The clinical exemplar reported in this article demonstrates the usefulness of the Center for Advanced Nursing Practice's Evidence-Based Practice Model in facilitating a structured approach to expanding outcomes management of rapid... more
The clinical exemplar reported in this article demonstrates the usefulness of the Center for Advanced Nursing Practice's Evidence-Based Practice Model in facilitating a structured approach to expanding outcomes management of rapid recovery for coronary artery bypass graft (CABG) patients. The evidence-triggered and evidence-supported components of the model were key in using research and evidence-based practices to analyze the current program of outcomes management used for CABG rapid recovery. The evidence-observed component further validated changes in clinical practice, which became part of the evolving outcomes management program.
Research Interests: Epidemiology, Evidence Based Medicine, Evidence Based Practice, Medicine, Critical Care, and 15 moreClinical Practice, Humans, Models, Intervention, Length of Stay, Artery, Nurse, Operation, Aged, Middle Aged, Adult, Intensive Care Medicine, Medical Records, Postoperative care, and Coronary Artery Bypass
Recently, the integrity of reporting nursing research studies has been brought into question, with claims that less than half of clinical trials published in leading nursing journals are officially registered (Gray et al 2017). These... more
Recently, the integrity of reporting nursing research studies has been brought into question, with claims that less than half of clinical trials published in leading nursing journals are officially registered (Gray et al 2017). These authors suggest that because of this, the quality of published outcome analysis definitions and trial registrations in nursing journals is often sub- optimal. This article is protected by copyright. All rights reserved.
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To analyse influential policies that inform practice related to pressure injury management in Australia, England, Hong Kong, New Zealand, Scotland and the United States of America. Pressure injuries are associated with significant harm to... more
To analyse influential policies that inform practice related to pressure injury management in Australia, England, Hong Kong, New Zealand, Scotland and the United States of America. Pressure injuries are associated with significant harm to patients, and carry economic consequences for the health sector. Internationally, preventing and managing pressure injuries is a key nursing activity and quality indicator. Comparative review and synthesis of pressure injury policies that inform practice. The predominant focus of policy is on patient risk assessment, compliance with documentation and pressure relief. Financial penalty for institutions is emerging as a strategy where pressure injuries occur. Comparisons of prevalence rates are hampered by the lack of consensus on data collection and reporting. To date there has been little evaluation of policy implementation and implemented policy strategies, associated guidelines remain founded upon expert opinion and low-level evidence. The pressu...
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Research Interests:
Older women have lower levels of physical functioning and higher associated health care costs than men after coronary artery bypass surgery (CABS). Clinical trials have demonstrated that interventions to increase physical activity levels... more
Older women have lower levels of physical functioning and higher associated health care costs than men after coronary artery bypass surgery (CABS). Clinical trials have demonstrated that interventions to increase physical activity levels can reduce the risk of recurrent cardiac events, reduce health care expenditures, prolong life, improve functional capacity, and increase quality of life in the elderly cardiac population. It is important for the patients, providers, health care payers, and policymakers to identify a cost-effective recovery intervention that has the potential to increase women's physical activity and functioning during their early recovery from CABS, especially in this time of limited health care resources. This home-based symptom management intervention has the potential to reduce the risk of recurrent cardiac events and health care cost by improving women's physical activity level after surgery. This information is vital to nursing leaders in making resour...
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This pilot study examined the impact of a hospital transition intervention for older adults (≥ 65 years of age) with heart failure (HF) to promote medication use self-management. Forty subjects, hospitalized with either primary or... more
This pilot study examined the impact of a hospital transition intervention for older adults (≥ 65 years of age) with heart failure (HF) to promote medication use self-management. Forty subjects, hospitalized with either primary or secondary HF, had a mean age of 76.9 ± 6.5 years; 65% were males. The majority of subjects (55%) had NYHA Class III HF. A prospective, repeated measures experimental design was used. Baseline and follow-up data (1- and 3-months after hospitalization) were obtained using the Medication Regimen Complexity Index, Brief Medication Questionnaire, Drug Regiment Unassisted Grading Scale, and Kansas City Cardiomyopathy Questionnaire. Using repeated measures analysis of covariance (ANCOVA), with baseline measures as covariates, the transition intervention group had higher levels of medication adherence ( F(1,35) = 13.4, p < .001), self-efficacy for HF self-care ( F(1,35) = 17.9, p < .001) and had significantly fewer HF related symptoms that impaired health re...
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To examine the influence during the early postoperative period of selected nursing interventions on mood and anxiety of patients undergoing heart surgery. Prospective, repeated measures, quasiexperimental, random assignment. The... more
To examine the influence during the early postoperative period of selected nursing interventions on mood and anxiety of patients undergoing heart surgery. Prospective, repeated measures, quasiexperimental, random assignment. The cardiovascular intensive care and progressive care units of a midwestern community hospital were used as the setting for this study. Ninety-six patients who underwent elective, heart bypass surgery; the mean age of the subjects was 67 years, with an age range of 37 to 84 years. Most subjects were men (n = 65, 68%). Physiologic measures of anxiety and mood include blood pressure and heart rate. Additional measures included the use of Spielberger&#39;s state-trait anxiety inventory (STAI) and patient verbal ratings of both mood and anxiety with use of a numeric rating scale (NRS). Patients were randomly assigned to one of three groups: (1) music therapy, (2) music-video therapy, or (3) scheduled rest group. Subjects in the groups received their assigned 30-minute intervention at two episodes on postoperative days 2 and 3. Subjects had physiologic measures of blood pressure and heart rate measured immediately before the intervention and at 10-minute intervals throughout the intervention. Mood and anxiety were evaluated by having subjects use a NRS (i.e., 0 to 10) to give rating of mood and anxiety immediately before and after each session. Anxiety was further measured with the STAI. A baseline measure of STAI was taken before surgery; patients also completed the &quot;state&quot; anxiety tool before the intervention session on postoperative day 2 and on completion of the session on postoperative day 3. With use of an analysis of covariance (ANCOVA), subjects&#39; mood ratings showed significant improvement in mood among subjects in the &quot;music intervention&quot; group after the second intervention when controlling for the preintervention rating of mood, F(2, 87) = 4.33, p = 0.016. However, no significant differences were reported for anxiety ratings as measured by the NRS and state anxiety instruments. With use of repeated measures analysis of variance (ANOVA), there were no significant interactions between the intervention groups and time for any of the physiologic variables. However, there were significant main effects over time for heart rate and systolic and diastolic blood pressure, which indicated a generalized physiologic relaxation response. Although none of the three interventions was overwhelmingly superior, the overall response by all intervention groups demonstrated a generalized relaxation response. It is also important to note that there was reduced anxiety and improved mood within all three groups.
Research Interests: Nursing, Music Therapy, Medicine, Anxiety, Affect, and 15 moreHumans, Blood Pressure, Female, Male, Heart rate, Aged, Middle Aged, Adult, Analysis of Variance, ANXIETY, Coronary artery bypass surgery, Postoperative care, Coronary artery bypass graft, Cardiovascular medicine and haematology, and Coronary Artery Bypass
Research Interests: Nursing, Treatment Outcome, Telemedicine, Medicine, Humans, and 15 moreFemale, Male, Patient Compliance, Aged, Questionnaires, Coronary heart disease, Home Health Care, Coronary artery bypass surgery, Pilot Projects, Home Care Services, Elderly patient, health status indicators, Coronary artery bypass graft, Cardiovascular medicine and haematology, and Coronary Artery Bypass
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Evidence-based nursing care is informed by research findings, clinical expertise, and patients’ values, and its use can improve patients’ outcomes. Use of research evidence in clinical practice is an expected standard of practice for... more
Evidence-based nursing care is informed by research findings, clinical expertise, and patients’ values, and its use can improve patients’ outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the strength of research studies, assess the findings, and evaluate the evidence for potential implementation into best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in practice.
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This article reviews the use of distance learning in nursing education and to summarize key questions that must be addressed by programs or students considering advanced practice nursing education using distance technology. An acute care... more
This article reviews the use of distance learning in nursing education and to summarize key questions that must be addressed by programs or students considering advanced practice nursing education using distance technology. An acute care nurse practitioner program using distance learning strategies is provided as an example to illustrate delivery of a clinically based curriculum. Examples of questions to be addressed in evaluating a distance education program include: How much of the course or graduate nursing program is available on-line? What are the specific informational technologies used? How does communication occur between graduate students and faculty? How are clinical requirements of a course managed? Are there any requirements for time to be spent directly on campus? Is it necessary for the student to have a computer and Internet provider? Knowledge of the available technology and components of distance education can enhance the ability of the advanced practice nurse to evaluate better and choose educational program offerings.
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Research Interests:
This descriptive study examined pain descriptors in a group of patients with arthritis prior to total knee replacement (TKR), and on postoperative days 1 and 3. The McGill Pain Questionnaire (MPQ), consisting of 78 descriptive words in 20... more
This descriptive study examined pain descriptors in a group of patients with arthritis prior to total knee replacement (TKR), and on postoperative days 1 and 3. The McGill Pain Questionnaire (MPQ), consisting of 78 descriptive words in 20 subclasses of descriptors scaled on intensity dimensions, was administered to each subject prior to and on two occasions after surgery. The findings support results from previous studies indicating that clusters of words are more often selected to express chronic pain, and other patterns are used to describe acute pain during the early postoperative period. Also, subjects experienced considerable pain intensity related to arthritis prior to surgery, and they reported less overall pain intensity following their TKR.
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The purpose of this experimental study was to determine the effects of second and third day postoperative music interventions (music, music video) on pain and sleep in 96 postoperative patients having CABG surgery. The Verbal Rating Scale... more
The purpose of this experimental study was to determine the effects of second and third day postoperative music interventions (music, music video) on pain and sleep in 96 postoperative patients having CABG surgery. The Verbal Rating Scale scores obtained before and after each 30-minute session showed that pain decreased over time for all three groups with no difference across groups. The McGill Pain Questionnaire (MPQ) was administered before session 1 and after session 2, and results indicated that Sensory, Affective, and Present Pain Intensity subscales showed no group difference for pain; however, pain decreased from Day 2 to Day 3 for all three groups. For the evaluative component of pain, those in the music group had significantly (F[2,93] = 4.74, p < .05) lower scores on postoperative Day 2 than the rest period control group. Effects of the intervention on sleep as measured by the Richard Sleep Questionnaire indicated that the video group had significantly (F[2, 92] = 3.18,...
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Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations... more
Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations from national guidelines and authoritative resources, retooling and updating of the pain management program was shaped to include a multidisciplinary team approach, principles of Total Quality Improvement, and outcomes management. Guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model and the leadership of clinical nurse specialists, organization-wide pain management initiatives have contributed to improved pain management practices. The end-point goal of a comprehensive pain management program that demonstrates positive patient outcomes along the care continuum provides an opportunity for merged health care organizations at two sites. This challenge will be supported by the model and the principles of continuous quality...
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The purposes of this study were to investigate the relationship of postoperative anxiety and pain following coronary artery bypass graft (CABG) surgery, and to determine the effects of level of anxiety, demographic, and other factors on... more
The purposes of this study were to investigate the relationship of postoperative anxiety and pain following coronary artery bypass graft (CABG) surgery, and to determine the effects of level of anxiety, demographic, and other factors on the level of postoperative pain. Pain intensity, sensory pain, and affective pain were measured along with anxiety on postoperative day 2 and day 3 by the McGill Pain Questionnaire Subscales (PPI, PRIS, and PRIA) and State Anxiety Inventory Scale, respectively. A direct relationship of anxiety with pain was found over time with the highest relationship on postoperative day 2 (r = 0.235-0.492, P < 0.001). A significant interaction between time and level of anxiety on affective pain was specific to postoperative day 2 (P < 0.01). Significant differences by level of anxiety and time were reported. Factors of age, gender, marital status, number of previous surgeries, and operation time had no effect on the level of postoperative pain.
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Shortened hospitalizations following cardiac surgery necessitate re-evaluation of how pertinent information for self-care management and reduction of coronary artery disease risk factors can be incorporated into an effective inpatient... more
Shortened hospitalizations following cardiac surgery necessitate re-evaluation of how pertinent information for self-care management and reduction of coronary artery disease risk factors can be incorporated into an effective inpatient cardiac patient teaching program. This study investigated the effect of three different teaching approaches (i.e., an inpatient teaching program, a postdischarge telephone follow-up program, and a postdischarge group teaching program) among 90 patients who had undergone coronary artery bypass graft surgery. Teaching outcomes were evaluated in this study by use of the Heart Disease Management Questionnaire and Cardiac Surgical Patient Teaching Satisfaction Inventory. Analyses of the data revealed similar patient teaching outcomes regardless of the type of teaching intervention the participant received. Findings supported the effectiveness of the inpatient teaching protocol which focused on "survival skills" for self-care management postdischar...
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The Center for Advanced Nursing Practice Evidence-Based Model was the catalyst and driving force that guided the application of evidence-based practice across boundaries of tertiary health care settings to rural health care settings. The... more
The Center for Advanced Nursing Practice Evidence-Based Model was the catalyst and driving force that guided the application of evidence-based practice across boundaries of tertiary health care settings to rural health care settings. The intent of this effort was to enhance knowledge and to streamline practice for the management of patients with chest pain. The model successfully supported practice changes and improved outcome management for this aggregate population.
Research Interests:
The clinical exemplar reported in this article demonstrates the usefulness of the Center for Advanced Nursing Practice's Evidence-Based Practice Model in facilitating a structured approach to expanding outcomes management of rapid... more
The clinical exemplar reported in this article demonstrates the usefulness of the Center for Advanced Nursing Practice's Evidence-Based Practice Model in facilitating a structured approach to expanding outcomes management of rapid recovery for coronary artery bypass graft (CABG) patients. The evidence-triggered and evidence-supported components of the model were key in using research and evidence-based practices to analyze the current program of outcomes management used for CABG rapid recovery. The evidence-observed component further validated changes in clinical practice, which became part of the evolving outcomes management program.
Research Interests:
Research Interests:
Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations... more
Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations from national guidelines and authoritative resources, retooling and updating of the pain management program was shaped to include a multidisciplinary team approach, principles of Total Quality Improvement, and outcomes management. Guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model and the leadership of clinical nurse specialists, organization-wide pain management initiatives have contributed to improved pain management practices. The end-point goal of a comprehensive pain management program that demonstrates positive patient outcomes along the care continuum provides an opportunity for merged health care organizations at two sites. This challenge will be supported by the model and the principles of continuous quality...
Research Interests:
Shortened hospitalizations following cardiac surgery necessitate re-evaluation of how pertinent information for self-care management and reduction of coronary artery disease risk factors can be incorporated into an effective inpatient... more
Shortened hospitalizations following cardiac surgery necessitate re-evaluation of how pertinent information for self-care management and reduction of coronary artery disease risk factors can be incorporated into an effective inpatient cardiac patient teaching program. This study investigated the effect of three different teaching approaches (i.e., an inpatient teaching program, a postdischarge telephone follow-up program, and a postdischarge group teaching program) among 90 patients who had undergone coronary artery bypass graft surgery. Teaching outcomes were evaluated in this study by use of the Heart Disease Management Questionnaire and Cardiac Surgical Patient Teaching Satisfaction Inventory. Analyses of the data revealed similar patient teaching outcomes regardless of the type of teaching intervention the participant received. Findings supported the effectiveness of the inpatient teaching protocol which focused on "survival skills" for self-care management postdischar...
Research Interests:
Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations... more
Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations from national guidelines and authoritative resources, retooling and updating of the pain management program was shaped to include a multidisciplinary team approach, principles of Total Quality Improvement, and outcomes management. Guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model and the leadership of clinical nurse specialists, organization-wide pain management initiatives have contributed to improved pain management practices. The end-point goal of a comprehensive pain management program that demonstrates positive patient outcomes along the care continuum provides an opportunity for merged health care organizations at two sites. This challenge will be supported by the model and the principles of continuous quality...
... eg, when encouraging patients to relax and thus enhancing the effectiveness of pain ... response, some benefi-cial clinical effects were clear when resting relaxation techniques were utilized in ... that had no restrictions on... more
... eg, when encouraging patients to relax and thus enhancing the effectiveness of pain ... response, some benefi-cial clinical effects were clear when resting relaxation techniques were utilized in ... that had no restrictions on activity during the intervention measurement period might ...
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The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary... more
The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary syndrome, heart failure, arrhythmia/atrial fibrillation, and angina, or patients undergoing cardiac interventions). An integrative review of the literature was conducted. A total of 102 studies summarizing information on 36 different instruments are reported in this integrative review. The majority of the instruments measured multiple symptoms and were used for one population. A majority of the symptom measures were disease-specific and were multi-dimensional. This review summarizes the psychometrics and defining characteristics of instruments to measure the four commonly occurring symptoms in cardiac populations. Simple, psychometrically strong instruments do exist and should be considered for use; however, there is less evidence of responsiveness...
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Although individual symptoms and symptom trajectories for various cardiovascular conditions have been reported, there is limited research identifying the symptom clusters that may provide a better understanding of patients'... more
Although individual symptoms and symptom trajectories for various cardiovascular conditions have been reported, there is limited research identifying the symptom clusters that may provide a better understanding of patients' experiences with heart disease. To summarize the state of the science in symptom cluster research for patients with acute coronary syndrome, myocardial infarction, coronary artery bypass surgery, and heart failure through systematic review and to provide direction for the translation of symptom cluster research into the clinical setting. Databases were searched for articles from January 2000 through to May 2015 using MESH terms "symptoms, symptom clusters, acute coronary syndrome (ACS), myocardial infarction (MI), coronary heart disease (CHD), ischemic heart disease (IHD), heart failure (HF), coronary artery bypass surgery (CABS), cluster analyses, and latent classes." The search was limited to human studies, English language articles, and original ...
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Acquired peripheral vascular disease (PVD) is a significant problem in the United States, resulting in both morbidity and mortality. The purpose of the pilot study was to determine patient outcomes after peripheral revascularization... more
Acquired peripheral vascular disease (PVD) is a significant problem in the United States, resulting in both morbidity and mortality. The purpose of the pilot study was to determine patient outcomes after peripheral revascularization surgery. The specific aims of the pilot study were to examine peripheral revascularization surgical patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction) and to determine the influence of selected patient demographic characteristics (gender, age) on selected patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction). A prospective, repeated measures design was used for the study. A total of 39 patients, 18 women and 21 men, participated in the study, with a mean age of 68.86 years (SD = 13.61). The average length of hospitalization after surgery was 4.05 days. At 1 month after discharge, the majority of patients had relief from claudication and paresthesia. In regard to outcomes related to atherosclerotic risk factor modification, patients reported that they exercised on a routine basis, an average of 5.31 +/- 1.97 times per week. Before surgery, 21 patients reported that they smoked; 6 patients reported that they continued to smoke at follow-up. There were no significant differences in mean total scores of atherosclerotic risk modification by either gender or age groups (&lt;65 or &gt; or =65 years) with the use of one-way analyses of variance (ANOVAs). By using a Likert scale (ie, 0 to 10), the mean level of functioning was 8.18 +/- 2.76, with women having significantly higher mean levels of functioning (F = 4.26, P &lt;.05). Comparing baseline scores of functioning on the Medical Outcomes Study Short-Form 36 (MOS SF-36), there was a significant improvement (F = 2.11, P &lt;.05) in general health subscale scores at 1 month after surgery. Subjects&#39; mean overall satisfaction with the results of surgery, with a 0 to 10 scale, was 7.33 +/- 2.84. Again, by using one-way ANOVAs, females had significantly higher mean satisfaction rating than males (F = 4.52, P &lt;.05). Although findings from this pilot study are limited in their generalizability, clinicians need to continue to evaluate opportunities to further reduce variability in clinical practice patterns for optimal patient outcomes. Study findings also indicated that additional interventions are warranted to educate and provide rehabilitation for patients regarding an exercise program and overall behavior modification strategies to reduce risk for atherosclerotic disease.
Research Interests: Nursing, Behavior Modification, Treatment Outcome, Clinical Practice, Prospective studies, and 15 moreHumans, Female, Male, Patient Satisfaction, Risk factors, General Health, Aged, Middle Aged, Pilot study, Repeated Measures, Peripheral Vascular Disease, Analysis of Variance, Risk Factors, Pilot Projects, and Age Groups
Collaborative nursing research is an effective means to increase research productivity. The essentials of collaborative research are contribution, communication, commitment, consensus, compatibility, and a cohesive approach toward a... more
Collaborative nursing research is an effective means to increase research productivity. The essentials of collaborative research are contribution, communication, commitment, consensus, compatibility, and a cohesive approach toward a positive outcome. The purpose of the demonstration project was to describe a collaborative process in one community, culminating in a research utilization study and development of nursing standards pertaining to an aggregate population of patients.
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Research Interests:
A better understanding of the relationships between symptom recognition, nursing response, and preferred thinking style is needed to improve nursing education practices. Final semester nursing students (N = 29) completed a high fidelity... more
A better understanding of the relationships between symptom recognition, nursing response, and preferred thinking style is needed to improve nursing education practices. Final semester nursing students (N = 29) completed a high fidelity patient simulation (HFPS) scenario; recognized symptoms (i.e., dyspnea) and responses (i.e., apply oxygen) were recorded, and compared with students' preferred thinking style using the Rational-Experiential Inventory-40. Relationships between concepts were explored. Significant relationships were noted between preference for Rational thinking styles and symptom recognition (p < .05). Preferred thinking style was not related to numbers of therapeutic responses. Thirty percent of students delayed application of oxygen until directed to do so by members of the health care team. Students having a stronger preference for rational thinking demonstrate greater accuracy in cue recognition. More nursing research is needed to explore the cognitive proce...
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The clinical exemplar reported in this article demonstrates the usefulness of the Center for Advanced Nursing Practice's Evidence-Based Practice Model in facilitating a structured approach to expanding outcomes management of rapid... more
The clinical exemplar reported in this article demonstrates the usefulness of the Center for Advanced Nursing Practice's Evidence-Based Practice Model in facilitating a structured approach to expanding outcomes management of rapid recovery for coronary artery bypass graft (CABG) patients. The evidence-triggered and evidence-supported components of the model were key in using research and evidence-based practices to analyze the current program of outcomes management used for CABG rapid recovery. The evidence-observed component further validated changes in clinical practice, which became part of the evolving outcomes management program.
Research Interests:
Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations... more
Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations from national guidelines and authoritative resources, retooling and updating of the pain management program was shaped to include a multidisciplinary team approach, principles of Total Quality Improvement, and outcomes management. Guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model and the leadership of clinical nurse specialists, organization-wide pain management initiatives have contributed to improved pain management practices. The end-point goal of a comprehensive pain management program that demonstrates positive patient outcomes along the care continuum provides an opportunity for merged health care organizations at two sites. This challenge will be supported by the model and the principles of continuous quality...
Research Interests:
Research Interests: Nursing, Organizational Culture, Evidence Based Practice, Educational Measurement, Motivation, and 12 moreNursing Research, Humans, Needs Assessment, United States, Emergency, Diffusion of Innovation, Emergency Nursing, Nursing Education and Research in Nursing, Clinical Sciences, Questionnaires, Professional Competence, and Cross Sectional Studies
Research Interests: Exercise therapy, Energy Metabolism, Homosexuality, Humans, Consensus, and 15 moreFemale, Cognitive Therapy, Male, Sexual Behavior, Risk factors, Sex Factors, Circulation, Age Factors, Cardiovascular Diseases, Risk Factors, Coronary artery bypass surgery, Heart Transplantation, Continuous Flow Heart Assist Devices, Cardiovascular medicine and haematology, and Coronary Artery Bypass
In patients with heart failure (HF), use of 30-day rehospitalization as a healthcare metric and increased pressure to provide value-based care compel healthcare providers to improve efficiency and to use an integrated care approach.... more
In patients with heart failure (HF), use of 30-day rehospitalization as a healthcare metric and increased pressure to provide value-based care compel healthcare providers to improve efficiency and to use an integrated care approach. Transition programs are being used to achieve goals. Transition of care in the context of HF management refers to individual interventions and programs with multiple activities that are designed to improve shifts or transitions from one setting to the next, most often from hospital to home. As transitional care programs become the new normal for patients with chronic HF, it is important to understand the current state of the science of transitional care, as discussed in the available research literature. Of transitional care reports, there was much heterogeneity in research designs, methods, study aims, and program targets, or they were not well described. Often, programs used bundled interventions, making it difficult to discuss the efficiency and effec...
Research Interests:
The Center for Advanced Nursing Practice Evidence-Based Model was the catalyst and driving force that guided the application of evidence-based practice across boundaries of tertiary health care settings to rural health care settings. The... more
The Center for Advanced Nursing Practice Evidence-Based Model was the catalyst and driving force that guided the application of evidence-based practice across boundaries of tertiary health care settings to rural health care settings. The intent of this effort was to enhance knowledge and to streamline practice for the management of patients with chest pain. The model successfully supported practice changes and improved outcome management for this aggregate population.
Research Interests:
Research Interests: Cardiology, Pain Management, General Surgery, Humans, United States, and 15 moreAdvisory Committees, Risk factors, Clinical Sciences, Cardiovascular system, Nuclear Cardiology, Public health systems and services research, Circulation, Cardiovascular Diseases, Risk Factors, American Heart Association, Disease Management, Research Report, Patient care management, perioperative care, and Cardiovascular medicine and haematology
To determine the effect of 2 standard methods (i.e., twill tape versus adhesive tape) of securement on unplanned extubation, oral mucosa, and facial skin integrity of the orally intubated patient. A prospective, quasi-experimental design... more
To determine the effect of 2 standard methods (i.e., twill tape versus adhesive tape) of securement on unplanned extubation, oral mucosa, and facial skin integrity of the orally intubated patient. A prospective, quasi-experimental design was used for the pilot study. The setting for the pilot study included critical care units of 3 community hospitals and 1 veterans&#39; hospital in a midwestern city. A total of 52 orally intubated adult subjects were enrolled in the study from the 4 clinical sites over a 6-month period of time. The participants in the study consisted of 30 men and 22 women. The subjects ranged in age from 22 to 85 years, with a mean age of 62.3 years. The mean length of intubation was 89.6 hours. The outcome measures of the study were (1) unplanned extubation, (2) oral mucosa status, and (3) facial skin integrity. Endotracheal tube securement with either the twill tape or the adhesive tape securement method. With use of multiple analysis of variances (MANOVA) and repeated analyses of variances (ANOVAs), there were no significant differences by time or type of endotracheal tube securement method on oral mucosa or facial skin integrity. A chi-square analysis demonstrated no significant association between the 2 types of endotracheal tube securement when comparing their efficacy in preventing unplanned extubation. The findings of this pilot study demonstrated both methods of endotracheal tube securement to be comparable in preventing unplanned extubation and in maintaining oral mucosa status and facial skin integrity.
Research Interests: Nursing, Face, Experimental Design, Critical Care, Humans, and 15 moreFemale, Male, Oral Mucosa, Aged, Middle Aged, Pilot study, Adult, Mouth mucosa, Analysis of Variance, Chi Square Distribution, Adhesives, Intensive Care Units, Pilot Projects, Outcome measure, and Cardiovascular medicine and haematology
This descriptive study examined pain descriptors in a group of patients with arthritis prior to total knee replacement (TKR), and on postoperative days 1 and 3. The McGill Pain Questionnaire (MPQ), consisting of 78 descriptive words in 20... more
This descriptive study examined pain descriptors in a group of patients with arthritis prior to total knee replacement (TKR), and on postoperative days 1 and 3. The McGill Pain Questionnaire (MPQ), consisting of 78 descriptive words in 20 subclasses of descriptors scaled on intensity dimensions, was administered to each subject prior to and on two occasions after surgery. The findings support results from previous studies indicating that clusters of words are more often selected to express chronic pain, and other patterns are used to describe acute pain during the early postoperative period. Also, subjects experienced considerable pain intensity related to arthritis prior to surgery, and they reported less overall pain intensity following their TKR.
Research Interests:
The purpose of this secondary analysis was to profile or cluster 226 patients, who had participated in a randomized controlled trial, on symptoms after coronary artery bypass surgery and to examine how these profiles could potentially be... more
The purpose of this secondary analysis was to profile or cluster 226 patients, who had participated in a randomized controlled trial, on symptoms after coronary artery bypass surgery and to examine how these profiles could potentially be used by clinicians to identify groups at risk for impaired functioning during the first 6 months after surgery. Variables measured were symptom presence and burden and functioning. The model-based clustering method was used for cluster analysis of the symptom burden measure, and analyses of covariance were used to determine if there were differences on functioning (physical functioning and physical activity) by symptom burden group at 6 weeks and at 3 and 6 months after dismissal. The majority of the 226 subjects were married (86%), male (83%), and had a mean age of 71 (SD, 4.96) years. Eight symptoms were used in the model-based clustering method-shortness of breath, fatigue, depression, sleep disturbances, pain, swelling, anxiety, and appetite problems-and demonstrated that there were 3 patient clusters of symptom burden. Cluster 1 had low symptom burden on all 8 symptoms, cluster 3 had moderate symptom burden on all 8 symptoms, and cluster 2 had a combination of low (shortness of breath, fatigue, depression, pain, and anxiety) and moderate symptom burden (sleep problems, swelling, and appetite problems). Analyses of covariance revealed no significant cluster x time interactions for any of the variables. However, there were significant main effects (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01) for symptom burden groups for physical functioning (physical and vitality functioning) and physical activity (estimated energy expenditure and mean daily total activity counts). Significant main effects for time indicated physical functioning and physical activity measures, except bodily pain, improved over time (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Study results indicate that the use of profiling coronary artery bypass surgery patients on their symptoms prior to hospital discharge may assist health care providers to identify patients who could be at risk for having more difficulty with physical functioning and physical activity during the first 6 months after surgery.
Research Interests: Nursing, Risk assessment, Fatigue, Energy Metabolism, Multivariate Analysis, and 15 moreActivities of Daily Living, Humans, Female, Male, Cluster Analysis, Postoperative pain, Aged, Edema, Analysis of Variance, Anorexia, Risk Assessment, Coronary artery bypass surgery, Severity of Illness Index, Cardiovascular medicine and haematology, and Coronary Artery Bypass
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Research Interests:
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Research Interests:
To examine functional status outcomes among patients with a coronary artery bypass graft (CABG) over time (ie, at baseline; 3 months, 6 months, and 12 months after surgery) and the impact of selected patient characteristics (ie, age, sex,... more
To examine functional status outcomes among patients with a coronary artery bypass graft (CABG) over time (ie, at baseline; 3 months, 6 months, and 12 months after surgery) and the impact of selected patient characteristics (ie, age, sex, comorbidities, and cardiac rehabilitation participation) on functional outcomes. A prospective, repeated-measures design was used to examine functional status in patients with a CABG over time. A midwestern community hospital and regional cardiac referral center was the setting for enrolling patients with a CABG. Functional status outcomes were measured by using the Medical Outcomes Study (MOS) Short Form 36 (SF-36) and Modified 7-Day Activity instruments. Baseline data were obtained by patient interview in the hospital setting after CABG surgery. At 3 months, 6 months, and 12 months after surgery, telephone interviews were conducted to administer research instruments. Baseline scores on 7 of the 8 subscales of the MOS SF-36 were significantly lower than at 3 months, 6 months, or 12 months after surgery. Role-emotional functioning baseline scores were not significantly lower than 3-month scores; however, baseline scores were significantly lower than 6-month and 12-month scores. Three-month subscale scores were also significantly lower than 6-month or 12-month scores except for the subscales measuring social and general health functioning. Functional status as measured by the Modified 7-Day Activity tool did not demonstrate any significant differences between 3-month, 6-month, or 12-month activity levels. There were no significant differences by age group on any of the 8 subscales of the MOS SF-36 instrument. Women and subjects with more than 1 comorbidity had a significantly lower preoperative level of physical functioning. Cardiac rehabilitation participants had lower preoperative scores on role-emotional functioning than subjects who were not in rehabilitation. Findings from this study can assist nurses and other health care workers to gain a perspective of the recovery and rehabilitation trajectory of patients with a CABG. The results of the study provide a basis for determining areas of functional limitations during recovery from CABG surgery. Study results can also be the foundation for evaluating outcomes of patients with a CABG when specific interventions (eg, pain management, psychosocial support, physical strengthening, fatigue management) are implemented during hospitalization, home recovery, and rehabilitation to target optimal psychosocial and physiologic functioning of patients with a CABG.
Research Interests: Nursing, Treatment Outcome, Comorbidity, Pain Management, Activities of Daily Living, and 15 moreProspective studies, Humans, Female, Male, STEM (short form), Health Care Workers, General Health, Repeated Measures, Coronary heart disease, Sex Factors, Cardiac rehabilitation, Coronary artery bypass surgery, Physical Function, Functional Status, and Age Groups
... Jennifer Williams, MSN, RN, CEN, CCRN, CNS Jean Proehl, MN, RN, CEN, CPEN, FAEN Carla Brim, MN, RN, CEN, CNS Melanie Crowley, MSN ... mean differences from oral temperatures of 0.27 °C, with limits of agreement of -2.13 to + 2.66 °C... more
... Jennifer Williams, MSN, RN, CEN, CCRN, CNS Jean Proehl, MN, RN, CEN, CPEN, FAEN Carla Brim, MN, RN, CEN, CNS Melanie Crowley, MSN ... mean differences from oral temperatures of 0.27 °C, with limits of agreement of -2.13 to + 2.66 °C (Marable, Shaffer, Dizon, & Opalek ...
The purpose of this study was to assess and describe the multidimensional postoperative pain experience of patients (N = 194) undergoing coronary artery bypass graft surgery (CABG) using the McGill Pain Questionnaire. Postoperative pain... more
The purpose of this study was to assess and describe the multidimensional postoperative pain experience of patients (N = 194) undergoing coronary artery bypass graft surgery (CABG) using the McGill Pain Questionnaire. Postoperative pain significantly decreased from postoperative day 2 to postoperative day 3 for all components of the McGill Pain Questionnaire. Sensory words chosen from the McGill Pain Questionnaire on postoperative day 2 included sharp, sore, aching, and tender. Affective words chosen included exhausting on postoperative day 2 and tiring on postoperative days 2 and 3. The evaluative word annoying was chosen for both postoperative days 2 and 3. The present pain intensity (PPI) rating completed on a scale from no pain = 0 to excruciating pain = 5, showed a mean intensity rating of 1.08 for postoperative day 2 and 0.67 for postoperative day 3. These findings describing the typical pattern of postoperative pain are clinically significant in the differentiation of &quot;normal&quot; postoperative pain from pain experienced with postoperative complications from CABG surgery.