalized adults. The search terms music, music therapy, pain, adults, inpatient, and hospitalized were used to search the Cochrane Library, Cinahl, Medline, Natural Standard, and Scopus databases from January 2005 to March 2011. (A systematic review conducted by the Cochrane Collaboration has extensively covered the time frame from 1966 to 2004.) Seventeen randomized controlled trials met criteria for review and inclusion. Seven of the research studies were conducted with surgical patients, three with medical patients, one with medical-surgical patients, four with intensive care patients, and two with pregnant patients. The combined findings of these studies provide support for the use of music as an adjuvant approach to pain control in hospitalized adults. The use of music is safe, inexpensive, and an independent nursing function that can be easily incorporated into the routine care of patients.

Antimicrobial susceptibility and multi-drug resistance of Salmonella enterica subspecies enterica serovars in Sudan.

This study was undertaken to determine the antimicrobial resistance patterns of Salmonella enterica subspecies enterica recovered from human, food, water, and animal samples collected in Khartoum State, Sudan. A total of 64 Salmonella isolates belonging to 28 different serovars were tested for their susceptibility to 13 antimicrobial agents. The majority of isolates (98.4 %) were resistant to at least one antimicrobial agent. Isolates were frequently resistant to ampicillin (90.6 %), cephalexin (50.0 %), nalidixic acid (25.0 %), streptomycin (21.9 %), kanamycin (18.8 %), gentamicin (17.2 %), and co-trimoxazole and trimethoprim (12.5 %). The most common pattern of multiple drug resistance included resistance to ampicillin and cephalexin. Most isolates were sensitive to chloramphenicol (98.4 %), ciprofloxacin (93.8 %), and norfloxacin (90.6 %). Two chicken- and the two human-origin S. Kentucky isolates were resistant to both ciprofloxacin and norfloxacin. All S. Kentucky isolates and the one S. Rissen isolate demonstrated multi-drug resistance. The results indicate the significance of multi-drug-resistant Salmonella serovars isolated from chickens and other animals and foods as sources for multi-drug-resistant Salmonella in humans in Sudan.

Perceptions of successful aging among older Latinos, in cross-cultural context.

Latinos are the largest and fastest growing minority group in the U.S. but they have been overlooked in studies of successful aging. This study used a multi-method approach with an open-ended question and Phelan et al.'s (Journal of American Geriatrics Society 52:211-216, 2004) Successful Aging Measure to determine whether the quantitative measure fully captured perceptions of successful aging of 60 older Latinos living in three Western states. Then, the findings were compared with other studies that had used the measure with Anglo, Japanese, Japanese-American, and Latin American samples. The results revealed that Latinos and Latin Americans responses are very similar to each other, and somewhat different from other cultural groups. Latinos focus on maintaining a positive outlook, living in the present, enjoying a sense of community, and relying on spirituality and family for comfort and meaning as they age, but they also worry about finances. There are several components of this study that professionals can use to guide their practice, including a summary of methodological challenges and ongoing conceptual debates in the successful aging literature.

Stress and grief among family caregivers of older adults with cancer: a multicultural comparison from Hawai'i.

In this study the authors investigated stress, anticipatory mourning, and cultural practices among family caregivers from independent and interdependent cultural groups. Focus groups were used to collect data from 56 caregivers providing care to family members with terminal cancer, representing four cultural groups in Hawai'i: Chinese, European Americans, Japanese, and Native Hawaiians. Participants from all four cultural groups identified similar stressors and agreed that support groups helped them cope with the stresses and sadness they were experiencing and differed in culturally based motivations for caregiving, perceived roles, and processing of grief. The findings of this study indicated a need for additional conceptual models of the caregiving trajectory and more culturally sensitive strategies, particularly indirect methods, for working with diverse populations of caregivers.

Issues confronting social workers in the provision of palliative care services in the Pacific Basin (Hawai'i and the U.S. affiliated Pacific Island nations and territories).

In this article, the authors highlight the complex issues associated with providing end-of-life and palliative care services to people who make up the diverse cultural groups of the Pacific. Many people from all over the Pacific Basin come to Hawai'i, USA to obtain palliative care services, due to lack of adequate health care in many Pacific Island nations. However, many barriers exist that sometimes prevent optimal care. Some of these barriers are due to a misunderstanding of cultural differences, while others are systemic. Both are discussed, as well as how social workers can assist with the provision of palliative care services in a culturally sensitive manner.

Ceftiofur resistance in Salmonella enterica serovar Heidelberg from chicken meat and humans, Canada.

The Canadian Integrated Program for Antimicrobial Resistance Surveillance describes a strong correlation (r = 0.9, p<0.0001) between ceftiofur-resistant Salmonella enterica serovar Heidelberg isolated from retail chicken and incidence of ceftiofur-resistant Salmonella serovar Heidelberg infections in humans across Canada. In Quebec, changes of ceftiofur resistance in chicken Salmonella Heidelberg and Escherichia coli isolates appear related to changing levels of ceftiofur use in hatcheries during the study period, from highest to lowest levels before and after a voluntary withdrawal, to increasing levels after reintroduction of use (62% to 7% to 20%, and 34% to 6% to 19%, respectively). These events provide evidence that ceftiofur use in chickens results in extended-spectrum cephalosporin resistance in bacteria from chicken and humans. To ensure the continued effectiveness of extended-spectrum cephalosporins for treating serious infections in humans, multidisciplinary efforts are needed to scrutinize and, where appropriate, limit use of ceftiofur in chicken production in Canada.

The role of attitudes and culture in family caregiving for older adults.

This study evaluated cultural differences in attitudes toward caregiving and the stress levels of family caregivers. Participants included 98 Japanese American and 86 Caucasian American family caregivers caring for frail elders. Analyses using MANOVA and multiple regression analyses revealed that the Caucasian caregivers had more positive attitudes and provided more hours of care than the Japanese caregivers but that both groups had elevated levels of caregiver stress. The stress that family caregivers currently experience could lead to a future generation of care recipients who enter old age in worse condition than their predecessors. Professionals need to work together to develop culturally appropriate, evidence-based interventions to address this issue.

Unraveling the mystery of acute pancreatitis.

On June 3, 57-year-old Paul Jackson has coronary artery bypass surgery. Two weeks later he is readmitted for treatment of acute pancreatitis, probably triggered by the trauma of surgery. Mild pancreatitis usually is self-limiting, but the more severe form has a mortality rate of nearly 50%. Complications can range from electrolyte imbalances to multisystem organ failure. This article discusses the care of the patient with pancreatitis and the prevention of further complications.