Alcohol Withdrawal Assessment Tool (AWAT) Reliability and Validity: Implications for Nurses Caring for Inpatients With Mental Health Disorders.

BACKGROUND: Alcohol use affects 14.5 million Americans and high prevalence of use and potential for withdrawal among hospitalized patients presents a challenge for health care professionals to anticipate and manage effectively. Due to the acuity and fast-paced nature of the hospital environment, nurses need assessment tools that can be readily completed and drive efficient protocol-based treatment. The purpose of this study was to examine psychometric properties of the alcohol withdrawal assessment tool (AWAT). AIMS: The aims were to examine AWAT (1) reliability, (2) validity, and (3) usability. METHODS: Patients (n = 55) and nurses (n = 47) were recruited from six hospitals within one health care system in the Midwest. Psychometric testing included inter-rater reliability and criterion-related validity testing, using the Clinical Institute Withdrawal Assessment of Alcohol Scale-Revised (CIWA-Ar) as a comparison. Usability was assessed with a 5-item Likert-type scale. RESULTS: Findings supported strong agreement (ICC: .931) between raters on the AWAT and a moderate correlation (Pearson r: .548) between scores on the AWAT and CIWA-Ar. Nurses agreed/strongly agreed that the AWAT took 2 min or less to complete (n = 42; 89%), was easy to use for assessment (n = 42; 89%) was easy to learn (n = 40; 85%), and they were confident using the AWAT (n = 39; 83%). CONCLUSIONS: Study findings provide evidence of reliability, validity, and usability of the AWAT in the hospital setting. The AWAT has potential to improve assessment efficiency and nurses caring for inpatients with mental health disorders should consider implementing the tool into practice.

Perspectives of Maternal Mortality Among Women Who Live in Indiana.

OBJECTIVE: To explore the perspectives of women in the lay public in Indiana on the topic of maternal mortality. DESIGN: Qualitative descriptive design. SETTING: The state of Indiana. PARTICIPANTS: Women in the lay public (N = 20) who were recruited from Facebook groups aimed at women with children. METHODS: We used semistructured phone interviews during which participants described their understanding of maternal mortality and their related experiences. We analyzed the transcribed interviews using content analysis to yield overall themes. RESULTS: We identified three main themes that described participants' perspectives of maternal mortality: Women Are Not Worried About Mortality Until They Experience Pregnancy Complications, Women Have Limited Information on Maternal Mortality, and Women Often Feel Dismissed During Maternity Care. CONCLUSION: Our findings suggest that nurses and other health care providers should increase their efforts to effectively communicate about maternal mortality and the associated risk factors and to follow evidence-based guidelines for respectful maternity care.

Descriptions of Maternal Mortality From Nurses Who Practice in Perinatal Settings.

OBJECTIVE: To explore nurses' descriptions of maternal mortality when caring for women in the perinatal period in Indiana. DESIGN: A qualitative descriptive approach was used to produce nurses' descriptions of maternal mortality. SETTING/PARTICIPANTS: Convenience sample of 16 nurses recruited from the Indiana Section of the Association of Women's Health, Obstetric and Neonatal Nurses. MEASUREMENTS: Semistructured phone interviews were conducted, and participants were asked to explain their experiences related to maternal mortality. This information, which was summarized using content analysis, provided data related to nurses' descriptions of maternal mortality when caring for women in the perinatal period. RESULTS: Analysis revealed three main themes that explain nurses' descriptions of maternal mortality: When It Comes to Maternal Mortality: Out of Sight Is Out of Mind, Nurses Express Detachment From Their Role in Preventing Maternal Mortality, and Experience With Maternal Mortality or a Near-Miss Event Is a Turning Point for Nurses. CONCLUSION: Nurses who have limited experience with maternal mortality and who approach the issue in a detached manner may miss opportunities to provide health education to women in the perinatal period. Nurses need education on substance use disorders in the perinatal period, guidance on how to support women in the postpartum period, and support for coping with death and dying in the perinatal period.

Family Presence During Resuscitation: Physicians' Perceptions of Risk, Benefit, and Self-Confidence.

BACKGROUND: Families often desire proximity to loved ones during life-threatening resuscitations and perceive clear benefits to being present. However, critical care nurses and physicians perceive risks and benefits. Whereas research is accumulating on nurses' perceptions of family presence, physicians' perspectives have not been clearly explicated. Psychometrically sound measures of physicians' perceptions are needed to create new knowledge and enhance collaboration among critical care nurses and physicians during resuscitation events. OBJECTIVE: This study tests 2 new instruments that measure physicians' perceived risks, benefits, and self-confidence related to family presence during resuscitation. METHODS: By a correlational design, a convenience sample of physicians (N = 195) from diverse clinical specialties in 1 hospital in the United States completed the Physicians' Family Presence Risk-Benefit Scale and Physicians' Family Presence Self-confidence Scale. RESULTS: Findings supported the internal consistency reliability and construct validity of both new scales. Mean scale scores indicated that physicians perceived more risk than benefit and were confident in managing resuscitations with families present, although more than two-thirds reported feeling anxious. Higher self-confidence was significantly related to more perceived benefit and less perceived risk (P = .001). Younger physicians, family practice physicians, and physicians who previously had invited family presence expressed more positive perceptions (P = .05-.001). DISCUSSION: These 2 new scales offer a means to assess key perceptions of physicians related to family presence. Further testing in diverse physician populations may further validate the scales and yield knowledge that can strengthen collaboration among critical care nurses and physicians and improve patient and family outcomes.

A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation.

AIMS AND OBJECTIVES: To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation. BACKGROUND: Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations. Research has not clarified the factors that influence the decision-making processes of nurses and physicians related to inviting family presence. This is the first study to elicit written data from healthcare professionals to explicate factors in decision-making about family presence. DESIGN: Qualitative exploratory-descriptive. METHODS: Convenience samples of registered nurses (n = 325) and acute care physicians (n = 193) from a Midwestern hospital in the United States of America handwrote responses to open-ended questions about family presence. Through thematic analysis, decision-making factors for physicians and nurses were identified and compared. RESULTS: Physicians and nurses evaluated three similar factors and four differing factors when deciding to invite family presence during resuscitation. Furthermore, nurses and physicians weighted the factors differently. Physicians weighted most heavily the family's potential to disrupt life-saving efforts and compromise patient care and then the family's knowledge about resuscitations. Nurses heavily weighted the potential for the family to be traumatised, the potential for the family to disrupt the resuscitation, and possible family benefit. CONCLUSIONS: Nurses and physicians considered both similar and different factors when deciding to invite family presence. Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team. RELEVANCE TO CLINICAL PRACTICE: Knowledge of factors that influence the decision-making of interprofessional colleagues can improve collaboration and communication in crisis events of family presence during resuscitation.

Being there: inpatients' perceptions of family presence during resuscitation and invasive cardiac procedures.

BACKGROUND: Although patients' families want to be invited to the bedside of hospitalized loved ones during crisis events, little is known about patients' perceptions of family presence. OBJECTIVE: To explore adult inpatients' perceptions of family presence during resuscitation, near-resuscitation, and unplanned invasive cardiac procedures shortly after the life-threatening event. METHODS: In this qualitative study, data were collected by interviews at least 13 hours after a crisis event and before hospital discharge. Data were audio recorded, transcribed, and analyzed for themes. RESULTS: From the bedside interviews (N = 48), the overarching theme of "being there" was explained more specifically as "being there is beneficial," "being there is hard," "families in the way," and "desire for control." Most participants preferred family presence, although preferences varied with types of crisis events, patients' predictions of family members' responses, and the nature of family relationships. New perspectives emerged about patients' decision making related to family presence. CONCLUSIONS: This study extends existing knowledge about factors that influence the decision-making processes of hospitalized patients regarding family presence during a crisis event. Health care professionals can provide support as patients ponder difficult decisions about who to have present and can reduce patients' fears that families might interfere with the life-saving efforts.

Perceptions Related to Falls and Fall Prevention Among Hospitalized Adults.

BACKGROUND: Prevention of falls during hospitalization depends in part on the behaviors of alert patients to prevent falls. Research on acutely ill patients' intentions to behave in ways that help prevent falls and on the patients' perceptions related to falls is limited. OBJECTIVE: To explore hospitalized adults' perceptions related to risk for falling, fear of falling, expectations of outcomes of falling, and intention to engage in behaviors to prevent falls. METHODS: Adult, alert, acutely ill inpatients (N = 158) at risk for falling completed a survey consisting of 4 scales and 3 single items. Nurses' assessments and patients' perceptions of the risk for falling were compared. RESULTS: Decreased intentions to engage in behaviors to prevent falls were correlated with patients' increased confidence in their ability to perform high-risk behaviors without help and without falling (P < .001), decreased fear of falling (P < .001), and decreased perceived likelihood of adverse outcomes if they did fall (P < .001). Although nurses' assessments indicated a risk for falls, 55.1% of the patients did not perceive a high likelihood of falling while hospitalized. Whereas 75% of patients intended to ask for help before getting out of bed, 48% were confident that they could get out of bed without help and without falling. CONCLUSIONS: Although assessments may indicate a risk for falling, acutely ill inpatients may not perceive they are likely to fall. Patients' intentions to engage in behaviors to prevent falls vary with the patients' fall-related perceptions of confidence, outcomes, and fear related to falling.

Nurses' perceptions of their self-confidence and the benefits and risks of family presence during resuscitation.

BACKGROUND: Debate continues among nurses about the advantages and disadvantages of family presence during resuscitation. Knowledge development about such family presence is constrained by the lack of reliable and valid instruments to measure key variables. OBJECTIVES: To test 2 instruments used to measure nurses' perceptions of family presence during resuscitation, to explore demographic variables and perceptions of nurses' self-confidence and the risks and benefits related to such family presence in a broad sample of nurses from multiple hospital units, and to examine differences in perceptions of nurses who have and who have not invited family presence. METHODS: Nurses (n = 375) completed the Family Presence Risk-Benefit Scale and the Family Presence Self-confidence Scale. RESULTS: Nurses' perceptions of benefits, risks, and self-confidence were significantly and strongly interrelated. Nurses who invited family presence during resuscitation were significantly more self-confident in managing it and perceived more benefits and fewer risks (P < .001). Perceptions of more benefits and fewer risks were related to membership in professional organizations, professional certification, and working in an emergency department (P < .001). Data supported initial reliability and construct validity for the 2 scales. CONCLUSIONS: Nurses' perceptions of the risks and benefits of family presence during resuscitation vary widely and are associated with how often the nurses invite family presence. After further testing, the 2 new scales may be suitable for measuring interventional outcomes, serve as self-assessment tools, and add to conceptual knowledge about family presence.

Faculty perceptions of critical thinking in student clinical experiences.

Critical thinking is an essential skill for nurses who practice in complex health care systems. This study explored nursing faculty members' perceptions of teaching critical thinking to baccalaureate student nurses in clinical settings. Six clinical faculty members were interviewed using an ethnographic approach. Findings focus on two domain analyses that describe the nature of critical thinking and strategies to effectively teach it. Faculty members conceptualized critical thinking as "putting it all together" through information seeking, reflecting, assigning meaning, problem solving, predicting, planning, and applying information. Faculty members perceived that they teach critical thinking through a number of approaches that include asking questions, reviewing written products, conducting clinical conferences, and evaluating student journals. The findings of this study have implications for faculty who seek a clearer definition of critical thinking in nursing and a rich description of strategies to teach this skill.

Subjective perceptions and physiological variables during weaning from mechanical ventilation.

BACKGROUND: As costs related to mechanical ventilation increase, clear indicators of patients' readiness to be weaned are needed. Research has not yet yielded a consensus on physiological variables that are consistent correlates of weaning outcomes. Subjective perceptions rarely have been examined for their contribution to successful weaning. OBJECTIVE: To explore the subjective perceptions of dyspnea, fatigue, and self-efficacy and selected physiological variables in patients being weaned from mechanical ventilation. METHODS: Data were collected prospectively on 68 patients being weaned from mechanical ventilation. Subjective perceptions were measured by using 3 visual analog scales; physiological variables were measured by using the Burns Weaning Assessment Program and a patient profile. Weaning outcomes were recorded 24 hours after data collection. RESULTS: Participants were primarily white women and required mechanical ventilation for a mean of less than 4 days. Participants reported mild dyspnea, moderate fatigue, and high weaning self-efficacy. High PaO2, low PaCO2, stable hemodynamic status, adequate cough and swallow reflexes, no metabolic changes, and no abdominal problems were associated with complete weaning (P = .05). Subjective perceptions were associated with physiological variables but not with weaning outcomes. CONCLUSIONS: Multidimensional assessment of both primary and secondary indicators of readiness to be weaned is necessary for timely, efficient weaning from mechanical ventilation. Primary assessments include physiological variables related to gas exchange, hemodynamic status, diaphragmatic expansion, and airway clearance. Secondary assessments include perceptions related to key physiological variables. Additional research is needed to determine the predictive value of physiological variables and perceptions of dyspnea, fatigue, and self-efficacy.

Outcomes of a transcultural nursing immersion experience: confirmation of a dimensional matrix.

Schools of nursing are positioned to increase cultural awareness for students and potentially change practice. Dimensions of culturally focused field experiences were investigated to determine the relevancy of the dimensions of the Matrix for Personal and Professional Growth Through a Transcultural Immersion Experience. A questionnaire was developed and administered to two samples of nursing students following participation in an immersion experience. Results provided evidence of validation for major dimensions of the matrix, including situational predetermining factors, modifying factors, transitional factors, and outcomes of the matrix. The model for transcultural nursing immersion experiences was conceptualized, and propositions were generated.