American Research Journal of Nursing

Fernanda RE Gimenes, PhD, RN1, Mirna I Sousa, RN, PhD student1, Maria CC Furtado, PhD, RN1, Ana Paula G Motta, RN student1, Mayara CG Rigobello, Ms, RN1, Adriane P de Medeiros, Ms, RN2 Rebecca O Shasanmi, MPH, BSN3  

 A descriptive study was conducted in a pediatric unit of a Brazilian hospital at São Paulo state. The purpose of this study were to classify the types of medication errors occurring in a pediatric unit, and to discuss the role of the nursing team in preventing these errors. The sample consisted of 23 medication errors that occurred during 20 days. Data was collected through direct and non-participant observation of medication preparation and administration. The most common errors detected were incorrect preparation technique (52.2%), incorrect time (34.8%) with higher frequency occurring during the morning shifts (50.0%), unauthorized drug (8.7%) and dose errors (4.3%). The pharmacological classes most involved in wrong technique were antimicrobials (66.7%), followed by analgesics (33.3%). The development of protocols for preparation and administration of medications can help the nursing professionals to provide medication safety, especially for pediatric patients, who usually receive fractionated doses. 

Atef Darwish MD PhD1, Alaa M. Ismail MD. 1, Michael N. Agban PhD. 2 and Hassan S Kamel MD1

Objectives: To determine whether gynecologists should treat cervical cysts discovered on speculum examination or by ultrasonography. Materials and methods: A prospective Cohort study done at the Woman's Health Center of Assiut University, Egypt as a tertiary care referral facility. It comprised cases with clinical and sonographic diagnosis of cervical cysts. Cervical swabs as well as cysts' aspirates were examined bacteriologically and cytologically. Cyst aspirate of these patients were evaluated for IL8, IL10 and MMP-9. The main outcome measures included bacteriologic, cytologic and immunochemical findings of cervical cysts aspirate. Results: Cervical cysts associated with negative cervical swabs were diagnosed in 75 cases. The mean size of the cervical cyst was 2.18 ± 0.609 cm. It was found that 61.4 % of cysts were cytologically and bacteriologically infected despite negative cervical swabs. Chlamydia Trachomatis, Gardenella Vaginalis, GBS and Mycoplasma hominis were detected in 13.33 %, 24 %,14.67 % and 14.67% of infected cysts respectively. Aspirate of the infected cysts had elevated IL-8 (P= 0.000), and had increased IL-10 (P= 0.000) in comparison with non infected cysts, while increased MMP-9 was higher in patients with persistent vaginal discharge and patients with deep dyspareunia more than the patients with unexplained infertility (P= 0.000). Conclusions: Cervical cysts should not be ignored as a potential cause of common gynecological symptoms especially large sized cysts. Being infected and associated with elevated inflammatory markers in 61.4% in this study would suggest routine prompt management of cervical cysts whenever clinically or sonographically diagnosed.  

Judith Paré PhD, RN1 

 In 1997, federal legislation was enacted as part of the Balanced Budget Act which authorized States to create a State Flex Program. The State Flex Program allowed certain healthcare facilities participating in the Medicare program to become Critical Access Hospitals (CAH). Critical Access Hospitals are hospitals certified to receive cost-based reimbursement from Medicare. This reimbursement is intended to optimize their financial performance and decrease hospital closings. Currently, the state of New Hampshire has 13 hospitals that have been designated as Critical Access Hospitals (Rural Assistance Center, 2014). Every CAH must meet federal standards in order to maintain this special designation. These standards include a rural location and the provision for 24-hour, 7-day-a-week emergency care services for patients of all ages and with varying types of medical and psychiatric needs. Critical access hospitals in New Hampshire provide local residents and tourists with a variety of health care services, some of which are related to primary care, while others involve life-saving interventions. The nurses working in these rural areas are expected to demonstrate excellence in clinical decision making and to function as independent practitioners meeting the holistic needs of patients of all ages (Hurme, 2009). However, there is a gap in the literature related to the lived experience of nurses working within these settings. Examining how nurses in CAHs perceive their role and experiences will provide insight into the systems necessary to support the professional and practice needs of this unique cohort of nurses. 

Anna Nguyen1, PhD, RN, Diana Blackmon2, DNP, RN, Linda Cook3, PhD, CNS, CNE 

Concept mapping (CM) has been used to help nursing students develop critical thinking skills and improve clinical judgment. CM is being used with greater frequency in health profession education settings to visually represent thought processes and links between variables that affect decision-making and patient outcomes. The objective of this pilot study was to evaluate the effectiveness of CM as a teaching tool to improve critical thinking and clinical decision-making skills of experienced nurses in a sub-acute care setting. Significant differences were found in participants’ critical thinking skills following a course involving concept mapping. This study offers staff development educators a new process to improve the critical thinking of experienced nurses. 

Satoko Ueki1, Masaaki Tsujitani2, Yumiko Teranishi1, Junko Miyamoto1, Reiko Mori3, Katsuji Kaida4, Takayuki Inoue4, Hiroyasu Ogawa4, and Kazuhiro Ikegame4 

 In this study, we established a predictive regression model using generalized additive models (GAM) to predict the incidence of skin lesions (SLs) in patients undergoing allogeneic hematopoietic stem cell transplantation (SCT). Among 81 patients who underwent SCT in the SCT unit of the Hyogo College of Medicine between April 2012 and March 2013, 28 developed SL (SL group), and the remaining 53 did not (control group). We defined the following events as states in our multistate model: Diarrhea, need for oxygen supply, hemorrhagic cystitis, skin graft-versus-host disease, encephalitis, and disease relapse. Of these events, diarrhea, need for oxygen supply, and hemorrhagic cystitis occurred more frequently in the SL group than in the control group. A comparison of the function independence measure score revealed more severe muscle weakness in the SL group. A logistic regression analysis using GAMs verified that SL development could be predicted based on serum albumin, blood sugar levels, daily activity scores, and post-transplant day. Of these four predictive covariates, only the post-transplant day exhibited a non-linear curve, with a susceptible peak at approximately 30 days after SCT. GAMs may be a powerful tool for prediction analyses involving time-dependent and non-linear covariates. Patient characteristics may also affect the SL development. 

Andréa Cristina Leite Nogueira, RN1, Patrícia Costa dos Santos da Silva, PhD, RN2, Eugenia Velludo Veiga, PhD, RN1, Rebecca O. Shasanmi, MPH, BSN3, Fernanda Raphael Escobar Gimenes, PhD, RN1

 This paper presents the case study of a 74 year old man with liver cirrhosis and consumptive syndrome. Data was collected in a Brazilian university hospital. The case study approach used was outcome present state test (OPT) model. The assessment was made by using the Conceptual Model of Wanda Horta. Also, the NANDA-I, Inc., Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC) linkages were used to capture accurate nursing care plan. The keystone nursing diagnosis was: Imbalanced nutrition: less than body requirements. The NOC outcomes chosen were Nutritional Status: Food and Fluid Intake; and Weight: Body Mass Control. The NIC interventions chosen for the patient were: Enteral Tube Feeding and Fluid Monitoring. The findings support that the use of a clinical reasoning web helps nurses to identify the priority focus of care in patients with complex health problem, and to prevent future complications associated with the evolution of disease. Future researches are needed to determine the NANDA-I, NOC, and NIC linkages based on a clinical reasoning model to capture accurate nursing care plan for all patients with chronic condition, in order to provide competent and safe care, thus improving patient outcomes.  

Major(Retd)Mrunalini, PhD Dr. Mrs. PAChandekar

 Most important criteria for effective learning in nursing education is developing Clinical competency by nursing students. Clinical competence mean “is the ability to integrate cognitive, affective and psychomotor skills effectively when delivering nursing care.” The aim of this study was to investigate factors that influence learning by students in nursing education. To achieve this, first studies and theories related to the subjects taught in nursing were reviewed. Some of the most important variables which influence teaching- learning were selected. A descriptive research method was usedin this study. This study was at the Siva Sai Vignan Collegeof nursing , Rajahmundry,Andhra Pradesh. Nursing students were taken as statistical purposive population. Using census and questionnaire Technique, 162 nursing students were studied. Data were analyzed using SPSS version 16.Results showed that there was a positive and significant relationship between independent variables including clinical learning environment, curricular, self efficacy traits, as well as interest, and dependent variable. Women significantly have accessed more clinical competence when compared to male students. There was no significant relationship between variables such as age, previous experience, socio economic data as well as expectancy, and dependent variable. The Regression analysis results showed that in total, clinical learning environment, gender, self efficacy beliefs and curricular variables explained 31/3 percent of the variance clinical competence as dependent variable. This study showed that the clinical learning environment and curriculum with self-efficacy had the great impact on clinical competency and learning in nursing education. The curriculum and clinical learning environment can have a significant impact on the learning and training of competent nurses.  

Marica G. Estrada, PhD, RN1*, April Joy M. Gascon, MAN, RN1, La. Arnie M. Lazalita, MAN, RN1

Background: Over a decade, only less than 60% of the total number of examinees passed the Nursing Licensure Examination. A steady decline in the Philippine Nurses Licensure Exam (PNLE) national passing rate was noted from years 2004 to 2014 with a range of 30.94 to 57.29 percent for the ten year board ratings (PRC, 2014). Methods: This retrospective qualitative inquiry made an attempt to explore the experiences of 13 thomasian PNLE topnotchers who successfully outshined the Philippine Nurses Licensure Exam for the past three years (2012-2014). Findings: Four emerging themes and eight subthemes captured what the thomasian topnotchers have done to attain their ranks in the Philippine Nurses Licensure Exam. Four success targets were identified and achieved in hierarchy that clearly guided them to maintain academic rigor and reach academic victory. These are the following; Visualize Success, Begin Early, Do more than what you can and Transform your own learning.  

Therese Jamison DNP, ACNP-BC1 and Katarina Vulaj MSN, FNP-BC2 

End of Life (EOL) conversations are complex entities that effect individuals, families, surrogates, and care providers across the lifespan as well as across the care continuum. The sensitive nature of these courageous conversations can be difficult for all parties involved. In this review of the literature (ROL), best practice and clinical practice protocols instituted within the last five years will be identified in an effort to provide critical care nurses and advanced practice nurses with the current practice guidelines. Both qualitative and quantitative studies will be identified. Definitions of EOL including a good and dignified death will be explored. Challenges surrounding EOL conversations as well as facilitators for providing EOL care including educational resources will be highlighted. Interprofessional collaboration is essential for providing care that is guided in humanism as well as evidenced based care. 

Khraim, Fadi1, Sandra Small PhD RN2, Daphne Crane MDE3, Claudine Morgan BN RN4

Smartphones are becoming ubiquitous with abundantly available nursing learning applications. Thirteen nursing students participated in a study to explore the benefits and barriers of using smart phones to access nursing learning resources in clinical practice. Voice- and data-enabled smart phones were provided to participants. A mix-methods research approach was used with pre- and post-surveys. Prior to the study, participants’ experience with smart phone technology ranged from no experience at all to having extensive experience. One key finding is that students did not feel comfortable using smart phones in the clinical setting. Therefore, smart phones received little use as a learning resource. Unprofessional appearance and the time needed to learn the technology were the main deterrent of smart phone use. The results of this investigation add to the growing body of research that discusses adoption of smart phone technology in nursing education.