Proceeding: 3rd Java International Nursing Conference 2015 “Harmony of Caring and Healing Inquiry for Holistic Nursing Practice; Enhancing Quality of Care”, Semarang, 20-21 August 2015

This is the proceeding of the 3rd Java International Nursing Conference 2015 organized by School of Nursing, Faculty of Medicine, Diponegoro University, in collaboration with STIKES Kendal. The conference was held on 20-21 August 2015 in Semarang, Indonesia. The conference aims to enable educators, students, practitioners and researchers from nursing, medicine, midwifery and other health sciences to disseminate and discuss evidence of nursing education, research, and practices to improve the quality of care. This conference also provides participants opportunities to develop their professional networks, learn from other colleagues and meet leading personalities in nursing and health sciences. The 3rd JINC 2015 was comprised of keynote lectures and concurrent submitted oral presentations and poster sessions. The following themes have been chosen to be the focus of the conference: (a) Multicenter Science: Physiology, Biology, Chemistry, etc. in Holistic Nursing Practice, (b) Complementary Therapy in Nursing and Complementary, Alternative Medicine: Alternative Medicine (Herbal Medicine), Complementary Therapy (Cupping, Acupuncture, Yoga, Aromatherapy, Music Therapy, etc.), (c) Application of Inter-professional Collaboration and Education: Education Development in Holistic Nursing, Competencies of Holistic Nursing, Learning Methods and Assessments, and (d) Application of Holistic Nursing: Leadership & Management, Entrepreneurship in Holistic Nursing, Application of Holistic Nursing in Clinical and Community Settings

Pain Management: Knowledge and Attitudes of Senior Nursing Students and Practicing Registered Nurses

Despite scientific advances in pain management, inadequate pain relief in hospitalized patients continues to be an on-going phenomenon. Although nurses do not prescribe medication for pain, the decision to administer pharmacological or other interventions for pain relief is part of nursing practice. Nurses play a critical role in the relief of patients\u27 pain. Some authors have argued that nurses are not well prepared in pain management because of deficiencies in nursing curricula. Over the past ten years, however a significant amount of information about pain management including assessment and intervention for relief has been incorporated into basic programs of study in nursing. Studies have described how clinical environments can induce feelings of reduced self-efficacy and low personal control leading nurses to act in ways which are contrary to their knowledge but are congruent with practices prevalent in the clinical environment. The purpose of the study was to investigate and to compare the knowledge and attitudes of senior nursing students and practicing registered nurses regarding pain management. This descriptive study utilized a convenience sample of registered nurses (n=121) and senior nursing students (n=100) who completed knowledge and attitude tools and a demographic data form. The study was conducted in two private universities and two teaching hospitals in the Midwest. The scores indicate poor performance by both groups, however the practicing nurses\u27 mean score of 74.0% while not reaching the expected 80% level was higher than the student nurses\u27 mean score of 69.5%. On the attitude measurement tool the practicing nurses\u27 mean scores in each category were not significantly different from the student nurses mean scores. Results indicated no evidence of association between education level or age with the knowledge and attitudes of practicing nurses regarding pain management. Experience was not shown to affect attitudes; however there was a slight positive relationship between years of experience and knowledge regarding pain management. The practicing nurse had statistically significant greater knowledge about pain management than did the senior nursing student; nevertheless, there was no significant difference in attitude toward pain management between the two groups. Findings of this study indicate the nursing profession has work to do to fulfill its promise to society to provide safe compassionate care. A structured approach to improving the quality of pain management is required. Education, affective and cognitive, is an essential part of this approach

Nursing Advocacy: A concept clarification in context of procedural pain care

The purpose of this study was to clarify the concept of advocacy in context of procedural pain care and to investigate the implementation of advocacy in that context. First, the concept of advocacy was described on the basis of a literature review (n = 89 empirical studies from 1990 to 2003). Then, the concept was described in the context of procedural pain care on the basis of interview data (n = 22 patients, 21 nurses) in a medical and surgical context. In the second phase, an instrument exploring the content of advocacy and the implementation of advocacy in context of procedural pain care was developed and validated. Then, the content of advocacy and implementation of it was explored in a sample of otolaryngeal patients (n = 405) and nurses (n = 118) in 12 hospitals. In the third phase, an update literature review (n = 35 empirical studies from 2003 to 2007) was conducted, and all data from phases one and two were reviewed in order to refine the elements the concept of advocacy, and the relationships between these elements. As a result of this study, advocacy in context of procedural pain care was defined as consisting of the dual aspects of patient advocacy and professional advocacy, and called nursing advocacy. It was divided into dimensions and subdimensions in which patient and nurse empowerment seems to play a vital role. All the data obtained lend support to this definition of nursing advocacy. Patients and nurses felt that nearly all of the activities that they considered as advocacy were implemented.Siirretty Doriast

Perceptions of Expert Practice by Active Licensed Registered Nurse Therapeutic Touch® Practitioners

Therapeutic Touch® (TT) is a nursing modality, developed in 1972, with a long history of research completion. It is also one of the leading complementary and alternative medicine (CAM) therapies. A comprehensive review of the literature (over 350 studies) from the 1960s to 2015 demonstrated a gap related to delineating expertise related to clinical practice from the view of the practitioner. This study examined the state of expert practice as envisioned by those who themselves qualified as experts in the discipline of TT. This study utilized a qualitative descriptive independent focus group methodology (Krueger, 1994, 2006; Krueger & Casey, 2001, 2009). This methodology has become popular in nursing studies. The choice of a synchronous method to collect data was made to provide a unique environment supported by the online environment with the university-supported platform. Focus groups were used as a stand-alone and self-contained method to conduct the study (Hupcey, 2005; Morgan, 1997). The sample consisted of 12 expert, registered nurse (RN) TT practitioners (TTPs), with a minimum of three years of TT experience. They also had attended a minimum of three TT workshops/courses, which included advanced training in the discipline. The use of electronic media facilitated a sample drawn from three countries across two continents. Six very small, synchronous, online focus groups (Toner, 2009) were conducted to reach data saturation and minimum sample size acquisition. Rich data were collected from these experienced practitioners. Parameters explored were the practitioners\u27 description of expert practice, their own expertise, how research impacted their practice, and the direction TT is headed in the future. Findings were supported by the expert practice literature. Krieger\u27s (2002) concept of transformation was especially apparent in the lives of many of the participants in this study. Respondents described how TT had become an integral part of their lives and influenced their lives immeasurably. The importance of practice as one factor leading to expertise was very apparent among the participants. Many of the studies stress the need for practice in order to gain expertise in specialty practice. TT is a form of specialty practice by nurses, supported in a holistic framework and caring environment. Sharing, which includes mentorship, collaboration, and teaching, is an important part of an advanced practice model, and is apparent in the practice of these advanced TTPs. Expert practice includes the components of expert practice knowledge, which is a necessary prequel to the ability to share it with others. It is also a necessary component to provide leadership to others, to conduct research in the field, and to further one\u27s own practice goals

THE ASSOCIATION OF CYP2D6 AND mu-OPIOID RECEPTOR GENOTYPESAND POSTOPERATIVE NAUSEA AND VOMITING IN ADULT ORTHOPEDIC PATIENTS WITH SINGLE EXTREMITY FRACTURES

Often considered the big little problem, postoperative nausea and vomiting (PONV) is a common surgical complication. Treatment of pain with opioids is the primary cause of PONV although other risk factors include female gender, non smoking status and history of PONV or motion sickness. Research has focused on medications to prevent or treat PONV, and risk factors that contribute to PONV. Genetics may also play a role. The purpose of this study was to explore the association of CYP2D6 and mu-opioid receptor genotypes with PONV in patients with single extremity fractures. Subjects (n=143), aged 18-70 were recruited for this exploratory, descriptive study. Informed consent was obtained. PONV was collected by self-report and chart audit. Saliva samples were collected for DNA extraction. Results of Taqman® allele discrimination were used to assign a CYP2D6 classification of poor metabolizer (PM), intermediate metabolizer (IM) extensive metabolizer (EM) and ultrarapid metabolizer (UM). Two SNPS of the mu-opioid receptor gene were analyzed, A118G and C17T by Polymerace Chain Reaction (PCR). Due to genetic differences within ethnic groups, only Caucasians (n=112) were included in the CYP2D6 analysis. The incidence of PONV in the PACU was 38%, increasing to 50% when assessed for 48 hours. CYP2D6 classification results were: 7 (6%) PM group; 34 (30%) IM group; 71 (63%), EM group; and no ultrarapid metabolizers. Gender and history of PONV were significant risk factors in this study (p<.05). There was a trend for age (p=.071), but smoking was not significant (p=.505). The CYP2D6 EM group served as the reference for binary logistic regression analysis which revealed a significant difference with the CYP2D6 PM group for presence of PONV (p =.003). The sample size for the mu-opioid receptor genotype analysis was 82, the genotype distribution was 58 (70%) AA or CC (wild type) and 24 (30%) polymorphism (AG, GG, CT, or TT were combined). No statistical differences were found in the mu-opioid receptor genotype groups for PONV. Ultimately personalized medicine will allow health care providers to treat all patients individually, so it is important for clinical genetic research to identify those risks that may lead to a negative outcome

An evaluation of the palliative care unit at Groote Schuur Hospital

Background: Patients often present to the Emergency Department (ED) at the end of life. Caring for these patients present a unique set of challenges, and often the patients' and families' needs are at odds with the pervasive rescue-oriented ED culture. A potential solution to this problem is an Acute Palliative Care Unit. Groote Schuur Hospital opened such a unit in April 2011, managed by the ED staff. This kind of service was not available in this tertiary, academic state hospital prior to that. Objectives: This study aimed to evaluate aspects of care at the Groote Schuur Hospital Palliative Care unit by designing a questionnaire based on the Liverpool Care Pathway assessing elements of care, describing the population admitted demographically, recording outcomes and making recommendations based on the findings. Methods: A retrospective folder review was completed on all patients who were admitted to the unit between April 2011 and May 2013. Data was collected onto an Excel spreadsheet, and was analysed using the SmallStata 13 software package. Demographic data collected included sex, age, area from which the referral came, diagnosis, length of stay and outcomes. Data on care were grouped into physical care, psychological care, spiritual care, communication skills and bereavement care. Results: 176 folders were identified. 167 were reviewed (nine were missing). Nine folders did not meet inclusion criteria. 158 folders were included in the study. The vast majority of patients were admitted from home via the ED. Mean age was 59.49 years (95% CI 56.76 – 61.53). Median length of stay was 25 hours (IQR 7-47). 97 patients had palliative care needs in the absence of malignancy, 60 had cancer. 111 (70.7%) patients died in the unit, 5 (3.18%) died en route to the unit, 16 (10.19%) went home, 8 (5. 1%) were referred back to other specialities and 17 (10.83%) were referred to step down facilities. 96% of patients had their medication adjusted, and 128 (81.53%) were commenced on syringe drivers. Morphine, haloperidol and hyoscine butyl bromide were the commonest prescribed medicine in the syringe driver. None of the patients had an official "Do Not Resuscitate" (DNR) form completed, but more than 75% of patients had a note or clear proxy measures indicating that resuscitation is not indicated. Difficulty with communication was present in 8 (5.26%) patients and 10 (6.58%) families. Less than 15% of patients had documented psychological support and less than 30% had documented spiritual care. Bereavement care was also poorly documented. Conclusion: This study described the demographics of, and evaluated the care offered in the Groote Schuur End-of-Life unit. Much of the care is comparable to current recommendations, but there is concern that symptoms may be underestimated in the absence of formal tools. Recommendations include using different terminology w.r.t. the unit, establishing a consulting and outpatient service based at the hospital, implementing formal symptom assessment tools, implementing the formal policy w.r.t. DNR orders, and improved overall documentation. There is scope for further research on interventions such as this one, especially on its impact on staff and its cost-effectiveness. This model of care achieves care comparable to current global recommendations in end-of-life care and can be implemented in similarly resource-restricted contexts

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

The effect of using a turn clock to cue patient repositioning for pressure ulcer prevention in an acute care setting

Hospital-acquired pressure ulcers, a nursing care quality indicator, are becoming increasingly common in United States acute care facilities. In fiscal year 2007, the Centers for Medicare and Medicaid Services (CMS) recorded 257,412 “avoidable” Stage III and Stage IV pressure ulcers acquired in our nation’s hospitals on patients who were admitted to receive care for their primary diagnosis (CMS, 2007). Pressure ulcers are associated with pain and suffering, loss of function, increased length of stay, increased morbidity and mortality, and significant financial burden (Ayello & Lyder, 2008). In October 2008, the CMS discontinued payments for additional costs associated with pressure ulcers acquired during hospitalization, leading to significant financial implications for acute care facilities and increased interest in pressure ulcer prevention programs (CMS, 2008). Repositioning patients approximately every two hours is a foundational element in preventing pressure ulcers (Ayello & Lyder, 2007). The purpose of this investigation was to determine if there is a difference in documented patient care staff repositioning behaviors when a turn clock is used to cue patient repositioning. Data collected can assist nursing leadership in improving pressure ulcer prevention, thus increasing patient safety. This investigation utilized a convenience sample of patient care staff (N = 38) on the oncology unit of a midwestern regional medical facility. Patient care staff assigned to patients with a pressure ulcer risk assessment score on the Braden Scale of 18 or less were included in the investigation. A power analysis provided an estimated result of 392. For both the pre-intervention phase (not cueing with a turn clock) and the intervention phase (cueing with a turn clock) of the investigation, 392 patient care staff documentations of “every two hour” patient repositions were assessed (N = 784). The data were obtained from the facility’s electronic medical record repositioning documentation. The research question was, “In the acute care setting, is there a statistically significant difference between documented patient care staff repositioning behaviors cued with a turn clock (post-intervention) and those not cued with a turn clock (preintervention)?” This question included several comparison analyses. Pre-intervention and post-intervention repositioning documentation for positioning intervals were compared. Pre-intervention data (n = 392) revealed 289 repositions occurring approximately every two hours while 103 repositions did not occur approximately every two hours. Post-intervention data (n = 392) results showed an increase to 318 repositions occurring approximately every two hours with a decrease to 74 repositions that did not occur approximately every two hours. A chi-square analysis was computed to determine if there was a difference between the number of times that staff documented repositions approximately every two hours. Findings indicated that staff cued with a turn clock were significantly more likely to reposition their patients approximately every two hours than staff who were not cued with a turn clock, X2 (1, N = 784) = 6.14, p \u3c .05. A post-hoc analysis was completed on the post-intervention data to compare the documented positions with the positions specified on the turn clock-repositioning schedule. Only the documented intervals that included a lateral or back reposition in the bed were included (N = 313). A sign test analysis was computed to determine whether the number of correctly documented positions (n = 169) was significantly greater than the number of incorrectly documented positions (n = 144) and if the number of correctly documented positions was greater than chance. Findings indicated that the correctly documented positions were not significantly greater than the incorrectly documented positions (p = .0874), thus the probability of a correctly documented position were no greater than chance based on the specified .05 significance level. Results of this investigation have shown that use of the turn clock as a cue for patient repositioning significantly increased documented staff repositioning behaviors at approximately every two-hour intervals. However, the turn clock was not shown to be an effective means for ensuring repositions to specified positions

BMC Geriatr

BackgroundUrinary tract infections (UTIs) are the most commonly treated infection among nursing home residents. Even in the absence of specific (e.g., dysuria) or non-specific (e.g., fever) signs or symptoms, residents frequently receive an antibiotic for a suspected infection. This research investigates factors associated with the use of antibiotics to treat asymptomatic bacteriuria (ASB) among nursing home residents.MethodsThis was a cross-sectional study involving multi-level multivariate analyses of antibiotic prescription data for residents in four nursing homes in central Texas. Participants included all nursing home residents in these homes who, over a six-month period, received an antibiotic for a suspected UTI. We investigated what factors affected the likelihood that a resident receiving an antibiotic for a suspected UTI was asymptomatic.ResultsThe most powerful predictor of antibiotic treatment for ASB was the presence of an indwelling urinary catheter. Over 80 percent of antibiotic prescriptions written for catheterized individuals were written for individuals with ASB. For those without a catheter, record reviews identified 204 antibiotic prescriptions among 151 residents treated for a suspected UTI. Almost 50% of these prescriptions were for residents with no documented UTI symptoms. Almost three-quarters of these antibiotics were ordered after laboratory results were available to clinicians. Multivariate analyses indicated that resident characteristics did not affect the likelihood that an antibiotic was prescribed for ASB. The only statistically significant factor was the identity of the nursing home in which a resident resided.ConclusionsWe confirm the findings of earlier research indicating frequent use of antibiotics for ASB in nursing homes, especially for residents with urinary catheters. In this sample of nursing home residents, half of the antibiotic prescriptions for a suspected UTI in residents without catheters occurred with no documented signs or symptoms of a UTI. Urine studies were performed in almost all suspected UTI cases in which an antibiotic was prescribed. Efforts to improve antibiotic stewardship in nursing homes must address clinical decision-making solely on the basis of diagnostic testing in the absence of signs or symptoms of a UTI