American Research Journal of Nursing

Anna Skördåker1, Anna von Wachenfeldt2, Elisabet Lidbrink 3, Johanna Stjärnfeldt4 , Aina Johnsson 5  

Purpose: The aim of this study was to examine if breast cancer patients’ estimated life satisfaction was affected during adjuvant endocrine treatment, if life satisfaction changed over time and if there were any differences in life satisfaction between breast cancer patients who experienced side effects from the treatment and those who did not. Material and methods: Consecutive breast cancer patients (n=68) referred for adjuvant endocrine treatment after radical breast cancer surgery at an oncology clinic were enrolled from November 2002 to August 2004. The patients scored their life satisfaction at inclusion, during treatment, and about 2 years after completing treatment. The ques tionnaire LiSat-11 was used. A report of side effects in medical records was also carried out. Comparisons, focusing on life satisfaction, between patients with and without side effects were made. Results: Of the patients in the study group 42(61.8%) had musculoskeletal symptoms noted in their medical records, 48(70.6%) reported menopausal symptoms and 40(58.5%) had psychological symptoms. At inclusion and during the treatment the study group estimated lower life satisfaction in most domains compared with a reference group. At post-treatment the study group still estimated lower life satisfaction in the domains sexual life, partner relationship, somatic and psychological health compared with a reference group. The study group estimated lower life satisfac tion at post-treatment compared to inclusion in the domains sexual life and partner relationship. In the other domains an improvement was observed when life satisfaction at post-treatment was compared with inclusion. Patients with side effects estimated lower life satisfaction in most domains compared with those that experienced no side effects Conclusion: The important findings are that the studied breast cancer patients receiving endocrine treatment esti mated their life satisfaction lower in most domains compared with the normal population already at inclusion. Dur ing the treatment, life satisfaction further deteriorated but the patients had recovered in most domains post-treatment. Notable is the deterioration in sexual life and partner relationship at post-treatment compared with inclusion. This study indicates that long-term effects of endocrine breast cancer therapy need to be further researched, with a par ticular focus on issues relating to sexuality and relationships.

Lora Humphrey Beebe1, PhD, PMMHNP, BC, 2Marian Roman, PhD; 3Gary Skolits, PhD; 4Hollie Raynor, PhD, RD, LDN; 5Dixie Thompson, PhD; 6Shaunta Ray, PharmD; 

Introduction: This article reports a pilot of the Recovery-Based Interprofessional Distance Education (RIDE) rotation - an interprofessional education (IPE) experience for graduate psychiatric mental health nurse practitioner, pharmacy, nutrition and exercise physiology students. The program was offered in a blended format, with online content enhanced by a 3 day, team-based clinical intensive experience. Methods: In this pilot, participants ( N = 12) completed pre and post assessments before and after the experience. Results: Pretest scores on the benefits of team training and contributing insight to teams were high with pretest means of 4.7 and 4.5 respectively. The experience did not change participants' perception of team training benefits, nor their perception that they could contribute valuable insights to teams, but attitudes about offering assistance to team members were improved. Student participation and these preliminary results indicate that offering an IPE program in an online blended format is feasible and acceptable to both graduate students and faculty. Discussion: These results suggest that an IPE program can enhance practical, team-based skills in graduate nursing, pharmacy, nutrition and exercise physiology students and can be feasibly delivered using an online blended approach. Conclusions: More research is needed examining formal IPE programs in graduate curricula, and the sustainability of such programs. Acknowledgement: This project was supported by the Health Resources and Services Administration, HRSA Grant number: D09HP25932-02-01

1 Ella, R. E. FWACN, RN/RM, RNT, Ph.D Senior Lecturer 2Akpabio, I.I. FWACN, RN/RM, RPHN,Ph.D Associate Professor 3Samson-Akpan, P.E. FWACN, RN/RM, RNT,Ph.D. Associate Professor 

Background: Poor performance of undergraduate nursing students in the university and professional examinations in recent times is a source of concern to both educators and other stakeholders. This study was conducted to determine the influence of study habits on undergraduate nursing students’ academic performance in the University of Calabar, Nigeria. Methods: A cross sectional descriptive study was conducted in 2012 with 160 students who were in years 3 to 5 of their studies. These were selected through simple random sampling technique. Data was collected using self constructed study habits inventory questionnaire with content validity index of 0.79 and a test-retest reliability coefficient of 0.81. Copies of the questionnaire were completed by the students in a classroom setting after which achievement tests were administered simultaneously based on the objectives of the course. Data was analysed using Independent t-test. Results: The result obtained from the analysis of the study revealed that majority of the participants were fourth year students (72; 45%), followed by third year (64; 40%) and fifth year students (24; 15%). There were no significant differences in academic performances of the students who practiced group and individual studies, those who read at the library hostel or away from the library and those who read at daytime compared to night time. Conversely, there were significant differences in academic performance between students who had 75% and above class attendance and others with less than 75% attendance. Conclusion: The result of this study affirms the fact that class attendance influences academic performance of students. Therefore, there is need to enforce mandatory 75% class attendance for undergraduate nursing students to enhance their academic performance. Despite the insignificant results between hostel and library reading, the library should be made more conducive for reading with necessary facilities to encourage usage. 

Meng-Jung Chen1

Non- invasive ventilation refers to the use of ventilator support without using an invasive artificial airway to avoid Intubation and improve oxygenation. Non-invasive ventilation has now become an important tool in the management of respiratory failure, in both the hospital care and in home setting provided that the patient can tolerate the therapy and breathe spontaneously. This article describes the use of non-invasive ventilation in the elderly. There is a lot of evidence supporting its use, but many questions still remain. Used early in appropriately selected patients, there are advantages over conventional invasive ventilation. It could be used in certain conditions, but careful monitoring and ongoing assessment is required.

Sarah E. Newton, PhD, RN1

Accelerated nursing (AN) programs have proliferated across the United States. Because AN curricula are taught at an accelerated pace, AN students tend to start their first clinical experiences early in the program, before they have received much formal education regarding what professional nursing is and what is expected of students in the clinical setting. The first clinical day has been described as stressful for nursing students (Wolf, Stidham, & Ross, 2015), yet there was nothing found in the literature that described what AN students think will happen on the first clinical day or what will be expected of them. As a result, one Midwestern school of nursing conducted a quality improvement project to assess what the AN students thought would happen on the first clinical day. Specifically, the students were asked to “Describe what you think will happen on the first day of clinical”. The results revealed four themes, but the majority of AN students thought they would be a “doer” and few reported the use of critical thinking or the application of newly learned nursing knowledge as something they would do on the first clinical day. Based on the project’s findings, the implications for nurse educators who teach in AN curricula are discussed

Marica G. Estrada1*, Ma. Socorro S. GuanHing1,2, and Susan N. Maravilla1

Background: The highly-evolving and technologically-advancing nursing practice necessitates the employment of competent nurses in medical institutions and thus, compels nursing institutions to enhance strategies to address the needs of various stakeholders, particularly the employers and patients. Nevertheless, a continuously growing rift in the clinical application of theoretical knowledge has existed over the years across the globe. Hence, our study analyzed the gap between Thomasian nursing education and clinical practice through determining the extent of preparedness of Thomasian Registered Nurses during their first year of professional practice. Methods: After ethics review exemption, we conducted a comparative-descriptive study among 35 purposively selected appraisal reports of Thomasian nurses in a tertiary medical institution. Power analysis revealed a power of 0.91 and an effect size of 0.36. We utilized the performance appraisal report form which had a Cronbach’s alpha of 0.93, 0.93, and 0.95 for the knowledge/skills, productivity, and personal attribute subsections, respectively. Attendance and conduct, however, depended on log records. Data were analyzed using MANOVA. Results: Most subjects had less than 6 months clinical experience (65.70%), were assigned in Medical-Surgical wards (65.70%), and demonstrated above average clinical performance (85.70%). Comparatively, the over-all performance of Thomasian Registered Nurses did not significantly differ regardless of the length of clinical experience (F=0.36, p=0.84) or area of assignment (F=0.39, p=0.93). Conclusion: Thomasian Registered Nurses are competent to enter the nursing practice and provide patient care. Further, the undergraduate program of UST has sufficiently prepared their students to be competent registered nurses. Nevertheless, it is imperative that nursing institutions constantly improve their strategies considering the ever changing nursing practice and standard. 

Barbara Penprase, PhD1, RN, CNE, ANEF and Deana Hays, DNP, FNP-BC2 

Emergency department (ED) services are expensive and often overused by the surrounding community, resulting in overcrowding and strain on healthcare services. ED overuse has been identified as major source of healthcare expenditure and can be as high as 3 times the costs from other healthcare settings To have an effective impact on admissions by ED frequent users, each hospital needs to understand its unique profile and the characteristics of patients who overuse ED services. Only then can an effective program be developed to alleviate their patients’ dependency on the ED for care. The purpose of this study was to develop a patient profile of ED frequent users at a mid-sized hopsital in the Midwest. This research used a descriptive retrospective design to review electronic medical health records of patients with 6 or more visits to the ED within a year. Data were collected for the following demographic information: gender, age, race/ethnicity, primary language, marital status, employment status, zip code, total visits per 12-month time period, time of visit to ED, presenting complaint, length of time in ED, admission to hospital, primary ECD 9 diagnosis, discharge disposition from ED, primary insurance, primary care provider, and reported health status. The research findings supports that older adults, especially females, with chronic illnesses such as CHF, diabetes, and respiratory illnesses are at high risk for becoming frequent users of ED services. The outcomes of this study are being used to develop a transitional care model program specifically designed for elderly patient with co-morbidities. The program will use a collaborative approach between ED physicians and nurses with nurse practitioner students to see patients not only in the ED but for 60 days following discharge. An overarching expected benefit will be to reduce overall ED costs while increasing patient satisfaction for frequent ED users. Developing programs to assist frequent ED users is imperative to assist elderly patients in coping with their chronic conditions without the reliance of ED services.

Atef M.Darwish1** MD, PhD, Howieda Fouly1* MSN, PhD, Sahar Naguib1*, PhD Marilyn Stringer2**, Dalal Eshra3***, PhD, 4Mohamed Galal$ PhD 

Objectives: To test if combining positive results of sequential magnified naked-eye examination (MNEE) and visual inspection of cervix after application of acetic acid (VIA) would increase diagnostic indices for precancerous and cancerous cervical lesions in comparison to the gold standard positive Pap test in a developing country set up. A secondary objective was to evaluate the effectiveness of nurse training and patient acceptance of this screening approach. Design: An analytic cross-sectional research design Setting: Gynecology and infertility out-patient clinics of the departments of Obstetrics and Gynecology, Woman’s Health University hospital, Assiut University, Egypt. Materials and methods: A total of 445 non-pregnant women aged between 17 and 44 years were counseled and entered this study. They were subjected to MNEE after cleaning of the cervix with 0.9% saline, exfoliative cytology and lastly VIA. Positive results were evaluated and managed accordingly. Colposcopy with or without subsequent cervical biopsy were done in all positive cases of MNEE, VIA and Pap smear. Main outcome measures included diagnostic accuracy of VIA alone versus VIA and MNEE as compared to cytology. Results: This study comprised 445 non pregnant women in the reproductive age. The main complaint was abnormal vaginal discharge in 403 cases (89.6%) . MNEE of the cervix indicated that 338 women (75.1%) and 112 women (24.9%) had healthy and unhealthy-looking cervices respectively. Pap smear sampling was negative for premalignant or malignancy in 377 cases (83.8%).VIA test findings were positive in 77 cases ( 17.3% ) and negative in 368 cases (82.6% ) All diagnostic indices increased significantly after combing MNEE and VIA positive results except negative predicative value if compared to VIA positive results alone as an alternative to the standard Pap smear. Nurses proved high level of skill in performing cervical cytology, MNEE and VIA as proved by lower rate of unsatisfactory results. Patient acceptability was very high after proper counseling. Conclusions: Sequential MNEE and VIA would improve most of diagnostic indices as an alternative diagnostic tool to the gold standard Pap smearing for detection of abnormal precancerous and cancerous cervical lesions. This simplified cheap approach with high percentage of patient acceptability would help expanding screening programs in countries were Pap smear is poorly available. Being performed by doctors as well as trained nurses on one-stop base is a clear advantage. More large sample sized studies on the cost-effectiveness of this approach versus colposcopically-guided positive histopathology are recommended before its universal spread. 

Cheryl Holden, DHSc, RN1 , Ladda Thiamwong, PhD, RN1 Deborah Martin, MSN, RN1, Kathleen M. Mathieson, PhD,CIP2, Guy Nehrenz, EdD, MA, RRT3

 Information technology is rapidly changing the manner in which health care is provided to consumers. The purpose of this research study was to determine if Epic®, an electronic health record, impacted the hospital length of stay (LOS) for patients admitted with hip fracture. When comparing six months of data pre- and post- implementation of Epic, there was not a significant difference in the hospital LOS for patients admitted with hip fracture. Although there was not a decrease in the hospital LOS post-implementation of an EHR, there was also no increase in hospital LOS, which might be expected with a major system change that required process and workflow modifications

Laurie Schluter MSN, FNP, ANVP1, Joe Tarsia MD 1, Alyana Samai BHS 1,2 Sheryl Martin Schild, MD, PhD 1 

The evaluation and management of strokevaries between patients due to differences in individual physiology and disease progression. The goal of this article is to provide health care professionals with a comprehensive resource that adequately catalogs the causes and physiological mechanisms of stroke, as well as diagnostic testing techniques and effective therapeutic interventions relevant to stroke care. This article examines what we consider at our center to be the core factors in ischemic stroke that areconsidered for each patient to deliver effective individualized care. These variables form a vital patient profile summarized in a mnemonic called the “P’s of Stroke”. The “P’s” encompass the influence and significance of cardiac dysfunction (pump), blood pressure, perfusate, arterial blood flow/vasculature (pipes), cerebralblood flow (plumbing), perfusion, parenchyma, penumbra, physical rehabilitation and recovery, and prevention with relation to acute ischemic stroke (AIS) assessment and treatment