Shared Decision Making and Decision Aids: An Important Part of Evidence-Based Practice

Requisite knowledge, skills, and attitudes for incorporating patient and family values and goals into clinical decision making is an essential part of the evidence-based practice (EBP) process that needs more attention in nursing education. Use of shared decision making (SDM) and decision aids (DAs) by clinicians in practice is limited (Couët et al., 2015). Little or no SDM content in graduate nursing programs may, in part, explain the gap. Therefore, the authors of the current article created a learning activity on SDM and DAs to address this gap

Differences Between Blacks and Whites With Coronary Heart Disease in Initial Symptoms and in Delay in Seeking Care

BACKGROUND: Mortality rates for coronary heart disease are higher in blacks than in whites. OBJECTIVES: To examine differences between blacks and whites in the manifestation of symptoms of coronary heart disease and in delay in seeking treatment. METHODS: Patients were directly observed as they came to an emergency department with symptoms suggestive of coronary heart disease. The sample included 40 blacks and 191 whites with a final diagnosis of angina or acute myocardial infarction. RESULTS: After controlling for pertinent demographic and clinical characteristics, logistic regression analysis revealed that blacks were more likely than whites to have shortness of breath (odds ratio = 3.16; 95% CI = 1.49-6.71; P = .003) and left-sided chest pain (odds ratio = 2.55; 95% CI = 1.10-5.91; P =.03). Blacks delayed a mean of 26.8 hours (SD = 30.3; median = 11 hours), whereas whites delayed a mean of 24.4 hours (SD = 41.7; median = 5 hours) in seeking care. Mean delay time was not significantly different for blacks and whites; differences in median delay time were of borderline significance (P = .05). CONCLUSIONS: Blacks were more likely than whites to have shortness of breath and left-sided chest pain as the presenting symptoms of coronary heart disease. Differences in delay in seeking treatment were not significant, although blacks tended to delay longer than did whites. The relatively small number of blacks may account for the lack of observed racial differences in both initial symptoms and in delay in seeking treatment

Sex and Race Differences in Electrocardiogram Use (The National Hospital Ambulatory Medical Care Survey)

There are sex and race differences in many aspects of health care delivery. For example, blacks and women are less likely to receive aspirin and thrombolytic drugs. Blacks and women presenting with chest pain are less likely to be referred for cardiac catheterization. Blacks and women diagnosed with acute myocardial infarction (AMI) are also less likely to undergo cardiac catheterization. The gender differences in diagnostic evaluation after AMI appear more pronounced among younger women. The American College of Cardiology and the American Heart Association joint electrocardiography guidelines state that all patients presenting to the emergency department (ED) with chest pain should undergo electrocardiography (ECG) to rule out acute ischemia or infarction, regardless of sex or age. It is possible that sex and race differences exist in the administration of this important screening tool among patients with chest pain, possibly reflecting a lower suspicion of coronary heart disease in women (especially young women) and blacks. These management differences may result in failure to diagnose coronary heart disease and may explain why these subgroups are referred less often for cardiac catheterization. Therefore, the purpose of this study was to examine whether this basic guideline is being implemented uniformly in a national sample of patients presenting to the ED with chest pain. Specifically, we hypothesized that young women and blacks presenting with chest pain would be significantly less likely to undergo ECG relative to their white male counterparts

Delirium Prevention, Identification and Management in the Oncology Setting: A Unique Partnership with Patients and Their Family Caregivers

Significance & Background: Delirium affects a significant number of hospitalized adults each year resulting in negative patient outcomes and family caregiver distress. Clinical identification of delirium by nurses and use of family caregivers as part of a multicomponent delirium prevention strategy are not consistently implemented in the practice setting despite being best practice.Purpose: An interdisciplinary team in this 800 bed level one trauma center has been created to create and implement this best practice delirium protocol. The purpose of this initiative was to incorporate the family caregiver into this existing multicomponent delirium prevention, detection and management protocol. Interventions: Consistent implementation of basic care interventions and personalized care for at risk patients can help to prevent delirium in the acute care setting. The team has focused on staff education on the use of the CAM (confusion assessment method) as a consistent delirium-screening tool as well as early implementation of the protocol. Use of non-pharmacological interventions can be effective in the prevention of delirium as well as in reduction of the episode if it does occur. Family caregivers can be educated and engaged by the nurse to help create a personalized plan of care. Evaluation: Evaluation of the protocol has been measured by hospital safety and quality metrics such as falls, length of stay, mortality rates as well as patient experience scores.Discussion: Oncology patients are at high risk for delirium and require a team approach to identify this medical emergency early and to begin evidenced based interventions. Cancer care is most often done in the out patient setting making partnerships with family caregivers even more critical. Non-pharmacological interventions are simple and easily taught to family caregivers. These interventions include encouragement of food and drink, ambulation, cognitive stimulation/orienting strategies and protected rest. This opportunity of partnership is missed by nurses and contributes to poor outcomes.Innovative: The identification and treatment of delirium is becoming an international priority as its negative impact to quality of life and the bottom line become undeniable. This medical emergency requires a team approach that includes the family caregiver and a personalized plan of care. The oncology nurse is poised to be an important team member to create positive outcomes

A Partnership Between Nursing Faculty, Students, and Urban Community Centers to Provide Vision Screenings for Low-income Immigrant Women: An Experiential Case Study

Given the current health care climate, it is critical for nurse educators to provide learning opportunities for students to collaborate with leaders in the community to provide much-needed services to vulnerable populations. We developed, implemented, and evaluated a process for vision screenings and referrals to a local eye center for low-income, immigrant women over three years in an urban setting in the United States. This is a report on the program, including the challenges faced by the faculty and lessons learned by the nursing students

Health Professions Faculty Beliefs, Confidence, Use, and Perceptions of Organizational Culture and Readiness for EBP: A Cross-sectional, Descriptive Survey

Background: Evidence-based practice (EBP) is an essential skill and ethical obligation for all practicing health professions clinicians because of its strong association with improved health outcomes. Emerging evidence suggests that faculty who prepare these clinicians lack proficiency to teach EBP

Presentation and Symptom Predictors of Coronary Heart Disease in Patients With and Without Diabetes

The aims of this prospective, observational study were to compare: (1) symptom presentation of coronary heart disease (CHD) between patients with and without diabetes and (2) symptom predictors of CHD in patients with and without diabetes. We directly observed 528 patients with symptoms suggestive of CHD as they presented to the ED of a 900-bed cardiac referral center in the northeastern United States. There were no significant differences in symptom presentation of CHD between patients with and without diabetes, although patients with diabetes were slightly more likely to present with shortness of breath (P =.056). Patients with diabetes reported their symptoms to be more severe compared with those without diabetes (P =.036). Neck/throat pain and arm/shoulder pain were of borderline significance in predicting CHD in patients with diabetes (P =.059 and P =.052, respectively). Classic chest symptoms and diaphoresis were independent predictors of CHD in patients without diabetes (P =.002 and P =.049, respectively). The perceived severity of symptoms was not predictive of CHD in patients with or without diabetes. Symptoms thought to be diagnostic of CHD are not helpful in patients with diabetes. Future research should focus on identifying more useful predictors of CHD in patients with diabetes

Using Simulated Family Presence to Decrease Agitation in Older Hospitalized Delirious Patients: A Randomized Controlled Trial

Background: Simulated family presence has been shown to be an effective nonpharmacological intervention to reduce agitation in persons with dementia in nursing homes. Hyperactive or mixed delirium is a common and serious complication experienced by hospitalized patients, a key feature of which is agitation. Effective nonpharmacological interventions to manage delirium are needed. Objectives: To examine the effect of simulated family presence through pre-recorded video messages on the agitation level of hospitalized, delirious, acutely agitated patients. Design: Single site randomized control trial, 3 groups x 4 time points mixed factorial design conducted from July 2015 to March 2016. Setting: Acute care level one trauma center in an inner city of the state of Connecticut, USA. Participants: Hospitalized patients experiencing hyperactive or mixed delirium and receiving continuous observation were consecutively enrolled (n = 126), with 111 participants completing the study. Most were older, male, Caucasian, spouseless, with a pre-existing dementia. Methods: Participants were randomized to one of the following study arms: view a one minute family video message, view a one minute nature video, or usual care. Participants in experimental groups also received usual care. The Agitated Behavior Scale was used to measure the level of agitation prior to, during, immediately following, and 30 minutes following the intervention. Results: Both the family video and nature video groups displayed a significant change in median agitation scores over the four time periods (p \u3c .001), whereas the control group did not. The family video group had significantly lower median agitation scores during the intervention period (p \u3c .001) and a significantly greater proportion (94%) of participants experiencing a reduction in agitation from the pre-intervention to during intervention (p \u3c .001) than those viewing the nature video (70%) or those in usual care only (30%). The median agitation scores for the three groups were not significantly different at either of the post intervention time measurements. When comparing the proportion of participants experiencing a reduction in agitation from baseline to post intervention, there remained a statistically significant difference (p = .001) between family video(60%) and usual care (35.1%) immediately following the intervention Conclusion: This work provides preliminary support for the use of family video messaging as a nonpharmacological intervention that may decrease agitation in selected hospitalized delirious patients. Further studies are necessary to determine the efficacy of the intervention as part of a multi-component intervention as well as among younger delirious patients without baseline dementia

Implementation and Evaluation of a Physical Activity and Dietary Program in Federal Incarcerated Females

The purpose of this 3-month quasi-experimental pilot study was to examine the effect of a physical activity and dietary education program on body mass index (BMI) and resilience. Participants were given data-storing pedometers to record their physical activity, attended classes on healthy eating, and used portion control tools from http://ChooseMyPlate.gov . MyPlate usage and commissary purchases were collected weekly. BMI and resilience scores were measured at baseline, 6 weeks, and 12 weeks. Twenty-nine female prisoners completed the study. There was a statistically significant reduction in BMI after 12 weeks (χ2 = 7.56, p = .023) and resilience levels increased but did not reach statistical significance (χ2 = 1.66, p = .437). A physical activity and dietary intervention delivered by a correctional health nurse practitioner was an efficacious approach to reducing BMI and improving resilience among female prisoners

Enteric Absorption of Ciprofloxacin During Tube Feeding in the Critically Ill

To determine the pharmacokinetic properties of ciprofloxacin in the critically ill, we studied seven mechanically ventilated patients with pneumonia during entcral feedings. Subjects received ciprofloxacin 750 mg every 12 h via nasogastric tube and serial serum drug concentrations were measured after the first and fourth dose. After the initial dose, the maximum serum concentration ranged from 1.24–3.06 mg/L, and the area under the time curve from 0–12 h ranged from 3.2–19.65 mg.h/L. Similar levels were noted after dose four. Gastrointestinal absorption of ciprofloxacin in tube fed critically ill patients was decreased, but well above MIC values for many pathogenic bacteria