Rapid Handheld Continuous Electroencephalogram (EEG) Has the Potential to Detect Delirium in Older Adults.

BACKGROUND: Delirium-related biochemical derangements lead to electrical changes that can be detected in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. Studies using limited lead EEG show a large difference between patients with and without delirium while discriminating delirium from other causes. Handheld rapid EEG devices may be capable of detecting delirium before symptom onset, thus providing an objective physiological method to detect delirium when it is most amenable to interventions. OBJECTIVE: The aim of this study was to explore the potential for rapid EEG to detect waveform pattern changes consistent with delirium status. METHODS: This prospective exploratory pilot study used a correlational design and mixed models to explore the relationships between handheld portable EEG data and delirium status. RESULTS: While being under powered minimized opportunities to detect statistical differences in EEG-derived ratios using spectral density analysis, sleep-to-wake ratios tended to be higher in patients with delirium. CONCLUSIONS: Limited lead EEG may be useful in predicting adverse outcomes and risk for delirium in older critically ill patients. Although this population is at the highest risk for mortality, delirium is not easily identified by current clinical assessments. Therefore, further investigation of limited lead EEG for delirium detection is warranted.

Is Perception Reality? Using Person-in-Context Simulation to Promote Empathic Understanding of Dementia Among Nurse Practitioner Students.

ABSTRACT: This one-group nonexperimental pretest/posttest repeated-measures design plus interpretative phenomenological analysis explored nurse practitioner students' perceptions of dementia using virtual simulation. Perceptions of dementia and its associated challenges differed after the simulation. A critical theme that emerged was "developing empathic understanding"; the two subthemes were "mirroring dementia behaviors" and "provoking emotions." Virtual dementia simulation is an inexpensive, low-fidelity strategy to challenge assumptions and preconceived belief systems about dementia. Person-in-context experiential learning is valuable in nurse practitioner education for facilitating empathic understanding. Further research is needed to explore the correlation between empathic understanding and altruistic helping behaviors in professional practice.

Nursing staff participation in end-of-life nutrition and hydration decision-making in a nursing home: A qualitative study.

AIM: To better understand the participation of nursing staff in end-of-life nutrition and hydration decision-making in an American nursing home. DESIGN: A qualitative exploration with ethnographic focus. METHODS: In April 2017, in-person, semi-structured interviews were performed with 19 nursing staff members in a nursing home located in the south-eastern United States. Additional information was gathered through participant observation during interviews and review of organizational and regulatory policies. Transcripts were coded and analysed using qualitative methods described by Roper and Shapira (2000). RESULTS: Three primary themes relating to nursing staff participation in end-of-life nutrition and hydration decision-making were identified: (a) Formal decision-making: decisions made and implemented by persons with the authority to make legal and binding care decisions in the nursing home setting; (b) Informal decision-making: decisions not requiring medical orders; and (c) Influential factors: factors that influence actions of nursing staff. CONCLUSION: A variety of factors have an impact on nursing staff participation in end-of-life nutrition and hydration decision-making. Participation is closely aligned with the type of decision, whether formal or informal, and role, whether Certified Nursing Assistant/Aide, Licensed Practical/Vocational Nurse, or Registered Nurse. IMPACT: End-of-life nutrition and hydration decision-making in nursing homes differs from decision-making in other care settings and presents a challenge globally. Interventions that support the participation of nursing staff in end-of-life nutrition and hydration decision-making have the potential to positively impact the experiences of residents and family members faced with these issues in the nursing home setting.

Family Influences on Patients' Decisions to Undergo Bariatric Surgery.

Bariatric surgery is the treatment of choice for many obese patients. Although bariatric surgery has recognized benefits, some patients wait several years before deciding to proceed and many patients rely on family member advice and support during the decision-making process. Using a secondary qualitative analysis of transcribed interviews, we examined family member influences on the patient's decision to undergo bariatric surgery. We identified four main themes: role modeling, quality of life with children, family and marital factors, and acquaintances' success with bariatric surgery. Participants indicated that being active with children and demonstrating healthier lifestyles was important, and that adult family members' perceptions of the surgery affect the decision. Because family member influences are evident in the decision-making process, perioperative nurses should be aware of the family's influence and include family members and significant others in the patient's decision-making process for bariatric surgery.

Screenings, Savings, and Service: Nurses Meeting Rural Older Adults in Their Communities.

Falls, depression, and dementia are major health concerns for older adults and communities across the country, which also result in increased health care expenditures. The improvement of early intervention is a tremendous need, especially for older adults who are isolated in rural areas. Nurses were deployed across 41 counties in eastern North Carolina to increase access to screening and improve the possibility of early intervention for rural community-dwelling older adults. The screenings identified at-risk older adults, who nurses then educated and referred for early intervention of falls risk, depression, and cognitive impairment. Through this grassroots intervention, nurses provided community-dwelling older adults with resources for early detection, early intervention, and cost savings. [Journal of Gerontological Nursing, 45(10), 24-28.].

Choosing the Right Delirium Assessment Tool.

Delirium is an increasing concern with current combined annual costs for the United States and Europe of approximately $350 billion. Although standardized definitions and diagnostic criteria exist, more than 80% of delirium in the acute care setting is overlooked or misdiagnosed. Delays in identification result in increases in severity and mortality and a reduction in quality of life. Selecting an assessment tool is the first step toward improving recognition.

Nicaraguan and US nursing collaborative evaluation study: Identifying similarities and differences between US and Nicaraguan curricula and teaching modalities using the community engagement model.

BACKGROUND: Curricula evaluation is an essential phase of curriculum development. Study describes the implementation of a formative evaluation used by faculty members between Universidad Nacional Autonóma de Nicaragua (UNAN-Leon) Escuela de Enfermeriá, Nicaragua and East Carolina University College of Nursing (ECU CON) in North Carolina, US. OBJECTIVES: Program evaluation study to conduct an assessment, comparison of a medical-surgical adult curriculum and teaching modalities. Also, explore the Community Engagement (CE) Model to build a Central American-US faculty partnership. DESIGN: Methodological evaluation study utilizing a newly developed International Nursing Education Curriculum Evaluation Tool related to adult medical and surgical nursing standards. Also, the CE Model was tested as a facilitation tool in building partnerships between nurse educators. DATA: Nicaragua and US nursing faculty teams constructed the curriculum evaluation by utilizing the International Nursing Education Curriculum Evaluation Tool (INECET) by reviewing 57 elements covering 6 Domains related to adult medical and surgical nursing standards. METHODS: Developed, explored the utilization of the INECET based on a standard of practice framework. The Community Engagement Model, a fivephase cycle, Inform, Consult, Involve, Collaborate, and Empower was utilized to facilitate the collaborative process. RESULTS: Similarities between the US and Nicaraguan curricula and teaching modalities were reflective based on the 57 elements covering 6 Domain assessment tool. Case studies, lecture, and clinical hospital rotations were utilized as teaching modalities. Both schools lacked sufficient time for clinical practicum time. The differences, included UNAN-Leon had a lack of simulation skill lab, equipment, and space, whereas ECU CON had sufficient resources. The ECU school lacked applied case studies from a rural health medical-surgical adult nursing perspective and less time in rural health clinics. The UNAN-Leon nursing standards generalized based on the Ministry of Health (MINSA) and the US program was specific based on the American Nurses Association and various sub-specialties of nursing practice requirements. The CE Model was a useful framework to facilitate a collaborative partnership. CONCLUSION: Collaborative evaluation study using the International Nursing Education Curriculum Evaluation Tool can be an effective method to evaluate medical and surgical curricula similarities and differences within international nursing schools. The Community Engagement Model fostered a faculty partnership.

Tipping point: factors influencing a patient's decision to proceed with bariatric surgery.

BACKGROUND: Despite the fact that bariatric surgery is the most effective intervention for morbid obesity, only a fraction of obese patients, even after undergoing evaluation for surgery, decide to undergo the surgery. Opting out by patients is fairly common yet little is known about factors that lead a patient to decide to undergo surgery. OBJECTIVE: The purpose of this qualitative study was to identify factors that "tipped the scales" in the patient's experience leading to a decision to move ahead with surgery. SETTING: The study was carried out in the bariatric surgical clinic of a southeastern regional medical center. METHODS: This qualitative descriptive study utilized semistructured interviews with patients (n = 24) at the time of their "decision visit" to determine the factors related to their positive decision to move forward. A modification of Colaizzi's procedural steps of analysis was used to extract, organize, and analyze data for central themes. RESULTS: Two main factors leading participants to decide to move ahead with bariatric surgery were their own worsening health issues and low energy levels that limited their activities. Participants also noted additional factors that impacted their "tipping point" such as financial considerations and family influences. CONCLUSIONS: The decision to move ahead with bariatric surgery is influenced by many factors to which this research provides additional insight. Further research is warranted to fully understand this phenomenon and develop appropriate outreach and educational approaches.

Enhancing nursing care by understanding the bariatric patient's journey.

Patients who undergo obesity-related bariatric surgery seek a lasting solution to weight loss and a desire for a healthier lifestyle. Perioperative nurses should be prepared to provide sensitive, high-quality care to this population. Effective assessment and management of bariatric patients involves understanding the motivating factors for seeking bariatric surgery, such as to address the stigma and health problems associated with obesity. Nurses should be knowledgeable about expected outcomes of bariatric care, including long-term processes and lifestyle changes that patients must participate in to sustain weight loss. The informed perioperative nurse is essential to the successful treatment of bariatric patients in their journey to healthier living.

Measuring HIV Knowledge Among Women Incarcerated in Jail.

Incarcerated women often have arresting behaviors that are also high risk for acquiring HIV, such as drug use and sex work. Little research has been done related to HIV knowledge among women in jail. This study assessed HIV knowledge among English-speaking women 18 years and older detained in a large, Southeastern jail (N = 202). HIV knowledge was assessed using the Brief HIV Knowledge Questionnaire. HIV knowledge scores were significantly lower among women over age 50, F(3, 195) = 7.39, p < .001; those with less than a high school education, F(2, 187) = 4.10, p = .018; and those with no history of sexually transmitted infections, F(1, 200) = 7.66, p = .006. Assessment of HIV knowledge among incarcerated women revealed a need for prevention education.

Men living with HIV and experiencing sexual dysfunction: an analysis of treatment options.

Men living with HIV (MLWH), especially younger MLWH, may experience sexual dysfunction in greater numbers than men without HIV infection. This manuscript describes the prevalence of two major causative factors of sexual dysfunction in MLWH: hypogonadism and erectile dysfunction. A description of assessment and evaluation is presented. Additionally, the evidence for use of pharmacological and herbal therapies is presented with recommendations for treatment. MLWH who exhibit hypogonadism and/or erectile dysfunction should receive similar care to those without HIV infection. There is evidence to support the use of testosterone replacement therapy and phosphodiesterase 5 inhibitors in this population, and there is limited evidence for the use of certain herbs such as yohimbine. The ethics of treating sexual dysfunction for MLWH are discussed. A case study follows as an example of the application of evidence-based treatments recommended for practice.

The crisis of IRIS: what every nurse should know about immune reconstitution inflammatory syndrome in patients infected with HIV.

Most health care providers are aware that beginning combination antiretroviral therapy (ART) for patients infected with HIV has reduced morbidity of AIDS-related opportunistic infections and subsequently reduced HIV-related mortality. Effective ART leads to significantly reduced viral loads and increased CD4+ T cell counts, especially in the first few months after initiation. ART stimulates immune system reconstitution, thereby reducing the risk of exacerbation or acquisition of an opportunistic infection.

Factors influencing adherence to antiretroviral therapy for HIV-infected female inmates.

New HIV cases are increasing among women, especially women of color. Moreover, the rate of infection for incarcerated women is twice that of incarcerated men. With advances in medication therapy, HIV has become a chronic illness that can be successfully treated, provided the patient is able to achieve adherence with the prescribed antiretroviral medication regimen. Incarcerated women, however, frequently come from environments burdened with violence, substance and physical abuse, homelessness, child-care issues, and mental illness. Such burdens negatively affect the ability of these women to adhere to the medication plan. This study explored incarcerated HIV-infected women's barriers to and facilitators of adherence to antiretroviral therapy (ART), the role of health care provider relationships in adherence, and the ways in which issues of medical privacy influence ability or desire to adhere while incarcerated. A secondary analysis of an existing set of qualitative interviews with HIV-infected female inmates was conducted.

Using a student response system to reduce academic cheating.

Communication technologies have increased academic integrity violations in nursing programs. Previous methods to reduce cheating may not be sufficient to circumvent the technology-savvy student. Teaching outcomes have improved using technology such as the student response system. The author discusses how the use of a student response system reduced academic integrity violations during examinations, improved student interest and participation in class, and reduced faculty workload when evaluating student performance.

Improving wound care simulation with the addition of odor: a descriptive, quasi-experimental study.

Improving problem-solving skills and expertise in complex clinical care provision requires engaging students in the learning process--a challenging goal when clinical practicums and supervisors are limited. High-fidelity simulation has created many new opportunities for educating healthcare professionals. Because addressing malodorous wounds is a common problem that may be difficult to "teach," a descriptive, quasi-experimental simulation study was conducted. Following completion of a wound care simulation and Laerdal's Simulation Experience Evaluation Tool by 137 undergraduate nursing students, 50 control subjects were randomly selected and 49 volunteer students (experimental group) participated in a wound care simulation after one of three cheeses with a strong odor was added to simulate a malodorous wound. Compared to the control group, study group responses were significantly better (P <0.001) for eight of the 12 survey variables tested and indicated the addition of odor was beneficial in enhancing the perceived realism and value of the simulation. Students responded that the addition of odor in the simulation laboratory improved realism and they felt better prepared to handle malodorous wounds in a clinical setting. An unanticipated outcome was the enhanced feeling of involvement associated with paired care teams as opposed to working in larger groups. The results of this study indicate that wound care education outcomes improve when nursing students are able to practice using a multi-sensorial wound care simulation model.

Inequities in screening for sexually transmitted infections in African American adolescents: can health policy help?

Although rates of sexually transmitted infections (STIs) in African Americans are higher than other populations, there are disparities in the screening and treatment of STIs for African American adolescents. Many African Americans distrust the health care system, resulting in a reluctance to seek health care. Adolescents may lack access to and the resources to pay for health care. This article reviews historical events believed to influence African American distrust of the health care system, discusses socioeconomic factors influencing adolescent access to services, and offers descriptions of services available to assist adolescents in receiving preventative services. Last, potential health policy solutions for nurses are noted.