Peer-Reviewed Journal Articles
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Item Will Virtual Clinical Learning during a Pandemic Affect Patient Safety?(2020-05-05) Hernandez, Angelica C.Item Keeping Prelicensure BSN Students Abreast of Covid-19 Disease Management(2020-07-14) Hernandez, Angelica C.Item What the American Journal of Critical Care Junior Peer Reviewers Were Reading during the First Year of the Program: Caring for Patients with Covid-19(2022) Hernandez, Angelica C.The Junior Peer Reviewer program of the American Journal of Critical Care provides mentorship in the peer review process to novice reviewers. The program includes discussion sessions in which participants review articles published in other journals to practice and improve their critical appraisal skills. The articles reviewed during the first year of the program focused on caring for patients with COVID-19. The global pandemic has placed a heavy burden on nursing practice. Prone positioning of patients with acute respiratory failure is likely to improve their outcomes. Hospitals caring for patients needing prolonged ventilation should use evidence-based, standardized care practices to reduce mortality. The burden on uncompensated caregivers of COVID-19 survivors is also high, and such caregivers are likely to require assistance with their efforts. Reviewing these articles was helpful for building the peer review skills of program participants and identifying actionable research to improve the lives of critically ill patients.Item What the American Journal of Critical Care Junior Peer Reviewers Were Reading during Year 2 of the Program(2022) Hernandez, Angelica C.The American Journal of Critical Care’s Junior Peer Reviewer program aims to mentor novice reviewers in the peer review process. To grow their critical appraisal skills, the participants take part in discussion sessions in which they review articles published in other journals. Here we summarize the articles reviewed during the second year of the program, which again focused on the care of critically ill patients with COVID-19. This article aims to share these reviews and the reviewers’ thoughts regarding the relevance, design, and applicability of the findings from the selected studies. High rates of delirium associated with COVID-19 may be impacted by optimizing sedation strategies and allowing safe family visitation. Current methodology in crisis standards of care may result in inequity and further research is needed. The use of extracorporeal carbon dioxide removal to facilitate super low tidal volume ventilation does not improve 90-day mortality outcomes. Continued research to better understand the natural history of COVID-19 and interventions useful for improving outcomes is imperative.Item Effects of Simulation-based Education in Nursing Care for Stroke Patients(2019) Ferencsik, LeesukThis study was conducted to examine the effects of simulation-based education (SBE) on nursing students' clinical performance, knowledge, and learner satisfaction in nursing care for stroke patients. The randomized controlled study involved 61 students who were enrolled in a geriatric nursing education course for a major at S university. Students in the simulation group received stroke patient care training by using a high-fidelity simulator, while those in the control group participated only in lectures. Collected data were analyzed using Chi-square, t-test, and independent t-test with the SPSS 24.0 for Windows program. The experimental group which had SIM-PBL showed significantly higher knowledge (t = 16.152, p< .001), learner satisfaction (t =7.358, p<.001), and clinical performance ability (t = 5.252, p <.001) for stroke patient care, compared with the control group. The results suggest that SIM-PBL is an effective teaching method to increase knowledge and clinical performance ability for nursing students. Therefore, it is necessary to develop simulation-based educational programs for clinical practicum, while further study is needed to determine the effects of diverse debriefing methods on student learning findings.Item Sleep Deprivation and Psychomotor Performance Among Night-shift Nurses(2010) Johnson, Arlene L.This study examined how sleep deprivation influenced psychomotor performance of nurses who worked the night shift. Psychomotor performance was measured with the d2 Test of Attention, which quantifies attention, concentration, processing speed, and quality of performance. A sample of 289 licensed nurses was tested with the instrument. Fifty-six percent of the sample was sleep deprived. Mean psychomotor performance scores (26.6 for men and 11.4 for women) were above the normative means (44.4 for men and 41.03 for women). A significant (p < .0001) inverse relationship was found between psychomotor performance and hours of sleep. Nurses reported more hours of sleep on a general self-report sleep item than in a sleep diary.Item Sleep Deprivation and Error in Nurses Who Work the Night Shift(2014) Johnson, Arlene L.OBJECTIVE: The aim of this study was to investigate the relationship between sleep deprivation and occupational and patient care errors among staff nurses who work the night shift. BACKGROUND: Whereas the aviation and trucking industries report that sleep deprivation increases errors, few studies have examined sleep deprivation association with occupational and patient care errors among nurses. METHODS: A cross-sectional correlational design was used to evaluate relationships between sleep deprivation and occupational and patient care errors in 289 hospital night shift nurses. RESULTS: More than half (56%) of the sample reported being sleep deprived. Sleep-deprived nurses made more patient care errors. Testing for associations with occupational errors was not feasible because of the low number of occupational errors reported. CONCLUSION: Interventions to increase the quality and quantity of sleep among hospital night shift nurses are needed. Improved sleep among night shift nurses will reduce the impact of sleep deprivation on patient care errors.Item Time and Resources of Peripherally Inserted Central Catheter Insertion Procedures: A Comparison Between Blind Insertion/Chest X-ray and a Real Time Tip Navigation and Confirmation System(2017) Rowe, LynnBackground: The Sherlock 3CG™ Tip Confirmation System (TCS) provides real-time peripherally inserted central catheter (PICC) tip insertion information using passive magnetic navigation and patient cardiac electrical activity. It is an alternative tip confirmation method to fluoroscopy or chest X-ray for PICC tip insertion confirmation in adults. The purpose of this study was to evaluate time and cost of the Sherlock 3CG TCS and blind insertion with chest X-ray tip confirmation (BI/CXR) for PICC insertions. Methods: A cross-sectional, observational Time and Motion study was conducted. Data were collected at four hospitals in the US. Two hospitals used Sherlock 3CG TCS and two hospitals used BI/CXR to place/confirm successful PICC tip location. Researchers observed PICC insertions, collecting data from the beginning (ie, PICC kit opening) to catheter tip confirmation (ie, released for intravenous [IV] therapy). An economic model was developed to project outcomes for a larger population. Results: A total of 120 subjects were enrolled, with 60 subjects enrolled in each arm and 30 enrolled at each of the four US hospitals. The mean time from initiation of the PICC procedure to the time to release for IV therapy was 33.93 minutes in the Sherlock 3CG arm and 176.32 minutes in the BI/CXR arm (p < 0.001). No malpositions were observed for PICC insertions using the Sherlock 3CG TCS, while 20% of subjects in the BI/CXR arm had a malposition. BI/CXR subjects had significantly more total malpositions (mean 0.23 vs. 0, p < 0.001). For a hypothetical population of 1,000 annual patients, adoption of Sherlock 3CG TCS was predicted to be cost saving compared with BI/CXR in all three analysis years. Conclusion: The results from this study demonstrate that Sherlock 3CG TCS, when compared with BI/CXR, is a superior alternative with regard to time to release subject to therapy, malposition rates, and minimization of X-ray exposure.Item Stress Resiliency Practices in Neonatal Nurses(2017) Rowe, LynnBackground: Multiple environmental changes were experienced in a large level III neonatal intensive care unit (NICU) causing a perception of work-related stress leading to high nurse turnover, decreased engagement, and decreased satisfaction. Purpose: To identify a preintervention measure of perceived stress resiliency and ranking of interpretive styles in a population of neonatal, bedside registered nurses faced with a change in the physical practice environment. Methods: A descriptive, cross-sectional, correlational design was used to measure stress resiliency. The Stress Resiliency Profile (SRP) questionnaire was administered to a convenience sample of 48 neonatal bedside nurses. The SRP identifies 3 distinct interpretive styles as constructs of stress resiliency including deficiency focusing (negative thinking), necessitating (managing forced change), and skill recognition. Statistical analysis was used to describe associations between ages, years of experience, and resiliency. Results: Results showed skill recognition to be significantly lower than expected in participants 40 years and older. Also, participants with greater than 5 years of NICU experience revealed low to moderate levels of resiliency. Implications for Practice: Although skill is critical in nursing, it may not be the key factor in reducing the perception of work-related stress. Implementation of interventions targeting interpretative styles known to enhance resiliency may promote positive coping and quality change management. Implications for Research: Baseline resiliency data are necessary to guide unit leaders to manage future challenges found in evolving NICU nurse practice environments. More research is warranted to determine the generalizability of study results as healthcare organizations strive to implement best practices, control costs, and deliver safe, quality care.Item Integration of Data to Establish a Standard Operating Procedure for the Diabetic Patient Undergoing Hyperbaric Oxygen Therapy(2017) Rowe, LynnPURPOSE: The purpose of this study was to describe occurrences of hypoglycemia in the diabetic population undergoing hyperbaric oxygen therapy (HBOT). We also examined 2 secondary aims: link industry standards for management of hypoglycemia in the general diabetic population to the HBOT environment; and integrate HBOT data into an electronic health record system, as patients transition across inpatient and outpatient services and settings. DESIGN: A retrospective, descriptive study. SUBJECTS AND SETTING: The study took place within a hyperbaric medicine department located in a 1393-bed acute care medical center, part of a large, multihospital system. The study sample comprised 100 diabetic patients who underwent HBOT between January 1 and May 31, 2015. Sixty-seven percent were male; the mean age of participants was 62 years (range 32-92 years). Admission status was nearly equal with 53% hospital inpatients and 47% ambulatory outpatients. Hospital protocol required all patients to have a minimal prehyperbaric blood glucose level (BGL) of 100 mg/dL. RESULTS: The incidence of hypoglycemia (defined as a BGL <100 mg/dL, 5.5 mmol/L) was 122 of 1175 treatments (10.4%). Additional analysis was based on records for 66 of the 122 incidences with evaluable data from electronic medical records. The mean BGL pre-HBOT was 177.86 mg/dL, 6.54 mmol/L (range 53-439 mg/dL, 2.94-24.36 mmol/L); the mean BGL after HBOT was 165.09 mg/dL, 9.16 mmol/L (range 56-414 mg/dL, 3.11-22.98 mmol/L). Analysis of these 66 occurrences revealed that 52 of 66 (79%) were managed with high-carbohydrate juices and snacks; 8 of 66 (12%) received oral glucagon; and 6 of 66 (9%) received glucagon and high-carbohydrate snack. We found that standard treatment protocols for hypoglycemia ranged from 70 to 100 mg/dL, 3.89 to 5.55 mmol/L, for the general population and 80 to 120 mg/dL, 4.44 to 6.66 mmol/L, for the general diabetic population. We also found that HBOT diabetic data were not fully integrated into the electronic health records across all settings. CONCLUSIONS: Hypoglycemia is prevalent during HBOT. We recommend a minimum pre-treatment serum glucose of 120 mg/dL, 6.7 mmol/L.Item Ethical Issues with Genetic Testing for Tay-Sachs(2017) Clayton-Levassuer, TriciaSeveral genetic disorders are specific to Jewish heritage; one of the most devastating is Tay-Sachs disease. Tay-Sachs is a fatal hereditary disease, causing progressive neurological problems for which there is no cure. Ethical issues surrounding genetic testing for Tay-Sachs within the Jewish community continue to be complex and multifaceted. A perspective of Tay-Sachs, using rights-based ethics and virtue ethics as a theoretical framework, is explored.Item Implementing Secure Laptop-based Testing in an Undergraduate Nursing Program: A Case Study(2012) Tao, David Jinyuan; Lorentz, Chris; Hawes, Stacey; Rugless, Fely; Preston, JaniceThis article presents the implementation of secure laptop-based testing in an undergraduate nursing program. Details on how to design, develop, implement, and secure tests are discussed. Laptop-based testing mode is also compared with the computer-laboratory–based testing model. Five elements of the laptop-based testing model are illustrated: (1) it simulates the national board examination, (2) security is achievable, (3) it is convenient for both instructors and students, (4) it provides students hands-on practice, (5) continuous technical support is the key.Item Switching to Blended Learning: The Impact on Students' Academic Performance(2014) Tao, David Jinyuan; Lorentz, ChrisAs more and more undergraduate nursing programs (UNP) adopt the blended learning model, which combines traditional face-to-face learning and e-learning, how it impacts on students’ academic performance comes into educators’ mind. The purpose of this study was to investigate whether the blended learning model adopted by a UNP could yield the same, if not better academic achievement as compared with the traditional classroom learning. Students enrolled in two undergraduate nursing courses in fall 2008 and spring 2009 semesters were taken as a convenient sample. Students’ academic achievements were compared before and after the two undergraduate nursing courses adopted blended learning. Faculty members who taught those courses before and after the adoption were interviewed for insights on students’ complains and their corresponding solutions. The statistic results showed that there was no significant difference in terms of academic performance before and after the courses adopted blended learning. Interviews from the faculty members suggested that there was some initial resistance from the students on taking the online content outside of class. Pop quizzes at the beginning of each face-to-face class helped motivate students to complete the online portion at home prior coming to the class.Item Using Blended Learning to Prepare Future Distance Learning: A Technology Perspective(2011) Tao, David Jinyuan; Ramsey, Carolyn; Watson, MarleneThe Associate of Science of Nursing (ASN) programs in the United States typically adopt face-to-face teaching mode due to nursing field's practice-oriented characteristic. Recently, more and more ASN programs have migrated to a blended mode where lectures are pre-recorded and hosted in a robust Course Management System, and the traditional face-to-face teaching is still conducted on regular basis to reinforce learning. For the RN-BSN programs, however, the online mode is the main format for support of full time working registered nurses. This paper presents an exploratory evaluation of a blended learning mode adopted by an ASN program in terms of students' technology competence. The aim of this study is to investigate whether the blended learning mode of an associate nursing program can technologically prepare its students for their future distance education.Item Young Adult African American Family Members' Perceptions, Knowledge, Attitudes, and Utilization Toward Advance Directives(2013) Ramsey, CarolynAdvance directives (ADs) give patients autonomy in making decisions regarding end-of-life preferences prior to becoming incapacitated or otherwise unable to communicate. Limited family-related research currently exists on young, adult African American families and their knowledge, attitudes, and perceptions toward the utilization of ADs. A mixed-method design of quantitative data, using the Advance Directives-Knowledge, Attitudes, and Utilization Questionnaire (AD-KAUQ); and qualitative data, using a focused group session, was conducted in a southeastern city in the United States. The study surveyed 112 young, adult African American family members, ages 21-40 years, to explore their perceptions, knowledge, and attitudes toward utilizing ADs, as well as to determine whether there was a relationship between gender, education level, marital status, and occupation in making this decision. The study findings did not support evidence of significant relationships between the variables with the exception for the relationship between gender and the feeling of being treated differently for having a living will in place. This finding suggested that there was a need for members of young, adult African American families to obtain knowledge of ADs.Item Treating Chronic Nonmalignant Pain: Evidence and Faith-based Approaches(2019) Snell, Sarah; Hughes, Tia; Fore, Carolyn; Lukman, RoyA significant portion of the world's population is impacted by chronic pain; in the United States, chronic pain costs billions annually in treatment and lost productivity. A needs assessment was conducted to evaluate the prevalence of chronic nonmalignant pain (CNMP) at a university occupational therapy clinic over a 3-month period; recommendations were made to improve pain management at the clinic and referring hospital system. Graded Chronic Pain Scale 2.0 results indicated the prevalence of CNMP was a significant problem. Three evidence-based interventions based on the biblically based CREATION Health Model were developed.