Nurse, Parent, and Nurse Leader Perspective on Adoption of iPads for Pediatric Preoperative Anxiety Reduction.

PURPOSE: The purpose of this study was to examine the use of an iPad to facilitate distraction and reduce anxiety with preoperative pediatric patients. DESIGN: The authors conducted a descriptive case study in a Pre-Anesthesia Surgical Suite. METHODS: Nurses were trained on the use of the iPad, which came preloaded with games. The research staff took detailed notes during training and implementation. Research staff conducted interviews with nurses, leaders, and patient guardians for the study. FINDINGS: The authors discovered different perspectives among the clinical nurse, parent, and nursing leadership. The clinical nurse felt the iPad afforded them more focused time with the parents before surgery, though there was some hesitation at the beginning due to ownership of the devices. The parents felt the iPads were helpful to distract their child but worried there were not enough games appropriate for various age ranges. Nursing leadership found the iPads helpful in building a connection with the patient and their parents. Still, they felt many obstacles made integrating the use of the iPads in the nurses' workflow very difficult. There were technological issues that also delayed and discouraged the use of iPads. Once these preliminary issues were resolved, the iPad appeared to reduce anxiety in both patients and their parents. CONCLUSIONS: The iPad is an evidence-based intervention used for preoperative anxiety reduction. This study identifies essential facilitators and barriers associated with adopting the technology from the perspective of key stakeholders (nurses, parents, and nursing leadership). Overall, the iPad was considered a valuable tool to help parents feel less stressed with their child, allowing them to interact more effectively with the clinician. However, additional work is indicated to address the limitations regarding sample size and actual measures of anxiety.

Music to reduce stress in hospitalized patients.

PURPOSE: To determine the impact of music on the physiologic and psychological stress experienced by hospital inpatients. METHODS: This pilot study monitored vital signs; utilized pain, anxiety, and agitation rating scales; and gathered verbal feedback from 50 participating inpatients at the authors' healthcare facility as they listened to music via an audiovisual interactive patient engagement technology system. RESULTS: After listening to music for 30 minutes, patients reported significantly lower pain and anxiety. CONCLUSION: Music offered a helpful tool to reduce pain and anxiety for patients in the ICU and telemetry units at the authors' healthcare facility. Future research may be geared toward incremental expansion and monitoring of this music intervention in other units.

Evidence-based practice knowledge, attitudes, practices, and barriers.

ABSTRACT: This study assessed nurses' knowledge, attitudes, practices, and perceived barriers related to evidence-based practice (EBP). Nurses reported highly positive attitudes toward EBP, and relatively strong EBP knowledge and practices, but they also identified several barriers. Removing barriers and building on strengths may close this knowledge-practice gap.

Symptoms Suggestive of Acute Coronary Syndrome: When Is Sex Important?

BACKGROUND: Studies have identified sex differences in symptoms of acute coronary syndrome (ACS); however, retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of sex differences. OBJECTIVE: The aim of this study is to determine the influence of sex on the occurrence and distress of 13 symptoms for patients presenting to the emergency department for symptoms suggestive of ACS. METHODS: A total of 1064 patients admitted to 5 emergency departments with symptoms triggering a cardiac evaluation were enrolled. Demographic and clinical variables, symptoms, comorbid conditions, and functional status were measured. RESULTS: The sample was predominantly male (n = 664, 62.4%), white (n = 739, 69.5%), and married (n = 497, 46.9%). Women were significantly older than men (61.3 ± 14.6 vs 59.5 ± 13.6 years). Most patients were discharged with a non-ACS diagnosis (n = 590, 55.5%). Women with ACS were less likely to report chest pain as their chief complaint and to report more nausea (odds ratio [OR], 1.56; confidence interval [CI], 1.00-2.42), shoulder pain (OR, 1.76; CI, 1.13-2.73), and upper back pain (OR, 2.92; CI, 1.81-4.70). Women with ACS experienced more symptoms (6.1 vs 5.5; P = .026) compared with men. Men without ACS had less symptom distress compared with women. CONCLUSIONS: Women and men evaluated for ACS reported similar rates of chest pain but differed on other classic symptoms. These findings suggest that women and men should be counseled that ACS is not always accompanied by chest pain and multiple symptoms may occur simultaneously.

Using Interactive Patient Engagement Technology in Clinical Practice: A Qualitative Assessment of Nurses' Perceptions.

BACKGROUND: Research has shown patients who are more engaged in their care are likely to have better health outcomes and reduced health care costs. Health care organizations are now focusing their efforts in finding ways to improve patient engagement. At the forefront of this movement are patient engagement technology systems. In this paper, these emerging systems are described as interactive patient engagement technologies (iPET). OBJECTIVE: The objective of this descriptive study was to gain an understanding of the perceptions of nurses who are integrating these iPET systems into their daily clinical practice. METHODS: The research team interviewed 38 nurses from 2 California-based hospitals using a focused rapid ethnographic evaluation methodology to gather data. RESULTS: The study participants reported that using iPET systems may enhance clinical nursing practice. The 4 key findings of iPET were that it (1) is effective for distraction therapy, (2) has functionality that affects both patients and nurses, (3) has implications for clinical practice, and (4) may require additional training to improve usage. CONCLUSIONS: With sufficient training on the iPET system, nurses believed they could use these technologies as an enhancement to their clinical practice. Additionally, nurses perceived these systems served as distraction therapy for patients. Initial findings suggest that iPET is beneficial, but more research is required to examine the usefulness of iPET systems in the inpatient settings.

Implementing clinical research in the high acuity setting of the emergency department.

INTRODUCTION: Clinical research in the emergency department provides supporting evidence needed for the development of practice guidelines, such as door-to-needle and door-to-balloon times for treatment of acute coronary syndromes, and is vital to improvements in patient outcomes. The purpose of this article is to describe barriers and lessons learned in launching a multisite clinical research study of symptoms of acute coronary syndromes in the emergency department. METHODS: Participants included ED and research staff in 4 busy emergency departments in 3 states. At each step of the study launch, the principal investigator at the clinical site identified barriers that either were anticipated or experienced and discussed them with the site staff and study principal investigator to validate the issue as a barrier. Orientation sessions and ongoing communication between clinicians, research staff, and the research study team provided opportunity for adjustment of study protocols. RESULTS: Barriers were lack of staff engagement in research, difficulty identifying eligible patients, perception of interference in clinical care, variability in research staff education and training, patient refusals, nurses' perceptions of lack of time, undifferentiated patients, and time-sensitive quality improvement indicators necessitating acceleration in care. DISCUSSION: Important strategies to overcome barriers were developed, including identification and support of unit champions in emergency nursing and medicine; minor protocol modifications to improve enrollment goals; development of specific written expectations, roles, research protocols, and algorithms; and sharing successes among sites.