Perceptions and experiences of perioperative nurses and nurse anaesthetists in robotic-assisted surgery.

AIMS AND OBJECTIVES: To explore the perceptions and experiences of perioperative nurses and Certified Registered Nurse Anaesthetists (CRNAs) in robotic-assisted laparoscopic surgery (RALS). The objective was to identify the factors that affect nursing care of patients who undergo robotic-assisted laparoscopic surgery (RALS). BACKGROUND: The rapid introduction of technological innovations into the healthcare system has created new challenges for perioperative nurses. RALS affects the physical and interpersonal context of the surgical team's work and subsequent patient outcomes. Despite significant changes to the workflow for perioperative nurses and CRNAs, there is little research focusing on the nurses' experience and their challenges with RALS. DESIGN: A qualitative descriptive study. METHOD: Semi-structured interview questions guided data collection. A total of seventeen participants including six preoperative and postoperative nurses, seven intraoperative nurses, and four CRNAs in the United States were interviewed. The interviews were conducted between 26 April-24 June 2018. Data were analysed using thematic analysis, and the COREQ checklist was used to report data collection, analysis and the results. RESULTS: Three major themes and two categories within each theme were identified: (a) surgical innovation: nurse perception and workflow; (b) interprofessional practice: teamwork and standards; and (c) outcome: patient outcomes and system outcomes. CONCLUSIONS: The findings indicate that RALS has the potential to improve patient outcomes when performed in a timely fashion by skilled surgeons, and efficient, well-trained surgical teams. For patients to experience full benefits of RALS, patient characteristics, the underlying reason for surgery, and cost must be considered. RELEVANCE TO CLINICAL PRACTICE: The results of this study highlight the necessity of promoting factors that improve the surgical team training and practice for RALS and will ultimately impact patient outcomes.

A Bayesian Approach to Gateway Course Identification With Implications for the Prenursing Curriculum.

BACKGROUND: Analysis of student performance in gateway courses has been an important predictor of successful admission into upper-division nursing. PURPOSE: The aim was to explore the utility of a Bayesian statistical framework for determining threshold grades in prenursing courses that serve as gateways for successful admission into upper-division nursing programs. METHODS: Records of 3500 prenursing students who entered the prenursing program of a midsized public university during the past decade were analyzed. The Bayesian framework was used to incorporate conditional probabilistic concepts of sensitivity and specificity to calculate gateway impact of various grade level cutoffs on successful upper-division nursing admission. RESULTS: Identification, sequencing, and combination of grades attained in these gateway courses revealed different pathways to successful admission into upper-division nursing based on first-semester grade point average and ethnicity. CONCLUSIONS: Identification of primary/secondary gateway courses enhances successful matriculation and provides valuable information for advisors and curriculum planners for prenursing majors.

Successful Modeling of Factors Related to Recruitment and Retention of Prenursing Students.

BACKGROUND: The traditional admission methodology used by many schools of nursing is the second-tier admission based on specified criteria. This method has been associated with a student body that is predominately female, white, and English speaking. PROBLEM: Rational judgment modeling (points assigned to criteria) used to evaluate applicants for admission into prenursing programs potentially overlooks students who do not fit into the traditional model. APPROACH: This study compared predictive logistic regression with traditional rational judgment models to classify potential nursing school applicants. OUTCOMES: A higher number of Hispanic and black prenursing students were identified for potential upper-level nursing program admission. CONCLUSIONS: The use of logistic regression modeling can identify a more diverse student population. Advisors at both high school and university/college levels can use results of this model to help students determine their progress, identify academic weaknesses, and develop individual plans of action to help students successfully complete the prenursing curriculum requirements.

Relationships Among Neonatal Mortality, Hospital Volume, Weekday Demand, and Weekend Birth.

Background Research findings indicate that hospital volume affects the quality of care, that quality and demand for care on weekends differs from weekdays, and that giving birth on the weekend increases odds of neonatal mortality. Purpose To explore relationships among neonatal mortality, hospital volume, weekday demand for services, and weekend birth and risk of neonatal mortality. Methods For this retrospective, population-based, cohort study design, data were obtained from 32,140 electronic birth certificate records matched with 92 death certificate records from the Texas Department of State Health Services for 2012. Statistical analyses include descriptive procedures, analysis of variance, bivariate correlation, t-test, logistic regression, and chi-square tests of association. Results Higher hospital birth volume and higher concentrations of births during the week were associated with fewer neonatal deaths. Weekend births were associated not only with higher rates of neonatal death but also with lower birth weight and ethnicity of the mother. Conclusions These findings suggest the need for further study of the ways hospital-level organization of services and resources interact with individual risk factors to play a significant role in raising the neonatal mortality risk associated with weekend birth.

Empowered Consumers and the Health Care Team: A Dynamic Model of Health Informatics.

This article presents a dynamic new model of health informatics. Within the model, the focus of health informatics changes from the provider to the consumer and incorporates the dynamic relationship of technological change to health care. Bioinformatics is the scientific discipline that is translated into care through the practice of health informatics. The loci of health informatics practices are the consumer (consumer informatics), the patient (clinical informatics), and the community (public health informatics). The continuum from individual to community interacts with and contributes to health care technology, which is represented as a constantly changing progressive wave.

Triple-negative breast cancer: what is known about it?

Triple-negative breast cancer (TNBC) is considered a rare diagnosis. This malignancy targets a specific population of women and has risk factors differing from those of other breast cancers. TNBC exhibits distinct pathologic features that result in aggressive metastasis and poor prognosis. Pathologically, TNBC cancer cells are characterized by negative receptors for progesterone and estrogen and by the lack of over-expression of human epidermal growth factor receptor 2, which limits chemotherapeutic treatment options for women with TNBC. Nurses can assist in early detection by offering patient education about the little known risk factors for TNBC. Psychosocial issues can overwhelm patients diagnosed with breast cancer. This article provides suggestions for nurses as they guide women who are experiencing an atypical breast cancer diagnosis with an uncertain prognosis and limited treatment options.

Congenital Reproductive Abnormalities.

Congenital defects of the reproductive system are associated with a number of adverse health consequences. The pathophysiology of these defects is thought to be müllerian abnormalities, but they can also be attributed to failure of cells to degenerate appropriately during embryogenesis. The management of these congenital defects is dependent on the type of defect present and the severity of presentation. Women with congenital defects of the reproductive system have physical as well as psychosocial issues that must be addressed, and the condition frequently creates medical challenges for health care providers.

Neurocysticercosis in pregnancy: not just another headache.

Infection with pork tapeworm, or Taenia solium, affects approximately 50 million people worldwide. The most important and potentially devastating form of the infestation, neurocysticercosis, occurs when the parasite invades the central nervous system. There has been a significant increase in the number of cases in the United States due to immigration from endemic areas. This case study of a pregnant woman in the 35th week of gestation exemplifies the serious consequences of this infection in pregnancy, and discusses an evidence-based approach to the diagnosis, treatment and eradication of this preventable disease.

Rediscovering.

The aim of this hermeneutic phenomenological inquiry was to explore the lived experience of aging for late-midlife women via reflective journaling and a photo elicitation interview, and to demonstrate how the creation of a collage allows women to make meaning of the aging experience. Using van Manen's philosophical framework, four themes were discovered: Invisibility, Conflicted Self, Freedom, and Relationality. Invisibility was expressed by the women as disregard, not being seen by others, or overlooked in daily activities. Conflicted Self involved the conflict between the inner being and the outer physical body. Freedom related to the ability to let go of others' expectations and allow themselves to be the people they were in their own reality. Relationality was the interconnectedness the women felt with family, friends, and colleagues, and the changes in these relationships. The women's narratives and collages portrayed a holistic picture of aging, not confined to decline but rather a life of anticipation.

Diagnostic breast evaluation: when to refer and what the results really mean.

Diagnostic breast imaging is an important tool in evaluating abnormal physical examination findings and assessing incomplete screening mammographic results. It is imperative for primary care providers to be knowledgeable regarding which patients would benefit from this evaluation to provide optimal healthcare.

Delivery of a polyp.

BACKGROUND: Colorectal cancer is uncommon during pregnancy. Although there is overlap between symptoms of colon cancer and normal pregnancy, clinicians should be vigilant identifying those at risk and offer colorectal cancer screening when appropriate. CASES: Three women in their 30s passed or prolapsed adenomatous tissue per rectum during the second stage of labor. Further evaluation lead to the diagnosis of premalignant lesions or colorectal cancer in each case. CONCLUSION: Colorectal cancer can present in young women of childbearing age, especially in those with a genetic predisposition. It may present with the prolapse or passage of tissue during vaginal delivery. Appropriate referral and screening are of critical importance for those at risk, especially those with a family history or pertinent physical findings.

Timing of birth after spontaneous onset of labor.

OBJECTIVE: To describe naturally occurring birth patterns in low-risk women with singleton gestations and spontaneous onset of labor at term. MATERIALS AND METHODS: The timing of birth of women who delivered in the low-risk labor unit at Parkland Hospital, Dallas, Texas, between January 1, 2000, to December 31, 2000, was analyzed. Women admitted to this unit were between 36(0/7) and 41(6/7) weeks of gestation, were in spontaneous labor, and had a singleton gestation. Women with contraindications to labor, significant medical problems, a known fetal anomaly, and stillbirths were excluded from analysis. The frequency of birth was analyzed in relation to the time of day, day of week, and month of the year. RESULTS: Low-risk women (n = 6608) met the study criteria and were included in the analysis. No association was found between the day of the week and the frequency of births (P =.31). Births were most common between the hours of 1 to 2 pm and least common between the hours of 10:00 to 12:00 hours (Central Standard Time, P =.04). Births were more common in the fall, September through November, and least common in the winter, December through February. Daylight Saving Time did not affect these results. CONCLUSION: Birth after the spontaneous onset of labor is most common in the early afternoon, and most births occur in the fall. There is no natural association between spontaneous birth in low-risk women and the day of the week. LEVEL OF EVIDENCE: II-2