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Opioids are commonly given to provide comfort at the end of life, yet patients often experience poor control of pain. The management of symptoms using opioids varies among nurses. To improve patient outcomes, a better understanding is needed of the way nurses titrate opioid infusions and the criteria involved in the decisions to adjust opioid doses. The purpose of this study was to investigate nurses' current knowledge, attitudes, and practice patterns. An investigator-developed survey was returned by 181 acute care nurses at three medical centers in a Midwest urban area who were 91% female, with an average age of 40 years old and average of 13 years of RN experience, working in a variety of units: ICU (22%), medical-surgical (15%), oncology (11%), or telemetry (11%). A majority of nurses (78%) felt always/often comfortable titrating opioids. Nurses who used titration in the last year (n = 104) and those with more experience were significantly more comfortable (P =.007 and.013). However, only one knowledge question was answered correctly by greater than 50% of respondents (68.5%). Most nurses used similar assessment parameters to determine appropriate doses. A majority (82.9%) indicated a need for more education, and 56.4% were unaware of hospital policies regarding opioid titration. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe Operation Iraqi/Enduring Freedom and Operation Desert Storm/Shield deployment experiences from the perspectives of 39 Army Medical Department personnel using a qualitative method in 2004. Thematic content analysis revealed themes from data collected during twelve focus groups. The themes with the most discussion that transcended across wars, branches, echelons of care, and grade were leadership and readiness concerns, followed closely by safety issues. The majority of discussion was about deficiency needs during deployment and the data suggests that problems experienced during deployment are timeless and are not unit-specific; issues were strikingly similar across the two wars, as well as across the varying AMEDD roles and types of medical units. Therefore, the findings of this study may be generically applicable to deployed AMEDD personnel with the potential to alter current policy regarding leadership, readiness, and safety for future AMEDD deployments. [ABSTRACT FROM AUTHOR]

Little information exists regarding competencies required to function as a charge nurse. This qualitative study identified charge nurse competencies. Data sources were interviews (N = 42) with charge nurses, head nurses, staff nurses, and supervisory personnel. A total of 54 competencies were identified in four categories: clinical/technical, critical thinking, organizational and human relations skills. The charge nurses who were interviewed primarily came from medical-surgical and intensive care units. The competencies derived from their interviews reflect leadership and management skills that medical-surgical nurses need to function as effective charge nurses. [ABSTRACT FROM AUTHOR]

We describe a follow-up study comparing nurse anesthesia research in the 1990s with findings of a previous study. Research reported in the AANA journal in 1995 and 1996 (n = 38 studies) was compared with the earlier description of research from 1985-1986 (n = 18) and 1975-1976 (n = 14) periods. The amount of research published in the Journal has increased steadily, with a stable focus on clinical practice. In addition, there has been an increase in educational and safety-related research reported. In an attempt to locate research published in other nursing and medical journals, we found and reviewed additional articles (n = 28) authored or coauthored by CRNAs during the 1995-1996 period. By the 1990s, all studies demonstrated at least 1 indicator of theoretical orientation. Convenience samples of hospitalized patients were the most common type of sample. As in the earlier study, there was minimal reporting on reliability and validity of data and the psychometric evaluation of instruments. Recommendations include increased emphasis on methodological studies, multisite studies, programs of research, and collaboration among CRNAs, nurses in other specialties, and people in other disciplines. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Patients commonly perceive that a provider has spent more time at their bedside when the provider sits rather than stands. This study provides empirical evidence for this perception. METHODS: We conducted a prospective, randomized, controlled study with 120 adult post-operative inpatients admitted for elective spine surgery. The actual lengths of the interactions were compared to patients' estimations of the time of those interactions. RESULTS: Patients perceived the provider as present at their bedside longer when he sat, even though the actual time the physician spent at the bedside did not change significantly whether he sat or stood. Patients with whom the physician sat reported a more positive interaction and a better understanding of their condition. CONCLUSION: Simply sitting instead of standing at a patient's bedside can have a significant impact on patient satisfaction, patient compliance, and provider-patient rapport, all of which are known factors in decreased litigation, decreased lengths of stay, decreased costs, and improved clinical outcomes. PRACTICE IMPLICATIONS: Any healthcare provider may have a positive effect on doctor-patient interaction by sitting as opposed to standing during a hospital follow-up visit. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effects of a virtual reality intervention on pain and anxiety in patients undergoing a bone marrow aspiration and biopsy procedure., Sample & Setting: 97 adults in an outpatient cancer center in the midwestern United States., Methods & Variables: In this quasiexperimental study, participants were assigned to either the experimental group (use of virtual reality goggles) or the control group (standard treatment). Vital signs, pain, and anxiety were measured before and after the procedure. T tests and chi-square tests were used to compare the two groups based on demographic data, pain, anxiety, and total amount of medication used during the procedure., Results: Participants who wore virtual reality goggles during a bone marrow aspiration and biopsy procedure did not experience a statistically significant decrease in pain and anxiety. However, the experimental and control groups showed a decrease in pain and anxiety levels from pre- to postprocedure., Implications for Nursing: Virtual reality goggles may be a feasible, noninvasive alternative to traditional pharmacologic treatment. The cost of any intervention would need to be considered. Virtual reality should be researched and adapted to benefit patients in appropriate settings.

Felty's syndrome is a triad of rheumatoid arthritis, splenomegaly, and neutropenia. This rare disorder is difficult to diagnose and produces many complications. The purpose of this descriptive qualitative case study was to provide a comprehensive, context-bound understanding of one patient's struggle with the condition.

Purpose: In this methodological article, the authors address the problem of underdeveloped themes in qualitative studies they have reviewed. Various possible reasons for underdeveloped themes are examined, and suggestions offered., Organizing Construct: Each problem area is explored, and literature support is provided. The suggestions that are offered are supported by the literature as well., Findings: The problem with underdeveloped themes in certain articles is related to 3 interconnected issues: (a) lack of clear relationship to the underlying research method, (b) an apparent lack of depth in interviewing techniques, and (c) lack of depth in the analysis. Underdeveloped themes in a qualitative study can lead to a lack of substantive findings that have meaningful implications for practice, research, and the nursing profession, as well as the rejection of articles for publication. Fully developed themes require knowledge about the paradigm of qualitative research, the methodology that is proposed, the effective techniques of interviewing that can produce rich data with examples and experiences, and analysis that goes beyond superficial reporting of what the participants have said. Analytic problem areas include premature closure, anxiety about how to analyze, and confusion about categories and themes., Conclusions: Effective qualitative research takes time and effort and is not as easy as is sometimes presumed. The usefulness of findings depends on researchers improving their research skills and practices., Implications for Practice: Increasingly researchers are using qualitative research to explore clinically important issues. As consumers of research or members of a research team, clinical nurse specialists need to understand the nature of this research that can provide in-depth insight and meaning.

Study Design:  Retrospective cohort study., Background:  Several studies focus on the long-term results of anterior cervical discectomy and fusion (ACDF) surgeries, but little information exists regarding how various patient-related, procedure-related, and payer-related variables may affect postoperative hospital length of stay (LOS)., Objective:  To determine what factors, if any, contribute to increased hospital LOS in patients who have had an ACDF., Methods:  Retrospective cohort study of 108 consecutive patients who underwent elective ACDF at a Midwest academic medical center. Extensive preoperative, intraoperative, and postoperative data were abstracted and analyzed to identify prognostic factors for an increased LOS. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on hospital LOS., Results:  103 patients met inclusion and exclusion criteria. The mean LOS for patients undergoing ACDF was 1.98 (±1.6) days. Only 29% of patients had one level fused. The mean blood loss during surgery was 87.4 ± 99.6 mL. One subject lost 700 mL of blood. Complications, though rare, included uncontrolled postoperative pain (13%), cardiac (6%), pulmonary (4%), and urinary (3%). Covariates included in the final model were age, sex, cardiac complication, urinary complication, and pulmonary complication. Factors that contributed to increased LOS and their associated adjusted mean days were: ≥50 years of age (2.5 ± 1.2 days), female gender (2.3 ± 1.2 days), and three particular types of complications. The complications that had the largest effect on increased LOS from least to most severe were cardiac (3.5 ± 1.3 days), urinary (4.7 ± 1.3 days), and pulmonary (5.3 ± 1.3 days)., Conclusions:  The information presented in this study may be useful for patients, clinicians, and insurance companies, including precertification and case-management services. Our results can be instrumental in designing future prospective studies using more detailed analyses with more patients, more surgeons, and multiple institutions. [Table: see text].

Between 27% and 53% of new graduates change jobs during the first year of work. One program to address this issue is a national nurse residency program, in which the University of Kansas Hospital has enrolled new graduates since 2003. The purpose of this study was to examine the relationships among job satisfaction, reasons for staying, and satisfaction with the nurse residency program to job commitment and retention of nurses who completed the program.