Using Aromatherapy to Improve Nighttime Comfort in Hospitalized Patients With Cancer: A Pilot Study.

BACKGROUND: Sleep disturbances have been shown to have negative health effects leading to inferior well-being, increased fatigue, and impaired performance. For hospitalized patients receiving oncology care, improving nighttime comfort may positively affect well-being and health outcomes, leading to decreased length of stay. Aromatherapy can improve sleep quantity and quality. OBJECTIVES: This pilot study aimed to determine whether aromatherapy improves nighttime comfort, in particular well-being and sleep quality, for hospitalized patients with cancer. METHODS: This quasi-experimental pilot study with a single-arm pre-/post-test design evaluated the effects of nighttime aromatherapy for hospitalized patients with cancer. Measures were the World Health Organization-Five Well-Being Index and Pittsburgh Sleep Quality Index. FINDINGS: A total of 34 hospitalized patients with cancer participated. After aromatherapy, mean well-being scores improved significantly. Mean sleep quality scores also improved but did not reach significance. Of participants who submitted open-ended responses, 20 of 22 described a positive experience with aromatherapy, including better sleep, relaxation, soothing effects, and nausea relief.

Relationships Between Perceived Importance of Chaplain Presence and Health Professionals' Emotional Well-Being in the United States.

Hospital-based chaplains receive specialized training to provide spiritual support to patients and healthcare staff during difficult health transitions. However, the impact of perceived chaplain importance on healthcare staff's emotional and professional well-being is unclear. Healthcare staff (n = 1471) caring for patients in an acute care setting within a large health system answered demographic and emotional health questions in Research Electronic Data Capture (REDCap). Findings suggest that as perceived levels of chaplain importance increase, burnout may decrease and compassion satisfaction may improve. Chaplain presence in the hospital setting may support healthcare staff emotional and professional well-being following occupational stressors including COVID-19-related surges.

Direct oral anticoagulants and warfarin safety in rural patients with obesity.

BACKGROUND: Direct oral anticoagulants (DOACs) are often used in patients with atrial fibrillation or flutter instead of warfarin and although supporting evidence is limited, available studies suggest this may be an acceptable route of care. Our study assessed the question: are DOACs as effective and safe as warfarin in patients with atrial fibrillation and class III obesity specifically in a rural population? METHODS: A retrospective analysis was conducted by examining the first 6-12 months of therapy with a DOAC (apixaban or rivaroxaban) or warfarin in patients with weight >120kg or class III obesity. Events of interest, thrombosis and bleeding, were documented for analysis. The risk and odds of events of interest for both groups were calculated and compared. RESULTS: Characteristics of both arms were similar (DOAC n=42; warfarin n=43). A lack of thrombosis events limited efficacy analysis. A total of 22 bleeds occurred with 8 in patients prescribed a DOAC (7 minor; 1 major) and 14 in those prescribed warfarin (12 minor; 2 major). Weight in kg (p<0.001), BMI (p=0.013) and HAS-BLED score (p=0.035) were predictive of a first bleeding event in patients prescribed warfarin. The odds ratio for any type of bleed on DOAC vs warfarin was 0.55 (0.180-1.681; 95% CI). CONCLUSIONS: In patients with atrial fibrillation and class III obesity, regarding safety, DOACs appear to be non-inferior to warfarin during the first six to 12 months of therapy in our rural population - consistent with other analyses; however, the lack of thrombosis events limited the efficacy analysis.

Influence of a Formal Mentor on Hospital-Based Nurse Research Resources and Outcomes.

ABSTRACT: Magnet® hospitals must conduct nursing research to maintain designation. Relationships between hospital research infrastructure, activities, and a designated nurse research mentor were explored in a large health system using survey methodology. Hospitals with a formal mentor reported more research resources (n = 23, m = 2.5) compared with those without (n = 16, m = 1.8, P < 0.001). Hospitals aspiring for Magnet may benefit from a doctorally prepared research mentor.

Quiet Time to Increase Breastfeeding Rates and Enhance Women's Hospital Experiences in the Postpartum Period.

OBJECTIVE: To facilitate optimal hospital experiences and breastfeeding clinical outcomes among women by reducing interruptions during their first 24 hours in the postpartum period. DESIGN: Evidence-based practice change initiated by a registered nurse staff member. SETTING/LOCAL PROBLEM: There was concern that numerous visitor and staff interruptions to women during their early postpartum hours were interfering with establishing breastfeeding and maintaining a restful environment on our 21-bed postpartum unit within a 377-bed, Magnet-recognized, religiously affiliated hospital in suburban southern California. PARTICIPANTS: Medically stable women with uncomplicated childbirth during the previous 24 hours and women in the postpartum period whose responses were recorded in facility databases maintained by the departments of Lactation Services and Nursing Research. INTERVENTION/MEASUREMENTS: A daily quiet time from 1:00 p.m. to 3:00 p.m. was instituted on the postpartum unit. Measurements before and after implementing quiet time included data on (a) interruptions, as the number of times someone opened or entered women's room doors; (b) exclusive breastfeeding rates; and (c) women's postdischarge reports of their hospital experiences. RESULTS: After quiet time was implemented, interruptions fell from an average of 74 to an average of 37 per day (n = 21, p = .02), and the percentage of women breastfeeding rose from 34% to 48% (n = 193, p = .39). Women's ratings of unit quietness improved significantly (n = 169, p = .008) to above the benchmark, and their overall facility rating and willingness to recommend the facility remained above the benchmark on surveys from the Hospital Consumer Assessment of Healthcare Providers and Systems. CONCLUSION: A daily afternoon quiet time for women hospitalized in the postpartum period may reduce interruptions to women and thereby potentially increase breastfeeding rates and improve women's perceptions of their hospital experiences. Unsolicited reports from staff suggested that quiet time was well received by nurses providing postpartum care.

Ongoing Use of SSRIs Does Not Alter Outcome in Hospitalized COVID-19 Patients: A Retrospective Analysis.

SARS-CoV-2 continues to have devastating consequences worldwide. Though vaccinations have helped reduce spread, new strains still pose a threat. Therefore, it is imperative to identify treatments that prevent severe COVID-19 infection. Recently, acute use of SSRI antidepressants in COVID+ patients was shown to reduce symptom severity. The aim of this retrospective observational study was to determine whether COVID+ patients already on SSRIs upon hospital admission had reduced mortality compared to COVID+ patients not on chronic SSRI treatment. Electronic medical records of 9044 patients with laboratory-confirmed COVID-19 from six hospitals were queried for demographic and clinical information. Using R, a logistic regression model was run with mortality as the outcome and SSRI status as the exposure. In this sample, no patients admitted on SSRIs had them discontinued. There was no significant difference in the odds of dying between COVID+ patients on chronic SSRIs vs. those not taking SSRIs, after controlling for age category, gender, and race. This study shows the utility of large clinical databases in determining what commonly prescribed drugs might be useful in treating COVID-19. During pandemics due to novel infectious agents, it is critical to evaluate safety and efficacy of drugs that might be repurposed for treatment.

Meaning of Courtesy and Respect: Nurse and Patient Experiences.

BACKGROUND: Treating patients with courtesy and respect has quality, ethical, and fiscal ramifications. PURPOSE: This qualitative study revealed meanings of nurse courtesy and respect as imbedded in nurse and patient stories. METHODS: Audio-recorded interviews were collected from 15 registered nurses and 17 patients on a medical-surgical unit in a 377-bed, nonprofit, Magnet-recognized facility. RESULTS: Six themes related to courtesy and respect emerged during descriptive content analysis by 2 researchers: (1) being attentive (with subthemes taking time, physical care, and proactive engagement); (2) giving empathetic support; (3) honoring culture and beliefs; (4) recognizing the family; (5) recognizing patient space; and (6) recognizing personhood (with subthemes of showing ordinary politeness and recognizing the individual and honoring choices). CONCLUSIONS: Informants' stories contributed toward a better understanding of what it means to treat patients with courtesy and respect; and they created context for interpreting HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) numerical results. Further research is warranted.

Exploring Resilience at Work Among First-Line Nurse Managers.

OBJECTIVES: This study explored the assessment of resilience at work among 1st-line nurse managers (NMs). BACKGROUND: Resilience is the ability to cope with stress. NMs have stressful roles and may ultimately withdraw from management if they lack resilient behaviors. Having a measurement of resilience at work in NMs and other healthcare workers may facilitate resilience development approaches. METHODS: In a descriptive, cross-sectional design, an electronic survey of 25-item, 7-subscale Resilience at Work (RAW) self-report assessment was distributed to 77 NMs. RESULTS: The highest reported subscale was living authentically; lowest was maintaining perspective. Total years as NM was related to overall RAW mean, maintaining perspective, staying healthy. CONCLUSION: The application of an instrument to determine resilience may focus support for NMs on maintaining perspective, for example. Further study exploring the application of the RAW assessment to healthcare workers is indicated.

Enhancing and Advancing Shared Governance Through a Targeted Decision-Making Redesign.

OBJECTIVE: The study aim was to determine if a targeted redesign of shared decision making improved shared governance (SG). BACKGROUND: Nursing SG is collaborative decision making between nurses at every level; it improves quality of care, empowers nurses, and enhances nurse satisfaction. METHODS: Using a quasi-experimental, pretest/posttest design, researchers electronically distributed the Index of Professional Nursing Governance (IPNG) to an inclusive, convenience sample of RNs in a Magnet®-designated 377-bed community medical center. Preintervention scores were used to tailor a redesign of shared decision making, and postintervention data were collected within 1 year to measure outcomes. RESULTS: IPNG overall score and 5 of 6 subscale scores significantly increased after the redesign. CONCLUSIONS: Changes to an SG structure can take 2 to 5 years to be realized. Our findings corroborate that the IPNG is a valuable tool in promoting setting-specific SG.

The effect of lactation educators implementing a telephone-based intervention among low-income Hispanics: A randomised trial.

OBJECTIVES: To assess whether a phone-based breastfeeding intervention delivered by lactation educators influenced exclusive breastfeeding rates amongst low-income Hispanic women in the USA. DESIGN: Randomised two-group design. SETTING: Pregnant low-income Hispanic women (298) were recruited from community health clinics in Los Angeles County (USA) and randomly assigned to either a control or an intervention group. METHODS: Data relating to the factors associated with breastfeeding were collected during the third trimester. Breastfeeding outcome data was collected at 72 hours, one month, three months, and six months postpartum. RESULTS: There were no differences between the groups in rates of breastfeeding initiation. There was a significant difference in the duration of exclusive breastfeeding among participants during the infant's first week of life. While not significant, after controlling for covariates and intent to breastfeed at third trimester, the duration of exclusive breastfeeding amongst all participants was, on average, longer for intervention group mothers than control group mothers. Additionally, , the intervention group mothers were more likely to report exclusive and only breastfeeding at all data points compared to the control group, and less likely to discontinue breastfeeding. CONCLUSION: Findings from this study suggest that telephone-based breastfeeding interventions delivered by a lactation educator show promise as a cost-effective strategy for improving both the quantity and duration of breastfeeding among low-income Hispanic women in the USA. Intervention group mothers not only sustained breastfeeding for a longer durations, but also provided their infants with greater amounts of breast milk over these longer durations.

Maternal grand mal seizure leads to a surprising diagnosis of Dandy-Walker variant.

Pregnant women may present with abnormal symptoms that are assumed to be related to the pregnancy. The purpose of this case study is to examine an obstetric case that provides a wider view of a grand mal seizure in a perinatal patient with previously undiagnosed Dandy-Walker Variant. When a pregnant or newly postpartum woman has seizures, eclampsia may be the most the most likely diagnosis, but it may not be accurate.

A community-based parish nurse intervention program for Mexican American women with gestational diabetes.

OBJECTIVE: To examine the effects of a Parish Nurse Intervention Program (PNIP) on maternal health behaviors, glycemic control, and neonatal outcomes among Mexican American women with gestational diabetes. DESIGN: A randomized controlled trial comparing care as usual (CAU) with a supplementary 1-hour education session for diabetes education reinforcement by a Parish Nurse. SETTING: An outpatient treatment clinic for gestational diabetes within a 250-bed tertiary care, non-profit hospital with a Parish Nurse partnership. PARTICIPANTS: One hundred Mexican American women were included in the study with randomization into Parish Nurse Intervention Program (n=49) and care as usual (n=51) groups. MAIN OUTCOME MEASURES: The Health Promoting Lifestyle Profile II (HPLP II) and two measures of glycemic control pre- and post-intervention, as well as newborn size, and days of maternal and neonatal hospitalization. RESULTS: Outcomes indicate significantly improved Health Promoting Lifestyle Profile II scores in the Parish Nurse Intervention Program group post-intervention compared with the Care As Usual group. No significant differences between groups regarding glycemic control, macrosomia, or days of maternal or neonatal hospitalization were found. CONCLUSIONS: A Parish Nurse Intervention Program for pregnant women of Mexican descent with gestational diabetes is effective in leading to improved self-reported health promoting behaviors.