Implementation of Best Practices in Simulation Debriefing.

ABSTRACT: This article describes how one school of nursing responded to the need to educate faculty in the pedagogy of simulation debriefing and how the International Association for Clinical Simulation and Learning Standard VI was implemented. Thirty faculty received training and were evaluated using the Debriefing Assessment for Simulation in Healthcare tool. Lessons learned and examples of student feedback are shared. Plans for future work are also described.

A family history intervention: enhancing cardiovascular risk assessment.

This article describes the effect of individualized counseling using family history data and objective cardiovascular risk factors on intent to change and actual exercise behavior in a diverse sample of working adults. Using a longitudinal, quasi-experimental, crossover design, objective data (blood lipids, glucose, blood pressure, and body mass index) and subjective data (awareness of heart disease risk, depression, spirituality, and knowledge of family history) were collected from 91 (mostly female and with a mean age of 45 years) primary and secondary teachers in a southwestern city. The Transtheoretical Model of Change guided the study and measured intent to exercise. Objective risks in this sample mirrored national indices of risk for obesity and abnormal lipids. Although some participants increased their exercise, no significant differences were found between the groups in exercise behavior at 6 and 12 months. Using knowledge of family history to raise awareness and encourage lifestyle changes related to cardiovascular risk warrants further study.

Pediatric clinical simulation: a pilot project.

With increased enrollment, nursing faculty are finding clinical placement for students more difficult, especially in clinical areas such as child health. Simulation using moderate-fidelity and high-fidelity manikins offers evidence-based and innovative approaches to augment traditional clinical experiences. However, few studies quantitatively examine student outcomes associated with clinical simulation. This article describes student learning outcomes related to traditional and hybrid (part simulation and part traditional clinical) undergraduate clinical experiences in a baccalaureate nursing program. In addition, the use of faculty-developed simulation scenarios integration of Quality and Safety Education for Nurses (QSEN) competencies into four pediatric scenarios, as well as the educational development of faculty at a simulation center, are presented.

Comparison of factors affecting repeat mammography screening of low-income Mexican American women.

PURPOSE/OBJECTIVES: To examine the level of cancer fatalism and other sociocognitive behavioral determinants in Mexican American women categorized as regular mammography screeners and infrequent mammography screeners. DESIGN: Cross-sectional, descriptive. SETTING: A southwestern American city on the U. S.-Mexico border. SAMPLE: 68 Mexican American women with low incomes recruited from a cancer consortium database. METHODS: Women who had been identified as regular or infrequent screeners based on screening history were contacted and invited to participate in a telephone survey. Participation consisted of completing the Powe Fatalism Inventory (PFI) and the Mammography Beliefs and Attitudes Questionnaire (MBAQ) in English or Spanish. MAIN RESEARCH VARIABLES: Total scores on the PFI and total scores on each of the MBAQ subscales. FINDINGS: Differences between the two groups were noted in cancer fatalism, perceived control over their participation in screening activities, and family history of cancer. No significant differences were noted in demographic characteristics. CONCLUSIONS: Cancer fatalism, generally believed to be highly related to socioeconomic status, may be mediated by women's perceptions of control over screening behavior or choices and by family history of cancer. IMPLICATIONS FOR NURSING: Further research is needed to explore cancer fatalism among Hispanic women, including other factors that can affect the level of cancer fatalism and perceived control over mammography screening participation. With this knowledge, culturally sensitive interventions may be developed to increase self-efficacy and facilitate perceived control.

Family history: value-added information in assessing cardiac health.

The purpose of this study was to describe family health history profiles and objective indices of cardiac health among ethnically diverse working adults. Family history of disease is an important predictor of individual health, yet is underused by clinicians. Participants were staff in an elder-care facility and completed a web-enabled program capturing family history, objective cardiovascular measures (blood lipids, blood pressure, height, weight, and waist-to-hip ratio), and subjective measures (anxiety, spirituality, and health status appraisal). Of the 44 participants, 89% were unable to provide complete information about their family health and mortality for the three-generation genogram; 25% had one or more first-degree relatives with cardiac disease; and more than two thirds had first-degree relatives with diabetes. More than 80% of the sample exhibited objective indices of risk including body mass indexes in the overweight or obese categories. Family history information was incorporated into health screening and enabled more appropriate health counseling for these employees.

Postoperative pain management outcome in Chinese inpatients.

In the absence of pain management outcome reports representing mainland China, the purposes of this study were to describe the outcome of postoperative pain management and the relationship between patient satisfaction and clinical outcomes in an indigenous Chinese population. From a sample of 388 second-day-postoperative inpatients, 304 (78%) reported pain in the past 24 hours and were enrolled in the study. Mean ratings for pain were moderate to severe. Patients reported mild to moderate pain-related interference with mood and physical activities. There were significant differences on worst pain intensity and pain interference with daily activity in the past 24 hours for different types of surgery. Top-ranked nonpharmacologic methods for managing pain were tolerating pain, changing positions, and family support. As measured by the Pain Management Index, 60.2% of patients were inadequately treated for pain, yet patients reported high satisfaction with pain management. Patient satisfaction, however, was inversely and significantly correlated with pain intensity. Study results indicate a need for standardized policies and guidelines about pain management and education among providers and for patients and families to overcome the suboptimal pain outcomes among this Chinese population.

Unequal quality of cancer pain management: disparity in perceived control and proposed solutions.

PURPOSE/OBJECTIVES: To examine poverty-related and racial and ethnic disparity in cancer pain management. DATA SOURCES: Published articles, conference proceedings, testimony, and clinical case studies. DATA SYNTHESIS: Disparity in the quality of cancer pain management exists resulting from interactions among patient, provider, and environmental factors. Irrespective of etiology, disparity results in inadequate management of cancer pain for vulnerable populations (poor patients, ethnic and racial group members, older adults) and is unacceptable in cancer care. Inadequate symptom management affects cancer treatment tolerance, exacerbating disparity in treatment outcomes and affecting end-of-life care. CONCLUSIONS: Evidence-based solutions include a systems approach, quality-improvement and quality-assurance processes that expose disparities and enforce evidence-based treatment per national guidelines, and statewide comprehensive cancer planning to target pain management outcomes. IMPLICATIONS FOR NURSING: Oncology nurses and interdisciplinary teams must be aware of disparities in cancer pain management for vulnerable groups, intervene to empower patients through customized educational approaches, and simultaneously implement systemwide strategies to ensure effective pain management and targeted monitoring for high-risk patients.

Surgical management of testicular cancer.

Surgery is an integral component in the management of testicular cancer. Prior to the advent of cisplatin chemotherapy, a retroperitoneal lymph node dissection (RPLND) was the only chance for cure of testicular cancer. Over the years, the surgical techniques have been improved greatly to decrease the occurrence of complications (e.g., incidence of retrograde ejaculation). Currently, RPLND can be done as the initial therapy or after chemotherapy. In either situation, the postoperative management of patients with testicular cancer can be complicated and requires thorough, ongoing assessment. This article presents the surgical indications for RPLND and the nursing management.

The hidden error of mismanaged pain: a systems approach.

Undertreatment of pain resulting in physiological, psychosocial, and economic consequences continues despite targeted improvement approaches. Starck et al. propose a systems framework for study of pain management errors. This secondary analysis examined pain outcomes of hospitalized inpatients to determine factors predicting adequate pain management. Data were collected from 964 hospitalized adult patients in the southwestern United States. The American Pain Society Patient Outcome Questionnaire and a demographic and chart audit form were used to collect data. The Pain Management Index (PMI) was computed for all participants. Results revealed that 30% of patients were undertreated for pain, with 67.5% reporting severe worst pain ratings (7 on a 0-10 scale). Non-whites, the elderly, and women had significantly higher pain ratings and higher proportions of negative PMI scores. Logistic regression predicted adequate pain management based on analgesic rating, ethnicity, age, and educational level with 0.89 accuracy. The study findings support conceptualizing mismanagement of pain as a medical error. An intervention model describes the use of a systems approach to identify high risk patients and ensure effective pain management practices for all.

Changing acute pain management outcomes in surgical patients.

Patient outcome studies indicate that patients accept pain as part of hospitalization. The majority of hospitalized patients who report experiencing pain are recovering from surgical intervention. To achieve successful outcomes, a comprehensive multidisciplinary effort must begin preoperatively and continue through discharge. The perioperative period is an essential link in effective pain management, and perioperative nurses are key in helping direct the care of surgical patients before, during, and after surgical procedures. Pain relief and the patients satisfaction with care frequently are used to measure pain management outcomes. This article examines the results of a secondary analysis of a subset of surgical patients drawn from a larger data set that was collected during two studies in urban and rural hospitals. It focuses on two outcomes, namely characteristics of pain and patient satisfaction with pain management after surgery. These outcomes were measured using the American Pain Society patient outcome questionnaire and the pain management index. Correlational, descriptive, and regression analyses indicate that postoperative management of patients' pain in these studies was less than optimal. From this new understanding, strategies for effective pain management of surgical patients are recommended.