Transcendental Meditation Enriches Nurses' Authentic Presence Through Caring for Self and Others.

Purpose of Study: Given the enormity of the most recent challenges to clinician well-being, intensified by the pandemic, we decided to explore the influence of Transcendental Meditation® (TM)® on the well-being of clinical nurses. The purpose of our study was to use qualitative analysis to enhance our understanding of the experiences of clinical nurses who practiced TM, as viewed through the lens of our conceptual model and Watson's holistic unitary caring science theory. Design and Method: This qualitative study involved a thematic analysis of clinical nurses' written descriptions following the completion of the TM program during the COVID-19 pandemic. Findings: The nurse participants shared their experiences with the practice of TM as creating present moment focus, leading to enhanced self-care, and development of authentic presence with others. The overall theme uncovered in the analysis is that authentic presence is veritas (truth) in knowing, being, doing, and becoming. Conclusions: The findings were congruent with Watson's unitary caring science theory and provided illumination of the holistic value of TM as a self-care strategy for supporting nurses' well-being with the goal of retaining nurses in practice. When nurses care for themselves, they are more likely and able to care for others, thus helping them to enjoy their nursing careers.

Clinical Nurse Well-being Improved Through Transcendental Meditation: A Multimethod Randomized Controlled Trial.

OBJECTIVE: To evaluate the impact of Transcendental Meditation® (TM®) practice on the multidimensional well-being of nurse clinicians affected by the COVID-19 pandemic. BACKGROUND: The health of clinical nurses has substantial impact on both the availability of a nursing workforce and the quality and safety of patient care. TM improved health and coping strategies across many populations. METHODS: Clinical nurses were recruited from 3 Magnet®-designated hospitals during the COVID-19 pandemic. Well-being outcomes included flourishing, burnout, anxiety, and posttraumatic stress disorder. Participants were randomized following completion of baseline surveys into immediate (intervention) or delayed (control) TM instruction. Surveys were repeated at 1 and 3 months following baseline survey or TM instruction. Repeated-measures analysis of variance compared differences in groups over time. RESULTS: Across the 3 sites, there were 104 clinical nurse participants. Repeated-measures analysis of variance showed significant medium to large effects in improvement over time in well-being measures for the intervention group. CONCLUSIONS: TM improved multidimensional well-being of clinical nurses by reducing posttraumatic stress disorder, anxiety, and burnout and improving flourishing. TM is easy to practice anywhere. The benefits are immediate and cumulative. Organizations and individual nurses can use TM to support clinical nurses in the difficult and meaningful work of patient care, especially in challenging times. Future studies may consider the feasibility of integrating TM into clinical shifts and evaluating its impact on patient and organizational outcomes.

Impact of Coaching on the Nurse-Physician Dynamic.

BACKGROUND: Limited resources and increased patient care demands have strained nurse-physician relationships in our hospital's neurosurgical intensive care unit, leading to low morale and adversarial dynamics. Studies exploring benefits of coaching interprofessional teamwork demonstrate performance improvements. Therefore, a coaching program designed to improve nurse-physician teamwork was initiated by the neurosurgery department of the hospital's affiliated university. OBJECTIVE: To assess the impact of a coaching program for nurses and physicians on workplace performance in a neurosurgical intensive care unit at a level 1 trauma center. METHODS: A coach was incorporated into everyday activities on the neurosurgical unit. After 3 months of observations, specific interdisciplinary initiatives were implemented to foster a more positive workplace environment. Nurses' perceptions before and after the initiatives were measured and compared using appropriate statistical tools. RESULTS: A significant improvement in relationships was found in 6 of 7 targeted categories after the program had been in place for 5 months. The results were sustained at 1 year. CONCLUSION: A coaching program is an effective method of improving nurse-physician relationships, leading to enhanced workplace performance.

The effect of caffeine on postoperative urinary retention after joint replacement surgery.

BACKGROUND: Review of data on complications following joint replacement surgery revealed that urinary retention is a potential cause of increased morbidity. Repeat catheterizations, urinary tract infections, and possible infection of the prosthetic joint can result in a prolonged hospital length of stay. This study examined the effect of warm caffeinated coffee on a patient's ability to spontaneously void after indwelling catheter removal and the correlation between bladder volume and the ability to void spontaneously. METHODS: This was a randomized, controlled, pilot study of subjects who underwent unilateral total knee arthroplasty or total hip arthroplasty. The indwelling catheter was removed postoperative day 1. If unable to void within 3 hours, participants were randomized into a control group and an intervention group. At scheduled intervals, the control group consumed 8 oz of warm water and the intervention group consumed 8 oz of caffeinated coffee. RESULTS: Thirty subjects were randomized; 14 were randomized to the water group and 16 to the caffeine group. Twenty-four subjects spontaneously voided after ingestion of fluid and six required straight catheterization. Of these six, five of the subjects had ingested water and one subject had ingested coffee. For those who spontaneously voided, there was not a significant difference between the caffeine group and the water group. There was a significant difference between caffeine ingestion and the volume of the void. DISCUSSION: Findings from this study suggest that ingestion of caffeine after removal of an indwelling urinary catheter in the postoperative patient may increase the amount of voiding volumes initially, therefore avoiding the need for straight catheterization. To accurately assess this, extending the study into postoperative day 2 would allow us to evaluate whether lower voiding volumes lead to the need for catheterization.

A prospective, descriptive study of characteristics associated with skin failure in critically ill adults.

Critically ill patients with multi-organ failure are especially susceptible to problems with skin integrity, including skin failure. An 18-month, prospective, descriptive study was conducted to identify and describe characteristics of intensive care unit (ICU) patients with skin failure and examine the relationships among patient demographics, nutritional status, laboratory parameters, the presence of other organ system failures, and use of mechanical assistive devices, support surfaces, and vasopressive and sedative medications. A total of 29 patients with acute skin failure were identified. All (100%) patients with skin failure were diagnosed with failure of at least one other organ system. Ninety percent (90%) had failure of more than one organ system other than skin, and 90% had an albumin level <3.5 mg/dL. In addition, generalized edema, ventilator use, age >50 years, weight >150 lb, creatinine >1.5 mg/dL, mean arterial pressure <70 mm Hg, and/or the use of sedatives and/or analgesic medications were observed in >75% of patients with skin failure. Significant positive correlations were seen between several pairs of variables, including sepsis and renal failure, and the concurrent use of several types of vasopressive agents. This is the first known study of its type and results confirm that nonskin organ system failure and skin failure can be expected to be observed at the same time. Research to ascertain whether skin failure occurs at the same time, precedes, or follows the development of nonskin organ system failure is needed, as are studies to understand the relationship among the various risk factors in order to optimize preventive care.

Medical flight crew perceived work-related musculoskeletal symptoms and related characteristics.

INTRODUCTION: Flight crews who provide stabilization and care for patients during air medical flights represent a specialty group, with unique safety, physical environment, and weather concerns, as well as patient care challenges. The purpose of this study was to identify the self-reported prevalence, location, and severity (frequency, duration, and intensity) of perceived work-related musculoskeletal symptoms and associated characteristics among flight crews, and to correlate any age-related differences between participants. METHOD: This study used a descriptive, cross-sectional survey design. An internet-based questionnaire was made available through a link from the Flightweb.com listserv to Survey Monkey. A convenience sample of 462 flight crewmembers responded. RESULTS: Significant differences were found by age group for two of four musculoskeletal symptoms (frequency and duration were significantly different by age group). Those 39 and older had a greater proportion of having been previously diagnosed with arthritis or osteoporosis (2χ = 8.503, P = .004). CONCLUSION: Age-related differences were believed to be a factor that contributed to more musculoskeletal complaints for older flight crewmembers; however, the data from this study only partially support that hypothesis. Flight crewmembers face a number of unique challenges that require maintaining physical strength and endurance.

The relationship between nurses' stress and nurse staffing factors in a hospital setting.

AIM: The present study objective was to examine the relationships between nurses' stress and nurse staffing in a hospital setting. BACKGROUND: Nurses have many job-related stressors. There is a lack of research exploring the relationship between job stressors to staffing and day of week worked. METHODS: The sample consisted of registered nurses (RNs) (N = 197) providing direct patient care. Data were collected via electronic software. Variables included demographic information, work setting information, Perceived Stress Scale (PSS) scores and Nursing Stress Scale (NSS) scores. Data analysis included descriptive statistics, correlations and analysis of variance. RESULTS: Among respondents, a positive correlation (r = 0.363, P 0.05) was found between the NSS and PSS and between age and patient work load (i.e. number of patients the nurse cared for) (r = 0.218, P < 0.05). A negative correlation (r = -0.142, P < 0.05) existed between NSS and respondents' age. Analysis of variance showed that younger nurses had more nursing stress than older nurses (F(1,195) = 4.283, P < 0.05). CONCLUSIONS: Age, patient work load and day of the week worked are important factors affecting nurses' stress levels. IMPLICATIONS FOR NURSING MANAGEMEN: Nurse managers should consider scheduling as a potential stressor for nurses.

The lift team's importance to a successful safe patient handling program.

Nurses continue to experience injuries related to patient handling. These injuries are costly to hospitals in both direct and indirect costs and intangible costs such as staff morale. The need for hospitals to establish safe patient handling programs is growing and is now mandated by legislation in several states. The authors describe the development, implementation, and 6-year outcomes of a lift team that is part of successful safe patient handling program.

Characteristics associated with unplanned extubations in a surgical intensive care unit.

BACKGROUND: Unplanned extubations can result in serious complications. OBJECTIVES: To determine characteristics of patients and nurses and risk factors that affect extubations. Methods A retrospective exploratory design was used. Ram-say Sedation Scale scores, need for reintubation, time between intubation and extubation, use of sedation and analgesia in the preceding 48 hours, and use of restraints were collected on 31 patients in a surgical intensive care unit who had unplanned extubations. For nurses, data collected included years' experience in nursing and as an intensive care nurse, professional credentials, and location at the time of extubation. RESULTS: All unplanned extubations were self-extubations; 15 required reintubation. Most patients had low levels of sedation in the hour preceding the extubation (mean Ramsay score, 2.42; SD, 1.06). Patients who needed reintubation had higher mean Ramsay scores (2.85; SD, 1.14) than patients who did not (2.00; SD, 0.86; P = .04). Ramsay scores correlated with need for reintubation (r=0.423; P=.03). Of the 31 patients, 27 (87%) were restrained at the time of extubation (chi2 = 17.06; df=1; P<.001). Among the nurses, 32.3% had less than 5 years' experience in nursing, and 51.6% had less than 5 years' experience in intensive care; 89% of extubations occurred when the nurse was away from the bedside. Sedative and analgesic doses in the 24 hours before extubation did not differ significantly from those in the 2 hours before extubation. CONCLUSIONS: Levels of sedation and use of restraints are associated with unplanned extubations and need for reintubation.

Family members' experiences of the intensive care unit waiting room.

AIM: This paper is a report of a study to explore family members' perspectives and experiences of waiting rooms in adult intensive care units. BACKGROUND: Waiting to visit family members who are hospitalized in intensive care units can be very stressful. Although flexible and or open visiting is practised in many hospitals, family members may spend a great deal of time in the waiting room. METHOD: A qualitative design using semi-structured interviews was used and the data were collected in 2004. A convenience sample of six visitors was recruited from waiting rooms of three different adult intensive care units. Data collection and analysis were concurrent. FINDINGS: Six categories emerged from the data that included structural and subjective aspects of waiting: 'close proximity' referred to the importance of a close physical distance to their family member; 'caring staff' captured the comfort family members felt when staff showed caring behaviours towards relative; 'need for a comfortable environment' represented the impact of the design of the waiting room on family members well-being; 'emotional support' referred to the waiting room as a place where comfort was found by sharing with others; 'rollercoaster of emotions' captured the range of emotions experienced by family members; 'information' referred to the importance of receiving information about their relative. CONCLUSION: Future research should focus on the impact of the interior design of waiting rooms on the comfort and welfare of family members and on identifying needs of family members across different cultures.