Credentialed and Privileged Clinical Nurse Specialists.

PURPOSE/OBJECTIVES: The purpose of this article is to illustrate, using exemplars, the practice of clinical nurse specialists (CNSs) in Michigan who are credentialed and privileged as providers by hospital/healthcare agencies to practice in acute inpatient and ambulatory settings. DESCRIPTION: The CNS provides expert specialty direct patient care to improve patient outcomes. They hold a graduate degree as a CNS, are professionally certified as a CNS in a specialty practice population, and are licensed or otherwise recognized to practice as an advanced practice nurse by the state nursing practice regulatory agency. OUTCOME: The exemplars illustrate CNS practice as an independent provider within a health system. CONCLUSION: Hospital-based credentialing and privileging facilitates CNS practice within the full scope of practice authority that consists of education, certification, and licensure and is a valuable contribution to cost-effective, high-quality clinical care for specialty populations.

The Immediate Physiological Effects of E-Cigarette Use and Exposure to Secondhand E-Cigarette Vapor.

BACKGROUND: Vaping continues to grow as an alternative to smoking and as a recreational activity for people of all ages, including minors. The billion-dollar industry offers users a plethora of flavors, nicotine concentrations, e-juice combinations, and devices. While some studies suggest vaping is beneficial for certain ailments and as a smoking cessation tool, many studies report concerning health outcomes associated with vape use. Recent FDA regulations have banned certain vaping products following an increase of vaping-related lung injuries reported in 2019. Health care providers need to better understand the physiological effects of vaping-specific products and the impact of secondhand vapor. The specific aims of the present study were to understand the immediate effects on heart rate, breathing frequency, blood pressure, blood sugar, [Formula: see text], pulmonary function, and oral temperature following e-cigarette use and secondhand vapor exposure. METHODS: A total of 149 volunteers participated in this study; 76 subjects vaped mint-flavored e-cigarettes with 5% nicotine for 20 min while seated next to 73 nonvaping subjects who agreed to be exposed to the vapor. Health variables including heart rate, blood pressure, breathing frequency, blood glucose, FVC, [Formula: see text], and oral temperature were obtained prior to vaping or exposure to vapor and again after 20 min. RESULTS: Subjects who vaped had significantly higher heart rate, breathing frequency, and oral temperature, and significantly lower blood oxygenation levels (ie, [Formula: see text]) after vaping for 20 min. Nonvaping subjects exposed to vapor had significantly higher oral temperature after 20 min of exposure. Blood sugar and FVC were not significantly affected by vaping or exposure to vapor. CONCLUSIONS: Vaping with mint-flavored e-cigarettes with 5% nicotine for 20 min resulted in significant immediate physiological changes. Exposure to e-cigarette vapor significantly increased oral temperature within the same amount of time.

Case of a 21-year-old man with persistent lung collapse leading to a pericardectomy linked to vape use.

This case report describes multiple organ failure in a young man with illicit vape use which he did not initially disclose to his health care providers. His symptoms were not readily diagnosed until he experienced lung collapse and significant heart failure. Treatment plan recommendations varied among health care providers leading to increased anxiety for the patient and his family. It was ultimately determined that illicit vape use along with chronic substance abuse contributed to a respiratory virus causing pulmonary collapse. The pulmonary virus migrated to the patient's heart causing severe restrictive pericarditis ultimately requiring a pericardectomy. Assessment, interventions, and follow-up care occurred during the global Corona-19 pandemic of 2020.

A Mixed Methods Pilot Study on the Short-Term Physiological Effects of Vaping and Attitudes Regarding Its Use and Health Effects in Samples of Young Adults.

Vaping is a fairly new and legal way young people are inhaling substances into their lungs. Very little is currently known about the immediate physiological impact or the psychosocial reasons surrounding vape use. This study used a mixed methods approach to (a) understand the short-term physiological implications of vape use compared with people who do not vape and (b) investigate the reasons people choose to vape compared with those who choose not to vape. Twenty-four people participated in the study: 12 self-identified as nonvapers, and 12 self-identified as people who vape. All participants were between 18 and 24 years old. Qualitative analysis suggested people vape because they think it is cool, think it is less risky than smoking, and enjoy the social aspects of vaping. People who choose not to vape are concerned about the unknown health implications, think it is a waste of resources, and are apathetic toward it. Quantitative results revealed statistically significant increases in heart rate and decreases in the percentage of blood oxygenation after 20 minutes of vape use. Blood pressure, respiratory rate, and blood sugar scores did not significantly change after 20 minutes of vape use. Differences in the frequencies of men and women across the two groups were found. Significant differences found for systolic blood pressure, respiratory rate, and pulmonary function test became nonsignificant after controlling for gender. Both long- and short-term effects of vaping need to be further evaluated. The psychosocial reasons why certain people vape whereas others in the same peer group do not also need to be better understood.

Effects on vital signs after twenty minutes of vaping compared to people exposed to second-hand vapor.

INTRODUCTION: Very little is known about the immediate physiological implications of vaping or inhaling second-hand vapor. This study used a quantitative approach to understand the short-term physiological implications of vape use and exposure to sec-ond-hand vapor for people who do not vape. MATERIAL AND METHODS: One hundred and forty-eight people participated in the study, 75 self-identified as non-vapers and 73 self-identified as people who vape. All participants were over the age of 18. Participants used or were exposed to non-flavored e-juice without nicotine in Sorin® vape devices. Heart rate, blood pressure, respiratory rate, blood oxygenation, blood glucose and pulmonary function tests were assessed. Physiological parameters were assessed prior to vape use or exposure to vapor and again after 20 minutes of vaping. RESULTS: Findings indicated there were no significant changes in most health parameters except blood pressure which was reduced in both groups. Heart rate was also significantly reduced for vaping participants. CONCLUSION: Vaping without flavorings or nicotine do not appear to have an immediate negative health impact on vital signs. The physiological effects of long-term exposure and/or vape use requires additional investigation. Information was established regarding the physiological effects of non-flavored, non-nicotine vaping so future studies can compare the effects of vaping with assorted flavors and nicotine concentrations to the effects of vaping only the base ingredients (vegetable glycerin and propylene glycol). New knowledge was gleaned relating to exposure to vapor, a phenomenon not previously examined but common espe-cially among non-vaping people who attend social events where people are vaping.

Readiness of newly licensed associated degree registered nurses to screen for domestic violence.

Lack of education and training have been identified as common barriers nurses experience in implementing domestic violence screening. The reasons for the barriers are poorly understood. Participants were interviewed to determine if and how they screen for domestic violence, which patients are screened, and how pre-licensure education and current workplace training has influenced this practice. An exploratory qualitative design guided by Constructivist Grounded Theory was used. Eligible participants were contacted via a social media and sixteen agreed to participate in the study. Individual interviews were conducted utilizing an open-ended interview guide. Data collection and analysis were done concurrently exploring factors influencing screening behaviors. Six themes emerged from the interview data: Preparedness, Discomfort, Taboo, Disenchantment, Presumptuous, and Evolving Realizations. These findings suggest nurses are not being taught about screening for domestic violence., Findings also suggested work environment and peers influenced if and how diligently nurses screened. The findings point to an interpersonal or intimate nature to screening for domestic violence that is unique and may require highly interactive training throughout pre-licensure education and work orientation.

Perception of Obesity in African-American and Arab-American Minority Groups.

BACKGROUND: Effectiveness of health education programs and interventions, designed to improve obesity rates, may vary according to perceptions of health within cultural groups. METHOD: A qualitative approach was used. Two minority cultural groups (Arab-American and African-American) living in the same county were studied to compare perceptions of health, nutrition, and obesity and subsequent health behaviors. RESULTS: Control, expectations, bias, acceptance, and access were the five themes identified. Arab-Americans that had lower weights, lower prevalence of chronic diseases, expected healthy weights, reported age and gender bias related to being overweight were not as accepting of being overweight and did not report difficulties in accessing healthy food choices compared to their African-American counterparts. CONCLUSIONS: Health interventions aimed at reducing obesity rates and related chronic diseases should be culturally specific and aimed at changing expected and accepted cultural norms. Cultural group's void of certain disease states should be studied and used as models to ameliorate the problem in other cultures. Changing health behaviors within a certain cultural group may produce better outcomes when initiated from a member of that same group. The impact of economic and environmental factors on health behaviors must also be considered.

Implications for Advanced Practice Nurses When Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) Is Suspected: A Qualitative Study.

INTRODUCTION: Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is a relatively new but controversial diagnosis affecting hundreds of children and their families. It is generally thought to be an autoimmune disorder resulting from a streptococcal infection that causes significant and bizarre behavioral changes in children. Currently no definitive diagnostic or treatment modalities exist, which has led to misdiagnoses, ineffective treatments, and delayed care. METHODS: A qualitative study was conducted that included 60 families with at least one child diagnosed with PANDAS. The purpose was to explore how families experience the disorder and what nurses can do to provide effective care. RESULTS: Using paradigmatic analysis of transcribed interviews, three themes were identified: fear, frustration, and not being heard. DISCUSSION: Results from this study suggest that more information is needed to better understand this challenging phenomenon from both medical and nursing perspectives. The study also reaffirms the importance of practicing the art of nursing, especially when the science is not yet established.

Caring nurse practice in the intrapartum setting: nurses' perspectives on complexity, relationships and safety.

AIM: This article reports on a qualitative study of nurse perceptions of caring nurse practice in the complex adaptive system of health care. BACKGROUND: Caring nurse practice encompasses technical skills and caring behaviours. Maternity care in the USA has seen worsening maternal and neonatal outcomes and safety has become a priority. As a result, hospital systems have begun efforts to improve outcomes, initiating safety and quality programmes that standardize care and implementing nursing frameworks that enhance relationships. DESIGN: Qualitative hermeneutic phenomenology. METHODS: A qualitative design analysed 13 nurses' perspectives on caring practice during the second stage of labour. In June and July of 2012, interviews were conducted with 13 labour and delivery nurses located in a hospital that had adopted a perinatal safety initiative and relationship-focused nursing model. The nurses described caring nurse practice and the factors that affected its provision. Transcripts of audio recordings and notes taken during interviews were analysed for themes and fundamental meanings. FINDINGS: Nurses' perspectives about the provision of caring nurse practice was affected by the complexity of the healthcare system, interactions with team members, challenges related to documentation; and respect for natural birth. CONCLUSION: Nurses at all levels of practice can use these perspectives to identify patterns in the complex adaptive healthcare system to improve quality and safety. Best practices include enhancing teamwork, implementing safety initiatives and promoting a Relationship-Based framework. Continued study of caring nurse practice could lead to establishment of additional safety and quality protocols vital to improving patient outcomes.

Perceptions of pediatric asthma in African American underserved families using metaphorical analysis.

PURPOSE: The purpose was to understand how African American children with asthma and their families living in underserved urban areas experience and perceive asthma. DESIGN AND METHODS: A narrative inquiry design with metaphorical analysis was used in this study with 20 African American children and their 10 families. RESULTS: Participants metaphorically viewed the family system as a functioning healthcare facility. Children didn't find their asthma abnormal but did use asthma symptoms to their advantage. Caregivers were viewed as first-line medical responders but often made errors in delivering medical treatment. Lack of knowledge relating to appropriate asthma interventions led to insufficient asthma care. PRACTICE IMPLICATIONS: Results provide evidence to improve patient-nurse interactions for this vulnerable patient group.

Improving lives using multidisciplinary education: partnering to benefit community, innovation, health, and technology.

University students are trained in specific disciplines, which can benefit disabled individuals in a variety of ways, including education, health promotion, assistive technologies, logistics, or design improvement. However, collaboration with other disciplines can have a greater impact on improving the health of disabled individuals than can training in one discipline alone. The University of Detroit Mercy Colleges of Engineering and Nursing have partnered to develop and provide assistive devices to disabled individuals while teaching innovation, technology, and collaboration to students. After 4 years of developing and implementing our multidisciplinary program, numerous unique and helpful assistive devices have been designed, created, and delivered to individuals in our community. More nursing schools should initiate multidisciplinary programs to train and prepare students for workplaces where such innovative, collaborative skills are increasingly sought. Nurses need to be at the forefront of such collaborative work.

Clinical nurse specialists: then, now, and the future of the profession.

PURPOSE: The role of the clinical nurse specialist (CNS) has evolved significantly over time and will continue to do so. Future students, faculty, and practicing CNSs should be aware of their roots, current status, and what the future may entail. RATIONALE: An accurate understanding and reflection of the past, present, and future of this specific advanced practice nursing specialty could ensure its continued success as a predominate force in health restoration and the promotion of the health and well-being of people. DESCRIPTION: A review of the literature yielded a lack of cohesive information about the evolution of the CNS role, prompting an investigation into the historical, current, and future aspects of the CNS. OUTCOME: This article compiles information related to the evolution of the CNS role and what the future may entail. CONCLUSION: An understanding of how the CNS role evolved, where it stands currently, and future considerations may help clarify the role, improve utilization of the CNS in a variety of settings, improve standards for CNS education and certifications, and advance this nursing practice specialty.