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Asthma Adherence and Self-Management in Pediatrics: A Quality Improvement Project
No full textThe purpose of this pilot project was a quality improvement initiative aimed to assess various interventions designed to enhance treatment adherence amongst pediatric patients in an understaffed, underserved, rural area. It had three goals: boost interdisciplinary understanding of asthma, promote self-management amongst pediatric patients with asthma, and reduce additional clinic and emergency department visits, as well as hospitalizations.Asthma, a chronic condition characterized by airway inflammation, affects over four million children in the US, impacting their quality of life. The condition manifests through a series of symptoms like wheezing. Without proper management, severe asthma can cause lifelong complications in pediatric patients. Nonadherence to treatment is a significant contributor to exacerbation and uncontrolled asthma.An asthma intervention bundle was implemented to assess its impact on the self-management of 30 patients. The bundle included appointment and medication reminders, an Asthma Control Test survey, an Asthma Action Plan, and medication reconciliation. The interdisciplinary team at the underserved pediatric pulmonary clinic received an educational session on asthma and resources to assist in implementing the bundle.The outcome of the interdisciplinary team knowledge increased by two points from a median pre-test score of 9.0 to a post-test score of 11.0. There was a decrease in emergency department visits, extra clinic visits, and hospitalizations recorded. The Asthma Control Test survey reflected an overall enhancement of self- management and decreased in patients\u27 symptoms.The implications for practice showed the pilot project had an impact for each intervention on clinic operations and patient adherence to asthma management plans. The project underscored the effects of resource scarcity on the clinic. Approximately 71% of patients attended their appointments, and a mere 7% brought their medications. However, there was a decrease in emergency visits from 30% at the beginning of the project to 10% at the end of project implementation.The Asthma Action Plan proved beneficial for patients and families. Although it was found to be time-consuming for documenting by the healthcare team, it was beneficial in the long run upon patient return visits
Innovation in Midwifery Competency-Based Simulation by Implementing Wearable Birth Simulators
No full textSimulation-based learning provides students the opportunity to apply knowledge and practice clinical skills in a safe environment1. Traditional simulators are standard in most nursing and midwifery curriculum. To improve communication with the simulated patient and allow active participation, an innovative wearable birth simulator was implemented into the nurse midwifery graduate program. This tool adds another level of realism and engagement that traditional simulators lack2. The simulated patient wearing the birth simulator can respond to all questions, move and mimic labor varying on its stage, and deliver in different positions. In this research, the wearable birth simulator is used during a scenario focused on shoulder dystocia. This simulation allows the student to run-through clinical skills and practice communication with the patient related to the topic. This birth complication needs repetition in a safe setting to support meeting program competency standards.The purpose of this research is to evaluate the implementation of the wearable birth simulator during a shoulder dystocia simulation using the Simulation Effectiveness Tool-Modified (SET-M). Set-M has a Cronbach alpha = .936. It has 19 criteria divided into three aspects of simulation: pre-briefing, simulation, and debriefing. The data shows students (N=9) met performance benchmarks in all three sections of pre-briefing, birth simulation, and debriefing. All 19 items were scored on a 3-point Likert Scale that supports meeting learning objective toward clinical competency and communication with the patient for this birth complication3.Benchmarks were set at 2.0 for each criterion with responses ranging from 2.56 - 2.78. Students were given an opportunity to disclose qualitative feedback after completing the SET-M survey. Feedback from students suggests further development of the scenario is needed related to improvement of communication between student and nursing staff within the simulation.
With competency-based accreditation in the United States, for midwifery education, it is important to demonstrate student preparedness for clinical practice4. The use of a wearable simulator offers an innovative level of simulation for both the student and nurse midwifery programs. Ongoing research into the of application wearable birth simulators and its continuing effects on clinical proficiency is necessary5
A Research Study of Art-Based Pedagogy in Nursing Education
No full textObjective: Art-based pedagogy (ABP) is a non-prescriptive teaching strategy that facilitates understanding of multiple perspectives and connects students and educators in the learning process (Obara et al., 2022; Rieger et al., 2020; Rieger & Chernomas, 2013). One nursing school has incorporated this approach in its undergraduate nursing research course. This cross-sectional study aims to evaluate the impact of incorporating ABP in the curriculum.Background: This investigation was guided by David A. Kolb’s Experiential Learning Theory (Kolb & Kolb, 2009; Rieger & Chernomas, 2013). This educational theory, which focuses on adult learners, emphasizes participation and reflection to promote student engagement and knowledge development. This theory can help structure nursing pedagogy and inform the use of specific strategies to improve critical thinking skills and result in transformational learning among nursing students (Kolb & Kolb, 2009; Rieger & Chernomas, 2013). Evaluating the use of ABP in nursing education can be useful in guiding effective curriculum development in nursing theory and research (Fowler et al., 2021; Rieger et al., 2020; Sandberg, 2024).Methodology: In one course, small groups of students were each assigned a theorist with global impact in health, education, and nursing. Students are invited to express their perceptions of the theorist visually by using various art media, including markers, colored pencils, craft paper, stickers, die-cut shapes and figures, and then disseminate their interpretation to their class peers. This exercise in ABP is intended to provide students an opportunity to improve skills in observation, problem-solving, critical thinking, team building, empathy, resilience, and cultural sensitivity (Anglin et al., 2020; Ferrara et al., 2020; Fowler et al., 2021; Sandberg, 2024). If a student elects to participate in the research study after completing the course, they will complete a survey using the Educational Practices Questionnaire, which has been validated in multiple languages for nursing education (Franklin et al., 2014; National League for Nursing, 2005).Results and Discussion: Findings will be available in the summer of 2025. The results of this investigation may be applied to expand the ABP curriculum for students in this nursing program. Additional research is needed to further delineate the potential role of ABP in nursing education
Effectiveness of Telenursing on Self-Management in Geriatric Patients With Heart Failure
No full textHeart failure (HF), a syndrome caused by heart abnormalities, affects up to 20% of those over 75, leading to symptoms like dyspnea, fatigue, and edema. Effective self-management in HF involves adherence to medications, nutrition, exercise, symptom monitoring, and timely healthcare-seeking behavior. Telenursing offers remote support through virtual platforms, which research suggests may reduce hospital readmissions and improve the quality of life in HF patients. This study aims to explore the impact of telenursing on self-management in elderly HF patients, addressing gaps in knowledge about symptom control, self-care capacity, and quality of life. A systematic review was conducted using studies from PubMed, Cochrane Library, Scopus, Web of Science, Medline (OVID), and CINAHL databases from April 3 to April 5, 2024. Keywords related to Heart Failure, Telenursing, Telemedicine, Aged, Geriatrics, Nursing Care, Self-Management, and Self Efficacy were used. The protocol was registered on PROSPERO. Eight studies met the inclusion criteria, consisting of one pilot study, one subgroup analysis, and six randomized controlled trials, with a total sample of 2,836 participants. Studies were conducted in the U.S., Sweden, Australia, Japan, Germany, Korea, and the Netherlands, using interventions such as computer-based training, telephone support, telemonitoring, web-based education, and mobile apps. Analysis showed that web-based cognitive training and tailored self-care education significantly improved self-care in HF patients. Participants in web or app-based programs showed better self-care outcomes than those in standard care, and remote monitoring programs led to improvements in self-care behaviors. Advances in information technology have provided new means to connect with patients, assess health, deliver information, and provide support. Teleservices, particularly in rural and elderly populations with limited access to healthcare, are cost-effective and support long-term management of chronic diseases, such as HF, which often require frequent visits for monitoring. This study highlights the effectiveness of telenursing practices in nursing practices and its contribution to patient care by revealing the positive effects of telenursing practices on self-care management, symptom control and quality of life in elderly heart failure patients
From Research to Practice: The Development and Evaluation of a National Nurse Residency Program
No full textOver the last decade, many employers internationally have addressed the transition issues new nursing graduates experience by providing formal 6 to 12 month nurse residency programs to reduce stress, foster workforce integration and competency, and decrease nurse turnover. The increasing international demand for nurses, compounded by the COVID-19 pandemic, further underscores the need for structured support systems to help new nurses navigate their transition into practice.
Our research aim is to (a) determine whether participation in a 6-month structured and formalized Nurse Residency Program (NRP) impacts nurse residents’ stress, competence, and confidence integrating into the registered nurse role; (b) understand the experiences contributing to their clinical competency during the transition to the professional nursing practice role.
The purpose of this presentation is to (a) showcase the evidence-based components of the Canadian Association of Schools of Nursing (2024) Nurse Residency Program and (b) explain the longitudinal evaluation research.This mixed-method study examines the impact of the NRP on new graduate transition. Using a longitudinal, cross-sectional correlational survey design, we examine the impact of a residency program on nurse residents’ clinical competence, levels and underlying causes of stress, and retention as professional nurses. Using a qualitative description approach, interviews and focus groups are used to advance our understanding and interpretation of the complex social interactions that exist in the everyday world of the newly graduated nurse, influencing and impacting on their professional role transition experience. Data is being collected from a national population sample of 300 Nurse Residents enrolled by their employers in the NRP, preceptor-mentors providing integration support, and managers supervising the nurse residents.We contend that the introduction of a national residency program for new nurses in Canada, along with research evidence supporting the value of such programs, offers a much-needed solution to the current nursing retention crisis. This research provides further evidence of the need for programs to address these transition challenges and promote competency integration of new graduates to flourish in the profession to meet global health human resource demands
Universal Screening of Intimate Partner Violence During Pregnancy: A Scoping Review
No full textBackground: Intimate partner violence (IPV) during pregnancy is a significant public health issue and leads to severe consequences for both the mother and fetus, including risks of preterm birth, low birth weight, and maternal psychological distress such as depression, anxiety, PTSD, and even maternal mortality. Despite its prevalence, comparable to conditions like gestational diabetes and preeclampsia, there is no global universal screening protocol for IPV.Objectives: This presentation covers the findings and discussions on a scoping review with the content of (1) existing clinical guidelines and practices for IPV screening across different countries; (2) current screening methods and tools, and (3) universal screening implementation.Results: Recommendations on universal screening vary across countries including US, UK, Australia and New Zealand. We highlighted challenges such as victim awareness, healthcare providers’ knowledge and training, and structural barriers in healthcare systems. Regarding the screening tools, we found there is a need for a valid and reliable screening tool, targeting pregnant women. Also, scientific evidence supporting the screening program, and integrating education, testing, clinical services, and program management are lacking. Apart from self-reporting, we explored potential biomarkers related to IPV, including inflammatory indicators, epigenetic and genetic influences, and various chemical compounds and proteins.Conclusion: With the advancement of digital technology and various biomarkers identification, screening and detecting IPV in clinical settings can be conducted systemically. A systems-level interventions with academia-community-industrial partnerships can help connect pregnant women to desire support services to avoid adverse maternal and child health outcomes
Patient Education Following Acute Stroke and Transient Ischemic Attack
No full textBackground: Stroke and transient ischemic attack (TIA), have an increasing impact on society through medical costs, low wages, and the burden on society and individuals. To prevent stroke or TIA reoccurrence, education needs to be accessible and presented in a way that gives patients the tools needed to make necessary lifestyle changes and recognize signs and symptoms of when to seek medical attention.
Objective: The objective of this study was to determine if providing an educational program on stroke and transient ischemic attack resulted in increased knowledge about the importance of adopting lifestyle behaviors following stroke or transient ischemic attack, how to prevent and recognize the signs of stroke or transient ischemic attack (TIA) reoccurrence, and when to seek medical attention.
Method: The tool for measurement was a paper pretest and posttests that included one personal identification number and 12 true/false or multiple-choice questions developed from the printed education materials provided to the participants. The measurements were created based on the available literature. Eligible participants are defined as patients and their primary caregivers who were identified at the time of admission. The study took place from July 31 to August 22, 2025 and included 12 participants.
Results: A dependent t-test was performed on the pre and first post-test data. The results provide evidence of a significant mean difference between the two time points (t = 14.83, df = 11, p \u3c .001). This shows that there was a significant increase in participant knowledge from the pre-test and first post-test. Conclusion: This project showed that the education packet improved patient and caregiver knowledge. It was shown to be statistically significant that participant knowledge increased after the education packet and education was provided
Behavioral Therapy on Relieving Urinary Incontinence and Poor Sleep Among Women With Diabetes
No full textBackground: Urinary incontinence and poor sleep are common in women with diabetes. As a close relationship exists between urinary incontinence and poor sleep, healthcare providers should consider both when providing management. This study examined the intervention effects of a nurse-led behavioral therapy program containing pelvic floor muscle training (PFMT) and Brief Behavioral Treatment for Insomnia (BBTI) on urinary incontinence and poor sleep.
Methods: This study was a prospective, repeated-measures interventional study. We recruited women with diabetes and randomly assigned participants to an experimental group (n=28) or a control group (n=26). Both groups received information about urological health promotion and PFMT. The experimental group received a 4-month behavioral therapy program containing PFMT, BBTI, and nursing guidance. The control group received information and nursing guidance about BBTI after the completion of data collection. Data were collected by a study questionnaire at baseline and 2- and 4-month after baseline. We used generalized estimating equations model analysis to examine the intervention effects.
Results: The experimental group displayed more significant decreases in the urinary incontinence severity index and sleep quality index scores than did the control group (p\u3c0.001). The experimental group displayed more significant proportion changes from experiencing urinary incontinence and poor sleep to not experiencing these conditions than did the control group (p\u3c0.001).
Conclusions: This study showed promising positive effects of a behavioral therapy program on ameliorating urinary incontinence and poor sleep among women with diabetes. Our study results can be a reference for future research, and community-based and primary healthcare services
Pain Management with Epidural Analgesia in Rib Fractured Patients: An IRR
No full textTraumatic rib fractures are a diagnosis associated with high morbidity and mortality rates (Duch & Moller, 2015). When pain is ineffectively managed, patients can experience limitations in their ability to cough and mobilize putting them at risk for significant atelectasis, retention of pulmonary secretions, and pneumonia (Diwan et al., 2022). Thoracic epidural analgesia is the gold-standard for pain control in this population but other modalities for pain control such as enteral, IV, and regional ultrasound guided techniques exist. Medline Complete, CINAHL Plus with Full Text, Health Research Premium Collection, PubMed and Cochrane were searched for peer reviewed articles. Search terms used were “epidural analgesia” and “traumatic rib fractures” and “systematic review or meta-analysis.” The search criteria were limited to articles published between the years 2017-2024 in Medline Complete and Health Research Premium Collection, 2009-2024 in CINAHL Plus with Full Text and PubMed, and no date limitations in Cochrane. A total of 122 articles were found with 6 duplicates. Only 12 articles could be included for the Integrative Research Review. Exclusion criteria consisted of articles not encompassing the study question, population, abstracts, and trials without results. Furthermore, 4 articles were found via bibliographic mining to be included into the 12 final article for review made of six level 1 systematic reviews, four level IV studies, and two level III studies. All articles were appraised using the Prisma checklist, the Mixed-Methods Appraisal Tool, or the AGREE II tool. The articles were graded using the EBR tool, step seven (Long & Gannaway, 2015) with the GRADE working group. While thoracic epidural analgesia is still the preferred analgesic modality for most patients with multiple traumatic rib fractures, there are less complex and comparable options available to patients with fewer contraindications (Diwan et al., 2022). A multimodal and multidisciplinary approach to traumatic rib fractures is the recommended technique for managing analgesia and reducing morbidity and mortality associated with rib fractured patients (Hammal et al., 2024). Further studies with larger sample sizes, higher quality of evidence, and lower risk for bias are necessary to confirm the optimization of pain with epidural analgesia compared with other analgesic intervention in patients with traumatic rib fractures (Duch & Moller, 2015)
Readiness for Advance Care Planning in Patients with Chronic Kidney Disease: A Cross-Sectional Study
No full textBackground: Chronic Kidney Disease (CKD) patient often face unpredictable progression, leading to sudden deterioration that impair communication of medical preferences in emergencies. Without Advance Care Planning (ACP), treatments may conflict with patient values, causing decisional conflicts and excessive interventions. While ACP helps ensure patient autonomy, there is limited understanding of CKD patients\u27 readiness for ACP restricts healthcare providers from delivering timely and appropriate supportive care.
Purpose: This study aims to identify factors influencing ACP readiness in CKD patients to inform strategies for patient-centered care.
Methods: A cross-sectional study was conducted with non-dialysis CKD patients using the validated Chinese version of the Advance Care Planning Engagement Survey (ACPES). Hierarchical regression analysis assessed the the impact of demographics, social support, and healthcare partnerships on ACP readiness.
Results: The study enrolled 189 participants who demonstrated moderate ACP readiness, with a mean score of 2.17 ± 1.07. Notably, 54-58.2% had considered end-of-life care planning, preferring discussions with decision-makers (32.3-33.3%) over physicians (4.8-6.3%). Regression analysis revealed that female gender (β = 0.17, p \u3c 0.05), older age (β = 0.19, p \u3c 0.05), higher educational levels (high school: β = 0.24, p \u3c 0.01; college: β = 0.22, p \u3c 0.05), and strong healthcare partnerships (β = 0.23, p \u3c 0.01),especially interactions with nurses, were significant predictors of ACP readiness, accounting for 13.8% of the variance.
Conclusion: The study reveals that while CKD patients show moderate ACP readiness, significant gaps exist in engagement, especially in discussions with healthcare providers. Key findings indicate female gender, older age, higher educational levels, and strong healthcare partnerships positively influence ACP readiness. However, many patients hesitate to initiate ACP discussions with physicians, possibly due to perceived hierarchical barriers in healthcare. It is recommended that nursing professionals actively foster ACP readiness by building trusting relationships and empower patients to make decisions aligned with their values. These findings highlight the essential role of healthcare providers, especially nurses, in promoting ACP by enhancing healthcare partnerships to support patient autonomy and improve end-of-life care quality