Media Interview Tips and Techniques for the Registered Nurse.

BACKGROUND: As the largest segment of the healthcare workforce, nurses have a unique opportunity to increase the visibility of the nursing profession's contributions to healthcare services and clinical outcomes across population groups by participating in media interviews. Although a media interview can be intimidating, there are steps one can take to ensure optimal media engagement. Nurses should collaborate with the media by becoming familiar with the elements of good reporting. OBJECTIVE: This article describes several tips and techniques all nurses can implement before, during, and after a media interview to ensure the audience receives a clear message. PROCEDURE: Techniques include thorough preparation before the interview, careful self-management during the interview, and follow-up after the interview. CONCLUSION: Nurses can conduct a successful media interview and pave the way for future nurse interviews using media training tips and techniques.

The 4M Model.

Engaging the health care team, including older adults and their caregivers, with the Institute for Healthcare Improvement 4M Model can help ensure every older adult receives (1) optimal health care, (2) is not harmed by health care, and (3) is satisfied with their health care. The evidence-based 4 Ms Model includes 4 significant concepts specific to older adult care: What matters, Mentation, Mobility, and Medication. Unfortunately, clinicians do not consistently apply the 4 Ms Model when caring for older adults. Personalized, age-friendly care based on the 4 Ms Model can improve outcomes for older adult patients.

Educating Bachelor of Science in Nursing Students in Leadership Strategies Needed for Care Management and Disease Management for the Heart Failure Patient Population.

During Bachelor of Science in Nursing (BSN) program education, student nurses are introduced to topics such as patient care across health care settings, health promotion, research, safety and quality, technology, and leadership in the health care system. As one of the most common diseases in the population, heart failure (HF) is covered throughout the BSN curriculum. There are various educational strategies used by nursing schools to ensure BSN students possess the necessary leadership skills and are prepared for providing HF patient care in care management settings. Strategies include active learning education delivery models, case studies, role play, and interactive games.

Effectiveness of an End-of-Life Nursing Education Consortium Training on Registered Nurses' Educational Needs in Providing Palliative and End-of-Life Patient Care.

Registered nurses play a critical role in delivering effective palliative and end-of-life patient care. Previous literature has cited that registered nurses report a lack of adequate palliative care training in academic and continuing education programs. Providing care to patients at the end of life requires knowledge in a variety of areas such as nonpharmacologic symptom management, cultural considerations, and pain management. This study aimed to investigate the impact of a professional development intervention among registered nurses on their educational needs in providing palliative care. Using a 1-group pretest-posttest design, a convenience sample of registered nurses completed an electronic survey containing demographic questions and the End-of-Life Professional Caregiver Survey. The professional development intervention consisted of an 8-hour training conducted by a content expert on palliative patient care addressing the competencies developed by the End-of-Life Nursing Education Consortium. The results revealed a significant increase in participant knowledge in providing quality palliative care to patients (P < .001). Education programs on quality palliative and end-of-life patient care can effectively improve the care delivered to this patient population.

Tacrolimus restores the high- and low-pressure baroreflex control of renal sympathetic nerve activity in cisplatin-induced renal injury rats.

NEW FINDINGS: What is the central question of this study? Does immunosuppression restore the baroreflex control of renal sympathetic nerve activity (RSNA) in an animal model of kidney injury? What is the main finding and its importance? Tacrolimus, a calcineurin inhibitor, restored the high- and low-pressure baroreflex control of RSNA following cisplatin-induced renal injury. ABSTRACT: Cisplatin administration causes depression of renal haemodynamic and excretory function and is associated with renal sympatho-excitation and loss of baroreflex regulation of renal sympathetic nerve activity (RSNA). This study investigated whether administration of the immunosuppressant tacrolimus in this cisplatin-mediated renal injury model could restore, or the acute intra-renal infusion of tumour necrosis factor α (TNF-α) could blunt, the high- or low-pressure baroreflex control of RSNA. Groups of control and cisplatin-treated (5 mg kg-1 , i.p. on day 0) rats received either saline or tacrolimus (0.25 mg kg-1  day-1 , i.p.) for 7 days prior to study. Rats were anaesthetised and prepared for measurement of mean arterial pressure (MAP), heart rate (HR) and RSNA. Baroreflex gain curves were generated and the degree of renal sympatho-inhibition determined (area under the curve (AUC) reported as %RSNA min) during acute volume expansion. Intrarenal TNF-α infusion (0.3 µg kg-1  h-1 ) in control rats decreased baroreflex gain by 32% (P < 0.05) compared to intra-renal saline infusion. In the cisplatin group (MAP: 98 ± 14 mmHg; HR: 391 ± 24beats min-1 ), the baroreflex gain for RSNA was 39% (P < 0.05) lower than that for the control group (MAP: 91 ± 7 mmHg; HR: 382 ± 29 beats min-1 ). In cisplatin-treated rats given daily tacrolimus (MAP: 84 ± 12 mmHg; HR: 357 ± 30 beats min-1 ), the baroreflex gain and renal sympatho-inhibition (AUC, 2440 ± 1071 vs. 635 ± 498% min) were restored to normal values. These findings provide evidence for the view that cisplatin administration initiates an injury involving inflammation which may contribute to the deranged baroreflex regulation of RSNA. This phenomenon appears mediated in part via the renal innervation.

Sepsis in the Burn Patient.

Sepsis is the leading cause of death in burn patients. Interventions are challenging owing to a lack of specific guidelines. All burn types involve a risk for complications. Interventions should include care of the burn, medication administration, continuous monitoring for infection development, infection prevention measures, and (if necessary) treatment of sepsis. Sepsis in burn patients is different from the unburned population. Efforts are needed to develop more accurate diagnostic strategies and guidelines to trigger rapid treatment via specific sepsis bundles.

Perceived Barriers to Exercise in the First Trimester of Pregnancy.

Regular physical activity has been shown to improve pregnancy outcomes. We sought to identify barriers to exercise during the first trimester of pregnancy. Five hundred forty-nine pregnant women in their first trimester rated barriers to exercise on a scale of 1 (not a barrier) to 5 (a huge barrier) and recorded physical activity (minutes/week). Women were placed into one of three classifications, nonexercisers (zero exercise), infrequent exercisers (<150 minutes/week), or exercisers (≥150 minutes/week). The greatest barriers (mean) were nausea/fatigue (3.0) and lack of time (2.6). Exercisers reported significantly lower barrier levels. Nausea/fatigue was a greater barrier for nonexercisers compared to exercisers (3.6 vs 2.8, p < .001). Focusing education and interventions on these barriers may help pregnant women achieve healthy exercise levels.

Creating a Research Agenda and Setting Research Priorities for Clinical Nurse Specialists.

PURPOSE/OBJECTIVES: The purpose of this article is to describe the evolution and results of the process for establishing a research agenda and identification of research priorities for clinical nurse specialists, approved by the National Association of Clinical Nurse Specialists (NACNS) membership and sanctioned by the NACNS Board of Directors. DESCRIPTION OF THE PROJECT/PROGRAM: Development of the research agenda and identification of the priorities were an iterative process and involved a review of the literature; input from multiple stakeholders, including individuals with expertise in conducting research serving as task force members, and NACNS members; and feedback from national board members. OUTCOME: A research agenda, which is to provide an enduring research platform, was established and research priorities, which are to be applied in the immediate future, were identified as a result of this process. CONCLUSION: Development of a research agenda and identification of research priorities are a key method of fulfilling the mission and goals of NACNS. The process and outcomes are described in this article.

Combined XIL-6R and urocortin-2 treatment restores MDX diaphragm muscle force.

INTRODUCTION: Duchenne muscular dystrophy (DMD) is characterized by progressive muscle degeneration leading to immobility, respiratory failure, and premature death. As chronic inflammation and stress are implicated in DMD pathology, the efficacy of an anti-inflammatory and anti-stress intervention strategy in ameliorating diaphragm dysfunction was investigated. METHODS: Diaphragm muscle contractile function was compared in wild-type and dystrophin-deficient mdx mice treated with saline, anti-interleukin-6 receptor antibodies (xIL-6R), the corticotrophin-releasing factor receptor 2 (CRFR2) agonist, urocortin 2, or both xIL-6R and urocortin 2. RESULTS: Combined treatment with xIL-6R and urocortin 2 rescued impaired force in mdx diaphragms. Mechanical work production and muscle shortening was also improved by combined drug treatment. DISCUSSION: Treatment which neutralizes peripheral IL-6 signaling and stimulates CRFR2 recovers force-generating capacity and the ability to perform mechanical work in mdx diaphragm muscle. These findings may be important in the search for therapeutic targets in DMD. Muscle Nerve 56: E134-E140, 2017.

Infection in the Critically Ill Older Adult.

Many challenges exist in caring for older adults with infection in critical care environments. Older adults are at high risk due to diminished reserve, age-related changes, comorbidities, subtle clinical presentations, and institutionalization. Additional risks include infections, such as pneumonia, influenza, and nosocomial infections. Age-related changes contribute to the increased risk of infection in older adults. Nursing assessments should be tailored to the needs of the older patient. To improve health care outcomes in this population, nursing care of the critically ill older adult with infection should include comprehensive assessment, surveillance for risks, and strategies aimed to aggressively treat infection.

Opportunistic Fungal Infections in Critical Care Units.

Fungal infections are rare compared with bacterial infections, but they are on the increase in critical care units. Diagnosis can be difficult, resulting in increased mortality. Immunocompromised patients are at higher risk for fungal infections, including organ transplant, oncology, and HIV/AIDS patients. Fatigue and fever are common symptoms that require critical care nurses to remain vigilant in assessment to identify at-risk patients and promote use of timely cultures and appropriate treatments for fungal infections. Critical care nurses can contribute to decreasing risk for fungal infections by controlling glucose levels, decreasing the use of invasive lines, and preventing unnecessary antibiotic use.

The Influence of Nurse Manager Leadership Style on Staff Nurse Work Engagement.

BACKGROUND: Nursing literature supports the importance of an engaged nursing workforce as a means to positively influence performance. Nurse manager leadership style plays a critical role in engaging staff nurses. These relationships have been minimally studied in nurse managers and staff nurses. OBJECTIVE: The aim of this study is to evaluate the influence of nurse manager leadership style factors on staff nurse work engagement. METHODS: Using a descriptive correlational research design, 441 staff nurses working in 3 acute care hospitals were surveyed. Survey instruments included the Utrecht Work Engagement Scale and the Multifactorial Leadership Questionnaire 5X short form. RESULTS: Transactional and transformational leadership styles in nurse managers positively influenced staff nurse work engagement. Passive-avoidant leadership style in nurse managers negatively influenced staff nurse work engagement. CONCLUSIONS: Nurse managers who provide support and communication through transformational and transactional leadership styles can have a positive impact on staff nurse work engagement and ultimately improve organizational outcomes.

Clinical diagnosis and chemical confirmation of ciguatera fish poisoning in New South Wales, Australia.

Ciguatera fish poisoning is common in tropical and sub-tropical areas and larger fish (> 10 kg) are more susceptible to toxin accumulation with age. Although the coastal climate of northern New South Wales is considered sub-tropical, prior to 2014 there has only been 1 documented outbreak of ciguatera fish poisoning from fish caught in the region. During February and March 2014, 2 outbreaks of ciguatera fish poisoning involved 4 and 9 individuals, respectively, both following consumption of Spanish mackerel from northern New South Wales coastal waters (Evans Head and Scotts Head). Affected individuals suffered a combination of gastrointestinal and neurological symptoms requiring hospital treatment. At least 1 individual was symptomatic up to 7 months later. Liquid chromatography-tandem mass spectrometry detected the compound Pacific ciguatoxin-1B at levels up to 1.0 µg kg(-1) in fish tissue from both outbreaks. During April 2015, another outbreak of ciguatera fish poisoning was reported in 4 individuals. The fish implicated in the outbreak was caught further south than the 2014 outbreaks (South West Rocks). Fish tissue was unavailable for analysis; however, symptoms were consistent with ciguatera fish poisoning. To our knowledge, these cases are the southernmost confirmed sources of ciguatera fish poisoning in Australia. Educational outreach to the fishing community, in particular recreational fishers was undertaken after the Evans Head outbreak. This highlighted the outbreak, species of fish involved and the range of symptoms associated with ciguatera fish poisoning. Further assessment of the potential for ciguatoxins to occur in previously unaffected locations need to be considered in terms of food safety.

Student participation in clinical handover-an integrative review.

AIM AND OBJECTIVES: To examine the literature exploring the current understanding of student nurse participation in clinical handover whilst they are enrolled in an undergraduate preregistration course. BACKGROUND: The importance of handing over the care of a patient to ensure continuity and safety of care is well-recognised. Effective preparation of student nurses to competently perform this critical task requires the use of appropriate teaching strategies to support this learning, within undergraduate preregistration nursing programs. DESIGN: An integrative literature review. METHOD: An integrative literature review was conducted to establish what is known about student nurse participation in relation to clinical handover. This resulted in 18 articles for inclusion in the literature review. An analysis was then undertaken of these 18 articles to extract key themes. RESULTS: Learning and teaching strategies need to address a variety of methods of the clinical handover process including verbal and written handovers. Participating in clinical handover prior to being given the responsibility of patient care prepares students for the workplace. Key themes identified within the literature included: learning strategies, limitations and challenges involved in putting theory into practice, handover structure and issues regarding confidentiality. CONCLUSION: Simulation and clinical practice are commonly used to prepare students for this role during their undergraduate education. The use of simulation and structured handover techniques prior to clinical placement increases student confidence to engage in clinical handovers during their clinical placements. RELEVANCE TO CLINICAL PRACTICE: This article raises the awareness of both clinical staff and educators as to the need for student nurses to develop their skills in clinical handover practice and suggests strategies to prepare student nurses to conduct clinical handover competently in the clinical setting.

Delivery of an Impacted Fetal Head During Cesarean: A Literature Review and Proposed Management Algorithm.

Effective and expedient management of an impacted fetal head (IFH) at cesarean delivery is essential to avoid maternal and neonatal morbidity. The incidence of an IFH at the time of cesarean may increase because of changing practice guidelines regarding the acceptable duration of the second stage of labor. Based on limited available evidence comparing the "push," "pull," and other methods for delivery of the IFH, we suggest the primary disengagement technique be selected based on surgeon experience and propose a management algorithm "ALERT" for clinical application.

What has the mdx mouse model of Duchenne muscular dystrophy contributed to our understanding of this disease?

Duchenne muscular dystrophy (DMD) is a fatal X-chromosome linked recessive disorder caused by the truncation or deletion of the dystrophin gene. The most widely used animal model of this disease is the dystrophin-deficient mdx mouse which was first discovered 30 years ago. Despite its extensive use in DMD research, no effective treatment has yet been developed for this devastating disease. This review explores what we have learned from this mouse model regarding the pathophysiology of DMD and asks if it has a future in providing a better more thorough understanding of this disease or if it will bring us any closer to improving the outlook for DMD patients.

Nursing bedside clinical handover - an integrated review of issues and tools.

AIMS AND OBJECTIVES: This article reviews the available literature that supports implementing bedside clinical handover in nursing clinical practice and then seeks to identify key issues if any. BACKGROUND: Clinical handover practices are recognised as being an essential component in the effective transfer of clinical care between health practitioners. It is recognised that the point where a patient is 'handed over' from one clinician to another is significant in maintaining continuity of care and that doing this poorly can have significant safety issues for the patient. DESIGN: An integrated literature review. METHOD: A literature review of 45 articles was undertaken to understand bedside clinical handover and the issues related to the implementation of this process. RESULTS: It was identified that there are a number of clinical handover mnemonics available that provide structure to the process and that areas such as confidentiality, inclusion of the patient/carer and involving the multidisciplinary team remain topical issues for practitioners in implementing good clinical handover practices. CONCLUSIONS: This literature review identified a lack of literature available about the transfer of responsibility and accountability during clinical handover and auditing practices of the clinical handover process. The nurses were more concerned about confidentiality issues than were patients. The use of a structured tool was strongly supported; however, no one singular tool was considered suitable for all clinical areas. RELEVANCE TO CLINICAL PRACTICE: Nursing clinicians seeking to implement best practice within their professional speciality should consider some of the issues raised within this article and seek to address these issues by developing strategies to overcome them.