Rural Community Case Management Experience for Bachelor of Science in Nursing Students: A Focus Group Evaluation.

BACKGROUND: This presentation concerns the evaluation of an additional clinical experience in case management for senior baccalaureate students. During their final leadership course, nursing students can elect to do an additional 80-hour precepted clinical experience focusing on case management in primary care clinics. As part of that experience, they rotate through seven nurse-managed rural primary health clinics in Tennessee. METHOD: As part of the evaluation process, students and preceptors were asked to review the experiences that students had participating in the clinical. RESULTS: For the most part, students were highly satisfied with the case management experience and thought it provided an additional skill set for them as they were completing their final year in nursing school and preparing to enter the nursing workforce as graduates of the Bachelor of Science in Nursing program. CONCLUSION: A community case management clinical opportunity in primary care allows a community experience for students that provides them with an opportunity to witness an RN practicing to the full scope of the license. [J Nurs Educ. 2018;57(9):557-560.].

Intensive Care Unit-Acquired Weakness: Implications for Case Management.

PURPOSE: The purpose of this case study is to provide a specific example of the disease trajectory for one patient's experience with intensive care unit-acquired weakness (ICUAW). This case study provides those in case management with an overview of some of the common signs and symptoms of ICUAW, as well as the possible prognosis and recovery from ICUAW. PRIMARY PRACTICE SETTING: The events in this case study take place in the acute care setting including the intensive care unit of a mid-sized health center, a general medical-surgical (med-surg) unit, and a long-term acute care facility. CONCLUSIONS: ICUAW affects the clinical, functional, and financial outcomes of patients. If the patient survives, their quality of life and the quality of life of their family members could be severely impacted. Case management practice has a significant role in coordinating care for those diagnosed with ICUAW. Case managers can use knowledge about ICUAW to improve the patient's transition throughout the hospital stay, improve discharge recommendations, and improve the patient's short-term and long-term outcomes. This may reduce unnecessary utilization of health care resources.

Implementation of an Obstructive Sleep Apnea Screening Program at an Overseas Military Hospital.

Anesthesia providers and surgeons do poorly at consistently identifying patients with obstructive sleep apnea (OSA) without use of screening tools. Aims of this evidence-based-practice project were to determine whether educating nurses about OSA and incorporating the STOP-BANG Questionnaire into preoperative forms was associated with an increased identification of patients with suspected OSA and an increased frequency of nurse-generated anesthesia consultation for OSA. A retrospective chart review of 100 consecutive records over a 1-month period using the STOP-BANG Questionnaire criteria was completed before and after implementation of the education and screening program at US Naval Hospital Okinawa, Japan. A STOP-BANG Questionnaire score of 3 or higher indicated high risk of OSA. Descriptive and inferential statistics were used to analyze results. Two hundred charts were reviewed. The prevalence of a STOP-BANG score of 3 or more increased from 5% to 21% after program implementation (P = .001). The frequency of anesthesia consultation for known or suspected OSA by our nursing staff increased from 5% to 26% after implementation (P = .0001). After this educational intervention with preoperative nurses and redesign of preoperative forms to incorporate the STOP-BANG Questionnaire, an increased proportion of patients at high risk of OSA were identified.

Reintegration Issues of Military Nurses: A Focus Group Approach.

PURPOSE OF THE STUDY: This qualitative study had three aims: (1) to interview a group of military nurses who had served in Afghanistan and Iraq, (2) to determine if the quantitative findings of the larger electronic survey resonated with veteran nurses, and (3) to identify other concerns and issues that were not addressed adequately in the survey. DESCRIPTION: This was a focus group convened to review the results of survey research conducted by Stanton and colleagues in 2016. Based on informal feedback from survey respondents, the investigators decided that a follow-up qualitative study with veteran nurses in the focus group could review the data and analysis from this survey. The group met and reviewed the results and their conversations were recorded and analyzed. METHODS: A multistage focus group approach was used to convene three meetings of nurse veterans (N = 8) who had been deployed and had experienced the reintegration process. RESULTS: During all three interviews, participants reinforced many of the findings of the survey by Stanton and colleagues. A range of life course issues beyond the scope of the electronic survey was also identified by the focus group as problematic during deployment and as challenging during the reintegration process. CONCLUSIONS: Military nurses and other medical caregiver groups might benefit from proactive planning and training that encourage/underscore the benefits of spirituality and mindfulness and other strategies that prepare and support them. Specific resources/toolkits that target common life course concerns have been initiated.

Employer Satisfaction With an Injured Employee's Health Care: How Does It Affect the Selection of an Occupational Health Care Provider?

PURPOSE/OBJECTIVES: The purpose of this article is to explore the most important factors that an employer utilizes in selecting an occupational health care provider for their employees injured on the job. PRIMARY PRACTICE SETTING(S): The primary practice setting is the attending physician's office who is an occupational health care provider. FINDINGS/CONCLUSIONS: The responding employers deemed "work restrictions given after each office visit" as their most important factor in selecting an occupational health care provider, with a score of 43. This was followed in order in the "very important" category by communication, appointment availability, employee return to work within nationally recognized guidelines, tied were medical provider professionalism and courtesy with diagnostics ordered timely, next was staff professionalism and courtesy, and tied with 20 responses in the "very important" category were wait time and accurate billing by the provider.The selection of an occupational health care provider in the realm of workers' compensation plays a monumental role in the life of a claim for the employer. Safe and timely return to work is in the best interest of the employer and their injured employee. For the employer, it can represent hard dollars saved in indemnity payments and insurance premiums when the employee can return to some form of work. For the injured employee, it can have a positive impact on their attitude of going back to work as they will feel they are a valued asset to their employer. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The case managers, who are the "eyes and ears" for the employer in the field of workers' compensation, have a valuable role in a successful outcome of dollars saved and appropriate care rendered for the employees' on the job injury. The employers in the study were looking for case managers who could ensure their employees received quality care but that this care is cost-effective. The case manager can be instrumental in assisting the employer in developing and monitoring a "stay-at-work" program, thereby reducing the financial exposure for the employer.

Qualitative Analysis of the Lived Experience of First-Time Nurse Responders in Disaster.

The study purpose was to examine the reflections of the lived experiences of nurses in shelters or temporary community medical clinics responding for the first time to a civilian disaster. The disaster-nursing literature echoes the need for development of disaster content in the nursing curriculum. However, little thematic analysis-supporting curriculum from the lived experience of first-time responders exists in the literature. This study's purpose is to identify the essential thematic knowledge and skills necessary to provide care to disaster survivors in communities and for determining the themes necessary to formulate education in emergency preparedness curricula. A narrative inquiry, with a phenomenological analysis, to explore the lived experiences of nurses who responded once to a community disaster was the methodology used to identify themes. Thematic findings demonstrated a lack of prior knowledge about volunteering during a disaster response, that previous mass casualty exercises did not help with their actual responses, and that the participant RNs identified specific and assessment skills necessary for disasters.

Hypnic Jerks: A Scoping Literature Review.

A scoping review is an approach to identify or map the extent of key concepts and main sources and types of evidence available on a topic. Hypnic jerks are considered a parasomnia categorized as a sleep-wake transition disorder. Although hypnic jerks are considered a benign sleep/movement disorder, some of the latest research indicates that they may be a clinical characteristic for other sleep disorders that affect health care outcomes. This article conducts a scoping review of the literature to determine the extent, range, and nature of the research activity related to hypnic jerks and identifies research gaps in the existing literature.

Psychiatric Case Management in the Emergency Department.

PURPOSE: The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse (). That is up 28% from just 4 years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, MD. Using a method called scoping, the purpose of this article is to examine the range, extent, and evidence available regarding case management as an intervention in the ED to manage mental health patients, to determine whether there is sufficient quantity and quality of evidence on this topic to conduct a meta-analysis, and to identify relevant studies that balance comprehensiveness with reasonable limitations. PRIMARY PRACTICE SETTINGS: One solution for ensuring that the costs are contained, efficiency is maintained, and quality outcomes are achieved is the placement of a case manager in the ED. According to , because the majority of hospital admissions come through the ED, it makes sense to have case managers located there to act as gatekeepers and ensure that patients who are admitted meet criteria and are placed in the proper bed with the proper status. FINDINGS/CONCLUSIONS: From the scoping techniques implemented in this study, the authors came to the conclusion that case management has been and can be used to effectively treat mental health patients in the emergency room. A good number of patients with psych mental health issues are frequent visitors and repeat visitors. Case management has not been used very often as a strategy for managing patients through the ED or for follow-up after the visit. Hospitals that have developed a protocol for managing these patients outside the main patient flow have had successful results. Staff training and development on psych mental health issues have been helpful in the ED. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: While there are not a large number of studies available on this topic, there is sufficient evidence to warrant further examination of this research topic. The findings in this scoping study have broader implications for research, policy, and practice. The framework of this study involved an outcomes-based approach. Clinical outcomes that positively enhance patient care and save the hospital money are necessary in the current health care environment.

Universal Postoperative Hip Instruction Protocol for Rehabilitation in Rural Skilled Nursing Facilities.

PURPOSE/OBJECTIVES: Hip fractures among the elderly increase the incidence of mortality and other health-related complications, lead to poor quality of life, and create major economic challenges. Elderly individuals often reside in rural skilled nursing facilities (SNFs) for rehabilitation after undergoing surgical fixation for a hip fracture. Orthopedic providers (OPs) can develop protocols that will encourage continuity of postoperative orthopedic follow-up care, guiding and educating SNF staff in best practices, and encouraging regular communication between SNF staff and OPs. The purpose of this article is to describe how an orthopedic practice developed a universal postoperative hip instruction protocol (UP-HIP) to promote a streamlined approach to postoperative follow-up assessment and rehabilitation for the elderly residing in rural SNFs. The overall goal of the UP-HIP is to provide the OP with assessment findings remotely and avoid putting frail elderly patients at risk by physically transporting them to and from follow-up appointments with the OP. PRIMARY PRACTICE SETTING(S): Orthopedic clinic setting and rural SNFs. FINDINGS/CONCLUSIONS: Comprehensive postoperative protocols focused on elderly patients with hip fracture in rural SNFs serve to improve remote communication during the rehabilitation phase and guide SNF in a coordinated approach to postoperative follow-up care. Future recommendations include the addition of telehealth technology to allow for remote real-time visual assessments by the OP while the elderly patient with hip fracture remains in the SNF environment. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The UP-HIP allows the OP and case manager to ensure continuity of postoperative care by conducting remote follow-up postoperative visits with elderly patients with hip fracture while they remain in the rural SNF setting. Comprehensive evidence-based protocols assist OPs and case managers with remotely monitoring rehabilitation progress in the rural SNF setting more efficiently and consistently. Telehealth technology added to evidence-based protocols enables the OP and case manager to conduct real-time visual assessments of the patient without the patient having to leave the rural SNF setting.

Dyspnea Management of Hospice Patients.

Up to 70% of hospice patients are reported to experience dyspnea at end of life. Despite the high prevalence of this burdensome symptom, there is little in the literature to guide effective treatment. Assessment of subjective symptoms and objective signs as well as physical, psychospiritual, sociocultural, or environmental barriers is critical to an effective plan of care. The purpose of the article is to review the current literature on assessment and management of dyspnea in hospice patients and provide implications for hospice clinicians.

The Effect of Transcranial Direct Current Stimulation (tDCS) on Resilience, Compassion Fatigue, Stress and Empathy in Professional Nurses.

The purpose of the study is to determine the effect of Transcranial Direct Current Stimulation (tDCS) on measured levels of resilience and empathy in professional nurses with evidence of compassion fatigue and other stress related problems. Lowered levels of resilience, compassion fatigue and decreased empathy are significant predictors of burnout in nurses. Enhanced levels of resilience are associated with improved empathic responses and overall emotional well-being. Nurses who work in high stress environments often exhibit compassion fatigue and post-traumatic stress disorders that may reduce their ability to function effectively. Because tDCS has been used successfully in a number of chronic disease conditions, it would seem that there is potential for it to be useful in a broader context. The treatment with tDCS may be a potential strategy for improving resilience and eliminating chronic stress responses. A timed series counterbalanced research design was used for the study. Participants completed 18 sessions of tDCS over a six week period. They also completed a resilience, compassion fatigue, stress and empathy scale before and after each tDCS administration. A repeated measure analysis was used to determine if tDCS had an impact on scale scores. The analysis showed that tDCS amperage had significant positive effects on empathy. On the outcomes of resilience, compassion fatigue and stress, tDCS did not produce any significant changes. This research provides a new approach to compassion fatigue, an old problem with caregivers. Notably, when implemented with individuals experiencing problems that involve apathy or indifference, tDCS is a non-effortful intervention that offers a pathway that may improve symptoms and does not require extensive outlays of physical or mental energy.

Memory performance and affect: are there gender differences in community-residing older adults?

After age 65, the incidence of episodic memory decline in males is greater than in females. We explored the influence of anxiety and depression on objective and subjective memory performance in a diverse sample of community-residing older adults. The study was a secondary analysis of data on three samples of adults from two states, Ohio and Texas: a community sample (n = 177); a retirement community sample (n = 97); and the SeniorWISE Study (n = 265). The sample of 529 adults was 74% female, the average age was 76.58 years (range = 59-100 years), and educational attainment was 13.12 years (±3.68); 68% were Caucasian, and 17% had depressive symptoms. We found no memory performance differences by gender. Males and females were similarly classified into the four memory performance groups, with almost half of each gender in the poor memory category. Even though males had greater years of education, they used fewer compensatory memory strategies. The observed gender differences in memory were subjective evaluations, specifically metamemory. Age was not a significant predictor of cognition or memory performance, nor did males have greater memory impairment than females.

Elders' use of folk medicine and complementary and alternative therapies: an integrative review with implications for case managers.

PURPOSE OF STUDY: The purpose of this study was to determine the prevalence of complementary and alternative medicine (CAM), folk medicine, and other nontraditional therapy use by the elderly population. PRIMARY PRACTICE SETTING: For all case managers who coordinate health care for the elderly as they transition from one setting to another and participate in health promotion and prevention activities. METHODOLOGY AND SAMPLE: A computerized database search of MEDLINE, CINAHL, ProQuest, and PsycINFO was completed before writing the integrative review. Six hundred ninety-seven abstracts were identified. Forty-five articles were further screened. Twenty-five articles met the criteria for inclusion. RESULTS: The integrative review is composed of 25 articles. Support for folk medicine and CAM use by older adults is located at Levels 5 and 6 of Melynk and Fine-Overholt's Hierarchy of Evidence. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Folk medicine and CAM are used by the elderly for self-care purposes. A combination of both nontraditional and traditional medical interventions is used by the elderly. Although the choice to use folk medicine and CAM seems to transcend culture, the specific therapies chosen often emerge from the individual's cultural or ethnic heritage. Traditional health care providers may be unaware of elders' use of CAM or folk medicine alternatives. Case managers as coordinators of care across the health continuum are in a unique position to encourage, support, and enhance the use of folk medicine and CAM that complements traditional medical interventions for the elderly.

Alabama Veterans Rural Health Initiative: a pilot study of enhanced community outreach in rural areas.

PURPOSE: Access, enrollment, and engagement with primary and specialty health care services present significant challenges for rural populations worldwide. The Alabama Veterans Rural Health Initiative evaluated an innovative outreach intervention combining motivational interviewing, patient navigation, and health services education to promote utilization of the United States Veterans Administration Healthcare System (VA) by veterans who live in rural locations. METHODS: Community outreach workers completed the intervention and assessment, enrolling veterans from 31 counties in a southern state. A total 203 participants were randomized to either an enhanced enrollment and engagement outreach condition (EEE, n = 101) or an administrative outreach (AO, n = 102) condition. FINDINGS: EEE participants enrolled and attended VA appointments at higher rates and within fewer days than those who received AO. Eighty-seven percent of EEE veterans attended an appointment within 6 months, compared to 58% of AO veterans (P < .0001). The median time to first appointment was 12 days for the EEE group and 98 days for the AO group (P < .0001). Additionally, a race by outreach group interaction emerged: black and white individuals benefited equally from the EEE intervention; however, black individuals who received AO took significantly longer to attend appointments than their white counterparts. CONCLUSIONS: Results provide needed empirical support for a specific outreach intervention that speeds enrollment and engagement for rural individuals in VA services. Planned interventions to improve service utilization should ameliorate ambivalence about accessing health care in addition to addressing traditional systems or environmental-level barriers.

Smartphone preventive health care: parental use of an immunization reminder system.

INTRODUCTION: This study examined the feasibility of using a smartphone application recall/reminder system for immunizations given in pediatric primary care. METHOD: The study used a typical descriptive study design. A convenience sample of parents and caregivers was recruited from a primary care pediatric office in a middle-class suburban area. Participants used an Android smartphone application ("Call the Shots") that served as a reminder/recall system for vaccinations and offered an embedded tool kit to obtain reliable information about vaccines. RESULTS: A total of 262 persons accessed the application's Web site. The application was downloaded and used by 45 of those persons during the study; six persons completed the survey. DISCUSSION: Data are insufficient to fully evaluate the usefulness of the "Call the Shots" smartphone application. However, initial results and feedback have been positive, and the application should be launched in Apple's platform to reach a wider test audience.

The incidence of fever in US Critical Care Air Transport Team combat trauma patients evacuated from the theater between March 2009 and March 2010.

INTRODUCTION: Most critically ill injured patients are transported out of the theater by Critical Care Air Transport Teams (CCATTs). Fever after trauma is correlated with surgical complications and infection. The purposes of this study are to identify the incidence of elevated temperature in patients managed in the CCATT environment and to describe the complications reported and the treatments used in these patients. METHODS: We performed a retrospective review of available records of trauma patients from the combat theater between March 1, 2009, and March 31, 2010, who were transported by the US Air Force CCATT and had an incidence of hyperthermia. We then divided the cohort into 2 groups, patients transported with an elevation in temperature greater than 100.4°F and patients with no documented elevation in temperature. We used a standardized, secure electronic data collection form to abstract the outcomes. Descriptive data collected included injury type, temperature, use of a mechanical ventilator, cooling treatment modalities, antipyretics, intravenous fluid administration, and use of blood products. We also evaluated the incidence of complications during the transport in patients who had a recorded elevation in temperature greater than 100.4°F. RESULTS: A total of 248 trauma patients met the inclusion criteria, and 101 trauma patients (40%) had fever. The mean age was 28 years, and 98% of patients were men. The mechanism of injury was an explosion in 156 patients (63%), blunt injury in 11 (4%), and penetrating injury in 45 (18%), whereas other trauma-related injuries accounted for 36 patients (15%). Of the patients, 209 (84%) had battle-related injuries and 39 (16%) had non-battle-related injuries. Traumatic brain injury was found in 24 patients (24%) with an incidence of elevated temperature. The mean temperature was 101.6°F (range, 100.5°F-103.9°F). After evaluation of therapies and treatments, 80 trauma patients (51%) were intubated on a mechanical ventilator (P < .001). Of the trauma patients with documented fever, 22 (22%) received administration of blood products. Nineteen patients received antipyretics during their flight (19%), 9 received intravenous fluids (9%), and 2 received nonpharmacologic cooling interventions, such as cooling blankets or icepacks. We identified 1 trauma patient with neurologic changes (1%), 6 with hypotension (6%), 48 with tachycardia (48%), 33 with decreased urinary output (33%), and 1 with an episode of shivering or sweating (1%). We did not detect any transfusion reactions or deaths during flight. CONCLUSION: Fever occurred in 41% of critically ill combat-injured patients evacuated out of the combat theater in Iraq and Afghanistan. Fewer than 20% of patients with a documented elevated temperature received treatments to reduce the temperature. Intubation of patients with ventilators in use during the transport was the only factor significantly associated with fever. Serious complications were rare, and there were no deaths during these transports.

Chief nursing officers' perceptions of the Doctorate of Nursing Practice degree.

PROBLEM: Nurse executives practice in a business environment, which requires a skill set that has traditionally not been included in advanced nursing curriculum. The Doctorate of Nursing Practice (DNP) essentials are designed to address this gap in education while maintaining the focus on advanced nursing practice and executive management competency. Current literature supports the appropriateness of the DNP with practice focus areas of advanced practice specialties and nursing leadership. Although certification and educational bodies, and some professional nursing organizations, have embraced the DNP as the terminal degree for non-research-focused nurses, there remains a gap in the literature in regards to the perceptions of validity of the DNP for nurse executives. METHOD: The purpose of this capstone project was to investigate the perceptions of practicing chief nursing officers (CNOs) in the acute care setting regarding the application of the DNP degree for nurse leaders. Utilizing an online survey, specific perceptions investigated included application and appropriateness of the DNP in a business-based practice model and managing daily nursing operations. FINDINGS: CNOs practicing in the acute care setting differed on their responses regarding whether the DNP should be the recommended or the required degree in CNO development programs. CNOs with tenure responded more positively to the perception that the DNP curricula contains advanced nursing knowledge content appropriate to nurse executive practice. CONCLUSIONS: Practicing CNOs in the acute care setting do perceive the DNP as an appropriate degree option for nurse executive roles at aggregate, system, and organizational levels.

Creating a successful environment for preparing doctoral-level nurse educators.

The ongoing nursing shortage requires that universities be creative in developing alternative methods to enhance the supply of nursing faculty. We report on an innovative collaborative program between colleges of nursing and education to prepare future nursing faculty. The evaluation of this initiative was accomplished using comparative data from doctoral students in other non-nursing programs. We found that the nurse educator program was positive in influencing students' knowledge and skill development and perceptions of faculty support, compared with other non-nursing doctoral programs.