Incidence, severity and detection of blood pressure and heart rate perturbations in postoperative ward patients after noncardiac surgery.

STUDY OBJECTIVE: We sought to determine changes in continuous mean and systolic blood pressure and heart rate in a cohort of non-cardiac surgical patients recovering on the postoperative ward. Furthermore, we estimated the proportion of vital signs changes that would remain undetected with intermittent vital signs checks. DESIGN: Retrospective cohort. SETTING: Post-operative general ward. PATIENTS: 14,623 adults recovering from non-cardiac surgical procedures. INTERVENTIONS & MEASUREMENTS: Using a wireless, noninvasive monitor, we recorded postoperative blood pressure and heart rate at 15-s intervals and encouraged nursing intervention as clinically indicated. MAIN RESULTS: 7% of our cohort of 14,623 patients spent >15 sustained minutes with a MAP <65 mmHg, and 23% had MAP <75 mmHg for 15 sustained minutes. Hypertension was more common, with 67% of patients spending at least 60 sustained minutes with MAP >110 mmHg. Systolic pressures <90 mmHg were present for 15 sustained minutes in about a fifth of all patients, and 40% of patients had pressures >160 mmHg sustained for 30 min. 40% of patients were tachycardic with heart rates >100 beats/min for at least continuous 15 min and 15% of patients were bradycardic at a threshold of <50 beats/min for 5 sustained minutes. Conventional vital sign assessments at 4-h intervals would have missed 54% of mean pressure episodes <65 mmHg sustained >15 min, 20% of episodes of mean pressures >130 mmHg sustained >30 min, 36% of episodes of heart rate > 120 beats/min sustained <10 min, and 68% of episodes of heart rate sustained <40 beats per minute for >3 min. CONCLUSIONS: Substantial hemodynamic disturbances persisted despite implementing continuous portable ward monitoring coupled with nursing alarms and interventions. A significant proportion of these changes would have gone undetected using traditional intermittent monitoring. Better understanding of effective responses to alarms and appropriate interventions on hospital wards remains necessary.

The Feasibility of Using Net Promoter Score to Measure Real-Time Employee Engagement.

This study aims to determine the feasibility of using a digital tool and net promoter scores to measure real-time employee engagement. Participation rates with the digital tool had a statistically significant improvement when teams were able to see their engagement score in real time. The team's interaction with the digital tool may have served as a positive distraction during the pandemic.

Out and about: Factors associated with nurses' use of COVID-19 personal protective behaviors when not at work.

AIM: To characterize nurses' engagement in Centers for Disease Control and Prevention promoted personal protective behaviors (PPBs) outside the work setting during the COVID-19 pandemic and factors that inform engagement in these behaviors. BACKGROUND: Nurses' health is of vital importance to the functioning of the healthcare system. Little is known as to what informs nurses' use of PPBs outside the work setting. DESIGN: Cross-sectional survey study. SETTINGS: A large healthcare system in the southeastern region of the United States. PARTICIPANTS: Nine hundred fifty eight registered nurses. METHODS: Participants surveyed during the week of September 14th. Survey contained questions regarding factors that may be linked to nurses' compliance with PPBs. RESULTS: The most frequently reported behavior practiced outside work was "cover mouth with cough or sneeze." Concern for COVID-19 infection and confidence in masks to control the spread of COVID-19 were positively related to both frequency and number of protective behaviors engaged in (p < .01), while fatigue was inversely related to engagement with PPBs (p = .01). There was some evidence that viewing self as role model may predict behavior. CONCLUSIONS: Personal factors drive engagement with protective behaviors outside the work setting. Implications for nursing management and education are explored.

Validation of the Revised Impact of Miscarriage Scale for Swedish conditions and comparison between Swedish and American couples' experiences after miscarriage.

INTRODUCTION: There is a lack of knowledge in women's and men's experience of miscarriage. The Revised Impact of Miscarriage Scale (RIMS) has been used in United States to measure the experiences after miscarriage. The first objective was to test the consistency of RIMS for Swedish conditions. The second purpose of this study was to compare Swedish and American couples' experience of miscarriage by use of the RIMS. METHODS: Forward and back translation was used for translating RIMS into Swedish. This is a hospital-based comparative study including Swedish couples (n = 70) and American couples (n = 70). The couples were matched by the women's age, week of miscarriage and number of children. All participants answered socio-demographic, fertility and depression-scale questions in addition to RIMS. RESULTS: Cronbach's alpha analysis was above 0.650, the mean value was 0.824. There was no significant difference between the Swedish and American participants on the factors 'Isolation/Guilt' and 'Devastating event', but the Swedish women and men scored significantly lower on the factor 'Loss of baby' than the American women and men. The men, Swedish and American combined, scored lower than the women in all factors but the correlation within the couples was similar for both Swedish and American couples. CONCLUSIONS: The high consistency between the countries suggests that the RIMS questionnaire is reliable for both women and men to be used in both countries and two of three factors were similar between the two countries.

Going Domestic: Importing the Study Abroad Experience. The Development of a Multicultural New York City Study Away Program.

PROBLEM: Significant off-campus domestic study away experiences have been shown to be a transformative active learning environment for students and achieve similar learning outcomes as study abroad programs. METHODS: This manuscript describes the conception, development, and pedagogical approach of a faculty-led domestic study away experience in New York City for pre-licensure and post-licensure nursing students as an active learning strategy for developing cultural competence. Students participated in service-learning activities that illuminated the realities and challenges persons from other cultures face as they interact with health care in a culture that is not their own. FINDINGS: In partnership with New York Cares©, students were immersed in well-established ongoing sustainable community-based projects. These experiences fostered reflective conversations between community members, student participants, and faculty regarding social factors, cultural issues and needs, and global issues and trends. CONCLUSIONS: Through the New York study away program, students were able to broaden their perspectives about social factors and culture beyond geographic or ethnic boundaries and apply these service experiences to their nursing practice. Study away programs are an excellent strategy for nursing educators to prepare students for care of multicultural populations and for proficiency in cultural competency within the globalization of the United States.

Making Research Delicious: An Evaluation of Nurses' Knowledge, Attitudes, and Practice Using the Great American Cookie Experiment With Mobile Device Gaming.

In the current healthcare environment, nurses must have a basic understanding of research to lead change and implement evidence-based practice. The purpose of this study was to evaluate the effectiveness of an educational intervention formulated on the framework of the Great American Cookie Experiment measuring nurses' research knowledge, attitudes, and practice using mobile device gaming. This multisite quantitative study provides insight into promotion of research and information about best practices on innovative teaching strategies for nurses.

Couples and Miscarriage: The Influence of Gender and Reproductive Factors on the Impact of Miscarriage.

OBJECTIVE: We sought to understand the effect of gender, age, mental health history, and reproductive factors on the appraisal of miscarriage in couples. DESIGN: We conducted a secondary analysis of data from the Couples Miscarriage Healing Project. SAMPLE: We analyzed data from 341 couples who had miscarried within 3 months of the original study recruitment. METHOD: Multifactorial analysis of variance was used to analyze baseline effects of gender, age, mental health history, infertility, number of miscarriages, living children, and gestational age on the impact of miscarriage as measured by the three subscales of the Revised Impact of Miscarriage Scale: Isolation/Guilt, Devastating Event, and Loss of Baby. RESULTS: Women scored significantly higher than men on all measures. Younger couples in whom either member had been previously treated for anxiety, depression, or grief were more likely to feel guilt and isolation over their miscarriage than those with no such history (13.30 vs. 11.64; p < .0001) and older couples with and without a mental health treatment history. Younger couples were also more likely to identify miscarriage as the "loss of a baby" and feel more devastated than older couples. Couples with infertility were more devastated (14.30 vs. 11.20; p < .01) and felt more isolation/guilt related to miscarriage (13.59 vs. 12.72; p < .05). CONCLUSIONS: In general, couples experiencing miscarriage after 8 weeks gestation were more impacted than when the miscarriage occurred before 8 weeks. Recommendations for future practice and research are discussed.

Measuring the meaning of miscarriage: revision of the Impact of Miscarriage Scale.

BACKGROUND AND PURPOSE: The purpose of this study was to determine a factor structure for the Impact of Miscarriage Scale (IMS). The 24 items comprising the IMS were originally derived from a phenomenological study of miscarriage in women. Initial psychometric properties were established based on a sample of 188 women (Swanson, 1999a). METHOD: Data from 341 couples were subjected to confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). RESULTS: CFA did not confirm the original structure. EFA explained 57% of the variance through an 18-item, 4-factor structure: isolation and guilt, loss of baby, devastating event, and adjustment. Except for the Adjustment subscale, Cronbach's alpha coefficients were > or = .78. CONCLUSION: Although a 3-factor solution is most defensible, with further refinement and additional items, the 4th factor (adjustment) may warrant retention.