Clinical Nurse Specialist最新文献

Purpose/objectives: Pressure injuries (PIs) are localized skin and tissue damage caused by prolonged pressure and shear. Hospital-acquired pressure injuries (HAPIs) remain a significant concern in acute care, with disparities in early detection among patients with darker skin tones. This project aimed to enhance early PI detection and reduce severity by integrating infrared thermography (IRT) into nursing skin assessments on a transplant unit.

Description: Nurses received education on the influence of skin tone variation and how to utilize IRT imaging as an added tool to identify early physiologic changes not always visible in traditional assessments. Data were collected over 3 months, including HAPI incidence, staging, and nurse-reported confidence levels.

Outcomes: A total of 303 thermal images were obtained from 86 patients using IRT. Of these, deep tissue injuries were seen in 33.6% of images, hypoperfusion in 39%, and signs of inflammation in 17%. Following implementation, early recognition of pressure injuries improved, leading to timely interventions. Nurses reported increased confidence in detecting PI with the device.

Conclusions: Combining IRT with education on skin tone variation and multimodal assessment improved equity in PI detection, reduced severity, and enhanced nurse confidence. Technology, paired with culturally sensitive practice, supports safety, quality, and equitable outcomes in pressure injury prevention.

Purpose: To examine the association of demographic characteristics, depression, anxiety, fatigue, sleep, and cancer treatment options with quality of life (QOL) in BCS.

Design: This cross-sectional study included BCS aged 21 years or older who completed adjuvant therapy. The research variables were sleep, fatigue, anxiety, cancer treatment, stage, marital status, race, and the relationship to QOL in BCS.

Methods: The Patient Health Questionnaire-9 (PHQ-9), Pittsburgh Sleep Quality Scale (PSQS), PROMIS-Anxiety Short Form, PROMIS-Fatigue Short Form, and Quality of Life-Cancer Survivors were used. Data were analyzed using measures of central tendency, correlations, and linear regression.

Results: The mean age (N=51) was 57 (SD=8.1) years. Tamoxifen (r = -0.36, P=0.02), aromatase inhibitors (r = -0.48, P=0.00), depression (r = -0.50, P < 0.00), anxiety (r = -0.45, P < 0.00), fatigue (r= -50 <0.00), and race (r = -0.31, P =0.04) were related to QOL. Anxiety (β=-0.51, P<0.001) was predictive of QOL. Age, marriage, cancer stage, surgery, chemotherapy, and radiation were not related to QOL.

Conclusions: Significant associations were found among depression, sleep, race, fatigue, anxiety, and cancer treatment with tamoxifen and aromatase inhibitors and QOL. Anxiety is a predictor of QOL in BCS and must be addressed in ongoing survivorship care.

Purpose/objectives: The purpose of this project was to explore patient safety, quality outcomes, and staff satisfaction related to decreasing comprehensive patient assessments to once weekly for patients with a discharge delay.

Description: The project involved piloting once-weekly comprehensive assessments for medically stable patients on a general medical-surgical unit and a long-stay unit. The pilots aimed to reduce the frequency of comprehensive assessments while maintaining patient safety, reducing patient interruptions, and improving staff satisfaction.

Outcome: The pilot for the general medical-surgical unit had low compliance and was discontinued. However, the pilot in the long-stay unit was successful, saving nurses an estimated 3534 minutes per week. Several measured quality indicators improved, although there were small increases in hospital-acquired pressure injuries and Clostridioides difficile infections. Staff satisfaction was high, with 87.5% of nurses supporting the continuation of weekly assessments.

Conclusions: The project demonstrated that weekly comprehensive assessments are effective for patients with delayed discharge who are medically stable. This intervention has the potential to be implemented in other units and organizations as long as appropriate patient identifiers are in place.

Purpose/aims: To evaluate the effect of a 10-day nurse-implemented early mobilization protocol on muscle strength and activities of daily living performance in mechanically ventilated patients.

Design: Quasi-experimental study with repeated measures examining the effectiveness of nurse-led mobilization interventions compared with standard care.

Methods: Fifty-three mechanically ventilated patients were recruited between January and December 2017. The control group (n=25) received standard physical therapy evaluation within 72 hours. The intervention group (n=28) received physical therapy evaluation within 24 hours and nurse-implemented early mobilization exercises within 48 hours for 10 consecutive days. Muscle strength and activities of daily living performance were assessed at baseline, immediately postintervention, and 1 week postintervention using validated instruments.

Results: The intervention group demonstrated significantly greater improvements in muscle strength across all measured muscle groups and activities of daily living performance at both measurement points compared with controls (P< 0.05). A significantly higher proportion of intervention group patients achieved out-of-bed mobility.

Conclusions: Nurse-implemented early mobilization exercises significantly improve muscle strength and functional outcomes in mechanically ventilated patients. Integration of structured mobilization protocols into routine nursing care represents an effective strategy for enhancing recovery in this vulnerable population.

Purpose/aims: We aimed to describe the experiences of nurses working on the COVID-19 frontlines and make recommendations for change at administrative, institutional, and health policy levels.

Design: We used a qualitative descriptive study design to gather a rich and data-near account of nurses' experiences in their own words.

Methods: We conducted 10 semistructured interviews with nurses practicing in emergency departments or intensive care in the United States during the pandemic. Using Sandelowski's method, we independently coded data and identified emerging themes through an iterative process.

Results: Most nurses worked in Indiana, were in their 20s, and had less than 5 years of experience (range, 1.5-23 years; mean, 6.2 years). Five themes about pandemic nursing challenges emerged: (1) Shortages, (2) The Public's View of Nursing, (3) Death and Moral Conflict, (4) Emotional Toll, and (5) Unrealistic Expectations. Nurses reported wide-scaling challenges, which interfered with their ability to deliver high-quality patient care and impacted their mental and emotional well-being.

Conclusion: Nurses faced significant challenges, and in many cases, the pandemic exacerbated existing issues in the healthcare system. In the aftermath of the pandemic, there remains a critical need for change at administrative, institutional, and health policy levels to support nurses and invest in the sustainability of the profession.