Distress, Pain, and Nausea on Postoperative Days 1 and 14 in Women Recovering From Breast-Conserving Surgery: A Repeated-Measures Study.

OBJECTIVES: To determine the incidence and trajectory of distress, pain, and nausea and vomiting at postoperative day (POD) 1 and at POD 14 following breast-conserving surgery. SAMPLE & SETTING: 75 women aged 18 years or older receiving breast-conserving surgery with sentinel lymph node biopsy for treatment of early-stage primary breast cancer at an ambulatory surgery center. METHODS & VARIABLES: This prospective, repeated-measures study assessed distress, pain, and nausea and vomiting using the National Comprehensive Cancer Network Distress Thermometer and Problem List on POD 1 and POD 14. RESULTS: Pain and distress scores were highest on POD 1. The number of women who reported depression increased from POD 1 to POD 14. Thematic analysis revealed that family concerns, fears and worries, and postoperative issues contributed to pain and distress. IMPLICATIONS FOR NURSING: Women experience pain and distress during recovery at home after breast-conserving surgery. Nurses can use these results to apply evidence-based practice to reduce this symptom burden. Future nursing research should focus on targeted interventions outside of the hospital setting.

Rigor in PhD dissertation research.

Recent reports from the Institute of Medicine document the increase in the number of nurses enrolled in doctoral education preparing for nurse scientist and leadership roles in the transformation of health care. This means that many doctoral students will acquire a knowledge of the research process, learn how to review and critique relevant literature, select appropriate research designs, and with the guidance of their dissertation chair and committee, design and conduct high quality, scholarly research studies that culminate in successfully defended doctoral dissertations. The health care profession expects that these dissertations, which include quantitative, qualitative, or mixed methods, will contribute to the knowledge base of the nursing profession and advance improvement in clinical and public health outcomes in the populations served by the nursing profession. This article reviews the concept of rigor in research, the rationale for rigor, various approaches that increase rigor, and the associated concepts that strengthen a research study.

SBIRT Education for Nurse Practitioner Students: Integration Into an MSN Program.

BACKGROUND: Substance use disorders are a major public health problem. As primary care providers, nurse practitioners (NPs) must be proficient at screening, identifying, and intervening for at-risk patients. Screening, brief intervention, and referral to treatment (SBIRT) is a well-established, evidence-based model for teaching behavioral health skills to health care providers. It is vital that Master of Science in Nursing (MSN)-NP programs incorporate SBIRT into their curricula. METHOD: SBIRT content was mapped to 10 courses across an MSN-NP program. Methods of integration included readings, lectures, case studies, role-plays, tutorials, symposia, and test questions, as well as tracking the use of SBIRT during clinical preceptorships. RESULTS: A total of 139 online and on-campus MSN-NP students were trained. Data demonstrate students successfully implemented SBIRT in precepted clinical settings. CONCLUSION: This approach provides a framework for integrating SBIRT training into MSN-NP curricula. [J Nurs Educ. 2017;56(12):725-732.].

Making the hard decisions: Ethical care decisions in wartime nursing practice.

BACKGROUND: Codes of ethics set forth standards of ethical conduct for nurses. However, nurses involved in wartime operations, or disasters, may often have their moral compass challenged by the patient care decisions necessary under adverse conditions. Reverse triage, resource allocation, and promotion of patient autonomy present multiple challenges to meeting commonly applied ethical principles. PURPOSE: The purpose of this study was to use the International Council of Nursing code of ethics as a framework to organize the ethical issues emerging from wartime nursing. METHODS: This article represents a secondary analysis of two studies using thematic analysis to identify ethical issues encountered by military nurses during the recent conflicts in Iraq and Afghanistan. Data were collected from nurses deployed from 2002 to 2015 and from 111 military nurses during focused interviews. DISCUSSION: Across both studies, issues such as resource allocation, patient triage, cultural differences, and equitable treatment for all emerged as challenges within the wartime environment. Nurses were at a loss at times as to how best to manage the situations and recommended that more education is needed in ethical decision making before, during, and after deployment as a debriefing strategy. Similar issues have been documented in military and disaster literature indicating that such challenges are not limited to the recent conflicts but cross time and location. CONCLUSION: By better understanding how nurses define, assess, and manage the ethical situations they encounter in wartime nursing practice, military nurses can better prepare for future conflicts, provide mentorship and targeted education to hopefully reducing any feelings of moral distress, and promote ethical decision making that will best promote outcomes in accordance with nursing's ethical codes.

Ethical Issues Encountered by Military Nurses During Wartime.

Military nurses encounter similar issues as civilian nurses in daily practice situations; however, wartime and humanitarian missions may bring unique and difficult ethical dilemmas. While nursing has the American Nurses Association code of ethics to provide a framework to guide ethical practice decisions, conflicts may arise from the unique aspects of nursing within a wartime environment. Understanding those conflicts occuring within the military wartime scenario can provide nurses with experiential examples from which to derive strategies for personal coping and professional behavior and decision making. This chapter describes the research that has focused upon the identification of these issues, the effects from uresolved issues, and those directions for future research to better prepare miltiary nurses before and during deployment.

Cultural Awareness: Nursing Care of Iraqi Patients.

PURPOSE: The aim of this study was to describe the cultural factors that have an impact on military nursing care for Iraqi patients. The results were part of a larger study in which the purpose was to understand nurses' experiences of delivery of care for Iraqi patients. METHOD: Three focus groups, consisting of military registered nurses and licensed practical nurses, were used to generate rich descriptions of experiences in a military combat support hospital in Iraq. Data were analyzed using thematic analysis methods. FINDINGS: Culturally, the differences between the Iraqi patients and the nurses included variations in communication, diet, and beliefs and values in reference to gender and patient dependency. CONCLUSION: The findings indicated that the nurses need language skills and cultural customs and beliefs training to provide care to culturally diverse patients. In addition, support services, such as dieticians, need to be involved in the plan of care to address applicable cultural issues. IMPLICATIONS: Implementation of learning to provide nurses language skills and cultural awareness of the diet, customs and beliefs of Iraqi people as well as the economic, political, and social factors that have an impact on their lives will promote quality nursing care and optimal health outcomes.

Chapter 6 impact of deployment on military families.

To date, approximately 300,000 families including 700,000 children have been affected by the increased and repeated number of deployments in support of the Global War on Terror in Iraq and Afghanistan since 2001. The purpose of this review is to discuss the impact of these deployments on family members of active duty and reserve/guard personnel. A search of literature across the years of military conflicts reveals waves of studies emerging after World War II, the Vietnam conflict, Desert Storm/Shield, and now the most recent wars. Study designs most frequently include qualitative exploratory, survey methods, and program evaluations. The field is limited by small scale projects, service- and facility-specific samples, and knowledge extracted from related topics. More research is needed to achieve a more comprehensive understanding across the trajectory of the deployment experience for both service personnel and family members as well as long-term outcomes.

Mothers going to war: the role of nurse practitioners in the care of military mothers and families during deployment.

PURPOSE: Many military women are being called to separate from their children to go to war. Most previous research has focused upon paternal, rather than, maternal, separation. The purpose of this article is to describe the experience of military mothers and their children during wartime deployments with clinical implications for nurse practitioners (NPs) in military or community settings. DATA SOURCES: Using grounded theory methods, 37 active duty and reserve component military women participated in a one-time interview. Included were women who deployed for at least 4 months to Iraq or Afghanistan and had at least one child under the age of 12 during the separation. CONCLUSIONS: Military families present unique challenges for NPs. Mother deployments offer opportunities for intervention and anticipatory guidance across the trajectory of the separation. Military women's emotional and physical health must be supported before, during, and following deployment. IMPLICATIONS FOR PRACTICE: NPs are ideally positioned to support military families. During deployment, the NP's focus may shift to care of the children and their caregiver. Before and at reintegration, NPs are in a key position to intervene early for posttraumatic stress and support family readjustment.

Military nursing care of Iraqi patients.

The purpose of this phenomenological study was to understand military nurses' experiences of care for Iraqi patients. Analysis yielded three themes-expanding practice, ethical dilemmas, and the cultural divide. "Expanding practice" is the nurses' descriptions of their personal initiative to seek opportunities for learning additional knowledge and skills so that they would be competent to provide care for all ages of patients from newborns to the elderly with a wide variety of complex diagnoses. "Ethical dilemmas" represented the mental distress the nurses experienced when confronted with moral imperatives related to the safe care of the patient. Nurses were faced with feelings of animosity toward provision of care of host nation patients, lack of trust in interpreters, and distressed because of their inability to ensure continuity of care. The "cultural divide" showed the challenges that the nurses confronted when caring for a population with a different language, value system, customs, and traditions. The themes support existing research and extend information about care of host nation patients adding depth and breadth to specific content areas. These nurses developed situated knowledge needed for particular challenges and experienced personal and professional growth.

Deployment of military mothers: supportive and nonsupportive military programs, processes, and policies.

Military mothers and their children cope with unique issues when mothers are deployed. In this article, we present mothers' perspectives on how military resources affected them, their children, and their caregivers during deployment. Mothers described beneficial features of military programs such as family readiness groups and behavioral health care, processes such as unit support, and policies on length and timing of deployments. Aspects that were not supportive included inflexibility in family care plans, using personal leave time and funds for transporting children, denial of release to resolve caretaker issues, and limited time for reintegration. We offer recommendations for enhanced support to these families that the military could provide.

Care of the patient with enteral tube feeding: an evidence-based practice protocol.

BACKGROUND: Care of patients with enteral feeding tubes often is based on tradition and textbook guidance rather than best evidence. Care practices can vary widely both between and within institutions, and this was the case at a northeastern military medical center that served as the site for this evidence-based protocol development and implementation project. OBJECTIVES: The purpose of this study was to describe the development and implementation of an evidence-based clinical protocol for care of patients with enteral feeding tubes. METHODS: This was an evidence-based implementation project with pretest-posttest measures. Protocol data collection occurred both before and after implementation of the protocol. Data collection tools were based on the literature review and included three domains: (a) documentation of patient procedures, (b) nursing knowledge of each of the specific procedures, and (c) environment of care. Descriptive statistics and data were analyzed using independent samples t tests. RESULTS: Overall staff knowledge of enteral feedings and methods used to unclog both large- and small-bore feeding tubes differed significantly before and after implementation (p < .05). Staff knowledge regarding the danger of using blue dye in feeding solution was significant (p < .001). There was improvement also in administration of medications separately rather than mixed together and in head of bed elevation of patients with feeding tubes. There was a 10% improvement in documentation of patient family education and a 15% improvement in recording fluid flushes during medication administration. After implementation, environment of care data collection showed 100% of patients with head of bed elevated and with functioning suction available, an improvement over levels before implementation. DISCUSSION: Care must be taken in the interpretation of these findings because it was generally not the same nurses who answered both surveys. High staff turnover within this military hospital also affected sustainment of the protocol implementation. Maintenance activities must be constant and visible within the organization. A champion for evidence-based practice greatly enhances uptake and maintenance of nursing practice change.

Factors related to childbirth satisfaction.

BACKGROUND: A woman's satisfaction with the childbirth experience may have immediate and long-term effects on her health and her relationship with her infant, but there is a lack of current research in this area. AIM: This paper reports a study to examine multiple factors for their association with components of childbirth satisfaction and with the total childbirth experience. METHOD: A correlational descriptive study was conducted with 60 low-risk postpartum women, aged 18-46 years, with uneventful vaginal deliveries of healthy full-term infants at two medical centres in the south-eastern United States. The Labor Agentry Scale, McGill Pain Questionnaire and Mackey Childbirth Satisfaction Rating Scale and a background questionnaire were completed by women. Obstetrical data were collected from the medical record. FINDINGS: Personal control was a statistically significant predictor of total childbirth satisfaction (P = 0.0045) and with the subscale components of satisfaction (self, partner, baby, nurse, physician and overall). In addition, having expectations for labour and delivery met was a significant predictor of satisfaction with own performance during childbirth. CONCLUSIONS: Personal control during childbirth was an important factor related to the women's satisfaction with the childbirth experience. Helping women to increase their personal control during labour and birth may increase the women's childbirth satisfaction.