Relationships Among Mode of Birth, Onset of Labor, and Bishop Score.

OBJECTIVE: To investigate mode of birth in relation to onset of labor and Bishop score. DESIGN: Retrospective observational cohort design. SETTING: A 434-bed Magnet e-designated community hospital. PARTICIPANTS: Nulliparous women, 18 years of age or older, who gave birth at 37 to 41 weeks gestation to live, singleton fetuses in the vertex presentation (N = 701). METHODS: We conducted a retrospective chart review and used chi-square analysis to measure the associations among mode of birth, onset of labor, and Bishop score. We used logistic regression to test the probability of cesarean birth for women undergoing elective induction of labor. RESULTS: Most participants (n = 531, 75.7%) gave birth vaginally. Significant findings included the following relationships: spontaneous onset of labor and vaginal birth (χ2 = 22.2, Ø = 0.18, p < .001) and Bishop score of greater than or equal to 8 and vaginal birth (χ2 = 4.9, Ø = .14, p = .028). Induction of labor was a significant predictor in cesarean birth when controlling for age and body mass index (OR = 2.1, 95% confidence interval [1.5, 3.1], p < .01). CONCLUSION: Reducing elective induction of labor in women with low-risk pregnancies may help lower the risk of cesarean birth. Clinically, Bishop score and mode of birth have a weak association, particularly when induction includes cervical ripening.

The Effect of an Educational Intervention on Nurses' Knowledge, Beliefs, and Actions to be Taken, Regarding Suicide.

OBJECTIVE: The aim of this study was to examine the effect of an educational intervention on nurses' knowledge defined as understanding, beliefs, and actions to be taken, regarding nurse suicide. BACKGROUND: Between 2007 and 2018, nurses were 18% more likely to die by suicide than the general public. As a result, an assessment of nurses' knowledge regarding suicide has become an important issue for nursing administration. METHODS: A quasi-experiment (N = 225) was conducted. Variables of interest were assessed pre and post an educational intervention on 3 domains related to suicide. RESULTS: Significant and meaningful differences were found regarding 2 domains of interest in nurses' understanding related to nurse suicide, and actions to be taken, pre and post intervention. A significant change occurred regarding beliefs; however, the difference was small and therefore not meaningful. CONCLUSIONS: Finding demonstrate that educational interventions focused on issues related to suicide can enhance nurses' knowledge of the challenges implicit when one considers taking one's own life.

Developing the Baptist Health Injury Risk Assessment Phase 1: Exploring Risk Factors.

OBJECTIVES: The aim of this study was to explore risk factors for developing hospital-acquired pressure injuries (HAPIs) among critically ill adult inpatients. BACKGROUND: Hospital-acquired pressure injuries remain a priority quality focus for Magnet ® organizations. Recent studies cite medical devices as a primary cause, yet published risk assessments lack inclusion of those threats. METHODS: Nurses at a 434-bed, 4-time Magnet ® -designated hospital led a retrospective study acros 9 American Nurses Credentialing Center-designated facilities. Using a chart review tool, data were collected within 48 hours of a confirmed HAPI. RESULTS: Of 207 HAPIs reported, 54% (n = 113) involved deep tissue pressure injuries and 50.2% (n = 104) involved 19 medical devices. Individuals with a HAPI also used 1 or more of 7 distinct types of mobility-limiting medical equipment. CONCLUSIONS: Study findings support the development of a critical care risk assessment with inclusion of a medical device and mobility-limiting medical equipment as risk factors. A secondary study is underway for specificity and sensitivity testing of this assessment.

Rehabilitation interventions for the management of breast cancer-related lymphedema: developing a patient-centered, evidence-based plan of care throughout survivorship.

PURPOSE: A work group from the American Physical Therapy Association Academy of Oncologic Physical Therapy developed and published a clinical practice guideline (CPG) to aid clinicians in identifying interventions for individuals with breast cancer-related lymphedema (BCRL). This guideline reviewed the evidence for risk mitigation and volume reduction beginning at cancer diagnosis and continuing through survivorship. Application of CPGs can be challenging due to the variability of clinical settings, heterogeneous patient populations, and range of rehabilitation clinician expertise. The purpose of this paper is to assist these clinicians in implementing the recommendations from the CPG to develop a patient-centered, evidence-based plan of care. METHODS/RESULTS: This publication presents important considerations for the implementation of recommended rehabilitation interventions across the trajectory of BCRL. CONCLUSION: Current evidence supports specific interventions to treat or mitigate the risk for the various stages of BCRL. As clinicians implement these recommendations into practice, they also need to address other impairments that may exist in every individual. Continued collaboration between clinicians and researchers is necessary to further develop optimal treatment modalities and parameters. IMPLICATIONS FOR CANCER SURVIVORS: By implementing evidence-based interventions as outlined in the CPG, clinicians can improve the quality of care for survivors of breast cancer.

Breakthrough Cancer Pain: What Outpatient Oncology Nurses Need to Know.

Breakthrough cancer pain (BCP) is a devastating symptom that can occur in individuals with cancer throughout the disease trajectory, particularly in those with advanced cancer. Oncology nurses have a critical role in treating.

Educating Nurses During a Pandemic to Manage Mechanically Ventilated Patients.

Providing care for critically ill patients diagnosed with COVID-19 presented a number of challenges. Initially, few treatment strategies were available; however, evidence of pulmonary complications led to patients' need for ventilators. This article describes the rapid development and implementation of a mechanical ventilation cross-training program for acute care nurses.

Chief Nursing Officers: Their COVID-19 Experience.

OBJECTIVE: The purpose of this study was to describe the experience of chief nursing officers (CNOs), including leadership strategies that they developed as they encountered the administrative challenges posed by COVID-19. BACKGROUND: The COVID-19 pandemic required CNOs to make difficult decisions and to support nursing staff as they cared for critically ill and dying patients, and therefore, they experienced intense stress during a pandemic of a highly infectious disease. Understanding the challenges that CNOs faced in this crisis will help hospitals and CNOs to better prepare for the future. METHODS: Using a descriptive qualitative approach, we conducted interviews with 9 CNOs from hospitals across the United States. The goal of the interviews was to develop an understanding of the difficulties that these CNOs encountered during the COVID-19 pandemic and their emotional response to the challenging situations. RESULTS: Themes of frustration, heartbreak, and feeling overwhelmed, exhausted, and helpless were revealed. In addition, pride in being a nurse was expressed. CONCLUSION: Themes revealed in this study suggested intentional leadership strategies that would be useful in future healthcare crises.

American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty.

SUMMARY: A multidisciplinary work group involving stakeholders from various backgrounds and societies convened to revise the guideline for reduction mammaplasty. The goal was to develop evidence-based patient care recommendations using the new American Society of Plastic Surgeons guideline methodology. The work group prioritized reviewing the evidence around the need for surgery as first-line treatment, regardless of resection weight or volume. Other factors evaluated included the need for drains, the need for postoperative oral antibiotics, risk factors that increase complications, a comparison in outcomes between the two most popular techniques (inferior and superomedial), the impact of local anesthetic on narcotic use and other nonnarcotic pain management strategies, the use of epinephrine, and the need for specimen pathology. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development and Evaluation methodology). Evidence-based recommendations were made and strength was determined based on the level of evidence and the assessment of benefits and harms.

The Effect of Hospital-Based Childbirth Classes on Birth Outcomes.

The purpose of this study was to examine the effect of a hospital-based childbirth preparation class on birth outcomes in nulliparous women (N = 222). Outcomes of expectant mothers who attended the class were compared to a matched control cohort who did not attend preparation classes. Findings revealed women in the intervention group were more likely to give birth vaginally. While trends in a positive direction occurred, no significant difference was found in the frequency of elective induction, preterm birth, or length of stay. Data were also analyzed pre COVID-19 pandemic and 14 weeks after. A shorter time between hospital arrival and birth was significant for the intervention group. In addition, a significant change in elective induction (increase) occurred in the control group.

The Baptist Health Lexington Nursing Orientation Progression Tool: A Methodological Study.

OBJECTIVE: The purpose of this study was to develop and test a tool to monitor a nursing orientee's progress to competence. BACKGROUND: The literature suggests that, during orientation, consistent documentation and communication among educators, preceptors, and nurse leaders facilitate a timely progression to independent practice for new nurses. METHODS: A 2-phase methodological study was conducted. Nurse educators clarified goals, identified essential competencies, and developed the Baptist Health Lexington Nursing Orientation Progression Tool (OPT). The tool was used to monitor orientees' progression through orientation. RESULTS: Content validity assessment of the OPT (content validity index = 0.98) demonstrated strong validity. Testing of the tool revealed 31 nurses completed orientation early, 12 completed orientation on time, and 18 nurses required extended orientation time. All requiring an extension were new graduates. CONCLUSION: The OPT guided preceptors to facilitate timely completion of orientation among newly hired nurses. Findings suggest that new graduates may need more assistance than experienced nurses.

COVID-19: The Lived Experience of Critical Care Nurses.

OBJECTIVE: The goal of this qualitative phenomenological study was to explore in-depth, critical care nurses' (CCNs) lived experience while caring for coronavirus disease 2019 (COVID-19) patients during the pandemic. BACKGROUND: CCNs play an important role during pandemics characterized by highly contagious, life-threatening disease. Understanding the experience of CCNs during a pandemic is particularly important because of the high rate of burnout within this group, as well as a shortage of these caregivers across the globe. METHODS: Using Heidegger's interpretive phenomenological approach, interviews were conducted with 10 CCNs caring for COVID-19 patients. The goal of the interviews was to access a deep layer of understanding regarding participants' lived experience. RESULTS: Themes of role frustration, emotional and physical exhaustion, and the importance of presence were revealed. CONCLUSION: Themes revealed suggest a number of actions hospital administrators could take to support CCNs as they experience the challenges of a pandemic.

A Charge Nurse Orientation and Development Program: An Evaluation.

Role transition from clinical nurse to charge nurse can be challenging. The purpose of this quasi-experiment was to evaluate a charge nurse orientation and development program, designed to increase nurses' confidence regarding this role. Patients' response to care as a result of this program was also assessed. It appears that nurse confidence regarding this transition improves following a formal intervention. Regarding patient satisfaction, charge nurse visits to patients increased as well.

Conducting a Virtual Research Symposium: Path to Success.

Strategies used to change an annual statewide research symposium from a face-to-face experience to a virtual event at a 434-bed Magnet® redesignated community hospital are described. The program met with success and increased access for attendees. For the 1st time, credited to the virtual format, representatives from all 9 hospitals in the system were able to attend. Feedback following the symposium suggested that participants who live at a distance from the hospital appreciated being able to attend the meeting without traveling, technical issues were promptly resolved, and presenters received positive evaluations.

Effect of a Parent Empowerment Program on Parental Stress, Satisfaction, and Length of Stay in the Neonatal Intensive Care Unit.

Parental stress is high when infants are admitted to a neonatal intensive care unit in community-based hospital. This quasi-experimental study explored the effect of implementing the "Creating Opportunities for Parent Empowerment" (COPE) program on parental stress, postpartum depression, parental satisfaction with care, and length of stay in a community-based hospital. A cohort of nurses completed a 1-day "COPE for HOPE" parent empowerment training session. A nurse implemented the COPE parent training at the bedside soon after birth and extended throughout hospitalization. The following instruments were used to collect data: a demographic data sheet, Parental Stress Scale: Neonatal Intensive Care Unit, Edinburgh Postnatal Depression Scale, and an investigator-designed parent satisfaction survey. Forty-nine parent sets participated in the study (29 in the intervention group, 20 in the comparison group). A significant difference was found between the groups related to lower parental stress. There was no difference in terms of parental depression scores or length of hospital stay. However, clear trends revealed that parents in the COPE group exhibited lower depression scores. Parents in both groups reported being greater than 95% satisfied with care across all items. These findings may motivate administrators in other community-based hospitals to implement this intervention.

The effect of education on nursing personnel's knowledge and attitudes regarding the use of integrative care techniques with hospice and palliative care patients.

PURPOSE: To examine the effect of education on nursing personnel's knowledge and attitudes regarding the use of hand massage, breathing techniques, and essential oils with hospice and palliative care patients. BACKGROUND: Unrelieved, end of life pain is common among hospitalized patients on hospice and palliative care units. Integrative care techniques such as hand massage, breathing techniques, and essential oils can be available to use with these individuals. Nursing personnel are often unaware of other techniques that are not a traditional pharmacology approach to pain. METHODS: A quasi-experiment was conducted to evaluate the effect of an educational intervention on nursing personnel's knowledge and attitudes regarding the use of three integrative care techniques (hand massage, breathing techniques, and essential oils) with hospice and palliative care patients in an acute care setting. Data on knowledge and attitudes were collected pre- and postintervention. RESULTS: Following the intervention, improvements in nursing personnel's attitudes and knowledge toward the use of the three techniques were found. CONCLUSION: Results of this study suggest that education of nursing personnel may positively influence knowledge and attitudes toward providing hand massage, breathing techniques, and essential oil for end of life patients.

Developing and Testing the Diagnostic Accuracy of a Brief Nursing Dysphagia Screen.

PURPOSE: The aim of the study was to develop and test the Groppo-Lawless nurse-initiated screen designed to identify patients diagnosed with pneumonia who are at risk for dysphagia. DESIGN: This is a two-phase methodological study. METHODS: Phase 1 involved three steps. First, risk factors (n = 27) for dysphagia were identified from the literature. Next, frequency of these risk factors was calculated from a chart review of patients diagnosed with pneumonia (N = 301). Finally, frequency of risk factors among those patients who failed the 3-oz water trial (n = 56) were calculated, and a five-item instrument, the Groppo-Lawless Dysphagia Screen, was constructed. In Phase 2, nurses' results using the screen were compared to blinded results of speech-language pathologists. FINDINGS: Sensitivity (81.1%), specificity (96.4%), and diagnostic odds ratio (22.43) were calculated. CONCLUSIONS/CLINICAL RELEVANCE: Given the strong psychometric properties of this screen, its use by nurses may increase the number of appropriate speech-language pathologist referrals among patients diagnosed with pneumonia.

Evaluation of a Multisite Nurse-Led Mobility Plan.

OBJECTIVE: The aim of this study was to examine the effect of nurses' mobility plan use on patients' length of stay, discharge destination, falls, physical therapy consults, and nurses' knowledge, attitudes, and beliefs regarding patient mobility. BACKGROUND: Functional decline due to decreased mobility during hospitalization results in diminished quality of life. Sixty-five percent of older inpatients lose the ability to ambulate during hospitalization and 30% do not regain that capability. METHODS: Using a quasi-experimental design, nurses' use of a mobility assessment on 4 patient outcome variables was examined before (n = 2,259) and after (n = 3,649) use. Nurses' attitudes, knowledge, and beliefs regarding mobility were also examined. RESULTS: Positive changes in patient variables occurred. Limited change occurred relative to nurses' knowledge, attitudes, and beliefs. CONCLUSIONS: Implementing a nurse-led mobility plan enhances therapy resource utilization through identification of appropriate consults and improves patients' discharge home. In addition, nurses' knowledge, attitudes, and beliefs toward patient mobility planning can be positively influenced.