Establishing Empathetic Collaborative Care for Survivors of Violence Through Multidisciplinary Simulation.

BACKGROUND: Although nurses are introduced to an array of patient populations in nursing school, how to care for and treat survivors of violence typically does not get the same time and attention. Treating survivors of violence not only includes professional competency, but also empathy and the ability to work collaboratively with multidisciplinary professionals. This article describes a multidisciplinary survivors of violence simulation involving nursing, criminal justice, and psychology students that addresses empathetic and collaborative care for victims of violence. METHOD: Students participated in sexual assault, domestic violence, and human trafficking simulations. A Socratic debriefing technique with the standardized patient present was used. RESULTS: Students established positive relationships within their groups through respect and effective communication. Discussions during debriefing indicated students understood the importance of competent, empathetic, collaborative care. CONCLUSION: This educational initiative suggests the potential to improve multidisciplinary care for victims of violence through simulation. [J Nurs Educ. 2022;61(12):716-719.].

Nurse Educators: Professional Quality of Life Related to Conditions of Work Effectiveness.

BACKGROUND: Professional quality of life (ProQoL) is the balance between compassion satisfaction (CS) and compassion fatigue (CF). The experience of CF results from secondary traumatic stress stemming from compassionate caregiving and burnout. PURPOSE: This study sought to identify the ProQoL of nurse educators and what conditions for work effectiveness affect this ProQoL. METHODS: An email survey link was sent to nurse educators from the northeastern region of the United States asking for participation. This included demographics, the ProQoL Version 5, and the Conditions for Work Effectiveness Questionnaire version II (CWEQ-II). RESULTS: The 211 nurse educators reported relatively high CS and relatively low burnout and secondary traumatic stress. When the measures of the CWEQ-II increased, so did their CS. In addition, as the measures of the CWEQ-II increased, their secondary traumatic stress and burnout decreased. CONCLUSIONS: Findings suggest that conditions for work effectiveness such as access to opportunity, resources, information, support, and formal and informal power have a relationship to the nurse educator's ProQoL.

Factors Influencing Work-Life Balance in Physicians and Advance Practice Clinicians and the Effect of Heartfulness Meditation Conference on Burnout.

BACKGROUND: Burnout levels have risen in recent years and satisfaction with work-life balance has decreased. Individual and organizational factors may affect burnout in physicians and advance practice clinicians (APCs). Meditation is a tool to mitigate stress and enhance well-being. In this study, we assessed the factors affecting work-life balance in physicians and APCs. We also measured the impact of Heartfulness meditation conference on burnout. METHODS: Physicians and APCs were surveyed through an abbreviated Maslach burnout inventory (aMBI) to assess the burnout levels and a question to assess the factors influencing work-life balance. Wellness initiatives included either attending a Heartfulness meditation conference or reading a book about burnout and wellness (approximated at a 3-h read). A repeat aMBI survey was sent 8 weeks after the conference. Pre- and postburnout scores were assessed. RESULTS: Of the 1393 physicians and APCs, 537 responded to the aMBI, and there were 414 comments (663 factors) for the question on work-life balance. Among the respondents, 60.5% and 32% had symptoms of moderate to severe emotional exhaustion (EE) and depersonalization, respectively. Twenty-eight percent of the respondents had symptoms of moderate to low personal accomplishment. The major factors impacting work-life balance included work load, work flow, and scheduling. A follow-up aMBI survey was completed by 79 from the conference group and 264 from the nonconference group. In the age-group between 30 and 50 for the conference group (n = 40), mean EE decreased from 9.8 to 8.6 with statistical significance (P = .014). There was no statistically significant change in the nonconference group in any age-group. CONCLUSION: Workload, workflow, and scheduling issues were the major factors affecting work-life balance. There is a significant level of burnout in physicians and APCs. Heartfulness meditation conference was associated with a significant decrease in EE in those aged 30 to 50 years. There was no significant change seen in the nonconference/book reading group.

Impact of Neurological Follow-Up on Early Hospital Readmission Rates for Acute Ischemic Stroke.

INTRODUCTION: Despite advances in stroke care, readmission rates for patients with ischemic stroke remain high. Although factors such as age, diabetes, and continuous use of antiplatelet agents have been found to predict readmission rates, the impact of after-hospital care has not been examined. METHODS: The present study reviewed the charts of 416 patients with acute ischemic stroke and recorded stroke-related comorbidities, neurology follow-up within 21 days, readmission at 0 to 30 days, readmission at 31 to 90 days, and any reasons for readmission. RESULTS: For those readmitted within 0 to 30 days, reasons for readmission were other medical conditions (62.5%), recurrent stroke (30.4%), and elective procedure (7.1%). For those readmitted within 31 to 90 days, reasons for readmission were other medical conditions (62.3%), recurrent stroke (15.1%), and elective procedure (22.6%). There was no significant relationship between being evaluated within 21 days and readmission at 0 to 30 or 31 to 90 days. However, those who did have a neurology follow-up at any point in time had a lower readmission rate of 10.6% compared to those who never came back (19.2%, P = .017). Patients with coronary artery disease and diabetes had a significantly higher likelihood of readmission within 0 to 30 days. CONCLUSION: The present study suggests that neurology follow-up at any point in time for patients with acute ischemic stroke may reduce short-term readmissions, but special attention to optimizing management of other underlying medical conditions, coronary artery disease, or diabetes may also help reduce overall readmissions. Patients with stroke, therefore, may benefit from a follow-up with both the primary care and neurology in a coordinated fashion to prevent early readmissions at 30 days.

Effect of heartfulness meditation on burnout, emotional wellness, and telomere length in health care professionals.

Background: Burnout poses significant challenges during training years in residency and later in the career. Meditation is a tool to treat stress-related conditions and promote wellness. Telomere length may be affected by burnout and stress. However, the benefits of meditation have not been fully demonstrated in health care professionals. Objective: We assessed the effects of a 12-week 'Heartfulness Meditation' program on burnout, emotional wellness, and telomere length in residents, faculty members, and nurses at a large community teaching hospital during the 2015-16 academic year. Methods: All subjects completed a baseline Maslach Burnout Inventory (MBI) and Emotional Wellness Assessment (EWA) at the beginning of the study. Meditators received instructions in Heartfulness Meditation. At week 12, subjects completed a follow up MBI and EWA scores. Salivary telomere length was measured at baseline and week 12. Results: Twenty-seven out of a total 155 residents (17.4%) along with eight faculty physicians and 12 nurses participated in the study. Thirty-five enrolled as meditators and 12 as controls. At 12 weeks, the meditators had statistically significant improvement in all measures of burnout and in nearly all attributes of EWA. Controls showed no statistically significant changes in either burnout or emotional wellness scores. Relative telomere length increased with statistical significance in a younger subset of meditators. Conclusion: Our results indicate that meditation offers an accessible and efficient method by which physician and nurse burnout can be ameliorated and wellness can be enhanced. The increased telomere length is an interesting finding but needs to be confirmed with further research. Abbreviations: EWA: Emotional wellness assessment; MBI: Maslach burnout inventory; EE: Emotional exhaustion; DP: Depersonalization; PA: Personal accomplishment; PI: Prinicipal investigator; JT: Jayaram Thimmapuram.

Are They Too Old for Surgery? Safety of Cholecystectomy in Superelderly Patients (≥ Age 90).

CONTEXT: Cholecystectomy is the most common general surgery procedure in patients older than age 65 years. By 2050, it is estimated that 2.0% of the population will be older than age 90 years. OBJECTIVE: To assess the mortality of cholecystectomy in superelderly patients (≥ age 90 years). DESIGN: Using the American College of Surgeons National Surgical Quality Improvement Program database, a retrospective analysis was performed of superelderly patients who underwent laparoscopic and open cholecystectomy between 2005 and 2012. MAIN OUTCOME MEASURES: Thirty-day mortality. RESULTS: A total of 1007 cholecystectomies were performed in superelderly patients between 2005 and 2012. Of these surgical procedures, 807 (80%) were nonemergent and 200 (20%) were performed emergently. Two hundred sixteen procedures (21.4%) were open and 791 (78.6%) were laparoscopic. Mortality did not decrease significantly during the study period. The overall mortality was 5.5%, significantly less for the laparoscopic group (3.7% vs 12%, p < 0.001) and for the nonemergent group (4.5% vs 9.5%, p < 0.005). The median length of stay for open cholecystectomy was 9 days compared with 5 days for laparoscopic (p < 0.001); for nonemergent cholecystectomy it was 5 days compared with 7 days for emergent cholecystectomy (p < 0.001). CONCLUSION: The mortality after cholecystectomy in superelderly patients did not change significantly during the study period. The mortality and morbidity for laparoscopic and elective procedures were significantly lower than for open procedures and for emergent procedures, respectively.

Use of glucagon in relieving esophageal food bolus impaction in the era of eosinophilic esophageal infiltration.

Esophageal food bolus impaction may require an urgent endoscopy. Glucagon is often administered to promote spontaneous passage of the food bolus. Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia, and food impaction is often the presenting symptom. Our study was aimed at determining the effectiveness of glucagon in relieving esophageal foreign body obstruction in general and in the setting of esophageal eosinophilic infiltration (EEI). A retrospective chart review was performed using the ICD codes and the emergency department database of adult patients presenting with symptoms of esophageal food bolus impaction from July 2004 to October 2010. Response to glucagon was defined as symptomatic relief of obstruction prior to endoscopic intervention. A total of 213 episodes of esophageal food bolus obstruction in 192 patients were identified during the study period. Glucagon was given in 125 cases of which 41 had a response (32.8 %). A total of 170 episodes had an Esophagogastroduodenoscopy performed either during the impaction event or at a later date. Of the 60 patients' biopsies, 45 had received glucagon (17 with EEI, 28 without EEI). None of the 17 episodes with EEI as compared to 8 of the 28 without EEI responded to glucagon (0 % vs. 28.5 %, p = 0.017). Glucagon is effective in about one third of patients with esophageal food bolus impaction, which is consistent with historical data. Patients with EEI appear less likely to respond to glucagon.

Clothes encounter: patient perception of nursing attire in a behavioral health unit.

BACKGROUND: In an acute behavioral health unit, patients' perceptions of nurses can be influenced by the type of clothing they wear. OBJECTIVES: The purposes of this study were to determine if mental health patients had preferences related to nursing attire, to determine if patient preference varied with age, and to determine if nursing attire affected patients' thoughts on approachability, competence, and professionalism. STUDY DESIGN: A six-question survey was distributed to patients who met specific criteria between August and December 2008. RESULTS: Overall, patients did not have a preference for the type of attire worn by staff. Identification of nurses was a concern for many. More than half of the respondents indicated approachability was not affected by attire; however, 29% said that street clothes made the nurse less approachable. Attire did not affect patient perception of competence or professionalism. CONCLUSION: As behavioral health care changes, staff attire may need to be reconsidered.

The informed consent process in whole blood donation.

CONTEXT: Informed consent in transfusion medicine has been an area lacking of significant research and it is unknown if donors fully comprehend the risks associated with whole blood donation. OBJECTIVE: To assess the adequacy of the informed consent process in whole blood donation. DESIGN: A brief questionnaire was constructed and distributed to whole blood donors visiting various fixed and mobile donor sites of the Central Pennsylvania Blood Bank. Questions consisted of demographic information; donor opinions of information content, length, and comprehension; and a short quiz pertaining to donor risks and eligibility. RESULTS: Analysis of 849 surveys demonstrated that donors comprehended a mean of 73.5% of the various donor eligibility and risks that were surveyed. Female and younger donors scored statistically higher on comprehension questions compared with male and older counterparts. Donors were most aware of (1) donor eligibility requirements related to acquired immunodeficiency syndrome comprehension, (2) the risk of dizziness postdonation, and (3) having lived in a certain country (93.7%-95.6% comprehension, respectively). Donors were least aware of (1) the risk of a possible referral to a physician for outstanding medical conditions or positive test results, (2) the risk of a positive test result, and (3) West Nile virus testing information (22.4%-49.3% comprehension, respectively). CONCLUSIONS: Whole blood donors believed that they were giving informed consent, but a significant percentage of donors were unaware of several of the risks associated with blood donation, including participation in West Nile virus research testing. Our data suggest that donors do not fully comprehend the risks of whole blood donation and that repetition of information to the donor, and in multiple formats, strengthens the level of comprehension and thus the informed consent process.

Cardiovascular reactivity and family history of hypertension: a meta-analysis.

A regression-based meta-analysis examined the degree to which the effects of a family history of hypertension on cardiovascular reactivity are moderated by the magnitude of cardiovascular responses elicited in challenge/task conditions. Mean change scores for negative family history groups were regressed on mean change scores for positive family history groups. The slopes of separate regression lines obtained for systolic and diastolic blood pressure and heart rate were significantly less than 1.0 and the y-intercepts for these regression lines were significantly greater than zero. This pattern indicates that family history differences in cardiovascular reactivity to stress are greatest in situations that elicit the smallest baseline-stressor change scores in non-family-history groups.