Integrating Complementary Therapies in Managing Phantom Limb Pain: A Case Review.

OBJECTIVES: This paper describes phantom limb pain (PLP), its impact on patients, and the various treatment options, including pharmacologic and complementary therapies. It investigates the efficacy of incorporating complementary and alternative therapies, both invasive and noninvasive, for amputees who have not achieved satisfactory results with pharmacologic treatments and suffer from adverse drug events. Furthermore, with the predicted increase in limb amputations, it is crucial for nurses, as frontline providers, to understand PLP, be prepared to manage persistent pain and associated psychological and functional issues and educate patients and families about alternative treatment options. APPROACH: The review includes recent studies on pharmacologic interventions for PLP, case reports, and randomized clinical trials on non-pharmacologic complementary therapies, covering both invasive and noninvasive modalities. Studies from 2013 to 2022 were identified using the PubMed search engine with terms such as "Amputation," "phantom limb pain," "invasive therapies," and "non-invasive therapies." RESULTS AND CONCLUSION: The pathogenesis of PLP remains unclear, complicating the identification of causes and the selection of targeted therapies for each patient. Uncontrolled PLP can severely impact the quality of life, causing psychological distress and loss of productivity. Traditional pharmacologic therapy often requires supplementation with other options due to PLP's refractory nature. A comprehensive, multimodal treatment plan, including non-pharmacologic therapies, can enhance rehabilitation and reduce complications. Incorporating these therapies can decrease reliance on medications, particularly opioids, and mitigate side effects. Although many potential PLP treatments exist, further clinical studies are needed to determine their effectiveness and establish protocols for optimizing patient outcomes.

Real-Life Patient Educational Recording Before Esophageal Manometry.

High-resolution esophageal manometry (HREM) is a fundamental diagnostic tool in esophagology. Educational tools for this procedure have remained scarce. This quality improvement project aimed to develop an enhanced digital recording about HREM and assess the effect on patient knowledge, anxiety, satisfaction, and procedure abortion rates. The Institute for Healthcare Improvement Model for Improvement and the self-regulation theory guided this project. An interprofessional team was formed. A video recording of the pre-, peri-, and post-HREM care was created. Participants were recruited in the following four cycles: Baseline, Workstation, Manometry, and Home. Questionnaires were collected pre- and postvideo education. The results demonstrated a significant increase in knowledge from 60% to 96% ( p < .001), 58% to 96% ( p < .001), 79% to 96% ( p < .001), and 92% to 97% ( p = .02) and reductions in anxiety from 7.1 to 5.5 ( p = .003), 7.6 to 6.1 ( p = .003), 7.1 to 6.5 ( p < .001), and 6.4 to 6.1 ( p = .03) in all four groups. Almost all (99.5%) participants liked the recorded education and only 2.6% of cases were aborted during the 1-year project implementation period from June 2020 to May 2021. Findings from this project support the positive impact of recorded patient education. An educational recording is standardized and has the potential to be implemented in variable settings.

Chagas Disease Cardiomyopathy.

Chagas disease is a prominent neglected tropical disease endemic to many countries in Latin America. Cardiomyopathy is the most serious manifestation due to the severity and complications of heart failure. As a result of expanded immigration and globalization, there is an increased number of patients with Chagas cardiomyopathy who are being admitted to hospitals in the United States. It is imperative as a critical care nurse to be educated on the nature of Chagas cardiomyopathy as it differs from the more commonly seen ischemic and nonischemic forms. This article provides an overview of the clinical course, management, and treatment options of Chagas cardiomyopathy.

Chronic Fatigue Predicts Hospital Nurse Turnover Intentions.

OBJECTIVE: The objective of this study was to determine the impact of workforce engagement factors on hospital nurse turnover intentions. BACKGROUND: Nurse turnover intentions are impacted by occupational fatigue and burnout, which are differentially impacted by fatigue, meaning and joy in work, and work-related resilience. METHODS: One hundred fifty-one nurses from a southwestern hospital completed online surveys. Path analyses evaluated relationships among variables. RESULTS: Chronic occupational fatigue was the only significant predictor of turnover intentions among nurses. Although strongly associated with emotional exhaustion and depersonalization (burnout components), burnout did not predict turnover intention. High levels of chronic fatigue predicted lower meaning and joy in work and lower work-related resilience. Although significantly correlated, meaning and joy in work and resilience did not predict total burnout scores when analyzed in causal models. CONCLUSIONS: Nurse administrators should focus efforts on factors such as chronic occupational fatigue that are likely to impact nurses' decisions to leave their positions.

Hospital Nurse Competency to Care for Patients With Behavioral Health Concerns: A Follow-Up Study.

Nonpsychiatric nurses care for hospital patients with behavioral health (BH) conditions. This study found BH care competencies of hospital nurses slightly changed from those 9 years earlier. On average, nurses reported moderate to strong perceived competence about assessing/intervening and accessing resources to care for BH patients. They perceived less competence in recommending psychotropic drugs for patients who may need them. Staff development programs that aim to enhance nurse BH care competencies are needed.

Impact of engagement factors on nurses' intention to leave hospital employment.

AIM: To determine the impact of workforce engagement factors on nurses' intention to leave their hospital. BACKGROUND: Nurse retention is important for safe patient care. It is unknown whether meaning and joy in work, occupational fatigue, job satisfaction and unprofessional behaviour experiences predict hospital nurse turnover intentions. METHOD: This cross-sectional study involved responses from 747 nurses from two south-western hospitals. Measures included surveys to capture meaning and joy in work, job satisfaction, occupational fatigue and unprofessional behaviour exposure/impact. RESULTS: Following correlational analyses, manifest variables significantly correlated with related latent factors. In structural equation modelling, greater chronic occupational fatigue was the strongest and meaning and joy at work (negative direction) the next strongest predictor of turnover intention. Although significant, job satisfaction and acute fatigue were weak predictors. Inter-shift recovery did not predict intent to leave. CONCLUSION: This is the first study to identify Chronic Fatigue and meaning and joy in work as significant predictors of hospital nurse turnover intentions. IMPLICATIONS FOR NURSING MANAGEMENT: Employing practices that decrease chronic fatigue and increase meaning/joy in work are recommended to improve nurse retention.

Effects of Transport on Oral Temperature of Postsurgical Patients Transported from PACU to Nursing Units.

PURPOSE: To determine the impact of transport from the postanesthesia care unit (PACU) to inpatient nursing units on postsurgical patient temperature. DESIGN: Exploratory correlational study. METHODS: PACU discharge oral temperatures of postsurgical adult patients were compared with oral temperature at unit transfer. FINDINGS: Temperatures on PACU discharge ranged from 97.3°F to 100.0°F (mean [M], 98.1 [0.5]), whereas those on unit arrival ranged from 97.3°F to 99.8°F (M, 98.0 [0.5]). Temperature differences between arrival and discharge ranged from -1.5°F to 0.9°F (M, -0.05 [0.34]); most showed decreases (n = 49; 52.7%). Correlations between temperature change and other variables (transport time, age, and gender) were less than 0.10 and nonsignificant. CONCLUSIONS: Transfers from the PACU to other hospital units may not clinically impact oral temperatures in postsurgical patients. However, post-transfer temperature should be monitored to assure that hypothermia does not occur.

Viral Myocarditis.

In recent years, more young patients are being admitted to hospitals with the diagnosis of heart failure secondary to myocarditis; many of these patients will progress to needing a heart transplant. Research shows that heart failure is increasing in prevalence and incidence and is expected to have 46% increases in prevalence by 2030, with hypertension, diabetes, and obesity pointed as risk factors (Cardiac Fail Rev. 2017;3(1):7-11). Nurses need to be aware of and educated on the infectious processes responsible for heart failure, presumable pathogens, new and emerging diagnostic tests, and possible treatments. This article explores the viral pathogens commonly found to cause myocardial inflammation, their sequelae, and treatment.

A Picture Is Worth a Thousand Words: Pictographs to Improve Understanding of Discharge Instructions.

INTRODUCTION: Poor comprehension of ED discharge instructions has been reported. Discharge instructions often include written information. Identification of home-care practices that were different from recommended discharge instructions among multiple clients led nurses at a community emergency department to evaluate health literacy among specific clients. METHODS: A bilingual translator administered the Newest Vital Sign-a 6-item validated scale that assesses health care literacy-to 150 English and Spanish-speaking parents of pediatric patients admitted to the fast-track area. RESULTS: Although mean scores for both groups indicated participants were, on average, "at risk" for health literacy problems, English speakers had a significantly higher mean total score (3.82, standard deviation [SD] = 1.60) than did Spanish speakers (2.61, SD = 1.71), indicating better literacy. DISCUSSION: Study findings of low levels of health literacy in many parents led to a practice change of using nurse-developed pictographs, along with discharge instructions, for specific common ED diagnoses. Postdischarge calls to parents or patients receiving the pictographs documented positive postdischarge client feedback. The pictograph strategy is transferable to other institutions.

Instrument Validation: Hospital Nurse Perceptions of Meaning and Joy in Work.

BACKGROUND AND PURPOSE: When workers experience meaning and joy in work (MJW), job satisfaction and retention are enhanced. No measure for MJW among nurses exists. The purpose of this work was to develop/test the MJW Questionnaire (MJWQ). METHODS: The initial MJWQ was piloted with a convenience sample of post-licensure nursing students. Factor analyses established MJWQ subscales for the MJWQ: "value /connections," "meaningful work," "caring." Subsequently, 463 employed nurses validated MJWQ psychometrics. RESULTS: The MJWQ demonstrated acceptable construct validity and internal consistency (α = .94). Scores were significantly associated with job satisfaction (r = .686). CONCLUSIONS: Initial testing supports adequate measurement of MJW for hospital nurses in varying roles. Testing in other settings, evaluation of sensitivity in determining intervention effectiveness, and inclusion in multivariate analyses of workforce engagement are suggested.

Mesenteric Ischemia: Concepts of Care for the Bedside Nurse.

Bedside nurses require excellent observational and assessment skills. Being knowledgeable about common diseases that often affect the population is essential; however, it is often more challenging to be informed about life-threatening conditions that rarely develop. Such is the case with mesenteric ischemia, a rare but complicated condition, which is difficult to diagnose, carries a degree of mortality of about 40%-70%, and is more common in people older than 50 years. Mesenteric ischemia requires that nurses be aware of the different etiologies and presentations of this uncommon disease to alert physicians of changes in a patient's condition and detect clues that may assist with an accurate and prompt diagnosis. Being educated about the diagnostic procedures, possible outcomes, and anticipated care and needs of patients affected by this medical complication is imperative to maintain the health status and well-being of these patients and their families.

Digitally Recorded Education: Effects on Anxiety and Knowledge Recall in Patients Receiving First-Time Chemotherapy.

BACKGROUND: Prechemotherapy information is overwhelming, and retention of critical information can be challenging. Patients from a Southern California infusion clinic had varying degrees of retention when nurses used traditional one-on-one teaching with supplemental handouts. OBJECTIVES: The intent of this article is to determine the effectiveness of standardized, digitally recorded education as an alternative teaching method for increasing knowledge recall and decreasing anxiety in English- and Spanish-speaking patients receiving first-time chemotherapy. METHODS: Baseline data were obtained from five patients who received traditional teaching. Using a pre-/post-test design, 92 patients receiving digitally recorded education completed a paper-and-pencil instrument that rated their anxiety and knowledge recall. FINDINGS: The digitally recorded education method produced significant decreases in anxiety and increases in knowledge recall.

Use of a Standardized Procedure to Improve Behavioral Health Patients' Care: A Quality Improvement Initiative.

PROBLEM: Meeting the complex needs of behavioral health (BH) patients in the emergency department is an ongoing challenge. Delays in care can have adverse consequences for patient and staff safety and delay transfer to specialized care. METHODS: A quality improvement, nurse-driven initiative using a standardized procedure (STP) was developed and implemented in our busy Southern California Emergency Department, which focused on improving time to first medication and reduction of restraints. The project used a multidisciplinary team to develop the STP scoring tool and corresponding medications. Improvement was seen in all quality metrics. Time to first medication decreased from 43 minutes to less than 5 minutes. Adopting the STP resulted in a 50% decrease in use of restraints and time in restraints. Staff injuries remained low, with less than 3.6% of staff sustaining physical injuries. DISCUSSION: The STP is an effective method to initiate immediate treatment of patients with signs of anxiety and aggression and thus reduce risk of violence. Additional benefits are reduced time to disposition and earlier initiation of specialized BH care. This process can be replicated in other emergency departments with similar clinical environments through the use of STPs or protocols based on state regulations. Contribution to Emergency Nursing Practice.

Effect of Concentrated Psychiatric Education on Perceived Competence to Care for Behavioral Health Patients.

CONTRIBUTION TO EMERGENCY NURSING PRACTICE: ABSTRACT INTRODUCTION: Increasing numbers of behavioral patients are presenting to emergency departments, where competency of staff to care for this group is unknown. METHODS: This pre-post study measured the effects of a 7-hour conference on perceived competency of nurses and allied health professionals to care for behavioral health (BH) patients, as measured by the 23-item Behavioral Health Care Competency (BHCC) survey. RESULTS: Of 102 participants, most were emergency nurses (72%), acute care nurses and case managers (20%), and allied health personnel (trauma technicians and paramedics) (8%). Before the conference, participants had moderate average perceived competency in caring for BH patients. BHCC scores differed significantly by job category, with emergency nurses scoring higher than did nonemergency nurses and allied health personnel. Overall competence of participants increased significantly after the conference. The effect size, as reflected by partial eta squared, was 0.265. Significant increases in scores from before to after the conference occurred for the total BHCC and 2 competencies: practice/intervention and resource adequacy. DISCUSSION: This study provides needed research demonstrating improved perceived competency of nurses and allied health professionals to care for BH patients in emergency departments after brief concentrated education. Improvements occurred despite the fact that participants had initial baseline competencies that were higher than those of general hospital nurses from a historical sample.

Magnet® Facility Nurses: Pursuing a Baccalaureate Degree in Nursing.

UNLABELLED: The aim is to explore factors that motivate and obstacles that impede nurses from pursuing baccalaureate education when employed by a Magnet® organization. BACKGROUND: In the Future of Nursing (2011), the Institute of Medicine concluded that the baccalaureate should be the minimum education for nurses. Magnet organizations are encouraged to meet the Institute of Medicine goal of 80% of nurses with a baccalaureate by 2020. METHOD: In February 2014, a 15-item on-line survey was sent to nurses at a western Magnet-designated hospital to assess factors that motivate registered nurses to achieve a baccalaureate. Descriptive statistics and a general thematic analysis were completed. RESULTS: A 20% response rate (N = 191) was achieved. Most respondents (78%) entered nursing as associate degree/diploma graduates, and most (84%) either had a baccalaureate or master's degree or were currently enrolled in school. Encouragement from other nurses was the factor most frequently selected as facilitating return to school. Impeding factors included age and family responsibilities. A minority of nurses reported that they did not believe that a baccalaureate would make them a better nurse. IMPLICATIONS: Findings suggest that peer and leadership support play a larger role in facilitating baccalaureate completion more than previously reported. Additional research is needed to explore the role of registered nurse to registered nurse encouragement in facilitating educational advancement.

Blood culture accuracy: discards from central venous catheters in pediatric oncology patients in the emergency department.

INTRODUCTION: Lack of specific guidelines regarding collection of blood for culture from central venous catheters (CVCs) has led to inconsistencies in policies among hospitals. Currently, no specific professional or regulatory recommendations exist in relation to using, reinfusing, or discarding blood drawn from CVCs before drawing blood for a culture. Repeated wasting of blood may harm immunocompromised pediatric oncology patients. The purpose of this comparative study was to determine whether differences exist between blood cultures obtained from the first 5 mL of blood drawn from a CVC line when compared with the second 5 mL drawn. METHODS: During 2009-2011, 62 pediatric oncology patients with CVCs and orders for blood cultures to determine potential sepsis were enrolled during ED visits. Trained study nurses aseptically drew blood and injected the normally discarded first 5 mL and the second specimen (usual care) into separate culture bottles. Specimens were processed in the microbiology laboratory per hospital policy. RESULTS: Positive cultures were evaluated to assess agreement between specimen results and to determine that the identified pathogen was not a contaminant. Out of 186 blood culture pairs, 4.8% demonstrated positive results. In all positive-positive matches, the normal discard specimen contained the same organism as the usual care specimen. In 4 matches, the normally discarded specimen demonstrated notably earlier time to positivity (4 to 31 hours) compared with the usual care specimen, which resulted in earlier initiation of definitive antibiotics. DISCUSSION: These findings support the accuracy of the specimen that is normally discarded and suggest the need to reconsider its use for blood culture testing.