There are no protocols in the literature describing how spiritual care from nursing staff should be provided to a bone marrow transplant patient and their family. Although a majority of nurses think that routine spiritual care would positively impact patients, only 25% of patients have reported receiving spiritual care. Increased education has been associated with positive perceptions of spiritual care. The solution to this need will be researched through a secondary data analysis from pre/post surveys from implementation of an education program on spiritual care for BMT nurses. The hypothesis of this PI is that a spiritual education program will enhance spiritual perspectives in nurses and increase spiritually-focused nursing care with patients. The purpose of this PI is to determine if a spirituality training class for Bone Marrow Transplant nurses will increase nurses' spiritual perspectives and their spiritual care of patients. A second purpose is to examine the relationship between nurses' spiritual perspectives and extent of spiritual care at both pre- and post- educational program times. This study is a secondary analysis of a data set from a pre/post survey of BMT nurses who attended a spiritual education program. Nurses were surveyed using the SPS tool and a NSQ tool. The spiritual education program was a one day, six hour class that was taught by the research team, and divided into sessions. There were 43 BMT nurses who completed the class and the posttest one month after taking the class. The slight increase of scores from pre- to post- survey with the SPS suggests that the spiritual education program provided a slight enhancement of personal spiritual perspectives and assisted the participants to reflect and further develop their values and beliefs on spirituality. The hypothesis that a spiritual education program would increase the frequency of spiritual care that nurses provided to patients was strongly supported. These findings suggest that participating in a spiritual education program provides the nurse with information that will enable one to conduct spiritual assessments, become more comfortable developing an individualized patient spiritual care plan, and accepting that providing spiritual care is part of a nurse's job description.

Objectives. The purpose of this practice inquiry (PI) was to develop an evidence based plan for promoting physical activity among Deaf adults in a primary care setting. The aims of this PI were to 1) review research about the relationship between physical activity and health 2) review research about use of pedometers to motivate increased walking and 3) describe baseline physical activity among Deaf adults using pedometer step counts based on a secondary analysis of an existing data set. Design. The secondary analysis of an existing data set analyzed demographic data and pedometer data (steps/day). Participants received standardized instructions about using the pedometer in-person, in American Sign Language (ASL) and also received a DVD with the instructions in ASL for review at home. The review of literature and secondary analysis were used to propose an evidenced-based plan to increase physical activity in Deaf adults in the primary care setting. Sample: Eighty-seven participants met inclusion criteria for this secondary analysis: 1) at least 45 years of age, 2) self-identified as a member of the Deaf community, 3) fluent in ASL, 4) no existing diagnosis of coronary artery disease, and 5) at least one risk factor for cardiovascular disease: overweight/obese, sedentary, diabetes, hypertension, hyperlipidemia. Results: Results support the value of physical activity for health promotion and risk reduction, and supported use of pedometers to encourage increased walking. The secondary analysis of data from 87 Deaf adults showed that their average steps/day were 5,667, which fall short of the 2008 Physical Activity Guidelines for Americans. Men tended to walk more than women, though the difference did not reach statistical significance. There was an inverse correlation between age and steps/day (r=.280, p=.007) consistent with a low active lifestyle. Conclusion. There is considerable support for providing pedometers to at-risk Deaf adults in primary care, with both group and individual instructions in ASL and follow-up to monitor increases in average steps/day as an effective strategy for increasing physical activity. This would not be a stand-alone intervention, but part of an overall risk assessment and evidenced based plan to increase physical activity in Deaf adults.

BACKGROUND/OBJECTIVES: Ventriculostomy associated infections are a present burden on our healthcare system as well as patients and their families. Use of nursing led protocols to decrease the incidence of healthcare-associated protocols has been supported in previous platforms. The purpose of this study is to determine a need for a ventriculostomy protocol that aligns with the needs of the unit and the current best practice standard for ventriculostomy management and then to create that protocol and necessary nursing education. DESIGN: Descriptive non-experimental study, which includes a retrospective chart review of 20 patients with ventriculostomies, placed in the neuroscience intensive care unit (ICU) and a focus group discussion of key stakeholders within the neuroscience ICU. METHODS: List of subjects for retrospective chart review obtained through CPT codes for ventriculostomy placement and convenience sampled in reverse chronological order. Descriptive statistics completed on participant characteristics and frequency of documentation present in charts during retrospective review. Focus group participants obtained through non-probability quota sampling. SETTING: 12-bed neuroscience ICU in a 337 bed ACS Level 1 certified trauma center and DNV Level I certified stroke center in Scottsdale Arizona. SUBJECTS: Retrospective chart review (n=20) most recent patients who had a ventriculostomy drain placed in the neuroscience ICU. Average age 54.6 y/o ±17.8 and average LOS 15.45 days ±9.1. Focus group discussion included 1 ICU manager, 2 ICU supervisors, 1 ICU educator and 3 bedside RNs. Informed consent obtained from all focus group participants. RESULTS: Retrospective chart review of patients (n=20) showed 100% documentation on antibiotic administration within 30 minutes of insertion and daily site assessment. There was 0% documentation on team member attire in the room during insertion, accessing of the system, whether the port was scrubbed prior to accessing and changing of the sterile bag. Focus group discussion showed varying opinions on current thoughts related to the available ventriculostomy charting. Many comments included a need for more in depth charting to capture the care that the bedside RN provides on a daily basis in regard to ventriculostomy management. Major barriers to introduction of a ventriculostomy protocol included stakeholder buy in and nursing staff education in use of the protocol. CONCLUSION: By determining a need for a ventriculostomy protocol, through a retrospective chart review of current documentation in the neuroscience ICU, and taking into account key stakeholder opinions, the JNM ventriculostomy management protocol was developed to improve standard of care within the neuroscience ICU and decrease infection rates. Educational information was created for nursing staff to learn the current best practice standards for ventriculostomy management as well as use of the JNM ventriculostomy protocol within their charting.

Background: Skin cancer is the most common cancer worldwide and one of the most preventable cancers. Despite prevention efforts, skin cancer incidence continues to rise among adolescents. This is especially a challenge for the state of Arizona, which has a high incidence of skin cancer. The inconsistent evidence-based practice guidelines for skin cancer prevention create challenges for counseling adolescents. The knowledge, attitudes, and practices of primary skin cancer prevention by nurse practitioners who care for adolescents is unknown in Arizona or elsewhere in the U.S. Purpose: This doctor of nursing practice project investigates knowledge, attitudes, and practices of skin cancer primary prevention by Arizona nurse practitioners caring for adolescents on an outpatient basis and determines congruency of their counseling with primary prevention guidelines. Methods: The design is descriptive cross-sectional. An online survey using Qualtrics software was distributed via professional listservs to eligible Arizona nurse practitioners currently in practice. Participants' knowledge of skin cancer, skin cancer prevention, and current practice guidelines and recommendations were assessed using multiple choice items. Participants' attitudes regarding counseling for skin cancer prevention within the adolescent population and current nurse practitioner behaviors, in relation to current practice guidelines, were measured using Likert-type scales. Outcomes: Thirty-nine nurse practitioners responded to the online survey. Participant overall knowledge regarding skin cancer was moderate to low, and less was known about skin cancer in adolescents. Despite participants' overall positive attitudes toward skin cancer prevention, they reported low rates of skin cancer prevention counseling for adolescents in practice. Skin cancer prevention recommendations, identified by participants as used in practice, were not congruent with established clinical guidelines on counseling for primary prevention of skin cancer in adolescents.

Background: Heart failure (HF) is a major public health problem in the United States and accounts for a large burden in rising health care expenditures. Appropriate use of evidence-based pharmacological treatment, including the use of renin-angiotensin-aldosterone inhibitors and beta-blockers can slow progression of the disease and reduce the need for hospitalization. Objectives: In a sample of individuals with HF in a primary care setting, the objectives of this study were to determine the level of providers' adherence to evidence-based pharmacological guidelines and the rate of cardiovascular-related emergency department or hospital visits. Methods: A convenience sample of patients 18 years of age and older with a diagnosis of HF was included. A retrospective chart review of 54 HF subjects was done between April and September 2014, using the American College of Cardiology Foundation and American Heart Association outpatient performance measurement set for HF. Results: Adherence to guideline recommendations for beta-blocker, angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker ARB), anticoagulation for atrial fibrillation, statin, and aldosterone receptor antagonist therapy was present in 81%, 77.8%, 78%, 80.7% and 23.1% of eligible subjects, respectively. The use of ACEIs/ARBs (OR=8.853, CI 1.212-64.66, p= 0.032) and beta-blockers (OR= 9.24, CI 1.212-70.438, p =0.031) was significantly associated with reduced number of (<1) cardiovascular-related emergency department or hospital visits after adjusted for confounders including age, sex, body mass index, and comorbidities. Conclusion: The use of ACEIs/ARBs and beta-blockers among primary care providers was comparable or higher than similar studies conducted in the primary care settings. However, despite the available evidence and recommendations, the use of aldosterone receptor antagonists in HF patients with myocardial infarction and diabetes mellitus was still low in the absence of any contraindications. These findings can be used by primary care providers to assess the existing gap in the use of HF guideline-recommended therapy and develop interventions to improve the utilization of evidence-based guidelines.

Cerebrovascular accidents (CVAs) are identified as the principal cause of long-term severe disability in the United States (American Heart Association, 2012). Cerebrovascular accidents (CVAs) are the fourth leading cause of mortality in the United States (Minino, Murphy, Xu & Kochanek, 2011). Small towns and rural areas are currently in a health care crisis. With most subspecialty services located in metropolitan areas, distance and lack of accessibility creates disparity in evidence-based practice implementation. The growing gap between the health of rural and urban Americans is evident and will widen without proper interjection (Alkadry, Wilson, & Nicholas, 2006; Brown, Lisabeth, Roychoudhury, Ye, & Morgenstern, 2005; Sacco et. al, 2006). While there have been significant recent advances to support patients during the acute phase of a stroke in Montana, guidance for primary care providers and patients is currently limited for secondary stroke prevention services in the state, including Northwest Montana. Current morbidity and mortality data due to stroke in rural northwestern Montana may reflect a gap between existing guidelines for secondary risk reduction and the current practice of instituting those prevention guidelines. Effective secondary stroke prevention strategies are those that are based on a model of care that is evidenced based, feasible, and meets the unique needs of the population. A qualitative descriptive design was used to achieve the AIMS of this study. A critical analysis of the literature was used (AIM 1) to identify previously published information related to TIA/stroke clinics and programs. Focus groups were used (AIM 2) to elicit information from health care professionals in northwestern Montana about the need for and preferences for an advanced practice nurse-run stroke/TIA clinic. We found that like other reports from rural sectors, Primary Care Providers and Neurology providers in Northwest rural Montana identified challenges in access to care and cultural influences on patient adherence. It was evident that Primary Care Providers and Neurology providers were in favor of instituting a Nurse Practitioner-led secondary prevention program for stroke and TIA. We propose a stroke/TIA program to serve Northwest rural Montana that includes Nurse Practitioner-led transitional care services, care coordination, and education and program evaluation services.

The prevalence of obesity and type 2 diabetes continues to rise. People with obesity and diabetes are at risk of developing ischemic vascular disease due to chronic activation of thrombotic (platelet) and inflammatory (polymorphonuclear [PMN] leukocyte) blood cells. However, little research has examined these blood cell changes in mouse models. Therefore, the purpose of this dissertation was to examine the changes in thrombotic and inflammatory blood markers in response to obesity and diabetes in mice and to explore the impact of these blood changes on ischemic stroke and reperfusion. We studied db/db, ob/ob, high fat fed, and high fat+streptozotocin (HF+STZ) mouse models of obesity and type 2 diabetes. Using flow cytometry and several measures of platelet aggregation, we did not find significant evidence of platelet or PMN activation in the db/db, ob/ob, or high fat fed models. However, we found that the HF+STZ mouse expressed increased levels of PMN CD11b and may develop platelet activation with prolonged disease. We found that mice fed a high fat diet develop lower PMN counts in response to hyperglycemia. To our knowledge, this is the first study that examined platelet and PMN activation after middle cerebral artery occlusion (MCAO) in obese, diabetic mice. MCAO in mice is associated with a high mortality. No diabetic mice survived MCAO. However, of the nondiabetic mice that survived MCAO, there was an increase in platelet and PMN activation at 24 hours of reperfusion. Our results indicate that platelet and leukocyte activation in the mouse models we examined do not reflect the blood activation observed in humans with obesity and type 2 diabetes. The HF+STZ model does demonstrate some aspects of platelet and PMN activation and may be the most suitable for studying these disease processes. Technical difficulties in performing experimental stroke in mice suggest that it may be necessary to examine these blood processes in other animal models or in human studies of stroke and reperfusion. The results of this research may lead to the development of novel biomarkers and treatments for obese, diabetic patients who are at risk for ischemic vascular disease.

Note: / The significant health benefits of breastfeeding are extensively documented, and it is now recommended to breastfeed exclusively (Le., feed infants nothing but breastmilk) for the first 6 months of life. Guided by the Interactional Model (Loiselle, 2001), this prospective correlational study explored the predictive and interactive influence of potentially modifiable personal (Le., breastfeeding self-efficacy, maternal infant feeding beliefs, perceived infant satisfaction with breastfeeding) and contextual factors (i.e., paternal infant feeding beliefs, breastfeeding informational support, general postpartum support) on breastfeeding duration and exclusivity among a convenience sample of 189 primiparous breastfeeding mothers. Personal, contextual, and control factors were assessed by self-report questionnaires and/or interviews during postpartum hospitalization, at 6 weeks, and at 4 months postpartum. Breastfeeding outcomes were assessed via telephone interview at 6 weeks, 4 months, and 6 months postpartum. [...] / Les importants benefices de I' allaitement maternel pour la sante sont tres bien documentes, et on recommande a. l'heure actuelle d'allaiter exclusivement (c.-a.-d. de ne donner que du lait maternel au nourisson) durant les six premiers mois de vie. Guidee par Ie modele interactionnel (Loiselle, 2001), cette etude prospective corelationnelle a examine l'influence predictive et interactive de facteurs potentiellement modifiables personnels (la confiance en l'allaitement, les croyances des meres face a. I'allaitement, la perception de la satisfaction du bebe qui allaite) et contextuels (les croyances des peres face a. l'allaitement, l'information disponible sur l'allaitement, Ie soutien en matiere de post-partum) conditionnant la duree et l'exclusivite de l'allaitement maternel d'un echantillon de convenance de 189 meres primipares allaitantes. Les facteurs personnels, contextuels, et de contr6le ont ete evalues en fonction de questionnaires d'auto-evaluation remplis durant l'hospitalisation, a. 6 semaines et a. 4 mois post-partum.[...]

<p> The purpose of this qualitative phenomenological study was to explore the lived experiences of nursing graduates concerning their preparation for the National Council Licensure Examination for Registered Nurses (NCLEX-RN) after failing on the first attempt, and their perceptions concerning the meaningfulness and essence of the experience. The results of interviews with 13 nursing graduates provided an empirical understanding of the lived experiences of their preparation for the NCLEX on their first unsuccessful attempt as well as how they changed their strategies in preparation for their second attempt. Findings included nursing graduates&rsquo; employment of available resources (e.g., textbooks, online sources), addressing test anxiety, and making test preparation a priority. School administrators may use the findings of this study to implement successful preparation guidelines in nursing programs. Additionally, student nurses can use these findings to improve their preparation for the NCLEX-RN. Recommendations for future research include conducting a similar study using quantitative or mixed methods approaches, possibly with a larger sample of participants for greater generalizability.</p>

Community care of heart failure (HF) requires ongoing management often involving family caregivers (FCG). FCGs who misunderstand patients’ (PT) symptom experiences may contribute to poor symptom management. This study tested for improved perceptual agreement between the FCG and the PT after FCG’s were instructed to engage in perspective-taking. Davis’ (1990) organizational model of empathy guided this one-group pre-test/post-test interventional pilot study (n=14 dyads). Wilcoxon signed-rank test evaluated PT/FCG discrepancy scores on the HF Symptom Survey (HFSS) and the Empathic Responding Scale (ERS). A qualitative interview captured PT and FCG responses to the intervention. Six of 14 HFSS symptoms demonstrated significantly improved perceptual agreement along at least one of four symptom dimensions: frequency, severity, interference with physical activity, and interference with enjoyment of life. Study findings provided ongoing evidence in support of a perspective-taking intervention that has a promising effect on improving or sustaining FCG’s understanding of the PT’s symptom experiences.