Improving Access to Palliative Care at a VHA Hospital.

OBJECTIVE: Explore veteran-specific factors impacting the acceptance of palliative care services at a Veterans Health Administration hospital. METHODS: Prospective, focused one-on-one interviews were conducted with 18 inpatient veterans with an initial consult to receive palliative care services. Domains impacting reception of outpatient palliative care management were evaluated including knowledge deficit, emotional barriers, physical barriers, psychosocial barriers, and physical support. Themes and trends from interview responses were analyzed using a qualitative directed content analysis approach. RESULTS: The following themes were discovered to influence veteran participation in outpatient palliative care: Knowledge Deficit, Environmental Factors, Positive Patient Satisfaction, Openness to Technology, and Resiliency. Characteristics of veterans interviewed included an average age of 71 with an average distance from the hospital of 59 miles. CONCLUSION: The identification of factors impacting veteran access to palliative care will be used to guide interventions and improve receipt of services. Care of seriously ill veterans may be substantially improved by facilitating access to palliative care.

Hoping to Pass: Randomized Trial of a One-Time Hope Intervention on Standardized Exam Passing Rates in BSN Students.

BACKGROUND: National standardized nursing exams serve as critical measures of student readiness for practice and carry significant consequences for students and academic institutions. Educational interventions that can enhance a student's performance increase the probability of academic success. Previous studies link hope to grade point average in college students and on standardized exam (SE) scores in nursing students, yet it is not clear if hope can be increased utilizing a one-time intervention in ways that produce lasting benefits for passing SEs. AIMS: Aim 1 tested the efficacy of a one-time hope intervention on increasing SE passing rates among BSN nursing students. Aim 2 examined the role of the interventions, selected state-mechanism variables, and trait characteristics in predicting SE passing. METHOD: This comparative-effectiveness trial utilized a randomized, controlled, multiple-cohort experimental design to compare a one-time 90-minute hope intervention to an attention-matched progressive muscle relaxation intervention on SE passing scores among BSN nursing students. RESULTS: Levels of hope briefly increased following the hope intervention. Both interventions demonstrated short-term improvement in state-level psychosocial indicators but did not affect SE scores. Among trait and mechanism factors, only academic self-efficacy was linked with passing SEs. CONCLUSIONS: This study demonstrated that a single-session hope intervention can increase short-term hope. In this sample of 292 BSN students, there was no statistically significant long-term effect on passing SEs; however, this study may lay the groundwork for future interventions investigating booster sessions, or how to modify the intervention for struggling students.

Prevention of Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: Are We Doing Enough?

The worldwide obesity epidemic has led to an increase in the number of bariatric procedures for treatment. Currently, the most commonly performed bariatric surgical operation in the United States is the laparoscopic sleeve gastrectomy (LSG). The risk of postoperative nausea and vomiting (PONV) is exceptionally high following the LSG: as much as 65%. Anesthesia providers should be mindful of this elevated risk and stay up to date on evidence-based techniques that help to mitigate the incidence of PONV related to this specific procedure. The purposes of this clinical review are to increase provider awareness of the PONV risk following LSG and to examine methods for improving PONV outcomes for this population.

Improving Perioperative Knowledge, Self-Efficacy, and Performance in Labor and Delivery Nurses: A Quality Improvement Project.

The obstetrical unit utilized a training product (Periop 101: A Core Curriculum OB) to enhance the knowledge, self-efficacy, and performance of nurses circulating for cesarean births. Knowledge was measured using product provided testing. Self-efficacy was assessed using a modified perioperative self-efficacy scale, and performance was evaluated by analyzing documentation accuracy and incident reports. Results demonstrated improvements in perioperative knowledge, self-efficacy, and documentation as well as a reduction in incident reports.

Sexuality and Intimacy in the Older Adult Woman.

In the United States, people older than 65 attend approximately 248 million health care visits each year, or 7 visits per older adult annually. One in every 5 older adults reports recent sexual activity, yet health care professionals do not ask, and patients do not tell when it comes to sexuality. The desire to engage in sex and intimate behaviors to meet important quality-of-life needs is present in people of all ages. Because it is important to communicate in a nonjudgmental manner, health care professionals must first examine their own personal attitudes and values regarding sexuality in older women.

Clinical Track Promotion Guideline Development for Nursing Faculty in a Traditional Research-Focused University.

BACKGROUND: The clinical track is a newer concept for universities traditionally placing a hefty emphasis on research and funding. OBJECTIVE: Guidelines should ensure equitable criteria for promotion of practicing faculty reflect teaching, scholarship, and academic outreach milestones. METHODS: This article describes the process, challenges, and overall experience of developing clinical track promotion guidelines within a research-focused university setting. RESULTS: The department's outdated clinical track promotion guidelines were revised to reflect current roles of clinical faculty. CONCLUSIONS: As DNP and clinically focused advanced practice faculty flood into 4-year academic settings, universities must ensure that criteria for promotion reflects clear and equitable teaching, scholarship, and academic outreach milestones. IMPLICATIONS FOR NURSING: The recent influx of DNP clinical faculty and advanced nursing practice faculty roles requires an overhaul of outdated guidelines.

Clinical Judgment During Simulation: A Comparison of Student and Faculty Scores.

This study utilized the Lasater Clinical Judgment Rubric (LCJR) to investigate the relationship between the student's self-assessment of clinical judgment skills and the faculty's assessment during a human patient simulation. The study used a quantitative design with baccalaureate nursing students (n = 94) enrolled in an adult health course as participants. The data revealed a positive correlation between evaluator and student scores on the LCJR. The findings support the use of the LCJR in combination with simulation to evaluate nursing students' clinical judgment skills and to quantify competency levels.

Can Faith and Hospice Coexist: Is the African American Church the Key to Increased Hospice Utilization for African Americans?

African Americans are twice as likely as Caucasian Americans to choose aggressive hospital treatment when death is imminent. Repeat hospitalizations are traumatic for patients and drain patient and health system resources. Hospice care is a specialized alternative that vastly improves patient quality of life at end-of-life. This study was conducted to determine if hospices partnering with African American churches to disseminate hospice education materials could increase utilization of hospice services by African Americans. Members of two African American churches (N = 34) participated in focus group discussions to elicit beliefs about hospice care. Focus group transcripts were coded and comments were grouped according to theme. Six themes were identified. Lack of knowledge about hospice services and spiritual beliefs emerged as the top two contributing factors for underutilization of hospice services. Study findings support partnerships between hospices and African American churches to provide hospice education to the African American community.

Assessment of High-Stakes Testing, Hopeful Thinking, and Goal Orientation among Baccalaureate Nursing Students.

BACKGROUND AND OBJECTIVES: High-stakes didactic testing assesses competency. Exams are stressful, and decreasing anxiety may enhance learning. Academic progression and graduation rates may result when higher levels of hopeful thinking (the belief in one's ability to achieve desired goals), and certain achievement goal orientation (why one desires to succeed) are present. METHODS: This non-experimental study engaged undergraduate nursing students via surveys to examined relationships among hopeful thinking, goal orientation, and scores on standardized high-stakes examination of students. RESULTS: Regression analyses (N = 151) indicated that hopeful thinking was significantly related to higher exam scores, and that performance-avoidance goal scores were significantly related to lower scores. CONCLUSION: The positive relationship between hopeful thinking and exam scores suggests the need to consider supporting hopeful thinking in nursing education. Additional research may explicate the relationship between performance-avoidance and scores on high-stakes exams.

Medication adherence in a nurse practitioner managed clinic for indigent patients.

PURPOSE: Little is published in the literature about medication adherence rates among patients who are medically indigent and patients receiving primary care from nurse practitioners (NPs). This project examined adherence rates and barriers to adherence among patients at an NP-managed health clinic (NPMC). DATA SOURCES: The setting for this research was an NPMC for uninsured and low-income patients. A cross-sectional convenience sample of patients (n = 119) completed surveys eliciting demographic information, self-report of medication adherence, health literacy, and barriers to adherence. CONCLUSIONS: Analysis of subjects demonstrated a vulnerable population, yet the mean adherence rate was surprisingly high (77%), compared to the rate usually cited in published literature. The best predictive model differentiating patients with high adherence from those with low adherence combined the total number of reported barriers, health literacy, and employment status. The barriers most frequently cited by subjects were difficulty paying for medications, and difficulty reading and understanding written prescription labels, which was particularly prevalent among Spanish-speaking patients. IMPLICATIONS FOR PRACTICE: Clinic efforts to improve patient access to affordable medications may have contributed to subjects' high rates of adherence. These efforts included helping patients with filling out prescription assistance program paperwork, prescribing generic medications, providing samples, and providing effective patient education.

The circle of caring model: medication adherence in cardiac transplant patients.

This column employs a case study approach to examine the application of the circle of caring model in actual nursing practice as it pertains to a medication education teaching plan for a cardiac transplant patient. The circle of caring model is applied by experienced registered nurses. The tailored medication education plan is based on the patient's conceptualized database, understanding patient responses, using a holistic/broadened approach to therapeutics, and considering the patient's views of outcomes. Individualized teaching plans improve patient adherence to complicated medication regimens, thus improving long-term quality of life and survival in transplant recipients.

The mock trial: a collaborative interdisciplinary approach to understanding legal and ethical issues.

To provide high-quality, safe, patient-centered care, RNs must exhibit a strong understanding of legal and ethical issues. The authors describe an interdisciplinary teaching learning strategy, the premock, actual, and postmock trial, to augment student retention of legal and ethical concepts and enhance the development of their personal accountability.

Social environment and problem behavior: perceived school safety, gender, and sexual debut.

In 2007, 48% of U.S. students of grades 9 to 12 had experienced sexual debut, 7% before the age of 13 years. Preventing early intercourse, sexually transmitted diseases, adolescent pregnancy, and the loss of educational opportunity are important concerns for nurses and educators. A secondary data analysis of the Youth Risk Behavior Survey (YRBS) 2003 provided data identifying the relationships among age at sexual debut, gender, location of residence, and perceived school safety (PSS) as framed by the theory of problem behavior. Mean age at sexual debut was 14.4 years. Males were younger at sexual debut than females. Students reporting positive PSS were older at sexual debut. Age at sexual debut was significantly associated with PSS, gender, and location of residence. School nurses are positioned to identify evidence-based programs, facilitate the development of collaborative interventions to improve PSS, and change trajectories of sexual activity leading to poor health outcomes in adolescents and health risk behaviors in adults.