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Endovascular Thrombectomy for Patients Over the Age of 75 with Acute Ischemic Stroke: A Systematic Review
Full text linkStroke is a leading cause of disability and death worldwide. According to Slawski et al. (2018), strokes will more than double in 2050, with the greatest percentage of affected patients being over the age of 75. Administering interventions to patients affected by acute ischemic stroke (AIS) has been a controversial topic when elderly patients were involved (Alawieh et al., 2018). Elderly patients have been known to be excluded from clinical trials solely due to their age and comorbidities (Karhi et al., 2018). The purpose of this project was to determine if the use of endovascular thrombectomy (EVT) is recommended for elderly patients over the age of 75 years of age who have suffered an acute ischemic stroke from a large vessel occlusion (LVO). Six studies met inclusion and were included in this systematic review. The overall findings of this systematic review suggest the use of EVT to be effective for elderly patients over the age of 75 years of age who have suffered an AIS from an LVO. Despite high mortality rates and less favorable outcomes in the elderly cohorts in the six studies, four of the six articles concluded that the alternative of not providing thrombectomy could have detrimental outcomes. Implications of this systematic review include the importance of the advanced practice nurse’s (APRN) role in advocating and educating patients and families about the benefits of receiving thrombectomy after suffering an AIS from an LVO. In addition, APRNs should educate their colleagues about the evidence regarding thrombectomy in order help bridge the gap in the lack of knowledge regarding EVT in the elderly population
Evaluation of Causes, Contributing Factors, and Potential Solutions to Medication Errors
Full text linkBackground: Medication errors are one of the most common errors in healthcare that have the potential to cause patient harm. Despite achieving the goal of 95% compliance with medication safety process metrics, medication errors persisted at the organization where the study was completed. Purpose: This project was launched as an organizational assessment to determine what the causes and contributing factors to medication errors are from the perspective of the bedside nurse. Nurses’ opinions regarding potential solutions to errors were also sought for future process improvement planning. Methods: The Lifespan and Rhode Island College Internal Review Board approved this research which consisted of a mixed-methods survey and focus group that completed a failure modes and effects analysis. Results: Major barriers to medication safety practices identified in the data were distractions, lack of time, availability of staff to perform safety checks, and scarcity of updated, working computers, and scanners. Factors contributing to errors were confusing or incorrect orders and inadequate communication between healthcare disciplines and the family. Potential solutions to errors proposed by the respondents were pharmacy preparation of exact medication doses, additional working computers, and more staff to verify doses and infusions when needed. Conclusion: Information gained from the failure modes effects analysis (FMEA) performed by the focus group substantiated the survey data and revealed educating the patient and family about medication being given is an important intervention for staff working with the pediatric population at this setting. Nurses participating in this study had adequate knowledge about safety practices and were able to identify barriers to the established medication administration process, factors associated with errors, and potential solutions to systems issues. Safety practices are not always followed by these nurses due to distractions, lack of time, staffing, and improperly functioning computers
The Effect of Happiness on Death Anxiety in the Nursing Population
Full text linkBackground: Registered Nurses (RNs) are often exposed to death and dying, putting them at risk for increased levels of death anxiety due to frequent exposure. Researchers have identified personal resources that people can possess that may limit the amount of death anxiety they feel, such as happiness. Purpose/Specific Aims: The purpose of this mixed-methods descriptive correlational study was to identify if a link exists between perceived happiness and death anxiety specifically within the acute care nursing population working in an urban VA hospital. Methods: A convenience sample of inpatient RNs were recruited and asked to complete a questionnaire to assess their level of perceived happiness, fear of death and how working around death and dying influenced their own life choices. Results: Sixteen RNs participated in the study. Two incomplete surveys were excluded, analyzed n=14). Mean happiness score was 5.27. Average scores for each scale were: Fear of your own death 2.1, Fear of your own dying 3.4, Fear of others death 3.19, and Fear of others dying 3. Each fear of death variable besides fear of others dying had a positive correlation with happiness, with high levels of happiness associated with high levels of fear of death. Conclusion: Moderate positive correlation between happiness and fear of death suggests a relationship between these emotions; when a nurse is happier or more content with their life, their fear of death and dying increases. A larger study is recommended for more conclusive results
San Francisco: A Love Affair, and Other Essays
Full text linkMy honors project is a collection of personal essays that focus on themes of place, identity, and interpersonal relationships. \u27San Francisco: A Love Affair,\u27 looks at the way one special place and cultural era can shape a life. \u27Ballet is a Country\u27 examines how an early path isn\u27t always the one ultimately followed. In \u27Our Truest Selves\u27 I explore family relationships using the technique of midrash, an ancient form of Hebrew scriptural commentary that augments the main text with added insight. \u27Wavelength\u27 is a brief treatise on the profound differences, at least to my eyes, between the east and west coasts, using the ocean as metaphor
Cancer Care Team Education and Oral Anticancer Medication Adherence
Full text linkThe expansion of oral chemotherapy treatment options reveals the need to improve strategies for assessment, patient education, adverse side-effect management, and ongoing monitoring of care. This quality improvement project provided the cancer care team with a focused review of the literature with an educational learning program derived from 2016 ASCO and Oncology Nursing Society (ONS) Administration Safety Standards to improve their knowledge, promote patient safety and improve OAM adherence. The cancer care team is in a unique position to improve OAM adherence with patient education and empower patients with interventions to improve symptom self-management activities, therefore enhancing patients’ confidence in being able to take care of themselves
Self-Efficacy and Self-Care Behaviors in Patients with Type 2 Diabetes Mellitus: A Systematic Review
No full textSelf-efficacy is a concept that refers to an individual’s belief in their ability to realize behaviors necessary to achieve desired outcomes. The relationship between self-efficacy and self-care behaviors in those with type-2 diabetes mellitus (T2DM) is an important topic of study. Self-efficacy in patients with T2DM is important for managing their disease through self-care behaviors with the desired outcome of reducing hemoglobin A1C (HbA1C) and achieving positive health outcomes. As acute care nurse practitioners T2DM will be a primary diagnosis or co-morbidity in numerous patient encounters throughout practice. Nurse practitioners must be aware of the role self-efficacy plays in the self-care behaviors in patients with T2DM. The purpose of this systematic review was to identify the relationship self-efficacy has in positively influencing self-care behaviors to promote good health outcomes in adults with T2DM
Assessment of Listening and Social Support in Dyadic Relations
Full text linkThe study examines ingroup heterogeneity and outgroup homogeneity in Black and White coworker\u27s assessments of listening and social support. The study uses the ideographic key person design and the social relations model
Efficacy of Nurse-Led Advance Care Planning in Patients with Chronic Diseases: A Systematic Review
Full text linkAdvance care planning (ACP) allows patients to discuss and negotiate their preferences for the future including clinical management at the end of life. Over the past few decades, despite multiple large-scale educational and legal efforts to promote engagement in advance care planning and completion of advance directives, over 60 percent of Americans have not completed advance directives (AD). Vulnerable populations such as elderly individuals and patients with chronic diseases are in particular need of ACP. Even though AD completion rates have increased, there is more work to be done. Barriers to advance care planning cited by studies include unwillingness by patients to engage in ACP and overestimation of prognosis (Hole and Salem, 2016). Physician-related barriers include limited time and poor ACP documentation (Bergenholtz et al. 2019). To address the gaps in ACP, research has examined the impact of non-physician members of the health care team on ACP engagement. The purpose of this systematic review was to evaluate the effectiveness of nurse-led advance care planning and engagement in EOL discussions on advance directive participation rates among adult patients with chronic diseases. Four final studies were included in this systematic review utilizing PRISMA guidelines and CASP tool for to ensure study integrity. Results of this review demonstrate the benefits of nurse involvement in ACP. The ACP process is multifactorial with many aspects in which nurses can have impact. Implications of this study include the importance for APRNs to identify where nurses can be involved in the ACP process to improve AD completion rates and documentation. APRNs can be at the forefront in improving education and training in ACP and can become more involve in policies that support improved ACP
Patient Characteristics Associated with Effective Fall Prevention Utilizing Telemonitoring
Full text linkFall prevention is a universal issue addressed daily by healthcare teams working in acute care hospitals. One method of fall prevention is through the use of remote video surveillance (telemonitoring). The characteristics that are associated with patients that are the most appropriate candidates for video surveillance to reduce fall rates have not been determined due to the use of telemonitoring being new and its sudden increase in use. A retrospective record review was conducted to identify patients that would potentially benefit from telemonitoring. Results supported patients that would benefit most were oriented to person and place, or person, place, time, and situation. This may verify the inference that a higher level of orientation correlates with successful telemonitoring. The age range of the included records was not revealing as the ages were evenly distributed in the included sample. This project reinforces the effectiveness of telemonitoring for patients at high risk of falls as 24 out of 25 patients were scored as a high risk for fall based on their fall risk assessment score. Implications for advanced nursing practice include the use of novel technologies such as telemonitoring to maintain patient safety while using resources in a cost effective and efficient way
Heart Failure Transition of Care: An Educational Program for Nurses
Full text linkHeart failure (HF) is becoming an epidemic as people are living longer and surviving cardiovascular events. According to the 2015 to 2018 data the American Heart Association estimates 6 million American adults aged twenty or older are living with HF (AHA, 2021). Heart failure is the nation\u27s leading 30-day readmission diagnosis costing the nation an estimated $30.7 billion according to the Division of Heart Disease and Stroke Prevention. Heart failure is a chronic progressive disease that if not managed correctly will lead to increased morbidity and decreased quality of life. A review of the literature on transition of care frameworks for HF patients validated the most effective interventions and best practices to reduce hospitalization in patients with heart failure. Nurses need to possess knowledge of heart failure care best practices to optimize patient outcomes. The purpose of this quality improvement project was to determine if implementation of a Heart Failure Transition of Care education program increased nurses’ knowledge of heart failure and heart failure transition of care best practices. The results of the educational program demonstrated improvement in nurses\u27 knowledge in all three categories; Heart failure facts and pathophysiology, best practice nursing interventions, and Heart failure assessment and goal directed medical therapy