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The purpose of this qualitative study was to synthesize frontline U.S. nursing perspectives about the current state of U.S. public health emergency preparedness and response. The study findings may inform public health policy change and improve future national pandemic planning and responses.We conducted a secondary thematic qualitative analysis using grounded theory methodology.Data collection occurred through semi-structured, in-depth focus groups between July and December 2020, from 43 frontline nurses working in hospitals in four states (Ohio, California, Pennsylvania, and New York). Data were analyzed deductively, aligned with Khan et al.'s Public Health Emergency Preparedness Framework and inductively for emergent themes.Three themes emerged: (1) Validation of the presence of health disparities and inequities across populations; (2) Perceived lack of consistency and coordination of messaging about pandemic policies and plans across all levels; and (3) challenges securing and allocating nursing workforce resources to areas of need.From a frontline nursing perspective, this study demonstrates the critical need to address health inequities and inequalities across populations, a consistent national vehicle for communication, and national plan for securing and allocating nursing workforce resources.

The purpose of this article is to share gaps in knowledge and research related to pandemic management identified by nurse leaders during the COVID-19 pandemic. As part of a larger Delphi study, nurse leaders responded to an open-ended question about gaps in research they saw as important following the pandemic. Responses were analyzed using directed content analysis. Results are presented as 4 supercategories: Organizational leadership preparedness, adaptive leadership in crisis, innovations in care delivery, and health, well-being, and resilience.

As healthcare faces the great resignation, it is important that nurse leaders understand the impact of generational variations in the recruitment of nursing staff. This article discusses the specific characteristics of millennials and Generation Z nurses and offers suggestions for tailoring recruitment strategies for these 2 generational groups.

The objective of this multisite study was to explore the professional and personal experiences of US nurse managers (NMs) during the COVID-19 pandemic.NMs are the most accessible and visible nurse leaders to the frontline staff during this pandemic.Thirty-nine NMs from 5 health systems across the US participated in focus groups in this qualitative study. Data were analyzed using a constant comparative method.Three major themes were identified: challenges, feelings and emotions, and coping. Subthemes emerged within each major theme.NMs across the country accepted considerable responsibility at great professional and personal consequence during the pandemic. NMs experienced challenges, ethical dilemmas, and expressed negative emotions. As the usual coping strategies failed, NMs reported that they are considering alternative career choices. This work provided evidence to help senior leaders strategize about mechanisms for reducing managerial dissonance during times of stress.

This study reports objective measurements of lower extremity activity (amount of walking, standing, sitting) in nurses working in medical/surgical (M/S) and intensive care units (ICU), and explores nurses’ perceptions of nursing unit design impact on workload, lower extremity activity, and musculoskeletal discomfort. Nursing units are expanding in size, leading to nurses spending more time on their feet. Though limited in number, studies consistently report elevated prevalence of lower extremity discomfort/injury in nurses. This was a mixed method approach using physical activity measurement and semi-structured interviews of M/S and ICU nurses. Lower extremity discomfort was prevalent in the study participants. Time on feet and step counts differed between nursing units with different layouts. Average hours on feet ranged from 7.3 to 9.5 across units over 12-hour shifts. Nurses’ comments explained ways in which walking and standing activities were influenced by unit layout design and culture. Nurse leaders must advocate for unit designs that maximize patient safety, promote a culture of team spirit, and provide a physically safe working environment for staff.

Since the development and introduction of the doctor of nursing practice (DNP) degree in 2004, the number of doctoral-prepared nurses has increased dramatically. The purpose of this article is to review the current challenges faced by DNP-prepared nurses as they enter the acute health care setting, and to share strategies we are exploring to enhance and showcase DNP practices and outcomes. In collaboration with our doctor of philosophy nursing colleagues, it is critical that we conduct studies that document the impact that DNP graduates have on health care organizations and, most importantly, patient outcomes.

Background Anecdotal reports from across the country highlight the fact that nurses are facing major challenges in moving new evidence-based practice (EBP) initiatives into the electronic health record (EHR). Purpose The purpose of this study was to: (a) learn current processes for embedding EBP into EHRs, (b) uncover facilitators and barriers associated with rapid movement of new evidence-based nursing practices into the EHR and (c) identify strategies and processes that have been successfully implemented in healthcare organizations across the nation. Methods A qualitative study design was utilized. Purposive sampling was used to recruit nurses from across the country (N = 29). Nine focus group sessions were conducted. Semistructured interview questions were developed. Focus groups were conducted by video and audio conferencing. Using an inductive approach, each transcript was read and initial codes were generated resulting in major themes and subthemes. Results Five major themes were identified: (a) barriers to advancing EBP secondary to the EHR, (b) organizational structure and governing processes of the EHR, (c) current processes for prioritization of EHR changes, (d) impact on ability of clinicians to implement EBP and (e) wait times and delays. Linking evidence to action Delays in moving new EBP practice changes into the EHR are significant. These delays are sources of frustration and job dissatisfaction. Our results underscore the importance of a priori planning for anticipated changes and building expected delays into the timeline for EBP projects. Moreover, nurse executives must advocate for greater representation of nursing within informatics technology governance structures and additional resources to hire nurse informaticians.

Increasingly, nurse executives are embracing evidence-based practice (EBP). Yet, it takes 17 years to move only 14% of research evidence into practice. Implementation science (IS) aims to reduce this gap through the study of factors that influence dissemination, adoption, implementation, and sustainability of evidence-based interventions. Nurse leaders aiming for EBP must be well equipped to support IS. This article introduces IS, leadership competencies essential for supporting implementation research and practice, and preparing an IS-ready workforce.

The aim of this study was to identify the challenges, barriers, and solutions for conducting nursing administration and leadership science (NALS) research.Evidence from leadership science should be at the forefront of nurse leaders' decision making. Yet, challenges remain in building the evidence and moving it into nursing administration and leadership practice.This study used a Delphi technique with open-ended questions and direct content analysis to evaluate survey responses of members of the Association for Leadership Science in Nursing and American Organization for Nursing Leadership.Open-ended responses were coded to yield super categories and supportive codes for areas with limited evidence to guide leadership practice and the challenges for conducting NALS research.These findings provide future directions for continuously driving NALS research and for building and leveraging leadership science to support nursing administration decision making.

Objective The objective of this study was to explore nurses' experiences and perceptions at selected United States (U.S.) healthcare sites during the COVID-19 pandemic. Background The COVID-19 pandemic brought rapid changes to the healthcare community. While a few studies have examined the early pandemic experiences of nurses in China and Europe, nurses' experiences across the United States have remained relatively underexplored. Design A qualitative study design was used. Methods Using a constructivist grounded theory methodology and methods, we conducted eight focus groups across four hospital sites in the eastern, midwestern and western United States. Registered nurses with a minimum of six months' experience working in all clinical specialties were eligible. Forty-three nurses participated. Data were analysed iteratively using the constant comparative method. The COREQ guidelines supported the work and reporting of this study. Results The nurses experiencing a pandemic (NEXPIC) grounded theory emerged positing associations between four interrelated themes: Challenges, Feelings, Coping and Ethics. Nurses reported Challenges associated with changes in the work environment, community and themselves. They expressed more negative than positive feelings. Nurses coped using self-care techniques, and teamwork within the healthcare organisation. Moral dilemmas, moral uncertainty, moral distress, moral injury and moral outrage were ethical issues associated with nurses' Challenges during the pandemic. Moral courage was associated with positive Coping. Conclusions Awareness of frontline nurses' complex and interrelated needs may help healthcare organisations protect their human resources. This new theory provides preliminary theoretical support for future research and interventions to address the needs of frontline nurses. Relevance to clinical practice Nurses face added distress as frontline at-risk caregivers. Interventions to promote nurses' ability to cope with personal and professional challenges from the pandemic and address ethical issues are needed to protect the nursing workforce. This study offers a new substantive theory that may be used to underpin future interventions.

Objective The aim of this study was to identify and prioritize research topics for nursing administration and leadership science. Background Nursing administration and leadership research priorities should provide a framework for building the science needed to inform practice. Methods The Association for Leadership Science in Nursing (ALSN) and American Organization for Nursing Leadership (AONL) Foundation (AONL-F) for Nursing Leadership and Education collaborated on a Delphi study. Initial input on research priority items were received from ALSN and AONL members. National experts participated in a 3-round Delphi study. Results Top-ranked priorities included: 1) nurses' health, well-being, resiliency, and safety in the workplace; 2) developing and managing a nursing workforce to meet current and future healthcare needs; 3) healthy work/practice environments for direct care nurses; 4) healthy work/ practice environments for nurse leaders; 5) quantification of nursing's value across the healthcare delivery system; and 6) nurse leader development and essential competencies. Conclusions Researchers and funders should use these priorities to guide future studies.

Academic-clinical research partnerships can benefit academic and clinical partners when goals are clearly articulated and mutually determined and include increased research dissemination and lower research costs. This article explores the history of academic-clinical research partnerships and discusses the drivers of collaborative academic-clinical research relationships, resources from academia and clinical sites, and sustainability of collaborative partnerships. Through collaboration, academic-clinical partners can improve clinical outcomes and reduce healthcare costs.

We identify the value and usage of a cognitive artifact used by hospital nurses. By analyzing the value and usage of workaround artifacts, unmet needs using intended systems can be uncovered. A descriptive study employed direct observations of registered nurses at two hospitals using a paper workaround (“brains”) and the Electronic Health Record. Field notes and photographs were taken; the format, size, layout, permanence, and content of the artifact were analyzed. Thirty-nine observations, spanning 156 hr, were conducted with 20 nurses across four clinical units. A total of 322 photographs of paper-based artifacts for 161 patients were collected. All participants used and updated “brains” during report, and throughout the shift, most were self-generated. These artifacts contained patient identifiers in a header with room number, last name, age, code status, and physician; clinical data were recorded in the body with historical chronic issues, detailed assessment information, and planned activities for the shift. Updates continuously made during the shift highlighted important information, updated values, and tracked the completion of activities. The primary functional uses of “brains” are to support nurses’ needs for clinical immediacy through personally generated snapshot overviews for clinical summaries and updates to the status of planned activities.

Aims The aims of the study were to compare characteristics, resources, benefits and outcomes of academic-clinical collaborations of nursing researcher leaders from academic, clinical and joint-employer sites. Background Few research-based publications addressed academic-clinical research collaborations. New knowledge could increase nursing and multidisciplinary research productivity, including implementation science. Design An anonymous survey using a 40-item questionnaire. Methods Information letters with a link to the questionnaire were emailed to United States nursing research leaders. Data were grouped by institution type: academic, clinical or joint-employer. Analyses included Kruskal-Wallis tests for ordered responses, Pearson's chi-square test or Fisher's exact test for categorical responses and Cohen's Kappa agreement statistic for expected and actual time devoted to research. STROBE guidelines were followed. Results Of 120 respondents from academic (n = 60; 50.0%), clinical (n = 53; 41.2%) and joint-employer (n = 7; 5.8%) sites, 78.3%, 92.3% and 100%, respectively, were from metropolitan areas. Mean (SD) priority for active collaborations was higher at joint-employer sites; p = .002. Clinical sites were more likely to have directors of evidence-based practice (p = .031) and informatics (p = .008) and librarians (p = .029). Sites with collaborations were more likely to have access to research subjects (p = .008) and post-award research account management (p = .045). By collaboration status, there were no differences in the number of ethics board-approved studies. Collaborating site benefits were perceived to be executive leadership support (p = .003), greater research engagement by clinical nurses (p = .048), more co-authored publications (p = .048) and more abstracts accepted at national meetings (p = .044). Despite more resources and perceived benefits, outcomes did not differ by collaboration status. Conclusions Sites with and without academic-clinical research collaborations differed; however, outcomes were similar. Future efforts should focus on nurse scientist collaboration to address important clinical questions aimed at improving clinical outcomes. Relevance to clinical practice Despite some successful outcomes, potential benefits of academic-clinical research collaborations have not been fully actualised.

Lower extremity musculoskeletal discomfort (MSD) is prevalent, but understudied, in nurses. A comprehensive, theoretical, aetiological model of lower extremity work-related MSD in hospital in-patient staff nurses was developed through a review of the literature to provide a framework for aetiological and intervention research. The framework informed the design of a survey of 502 hospital staff nurses. Symptom prevalence ranged from 32% in hip/thigh to 59% in ankle/foot regions. Logistic regression modelling using survey data showed that different work and personal factors were associated with discomfort in different regions of the lower extremity. Individual factors (e.g. older age, higher BMI or having any foot condition), physical factors (e.g. higher frequency of patient handling), psychosocial factors (e.g. lower job satisfaction) were associated with discomfort in one or more parts of the lower extremity. Future research should target these factors for intervention, to attempt to reduce occurrence of lower extremity discomfort in nurses. Practitioner Summary: Practitioners may find useful the illustrated, theoretical aetiological model of factors that could influence the prevalence of lower extremity discomfort in nurses. The model could guide conversations with nurses and observational analyses of nursing work. The model and survey results may provide ideas for intervention exploration. Abbreviations: MSD: musculoskeletal discomfort; BMI: body mass index; MSK: musculoskeletal; ICU: intensive care unit; NLERF: nurses' lower extremity MSD risk factor; NASA-TLX: NASA-task load index.

One in 3 patients is estimated to experience health care-related harm during hospitalization. This descriptive, cross-sectional study used the Safety Attitudes Questionnaire to measure interprofessional staff perceptions of safety and teamwork climate and a retrospective, modified Global Trigger Tool chart review methodology to measure unit-level patient outcomes. Safety climate and teamwork did not have a statistically significant relationship with the frequency of adverse events identified by the Global Trigger Tool. Researchers may consider the Global Trigger Tool for detecting unit-level adverse events.

Health systems produce vast amounts of complex, multidimensional data. Health systems nurse leaders, informaticians, and nurse researchers must partner to turn these data into actionable information to drive quality clinical outcomes. The authors review health systems in the era of big data, identify opportunities for health systems-nursing research partnerships, and introduce emerging approaches to data science education in nursing.

Maintenance of a patent airway while the neonate is on nasal continuous positive airway pressure (nasal CPAP) requires vigilant monitoring and oral/nasopharyngeal suctioning. Currently, no evidence-based guidelines for safe suctioning in neonates while on bubble nasal CPAP have been published.(1) To characterize the clinical and behavioral responses of neonates on bubble nasal CPAP in a level III neonatal intensive care unit following routine oral and nasopharyngeal suctioning.This pilot study has a 1-sample within-subject repeated-measures design in which neonates (N = 16) served as their own control. Data on a neonate's physiological and behavior measures (heart rate, respiratory rate, oxygen saturation [SaO2], and Premature Infant Pain Profile [PIPP] score) were collected before, during, and after the completion of suctioning sequence.A total of 16 neonates with a mean gestational age of 29.76 weeks and an average day of life of 3.4 were enrolled. The infant's heart rates did not differ significantly (P = .51) across the suctioning sequence. There were no statistical significant changes in the average respiratory rate across the suctioning sequences (P = .79). SaO2 demonstrated a drop between baseline and after each suctioning (P.001). The PIPP score demonstrated a precipitous increase throughout the procedure (P.001). On average, it took 9.5 seconds (SD = 4.9) to complete the suctioning sequences.Our results suggest that the guideline tested is safe and tolerated by infants.This guideline should be tested in a larger sample and with neonates on other nasal CPAP systems.

Registered nurses have a higher incidence rate of work-related musculoskeletal disorders (MSDs) compared with the overall rate for MSDs in the U.S. Attention has been on back pain in nurses, but the lower extremities are also a frequent site of discomfort in nurses, though only a few studies have reported on this problem, investigations of risk factors are limited, and reports of successful interventions are primarily anecdotal. Studies in other populations have identified prolonged time on one’s feet as a risk factor for various lower extremity problems. This study aims to determine the prevalence of hospital inpatient staff nurses’ lower extremity discomfort and to subjectively and objectively quantify lower extremity physical activities exposure during work, specifically walking, standing, and sitting, and examine any interaction with type of unit or shift, in order to begin to describe the physical loading of the lower extremities in this type of nursing work.

Background In early 2016 the Partnership for Health IT Patient Safety released safe practice recommendations for the use of copy-paste for electronic health record (EHR) documentation. These recommendations do not directly address nurses‘ use of copy-forward to document patient assessments in flow sheet software in hospital settings. Similar to clinicians' use of copy-paste and copy-forward with progress notes, concerns exist about patient safety issues from the use of potential inaccurate or outdated information to achieve increased efficiency of documentation. Methods A multiple-methods approach—which included a literature review, litigation search, stakeholder analysis, and consensus opinion from experts from multiple disciplines—was employed. Results Four recommendations correspond closely with copy-paste guidance for EHR documentation from the Partnership: (1) Provide a mechanism to make copied-forward content easily identifiable, (2) Ensure that the provenance of copied-forward content is readily available, (3) Ensure adequate staff training and education regarding the appropriate and safe use of copy-forward in flow sheet software, if available, and (4) Ensure that copy-forward practices are regularly monitored, measured, and assessed. A fifth additional recommendation is made to improve the efficiency of data entry mechanisms, which may reduce patient safety risk. Emerging promising areas for innovation are to optimize interface usability and flow sheet content, use templates, use digital photographs, and eliminate work-flow steps with better methods for authentication and data entry. Conclusions A thoughtful and measured approach to safe use of copy-forward in flow sheets by nurses in hospital settings is expected to result in improvements in efficiency of documentation, work flow, and accuracy of information.

NURSING RESEARCH IS NO LONGER solely the purview of nursing faculty in academia. Inquiry and science are fundamental to raising the bar in nursing practice, improving the patient experience, and enhancing patient outcomes. Acute care hospital environments provide excellent settings for clinical nurs

Background Moral distress is the psychological response to knowing the appropriate action but not being able to act due to constraints. Previous authors reported moral distress among nurses, especially those that work in critical care units. Aims The aims of this study were: (1) to examine the level of moral distress among nurses who work at an academic health system, (2) to compare the level of moral distress in nurses who work across specialty units at an academic health system, (3) to compare moral distress by the demographic characteristics of nurses and work experience variables, and (4) to identify demographic characteristics and type of clinical setting that may predict which nurses are at high risk for moral distress. Methods A cross-sectional survey design was used with staff nurses who work on inpatient units and ambulatory units at an academic medical center. The moral distress scale-revised (MDS-R) was used to assess the intensity and frequency of moral distress. Results The overall mean MDS-R score in this project was low at 94.97 with mean scores in the low to moderate range (44.57 to 134.58). Nurses who work in critical care, perioperative services, and procedure areas had the highest mean MDS-R scores. There have been no previous reports of higher scores for nurses working in perioperative and procedure areas. There was weak positive correlation between MDS-R scores and years of experience (Rho = .17, p = .003) but no correlation between age (Rho = .02, p = .78) or education (Rho = .05, p = .802) and moral distress. Linking Evidence to Action Three variables were found useful in predicting moral distress: the type of unit and responses to two qualitative questions related to quitting their job. Identification of these variables allows organizations to focus their interventions.

This article describes the initiatives of doctorate of nursing practice (DNP)-prepared nurses in a large healthcare system supporting the DNP competencies as outlined by the American Association of Colleges of Nursing. The goal of this group was to demonstrate the impact of DNP education on the roles for nurse administrators, advanced practice nurses, and educators in a large health system. Exemplars profile nurse administrators, clinical nurse specialists, and a nurse educator.

Introduction Although the safety of water immersion during labor is largely supported by evidence from research, the risks to women and neonates during waterbirth are not well established. The purpose of this study was to generate evidence regarding maternal and neonatal outcomes related to water immersion in labor and during birth. Methods A retrospective cohort study included a convenience sample of women receiving prenatal care at a nurse-midwifery practice. Participants were categorized into 3 groups: 1) waterbirth, 2) water labor, or 3) neither. Participant characteristics, maternal outcomes, and newborn outcomes were collected at time of birth and health record abstraction. At the 6-week postpartum visit, another maternal outcome, satisfaction with birth, was measured using the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale. Analysis included effect size, descriptive statistics (sample characteristics), and maternal and neonatal group differences (analysis of variance and chi-square) with a significance level of P Results Women in the waterbirth (n = 58), water labor (n = 61), and neither (n = 111) groups were primarily white, married, and college educated and did not differ by age or education. Women in the waterbirth group were more likely to be multiparous. Nulliparous women who had a waterbirth had a significantly shorter second stage of labor than nulliparous women who did not have a waterbirth (P = .03). The most commonly cited reasons for discontinuation of hydrotherapy were maternal choice (42.6%) and need for pain medication (29.5%). Significantly more women in the waterbirth group experienced a postpartum hemorrhage, compared with water labor or neither (n = 5, n = 3, n = 1, respectively; P = .045); there was no difference in related clinical measures. Neonatal outcomes were not significantly different. Maternal satisfaction was high across all groups. Discussion The results of this study suggest that waterbirth, attended by qualified intrapartum care providers in hospital settings in the United States, is a reasonable option for low-risk women and their neonates.

Background Oral care is standard practice to prevent hospital-associated infections while patients are intubated and in the intensive care unit. Following extubation and transfer, infections remain an important risk for patients, but less attention is paid to oral care. Few studies have assessed the impact of oral care in recently extubated acutely ill patients. Aims To develop an evidence-based oral care protocol for hospitalized patients and determine the impact of this protocol on health outcomes in recently extubated patients. Methods In this randomized controlled trial, subjects were randomized to usual care or an intervention protocol that included tooth brushing, tongue scraping, flossing, mouth rinsing, and lip care. Major outcome measures were the revised THROAT (R-THROAT; oral cavity assessment) and overall prevalence of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus on oral cultures. Results Seventy-four subjects were randomized. As measured by the R-THROAT, oral cavity health improved over time in both groups, but the intervention group demonstrated significantly more improvement than the control group (R-THROAT score improved by 1.97 intervention vs. 0.87 control; p = .04). Two categories, tongue and mouth comfort, demonstrated the most significant improvement. There was no difference in MSSA/MRSA colonization between the groups at the conclusion of the study. Overall, subjects in the intervention group were more satisfied with their protocol than subjects in the usual care group. Linking Evidence to Action This study offers an important evaluation of an oral care protocol after extubation. Results demonstrated improvement in the oral cavity assessment with the designed oral care protocol. Patients expressed a preference for the intervention protocol, which included a battery-operated toothbrush, higher-quality toothpaste and mouth rinse, tongue scraper, floss, and lip balm. The implementation of an oral care protocol specifically addressing patients in the immediate postintubation is essential.

Background and Purpose: Nurses’ attitudes play an important role in the consistent practice of safe patient handling behaviors. The purposes of this study were to develop and assess the psychometric properties of a newly developed instrument measuring attitudes of nurses related to the care and safe handling of patients who are obese. Methods: Phases of instrument development included (a) item generation, (b) content validity assessment, (c) reliability assessment, (d) cognitive interviewing, and (e) construct validity assessment through factor analysis. Results: The final data from the exploratory factor analysis produced a 26-item multidimensional instrument that contains 9 subscales. Conclusions: Based on the factor analysis, a 26-item instrument can be used to examine nurses’ attitudes regarding patients who are morbidly obese and related safe handling practices.

The aim of this study was to describe differences in associate degree (ADN) and baccalaureate degree-prepared (BSN) nurses' perceptions of top-of-license (TOL) practice.To date, no empirical work has examined whether ADN and BSN nurses approach TOL practice nursing activities differently.We conducted a qualitative pilot study with focus groups to explore the perceptions of a group of ADN- and BSN-prepared nurses concerning nursing activities and their relation to TOL practice.Subthemes emerged differentiating how ADN and BSN nurses perceived their responsibilities related to critical thinking, communication, and patient education. For professional nursing care, 5 subthemes further emerged: (a) approaches to assessment, (b) chart review, (c) psychosocial patient care, (d) documentation, and (e) handoff.The differences identified in approaches to TOL practice activities by educational preparation have implications for staffing patterns that can optimize the contribution of ADN- and BSN-prepared nurses. Further research is indicated.

The aims of this study were to describe nurses' perceptions of nursing activities and analyze for consistency with top-of-license (TOL) practice.The Advisory Board Company expert panel proposed 8 TOL core nursing responsibilities representing practice at its potential. Thus far, no empirical work has examined nursing practices relative to TOL, from staff nurses' points of view.This qualitative study used focus groups to explore perceptions of typical nursing activities. We analyzed activities for themes that described nurses' work during typical shifts.Nurses' full scope of work included TOL-consistent categories, as well as categories that did not exemplify TOL practice, such as nonnursing care. A proposed model was developed, which depicts nurses' total scope of work, inclusive of all activity categories. In addition, hindrances to TOL practice were also identified.Findings from this study can inform leadership imperatives and the development of innovative, sustainable nursing practice models that support nursing practice at TOL.

Purpose/objectives To determine if the use of aromatherapy improves insomnia and other common symptoms in hospitalized patients with newly diagnosed acute leukemia. Design A randomized, crossover, washout trial. Setting An inpatient acute leukemia unit at the Arthur G. James Cancer Hospital and Richard L. Solove Research Institute of the Wexner Medical Center at Ohio State University in Columbus. Sample 50 patients who were newly diagnosed with acute leukemia and hospitalized to receive their initial four weeks of intensive induction chemotherapy. Methods Patients were offered a choice of three scents to be used during the trial: lavender, peppermint, or chamomile. Each patient was randomized to receive either the chosen aromatherapy intervention or a placebo intervention during alternate weeks, with a washout period in between. Sleep quality and other common symptoms were measured. Main research variables Aromatherapy, sleep, insomnia, pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and well-being. Findings Most patients reported poor quality sleep at baseline, but aromatherapy had a statistically significant positive impact. Improvements were noted in tiredness, drowsiness, lack of appetite, depression, anxiety, and well-being because of aromatherapy. Conclusions Aromatherapy is a viable intervention for improving insomnia and other symptoms commonly experienced by patients with acute leukemia. Implications for nursing Oncology nurses can employ aromatherapy safely and inexpensively, and with minimal training, as an effective tool in decreasing many symptoms that plague patients with leukemia. Patients can exercise a greater sense of control over their treatment environments through the use of aromatherapy.

Purpose The pilot study purpose was to determine the effects of a new standardized oral care protocol (intervention) to usual care practices (control) in poststroke patients. Design This study is a randomized controlled clinical trial. Method Fifty-one subjects were enrolled. Subjects in the intervention group received oral care twice a day including tooth brushing, tongue brushing, flossing, mouth rinse, and lip care while control patients received usual oral care. Findings Subjects in the control and intervention groups showed improvement in their oral health assessments, swallowing abilities and oral intake. There were no significant differences between the two groups. Although not statistically significant, overall prevalence of methicillin-resistant Staphylococcus aureus and methicillin-sensitiveStaphylococcus aureus colonization in the control group almost doubled (from 4.8% to 9.5%), while colonization in the intervention group decreased (from 20.8% to 16.7%). Conclusions/Clinical Relevance These findings demonstrate the importance of oral care in the poststroke patient with dysphagia.

Aims The objective of this study was to examine the relationship between measures of coordinated insulin delivery and capillary blood glucose (CBG) levels among hospitalized patients and to assess nurse perceptions of insulin administration. Methods Hospitalized patients ( n = 451) receiving rapid acting insulin analog (RAIA) using carbohydrate counting were retrospectively analyzed. Nurses ( n = 35) were asked to complete an 18-item anonymous survey assessing perception of RAIA dosing. Results The median time from breakfast CBG to RAIA dose was 93 (IQR 57-138) min. There was no association between timeliness measures and mean CBG at lunch or dinner. Hypoglycemia was rare ( N = 2). More than half (54%) of nurses were confident all of the time in determining the correct dose of RAIA, though none were confident in administering it on time. The majority of nurses perceived an electronic dosing calculator and a patient reminder to notify the nurse at the end of the meal favorably. Conclusions The data demonstrate suboptimal coordination of CBG monitoring and insulin doses using a flexible meal insulin dosing strategy, though there was minimal impact on glycemic control. Nurses reported high confidence in the ability to calculate the correct insulin dose but not in the ability to administer it on time.

Moral distress is the psychological response to knowing the appropriate action but not being able to act due to constraints. Previous authors reported moral distress among nurses, especially those that work in critical care units.The aims of this study were: (1) to examine the level of moral distress among nurses who work at an academic health system, (2) to compare the level of moral distress in nurses who work across specialty units at an academic health system, (3) to compare moral distress by the demographic characteristics of nurses and work experience variables, and (4) to identify demographic characteristics and type of clinical setting that may predict which nurses are at high risk for moral distress.A cross-sectional survey design was used with staff nurses who work on inpatient units and ambulatory units at an academic medical center. The moral distress scale-revised (MDS-R) was used to assess the intensity and frequency of moral distress.The overall mean MDS-R score in this project was low at 94.97 with mean scores in the low to moderate range (44.57 to 134.58). Nurses who work in critical care, perioperative services, and procedure areas had the highest mean MDS-R scores. There have been no previous reports of higher scores for nurses working in perioperative and procedure areas. There was weak positive correlation between MDS-R scores and years of experience (Rho = .17, p = .003) but no correlation between age (Rho = .02, p = .78) or education (Rho = .05, p = .802) and moral distress.Three variables were found useful in predicting moral distress: the type of unit and responses to two qualitative questions related to quitting their job. Identification of these variables allows organizations to focus their interventions.

OBJECTIVE The study aim was to describe nurses' perceptions of dynamic patient events (DPEs) impact on workflow and patient care. BACKGROUND The process of determining optimal nurse staffing has challenged nurse leaders for decades. METHODS This study took place on 3 inpatient units in 3 hospitals at a large academic medical center. A qualitative design that included focus groups composed of RNs with a minimum of 1-year experience was used. RESULTS The most commonly identified DPEs were patient travel, code blues, rapid emergency response events, and requirement for an unplanned 1-on-1 sitter. The impact of DPEs influences the nurse's perception on job satisfaction, workflow, patient's safety/satisfaction, and delayed/missed care. CONCLUSION It is incumbent upon nursing leaders to understand DPEs and anticipate how these events impact nursing workload, staffing, and care delivery.

BACKGROUND: Clients with severe mental illness are known to have higher morbidity than the general population, but little is known about their perception of disease burden. OBJECTIVE: This study examined the disease burden in a cohort of community-dwelling persons diagnosed with severe mental illness. STUDY DESIGN: This was a descriptive study that included: interviews, measures of blood pressure, height and weight, and chart audits from 109 volunteers. RESULTS: Mean scores on the Medical Outcomes Study Short Form–12 (MOS SF-12) were compared by gender and five chronic illnesses. The participants had lower scores on the physical (PCS) and mental (MCS) health components of the MOS SF-12 than the general population. Participants with depression, hypertension, arthritis, diabetes, and chronic lung disease scored lower than the general population on the PCS and MCS. CONCLUSION: This study suggests that clients with severe mental illness and physical health problems experience a greater disease burden than do their counterparts in the general population.

A growing body of research on workplace bullying which addresses the detrimental consequences of bullying in nursing has emerged. This quasi-experimental pilot study was aimed at examining the effect of an educational program provided to nursing staff on workplace bullying. The development of an educational program and use of a registered nurse educator in a group setting is an effective method for addressing workplace bullying.

This study describes the incidence of workplace bullying among perioperative RNs, surgical technologists, and unlicensed perioperative personnel in two academic medical centers. The study sought to determine whether the demographic variables of gender, ethnicity, hospital, years of experience on the unit, years in the profession, and job title predict the experience of workplace bullying; whether a relationship exists between workplace bullying and emotional exhaustion; and whether bullying is associated with perceptions of patient safety in the OR. The cross-sectional design included perioperative nurses, surgical technologists, and unlicensed perioperative personnel (N = 167). Fifty-nine percent of the study participants reported witnessing coworker bullying weekly, and 34% reported at least two bullying acts weekly. Having one's opinion ignored is the most common bullying act, with 28% of respondents experiencing being ignored. Differences in the experience of bullying can be found between hospitals and among ethnicities. Emotional exhaustion also was correlated with bullying. The participants did not perceive bullying as affecting patient safety.

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and ultimately fatal disorder of the central nervous system. CJD occurs worldwide with an incidence of approximately .5-1 new cases per million population per year. Despite numerous epidemiological and laboratory studies, the etiologic agent and mode of transmission remain unclear. Clinical diagnosis is challenging and is based on clinical symptoms. No specific treatment is available and medical management remains limited to supportive care. Health care workers must be well informed about necessary precautions and decontamination procedures. Nurses play a major role in providing supportive care, educating community organizations and agencies about CJD and assisting the family through the grieving process.

Purpose: The purpose of this study was to determine the impact of implementation of evidence-based alcohol withdrawal syndrome (AWS) guideline using the Clinical Institute Withdrawal Assessment of Alcohol Scale-Revised scale on care and outcomes of burn patients with comorbid alcohol use and on physician and nurse documentation of alcohol screening, education, and referral. Design: A retrospective medical record review of burn patients (n = 428) was completed. Data were collected on admissions 1 year before implementation of the alcohol withdrawal guideline and 1 year after implementation. Data collection included alcohol use, use of benzodiazepines, sitter use, restraint use, total body surface area, inhalation injury, previous alcohol withdrawal, length of stay, and physician and nurse documentation. Setting: A Midwestern academic medical center with an American Burn Association and the American College of Surgeons verified burn center. Methods: A multidisciplinary team developed evidence-based practice guidelines for the treatment of AWS. Treatment of AWS was evaluated before and after implementation of the new guidelines. Results: Burn severity and inhalation injury were associated with patients at risk for alcohol abuse. There was no difference in the experience of alcohol withdrawal after guideline implementation. Documentation in the medical record of alcohol use, abuse, or previous withdrawal improved after implementation of the guideline. Conclusion: Screening and treatment of alcohol abuse in the burn patient are still less than ideal. Implications: Greater efforts should be directed at managing alcohol withdrawal. An advance practice nurse can make an important contribution.