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Clinic Nurse
No full texthttps://scholarlycommons.baptisthealth.net/one-map-limitless-destintions-2025/1044/thumbnail.jp
Retrospectively Examining the Probability of Acute Skin Failure among Hospitalized Patients with Hospital-Acquired Pressure Injuries
No full textIntroduction: Acute skin failure (ASF) in hospitalized patients is a growing concern and a product of multisystem organ failure. Unlike hospital-acquired pressure injuries (HAPIs), ASF is not preventable despite prevention measures. The Skin Failure Clinical Indicator Scale (SFCIS) was recently developed to assess the probability of ASF. The purpose of this study was to retrospectively examine the probability of and factors associated with ASF in hospitalized individuals with HAPIs.
Methods: Data were collected from the electronic health records of in-patients with stage 3 or greater HAPIs over two years. Collection included demographics, comorbidities, COVID status, wound staging, injury location, SFCIS, and additional clinical indicators. The data analysis plan included descriptive statistics, correlation analyses, and multiple linear regression analysis.
Results: Among 104 participants, the SFCIS scores showed 44% with moderate ASF probability, 34% low probability, and 22% high probability. Correlation analyses showed the following statistically significant positive and negative relationships with SFCIS scores: negative—age; positive—total length of stay (LOS), intensive care unit LOS, admitting diagnosis, comorbid cardiovascular disease, and COVID-19 positive status.
Discussion: Distinguishing between ASF and HAPI is paramount to diagnosis accuracy. Alarmingly, when considering high and moderate probability together, 66% of the sample possibly had ASF, provided that all prevention measures were in place. Our results provide valuable insight to support incorporation of ASF probability assessment into nursing practice to promote early identification, thus potentially preventing HAPI misidentification and the associated negative sequelae. However, more research on the SFCIS’s reliability and validity are needed
Promoting Healthy Diet Adherence using a Multisensory Approach for Post-Stroke Patients: A Pilot Randomized Controlled Trial
No full textIntroduction: Evidence supports a healthy diet for secondary stroke prevention; however, programs to implement nutrition education remain inconsistent. This study assessed the feasibility and efficacy of using a multisensory approach called the “Hands-on Training” program (HOT) to improve healthy diet adherence among patients rehabilitating after stroke.
Methods: This pilot randomized controlled study was conducted at an inpatient rehabilitation facility. Stroke patients were randomly assigned to either an experimental group who received HOT or a control group who received conventional education. The HOT group received real-time meal choice coaching, a healthy meal preparation experience, and additional written education. The Mediterranean Eating Pattern for Americans (MEPA) III Questionnaire evaluated dietary habits at baseline, discharge, and 90-day follow-up. MEPA scores range from 0 to 21, with higher scores reflecting healthier diets.
Results: Twenty patients were enrolled; 18 completed the discharge survey and were included in the initial analysis. Fewer patients completed the 90-day follow-up. Overall mean MEPA scores were 8.15 at baseline, 9.28 at discharge, and 8.75 at follow-up. The HOT group showed a significant improvement in MEPA scores from 7.71 at baseline to 9.43 at 90-day follow-up (p = .008), whereas no significant change was observed in the control group (7.8 at both baseline and follow-up; p \u3e .99).
Discussion: This pilot feasibility study with multisensory learning intervention resulted in statistically significant and sustained improvements in healthy dietary adherence at 90 days post-discharge. Further study with a larger sample is needed to clarify its role in reducing secondary stroke risk
A Case of Monocular Diplopia in the Setting of High-Grade Urothelial Bladder Carcinoma Treated with Pembrolizumab
No full textCase Presentation: We present the case of a 70-year-old male with a history of highgrade urothelial carcinoma who had been treated with multiple cycles of immune checkpoint treatment, pembrolizumab, presenting to the emergency department with worsening bone pain, abdominal discomfort, and hematuria.
Clinical Course: He reported blurry vision and monocular diplopia in the right eye for the past month. Physical examination revealed an inability to fully track with the right eye along with fatigue-induced diplopia, raising concerns for metastatic or immunotherapy-related ocular involvement. Imaging primarily revealed metastatic disease in the right orbital apex involving the rectus muscles, intraconal fat, and optic nerve. A differential diagnosis included metastatic disease, pembrolizumab-induced ocular myositis, and ocular myasthenia gravis. He was diagnosed with a rare presentation of monocular diplopia associated with metastatic urothelial carcinoma and pembrolizumab-induced complications. Radiation Oncology recommended radiation therapy; however, he declined.
Discussion: Early recognition of ocular symptoms in cancer patients is critical for timely intervention and improved care outcomes. This case underscores the complexity of differentiating between metastatic disease and immune-related adverse events (irAEs) in patients on immunotherapy drugs. It highlights the importance of integrating advanced imaging and multidisciplinary consultations to guide diagnosis and management
The Impact of Awake Prone Positioning in the Patient with COVID-19
No full textBackground: Prone positioning has been shown to improve clinical outcomes for sedated, mechanically ventilated individuals with moderate to severe respiratory illnesses. Some studies also show potential benefit to awake individuals with COVID-19.
Objectives: The primary aim of this study was to investigate if hospitalized non-critically ill individuals diagnosed with SARS-CoV-2 who engage in frequent proning are more likely to have improved outcomes compared to non-proning individuals.
Methods: A retrospective cohort design was used to assess outcomes associated with awake prone positioning. A convenience sample was used to select two cohorts of individuals admitted with COVID-19 from April 2020-March 2021. Cohort 1 included 89 individuals who did not engage in awake prone positioning (APP) for at least 3 hours per day, while Cohort 2 included 89 individuals who engaged in APP for at least 3 hours per day. Chart abstraction was used to collect patient demographics, clinical data, and subjective and objective observations related to pronation.
Results: Non-APP individuals were older (mean age 66.9 vs. 57.5; p = .001) and diagnosed with COVID-19 earlier (-0.27 vs. 2.07; p = .004) compared to APP individuals. APP individuals transferred to the ICU (27% vs. 13.5%; p = .03) and required endotracheal intubation (16.9% vs. 6.7%; p = .04) at a higher prevalence than non- APP individuals.
Discussion: APP was not associated with significantly fewer intubations and ICU transfers in this cohort of individuals with COVID-19. Stronger designs, such as randomized controlled trials, are needed to determine when APP is most beneficial in awake patients with COVID-19
Promoting Self-Reflection and Implicit Bias Awareness in Nursing: A Mixed-Method Study Advancing Practice and Fostering Healthcare Equality
No full textBackground: Implicit biases influence how nurses perceive and interact with patients and shape clinical practice. Awareness is crucial because implicit biases are difficult to detect. Our study evaluated how educational sessions impacted awareness and understanding of implicit bias. In our study, we sought to mitigate effects of these biases on patient care to promote equitable healthcare outcomes.
Methods: The research involved registered nurses from all levels employed at nine hospitals. Data were collected anonymously through voluntary participation to ensure confidentiality. A mixed-methods approach with a quasi-experimental prepost design was utilized to measure the effectiveness of the educational session. Descriptive statistics were reported for variables of interest. Differences in proportions and means were reported to evaluate the changes in nurses’ awareness pre- and post-intervention. Open-ended questions further explored the nurses’ perceptions of the session, and the role implicit bias played in perpetuating healthcare disparities.
Results: There were 123 participants in the pre- and 121 participants in the postgroup. Analysis was conducted on 121 matched pairs. Missing data were excluded. All six domains showed improvements in the postassessment. Improvements, with a 23% change, was observed in the impact and perception of bias domains. Three themes emerged from the analysis: Enhanced Awareness, Commitment to Equitable Care, and Strategies for Mitigating Bias.
Conclusion: To promote health equity and reduce disparities, it is critical to educate nurses about implicit bias. Addressing and mitigating biases in healthcare leads to better, more inclusive patient care, supporting optimal health outcomes for diverse populations
Bridging the Gap – Enhancing Nurse Floating Experience
No full texthttps://scholarlycommons.baptisthealth.net/se-2025-smh-bpf/1006/thumbnail.jp
Teamwork in Print: The 5 East Tower Times Effect
No full texthttps://scholarlycommons.baptisthealth.net/se-2025-smh-bpf/1001/thumbnail.jp
A Descriptive Study of Non-Pharmacological Interventions in Early Labor in Nulliparous Term Singleton Vertex (NTSV) Women
No full textIntroduction: Positional changes may contribute to progression of labor in nulliparous women. We investigated the use of non-invasive, non-pharmacological interventions during the first stage of labor in nulliparous, term, singleton, vertex (NTSV) women at a community hospital in the U.S. Another aim was to compare the times from the first intervention to completion of the first stage of labor across three interventions.
Methods: Ours was a descriptive, retrospective study of 98 NTSV women from January to June 2025. Descriptive and inferential statistics were analyzed using Statistical Package for Social Sciences version 27.
Results: Most women were Hispanic (71%), averaging 31 years old (SD = 4.66), with a mean gestational age of 39 weeks (SD = 1.31). Kruskal-Wallis testing indicated a statistically significant difference in mean duration of labor in minutes across the three groups, Χ2(2, 97) = 54.94, p \u3c .001. Pairwise comparisons using Dunn-Bonferroni corrections revealed that the mean rank for the peanut ball group was significantly lower than the CUB device (p \u3c .001) and the WMFMS (p \u3c .001). The peanut ball group was associated with a shorter duration for the completion of first-stage labor by 811 minutes over the wireless maternal fetal monitoring group, and by 679 minutes over the comfortable upright birth device group.
Discussion: Routine implementation of non-invasive, non-pharmacological interventions to support nulliparous women with positional changes that may contribute to a positive birthing experience are needed. Interventions that encourage a non-supine posture and movement during the first stage of labor should be advocated
Pilot Testing the Reliability and Validity of the Modified Obstetric Fall Risk Assessment System
No full textIntroduction: A recent review revealed falls were the second most frequent cause of traumatic injuries during pregnancy. Standard risk assessment tools, such as the Morse Fall Scale (MFS), may not capture the unique risk factors of obstetrical patients. The Obstetric Fall Risk Assessment System (OFRAS) is specific to obstetrical patients. However, evidence of the OFRAS\u27s reliability/validity was not found.
Purpose: To test the reliability and validity of a modified version of the OFRAS.
Methods: This was a cross-sectional pilot study. The target population was nurses within perinatal services units. Data collection consisted of: Part 1 - conducting paired fall risk assessments on actual patients using the MFS and OFRAS-M, including collection of patient demographics, and Part 2 – completion of two scenario-based OFRAS-M assessments. Data analysis included tests for internal consistency, external consistency/interrater reliability, convergent validity (CV), and evaluation of construct validity using exploratory factor analysis (EFA).
Results: Nurses completed 104 OFRAS-M/MFS paired assessments, and 81 and 80 OFRAS-M completions for the low-risk and high-risk scenarios, respectively. Internal consistency/stability of the OFRAS-M was acceptable (Cronbach’s alpha = .764). Fleiss kappa analysis suggested moderate external consistency (k = .55, p \u3c .001; k = .484, p \u3c .001). Pearson\u27s correlation coefficient (r = .649, p \u3c .001) suggested CV. The EFA showed OFRAS-M items loaded onto two factors.
Discussion: The results suggest the OFRAS-M validly and reliably measures fall risk in obstetrical patients. However, testing in a larger sample with confirmatory factor analysis is needed to further validate our results