ABSTRACT
BACKGROUND: Bedside ultrasound technology is an innovative, cost-effective, safe, and reproducible method used to make efficient decisions that directly affect the care of critical care patients. PURPOSE: To validate the use of ultrasound technology when compared with the use of standard chest radiography for the detection of pneumothorax following chest tube removal. METHODS: A prospective observational comparison study of 50 cardiothoracic patients with surgically placed pleural chest tubes was conducted. The accuracy of bedside ultrasound technology was compared with standard chest radiography to detect pneumothorax. RESULTS: The sample kappa statistic was 1.000, indicating a perfect agreement between bedside ultrasonography and chest radiography in the detection of pneumothorax. Completion of the bedside ultrasound procedure took significantly less time than chest radiography. CONCLUSIONS: Bedside ultrasound technology is as accurate as chest radiography in detecting pneumothorax following chest tube removal and can save institutions' time and money.
Subject(s)
Chest Tubes , Device Removal , Lung/diagnostic imaging , Pneumothorax/diagnostic imaging , Point-of-Care Systems , Ultrasonography , Adult , Advanced Practice Nursing , Aged , Aged, 80 and over , Critical Care , Critical Illness , Female , Humans , Male , Middle Aged , Pneumothorax/nursing , Prospective Studies , RadiographyABSTRACT
The purpose of this study was to compare the efficacy and safety of extended-release epidural morphine (EREM) and perineural infusion (PNI) to control pain after total knee arthroplasty. A convenience sample of 200 patients was obtained using a retrospective chart review of patients who underwent a total knee arthroplasty. Institutional review board approval was obtained, and 100 charts of patients who received EREM and 100 patient charts for PNI were reviewed. The main end points were pain scores up to 48 hours postoperatively, and the ancillary end points were supplemental opioid requirements and adverse effects. Data were analyzed using the Pearson chi2 where appropriate or the Fisher exact test, and all continuous variables were examined using a Wilcoxon rank test. The results of the study showed no significant differences between the 2 groups for the levels of pain preoperatively, immediately postoperatively, and at 48 hours postoperatively. However, at both 12 hours and 24 hours postoperatively, the PNI group had a significantly higher pain score than the EREM group. The EREM group had better pain scores; however, one must look at a number of different variables when deciding if EREM is the correct choice for postoperative pain management.
Subject(s)
Analgesia, Epidural , Analgesics, Opioid/administration & dosage , Arthroplasty, Replacement, Knee/adverse effects , Morphine/administration & dosage , Nerve Block , Pain, Postoperative/drug therapy , Aged , Aged, 80 and over , Analgesia, Epidural/methods , Analysis of Variance , Female , Humans , Male , Michigan , Middle Aged , Nerve Block/methods , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Patient Selection , Postoperative Care/methods , Retrospective Studies , Safety , Severity of Illness Index , Statistics, Nonparametric , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: To analyze and clarify the conceptual basis of advanced practice nursing to determine the state of the knowledge from the perspective of four overarching principles derived from the philosophy of science: epistemological, pragmatic, linguistic, and logical. DATA SOURCES: Written discourse regarding advanced practice nursing from refereed journals published between 2000 and 2007. CONCLUSIONS: Conceptualization of a core definition of advanced practice nursing will enhance external legitimacy and recognition; understanding advanced practice nurse (APN) roles, sub-roles, and competencies will enhance internal cohesion. The outcome of this concept analysis is a greater understanding of the conceptual basis of advanced practice nursing and a current best estimate of the probable truth surrounding advanced practice nursing. IMPLICATIONS FOR PRACTICE: A greater understanding of the conceptual basis of advanced practice nursing will help to gain clarity, internal cohesion, external legitimacy, and acceptance of APN roles by society and other healthcare professions.
Subject(s)
Health Knowledge, Attitudes, Practice , Nurse Practitioners , Nursing Theory , Humans , Knowledge , Linguistics , Logic , Models, TheoreticalABSTRACT
PURPOSE: The purpose of this descriptive study is to determine what strategies were most helpful for women to begin and maintain a walking program. METHOD: Data from the field notes of a randomized clinical trial to promote walking in 97 women were used for the qualitative analysis discussed in this article. FINDINGS: Overall, the majority of participants met the study goal of walking 90 minutes per week. CONCLUSIONS: In addition, the participants reported other benefits, including becoming more physically fit, mental and emotional satisfaction, and stress reduction. Some of the barriers mentioned by participants were personal and/or professional obligations, weather, injuries and/or illnesses, and psychosocial factors. When benefits outweighed barriers, the participants had greater success meeting their walking goals. IMPLICATIONS: Furthermore, the participants stated that making time, problem solving, internal motivation, and the support of family and/or friends were the most helpful factors in achieving their walking goals.
